Who owns the case record? Client access to case records in Canadian social work practice

Abstract

This study looked into client access to their case records routinely maintained by social workers in the course of professional practice. An online survey and semi-structured interviews were undertaken with Canadian social workers. The study found that while the majority of the participants indicated that they granted clients access to their case records, clients were not effectively granted such access in practice. Client access to their case records is a core issue in social work, and social workers need to proactively grant such access if they are to live by the core values of social work.

Keywords

Access provision client rights emancipatory social work practice records management

Introduction

This study examined the practice of Canadian social workers as it relates to clients’ access to their own case records. Specifically, the study sought answers to the question: To what extent are clients granted access to their own case records by Canadian social workers? The aim was to explore the extent to which social workers in Canada provided their clients access to the case records that they keep of these clients and the reasons underpinning their practice. This study has direct relevance to conceptions of social work that invoke such principles as respect for human worth and dignity, participation, empowerment, and social justice.

Background

We often speak of client participation, empowerment, and self-determination in social work. But what do these words really mean? To what extent are they reflected in practice? This study is an inquiry into how these principles are enacted in a specific and important aspect of practice: clients’ access to their case records. While acknowledging that terms such as ‘clients’ and ‘services’ are problematized in the social work literature (see e.g. McLaughlin, 2009), this article will use these terms to refer to people whose lives are directly affected by the actions and decisions of social workers, and the work undertaken by social workers, respectively. The key question is: To what extent are clients given access to their own case records in social work practice?

Professional practice standards mandating client access to their case records are informed by particular conceptions of social work. The most widely accepted definition of social work portrays it as a profession and discipline that ‘promotes social change … and the empowerment and liberation of people’ (International Federation of Social Workers, 2014). The mention of social change suggests an understanding of society that recognizes the need for broad, structural transformation. The reference to emancipating people and enabling them to exercise power implies recognition of gross social inequality, and the subjugation of certain members of society. This definition places critical interrogation of social relations at the heart of social work. Social divisions along gender, race, class, ability, sexual orientation, and other lines are examined in an active process of rooting out injustice and challenging oppression (Mullaly, 2010). The privileging of some is systematically questioned. Such critical interrogation extends to the practice of social work itself.

Seen from a critical perspective, social work represents an exercise of power. Social work embodies state authority. As O’Rourke (2010) poignantly noted, ‘The very exercise of observation and interpretation of clients’ behavior, and the recording of those observations and interpretations, is an exercise in power …’ (p. 29). Social work is nested within political economic contexts and is influenced by dominant ideologies and values. The practice of social work can thus bear elements of the very social inequalities it is claimed to challenge. Class inequality is, for example, a common feature of the relationships between qualified professionals and their often less formally educated clients. Left unexamined, these inequalities can be reinforced in professional relationships and experienced as oppressive forms of intervention. Social work should thus be subjected to critical interrogation to ensure that professionals do not, through their actions, decisions, and relationships with their clients, enact the very oppression that they are meant to challenge (Laird, 2008), as some forms of practice do (see e.g. Margolin, 1997).

The keeping of client records has become a hallmark of professional practice (Kagle and Kopels, 2008). As a routine part of their work, social workers often keep copious notes about their clients, recording intimate information that could include details about clients’ mental health status, personal relationships, and any sense of ‘progress’ in their lives. The principles of client participation, empowerment, and self-determination suggest that clients should be involved in decisions about what information goes into those records, and who has access to them. It is in this context that we examine how case records are kept, and the extent to which clients have control over and access to them.

Literature review

Case records are a key feature of contemporary social work practice. They contain vital information about clients, including identifying and contact information as well as clients’ concerns, problems, goals, plans, processes, progress, and outcomes of services (Kagle and Kopels, 2008). Client access to their case records gained some attention in the social work literature more than two and a half decades ago (see e.g. Cigno and Gottardi, 1989; Gelman, 1991, 1992). Some argued for active client participation in the record-keeping process, given its usefulness in improving record keeping (Cohen, 1982; Gelman, 1992; Ovretveit, 1986) and ensuring accountability (Gelman, 1989). Others noted its value in enhancing interventions (British Association of Social Workers, 1980; Wilczynski, 1981). In contrast to these functionalist arguments, clients’ access to their case records was understood by some as the enactment of a client-centered practice framework (Ovretveit, 1986), the application of practice principles such as the client’s right to participation (Doel and Lawson, 1986), or a right in and of itself (Cohen, 1982; Prochaska, 1977). Murray (1985, as cited in Gelman, 1991) classified approaches to the implementation of client access to case records as (1) ideological/political, (2) professional, and (3) bureaucratic/administrative. Professional approaches aim to improve the overall quality of practice, bureaucratic/administrative approaches focus on institutional procedures that govern client access to selected information, while ideological/political approaches are driven by discourse on client rights.

