Advocacy is key for the clinical mental health counseling profession. Clinical mental health counselor advocates (CMHCAs) rely on the advocacy competencies to guide their assistance to clients in removing barriers and to secure deserving resources, or to advocate on behalf of clients, groups, or communities. This chapter addresses the importance of advocacy and social justice advocacy, and the strategic positionality of the clinical mental health counselor as an advocate for addressing social and institutional barriers that reduce client access, equity, and success. It identifies the advocacy competencies and approaches to advocate for clients care, and emphasizes the ways that they foster resilience and growth. Specific cases illustrate clients' and professionals' understandings of and access to a variety of community-based resources. The chapter also addresses strategies to advocate for the profession and for clinical mental health counseling professionals.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.

The practice of professional counseling is governed at the national and state levels by a variety of governing boards and regulatory agencies. This chapter focuses on the legal and ethical issues that are salient to clinical mental health counselors. Specifically, it discusses the American Counseling Association (ACA) Code of Ethics, the American Mental Health Counselors Association (AMHCA) Code of Ethics, state licensure and national certification, confidentiality, mandated reporting, duty to warn, and scope of practice. The chapter also focuses on the responsibility of counselors to engage in ethically based practice. In addition, the chapter connects the ACA and AMCHA ethical codes and the Council for Accreditation of Counseling and Related Educational Programs standards to several topics in ethical practice, including values clarification, bias assessment, boundary awareness and maintenance, and self-reflection. The chapter concludes with a case scenario to illustrate chapter concepts and a section on resources to provide further information.

It is important for beginning Clinical Mental Health Counseling (CMHC) students to understand that their engagement in the CMHC specialty is one part of the larger professional counseling framework. This chapter provides a historical overview of the counseling profession and its developmental trajectory, emphasizing the origins of mental health treatment and the reemergence of counseling as a wellness-based approach. It offers discussion concerning the push toward a pathogenic model of conceptualizing mental illness and the subsequent, current resurgence of a strength-based notion of care. The chapter provides an overview of the major theories of counseling as a means for understanding the development of counseling as a unique and separate field from psychology, psychiatry, and social work. It identifies the specializations within the counseling field, the range of employment opportunities and the current labor market, and how counseling is integrated within a system-of-care approach.

Samantha has been the middle school counselor in a small rural district in the Midwest for the past 3 years. She has spent most of her time in program development and building relationships with students, parents, staff, and community partners. Currently, she is working with community and district administrators to increase access to Internet and other technology in her building for more program options; unfortunately, the district’s increasingly tight budget precludes upgrades to current systems. As the academic year comes to a close, she talks with Rachel, a veteran teacher with considerable experience in differentiation. Rachel is concerned about some of her math students. By year’s end, due to her differentiated curriculum, at least seven will have completed Algebra 1, the most advanced math class at the school. Rachel wonders what can be planned for them for next year. A few parents have expressed concerns about future classes as these students progress. She asks to meet with Samantha about this situation.

Ben, the middle school counselor from Chapter 5, continues to work with the district’s task force. There, he also meets Julie the district’s coordinator of gifted and talented services. Based on the superintendent’s concerns, Julie wants to re-imagine the district’s identification and programming for gifted youth. Ben’s experiences have given Julie new insights into potential roles of school counselors when working with high-ability learners and their parents. Julie was particularly drawn to Ben’s discussions of talking with parents about why their students were not identified. Ben’s frustrations with the gifted services have also included the pervasive mythology that the program is a “cookie” program used as a reward for “good” students with “good” behavior and even better grades—a myth that disenfranchises diverse populations in the school district, including underachieving students, and doesn’t accurately identity those students who may need services. Historically, because the district has implemented identification procedures in third grade, Julie has contacted several of the elementary school counselors in her district to get their perspectives. She is surprised by the range of their knowledge about identification and the degree of the school counselors’ involvement in this process. While Ben has informed her that all practicing school counselors have training in testing and assessment, not all have connected this with identification practices for gifted learners—until they meet with their first parent.

School counselors collaborate, consult, and coordinate resources. They partner with community agencies, empower parents and families, advocate for students, and are probably part of the leadership team in their schools. Every day school counselors probably make lists of tasks that must be accomplished and then prioritize those according to level of urgency. When prioritizing student needs, the needs of gifted students may not rise to the top in the mind of the school counselor. Most educators equate "gifted" with high-achieving, perfectionistic, perhaps slightly eccentric students who have helicopter parents. School counselors work with gifted students regularly. These students come with a variety of different concerns ranging from typical developmental needs to mental health concerns that warrant immediate attention and service. While gifted students are no more or less likely to experience concerns tied to mental health, they do experience the world differently by nature of being gifted.

