Peer Specialists, Recovery Coaches, Indigenous Workers:

1
Peer Specialists, Recovery Coaches, Indigenous
Workers

• Ethical Challenges on the Road to Recovery

2
Peer Specialists, Recovery Coaches, Indigenous
Workers

• Are these more ethically challenging positions?
  Why??
• Substance Use Disorders, MH, Homeless, Community
  Corrections, Community Interventions

3
Goals and Objectives

• Describe a process for making decisions that peer
  specialists can use when confronted with ethical
  dilemmas.
• Recognize ethical challenges and boundary
  problems early on and determine personal clues
  for vulnerabilities.
• Propose a paradigm shift for the supervision and
  management of new treatment models that supports
  an ethical culture.

4
Ethical Challenges

• What types of work, settings or situations are
  the most ethically challenging for Peer
  Specialists, Recovery Coaches and Indigenous
  Community Workers?

5
Ethical Challenges

• Home visits
• Community based work
• Engagement process
• Assertive outreach (ACT) coercive/paternalistic
• Attending social events at the clients request

• Attending Recovery meetings with clients
• Running into clients at social/support
  activities you both participate in
• Friendships/intimate relationships
• Clients requesting money

6
Ethical Challenges

• Value conflicts
• Gifts
• Discussing client with family members and other
  concerned persons (landlord, neighbor, church
  people, sponsor)

• Dual relationships in general
• Am I a consumer/clientor am I an employee

7
Ethical Challenges

• Ethical challenges in community based work are
  especially complex. Consider the competing
  concerns Confidentiality, informed consent,
  client autonomy, client safety and the safety of
  others
• Consider the outreach worker Confidentiality
  vs. the Safety of Others

8
Peer Specialist vs. Professional vs. Sponsor

• So whats the difference?
• New service roles sprout from the soil of unmet
  need. White, W. (2006). Sponsor, Recovery Coach,
  Addiction Counselor The Importance of Role
  Clarity and Role Integrity. Philadelphia, PA
  Philadelphia Department of Behavioral Health and
  Mental Retardation Services.

9
What A Coach/Peer Specialist Is Not

• Not a therapist
• if a client is primarily seeking relief from
  emotional or psychological pain they must to be
  referred to a therapist. Coaching is often used
  concurrently with therapy but should not be
  considered a substitute for therapy.

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What A Coach/Peer Specialist Is Not

• Not an expert nor authority or healer
• the client is the expert about his or her life.
• In order to be considered ready for coaching, a
  coaching client must be healthy enough to engage
  in the coaching relationship, relating to the
  coach as a partner.

11
What A Coach/Peer Specialist Is Not

• Coaches are not personal helpers such as friends
  and family
• coaches dont have a personal stake in the
  choices you make.

12
What A Coach/Peer Specialist Is Not

• Affiliated with any 12-step program and does not
  promote a particular path or way to recover.
• A coachs job is to challenge and support their
  client as they make lifestyle changes and begin
  to have a better quality of life.
• exposing vs. imposing
• Is not a sponsor

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A Recovery Coach is

• Motivator
• Ally and confidant
• Truth-teller ( consistent source of honest
  feedback regarding self-destructive patterns of
  thinking, feeling and acting),
• Role Model and Mentor (offering personal
  examples)
• Recovery educator
• Problem solver

• Resource broker (links individuals/families to
  formal and indigenous sources of sober housing,
  recovery-conducive employment, health and social
  services, and recovery support),
• Advocate
• Community Organizer
• Lifestyle Consultant

White, W. (2006). Sponsor, Recovery Coach,
Addiction Counselor The Importance of Role
Clarity and Role Integrity. Philadelphia, PA
Philadelphia Department of Behavioral Health and
Mental Retardation Services.
14
So, Am I a consumer/clientor am I an employee

• Case 1 scenario
• Discuss the conflicts endemic in this role.

15
Role Difference and Ethical Implications

• Professional
• Education and Training
• Minimal self-disclosure
• Locus of control Treatment
• Clearly defined time frames
• Core competencies clinical
• Special knowledge and skill, fiduciary
  relationship and inequality of power governed by
  legal codes and ethical mandates.

• Peer Specialist
• Experiential knowledge
• Self disclosure inherent to the role
• Locus of control Natural Environment
• Length of relationship often ambiguous
• Core competencies indigenous recovery support
  systems
• Special knowledge and skill, fiduciary
  relationship and inequality of power governed by
  legal codes and ethical mandates.

