Upgrading Member Care: Five Stones for Ethical Practice

by Kelly O’Donnell

Providing ethical and responsible member care to mission/aid staff is crucial to the health and well-being of both the individual and the organization.

Member care is a broad field with a wide range of practitioners. As this field continues to grow, it is important to offer guidelines to further clarify and shape good practice. Any guidelines must carefully consider the field’s international diversity, and blend together the best interests of both service receivers and service providers. They also need to be applicable to member care workers (MCWs) who have had different types of training and experience.

The purpose of this article is to help upgrade the ethical quality of the supportive care that we offer mission/aid staff. By “ethical” I mean in accordance with recognized guidelines which promote responsible care and good practice. Such guidelines deal with areas like confidentiality, skill competencies, continuing growth, accountability, sensitivity to human diversity and organizational responsibility for staff care. This article is meant for caregivers from different cultural backgrounds, including MCWs, leaders, staff and sending organizations.

SOME EXAMPLES
There are four premises that influence the ethical practice of member care. First, staff are human beings with intrinsic worth—not just resources with strategic worth. Second, ethical care is committed to the integrity of the organization and its purposes, as well as the well-being of its staff, including its leaders. Third, sacrifice and suffering are normal parts of mission/aid work. And fourth, how we provide services to staff is as significant as the actual services themselves. We provide quality care, carefully. Consider these three examples—all of which focus on specific issues in dealing with member care.

Competence. An experienced consultant makes recommendations to a humanitarian service organization based in Asia. The consultant is addressing the care of the emergency staff who are working in a massive disaster area that is rampant with cholera and malaria. The consultant is vaguely familiar with that cultural context and the organization itself. To what extent does the consultant need to inform the agency about limitations in his or her background? When is it okay to “stretch” beyond one’s area of training and experience? If no one else is readily available to offer advice, is the consultant acting competently by offering advice outside of his or her area of expertise?

Confidentiality. A compassionate leader informally exchanges a few emails with a man in the same organization who is having marital struggles. The man tells the leader that he and his wife have frequent fights that can be overheard by African neighbours. Later, the leader prays with his own wife about the other couple’s struggles. Is it okay for one’s spouse to know such things? Is the disclosure of “significant problems” protected information? Would asking the leader to not share be “secretive”? What type of confidentiality is appropriate?

Responsibility. A reputable sending organization shortens a family’s field preparation from three months to one month so that the husband, a medical doctor, can fill a crucial and vacant position in a refugee hospital in the Middle East. To what extent does making such “adjustments” simply reflect the realities of mission/aid work? What if individual lives are at stake? To what extent is the organization acting responsibly toward the family and the refugee patients?

Many other types of ethical issues get stirred up in mission/aid settings as well. These include:

—assessing physical/mental disabilities during selection (e.g., whether hiring, locating or promoting staff is based on such disabilities)

—determining who has access to personnel files (e.g., whether team leaders have access to team member personnel files, especially to “negative” information)

—working in stressful settings with limited supervision, contingency plans and personal debriefing (e.g., whether senders can support staff adequately in risky, disaster settings, or in longer-term, isolated settings)

—consulting with people with whom one has many types of social/work relationships (e.g., whether to offer conflict mediation to an interagency group that includes people from one’s own agency)

—confronting unhealthy practices of leaders and staff (e.g., whether certain lifestyle choices are private affairs, and how to protect staff that point out problems)

Ethical member care involves more than just identifying the right ethical guidelines and then simply applying them. Rather, it is fundamentally a way of thinking through problems, practices and the possible consequences of our actions. It develops over time through training, experiencing and reviewing various scenarios with others.

For example, before we send an email response to a question about a child’s misbehavior, a depressed team member or a conflict with an organizational policy, we would do well to “think ethically.” We must pause and ask ourselves these questions:

—Who may be seeing our communications, now and in the future?
—Do the communication exchanges need to be encrypted?
—Am I responding informally as a colleague, “officially” on behalf of an organization or as an MCW?
—Do I have enough information to offer input?
—How accurate is the information I have?
—Should I consult with anyone about the situation?
—Which ethical guidelines are relevant?
—What may be the consequences of my response and/or advice?

