You run a community violence prevention program, working with young people who have experience with gangs or the justice system. The young people trust you, and sometimes share sensitive information with you. Law enforcement also knows about your work and may ask you for information about particular participants. What information are you obligated to share, and what are you obligated to keep confidential? The right of a person to understand what happens to information they share in the course of a community intervention falls under the heading of ethics. A participant in a community program -- a health clinic, an adult literacy class, a youth leadership initiative -- has a right to certain expectations about how they and the information they share are treated. The community also has expectations about the reliability, competence, honesty, and accountability of programs that serve community members. In this section, we'll discuss some of those expectations and the ethical and legal responsibilities that may apply to your organization or initiative. What do we mean by ethics? Ethics refers to principles and standards that guide decisions about what is right, fair, responsible, and respectful. Although ethical decisions can vary depending on circumstances, cultures, professions, and laws, community interventions generally share several guiding principles: Do no harm. Hippocrates put this principle into words more than 2,000 years ago, and it remains a fundamental ethical consideration. Sometimes, doing no harm can mean reconsidering whether a particular community intervention should be started at all. As John McKnight argues in The Careless Society: Community and Its Counterfeits, well-intended services can sometimes overlook people's strengths, relationships, economic circumstances, or connection to community life. Before beginning an intervention, it may be helpful to ask questions such as: Could the proposed service have unintended negative effects for the people it is intended to support? How might this service interact with other programs, systems, or requirements already affecting participants? Could an approach that builds on people's strengths, capacities, and community assets be more effective than one focused primarily on needs or deficits? Could some of the resources proposed for the service be used more effectively through direct financial or material support? Would greater inclusion in community life be more beneficial than separating people into specialized services or settings? Respect people as ends, not means: Treat each person as an individual with dignity, rights, strengths, and goals -- not simply as a number in a political, social, organizational, or clinical calculation. Respect participants' ability to help determine what they need. Don't assume that professional staff or program planners necessarily know what's best for an individual or community. People with lived experience should have meaningful opportunities to shape decisions that affect them. Respect everyone's human, civil, and legal rights. This includes non-discrimination, accessibility, cultural responsiveness, privacy, autonomy, and equitable treatment. Seek outcomes that are fair and beneficial under the circumstances. You may not be able to meet every person's needs in every situation, but decisions should consider the well-being, rights, and perspectives of everyone affected. This is a valuable guideline, but it can also be difficult to apply. Different people may have competing needs, values, rights, or interests, and there may be no outcome that benefits everyone equally. Ethical decision-making often requires weighing these considerations carefully, consulting the people affected, and being transparent about how decisions are made. Don't misuse your position or exploit a participant for personal advantage or power. This includes taking advantage of participants or others for political, social, sexual, professional, or financial gain. Don't attempt an intervention in areas in which you're not appropriately trained or competent. This principle goes along with "do no harm." Community organizations sometimes operate in settings with limited resources, but staff should recognize the limits of their expertise, seek appropriate supervision or consultation, make referrals when necessary, and avoid taking on responsibilities that create unreasonable risks for participants. Actively strive to improve, to the extent possible, the circumstances of participants and the community. This means providing effective and responsive services, listening to participants, strengthening community assets, and addressing underlying conditions that contribute to the issues the intervention is intended to address. This last point raises a larger ethical question. If you are actively trying to contribute to positive change, how far does that responsibility extend? If other issues affecting the community fall outside your organization's mission, should you become involved? What if you don't fully understand the situation, or your involvement could create unintended harm? What if taking a public position could affect participants, staff, partnerships, or the sustainability of your intervention? These are difficult questions, and there may not be one correct answer. What matters is recognizing that these tensions exist and developing thoughtful ways to consider them when they arise. Why is ethical behavior important in community interventions? In addition to being the right thing to do, consistent ethical behavior can strengthen your program. It can improve effectiveness, build trust and credibility in the community, support responsible leadership, and help your organization remain in good professional and legal standing. Program effectiveness. Consistent ethical