Texas HomelessEducation Office

1-800-446-3142http://www.utdanacenter.org/theo

The University of Texas at AustinCharles A. Dana Center2901 N IH 35, Room 2.200Austin, Texas 78722

Region 10 ESC

USDE

Jeanne Stamp: 512-475-6898jeannestamp@austin.utexas.edu

Ethical Considerations in Working With Homeless and Unaccompanied

Homeless Youth

Ethical Considerations for Working with Unaccompanied and Homeless Youth

AGENDA• Definitions• Identify unaccompanied youth needs and

challenging situations• Identify common ethical issues when working

with homeless unaccompanied youth

• Identify common ethical standards• Identify possible solutions & application of

ethical practice• The ethics of digital communication

4

Definition of Homeless?

Must meet the McKinney-Vento definition of homeless: Children and youth who lack a fixed, regular, and adequate nighttime residence:

– Doubled up -sharing the housing of others due to loss of housing, economic hardship, or similar reason, “couch surfing”

– Living in motels, hotels, trailer parks, camping grounds due to lack of adequate alternative accommodations

– Living in emergency or transitional shelters– Abandoned in hospitals– Awaiting foster care placement– Living in a public or private place not designed for humans to live

– Living in cars, parks, abandoned buildings, bus or train stations, etc.– Migratory children living in above circumstances

– Children of deployed military whose “plan” breaks down– Undocumented students living in a homeless situation

5

Who Are Homeless Unaccompanied Youth?

• Are not in the physical custody of a parent or legal guardian

• Is there an age limit on serving homeless secondary students?MV applies to all school-aged youth (as defined by state law); typically states allow youth to attend school up to the age of 21 – in Texas this has been extended to age 26 in certain circumstances, 22 for Special Education

TEA defines unaccompanied as under age 21 on September 1 of the school year

6

RECAP MV: Must schools enroll children and youth in school if there is no proof of guardianship?

Yes. • Lack of guardianship papers cannot delay or prevent

enrollment. Enrolled is defined as attending and fully participating. School districts may establish their own policies to meet this mandate.

– HOWEVER…

• Schools/districts cannot require individuals/caretakers to obtain guardianship of youth after enrollment, or within a specified number of days, in order for youth to remain enrolled and attending. How does your state/district handle this?

7

RECAP: Must schools enroll children and youth in school if there is no proof of residence?

Yes. • Lack of proof of residence cannot delay or prevent

enrollment. School districts may establish their own policies to meet this mandate.

– HOWEVER…

• Schools/districts cannot require proof of residency from those in homeless situations.

• Cannot require dual residency affidavits • How does your state/district handle these “proofs”

8

RECAP: Must schools enroll children and youth in school without previous school records?

Yes. • Lack of school records cannot delay or prevent

enrollment. The enrolling school district must send to the previous district for the records.

– And…

• The previous district has 10 days in which to send the records. If the student has not been withdrawn previously, he/she is to be withdrawn from the previous district when they receive this request for records – how does your state/district handle this?

9

RECAP: Must schools enroll children and youth in school without immunizations or immunization records?

Yes. • Lack of immunizations or immunization records cannot

delay or prevent enrollment of students in homeless situations. The enrolling school district must send to the previous district for the records. Immunization records should be sent with the other school records, but must be presented within 30 days.

– or…

• If the student does not have his/or her immunizations, the Homeless Liaison must make arrangements for the student to begin them within 30 days. How does your state/district handle this?

10

What obligation does a school have to help unaccompanied youth make up lost credits?

• Many youth lose credits due to mobility and absences—consequences of homelessness

• McKinney-Vento requires that schools and districts remove barriers to enrollment and retention and provide academic support—LEA policies should be revised

• Youth should be provided academic support through tutoring, programs with cooperating universities, or online courses, for example; appropriate use of Title I set aside funds

11

Who can make decisions for an unaccompanied youth regarding participation in extra curricular activities,

field trips, etc.?

• States and school districts have implemented a variety of policies and procedures

– Youth make decisions on their own– Local liaison makes decisions– Caregiver forms allow other adults to make

decisions – act in the role of a parent– Schools assign a surrogate

Why are Youth Homeless on Their Own?

