Ethics And Boundaries - Three Rivers CAP
11/4/2018Ethics and BoundariesDr. Laura StrunkDr. Kimberly ZammittLearning Objectives Understand the definition of ethics Understand current practice standards Identify ethical challenges in practice Develop strategies for minimizing risk for ethicalviolations Understand importance of maintaining professionalboundaries Understand the difference between boundaryviolations and boundary crossing Implications of self-disclosure Understand digital/electronic boundaries1
11/4/2018Definition of Ethical Pertaining to or dealing with morals or theprinciples of morality; pertaining to right and wrongin conduct Being in accordance with the rules or standards forright conduct or practice; especially the standardsof a ethical)Definition of Ethics “A codification of the special obligations that ariseout of a person’s voluntary choice to become aprofessional, such as a social worker” “Professional ethics clarify the professional aspectsof a professional practice” “Professional social work ethics are intended tohelp practitioners recognize morally correctpractice and learn how to decide and act ethicallyin any professional situation”(Dolgoff, Loewenberg, & Harrington, 2009)2
11/4/2018Ethical DilemmasNot all difficult decisions that socialworkers need to make are ethicaldilemmas Termination of services Reporting client’s illegal behavior to lawenforcement Termination of parental rights Assisting a client in gaining access to abortionservicesEthical Dilemmas arise when: There is conflict between client, client system,workers, agencies, community, and profession inregard to: Defining the problemGoal settingIdentifying prioritiesDetermining how goals will be reachedDefining desired outcomesEvaluation of success/failure(Dolgoff, Loewenberg, & Harrington, 2009)3
11/4/2018Because Each involved participant has differing views on Human nature Values Issues System policies(Dolgoff, Loewenberg, & Harrington, 2009)Examples of poor ethical behavior Bribery/use of personal money Letter of recommendation4
11/4/2018How to improve ethical behaviors Observation (thoughts, feelings, behaviors,attitudes) Consultation Practice, practice, practice Being aware of professional and personal values Being able to clarify and discuss conflicting valuesCollision of personal andprofessional values What do you do when your personal values conflictwith professional values? When might this occur? Is it okay to use your personal values when makingprofessional decisions? What do you do if you realize you made a decisionbased on personal values instead of professionalvalues?5
11/4/2018What happens when the law andethics collide?“Instances may arise when social workers’ ethical obligationsconflict with relevant laws or regulations. When suchconflicts occur, social workers must make a responsible effortto resolve the conflict in a manner that is consistent with thevalues, principles, and standards expressed in this Code. If areasonable resolution of the conflict does not appearpossible, social workers should seek proper consultationbefore making a decision.”(NASW Code of Ethics)When might you choose ethicsover law? Working with undocumented individuals Working with individuals who are HIV positive orhave AIDS Client/worker privilege Other examples?6
11/4/2018Consequences for unethicalpractice Social workers can be held liable for malpractice incivil suits (potential monetary charges) Social workers can be held liable for malpractice incriminal cases (potential criminal sanctions) Social workers can be held liable for professionalsanctions (sanctions with MN BOSW, loss oflicensure)(Dolgoff, Loewenberg, & Harrington, 2009)Examples of possible malpracticesuits Providing treatment without obtaining and documenting consent Providing client with incorrect diagnosis and incorrect treatmentinterventions Failure to consult with or refer a client to a specialist Failure to prevent or causing a client’s suicide (this is a tough one) Breach of confidentiality Sexual involvement with client(s) Abrupt or inappropriate termination of treatment Failure to report suspected abuse or neglect Use of unestablished practice methods Practicing beyond scope of competence(Dolgoff, Loewenberg, & Harrington, 2009)7
11/4/2018How to avoid malpractice suits Knowledge Sound ethical practice Licensure Protocols for emergencies are in place and followed Liability insurance Client records are well maintained and protected Consulting with legal counsel when necessary Continuing education Refer to specialists for: Diagnosis and treatment Second-opinion referrals Ruling out organic causes of problems Psychological testing Evaluations regarding the proper use of psychotropic meds(Dolgoff, Loewenberg, & Harrington, 2009)Traditional Boundaries Gifts Touch Self disclosure Home visits Dual/Multiple relationships Bartering Fees, time, length of session Proximity, spacing, clothing, language8
