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ETHICS FOR REHABILITATION COUNSELORS PROGRAM II A HOME STUDY PROGRAM COMMISSION ON REHABILITATION COUNSELOR CERTIFICATION 300 N. MARTINGALE ROAD, SUITE 460 SCHAUMBURG, IL 60173 (847) 944-1325 www.crccertification.com |
INTRODUCTION The Commission on Rehabilitation Counselor Certification (CRCC) believes that individuals certified as rehabilitation counselors (CRCs, CCRCs, CRC-MACs, and CRC-CSs) should continue to expand their skills in order to enhance the quality of services they provide. CRCC’s certification renewal requirements are designed to encourage rehabilitation counselors to continue their professional education through courses and other activities that will help them serve their clients more effectively. |
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FROM THE AUTHORS… These materials have been written to respond to the continuing needs of rehabilitation counselors who provide rehabilitation services to individuals with disabilities. |
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MODULE I – ELECTRONIC COMMUNICATIONS LEARNING OBJECTIVES: Communications via e-mail, facsimile, and cellular phones expose rehabilitation counselors to potential violations of the Code of Professional Ethics for Rehabilitation Counselors (2001). |
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| 1. | have a better understanding of how to avoid coming in conflict with the Code when using these communication methods. |
| 2. | have a better understanding of potential ethical pitfalls that can readily occur when communicating client information via e-mail. |
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ETHICS: SETTING BOUNDARIES By: Thorv Hessellund, Ed.D., CRC The Phone Call Versus E-mail: Rehabilitation counselors often don’t think in terms of the Code as they work on their job from day to day. As counselors, we do our job as best we can, working in compliance with the rules and parameters established by our employer and appropriate regulations that govern the delivery of our counseling services. The advent of computer and e-mail technology presents daily communication challenges that could be interpreted as a “possible” Code violation. Let’s take a look at a couple of examples that highlight these possibilities. A private sector CRC learns during an initial interview with client John Smith that Mr. Smith is planning to relocate to another part of the state. After this first meeting, he recommends a colleague to the claims examiner at Zydeco Insurance Company. The CRC sends his colleague a “heads up” e-mail noting that he will be receiving a referral soon from Zydeco Insurance in regards to John Smith who is recovering from a head injury. Are there potential Code violations with this e-mail communication? Some questions to consider in making this determination are listed below. First, during this initial meeting as part of the disclosure process, was it disclosed that e-mail is likely to be one of the forms of communication used? Was a release signed to cover this method of communication? In respect to a client’s right to privacy, has there been a breach in client confidentiality by using the name in the electronic communication sent to a colleague? Is there more of a potential for a Code violation because the name and disability were linked together? Prior to our having access to e-mail, the CRC would have been much more likely to pick up the phone and call his colleague to explain what occurred and to expect the referral. It is much easier in today’s world to shoot off a quick e-mail. The obvious difference with e-mail is that now it is documented, in writing, for anyone who has access to that e-mail to view. A major step toward avoiding potential Code violations is to be clear in the initial meeting and throughout any counseling process how electronic communications will be used and to include in signed release forms an acknowledgment that this method of communication will be used. If Mr. Smith was so informed at the time of the initial interview and prior to and following the email, there will likely not be any violation. If not, there is the possibility of a Code violation. Linking the client’s name with the disability does increase the likelihood that a violation has occurred, as this could be considered an unwarranted disclosure of confidential information. To avoid any possible Code violation, it would have been much simpler to send an e-mail without using the client’s name and requesting the CRC to give a call if there are any questions. Electronic Referrals: Let’s take a look at another example where Code violations could easily occur. In this situation, the CRC works for a company that manages disability nationwide. The company is made up of a central administrative home office along with a nationwide network of case management service providers and consulting specialists, including physicians. All are on a dedicated electronic communication network with the most sophisticated firewalls available to insure internal confidentiality. Electronic reporting of patient medical information is a necessary part of everyday business operations. On occasion, there is the requirement to make a non-network referral to an outside service provider, such as a vocational specialist. When such a referral is made, the CRC uses an electronic referral form that includes all necessary data, including client contact information, and specifics regarding the disability. The most recent medical report and work restrictions are also sent electronically or via fax. When reviewing potential violations, one of the factors to consider is whether or not a counseling relationship has been established. In this situation, the CRC working for the case management company may or may not have talked with the client via telephone. However, it is not likely there has been a counseling relationship established. According to the Code, the definition of clients are “individuals with disabilities who are receiving services from rehabilitation counselors.” From this perspective, communications with the client would be considered as covered by the Code. If there is no harm as a result of this standard business practice, then the practice is likely to continue unless a complaint is filed. The CRC may also assume all communication is secure as their employer is in compliance with the Health Insurance Portability and Accountability Act (HIPAA). If, however, a complaint is filed and then reviewed by the CRCC Ethics Committee, questions will be asked as to whether or not the client signed a waiver to the right to privacy as well as whether or not it was disclosed that this type of information exchange would occur. If not, there is likely to be further inquiry as to whether or not a violation occurred. Some further considerations: What if someone else has access to the receiving counselor’s email and views the referral information? Is the receiving fax confidential? What if, when sending out the e-mail with medical information attached, a key is accidentally hit that sends the e-mail and the attachments to the wrong person or is sent out on a broadcast e-mail? Section I of the Code is devoted to Electronic Communications and Emerging Applications. Emerging is a key word here, as there are many arenas and business practices yet to be tested as to whether or not ethics violations have occurred. The examples given above reflect two situations where some violations are clear and others not so clear. For all CRCs, the best practice is to be aware of the Code as it applies to these emerging methods of electronic communications and take steps to protect our clients from potential harm. One of the best ways to do this is to be thoroughly familiar with the Code and review with one’s peers any concerns where these types of ongoing business practices could result in a violation. REFERENCES Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author. Health Insurance Portability and Accountability Act of 1996. Public Law 104-191. 104th Congress.