• Over half of callers to Runaway Hotline report being physically abused at home; over one-third report sexual abuse; over two-thirds report that at least one of their parents abuses drugs or alcohol

• Other youth are thrown out of their homes because they are pregnant, gay or lesbian, or because their parents believe they are old enough to take care of themselves

• Some children and youth are abandoned by their parents, or are on their own due to death of parents

• Some children and youth are in unstable living situations due to parental incarceration, illness, or hospitalization

Why are Youth Homeless on Their Own?

• Over half of youth living in shelters report that their parents either told them to leave, or knew they were leaving and did not care

• Some youth become homeless with their families, but, due to lack of space in doubled-up or motel situations, end up homeless on their own

• Natural disasters cause youth to be separated from family during their homelessness

• Aging out of foster care into homelessness; running away from foster care placements due to abuse in the foster home, or to reconnect with siblings and family

Impact of Homelessness on UHY

• Higher rates of acute and chronic illness, depression and anxiety; experiences of trauma and loss

• For unaccompanied youth, lack of support from any caring adult leads to faulty decision making

• Unaccompanied youth are frequently victimized. As many as half have been assaulted or robbed; one in ten runaways reports being raped – likely a low report

• According to the National Runaway Switchboard, 5,000 unaccompanied youth die each year from assault, illness, or suicide

• Perform lower on academic assessments• 50% of homeless youth & 75% of unaccompanied homeless youth do

not graduate

Do we have an ethical obligation to identify and intervene?

15

Unaccompanied Youth—Key Provisions

• Liaisons must help unaccompanied youth choose and enroll in a school, after considering the youth’s wishes, and inform the youth of his or her appeal rights – school of origin is the first consideration

• School personnel must be made aware of the specific needs of runaway and homeless youth.

16

What about discipline and a homeless student?

Generally students in homeless situations must follow the same rules of behavior as all other students, but

If discipline action was taken against a youth for reasons related to homelessness (for example, excessive absences caused by homelessness), the youth must not be penalized or denied enrollment and the policy should be revised

17

Do schools have to contact the police when enrolling unaccompanied youth?

• State law determines the obligation of a school liaison or service provider to alert other agencies about unaccompanied youth

• Most state laws that address this issue (including Texas) permit, but do not require, schools to report unaccompanied youth; many laws also give schools the option to contact social services instead of the police

• The school district should work with police and social services regarding mandatory reporting to ensure that care is exercised to keep a youth in school and serve his/her best interest

18

Who can make decisions related to special education for an unaccompanied youth?

• IDEA requires LEAs to appoint surrogate parents for unaccompanied homeless youth within 30 days – expands the definition of parent

• IDEA regulations permit staff members of emergency shelters, transitional shelters, independent living programs and outreach programs to serve as temporary surrogate parents for unaccompanied homeless youth

• Districts should have a surrogacy program to train potential surrogates. They cannot be employees of the school district

19

What about school liability or parental disapproval?

Liability is based on the concept of negligence, or a failure to exercise reasonable care — following federal law and providing appropriate services are evidence of reasonable care

School districts must follow MV and state laws

20

Can unaccompanied youth consent to their own medical treatment?

• Generally, only persons age 18 and over can consent to their own medical, dental, and health care; minors need consent of a parent or guardian – state laws vary

• The Texas Family Code gives youth 16 or older who are independent of parents the right to consent to their own medical treatment.

• Texas Students of any age can access certain health and mental health services under certain circumstances, i.e., in cases of abuse

UHY barriers

• What are some of the barriers cited in this video?

• What are some of the ethical considerations when working with the youth in this video?

In the original session PowerPoint, a video was embedded on this slide. Due to file size

restrictions, the video could not be included for downloading the handout from the NAEHCY

website. Please contact the presenters directly if you’d like to have more information about this

video.

22

UHY barriers

• What are some of the barriers cited in this video?

• What are some of the ethical considerations when working with the youth in this video?

