Ethics and Supervising

Andrea Standley PhD

Values◦ Beliefs and attitudes that provide direction to

everyday living Internal

Ethics◦ Beliefs we hold about what constitutes right

conduct. Ethics are moral principles adopted by an individual or group to provide rules for right conduct External

Ethics

Cory, Cory & Calanan (2011)

Autonomy: to promote self-determination

Beneficence: to do good for others and promote the well-being of participants

Non-maleficence: to avoid doing harm

Basic Principles to Guide Ethical Decision Making

Justice: to be fair by giving equally to others and to treat others justly

Fidelity: to make realistic commitments and keep these promises

Veracity: to be truthful and deal honestly with participants

Basic Principles to Guide Ethical Decision Making

The National Organization for Human Services promotes the following ethical standards:

◦ Respect the integrity and welfare of the participant at all times

◦ Protect the participant’s right to privacy and confidentiality except when such confidentiality would cause harm to the participant or others

Ethical Standards

◦ Protect the integrity, safety and security of participant records

◦ Protect the participant’s right to self-determination Recognize the participant’s right to receive or refuse

services Self-Neglect Hoarders

◦ Recognize and build on participant strengths

◦ Keep informed about current social issues as they affect the participant and the community.

Ethical Standards

◦ Act as advocates in addressing unmet participant and community needs

◦ Provide services without discrimination or preference based on age, ethnicity, culture, race, disability, gender, religion, sexual orientation or socioeconomic status

◦ Be knowledgeable about the cultures and communities within which you practice

◦ Be aware of your own cultural backgrounds, beliefs, and values

Ethical Standards

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Passed by congress to promote standardization and efficiency in the health care industry and to give patients more rights and control over their health information.

HIPAA

The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities

It provides patients an array of rights and respect with respect to that information

The Privacy rule is balanced so that it permits the disclosure of personal health information needed for patient care

HIPAA Privacy Rule

Establishes administrative, technical and physical standards for the security of electronic health information

Requires that we maintain the availability, integrity, and confidentiality of electronic health information

HIPAA Security Rule

Protected Health Information (PHI) under HIPAA means any information that identifies an individual and relates to at least one of the following:◦ The individual’s past, present or future physical or

mental health

◦ The provision of health care to the individual

◦ The past, present or future payment for health care

Protected Health Information

Name Address Birth Date Social Security number E-mail address Health plan beneficiary number Account number Photographic image Any other characteristic that could uniquely

identify the individual

Identifiers Under HIPAA

Make sure participants know that information is confidential

Power of Attorney

Release of information form

Provide Notice of Privacy Practices

Privacy in Hospitals

Confidentiality

When clerical assistants handle information

When an in-home service worker or care coordinator is being supervised

When a participant has given consent

When a participant poses a danger to self or others

Limits to Confidentiality

When a participant discloses intention to commit a crime

Suspected abuse or neglect of a child or vulnerable adult

Court orders

Public health purposes to control disease

Limits to Confidentiality

Assisting the government in overseeing health care programs

Law enforcement purposes

National security purposes

Limits to Confidentiality

Mandatory Reporting◦ Designed to encourage reporting of any

suspected cases of child, elder, or dependent abuse

◦ If children, the elderly, or other dependent adults disclose that they are being abused or neglected, the professional is required to report

◦ We have an obligation to protect those who cannot advocate for themselves

Protecting Children, the Elderly, and Dependent Adults From Harm

Child Abuse 1-800-252-2873

Elder Abuse 1-866-800-1409

Contact information for Reporting Abuse

Balancing participant confidentiality and protecting the public is a major ethical challenge

◦ We must exercise the skill and care of a reasonable professional to: Identify participants who are likely to do physical

harm to third parties

Protect third parties from participants judged potentially to be dangerous

Duty to Protect Potential Victims

Most ethics codes address diversity, however, reliance on ethics codes alone does not guarantee multicultural competence

Ethical practice requires that professionals be trained to address diversity factors

We need to reflect on our own assumptions and challenge stereotypical beliefs and cultural bias

Multicultural Competence

A temporary dependence is not necessarily problematic

A ethical issue occurs when workers/professionals encourage and promote dependence

Ethics and Participant Dependence

Supervising is a process that involves a supervisor overseeing the professional work of a trainee with five major goals:

◦ To promote employee growth and development

◦ To protect the welfare of the participant

◦ To not participate in dual relationships

Ethical Issues in Supervising

◦ To monitor supervisee performance and to serve as a gatekeeper for the profession

◦ To empower the employee

Can you think of other goals of a supervisor?

