Week 3 Homework Assignment (Ethical Issues in Clinical Supervision)

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  • #4532
    Patricia Burke
    Keymaster

    The following is a scenario of a supervisor/clinician working in an outpatient substance abuse and mental health treatment program. After reading the vignette answer the questions which are, once again, based on Reamer’s systematic method of ethical decision making.

    Vignette

    Steve is a Licensed Clinical Social Worker who was promoted to the position of clinical supervisor six months ago after receiving his license as a Certified Clinical Supervisor. Since the program is a small satellite of a larger agency, Steve is the only clinical supervisor available to supervise the clinical team of which he used to be a peer member. John is also an LCSW and has been working as an outpatient therapist on this same team for the past five years. John is a recovering drug addict. He became addicted to narcotic pain medication after a back operation. He has been clean and sober six years.

    Steve and John have become friends over the years and socialize with each other and their families at picnics, parties and some holiday events. Steve has had several conversations with John about the change in their professional relationship and potential conflicts that might arise. They both agreed that they could maintain their friendship and keep it separate from work.

    Over the past two months there has been an influx of clients into the program with trauma histories who suffer from complex PTSD and multiple substance abuse issues. John has had extensive training and experience in treating people with trauma and addictions so Steve has assigned most of these new clients to him. During recent supervision sessions Steve has noticed that John is resistant to talking about clinical issues and mostly complains about the piles of paperwork he has had to do since APS took over MaineCare reimbursements to the agency. Steve has also noticed that John has become argumentative with support staff, hyper-vigilant and suspicious of other clinicians, and very defensive when Steve asks him to discuss specific clients in supervision. Steve also overheard him being angry with a client who cancelled an appointment. Several staff have mentioned their concerns about John to Steve.

    Yesterday Steve thought he smelled alcohol on John’s breath in the morning when he came into work. When Steve mentioned this to John, John admitted that he put a shot of whiskey in his coffee. He asked Steve to overlook the incident because they were friends and promised Steve that it would never happen again.

    You are a clinical supervisor in another program at the agency. Steve calls you up to consult on the situation with John. Answer the following questions based on Reamer’s Ethical Decision-Making Process in order to help him develop an ethically sound course of action in this complex clinical supervision scenario.


    Homework Questions

    Question 1

    Who are the parties that will be impacted by whatever course of action is chosen?

    Question 2

    What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?

    Questions 3 & 4

    What are all the viable courses of action and the possible benefits and risks for each?

    Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.

    Question 5

    Who should the clinical supervisor (Steve), consult regarding this scenario and why?

    Question 6

    What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?

    Question 7

    How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?


    To post your assignment, please reply to this topic below.

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    #16639
    CHELSEA SPEAR
    Participant

    Question 1

    -John
    -john’s clients
    -Steve
    -Other staff members at the agency

    Question 2

    -Steve’s ethical duty to address colleagues’ and/or supervisees’ impairment in order to ensure clients are not harmed

    -john’s right to privacy

    Questions 3 & 4

    1. Steve could do as John asked and say nothing.
    Pros- It might preserve friendship
    Cons- high risk of leading to further impairment and clients being harmed
    John not getting the help he needs

    2. Steve could have a direct conversation with John about his concerns and urge him to get help
    Pros- might lower John’s defensiveness and increase likelihood to get the help he needs
    Cons- This could be seen as Steve not handling the situation seriously enough and violating NASW code of ethics

    3. Steve could involve Human Resources as needed and urge John to take a leave to get help
    Pros- clients will be protected
    John might get help he needs
    Follows ethical codes
    Cons- could easily end working and personal relationship between the two

    Question 5

    -his own supervisor
    -Human Resources
    -board if needed (if John continues behavior)
    -peers

    Question 6

    Third option- sit down with John and HR. John didn’t respond well to Steve’s first attempts to handle the situation and it is clear in order to do ethical duty of assessing clinician impairment, a higher level of intervention is needed

    Question 7

    He should document all noted concerns from staff and himself, document the incident where Steve was drinking on the job and his subsequent reaction, and document all supervision he receives on the matter.
    Steve should have a witness to the conversation he has with Steve and should have follow up meetings to ensure needed plan is in being followed

    #16658

    1. Parties impacted
    John (the supervisee), Steve (the supervisor), their satellite agency peer team, their families, John’s clients, the larger agency administrative staff including Steve’s clinical supervisor of his supervision.