11/4/2018Digital Boundaries Online self-disclosure and online transparency Clients Googling professionals Accessibility between services via cell phone, text,e-mail, chats, Skype, Facebook Texting or cell phone calls during service Professionals Googling clients Social networking with clients (Facebook, Twitter,Snapchat, LinkedIn, etc.)The Helping Relationship andBoundaries Distinguishes the helping relationship from othertypes of relationships (social, business, intimaterelationships) Outlines the “helping frame” Defines the service-fiduciary relationship Illustrates the protection of the power differential9
11/4/2018Boundary Violations Vs. BoundaryCrossings Boundary violations Cross the line of decency, violate or exploit their clients,or intentionally harm them Sexual exploitation Abuse of power Financial exploitationBoundary Violations Vs. BoundaryCrossings Boundary crossings Neutral, appropriate, ethical, benign, or clinicallyeffective interventions Traditional Appropriate self-disclosureHome visits for service provisionNon-sexual, comforting touchAppropriate gifts or barteringEscorting client to an important appointment Digital Appropriate emails/texts between sessions Googling clients for safety reasons10
11/4/2018Types of Boundaries AROUND the helping relationship BETWEEN the professional and the clientAround Boundary Traditional TimePlace of service (home visit, etc.)Fees & barteringConfidentiality Digital Digital and confidentially and privacy11
11/4/2018Between Boundary Traditional Self-disclosure Touch, gifts, dual relationships Language and dress, proximity Digital Social networking with clientsEmails, texts, chats, SkypeClients googling service providersService providers googling clientsTypes of BoundaryCrossings/Violations Service provider initiated boundary crossing andboundary violation Example: Googling clients Client initiated boundary crossing and boundaryviolation Example: Client’s Facebook friend request12
11/4/2018Boundary Violations By Service Provider Sex, inappropriate gifts, language, attire, exploitativedual relationships, misuse of power By Client Inappropriate gifts, language, attire, cyber stalking,Internet harassment, abuse of powerSelf-Disclosure Self-disclosure is revealing of personal rather thanprofession information about the service providerto the client.13
11/4/2018Types of Self-Disclosure Traditional Verbal vs. Non-Verbal Deliberate – Intentional Unavoidable – Accidental Digital Web transparency Clients’ actions on the webService Providers’ Transparency inthe Digital Age Clients Googling service providers Online evaluations (Yelp) Social networking ( Facebook, etc.) Licensing boards14
11/4/2018The “Google Factor” Level 1 : Curiosity ( “Google light”) Level 2: Due diligence – thorough search Level 3: Intrusive search to listservs Level 4: Deceitful – FaceBook, chatrooms Level 5: Illegal search – Cyber-stalking (Zur, 2016)Internet Disclosures Expect to be Googled Watch what you post Google yourself regularly15
11/4/2018Phones or Texting During ServiceProvision Clients Receiving or making phone calls Receiving or sending texts NORMAL for many digital natives Service Provider Receiving or initiating phone calls Receiving or sending textsTo Google or Not to Google OurClients Is it ethical? Do we need to tell the clients? Do we need an informed consent? What is the standard of care?16
11/4/2018To Google or Not to Google OurClients When is it ethical? Do we need to always tell clients? Do we always need an informed consent? Is it ethical if it may save lives? What about home office and other safetyconsiderations? Should we add a note to Office Policies? Are there any guidelines?To Google or Not to Google OurClients The answers all depend on the CONTEXT ClientService ProviderSettingService ProvisionRelationships17
