Maintaining Professional Boundaries with Individuals Receiving Services

In this episode, we'll discuss the concept of professional boundaries, help to clearly define what they are, why they're non-negotiable, and how to train providers and staff on maintaining clear, respectful, and appropriate professional boundaries when working with individuals with disabilities. 

We'll also tackle the tricky side: the risks associated with failing to uphold professional boundaries and the common challenges that often arise.  

Finally, we’ll walk through a Justice Center case study and provide actionable guidance on how to train your staff on maintaining professional boundaries. 

Today’s episode isn’t about establishing rules; it’s about creating safe environments built on respect and individual autonomy. 

Featured Guests 

• Brandi Young, Quality Care Facility Review Specialist, NYS Justice Center 
• Sara Nelson, Quality Care Facility Review Specialist, NYS Justice Center 

Transcript

Erin Hogan (00:10):

Hello, and welcome to the “Could This Happen in Your Program?” podcast, where we find collaborative solutions to protecting New York's most vulnerable populations. Today, we discuss why it's so important to maintain proper professional boundaries while caring for others. We'll also tackle the tricky side, the risks associated with failing to uphold those professional boundaries, and the common challenges that often arise in programs. Finally, we'll walk through a Justice Center case study and provide actionable guidance on how to train your staff.

Okay. Well, Brandi and Sara, thank you so much for joining us today.

Could I just let you introduce yourselves to our listeners who are tuning in?

Brandi Young (00:48):

Yeah, no problem. I'm Brandi Young. I work for the Prevention Quality Improvement Department. I am a Quality Care Facility Review Specialist, and I complete corrective action plan audits following investigations. And, on top of that, I aid in creating prevention resources for our department and doing trainings on those.

Sara Nelson (01:12):

And I'm Sara Nelson. I'm also in the Prevention and Quality Improvement Unit. I'm a Quality Care Facility Review Specialist, and I focus on the prevention products and the prevention trainings that we also provide. And so that's my main focus. And just for a little context too, with professional boundaries, Brandi and I have just in this year alone, have worked with the training unit and completed 14 virtual trainings, and we have three more. And we've also in just this year, have presented to over 200 people in person for professional boundaries. So it's something that we're very, yeah, and something we're very excited about.

Erin Hogan (01:56):

Okay. Well, you alluded to our topic, which I mentioned in the intro, but Professional Boundaries is what we're here to talk about today. Can you just either one of you kind chime in and explain for our listeners what we mean when we say professional boundaries, and kind of introduce the topic a bit?

Sara Nelson (02:12):

Yeah. So I usually like to say professional boundaries, very simplified, is a line. It's a limit to keep everyone safe. And so I always like to give the example of personal boundaries with the intention of creating a space that's safe for me.

So, the example I give in trainings, is I put my phone on silent at night when I sleep. So that keeps me in a good health state. And when we look at professional boundaries, the intention is really what can I do to create a safe space for the people that we're serving? And so with the phone, another example could be I put the phone in my bag when I get to the office, so that way I can be more alert to serve the people we support. So, that's a very basic looking at it, and it's really just the focus on how the limits that you set for safety change from when you're outside of work to when you are then at work and working with both your colleagues and the people receiving services, excuse me, to make sure that health and safety are maintained.

Brandi Young (03:32):

I mean, Sara really hit on all the main points of what the topic's about really when we're providing it, we really try to just continually emphasize that we're trying to get people to understand how their actions impact the people they're working with, maintaining that health and safety and how their actions can lead to setbacks for the people they're supporting, how it can really impact them in ways that they might not necessarily understand or grasp at the time. And our training, I think, gives some good examples like concrete ones that they can leave with and apply in their work.

Erin Hogan (04:10):

And I think it gets really hard too when you go to work every day with individuals who are receiving care, but those lines can get blurred pretty easily. People develop friendships, and I know I've even had conversations with individuals receiving services who say they even often feel like they are infringing on a professional boundary for their caretaker because, and they don't want to get them in trouble, of course. But it is a very unique topic. So, can you run into some of those examples and what you tend to see, and for our listeners, many folks may not understand our jurisdiction, but it's quite broad. And we have jurisdiction over six different state agencies, anywhere from children to individuals with disabilities, individuals receiving psychiatric care. So yeah, can you run down a couple of scenarios or examples?