Hessellund, T. (2006). Ethics: Electronic communication. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 1-3). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html |
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MODULE II - DISCLOSURE LEARNING OBJECTIVES: |
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understand the competing influences that are present in a case.
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| 2. | distinguish between direct service and indirect service provision. |
| 3. | establish a “code of conduct” appropriate for each. |
| 4. | understand the potential problems with changing roles after a client/counselor relationship has begun. |
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ETHICS: DISCLOSURE By: Jeffrey E. Carlisle, M.A, CRC, CCM, CDMS & Jill C. Falk, M.Ed., CRC, CDMS Kaitlin works as a vocational rehabilitation counselor providing assessment and job placement services in the workers’ compensation system. One year ago she provided services to Joe that initially included vocational assessment and a report. Kaitlin made recommendations for formal job placement services. Joe worked as a waste water treatment plant operator at the time of the injury. Kaitlin developed a résumé, provided Joe with job seeking and interviewing skills instruction, and coordinated employment interviews. She worked with Joe for approximately three months at which time vocational services were interrupted and the case closed as Joe underwent additional low back surgery. A year after she closed the case, Kaitlin received a call from the referral source who reported that they were in need of further assistance. Joe had undergone the surgery and had a lengthy recovery that included physical therapy. The referral source was frustrated with the length of the recovery process and was of the opinion that Joe should be capable of returning to work, feeling that Joe was doing things beyond his physician assigned physical capacities at home. A former co-worker had seen him boating. The referral source had hired an investigator and surveillance was conducted. They were requesting that Kaitlin take the video tape produced from surveillance to the doctor to determine whether Joe was doing things beyond his capacities and to discuss his ability to work. They said that she should not tell Joe about the tape. Kaitlin said that she would take the case but after she got off the phone she began to think about what she had agreed to. She did not feel comfortable taking a video tape to the doctor without Joe’s knowledge. She questioned whether or not this was her proper role. What were her responsibilities to the referral source and to her past client, Joe? Could she do this because he was not a current client? Could she do this because she had no need to meet with him and therefore this was a forensic case with no client counselor relationship? If Joe is still her client, then what? What steps could she take to find the answers to these questions? The Code of Professional Ethics for Rehabilitation Counselors (2001) is clear that the counselor’s primary obligation is to the client and the referral source should be reminded of this. Although Kaitlin was no longer working with Joe, she had previously developed a client–counselor relationship with him and would be right to expect that relationship to resume once Joe recovered from his additional back surgery, assuming he was still in need of vocational counseling and job placement services. Having already worked with Joe in a direct service arrangement, she was now being asked to take on a different role in the case, which could be viewed as being adversarial to Joe. Whereas it could be proper for her to review the “investigation tape” to learn what information it revealed about the types of vocational activities Joe was capable of performing, it would also require that she disclose this to Joe and provide him with an opportunity to comment on this. For her to withhold this information from Joe and meet with the doctor with the expressed purpose of getting the doctor to comment on whether or not Joe was performing activity beyond his doctor assigned physical capacities is clearly an attempt on the part of the referral source to document such with the intent of reducing or stopping Joe’s workers’ compensation benefits. Should Kaitlin follow through on this, she would be changing her role in the case and creating a conflict of interest for herself given the previous establishment of a client-counselor relationship with Joe. Any change in the role of the counselor should be thoroughly reviewed and considered. While in some instances it is not unethical to change the role, this is fraught with many potential ethical problems and should only be done in the rarest of circumstances and only with consultation. Kaitlin realized that the case could now be considered a forensic case because the referral source was requesting that she not meet with the client. However, she had already met with the client in the past and she could not simply convert Joe to a forensic case, ducking her responsibilities. In the past, she had already established a client/counselor relationship. The CRCC Code is not clear on how long after case closure a counseling relationship would continue. This needs to be looked at on a case-by-case basis. However, given that Kaitlin’s work with Joe was interrupted only because of his need for surgery, Joe would have a right to expect that the client-counselor relationship with Kaitlin was still in effect and would resume at some point in the future. Once client contact is made by phone, e-mail, facsimile or other means, this is the beginning of direct client services. A much wider range of responsibilities are required under the CRCC Code. This is to protect the client. If no contact is made directly with a client, there is no client-counselor relationship. However, the counselor still has the responsibility to provide a fair and accurate evaluation under the Code when providing indirect services. Kaitlin did not have a good feeling about the situation and that was a good sign that the situation needed to be examined more closely. She could have reviewed the CRCC Code. She could have discussed the situation with her supervisor or a peer. She could have consulted an expert in rehabilitation counseling ethics. If she was unable to determine the correct course of action after that, she could have contacted the CRCC Ethics Committee for an Advisory Opinion. Kaitlin also should have told the referral source that she could not take the tape without Joe’s knowledge or input, citing that she is ethically bound to have an open and honest counseling relationship with Joe. Although this can be difficult to do, most referral sources hire certified individuals because of their experience and expertise, but also because they are bound by sound professional ethics. She should also consider disclosing to her referral sources that she cannot participate in investigations of clients prior to referral and that if informed of an investigation on a current client that this information would need to be shared with that client. REFERENCES Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author.
Carlisle, J. E., & Falk, J. C. (2006). Ethics: Disclosure. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 4-6). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html |
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MODULE III – DISPARAGING REMARKS LEARNING OBJECTIVES: |
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| 1. | define a disparaging remark that may potentially lead to an ethical breach. |
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distinguish between a critique of a work product and a criticism of an individual.
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3.
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understand the application of fact versus fiction in the context of disparaging remarks.
