Standards of Care & Ethical Issues in Behavioral Health
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Describe and Define Standard of Care & Ethics Describe and Define Laws Identify Top Ethical Issues visa vie Snowball Sample Recommend Ethical Decision Making Models CARE Challenge Providers to Develop Mission, and Ethics Statements for Behavioral Health Care Centers
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Standards of Care & Ethical Issues in Behavioral Health
- 1. Standards Of Care & Ethical Issues
- 2. Louise Stanger Ed.D, LCSW ▪ Director All About Interventions ▪ Faculty SDSU ▪ Member NII, AIS ▪ MINT Trainer ▪ Author, Falling Up-A Memoir of Renewal ▪ & Learn to Thrive
- 3. Objectives ▪ Describe and Define Standard of Care & Ethics ▪ Describe and Define Laws ▪ Identify Top Ethical Issues visa vie Snowball Sample ▪ Recommend Ethical Decision Making Models ▪ CARE Challenge Providers to Develop Mission, and Ethics Statements for Behavioral Health Care Centers
- 4. Getting to Know You ▪ What brings you here today? ▪ What groups do you represent?
- 7. Definitions ▪ Tort Law- The level at which the average provider in a given community would practice ▪ A diagnostic and treatment process that a clinician would follow for a certain type of patient, illness or clinical circumstance - New England Journal of Medicine 2004
- 8. Benefits Of JACHO ▪ Organize ad Strengthen patient safety efforts ▪ Strengthens community confidence in quality of care ▪ Provides Competitive Edge in Marketplace ▪ Improves Risk Management and risk reduction ▪ May reduce Liability Insurance Costs ▪ Provides education to improve business operations ▪ Provides professional advice and counsel ▪ Provides customized and intensive review
- 9. ▪ Enhances staff review and recruitment ▪ Provides deeming authority for medicare ▪ Provides a framework for organizational structure and management ▪ May fulfill regulatory requirements ▪ Provides practical tool to strengthen ▪ Aligns health care organizations 603-792-5000
- 10. Money, Ethics & Behavioral Health Care
- 11. What are Ethics ?????? ▪ Ethics are the beliefs an individual or group maintains about what constitutes correct or proper behavior ▪ Standards of conduct an individual uses to make decisions.
- 12. LAWS What do you stand for ? ▪ Folks that do not understand the laws ▪ Folks that understand the laws they do not have a strong sense of ethics
- 13. Ethical Issues ▪ Individual ▪ Group ▪ Organizational ▪ Societal
- 14. How do Ethical Problems Occur ? ▪ People are human they make mistakes ▪ Clients misreport ▪ Inexperience ▪ Ignorance ▪ Unpredictable /Unforeseen situations ▪ Inadequate Agency Policies ▪ Guidelines not adequate for situation ▪ Ethics in conflict with law
- 15. How do Ethical Problems Occur? ▪ Greed ▪ Need to Fill Beds ▪ Quotas ▪ Job Security ▪ Inadequate Guidelines
- 16. What’s Your Codes of Ethics ▪ American Association of Advertising Agencies ▪ Direct Marketing Association ▪ Public Relations Society of America ▪ American Marketing Association ▪ Foundation for Public Affairs ▪ American Hospital Association ▪ NATAP
- 17. Code Of Ethics ▪ NAADAC ▪ NASW- Social Workers ▪ MFT ▪ NATAP ▪ CARF ▪ Psychologists ▪ Nurses –Doctors ▪ Lawyers ▪ Interventionists ▪ Insurance Company ▪ Treatment Center ▪ Web Developer
- 18. Code of Ethics ▪ Association of Intervention Specialists ( AIS) ▪ Network of Independent Interventionists (NII) ▪ Recovery Coaches ▪ Certified Rehabilitation Counselors ▪ Hayes-Davidson Ethics Pledge
- 19. What are your top 3 Ethical Concerns
- 20. Snowball Sample ▪ Qualitative Research ▪ Set Up Open Ended Question ▪ Ask the question and then ask who else might I talk to ▪ Collapse and collate Data ▪ Asked in different areas
