Ethical Decision-making 2017 Ohio Recovery Housing ...conference.ohiorecoveryhousing.org/wp-content/uploads/...Ethical Decision-making 2017 Ohio Recovery Housing Conference Beth Sanders

Ethical Decision-making 2017 Ohio Recovery Housing ConferenceBeth Sanders & George Braucht

[email protected]@brauchtworks.com

1

ETHICAL DECISION-MAKING USING THE NARR AND ORH CODES OF ETHICS

Beth Fisher Sanders, Executive Director Hope Homes

George S. Braucht, Brauchtworks Consulting

Ohio Recovery Housing Conference; Wednesday, March 1, 2017; 1:45pm – 3:00pm

Objectives: Upon completion of this session you will be able to….

Use a four-step ethical decision-making model adapted from White, W. L. & Popovits, R. M. (2001, 2nd ed.). Critical incidents: Ethical issues in the prevention and treatment of addiction.

Initiate routine vital incident discussions using the ethical decision-making model with the Ohio Recovery Housing and National Alliance for Recovery Residences’ Codes of Ethics.

Compile an organization-specific Catalogue of Organizational Practices and Ethics that melds professional ethics codes into new employee orientations and ongoing staff development trainings.

Why ethics?

Recovery Residences?

DoNo

Harm

Ethical issues occur because . . . . .

• Unscrupulous Operators

• Lack of Knowledge or Training

• Need

Questionable Ethics



2

What are Ethics?

Ethical sensitivity is sustained vigilance in preventing harm and injury to those to whom we

have pledged our loyalty/service…

William White

* Ethics are the core that drives an organization.

* Enables us to provide the best possible service we can give.

* Ethics drive all decision making for the organization and operation (including policy and procedure).

Ethics statements (and the NARR/ORH code) ARE NOT……

• Specific policies and procedures.

• Acceptable alternatives to actual practice.

• Ethereal ideals – it is the application of the ethics that make them real and meaningful.

• Unreasonable – these are not lofty statements.

The NARR Code of Ethics

Development Process

* Distilled 20 core values of quality recovery residence operation

* Essential to quality operation

* Provides foundational concepts for decision making



3

NARR CODE OF ETHICS July 2016

All persons working in NARR Affiliates and their organizations (recovery residence owners, operators, staff and volunteers) are expected to adhere to the

It is the obligation of all recovery residence owners/operators and staff to value and respect each resident and to put each individual’s recovery and needs at the forefront of all decision making. To meet this obligation, we adhere to the following principles:

You are a representative of your state affiliate charged with looking into complaints about residences accepted or soon-to-be-considered for acceptance into your state organization. Your duty is to review the complaint, investigate if necessary, look up relevant ORH/NARR Standard and Ethics and then report to the state affiliate’s board, including recommendations for dealing with the issue.

Scenarios

SCENARIO 1



4

Someone complains that WEWANNAHELP Recovery Residence is not doing its job well.

It was approved as a Level II (NARR level) residence. It is an 11-bed facility. It is a non-profit organization and is struggling to keep the operation solvent.

The complainant says that the owner/operator is letting people in who are dealing with what s/he considers “significant mental health issues” and, in some cases, people who have only been sober for a day or two prior to coming to the house. People with alcohol disorders sometimes get in after being taken into a hospital and being hydrated overnight. People who do not have developmentally-appropriate educational, social, or work skills experiences come into the mix, and this is frustrating for the residents who are more functional. In general, the majority of the residents at the facility arrive at the facility with the skills and experiences generally accepted as appropriate for Level II placement.

You discover that the recovery residence is in a remote and impoverished county of the state and far removed from cities. This recovery residence is the only residence within 50 miles. However, there is a Behavioral Health Center and a Community Health Program that includes outpatient psychiatric services within 20 miles of the recovery residence.

SCENARIO 2

You receive a complaint about the WEFIXEMALL Recovery Residence. The owner/operator also owns an outpatient treatment center. The complainant applied to live in the recovery residence (NARR level II) and was accepted. However, after moving in, the resident was told s/he needed to enroll in the provider’s IOP to continue staying in the residence.

Reflect upon the ORH and NARR Codes of Ethics. How might you and other state representatives respond to this issue?

