Drug Court Conference Murfreesboro, TN

12/7/2012

Objectives
Drug Court and Ethics

Presented by:

Frances Patterson, Ph.D., MAC, BCPC, QSAP, CCJAS, QCS

Footprints Consulting Services, LLC

Discuss Confidentiality in the Drug Court Setting Examine the difference between Case Management, Intensive CM, Monitoring and Micromanagement Explore the difficulties in Wearing Two Hats: monitoring vs. counseling Discuss how self care is a part of professionalism
Define a team approach to present a united front and avoid Staff splitting
Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Confidentiality in the Drug Court Setting

Disclosure of treatment info

The Federal laws and regulations define a treatment program:

Legal liability for unauthorized disclosure extends to:

an individual or entity that provides diagnosis of chemical dependency and referral to treatment in addition to providing actual rehabilitative services.

An employee of a drug court performs an assessment of chemical dependency of a drug court participant, and/or a referral to treatment, that drug court is considered a treatment program for purposes of the application of the Federal confidentiality regulations (42 CFR 2.11)
Frances Patterson, PhD, MAC

employees of programs that assess and/or diagnose substance abuse, case managers who refer clients to treatment any administrators or other staff who are paid exclusively to work with the drug court program, treatment programs or providers that perform the actual treatment and rehabilitative services.

Frances Patterson, PhD, MAC

Responsibility to protect

Implications for Professionals

Shared ethical responsibility for protecting the confidentiality rights of mandated clients:

Judges prosecuting and defense attorneys probation department staff child welfare staff other individuals involved in the drug court program in a non-treatment provider capacity

Must honor the intent of Congress in providing the confidentiality protections Need education regarding legal limitations on disclosure and subsequent use of treatment info, proper processes for obtaining consent from participants to permit the exchange of information necessary for the drug court program to function.
Frances Patterson, PhD, MAC

Such as therapists, teachers, social workers, substance abuse counselors, and mediators, Involved in problem-solving courts, (drug, MH courts) and other processes in which several professionals, all representing different interests, meet as a team. Profession have independent rules about confidentiality and the relationship with the client Have clients and other participants sign waivers. Poorly crafted waivers may be problematic Clients may not be fully informed to make a knowing, voluntary, and intelligent waiver or consent

Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Insuring Compliance

Example

Drug court team members can still, within current confidentiality legal provisions, obtain the level of information to evaluate compliance with drug court program criteria. There may be instances in which compliance with these provisions will require limiting the extent of information disclosed as well as the forum in which it is presented. Examples of when this might happen?

Frances Patterson, PhD, MAC

Pat is a SA counselor in a drug court treatment program. During drug court, where all participants are in attendance, the judge requests an update on one of her clients. Pat shares with the judge that the client has been having difficulty staying clean because of being raped as a teenager by her uncle. Pat continues with details of other childhood abuse which led to early drug and alcohol use. Pat is appealing to the judge to give her client leniency due to these circumstances.
Frances Patterson, PhD, MAC

How much to share in the courtroom

Revocation of Consent

Is it OK to tell all in open drug court? What should be shared with judge? Is there information that should not be shared? Confidentiality vs. secrets

Individuals mandated to treatment by court as a condition of the disposition of a criminal proceeding, such as through probation, parole, sentencing, an agreement for dismissal of charges, or an order for release from imprisonment, may not revoke their consent (42 CFR 2.35).
Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Revocation (cont)

Informed Consent of Clients

The event that triggers termination of consent for individuals referred to substance abuse treatment by a criminal drug court should be:

the final disposition of the case discontinuation of all court and/or probation supervision for an individual who has successfully completed the drug court program, sentencing a defendant for a violation of the courtimposed conditions

No future disclosures can be made after an event occurs that triggers the revocation or termination of consent.
Frances Patterson, PhD, MAC

Participants must be informed about their right to confidentiality at the time of their initial screening or assessment Asked to sign consent that will permit disclosure to and exchanges of information between the judge, prosecutor, defense counsel, the probation department, or other relevant party, and the treatment provider that will be providing direct services.
Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Drug court policy should specify:

Need to Know

failure to sign the consent form is grounds for exclusion from drug court participation, drug court operations require that all members of the team be able to follow each participants treatment compliance and progress. In exchange for this consent participants assured that information cannot be used to expose them to other criminal jeopardies except to the extent that they may be subject to sanctioning as a result of noncompliance with drug court policies.
Frances Patterson, PhD, MAC

Does a judge have the right to know everything about the clients substance abuse treatment? What does he/she have a right to know?

