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Ethical Considerations for the Rehabilitation Professional: Serving Culturally Diverse Populations

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Title: Ethical Considerations for the Rehabilitation Professional: Serving Culturally Diverse Populations


1
Ethical Considerations for the Rehabilitation
Professional Serving Culturally Diverse
Populations
  • Maureen McGuire-Kuletz, Ed.D., CRC
  • Director/Assistant Research Professor
  • George Washington University RRCEP
  • 2011 I Street, NW
  • Suite 300
  • Washington, D.C. 2005
  • 202-973-1558/mkuletz_at_gwu.edu

2
Learning Objectives
  • To discuss diversity in terms of vocational
    rehabilitation practices
  • Develop strategy for exploring cultural diversity
  • Explore ethics as related to professional
    practice with diverse populations
  • Analyze case studies for culturally diverse
    populations

3
What is Culture?
  • ??

4
Culture
  • The sum total of ways of living including
    values, beliefs, esthetic standards, linguistic
    expression, patterns of thinking, behavioral
    norms, and styles of communication which a group
    of people develop to assure their survival in a
    particular physical and human environment.

5
Cross Cultural Awareness
  • ????

6
Cross Cultural Awareness
  • Refers to the basic ways of learning that
    behavior and ways of thinking and perceiving are
    cultural conditioned rather than being universal
    aspects of human nature. In this learning,
    unconscious, culturally-based assumptions and
    values held by individuals are brought to the
    surface.

7
Cultural Competence
  • ???

8
Cultural Competence
  • The ability of individuals to see beyond the
    boundaries of their own cultural interpretations,
    to be able to maintain objectivity when faced
    with individuals from cultures different from
    their won and to be able to interpret and
    understand the behaviors and intentions of people
    form other cultures nonjudgmental and without
    bias.

9
Terms
  • INSTITUTIONAL BEHAVIOR (FAMILY POLITICAL
    RELIGIOUS ECONOMICAL) ASSOCIATIONS
  • VALUES THESE ARE DEFINED ASBELIEFS THAT LEAD
    TO ACTION (E.G. "WORK IS GOOD FOR YOUR
    CHARACTER" "IT IS GOOD TO BE A VEGETARIAN").
  • NORMS ARE DEFINED ASIMPLICIT RULES OF BEHAVIOR
    (EG., BEING PUNCTUAL GETTING UP EARLY).
  • ROLES THESE ARE DEFINED AS PERFORMANCE OF
    FUNCTIONS (E.G. "LOVING" MOTHER"SUBMISSIVE"
    WIFE "EMPATHIC COUNSELOR").

10
  • STATUS RELATIVE POSITION IN A PRESTIGE
    HIERARCHY  (EG., ECONOMIC,SOCIAL, PROFESIONAL).
  • MINORITY A GROUP THAT RANKS AS SUBORDINATE,
    BASED ON DIFFERENTIALPOWER OR POPULATION
    SIZE.MINORITY MEMBERSHIP IS TRANSMITTED BY RULE
    OF DESCENT OF SPECIFIC CULTURAL AND/OR PHYSICAL
    TRAITS THAT ARE HELD IN LOWESTEEM BY DOMINANT
    SOCIETY.

11
  • DOMINANT A GROUP WITH COMMON HISTORY, VALUES AND
    LANGUAGE SEEKING TO ADVANCE OWN INTERESTS OVER
    THOSE OF OTHER GROUPS BASED ON ECONOMIC AND
    POLITICAL POWER.
  • ETHNOCENTRISM THE DOMINANT GROUP ASSUMES THAT
    SURVIVAL OF THE GROUP AND SOCIETY DEPENDS ON
    PERPETUATION OF OWN VALUES.
  • RACISM THE BELIEF ON RACE SUPERIORITY
    (IDEOLOGICAL) NEED TO DEFINE OTHERS AS INFERIOR
    (PSYCHOLOGICAL) STRUCTURED INEQUALITY JOB
    BARRIERS LOW EDUCATIONAL OPPORTUNITTIESLOW
    POLITICAL PARTICIPATION.