behavior can contribute to a more effective program. Considering ethical principles in all aspects of a community intervention can lead to more respectful, responsive, and community-centered methods and can strengthen participation, relationships, and community support. Standing in the community. An organization with a reputation for ethical behavior is more likely to earn trust from participants, partners, and the broader community. That trust can make it easier to recruit staff, volunteers, Board members, partners, and participants and to build public and financial support. Ethical credibility and leadership. If your work is intended to promote social change, social justice, reduce suffering, foster human dignity, or provide needed services, your organization's actions should reflect those values. Ethical conduct helps ensure that your practices are consistent with your mission and strengthens your credibility when advocating for change. Professional and legal issues. Many health, legal, education, mental health, social service, and other professionals involved in community interventions are governed by professional codes of ethics, certification requirements, licensing rules, and laws. Professional associations and licensing bodies may establish standards related to confidentiality, informed consent, professional boundaries, competence, recordkeeping, conflicts of interest, and other areas. Serious violations of professional responsibilities can result in disciplinary action, suspension or loss of a professional license, employment consequences, civil liability, or, in some circumstances, criminal penalties. People working in regulated professions are responsible for understanding the ethical standards, laws, organizational policies, and professional requirements that apply to their work. Legal and ethical responsibilities frequently overlap, but they are not always identical. Organizations should have clear policies and access to appropriate professional or legal consultation when difficult questions arise. Who is subject to a code of ethics in community interventions? The short answer is that everyone who works in a community program or interacts with people in a professional or service role has ethical responsibilities. Some people are also subject to formal professional codes, licensing requirements, organizational policies, or legal obligations. Here are some examples of people who may be expected to follow formal ethical or professional standards: Medical and health care professionals, such as physicians, nurses, emergency medical personnel, and other licensed or regulated health practitioners Mental health professionals, such as psychiatrists, psychologists, therapists, and counselors Social workers Clergy and other faith leaders Public officials Educators Youth workers People who work with children and young people, including child welfare professionals Lawyers and paralegals Mediators Administrators of community programs and sponsoring organizations Direct-service and support staff, such as home health aides and staff at residential programs or shelters Depending on the jurisdiction and professional role, some of these people may be considered mandated reporters. Mandated reporters may be legally required to report suspected child abuse or neglect, and in some jurisdictions may have other reporting obligations. Because requirements vary, organizations and staff should understand the laws and policies that apply to their roles. We'll return to the implications of mandated reporting later in this section. What are the ethical issues that need to be considered, and how do they play out in community interventions? Ethical behavior in community interventions relates to the treatment of people, information, resources, and money, as well as to the actions of staff and organizations even when they are not dealing directly with participants. Not every issue below is governed by the same laws or professional codes in every setting, but all are important considerations for community programs. Confidentiality One of the most familiar ethical issues is the expectation that personal information shared by participants in the course of a community intervention or program -- including conversations, records, notes, assessments, test results, and other information -- will be handled responsibly and protected from inappropriate disclosure. Legal responsibilities vary by program, profession, type of information, and jurisdiction, so organizations should have clear confidentiality policies that reflect applicable law and professional standards. Confidentiality protects participants' privacy and can help establish trust between participants and the program. Depending upon the program, the staff member's role, and applicable requirements, confidentiality may take several forms: Only staff members who need particular information for an appropriate program purpose have access to it, unless the participant has authorized broader disclosure. Paper and electronic records should be stored securely and protected from unauthorized access. There may be circumstances in which confidentiality is limited by law, professional ethics, or program policy. Depending on the situation and jurisdiction, these may include mandated reporting requirements, serious concerns about imminent harm, certain court orders or legal processes, or information sharing authorized by the participant. Staff should not have to make these decisions alone. Programs should establish clear confidentiality and recordkeeping policies, provide training, and identify who staff should consult when a difficult situation arises. When legal obligations are uncertain, the organization may need qualified legal or professional guidance. Exceptions to confidentiality should be explained