Frances Patterson, PhD, MAC

Scope of Disclosures

Difficulties for the Judges

Limited to information necessary to carry out the purpose of the disclosures Drug court consent forms should narrow the scope of disclosure to:

Change in judges traditional role to motivator, mentor, cheerleader Ethical concerns for judges:

report[s] of the participants eligibility and/or acceptability for substance abuse treatment services, and report[s] oftreatment attendance, compliance and progress in accordance with drug Court monitoring criteria which are necessary for and pertinent to hearings or reports concerning the participants [charges/ indictment/termination of parental rights, etc.].

Consent forms should never permit a treatment provider to turn over the entire client file to anyone.

Does this include the judge?

Frances Patterson, PhD, MAC

Extrajudicial activities, (fund raising, community events, and drug court functions) Outside communication with participants Confidentiality, e.g. defendant has involvement in another court at some point Drug testing and obtaining other evidence through court order Need to be impartial: Balancing act between praise or sanction and being impartial Program promotion Coercion: ordering medication compliance, where to live, who they can and cant associate with, mandated meetings, etc. Use of judicial power versus a team approach.
Frances Patterson, PhD, MAC

Some solutions

Drug Testing

Memorandum of Understanding (MOU) from the start Clarify rules from the beginning Anticipate problems and have P&P to resolve before they arise Rely on and be familiar with resources for judges Promote program in a positive
Specialized and Problem-Solving Courts: Trends in 2002: The Ethics of Problem Solving Anne Endress Skove

Courts that meets the statutory definition of programthat is, an entity that provides diagnosis of chemical dependency and referral to treatmentrequires drug testing, the results are subject to confidentiality laws.
Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Question

Answer: Yes

Our drug court employs a counselor to screen and assess proposed drug court participants to determine if they are substance abusers in order to refer them to treatment. Since this person is not employed by an agency that provides therapeutic or rehabilitative services, does he or she need to have written consent from the potential participant before sharing the assessment findings with the judge or prosecutor?
Frances Patterson, PhD, MAC

A program is defined as an individual or entity (other than a general medical care facility) who...provides alcohol or drug abuse diagnosis, treatment or referral for treatment. Diagnosis is defined as any reference to an individuals alcohol or drug abuse...which is made for the purpose of treatment or referral to treatment. A drug court employee is considered a treatment program even if he or she is not personally providing therapeutic or rehabilitative services. This employee should obtain signed consent from each individual before beginning the screening or assessment, since reporting the findings without written consent would be a violation of the confidentiality law.
Frances Patterson, PhD, MAC

U.S. Department of Justice Office of Justice Programs Drug Courts Program Office

Ethics in the Treatment Program

The Difference
Substance Abuse Case Management Intensive CM Monitoring Micromanagement

Frances Patterson, PhD, MAC

Understanding roles/role confusion Honoring code of Ethics, courts, clients Whos the client??