12
  • DISCRIMINATION DIFFERENTIAL AND UNEQUAL
    TREATMENT OF THE MINORITY GROUPS BY THE DOMINANT
    GROUP.  E.G. WAGEDIFFERENTIALS UNEQUAL ACCESS
    TO PROMOTION LOW ADMISSION RATES TO SCHOOLS,
    ETC. WHEN DISCRIMINATION IS BASED ON RACE
    DIFERENCES THEN IS CALLED RACISM, OR SEXISM WHEN
    BASED ON SEX DIFFERENCES.
  • SEGREGATION ENFORCED PATTERN OF SETTLEMENT/USE
    OF FACILITIESE.G., RESIDENTIAL RESTRICTIONS.  IT
    MAY BE BASED ONRACE, RELIGION, ETC.
  • PREJUDICE UNFAVORABLE ATTITUDES TOWARD A GROUP
    OR INDIVIDUAL BECAUSE OF FALSE PERCEPTIONS OR
    STEREOTYPES

13
  • SEGREGATION ENFORCED PATTERN OF SETTLEMENT/USE
    OF FACILITIESE.G., RESIDENTIAL RESTRICTIONS.  IT
    MAY BE BASED ONRACE, RELIGION, ETC.
  • PREJUDICE UNFAVORABLE ATTITUDES TOWARD A GROUP
    OR INDIVIDUAL BECAUSE OF FALSE PERCEPTIONS OR
    STEREOTYPES
  • RELATIONSHIP PATTERNS BETWEEN DOMINANT AND
    MINORITY GROUPSSTABILIZED ACCOMODATION BY WHICH
    SUBORDINATION IS TAKEN FOR GRANTED

14
  • ASSIMILATION THAT THE INDIVIDUAL OR GROUP
    ASSUMES THE IDENTITY AND BEHAVIORS OF THE
    DOMINANT CULTURE
  • PLURALISM THE COEXISTENCE OF DIFFERENT GROUPS IN
    WHICH EACHGROUP RETAINS ITS IDENTITY AND
    BEHAVIORS. INTEGRATION OF DIFFERENT GROUPS BASED
    ON INDIVIDUAL EQUALITY.
  • MELTING POT ALL DIFFERENT GROUPS MERGE INTO ONE
    THAT IS THE PRODUCT OF THE MIX OF ALL CULTURES.
  • (Garcia, 2003)

15
Cultural Perceptions (adapted from Collier, 2002)
  • English
  • Japanese

16
Cultural Perceptions
  • Spanish
  • Altabascan

17
Difference versus Disability
  • The side effects of culture shock can look like
    indicators of learning and behavior disabilities.

18
Locus of control (LOC)
  • Individuals who feel that LOC is external may not
    feel that counseling is a credible source of
    help.
  • Individuals with internal LOC more likely to take
    action on their own behalf
  • ( Brown Lent, 1992)

19
Ways to Value Diversity(Advancement Strategies,
1992)
B Be aware. Broaden your general knowledge of groups and cultures
I Include others Have a variety of people involved in activities and groups
N Never assume! Ask questions listen carefully check understanding
G Give Respect. Treat all people fairly, honestly, and with positive regard.
O Openly communicate. Share information, expectations and unwritten rules with everyone
20
Number of Persons with Disabilities
  • Debates continue concerning how many of us are
    disabled, however. Depending on the criteria
    used, estimates vary from a low of about 36.1
    million (LaPlante, 1992) to about 54 million
    (National Council on Disability, 1997).

21
STAGES OF MULTICULTURAL DEVELOPMENT (Pederson,
1999)
  • AWARENESS
  • KNOWLEDGE
  • SKILLS

22
Awareness
  •  
  • ABILITY TO JUDGE A CULTURAL SITUATIONFROM ONE'S
    OWN AND THE OTHER'S CULTURAL VIEWPOINT.
  •  AWARENESS REQUIRES
  •        - RECOGNIZE COMMUNICATION STYLES  (E.G.,
    VERBAL VS NON VERBAL)
  •        - SENSITIVITY TO NONVERBAL CUES (E.G.,
    PROXEMICS OR HOW CLOSE A PERSON GETS TO ANOTHER
    WHEN INTERACTING KINETICS OR HOW A PERSON
    EXPRESSES HROUGH GESTURES, ETC)       -
    RECOGNIZE CULTURAL AND LINGUISTIC
    DIFFERENCES        - SENSITIVITY TO MYTHS AND
    STEREOTYPES  (E.G., ALL LATINOS ARE MACHISTAS
    ALL LATINO WOMEN ARE SUBMISSIVE) OF THE
    CULTURE   

