Ethical Considerations for Behavioral Health Professionalsattcnetwork.org/regCenters/activityDocs/10/Ethical Considerations... · supervisor about the ethical, legal and personal

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Ethical Considerations for Behavioral Health

Professionals Vince Collins, MSW

NWATTC

March 16, 2017

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The ATTC NetworkTen Regional Centers

Four National Focus Centers• SBIRT• Hispanic & Latino• Native American-

Alaska Native• Rural & Frontier

Two Centers of Excellence• YMSM + LGBT• PPW

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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?

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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

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Behavioral Health personnel -roles• Peer support specialist

• Recovery Coach

• Counselor

• DOH licensed staff

• National credentialed staff

• Medical staff

• Others

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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

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Behavioral Health RolesPeer 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

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Behavioral Health Roles

Medical Staff

• Provide medical/psychiatric diagnosis

• Offer medical advise

• Prescribed medications

Who else can do these activities?

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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?

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Definition of Ethics

• Define ethics

• Share definition

• Find common themes

• Explain the relationship among ethics, morals, values and principles

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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

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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

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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

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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

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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

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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

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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

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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

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Ethical Decision Making Modelfrom 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

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Ethical Decision Making Model

oEvaluate the rights, vulnerabilities, and responsibilities of all parties involved. Determine your relationship (if any) and obligations (if any) to each of these parties

oObtain 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

oConsider 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

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• 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

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• 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

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http://www.centerforethicalpractice.org/articles/models-mary-alice-fisher-phd/ethical-decision-making-model/

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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

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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

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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?”

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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.”

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Internet and Ethics

What is out there on the internet?

1. Facebook

2. Social media

3. Recovery apps

4. Communication

5. Scheduling

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For Behavioral Health ProfessionalsWhat 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

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State and Federal Laws that Govern Washington State Counseling Professions and Licensing

• Chapter 246-809 WAC

• Mental health, marriage and family therapy, social workers


• Counselors


• Chemical dependency professionals and chemical dependency professionals trainees


• Behavioral health services administrative requirements

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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

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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)

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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

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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

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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

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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

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Ethical Practices andWashington 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

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• 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

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• 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

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Ethical Practices andWashington Requirements for Counselors• The counseling relationship

• Standards include: • Client welfare

• Client self-determination

• Dual relationships

• Groups standards

• Preventing harm

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Ethical Practices andWashington 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

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Ethical Practices andWashington 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

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• 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

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• 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

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• 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

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Ethical Practices andWashington 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

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• 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

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• 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

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Ethical Practices andWashington 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

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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

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http://www.socialworkers.org/

http://www.naadac.org/

http://www.aamft.org/

http://www.centerforethicalpractice.org/

http://www.doh.wa.gov/licensing/

http://www.leg.wa.gov/

http://www.gpoaccess.gov/fr/

http://www.ethics.wa.gov/

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Ethical Decision Making ModelMary 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

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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.

http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx




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Ethical Considerations for Behavioral Health Professionalsattcnetwork.org/regCenters/activityDocs/10/Ethical Considerations... · supervisor about the ethical, legal and personal