Running head: Confidentiality

SHB5315 - Ethics and Leadership in Studies in Human Behavior
U10al Analysis of Work Environment and Ethical Dilemma
Due: June 15, 2012
By: Katrina Hines

The purpose of this paper is to analyze a hypothetical ethical dilemma within a hypothetical work environment, describing professional role within the environment, structure within the professional role who does one supervise and who supervises one, identifying the population that will be served in the professional role and the diversity of the population, addressing social and cultural diversity. Selection; of the appropriate code of professional ethics and ethical decision model; evaluating the function of the work environment in relation to the legal and accepted standard of practice for setting.

Selection of the environment
Helping Hands is North Carolina’s leading provider of children’s behavioral healthcare. The Psychiatric Residential Treatment Facility (PRTF) accepts children from throughout the state. The organization is accredited by the joint Commission, which is recognized nationwide as a symbol of healthcare quality reflecting the highest level of performance and certified by the North Carolina Department of Human Services as a Critical Assess behavioral Health Agency (CABHA). The agency offers a comprehensive array of treatment options for children with emotional and behavioral difficulties. Helping Hands mission is to provide quality professional treatment to children with emotional and behavioral problems; effective and efficient array of services, enabling children and families to exercise self- determination, achieve their potentials and become positive contributors to society. The website is www.Helpinghands@cabha.org.
The organization would be considered a medical model, human service model and prevention model. Programs and services are divided into three categories: diagnostic and outpatient office services, community based programs, and counseling treatments are rendered for potential clients. Job title is Intensive in Home – Team Lead- Licensed Professional Counselor. Intensive – in Home Service is a team approach designed to address the identified needs of children and adolescents, who due to serious and chronic symptoms of an emotional, behavioral and or substance use disorder. The service is time- limited intensive child and family intervention based on the clinical needs of the youth through the age of 20 for Medicaid – funded services and through the age of 17 for state- funded services. The team would consist of therapist and two qualified professionals with a caseload of eight youths. The two qualified professionals are supervised by the Team Lead. Team lead is supervised by the Clinical Director. Monthly Child Family Team Meeting facilitated by the Team Leader (Therapist) is conducted so that all persons involved in treatment can assess the needs of the client and family; weekly team meetings are also conducted to review cases.
Diversity and Cultural Competency
According to Cannon (2008) “the changing demographics of the United States population demands that counselor education programs provide training experiences that facilitate the development of multiculturally competent counselors”. To be culturally competent, individuals must be open-minded and recognize that valuing and respecting cultural differences requires a commitment to life-long learning and being able to make sound ethical decisions within diverse cultural contexts (ACAPCD - Lee, 2008). According to (Ahmed, Wilson, Henriksen Jr & Windwalker Jones, 2011) “the most important work for every counselor and mental health professional is to become more culturally responsive and respectful. Cultural competence is first and foremost a commitment to take the next step, and the next and the next toward offering accessible and appropriate services for the diverse clients and communities being served; counselors need to learn to ask questions sensitively and to show respect for different cultural beliefs”. The Helping Hands is dedicated to ensure a diverse pool of employees in efforts to provide quality services to each and every individual in need of mental health services, regardless of race, color, sex, religion, national origin, ancestry, physical disability, sexual orientation.
Professional Code of Ethics
The Help Hands organization refers to the American Counseling Association Code of Ethics. The American Counseling Association is an educational, scientific, and professional organization whose members work in a variety of settings and serve in multiple capacities. ACA members are dedicated to the enhancement of human development throughout the life span. Association members recognize diversity and embrace a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts (American Counseling Association 1995). For this ethical dilemma we will be focusing on section B: Confidentiality, Privileged Communication and Privacy Section. According to (American Counseling Association, 1995; American Mental Health Counselors Association, 2000), Confidentiality is one of the most critical aspects of any counseling relationship. The counselor's responsibility is to protect the client; confidentiality might be seen as protecting the counseling relationship and the strength of its therapeutic alliance (Issacs, Stone (2001). Minors see themselves as entitled to confidentiality rights similar to adults, although acknowledge that parents should be made aware of information about sexuality, pregnancy, physical or sexual abuse, substance abuse, crimes against property, and dangerousness to self or others (Collins & Knowles, 1995; Levick, 2000; McGuire 1994; Messenger & McGuire, 1981; Rubanowitz, 1987; VandeCreek, Miars, & Herzog; 1987). According to Collins & Knowles, 1995; Swenson, 1997) proposed that the balancing of client rights with the legal and ethical requirement to protect clients and to consider legitimately interested third parties (families, victims, or the broader society)—is complicated in the face of conflicting laws and ethics. This balancing act is managed with little guidance with regard to the concerns of the special population called minor client: (Lawrence & Kurpius, 2000.)
Research has suggested that minor clients are sometimes reluctant to enter counseling and that confidentiality is their most salient concern with few differences in beliefs about disclosure by age (Collins & Knowles, 1995; Kaser-Boyd, Adelman, & Taylor, 1985.) It has further been suggested that decisions to enter counseling and degree of therapeutic alliance created with disclosure of sensitive personal information are greatly impacted by assurances of confidentiality, counselor behavior to protect disclosures, and freedom from disclosure of private information (Gustafson & McNamara, 1987; Smith-Bell, & Winslade, 1994.)
