Ethics and TEAP

1. Ethics and TEAP Diane Tennies, PhD, LADC October 2018

2. Learning Objectives • After this presentation, participants will be able to: • 1.) Differentiate between values, ethics and the law • 2.) Articulate the elements of an ethical decision-making model • 3.) Describe 3 relevant standards of the NADAAC ethics code as it applies to Job Corps • 4.) Identify elements of ethical practices related to boundaries, confidentiality and documentation

3. Values versus Ethics – Here is a visual

4. Values (represented by Superman) • The various beliefs and attitudes that determine how a person or group actually behaves. • Values identify what should be judged as good or ideal in a given culture. • A well-defined value system is makes a fine moral code… • But is it not a professional ethical code. • What values do you have that might impact your work? • Kind and giving person; want to help; wanting to share past experiences to benefit others

5. Ethics (Represented by Batman) • Ethics is an action concept, not best wishes or good intent. • Ethical principles provide a framework for how to turn values into professional action or inaction. • Ethical principles are a matrix of rules of professional conduct, not just a convenience. • Ethical decision making is a rational and cognitive, not an emotional, process.

6. What ethics code applies to TEAP specialists? • Depends on state law (some states have own code of ethics written into regulations) • NADAAC- National Association for Alcoholism and Drug Abuse Counselors. (https://www.naadac.org/code-of-ethics) • Yes the ethics code applies even if you are not a member • It is the accepted standard of conduct for addiction professionals • The NAADAC Code of Ethics is designed as a statement of the values of the profession and as a guide for making clinical decisions. This Code is also utilized by state certification boards and educational institutions to evaluate the behavior of Addiction Professionals and to guide the certification process. • Updated 10/2016

7. So if Superman is Values and Batman is Ethics then who would represent Laws?

8. Ethics versus Values versus Law • Values are our beliefs but not necessarily relevant to our ethics or application of law • Ethics establish a higher standard than is required by laws or regulatory bodies. • Name the two Federal regulations which protect TEAP-related information for Job Corps students: 42 CFR Part 2 and HIPAA • These federal regulations shape our practices and determine our actions (such as around informed consent and confidentiality) as well as frame our decision-making. • Our ethics code helps us determine how to apply our decisions. • There are also state laws that are different in each state – such as who hold the decision making authority for disclosure of drug testing results – this also shapes our actions. • Because of the highly charged emotional nature of the substance abuse treatment field, providers should possess the tools to explore ethical dilemmas objectively (being mindful of the power of our values)

9. Elements of Ethical Decision-Making • Thinking ethically is about changing our mindset. • Ethical behavior rests on established rules and rights. Permanently defined principles do not change merely as a result in the change of circumstances. There is a right way to act and that applies to all similar situations. • Ethical actions are practiced by applying a principle to each situation that arises. The interplay between the situation and the principle determines the ethical decision and action. • Following ethical principles helps us to look beyond the present to the results of behaviors/decisions. • Ethical practices put the client (student) first.

10. NAADAC recommends consideration of the following when making ethical decisions: • Autonomy: To allow others the freedom to choose their own destiny • Obedience: The responsibility to observe and obey legal and ethical directives • Conscientious Refusal: The responsibility to refuse to carry out directives that are illegal and/or unethical • Beneficence: To help others • Gratitude: To pass along the good that we receive to others • Competence: To possess the necessary skills and knowledge to treat the clientele in a chosen discipline and to remain current with treatment modalities, theories and techniques • Justice: Fair and equal treatment, to treat others in a just manner • Stewardship: To use available resources in a judicious and conscientious manner, to give back

11. Continued • Honesty and Candor: Tell the truth in all dealing with clients, colleagues, business associates and the community • Fidelity: To be true to your word, keeping promises and commitments • Loyalty: The responsibility to not abandon those with whom you work • Diligence: To work hard in the chosen profession, to be mindful, careful and thorough in the services delivered • Discretion: Use of good judgment, honoring confidentiality and the privacy of others • Self-improvement: To work on professional and personal growth to be the best you can be • Non-malfeasance: Do no harm to the interests of the client • Restitution: When necessary, make amends to those who have been harmed or injured • Self-interest: To protect yourself and your personal interests.

12. NADAAC Principles • Principle I: The Counseling Relationship • *Principle II: Confidentiality and Privileged Communication • Principle III: Professional Responsibilities and Workplace Standards • *Principle IV: Working in a Culturally Diverse World • *Principle V: Assessment, Evaluation, and Interpretation • Principle VI: E-Therapy, E-Supervision, and Social Media • Principle VII: Supervision and Consultation • Principle VIII: Resolving Ethical Concerns • Principle IX: Research and Publication

13. Application of Selected Principles to Job Corps

14. Principle II–1: Confidentiality • Addiction Professionals understand that confidentiality and anonymity are foundational to addiction treatment and embrace the duty of protecting the identity and privacy of each client as a primary obligation. Counselors communicate the parameters of confidentiality in a culturally-sensitive manner. • So how does this apply to Job Corps? • What do you tell students about who has access to their drug testing information? • How about who has access to the SHR? • What about what is disclosed in the intervention sessions? For instance, if they disclose drug use.

15. Principle II–2: Documentation • Addiction Professionals shall create and maintain appropriate documentation. Providers shall ensure that records and documentation kept in any medium (i.e., cloud, laptop, flash drive, external hard drive, tablet, computer, paper, etc.) are secure and in compliance with HIPAA and 42 CFR Part 2, and that only authorized persons have access to them. Providers shall disclose to client within informed consent how records shall be stored, maintained, and disposed of, and shall include time frames for maintaining active file, storage, and disposal. • What do you tell students about this? For instance, if they want to obtain their records after they leave Job Corps.

