1. Doing the Right Thing.
Doing it the Right Way.
A presentation on Ethics
By
Catherine McAlpine, Ph.D., LCSW-C

2. Workshop Objectives
• Learn about the types of support offered
by para-professionals to people in
recovery.
• Understand the difference between being
a paid helper and being a peer or friend.
• Discuss dual relationships and how ethics
protect employees and clients.
• Discuss boundaries and importance of
supervision in our daily work.

3. Vision Statement from
SAMHSA
• A Life in the Community
for Everyone.
• Prevention Works.
• Treatment is Effective.
• People Recover.

4. Ethical relationships are a
balancing act.
• We don’t know what we
don’t know.
• Stay in your lane.
• You’re only as sick as
your secrets.
• Is it a secret or is it a
surprise.
• Don’t ask, don’t tell.
• Just between you and me
…
• Can you keep a secret?
• Confidentiality, anonymity
and privacy

5. Ethics
• Moral standards by which people judge
and behave.
• A code of conduct, often supported by a
profession, organization or other group.

6. Equity
• A state or quality or ideal of being, just, fair
and impartial.
• Non-hierarchical
• People as a resource
• Ethics = Equity = Fairness

7. Unequal Power
• Exploitation is a risk when a relationship is
unequal in power.
• Power inequality is always true …
– Between an employer and employee
– Between a supervisor and a supervisee
– Between a business and a customer
– Between staff and clients
– Between criminals and victims
– Between adults and children

8. Ethics Law for Public Employees
• Sec. 19A-15. Disclosure of confidential
information; ex parte communication
• Soliciting or accepting gifts
• Political activities of quasi-judicial officials
• Equal Employment Opportunity
• Nepotism
• Favoritism
• Non-discrimination: racism, age-ism, sexism or
any discriminatory or unequal practices

9. Rights and Responsibilities
• Privacy belongs to the person. Our duty is to
respect and control personal information.
– Confidentiality
• Avoid re-disclosure – sharing confidential information you
gained from another source
• Exceptions: medical emergency, duty to warn, abuse
– Privacy
– Protected Health Information
– Need to know
– Anonymity

10. Informed Consent
Protection of persons right to privacy and our duty
to protect client information, avoid doing any
harm, and always adhere to laws.
– Person must know risks & benefits
– Person must be competent or capable
– Person is told of limits of confidentiality
– No “to whom it may concern” or blank forms
– Written consent is dated, time limited
– May be revoked at any time by client
– Some rules may not apply to Court Orders/DPP

11. Code of Federal Regulations
• CFR 42 Section 2 applies to Alcohol and Drug
Treatment Services.
– Documentation in case records or electronic
– Use of e-mail & password protection
– Responding to a subpoena
– Client disclosure of criminal activity past/now
– Client as “fleeing felon” or current criminal act
– Handling an active arrest warrant
– Sharing on a “need to know basis”
– Exceptions – duty to warn, child abuse & medical emergency

12. HIPAA
• Health Insurance Portability and
Accountability Act
– Protected Health Information
– Patients’ right to access own medical records
– Business Partner Agreements
– Sanctions for Violation
– Must self-report any violation
www.hipaa.samhsa.gov

13. Code of Ethics or Code of Conduct
• Most professions have a Code of Ethics with
clear advise against Dual Relationships.
• Most employers have a Code of Conduct.
• Maryland has Professional Boards under which
all doctors, counselors and therapists must
adhere to standards of education, training,
supervision and conduct.
• Boards issue sanctions
• You may be subject to personal liability as well

15. Do No Harm
• Iatrogenic – unintended harm caused by
treatment or intervention that causes injury.
Example:
• Fiduciary – a special duty or obligation to care
for another person, usually some one who is not
able to fully care for self. Example:
• Boundary Management – decisions that
increase or decrease intimacy in the
relationship. Example:
• Conflict of Interest or Dual Relationship – having
more than one role with the person. Example:
employer & relative, coach & selling products

16. Dual Relationships
• Has a primary professional role with a person
while
– 1) at the same time,
– 2) at an earlier time or
– 3) at a later time has another type of relationship
• Potential for harm might not be apparent in the
moment.
– Must weigh anticipated and unanticipated effects
– Use supervision and a skill called “reflective
awareness” to discuss boundaries and blurred
boundaries or when a line has or may be crossed.

