45 Ethical Considerations

Excerpts from “Seeking Coherence”, Jerome R. Gardner, 1992

ETHICAL CONSIDERATIONS

The question of ethics in human services is unfortunately not always a priority consideration for the people involved. We cannot have failed our children so consistently over such a long period of time, and have considered very seriously or deeply the ethics of what we are doing. This article does not presume to present all of the ethical issues which might be considered in human services, but hopes to highlight the need for thought about ethics and how our decisions conscious or nonconscious impact our expectations, implementations and outcomes.

A basic premise of human services that it is helpful in ethical consideration is to consider all human services to be experiments with human subjects. In fact, a strong argument could be made through examination of how such services are organized and implemented, that this is exactly what occurs. From that premise, the basic ethical principals of the Belmont Report become an appropriate place to start.

BASIC ETHICAL PRINCIPLES

Because of the immense failure of human service interventions in the past and to help develop the parameters around which the helping agency, as a learning organization, might properly function, each individual intervention with a child needs to identify and abide by ethical principles. Such a focus will help to avoid such practices as destructive and on-going intervention in the future that we have experienced in the past. Through a direct movement towards constructivist learning theory interventions combined with a perspective of experimentation, which abides, as much as possible, to the ethical principles and guidelines designed for research involving human subjects, we can develop a context for rigorous analysis. The guidelines articulate three basic ethical principles generally accepted by our cultural tradition as particularly relevant:

Respect for Persons

This principle incorporates at least two ethical convictions: 1) that individuals should be treated as autonomous agents, and 2) that persons with diminished autonomy are entitled to protection. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect.

An autonomous person is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation. To respect autonomy is to give weight to autonomous persons’ considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others. To show lack of respect for an autonomous agent is to repudiate that person’s considered judgements, to deny an individual the freedom to act on those considered judgements, or to withhold information necessary to make a considered judgement.

Person centered planning which includes the deliberation and considerations of the child/family regarding ultimate decision-making in the development of the individual education plan are included in federal law and state education regulation.

A final consideration, which is both ethical and practical, is the informed consent of the child. Because we believe so strongly in the need for the child to participate proactively in the solution in order for it to be effective, an effective intervention will require that the child is engaged in a significant trust relationship in which the child authorizes both the outcome expectation [end, goal] and the intervention [means, process]. Such authorization avoids the coercion of models that “do things for the child’s own good” and ultimately help the child decide what is good. The inclusion of the child as a proactive participant does not simply reduce coercion, but in fact, improves the expectation of successful intervention through a salient “you’re OK” message. The measure of quality is that the child is able to function significantly better in a specific area of his/her life.

Beneficence

Persons are treated in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being. In this context, beneficence is understood as an obligation. Two general rules apply: 1) do no harm and 2) maximize possible benefits and minimize possible harms. The question of harm through lack of self-determination, failure of inclusion or focus on disability rather than competence are issues of concern to the educational process.

A construct of benefice that has both ethical and legal implications is the concept of a fiduciary relationship. Black’s Law Dictionary defines a fiduciary as “a person [or entity] having the duty created by his undertaking, to act primarily for another’s benefit in matters connected with such undertaking…. One is said to act in a fiduciary capacity when the business s/he transacts, or the money s/he handles, is not for his/her own benefit, but for the benefit of another person…” While normally a term used in financial circles, the conceptual basis is applicable and appropriate for human services including education, as it incorporates the second tenet of beneficence: “maximize possible benefits and minimize possible harms.” The responsibility to act on behalf of the student and for no other purpose has salient implications.

Justice

An injustice occurs when some benefit to which a person is entitled is denied without good reason or when some burden is imposed unduly. The concept of justice regarding “free and appropriate education” are vital components of federal law regarding education and the question of justice arises whenever a child is separated from a mainstream environment. The concept of justice in least restrictive environments is applicable to all human services, which equally have abrogated the personal rights of individuals through failure to consider the outcomes of present day usage. This failure will be reviewed more thoroughly in the section of organizational duties.

INDIVIDUAL DUTIES & RESPONSIBILITIES

Legal Duties

Duty to act for the good of others

There is legal aspect to the ethical responsibilities for fiduciary benefice. The chief legal duty of the staff is to exercise powers for the benefit of the individual client. Each event in the process of service delivery with each client must meet this test of personal benefit to the individual client. The test will clearly be most difficult at times of stress and therefore, it is advised that the organization develop a decision-making protocol to examine whether the fiduciary test is being met during such times.

Duty to act on the acts of others

Along with the duty to act for the personal benefit of the client, there is a requirement to protect this person from others. This requires that an individual staff person, when they see another individual acting in a manner that is contrary to the fiduciary responsibility and not for the good of the individual client, must take immediate steps to abate that action. Since the fiduciary responsibility is held by both the organization and the individuals who work for the organization, this is a contractual obligation that needs to define both levels of responsibility and duty. The organization must make it both the responsibility for implementation and corrective action easy for individual staff members through both policy and procedure.

Duty to not intrude or infringe

The person providing services to children, particularly through the use of public funds, assumes a different relationship to the child and a higher standard of legal duty. The affirmative duty to least restrictive alternative is one that is quite familiar to most who are involved in education. The implications of this duty are that government must pursue its ends in a manner that least intrudes or infringes upon individual rights. Since some of the methods of “medical necessity” are in fact intrusive and since the traditional response to children with problems in living is to remove them from the school situation, this duty is said more often than done. In fact, through the leadership of the medical and psychodynamic expert models, the implementation of the least restrictive environment concept has lead to cognitive errors which have allowed just the opposite to happen. Steven Taylor [1988], as we have indicated in Book II, indicates seven specific pitfalls that have allowed abuse to develop under the guise of “doing good”. As implemented, Taylor suggests and we concur and reiterate, and will expand later, the LRE principle:

ligitimatizes restrictive environments.
confuses segregation and integration on the one hand with intensity of services on the other.
is based on a “readiness model”.
supports the primacy of professional decision making.
sanctions infringements on people’s rights.
implies that people must move as they develop and change.
directs attention to physical settings rather than the services and supports people need to be integrated into the community.

None of these constructs is consistent with either the way human services say they operate nor with the way we would desire that they operate. Hence the duty to least restrictive alternative is one that needs rigorous analysis and monitoring. This responsibility, like many of the others, is of course both an individual and organizational one, and the detail will be taken up in the organizational format. However, each individual employee has a duty to assure least restrictive environments as a matter of law in carrying out their duties.

