Boundaries, Ethics & Scope of Practice

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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:

• We remain focused on our mission of responsiveness and recovery by:
• > providing services to everyone who needs them, regardless of their ability to pay;
• > responding immediately to the basic needs of people who ask us for help;
• > conducting high quality, person-centered assessment and treatment planning, and with the people we serve;
• > using standardized methods to review progress regularly with them, celebrating success, and making changes in our methods and strategies as needed.

• We develop professional therapeutic relationships with the people we serve emphasizing unconditional positive regard, trust, and mutual respect, recognizing that:
• > unconditional positive regard means that we recognize the inherent worth and dignity of all persons regardless of behavioral or other impacts of disability or illness;
• > we establish trust by being trustworthy. We must keep our promises to the people we serve and avoid making promises we cannot keep; and that;
• > we establish respect by being respectful, and must always treat the people we serve and others with respect in the way we interact with them and the way we talk about them.

• We shall always fully inform the people we serve of, and assist them in exercising, their rights, especially their rights to:
• > be treated with dignity and respect;
• > be fully informed of their options for care and treatment;
• > choose freely from whom they receive treatment;
• > participate in developing their treatment plans;
• > refuse or end treatment as they desire; and
• > be assured that information about them will be treated with utmost privacy and confidentiality.

• Understanding the risk of undue influence in a professional therapeutic or care-giving relationship, we avoid to the greatest extent possible, dual relationships with clients that:
• > present actual, perceived, or potential risk of exploitation of the trust of the client;
• > hinder the effectiveness of the professional relationship;
• > foster dependence of the client; or
• > violate the confidential nature of the professional relationship.

• We promote diversity of all kinds by:
• > seeking opportunities to increase our knowledge of, understanding, and appreciation of diverse cultures and people; and
• > avoiding the imposition of our own personal moral, religious or cultural values upon the people we serve.

• We recognize that our duty to clients includes the duty to provide services of the highest possible quality, and shall always work to provide the highest quality of services by:
• > continually seeking to improve our own competence and skill through continuing education;
• > conducting ongoing research into best practices and implementing these wherever possible in our treatment services;
• > appropriately terminating services when we have determined that we are unable to provide therapeutic benefit; and
• > working cooperatively with the client to coordinate or facilitate a transition to a new provider, if desired by the client.

• We recognize that as members of a provider community, we have an obligation to develop and maintain positive and person-centered relationships with other service providers.
• > judging our own success by how well we achieve our own quality improvement goals and objectives, not by how we compare to others;
• > coordinating care and services to clients with their other providers;
• > recognizing differences between providers; and
• > resolving conflicts and problems where they occur with an appreciation for differences.

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:

• > Use your Accend-issued mobile phone or office landlines only for calling the people you serve, and set limits on the hours when you accept work calls.
• > Disclose personal information and history thoughtfully, with consideration for how it contributes to or may potentially harm building rapport and improving upon the therapeutic nature of the relationship. Disclosing to a person you serve that you have had similar experiences and struggles can build rapport, establish credibility and trust. It can also harm trust or blur the boundary between a professional and personal relationship. Choose wisely when opting for self-disclosure as a treatment, or rapport-building strategy.
• > Maintain only private social media accounts and do not accept "friending" or "following" by the people you serve in a professional capacity.
• > Stay within scope of practice, referring the people you serve to other community resources for unmet needs that fall outside of scope.
• > Report to and discuss with your Treatment Supervisor, any discomfort or concern you have about your own ability to be objective with the people you serve, or your observations about their perception of the relationship.

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:

• > joins a social, civic, religious or leisure/recreational or other group or organization to which you belong,
• > develops a friendship or relationship with one of your relatives or friends,
• > becomes a neighbor,
• > becomes a customer or client of a business you or your spouse or partner operates, or
• > discovers and follows you on social media,
• > many other examples.

