Boundaries and the CASAC Canon of Ethics

  Week 5 – Boundaries and the CASAC Canon of Ethics Previously, we have discussed the counselor-client relationship and that power is an inherent dynamic within it. If this power is misused, it can contribute to boundary violations that range from minor to severe. What are the characteristics of a boundary violation? This week we are focusing on identifying these. Additionally, one of the defining characteristics of any profession is that it has a code of ethics. For CASAC Counselors, there is the CASAC Canon of Ethics. This provides specific standards on a range of Counselor behaviors. Therefore, in order to ensure that we are ethical professionals, Counselors need to understand: What are the parameters of what we should and should not do with clients. To this end, this week we will focus on the following class goals: 1. To identify the characteristics of boundary violations 2. To apply the CASAC Canon of Ethics to avoid and resolve boundary violations 3. To compare and contrast the CASAC Canon of Ethics with that of NAADAC: The Association for Addiction Professionals. READINGS: White, W.L. & Popovitz, R. (2001). Critical Incidents: Ethical Issues in the Treatment and Prevention of Addiction. Bloomington, Illinois: Chestnut Health Systems. ◦Chapter 2:◦The code of professional practice, pp.13-25. Discussion 1: Think about a situation in which you found yourself in a dual relationship. (For example, being friends with a co-worker, or meeting your new boss at a social event, etc.). Describe the potential boundary concerns this raised for you including what level of boundary violations could have occurred. What tenets of any of the Ethical Canons could have guided you in this situation? How did it turn out for you? Disscussion 2: 2) Your agency hires a new Counselor, Paul. When he goes to facilitate a group, he realizes that an old girlfriend is one of the members. Paul has not seen her in six years and has no idea what has been going on with her. Paul is sure that he can be a fair and objective Counselor, so he makes the decision to continue to work with her. In fact, Paul is sure that he may even be in a better position to assist his old girlfriend than some of the other Counselors. Paul still has positive feelings towards her. He confides this to you during your mutual lunch break. Are there any boundary violations here? If so, identify the characteristics and levels of the boundary violation/s? What standard/s of the Canon of Ethics and the NAADAC Code are involved? As his colleague, what might you do? Content Week 6 - Structuring the Therapeutic Relationship to Ensure Ethical Care Interpersonal and communication skills are the primary tools that Counselors use to work with clients. These include a broad group of both verbal and non-verbal skills, such as how does a Counselor go about showing empathy; and how does a Counselor help clients explore their issues in more depth. Counselors, however, do not use skills within a vacuum. Instead, the onus is on the Counselor to build a therapeutic relationship with the client, which can allow him or her to best engage the person. The goals of this class thus focus on the following aspects of the therapeutic relationship. Class Goals: 1. To define the stages of the counseling relationship 2. To apply the stages of the counseling relationship to effectively structure individual counseling sessions 3. To integrate an ethical perspective at all times into the counseling relationship Week 6 - Discussion #1 1) As a new Counselor, there is a high likelihood that you will be working with clients who are ethnically diverse. You are sitting with such a client for the first time. What might be your greatest fear/s regarding this? Week 6 - Discussion #2 2) If you are not familiar with a client’s culture – racial and/or ethnic background, geographical origin, history, language, religion, food, customs, etc. – how might you prepare yourself to work ethically and effectively with that client? Week 7-Confidentiality & Privacy Basics Goals: To be able to articulate the history, intent and scope of the Confidentiality & Privacy Regulations To identify the basic conditions for disclosure Week 7 - Discussion #1 #1. The KBCC Treatment Program is faced with budget cuts due to the new state and federal administration. Your supervisor calls a staff meeting and asks the counselors, including you, to organize clients for a trip to Albany to lobby their representatives. Discuss how you will need to engage any of the clients for each of the following activities. Make sure you use your Canon of