Transcript Session 9: Boundary Issues in Peer Support

Boundaries/Ethics
& Peer Specialist Services
Matthew R. Federici, M.S., CPRP
Program Director
Institute for Recovery & Community Integration
Mental Health Association of Southeastern Pennsylvania
700 East Main Street, 2 North
Norristown, PA 19401
610-292-9922 Ext. 114
Fax 610-292-0388
www.mhrecovery.org
www.mhasp.org
Dec 4th 2009
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Objectives:
 Through participation in this
teleconference you will be able to:
 Define and categorize boundary and
ethical challenges in the context of Peer
Specialist Services
 Utilize situational analysis tools to more
effectively navigate daily boundary and
ethical challenges.
Dec 4th 2009
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History and Context of Boundary/Ethics in
the mental health system
 Old Standards New Dilemmas:
 Traditional System Based on
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Institutionalization
Concept of professional distance;
Clinical definition = objective observation
Clear segregation between staff and “patient”
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Community Based,
Concept of Mutuality;
Subjective = individualized and holistic;
Integration and people first. i.e. like everyone else.
 Recovery Oriented System:
Based on Old Standards, New Dilemmas: ethics and Boundaries in Community Support Service
by Laurie C. Curtis and Martha Hodge
Dec 4th 2009
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History and Context of Boundary/Ethics in
the mental health system
 In this new Environment Boundaries and
Ethical Guidelines must be
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Flexible
Contextual
Case by case situations
Require more on-going supervisory dialogue to
problem solve
-Based on Old Standards, New Dilemmas: ethics and Boundaries in Community Support Service by Laurie C.
Curtis and Martha Hodge
Dec 4th 2009
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Not So Complicated…
 Boundary/Ethical Issues are Not
Violations;
 Violations:
 Abuse
 Illegal activity
 The media test: if the 11O’Clook News
were to televise what you did, how would
you feel when your friends heard?
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“Boundary Issues
or Boundary Violation”
 Issues:
 Inevitable
 Not right or
wrong
 Ongoing
 “It Depends”
 Violation:
 Abuse
 Sexual
Relationships
 Drugs and Alcohol
 Usually clear laws,
policies or rules
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Defining the issues:
 The majority of challenges are not because
we are peer specialist but because we
represent the shift toward recovery
oriented & community integrated services
 The key distinction in the Peer Specialist
Service is its unique potential value of
DISCLOSURE & MUTUALITY
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Defining the issues:
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The biggest perceived concern:
 Peers ability to handle confidentiality and boundaries
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(based on literature review around implementation concerns with consumers as
providers and focus groups with administrators and existing agency workforce)
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Reality = the biggest challenge is the agency and organizations
ability to handle confidentiality and boundaries between people
as members of their community and their workforce
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Confidentiality and boundary issues are huge challenges to
the quality of services
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but it has always existed and the issues apply to everybody working
in community based services
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Defining the issues:
 The biggest contributing factor to ethical
and boundary problems is when the roles
are not clearly defined and communication
is not occurring.
 This is not only true when we transition
from one’s friend in the hospital to their
paid support, but also when we transition
from their colleague to their boss or
supporter to colleague.
 The contexts of our relationships are fluid
and not static relationship
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Defining the issues of Disclosure:
 Disclose to Inspire not to Vent:
 As peer specialists the purpose is not to
hire or be valued because of our stories
of illness it is to be hired and valued for
our skills and story in recovery
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Disclosure or information sharing
 “Professional guidance is not to be
confused with telling clients what to
do”

By Gerard Eagan:The Skilled Helper
 This is the same principle for our
recovery experience.
 Regardless if it is our knowledge as
trained in a therapeutic method or from
our own lived experience
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Two Key Challenges of Disclosure
1. Creates a form of intimacy
2. Indirectly communicates a challenge:
 i.e. “You can do it, too”
Seven Tools to Guide Disclosure:
1.
2.
3.
4.
5.
6.
7.
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Orient the person to disclosure
Disclose to inspire not vent
Watch your timing
Focused and selective to the persons recovery goals
Not too frequent
Don’t burden and already overburden
Be flexible: different use to the person’s situation
Based on Text By Gerard Eagan: The Skilled Helper
Dec 4th 2009
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Defining the issue of Mutuality
 Think of the “helper principle” a well research fact of
our field that people receive positive therapeutic
outcomes when helping others.
 For peers this can have even a greater impact.
 This dynamic can go in either direction i.e. helping
each other get high or maintain other unhealthy
behaviors
 The key is focusing on the goal of recovery and
togetherness
 If it is not working for one of us it is probably not
working for either of us
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Tools: Eight Core Principles to Guide
Our Work
 Do the Most
 Focus on the
Interdependence
 Be
 Tell the
 Informed
 Do No
 Continuing
 Privacy &
Good
Individual &
Fair and Just
Truth
Consent
Harm
Education
Confidentiality
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Relationship Boundaries
 Relationship boundaries are
established to:
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Promote trust.
Increase safety.
Demonstrate respect.
Develop rapport (working alliance).
Provide structure to helping relationship.
Dec 4th 2009
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Near Impossible Dual Roles=
Conflict of Interest
 Supervisor and Therapist
 Controlling your finances and supporting your
self-directed recovery goals.
 Peer specialist and sponsor
 Holding and dispensing your medication and
being your Peer Specialist or supporter
 Profiting from you and Paid Supporter i.e “hey
can you wash my car for five bucks.
 Being your landlord and primarily for your
recovery
 Being your spouse and/or “significant” other
and providing you Peer Support Services
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Five Decision Making Tools
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Principle
Principle
Principle
Principle
Principle
of
of
of
of
of
Primary Benefit
Ethical Action
Expectation
Resources
Satisfaction
Dec 4th 2009
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Simple Tips To Guide The Day
Boundary Issues are not Boundary Violations
Disclose to inspire not to vent
CONSULT CONSULT CONSULT!
THE 11 O’ Clock NEWS!
If you are not discussing boundaries and ethical
dilemmas in staff meetings and supervision then your
are not have supervision or doing your job.
 IT IS About the RELATIONSHIP, Relationship,
Relationship!
 i.e. “if its not working for me it is probably not
working for you.”
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Dec 4th 2009
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