Bill Johnson – Administrator, ICPG Bartonville, IL 217 652

Bill Johnson – Administrator, ICPG
Bartonville, IL
217 652-9611
[email protected]
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Schedule
8:15 – 9:00
Welcome/Introduction
9:00 – 9:30
Updates
9:30 – 10:30
Workshop
10:30 – 10:45 Networking
10:45 – 12:15 Workshop Continued
12:15 – 12:30 Question/Answer
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OBJECTIVES
v  Define terms
v  Question-Discuss-Interact
v  Discuss a code of professional practice
v  Become familiar with tools for ethical
decision making
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OBJECTIVES
(con’t)
v  Provide opportunities to analyze ethical
dilemmas
v  Examine actual ethical complaints made
to different systems
v  Increase awareness of ethical issues
5
Do You have an Open Mind?
FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE
EXPERIENCE OF MANY YEARS
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Special Thanks
Critical Incidents: Ethical Issues in the Prevention
and Treatment of Addiction
Authors:
William L. White
Renee M. Popovits
The Greatest Threat to our Field
Bill White – Critical Incidents Second Edition
“The greatest threat to our field comes not from changing
behavioral health trends, external regulation, or changing
methods and levels of reimbursement, but from our own
failure to define our work and ourselves. Ideological splits,
competition, and a marked propensity for organizational
isolation make it unlikely that the whole field will come
together to fully back a single set of ethical standards and
values. There is however, a movement within local
programs to more clearly define ethical standards and
processes of ethical decision-making.”
AODA Credentialing
§  AA - 1930’S (Founding principles
published in 1938)
1. 
2. 
3. 
4. 
5. 
We admitted we were powerless over alcohol
We got honest with ourselves
We got honest with another person in confidence
We made amends for harms done to others
We worked with other alcoholics without demand for
prestige of money
6.  We prayed to God to help us to do these things as best we
could
Minnesota Model
Pioneer House ( Given two books at
admission AA Big Book & 12 x 12)
Hazelden 1949
Willmar State Hospital (MN) 1954
Ø  created a means to credential recovering
alcoholics to work in the field
Ø  acceptance of the recovering alcoholics as a
legitimate member of an alcoholism treatment
team
Ø  clarifying boundaries between the status as AA
member and responsibilities as a counselor
WHO ARE WE?
§ 
§ 
§ 
§ 
§ 
Believe in all 10 commandments
Call in Sick when they are not
Lie Regularly (Work or Home)
Married people having/had an affair
Don’t know next door neighbors
72%
§  Say there are no American heroes
70%
“Moral Regions”:
New England:
#1 in Giving to Charity
#1 in Cheating on Spouses
Patterson & Kim
“The Day America Told the Truth”
13%
50%
91%
31%
WHO ARE WE?
§ 
§ 
§ 
§ 
§ 
§ 
Believe in all 10 commandments
Call in Sick when they are not
Lie Regularly (Work or Home)
Married people having/had an affair
Don’t know next door neighbors
Say there are no American heroes
10%
90%
100%
61%
85%
90%
Behavioral Health Program Chicago, IL
100 Participants
“You cannot make yourself feel
something you do not feel, but you
can make yourself do right in spite
of your feelings.”
Pearl S. Buck
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What Is Ethics?
Ethics refers to principles that define
behavior as right, good and proper. Such
principles do not always dictate a single
"moral" course of action, but provide a
means of evaluating and deciding among
competing options.
Michael Josephson
The Josephson Institute for Ethics
14
Ethics vs. Values
(con’t)
“Ethics" and “Values“-Not interchangeable
terms
v  Ethics-How a moral person should behave.
v  Values-Inner judgments that determine
how a person actually behaves.
Michael Josephson
The Josephson Institute for Ethics
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Ethics vs. Values
(con’t)
Values concern ethics when they pertain to
beliefs about what is right and wrong. Most
values, however, have nothing to do with
ethics. For instance, the desire for health and
wealth are values, but not ethical values.
