basics of addiction counseling: ethical & … of addiction counseling: ethical &...
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NAADAC Pre-Conference Workshop
Basics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017
Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Copyright
THE BASICS OFADDICTION COUNSELING
DESK REFERENCEMODULE III: ETHICAL ANDPROFESSIONAL ISSUES INADDICTION COUNSELING,
Eleventh Edition -October 2017
The information presented in this presentation is based on:
Therefore, these presentation slides are property of NAADAC and may not be used without NAADAC written permission.
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Agenda
•NAADAC Code of Ethics--Introduction•Ethical Decision Making•Nine Principles•SAMHSA TAP 21 Addiction Counseling Competencies
•SAMHSA Tools & Practices to Guide Ethical Use of TAC34
•Ethics Links and Resources
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Workshop Objectives
•Workshop Overall Objectives• Present NAADAC 2016 Code of Ethics & SAMHSA
Competencies & Their Relevancy• Review Professional & Ethical Behavior• Provide Tools for Critical Analysis & Ethical
Decision-Making• Provide Resources for Further Professional
Development
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Ethics
•Aspirational Ethics: What is the best – highest level of practice?
•Mandatory Ethics: What does the law, rule, or ethic’s code require of me?
•Positive Ethics: How can I be da support, help, resource?
•Principle Ethics: What should I do?•Value Ethics: Who am I – what do I believe personally?
•Virtue Ethics: Who am I when no one is watching? Who should I be?
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Core Values: Principle/Virtue
•Autonomy•Beneficence•Competence•Conscientious Refusal•Diligence•Discretion•Fidelity•Gratitude•Honesty & Candor
•Justice•Loyalty•Nonmaleficence•Obedience•Restitution•Self-improvement•Self-Interest•Stewardship
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NAADAC 2016 Code of Ethics
•Purpose & Function—Standard of Practice, Assist, & Guide
•Maintain Ethical Professional Practice & Risk Management
•Highlight Emerging Issues & Areas of Concern
•Study Guide for NCC AP’s Credentialing Exams
•Professional Development
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NAADAC Member Expectations
1. Position of trust & responsibility; High quality care; Acts in client’s best interests; Assists clients to help themselves.
2. Adhere to NAADAC Code of Ethics; High level of ethical conduct; Perform competently & consistently.
3. Read and promise to adhere to the code of ethics; Failure to meet ethical standards risks disciplinary action/revocation.
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2016 Code of Ethics--Principles
• Principle I: The Counseling Relationship
• Principle II: Confidentiality & Privileged Communication
• Principle III: Professional Responsibilities & Workplace Standards
• Principle IV: Working in A Culturally-Diverse World
• Principle V: Assessment, Evaluation, & Interpretation
• Principle VI: E-Therapy, E-Supervision, & Social Media
• Principle VII: Supervision & Consultation
• Principle VIII: Resolving Ethical Concerns
• Principle IX: Publication & Communications
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SAMHSA Competencies-TIP 21Four Transdisciplinary Foundations
Transdisciplinary Foundation I: Understanding Addiction
Transdisciplinary Foundation II: Treatment Knowledge
Transdisciplinary Foundation III: Application to Practice
Transdisciplinary Foundation IV: Professional Readiness
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SAMHSA Competencies-TIP 21
Eight Practice DimensionsI: Clinical Evaluation
Screening Assessment
II: Treatment Planning
III: Referral
IV: Service CoordinationImplementing the Treatment PlanConsultingContinuing Assessment & Treatment Planning
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SAMHSA Competencies-TIP 21Eight Practice Dimensions--Continued
V: CounselingIndividual CounselingGroup CounselingCounseling Families, Couples, & Significant Others
VI: Client, Family, & Community Education
VII: Documentation
VIII: Professional & Ethical Responsibilities
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Ethics Links & ResourcesNAADAC, the Association for Addiction Professionals http://www.naadac.org
https://www.store.samhsa.gov/product/TIP-21-Combining-Alcohol-and-Other-Drug-Abuse-Treatment-With-Diversion-for-Juveniles-in-the-Justice-System/SMA09-4073
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Ethical Decision Making
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017
Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Comprehensive Decision-Making Process
1. Identify and define the problem.
2.Review the NAADAC Code of Ethics to determine which Principles are applicable.
3.Consult with a supervisor or experienced colleague.
4.Determine if there are any potential legal concerns, and if consultation with an attorney is warranted.
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Comprehensive Decision-Making Process
5. Identify all potential courses of action and their potential consequences.
6.Decide on a specific course of action.
