Texas Homeless
Education Office
The University of Texas at Austin
Charles A. Dana Center
2901 N IH 35, Room 2.200
Austin, Texas 78722
Jeanne Stamp: 512-475-6898
jeannestamp@austin.utexas.edu
USDE
Region 10 ESC
1-800-446-3142
http://www.utdanacenter.org/theo
Ethical Considerations in Working
With Homeless and
Unaccompanied Homeless Youth
Ethical Considerations for Working with
Unaccompanied and Homeless Youth
AGENDA
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Definitions
Identify unaccompanied youth needs and
challenging situations
Identify common ethical issues when working
with homeless unaccompanied youth
Identify common ethical standards
Identify possible solutions & application of
ethical practice
The ethics of digital communication
Definition of Homeless?
Must meet the McKinney-Vento definition of homeless: Children and youth
who lack a fixed, regular, and adequate nighttime residence:
– Doubled up -sharing the housing of others due to loss of housing,
economic hardship, or similar reason, “couch surfing”
– Living in motels, hotels, trailer parks, camping grounds due to lack of
adequate alternative accommodations
–
–
–
–
Living in emergency or transitional shelters
Abandoned in hospitals
Awaiting foster care placement
Living in a public or private place not designed for humans to live
– Living in cars, parks, abandoned buildings, bus or train stations, etc.
– Migratory children living in above circumstances
– Children of deployed military whose “plan” breaks down
– Undocumented students living in a homeless situation
4
Who Are Homeless Unaccompanied
Youth?
• Are not in the physical custody of a parent or legal
guardian
• Is there an age limit on serving homeless secondary
students?
MV applies to all school-aged youth (as defined by state
law); typically states allow youth to attend school up to the
age of 21 – in Texas this has been extended to age 26 in
certain circumstances, 22 for Special Education
TEA defines unaccompanied as under age 21 on September
1 of the school year
5
RECAP MV: Must schools enroll children and
youth in school if there is no proof of guardianship?
Yes.
• Lack of guardianship papers cannot delay or prevent
enrollment. Enrolled is defined as attending and fully
participating. School districts may establish their own
policies to meet this mandate.
– HOWEVER…
• Schools/districts cannot require individuals/caretakers to
obtain guardianship of youth after enrollment, or within a
specified number of days, in order for youth to remain
enrolled and attending. How does your
state/district handle this?
6
RECAP: Must schools enroll children and youth in
school if there is no proof of residence?
Yes.
• Lack of proof of residence cannot delay or prevent
enrollment. School districts may establish their own
policies to meet this mandate.
– HOWEVER…
• Schools/districts cannot require proof of residency from
those in homeless situations.
• Cannot require dual residency affidavits
• How does your state/district handle these “proofs”
7
RECAP: Must schools enroll children and youth in
school without previous school records?
Yes.
• Lack of school records cannot delay or prevent
enrollment. The enrolling school district must send to the
previous district for the records.
– And…
• The previous district has 10 days in which to send the
records. If the student has not been withdrawn
previously, he/she is to be withdrawn from the previous
district when they receive this request for records – how
does your state/district handle this?
8
RECAP: Must schools enroll children and youth in school
without immunizations or immunization records?
Yes.
• Lack of immunizations or immunization records cannot
delay or prevent enrollment of students in homeless
situations. The enrolling school district must send to the
previous district for the records. Immunization records
should be sent with the other school records, but must be
presented within 30 days.
– or…
• If the student does not have his/or her immunizations, the
Homeless Liaison must make arrangements for the
student to begin them within 30 days. How does your
state/district handle this?
9
What obligation does a school have to help
unaccompanied youth make up lost credits?
• Many youth lose credits due to mobility and
absences—consequences of homelessness
• McKinney-Vento requires that schools and
districts remove barriers to enrollment and
retention and provide academic support—LEA
policies should be revised
• Youth should be provided academic support
through tutoring, programs with cooperating
universities, or online courses, for example;
appropriate use of Title I set aside funds
10
Who can make decisions for an unaccompanied youth
regarding participation in extra curricular activities, field
trips, etc.?
• States and school districts have
implemented a variety of policies and
procedures
– Youth make decisions on their own
– Local liaison makes decisions
– Caregiver forms allow other adults to make
decisions – act in the role of a parent
– Schools assign a surrogate
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Why are Youth Homeless on Their Own?
• Over half of callers to Runaway Hotline report being
physically abused at home; over one-third report
sexual abuse; over two-thirds report that at least one
of their parents abuses drugs or alcohol
• Other youth are thrown out of their homes because
they are pregnant, gay or lesbian, or because their
parents believe they are old enough to take care of
themselves
• Some children and youth are abandoned by their
parents, or are on their own due to death of parents
• Some children and youth are in unstable living
situations due to parental incarceration, illness, or
hospitalization
Why are Youth Homeless on Their Own?
• Over half of youth living in shelters report that their
parents either told them to leave, or knew they were
leaving and did not care
• Some youth become homeless with their families,
but, due to lack of space in doubled-up or motel
situations, end up homeless on their own
• Natural disasters cause youth to be separated from
family during their homelessness
• Aging out of foster care into homelessness; running
away from foster care placements due to abuse in
the foster home, or to reconnect with siblings and
family
Impact of Homelessness on UHY
• Higher rates of acute and chronic illness, depression and anxiety;
experiences of trauma and loss
• For unaccompanied youth, lack of support from any caring adult leads
to faulty decision making
• Unaccompanied youth are frequently victimized. As many as half
have been assaulted or robbed; one in ten runaways reports being
raped – likely a low report
• According to the National Runaway Switchboard, 5,000
unaccompanied youth die each year from assault, illness, or suicide
• Perform lower on academic assessments
• 50% of homeless youth & 75% of unaccompanied homeless youth do
not graduate
Do we have an ethical obligation to identify and intervene?
Unaccompanied Youth—Key Provisions
• Liaisons must help unaccompanied youth
choose and enroll in a school, after
considering the youth’s wishes, and inform
the youth of his or her appeal rights – school
of origin is the first consideration
• School personnel must be made aware of the
specific needs of runaway and homeless
youth.
15
What about discipline and a homeless
student?
Generally students in homeless situations must
follow the same rules of behavior as all other
students, but
If discipline action was taken against a youth for
reasons related to homelessness (for example,
excessive absences caused by homelessness),
the youth must not be penalized or denied
enrollment and the policy should be revised
16
Do schools have to contact the police when
enrolling unaccompanied youth?
• State law determines the obligation of a school liaison or
service provider to alert other agencies about
unaccompanied youth
• Most state laws that address this issue (including Texas)
permit, but do not require, schools to report
unaccompanied youth; many laws also give schools the
option to contact social services instead of the police
• The school district should work with police and social
services regarding mandatory reporting to ensure that
care is exercised to keep a youth in school and serve
his/her best interest
17
Who can make decisions related to special
education for an unaccompanied youth?
• IDEA requires LEAs to appoint surrogate parents
for unaccompanied homeless youth within 30
days – expands the definition of parent
• IDEA regulations permit staff members of
emergency shelters, transitional shelters,
independent living programs and outreach
programs to serve as temporary surrogate
parents for unaccompanied homeless youth
• Districts should have a surrogacy program to
train potential surrogates. They cannot be
employees of the school district
18
What about school liability or parental
disapproval?
Liability is based on the concept of
negligence, or a failure to exercise
reasonable care — following federal law
and providing appropriate services are
evidence of reasonable care
School districts must follow MV and state
laws
19
Can unaccompanied youth consent to their
own medical treatment?
• Generally, only persons age 18 and over can consent
to their own medical, dental, and health care; minors
need consent of a parent or guardian – state laws
vary
• The Texas Family Code gives youth 16 or older who are
independent of parents the right to consent to their own
medical treatment.
• Texas Students of any age can access certain health
and mental health services under certain
circumstances, i.e., in cases of abuse
20
UHY barriers
• What are some of the barriers cited in this
video?
• What are some of the ethical considerations
when working with the youth in this video?
In the original session PowerPoint, a video was
embedded on this slide. Due to file size
restrictions, the video could not be included for
downloading the handout from the NAEHCY
website. Please contact the presenters directly if
you’d like to have more information about this
video.
22
UHY barriers
• What are some of the barriers cited in this
video?
• What are some of the ethical considerations
when working with the youth in this video?
Barriers to Education
• High mobility: 41% will attend at least two different schools; 28% will
attend three or more
• Unaccompanied youth: lack of a parent or guardian to sign forms
• Lack of school records and other paperwork
• Lack of transportation
• Lack of school supplies, clothing
• Credit accrual policies, attendance policies
• Low expectations by family, school
• Lack of stable housing
• Emotional crisis / mental health issues
• Employment - need to balance school and work
• Fatigue, poor health, hunger
• Concerns about being captured by authorities
Do we have an ethical obligation to identify and intervene?
Runaway YOUTH ARE HOMELESS
Runaway, pushed out,
and unaccompanied youth
are a growing proportion of
children in homeless situations
They often know what they are running
from, but have no realistic idea of what
they
are running to.
These youth are vulnerable to
exploitation
Signs of Homelessness
• Tired, sleeping in class, lack of energy
• Poor hygiene
• Wear the same clothes day after day
• Inability to concentrate
• Doesn’t turn in homework assignments
• Doesn’t complete special projects
• Is frequently tardy or absent
• Comes to class “unprepared”
• Change in behavior
• Is angry, hostile, anxious
• Is secretive, afraid to share information
• Moves around a lot
• Grades fall off, gaps in learning
Do we have an ethical obligation to identify and intervene?
Define Ethics
What are Ethics?
What are Ethics?
Standard of Conduct
Accountability
Rules of Our Profession
Acceptable Standards of Care
Licensing Standards
Professional Standards
What contributes to unethical behavior in
the helping profession ?
Money
Human nature
Influenced by clients
Ego
Environment
Insecurity
Bias
Our own issues
Dual roles
Lack of self-awareness
Homeless & UH Youth
What are some of your biggest
challenges when working with
homeless and
unaccompanied homeless youth?
What are some ethical issues you
encounter?
What breaches of ethics have you
witnessed?
Common situations that have ethical implications when
working with youth
Meeting with youth in “non-traditional” settings
Mistaking friendship for appropriate trust building
Keeping Confidentiality – to whom to tell what? When the youth says
“Don’t tell anyone.”
Reporting abuse and neglect – concerns for youth safety
Reporting runaway – concerns for youth safety
Addressing risky behaviors – if you do, will they leave?
Giving Money, taking kids home, leaving youth in unsafe setting
Failing to report or to act on information shared
Dealing with “I only trust you” with certain information
Is adolescence synonymous with “borderline personality?”
Common Ethical Issues When
Working with HY & UHY
1.
2.
3.
4.
5.
Standard of care- What an ordinary,
reasonable, and prudent professional, with the
same or similar training, would have done under
the same or similar circumstances.”
Informed consent - Capacity to consent (e.g.,
age, competency)
Confidentiality
Who is the client
Trust building
Common Ethical Issues
When Working with UHY
Boundary issues - Boundary crossings v. boundary
violations
Types of dual or multiple relationships
Intimate relationships
Personal benefit
Emotional and dependency needs
Altruism
Unavoidable and unanticipated circumstances
Ethical Practices &
Concerns
Allowing youth self determination
Addressing unsafe
behavior/leaving kids in unsafe
situations
Contacting parent or guardian
Ethical Practices &
Concerns
Sharing information with schools,
CPS, other service providers
Records
Meeting in Non-traditional settings
Common ethical principles when working with youth
• Dissonance: when your values differ from those of your client,
your agency, your professional licensure, society at large.
Example: abortion, HIV services, GLBT, etc.
• Confidentiality: issues with confidentiality that can particularly
occur within residential, street, and home-based settings who should be present when a home visit is occurring? What
happens when other residents overhear information about a
particular client? How do different agencies safeguard against
this? Who needs to know which information?
• Referral: how to access other services for a client, without
sharing confidential information? How to know when to access
a referral, and how much information to share?
• Boundaries: are frequent issues within residential,
community, and home- based settings, and when working
with unaccompanied youth.
• Fairness – treating all youth in a manner that is equally helpful
• Honesty – telling youth the truth – they know when we aren’t
Common ethical principles when working with youth
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Agency or professional policies and/or practices that are particularly
helpful in addressing ethics conflicts.
Do no harm – Understanding competencies: What tells social workers
that they are working beyond their competence?
Dual Relationships – business, social, relative, friends, etc.
Language – What workers see and what they say frames the work for
possibilities or barriers; labels, or enables the client.
Informed consent – self consent for unaccompanied youth? At what
age?
Crisis work – what happens when you are in crisis mode? Does
“business as usual” go out the door and what does this mean for
ethical
When are practitioners crossing ethical lines? When are boundaries fluid
and when are they rigid? What information is too much to share, and
what is not enough? Who does the youth worker look to for guidance in
making ethical decisions in his/her work? How do crisis situations
challenge ethical standards? Reporting, trust loss if you do; when safety
and rapport building seem to be at odds.
Common ethical principles when working with youth
• Agency or professional policies and/or practices that are
particularly helpful in addressing ethics conflicts.
• Do no harm – Understanding competencies: What tells social
workers that they are working beyond their competence?
• Dual Relationships – business, social, relative, friends, etc.
• Language – What workers see and what they say frames the work
for possibilities or barriers; labels, or enables the client.
• Informed consent – self consent for unaccompanied youth? At what
age?
• Crisis work – what happens when you are in crisis mode? Does
“business as usual” go out the door and what does this mean for
ethical practice
• Practicing outside your scope of expertise – we do not have the
answers to all our youth’s problems
Common ethical questions when working with youth
• When are practitioners crossing ethical lines?
• When are boundaries fluid and when are they rigid?
• What information is too much to share, and what is not
enough?
• Who does the youth worker look to for guidance in making
ethical decisions in his/her work?
• How do crisis situations challenge ethical standards?
• Reporting? Trust loss if you do;
• When do safety and rapport building seem to be at odds?
• Who do you consult with regarding these issues?
How does your district or
organization handle:
• Lack of parental signature for field trips, playing
sports, other activities, services?
• Who goes on the contact form?
• Who receives school notices & reports?
• Who gets called in case of illness, a behavior
issue, or an emergency?
• Who is held accountable for poor school
attendance?
• Who requests and attends an ARD?
Tips for a coordinated approach to addressing the
needs of unaccompanied youth
• Revise LEA policies to accommodate unaccompanied
youth and comply with the McKinney-Vento Act.
• Train LEA homeless liaisons and all school enrollment staff,
secretaries, guidance counselors, principals and teachers
on the definition, rights and needs of unaccompanied
youth.
• Develop caretaker forms, self-enrollment forms for
unaccompanied youth, and other forms to replace typical
proof of guardianship. Such forms should be carefully
crafted so they do not create further barriers or delay
enrollment.
41
Tips for a coordinated approach to addressing the
needs of unaccompanied youth
• Provide unaccompanied youth the opportunity to enroll in
diversified learning opportunities, such as vocational education,
credit-for-work programs and flexible school hours.
• Provide a “safe place” and trained mentor at school, for
unaccompanied youth to access as needed.
• Permit flexible exceptions to school policies on class schedules,
tardiness, absences and credits to accommodate the needs of
unaccompanied youth.
• Build relationships with legal services for trainings, updates,
advocacy for individual students in non-educational areas.
• Provide opportunities for extra curricular activities.
• Address issues with electronic information and privavy
42
In a Digital World: Ethical and RiskManagement Issues
Electronic communications & Social Media
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The Good(?) Old Days:
The Way It Used to Be
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More Nostalgia
45
A Little More Nostalgia
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And What The Heck is This?
47
And Now We Have . . .
Cybertherapy
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Common ethical principles when working with youth
• When are practitioners crossing ethical lines?
• When are boundaries fluid and when are they rigid?
• What information is too much to share, and what is not
enough?
• Who does the youth worker look to for guidance in making
ethical decisions in his/her work?
• How do crisis situations challenge ethical standards?
• Reporting? trust loss if you do;
• When do safety and rapport building seem to be at odds.
Key Stages
• Morality period (late 19th to early 20th
century)
• Values Period (up through 1970s)
• Ethical dilemmas and decision making
(late 1970s to present)
• Ethics risk management (early 1990s to
present)
• Digital era (mid 2000’s to present)
51
Key Stages
• Morality period (late 19th to early 20th
century)
• Values Period (up through 1970s)
• Ethical dilemmas and decision making
(late 1970s to present)
• Ethics risk management (early 1990s to
present)
• Digital era (mid 2000’s to present)
52
Key Issues
• Digital and electronic
communications
• Digital and electronic services
–Clinical services
–Information and education
• Digital and electronic search
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Forms of Electronic Communication
That Carry Ethical considerations
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Chat (live)
Moderated forum
Web-based psychoeducation
Self-guided Web-based interventions with automated feedback (e.g., anxiety,
phobia, self-esteem, anger, weight loss)
– Human support
– No human support
Skype
Social networking: Facebook, Twitter, Instagram, etc
Email exchanges
Text messages
Blogs
Twitter
Voice messaging
Searches
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Three Key Issues
• Digital and electronic
communications
• Digital and electronic services
–Clinical services
–Information and education
• Digital and electronic search
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Key Issues
Digital records storage
Privacy of communications
Confidentiality
Is anything ever deleted?
Is there always a trail left behind?
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Three Key Issues
• Digital and electronic
communications
• Digital and electronic services
–Clinical services
–Information and education
• Digital and electronic search
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Digital Trends in Clinical Practice: The
Changing Nature of Mental Health and Social
Services
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What do we mean by relationship?
Who do we aim to serve?
What do we mean by privacy?
What are the boundaries of professionalclient relationships?
• What do we mean by informed consent?
• When we communicate electronically, are we
sure our words have the same meaning?
58
Key Stages
• Morality period (late 19th to early 20th
century)
• Values Period (up through 1970s)
• Ethical dilemmas and decision making
(late 1970s to present)
• Ethics risk management (early 1990s to
present)
• Digital era (mid 2000’s to present)
59
Key Stages
• Morality period (late 19th to early 20th
century)
• Values Period (up through 1970s)
• Ethical dilemmas and decision making
(late 1970s to present)
• Ethics risk management (early 1990s to
present)
• Digital era (mid 2000’s to present)
60
Digital Trends in Clinical Practice: The
Changing Nature of Mental Health Services
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•
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What do we mean by relationship?
Who do we aim to serve?
What do we mean by privacy?
What are the boundaries of professional-client
relationships?
• What do we mean by informed consent?
• What is the role of paternalism in the digital age?
• When we communicate electronically, are we
sure our words have the same meaning?
61
Texting can be dangerous!
considerations
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Chat (live)
Moderated forum
Web-based psychoeducation
Self-guided Web-based interventions with automated feedback (e.g.,
anxiety, phobia, self-esteem, anger, weight loss)
– Human support
– No human support
Skype
Social networking: Facebook, Twitter, Instagram, etc
Email exchanges
Text messages
Blogs
Twitter
Voice messaging
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Apps that teens use
• Social Media Tools Parents Need to Know About Now
• Twitter
Instagram
Snapchat
Tumblr
Google+
Vine
Wanelo
Kik Messenger
Ooovoo
Ask.fm
Yik Yak
WhatsApp
Omegle
Yo.
Whisper
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Boundaries, Dual Relationships and
Conflicts of Interest
• Social networking (Facebook, LinkedIn)
• Current clients
• Former clients
• Former Facebook friend becomes client
• Helping professionals’ self-disclosure
• Helping professionals’-client access
• Time of day/night
• Form of access, e.g., text message, email
• Relationships with former clients
• Conflicts of interest, e.g., commercially sponsored
video conferencing software with ads
64
Collegial Relationships
• Treating with respect
• Avoiding derogatory and defamatory postings
• Respecting colleagues’ privacy (e.g., Google
searches)
• Respecting colleagues’ work products (plagiarism,
unauthorized uploads)
• Responding to colleagues’ unethical conduct (e.g.,
inappropriate postings, cyberbullying)
• Avoiding cyberbullying, collegial harassment
65
Developing a Social Media Policy
• “Friending” on Facebook
o Boundaries issues
o Rejection issues
o Privacy issues (e.g., acquaintances in common)
• Electronic interactions (Facebook, email)
– Privacy issues
– Documentation issues
• To Google or not to Google
o “Curiosity” searches
o Crisis searches
• Business review sites (e.g., Yelp, Healthgrades)
• Location-based services (e.g., Foursquare, Gowalla, Loopt)
• Example of a social media policy:
http://www.drkkolmes.com/docs/socmed.pdf
66
“Friending” Youth on Facebook:
Questions to Consider
• What is on the Facebook profile?
o Facebook Page: professional use, one-way
o Facebook Profile: personal content, photos, etc.
