Ethics and Boundaries in Behavioral Health Treatment 2022 New Logo.pptx

Ethics and Boundaries in Behavioral Health Treatment THE JUDE HOUSE Identify the purpose of ethical standards. Review realistic scenarios where boundaries and ethics apply in SUD treatment. Explore the value of supervision to manage ethical concerns. JH policy: Code of Ethics: Ethical Standards o...

Ethics and Boundaries in Behavioral Health Treatment THE JUDE HOUSE Identify the purpose of ethical standards. Review realistic scenarios where boundaries and ethics apply in SUD treatment. Explore the value of supervision to manage ethical concerns. JH policy: Code of Ethics: Ethical Standards of Conduct see Pages 99 – 103 in JHI Policy and Procedure Manuel. The purpose of ethical standards: Guide professional behavior to support the mission and vision of The Jude House. Foster a treatment culture that supports recovery. Create an environment that is safe for the patients. Create an environment that is safe for us as employees. Prioritize a need for clear physical, emotional and psychological boundaries in the workplace Create a standard approach to our work. So that we know what to expect and the patients know what to expect. Establish principles that form ethical decision making. The Professional Relationship Patient Welfare Make sure patients are safe Be sensitive and respectful Treat everyone with dignity Act for the good of the patient The number one job in the Professional Relationship is the safety and well-being of the patient in treatment. Boundary Violations in Substance use Disorder Treatment Do not make derogatory remarks towards patients or staff members. No sponsoring patients. No inappropriate sharing of personal information with patients. Do not give patients your personal number or email. Do not show patients things on your personal phone or computer. No making sexual advances towards a patient (verbal or physical). You must respond appropriately to sexual advances made by a patient immediately and report to your supervisor. No planning of social encounters or becoming social friends. No staff and patient dating. JH policy: Code of Ethics: Ethical Standards of Conduct see Pages 99 – 103 in JHI Policy and Procedure Manuel. Exploitation Using your power and authority to take advantage of others. Using your relationship for personal gain. We cannot violate the trust, legal or civil rights of patients. We do not do conversion therapy or use coercive or threatening methods as part of treatment. Shame and humiliation have no place at the Jude House. We do not impose our religious or political values on patients. CONVERSATION STARTER: BOB IS A PATIENT IN TREATMENT AND OWNS A ROOFING COMPANY. RIGHT BEFORE HE COMPLETES TREATMENT, BOB TELLS YOU THAT HE APPRECIATES EVERYTHING YOU’VE DONE FOR HIM AND THAT IF YOU EVER NEEDS A ROOF, TO GIVE HIM A CALL. THREE YEARS LATER, YOU HAVE A LEAK IN YOUR ROOF. AFTER PRICE SHOPPING, YOU REALIZE THAT BOB’S COMPANY HAS THE MOST COMPETITVE RATES FOR ROOF REPLACEMENT. CAN YOU CALL BOB’S ROOFING TO FIX YOUR ROOF? Dual Relationships & Conflicts of Interest JHI policy: Compliance: Code of Conduct see Conflicts of Interest #1-7 on Pages 108 – 109 in JHI Policy and Procedure Manuel. Conversation starter: Which of these are Dual Relationships? Virtual Relationships… ARE a conflict of interest and a dual relationship Jude House employees are Prohibited from engaging in a personal or romantic virtual e-relationship with current or former patients. Jude House employees Shall not accept current or prior patients’ “friend” requests on social networking sites or email (from Facebook, Instagram, etc.), and shall immediately delete all personal and email accounts to which they have granted patient access and create new accounts. Personal social media relationships, messaging and other digital communications with patients, former patients and family members involved in treatment are not permitted. JH policy: Code of Ethics: Ethical Standards of Conduct see Pages 99 – 103 in JHI Policy and Procedure Manuel. RESPONDING TO VIRTUAL FRIEND REQUESTS: (INCLUDING EMAIL AND ALL SOCIAL MEDIA PLATFORMS) oDO NOT RESPOND TO “FRIEND REQUESTS”. oIGNORE OR BLOCK PATIENT REQUESTS FOR VIRTUAL CONNECTION. oDO NOT RESPOND TO EMAILS OR MESSAGES, INCLUDING TEXT. oINFORM YOUR SUPERVISOR IMMEDIATELY THAT THE PATIENT HAS MADE CONTACT WITH YOU VIRTUALLY. Digital Communication  As individuals, we are not permitted to post or speak on behalf of Jude House on social media or through electronic communication. The only time this is appropriate is if it is within the purview of your role at Jude House. For example, employees that that help with alumni and outreach.  If you are unsure about whether or not you can post on behalf of Jude House, please connect with your direct supervisor.  It is okay to “share” or “forward“ communications developed by Jude House to others. Two hatter conflict We APPRECIATE and VALUE all of our employees, including those in recovery! We also need to be aware that treatment and support group meetings, including 12 step meetings, are different. When we are at work, we wear the hat of our “role.” This cannot be confused with the hat we would wear at a meeting, including detailed self disclosure, providing personal experience, information or opinions regarding the ‘right’ way to access recovery. These hats can create conflict and confusion for us and for the patient. Two Hatter Conflict Conversation starter: Hypothetically speaking, you’re at a support group meeting and a patient that discharged from treatment four months ago approaches you. After some brief discussion, the patient asks if you can be their sponsor. What is your response? Conversation Starter: You are walking a patient to the cafeteria and are talking about how their morning has gone so far. The patient then asks, “Are you in recovery?” How do we move forward? Sexual Relationships