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Ethical Implications

• The strengths and vulnerabilities of Peer Based
  Support Services are integrally connected
  (White, 2004)
• The reciprocal, non-hierarchical nature of these
  services leaves open the danger of boundary
  violations and hidden abuses of power.
• Over extension and burnout
• Dual relationships

17
Lessons Learned

• Ambiguity, role conflict and inadequate role
  support can set the coach/peer specialist at risk
  for exploitation and vulnerability (White, 2004)
• Those served by the recovery coach/peer
  specialist can be at risk for exploitation and
  injury due to inadequate training, the power
  differential(White, 2004)

18
Lessons Learned

• The RC role represents a connection between
  professional systems of care and indigenous
  communities of recovery and between professional
  helpers and sponsors.
• When those filling this role abandon this middle
  ground and move too far one direction or the
  other, that connecting function is lost. (Bass
  Calori, 2006).
• The old days peer support is nothing new!
  The wisdom of 12 step programs

19
Other Challenges

• Generally, across fields and types of service,
  and within a field and a type of service there is
  not consensus on what is considered to be
  appropriate ethical behavior.

20

• So where do we go from here???
• Creating an Ethical Culture.

21
Recommendations

• Teach and Practice an Ethical decision making
  process.

22
Ethical Decision Making Process

• Review code of ethics and legal mandates (also
  agency policy and team policy-consistency,
  consistency, consistency!!!)

Subtle Boundary Dilemmas, Ethical Decision Making
for Helping Professionals, Shelia McGuire, 1996
23
Common elements of Professional Ethical Codes

• Avoid dual relationships (social, financial,
  sexual)
• Avoid discriminatory behaviors
• Restrict service provision to your area of
  competence
• Respect the autonomy of clients

• Respect the rights, views and practices of others
• Hold colleagues accountable
• Continue to grow professionally participate in
  training stay informed
• Consultation/ supervision
• Confidentiality

Subtle Boundary Dilemmas, Ethical Decision Making
for Helping Professionals, Shelia McGuire, 1996
24
Ethical Codes Suggested for Peer Specialists

• Primary difference is emphasis on
  self-disclosure.
• More simplistic language but the essence of
  professional codes.
• Function as guidelines rather than hard and fast
  rules.

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Ethical Decision Making Process

• Seek input form a second or several other people
  (supervision)-aversion/seduction.
• Determine what motives or values are involved.
  (Is this in the clients best interest, what are
  we getting out of it value conflicts).
• Determine the long-term affects of your choices
  on the consumer. Do this in a staff meeting to
  get ideas.

Subtle Boundary Dilemmas, Ethical Decision Making
for Helping Professionals, Shelia McGuire, 1996
26
Recommendations

• Collaborate and share information with everyone.
  
• As much transparency as possible.
• As traditional roles are changing from
  staff/client to colleagues with different
  experience and expertise. (Backler and Cutler,
  2002)
• Create boundaries for empowerment.
• Mission, values, role clarification, ethical
  guidelines.

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Recommendations

• Fully discuss potential ethical dilemma's
  ideally with a team rather than 11 Supervision
• Create a culture where it is acceptable to make
  mistakes and ask for help. The discussions are
  invaluable.
• Create an Ethics Committee

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Resources

• Backlar, Patricia and Cutler, David L. (2002).
  Ethics in Community Mental Health Care
  Commonplace Concerns.
• Bass, B., Calori, C. (2006). Community
  Recovery Support Peer Recovery Support Service
  Organizations. El Paso, Texas El Paso Alliance,
  Inc.
• Corey, Gerald, Schneider Corey, Marianne, and
  Callanan, Patrick, 2005. Issues and Ethics in
  the Helping Professions, 7th edition.
• McGuire, Shelia (1996). Subtle Boundary Dilemmas,
  Ethical Decision Making for Helping
  Professionals.
• Recovery Coaches International
  http//www.recoverycoaching.org/
• White, W. (2004). The history and future of
  peer-based addiction recovery support services.
  Prepared for the SAMHSA Consumer and Family
  Direction Initiative 2004 Summit, March 22-23,
  Washington, DC.
• White, W. (2006). Sponsor, Recovery Coach,
  Addiction Counselor The Importance of Role
  Clarity and Role Integrity. Philadelphia, PA
  Philadelphia Department of Behavioral Health and
  Mental Retardation Services.