Michael Josephson
The Josephson Institute for Ethics
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Why Be Ethical?
v  Inner Benefit-Virtue is its own reward.
v  Personal Advantage-It is prudent to be
ethical. It’s good business.
v  Approval-Being ethical leads to selfesteem, admiration of loved ones and the
respect of peers.
Michael Josephson
The Josephson Institute for Ethics
17
Ethics - internet
A certified counselor text messages with
her clients about non-counseling issues.
A certified counselor text messages sexual
Explicit texts with a client.
A certified counselor “friends” a client on
face book.
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Moral
v involving right and wrong:
relating to issues of right and wrong and
to how individual people should
behave
Moral
v derived from personal
conscience:
based on what somebody’s
conscience suggests is right or
wrong, rather than on what rules or
the law says should be done
Moral
v according to common standard of
justice:
regarded in terms of what is known to be
right or just, as opposed to what is
officially or outwardly declared to be right
or just
(a moral victory)
Moral
v encouraging goodness and
decency:
giving guidance on how to behave
decently and honorably
Moral
v  good by accepted standards:
good or right, when judged by the
standards of the average person or
society at large
Why Be Ethical ?
(con’t)
v  Religion-Good behavior can please or
help serve a deity.
v  Habit-Ethical actions can fit in with
upbringing or training.
Michael Josephson
The Josephson Institute for Ethics
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ETHICS: What’s the Big Deal?
v  Career Survival
v  Community view of AODA Treatment
v  Media Coverage
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ETHICS: What’s the Big Deal?
(con’t)
v  In-House Dissension
v  Personal Stress
v  It’s the “Right Thing to Do”
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Situation # 1
A certified counselor is privy to information
that may indicate that a certified co-worker
has violated one or more IBC Codes of
Ethics. What should that counselor do?
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Ethical Decision Making Process
1) 
2) 
3) 
4) 
5) 
6) 
7) 
Whose interests are involved
Who can be harmed
Assess interest vs. harm
Identify and clarify relevant Standards, Laws and or
Policies
Discussion Summary
Conclusions and Recommendations
Outstanding Issues
What about these situations?
A)
1.
2.
B)
1. 
2. 
A client tells his certified counselor that he’s started a side job
doing handyman tasks. The counselor hires his client to do
some work.
What are some potential problems with this?
Is this an ethical violation?
A client has a job selling cars, and offers you a good deal if
you’ll come and see him.
What are some potential problems?
Is this an ethical violation if you in fact buy a car from him?
C) 
You’re at the grocery store and checking out, when you recognize the
clerk as a current client of yours.
1.  Is this the same situation as the car salesman?
2.  Is there a time and place where you do business with a current client?
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Jennifer Kenney Hollander, Ph.D.
Surveyed 7 states out of 30 states that
applied
AZ, IL, Maine, Maryland (DC), MT, NC. WY
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Clients
v  Who are our clients?
v  How and when does one achieve the
status of client?
v  Once attained, when if ever, does one
lose the status of client?
v  Does a client stay a client for ever?
31
Clients
(con’t)
v  What does your code of ethics say about a
“Client”?
v  What do you say about who is your client?
v  What does your code of ethics say about
having an intimate relationship with a client/
ex-client?
32
42 CFR 2.12
Patient as defined by federal
confidentiality law, and consistently
used across all the states.
… “any individual who has applied for or been
given a diagnosis for treatment for alcohol
or drug abuse at a federally assisted
program and includes any individual who,
after arrest on a criminal charge, is
identified as an alcohol or drug abuser in
order to determine that individuals eligibility
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to participate in a program.”
BREAK FOR
Multiple Relationship Survey
As it relates to your clients
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Ethics of Multiple Relationships
v Accept a gift worth less that $10
v Attend the same 12 meeting as a current
client
v Go out to eat with a client after outpatient
group
35
Ethics of Multiple Relationships
(con’t)
v  Serve as a clients 12-step sponsor
v  Lend a client cigarettes or a small amount
of money. (Less than $10)
36
Ethics of Multiple Relationships
(con’t)
v Hire a client to baby-sit your children
v Keep quiet about a clients relapse to other
treatment team members
v Disclose one client’s progress to another
client
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Ethics of Multiple Relationships
(con’t)
v  Decline to write a job recommendation or
letter of reference for a client.
v  Avoid attending the same religious or
social activity as a client.
v  Talk about a client’s therapy issues to
colleagues outside the treatment team.
