Describe and Define Standard of Care & Ethics
Describe and Define Laws
Identify Top Ethical Issues visa vie Snowball Sample
Recommend Ethical Decision
Making Models
CARE Challenge Providers to Develop Mission, and Ethics Statements for Behavioral Health Care Centers
2. Louise Stanger Ed.D, LCSW
▪ Director All About
Interventions
▪ Faculty SDSU
▪ Member NII, AIS
▪ MINT Trainer
▪ Author, Falling Up-A
Memoir of Renewal
▪ & Learn to Thrive
3. Objectives
▪ Describe and Define Standard of Care &
Ethics
▪ Describe and Define Laws
▪ Identify Top Ethical Issues visa vie Snowball
Sample
▪ Recommend Ethical Decision Making Models
▪ CARE Challenge Providers to Develop
Mission, and Ethics Statements for Behavioral
Health Care Centers
4. Getting to Know You
▪ What brings you
here today?
▪ What groups do
you represent?
7. Definitions
▪ Tort Law- The level at which the average
provider in a given community would
practice
▪ A diagnostic and treatment process that a
clinician would follow for a certain type of
patient, illness or clinical circumstance -
New England Journal of Medicine 2004
8. Benefits Of JACHO
▪ Organize ad Strengthen patient safety efforts
▪ Strengthens community confidence in quality of
care
▪ Provides Competitive Edge in Marketplace
▪ Improves Risk Management and risk reduction
▪ May reduce Liability Insurance Costs
▪ Provides education to improve business operations
▪ Provides professional advice and counsel
▪ Provides customized and intensive review
9. ▪ Enhances staff review and recruitment
▪ Provides deeming authority for medicare
▪ Provides a framework for organizational
structure and management
▪ May fulfill regulatory requirements
▪ Provides practical tool to strengthen
▪ Aligns health care organizations 603-792-5000
11. What are Ethics ??????
▪ Ethics are the beliefs
an individual or group
maintains about what
constitutes correct or
proper behavior
▪ Standards of conduct
an individual uses to
make decisions.
12. LAWS
What do you stand for ?
▪ Folks that do not
understand the laws
▪ Folks that
understand the laws
they do not have a
strong sense of
ethics
14. How do Ethical Problems
Occur ?
▪ People are human they make mistakes
▪ Clients misreport
▪ Inexperience
▪ Ignorance
▪ Unpredictable /Unforeseen situations
▪ Inadequate Agency Policies
▪ Guidelines not adequate for situation
▪ Ethics in conflict with law
15. How do Ethical Problems Occur?
▪ Greed
▪ Need to Fill Beds
▪ Quotas
▪ Job Security
▪ Inadequate
Guidelines
16. What’s Your Codes of Ethics
▪ American Association of Advertising
Agencies
▪ Direct Marketing Association
▪ Public Relations Society of America
▪ American Marketing Association
▪ Foundation for Public Affairs
▪ American Hospital Association
▪ NATAP
17. Code Of Ethics
▪ NAADAC
▪ NASW- Social Workers
▪ MFT
▪ NATAP
▪ CARF
▪ Psychologists
▪ Nurses –Doctors
▪ Lawyers
▪ Interventionists
▪ Insurance Company
▪ Treatment Center
▪ Web Developer
18. Code of Ethics
▪ Association of
Intervention Specialists
( AIS)
▪ Network of Independent
Interventionists (NII)
▪ Recovery Coaches
▪ Certified Rehabilitation
Counselors
▪ Hayes-Davidson Ethics
Pledge
20. Snowball Sample
▪ Qualitative Research
▪ Set Up Open Ended
Question
▪ Ask the question and
then ask who else
might I talk to
▪ Collapse and collate
Data
▪ Asked in different areas
21. Areas Covered
▪ CEOS
▪ Marketers
▪ Admissions
▪ Web Designers
▪ Clinicians
▪ Interventionists
▪ Thought Leaders
22. David Skonezny-CADC-II ICAD
CEO-Simple Recovery
Ethics Chair-CCAPP Board of Directors
▪ Paying For Referrals
▪ Improper UA Billings-
Facilities owning labs
▪ Incorrect Billing
▪ Having Non
Credentialed Staff
facilitate Clinical
Events
23. Denise Klein-Milestones Ranch
▪ Lack of Standardized
and Best Practice
Training
▪ Exploitation of
Insurance Companies
▪ Over Promising -
Under delivering of
Services
▪ Unlawful Kickbacks
24. Marsha Stone
BRC Recovery
▪ Competence
▪ Misrepresentation
of Services
▪ Lack of
Compassion
▪ Folks do Not
Understand Laws
25. David Lisonbee CEO Twin Town
▪ Waiving Deductibles-
Kickbacks
▪ General Public
Distrust of Treatment
Industry
▪ Treatment perceived
as a scam
26. Paul Alexander CEO
Northbound
▪ Accreditation and
Standardization of
Care
▪ “CURES”
Promised as
opposed to Solution
▪ Mission and Code
of Ethics
27.