Ordinary Man Standards

Teachers and other staff members are usually held to a standard of diligence, skill and care of an ordinary man in a like situation. This is a vague enough standard to make it necessary to decide practically every event on it’s own merits. Despite the fact that staff may be paid or voluntary, or that they are adequately or inadequately trained, this does not justify actions which are careless or of gross stupidity. Incompetence is, in and of itself, no cause for him/her to be held personally liable for any losses caused by this inadequacy. If however, s/he omits the reasonable precautions established by the fiduciary test or by ordinary common sense, s/he may be grossly negligent and may be held personally liable for resulting injuries or loss to the child and his/her family.

So long as the person exercises reasonable diligence and care s/he is free from personal liability — when poor judgement causes loss or injury. Good faith is the principle [but not the sole test] of the adequacy of the person’s diligence and care. However, common law recognizes the principle that a person rendering an affirmative duty cannot leave the person in a worse position or state after being rendered aid. And yet, we are aware that children often perform better before “special intervention” than after. It is incumbent upon the administration to assure that these outcomes are identified and resolved.

But remediation is not ultimately satisfactory. The development of training that identifies the duties and responsibilities and provides procedural protocol concerning behavioral expectations of staff can enable the individual staff member to rethink their belief system in regard to self determination, community membership and competence. The “mystical” aspects of a failed service will have much less appeal in light of a clear understanding and accountability to appropriate duties and responsibilities. The only protection for the individual providing services in an arena which truly promotes and exacts the duties and responsibilities of ethics and law, will come from the ability to identify and enhance positive quality outcome. The requirements for the development of such protection will require an investigative attitude that tests interventions and documents impact upon the child’s quality of life.

Obedience & Fidelity

Full exploration of the concept of ethical behavior in human services would examine closely the constructs of obedience and fidelity.

Gabriel Marcel [1951] does such an exploration in depth and although his focus is on religion, some of his thoughts bear consideration. He suggests that we must first, reconsider the construct of obedience: “An adult who was obedient in his whole manner of living…would be unworthy of the name of man.” “…[obedience] is a function, hence the duty of obedience does not fundamentally and necessarily involve the being of him who obeys.” Marcel is limiting the obedience to that which one has committed himself. And even here, there are parameters: “Would it not be better …to recognize that the only true fidelity is fidelity to myself, and that it is by such fidelity alone that I can give proof of what is incorrectly regarded as fidelity to another? In other words, I may make it a point of honor to perform certain actions which are to the advantage of another person, but in the last analysis my only real obligation is to myself.”

Marcel does not mean, of course, that we can therefore whimsically decide to be obedient to one master one day and a different one tomorrow. To be true to oneself is a rigorous activity that demands first, that one commits him or herself to obedience and fidelity only with clear awareness and deliberation. Frivolous commitment is to avoid one’s own sense of right and wrong. Using Donahue’s construct of agency, one must commit to the principal’s intent in order to become an agent. Having made the commitment, however, one is required to continued awareness. “If I admit without discussion that to be faithful to myself means to be faithful to certain principles which I have adopted once and for all, I am in danger of introducing into my life a foreign, and we can even say … destructive…element.” “If I were absolutely sincere I should have to compel myself to examine these principles at frequent intervals, and to ask myself periodically whether they still correspond to what I think and believe” [Marcel – 1951 – emphasis ours].

Awareness, consciousness of our thoughts and actions is a requirement of duty, obedience and fidelity. Taking a position as a public or human servant requires that the individual, and through these individuals, the organization, rigorously analyze their own behavior in light of coherence to their avowed beliefs. This is not easy to do, particularly if the principal’s goals, expectations, etc are nebulous. Such rigorous thinking takes energy, and we may not be prepared to deal with the consequences of what we find needs to be done. But this is the requirement of duty and service. And the public and human service person has a higher duty to maintain.

The principal principles which each individual needs to examine need to be spelled out in mission, values and contract by the local governmental authority, and might include the following considerations.

ORGANIZATIONAL DUTIES & RESPONSIBILITIES

“We have met the enemy and he is us.”- Pogo

Intentionality & purpose

The human services organization [health, education & welfare] has duties and responsibilities as well, not the least of which is to make policy, train and develop methods of identifying and measuring the accountability of individual staff to the ethical and legal principles which shape their practice. However, on a larger scale, human service organizations have a need and responsibility to identify their own “reason for being” and to closely question whether of not they should continue to exist, or at least exist in their present form.

All living entities have two purposes: one is to choose how to live and the other to survive. With lower organisms, these may appear to, and in fact, be identical. But certainly higher organisms have other purposes than mere survival. Whether one accepts Frankl’s position on the need to decide on a meaning for life, or whether the meaning comes from other philosophies, human beings sense a meaning other than survival. Living has a purpose. This is even more apparent in human organizations. People ban together for a purpose. For some, it is simply to make money; in human services, it is presumably to address some identified social deficit or evil.

But once formed, the organization, like all other living entities develops a strong need to survive. As long as these two overarching purposes are kept in proper order; mission first, the organization has some ability to carry out its functions in a proper manner. When survival becomes the first purpose; the organization strangles on its “bureaucracy” and become moot. Thus the only real test of purpose in human services is the willingness to go out of business.

The entanglement of purpose and patchwork development of a human service system has created confusion for many who pride themselves as having highly professional, competent, and quality organizations. Part of the problem, which we will only touch on here because of constraints of our purpose, is the lack of a true organizational performance test. The performance test of most human service organizations is growth. Larger budgets, more services, more staff, high profile; these are how we judge the performance of these organizations. The human service organization grows through the creation of “waiting lists”, which are developed by the creation of program “boxes” through which people rarely, if ever move. The reason is that if people successfully moved through, there would be no waiting lists [no identification of more need]. In fact, there could be a reduction in the size of the organization, since funding sources look for more service, not more outcome. Positive outcome means that people no longer need the service, thus reducing identifiable need for the organization.

Interactive Iatrogenic Effects

There are of course other factors which skew the “reality of the organizational performance such as who is the “customer’. In almost every case it is the funding source, not the client. This should be sufficient to give the reader an idea of the problems. John McKnight goes even further in identifying the confusion about human services. McKnight suggest that the limits on the public purse result in “trade offs” in regard to who actually gets funded. While this is a reasonable process in most areas of government, the process between major expenditures in human services is highly confused.

“The same process occurs within the human service budget. Here, however, it is less well understood because the basic competition for the limited funds available for the “disadvantaged” is between the human service system and cash income for labeled people [emphasis added]. Service system lobbyists and advocates see the competition for limited public resources as a jockeying between various service providers and systems. They rarely recognize or acknowledge, however, that the net effect of their lobbying is to limit cash income for those they call “needy” [emphasis added] and increase the budget incomes of service programs and providers [McKnight – 1989].

McKnight goes on to point out that as federal and state cash assistance programs grew 105% over a twenty-five year period, service programs grew by 1,760%. This despite the fact that “we have no effective measures that allow legislators or policymakers to assess whether public investments for services would be more enabling as cash income” [McKnight – 1989]. This is not the full extent of McKnight’s concern as he points out four structurally negative effects of human services.

Human services emphasize deficiencies -> which undermine the sense of capacity and self worth of a client.
Human services create a demand on -> which reduces the cash income public budget. and market choices of the client tax allocation
Human services focus on problem -> which decreases participation solving by experts and systems. in community life by the client.
A dense environment of services -> which intensifies dependency, surrounds individuals and communities. stimulates deviance and neutralizes the positive potential of individual s programs of service intervention.

Regardless of whether you accept Mcknight conclusions, he has raised important questions about the style, scope and purposes of the human service system which each organization has a responsibility to examine in light of its own existence and a duty to restructure its performance to ameliorate these kinds of problems. Unless the organization is willing to go out of business, it has no ethical position to stay in business.

McKnight suggests specific responsibilities for protecting against the impact of the interactive iatrogenic effect of a multitude of service interventions. “Just as the ethical medical professional recognizes and protects against the negative effects of the interaction among many drugs, the human service professional should be required to identify the negative effects of aggregating programs around a person’s life and define the safeguards that will be used to protect against the dependency and deviance that so frequently results from a “forest” of services.” We would suggest, however, that this is not just or more importantly, a primary responsibility of the individual professional, but is a responsibility of the organizations individually and collectively.

Learning from mistakes

A critical question is inherent in the preceding discussions: “Is this a system?”. In other papers the author has pointed out that human services has none of the components of a feedback system and is excessively skewed in fitness between its avowed purposes and its actual implementation. “The critical relationship [covenant] of the present system is between the provider and the funding source. The failure of this equation is the lack of a place for the client. At least in theory, a provider agency can please the funding source through activities that have little to do with pleasing [and helping] the client. There is no a focus on substantive achievement which is, or should be, the “driving force” of the public/not-for-profit system”.

“At its core, business…[profit]…is a feedback system, capital owners, employees and consumers are member of the same system. They co-produce its output. In the ideal, each member contributes value to the system’s processes and requires in return a share of the system’s output… [Sherwin, 1983].

It must be recognized that this feedback system does not exist in the human service system. The characteristics of ownership are fragmented between the community-at-large, the fiduciary board, the funding source, and the management, each of which at times plays an ownership role. At the same time the consumer is split between the buyer [funding source] and the user [recipient of services]. Perhaps the final irony is that the use of our services is the buyer’s product, in that “improved” clients are the funder’s outcome of choice [although measurements of this improvement, and therefore effectiveness of intervention have never been implemented]. [Gardner, J.R. – 1987]

At a time when business is re-evaluating its reason for being and restructuring itself for quality, there is a great resistance regarding the same transformational process in human service systems. While conservatives attempt to “end welfare as we know it”, the human service system continues to compete with their constituents for limited public dollars without even basing such competition on valid, measurable criteria. The incongruence between intent and outcome requires major renovation. Effective organizational behavior must be defined as behavior that leads to higher levels of goal attainment, utilization of resources and adaptation.

O’Brian [1989] has suggested that “the fundamental question for those concerned with high quality services for people with severe disabilities is, How can we use our resources to assist the people who rely on us to live better lives?” An outcome such as a “better life” is, of course, a moving target as the person living the life is always striving to achieve more. More importantly, most consumers would define a “better life” in terms of fewer, not more services. Such fundamental issues make us uneasy. “But responsible policy makers and practitioners won’t try to dodge the question by reducing the pursuit of service quality to conformity with external standards and regulations or by retreating into arguments about the impossibility of doing anything until science produces objective measures of ‘better lives’” [O’Brian – 1989].

Legal Obligations & Duties

Incompetence of an employee is in and of itself, not a basis for a breach of personal fiduciary duty, but it can be a breach of organizational responsibility. Each organization has a management responsibility to recruit, select, orient and train competent [as opposed to credentialed] staff. Thus, failure of a staff person to act in a fiduciary manner will reflect upon the organization’s ability to effectively carry out this management responsibility.

Breach of organizational duty

An apparent or alleged breach of organizational fiduciary responsibility requires a system investigation to be carried out by the local administrative office and/or its designee. Remedial action could include technical assistance and training or, in cases of clear contract failure, decrease or termination of the contract.

Duties of individual employees

Staff members are usually held to a standard of diligence, skill and care of an ordinary man in a like situation. This is a vague enough standard to make it necessary to decide practically every event on its own merits. Despite the fact that staff may be paid or voluntary, or that they are adequately or inadequately trained for their positions, this does not justify actions which are careless or of gross stupidity. Incompetence is, in and of itself not cause for him/her to be held personally liable for any losses caused by this inadequacy. If, however, s/he omits the reasonable precautions established by the fiduciary test protocol or by ordinary common sense, s/he may be grossly negligent and may be held personally liable for resulting in injury or losses to the client.

Breach of individual duty

An apparent or alleged breach of individual fiduciary responsibility requires that the organization’s management investigate the alleged breach and make a report that includes a remedial response and a plan of correction. Failure to act in a fiduciary manner because of a lack of training or judgement requires that the individual must be given sufficient support and experience to improve the quality of judgements. Repeated failure to make good judgements requires that actions be taken to separate this employee from like situations.

Worse position or state

Common law recognizes the principle that a person rendering an affirmative duty cannot leave the person in a worse position or state after being rendered aid. This common law position is similar to the ethical position of “do no harm” which McKnight suggest needs to be added to human services. It is distressing to note that this lack is apparent even while the common law exists. It raises serious question as to who is “watching the store”.

Restitution

In all cases of fiduciary breach or failure, an investigative report must assess and document the loss or injury [worse position] of the individual client and must indicate appropriate action for restitution by the party of cause. Regardless of whether the person is legally liable, harm to a client becomes the responsibility of the organization and restitution becomes mandated.

Duty to not reject or abandon

Two affirmative actions must be embellished in the contractual relationship:

• That there can be no rejection of services for a person who would be the responsibility of the local governmental authority if they were not served by the provider.

One cannot expect to take on the responsibilities of public service only when it is convenient. The government has two options in fulfilling its responsibilities to its citizens; it can contract for services or provide them. If it contracts for services and the providers do not provide them, then the government should seek to cancel the contract. Why should the government contract for only those services that are easy to provide? If the government is required to provide the services to the people with the most difficult problems in living, they might as well provide the services to the people with lesser problems as well.

• There can be no abandonment of the person in service under the same circumstances.

It follows, that if the provider cannot refuse, the provider cannot abandon. Yet when the going gets tough, this is exactly the position taken by many provider organizations. That such deterioration says something about organizational performance and that the abandonment results in a breach of fiduciary duty as well is often ignored.