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Rehabilitation counselors encounter the potential of dealing with disparaging remarks in almost
every aspect of their work, and all levels of their career. Here are some examples: |
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Given my expertise in dealing with multicultural issues, my supervisor requests that I review the report of a colleague new to the rehabilitation team. In examining the report, I comment on the lack of considering cultural implications of vocational opinions rendered. This would have relevant consequences to the successful outcome of the vocational rehabilitation plan. Is that a disparaging comment? How about if I add that the vocational recommendations demonstrate that my colleague is clearly inept as a rehabilitation counselor?
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A colleague from another state is considering applying for a job with an agency where I previously worked and seeks my advice. Although having left the institution on good terms, I have concerns about the manner in which the agency is managed. Through former co-workers still with the agency, I recently learned that consumers and staff filed several grievances. Just this morning, there was a short article buried in the local newspaper regarding some of the issues surrounding the grievances. What should I say to the out-of-state colleague considering applying for a job with the agency?
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I have been retained to review/critique the vocational opinion of a former professor and internship advisor. We had many differences of opinion regarding case issues and did not part on good terms. I have not sought out this person’s advice on cases, or otherwise had contact with him/her in 10 years. This person does not attend or present at any of the local or national rehabilitation conferences. In my deposition, opposing counsel asks if I respect this individual as an authority and leader in the field of rehabilitation. If I answer "No" to this question, is this a disparaging remark?
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Whether in a professional setting, in academia, or in a public forum, we all have heard comments that make us feel uncomfortable as to how they impact the source at which they are directed. However, are those remarks disparaging?
A clear definition of what constitutes a disparaging remark must be understood. The Merriam- Webster Online Dictionary defines disparaging as, “to lower in rank or reputation” (www.webster.com). To disparage someone is to degrade, belittle, minimize, defame, demean, humiliate, or scorn them. Most relevant to our discussion, to disparage an individual is to attack or call into question their moral or intellectual character. The same definition could be applied to institutions or groups of individuals. Specific to the Code of Professional Ethics for Rehabilitation Counselors (2001), Standard D.7.a. requires that we “… not discuss in a disparaging way the competency of other professionals or agencies, or the findings made, the methods used, or the quality of rehabilitation plans.” Intrinsic in this Standard are two themes to consider in assessing whether a remark about an individual is considered disparaging: 1) critique v. criticism; and, 2) fact v. fiction. Critique v. Criticism: Although seemingly synonymous, critique and criticism in a professional context are different. To offer critique symbolizes an academic or specialized review of someone’s work vis-à-vis standards of that profession resulting in a commentary based on the work product. It could mean considering aspects of the analysis that were missed, other methods of analysis, research designs, or case conceptualization systems that might be more appropriate to the premise or assignment, and/or how findings, conclusions, and recommendations might be affected. On the other hand, criticism crosses the line away from the work product to a more personal attack of professional character. A rehabilitation counselor who ascribes to an accepted counseling method within the profession, that may not be considered the mainstream, may often have their work critiqued by other professionals. It is different if any of those professionals belittle the counselor’s work through personal affronts in an attempt to demean the counselor as an individual, or intellectually. Back to our first example at the beginning of the paper, it is not disparaging to critique the colleague’s report if there are aspects of the method and conclusions that miss important cultural considerations relevant to potential successful vocational outcomes. However, to criticize the counselor’s inexperience in cultural issues by calling into question their integrity, clearly disparages the colleague’s intellectual abilities based merely on exposure to one report. In short, critiques attempt to provide comparisons of thoughts, ideas, methods, or conclusions to other standards in the field as they apply to a work product, a case, or even an organization. On the other hand, criticisms are comments, conclusions, or opinions that are about the value of a person, or organization’s quality. Fact v. Fiction: A fact is something that has already happened. Sometimes there can be disputes about how something happened, or even if it happened at all. Some facts, however, are undeniable. In our example with the out-of-state colleague, grievances were filed against the agency. That is a fact that is derived from two sources: the rehabilitation counselor’s former co-worker and the morning newspaper. What crosses the threshold into fiction is when there is an assumption of fact that is based on a possibility. That is, arriving at conclusions as to how the grievances will result, the inherent worth of the agency as an employer, or a brush stroke criticism of all management of the agency may be crossing into an attempt to disparage the agency, or the management colleagues working within it. Walking the fine line between fact and fiction is difficult. I may want to protect my colleague from an expensive move by accepting employment with an agency that is in turmoil. Conversely, the colleague may be the solution to solving some of the agency’s problems. Ultimately, sticking to facts and steering away from fiction when discussing individuals or organizations helps rehabilitation counselors safeguard against potential ethical complaints regarding disparaging remarks. As described in the third scenario, does it matter to an experts’ professional opinion whether an opposing expert is a leader in the field? If, after bringing this to opposing counsel’s attention, the counselor is still forced to respond, the fact v. fiction dichotomy can be useful. An approach may be to narrow counsel's focus of the question by asking to set the parameters. That is, "Counsel, could you clarify what you mean by ‘authority and leader’ in the field of rehabilitation? I'm not clear what you mean by those terms." If the definition of an authority is someone who writes on the topic, presents at professional conferences, etc. then you could truthfully say that, at least within the circles you have traveled professionally, you have not seen the person present, write, etc. in the past 10 years. Thus, based on counsel’s definition, the person would not be considered an authority or a leader since their activities do not fall into the dictionary definition of the terms. The answer is based on fact. If the definition offered is that the expert is retained frequently, the aspect of the definition "appealed to as an expert," may be used to enter into the record that this person is viewed as an authority since the definition offered by the authority supports it. Unless an expert has completed a study to truthfully assess whether another person has the power to influence or command thought, opinion, or behavior, this question is outside the scope and is more appropriately addressed to the trier of fact. By keeping responses in the fact realm, and in one’s area of expertise, potential problems involving disparaging remarks based on an emotional response may potentially be avoided. Summary: Deciphering whether a remark is disparaging is not as clear cut as it seems at face value. Stating a fact or critiquing a colleague’s work product or opinion may still humiliate an individual who is the recipient of such commentary, depending on the person’s sensitivity or ability to deal with such assertions. However, those comments are not necessarily disparaging as defined, or implied in D.7.a. If those comments fall into criticisms of the individual as a person, their character or intellect, or are based on incorrect assumptions or fictional claims, potential ethical breaches could be construed. REFERENCES Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author. http://www.webster.com/dictionary/disparaging
