Implement the Decision

Implementing the decision begins by double-checking that the course of action that is chosen passes six ethical tests prior to enactment. The chapter focuses on six final checks: the Golden Rule, fiduciary responsibility, justice and fairness, publicity, universality, and mitigation of harm. It recommends that mental health professionals be prepared to justify the decision by managing criticism. Criticism can be assuaged by emphasizing protection of the client, a focus on the present, and the positive outcomes achieved. It recommends that clinicians document their ethical decision-making process and use established parameters to justify their decision.

Ethical Recordkeeping

Ethical recordkeeping is new to this edition and begins by identifying the purposes of good recordkeeping. The chapter then addresses seven ethical issues related to recordkeeping, including privacy, accuracy, confidentiality, access, communication, documentation, and retention and destruction. Privacy asks: What information should I collect? Accuracy asks: How precise do I need to be? Confidentiality asks: To whom can I disclose information? Access asks: Who should be able to access my records? Communication asks: How should I transmit records? Documentation asks: What information should I record? Retention and destruction ask: How long should I keep records and how should I dispose of them?

Review and Document the Process

After reviewing and documenting the process, this chapter argues that it is unethical to stop the ethical decision-making process with implementation. The chapter recommends monitoring and evaluating the consequences of the ethical decision by engaging in post-decision activities. It uses two case studies where well-meaning mental health professionals inadvertently created iatrogenic effects for their clients. It details what went wrong in each case and how outcomes might have been improved. In these situations, mental health professionals are strongly encouraged to re-engage the ethical decision-making process on behalf of their clients, including apologizing for missteps previously made.

Conclusion

Our goal in writing this book was to make it fundamentally different from most other books on ethics. First, we focused on sharing a process of making ethically sound and justifiable decisions, rather than addressing specific issues that require ethical judgments. The process involves taking proactive steps to be as well prepared as possible to manage ethical predicaments. School mental health professionals should analyze the situation fully, followed by seeking consultation from authoritative and objective sources, before identifying a full range of possible courses of action. Those courses of action and their anticipated outcomes for both the student and stakeholders are carefully considered. The selected course of action is “tested” before implementation to help ensure the best possible outcomes for the student and stakeholders and avoid unanticipated, adverse outcomes. The pupil services professional documents the steps taken to make the decision and is prepared to justify the decision, should any criticism arise. Finally, the implemented course of action is monitored and reflected upon to protect the student and improve future professional practice....

Analyze the Predicament

Analyzing the ethical predicament begins with identifying the primary client. This chapter differentiates the primary client from other participants, such as supplicants, targets, beneficiaries, and consultees. This chapter also identifies important nonclient stakeholders, including school administrators, teachers, other mental health professionals, other students, and community members. It provides eight types of organizational power that stakeholders can wield, including legitimate, reward, coercive, expert, referent, information, affiliation, and group power. It recommends determining the ethical values in conflict and the competing ethical principles involved. It recommends that mental health professionals provide an ethical orientation at the outset of the relationship and understand the differences between informed consent, informed assent, passive consent, and informed dissent.

Seek Consultation

Seeking consultation commences with the recognition that seeking consultation is itself an ethical duty to the client. The chapter recommends three types of consultation, including ethical consultation, clinical consultation, and legal consultation. Ethical consultation occurs best when it is regularly scheduled, part of an ongoing relationship, and nurtures the professional’s own ethical growth. Clinical consultation can be used for ongoing supervision, understanding the connection between emotional and academic problems, staying current with clinical theory and interventions, recognizing the need for self-care, and managing clinical concerns. Legal consultation can assist with understanding constitutional rights of due process and equal protection, federal statutes such as the Every Student Succeeds Act or Individuals with Disabilities Act, state statutes, administrative regulations, and case law, such as the Tarasoff duty to protect and Jaffee v. Redmond. It ends with a discussion of the relationship between law and ethics and provides guidance regarding civil disobedience.

Identify Courses of Action

Identifying courses of action warns mental health professionals not to be caught in false dilemmas where only polar options are available. This chapter suggests using the “rule of three” to ensure that least three courses of action are ascertained. Next, it recommends considering the consequences of each possible course of action. To evaluate each of the alternatives, professionals should consider the moral values involved and responsibilities to multiple stakeholders. Based on the moral development of the students involved, professionals should involve them in collaborative decision-making and treat students as partners in the ethical process.

Know Yourself and Your Responsibilities

Knowing yourself and your responsibilities requires that you understand your ethical assumptions and frameworks. This chapter identifies four major ethical theories that inform professional codes of ethics: deontology, consequentialism, ethics of care, and virtue ethics. It also provides a typology for the mental health professional’s use of self that includes (a) negative underinvolvement, (b) positive underinvolvement, (c) positive overinvolvement, and (d) negative overinvolvement. It ties each of these positions to the use of a hierarchy of professional influence, ranging from persuasion, leverage, inducement, and threat to compulsion. It also addresses the professional responsibilities of school-based mental health providers in regards to federal legislation, self-care, and their respective codes of ethics. It ends with a set of ethical guidelines and exercises for reflection.

Manage Clinical Concerns

Managing clinical concerns is a reminder that the therapeutic relationship is important throughout an ethical crisis. This chapter focuses two kinds of threat assessment: suicidal threats and threats against others. It encourages mental health professionals to help students grow through the crisis and to take a developmental approach to shared decision-making while being aware of the risk factors that impair adolescent cognition. It recommends using Vygotsky’s zone of proximal development and cultural sensitivity when addressing ethical issues. Clinicians are warned about ethnocentric reactions to child discipline and to pay attention to power dynamics when working with minority families. It ends with guidance about how to create a welcome space to discuss clinician-client differences, especially due to intersectionality.