Remember, there is always an ethical context and an ethical mentality that accompanies our member care work.

Many types of professional ethical guidelines called codes exist that relate to the practice of member care. Such ethical codes are primarily relevant for the disciplines and countries for which they were intended. Yet many MCWs enter the member care field with a combination of life experiences and informal training, and are not part of a professional association with a written ethics code. Common sense and one’s sense of morality only go so far—as does appealing to another country’s or discipline’s ethical code, which can result in a rather cumbersome match between the person and the code. This “mismatch” is akin to David being outfitted in Saul’s armor (1 Sam. 17:38-39), only to find it was too large for him—too cumbersome—and hence more a liability than an asset as he prepared to fight the Philistine Goliath. David needed something custom-fit to the way God made him. He needed only a sling, some stones and the power of God.

By analogy, MCWs and sending groups need to identify ethical frameworks which can guide their member care practice and help further shape their ethical mentality. We need to carefully identify “smooth stones”—relevant ethical guidelines—that fit into our cultural and experiential “slings.” We must ask ourselves, “What might some of these stones look like?”
The following are five special stones which will help us in fulfilling these four purposes: (1) to emphasize quality of services by senders and MCWs, (2) to encourage ongoing development for MCWs and senders, (3) to educate those who are using and/or providing MCW services and (4) to protect service receivers via safeguards.

STONE ONE: COMMITMENTS FOR MEMBER CARE WORKERS
Stone one offers fifteen core guidelines (see below) in the form of MCW commitments (O’Donnell 2004, 95-97). It focuses on the personal qualities, skills and training needed in order to do member care ethically. The underlying principle is that MCWs are committed to providing the best services possible in the best interests of the people whom they serve. The guidelines are intended to be referred to regularly, to be discussed with colleagues and to be applied in light of the variations in our backgrounds.
Personal qualities and qualifications. Character, competence and compassion are necessary to practice member care well. These “three Cs” are embedded in the fifteen commitments above.

Character refers to moral virtue, emotional stability and overall maturity. The qualifications for leaders that Timothy and Titus list in scripture (see 1 and 2 Timothy and Titus) reflect the character traits MCWs need. Those in member care ministry have positions of trust and responsibility and work with people who are often in vulnerable places. Therefore they need to model godly characteristics as they minister responsibly in order to protect and/or provide for those who receive their services.

MCWs, like anyone else, can experience serious problems, including emotional, familial or moral struggles. In such cases, the quality of
MCWs’ services can decrease, and MCWs need help, accountability and often a time of restoration. If MCWs cannot manage their own life well, it will be difficult for them to manage the mission/aid “household” (2 Tim. 3:4-5). Member care receivers expect Christian MCWs to model a healthy, godly lifestyle and to maintain a close relationship with the Lord. Commitments 1, 2 and 15 (personal growth, accountability, relationship with Christ) are the most relevant for MCW character.

Competence refers to having the necessary skills to help well. Competence is not necessarily based on degrees or certification, although the systematic training that is required to get these “validations” is a very important consideration. People without such institutional validation are also capable of doing member care well, and indeed in many places they are the primary service providers (e.g., peers, team leaders). Note that MCWs, like others in the healthcare field, can be stretched at times to work in ways that may go beyond their skill level. And many services can be in ambiguous, complex and difficult settings, with the outcomes (positive or negative) not easy to predict. Caution and consultation with others are needed in such cases.

