Counselor Advocacy & ETHICS in

1. Counselor Advocacy & ETHICS in Presented by Angela Corrigan, Ed.D., LPC, LMFT Sponsored by the Northeast Texas Counseling Association May 3, 2013

2. Counselor Advocacy • Watch TCA advocacy video – presented by Jan Friese http://www.txca.org/tca/Course-Advocacy.asp • Current Legislative Platform • Advocacy Dos and Don’ts • Contacting Legislators • Writing Letters

3. TCA 2013 Legislative Agenda • Maintain current regulatory structures for all Professional Counselors. • Support funding for research on evidence-based solutions and effective outcomes that promote resiliency, retention and economic success. • Expand access and increase funding for behavioral, mental health and educational services for underserved populations including those in juvenile and criminal justice systems, the medically underserved, the homeless, and the chronically mentally ill. • Amend the Education Code to provide consistent references to School Counselors. • Add educational and licensing standards for College Counselors to the Education Code. • Allocate funding for public and higher education based on evidenced-based practices. • Revise TRICARE, CHIP, Medicaid and Medicare rules and Veteran Administration policies to include Licensed Professional Counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs) as independent providers at full reimbursement rates.

4. Advocacy Tips Things to “Do”: • Sign the guest book. • Ask to speak with the staff person working on education and/or mental health issues. • Be professional, courteous, positive, direct, clear, concise, factual, credible, and specific. • Try to establish a relationship of mutual trust with your legislator. Use the “Golden Rule.” • Be sure to make your ask! Be clear and concise about what you want. • Be reasonable; remember everyone thinks his/her issue is the most important one being considered. • Keep it simple; avoid jargon and acronyms. • Thank legislators for meeting with you and for their consideration, even if your comments are not well received. • Leave behind your business card, fact sheets, and/or written testimony at the end of the meeting. Be sure they include how you can be reached. • Follow up visits with a letter to the staffer and/or the legislator with an offer to be of assistance in the future. • Always follow up with information/research you have promised to provide. BIGGEST DO: Speak from your heart, tell your story; use anecdotes from your community. For example… • Have you had to turn away referrals and/or turn down or stop seeing a patient who was a Medicaid beneficiary? • As a school counselor, do you shuttle between two or more schools, or deal with an unreasonably high student caseload? • Do you know of students, children, or family friends with mental, emotional, or substance-use related problems interfering with their learning or ability to hold a job? • Have the recent Medicaid rate and reimbursement rate reductions had an impact on your practice?

5. Advocacy “Don’ts” Things to Avoid: • Don't give inaccurate information or purposely lie. It’s okay to say, “I don’t know, but I can get back to you.” • Don’t get sidetracked or go off message. • Don’t get defensive or badmouth the other side. • Don’t get upset if you can’t meet with your Representative or Senator. • Don't send form letters or emails. • Don't be argumentative or abrasive. • Don't cover more than one subject, unless asked. • Don't write a letter longer than one page. • Don't give up. • BIGGEST DON’T: Don’t forget to follow-up with the information you promised.

6. ETHICS in JEOPARDY Outline • TSBEPC Enforcement Actions and Penalties • ACA Code of Ethics 2014 Proposed Changes • Ethical Decision Making Models ACA 7 Step Model ASCA 9-Step Model

7. TSBEPC Enforcement Actions http://www.dshs.state.tx.us/counselor/lpc_enforce.shtmposted as of April, 2013

8. ACA Code of EthicsHighlights of 2014 Proposed Revisions PREAMBLE • The following are core professional values of the counseling profession: 1. the enhancement of human development throughout the life span; 2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts; 3. promotion of social justice; 4. safeguarding the integrity of the counselor-client relationship; 5. competent practice.

9. ACA Code of Ethics 2014 Proposed Revisions PREAMBLE The following fundamental principles of professional ethical behavior are: 1. Autonomy: The right of clients to control the direction of their lives, thoughts, actions, and future. 2. Nonmaleficence: Avoiding any actions that case harm to clients. 3. Beneficence: Working for the good of the clients, promoting their wellbeing and health. 4. Justice: Treating others justly, fostering fairness and equality, and providing appropriate services to all clients. 5. Fidelity: Honoring commitments and keeping promises. This includes fulfilling one’s responsibilities of trust in professional relationships. 6. Veracity: Dealing honestly and truthfully with all those with whom counselors come into professional contact.

10. ACA Code of Ethics 2014 Proposed Revisions SECTION A: THE COUNSELING RELATIONSHIP A.5.e. Personal virtual relationships with current clients: • Counselors are prohibited from engaging in a personal virtual relationship with individuals with whom they have a current counseling relationship. (see H.7.a) A.11.c. Establishing Fees: • In establishing fees for professional counseling services, counselors consider the financial status of clients and locality. If a counselor’s usual fees create undue hardship for the client, the counselor may adjust fees or assist to locate comparable, affordable services.

11. ACA Code of Ethics 2014 Proposed Revisions A.12.b. Values: • Referral based on counselor values conflicting with client goals that are consistent with the definition of counseling may constitute a discriminatory referral (glossary) and should be avoided. (See preamble, A.1.a, A.2.a, A.4.b.) A.13. ABANDONMENT AND NEGLECT: • Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

12. ACA Code of Ethics 2014 Proposed Revisions B.6.a Creating and Maintaining Records and Documentation: • Counselors create and maintain records and documentation necessary for rendering professional services. This applies to records and documentation kept in any medium. (See A.1.c.) B.6.h. Storage and Disposal After Termination: • Counselors store records following termination of services to ensure reasonable future access, maintain records in accordance with federal and state laws and statutes such as licensure laws and policies governing records, and dispose of client records and other sensitive materials in a manner that protects client confidentiality.

13. ACA Code of Ethics 2014 Proposed Revisions Section C: Professional Responsibility • Counselors are encouraged to contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return (pro bono publico). C.6.e. Pro Bono Publico: • Counselors make a reasonable effort to provide services to the public for which there is little or no financial return (e.g., reduced fees, speaking to groups, sharing of professional information, etc.).

14. ACA Code of Ethics 2014 Proposed Revisions C.7.b. Development and Innovation: • When counselors use developing or innovative techniques/procedures/modalities, they explain the potential risks and ethical considerations of using such techniques/procedures/modalities. • Counselors work to minimize any potential risks or harm when using these techniques/procedures/modalities C.7.c. Harmful Practices: • Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm to clients. (See C.5) SECTION F: Supervision, Training, and Teaching • F.6.f. Use of Case Examples: • The use of client, student, or supervisee information for the purposes of case examples in a lecture or classroom setting is permissible only when: (1) they have reviewed the material and agreed to its presentation, or (2) the information has been sufficiently modified so as to obscure identity.

15. ACA Code of Ethics 2014 Proposed Revisions Section H: Distance Counseling, Technology, Social Media A new and separate section was developed to provide a more comprehensive review of the ethical obligations counselors have when infusing these tools into their practices. Section I: Resolving Ethical Issues Changes in this section reinforce the need for all counselors to use a formal ethical decision-making model in their practice (see I.1.b). Counselors continue to be required to know and adhere to the ACA Code and to be familiar with the ACA Policy and Procedures for Processing Complaints of Ethical Violations (2005 current) and use it as a reference for assisting in the enforcement of the ACA Code of Ethics.

16. American Counseling AssociationEthical Decision Making Model 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.

17. 1. IDENTIFY THE PROBLEM Gather as much information as you can. Be as specific and objective as possible. Write ideas on paper to help you gain clarity. Outline the facts, separating out innuendos, assumptions, hypotheses, or suspicions. Ask yourself: Is it an ethical, legal, professional, or clinical problem? Is it a combination of more than one of these? If a legal question exists, seek legal advice. Other questions that it may be useful to ask yourself are: Is the issue related to me and what I am or am not doing? Is it related to a client and/or the client's significant others and what they are or are not doing? Is it related to the institution or agency and their policies and procedures? If the problem can be resolved by implementing a policy of an institution or agency, you can look to the agency's guidelines.

18. 2. APPLY ACA CODE OF ETHICS Refer to the most current Code of Ethics to see if the issue is addressed there. If there is an applicable standard or several standards and they are specific and clear, following the course of action indicated should lead to a resolution of the problem. If a resolution does not seem apparent, proceed with further steps in the ethical decision making process.

19. 3. Determine the nature and dimensions of the dilemma Consider the moral principles of autonomy, nonmaleficence, beneficence, justice, and fidelity. Decide which principles apply to the specific situation, and determine which principle takes priority for you in this case. Determine the priorities when two or more of them are in conflict. Review the relevant professional literature to ensure that you are using the most current professional thinking in reaching a decision. Consult with experienced professional colleagues and/or supervisors. Consult your state or national professional associations.

20. 4. Generate potential courses of action. Brainstormas many possible courses of action as possible. Be creative and consider all options. If possible, enlist the assistance of at least one colleagueto help you generate options. 5. Consider the potential consequences of all options and determine a course of action. Evaluate each option. Assess the potential consequences for all the parties involved. Ponder the implications of each course of action for the client, for others who will be effected, and for yourself as a counselor. Eliminate the options that clearly do not give the desired results or cause even more problematic consequences. Review the remaining options to determine which option or combination of options best fits the situation and addresses the priorities you have identified.

21. 6. Evaluate the selected course of action. Review the selected course of action to see if it presents any new ethical considerations. Stadler (1986) suggests applying three simple tests to the selected course of action to ensure that it is appropriate. • the test of justice: assess your own sense of fairness by determining whether you would treat others the same in this situation. • the test of publicity: ask yourself whether you would want your behavior reported in the press. • The test of universality asks you to assess whether you would recommend the same course of action to another counselor in the same situation.

22. 7. Implement the course of action Strengthen your ego to allow you to carry out your plan. Follow up to assess the outcome of your actions. If you follow a systematic model, you will be able to give a professional explanation for the course of action you chose. Van Hooseand 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" (p.58).

23. American School Counselors Association Ethical Decision Making Model G.3. When faced with any ethical dilemma school counselors, school counseling program directors/supervisors and school counselor educators use an ethical decision-making model such as Solutions to Ethical Problems in Schools (STEPS) (Stone, 2001): 1.Define the problem emotionally and intellectually 2. Apply the ASCA Ethical Standards and the law 3. Consider the students’ chronological and developmental levels 4. Consider the setting, parental rights and minors’ rights 5. Apply the moral principles 6. Determine your potential courses of action and their consequences 7. Evaluate the selected action 8. Consult 9. Implement the course of action

24. References Corey, G., Corey, M. S., & Callanan, P. (2006). Issues & ethics in the helping profession (7th ed.). California: Thomson Brooks/Cole. Forester-Miller, H. & Davis, Thomas (1996) A Practitioner's Guide to Ethical Decision Making, American Counseling Association. Francis, Perry C (2013) Overview of Revisions to the American Counseling Association 2005 Code of Ethics, ACA Ethics Revision Task Force Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. Counseling Psychologist, 12(3), 43-55. Sileo, F. & Kopala, M. (1993). An A-B-C-D-E worksheet for promoting beneficence when considering ethical issues. Counseling and Values, 37, 89-95. Stadler, H. A. (1986). Making hard choices: Clarifying controversial ethical issues. Counseling & Human Development, 19, 1-10. Van Hoose, W.H. & Paradise, L.V. (1979). Ethics in counseling and psychotherapy: Perspectives in issues and decision- making. Cranston, RI: Carroll Press. TEXAS STATE AGENCIES Department of State Health Services Texas Council on Sex Offender Treatment http://www.dshs.state.tx.us/csot/default.shtm Texas Department of Family and Protective Services http://www.dfps.state.tx.us/ Texas Education Agency http://www.tea.state.tx.us/ Texas State Board of Examiners of Marriage and Family Therapists http://www.dshs.state.tx.us/mft/default.shtm Texas State Board of Examiners of Professional Counselors http://www.dshs.state.tx.us/counselor/default.sht PROFESSIONAL ASSOCIATIONS National and State Professional Association Codes of EthicsAmerican Counseling Association Code of Ethics (2005) http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspxTexas Counseling Association http://www.txca.org/tca/Default.aspAmerican School Counselor Association Code of Ethics (2010)http://asca2.timberlakepublishing.com//files/EthicalStandards2010.pdf National Board for Counselor Certification Code of Ethics http://www.nbcc.org/ethics/Default.aspx