SCENARIO 3



5

Alex’s One Way Recovery Residence has a stellar reputation in the community as a safe and effective facility. A funding offer is received from a local drug court that would pay the resident’s fees for 6 months contingent on resident’s sustained engagement in the mandated intensive outpatient program three times a week for the first 6 weeks followed by 5 months in the treatment providers’ outpatient program.

SCENARIO 4

Jesse’s Recovery Happens Recovery Residence is looking to improve the safety of its facility while promoting abstinence among its residents. A local physician who currently provides physical exams for Alex’s indigent residents offers to conduct twice-a-week urine testing for drugs. The fee is a little above what Alex is now paying but it includes free tests for indigents, the cost of which will be covered by the reimbursements provided by other residents who have insurance.

SCENARIO 5



6

Just Right Rehab would like to engage you in an exclusive referral relationship whereby you will be their only ‘preferred provider’ sober living.

Implications for our organizations…?

NARR Standard as a guide.

Raise the bar for quality.

Public sees a well run operation that is part of a profession.

Four Step Ethical Decision-making Process

Use the Ethical Decision-Making Worksheet (in handout) to identify:

1. The vulnerable parties in the situation and estimate the potential danger to each party.

2. Which of your organization’s core values may apply to the situation and are what behavior is called for?

Four Step Ethical Decision-making Process (cont.)3. Identify the laws, professional ethics codes, and historical

practices (see COPE) that may guide your conduct in this situation.

4. Document

a) with whom you discussed the situation,

b) what you decided to do, and

c) the outcome

Add to your COPE

Documented,Happened

Documented,Happened



7

Your organization supports Addiction Recovery Awareness Day at the Capitol, gets it’s logo on the tee shirt, and purchases shirts for staff and residents to wear who attend the rally. Residents are told that all services are canceled that day. Some residents decide they do not want to participate. Other say they want to go but they don’t want to wear the shirts.

Page 10 Your organization supports Addiction Recovery Awareness Day at the Capitol, gets it’s logo on the tee shirt, and purchases shirts for staff and residents to wear who attend the rally. Residents are told that all services are canceled that day. Some residents decide they do not want to participate. Other say they want to go but they don’t want to wear the shirts.

Catalogue of OrganizationalPractices and Ethics (COPE)

I. Strategic purpose: Guide decisions and behaviors in pursuit of the agency’s vision, mission and values via explicitly defined obligations and practices

II. Build an agency-specific, real-issues COPE that cuts across all professional codes of ethics

Catalogue of OrganizationalPractices and Ethics (COPE, cont.)

III. Add Ethical Decision-Making Worksheets as real situations arise to inform and update staff, volunteers, & residents/peers/clients

IV. Uses

Ongoing professional development initiatives

Monthly/quarterly in-service trainings

New board member, employee, volunteer, and resident/peer/client orientations



8

ResourcesQuestions?

Objectives: Upon completion of this session you will be able to….

Use a four-step ethical decision-making model adapted from White, W. L. & Popovits, R. M. (2001, 2nd ed.). Critical incidents: Ethical issues in the prevention and treatment of addiction.

Initiate routine vital incident discussions using the ethical decision-making model with the Ohio Recovery Housing and National Alliance for Recovery Residences’ Codes of Ethics.

Compile an organization-specific Catalogue of Organizational Practices and Ethics that melds professional ethics codes into new employee orientations and ongoing staff development trainings.

Excellence in Action

Brauchtworks Consulting Applying Science to Practice brauchtworks.com Email: [email protected]

Ethical Decision-Making Worksheet 150529

Adapted by George S. Braucht, LPC & CPCS and distributed with the permission of Bill White. From: White, W. L. & Popovits, R. M. (2001, 2nd Edition). Critical incidents: Ethical issues in the prevention and treatment of addiction. Lighthouse Institute: Bloomington IL.

Brief summary of the incident: Step One: Who is vulnerable to harm in this situation, & what is the potential risk of harm?

Potential Risk of Harm () Vulnerable Party Minimal Moderate Significant

You Individual/Family Being Served Service Provider Service Provider Organization/Agency Professional Service Field Recovery Community Community/Public Safety

Step Two: each core recovery value that applies to this situation. What action would that value suggest? Note: Replace the below items with your organization’s values.