    2. Ethical Issues
    There are multiple boundary issues that Steve and John are dealing with in this situation. Steve worked to minimize these possible pitfalls in discussing their dual relationship up front within their new relationship. It may have also been helpful to advocate for supervising in another office to minimize dual relationships.
    Doing no harm to the client is another important ethical consideration. John’s heavy caseload seems to be increasing his stress responses to his clients and others around him.
    Self-care is another ethical consideration when looking at John’s high risk of vicarious traumatization leading to relapse. All parties may be impacted by his unhealthy self-care choices. Steve may also be struggling with self-care due to his dual relationship.

    3&4. Viable courses of action, include benefits and risks
    a. Meet with John to address his client load/stress issues and caseload management.
    Benefits for John: helps him address work stress and possibly move toward his own self-care.
    Risk for John: has to be self-motivated, doesn’t address relapse and therefore may affect friendship and further clinical work.
    Benefits for Steve: helps his supervisee, avoids difficult conversation
    Risks for Steve: avoiding issue reinforces maladaptive coping skills from Co-occurring patterns, no accountability for John’s actions, risk of Steve’s own professionalism and job if John continues drinking.
    Benefits/risks for the clients/agency: continued compromised clinical care and legality issues.
    b. Meet with John to address his relapse at work, including creating a restorative, corrective plan including being transparent about agency rules. Plan includes consequences of continuing behavior.
    Benefits to John: clarity about agency regulations, supportive plan
    Risks to John: no focus on the increased stressors or other personal self-care, may feel friendship is compromised.
    Benefits to Steve: clarity about agency regulations
    Risks to Steve: may feel punitive, compromised friendship, feeling torn about his dual roles. Client care may also be compromised in the long run if John’s client care is not addressed.
    c. Hold John’s confidence while increasing support for his heavy load and plan for self-care.
    Benefits for John: gives him another chance to get back on track personally, preserves the friendship, helps support his work stress for restoration.
    Risk for John: at higher risk toward getting fired due to not knowing the agencies guidelines, easier to hide problem and not address root causes.
    Benefits for Steve: hopeful to preserve friendship and still help him as a supervisee.
    Risks for Steve: torn between friendship and clinical obligations
    Risks for the clients/agency: compromised clinical care and legality issues.
    d. Steve transfers to another satellite agency
    Risks for John: continued risk of relapse, compromised clinical care and possible consequences in the future
    Benefits for Steve: avoidance of losing his friendship, decreased further dual relationships
    Risk for Steve: decrease in self-efficacy for not addressing the issue directly, decreased confidence from co-workers and within the agency.
    e. Fire John directly.
    Multiple Risks for all parties including client and co-worker loss of a clinician/team member, loss of friendship, unethical treatment of an employee, agency not supporting John in his recovery, as is their mission as a co-occurring treatment center, etc.

    5. Consultation and why?
    It is good that Steve consulted within agency, due to their specialty. Consultation can help Steve determine his professional plan of action to support John’s clients AND John, but also to help himself balance his own self-care and recovery progress.

    6. Best possible course of action
    I would say a combination of a and b above. Steve can meet with the client to address all issues: compromised clinical care, supervisee’s compromised self-care and relapse, a plan of corrective action and clear consequences if these are not addressed. Steve would continue supervision of supervision (or consultation) to manage his own professional ethical work with this supervisee as well as his own self-care.

