michael moyer

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Michael Moyer, Ph.D., and Jeremy Sullivan, Ph.D.,are assistant professors at the University of Texas at San Antonio. Email!Michael.Moyer"utsa.edu

Student Risk-Taking Behaviors:

When Do School CounselorsBreak Confidentiality?

A total of #$% middle and hi&h school counselors from across the United States responded to a survey in 'hich they 'ere as(ed

to determine 'hether they vie' specif ic adolescent ris(ta(in& )ehaviors of varyin& intensi ty, fre*uency, and duration as

'arrantin& parental notification. +esults su&&est that counselors percep tions that it is ethical to )rea( confidentiality andreport the ris(ta(in& )ehaviors increased 'hen the )ehaviors 'ere more intense, more fre*uent, and of lon&er duration. -urther,

althou&h there 'as less am)i&uity re&ardin& the perceived dan&erousness of some )ehaviors e.&., suicidal ideation/, all

)ehaviors sho'ed some variance or disa&reement amon& respon dents 'ith re&ard to their 'illin&ness to )rea( confi dentiality.0mplications and su&&estions for school counselors are considered. School working ents, and counselors with administrators

large have numbers while the daunting of at the students, same task time par- of conforming to one or more ethical codes, abiding

by state laws, and following the guidelines of their local school board. When combined with these compli- cating factors,working with risk-taking students and maintaining confidentiality presents the school counselor with especially challenging

ethical dilemmas (see Bodenhorn, 200!. When is it appropriate for a school counselor to contact parents about risky behaviorsin which their son or daughter is engaging" #o what e$tent do factors such as the fre%uency, intensity, and duration of risk-

taking behaviors impact the counselor&s decision to breach confidentiality" 's there agreement among school counselors

regarding the meaning of clear and imminent danger to the student or others) as described by the *merican +chool ounselor*ssociation (*+*, 200, p. 2!"

+chool counselors are e$pected to respect their clients& right to privacy, but their clients most often are minors, and parentsmay be included in the counseling relationship (edyard, /1!. 'saacs and +tone (/! described confidentiality as the most

difficult ethical issue facing school counselors) (p. 21!. *lthough ethical guidelines have been set forth, many times school

counselors do not agree on when breach of confidentiality is appropriate. 3urther, legal and ethical guidelines sometimes arevague, and rarely offer a clear or ideal solution to ethical challenges (awrence 4 5urpius, 2000!. 6emley and 7erlihy (200/!

argued that the best way for school counselors to defend their ethical decision-making is to act as a reasonable counselor would in

a similar situation.

*lthough helpful, the idea of reasonable counselor) potentially is sub8ect to many interpretations, especially when it comesto breaching confidentiality with students. While research (e.g., 9c:uire, ;arnell, Blau, 4 *bbot, /! suggests that adoles-cents understand there are limits to absolute confidentiality, they value privacy ... and given the choice would typically prefer

more privacy than they believe they will be afforded) (p. guardians to care for their children (+ection B./.a!. +imilarly, 6emley and 7erlihy (200/!

e$plained that students have an ethical right to confidentiality while also noting that parents have a legal right to their child&s

privacy. #hus, minors may have

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the same ethical right to privacy as adults, but parents>guardians have a legal right to know what is discussed during the

counseling relationship (:losoff 4 ;ate, 2002!. :losoff and ;ate described this dilemma as a fundamental conflict) that school

counselors face (p. 22!. 5nowing this, school counselors must consider both their obligation to keep parents informed abouttheir children and the possi- bility of betraying students& trust if they breach confidentiality. * considerable amount of literature

has been written focusing on the legal and ethical responsibilities of school counselors when it comes to responding to the

demands of parents>guardians (=avis 4 9ickelson, /? :losoff 4 ;ate? 'saacs 4 +tone, /? edyard, /1? 9itchell et al.,

2002!. :enerally, if parents re%uest information about a counseling session with their child, a school counselor is e$pected toprovide some type of information in response. 't also should be noted that complete disclosure of specific information is not

re%uired and school counselors are advised to use some discretion in the amount and details of the information provided (orey,orey, 4 allahan, /1? 9itchell et al.!.