Christian workers in South Asia are being trained to provide pastoral care for staff in their organizations. Most do not have backgrounds in the health sciences, but they are mature people who have been chosen by their leaders to receive special training in areas like basic counseling, crisis care, running a personnel office and team building. They also have access to the trainers for case consultation via email and/or telephone. These MCWs reflect a growing number of caregivers who are recognized within their organizations as being able to offer helpful services. Another example is the “peer debriefers” who are being trained in Africa as a first line of help when critical incidents occur. Commitments 4, 7, 11 and 13 (knowing strengths/limits, getting supervision, respecting different MCW norms, abiding by local laws) are especially important for MCW competence.

Compassion refers to our core motivation for member care work. It is the love of Christ that compels us. We value people for their inherent worth. MCWs often sacrificially give of themselves. They do so not to compensate for personal deficits; rather, it comes from a compassionate commitment to help others grow. Compassion has limits, and MCWs need to know their boundaries and practice self-care. Nonetheless, there are times and even seasons when serving others is costly, when helping may be done out of a sense of duty and obedience. This may temporarily interrupt our commitment to self-care (e.g., the tired disciples being asked to serve the crowds in Luke 9:10-17). Commitments 1, 5, and 15 (self-care, sensitivity to others’ felt needs, relationship with Christ) are key for maintaining MCW compassion.

STONE TWO: GOOD PRACTICES FOR SENDING ORGANIZATIONS
“Good practice” is a term used by many human service organizations, and it is the essence of stone two. This term refers to the development of principles that promote quality services. Quality care by an organization is intended for both service receivers (e.g., helping and treating patients) and service providers (e.g., managing and supporting staff). “Key indicators,” specific criteria to assess how each principle is being followed, are also identified in good practice.

Stone two, side one: general principles. Good practice in member care is rooted in the example of the care offered by Christ, the “good practitioner.” Consider the “continuum of care” (below), in which our Lord’s relationship with us serves as a foundation for our interaction with others. The middle two dimensions, comforted and/or challenged, are normative for us and reflect many of Jesus’ encounters with disciples in the New Testament. The extremes on the continuum represent “worst practice” and do not reflect Christ’s relationship with us. Likewise, they should not reflect our relationships with mission/aid personnel. We should not overly protect our personnel or insufficiently challenge them (coddling) and we should not blame them for having needs and/or frailties (condemning). The Lord’s relationship with us is foundational to the five good practice principles in side one of stone two.

An international Christian mission focuses on orphanage work in Africa. Many children receive good care, a solid education and practical vocational training. But both home office personnel and field personnel in Africa average only two years of service. What is the best thing to do in this situation?

Good Practice. Get information from staff. Leaders discuss staff input in light of these five good practice principles and the mission’s goals. They talk about the agency’s “culture” of work and care, policies and the leadership styles that might contribute to staff growth or turnover. They ask hard questions about (1) their own spiritual life and that of staff, (2) maintaining work-life balance, (3) structures to help staff support each other (email access, small groups, retreats), (4) funds to further train staff, (5) a referral list for specialist services and (6) the agency’s connections with mission and member care networks. And they pray!
Poor Practice. The leaders do not meet, nor talk openly, most likely because they feel threatened. They are too busy and don’t get the perspectives of those on staff. Nor do they have records, surveys or exit interviews that can provide objective data. The leaders may discuss issues one-on-one, but no action is ever taken from those discussions. There is no review process in place regarding work-life balance, staff effectiveness, staff development, organizational practices and staff morale. (See Principles for Senders on page 351.)

Stone two, side two: specific principles. Side two expands Principle 3 (Sender Care) on the previous side of this stone. It is an abridged version of the Code of Good Practice (2003) developed by People In Aid, an international network of development and humanitarian agencies (see page 353). It includes seven principles and several key indicators or specific criteria. Sending organizations can use it to monitor how their member care (human resources) policies are integrated into their overall goals.
A sending church in Europe helps support ten mission/aid workers. The workers are part of separate agencies and they work on four different continents. Their biggest issue is maintaining communication with these workers, and feeling connected with each other. Most of the responsibilities for “managing and supporting staff” are assumed to lie with the sending agency rather than the church. During the past year, one of these workers was severely injured in a car crash and needed several months of intensive physiotherapy, while another suffered from recurrent malaria. What is the best thing to do in this situation?