to participants at the beginning of their involvement in the program whenever possible. Participants should understand what information will be protected, what may be shared, with whom, and under what circumstances. Information may be confidential within a program but shared among appropriate staff members when necessary for consultation, supervision, coordination, or service delivery. Staff should share only the information needed for the purpose and follow applicable privacy requirements. Educational records may also be subject to specific privacy protections. In the United States, for example, the Family Educational Rights and Privacy Act (FERPA) establishes rights and requirements related to many student education records. Programs connected to educational institutions should understand which privacy rules apply to them. Information may sometimes be shared with another program or organization when coordination is appropriate and the participant has given valid authorization, or when another lawful basis for sharing exists. Programs should clearly explain what information will be shared, with whom, for what purpose, and for how long the authorization applies. Funders may request information documenting services, participation, or outcomes. Programs should anticipate these requirements before making promises of confidentiality and should provide only the information that is necessary and permitted. Whenever possible, reports should use aggregate or appropriately de-identified information rather than personally identifiable participant records. Privacy concerns may be especially important for participants whose immigration status, health information, legal involvement, sexual orientation or gender identity, experiences of violence, or other personal circumstances could place them at risk if disclosed. Organizations should be transparent about what information they collect, why they collect it, how it is stored, and when it might be shared. Some programs cannot offer complete confidentiality. Participation may be court-ordered, required by another agency, or subject to reporting requirements. In these circumstances, participants should still receive clear information about what will remain private and what may be disclosed. In all circumstances, ethical treatment of participants requires transparency about confidentiality. People should receive understandable information about the program's privacy practices and any limits on confidentiality so they can make informed decisions whenever they have a choice about participation. Consent There are several forms of consent relevant to community interventions: consent to share records or information; informed consent for services, treatment, research, or program conditions; and questions about community participation and acceptance when an intervention is introduced into a neighborhood or community. Consent to sharing of information. When participant information is protected, sharing it with another organization or person generally requires an appropriate legal or ethical basis. When participant authorization is required, the person should understand what information will be shared, with whom, for what purpose, and for how long. Informed consent for services, treatment, research, or program conditions. Ethical practice requires that people receive understandable information about what they are being asked to participate in, what the potential benefits and risks are, what alternatives may exist, what is expected of them, and what rights they have. Participants should have meaningful opportunities to ask questions before making a decision. In health care, informed consent generally involves discussing the recommended treatment or procedure, its purpose, potential risks and benefits, alternatives, and the option to decline when legally permitted. The specific requirements depend on the situation and applicable law. In research, participants generally need clear information about the purpose of the study, what participation involves, how information will be used and protected, who may have access to the data, and whether participation is voluntary. Research involving human participants may also be subject to formal review and additional protections. Community involvement and acceptance. Ethical questions can arise when an organization wants to locate or operate a program in a neighborhood. For example, how should a community be involved when an organization plans to open supportive housing, a residential reentry program, a shelter serving people experiencing homelessness, or another service? Whose perspectives should be considered, and how should concerns be balanced against the rights and needs of people who will use the service? In practice, it usually makes sense to communicate openly about what is planned, listen to concerns, provide accurate information, and involve community members where appropriate. At the same time, opposition to a needed service does not automatically mean the service should not exist. Ethical decision-making may require balancing neighborhood concerns with the rights, safety, dignity, and needs of the people the program is intended to serve. These issues are seldom easy or clear-cut. Honest communication, meaningful engagement, attention to rights and equity, and a willingness to address legitimate concerns can help organizations navigate them. Both confidentiality and consent bring up the broader issue of privacy. Digital technology, electronic records, online communication, data sharing, and increasingly interconnected information systems have created new opportunities and new risks. Organizations should think carefully about what information they collect, how long they retain it, who can access it, and how it is protected. Disclosure Like consent, disclosure