Ethics and Supervising

1. Ethics and Supervising Andrea Standley PhD

2. Ethics • 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

3. Basic Principles to Guide Ethical Decision Making • 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

4. 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

5. Ethical Standards • 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

6. 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.

7. 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

8. HIPAA • 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.

9. HIPAA Privacy Rule • 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

10. HIPAA Security 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

11. Protected Health Information • 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

12. Identifiers Under HIPAA • 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

13. Confidentiality • Make sure participants know that information is confidential • Power of Attorney • Release of information form • Provide Notice of Privacy Practices • Privacy in Hospitals

14. Limits to 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

15. 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

16. Limits to Confidentiality • Assisting the government in overseeing health care programs • Law enforcement purposes • National security purposes

17. Protecting Children, the Elderly, and Dependent Adults From Harm • 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

18. Contact information for Reporting Abuse • Child Abuse 1-800-252-2873 • Elder Abuse 1-866-800-1409

19. Duty to Protect Potential Victims • 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

20. Multicultural Competence • 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

21. Ethics and Participant Dependence • A temporary dependence is not necessarily problematic • A ethical issue occurs when workers/professionals encourage and promote dependence

22. Ethical Issues in Supervising • 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

23. 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?

24. Ethical Violations by Supervisors • 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

25. Rights of Employees • 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

26. Information Provided to 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

27. Information Provided to Employees • Risks and benefits • Evaluation of job performance • Complaint procedures and due process • Professional development goals

28. Rights of 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

29. The Supervisor’s Roles and Responsibilities • 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

30. 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

31. Risk Management Practices for Supervisors • Don’t supervise beyond your competence • Evaluate and monitor employee’s competence • Be available for supervision consistently • Maintain written policies • Document all supervisory activities

32. 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

33. Stress in the Human Service Profession • 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.

34. Signs which lead to Potential Burnout • 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

35. Signs of Burnout • Low productivity • Depression • Negativity • Frustration • Agitation • Feeling of futility

36. Question • 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?

37. Potential Ethical Participant Issues • Paid Family Caregivers • Gift Giving • Can you think of any other ethical issues?

38. What is Medicaid Fraud? • 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.

39. Reporting Medicaid Fraud • Two Ways to report Medicaid Fraud • Illinois State Police • 1-888-557-9503 • Healthcare and Family Services • Office of Inspector General

40. Reporting Medicaid Fraud

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

42. References • 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_conte nt&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