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Boundaries, Ethics & Scope of Practice




Hello there!

Establishing solid professional boundaries, adhering to a strict code of professional ethics, and working within scope of practice are key to your success as a mental health provider.

This policy/procedure was last updated on June 1, 2022.

Code of Ethics

At Accend Services, we believe our primary responsibility in promoting recovery for the people we serve is to respect and promote their inherent worth and dignity, and protect the professional integrity and therapeutic nature of our relationships with them. For this reason we adhere to the following ethical guidelines:

Professional Boundaries

What You Will Learn

Establish and maintain professional boundaries with all persons served

Avoid dual relationships with the people to whom you provide services, and report unintentional dual relationships

Work strictly within scope of practice at all times

Understand and avoid prohibited conduct.

Self-report and work cooperatively with management to correct potential ethics violations

Work cooperatively with co-workers and management to help all team members uphold high ethical standards

Establishing and maintaining professional boundaries is essential to effective treatment and requires sound judgment. Establishing professional boundaries includes but is not limited to avoiding dual relationships and staying within scope of practice, both of which are discussed in more detail below.

Establishing professional boundaries also includes all of the following:

Dual Relationships

Coincidental/Unintentional

Dual relationships, a potential boundary violation, occur any time that you have a relationship with someone you serve outside of the professional/treatment relationship. Dual relationships may occur as a coincidence: without your knowledge or intent.

Examples of coincidental dual relationships might be that someone you serve:

When such unexpected coincidental dual relationships develop, inform your supervisor and seek guidance. You and your supervisor will discuss whether or not this dual relationship can be managed without harming your professional relationship with the person you serve.

Intentional

Intentionally pursuing or inviting someone you serve into a dual relationship is strictly prohibited.

This includes, but is not limited to the following examples:

Pursuing or developing personal relationships with people you have formerly served is also prohibited by our policy for a period of two years after the end of the professional relationship. Intentionally pursuing or agreeing to dual relationships with people you serve, or failing to report coincidental dual relationships may be grounds for termination.

Scope of Practice

Helpful Tip:

Set clear boundaries from the start, as a part of educating the people you serve about the services you provide. It will be much more difficult to say "no" in the future if you say "yes" now.

Simply put, Scope of practice refers to limiting the services and supports you provide to:

Avoiding Scope of Practice Violations in Day-to-Day Service Activities

You will be confronted by a myriad of scope of practice questions frequently in your work. Defining your scope of practice in some areas is subtle, and in others more clear-cut. It is impossible to create a finite list of the decisions about scope of practice you may face.h5 What follows is a list of examples that provide guidance, but falls short of a comprehensive list.

Activity General Guidance
Helping with housework. Ok when doing with as an opportunity to learn, assess, plan and teach skills.
Not ok when doing for as in a housekeeping service.
Giving rides. Ok when ride-sharing to a location where you will provide medically necessary services.
Not ok as a favor, or to gain favor with a person served.
Running errands. Ok when teaching skills at the destinations to which you travel.
Not ok as a favor, or to gain favor with a person served.
Providing help or advice with legal matters, filing court documents, appealing legal decisions. Not ok. Refer the individual to a legal professional.
Writing letters of advocacy or support for medically necessary services or accommodations. Refer the individual to a clinical professional.
Assisting with housing applications and searches. Ok for those elements that are defined as skills training objectives in the ARMHS Treatment plan. Ok as Case Management when identified in the ICSP. Case Managers must not delegate this work to ARMHS other than the skills training elements.
Advocating on behalf of individuals for health care, treatment or crisis placement, waiver services, etc. This is an important role, especially for Integrated Care Managers. Practitioners also help clients advocate on their out behalf, or on advocate on their behalf as a part of COmmunity Intervention. Seek your Program Director or Treatment Supervisor's permission and guidance on health care and treatment advocacy activities if you are unsure.
Practitioner versus Clinical Professional Scope of Practice

Staying withing scope of practice in the boundary between rehab work or case management and psychotherapy can be a subtle distinction. You might find at times that this boundary becomes blurred when trust develops, and individuals become more open and disclose more. Avoiding crossing this boundary might also best be understood by use of the examples. The examples that follow do not constitute an exhaustive list. These should be used only as a reference and you should seek guidance from your supervisor when unsure.

Clinical Professional Practitioner
Identifies symptoms and diagnoses. Draws conclusions. Observes and reports behavior. Provides data for decision-making.
Explores root causes of emotion and behavior. Teaches approved skills for emotion and behavior regulation and symptom management.
Explores and counsels on traumas or unresolved issues from the past. Teaches approved skills for coping with current symptoms. Encourages people to seek psychotherapy services when unresolved issues are a barrier to recovery.
May counsel, advise or recommend. Educates from an informed perspective about options.


