Discussion 1

You are the executive director of a small publicly funded behavioral health agency that serves indigent clients. After 10 years of being able to serve all clients seeking help, your agency has just received a 20% budget cut and must prioritize which services to discontinue and which clients to turn away. The community has many suggestions: stop serving undocumented immigrants and their children; stop serving substance abuse clients, limit all clients to six sessions, discontinue providing expensive services like psychiatry, lay off professional counselors and hire non-licensed paraprofessionals, stop providing counseling and instead simply offer peer self-help groups and parenting classes, serve only the most seriously ill (or the least seriously ill), and serve only children. How would you approach the difficult task of cutting services by 20% in a manner that reflects your ethical obligations as a community counselor? Would your plan differ if you were in a private sector? If yes, how? What criteria would you consider? What theoretical or standard of care practice will you follow to make a final decision about what to cut from your program? Reference the ACA and/or NAADAC Code of Ethics to support your answer.

Discussion 2

A managed care clinician completed a utilization review and has just denied authorization for you to continue treating a client. You believe that the client could benefit from four additional sessions. At the same time, you understand that the managed care clinician must apply criteria of medical necessity to justify continued treatment, and you are aware that many of your agency’s clients have problems much more severe than your client’s. Make a list of all of the ways that you could try to ensure that the managed care system does not prevent you from giving your client the type and duration of treatment services that he or she needs. Categorize each of the items into two groups reflecting those that would be considered professionally appropriate and ethical, and those that would be considered to be a violation of professional ethical standards.