Brandi Young (05:03):

Yeah, I mean, the most obvious and common ones you would see that we talk about with staff are things like romantic relationships. That's a hard, fast, red. We're not crossing that boundary, right? But in terms of, well, you had mentioned friendships, staff are working with people closely, and like you said, you develop a fondness for one another, but we have to continually remind staff that you are an employee.

Brandi Young (05:33):

You are not their friend. They don't call you on the weekend to check in and things like that. And that can be hard to hear, and it can be hard to separate those relationships. But when you don't do that, it can really snowball into something that can become both detrimental to the staff and lead to abuse, neglect, allegations, and costs of their jobs. And the other person, it just blurs the lines, and they become more confused about what is and is not okay.

(06:00):

Some other things, we like to make sure that we give examples of our physical contact because when working with people in the Office for People with Developmental Disabilities, you're putting hands on to help them provide actual care. And that can also lead to some blurred lines as well. So, it's not easy. So that's why we think this, in particular, this training is one of our most popular because of that. Because it's not clear, it's not as black and white as people think. Some things are, but it can be difficult for staff to navigate. So, that's why we like to offer this out to the providers.

Sara Nelson (06:35):

Yeah, absolutely. And some of the other examples, I guess that are more along the lines of blurred lines or gray areas, similar to what Brandi mentioned, oversharing we see quite often, and which can always, again, be because there are friendships and because you are working so closely. And so that's also why it's super important for agencies to have these policies and to really follow the Justice Center Code of Conduct, the licensing agency, any guidance, policies, regulations too, because that really helps to kind of clarify and to keep everyone on track with the expectations and, really, keeping those boundaries in place.

Erin Hogan (07:28):

And what would some of those policies be? And is that something you walk through in the professional boundaries training? What policies a provider facility should have in place for its staff?

Brandi Young (07:39):

Yeah, definitely. We touch on mainly just asking them, do you have one, first of all? And you would hope yes, you'd hope, but it's not always the case. And then some people will be like, yes, we do. And then we'll ask like, well, what does it say? And that's where the disconnect comes. Many will have the policy, but the staff don't actually know what they  need to do and what's in it.

So we do like to bring up that and encouraging them to seek it out if they don't know if they have one, ensuring that the policy gives them good concrete examples and what their responsibilities are, what their limitations are. Because depending on what agency or providers they're with, what the boundary is for Office of Children & Family Services is going to be different than what might be for OPWDD or OASAS or one of them. So again, it's making sure that they know if it's there, what's in it. And we do have some other things that we can provide for that.

Sara Nelson (08:36):

Yes, we actually have a few different resources. We have a two page resource on our website on the prevent abuse page that also has a quick guideline for creating a policy. And then we have a more in depth resource as well in our spotlight on prevention toolkits. And those also outline what a great professional boundaries policy would have.

Brandi Young (09:08):

Yeah, it has the social media too, because that's something we also talk support is social media and how that has created some more areas that agencies need to be thinking about now to help prevent any boundaries being crossed outside of work.

Erin Hogan (09:25):

And I can imagine just the dawn of social media eras has really made things difficult for people understanding what’s me showcasing my role at work versus me infringing on somebody's personal safety, personal rights, identifying information that they may not have wanted shared.

Sara Nelson (09:43):

I feel like we often see staff have a good intention. Staff are wanting to either help the person that they're serving or their client or they have a similar story. And so they want to be able to share that experience in order to help that person. And what's hard with that is that, and what we talk about a lot in our trainings is that you're not always thinking about the impact that that's going to have on that person and the idea that maybe they're now having to hold this information for responsibility or possibly it could re-trigger them also. So that's also something that we talk about a lot is even if your intentions are very well-meaning, you still really need to maintain those boundaries because that's in the best interest of the person you're supporting.

Erin Hogan (10:36):

And I think that's a really good point. I think we all go to the most egregious cases, the sex abuse cases, the abuse, et cetera. But, really, it sounds like a lot of the allegations we see in this area are those that are toeing the line between appropriate behavior and again, something that's infringing on someone's safety. And, so how do you touch on that? Tell me a little bit more about the Professional Boundaries training. And for our listeners, we'll make sure to link it up all of the training and resources in the note section of the podcast. So please take a look at that and we'll provide a little link on the screen. But can you tell us a little bit more about the training program and how our listeners might be able to have you all come to their facility and give them a training?

Brandi Young (11:27):

Do you want to take that one? You're kind of our coordinator at the moment.

