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Legal And Ethical Implications Of Assessment

Consider the following scenario:

A client comes in to see you for case management services. She has many serious family problems, including some bouts of depression that seem to be only “situational” based on the current problems she is facing. She is in need of help, but reports that she cannot afford private counseling. You work for the only mental health agency in town and the agency charges client fees on a sliding scale. The client is not eligible for Medicaid, but has health insurance through her employer. She cannot afford to pay, even at the bottom of the sliding fee scale.

After informing her insurance company of her need for services, you find out that the only way they will approve of services and reimburse your agency is if she has a major mental health diagnosis code from the DSM V (Diagnostic and Statistical Manual of Mental Disorders) such as “major depression”. Your colleagues tell you that even though the client does not have a serious enough depression problem to be diagnosed with such a code, you should diagnose her with one anyway so that her insurance will pay for her services.

What are the legal and ethical implications that exist in this scenario?
If you were the case manager, what would you do in this situation?
Discuss other courses of action, including 3 assessment tools that may exist to help the client receive services she needs that are both legal and ethical. Explain why you chose each assessment tool and how it might help this specific client.

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Legal and Ethical Implications

This scenario presents several legal and ethical concerns:

False Diagnosis: Assigning a diagnosis that does not accurately reflect the client’s condition violates ethical codes for mental health professionals, including APA, NASW, and ACA. It constitutes misdiagnosis and potentially insurance fraud. Client Harm: A false diagnosis can have unintended consequences for the client, such as unnecessary medication, stigma, and future employment or insurance issues.

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Agency Liability: The agency could face legal repercussions for knowingly submitting fraudulent billing practices.

Case Manager’s Response

If you were the case manager, here are some options:

Refusal to Misdiagnose: This is the ethically and legally sound option. Explain to the client the reasons for your refusal and discuss alternative resources based on her income and situation. Seek Consultation: Discuss the dilemma with a supervisor, ethics committee, or professional liability insurance provider to explore options and minimize risk. Explore Alternative Payment Options: Offer reduced fees, payment plans, or pro bono services based on your agency’s policies. Advocate for insurance reform to expand mental health coverage.

Alternative Assessment Tools:

  1. Patient Health Questionnaire (PHQ-9): This self-administered screener measures depression severity with good reliability and is widely recognized. While not diagnostic, it can support your judgment and document the client’s symptoms. 2. Beck Depression Inventory-II (BDI-II): This clinician-administered assessment provides a more detailed picture of the client’s depressive symptoms and severity. It can be used to monitor progress but isn’t a substitute for diagnosis. 3. Social and Occupational Functioning Assessment Scale (SOFAS): This tool measures the impact of mental health issues on daily functioning. It can help demonstrate the client’s need for services even without a major diagnosis.

Rationale for Using These Tools:

  • Objectivity:They provide data to support your clinical judgment and advocate for alternative services.
  • Client-Centered:They involve the client in their own assessment and treatment planning.
  • Non-Diagnostic:They focus on symptoms and functioning, without resorting to potentially unethical diagnoses.

Remember, prioritizing the client’s well-being, ethical practice, and legal compliance is paramount. By utilizing these tools and advocating for accessible mental health resources, you can help the client receive the needed support while upholding your professional responsibility.

 

 

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