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MR – Incident
Sharee, a withdrawn adolescent who has
been slowly emerging from her shell,
enters your office and offers you a gift
she’s purchased.
The gift is a silk flower in a small glass
vase.
Sharee says this is her way to say
thanks for “hanging in with her.”
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“Ethics Check” Questions :
v  Is It Legal ?
v  Is it is Balanced ?
v  How will I feel about myself ?
Blanchard and Peale
“The Power of Ethical Management”, 1988
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MR – Incident Sharee
(con’t)
v What’s your response?
v Any situation where refusal of the gift
would be clinically or ethically
inappropriate?
v What kind of protocol should guide our
decision regarding acceptance or refusal of
gifts from clients?
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What To Consider
v Value of the gift?
v Purpose of the gift?
v Circumstances under which the gift was
given?
v What is the position and sensitivity to
influence of the person receiving the
gift?
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What to Consider
(con’t)
v What are accepted business practices in
the area?
v What is the company policy?
v What is the law?
43
ASK FOR HELP & ACT
v A – Identify Alternatives
v C - Project Consequences
v T - Tell your story (Consider your
Defense)
Michael Josephson
The Josephson Institute for
Ethics
44
Situation # 2
A certified counselor is named as a
corroborator in an ethics complaint
received by XXX, and XXX contacts them for
information.
What is that counselor’s
responsibility?
45
Responsibility
to Clients
Alcohol and drug counselors respect the rights of
those person seeking their assistance and make
reasonable efforts to ensure that their services are
used appropriately
46
Responsibility to
Clients (con’t)
v Alcohol and drug counselors don’t discriminate
against or refuse professional service to anyone
on the basis of race, gender, religion, national
origin or sexual orientation.
v Alcohol and drug counselors avoid bringing
personal or professional issues into the
counseling relationship. Through an awareness of
the impact of stereotyping and discrimination, the
counselor guards the individual rights and
personal dignity of clients.
47
Professional competence and integrity
Acting in such a manner as to
present a danger to public health or
safety, or to any client including, but
not limited to, impaired behavior,
incompetence, negligence or
malpractice
48
Responsibility to the profession
Alcohol and drug counselors report the
unethical conduct or practice of others
in the profession to the appropriate
certifying authority.
49
(Cont)
Using any alcoholic beverage to the
extent or in such manner as to be
dangerous or injurious to self or
others, or to the extent that such use
impairs the ability of such person to
safely provide professional service
50
Exercise #1
Handouts
Group Work
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Do you have a responsibility?
You and a friend are out on the town in
another city away from where you
work. Across the room you see a coworker from your agency, a highly
visible and self-proclaimed recovering
alcoholic, drinking, what appears to be
a beer.
52
Making Ethical Choices
v The Bell
v The Book
v The Candle
Michael Josephson
The Josephson Institute for Ethics
53
Do you have a responsibility ?
(con’t)
v  What would you do?
v  Would you communicate directly with the
staff person and, if so, what would be the
nature of your communications?
v  Would you communicate what you had
observed to anyone else, e.g., your
supervisor?
54
Legal and Moral Standards
Grounds for discipline
Conviction of any felony or misdemeanor, excluding
minor traffic offenses, whether or not the case is
pending an appeal. A plea or verdict of guilty or a
conviction following an Alford Plea, or any other plea
which is treated by the court as a plea of guilty and all
the proceedings in which the sentence was deferred
or suspended, or the conviction expunged shall be
deemed a conviction within the meaning of this
section.