Ethics to examine if it is ethical, as well as the confidentiality and privacy guidelines to determine if it is legal. a) Can you mandate a client to participate in this lobbying activity? Why or why not? b) Can you provide clients with T-shirts and placards that say KBCC Treatment Program, Coney Island, NY? Why or why not? Week 7 - Discussion #2 #2. The KBCC Treatment Program is faced with budget cuts due to the new state and federal administration. Your supervisor calls a staff meeting and asks the counselors, including you, to organize clients for a trip to Albany to lobby their representatives. Discuss how you will need to engage any of the clients for each of the following activities. Make sure you use your Canon of Ethics to examine if it is ethical, as well as the confidentiality and privacy guidelines to determine if it is legal. c) Can you ask clients to talk to the media and be videotaped for Channel 7 News? Why or why not? d) Can you ask clients to meet with the representatives in Albany individually or to testify before the legislative committee that is responsible for budgeting? Why or why not? Week 8 - Applying the Confidentiality & Privacy Laws Goals: a)To learn and apply the guidelines for internal versus external use and disclosure b)To identify special situations including HIV/AIDS and guidelines around their use and disclosure Week 8 - Discussion #1 1) Peter Pan has consented for his toxicology reports to go to his Probation Officer. He asks the Counselor to withhold two reports that show opiate use. The Counselor refuses to do so. a. Should the Counselor have refused? Discuss this from an ethical perspective. Identify any guidelines from the Canon of Ethics or from your prior readings which apply here. Week 8 - Discussion #2 2) Peter becomes very angry and verbally abusive to the Counselor and tells her that he is withdrawing his consent. The Counselor advised him that she already faxed the toxicology reports to his Probation Officer. Peter threatens “to wait outside” for her when she leaves work at 6pm. a. Can Peter withdraw his consent? Why or why not? Discuss what Confidentiality of Privacy guidelines might apply here? b. Can the Counselor notify law enforcement? Why or why not? Discuss what Confidentiality of Privacy guidelines might apply here? What would you do? Week 9 - Using the Critical Incident Worksheet Goals: To review The Work Sheet For Critical Incident Discussion Groups White & Popovits _2001, p. 28_..jpeg To apply the Model to make reasoned decisions regarding dilemmas that may occur in the field By now, you should have realized that ethics, confidentiality and privacy is important to all that we do in chemical dependency organizations — from managing an agency appropriately, to supervising staff including counselors and support staff, to working directly with clients, and to keeping those clients safe. As some of you have observed in the real world setting and from some of the vignettes we have been working on, we know that there are persons who are employed to assist clients who may not always act in the clients’ best interests. Sometimes the person just may not care. However, this might also occur as the person is not familiar with ethical and other guidelines. Lastly, it may occur as the person arrives at a decision that is less than optimal as he/she has not fully considered all aspects of the situation. Hopefully, none of us fall into groups 1 & 2 above. However, in order to assist us in using critical thinking and arriving at appropriate client decisions, it is helpful to adopt a consistent method of examining situations that arise. The Work Sheet For Critical Incident Discussion Groups (White & Popovits, 2001, p.28) provide a framework that we can all use as a group or individually. In Section I, we think through whose interests are involved, who can be harmed, and what might be the level of harm. In Section II, we determine which universal values apply to the situation. In Section III, we apply the standardized guidelines of the Cannon of Ethics, the Confidentiality and the Privacy Laws, other state laws such as the Mental Hygiene Law, the agency’s Policy & Procedures, any other standards or historical practices that are relevant. Using a reasoned, critical thinking process is the most effective way for us to minimize biases and provide the best opportunity for quality client care. Reference White, W.L. & Popovitz, R. (2001). Critical Incidents: Ethical Issues in the Treatment and Prevention of Addiction. Bloomington, Illinois: Chestnut Health Systems. Week 9 - Discussion #1 1. Peter has a history of chronic