17. Risks of Dual Relationships
• Law suits or formal complaints, lose license
• Impaired judgment or impaired decision making
• Injury to self or other, including to reputation and
other relationships
• Loss of employment (being fired)
• Charges of harassment or sexual assault
• Giving preferential treatment
• Using emotional abuse or other exploitation
• Being exploited or otherwise harmed yourself

18. Documentation
• If a tree falls in the woods and no one
hears it, did it really fall?
• Burden of paperwork v. accountability
• Future standards for fees &
reimbursement
• Mutual protection
• Validates importance of peer-to-peer work
• Confidentiality, need to know & KISS

19. Supervisor Ethics
• Uphold highest professional standards
• Seek professional help when work or personal
issues may interfere
• Conduct is as a role model & Agency rep.
• Reinforce zero tolerance for interactions that are
not courteous, compassionate and/or
professional.
• Uphold vision, values & principles of wellness
• Treat supervisee, colleagues, peers & clients
with dignity and respect
• Adhere to all standards & regulations of privacy

20. Sexual Harassment
• Harassment is verbal or physical conduct that demeans or
shows hostility or aversion toward an individual for any
reason. It is the policy of CCAR to prohibit all forms of sexual
and/or other harassment in the workplace.
• Harassing conduct includes: slurs, negative stereotyping,
threatening language, and intimidating or hostile acts.
• Sexual Harassment means any unwelcome sexual advance.
– Verbal: Suggestive comments, threats, insults and jokes
– Non-Verbal: Making suggestive or insulting noises, obscene gestures,
whistling, and displaying derogatory or pornographic posters, cartoons
or drawings.
– Physical: Unwelcome touching, brushing, hugging, kissing, pinching.
• It is your right to work/volunteer in an environment free from
harassment.
Slide 2.6

21. Liability and Sexual Harassment
• Harasser is always liable.
• Employer is liable for harassment by
supervisors and managers and quid pro
quo harassment.
• Supervisor or manager is liable when
harassment occurs and no quick, effective
action is taken.
Slide 2.8

23. A Slippery Slope
• Defense Mechanisms are a signal that
things are not going so great.
• Pay attention to your own DMs or gut
feelings. You may become defensive!
• Listen for the “yes, but …” phrase
– Denial
– Externalizing
– Rationalizing

24. Stop/Look/Listen
• Remember when you
learned to cross the
street? There were 3
simple rules: stop, look
and listen.
• Use your eyes, your ears,
your brain and your gut.
Check-in and look around
before you reply.
• Slow it down. You don’t
have to have or give all
the answers.
– Say what you mean
– Mean what you say
– Don’t say it mean

25. Types of Support
• Emotional support – show empathy, caring
• Informational support – give health or wellness
information, educate or help acquire new skills
(may be feedback or role play)
• Instrumental support – concrete or “hands-on”
assistance with a task or offering to help with
transportation or childcare
• Affiliation support – opportunity for positive
social connections, learn social and recreational
skills in a sober environment

26. Social Emotions are Human
• Checking our Own Attitudes & Feelings
– Condemning – contempt, anger, disgust
– Praising, gratitude
– Sympathy
– Compassion
– Empathy
– Guilt
– Shame
– Embarrassment
– Going native

27. What is My Role?
• It’s not about me, it’s about you =
Recovery Support
– Sponsor
– Counselor/Therapist
– Pastor/Clergy
– Nurse/Doctor
– Friend/Friends with Benefits
– Mentor
– Companion or “Big Buddy”

28. What is My Goal?
• Employer expectations
• Volunteer or unpaid staff person
• Supportive Listener
• Outreach
• Education
• Information
• Crisis Intervention
• Problem Solving

29. Telling Your Story
• Myths and the Classic Hero’s Story
• The myth of the American West (my way)
• 12 Step “sharing” and “war stories”
• Goal = Experience, Strength and Hope
– Who is going to feel better?
– Is this a teaching moment (person receptive)?
– Is it more about me than about you?
– Is there a risk of harm now or in the future?

30. Exercise
• Think about these last few hours. Our
conversation have been about change.
This has the potential for a big impact on
YOU, your life.
– How are you feeling?
– What coping skills are you using?
– Where do you plan to seek out support?
– Who will help you the most?

31. International Consortium of
Reciprocal Certification (ICRC)