From Boundaries to Ethics: a Supervisory Approach to Ethical Child and Youth Care

From Boundaries to Ethics 1

From Boundaries to Ethics: A Supervisory Approach to Ethical Child and Youth Care

Peter Rosenblatt, MSW

Martha Mattingly, PhD

ABSTRACT. This paper discusses the use of the Code of Ethics: Standards for Practice of North American Child and Youth Care Professionals for values based management. Child and youth care practitioners are most often not trained in use of the Code. Literature indicates a very limited discussion of practitioner ethics mostly within social work and focused on a narrow range of practice. The Code of Ethics is a statement of the values of child and youth care which is best used in an educative and consciousness raising manner. This demonstration presents a detailed practice problem with a process for supervisory use of the code for values based management. The next steps for the implementation of ethical thinking in practice are: soliciting case examples; developing an on-line ethics training for practitioners and encouraging research to explore the impact of ethics processes on the quality of care for children, youth and families.

KEYWORDS. Ethics, supervision, values based management, residential treatment, child and youth care work

It has been almost 10 years since the International Leadership Coalition for the Professionalization of Child and Youth Care (ILC) finalized, received professional ratification for, and published the Code of Ethics of Child and Youth Care Professionals (1995). During this time much has been done from a professional and educational perspective regarding the implementation of ethical practice throughout the field.

However two events have lead the authors (who were members of the ILC’s draft committee for the Code) to question if those within our field with the most direct client contact (on-line direct care child and youth care workers) have a working understanding of the Code and its use on a daily basis. As the authors travel throughout the US (and Canada) to train child and youth care workers on the Code and ethical conduct, on the one hand they hear that the staff in attendance have had no exposure to the Code and yet we cannot be sure because the numbers of seminar participants is always small (usually less than 20 child and youth care professionals). In addition, when preparing to craft an on-line ethics tutorial to assist workers to prepare for the NACP (North American Certification Project) certification exam (Thomas, 2002; Mattingly, Stuart, & VanderVen, 2002) a literature review was done on the use of ethics and ethics training within the continuum of child welfare programming. Scant references were found regarding the use of ethics in training on-line direct care staff within the residential sphere. It appears as though concern for ethical practice and ethics training is occurring primarily within the world of social work, applicable primarily for private practitioners as well as child protective services staff. This dearth of information combined with their experience bringing the code to on-line direct care child and youth care workers, prompted the authors to present a method for supervisors to use the Code as an educative tool within their supervision of child and youth care staff.

What Are Professional Ethics and How Do They Guide Practice?

While the term “professional ethics” has a reasonably specific meaning it is often confused with or not distinguished from other ways in which our values and behavior are determined. Each practitioner brings a set of beliefs and values that guide behavior. These include the values of individual history, native morality and personal values developed through life experiences. It is, however, quite clear that the ethics of diverse individuals are not particularly congruent. They vary widely among individual practitioners and among cultural sub-groups of practitioners. It is also common for laws and regulations to be considered sufficient guidance for practice. Laws and regulations, however, are set by the state and may or may not reflect the values of the profession.

Our professional ethics are the organized and systematic articulation of “child and youth care professionals’ values” to which practitioners can hold a common commitment and their application to the issues encountered in practice.

There is a view, strongly held by some, that child and youth care ethics should have a strong regulatory function. The strength of this view often arises simply from the frustration of good practitioners knowing what standards of good practice are yet seeing them frequently violated. But a more effective use of professional ethics in child and youth care is educative and consciousness raising. Ethics discussions and the consideration of dilemmas from real practice serve to raise the consciousness of the individual practitioner, the agency, and the profession. Child and youth care practice is always value based. The well considered and organized values of the field must be central to “values based management” (Mattingly, 1995).

