Code of Professional Conduct
Clarifying and Establishing Boundaries in
SCDMH Peer Delivered Services
Peers as Providers
Peer delivered services are still seen as relatively new
concepts in formal systems of mental health care.
Subsequently, concern has been voiced about:



Dual relationships
Professional ethics and boundaries
Peers being viewed as a “friend” rather than as a
provider
Objectives
The learning objectives for the peer support specialist in
this training are to:
1.
Understand what dual relationships are & why they can be
harmful.
2.
Understand SCDMH policies surrounding ethics & acceptable
employee conduct.
3.
Clarify different types of boundaries.
4.
Understand how violations are harmful & how to recognize
boundary violation patterns.
5.
Develop a framework for making better ethical decisions at work.
Dual Relationships
A dual relationship is one in which roles are or
could be mixed.
For example:
 A peer support specialist is providing services
to a client with whom they also have a
friendship.
Or
 A peer support specialist supervisor and case
manager is the same person.
Ethics
For the purpose of this training “Ethics” are:

The hard and fast non-negotiable rules that all
SCDMH employees are subject to.

The Professional Code of Conduct that govern
all SCDMH Certified Peer Support Specialists (CPSS).
Boundaries
Boundaries are more ambiguous. They are:




The unseen lines that you won’t cross
Undefined physical and emotional distances
Parameters that make you unique
Self imposed and self defined

Boundaries require the use of good judgment.
Why all the Concern?
All of the helping professions (medicine, nursing,
psychology etc.) have established codes of conduct.
This is because there exists an accepted inherent belief
that not addressing these issues unacceptably increases
the chances of harm and/or exploitation for a person
(client) seeking services.
Concerns continued
In as much as peer support specialist’s are SCDMH
employees they should not be treated differently or have
additional rules created to enhance or excuse them from
standards of conduct that is expected of all SCDMH
employees or contracted affiliates.
Concerns continued
When acting within one’s role as a professional, a peer
must be able to recognize, maintain and balance
boundaries that establish appropriate limits to
relationships.
If we lose our ability to be objective, we
tend to become too involved in a person or
situation.

Concerns continued
Good, healthy, and appropriate boundaries are the
distance and emotional detachment that need to be
maintained to ensure an effective perspective on a
situation.

Maintaining personal boundaries is indicative of a
well-trained, experienced peer supporter.
Ethics & Dual Relationships
Ethical Practice, Duality & SCDMH Policy
For all professional staff, it is uniformly contrary to
standards governing the practice and conduct of the
respective health care professions to form personal or
business relationships with patients or clients under their
care.
Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited
Ethical Practice, Duality & SCDMH Policy
All employee relationships with patients and clients of the
SCDMH should be therapeutic and professional in nature.
In order to protect the welfare of patients and clients,
encourage adherence to professional standards and
preserve the public image and integrity of the Department,
the following guidelines are issued to supplement the
prohibited conduct listed in paragraph III of the directive:




Physical Abuse
Psychological Abuse
Neglect
Exploitation
Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited
Ethical Practice, Duality & SCDMH Policy
It is the policy of the SCDMH that an employee shall not
be directly involved in providing care or treatment of a
patient or client who is a friend or relative of the
employee.
Employees are prohibited from forming social or
business relationships with patients or clients or
former patients or clients except as outlined in
the directive.
Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited
Ethical Practice, Duality & SCDMH Policy
Any professional employee who engages in conduct
contrary to the standards published by the licensing body of
the employee's respective profession is subject to discipline
by the Department.
Directive 885-07 Abuse, Neglect or Exploitation of Patients and Clients Prohibited
Ethical Practice, Duality & SCDMH Policy
Regardless of the circumstances for the CPSS it is:
1.
Never appropriate to develop social relationships
with those that you provide services to.
2.
Never appropriate to provide services to those with
whom you have a pre-existing social relationship.
3.
Never appropriate to discuss work concerns /issues
with clients whether you provide services to them or
not.
SCDMH Certified Peer Support Specialist
Code of Professional Conduct
SCDMH Certified Peer Support Specialist Code of
Professional Conduct
Peer Support is a helping relationship between mental health
clients and Certified Peer Support Specialists (CPSS)
encouraging respect, trust, and warmth. The primary
responsibility of Certified Peer Support Specialists is to help
empower clients to achieve their own needs, wants, and goals as
specified in the plan of care. As such they are committed to
providing and advocating for effective recovery based services
for the people they serve. SCDMH Peer Support Specialists
recognize the importance of a Code of Conduct and are dedicated
to these standards being rigorously enforced.
SCDMH Certified Peer Support Specialist
Code of Professional Conduct
1.
Certified Peer Support Specialists will not practice, condone,
facilitate, or collaborate in any form of discrimination on the basis
of ethnicity, race, sex, sexual orientation, age, religion, national
origin, marital status, political belief, mental or physical disability,
or any other preference or personal characteristic, condition, or
state. Certified Peer Support Specialists will adhere to policies set
forth by the South Carolina Department of Mental Health directive
885-07 (4-100) Abuse, Neglect or Exploitation of Patients and
Clients Prohibited
2.
Certified Peer Support Specialists will maintain high standards of
personal and professional conduct and shall not be party to any
type of behavior, activity or policy that denies any client equal,
non-discriminatory access to service and/or support; or which
deliberately demeans the rights and/or dignity of any client, staff
or colleague.
SCDMH Certified Peer Support Specialist
Code of Professional Conduct
3.
Certified Peer Support Specialists will, at all times, respect the
dignity, privacy and confidentiality rights of the clients they serve.
4.
Certified Peer Support Specialists will never engage in
sexual/intimate activities with the clients they serve.
5.
Certified Peer Support Specialists shall avoid being drawn into
dual (friendships, business bartering etc.) relationships with
clients while the support relationship is ongoing.
6.
Certified Peer Support Specialists never give out their personal
contact information to clients, but will ensure clients know how to
contact them through the mental health center.
SCDMH Certified Peer Support Specialist
Code of Professional Conduct
7.
Certified Peer Support Specialists shall only provide service and
support within the hours, days and locations that are sanctioned
by the mental health center.
8.
Certified Peer Support Specialists will conduct themselves in a
manner that fosters their own recovery. In so doing, Peer Support
Specialists are expected to conduct themselves in a professional
manner and take the necessary steps to ensure their conduct
does not negatively impact on the perception of this program.
9.
Certified Peer Support Specialists will openly share with clients
and colleagues their recovery stories from mental illness as
appropriate for the situation in order to promote and support
recovery and resilience.
SCDMH Certified Peer Support Specialist
Code of Professional Conduct
10.
Certified Peer Support Specialists will keep current with emerging
knowledge relevant to recovery, and openly share this knowledge
with their colleagues while refraining from giving advice or
opinions that exceeds the scope of practice as defined in the
Community Mental Health Services Provider Manual Section 2
Policies and Procedures 2-68 for the Peer Support Service.
11.
As state employees Certified Peer Support Specialists cannot
accept personal gifts.
Establishing Professional
Boundaries
What are Professional Boundaries?
Professional boundaries define effective and appropriate
interaction between professionals and the public they
serve.

They are the space between the professional's
power and the client's vulnerability.

They exist to protect both the professional
and the client.
Boundaries
When we talk about
interpersonal or workplace
boundaries, it can sometimes
be a difficult concept to grasp
because it isn’t something
that we can see.
Boundaries
But just because we can’t
see a boundary doesn't
mean that it isn’t there or that
it isn’t important.
Boundaries
The definition of a boundary
is the ability to know where
you end and where another
person begins.
Boundaries are an Important
Issue
The amount & type of boundary responsibility you have
with a person differs according to the type of
relationship:



Friendship
Colleague
Client
Friendship Boundaries
This is a person that you know, like, and trust and
one with whom you have a close personal connection. It
can be a person with whom you are allied in a struggle or
cause. The difference between this person and a client
you work with is in the equitability of the relationship.
No One has Power or Authority Over the Other
Colleague Boundaries
A colleague is a fellow member of a profession. That
person may have power and authority over you, be equal in
power and authority to you or have less power and
authority than you.
Colleague Boundaries
Like the relationship with clients,
professional or business relationships
can become sticky because of the
types of power and authority and who
has the ability to enforce them.
Power and Authority Are Not
Always Equal
Client Boundaries
With respect to the SC Department of Mental Health the
term client is used to describe a person who is seeking
professional psychiatric services. Depending on their
circumstances each individual may hold different types of
power and authority.
Power and Authority Varies
What are Boundary Violations?

They are any behavior or interaction which damages a
client, a professional, and/or the professional
interaction.

The victimization and/or exploitation of a client by a
professional.

A betrayal of the sacred covenant of trust.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
How do Violations Occur?
A boundary violation occurs when a professional,
consciously or unconsciously, uses the professional-client
relationship to meet personal needs rather than client
needs.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Who can be Harmed?
Boundary violations can harm both the client and the
professional. The ramifications can be widespread.
Damage can extend to marriages, families, other clients
communities, clinics, institutions, and the profession in
general.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
How Do Boundaries Help?
Preservation of boundaries needs not be seen as a barrier
to the professional relationship, but rather as a way to
facilitate it.
Maintaining boundaries protects the safe space in the
relationship thereby enhancing the building of the trust
which is essential to enable clients to reveal their needs.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Boundary Violations:
Four Common Elements
Four elements characteristically appear in boundary
violations:

Secrecy
Role Reversal
Double Bind

Indulgence of Professional Privilege


Adapted from MINNESOTA BOARD OF NURSING, January 2000
Secrecy
Secrecy involves the professional keeping critical
knowledge or behavior from the client and/or others or
selectively sharing information.
Example: A CPSS takes a client into their home and tells
the client the CPSS’s employer cannot know about this or
they will lose their job.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Role Reversal
Role reversal occurs when the client takes care of the
professional. They look to the client for satisfaction and
gratification, rather than placing client needs first. They
may not be consciously aware of this role reversal or
may attempt to justify it by contending his or her actions are
for the client's benefit.
Example: A client becomes a CPSS’s A.A. or N.A.
sponsor.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Indulgence of Professional
Privilege
Indulgence of professional privilege involves using
information obtained in the relationship with a client for the
benefit of the professional.
Because professionals can have or exert authority over a
client's situation, they can be at risk to extending that
authority to intrude on the client.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Indulgence continued
Having access to information does not constitute a right
to it. Access is a professional privilege; it is not a
professional’s right to use the information for one's own
benefit.
Example: A CPSS has been helping a client with severe
financial problems develop a budget. The CPSS uses
that information to try to purchase the client’s car below
market value.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Double Bind
A double-bind consists of messages that contradict each
other while discouraging the receiver of the messages from
noticing the difference.
The client is left feeling caught in a conflict of interest and
any attempt at resolution places the client at risk of loss.
The client is torn between the desire to end the relationship
and the realization that this may also end any form of help
from the professional.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Double Bind continued
The double-bind contains an implied threat. A sense of guilt
and fear of possible abandonment by the professional
blocks the client from taking action. The double-bind
constricts the client from using all available options and
thus limits growth.
Examples: (1) A CPSS makes negative comments about
other CPSS’s caring for a client who has development of
trust as a therapeutic goal. (2) A CPSS’s tells a client that
they may begin a personal relationship when the client is no
longer receiving services.
Adapted from MINNESOTA BOARD OF NURSING, January 2000
Boundaries: Are You Helping or
Are You Hurting?
There are more gray areas
than black and white ones
when thinking about
boundaries.
Peer specialists can make
more considerate decisions
if they will take time to think
about some of the basics of
boundaries.
Some Warning Signs
of Boundary Violations
Although not an exhaustive list, the following are helpful “cues”
when setting professional boundaries:
 Choosing sides
 Making exceptions
 Keeping secrets
 Giving or receiving gifts
 Borrowing or lending money
 Feeling as if no one but you has interest in the client
 Feeling no but you will be able to assist the client
 Feeling responsible for a client’s progress or failure
 “Owning” a client’s success’s or failure’s
 Confiding personal or professional issues or troubles
Developing A Framework
The “Yes’s” and the “No’s”
If you are unsure about your interactions try asking yourself the
following questions: If you answer “No” to 1 - 2 or “Yes” to 3 - 4
you need to stop and evaluate your interaction.
1.
2.
3.
4.
Is the relationship in the client’s best interest?
Is this something that other CPSS’s would do?
Can this affect my objectivity in providing care?
Will this cause confusion in my role?
Still Unsure?
If you are still unsure try asking:
1.
How would this appear to
others (peers, family,
colleagues and/or supervisor)?
2.
How does this appear to the
client?
3.
Is this decision making me
uncomfortable?
Trouble Shooting Problem Spots: Time
When, where, and how often you meet with a
client can be a troublesome issue. If it feels
wrong it probably is, but ask yourself the
following questions to help clarify
the situation:
1.
2.
3.
How much time am I spending with a client?
Does it vary from that spent with other
clients?
Am I spending "off duty" time with the
client?
Trouble Shooting Problem Spots: Location
If a client wants to talk or meet somewhere other than a center
approved location you're beginning to slide toward a questionable
boundary as well as possible policy violation. Try asking:
1.
2.
3.
4.
Is the location of the interaction appropriate to the
relationship?
Would you provide peer services to other clients at this
location?
Is there is a legitimate need to meet?
Have I made the meeting known to others and documented
it?
Trouble Shooting Problem Spots: Gifts
Accepting or giving a gift can get tricky. If you are unsure ask:
1.
Does the gift giving create a sense of obligation
on the part of you or the recipient?
2.
Do you do this routinely as part of your job,
regardless of the age or gender of the client?
3.
Is the gift of a personal nature that would only be to or from
a specific person?
4.
Is there a department or center policy regarding gifts?
Asking For Help
At all times, if you are unsure about a situation
or confused about whether an interaction could
be interpreted as a boundary
violation you always should:




?
Consult your supervisor
Refer to SCDMH Directives
Consult the Quality Assurance Coordinator or Client Advocate
Consult other clinical colleagues
ALWAYS
Remember…
It is never a good idea to ignore a situation or
interaction and just hope all works out.
The chances are that if you are experiencing
problems other CPSS’s are too!
Thank You!!!
Clarifying and Establishing Boundaries in
SCDMH Peer Delivered Services
For more information Contact:
Katherine M. Roberts, MPH Director
SCDMH Office of Client Affairs
kmr50@scdmh.org
Bobbie Lesesne, CCETT Coordinator
SCDMH Office of Client Affairs