Conflict of Duty

A particular area of organizational responsibility is to carry out the responsibility to each client individually and separately, while being, at the same time responsible to all clients. When these two duties appear to be in conflict, it may be necessary to request an outside agent to bolster the fiduciary responsibility to the one atypical client. [Such situations arise for example when the actions of one client might be harmful to others.] This does not, however, remove the responsibility of the organization to continue to assure this duty to each person individually. The atypical client cannot be abandoned and/or refused services simply because of this potential harm, but must be treated individually in a fiduciary manner.

Duty to least restrictive alternative

Just as there is an individual staff responsibility, there is also an organizational responsibility to the least intrusive approaches. Government must pursue its ends in a manner that least intrudes or infringes upon individual rights. The implications of this duty have been virtually ignored by both government and contracted providers as the rationalization of a continuum of services has had extremely negative consequences for the people being served. The question of restrictiveness is one that has been rigorously examined by Steven Taylor [1988]. As we identified above, Taylor identifies seven specific pitfalls of the least restrictive environment as practiced by present practitioners.

It legitimizes restrictive environments. “A principle that contains a presumption in favor of the least restrictive environments implies that there are circumstances under which the most restrictive environment would be appropriate” [Taylor – 1988].
It confuses segregation and integration on the one hand with intensity of services on the other. “As represented by the continuum, LRE equates segregation with the most intensive services and integration with the least intensive services” [Taylor – 1988].
Least restrictive environment is based on a “readiness model”. “Implicit in LRE is the assumption that people with …disabilities must earn the right to move to the least restrictive environment” [Taylor – 1988].
Least restrictive environment supports the primacy of professional decision making. “…LRE is invariably framed in terms of professional judgements regarding “individual needs”.” “The phrase “least restrictive environment” is almost always qualified with words such as “appropriate”, “necessary”, “feasible”, and “possible” [and never with “desired” or “wanted”] [Taylor – 1988].
The least restrictive principle sanctions infringements on people’s rights. “The question implied is not whether people with …disabilities should be restricted, but to what extent [Turnbull – 1981, p. 17]” [Taylor – 1988]
The least restrictive principle implies that people must move as they develop and change. “As LRE is commonly conceptualized, people with …disabilities are expected to move toward increasingly less restrictive environments” [Taylor – 1988].
The principle directs attention to physical settings rather than to the services and supports people need to be integrated into the community. “As Gunnar Dybwad [personnel communication, February, 1985] has stated, “Every time we identify a need in this field, we build a building” [Taylor – 1988].

The outlining of such pitfalls should remind us that even the best values can be used perversely if we are not diligent in our rigorous analysis of what is actually happening and what we are participating in.

Administrative requirements of provider organizations:

The provider organization is required to have and show evidence of:

a policy regarding acting on the acts of others and a procedural protocol concerning behavioral expectations of staff who identify potentially nonfiduciary actions.
a decision making protocol which is to be followed when a question arises as to whether an action is fiduciary.
an investigative protocol to determine failure of individual fiduciary responsibility.
a standing or ad hoc committee capability to review evidence of loss or injury and to determine restitution.
a process of orientation and training regarding fiduciary duties for all staff.
signed statements of all staff that they have learned and understood their fiduciary responsibilities.
archives of the investigative committee.

Administrative requirements of Local Administrative Offices -Standard Of Care:

A breach of duty consists of a failure to follow a established standard of care.

The standard of care is at minimum, determined by what common law has termed the reasonable man test. Simply stated, conduct that would be attributed to a reasonable person or from which a reasonable person would refrain establishes a guideline for conduct. The test is subject to several practical qualifications. People employed in provider agencies specifically to provide an affirmative and fiduciary duty to a vulnerable individual are held to a higher degree of care than others in similar circumstances. Consideration will also be given to the person’s level of training and experience. In addition, while somewhat eroded by the communication explosion, the norm is established geographically.

In the final analysis the local management entity is responsible for delineating the local standard of care and assuring its implementation.

Outcome Orientation

The idea of treating each intervention as an experiment and the rethinking of organization performance and survival goes beyond simply taking precautions to protect the children we serve; it demands attention to outcome. Evans and Myers [1985] introduce the issue of evaluation: “Special education teachers will generally have been trained in single-subject experimental methodology and taught important principles of research design in order to evaluate the effectiveness of an intervention. While having this background is critical for the special educator as a consumer of research, we doubt that the most feasible way for practicing professionals to evaluate their behavioral interventions is by carrying out experiments that rigorously control for extraneous variables – even if these studies were clinically practical. There are more informative and valuable methods for evaluating one’s activities in this critical area.” “…objective improvement must be accompanied by recognition of Improvement from people who really matter in the child’s life: Parents, neighbors, employers.”

For many years the standard accepted method of evaluating interventions within the context of “mental health” interventions has included the reduction or control of symptoms and the continuation of services. People with mental health problems who dropped out of service were considered to be resistive to services and/or too “sick” to benefit from them. Even if peoples’ symptoms were reduced and they left services, they are generally expected to fail; the fact that many of them never resurface in the mental health system not withstanding. The philosophy of the service delivery system is highly pessimistic and this persists despite the fact that even in the most severe and persistent cases [chronic schizophrenia] recent research has indicated that people tend to get better. One study, the Vermont Longitudinal Study of Chronic Mental Patients , followed such patients for over thirty years and found that with or without medication and with no services at all over 60% of them showed no continuing signs of mental illness. The critical factor which changed the lives of these people was not service, but the lack of it; they had been released from the State Mental Hospital into the community.

By contrast to this general human services perspective, the standard accepted method for evaluating interventions with severely disabled students in educational settings has been the individual baseline, derived from periodic observations of the frequency of a given behavior. “Teachers of severely handicapped students are expected to have the competencies of the applied scientist, in much the same way as practicing psychologist are admonished to be “empirical clinicians” [Barlow, 1981 as cited by Evans and Myers – 1985]. Systematic data gathering is a prerequisite for carrying out a formal functional analysis of excess behavior. Such a scientific heritage has been the hallmark of behavioral interventions.