According to Gelman (1991), clients in Canada had ‘passive’ ‘full’ access to their records in public agencies. ‘Passive’ access implied that access was possible if requested, but not seen as integral to service and practice; ‘full’ access meant that ‘a wide range of social service records’ was accessible to clients (pp. 191–192). The extent to which such policy was enacted in practice was not examined in the international expert meeting on which Gelman’s account was based.

Kagle and Kopels (2008) indicated that, as a matter of principle, ‘Good records are written as if the client … were going to read them’ (p. 10, emphasis provided). However, practice standards go well beyond that. The Guidelines for Ethical Practice of the Canadian Association of Social Workers (CASW) (2005) stipulate ‘Social workers ensure that clients have reasonable access to official social work records concerning them’ (Section 1.7.5). Similar provisions are reflected in the Code of Ethics of the Australian Association of Social Workers (2010), the Code of Ethics of the American National Association of Social Workers (2008), and the British Association of Social Workers (2012). The spirit and intent of these standards call for clients to have access to their case records to the fullest extent possible.

Client access to case records signifies their place in the client–worker relationship. The CASW (2005) guidelines identify respect for the inherent worth and dignity of persons as core values, and prioritizing clients’ interests and promoting their self-determination as key ethical responsibilities. Active client involvement is encouraged in all aspects of the helping process. Current standards of practice and professional literature focus on this in the process of service provision, but fail to problematize client involvement in the keeping of and access to case records. For example, in their explanation of ‘client involvement’ in record keeping, Kagle and Kopels (2008) state that: ‘Good records document the client’s role in all aspects of the service process including decision making and action taking’ (p. 10). While this does not rule out client involvement in record keeping or access, neither does it explicitly require it. This study explored to what extent social workers in Canada grant clients access to their own case records.

Methodology

This study utilized an online nationwide survey alongside semi-structured qualitative individual interviews with members of the CASW and provincial associations of social work. Survey data explored the practices of client access to records, while qualitative data contextualized and deepened the understanding of these practices. The study was undertaken with the approval of the Research Ethics Board of Trent University (Canada) and the University of South Australia Human Research Ethics Committee (Australia). In line with the approved protocol, informed consent was sought and obtained from all participants. An invitation to participate in the study in English and French was distributed through the CASW monthly e-newsletter (CASW Reporter – Resources and Research section), provincial associations’ info-letters, e-bulletins, and email circulation to the association membership or posted on the association’s website (as per associations’ protocols). The invitation contained information about the study’s goals and procedures, target participants, and a link to the survey in English or French.

Prospective survey participants screened themselves by confirming that they (1) held a qualifying degree in social work and (2) were engaged in direct practice with clients. The survey requested background information including length of time as a qualified social worker, official designation, type and size of their organization, services offered, and work undertaken. Survey participants were asked about their practices of record-keeping: whether they maintained case records, involved clients in the creation and maintenance of the said records, informed clients of record access privileges, and granted clients access to their records. Survey respondents could answer that clients had either (1) partial access to their records, (2) full access to their records, (3) conditional (no access except under Freedom of Information processes), or (4) no access to their records.

A total of 311 self-selected participants completed the survey. The majority (191 or 61.4%) worked for government agencies, 61 (19.6%) worked for not-for-profit organizations, while 37 (12%) were in private practice. The rest worked in for-profit organizations, community care or health centers, and medical or primary care organizations. The majority (165 or 53%) reported having over 10 years of experience, while 33 (10.6%) had 2 or less years of professional qualification. Please refer to Table 1 for a detailed summary of the survey participants’ background.

Table 1.

Participants’ background (n = 311).

