Running head: ETHICAL POLICY-MAKING EXERCISE

Ethical Policy-Making Exercise Jo Friesen University of Calgary

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The AIM Clinic (Assess, Intervene, eMpower) The AIM Clinic is a non-profit organization located in East Vancouver, in an underresourced neighbourhood that is ethnically and culturally diverse, with many low SES families. Our target clientele are children who are currently in elementary school; specifically those who are struggling academically, socially and/or behaviourally and whose support needs are not currently being met. In order to provide the best support for these children, by extension we also serve their families, the local schools and other community groups that have a vested interest in the child. Our clinic is located in the Commercial Drive area (close to transit) and offers private assessment rooms, a workshop and training room, a tutoring centre, an activity/interventions centre (including play room), interview rooms, an intake/waiting room, as well as secure storage rooms for files and tests. In certain situations, if location is a barrier to service, we are able to provide some of our services at alternate locations, including local schools, churches and community centres. Our Mission Statement The AIM Clinic works in under-resourced neighbourhoods, with elementary-aged children who are experiencing academic, social and/or behavioural challenges at school and in need of additional support. We provide psycho-educational assessments, a wide variety of interventions, and training workshops in order to help children, their parents and school personnel to understand the true nature of each childs challenges, to develop strong, effective systems of support and to empower children to reach their full potential. Our Purpose and History After working in the East Vancouver neighbourhood for many years, it became evident that there is a need for consolidated support services to support children and families during elementary school. Due to a lack of funding and staffing, local schools are unable to keep up with the demand for assessment and specialized educational services, and only the most desperate cases receive the support they need. Additionally, due to language barriers, cultural differences and the fact that

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many parents do not know what they could or should be advocating for on behalf of their child, few families know how to find or navigate through potential outside resources for their child. In many cases, finances is also a barrier to service, as many families cannot afford private assessment and may not be able to take the time off work transport their child to another part of the city. In some cases, children do not have anyone willing or able to advocate for them. The AIM Clinic seeks to address these community needs by standing in the gap, and not only offering necessary services, but co-ordinating existing services, teaching parents about available services and advocating for access to services for all children through community outreach and education programs. Our Services The AIM Clinic offers a variety of services in order to fulfill our organizational purpose. First, we offer Psychological and Educational Assessments for children who have been referred to us by their parents, their school, their doctor or another community organization. We also offer follow up services for children who are referred, but whose parent/guardian does not follow through. Second, we offer a variety of Academic, Behavioural and Social Interventions designed to support children with identified learning disabilities, behavioural problems or social difficulties. We offer both one-on-one and small group interventions, activities and counselling. Third, we offer community Workshops, designed to help educate parents, school personnel and community agency personnel on issues surrounding academic, social and behavioural challenges children face. Topics range from practical (how to provide tutoring support to a child with dyslexia, how to apply for funding for a private assessment, how to develop good family school support habits) to theoretical (understanding learning disabilities, understanding why a child needs an advocate, what rights parents have, what schools and families can do to support one another). Finally, we offer

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Networking and Referral Services. At the AIM Clinic, we strive for excellence in what we do, which means we need to limit our services to our areas of competence and refrain from duplicating what others are already doing well in the community (CCE II.18). However, as we have recognized that one area of need is helping parents to navigate what services are available and how to access them, we do provide services to help parents make those links and access other services. We are able to offer assessment services in English, French and Cantonese, and make referrals if assessments are needed in other languages. Our intervention services are offered only in English and French (so as to be applicable to our local school systems). We are able to accommodate ESL students into all of our intervention services, however we do not offer specific ESL tutoring. If an ESL student has no other identified academic, behavioural or social concerns, we refer them to other community ESL tutoring programs. Translators are available when needed for additional communication with parents in regards to the nature of our services and in obtaining informed consent. The services we offer can be combined so that a family is taking advantage of the fullrange of services, or families can choose to only participate in one area. For instance, when offering workshops, any parent is welcome to attend, not only those who have signed their child up for other services in the agency. Likewise, parents who have an assessment done on their child are under no obligation to avail themselves of our tutoring service. While we do encourage parents to choose the range of services that will maximize the benefits to their child, we also recognize that requiring parents to take all or nothing would mean that some children would be unfairly left out of services they may need, whether it be to financial constraints, cultural differences or even parental motivation. Our Team

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Our team at the AIM Clinic consists of a group of individuals dedicated to our organizational mission statement and passionate about empowering children. Our team includes:

Psychologists, who provide assessment and counselling services, as well as oversee intervention services. Our Chief Psychologist is responsible to co-ordinate and oversee the distribution of clients, maintain the security of their records and manage all grievances.