23
Awareness requires.
  •      
  • - CONCERN FOR WELFARE OF
    OTHERS         - ARTICULATE ELEMENTS OF OWN
    CULTURE (E.G., FORMALITY, LINEAR THINKING,  FOCUS
    ON VERBAL COMMUNICATION, NUCLEAR FAMILY, ETC.)
             - APPRECIATE IMPORTANCE OF
    MULTICULTURAL  TEACHING         - AWARENESS OF
    RELATIONSHIPS BETWEEN  CULTURAL GROUPS (E.G.,
    RACISM, SIMILARITIES)         - JUDGING
    "GOODNESS" AND "BADNESS" IN THE OTHER CULTURE
    (FROM THE OTHER CULTURE'S PERSPECTIVE)

24
KNOWLEDGE REQUIRES INFORMATION ABOUT
  •         
  • - HISTORICAL EXPERIENCES (E.G.,
    INTERNMENT, WARS, ETC.)         - TEACHING AND
    LEARNING RESOURCES         - ROLES OF
    EDUCATION         - SOCIOECONOMIC
    BACKGROUNDS         - VALUES, ATTITUDES,
    BEHAVIORS         - CUSTOMS, SLANG         -
    LEARNING STYLES AND WAYS OF THINKING          -
    KNOWLEDGE ABOUT OWN CULTURE IN  RELATION TO THE
    OTHER           - PROFESSIONAL EXPERTISE IN AN
    AREA             VALUED BY THE OTHER CULTURE

25
SKILL DEVELOPMENT
  •             - APPROPRIATE TEACHING/LEARNING  TECHN
    IQUES AND STYLE FOR WORK IN THE                   
      OTHER CULTURE             - EMPATHY WITH
    PERSONS FROM OTHER  CULTURE 9E.G., IDENTIFY
    FEELINGS CORRECTLY)             - ABILITY TO
    RECEIVE AND ANALYZE FEEDBACK FROM PERSONS OF
    THE                OTHER CULTURE              -
    ABILITY TO DEVELOP NEW METHODS FOR WORK IN THE
    OTHER CULTURE (E.G., MORE OR LESS DIRECTIVE, MORE
    OR LESS FAMILY ORIENTED MORE OR LESS VERBAL,
    ETC).

26
  • CULTURALLY BIASED ASSUMPTIONS
  • THE FOLLOWING IS A LIST OF FALSE ASSUMPTIONS
    THAT WE MAKE ABOUT OTHERS

27
  •   - BELIEVING THAT WE SHARE A COMMON VIEW OF WHAT
    "NORMAL" MEANS.  - BELIEVING THAT INDIVIDUALS
    INSTEAD OF GROUPS ARE THE BASIC BLOCKS OF
    SOCIETY  - THINKING THAT OTHERS WILL UNDERSTAND
    OUR ABSTRACT WORDS THE SAME WAY WE DO. THIS MEANS
    THAT WE NEED TO PAY MORE ATTENTION TO CONTEXT SO
    OTHERS CAN UNDERSTAND WHAT THE CONCEPT MEANS
    (E.G., FAIRNESS, HUMANE, BAD, ETC.)  - THE
    BELIEF THAT INDEPENDENCEDESIRABLE AND DEPENDENCE
    UNDESIRABLE. FOR EXAMPLE IN MANY CULTURES
    INTERDEPENDENCE IS MORE IMPORTANT THAN
    INDEPENDENCE AS A GOAL FOR A PERSON WITH A
    DISABILITY. - BELIEVING THAT FORMAL COUNSELING
    IS BETTER THAN NATURAL SUPPORT. IN MANY CULTURES
    THIS MAY BE THE OPPOSITE.

