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The Relationship between Gender, Sexual Attitudes, Attitudes toward Gender and High School Counselors' Ethical Decision-...

Permanent Link: http://ufdc.ufl.edu/UFE0042031/00001

Material Information

Title: The Relationship between Gender, Sexual Attitudes, Attitudes toward Gender and High School Counselors' Ethical Decision-Making Regarding Adolescent Sexuality
Physical Description: 1 online resource (139 p.)
Language: english
Creator: Martin-Donald, Kim
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: adolescent, attitudes, confidentiality, counselors, gender, school, sexual
Human Development and Organizational Studies in Education -- Dissertations, Academic -- UF
Genre: School Counseling and Guidance thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: This study investigated relationships between high school counselors ethical decision-making, gender, attitudes towards gender, and sexual attitudes. Of the 161 respondents, only 157 participants data sets were included in the data set. Participants completed the Ethical Decision-Making Questionnaire, The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006), the Sex-Role Egalitarianism Scale (King & King, 1997) and a demographics questionnaire. Findings showed that student gender was not significant in predicting the subscales of the Ethical Decision-Making Questionnaire. Regression analyses indicated that counselor s religious affiliation, counselor age, Sex-Role Egalitarianism Scale scores, and frequency of counseling male students predict Consensual Sexuality Activity subscale scores. Permissiveness and Birth Control subscales and religious affiliation predict Sexual Activity with Victimization scores. And Instrumentality, Birth Control, and the Sex-Role Egalitarianism Scale scores predict Sexual Activity with HIV scores.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kim Martin-Donald.
Thesis: Thesis (Ph.D.)--University of Florida, 2010.
Local: Adviser: Smith, Sondra.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0042031:00001

Permanent Link: http://ufdc.ufl.edu/UFE0042031/00001

Material Information

Title: The Relationship between Gender, Sexual Attitudes, Attitudes toward Gender and High School Counselors' Ethical Decision-Making Regarding Adolescent Sexuality
Physical Description: 1 online resource (139 p.)
Language: english
Creator: Martin-Donald, Kim
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2010

Subjects

Subjects / Keywords: adolescent, attitudes, confidentiality, counselors, gender, school, sexual
Human Development and Organizational Studies in Education -- Dissertations, Academic -- UF
Genre: School Counseling and Guidance thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: This study investigated relationships between high school counselors ethical decision-making, gender, attitudes towards gender, and sexual attitudes. Of the 161 respondents, only 157 participants data sets were included in the data set. Participants completed the Ethical Decision-Making Questionnaire, The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006), the Sex-Role Egalitarianism Scale (King & King, 1997) and a demographics questionnaire. Findings showed that student gender was not significant in predicting the subscales of the Ethical Decision-Making Questionnaire. Regression analyses indicated that counselor s religious affiliation, counselor age, Sex-Role Egalitarianism Scale scores, and frequency of counseling male students predict Consensual Sexuality Activity subscale scores. Permissiveness and Birth Control subscales and religious affiliation predict Sexual Activity with Victimization scores. And Instrumentality, Birth Control, and the Sex-Role Egalitarianism Scale scores predict Sexual Activity with HIV scores.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Kim Martin-Donald.
Thesis: Thesis (Ph.D.)--University of Florida, 2010.
Local: Adviser: Smith, Sondra.

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2010
System ID: UFE0042031:00001


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THE RELATION SHIP BETWEEN GENDER, SEXU AL ATTITUDES, ATTITUDES TOWARDS GENDER AND HIGH SCHOOL COUNSELORS ETHICAL DECISIONMAKING REGARDING ADOLESCENT SEXUALITY BY KIMBERLY A. MARTIN-DONALD A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORID A IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010 1

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Kimberly A. Martin-Donald 2

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To My husband, Dan Jack Donald, for his c onstant faith and everlasting love 3

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ACKNOWLEDGEMENTS I wish to thank the people who assisted me during this dissertation project. I thank my parents, John and Nita Martin, for teaching me the value of education from a very young age. They supported my goals and encouraged me to reach the highest educational level possible. They also helped to keep me going by frequently asking How much longer do you have on that dissert ation? I thank my husband, Dan, for his love, faith, and support. He was always t here when I needed comforting, entertainment, a good back rub, or someone to celebrate ac complishments and milestones with me. I thank my two puppies, Rygel and Ripley, for waking me up early on Saturdays to work on my dissertation and snoring softly during t heir many naps under my desk. I thank my chair, Dr. Sondra Smith Adcock, for her encouragement, her ideas, for sharing her precious family time with me, and for her amaz ing editing abilities. I would also like to thank my committee members, Dr. MaryAn n Clark, Dr. Ellen Amatea, and Dr. James Algina for all of their support and assistance with this process. I wish to thank the school counselors all across the state of Flor ida who took time out of their very busy days to participate in this study. And finally I would like to thank all the students who open their lives to me every day and who helped to inspire this study. 4

