2.3 Non-discrimination, Cultural Competence, and Client Referrals

Professional Responsibility and Non-Discrimination

Licensed Professional Counselors (LPCs) in Oklahoma are legally and ethically bound to uphold the dignity and protect the welfare of all clients they serve. Under OAC 86:10-3-1(d) and OAC 86:10-3-3, LPCs are strictly prohibited from condoning, engaging in, or facilitating any form of discrimination in the delivery of professional services.

• Prohibited Bases of Discrimination: The OAC rules explicitly prohibit discrimination based on race, gender, religion, national origin, age, sexual orientation, disability, socioeconomic status, or any other basis proscribed by law.
• Ethical Obligation to Serve: Counselors must provide services that are respectful of and responsive to the diverse needs of their clients. Discriminating against a client or refusing to provide services based on any of these protected characteristics is a severe violation of the professional code and is subject to immediate disciplinary investigation by the Board's Complaint Committee.
• The Principle of Justice: The prohibition against discrimination aligns with the fundamental ethical principle of justice, which demands that counselors provide equitable access to counseling services and treat all clients with fairness, dignity, and respect, regardless of their cultural or demographic background.

Maintaining Cultural Competence

Cultural competence is not merely an aspirational goal; it is a regulatory requirement under OAC 86:10-3-1(c).

• Defining Competence: Counselors must actively work to understand the cultural backgrounds, beliefs, and values of the clients they serve. This includes developing awareness of how their own cultural identity and biases may impact the therapeutic process.
• Continuous Education: LPCs must seek out continuing education, professional consultation, and supervision to expand their knowledge and skills in multicultural counseling. If an LPC encounters a client from a cultural background with which they are unfamiliar, they have a professional duty to obtain the necessary education and consultation to provide competent care.
• Diverse Populations in Oklahoma: Counselors in Oklahoma must be prepared to serve diverse populations, including Native American tribal members, rural communities, racial and ethnic minorities, and LGBTQ+ individuals, understanding the unique cultural, historical, and systemic factors that affect their mental health.
• Assessment and Diagnosis: Under ACA and BBHL guidelines, counselors must recognize that diagnostic categories and assessment instruments may have cultural limitations. LPCs must exercise caution when diagnosing and assessing clients from diverse backgrounds to avoid pathologizing culturally normative behaviors or expressions of distress.

The Referral Process and the Prohibition on Abandonment

Under OAC 86:10-3-3(d), LPCs have a strict obligation not to abandon or neglect clients in treatment.

• When a Referral is Necessary: If an LPC determines that they are unable to assist a client—either due to a lack of clinical competence in a specific area (e.g., eating disorders or severe substance use disorders) or because the client is not making therapeutic progress—the LPC must terminate the relationship in a professional manner and facilitate a referral.
• Refusing Services Based on Personal Values: Counselors must not refer or refuse to treat a client based solely on the therapist's personally held religious, political, or moral beliefs (aligned with ACA Code of Ethics Section A.11.b). Referrals must be based strictly on clinical competence, training limitations, or a lack of therapeutic efficacy, not on a desire to avoid working with a client whose lifestyle or values differ from the counselor's.
• The Mandated Referral Protocol: To legally and ethically refer a client in Oklahoma without committing abandonment, the LPC must follow this exact protocol:
  1. Clinical Discussion: The LPC must discuss the rationale for termination and referral with the client in advance, presenting it as a decision to ensure the client receives the most appropriate and competent care.
  2. Provide Multiple Options: The LPC must provide a minimum of three (3) appropriate referral sources or alternative providers. These referrals must be viable, accessible, and qualified to treat the client's specific clinical needs. If three options are not geographically available (e.g., in a remote rural area), the LPC must document this constraint and provide virtual or telehealth options.
  3. Written Authorization: The LPC must obtain written authorization from the client to release relevant clinical records and coordinate care with the new provider.
  4. Transition Period: The LPC must continue to provide counseling services for a reasonable transition period (typically up to 30 days) while the client establishes contact with the new provider. This ensures continuity of care and prevents crisis situations.
  5. Documentation: Every step of the referral process—including the clinical rationale, the specific referral sources provided, the client’s response, and the transition plan—must be documented in detail in the client's clinical file.

Financial Arrangements and the Ban on Referral Fees

To maintain professional integrity and prevent conflicts of interest, Oklahoma rules place strict controls on financial arrangements and referrals:

• Financial Disclosures (OAC 86:10-3-1(g)): LPCs must clearly explain all financial arrangements, fee structures, and collection policies to the client prior to commencing counseling. This explanation must be documented in the Professional Disclosure Statement and signed by the client.
• Prohibition on Referral Remuneration (OAC 86:10-3-3(e)): LPCs are strictly prohibited from giving or receiving commissions, rebates, referral fees, or any other form of monetary or non-monetary remuneration for referring clients to other professionals or agencies.
• The Proscribed Practice of Fee-Splitting: Fee-splitting—where a counselor pays a percentage of their client fees to another professional or entity solely for the referral—is illegal under Oklahoma law. All financial transactions must represent the direct payment for professional services rendered, not for the procurement of clients.