- 21. Areas Covered ▪ CEOS ▪ Marketers ▪ Admissions ▪ Web Designers ▪ Clinicians ▪ Interventionists ▪ Thought Leaders
- 22. David Skonezny-CADC-II ICAD CEO-Simple Recovery Ethics Chair-CCAPP Board of Directors ▪ Paying For Referrals ▪ Improper UA Billings- Facilities owning labs ▪ Incorrect Billing ▪ Having Non Credentialed Staff facilitate Clinical Events
- 23. Denise Klein-Milestones Ranch ▪ Lack of Standardized and Best Practice Training ▪ Exploitation of Insurance Companies ▪ Over Promising - Under delivering of Services ▪ Unlawful Kickbacks
- 24. Marsha Stone BRC Recovery ▪ Competence ▪ Misrepresentation of Services ▪ Lack of Compassion ▪ Folks do Not Understand Laws
- 25. David Lisonbee CEO Twin Town ▪ Waiving Deductibles- Kickbacks ▪ General Public Distrust of Treatment Industry ▪ Treatment perceived as a scam
- 26. Paul Alexander CEO Northbound ▪ Accreditation and Standardization of Care ▪ “CURES” Promised as opposed to Solution ▪ Mission and Code of Ethics
- 27. Incredible Marketing :Wes Jones CEO ▪ Misrepresenting treatment modalities in website content ▪ Accepting Clients that are not a fit ▪ Misrepresenting Culture
- 28. More About The Web ▪ Misrepresenting Location ▪ Adding Fake locations ▪ Using high end photos ▪ Misrepresenting amenities ▪ Fake Positive reviews ▪ Buying Competitions Keywords ▪ Referrals based on ▪ Kickbacks ▪ Reciprocation
- 29. Where does your name go ? ▪ Search your Center ▪ Independent Review Sites ▪ Trademark Rules ▪ Come ons- ▪ Flights paid ▪ Deductibles Paid ▪ Come and Go
- 30. Questionable Practices ▪ Internet marketing scams ▪ Using Brain scans with other unproven treatments and billing the patient ▪ AP, March 2013
- 31. Questionable Practices ▪ Call Centers share Patient Prospect info between treatment Providers ▪ Call Centers run through 5013C Non Profits ▪ Landlords -Drug Companies and Sober Living Homes ▪ Insurance Companies Dictate Treatment
- 32. Paying Kickbacks ▪ To Interventionists ▪ Paying bounties to for referrals ▪ Claiming to take a patient’s insurance when reimbursement is low ▪ To Labs
- 33. Kickbacks-Federal Laws Anti-Kick Back Statue Criminal offense for anyone to give a kickback with the Intent of influencing referral of patients Stark Law Physicians Self referral law Kickback occurs when a physician refers a patient to a facility he owns or family has financial interest Trips , hotels, gifts
- 34. Whistleblower –False Claim Act ▪ False Claims Act ▪ Unlawful for anyone knowingly or willingly submit or cause a fraudulent claim to the government for payment
- 35. Questionable Practices ▪ Promising a cure ▪ Using nutrient supplements that are proprietary and billing the patient
- 36. Historical Context ▪ In Nazi Germany 1945-1946 and 1935 American Public Health research African American men ▪ 1966 Public Health Services established ethical regulation ▪ 1979 Belmont Report (Protection of Human Subjects) ▪ 1970s bio ethics emerged ▪ 1980s Watergate ▪ 1996 Revised Codes ▪ As professions grow code of ethics are formed
- 37. Do not confuse Ethics and Morality !!!!! ▪ The word Morality comes from Latin word MORES which translates into custom or values ▪ Morality involves the judgment or evaluation of an ethical system, decision, or action based on socialcultural or religious norm
- 38. Ethical Principles ▪ Autonomy ▪ Beneficence- To do Good-To Do No Harm ▪ Confidentiality ▪ Fidelity _To keep ones promise or word, Duty to report , honesty, trustworthiness ▪ Gratitude ▪ Justice ( treat all fairly) ▪ Nonmalefience :The duty to cause no harm ▪ Reparation –duty to make up for a wrong
