Pressures From All Sides
Kate was delighted to be hired as a vocational rehabilitation counselor by the Metropolitan Rehabilitation Company immediately after she graduated from her master’s degree program in rehabilitation counseling. A client named Brad was one of her first referrals.
Brad had been a construction worker all his life. He started working at the age of 16, helping on a construction site near his home. By the time Brad was 20, he was a skillded worker with a formal apprenticeship behind him. He met and married Pam, and they had two children.
Brad was on the job when a rope broke, causing him to fall from a scaffolding 20 feet above the ground. He hit his head and sustained an injury to his spinal cord that resulted in incomplete paraplegia of his lower extremities. After being treated in a trauma center, Brad was sent to a rehabilitation hospital where he learned to use a wheelchair. His major concern was whether he would walk again. After several months of physical therapy, he was able to walk a short distance using two canes. However, he was sent home with his wheelchair for primary mobility. His doctor documented that he had a mild brain injury with some short-term memory loss. He was trained to use a memory notebook as a conpensation strategy.
While Brad was still in the hospital, he received a letter from an attorney who stated that he should be informed of his rights to recover damages because of his employer’s negligence. Brad hired this attorney to represent him should the need arise. Because his injury was job-related, Brad qualified for worker’s compensation to cover his medical expenses and wage loss. At the suggestion of the hospital social worker, he also applied for Social Security Disability Insurance. This could eventually provide additional income and qualify him for Medicare. Following his discharge from the rehabilitation hospital, Kate visited Brad at home, informing him that the insurance company had hired her company to help him return to work.
After initial interview with Brad, Kate received a series of phone calls. The first was from the attorney whom Brad hired. The attorney told Kate that Brad was too disabled to pursue employment at this time and that Kate should not contact him again. The second call was from the claims adjuster who told her that she should get Brad back into sedentary work with the construction firm as soon as possible to minimize the long-term costs to the insurance company.
The third call was from Brad’s wife, Pam, who expressed concern that Brad not be forced into going back to work too soon. His income from his construction job had been good when he was working, but periods of employment had been interspersed with periods of unemployment and limited income. Pam thought that because of the severity of Brad’s injury, he should continue to draw benefits that could provide a steady income to the family. She also expressed her concerns about medical expenses should Brad not be covered by medical insurance in the future.
Finally, Brad called and tearfully told Kate that he did not want to spend the rest of his life as a cripple and that he wanted to get back to work as soon as possible. Unsure what to do next, Kate spoke with her supervisor. The supervisor reminded her that Brad’s insurance carrier did a lot of work with their company and suggested that she work with Brad’s employer to get Brad back to work as soon as possible, if not sooner. (Herlihy & Corey, 2006)
Brad has the following rights:
He has a right to recover damages because of his employer’s negligence.
He qualifies for workers’ compensation
He has the right to apply for SSI.
Brad also has a right to full disclosure from Kate, his rehabilitation counselor, about what the counseling process will entail and an explanation of the limits of confidentiality; he also has a right to refuse any recommended services and to be advised of the consequences of that refusal. Kate must inform him that she needs to report his progress to the insurance company (Herlihy, Corey 2006).
Kate needs to consider the following additional elements of informed consent with Brad:
What therapeutic process will be used to get Brad ready for work,
Kate’s background and training which enables her to provide services to Brad
The length of therapy and termination
Whether she will be consulting with colleagues regarding Brad’s case and how much information will be shared
Benefits and Risks of treatment
Brad’s right to see his files
(Corey, Corey, Callan, 2007)
Even when informed consent has been established, problems and conflicts may still arise along the course of treatment so Kate should be ready to discuss any issues with brad which come up in this area. (Blackwell, Strohmer, Belcas, Burton. 2002)
References:
Herlihy, B., Corey G.; ACA Ethical Standards casebook, 6th edition;American Counseling Association,2006
Corey, G., Corey, M., Callanan, P., (2007). Issues and ethics in the helping professions, (7th, ed). United States: Thomson Brooks/Cole.
Blackwell TL; Strohmer DC; Belcas EM; Burton KA; Ethics in rehabilitation counselor supervision. Rehabilitation Counseling Bulletin, 2002 Summer; 45 (4): 240-7, 252-5
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