Barriers to Education

• High mobility: 41% will attend at least two different schools; 28% will attend three or more

• Unaccompanied youth: lack of a parent or guardian to sign forms• Lack of school records and other paperwork• Lack of transportation• Lack of school supplies, clothing• Credit accrual policies, attendance policies• Low expectations by family, school• Lack of stable housing• Emotional crisis / mental health issues• Employment - need to balance school and work• Fatigue, poor health, hunger• Concerns about being captured by authoritiesDo we have an ethical obligation to identify and intervene?

Runaway, pushed out,

and unaccompanied youthare a growing proportion of

children in homeless situationsThey often know what they are running from, but have no realistic idea of what

theyare running to.

These youth are vulnerable to exploitation

Runaway YOUTH ARE HOMELESS

• Tired, sleeping in class, lack of energy• Poor hygiene• Wear the same clothes day after day• Inability to concentrate• Doesn’t turn in homework assignments• Doesn’t complete special projects• Is frequently tardy or absent• Comes to class “unprepared”• Change in behavior• Is angry, hostile, anxious• Is secretive, afraid to share information• Moves around a lot• Grades fall off, gaps in learningDo we have an ethical obligation to identify and intervene?

What are Ethics?

Define Ethics

Standard of ConductAccountability

Rules of Our Profession Acceptable Standards of Care

Licensing Standards Professional Standards

What are Ethics?

MoneyHuman nature

Influenced by clients Ego

EnvironmentInsecurity

BiasOur own issues

Dual rolesLack of self-awareness

What contributes to unethical behavior in the helping profession ?

What are some of your biggest challenges when working with homeless

and unaccompanied homeless youth?

What are some ethical issues you encounter?

What breaches of ethics have you witnessed?

Homeless & UH Youth

Common situations that have ethical implications when working with youth

Meeting with youth in “non-traditional” settings

Mistaking friendship for appropriate trust building

Keeping Confidentiality – to whom to tell what? When the youth says “Don’t tell anyone.”

Reporting abuse and neglect – concerns for youth safety

Reporting runaway – concerns for youth safety

Addressing risky behaviors – if you do, will they leave?

Giving Money, taking kids home, leaving youth in unsafe setting

Failing to report or to act on information shared

Dealing with “I only trust you” with certain information

Is adolescence synonymous with “borderline personality?”

Common Ethical Issues When Working with HY & UHY

1. Standard of care- What an ordinary, reasonable, and prudent professional, with the same or similar training, would have done under the same or similar circumstances.”

2. Informed consent - Capacity to consent (e.g., age, competency)

3. Confidentiality

4. Who is the client

5. Trust building

Common Ethical Issues When Working with UHY

Boundary issues - Boundary crossings v. boundary violations

Types of dual or multiple relationshipsIntimate relationships

Personal benefitEmotional and dependency needs

AltruismUnavoidable and unanticipated circumstances

Ethical Practices & Concerns

Allowing youth self determination

Addressing unsafe behavior/leaving kids in unsafe situations

Contacting parent or guardian

Ethical Practices & Concerns

Sharing information with schools, CPS, other service providers

Records

Meeting in Non-traditional settings

Common ethical principles when working with youth

• Dissonance: when your values differ from those of your client, your agency, your professional licensure, society at large. Example: abortion, HIV services, GLBT, etc.

• Confidentiality: issues with confidentiality that can particularly occur within residential, street, and home-based settings - who should be present when a home visit is occurring? What happens when other residents overhear information about a particular client? How do different agencies safeguard against this? Who needs to know which information?

• Referral: how to access other services for a client, without sharing confidential information? How to know when to access a referral, and how much information to share?

• Boundaries: are frequent issues within residential, community, and home- based settings, and when working with unaccompanied youth.

• Fairness – treating all youth in a manner that is equally helpful• Honesty – telling youth the truth – they know when we aren’t

 

Common ethical principles when working with youth

• Agency or professional policies and/or practices that are particularly helpful in addressing ethics conflicts.

• Do no harm – Understanding competencies: What tells social workers that they are working beyond their competence?

