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QUESTION
In-Service Scenario Analysis
Directions: In 750-1,000 words, select one of the scenarios below to write an essay that answers the reflection questions. Use a minimum of three scholarly references to support your analysis.
Scenario 1:
Marcie is a new client and a 22-year-old female who works as a receptionist in a doctor’s office. She has just revealed to you during the intake session that she has recently lost interest in most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes she could cease to exist. She mentioned feeling as though she has been “on an emotional roller coaster” during the past year, throughout her on-again/off-again relationship with a 35-year-old married man. The last breakup with him seemed final, and Marcie has felt herself sinking deeper and deeper into depression ever since. When probed further about suicidal ideations, Marcie admitted that she has considered killing herself, although she is uncertain whether or not she would actually do it.
Scenario 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 problems.
Reflection Questions:
1. Does the primary diagnosis via the current DSM play a factor in what you would do as an administrator of the facility?
2. What steps would ensure the safety of the client within a community/mental health care setting?
3. Would communication be a concern within the agency? How would you, as the administrator address training to ensure the privacy of the client? What could be included within the informed consent process to ensure emergency notification for the client?
4. 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.
5. Categorize each of the items from question 4 into two groups reflecting those that would be considered professionally appropriate and ethical, and those that would be considered a violation of professional ethical standards.
ANSWER
In-Service Scenario Analysis
Scenario 1
The response of a facility administrator towards a patient and the provision of care is largely influenced by the primary diagnosis of a patient via the current DSM. Marcie seems to be suffering from psychosocial and environmental problems category as indicated in the current DSM. She is emotionally and mentally unstable as a result of failed relationships and depression. As a facility administrator, I would say that the counselor who reviewed the new patient in the intake session did a proper suicide evaluation on her. Based on the information provided by Marcie, I would recommend that the counselor consults the supervisor on how to handle the patient before making any further decisions on the matter. The issue of a client talking about suicide, as prescribed in the DSM, should never be taken lightly or not acted upon. It is important that the matter is taken seriously and the client is taken into counseling and care immediately.
Marcie seems to have come for counseling or sought counseling services voluntarily. Therefore, I would assume that she is aware that she needs expert attention and that she is ready to follow any guidelines provided by counselors and other experts. She also seems to trust the counselor since she opens up about what she has been going through and her personal affairs. The trust between her and the counselor must not be broken through acts such as disclosing her personal problems and the emotional issues that she is facing to members of her family or her friends. However, the code of ethics states that the importance of keeping a client’s information confidential does not apply where disclosure of such information is necessary to protect the client from foreseeable harm (American Counseling Association, 2014). It would be best to inform a family member of the client of the suicidal thoughts that she is experiencing. However, it would be good if the client is not made aware that a family member was notified.
The proper decision would be to take in the client and enroll her in the community facility for counselling and assistance. To ensure the safety of the client within the community healthcare setting, the following steps should be taken (World Health Organization, 2017):
- Establishing a proper safety and health management system: guidelines should be formulated to ensure compliance with patient safety protocols. Everyone in the facility should be involved in decision making and performance reviews to ensure coordination and adherence to safety guidelines.
- Accompanying the client to the facility and throughout all counseling and care procedures to protect them from causing any harm to themselves and to show them that they are cared for.
- Ensuring that all employees within the facility know and understand the safety policies in place: everyone working in the community healthcare facility environment should understand their roles in ensuring safety (World Health Organization, 2017). All employees should be trained and regularly updated on safety policy changes. All duties related to upholding patient safety should be clearly understood.
- Developing a safety compliance plan: it is important that facility administrators to regularly monitor and evaluate how the nurses, patients, and employees within facilities follow and implement established safety policies. Where necessary, safety policies should be reviewed or adjusted to improve patient care.
Effective communication is very important in the provision of quality patient care. To ensure the provision of proper care and the safety of the client within the facility, it would be necessary to ensure effective communication within the agency and the facility. All the employees working closely with the client have to be provided with training on various issues related to patient care provision, including the privacy of client information and their safety. All new employees must be taken through proper training on the importance of ensuring the privacy of client information and the provision of proper care, including any emergency care necessary. It is also important that informed consent is ensured before the client can be taken into care. The various risks, benefits, and alternatives available for the client should be explained to them to ensure that they understand what they are getting into and make a voluntary decision to undergo care and counseling (Gossman, 2020).
Sometimes, managed care may come in during the provision of patient care and prevent a client from getting the type of treatment services that they may need (Davidson & Davidson, 1996). To ensure that the managed care system does not prevent the facility from providing Marcie with the treatment services that she requires, various factors should be considered. These factors may be a violation of professional ethical standards but may be necessary to ensure that the client gets the services that she needs. Minimizing the number of facility visits by scheduling counseling sessions at home, asking the client to pay for some services from their pocket rather than billing all services to their medical cover, having short durations of appointments, and providing lower quality but affordable services to the client are all methods that can be used to prevent the managed care system from interfering with the provision of treatment services to the client.
While minimizing the number of facility visits, having short durations of appointments, and asking the client to pay for some services is professionally ethical, providing lower quality but affordable service to clients is a violation of professional ethical standards. Only the professional ethical efforts should be practiced to ensure that the client receives quality care and treatment services without the interference of the managed care system.
References
American Counseling Association. (2014). ACA Code of Ethics: As Approved by the ACA Governing Council… American Counseling Association.https://www.counseling.org/resources/aca-code-of-ethics.pdf
Davidson, J. R., & Davidson, T. (1996). Confidentiality and managed care: Ethical and legal concerns. Health & Social Work, 21(3), 208-215.https://doi.org/10.1093/hsw/21.3.208
Gossman, W. (2020, February 18). Informed Consent. Retrieved March 16, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK430827/
World Health Organization. (2017). Patient safety: making health care safer (No. WHO/HIS/SDS/2017.11). World Health Organization.https://apps.who.int/iris/handle/10665/255507
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