1
Whose Records? Ethical Decision-Making for Client Access Requests in Addiction
Counseling
Jero E Jenkins
Liberty University
ADCN501: Ethical and Legal Issues in Addiction Counseling
Professor K Dumont
10/10/2025
2
Abstract
The case presented in this paper uses the ACA model of ethical decision-making of the
Whose Records? Vignette. It states the facts. It determines ethical and legal problems. It uses
NAADAC and ACA standards. It includes state and federal legislation. It weighs moral
principles. It then provides practical steps that safeguard the rights of the clients and
minimize risk.
3
Whose Records? Ethical Decision-Making for Client Access Requests in Addiction
Counseling
Introduction
Clients are entitled to access much of their clinical records. Protection of
confidentiality and safety should not interfere with counselors respecting that right. This
balance is challenged by Whose Records? Vignette. It features a client who needs access and
orders the end of care. In this paper, an ethical decision-making model is applied to the
situation. It determines facts and problems. It puts NAADAC and ACA standards into practice.
It incorporates state and federal legislation. It then offers justifiable measures that honor the
rights and minimize the risks.
Identify the Problem
The client arrives upset. The client claims that the therapy is ineffective. She requests
my records. The client desires the little notes, the counselor's own notes, and the notes of
other counselors. The customer prefers to terminate it now. The counselor advises that the
notes are not necessarily useful. The client replies that helpfulness is not the point. The
client believes that it is her records.
These are the facts. No assumptions are added. The problem is ethical. It deals with
the rights of clients, access, and non-abandonment. It is also legal. Access and disclosure are
regulated by HIPAA and 42 CFR Part 2. It is clinical and professional. The counselor has to
deal with termination and continuity of care. It also entails records technology. The Access
enables the psychotherapy notes and the designated record set.
It is a conglomerate of ethical, legal, clinical, and records problems in short.
Apply both the NAADAC Code of Ethics and ACA Code of Ethics
NAADAC
Two standards are central. To start with, Standard II-3: Records Access. Counselors
offer fair access in instances where there is a written request by the clients. To avoid
damage, they can restrict access. They can provide an overview of the treatment in cases
where unrestricted access will be detrimental to the client. They have to either eliminate or
4
guard third-party data. When they do not know, they consult (NAADAC, 2025). This fits the
request here.
Second, Standard II-20: Transfer and Disclosure of Records. No disclosure is made
without written permission from counselors. They subscribe to HIPAA and 42 CFR Part 2.
They would not re-release records they obtained through other providers without lawful
authorization or approval (NAADAC, 2025). This takes care of the request of other counselors
regarding their notes.
There are two standards that are related to practice. Standard I-24: Termination and
Referral guides ethical dismissal with necessary referrals. Standard I-31: Records and Fees
cautions that it is prohibited to retain required records due to nonpayment (NAADAC, 2025).
The ACA Code
It addresses access, confidentiality, and termination. B.6.d Client Access to Records
promotes sensible access to records and prevents harm and guards against disclosure of the
third party (American Counseling Association, 2014). B.3 Confidentiality states that the third
parties mentioned in the file need to be protected (American Counseling Association, 2014).
A.11 Termination and Referral forbids the abandonment and requires proper referral and
documentation (American Counseling Association, 2014). In conjunction, NAADAC and
ACA assist a cautious, open discharge procedure and a risk-free termination strategy .
Applicable State Codes/Laws and Federal Mental Health Laws
State Law (Example: Florida)
The Florida regulations of licensed substance use programs provide those clinical
records by which they are secured and in accordance with 42 CFR Part 2 and 397.501, F.S.
They also provide the access, retention, and disclosure expectations (F.A.C. 65D-30.0041,
2023). The chapter puts into context how programs manage client requests and record
transfers (F.A.C. 65D-30, 2023).
Federal law
Most of this scenario is under the control of two regimes.
5
HIPAA Right of Access: Clients are entitled to view and access a copy of their secured
health information (PHI) in the set of designated records. There are narrow exceptions.
When stored outside of the medical record, psychotherapy notes are not counted (45 C.F.R.
§164.524; HHS OCR, 2024/2025). The record set assigned contains PHI to make care
decisions. It may consist of things that are made elsewhere, provided they are stored in the
client record.
42 CFR Part 2 (2024 Final Rule): The records of substance use disorder (SUD) are
specially protected. Disclosure and re-disclosure require a proper consent or a qualifying
order of court. Lots of characteristics are in line with the HIPAA now, yet increased privacy is
still ( Confidentiality of SUD Patient Records, 2024). Providers should not re-distribute
records of other organizations unless it has been authorized by consent or law.
Implications: The specific record set allows the client to access most of the clinical
records. Notes of psychotherapy are not to be included in case they are stored separately.
The information of third parties should be secured. Disclosure shall comply with HIPAA and
Part 2. Exchange of extraneous records is restricted.
Determine the Nature and Dimensions of the Dilemma
Autonomy: The client desires to have individual control of information and care. Access
promotes self-determination and informed decisions (Kharko et al., 2024).