28
  • -  THE ASSERTION THAT LINEAR THINKING IS THE NORM
    (DEPENDENCE ON MEASURES CAUSE AND EFECT)
    THINKING OTHER CULTURES MAY VALUE COMPLEMENTARITY
    (TWO ASPECTS OF THE SAME REALITY) INSTEAD OF
    CAUSE-EFFECT RELATIONSHIPS BETWEEN TWO
    EVENTS.  - THE BELIEF THAT INDIVIDUALS NEED TO
    FIT THE SYSTEM INSTEAD OF THE SYSTEM FITTING THE
    INDIVIDUAL..- BELIEVING THAT HISTORICAL CONTEXT
    IS NOT RELEVANT AND THAT COUNSELORS NEED TO FOCUS
    ON IMMEDIATE EVENTS PRIMARILY.  MANY TIMES
    UNDERSTANDING THE CLIENT'S PERSPECTIVE
    REQUIRES  KNOWLEDGE OF HISTORICAL BACKGROUND THAT
    THE CLIENT FEELS IS RELEVANT.-  THE BELIEF THAT
    WE ALREADY KNOW ALL OUR CULTURALLY-BIASED
    ASSUMPTIONS.  WE NEED TO UNDERSTAND THAT OTHER
    GROUPS MAY HAVE DIFFERENT ASSUMPTIONS SO WE CAN
    INTEGRATE OR COORDINATE THOSE ASSUMPTIONS WITH
    OURS.

29
SKILLS RELATED TO RECOGNIZING SPECIFIC CLIENT
RESISTANCE
30
  • COPING  THE CLIENT MAY BE UNABLE TO COPE WITH
    THE STRESS OF THE SESSION
  • VALUES CONFLICT  IT MAY BE THAT THE CLIENT
    PERCEIVES THE COUNSELOR IS JUST RESPONDING TO HIS
    OR HER OWN VALUES.
  • OPEN VS CLOSED QUESTIONS  THE CLIENT MAY BE MORE
    COMMUNICATIVE WHEN ASKED OPEN QUESTIONS
  • DIRECTIONS  THE CLIENT MAY NEED SOME SPECIFIC
    STEPS THAT HE/SHE MAY AGREE TO TAKE.

31
  •  CONFRONTATION  IT MAY BE THAT THE COUNSELOR
    NEEDS TO BRING UP THE CONTRADICTION THAT THE
    CLIENT IS FACING (E.G., "YOU SAY YOU ARE ANGRY
    ABOUT YOUR EMPLOYER BUT YOUR ACTIONS DO NOT
    REFLECT THAT").
  • INTERPRETATION  BE AWARE THAT YOUR
    INTERPRETATION OF THE CLIENT'S PROBLEM MAY BE
    OFFENSIVE TO HIM (E.G., "WHAT YOU SEEM TO NEED IS
    GOING BACK TO YOUR COUNTRY").
  • FOCUS ON TOPIC  THIS IS WHEN THE COUNSLOR DRIFTS
    AWAY FROM WHAT THE CLIENT WANTS TO FOCUS ON
    (E.G., FOCUS ON JOB INSTEAD OF RACISM).
  • FOCUS ON GROUP  YOU MAY BE TALKING ABOUT LATINOS
    IN GENERAL WHEN THE CLIENT WANTS TO TALK ABOUT
    HIS INDIVIDUAL SELF.

32
  • SELF-AWARENESS  THE COUNSELOR MAY NEED TO BECOME
    AWARE OF HIS/HER ATTITUDE DURING THE SESSION
    (E.G., BEING PATERNALISTIC INSTEAD OF RESPECTING
    THE CLIENT).

33
  • SKILLS RELATED TO DIMINISHING THE COUNSELOR'S
    OWN DEFENSIVENESS WHEN WORKING WITH CLIENTS FROM
    DIFFERENT CULTURES

34
  • SENSE OF HUMOR  COUNSELORS DO NOT HAVE TO BE
    AFRAID OF USING HUMOR WHEN THEY FEEL THEY MADE A
    MISTAKE (E.G., MAKING THE WORNG JUDGEMENT ABOUT
    THE CLIENT'S CULTURAL IDENTITY).
  • SELF DISCLOSURE COUNSELORS CAN MAKE
    SELF-DISCLOSURES WHICH ARE USUALLY VERY
    APPROPRIATE IN MULTICULTUTAL COUNSELING AS LONG
    AS THEY DO NOT DOMINATE THE SESSION (E.G., "AS A
    CHILEAN I CAN UNDERSTAND HOW YOU FEEL ABOUT HUMAN
    RIGHTS VIOLATIONS").
  • DESCRIPTIVE  THE COUNSELOR NEEDS TO BE
    NONJUDGEMENTAL ABOUT THE CLIENT FROM OTHER
    CULTURE WHICH REDUCES COUNSELOR DEFENSIVENESS.