- 39. Competence Integrity Importance Of Human Relationships Dignity of Individual Social Justice Service VALUES
- 40. Ethical Principles ▪ Respect for Others ▪ Universality ▪ Utility- the duty to provide the greatest good or least harm to greatest number of people ▪ Ordering
- 41. Ethical Considerations ■ Fiduciary Relationships with Providers ■ Call Centers ■ Pay per click ■ Truth in advertising ■ Gifts & Kickbacks ■ Internet Marketing scams
- 42. Ethical Principles ▪ Veracity –To tell the Truth ▪ Herein lies dilemmas ▪ Between self, IP, agency and outside world
- 43. Ethical Responsibilities ▪ To Clients ▪ To Colleagues ▪ To Practice Settings ▪ As Professionals ▪ To Professional Affiliations ▪ To Broader Society
- 44. 8 Step Model for Ethical Decision Making ▪ 1. Identify the Problem or Issue - Clinical - Legal - System (polices etc) - Cultural - Ethical - counselors own issues
- 45. Steps 2-4 ▪ Apply a code of ethics ▪ Determine Nature and Dimensions of Dilemena ▪ Pros and Cons
- 46. Steps 5-8 ▪ Choose Course of Action ▪ Implement a Course of Action ▪ Evaluate the Outcome ▪ Evaluate the implications
- 47. Congress Ethic Model ▪ Examine ▪ Think ▪ Hypothesize ▪ Identify ▪ Consult
- 48. CONFIDENTIALITY ▪ Hallmark of Therapeutic Relationship ▪ Consent Forms ▪ Mandated Reporting- Duty to Warn ▪ Exceptions ( Drug Court, federally assisted treatment programs
- 49. Confidentiality and Minors ▪ Age of Consent ▪ Being Familiar with state laws ▪ Can Clara or parents know everything if they are under 18?
- 50. Informed Consent Description of any reasonable foreseeable risks or discomforts Description of any benefits to the subject or others Disclosure of alternative treatments & medications Statement describing extent to which confidentiality of records identifying client will be maintained Explanation on limits of confidentiality Explanation on who to contact in emergency Costs to client Consequences of early withdrawal
- 51. Record Keeping ▪ Client prior hx of services ▪ Present reason for call ▪ Dx of bio-psycho-social ▪ Documentation of any changes since assessment ▪ Treatment plan goals & objectives (changes in Tx) ▪ Duration & frequency of service ▪ Progress notes ▪ Rec for further treatment- discharge plans ▪ Doc. Of fees charged and paid ▪ HIPPA Forms
- 52. Competence ▪ Competence? ▪ How do you achieve and maintain ▪ Cultural competence ▪ Is it ok to practice outside of ones competence?
- 53. Advertising ▪ Truthful ▪ “Number 1 , Unique, Cure “
- 54. Wireless Devices ■ How are these used to protect confidentiality ??? ■ Laptops, Ipads, Phones, Earpieces, &other devices
- 56. Visual Wrong doing ▪ Web Sites that are misleading ▪ Fake addresses ▪ Toll free numbers ▪ Posting of photos on misleading websites ▪ Certificates
- 57. Social Media ■ Written Materials ■ Business Cards ■ Letterhead etc ■ Website ■ Mailings ■ Texting ■ Facebook, Twitter and Linked In
- 58. BOUNDARIES ▪ Length of counseling, self disclosure by counselor, confidentiality, giving of gifts, touch or personal communication between counselor and client and client, counselor and supervisor’ ▪ Intimate relationships ▪ Personal benefit ( monetary goods , services) ▪ Emotional dependency needs of counselor ▪ Altruistic gestures which can be misinterpreted ▪ Unexpected situations such as meeting sisters new boyfriend who turns out to be a client
- 59. DUAL RELATIONSHIPS ▪ Friendships between client and counselor, supervisor and supervisee ▪ Sexual Relationships ▪ Professional –where client and counselor are professional colleagues ▪ Business dual relationships where counselor and client are business partners or have an employee/ employer relationship ▪ Communal –where both belong to same community (AA, NA, Alanon, SA etc.)