Evans and Myers suggest that there are limitations to this approach. First, it is a singular measure of a singular behavior in a singular situation; while what is needed is a repertoire of behaviors available for a variety of situations. “As an evaluative approach, the charting of individual responses leaves much to be desired. It will not answer the question of whether the change documented is clinically or educationally significant; it will not answer the question of whether the intervention strategy itself was appropriate, humane, and in keeping with philosophical or legal assumptions regarding the handicapped child’s rights.” [Evans & Myers – 1985]

Edward Deming in his thesis on quality suggests that there must be a material impact on the consumer’s life. By this standard, until the child’s quality of life improves; until the child is able to perform appropriate behaviors in normal and valued settings; the interventions, no matter how well intended, have failed. “For children with severe handicaps… it is important to take seriously any evidence that some skills are more powerful or useful than others and should thus be given priority as educational goals. Guess and Noonan’s [1982] critical skill and Wahler’s [1975] keystone behavior concept reflect the idea that there are certain target behaviors that are particularly crucial to maximum participation in everyday life. Such behaviors are said to produce multiple benefits in return for instructional planning, either because they are somehow pivotal skills needed for the development of other important skills or because they are associated with multiple uses in a variety of current situations.” [Evans & Myers]

Evans & Myers suggest other evaluative criterion including educational validity, which is contingent upon meaningfulness of the behavior change and the specifications of the educational plan. We are talking about a learning process that must be tied closely to the child’s skill acquisition goals. Monitoring of skill acquisition must be accomplished with consideration to impact on other areas of the child’s educational intent. Social validity refers to the relative value that different persons would place on the behavior. The social validity of a goal can be established by evidence that significant people in the child’s life see the goal as one that is meaningful to them. This emphasizes the role of the child/parents in designing the educational goals of the individual education plan. Empirical validity can be established by the immediate effects of learning a skill and is additionally supported by evidence that the goals attainment produces an exponential effect that demonstrates long term outcome. Changes of behavior that lead to employment after graduation demonstrate long-term material impact that can be empirically determined. Mastery criteria include evidence of generalization and maintenance of behaviors over time.

The quest is not for pristine research conditions, but rather for practical and defined intention against which generalized outcome can be determined. “While we strongly share the value of science as a model for thinking, we …feel that a slightly more liberalized view of basic research should be adopted if we are to make the most of research findings.” We have argued that traditional evaluation strategies are inadequate. “Decision making by clinicians is simply not summative. The clinician must observe and respond to nearly moment-to-moment information on each pupil’s performance in a formative way [Evans & Myers – 1984].”

Summative data which judges whether the intervention has worked is clinically appropriate to cumulative data across many students and many interventions, while interactive evaluation is necessary for “fine tuning” the intervention to assure outcome with this particular student, at this particular time.

The question then of therapeutic, medical interventions and their effectiveness with behavioral disorders, despite failure to keep cumulative summative data regarding outcomes has been significantly tested. The question of failure can be determined from two perspectives:

1) specific summative outcome data from pristine, controlled tests and 2) from generalized cumulative data drawn from years of formative practice. As we shall see in later sections, the medical model has failed from both perspectives as defined by it own supporters.

Two other areas of interest are pointed out by Evans and Myers. The first they call educational integrity. “Almost all traditional and behavioral assessments used in educational programs focus on student performance and behavior. However, many of the intervention procedures described in the behavioral literature really refer to changes in the clinician’s behavior. Adoption of any specific educational program plan alters the existing ecological system in the classroom.” This is a very powerful point and is one of the cornerstones of the propositions that will be developed later in this paper. Second, “the strongest evidence of the effectiveness of any skill training program would still probably be replications of those effects across children”. Just as the traditional medical and therapeutic models have consistently failed to demonstrate cumulative effectiveness across the whole spectrum of population and time; so any new intervention system that claims to be effective must meet this challenge through long term demonstration and documentation. It is not significant to demonstrate that this child was helped, or these children learned these skills. It is necessary to demonstrate that this method:

a) prevents social interpersonal deterioration, and/or

b) Enhances the ability of most children who demonstrate problems in living to function adequately in valued settings.

Our purpose is to identify an approach which is congruent to other educational processes and which shows potential for the development of interventions which can be done within the context of the school and which will support measurable outcomes.

These outcomes must realistically be connected to the intention of the intervention, thus requiring the intervention to be outcome specific. Intervention without explicit goals and targeted time limits are much less likely to be helpful. This requirement of specific outcome orientation should focus the practitioner on defining specifically what s/he feels can and cannot be accomplished through the intervention, which in and of itself can improve the process of helping. The determination of what outcome expectations should be pursued is discussed within the decision making section.

Crisis Management

In some ways all human service implementation is crisis management, since either the person has reached a point where they can no longer cope with life, or someone else has decided that they are not coping appropriately, which carries its own crises. This is not to imply that the management of the organization should be crisis oriented, although many are. Rather it is recognition that the process of working with people in crisis has its own ethical requirements.

“A semantic analysis of the word crisis reveals concepts that are rich in psychological meaning. The Chinese term for crisis [weiji] is composed of two characters that signify danger and opportunity occurring at the same time [Wilhelm – 1967]. The English word is based on the Greek krinein meaning to decide. Derivations of the Greek word indicate that crisis is a time of decision, judgement, as well as a turning point during which there will be a change for better or worse” [Lindell & Scott – 1968]. [Slaikeu – 1990]

Slaikeu goes on to suggest that crisis is an essential building block in any structured understanding of human growth and development. Far too often people think of crises as the unusual, mostly negative events that bring disruption to “normal” life. The implication is that an ideal world would be one without crisis, with things moving along pretty much on an even keel. In real life, very few people avoid crises altogether. Adult life, whether neurotic or normal, healthy or ill, optimistic or pessimistic in outlook, is a function of how we have weathered earlier crises, whether changing schools, surviving the divorce of one’s parents, dealing with life-threatening illness, or surviving the loss of a first love.

Crisis is a time when “everything is on the line”. Previous means of coping and managing problems break down in the face of new threats and challenges. Clinical data suggests that some form of reorganization will begin in a matter of weeks after the onset of crisis. But whether that reorganization is toward growth and positive development or toward psychological impairment depends on the way in which the individual perceives and uses the disorganization and disequilibrium of the crisis. If the perception is one of a temporary loss of control from which one can learn new skills in coping and problem solving for the future, then the process of reorganization is a strengthening one. “That which does not kill me makes me strong” -[Neitzche]. On the other hand if one perceives the crisis to be something over which they do not have, nor never will have control, the outcome is likely to be quite different.

Anyone intervening in a crisis on behalf of another person is required therefore to begin immediately to do things in a manner that conveys the potential for regained self-control. Such methods unfortunately are not the normal form of intervention with children in crises. The considerations of a crisis are not just negative despite how they may feel to the people involved in the heat of the situation. When the stakes are high, the people required to respond must find a way to make their intervention one that will support the opportunity and not enhance the danger. Yet the interventions into emotional and behavioral difficulties often support the notion that the person is “out of control” and unlikely to be able to make positive use of the experience. Part of this impact may come about because the people immediately available are not properly prepared to intervene appropriately. But unfortunately, it seems that those professionals charged with the responsibility of crisis resolution are equally prepared to dramatize and traumatize. The persistent use of medication and removal seem to give very powerful negative messages about the situation.