16. Principle II–10: Essential Only • Addiction Professionals shall release only essential information when circumstances require the disclosure of confidential information. • Does this sound familiar? Similar to what 42 CFR Part 2 says. • What information is disclosed to staff? • CSIO • Other Wellness Staff (importance of documenting in chronological record) • Academic and Trades • Counseling

17. Principle IV–4: Personal Beliefs • Addiction Professionals shall develop an understanding of their own personal, professional, and cultural values and beliefs. Providers shall recognize which personal and professional values may be in alignment with or conflict with the values and needs of the client. Providers shall not use cultural or values differences as a reason to engage in discrimination. Providers shall seek supervision and/or consultation to address areas of difference and to decrease bias, judgment, and microaggressions.

18. Principle IV–8: Personal Beliefs • Addiction Professionals shall use methodologies, skills, and practices that are evidence-based and outcome-driven for the populations being serviced. Providers will seek ongoing professional development opportunities to develop specialized knowledge and understanding of the groups they serve. Providers shall obtain the necessary knowledge and training to maintain humility and sensitivity when working with clients of diverse backgrounds. • This is why have incorporated CRAFFT into SIF because it is for this population and is empirically based. (If using formalized assessment measures they must meet same criteria – for this population and student’s responses are then compared to a known normative group).

19. Principle VIII–3: Decision-Making Model • Addiction Professionals shall utilize and document, when appropriate, an ethical decision-making model when faced with an ethical dilemma. A viable ethical decision-making model shall include but is not limited to: (a) supervision and/or consultation regarding the concern; (b) consideration of relevant ethical standards, principles, and laws; (c) generation of potential courses of action; (d) deliberation of risks and benefits of each potential course of action; (e) selection of an objective decision based on the circumstances and welfare of all involved; and (f) reflection, and re-direction if necessary, after implementing the decision

20. Ethical Practices: Let’s Get Practical • Applying Ethical decision-making in the following areas: • Boundaries • Confidentiality • Documentation

21. Boundaries: • Boundaries are the space (emotional or physical) between yourself and another person.

22. Boundaries: Why have them? • Set structure and provide framework for services. • The limits that control the professional’s power so that students are not hurt. • Are parameters that keep professionals as objective as possible. • To maintain appropriate boundaries, the relationship should ALWAYS remained focus on client (student) and their needs. • Self-disclosure is good example – why am I telling them this? • Some boundaries are clear. For instance, it is ethically problematic to provide services to an family member (such as a sibling or our child who may be a student at JC) because the pre-existing relationship impairs objectivity and undermines professional relationship. • Boundaries help us to: • Clarify our roles • Manage the stress of the work • Let go and not take things personally • Increase positive outcomes

23. Examples of Boundary Setting Dilemmas • A student whom you really like and who is struggling with cravings, asks you to go to a self-help meeting off-center with them on your own time. Do you go with them? • A staff member says they are very concerned about a student and their safety and asks to you to allow them to read your notes so they better understand what is happening with the student. Do you let them look at your notes? • A student is leaving for winter break and has no money for a bus pass so they can attend self-help meetings. They ask you if you could give them money. Should you give them the money?

24. Confidentiality What applies? • NAADAC Code • HIPAA • 42 CFR Part Two (aka: Who has a need to know)

25. Practical Safeguards for Confidentiality • Do not leave papers/SHR containing PII (personally identifiable information) lying around where others can see them. • At end of workday – clear desk or other exposed areas of PII and return SHR to locked cabinets. • TEAP group/individual notes are NOT to be stored separately and MUST be in the SHR. • Do not talk about students in public areas. • Do not share one students information with another student. • Do not take home PII under any circumstance.

26. Confidentiality Dilemmas • A student discloses in your individual intervention session that they have been smoking marijuana behind the trade building on campus. Who should you tell about this? • The CSIO asks what drugs the student tested positive for on entrance. What do you tell them? • The counselors use CIS to make a referral for a student to TEAP. What are the concerns here? • A minor student tests positive on entry. Do you notify the parents/caregivers? If so, how do you notify them?

27. Documentation • Why document? • Important for other health staff to know what happening • ePRH requires that students receive intervention services • Required by ethics code and Federal Laws • Where document? • SHR – TEAP section and make a note in chronological section • What are the elements to document? • Date/signature/credential (can use initials if key available in each SHR) • Content of session (if group note this can be templated) • Individual student response and the plan

28. Documentation Dilemmas • You have very limited hours on center and no clerical support. You barely have time to meet with students and complete other responsibilities. You don’t have any documentation time. What are some options? • Since you have limited time for filing, you keep the TEAP records in your desk until the student graduates from the intervention phase and then you file it. Saves time. Are there concerns with this approach? • The easiest and fastest way to do your group notes is to do one note for everyone and use initials for group members. That’s acceptable, right?

29. Example:

30. Learning Objectives - REVISTED After this presentation, participants will be able to: 1.) Differentiate between values, ethics and the law • Superman versus Batman versus Justice League. 2.) Articulate the elements of an ethical decision-making model • Ethics code woven in with Federal and State regulation allow for consistent decisions. 3.) Describe 3 relevant standards of the NADAAC ethics code as it applies to Job Corps • Confidentiality; Working in Culturally Diverse World; and Resolving Ethics Complaints (relevant subsections). 4.) Identify elements of ethical practices related to boundaries, confidentiality and documentation • Boundaries to establish parameters for services; making decisions about what to disclose and necessity of documenting in the SHR.

31. Questions – We will open the lines and use the chat box as well