Transcript Ethics and Care Coordination

Andrea Standley PhD
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Values
◦ Beliefs and attitudes that provide direction to
everyday living
 Internal
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Ethics
◦ Beliefs we hold about what constitutes right
conduct. Ethics are moral principles adopted by an
individual or group to provide rules for right
conduct
 External
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Cory, Cory & Calanan (2011)
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Autonomy: to promote self-determination
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Beneficence: to do good for others and promote the
well-being of participants
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Non-maleficence: to avoid doing harm
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Justice: to be fair by giving equally to others and to
treat others justly
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Fidelity: to make realistic commitments and keep
these promises
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Veracity: to be truthful and deal honestly with
participants
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The National Organization for Human
Services promotes the following ethical
standards:
◦ Respect the integrity and welfare of the participant
at all times
◦ Protect the participant’s right to privacy and
confidentiality except when such confidentiality
would cause harm to the participant or others
◦ Protect the integrity, safety and security of
participant records
◦ Protect the participant’s right to self-determination
 Recognize the participant’s right to receive or refuse
services
 Self-Neglect
 Hoarders
◦ Recognize and build on participant strengths
◦ Keep informed about current social issues as they
affect the participant and the community.
◦ Act as advocates in addressing unmet participant
and community needs
◦ Provide services without discrimination or
preference based on age, ethnicity, culture, race,
disability, gender, religion, sexual orientation or
socioeconomic status
◦ Be knowledgeable about the cultures and
communities within which you practice
◦ Be aware of your own cultural backgrounds, beliefs,
and values
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The Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
 Passed by congress to promote standardization and
efficiency in the health care industry and to give
patients more rights and control over their health
information.
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The HIPAA Privacy Rule provides federal
protections for personal health information
held by covered entities
It provides patients an array of rights and
respect with respect to that information
The Privacy rule is balanced so that it permits
the disclosure of personal health information
needed for patient care
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Establishes administrative, technical and
physical standards for the security of
electronic health information
Requires that we maintain the availability,
integrity, and confidentiality of electronic
health information
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Protected Health Information (PHI) under
HIPAA means any information that identifies
an individual and relates to at least one of the
following:
◦ The individual’s past, present or future physical or
mental health
◦ The provision of health care to the individual
◦ The past, present or future payment for health care
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Name
Address
Birth Date
Social Security number
E-mail address
Health plan beneficiary number
Account number
Photographic image
Any other characteristic that could uniquely
identify the individual
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Make sure participants know that information
is confidential
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Power of Attorney
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Release of information form
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Provide Notice of Privacy Practices
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Privacy in Hospitals
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When clerical assistants handle information
When an in-home service worker or care
coordinator is being supervised
When a participant has given consent
When a participant poses a danger to self or
others
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When a participant discloses intention to
commit a crime
Suspected abuse or neglect of a child or
vulnerable adult
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Court orders
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Public health purposes to control disease
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Assisting the government in overseeing
health care programs
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Law enforcement purposes
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National security purposes
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Mandatory Reporting
◦ Designed to encourage reporting of any suspected
cases of child, elder, or dependent abuse
◦ If children, the elderly, or other dependent adults
disclose that they are being abused or neglected,
the professional is required to report
◦ We have an obligation to protect those who cannot
advocate for themselves
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Child Abuse 1-800-252-2873
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Elder Abuse 1-866-800-1409
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Balancing participant confidentiality and
protecting the public is a major ethical
challenge
◦ We must exercise the skill and care of a reasonable
professional to:
 Identify participants who are likely to do physical harm
to third parties
 Protect third parties from participants judged
potentially to be dangerous
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Most ethics codes address diversity, however,
reliance on ethics codes alone does not
guarantee multicultural competence
Ethical practice requires that professionals be
trained to address diversity factors
We need to reflect on our own assumptions
and challenge stereotypical beliefs and
cultural bias
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A temporary dependence is not necessarily
problematic
A ethical issue occurs when
workers/professionals encourage and
promote dependence
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Supervising is a process that involves a
supervisor overseeing the professional work
of a trainee with five major goals:
◦ To promote employee growth and development
◦ To protect the welfare of the participant
◦ To not participate in dual relationships
◦ To monitor supervisee performance and to serve as
a gatekeeper for the profession
◦ To empower the employee
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Can you think of other goals of a supervisor?