55
Alford Plea
v In an Alford Plea, the criminal defendant does not admit
the act, but admits that the prosecution could likely
prove the charge. The court will pronounce the
defendant guilty. The defendant may plead guilty yet not
admit all the facts that comprise the crime. An Alford
plea allows defendant to plead guilty even while unable
or unwilling to admit guilt. One example is a situation
where the defendant has no recollection of the pertinent
events due to intoxication or amnesia. A defendant
making an Alford plea maintains his innocence of the
offense charged. One reason for making such a plea
may be to avoid being convicted on a more serious
charge. Acceptance of an Alford plea is in the court's
discretion.
56
BEN
Ben, a staff member who conducts
remedial education classes for impaired
driving offenders at your agency, was
arrested Saturday night for impaired
driving.
57
BEN
(con’t)
v  He was not on duty.
v  There was no agency car involved in the
incident.
v  To the best of our knowledge Ben has no
history of alcohol or other drug related
problems and did not self-identify as recovering
when hired.
58
So what happens now ?
The same weekend, Fred, a staff member who
works in the mental health division at the
same agency, was also arrested for the
same charges.
59
So what happens now ?
(con’t)
v  Should Fred and Ben be subject to the
same disciplinary action?
v  Does this behavior constitute private
behavior?
v  Should our response to Ben and Fred be
different?
60
A Certified Alcohol and Drug
Counselor bartered office support
services in lieu of payment for
counseling.
Provider hired husband of recipient of
services to remodel kitchen!
61
Bartering Services in Lieu of
Payment for Counseling
v  Is there ever a case when this would be
acceptable?
v  Who would/could be affected by this activity and
how?
v  Client alleged they didn’t get paid what was
promised.
v Provider alleged the services were of poor quality
and not done correctly.
62
Dual Relationships
Alcohol and drug counselors are aware of their influential
position with respect to clients, and they avoid exploiting
the trust and dependency of such persons. Counselors,
therefore, make every effort to avoid dual relationships
with clients that could impair professional judgment or
increase the risk of exploitation. When a dual relationship
cannot be avoided, counselors take appropriate
professional precautions to ensure judgment is not
impaired and no exploitation occurs. Examples of such
dual relationships include, but are not limited to, business
or close personal relationships with clients and/or their
family members.
63
Responsibility to clients
v Alcohol and drug counselors avoid bringing
personal or professional issues into the
counseling relationship.
v Alcohol and drug counselors do not use their
professional relationships with clients to further
their own interests.
v Alcohol and drug counselors respect the
integrity and protect the welfare of the client.
The counselor, in the presence of professional
conflict, is concerned primarily with the welfare
of the client.
64
A Certified professional admitted to
borrowing money from a client who he
transported in a van for services at
another agency.
65
v  Is there ever an opportunity when a
professional counselor should borrow
money from a client of their agency?
v  What’s your agency policy on this
issue?
v  What about a small amount of money?
66
Legal and Moral Standards
AODA Counselors uphold the law and have high
morals in both professional and personal conduct.
Is it ever OK to Engage in sexual conduct with a
client during a period of time in which a
professional relationship exists?
67
Emotionally Dependent
CHAPTER 709 SEXUAL ABUSE
Emotionally dependent" means that the nature of the
patient's or client's or former patient's or client's
emotional condition or the nature of the treatment
provided by the counselor or therapist is such that
the counselor or therapist knows or has reason to
know that the patient or client or former patient or
client is significantly impaired in the ability to
withhold consent to sexual conduct
68
PATIENT
"Patient or client" means a person who receives
mental health services from the counselor or
therapist.
69
FORMER PATIENT
"Former patient or client" means a person
who received mental health services from the
counselor or therapist.
d. "Mental health service" means the
treatment, assessment, or counseling of
another person for a cognitive, behavioral,
emotional, mental, or social dysfunction,
including an intrapersonal or interpersonal
dysfunction.
70
Sexual Contact
Includes any of the following, whether or not
occurring with the consent of a patient or
former patient:
v  Sexual intercourse
v  Kissing or intentional touching by the
professional
v  Kissing or intentional touching by the
patient
71
NOW WHAT?????
