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
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
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.
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.
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
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