Ethical Issues in Supervising

Ladany and Colleagues(1999) conducted a study and found:◦ 51% of employees sampled (151) reported ethical

violations by their supervisors.

◦ Ethical violations included: Performance evaluations Confidentiality issues Ability to work with alternate perspectives

Ethical Violations by Supervisors

It is beneficial to discuss the rights of employees from the beginning of the supervisory relationship

When employees learn what they can expect and what they need to do to achieve success, they are empowered to do a good job

Rights of Employees

Supervisors should be upfront with employees by providing:◦ Methods to be used in supervising

◦ Responsibilities and requirements For supervisor and employee

◦ Policies pertaining to confidentiality and privacy

◦ Documentation of supervision

Information Provided to Employees

Risks and benefits

Evaluation of job performance

Complaint procedures and due process

Professional development goals

Information Provided to Employees

Supervisory sessions should be in private

To be fully informed of supervisor’s approach

Confidentiality with regard to employee’s disclosure

Confidentiality with regard to participants except as mandated by law

Rights of Employees

Supervisors are ultimately responsible, both ethically and legally for the actions of their employees

Supervisors have responsibilities to current participants and future participants as well

The Supervisor’s Roles and Responsibilities

Supervisors must have a clearly developed framework for supervision and a rationale for the methods they employ

Good supervisors demonstrate the four A’s:◦ Available◦ Accessible◦ Affable◦ Able

The Supervisor’s Roles and Responsibilities

Don’t supervise beyond your competence

Evaluate and monitor employee’s competence

Be available for supervision consistently

Maintain written policies

Document all supervisory activities

Risk Management Practices for Supervisors

Maintain a working knowledge of ethics codes, legal statutes, and certification regulations

Use multiple methods of supervision

Have a feedback and evaluation plan

Establish a policy for ensuring confidentiality

Manage boundaries

Risk Management Practices for Supervisors

Human services can be a stressful profession which can lead to empathy fatigue.

Some sources for stress are:

◦ Feeling of not helping their participants enough

◦ The tendency to accept full responsibility for participant’s progress

◦ Feeling a pressure to quickly solve participant’s problems

◦ Having extremely high personal goals and perfectionist strivings.

Stress in the Human Service Profession

An absence of boundaries with participants or employees

Preoccupation with work

Inability to say no

Poor health habits in the areas of nutrition and exercise

Signs which lead to Potential Burnout

Low productivity

Depression

Negativity

Frustration

Agitation

Feeling of futility

Signs of Burnout

As supervisors, what can you do to minimize the possibility of burnout in your employees?

As supervisors, what can you do to minimize the possibility of burnout in yourself?

Question

Paid Family Caregivers

Gift Giving

Can you think of any other ethical issues?

Potential Ethical Participant Issues

Any effort to defraud the Medicaid system by billing for services not delivered, or under delivered.

It can also manifest itself in cases where physical abuse or neglect has occurred.

In order for there to be Medicaid Fraud, Medicaid money must be involved.

Medicaid fraud can also occur when participants knowingly falsify Medicaid/CCP applications.

What is Medicaid Fraud?

Two Ways to report Medicaid Fraud

Illinois State Police◦ 1-888-557-9503

Healthcare and Family Services◦ Office of Inspector General

Reporting Medicaid Fraud

Reporting Medicaid Fraud

“Never let your sense or morals get in the way of doing what’s right.”

Isaac Asimov

Corey, Cory & Callanan (2011). Issues and ethics in the helping professions. Brooks/ Cole – Cengage Learning

Hall, J. (2012) Staff retention and minimizing burnout. Retrieved on 2/11/2013 fromhttp://humanservices.ucdavis.edu/resource/library/pdf/D14%20Staff%2

0Retention%20and%20Minimizing%20Burnout.pdf

Ladany and colleagues (1999). Psychotherapy supervisor ethical practice: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counseling Psychologist, 27(3), 443- 475.

National Organization for Human Services (2013). Ethical standards for human service professionals. Retrieved on 1/29/13 from

www.nationalhumanservices.org/index.php?option=com_content&view==article&id=

U.S. Department of Health and Human Services (2013). Health Information Privacy. Retrieved on 1/29/2013 from www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

References