Ethical and Boundary Issues for Home Visitors and In-Home Workers

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1 Ethical and Boundary Issues for Home Visitors and In-Home Workers Elizabeth R. Cohen, LICSW, MSW Mental Health and Wellness Division Director UHA Dept of OB/GYN

2 Course Objectives Attendees will become familiar with the NASW Code of Ethics. Attendees will gain an understanding of how ethical issues impact relationships with families. Attendees will learn how to recognize potential conflicts and ethical dilemmas. Attendees will learn strategies to navigate/ reduce ethical conflicts.

3 Codes of Ethics A code of conduct that is the hallmark of a profession, summarizing principals and identifying core values. Prescribes the behaviors of professionals in the context of protecting clients, colleagues, and the public at large. Found in many professions, such as law, medicine, dentistry, journalism, nursing, and psychology.

4 Codes of Ethics Necessary, but not solely sufficient for problem solving. Do not guarantee ethical behavior. Ethical decision making involves a process; there are many models available.

5 NASW Code of Ethics Revised and effective 1/1/97 Identifies Core Values on which social work s mission is based. Summarizes broad ethical principals and establishes a set of specific ethical standards that should be used to guide SW practice. Designed to help SWers identify relevant considerations when professional considerations conflict or ethical uncertainties arise. Provides ethical standards to which the general public can hold the profession accountable.

6 NASW Code of Ethics Socializes practitioners new to the field to SW s mission, values, ethical principals, and ethical standards. Articulates standards that the SW profession itself can use to assess whether SWers have engaged in unethical conduct.

7 NASW Code of Ethics Based on 6 Core Values of the Profession Service Social Justice Dignity and Worth of the Individual Importance of Human Relationships Integrity Competence

8 NASW Code of Ethics Pertinent Sections for Home Visitors: 1.06 Conflicts of Interest 1.07 Privacy and Confidentiality 1.09 Sexual Relationships 1.10 Physical Contact 1.11 Sexual Harassment

9 Home Visitation Programs Programs are often made up with a combination of professional, semi-professional, and lay individuals. Trained in different areas: social work, nursing, parenting, education, etc. Provide relationship-based interventions where partnerships and trust are built with the client using empathy and transparency. Ethical conflicts guided by professional codes of ethics, agency policies, supervision, or agency infrastructure.

10 Home Visitation Programs Potential for a great deal of personal information to be shared with worker, including: Family history Financial history Medical histories Abuse history Relationship problems Parenting concerns Potential for ethical issues and boundary violations is great

11 Home Visitation Programs Initial relationship building with client should include: Clarifying roles and expectations Explain in terms of agency/program philosophy Creating clear professional boundaries Establishing goals and objectives Consent forms Awareness of personal values, beliefs, and the unequal nature of the relationship in terms of power and responsibility

12 Home Visitation Programs Potential Conflict Areas: Confidentiality Conflicts of interest Record keeping/documentation Boundary Violations/Boundary Crossings Dual relationships Client s right to self-determination Self disclosure Gifting

13 Ethical vs. Legal Ethically questionable situations refer to situations in which the workers actions are not reprehensible, liable, intentionally exploitative, or coercive. But, they may be harmful nonetheless. Legally questionable behaviors refer to those behaviors that negate the fiduciary aspect of the relationship; that the practitioner be competent and trustworthy, act within the standards of the profession/agency, and with the best interests of the client in mind. The worker must also acknowledge the relationship is based on unequal power and unequal responsibility.

14 Home Visitor Boundary Questions to Consider: How do I know when it is ok to share something personal about myself with a family? When I m asking questions about the family s life and routines, how do I remain respectful of the family s privacy and their right to determine when to share information? (Allen & Tracy 2008)

15 Boundary Questions cont: What if the family invites me to dinner or to a family event? Is it ever ok to attend? What if the family and I have a good connection and want to make plans to spend more time together? What if I disagree with something the family is doing, or it makes me uncomfortable? Can I say something? Should I give a client my personal phone number? (Allen & Tracy 2008)

16 Ethical Decision Making There are no answers, only choices A process of critical reflection, evaluation, and judgment through which a practitioner resolves ethical issues, problems, and dilemmas. Is never easy (Gray & Gibbons, 2007) Is not the same as legal decision making Is rarely black or white; ethics is the grey area

17 ETHIC Model: Examine relevant personal, societal, agency, client, and professional values. Think about what ethical standard of the relevant Code of Ethics applies to the situation, as well as relevant laws and case decisions. Hypothesize about possible consequences of different decisions. Identify who will benefit and who will be harmed. Consult with supervisor and colleagues. (Gray &Gibbons 2007)

18 Case Examples to Resolve You provide home visitation services to a single mom. At your first home visit, you realize that the client lives close to your neighborhood, and that your 10 year old son plays with her 10 year old son. You are providing home visitation services to a family where the father has recently been laid off. You know he did grounds-keeping work, and you are in the position of needing help with your yard work. You decide to help the family out financially by hiring him to do the work.

19 Ways to Avoid Ethical Conflicts Notice if the rules change Pay attention to any feelings of transference or counter-transference Take notice if client starts to need your approval, or if you start to need theirs Discuss in advance, and work out plan for any chance meetings Be sure your social support network does not include client Use supervision; be aware of potential conflicts and avoid them

20 Question to ask yourself Is this in my client s best interest? Whose needs does it serve? Will it have a positive impact on the services I deliver? How would the client s family view this? How would I feel telling a colleague? Am I treating this client differently? Does this client mean something special/different to me? Am I comfortable documenting this?

21 Possible Consequences of Ethical Risk- Taking Emotional or physical harm to the client or worker; compromised personal safety Loss of job or licensure Loss of membership in professional association Legal problems Damage to agency s reputation

22 Consequences for failure to comply with the SW Code of Ethics: Loss of Social Work license Censure by the WV Board of SW Examiners Civil lawsuits Criminal lawsuits

23 Words to live by If you think you shouldn t..don T!!

24 References Allen, Susan and Tracy, Elizabeth (2008). Developing Student Knowledge and Skills for Home-Based Social Work Practice. Journal of Social Work Education, Vol. 44, No. 1 p Boland-Prom K., Anderson S.C. (2005) Teaching Ethical Decision Making Using Dual Relationship Principles as a Case Example. Journal of Social Work Education, Vol. 41, No.3 p Gray Mel and Gibbons, Jill (2007). There are no Answers, Only Choices: Teaching Ethical Decision Making in Social Work. Australian Social Work, Vol. 60, No. 2 p

25 References Healthcare Training Institute. How to Ethically Set Client Confidentiality Boundaries. Kagle Jill and Giebelhausen, Pam (1994). Dual Relationships and Professional Boundaries. Social Work, Vol. 39, No. 2 p NASW Code of Ethics (revised and effective 1997). Reamer, F. G. (2009). The Social Work Ethics Casebook. Washington, DC: NASW Press. Wahl, E. & Johns, D. (2010). Ethics & Boundaries and Home Visiting. Waisman Center, University of Wisconsin, Madison.

26 Resources National Association of Social Workers: National Association of Social Workers WV Chapter: Elizabeth Cohen, LICSW, MSW or

Professional Boundaries & Ethics Florida Independent Living. Conference 2010

Professional Boundaries & Ethics Florida Independent Living 1 Conference 2010 Robin M. Kohn, MSW, LCSW School of Social Work University of Central Florida BSW Coordinator & Clinical Instructor SCI Network