Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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8/15/23  1:36 pm
Commenter: Jess Linquist, Brain Injury Services

Potential Ethical Violations

I have ethical concerns related to the following Case Management Agency Requirement: "Guarantee that individuals have access to emergency assistance either directly or on-call 24 hours per day, seven days per week and holidays. This may be done via telephone and face-to-face contact and/or coordination with other providers and DBHDS administered crisis services."  I am also concerned with the requirement for face-to-face meetings.

As a Certified Rehabilitation Counselor through the CRCC, I am obligated to abide by the CRCC Code of Ethics. One of our guiding principles is "promoting empowerment through self-advocacy and self-determination." I am concerned that requiring non-medical, non-emergency service providers (i.e., non-profit organizations such as Brain Injury Services) to be available 24/7 does not align with this ethical principle, as it opens the possibility to boundary violations and dependency within client-counselor relationships. 

CRCC Code C.1.c states "EMPOWERING THE CLIENT. CRCs/CCRCs work to ensure the voice of the client is heard, valued, and given full consideration by supporting informed choice and client engagement in decision-making and treatment planning. CRCs/CCRCs foster self-advocacy skills of clients to achieve maximum independence."

Opening the door to potential boundary violations and dependency within relationships not only clashes with this ethical code, but also the mission of agencies like Brain Injury Services, where the goal is to empower clients to achieve independence. I am also concerned that requiring face-to-face contact works against this ethical code, as some clients either prefer to meet virtually or are unable to offer home visits due to safety concerns (i.e., domestic violence, pests, weakened immunity/susceptibility to illness). Given what we have learned from the COVID-19 pandemic about increasing accessibility, this feels like a step backwards for disability inclusivity and accessibility.

Justice is another foundational CRCC principle, which is defined by the as being "fair in the treatment of all clients; to provide appropriate services to all." By making ourselves available 24/7 to some clients but not others, my work would not be aligned with this principle. This could cause individuals like myself (CRCs, LCSWs, etc.) to risk losing our certifications and/or licenses. 

CommentID: 218712