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@gwu.edu

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

What is Culture?

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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.

Cross Cultural Awareness

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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.

Cultural Competence

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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.

Terms: INSTITUTIONAL BEHAVIOR (FAMILY; POLITICAL; RELIGIOUS;

ECONOMICAL) ASSOCIATIONS

VALUES: THESE ARE DEFINED AS:BELIEFS THAT LEAD TO ACTION (E.G.: "WORK IS GOOD FOR YOUR CHARACTER"; "IT IS GOOD TO BE A VEGETARIAN").

NORMS ARE DEFINED AS:IMPLICIT 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").

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.

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 OPPORTUNITTIES;LOW POLITICAL PARTICIPATION.

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

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 GROUPS:STABILIZED ACCOMODATION BY WHICH SUBORDINATION IS TAKEN FOR GRANTED

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)

Cultural Perceptions (adapted from Collier, 2002)

English

Japanese

Cultural Perceptions: Spanish

Altabascan

Difference versus Disability

The side effects of culture shock can look like indicators of learning and behavior disabilities.

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)

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

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).

STAGES OF MULTICULTURAL DEVELOPMENT (Pederson, 1999)

AWARENESS

KNOWLEDGE

SKILLS

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

   

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)

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

SKILL DEVELOPMENT:             - APPROPRIATE TEACHING/LEARNING  TECHNIQUES 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).

CULTURALLY BIASED ASSUMPTIONS:

THE FOLLOWING IS A LIST OF FALSE ASSUMPTIONS THAT WE MAKE ABOUT OTHERS:

  - 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 INDEPENDENCE=DESIRABLE 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.

-  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.

SKILLS RELATED TO RECOGNIZING SPECIFIC CLIENT RESISTANCE

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.

 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.

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).

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

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.

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").

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.

RESPECT CULTURAL DIFFERENCES WHEN COUNSELING DIFFERENT CULTURAL GROUPS

ETHICAL PRINCIPLES

• Ethical Principles:

• Translation of our beliefs about what we value

• Rules of conduct that are derived from values

Ethical Principles:

Beneficence Autonomy Nonmaleficience Justice Fidelity

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* Counselor’s information re: customer/client situation increases obligation to ‘promote good’

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.

NONMALEFICENCE

AUTONOMY

Concept Self-governance, liberty, privacy and being one’s own person

Definition

Counselors are required to recognize and honor the client/customer freedom of choice to control their own lives

JUSTICE

Definition:

• The fair allocation of caseload resources and monies to clients

• Fair allocation of the counselor’s time to provide services and achieve outcomes

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

CRC Code of Professional Ethics for Rehabilitation Counselors:

Adopted in June 2001 by the Commission on Rehabilitation Counselor Certification

Effective January 1, 2002

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

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

CRC Code of Ethics:

H: Research and publication I: Electronic communications and emerging

applications J: Business practices K: Resolving ethical issues

A.2. Respecting diversity:

a. Respecting culture

b. Interventions

c. Non-discrimination

C.1. Advocacy

a. Attitudinal barriers

D.1. Professional Competence

h. Continuing education

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)

Data

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

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

What are the characteristics/criteria of an ethical dilemma?

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

Ethical Decision Making Models

RationalIntegrativeTranscultural Integrative

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.

Ethical model continued….

6. Evaluate the selected course of action

7. Implement the course of action

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.

Outline of Model:

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:

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 client’s culture and issues of cultural identity, acculturation, gender role socialization, and the work skills of the client;

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.

Step 1 continued…

(c) To determine the parties involved in the dilemma and examine how close or opposed they are from client’s values. 

Step 1 continued…

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

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.  

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

Considerations…

(b) To examine the ethics code of the counselor’s 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. 

Considerations…

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

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

Considerations…

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

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.

Step 3

Planning and executing the course of action selected.  

Considerations:

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

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

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 client’s culture) meaning.

Case Study:

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

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 client’s 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 Maria’s 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).

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.

Step 1 continued..

(c) To determine the parties involved in the dilemma and examine how close or opposed they are from Maria’s 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).

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.

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).

Step 2 continued…

(b) To examine the ethics code of the counselor’s 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 Maria’s 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.

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.

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.

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.

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.

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.

(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.

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 counselor’s general strategy.

“Counselor, Know Thyself”Culturally 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.

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)

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@gwu.eduThis information is the intellectual property of the George Washington

University and is to be used for training purposes only.