These case studies, involving fictitious victims, represent a collection of facts identified from multiple Justice Center investigations and are used for illustrative purposes only to aid in staff training. The case studies below present a variety of examples of boundary problems with a range in severity of actions and potential consequences. A printable copy of this page can be found below.

Case 1

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

Red Flags

  • Carlita is sharing pictures without the consent of the people in care, their family, or legal guardian.
  • Fellow staff members have told Carlita that she is not adhering to an agency policy about the use of social media.
  • Carlita does not have a clear understanding of her agency’s social media policy.

Potential Risks and Harmful Outcomes

  • Carlita is breaching her duty to maintain the confidentiality of people in her care.

Case 2

A 16-year-old boy, Brandon, has recently been discharged from a residential treatment facility. Brandon’s parents are very grateful for the work the clinician, Matt, did to help stabilize their son and return him to their care. Matt went above and beyond for Brandon on more than one occasion, spending extra time with Brandon to help him feel comfortable attending groups and providing additional one-to-one support during transitions.   When Brandon was discharged, his parents brought Matt cupcakes and a card. After they leave, Matt finds a $50 gift card was included in the envelope. Matt does not report this to his supervisor and uses the gift card. Later, Brandon has another crisis and his parents reach out to Matt directly to see if Matt can help get Brandon re-admitted. Matt explains that he cannot help in this situation because he is not in charge of admissions. Brandon’s parents are upset about Matt’s response and repeatedly call Matt and leave him voicemails at all times of the day and night.

Red Flags

  • Matt spent extra time with Brandon.
  • Matt received a monetary gift and did not report it to his supervisor.
  • Matt accepted the gift and did not return it to the family.
  • The family became upset when they were not given preferential treatment.

Potential Risks and Harmful Outcomes

  • Trust is damaged. Brandon’s parents feel misled by acceptance of the gift.
  • Matt has compromised clinical ethical standards and agency policy, putting his reputation at risk.
  • Care of other people receiving services is compromised due to increased attention to Brandon and reduced attention to others.
  • Other people receiving services and/or family members find out about the gift and either attempt the same thing with other staff or feel they will be treated unfairly due to their limited resources or desire to buy gifts.

Case 3

Rebecca is 37 years old and has arrived at a residential program for substance abuse treatment. She has a significant trauma history, and this is her first time in a residential setting. Rebecca is expressing serious concerns about relapsing to Rob, a staff person. Rebecca feels connected to Rob when he tells her she reminds him of himself at that age, when he too was in treatment for substance abuse. Rebecca tells Rob that she struggles the most at nights, so Rob offers her his phone number in case she needs extra support. The agency policy states that calls after hours are not permitted between staff who are not on duty and people receiving services. However, Rob feels he has strong rapport with Rebecca and that he could help her if she needed it. Rebecca and Rob begin texting every night. Rob takes Rebecca outside with him to put out the agency garbage on several occasions. Agency policy prohibits unsupervised contact between staff and people receiving services. Rebecca develops a crush on Rob and tells him she is interested in more than friendship. He tells her he feels the same way. Rebecca tells her roommate about their conversation and her roommate tells the House Manager who reports the incident to the Justice Center.

Red Flags

  • Rob’s behavior is a sign that he is either over-identifying with Rebecca or grooming her.
  • Rob violates agency policy when he gives Rebecca his personal phone number and does not encourage her to use the approved methods for reaching out for help when needed.
  • Rob violated agency policy when he took Rebecca outside with him while he took out the garbage.
  • Rob and Rebecca talk about their interest in having a sexual relationship.

Potential Risks and Harmful Outcomes

  • Rebecca is no longer in an emotionally safe and therapeutic environment necessary to her recovery and could cause her to relapse.
  • If they engage in a sexual relationship, Rob faces legal consequences for committing a crime.
  • Rebecca leaves treatment prematurely and relapses.
  • Other people receiving services are triggered by the inappropriate relationship, their trust in treatment is broken and their recovery is compromised.

Case 4

Mary is a 15-year-old who has been placed in a secure juvenile detention facility. Mary has been in crisis repeatedly since finding out her visits with her mother have been revoked. Mary starts writing notes to a staff member, Sue, about her feelings. Sue feels sorry for Mary and hides the notes from her supervisor but tells another staff member about them. Mary then begins writing Sue notes telling Sue how much she loves her, that she waits all day to see Sue and that Sue is the only staff who helps her feel better about not seeing her mother. Mary asks to speak with Sue, but Sue is busy and doesn’t have time to speak with Mary before her shift ends. Mary becomes upset and writes a suicide note. Staff find the note and they intervene before Mary could harm herself. The note references the other notes that Mary has sent to Sue, and that Mary thought this meant they were in love. Staff report this to Sue’s supervisor who immediately suspends Sue.

