I would wait a few minutes. I am getting a lot of people saying yes.

Transcription

1 Event ID: Event Started: 4/23/ :52:39 AM ET Please stand by for realtime captions Welcome. This is Martha Garber welcoming you to Ethics: The Impact of Personal Values and I will be your host today. Norine Gill will be at her first employment task force meeting today. Before I introduce the presenter I want to make sure you can hear me. Please send me an at UNTWISE@UNT.EDU or use the question box to the right of your screen to say yes and let me know you can hear me. I would wait a few minutes. I am getting a lot of people saying yes. As advertised we will If you registered on the webinar, we will know you are here. If you are listening with someone else let us know during the broadcast that you are listening by sending us an or a note in the webinar session that you are here and if you are only listening by phone you when the -- you will need to send us an . I will now move right along and introduce the speaker. We are glad to have Dr. Linda Holloway speaking to us today. Many of you in the audience know her and love to hear her presentation. She has over 30 years of experience. You could not tell it by looking at her. Yeah, right. [laughter] She has a professional background including extensive work with people with significant disabilities and she has worked in a number of rehabilitation community programs. She has provided employment services and psychosocial rehabilitation and community mental health services. She has also served in a leadership responsibility in a number of organizations including the commission certifying rehabilitation counselors. She has been a Commissioner and a chairperson also. We are very fortunate to hear from her today. I will be quiet and say welcome, Linda. Thank you. Morning, everyone. I hope it is a beautiful day there as it is here in Denton, Texas today. It is my honor to provide this presentation on Ethics: The Impact of Personal Values. This is my first time for a webinar. Please be patient. First I thought we would start off -- I know all of you have had ethics training before and are aware of many of the dilemmas and issues that we face in the field of real dilatation. I thought I would start basically with is an ethical dilemma? Dilemma is a choice between two courses of action. There are significant consequences for taking either action. Each of the choices can be supported by one or more ethical principle. However, the ethical principles supporting the action not chosen will be compromised. That is why we call it a dilemma. Which of the following do you think is an ethical dilemma --

2 1 -- Having sex with a consumer. 2 a treatment that has a great likelihood of success that comes with a high risk. If you chose number 2, you are correct. Having sex with a consumer is wrong under any circumstances. Yet, often when I am doing presentations I have people use as an example of an ethical dilemma. As you can see, that is not a dilemma because there are not 2 a courses of action which can be right. You are compromising your ethics and morals any time you have sex with a consumer. As we know, there are a number of different codes that allow you to have relationships with consumers. The licensed chemical dependency counsel allows you to have relationships with clients have 2 years. Many say after 5 years. You want to be cautious about that. In my pit opinion -- why would you not want to have sex with a consumer -- there is the power differential. Even if they are no longer your consumer or client, you have information that gives you some control or power over the person. It's always something to tread lightly with. Having a dilemma -- there was a quote that I used several years ago -- when there is no choice, there is no anxiety and there is a happy release from responsibility. Unfortunately, we are in a field in which we have to make choices every day. As you know, there are a lot of gray areas. Considering ethical dilemmas is an important component to be aware of. Let's look at the CRC code of ethics -- there are a number of codes of ethics but we will stick with CRC which is adopted by the agency and it tends to be a generic code of ethics for everyone in the field of rehabilitation. First go to -- one of the major principles under this is autonomy. I'm sure you of heard this before. It is basically respecting the right of your consumer to be self-governing. Understanding - - getting a person the freedom to choose what they think is in their best interest. The next principle is beneficence. Basically, do good. Promoting the well-being of the consumers you serve. The third principle is non-maleficence. It is a component that all of us are aware of. We don't want to do anything that will harm anyone. As we discussed further in the presentation, sometimes you do things that you have risk. You don't want to intentionally put someone at eight tremendous harm and yet you may do things that post risk for that individual. The next principle is fidelity. Just to be faithful and keep your commitments and to follow-up when you say you will. If you say you will call a consumer back in a certain day or you make a commitment to put in an application for that individual, be faithful. Keep your promise. The next principle is one that we called justice. Justice comes into place because we need to be there in the treatment of consumers. Sometimes that means doing things that may not be the ideal for everyone but overall provides the best treatment. When you work in a system in which you have limited resources, you a have to choose that as an option. You need to be fair to the

