code of professional conduct clarifying and establishing boundaries in scdmh peer delivered services

Code of Professional Conduct

Clarifying and Establishing Boundaries in SCDMH Peer Delivered Services

Peers as Providers

Peer delivered services are still seen as relatively new

concepts in formal systems of mental health care.

Subsequently, concern has been voiced about:

Dual relationships Professional ethics and boundaries Peers being viewed as a “friend” rather than as a

provider

Objectives

The learning objectives for the peer support specialist in

this training are to:1. Understand what dual relationships are & why they can be

harmful.

2. Understand SCDMH policies surrounding ethics & acceptable employee conduct.

3. Clarify different types of boundaries.

4. Understand how violations are harmful & how to recognize boundary violation patterns.

5. Develop a framework for making better ethical decisions at work.

Dual RelationshipsA dual relationship is one in which roles are or could be mixed.

For example: A peer support specialist is providing services

to a client with whom they also have a friendship.

Or A peer support specialist supervisor and case

manager is the same person.

EthicsFor the purpose of this training “Ethics” are:

The hard and fast non-negotiable rules that all

SCDMH employees are subject to.

The Professional Code of Conduct that govern

all SCDMH Certified Peer Support Specialists (CPSS).

BoundariesBoundaries are more ambiguous. They are:

The unseen lines that you won’t cross Undefined physical and emotional distances Parameters that make you unique Self imposed and self defined

Boundaries require the use of good judgment.

Why all the Concern?All of the helping professions (medicine, nursing,

psychology etc.) have established codes of conduct.

This is because there exists an accepted inherent belief

that not addressing these issues unacceptably increases

the chances of harm and/or exploitation for a person

(client) seeking services.

Concerns continued

In as much as peer support specialist’s are SCDMH

employees they should not be treated differently or have

additional rules created to enhance or excuse them from

standards of conduct that is expected of all SCDMH

employees or contracted affiliates.

Concerns continuedWhen acting within one’s role as a professional, a peer

must be able to recognize, maintain and balance

boundaries that establish appropriate limits to

relationships.

If we lose our ability to be objective, we

tend to become too involved in a person or

situation.

Concerns continuedGood, healthy, and appropriate boundaries are the

distance and emotional detachment that need to be

maintained to ensure an effective perspective on a

situation.

Maintaining personal boundaries is indicative of a

well-trained, experienced peer supporter.

Ethics & Dual Relationships

Ethical Practice, Duality & SCDMH

Policy

For all professional staff, it is uniformly contrary to

standards governing the practice and conduct of the

respective health care professions to form personal or

business relationships with patients or clients under their

care. Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients

Prohibited

Ethical Practice, Duality & SCDMH Policy

All employee relationships with patients and clients of the SCDMH should be therapeutic and professional in nature. In order to protect the welfare of patients and clients, encourage adherence to professional standards and preserve the public image and integrity of the Department, the following guidelines are issued to supplement the prohibited conduct listed in paragraph III of the directive:

Physical Abuse Psychological Abuse Neglect Exploitation

Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited


It is the policy of the SCDMH that an employee shall not be directly involved in providing care or treatment of a patient or client who is a friend or relative of the employee.

Employees are prohibited from forming social or business relationships with patients or clients or former patients or clients except as outlined in the directive.

Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited


Any professional employee who engages in conduct

contrary to the standards published by the licensing body of

the employee's respective profession is subject to discipline

by the Department. Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients

Prohibited


Regardless of the circumstances for the CPSS it is:

1. Never appropriate to develop social relationships with those that you provide services to.

2. Never appropriate to provide services to those with whom you have a pre-existing social relationship.

3. Never appropriate to discuss work concerns /issues with clients whether you provide services to them or not.

SCDMH Certified Peer Support Specialist Code of Professional Conduct


Peer Support is a helping relationship between mental health clients and Certified Peer Support Specialists (CPSS) encouraging respect, trust, and warmth. The primary responsibility of Certified Peer Support Specialists is to help empower clients to achieve their own needs, wants, and goals as specified in the plan of care. As such they are committed to providing and advocating for effective recovery based services for the people they serve. SCDMH Peer Support Specialists recognize the importance of a Code of Conduct and are dedicated to these standards being rigorously enforced.


1. Certified Peer Support Specialists will not practice, condone, facilitate, or collaborate in any form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference or personal characteristic, condition, or state. Certified Peer Support Specialists will adhere to policies set forth by the South Carolina Department of Mental Health directive 885-07 (4-100) Abuse, Neglect or Exploitation of Patients and Clients Prohibited

2. Certified Peer Support Specialists will maintain high standards of personal and professional conduct and shall not be party to any type of behavior, activity or policy that denies any client equal, non-discriminatory access to service and/or support; or which deliberately demeans the rights and/or dignity of any client, staff or colleague.


