Transcript Ethics and Boundaries - Wisconsin Alliance for Infant Mental Health

Ethics and Boundaries
Relationship-Based Practices with Families: No Easy Answers
2014 WI Infant and Early Childhood Mental Health Conference
Elizabeth Wahl, MSSW CAPSW
Purpose and Intended Outcomes
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Explore topic of ethics and boundaries together
Acknowledge the complexity of the work
Provide information from literature including history, frameworks, and tools
Provide examples from WI practitioners
Provide agency considerations
Hear your stories
NOT to counsel, advise or tell you what to do
Our Time Together Today
• Safety and confidentiality are critical
• Offer what you need
• Recognize my own limitations
My Earliest Experiences with Ethics and
Boundaries
Words of Wisdom from an Expert Witness
Gary R. Schoener M. Eq., Licensed Psychologist reminds us:
Think it through
Do your best, at times we make mistakes
Get help from colleagues
Stay Educated
Be Good Enough
He also says…☺
Cornerstone of Ethics
“Ethics is the defining quality that says I am a professional” Samara Fritchman
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Beneficence – doing good, helping, promoting client well-being
Non-maleficence – avoiding harm
Autonomy – client’s input and role
Fidelity – consistent with what was promised
Justice – fair use of resources, welfare of client and others
Why Do Codes Exist?
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Protect families/clients
So the general public can hold the profession accountable
Summarize principles & core values of a profession
Provide guidance for practice
Socialize new practitioners
Codes Provide Some Parameters, but…
• Codes are necessary, but not sufficient
• Ethical codes do not guarantee ethical behavior
• Ethical decision-making involves a process - Comparative ethicality of the
options
• There are No Answers, Only Choices – Mel Gray & Jill Gibbons, 2007
Apitz, 2009, Fritchman, 2010
Standards for Conduct
• Agency rules & policies
• Ethics codes from Professional Association (e.g. NASW) – member or not,
codes apply
• Codes of conduct – licensure boards
• Laws & rules
Standard of Care: what a reasonable & prudent practitioner would do in the
same or similar circumstances
Adapted with permission from Ethics & Social Media for Social Workers, 2014
– Gary R. Schoener, M.Eq., Licensed Pyschologist
Basic Definitions
• Ethics – principles of conduct governing an individual or group; a guiding
philosophy, a theory or system of values
• Boundaries – boundaries are limits within the professional relationship that allow
for safe connections based on the needs of individuals (Jacobson, 2002)
• Dual Relationships – Service provider has a professional relationship & personal,
social, or business relationship with a client (Brandt, 2008)
• Conflict of Interest – Service provider’s involvement with a client poses
confidentiality concerns (Brandt, 2008) Interferes with exercise of professional
discretion and impartial judgment (Reamer, 2003)
Dual or Multiple Relationships
Rural WI Communities
“Social workers should not engage in dual or multiple relationships with
current or former clients in which there is a risk of exploitation or harm to the
client. In instances where dual or multiple relationships are unavoidable, social
workers should take steps to protect clients & are responsible for setting clear,
appropriate & culturally sensitive boundaries.”
(NASW Code of Ethics)
Conflicts and Dilemmas
• Be aware of potential conflicts of interest with families and avoid them
before they occur
• It is our responsibility to let families know when we see a potential or actual
conflict of interest
(Allen & Tracy, 2008 Jacobson, 2002)
Ethical Codes – Key Topics
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Confidentiality & Privacy
Informed Consent
Client Right to Self-Determination
Competence (Evidence-based practices, cultural competence)
Conflict of Interest
Record Keeping/Documentation
Relationships with Clients
Payment for Services
Termination of Services
Agency Infrastructure: how does our agency
integrate safeguards into the process to support
staff ?
