Navigating Ethics & Boundaries in Professional Practice

TODAY’S LEARNING OBJECTIVES Gain understanding of: Codes of Professional Conduct Ethics Boundary Crossings & Violations Dual Relationships (CCMC & NASW) Is This a Boundary Issue?

CODES OF PROFESSIONAL CONDUCT

CCMC & nasw Codes Codes provide case managers (CCMC1) and social workers (NASW) with guidance on practicing ethically and honoring professional boundaries We use such guidance in making decisions in our practice Such decisions are not cut-and-dried 1.Https://ccmcertification.org/sites/default/files/downloads/2015/0000.%20Code%20of%20Professional%20Conduct_FINAL%20%26%20APPROVED_January%202015.pdf

ETHICS

What they are not… Not the same as feelings: sometimes our feelings deviate from the ethical Not the same as religion: non religious people have ethical standards Not the same as following the law: laws may incorporate ethical standards but they may deviate from what is ethical Not the same as societal standards

What they are…

Ethics & Laws Ethics: Focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws. Law: Legal justice; following the norms established by society through the political process (legislature).

Basic Ethical Principles Justice (distributive, rights-based & legal) Beneficence Non-maleficence Understanding/Tolerance Publicity Respect for the person

Beneficence & Maleficence Beneficence: Do good Non-Maleficence: Do no harm Provision of net benefit with minimal harm Honest assessment needed of risks and benefits Involves respecting patient autonomy Education and information essential

BOUNDARY CROSSINGS & BOUNDARY VIOLATIONS

Boundary Crossings Not intended to be harmful for client but can become exploitive and unethical These crossing can be therapeutic such as holding a client’s hand For example, clients who were former teachers, neighbors, or professionals

Boundary violations Relationships that become unethical because they exploit, manipulate, deceive or coerce the client. Sanders, Bullock & Broussard (2012)

DUAL RELATIONSHIPS (CCMC & NASW)

conflicts of interest Disclosure of any current or potential conflict of interest Resolution that puts clients' interests first May require termination of the professional relationship with proper referral of the client One particular issue is dual relationships

Dual Relationships

dual relationship categories Intimacy (rewarding, fills emotional need) Person benefit (monetary gain) Emotional/dependency needs(our emotional needs interfere with client’s) Unintentional/unplanned relationships (accidental crossings) Altruism (actions based on wanting to help) Reamer(2001)

Rural dual relationships Assess current and future relationship on dimensions of power, duration, and termination Determine extent of role incompatibility Seek consultation Discuss decision with clients in terms of possible ramifications Gottlieb

Assessment of rural dual relationships If assessment of power, duration, and termination all in low range, dual relationship may not be prohibited If assessment of two or three dimensions are in low-to-mid range, proceed with caution If any assessed dimensions in high range, then best to avoid Gottlieb

IS THIS A BOUNDARY ISSUE?

Questions to ask ourselves Why am I taking (or considering taking) this action? Why am I doing this at this time? Why with this client? Would I do the same with other clients? If not, what makes this situation different? What needs are being met and whose needs are they? How does this impact the treatment plan? LIPSCHUTZ 2011

Questions to ask ourselves How will the client/colleague interpret my actions? What risks/benefits are involved? Are there intermediate steps that can be taken (rather than an all or nothing approach)? Am I documenting my decision making process and actions? Is there a reason I am excluding information? LIPSCHUTZ 2011

Steps for Preventing & Managing Boundary Crossings Recognize risk factors that may lead to boundary crossings, including: a. Identification with patient or family by professional b. Unresolved loss or grief on part of professional c. Professional sense of failing the patient d. Complex or dysfunctional patient–family dynamics e. Patient and family mistrust of medical providers MEIER ET AL. 2001

Steps for Preventing & Managing Boundary Crossings 2. Examine the presence of behaviors or emotions that indicate a boundary has been crossed, including: a. Avoidance b. Increased contact with client and family even when medically unnecessary c. Negative feelings of anger, resentment, feeling trapped d. Feeling a personal responsibility to save client e. Feeling no other provider can care for client in same way MEIER ET AL. 2001

Steps for Preventing & Managing Boundary Crossings 3. Consider how boundary crossing affects client’s care 4. Discuss the situation with a colleague, supervisor, or the interdisciplinary team MEIER ET AL. 2001