Clinical Mental Health Counseling PDF

SECTION IV WORKING WITHIN SYSTEMS Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved....

SECTION IV WORKING WITHIN SYSTEMS Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  CHAPTER 9 CLIENT ADVOCACY, ACCESS, EQUITY, AND RESILIENCE CARLOS P. ZALAQUETT This chapter addresses the importance of advocacy and social justice advocacy, and the strategic positionality of the clinical mental health counselor as an advocate for addressing social and institutional barriers that reduce client access, equity, and success. Advocacy competencies and approaches to advocate for clients care are identified, and the ways that they foster resilience and growth are emphasized. Specific cases illustrate clients’ and professionals’ understandings of and access to a variety of community-based resources. The chapter also addresses strategies to advocate for the profession and for clinical mental health counseling professionals. The following Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are addressed in this chapter: CACREP 2016: 2F1.e, 2F2.h, 2F3.i, 2F5.k, 5C3.e CACREP 2009: Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. 2G1.h, 2G1.i, 2G2.d, 2G2.e, 2G2.f LEARNING OBJECTIVES After reviewing this chapter, the reader should be able to: 1. Explain the critical role of advocacy for the mental health field; 2. Define advocacy and social justice advocacy; 3. Describe the clinical mental health counselor advocate; 4. Identify the American Counseling Association’s (ACA) social justice advocacy competencies; 5. Analyze potential strengths and limitations of social justice advocates; and, 6. Outline possible issues for clinical mental health counseling advocacy. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  186 Section IV Working Within Systems INTRODUCTION TO ADVOCACY AND SOCIAL JUSTICE ADVOCACY Advocacy is key for the clinical mental health counseling profession. Counseling professionals recognize the significant influence that sociopolitical systems have upon the mental health of individuals, couples, groups, communities, and society (ACA, 2014; American Mental Health Counseling Association [AMHCA], 2017; CACREP, 2016). They realize that working with a client one-on-one is not always enough and that challenging the prevailing environment may be necessary in order to make significant differences (Chung & Bemak, 2012; Lee, 2019; Zalaquett, Ivey, & Ivey, 2019). All counseling organizations have agreed that it is essential for counselors to inter- vene with clients beyond the individual level, to address the role of factors such as inequalities, oppression, discrimination, barriers, or access to services that affect the lives of clients (Chang, Crethar, & Ratts, 2010, p. 83). Furthermore, as the evolution of advocacy in counseling has progressed, the term advocacy has become identified with counselors’ actions to champion the profession of counseling and related associations, and the term social justice advocacy was introduced to identify advocacy in the ser- vice of client and groups (Toporek, Lewis, & Crethar, 2009). Social justice advocacy includes “the action taken by a counseling professional for the purpose of removing external and institutional barriers to clients’ well-being” (Toporek et al., 2009, p. 6). The two overarching goals of social justice advocacy are: (a) to increase a client’s sense of personal power, and (b) to foster environmental changes that reflect greater respon- siveness to a client’s personal needs (Lee, 2019). Efforts to advance social justice advo- cacy among counselors have increased in recent years (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2016). Clinical mental health counselors are in a fundamental position to advocate for their profession, associations, groups, and their clients. Equipped with a bioecologi- cal perspective, clinical mental health counselors understand how clinical issues are Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. affected by the social systems in which their clients are immersed (see Chapter 11). Furthermore, by virtue of their professional training, competencies, and roles, clin- ical mental health counselors can identify societal aspects that affect the well-being of individuals and groups, in both positive and negative ways, and, in turn, serve as clinical mental health counselor advocates. Clinical mental health counselor advocates have the responsibility to intervene when negative effects are identified. This expectation explicitly is mentioned in the ACA Code of Ethics: “Counselors are expected to advocate to promote changes at the individual, group, institutional, and societal levels that improve the quality of life for individuals and groups and remove potential barriers to the provision or access of appropriate services being offered” (ACA, 2015, p. 4). The standards of the CACREP (2016) and the professional standards of the AMHCA (2015) articulate similar expectations. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 187 T I P F R O M T HE FI E LD 9. 