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Obtaining informed consent for services from clients is required of human services providers; however, it is not always an easy task. Clients typically grant consent by signing documents presented by the agency or the provider that, at minimum, explain the services that will be provided, the client rights, and information on the steps to rescind the consent.

In situations where minors or individuals under some form of guardianship are the clients, it is necessary to obtain consent from the legal guardian or authority. However, there are times when obtaining informed consent is not as simple as asking for a signature from the client or guardian. These situations require more thought by the human services providers with emphasis on balancing the client’s right to consent with other factors that might influence treatment outcomes or decisions.

In this assignment, you will review a case that illustrates the various facets of informed consent.

The Case:

Smith is a thirty-eight-year-old African American male referred for counseling by his mother to address recent incidents of aggression. Smith resides with his mother because he is not able to live on his own. Smith is unable to hold on to a job and has difficulty establishing and maintaining relationships with others. He is open to counseling but thinks his mother is overreacting to his anger outbursts because she is old and does not understand him. Recently, there have been notable conflicts between them due to Smith’s aggressive behaviors that were directed toward his mother.

Tasks:

Analyze the case and in a 2- to 3-page paper, address the following:

What steps would you, as the counselor, take for obtaining informed consent from Smith?
Would you, as the counselor, include his mother in the counseling sessions, if you believe it would help with Smith’s aggression problem? Why or why not?

In your answers, consider the following:

Smith is not able to live independently.
Smith’s aggression might put his mother at risk if he does not get counseling.
Smith has to comprehend what is being asked of him when he provides his consent to receive counseling services.
There might be cultural differences between you and Smith.

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July 1, 2023



Small Fish Case

Small Fish is an "image management" firm. It was initiated by two graphic design graduates, Nadine and Hafiz in 2015. They began designing logos and corporate images for mid to large corporations, as well as annual reports, and other self-promotion material. Spurred on by a slick and sleek, no-nonsense image, they began to expand into advertising. During these boom years, the firm expanded, with the hiring of designers and copywriters.

During the early days Hafiz preferred a conventional (read “safe”) business approach, whereas Nadine was far more radical and “wild west”. This gave rise to some serious disagreements about how Small Fish should proceed. Hafiz wanted to “play it safe” both in terms of the design formula as well as in terms of business expansion. Nadine, on the other hand, saw opportunities where Hafiz saw dangers. This gave rise to some serious conflict during their first expansion, to the point that Nadine and Hafiz seriously contemplated disbanding the studio all together. The staff for the most part took sides, until it reached a point where bickering dominated the working day. It was at this point that Nadine and Hafiz took a trip to Zürich for a design conference, and, although there were rumours, no one knew what transpired other than that they announced that Small Fish was back in business and ready to take on the world. They returned full of enthusiasm for “Small Fish 2.0” which they saw as a socially conscious, aesthetically daring, and fiscally conservative company that sought to expand into new markets, with fantasies of corporate social responsibility, and indeed radical design concepts.

Small Fish was a fun place to work, by most accounts. The studio was in an old but renovated building in the Barri Gotic, with big windows and open spaces. Designers, techs, and copywriters sat at long tables with French crooners like Edith Piaf, Arabic music or jazz playing in the background. It was a pleasant atmosphere that reflected the cultures of Nadine (France) and Hafiz (Syria). It was an afternoon ritual to kick back, sip sweet mint tea, and discuss the latest goings on. The staff loved these moments where the intensity of meeting deadlines was put on hold and everyone, from the most junior intern to the big bosses would hang out and chat. There was a real sense that Small Fish was going places, with their design and with their social activism. Things, to say the least, were going well. Internships were competitively sought after, both because of the high quality design (Small Fish had been featured in various international design journals having won a number of awards), and because of the “cool” environment.

As business was going well, Hafiz and Nadine preferred to dedicate themselves to the creative side of things, and decided to hire someone with "business sense" who would attend to growing the firm, increasing client base, and above manage the financials, something that neither Nadine nor Hafiz were all that interested in (or good at). Montse was hired on as corporate director in 2018. Hafiz was designated "executive director", a position that functioned more in spirit (and in large part served to ensure that the immigration people renewed his work visa) than in day-to-day operations, and Nadine was made head of the design department.

