Transcript The Great Balancing Act Ethics in the EA Professional Oct 2014

The Great Balancing
Act: Understanding the Ethical
Challenges EA Professionals
Encounter
Libby Timmons, M.Ed., LISAC, CEAP
President Southern AZ EAPA Chapter
Clinical Outreach Specialist Life Healing
Center
[email protected]
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Goals
• Identify "scope of expertise" challenges in
clinical practice and EA Settings
• Identify strategies to protect your clients’
privacy with employers and other
organizations
• Identify symptoms of clinician burnout and
ways to address your own self care needs
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Ethics and Therapeutic Alliance
Second to cost (81%), lack of confidence in the outcome of the service
is the primary reason.
(78%). Fewer than 1 in 5 cite stigma as a concern.
http://www.apa.org/releases/practicepoll_04.html
Clinical Psychology, 10 Psychotherapy; Bulletin, 40
Drop out rates average 47%;
•Therapists frequently fail to identify failing cases;
•1 out of 10 clients accounts for 60-70% of expenditures
Technique makes the smallest percentage wise contribution
to outcome of any known ingredient.
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Therapeutic Alliance
Outcome of Treatment:
•60% due to “Alliance” ([aka
“common factors”] 8%/13%)
•30% due to “Allegiance”
Factors (4%/13%)
•8% due tomodel and
technique (1/13)
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Ethics
 Moral
– determined in broad context of society
 Legal
– agreed-on rules of society (dictates minimum
(based on values)
standards of citizens)
 Personal
 Ethical
– one’s own values
– “moral principles adopted by a group to
provide rules for appropriate conduct” (dictate
minimum standards of behavior of professionals)
 Best
practice – ideal standards of behavior expected
from a professional
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Principle Ethics
• Respect for Autonomy – respect right of client to
choose
• No maleficence – do not harm
• Beneficence – do good
• Justice – commitment to fairness
• Fidelity – fulfill responsibility of trust in
relationship
• Veracity – truthfulness of counselor
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Virtue Ethics
1)
2)
3)
4)
5)
Integrity – do what is right because
you believe it to be right
Discernment – recognize and respond
to ethical situation
Acceptance of Emotion – recognize
role of emotion in ethical decision
making
Self-awareness – know self
Interdependence with community –
values cannot be espoused without
awareness of community
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EAPA Standards of Practice
• Employee assistance program services shall be provided
through a distinct, identifiable delivery system. The
service delivery system must reflect the unique needs of
the organization and its employees
• When considering the addition of any new services, the
EAP must first determine that the new services are
consistent with and will not damage the core EAP
functions, goals, and objectives
• The employee assistance program shall require that all
employee assistance personnel adhere to the EAPA Code
of Ethics.
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Confidentiality
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Origins/importance of confidentiality
Only ethical issue to which an entire ACA
code of ethics section is devoted
Belongs to the client (not counselor)
Vs privileged communication
Confidentiality and consultation
 Confidentiality and supervision
 Other professionals and organizations
involved in treatment
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NOTES
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Why keep progress notes?
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Refresh memory (client leaves EAP engagement then
returns)
Stay on target with goals
Conceptualize and process session
Share info with other professionals (don’t reinvent the
wheel)
Have in case called to court months/years later
Not keeping notes?

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Expected in profession
Still must reveal info from memory in court
Taking notes helps you function professionally
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NOTES
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When keeping notes:
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Assume they will be read by others
Include only appropriate content
Narrative notes should include:
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Information reported
Observations (whether related to screening
information or simply your observations)
Your impressions/conclusions resulting from
review of data/information
Treatment needs, direction, plan, goals, etc.
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Ethical Decision Making
1)
Identify and define problem
-there really is no such thing as an ethical emergency
2)
3)
4)
5)
6)
7)
8)
Consider moral principles
Tune in to your feelings
Consult, Consult, Consult
Involve your client (throughout process)
Identify desired outcomes (rarely does only
a single outcome emerge in ethical
dilemmas)
Consider possible actions (ponder
implications of each)
Choose and act
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Competence
Law states minimum/code encourages
maximum
 Moral principle related is
nonmaleficence
 “practice only within boundaries of
competence”
 How do you know if/when a counselor
is competent?
 Competence directly tied to
MALPRACTICE
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Competence

Preparation (entering profession)

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Getting into a graduate program (standards?)
Quality/requirements of program toward producing
competent counselors
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Licensure/Credentialing (specializations)
Maintaining competence
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Regional accreditation of institution/CACREP
Continuing education
Peer review (consultation/supervision)
Knowing when to refer
Diversity issues
Distress/Burnout/ Impairement
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EAPA STANDARDS
• The employee assistance program shall require employee
assistance professionals to maintain and upgrade their
professional knowledge and skills, and shall support their
efforts to do so.
• The organization shall adopt a written employee assistance
program policy which defines the employee assistance
program’s relationship to the organization, describes the
program as a confidential resource, and states the scope and
limitations of the program’s services.
• The employee assistance program shall establish
procedures to determine when to provide short-term
problem resolution services, and when to make a referral
to professional and/or community resources.
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Boundary Issues/Dual Relationships
• What are they?
• Why are they harmful?
• Boundary crossing vs. boundary violation
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Dual Relationships
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Bartering
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Social Relationships with clients
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housekeeping, babysitting, carpentry
Accepting gifts from clients
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Small town rule
Business/financial relationship with clients
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See code
Diversity considerations
Consider context and client’s motivation for giving
Self disclosure
Physical contact
Sexual Dual Relationships
EA challenges- multiple levels of issues
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Boundaries
• No is a complete sentence
• Most complaints are related to dual
relationships and broken boundaries
• What do the code of ethics say about
contact with a client after they end
treatment?
• Ask 3 people- Consult, Consult, Consult
• Within your scope of practice
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Technology
Do you text with clients?
Do you have a Facebook account?
How do you back up your electronics?
Some facts about internet misuse- chat
rooms, blogs, games?
Do you have an e policy in your policy and
procedures?
What is the EAPA policy on Technology
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Resources
• Eric A. Schmidt, Ph.D., LPC, LCDC
• Ethics, Laws, and Adolescents: Confidentiality,
Reporting, and Conflict M. Sherrill Luther Pitcairn
and Kristi Ann Phillips
• American Counseling Association
• National Association of Social Workers
• American Psychological Association
• Employee Assistance Professional Association
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