Peer Support EthicsFor peers and clinicians

Presented byMarlene Sorenson, LADC, CPSWS

• Describe ethical guidelines for Nebraska Peer Support other leading organizations

• Describe peer responsibility to their employer or volunteer organization.

• Compare ethical-decisions of clinicians to peer specialists.

• Identify ethical considerations of peer support (PS) in treatment planning, informed consent, peers’ rights, and termination & referral practices.

• Consider the PS ethical commitment to other professionals, supervisors, peer specialists, peers, and to the public.

3

Values

SkillsEthics

Values Ethics

• Beneficence• Nonmaleficence• Fidelity and

Responsibility• Integrity• Justice• Respect for

People’s Rights and Dignity

• Do no Harm• Business &

Personal Awareness

• Practice within Scope

• Evidence Based• Least

Restrictive• Patient

Centered

Competencies

• Human Relations

• Law, Regulations

• Record Keeping & Fees

• Research & Publication

• Assessment• Therapy

Role Boundary Integrity: CPSWS is NOT a Sponsor (or equivalent)• Perform AA/NA or other mutual aid group service work in your RC role• Guide someone through the steps or principles of aparticular recovery program.

Nebraska Model for Peer Support IsIntentional Peer Support

Nebraska Certified Peer Support &Wellness Specialist Skills Training

• Transformation Transfer Initiative (TTI) Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2009.

• Training from Focus on Recovery United, which included Heather McDonald of FOR-U, Chyrell Bellamy of Yale University, and Shery Mead and Chris Hansen of Shery Mead Consulting.

• A curriculum for the State of Nebraska’s Office of Consumer Affairs was purchased that focuses on trauma-informed Intentional Peer Support.

Intentional Peer SupportValues Ethics

• Hope• Personal

Responsibility• Education• Self Advocacy• Support• Independence &

Civil Rights

• Shared Risk• Negotiated Limits• Fixed Boundaries• Relationship Centered

Competencies

• Connection• World View• Mutuality• Moving Toward• Trauma informed• Advocacy

Shared Risk: Redefining Safety

Shared Risk verses Do No Harm

• Systems will not become "recovery oriented" until they deal with the topic of risk.

• Mental health systems talk about choice and self-determination up until they get scared, and then it's back to coercion and control.

• Without talking about risk and recovery, nothing significant can really change.

Copyright by Intentional Peer Support LLC; FOR-U; & Yale-PRCH ©2013

Re-defining Safety: Shared Risk• In traditional treatment, safety is defined by liability and risk.

• In intentional peer support, safety is defined by the extent to which we feel trust and non-judgment.

• In peer support, we work at creating relationships in which safety is negotiated.

Self-Evaluation of Mutually Responsible Relationships

Negotiating boundaries works but is takes practice and input during co-reflection.

Some of the things that may be challenging are:

• Staying out of the service provider role

• Wanting to take power in order to get things back on track- like doing a suicide risk assessment.

• Confusing being friends with peer support.

Situations

Ethical Guidelines for the Delivery of Peer-based Recovery Support Services 2007 (William L. White, MA, et al.)

I will read a situation and we will pick a Zone as a group and then explain why .

The Big QuestionHow to incorporate a “pure” IPS model into a clinical structure

Ethical Guidelines for the Delivery of Peer-based Recovery Support Services 2007 (William L. White, MA, et al.)

• The application of 42 C.F.R. Part 2 (Health Insurance Portability and Accountability Act (HIPAA)

• Mandatory Child Abuse Reporting

• Informed Consent

• Organizational Liability• Funding sources requirements

& Contracts• Federal Oversight• Volunteer vs. Paid Peers• Dual Relationship definitions

AS PEER SUPPORT IS “PROCEDURALIZED” IT BECOMES LESS “EQUAL” IN TERMS OF POWER AND ACCESS.

“Pseudo-Clinical” Peer SupportValues Ethics

• Freedom To Choose

• Hope• Empathy• Respect• Honesty

• Voluntary W/O Coercion

• Open-mind• Person/Relationship

Centered

From INAPS using Ethical Guidelines for the Delivery of Peer-based Recovery Support Services 2007 (William L. White, MA, et al.)

Competencies

• Facilitate Change

• Mutual & Reciprocal

• Shared Power• Strengths-

focused• Transparency• Person-

driven

Adapted from Wilma Townsend, Presentation at Pillars of Peer Support (2012).

• There is hope, people can and do get well, stay well for long periods of time, and accomplish what they want to do with their lives.

• Self determination, personal responsibility, empowerment, and self-advocacy are keys to mental health recovery.

• Decisions about care and life are made by the person whose life it is and, if necessary, by people who have been identified by this person as their proxy.

Mental Health Recovery and WRAP Values and Ethics Checklist

Values and Ethics that Support Recovery Copeland Center

• Every person is treated as an equal with dignity, compassion, mutual respect, and unconditional high regard at all times.

