Academic journal article Journal of Human Services

Self-Injury and Eating Disorders in Minors: When Should the Human Service Professional Break Confidentiality?

Academic journal article Journal of Human Services

Self-Injury and Eating Disorders in Minors: When Should the Human Service Professional Break Confidentiality?

Article excerpt

Human service professionals are responsible to learn, understand, and uphold the ethics of the profession (Milliken & Neukrug, 2009; Neukrug, 2013). The NOHS Code of Ethics provides standards for the human service professional's responsibility to clients, community and society, colleagues, the profession, employers, the self, and the human service educator (Wark, 2010). While the NOHS Ethical Standards serve as a useful guide for practitioners, it is important to recognize that the current ethical standards are now more than 15 years old. Thus, issues that emerged in recent years as relevant to the human service professional may not be included (Neukrug & Milliken, 2009).

Ethical decision making is a critical skill for the human service professional (Corey, Corey, & Callanan, 2011). Keeping client information confidential is a critical ingredient in the client-helper relationship (Neukrug, 2013). However, when one's client is a minor, the issues of confidentiality become even more complex (Isaacs & Stone, 2001). The responsibility to protect client confidentiality is as great as the enormity of breaching confidentiality. Making the decision whether or not to breach confidentiality should not be an easy one; it should cause the human service professional great discomfort (Lavosky, 2008).

While there is no specific ethical decision making guide for human service professionals, researchers in the related fields of social work and counseling have developed ethical decision making tools to assist practitioners in making ethical decisions. For example, Dolgoff, Loewenberg, and Harrington (2005) developed the Ethical Principles Screen. This screening tool is prominent in the field of social work and includes seven principles to consider prior to making an ethical decision. The first principle starts with the protection of life and also considers the principles of Equality and Inequality, Autonomy and Freedom, Least Harm, Quality of Life, Privacy and Confidentiality and Truthfulness and Full Disclosure. Additionally, The Ethical Decision Making Model designed by Corey, et al. (2011) is a commonly used model in the counseling field. This model relies largely on personal values and how the professionals value effect the client. Similar to the Ethical Principles Screen, the model by Corey, et al. (2011) also includes seven steps to consider prior to making an ethical decision. These steps are to (1) Identify the problem; (2) Identify the potential issues involved; (3) Review the relevant ethical guidelines; (4) Know the relevant laws and regulations; (5) Obtain consultation; (6) Consider possible and probable courses of action; (7) List the consequences of the probable courses of action.

A shared commonality in the above models that will be explored in this paper is confidentiality, a critical agreement between the client and the human service professional (Neukrug, 2013). Thus, it is not surprising that the human service professional routinely encounters ethical dilemmas surrounding confidentiality. The issue of confidentiality can be found within the human service professional's responsibility to clients, specifically in Statement 3 and Statement 4 (National Organization of Human Services, 1996):

Statement 3: Human service professionals protect the client's right to privacy and confidentiality except when such confidentiality would cause harm to the client or others, when agency guidelines state otherwise, or under other stated conditions (e.g., local, state, or federal laws). Professionals inform clients of the limits of confidentiality prior to the onset of the helping relationship.

Statement 4: If it is suspected that danger or harm may occur to the client or to others as a result of a client's behavior, the human service professional acts in an appropriate and professional manner to protect the safety of those individuals. This may involve seeking consultation, supervision, and/or breaking the confidentiality of the relationship. …

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