Ethical Considerations for Behavioral Health Professionals Vince Collins, MSW NWATTC March 16, 2017 3/2/2017 1 The ATTC Network Ten Regional Centers Four National Focus Centers SBIRT Hispanic & Latino Native American- Alaska Native Rural & Frontier Two Centers of Excellence YMSM + LGBT PPW 1
Visit Us Online! Upcoming trainings The range of training and technical assistance services we offer Resources and links on key topics www.attcnetwork.org/northwest Introductions Name Years in the business How many different hats have you worn? Any Ethics aha moments What is your foundation of what is right or wrong? 2/26/2015 5 Learning objectives Participants will be able to: Lists several roles and describe how ethics are relevant to each Define ethics Describe a model for ethical decision making 2/26/2015 6 2
Behavioral Health personnel - roles Peer support specialist Recovery Coach Counselor DOH licensed staff National credentialed staff Medical staff Others 2/26/2015 7 Small group Exercise Form a small group that includes others with different roles in dealing with clients Discuss for 10 minutes the provided situation in relationship to the role of staff Record key observations Select a group spokesman to share your findings 2/26/2015 8 Behavioral Health Roles Peer Counselor/Recovery Coach Outreach worker Motivator Role model/mentor Resource Broker Not a Sponsor moving beyond your role if you: Perform AA/NA or other mutual aid services Guide someone through the steps or principles of a particular recovery program 2/26/2015 9 3
Behavioral Health Roles Medical Staff Provide medical/psychiatric diagnosis Offer medical advise Prescribed medications Who else can do these activities? 2/26/2015 10 Behavioral Health Roles Therapist or Counselor Assess/Diagnose per your credential Counsel and/or manage therapeutic activities Focus/define problem areas/issues/trauma Where is the boundary for this role with medical staff? 2/26/2015 11 Definition of Ethics Define ethics Share definition Find common themes Explain the relationship among ethics, morals, values and principles 2/26/2015 12 4
Some Definitions Aspiring to be ethical involves sustained vigilance in preventing harm or injury to those we are working to help Ethics - A system of moral values or standards Principle A fundamental truth, law, doctrine upon which others are based Do no Harm Morals Principles with respect to right or wrong Values Social principles held by an individual, group, or society 2/26/2015 13 More on Ethics A set of developed and accepted standard or principles of behavior for both individuals and organizations within a profession A standard or code of behavior that is created to enhance service provision and create a climate of dignity and respect An agreed upon set of morals, values, and group conduct standards accepted by a group 2/26/2015 14 Ethical Considerations Behavior can be considered ethical if it: Increase trust among people Promotes integrity and decreases deceit in relationships Does not exploit others Increase cooperative attitudes Enhances self respect Dissolves barriers between people 2/26/2015 15 5
Ethical and Moral Behaviors - Definition A behavior may be determined as right or wrong (moral or immoral) Ethics guide us as to why we determine a behavior to be right or wrong (moral or immoral) and how we make up our minds A key feature of an ethics problem is that it concerns something controversial and undecided 2/26/2015 16 NAADAC, NASW and AAMFT Ethical Principles for Counselors Ethics are based on the core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. These standards govern the conduct of a counselor The absence of an explicit reference to a specific behavior or situation in the code does not mean that the behavior is ethical or unethical 2/26/2015 17 NAADAC, NASW and AAMFT Ethical Principles for Counselors Lack of awareness or misunderstanding of an ethical standard is not a defense to a charge of unethical behavior Ethics are a statement of the counseling professionals values and a guide for making clinical decisions Ethical decisions involve the process of self-reflection and awareness of our own values, and cultural, spiritual/religious beliefs and practices Personal and professional ethics should not be separate standards 2/26/2015 18 6
Four technical terms Iatrogenic means provided service caused unintended harm or injury Fiduciary relationship in which one person has assumed a special duty and obligation for the care of another Boundary Management decisions related to level of intimacy/sharing allowed Multi-party Vulnerability relates to how multiple parties can be injured by decisions or circumstances 2/26/2015 19 Assumptions do you agree? 1. People who have a long and, by all appearances, high-quality recovery can be counted on to act ethically as peer counselors or recovery coaches 2. New staff should come with a well developed ethical framework 3. Ethical lapses are made by bad people 4. Adhering to existing laws and regulations will ensure ethical conduct 5. Ethical codes are not needed for volunteers 2/26/2015 20 Ethical Decision Making Model from Mary Alice Fisher, Ph.D. ASSESS o Identify the problem and determine whether the matter is an ethical one. Use your Ethics Code and other professional guidelines to identify the specific ethical issues o If this involves a clinical issue, describe and clarify the relevant clinical components o Consider whether there are any legal requirements, contractual obligations or agency considerations that might influence your decision or limit your options o Consider, as clearly as possible, any relevant personal values (or other personal factors) that might affect your objectivity, introduce bias, or otherwise influence your decision 2/26/2015 21 7