Barros-Bailey, M., & Neulicht, A. (2006). Understanding disparaging remarks in ethics. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 7-9). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html |
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MODULE IV – TESTING AND ASSESSMENT LEARNING OBJECTIVES: |
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| 1. | describe the challenges facing rehabilitation counselors who provide testing and assessment. |
| 2. | describe some key ethical considerations related to testing and assessment. |
| 3. | describe several strategies for ensuring ethical compliance in assessment. |
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ETHICS: TESTING AND ASSESSMENT By: Terry L. Blackwell, Ed.D., CRC, LCPC Testing and assessment can have a significant impact on clients. Inadequate assessment can deprive clients of appropriate services and effective interventions related to their overall rehabilitation. Poorly performed assessment may result in a lack of adequate goods and services necessary for subsequent rehabilitation planning efforts; inappropriate job goals; and denial of realistic training and career options. Ironically, while roles and functions surveys have found that rehabilitation counselors spend a significant portion of their professional time in testing and assessment, this is also one of the more troublesome areas of practice for them. Counselors are continually faced with challenges in consistently performing assessments that are ethical, accurate, useful, and consistent with the latest advances in research and theory (Pope & Vasquez, 1998). The Code of Professional Ethics for Rehabilitation Counselors: Section F of the Code of Professional Ethics for Rehabilitation Counselors (2001), entitled Evaluation, Assessment and Interpretation, includes standards on competence to select, use, and interpret tests and the release of test data. Client rights in testing and test security are also addressed. Rehabilitation counselors who provide, interpret, or utilize assessments should be thoroughly familiar with the standards provided within this section of the Code. Testing and Assessment: Rehabilitation counselors need to distinguish between testing and assessment in their work with clients. A test is a tool that is used to gather information such as a measure of an individual’s aptitudes, educational achievement, vocational interests, etc., as part of the assessment process. The assessment or assessment process, on the other hand, is the planning, collection, and evaluation of information pertinent to a rehabilitation concern. Both testing and assessment need to be conducted by professionals who are trained and qualified to gather a variety of different types of information (e.g., review of medical records, vocational information, academic records, observations, interviews, test results, etc.) from a variety of different sources (e.g., client, family, physicians, employers, other health care providers, etc.) and to interpret or give meaning to that information, given the client’s unique characteristics and situation (F.5.a). Test Integrity and Security: Rehabilitation counselors who administer tests have ethical obligations to both the test developers and the test takers. As virtually all tests are copyrighted and valid results are dependent on the unfamiliarity of test takers with the items, test users have a duty to protect the integrity and security of a test from compromise and unwarranted uses. This obligation means that rehabilitation counselors must maintain the security of tests in their possession and refrain from copying, modifying or otherwise disseminating test items without expressed acknowledgment and permission from the publisher (F.9). Further, the practice of sending a standardized test home with the client is incompatible with the duty to protect test security in addition to the clinical issues this practice raises. Competence to Test: In administering tests, the rehabilitation counselor’s first ethical duty is competence (F.5). While it is possible in testing and assessment to be competent without being ethical, it is not possible to be ethical without being competent (Weiner, 1989). The process of choosing the right test for the intended purpose and clientele requires sound professional judgment and training to understand test manuals and research data. Similarly, proper test administration is crucial to a meaningful outcome and requires more than the ability to follow test instructions; it also demands knowledge of how to adapt the testing conditions to unique client circumstances without jeopardizing the validity of the results. Since different tests require different levels of competence for administration, scoring, and interpretation, counselors must recognize the limits of their competence and perform only those testing and assessment services for which they are trained (F.5.a). Rehabilitation counselors need to be able to document that they have had adequate training, supervision and experience in gaining competence in the tests they use. Further, it is important that rehabilitation counselors do not use obsolete tests or outdated test results (F.10) as a basis for their assessment, intervention decisions, or recommendations. In addition to being trained and familiar with the instruments they use in an assessment process, competency also requires that rehabilitation counselors keep up to date on current developments in the areas of testing and assessment through activities such as continuing education and professional development; peer support and consultation; and continual review and adherence to respective ethical standards and guidelines and relevant federal, state, and local regulations concerning assessment. Measurement, Validation, Research: In addition to evidence of competence, rehabilitation counselors need to be able to demonstrate an understanding of reliability, validity, related standardization, error of measurement, and proper application of any technique utilized (F.5.a). Counselors need to use assessment techniques that are appropriate in a given situation or with a particular client (F.6.a), based on normative and validation studies. This applies to the use of automated interpretation and testing services as well (F.8.d, F.8.e). Rehabilitation counselors need to know the purpose of each assessment instrument they use and how well it measures what it purports to measure. In addition, they need to be aware of test bias as it may impact the findings for clients from diverse populations and those who are not represented in