• Supervision
• Orientation, Training, Ongoing
Professional Development
• Intake/First Contact
• Initial Assessment
• Service Planning
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Ongoing intervention
Team Meetings
Consultation
Transition/ Termination
Payment /Fiscal Considerations
Crisis management
Examples in WI CY 2013
WI Dept. of Safety & Professional Services https://online.drl.wi.gov/orders/searchorders.aspx
• County Social Worker - Emailed colleague to look at client Facebook account,
confidentiality breach – terminated, Reprimanded – 90 days to complete continuing ed &
submit proof, pay costs, $350
• Speech Pathologist - Stealing technology/personal property – charged and convicted with
theft, Reprimanded - license suspended 30 days, pay costs $250
• Occupational Therapist - Intervention causing harm/negligence –engaged in unprofessional
conduct, engaged in practice which may constitute danger to health, welfare, safety of client
or public – Continuing Ed courses (4), Reprimanded, $755
• Social Worker, Child Welfare - Falsifying Documentation, added false case notes,
overwhelmed with caseload – terminated, Voluntary Surrender of certificate to practice as
social worker in WI & may be denied in future
Examples in WI CY 2013
• Social Worker/Substance Abuse Counselor – romantic relationship with
client – License Revoked, may not apply in the future, pay costs $1,225
• Social Worker – failure to complete case management duties due to death in
family. – Reprimanded – comply with supervisor’s agreement and 1 year plan
• Social Worker – failed to act on CPS investigation due to burn out
• Social Worker – accessed client data base without authorized use
Consequences
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Harm to the client/family
Loss of professional license
Loss of membership in professional association
Legal problems/fees
Damage to agency’s reputation in the community
Personal safety could be compromised
(Kagle & Giebelhausen, 1994)
The Practice Continuum
Under-involved
Distant
Cold
Detached
What might cause us to drift?
Over-involved
Enmeshed
Intrusive
Dependent
Portage Project, CESA 5
Disclosing Personal Information
Benefits
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Reciprocity
Trust-building
Normalize - parents won’t feel all alone in their journey
May help parents process their own feelings about their child or their
situation
• Therapeutic in unique circumstances
Ask yourself, “Am I building capacity by sharing this information?” “Is it
modest self-disclosure?”
(Reamer, 2003)
Disclosing Personal Information
Dangers
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Role-reversal, parents feel responsible for helping the professional
Could make parents uncomfortable
Could confuse parents about boundaries
Focus should be on the family and child, it’s their time
(Reamer, 2003)
Opportunity for repair – “Rupture and Repair”
Boundary Questions to Consider in Your
Agency
• Is it ok to share something personal about myself with a client? When? How?
• What if a family invites me to dinner or other family event – wedding, birthday,
funeral?
• What are the technology boundaries – personal cell phone, texting, Facebook?
• Is it ok to give a client a hug or other touch? When?
• What if the family is doing something that makes me uncomfortable? Smoking,
clothing choices (or lack of), discipline, profanity?
• What if I’m concerned my co-worker is crossing a boundary, what should I do?
Two Possible Constructs
Boundary Challenges
High Risk Boundary Challenges
• Gifts
• Attending birthdays, weddings,
• Suicide intervention & safety plans
• Intervening with dangerousness
• Challenge of talk, writings, internet
funerals
• Social encounters
posts & what they mean
• Duty to warn/protect
Agency Infrastructure: how does our agency
integrate safeguards into the process to support
staff ?
• Supervision
• Orientation, Training, Ongoing
Professional Development
• Intake/First Contact
• Initial Assessment
• Service Planning
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Payment /Fiscal Considerations
Ongoing intervention
Team Meetings
Consultation
Transition/ Termination
Crisis management …
Ethical Decision-Making
“It is often not what is ethical vs. unethical, but the comparative ethicality of
the options” Schoener, 2014
Decision Table or Chart
ALCOHOL and
DRUG SCREENING
Screen All Families
Do Not Screen Families
Screen Some Families
Positives
Negatives
Genograms
Experienced Based Discussion Process
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What do I want help thinking about?
What are the strengths/capacities of those involved?
What are possible interpretations for what we are seeing, hearing and feeling?
What do we need to know more about?
Next Steps
Module 2: Empowering Partnerships with Families to Support Growth
The Family Service Credential, The Portage Project, CESA 5
Working through Crises or the Unexpected
Questions to Ask Yourself
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What is the nature of the crisis? Immediate danger/safety?
Is the family asking me for help?
Do I feel competent addressing this issue?
Who should I go to if this is not something I am comfortable taking
on?
• What can I learn from this experience to help me feel more competent
in the future?
