Collaborating with Human Services Professionals
Collaborating with Human Services Professionals
The profession of counseling as a whole (and individual counselors) seem to agree that collaborating with an effective team or advocating for clients provides a good therapeutic balance for those clients who seek assistance. Moreover, it has been said and has been written about in detail how therapeutic relationships rely on trust first and foremost for the eventual success of eliminating barriers and providing autonomy for clients ( Remley, & Herlihy, 2014).
Collaboration, advocacy, and especially trust can often create ethical and legal boundary issues. These three are often hard to balance in a legal environment. According to Nylen (2007), it has been claimed that while collaboration with human services may improve the quality of therapy and reduction of costs, collaboration can be viewed and implemented in a variety of ways which may alter the overall effectiveness depending on the ever changing combinations of “formalization” and “intensity” during collaboration which defines the degree of positive impact or possible risk. Nylen (2007), states:
“Combining low intensity with medium high formalization into ‘an assignments reallocation strategy’ of collaboration appears to have modest impact, whereas medium high intensity in combination with low formality, that is, ‘a commitment-based networking strategy’, has a high potential to increase effectiveness. High intensity in combination with high formalization produces ‘a formalized team-building strategy’, which is simultaneously promising and risky” (pg. 143).
There is so much to consider when deciding whether or not to form a team for a client or to be the sole advocate and helper. Every client is different, every situation is different, not to mention that a counselor’s own values and ideas may play a part in the end result– successful or not. Herlihy & Corey (2015), point out that colleagues can be helpful to counselors in many situations. Colleagues and other professionals may raise other issues and perceptions that might otherwise be overlooked and unnoticed. Collaborating with our colleagues can help us to consider other perspectives and be more objective and aware. In addition (legally speaking), consultation [collaboration] may also protect a counselor in court showing that the counselor sought guidance and had the support of other professionals in the field for whatever decisions or conclusions that he/she made. Another important point that Herlihy & Corey make is that these consultations [collaborations] need to be documented specifically at the time of any incident or question.
Ethical codes do not always answer all ethical questions. Doing the right thing sometimes seems impossible to decipher or discover. The ACA Code of Ethics sometimes seems to contradict. This can become confusing and frustrating since “codes” and “laws” often do not provide proper guidance in specific situations (Calmes, Piazza, & Laux, 2013).
Consider the case of a 31 year old mother. She has 3 children, is single, and has stated that she feels that she is a horrible mother who will eventually have her kids taken away. She is currently seeing a therapist, has a social worker, and her children are seeing a child therapist for play therapy.
In this case, the client has a team that includes a therapist, a social worker, a psychologist (for testing assessments), her childrens’ play therapist, and she has also asked for a referral to a psychiatrist. She has signed all of the required consent forms in order to keep everyone “on the same page”. She appears to be willingly transparent and committed to wellness and autonomy for herself whatever it takes.
The social worker has recently informed the therapist that she (social worker) may want to pursue Child Protective Services due to her concerns with the client’s possible substance abuse issues. The psychologist suspects personality disorders and paranoid or delusional thinking ruling out bipolar disorder. However, this psychologist also acknowledges that since the client has not yet completed the assessment battery, these “suspicions” are only gut observations. In addition the children’s play therapist is suggesting consultation with the kids’ teachers due to her own concerns.
The “team” seems already in place due to the client’s willingness and consent forms that she signed in order for all of these professionals to evaluate her and collaborate on her behalf. This client clearly wants to “be well” and seems committed . With all of the varying opinions of different professionals thus far, the counselor has much on her plate and is pleased to be working with such a sincere and dedicated client. This client has also asked to see a psychiatrist and has asked the therapist for a referral. Under the circumstances, the counselor agrees. This counselor sends a letter to a trusted colleague (psychiatrist ) which reads:
FAMILY AND CHILDREN’S CENTER
1515 Highland Avenue Eau Claire, WI 54702
Juanita J. Duffy
Family and Children’s Center
1515 Highland Avenue Eau Claire, WI 54702
Dr. Daniel Robertson
Robertson Psychiatric Services
406 Commonwealth Blvd Eau Claire, WI 54703
Hello again Dr. Robertson,
I am currently working with a client who has requested a referral for a psychiatric evaluation and I would enjoy working with you again if you are able or see fit to do so. My client (Marsha Davis) is a 31 year old single parent of three young children who are all involved in play therapy with Lisa Lewis here at the clinic. I have been seeing Marsha for 4 months. She is also working with a social worker and is scheduled for an assessment battery with our psychologist.
Marsha is a cooperative and pleasant client but seems to be driven by fear. She states that she is afraid that her children will be taken away from her. She has admitted to drinking a few times a week but the play therapist, the social worker, and another staff here at the clinic all reported to me that they have observed her acting (or sounding) disoriented at times as well as smelling of alcohol. I have not witnessed this myself but I do have concerns based on their reports. However, I do not see any danger to her children at this time.
I suspect that Marsha’s “paranoia” (as documented by our psychologist) may be linked to how often this professional feels that Marsha self-medicates. But, I am not certain. Our play therapist has expressed other concerns and would like to consult with the teachers at school, but we have not yet signed the consents for that to happen.
We have a good team of people to help Marsha and I would very much like you to be a part of that team. There seems to be several issues to address and everyone has their own opinions and suggestions. I have set up our first team meeting for next Thursday and then another one in 3 weeks so that we can address all of the variables and collaborate together.
I will send you my notes including the observations of the other team members after our first team meeting in order to provide you with more information and then will look forward to hearing your thoughts. If we could talk a bit this Thursday anytime after 10:00 am, that would be ideal. Please let me know what works for you and I will accommodate.
I would like to avoid involving Child Protective Services if at all possible at this time which is what the social worker is suggesting to me. I look forward to hearing your views and hope that we can help this client together. We may have to involve an AODA counselor but I am unsure at this point and would appreciate your evaluation in several areas.
I have always respected your work. You have proved to be a good and trusted support in similar situations with my clients. I have attached a copy of Marsha’s consent for us to share information. Thanks again!
Certified Mental Health Counselor
Since the therapist is the team lead in this case, all information and/or suggestions are reported to her (the therapist) by other team members. The client has willingly signed all of the necessary forms for everyone to share information and collaborate on her (client’s) behalf. The client is seeking alternative views which make collaboration necessary and appropriate.
Calmes, S. A., Piazza, N. J., & Laux, J. M. (2013). The use of touch in counseling: An ethical decision-making model. Counseling and Values, 58(1), 59-68. Retrieved from http://search.proquest.com.library.capella.edu/docview/1346947316?accountid=27965
Herlihy, B., & Corey, G. (2015). ACA ethical standards casebook (7th ed.). Alexandria, VA: American Counseling Association. ISBN: 9781556203213.
Nylen, U. (2007). Interagency collaboration in human services: Impact of formalization and intensity on effectiveness. Public Administration,85(1), 143-166. doi:10.1111/j.1467-9299.2007.00638.x
Remley, T. P., Jr., & Herlihy, B. P. (2014). Ethical, legal, and professional issues in counseling (4th ed.). Upper Saddle River, NJ: Pearson Education.
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