the norm group (F.6.c, F.6.d). Diverse Populations: Rehabilitation counselors need to be alert to ways in which age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, and socioeconomic status may affect the appropriate scoring and interpretation of assessment tools (F.8.b). One important consideration in this area is the availability of normative data for the client’s population. When tests do not have norms for particular cultural groups, alternative measures should be sought. If no alternatives exist, those results should be interpreted with great caution (F.8.a). Client Rights in Testing: Rehabilitation counselors must be aware of their ethical responsibilities regarding informed consent of the client prior to assessment (F.1). Prior to any testing, they need to ensure the client understands the nature and purposes of assessment and the specific use of results so that the client can give or withhold informed consent at any phase of the testing or assessment process. Typically, the counselor is responsible for making the necessary efforts to provide a fully understandable explanation and to form a professional opinion regarding whether a client understands and consents. This explanation needs to be provided in language that is reasonably understandable to the client or other legally authorized person on behalf of the client. When testing or assessment without consent is mandated by law or governmental regulation, best practices would suggest the client should still be informed concerning the assessment process. Interpretations: When interpreting assessment results, including automated test interpretations, the rehabilitation counselor must indicate any reservations that exist regarding validity or reliability of the circumstances of the assessment or the inappropriateness of the norms for the individual being tested (F.8.a). The counselor needs to clearly acknowledge any significant reservations regarding the accuracy or other limitations of these results. Unless prohibited from discussing the results of assessment by virtue of their role or setting (e.g., forensic evaluations, third party referrals, etc.) counselors will typically inform the client of the test results and outcomes of assessment. In cases where they are prohibited from discussing the assessment results with the client, rehabilitation counselors need to inform the client in advance that they will not be giving the client any results or interpretations (F.1.b, F.12). Release of Test Data: The appropriate release of test data has gained considerable attention in recent years. In general, consent of the client or the client’s legal representative will be criteria for determining the recipients of the assessment results. However, in releasing assessment information to third parties, rehabilitation counselors need to be aware of evolving legislative and case law regarding what is to be disclosed and what their ethical and legal obligations are to the client in this regard. In releasing any test data, rehabilitation counselors also need to be aware of their obligations for maintaining test security and make it a practice to release testing or other copyrighted material only to persons recognized by the counselor as competent to interpret the data (F.2.a, F.2.b). Summary: In summary, rehabilitation counselors are often faced with a number of questions and issues when providing assessments that are ethical, accurate, useful, and consistent with the latest advances in research and theory. As a result, they need to be able to balance the ethical standards of their profession with legal and regulatory mandates in order to ensure that assessment procedures are used only in ways that protect the rights and promote the well being of the client.
Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics forRehabilitation Counselors. Schaumburg, IL: Author. Pope, K. S., & Vasquez, M. J. T. (1998) Ethics in psychotherapy and counseling: A practical Guide (2nd ed). San Francisco: Jossey-Bass. Weiner, I. B. (1989). On competence and ethicality in psychodiagnostic assessment. Journal of Personality Assessment, 53, 827-831.
Blackwell, T. L. (2006). Ethics: Testing and assessment. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 10- 13). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html
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MODULE V – STUDENT SUPERVISION LEARNING OBJECTIVES: After reading this module, the reader will: |
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| 1. | appreciate the importance of orienting students to the expectations and processes associated with their academic work, including fieldwork. |
| 2. | understand the basic characteristics of effective fieldwork evaluation. |
| 3. | understand the rehabilitation counselor’s ethical responsibilities in addressing substandard practicum or internship performance. |
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ETHICAL ISSUES IN STUDENT SUPERVISION By: Linda R. Shaw, Ph.D., LMHC, CRC The supervision of students completing practica and/or internships is one of the most rewarding parts of the job of both academicians and practicing rehabilitation counselors. Students can challenge you, motivate you, energize you, and create an enormous sense of satisfaction in having mentored a budding rehabilitation counselor. The assumption of responsibility for the supervision of a student is also a weighty responsibility, however. Whether one is a professor or a field supervisor, the commitment in time, resources, effort and liability is substantial and not to be taken lightly. Ethical student supervision requires careful consideration of a number of issues, including 1) evaluation of one’s supervisory skills; 2) the obligation to provide students appropriate orientation and conditions that promote student success; 3) the need to provide appropriate and ongoing evaluation and feedback; and 4) one’s role as a “gatekeeper” to prevent harm to both current and future clients. Each of these responsibilities will be discussed in greater detail below: REFERENCES Bordin, E. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research and Practice, 16, 252-260. Bradley, J. R. & Post, P. (1991). Impaired students: Do we eliminate them from counselor education programs? Counselor Education and Supervision, 31, 100-108. Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author. Koch, L. (2004). The student-teacher working alliance in rehabilitation counselor education. Rehabilitation Education, 18(4), 235-242. Procidano, M. E., Busch-Rossnagel, N. A., Reznikoff, M., & Geisinger, K. F. (1995). Responding to graduate students’ professional deficiencies: A national survey. Journal of clinical Psychology, 51, 426-433.
Shaw, L. R. (2006). Ethical issues in student supervision. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 14- 17). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html
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MODULE VI – AGING POPULATION LEARNING OBJECTIVES: As medical science advances and people are living and working longer, rehabilitation counselors will find themselves working with an older population. After reading this article the reader will be more knowledgeable about the changing age characteristics of the population and some basic issues of which they need to be aware. The reader will be able to: |
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| 1. | identify reasons why the population is growing older. | |
| 2. | describe the life stages of middle and older life. |
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identify characteristics of successful aging and adaptation to growing older.
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be aware of ageism in oneself and others.
