PSS Ethical Problem-Solving and Confidentiality 3 — Questions and Answers
Question 1: Under 42 CFR Part 2, substance use disorder treatment records receive protections that are:
- Identical to standard HIPAA protections
- Weaker than HIPAA because addiction is criminalized
- Stricter than general HIPAA rules and require specific written consent for most disclosures (Correct answer)
- Only applicable in inpatient settings
Correct answer: Stricter than general HIPAA rules and require specific written consent for most disclosures
42 CFR Part 2 imposes more stringent confidentiality requirements on SUD records than standard HIPAA, requiring explicit written consent for nearly all disclosures.
Question 2: A peer specialist receives a subpoena for records related to a person they support. The correct response is to:
- Immediately comply and release all records
- Consult with a supervisor and agency legal counsel before releasing anything (Correct answer)
- Destroy the records to protect the person's privacy
- Inform the person and release only what they verbally approve
Correct answer: Consult with a supervisor and agency legal counsel before releasing anything
A subpoena does not automatically override confidentiality—legal counsel must determine if a valid exception applies before records are released.
Question 3: Dual relationships in peer support are problematic primarily because they:
- Violate labor laws
- Create conflicts of interest that can compromise the support relationship (Correct answer)
- Are prohibited by Medicare billing rules
- Make documentation more complex
Correct answer: Create conflicts of interest that can compromise the support relationship
Dual relationships blur boundaries and can lead to bias, exploitation, or compromised objectivity in the support relationship.
Question 4: A person served by a peer specialist asks the peer specialist to be their Facebook friend. The most ethical response is to:
- Accept to show warmth and reduce stigma
- Accept but set the account to private
- Decline and explain the professional boundary around social media connections (Correct answer)
- Accept but immediately unfriend them after services end
Correct answer: Decline and explain the professional boundary around social media connections
Social media connections with people served create boundary violations by blending personal and professional relationships.
Question 5: A person in peer support says, 'I want to hurt my neighbor who keeps harassing me.' The peer specialist's first priority is to:
- Immediately call 911
- Explore the statement to assess intent, plan, and means (Correct answer)
- Document it and wait for the next scheduled appointment
- Reassure the person and change the subject
Correct answer: Explore the statement to assess intent, plan, and means
Assessing the seriousness of a threat—intent, plan, access to means—must precede any reporting or intervention decision.
Question 6: Which of the following is an example of practicing within the scope of a peer specialist's role?
- Diagnosing a co-occurring disorder based on observed symptoms
- Sharing a personal recovery story to illustrate hope (Correct answer)
- Prescribing a coping strategy as the clinically indicated treatment
- Writing a formal treatment plan
Correct answer: Sharing a personal recovery story to illustrate hope
Using lived experience to inspire hope is a core, in-scope peer support function, unlike clinical assessment or treatment planning.
Question 7: A peer specialist is offered a gift of significant monetary value by a grateful person they support. The ethical action is to:
- Accept it to honor the person's gesture and avoid shame
- Accept it privately but report it to the supervisor later
- Decline politely and explain the agency's gift policy (Correct answer)
- Accept it only if services have formally ended
Correct answer: Decline politely and explain the agency's gift policy
Accepting significant gifts creates boundary violations and potential conflicts of interest, and most agencies have explicit policies prohibiting it.
PSS Ethical Problem-Solving and Confidentiality 3
Under 42 CFR Part 2, substance use disorder treatment records receive protections that are: