Case Management and Ethics
Read
Becoming an Addictions Counselor: A Comprehensive Text, 3rd edition:
Chapters 7 and 8
Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
Consider the discussion and the any insights you gained from it. be sure to cite your sources, use APA style as required
Assignment 5:
Part 1:
Choose one of the nine areas of biopsychosocial assessment outlined in the text. Develop assessment questions for that knowledge area. In doing so, consider the impact of each question on the client, the appropriate timing, and the effect on the development of empathy and a treatment alliance. For example, in the area of family and friends, you might ask, “Who was important to you as you grew up?” “Who could you turn to in your life?” “Who were you close to?” “Who did you have a problem or conflict with?” “Have you lost someone important to you?” “What are some good memories you have of your childhood/ teen years?”
Part 2:
To practice writing treatment goals, write three treatment objectives you might have for a client. Discuss the following questions in a 500 word essay: Would the client take ownership of the objective? When in the treatment process would it be appropriate to address the goal? How would you or the client know when the objective is accomplished? What would the client need to do to accomplish the objective, and what resources would he or she need?
Part 3:
Read the case of Lee C., and then complete the following steps 1 through 8.
Case: Lee C. is a 25- year- old married male who is participating in an outpatient chemical dependency program. Lee is an electrician who had worked steadily until he was recently suspended from his job after a period of absenteeism and tardiness due to his drinking. Lee has been in treatment in the past and has maintained several periods of sobriety ranging from three to six months, with Alcoholics Anonymous participation. He often states that he drinks after arguments with his wife. They often fight about money and his running off to his mother’s after they fight. He often drinks with his best friend and co- worker, Kim. Lee’s wife does not permit him to live in the house when he is drinking, but his mother always allows him to stay with her. Lee recognizes he has “some kind of drinking problem” and wishes to stay sober because he is afraid of losing his wife and job. Following the steps, write a treatment plan for Lee C.
List Lee’s strengths and resources.
List his needs.
Write a goal for Lee.
Write a problem statement for Lee.
Write an objective for him.
Write a set of steps to accomplish the objective.
Determine who will be responsible for each step.
Set a date for each step.
Part 4:
Review and evaluate the following treatment objectives. Which objectives do you believe are satisfactory and complete? Rewrite objectives that are unsatisfactory or incomplete.
Mr. A will improve his self- esteem.
Mrs. B will work on her sobriety.
Mr. C will attend five AA meetings per week for the next six weeks.
Ms. D will start attending community college.
Mr. E will improve his social skills by the end of group therapy.
Mrs. F will participate by the third week of group by describing how her dependence on pills affected her.
Part 5:
Phil is a counselor in an intensive outpatient program where you work. He has been employed in the field for three years and has been in recovery for six years. You have been close to him for most of that time. A month ago, Phil’s son was killed in an automobile accident. In his grief, Phil went out and got drunk. He immersed himself without delay in his recovery fellowship as well as in short- term bereavement counseling, and he has confided only to you about the situation. State regulations mandate that counselors have at least two years uninterrupted “clean time.” Phil is very afraid that if the agency finds out about his relapse, he will lose his job. Discuss:
How do you feel about this situation?
What would you say to Phil?
Can you consult someone about this to get advice on your position?
What should or can you say to the agency administrators?
When is withholding information a breach of honesty?
If you fail to disclose Phil’s relapse, do you think you’d lose your job?
How can you reconcile, on one hand, the trust and confidence of a friend and, on the other, loyalty to the agency and safety of clients?
What do you think would be the best thing to do for your friend?
What would be the right thing to do? Does this conflict with what you think would be best for Phil?
Part 6:
Your 28- year- old male client was married but engaged in anonymous sexual encounters with men. His family and in- laws were very anti- gay. He contracted a sexually transmitted disease, and discontinued treatment. Then you read in the newspaper that he committed suicide. His grief-stricken father called you, requesting any information you have that would help the family understand why his son killed himself. They speculate over what they did or did not do that was responsible for his death. Your memories and notes clearly show that his suicide was related to factors over which they had no control. What do you do? Because the client is no longer alive, can it hurt to share information with the family? Discuss:
How should you respond to this family’s wishes?
Do you have an ethical responsibility to your client’s family?
Do you have to maintain this client’s confidentiality even though he’s dead? After all, you have information that would definitely lighten their grief.
If the police investigate this unnatural death, what would you contribute to their fact finding?