(Rosin, et al, 1993)
Risk Management Protocol/Criteria
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Be alert to potential or actual conflicts of interest
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Consult colleagues and supervisors, relevant professional literature, regulations, policies, and ethical
standards to identify pertinent boundary issues and constructive options
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Design a plan of action that addresses the boundary issues and protects parties involved to greatest
extent possible
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Document all discussions, consultation, supervision, and other steps taken to address the boundary
issues
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Develop a strategy to monitor implementation of action plan
Inform clients and colleagues about potential or actual conflicts of interest; explore reasonable
remedies
(Reamer, 2003)
Remember: We Don’t Have to Do This All
Alone
Agency Infrastructure and Support for
Reflective Practice
• Reflective practice and supervision is critical even for the most experienced
professionals
• Is reflective practice and supervision part of our agency’s infrastructure?
• How can we build capacity for reflective supervision?
• Where are the opportunities for on-going discussion about ethics and
boundaries?
• How to build a safe and supportive environment/agency culture to have
these conversations?
PROFESSIONAL ASSOCIATIONS
NASW Ethics Questions and Dilemmas
https://www.socialworkers.org/nasw/ethics/ethicsoepr.asp
As a service to members, the OEPR provides ethics consultations for current NASW members. Ethic
consultations are a resource for members who are experiencing an ethical dilemma. We do not provide
advice or tell members what to do. However, we do guide them through the Code and point them to
the areas of the Code that address their concerns. We provide dialogue and considerations that allow
members to make ethical decisions. We may also refer members to the appropriate areas if their
questions do not appear to be related to ethics but are more related to legal issues or standards of
practice.
Hours & Contact Info
(800) 638-8799 ext. 231
Tuesdays:
10:00am - 1:00pm (ET)
Thursdays:
1:00pm - 4:00pm (ET)
Chapter staff may contact the OEPR during regular business hours to ask questions.
Self-Care ~Six Circles
Sarah Strong, LCSW & Jim Van Den Brandt, LCSW
When we are held, we are able to hold those for whom we
provide services
References
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Allen S.F., Tracy E.M. (2008). Developing Student Knowledge and Skills for Home-Based Social Work Practice. Journal of Social Work
Education, Vol. 44 No. 1 p. 125-143.
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Boland-Prom K., Anderson S.C. (2005). Teaching Ethical Decision Making Using Dual Relationship Principles as a Case Example. Journal of
Social Work Education, Vol. 41 No. 3 p.495-510.
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Jacobson, G.A. (2002). Maintaining Professional Boundaries: Preparing Nursing Students for the Challenge. Journal of Nursing Education,
Vol. 41, No. 6 p. 279-281.
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Joanne Bardnt- ACSW LCSW (2008). Clinical Associate Professor Emerita Social Work Field Program, University of Wisconsin- Milwaukee.
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Lea, D. (2006). “You Don’t Know Me Like That”: Patterns of Disconnect Between Adolescent Mothers of Children with Disabilities and
Their Early Interventionists. Journal of Early Childhood, Vol. 28 No. 4 p.264-282.
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Reamer, F.G. (2003). Boundary Issues In Social Work: Managing Dual Relationships. Social Work, Vol. 48, No. 1 p. 121-133.
Kagle, J.D., Giebelhausen, P.N. (1994). Dual Relationships and Professional Boundaries. Social Work, Vol. 39 No. 2 p. 213-220
Gray, M. Gibbons, J. (2007). There are no Answers, Only Choices: Teaching Ethical Decision Making in Social Work. Australian Social Work,
Vol. 60,. No.2 p. 222-238.
Rosin, P., Whitehead, A., Tuchman, L., Jesien, G., Begun, A. (1993). Strategies for Dealing with Unexpected Immediate Needs or Crisis.
Partnerships in Early Intervention: A Training Guide of Family-Centered Care, Team Building, and Service Coordination.
Acknowledgments
• Gary R. Schoener, M. Eq., Licensed Psychologist
• Samara C. Kezele Fritchman, LMHC, JD, PhD
• The Family Service Credential, The Portage Project, CESA 5
Thank You
Elizabeth Wahl, MSSW CAPSW
[email protected]
608-265-9423