ETHICS For Prevention Specialists

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ETHICS For Prevention Specialists

• Sandra Puerini Del Sesto, MEd. CPSS

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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

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Pre-Test

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

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Activity

• Define ethics in small groups
• Share definitions
• Find common themes in the definitions
• Explain the relationship among ethics, morals,
  values and principles.

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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

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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

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Definitions and Thoughts on Ethics

• A code of ethics is .
• a blueprint of the norms of conduct for a
  profession or group

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An Equation

• Ethics
• Basic Beliefs
• Value System
• Developmental Age

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Legal versus Ethical?

• Legal
• Ethical

• Legal
• Unethical

• Illegal
• Ethical

• Illegal
• Unethical

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Legal versus Ethical? What Do You Think?

• Legal Ethical
• Social host law
• Server law
• Child abuse reporting

• Legal Unethical
• Sending youth home from a drinking party
• Withholding care from unensured

• Illegal Ethical
• Not reporting illegal immigrants in a hospital
  setting
• Disclosing HIV status to partners
• Social/civil rights protest

• Illegal Unethical
• Selling illegal drugs
• Drinking driving

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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

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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)

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Prevention Code of Ethics Six Standards

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

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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

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Code of Ethics Standards

• Non- Discrimination
• Shall not participate in discrimination of any
  kind
• Shall broaden ones understanding and acceptance
  of cultural and individual differences
• Will render services sensitive to those
  differences

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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

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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

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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

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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.

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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

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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.

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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

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Comprehensive Prevention Strategies CSAP

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

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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

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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.

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Release of Confidential Information

• To medical personnelto meet a bonafide emergency
  posing an immediate medical attention (sec 2.51)
• If authorized by an appropriate order of the
  court showing good causeand weighing public
  interest and need for disclosure against injury
  to the patient.
• To qualified personnelto conduct
• scientific research
• management audits or
• program evaluation
• but not identifying, directly or indirectly,
  any client in any report

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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.

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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 minors 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.

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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)

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Liability Issues Related to Ethics

• Acts of omission (When I should say or do
  something ethically and dont speak or act)
• Acts of commission (When I say or do something I
  shouldnt have ethically said or done)
• Consent (When I agree to, support or allow an
  action done by others that ethically I should not
  )

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Violations

• Penalty First Offense 500
• Subsequent Offenses 5000
• Violations must be reported to the US Attorney
  for the jurisdiction or state.

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Which law do I follow?

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

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Does 42 CFR Part 2 Apply?
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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?

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

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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?

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• 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.

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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?

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• 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 programs help, the program is
  free to discuss the youths 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.

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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.

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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)

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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.

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Ethical Decision Making
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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

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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.

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• 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?

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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.

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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 dreamssometimes
  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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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