35
  • SPONTANEITY  THIS HAS TO DO WITH BEING GENUINE
    AS WELL WHICH MAY REDUCE THE COUNSELOR FEARS
    ABOUT THE CLIENT'S CULTURE.
  • RECEPTIVITY  BEING OPEN AND RESPONSIVE TO THE
    CLIENT'S COMMUNICATIONS ABOUT THE COUNSELOR'
    CULTURE.
  • ADMITTING DEFENSIVENESS  THE COUNSELOR IS BETTER
    OFF BY COMMUNICATING TO THE CLIENT HIS
    DEFENSIVENESS IN AN APPROPRIATE WAY (E.G., " YOU
    MUST KNOW THAT I FELT VERY RELUCTANT TO ADDRESS
    THAT TOPIC AT THE BEGINNING").

36
  • APOLOGIZING  THE COUNSLOR CAN APOLOGIZE
    APPROPRIATELY FOR MAKING A JUDGMENT ABOUT THE
    CLIENT (E.G., "EXCUSE ME FOR TAKING YOUR COMMENT
    AS OFFENSIVE").
  • MANPULATION  DO NOT BE AFRAID TO MAKE
    SUGGESTIONS AND/OR GUIDE YOUR CLIENT/CUTOMER -
    SOMETIMES CLIENTS APPRECIATE SUGGESTIONS WHEN
    THEY FEEL IT IS IN  THEIR BEST INTEREST.

37
  • RESPECT CULTURAL DIFFERENCES WHEN COUNSELING
    DIFFERENT CULTURAL GROUPS

38
ETHICAL PRINCIPLES
  • Ethical Principles
  • Translation of our beliefs about what we value
  • Rules of conduct that are derived from values

39
Ethical Principles
  • Beneficence
  • Autonomy
  • Nonmaleficience
  • Justice
  • Fidelity

40
BENEFICENCE
  • Definition - (be-nef-e-sens)
  • Helping others further their important and
    legitimate interests, Do the Right Thing
  • Justification
  • Society has an obligation to provide help
  • Society is responsible for the handicap of
    individuals
  • Counselors information re customer/client
    situation increases obligation to promote good

41
NONMALEFICENCE
  • Nonmaleficence
  • Definition (non-mal-ef-e-sens)
  • Working at and/or ensuring that no harm, no
    evil preventing negligence or harm from
    happening
  • Justification
  • Civilized societies are responsible for doing no
    harm to clients.

42
AUTONOMY
  • Concept
  • Self-governance, liberty, privacy and being
    ones own person
  • Definition
  • Counselors are required to recognize and
  • honor the client/customer freedom of choice to
    control their own lives

43
JUSTICE
  • Definition
  • The fair allocation of caseload resources and
    monies to clients
  • Fair allocation of the counselors time to
    provide services and achieve outcomes

44
FIDELITY
  • Definition
  • Keeping promises or commitments being loyal to
    clients/customers, agencies and organizations
  • Justifications
  • Mutual trust based upon commitment and
    promises
  • Unequal relationship between client and
  • counselor mandates counselor honesty

45
CRC Code of Professional Ethics for
Rehabilitation Counselors
  • Adopted in June 2001 by the Commission on
    Rehabilitation Counselor Certification
  • Effective January 1, 2002

46
Code of Ethics
  • Developed in response to the Rehabilitation Act
    of 1973
  • Developed, in part, as a response to the
    need/desire to professionalize the field

47
Section of Code
  • A The Counseling Relationship
  • B Confidentiality
  • C Advocacy and accessibility
  • D Professional responsibility
  • E Relationships with other professionals
  • F. Evaluation, assessment, and interpretation
  • G Teaching, training, supervision

48
CRC Code of Ethics
  • H Research and publication
  • I Electronic communications and emerging
    applications
  • J Business practices
  • K Resolving ethical issues