Sara Nelson (11:30):

You can talk about the virtual screenings or the training unit, and I'll talk about, so we have been, and our unit has always tried to accommodate agencies that request our presence for training on professional boundaries. Recently this year we've completed two professional boundary trainings that were tailored for the agency. The agency, for example, one agency was having more increased cases in more of a touching professional boundary, such as play fighting or horse play.

Sara Nelson (12:09):

We tailored that training to really specifically focus on that concern. Another agency, their main, the cases that were coming up for them had a lot of social media and self-disclosure. So for that training, we tailored to really focus on that aspect and dive in deep to that. So that's really nice with being able to go in person to the agencies, we're really able to connect. We've been able to work with the agency and also give them suggestions for their policies that they provide. And then we're able to use the policies in the presentation as well and be able to really have that interactive participation with the participants and the attendees. So that's been really, really valuable.

Erin Hogan (13:03):

And set them up for success. I mean, ultimately, that's what we're here to do is inform them so that employees understand the appropriate line and understand what happens, the consequences of crossing that line.

Sara Nelson (13:17):

Yeah, they really appreciate the case scenarios that we bring in the, “Could This Happen In Your Program” toolkit.

Erin Hogan (13:30):

The inspiration for this podcast, if you will.

Sara Nelson (13:31):

Exactly. So we always bring that in. And we also will give other examples of cases that we've seen. And the staff are always so surprised.

Sara Nelson (13:44):

They’re always completely shocked that this is a common thing that we see. Which again, for me means that the staff is really having that good intention and it's just clarifying, yes, and clarifying and helping to refresh that.

Brandi Young (14:01):

And like you said, it's not always these horrible, egregious things. I mean, we share scenarios where it's something as simple as I brought a gift in for one person and not the other.

(14:11):

And how that alone can now create, oh, I'm showing favoritism. She doesn't like me as much as the other person. And you don't necessarily think of that. You think, oh, I'm giving them a gift for their birthday or whatever it might be. And staff I think, can connect with that and like, oh, I didn't think of that, which wouldn't necessarily. So yeah, I think the case scenarios have been probably one of the big highlights from our trainings.

Erin Hogan (14:40):

Well, that's a great lead into the second half of our show because we're going to go through case scenario again, for those of you haven't seen the podcast, what we do is talk about the issue a little bit and then we go through a case scenario and we talk about the issues that we spot within the case and discuss alternate strategies that an individual in that scenario might use at their program. So see you right back after the break and we'll give you guys a chance to take a rest and then we'll chat again. Thank you. Sounds good.

(15:12):

Carita works in an inpatient psychiatric center. Carita loves their job and cares a great deal for the people they support at the center. As part of their job, Carita assists with leading recreational activities such as movie or game nights in the community room. Carita often takes pictures of the people on their cell phone when they're participating in these activities and post them onto their social media accounts. Other staff members have pointed out to Carlita that the agency has a strict policy about using social media related to their work. Carlita states that they are not breaking confidentiality because they do not identify anyone posted in the pictures other than by their first name and do not post the pictures until they get home after their shift.

So there are some red flags here, and we talked about social media when we spoke earlier in the show. So maybe could you all touch on what do we see in this case? What are some of the areas that you as the experts would point out as some failures?

Brandi Young (16:08):

Well, first, taking photos of the people you're supporting is overall something that we would say avoid, don't do. Definitely check your agency policy on that. I've seen policies where it's included and they say people have to sign it because sent form for that to happen.

(16:25):

Again, referring back to your agency's own policy procedures, first and foremost,

Sara Nelson (16:32):

Kudos to the staff for pointing that out to Carlita of, “Hey, this is really against our policy.” Kudos to those staff for pointing that out.

Brandi Young (16:47):

I mean, I can understand, Carlita might've been a little confused here as well, because in her defense on this, the policy itself may not be clear enough on saying yes, while she's not identifying anyone necessarily by their full name, there's other identifiers that could possibly be in the photo that could allude to where the person is, who they are, who they're around. So if that were the case, I would recommend that the supervisor, administrator, whomever it might be, look at the policy and if it needs to be adjusted to specifically make it more black and white, that we don't take photos, we don't post 'em on our own social media. That could be another step to help prevent something like that.

Sara Nelson (17:28):

And the other thing that really sticks out to me is Carlita didn't ask, or it seems in the scenario, Carlita didn't ask any of the people if they wanted their photo taken at all. And so not even considering their wants or preferences and what's in their best interest. Again, like Brandi said, of identifying factors. So the fact that she wasn't really thinking about the people she's actually serving, and more about the posts, that's the concerning intention that pops out to me.