3 majority of your consumers when you may not be able to do everything that you like for each of them. Voracity is the last principle that was added with the recent code provision. It was in Be honest. Let's go through a couple of scenarios so you will have an opportunity to work with those principles. If you have a budget of $10,000 to spend on your consumers for job support, and you have a person with multiple disabilities and they need a job accommodation that costs $7500, what are the 2 principles you feel would be considered in that scenario? Take a minute to look and refer back to those six principles if you need to. Put your answers in the question box when you have them and I will read them to Dr. Holloway. I'm sure we have people typing. Yes. Mary says Justice and Voracity. That could be two of the principles. Justice place into that with a budget of only $10,000. You do have to consider how you will use those to serve the majority of the clients -- the consumers you have? Spending $7500 on one person is going to compromise the amount of money you have with the other. So, Justice clearly. Luke says justice and beneficence. You can see where it is not always one right answer. Justice and beneficence would probably be the two principles that would most be concerned. I can see where voracity -- you want to be honest and do what is best for that person. But if you think about overall, beneficence -- providing $7500 of job support for that person would do a lot of good for that person; however, you will compromise the principle of justice because then you only have $2500 to spend on all the other consumers in the caseload. So I think you have a good understanding of how that works. Next scenario -- you have a consumer who wants to get a job in a fairly rough part of town and yet she has a tendency to be very trusting. What 2 principles should you consider when assisting that person to make a good decision? We wait for people to give us their answers. This one says beneficence and voracity. It may have come from -- now we have autonomy. Autonomy and beneficence. And we have from Catherine non-maleficence and voracity. Okay.

4 Lisa said -- I would recommend that she only works during the daytime. [laughter] That might be ultimately a good decision. Yes. Amy says autonomy and Veracity Autonomy and beneficence. We have more autonomy and non-maleficence. Let's take autonomy. There seems to be a lot of consensus that autonomy is a principle to consider there. Helping a person to select a job they want would be an example of autonomy, correct whacks you are trying to support their choice. Non-maleficence -- if it is a rough area of town you would want to do what you could to help protect the individual. You do not want to put the members. You could see how non-maleficence and the beneficence are two sides of the same coin. I could see why individuals with select both of those. As well as justice. However, if you boiled it down to the primary principles -- autonomy -- supporting the person and their choice and non-maleficence -- assisting them to make sure you're not doing something to put them in harm would probably be the 2 primary principles that we would be working with on that particular scenario. Let's take a look at the next one -- your consumer is psychologically fragile and has a disability likely result in death and he asked you about his prognosis. You may find that often individuals that you work with -- you have the medical records. You know information they may not even be privy to. It puts you in a precarious situation at times. I have also found that sometimes positions are afraid to till a person about the prognosis. When I worked in mental health I found many psychiatrists that didn't want to tell a person with a diagnosis was. They were fearful that then they would know they were really ill. That goes against the common norm today. We know that the more people know and understand -- generally they are better able to cope with a particular issue. When you know a person is most likely to die -- they are psychologically fragile. How would you handle that? Will be the principles to consider their? Let's take a minute on that. Beneficence and-- trick Veracity -- Veracity and non-maleficence. Okay. I've got three -- Jamie also said that. Very good. Veracity, as we know, is simply to be honest. When the person asks you -- you want to be honest and straightforward with them and yet that principle -- again, beneficence or non-

