Ethics and Boundaries

Ethics and Boundaries

Relationship-Based Practices with Families: No Easy Answers

2014 WI Infant and Early Childhood Mental Health Conference

Elizabeth Wahl, MSSW CAPSW

Purpose and Intended Outcomes

• Explore topic of ethics and boundaries together• Acknowledge the complexity of the work • Provide information from literature including history,

frameworks, and tools• Provide examples from WI practitioners• Provide agency considerations • Hear your stories • NOT to counsel, advise or tell you what to do

Our Time Together Today • Safety and confidentiality are critical• Offer what you need• Recognize my own limitations

My Earliest Experiences with Ethics and Boundaries

Words of Wisdom from an Expert Witness

Gary R. Schoener M. Eq., Licensed Psychologist reminds us:Think it throughDo your best, at times we make mistakesGet help from colleaguesStay EducatedBe Good EnoughHe also says…☺

Cornerstone of Ethics“Ethics is the defining quality that says I am a professional” Samara

Fritchman

• Beneficence – doing good, helping, promoting client well-being• Non-maleficence – avoiding harm• Autonomy – client’s input and role• Fidelity – consistent with what was promised• Justice – fair use of resources, welfare of client and others

Why Do Codes Exist?

• Protect families/clients• So the general public can hold the profession accountable• Summarize principles & core values of a profession• Provide guidance for practice• Socialize new practitioners

Codes Provide Some Parameters, but…

• Codes are necessary, but not sufficient• Ethical codes do not guarantee ethical behavior• Ethical decision-making involves a process - Comparative

ethicality of the options• There are No Answers, Only Choices – Mel Gray & Jill

Gibbons, 2007

Apitz, 2009, Fritchman, 2010

Standards for Conduct• Agency rules & policies • Ethics codes from Professional Association (e.g. NASW) – member or

not, codes apply• Codes of conduct – licensure boards• Laws & rules

Standard of Care: what a reasonable & prudent practitioner would do in the same or similar circumstances

Adapted with permission from Ethics & Social Media for Social Workers, 2014 – Gary R. Schoener, M.Eq., Licensed Pyschologist

Basic Definitions • Ethics – principles of conduct governing an individual or group; a

guiding philosophy, a theory or system of values • Boundaries – boundaries are limits within the professional relationship

that allow for safe connections based on the needs of individuals (Jacobson, 2002)

• Dual Relationships – Service provider has a professional relationship & personal, social, or business relationship with a client (Brandt, 2008)

• Conflict of Interest – Service provider’s involvement with a client poses confidentiality concerns (Brandt, 2008) Interferes with exercise of professional discretion and impartial judgment (Reamer, 2003)

Dual or Multiple Relationships Rural WI Communities

“Social workers should not engage in dual or multiple relationships with current or former clients in which there is a risk of exploitation or harm to the client. In instances where dual or multiple relationships are unavoidable, social workers should take steps to protect clients & are responsible for setting clear, appropriate & culturally sensitive boundaries.”

(NASW Code of Ethics)

Conflicts and Dilemmas

• Be aware of potential conflicts of interest with families and avoid them before they occur

• It is our responsibility to let families know when we see a potential or actual conflict of interest

(Allen & Tracy, 2008 Jacobson, 2002)

Ethical Codes – Key Topics • Confidentiality & Privacy• Informed Consent• Client Right to Self-Determination• Competence (Evidence-based practices, cultural competence)• Conflict of Interest• Record Keeping/Documentation• Relationships with Clients• Payment for Services• Termination of Services

Agency Infrastructure: how does our agency integrate safeguards into the

process to support staff?• Supervision• Orientation, Training,

Ongoing Professional Development

• Intake/First Contact• Initial Assessment • Service Planning

• Ongoing intervention• Team Meetings• Consultation • Transition/ Termination• Payment /Fiscal

Considerations • Crisis management

Examples in WI CY 2013WI Dept. of Safety & Professional Services https://online.drl.wi.gov/orders/searchorders.aspx

• County Social Worker - Emailed colleague to look at client Facebook account, confidentiality breach – terminated, Reprimanded – 90 days to complete continuing ed & submit proof, pay costs, $350