1 THE ADVOCATE ROLE OF THE CLINICAL MENTAL HEALTH COUNSELOR The AMHCA Code of Ethics defines the advocate role of clinical mental health counselors as follows: 2. Advocate Mental health counselors may serve as advocates at the individual, institutional, and/ or societal level in an effort to foster sociopolitical change that meets the needs of the client or the community. a) Mental health counselors are aware of and make every effort to avoid pitfalls of advocacy including conflicts of interest, inappropriate relationships and other negative consequences. Mental health counselors remain sensitive to the poten- tial personal and cultural impact on clients of their advocacy efforts. b) Mental health counselors may encourage clients to challenge familial, institu- tional, and societal obstacles to their growth and development and they may advocate on the clients’ behalf. Mental health counselors remain aware of the potential dangers of becoming overly involved as an advocate. c) Mental health counselors may only speak on their behalf and are clear, cautious, and authorized to speak on the behalf of any counseling organization. d) Mental health counselors endeavor to speak factually and discern facts from opinions. (AMHCA, 2015, p. 4) The AMHCA Code of Ethics description of the role of an advocate highlights the importance of considering the clients’ context and avoiding treating clients in isolation, because the clients’ issues may stem from the oppression and discrimination these clients experience from the social systems with which they interact (Ratts & Hutchins, 2009). The Code fur- ther stipulates the importance of maintaining appropriate professional counselor–client boundaries, which has very important and essential implications for work in the field. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. THE CLINICAL MENTAL HEALTH COUNSELOR ADVOCATE Clinical mental health counselor advocates acknowledge the need to confront inequal- ities, oppression, discrimination, and limited access to health systems at the individual (micro), community (meso), and public policy (macro) levels, as outlined by the ACA Advocacy Competencies. They work to change the conditions of the systems that have an impact on their clients, work to empower their clients so that they can advocate for themselves, and work to effect changes within their profession so that they can become more effective agents of change (Lewis, Arnold, House, & Toporek, 2002). Clinical mental health counselors understand that each of their clients is a part of the environments that may be oppressing them socially, culturally, or economically (Chang et al., 2010). The need for advocacy may include initiatives to increase mental healthcare in schools; to remove health and work inequalities; to promote gender equity; to combat López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  188 Section IV Working Within Systems racism; and to implement social action strategies with lesbian, gay, bisexual, transgen- der, queer, asexual, and other sexual orientation (LGBTQA+) communities, older adults, clients with disabilities, and counseling services for undocumented immigrants. Clinical mental health counselors avoid traditional intrapsychic or individualistic approaches to mental healthcare, because these approaches may deny clients, especially marginalized clients, of the realities in which they live and from which they suffer. These approaches fault the clients for their issues, perpetuate a blame-the-victim attitude, use culturally biased diagnostic criteria, and preserve social injustice and cultural oppression within the counseling profession (Greenleaf & Williams, 2009). Clinical mental health coun- selor advocates recognize that diagnoses such as depression, anxiety, and oppositional defiant disorder may be the result of the stress experienced by populations that lack power, are oppressed, or are marginalized (Greenleaf & Williams, 2009). Research on health inequalities shows how marginalized populations are frequently under-, over-, or misdiagnosed with psychopathology within the healthcare professions (Greenleaf & Williams, 2009). Furthermore, findings from various studies show the con- nection between social oppression—including classism, ethnic/racial discrimination, ageism, and sexism, to mention a few—and negative health outcomes such as depression, anxiety, posttraumatic stress disorder, substance use, and suicide (Greenleaf, Williams, & Duys, 2015). Many of the marginalized populations under discussion here are “benefici- aries” of historical or transgenerational trauma, which is a direct consequence of earlier colonialism and oppression (see Chapter 5 for a fuller discussion). Social justice advocacy “uses social advocacy and activism as a means to address inequit- able, social, political, and economic conditions that impede the academic, career, and per- sonal/social development of individuals, families, and communities” (Ratts & Hutchins, 2009, p. 160). Social justice advocacy typically is initiated at the client level, using appropriate self-empowerment techniques; however, clinical mental health counselor advocates need to be prepared to address systems of oppression, discrimination, and privilege, at multiple lev- els, in order to advance the well-being of their clients. To achieve this goal, clinical mental Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. health counselor advocates need to have the awareness, knowledge, skills, and actions to do so (Decker, Manis, & Paylo, 2016). Case Illustration 9.1, presented at the end of the chapter, illustrates a counselor’s social justice advocacy on behalf of those who use a service dog for a medical or psychological purpose. Tip from the Field 9.2 presents the advocacy competencies model to help clinical mental health counselors sharpen their advocacy skills. T I P F R O M T H E FI E LD 9. 