ETHICS For Prevention Specialists

Sandra Puerini Del Sesto, MEd. CPSS

Training Objectives By the end of this training, participants will:

Define ethics, morals, values, principles.

Explain the prevention code of ethics

State the laws regarding child abuse and background checks.

Apply Federal Law 42 CFR Part 2 to prevention practice.

Apply an ethical decision making model to situations in prevention work

Pre-Test

When does the federal law on confidentiality, 42 CFR Part 2, apply?

Activity

Define “ethics” in small groups Share definitions Find common themes in the definitions Explain the relationship among ethics,

morals, values and principles.

Basic Definitions

Ethics: A system of moral standards or values

Principle: A fundamental truth, law, doctrine or motivating force upon which others are based; a rule of conduct, e.g. “Above all do no harm.”

Morals: Principles with respect to right or wrong in conduct

Values: Social principles, goals or standards held by an individual, group or society

Definitions and Thoughts on Ethics

A set of developed and accepted standards or principles of behavior and action for both individuals and organizations within a profession

Standards or codes of behavior that are created to enhance professionalism and create a climate of dignity and respect

An agreed upon set of morals, values and professional conduct standards accepted by a group

REf: NAPPA

Definitions and Thoughts on Ethics

A code of ethics is ….

a blueprint of the norms of conduct for a profession or group

An Equation…

Ethics=

Basic Beliefs +

Value System+

Developmental Age

Legal versus Ethical?

Legal

&

Ethical

Legal

&

Unethical

Illegal

&

Ethical

Illegal

&

Unethical

Legal versus Ethical? What Do You Think?

Legal & Ethical

Social host law

Server law

Child abuse reporting

Legal & UnethicalSending youth home

from a drinking party

Withholding care from unensured

Illegal & EthicalNot reporting illegal

immigrants in a hospital setting

Disclosing HIV status to partners

Social/civil rights protest

Illegal & Unethical

Selling illegal drugs

Drinking & driving

Individual behavior can be considered ethical or good if it:

Increases trust among people

Promotes integrity and decreases deceit in relationships

Does not exploit others

Increases cooperative attitudes

Enhances self respect Eliminates confusion

about standards for behavior

Dissolves barriers between people

Decisions that affect groups of people are

most ethical when they produce: The greatest good for the most people (good

motives and good results)

Justice (fair and impartially administrated)

Utilitarianism and universal application (practical enough that it can work for all in foreseeable circumstances)

Prevention Code of Ethics: Six Standards

*Competence*Non-Discrimination*Ethical Obligation to Advocate*Integrity*Nature of Services*Confidentiality

Code of Ethics: Standards

Competence Maintain current knowledge and skills in prevention Participate in ongoing education Be clear about the nature of deliverable services Recognize and clarify boundaries/limitations Provide accurate representation of qualifications Associate with no misleading services/products Make no misrepresentation of products/materials Define loyalties Provide publication credit

Code of Ethics: Standards

Non- Discrimination Shall not participate in discrimination of any

kind Shall broaden one’s understanding and

acceptance of cultural and individual differences

Will render services sensitive to those differences

Code of Ethics: Standards

Ethical Obligation to Advocate Advocate for consistent health promotion to

the public Provide factual and current information to

consumers Advocate for public policy supporting

prevention Model a healthy lifestyle

Code of Ethics: Standards

Integrity Should not subordinate service and the public trust to

personal gain/advantage Should not make false statements to certifying

authority Shall alert a colleague to potentially unethical

behavior Must report violations of ethical conduct by others to

disciplinary body (ies) Shall not engage in any action that violates the

consumers’ civil/legal rights

Code of Ethics: Standards

Nature of Services Shall practice respectful and non-exploitive

practices Should protect consumers from harm Shall maintain an objective, non-possessive, non-

exploitive relationship with clients/participants Shall comply with all laws and regulations that apply

to professional conduct Must report child or other vulnerable abuse to the

appropriate authorities

Bureau of Criminal Investigation Background Checks State law requires that agency staff or

volunteers in a caretaking role for a minor for two or more hours per week submit to a background BCI check as per state law.

Agencies should have a policy regarding the actions to be taken given a positive BCI.

Child Abuse Reporting

Must report any child abuse by a current caretaker

Mandated by law to report within 24 hours All forms of child abuse reportable Reporting person protected in reporting

Code of Ethics: Standards

Confidentiality Shall be aware of and comply with all federal,

state and other jurisdictional guidelines, regulations, statutes, and policies regarding confidentiality.

Client/participant is protected by 42 CFR part2:

Once you ask questions regarding substance use and continue to ask questions for purposes of “diagnosis” or referral.

Your program is presented as a resource for “diagnosis” or referral and…

-person asks for services/assistance

-you recommend for treatment, diagnosis or referral

If you receive federal funds that could be used for AOD treatment or referral

Comprehensive Prevention Strategies: CSAP

Information Dissemination Prevention Education Alternatives Environmental Changes Community-Based Processes Problem Identification and Referral

What persons are covered by regulations?

Paid full-time and part-time employees Volunteers Student interns Former staff members Administrative, executive and support staff Prevention staff Clinical staff Contracted services providers

Security of Client Records(Sec 2.16a, 2.19a, 2.22)

Locked cabinet Promulgate written procedures regulating access to

and use of records Purge identifying information from records or destroy

records if program discontinues or is taken over unless written permission of patient to transfer record is received

Communicate procedures re: confidentiality to patient in writing.

Release of Confidential Information

To medical personnel…to meet a bonafide emergency posing an immediate medical attention (sec 2.51)

If authorized by an appropriate order of the court… showing good cause…and weighing public interest and need for disclosure against injury to the patient.

