A non-custodial parent comes to you asking for help with her children, what do you do? What are the ethical considerations that you need to adhere to in order to stay within the scope of the law and the American Psychological Association’s Code of Ethics? Will you be able to provide the help that the mother is asking for? Can you talk to her children and discover their point of view? Who can you legally treat in the case study that follows and what types of assessment strategies would you use?
These are questions that I will answer after the initial screening visit from the case summary that follows. A 31 year old mother of three presents asking for help. She says that she is divorced from their father and he has legal custody of the three children, a 15 year old boy, 13 year old girl, and an 11 year old boy, all of whom she has brought to the interview. She admits to an alcohol addiction which she states is currently in remission. She says that she was “a bad mom” and that she “was sick” but has been sober for 3 and ½ years.
Initially stating that her husband has given her the children due to her sobriety, she later states that the father is married with a 7 year old boy and a baby and the father and his new wife do not feel that they can handle teenagers at this time. She is concerned because she “cannot afford three teenage kids. ” She lives with her mother who was injured in the military and is on a fixed income. She says that her mother drinks, feels that she may be “using some smoke” and tells me that her mother cannot “manage” the children. She asks if I will call their father and explain the situation so that he may help.
She tells me that there was prior talk of suicide with her children but does not tell me which one. She says that she was prescribed Prozac and has been administering the medication to her two oldest children and says that her youngest may need some. She states that she thinks her youngest child is on medication for Attention Deficit Disorder, but she is unsure of the diagnosis or medication. She asks me to call her family doctor so that her children can get a prescription for the Prozac and to find out information about her youngest child.
She tells me that she has brought her children here so that they can tell me that they want to stay with her. She states the oldest child wants to quit school and get a job so that they can stay together. She tells me that her 13 year old daughter “is with her boyfriend all the time” and admits to not knowing where her 11 year old son spends his time. She questions if drug use may be an issue. She wants me to talk to her children to find out “what is going on” and then give her the information so that she may talk to the children herself.
She then asks me to call their respective schools and let them know that they “are working on things. ” Before I can continue with Shana, I must ask her to have her children leave the room. I will provide a copy of my offices privacy practices and have her sign my consent to treatment form for her alone. I will let her know that I am in no position to call the children’s school or family physician at her request. Although Shana states that she has physical custody, she has already told me that her ex-husband has legal custody of the children.
Any decisions that are to be made regarding the treatment of minor children are the responsibility of the parent with legal custody of the children (Souders, Gottfried, & DeVito, 2009). I will need to explain to Shana that she is the non-custodial parent and as such does not have the right to give consent to mental health treatment for Jason, Maria, and Adam (Souders, et al. ). Had the two older children come into my office on their own requesting treatment, according to the laws of the state of Maine, I would be able to provide these services to them (Physicians for Reproductive Choice and Health, 2002).
This is not an option at this point in time. Shana has spoken for her children during this entire session and I feel that the possibility exists that she may have coached the children to convey answers that are favorable to her situation. I would need permission from the children’s father and I would want him to provide me with legal documentation stating that he is the parent with the right to make these decisions (Souders, et al. ). I would also have the children referred to a different counselor because of their known association between me and their mother.
I want them to feel comfortable in a counseling situation and I believe that this could be done by utilizing a different treatment provider. I am very concerned about the health and welfare of the children. As a therapist, I am legally delegated by the state and federal government as a mandatory reporter (Child Welfare Information Gateway, 2010). A mandatory reporter is a professional obligated to report to the Department of Human Services Child Welfare Division when one “suspects or has reasons to believe that a child has been abused or neglected” (Child Welfare Information Gateway, 2010. p. 3). I am also obligated to report if I know that a child is in a situation in which harm may be a result of the caregiver’s actions (Child Welfare Information Gateway, 2010). Shana has already told me that she placed her children on Prozac of her own accord. This is a situation in which direct harm to the children could come about. Prozac is a prescription drug for the treatment of depression (The Mayo Clinic Staff, 2010).
Prozac, as with most antidepressant medication has been shown to increase suicidal ideation when administered to children and teenagers and should not be used if a child has had thoughts of suicide, as Shana admitted to me during the initial interview (The Mayo Clinic Staff, 2010). It should only be used under the direct supervision of a medical professional (The Mayo Clinic Staff, 2012). Shana is also breaking federal and state laws by giving her children her medication (Clark, n. d. ).
The penalty for the first offence could be upwards of 20 years in prison and a fine of 1 million dollars (Adamec, 2010). Another concern of mine is the fact that she does not seem to provide much adult supervision of her children. She stated that Maria is with her boyfriend “all the time” and admits that she does not know where Adam is spending his time. She has also told me that her 15 year old wants to quit school to find work; this too would be breaking the law. In the state of Maine the law for attendance in school is applicable to all persons between the ages of 7-17 (Maine Legislature, 2012).
Violation of this law could result in civil action against Shana, fines imposed, and the school must report the truancy to the Department of Human Services (Gendron, 2008). I need more information on Shana and her life. I am afraid that she may be abusing substances, but with her vehement denial of any use I do not believe that an assessment of this issue would be of any consequence because the results depend on the honesty of the client. Utilizing a structured interview style, I would gather a complete biographical inventory during this visit with Shana.
A structured interview is a set of predetermined questions used to assess an array of behaviors (Neukrug & Fawcett, 2010). The biographical inventory is a comprehensive set of questions that would provide me with information regarding Shana’s life from birth to the present (Neukrug & Fawcett, 2010). It includes information on the demographics of an individual as well as information about current and past family history, educational history, vocational history, financial history, any prior mental health treatment, and a medical history (Neukrug & Fawcett, 2010).
Other areas covered that would be of use are areas of substance use and/or abuse, legal problems, information on behaviors and current mental state (Neukrug & Fawcett, 2010). Because I will be reporting the suspected child welfare issues, I would refer Shana to another therapist. The biographical inventory will help the new psychological professional to determine whether more assessments are needed and aid in the clinical interview process (Neukrug & Fawcett, 2010).
In the referral I would suggest the use of the Millon Clinical Multiaxial Inventory (MCMI). It is used in conjunction with the DSM-IV-TR to help with diagnosis of personality disorders but also addresses issues of symptomology of clinical syndromes (Neukrug & Fawcett, 2010). It can aid in the diagnosis of Anxiety, Bipolar disorder, drug or alcohol dependence, Post-Traumatic Stress Disorder, major depression and other mental health issues. It may be of help in determining if a neuropsychological