Good Practice. Each worker is assigned a volunteer advocate from the sending church who stays in monthly contact with the worker. The mission coordinator reviews these seven good practice principles with the church pastors and elders. They agree to adopt these principles and send copies of the Code of Good Practice to the volunteer advocates, workers and sending agencies. Over the next two months the mission coordinator talks with the personnel director of each sending agency. They review how best to support the respective workers, taking special note of Principles 4, 6 and 7 (communication with staff, learning opportunities, health/safety issues).

Poor Practice. The sending church agrees to help send three more mission workers. The addition of three more photos looks pretty good on their world map in the entrance of the church. The mission coordinator gets a copy of the Code of Good Practice, reads it with appreciation and dutifully files it…until a new crisis hits one of their thirteen mission/aid workers.

STONE THREE: ETHICAL SUB-STANDARDS FOR SENDERS AND MCWS
Stone three consists of ten areas of rationalization (called sub-standards) that we can all-too-easily adopt (see 354). This stone helps us to regularly scrutinize both our motives and the ethical quality of our member care work. According to Ken Pope and Melba Vasquez, who originally spoke on these sub-standards,

Faced with the complex demands, human costs, constant risks and often limited resources from our work, we may be tempted to simplify life by changing or overlooking our ethical responsibilities. Not wanting to view ourselves or have others view us as being unethical, we use common fallacies and rationalizations to justify our unethical behaviours and quiet a noisy conscience. These attempts to disguise our unethical behaviours might be called ethical sub-standards, although they are not really ethical. (1999, 1)

At an international member care conference, a group of mission leaders and MCWs discuss member care issues during a special interest group. The facilitator uses the ten areas of rationalization as a springboard to discuss how quality services can be compromised. Many tricky examples are voiced: “I needed to do what I thought was best as there was not opportunity to consult a book or colleague”; “I do prayer ministry for depression and professional ethics are not relevant”; and “I am a good person and my good intentions guide how I run the personnel department.” The participants then break into small groups to relate these ten rationalizations with sayings from the book of Proverbs. They also use several safeguards from stone one to help prevent them from lapsing into ethical sub-standards.

STONE FOUR: YOUR CHOICE
Stone four involves identifying or developing a set of guidelines that fit with one’s background and context. For several ideas, refer to chapter 23 in Missionary Care (1992, 315-331); chapter 52 in Enhancing Missionary Vitality (2002, 445-452); and the ethical guidelines from chapter 44 in Helping Missionaries Grow (1992, 260-268).

Some MCWs are specialists and have advanced degrees/certification in their respective disciplines. So in addition to making use of the previous three stones, they abide by a fourth stone, which is their respective disciplinary/professional association’s code of ethics. An example of five general principles that are common to several professional codes is found in chapter 19 of Missionary Care (1992, 260-268).

Other MCWs take less formal or systematic training routes (e.g., taking workshops, much life experience). Currently there is no generic accreditation or professional association for MCWs in this category. Stone one and stone three will be helpful to them. For instance, in line with commitment fourteen of stone one, they are encouraged to identify a specific code of ethics that “fits” them (e.g., national or other codes for Christian counselors, “life skills” coaches and human resource managers). They are also encouraged to have a written endorsement from their organization that attests to their competence and accountability.

Sending organizations that solicit/receive MCW services are responsible for carefully choosing MCWs who will serve as either in-house or outside caregivers. The fifteen commitments of stone one, for instance, can serve as a grid to help evaluate prospective service providers. Responsibilities also include orienting staff concerning the availability of member care resources. Senders are also encouraged to endorse or adapt one or more Codes of Good Practice for managing and supporting their staff that fits their context (stone two). An example of codes from the United Kingdom and Canada are included in chapter 26 in Doing Member Care Well (2002, 269-276). Smaller and younger sending groups can also get ideas from larger and older groups.

