Ethics - the comeback kid
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This document discusses ethics in behavioral healthcare. It begins by defining ethics as beliefs about proper behavior and standards of conduct. It notes that ethics are not the same as laws or morality. Several ethical principles are described like autonomy, non-maleficence, beneficence, and justice. Ethical issues can occur at the individual, group, organizational and societal levels. Top concerns in behavioral healthcare ethics include patient brokering, improper billing, kickbacks, unqualified staff, and lack of standardization. The document outlines an 8-step model for ethical decision making and provides numerous resources on ethics codes and guidelines.
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Ethics - the comeback kid
- 1. Ethics Louise A. Stanger Ed.D, LCSW, CDWF, CIP
- 2. Clearing Your Path to Compliance www.addiction-tx.com
- 3. Welcome
- 4. Objectives Describe, Define and Discover Ethics (Principles, Standards & Values) Describe and Define Laws Identify Top Ethical Concerns in Behavioral Health Care Field Illustrate Ethical Decision Making Models and Invite Curiosity To Challenge Behavioral Health Care Providers
- 5. What are Ethics ? Beliefs an individual or group make about what constitutes proper behavior Standard of Conduct
- 6. Ethics are Not Laws
- 7. Do Not Confuse Morality (custom and values) With Ethics
- 9. 1970 1945-46 Nazi Germany, African Americans, 1966 Public Health regulations, 1980’s Watergate- 1996 Revised Codes: professions grew so did codes of ethics
- 10. Moral Principles of Ethics Autonomy - freedom of choice Non-malfeasance - To Cause No Harm Gratitude Beneficence - To Do Good Justice - Treat all Fairly Fidelity - honoring Commitments Reparation - duty to make up for wrongs
- 12. How many groups or organizations do you belong to that have stated ethics? Membership has its privileges and its obligations.
- 15. How do Ethical Problems Occur Human error Clients misreport Inexperience Ignorance Unpredictable / Unforeseen situations Inadequate Agency policies Ethics in conflict with law
- 18. Need Clients
- 19. Ethical Responsibilities Micro-Individual Level To Clients To Colleagues To Practice Settings To Professional Affiliations To Broader Society
- 20. Ethical Principles Respect for one another Universality Utility - the duty to provide the greatest good or least harm to the greatest number of people Ordering of priorities
- 21. Competence Integrity Importance Of Human Relationships Dignity of Individual Social Justice Service VALUES
- 22. Ethical Considerations Fiduciary Relationships with Provider Call Centers Pay per Click Truth In Advertising Gifts and Kickbacks Confidentiality
- 23. The Dilemma To tell the Truth Herein lies the dilemma: Between self, IP, Agency and Outside World
- 24. Ethical Issues Qualitative Research - SnowBall Sample Open-Ended Questions - to Wide Spectrum of Professionals Collapse Date Triangulation of Data with other sources - TV, Newspaper Clippings, Social Media Magazine Articles, etc.
- 25. Top Concerns Patient Brokering - Paying for Referrals Improper Billing - UA Billings Incorrect Billing with Insurance and Private Pay (Waving Deductibles) Unlawful Kickbacks Deployment of Staff - Having Non-Credentialed Staff Facilitate Clinical Events
- 26. Top Concerns Lack of Accreditation and Standardization of Care Lack of Standardization and Best Practice Training Knowing the Laws Mission Statement and Code of Ethics “Cures Promised Instead of Solutions” Over Promising and Under Delivering Services
- 27. Top Issues Dual Relationships Friendships / Counselor-Client Sexual Relationships Professional - Client and colleague are professionals Business - Counselor and client are business partners or have an employer relationship Communal (both belong to same community: AA, ALANON, NA, etc.)
- 28. Confidentiality and Duty to Warn Hallmark of therapeutic relationships Record Keeping Gossiping/Slander Photos Intentional infliction of emotional distress Tarasoff Rule With minors and with groups
- 30. Competence How do you achieve and maintain? Cultural Is it ok to practice outside of cultural competence?
- 31. More Issues Patient deaths Non-profits set up to run call centers Ownership - should labs own treatment centers Insurance companies dictate treatment Public's distrust of the behavioral healthcare industry Lack of generalized training and standards
- 34. World Wide Web Advertising Misrepresentation of facility and of its culture in website content Misrepresenting location, adding fake locations Using high end photos that have nothing to do with center Misrepresenting amenities and treatment modalities
- 35. Google Analytics and Other Issues Buying ad words Fake positive reviews Buying competition's keywords Kickbacks - reciprocation Stealing websites - called redirecting
- 36. Global Issues Should every home have Narcan? Should cannabis be used for opiate withdrawal? How should cannabis be marketed and regulated? Advertising and regulating Drug trafficking - human trafficking
- 37. 8 Step Model For Ethical Decision Making (Cory, Cory, Callahan) 1. Identify the Problem or Issue Clinical Legal System - Policies, etc. Cultural Personal
- 38. Steps 2 - 4 Identify the potential issues Look at relevant codes of ethics for general guidance Consider applicable laws and regulations and determine how they may have bearing on ethical dilemma
- 39. Steps 5 - 7 Seek consultation from more then one source to gain multiple perspectives to the dilemma Brainstorm various courses of Action List pros and cons of potential action
- 40. Step 8
- 41. What are you going to do?
