Clients who lack decision-making capacity The practitioner’s responsibility is to safeguard the rights and interests of clients who lack decision-making capacity. Persons who lack this capacity include intellectually delayed or impaired individuals, some older adults, and children under the age of 18. It is especially important to utilize consent forms at all times, and inform and document contact with family and other service providers. In addition, social work professionals should understand how these clients may become vulnerable to – and potentially harmed by – businesses, institutions, and family or other caregivers. Social workers, for example, are obligated to serve within the best interests of children, and to help guide decision making; to ethically work toward children’s well-being, therefore, social workers must focus on the potential for abuse. The welfare of all children must be of utmost concern to society: Their best interest is at the heart of decision making. Yet caring and ethical conduct also stresses the importance of promoting positive relationships – working toward the prevention of family disintegration. This can pose an ethical dilemma in some scenarios. Payment for services With regard to payment for services, it is most helpful to refer to your particular professional association’s financial arrangement ethical standards. Professional association ethical guidelines, in general, call for fair and reasonable fees for services, prohibition or no prohibition of solicitation of fees for services entitled and rendered through the workers’ employer, and avoidance of bartering arrangements. Other guidelines include no Interruption of services and termination Mental health practitioners should demonstrate reasonable efforts for continuity of services when services must be interrupted or terminated. Interruptions may come from practitioner’s or client’s vacation or illness. There may be a loss of funding for the service. The typical reasons termination occurs is ● Client can no longer benefit from treatment/service. ● Client will be referred to another professional or service. Other reasons include a client’s failure to make adequate progress toward treatment goals or failure to comply with treatment recommendations, therapist retirement, discovery of a hitherto unrecognized conflict of interest, or client noncompliance or a client ceasing to communicate (Felton, 2015). In the case of termination for nonpayment of agreed-upon fees, there are criteria to be met (Felton, 2015): when the client and practitioner agree that the: ● Goals of treatment or service have been met. ● The fee arrangements have been made clear to the client. ● The client poses no imminent danger to himself or herself or others. ● The consequences, including the clinical consequences, of nonpayment have been discussed with the client. Administration Mental health administrators should advocate within and outside their agencies for adequate resources, open and fair allocation procedures, and a work environment that is not only consistent with but encourages compliance with ethical standards of Billing Practitioners need to establish and maintain accurate billing practices that clearly identify the provider of services. Many agencies, associations and boards include these expectations Client transfer Mental health practitioners should consider the needs and best interests of clients being served by other professionals or
For example: Parental rights are in the process of being terminated for two sibling clients. Ana, their mental health counselor, must consider how the two girls would adjust to their prospective adoptive placement: One of the children has a severe attachment disorder. Should the two children be placed together, or will placing them together prolong a prospective adoption? Should each sibling’s placement be separately planned? Ana knows that sibling bonds may be stronger than parental attachments in families where the parental system is dysfunctional. So she must refer to sources outside of her immediate level of expertise as she considers her recommendations. One important source of information would be the Child Welfare League of America’s (2016) standard for out-of-home care for neglected and abused children, which states that siblings should remain together. However, the standard also indicates that, in some cases, separation is indicated. acceptance or offering of kickbacks, rebates, bonuses, or other remuneration for referrals. Clear disclosure and explanation of financial arrangements, reasonable notice to clients for intention to seek payment collection, third-party payor fact disclosure, and no withholding of records because payment has not been received for past services, except otherwise provided by law, are also examples of ethical financial guidelines. In any case, if the client is in crisis, termination should be delayed, and it is vitally important to avoid abandonment of a client, for both legal and ethical reasons. Felton (2015) offers the following termination tips: ● Start preparing for termination and discuss termination with the client early on so that the process can be discussed during several sessions. ● If referring, offer at least three detailed referrals, and, if the client consents, assist in the transition. ● If possible, conduct the final session in person, and not electronically. ● Be certain that the client understands why and how therapy is being terminated. ● Document termination discussions. ● Send the client a personalized termination letter. Do not use a form letter. When a referral is made, the referring clinician is obligated to determine the appropriateness of the referral, including the abilities of the receiving professional or agency, and should follow up on the client’s progress wherever possible and permitted. Finally, mental health practitioners should continue to refer to their professional association’s ethical code guidelines and state laws regarding a related issue: the disposition of client records upon termination, referral, or practice closure.
ETHICS IN PRACTICE SETTINGS
practice. Ethical standards of practice should be included with materials given to new workers and emphasized during staff hiring. And some form of ethics language should be included with a mission statement.
in their own values and codes of ethics, commonly under the category of stewardship.
agencies before agreeing to provide services, and discuss with the client the appropriateness of consulting with the previous
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Book Code: SWUS1524
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