2 EX A M P L E O F SO CI AL JU STI CE A D VOCACY BY A CL IN ICAL MEN TAL H EA LT H C O U NSE LOR According to Toporek et al. (2009), the ACA’s (2003) set of advocacy competencies could serve as a framework for counselor social justice advocacy efforts to promote systemic changes in the child welfare system. Ackerman’s (2017) efforts to improve the child wel- fare system provide a good example of social justice advocacy. Her call to action identified the following major concerns regarding the welfare system and offered a plan for action: López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 189 (1) Racial disproportionality: Children of color (33% of the total child population in the United States) make up more than 55% of children in foster care. These children have fewer contacts with caseworkers, fewer written case plans, and fewer developmental or psychological assessments, and they receive fewer vis- its with their birth families and remain in foster care longer than White children, with similar conditions. (2) Organizational issues: High number of cases, poor working conditions, and public criticism of the child welfare system produce a negative effect on social workers, creating job stress and burnout, thus reducing performance effectiveness and increasing personnel turnover rates. (3) The inaccessibility of adequate services for families: Families involved with the child welfare system report higher numbers of barriers to attending child mental health service appointments and have a high risk of premature treatment termination. (4) The recruitment and retention of foster parent caregivers: Negative perceptions about the child welfare system, poor preparation for foster-care roles, low fos- ter parent reimbursement rates, and the high cost of housing negatively affect recruitment and retention of foster parents. Many foster parents quit fostering within the first year of service. After describing the disproportionate removal of children of color as a crisis in the child welfare system, Ackerman (2017) called for action to address racism, discrimination, and the differential treatment of children and families of color. She has offered an integrated model for counselor advocacy within the child welfare system and has reminded profes- sionals that counselors are uniquely qualified to engage in social justice advocacy efforts on behalf of children. Clinical mental health counselors are uniquely qualified to work with child welfare work- ers and foster families in order to improve training and stress management. Furthermore, they have expertise in assessing trauma exposure and severity, and using trauma-focused treatments, which are relevant competencies for offering counseling to children with com- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. plex trauma histories. More clinical mental health counselors should advocate for internal counseling positions within child welfare organizations. THE ACA’S SOCIAL JUSTICE ADVOCACY COMPETENCIES The ACA’s Advocacy Competencies (Lewis et al., 2002) offer 43 specific behaviors to guide counselors, in general, and clinical mental health counselor advocates in particu- lar, to act at three levels of intervention: the client or student, the school or community, and the public. Social justice advocacy competencies is the term that currently is used for interventions at the client, group, or public level. The competencies are organized into six domains: (a) client empowerment, (b) client advocacy, (c) community collaboration, (d) systems advocacy, (e) public information, and (f) social/political advocacy (Toporek et al., 2009). Figure 9.1 shows a 3 × 2 matrix of the domains, where the horizontal axis identifies the level of engagement, from micro to macro, and the vertical axis identifies whether the action is with, or on behalf of, the client. The top identifies the level of López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  190 Section IV Working Within Systems Client/Student School/Community Public Arena Acting With Client/Student Community Public Empowerment Collaboration Information Client/Student Systems Social/Political Advocacy Advocacy Advocacy Acting on Behalf Microlevel Macrolevel FIGURE 9.1 American Counseling Association’s advocacy competency domains. SOURCE: Lewis, J., Arnold, M. S., House, R., & Toporek, R. (2002). ACA advocacy competencies. Retrieved from https://www.counseling.org/Resources/Competencies/Advocacy_Competencies.pdf intervention and the six domains identify the specific counselor competencies that are relevant to that domain. Table 9.1 provides a sample of those competencies per domain. Clinical mental health counselors can use the social justice advocacy competencies to empower clients by helping them to identify their own personal strengths and resources, and to learn the skills necessary to take action and promote change. Throughout this pro- cess, clients will become aware of their own abilities to advocate for themselves and will grow more resilient. The current multicultural