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ETHICS: AGING POPULATION By: Donald C. Linkowski, Ph.D., CRC, LPC Introduction National demographic estimates predict that in the year 2020 there will be 53.7 million persons the age of 65 and over, as compared to 34.8 million of persons this age in the year 2000 (A Profile of Older Americans, 2004). Life expectancy has been changing, too. In 1900, an average person could expect to live until he or she was 47 years of age, 90 years later life expectancy increased to 75 years of age; today, it is estimated to be 83 years (NIH, 2000). This means that people will be working longer and already retirement is being delayed beyond the traditional 65 years old (www.ssa.gov). Adult Development and Aging: Most theory and research on human development has focused on infancy and childhood. One of the first to recognize the stages of adult development is Erickson. Of his eight stages, two are specific to adulthood and older age persons—Generativity vs. Stagnation and Integrity vs. Despair. These stages build on the young adult stages of Identity vs. Identity vs. Diffusion, and Intimacy vs. Isolation. Generativity pertains to helping others to grow and develop as in child rearing, teaching, or coaching younger persons giving oneself to others to guide the next generation, yet respecting their autonomy. It can take the form of being a consultant or mentor to others. As people grow older, their need for achievement generally declines and a need for community or affiliation increases. It is through caring and giving of oneself that stagnation is avoided. Integrity is the last stage of life and is that time when people takes stock of their lives and reflect on their accomplishments. It is an experience that conveys some world order and a spiritual sense. Erikson suggested that wisdom was the virtue of Integrity. For those who don’t master this stage, the experience is one of Despair. Successful Aging and Adaptation to Aging: Like disability, aging can be looked at as negative or positive, as loss or gain. It is more helpful to an older person to focus on his or her assets in developing a rehabilitation plan. To build on the positive such as experience and knowledge and skills that have been developed is more helpful than focusing on losses. Successful aging has also been the subject of various conceptualizations. Havighurst (1961) defined successful aging as “adding life to the years” and “getting satisfaction from life”; Rowe and Kahn (1987) conceptualized it as a function of various physiological and psychosocial variables, while Ryff (1989) defined successful aging as “positive or ideal functioning related to developmental work over the life course.” Ten years later, Fisher (1992) interviewed 19 senior participants in a day-care facility of those aged 62-85 and found that these tended to define their successful aging in terms of utilized strategies for coping. Soon after, Gibson (1995) stated that successful aging “refers to reaching one’s potential and arriving at a level of physical, social, and psychological well-being in old age that is pleasing to both self and others.” Linkowski and Borzuchowska used focus groups in their development of the Adaptation to Aging (AtA) Scale (http://home.gwu.edu/~dcl). They defined adaptation to aging in terms of self-renewal, health and wellness practices, self-determination and independent living, and meaning in life and spirituality. Successful adaptation to the aging process in America appears to be based on those components. Counselors can help their clients self-assess their adaptation to aging and facilitate their personal growth. As with disability, counselors need to be aware of discrimination against persons because of age. Ageism can affect how the counselor views his/her client as well as how employers view older persons who are applying for employment. Persons need to be viewed in terms of their strengths and abilities. Unemployment in mid-life can affect self-esteem. Persons need to be encouraged to put their best foot forward and view themselves as worthy persons. Summary: Counselors can expect greater numbers of older clients coming for service. The population overall is growing older because persons are living longer and the retirement age is getting older. Counselors need to be aware of the developmental stages of adults and older persons as well as issues involved in successful aging and problems of ageism. Note: The accuracy of the content of this article and subsequent reference reflect the author’s work prior to his untimely death. ADDENDUM BY: Susan G. Sherman, MS, CRC, LPC Dr. Don Linkowski drafted this article on the Aging Population just before his untimely death on January 8, 2006. He had retired just days before from a distinguished 38 year career with George Washington University. Dr. Linkowski has left a legacy of research, leadership and service. Throughout his lifetime, Dr. Linkowski was instrumental in shaping the mission and standards of rehabilitation counseling and advancing the professional quality of the field. It is with the utmost respect for the work of Dr. Linkowski that I offer an addendum and questions related to the ethical considerations discussed in his last article on the Aging Population. The CRCC Code of Professional Ethics for Rehabilitation Counselors (2001) preamble discusses the fundamental spirit of caring and respect with which the Code is written and the five principles of ethical behavior upon which it is based. These include Autonomy-to honor the right to make individual decisions; Beneficence-to do good to others; Nonmaleficence to do no harm to others; Justice-to be fair and give equally to others; and Fidelity-to be loyal, honest, and keep promises. As life expectancy increases, vocational rehabilitation counselors will need to display these principles to a population that is increasingly composed of people with disabilities and yet wish to stay employed and active. Aging individuals are used to being able to make their own decisions, as they have throughout their lifetime. The counselor must guide this client in making informed decisions and show respect for individual decisions. Ageism can affect how the counselor views his or her clients as well as how employers may view older persons. The CRCC Code addresses the issue of attitudinal barriers in the section on advocacy C.1.a. Rehabilitation counselors must strive to eliminate attitudinal barriers, including stereotyping and discrimination, towards individuals with disabilities and to increase their own awareness and sensitivity to ageism when working with such individuals. Care must be taken by the rehabilitation counselor to assure myths and stereotypes do not color the counselor’s judgment in working with older individuals. Should the rehabilitation counselor find himself or herself uncomfortable with issues of an aging client population, under the Code of ethics in Section D:, (Professional Responsibility) the rehabilitation counselor should take steps to ensure the competence of their work (D.1.c) and practice only within the boundaries of their competence (D.1.a). The rehabilitation counselor should seek to gain knowledge, personal awareness, sensitivity, and the skills pertinent to working with this population of aging individuals and engage in continuing education to develop competence with this special population (D.1.h) In Dr. Linkowski’s article, the term Generativity, discussed by Erickson in his eight stages of life, refers to the stage in life where one mentors or teaches others. The concept of giving of self to others can be very important to the aging individual. Not only does Generativity increase the aging individual’s self-worth, but is a way of passing life experiences on and to share that wisdom so such life experiences can be passed to the next generation. Section G of the Code addresses how rehabilitation counselor educators and trainers teach, train and provide supervision to others with less experience. In line with