    7. Implementation, documentation of the decision making process and monitor/evaluate effects of the decision?
    Implementation of the meeting is done with immediacy. Steve will communicate his concern for John professionally and personally. Focus of the supervision will be on John’s self-care, management of his caseload and restorative planning for ethical, clinical client care. Steve will be upfront with John about documenting this supervision as well as having John sign any restorative plan created in the meeting. The plan will also include the awareness of possible consequences if John continues to drink at work. Self-care planning will be discussed and may include Steve discussing possible further supportive referrals for John (AA meetings, his own counseling, etc.) Steve may offer to increase supervision to weekly for a short period of time (agency work can be group focused, bi-weekly or monthly) to make sure John feels supported in his work at the agency. All actions will be documented.
    Steve may also bring up their dual relationship again, stressing supports and also being clear about boundaries.
    Steve may decide to increase his own supervision of supervision for his own self-care, as well as his own outside supports.

    #16672
    bethandrews.hope
    Participant

    Question 1
    Who are the parties that will be impacted by whatever course of action is chosen? John, Steve, John’s clients, other clinicians
    Question 2
    What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
    Potential conflict because Steve and John were already friends. It appears they were both aware of this and took steps to mitigate before any problems arose. Steve’s inexperience as a supervisor may have lent to his conviction this could be a safe scenario.
    John could have felt overwhelmed by the high-needs case load he was being assigned, and if so, he had an ethical responsibility to speak up and let Steve know he was struggling with this. He may not have felt he could speak up, since he and Steve are friends, and Steve is new to the job. Perhaps John didn’t want Steve to feel badly, but in so doing, compromised his own recovery.
    Steve may not have stopped to think about whether or not he was overloading John, and ethically had a responsibility to be checking in with John on a regular basis to make certain he was feeling his caseload was manageable. Again, it appears assumptions were made that the other man would have shared concerns as they arose, but neither did so, perhaps because of their friendship and not wanting to introduce conflict into it.
    John did not handle his stress well when he started sharing his specific frustrations and general dissatisfaction inappropriately with other clinicians. Ethically, his first stop should have been checking in with himself and asking himself what he needed to maintain his professional stance, and take care of himself. He should also have told his supervisor that he needed more support, and perhaps ask for some client reassignments or a more balanced caseload going forward.
    John attempted to use their friendship to manipulate Steve into ignoring his relapse, as well as his other unprofessional behavior.

    Questions 3 & 4
    What are all the viable courses of action and the possible benefits and risks for each?
    Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.
    1) Steve does as John requests, and ignores his “slip,” based on their friendship, and tries to believe it was a one time incident. Pros: I see none. Cons: John is actively relapsing, due, at least in part, to acute work-related stress. Doing nothing would only further compromise John and his clients, put the agency and everyone involved at risk. John has an ethical responsibility to take care of himself, so as to do no harm at work. Self-care is a critical component of providing healthy care to others. Steve would not being carrying out his responsibilities as the one tasked with keeping the satellite office safe and a therapeutic environment for clients and staff. He would be role-modeling some unhealthy behaviors of his own.
    2) Steve meets with John, shares his concerns and they collaborate on a course of action. Steve, having consulted with me, would already have his preferred plan of action prepared, but would be open to hearing John’s thoughts as well, as it would be best if John has some ownership and self-determination in the process. One can assume that John has been informed of his rights and responsibilities as a clinician at the agency (informed consent, agency practice regarding disciplinary issues)
    a. John acknowledges his relapse and takes a leave of absence to take care of himself. He gets himself on a healthier track, and is eventually able to return to work, under closely supervised and pre-determined conditions. His clients are reassigned to other agency clinicians. Steve is able to provide continuity for John’s clients, create a safe working environment, perhaps preserve his friendship.
    b. John does not acknowledge his relapse, remains defensive and does not admit to needing to focus on self-care. Steve then insists John must take time off to get sober/healthy, because ethically John is not able to work effectively at this time. John’s willingness or lack thereof may determine how or if he is able to return to work eventually. Steve’s first responsibility must be to the clients, which means John will need to demonstrate that he has found ways to better manage the vicarious trauma he was experiencing.
    c. Lowest priority in the hierarchy is preserving their friendship, and ethically speaking, can not be a determining factor in the decisions made.
    d. There is likely a report that must be made to the licensing body. This is another ethical dilemma and one that Steve and myself must decide how to handle. It is hoped that there is a progressive disciplinary plan of action laid out that we can follow.
    Question 5
    Who should the clinical supervisor (Steve), consult regarding this scenario and why? Steve should be consulting his supervisor and possibly his Human Resources department. If there is a legal department, they should probably be involved as well. This is to protect the agency, Steve and John.
    Question 6
    What is the best possible course of action for a clinical supervisor (Steve) to take in this situation? If it is possible, I believe the best course of action is to know ahead of time what the bottom-line expectations are (likely that John takes/is given time off to take care of himself and manage his own struggles), and meet with John to discuss. Best case would be that John chooses this course of action, as he then will feel like he has already started making better choices for himself, and he may face less punitive responses from the agency for taking responsibility. He could perhaps be given the chance to meet with his clients (with Steve present) to explain that he is taking time off for his own self-care (no specific personal information need be given, and the extent of this could be pre-planned), which provides healthy role-modeling for his clients. Steve can then reassign clients with sensitivity to the experience they have just been through and support both the client and the new clinician to work through how to discuss the change without violating John’s confidentiality.
    Question 7
    How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision? Implementations will be different depending on whether or John agrees with the decision being made. If he is on board, it could go as described above. If he is not on board, it would not be beneficial to clients to have John meet with them to transfer to new clinician. Steve would have to do this without John. Either way, if John does take the time off and take care of himself, it will be up to Steve to communicate the expectations that will be in place for John to return to work, and what could happen if these conditions are not followed. Informed consent would be important. Steve must document all conversations he has with John, concerned staff (or clients), myself (Steve’s supervisor), HR, legal. Before John goes on leave, Steve would be well-advised to let John know that the friendship must now take a backseat to the needs of the agency, and that subsequent contact will be for the business of making sure John is effectively working towards coming back to work, rather than for maintaining their friendship.

