Assignment Directions:
Reply to TWO fellow team members.
You will respond thoughtfully to two other learners regarding their strategies. Focus on their strategies and if you see any challenges or concerns with them ethically.
1. Fairway Recovery Center
Fairway Recovery Center is a non-profit inpatient substance abuse treatment facility that provides treatment for adults who are struggling with substance use addiction in the community of Southwest Virginia (serving Wise, Scott, and Lee Counties). The center is an integrated facility where medical and mental health services work together to provide comprehensive and holistic care in addressing the intricate needs of individuals struggling with substance abuse.
Strategies for Working with Court-Referred Clients
Strategy 1:
One strategy that I would utilize at Fairway Recovery Center regarding court-referred clients would involve the importance of protecting confidentiality. It is essential that counselors be honest and forthcoming with court-referred clients regarding the limits of confidentiality. Clients must agree to communications regarding their treatment and progress to an outside party, such as a probation officer or parole officer, through the signing of a consent form before any disclosures (Hutchison, 2023, The Limits of Confidentiality, para. 3). At Fairway Recovery Center, information that is related to clients would only be released to the court when there is a valid court order. It would also be important to ensure that the release of information is limited regarding what is specifically being requested. Any unnecessary personal information would additionally be redacted before being submitted to the court. I would also make sure that Fairway Recovery Center understood the following regarding protecting confidentiality of therapy sessions for court-referred clients: 1. The legal and ethical obligations in relation to HIPPA compliance and 42 CFR Part 2; 2. Informed consent (explaining limits of confidentiality and obtaining written consent); 3. Securing communication (privacy; encrypted communication for any telehealth sessions); 4. Records (all physical records kept in locked cabinets and electronic records stored in secure systems); 5.Minimal disclosure; 6. Staff training (regular trainings on confidentiality procedures and policies; limiting access to client information to only staff members who require it to perform their duties); 7. Advocacy (working with legal counsel to protect sensitive information; utilizing need-to-know criterion); and 8. Audits (conducting regular audits to ensure compliance with laws and confidentiality practices).
Strategy 2:
A second strategy I would implement at Fairway Recovery Center regarding court-referred clients would involve finding ways to work with resistance. I think it would be important for counselors to acknowledge and normalize the client's feelings. It is crucial that counselors be open to listening and giving the clients time to process their feelings about being a mandated client (Hutchison, 2023, Ways to Work with the Resistance, para. 1). Clients may demonstrate mistrust and reluctance to opening up to a counselor, as they might perceive them as an authority figure, so it is essential that counselors work with the clients to acknowledge their feelings while also addressing any cognitive distortions (Hutchison, 2023, Ways to Work with the Resistance, para. 1). Additionally, clients may be resistant or hesitant to engage in treatment due to denial, stigma, or shame about their substance use. Ways a counselor could assist clients with these feelings would include the following: showing genuine empathy and understanding of their situation and demonstrate a non-judgmental attitude to make them feel safe and respected; providing them with psychoeducational materials and resources; finding the right balance between control and flexibility/forming a dual-role relationship (Hachtel et al., 2019, p. 6); involving family and support systems; conducting regular check-ins; celebrating small successes; and encouraging participation in peer support groups. Through the development of rapport and trust, counselors can help clients overcome resistance and engage more effectively in their treatment. Clinicians will be required to participate in consistent trainings related to this topic.
Strategy 3:
A third strategy I would utilize at Fairway Recovery Center regarding court-referred clients would involve the implementation of rules related to therapy attendance and the implementation of therapeutic interventions. At Fairway Recovery Center, it will be necessary for court-referred clients to attend their scheduled sessions as this will be a part of their treatment plan and legal agreement. If clients miss any sessions, it will be documented and reported to the court and/or their probation officer. Clients will receive a warning upon their first missed session and extended therapy sessions and/or treatment services for continual absences. Clients will be made aware of the consequences of noncompliance related to therapy session participation (contempt of court; additional fines; potential incarceration). Fairway Recovery Center will coordinate additional therapeutic techniques and interventions to address reasons for missed sessions via the utilization of CBT (Cognitive Behavioral Therapy) and MI (Motivational Interviewing). Through the use of CBT, counselors could help clients recognize and change their harmful thought patterns and behaviors. Through the use of MI, counselors could assist with enhancing clients' motivation to change and engage in the treatment process. The clients' treatment plans would also be tailored to meet their needs and address specific issues and obstacles that may be contributing to resistance behaviors. The primary focus would be for the counselors to build and develop a strong therapeutic alliance.
