"When it comes to ethical decisions, there are no answers, there are only decisions."
—Mel Gray and Jill Gibbons
There are a number of ethical issues and dilemmas that can arise during home visiting. The very intimacy of having an ongoing relationship within someone’s home, with no other professionals present, can lead to confusing situations.
Ethical dilemmas are those gray areas where there is no legal mandate. These issues are best handled by having agency policies in place, in anticipation of their possibly coming up, and through the creation of additional policies when new situations arise.
During an initial meeting, it is important to establish what information (if any) will be kept confidential between you and the family and what information will be shared with others in your agency and under what circumstances. You must be very clear that you are required to report child abuse or neglect including domestic violence or use of illegal drugs by anyone in the home. It is also important to discuss the agency’s policy on keeping family health information confidential and only disclosing personally identifiable health information with written parental permission.
The term boundary refers to the differences between a professional and personal relationship with someone. Boundaries are frequently discussed within home-based programs, because the very nature of being in someone’s home every week brings an intimacy that can be more like friendship than if the parent and child come to a center. Reflective supervision can be extremely helpful as you explore your relationship with individual families. However, this is such a pervasive issue in home-based programs that staff and Policy Councils often work together to establish guidelines that a home visitor can refer to in the moment.
In any home visiting situation, you may become genuinely fond of a family, live in the same community, and find yourself disclosing information about yourself on more of a friendship level than a professional level. In small communities, you may have known the family all their lives or even be related to them, as happens in some very small, rural programs. Your behavior may be determined to some extent by your desire to be liked by the family. Your agency should consider the community it serves and then set policies about self-disclosure or about maintaining your professional role during the home visits.
There may be times of crisis when a family member needs transportation to an emergency room, when there is no food in the house and the food banks are closed, or when some other emergency may occur that will tempt you to provide cash or services that are completely outside of your regular services. Again, your agency needs to develop protocols for these kinds of events.
You may also be tempted to give a family your private phone number. Your agency should have a policy to give you direction.
The family may invite you to dinner or a birthday party. You may run into each other at elementary school events or at the grocery store. Reflective supervision and agency policies can help you know how to respond in these situations.
Many differences of values, beliefs, and customs may emerge when the home visitor and the family are from different cultures. Ideally these may lead to mutual learning, discussion, and negotiation of differences with an eye toward a shared goal, such as supporting the child’s learning. Some cultural differences, however, present ethical dilemmas.
A common example is the American, individualistic emphasis on autonomy, which contradicts the more common collectivist emphasis on valuing the group over the individual. One culture’s etiquette may require them to offer something to eat or drink-and that the guest accept. An EHS home visitor often brings the snack and uses as part of sharing nutrition information. The home visitor may resist accepting tea or coffee out of a concern for hot drinks near little children. These differences can be discussed, and home visiting services can be delivered in a culturally competent and respectful manner. Perhaps the home visitor could accept a glass of water.
In an article on ethical issues in cross-cultural business dealings, Pitta, Fung, and Isberg (1999) list several ways of dealing with these dilemmas, many of which are ineffective, such as avoidance or one party forcing its way on the other. The most positive approach is “negotiation and compromise-uncovering problems in the ethical relationship and solving those problems to mutual satisfaction” (1999, p. 254). In this approach, both parties work to find a mutually beneficial and acceptable solution.
Clearly, physical abuse cannot be tolerated, but can a little spanking be accepted while a cultural mediator may ultimately help the family to participate in the program where they may learn different methods of guidance and parenting if there is time for negotiation and compromise?