specialty training series: 11/15/2019 clinical supervision … · 2019. 11. 13. · ce certificate...

NAADAC Specialty Training Series: Clinical Supervision in Addiction Profession Part 3 of 6

11/15/2019

Presented by Thomas Durham, PhD 1

ETHICAL AND LEGAL ISSUES IN SUPERVISION

PRESENTED BY THOMAS G DURHAM, PHD

SAMSON TEKLEMARIAM, MA, LPC, CPTM

• Director of Training and Professional Development

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

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PRODUCED BY

NAADAC, THE ASSOCIATION FOR ADDICTION PROFESSIONALS

WWW.NAADAC.ORG/WEBINARS

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WWW.NAADAC.ORG/CLINICAL‐SUPERVISION‐ONLINE‐TRAINING‐SERIES

CE CERTIFICATE

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CE HOURS AVAILABLE:1 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

1. Watch and listen to this entire training.

2. Pass the online CE quiz, which is posted at: www.naadac.org/legal‐and‐ethical‐issues‐in‐supervision‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

To obtain a CE Certificate for the time you spent watching this training:

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Using GoToWebinar –(Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

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WEBINAR PRESENTER

Thomas G Durham, PhD

[email protected]

301‐792‐3829

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Define ethical issues in clinical supervision

including dual relationships and confidentiality

LEARNING OBJECTIVE ONE

Define legal considerations in clinical supervision including vicarious liability and duty to

warn

LEARNING OBJECTIVE TWO

Explore the supervisor’s role in modeling ethical

behavior

LEARNING OBJECTIVE THREE

Analyze ethical obligations and ethical decision‐making of the supervisor

LEARNING OBJECTIVE FOUR

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Ethical decision‐making is a continuous and active process

There are no “cook book” answers:

Answers to ethical dilemmas are elusive

Ethical standards are not easy to follow

Each situation is unique

Simple fact: people make mistakes

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Gatekeepers for ethical and legal issues

Responsible for upholding the highest standards

Role models for staff

Responsible for maintaining awareness of and responding to ethical concerns

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“help integrate solutions to everyday legal and ethical issues into clinical practice”

TIP52 (CSAT, 2009)

LEGAL ISSUES IN SUPERVISION

Duty to warn

Liability

Confidentiality

Standards of Care

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Landmark Case: Tarasoff v. Regents of the University of California (1976)

When a potential victim is clearly identified by a client or could be identified upon “a moment’s reflection”

Duty may include more than warning the intended victim

Supervisors must remain alert to any potential violence by a client of each supervisee

Challenges to Tarsoff various interpretations at the State level

DUTY TO WARN

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The supervisor’s control over the supervisee

The location and time at which the act occurred

The motivation of the supervisee for committing the act

The supervisee’s scope of duty to perform the act

Whether it was foreseeable by the supervisor that the supervisee

would perform the act

Wheeler & Bertram (2015)

LIABILITY – FACTORS TO DETERMINE NEGLIGENCE

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Establish an open and trusting supervisory relationship

Maintain professional liability insurance

Practice within the boundaries of your competence

Document carefully

Respect the due process rights of the supervisee

Consult with colleagues (and your own supervisor)

Keep up to date with evolving ethical standards and legal developmentCampbell (2011)

MALPRACTICE PREVENTION STRATEGIES

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“Clinical supervisors shall not disclose confidential information in teaching or supervision without the expressed written consent of a client, and only when appropriate steps have been taken to protect the client’s identity and confidentiality” (NAADAC Code of Ethics)

Although not covered by confidentiality regulations, personal supervisee information must be respected with the utmost sensitivity

CONFIDENTIALITY – SUPERVISEE CONSULTATION

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Confidentiality, Privileged Communication, and Privacy: “Confidentiality is the counselor’s ethical duty to protect private client communication”

“Privilege is the protection of confidential communications between two parties in the context of a judicial setting”

“Privacy is a basic right of a person to be left alone and to control his or her personal information” (Wheeler & Bertram, 2015)

Confidentiality of SUD client information is governed by the federal regulation 42 CFR, Part 2.

CONFIDENTIALITY – CLIENT INFORMATION

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Defined as: “a level of care that is consistent with the degree of learning, skill, and ethics ordinarily possessed and expected by reputable counselors practicing under similar circumstances” (Wheeler & Bertram, 2015)

Clinical supervisors are held to an assurance that professional activities are consistent with what is expected of similarly trained professionals

Standards of care are influenced by continuously evolving sources such as ethical codes, licensing protocols, and state and federal law.

Become familiar with the NAADAC Code of Ethics: https://www.naadac.org/code‐of‐ethics

STANDARDS OF CARE

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Give counselors a framework for decision making

Promote ethical thinking for counselors

Monitor the ethical conduct of counselors

Ensure clarity of expectations

Set boundaries

Promote cultural humility

Ensure autonomy

Whose interests are involved and who can be harmed?

Who are the potential winners and losers?

Whose interests, if any, are in conflict?

How are primary stakeholders involved, affected or harmed?

Whose interests, if any, are in conflict?

What universal values can be applied?

Are any values in conflict?