• Dual Relationships – business, social, relative, friends, etc. • Language – What workers see and what they say frames the work for

possibilities or barriers; labels, or enables the client.• Informed consent – self consent for unaccompanied youth? At what age?• Crisis work – what happens when you are in crisis mode? Does

“business as usual” go out the door and what does this mean for ethical  • When are practitioners crossing ethical lines? When are boundaries fluid

and when are they rigid? What information is too much to share, and what is not enough? Who does the youth worker look to for guidance in making ethical decisions in his/her work? How do crisis situations challenge ethical standards? Reporting, trust loss if you do; when safety and rapport building seem to be at odds.

 

Common ethical principles when working with youth

• Agency or professional policies and/or practices that are particularly helpful in addressing ethics conflicts.

• Do no harm – Understanding competencies: What tells social workers that they are working beyond their competence?

• Dual Relationships – business, social, relative, friends, etc. • Language – What workers see and what they say frames the work

for possibilities or barriers; labels, or enables the client.• Informed consent – self consent for unaccompanied youth? At what

age?• Crisis work – what happens when you are in crisis mode? Does

“business as usual” go out the door and what does this mean for ethical practice

• Practicing outside your scope of expertise – we do not have the answers to all our youth’s problems 

 

Common ethical questions when working with youth

• When are practitioners crossing ethical lines? • When are boundaries fluid and when are they rigid?• What information is too much to share, and what is not

enough? • Who does the youth worker look to for guidance in making

ethical decisions in his/her work? • How do crisis situations challenge ethical standards?• Reporting? Trust loss if you do;• When do safety and rapport building seem to be at odds?• Who do you consult with regarding these issues?

How does your district or organization handle:

• Lack of parental signature for field trips, playing sports, other activities, services?

• Who goes on the contact form?• Who receives school notices & reports?• Who gets called in case of illness, a behavior

issue, or an emergency?• Who is held accountable for poor school

attendance?• Who requests and attends an ARD?

41

Tips for a coordinated approach to addressing the needs of unaccompanied youth

• Revise LEA policies to accommodate unaccompanied youth and comply with the McKinney-Vento Act.

• Train LEA homeless liaisons and all school enrollment staff, secretaries, guidance counselors, principals and teachers on the definition, rights and needs of unaccompanied youth.

• Develop caretaker forms, self-enrollment forms for unaccompanied youth, and other forms to replace typical proof of guardianship. Such forms should be carefully crafted so they do not create further barriers or delay enrollment.

42

Tips for a coordinated approach to addressing the needs of unaccompanied youth

• Provide unaccompanied youth the opportunity to enroll in diversified learning opportunities, such as vocational education, credit-for-work programs and flexible school hours.

• Provide a “safe place” and trained mentor at school, for unaccompanied youth to access as needed.

• Permit flexible exceptions to school policies on class schedules, tardiness, absences and credits to accommodate the needs of unaccompanied youth.

• Build relationships with legal services for trainings, updates, advocacy for individual students in non-educational areas.

• Provide opportunities for extra curricular activities.• Address issues with electronic information and privavy

In a Digital World: Ethical and Risk-Management Issues

Electronic communications & Social Media

43

The Good(?) Old Days: The Way It Used to Be

44

More Nostalgia

45

A Little More Nostalgia

46

And What The Heck is This?

47

And Now We Have . . .

Cybertherapy

48

49

Common ethical principles when working with youth

• When are practitioners crossing ethical lines? • When are boundaries fluid and when are they rigid?• What information is too much to share, and what is not

enough? • Who does the youth worker look to for guidance in making

ethical decisions in his/her work? • How do crisis situations challenge ethical standards?• Reporting? trust loss if you do;• When do safety and rapport building seem to be at odds.

