The design and use of the Bioethics Consultation Form

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the Bioethics Consultation Form as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case.The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.     

An advocacy intervention program for women with abusive partners: Six-month follow-up

Presented the 6-month follow-up findings of an experimental intervention designed to provide postshelter advocacy services to women with abusive partners. The intervention involved randomly assigning half the research participants to receive the free services of an advocate, 4 to 6 hours per week, for the first 10 weeks postshelter. One hundred forty-one battered women were interviewed about their experiences immediately upon their exit from a domestic violence shelter: 95% of the sample were interviewed 10 weeks thereafter (postintervention), and 93% were successfully tracked and interviewed 6 months later. At the 6-month follow-up, participants in both groups reported increased social support, increased quality of life, less depression, less emotional attachment to their assailants, and an increased sense of personal power. Although women in both groups reported some decrease in physical abuse over time, there were no statistically significant differences between those with and those without advocates, and abuse continued to be a problem for many women. Those who were still involved with their assailants continued to experience higher levels of abuse and had been more economically dependent upon the men prior to entering the shelter. Women who had worked with advocates continued to report being more satisfied with their overall quality of life than did the women in the control group. The authors thank the Editor and anonymous reviewers for their helpful comments. Thanks also to all present and past staff of the Community Advocacy Project, who helped in data collection and analyses. This work was supported by National Institute of Mental Health Grant 1R01 MH 44849.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Citizen Advocacy Observed: Tool or Tokenism?

Citizen advocacy, where a volunteer works in partnership with a vulnerable person, compliments self- and legal advocacy. In the context of mental health services, citizen advocacy is a tool for enabling and empowering people who use these services, and is founded on the recognition that mental health service users are frequently socially oppressed and disadvantaged. This article describes the development of a Citizen Advocacy service for people with mental health difficulties, and also the problems they brought to this service. The problems encountered in sustaining the service are noted and lessons are drawn for the future.     

Introduction to the Special Issue

The authors introduce the special issue of the Journal of Counseling & Development on “Integrating the Multicultural and Social Justice Counseling Competencies Into Practice, Research, and Advocacy.” They first discuss the rationale and importance of the special issue, as well as the transformative opportunities that the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015) have to influence counseling and the broader helping professions. Then they provide an overview the special issue articles and their respective contributions. They conclude by explicating the challenges and opportunities in integrating and implementing the MSJCC into counseling practice, research, and advocacy.     

Client Advocacy and Collaboration with Insurance and Laboratory Testing Agencies: A Case Study Illustrating Genetic Counselor Roles

Genetic counseling and the many roles a genetic counselor must assume to provide quality genetic health care are becoming increasingly complex, especially when the genetic condition is rare, and DNA testing is costly and not yet routinely used. A case study of a couple with a family history of retinoblastoma and their pursuit of DNA testing for prenatal diagnosis is presented. The case study illustrates the instrumental role of the genetic counselor in advocating for clients for genetic services such as DNA testing and in educating insurance companies in the nature and importance of such services to achieve improved client health care outcomes.     

Feminist identity and program characteristics in the development of trainees’ social advocacy

Feminism, multiculturalism, and social justice (SJ) are closely related constructs, with an important shared emphasis on societal barriers and client empowerment. Yet, research on the relationships between the three variables in their links to counselor advocacy remains scarce. Employing the Input–Environment–Outcome framework, this study examined the unique contributions of 235 female trainees’ feminist identity, training environment SJ supports, and training multicultural focus in explaining trainees’ advocacy using a three-step hierarchical MMLR model. Findings revealed that all three factors were important to trainees’ advocacy. However, the extent to which each factor influenced advocacy varied. For instance, the more strongly identified trainees were with the Feminist Identity Active Commitment stage, the more likely they were to engage at all four levels of advocacy. Conversely, the more aligned trainees were with Passive Acceptance, the less likely they were to empower clients. Moreover, although both training environment SJ support and multicultural focus were influential, SJ training environment was a better predictor of trainee’s advocacy than multicultural training environment. These findings not only highlight the distinctions between SJ and multiculturalism, but also argue for the importance of SJ training in addition to multicultural training. Implications for theories, training, and practice are discussed.     

Advocacy in the study of religion\s

Abstract

This article introduces a thematic issue on advocacy in the study of religion\s. It reflects on some issues relating to instances of advocacy in the study of religion\s such as the importance of personal relationships, intervention on behalf of marginal and controversial religions, forms of and audiences for advocacy, its legitimation, and its relations to scholarly identity and the academy.     

Effective coordination in medical emergency teams: The moderating role of task type

Coordination in health care action teams is an important factor in clinical performance and patient safety. Implementing a high-fidelity in situ simulation study, we investigated the performance-relevant effects of task distribution, provide information without request (PIWR) and closed-loop communication (CLC) in 68 medical emergency teams (METs) composed of fully qualified clinicians. We differentiated between two task types: algorithm-driven and knowledge-driven tasks. We assigned two different emergency tasks to each task type. We proposed not only a direct relationship between the three coordination behaviours and clinical performance, but also a moderating role for the type of task. Only CLC was related to performance and also moderated by task type. There was no relationship between the coordination behaviours task distribution and PIWR and performance. We discuss the differential effects of the three coordination behaviours on performance and emphasize the importance of the task in team research. In particular, we highlight theoretical and practical implications.     

Advocacy,Political Participation,and Citizenship: Lutheran Contributions to Public Theology1

Abstract : Martin Luther never developed a political theory, but his theology does inform the way Christians live in society, making it both public and political. Luther's “two kingdom theory” often has been misinterpreted to justify passivity and obedience toward civil authorities. Under closer examination, however, his theology applies to the everyday practices of politics, economics, and religious affairs. In the context of nation‐building, a Lutheran theology fosters citizenship not only as individual rights and responsibilities, but as active participation in civil society.