An addictions treatment agency well know for
its warm, family atmosphere, has evolved a
ritual of frequent hugging between staff
members and clients.
72
NOW WHAT?????
(con’t)
v  Are there situations in which such
familiarity could be experienced by the
client as disrespectful or a violation of
appropriate boundaries in the therapy
relationship?
v  How can we be supportive and nurturing
without being disrespectful and invasive?
73
NOW WHAT?????
(con’t)
v  Is there a value of standard that helps staff
define appropriate and inappropriate
touch ?
v  Does the value or standard explicitly define
the parameters of touch as a component of
counseling technique and counseling
relationship?
74
Sexual Contact
Sexual contact does not include conduct that
is a part of standard medical treatment of a
patient, casual social contact not intended to
be sexual in character, or inadvertent
touching.
75
Therapeutic Deception
Representation by a
psychotherapist, unlicensed
health professional, or unlicensed
mental health professional that
sexual contact with the
psychotherapist, unlicensed
health professional, or unlicensed
mental health professional is
consistent with or part of the
patient's or former patient's
treatment.
76
Professional Competence &
Integrity
Alcohol and drug counselors maintain high
standards of professional competence and
integrity.
.
77
(Cont.)
v Alcohol and drug counselors do not
diagnose, treat, or advise on problems
outside the recognized boundaries of their
competence
v Failing to obtain an appropriate
consultation or make an appropriate
referral when the problem of the client
is beyond the alcohol and drug
counselor's training, experience or
competence.
78
???????????
v Sex
v Internet
v Food
v Gambling
v Pain
v  Other
v Shopping
79
Situation # 3
A certified counselor has been named in an
ethics complaint to XXXX, and XXXX has
contacted them for more information. What
should that counselor do?
80
81
Break for Work paper
“Communications Exercise”
82
Nature of Verbal Communications
v  “You’re very attractive.
v  Using profanity with or directed at client.
v  “You’re very special to me.”
83
Nature of Verbal Communications
(con’t)
v  “I like you.”
v  “There are times I forget you’re a client.”
v  Talking with the client about sexual issues.
84
Nature of Verbal Communications
(con’t)
v Increasing frequency or duration of client
interviews.
v Calling client by his/her first name.
v “We’ve become very close since we started
seeing each other.”
85
Nature of Verbal Communications
(con’t)
v  Asking\Answering client questions about
your personal life.
“I’m going through a difficult divorce
myself.”
v Asking questions about the client’s
personal life not related to presenting
problem(s).
86
Nature of Verbal Communications
(con’t)
v  Using the client’s time to discuss
counselor’s interests/hobbies.
v “I’ll always be there for you.”
v  Using terms of endearment with a client,
e.g., Honey, Sweetheart, etc.
87
Nature of Verbal Communications
(con’t)
v Calling the client at home.
v Meeting the client outside the office.
v “I love you.”
88
The Boundaries of Physical Touch
v  Frontal Hugs (face to face full
body)
v  Holding a client on your lap
v  Kissing a client on the cheek
v  Touching a client
89
The Boundaries of Physical Touch
(con’t)
v  Asking client for a massage
v  Touching a clients knee
v  Side Hug (One arm around client)
90
The Boundaries of Physical Touch
(con’t)
v  Touching clients face as if wiping away a
tear or touching cheek
v  Brief holding of hand
v  Massaging a clients face, neck/shoulders
91
The Boundaries of Physical Touch
(con’t)
v  Kissing a former client on the lips
v  Sexual intercourse with clients relative
92
Self-Help and Confidentiality
You attend self-help meetings where a number of your
clients / patients also attend.
During a meeting a client preparing to be discharged as
treatment complete “cops” to the fact that he’s been
shooting drugs for the last year. Somehow he’s been
able to doctor the drops so that his use hasn’t been
exposed! He’ll be released off federal parole when your
agency discharges him “Treatment Complete” this
week!
93
Self-Help and Confidentiality
(con’t)
v  What is your responsibility?
v  “What you hear here - let it stay here when you leave here?
v  Does your responsibility as a
professional counselor end when you walk
out the door of you place of employment?
v  Who and what could be affected by your
decision?
