Chapter Seven Guiding Principles (2016) Berthold, T., Editor Foundations For Community Health Workers (2nd Edition) (2016) Berthold, T., Editor San Francisco, C.A.: Jossey-Bass Chapter Seven Copyright © 2000-2017 by John Wiley & Sons, Inc., or related companies. All rights reserved. Guiding Principles

Reflection of Last Session What did you learn? Share experiences from stepping outsize your cultural comfort zone Culture Cultural Humility LEARN Model What do I need to work on? Have students share what they learned from the last session on these key topics.

What You Will Learn Define ethics and explain how ethics are different from laws Discuss key articles from the CHW Code of Ethics Explain ethical guidelines relating to informed consent and confidentiality Apply the Framework for Ethical Decision Making to resolve ethical questions Define and discuss professional boundaries and dual or multiple relationships

What You Will Learn Explain how CHWs may cross professional boundaries, and the potential risks of doing so Explain self-disclosure and analyze the potential risks and benefits for clients and CHWs Define self-awareness Explain the importance of self-awareness to the work of CHWs Identify practical strategies for enhancing self-awareness

What You Will Learn Define scope of practice Identify competencies that may lie within and outside the CHW scope of practice Analyze the potential consequences of working outside of the CHW scope of practice Explain how to respond when confronted with a challenge regarding your scope of practice as a CHW Explain the key elements for successful teams

What You Will Learn Identify common challenges to team work Discuss strategies for working successfully as part of a multidisciplinary team Identify behaviors that clients may wish to change Apply the ecological model to analyze individual, family, community, and societal factors that influence behavior and behavior change Discuss and analyze four common mistakes that CHWs make when supporting clients to change behavior

What You Will Learn Discuss the central concepts of client-centered practice Explain the value of a strength-based approach to working with clients Discuss implicit theory and how you will develop your own implicit theories of behavior change

Words to Know Boundary Crossing Media Advocacy Confidentiality Dual or Multiple Relationships Ethics Informed Consent Media Advocacy Professional Boundaries Self-Disclosure Treatment Adherence or Compliance

Ethical Guidelines Ethical standards provide guidance for professionals regarding “right conduct” and what to do when faced with a challenge or dilemma Community Health Worker Code of Ethics is a framework for CHWs, supervisors, and employers of CHWs to discuss ethical issues facing the profession

Ethical guidelines and Code of Ethics for CHWs (pg. 160) Article 1. Responsibility in the Delivery of Care 1.1. Honesty 1.2. Confidentiality 1.3. Scope of ability and training 1.4. Quality of care 1.5. Referral to appropriate services 1.6. Legal obligations Article 2. Promotion of Equitable Relationships 2.1. Cultural humility 2.2. Maintaining the trust of the community 2.3. Respect for human rights 2.4. Anti-discrimination 2.5. Client relationships

Ethical Guidelines and Code of Ethics for CHWs Article 4. Professional Rights and Responsibilities 4.1. Continuing Education 4.2. Advocacy for Change in Law and Policy 4.3. Enhancing Community Capacity 4.4. Wellness and Safety 4.5. Loyalty to the Profession 4.6. Advocacy for the Profession 4.7. Recognition of Others Article 3. Interactions With Other Service Providers 3.1. Cooperation 3.2. Conduct 3.3. Self-Presentation

Ethical Guidelines Informed consent is the obligation to provide clients with all the information they need to make a sound decision about whether or not to participate in a program, service, or research study. Information should include: information about anything harmful, costs, insurance coverage, requirements, limitations, and confidentiality

Ethical Guidelines Confidentiality protects a client’s communication. The Health Insurance Portability and Accountability Act (HIPPA) is a federal law that requires the protection and confidential handling of all health information. Limits to confidentiality should be clearly explained to a client. Limits include: If the client discloses information about harm or the threat of harm to themselves or others. CHWs have an obligation to report this to a third party such as their supervisor or the police.

Confidentiality and Reporting: Faculty Interview

Mandated Reporting See handouts in Blackboard… Confidentiality Basics CHW Confidentiality Quiz Mandatory Reporting Basics Mandatory Reporting Checklist Mandatory Reporting Scenarios Use the handouts provided and walk students through them. Realize that laws and regulations differ by state. A CHW should familiarize themselves with all mandated requirements and work carefully with their employer to receive updated training in order to understand expectations.

Framework for CHWs Ethical Decision Making Describe the problem Review ethical guidelines/codes Review laws/regulations Seek consultation Consider possible action Outline consequences of decisions Decide on action This framework helps when faced with ethical problems. Consider yourself, your client, your supervisor, your colleagues, and the community when examining each of these steps.

Professional Boundaries Professional Boundaries are guidelines that define professional working relationships. Deviating from a strictly professional role is known as boundary crossing Boundary issues include: Physical contact Romantic/sexual involvement Self-disclosure of personal information to a client Managing dual or multiple relationships

Setting Professional Boundaries: Faculty Interview

Setting Boundaries with Clients: Role Play, Counter

Setting Boundaries with Clients: Role Play, Demo

Self-Disclosure Recommended Guidelines Keep it brief Keep it limited Considerations for Self-Disclosure: Benefits Alternatives Burden on the client Nature of disclosed information Context Condition of Client Timing Recommended Guidelines Keep it brief Keep it limited Quickly shift focus back to the client If uncertain, don’t disclose!