What laws, standards, policies, historical practices, or cultural

teachings should guide the decision?White & Popovits (2001)

Client vs. Supervisee Welfare

Autonomy of Supervisee vs. Expectations of Supervisor

Double Standard of Self‐Care

CompetencyOngoing EducationAwareness of limitations

Monitoring/observing supervisees

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Since our last meeting has anything happened that might put you in a different light with a client?

Do you have any concerns about any clients?

Are any clients dangerous or suicidal?

Have you failed in any way to maintain client confidentiality?

Is there anything a client shared with you that gives you duty to warn?

1. Competence

2. Dual relationships and boundary control

3. Informed consent

4. Due process

5. Promoting ethical thinking

Education, training and experience

Competent clinician to competent supervisor?

Specialized training:o Process and methods of supervision

o In‐depth knowledge of treatment of SUDs and CODs

oWithout proper training and experience, supervisors are at risk for harm

Ability to maintain awareness of supervisee compentence

Understand limits to supervisee’s level of competence

Gaining cultural humility (for themselves as well as supervisees)

COMPETENCE

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Supervising a family member (or intimate partner)

Developing a business relationship with a supervisee

Allowing supervision to slip into psychotherapy

Only game in town

Promotion from the ranks

“Two hatter” issues for supervisors in recovery

Similarities between therapy and supervision

Supervisors use “what they know” in their supervisory role

Supervisors model therapeutic behavior in supervision

Supervision is the “isomorph” (a near‐replication) of therapy

A good clinical supervisor is a therapist doing supervision not

a supervisor doing therapy

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Client:o Seek assurance that supervisees are following the obligation to provide relevant treatment information to clients

o Informing clients of the process of sharing information

o Receive consent by client when supervisor observes a session

Supervisee:o Supervisor’s expectation for supervision

o Monitoring and evaluative role of supervisor

o Methods to be used in supervision

Documentation of the above

INFORMED CONSENT

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Constitutional protection before fair removal of a righto To protect the rights of clientso Extends to supervisees as well

Provision of clear documentation (for supervisees):o Performance standards

o Expectations

o Standards of care

Provision of a clear procedure that ensures supervisee’s due process rights are being protected

DUE PROCESS

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Help supervisees develop the ability to “think forward” to consequences of professional behavior

Reduces incidents of unethical conduct

Promote and develop independent clinical decision making

Achieved through modeling by the supervisor

Challenge supervisees to be vigilant and alert

Brainstorming, via group and/or individual supervision

PROMOTING ETHICAL THINKING

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Two scenario handouts are available for participants

The scenarios will also be read by the presenter

Participants will be asked to answer a polling question for each scenario

Scenario #1: The Case of Joan

POLLING QUESTION FOR THE FIRST ETHICAL DILEMMA

Which of the following best fits with what you would do in this situation?

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A. Joan must leave her job B. NothingC. Restrict Joan from client records

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Scenario #2: The Case of Sarah

POLLING QUESTION FOR THE SECOND ETHICAL DILEMMA

Which of the following best fits with what you think should be done in this

situation?

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A. Discontinue their social relationshipB. Keep social relationship separateC. Assure staff no favoritism

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“laws dictate the minimum standards of behavior that society will tolerate, whereas

ethics represent the ideal standards expected by the profession”

Remley & Herlihy (2014)

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QUESTIONS AND ANSWERS WITH YOUR PRESENTER

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“TRUE HUMILITY IS NOT THINKING LESS OF YOURSELF; IT IS THINKING OF YOURSELF LESS”

C.S. LEWIS

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• Bernard, J. & Goodyear, R. (2018). Fundamentals of clinical supervision (6th ed).Boston: Pearson.

• Campbell, J.M. (2011). Essentials of clinical supervision. Hoboken, NJ: Wiley.• Corey, J., Haynes, R., Moulton, P., & Muratori, M. (2010). Clinical Supervision in the helping professions (2nd ed.). Alexandria, VA: ACA.

• Falvey, J.E. (2002). Managing clinical supervision: Ethical practices and legal risk management. Pacific Grove, CA.

• Legal Action Center (2012). Confidentiality and communication: A guide to federal drug and alcohol confidentiality law and HIPPA. New York: Author.

• Remley, T.P. & Herlihy, B. (2014). Ethical, legal, and professional issues in counseling (4th ed.). Upper Saddle River, NJ: Pearson.

• Wheeler, A.M. & Bertram, B. (2015). The counselor and the law: A guide to legal and ethical practices (7th ed.). Alexandria, VA: American Counseling Association.

• White, W. & Popovits, R. (2004). Ethical incidents in the prevention and treatment of addiction (2nd ed.). Bloomington, IL: Lighthouse Publishing.

REFERENCES

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[email protected]

301‐792‐3829

THANK YOU!

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www.naadac.org/clinical‐supervision‐online‐training‐series

CE CERTIFICATE

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CE HOURS AVAILABLE:1 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

To obtain a CE Certificate for the time you on this training:

1. Watch and listen to this entire training.

2. Pass the online CE quiz, which is posted at: www.naadac.org/legal‐and‐ethical‐issues‐in‐supervision‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

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specialty training series: 11/15/2019 clinical supervision … · 2019. 11. 13. · ce certificate...

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