1. Navigating Ethics & Boundaries in Professional Practice

2. TODAY’S LEARNING OBJECTIVES
Gain understanding of:
Codes of Professional Conduct
Ethics
Boundary Crossings & Violations
Dual Relationships (CCMC & NASW)
Is This a Boundary Issue?

3. CODES OF PROFESSIONAL CONDUCT

4. CCMC & nasw Codes
Codes provide case managers (CCMC1) and social workers (NASW) with guidance on practicing ethically and honoring professional boundaries
We use such guidance in making decisions in our practice
Such decisions are not cut-and-dried 1.

5. ETHICS

6. What they are not…
Not the same as feelings: sometimes our feelings deviate from the ethical
Not the same as religion: non religious people have ethical standards
Not the same as following the law: laws may incorporate ethical standards but they may deviate from what is ethical
Not the same as societal standards

7. What they are…

8. Ethics & Laws
Ethics: Focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws.
Law: Legal justice; following the norms established by society through the political process (legislature).

9. Basic Ethical Principles
Justice (distributive, rights-based & legal)
Beneficence
Non-maleficence
Understanding/Tolerance
Publicity
Respect for the person

10. Beneficence & Maleficence
Beneficence: Do good
Non-Maleficence: Do no harm
Provision of net benefit with minimal harm
Honest assessment needed of risks and benefits
Involves respecting patient autonomy
Education and information essential

11. BOUNDARY CROSSINGS &
BOUNDARY VIOLATIONS

12. Boundary Crossings
Not intended to be harmful for client but can become exploitive and unethical
These crossing can be therapeutic such as holding a client’s hand
For example, clients who were former teachers, neighbors, or professionals

13. Boundary violations
Relationships that become unethical because they exploit, manipulate, deceive or coerce the client.
Sanders, Bullock & Broussard (2012)

14. DUAL RELATIONSHIPS (CCMC & NASW)

15. conflicts of interest
Disclosure of any current or potential conflict of interest
Resolution that puts clients' interests first
May require termination of the professional relationship with proper referral of the client
One particular issue is dual relationships

16. Dual Relationships

17. dual relationship categories
Intimacy (rewarding, fills emotional need)
Person benefit (monetary gain)
Emotional/dependency needs(our emotional needs interfere with client’s)
Unintentional/unplanned relationships (accidental crossings)
Altruism (actions based on wanting to help)
Reamer(2001)

18. Rural dual relationships
Assess current and future relationship on dimensions of power, duration, and termination
Determine extent of role incompatibility
Seek consultation
Discuss decision with clients in terms of possible ramifications
Gottlieb

19. Assessment of rural dual relationships
If assessment of power, duration, and termination all in low range, dual relationship may not be prohibited
If assessment of two or three dimensions are in low-to-mid range, proceed with caution
If any assessed dimensions in high range, then best to avoid
Gottlieb

20. IS THIS A
BOUNDARY ISSUE?

21. Questions to ask ourselves
Why am I taking (or considering taking) this action?
Why am I doing this at this time?
Why with this client?
Would I do the same with other clients? If not, what makes this situation different?
What needs are being met and whose needs are they?
How does this impact the treatment plan?
LIPSCHUTZ 2011

22. Questions to ask ourselves
How will the client/colleague interpret my actions?
What risks/benefits are involved?
Are there intermediate steps that can be taken (rather than an all or nothing approach)?
Am I documenting my decision making process and actions? Is there a reason I am excluding information?
LIPSCHUTZ 2011

23. Steps for Preventing & Managing Boundary Crossings
Recognize risk factors that may lead to boundary crossings, including:
a. Identification with patient or family by professional
b. Unresolved loss or grief on part of professional
c. Professional sense of failing the patient
d. Complex or dysfunctional patient–family dynamics
e. Patient and family mistrust of medical providers
MEIER ET AL. 2001

24. Steps for Preventing & Managing Boundary Crossings
2. Examine the presence of behaviors or emotions that indicate a boundary has been crossed, including:
a. Avoidance
b. Increased contact with client and family even when medically unnecessary
c. Negative feelings of anger, resentment, feeling trapped
d. Feeling a personal responsibility to save client
e. Feeling no other provider can care for client in same way
MEIER ET AL. 2001

25. Steps for Preventing & Managing Boundary Crossings
3. Consider how boundary crossing affects client’s care
4. Discuss the situation with a colleague, supervisor, or the interdisciplinary team
MEIER ET AL. 2001