the concept of Generativity, is the idea of sharing knowledge yet respecting the autonomy of those with whom knowledge is shared. Section G.2.e of the Code discusses the need to present varied theoretical positions so that students may make comparisons yet have the opportunity to develop their own positions. The importance of mentoring and teaching of others as one ages and acquires knowledge and experiences can be one strategy to successfully adapting to growing older that may lead to staying employed and maintaining an active lifestyle. Researchers, such as Linkowski and Borzuchowska in their development of the Adaptation to Aging (AtA) Scale, have looked at successful aging using various techniques such as focus groups or interviews of aging participants. These studies have sought to define successful aging or adaptation to aging by defining strategies for coping or individual practices related to the components of self-renewal, health and wellness practices, self-determination and independent living, the meaning of life and spirituality. Section H of the Code discusses the ethical implications of conducting research and publication of research results. In conducting research it is important for the rehabilitation counselor to obtain the informed consent of individuals participating in the research. In obtaining the informed consent of aging individuals, or any individuals, rehabilitation counselors must use language that is understandable to the research participants. Participation in research studies must be voluntary and after data is collected, rehabilitation counselors need to provide participants with full clarification of the nature of the study to remove any misconceptions. It is important to note that counselors who help their aging clients to self-assess their adaptation to aging can facilitate the individual’s personal growth. As the retirement age moves up and people live longer, rehabilitation counselors can expect a greater number of aging clients to seek services. As the article on the Aging Population discusses, unemployment in mid-life can affect self-esteem. The counseling relationship is discussed in Section A of the Code. Erickson’s stages of adult development include the stage of Integrity which is the last stage of life. Erickson suggests for those who don’t master this stage, the experience is one of Despair. The counseling relationship can be a key to assisting the aging individual to focus on the experience, knowledge and skills that the individual has developed over his/her lifetime. Respect for the individual’s cultural background and developing interventions and services to incorporate cultural perspectives is something the counselor must consider when assessing the client’s employment needs. Working with aging individuals to obtain and maintain employment and active leisure activities in an ever-changing world will require the rehabilitation counselor to be well versed in the profession’s Code of ethics. A counselor knowledgeable of the Code will be able to more effectively assist aging individuals to take stock of their lives and to use those life experiences to enhance themselves and others in the work environment. Assisting aging individuals towards Integrity vs. Despair in their final last stage of life allows the aging individual to make a positive impact on the future that can last well beyond his/her lifetime.
Administration on Aging. A profile of older Americans: 2004. U.S. Department of Health and Human Services. Retrieved July 6, 2006 from http://assets.aarp.org/rgcenter/general/profile_2004.pdf Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author. Havighurst, R. J. (1961). The learning process. American Journal of Public Health, 51, 1694-7. National Institutes of Health (2000) Rowe, J., & Kahn, R. (1987). Human aging: Usual and successful. Science, 237(4811), 143-149. Ryff, C. (1989). Beyond Ponce de Leon and life satisfaction: New directions in quest of successful ageing. International Journal of Behavioral Development, 12(1), 35-55. Social Security Administration. Full retirement age is increasing. Social Security Administration. Retrieved July 6, 2006 from http://www.ssa.gov/retirechartred.htm
Linkowski, D. C., & Sherman, S. G. (2006). Ethics: Aging population. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 18-22). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html
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MODULE VII – ADVOCACY LEARNING OBJECTIVES: As many persons with disabilities will attest, one of the most difficult aspects of living with a disability is having their voices heard. After reading this article the reader will be knowledgeable about how to help people not only understand their rights, but also know how to help them achieve that to which they are entitled. The reader will be able to: |
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| 1. | identify attitudinal barriers and achieve a heightened sensitivity to issues facing people with disabilities. |
| 2. | understand the CRC’s role in ensuring effective service delivery. |
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ADVOCACY: THE VOICE OF DEMOCRACY By: Gregg Newberry, M.A. More than 225 years ago, as we Americans all know our history, the 13 original colonies felt it was unfair for England to impose taxes on tea. “No taxation without representation,” was echoed throughout the land and was the beginning of the most famous advocacy effort in our nation’s history, The Boston Tea Party. Advocacy can take on many forms and people with disabilities frequently need advocacy to ensure adequate services. Many times it becomes the role of the rehabilitation counselor to help people with disabilities know their rights. It is the rehabilitation counselor’s role to remain aware of actions taken on behalf of their clients by others and, if necessary, the rehabilitation counselor may need to act as an advocate for the client to ensure effective and timely service delivery. There are a number of laws that protect the rights of individuals with disabilities such as the Individuals with Disabilities Education Act, the Rehabilitation Act, the Fair Housing Act, and others. For the purposes of this training module, the focus will be on the Americans with Disabilities Act (ADA) and its implications. In order to be effective in advocating, one must understand the regulations set forth by the ADA. President George H.W. Bush signed the ADA into law on July 26, 1990. At the time of signing, The ADA was heralded as one of the most sweeping pieces of civil rights legislation since the Civil Rights Act of 1964. The ADA covers all aspects of American society and is divided into five sections, or titles. Title I covers all aspects of the employment process, including the application process, interviewing practices, hiring methods, testing policies, promotions, and termination. Title II covers State and Local Government Agencies and also addresses Program Accessibility, which will be discussed in further detail in this module. Title III, which addresses Public Accommodations, includes a 12-category list of general classifications. Title IV covers Telecommunications, which involves phone systems, and other forms of communications for people who are Deaf or hard of hearing. Finally, Title V is a miscellaneous category, which covers a number of issues that are not covered in the other Titles. Let’s look at some possible scenarios. For example, a counselor refers a client who is deaf for job counseling services. Is the responsibility of the service provider to provide a sign language interpreter or would it be considered effective communication to pass written messages back and forth as a means of dialogue? Another example could involve the following scenario. A counselor refers a person who uses a wheelchair for mobility due to cerebral palsy to an agency providing training classes on computers and Internet access. When the person arrives at the location of the agency, the person discovers the location to