Ethical issues in the provision of wraparound services

Although ethical dilemmas abound in all clinical settings to one degree or another, a particular ethical challenge is created when mental health services are provided in clients' homes or in the community setting. Wraparound services in Pennsylvania target children and adolescents with mental health needs and are provided in clients' homes or schools.;Despite the fact that these types of services are replete with ethical traps for the clinicians who provide them, little research addressing the possibilities of inherent ethical problems exists. Consequently, this study aimed to explore such issues and fill this gap in the professional literature.;One hundred eight (108) wraparound workers were surveyed, using a three part questionnaire, to determine the extent to which academic training received in ethics, academic discipline, major area of study and years of experience working in wraparound services predicted the ability to make decisions congruent with current professional Ethical Codes of Conduct. A factor analysis was also conducted on Part II of a questionnaire, based on one used by Borys and Pope (1989) to establish the presence of their three factors and a theorized fourth factor termed confidentiality.;Results from the multiple regression analysis indicated that none of the independent variables significantly predicted ethical decision making. Additionally, while the factors derived in the factor analysis included a confidentiality factor as theorized, none of the loadings were consistent with the Borys and Pope (1989) findings. The four factors derived from this study seemed to indicate that this sample attended more to the scale of the ethical violation described rather than to a categorical judgment of ethical violation as defined in the Borys and Pope (1989) study.;These results may indicate that the majority of wraparound workers have a greater awareness of ethical decision making than was believed and, as a group, these providers report the confidence, as well as training, awareness and knowledge of professional ethics to guide their practice. Results are discussed in terms of sampling limitations and differences between this study and the Borys and Pope (1989) study and the possibility of a social desirability bias influencing subject responding.