Case Study
Patient Demographic: Client Age: 9 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Single Counseling Setting: Private practice clinic Type of Counseling: Individual counseling with family involvement Presenting Problem: Behavioral problems and social skills issues Diagnosis: Autism spectrum disorder, without accompanying intellectual impairment (F84.0)
Mental Status Exam: Mental Status Exam: The client is oriented to person, place, situation, and time. The client appears clean and is wearing season-appropriate clothing; however, his parents report that he often wears the same outfit for several days because he gets frustrated with having to change his clothes and showering. The client was minimally involved in the intake session and was instead focused on reading a video game walk-through
Presenting Problem: You are a private practice, licensed counselor. The client is 9 years old and comes to the first session with his parents. The client has been previously diagnosed with autism via use of the Autism Diagnostic Observation Schedule-Second Edition by a psychologist, and you receive supporting documentation for this diagnosis. The client demonstrates difficulties with normal back-and-forth communication with peers, difficulty maintaining eye contact during the session, and difficulty with imaginative play with peers as reported by his parents. The client and his parents also report what they call “OCD behavior”—for example, he often lines up toys and insists that they “have to be this way”—and that he has trouble with changes in schedule, often becoming aggressive toward the parents if changes occur. The parents report that he is very rigid and that certain activities and play have to be done a certain way or he becomes upset, which affect the home, social, and school settings. The client’s intellectual quotient is above average for his age per the supportive testing provided. The parents report that the client’s difficulty with changing plans or daily changes causes him to become angry and confrontational.
Other Contexts:     book. Family History: The client reports that his parents are supportive of his issues that are a result of autism. The client says that his 8-year-old brother gets frustrated sometimes because his parents often support the client and focus on him more due to his autism. The client reports that he does not have any friends.  During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately

Question: During the end of the session, the parents express concern about bills for these services, wanting to ensure that they pay them appropriately. When considering fees, which of the following is the most appropriate response when the payment amount for a session causes economic hardship for the client and they are unable to pay?
(A): The clinician will inform the client about the use of a collection agency in the process of obtaining informed consent and will seek support from the agency when collection is needed.
(B): The clinician will write off the session as pro bono because this would best support the client.
(C): The clinician will use a collection agency if fees cannot be paid.
(D): The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent.

Correct Answer: The clinician will inform the client regarding payments due and seek their payment prior to using the collection agency even when it was included within the informed consent.
Explanation: The most ethical consideration according to the ACA Code of Ethics is providing an opportunity for the client to make a payment prior to seeking a collection agency (ACA Governing Council, 2014). Using a collection agency is ethical if the client is informed of this in the informed consent process and if they have been provided a chance to pay the fees. Writing off the sessions as pro bono should not be the first consideration because you want to settle on a payment rate that the client can pay prior to considering providing services for free. Therefore, the correct answer is (C)
Competency: professional practice and ethics