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Putting Clients First

Fundamentals of Client-Centred Service Delivery

Without feelings of respect, what is there to distinguish men from beasts? ~ Confucius

Client-centred service in the communicare sector is focused on meeting clients’ needs and preferences. It involves respecting the client’s autonomy, voice, values, and participation styles in decision-making. It is multi-dimensional and encompasses all aspects of how services are delivered. The fundamentals include:

Service providers should discuss with clients their rights and responsibilities and provide them with accurate information regarding:

Service Provider’s Self Awareness

We live in a house of mirrors and think we are looking out the windows. ~ Fritz Perls

Service providers must have awareness of how their personal values, beliefs, and biases inform their practice and influence their relationships with clients. Client-centred service delivery also requires service providers to know and acknowledge how stereotypes and systemic “isms” (racism, sexism, heterosexism, ageism, and classism) influence their responses to clients.
Developing self-awareness is important because values, beliefs, attitudes and fears:

Social Location

Social location refers to an imaginary point on a comparative continuum which determines an individual’s social hierarchy, power and voice.

Various factors affect individual social location such as ability, age, citizenship status, class, education, gender, race, religion, sex, sexual orientation, socio-economic status…These attributes may intersect.

It also applies to social roles (sister, spouse, friend) and extends to include one’s experiences within these relationships.

Social location influences the context of how one sees the world and how the world sees the individual.

Attitudes, Beliefs and Values in Practice

Social location impacts what individuals believe in, what they see as important, and what they see as desirable or unacceptable. These attitudes, beliefs and values influence their personal and professional life.

It is important for service providers to be aware of their own beliefs and biases in their dealing with their clients. Being aware of their beliefs about culturally and socially divisive topics such as abortion, euthanasia, homosexuality, and female genital mutilation is not enough; they must also be aware of their beliefs about ordinary issues of daily life such as food, clothing, shelter, family relationships, age of consent, schooling, children’s autonomy…..

Service providers are required to put aside their beliefs and attitudes in order to put their clients’ needs, preferences and values first. Service providers who are self-aware are able to:

On the other hand, service providers who avoid or are unaware of their feelings are more likely to:

Self-Awareness Exercise

Bob Shebib (2003) recommended the following exercise for service providers to understand their own beliefs and attitudes regarding issues that might affect their relationships with their clients.

Instruction: Complete each sentence quickly without attempting to edit your thoughts. Reflect on your answers.

Client-Centred Service Delivery

Kind words can be short and easy to speak, but their echoes are truly endless. ~ Mother Teresa

Client-centred service delivery is based on ethical principles of respect for the individual, inclusivity and empowerment.

Self-determination

“The power of a person to act (1) freely and intentionally; (2) with substantial understanding; and (3) without controlling powers forcing them to choose to act in one way rather than another. The term ‘self determination’ has a similar meaning.” (Clifford & Burke 2009, p. 64)

Service providers must respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. However, the limit to clients' right to self-determination extends to:

Informed Consent

“In general, for consent to be considered valid six standards must be met: (1) coercion and undue influence must not have played a role in the client’s decision; (2) clients must be mentally capable of providing consent; (3) clients must consent to specific procedures or actions; (4) the consent forms and procedures must be valid; (5) clients must have the right to refuse or withdraw consent; and (6) clients’ decisions must be based on adequate information.” (Reamer 2006, pp. 167, 168)

The client must be given an opportunity to accept, decline, or withdraw from a service after facts and process have been explained. Prior to the delivery of service, the service provider must make sure the client understands agency or legal requirements regarding documentation, data collection or sharing of information. The limitations to confidentiality include:

Privacy and Confidentiality

Service provider should respect clients' right to privacy. They should not ask for personal information from clients unless it is essential to providing services. Once private information is shared, standards of confidentiality apply (with limitations mentioned above).

Case Management
Service providers can only use confidential information for the purpose for which it was acquired; or, with the written consent of the client, for a directly related purpose such as referrals.

Service providers must ensure clients’ anonymity and remove identifying details when permitted to use confidential information for purposes such as case presentation, consultation, or research.

Service providers should inform clients, to all possible extent, about the potential consequences of disclosure of confidential information before the disclosure is made.

When service providers offer services to families, couples, or groups, they should seek agreement among all persons involved about each individual's right to confidentiality and the obligation to preserve the confidentiality of information shared by others. However, they should be aware that service providers/the agency cannot guarantee that all participants will honour such agreements.

Service providers should not discuss confidential information with others in any setting unless privacy can be ensured. Confidentiality should be maintained when information is sent through the email or fax, or on messages left on voicemail or answering machines. 

Storage
Service providers should store clients' records (clients' written and electronic records and other sensitive information) properly and make sure that clients' records are not available to those who do not have authorized access.

Outdated client records should be shredded.

Confidentiality of deceased clients remains consistent with ethical and legal standards.