Community Outreach Staff, social workers who bridge the gap between the child and our programs by working within the community, schools and directly with families to remove as many barriers as possible to a child receiving necessary services.

Intervention Support Staff, who work under supervision of the psychologists to assist with interventions

Workshop Co-ordinator Networking & Referral Consultant Administrative Staff take care of tasks related to office management, including accounting, maintenance, communications, scheduling, and fund-raising

Our Policies and Procedures The AIM Clinic seeks to operate ethically, responsibly, competently and effectively in all areas of our organization. While not all of our staff members are Psychologists, as an agency offering Psychological services, we have based our policies and procedures on the Canadian Code of Ethics for Psychologists (CPA, 2000) and Practice Guidelines for Providers of Psychological Services (Sinclair & Pettifor, 2001), as well as ethical and sound business principles. We recognize our responsibility to communicate these procedures clearly to all team members and to those who use our services. Responsible Provision of Services

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It is the overall responsibility of the Chief Psychologist to ensure there is responsible provision of services throughout our agency (CCE II. 50). It is important to ensure we are caring for one another on our team, and for each of our clients responsibly (CCE II.49). Responsible care for the team involves encouraging, modeling and promoting good self-care habits (CCE II.12), managing conflict effectively, providing opportunities for professional growth and development, maintaining an effective workplace environment, promoting equality, and developing healthy, collaborative relationships among team members (Sinclair & Pettifor, 2001). Responsible care for our clients includes ensuring we are cultural sensitive and that our services account for individual and cultural differences (CCE II.14). The AIM Clinic provides flexible and individualized service delivery in order to meet these needs, as well as offering staff training when necessary, hiring staff with consideration of diversity. We are also committed to a timely delivery of services, recognizing that a delay in services can both continue to harm a child and may result in less follow through from some families. Depending on the nature of the referral, standards for delivery are set during the initial consultation with the family and both the AIM Clinic and the family are expected to adhere to those standards. We provide regular review and evaluation of services, and amend or terminate services if it is in the best interest of the child or if the child is no longer gaining any benefit from our services (CCE II.37). We work as a team to co-ordinate our in house services (CCE II.18, II.20), make necessary outside referrals to other agencies and professionals, (CCE II.21, II.31) and ensure that our interventions are not only empirically-supported, but relevant to the individual client (CCE II.21). This is done through weekly team meetings, one-on-one consultation with other team members and in co-ordination with families and other outside parties, such as the childs school. Our goal is to

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create the best possible support system for each individual child, and we recognize that each participant in the childs life has a role to play, and strengths and abilities they can offer the child. If another professional or agency is better equipped to provide a service, or if a client needs a service that we are not competent to provide, we will make necessary referrals, offer support for follow through, and provide follow up accountability (Sinclair & Pettifor, 2001). Confidentiality One of the most vital aspects of our services is that we pro-actively protect and safeguard the confidentiality of our clients. The level of confidentiality that is ethically expected and legally required varies depending on the nature of the services the client is coming to the AIM Clinic for. In regards to our psycho-educational assessments and the directly related intervention services, we require strict confidentiality that meets all the requirements of the CCE (I.37-44). This includes how we manage our record keeping system, what information we collect, who we share that information with and how we communicate the process with parents of our clients. Since we are working in a collaborative, team environment, we will need to develop and communicate strict, detailed guidelines regarding access, and ensure we have communicated those clearly during the informed consent process. This will also require us to manage and organize our files carefully, in order to ensure that access guidelines are not accidently or carelessly breached.

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Informed Consent Informed consent is both ethically and legally required for all provision of services at the AIM Clinic. Since all of our clients are minors, this requires us to obtain informed consent from both the parents/guardians and from the child (CCE I.8, CCE I.16). Part of our mandate as an organization is to empower children to reach their full potential, and we believe that is done not through force, but through co-operation. This means that if a child is opposed to participating in our services, we will not allow or require them to, though our team may attempt to carefully persuade them through developing rapport, restructuring services to fit the child better and helping a child to understand the full benefit. At the AIM Clinic, informed consent involves honestly and accurately communicating the purpose and nature of all activities, clearly defining responsibilities, outlining privacy/confidentiality protections and limitations, the risks and benefits of services, and of nonaction, and any alternatives. It also involves ensuring the client and parent knows they can rescind consent at any time (and how to do so), what services and time frame the consent covers and that they always have the option to refuse or withdraw from an individual activity (CCE 1.24). During this process, we also communicate who will be working with their child, what information they will have access to and clarify any 3rd-party access to records, including collaboration with the childs school (CCE 1.26). For our less formal services, such as our tutoring, workshops and referral services, the informed consent process still takes place, but in a modified format to cover the specifics of those services. Due to the diversity of the neighbourhood in which we work, we recognize the need for translation services for some families. The AIM Clinic has developed a network of respected volunteer translators that are able to assist with the informed consent process. If a translator is used

