Boundaries/Ethics & Peer Specialist Services Matthew R. Federici, M.S., CPRP Program Director Institute for Recover

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 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” • Violation: • Abuse • Sexual Relationships • Drugs and Alcohol • Usually clear laws, policies or rules • Issues: • Inevitable • Not right or wrong • Ongoing • “It Depends” 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. 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 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 Dec 4th 2009

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 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 • 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 • Don’t burden and already overburden • 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.” Dec 4th 2009