- 42. As an Individual Behavioral Healthcare Provider Review your professional Code of Ethics Engage in continuing education Join professional groups, sign ethic pledges Advocate for ethical behaviors - lobby Walk your talk - share
- 43. As a Treatment Owner Make sure you have a mission and ethics statement that is clear: on website, business cards, employee handbooks, etc. Be accredited: JACHO, CARF - HIPPA-compliant, etc. Practice ethically in a digital electronic world Require staff to have CEU - hold meetings Membership in appropriate professional organizations Let consumers know
- 44. As a Global Citizen
- 46. Be Visible, Vocal & Visionary!
- 48. Stanger Articles on Ethics Partial Listing Ethics 101 with Heather Hayes: https://www.huffingtonpost.com/ entry/ethics-101_us_59b70e83e4b0678066213dfd Be Bold, Vocal and Visionary - Counselor Magazine & June 2017, DB Recovery Magazine, 2017 Stanger-Porter Too Big to Fail: Wealthy People - Recovery Plus - May - June 2017 - Stanger & Porter Digital Media Marketing and Interventionists https:// www.allaboutinterventions.com/2017/03/09/digital-media- marketing-interventionists-etiquette/ Stanger & Porter
- 49. Resources The Ethics of an Addiction Counselor The Association of Addiction Professional The NASW Code of Ethic AIS Code of Ethics Ethics Update - HIPPA Update The Elements of Ethics for Professionals - Brad Johnson Center for Study of Ethics in the Professions Internet Counseling - http:www.nbcc.org/asset/ethics/internetcounseling.pdf http:www.mentalhealthlaw.us/10/Practice_Dilemnas.htlm
- 50. Resources Dreamscape Dreamscape Marketing Code of Ethics https://www.dreamscapemarketing.com/about-dreamscape- marketing/code-of-ethics/ Twin Town http://twintowntreatmentcenters.com/about-twin- town-tc/our-mission/ Cinga http://www.cigna.com/about-us/corporate-governance/ code-of-ethics Hayes and Associates http://www.hayesethicspledge.org:// www.apa.org
- 51. Resources ▪ Joint Commission on Accreditation of Rehabilitation Facilities ▪ JACHO Accreditation http://www.jointcomission.org ▪ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/The ▪ http//:www.carf.org./home/ for Commission on Accreditation of Rehabilitation Facilities ▪ National Council for Recovery Residences http://narronline.org ▪ The ASAM National Practice Guideline for Use of Medications in Treatment of Addiction Opioid USE
- 52. ▪ Joint Commission on Accreditation of Rehabilitation Facilities ▪ JACHO Accreditation http://www.jointcomission.org ▪ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/ TheStandard ▪ http//:www.carf.org./home/ for Commission on Accreditation of Rehabilitation Facilities ▪ National Council for Recovery Residences http://narronline.org ▪ Trauma - Informed Care in Behavioral Health Services TIP 57 ▪ The ASAM National Practice Guideline for Use of Medications in The Treatment of Addiction Opioid USE ▪ http://www.jcrinc.com/2016-cambhc-behavioral-heath
- 53. Additional Resources Ethical Decision Making
- 56. Additional Resources Use of Technology Tips
- 57. Secure Computer Systems Gelman et al, 1996 Block unauthorized users from accessing info Verify source of information to confirm authenticity Keep a record of communications to and from system Recover quickly and effectively from anticipated disruptions
- 58. Computer Safeguards Koocher & Keith Spiegal, 2008 Apply encryption software to protect data transmission Protect stored information with complex passwords Apply internet firewalls Consult with professionals when storing files, back up, etc. Keep removable data storage media in safe place Protect passwords, change frequently
- 59. Be knowledgable about security measures when using wireless devices Never reveal confidential information in an email or instant messaging without encryption Always use privacy screen to shield monitors or other screens from view Protect physical security of all portable devices such as laptops, small computers, personal digital devices and smartphones Update virus protection Remove all info when disposing of computers Consult with technology specialists Always consult organizations code of ethics
- 64. Clearing Your Path to Compliance www.addiction-tx.com