Professional, Ethical, and Legal Issues and Violations in Human Services

Ethical violations have and continue to plaque the human service profession. In a variety of areas and topics in the human service profession, potential ethical violation areas include informed consent, confidentiality, boundaries, and respect for religious, cultural, and other differences. A comprehensive understanding of relevant state laws and professional guidelines accompanied with knowledge of best practices are essential to reduce potential ethical violations. According to DePauw (1996), the goal of all ethical exploration is to assist professionals in addressing their primary responsibility to promote the welfare and respect the integrity of the clients. Ethical standards directly challenge members to stimulate greater concern for their own professional functioning and for the conduct of fellow professionals.

Confidentiality - Confidentiality in the human services field is important. Confidentiality in respect to counselors or therapists means service professionals will not share information a client has shared. Many people are not aware of the exceptions to confidentiality. Therapists have a duty to warn, meaning professionals are required by law to warn the appropriate people in cases that harm is suspected. The human service professional is required to contact and warn the appropriate authorities or people involved in what could be potentially harmful situations. Specific laws on duty to warn vary from state to state. When human service workers become aware of any type of abuse, professionals are required to break confidentiality and protect the abused. Another situation a client's information may be shared is in the event a court order demands information (Grohol, 1999).

If clients are children, confidentiality rules can change. States vary in rules regarding the confidentiality of children's information; however, in many states, guardians or parents are entitled to most, if not all, information during counseling or therapy sessions. When children go to human service workers with information, children expect counselors to keep information confidential. When parents ask human service workers for information, service professionals are put in a tight spot. By sharing information with parents, counselors risk losing the trust of the children they serve. Sharing information with parents is an ethical decision workers must decide on a case by case basis. Many times, service professionals will try to keep information confidential unless they believe children are in danger (Clifton Mitchell, 2002).

Respect for Religious, Cultural, and Other Differences - America is a country where people are free to make many of their own personal choices; people are free to believe in almost anything they choose which makes America culturally diverse. Many differences clients have include income levels, religious beliefs, values, morals, sexuality, and race. Human service workers need to be aware of a client's background and beliefs. When counselors focus on the culture of the what they believe is the majority, it can be difficult to reach those who do not fit into a preconceived notion. To address this problem, human service workers need to realize the differences in people and how their differences make them who they are (Young, n.d.).

While in counseling or therapy, clinicians should never try to force their beliefs on the client. Instead, it is important to help clients find who they are in their own self identified culture. Knowing too much is not possible. Reading and learning about different cultures, religions, and ethnic groups is beneficial. Counselors or therapists make up decisions on what is best for clients in the client's way of life; learning as much as possible about their specific culture, religion, or ethnicity is important (Young, n.d.). Sometimes clients will request therapists or counselors who share the same background. Clients often believe clinicians will be able to understand them better. Clinicians should not be offended; clients need to feel comfortable with who is assisting them. Differences in the approach to counseling and therapy in different cultures can come across being too passive or too rigid because of the differences (Kupersanin, 2002).

Informed consent - People seeking treatment from a human service professional need to first consent to treatment. Informed consent gives clients a full understanding about what they are agreeing to participate in (Freeman, 2000). A thorough informed consent document includes the goals of the organization and makes people aware of stipulations and details about services. An informed consent document should be clear, concise, thorough, voluntary, and easily understood by the majority of people. Once informed, people should understand fully what the organization does and does not do and understand what their rights and responsibilities and the rights and responsibilities of service professionals are during treatment. An informed consent should give full information about authorization needed from clients before use or disclosure of confidential information regarding the client.

Clients should receive a copy of any signed documents. Some informed consent documents include a release form, releasing the organization from certain liabilities. Informed consent documents can offer an explanation of procedure, any possible risks or discomforts, benefits, alternatives, and costs to the client (Anonymous, 2010). Although each organization differs in the details of informed consent documents, service professionals should supply full information to all clients.

Boundaries - Boundaries exist in the human service profession to define and guide the interactions between professionals and clients. Although boundaries exist, boundary violations can occur. Reamer (2003) states human service professionals, be they clinicians, community organizers, policy makers, supervisors, researcher administrators, or educators, often encounter circumstances that pose actual or potential boundary issues. Boundary issues involve circumstances in which social workers encounter actual or potential conflicts between their professional duties and their social, sexual, religious, or business relationships.

Human service professionals and clients should maintain a fiduciary relationship. A fiduciary relationship establishes trust and confidence between human service professionals and clients. Maintaining a fiduciary relationship does not completely do away with possible boundary conflicts but does greatly reduce the risk of boundary violations. A fiduciary relationship exists when one party accepts the trust and confidence of another party, the entrustor, and agrees to act in the entrustor's best interest (Jorgenson, Hirsch, Wahl, 1997).