Non-maleficence: Some clients are bothered by unfiltered notes. It is also possible to reveal
the information of third parties. ACA and NAADAC allow restricted access or a treatment
summary, avoidance of harm (American Counseling Association, 2014; NAADAC, 2025).
Fidelity: The counselor should keep his words (Forester-Miller & Davis, 2025). This involves
telling the truth as regards rights and limits, and follow-through when terminating.
Justice: Clients should be able to access and have equal schedules.
Veracity: Explanations that are clear and honest regarding what will be released or what will
not be are a way of creating trust.
6
Priority: Autonomy and fidelity lead. Non-maleficence and law are the boundaries they are
confine them. It is the right thing to do to respect access privileges, avoid predictable
injuries, guard third parties, and provide continuity of care.
Recent Literature
The studies that provide open notes demonstrate advantages in understanding and
engagement when clinicians orient clients to the content and way of reading notes (Kharko
et al., 2024). The literature on termination emphasizes planning, documentation, screening
of risks, and timely referral to prevent abandonment (West & Hinkle, 2024).
Generate Potential Course of Action
Option 1: Deliver A Completed, Timely Copy of The Specified Record Set or, in Cases of
Necessity, A Treatment Summary
Request the client to fill out a written request. Verify identity. Describe the right of
access and conventional timelines. A copy of the assigned record set should be prepared.
Notes on psychotherapy that are not kept together should be excluded. Eliminate third-party
identifiers when necessary. In case the full access would be of substantial harm, the clinical
judgment must be documented with a brief summary of the treatment (NAADAC, 2025).
Propose to respond to questions once the client has gone through the materials. The
opennotes research indicates that the orientation and follow-up can alleviate the confusion
and distress (Kharko et al., 2024).
Option 2: Directly Send Records to The New Counselor on a Written, Part 2-
Conforming Consent; Do Not Re-Release External Records
Provide a Release of Information containing a list of recipients, purpose, and specific
scope. Make use of 42 CFR Part 2 language. Send that which the consent and the law permit.
Do not discontinue records under the consent or the law of other providers. Rather, assist
the client in demanding such records from the original source. This is based on NAADAC II-
20, F.A.C. 65D-30.0041, and the Part 2 rule of 2024. It assists continuity of care, and risk is
also limited.
Option 3: Have a Short Continuity, Risk, and Referral Termination Session; A Written
7
Document to Prevent Abandonment
Acknowledge the wish to end. Offer a final session or call. Evaluate progress and
existing risks. Give at least three referrals that are in line with the needs of the client. Supply
crisis resources. Offers and outcomes of documents. This is according to ACA A.11 and
NAADAC I-24. Termination guidance is more favorable towards planning and comprehensive
record-keeping (West & Hinkle, 2024).
Option 4: Coaching on What is in the File, Third-Party Protections, and Interpreting Notes
Provide a summary in plain language. Describe the contents of the identified record
set. The reason why psychotherapy notes are not included. Elaborate on the policies of
thirdparty data. Invite questions. Provide a brief consultation upon the client having looked
at the copy or summary. This enhances autonomy and veracity, and minimizes harm risk
(Kharko et al., 2024).
Risk Controls Across All Options
Time-stamp all steps. Retain a copy of the written request. Follow the legal deadline.
Use secure transmission. Record what was discharged and to whom. Do not re-release
records of external providers unless permitted to do so. Record all referrals and client
responses. These controls minimize legal and clinical risk and demonstrate good-faith
compliance.
Conclusion
The demand of the client is valid. The client is entitled to the prescribed record set.
Psychotherapy notes are not included in case they are stored in isolation. Information from
third parties should be secured. HIPAA and 42 CFR Part 2 apply. Reasonable access,
transparency, and non-abandonment are guided by NAADAC and ACA. The most appropriate
one is a combination of rights and safeguards. Making available or giving an overview when
reasonable. Protect third parties. Coordinate a warm handoff. Document every step.
8
References
American Counseling Association. (2014). ACA Code of Ethics. American Counseling
Association. https://www.counseling.org/docs/default-source/default-
documentlibrary/ethics/2014-aca-code-of-ethics.pdf
Forester-Miller, H., & Davis, T. E. (2025). A Practitioner’s Guide to Ethical Decision
Making . Nla.gov.au. https://nla.gov.au/nla.cat-vn5611174
Kharko, A., Buergler, S., Bärkås, A., Hägglund, M., Gaab, J., Fagerlund, A. J., Locher, C., &
Blease, C. (2024). Open notes in psychotherapy: An exploratory mixed methods
survey of psychotherapy students in Switzerland. Digital Health, 10.
https://doi.org/10.1177/20552076241242772
NAADAC. (2025). The Association for Addiction Professionals: NAADAC/NCC AP code of ethics
(Principles I & II). Naadac.org; NAADAC. https://www.naadac.org/
West, T., & Torrico, T. J. (2024). Terminating the Therapeutic Relationship. StatPearls.
https://pubmed.ncbi.nlm.nih.gov/39383280/
Powered by TCPDF (www.tcpdf.org)
