Dec 4th 2009 1

Boundaries/Ethics & Peer Specialist Services

Matthew R. Federici, M.S., CPRP

Program DirectorInstitute for Recovery & Community Integration

Mental Health Association of Southeastern Pennsylvania700 East Main Street, 2 North

Norristown, PA 19401610-292-9922 Ext. 114

Fax 610-292-0388 www.mhrecovery.org

www.mhasp.org

Dec 4th 2009 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.

Dec 4th 2009 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

Dec 4th 2009 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

Dec 4th 2009 5

Not So Complicated…

Boundary/Ethical Issues are Not Violations; Violations:

Abuse Illegal activity The media test: if the 11O’Clook News

were to televise what you did, how would you feel when your friends heard?

Dec 4th 2009 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

Dec 4th 2009 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

Dec 4th 2009 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

Dec 4th 2009 9

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 one’s 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

Defining the issues:

Dec 4th 2009 10

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

Defining the issues of Disclosure:

Dec 4th 2009 11

Disclosure or information sharing

“Professional guidance is not to be confused with telling clients what to do”

By Gerard Eagan:The 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

Dec 4th 2009 12

Two Key Challenges of Disclosure

1. Creates a form of intimacy 2. Indirectly communicates a challenge:

i.e. “You can do it, too”

Seven Tools to Guide Disclosure:1. Orient the person to disclosure2. Disclose to inspire not vent3. Watch your timing4. Focused and selective to the persons recovery goals 5. Not too frequent6. Don’t burden and already overburden 7. Be flexible: different use to the person’s situation

Based on Text By Gerard Eagan: The Skilled Helper

Dec 4th 2009 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

Dec 4th 2009 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

Dec 4th 2009 15

Relationship Boundaries

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

Dec 4th 2009 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

Dec 4th 2009 17

Five Decision Making Tools

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

Dec 4th 2009 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.”