Boundary violations usually do not occur instantaneously. There are usually situations or circumstances that lead to boundary violations. Boundary violations can occur on behalf of human service professionals or clients. Noticeable characteristics concerning boundary violations have been noted. According to Anderson & Heidi (2002), the four characteristics of boundary violations are: (1) a reversal of roles, (2) a secret, (3) a double bind, and (4) an indulgence of professional privilege. These characteristics are interrelated in a system that has its own existence. In all cases, it is always the responsibility of the clinician to maintain boundaries.

There are a variety of boundary violations that may occur between human service professionals and clients. A clear boundary violation may include an inappropriate economic relationship related to scheduling of time and place or related to billing procedures. Other boundary violations may encompass inappropriate or sexual contact, dual relationships, self disclosure, inappropriate gifts, interactions with a client's family, and improper social relations. Boundaries depend on the place, the time, and the amalgam of idiosyncrasies brought to the relationship by the therapist and the client (Jorgenson et al. 1997).

Ethical rules and procedures of all major mental health professions, ethic committees, the American Medical Association, National Association of Social Workers Code of Ethics, Ethical Principles of Psychologists and Code of Conduct, and The American Psychiatric Association are just a few sources that have established and implemented guidelines, regulations, and laws in an attempt to reduce boundary violations (Reamer, 2003). In 1994, the Board of Registration in Medicine of the Commonwealth of Massachusetts established guidelines applicable to boundary maintenance in the practice of psychotherapy (Jorgenson et al., 1997). These guidelines enumerate the areas in which clear boundaries are essential and include the following: appointment time and place, billing practices, other economic relationships, physical contact, self-disclosure, gifts, non-sexual social relations, and interactions with a client's family. Additionally, the guidelines alert practitioners to the red flags of changes in behavior regarding potential boundary violation and propose circumstances under which termination of the therapeutic relationship may be warranted if boundaries cannot be maintained.

There are steps human service professionals can take to reduce the risk of boundary violations. Setting clear boundaries from the beginning of therapy is essential. A clear understanding of a case manager's expectations must be established. Case managers may need to constantly clarify boundaries with clients. A client's privacy must be taken into consideration.

Potential ethical violations can be prevented if human service professionals are aware of standards and conduct themselves in ethical ways. Within the human service field, professionals need to maintain boundaries with clients. Human service professionals are responsible for making sure clients know about expected boundaries in the work relationship. Human service professionals need to be confidential in regard to client information and communications and need to be aware of exceptions to confidentiality. Clinicians also need to be aware of diversity among clients and respect various values and beliefs. Human service organizations have a responsibility to inform clients about all aspects of treatment by way of an informed consent document. When human service professionals follow ethical guidelines, they are better able to serve clients and not likely to harm clients.

References

Anderson, H. & Heidi, M. (2002). Dealing with boundary violations. Journal of Pharmacy Teaching. 9(3), 105. Retrieved from EBSCOdatabase

Anonymous. (2010). Sample informed consent document. Retrieved from
www.uab.edu/irb/forms/sample-consent-form.doc

Clifton Mitchell, G. D. (2002, December). When parents want to know: responding to parental
demands for confidential information. Retrieved from Health Care Industry: http://findarticles.com/p/articles/mi_m0KOC/is_2_6/ai_96194766/?tag=rbxcra.2.a.44

DePauw, M. (1986). Avoiding ethical violations: A timeline perspective for individual counseling. Journal of Counseling & Development. 64(5), 303. Retrieved from EBSCOdatabase.

Freeman, S.J. (2000). Freeman, S.J. (2000). Ethics: An introduction to philosophy and practice,
1e. Retrieved from HYPERLINK https://ecampus.phoenix.edu/content/eBookLibrary2/content/eReader.aspx" https://ecampus.phoenix.edu/content/eBookLibrary2/content/eReader.aspx

Grohol, J. M. (1999, April 8). Best practices in e-therapy. Retrieved from http://psychcentral.com/best/best2.htm

Jorgenson, L., Hirsch, A., Wahl, K. (n.d.) Fiduciary duty and boundaries: Acting in the client's best interest. Behavioral Sciences & the Law. 15(1), 149-162. Retrieved from EBSCOdatabase

Kupersanin, E. (2002, May 17). Cultural issues in therapy not always predictable. Retrieved
from http://pn.psychiatryonline.org/content/37/10/34.full

Reamer, F. (2003). Boundary issues in social work: Managing dual relationships. Social Work. 48(1), 121-133, Retrieved from EBSCOdatabase.

Young, A. S. (n.d.). Cultural diversity in counseling. Retrieved from http://www.helium.com/items/340668-cultural-diversity-in-counseling