5 maleficence are the same kind of concept but to different sides. Not wanting to harm the person. You are worried about their psychological ability to handle the issue so you have to make a decision there. Am I honest? Should I do what I need to protect -- to protect them or do good for them? The final scenario we have for this is -- you told your consumer that you would call her at 3 on Tuesday and yet you are with a consumer threatening to commit suicide. When I left mental health and came back to vocational rehab, I thought I will get out of the crisis business and yet the first week on my job I had a consumer call and say if I don't have a job by five o'clock today I will kill myself. Even though you may think you are not in the mental health business, I'm sure many of you have had a situation in which you had individuals that had some pretty significant mental health issues and you were sometimes the first person they reached out to. So, while you may not be a trained counselor if an individual is threatening suicide you must first -- what? Protect the person. There is the issue of non-maleficence or again -- beneficence -- protecting that person and doing good for them and ensuring that you don't to harm. What would be the other principal? Fidelity -- a number of people. Very good. As you can see, fidelity is to keep your commitments and to do what you say you're going to do to honor your promise. In this situation this is probably a no-brainer. You know you need to stick with the individual having these societal -- suicidal ideations and you would feel cold to keep your commitment to the consumer. There are a lot of different ways to handle that. Ask someone else to call them or deal with the individual or contact your consumer right away. It puts you in a bit of a quandary and hence the ethical dilemma. Where do you fit in? The title of this is ethics and personal values. What's the difference between ethics and morals? Ethics refers to the rules provided by an external source such as your profession, certification, your organization. A lot of businesses now have what they call a code of conduct. We can understand why, given some of the issues that we've seen in the business world. Having a code of conduct and a set of rules that guide you -- that's where your ethical principles and ideas will come in. Morals refer more to your own personal values -- your individual principles of what is right and wrong. Ethical dilemmas can be impacted by both the ethical principles or code of contact that you adhere to based on your own professional role as well as your personal values and morals. So, when you are having an ethical decision to make, it will be impacted by your own values, beliefs, assumptions that you have hope about the consumer should work with as well as employers and society at large. Your own experience -- the longer you are in the field, the more ethical dilemmas you will probably face. So, over time you will develop guidelines and principles that help guide you. Your own self-knowledge -- the risk in working with consumers at any time is when we aren't aware of our own biases in our own values. -- And our own values.

6 Self-knowledge -- being honest with yourself. That's not always easy to do. There are a couple of different toys grids or prioritizing grids that you can go to at some point if you would like. The author of But Color is your Parachute -- they have some things to help you prioritize this. Begin to prioritize -- what are the major principles and ethical guidelines that you follow within your profession as well as your own personal issues. Personal characteristics that we need to think about -- self-awareness. Some people when I say what is an ethical dilemma and what are ethics they often talk about their own got feeling and I do say that while ethics and morals don't is fairly -- your feelings may or may not be a part of this, but they do impact us. So, when we make an ethical decision that optimizes our own personal values and morals we are going to get what they call cognitive dissonance. Uncomfortableness. Being aware of your own values and morals and principles that guide you is an important component in any kind of helping profession. The ability for critical thinking. Consider all the options. This is an important component. Your willingness to take personal responsibility. Because as we discussed previously, you often do -- there are choices you have to make and how you will serve the individual and ultimately we want to consider what their own needs are. Your personal responsibility in the end may have to be something that you consider. Openness to considering alternative choices. I tell folks that we run into the most difficulties when we see no choice. Yet, there are always some choices. Some may be that are than others, but what we think we have no choice at all or when a consumer we are working with feels as if they have no choice at all, it is a powerless feeling. There has been a lot of research looking at the issues of internal locus of control versus external control. When people feel that everything is outside of their control and they have no responsibility, it is a helpless feeling. We do find, also, that we have consumers that want to put us in the driver s seat because having somebody else make the decision for you takes the responsibility off of them. So, it always needs to be a shared responsibility. The ability to monitor and implement and seek feedback for what you did are important characteristics. The idea of -- can people make good choices? Do bad people make bad choices? To good people sometimes make bad choices? Yes. I served on the ethics committee for certification for years. We had far fewer complaints that I have seen with other professions such as chemical dependency counseling or general counseling, but I saw people make bad decisions. So, that is why having consideration and having folks that you trust and having an ethical kind of decision-making model that you use are important. Yes, anyone of us are good people and yet we can make bad decisions at times. There's a song that I like -- I wish I could play it for you. It is written by Ever last. You may have never heard of. It's called What It's Like. It talks about different scenarios in which the person says I've seen a rich man bag and a good man sin in an honest man lie. That speaks to the ethical dilemmas we may run into. Good people can make bad decisions.