in this context has more than one meaning. Disclosure to participants of the conditions of the program they're in -- including confidentiality policies and their limits, available services, program requirements, costs, time limits, grievance procedures, research activities, and other important conditions. Information should be provided in clear and accessible language so participants can understand what they are agreeing to and make informed choices whenever possible. Many programs have grievance or complaint procedures for participants who believe they have been denied services unfairly, treated disrespectfully, or harmed through their involvement with a program. Participants should know that these procedures exist, understand how to use them, and have access to the information they need to raise concerns without fear of retaliation. Disclosure of participant information to other individuals or organizations. Programs should follow applicable confidentiality laws, professional standards, participant authorizations, and organizational policies. Any exceptions or limits to confidentiality should be communicated clearly when participants enter the program. Disclosure of conflicts of interest. Staff members, Board members, contractors, researchers, and organizations should disclose financial, professional, family, political, or other interests that could reasonably affect -- or appear to affect -- their judgment or decisions. Laws, grant requirements, contracts, and organizational policies may require specific disclosures of conflicts of interest. Programs should understand these requirements and develop procedures for identifying, reporting, and managing potential conflicts. Competence By offering services of any kind, an organization is making a commitment to participants that it will make a responsible effort to provide the services it says it will provide. That includes ensuring that the people doing the work have appropriate knowledge, skills, training, supervision, and support. No program or individual will succeed 100% of the time. Outcomes may be affected by many factors, including the fit of the intervention, accessibility, available resources, participants' goals and circumstances, broader social conditions, and the quality of implementation. A program should not automatically interpret limited participation or unsuccessful outcomes as evidence that participants are "resistant" or unwilling to change. Competence means more than simply having appropriate credentials or prior experience. A competent organization recruits qualified staff, provides supervision and professional development, seeks participant feedback, evaluates its work, and responds when services appear ineffective or harmful. If staff members need additional training or support, the organization should provide it when possible. If someone cannot perform essential responsibilities safely and effectively even with appropriate support, the organization may need to change their responsibilities or employment. There may also be professional and legal consequences when licensed or regulated service providers practice outside the limits of their competence or fail to meet required standards. Organizations should make sure staff understand the responsibilities and limits associated with their roles. Conflict of interest. A conflict of interest is a situation in which someone's personal, financial, professional, political, social, family, or other interests could improperly influence -- or appear to influence -- their judgment or actions. In community interventions, conflicts of interest can affect decisions about services, hiring, purchasing, funding, research, referrals, or relationships with participants. Conflicts can also affect an organization, particularly where a Board of Directors or governing body is involved. For example, a Board member with a financial interest in a company being considered for a contract should disclose that interest and generally should not participate in the decision about awarding the contract. A conflict of interest does not always mean that someone has acted unethically, but undisclosed or unmanaged conflicts can undermine trust and lead to unfair or biased decisions. Organizations should identify potential conflicts, disclose them appropriately, and manage or eliminate them when necessary. If you find yourself in such a situation, the ethical response generally has two parts: Disclose the conflict to the appropriate person or body -- such as your employer, supervisor, Board, funder, participant, or other relevant party -- and discuss how it should be handled. Manage or eliminate the conflict. Depending on the situation, this might mean removing yourself from a decision, using an independent review process, transferring responsibilities, declining funding, ending a financial arrangement, or making another change that protects participants and the integrity of the organization. Some examples of conflicts of interest and possible responses include: A program director considering the purchase of equipment from a company owned by a close family member. The director has both a personal and financial connection to the decision. The relationship should be disclosed, and the director should generally step away from the purchasing decision. A staff member considering a romantic or sexual relationship with an intern or person they supervise. The power difference creates significant ethical concerns and may violate organizational policy or professional standards. The appropriate response is to follow applicable policies and ethical rules, protect the person with less institutional power, and remove the conflict rather than relying on informal arrangements. A researcher accepting funding from a company that could benefit financially