49
A.2. Respecting diversity
  • a. Respecting culture
  • b. Interventions
  • c. Non-discrimination

50
C.1. Advocacy
  • a. Attitudinal barriers

51
D.1. Professional Competence
  • h. Continuing education

52
DATA
  • 45 of Rehabilitation Counselors attempt to
    resolve dilemmas without any consideration of
    ethical principles
  • (Wright, Emener, 1996)
  • 75 of Counselors believe that ethical dilemmas
    are increasing
  • (Patterson, 1999)

53
Data
  • The Ethics Resource Center 2000 survey found that
    when ethics training and written ethics standards
    (Code of Ethics) were in place, employees were

54
Data
  • Less likely to feel pressured to compromise
    ethics standards
  • Less likely to observe misconduct in peer or
    supervisors
  • More satisfied with their organizations
  • More likely to see themselves as valued members
    of the organization

55
  • What are the characteristics/criteria of an
    ethical dilemma?

56
Characteristics/Criteria of an Ethical Dilemma
  • A choice must be made between two courses of
    action
  • Significant consequences are present for taking
    either course of action
  • Each course of action can be supported by one or
    more of the ethical principles
  • The ethical principles supporting the unchosen
    course of action will be compromised

57
Ethical Decision Making Models
  • Rational
  • Integrative
  • Transcultural Integrative

58
Rational model
  1. Identify the Problem
  2. Apply the CRC Code of Ethics
  3. Determine the nature and dimensions of the
    dilemma.
  4. Generate potential courses of action
  5. Consider the potential consequences of all
    options, choose a course of action.

59
Ethical model continued.
  1. Evaluate the selected course of action
  2. Implement the course of action

60
Transcultural Integrative Model
  • Description The transcultural integrative model
    for ethical decision-making in counseling
    addresses the need for including cultural factors
    in the process of ethical dilemma resolution.
    This transcultural model incorporates
    state-of-the-art concepts from multicultural
    theory into an ethical decision making model that
    borrows primarily from the integrative model
    developed by Tarvydas.

61
Outline of Model
62
Step 1
  • 1.Interpret the situation through awareness and
    fact-finding.  The goals here are to determine
    our sensitivity and awareness about the variables
    involved, to reflect about the dilemma involved,
    to determine the major stakeholders and to extend
    our knowledge about the facts of the case.  From
    the cultural standpoint it means

63
Step 1 continued.
  • (a) To examine our own emotions and attitudes
    related to this case and analyze to what extent
    we are satisfied with our knowledge about the
    clients culture and issues of cultural identity,
    acculturation, gender role socialization, and the
    work skills of the client

64
Step 1 continued.
  • (b) To reflect about the nature of the dilemma
    and see whether different worldviews of the
    counselor and client may lead to different
    courses of action.

65
Step 1 continued
  • (c) To determine the parties involved in the
    dilemma and examine how close or opposed they are
    from clients values. 

66
Step 1 continued
  • (d) To gather as much cultural information as
    relevant to the case, such as immigration
    history, family composition and community
    relationships

67
Step 2
  • Formulate an ethical decision or course of
    action.  This step involves basically the same
    steps that comprise the rational ethical dilemma
    resolution model, but under the transcultural
    model the counselor needs to consider the
    cultural aspects involved.  

68
Considerations
  • a. To make sure that after compiling new
    cultural information about the situation the
    counselor still hold the same opinion about he
    nature of the dilemma

69
Considerations
  • (b) To examine the ethics code of the counselors
    professional association, laws, and ethical
    principles that may apply to the case, in
    addition to examining the institutional policies
    and procedures that may impact on this case. 

70
Considerations
  • (c) To generate reasonable courses of action
    based on an analysis of the case and taking into
    account the different worldviews involved. 

71
Considerations
  • (d) To consider all the positive and negative
    consequences of each of the courses of action
    identified above, including the impact on aspects
    valued by the culture of the client

72
Considerations
  • (e) To consult with colleagues or experts with
    knowledge about multicultural counseling to see
    whether the courses of action reflect culturally
    appropriate analysis.  

73
Considerations
  • (f) To determine which is the best course of
    action, based on a review of the information
    gathered in step 1 plus the examination of the
    courses of action in step 2.  At this point, the
    counselor may decide that course of action 3 is
    the best since it accounts for the client values
    and responds to the interests and values of the
    other parties involved.  The course of action
    must also be compatible with the ethical
    principles that support it, such as autonomy
    defined from the cultural perspective of the
    client, or fairness to the parties involved.

