Presentation on theme: "Code of Professional Conduct"— Presentation transcript:
1 Code of Professional Conduct Clarifying and Establishing Boundaries in SCDMH Peer Delivered Services
2 Peers as ProvidersPeer delivered services are still seen as relatively newconcepts in formal systems of mental health care.Subsequently, concern has been voiced about:Dual relationshipsProfessional ethics and boundariesPeers being viewed as a “friend” rather than as a provider
3 Objectives The learning objectives for the peer support specialist in this training are to:Understand what dual relationships are & why they can be harmful.Understand SCDMH policies surrounding ethics & acceptable employee conduct.Clarify different types of boundaries.Understand how violations are harmful & how to recognize boundary violation patterns.Develop a framework for making better ethical decisions at work.
4 Dual Relationships A dual relationship is one in which roles are or could be mixed.For example:A peer support specialist is providing services to a client with whom they also have a friendship.OrA peer support specialist supervisor and case manager is the same person.
5 Ethics For the purpose of this training “Ethics” are: The hard and fast non-negotiable rules that allSCDMH employees are subject to.The Professional Code of Conduct that governall SCDMH Certified Peer Support Specialists (CPSS).
6 Boundaries require the use of good judgment. Boundaries are more ambiguous. They are:The unseen lines that you won’t crossUndefined physical and emotional distancesParameters that make you uniqueSelf imposed and self definedBoundaries require the use of good judgment.
7 Why all the Concern?All of the helping professions (medicine, nursing,psychology etc.) have established codes of conduct.This is because there exists an accepted inherent beliefthat not addressing these issues unacceptably increasesthe chances of harm and/or exploitation for a person(client) seeking services.
8 Concerns continued In as much as peer support specialist’s are SCDMH employees they should not be treated differently or haveadditional rules created to enhance or excuse them fromstandards of conduct that is expected of all SCDMHemployees or contracted affiliates.
9 Concerns continuedWhen acting within one’s role as a professional, a peermust be able to recognize, maintain and balanceboundaries that establish appropriate limits torelationships.If we lose our ability to be objective, wetend to become too involved in a person orsituation.
10 Concerns continued Good, healthy, and appropriate boundaries are the distance and emotional detachment that need to bemaintained to ensure an effective perspective on asituation.Maintaining personal boundaries is indicative of awell-trained, experienced peer supporter.
12 Ethical Practice, Duality & SCDMH Policy For all professional staff, it is uniformly contrary tostandards governing the practice and conduct of therespective health care professions to form personal orbusiness relationships with patients or clients under theircare.Directive Abuse, Neglect or Exploitation of Patients and Clients Prohibited
13 Ethical Practice, Duality & SCDMH Policy All employee relationships with patients and clients of theSCDMH should be therapeutic and professional in nature.In order to protect the welfare of patients and clients,encourage adherence to professional standards andpreserve the public image and integrity of the Department,the following guidelines are issued to supplement theprohibited conduct listed in paragraph III of the directive:Physical AbusePsychological AbuseNeglectExploitationDirective Abuse, Neglect or Exploitation of Patients and Clients Prohibited
14 Ethical Practice, Duality & SCDMH Policy It is the policy of the SCDMH that an employee shall notbe directly involved in providing care or treatment of apatient or client who is a friend or relative of theemployee.Employees are prohibited from forming social orbusiness relationships with patients or clients orformer patients or clients except as outlined inthe directive.Directive Abuse, Neglect or Exploitation of Patients and Clients Prohibited
15 Ethical Practice, Duality & SCDMH Policy Any professional employee who engages in conductcontrary to the standards published by the licensing body ofthe employee's respective profession is subject to disciplineby the Department.Directive Abuse, Neglect or Exploitation of Patients and Clients Prohibited
16 Ethical Practice, Duality & SCDMH Policy Regardless of the circumstances for the CPSS it is:Never appropriate to develop social relationships with those that you provide services to.Never appropriate to provide services to those with whom you have a pre-existing social relationship.Never appropriate to discuss work concerns /issues with clients whether you provide services to them or not.
17 SCDMH Certified Peer Support Specialist Code of Professional Conduct
18 SCDMH Certified Peer Support Specialist Code of Professional Conduct Peer Support is a helping relationship between mental healthclients and Certified Peer Support Specialists (CPSS)encouraging respect, trust, and warmth. The primaryresponsibility of Certified Peer Support Specialists is to helpempower clients to achieve their own needs, wants, and goals asspecified in the plan of care. As such they are committed toproviding and advocating for effective recovery based servicesfor the people they serve. SCDMH Peer Support Specialistsrecognize the importance of a Code of Conduct and are dedicatedto these standards being rigorously enforced.
