ETHICS
For Prevention Specialists
Sandra Puerini Del Sesto, MEd. CPSS
Training Objectives
By the end of this training, participants will:
 Define ethics, morals,
 Apply Federal Law 42
values, principles.
 Explain the prevention
code of ethics
 State the laws
regarding child abuse
and background
checks.
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
Illegal
&
Ethical
Legal
&
Unethical
Illegal
&
Unethical
Legal versus Ethical? What Do You
Think?
Legal & Ethical
Social host law
Server law
Child abuse reporting
Illegal & Ethical
Not reporting illegal
immigrants in a
hospital setting
Disclosing HIV status to
partners
Social/civil rights protest
Legal & Unethical
Sending youth home
from a drinking
party
Withholding care from
unensured
Illegal & Unethical
Selling illegal drugs
Drinking & driving
Individual behavior can be
considered ethical or good if it:
 Increases trust among
 Increases cooperative
people
 Promotes integrity and
decreases deceit in
relationships
 Does not exploit others
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
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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
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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
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Nature of Services
Shall practice respectful and non-exploitive
practices
Should protect consumers from harm
Shall maintain an objective, non-possessive, nonexploitive 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
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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