Conflicts of Interest

Service providers should be aware of and avoid conflicts of interest that interfere with professional and impartial behaviour. In some cases, protecting clients' interests may require terminating the professional relationship and making a referral to another equally competent service provider.

Service providers should not take advantage of any professional relationship to further their personal, religious, political, or business interests.

When service providers offer services to couples or family members, they should clarify their role with all the people concerned.

Cultural and Diversity Competence

“The core of the [client-centred] model is to recognize and respect clients’ ethnic, cultural and race-based values, characteristics, traditions and behaviour, and to integrate these characteristics successfully into practice.” (Soydan 2010, p. 144)

 Service providers should try to understand the client’s social location and any oppression they may face because of it. Factors that influence social location and lived experience include ability, age, ethnicity, marital status, national origin, political belief, race, religion, sex, sexual orientation.

Service providers should take steps to ensure clients' comprehension. When clients are not literate or have difficulty understanding English/French an interpreter or translator should be provided

Physical Contact

Service providers should not of their own initiative touch, hug, kiss, or engage in physical contact with clients. This is particularly important when there is a possibility of psychological harm to the client as a result of the contact.

If the service provider, in an extraordinary case, initiates physical contact, consent from the client must be assured, implicitly or explicitly.

Dual or multiple relationships

“Dual or multiple relationships between [service providers] and clients can assume many forms. Issues can arise in relation to having social contact, exchanging gifts, sharing meals, maintaining friendships, sharing personal details with clients, having business dealings with clients, and becoming involved with clients sexually” (Reamer 2006, p. 109).

Dual or multiple relationships refer to when service providers share more than one relationship with clients, whether professional, social, or business. Dual or multiple relationships can occur at the same time or one after the other.

Service providers should not engage in dual or multiple relationships with clients or former clients in which there are risks of exploitation or potential harm to the client.

In instances when dual or multiple relationships are unavoidable, service providers are responsible for setting clear, appropriate, and culturally sensitive boundaries

Service providers should under no circumstances engage in romantic or sexual contact with:

Service providers should not provide services to individuals with whom they have had a prior romantic or sexual relationship.

Gifts for Service

Service providers should avoid accepting goods or services from clients as payment for professional services.  Other points to keep in mind when accepting tokens of appreciation:

Service providers should not solicit gifts or other forms of remuneration for providing services to clients who are entitled to such services through the agency for which the service provider works.

Maintaining a client-centred approach to service delivery is an ongoing process, and is not just the responsibility of the service provider; to be successfully implemented there has to be adequate resources and the involvement of all staff whether in a direct or indirect supportive role. It also requires institutionalized monitoring through agency evaluations, discussions at supervision and staff meetings, in-service training, and feedback from clients. **

References

Canadian Association of Social Workers. (2005). Guidelines for ethical practice.  Retrieved May 13, 2007, from
http://www.casw-acts.ca/sites/default/files/attachements/CASW_Guidelines_for%20Ethical_Practice_e.pdf

Clifford, D & Burke, B, (2009). Anti-oppressive ethics and values in social work. Palgrave Macmillan, Basingstoke (UK).

Dinshaw, F. M. (July 12 and July 19, 2007). Service providers’ ethical responsibility.  In-house Staff Workshop. COSTI Immigrant Services, Toronto (Canada). 

Reamer, F (2006). Social work values and ethics, 3rd edn, Colombia University Press, New York (USA).

Shebib, B. (2003). Choices. Allyn & Bacon, New York. (USA)

Soydan, H. (2010). ‘Anti-racist practice’, in M Gray & S Webb (eds) Ethics and value perspectives in social work, Palgrave Macmillan, Basingstoke (UK), pp. 135–147.

Resources

Canadian Association of Social Workers. (2005). Guidelines for ethical practice.  Retrieved May 13, 2007, from
http://www.casw-acts.ca/sites/default/files/attachements/CASW_Guidelines_for%20Ethical_Practice_e.pdf

Centre for Addiction and Mental Health (n.d.). Bill of client rights. Retrieved on March 15, 2012 from
http://www.camh.net/About_CAMH/Boards_and_Governance/Client_Bill_of_Rights/client_bill_rights0405.pdf

Girls Action Foundation. (n.d.).Understanding your social location as a facilitator. Retrieved on March 15, 2012 from http://girlsactionfoundation.ca/en/amplify-toolkit-/section-2-considerations-for-facilitators/facilitator-identity-and-facilitating-across-difference/understanding

The CommUNITY Education (CUE) Program, Indiana University. (n.d). Cultural diversity self-assessment. Retrieved on March 15, 2012 from http://www.cue.indiana.edu/activitymanual/activities/Cultural%20diversity%20self%20assessment.pdf




This document may be reproduced for educational or non-commercial purposes without permission provided an appropriate credit or citation appears in the copied work as follows:
Dinshaw, F.M. (2012). Putting clients first.Ishoni Professional Development, Toronto, Canada