Doing the Right Thing.Doing it the Right Way.

A presentation on Ethics

By

Catherine McAlpine, Ph.D., LCSW-C

Workshop Objectives

• Learn about the types of support offered by para-professionals to people in recovery.

• Understand the difference between being a paid helper and being a peer or friend.

• Discuss dual relationships and how ethics protect employees and clients.

• Discuss boundaries and importance of supervision in our daily work.

Vision Statement from SAMHSA

• A Life in the Community for Everyone.

• Prevention Works.

• Treatment is Effective.

• People Recover.

Ethical relationships are a balancing act.

• We don’t know what we don’t know.

• Stay in your lane.• You’re only as sick as

your secrets.• Is it a secret or is it a

surprise.• Don’t ask, don’t tell.• Just between you and me

…• Can you keep a secret?• Confidentiality, anonymity

and privacy

Ethics

• Moral standards by which people judge and behave.

• A code of conduct, often supported by a profession, organization or other group.

Equity

• A state or quality or ideal of being, just, fair and impartial.

• Non-hierarchical

• People as a resource

• Ethics = Equity = Fairness

Unequal Power

• Exploitation is a risk when a relationship is unequal in power.

• Power inequality is always true …– Between an employer and employee– Between a supervisor and a supervisee– Between a business and a customer– Between staff and clients– Between criminals and victims– Between adults and children

Ethics Law for Public Employees

• Sec. 19A-15. Disclosure of confidential information; ex parte communication

• Soliciting or accepting gifts• Political activities of quasi-judicial officials• Equal Employment Opportunity• Nepotism• Favoritism• Non-discrimination: racism, age-ism, sexism or

any discriminatory or unequal practices

Rights and Responsibilities

• Privacy belongs to the person. Our duty is to respect and control personal information.– Confidentiality

• Avoid re-disclosure – sharing confidential information you gained from another source

• Exceptions: medical emergency, duty to warn, abuse

– Privacy– Protected Health Information– Need to know– Anonymity

Informed Consent

Protection of persons right to privacy and our duty to protect client information, avoid doing any harm, and always adhere to laws.– Person must know risks & benefits– Person must be competent or capable– Person is told of limits of confidentiality– No “to whom it may concern” or blank forms– Written consent is dated, time limited– May be revoked at any time by client– Some rules may not apply to Court Orders/DPP

Code of Federal Regulations

• CFR 42 Section 2 applies to Alcohol and Drug Treatment Services.– Documentation in case records or electronic– Use of e-mail & password protection– Responding to a subpoena– Client disclosure of criminal activity past/now– Client as “fleeing felon” or current criminal act– Handling an active arrest warrant– Sharing on a “need to know basis”– Exceptions – duty to warn, child abuse & medical emergency

HIPAA

• Health Insurance Portability and Accountability Act– Protected Health Information– Patients’ right to access own medical records– Business Partner Agreements– Sanctions for Violation– Must self-report any violation

www.hipaa.samhsa.gov

Code of Ethics or Code of Conduct

• Most professions have a Code of Ethics with clear advise against Dual Relationships.

• Most employers have a Code of Conduct.• Maryland has Professional Boards under which

all doctors, counselors and therapists must adhere to standards of education, training, supervision and conduct.

• Boards issue sanctions• You may be subject to personal liability as well

Do No Harm

• Iatrogenic – unintended harm caused by treatment or intervention that causes injury. Example:

• Fiduciary – a special duty or obligation to care for another person, usually some one who is not able to fully care for self. Example:

• Boundary Management – decisions that increase or decrease intimacy in the relationship. Example:

• Conflict of Interest or Dual Relationship – having more than one role with the person. Example: employer & relative, coach & selling products

Dual Relationships

• Has a primary professional role with a person while – 1) at the same time, – 2) at an earlier time or – 3) at a later time has another type of relationship

• Potential for harm might not be apparent in the moment.– Must weigh anticipated and unanticipated effects– Use supervision and a skill called “reflective

awareness” to discuss boundaries and blurred boundaries or when a line has or may be crossed.

Risks of Dual Relationships

• Law suits or formal complaints, lose license• Impaired judgment or impaired decision making• Injury to self or other, including to reputation and

other relationships• Loss of employment (being fired)• Charges of harassment or sexual assault• Giving preferential treatment• Using emotional abuse or other exploitation• Being exploited or otherwise harmed yourself

Documentation

• If a tree falls in the woods and no one hears it, did it really fall?