94
???????
“There’s something very important that I
need to tell you! But you’ve got to promise
that it will stay just between you and me !!”
v  Can you ever make that promise?
v  How should you deal with this
situation?
95
96
Complaint #1
CADC, who used to be hair stylist before
going into counseling, assists a past client
(of less than one year) with wedding
planning (she was the unofficial planner for
their church and also did the woman’s hair
for the wedding.
97
Complain #2
CADC who is filling in with a group, makes
disparaging remarks about another certified
counselor (the one who usually runs the
group)!
98
Complaint #3
Client tells the counselor that he is out of
food and needs groceries , and his payday
isn’t for a few more days. The counselor
gives the client $25.00 and goes with him
into the store. Client pays him back the next
week at their appointment.
99
Complaint #4
A client tells his certified counselor that he
has started a side job doing handyman
tasks. The counselor hires his client to do
some yard work. Is this an ethics violation?
100
Complaint #5
A client calls her counselor to say she can’t
make her appointment later that morning
because she is snowed in, has an injury and
cannot shovel her driveway to get out. The
certified counselor gets a break and heads
to her house to shovel the driveway. Is this
an ethics violation?
101
Complaint #6
A certified counselor receives an OWI ….
should he report this to IBC? Why?
102
Complaint #7
A certified counselor lets her certification
lapse, but continues to use “CADC”
following her name. Is this an ethics
violation?
103
Complaint #8
A certified counselor text messages with
her clients about non-counseling issues. Is
this an ethics violation?
104
Complaint #9
A certified counselor text messages
sexually explicit texts with a client. Is this
an ethics issue?
105
Complaint #10
A certified counselor “friends” a client on
Facebook. Is this an ethics violation?
106
Complaint #11
A certified counselor begins counseling
with a friend of her son’s (and she knows
they are friends). Is this an ethics violation?
107
Complaint #12
A certified counselor’s agency sends him to
a training with multiple break-out sessions
throughout the day. He received his
certificate of completion indicating
attendance the full day, but the agency later
finds out that he actually went shopping
during 2 of the break-out sessions. Is this
an ethics violation?
108
Complaint #13
A female certified counselor makes frequent
derogatory remarks about men to her
groups. Is this an ethics violation?
109
Complaint #14
A certified counselor finds out that a client
is not properly caring for her child and calls
DHS. Is this an ethics violation?
110
Complaint # 15
A certified counselor is told that a friend/
relative may have been admitted so checks
the company computer records to verify
this. Is this an ethics violation?
111
Complaint #16
A certified counselor asks a client to set her
up on a date with the client’s friend. Is this
an ethics violation?
112
Complaint #17
A certified counselor is involved in a
personal relationship with the ex-spouse of
a current client. Is this an ethics violation?
What if he was involved in a personal
relationship with the ex-spouse of a past
client?
113
Complaint #18
A certified counselor is coming to work
obviously intoxicated and co-workers smell
alcohol on her breath. Is this an ethics
violation?
114
Complaint #19
A certified counselor posts a picture of
herself on Facebook holding a margarita
glass in a bar. Is this an ethics violation?
115
Complaint #20
A counselor working on his certification
application signs his supervisor’s name on
one of his application forms because his
supervisor wasn’t available, they had
already reviewed the form together and he
didn’t think this supervisor would mind. Is
this an ethics violation?
116
Complaint #21
Acer&fiedcounselorhasworkedoutan
“arrangement”withana8orneyfriendwhereby
thecounselorsendshisOWIclientstothe
a8orneyforlegalrepresenta&onandthea8orney
sendshisOWIclientstothecounselorfor
assessmentsasameansofincreasingclientsfor
bothofthem.Isthisanethicsviola&on?
117
Complaint #22
A certified counselor attends the same AA
group as some of his clients. Is this an
ethics violation?
118
Complaint #23
A certified counselor indicates that a fellow
AA group member is or has been a client. Is
this an ethics violation?
119