1. The Great Balancing Act: Understanding the Ethical Challenges EA Professionals Encounter Libby Timmons, M.Ed., LISAC, CEAP President Southern AZ EAPA Chapter Clinical Outreach Specialist Life Healing Center etimmons@crchealth.com 1

2. Goals Identify "scope of expertise" challenges in clinical practice and EA Settings Identify strategies to protect your clients’ privacy with employers and other organizations Identify symptoms of clinician burnout and ways to address your own self care needs 2

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4. Ethics and Therapeutic Alliance Second to cost (81%), lack of confidence in the outcome of the service is the primary reason. (78%). Fewer than 1 in 5 cite stigma as a concern. http://www.apa.org/releases/practicepoll_04.html Clinical Psychology, 10 Psychotherapy; Bulletin, 40 Drop out rates average 47%; Therapists frequently fail to identify failing cases; 1 out of 10 clients accounts for 60-70% of expenditures Technique makes the smallest percentage wise contribution to outcome of any known ingredient. 4

5. Therapeutic Alliance Outcome of Treatment: 60% due to “Alliance” ([aka “common factors”] 8%/13%) 30% due to “Allegiance” Factors (4%/13%) 8% due tomodel and technique (1/13) 5

6. Ethics  Moral – determined in broad context of society (based on values)  Legal – agreed-on rules of society (dictates minimum standards of citizens)  Personal – one’s own values  Ethical – “moral principles adopted by a group to provide rules for appropriate conduct” (dictate minimum standards of behavior of professionals)  Best practice – ideal standards of behavior expected from a professional 6

7. Principle Ethics Respect for Autonomy – respect right of client to choose No maleficence – do not harm Beneficence – do good Justice – commitment to fairness Fidelity – fulfill responsibility of trust in relationship Veracity – truthfulness of counselor 7

8. Virtue Ethics 1) Integrity – do what is right because you believe it to be right 2) Discernment – recognize and respond to ethical situation 3) Acceptance of Emotion – recognize role of emotion in ethical decision making 4) Self-awareness – know self 5) Interdependence with community – values cannot be espoused without awareness of community 8

9. EAPA Standards of Practice Employee assistance program services shall be provided through a distinct, identifiable delivery system. The service delivery system must reflect the unique needs of the organization and its employees When considering the addition of any new services, the EAP must first determine that the new services are consistent with and will not damage the core EAP functions, goals, and objectives The employee assistance program shall require that all employee assistance personnel adhere to the EAPA Code of Ethics. 9

10. Confidentiality  Origins/importance of confidentiality  Only ethical issue to which an entire ACA code of ethics section is devoted  Belongs to the client (not counselor)  Vs privileged communication  Confidentiality and consultation  Confidentiality and supervision  Other professionals and organizations involved in treatment 10

11. NOTES Why keep progress notes?  Refresh memory (client leaves EAP engagement then returns)  Stay on target with goals  Conceptualize and process session  Share info with other professionals (don’t reinvent the wheel)  Have in case called to court months/years later Not keeping notes?  Expected in profession  Still must reveal info from memory in court  Taking notes helps you function professionally 11

12. NOTES  When keeping notes: Assume they will be read by others Include only appropriate content  Narrative notes should include:  Information reported  Observations (whether related to screening information or simply your observations)  Your impressions/conclusions resulting from review of data/information  Treatment needs, direction, plan, goals, etc. 12

13. Ethical Decision Making 1) Identify and define problem -there really is no such thing as an ethical emergency 2) Consider moral principles 3) Tune in to your feelings 4) Consult, Consult, Consult 5) Involve your client (throughout process) 6) Identify desired outcomes (rarely does only a single outcome emerge in ethical dilemmas) 7) Consider possible actions (ponder implications of each) 8) Choose and act 13

14. Competence  Law states minimum/code encourages maximum  Moral principle related is nonmaleficence  “practice only within boundaries of competence”  How do you know if/when a counselor is competent?  Competence directly tied to MALPRACTICE 14

15. Competence  Preparation (entering profession) Getting into a graduate program (standards?) Quality/requirements of program toward producing competent counselors  Regional accreditation of institution/CACREP Licensure/Credentialing (specializations)  Maintaining competence Continuing education Peer review (consultation/supervision) Knowing when to refer Diversity issues  Distress/Burnout/ Impairement 15

16. EAPA STANDARDS The employee assistance program shall require employee assistance professionals to maintain and upgrade their professional knowledge and skills, and shall support their efforts to do so. The organization shall adopt a written employee assistance program policy which defines the employee assistance program’s relationship to the organization, describes the program as a confidential resource, and states the scope and limitations of the program’s services. The employee assistance program shall establish procedures to determine when to provide short-term problem resolution services, and when to make a referral to professional and/or community resources. 16

17. Boundary Issues/Dual Relationships What are they? Why are they harmful? Boundary crossing vs. boundary violation 17

18. Dual Relationships  Bartering See code Diversity considerations  Social Relationships with clients Small town rule  Business/financial relationship with clients housekeeping, babysitting, carpentry  Accepting gifts from clients Consider context and client’s motivation for giving  Self disclosure  Physical contact  Sexual Dual Relationships  EA challenges- multiple levels of issues 18

19. Boundaries No is a complete sentence Most complaints are related to dual relationships and broken boundaries What do the code of ethics say about contact with a client after they end treatment? Ask 3 people- Consult, Consult, Consult Within your scope of practice 19

20. Technology Do you text with clients? Do you have a Facebook account? How do you back up your electronics? Some facts about internet misuse- chat rooms, blogs, games? Do you have an e policy in your policy and procedures? What is the EAPA policy on Technology 20

21. Resources Eric A. Schmidt, Ph.D., LPC, LCDC Ethics, Laws, and Adolescents: Confidentiality, Reporting, and Conflict M. Sherrill Luther Pitcairn and Kristi Ann Phillips American Counseling Association National Association of Social Workers American Psychological Association Employee Assistance Professional Association 21