Ethics, Confidentiality, and Legal Issues with Minors
Domain 6: Ethics, Confidentiality, and Legal Issues with Minors
This domain tests the NAADAC/NCC AP Code of Ethics, informed consent, minor confidentiality, 42 CFR Part 2, HIPAA, mandatory reporting, and duty to protect.
Ethical framework
Core principles include autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. Obtain developmentally appropriate assent and informed consent, define the counselor's role and fees, avoid dual relationships, maintain competence, document objectively, and manage social media boundaries.
Confidentiality and minors
Federal 42 CFR Part 2 protects SUD treatment records of federally assisted programs and is stricter than HIPAA; disclosure requires written consent with specified elements, and the 2024 final rule better aligns Part 2 with HIPAA but retains SUD-specific protections. State law governs whether minors can consent to SUD treatment; many states allow it. Parental access is not automatic. Explain limits at intake: imminent danger, suspected abuse or neglect, and court orders.
Mandatory reporting and duty to protect
Report suspected child abuse or neglect under state law. When a client poses serious danger to an identifiable person, follow state duty-to-protect law (Tarasoff), which may require warning, protection, or emergency evaluation.
Worked example
A 16-year-old discloses sexual abuse by an uncle and suicidal ideation with a plan. You make a child protective services report, arrange emergency evaluation, disclose only the minimum necessary, document the actions and rationale, and do not promise secrecy.
Traps that cost marks
- Promising absolute confidentiality.
- Assuming parents automatically receive all records.
- Releasing records on a subpoena without consent or a court order.
- Overlooking 42 CFR Part 2 or state minor-consent law.
- Friend or follower requests on social media.