This document discusses boundaries and ethics in residential settings. It provides examples of boundary issues that staff may encounter, such as self-disclosure, becoming too comfortable with patients, and dual relationships that can risk exploitation. It also offers guidance on maintaining appropriate boundaries, including keeping interactions professional, not sharing personal information, and seeking supervision when unsure about a situation. Role-playing examples demonstrate potential boundary issues and ways to address them.

1. Boundaries and Ethics in Residential Settings A presentation by Sue Kucklick. PCC With the assistance of clients who provided their valuable input

2. Zone of helpfulness1 1. Revitalizing Professional Boundaries Policy Into Meaningful Practice Improvement Shelly Bolin Morton, RN, BSN Home Health Care Management & Practice / June 2004 / Volume 16, Number 4, 255-260

3. elements

4. Self disclosure: Ask--

6. boundaries “Sometimes I feel like I live in a

7. boundaries “What was I supposed to think? They gave me hugs, they talked to me and spent time with me. I thought they were my friends. They even told me where they lived.”

8. boundaries and confidentiality “There are no secrets here in this building.” “I don’t expect to tell a staff member something in confidence and then be confronted with it by another staff member the next day.” “I don’t think staff knows how much we hear when they’re talking loudabout us.”

9. guidance Sometimes we all need a little bit of light!

10. effective guidance

11. “Case managers and other staff should feel free to be confused and to seek counsel from their supervisors and peers. The multidisciplinary team approach may mitigate boundary violations and guide successful interactions by offering support, insight, practical assistance, and training.”2 2. Community Mental Health Journal, Vol. 34, No. 3, June 1998 Case Managers and Boundaries Robert E. Drake, M.D. Nina Marlowe, M.D.

12. role play What religion are you? Have you ever been depressed? Where do you live? Do you have children? Are you married? Can I buy you lunch? Did you ever do drugs?

13. dual relationships-appropriateness andrisk of exploitation3 Dual relationships often exist in one way or another Cannot sell items to, or buy items from clients Cannot request or accept compensation in addition to pay from clients Cannot engage in relationships outside work with clients 3. Community Mental Health Journal, Vol. 33, No. 6, December 1997 ETHICS IN COMMUNITY MENTALHEALTHCARE Can We Bridge the Gap BETWEEN the Actual Lives of Persons with Serious Mental Disorders and the Therapeutic Goals of Their Providers? Patricia Backlar, Editor Portland, Oregon

14. small group discussion Client Carl is short on funds and sells his gently-used flat screen TV to Staff Celia for an excellent price so he can attend his sister’s wedding. Staff Sara wants to help a resident who has no income gain job skills. She has Resident Randy to do some yard work at her home and pays him in cash. Staff Stefan is short on cash for gas and borrows some money from Resident Ralph until day after tomorrow. Staff Stan has a store and hires some clients to work there so they can get some job skills.

15. What would you change? Protecting health information Interaction with staff Interaction with clients