Ethics and Boundaries in helping professions

What are Ethics? Law vs. Ethics Law – legal justice; following the norms established by society through the political process. Ethics – focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws.

Definitions Ethics: the “rightness” or “wrongness” of an action. Moral standards by which people judge and behave. Code: a “set” of personal ethical principles which guide an individual’s decision making. Professional code: a set of guidelines for performance and evaluation based on core values and principles of a profession. The code for social workers/case managers is the NASW Code of Ethics.

NASW Code of Ethics Accepted Standard of Practice for Social Work even if you are not a licensed Social Worker Ethical Standards and Responsibilities To Clients To Colleagues In Practice Settings To the Profession To Broader Society Purpose: To guide the conduct of social workers – social workers are to follow these standards regardless of professional function, work setting, or populations being served. Applicable to FSS case managers. Clients: Commitment: Promote the well being of clients, clients’ interests come first except where client may bring harm to someone else – child abuse, murder, etc. Self determination: Except where clients’ actions pose a “serious, foreseeable, and imminent risk to themselves or others Informed consent: Factors to consider – literacy, language, lack of capacity, receiving services involuntarily. Competence: Practice only within boundaries of education, license, certification, etc. Cultural competence and social diversity: Knowledge base of clients’ culture, sensitivity Conflicts of interest: Recognize and resolve conflicts, don’t take advantage to exploit others to pursue their personal, religious, political, business interests Privacy and confidentiality: Not solicit information that is unnecessary to providing services, get releases of information for only necessary agencies, be aware of where you discuss client info, make sure clients understand the limitations of confidentiality (who has access). Technology has had a significant impact on privacy and confidentiality (email, fax, cell phones, texting, social media – facebook). Access to records: Clients should generally have access to their records unless there is compelling evidence it would cause harm to the client. Requests and any denials should be documented in case notes. Sexual Relationships: NO. With clients, clients’ family members or other people the client has a close personal relationship with. Physical contact: Generally not a good idea. If you engage in physical contact you are responsible for setting clear, appropriate, and culturally sensitive boundaries. Sexual harassment: Includes sexual advances, solicitation, requests for sexual favors and other verbal or physical conduct of a sexual nature. Derogatory language: Written or verbal. Payment for services: Fees are to be fair and reasonable. Ability of client to pay needs to be taken into consideration. Lack of capacity: Safeguard interests and rights of clients. Interruption of services: Make reasonable efforts to continue services in the event social worker is not available. Termination of services: When services are no longer required. Don’t abandon clients. Non-payment – can terminate if client does not pose risk to self or others. Colleagues, etc.: Respect, Reporting of unethical conduct, Competency, Continuing Ed, Non-Interference of Private Conduct, Promotion of General Welfare of Society, Prevention of Discrimination and Exploitation.

NASW Core Values Service – helping people in need Social Justice – challenge injustice Dignity & Worth of the Person – respect for each individual Importance of Human Relationships – recognition and support Integrity – act honestly and responsibly Competence – increase knowledge Service: Empowering people, not rescuing them. Social justice: Advocate for clients, be aware of issues, be involved. Dignity and Worth: Culturally competent, appreciation of diversity, non-judgemental. Pay attention to tone of voice, expressions, etc. Integrity: Don’t make promises you can’t keep, follow through. Keep client information confidential. Competence: Do not practice outside your area of knowledge, continuing education

What are Boundaries? Clearly established limits that allow for safe connections between service providers and their clients Understanding of the limits and responsibilities of your role as a service provider Why talk about boundaries? Reduces risk of client exploitation Reduces client anxiety as rules and roles are clear Increases well-being of the worker Provides role model for clients

Importance of Boundaries Role modeling healthy communication and professional relationships Avoiding “rescuer” role Staying focused on your responsibilities to the client & provision of appropriate services to the client Avoiding compassion fatigue (burn-out) Maintaining healthy, functioning team (if working with other providers) Maintaining physical and emotional health and safety

Awareness Understanding your own needs Understanding your role as a professional Staying focused on the job at hand Taking care of your emotional and physical health Establishing clear limits

