Wearing many hats--Ethical dilemmas in education

I had a really rough few days a few weeks ago.  So much so, that I left early because I knew the mental space I was in would not be helpful in my role (I was also not feeling well, so this further compounded the issue).  Fortunately, there have not been many of these instances since I transitioned into the position I have now...but, this one threw me for a loop.

I take the confidentiality of my students and clients very seriously.  Having worked for 10yrs in the community mental health system as an LCMHC, I encountered countless instances of individuals who engaged in Non-Suicidal Self Injurious Behavior (NSSIB) and have become very familiar with suicide risk and screening (to the point that I offer 6hr trainings on the subject).  And in truth because of this high level of exposure, I may be more willing to take on the risk than others, yet it was rare that I ever notified anyone of the behavior aside from documenting it in the clinical note.  Yet, now being in the school environment, I learned the hard lesson that this is not the typical practice.  I had a student engage in NSSIB for the first time a few days prior and this information found its way to the administration.  The school social worker (also a reformed CMHC employee) and I met with the student and determined that there was no imminent risk--the grounds by which we can break confidentiality under our respective licenses (LCMHC and LICSW).  However, our principal was clear that we needed to call home albeit understanding of our ethical disagreement. However, the distinction being that we now both work for a school district...so we needed to consider the ethical guidelines that are associated with our roles not just our licenses which added a layer of complexity neither of us had considered.  In trying to wrap my brain around this notion, I reached out to my professional list serve/former professors and received multiple responses that in fact I did need to call--here is one such reply:

When I read your ethical question, and saw all of the letter after your name, I recognized that you may have several sets of professional responsibilities that you may interact with, some of which may not line up neatly with each other.   Given that, I am only answering this question from the perspective of the professional duties of School Psychologist, via the NASP Standards.     

I saw that you mentioned that the student ‘s NSSI does not place the student in a risk of imminent harm.  Even if the student is not in an imminent risk from the NSSI, it is a symptom of chronic illnesses, which the parent is entitled to know about, so they can make decisions about the student’s healthcare, as well as necessary counseling interventions.  Further the School Psych has a general duty to include parents in discussions about the student’s progress and counseling needs.  See NASP Standard II.3.10 (Below).   

 “Standard II.3.10 School psychologists encourage and promote parental participation in designing interventions for their children. When appropriate, this includes linking interventions between the school and the home, tailoring parental involvement to the skills of the family, and helping parents gain the skills needed to help their children. N School psychologists discuss with parents the recommendations and plans for assisting their children. This discussion takes into account the ethnic/cultural values of the family and includes alternatives that may be available. Subsequent recommendations for program changes or additional services are discussed with parents, including any alternatives that may be available. N Parents are informed of sources of support available at school and in the community” 

Intellectually, I get it...I have to practice within the ethical guidelines and these err on the side of caution and district liability.  But, it still gives me an icky feeling. Some of this is residual from the perspective of previous clinical practice and some is from the reality that if students think I will call home on everything--they won't talk to me or access the support that may get them the assistance they need. This is not to say that I think I should be the only one kids go to or that I can "fix" it all...but, in terms of creating a safe space for the individual to be real with what is going on....and we can talk about the pros/cons of talking with parents--ideally, having the student be the one to do so.

The following evening in one of the courses I teach, a student (who happened to see my post on the listserve as he is a school psych in another district) brought up my ethical dilemma and one of his own pertaining to assessment and learning that a student is under the influence of substances at the time of the evaluation.  This generated a lively discussion about a number of issues related to how school psychologists and school counselors navigate these situations.

I am fortunate to work for the district I do--my principal understood my concern and we came up with a way to call home without going into detail.  He was comfortable with my speaking in generalities about needing support beyond the school--so, in the end I felt okay with how this situation was resolved and am walking away with a renewed appreciation for the ethical quagmire.