1. 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 ©  by John Wiley & Sons, Inc., or related companies. All rights reserved.
Guiding Principles

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. Confidentiality and Reporting: Faculty Interview

15. 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.

16. 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.

17. 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

18. Setting Professional Boundaries: Faculty Interview

19. Setting Boundaries with Clients: Role Play, Counter

20. Setting Boundaries with Clients: Role Play, Demo

21. 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!

22. Self-Disclosure: Role Play, Counter

23. Self-Disclosure: Role Play, Demo

24. 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?

25. 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.

26. 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.

27. 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

28. 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

29. 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

30. 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

31. Giving Advice: Role Play, Counter

32. Giving Advice: Role Play, Demo

33. 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?

34. 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.

35. 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

36. Big Eyes, Big Ears, Small Mouth: Faculty Interview

37. Talking Too Much: Role Play, Counter

38. 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?

39. Your Approach to Client-Centered Counseling: Faculty Interview

40. 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

41. 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

42. 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

43. 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

44. 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
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