7. Implement the course of action. Document the entire situation appropriately.
8.Reflect on the outcome of the course of action. Make adjustments if needed.
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Three Key Attributes
• Commitment: the desire to do the right thing, regardless of the cost;
• Competency: the ability to collect and evaluate information, develop alternatives, and foresee potential consequences and risks; and
• Consciousness: the awareness to act mindfully and consistently, applying moral convictions to behavior.
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Important Elements
Best Decisions:
Are ethical and effective
Accomplish desired outcomes
Promote professionalism
Meet short-term and long-term goals
Remembers the client is the main concern
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Case Example
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Case Evaluation
What is wrong with this picture?
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Principle I: The Counseling Relationship
September 22, 2017
Dr. Deborah Fenton-NicholsEdD, LPC, LAC, NCC
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
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Principle I Ethics Base
• Principle Ethics–Autonomy–Fidelity
• Virtue Ethics–Loyalty
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Informed Consent/Mandatory Disclosure• Before services begin
– Informed consent process– Orally– In writing (translations if needed)– Signatures of client and provider – Client copy and file copy
• Reminders of informed consent– After detox– Crisis– Elements arising in session– Cognitive challenges
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Informed Consent Elements
• Names of agency & providers with roles in treatment
• Provider(s) scope of competence – Education/Training– Qualifications/Credentials– Specialty areas
• Specifics of services offered• Nature/Effectiveness• Referral & Termination policies• Where, duration, and limits of services
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Informed Consent Elements—Continued • Privileged & confidential limits/breaches
• Duty to warn rules
• Conflicts of interest
• Access to all relevant ethics codes
• Parameters of documentation storage and time requirements
• Client expectations/consequences
• Social media boundaries/risks
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Informed Consent Elements—Continued
• Cancellation policy/missed appointments
• Service costs
• Nonpayment policies and procedures
• Insurance use/denial
• Information for filing grievances
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Counseling Relationship Services
• Right to language/medium of primary language
• Alternate arrangement – English proficiency
• Check understanding of the client
• Willing to change/not change
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SMART Goals—Treatment Plan
• Specific• Measurable• Attainable• Realistic• Timely
Collaboratively with client
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Clinician Alertness
• Value conflicts
• Transference/countertransference
• Supervision/consultation
• No romantic or sexual relationships– Once a client—always a client.
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Dual (Multiple) Relationships• Discussed openly
• Professional not casual/personal
• No financial/material gain
• Will not exploit clients
• Seek supervision before attending social gatherings. Boundary extensions• Document decision & therapeutic
rationale
• Rules for social media
• Providers do not “friend” clients.
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Responsibilities & Rights
• Provider to inform client of any change to role
• Client has right to refuse service due to provider role change
• Provider responsible to manage and maintain counseling relationship• Communicate nature of professional
relationship
• Inform client of rights to autonomy
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Professional Loyalties
• Maybe in conflict with client welfare
• Clearly define the client
• Communicate role & obligations to all parties prior to informed consent.
• Advocate for clients
• Know agency policies• Self-referrals, fee splitting, fees, termination
• Not abandoned or neglected
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Documentation• Record or file containing all documents
related to the client.
• Complete in timely manner
• Changes require dates and signatures
• Meet agency, state & federal rules and regulations
• Safety and confidentiality maintained
• Cloud-storage: BBA—Business associate agreement
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The Counseling Relationship
Case example
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Principle II: Confidentiality & Privileged Communication
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional IssuesSeptember 22, 2017
Dr. Deborah Fenton-Nichols EdD, LPC, LAC, NCC
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• Principle EthicsBeneficence
• Virtue EthicsDiscretionLoyalty
Principle II Ethics Base
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• The “assurance that information will be kept secret, with access limited to only appropriate persons.”
• General Rule• “Do not disclose any information
concerning a client, to anyone, without their written consent.”
Confidentiality
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2
3
Facility Services1
Support Groups
Self-Help Groups
Do Not Confirm or Deny Enrollment In:
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2
3
4
Spouse1
Third-Party Payor
Courts
Treatment Team Members
Requires client written consent & only pertinent information is to be disclosed.
Do Not Reveal Session Contents To:
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“Legal recognition of a private, protected
relationship where information disclosed
between the two parties (Provider and
client(s))—with a few exceptions—remains
confidential and cannot be forcibly disclosed
by the legal system” (p. 57-58).
