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Case study: Shana and family - Ethics

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Shana, 31, mom

Jason, 15, son

Maria, 13

Adam, 11

Ex-husband, the custodial parent, name unknown

Shana takes her three children to see you. They are now in your office, the four of them. Shana talks for herself and her three children and here is what she says:

I really need help and my neighbor said you would be the best. Thank you. I am 31 years old and these kids are all having some trouble. I need help. I divorced their father and he got custody of them but after a while, because now I am sober, he brought all three back to me. He married some woman with a 7 year old and now they have a baby. They don't think they can handle teens any more. These are good kids. I was a bad mom. I mean I was sick, I guess. I drank a lot but now I am 3 and ½ years sober and working and doing good.

Jason is 15, Maria is 13, and Adam is 11, and they are all here today to tell you they want help to stay with me. I just cannot afford three teenage kids. Their dad needs to help with the money. Jason wants to quit school and work to keep us all together. Maria is with her boyfriend all the time and Adam is never around. I guess he's at the mall or something. His dad says he gets good grades but I don't see how. I think he is doing marijuana or something. I want them all to go to Alateen or something and I need help. I live with my mom, but she drinks and is on some government pension of some kind. She got hurt in the military, real bad. She's okay. But she can't manage these kids. I don't know; she may even be using some smoke, too. Not me though. I learned to keep straight and go to meetings and call my sponsor but we are losing money galore now.

Can you call my husband and tell him these kids are his responsibility and even if we are divorced he still has custody? I mean, I could take him to court or something but that doesn't seem right. Just call him for me and explain things for me and get him in here to help. Would you please talk to each of the kids now and see what is going on with each of them then tell me so I can talk to them? We could get somewhere then. Thanks. I think they like you already, huh guys? Thanks. You are great. I knew you would help if I just got in here. My neighbor said you would help.

Here, I wrote down the teacher and school number for each of my kids. If you would call and say we are working on things and have them send the homework home with a note, then I could check it for them before they leave in the morning. Whew. I feel better already. I knew you would start doing something for us. Thanks. Oh, by the way you should call my family doctor. I got some Prozac and put the kids on it to help them through this thing. I thought the two oldest needed some but I guess the third one could use some too. I just did it until we could get here and find some help for all of us. I guess it would help the youngest one with depression, too. What do you think? The last time I heard the word suicide was before the medicine. I guess you should talk to the doctor. Here is his number. Just call him now and he will call you back. He s real good about that stuff. The youngest has been on something for ADD I think. Better check that, too.

As the therapist, you know that helping Shana and her family is going to take more than making the phone calls she requests. Begin with a discussion of the ethical issues that are presented in this case:
1.How do these ethical issues influence how you move forward to help Shana and her family?
2.With these ethical considerations in mind, which assessments/tests (remember to think back to past learning in this course) would you want to have done, for whom and for what purpose?
3.Who should do these assessments/tests and why? Would you, or would you not, conduct the assessments/tests yourself?

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This solution discusses ethics for a specific case study

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Among the ethical issues presented in this case is the knowledge that Shana does not have custody of the children, and you cannot counsel, or treat the children without the consent of the custodial parent. Next, she has asked the therapist to call the school for the children's records, and the doctor for their medical records; this cannot be done without informed consent. Finally, an ethical problem exists with the disclosure of the information that Shana has taken it upon herself to medicate the children. Although, it is not indicated in the vignette, the state in which she resides, most states have mandated laws of reporting when a child is abused, or put in harm's way. Certainly giving the children unprescribed drugs could cause them harm. Moreover, the kids are teenagers and therefore minors. and thus, informed consent is required by the legal parent (or in this case the custodial parent) to provide treatment. There may also considered the issue of professionalism. Shana has approached the therapist in haphazard fashion. To take on a counseling relationship is a professional responsibility. There needs to be established a formal agreement and consent if treatment is going to be provided.

1. How do these ethical issues influence how you move forward to help Shana and her family?

My first consideration would be the children, as their safety would take priority. The children appear to be abandoned by their father, and it is obvious that Shana is ...

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