3. Certified Peer Support Specialists will, at all times, respect the dignity, privacy and confidentiality rights of the clients they serve.

4. Certified Peer Support Specialists will never engage in sexual/intimate activities with the clients they serve.

5. Certified Peer Support Specialists shall avoid being drawn into dual (friendships, business bartering etc.) relationships with clients while the support relationship is ongoing.

6. Certified Peer Support Specialists never give out their personal contact information to clients, but will ensure clients know how to contact them through the mental health center.


7. Certified Peer Support Specialists shall only provide service and support within the hours, days and locations that are sanctioned by the mental health center.

8. Certified Peer Support Specialists will conduct themselves in a manner that fosters their own recovery. In so doing, Peer Support Specialists are expected to conduct themselves in a professional manner and take the necessary steps to ensure their conduct does not negatively impact on the perception of this program.

9. Certified Peer Support Specialists will openly share with clients and colleagues their recovery stories from mental illness as appropriate for the situation in order to promote and support recovery and resilience.


10. Certified Peer Support Specialists will keep current with emerging knowledge relevant to recovery, and openly share this knowledge with their colleagues while refraining from giving advice or opinions that exceeds the scope of practice as defined in the Community Mental Health Services Provider Manual Section 2 Policies and Procedures 2-68 for the Peer Support Service.

11. As state employees Certified Peer Support Specialists cannot accept personal gifts.

Establishing Professional Boundaries

What are Professional Boundaries?

Professional boundaries define effective and appropriate interaction between professionals and the public they serve.

They are the space between the professional's power and the client's vulnerability.

They exist to protect both the professionaland the client.

BoundariesWhen we talk about

interpersonal or workplace

boundaries, it can sometimes

be a difficult concept to grasp

because it isn’t something

that we can see.

BoundariesBut just because we can’t

see a boundary doesn't

mean that it isn’t there or that

it isn’t important.

BoundariesThe definition of a boundary

is the ability to know where

you end and where another

person begins.

Boundaries are an Important Issue

The amount & type of boundary responsibility you have

with a person differs according to the type of

relationship:

Friendship Colleague Client

Friendship Boundaries

This is a person that you know, like, and trust and

one with whom you have a close personal connection. It

can be a person with whom you are allied in a struggle or

cause. The difference between this person and a client

you work with is in the equitability of the relationship.

No One has Power or Authority Over the Other

Colleague BoundariesA colleague is a fellow member of a profession. That

person may have power and authority over you, be equal in

power and authority to you or have less power and

authority than you.

Colleague BoundariesLike the relationship with clients,professional or business relationships can become sticky because of the types of power and authority and who has the ability to enforce them.

Power and Authority Are Not Always Equal

Client Boundaries

With respect to the SC Department of Mental Health the

term client is used to describe a person who is seeking

professional psychiatric services. Depending on their

circumstances each individual may hold different types of

power and authority.

Power and Authority Varies

What are Boundary Violations? They are any behavior or interaction which damages a

client, a professional, and/or the professional interaction.

The victimization and/or exploitation of a client by a

professional.

A betrayal of the sacred covenant of trust.

Adapted from MINNESOTA BOARD OF NURSING, January 2000

How do Violations Occur?A boundary violation occurs when a professional, consciously or unconsciously, uses the professional-client relationship to meet personal needs rather than clientneeds.


Who can be Harmed?

Boundary violations can harm both the client and the

professional. The ramifications can be widespread.

Damage can extend to marriages, families, other clients

communities, clinics, institutions, and the profession in

general. Adapted from MINNESOTA BOARD OF NURSING, January 2000

How Do Boundaries Help?

Preservation of boundaries needs not be seen as a barrier

to the professional relationship, but rather as a way to

facilitate it.

Maintaining boundaries protects the safe space in the

relationship thereby enhancing the building of the trust

which is essential to enable clients to reveal their needs.


Boundary Violations: Four Common Elements

Four elements characteristically appear in boundary

violations:

Secrecy Role Reversal Double Bind

Indulgence of Professional Privilege


SecrecySecrecy involves the professional keeping critical

knowledge or behavior from the client and/or others or

selectively sharing information.

Example: A CPSS takes a client into their home and tells

the client the CPSS’s employer cannot know about this or

they will lose their job. Adapted from MINNESOTA BOARD OF NURSING, January 2000

Role Reversal Role reversal occurs when the client takes care of the professional. They look to the client for satisfaction and gratification, rather than placing client needs first. They may not be consciously aware of this role reversal or may attempt to justify it by contending his or her actions are for the client's benefit.

