Preliminary Rehabilitation Assessment

General Review:

Carlosis a 33-year old Hispanic man who is married and has one child at home. Although both ofCarlos' parents are hearing,Carloshas been hard of hearing since birth. His most recent audiogram from 2019, indicated a BEA=78 dB, which is within the severe hearing loss range.Carlosreports however, that he has never used hearing aids.Carloswas employed as a clerk and stock person in a postal exchange connected to a military installation. Recent base cutbacks resulted in job termination after 6 years in this position, and a 20-month search has yielded no new job to date. He is currently receiving Social Security Income benefits. Carlossays he would like to be an architect or draftsperson because "they can make like $80,000 per year!" He has a general idea of rehabilitation from contact during high school and community college.Carlosis seeking career guidance and help dealing with the stress of no longer being a fit husband or leader of his family.

Medical:

Carlos's medical history is generally unremarkable. He does not have a history of serious physical illnesses or extremely high fevers (106 degrees or more). He underwent surgery in Mexico in 2010 for removal of a kidney stone. His mother's pregnancy with him and his own birth were without complications. Carlos reached most developmental milestones on time except for those involving auditory and speech development. He does not have any other history of serious injuries or accidents. He has never lost consciousness or had seizures.

Carlos's family has a history of diabetes and hypothyroidism in his mother's side of the family. In his father's side of the family, there is a history of High Blood Pressure and Heart disease.

Educational:

Carlosattended a day program for deaf and hard of hearing students in Dallas, Texas after moving to the area to live with his aunt when he was 16 years old. After high school he attended Collin County Community College for 2 years, taking a variety of online classes. He received no certificate or degree. Carlos is familiar with computer applications and has keyboarding skills. He typically keyboards in Spanish and uses Google Translate to convert the content to English. Carlos has a driver's license and a vehicle.

Family/Social:

Carlos has been married to his wife Sylvia for the past 10 years. Carlos' wife is working as a maintenance woman at a local high school.They have one daughter aged 9 who is in first grade at Dallas Elementary School. Carlos's father is deceased. He worked for the government in Mexico in their postal system. His mother is a homemaker. Carlos has four brothers and one sister. His sister is the oldest in rank and is a homemaker. His brothers are employed in different settings. One works for the government. Another sells irrigation equipment to farmers. His other brother creates dental prosthetics.

Carlos moved to Texas 15 years ago looking for better educational opportunities for himself upon the insistence of his aunt Petra who lived in Dallas and had heard of the special school for deaf and hard of hearing children. Carlos reports that his transition has gone well. Although Carlos and Sylvia have limited family support in Texas (only aunt Petra), they have been able to develop and maintain a very solid social support network within the Hispanic community.

Carlos reports getting along well with others in general. He meets people easily and has four to five close friends. He is not a member of any social or professional clubs or groups. Carlos attends Our Lady of the Lake Catholic Church. Prior to his loss of hearing, he enjoyed listening to songs, playing some musical instruments, and being physically active with group contact sports such as soccer, volleyball and basketball. Post hearing loss, he does not engage in any of these activities and reports trying to read instead.

Psychological:

Carlos reports feeling generally content with his life. He says, "I'm happy because I'm alive. I have a wonderful wife and a lovely daughter. That's my happiness." He also describes himself as being a "worrier." Carlos says that he does worry a lot about being unable to find a job again due to his hearing limitations and being unable to fully demonstrate work duties to employees. He has also expressed his concern with not being a provider for his family over the past 20 months and depending on his wife's wages for everyday living costs.

Carlos also says, "I want desperately to be able to engage in musical activities again!" He has not seen a counselor or therapist. However, he is interested in joining some type of group sport with people who have disabilities similar to his own. Carlos has never been in trouble with the law. He denies any alcohol or drug abuse.

Vocational:

Carloswas employed as a clerk and stock person in a postal exchange connected to a military installation. As part of his job duties, he was responsible for ringing up purchases, ordering inventory to maintain stock, cleaning the store at the end of the day, and helping with some minor administrative tasks such as creating the weekly work schedule for all the employees. Recent base cutbacks resulted in job termination after 6 years in this position, and a 20-month search has yielded no new job to date. He is currently receiving Social Security Income benefits.

Behavioral Observations:

Carlos is a 33-year-old Hispanic man who is right hand preferred. He is fluent in English and Spanish. Carlos arrived 10 minutes late for his appointment and was unaccompanied. He appeared his stated age and was well groomed. Carlos was of average height (5'9") and average weight (169 pounds). He was neatly and casually attired. Carlos's motor activity was normal. He was attentive and maintained eye contact with the examiner but appeared to strain frequently to listen to the examiner. Rapport was easily established. Carlos related easily to the examiner and was engaged in the evaluation process although he requested the examiner to repeat instructions several times. Mental activity was spontaneous and relevant. Carlos appeared relaxed at the start of the assessment but appeared to become more anxious as testing progressed. He demonstrated a normal frustration tolerance even when he was informed by the examiner that some instructions for tests could not be repeated because of standardization procedures. He worked diligently but slowly on tasks.

