Professional Practice and Ethics: Scope, Boundaries, and Confidentiality
The code is your decision tree
Ethical practice rests on the profession's code of ethical responsibility plus familiar principles: beneficence, nonmaleficence, autonomy, justice, fidelity, and veracity. Questions often test whether you can name the principle at stake and the correct first action-usually consult your supervisor and follow organizational policy before improvising.
Scope of practice. Know where your competence ends. Providing psychotherapy, diagnosing, giving medical advice, or interpreting results is outside child life scope; the correct move is referral and collaboration. Practicing outside scope-even with good intentions-is the most common ethical error in exam items.
Confidentiality. HIPAA and institutional policy govern what you share. Discussing a patient in an elevator, hallway, cafeteria, or on social media is a violation even when no name is used, if the person is identifiable. In team settings, share only what is needed for care.
Boundaries. Dual relationships, befriending families, extensive personal disclosures, and accepting gifts raise concern. Small tokens may be acceptable under policy; the defensible answer is sensitive refusal or policy consultation when a gift is significant or creates obligation.
Secrets and assent. Never promise secrecy. Tell children and adolescents up front the limits of confidentiality, and obtain developmentally appropriate assent for interventions while caregivers provide consent.
Also in scope: mandatory reporting, accurate and timely documentation, cultural humility, continuing education, supervision, research ethics, and self-care for compassion fatigue.
Rule of thumb: if you are unsure, slow down, consult, and document your reasoning-never act alone on an ethical gray area.
Worked example: A 15-year-old discloses self-harm thoughts and asks you to tell no one. You had already explained the limits of confidentiality. You acknowledge feelings, stay with the youth, and share the safety concern with the team per policy-rather than holding the secret or dismissing it.