ETHICS, VALUES AND CULTURAL COMPETENC E IN ADULT PROTECTIVE SERVICES

ETHICS, VALUES AND CULTURAL COMPETENC E IN ADULT PROTECTIVE SERVICES NCEA/NAPSA NCEA/NAPSA Core Core Competencies Competencies Curriculum Curriculum MODULE MODULE # #2 2 For more information : Kathleen Quinn National Adult Protective Services Association Phone: 720.565.0906 Email: [email protected]

Address: National Center on Elder Abuse c/o Center for Community Research and Services University of Delaware 297 Graham Hall Newark, DE 19716 Phone: 302-831-3525 Fax: 302-831-4225 Email: [email protected] Web Site: www.ncea.aoa.gov The National Center on Elder Abuse is funded by the U.S. Administration on Aging Grant No. 90-AM--2792

This training is a product of the National Center on Elder Abuse (NCEA), which is funded in part by the U.S. Administration on Aging under Grant # 90-AM-2792. The project was developed by the National Adult Protective Services Association (NAPSA), and its contractor, the REFT Institute, Inc. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging policy. NAPSA 2006

NATIONAL ADULT PROTECTIVE SERVICES ASSOCIATION NAPSA is the only national organization which represents APS professionals, programs and clients NAPSA is the National Voice of APS NAPSA is a partner in the National Center on Elder Abuse NAPSA has members in 49 states and DC

HOUSEKEEPING AND INTRODUCTIONS Schedule for the day CEU instructions Location of restrooms Set cell phones to vibrate Introductions 5

DEVELOPING AN ID CODE What are the first three letters of your mother’s maiden name? Alice Smith What are the first three letters of your mother’s First name? Alice Smith What are the numerals for the DAY you were born? Nov th 29 Trainee ID Code S M I A L I 2 9 6

EVALUATION PROCESS Transfer of Learning Activity Satisfaction Survey Embedded Evaluation 7

APS CORE COMPETENCIES There are twenty-three modules in the Adult Protective Services (APS) Core Competencies identified by NAPSA. This module, Ethics, Values and Cultural Competence in Adult Protective Services, is #2.

ETHICS AND VALUES IN APS PRACTICE

TRAINING GOALS Provide a culturally competent ethical decision-making framework. Increase ethical selfknowledge. Increase knowledge and use of ethical multiculturalism principles.

LEARNING OBJECTIVES Define 7 ethical concepts in APS work. Describe 5 population changes that influence work with vulnerable adults. List 4 major influences on APS

LEARNING OBJECTIVES Describe the cultural competence continuum. Provide an example of using ethical multiculturalism principles. List 5 parts of an ethical and culturally competent decision-making framework.

ETHICS CODES AND CONCEPTS

ACTIVE LEARNING #1: LARGE GROUP Brainstorming: What are some ethical issues you confront in your daily practice?

ETHICS: DEFINED “Good” or “right” conduct Branch of philosophy dealing with values of human conduct Useful in assessing the rightness of decisions and the fairness of the decision-making process

ETHICS: CODE OF ETHICS Why do we need them? How do they guide us professionally?

NASW Code of Ethics Social Service Justice Individua l Dignity Module 2: Ethics and Values Human Relationships Slide 17

APS GUIDING VALUES Every action taken by APS must balance the duty to protect with the right to self determination Older people and people with disabilities who are victims of abuse, exploitation or neglect should be treated with honesty, caring and respect.

NAPSA: APS ETHICAL PRINCIPLES o Adults have the right to be safe. o Adults retain all their civil and constitutional rights unless some of these rights have been restricted by court action. o Adults have the right to accept or refuse services o Adults have the right to make decisions that do not conform with societal norms as long as these decisions do not harm others. o Adults are presumed to have decision-making capacity unless a court adjudicates otherwise.

ETHICAL CONCEPTS Autonomy Beneficence Non-maleficence Privacy Fidelity Accountability Justice

ETHICAL CONCEPTS: AUTONOMY Right of individuals to make choices as long as they have decision-making capacity and cause no harm to others. Decisions should be voluntary, intentional and not due to coercion, duress, or undue influence. APS Workers: Respect the client’s selfdetermination.

ETHICAL CONCEPTS: BENEFICENCE Right to receive care by others that maintains and/or enhances the client’s welfare. APS Workers: Do good for others. Promote the welfare of others.

ETHICAL CONCEPTS: NONMALEFICENCE Right to expect others to “do no harm” in the maintenance or enhancement of the client’s welfare APS Workers: Do not act in a way that will inflict harm on others. Weigh out all the possible consequences of your actions.

ETHICAL CONCEPTS: PRIVACY Right to maintain privacy regarding personal information, interpersonal relationships, physical environment, and lifestyle, as long as it does not infringe on the rights of others. APS Workers: Respect client’s right to control information about him/herself.

ETHICAL CONCEPTS: FIDELITY Right to have others show loyalty or commitment to the client when they need help. Right and responsibility of family members to care for and assist one another (e.g. filial piety). APS Workers: Include and respect ideas of family members and significant others.