7 Having folks that you trust and having the ability to be self-aware and to think critically and to try to make decisions in your consumer's best interest are really important. Listen to that song later. Let's talk about the pretzel balls we talked about earlier. Take a moment and in your header if you want to take a piece of paper, write down which of the principles you think you rate as most important? We have values and vegetables that are our go to principles. Thanks to the six principles and which ones you feel are most -- that most guide the practice. When we have to make choices, what are some that are most impacted by our own personal values and our own way of doing business? I have a comment -- when we discussed this, you challenged me to do this. What I found was that if I look at ranking them it is easy for me to rank which one is the most important for me. It has been autonomy. I will sell to close. It may be true for a lot of rehabilitation professionals. We want the person to have control over their lives. Then when I start to compare one to the other, the choices become more difficult. Yes. Hence the dilemma. It's not easy. There is not one perfect right or wrong area -- answer. There are a lot of gray areas. When we are faced with the dilemma we ought to look at the principles being considered and one will sometimes service for many of us. I did ethical training for years with rehab counselors and social workers and licensed chemical dependency counselors all in the same room. I found that many of us that choose rehab over a more traditional social work role tended to Frank autonomy as one of the four values -- rank autonomy as one of the values. Some of you have heard the dignity of risk -- in serving these people -- of we always protect that we don't give them the dignity of risk. The opportunity to make decisions and choices that sometimes put them at a bit of a risk. Our role is to keep them from having to significant of a risk. But, if you ranked non-maleficence over autonomy you may find that you encourage your consumers to play it safe a little bit. If you ranked autonomy over non-maleficence as Martha self-disclosed, autonomy is one of the principles that tend to rise to the top for her. You may be more inclined to encourage your consumers to take some rest. You can see how your own personal values and principles play into that. We are always trying to do what is best for the consumers. They are involved in the choices. But they often look to us for guidance. If you ranked non-maleficence over veracity, you might be inclined to tell a consumer a white lie --. If the protected them. In the earlier scenario when a person asked you about their prognosis, if you were more concerned about doing harm to them over being truthful, you might want to tell some kind of a white lie.

8 On the other hand, if you ranked justice over non-maleficence you might be included to survey large group of consumers the best you could rather than a small group very well. This is often a dilemma that we face in rehabilitation. We always have more needs and consumers than money. If there is anyone in the room that feels like they have enough money to do everything they wanted to do for their consumers, raise your hand right now. Let me see if we have any. I will go to that screen. I'm not seeing a single one. I don't think so. As you know, we are in a system in which we don't have enough resources to do only one. So, we have to make tough choices. When I was director of mental health services we had funding cuts. Everyone was seeing clients one hour any time. You get to make decisions. Is that the best use of resources are can we still accomplish some of the good we want to do and maybe do it with groups? Are there other ways to be efficient? When I talk about rehabilitation it is actually more art than science. We try to make it a science and yet much of we do is be creative component. I am sure that you are very artistic in your own way and how you go about serving your consumers. In the 2010 code provision for CRC, they made a new guideline that everyone faced with ethical dilemmas needed to have some kind of a decision-making model that they utilized to make those decisions. There are a number of models you can find. The American psychological Association has some. [indiscernible] has written on this subject. There are a number will of individuals in rehab in counseling and psychology. The fourth what they consider -- Jorge Garcia did a multicultural decision-making model. I look for one that I thought was generic and simple enough and didn't require you to be a counselor but if you are it wouldn't cover mice what you did. I found a simple model called the Plus decision-making model. It was from WW W.ethics.org. Barbara and I adapted this to include the I-PLUS model. The field we are in working with individuals, particularly those that often have been marginalized and not had the ability to represent themselves or haven't been listened to as wedges they should have, without that the first thing that we in the field need to think about is the individual reserve. Who are we serving or who we represent fax we need to look at a decision -- the kind of decision we are trying to make -- see if it is consistent with that person's values or goals? That should be the first thing we consider any time we are faced with the dilemma that we need to help our consumer or need to make a decision with. The P in the plus model stands for policies. Is the decision I am leaning toward consistent with my organization procedures and guidelines fax looking within your organizations, what to the policies say? What are the guidelines you need to follow to be a good citizen within the organization? The L stands for Legal. There has often been a discussion -- can something be it legal and ethical? Yes. You can something be legal and unethical?