• Speech Pathologist - Stealing technology/personal property – charged and convicted with theft, Reprimanded - license suspended 30 days, pay costs $250

• Occupational Therapist - Intervention causing harm/negligence –engaged in unprofessional conduct, engaged in practice which may constitute danger to health, welfare, safety of client or public – Continuing Ed courses (4), Reprimanded, $755

• Social Worker, Child Welfare - Falsifying Documentation, added false case notes, overwhelmed with caseload – terminated, Voluntary Surrender of certificate to practice as social worker in WI & may be denied in future

Examples in WI CY 2013

• Social Worker/Substance Abuse Counselor – romantic relationship with client – License Revoked, may not apply in the future, pay costs $1,225

• Social Worker – failure to complete case management duties due to death in family. – Reprimanded – comply with supervisor’s agreement and 1 year plan

• Social Worker – failed to act on CPS investigation due to burn out

• Social Worker – accessed client data base without authorized use

Consequences • Harm to the client/family• Loss of professional license• Loss of membership in professional association• Legal problems/fees• Damage to agency’s reputation in the community• Personal safety could be compromised

(Kagle & Giebelhausen, 1994)

The Practice Continuum

Under-involvedDistant Cold Detached

Over-involvedEnmeshedIntrusiveDependent

What might cause us to drift?

Portage Project, CESA 5

Disclosing Personal Information

Benefits• Reciprocity• Trust-building• Normalize - parents won’t feel all alone in their journey• May help parents process their own feelings about their child

or their situation• Therapeutic in unique circumstances

Ask yourself, “Am I building capacity by sharing this information?” “Is it modest self-disclosure?” (Reamer, 2003)

Disclosing Personal Information

Dangers• Role-reversal, parents feel responsible for helping the

professional• Could make parents uncomfortable• Could confuse parents about boundaries• Focus should be on the family and child, it’s their time

(Reamer, 2003)

Opportunity for repair – “Rupture and Repair”

Boundary Questions to Consider in Your Agency

• Is it ok to share something personal about myself with a client? When? How?

• What if a family invites me to dinner or other family event – wedding, birthday, funeral?

• What are the technology boundaries – personal cell phone, texting, Facebook?

• Is it ok to give a client a hug or other touch? When?• What if the family is doing something that makes me uncomfortable?

Smoking, clothing choices (or lack of), discipline, profanity?• What if I’m concerned my co-worker is crossing a boundary, what should I

do?

Two Possible Constructs

Boundary Challenges • Gifts• Attending birthdays,

weddings, funerals• Social encounters

High Risk Boundary Challenges • Suicide intervention & safety

plans• Intervening with dangerousness• Challenge of talk, writings,

internet posts & what they mean• Duty to warn/protect

Agency Infrastructure: how does our agency integrate safeguards into the

process to support staff?• Supervision• Orientation, Training,

Ongoing Professional Development

• Intake/First Contact• Initial Assessment • Service Planning

• Payment /Fiscal Considerations

• Ongoing intervention• Team Meetings• Consultation • Transition/ Termination• Crisis management …

Ethical Decision-Making

“It is often not what is ethical vs. unethical, but the comparative ethicality of the options” Schoener, 2014

Decision Table or Chart ALCOHOL and DRUG SCREENING

Positives Negatives

Screen All Families

Do Not Screen Families

Screen Some Families

Genograms

Experienced Based Discussion Process

• What do I want help thinking about?• What are the strengths/capacities of those involved?• What are possible interpretations for what we are seeing,

hearing and feeling?• What do we need to know more about?• Next Steps

Module 2: Empowering Partnerships with Families to Support GrowthThe Family Service Credential, The Portage Project, CESA 5

Working through Crises or the Unexpected Questions to Ask Yourself

• What is the nature of the crisis? Immediate danger/safety?• Is the family asking me for help?• Do I feel competent addressing this issue?• Who should I go to if this is not something I am comfortable

taking on?• What can I learn from this experience to help me feel more

competent in the future?

