Reamer Model in Solving Ethical Dilemma

Please read and review the ethical framework guideline of Reamer for analysis of an ethical dilemma. Please read case below from the Case Studies Social Work Practice book. What is the ethical dilemma that is presented to you? Use the Reamer model to apply the decision-making process in solving the ethical dilemma. THE CASE OF MAI Mai Khang 2 was a 15-year-old Hmong American girl who presented with frequent and serious suicidal gestures and episodes of aggression. Upon referral to a social work team that provides intensive, in-home, behaviorally oriented services, it was reported that she drank small amounts of toxic chemicals (e.g., bleach, nail polish remover, laundry detergent) two to three times per day and assaulted her mother or father roughly one to two times per day. Mai frequently ran away from home and “hooked up with undesirable strangers.” It was also noted that she had, on occasion, threatened to kill her parents with an axe. The mental health therapist who referred her for behavioral intervention had given her a diagnosis of major depressive disorder with psychotic features, largely as a result of her reported visual and auditory hallucinations and suicidal ideations. The behavioral specialists began, with the assistance of a Hmong-speaking interpreter, to attempt engagement with Mai’S monolingual Hmong-speaking mother and father. The initial focus of services was on specifying the girl’S high-risk behaviors and on developing a preliminary safety plan. The workers subsequently conducted a functional behavior assessment that defined the frequency and nature of the child’S target behaviors, as well as their antecedents and consequences. Through this process, it was observed that Mai’S aggressive and self-injurious behaviors were usually triggered by rejection by a “boyfriend,” limit setting by her parents (particularly with regard to phone use), or boredom (her access to age-appropriate activities was limited because of her parents’ unwillingness to transport). The typical consequence of her acting-out behaviors was determined to be increased access to the people, places, and attention she desired. Thus, these dangerous behaviors were thought to express an underlying need for connection and belonging with others. Consistent with this assessment, the behavior specialists initiated strategies aimed at increasing Mai’S access to recreational and peer-based activities in the community (e.g., Boys’ and Girls’ Club programs, youth group at Hmong Community Center). A safety plan was also developed to decrease her access to toxic solutions and “undesirable” strangers. With the assistance of the Hmong interpreter, her parents were encouraged to closely monitor her whereabouts at times when she was likely to sneak out of the home (late at night), limit her access to the phone, and utilize a behavior chart for tracking nonaggressive behavior. In addition, a system of positive reinforcement was set up in which Mai’S parents were asked to reward her with stickers and other tokens when she behaved in a safe and responsible manner. None of these interventions proved successful. Mai refused to attend peer-related activities in the community. Her parents did not follow through with the behavior management systems recommended, despite their reported willingness to do so. They continued to assert that Mai was of an age to be married and cared for by a husband, who would deal with her need for structure. Eventually, the service providers concluded that they were stuck. Not having a full understanding of the values and practices of the Hmong culture, they were operating in the dark and making little headway toward managing the risk involved with Mai’S behavior. These workers sought out the assistance of a cultural consultant, who contracted with the County Department of Mental Health to provide input to mental health providers regarding culturally specific issues that can impact a Hmong client or family’S progress in treatment. Upon referral by the County Department, the Hmong psychiatric consultant contacted the service providers on this case to gain basic information regarding the need for his services. Next, this consultant conducted several meetings at the provider’S office, the first of which was held with the child recipient of services. He subsequently met with Mai’S mother and sister-in-law and elicited information regarding their perspectives of her behavioral challenges. Finally, he debriefed with the primary providers, at which time he shared his findings and offered recommendations. As a result of this experience with consultation, the primary social workers learned a great deal about faulty assumptions they had made that contributed to poor progress on the part of the child and family. Those incorrect assumptions were as follows: Mai’S language of choice was English. It was apparent to the consultant that, although Mai is bilingual (Hmong One of the most striking insights that emerged out of the cultural consultation process concerned the parents’ interpretation of Mai’S symptoms and behaviors. It was revealed that they understood