Valerie McClellan, LCSW, ACSW
Diane Braman, LCSW
Matt Anderson, LMSW
Miracle Paige, NCC, Ed.S, PCMHT
 Rules
of conduct governing a
group or individual.
 The
discipline dealing with what is
right and wrong and with moral
duty and obligation.
Merriam Webster
A
complex situation that will often
involve an apparent mental
conflict between moral
imperatives, in which to obey one
would result in violating another.
National Association of Social Workers
Ethical Responsibilities to Clients
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Informed Consent
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Competence
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Conflict of Interest
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Privacy and Confidentiality
American Psychological Association
Ethical Principals of Psychologists & Code
of Conduct
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Competence
Privacy & Confidentiality
Assessments
Informed Consent
Multiple Relationships
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How does the code of ethics apply to trauma
treatment of children & adolescents?
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Why does it matter if we are trauma
informed?
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Why are we talking about being trauma
informed care in an ethics seminar?
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Is it ethical to treat trauma if we aren’t
trauma informed?
 Informed
Consent
 Competence
 Conflict of Interest
 Privacy & Confidentiality
 Use of Assessments
 Clarification of Roles
An emotional and/or behavioral
reaction resulting from severe mental
or emotional stress.
Merriam-Webster
Features:
 sudden or unexpected events
 death or threat to life or bodily integrity
 subjective feeling of intense terror, horror or
helplessness
American Psychiatric Association
Examples:
 child physical & sexual abuse,
 witnessing/a victim of violence
 severe accident
 life threatening illness
 natural/man made disasters
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an organizational structure and treatment
framework that involves understanding,
recognizing, and responding to the effects of
all types of trauma.
emphasizes physical, psychological and
emotional safety for both consumers and
providers
helps survivors rebuild a sense of control and
empowerment.
Adverse Childhood Experiences study:
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examined the health and social effects of
adverse childhood experiences over the
lifespan, 18,000 participants. Kaiser
Permanente and CDC.
ACEs-sexual & physical abuse, psychological
abuse, exposure to DV, substance abuse or
mental illness by caregiver, incarcerated
caregiver, separation or divorce by parents.
ACEs-strongest predictor of physical and
mental health problems in adulthood.
ACEs determine the likelihood of 10 most
common causes of death in U.S.
Nat’l Survey on Child & Adolescent Well-Being II:
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Examined impact of ACEs on child mental health.
5872 children/adolescents, 2 follow-up interviews
at 18 month intervals with caregivers, caseworkers
and children, use of standardized measures.
Findings-Caregiver mental illness was only ACE
predictive of child mental health problems in all
age groups. Accumulation of ACEs may have
latent effects on mental and physical health.
Studies found dose-response relationships in early
adolescents but not in young children.
If you have an ethical dilemma that you would
like feedback from the group on, please
write it down and give it to one of the
presenters. We will discuss them tomorrow at
the end of the session.
What does trauma look like
behaviorally and/or emotionally?
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ADHD
Oppositional Defiant Disorder
Bipolar Disorder
Anxiety Disorders
Depressive Disorders
High Blood Pressure
Sleep Disorders
Addiction Issues
Etc.
We possibly end up treating the symptoms
instead of the core issue.
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Become Trauma Informedread, on-line trainings, outside trainings by
certified trainers.
Screen for trauma & refer:
Child Trauma Screening Questionnaire, Brief
Trauma Questionnaire, Child Stress Disorder
Checklist, Trauma Symptom Checklist, etc. or
simply DMH Initial Assessment.
(Google “child trauma screeners”)
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Exert from the DMH Initial Assessment:
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Traumatic Event or Exposure History:
Serious accidents
Natural disaster
Witness to a traumatic event
Sexual assault
Physical assault (with or without a weapon)
Childhood sexual molestation
Close friend or family member murdered
Homeless
Victim of stalking or bullying
Other (specify)
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Google: Certified TF-CBT Therapist:
https://rtfweb.wpahs.org/tfcbt/
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Email: valerie.mcclellan@ccjackson.org
(I can guide you in searching for either a
TFCBT or EMDR therapist.)
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Trauma Treatment-designed to help a
child/adolescent process a trauma/traumas
he/she experienced and learn how to cope
with the thoughts and feelings associated
with the experience.
Evidence-Based Practice: a combo of
(1) best research evidence
(2) best clinical experience
(3) consistent with family/client values
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Ensures families are referred to & receive the
most effective & efficacious treatment
available.
Empowers families in crisis to resolve their own
conflicts, using well-tested programs.
May cause families to make a greater
commitment to treatment.
Help providers understand what is available &
make informed choices when referring
Used for resource development (grant writing),
program development, policy development and
advocacy.