Addiction Professionals shall not engage in any form of sexual or romantic relationship with any current or former patient. Often when physical boundaries are crossed, emotional and psychological boundaries are also crossed. Self-awareness is key! JH Policy Code of Ethics: Ethical Standards of Condu Pg: 99 – 103 in JHI Policy and Procedure Manuel. Jude House staff should minimize physical contact with patients. Shaking hands and fist-bumping are permitted. This rule does not apply to contact that is necessary in the performance of treatment duties. Some examples are injections given by nurses or assisting a patient in the midst of a seizure. Conversation Starter: You are walking alongside a patient when they lose their balance and begin to fall. Are you able to provide physical support to prevent the patient from falling and injuring themselves? Physical Boundaries & Physical Contact Gifts Addiction Professionals recognize that patients may wish to show appreciation for services by offering gifts. Jude House Staff are not allowed to give or receive gifts or money from current patients, former patients, or family members of patients. JH Policy Code of Ethics: Ethical Standards of Conduct Pg: 99 - 103 Confidentialit y and Privacy The state of keeping or being kept secret or private It is very challenging for some people to seek help. Legal and ethical responsibility to maintain the confidentiality of patients and families from any individual or entity that may inquire about the Patient’s status or presence in treatment. Bound by multiple laws to protect patient privacy. Read JHI Confidentiality Policy and Health Insurance Portability and Accountability Act (HIPAA) Pg: 16 – Pg: 17 in JHI Policy and Procedure Manuel. Confidentiality and Privacy: What should you do? Closed Door Discussions Lock your computer Private Print Clean Workspace Limits of Confidentiality There are times when Confidentiality laws DO NOT apply, including but not limited to: Imminent Danger (SI/HI) Communicable Diseases Child, Elder and/or Dependent Adult Abuse Medical Crisis When in Doubt-Ask your supervisor! An immediate threat of harm Reflects the following three (3) components: Imminent Danger A strong probability that certain behaviors will occur. The potential for such behaviors to present a significant risk of serious negative consequences to the individual and/or others. The likelihood that such harmful events will occur in the near future. Informed Consent Permission granted in the knowledge of the possible consequences Includes some or all the following: Detailed explanation of services offered. Goals, risks and limitations of services offered. Professional qualifications and credentials of the treatment team. Right to confidentiality and explanation of its limits including duty to warn. Policies regarding continuation of care should the counselor be unavailable. The role of technology in treatment. Implications of diagnosis and the intended use of tests and reports. Fees and billing, nonpayment, policies for collecting nonpayment. Specifics about clinical supervision and consultation. Right to Refuse Services and Treatment. Professional Responsibilities Addiction Professionals shall abide by the NAADAC Code of Ethics. Addiction Professionals have a responsibility to read, understand and follow the NAADAC Code of Ethics and adhere to applicable laws and regulations. Un-Ethical Marketing: Patient Brokering Un-Ethical Marketing: Patient Brokering WHAT IS IT? Marketers will receive compensation for referring a patient to a drug treatment facility. Compensation can include vast amounts of cash, lavish trips, or expensive event tickets. This is done by using out-of-network benefits, that don’t have a negotiated rate with the insurance companies and every “service” delivered will be charge separately (and often exorbitantly). *Using Out- of –Network Benefits is NOT illegal or unethical when following best practices. Unethical practices that have been used include trolling 12 step meetings, using drugs or money to entice patients to WHAT’S THE LAW? Signed into law in 2018, the Eliminating Kickbacks in Recovery Act (EKRA), as part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 (SUPPORT Act) makes it a federal crime to “knowingly and willfully” solicit, or receive, any remuneration directly or indirectly, overtly or covertly, in cash or in kind, in return for referring a patient or patronage to a recovery home, clinical treatment facility, or laboratory (AHLA, 2020). KICKBACKS are ILLEGAL & UNETHICAL! Discrimination… Treating people differently based on one of more of the following characteristics: Age Race Military Engagement Ethnicity Socioeconomic Status Religion Immigrant Status Political Affiliation Language Preference Disability Sexual Orientation Gender Gender Identity Marital Status Personal Values & Beliefs Self-Awareness & Bias Identifying Spirituality vs. Religious Beliefs Heinous Crimes Transference & Counter-transference Harassment Aggressive pressure or intimidation. Unwanted attention. Addiction Professionals shall not engage in or condone any form of harassment, including sexual harassment. Selfawareness is key. CULTURAL DIVERSITY KNOWLEDGE Awareness of cultural, individual, societal, and role differences amongst the patients they serve. Services should be offered that demonstrate appropriate respect for the rights, dignity and worth of all patients. ADVOCACY Advocate for the needs of the diverse populations they serve. No matter your role at the Jude House, you are an advocate. Supervision Seek consultation and direction from supervisors when uncertain about whether a situation or course of action may be in violation of the NAADAC Code of Ethics or The Jude House Policy and procedure. Providers consult with persons who are knowledgeable about ethics, the NAADAC Code of Ethics, and legal requirements specific to the situation. Questions?