Strategy 4:
A fourth strategy I would implement at Fairway Recovery Center related to court-referred clients would involve the use of an integrated treatment approach. It will be essential for Fairway Recovery Center to address both substance use and any co-occurring mental health disorders simultaneously. Helping clients understand whether their mental or substance abuse issue came first will be helpful as their long-term recovery will depend on them getting treatment for both disorders by the same treatment team. Holistic care, which is a primary focus at Fairway Recovery Center, will involve medical, psychological, and social support services working together to provide comprehensive care to the clients and ensuring that the environment is conducive to their long-term recovery.
Strategy 5:
A fifth strategy I would implement at Fairway Recovery Center related to court-referred clients would involve the administration of regular evaluations and feedback. Fairway Recovery Center will implement regular evaluations to assess the effectiveness of treatment planning and make needed adjustments when necessary. Feedback will also be detrimental in gathering input from clients and staff and improving the facility on a consistent basis. Feedback methods might include surveys, progress reviews, digital tools, and court reviews. All feedback tools will respect client confidentiality and be implemented in a non-judgmental manner. Staff will be trained in how to gather and use feedback to enhance client care.
References:
Hatchel, H., Vogel, T., & Huber, C. G. (2019, April 12). Mandated treatment and its impact on therapeutic process and outcome factors. Frontiers in psychiatry.
Hutchison, L., Blore, J., Vale, A., Zbrog, M., Jaracz, J., Stitt, A., & Freberg, L. (2023, August 23). Working with court-mandated clients. Counseling Schools.
2. When discussing court-mandated clients and looking up processes and how therapy is done for them, it does not discuss the need for special training for these therapists. For my agency, I ensure the therapist understands the circumstances around clients with court-manded therapy. One of the things stated in the video was to acknowledge the mandate, validate the situation, and find middle goals. These are important because they set a good foundation for therapy with this population. After all, this population does not want to be in treatment despicably. It is essential to validate that the person does not want to be in therapy and to find goals they want to work on, not just tell the client what they need to do.
When clients do not attend sessions, it's essential to consider the reporting requirements. Some clients may need to document each session they attend. In such cases, it's necessary to enforce the policy that if documents need to be reported, then do so and document that they were reminded and did not show. This documentation can be helpful if it's asked to prove that the client did not attend. Following the policies to terminate no-shows is crucial, as well as ensuring accountability and professional conduct.
To safeguard confidential therapy sessions, it is essential to discuss with a court-mounted client the facts about confidential sessions with this type of therapy. Some things are not followed, like informed consent, voluntary participation, confidentiality, and do not harm. These things need to be followed due to the requirements by law. With this, the therapist should be honest with the clients about why these things can not consistently be implemented. They are upfront about what these things mean and why they can only sometimes apply with being court-mandated. It also needs to be discussed how the client can still feel safe in these sessions, why it benefits them, and what can be worked on.
There can also be a discussion of what information is required in the notes and what is not to protect clients and their privacy. With court-maintained clients, there is a fine line with the fact that their records can be requested depending on what they are in service for and why they are being maintained. The policy ensures that information is documented and only gives information needed in notes. There are things that clients say that can be kept for therapists and clients.
YouTube. (2017, April 13). Examining court-ordered counseling services. YouTube.
Hachtel, H., Vogel, T., & Huber, C. G. (2019, April 12). Mandated treatment and its impact on therapeutic process and outcome factors. Frontiers in psychiatry.