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:

• > inviting them to join your church, civic, social or leisure or other group or organization,
• > inviting them to join a support group (such as AA) you attend,
• > agreeing to see them outside of work hours for any reason,
• > electronic communication or correspondence of a personal nature not related to the professional treatment relationship,
• > inviting them to become a customer or client of a business (including online sales or services) you, your spouse or a close family member operates,
• > selling them your personal belongings directly or through online sites (like Craig's list), bartering or trading property or possessions with them,
• > purchasing personal property from them,
• > accepting property from individuals for any reason, such as to store for them for any period of time, or any other reason,
• > inviting them to your home, or to a social activity in which you are participating with family or friends,
• > inviting friends or family members to participate in activities you attend with persons you serve, and
• > accepting invitations from people you serve to their personal or family events, except in a professional capacity (seek guidance on this example from your supervisor: there are situations where attending events such as graduations and other life milestones are appropriate when they are celebrations of treatment recovery goals),
• > any other similar situations in which you initiate contact with individuals you serve outside of the professional relationship.

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:

• > only those services defined in the service/treatment plan;
• > only activities allowed by the definition of the specific service you are providing; and
• > only services you are qualified to provide.

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.

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.

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.

• > Conviction of a crimes that disqualify one from providing mental health services, or failure to report arrests, charges or convictions for potentially disqualifying crimes.
• > Entering into or failure to report a dual (personal or professional) relationship with a person served that might negatively impact the therapeutic nature professional relationship.
• > Undertaking or continuing a professional relationship with a client in which the objectivity of the professional would be impaired.
• > False, fraudulent, deceptive, or misleading self-representation, including, but not limited to misrepresenting qualifications or credentials.
• > Willful or careless disregard for the health, welfare, or safety of a client; or any other practice that may create unnecessary danger to any client's life, health, or safety, whether or not actual injury occurs, including, but not limited to:
• > Inability to provide mental health services with reasonable safety to clients, including but not limited to:
• > Adjudication as mentally incompetent, or as a person who is dangerous to self, or adjudication pursuant to chapter 253B, as chemically dependent, mentally ill, developmentally disabled, mentally ill and dangerous to the public, or as a sexual psychopathic personality or sexually dangerous person.
• > The habitual overindulgence in the use of or the dependence on intoxicating liquors.
• > Improper or unauthorized personal or other use of any legend drugs or any chemicals as defined in Mn Statute 151, or any controlled substance as defined in Mn Statute 152.
• > Misuse of prescription medications, or reporting to work under the influence of medications that impair judgment and safety.
• > Failure to report conditions or circumstances where the life, health or safety of any individual is threatened.
• > Disclosing protected private information from or about a client to unauthorized persons, except when required or permitted by law. This includes disclosure of information to law enforcement officials without an authorization to release it, or a subpoena, except when the disclosure is made to prevent serious harm or injury to any person.
• > Violation of any client health care or civic rights.
• > Failure to comply with a client's request made under the Minnesota Health Records Act, or to provide a health record or report required by law.
• > Intentional or negligent behavior resulting in fraud waste or abuse, including but not limited to:
• > Creating intentionally false or negligently inaccurate health care services records.
• > Splitting fees or promising to pay a portion of a fee to any other professional other than for services rendered by the other professional to the client.
• > Bartering for services with a client.
• > Exchange of money or property between providers and clients is prohibited, including:
• > Obtaining money, property, or services from a client, other than reasonable fees for services provided to the client, through the use of undue influence, harassment, duress, deception, or fraud.
• > Accend Services further prohibits any employee from entering into a business relationship with, purchasing goods or services from, or selling goods or services to a client, except in situations where the sale of goods or services by the client is part of a regular business activity operated by the client and no special price was offered to the employee by the client. These transactions should be reported to the Clinical Director and reviewed prior to occurring.
• > Accend also prohibits providers from soliciting or accepting donations of money or goods from clients.
• > Also strictly prohibited is any loan of money or materials from employees to clients or from clients to employees.
• > Accepting gifts of significant monetary value (exceptions would include small tokens, cards, handmade items, etc.) from clients is prohibited. Report all gifts received from clients to the Clinical Director.
• > 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. Sexual contact with a client fitting these circumstances fits the definition of maltreatment.
• > Revocation, suspension, restriction, limitation, or other disciplinary action against the mental health practitioner's license, certificate, registration, or right of practice in this or another state or jurisdiction, for offenses that would be subject to disciplinary action in this state, or failure to report to the Office of Mental Health Practice that charges regarding the practitioner's license, certificate, registration, or right of practice have been brought in this or another state or jurisdiction.
• > Failure to make reports as required by licensing or maltreatment laws, or cooperate with an investigation of licensing boards or investigations, internal or external.