Category		Frequency(counts)	Frequency(proportion)
Auspice	Government agency	191	61.4
	Not-for-profit	61	19.6
	Private practice	37	11.9
	For-profit	5	1.6
	Other	17	5.5
Is Chief Executive a qualified social worker?	Yes	131	42.1
	No	157	50.5
	Don’t know	21	6.8
	No answer	2	.6
Paid full-time staff in a site	Under 5	57	18.3
	6–15	66	21.2
	16–24	39	12.5
	25–34	22	7.1
	35+	126	40.5
	No answer	1	.3
Official position title	Social worker	213	68.5
	Other	95	30.5
	No answer	3	1
Years of qualification	2 years or less	33	10.6
	3–6 years	63	20.3
	7–10 years	49	15.8
	11–14 years	26	8.4
	15 years or more	139	44.7
	No answer	1	.3
Practice setting	Mental health	98	31.5
	Medical/hospital	50	16.1
	Family and children’s services	85	27.3
	Other	75	24.1
	No answer	3	1
Population served	Individuals (all genders, across the life span), families, and/or couples	205	66
	Children	79	25.4
	Women	27	8.6
Term used to refer to recipients of service	Client	211	67.9
	Patient	62	19.9
	Other	38	12.2

At the end of the survey, respondents were invited to participate in a 1-hour semi-structured interview to explore in more depth their survey responses. The interviews were intended to examine specific practices of selected participants with the hope of gaining a more in-depth understanding of the broad range of practices represented by the survey responses. A total of 35 participants expressed interest in participating in a qualitative interview. As per study design, a sample of 10 interviewees was chosen, aiming to include social workers from different auspices (government, non-for-profit, private practice), size of organizations, fields of practice (health, relationship counseling, disabilities, family violence, child protection, etc.), and levels of record access granted to clients. Of the 10 interview participants 8 were female, with professional social work experience ranging from 3.5 to 35 years. Table 2 summarizes information on interview participants’ characteristics and contexts of practice.

Table 2.

Interview participants’ characteristics and contexts of practice (n = 10).

Name	Gender	SW experience/current setting (years)	Practice setting	FT staff	Main service provided/population group served	Kind of access
Nancy	F	11/8	Government /family court	21–25	Family court resolution services/parents	Conditional
Evan	M	9/1	Private practice in NFP/health	<5	Advocacy/adults and children with physical and mental health concerns	Conditional
Peter	M	9/9	Government/health	41+	Counseling/seniors	Conditional
Kate	F	15/10	NFP/womens’ shelter	16–20	Residential and outreach services/women and children	Partial
Julie	F	5/5	Government/family and child services	11–15	Child protection/families	Partial
Ann	F	18/7	Private practice/mental health	<5	Counseling/women	Partial
Lucy	F	22/3	Government/family and child services	41+	Child protection/women	Partial
Lisa	F	3.5/3	NFP/disability organization	16–20	Counseling/adults with disabilities	Full
Tara	F	35/8	Private practice/mental health	<5	Counseling/individuals and couples	Full
Elsa	F	16/16	Government/health	41+	Overseeing the implementation of privacy and confidentiality legislation	Full

SW: social worker; FT: full time; NFP: not-for-profit.

Notably, only one interview participant indicated that they gave no access to clients, and during their interview this participant changed their definition of client access from ‘no access’ to ‘conditional access’. There was wide representation of agencies in terms of auspices and size in each one of the three other categories of access, so three interviewees were chosen for each category. During the interviews, one other participant changed their definition of client access from ‘conditional’ to ‘partial’ access.

Findings

The presentation of findings starts with the general survey results followed by findings from the interviews set in the context of survey results pertaining to the relevant cohort.

General survey results

Almost all of the survey participants (297 or 95.5%) reported that they maintained client case records as a standard procedure. The majority (211 or 69.2%) indicated that they, as a general rule, informed clients about the records they maintained. However, almost two-thirds of the survey participants (196 or 64.3%) stated that client involvement in record creation or maintenance was not practiced in their agencies. Only 34 (11.1%) participants reported active client involvement in the creation and maintenance of their records. As for how clients learned how to access their records, over half of participants (174 or 57%) reported that clients were informed if they asked, with only 102 (33.4%) reporting that the information was given as part of the standard induction process.