Core Value Suggested Course of Action Autonomy/Choice (Self-direction) Obedience(Legal/Ethical) Conscientious Refusal Beneficence (Do good/help others) Gratitude (Pass good along to others) Competence (Knowledge/skills) Justice (Be fair; distribute by merit) Stewardship (Use resources wisely) Honesty and Candor (Tell the truth) Fidelity ( Keep your promises) Loyalty (Don’t abandon) Diligence (Work hard) Discretion (Respect confidence and privacy) Self-improvement (Be the best that you can be) Non-maleficence (Do no harm) Restitution (Make amends to injured persons) Self-Interest (Protect yourself) Other Culture-Specific Value: _____________

(over)

mailto:brauchtworks.com

mailto:[email protected]

Brauchtworks Consulting Applying Science to Practice brauchtworks.com Email: [email protected]

Ethical Decision-Making Worksheet (cont.)

Step Three: What laws, standards and historical practices guide your conduct in this situation? Step Four: Document What options you considered:

Who you consulted:

What decision(s) you made and what you did:

The outcome of the decision(s) made and action(s) taken:

mailto:brauchtworks.com

mailto:[email protected]

Code of Ethics (as adapted from the Illinois Association of Extended Care) All associate ORH operators and staff have agreed to operate by a code of ethics that:

1. Demonstrates dedication to the belief in the dignity and worth of all human beings.

2. Pledges to provide service for the welfare and betterment of all persons served.

3. Promotes and assists in the recovery of all persons.

4. Maintains an appropriate supportive relationship with all persons supported, never becoming socially, sexually or romantically involved, not committing any act of violence or threats of violence, and avoiding becoming financially involved with the same.

5. Refrains from undertaking any activity where personal conduct, including the inappropriate use of alcohol and other mood-altering drugs, is likely to result in inferior services or constitute a violation of the law.

6. Regularly evaluates skills, strengths and limitations, striving always for self-improvement, personal growth and increased knowledge through further education and training.

Final: July 2016

NARR CODE OF ETHICS

All persons working in NARR Affiliate organizations, (recovery residence owners, operators, staff and volunteers) are expected to adhere to the following Code of Ethics:

It is the obligation of all recovery residence owners/operators and staff to value and respect each resident and to put each individual’s recovery and needs at the forefront of all decision making. To meet this obligation, we adhere to the following principles:

1. Assess each potential resident’s needs, and determine whether the level of support available within the residence is appropriate. Provide assistance to the resident for referral in or outside of the residence.

2. Value diversity and non-discrimination. 3. Provide a safe, homelike environment that meets NARR Standards. 4. Maintain an alcohol- and illicit-drug-free environment. 5. Honor individuals’ rights to choose their recovery paths within the parameters defined by

the residence organization. 6. Protect the privacy and personal rights of each resident. 7. Provide consistent and uniformly applied rules. 8. Provide for the health, safety and welfare of each resident. 9. Address each resident fairly in all situations. 10. Encourage residents to sustain relationships with professionals, recovery support service

providers and allies. 11. Take appropriate action to stop intimidation, bullying, sexual harassment and/or

otherwise threatening behavior of residents, staff and visitors within the residence. 12. Take appropriate action to stop retribution, intimidation, or any negative consequences

that could occur as the result of a grievance or complaint. 13. Provide consistent, fair practices for drug testing that promote the residents’ recovery and

the health and safety of the recovery environment and protect the privacy of resident information.

14. Provide an environment in which each resident’s recovery needs are the primary factors in all decision making.

15. Promote the residence with marketing or advertising that is supported by accurate, open and honest claims.

16. Decline taking a primary role in the recovery plans of relatives, close friends, and/or business acquaintances.

17. Sustain transparency in operational and financial decisions. 18. Maintain clear personal and professional boundaries. 19. Operate within the residence’s scope of service and within professional training and

credentials. 20. Maintain an environment that promotes the peace and safety of the surrounding

neighborhood and the community at large.

Documents

Ethical Decision-making 2017 Ohio Recovery Housing ...conference.ohiorecoveryhousing.org/wp-content/uploads/...Ethical Decision-making 2017 Ohio Recovery Housing Conference Beth Sanders