• There is unconditional acceptance of each person as they are: unique, special individuals, including acceptance of diversity with relation to culture, ethnicity, language, religion, race, gender, age, disability, sexual preference, and “readiness” issues.

Mental Health Recovery and WRAP Values and Ethics Checklist

Values and Ethics (cont.)

Values and Ethics (cont.)

• All efforts are based on the premise that there are “no limits” to recovery.

• All participation in programs, activities and initiatives is voluntary.

• It is understood that each person is the expert on her or himself.

• The focus is on individual strengths and away from perceived deficits.

• Clinical, medical and diagnostic language is not helpful and is avoided.

• The focus is on people working together and learning from each other toincrease mutual understanding, knowledge and promote wellness.

Mental Health Recovery and WRAP Values and Ethics Checklist

Values and Ethics (cont.)

• Programs and initiatives emphasize strategies thatare simple and safe for anyone, and avoid those thatmay have harmful effects.

• Difficult feelings and behaviors are seen as normalresponses to traumatic circumstances (in thecontext of what is happening and not as "symptoms"or a "diagnosis“).

• People are encouraged, supported and validated insharing their thoughts, feelings, needs andexperiences.

http://mentalhealthrecovery.com/wrap_values_ethics.php 21

respect the dignity and worth of all people. value diversity facilitate self-determination and shared-decision. They encourage and nurture peers to find their own voice while advocating for the right of all people to make their own decisions in all matters when dealing with other professionals. respect the privacy and confidentiality of private information. keep current with emerging knowledge relevant to recovery. Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Nebraska Peer Support & Wellness Specialist Code of Ethics (condensed)

As to those utilizing peer services Peer Support Staff will:

Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Cont. NE CPSWS C.o.E.(condensed)

Peer Support Staff will:

only accept gifts of insignificant value (under $5.00) from people in services. maintain high standards of personal conduct, modeling accountable relationships, and fostering their own recovery. acknowledge their limits to knowledge when discussing areas outside the expertise of the field of wellness, like prescribing medications or making diagnoses. speak in simple terms, use people first language, and avoid clinical jargon, strive to break down concepts, like recovery and trauma, for those unfamiliar with recovery language.

Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Cont. NE CPSWS C.o.E.(condensed)

Peer Support Staff will:

only accept gifts of insignificant value (under $5.00) from people in services. maintain high standards of personal conduct, modeling accountable relationships, and fostering their own recovery. acknowledge their limits to knowledge when discussing areas outside the expertise of the field of wellness, like prescribing medications or making diagnoses. speak in simple terms, use people first language, and avoid clinical jargon, strive to break down concepts, like recovery and trauma, for those unfamiliar with recovery language.

Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Cont. NE CPSWS condensed)

Peer Support Staff will:

advocate for the full integration of individuals into their chosen community living environment, and all individuals have the right to live in the least restrictive and most inclusive setting possible. work to keep their environments physically and emotionally safe for others. strive to understand variables that impact peer relationships be trauma-informed

Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Cont. NE CPSWS condensed)

Peer Support Staff will NOT:

exploit peer support service relationships for financial gain. practice, condone, facilitate or not collaborate in any form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference or personal characteristic, condition or state. engage in romantic or sexual intimacies with the people utilizing peer support services in the organization where the person is working.

Nebraska Office of Consumer Affairs: Division of Behavioral Health: DHHS

Cont. NE CPSWS condensed)

Peer Support Staff will NOT:

Provide peer support services to anyone with whom they've had romantic or sexual intimacies in the past. intimidate, threaten, harass, use undue influence, physical force or verbal abuse, or make unwarranted promises of benefits to the people that utilize peer support services. not abuse illegal substances under any circumstance. reveal confidential information to anyone unless necessary for supervision, required by law, or otherwise consented to by the individual personally.

Questions?Comments?

For More information• Contact (me) ▫ Marlene Sorenson▫ 402-489-3802 x6614

• Office of Consumer Affairs▫ Cynthia Harris - Interim Manager OCA ▫ 402-471-7766

Recourses:http://dhhs.ne.gov/behavioral_health/Pages/beh_mh_mhadvo.aspx

http://dhhs.ne.gov/behavioral_health/Documents/FinalDraft-CodeofEthics.pdf

http://mentalhealthrecovery.com/info-center/mental-health-recovery-and-wrap-values-and-ethics-checklist/

https://inaops.org/national-standards/

http://na4ps.wordpress.com/library

http://rtp4ps.org

http://www.integration.samhsa.gov/Supervisor_Guide_to_Peer_Support_Whole_Health_and_Wellness_-c-_2013.pdf

Recourses cont.:

http://www.pillarsofpeersupport.org/POPS2011.pdf

http://www.bhrm.org/recoverysupport/EthicsPaperFinal6-8-07.pdf

http://store.samhsa.gov/product/What-Are-Peer-Recovery-Support-Services-/SMA09-4454

http://www.naadac.org/understandingtheroleofpeerrecoverycoachesintheaddictionprofession