from a particular study outcome. The financial relationship should be disclosed and managed through appropriate safeguards, independent oversight, or another funding arrangement when necessary. A counselor or therapist providing professional services to a close family member, current partner, former partner, or other person with whom they have a significant personal relationship. Professional boundaries and objectivity may be compromised, so referral to another qualified provider is usually more appropriate. A youth program staff member assigned to work closely with a young person whose family has an ongoing personal conflict with that staff member. The program should consider whether another staff member can provide services more fairly and effectively. A health care professional referring patients to a practice in which they have a financial interest. The relationship should be disclosed and managed according to applicable professional standards, organizational policies, and laws. Another type of conflict can arise when funding structures reward programs for particular participant outcomes in ways that unintentionally discourage them from serving people who face greater barriers or need additional support. For example, an employment program might receive more funding when participants complete training and quickly obtain jobs. If funding depends too heavily on those outcomes, the organization may feel pressure to enroll people who are already most likely to succeed rather than people who could benefit substantially but may need more time, accommodations, or support. This creates a conflict between financial sustainability and the program's responsibility to provide equitable access to services. Similar pressures can arise in education, health care, housing, behavioral health, and other areas. Organizations can try to address these conflicts by negotiating funding expectations, documenting the resources required to serve people with different support needs, advocating for measures that recognize meaningful progress rather than only final outcomes, diversifying funding sources, and being transparent about the effects that funding structures may have on program decisions. Grossly unethical behavior. Some behaviors go far beyond ordinary ethical disagreements and involve serious violations of professional responsibilities, participant rights, organizational standards, or the law. Community programs should establish clear standards, reporting procedures, safeguards, and consequences for serious misconduct. Depending on the behavior, responses may include investigation, disciplinary action, termination, reporting to licensing or regulatory bodies, or referral to law enforcement. Examples of serious ethical violations may include: Sexual or romantic relationships in professional situations where there is a significant power imbalance and where such relationships violate professional standards, organizational policy, or law. Exploiting participants financially, accepting bribes, or giving preferential access to services in exchange for money, gifts, favors, or personal benefits. Defrauding funders, such as billing for services that were never provided or falsifying records. Improperly denying necessary services because a person cannot pay when doing so violates professional, organizational, or legal obligations. Discriminating in service delivery on the basis of protected characteristics or otherwise treating people inequitably without a legitimate and lawful program reason. Programs may sometimes be designed to serve a particular population because of a specific need or mission. Eligibility criteria themselves are not necessarily discriminatory, but they should have a legitimate purpose, be applied fairly, and comply with applicable civil rights and anti-discrimination requirements. Criminal or abusive conduct connected to the program, such as theft or misuse of program funds, abuse or exploitation of participants, falsification of records, or other serious misconduct. General ethical responsibilities. Ethical behavior for a community intervention is more than simply following professional codes and avoiding misconduct. It means actively trying to do what is fair, responsible, respectful, and beneficial for participants, staff members, funders, community partners, and the broader community. By working in the community, you take on a number of responsibilities: Responsibility to funders. You are responsible for being financially accountable, using funds appropriately, meeting legitimate reporting requirements, and making a good-faith effort to carry out the work you agreed to do. If a funder asks for something that conflicts with your organization's mission, ethical standards, participant rights, or commitments, address the issue before accepting the funding whenever possible. Be transparent about what your organization can and cannot agree to, and try to negotiate requirements that allow you to meet both your ethical responsibilities and the legitimate needs of the funder. Responsibility to staff members. You are responsible for treating staff fairly; compensating them appropriately for their work; providing reasonable autonomy, supervision, and opportunities for professional development; and taking reasonable steps to protect their health and safety. A community violence prevention outreach worker, for example, may need training related to neighborhood dynamics, conflict de-escalation, trauma-informed practice, confidentiality, personal safety, professional boundaries, and local resources. Staff should also receive clear information about job risks and the support available to them from the organization. Responsibility to participants. You are responsible for making a continuing effort to provide effective, respectful, and