STONE FIVE: THE "UNKNOWN STONE"
This stone I leave for others to develop together in the future. It will likely be different though complimentary to the other four in this article. It may emphasize an ethical imperative for personal and group sacrifice on behalf of humanity. Or perhaps it will become the “mother of all stones” and pull together many principles for ethical care in a comprehensive, transcultural framework.

FINAL THOUGHTS — RESPECTING DIVERSITY
Taken together, these stones provide a relevant framework for doing member care ethically. I have found it helpful to review these stones regularly, discuss them with colleagues and above all use them. For most of us, I believe they can fit well in our “cultural and experiential” slings. For others, these stones may still feel cumbersome and “foreign,” like Saul’s armour was for David. In such cases I encourage colleagues to see them as aspirational points of departure, and apply them in view of their cultural and organizational contexts and ongoing experience. We in member care are committed to acknowledging and respecting our diversity. And we are committed to identifying and embracing appropriate guidelines to upgrade both the way we think about member care and the way we practice it.

References
Gropper, Rena. 1996. Culture and Clinical Encounter: An Intercultural Sensitizer for the Health Professions. Yarmouth, Maine: Intercultural Press.

Hall, Elizabeth and Betsy Barber. 1996. “The Therapist in a Missions Context: Avoiding Dual Role Conflicts.” Journal of Psychology and Theology. 24 (3): 212-219.

Mattis, Robert and John Johnson. 2003. Human Resource Management, 10th edition. Mason, Ohio: Thomson.

Nagy, Thomas. 2005. Ethics in Plain English: An Illustrative Casebook for Psychologists. 2nd edition. Washington D.C.: American Psychological Association.

O’Donnell, Kelly, ed. 1988. Helping Missionaries Grow: Readings in Mental Health and Missions. Pasadena, Calif.: William Carey Library.

____. 1992. Missionary Care: Counting the Cost for World Evangelization. Pasadena, Calif.: William Carey Library.

_____. 2002. Doing Member Care Well. Perspectives and Practices from Around the World. Pasadena, Calif.: William Carey Library.

_____. 2004. “Guidelines for Member Care Workers: 15 Commitments.” Connections: The Journal of the WEA Mission Commission. 3 (2): 95-97.

People In Aid. 2003. Code of Good Practice in the Management and Support of Aid Personnel. Accessed July 30, 2004 from www.peopleinaid.org.

Pope, Ken and Melba Vasquez. 1999. “On Violating the Ethical Standards.” California Board of Psychology Update. May: 1-2.

Powell, John and Joyce Bowers, eds. 2002. Enhancing Missionary Vitality: Mental Health Professions Serving Global Mission. Palmer Lake, Colo.: Mission Training International.

Psychotherapy Networker. March 2003. Special issue on ethics. Accessed July 30, 2004 from www.psychotherapynetworker.org.

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FIFTEEN COMMITMENTS FOR MEMBER CARE WORKERS
1. Ongoing training, personal growth and self-care.
2. Ongoing accountability for personal areas and member care ministry.
3. “Doing no harm” and having high standards in my services.
4. Recognizing the strengths and/or limits in myself, skills and services.
5. Understanding and respecting
the felt needs of those with whom I work.
6. Working with other colleagues, and making referrals when needed.
7. Consulting and getting supervision regularly and as needed.
8. Representing my skills and background accurately.
9. Preventing problems as well as offering supportive and restorative services.
10. Having cultural and organizational sensitivity and respectingdiversity.
11. Not imposing my disciplinary and/or regulatory norms on other MCWs.
12. Serving as a link and/or mediator between staff and organizations when needed.
13. Abiding by legal requirements for offering member care in a given country.
14. Practicing member care ethically, based on specific ethical guidelines.
15. Growing in my relationship with Christ, the best practitioner.

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PRINCIPLES FOR SENDERS FROM DOING MEMBER CARE WELL (2002)
Principle 1: Master Care. Our relationship with Christ is fundamental to our well-being and work effectiveness. Member care resources strengthen our relationship to the Lord and help us encourage others in the Lord. Master care—care from the master—is the heart of member care.