Ethical Decision Making Model o Evaluate the rights, vulnerabilities, and responsibilities of all parties involved. Determine your relationship (if any) and obligations (if any) to each of these parties o Obtain consultation. Consult with a trusted colleague or supervisor about the ethical, legal and personal issues involved. If needed, obtain a formal consultation with an ethics consultant or with the ethics office of your professional association. If necessary, obtain legal consultation and/or medical consultation o Consider whether members of your team or practice group should be engaging in this decision-making process with you. If so, begin discussing the issue collaboratively 2/26/2015 22 Ethical Decision Making Model PLAN Generate a list of possible decisions/solutions. (At this stage, do not censor; consider and assess all possible courses of action, no matter how wild/crazy/inappropriate they seem.) Using this list, eliminate any options that are clearly unethical, illegal, or clinically inappropriate, using the assessment above as a guide Enumerate, consider, and weigh the consequences of each of the remaining options 2/26/2015 23 Ethical Decision Making Model IMPLEMENT Make a decision. Decide how to best act on (carry out) your decision Carry out the decision you have made EVALUATE Document your decision-making process and your actions Evaluate the process, your decision, and its outcome 2/26/2015 24 8
Exercise 2 Please review Handout 2.1 considering role: 1. Write down your impressions for role (case manager, and peer counselor) as you review the list 2. Complete Handout 2.2 for the role considering the provided circumstance 2/26/2015 25 Cognitive Strategies to Justify Unethical Behavior It s not unethical as long as a managed care administrator or insurance care reviewer requires or suggests it It s not unethical if the professional association you belong to allows it It s not unethical if an ethics code never mentions the concept, term, or act It s not unethical as long as no law is broken 2/26/2015 26 Cognitive Strategies to Justify Unethical Behavior It s not unethical as long as we can name others who do the same It s not unethical as long as we didn t mean to hurt anyone It s not unethical if we could not or did not anticipate the unintended consequences of our actions It s not unethical if we can say any of the following: What else could I do? 2/26/2015 27 9
Cognitive Strategies to Justify Unethical Behavior Anyone else would ve done the same thing. It came from the heart or my soul. I went with my gut. No one ever complained about it. I just knew that s what the client needed. It worked before. Look. I was between a rock and a hard place. It made sense at the time. 2/26/2015 28 Internet and Ethics What is out there on the internet? 1. Facebook 2. Social media 3. Recovery apps 4. Communication 5. Scheduling 2/26/2015 29 For Behavioral Health Professionals What are the issues of using the internet? 1. For the client 2. For the clinician 3. For the agency 4. For 42CFR 5. For HIPPA 2/26/2015 30 10
State and Federal Laws that Govern Washington State Counseling Professions and Licensing Chapter 246-809 WAC Mental health, marriage and family therapy, social workers Chapter 246-810 WAC Counselors Chapter 246-811 WAC Chemical dependency professionals and chemical dependency professionals trainees Chapter 388-877 WAC Behavioral health services administrative requirements 2/26/2015 31 State and Federals Laws Governing Counselors Chapter 70.96A RCW Treatment for alcoholism, intoxication, and drug addiction Chapter 71.05 RCW Mental illness Chapter 71.24 RCW Community mental health services act Chapter 71.34 RCW Mental health services for minors 2/26/2015 32 State and Federals Laws Governing Counselors RCW 18.130.180 Unprofessional conduct RCW 18.130 Regulation of health professions uniform disciplinary act WAC 246-810-031 Disclosure statement to be provided to clients by certified counselors and certified advisers Health Insurance Portability and Accountability Act of 1996 (HIPAA) 2/26/2015 33 11
State and Federals Laws Governing Counselors 42 C.F.R. Part 2 Federal regulations for confidentiality of alcohol and drug abuse patient records Chapter 70.02 RCW Medical records health care information access and disclosure 2/26/2015 34 Diagnostic and Clinical Tools DSM-5 Diagnostic and Statistical Manual of Mental Disorders 5th Edition ASAM American Society of Addiction Medicine, Patient Placement Criteria for the Treatment of Substance Related Disorders 2/26/2015 35 Diagnostic and Clinical Tools 2012 Edition Confidentiality and Communication: A Guide to the Federal Drug and Alcohol Confidentiality Law and HIPPA Clinical Supervision and Professional Development of the Substance Abuse Counselor TIP 52 Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice TAP 21 2/26/2015 36 12
Further focus for your Code of Ethics The counseling relationship Evaluation, assessment and the interpretation of client data Confidentiality/privileged communication and privacy Professional responsibility Working in a culturally diverse world Workplace standards Supervision and consultation Resolving ethical issues Communication and publishing works Policy and political involvement 2/26/2015 37 Washington Requirements for Counselors When counselors have knowledge that another counselor might be acting in an unethical manner, they are obligated to take appropriate action based on state requirements 2/26/2015 38 Washington Requirements for Counselors Supervision and consultation Standard includes: Counselors who supervise others accept the obligation to facilitate the professional development of the trainee. The supervisor will provide accurate and current information, timely evaluations and consultation 2/26/2015 39 13