Part 7:
Two hats is a term for an individual who has dual roles. Employees of addictions agencies often talk about two- hat problems to denote the staffer who is in a recovery fellowship with clients. Don is a recovering cocaine addict who works at Reality Lodge, a large long-term treatment program staffed largely by graduates of this therapeutic community. Don attends Narcotics Anonymous to maintain and strengthen his own recovery from addiction. At one meeting, a young woman named Cheryl makes a comment after the main speaker, in which she shares the difficulty she is having in staying drug- free. Cheryl happens to be a court-mandated client at the outpatient department of Reality Lodge, and Don knows that she has not shared these minor relapses with the staff. As an NA member, Don would never carry that information outside of the meeting, but as a counselor he would notify his agency and then the court. Which hat decides what he does? Discuss:
What if Don calls the client on this and urges her to come clean herself? What if Cheryl tells him to mind his own business and warns Don not to break the confidentiality of NA?
Should Don tell the agency staff what he heard at the NA meeting regarding this client’s lack of sobriety? In weighing the anonymity of NA and the confidentiality of Don’s agency, which carries more weight? What information can he share legally?
What federal or state (use your state) regulations are relevant to Don’s decision?
Can you write a guideline for this type of situation to state clearly the agency’s obligations? Shouldn’t the agency tell counselors to leave a meeting where a client is present?
What, if anything, should Don say to Cheryl?
If Don remains silent, what are the implications for his interactions and relationships with his own supervisor and Cheryl’s counselor?
Part 8:
Marcia, who comes from a Hasidic Jewish family and rebelled to marry a secular Jewish man, enters treatment under family pressure. She goes to a few AA meetings at the urging of her counselor, but feels she is being forced to go along with something she considers similar to her “repressive” family environment. “Another dogmatic in- group who only talk to them-selves,” is the way she puts it. She strongly declares her desire to recover from her alcoholism but does not want to be forced to go along with “the God thing.” Discuss:
How would you approach Marcia?
Are these religious issues or family issues?
Would you address her issues about religion in a treatment plan? If so, how?
Would forcing Marcia to attend AA meetings or denying her treatment be religious discrimination?
Do you know anything about Hasidism?
Would you need to know about Hasidism? Her family?
Would it be ethical or appropriate to refer MaDEVELOPMENT HISTORY (CHILDHOOD AND
ADOLESCENCE)
Student’s Name
Institutional Affiliation
Date
Age
Development History
(childhood and adolescence)
1)
Do you have any family member who is has
suffer from drug or alcohol abuse before?
…………………………………………………………………………………………………………………………………………………………………………………………
2)
Do you currently have any medical
condition? Yes [ ] No [ ] if yes, list all of then and please explain?
……………………………………………………………………………………………………………………………………………………………………………………
3)
Do you get along with other children?
……………………………………………………………………………………………………………………………………………………………………………………
4)
Who do you live with currently? List all
the family members?
……………………………………………………………………………………………………………………………………………………………………………………
5)
What do you consider your hobby(s)?
…………………………………………………………………………………………………………………………………………………………………………………………………….
6)
Have you ever take drugs before? What is
the drug? How much have you take?
…………………………………………………………………………………………………………………………………………………………………………………….
7)
Have you been physically, emotionally
and sexually abused? Yes [ ] No [ ] If yes please explain? (E. Ackerman, 2020)
…………………………………………………………………………………………………………………………………………………………………………………..
Part
two
Treatment Objectives
1)
The counselling sessions should start
showing results after two weeks.
2)
We will be having three counselling
sessions per week.
3)
We will start by discussing general
personal issues before digging deep to complex issues.
A treatment plan is essential for an
effective counselling session. Many practitioners prefer to have a
professionally written treatment plan to provide seamless and entrenched
guidelines in dealing with clients. Furthermore, it helps in defining the
problems, goals and even intervention in the assessment sessions. Having this
information in mind, a well-planned assessment will be effective in realization
of the objectives of the treatment.
Clients will take ownership of
objectives that are promising optimization of their satisfaction. The goals
should be in a language that clients comprehend. Objectives should address the
client’s problem and be achievable within the treatment period. This will boost
client morale and make him or her ready to achieve the goals. This means that
the context of that objective should be aligned with the client willingness and
readiness. Moreover, clients are likely to adopt objectives that do not let
them work on themselves but give room for practitioners to guide them in the
process of healing. Therefore, the objective should respect the client decision
and agency (Mark Tyrell, 2016).
The treatment goal is suitable
introduced and discussed after listening and understand the client agenda. It
is advisable for the counsellor to first establish warmth and trustable
environment. This will make the clients comfortable and ready to cooperate.
Clients should then able to clarify the help they need especially in written
forms. Therefore, this should create the ground for the counsellor listening
and understanding client problem. It should enable interpretation and focus on
the emotion of the client. After all, this has been achieved; the objective
goal should be introduced where the problem statement will be converted to goal
statements.
