Values and Ethics for BHA/Ps

In order to practice ethically and effectively, BHA/Ps must be familiar with Alaska Native cultural values, which are important to Alaska Native people, BHA/Ps, families, and communities. Cultural values influence ways of gathering knowledge and living together, provide clear instructions to community members, and help ensure community social order.

Values may differ based on age, generational status, gender, or language dynamics, and the differences may influence what constitutes effective counseling practices.

Ethics are part of Alaska Native values. Ethics involve standards that guide you in decision-making and actions. They protect you and your clients and help you to practice with quality.

If your THO provides an ethics code, follow its ethical guidelines. For a listing of commonly accepted behavior health ethics, see the National Association of Alcohol and Drug Abuse Counselors (NAADAC), the Alaska Chapter of the National Association of Social Workers (NASW), the American Psychological Association (APA), or the National Board for Certified Counselors (NBCC).

In addition to values and ethics, seek to understand Alaska Native traditional practice. Fully listing all customs is beyond this manual’s scope. As a BHA/P, you should ask local elders, community leaders, and culture bearers to help you become familiar with local traditional practices.

Way of Respect

• Establish trust.
• Be a real person.
• Know who you are.
• Behave in a way that is respectful to the culture and community.
• Have self-respect.
• Respect others’ cultural beliefs.
• Respect your coworkers and supervisors.
• Be a good role model.
• Embrace diversity.

Way of Listening

• Recognize the spiritual nature of people’s connection to one another.
• Be willing to accept the problems, issues, and concerns your clients share.
• Be willing to also accept the compliments and appreciation your clients share.
• Be sensitive to your clients’ feelings and reactions.
• Notice your clients' voices, gestures, body language, and facial expressions.
• Pay attention to the things clients are not willing to talk about, which could be warning signs.

Way of Caring

• Show care and concern for each client as an individual person.
• Ask your clients' permission before initiating physical contact; find out if a handshake or hug is appropriate.
• Help your clients feel comfortable and welcome.
• Honor your clients' independence and self-determination.

Way of Helping

• Do no harm.
• Treat all clients equally.
• Know scientific and traditional counseling ways, and walk a respectful balance between worldviews.
• Help clients take ownership of their change journeys.
• Support positive change; provide encouragement.
• Maintain safety.
• Promote good health. Do what is in your clients’ best interest.
• Learn knowledge and skills and stay updated on new approaches.

Way of Honesty

• Respect clients’ privacy and keep their information confidential.
• Follow the BHAM guidelines and work within the boundaries of your job responsibilities and certification level.
• Practice all you have been taught in the BHA/P ethics class.
• When concerned with another provider’s treatment approach, talk to your supervisor.
• Speak with clients with whom you have a dual relationship about how to safeguard the counseling relationship.

Way of Sharing

• When appropriate, be willing to share your personal experiences as a therapeutic tool to create a warm and trusting atmosphere.
• If your organization allows it, you might accept small gifts your clients offer (such as traditional foods or Native arts) in order to help them feel honored and respected.

You may encounter challenges when multiple types of relationship exist between you and a client. These are called dual relationships.

Dual relationships occur when you have a client who is also a friend, family member, employee, or business associate. For example:

• The court may refer a family member to you for drug and alcohol services because you are the only person in the village who can provide this professional support.
• Your client may be the same person who cuts your wood, delivers your fuel, serves with you on a committee at church, or has been your neighbor for many years.

You are likely to be called to serve some of the people that you are closest to. Dual relationships are among the most challenging aspects of BHA/P practice. Common problems include:

• Conflicts of interest.
• Manipulation or intimidation.
• Difficulty for both of you in knowing where the personal relationship ends and the professional one begins.

In some situations, you can work with clients with whom you have dual relationships. In others, you'll need to refer them to a different counselor.

• If you have questions or concerns, consult your supervisor.
• The decision to practice with a client depends on the nature of your previous or current relationship, the presenting problem, the comfort level of the client, what your supervisor says, and the accessibility of alternate services.

If you have a dual relationship with a client, start by recognizing the challenges inherent in your dynamic. Have an open discussion with your client about the challenges of a dual relationship. Begin each session by identifying your professional role and going over ground rules. If the client strays into private aspects of your relationship during sessions, gently guide the conversation back on track. Remind clients you are here to serve them in your professional capacity.

