____________________________________________ Professional Ethics and Law in California, 2nd Edition
• 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 . Self-Assessment Question 13. According to the U.S. Department of Health and Human Services, what does cultural competence involve? A) Understanding only the impact of culture on human behavior B) Responding effectively to people from all cultural backgrounds C) Exclusively valuing diversity in cultural practices D) Adapting to diversity in cultural contexts
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 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. Boundary Violations Conflicts of interest relate closely to other types of unpro- fessional 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. Likewise, most can identify examples of boundary vio- lations 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. Boundary issues involve circumstances in which there are actual or potential conflicts between workers’ professional duties and their social, sexual, religious, or business relation- ships. These are some of the most challenging issues faced in the mental health profession and typically involve conflicts of interest that occur when a worker assumes a second role with one or more clients. Such conflicts of interest may involve relationships with current clients, former clients, colleagues, and supervisees and students. With that in mind, the following would be examples of inappropriate boundary violations, and thus unethical, in that workers are involved in a dual relationship that is exploitative, manipulative, deceptive, or coercive in nature. • Buying property from a disaster client at far below its market level • Falsely testifying to support fraudulent actions of clients • Imposing religious beliefs on a client • Suggesting that a hospice client make you executor of his/her will
Self-Assessment Question
14. What are the elements that mental health practitioners should understand to achieve cultural competence? A) Valuing diversity, conducting cultural self-assessment, and acknowledging cultural importance B) Adapting to diversity, recognizing and appreciating culture, and seeking cultural knowledge C) Managing the dynamics of difference, recognizing cultural dynamics, and considering social diversity D) Conducting cultural self-assessment, acquiring and integrating cultural knowledge, and adapting to cultural contexts CONFLICTS OF INTEREST 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. 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. 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 exploi- tation of clients for personal, religious, political, or business interests should never occur.
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