    #16673
    melissa cormier
    Participant

    Question 1
    Who are the parties that will be impacted by whatever course of action is chosen?
    John, the agency that John and Steve work for, Steve, John’s direct clients, John and Steve’s families, other clients in the agency when John is working, other co-workers

    Question 2
    What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?

    Practicing counseling while intoxicated is at the heart of the conflict. There is also a need to help John get the support he needs from his supervisor. There may be possible burn out, and/or secondary/vicarious trauma going on for John based on his heavy caseload. John’s clients are also being impacted by his change in demeanor. It is unclear why the change has occurred, and the only clue is smelling alcohol on John’s breath.

    Questions 3 & 4
    What are all the viable courses of action and the possible benefits and risks for each?

    Steve does not follow up with John and hopes that it doesn’t happen again. This is risky for John, the agency, and the clients. This would possibly preserve John and Steve’s friendship, however. This will but the agency at great risk if something happens to John at work due to his drinking or with one of his clients and it came out that Steve knew about the problem but did not address it. This would put Steve’s license at risk.

    Steve follows up with John and asks to talk about how John is doing overall. They could discuss self-care strategies, and make a plan for what John needs to return to work. This strategy may preserve the friendship if Steve is able to approach John in a non-threatening and compassionate way. Based on their friendship, this may work if they have a solid relationship. A con is if John is unwilling to acknowledge what is going on for him, it puts John in a position where he may need to make a difficult decision that is in the best interest of the clients and the agency. The ethical standard of do no harm to clients I feel is the primary driver of this decision.

    Steve could fire John for showing up at work intoxicated. This will damage the friendship and impact client/counselor relationship because the relationship would end abruptly. The agency would be protected.

    Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.

    Question 5
    Who should the clinical supervisor (Steve), consult regarding this scenario and why?

    I would get peer consultation as Steve did in this situation. I would also consult with Legal to make sure we are acting in a way that is in accordance with the law. I would also consult the board if I felt I was stuck and unsure of where to go.

    Question 6
    What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?

    I would send John home for the day and ask to meet with him the following day when he was not intoxicated. I would discuss my worry for him, the value he brings to the agency and talk about what he might need in the way of self-care and work modifications in order to feel healthy again. If John was unwilling to discuss this with me, I would consult with legal and I am guessing would be given guidance to move towards a disciplinary process with documentation of expectations for work for John.