Self-Disclosure: Role Play, Counter

Self-Disclosure: Role Play, Demo

Self-Disclosure: Role Plays What personal information did the CHW disclose to the client, and why? What did the CHW do well – and not-so-well – in terms of disclosure? What would you have done differently if you were the CHW? What are your guidelines for providing a self- disclosure to the clients or communities you work with?

Self-Awareness When your issues are present you may not be aware that they are influencing your ability to work with others. You may unconsciously guide, direct, or pressure clients to talk about or avoid certain topics, to make choices that are more about your own needs than those of the client. Developing self-awareness is a lifelong task to better understand yourself including life experiences, values and beliefs, and prejudices. Ways to improve self- awareness: counseling, talking with family & colleagues, professional development, etc.

Scope of Practice (pg. 173) Scope of practice is used to determine which skills CHWs are competent to perform and which are beyond their expertise. The CHW field is still in development and lacks well- defined guidelines. Guidelines depend on: state and local laws, the agency, the program, the supervisor, type of health issue, training, CHW’s comfort level, etc.

Scope of practice Culturally competent health education Informal counseling Case management services and referrals Recruitment of clients Conduct initial interviews Community organizing and advocacy Support clients in accessing services and improving their health and wellness

Team-Based Care Successful Healthcare Teams include: Shared goals Clear roles Mutual Trust Effective Communication Measurable processes and outcomes CHWs Role Within Team: Client-centered counseling/ case-management Medication management Communication Outreach Home visits Patient education

Behavior Change Supporting the behavior change of a client is the most common role for CHWs. Factors that influence the ability of a client to change their behaviors include: Individual factors Family and friends Neighborhood and community factors Societal factors

Behavior Change: Common Mistakes Four common mistakes that CHWs make are: Relying on information alone Information alone is not enough for behavior change Giving advice Instead of “You should try”, say: “have you thought about?”, “what do you think about?” Blaming the client Assumes the clients health and behavior are determined 100% by the client Failing to address issues of accountability Deprives the client to reflect about behaviors

Giving Advice: Role Play, Counter

Giving Advice: Role Play, Demo

Giving Advice: Role Plays What classic mistake does the CHW make in the counter role play? How may this impact or affect the client? What does the CHW do differently in the demo role play? What would you do differently if working with this client, and why?

Client-Centered Practice The client-centered approach views CHWs as facilitators who support clients to make changes that promote their health. For these changes to be most effective and long- lasting, they must come from the client and community. CHWs role is to support clients and communities by carefully analyzing the factors that both harm and promote their health.

Client-Centered Practice Approach is strength-based – emphasizes internal and external resources the client already has Involves: Assessing knowledge Assessing resources Assessing readiness to change Identifying actions to promote health

Big Eyes, Big Ears, Small Mouth: Faculty Interview

Talking Too Much: Role Play, Counter

Talking Too Much: Role Play, Counter What information is the CHW trying to share with the client? Why might CHWs make the mistake of talking too much when working with a client? How might talking too much impact or affect the client?

Your Approach to Client-Centered Counseling: Faculty Interview

Practice Reflect on mandatory reporting as you listen to the news. What if you were involved in a current publicized case? How would you handle it?  Look up the Code of Ethics for any other profession. How does it differ from the CHW Code? Complete Chapter 7 HW & DB in Blackboard Read Chapters 8 & 9

Resources: Image on slide 2 digital-drugs-binaural-beats by digitalbob8 is licensed under CC BY 2.0 Image on slide 3 Bring Light Bulb is available in the public domain under CC0 Public Domain Image on slide 8 and 9 Morals and ethics by Teodoraturovic is licensed under CC BY-SA 4.0 Video on slide 10 Confidentiality and Reporting: Faculty Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Image on slide 11 Checklist is available in the public domain under CC0 Public Domain Video on slide 14 Setting Professional Boundaries: Faculty Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 15 Setting Boundaries with Clients: Role Play, Counter, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License

Resources: Video on slide 16 Setting Boundaries with Clients: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 18 Self-Disclosure: Role Play, Counter, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 19 Self Disclosure: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Image on slide 26 Sad Eyes Dog by Circe Denyer is available in the public domain Video on slide 27 Giving Advice: Role Play, Counter, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 28 Giving Advice: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 31 Big Eyes, Big Ears, Small Mouth: Faculty Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License

Resources: Video on slide 32 Talking Too Much: Role Play Counter, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Image on slide 34 Screen door by Swoolverton is licensed under CC BY-SA 3.0

Acknowledgements: MoSTEMWINs Adapted from the Foundations for Community Health Workers, 2nd Edition (Berthold) with permission from Wiley Publishing by the Institute of Workforce Innovation of the Metropolitan Community College Kansas City and the Workforce Solutions Group of St. Louis Community College. Unless otherwise noted this material by St. Louis Community College is licensed under a Creative Commons Attribution 4.0 International License. This product is partially funded by the MoSTEMWINs $19.7 million grant from the U.S. Department of Labor Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership MoSTEMWINs