Post University Working with Vulnerable Adults Discussion
Description
Shaconna S
RE: Working with Vulnerable Adults
Studies suggest that there are several definitions available for the term “vulnerable population”, the words simply imply the disadvantaged sub-segment of the community requiring utmost care, specific ancillary considerations and augmented protections in research. (Vulnerable, 2013) The vulnerable individuals’ freedom and capability to protect one-self from intended or inherent risks is variably abbreviated, from decreased freewill to inability to make informed choices. (Vulnerable, 2013) In serving this population there may be situations in which the individual is unable to advocate or identify the best course of action in relation to their specific area of need. Providers often provide services to individuals who can be identified as “vulnerable” ; an example is working with African American. Velasco-Mondragon (2016) used a modified social ecological model to conduct a review of the literature and nationwide statistics on African American health which identifies the disadvantages of this specific group of people from protecting themselves from inherent risk. In speaking to why these individuals would be classified as a “vulnerable population” Velasco-Mondragon (2016) discusses the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. Velasco-Mondragon (2016) suggests that mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. This is important to identify as a potential barrier to treatment. Inevitably most providers will encounter some ethical dilemmas associated with this population, one of which is discussed below.
Ethical Dilemma: Differences in treatment that are not directly related to differences in individual patients’ needs can constitute an ethical dilemma. One issue that often happens is misdiagnosis. Studies suggest that a black child who is disruptive in school may be identified by the teacher as having oppositional defiant disorder and be treated punitively while on the other hand, a white child being equally disruptive may be identified as having ADHD.
Legal Consideration: Discrimination due to race, color or creed is unacceptable and there are laws that govern such discriminations.
ACA Codes: The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct which suggest that psychologists protect the welfare and rights of those with whom they interact professionally. Additionally Psychologists are expected to be aware of and respect cultural, individual, and role differences, including those based on age, gender, race, ethnicity, culture, national origin, disability, language, and socioeconomic status, and consider these factors.
Solution: This writer would encourage the counselor to seek supervision in addition to getting more education on cultural differences and information on cultural competency. The provider should work to understand the cultural competence in therapy, the beliefs, backgrounds, and values of their clients and themselves to avoid projecting false narratives on individuals being served.
References
Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016 Oct 3;37:12. doi: 10.1186/s40985-016-0025-4. PMID: 29450054; PMCID: PMC5810013.
Shivayogi P. Vulnerable population and methods for their safeguard. Perspect Clin Res. 2013 Jan;4(1):53-7. doi: 10.4103/2229-3485.106389. PMID: 23533983; PMCID: PMC3601707.
Heather A
RE: Working with Vulnerable Adults
In my former role, I was presented with many situations in which an individual’s age and the complications that came along with aging, began to outweigh their mental health treatment. In particular, there was a client who was very rapidly becoming unable to perform basic care and it was gravely affecting their quality of life. This was in a residential setting so there were nurses who came to distribute meds but there was no real medical oversight. This client would not leave the program and staff were unable to get them to go to any medical appointments. Months would go by, and this person would not shower. The longest period that I can remember was over 7 months. I would call the ambulance regularly, requesting transport, so that they could at the very least bathe him while he was there. Often they refused and sent him back within a few hours. I would call constantly to have him transported for medical care. He was often overlooked and again, back within a few hours. I would report my concerns to my supervisor and DMHAS constantly to no avail. No one seemed to care that this person needed to be in a nursing home and not a mental health facility. This person even had a conservator, who made these decisions for them and still seemed to think he was fine where he was. Things got so bad at one point that he had finally been sent to emergency for foot pain. This person had gone so long without cutting their toenails that they had encased their foot like a hove. I fought for this person DAILY, documented my efforts heavily, and did anything that I could think of to advocate for them. I felt like because of their mental health and their history no one truly cared what happened to them. There was a constant worry that if something more serious happened to him while living in the facility we would be held liable. The staff (outside of upper management) went above and beyond to help this individual and after years was finally able to get him into a nursing home.
Mental health services for the elderly are certainly not up to par. “The American Psychological Association (2003) estimated that 63% of older adults with mental disorders do not receive needed services. Older persons who are homebound have little access to mental health services, and those residing in long-term care settings almost never receive mental health treatment” (Borros 2011). I can attest, seeing firsthand that this is very much the case. The thought that more than half of our elderly are not receiving the appropriate level of services is shameful.
Borsos, D. P., Weikel, W. J., & Palmo, A. J. (2011). Foundations of Mental Health Counseling (4th Ed.): Vol. 4th ed. Charles C Thomas Publisher, Ltd.