Example: A client becomes a CPSS’s A.A. or N.A.sponsor.


Indulgence of Professional Privilege

Indulgence of professional privilege involves using

information obtained in the relationship with a client for the

benefit of the professional.

Because professionals can have or exert authority over a

client's situation, they can be at risk to extending that

authority to intrude on the client.


Indulgence continuedHaving access to information does not constitute a right to it. Access is a professional privilege; it is not a professional’s right to use the information for one's own benefit.

Example: A CPSS has been helping a client with severe financial problems develop a budget. The CPSS uses that information to try to purchase the client’s car belowmarket value.


Double BindA double-bind consists of messages that contradict each other while discouraging the receiver of the messages from noticing the difference.

The client is left feeling caught in a conflict of interest and any attempt at resolution places the client at risk of loss.

The client is torn between the desire to end the relationship and the realization that this may also end any form of help from the professional.


Double Bind continuedThe double-bind contains an implied threat. A sense of guilt and fear of possible abandonment by the professional blocks the client from taking action. The double-bind constricts the client from using all available options and thus limits growth.

Examples: (1) A CPSS makes negative comments about other CPSS’s caring for a client who has development of trust as a therapeutic goal. (2) A CPSS’s tells a client that they may begin a personal relationship when the client is no longer receiving services.


Boundaries: Are You Helping or Are You Hurting?

There are more gray areas

than black and white ones

when thinking about

boundaries.

Peer specialists can make

more considerate decisions

if they will take time to think

about some of the basics of

boundaries.

Some Warning Signs of Boundary Violations

Although not an exhaustive list, the following are helpful “cues” when setting professional boundaries: Choosing sides Making exceptions Keeping secrets Giving or receiving gifts Borrowing or lending money Feeling as if no one but you has interest in the client Feeling no but you will be able to assist the client Feeling responsible for a client’s progress or failure “Owning” a client’s success’s or failure’s Confiding personal or professional issues or troubles

Developing A Framework

The “Yes’s” and the “No’s”

If you are unsure about your interactions try asking yourself the

following questions: If you answer “No” to 1 - 2 or “Yes” to 3 - 4

you need to stop and evaluate your interaction.

1. Is the relationship in the client’s best interest?

2. Is this something that other CPSS’s would do?

3. Can this affect my objectivity in providing care?

4. Will this cause confusion in my role?

Still Unsure?

If you are still unsure try asking:

1. How would this appear to others (peers, family, colleagues and/or supervisor)?

2. How does this appear to the

client?

3. Is this decision making me

uncomfortable?

Trouble Shooting Problem Spots: Time

When, where, and how often you meet with a client can be a troublesome issue. If it feels wrong it probably is, but ask yourself the following questions to help clarify the situation:

1. How much time am I spending with a client?2. Does it vary from that spent with other

clients? 3. Am I spending "off duty" time with the

client?

Trouble Shooting Problem Spots: Location

If a client wants to talk or meet somewhere other than a center approved location you're beginning to slide toward a questionable boundary as well as possible policy violation. Try asking:

1. Is the location of the interaction appropriate to the relationship?

2. Would you provide peer services to other clients at this location?

3. Is there is a legitimate need to meet?4. Have I made the meeting known to others and documented

it?

Trouble Shooting Problem Spots: Gifts

Accepting or giving a gift can get tricky. If you are unsure ask:

1. Does the gift giving create a sense of obligation

on the part of you or the recipient?

2. Do you do this routinely as part of your job,

regardless of the age or gender of the client?

3. Is the gift of a personal nature that would only be to or from a specific person?

4. Is there a department or center policy regarding gifts?

Asking For HelpAt all times, if you are unsure about a situation

or confused about whether an interaction could

be interpreted as a boundary

violation you always should:

Consult your supervisor Refer to SCDMH Directives Consult the Quality Assurance Coordinator or Client

Advocate Consult other clinical colleagues

?

ALWAYS

Remember…

It is never a good idea to ignore a situation or

interaction and just hope all works out.

The chances are that if you are experiencing

problems other CPSS’s are too!

Thank You!!!Clarifying and Establishing Boundaries in

SCDMH Peer Delivered Services

For more information Contact:Katherine M. Roberts, MPH Director

SCDMH Office of Client Affairs

[email protected]

Bobbie Lesesne, CCETT Coordinator

SCDMH Office of Client Affairs

code of professional conduct clarifying and establishing boundaries in scdmh peer delivered services

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scdmh employees

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scdmh policies

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