The majority of participants (226 or 73.6%) either strongly agreed or agreed with the principle of granting clients access to their case records when asked to indicate their personal stance. A notable minority either was ambivalent (47 or 15.4%) or disagreed (31 or 10%) with the proposition. Regarding clients’ access to their records, 108 (35.4%) reported full access, 97 (31.8%) noted conditional access, 81 (26.6%) indicated partial access, and 17 (5.6%) reportedly provided no access at all. Only in 89 (28.3%) of 286 cases did a simple verbal request suffice to enable clients’ access to their case records. In most cases, clients either had to complete a form (143 or 50%) or file required a formal request to department/agency head or a court (49 or 17.1%) to gain access to their records. Almost half of the participants (141 or 49.3%) reported it would take up to 1 week for clients to be granted access to their records.

It is instructive to note that almost half of the survey participants (145 or 47.5%) indicated that agency staff not directly involved in case management could potentially access their clients’ case records; 83 (57.2%) of them reported that such incidental access ‘may be gained in the absence of security measures’, with electronic records facilitating such access.

Interview results

No interview participant came forward to discuss the practice of not granting clients access to their case records. All 10 interview participants provided conditional, partial, or full access.

Conditional access

Ninety-seven (31.8%) of survey participants comprise this cohort. A total of 66 (68%) of them reported informing clients about records they maintained. However, only a minority (9 or 9.3%) reported that the clients were actively involved in the creation and maintenance of those records. Most practitioners in this cohort (71 or 73%) only informed clients on how to access their records when and if clients asked. For the most part (69 or 71%), clients had to complete a form to obtain access. Of this cohort’s participants, 33 (34%) reported that it took up to 1 week to access the records, while 25 (26%) could not say how long it took to make the records available to a client. Most (60 or 62%) of the participants in this cohort either agreed or strongly agreed with the proposition that clients should be granted full access to their records, while 24 (24.7%) were ambivalent and 13 (13.4%) disagreed or strongly disagreed with the idea.

The experiences of three interview participants – Nancy, Evan, and Peter – help shed light on these practices in more detail. For Nancy and Evan, legislation regulated conditional client access to their records. Nancy, who worked in family court resolution services, maintained the following:

FOIP [Freedom of Information and Protection of Privacy Act] governs our practice, as does the Court policy for releasing information regarding court documents. We maintain confidentiality and assure clients have access to their own private information. But the client would make a FOIP request. Clients have access to their records with Resolution Services if it directly and solely pertains to them … Because files are based on the family, a father would not have access to, for example, the mother’s domestic violence screening.

The conditional access Nancy granted her clients was mandated by relevant legislation and guidelines that would have made her culpable had she done otherwise. Evan, who did community advocacy in a not-for-profit healthcare organization, explained their practice of granting access to records as being guided by law, although he could not specify what law it was:

My understanding from my boss is that the law in [province] stipulates that patients are allowed immediate and full access to all their health care records … the way it was explained to me is that records belong to the patient, not to the agency, but they are stored in the agency. It’s [access] immediate, following immediate action. I wait until they ask.

While Evan indicated that they granted ‘conditional access’, it appears that the only condition as far as his practice setting was concerned was for clients to request such access. In this sense, clients veritably had full access to records that ‘belonged’ to them. But then, such theoretical ‘full access’ was, in practical terms, only achieved on the ‘condition’ that clients asked for their records. And so some of the survey responses indicating ‘full access’ may have to be understood in this light. Peter, who provided counseling for seniors in a large governmental healthcare organization, did not refer to any particular law. For him, client access to records was conditional because of organizational requirements:

Clients need to tell staff exactly what they want to see in the record … Then the files would be pulled and the access would be vetted, depending on what I guess is written in the file. The clients have to be very specific about what they want from the file, they will have to specify the dates, for example. The management would make decisions what information should be vetted, for example information on third parties, noted in the file.

Peter maintained that such policy was designed to limit rather than facilitate access, and served the organization more than a client: ‘I think they set it up that way as a common deterrent actually … I guess it’s more to protect the agency from lawsuits’.

Although the participants were in favor of granting access, this was not enacted in practice. Evan shared a conflict he experienced as a social worker in a healthcare system. He explained that although his organization followed the law that provided clients access to their health records, there was no guidance on what constituted this record, and no provisions for record keeping. He explained:

… I keep certain kinds of information that nobody else keeps … I generally keep a copy for myself in case the original gets lost. But I don’t have an office, so I just store it in my living room in a filing cabinet. I asked my boss where should I be putting these and she said, ‘You shouldn’t, you don’t need to hold on to these, you can just throw it away’.