Incredible Marketing :Wes Jones CEO
▪ Misrepresenting
treatment modalities
in website content
▪ Accepting Clients that
are not a fit
▪ Misrepresenting
Culture
28. More About The Web
▪ Misrepresenting Location
▪ Adding Fake locations
▪ Using high end photos
▪ Misrepresenting amenities
▪ Fake Positive reviews
▪ Buying Competitions Keywords
▪ Referrals based on
▪ Kickbacks
▪ Reciprocation
29. Where does your name go ?
▪ Search your Center
▪ Independent Review Sites
▪ Trademark Rules
▪ Come ons-
▪ Flights paid
▪ Deductibles Paid
▪ Come and Go
30. Questionable Practices
▪ Internet marketing
scams
▪ Using Brain scans
with other unproven
treatments and
billing the patient
▪ AP, March 2013
31. Questionable Practices
▪ Call Centers share
Patient Prospect info
between treatment
Providers
▪ Call Centers run through
5013C Non Profits
▪ Landlords -Drug
Companies and Sober
Living Homes
▪ Insurance Companies
Dictate Treatment
32. Paying Kickbacks
▪ To Interventionists
▪ Paying bounties to for
referrals
▪ Claiming to take a
patient’s insurance
when reimbursement
is low
▪ To Labs
33. Kickbacks-Federal Laws
Anti-Kick Back Statue
Criminal offense for
anyone to give a
kickback with the
Intent of influencing
referral of patients
Stark Law
Physicians Self referral
law Kickback occurs
when a physician refers
a patient to a facility
he owns or family
has financial interest
Trips , hotels, gifts
34. Whistleblower –False Claim
Act
▪ False Claims Act
▪ Unlawful for anyone
knowingly or
willingly submit or
cause a fraudulent
claim to the
government for
payment
36. Historical Context
▪ In Nazi Germany 1945-1946
and 1935 American Public
Health research African
American men
▪ 1966 Public Health Services
established ethical regulation
▪ 1979 Belmont Report
(Protection of Human
Subjects)
▪ 1970s bio ethics emerged
▪ 1980s Watergate
▪ 1996 Revised Codes
▪ As professions grow code
of ethics are formed
37. Do not confuse Ethics and
Morality !!!!!
▪ The word Morality comes from Latin word
MORES which translates into custom or
values
▪ Morality involves the judgment or
evaluation of an ethical system, decision,
or action based on socialcultural or
religious norm
38. Ethical Principles
▪ Autonomy
▪ Beneficence- To do
Good-To Do No Harm
▪ Confidentiality
▪ Fidelity _To keep ones
promise or word, Duty to
report , honesty,
trustworthiness
▪ Gratitude
▪ Justice ( treat all fairly)
▪ Nonmalefience :The duty
to cause no harm
▪ Reparation –duty to make
up for a wrong
40. Ethical Principles
▪ Respect for Others
▪ Universality
▪ Utility- the duty to provide
the greatest good or least
harm to greatest number
of people
▪ Ordering
42. Ethical Principles
▪ Veracity –To tell the
Truth
▪ Herein lies dilemmas
▪ Between self, IP,
agency and outside
world
43. Ethical Responsibilities
▪ To Clients
▪ To Colleagues
▪ To Practice Settings
▪ As Professionals
▪ To Professional
Affiliations
▪ To Broader Society
44. 8 Step Model for Ethical
Decision Making
▪ 1. Identify the
Problem or Issue
- Clinical
- Legal
- System (polices etc)
- Cultural
- Ethical -
counselors own issues
45. Steps 2-4
▪ Apply a code of
ethics
▪ Determine Nature
and Dimensions of
Dilemena
▪ Pros and Cons
46. Steps 5-8
▪ Choose Course of
Action
▪ Implement a
Course of Action
▪ Evaluate the
Outcome
▪ Evaluate the
implications
49. Confidentiality and Minors
▪ Age of Consent
▪ Being Familiar with
state laws
▪ Can Clara or parents
know everything if
they are under 18?
50. Informed Consent
Description of any reasonable foreseeable risks or discomforts
Description of any benefits to the subject or others
Disclosure of alternative treatments & medications
Statement describing extent to which confidentiality of records
identifying client will be maintained
Explanation on limits of confidentiality
Explanation on who to contact in emergency
Costs to client
Consequences of early withdrawal
51. Record Keeping
▪ Client prior hx of services
▪ Present reason for call
▪ Dx of bio-psycho-social
▪ Documentation of any changes
since assessment
▪ Treatment plan goals & objectives
(changes in Tx)
▪ Duration & frequency of service
▪ Progress notes
▪ Rec for further treatment-
discharge plans
▪ Doc. Of fees charged and paid
▪ HIPPA Forms
52. Competence
▪ Competence?
▪ How do you
achieve and
maintain
▪ Cultural
competence
▪ Is it ok to practice
outside of ones
competence?
54. Wireless Devices
■ How are these used
to protect
confidentiality ???
■ Laptops, Ipads,
Phones, Earpieces,
&other devices
55.