• Are privacy controls set?
o Digital “natives”
o Digital “immigrants”
• What is the context of the work? (e.g., client age, culture, clinical
setting, size of community)
• Who is the client? (e.g., clinical issues, boundary instincts)
• Will client “postings” be seen by other clients?
• If so, is this appropriate?
• How do you control what is posted?
• Will “Friending” a client create complex boundary, confidentiality
and privacy issues?
Our Suggestion: Don’t do it!
67
Facebook Privacy Disclaimer
“Risks inherent in sharing information. Although we allow you
to set privacy options that limit access to your information,
please be aware that no security measures are perfect or
impenetrable. We cannot control the actions of other users
with whom you share your information. We cannot guarantee
that only authorized persons will view your information. We
cannot ensure that information you share on Facebook will
not become publicly available. We are not responsible for
third party circumvention of any privacy settings or security
measures on Facebook. You can reduce these risks by using
common sense security practices such as choosing a strong
password, using different passwords for different services,
and using up to date antivirus software.”
68
Email Considerations
• Is the email communication for administrative or
therapeutic purposes?
• How often must I check my email messages? (provide
clients with written and verbal information about your
policy)
• Does email communication fall under HIPAA?
• What are the confidentiality and privacy issues?
• Do I need to document emails in the youth’s record?
• Do I need consent to communicate electronically with
youth?
69
Developing an electronics use policy
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What things would you include?
•
Identify the main areas of liability
70
Confidentiality Issues
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Duty to protect/warn
Mandatory reporting
FERPA: Family Education Rights &
Privacy Act
HIPAA: Health Insurance
Portability and Accountability Act
Disclosure: Other agencies
Disclosure: Within agencies
Peer Consultation
Informed consent
Expiration date
Scope of consent
Blank forms
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Group counseling
Self-help groups
Minors
Sexual misconduct by professionals
News media
Law enforcement
CPS reports
Interns
Personal notes
Competence and scope of work
HIPAA & FERPA
71
Questions?
Thank You!
72
Resources Online Services: Resources
and Ethics Guidelines
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International Society for Mental Health Online: https://www.ismho.org/home.asp
American Distance Counseling Association: http://www.adca-online.org/
Association for Counseling and Therapy Online: http://www.acto-uk.org/index.htm
Online Therapy Institute: http://onlinetherapyinstitute.com/ethical-training/
American Telemedicine Association:
http://www.americantelemed.org/i4a/pages/index.cfm?pageID=3604
The Use of Technology in Mental Health: http://www.amazon.com/The-UseTechnology-Mental-Health/dp/0398079536
Online Counseling: A Handbook for Practitioners (Jones and Stokes, 2009):
http://www.amazon.com/gp/product/0230201954/ref=pd_lpo_k2_dp_sr_1?pf_rd
_p=486539851&pf_rd_s=lpo-top-stripe1&pf_rd_t=201&pf_rd_i=0124259553&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=09T6Z
8A12GZ17387HCCR
Online Counseling: A Handbook for Mental Health Professionals (Kraus, et al.,
2004): http://www.amazon.com/Online-Counseling-Professionals-PracticalProfessional/dp/0124259553
73
Resources:
An Example of a Health System’s
Social Networking Policy
Inova Health System: Social Networking and
Communications Policy:
http://www.inova.org/upload/docs/aboutInova/Social%20Networking%20Policy.pdf
74
Resources:
Examples of Ethical Standards:
Electronic Services and Interventions
• http://www.apa.org/ethics/education/telepho
ne-statement.aspx
• http://www.nbcc.org/assetmanagerfiles/ethic
s/internetcounseling.pdf
• https://ismho.org/suggestions.asp
• http://www.actouk.org/professionalconduct.htm
75
Key Stages
• Morality period (late 19th to early 20th
century)
• Values Period (up through 1970s)
• Ethical dilemmas and decision making
(late 1970s to present)
• Ethics risk management (early 1990s to
present)
• Digital era (mid 2000’s to present)
76