In Evan’s case, the lack of organizational provision for record-keeping made it difficult for clients to access their full records because such records were not meant to exist. Agency policies and practices can thus stand in the way of granting clients access to their case records where records are kept. Nancy noted that ‘Resolution Services does not officially or consistently mandate a waiver that advises the client of the information we collect’. The policies of Peter’s agency basically barred him from providing such access with him saying: ‘I have no issues with the client who had come and asked to print off their records. But I can’t do that because of the policy.’ In summary, while workers may wish to grant clients full access to their records, legal and organizational conditions can prevent this.

Partial access

Altogether, 81 (26.6%) survey participants comprised the partial access cohort. While 51 (63%) of them routinely informed clients about records they kept, only 10 (12.3%) indicated that their clients were actively involved in the creation and maintenance of their records. A sizable number (28 or 34.6%) of these practitioners informed their clients about how they could access their records as part of the standard induction process, but the majority (47 or 58%) only gave such information ‘if and when’ their clients asked. Clients generally needed to complete a form (33 or 40.7%) to obtain access, which took up to 1 week for nearly half (40 or 49.4%) of the cases. Redaction of the following information was reported: ‘statements regarding clients from third parties’, ‘speculation on problem causation, treatability or prognosis’, ‘highly personal data about clients’, ‘diagnostic labels’, ‘personality traits and characteristics’, ‘results of psychiatric or psychological evaluation or testing’, ‘previous admissions to correctional or mental health institutions’, and ‘statements from third parties including the source of referral/report’. A small number of participants indicated they would consult a doctor or a psychiatrist to vet whether sharing information might be harmful to the client. Despite their agencies’ protocol, 57 (70.3%) of the survey participants in this cohort agreed or strongly agreed with the idea of providing clients with full access to their records.

The experiences of four practitioners – Kate, Julie, Ann, and Lucy – offer a more in-depth understanding of the practice of granting clients partial access to their case records. A key concern for the practitioners was the quality of their documentation. Julie noted, ‘[w]e strive to be very factual and very detailed … write information that you’re prepared to defend to the client or to a court … We have to be able to back it up. Not just with a feeling, but with a fact’. Similarly, Kate stressed that to ensure strong ethical practice, she provides ‘a solid training on record keeping with staff, we have done a lot of work around opinion and assumption versus evidence based conclusion’. How factual and how ‘objective’ the contents of records are may well be relevant considerations in the granting of partial access to clients.

Clients could access their records, but with some information redacted. Julie and Lucy, who both worked in child protection, spoke of the importance of protecting third-party information to allow their agencies to function:

Clients have access to all the information except the information on who made the referral. This is a formal agency policy … If the referral sources were identified to the client … the referral sources wouldn’t feel like they could call in and make a referral. (Julie)

We [prioritize protecting the confidentiality of any referral sources], as we want to continue to encourage people to come forward … and if they know that their name is going to be shared, it might prohibit them from doing that. (Lucy)

Kate, who worked in a women’s shelter, shared similar considerations. Kate passionately argued for feminist principles of transparency, trust, and equality in relationships with clients, and she allowed clients access to their records. However, even though the agency did not have a specific policy that outlined limits of access, Kate noted that she would ‘[n]ot allow access to some information in certain cases. Third party referrals or other information that comes to us from a source that asks to be protected for example. Police and child protection investigations come to mind’.

While redaction of clients’ records for the three practitioners was necessary to protect sources of information, Ann, who worked in private practice in mental health counseling, considered ‘not letting clients see everything in the notes’ proper practice. For her, concerns about the effects that some details of her case records might have on her clients and their relationship justified her redaction of her own professional judgments, as explained below:

I work with people with borderline personality disorder who can be extremely reactive and very triggered … Like that one client where I altered the notes. I knew if she had seen some of what I had said (which wasn’t mean, it was just truthful), she would have gone into a complete rage and our relationship would be completely destroyed. I thought that’s not going to be good and that was a lesson for me to not be overly honest in my notes. I went through her file in detail. There were maybe 4–5 notes in there that she may have taken in a bad way and I just took out the controversial pieces and retyped them.

Julie and Lucy seemed to assume that clients have the right to access records pertaining to them. Their only concern related to the workload associated with ensuring confidentiality of third-party information. Lucy explained: ‘we have to remember that it takes a lot of human resources to make this happen’.