Under Montse, the firm was organized and expanded. She created three departments: Marketing, design, and copywriting. Only design remained fully under Nadine’s and Hafiz’s control. The new marketing and copywriting departments were tightly run with firm schedules and clearly defined objectives that were reviewed regularly. Montse insisted that design do the same, and drop the rap sessions (long gone in the other deparments), but Nadine and Hafiz held firm.The firm did very well under Montse’s corporate vision, increasing sales considerably. Hafiz and Nadine were somewhat overwhelmed with the expansion and expressed their appreciation to Montse, at the same time, they had hoped to see those corporate social responsibility fantasies come to fruition. Montse insisted she was moving things in that direction, by getting clients such as Doctors without Borders and Caritas, both of which had large budgets, but to Hafiz and especially Nadine, it looked more like Small Fish was lining their pockets rather than “making a difference” in any real sense.

And just as they were expanding under Montse’s careful guidance, the pandemic hit, business began to wane considerably, and tensions increased in kind. For one thing, the expansion had resulted in the different departments becoming increasingly separated. In the face of the various restrictions, people worked remotely, and of course the rap sessions and anything of the “cool vibe” were increasingly difficult to maintain. As the cash inflow slowed, people had to be let go or had their hours reduced, and things began to become more tense. Even as employees returned to the office, Montse would remind Hafiz and Nadine that business was such that there was it made no financial sense to pay employees to sit around and do nothing (as she saw the rap sessions).

(the back story on Montse: She had always been a serious student and hard worker, and very ambitious at that. She studied business at the University of Barcelona, and got a job at Deloitte after having interned there. Things went really well for her for a few years, until she got into a rather big bust-up with one of the executives. It was never clear what happened, but much to her chagrin, she found herself unemployed, now in her early 30s, competing against grads for jobs. Someone told her about the Small Fish gig, and although she had never had much time for idealism and art, she was intrigued by the challenge, and decided to see what she could do.)

In the past few months the atmosphere at Small Fish has been getting rather uncomfortable. The weekly “exec” meetings were fraught with tension, with Montse telling anyone who would listen that “artists could be so smart but sooo stupid”. Meanwhile Nadine and Hafiz openly criticized Montse for being a “corporate vampire”. “We are losing our soul” they would lament over red wine after work.

The tension really began to mount. What set the whole thing off as that Montse had organized an important business meeting with a potential client--the latest cryptocurrency that was showing tremendous potential--to discuss corporate image. That might have been fine, although both Nadine and Hafiz, as progressives, were very critical of cryptocurrencies, and as it turns out, Montse did not inform nor include Hafiz or Nadine in the meeting. Furthermore, she asked Magda, head of marketing, to present Small Fish’s “curriculum”, and expressly asked her not to say anything to Hafiz and Nadine.

Of course, they learned about the meeting, and at the next staff meeting, Hafiz and Nadine expressed considerable dismay over how Montse was handling the firm. They felt she was turning it into a "corporate lackey", drooling for the buck, and completely betraying the aesthetic and ethical spirit that Hafiz and Nadine felt characterized (and differentiated) their firm. Montse responded with a steely voice that a crisis was on, and that at this point the key thing was liquidity and maximizing the client base. She asserted that although Hafiz and Nadine were excellent designers, they had poor business sense--which was why they hired her in the first place. She asserted that they should let her do her job (after all, she did not poke her nose in their design stuff). They should respect her expertise; this was not the time for "bleeding heart" morals nor for aspiring to have their work in Spanish and international design magazines. This was the time to pull themselves up by the bootstraps, and if she had Magda run the meeting with Zapitup, it was because she "spoke the corporate language", that the Zapitup folk were not interested in aesthetics but in profit. Nadine herself broke down a cried, and threw up her hands Hafiz responded, in a loud voice, that was all fine but Small Fish had a specific identity and mission, and, at any rate, Montse should keep in mind that although money talks, she is not the CEO. He also reminded her that Small Fish is, always has been, and always will be Nadine’s and his. They were successful before they hired her on. Montse stared at him, steely eyed, and asserted that is was precisely for this sort of behavior that she was the one who should be running the show, that without her running things the “artistes” would run Small Fish into the ground. The rest of the staff present were shocked but not surprised. Morale was at rock bottom, with more and more people either calling in sick or simply being absent from work. Rumors were even circulating amongst some of the clients that Small Fish was

Hafiz and Nadine recognized that the crisis meant that they needed to find new ways of drumming up business, but they also insisted that they did not want to lose their “soul”. For her part, Montse repeated her concern about their “bleeding heart” morals, that were all fine and dandy when the money was flowing in, but the financial liquidity was the bottom line, and ideals were secondary at best. She suggested that Hafiz and Nadine really did not understand business not the local context, nor did they give her the credit she deserved for the tremendous effort she made to keep Small Fish afloat

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