C$"#R #ND !&&!N"NT D#N*"R

3ew empirical studies have e$amined the point at which a counselor voluntarily should offer information to parents>guardians

regarding interac- tions between the counselor and student when the parent has not specifically re%uested this information fromthe counselor. +ection *.2.b of the *+* code of ethics states that the school counselor keeps information confidential unless

disclosure is re%uired to prevent clear and imminent danger to the student or others or when legal re%uirements demand that

confidential information be revealed) (*+*, 200, p. /!. 7owever, as 'saacs (/

means free from ambiguity, or free from doubt) and imminent is defined as ready to take place, or hanging threatening over

one&s head.) #hus, clear and imminent danger would mean danger that is without a doubt ready to happen. ounselors&interpretations of this standard and the situations that re%uire them to breach confidentiality because of the duty to warn or duty

to protect may vary based on their own religious beliefs, morals, and>or values ('saacs 4 +tone, /!, in addition to othervariables such as training and years of e$perience.

+R",!OS R"S"#RC. CONC"RN!N* STD"NT R!S/-T#/!N* B".#,!ORS

'saacs and +tone conducted two surveys in which they asked counselors how they handled confidentiality when working with

minors. 'n their first survey, 'saacs and +tone (/! asked counselors to respond to 22 scenarios covering situations such asdrug>alcohol use, physical>se$ual abuse, se$ual ac- tivity, and criminal behaviors. #he authors investi- gated under which

situations counselors would breach confidentiality while at the same time consid- ering students& age and the school level at

which the school counselor was employed. 6esults showed that school counselors& decision to break confidentiality was based onthe perceived degree of dangerousness of the behaviors (e.g., using cocaine was seen as more dangerous than smoking

cigarettes!. #heir sec- ond pro8ect ('saacs 4 +tone, 200/! e$panded on the first, but surveyed mental health counselors regard-+chool counselors ing their feelings about breaching confidentiality. +imilar to their findings with school counselors, 's-fre%uently must aacs and +tone found that mental health counselors also tended to base their decisions on the perceived decide

between dangerousness of the behavior. ounselors also were willing to afford more autonomy to older clients. respecting the

6ae, +ullivan, 6a@o, :eorge, and 6amire@ (2002! conducted a survey with pediatric psychologists, and privacy and found thatrespondents were more likely to perceive it ethical to break confidentiality when risk-taking confidentiality of behaviors such as

smoking, alcohol use, drug use, se$ual behavior, and suicidal behavior were more students while intense, more fre%uent, and oflonger duration. +imilar research e$amining factors such as intensity, responding to the fre%uency, and duration needs to be

conducted with other groups of mental health professionals, such as rights and concerns school counselors, whose ethical

decision-making may vary from other professionals as a function of others. differences in training, work setting, and types ofrisk-taking behaviors encountered in daily practice. 3urther, the study by 6ae et al. did not e$amine other risk-taking behaviors

that may be especially salient for school counselors, such as self-mutilation and antisocial behaviors (e.g., theft and burglary!, and

did not e$amine differences in respondents& perceptions based on age of the student or client. #hus, the purpose of this studywas to investigate the influence of intensity, fre%uency, duration, and type of risk-taking behaviors on school counselors& per-

ceived appropriateness of breaking confidentiality to report the behaviors to parents.

&"T.OD

;articipants * total of 2,000 randomly selected names were re%uested from the *+* national membership

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database, including /,000 names of members describing themselves as high school counselors and /,000 describing themselvesas middle school counselors. #he reason for choosing these two levels and not the elementary level was because the risk-taking

behaviors addressed in our survey seem to be most prevalent among middle and high school students. 3or e$ample, early to mid-

adolescence is a time when recreational drug use usually begins (=ow- eiko, 2002!, as well as self-in8urious behaviors (3roe-schle 4 9oyer, 200? 9oyer 4 Aelson, 200


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to care for their

content was identical across the four forms. #he following vignette is from the female high school formF

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#erry is a /-year-old female who was referred to your office by her teacher for acting out in class, which has gotten much worse

in the last few weeks. #erry is an average student who is involved in several e$tracurricular activities at the school. *s you and

#erry begin to talk she seems somewhat reserved and mentions that she has some concerns about confidentiality. Iou assure#erry that you will only break confidentiality to her parents (or others! if she presents imminent danger to herself or others.