and social justice competencies (Ratts et al., 2016) assert that multicultural and social justice counselor advocates (a) address the intrapersonal processes that have an impact on clients, (b) address inequities at the institutional level (e.g., schools, churches, and community organizations), (c) address norms, values, and Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. regulations that impede the development of individuals, groups, and communities, (d) address public policy issues that impinge on client development with and on behalf of clients, and (e) address international and global events, affairs, and policies that hinder client development with and on behalf of clients. Counselors believe that every client, regardless of race, ethnicity, gender identity, socioeconomic status, and beliefs, has the right to quality education, healthcare services, and employment opportunities (Lewis, Ratts, Paladino, & Toporek, 2011). Clinical mental health counselor advocates act with the specific goal of ensuring that clients have the opportunity to reach their personal, social, and career potentials, free from unnecessary barriers. POTENTIAL STRENGTHS AND LIMITATIONS OF SOCIAL JUSTICE ADVOCATES Effective clinical mental health counselor social justice advocates work directly with cli- ents, families, and groups and contribute to changing social policies through professional López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 191 TABLE 9.1 Examples of the 43 advocacy competencies (Lewis et al., 2002) within each advocacy domain, listed by their original numbers CLIENT/STUDENT SCHOOL/COMMUNITY PUBLIC ARENA Client/Student Community Collaboration Public Information Empowerment When working collaboratively In informing the public about In direct interventions, the with community partners, the the role of environmental counselor is able to: counselor is able to: factors in human develop­ 1. Identify strengths and re­ 16. Develop alliances with ment, the advocacy-oriented sources of clients and students. groups working for change. counselor is able to: 3. Recognize the signs 17. Use effective listening 30. Recognize the impact of indicating that an individu­ skills to gain understanding oppression and other barriers al’s behaviors and concerns of the group’s goals. to healthy development. reflect responses to systemic 21. Assess the effect of coun­ 31. Identify environmental or internalized oppression. selor’s interaction with the factors that are protective of 6. Help students and clients community. healthy development. develop self-advocacy action 34. Disseminate information plans. through a variety of media. Client/Student Advocacy Systems Advocacy Social/Political Advocacy In environmental interven­ In exerting systems-change In influencing public policy tions on behalf of clients and leadership at the school or in a large, public arena, the students, the counselor is community level, the advo­ advocacy-oriented counselor able to: cacy-oriented counselor is is able to: 8. Negotiate relevant services able to: 41. With allies, prepare con­ and education systems on 22. Identify environmental vincing data and rationales behalf of clients and students. factors impinging on stu­ for change. 9. Help clients and students dents’ or clients’ develop­ 42. With allies, lobby legisla­ gain access to needed re­ ment. tors and other policy makers. sources. 24. In collaboration with 43. Maintain open dialogue 12. Identify potential allies for other stakeholders, develop a with communities and clients confronting the barriers. vision to guide change. to ensure that the social/pol­ 13. Carry out the plan of 28. Recognize and deal with itical advocacy is consistent action. resistance. with the initial goals. SOURCE: Lewis, J., Arnold, M. S., House, R., & Toporek, R. (2002). ACA advocacy competencies. Retrieved from https://www.counseling.org/Resources/Competencies/Advocacy_Competencies.pdf Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. writings and collaboration with the social systems affecting clients. Clinical mental health counselor advocates are well trained in counseling skills and multicultural competencies; recognize human suffering; use effective communication skills; use a systems-of-socio- cultural-influence perspective; identify mental health disparities; have individual, group, and organizational intervention skills; are competent in social justice advocacy skills; have the ability to deal with conflict; know effective psychoeducational methods to empower clients with self-advocacy skills; collaborate with clients in a diversity-sensitive manner; and act with the best interest of the client in mind (Brubaker, Puig, Reese, & Young, 2010; Chung & Bemak, 2012). At a personal level, counselor advocates are intentional, motivated, persistent, tenacious, flexible, patient, assertive, organized, resourceful, cre- ative, display humility, and have a profound respect for others (Chung & Bemak, 2012). Ineffective clinical mental health counselor advocates are guided by personal or hidden agendas oriented toward personal gains, have some desire to fulfill personal motivations, need to promote themselves, augment their notoriety, or increase their personal power (Smith, Reynolds, & Rovnak, 2009). López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  192 Section IV Working Within Systems T I P F O R T H E FI E LD 9. 