ethics in case management: basics, boundaries, and burnout€¦ · principles, healthy boundaries,...
TRANSCRIPT
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OBJECTIVES
1 – Understand and articulate the overlap between ethical
principles, healthy boundaries, and prevention of burnout.
2- Effectively strategize to deliver services ethically, implement
appropriate interventions, and maintain healthy
boundaries.
3- Summarize ways to successfully maintain healthy self-care
practices to prevent burnout.
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OUTLINE
Basics: Ethical Principles of Case Management
▪ Ethical codes
▪ Purpose
▪ Intent vs. effect
▪ Common factors
▪ Additional suggestions
▪ Application
Boundaries: Case Manager-Client Interactions
▪ Boundaries
▪ Purpose
▪ Typology
▪ Healthy vs. unhealthy
▪ Transference and counter-transference
▪ Ethical considerations
▪ Effects on interactions
▪ Case studies
Burnout: Poor Boundaries + Blurred Ethics = Burnout
▪ Burnout defined
▪ Effects of burnout
▪ Role play!
▪ Self-care
Conclusion
▪ Key strategies for ethical implementation, boundaries-setting, and burnout-prevention
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BASICS: ETHICAL CODES
What is ethics?
▪“an area of study that deals with ideas about what is good and bad behavior : a branch of philosophy dealing with what is morally right or wrong” (Merriam-Webster)
What are ethics?
▪“the principles of conduct governing an individual or a group” (Merriam-Webster)
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BASICS: ETHICAL CODES
Why have ethics, anyway?
What is its purpose in case management?
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BASICS: ETHICAL CODES
“Recognition that case management is guided by the principles of autonomy, beneficence, non-maleficence, and justice.” (Code of Professional Conduct for Case Managers, 2009)
Other principles that are relevant to case management?
▪Social benefit
▪Accountability
▪?
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BASICS: APPLICATION
Name some ways that you can enhance (or enact):
▪Your client’s autonomy
▪Social benefit via interactions with your client
▪ Justice as a case manager
▪Non-maleficence and beneficence
▪Accountability between you and your client?
▪Between you and your colleagues?
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BOUNDARIES
As case management professionals, why is it important
for us to set and maintain boundaries?
How do you know when a client can benefit from
additional boundaries-setting?
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BOUNDARIES
Typology
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BOUNDARIES
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Remember: Even when boundaries are addressed and
enhanced, transference and countertransference can,
and inevitably will, occur within the case
management-client relationship!
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BOUNDARIES, TRANSFERENCE, &
COUNTERTRANSFERENCE
Transference
-experienced by the participant, client, patient, etc.
-happens when the participant “transfers” feelings, thoughts, and beliefs regarding
“significant others” from childhood onto the case manager, and has an emotional reaction
Countertransference
-experienced by the case manager, therapist, etc.
-occurs as an emotional reaction to the participant; case manager also “transfers”
feelings, thoughts, and beliefs onto the participant
TRANSFERENCE AND COUNTERTRANSFERENCE CAN BE POSITIVE AND/OR NEGATIVE!
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Client Case Manager
Transference
Countertransference
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How is attachment theory relevant here?
“Clients’ patterns of relatedness manifest within the therapy
relationship, often along with potential responses that the client
attempts to pull from the therapist, in order to confirm or perpetuate
their working model of self and others.” (Skourteli & Lennie, 2011)
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Problem?
Client’s
Attachment Style
Client’s Interaction w/ CM CM’s Countertransference
Response
Ambivalent
-excessively contacts
-always seeks
reassurance
-dependent
-helpless
-Attempts to “rescue”
-Burn-out
-Overwhelmed
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BOUNDARIES
What are the ethical implications of poor boundaries?
How can healthy boundaries impact our clients?
In what ways can unhealthy boundaries hinder our
clients’ success?
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BOUNDARIES
Case Study: Ricky the Rescuer
Case Study: Olivia the Over-sharer
Case Study: Tom the Time-giver
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BURNOUT
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BURNOUT
“…a state of chronic stress that leads to physical and
emotional exhaustion, cynicism and detachment, and
feelings of ineffectiveness and lack of
accomplishment.” (Carter, 2013)
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BURNOUT
http://irisclasson.com/2013/10/07/burning-out-the-what-why-and-who-question-145-148/
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BURNOUT
Affects individuals emotionally, mentally, physically,
spiritually, and socially
Effects are insidious and not sudden
Often, other people in your life will notice that you are en
route to or suffering from burnout before you do
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BURNOUT, BOUNDARIES, AND ETHICS
Role Play!
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ADDRESSING BURNOUT
The Three R’s
▪Recognition
▪Reversal
▪Resilience
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BURNOUT - RECOGNITION
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BURNOUT - REVERSAL
• Self-care helps with prevention,
reversal, and building resilience
• Adopt healthy exercise, sleep,
and eating habits
• Utilize coping skills to effectively
manage stress
• Take a break from technology and
indulge in recreational activities
• SET BOUNDARIES!!!
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BURNOUT - REVERSAL
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BURNOUT - REVERSAL
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BURNOUT - RESILIENCE
Recover from burnout first!
▪Slow down
▪Obtain support
▪Re-assess your goals and priorities
▪Remember: “Begin with the end in mind.” - Covey
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CONCLUSION
Putting it all together:
▪Ethical considerations guide our implementation of boundaries
▪Lack of boundaries, or poor boundaries-setting, leads to burnout
in our profession
▪So…services should be delivered ethically and with boundaries
in place, to guide us in building resilience, reversing the effects
of burnout, and recognizing the phases that precede burnout
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HELPFUL RESOURCES
Self-Care:
http://homeless.samhsa.gov/channel/self-care-for-providers-27.aspx
Ethics & Boundaries:
http://www.health.qld.gov.au/abios/behaviour/professional/boundaries_pro.pdf
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REFERENCES
http://www.helpguide.org/mental/burnout_signs_symptoms.htm
http://www.mayoclinic.org/healthy-living/adult-health/in-depth/burnout/art-
20046642
http://www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-
signs-burnout-do-you-have-them
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THE END
Questions?
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