Kate had a different experience. In her view, clients were generally not interested in their records, saying ‘Because we have good relationships with our clients, I don’t think there is any reason for them to think that there is anything that’s been recorded that they don’t know about’. This argument potentially frames any request for access as a question of trust. In Kate’s 10-year career in the shelter, only one woman had requested to access her file. Notably, Kate began to wonder whether the agency should grant full, unsupervised access during the interview. In summary, granting partial access to clients came with varying assumptions and motivations. There were also notable differences in what was regarded as needing redaction.

Full access

Of the 103 survey participants who reported granting clients full access to their records, 82 (or about 80%) indicated that they informed clients about the records they kept and the purposes for which such records were made, but 68 (66%) of them also said that their clients were not actively involved in the creation and maintenance of these records. Roughly half (50 or 48.5%) said that clients were told how they could gain access to their records ‘as part of the standard induction process’, while the same number said that clients were told ‘if and when’ they asked. Clients needed to make a verbal request (49 or 47.2%) or complete a form (37 or 36.1%) to gain access to their records. Access was immediate (24 or 23.1%), within 1 day (18 or 17.6%), and within 1 week (24 or 23%) in this cohort. It is instructive to note that 95% of participants in this cohort reported that they agreed or strongly agreed with allowing clients full access to their records, compared with 62 percent and 70 percent of those who reported conditional and partial access, respectively. The personal stance of practitioners seems to correspond to some extent with their practice environments.

Three practitioners – Lisa, Tara, and Elsa – provided more details on how full access was granted. The accounts of these practitioners reflected a ‘rights’ model (Murray, 1995, as cited by Gelman, 1991), citing client ownership of the record, self-determination, and control over the case record. Lisa talked about ownership in the context of the provider–consumer relationship adopted by the disability organization she worked in: ‘[t]he information in a consumer’s file is their personal information that they have told to us voluntarily. In this regard, we consider it their property ….’ Reflecting on her private practice in mental health and relationship counseling, Tara cited client self-determination and entitlement as important considerations:

Clients’ self-determination is one major principle … I see the clients being in charge of their information; they may request or interest me with, you know, to help them work through stuff but it’s their stuff, it’s not mine … I trust that my clients ultimately make their own decisions and I am sort of custodial of their information, I am not the owner of it … [My clients] have the right to know what I think of them.

Elsa, who was responsible for implementation of privacy and confidentiality legislation in her province, explained that legislation granted individuals the right to access their health records. She recounted a shift in thinking:

Years back, we defined the case record as belonging to the government. Now we have amendments and regulations that clearly state that the health information that we collect belongs to the client even though we act as custodians of it … Therefore they have the right to access this information …

Full access did not mean immediate, unmediated access. Clients were generally granted access only after they asked. As Lisa explained, ‘Consumers are told that if they ever want access to or would like a copy of something in their file that they need only ask’. In Elsa’s organization, clients must submit a formal request and note exactly what records they want to access:

There is a standard request process, a standard form they have to complete … They tell us what services they received, or what records they want, we do not necessarily give them everything we have … We review it … what we would provide would be specific to the scope of the request that we receive.

In this sense, the term ‘full access’ did not necessarily mean clients had unfettered access to their records. For Tara, full access preferably involved practitioner-assisted interpretation of the contents:

When a client wants to read their notes, I am entirely happy to sit down with client and have them read through everything I’ve written about them … if a client said they would want to do it without me, I would do that … However, I wouldn’t want to leave them, you know, uncertain about what I meant or over- interpreting clinical terms or not understanding something.

Tara was able to find time to assist her clients in interpreting the records only because very few clients asked her to see them. If more clients asked, Tara said she would have had to ‘shorten my notes to almost nothing. It doesn’t sound right, but in practice I could see [this] being the case’.

For Elsa, full client access to records was preceded by a systematic review of pertinent records, and included the presence of a responsible staff member:

When a client requests their mental health record, there is a thorough manager review in terms of whether or not certain information may cause some harm to the client. So for a mental health file, it would be advisable for a client to sit down to review the file with the clinician … so we manage a safe transfer of this information from us to them … The reason why we’re able to do that is that legislation provides that discretionary ability to assure the protection and safety of the client.