responsive services. This means looking for better methods and ideas; listening to participant feedback; building on program strengths; identifying and correcting weaknesses; respecting participants' rights; and recognizing participants as people with knowledge, agency, strengths, and goals. Questions about participant autonomy can be especially difficult when professionals believe they know what would be best for someone. Consider an adult with a mental health condition who is capable of making informed decisions and receives a medical procedure without having given informed consent. The violation of bodily autonomy is serious, but ethical questions may still arise about how an organization should respond if the person does not want to file a complaint or pursue action against the provider. Situations like this involve several important principles at once: autonomy, informed consent, protection from harm, accountability, and respect for the person's own choices. Ethical decision-making should not assume that a disability or mental health condition eliminates a person's right to make decisions about their own life. Respect also does not mean that participants may harm, threaten, harass, or discriminate against staff members or other participants without limits. Programs should develop clear, fair, and consistently applied expectations for behavior and procedures for responding to conflict, harassment, threats, discrimination, and safety concerns. People can be treated with dignity while still being held accountable for behavior that harms others. Responsibility to the community. You are responsible for trying to understand community priorities, strengths, needs, and concerns; being responsive to community knowledge and perspectives; and using your intervention to contribute positively to community well-being without compromising essential ethical principles or participant rights. The participatory nature of community interventions can itself raise ethical questions. Involving people most directly affected by an issue and the broader community in planning is generally both ethically and practically valuable. Community members bring lived experience, history, relationships, knowledge, and ideas that professional staff may not have. Meaningful participation does not mean that everyone will always agree. Community members, service providers, researchers, funders, and other partners may have different interpretations of the issue or different ideas about what should be done. Ethical collaboration requires taking those perspectives seriously, explaining relevant evidence and constraints, being transparent about who has decision-making authority, and seeking shared solutions when possible. The reality is that there aren't simple answers to many ethical questions. Clear principles and policies help, but organizations will still encounter situations in which legitimate values or responsibilities conflict. Ethical practice involves recognizing those tensions, consulting appropriate people, listening to those affected, documenting important decisions, and continually asking whether the organization's actions are consistent with its mission and responsibilities. In Summary Ethical considerations are extremely important in community interventions. A program that behaves unethically or allows serious ethical problems to go unaddressed risks harming participants, undermining its mission, damaging community trust, and reducing its effectiveness. Because ethical issues are not always clear-cut, community programs should establish ethical guidelines, policies, and decision-making procedures before difficult situations arise. Clear expectations related to confidentiality, consent, disclosure, competence, professional boundaries, conflicts of interest, participant rights, staff responsibilities, and organizational accountability can help staff respond consistently and responsibly. Just as important, organizations should remain willing to learn from participants and community members and revise their practices when those practices do not live up to their ethical commitments. Contributor Phil Rabinowitz Resources Online resources American Psychological Association. This site features a number of areas relevant to ethics, including the APA Ethics Code. Applied Ethics Resources. This site features links to codes of professional ethics online. Chapter 11: Community Interventions in the "Introduction to Community Psychology" explains professionally-led versus grassroots interventions, what it means for a community intervention to be effective, why a community needs to be ready for an intervention, and the steps to implementing community interventions. Code of Ethics. The Code of Ethics of the National Association of Social Workers. "Ethics and Conflict of Interest," an article by Michael McDonald of the University of British Columbia. Massachusetts Medical Society. Privacy and confidentiality guidelines of the Massachusetts Medical Association. Also links to guidelines for and discussions of ethics issues. Mental Health Patients Rights. Athealth.com is a large site with mental health information for both practitioners and consumers. This page is a series of items relating to mental health patients' rights. Privacy And Confientiality. One counseling center's disclosure of privacy policy. Print resource Bok, S. (1999). Lying: Moral Choice in Public and Private Life. New York, NY: Vintage. Fried, C. (1978). Right and Wrong. Cambridge, MA: Harvard University Press. McKnight, J. (1985). The Careless Society: Community and Its Counterfeits. New York, NY: Basic Books. Ram D. & Paul G. (1985). How Can I Help: Stories and Reflections on Service. New York, NY: Knopf. Singer, P. (1193). Practical Ethics. Cambridge, England: Cambridge University Press.