At its core this paper raises the question whether teachers and clinicians will be prepared to help children protect themselves against the dangerous outcomes of crisis and mobilize resources to take advantage of the opportunities for constructive change. The potential for a first order intervention [psychological first aid], which in function is similar to cardio pulmonary resuscitation [CPR] in that it maintains the most positive “life signs” until the professional is able to take charge, should be a required skill of all teachers and other adults. From a sociocultural aspect, crisis services should be integrated into a wide range of community systems.

Several factors are involved in whether the crisis results in growth or harm. An initial consideration is the severity of the event touching off the crisis. But despite our personal views of this precipitating event, the individual children based upon their own personal resources may view the severity differently. Whether born that way, or seasoned through life experience, some children are better equipped than others to cope with life’s stresses.

A third set of variables includes the social resources present at the time of crisis. For a child in the classroom, the list can be reasonably long and includes other students, teachers, school nurse, administrative personnel, friends, etc. The fact that most of these people are at least aware of CPR and not at all aware of psychological first aid [PFA] is not surprising with the “mystification” given to psychological processes by the professionals involved with them. It is however, a major failure that needs correction. Each of these people is capable of providing a first-order crisis intervention. In fact, many of them will. They will attempt to “console” or “control” the child in crisis and whether that intervention is helpful or harmful is purely determined by the “luck of the draw”.

Salikeu describes this first-order crisis intervention as a helping process aimed at assisting a person or family to survive an unsettling event so that the probability of effects [e.g., emotional scars, physical harm] is minimized, and the probability of growth [e.g., new skills, new outlook on life, more options in living] is maximized. Crisis intervention is something that takes place after an unsettling event has occurred, though before its ultimate resolution, whether positive or negative.

“An examination of the history of psychiatric patients shows that, during certain of these crisis periods, the individual seems to have dealt with his problem in a maladjusted manner and to have emerged less healthy than he had been before the crisis” [Caplan – 1965]. If an examination of adult psychiatric patients concluded that a poorly handled crisis or transition led to subsequent disorganization and mental illness, then it follows that prevention should look closely at developmental transitions of childhood and early adulthood. [Slaikeu -1990]

As we will note later cognitive growth is a result of dissonance caused by the failure of cognitive structures to predict and control events. Put more strongly “(g)rowth can only occur after previous patterns have been destroyed and the rebuilding process takes place” [Slaikeu – 1990]. If crisis can result in either negative or positive outcomes, the goal of intervention is not to prevent crisis, but rather to enhance or enrich a child’s abilities to deal constructively with those events.

Primary prevention aims to reduce the incidence of disorders; and we will delineate a means of developing a more prosocial environment as well as increasing an individual child’s cognitive skills which may be able to reduce both the frequency and the severity of unsettling incidents. Secondary prevention aims to minimize the harmful effects of events that have already occurred, which is what PFA as a first order intervention would provide. Tertiary prevention aims to repair damage long after its original onset. To a substantial degree this is seen as the provision of a one-on-one cognitive behavioral mentor who would provide the child with in situ opportunities to review alternative responses; develop rigorous analytical rules of evidence; and finally teach interpersonal and utilitarian skills which can help to re-establish the child within the mainstream of school life.

Both the opportunity and the means exist to provide children with an optimistic milieu for growth and development, but this requires that our intervention in the crisis in living be focused on helping restore, rather than taking control.

ETHICAL DECISION MAKING

“The medical profession has long understood that its interventions have the potential to hurt as well as to help. The Hippocratic oath … concludes with the primary mandate “This above all, do no harm.” The harmful capacity of medicine is recognized in what current medical language calls iatrogenic disease – doctor created maladies” [McKnight – 1989]. The other human service professions according to McKnight have “no tradition of routinely analyzing [if] possible negative side-effects exist.”

If as McKnight suggests, “it is critical that we begin to understand the iatrogenic aspects of the major agent of public policy – the human service professional”, we must begin to examine how these professionals make decisions within the context of funding and organizational policies with regard to human impact.

When people are providing help to others they are in a position of great decision making flexibility. In human services the individual direct service worker is faced with what appear to be indeterminate decisions every day with regard, at least, to the direct interactions with clients. Clearly the argument could be made that human behavior, particularly that of a severely disorganized and depreciated child, can not be accurately assessed and defined in a manner which indicates that there is a significant probability of a single actions producing expected results with a given individual. However, for individual behavior all is probability.

The process of responsible decision making involves recognition of those to whom we are responsible, and the sorting out of the things for which we are responsible. To choose to be responsible for one thing often excludes the possibility of being responsible for another [Gustafson & Laney – 1968]. Developing the answers to the questions of to whom and for what the helping professional is responsible has requisites for both the organization in which the helper functions and for the helper as an individual. The expectation of a professional dialogue between the two in which a rational determination is made prevails upon the ethics of both.

Within the parameters of organizational principles and individual client complexity, the human service worker needs to find some comfort that they are making the right decisions. Part of this responsibility adheres to the human service administrator, who must narrow the decision field to make it more deterministic. We cannot [or at least should stop] allowing individual direct service workers to make salient decisions about clients purely on their own initiative. While anyone who has ever received help can tell stories about “wonderful” helpers, this is all too often outweighed by the “awful” ones.

We define several states of decision making which are developed from three basic decision making factors: 1) the state of the problem, 2) the state of the decision maker and, 3) the intention of the decision maker. In regard to the state of the problem we range from the simple, deterministic problem to the highly stochastic, indeterminant problem. Sutherland – [1977] groups the range as follows:

Deterministic: Where for any given set of starting-state conditions, there is one and only one event that may be assigned a significant probability of occurrence.
Moderately stochastic: Where for any given set of starting-state conditions, a limited number of qualitatively similar events must be assigned significant probability of occurrence.
Severely stochastic: Where, for any given set of starting-state conditions, some number of qualitatively different events must be assigned significantly high probability of occurrence.
Indeterminate: Where, for any given set of starting-state conditions, there is no event that can be assigned a significant probability of occurrence; thus the high probability that some outcome we have not been able to pre-specify will occur.

The question of complexity is an important issue in regard to human service interventions, for part of the creative process is to increase the number of alternatives through overcoming the hierarchy of ideas that keeps traditional [and therefore less novel] ideas at the forefront of thought. Thus, part of the professional process is to increase the complexity of the decision by increasing the probable options.

Regarding the state of the decision maker, we are interested in the psychological state, ranging from instinctive, to emotional, to rational. The more aware the decision maker is with regard to goals, objectives and outcomes; values and principles, antecedents and consequences, and sequences and linkages of decision making, the more rational their decision making is likely to be. Clearly, the professional decision maker is, or should be rational. The professional should have a clear set of principles and values upon which client decisions are made. They should understand the outcomes that are desired and weigh outcomes before decisions are made, not simply rationalize afterwards. They must identify the sequence of events and the linkages of this event to future goals if they are to enhance their professionalism.