Ethical dilemma Angel, 17-year-old Afro- American female, honor student, captain of cheerleading squad, president of student body, participated in the youth group at her church and other community services. All of the students admired her, and the faculty members considered her a role- model. Angel was also known in her church community and school environment as an advocate for the youth. Angel recently was awarded a full scholarship at Howard University. According to School Guidance Counselor, three-months prior she became aware of Angel’s decline in school performances, social interactions, personal appearance, and her apathy towards life, school and her future. School Guidance Counselor and concerned parent referred Angel to Helping Hands for psychotherapy for treatment of depression.
Previously Guidance Counselor had contacted the parent due to Angel missing school for several days, and concerned about the decline of her academic performance, and her decision to not participate in her extra curriculum activities. Angel refused to communicate with the Guidance Counselor.
According to Angel’s mother in her home environment Angel would isolate herself from family members, often caused chaos between her siblings and was disrespectful towards her parents. Angel’s mother stated to Guidance Counselor and therapist that Angel has done a 360-degree turn. Per Angel’s mother, Angel does not comply with curfew. She stays away from home several nights at a time; her demeanor has become moody, irritable and unpredictable and has completely ostracized herself from family members, school and society.
During one session, Angel confined to the therapist that she is pregnant. Angel has not told to her parents of her pregnancy. Angel reports that she is afraid, experiences insomnia, difficulty concentrating and anxiety. She is afraid that her parents would not support her; and requested that the therapist does not inform her mother of her pregnancy. Her boyfriend told her he does not want a baby. Angel as well, does not want a baby. What is the responsibility of the therapist? Is she obligated to inform the parent of Angel’s pregnancy? Angel will be turning eighteen in a couple of months; would she be considered an adult? Is she capable of making sound decision regarding her pregnancy? If therapist informs parents is this a breach of confidentiality? How would the decision to inform parents’ effect the client- therapist relationship? According to Collins & Knowles, 1995; Swenson, 1997) proposed that the balancing of client rights with the legal and ethical requirement to protect clients and to consider legitimately interested third parties (families, victims, or the broader society)—is complicated in the face of conflicting laws and ethics.
Ethical decision making model
The ACA Ethics Committee has developed A Practitioner's Guide to Ethical Decision Making The guide offers professional counselors a framework for sound ethical decision making addressing guiding principles that are globally valuable in ethical decision making, and a model that professionals can utilize as they address ethical questions in their work.
The ACA incorporated the work of Van Hoose and Paradise (1979), Kitchener (1984), Stadler (1986), Haas and Malouf (1989), Forester-Miller and Rubenstein (1992), and Sileo and Kopala (1993) into a practical, sequential, seven step, ethical decision making model. Following steps are recommended: (1) Identify the problem, (2.) Apply the ACA Code of Ethics, (3).Determine the nature and dimensions of the dilemma, (4). Generate potential courses of action, (5). Consider the potential consequences of all options; choose a course of action, (6). Evaluate the selected course of action, (7). Implement the course of action. Van Hoose and Paradise (1979) suggest that a counselor "is probably acting in an ethically responsible way concerning a client if (1) he or she has maintained personal and professional honesty, coupled with (2) the best interests of the client, (3) without malice or personal gain, and (4) can justify his or her actions as the best judgment of what should be done based upon the current state of the profession; following this model will help to ensure that all four of these conditions have been met”.
Legal and Ethical Issues
One of the most difficult and ethical dilemmas for counseling working with minors is the issue of confidentiality, what to share and what not to share with parents or legal guardians. The basic dilemma with respect to confidentiality is who is the client, parent or child ( Lawerence, Kurpius, 2000). Hendrix 1991, proposed four positions regarding confidentiality, with minor children, (a). complete confidentiality with counselor disclosing nothing of the treatment with parents,(b) limited confidentiality, which requires the minor to waive, in advance the right to know what will be revealed to parent or guardian, (c) informed forced consent which occurs when the child is informed before disclosure is made to the parents but the child has no say in what is disclosed and (d) no guarantee of confidentiality is made to the child. Reflecting on Angel’s case, the decision to inform parents of her pregnancy was the plan of action. Reviewing the company policies and ACA ( American Counseling Association on confidentiality, signed consent forms, consulting with professional colleagues and finally session with Angel to discuss decision to inform parents of pregnancy. It is the counselor’s responsibility to inform parents of sexuality, pregnancy, physical or sexual abuse, substance abuse, crimes against property, and dangerousness to self or others. (Collins & Knowles, 1995; Levick, 2000; McGuire 1994; Messenger & McGuire, 1981; Rubanowitz, 1987; VandeCreek, Miars, & Herzog; 1987), states that “ minors see themselves as entitled to confidentiality rights similar to adults, although acknowledge that parents should be made aware of information about sexuality, pregnancy, physical or sexual abuse, substance abuse, crimes against property, and dangerousness to self or others.
Conclusion
Agreeing with Lawerence & Kurpius(2000) statement” confidentiality with minors must be sensitively handled both with the minor client and parent. The most effective approach is one that creates trust and elicits cooperation from both client and parents. Involving the parents in the creation of mutually agreed guidelines for disclosure and motivating the minor client to disclose on his or her own are two positive strategies that benefit the parents and the client and protect the counselor”.