Privileged Communication
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“The client’s right to be selective about
what information is released and what
information is kept confidential” (p. 58).
Privacy
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Nine Exceptions: Confidentiality & Privacy
1. Clear & Imminent Danger
2. Suspected Child or Elder
Abuse/Neglect3. Consultation
4. Medical Emergency
5. EthicalGrievance Filed
6. Attorney Consultation
7. CrimePremises/Staff
8. Insurance “Need to Know”
9. Written Consent-Legal
Guardian
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Building Blocks for Trust
Transparency Engagement
Genuineness Connection
Privileged Communication
Maintaining Confidentiality
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Recognize Importance of Being:
Informed consentServices
Termination & Referral
Culturally-sensitiveCulturally-informed
Culturally-appropriate
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• 42 CFR Part 2• Providers: Federally-funded or –assisted
programs• Four possible disclosures w/o client
consent• Medical emergencies• Research activities• Court order• Audit & evaluation activities
Federal Confidentiality Act
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• Disclosure cannot be made on any consent where:• Consent has expired• Fails to conform to required elements• Known to have been revoked• Materially false: known or reasonable diligence
• Repeat disclosure requires client’s express consent.
42 CFR Part 2—Cont.
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• Health Information Portability and Accountability Act of 1996• Privacy rights & protections—health
information• Use & disclosure• All devices & storage to be secure
HIPAA
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• State & federal laws and professional ethic codes
• Virtual private network (VPN)• Multi passcodes• Encryption• Data security• Media sanitization
Data Safeguards
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• Fax is more secure than email• Email requires secure, encrypted
server• Clients right to refuse mode of
transmission
Data Transmission
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Appropriate Client Records• Protects provider/agency
• Malpractice & indictments of negligence
• Protects client
• Provider & treatment accountability
• Documents client treatment
• Records supervision/consultation
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Record Recommendations
• Legible & in written ink (no whiteout)
• Dates & type of service
• DAP or SOAP note format
• Clearly distinguish objective data from subjective interpretations.
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Record Recommendations
• Provider signature, date, and credentials for each entry
• Medication dispensing meet federal & state laws
• Maintain for period stipulated by federal or state law or contract – whichever is longest (7 years)
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Case example
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References• http://www.naadac.org/assets/1959/16ak_heyman-
layne_hipaa_and_42_cfr_ppt.pdf
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Principle III: Professional Responsibilities& Workplace Standards
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017 Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Principle III Ethics Base
• Principle ethics – Beneficence – Nonmaleficence
• Virtue ethics – Justice – Loyalty
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Definitions
• Integrity: Being honest, decent, moral, fair, virtuous, truthful, congruent, genuine, principled
• Discrimination: Unjust & biased treatment due to race, ethnicity, age, gender identity, sexual orientation, drugs used & abused, addictive behaviors, mental health disorders.
• Microaggression: Casual degradation of a marginalized group.
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Definitions—Continued
• Covert racism: Racial discrimination disguised and subtle
• Fraud: Wrongful or criminal deception for financial or personal gain.
• Advocacy: Act or process of supporting a cause, idea, or proposal
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Client Rights
• Respect• Empathy• Best treatment available• Qualified & competent provider• Own beliefs, values and attitudes
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Definitions
• Scope of Practice (Boundaries of Competence): Gained through education, training, skills development, & supervised experience.
• Standards of Practice: Industry expectations and standards
• Multidisciplinary Care: A team of professionals from a range of disciplines collaborating delivery of care and outcomes for clients
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Definitions—Continued
• Dual Relationships: Where multiple roles (professional & personal) exist between Provider and client.
• Impairment: Loss of any normal functioning physiologically, socially, psychologically and/or emotionally.
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Building Scope of Practice
• Professional organizations• Conferences• Webinars• Educational & specialized training• Supervision/Consultation
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Providers Will…
• Seek supervision, consultation & training to increase multicultural knowledge
• Obtain supervision & consultation from person with extensive experience
• Obtain client written informed consent for new techniques, tools or treatment modalities prior to use
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Providers Will…
• Engage in evidence-based, research-driven activities supported by outcome data
• Offer sliding-scale or pro bono services• Engage in healthy self-care reducing burn-
out and aid in the provision of the highest level of care
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Definitions
• Transference: Where the client is redirecting feelings to others on to the Provider.
• Countertransference: Where the Provider reacts to the client’s transference by directing feelings toward the client.
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When in doubt, seek supervision or consultation.
