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101.2 Ethics, Boundaries and Confidentiality
The CHW code of ethics, healthy boundaries, privacy and consent
Your materials
Slides (PowerPoint) Handout (Word)
For instructors
Facilitator guide Printable pre and post tests Quiz (LMS import)
What you will learn
- Describe the main parts of the CHW Code of Ethics
- Set clear boundaries on gifts, social media and dual relationships
- Explain confidentiality, consent and HIPAA in plain words
- Name when confidentiality ends and what to do next
Start here
A neighbor tells you something private at the bus stop. Who do you tell, and who do you never tell?
Lesson
The CHW Code of Ethics
The national CHW Code of Ethics (2008) has four parts:
- Delivering care: Honesty, confidentiality, staying in your training, quality of care, good referrals and following the law.
- Equitable relationships: Cultural humility, keeping community trust, human rights, no discrimination and clear boundaries with clients.
- Working with others: Cooperating with other providers, good conduct, and being honest about who you are and what you can do.
- Rights and duties: Keep learning, speak up for fair laws, build community power, care for yourself and honor others.
Being a neighbor and a worker
Healthy boundaries
- Use a work phone and work email with clients
- Say no kindly to cash or costly gifts
- Tell your supervisor if a client is a relative or friend
- Keep client stories out of your social media
- Help within your role, then refer
Boundary problems
- Lending money to a client or borrowing from one
- Friending clients online or posting about visits
- Dating or any sexual conduct with a client
- Getting involved in a client's family fights or money
- Doing favors that make a client depend on you
Confidentiality and consent
Confidentiality means keeping a client's information private. Here is how we do it:
- Explain at the start: Tell clients what you keep private and the few times you cannot.
- Get consent first: Ask before you share anything, and use the agency's signed release form.
- Share only what is needed: Give the care team the facts needed to help, nothing more.
- Talk in private: No client details in hallways, buses, group chats or texts.
- Store records safely: Lock paper files and never leave screens open or passwords shared.
HIPAA in plain words
| Question | Plain answer |
|---|---|
| What is HIPAA? | A federal law that protects health information |
| What does it cover? | Written, electronic and spoken health information |
| Who must follow it? | Most providers, health plans and their business partners |
| What rights do clients have? | See their records, ask for fixes, get a privacy notice |
| Can family be told? | Only those helping with care, unless the client objects |
When confidentiality ends
Tell clients at the start that you must act in these cases:
- Danger right now: Someone is hurt or in danger now. Call 911.
- Risk to self: A person talks about suicide or self-harm. Stay with them and call or text 988 together.
- Child abuse or neglect: Follow agency protocol and Ohio law. Cuyahoga County hotline: 216-696-KIDS (5437), open 24 hours.
- Elder or adult abuse: Follow protocol. Cuyahoga County Adult Protective Services: 216-420-6700, open 24 hours.
Why trust is a health issue
- What we see: Mr. Reyes in Clark-Fulton will not share his health history or sign any forms.
- Why it happens (upstream): His family has seen health records shared with landlords and agencies. Past mistreatment by systems teaches people that sharing is risky.
- What we can build on (assets): His parish health ministry, a promotora he already knows, and clear consent forms in Spanish.
Situation: the gift and the friend request
Situation: Ms. Tanya in Slavic Village has worked with you for six months. After her lights are back on, she hands you an envelope with $50 and sends you a friend request on Facebook that night.
What do you say and do?
- Thank her warmly and say you cannot accept cash
- Suggest a card or thank-you note instead, if she wants
- Do not accept the friend request; explain it protects her privacy
- Write it in your notes and tell your supervisor
Talk it over
- Where in your own life will boundaries be hardest: church, family, block or online?
- How would you explain confidentiality to a teenager? To an elder?
- What will you say when someone asks, 'Did you see so-and-so this week?'
Study sheet
The big idea: Trust is the heart of CHW work, and ethics, boundaries and confidentiality are how we protect it.
Key points
- The CHW Code of Ethics covers care, fair relationships, working with others, and professional rights and duties.