All is lost however, if their motivation is suspect. The final factor, the intentionality, is a critical one. The volition or motives of the professional decision maker in regards to the personal or fiduciary benefit of the decision are critical to meeting professional criteria. Increasing complexity through multiple alternatives and making rational decisions about goals which are not the client’s, are not professional decisions.

The highest order of professional decision making would then be defined as complex, rational and fiduciary and the lowest order would be the simple, emotional and personal. The orders could be expanded and prioritized by placing the highest value on the principle of fiduciary; the next on rationality; and the next on complexity. We cannot afford to allow individual helping person’s to simply make any order decision they like when the helping is with a highly vulnerable child/family who has turned to the helper in trust.

The first step in the process of honing the decision field is for the administration to articulate a clear mission and the underlying philosophy. Many feel as though such abstract thought is neither pragmatic nor appropriate to “getting the job done”, but we suggest that it is critical. If one is to test effectiveness and to promote best practices, one must have a way of assuring [within practical reason] that the people directly relating to the child with problems in living are “doing the right things” and “doing them right”. These two distinct dimensions are part of training and of supervision.

Every art and every inquiry and similarly every action and pursuit, is thought to aimed at some good; we act toward an end or are purposive. We are, however, by no means unanimous in the choice of ideals to be realized nor in the estimate of the potentialities of the material that is to be given the desired or desirable form [Niebuhr – 1968]. It is essential, therefore that the organization and it’s helping professionals enter into a conscious dialogue about the ideals, goals, values and a conceptual understanding about the people they are serving; the client’s capacities for growth and development and the preferred means to achieve those goals and ends. There must be accord regarding what we are about.

Once having achieved such accord [and failure to do so should explicitly mean a change of employment for any responsible professional]; policies must be developed which will provide guidelines for action within the organization. We come under the rules of family, neighborhood, and nation, subject to the regulation of our action by others. Against these rules we can and do rebel, yet find it necessary … to consent to some laws to give ourselves rules, or to administer our lives in accordance with some discipline [Niebuhr – 1968]. The organizational life must be considered as both consenting to rules and policies and as taking part in their development. The freedom to accept the policies as the rules of organization are part of finding guidance in the making of complex decisions.

Because we inherently see the value of individualized services and the indeterminacy of decision making, we tend to think that standardization is taboo. What happens, of course, is that the services become individualized based upon the belief system of the individual direct service worker, not on the individualized needs of the child and his or her family. Thus the root of an individualized system is paradoxically to insist that certain thing be done the same way [with the same principles and values] all the time and every time. The basis of standardization should be the principles and values that the administration believes are significant to the attitudes and actions that are helpful.

We further suggest that these values that the administration has stated as principles of methodological intervention must be held as commitments, not simply as ideals or goals. The administration must articulate these principles with the intention that they will be implemented and have the means to identify when they are or are not. In this way, these principle values become more than abstract ideas but become the fabric of the intervention process. Had the medical model agencies clearly articulated their intentionality, rather than allowing each worker to “eclectically” intervene in their own pattern, the failure of the system would have been much more quickly apparent.

While we at once admonish human service administrators to develop standardized methods of acting for their staff and for developing the philosophical principles and values upon which the helping person must act, we equally recognize the situational aspect of decision making of the helping relationship and equally encourage helping people to break the rules.

In the history of theoretical ethics, as well as in practical decision making, two great symbols for understanding have led to many disputes as well as to many efforts at compromise and adjustment. Those who consistently think of man-as-idealist [goal seeker] subordinate the giving of laws to the ends. For them the right is to be defined by reference to the good; rules are utilitarian in character; they are means to ends. All laws must justify themselves by the contribution they make to the attainment of a desired or desirable end. Those, however, who think of man’s existence primarily with the aid of the law-abider image seek equally to subordinate the good to the right; only right life is good and right life is no future ideal but always a present demand [Niebuhr – 1968].

The consequencialist, or goal seeker will therefore break rules in order to achieve ends, while the legalist ignores ends to justify the means. As with most dilemmas, the answer is rarely either or, but is somehow a creative interlude between the two. The rock-bottom issue in all ethics is “value”. Where is it, what is it’s locus? Is the worthiness or worthlessness of a thing, action or belief inherent in itself? Or is it contingent, relative to other things? Is the good or evil of a thing, and the right or wrong of and action, intrinsic or extrinsic?

Martin Buber says plainly: that “value is always value for the person rather than something absolute, independent existence.” Nothing is worth anything in and of itself. It gains or acquires its value only because it happens to help persons [thus being good] or to harm persons [thus being bad]. People determine value, and they determine something to be of value for some person’s sake. In the context of health, education and welfare, it is the person being served for whom we make decisions, and they and they alone who determine value. Value can only be determined by outcome. Either the outcome was helpful to the client, or it was not.

The first element in a theory of responsibility is the idea of a response. If we use value terms, then the difference among the three approaches may be indicated by the terms, the good, the right, and the fitting; for teleogy is concerned always with the highest good which subordinates it to the right; legalism is concerned with the right, no matter what may happen to our good; but for the ethics of responsibility the fitting action, the one that fits into a total interaction as response and as anticipation of further response, is alone conducive to good and right for it strives to act in the most appropriate manner to achieve the most preferred outcome as defined by the individual being served.

The rightness of an act depends on the way in which the act is related to the circumstances impacting upon the child with whom we work. Caring is not something we have or are; it is something we do. Our task is to act so that more appropriate outcome will occur than any other possibility. It is an attitude, a disposition, a leaning, a preference, and a purpose.

The enhancement of the child’s self actualization is the regulating principle. In order to be self actualizing, the child must first determine what to be. The child must then understand the steps that must be taken to become. Then the child must try out this new skill, attitude, belief, and behavior and test the validity of the experience. Then the child becomes.

The helping person must do what s/he can, where s/he is; the true opposite of caring is indifference – you turn the child into an it, a thing, a label . The helping person enters into every decision making situation fully armed with the ethical maximums of his or her agency, profession, community and heritage and s/he treats them with respect as illuminators of the problem. However, s/he must be prepared in any situation to compromise them or set them aside if a caring attitude seems better served by doing so.

Thus reason becomes the instrument of judgement; not law, or policy or rules. This reason is honed by the universal principle of the child as the primary driving force in the decision making process and the corollary obligations to the most appropriate result as judged by the child/family’s stated preferred outcome. Continued discussion of ‘need’, need to be rethought as discussion of preference.

Universal obligation attaches not to particular judgements or conscience, but to conscientiousness. What acts are right may depend on circumstances…but there is an absolute obligation to do whatever may on each occasion be right. Our obligation is relative to the situation, but obligation in the situation is absolute. [Fletcher – 196? ]

Helpful decision making aims at the contextual appropriateness – not the “good” or the “right”, but the fitting. Circumstances [preferences] alter cases, rules and principles providing reason is honed by the child’s self-actualization. The creative tension between the administration’s clear intentionality and the resultant rigorous attention to the outcome of that intention and the ethical posture of individual workers has a tendency to hone apparently positive principles into ever improving policy. But this can only happen, if the attention to the questions of validity is rigorously pursued.

