Ethical Considerations in Case Management Introductions Name Occupation Place of employment Julia Ellifritt, LISW-S Cornerstone of Hope Bereavement Center Boundary Issues: Boundary Style: Healthy Boundaries Social Media Friendships Baby showers at work Selling kids candy Referral process Two healthy independent beings but close enough to have an effect on each other s lives. Circles can move closer or further apart as conditions warrant. Boundary Style: Enmeshed Boundary Style: Rigid Boundaries almost do not exist. Difficult to tell where one leaves off and the other begins. Usually self contained and have little or no capacity for intimacy; little interaction with coworkers. 1
Boundaries are not about selfishness, they re about stewardship. What is a Boundary? A property line The invisible property lines of my life A dividing line that indicates where one person ends and another begins It protects things of value Where I stop and others start Defines who I am and for what I am responsible What are Healthy Boundaries? They define who we are in life and what we expect from ourselves and others They make us aware of what is socially appropriate (culture) They help us learn to trust and let down our defenses when we feel safe They help us accept people who are different from us They help us define our needs and find ways to meet them They permit us to experience intimacy in relationships They bring order into our lives They allow us to determine how we would like to be treated Healthy Boundaries also. Give us self-discipline, maturity, and character Empower us to stand against manipulation Place us firmly in charge of our lives Define what we are and are not responsible for Empower us to set priorities and make choices Allow us to hold our ground without hostility 2
Prevent the build-up of resentment toward others Allow us to protect ourselves, to avoid victimization Permit us to maintain our identity in relationships Help us negotiate differences and achieve goals Assist us in solving conflicts so everyone wins something Help us to love and esteem ourselves Colleague NH Staff PT Boss Volunteer Nurse Chaplain ST Marketing Social Worker Home Health Aide Administrative Intern Doctor OT Housekeeping Establishing appropriate boundaries is essential for developing a healthy, balanced lifestyle, for spiritual growth, and for our ability to give and receive love. 4 common but troublesome boundary personalities 1. Overly compliant (Cinderella complex) 2. Isolate and Avoidant (can t ask for help) 3. Controlling (don t respect boundaries of others) 4. Non-responsive (neglect responsibilities) Healthy boundaries mean you: Know yourself, like yourself and are able to be yourself You ve learned healthy ways to get your needs met You re able to say no and hear no without paralyzing fear You can take responsibility for the consequences of your choices and actions You have realistic expectations in relationships You re able to manage your emotional responses and cycles You allow others to experience the consequences of their choices You don t manipulate or attempt to control others You recognize and resist the attempts of others to control you 3
Professional Boundaries Defined Lines that separate professional behavior from any other behavior which, well intentioned or not, could reduce the benefit of care to patients, clients, families or communities. Professional Roles The professional relationship exists for the purpose of meeting the patient s needs. It is the professional s responsibility to maintain the boundaries and help patients and colleagues maintain theirs. Principles to Guide the Development of Professional Relationships Have respect for human dignity Avoid personal gratification at the client s expense Do not interfere in a client s personal relationships Promote client autonomy and selfdetermination Promote a relationship built on trust abuse neglect Boundary Issues ZONE OF HELPFULNESS caring about, not caring for Where Boundaries Can Become Blurred Self disclosure Giving or receiving significant gifts Dual and overlapping relationships Becoming friends Maintaining established conventions Physical contact Warning Signs Frequently thinking of the client when away from work Frequently planning other client's care around one client s needs Spending free time with the client Sharing personal information or work concerns with client 4
Feeling responsible if the client s progress is limited Swapping patient assignments Receiving gifts or continued contact and/or communication with the patient after discharge Acting and/or feeling possessive about the client Denying that you have crossed the boundary from a therapeutic to a nontherapeutic relationship Areas of Risk Favoritism Giving out home phone numbers Co-dependence Thinking only you can give really good care Socializing Friendship Boundary Crossings Brief intentional excursions across the lines and there is a clear return to established limits of the professional relationship within a short period of time For example: appointment changes, disclosure of bits of personal information and small gifts Boundary Violations Boundary crossings can often be extremely helpful, whereas boundary violations are usually harmful. Violations are any actions by a professional to use the relationship with the client to meet their own personal needs. Self-Disclosure Violations Disclosing current personal needs or problems Disclosure as common, rather than a rare event during a visit Disclosing things not clearly connect to patient s problems or experiences; or not clearly which would be likely to encourage or support patient. Self-disclosure not only frequent, but uses up more than a few minutes in a visit Some Definitions 5
Self-disclosure Sharing with a patient who has suffered a great loss, about a personal tragedy you overcame with assistance despite initially feeling this couldn t be possible vs. sharing with an attractive patient about the difficulties you re having in your marriage and how unsympathetic your spouse is to the many stresses you are under. Our Time Allowing a visit to run over the allotted time for a patient who is clearly in crisis and in need of immediate assistance and intervention vs. spending increasing amounts of time with a patient who is particularly attached to you and even scheduling these visits at the end of the day so you won t have to rush off to other visits. Our Role Providing service to a member of your church or synagogue when refusing to do so would result in the person not receiving needed services vs. providing service to your spouse s employer when there are other qualified clinicians who could easily provide this service. Giving and Receiving Gifts Small, occasional gifts especially related to cultural practices and beliefs Financial gifts Gifts of gratitude Decision Making Framework Is the behavior consistent with your duty to always act in the best interest of the patient? Does the behavior promote client autonomy and self determination? Is this a behavior that you would want other people to know you have engaged in with the client? Summary Patient needs are always the basis for the relationship There is a difference between being friendly and being a friend Professional boundaries protect the patient and the professional Keeping good boundaries is like steering a car ~ there is constant correction and when we think we ve got it, we hit a bump in the road! 6
Thank You for participating! 7