alcoholism for more than 10 years. He is admitted to the KBCC residential treatment program for 6-9 months treatment, due to receiving a DUI. You are doing bed checks one week after Peter is admitted and you find a pint of vodka hidden under his bed. Some members of the treatment team believe Peter should be immediately terminated. You aren't so sure because you understand how difficult it must be for Peter to stop using alcohol. What will you do? Use the Critical Incident Framework to work through your process. Remember to discuss your reasoned thinking. Week 9 - Discussion #2 2. Frank has been admitted to the 6-9 month, KBCC residential treatment program several times. On at least three prior occasions, once the weather became warm, Frank checked himself out of the facility against medical advice or AMA. It is now November and very cold. Frank presents for treatment admission for his Alcohol Use Disorder (AUD). Several staff do not want to admit him as they believe he is just looking for a warm place to sleep and free food until the weather warms up. Some staff believe that admitting Frank is enabling him. To complicate things, another client with an AUD shows up at KBCC also seeking admission, but he arrived after Frank. What will you do? Use the Critical Incident Framework to work through your process. Remember to discuss your reasoned thinking. Week 10's Materials Week 10 – Is Thinking an Ethical Process Over the past weeks, have you been consistently using critical thinking to process the variety of concepts, laws and potential issues we can encounter in the field? Or, where might you have fallen short? Do you understand what a fallacy is and how you might be using thinking patterns such as mind tunnels, which can contribute to poor decision making? For the next two weeks, we will focus on the following: Goals: • Identify some of the reasons your thinking might be poor. • Review the various types of fallacies in relation to your own thinking. • Honestly assess what you may need to work on in your thinking to decrease your risks of being unethical. Readings: Weeks 10-11: Taleff, M. (2006). Critical Thinking for Addiction Professionals. New York, NY: Springer Publishing Co. Inc. • Chapters 6-7, pp. 60-75. • Chapter 8’s Summary, p.88 • Chapter 9’s Summary, p.103-104. • Chapter 10’s Summary, p.110. • Chapter 11’s Summary, p.128. • Glossary, pp.137-142. Week 10 - Discussion #1 After completing the readings for this week, select any of your peer’s prior posts on Blackboard in which you believe he/she used critical thinking. Critically assess the post using the guide: a. What would be the proof for any statements made by the writer? b. Did he/she include evidence for any statements they made? c. Give two reasons you would want to believe the statement? d. How could you be sure the statement is true? (Adapted from Taleff, 2006, p.74). Reference Taleff, M. (2006). Critical Thinking for Addiction Professionals. New York, NY: Springer Publishing Co. Inc. Week 10 - Discussion #2 After completing the readings for this week, select any of your prior posts on Blackboard in which you believe you used critical thinking. Critically assess the post using the guide: a. What would be the proof for any statements you made? b. Did you include evidence for any of your statements? c. Give two reasons you or the reader would want to believe the statement? d. How could you be sure the statement is true? (Adapted from Taleff, 2006, p.74). Reference Taleff, M. (2006). Critical Thinking for Addiction Professionals. New York, NY: Springer Publishing Co. Inc. Week 11 Critical Thinking as an Ethical Process We will continue to focus on the following from last week: Goals: • Identify some of the reasons your thinking might be poor. • Review the various types of fallacies in relation to your own thinking. • Honestly assess what you may need to work on in your thinking to decrease your risks of being unethical. Readings: Weeks 10-11: Taleff, M. (2006). Critical Thinking for Addiction Professionals. New York, NY: Springer Publishing Co. Inc. • Chapters 6-7, pp. 60-75. • Chapter 8’s Summary, p.88 • Chapter 9’s Summary, p.103-104. • Chapter 10’s Summary, p.110. • Chapter 11’s Summary, p.128. • Glossary, pp.137-142. Week 11 - Discussion #1 1) Select any post from one of your peers in which he/she used a fallacy. Name what type of fallacy this was. How might the person have been able to address/correct this? Week 11 - Discussion #2 2) Select any of your prior posts in which you used a fallacy. Name what type of fallacy this was. How might you address/correct this as you move forward?