Ethics in Rehabilitation Counseling

1. Ethics in Rehabilitation Counseling Michael Maxwell PhD. Candidate Sam Houston State University

2. Rehabilitation Counseling • Definition – from text (as taken from Szymanski & Danek, 1985) • “A profession that assists persons with disabilities in adapting to the environment, assists in accommodating the needs of the individual and works toward full participation of persons with disabilities in all aspects of society, especially work” (Szymanski & Danek, 1985, p.83)

3. Rehabilitation Counseling • Definition – George Washington University Rehabilitation Counselor Education Programs • “ …. Concerned with assisting individuals who have disabilities with maximizing their potential and their independence.” (http://www.gwu.edu/~chaos/rehab/Rc_def.htm)

4. What specific disabilities do Rehabilitation Counselor work with? • Physical disabilities (ie. cerebral palsy) • Sensory disabilities (ie. blindness) • Developmental disabilities (ex. mental retardation) • Cognitive disabilities (ie. head injured) • Emotional disabilities (ie. substance abuse)

5. Ethics • Definition – Van Hoose & Kottler, 1985 • “Ethics is concerned with questions that have no ultimate answers, yet are important to planning one’s life, justifying one’s activities, and deciding what one ought to do” (p.3).

6. Ethical Dilemma As defined by Toriello & Benshoff (2003) • A choice must be made between 2 courses of action • There are significant consequences for taking either course of action • Each course of action can be supported by ethical principal • The ethical principal supporting the unchosen course of action will be compromised.

7. Brief History of Rehabilitation Counseling • Began in the early 20th century in the area of vocational counseling. • Evolved out of events such as the Industrial Revolution, vast immigration, the Great Depression, and World Wars I and II.

8. Brief History of Rehabilitation Counseling • Later, rehabilitation counselors adapted their vocational approaches to match the needs of clients with disabilities. • During the 1970s, the independent living movement stimulated another surge in the service delivery of rehabilitation counseling.

9. Why rehabilitation counselors? • Attitudinal, social, and economic barriers exist when it comes to individuals with disabilities obtaining fair market employment • Rehabilitation Counselors work more as social advocates within, as well as outside of session

10. Striking statistic • As of 2004, there were an estimated 43 million Americans who had disabilities that restricted some major life activity, and prevented them from attaining a job

11. Striking statistic • As of 2001, there were 99accredited rehabilitation counseling master’s-degree programs

12. Rehabilitation Counselor Skills • Rehabilitation counselors primarily work as generalists, vocation specialists, and personal adjustment assistants • Following are the specific areas of expertise a rehabilitation counselor may be expected have:

13. Rehabilitation Counselor Skills • Assessment • Diagnosis • Careers • Individual and groups counseling • Case management • Program evaluation • Advocacy • Consultation • Job placement • technology

14. New trend: Teamwork • Rehabilitation practice is typically conducted within a collaborative team context. • Training in this area will be imperative • Case management and medical knowledge should be areas of strength

15. Rehabilitation Counselor Qualification Standards For certification, a rehabilitation counselor must have: • Master’s degree in rehabilitation counseling or related program • Achieved national certification • Attained state licensure

16. Rehabilitation Counseling Pre - Test

17. Ethical Issues in Rehabilitation Counseling • Confidentiality & Privilege Communication • Informed Consent • Client to counselor relationship • Responsibility • Counselor Competence

18. Confidentiality & Privilege Communication Areas of possible ethical dilemmas: • Maintaining confidentiality in institutional settings • Disclosure to client employer of danger or discipline • Sharing client info. with family members • 3rd party payment agencies and disclosure • Client illness unsafe to self and others

19. Confidentiality & Privilege Communication Additional areas of ethical dilemmas: • Group counseling setting • Treatment team debriefings

20. Confidentiality & Privilege Communication • In all cases, maintain a conceptualization of client advocacy • A clear and concise explanation of your limitations and obligations as a counselor is imperative, via personal statement and informed consent. • Share only what is pertinent and necessary.

21. Informed Consent • Three areas pertaining to rehabilitation counselors : • Capacity • Comprehension • Voluntariness

22. Informed Consent • It is the counselor’s duty to be certain that the client either has the capacity to give consent, or a legal authority ( parent or bureaucratic appointed ) provides consent. • Again, as an expression of advocacy, any attempt to equalize the power differential between counselor and client is recommended.

23. Client – Counselor Relationship • Sexual relations with a client is illegal in all 50 states. • Sexual relations with a client is potentially harmful, at the least • New code allows for client-counselor relations a minimum of 5 years after termination • Take to the notion: Do No Harm.

24. Responsibility • Code clearly specifies that the primary responsibility of the rehabilitation counselor is the client ( advocacy ) • Cannot deny secondary responsibility to other parties ( employer, 3rd party payment, law, etc. ) • Issues of paternalism / co-dependence need to be processed.

25. Counselor Competence • Rehabilitation counselors should practice only within the realm of their scope of practice. • New to the field is diagnosing according to a medical model. • Continuing education is a must • Refer out whenever necessary.

26. Rehabilitation Counseling Case Scenarios

27. A few hand picked areas of concern, for rehabilitation counselors and ethics. • Working with 3rd party payment agencies • Traits clients find most and least important from rehabilitation counselors • HIV positive patients • 12 step programs

28. Ethics in Managed Care Organization (MCO ) • Understand the MCO is a business and looks for profit. • Look for best balance between advocacy and fulfilling needs of MCO • Explain MCO service limits to client • Do no harm ( Kontosh, 2000 )

29. Traits clients find most and least important from Rehabilitation Counselors • Top 3 traits: 1. Consumer first attitude and advocacy (28.5%) 2. Nurturing and promotion of counselor relationship ( 20% ) 3. Knowledge about disability and rehabilitation ( 14% )

30. Traits clients find most and least important from Rehabilitation Counselors • Bottom 3 traits: • Disability experience in personal life (4%) • Educational background ( 2.5% ) • Maturity and professional experience (1.5%) ( McCarthy & Leierer, 2001 )

31. HIV positive client and duty to break confidentiality / privacy • This is a hot dilemma that most practicing counselors face. • The stance of the law is unclear • The danger is advising sex partners of the client & advising the employer or third party payment agency. • No clear answer to provide • Client advocacy is the key.

32. 12-step Programs • Have proven to be very effective for the rehabilitation of substance abusers • They have a regimented format, with little room for adaptation • All require an admittal to a problem (not consistent with some theoretical constructs) • All require an admittal that a higher power is the only means to help (N/A for a counselor who does not share same beliefs)

33. References Cotton, R.R., & Tarvydas, V.M. (2003). Ethical and professional issues in counseling 2nd ed. Upper Saddle, NJ: Pearson Education. Kontosh, L.G. (2000) Ethical rehabilitation counseling in a managed-care environmen. The Journal of Rehabilitation. 66, 9-24. McCarthy, H. & Leierer, S.J. (2001) Consumer concepts of ideal characteristics and minimum qualification for rehabilitation counselors. Rehabilitation Counseling Bulletin,45, 12-23. Szymanski, E M.; Danek, M. M.; (1985). School-to-work transitions for students with disabilities: Historical, current, and conceptual issues. Rehabilitation Counseling Bulletin,29, 81-89. Torielly, P.J., Benshoff, J.J. (2003) Substance abuse counselors and ethical delimmas: The influence of recovery and education level. Journal of Addictions and Offender Counseling, 23, 83-98. Van Hoose, W.H., & Kottler, J.A. (1985) Ethical an legal issues in counseling and psychotherapy 2nd ed. SanFrancisco: Jossey Bass,,p .258.