Red Flags

  • Mary begins writing notes to Sue about her feelings.
  • Sue doesn’t address the problem when Mary’s letters become romantic. She does not report it to her supervisor or request time to speak with clinical staff to ensure Mary’s treatment needs are met.
  • Mary assumes that Sue is her only support at the agency and does not learn how to rely on other staff on duty during a crisis.

Potential Risks and Harmful Outcomes

  • Mary transfers her feelings to Sue rather than getting the help she needs to address the loss of her mother in her life.
  • Mary becomes jealous and more depressed whenever others get Sue’s attention.
  • Sue quits or is terminated, when she could have received support in handling the issue if she sought it out.
  • Mary considers attempting suicide.

Case 5

Valerie is a 52-year-old woman who resides in a residential program for people with developmental disabilities. Valerie uses gestures to communicate. Valerie expresses her appreciation and happiness by hugging people. She often seeks staff out in the dining hall to hug them before, during and after meals. There is no agency policy about physical affection but a staff member, Pat, is feeling very uncomfortable when Valerie hugs him. Pat raises this concern with his supervisor who tells Pat he needs to relax because hugs help Valerie feel loved and understood.

Red Flags

  • The agency does not have a policy about physical affection with people receiving services.
  • Pat does not want to hug or be hugged by Valerie.
  • Pat raises the concern with his supervisor who does not provide adequate support and training for Pat on this issue.

Potential Risks and Harmful Outcomes

  • Pat avoids interacting with Valerie and neglects his duties to care for her because he has not been given adequate supervisory support and training.
  • Valerie does not receive any support or opportunity to learn how to maintain personal boundaries, which would reduce her risk of harm and exploitation.
  • Pat quits.

Case 6

Ron is a 1:1 teacher’s aide and has a student in 8th grade, Haley, who is extremely artistic. Haley gives Ron every art project she makes including paintings, drawings and sculptures. There is no policy about receiving items from students, but Ron is starting to get uncomfortable with the volume of items Haley is giving him. Other staff members begin to joke that she has a crush on Ron. Ron doesn’t know how to deal with this and is afraid he will get in trouble because of Haley’s crush so he begins avoiding and firmly rejecting Haley whenever she approaches him.

Red Flags

  • Staff members have observed that Haley has strong feelings about Ron and they joke about this instead of addressing it.
  • Ron begins to avoid Haley and treats her somewhat harshly.
  • Ron does not seek support from his supervisor or clinical staff or bring this issue to a team meeting.

Potential Risks and Harmful Outcomes

  • Haley misses out on an opportunity to learn about personal boundaries, which increases her risk of harm and exploitation.
  • Haley becomes emotionally traumatized. Her feelings continue to grow, unreciprocated, and over time, she feels distraught and traumatized by the rejection.
  • Ron asks for a transfer to another program and never communicates he’s leaving to the class, and the students who liked Ron feel abandoned and hurt.
  • Ron quits his job because of a lack of support and training on how to handle this type of situation.

Case 7

Jonathan is a 54-year old man who attends a day habilitation program for adults with disabilities four days a week and has a job at an office one day a week. Jonathan is paid for his clerical job in the form of a check each Friday. On a Friday, Angela, a staff member, found Jonathan crying. When Angela approached Jonathan, he explained to her that he got a check for twenty dollars, but that his house did not have enough staff that evening to take him to the bank to cash his check. Jonathan told Angela he was worried he would not be able to go to the movies on Saturday, as planned. Although agency policy does not allow loaning money to people in care, Angela felt bad for Jonathan, handed him twenty dollars, and asked that he pay her back the next week. Jonathan thanked Angela and put the money in his backpack. Angela was then approached by Mark, another person receiving services, who overheard the discussion, and Mark asked her if he could borrow money from her. Angela told him no and Mark stormed off, slamming the door behind him.

Red Flags

  • Angela is giving her money to a person receiving services as a loan.
  • Angela may be showing favoritism towards Jonathan.
  • Angela is not following her agency’s policy on giving money to a person receiving services.
  • Angela did not follow up with her supervisor to explain the situation and seek direction on how to address issues like this in the future.

Potential Risks and Harmful Outcomes

  • Since Angela loaned one person receiving services money, other people receiving services may feel entitled to the same treatment.
  • Angela may not receive her money back.
  • Mark’s reaction could lead to a more serious event, where he or another person is hurt.

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