Values Based Management

Supervision is a process by which direct care staff can increase their skill base as members of a larger team. It is an opportunity for the supervisee and supervisor to reflect on the former’s professional development and professional/program accountability. The lead author uses an approach taught to him at an agency where he used to work which is referred to within that organization as Values Based Management (VBM). While a full description of VBM (Morrow, 1978) is beyond the scope of this paper, one aspect needs to be highlighted: the supervisory style it includes is grounded in the guiding principles that we as a field hold close. These are: respect of one another, the potential of all employees, professional accountability, a structured multi-modal learning environment, and staff taking a leadership role in their own professional growth. In addition, the core competencies and values of the field are placed at the forefront as they create the matrix by which the supervisory session can be conducted. The goal within VBM is not to solely create a better agency employee but rather to help in the development of a better child and youth care professional. Regarding the use of the Code within the supervisory session, since ethical conduct is one of the core competencies of the field and since we within the profession place a value on the use of ethical conduct, the discussion of ethics and review of ethical dilemmas (both as they arise as well as through the study of non site-specific examples) is a natural fit within the VBM approach.

The Practice Problem

The following is but one example of how ethical issues arose on-line and how a supervisor intervened.

Once a month a program director meets with her program supervisors and reviews the treatment status of each youth within her multi-site child and adolescent community based group homes.[1] At one such meeting, a supervisor from the boys’ facility mentioned that Billie was doing well and that she seemed to be adjusting to the transition from the secured hospital to the open group home. The program director expressed confusion as to whom the supervisor was referring and said, “why would a ‘she’ be in the boys group home?” She was told that Billie used to be Roger but that the staff are honoring her request to be called Billie, as she is transgendered. The program director asked the supervisor how the team knew that Roger was transgendered, as she did not recall this information being shared during the comprehensive intake process only a month or so ago. She was told that shortly after admission, Roger disclosed his gender identity.

During the conversation that ensued, the supervisor discovered that:

There is no mention of any gender identity issues in any of Roger’s intake material; including several years of comprehensive mental health in-patient and outpatient care preceding placement in this current group home.
Immediately after admission, Roger, after a very tense home visit, reported to staff that he disclosed his bi-sexuality to his father and that Dad, “didn’t seem to care.”
The following week, Roger then disclosed his homosexuality to his father who remained supportive but, “did not care,” as he continued to want to discuss the issues that had caused Roger to go into care in the first place (none of which had to do with sexual orientation or gender identity).
By the end of the following week, Roger disclosed to his father and staff alike that he was transgendered and wanted to be referred to as Billie.
Staff within the facility referred Billie (upon her request) to two local support groups for transgendered youth as well as three 12-Step groups for her (also recently disclosed) drug use which included (according to client self report) regular narcotic use.
The procedure for changing a youth’s name while in the facility was not used. While not lengthy in nature, the procedure allows the youth time to reflect on the name change and for the youth’s support team to get together to discuss this significant event.
And finally, no staff person within the facility contacted any of the non-group home team members (local mental health agent, state case worker, prior placements, or the family), nor the Program Director (who also serves as the program clinical director), for any consultation on the name change, the clinical issues present, or the addition of five community based support groups to the youth’s treatment plan.

By the end of the meeting the program director (based on her understanding of Roger’s presenting mental health and family issues as well as her frustration with the staff’s blatant disregard for any of the team supportive policies and procedures within the facility) let the supervisor know that he’d have to let the team know that Roger was to be referred to as Roger until the process for a name change occurred, that the five community based support groups were to cease immediately until a full team meeting could take place so they could (if deemed necessary) be added to the Master Treatment Plan, and that she would be attending the upcoming staff meeting to further debrief the situation with the team.

At the next weekly staff meeting the program director expressed her concern over the manifestation of clinical issues as well as the team’s response. The salient points made were: a) Roger has a long documented history of Reactive Attachment Disorder with possible psychotic traits; b) he has no history of documented drug use prior to intake or since being in the facility; c) the staff decision to include the use of 12-Step and transgendered support groups was likely supporting manipulation or confusion by the client; d) frustration that issues such as these were not mentioned to the program director prior to the casual comment made in a management team meeting the week prior; and e) a reminder of the program’s team based treatment format and questions over why the full team was not included in any of the decisions made regarding Roger. The last point was the one that drew the clearest response from several staff members “Billie’s family are not supportive of her choice to live as a transgendered person and neither would the therapist or the state case worker.” When asked how this staff knew this, the director was told, “Billie told us so.”

At this point the director made the following decision: Roger was to continue to be referred to as Roger, the supplemental support groups were to cease immediately, and a full treatment team meeting was to be called for as soon as possible. The meeting was set for two weeks later due to scheduling conflicts of some of the members. Roger was told of the decisions and while annoyed, did comply with them.