19 SCDMH Certified Peer Support Specialist Code of Professional Conduct Certified Peer Support Specialists will not practice, condone, facilitate, or collaborate in any form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference or personal characteristic, condition, or state. Certified Peer Support Specialists will adhere to policies set forth by the South Carolina Department of Mental Health directive (4-100) Abuse, Neglect or Exploitation of Patients and Clients ProhibitedCertified Peer Support Specialists will maintain high standards of personal and professional conduct and shall not be party to any type of behavior, activity or policy that denies any client equal, non-discriminatory access to service and/or support; or which deliberately demeans the rights and/or dignity of any client, staff or colleague.
20 SCDMH Certified Peer Support Specialist Code of Professional Conduct Certified Peer Support Specialists will, at all times, respect the dignity, privacy and confidentiality rights of the clients they serve.Certified Peer Support Specialists will never engage in sexual/intimate activities with the clients they serve.Certified Peer Support Specialists shall avoid being drawn into dual (friendships, business bartering etc.) relationships with clients while the support relationship is ongoing.Certified Peer Support Specialists never give out their personal contact information to clients, but will ensure clients know how to contact them through the mental health center.
21 SCDMH Certified Peer Support Specialist Code of Professional Conduct Certified Peer Support Specialists shall only provide service and support within the hours, days and locations that are sanctioned by the mental health center.Certified Peer Support Specialists will conduct themselves in a manner that fosters their own recovery. In so doing, Peer Support Specialists are expected to conduct themselves in a professional manner and take the necessary steps to ensure their conduct does not negatively impact on the perception of this program.Certified Peer Support Specialists will openly share with clients and colleagues their recovery stories from mental illness as appropriate for the situation in order to promote and support recovery and resilience.
22 SCDMH Certified Peer Support Specialist Code of Professional Conduct Certified Peer Support Specialists will keep current with emerging knowledge relevant to recovery, and openly share this knowledge with their colleagues while refraining from giving advice or opinions that exceeds the scope of practice as defined in the Community Mental Health Services Provider Manual Section 2 Policies and Procedures 2-68 for the Peer Support Service.As state employees Certified Peer Support Specialists cannot accept personal gifts.
24 What are Professional Boundaries? Professional boundaries define effective and appropriateinteraction between professionals and the public theyserve.They are the space between the professional'spower and the client's vulnerability.They exist to protect both the professionaland the client.
25 Boundaries When we talk about interpersonal or workplace boundaries, it can sometimesbe a difficult concept to graspbecause it isn’t somethingthat we can see.
26 Boundaries But just because we can’t see a boundary doesn't mean that it isn’t there or thatit isn’t important.
27 Boundaries The definition of a boundary is the ability to know where you end and where anotherperson begins.
28 Boundaries are an Important Issue The amount & type of boundary responsibility you havewith a person differs according to the type ofrelationship:FriendshipColleagueClient
29 Friendship Boundaries This is a person that you know, like, and trust andone with whom you have a close personal connection. Itcan be a person with whom you are allied in a struggle orcause. The difference between this person and a clientyou work with is in the equitability of the relationship.No One has Power or Authority Over the Other
30 Colleague BoundariesA colleague is a fellow member of a profession. Thatperson may have power and authority over you, be equal inpower and authority to you or have less power andauthority than you.
31 Power and Authority Are Not Always Equal Colleague BoundariesLike the relationship with clients,professional or business relationshipscan become sticky because of thetypes of power and authority and whohas the ability to enforce them.Power and Authority Are Not Always Equal
32 Power and Authority Varies Client BoundariesWith respect to the SC Department of Mental Health theterm client is used to describe a person who is seekingprofessional psychiatric services. Depending on theircircumstances each individual may hold different types ofpower and authority.Power and Authority Varies
33 What are Boundary Violations? They are any behavior or interaction which damages aclient, a professional, and/or the professional interaction.The victimization and/or exploitation of a client by aprofessional.A betrayal of the sacred covenant of trust.Adapted from MINNESOTA BOARD OF NURSING, January 2000
34 How do Violations Occur? A boundary violation occurs when a professional,consciously or unconsciously, uses the professional-clientrelationship to meet personal needs rather than clientneeds.Adapted from MINNESOTA BOARD OF NURSING, January 2000
35 Who can be Harmed? Boundary violations can harm both the client and theprofessional. The ramifications can be widespread.Damage can extend to marriages, families, other clientscommunities, clinics, institutions, and the profession ingeneral.Adapted from MINNESOTA BOARD OF NURSING, January 2000
36 How Do Boundaries Help?Preservation of boundaries needs not be seen as a barrierto the professional relationship, but rather as a way tofacilitate it.Maintaining boundaries protects the safe space in therelationship thereby enhancing the building of the trustwhich is essential to enable clients to reveal their needs.Adapted from MINNESOTA BOARD OF NURSING, January 2000
