Ethical Considerations in Home Visiting

Maggie Brett, L.C.S.W.

May 18, 2012

There are no experts, in the usual sense, in ethics or morality.  Objectivity (and the move away from subjectivity) in ethical judgments is increasingly achieved as one's ethical judgments are grounded in a broader and broader base of human experience ‑‑ both one's own personal experience and the experience of other humans shared in dialogue.

-David T. Ozar, Ph.D.

Overview

Lay a foundation: What are ethics? NASW Code of Ethics

Build a framework: Model of Ethical Decision Making

Put up a few walls: Abuse and Neglect Reporting, Informed Consent, Confidentiality

Agenda

It is not enough, to know, one should also use; it is not enough to want, one

should also act.

Geothe

Ethics are not feelings, science, following the law, religion, or culturally accepted norms (Santa Clara University)

Moral principals that govern a person’s or group’s behavior

A person’s or group’s responsibilities to the larger society

Behavioral expectations “Values in action,” (Levy, 1976)

What are ethics?

One’s own family and upbringing Culture Informal life contacts Religious background Education Professional experience Personal reflection

--David T. Ozar, Ph.D.

How do we come to develop a system of ethics?

Rooted in 6 Core Values: Service Social justice Dignity and worth of the person Importance of human relationships Integrity Competence

“Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience.”

NASW Code of Ethics

Does not state a hierarchy of values, so there can be reasonable differences of opinion.

Considers ethical decision making as a process which considers even competing values.

Requires the professional to look at conflicts between personal and professional values

Recognizes that there may be times that what is ethical by these standards may not be in accordance with the law or agency regulations.

Sets forth standards to which a professional should aspire or by which their actions could be judged.

Asks for a commitment to “engage in ethical practice.”

NASW Code of Ethics

Some specific ethical standards relating to responsibility to clients:

Promote well-being of clients Promote self-determination Informed consent Competence Cultural competence Avoid conflicts of interest Guaranteeing confidentiality and privacy

NASW Code of Ethics

Obligated to inform client in a way she/he can understand about all the parameters of treatment (e.g., purpose, risk, cost, etc.)

When client does not have the capacity to provide informed consent (e.g., a young child or client with developmental issues), professional has to seek consent of a 3rd party. The professional needs to ensure that the 3rd party is looking out for the client’s best interests.

Informed Consent

When a professional provides services to more than one member of a family, it is essential that it is clear who the client is and what the boundaries are between family members.

When a parent’s goals for intervention are unrealistic or even harmful, it is the professional’s responsibility to be clear about the limits of the intervention.

Conflicts of Interest

Privacy—the right of an individual to make decisions about how much of her/his thoughts, feelings, or information is shared with others

Confidentiality—the obligation of a professional to refrain from disclosing any information about a client, except under very specific circumstances

When a client is unable to make decisions, a 3rd party makes all the decisions regarding confidentiality.

Home visitors should engage the clients in a discussion about the release of information and its subsequent use.

Privacy and Confidentiality

Related to the ethical standard of commitment to client’s well-being

Involves other ethical standards: conflict of interest, informed consent, and confidentiality

Child Abuse and Neglect Reporting

Ignorant of the full extent of reporting laws Feel it’s not in the child’s or family’s best

interest Feel it’s not serious enough Not sure if it really happened Is concerned about DCFS and its ability to

correct the situation Doesn’t want to disrupt the relationship Afraid of retaliation

-LeRoy G. Schultz

Why are some professionals reluctant to report?

Competing values Competing loyalties Differing perspectives because of

culture, religion, gender, ethnicity, etc.

-Braniff

Some root causes of ethical dilemmas

1. Identifying the alternatives2. Determining what is

morally/ethically at stake by reason of our social roles

3. Determining what else is morally/ethically at stake

4. Determining what should be done all things considered

5. Choose a course of action

An Ethical Decision Making Model(work of David T. Ozar, Ph.D.)

Recognize an ethical issue Get the facts Evaluate alternative actions Make a decision and test it (publicity,

universality) Act and reflect on the outcome

An Ethical Decision Making Model(Markkula Center for Applied Ethics at Santa Clara University)

Using Kitchener’s (1984) 5 moral principles (autonomy, nonmaleficence, beneficence, justice, and fidelity) as the cornerstone:

1. Identify the problem.2. Apply the Code of Ethics.3. Determine the nature and dimensions of the dilemma.4. Generate potential courses of action.5. Consider the potential consequences of all options

and determine a course of action.6. Evaluate the selected course of action. 7. Implement the course of action.

An Ethical Decision Making Model(based on1996 American Counseling Association model)

Reflective Practice needs to be infused in the process; part and

parcel of each step in ethical decision making.

Our own histories, vulnerabilities, and countertransference can influence our ability to make

ethical decisions.

Addendum to Framework

Act promptly and appropriately when a complaint is received

Remedy any harm done and work to avoid further harm

Apologize if appropriate Discuss with supervisor, manager, or

consultant ways to remedy current situation and/or prevent it from happening in the future

If the home visitor feels she/he acted appropriately, may be necessary to bring in 3rd party for mediation or a second opinion

When things go wrong with a client

Action indeed is the sole medium of expression for ethics.

Jane Addams