At the program supervisors’ meeting two days after the staff meeting, the supervisor told the program director that the staff of the group home were stating that the decisions the program director had made were unethical in nature and that this (the ethics of the case) was becoming a divisive issue within the team and the house as a whole. The program director let the management know that she would again attend the upcoming staff meeting so that the ethics of the case could be discussed. For the remainder of the day the director questioned herself as to whether she had in fact been unethical in her response.

Ethics Supervision: Case Review

To assist her with her dilemma, the program director immediately sought out consultation in several areas: a meeting was set with the clinical director of the mental health agency providing counseling services to Roger; a few meetings were set with local transgender community professionals; and a supervision was arranged between her and her supervisor. These various meetings all yielded the same response: namely that the program director did the right thing by slowing down the process until the entire team (of which the client is a primary member) had an opportunity to meet. There was general concern over the co-morbid mental health issues present prior to intake, the newly disclosed gender identity issues, the speed at which decisions were made by some members of the team, and the way in which other team members were left out. Given that Roger had been in the program for less than two months and that none of these issues were manifest prior to intake, the program director’s consultants and supervisor agreed that the interim decisions she made were not going to be devastating to the process that Roger might be going through as a possible transgendered person. However, as all agreed that the decisions were right, the question of whether they were ethical had yet to be answered.

In order to best determine the ethics of the case, her supervisor reminded the program director about the ethics litmus test that they had been using throughout their VBM supervision sessions: does the situation at hand violate a principle and/or standard within a known professional code of ethics? As ethics are part of a profession’s identity they are public by nature. Something cannot be unethical solely because someone says so or because something goes against one’s own belief system. In addition, something may be unethical to one profession/professional but not to another. (As a crude example: it would be unethical for a child and youth care professional to purposely kill someone in the line of duty and yet might not be unethical for a police officer to do so in response to the same actions if he came on the scene.) As the program director is by education and practice a child and youth care professional, then she had to explore the Code of Ethics for her profession. As she reviewed the Code[2] with her supervisor, the following sections came to light as being supportive of her actions:

1: (I.A.2) Obtains training, education, supervision, experience, and/or counsel to assure competent practice.

While this happened after the decision to slow the process down was made, the program director had received and was using supervision to help her explore the situation and its ramifications.

2: (III.A) Treats colleagues with respect, courtesy, fairness, and good faith.

As some of the team members had intentionally omitted others within the team, the decision to hold a large team meeting within the next two weeks was an attempt to re-establish the respect of the team as a whole and of those members who were originally omitted.

3. (IV.C) Encourages collaborative participation by professionals, client, family, and community to share responsibility for client outcomes.

As the originally agreed upon treatment plan had been altered without full participation, the decision to gain full participation and support is encouraged.

4. (V.B) Promotes understanding and facilitates acceptance of diversity in society.

The members of the group home reacted to what they perceived as homo/trans-phobic behavior on behalf of the parents and case worker by omitting them from the decision making process; however, by bringing them to the table it will be possible to ensure that if such beliefs are present that they are explored and responded to accordingly.

After an examination of the Code by both the program director and her supervisor there seemed to be support for the decisions that were made; however, the two initially deferred review of the second section of the code that refers specifically to one’s professional responsibility to clients. Now it was time to examine that section. Section Two (Responsibility to the Client) has several non-discrimination clauses: references to advocating in the best interest of the client, and acknowledgment of the unique life span perspective, development stage, and treatment issues of each client. There was no direct reference to the specifics of this particular dilemma. So the supervisor began asking the program director to clarify her stance on the issues at hand. As such, what emerged was: a) the program director’s concern over the speed at which the client went from manifesting himself as male to fully accepting and demonstrating a transgender identity; which seemed to contradict what the program director knew about both coming out and transgender issues; b) the awareness of other documented mental health issues which could be paramount here or could simply be a mis-diagnoses due to the client’s gender identity issues; c) the awareness of a long and well reported (by the client and his family) history of family strife with the client seemingly spending much time trying to “get mom and dad upset”; and d) the realization that what was of major concern was not the possibility of having a transgender youth in the facility but rather the process by which clinical issues had been made.