• Burden of paperwork v. accountability

• Future standards for fees & reimbursement

• Mutual protection

• Validates importance of peer-to-peer work

• Confidentiality, need to know & KISS

Supervisor Ethics

• Uphold highest professional standards• Seek professional help when work or personal

issues may interfere• Conduct is as a role model & Agency rep.• Reinforce zero tolerance for interactions that are

not courteous, compassionate and/or professional.

• Uphold vision, values & principles of wellness• Treat supervisee, colleagues, peers & clients

with dignity and respect• Adhere to all standards & regulations of privacy

Sexual HarassmentSexual Harassment• Harassment is verbal or physical conduct that demeans or Harassment is verbal or physical conduct that demeans or

shows hostility or aversion toward an individual for any shows hostility or aversion toward an individual for any reason. It is the policy of CCAR to prohibit all forms of sexual reason. It is the policy of CCAR to prohibit all forms of sexual and/or other harassment in the workplace. and/or other harassment in the workplace.

• Harassing conduct includes: slurs, negative stereotyping, Harassing conduct includes: slurs, negative stereotyping, threatening language, and intimidating or hostile acts. threatening language, and intimidating or hostile acts.

• Sexual Harassment means any unwelcome sexual advance. Sexual Harassment means any unwelcome sexual advance. – Verbal:Verbal: Suggestive comments, threats, insults and jokes Suggestive comments, threats, insults and jokes– Non-Verbal:Non-Verbal: Making suggestive or insulting noises, obscene gestures, Making suggestive or insulting noises, obscene gestures,

whistling, and displaying derogatory or pornographic posters, cartoons whistling, and displaying derogatory or pornographic posters, cartoons or drawings. or drawings.

– Physical:Physical: Unwelcome touching, brushing, hugging, kissing, pinching. Unwelcome touching, brushing, hugging, kissing, pinching. • It is your right to work/volunteer in an environment free from It is your right to work/volunteer in an environment free from

harassment.harassment.

Slide 2.6

Liability and Sexual HarassmentLiability and Sexual Harassment

• Harasser is always liable.Harasser is always liable.

• Employer is liable for harassment by Employer is liable for harassment by supervisors and managers and quid pro supervisors and managers and quid pro quo harassment. quo harassment.

• Supervisor or manager is liable when Supervisor or manager is liable when harassment occurs and no quick, effective harassment occurs and no quick, effective action is taken. action is taken.

Slide 2.8

A Slippery Slope

• Defense Mechanisms are a signal that things are not going so great.

• Pay attention to your own DMs or gut feelings. You may become defensive!

• Listen for the “yes, but …” phrase– Denial– Externalizing– Rationalizing

Stop/Look/Listen

• Remember when you learned to cross the street? There were 3 simple rules: stop, look and listen.

• Use your eyes, your ears, your brain and your gut. Check-in and look around before you reply.

• Slow it down. You don’t have to have or give all the answers.– Say what you mean– Mean what you say– Don’t say it mean

Types of Support

• Emotional support – show empathy, caring• Informational support – give health or wellness

information, educate or help acquire new skills (may be feedback or role play)

• Instrumental support – concrete or “hands-on” assistance with a task or offering to help with transportation or childcare

• Affiliation support – opportunity for positive social connections, learn social and recreational skills in a sober environment

Social Emotions are Human

• Checking our Own Attitudes & Feelings– Condemning – contempt, anger, disgust– Praising, gratitude– Sympathy– Compassion– Empathy– Guilt– Shame– Embarrassment– Going native

What is My Role?

• It’s not about me, it’s about you = Recovery Support– Sponsor– Counselor/Therapist– Pastor/Clergy– Nurse/Doctor– Friend/Friends with Benefits– Mentor– Companion or “Big Buddy”

What is My Goal?

• Employer expectations• Volunteer or unpaid staff person• Supportive Listener• Outreach• Education• Information• Crisis Intervention• Problem Solving

Telling Your Story

• Myths and the Classic Hero’s Story

• The myth of the American West (my way)

• 12 Step “sharing” and “war stories”

• Goal = Experience, Strength and Hope– Who is going to feel better?– Is this a teaching moment (person receptive)?– Is it more about me than about you?– Is there a risk of harm now or in the future?

Exercise

• Think about these last few hours. Our conversation have been about change. This has the potential for a big impact on YOU, your life.– How are you feeling? – What coping skills are you using?– Where do you plan to seek out support? – Who will help you the most?

International Consortium of Reciprocal Certification (ICRC)