    Question 7
    How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?

    I would keep a written log of who I talked to, what the direction was and a timeline for implementation. When I met with John I would also document our conversation and have him sign the notes at the end so we are both in agreement of the plan moving forward. I would have frequent, regular, and documented check-ins with JOhn for a specific amount of time. If John decides to take time off, we would discuss his cases and appropriate coverage while he is out. We would also discuss messaging he is comfortable sharing with his co-workers and clients. This plan would be documented in writing.

    #16674
    dsinskie
    Participant

    Question 1
    Who are the parties that will be impacted by whatever course of action is chosen?
    Steve, John, other staff, the agency and clients of the agency.
    Question 2
    What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
    1. Dual relationships between Steve and John
    2. John’s impairment
    3. John is vicariously traumatized and burning out
    4. Steve’s supervisory competence
    Questions 3 & 4
    What are all the viable courses of action and the possible benefits and risks for each?
    Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.
    1. Do nothing – Pros-Steve wont have to make a decision and confront his friend. Cons – the agency is at risk, clients not getting appropriate treatment, alienation of other staff, john continues to use and doesn’t get help, john continues to burnout
    2. Bring John in for a discussion about his alcohol use and offer assistance. Pros – John gets help, Steve has addressed the issues, clients and agency may not be at risk, Cons – John and Steve’s relationship suffers, John goes to agency and says Steve is a hostile and incompetent supervisor.
    3. Steve goes to the agency director and reports John. Pros – the situation is managed, agency and clients protected, Cons – Steve doesn’t directly address the situation, john is fired, john relapses further, Steve continues to supervise without being aware of what happened.
    Question 5
    Who should the clinical supervisor (Steve), consult regarding this scenario and why?
    Steve should consult another (or more than one) supervisor with more experience than he has. Steve is a new supervisor and there are a lot of things that he hasn’t experienced yet. He can learn from the other supervisor (s) for the next time that something like this occurs. Also, by seeking consultation, he is mitigating the liability if anything happens.
    Question 6
    What is the best possible course of action for a clinical supervisor (Steve) to take in this situation? Steve would be wise to refer John to another supervisor. He is too close to the situation and friends with John. Also his lack of experience may be a contributing factor. Steve doesn’t know what he doesn’t know.
    Question 7
    How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
    Steve should discuss this with the supervisor he wants to refer John to. Then he should meet with John to advise him of the change and why. This should be well documented in the ethical decision framework model. Steve could then monitor the effect this change had on staff and clients as well as himself. If John and Steve remain friends, Steve may see a positive change in John.