her high-risk behavior to be an indication of her call into shamanism, a form of healing that originated more than 10,000 years ago. The primary providers learned that, according to Hmong tradition, the call to shamanism occurs through the visitation of spirits. Typically, a young person is summoned to this vocation during a psychic or spiritual crisis that accompanies a physical illness. By overcoming the disease, the youth reportedly acquires the ability to heal others with compassion. In the Hmong community, the shaman is revered and thought to serve as a bridge between the material and spiritual worlds (The Split Horn, n.d.). Mai’S parents reported that an elder shaman had once confirmed that she had, in fact, been called into this profession. Because they respected her emerging role as a shaman, Mr. and Mrs. Khang did not wish to curtail her risky behaviors entirely; they merely wanted to keep her alive and free from serious harm. Mai, on the other hand, was not convinced that she was a shaman and appeared anxious when the topic was raised. Once the primary providers demonstrated their ability to discuss shamanism with her in a nonjudgmental manner, her discomfort with this subject began to dissipate. It is always appropriate to enter Mai’S house for a home visit if a family member answers the front door. The cultural consultant clarified for the workers that when a cluster of green leaves is found hanging on the front door, it is a signal that spiritual cleansing is taking place within the home. This ritual, referred to as caiv, is performed to protect the family from evil spirits. It was advised that when the team encountered this type of leafy display that they avoid entering the house; otherwise, they would disrupt the ritual, resulting in a need for the family to reinitiate the cleansing process. Based on these new insights, the behavioral specialists reconceptualized the therapeutic needs of Mai and her family. They redefined the function of her aggressive and self-harmful behavior as expression of her need to resolve identity confusion and attain validation within her family and cultural community. Consequently, their interventions focused on the following: The use of written narratives and scrapbooking. These activities were done to assist Mai in ethnic identity formation and goal-setting. Through this process, she identified an interest in pursuing a career as a translator, teacher, or mortician (interestingly, all aspects of the role of shaman). Joining with the family by recognizing their cultural beliefs and customs. The workers made an increased effort to recognize the family’S beliefs and traditions. They began noticing and asking about pictures in the home that depicted extended-family celebrations. In addition, they expressed an interest in learning more about shamanism from Mai and her parents. Consequently, family members welcomed visits by the providers and appeared more open to input and suggestions aimed at managing Mai’S behavior. Building skills in emotions regulation. Mai was taught how to formulate and utilize coping statements (e.g., “I can find something positive to do when I am bored,” “I can control myself when I am mad,” and “I don’t need a boyfriend to be happy”). Social skills were also taught and practiced to prepare her for connection to age-appropriate social activities. Following this shift in strategy on the part of the behavior specialists, Mai made substantial progress. She learned how to access reading material at the public library and discovered a particularly strong interest in Hmong literature. Most importantly, she evidenced marked improvements in her behavior. Although Mai continued to leave the home at times without permission, incidents of self-harm diminished, and she displayed a newfound ability to control her aggression. When the providers neared completion of services, a Hmong-speaking staff member from their agency interviewed Mai and her parents with the intent to explore the extent to which they observed a change in the nature of service delivery subsequent to the implementation of cultural consultation. The family reported that the cultural consultant encouraged them to use the therapeutic services available, thereby granting implicit permission for them to accept help from members outside of their cultural community. Mai and her parents all noted that following the meetings with the cultural consultant, the primary workers appeared more open to  their culture and respectful of their customs. Mr. and Mrs. Khang also stated that, over time, the providers began encouraging them to use their cultural practices to help Mai decrease her dangerous behaviors. They recognized these workers for not giving up on them or their daughter and expressed their gratitude and appreciation for services rendered. and English), she much preferred speaking in Hmong. When communicating in English, she often had difficulty grasping certain concepts that were being relayed by the English speaker. Mai’S parents understood her target behaviors to be dysfunctional and wanted them to stop.

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