ethics in case management: basics, boundaries, and burnout€¦ · principles, healthy boundaries,...

OBJECTIVES

1 – Understand and articulate the overlap between ethical

principles, healthy boundaries, and prevention of burnout.

2- Effectively strategize to deliver services ethically, implement

appropriate interventions, and maintain healthy

boundaries.

3- Summarize ways to successfully maintain healthy self-care

practices to prevent burnout.

OUTLINE

Basics: Ethical Principles of Case Management

▪ Ethical codes

▪ Purpose

▪ Intent vs. effect

▪ Common factors

▪ Additional suggestions

▪ Application

Boundaries: Case Manager-Client Interactions

▪ Boundaries

▪ Purpose

▪ Typology

▪ Healthy vs. unhealthy

▪ Transference and counter-transference

▪ Ethical considerations

▪ Effects on interactions

▪ Case studies

Burnout: Poor Boundaries + Blurred Ethics = Burnout

▪ Burnout defined

▪ Effects of burnout

▪ Role play!

▪ Self-care

Conclusion

▪ Key strategies for ethical implementation, boundaries-setting, and burnout-prevention

BASICS: ETHICAL CODES

What is ethics?

▪“an area of study that deals with ideas about what is good and bad behavior : a branch of philosophy dealing with what is morally right or wrong” (Merriam-Webster)

What are ethics?

▪“the principles of conduct governing an individual or a group” (Merriam-Webster)

BASICS: ETHICAL CODES

Why have ethics, anyway?

What is its purpose in case management?

BASICS: ETHICAL CODES

“Recognition that case management is guided by the principles of autonomy, beneficence, non-maleficence, and justice.” (Code of Professional Conduct for Case Managers, 2009)

Other principles that are relevant to case management?

▪Social benefit

▪Accountability

▪?

BASICS: APPLICATION

Name some ways that you can enhance (or enact):

▪Your client’s autonomy

▪Social benefit via interactions with your client

▪ Justice as a case manager

▪Non-maleficence and beneficence

▪Accountability between you and your client?

▪Between you and your colleagues?

BOUNDARIES

As case management professionals, why is it important

for us to set and maintain boundaries?

How do you know when a client can benefit from

additional boundaries-setting?

BOUNDARIES

Typology

BOUNDARIES

Remember: Even when boundaries are addressed and

enhanced, transference and countertransference can,

and inevitably will, occur within the case

management-client relationship!

BOUNDARIES, TRANSFERENCE, &

COUNTERTRANSFERENCE

Transference

-experienced by the participant, client, patient, etc.

-happens when the participant “transfers” feelings, thoughts, and beliefs regarding

“significant others” from childhood onto the case manager, and has an emotional reaction

Countertransference

-experienced by the case manager, therapist, etc.

-occurs as an emotional reaction to the participant; case manager also “transfers”

feelings, thoughts, and beliefs onto the participant

TRANSFERENCE AND COUNTERTRANSFERENCE CAN BE POSITIVE AND/OR NEGATIVE!

Client Case Manager

Transference

Countertransference

How is attachment theory relevant here?

“Clients’ patterns of relatedness manifest within the therapy

relationship, often along with potential responses that the client

attempts to pull from the therapist, in order to confirm or perpetuate

their working model of self and others.” (Skourteli & Lennie, 2011)

Problem?

Client’s

Attachment Style

Client’s Interaction w/ CM CM’s Countertransference

Response

Ambivalent

-excessively contacts

-always seeks

reassurance

-dependent

-helpless

-Attempts to “rescue”

-Burn-out

-Overwhelmed

BOUNDARIES

What are the ethical implications of poor boundaries?

How can healthy boundaries impact our clients?

In what ways can unhealthy boundaries hinder our

clients’ success?

BOUNDARIES

Case Study: Ricky the Rescuer

Case Study: Olivia the Over-sharer

Case Study: Tom the Time-giver

BURNOUT

BURNOUT

“…a state of chronic stress that leads to physical and

emotional exhaustion, cynicism and detachment, and

feelings of ineffectiveness and lack of

accomplishment.” (Carter, 2013)

BURNOUT

http://irisclasson.com/2013/10/07/burning-out-the-what-why-and-who-question-145-148/

BURNOUT

Affects individuals emotionally, mentally, physically,

spiritually, and socially

Effects are insidious and not sudden

Often, other people in your life will notice that you are en

route to or suffering from burnout before you do

BURNOUT, BOUNDARIES, AND ETHICS

Role Play!

ADDRESSING BURNOUT

The Three R’s

▪Recognition

▪Reversal

▪Resilience

BURNOUT - RECOGNITION

BURNOUT - REVERSAL

• Self-care helps with prevention,

reversal, and building resilience

• Adopt healthy exercise, sleep,

and eating habits

• Utilize coping skills to effectively

manage stress

• Take a break from technology and

indulge in recreational activities

• SET BOUNDARIES!!!

BURNOUT - REVERSAL

BURNOUT - REVERSAL

BURNOUT - RESILIENCE

Recover from burnout first!

▪Slow down

▪Obtain support

▪Re-assess your goals and priorities

▪Remember: “Begin with the end in mind.” - Covey

CONCLUSION

Putting it all together:

▪Ethical considerations guide our implementation of boundaries

▪Lack of boundaries, or poor boundaries-setting, leads to burnout

in our profession

▪So…services should be delivered ethically and with boundaries

in place, to guide us in building resilience, reversing the effects

of burnout, and recognizing the phases that precede burnout

HELPFUL RESOURCES

Self-Care:

http://homeless.samhsa.gov/channel/self-care-for-providers-27.aspx

Ethics & Boundaries:

http://www.health.qld.gov.au/abios/behaviour/professional/boundaries_pro.pdf

REFERENCES

http://www.helpguide.org/mental/burnout_signs_symptoms.htm

http://www.mayoclinic.org/healthy-living/adult-health/in-depth/burnout/art-

20046642

http://www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-

signs-burnout-do-you-have-them

THE END

Questions?

Comments?

Concerns?

Suggestions?