be inaccessible due to a set of stairs with no elevator to help access the building. Due to some of the confusion surrounding the implications of laws such as the ADA, it is possible that clients may be unaware of their rights, and therefore it becomes the counselor’s role to provide clients with appropriate information to support their advocacy efforts. When considering advocacy efforts invoking the statutes defined in the ADA, one must keep in mind the definition of a disability. The ADA defines a disability as a physical or mental impairment that substantially limits one or more major life activities such as working, talking, hearing, seeing, or caring for oneself. The law also prohibits discrimination against individuals with a record of impairment, such as cancer patients in remission, and those regarded by others as having an impairment, such as individuals with severe facial scarring. Under the ADA and similar civil rights legislation, a private employer, state or local government entity or public accommodation may need to consider hiring a sign language interpreter for someone who is Deaf or hard of hearing to ensure that effective communication takes place. Under the ADA there is a requirement to provide effective communication in employment situations, in situations where public services are rendered by government agencies and when goods and services are provided by public accommodations. The ADA does not specifically state that an interpreter must be offered as the method of providing effective communication. However, it is important to assess when an interpreter is the appropriate choice for accommodation. Additionally, it would be important to assess which method of accommodation the individual feels most comfortable using to communicate. In situations where an individual's primary communication occurs through using American Sign Language, another form of sign language or an oral interpreter, it may be necessary to provide an interpreter. Some individuals who are deaf may not know English as their primary language. A language barrier may be an issue in this case. Consider the situation much like one where an individual may speak Spanish or French as their primary language. When a language barrier results, written notes may not be an effective accommodation because the individual may not be able to read and write English. In the second scenario, concerning the individual who uses a wheelchair for mobility, public entities have a requirement to ensure programs and services are accessible to individuals with disabilities. Essentially, all programs and services are to be readily accessible and usable by individuals with disabilities. However, not all facilities are required to be physically accessible; only the programs must be accessible. This requirement is known as “program accessibility.” For example, it is not required that the agency office be accessible to individuals with disabilities as long as the programs and services offered by the agency can be readily accessed and used. So, in regard to the computer and Internet training class, the agency would be required to provide the training in a location that would be accessible and usable to the individual. In this scenario, program accessibility would not be achieved by providing the training in the individual’s living arrangement. Although this would be an accommodation of an individual’s disability, it would not satisfy the requirements of program accessibility because it would not allow the wheelchair user the same opportunities for social integration as it provides to the other participants. By being a part of the classroom training, other participants have the chance to interact with fellow classmates, make friends and acquaintances, and learn from classmates’ insight and mistakes. In the previous scenarios, the rehabilitation counselor may find him/herself in a situation where he/she feels caught between his or her employer and the consumer or the client. In the first scenarios, the referral agency may not want to provide a sign language interpreter due to possible budget restraints. The referring agency may be reluctant to become involved in the advocacy process because of the potential for jeopardizing the working relationship that exists between the two agencies. Likewise, in the second scenario, the agency providing the computer training may have to move the location of the training to an accessible location, which could be more costly. Again, for any number of reasons, the referring agency may not want to be involved in the advocacy efforts. For the most part, both scenarios come down to the same point. One of the responsibilities of the rehabilitation counselor is to support selfadvocacy. By helping the consumer/client understand his/her rights under the various laws, the rehabilitation counselor would be supporting and promoting advocacy, as well as teaching the individual with a disability important skills, which could last a lifetime. At times, however counselors may need to advocate for the rights of clients with their own employers. While requiring sensitivity to the employer’s concerns, rehabilitation counselors do have a responsibility to “attempt to affect change through constructive action within the organization: and to “take appropriate further action” as necessary CRCC Code of Professional Ethics for Rehabilitation Counselors (2001). Because of the efforts of tens of thousands of people throughout this country, the disability community can be proud of laws such as the Americans with Disabilities Act, the Individuals with Disabilities Education Act, as well as many other federal and state laws. It is because of these laws people with disabilities can make their voices heard, and thus share in the process of our American democracy. |
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REFERENCES Commission on Rehabilitation Counselor Certification. (2001). Code of Professional Ethics for Rehabilitation Counselors. Schaumburg, IL: Author. The Americans with Disabilities Act of 1990. Public Law 101-336.
Newberry, G. (2006). Advocacy: The voice of democracy. In Commission on Rehabilitation Counselor Certification (Ed.). Ethics for Rehabilitation Counselors, Program II (pp. 23-25). Retrieved [date] from, http://www.crccertification.com/pages/25home_study.html
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MODULE VIII – TRANSCULTURAL DECISION-MAKING LEARNING OBJECTIVES: After reading this module, the reader will be able to: |
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| 1. | identify different ethical decision making models. |
| 2. | describe virtue ethics. |
| 3. | identify and describe the stages of the transcultural ethical decision-making model. |
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TRANSCULTURAL ETHICAL DECISION-MAKING IN COUNSELING By: Jorge Garcia, Rh.D., LPC, CRC, Professor of Counseling, The George Washington University Vocational rehabilitation counselors are employed in a variety of settings and serve a diverse population. They respond to a variety of ethical situations when engaged in counseling,assessment, case management, and job placement. They are required to conduct themselves in a professional manner. When working with culturally diverse populations of language minority consumers, counselors are required to facilitate the provision of services in the least restrictive environment. However, one potential source for bias for the assessment professional may be ethnic or racial stereotypes, which could lead the practitioner to make invalid assumptions and incorrect recommendations (Rosenthal & Kosciulek, 1996). There are a variety of ethical decision-making models from which rehabilitation counselors can choose. The transcultural integrative model offers another resource for vocational rehabilitation counselors when faced with questions of how to best serve persons with disabilities from diverse cultures. The Ethical Responsibility to Respect Diversity by the Vocational Rehabilitation Counselor: | |