Kirstie L
RE: Family Secrets
When counselors meet with clients they have to follow the Code of Ethics. In the Code of Ethics it states that the counselor needs to follow confidentiality with their clients. Confidentiality is important when building the therapeutic relationship and building trust. If a family member tries to find out what is happening during the sessions it cannot happen unless there is harm that is happening. (ACA, 2014) This author feels that if a counselor knows a family secret than the counselor should keep that a secret. The only time a secret should be exposed to others would be if the client is being harmed or someone is being harmed through that secret. This author feels like if there is a family secret is still important to keep if the client doesn’t want it to be told. (ACA, 2014) If there is a child in the counseling session the parent cannot try to get information out of the counselor unless it is essential for the parents to know that information. When the sessions begin the counselor needs to discuss with the parents and the child about their confidentiality agreement. It will be important that the parents understand what confidentiality means so that there is no confusion on either end. The parents do have the authority to know what is discussed during a session and the information that is shared. When a client knows about confidentiality and what information remains confidential than the client will be more compelled to indulge information that can help with the sessions. If the counselor breaks the confidentiality agreement is can be used in court against the counselor. (Barsky, 2010) An example of a family secret that this author would not tell others would be if one of the parents is having an affair in the relationship. If the other parent does not know about the affair it is not the counselors business to tell the other parent. It is not something that is harming another or putting the child at risk unless the person who is apart of the affair is hurting the child. If the child was getting hurt by the mystery person than this author would tell the other parent and would tell authorities as well. (Barsky, 2010)
American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
Allan E. Barsky. (2010). Ethics and Values in Social Work : An Integrated Approach for a Comprehensive Curriculum. Oxford University Press.
Shamika E
RE: Family Secrets
The writer has always felt that family therapy can be difficult. Mainly because you are working with multiple individuals who may have very different point of views about treatment, why they’re in treatment, and if treatment will help them. “A social workers primary ethical obligation is to promote the well-being of each client (Barsky, 2010). Barsky discusses identifying the client. There are times when multiple people may go to treatment in support of the client. But other times everyone is being treated. An example is if a teen is seeking treatment alone but being brought to treatment by his parents. They’re the client. But if his parents also agree to getting treatment, they will all be the clients (Barsky, 2010).
There are often family secrets. They’re normally discussed in counseling. The writer feels like if there are private and individual counseling sessions client’s confidentiality should be kept. Allan Barsky states that how confidentiality is kept should be discussed doing the initial stages of treatment (Barsky, 2010). In family counseling everyone is a client. “NASW code of ethics states an agreement on how information should be shared needs to be made” (Barsky, 2010). If everyone is not in agreeance, then the counselor will need to keep the confidentiality of each of their client.
References
Allan E. Barsky. (2010). Ethics and Values in Social Work: An Integrated Approach for a Comprehensive Curriculum. Oxford University Press.
Jeffrey H
RE: Reporting suspected child abuse or neglect
With this ethical decision, my first thought is that I hope I am not alone in making this phone call and that I have peers and a supervisor to discuss the situation. The first thing I would do is gather more information as I would want to know the level of danger the child was in currently (Howard, 2018). Getting information is important for the patient and for the safety of all involved (Howard, 2018). It is important to know if siblings or other family are also in danger (Howard, 2018). With having to break confidentiality, the first thing I would do is discuss with the patient why I would be breaking confidentiality, which is due to safety concerns (ACA, 2014). Then, I would call child protective services as there is a duty to warn and protect the patient (Barskey, 2010). Based on the call with child protection services and the additional information gathered, I would determine the next step. If the patient is at immediate risk and is going to be home alone with her father, my next call would be to the police in conjunction with child protection services. Lastly and depending on the current living conditions, I would contact the mother and father to see if the parents are still living together. It is very important to know your state laws around child abuse and neglect, and what to report as they vary by state (Barskey, 2010).
References
Howard, E. (2018) Four what ifs of child abuse reporting. Psychology Today. Four “What If’s” of Child Abuse Reporting | Psychology Today
American Counseling Association. (2014). ACA code of ethics.https://www.counseling.org/resources/aca-code-of-ethics.pdf
Barskey, A. (2010). Ethics and values in social work: An integrated approach for a comprehensive curriculum. Oxford University Press.
Keyoka C
RE: Reporting suspected child abuse or neglect
A clinician should first take stock of the facts and the duties owed the client. Counselors are ethically and legally mandated to report suspicion of child sexual abuse to authorities. Fundamental ethical principles such as fidelity (i.e., trustworthiness), beneficence (i.e., doing good) and nonmaleficence (i.e., doing no harm) now become critically important guideposts (Kalichman, 1993).
As a clinician we are not required to investigate the validity of the claim when it comes to minors. Reporting suspicions of sexual abuse enables child protection services and/or law enforcement to move toward early intervention.
Consequently, reasonable suspicions of child sexual abuse must be reported immediately and directly to child protective services or law enforcement, so these are the steps that this clinician would take, because the report has to come from the person whom the assault was reported to. The mother and father would be contacted by the authorities for the childs protection.
References:
Kalichman, S. C. (1993). Mandated reporting of suspected child abuse. Washington, DC: American Psychological Association.
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