74
Step 3
  • Planning and executing the course of action
    selected.  

75
Considerations
  • a. To formulate steps that are consistent with
    the general plan of action

76
Considerations
  • b. To develop strategies (e.g. negotiation,
    consensus building) to counter possible barriers
    to the implementation of the course of action
    chosen, such as their own personal values
    collegial, institutional or societal values and
    regulations, as well as client doubts, employer
    biases, or professional prejudices

77
Considerations
  • c. To evaluate the plan of action, which entails
    collecting valid and reliable information that
    has both universal (applicable to all people) and
    cultural (applicable to the specific clients
    culture) meaning.

78
Case Study
79
Case Study
  • Maria is a Latina from a rural area in El
    Salvador who moved to the United States three
    years ago and while working as a cook (she has a
    work permit) in a restaurant she fell from a high
    set of stair and suffered a moderate brain injury
    that left her with physical and cognitive
    sequelae that has prevented her to work in the
    last six months she is married but her husband
    is back in El Salvador and very rarely sends her
    monetary support.  She lives with her three
    children and three members of her extended family
    (who hold unskilled occupations) in the US. She
    has been sent to a VR counselor who is a
    Caucasian female with five years of
    experience.  She is unsure about going back to
    work or staying on disability benefits.  She has
    also sought legal advise from a refugee center
    who provides those kind of services and attends a
    bilingual support group held at a local
    multicultural counseling center.  She is unsure
    about returning or continuing to work, or just
    staying on disability benefits. This is a dilemma
    for the VR counselor who has to find the best
    solution to this conflict

80
Step 1
  • (a) To examine our own emotions and attitudes
    related to this case and analyze to what extent
    we are satisfied with our knowledge about the
    clients culture and issues of cultural identity,
    acculturation, gender role socialization, and the
    work skills of the client for example, the
    counselor may have negative attitudes toward
    immigrants and experience angry feelings toward
    them to the extent that she would like to
    recommend Nancy to go back to her own country it
    could also mean that the counselor needs to
    gather more information about Marias
    acculturation which can be done by asking
    questions about how she feels toward the dominant
    culture, her English language skills, or her
    preferences and behavior.  The counselor can also
    ask Maria about her role as a woman in her family
    and with respect to her husband (gender role
    socialization).

81
Step 1 continued
  • (b) To reflect about the nature of the dilemma
    and see whether different worldviews of the
    counselor and client may lead to different
    courses of action for example the counselor may
    have strong feelings about work as a central part
    of her belief structure whereas Maria may believe
    that family is the central value.  One belief
    could lead to perceive work at any cost as the
    only option and the other to consider what would
    be the best for the family.

82
Step 1 continued..
  • (c) To determine the parties involved in the
    dilemma and examine how close or opposed they are
    from Marias values.   For example, Maria can
    give more credence to the report presented by a
    family member than to the one presented by
    somebody who is using her cultural values against
    her (e.g. she believes in family values so she
    needs to return to El Salvador).

83
Step 1 continued
  • (d) To gather as much cultural information as
    relevant to the case, such as immigration
    history, family composition and community
    relationships. For example, one of the facts
    could be that she is here as a refugee and going
    back to her country is not an option.

84
Step 2
  • (a) To make sure that after compiling new
    cultural information about Maria, the counselor
    still holds the same opinion about the nature of
    the dilemma or whether this has changed (e.g.,
    the counselor now believes that she needs to find
    options for Maria here in the US).

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Step 2 continued
  • (b) To examine the ethics code of the counselors
    professional association, laws, and ethical
    principles that may apply to the case, in
    addition to examining the institutional policies
    and procedures that may impact on this case.  For
    example, the counselor should review the
    diversity standards contained in the code, which
    could shed some light as to the options the
    counselor should consider.  The counselor may
    also find that the immigration laws favor or
    damage Marias aspirations, or that the
    institutional policies have strict regulations
    about working with bilingual clients. From an
    ethical principle perspective, the counselor
    needs to examine the cultural interpretation pf
    principles such as autonomy, beneficence, and
    justice, to name some.  For example, autonomy of
    the family could mean more to the client than her
    own individual autonomy.