=uring the course of your conversation #erry admits to some risk-taking behaviors.

#his vignette was followed by a set of /1 items (see #able /! in which participants were asked to consider specific risky

behaviors that are unknown to #erry&s parents. Gach item varied in intensity of the specific risky behavior (e.g., number of

cigarettes smoked, amount of alcohol consumption!, in addition to fre%uency and duration of the behavior (i.e., once severalmonths ago, monthly for several months, weekly for several months, nearly daily for the last year!. #he items were designed to

help us discern the importance of intensity and fre%uency> duration of the behaviors in determining whether participants wouldfind it ethical to break confidentiality. ;articipants rated their beliefs about the degree to which it was ethical to break

confidentiality under these conditions using a -point scale ranging from /, un%uestionably not ethical, to , un%uestionably

ethical. * ikert scale was used instead of a binary choice format (i.e., Ies) or Ao)! in order to e$plore the strength of partici-pants& beliefs.

;rocedure 3ollowing approval by the institutional review board, participants were mailed a packet containing the survey, a cover

letter e$plaining the purpose of the study, and a self-addressed, stamped return enve- lope. 9iddle school counselors were sent

the /C- year-old forms, and high school counselors were sent the /-year-old forms. 9ale and female forms were assignedrandomly after the surveys were divided into the middle and high school groups. #his process resulted in /10 surveys completedand returned. *fter this initial round, the survey was for- matted for online distribution using +urvey 9onkey in an attempt to

increase the response rate. *ll of the participants in the sample were then mailed a reminder asking them to either complete the

paper version of the survey, or to access and complete the survey online. #his process resulted in 2 online surveys completed.*cross paper and online versions, all responses were anonymous. hi-s%uare tests and analysis of variance (*AH*! tests

indicated that there were no significant differences (at the p J .0/ level! in terms of participants& demographic charac- teristics

using survey mode as the independent vari- able (i.e., based on whether participants completed the paper or online version of thesurvey!.

R"S$TS

#he distribution of returned surveys was as followsF 9iddle +chool 9ale 3orm (n E C, /.D!, 9iddle +chool 3emale 3orm (n

E 2, 2.D!, 7igh +chool 9ale 3orm (n E duration of the risk- taking behaviors. 'nterestingly, the three items

under the +uicidal Behavior domain (items /C, /, and /! demonstrated the highest means and lowest standard deviations of all

the items, suggesting that these items resulted in the most agreement among participantsF most felt that it was ethical to breakconfidentiality when the student was engaging in suicidal behaviors, even at the lowest levels of intensity and

fre%uency>duration. #he +elf-9utilation, +ubstance Kse, and *ntisocial Behavior items also demonstrated high means,

particularly at the highest levels of fre%uency>duration. 7owever, these items also had high standard deviations, suggesting morevariability (or less agreement! among respondents on whether it was ethical to report these behaviors. With the +e$ual Behavior

and *lcohol domains, participants generally did not believe it was ethical to break confidentiality at low levels of intensity andfre%uency>duration, but ratings of ethicality increased at the higher levels of intensity and fre- %uency>duration. 3inally, with the

+moking Gthical and legal main, respondents were unlikely to find it ethical to break confidentiality even at the highest levels of

obligations do not intensity and fre%uency>duration.Ae$t, overall means and standard deviations were always coincide,computed for each of the seven behavior domains by creating new variables that summed all of the reoftentimes leaving sponses

within each domain. 3or e$ample, with the +moking domain, items /a, /b, /c, /d, 2a, 2b, 2cprofessionals to and 2d weresummed and then divided by the number of items (eight! in order to facilitate interpreta choose the best tion using the -pointikert-type scale. *ll participants& mean scores for the +moking domain were course of action then summed and divided by thenumber of participants in order to calculate the overall mean score while balancing for that domain. #hese descriptive statistics

are provided in #able 2 and serve as the basis for the ne$tethical and legal step of analysis e$amining the influence of severalindependent variables on participants& responses.standards. #able 2 shows that, overall (i.e., when we combined all levels ofintensity and fre%uency>duration within the same behavioral domain!, participants were most likely to believe it ethical to breakconfidentiality to report suicidal behavior, followed by self-mutilation behaviors. ;articipants rated the lowest levels of

ethicality for smoking, se$ual behavior, and alcohol use, suggesting that participants generally did not find it ethical to break

confidentiality for these behaviors under most circumstances. 3urther, consistent with the pattern seen in #able /, the stan- darddeviation for the +uicidal Behavior domain was much lower than the other standard deviations, suggesting much more


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agreement among participants about breaking confidentiality to report suicidal behaviors as compared to the other behaviorsunder study.