- 60. Hiring Practices ▪ Former counselor calls to ask if she or he can hire a former client of hers and mine from a different treatment center that has less then a year recovery
- 61. Employer Relationships ▪ A handsome admissions person is your subordinate. He is also in a 12 step program. You invite him for coffee after the meeting. ▪ ?? Ethical Considerations
- 63. Money for Admits ▪ An admissions officer offers you money for referrals
- 64. Consent and HIPPA ▪ Mother wants to know what daughter is saying about their relationship ▪ 19 yo daughter has not signed consent form for mother
- 65. Other Considerations ▪ You are a substance abuse/mental business professional and are attending the same 12 step meeting as your client do you need to share, what do you do?? ▪ Organizations referral practices ▪ Organizations billing practices ▪ Other Examples
- 66. Gifts ▪ A $100.00 Starbucks card ▪ Court side Laker Tickets ▪ Boxes From Tiffany ▪ A Rolex Watch ▪ A center offers you referral fees ▪ ??What do you do
- 67. Standard of Care Challenge ▪ Develop Mission Statement for your Organizations ▪ Articulate the Organizations Values ▪ Revisit or Develop Organizations Ethical Code ▪ Obtain Appropriate Licensure ▪ The World Know-Mission, Values and Ethical Statement
- 68. Standard of CARE ▪ Review Your Professional Code of Ethics ▪ Engage in Appropriate Continuing Education ▪ Sign Hayes-Davidson Pledge ▪ Work tirelessly to elevate Behavioral Health Care Field
- 69. Let Me Know ▪ Meet me Oct 13 & 14 ▪ Admissions and Marketing Seminar ▪ Tell the world what you are doing ▪ Send me ( drstanger@me.com) your Mission, Values and Organizational Ethics and I will share on my www.allaboutinterventions.com and on my blog
- 70. It Takes A Village
- 71. Questions
- 72. Resources ▪ The Ethics of an Addiction Counselor ▪ The Ethics of an Addiction Counselor , The Association of Addiction Professionals ▪ NASW Code Of Ethics ▪ NII Code of Ethics ▪ AIS Code of Ethics ▪ Ethics Updates http://ethics.sandiego.edu ▪ The Elements of Ethics for Professionals-Brad Johnson ▪ Center for the Study of Ethics in the Professions ▪ National Board for Certified Counselors; The Practice of Internet Counseling http://www.nbcc.org/assest/ethics/ internetcounseling.pdf ▪ http://www.mentalhealthlaw.us/10/Practice_Dilemmas.html
- 73. Resources ▪ Hayes- Davidson Ethics Hayes -http://www.hayes- davidson-ethicspledge.org ▪ Northbound Code Of http://www.livingsober.com/about- us/northbound-code-of-ethics/ ▪ Dreamscape Marketing Code of 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
- 74. Resources ▪ Joint Commission on Accreditation of Rehabilitation Facilities ▪ JACHO Accreditation http://www.jointcomission.org ▪ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/The Standard ▪ 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
- 75. Dr. Louise Stanger Ed.D, LCSW, BRI II, CIP ▪ Faculty SDSU Interwork Institute ▪ Member NII ▪ Member AIS ▪ MINT Trainer of Trainers ▪ Director All About Interventions ▪ http://www.allaboutinterventions.com ▪ Falling Up-A Memoir of Renewal -Amazon ▪ 619-507-1699 ▪ DrStanger@allaboutinterventions.com ▪ 619-507-1699