As best friends in a small Midwestern town, Jon and Stephen, both extremely bright and inquisitive, often talked with each other about their dreams of jobs they would have as adults. Throughout childhood, made alive through imaginative play, their wide-ranging ideas about careers were inspired largely by television and movie characters. They were enthralled with the idea of “special powers” to save the universe, but soon realized that “superhero” wasn’t a career. A few years later, they considered becoming crime scene investigators, lawyers, emergency room doctors, and, briefly, even astronauts. Jon and Stephen were inseparable and were regarded by the elementary school’s Gifted and Talented (G/T) coordinator as the most academically advanced students in her memory. They loved to learn, had vivid imaginations, and inspired their classmates and each other to “dream big” about the future. They were big fish in a little pond (e.g., Marsh, 1987; Salchegger, 2016).

Then Jon’s family relocated to an affluent suburban neighborhood on the West Coast after his father took a position in Silicon Valley. Jon, in middle school, had to adjust to a new set of expectations and found the adjustment quite challenging—in fact, far more so than he had imagined. Surrounded by a large group of intense and extremely driven students, who all seemed to aspire to top-tier universities, and struck by the harsh realization that he was no longer one of the very best students, Jon now felt as if he were a fish out of water. He was plagued with self-doubt about his abilities and future educational and career prospects. Compared to the other students, who had long positioned themselves to earn coveted spots in the local STEM-oriented magnet high school, Jon felt inadequately prepared to compete and felt his excitement for learning fading quickly. Once a confident and enthusiastic student, Jon was immobilized by his fear of making mistakes, especially in the presence of his new peers, and he began to retreat from others both at school and at home. He had difficulty dealing with even minor setbacks and grew to resent the students who seemed ambitious and competitive. Adopting a defensive posture, Jon downplayed the importance of thinking about future goals; in his own words, it was “stupid” to worry too much about college and career. Although he generally maintained respectable grades (mainly to make his parents happy and to keep their anxieties at bay), he refused to take the most challenging courses at school and stopped taking academic risks. Since he was getting mostly As and Bs and an occasional C on his report card, Jon’s parents were not alarmed by the changes in his behavior and failed to notice that he had turned away from learning. His academic self-concept had taken a major hit.

In contrast to Jon, Stephen remained in the same small Midwestern school district for the remainder of his precollege years and continued to feel passionate—about everything! Stephen’s parents encouraged him to indulge his intellectual curiosity and explore every subject that captured his interest. But Stephen had difficulty narrowing his interests for the sake of establishing career direction. When he was first exposed to chemistry, for instance, he quickly memorized the periodic table and spent many nights at the dinner table teaching his younger brother everything he had learned about each element. Later, when introduced to physics, he could hardly contain his excitement about quantum field theory, cosmic inflation, fluid dynamics, and a host of other topics. Of course, he also loved math and was eager to learn computer languages. Adept not only in STEM subjects, Stephen also excelled in and enjoyed writing, history, and politics. However, because the school district was small and lacked resources, he often learned advanced content on his own by reading books and searching the Internet. The local public high school he attended offered few Advanced Placement (AP) courses, and school officials believed they could not justify offering additional AP courses just for him. Without his friend Jon, he had no intellectual peer with whom he could share ideas and interact meaningfully. As his precollege years progressed, Stephen did not gain sufficient clarity about educational and career direction to focus his efforts on developing any particular interest to a high level outside of the classroom.

Childhood bereavement support is provided by a variety of professionals including chaplains, social workers, mental health counselors, psychologists, child life specialists, nurses, school counselors, thanatologists, and educators. This chapter discusses the issue of professional accountability and ethical considerations when working with bereaved children and their families in order to offer a framework for standards for this important type of support. It is not enough to solely provide orientation training to volunteers, it is also important to offer continued training for both new and existing volunteers. Organizations that provide support to bereaved children should establish written, agreed upon standards of practice to which program staff and volunteers are held accountable. The parent or legal guardian of children attending individual support, peer support groups, or grief camps should be provided a clear description of services being provided. Services provided should fit within the mission, vision, and values of the organization.

Angela was extremely excited to begin school as a kindergarten student and was matched with a supportive teacher for her first year in the rural community in which her family lived. She was lively and talkative around adults, and her parents worked hard to find opportunities for Angela to connect with kids her own age. However, in their small community there were limited possibilities for connection, and Angela often retreated physically behind her parents in public.

During the first parent–teacher conference for Angela, her parents were surprised at the teacher’s observations that Angela was reading well beyond the level of her peers. Not knowing many other children with whom to compare Angela’s abilities, they had assumed she was on par with most other kids her age. While there were no services available in their school system until the third grade, the kindergarten teacher remarked that the Lees might want to look into additional enrichment opportunities for Angela elsewhere. However, the teacher was eager to provide additional reading opportunities. Because reading was one of Angela’s favorite activities, this arrangement seemed to be a good fit.

It was during Angela’s third-grade year that challenges began for her at school. She often came home upset that she was reprimanded at school, and she rarely talked about positive interactions with her peers. She shared with her parents that she did not have much in common with many of the girls in her class, and that they often teased her about her friendship with a boy in the class they all thought was “weird.” This social tension was exacerbated when she was reprimanded for not showing her work in math class. She expressed her frustration with “Why do I need to write out all the steps for something when I just know the answer!” A friend of Angela’s parents worked in the school Angela attended and shared with them that contacting the school counselor might be the best next step.