Case 2. Cultural Values and CompetentMental Health Services to MinorsIrina, a 13-year-old girl of Arabic cultural heritage living in Boston, Massachusetts,was brought by her parents to a hospital emergency room after an assault by astranger. Based on her injuries, the hospital staff suspected that the attacker hadalso sexually assaulted the girl, but she and her parents refused medical evaluationsfor rape. The family received a referral to see Janet Matthews, a clinical psychologistspecializing in adolescent trauma. During their initial meeting with Dr. Matthews,the parents asked the psychologist not to discuss any sexual aspects of the assaultwith their daughter but to treat the psychological trauma from the assault in general.They told the psychologist that admitting a rape had taken place would cast astigma on their daughter and make her ineligible to be married to men in theirclosely knit ethnic community. When asked in private, the girl also requested thatsexual issues not be discussed for the same reason.Discussion Questions1. Why is this an ethical dilemma? Which APA Ethical Principles help frame thenature of the dilemma?2. Who are the stakeholders and how will they be affected by how Dr. Matthewsresolves this dilemma?3. How might Irina’s age and parents’ involvement in the referral affect howDr. Matthews can resolve this dilemma? How might state law on treatmentof minors and HIPAA rules on access of guardians to a minor’s health carerecords influence Dr. Matthew’s decision? (See sections on “A Word AboutHIPAA” in the Preface of this book, on parental rights under Standards 3.10b,Informed Consent, in Chapter 6, and the Hot Topic at the end of Chapter 7“Confidentiality and Involvement of Parents in Mental Health Services forChildren and Adolescents.”)4. What attitudes, knowledge, and skills are required to develop a culturallycompetent treatment plan for Irina (see the Hot Topic for Chapter 5“Multicultural Ethical Competence”)?5. Is Irina likely to benefit from the treatment if the possibility of sexual aspectsto the trauma is not explored?6. How are APA Ethical Standards 2.01a, b, and c; 2.04; 3.04; 3.06; 4.01; 4.02;and 10.10a relevant to this case? Which other standards might apply?7. What are Dr. Matthews’s ethical alternatives for resolving this dilemma?Which alternative best reflects the Ethics Code aspirational principles andenforceable standards, legal standards, and Dr. Matthews’s obligations tostakeholders? Can you identify the ethical theory (presented in Chapter 3)guiding your decision?8. What steps should Dr. Matthews take to ethically implement her decisionand monitor its effect?