Helps identify outcomes
Payment sources are beginning to require
Well-Supported by Research Evidence:
2 studies in different settings,
effects last at least 1 yr:
-Trauma Focused Cognitive Behavioral Therapy
-Eye Movement Desensitization Reprocessing
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Supported by Research Evidence:
1 study , effects last 6 months:
- Child Parent Psychotherapy
- Prolonged Exposure Therapy for Adolescents
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Based on California Evidence-Based Clearinghouse
for Child Welfare
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Break into groups
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Take your case study
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Brainstorm how you would address
the ethical dilemma & what ethical
standard it
Present to the larger group
NASW
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Informed Consent
Competence
Conflict of Interest
Privacy &
Confidentiality
APA
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Informed Consent
Competence
Privacy &
Confidentiality
Assessments
Multiple
Relationships
An 8 year old child had been a victim of neglect and sexual abuse while in the
mother’s care. Upon entering treatment, the child was in the care of the maternal
grandmother while the father was serving in Afghanistan.
The family completed treatment. The father was able to come to the termination
session. The family then moved on to their home in another state.
A month or so after termination, the grandmother emailed the therapist and let the
therapist know that the child was transitioning well into her home with her father and
thanked the therapist for services provided and the support she’d needed to care for
her grandchild.
She went on to say “and when you’re ready to schedule a message therapy session
just let me know. (The therapist, prior to treating the child, had been referred to this
message therapist from several colleagues who spoke highly of the quality of her
services. In addition, this massage therapist is the only one in the area who has
specialized therapeutic training to work with folks who’ve suffered various physical
medical problems.)
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What ethical standards come to mind?
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How would you handle this situation?
Two children; 9 year old female and 11 year old male, they live with their biological mother.
The mother and the children's father are separated . The client's father has been verbally and
physically abusive towards mother.
Before the case is even open, the father comes to the agency twice demanding to talk to the
assigned therapist and see the clinical documentation.
Upon opening the case and beginning the assessment process, the clinician learns that there has
been no court order regarding legal or physical custody.
The children are fearful of their father but have not reported any abuse that could be considered
dangerous or required to be reported. On one occasion, while in a vehicle, he did pull a gun out
and put it on the seat. He did not threaten the children with it.
Mother would like the children to participate in therapy to help with their reaction to their parents'
separation and divorce. The children are obviously traumatized by the parents' arguments during
their marriage and separation.
The mother is aligned and engaged with treatment.
Mother upon intake request the therapist not disclose any information about the children's
treatment nor report on any progress within treatment. to their father By this, she meant for the
therapist to make no notes nor document any contact with the children in case the father requests
copies of their charts.
After a temporary hearing, the children’s mother has physical custody and both parents have legal
custody.
Mother has also been referred for treatment for her own traumatic needs related to her abuse
from her husband.
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What ethical standards come to mind?
How would you handle this situation?
KC is a 13 year old female who was raped by an older
male. KC’s case was a statutory rape case. KC also
reported molestation as a child. KC was removed from
mother's home and placed with father.
KC’s treatment consisted of trauma focused therapy.
As time passed, KC revealed that she was over her
cousin's house and had sex with a male her age.
According to the law, she was not old enough to
consent to sex.
What ethical standards come to mind?
How would you handle this situation?
A 35 year old Hispanic female presents for therapy upon referral from Catholic
Charities Migrant Support Services program. She was encouraged by them to get
counseling to address her exposure to 10 plus years in a domestic violence
relationship.
She presented for her first session with a friend to provide interpretation services for
her since she has limited English speaking abilities.
During the screening and assessment process it was discovered that she was
exposed to multiple traumatic childhood events including child sexual abuse. Other
details discovered in this family include: the client is undocumented; she has been
separated 6 months from the man with whom she was in a domestic violence
relationship. This man continues to harass her by coming by her house in the middle
of the night, drunk, knocking on her door, trying to get her to take him back,
threatening to call immigration services if she doesn’t take him back. Sometimes
he’ll threaten to hurt himself also.
They have 2 children together and she doesn’t want him to take the kids because
sometimes he acts like he’s been drinking and other times the kids come back home
saying that daddy has been talking bad about their mother.
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What ethical standards come to mind?
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How would you handle this situation?
A Hispanic mother and her 14 year old daughter presented for therapy upon
referral from the MS Child Advocacy Center. The daughter had disclosed to a
friend that an 21 year old male, a close friend of the family, had been sexually
abusing her. This friend’s mother then told the client’s mother who called the
police and reported it which initiated the investigation process.
Additional information gained at intake: 14 year old is smoking marijuana.
Mom is undocumented. She makes money by cleaning houses. She shares a
home with another single mother and kids in order to pay the bills. Mom has
been in the US for 15 years, the client was born here. Mom’s extended family,
maternal grandmother & maternal aunt families, also live in the area, in the
same housing development as this family. The mom has been very close to the
aunt and maternal grandmother – until the sexual abuse was disclosed. The
maternal grandmother, aunt and other family members reportedly don’t believe
the sexual abuse happened. In addition, the extended family is reportedly
blaming the client because she had recently reportedly started dressing sexy &
seductively, and had been found trying to meet guys in texting and over the
internet and facebook. As a result of the extended family’s reactions, the
mother has had to cut off all contact with these family members.
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What ethical standards come to mind?
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How would you handle this situation?
your ethical dilemmas