Key Stages

• Morality period (late 19th to early 20th century)

• Values Period (up through 1970s)• Ethical dilemmas and decision making (late

1970s to present)• Ethics risk management (early 1990s to

present)• Digital era (mid 2000’s to present)

51

Key Stages

• Morality period (late 19th to early 20th century)

• Values Period (up through 1970s)• Ethical dilemmas and decision making (late

1970s to present)• Ethics risk management (early 1990s to

present)• Digital era (mid 2000’s to present)

52

Key Issues

• Digital and electronic communications

• Digital and electronic services–Clinical services–Information and education

• Digital and electronic search

53

Forms of Electronic Communication That Carry Ethical considerations

• Chat (live)• Moderated forum• Web-based psychoeducation• Self-guided Web-based interventions with automated feedback (e.g., anxiety, phobia,

self-esteem, anger, weight loss)– Human support– No human support

• Skype• Social networking: Facebook, Twitter, Instagram, etc • Email exchanges • Text messages• Blogs • Twitter• Voice messaging• Searches

54

Three Key Issues

• Digital and electronic communications

• Digital and electronic services–Clinical services–Information and education

• Digital and electronic search

55

Key Issues

Digital records storage Privacy of communicationsConfidentialityIs anything ever deleted?Is there always a trail left behind?

56

Three Key Issues

• Digital and electronic communications

• Digital and electronic services–Clinical services–Information and education

• Digital and electronic search

57

Digital Trends in Clinical Practice: The Changing Nature of Mental Health and Social

Services• What do we mean by relationship?• Who do we aim to serve?• What do we mean by privacy?• What are the boundaries of professional-

client relationships?• What do we mean by informed consent?• When we communicate electronically, are we

sure our words have the same meaning?

58

Key Stages

• Morality period (late 19th to early 20th century)

• Values Period (up through 1970s)• Ethical dilemmas and decision making (late

1970s to present)• Ethics risk management (early 1990s to

present)• Digital era (mid 2000’s to present)

59

Key Stages

• Morality period (late 19th to early 20th century)

• Values Period (up through 1970s)• Ethical dilemmas and decision making (late

1970s to present)• Ethics risk management (early 1990s to

present)• Digital era (mid 2000’s to present)

60

Digital Trends in Clinical Practice: The Changing Nature of Mental Health Services

• What do we mean by relationship?• Who do we aim to serve?• What do we mean by privacy?• What are the boundaries of professional-client

relationships?• What do we mean by informed consent?• What is the role of paternalism in the digital age?• When we communicate electronically, are we sure

our words have the same meaning?

61

Texting can be dangerous! considerations

• Chat (live)• Moderated forum• Web-based psychoeducation• Self-guided Web-based interventions with automated feedback (e.g., anxiety,

phobia, self-esteem, anger, weight loss)– Human support– No human support

• Skype• Social networking: Facebook, Twitter, Instagram, etc • Email exchanges • Text messages• Blogs • Twitter• Voice messaging

62

Apps that teens use• Social Media Tools Parents Need to Know About Now• Twitter

InstagramSnapchatTumblrGoogle+VineWaneloKik MessengerOoovooAsk.fmYik YakWhatsAppOmegleYo.Whisper

63

Boundaries, Dual Relationships and Conflicts of Interest

• Social networking (Facebook, LinkedIn)• Current clients• Former clients• Former Facebook friend becomes client

• Helping professionals’ self-disclosure• Helping professionals’-client access

• Time of day/night• Form of access, e.g., text message, email

• Relationships with former clients• Conflicts of interest, e.g., commercially sponsored

video conferencing software with ads 64

Collegial Relationships

• Treating with respect• Avoiding derogatory and defamatory postings• Respecting colleagues’ privacy (e.g., Google

searches)• Respecting colleagues’ work products (plagiarism,

unauthorized uploads)• Responding to colleagues’ unethical conduct (e.g.,

inappropriate postings, cyberbullying)• Avoiding cyberbullying, collegial harassment

65

Developing a Social Media Policy• “Friending” on Facebook

o Boundaries issueso Rejection issueso Privacy issues (e.g., acquaintances in common)

• Electronic interactions (Facebook, email)– Privacy issues– Documentation issues

• To Google or not to Googleo “Curiosity” searcheso Crisis searches

• Business review sites (e.g., Yelp, Healthgrades)• Location-based services (e.g., Foursquare, Gowalla, Loopt)• Example of a social media policy: http://

www.drkkolmes.com/docs/socmed.pdf

66

“Friending” Youth on Facebook: Questions to Consider

• What is on the Facebook profile?o Facebook Page: professional use, one-wayo Facebook Profile: personal content, photos, etc.