Prohibited Conduct

The following conduct by unlicensed mental health staff working for Accend Services may be grounds for termination. In some cases, ethical standards adopted by Accend Services extend beyond conduct prohibited by law.

Other Ethical Standards

Accend Services recognizes that certain professions, professional and credentialing organizations and associations of our staff have developed their own codes of ethics. We encourage strict adherence to these ethical standards for our staff members who are members of such organizations and they do not conflict with our own standards.

Additionally, however, Accend Services recognizes that the personal, moral and spiritual beliefs of certain staff members, and the ethical codes that might accompany them, might come into conflict with agency policies, procedures and standards of ethics, or their interpretation. When a staff member becomes aware of any potential conflict, he or she should immediately inform an Accend Services officer. Adhering to our own codes of ethics regarding diversity, we will work openly with staff members to eliminate the conflict in a way that is respectful of all persons involved. Where conflicts are unavoidable, our first duty is to assure that the conflict will not adversely impact clients or result in any other problems with service delivery, duties, or perception of the agency.

Prohibited actions for licensed mental health professionals can be found at the links to those licensing boards below under the Section labeled “Legal Obligation to Report to Licensing Boards.”

Reviewing Ethical Dilemmas

During Treatment Supervision sessions with each staff member, Clinical Director will review with all staff, any ethical dilemmas reported by staff members, clients, or other parties, and shall develop resolutions to problems that might be presented by them.

Reporting Problems

When anyone, an employee or client, or other outside party perceives or becomes aware of a potential ethical violation by an Accend Services staff member, he or she is asked to report the problem immediately to his or her immediate supervisor who will investigate the complaint confidentially. The supervisor receiving the report shall in turn immediately inform the Executive Director of the report and update them on all stages of the investigation. In some cases, staff members may feel that it is necessary or more appropriate to report the violation directly to the Executive Director, and may do so at any time.

Outside Reporting

Employees may seek guidance on reporting to outside authorities, or may report externally if they beleive this is necessary. Potential reports may be made to the Minnesota Department of Human Services, the Office of Ombudsman for Mental Health and Developmental Disabilities, the Department of Health, a health-related licensing board, a law enforcement agency, or a local agency investigating a complaint regarding a client's rights, health, or safety.

Protection for Reporters

Your choice to report a problem described in this chapter internally or externally in good faith will not adversely affect your retention, promotion, job assignment, or pay. If you beleive that you have been retaliated against or harassed in any way after reporting, you may file a complaint or grievance using the procedures in our Personnel Policy here.

Obligation to Self-Report

Any licensed or unlicensed mental health practitioner shall report to Accend Services any personal action that may violate the ethical standards established in this policy and procedure.

Investigation and Response to Ethics Complaints

All concerns or complaints of ethics violations shall be investigated and actions taken to correct any problems identified.

Initial Investigation

As soon as we are made aware of the problem, concern, conflict or incident involving potential ethical violations, a delegate of the Executive Director will begin a full investigation of the complaint, including, but not limited to the following. This investigation shall normally occur within the first 3-5 business days following receipt of the complaint, but may take longer as documented in the investigation notes if information is not available:

Remediation and Resolution

Immediately following an initial investigation (within three business days) the investigating officer shall remediate and resolve the complaint as follows:

Additionally, the investigating officer shall do the following:

Recording Investigation Results

Immediately following the investigation of an ethics complaint, the officer shall fully document the incident, investigation and follow-up. Assuring confidentiality of all persons involved, the officer shall place reports as applicable in client and staff files, and maintain the full report in a secure file.

Legal Obligation to Report To Licensing Boards

Incidents involving conduct prohibited by law must also be reported to appropriate government offices, including the following. Reports of internal investigations that merit reporting to a licensing board shall be made by the Executive Director, Treatment Director, or Clinical Director, but any staff member who feels that it is his or her legal obligation to report a violation may do so in good faith without fear of retaliation.

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Updates to this Chapter

Updates to this Chapter are listed here starting June, 2022.



June 1, 2022:

"Entering into a personal, romantic, or sexual relationship with any client of Accend that did not exist prior to the client's admission, or the employee's date of hire..." is added to the list of prohibited conduct.



May 31, 2024:

Language added clarifying protections for reporters. Broken Table of Contents links fixed and others added.