Boundaries/Ethics

1

• Boundaries/Ethics
• Peer Specialist Services
• Matthew R. Federici, M.S., CPRP
• Program Director
• Institute for Recovery Community Integration
• Mental Health Association of Southeastern
  Pennsylvania
• 700 East Main Street, 2 North
• Norristown, PA 19401
• 610-292-9922 Ext. 114
• Fax [phone] 
• www.mhrecovery.org
• www.mhasp.org

2
Objectives

• Through participation in this teleconference you
  will be able to
• Define and categorize boundary and ethical
  challenges in the context of Peer Specialist
  Services
• Utilize situational analysis tools to more
  effectively navigate daily boundary and ethical
  challenges.

3
History and Context of Boundary/Ethics in the
mental health system

• Old Standards New Dilemmas
• Traditional System Based on
• Institutionalization
• Concept of professional distance
• Clinical definition objective observation
• Clear segregation between staff and patient
• Recovery Oriented System
• Community Based,
• Concept of Mutuality
• Subjective individualized and holistic
• Integration and people first. i.e. like everyone
  else.
• Based on Old Standards, New Dilemmas ethics and
  Boundaries in Community Support Service by Laurie
  C. Curtis and Martha Hodge

4
History and Context of Boundary/Ethics in the
mental health system

• In this new Environment Boundaries and Ethical
  Guidelines must be
• Flexible
• Contextual
• Case by case situations
• Require more on-going supervisory dialogue to
  problem solve
• -Based on Old Standards, New Dilemmas ethics and
  Boundaries in Community Support Service by Laurie
  C. Curtis and Martha Hodge

5
Not So Complicated

• Boundary/Ethical Issues are Not Violations
• Violations
• Abuse
• Illegal activity
• The media test if the 11OClook News were to
  televise what you did, how would you feel when
  your friends heard?

6
Boundary Issues or Boundary Violation

• Issues
• Inevitable
• Not right or wrong
• Ongoing
• It Depends

• Violation
• Abuse
• Sexual Relationships
• Drugs and Alcohol
• Usually clear laws, policies or rules

7
Defining the issues

• The majority of challenges are not because we are
  peer specialist but because we represent the
  shift toward recovery oriented community
  integrated services
• The key distinction in the Peer Specialist
  Service is its unique potential value of
  DISCLOSURE MUTUALITY

8
Defining the issues

• The biggest perceived concern
• Peers ability to handle confidentiality and
  boundaries
• (based on literature review around implementation
  concerns with consumers as providers and focus
  groups with administrators and existing agency
  workforce)
• Reality the biggest challenge is the agency and
  organizations ability to handle confidentiality
  and boundaries between people as members of their
  community and their workforce
• Confidentiality and boundary issues are huge
  challenges to the quality of services
• but it has always existed and the issues apply to
  everybody working in community based services

9
Defining the issues

• The biggest contributing factor to ethical and
  boundary problems is when the roles are not
  clearly defined and communication is not
  occurring.
• This is not only true when we transition from
  ones friend in the hospital to their paid
  support, but also when we transition from their
  colleague to their boss or supporter to
  colleague.
• The contexts of our relationships are fluid and
  not static relationship

10
Defining the issues of Disclosure

• Disclose to Inspire not to Vent
• As peer specialists the purpose is not to hire or
  be valued because of our stories of illness it is
  to be hired and valued for our skills and story
  in recovery

11
Disclosure or information sharing

• Professional guidance is not to be confused with
  telling clients what to do
• By Gerard EaganThe Skilled Helper
• This is the same principle for our recovery
  experience.
• Regardless if it is our knowledge as trained in a
  therapeutic method or from our own lived
  experience

12
Two Key Challenges of Disclosure

• Creates a form of intimacy
• Indirectly communicates a challenge
• i.e. You can do it, too
• Seven Tools to Guide Disclosure
• Orient the person to disclosure
• Disclose to inspire not vent
• Watch your timing
• Focused and selective to the persons recovery
  goals
• Not too frequent
• Dont burden and already overburden
• Be flexible different use to the persons
  situation
• Based on Text By Gerard Eagan The Skilled Helper

13
Defining the issue of Mutuality

• Think of the helper principle a well research
  fact of our field that people receive positive
  therapeutic outcomes when helping others.
• For peers this can have even a greater impact.
• This dynamic can go in either direction i.e.
  helping each other get high or maintain other
  unhealthy behaviors
• The key is focusing on the goal of recovery and
  togetherness
• If it is not working for one of us it is probably
  not working for either of us

14
Tools Eight Core Principles to Guide Our Work

• Do the Most Good
• Focus on the Individual Interdependence
• Be Fair and Just
• Tell the Truth
• Informed Consent
• Do No Harm
• Continuing Education
• Privacy Confidentiality

15
Relationship Boundaries

• Relationship boundaries are established to
• Promote trust.
• Increase safety.
• Demonstrate respect.
• Develop rapport (working alliance).
• Provide structure to helping relationship.

16
Near Impossible Dual Roles Conflict of Interest

• Supervisor and Therapist
• Controlling your finances and supporting your
  self-directed recovery goals.
• Peer specialist and sponsor
• Holding and dispensing your medication and being
  your Peer Specialist or supporter
• Profiting from you and Paid Supporter i.e hey
  can you wash my car for five bucks.
• Being your landlord and primarily for your
  recovery
• Being your spouse and/or significant other and
  providing you Peer Support Services

17
Five Decision Making Tools

• Principle of Primary Benefit
• Principle of Ethical Action
• Principle of Expectation
• Principle of Resources
• Principle of Satisfaction

18
Simple Tips To Guide The Day

• Boundary Issues are not Boundary Violations
• Disclose to inspire not to vent
• CONSULT CONSULT CONSULT!
• THE 11 O Clock NEWS!
• If you are not discussing boundaries and ethical
  dilemmas in staff meetings and supervision then
  your are not have supervision or doing your job.
• IT IS About the RELATIONSHIP, Relationship,
  Relationship!
• i.e. if its not working for me it is probably
  not working for you.