    #16675
    Sindee Gozansky
    Participant

    Question 1
    Who are the parties that will be impacted by whatever course of action is chosen?
    John, Steve, clients of John, clinicians at the agency, friends and family of John and Steve
    Question 2
    What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
    Dual relationship of friendship and supervisory relationship between John and Steve
    Agency/Mainecare requirements with large volume of documentation for John’s caseload versus ability to focus on client clinical care and potential competing interests of agency requiring completion of documentation with delivery of client care
    Competency of John as counselor due to potential impairment from drinking
    Agency mission to promote recovery for clients and how would that also be extended to John as a provider to be aligned with agency mission but competing with counselor requirements to not be impaired on the job
    Vicarious trauma impact on John affecting his work, mental health and recovery, and whether agency has an obligation given the large high trauma caseload they assigned him
    Questions 3 & 4
    What are all the viable courses of action and the possible benefits and risks for each?
    Please include the pros and cons of each course of action based on relevant codes of ethics, laws, agency policies, licensing board regulations, reasonable and customary clinical supervision theory and practice, and personal values including religious, cultural, ethical and political ideology.
    1) Steve could talk to John about developing an action plan with disciplinary results if changes don’t occur. It might involve things like leave of absence to resume recovery and self-care and obtain treatment as needed, monitoring return and work performance, staff interaction, etc. I’d assume it really would have to involve HR. Pros are that John may get help and not lose job, cons are that he may feel singled out and exposed to his peers/colleagues at the agency, may interrupt client care. Cons are that it also may be difficult to monitor this kind of plan.
    2) Steve could take more severe action and report John to licensing board, terminate him. Pros may be that he follows strict agency rules, cons are that John does not get a chance to rehabilitate, loses friendship and trust with Steve.
    3) I can’t really imagine Steve not doing anything as a supervisor and friend. I know that’s simply put, but it would not serve either of them well. If Steve cares about John as a friend, he would want to see him get help for burnout, relapse, etc., and come up with a plan that may allow for John to keep his job with appropriate rehab, and ultimately John would see the position in which he place Steve and make amends about that as well.
    Question 5
    Who should the clinical supervisor (Steve), consult regarding this scenario and why?
    Steve should seek supervision of supervision with another supervisor and also consult with someone at his agency. He could consult with his professional organization as well; for instance, the ACA will offer ethical and legal consultation.
    Question 6
    What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?
    My opinion is Steve should meet with John again when he is not impaired, come up with a probationary plan that would include some time off, reduced PTSD caseload, and some form of monitoring or check in to ensure he is performing unimpaired. Another consideration would be whether Steve should continue to supervise John going forward, given their friendship and dual relationship, and to consider whether this is in the best interest of John’s mental health/recovery/work performance. That should be a conversation between John and Steve at some point, if there is even another supervisor available. The relational repair that could happen I think would be far better than transferring to a different supervisor, but it is still a course of action potentially.
    Question 7
    How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision?
    Steve should document all meetings he has with John, other supervisors, agency staff around this issue. If they make a plan of rehab or treatment, documentation may be required from John to Steve of attendance or completion. More frequent check-ins if Steve continues to supervise John would be important as part of monitoring/evaluation.

    #16679
    Esther Cyr
    Participant

    1. Who are the parties that will be impacted by whatever course of action is chosen?
    Steve, John, Clients, Other clinicians at the agency

    2. What are the ethical issues involved in this scenario, including conflicting and competing values of the parties involved?
    Dual Relationship/Impairment of colleague/Ethical responsibility to client.

    3. and 4. What are the viable courses of action and the possible benefits and risks of each?
    a. Dual relationship role with Steve and John. Steve speak of John about the current issues as connected to the dual relationship role and how this has impacted current situation. Benefits: address blurred boundaries and create a corrective plan. Risks: John does not link current issues to the dual relationship roles and issues cannot be resolved between colleagues.
    b. Impairment of clinician at work. Benefits: Steve could discuss John’s caseload at work, reason he assigned the co-occurring clients to him. Discuss how the number assigned to him has impacted his practice and ability to function ethically. Addressing what has prevented John from discussing issues within supervision. Develop a plan of action to address impaired behaviors. Risks: John is not responsive to address his behaviors, concerns, ethical dilemma’s with Steve. Issue/impairment plan is not developed which means Steve would have to take other steps such as reporting to the Social Work State Board. Steve would follow agency policies on reprimanding the clinician. Clients may have to be reassigned if John is unable to meet his clinical responsibilities.
    5. Who should the clinical supervisor (Steve), consult regarding this scenario and why?
    Steve would consult with a clinical Director or CEO of the agency he works for regarding ethical dilemma’s. Steve would have to address the clinician’s impairment and impact on clients and office staff.
    6. What is the best possible course of action for a clinical supervisor (Steve) to take in this situation?
    Steve would address the dual relationship role, how it has impacted the current situation, and seek to address John’s behaviors to reestablish an ethical working relationship with John. This would include the possibility that because of Steve and John’s personal relationship, it may not be possible at this point for Steve to supervise John.
    7. How should the clinical supervisor (Steve) implement the decision, document the decision making process, and monitor and evaluate the effects of the decision.
    Steve should implement his decision based on his consultation with a supervisor, direct supervision with John and the plan of action he has written. Documentation would have dates for each plan of action with follow-up plan to review progress. All of this should be in John’s employee record and part of his employee file. A human resource worker might be part of this implementation and follow-up depending on agency policy.

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