In other cases, legislation required the redaction of some information to protect third-party information:

We had protected information for example from corrections, adoptions, if somebody made a referral to F&CS for protection of the child. All three of those information types are protected information. So obviously, before a record is provided to a client, it has to be vetted … (Elsa)

Again, in this case, the use of the term ‘full access’ did not mean that clients were assured of unrestrained access to their records. The degree of access was contingent on the worker’s discretion, with the decision framed in terms of the wellbeing of clients while possibly informed by more self-serving interests such as the protection of the worker and/or agency. It could well be argued that some of these practices do not substantively represent so-called ‘full access’ as the participants regarded them.

In summary, full client access to their records was strongly informed by recognition of clients’ rights and information ownership. However, even though practitioners said that they granted clients full access to their case records, it did not mean that they in fact granted such access in practice.

Discussion

The survey indicated that while most Canadian social workers identify with the spirit of the Code of Ethics and Standards of Practice with regard to granting clients access to records, this is not strongly reflected in their practice. The findings from the survey suggest that social workers’ practices in the keeping of records do not embody the principles they espouse relating to participation and partnership in the helping process. Some of the survey participants’ responses reflected a strong professional/expert approach to client access to records, where professional discretion and what Chambon (2013: 120) referred to as ‘professional distance of the expert position’ took precedence over client rights.

The interview results, however, helped place in context the survey results. For one, we know from the case of Evan that while survey participants may have indicated that they granted ‘conditional access’, they could have granted what could be thought of as ‘full access’. But the very same case tells us that ‘full access’ could effectively be negated when it is made contingent on the clients’ initiative to request access. And so some of the survey responses indicating ‘full access’ may have to be understood in this light. To effectively gain access, clients generally needed knowledge of the existence as well as the scope and breadth of such records, as may be gained from involvement in their creation and maintenance if, as in the case of Peter and Elsa, clients had ‘to be very specific’ about ‘what records they want’ such as ‘the dates’. This would not have been assured in most cases where there was no active client involvement in record keeping.

The findings reflect concerns about the direction the profession has taken within the evolving global political and economic climate. The influence of neoliberalism and managerialism has wrought dominant forms of practice where any ‘process of collective self-scrutiny’ (Taylor, 2008: 40) was driven by accountability and managerial control. Documentation standards have shifted from focusing on understanding clients and documenting ‘the worker’s diagnostic thinking and the development of the client’s self-knowledge and social competence’ to a narrower concentration on ‘the definition and remediation of a specific problem or need’ (Kagle, 1993: 193). The focus is on diagnosis, service goals and plans, service activities/treatment, and service impact/outcome. These are often presented as ‘neutral intermediary for the reporting of events’ and facts (Taylor, 2008: 30). In the process, the creation of case records has become the prerogative of the practitioner, highlighting what Chambon (2013: 124) described as ‘[t]he power of inscription that is ubiquitous in bureaucracies’ that can be seen in ‘how we name, how we characterize, how we present and represent selves and Others in our professional discipline’.

While most practitioners may rhetorically identify with the philosophy underlying client access and partnership (as was the case of the study participants), many may not actively incorporate these principles into their practice. Many are likely not inclined to take the risk of initiating the process and relinquish their control over record sharing. Echoing Gelman’s (1991) account over a quarter of a century ago, contemporary practice in relation to client access to records, it seems, has remained ‘paternalistic and protective of bureaucratic and professional discretion’ as opposed to being ‘an integral part of the helping process’ (p. 192).

Practitioners have a seemingly reasonable excuse for not granting clients access to their records: clients do not ask for their case records often. Clients may only ask to access their case records if they need them in seeking out other services/access to benefits, or when a problem arises in the socialworker–client relationship. Gelman (1991) offered several explanations for the paucity of client requests for record access: lack of awareness of policies allowing access; lack of interest unless a problem arises in the relationship with a social worker; lack of courage or worry that their request might be seen as disrespectful; and lack of capacity to engage in the process due to the nature of a disability. Given this, he argued that ‘the process of sharing records must be initiated by the worker’ (Gelman, 1991: 200). In other words, we cannot hide behind the fact that clients rarely ask to see their records.

