This is my final discussion question for this week. The directions are below.

QUESTION: You are the executive director of a small publicly funded behavioral health agency that serves indigent clients. After 10 years of being able to serve all clients seeking help, your agency has just received a 20% funding cut and must prioritize which services to discontinue and which clients to turn away. The community has many suggestions: stop serving undocumented immigrants and their children; stop serving substance abuse clients; limit all clients to six sessions; discontinue providing expensive services like psychiatry; lay off professional counselors and hire non-licensed paraprofessionals; stop providing counseling and instead simply offer peer self-help groups and parenting classes; serve only the most seriously ill (or the least seriously ill); and serve only children. How would you approach the difficult task of cutting services by 20% in a manner that reflects your ethical obligations as a community health setting? How would you communicate this to your stakeholders? What are the ethical issues, privacy laws, HIPAA regulations, and boundaries to consider? How would you make a final decision about what to cut from your program?