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Thursday, September 1

Ethics Corner: Ethical Considerations with Addictions – Part 1

Ruth Lipschutz, LCSW, ACSW

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Confidentiality and Minors

A social worker in a high school setting has been meeting with a fifteen-year-old student. The student is not special ed. She reveals to the social worker that she has tried some of her friend’s attention deficit disorder (ADD) medication, smokes marijuana, and “drinks a lot at parties.” She is open to exploring concerns around these issues, but does not want to tell her parents. Her grades are starting to drop. She has attended school regularly, but is starting to miss classes. She is not suicidal. What would you do?

The social worker is presented with an ethical dilemma. There are conflicting sections of the NASW Code of Ethics and laws. There may also be conflicts between the social worker’s personal values and school policy.

In addressing an ethical dilemma, social workers need to implement a procedural standard of care; an accepted decision-making process or procedure for critically analyzing the dilemma; and determining the best actions to implement.

The first step is to identify the competing ethical duties.

There are potential conflicts between several sections of the NASW Code of Ethics, including:

  • Self-Determination (1.02) and Commitment to Clients (1.01)
  • Section (a) and section (c) of Privacy and Confidentiality (1.07)
  • Commitment to Clients (1.01) and Clients Who Lack Decision-Making Ability (1.14)

The student does not want the social worker to share information with her parents, but the social worker may feel that to fulfill her “primary responsibility” to “promote the well-being of clients,” the parents need to be involved. The social worker may assess that the client’s ability for decision-making is impaired and that the obligation to “take reasonable steps to safeguard the interests” of the student require informing her parents. Section (a) of Privacy and Confidentiality requires social workers to “respect client’s right to privacy,” yet section (c) states that information may need to be shared for “compelling professional reasons.”

Additionally, Illinois and federal law outline distinct confidentiality guidelines related to drugs and alcohol. Social workers in all settings, not only formal drug and alcohol treatment programs, need to be aware of the provisions in the following two laws:

  • Consent by Minors to Medical Procedures Act (410 ILCS 210/)
  • Alcohol and Drug Abuse Patient Records Confidentiality Regulations (42 C.F.R. Part 2 of federal Public Health Service Act)

These acts provide expanded rights to confidentiality for minors.

The Consent by Minors to Medical Procedures Act section on “substance abuse treatment” applies broadly. It is not limited to formal treatment programs. It states:

“Minors 12 years of age or older who may be determined to be an addict, an alcoholic or an intoxicated person or who may have a family member who abuses drugs or alcohol, may give consent to medical care or counseling related to diagnosis or treatment. The consent of the parent, parents or legal guardian shall not be necessary to authorize medical care or counseling.”

With the minor's consent anyone involved in providing medical care to the minor or counseling related to the drug or alcohol use by the minor or a member of minor’s family shall make reasonable efforts to involve the minor’s family in his or her treatment, if the person furnishing the treatment believes that the involvement of the family will not be detrimental to the progress and care of the minor. Reasonable effort shall be extended to assist the minor in accepting his or her family’s involvement in the care and treatment being given.”410 ILCS 210/4

“Any provider who provides counseling to a minor who abuses drugs or alcohol or has a family member who abuses drugs or alcohol shall not inform a minor’s parent, parents, or legal guardian or other responsible adult of a minor’s condition or treatment without the minor’s consent unless that action is, in the person’s judgment, necessary to protect the safety of the minor, a family member, or another individual.” 410 ILCS 210/5

The Alcohol and Drug Abuse Patient Records Confidentiality Regulations give minors expanded rights related to release of confidential information. They state that: “If a minor obtained treatment without parental consent, then minor needs to consent to release of information. If parental consent is needed to obtain treatment, then both parental and minor's consent need to occur before release of information.”

This act also “requires separate and explicit consent for disclosure of drug or alcohol treatment records.”

The Illinois Mental Health and Developmental Disabilities Act states that a minor can have “five outpatient counseling sessions” without parental consent. Sessions are defined as forty-five minutes long. The Consent by Minors to Medical Procedures Act expands the rights of minors over twelve “who may be determined to be an addict, an alcoholic or an intoxicated person or who may have a family member who abuses drugs or alcohol.”

These situations often require social workers to rank order ethical obligations. A procedural standard of care step for rank ordering involves thoroughly examining the reasons in favour of and opposed to each course of action, considering relevant:

  1. ethical theories, principals and guidelines
  2. codes of ethics and legal principles
  3. applicable laws
  4. personal values

An overriding ethical obligation is social workers’ awareness of their own knowledge and skill level related to drug or alcohol–related issues. The expectation is not that social workers be all-knowing or expert in every area. This is impossible. The ethical duty is to be self-aware and honest about our knowledge base, intervention skills, comfort level, and personal values. Personal values are part of every ethical decision we make. They are even more likely to arise in working with minors. Addiction-related issues with this population can be complex and difficult. Seeking appropriate supervision or consultation is an integral part of a procedural standard of care.

FOOTNOTES

Ruth Lipschutz, LCSW, ACSW, is a licensed clinical social worker with postgraduate certification in ethics, mediation, Transformational Imagery, hypnotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). She received her MSW from the University of Illinois in 1978 and went on to complete the two-year postgraduate training program of the Institute for Family Studies at Northwestern University. She has extensive experience in the areas of ethics, mental health, addictions, traumatology, program development and implementation, supervision, consultation and Alternative Dispute Resolution. She is the chairperson of NASW’s National Ethics Committee and has served as a panelist, consultant, mediator, and trainer for the NASW Illinois Chapter Ethics Committee. She is currently in private practice.

Posted on 09/01/11 at 08:18 AM

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