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:

• Questions about the complaint:
• > Was the action a violation of the Accend Services Code of Ethics or other policies and procedures?
• > Were any applicable outside Codes of Ethics violated?
• > Did maltreatment or exploitation occur?
• > Were any rules or laws broken?
• > Questions about the impact:
• > What, if any, harm occurred?
• > What potential harm could occur if the conflict is not resolved?
• > What perception of harm does the conflict raise?
• > Questions about the individual (staff member) involved:
• > Was the action intentional?
• > Was the individual aware of the potential conflict (fully informed, educated, trained)?
• > Was/is the conflict avoidable?
• Does investigation of the incident indicate a need for:
• > Changes or additions to the agency Code of Ethics?
• > Changes or additions to policy and procedure?
• > Improved enforcement of internal policies, procedures, or ethical codes?
• > Additional or improved staff training?
• > Other initiatives to prevent future occurrences?

Remediation and Resolution

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

• > Present the final report and recommended remedial actions to the Executive Director and obtain approval for the remediation plan.
• > Meet with the staff member(s) involved to discuss a remediation plan.
• > Meet with the client as needed to involve him or her in resolution of the problem.
• > Meet with the complainant to discuss resolution of the problem, within limits of confidentiality of staff and clients.
• > Complete other follow-up as needed.
• > Complete a full report of the investigation and remediation.

Additionally, the investigating officer shall do the following:

• Legal issues:
• > If the incident represents maltreatment, report immediately to proper authorities immediately (within 24 hours).
• > If the incident represents a rule, law, credentialing, or licensing violation, report as per requirements of the governing authority immediately (within 24 hours of completing the investigation that determines a reportable violation).
• > Violations of internal policies and procedures or ethical codes:
• > Assure that the staff member has been made aware of and understands agency policies.
• > Conduct additional training with the individual and others as needed.
• > Deliver performance correction/disciplinary action if applicable and appropriate.
• > With the staff member, develop a plan to avoid future ethical or policy violations.
• > Fully document the incident, respecting client confidentiality, in the staff member's personnel file.
• > Problems or issues not previously or adequately addressed in policy or staff training:
• > Identify and make changes in policies, procedures or training needed.
• > Fully train all staff in the changes made.
• > Implement systems to assure that the training and/or changes are carried forward into the future.
• > Unintentional or unavoidable conflicts or dual relationships:
• > Meet with the staff member and/or other parties to identify the potential harm or problems that could result.
• > Develop strategies to reduce or mitigate potential harm.
• > If risks of harm are too great, re-assign the client to another employee.

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.

• > For Social Workers, the Minnesota Board of Social Work: (http://www.socialwork.state.mn.us/)
• > For practitioners licensed under the Board of Behavioral Health and Therapy: http://www.bbht.state.mn.us/)
• > For licensed Psychologists, the Minnesota Board of Psychology: (http://www.psychologyboard.state.mn.us/); and
• > For licensed Marriage and Family Therapists, the Minnesota Board of Marriage and Family Therapy: (http://www.bmft.state.mn.us/)

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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.