3 P O S S I B LE I SSU E S FO R CLI NI CA L MEN TAL HEALTH COUN SEL OR A D VO C A C Y Jim Messina (2019), one of the founders of the AMHCA, has offered a list of potential targets for social advocacy by clinical mental health counselors. This list has focused on addressing the long-standing social stigma associated with mental health services as well as on helping clients and their families to cope with the effects of stigma. Messina also advises clinical mental health counselors to proactively assist clients who have been victimized or marginalized in any way, and to think through these issues with pre- ventive measures in mind. This list is helpful in terms of thinking through many of the professional advocacy issues that continue to demand the attention of clinical mental health counselors. The full list can be found at the following website: http://coping.us/ cmhcprofessionalization/advocacyissuesforcmhcs.html The ACA advocacy competencies naturally have steered counselors to populations such as those mentioned in Messina’s list. In their ACA Advocacy Competencies, Lewis et al. (2002) have articulated an imperative for recognizing and validating the systemic influence of cultural, political, social, and economic factors upon people and their com- munities. They have suggested that such an imperative pushes counselors to engage in activism that, in turn, can assist the clients with whom counselors work to empower themselves. These advocacy competencies can be found at the following website: www.counseling.org/docs/default-source/competencies/aca-2018-advocacy-competencies.pdf?sfvrsn=1dca552c_6 Two Ongoing Advocacy Efforts Two ongoing advocacy efforts continue to require the attention of the professional coun- seling field: including clinical mental health counselors in Medicare and facilitating and Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. implementing a strategy for the national portability of professional counselor licenses. These important issues are outlined, briefly, as follows. Inclusion of Clinical Mental Healthcare Counselors in Medicare Medicare, the largest healthcare program in the United States, reimburses psychiatrists, psychologists, clinical social workers, and psychiatric nurses for outpatient behavioral mental health services. The program does not reimburse clinical mental health coun- selors for similar services. Advocacy for parity of clinical mental health counselors with other professions is an ongoing effort. Licensure Portability A national licensure portability program is necessary in a world with a mobile workforce, thus emphasizing the need to ensure a minimum quality of preservice preparation for professional mental health providers. Being a clinical mental health counselor should López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 193 have the same meaning from state to state. A portable license would affirm minimum standards for safe practice, create consistency in licensure standards across all the U.S. states, protect clients, and increase public access to qualified care. Discussion Clinical mental health counselors are well qualified to provide the mental health services covered by Medicare. Medicare beneficiaries need more mental health services than are available currently, and they should have the right to access the type of mental health care- giver, across the various mental health disciplines, who best meets their needs. Licensed clinical mental health counselors are trained to diagnose and treat mental health disor- ders and are available to serve clients in rural and underserved areas, which are areas of high need for services. Clinical mental health counselors need to support ongoing and upcoming efforts to gain access to Medicare and license portability. CASE ILLUSTRATION 9.1 CHALLENGES FACED BY SERVICE DOG HANDLERS AND THEIR ADVOCATES By K. Lynn Pierce Todd is a young professional who uses a service dog for medical alert assistance. His service dog is able to let him know when his vital signs are outside of his normal threshold. He can also retrieve objects or get help for Todd in an emergency. Because many people are un- aware of the laws pertaining to service dogs, Todd routinely encounters access issues where owners of businesses attempt to exclude him, often referencing problems with other animals in the past. He is afraid of standing up for himself in these situations and will often leave and go somewhere else, because a storeowner once called the police. The police didn’t know the laws either and made him leave. He sometimes risks leaving his service dog at home to Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. avoid the embarrassment of being asked to leave. Todd has found that his service dog has a drastic impact on his ability to network and develop his professional identity. At conferences, people around him discuss research and projects. He is almost never asked about anything except his service dog. He has to main- tain his service dog’s training and his own safety by preventing distractions but knows he is sometimes seen as rude when he asks people not to pet her or talk to her. Because of a lack of awareness of service dog etiquette, he finds himself constantly othered (to be viewed as and treated as different or lesser) because of his need for a service dog as an assistive device. He frequently is excluded from opportunities to engage as others do or to receive the same access, services, and experiences as others. As a counselor and a counselor educator in training, I have worked with and advocated for individual handlers like Todd, as well as counselors and other service providers who work with this demographic. Service dogs increasingly are used for a variety of disabilities. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  194 Section IV Working Within Systems In the case of those with mental health concerns that can be helped by a service dog, coun- selors play an important role in providing access to resources. They can help their client de- termine whether a service dog is the right treatment choice, direct the client toward quality information and resources, and may provide a recommendation for a training program that may take on the client as a prospective service dog handler. Having this knowledge allows counselors to provide more comprehensive care. In my advocacy work supporting service dog handlers, I have worked on a number of levels and in different ways to support clients and the needs of the community of indi- viduals who use service dogs. I have educated mental health professionals about service dog laws and etiquette and provided consultation for clinicians whose goal is to assess a client’s suitability as a service dog handler. For existing handlers like Todd, providing a safe environment might involve ensuring that colleagues know the basics of etiquette and that Todd has a way to escape a negative interaction with another client in the waiting room. In working with Todd, some goals may be to increase resources for self-advocacy, to process the trauma inflicted by the high levels of discrimination that service dog handlers experience, and to make plans to address likely barriers moving forward. On a broader level, I have seen success in educating professionals who are most likely, inadvertently, to cause barriers to necessary services/support to service dog handlers due to lack of awareness and education. Counselors are in a position to form alliances with police departments, behavioral health units, medical professionals, and other service providers. We also can ensure that access to information about marginalized populations is available and disseminated in our profession. Our research can provide the basis for new policies for and new understandings about underrepresented groups in the broader society. For advocacy-oriented counselors, one key is to continue to seek new opportunities for advocacy and new alliances. Public perception, embedded stigma, and far-reaching laws and policies are not going to be changed drastically in a short period of time. I have watched as people I have educated have begun to educate others. Through my community connec- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. tions, I hear positive stories that are the result of my work or the work of others who are doing similar things. I have found that I need to recalibrate my expected outcomes to be open to the evidence that shows that I am making an impact. This recalibration allows me to be a more empowered advocate, when at times it would be easy to become frustrated and discouraged. It also informs my future advocacy work, as I am more aware of small results and can build purposefully upon those toward bigger successes. To learn more about how counselors can work effectively and compassionately with ser- vice dog handlers, see “Understanding and Working with Service Dog Handlers” in Coun- seling Today. RESOURCES ADA National Network. (2014). Service animals and emotional support animals. Retrieved from https://adata.org/publication/service-animals-booklet López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 195 Assistance Dogs International. (2019). Home. Retrieved from http://www.assistancedogs international.org Counseling Today. Retrieved from https://ct.counseling.org/2018/10/understanding-and -working-with-service-dog-handlers Mills, M. (2017). Invisible disabilities, visible service dogs: The discrimination of service dog handlers. Disability & Society, 32, 635–656. doi:10.1080/09687599.2017.1307718 Pierce, K. L. (2018, October). Understanding and working with service dog handlers. U.S. Department of Justice. (2011). ADA requirements: Service animals. Retrieved from https://www.ada.gov/service_animals_2010.htm CONCLUSION This chapter addressed the importance of advocacy skills and emphasized using social justice advocacy competencies in the work with clients. Clinical mental health coun- selor advocates rely on the advocacy competencies to guide their assistance to clients in removing barriers and to secure deserving resources, or to advocate on behalf of clients, groups, or communities. Clinical mental health counselors are in a privileged position to address social and institutional barriers depriving clients, especially clients from underprivileged groups, access to quality mental health services. Clinical men- tal health counselor advocates use their awareness, knowledge, and competencies to address inequalities, to help clients gain knowledge of available resources, and to pro- mote the development of