agreements contracts by Traonbass


									                                                                            I. A. Sample 1


1304.4-2 (C)

“The Plan shall provide for the establishment, maintenance and CONFIDENTIALITY of
records of up-to-date, pertinent family data, including completed enrollment forms, referral
and follow-up reports, reports of contacts with other agencies, and report of contacts with

       Head Start staff, including volunteers, are representing the agency in their service to
families. Therefore, families are placing their confidence in the agency, who becomes the
caretaker of the information and guarantees the responsible use of the information in
serving that family.

        The Head Start program has implemented a system of recordkeeping to assure the
confidentiality of all documentation received regarding our families. All documentation,
whether in the main office or the center classrooms, are to be kept under lock and key at
all times. Access to this information is limited only to those Head Start staff working
directly with a family.

       Information on families is not to be shared among staff members on a casual basis.
In order for families to feel free to talk to staff and to seek assistance from the program,
they must have confidence in you as an employee of Head Start.

        The ideal time to begin to build a trusting relationship with families is during your
first visit to their home. You must let families know that you are there to assist in meeting
their needs, and that any information given you will be kept in the strictest confidence.

        All information on families is to be documented in writing and kept in a locked file
either in the office or the classroom.


                          CONFIDENTIALITY AGREEMENT

By signing this agreement I acknowledge that I have read the preceding explanation of
confidentiality and I will abide by the guidelines set forth:

       I WILL NOT:

             1.      Discuss a child or family in front of that child or any
                     other child(ren).

             2.      Discuss a child or family in front of other volunteers,
                     visitors, parents or staff not directly involved with
                     that family.

       I WILL:

             1.	     Document in writing all information on families as
                     required by the program.

             2.	     Keep information that is confidential in a locked




     Families have the right to protection of personal information about them in their
relationship with Head Start during and following the process of obtaining services. The following
principles should be kept in mind:

 1.	 Parents should be the primary source of information about themselvcs, and information sought
     from them should be limited to that which is essential for se&cc.

 2.	 Parents and other volunteers are prohibited from reviewing records other than those of their
     own children.

3.	 Children’s health and education and social services records on families arc open only to Head
    Start staff and special consultants on a “need to know” basis (to the extent necessary to
    provide services).

 4.	 Families must be informed about information that will be shared with other Head Start staff
     and the reasons why. (For example, a signed consent form which includes how information is
     shared and with whom, could be helpful.) When in doubt about releasing information. obtain
     permission from a family mcmbcr.

 5.	 No information should be released to anyone outside the program without writtcn consent
     from the family, except in reporting suspected child abuse and neglect.

 6.	 Other agencies and individuals should bc consulted only with the family’s consent and within
     the limits of that consent.

 7.	 Avoid use of consolidated forms (such as blanket permission forms for a field trip. release of
     information to other agencies. etc.).

 8.	 On a yearly basis, with help from parents and staff, decide what information will be collected.
     how it will be shared and with whom.

9.	 Include information on how forms will be used and how information will be released as a part
     of the agency’s plan or policy for confidentiality.

10.	 Only that information should be recorded and those records maintained that are essential to
     provide service; and the use of records should be determined by agency function and the
     consent of the family.

                                                                                           MODULE        I   ,
                                                                                             Session 5
   .’	   .                                                                                  Handout -l

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