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for the informed consent process, part of the consent we obtain also includes that the family be willing to use the same translator to discuss assessment and intervention with us. Competence At the AIM Clinic, it is important that we are practicing within limits of our competence, both organizationally and as individual members of the team. To ensure this is happening, we require all team members to participate in continuing professional development (CCE II.15). The parameters of this vary from role to role, but include continuing education, regular evaluation and assessment of competence, cultural awareness training, and supervision (CCE IV.4, IV.8, IV.9, IV.15). The services we offer require a wide variety of competence, so it is important that we have a system in place to ensure that we are clear about who is able to provide what services and that it is not acceptable to delegate roles to people who are not competent (CCE II.6, II.7). Providing competent services for our clients also involves our team ensuring that we are culturally sensitive, that our access to services is fair and unbiased, and that we seek to educate ourselves in any areas of need that arise where we are lacking. Before offering any new services, whether interventions or workshops, we conduct pilot studies in order to determine their efficacy before offering to the community (CCE II.15), as it is important that we are actually meeting the needs in our community. Boundaries In any helping relationship it is important that client/counsellor boundaries are clear and unambiguous (Sinclair & Pettifor, 2001). For the AIM Clinic this means establishing and communicating clear boundaries in regards to our interactions with each child and their families, including safeguards to protect both clients and team members from physical, emotional or sexual harm or accusations of harm (CCE II.28).

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It is also important that we have clear job descriptions and accountability for responsibility. Using a team approach to working with clients means it is vital that all aspects of client care are accounted for and no assumptions are made that someone else is taking care of something. Everything from gaining informed consent, to scheduling, to fee collection, to referrals, to follow up is documented and assigned to individual team members. This information is also communicated to parents. Communication All communication with clients and their parents at the AIM clinic should be clear, complete and objective (CCE III.11). It is important for team members to acknowledge any limitations, accurately represent their credentials and skills, and be honest and straightforward regarding the nature of the services that are offered (CCE II. 18, III.8, III. 3, III.5). Communication in regards to advertising our services must be clear and honest, and reflect sound research findings (Sinclair & Pettifor, 2001), and we must at all times use language that conveys respect (CCE I.3). The AIM Clinic also has a system in place for dealing quickly and honestly with grievances, both within the agency, and with clients, parents and outside parties. This system is overseen by the Chief Psychologist and includes guarding against multiple relationships, acknowledging and working through biases, creating respectful working relationships and using the Code to resolve ethical dilemmas (CCE III.31-36, Sinclair & Pettifor, 2001). Record Keeping Keeping complete, accurate records is both ethically mandated and necessary for the competent delivery of services. The AIM Clinic has clear parameters in regards to the content that team members are required to record, in keeping with the CCE (I.37, 39, 41, 42, II. 19, 22, 30). The collection, storage and access of files needs to adhere to all privacy and confidentiality

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requirements, and must ensure that records are secure and safeguarded against loss or unauthorized release. At the AIM Clinic, we have locked file storage room, records themselves are locked in controlled cabinets, and only necessary team members have access to the necessary sections of the each file. Access to files is overseen by the Chief Psychologist, and takes into account decisions made with families during the informed consent process. The back-up system consists of an encrypted, electronic back up that is stored in a secure facility off-site, along with vital paper duplicates. Fee Structure The AIM Clinic seeks to provide services for all children, which includes being pro-active to remove known barriers to service, such as the cost of such services. Therefore, the AIM Clinic offers sliding scales of fees to its clients based on ability to pay and other considerations. In order to do this, and still provide fair compensation for our team members, we rely on grant and private donations to the Clinic, and all team members donate some portion of their time and services, consistent with CCE IV.12. During the intake process, the fee requirements are communicated in a straightforward manner and families are encouraged to seek alternative sources of funding as well, including extended family support, insurance and community grants.

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References Canadian Psychological Association. (2000) Canadian Code of Ethics for Psychologists (3rd ed). Ottawa, ON: Author. Sinclair, C., & Pettifor, J. (2001). Companion manual to the Canadian code of ethics for Psychologists, Third Edition. Ottawa, ON. Canadian Psychological Association.