● Lapse in including appropriate questions within the context of acquiring background information. ● Inability to appropriately present questions that elicit valuable information or feedback. ● Non participation in multicultural activities that facilitate cultural awareness that would include interactions among people of similar and different racial identities. ● Little or no processing of cultural difference in supervision. ● Inability to identify multiple hypotheses and integrate this information in a culturally competent manner into a client’s presenting problem. A lack of cultural awareness can manifest as “microaggressions,” which are a form of often unconscious racist behavior. Examples of microaggressions are complimenting a U.S.-born Asian American person’s English or “over-identifying” by asserting that as a woman one understands the oppression suffered by African Americans. It is often assumed of African American women that they are “strong” (Williams, 2013). It is important to reflect on one’s own assumptions and biases. Although microaggressions are common and may seem mild to those not on the receiving end, research shows that an accumulation of microaggressions can harm mental and physical health. When the microaggressions come from healthcare and service providers, they can erode trust in the system (Torino, 2017). Recommendations to promote ethical cultural competence were developed by the Georgetown University National Center for Cultural Competence (2009). Mental health practitioners can use these recommendations to promote ethical practice in cultural competence through the following: ● Display materials that reflect cultures and ethnic backgrounds of clients within your practice. ● Printed materials in your reception area are of interest to and reflect cultures of people served. ● Treatment aids such as play therapy and games reflect cultures of people served. One of the most difficult areas of responsibility to clients is conflict of interest. Workers need to avoid conflicts of interest that interfere with the exercise of: ● Professional discretion, and ● Impartial judgment. Dual or multiple relationships Dual or multiple relationships occur when mental health professionals relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively. Dual or multiple relationships with current or former clients should be avoided whenever possible, and the exploitation of clients for personal, religious, political, or business interests should never occur. Further, workers should not engage in dual or multiple relationships with clients or former clients where there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, workers should take steps to protect clients Boundary violations Conflicts of interest relate closely to other types of unprofessional behavior, such as “boundary violations,” a term that more specifically identifies harmful dual relationships. Most mental health professionals can easily recognize and identify common boundary issues presented by their clients.
● Attempt to learn and use key words in client’s language. ● Attempt to determine familial colloquialisms that impact assessment and treatment. ● Use visual aids, gestures, and physical prompts when appropriate with clients who are limited in English proficiency. ● Utilize bilingual colleagues or trained and certified interpreters to assist you with assessment and treatment. ● Try to ensure that all written communication, including consent forms, are written in client’s first language. ● Screen books before sharing them with clients. ● Recognize that clients have varying degrees for acculturation. ● Understand that meaning or value of medical treatment, health care, and health education varies in clients. ● Understand that beliefs and concepts of emotional well- being vary from culture to culture. ● Understand that mental health and emotional disability are culturally based and that responses to these conditions are influenced by culture as well. ● Recognize that folk and religious beliefs may influence a family’s reaction and approach to a child born with a disability or later diagnosed with physical/emotional disability or special health care needs. ● Understand that traditional approaches to disciplining children are influenced by culture. ● Understand that families from different cultures will have different expectations of their children for acquiring toileting, dressing, feeding, and other self-help skills. ● Accept and respect that customs and beliefs about food, its value, preparation, and use are different from culture to culture. ● Before providing in-home mental health services, seek information on acceptable behaviors, courtesies, customs and expectations that are unique to families of specific cultures and ethnic groups served by you. ● Acquire information during intake and/or assessment about natural helpers that may assist you, with informed consent, in providing services.
CONFLICTS OF INTEREST
The issue of informed consent should include both prescribing the need to inform clients of potential or actual conflicts and taking reasonable steps to resolve any conflict in a way that protects the client’s needs and interests.
and are responsible for setting clear, appropriate, and culturally sensitive boundaries. Recognizing that there are many contexts within which mental health work is practiced, dual relationships are not always entirely banned by different professional association ethical codes. The word “should” in sections where dual or multiple roles are outlined within various codes of ethics implies that there is room for exceptions. However, what they are usually distinguishing is that dual relationships are not permitted when there is risk of exploitation or harm . Not banning all dual relationships puts the burden on each worker both of determining and, if needed, proving that the relationship was not harmful to the client. Likewise, most can identify examples of boundary violations around professional behavior – for example, sexual misconduct. While not exclusive to the clinical role, there are certain situations that are more challenging than others, especially for workers vulnerable to committing boundary violations.
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Book Code: SWTX1525
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