• Continually monitor themselves for issues needing to be addressed
• When impaired, Provider is expected to limit, suspend, or terminate professional responsibilities
Providers Will…
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Providers Will…• Correct errors in credentials, education,
practice, and products• Arrange for an identified colleague or
records custodian in writing and outlined in the Provider’s Will in the event:– Provider retires– Is incapacitated– Or dies
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Principle IV: Working In A Culturally Diverse WorldNAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017
Dr. Deborah Fenton-NicholsEdD, LPC, LAC, NCC
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Culture
• The sum of attitudes, customs, beliefs, and history that distinguishes one group of people from another.
• Is transmitted through language, objects, art, ritual and institutions from one generation to the next.
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Cultural Diversity & Competency
• Diversity is cultural variety and differences existing in:–An organization, institution,
practice, community, nation, world
• Competency implies Providers function with thorough knowledge of customs and beliefs of another culture.
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Humility
• Provider’s willingness to accurately assess:–Oneself & one’s limitations–Gaps in knowledge–Openness to new ideas–Contradictory information &
advice—without stereotyping or bias
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Cultural Humility & Sensitivity
• “Cultural humility is a life-long practice of self-reflection and self-critique that empowers the Provider to actively engage in interpersonal relationships that are dynamically diverse and mutually respectful” (p. 81).
• “Cultural sensitivity is the Provider’s willingness to adapt his/her behavior and communication to be compatible with a client’s cultural norms” (p. 81).
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Multicultural Development
• CEU• NAADAC• Professional conferences• Academically-rigorous professional
websites• TED Talks• Webinars & podcasts• Professional literature• Culturally-experiential activities
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Multicultural Treatment• Match client needs with Provider
competency• Appropriate referrals to meet client
needs• Modify behaviors to be culturally
appropriate– Professional distancing– Self-disclosure– Non-erotic touch, hugs– Meeting outside of the office– Accepting gifts– Incorporating traditional spiritual
/healing activities
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Multicultural Treatment—Cont.
• Use culturally appropriate assessment and diagnostic tools. Adjust as needed.
• Deliver information in a developmentally and culturally appropriate manner.
• Translation, interpretation & other services as needed
• Problems are defined and described through cultural lens
• DSM-5 Cultural Formulation Interview• Address potential barriers & obstacles to
treatment services.
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Professional Responsibilities& Cultural Diversity
Case example
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Principle V: Assessment, Evaluation & Interpretation
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017
Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Assessment
• Culturally sensitive & appropriate • Linguistically-appropriate• Validity• Reliability• Administer as standardized• Sufficient empirical data• Integrity & Security of assessments• “Do No Harm”
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Evaluation, Interpretation,& Diagnoses• Accurate• Culturally sensitive• Encompass more than one instrument
and clinical interview• Proper Releases of Information• Cultural Context• Aware of and mitigate Provider biases• Client’s mental capacity• Sharing diagnosis with client
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Forensic Evaluations• Objective findings• Accurate report of findings• Based on professional knowledge,
research, expertise, and supported by data.
• Clients informed in writing– Nature– Purpose– Who will see the results– Not therapy
• Court ordered evaluation can be done without client consent.
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Principle VI: e-Therapy,
e-Supervision & Social Media
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical
& Professional Issues
September 22, 2017
Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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e-Therapy
• e-Therapy: telemental health, telepsychology, telepsychiatry, & telebehavioral health
• Use of technology (online, telephone) to provide services.
• Synchronous delivery: live real time, face to face
• Asynchronous delivery: emails, distant site, not live in the moment
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e-Therapy
• Text messaging—synchronous or asynchronous
• Mobile devices—computers, tablets, mobile phones & smart phones
• “app”—application or software run on technology devices
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Technology-Assisted Care (TAC)
2
3
4
Individuals1
Couples
Groups
Families
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• Increased access of care
• Reduces travel time and costs
• Improves satisfaction with SUD, ABD, & MH system
• Enables continuity of care
Evidence-Based TAC Benefits
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• Reduces delays initiating services
• Serves diverse group with similar presenting concerns
• Greater alignment with telehealth
• Reducing stigma
Evidence-Based TAC Benefits
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• Telephone-based services
• Email-based services
• Chat-based services
• Video-based services
• Social Network-based services
• Self-directed, technology-based therapeutic tools
TAC Delivery Options
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• Ensure electronic means are within regulatory standards
• Are located, certified/credentialed in the client’s state of residence
• Will document all relevant laws & regulations
• Will use encryption software & VPN servers
TAC Providers
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• Provide a separate e-therapy/technology informed consent
• Communicate risks & benefits to client
• Maintain a secured backup system with its own encryption security.