ETHICAL CONCEPTS: ACCOUNTABILITY Right to expect others to tell the truth and be responsible for their actions. Right to expect others to expose the deception and irresponsibility of others. APS Workers: Be accountable and responsible for your actions and expect others to do the same.

ETHICAL CONCEPTS: JUSTICE Right to be treated equitably whether they are a caregiver or care receiver. APS Workers: Fairly distribute benefits (or costs or harms) among individuals.

ETHICAL CONCEPTS: IMPACT Typical problems begin with specific situations: Limited, specific, individual focus, requiring Limited, specific, individual answers. At the same time, we use a set of standards in order to analyze situations.

ETHICAL DILEMMA

ETHICAL DILEMMA: DEFINITION An ethical dilemma presents a choice between two relevant sets of values, two good things. OR

ACTIVE LEARNING #2 Large Group Exercise Individually read scenarios on handout. Share ethical issues and dilemmas found with large group.

ACTIVE LEARNING #3 Small groups discuss one influence Report shared with large group Large group brainstorming of strategies

FACTORS INFLUENCING DECISION-MAKING Client Client wishes wishes Professional Professional obligations obligations Personal Personal values values Community Community pressure pressure

ETHICAL MULTICULTURALISM IN APS PRACTICE

CHANGES IN THE UNITED STATES

POPULATION IS CHANGING More elders as Baby Boomers age More racially and ethnically diverse elders More elders who were born in other countries More vulnerable adults

POPULATION CHANGES Baby Boomers (65 ) 70 57.8 60 50 40 35 2000 2030 30 20 10 0 In millions

POPULATION CHANGES Population Ethnicity (65 ) 70 64% 60 50 White Hispanic Black Other 40 30 20 10 16% 12% 0 2050 7%

POPULATION CHANGES More Diverse Immigrants 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 92.1% 88.9% US Born Foreign Born 7.9% 1990 11.1% 2000

POPULATION: IMPACTS OF CHANGES Greater cultural differences among our vulnerable adults add to differences already created by: Age Disabilities Race Ethnicity Religion Social class Gender Sexual orientation

POPULATION: IMPACTS OF CHANGES The U.S. is no longer a “melting pot” but a dynamic multicultural nation. There are cultural groups that are keeping their identity and others that are blended. All contribute to the rich strength of this nation.

CHANGES IN CONTEXT Funding is changing. Service demands are changing. Accountability is changing.

CONTEXT: IMPACTS OF CHANGE It will be harder to find “standard responses” to the ethical dilemmas APS workers will face.

DEVELOPING CULTURAL INTELLIGENCE

UNDERSTANDING SELF Become culturally competent in your use of ethical multiculturalism!

WHAT DOES CULTURE HAVE TO DO WITH THIS? CULTURE is “that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits than can only be acquired by [an individual] as a member of society.” Source: Tyler 1988. We are ALL socialized (e.g., raised by our parents/caregivers) into our respective cultures.

CULTURAL INTELLIGENCE: DEFINED Cultural intelligence is the ability to successfully function in environments where individuals have experienced different [cultural training]. Source: Offermann and Phan 2002.

CULTURAL INTELLIGENCE: CHARACTERISTICS Uses the knowledge and skills APS workers already have. Understands one’s own learned values and biases. Understands others. Matches appropriate behaviors and expectations to the situation.

CULTURAL INTELLIGENCE: UNDERSTANDING SELF Culture hides much more than it reveals, and, strangely, it hides itself most effectively from its own participants. The real job is not to understand [other] cultures, but to understand one’s own. Source: Offerman and Phan 2002

CULTURAL INTELLIGENCE

ACTIVE LEARNING # 4 Self reflection on social groups Small group sharing Guided activity Self-reflection Large group debriefing

CULTURAL INTELLIGENCE: UNDERSTANDING SELF Some of the values of mainstream American culture include: Primary importance of the individual Happiness orientation Equality orientation Practicality Change orientation Achievement orientation Data-driven decision-making Source: Hoppe 1998.

CULTURAL INTELLIGENCE: UNDERSTANDING OTHERS This process: Often starts with cultural blindness. Develops cultural awareness, appreciation of diversity. Develops cultural knowledge about cultural differences and their impacts on attitudes and behaviors.

CULTURAL INTELLIGENCE: UNDERSTANDING OTHERS This process continues: Develop cultural sensitivity by showing understanding, and non-judgmental respect for and acceptance of different viewpoints. Develop cultural competence by showing empathy in understanding more fully how others perceive and experience the world.

CULTURAL COMPETENCE CONTINUUM Cu ltu ral Pr ofi cie nc y Cul tur al Co mp ete nc e Cu ltu ral Se nsi tivi ty Cu ltu ral Kn ow le dg e Cu ltu ral Aw ar en es s Cu ltu ral Bli nd ne ss

CULTURAL COMPETENCE MEANS The APS worker flexibly and skillfully responds and adapts when in a different cultural situation than his or her own. The APS worker understands and uses his or her own skills and knowledge in culturally congruent ways.