56. Visual Wrong doing
▪ Web Sites that are
misleading
▪ Fake addresses
▪ Toll free numbers
▪ Posting of photos
on misleading
websites
▪ Certificates
57. Social Media
■ Written Materials
■ Business Cards
■ Letterhead etc
■ Website
■ Mailings
■ Texting
■ Facebook, Twitter and
Linked In
58. BOUNDARIES
▪ Length of counseling, self disclosure by counselor,
confidentiality, giving of gifts, touch or personal
communication between counselor and client and client,
counselor and supervisor’
▪ Intimate relationships
▪ Personal benefit ( monetary goods , services)
▪ Emotional dependency needs of counselor
▪ Altruistic gestures which can be misinterpreted
▪ Unexpected situations such as meeting sisters new
boyfriend who turns out to be a client
59. DUAL RELATIONSHIPS
▪ Friendships between client and counselor,
supervisor and supervisee
▪ Sexual Relationships
▪ Professional –where client and counselor are
professional colleagues
▪ Business dual relationships where counselor and
client are business partners or have an employee/
employer relationship
▪ Communal –where both belong to same community
(AA, NA, Alanon, SA etc.)
60. Hiring Practices
▪ Former counselor
calls to ask if she or
he can hire a
former client of
hers and mine from
a different
treatment center
that has less then a
year recovery
61. Employer Relationships
▪ A handsome
admissions person is
your subordinate. He
is also in a 12 step
program. You invite
him for coffee after
the meeting.
▪ ?? Ethical
Considerations
64. Consent and HIPPA
▪ Mother wants to know
what daughter is
saying about their
relationship
▪ 19 yo daughter has
not signed consent
form for mother
65. Other Considerations
▪ You are a substance abuse/mental
business professional and are attending
the same 12 step meeting as your client
do you need to share, what do you do??
▪ Organizations referral practices
▪ Organizations billing practices
▪ Other Examples
66. Gifts
▪ A $100.00 Starbucks
card
▪ Court side Laker
Tickets
▪ Boxes From Tiffany
▪ A Rolex Watch
▪ A center offers you
referral fees
▪ ??What do you do
67. Standard of Care Challenge
▪ Develop Mission Statement for your
Organizations
▪ Articulate the Organizations Values
▪ Revisit or Develop Organizations Ethical
Code
▪ Obtain Appropriate Licensure
▪ The World Know-Mission, Values and
Ethical Statement
68. Standard of CARE
▪ Review Your Professional Code of Ethics
▪ Engage in Appropriate Continuing
Education
▪ Sign Hayes-Davidson Pledge
▪ Work tirelessly to elevate Behavioral
Health Care Field
69. Let Me Know
▪ Meet me Oct 13 & 14
▪ Admissions and Marketing Seminar
▪ Tell the world what you are doing
▪ Send me ( drstanger@me.com) your
Mission, Values and Organizational Ethics
and I will share on my
www.allaboutinterventions.com and on
my blog
72. Resources
▪ The Ethics of an Addiction Counselor
▪ The Ethics of an Addiction Counselor , The Association of
Addiction Professionals
▪ NASW Code Of Ethics
▪ NII Code of Ethics
▪ AIS Code of Ethics
▪ Ethics Updates http://ethics.sandiego.edu
▪ The Elements of Ethics for Professionals-Brad Johnson
▪ Center for the Study of Ethics in the Professions
▪ National Board for Certified Counselors; The Practice of
Internet Counseling http://www.nbcc.org/assest/ethics/
internetcounseling.pdf
▪ http://www.mentalhealthlaw.us/10/Practice_Dilemmas.html
73. Resources
▪ Hayes- Davidson Ethics Hayes -http://www.hayes-
davidson-ethicspledge.org
▪ Northbound Code Of http://www.livingsober.com/about-
us/northbound-code-of-ethics/
▪ Dreamscape Marketing Code of https://
www.dreamscapemarketing.com/about-dreamscape-
marketing/code-of-ethics/
▪ Twin Town http://twintowntreatmentcenters.com/about-
twin-town-tc/our-mission/
▪ Cinga http://www.cigna.com/about-us/corporate-
governance/code-of-ethics
74. Resources
▪ Joint Commission on Accreditation of Rehabilitation Facilities
▪ JACHO Accreditation http://www.jointcomission.org
▪ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088386/The
Standard
▪ http//:www.carf.org./home/ for Commission on Accreditation of
Rehabilitation Facilities
▪ National Council for Recovery Residences http://narronline.org
▪ Trauma -Informed Care in Behavioral Health Services TIP 57
▪ The ASAM National Practice Guideline for Use of Medications in
The Treatment of Addiction Opioid USE
▪ http://www.jcrinc.com/2016-cambhc-behavioral-heath
75. Dr. Louise Stanger
Ed.D, LCSW, BRI II, CIP
▪ Faculty SDSU Interwork Institute
▪ Member NII
▪ Member AIS
▪ MINT Trainer of Trainers
▪ Director All About Interventions
▪ http://www.allaboutinterventions.com
▪ Falling Up-A Memoir of Renewal -Amazon
▪ 619-507-1699
▪ DrStanger@allaboutinterventions.com
▪ 619-507-1699