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Step 2.
  • (c) To generate reasonable courses of action
    based on an analysis of the case and taking into
    account the different worldviews involved.  In
    consequence, some potential courses of action
    could be to first give priority to an employment
    outcome by establishing this as an absolute goal,
    second to give priority to the future of the
    family by establishing that benefits could be of
    most value to Maria and her family, or third, to
    find a middle ground that would mean continue
    working on an employment option but considering
    the input and goals of the family.

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Step 2
  • (d) To consider all the positive and negative
    consequences of each of the courses of action
    identified above, including the impact on aspects
    valued by the culture of Maria and her
    family.  For example, the employment option could
    lead to guilt feelings in her family members who
    see as their responsibility to take care of her.

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Step 2
  • (e) To consult with colleagues or experts with
    knowledge about multicultural counseling to see
    whether the courses of action reflect culturally
    appropriate analysis.  For example, a colleague
    from a different cultural background may believe
    that the counselor may be offending Maria by
    stereotyping her as a dependent, submissive
    woman, without taking into account her level of
    acculturation.

89
Step 2.
  • (f) To determine which is the best course of
    action, based on a review of the information
    gathered in step 1 plus the examination of the
    courses of action in step 2.  At this point, the
    counselor may decide that course of action 3 is
    the best since it accounts for the client values
    and responds to the interests and values of the
    other parties involved.  The course of action
    must also be compatible with the ethical
    principles that support it, such as autonomy
    defined from the cultural perspective of the
    client, or fairness to the parties involved.

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Step 3
  • (a) To formulate steps that are consistent with
    the general plan of action. Such steps could
    include Reaching consensus with the parties
    involved through negotiation and consensus
    building activities evaluation of the brain
    injury sequelae, analysis of transferable skills
    (if applicable), and conduct a job analysis that
    would all result in appropriate long-term
    vocational goals engaging the client in job
    development and placement motivating the client
    to actively participate and exercise her choice
    rights waiting until the client and family
    members are ready for placement and until then
    continue with disability benefits working with
    employers and service providers (including DSS
    personnel) toward the plan and evaluate the
    implementation of the plan.

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  • (b) To develop strategies to counter possible
    barriers to the plan such as client doubts,
    employer biases, or professional prejudices.  For
    example, the counselor may set up support
    meetings with the client, schedule regular
    meetings with employers, or bring the case in
    professional meetings on a regular basis.

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  • c) To evaluate the plan of action, which entails
    collecting valid and reliable information, that
    has both universal and cultural meaning.  For
    example, the counselor may establish bi-weekly
    meetings with Maria, the her family and the
    employer to obtain information about motivation,
    work performance, and overall satisfaction
    (universal) but also collect information about
    cultural aspects such as potential cultural
    prejudice, language difficulties, relationship
    with peers, and cultural compatibility of the
    job.  A relational method that implies keeping
    all the parties informed and in agreement should
    be the counselors general strategy.

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Counselor, Know ThyselfCulturally Skilled
Counselors Should
  • Be aware and sensitive to his/her own cultural
    heritage
  • Be aware of his/her values and biases and how
    these biases may affect minority consumers
  • Be comfortable with cultural/racial differences
    that exist between themselves and the consumers
    they serve
  • Be sensitive to circumstances that may dictate
    referral of minority consumers to a member of
    their own race/suture or to another counselor in
    general.

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  • Possess specific knowledge and information about
    the value systems and work views of the
    particular minority group he/she is working with
  • Have a good understanding of the socio-political
    systems that operate in their geographical region
    with respect to the treatment and service
    delivery for minorities
  • Have a clear and explicit knowledge and
    understanding of generic characteristics of
    counseling and theory.
  • Adapted from Sue Sue (1990)

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Ethical Considerations for the Rehabilitation
Professional Serving Culturally Diverse
Populations
  • Maureen McGuire-Kuletz, Ed.D., CRC
  • Director/Assistant Research Professor
  • George Washington University RRCEP
  • 2011 I Street, NW, Suite 300
  • Washington, D.C. 2005
  • 202-973-1558
  • mkuletz_at_gwu.edu
  • This information is the intellectual property of
    the George Washington University and is to be
    used for training purposes only.
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