To understand the impact of the prevalence of the professional/expert approach to granting client access to case records, it is helpful to refer to the works of the authors who problematize ‘professional privilege’ in social work. Midgley (2012) bemoaned the preponderance of ‘professional imperialism’, questioning social workers’ construction of expertise over others’ lives. Chambon (2013: 127) highlighted social work’s ‘long-standing heritage of Othering’ and how social work maintains professional/expert power through exercising distance between social workers and their clients. Rossiter (2001) and Weinberg (2015) expounded on the notion of ‘ethical trespass’, developed by Hannah Arendt and elaborated by Melissa Orlie. Ethical trespass refers to unintentional harm caused through participation in social processes and identities. The professional privilege of social workers to determine ‘what is seen as common sense and ethical regarding health and functionality’ (Weinberg, 2015: 8) can be seen as such. Professionals ‘walk a tightrope of advantage that both not only benefits service users but also carries the potential for harm’ (Weinberg, 2015: 13). Rossiter (2001) suggested that professionalism itself is the main trespass: when knowledge becomes the property of one professional group, professionals can become increasingly ignorant of multiple and diverse viewpoints. Weinberg (2015: 10) suggested the need to decrease our ‘sense of superiority and entitlement’, reminding us of a key assumption that underpins our claims about human rights and social justice – ‘we’ (those who provide the services) are not separate from and above ‘them’ (those who access the services we offer)’.

Conclusion

This study examined clients’ access to their case records in social work practice in Canada. The results indicated that while Canadian social workers identified with the spirit of the Code of Ethics and Standards of Practice with regard to granting clients access to their records, this was not necessarily reflected in practice. The findings suggest the privileging of organizational interests above those of clients, even where relevant legislation is in place. This reinforces the traditional professional/expert–client approach to the management of case records, which perhaps brings comfort to the notable minority of the survey participants who either were ambivalent or disagreed with the proposition that clients be granted access to their case records. Where participants claimed to offer full access, such access appeared to have been mainly in principle. This does not embody the spirit and intent of relevant practice standards around clients’ access to their case records.

From a critical perspective, the challenging of structural inequality, and the disadvantage and oppression that go with it, starts with the client–worker relationship (Baines, 2017; Morgaine and Capous-Desyllas, 2015). Social workers cannot speak of promoting equality in society while maintaining unequal relationships with their clients. Practitioners cannot claim to empower clients while the clients are disempowered in relation to helping professionals. Social workers cannot profess to work collaboratively with clients while maintaining that key and fundamental aspects of their work, like the keeping of information pertaining to clients, are simply beyond the latter’s ken. Workers cannot speak of prioritizing clients’ interests and promoting their self-determination without having to account to them for the notes they keep on some of the most intimate aspects of their clients’ lives. While there may be professional, ethical, or legal reasons for withholding access, the spirit and intent of the practice standards is clear: social work professionals must grant clients access to their case records to the fullest extent possible. This is not a peripheral concern. The place of clients in the helping relationship is at the heart of the 100-year debate in social work (Haynes, 1998). In a way, how social workers enact this principle reflects the side that they are taking in this debate. If social workers are to live by the values they claim to espouse, allowing clients’ access to their case records should not only be in principle, but should form a part of their everyday practice.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author biographies

Dr. Marina Morgenshtern is an Assistant Professor at the Department of Social Work, Trent University, Canada. Before joining academia, she was engaged in social work practice with immigrant and minoritized individuals, families and communities in Israel. She teaches family social work, community social work, social work research and field placement seminars. Her research and teaching are informed by critical and anti-oppressive approaches to social work and interest in the inclusion of marginalized voices into social work theory, research and practice. Her current research project is the exploration of diverse university students’ experience and sense of belonging in academia.

Dr Nilan Yu is a lecturer in social work at the University of South Australia and program director of the University’s Master of Social Work. He has been a social work academic for two decades. Before joining academia, he was engaged in community development work in the Philippines. His practice experience also includes work with Indigenous and rural communities and informal settlements in urban areas. He teaches human rights and community development, social research, and working with human service organisations. His current research interests are in the areas of disability, migration, ageing, and critical practice. His current research projects include exploring post-parental care for people ageing with intellectual disability in rural areas, ageing amongst older migrants, and client access to records in social work practice. He is the editor of Consciousness-raising: Critical pedagogy and practice for social change, co-edited (2018) and co-edited Subversive action: Extralegal practices for social justice (with Deena Mandell, 2015, Wilfrid Laurier University Press) and Faces of homelessness in the Asia Pacific (with Carole Zufferey, 2017, Routledge).

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