37 Boundary Violations: Four Common Elements Four elements characteristically appear in boundaryviolations:SecrecyRole ReversalDouble BindIndulgence of Professional PrivilegeAdapted from MINNESOTA BOARD OF NURSING, January 2000
38 Secrecy Secrecy involves the professional keeping critical knowledge or behavior from the client and/or others orselectively sharing information.Example: A CPSS takes a client into their home and tellsthe client the CPSS’s employer cannot know about this orthey will lose their job.Adapted from MINNESOTA BOARD OF NURSING, January 2000
39 Role Reversal Role reversal occurs when the client takes care of the professional. They look to the client for satisfaction andgratification, rather than placing client needs first. Theymay not be consciously aware of this role reversal ormay attempt to justify it by contending his or her actions arefor the client's benefit.Example: A client becomes a CPSS’s A.A. or N.A.sponsor.Adapted from MINNESOTA BOARD OF NURSING, January 2000
40 Indulgence of Professional Privilege Indulgence of professional privilege involves usinginformation obtained in the relationship with a client for thebenefit of the professional.Because professionals can have or exert authority over aclient's situation, they can be at risk to extending thatauthority to intrude on the client.Adapted from MINNESOTA BOARD OF NURSING, January 2000
41 Indulgence continuedHaving access to information does not constitute a rightto it. Access is a professional privilege; it is not aprofessional’s right to use the information for one's ownbenefit.Example: A CPSS has been helping a client with severefinancial problems develop a budget. The CPSS usesthat information to try to purchase the client’s car belowmarket value.Adapted from MINNESOTA BOARD OF NURSING, January 2000
42 Double Bind A double-bind consists of messages that contradict each other while discouraging the receiver of the messages fromnoticing the difference.The client is left feeling caught in a conflict of interest andany attempt at resolution places the client at risk of loss.The client is torn between the desire to end the relationshipand the realization that this may also end any form of helpfrom the professional.Adapted from MINNESOTA BOARD OF NURSING, January 2000
43 Double Bind continuedThe double-bind contains an implied threat. A sense of guiltand fear of possible abandonment by the professionalblocks the client from taking action. The double-bindconstricts the client from using all available options andthus limits growth.Examples: (1) A CPSS makes negative comments aboutother CPSS’s caring for a client who has development oftrust as a therapeutic goal. (2) A CPSS’s tells a client thatthey may begin a personal relationship when the client is nolonger receiving services.Adapted from MINNESOTA BOARD OF NURSING, January 2000
44 Boundaries: Are You Helping or Are You Hurting? There are more gray areasthan black and white oneswhen thinking aboutboundaries.Peer specialists can makemore considerate decisionsif they will take time to thinkabout some of the basics of
45 Some Warning Signs of Boundary Violations Although not an exhaustive list, the following are helpful “cues”when setting professional boundaries:Choosing sidesMaking exceptionsKeeping secretsGiving or receiving giftsBorrowing or lending moneyFeeling as if no one but you has interest in the clientFeeling no but you will be able to assist the clientFeeling responsible for a client’s progress or failure“Owning” a client’s success’s or failure’sConfiding personal or professional issues or troubles
47 The “Yes’s” and the “No’s” If you are unsure about your interactions try asking yourself thefollowing questions: If you answer “No” to or “Yes” to 3 - 4you need to stop and evaluate your interaction.Is the relationship in the client’s best interest?Is this something that other CPSS’s would do?Can this affect my objectivity in providing care?Will this cause confusion in my role?
48 Still Unsure? If you are still unsure try asking: How would this appear to others (peers, family, colleagues and/or supervisor)?How does this appear to theclient?Is this decision making meuncomfortable?
49 Trouble Shooting Problem Spots: Time When, where, and how often you meet with aclient can be a troublesome issue. If it feelswrong it probably is, but ask yourself thefollowing questions to help clarifythe situation:How much time am I spending with a client?Does it vary from that spent with other clients?Am I spending "off duty" time with the client?
50 Trouble Shooting Problem Spots: Location If a client wants to talk or meet somewhere other than a centerapproved location you're beginning to slide toward a questionableboundary as well as possible policy violation. Try asking:Is the location of the interaction appropriate to the relationship?Would you provide peer services to other clients at thislocation?Is there is a legitimate need to meet?Have I made the meeting known to others and documented it?
51 Trouble Shooting Problem Spots: Gifts Accepting or giving a gift can get tricky. If you are unsure ask:Does the gift giving create a sense of obligationon the part of you or the recipient?Do you do this routinely as part of your job,regardless of the age or gender of the client?Is the gift of a personal nature that would only be to or from a specific person?Is there a department or center policy regarding gifts?
52 Asking For Help ? At all times, if you are unsure about a situation or confused about whether an interaction couldbe interpreted as a boundaryviolation you always should:Consult your supervisorRefer to SCDMH DirectivesConsult the Quality Assurance Coordinator or Client AdvocateConsult other clinical colleagues?
53 ALWAYS Remember… It is never a good idea to ignore a situation or interaction and just hope all works out.The chances are that if you are experiencingproblems other CPSS’s are too!
54 Thank You!!! Clarifying and Establishing Boundaries in SCDMH Peer Delivered ServicesFor more information Contact:Katherine M. Roberts, MPH DirectorSCDMH Office of Client AffairsBobbie Lesesne, CCETT Coordinator