Ethics and Confidentiality in Substance Abuse and Mental Health

1. Ethics and Confidentiality in Substance Abuse and Mental Health Linda K. Harrison, MS, LPCS, CCS, MAC Asheville Clinical Counseling, Supervision, and Training 828-380-2948

2. Write Down An Ethical or Legal Concern • Write down an ethical or legal concern. Be specific to what concerns you most. You can also add if you were able to report it and what was done. Behavioral health ethical concerns in any setting. • Share any concerns you have about repercussions around making ethical reports to your supervisor or state board.

3. Ethics Defined: • Gather in small groups of 3-4 and define ethics: purpose, function, parameters, etc • Solo assignment: On a 3x5 note card, write down an ethical concern or violation that you have seen or experienced while in your professional role.

4. The Power Differential • Client to counselor • Counselor to supervisor • Supervisor to governing board and professional board • Governing board to professional board and legal system

5. Approaches to Ethics • Normative: What is normally acceptable. • Common Morality: What does society hold to in accepted standards of morality. • Codes of Professional Ethics: APA, NASW, NBCC, NCSAPPB • Governmental Guidelines/Public Policy/Agency Policy

6. Kitchener’s Model of Ethical Formation • Ethical Theory leads to…… • Ethical Principles leads to….. • Ethical Rules and Guidelines leads to……… • The Intuitive Level which is immediate action and judgement based on…. The facts of the situation and ordinary common sense.

7. Four Principles of Ethical Decision-Making • Autonomy • Beneficence • Non-Malfeasance • Justice

8. Four Principles of Ethical Decision-Making • Autonomy • Beneficence • Non-Malfeasance • Justice

9. Four Questions That Assist with Ethical Decision-making • Is the counselor giving the client the freedom to make choices about his or her direction in treatment? (Autonomy) • Is the counselor providing hope, encouragement, and support for the client’s decisions that are individualized , in line with the client’s values, and in the client’s best interest regarding change toward successful recovery? (Beneficience)

10. Four Questions That Assist with Ethical Decision-making • Is the counselor working with the client in a way that will “do no harm”? (Non-malfeasance) 4. Are ethical codes, laws, and universal values being followed by the counselor and is the counselor providing fairness to all that are involved with this client’s treatment?

11. Ethical and Legal Perspectives • Ethical: Exercise control to the highest ethical standards of the profession • Legal: Exercise minimal control, just above the level of acceptable practice in the profession

12. Acid Test for Ethical Dilemmas • Is it legal? • Is it fair? • How do I feel about it myself? • Have I checked it out with someone I trust and who has strong ethical and moral values?

13. Ethical Decision Making • Whose interests are involved? • Who can be harmed and do they have a voice? • What universal values apply? • Are there values in conflict? • What ethical or legal standards apply?

14. The Spirit of Ethical Decision-making and Behavior Do no harm. Do support the benefit of the client. Do set down an example that rises above. Do seek to grow in your own right as a professional. Do give back with pro bono service. Do sit in the stillness, feeling and knowing the Spirit of all goodness and healing has brought you to this place.

15. Codes of Ethics: The Categories • Purpose and Scope • Counseling Relationship • Confidentiality, Privileged Communication, Privacy • Counselor Supervision, Training and Teaching • Professional Responsibility • Relationships With Other Professionals • Evaluation, Assessment and Interpretation • Research and Publication • Resolving Issues

16. Ethics: Purpose and Scope • Ethics involve the recognition of diversity, embracing a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts.

17. Ethics: Purpose and Scope • Professional values are an important way of living out an ethical commitment. Values inform principles. Inherently held values that guide our behaviors or exceed prescribed behaviors are deeply ingrained in the counselor and developed out of personal dedication, rather than the mandatory requirement of an external organization.

18. The Counseling Relationship: • Primary responsibility is to respect the dignity and to promote the welfare of the client.

19. Group Exercise • Explore, discuss and list how the primary responsibilities of the counseling relationship manifests in the counseling experience in the very first step of developing/informing the client counselor relationship… • Hint: Every licensure board has the counselor provide one of these……client’s informed consent or disclosure statement!

20. Defining the Counseling Relationship • Records • Treatment planning • Utilize client support network • Informed consent • Avoid harm • No romantic or sexual relationships (5 years) • Advocacy for client • Confidentiality • Screening and protecting clients (group work) • End of life care • Refer out if there is a bias or conflict of interest • Establishing fees and dealing with nonpayment and bartering • Technology applications • Termination and Referral

21. Confidentiality, Privileged Communication and Privacy Trust is the cornerstone of the counselor relationship. Counselors aspire to earn the trust of the client by creating an ongoing partnership, establishing and upholding appropriate boundaries and maintaining confidentiality.

22. Group Exercise: • Explore, discuss and list how confidentiality, privileged communication and privacy is carried out in the counseling experience.

23. Confidentiality • Respecting client rights • Exceptions • Information shared with others • Confidentiality in groups • Clients lacking capacity for informed consent • Records • Research and Training • Consultation

24. Professional Responsibility • Counselors actively participate in the world, taking on responsibilities from self to all levels of society that impact the counselor and the counseling profession.

25. Professional Responsibility • Boundaries of competence: Scope of practice • Advertising and soliciting clients • Professional qualifications • Nondiscrimination • Public responsibility

26. Relationships with Other Professionals • Counselors are respectful of approaches to counseling different than their own. • Counselors work to develop and strengthen interdisciplinary relations with colleagues • Counselors participate in interdisciplinary teams • Counselors alert their employers of inappropriate practices • Counselors consult within their expertise.

27. Evaluation, Assessment, and Interpretation Counselors use assessment instruments as one component of the counseling process, taking into account the client personal and cultural context. Counselors promote the well-being of individual clients or groups of clients by developing and using appropriate educational, psychological, and career assessment instruments.

28. Evaluation, Assessment, and Interpretation • Explore, discuss and list how evaluation, assessment and interpretation are carried out in the counseling experience.

29. Supervision, Training, and Teaching Counselors aspire to foster meaningful and respectful professional relationships and to maintain appropriate boundaries with supervisees and students. Counselors have theoretical and pedagogical foundations for their work and aim to be fair, accurate, and honest in their assessments of counselors-in-training.

30. Supervision, Training, and Teaching • Counselor supervision and client welfare • Counselor supervision competence • Supervisory relationships • Supervisor responsibilities • Counselor educator responsibilities

31. Research and Publication Counselors who conduct research are encouraged to contribute to the knowledge base of the profession and promote a clearer understanding of the conditions that lead to a healthy and more just society. Counselors support efforts of researchers by participating fully and willingly whenever possible. Counselors minimize bias and respect diversity in designing and implementing research programs.

32. Research and Publication • Explore, discuss and list how research and publication are carried out in the counseling world.

33. Resolving Ethical Issues Counselors act in a legal, ethical, and moral manner in the conduct of their professional work. They are aware that client protection and trust in the profession depend on a high level of professional conduct. They hold other counselors to the same standards and are willing to take appropriate action to ensure that these standards are upheld.

34. Resolving Ethical Issues • Standards and the law • Suspected violations • Cooperation with ethics committees

35. Resolving Ethical Issues • Let’s discuss the ethical issues you shared at the beginning of class!