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Ladany and Colleagues(1999) conducted a
study and found:
◦ 51% of employees sampled (151) reported ethical
violations by their supervisors.
◦ Ethical violations included:
 Performance evaluations
 Confidentiality issues
 Ability to work with alternate perspectives
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It is beneficial to discuss the rights of
employees from the beginning of the
supervisory relationship
When employees learn what they can expect
and what they need to do to achieve success,
they are empowered to do a good job
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Supervisors should be upfront with
employees by providing:
◦ Methods to be used in supervising
◦ Responsibilities and requirements
 For supervisor and employee
◦ Policies pertaining to confidentiality and privacy
◦ Documentation of supervision
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Risks and benefits
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Evaluation of job performance
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Complaint procedures and due process
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Professional development goals
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Supervisory sessions should be in private
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To be fully informed of supervisor’s approach
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Confidentiality with regard to employee’s
disclosure
Confidentiality with regard to participants
except as mandated by law
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Supervisors are ultimately responsible, both
ethically and legally for the actions of their
employees
Supervisors have responsibilities to current
participants and future participants as well
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Supervisors must have a clearly developed
framework for supervision and a rationale for
the methods they employ
Good supervisors demonstrate the four A’s:
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Available
Accessible
Affable
Able
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Don’t supervise beyond your competence
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Evaluate and monitor employee’s competence
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Be available for supervision consistently
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Maintain written policies
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Document all supervisory activities
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Maintain a working knowledge of ethics codes,
legal statutes, and certification regulations
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Use multiple methods of supervision
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Have a feedback and evaluation plan
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Establish a policy for ensuring confidentiality
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Manage boundaries
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Human services can be a stressful profession which
can lead to empathy fatigue.
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Some sources for stress are:
◦ Feeling of not helping their participants enough
◦ The tendency to accept full responsibility for participant’s
progress
◦ Feeling a pressure to quickly solve participant’s problems
◦ Having extremely high personal goals and perfectionist
strivings.
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An absence of boundaries with participants or
employees
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Preoccupation with work
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Inability to say no
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Poor health habits in the areas of nutrition
and exercise
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Low productivity
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Depression
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Negativity
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Frustration
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Agitation
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Feeling of futility
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As supervisors, what can you do to minimize
the possibility of burnout in your employees?
As supervisors, what can you do to minimize
the possibility of burnout in yourself?
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Paid Family Caregivers
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Gift Giving
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Can you think of any other ethical issues?
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Any effort to defraud the Medicaid system by
billing for services not delivered, or under
delivered.
It can also manifest itself in cases where physical
abuse or neglect has occurred.
In order for there to be Medicaid Fraud, Medicaid
money must be involved.
Medicaid fraud can also occur when participants
knowingly falsify Medicaid/CCP applications.
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Two Ways to report Medicaid Fraud
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Illinois State Police
◦ 1-888-557-9503
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Healthcare and Family Services
◦ Office of Inspector General
“Never let your sense or
morals get in the way of
doing what’s right.”
Isaac Asimov
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Corey, Cory & Callanan (2011). Issues and ethics in the helping professions.
Brooks/ Cole – Cengage Learning
Hall, J. (2012) Staff retention and minimizing burnout. Retrieved on 2/11/2013
fromhttp://humanservices.ucdavis.edu/resource/library/pdf/D14%20Staff%2
0Retention%20and%20Minimizing%20Burnout.pdf
Ladany and colleagues (1999). Psychotherapy supervisor ethical practice:
Adherence to guidelines, the supervisory working alliance, and
supervisee satisfaction. The Counseling Psychologist, 27(3), 443- 475.
National Organization for Human Services (2013). Ethical standards for human
service professionals. Retrieved on 1/29/13 from
www.nationalhumanservices.org/index.php?option=com_conte
nt&view==article&id=
U.S. Department of Health and Human Services (2013). Health Information
Privacy. Retrieved on 1/29/2013 from
www.hhs.gov/ocr/privacy/hipaa/understanding/index.html