25. TEXAS CODES and LAW Texas Administrative Code (State Agency Rules) http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTACTitle 22 Examining Boards Part 30, Professional Counselors, Chapter 681, License and Regulation of Professional Counselors Texas State Board of Examiners of Professional Counselors, Code of Ethics, Amended March 1, 2011 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=30&ch=681&sch=C&rl=YPart 34, Chapter 781, Rules Relating to the Licensing and Regulation of Social Workers, June 12, 2011 Texas State Board of Social Workers Examiners Code of Conduct (January 27, 2011)) http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=34&ch=781&sch=B&rl=YPart 35. Marriage and Family Therapists, Chapter 801. Licensure and Regulation of Marriage and Family Therapists, Texas State Board of Examiners of Marriage and Family Therapists, Code of Ethics, Amended June 5, 2011 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=22&pt=35&ch=801&sch=C&rl=Y Texas Civil Practice and Remedies Code http://www.statutes.legis.state.tx.us/Docs/CP/htm/CP.81.htmTitle 4. Liability in Tort, Chapter 81. Sexual Exploitation by Mental Health Services Provider Chapter 81 Duty to Report Sexual Exploitation by a Mental Health Services ProviderThis statute requires a mental health services provider who, during the course of providing services to a client, learns that the client has been sexually exploited by a mental health services provider, to report that knowledge to the appropriate licensing agency and the appropriate district attorney within 30 days. Texas Education Code http://www.statutes.legis.state.tx.us/?link=EDChapter 33Service Programs and Extracurricular ActivitiesSubchapter A School Counselors and Counseling Programs - This statute addresses responsibilities of school counselors and parental involvement Texas Family Code Chapter 32 Consent to Medical, Dental, Psychological, and Surgical Treatment by a MinorThis statute addresses consent to treat a minor by a non-parent; consent form; consent to treatment by child; and consent to counseling. http://www.statutes.legis.state.tx.us/Docs/FA/htm/FA.32.htm Chapter 153 Conservatorship, Possession, Access - This statute addresses rights and duties of managing conservators and possessory conservators of minor children. http://www.statutes.legis.state.tx.us/Docs/FA/htm/FA.153.htm Chapter 261 Report of Abuse or Neglect - This statute addresses persons required to report; time to report; matters to be reported; report to appropriate agency; contents of report; referral of report by department of law enforcement; notification of district attorneys; immunities; false report; and failure to report. http://www.statutes.legis.state.tx.us/Docs/FA/htm/FA.261.htm

26. Texas Health and Safety Code Chapter 161.132 Report of Abuse or Neglect -This statute requires a person to report abuse or neglect in an inpatient mental health facility, a treatment facility, or a hospital to the facility licensing agency. Chapter 161.201-204 Medical or Mental Health Records - This statute addresses a prohibition against a mental health provider charging a client for a mental health record to be used for purposes relating to an application for benefits and assistance under certain state and federal government programs. Chapter 611 Mental Health Records - This statute addresses mental health records: confidentiality; authorized disclosure of confidential information other than in judicial or administrative proceeding; right to mental health record; legal remedies for improper disclosure or failure to disclose; authorized disclosure of confidential information in judicial or administrative proceeding; revocation of consent; request by patient. Texas Human Resources Code http://www.statutes.legis.state.tx.us/Docs/HR/htm/HR.48.htmChapter 48 Requires Report of Abuse or Neglect of Elderly or Disabled Person Texas Occupations Code Chapter 53 Consequences of Criminal Conviction - This statute addresses the authority of a licensing agency to revoke, suspend, and deny licenses due to a criminal conviction of a license holder or license applicant. http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.53.htmChapter 110 - Sex Offender Treatment Providers http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.110.htmChapter 502 - Marriage and Family Therapistshttp://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.502.htmChapter 503 - Professional Counselors http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.503.htmChapter 504 - Chemical Dependency Counselors http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.504.htmChapter 505 - Social Workers http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.505.htm Texas Penal Code Chapter 22.011 Sexual Assault – This statute addresses sexual assault of a client or former client by a mental health professional. http://www.statutes.legis.state.tx.us/Docs/PE/htm/PE.22.htm#00