References
Ahmed, S., Wilson, K., Henriksen Jr, R., & Windwalker Jones, J. (2011). What does it mean to be a culturally-competent counselor?. Journal for Social Action in Counseloring and Psychology, 3(Number 1), doi: ISSN 2159-8142
American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria, VA: Author
American Mental Health Counselors Association. (2000). Code of ethics for mental health counselors. Alexandria, VA: Author.
Cannon, E. P. (2008). Promoting moral reasoning and multicultural competence during internship. Journal of Moral Education, 37(4), 503-518.
Collins, N., & Knowles, A. D. (1995). Adolescents' attitudes towards confidentiality between the school counselor and the adolescent client. Australian Psychologist, 30, 179–182.
Gustafson, K. E., & McNamara, J. R. (1987). Confidentiality with minor clients: Issues and guidelines for therapists. Professional Psychology: Research and Practice, 18, 503–508.
Isaacs, M,L., Stone, C (2001). Confidentiality with minors: mental health counselors' attitudes toward breaching or preserving confidentiality. Journal of Mental Health Counseling; Oct2001, Vol. 23 Issue 4, p342, 15p, 4 Charts
Lawrence, G., & Kurpius, S. E. (2000). Legal and ethical issues involved when counseling minors in nonschool settings. Journal of Counseling and Development, 78, 130–135
Levick, M. (2000). Privacy rights of minors. In F. W Kaslow (Ed.), Handbook of couple and family forensics: A source book for mental health any legal professionals (pp. 105–119). New York, NY: John Wiley.
Messenger, C., & McGuire, J. (1981). The child's conception of confidentiality in the therapeutic relationship. Psychotherapy: Theory, Research and Practice, 18, 123–130.
Rubanowitz, D. E. (1987). Public attitudes toward psychotherapist-client. Professional Pychology: Research and Practice, 18, 613–618
References

Van Hoose, W.H. & Paradise, L.V. (1979). Ethics in counseling and psychotherapy:
Perspectives in issues and decision-making. Cranston, RI: Carroll Press.

References
Swenson, L. C. (1997). Psychology and law for the helping professions (2nd ed.). Pacific Grove, CA: Brooks-Cole.
VandeCreek, L., Miars, R. D., & Herzog, C. E. (1987). Client anticipations and preferences for confidentiality of records. Journal of Counseling Psychology, 34, 62-67