To qualified personnel…to conduct scientific research management audits or program evaluation

… but not identifying, directly or indirectly, any client in any report

Client Consent (example)

I (name) on (time) request that (name of program/ agency) disclose (kind of information) for (purpose of disclosure). This consent is subject to revocation at any time to the extent that program has already taken action based on the above consent. If not , this consent will terminate on (specific date, event, condition).

Date Signature of Client Signature of Parent/Guardian

Note: A general authorization is not sufficient for client consent.

Parental Consent (Sec 2.14.c)

Written consent for disclosure is required from both a minor and his/her parent or guardian in states where parental consent is required unless: The minor lacks the capacity to make a

rational choice as judged by the program director

The minor’s situation poses a substantial threat to the life or physical well being of him/ herself or others.

Capacity- extreme youth, impinging mental or physical condition.

Exceptions to the General Rule Prohibiting Disclosures

Communications within a program or between a program and an entity having direct administrative control over that program.

Communication without participant identifying information (e.g.for research or evaluation)

Liability Issues Related to Ethics

Acts of omission (When I should say or do something ethically and don’t speak or act)

Acts of commission (When I say or do something I shouldn’t have ethically said or done)

Consent (When I agree to, support or allow an action done by others that ethically I should not )

Violations

Penalty: First Offense: $500

Subsequent Offenses: $5000

Violations must be reported to the US Attorney for the jurisdiction or state.

Which law do I follow?

If there is a discrepancy between state and federal law related to confidentiality, the stricter law always applies.

Does 42 CFR Part 2 Apply?

The Uptown School provides classroom education on alcohol and other drugs. The teachers conducting these classes are not responsible for counseling individual students or making formal referrals. However, students sometimes confide in the teacher after class. The teacher listens to their problems and provides support and advice, including advice to seek treatment.

Does 42 CFR Part 2 apply?

No, because the Federal regulations apply only to programs that specialize in providing diagnosis, treatment or referral for treatment.

The Downtown School has a counseling program that deals with a wide range of student problems, including psychological, emotional, and family problems as well as alcohol and other drug use. Program staff run “rap groups,” provide counseling to individual students, and make referrals to treatment programs in the community.

Does 42 CFR Part 2 apply?

Yes. This program is covered by the federal regulations, since the regulations apply to those that specialize, in whole or in part, in alcohol or other drug counseling, assessment or referral. However, only the information identifying a particular youth as an alcohol or other drug user is confidential.

The Midtown school-based program, which has determined that it is governed by the Federal regulations, wants to meet with parents, teachers, or others to discuss whether Jerry Jones, a student who is suspected of having an alcohol or other drug problem, needs intervention and treatment.

Does 42 CFR Part 2 apply?

No. Only individuals who have applied for or received services from a program are protected by the Federal law. Thus, if a youth has not yet been evaluated or counseled by a program and has not sought the program’s help, the program is free to discuss the youth’s alcohol or other drug problems with others. However, from the time the program first conducts an evaluation or begins to counsel the youth, or the youth applies for these services, the program must comply with the Federal regulations when disclosing any information that would identify him or her as an alcohol or other drug user.

Hilltop is a counseling program much like Downtown, except that it deals exclusively with alcohol or other drug problems.

Yes. The confidentiality regulations restrict all disclosures that reveal or acknowledge that a particular youth is being or has been counseled, evaluated, or referred by the program, since disclosing that information necessarily implies that the youth is or was an alcohol or other drug user.

Consent for Program Participation

Presently many funders require that participating youth and their parents sign consent forms approved by an INSTITUTIONAL REVIEW BOARD (IRB) (i.e. a college or hospital board charged with the responsibility to ensure the health and safety of participants in any study are protected)

Consent for Program Participation

Active Consent requires signature of participant and/or parent agreeing to the conditions of participation (i.e. content, time, testing, etc.) listed on an IRB-approved form

Passive Consent requires that an IRB-approved letter be set to parents of minors describing the program and asking them to indicate their wish that their child NOT participate by signing a form. No parental signature is needed if the parent approves participation.

Ethical Decision Making

An Ethical Decision Making Model

1. Clarify the issues and relate to a section in the prevention code of ethics.

2. Assembly your facts.3. Develop all possible options.4. Assess the options from an ethical perspective.5. Make a decision.6. Develop a plan for implementing the decision.7. Implement the plan.8. Evaluate the plan.

Adapted from the Bay Group 1990

You decide using the model…

Gary is by everyone's agreement one of the best workers at your agency. In some ways he is too good. Gary works an excessive number of hours every week. He is clearly married to his job. You are concerned about his well-being and his work/personal boundaries.

What section of the Code of Ethics apply? Define the issue in this context. What are the facts? What else might you

need to know? Identify your options. Can you reach consensus on a course of

action?

Activity: Critical Incidents

Given the case studies provided, review the facts.

Cite the section of the Code of Ethics that applies.

Use the Ethical Decision Making Model to decide on a course of action.

Share your decision with the group.

A Humanist Code of Ethics

Do no harm to the earth, she is your mother.Being is more important than having.Never promote yourself at another's expense.Hold life sacred; treat it with reverence.Allow each person the dignity of his or her labor. Open your home to the wayfarer.Be ready to receive your deepest dreams;sometimes they are the speech of unblighted conscience.Always make restitutions to the ones you have harmed.Never think less of yourself than you are.Never think that you are more than another. ARTHUR DOBRIN

And finally…

“A people that values its privileges above its principles soon loses both.” Dwight Eisenhower

“If we want to produce people who share the values of a democratic culture, they must be taught those values and not be left to acquire them by chance.” Cal Thomas