9 Yes. Part of what you need to do is look at your contractual agreements. If you are a vendor -- what to your contractual agreements say. If you have contact with other organizations, what do they say? What are the applicable laws and regulations? Considering those, again, you put this into your toolkit or keep in the back of the brain so that as you face tough decisions you think about these issues. The U stands for Universal. Does it conform to the universal principles and values that my organization has adopted? When I coach students here at UNT in places they might consider going to their first job as an undergraduate or a Masters student, one thing that I suggest they do is look at the mission and values of the organization in which they are applying for a job. If that mission and those values are in conflict with any of your primary principles and values and morals that you hold as an individual, you will find that that organization may not be a good fit for you. When you make a tough decision, you want to look at the principles and values and the mission that my own organization has adopted and make sure that you are as consistent with that is you can be. Finally, S. yourself -- does it satisfy my personal definition of right, good, and there fax These are all pieces to keep in mind as you move forward when you make a tough decision. The steps in the I-PLUS model -- define the problem -- you have to know the issue you are looking at. Identify potential solutions to the problem. Again, remembering -- sometimes when you brainstorm throw out all the potential solutions even though you make side think that some are not that great. Put on the table. Include your consumer in the process. Include others in the organization that you trust. Seek guidance from the supervisor. These are important things to do. Identify all possible solutions to the problem. Then, evaluate the solutions using the I-PLUS considerations. Are the ethical trade-offs acceptable? If I'm going to do something that will compromise justice but support autonomy, is the trade-off I am considering acceptable? Is it something that the individual can live with that fits within the organization and principal in value and mission? Is it acceptable based on my contract and the loss of I work with? Consider all of these things. Then make the decision. If you determine that the trade-off is except the bull and you can live with it. We have compromise one principle, but the principle we are upholding outweighs the -- the good outweighs the bad. Make a decision. Lament the decision. Then, evaluate the decision. Some decisions may be irreversible but many are not. Evaluate the decision after you implemented it. Be comfortable if need be to go back and readjust or make changes.

10 If you put an individual in a job -- you looked at the trade-offs and you think yes, this might put the person that a bit of a risk and yet it does support their autonomy, if you get in a situation and you or the consumer has significant concerns about their safety, be brave and bold and go back and tell them -- I think we need to may they be look at another job. This may not be the best. We present is a place and supported the decision. Yet, as I have done my job coaching and visits to the site I have some real concerns and I don't want to put this person at that much risk. Discuss it with the consumer and anyone else that is a stakeholder in the decision. Let's take a scenario. This is the case of Larry. He is a 26-year-old man who is diagnosed with schizophrenia, paranoid type. He taught high school computer science for three years. The last two years have been marked by hospital admissions and the inability to get along with coworkers and supervisors. Larry has decided that he would like to secure a position as the computer salesperson. The goal was compatible with his skills, interests, and abilities as well as his disability. He has not had any hospital admissions for six months. He continues his medication, and appears stabilized. You found a sales position at the local computer store and Larry would like to apply for it. However, in discussing this with his psychiatrist, the psychiatrist believe he is unable to handle the stress. You must decide whether to A assist them in applying for the sales position or B assist him in obtaining some other type of employment that the psychiatrist views as a more suitable. If any of you are working with individuals with a mental health diagnosis this may seem familiar. Martha and I have a dear friend, Joe Maroney has talked about how people say individuals with serious mental illness can't go to work because it will be too stressful. His comeback is -- well, if that's too stressful, what is unemployment and poverty? How much stress does that place on a person? Yes, we also have positions of authority that think a person can to do something because it may be too stressful for them. Let's look at some of the reasons to support each action. I have given you action A -- if you support Larry in applying for the position and seeking the position in the computer store, what are you supporting? A -- Larry would have an opportunity to obtain the job he desires. By remaining faithful to the jointly agreed goals, Larry's trust in your will be reinforced. However, if you are concerned and you listen to what the psychiatrist says, then B -- help him to obtain a different position another kind of setting -- Larry will be assisted in obtaining the type of employment in which his psychiatrist believe he is most likely to be successful. Again, as we know, we have often given physicians power. In fact, many people think that if a doctor says it it must be so. Yet we know how much real experience in employment services to doctors have?