self-advocacy skills and stronger resiliency in clients. Clinical mental health counselor advocates also work with allies on behalf of their clients. They become the voice of marginalized groups to identify and remove barriers to mental healthcare, increase quality of required services, and influence policies and regulations to ensure best treatments and quality services for those in need. Advocacy for the pro- fession is also an important function of clinical mental health professionals. Clinical mental health counselors are trained and licensed to provide services in multiple types of behavioral health organizations, to be covered by Medicare, to serve populations Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. in need of services, with sensitivity to diversity, and to work in underserved areas. Clinical mental health counselor advocates are guided by the belief that every client, regardless of race, ethnicity, gender identity, socioeconomic status, and beliefs, has the right to quality healthcare services, and they advocate to ensure that each client has the opportunity to reach his or her personal, social, and career potential, free from unnecessary barriers. RESOURCES American Counseling Association's (ACA) Government Affairs: https://www.counseling​.org/government-affairs/actioncenter. ACA supports the counseling profession through government affairs initiatives at the federal and state levels. ACA’s voting system represents an effective way to communicate with legislators and policy member to advance policies that increase counselors access to behavioral health services, develop parity with other professionals, and create better systems of care. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  196 Section IV Working Within Systems American Mental Health Counselors Association Advocacy Handbook: Federal Advocacy Handbook for the American Mental Health Counselors Association. https:// higherlogicdownload.s3.amazonaws.com/AMHCA/6664039b-12a0-4d03-8199 -32c785fe1687/UploadedImages/Documents/AdvocacyHandbook.pdf. The handbook offers best ways to navigate the legislative system and send advocacy messages that get the attention of the relevant legislators. American Mental Health Counselors Association’s Policy Agenda: http://www.amhca.org/ advocacy/policyagenda. Find current information on AMHCA’s advocacy initiatives in Congress and state legislatures. Chung, R. C-Y., & Bemak, F. (2012). Social justice counseling: The next steps beyond multiculturalism. Thousand Oaks, CA: Sage. The book addresses issues of social class, race, and ethnicity, and others from a social justice perspective. Courtland C. Lee (Ed.) (2019). Counseling for social justice (3rd ed.). Hoboken, NJ: Wiley. A thorough examination of social justice counseling from local and global perspectives. Ideas for promoting social justice and challenging oppression and marginalization with individual clients and communities are presented. Donald, E. J., & Moro, R. R. (2011). Engaging students and supervisees in social justice: The social justice toolbox. Article 10. Vistas Online. Retrieved from https://www.counseling​.org/docs/defaultsource/vistas/article_10.pdf?sfvrsn=1c003afc_12. A collection of tools to become actively involved in social justice advocacy. Medicare Coverage for Clinical Mental Health Counseling, a Gulf Coast Mental Health Counselors’ call for legislative action to include clinical mental health counseling under Medicare coverage. This video, created by the legislative committee of GCMHC, can be accessed here: https://www.youtube.com/watch?v=wjfILTJ-o-w&feature=youtu.be Multicultural Counseling and Social Justice Competencies: http://toporek.org/index.html. The website, produced by Rebecca Toporek, offers a wide variety of resources to develop multicultural, social justice, advocacy, and counseling competence. NBCC Government Affairs: https://www.nbcc.org/GovtAffairs. NBCC supports the counseling profession through government affairs initiatives at the federal and state levels. NBCC works with public and private stakeholders to implement policies that increase access of counselors to existing agencies or funders (e.g., Medicare), add more funding to counselors, and create better systems of integrated care. World Health Organization. (2003). Advocacy for mental health. https://www.who.int/mental Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. _health/policy/services/1_advocacy_WEB_07.pdf. Information about the importance of mental health advocacy to promote the human rights of persons with mental disorders and to reduce stigma and discrimination. Provide various actions aimed to change structural and attitudinal barriers to achieving positive mental health outcomes in populations. REFERENCES Ackerman, A. M. (2017). An integrated model for counselor social justice advocacy in child welfare. The Family Journal, 25, 389–397. doi:10.1177/1066480717736061 American Counseling Association. (2015). ACA code of ethics. Alexandria, VA: Author. American Mental Health Counselors Association. (2015). Code of ethics. Retrieved from https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?Document​ FileKey=5ff5bc94-e534-091e-c7c1-e3ea45cf943e&forceDialog=0 American Mental Health Counselors Association. (2017). AMHCA standards for the practice of clinical mental health