Tests and Procedures Administered:

• WechslerAbbreviated Scale of Intelligence (WASI): Verbal and non-verbal intelligence scales
• Wide Range Achievement Test - Revision 3 (WRAT-3): A measurement of reading recognition (pronunciation), spelling and arithmetic skills
• Woodcock Johnson Passage Comprehension Subtest (WJPC): Reading comprehension ability
• Bender Visual Motor Gestalt Test - Regular and Memory Presentations (BVMGT): Measures an individual's visual-motor integration abilities (hand-eye coordination), delayed visual memory and spatial localization abilities.
• HapticVisual Discrimination Test (HVDT): Tactile-visual integration abilities (requires a synthesis of particular elements into a unified whole); visual-spatial problem-solving skills, immediate recall and matching skills are utilized
• Strong Interest Inventory (Strong): In-depth assessment of interests among a broad range of occupations, work and leisure activities, and educational subjects

Test Results and Interpretations:

WechslerAbbreviated Scale of Intelligence (WASI)

Intelligence and Achievement: Carlos'sFull Scale I.Q. of 85 on the WASI is in the average range of intellectual functioning. A significant disparity is observed between his Verbal (VIQ = 71) and Performance (PIQ = 104) cognitive abilities. His expressive vocabulary and abstract reasoning (in English) are in the below average range. Within the non-verbal factor, his visual-spatial constructional abilities are in the average range. His abstract reasoning is in the above average range. Subtest scaled scores are as follows: Vocabulary = 3; Block Design = 9; Similarities = 4; Matrix Reasoning = 13. The following are his WASI results:

FSIQ = 85

VIQ = 71

PIQ = 104

Wide Range Achievement Test - Revision 4 (WRAT-4)

Carlos was administered the WRAT-4 (Blue form) to assess basic academic achievement levels in reading recognition, spelling and arithmetic. The reading and spellingsubtestswere administered to gain insight into his functional abilities in English at present.Carlos's reading recognition (pronunciation) standard score of 83 is at the eighth grade level and represents a relative strength for him.His spelling standard score of 78 is equivalent to the sixth grade.Carlos's arithmetic standard score of 99 is essentially commensurate with his nonverbal cognitive abilities as measured by the WASI.His arithmetic skills are at the high school level.

Woodcock Johnson Passage Comprehension Subtest (WJPC)

The Woodcock Johnson Passage Comprehension Subtest (WJPC) measures an individual's ability to comprehend written material. The subject is asked to read a short passage and identify a missing key word.Carlos's WJ Passage Comprehension standard score of 80 is in the below average range and is commensurate with a gradeequivalencyof 3.5. Functionally, his reading comprehension skills in English are in the below average range.

Bender Visual Motor Gestalt Test - Regular and Memory Presentations (BVMGT)

The BVMGT measures an individual's visual-motor integration abilities (hand-eye coordination), delayed visual memory and spatial localization abilities.Carlos's visual-motor integration abilities are in the average range as measured by the BVMGT (standard score = 88). In general, his visual-motor integration abilities and delayed visual memory are in the average range. His spatial localization abilities are in the above average range and represent a relative strength for him.

HapticVisual Discrimination Test (HVDT)

The HVDT measures tactile-visual integration skills - visual-spatial problem-solving, immediate recall and matching skills are utilized. Tactile-visual integration skills are highly predictive of the rate of learning on a work task. Carlos's overall tactile-visual integration abilities are in the very superior range as measured by the HVDT (standard score = 139). His sensory abilities are in the very superior range bilaterally (right standard score = 133; left standard score = 145). His performance suggests well above average capacity for learning verbal information presented in a traditional classroom setting (in his native language) as well as hands-on learning. It is also an optimistic indicator of his ability to improve his communication and foundation academic levels in English, should he elect to pursue such endeavors. This measure is independent of language, cultural, or social bias. It is unaffected by socioeconomic status or educational attainment.

Strong Interest Inventory

Carlos's responses to the Strong Interest Inventory indicate a very high interest in social occupational themes. He has a high level of interest in investigative and artistic themes. Carlos has a moderate level of interest in enterprising, conventional and realistic occupational themes. No low areas of interest were noted.

Carlos's personal style scales preferences:

1. He likely prefers a balance of working alone and working with people.
2. He appears to prefer to learn through lectures and books.
3. He is probably comfortable leading by example and taking charge.
4. He may like taking risks
5. He probably enjoys participating in teams.

Last year, Carlos applied for vocational rehabilitation assistance with the idea of completing his college degree. He originally wanted to pursue architecture, but there was no program available at the college near his home and he was unable to relocate due to family issues. After a lengthy process, he decided to pursue a degree in computer science and hopes to take some computer drafting courses. In order to support him in his education, VR purchased a computer for him. After five months, the Rehabilitation Counselor's supervisor received a phone call from another VR sponsored student who reported that Carlos was using drugs and had pawned the computer. An investigation revealed the computer had indeed been pawned. However, Carlos tested negative for drug use. Carlos reported that his child was very ill and that his friend suggested he pawn the computer to get additional money for his treatment. Carlos' friend was the one who actually pawned the computer and then did not return any of the monies received to Carlos for his son. The Rehabilitation Counselor does not believe the consumer has been involved in any wrong doing; however, the supervisor refuses to allow any additional agency funds to be spent on this individual. The Consumer is in need of a new computer to continue his education, and now has an even more desperate need for employment income due to his daughter's illness. The counselor believes that it is unethical to refuse services to someone who is otherwise eligible for services without at least a preponderance of the available evidence indicating that the consumer has been involved in wrongdoing.

There are six ethical principles discussed in the CRC Code of Ethics. When 2 or more ethical principles are in conflict, an ethical dilemma exists.

a.What do you believe to be the ethical dilemma in this case and which ethical principles have you determined to be in conflict?

b.Based on the ethical dilemma you have identified, describe the specific steps you would take to resolve this issue.