Applying the ACA Decision Making Model

Applying the ACA Decision-Making Model

Introduction

There are all kinds of different and complex dilemmas that can arise when counseling. There are no definite right or wrong ways to address these dilemmas that counselors are faced with. Counselors will approach these situations with training and information that has been accumulated over their counseling career. Thankfully, the American Counseling Association (ACA) has provided the ethical decision-making model with seven different steps to follow in deciding a course of action when faced with an ethical dilemma.

Identify the Problem

Jason is a minor who is having suicidal thoughts stemming from both personal and family issues that appear to be legitimate. Some important questions to ask when faced with this kind of situation is where are the problems coming from and if there is an imminent threat present. When asking the first question, answers can vary from Jason’s parents struggling with their marriage and that having a trickle-down effect to whether Jason is actually satisfied with himself or not. During this period of development, an adolescent can be in a very tumultuous state because they are trying to form their own thoughts and opinions separate from their parents. Finding out the exact reasoning for Jason’s suicidal ideations will help a counselor determine the next best course of action. The second question to ask is whether Jason presents as a danger to himself and others around him. His suicidal intentions have been established, so figuring out how to take the appropriate next step would be in order.

Apply the ACA Code of Ethics

According to the ACA Code of Ethics, it states that if there is any serious or foreseeable harm, client confidentiality is temporarily waived in that situation to disclose the potential danger to appropriate third parties (B.2.a.). The ACA Code of Ethics also states that in cases of minors, consent and disclosure of information must be sought from the appropriate third party, meaning parents or guardians (B.5.c.). In Jason’s case, informing his parents of his suicidal ideations would be one of the correct steps to take, along with seeking permission to disclose the potential threat to the police and principal if he poses a threat to others.

Determine the Nature and Dimensions of the Dilemma

When reviewing this dilemma’s consequences with the foundational principles, there is a conflict that presents itself. The principle of nonmaleficence comes into conflict with the principle of beneficence. Corey, Corey, and Corey (2015) defined nonmaleficence as “avoiding doing harm, which includes refraining from actions that risk hurting clients” (p.16). This comes directly into conflict with beneficence, which ties into caring for the welfare of society. Because Jason has voiced his potential for suicide, it is vital to determine if this self-harm involves jeopardizing others in the form of a school shooting. Bringing up the possibility of a school shooting or other societal harm to both the principal and the police, and the harm was only directed at Jason himself, then a counselor is jeopardizing the possibility of Jason returning to his school. Jeopardizing Jason’s return to his current school is a form of doing harm to the client because he may have to then attend a new school with a whole different set of people and expectations. To better understand and evaluate whether Jason presents a danger to himself, an evaluation of professional thinking and literature is needed. Current research points to evaluating different risk factors and looking for warning signs that present in a range of ways, such as behavioral, verbal, physical, and emotional. When these warning signs present singularly, there is some cause for alarm, but when they present in combination, it is especially important to assess the possibility of suicide. The mnemonic “IS PATH WARM” put out by the American Association of Suicidology was designed to help counselors remember the signs of suicide. They are as follows: suicide ideation, substance abuse, purposelessness, anger, trapped, hopelessness, withdrawal, anxiety, recklessness, and mood change. Because Jason has presented as imminently at risk of suicide, he should be exhibiting multiple signs listed above, which means this is an emergency situation where immediate action should take place. Personnel that should be consulted in this stage would be a clinical mental health counsellor, the principal, and some type of emergency service. Once these personnel have been consulted, informing the parents of the situation would be the next step to take.

Generating Potential Courses of Action

This step is designed for the option of identifying all courses of action that could be taken to prevent Jason’s suicide and then implementing the correct course of action. The first course of action that can be taken after identifying that Jason is at imminent risk of suicide is quietly confiscating Jason’s backpack without escalating the situation. This can be done in a couple of ways, such as asking him to leave his backpack outside the office, asking him to place it in his locker, or simply asking him to leave it in the corner of the office. This type of thought is generated because it is possible that Jason’s method of suicide is contained in his backpack, so it is always within arm’s length. The next step to take would be to identify if Jason has any dangerous weapons on his person. Knowing the laws for possession of a weapon in the state would be important since most but not all weapons are prohibited. After identifying weapon possession, the next step to take would be to notify the school administration. Since not all schools have multiple counselors, it may be difficult to take the necessary steps for notification. In this case, the next course of action would be notifying the principal of the situation and having him or her notify emergency services. The principal can either be notified through a phone call or verbally. If it is verbal, the counselor will need to have someone else carry the message because they need to stay in the room with Jason. If it is over the phone, great care needs to be taken not to be distracted from the client and not to alarm the client. Once the principal has been notified, they will need to inform emergency services. It is important to keep in mind that during the period of emergency notification, it will be important that the principal does the notification in a separate room to avoid an escalated situation. While the notification is being made, it will be the counselor’s job to stay with Jason to avoid an attempted suicide in the office. Doing things like holding his hand, keeping eye contact, and keeping his mind off of an attempt at suicide will be important. When the principal is notifying emergency services, either the police or hospital will be notified. Upon arrival of emergency services, Jason will need to be escorted out to the ambulance or police car. It is best if the counselor walks out with Jason and then, from there, allows emergency services to take over. Once Jason has been safely secured, the last step would be to notify the parents of the situation and location of their son.