We conducted several analyses in order to e$amine the influence of independent variables on differences

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!&+$!C#T!ONS OR SC.OO$ CONS"$ORSBased on the results presented above, the following recommendations are given to school counselors for best preparing

themselves and colleagues to deal with these unavoidable ethical dilemmas. (a! +chool counselors should attend school, district,and statewide pre-service trainings to better familiari@e themselves with ethical codes, state statutes, and district policies. (b!

+chool counselors should consider how their own e$periences, morals, values, and spir- itual beliefs affect how dangerous theyperceive a student&s behavior to be (:losoff 4 ;ate, 2002!. *lthough it may be impossible to completely remove our own values

from the counseling relationship, we can continuously challenge our tenden- cies and perceptions so that we do not impose our

own values on the student (*+*, 200!. (c! +chool counselors should seek consultation with colleagues and>or supervisorsand engage in open dia- logue with others in the school counseling profes- sion discussing the different ethical dilemmas that

each may face. 6eviewing pertinent information with other professionals may be helpful in getting school counselors closer to

identifying how a reasonable counselor) would act in difficult situations. (d! +chool counselors should consider all of the pos-sible ramifications of their disclosure or lack of disclosure. +chool counselors should take into consid- eration both legal and

ethical re%uirements when deciding the best possible course of action.

Kltimately it is the school counselor&s decision to make whether to notify parents>guardians or keep information confidential.

Whichever route is chosen, it is essential to document the decision-making

process including various pieces of information that contributed to the decision. #hese pieces of information may include suchfactors as the age of the student? fre%uency, intensity, and duration of the behavior? the potential impact of the behavior on the

student&s physical health, psychological health, and academic functioning? and the conte$t within which the student reported therisk-taking behavior. #aking the time to document the decision-making process can provide school counselors with some support

should their professional 8udgment be called into %uestion.

CONC$S!ON

#here is a great deal of ambiguity concerning the issue of confidentiality and when or when not to breach that confidentialitywith risk-taking students. #he results of this study show that there was some consensus among school counselors with regard to

breaking confidentiality to report suicidal ideation, but there was much less consensus with the other risk-taking behaviors.

7owever, ethical decisions must be made on a daily basis and the most ambigu- ous or most difficult areas may be the ones that

we are forced to navigate the ma8ority of the time (9illstein, 2000!. 3or e$ample, self-mutilation is becoming a more commonbehavior observed in schools (White 5ress et al., 200!, yet the counselors in our sample didn&t agree on how to respond to this

behavior.

#his study sought to shed some light on the difficult ethical decisions that professional school counselors must make on a

daily basis. 7owever, addi- tional research is needed in this area to offer better guidelines and standards for counselors to follow.3or e$ample, more information is needed to identi- fy factors that contribute to school counselors& decision to break

confidentiality. By understanding the decision-making process and the considerations that school counselors must navigate before

finali@ing a decision, counselor educators and supervisors will be better e%uipped to provide support and direction to newprofessionals.

References American Sc!!" C!#nse"!r Ass!cia$i!n% &2004'%E$ica"

s$an(ar(s f!r sc!!" c!#nse"!rs% A"e)an(ria* +A: A#$!r% ,!(en!rn* N% &200-'% E)."!ra$!r/ s$#(/ !f c!mm!nan( ca""enin e$ica" (i"emmas e).erience( / .r!fessi!na" sc!!" c!#nse"!rs% Pr!fessi!na" Sc!!" C!#nse"in*10* 13202% C!""ins* N%* 5 6n!7"es* A% % &13'% A(!"escen$s9 a$$i$#(es

$!7ar(s c!nfi(en$ia"i$/ e$7een $e sc!!" c!#nse"!r an( $e a(!"escen$ c"ien$%A#s$ra"ian Ps/c!"!is$* 0* 1;182%

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