Brandi Young (18:04):

And it comes back to was she trying to do anything malicious? Was she trying to make cross a boundary here? Probably not. No. And again, that's how things can snowball, though. It starts off as something very innocent and then before you know it, you're getting a call from the Justice Center because of something like that.

Sara Nelson (18:22):

And again, for I guess the next steps that I would suggest is for that staff that had already approached Carlita would be to notify supervisor or someone above just identifying what the issue was and explaining that they also explained to Carlita that this was against the policy. And then maybe there's a confusion. We want to assume the best, but this way the supervisor can really dive into the policies, can have that conversation with Carlita, and then can establish a plan going forward that will hopefully say or identify that pictures should not be posted on their social media.

Erin Hogan (19:09):

And I think there may be a difference too in this person's personal social media versus the provider’s social media account. Maybe the consent form says you consent to your photo being used for marketing purposes or whatever it might be for the provider, but not for someone's personal account, which it gets really muddy there. And I think that's a huge deal. I know that when, from just a basic marketing and communications background, going into facilities, a lot of times they'll say, you can get a picture from behind, but you can't get anyone's likeness without a consent form. Even sometimes there are certain rooms where there are flyers on the wall that'll say, your presence in this room for a public event indicates you consent to having your photo taken. And that exists as a consent form. But, if it's not clear, that's where those lines definitely can get crossed.

Sara Nelson (20:06):

One of the agencies I worked for previously, they had a consent form that was required per event for whatever the photo was being used for. So that way the person, as well as any of their family advocates, anyone on their team really supporting them could also help to say, this is an event that the picture would be appreciated, or this is something that person's not interested in and would not like their picture associated with. And so I thought that that was nice because it really considered what the person wanted.

Erin Hogan (20:38):

Yeah, and I think even just for me, a general thought of what, “would you want if this was your loved one in care,” your child, your sibling, your parent, would you want their image taken if they didn't consent to it? Probably not. Right. So yeah, I mean, I can certainly understand where that happens. Anything else related to social media or this specific case?

Brandi Young (21:05):

I mean, social media, it is a complicated topic. That's why we're trying to create and come up with more resources for it so that things like this don't occur. Because now Carlita now has photos of people that she works with on her phone, and that in of itself is a boundary that you wouldn't want to necessarily cross and have that type of images and things on your phone, even if it's innocent and it's of a party that they're all having fun at. It's just, yeah. So they create a lot of great discussion in our trainings. I'll say that.

Sara Nelson (21:39):

Absolutely. The other thing I would say with social media, and especially in this particular scenario, because I believe Carlita tagged the people as well, so it's unclear,

Erin Hogan (21:53):

We'll identify them by their first name. I think it's

Sara Nelson (21:56):

Identified by their first name. Yeah.

Erin Hogan (21:57):

Okay.

Sara Nelson (21:57):

Thank you for clarifying. So the other thing with that is if any of them also had social media, what that can do is that can open up the opportunity for messaging, direct messaging, and when you're using social media that the inhibitions are decreased. And so again, it really opens up a very big door for opportunities that you just don't want to see go down the wrong way.

Erin Hogan (22:34):

Well, I guess to close out, what would you say the single most important piece of advice you would give either folks that you were training or individuals listening here today about maintaining those professional boundaries? What's the most important thing, or two things, since there are two of you?

Brandi Young (22:52):

Me, I'm going to go with self-awareness and always having in the back of your head, is what I'm doing in their best interest, not to make myself feel better. Is what I'm sharing going to help them? How is it going to help them? And always just coming back to that and checking in with yourself and making sure you're maintaining the boundaries you should be. Again, you get friendly, you like the people you're working with, but you have to always be checking yourself to make sure.

Sara Nelson (23:21):

Yeah, that's a good one. What I would say is definitely looking at your agency's policies, and especially with social media, we do see that often and phones. And so keeping your personal phone number personal and not sharing that and keeping any sort of social media profiles. Also, keeping a difference between anything professional and personal. Again, looking at those agency policies and what they have, but that would be my one.

Erin Hogan (23:57):

And erring on the side of caution, when in doubt, just don't do it. Don't take that photo. Don't bring your phone to a meeting you shouldn't be in. Yep. Well, this was great. Thank you so much for sitting down with us. Sara and Brandi really appreciated having you. We look forward to having you back sometime. And for the listeners here, this has been the “Could This Happen In Your Program?” podcast, and we hope you have a great rest of your day.