Consider the Potential Consequences of All Options and Determine a Course of Action

The above plan and considerations for Jason’s safety and confidentiality will determine the correct steps that need to be taken. Having Jason place his backpack in the corner at a safe distance would be the best first step to take. The presence of the backpack will help avoid escalation, but at the same time, the distance will prevent Jason from using anything that could be in the backpack. After getting Jason to sit down and begin talking things out, notifying the principal via a third party would be the most beneficial. Once the principal has been notified of the situation, he should notify the hospital of a suicidal student in a separate room from Jason. The reasoning for choosing an ambulance rather than the police is that the ambulance is less indicative that Jason has done something wrong compared to the police rolling up and using handcuffs. EMTs are also more qualified to deal with a mental health crisis than police officers. In the meantime, the counselor should talk to Jason and prevent him from thinking about committing suicide. Once the EMTs arrive, the counselor should walk with Jason through a more private exit to the EMTs, where they will take over. Once the EMTs have left, the parents should be notified of the situation and where Jason is located. This course of action will work best to ensure that Jason is not put on a public display, enable limited chances for escalation, prevent Jason from ever being left alone, and also include the most qualified professionals to handle the situation. Choosing this option also limits the possibility of violating the principle of beneficence because there is limited exposure to other people outside of the counselor, principal, EMTs, and whoever notified the principal of the situation.

Evaluate the Selected Course of Action

The selected course of action does not present any new ethical considerations for the seven principles that were discussed earlier. There are three new tests that need to be applied to assess whether this course of action is appropriate from an ethical standpoint. The first test to apply is the test of justice, which means that you would treat any other situation in a similar manner. In this instance, there is nothing that would indicate a wrongful course of action. Jason is just like any other student and deserves the same duty to protect her as any other student. The second test is publicity, which essentially asks if you would want your actions publically scrutinized. In this situation, everything was done to prevent public disclosure of the situation that occurred with Jason. He is just a troubled kid who needs help working through some serious problems. In using the EMTs and not making a scene within the school, the breach of Jason’s confidentiality was minimal. The last test that needs to be applied is the test of universality, which is a test that asks the question of whether you would recommend this plan to another counselor. Pending the outcome of Jason’s admittance to the hospital, I would recommend this plan of action to another counselor without any hesitation.

Implement the Course of Action

When faced with an ethical dilemma, it is easy to talk about courses of action, but implementing them can be much more difficult. It is important to remember that this course of action is what is best for the client and is designed with much thought being given to the consequences and outcomes to occur. Also, at the same time, consultation with other professionals is encouraged because of the enormity and implications of ethical dilemmas. With careful consideration and professional endorsement, it becomes a little bit easier to implement a plan of action. Ways to help implement a course of action is to discuss a plan for future events just in case something comes up. For example, discussing correct procedures with a principal when dealing with suicidal students will make it easier to implement the plan of action when it is actually needed. Rehearsing the events and making sure to follow any ethical or legal guidelines will help ensure the right steps are taken when they are needed. In the end, following up with a situation and observing the outcome will help solidify future actions in an ethical dilemma.

Conclusion

Ethical dilemmas are something that counselors will come across occasionally, and no two are alike. Using the ethical decision-making model will help guide a counselor when faced with difficult situations. Some important considerations to take into account every time there is an ethical dilemma are to maintain client confidentiality if possible and consider both legal and ethical. Implications: discuss solutions with another qualified professional and use the ethical decision-making model to help guide choices for plans of action.

References

American Counseling Association. (2014). ACA code of ethics. Retrieved from http://www. counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf

Board of Counseling (2019). Virginia Department of Health Professions. Retrieved from: https://www.dhp.virginia.gov/counseling/counseling_laws_regs.html#law

Brock, S. E., & Louvar Reeves, M. A. (2018). School suicide risk assessment. Contemporary School Psychology, 22(2), 174-185. doi:10.1007/s40688-017-0157-7

Corey, G., Corey, M.S., & Corey, C. (2019). Issues and ethics in the helping professions (10th ed.). Stamford, CT: Brooks/Cole Publishing Co. ISBN: 9781337406291

Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s Guide to Ethical Decision Making. Alexandria, VA: American Counseling Association. Doi https://www.counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical- decision-making. pdf?sfvrsn=f9e5482c_10

Granello, P. F., & Zyromski, B. (2018). Developing a comprehensive school suicide prevention program. Professional School Counseling, 22(1), 2156759. doi:10.1177/2156759X18808128

Schilling, E. A., Lawless, M., Buchanan, L., & Aseltine, R. H. (2014). “signs of suicide” shows promise as a middle school suicide prevention program. Suicide and Life-Threatening Behavior, 44(6), 653-667. doi:10.1111/sltb.12097

School Counseling & Advertising (2019). Virginia Department of Education. Retrieved from: http://www.doe.virginia.gov/support/school_counseling/counselingstandards.pdf

Warning Signs. (2019, July 30). Retrieved from https://suicidology.org/resources/warning-signs/.

Wyman, P. A., Pickering, T. A., Pisani, A. R., Rulison, K., Schmeelk‐Cone, K., Hartley, C., Valente, T. W. (2019). Peer‐adult network structure and suicide attempts in 38 high schools: Implications for network‐informed suicide prevention. Journal of Child Psychology and Psychiatry, 60(10), 1065-1075. doi:10.1111/jcpp.13102

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Question

You are asked to review and discuss changes that occurred to the ACA in 2014.

Applying the ACA Decision-Making Model

There were several impactful changes; tell me how you think these changes will improve or damage the act overall.