When both the counsellor and the client
are looking forward to the treatment sessions, then it is a significant
objective of the treatment is realized. When a client is comfortable in the
sessions and can open freely, then the treatment is having some breakthrough.
Clients and counsellors are both enjoying themselves and having a good working
relationship. The connection makes the client not to be nervous about the
sessions.
Clients setting up of goals will come
in handy in the achievements of the goals. Setting up goals will make clients
be more focus on the goal and reduce the chance of going back to the old ways.
With the help of the counsellors, the clients should able to wrap their head in
a more specific goal. Moreover, clients need to focus on one part at a time. If
the treatment session is ten steps, then they should complete step one
completely before moving to the next one (Myers et al., 2007)
Support from families will help the
client achieve the treatment goal within the timeframe. Client needs to have
support from the counsellor and his or her family. This will encourage him or
her to work hard toward the goal of the treatment. The client should understand his or her
commitment means a lot to the process and every ounce of energy is required.
Summarily, for an effective treatment
session both parties need to be committed. The counsellor need to do things
right to earn client trust. All the policy protecting client’s information
should be followed without any excuses. The objectives should be in a language
that the client understand and achievable.
Part 3:
List
Lee’s strengths and resources
Lee’s Mother
Lee recognizing his drinking
problem
List
his needs.
Lee needs his job back
Lee needs a treatment session to
stop drinking problem
Lee needs to live in peace with his
wife.
Write
a goal for Lee
Lee will develop a positive
commitment to a sober lifestyle.
Write a problem statement for Lee
Can lee understand the illness of
addition?
Write an objective for him
Lee will go for a rehabilitation to
learn and know how to stay sober.
Write
a set of steps to accomplish the objective
Lee to be specific with achieving
sobriety
Come up with plan of actions
Make the lists of steps in fighting
alcoholism
Act on the plans
Read and listen for any advice
Seek for the alternatives plan
Examine the goals from time to time
Determine who will be
responsible for each step
Step1
Lee
Step
2 counsellor
Step
3 counsellor
Step
4 both Lee and counsellor
Step
5 lee
Step
6 counsellor
Step
7 both Lee and Counsellor
Set a
date for each step
Step
1. 1 week
Step
2. 2 weeks
Step
3. 1 month
Step
4. 2 months
Step
5. 2 weeks
Step
6. 2 weeks
Step
7. 5 months
Part 4:
Mr. A will improve his
self- esteem.
Incomplete
Mr.A
will improve his self-esteem by attending the treatment session one per week
Mrs.
B will work on her sobriety
Incomplete
Mrs.
B will work on her sobriety with his family in a conjoint meeting
Mr. C
will attend five AA meetings per week for the next six weeks.
Complete
Ms.
D will start attending community college.
Incomplete
Ms.
D will start attending community college to share is hurt and angry feelings
Mr.
E will improve his social skills by the end of group therapy.
Complete
Mrs.
F will participate by the third week of group by describing how her dependence
on pills affected her.
Complete
Part 5:
How
do you feel about this situation?
This is a bizarre situation with
two sides. Phil is facing emotional crises and reporting him that he has lapsed
will worsen his mental situation. The situation is delicate ad need to be
handled carefully.
What
would you say to Phil?
As
the counsellor I will advice Phil that his situation of losing his son is
painful but he needs to face his problems head on. Moreover, alcohol is not the
solution to his problem and furthermore, may make him lose his job.
Can you consult someone
about this to get advice on your position
Yes,
I perceive this matter as delicate and rushing to make an autonomous decision
is not good. Consulting other people will help to come up with various ways of
tackling the issues. Moreover, it gives room for the best alternative decision.
What
should or can you say to the agency administrators
I
will tell the agency the crime Phil has committed. This will help to avoid any
concerns if Phil will be found drunk in the line of duty. Moreover, I will let
know to the agency the final decision is on them, but to be considerate. This
will base on the unique situation on the hand.
When is withholding
information a breach of honesty?
This
is when you are withholding information that affects the company directly. For
example, Phil continuing taking alcohol may hinder his performance and
eventually affects the agency.
If you fail to disclose
Phil’s relapse, do you think you’d lose your job?
Yes,
I feel Phil make take the advantage and continue drinking which eventually, the
agency in one way or another will come to know. Then, it will be incompetent on
my side.
How can you reconcile, on one hand, the
trust and confidence of a friend and, on the other, loyalty to the agency and
safety of clients?
This
is by properly advising a friend and tries to make him see they are other ways
of handling problems. On the other hand, I will try to make the agency
understand the problem and advice them to make it an exception.
What do you think would
be the best thing to do for your friend?