11 My guess is that most have none. You have far more experience. However good, because the doctors involved you have to look at things like policies and what your contract states and discussing that with your supervisor as well. It's not quite as easy as one might think. We have a comment. Okay. Ready? Sure. I was trying to see who was from. Erica says B -- talk with him about different positions that are suitable for him so he can to the final decision. Very good. As you see, always including the individual in the process -- being honest and forthright. The doctor may not tell them we don't think this is a good position. That would be something that you would want to discuss with your consumer. This is what your physician has said. This is what you have said. Let's look at the different alternatives and what you think. So, there are different principles that would be supported based on each course of action. Going back to the major principles that we discussed earlier from the CRC code of ethics -- action A -- this supports the principles of autonomy and fidelity. You would be supporting the person's choice and you would be -- keeping your commitment to his plan you have agreed on. Action Would support the concept -- beneficence as well as non-maleficence. You would be trying to do what the doctor that was in his best interest and you would also be trying to do no harm if the physician felt that that particular position might not be a good fit for him. When you look at the reasons for supporting each of those -- let's look at the reasons for not supporting this. Erica made great comment. Under action A -- if you can assist them in getting a job and he did experience stress and lose his job, that would be a potential problem you might face. The stress of the job might also compromise his stability. Some of the reasons for not supporting action B in helping him to find another career would be that stand might not be offered the opportunity to apply for the job he desires. He wouldn't -- you would not be supporting is a tiny and you would be allowed to apply for that particular job that he wanted. P -- the goal of the plan would not be adhered to. We also understand -- especially if you are CRP, you are often working on a goal or plan that is been deep predetermined both by Stan as well as his rehab counselor. When you make a different choice or you are looking at a

12 different vocational goal, the counselor as well as Stan would need to be involved in making a different plan. What are the principles that would be compromised for ejection? Again, supporting one -- you will compromise non-maleficence and beneficence. If you choose action A. If you choose B you would compromise his autonomy by not supporting the job he is chosen and the optimizing potentially fidelity because he may not -- he may not know that you're going to keep your commitment to him. We have a lot of comments from the group. One of them suggests that an option -- B -- tried to meet with the psychiatrist and consumer together to help sort out the different -- it would let everybody help to sort out the principles. Yes. I thought that was an interesting approach. I think that is a great idea, especially if you have a psychiatrist who is actively involved. We know under evidence-based practices that integrated treatment is one of the best practices. So, getting everybody at the table is critical and if you can do that I would highly recommend it. We also have a comment that in looking at -- starting -- serving people from other cultures, their value systems are different. How do we approach that? That's excellent -- part of it is to first work with that individual. One thing that we know in the general European the class kind of bias that we often approach things with is that we often look at individuality as being very important. If the person's choice. They are the consumer. We don't want to hear from the family and yet we know in other cultures that there may be more of a group thing and it would be important for the person's family to be considered because not considering the family I put this individual in their own bit of cognitive dissonance, if you will. So, looking at multicultural issues is critical and there are models. As I mentioned, Jorge Garcia and his colleagues have done work in that area. The most important thing is to try to understand as much as you can about the culture. I know when I took a multicultural class in the 80s it was -- read a book. Reading books is a good thing and yet it doesn't give you a full understanding of that culture. How it plays out for that particular individual. That is where a lot of the work that you would too if you do a [indiscernible] -- a link the discovery process. Really understanding the individual's culture as much as possible. Asking questions. If the person uses words to communicate, ask them to help you understand what their culture is like and how it impacts their lives and decision.