11/4/2018Internet Search Policies Examples At times I may conduct a web search on my clientsbefore the beginning of therapy or during therapy. Ifyou have concerns or questions regarding this, pleasediscuss with me. While my present or potential clients might conductonline searches about my practices and/or me. I do notsearch my clients on Google , other search engines, oron social networking sites. If clients ask me to conductsuch searches or review their websites or profiles and Iconsider it might be helpful, I will consider it. It is NOT a regular part of my practice to search forclients on Google or Facebook or other search engines.Extremely rare exceptions may be made during times ofcrisis or emergency.Responding to Clients’ FacebookFriends Requests Is it ethical to have a client as a Facebook friend? What is on the professional’s Facebook profile? Is it the professional’s professional Facebook profileor is it a personal profile? What is on your Facebook profile? Are social media policies necessary? Is is a dual relationship?18
11/4/2018Facebook Considerations What is on your profile? Understanding how this impacts confidentiality Records Privacy settings Public access Office policies Dual relationships Proceed with caution!!!Social Networking Policy Example I do not accept friend requests from current orformer clients on social networking sites. I believethat adding clients as friends on these sites cancompromise your confidentiality and our privacy.For the same reason, I am requesting that clientsdo not communicate with me via any interactive orsocial networking website.19
11/4/2018Emailing Clients Is email consider client contact? Is email part of client records? Is it confidential? Is it encrypted? Email signature that this is not a confidential formof communication How often do you check email?Email Signatures This message is confidential, intended for thenamed recipient(s) and may contain informationthat is privileged or exempt from disclosure underapplicable law. If you are not the intendedrecipient(s), you are notified that thedissemination, distribution, or copying of thismessage is strictly prohibited. If you receive thismessage in error, or are not the named recipient(s),please notify the sender at the email address aboveand delete this email from your computer. Thankyou.20
11/4/2018Email Policy Example I prefer using email only to arrange or modifyappointments. Please do not email me content relatedto your therapy sessions, as email is not completelysecure or confidential. If you choose to communicatewith me by email, be aware that all emails are retainedin the logs of your and my Internet service providers.While it is unlikely that someone will be looking atthese logs, they are, in theory, available to be read bythe system administrator(s) of the Internet serviceprovider. You should also know that any emails I receivefrom you and any responses that I send to you becomea part of your legal record.Digital Harassment Clients put multiple negative postings about theirservice provider on the internet Clients post their online comments under manypseudonyms on many different sites Clients post special websites21
11/4/2018What can you do about digitalharassment? Do not act impulsively Consult with colleagues and supervisors Consult legal experts Have colleagues or supervisors write positivereviewsOnline Dating Professionals beware that clients may be on thesesites too What are you putting in your profile? What are the site’s privacy settings?22
11/4/2018How to practice safer digitally? Create a social media policiesReferences Association of Social Work Boards. (2015). Model regulatory standards fortechnology and social work practice . Retrieved from ial-Work-Practice.pdf Dolgoff, R., Harrington, D., & Loewenberg (2009). Ethical decisions for socialwork practice. Brooks Cole Cengage Learning. Ethical. (2018). Retrieved from https://www.dictionary.com/browse/ethical Kolmes, K. (2014). Private practice social media policy. Retrieved fromhttp://www.drkkolmes.com/docs/socmed.pdf National Association of Social Workers and Association of Social Work Boards.(2005). Standards for technology and social work practice. Retrieved /TechnologySWPractice.pdf National Association of Social Workers. (2008). Code of ethics of the NationalAssociation of Social Workers. Retrieved fromhttp://www.naswdc.org/pubs/code/code.asp. Reamer, F. (2013). Social work in a digital age: Ethical and risk managementchallenges, Social Work, 58(2), 163-72. Zur, O. & Zur, A. (2016): On Digital Immigrants and Digital Natives: How theDigital Divide Affects Families, Educational Institutions, and the Workplace. ZurInstitute - Online Publication. Retrieved on month/day/yearfrom http://www.zurinstitute.com/digital divide.html.23
Definition of Ethics "A codification of the special obligations that arise out of a person's voluntary choice to become a professional, such as a social worker" "Professional ethics clarify the professional aspects of a professional practice" "Professional social work ethics are intended to
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