counseling. Retrieved from http://www.amhca.org/learn/standards López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  Chapter 9 Client Advocacy, Access, Equity, and Resilience 197 Brubaker, M. D., Puig, A., Reese, R. F., & Young, J. (2010). Integrating social justice into counseling theories pedagogy: A case example. Counselor Education and Supervision, 50(2), 88–102. doi:10.1002/j.1556-6978.2010.tb00111.x Chang, C. Y., Crethar, H. C., & Ratts, M. J. (2010). Social justice: A national imperative for counselor education and supervision. Counselor Education & Supervision, 50, 82–87. doi:10.1002/j.1556-6978.2010.tb00110.x Chung, R. C., & Bemak, F. P. (2012). Social justice counseling: The next steps beyond multiculturalism. Thousand Oaks, CA: SAGE. Council for Accreditation of Counseling and Related Educational Programs. (2016). 2016 standards. Alexandria, VA: Author. Decker, K. M., Manis, A. A., & Paylo, M. J. (2016). Infusing social justice advocacy into counselor education: Strategies and recommendations. Journal of Counselor Preparation and Supervision, 8(3). doi:10.7729/83.1092 Greenleaf, A. T., & Williams, J. M. (2009). Supporting social justice advocacy: A paradigm shift towards an ecological perspective. Journal for Social Action in Counseling and Psychology, 2, 1–14. Greenleaf, A. T., Williams, J. M., & Duys, D. K. (2015). Awareness of counselor trainees on clients’ social barriers. Journal of Counselor Practice, 6, 25–38. doi:10.22229/ctc592017 Lee, C. C. (Ed.). (2019). Counseling for Social Justice (3rd ed.). Alexandria, VA: American Counseling Association Foundation. Lewis, J., Arnold, M. S., House, R., & Toporek, R. (2002). ACA advocacy competencies. Retrieved from https://www.counseling.org/docs/default-source/competencies/aca-2018​ -advocacy​-competencies.pdf?sfvrsn=1dca552c_6 Lewis, J. A., Ratts, M. J., Paladino, D. A., & Toporek, R. L. (2011). Social justice counseling and advocacy: Developing new leadership roles and competencies. Journal for Social Action in Counseling and Psychology, 3, 5–16. Messina, J. (2019). Social advocacy issues for which CMHCs could advocate. Retrieved from http://coping.us/cmhcprofessionalization.html Ratts, M. J., & Hutchins, A. M. (2009). ACA advocacy competencies: Social justice advocacy at the client/student level. Journal of Counseling and Development, 87, 269–275. doi:10.1002/j.1556-6678.2009.tb00106.x Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. profession. Journal of Multicultural Counseling and Development, 44, 28–48. doi:10.1002/ jmcd.12035 Smith, S. D., Reynolds, C. A., & Rovnak, A. (2009). A critical analysis of the social advocacy movement in counseling. Journal of Counseling & Development, 87, 483–491. doi:10.1002/j.1556-6678.2009.tb00133.x Toporek, R. L., Lewis, J. A., & Crethar, H. C. (2009). Promoting systemic change through the ACA Advocacy Competencies. Journal of Counseling & Development, 87, 260–268. doi:10.1002/j.1556-6678.2009.tb00105.x Zalaquett, C. P., Ivey, A., & Ivey, M. B. (2019). Essential theories of counseling and psychotherapy: Everyday practice in our diverse world. San Diego, CA: Cognella Academic Publishing. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  CHAPTER 10 PROFESSIONAL ROLES AND FUNCTIONS IN CLINICAL MENTAL HEALTH COUNSELING REGINA R. MORO This chapter takes an in-depth look at the variety of functions, counseling and administrative roles, and tasks that may be required of counselors in clinical mental health settings. Pertinent issues include balancing consumer care with administrative duties, balancing employee well-being with productivity standards/financial concerns, ethical marketing and recruitment, and remaining current in the field while in nonclinical roles. The following Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are addressed in this chapter: CACREP 2016: 2F1.b, 2F1.i, 5C2.a CACREP 2009: 2G1.a, 2G1.b Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. LEARNING OBJECTIVES After reviewing this chapter, the reader should be able to: 1. Name common roles and functions of clinical mental health counselors. 2. Discuss the clinical tensions experienced among clinical mental health counsel- ors in relation to their job roles. 3. Synthesize an understanding of the complex role a clinical mental health counselor serves in relation to best practices, professional ethics, and legislative regulations. 4. Recommend roles and functions that a clinical mental health counselor could perform in a larger system of care. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-04 19:27:30.  200 Section IV Working Within Systems INTRODUCTION This chapter explores the professional roles and functions of clinical mental health coun- selors working in integrated systems of care. The common English phrase, “the more things change, the more they stay the same,” captures the essence of this chapter well. Our professional roles have evolved over time, and there is a great variety among the roles and functions of clinical mental health counselors in each and every different sys- tem of work. However, there are also great commonalities that continue to define our identity as professionals. As a master’s student doing my first field placement in a college counseling center, I remember being amazed by the professional counselors with whom I was working. I was