- Ohio rules require CHWs to set and keep professional boundaries with every client.
- Say no kindly to cash, loans, dating and social media ties with clients.
- Get consent before sharing, and share only what the care team needs.
- Confidentiality ends when someone is in danger or abuse is suspected; follow protocol and tell your supervisor.
- Ohio requires one continuing education hour on professional boundaries each renewal period.
Remember
- Emergency: 911. Suicide or mental health crisis: call or text 988
- Cuyahoga County child abuse hotline: 216-696-KIDS (5437), 24 hours
- Cuyahoga County Adult Protective Services: 216-420-6700, 24 hours
- Renewal CE: 15 hours, including 1 on Ohio law and rules and 1 on boundaries
Ask yourself
- Which of my relationships in the community might become dual relationships?
- How will I say no to a gift without hurting someone's feelings?
- Do I know my agency's reporting protocol by heart?
Vocabulary
| Word | What it means |
|---|---|
| Ethics | Shared rules about right and wrong that guide how professionals act. |
| Code of ethics | A written set of values and duties that a profession agrees to follow. |
| Professional boundary | A clear line between your work role and a personal relationship with a client. |
| Dual relationship | When you have two roles with one person, such as CHW and cousin, neighbor or church member. |
| Confidentiality | Keeping a client's private information safe and sharing it only with permission or when the law requires. |
| Consent | Freely agreeing to something after you understand what it means. |
| HIPAA | A federal law that protects people's health information held by most providers and health plans. |
| Release of information | A signed form that lets you share certain information with a named person or agency. |
| Mandated reporter | A worker Ohio law requires to report suspected child abuse or neglect. |
| Minimum necessary | Sharing only the smallest amount of information needed to help. |
Real-life situations
The cousin on your caseload
You are assigned a new client in Glenville, Ms. Denise. At the first visit you realize she is your mother's cousin.
What to do
- Tell your supervisor the same day
- Ask Ms. Denise if she is comfortable working with you or would like another CHW
- If you keep the case, agree together on what stays private at family events
- Follow your supervisor's decision and note it in the file
Why: A dual relationship is not always wrong, but it must be named and managed so the client's privacy and choice are protected.
The question at church
After service at a church in Fairfax, a deacon asks you how Brother James is doing since his hospital stay. He knows you visit Brother James for work.
What to do
- Smile and say you cannot talk about anyone you work with
- Suggest the deacon ask Brother James directly
- Do not confirm or deny that he is your client
- Do not share anything later, even in prayer requests
Why: Even saying someone is your client is private information. Confidentiality applies in every setting, not only at work.
The bruise on the child
During a home visit in East Cleveland, you see a large bruise on a five-year-old's face. The parent says he fell, then changes the story.
What to do
- Stay calm and do not accuse or question the child about it
- If the child is in danger right now, call 911
- Follow your agency protocol and call 216-696-KIDS (5437)
- Tell your supervisor the same day and write objective notes
Why: You do not need proof to report a concern. Child safety comes before confidentiality, and the hotline is open 24 hours.
Activity: My boundary plan
About 25 minutes.
- List three places in your life where you might meet clients outside work, such as church, the store or family events.
- For each place, write one sentence you will say if someone asks about a client.
- Write your own script for saying no to a gift.
- Find your agency's reporting protocol, or ask your instructor for the program's sample, and write the steps in your own words.
- Share one script with a partner and give each other feedback.
Post-test
Ten questions. You need 75% to pass, with one retake. Your result is saved in this browser.
Sources
- Community Health Worker Code of Ethics (2008), hosted by NACHC
- Ohio Administrative Code 4723-26-10, Standards of safe care for CHWs
- Ohio Administrative Code 4723-26-05, Continuing education
- Ohio Administrative Code 4723-26-13, Standard curriculum
- U.S. HHS, Your Health Information Privacy Rights (HIPAA for consumers)
- Child Welfare Information Gateway, Mandatory Reporting in Ohio
- Cuyahoga County, Mandated Reporting of Child Abuse and Neglect
- Cuyahoga County, Adult Protective Services