Ethical issues around the use of integrative approaches in child and adolescent psychiatry arise in relation to diverse aspects of practice but especially in collaborative work with other disciplines. Child and adolescent psychiatrists work with nurses, social workers, psychologists, psychotherapists, family practitioners, paediatricians, those working in the juvenile justice system and educationists. Different ethical issues arise in relation to work with different disciplines and examples will be given. But there are common ethical issues arising from different standards of confidentiality and the communication of information as well as in the exercise of medical responsibility. Ethical issues can sometimes hinder the delivery of effective, evidence-based care. This is paradoxical for failure to deliver such care itself offends against ethical principles.