(Rosin, et al, 1993)

Risk Management Protocol/Criteria

1. Be alert to potential or actual conflicts of interest2. Inform clients and colleagues about potential or actual conflicts of interest; explore

reasonable remedies3. Consult colleagues and supervisors, relevant professional literature, regulations, policies,

and ethical standards to identify pertinent boundary issues and constructive options4. Design a plan of action that addresses the boundary issues and protects parties involved

to greatest extent possible5. Document all discussions, consultation, supervision, and other steps taken to address the

boundary issues6. Develop a strategy to monitor implementation of action plan (Reamer, 2003)

Remember: We Don’t Have to Do This All Alone

Agency Infrastructure and Support for Reflective Practice

• Reflective practice and supervision is critical even for the most experienced professionals

• Is reflective practice and supervision part of our agency’s infrastructure?

• How can we build capacity for reflective supervision?• Where are the opportunities for on-going discussion about

ethics and boundaries? • How to build a safe and supportive environment/agency

culture to have these conversations?

PROFESSIONAL ASSOCIATIONSNASW Ethics Questions and Dilemmas

https://www.socialworkers.org/nasw/ethics/ethicsoepr.aspAs a service to members, the OEPR provides ethics consultations for current NASW members. Ethic consultations are a resource for members who are experiencing an ethical dilemma. We do not provide advice or tell members what to do. However, we do guide them through the Code and point them to the areas of the Code that address their concerns. We provide dialogue and considerations that allow members to make ethical decisions. We may also refer members to the appropriate areas if their questions do not appear to be related to ethics but are more related to legal issues or standards of practice.

Hours & Contact Info(800) 638-8799 ext. 231Tuesdays: 10:00am - 1:00pm (ET) Thursdays:1:00pm - 4:00pm (ET)

Chapter staff may contact the OEPR during regular business hours to ask questions. 

Self-Care ~Six Circles Sarah Strong, LCSW & Jim Van Den Brandt, LCSW

When we are held, we are able to hold those for whom we provide services

References• Allen S.F., Tracy E.M. (2008). Developing Student Knowledge and Skills for Home-Based Social Work Practice. Journal of

Social Work Education, Vol. 44 No. 1 p. 125-143. • Boland-Prom K., Anderson S.C. (2005). Teaching Ethical Decision Making Using Dual Relationship Principles as a Case

Example. Journal of Social Work Education, Vol. 41 No. 3 p.495-510. • Jacobson, G.A. (2002). Maintaining Professional Boundaries: Preparing Nursing Students for the Challenge. Journal of

Nursing Education, Vol. 41, No. 6 p. 279-281. • Joanne Bardnt- ACSW LCSW (2008). Clinical Associate Professor Emerita Social Work Field Program, University of

Wisconsin- Milwaukee. • Kagle, J.D., Giebelhausen, P.N. (1994). Dual Relationships and Professional Boundaries. Social Work, Vol. 39 No. 2 p. 213-220 • Gray, M. Gibbons, J. (2007). There are no Answers, Only Choices: Teaching Ethical Decision Making in Social Work.

Australian Social Work, Vol. 60,. No.2 p. 222-238.• Lea, D. (2006). “You Don’t Know Me Like That”: Patterns of Disconnect Between Adolescent Mothers of Children with

Disabilities and Their Early Interventionists. Journal of Early Childhood, Vol. 28 No. 4 p.264-282. • Reamer, F.G. (2003). Boundary Issues In Social Work: Managing Dual Relationships. Social Work, Vol. 48, No. 1 p. 121-133. • Rosin, P., Whitehead, A., Tuchman, L., Jesien, G., Begun, A. (1993). Strategies for Dealing with Unexpected Immediate Needs

or Crisis. Partnerships in Early Intervention: A Training Guide of Family-Centered Care, Team Building, and Service Coordination.

Acknowledgments

• Gary R. Schoener, M. Eq., Licensed Psychologist • Samara C. Kezele Fritchman, LMHC, JD, PhD• The Family Service Credential, The Portage Project, CESA

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Thank You

Elizabeth Wahl, MSSW [email protected]

608-265-9423