13 If it is an individual who doesn't use words to communicate, then observations -- discussion with family. Discussion with other individuals that know the person well. How does that culture play out? Yes, this is very important. We have a scenario later that we can look at and go through that as well. Not one right or wrong answer, but as much as possible, always consider that an included. As we know, culture is not just about race and ethnicity but it can be social economic background and gender issues. Sexual preference. Really listening to the person and getting to know them as much as you can, that is why I like the whole concept of doing a detailed discovery process. Get to know that person and think about that -- when you are faced with a dilemma, how will this impact that particular persons values and their cultural constructs that they have and bring to the table? That is a great question. I don't have just one specific answer but it is something that you always he didn't take it out. Even when you are placing people in certain kinds of setting, looking at who is in the setting and how that individual is going to get in. Are there going to be cultural clashes to consider? If so, does that make it a good fit? Sometimes it doesn't. The job itself -- the task may be fine but the culture of the organization may always be a clash with this particular individual's culture. Great comment. PQ. -- Thank you. We have a scenario with stand. -- Stan. Which course of action is most consistent with the job seekers value and goals? Having that discussion -- if you choose this job at the computer store, this is what you stated for your own vocational goal. It states it fits your own values. Yet, they can sure that they have the information about the physician s comments as well. There are some comments. Mike said I would choose C -- this group is very creative and they want to go out -- go outside. Yes. That's good. A true we have professional -- a tent in a trial experience in a limited amount of time to see if they could handle the stress. Very good -- great option. To Mike say that? Mike, great option. Is that there is no way not always just one particular right course of action. Doing that -- discussing it with stand -- Stan. I understand your position. Make sure that the others involved are aware of this and they understand that you are doing what is in the best interest of Stan. I've heard your concerns. Again, the physician will not go out and observe the job site itself. You have to have a role for that and saying I observed the job site and look at the stress level. Some of you might even have thought about things such as the time of day the person is working. This may be critical. If you

14 go to Best Buy on Saturday afternoon it looks different than it does on Tuesday morning, correct? Yes. That goes along with Mary comment -- determine with the consumer what supports may help reduce possible stress and help them negotiate these. Very good. Looking at those accommodations that would support the person and minimize stress. Great idea. Yes. Thoughtful group. Yes. I can see why you are good at your job. So, you look at the courses of action -- first we consider the individual job seeker. What is most consistent with their values and goals? Next we do need to consider the organizations -- organization's procedure and guidelines -- you don't want to be terminated. What will you do that will support that are not support that? Ensure that you keep that in mind. L -- what is most acceptable with the laws, regulations, and contractual agreements of my organization? We touched on this earlier. If you're contract says that you must assist the person in meeting the vocational goals stated on their plan, then you would have to make sure that you consider that or go to the table and renegotiate with that particular [indiscernible]. U -- which most closely conforms to the principles and values of my own organization has adopted? And S -- which of the scenarios most closely support my core values and beliefs? You came up with great ideas of ways to support Larry and consider what the psychiatrist said -- we don't want to ignore what the physician s requests are and yet you came up with some great ways of doing this. Let's try some accommodations and support and look at stress. I know I had the pleasure of starting the first program for individuals with psychiatric disabilities in Texas. When I first started every Dr. to a T said these individuals cannot work because they are too ill. There's going to be too much stress. Yet, they had looked at the jobs. They didn't know what the stress level was. Each of us have different stress triggers. Some of you thrive on a busy environment whereas others find a busy environment to be extremely stressful. For me a stressful environment is one of which I don't have enough to do. Again, going back to the discovery process and looking at your consumer. You will be able to help determine what is their stress level. Other things to consider? I love the suggestion of looking at accommodations. Also