Working Suppositions

Personalism

The helping process deals with human relations. We put people, not things at the center of concern. Obligation is to the child and his/her family, not to laws, security, or property. True existence lies in personal relationships. Only free persons, capable of being the responsible self can sustain relationship and thereby enter the field of obligation. Children become capable of true existence within personal relationships and need to make choices and be responsible for them in order to be.

“Treat persons as ends, never means.” – Kant

Pragmatism

Outcome is the focus of our activities. Good is what works and gives satisfaction; having a material impact on the quality of life. To be correct or right a thing – a thought or action – must work. The very first question must be measured by the universal principle of what maximizes the child’s self-actualization, which can be modified only by a standard of caring. We must turn our backs on abstractions and verbal solutions, from fixed principles and pretended absolutes and origins. We must turn toward concreteness and adequacy, towards facts, toward actions and toward power.

Relativism

As the strategy is pragmatic, the tactics are relativistic. Perhaps the most pervasive cultural trait of the scientific era and of contemporary man is the relativism with which everything is seen and understood. We have become fully and irreversibly contingent. The helper avoids words like never, perfect, always, and complete. However, there must be an absolute or norm of some kind if there is to be any true relativity; to be absolutely relative is an uneasy combination of terms which implies random, unpredictable and meaningless.

Our ultimate criterion remains the preferred self actualization of the child. In this context, all issues are of relative importance. We are always expected to act caringly, but how we do it depends on our own responsible estimate of the situation’s impact on the child’s self actualization. There can be no prescriptions or law. Only caring and self actualization are constant; all else is relative. Every moral law is abstract in relation to the unique and totally concrete situation.

Positivism

Any moral or value judgement is a decision – not a conclusion. It is a choice, not a result reached by force of logic. One cannot prove that we have chosen the highest good or right. Reason can note facts and infer relations, but it cannot find values [goodness]. A “leap of affirmation” is essential. Value choices are made and normative standards embraced in a fashion every bit as arbitrary and absurd as the leap of faith. Ethical decisions seek justification through appropriate results, whereas cognitive conclusions seek verification. We cannot verify moral choices. They may be vindicated, but not validated.

Thus we posit the position that a preferred self actualization is the honing force of the professional decision making process and it must be accepted as a matter of faith.

If we put these suppositions together [personalism, pragmatism, relativism, and positivism] their shape is obviously one of action, existence and eventfulness. Helpful people make decisions instead of “looking them up” in a manual of prefabricated rules. “It’s our policy” is an irrelevant and irresponsible remark. If the policy is appropriate use it and stand by the value of it not the words. If it is invalid, break it. The helper must be prepared to justify this breach of policy, but it should be easily done if the purpose was a fitting one.

Another focus of the ethical decision making professional is his/her concern with the antecedent rather than consequent conscience, i.e., with prospective decision-making rather then retrospective judgement passing. Remedy, not blame is the appropriate issue. The rationale for the decision needs to be explicit in the helping person’s mind before the decision is made.

Every individual is unique; every concrete situation is unique. There are no easy solutions. After thorough consideration of all the values involved, the helper chooses what s/he believes to be the demands of preferred self actualization in the present situation.

Only one thing is intrinsically acceptable: preferred self actualization. The helper seeks the child’s best interest with a careful eye to all the factors in the situation. The principle is non reciprocal. It is will, disposition; it is an attitude, not a feeling. Implementation calls for more critical intelligence and more self-starting commitment than most people can bear.

Most people do not want freedom, they want security. Freedom is danger, openness. They want law, not responsibility. The helping professional is called upon to be mature, to respond to life, to be responsible. S/he seeks the most fitting response possible in every situation. This maximizes obligation. You are responsible for what you have done or what you could have done. Not only must the professional helper accept this, but also they must enable the child/family to accept this. Legalists and idealists are safe, whereas the professional helper is always vulnerable to error in any decision making situation. Laws and ideals cut down our range of free initiative and personal responsibility by doing our thinking for us. This makes us much less as persons and professionals. We seek more and more fitting response, not merely obey the law or live up to the ideal. We are in the business of loving the unlovable in a nonreciprocal way.

In responsible decisions, will is the key; we shall will another’s good only if the self takes second place. Four factors are at stake in every decision situation, all of which must be balanced.

First there is the end, the outcome expectation. What is it that is wanted? What is the result aimed at? Without a clear goal, decision making is moot. With a clear goal, the measure of actualization is available.

Second, by what means. What method should we employ? With the measure, actualization come demonstrable best practices. With best practices and continued tests, come improved services; a new standard.

Third is motive. What is the wanting dynamic behind this desire? Whose problem is it? Have we made the decision because it makes it easier for us, or is most caring and helpful for the child? Know thyself.

Finally, a fourth factor. What are the foreseeable consequences? There are more results entailed than just the end wanted and they must all be weighed and weighted. Human behavior is complex and requires great thought.

Decisions are made situationally, not prescriptively. For real decision making, freedom is required, an open-ended approach to situations. The helping professional affirms the basis of three of the seven questions that must always be asked. S/he knows the what; preferred self actualization, the why: for the child’s sake, and the who; the child. Only the situation can answer the other four questions when, where, which and how?

The decision making process takes into as full account as possible the context [environment] of every decision looking at the full play of ends, means, motives and results.

CONCLUSION

Once the relative course to provide services to human being who is having problems in living is chosen, the obligation to pursue it ethically is absolute. McKnight has challenged the helping professionals. “Regressive policymakers and human service professionals have made unintended common cause because the profession is unable to analyze the negative effects its interventions have had as the potential cause of failed policy.” The author would contend that such failure is potentially correctable, but requires that professionals be prepared to both commit to the development of appropriate policy and to the rejection of it when necessary.

The views of Eysenck, Mårtensson, Breggin, Szasz and other individuals and organizations such as the National Mental Health Association [All Systems Failure – 1993] have articulated systematic and methodological failure, which is all too apparent to the man on the street. Policy makers fail to understand the nuances of necessary change, as they continue to “mouth” platitudes, while pouring more and more money into systemic failure. Somehow, they accept that they have failed, but believe that if we had more money they could do more of the same and get different results.

Even if the systems change in the most positive form, until organizations and individual staff people begin to take ethical responsibility for their decisions and actions, the initiatives meant to help will continue to fail. This is because clients are people, and people and situations vary. No approach other than responsible decision making within policy context provides for both the good and the right; ultimately leading to the fitting.