I
will advise him to reconsider his stand. Let him understand that he is not
alone in this situation as other people are with him. Also, advice he to move
with earnest and ask for forgives from the agency and show willingness to do
the right thing.
What would be the right
thing to do? Does this conflict with what you think would be best for Phil?
Have
a long conversation with Phil. Advice him to do things that will quickly do
away the memory of his son. Encourage him to join support group that will help
him to share his problems and get advice from colleagues who have been through
the same.
Part 6:
How
should you respond to this family’s wishes?
I
will let the family know that their son was my client but would not reveal
anything past that. I believe in counsellor-client confidentiality policy and
breaking it will dent my principles.
Do you have an ethical
responsibility to your client’s family?
No,
my contract was with their son and it will remain like that irrespective of the
prevailing situation.
Do you have to maintain
this client’s confidentiality even though he’s dead? After all, you have
information that would definitely lighten their grief.
Yes,
I believe client’s confidentiality is a policy that must be upheld either way.
As a profession following of my profession guidelines mean a lot to me. I also, understand the situation but also
aware of more situation like this arising in the future.
If
the police investigate this unnatural death, what would you contribute to their
fact finding?
My
only contribution is that he was my client and unless the law compel me to
reveal confidential information, I am unwilling to give it to them. This will
be in line with protecting my client confidentiality.
Part 7:
What
if Don calls the client on this and urges her to come clean herself? What if
Cheryl tells him to mind his own business and warns Don not to break the
confidentiality of NA?
Don
should not break the confidentiality of NA. He should first try to talk to
Cheryl to see if they can figure something out. This will go along with the
spirit of the group that advocates members to work together.
Should Don tell the agency staff what he
heard at the NA meeting regarding this client’s lack of sobriety? In weighing
the anonymity of NA and the confidentiality of Don’s agency, which carries more
weight? What information can he share legally?
Yes,
he should tell the agency. This is because confidentiality of Don’s agency
carries more weight. H e should reveal the substantial hint about Cheryl’s
identity. He can share information that he is certain with.
What federal or state
(use your state) regulations are relevant to Don’s decision
The
federal law does not protect any crime committed by a client. This applies at
the program or any individual working in the program (Tonnelat, 2007).
Can you
write a guideline for this type of situation to state clearly the agency’s
obligations? Shouldn’t the agency tell counselors to leave a meeting where a
client is present?
There
is a litigation that allows the agency to acquire client’s information. No it
should be done in the presence of the client.
What, if anything,
should Don say to Cheryl?
Yes,
they are in the say group and they can exchange ideas and advice.
If Don remains silent, what are the
implications for his interactions and relationships with his own supervisor and
Cheryl’s counselor?
This
means if anything bad happen he will be responsible. It is because he was in a
position to prevent it before it took place.
Part 8:
How would you approach
Marcia?
I
will let her know marriage is a long term thing that needs a good decision. I
will also advice her to take her time and come up with what she thinks is best
for her.
Are
these religious issues or family issues?
It
is family issues. Her family is denying her freedom to express her feelings.
The family are demanding her to follow their wish and will.
Would
you address her issues about religion in a treatment plan? If so, how?
Yes,
need to understand and believe the decisions of the clients based on their
religion beliefs and not hold any bad blood.
Would forcing Marcia to attend AA meetings
or denying her treatment be religious discrimination?
Yes,
she needs to be let alone to decide on her own. This may be through her
religious beliefs.
Do you know anything about Hasidism?
Yes,
they are well bonded communities that are spiritually centred on a religious
leader known as rebbe (Marsen, 2009).
Would
you need to know about Hasidism? Her family?
Yes,
this will help me more to understand her background and more information about
herself.
Would it be ethical or appropriate to refer
Marcia to another pro-gram or agency?
Yes,
if she will agree. First I will ask her to seek her permission. Any transfer
must be done on her consent and willingness.
References
Ackerman,
E. (2020, April 16). Mental Health Treatment Plans: Templates, Goals &
Objectives. Retrieved from positivepsychology:
https://positivepsychology.com/mental-health-treatment-plans/
Tyrell, M. (2016, july). How to Help Your Clients
Achieve Their Therapy Goals. Retrieved from unk:
https://www.unk.com/blog/how-to-help-your-clients-achieve-their-therapy-goals/
Madsen, R. (2009). The
Archipelago of Faith: Religious Individualism and Faith Community in America
Today. American Journal of Sociology, 114(5),
1263-1301. doi:10.1086/595946
Tonnelat, S. (2007).
Keeping space public: Times Square (New York) and the Senegalese
peddlers. Cybergeo. https://doi.org/10.4000/cybergeo.4792
Myers, P., & Salt, N. (2007). Becoming
an addictions counselor. Jones and Bartlett Publishers.