15 the job tryout. We often don't know until we get on the job what is really required and whether it is a good fit. Luke made a comment -- he likes to be consistent with the organizational procedures and guidelines. However, he must discuss the pros and cons with the consumer to let him or her know I am trying to help them achieve their job role. Very good. Yes. Hopefully there will be guidelines and procedures that don't support you you won't have those. So it is more of a craft and art than a science. You have to have all of the scientific knowledge of the individual and their ethical and psychological issues that you need to consider. You've got to have the information about the particular job itself and information about accommodations and strategies and systematic instructions. Doing employment services is a complex job. You have to put all of those pieces together a blog. So, faced with tough ethical decisions -- keeping these in the back of your mind is the same time you keep all the other information about the job of the individual job seeker is a lot to handle. I often suggest that people write things out. If you process things better with this, you may want to use something similar to the strategy we did with Stan in which you actually write out -- if we use course A, what are the principles we will be supporting? If we choose will be, what are the principles we would be supporting? Again looking at the principles you would compromise. Very good. Other comments or questions? I think it is good that we understand first where we are coming from in terms of our own values. When I self-disclosed that autonomy is one of my biggest ones, but I am working with a consumer who values their family and the family's acceptance of what they are doing and that is more important in their own individual desire. I need to respect that and consider that when I work with that person. It seems to be the kind of thing that if I want to fail I don't pay attention to what the consumer values. Very good. Exactly. And if you want to fail, you are not aware of your own biases, either. Yes. I am like you -- autonomy is one of my core values as is justice. I have been in situations where I had to be careful, particularly with students, but I wasn't encouraging them to stand up and rally in go and strike because I felt something was unjust. It needed to be their decision. We have a lot of influence. While we are not always thinking about it, we need to understand that for the consumers and often the family members and employers and everyone that we interact with, you are the specialist. The employment specialist. You are the expert. So, people will often look to

16 you and try to put you in positions of making decisions that sometimes you shouldn't be making. Keeping those principles and knowing yourself is really critical. There we go. Let's look at the next scenario -- you can think about yourself. This is the case of Maribel. She has an ass and can help with the family business but she has expressed an interest in helping others to sell. She graduated in the top 10% of her class. Some of her inventory shows that she has high interest in the social work field. What would you encourage her to do? Take a moment and think a little bit about what different principles you would be supporting and which principles you might be compromised. The two choices there -- to help support her in the family-owned business versus encouraging her to go back to school and select a career in social work. We don't have too much time. It is 10:59. You are corrected -- sorry -- because I have the PowerPoint top I don't have the clock on my computer. My apologies. I have given you a couple of other scenarios. I would encourage you to take a look at these. If you are working with a group, maybe there are a couple of you from your organization that took the webinar today. Sit down with them and work through these and talk about them. This is where we gain the most -- considering these things and is seeking input from others that we value and that we know have the best interest of the consumer in mind. Any closing comments? Erica said she was thinking -- whatever Maribel wants to do. Antonio said I would look at Maribel's goal and determine if this can accommodate her goal in some way. There we go. A lot of that -- interested in doing what Maribel wants to do. Yes, I am glad to hear that. One scenario that we did get a chance to talk about was that sometimes you are pressured to get a job and get you may take it is not in the best interest of the consumer. Look at those scenarios. I apologize I didn't get enough time to finish. This has been a great webinar. Linda, thank you so much for presenting this for us. I think the audience enjoyed it. You can tell that by all the participation we've had. Thank you again. Participants will receive an with an evaluation form of this session. Please complete this and once you have completed it, return it. We were you your CRC credit. We have other comments -- it says thank you -- accrete information. -- Great information. Thank you again.

17 Ache. Keep up your good work. You have a tough job and we need you. Take you. Goodbye. Thank you for your participation. Goodbye. [Event concluded]