Frances Patterson, PhD, MAC

Case Management Principles

Case Management includes:

Single Point of Contact Client Driven Driven by Client Need Advocacy Community-based Anticipatory Flexible Culturally Sensitive
Frances Patterson, PhD, MAC

Assessment Planning Linkage Advocacy Monitoring

Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Potential Problems of Case Management

Problems (Cont)

Unrealistic Expectations by Clients Unrealistic Expectations of Other Agencies Disagreements Over Resources Conflicting Loyalty Final Authority Honeymoon Ends
Frances Patterson, PhD, MAC

Differences in Philosophies Triangling by Clients Improper Demands by Clients Resentments Over Administrative Requirements Administrative Issues
Frances Patterson, PhD, MAC

Advocacy

.Does not mean the client always gets what he or she wants!! .It means taking away barriers
Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Referral

Service Coordination

Frances Patterson, PhD, MAC

Knowledge of Resources Linkages to Resources Personal Contact with Resources Resource Directory

Collaboration QSOA Service Agreements Release of Information Culturally Sensitive Awareness of Roadblocks Multidisciplinary
Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Culturally Competent Case Managers

Self-Aware Identification of Differences as an Issue Acceptance of Others Clients Seen as Individuals Willingness to Advocate Understanding of Culturally Specific Responses to Problems
G. Rogers, 1995
Frances Patterson, PhD, MAC Frances Patterson, PhD, MAC

Intensive Case Management

Monitoring

Engage client to facilitate process & connect with community-based treatment programs Assess needs, identify barriers & facilitate access to treatment Offer practical assistance & facilitate linkages Make referrals Advocate for client Monitor progress Provide counseling & support Crisis intervention Assist in facilitating communication between service Frances Patterson, PhD, MAC providers

Compliance Monitoring or Controlling Client autonomy Trust or Judgment? Babysitter or Oversight? What is the role of monitor?

Frances Patterson, PhD, MAC

Micromanagement

Wearing Two Hats

Be careful what you ask for! Control vs. trust Motives Agendas Curfew checks or spying

Monitor or Counselor? Boundaries

Rigid vs. flexible vs. non-existent

Defining Roles Where do realities collide?

Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

Self Care and Professionalism

Why have boundaries?

Define your identity

Setting professional boundaries Staying Healthy Results of burnout

shape your beliefs and preferences preventing others from manipulating or controlling you

Protect you from violators

Bring order to your life Keep you safe

emotionally, physically, mentally and spiritually

Encourage respectful relationships Promote you as a confident person

instilling confidence in you allowing good in while keeping bad out

Frances Patterson, PhD, MAC

Flexible and inflexible limits

Frances Patterson, PhD, MAC

Communication in a direct, honest and non-offensive way

Activity

Setting Healthy Boundaries

List five firm boundaries that you set with clients When have you violated your own boundaries? When have you allowed a client to violate your boundaries? What were the consequences?
Frances Patterson, PhD, MAC

Begins with self care Empathy vs. Sympathy Involved but detached

do not become personally involved

Caregiving vs. Caretaking Dont take the problem home Whats said there, stays there Know the difference between confidentiality and keeping secrets

I have to tell you something but you cant tell anybody

Frances Patterson, PhD, MAC

Dont bend the rules

Neglect of Self Care Leads to Burnout

Disrespecting Clients and work Making mistakes and losing interest in work Lacking energy Negative feelings and lack of self confidence Using work to cover negative emotions Isolating from colleagues, family, friends Feeling unsupported
Frances Patterson, PhD, MAC Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD

Drug Court Conference Murfreesboro, TN

12/7/2012

There is no I in Team

A united front Avoid staff splitting: Whats the payoff? The dysfunctional pseudo-family The games people play:

Clients Know!!!
They are masters of the game!
Frances Patterson, PhD, MAC

I know and Im not telling I dont know why you do it that way He said, she said
Frances Patterson, PhD, MAC

Albert Einstein
A human being is part of the whole, called by us universe, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest. A kind of optical delusion of his consciousness. This delusion is a kind of prison for us, Restricting us to our personal desires and affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circle of comparison to embrace all living creatures and the whole of nature in its beauty. Frances Patterson, PhD, MAC

Frances Patterson, PhD, MAC

Frances Patterson, Ph.D., MAC,

BCPC, CCJAS, QSAP, QCS
Footprints Consulting Services, LLC (615) 289-4905 frances@footprints-cs.com www.Footprints-cs.com
Frances Patterson, PhD, MAC

Use only by permission of Frances Patterson, PhD