ETHICAL MULTICULTURALISM

How do cultural competence and ethics work together in APS practice?

ETHICAL MULTICULTURALISM: DEFINITION Ethical multiculturalism takes fundamental ethical principles and applies them in a culturally relevant manner. Source: Harper 2006

ETHICAL MULTICULTURALISM Characteristi cs Middle ground between two competing approaches to ethics: Absolutism ethical principles are universally applicable, or Relativism ethical principles are culturally bound and context dependent. Source: Harper 2006. Module 2: Ethics and Values Slide 63

ETHICAL MULTICULTURALISM Foundational Principles Foundational ethical principles: Respect for persons, community, autonomy Beneficence Justice Additionally: Caring Source: Harper 2006 Module 2: Ethics and Values Slide 64

ETHICAL MULTICULTURALISM In Practice Skills needed: Understanding the underlying intent of an ethical principle Ability to analyze how the underlying intent can occur in a specific cultural situation Module 2: Ethics and Values Slide 65

Module 2: Ethics and Values ETHICAL MULTICULTURALISM In Practice Autonomy analysis: Who is the fundamental decision-making unit in the culture? To whom are they accountable? Beneficence analysis: Whose welfare is being promoted in this cultural situation? Slide 66

ETHICAL MULTICULTURALISM In Practice Justice analysis: What is a “fair” distribution of benefits and negatives of the services in this cultural situation? Module 2: Ethics and Values Slide 67

ETHICAL MULTICULTURALISM In Practice Caring analysis. What is experienced as caring in this cultural situation? What norms guide interpersonal interactions? Module 2: Ethics and Values Slide 68

Module 2: Ethics and Values CULTURAL COMPETENCE Being culturally competent is essential in order to apply ethical multiculturalism in APS Practice! Slide 69

Module 2: Ethics and Values FRAMEWORK Ethical and Culturally Competent Decision-Making Slide 70

ACTIVE LEARNING # 5 Making ethical and culturally competent decisions in APS Practice Case Study Small group and large group discussions and sharing Module 2: Ethics and Values Slide 71

FRAMEWORK FOR DECISION-MAKING OVERVIEW OF STEPS: 1. 2. 3. 4. Define the problem. Identify stakeholders and their cultural backgrounds. Identify relevant ethical and cultural principles involved in case. Brainstorm possible options and actions. Module 2: Ethics and Values Slide 72

FRAMEWORK FOR DECISION-MAKING 5. 6. 7. 8. Select the most appropriate action(s). Evaluate your selected solution. Document your plan of action. Be open and flexible to revision when appropriate. Module 2: Ethics and Values Slide 73

FRAMEWORK: DEFINING THE PROBLEM Examine it from all sides. Obtain as much information as possible. Evaluate your sources of information. Identify different cultural interpretations of facts. Separate facts from opinions, beliefs, theories held by all. Module 2: Ethics and Values Slide 74

FRAMEWORK: IDENTIFY STAKEHOLDERS Take into account the individuals, families, communities and agencies that are involved in the situation. Understand their relationship to the client, including their motivation and influence on the client. Assess how the decision(s) may affect them all. Module 2: Ethics and Values Slide 75

FRAMEWORK: IDENTIFY CONCEPTS AND STANDARDS Determine the conflicts and dilemmas presented. Be aware of your own personal values. Remember your professional values. Consider the values of the stakeholders and how they may perceive the situation. Module 2: Ethics and Values Slide 76

FRAMEWORK: BRAINSTORM OPTIONS Determine benefits and burdens of each possible action for all involved. Eliminate the impractical, inappropriate, illegal. Obtain stakeholders’ input. Ask for consultation. Module 2: Ethics and Values Slide 77

FRAMEWORK: SELECT MOST APPROPRIATE ACTION Find an acceptable balance that meets the challenge. Look at the long term as well as the immediate fix. Reduce as much harm as possible to all involved. Module 2: Ethics and Values Slide 78

FRAMEWORK: EVALUATE YOUR SOLUTION Put yourself in the situation and see how it feels. Run it by your supervisor. Imagine the media getting a hold of the story: plan your response. Module 2: Ethics and Values Slide 79

FRAMEWORK: DOCUMENT ACTION PLAN Make a systematic step by step outline. Plan how you will deal with those who disagree with you. Follow up and monitor your plan. Be willing to accept new credible information and change your course of action. Module 2: Ethics and Values Slide 80

CASE STUDY Making Ethical and Culturally Competent Decisions Choose a recorder. Use the framework to develop a plan of action. Listen to and respect ideas of all group members (brainstorm). Document your plan in writing. Be prepared to defend it. Module 2: Ethics and Values Slide 81

Module 2: Ethics and Values THANK YOU FOR YOUR ATTENTION! Please remember to complete the course evaluation. Slide 82