Boundary Crossings and Violations Intimate Relationships Personal Benefit Emotional and Dependency Needs Altruism Unavoidable Circumstances Planning social activities with clients Having sex with clients Having family members or friends as clients Being “friends” on facebook A client should not be your: Lover Relative Employee or Employer Instructor Business Partner Friend Blurred Boundaries: Self disclosure – telling client excessive personal info Giving or receiving significant gifts Dual or overlapping relationships Becoming friends Physical contact Provider/client providing services outside of work relationship – transportation, repair work, babysitting

Consequences of Poor Boundaries Compassion fatigue – service provider’s role may not feel sustainable Client may not receive appropriate or helpful services, which could affect his/her willingness or ability to accept future services Client may feel betrayed, abandoned, or poorly served Teamwork with other agencies may fall apart Service provider may act unethically Reputation of agency/profession may be compromised Client and/or service provider may be emotionally traumatized and/or put in physical danger Exploitative – Client may feel they “owe” you Impair judgment - Giving a client preferential treatment Negative consequences – loss of trust

Why is it difficult to establish/maintain boundaries? Dual relationships – service provider & client know each other from another setting Values conflicts – client and service provider do not share similar viewpoints on choices, relationships, lifestyle, etc. Vicarious trauma – service provider may experience trauma symptoms due to hearing about client’s experiences Playing the “hero” – service provider feels the need to “save” the client Service provider does not trust other team members, believes they can provide services better, believes they are the only ones who can help client

Dual Relationships Some dual relationships may be unavoidable You and a client belong to the same church A client lives in your neighborhood Your agency hires clients as staff or utilizes clients as volunteers Dealing with dual relationships: Open and honest discussion with client on the nature of your relationships Separate functions by locations- work, home, etc. Be aware of threats to confidentiality Understand your role as professional Volunteers? Who sees confidential info? Training? Clients as volunteers? What if you had a relationship prior to becoming a person’s service provider?

Questions to Ask in Examining Potential Boundary Issues: Is this in my client’s best interest? Whose needs are being served? How would I feel telling a colleague about this? How would this be viewed by the client’s family or significant other? Does the client mean something ‘special’ to me? Am I taking advantage of the client? Does this action benefit me rather than the client?

Signs of Boundary Issues Service provider & client begin referring to each other as friends Service provider receives gifts from or gives gifts to clients Sharing of home phone numbers or other significant personal information Asking/expecting socialization outside of professional setting Service provider reveals excessive personal information to client Discussion regarding work/clients dominates service provider’s social interactions with friends & family Service provider offers to provide assistance to client outside of his/her role (babysitting, transportation, etc.) Service provider finds him/herself “venting” with client about other service providers

Creating & Maintaining Boundaries As early as possible in the relationship, establish clear agreements regarding your role as a service provider, your availability, best ways to communicate with you, what to do if you see each other in a public setting When boundary issues appear, address them quickly and clearly being sensitive to your client’s feelings If you disclose personal information, make sure it is relevant to the client’s goals. Too much self-disclosure shifts the focus from the client to the provider and can confuse the client’s understanding of the relationship.

Creating & Maintaining Boundaries You may need to frequently clarify your role and boundaries to ensure understanding. Use your supervisor or professional colleagues as a sounding board if you have questions or concerns. Dual relationships – if you had a social relationship with a client prior becoming a service provider you must consider how future interactions impact a client’s confidentiality, and physical and emotional security.

Creating & Maintaining Boundaries Working with a team of providers: Promote positive, open communication and respectful sharing of information. Build trust and recognize that you can’t and shouldn’t be the only help your client receives. Take care of yourself! Make sure you are getting enough sleep, eat well, have healthy relationships, exercise and “leave work at work”.

Scenario A tenant, who is a mother of three children, is facing the breakup of her marriage. She is very concerned about how her children will respond, what steps she can take to minimize the disruption to their lives, and how she will manage financially with the reduced income. You decide to relate your own experience of divorce and the parenting issues which followed.

Scenario One of your favorite tenants moves out of your housing units. After several years you see the tenant at a shopping mall. She offers to take you to the food court for lunch to show appreciation for all the help provided during the time she lived in your housing project.

Scenario You have a tenant who recently started his own small tax accounting business. He has shared with you that the business is struggling and he does not know what he will do if the business fails. The client asks to prepare your taxes this year.

Resources & Contact Info http://www.naswdc.org/ (National Association of Social Workers) http://www.zurinstitute.com/ rthibado@wcap.org Carrie.poser@icalliances.org