Principle 2: Self and Mutual Care. Self care is basic to good health. Self-awareness, monitoring one’s work-life balance, a commitment to personal development and seeking help when needed are signs of maturity. Likewise, quality relationships are necessary with family and friends in our home and host cultures. Member care is a two-way street; we receive it from others and we also give it to others.

Principle 3: Sender Care. Our organization’s staff, including home office and field workers and their families, is our most important resource. We acknowledge the need for staff to freely and sacrificially give of themselves to others, often in very stressful settings. We therefore provide and develop a variety of resources in order to support our staff, from recruitment through retirement. We offer quality services for staff and we expect quality services from staff.

Principle 4: Specialist Care. Mission/aid work requires specially trained people who at times need the support of specialist services. We therefore carefully select and develop ongoing relationships with qualified specialists from such fields as tropical medicine, psychology, pastoral care and family life. Our goal in providing specialist care is empowerment—to help personnel further develop the resiliency and capacities needed for their lives and work.

Principle 5: Network Care. In light of our organizational purposes, we connect with geographic and specialist networks in the member care field. We also contribute to the development of this field as we can, and work with others to actively “knit a net” of resources for the overall benefit of the mission/aid community.

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PRINCIPLES FOR SENDERS FROM PEOPLE IN AID (2003)
Principle 1: Human Resources Strategy. Human resources are an integral part of our strategic and operational plans. The organization allocates sufficient human and financial resources to achieve the objectives of the human resources strategy.

Principle 2: Staff Policies and Practices. Our human resources policies aim to be effective, fair and transparent. Policies and practices that relate to staff employment are in writing, are monitored and are reviewed. Staff are familiarized with policies and practices that affect them.

Principle 3: Managing People. Good support, management and leadership of our staff is key to our effectiveness. Staff have clear work objectives and performance standards, know whom they report to and know what management support they will receive. All staff are aware of grievance and disciplinary procedures.

Principle 4: Consultation and Communication. Dialogue with staff on matters likely to affect their employment enhances the quality and effectiveness of our policies and practices. Staff are informed and consulted when we develop or review human resources policies or practices that affect them.

Principle 5: Recruitment and Selection. Our policies and practices aim to attract and select a diverse workforce with the skills and capabilities to fulfill our requirements. Written policies and procedures outline how staff are recruited and selected to positions in our organization. Our selection process is fair, transparent and consistent.

Principle 6: Learning, Training and Development. Learning, training and staff development are promoted throughout the organization. Adequate induction and briefing specific to each role is given to all staff. Written policies outline the training, development and learning opportunities staff can expect from the organization.

Principle 7: Health, Safety and Security. The security, good health and safety of our staff are a prime responsibility of our organization. Written policies are available to staff on security, individual health, care and support, health and safety. Program plans include written assessment of security and travel and health risks specific to the country or region and are reviewed at appropriate intervals. Before an international assignment, all staff receive health clearance. In addition, they and accompanying dependents receive verbal and written briefings on all risks relevant to the role being undertaken, and the measures in place to mitigate those risks, including insurance. Briefings are updated when new equipment, procedures or risks are identified. All staff have a debriefing or exit interview at the end of any contract or assignment. Health checks, personal counseling and career advice are available. Managers are trained to ensure these services are provided.

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ETHICAL RATIONALIZATIONS TO AVOID
1. It is ethical as long as you don’t know a Bible verse, law or ethical principle that prohibits it.
2. It is ethical as long as your colleagues or service receivers do not complain about it; or as long as no one else knows or wants to know; or as long as you can convince others that it is okay.
3. It is ethical as long as you or your telecommunications technology were having a “bad day,” thus affecting your usual quality of work; or as long as the circumstances and decisions are difficult; or as long as you are busy, rushed or multi-tasking.
4. It is ethical as long as you follow the

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