Do not take advantage of the counseling relationship or allow the client to treat you in a special manner, such as accepting favors or discounts in business transactions from a client.

NEVER discuss a client’s behavioral health issues in the community, even if the client brings it up first.

Refer to your organizational policies about social media and interactions with clients via social media.

Do not talk about counseling matters outside of your normal counseling sessions. Explain to clients that they should not contact you in your professional role after hours—by phone or in person—unless there is an emergency. If a client does contact you, evaluate the situation to determine if it is a crisis, and follow your organizational procedures for working with a client in crisis.

• If it is not a crisis, encourage the client to bring the subject up in the next session and remind your client about the professional boundaries of your relationship.
• If it is a crisis, deal with the crisis by providing immediate support and trying to arrange a plan for the client to follow up at the clinic at a specific day and time. You may also help to identify immediate supports, which may include reminding the client of the safety plan and natural, healthy coping strategies and self-care techniques. If your client is actively suicidal and appears intent on self-harm, keep the conversation going until the client is stable and contact local authorities to conduct a welfare check. Contact your supervisor as soon as possible to discuss the situation and confirm next steps. See: Suicidal Thoughts and Plans for additional information and guidance.

Boundaries are the limits you set in your professional and personal relationships.

Professional boundaries help you manage expectations, build respect, and ensure the overall safety and independence of the client and clinician. They also help you achieve personal and professional success. Boundaries require both communication and action.

• NEVER develop a romantic or physically intimate relationship with a client.
• Encourage self-determination. Clients should always maintain a sense of independence, freedom of choice, and ownership of their treatment.
• When a client offers a gift, consider the reason for gift giving, consult your supervisor, and follow organizational policies.
• When a client is being inappropriate or confrontational, use the skills detailed in: Working with Difficult Clients.

Personal boundaries are physical, emotional, and mental rules and limits that each person establishes to identify reasonable, safe, and permissible ways for others to behave around them. Boundaries help people to feel safe, protected, and respected.

For more information on personal boundaries, see the appropriate heading in: Wellness and Prevention.

Tips for Setting Boundaries

• Know you have a right to practice personal boundaries.
• Determine how you will allow others to treat you. Commit to stand by this.
• Learn to say “no."
• Tell others when you need emotional and/or physical space.
• Trust and believe in yourself. You know what you need, want, and value.
• If you have personal experiences relevant to your client's situation, be aware of your client’s age when deciding how much to self-disclose.
• Recognize that the issues discussed in counseling belong to your clients. They are not your issues. Remember that your job is to help your clients help themselves.
• Do not talk about counseling matters outside of your normal counseling sessions and NEVER discuss a client’s behavioral health issues in the community, even if the client brings it up first.
• It can be tempting to intervene and save the day for a client, overstepping your own boundaries in the process. Doing so can be harmful.
  • Sometimes clients learn valuable lessons by making mistakes and experiencing the consequences of their mistakes.
  • Keeping your clients from consequences is a form of enabling. Enabling makes recovery seem less necessary or appealing and can discourage clients from addressing their problems.

For additional tips, see: Working with Difficult Clients.

All client information, including names, is considered confidential and private and is protected by law.

• Client information cannot be shared with anyone unless the client has authorized you to do so in writing. You need to protect client information from being shared with your family and friends, the client’s family and friends, and other health care providers.
• If your client is a minor child (age 17 or younger):
  • The parent or guardian has the right to request the child’s records from the medical records department.
  • At the onset of services, you should have a discussion with the minor and the parent/guardian establishing clear boundaries about what information will and will not be disclosed to the parent.
  • Several factors will contribute to what information can and should be disclosed, such as the age of the client and the nature of the presenting problem. You should consult with your supervisor about how to navigate confidentiality with a minor child receiving behavioral health services.

Exceptions.There are times when you MUST share private client information. This includes when:

• The client is suspected of self-harm or harming others (see Duty to Warn).
• There is suspected child or elder abuse (see Mandatory Reporting).

In many cases, you can discuss client care with members of your clinical team, as long as it relates directly to the client's care. However, in some cases, such as those related to substance use treatment, there are more strict rules about what information can be shared. See: Confidentiality and Release of Information for more information. You can also find more specifics about the legal requirements and processes for protecting client information from the following sites: Health Insurance Portability and Accountability Act and 42 CFR Part II.