Washington Requirements for Counselors The counselor who provides supervision to trainees and employees must have completed education and training specific to clinical and/or administrative supervision Supervision is provided at specified intervals and supervision will be documented 2/26/2015 40 Washington Requirements for Counselors The counseling relationship Standards include: Client welfare Client self-determination Dual relationships Groups standards Preventing harm 2/26/2015 41 Washington Requirements for Counselors Evaluation, assessment and interpretation of client data Standards include: Scope of competency Informed consent Screening Basis for assessment Release of assessment results Release of data to qualified professionals 2/26/2015 42 14
Washington Requirements for Counselors Evaluation, assessment and interpretation of client data Standards include: Diagnosis of mental health disorders Unsupervised assessments Assessment security Outdated assessment results Cultural sensitivity Social prejudice 2/26/2015 43 Washington Requirements for Counselors Professional responsibility Standards include: Counselors will respect institutional policies and management functions of the agency Counselors will uphold the legal and ethical standards of their profession by educating themselves of all federal and state laws that govern their profession 2/26/2015 44 Washington Requirements for Counselors Counselors will honestly represent their professional qualification, affiliations, credentials and experience Counselors will practice honesty and congruency in all aspects of practice accurate billing, accounting of expenses, reporting of interactions with clients, and professional activities Counselors shall treat colleagues with respect, courtesy, and fairness 2/26/2015 45 15
Washington Requirements for Counselors Counselors will seek appropriate treatment for themselves or colleagues Counselors will assure that records are kept in a locked cabinet or room not easily accessible to those not providing the clinical services Counselors will create, maintain, disseminate, store, retain and dispose of records related to research, practice, payment for services, payment of debts and other work in accordance to legal standards that permit/satisfy ethical standards 2/26/2015 46 Washington Requirements for Counselors Cultural competence and social diversity Standard: Counselors should understand culture and its function in human behavior and society, recognizing the strengths that exists in all cultures Counselors should obtain education about, and seek to understand the nature of, social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, immigration status, and mental or physical disability 2/26/2015 47 Washington Requirements for Counselors Work place standards: The counselor recognizes the need for ongoing education as a component of professional competency and development The counselor recognizes boundaries and limitations of their own professional competencies The counselor is willing to seek appropriate treatment for oneself or for a colleague 2/26/2015 48 16
Washington Requirements for Counselors The workplace will be maintained in a manner that is safe for clients, colleagues and employees Support staff are competent in confidentiality standards and respectful to clients seeking services 2/26/2015 49 Washington Requirements for Counselors Communication and publishing works Counselors who submit works for publication or prepare handouts for clients, students or for general distribution, shall be aware of and follow copyright laws Counselors respect the limits of present knowledge in public statements related to substance related disorders. Statements of fact are based on what has been empirically validated as fact 2/26/2015 50 Ethics Training Material Resources www.socialworkers.org www.naadac.org www.aamft.org www.centerforethicalpractice.org Department of Health Information: www.doh.wa.gov/licensing/ Find WAC, state laws and rules: www.leg.wa.gov Find federal laws: http://www.gpoaccess.gov/fr/ State Ethics Board: http://www.ethics.wa.gov/ Some slides from Mary Testa-Smith 2/26/2015 51 17
Ethical Decision Making Model Mary Alice Fisher, Ph.D. The Center for Ethical Practice, Inc. This Ethical Decision Making Model was constructed using principles that are included in existing decision making models from several mental health professions, including the following: Forester-Miller, H., & Davis, T. (1996). A Practitioner s Guide to Ethical Decision Making. American Counseling Association Knapp, S. & VandeCreek, L. (2006). Practical ethics for psychologists: A positive approach. Washington D.C., American Psychological Association Koocher, G.P. & Keith-Spiegel, P. (2008) Ethics in Psychology: Professional Standards and Cases. New York, Oxford U. Press Mattison, M. (2000) Ethical Decision Making: The Person in the Process. Social Work, 45, 201 Pope, K. S., & Vasquez, M. J. T. (2007). Ethics in psychotherapy and counseling: A practical guide (3rd ed.). San Francisco: Jossey Bass Reigle, J. (1996) Ethical Decision Making Skills. In: Hamric, A.B., Spross, J.A. & Hanson, C.M. (Eds) Advanced Nursing Practice: An Integrative Approach. Philadelphia, W. B. Saunders Company 2/26/2015 52 Evaluations Thank you for sharing your feedback on our programming with us! We use this information to improve our services and to share information with SAMHSA about our work. Please complete the Evaluation Form and the Thirty- Day Follow Up Consent Form. 18