• Are privacy controls set?o Digital “natives”o Digital “immigrants”

• What is the context of the work? (e.g., client age, culture, clinical setting, size of community)

• Who is the client? (e.g., clinical issues, boundary instincts)• Will client “postings” be seen by other clients?• If so, is this appropriate? • How do you control what is posted?• Will “Friending” a client create complex boundary, confidentiality and

privacy issues?Our Suggestion: Don’t do it! 67

Facebook Privacy Disclaimer

“Risks inherent in sharing information. Although we allow you to set privacy options that limit access to your information, please be aware that no security measures are perfect or impenetrable. We cannot control the actions of other users with whom you share your information. We cannot guarantee that only authorized persons will view your information. We cannot ensure that information you share on Facebook will not become publicly available. We are not responsible for third party circumvention of any privacy settings or security measures on Facebook. You can reduce these risks by using common sense security practices such as choosing a strong password, using different passwords for different services, and using up to date antivirus software.”

68

Email Considerations• Is the email communication for administrative or

therapeutic purposes?• How often must I check my email messages? (provide

clients with written and verbal information about your policy)

• Does email communication fall under HIPAA?• What are the confidentiality and privacy issues?• Do I need to document emails in the youth’s record?• Do I need consent to communicate electronically with

youth?

69

Developing an electronics use policy

• What things would you include? • Identify the main areas of liability

70

Confidentiality Issues

• Duty to protect/warn• Mandatory reporting• FERPA: Family Education Rights &

Privacy Act• HIPAA: Health Insurance

Portability and Accountability Act• Disclosure: Other agencies• Disclosure: Within agencies• Peer Consultation• Informed consent• Expiration date• Scope of consent• Blank forms

• Group counseling• Self-help groups• Minors• Sexual misconduct by professionals• News media• Law enforcement• CPS reports• Interns• Personal notes• Competence and scope of work • HIPAA & FERPA

71

Questions?

Thank You!

72

Resources Online Services: Resourcesand Ethics Guidelines

• International Society for Mental Health Online: https://www.ismho.org/home.asp • American Distance Counseling Association: http://www.adca-online.org/ • Association for Counseling and Therapy Online: http://www.acto-uk.org/index.htm • Online Therapy Institute: http://onlinetherapyinstitute.com/ethical-training/• American Telemedicine Association: http://

www.americantelemed.org/i4a/pages/index.cfm?pageID=3604 • The Use of Technology in Mental Health: http://

www.amazon.com/The-Use-Technology-Mental-Health/dp/0398079536 • Online Counseling: A Handbook for Practitioners (Jones and Stokes, 2009):

http://www.amazon.com/gp/product/0230201954/ref=pd_lpo_k2_dp_sr_1?pf_rd_p=486539851&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=0124259553&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=09T6Z8A12GZ17387HCCR

• Online Counseling: A Handbook for Mental Health Professionals (Kraus, et al., 2004): http://www.amazon.com/Online-Counseling-Professionals-Practical-Professional/dp/0124259553

73

Resources:An Example of a Health System’s

Social Networking Policy

Inova Health System: Social Networking and Communications Policy: http://www.inova.org/upload/docs/about-Inova/Social%20Networking%20Policy.pdf

74

Resources:Examples of Ethical Standards:

Electronic Services and Interventions

• http://www.apa.org/ethics/education/telephone-statement.aspx

• http://www.nbcc.org/assetmanagerfiles/ethics/internetcounseling.pdf

• https://ismho.org/suggestions.asp • http://www.acto-uk.org/professionalconduct.

htm

75

Key Stages

• Morality period (late 19th to early 20th century)

• Values Period (up through 1970s)• Ethical dilemmas and decision making (late

1970s to present)• Ethics risk management (early 1990s to

present)• Digital era (mid 2000’s to present)

76