• Screen potential clients for appropriateness.
TAC Providers
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• Knowledge
• Skills
• AttitudesSAMHSA (2015). TIP 60: Using Technology-Based Therapeutic Tools
in Behavioral Health Services. Rockville, MD: Center for Substance Abuse Treatment. p. 105.
Clinical supervision/e-supervision require a distinct set of competencies.
Technological Competencies
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• Will ensure client ID
• Establish codes for continued identification
• Establish emergency services in client area
• Discuss confidentiality
• Use cultural sensitivity
• Discuss safety & location of any documentation
TAC Providers
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Social Media
• Professional from Private• Communicate boundaries in detail• Use with active and former clients• Discuss risks• Viewing client’s social media pages
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Electronic Health Records (EHR)
Recordkeeping
Quality of Client Care
Patient Transitions Across Providers
Outcome Reporting
EHRs are intended to improve:
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EHR Benefits
• Access to client records remotely• Alerts regarding lab results• Alters regarding medication errors• Reminders specific to preventative care• Provide care meeting clinical guidelines• Facilitate direct communication between
Provider and Client• Enhance overall patient care
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Evaluation & e-Therapy
Case example
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Do you haveany questions? ??
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Principle VII: Supervision & Consultation
Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Clinical Supervision
• Function–Monitoring and training– Job satisfaction–Treatment outcomes–Counselor wellness
• Relationship and Intervention–Observation, evaluation, & feedback– Instruction, modeling, & mutual problem-
solving–Competent manner, ethical standards,
legal prescriptions, & professional practices
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Clinical Supervisor Roles
• Teacher• Sounding board• Mentor• Evaluator• Problem-solver• Empower-er
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The Relationship
• Professional, formal, hierarchical, & evaluative
• Extends over a specified length of time
• Enhances professional growth, development, and functioning of the junior member
• Monitors the quality of services provided
• Ongoing gatekeeping responsibility
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Clinical Supervision Goals
• Promote professional & ethical growth and development of junior member.
• Protect the welfare of clients.• Monitor performance of the junior
member.• Empower the junior member to
“self-supervise”.
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Cognitive & Behavioral Change
• Provided–Comprehensive plan of action–Management support–Effective mentoring & leadership– Invested for a sufficient period of
effort
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Clinical Supervision &Addiction Counseling
• Parallel Process–Strong supervisory = Strong
clinical relationships–Supervisory relationship parallels
clinical relationship–Supervisee’s interactions with
supervisors parallel supervisee’s interactions with clients
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Clinical Supervisors…
• Are culturally sensitive• Clarify relationship boundaries• Actively listen• Do not stereotype supervisees.• Recognize confidence and power
differentials• Self-aware of own identity & biases• Teach to supervisee’s strengths• Create a collaborative environment
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Clinical Supervisors…
• Are gatekeepers of addiction & mental health counseling profession
• Uphold highest standards for clinical service delivery
• Acts as a role model• Has awareness and responds to
ethical concerns—timely & prudent manner
• Teach principles of ethical decision-making
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Five Primary Ethical Issues
• Vicarious liability: liability to the supervisor due to supervisee’s actions or lack of action
• Dual relationships and boundary management
• Informed consent• Confidentiality & appropriate
releases• Duty to warn
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Supervisee’s 3 Levels Include
• Overview of Stage• Self-Other Awareness• Motivation• Autonomy
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Level 1
• Limited training or experience• High levels of self-focus• Little self-evaluation• Anxiety related to supervisor evaluation• Concern: “Doing it right”• Motivation & anxiety are focused on
acquisition of skills• Wants to know the “correct” approach• Very dependent upon supervisor• Requires high levels of structure• Need positive reinforcement• Unable to tolerate direct confrontation
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Level 2
• Transitioning from high levels of dependence & imitative forms
• Beginning to respond to highly structured supervisory practices
• Increased ability to focus on client & exhibit empathy
• Still struggles to balance focus on self & client• May become confused & enmeshed with client• Fluctuates high levels of confidence, feelings of
incompetence, and confusion• Vacillates between autonomy & dependence
(resistance)
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Level 3
• Developing personal approach to counseling• Understands & utilizes “self” in therapy• Greater level of self-awareness• Ability to focused on client while attending to
personal reactions & responses to client• Motivation is consistent as confidence
increases• May still exhibit some self-doubt but less
impactful• Solid belief in own judgment and skills• Supervision becomes more like consultation
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Level 3i: Integrated
• Supervisee has reached Level 3 across multiple domains
• Personal style of counseling has emerged• Demonstrates high levels of awareness
regarding personal competency
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Clinical Supervision
• Conducted on a regular basis• Face to face or using electronic
formats • Supervision Contract• Individual or group• Group 6 supervisees/ 4 preferred• Administrative supervisor providing
clinical supervision discusses dual relationship keeping roles separate.
• Peer supervision: nonhierarchical
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Supervisees…
• Provide clients with supervisory information on the mandatory disclosure statement
• Discuss requirements/limits of confidentiality
• Disclose frequency and modality
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Supervisors…• Do not counsel friends or family.• Do not have intimate relationships
with supervisees.• Do not engage in sexual
harassment activities against a supervisee.
• Is knowledgeable of technology requirements and competencies necessary for supervision when conducting e-supervision.SAMHSA (2015). TIP 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services. Rockville, MD: Center for Substance Abuse Treatment. p. 132
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Supervision Is Sought…• Rural area dual relationships• Concerns regarding viability of the
counseling relationship• Discuss termination/referral• To help determine area of
competency • Encouraged for all Providers to
provide ongoing feedback regarding knowledge, skills, & areas of competence
• And documented as well as trainings and credentials
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Administrative Supervision
• Assessing client, clinician, & staff needs• Scheduling & planning
agency/clinician/staff workflow, and human resources needs
• Tracking activities• Applying for grants & other sources of
funding, and monitoring funding compliance
• Scheduling clinician & staff vacations and other time off
• Managing the office/agency
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Consultation
• Collaborative problem-solving process• Clinician engages a subject-matter expert• Advancing appropriate, ethical, & legal
care to a specific client• Act or not act on received advice• Consultation is between two peers in non-
hierarchical relationship
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Supervision
Case example
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Principle VIII: Resolving Ethical Concerns
NAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017
Dr. Deborah Fenton-Nichols EdD, LPC, LAC, NCC
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NAADAC’S 10-Step Ethical Decision Making Model:1. Identify ethical dilemma and/or legal
issues (nature & dimensions)2. Apply the NAADAC Code of Ethics &
applicable laws.3. Consult with clinical supervisor,
consultant-expert, or experienced colleague. Determine potential legal concerns (consult with attorney)
4. Generate list of all potential courses of action & solutions.
5. Evaluate each option for potential consequences (beneficial & detrimental)
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NAADAC’S 10-Step Ethical Decision Making Model:6. Implement the chosen course(s) of
action.7. Document the entire situation, including
this ethical decision-making activity8. Analyze the implementation of the chosen
course(s) of action.9. Reflect on the outcome(s) of the course
of action. Make adjustment if needed.10.Re-assess if implementation was not
successful, and begin decision-making process again.
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Ethical Decision-Making• Use NAADAC 10-Step Process
– For questionable & concerning situations & problems
– To demonstrate intent to act ethically, legally, & professionally responsible through documentation & consistent use.
– Earlier in career provides more protection from future legal & ethical claims
– Is intentional risk management cornerstone & underscores desire for excellent clinical care by protecting the client(s), Provider(s), agency, community, & profession
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Ethical Decision-Making
•Case example
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Principle IX: Publication & CommunicationNAADAC Pre-Conference WorkshopBasics of Addiction Counseling: Ethical & Professional Issues
September 22, 2017 Dr. Deborah Fenton-Nichols, EdD, LPC, LAC, NCC
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Increasing
• Advancements• Articles• Books• Presentations• Contributions to knowledge base
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Findings & Facts• Obligation to present oral or
written findings/facts in an ethical & professional manner
• Providers, researchers, scientists, & organizations have research & publication obligations & responsibilities– Planning, designing, conducting, &
reporting findings• Published consistent with relevant
ethical principles, laws, institutional regulations, & pertinent scientific standards
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Credit for Material Published• Addiction-related materials to
whom it is due• Providers do not take credit for
material they did not participate in developing.
• Providers do not present ideas, formulations, practices and/or research of others.
• Ethical providers always give appropriate credit to the originators in written & spoken communications
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Credit for Material Published• It is unethical to deny credit to
those who provide assistance.– Editing, typing, background research,
joint authorship• Authors positions determined by
size of contribution in descending order.
• Addiction professionals must never use any copyrighted material without permission for the author.– Materials can never be reproduced for
profit, regardless of the educational purpose.