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TABLE OF CONTENTS page ACKNOWLEDGEMENTS ...............................................................................................4LIST OF TABLES ............................................................................................................7LIST OF ABBREVIATIONS .............................................................................................8ABSTRACT .....................................................................................................................9CHAPTER 1 INTRODUCTION ....................................................................................................10Scope ......................................................................................................................10Nature of the Problem .............................................................................................11Need for the Study ..................................................................................................16Theoretical Framework ...........................................................................................21Purpose of the Study ..............................................................................................22Research Questions ...............................................................................................23List of Variables ......................................................................................................24Definition of Terms ..................................................................................................24Overview of the Re mainder of the Study ................................................................252 REVIEW OF RELATED LITERATURE ...................................................................26Confidentiality .........................................................................................................26Ethical Guidelines .............................................................................................26Ethical Decision-Making Recommendations for School Counselors ................29Laws Protecting Confidentiality ........................................................................32Studies on Ethical Decision-Making .................................................................33Sexuality Literature .................................................................................................40General Definitions and Theories .....................................................................40Counselor Sexual Values .................................................................................42School Counselors Concerns about Adolescent Sexuality ..............................43Legal Issues Pertaining To Adolescent Sexuality .............................................46Sex Education ..................................................................................................50Gender ....................................................................................................................53Studies Related to C ounselor Gender Beliefs .........................................................583 METHODOLOGY ...................................................................................................63Relevant Variables ..................................................................................................63Sampling Procedures and Data Collection Methods ...............................................64Hypotheses .............................................................................................................66Instruments .............................................................................................................67 5

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Ethical Decision-Making Questionnaire (EDMQ) ..............................................67The Brief Sexual Attitudes Scale ......................................................................71Sex-Role Egalitarianism Scale .........................................................................72Demographic Information .................................................................................74Procedures .............................................................................................................75Data Analyses .........................................................................................................754 RESULTS ...............................................................................................................77Demographic Characteristics ..................................................................................77The Ethical Decision-Making Questionnaire ...........................................................80Hypothesis Testing .................................................................................................83Summary ................................................................................................................915 DISCUSSION .........................................................................................................98Discussion of Findings ............................................................................................98Ethical Decision-Making: Consensual, Victimization, and HIV ........................98Gender, Attitudes Toward Gender and Ethical Decision-Making ...................100Counselors Sexual Attitudes and Ethical Decision-Making............................102Other Counselor Characteristics, Frequency of Counseling, & Ethical Decision-Making ..........................................................................................104Implications for Practice ........................................................................................107Implications for Theory ..........................................................................................108Limitations .............................................................................................................110Recommendations for Research ..........................................................................112Summary ..............................................................................................................114APPENDIX A ETHICAL DECISION-MAKING QUESTIO NNAIRE (EDMQ) FEMALE STUDENT 117B ETHICAL DECISION-MAKING QUESTIO NNAIRE (EDMQ) MALE STUDENT VERSION ..............................................................................................................120C BRIEF SEXUAL ATTITUDES SCALE (H endrick, Hendrick, & Reich, 2006). ........123D SEX-ROLE EGALITARIANISM SCALE (King & King, 1997) ................................125E DEMOGRAPHICS QUESTIONNAIRE ..................................................................126F INFORMED CONSENT ........................................................................................128LIST OF REFERENCES .............................................................................................130BIOGRAPHICAL SKETCH ..........................................................................................139 6

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LIST OF TABLES Table page 4-1 Factor Loadings for the Ethi cal Decision-Making Questionnaire ........................924-2 Frequency of participants responses to EDMQ with percentage of participants selecting each response choice. .....................................................934-3 Pearson product-moment correlati ons between continuous variables ................944-4 Additional Pearson product-moment correlations ...............................................944-5 Model Summary for Hypothesis 2 .......................................................................954-6 Coefficients Hypothesis 2 ...................................................................................954-7 Model Summary for Hypothesis 3 .......................................................................954-8 Coefficients Hypothesis 3 ...................................................................................954-9 Model Summary for Hypothesis 4 .......................................................................954-10 Coefficients Hypothesis 4 ...................................................................................954-11 Model Summary for Hypothesis 5 .......................................................................954-12 Coefficients Hypothesis 5 ...................................................................................954-13 Model Summary for Hypothesis 6 .......................................................................964-14 Coefficients Hypothesis 6 ...................................................................................964-15 Model Summary for Hypothesis 7 .......................................................................964-16 Coefficients Hypothesis 7 ...................................................................................964-17 Model Summary for Demographic Information & Consensual subscale .............964-18 Coefficients for Demographic Information & Consensual subscale ....................964-19 Model Summary for Demographic Info rmation & the Victimization subscale ......964-20 Coefficients Demographic Informat ion & the Victimization subscale ..................974-21 Model Summary for Demographic Information & the HIV subscale ....................974-22 Coefficients for Demographic Information & the HIV subscale ...........................97 7

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LIST OF ABBREVIATIONS ACA American Counseling Association ASCA American School Co unselor Association EDMQ Ethical Decision-Making Questionnaire SRES Sex-Role Egalitarianism Scale 8

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Abstract of Dissertation Pr esented to the Graduate School of the University of Florida in Partial Fulf illment of the Requirements for t he Degree of Doctor of Philosophy THE RELATIONSHIP BETWEEN GENDER, SEXUAL ATTITUDES, ATTITUDES TOWARDS GENDER AND HIGH SCHOOL COUNSELORS ETHICAL DECISIONMAKING REGARDING ADOLESCENT SEXUALITY By Kimberly Angela Martin-Donald August 2010 Chair: Sondra Smith Adcock Major: School Counseling and Guidance This study investigated relationships between high school counselors ethical decision-making, gender, attitudes towards gender, and sexual attitudes. Of the 161 respondents, only 157 participants data sets were included in the data set. Participants completed the Ethical Decision-Making Questi onnaire, The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006), the Sex-Role Egalitarianism Scale (King & King, 1997) and a demographics questionnaire. Findi ngs showed that student gender was not significant in predicting the subscales of the Ethical Decision-Making Questionnaire. Regression analyses indicated that counselors religious affiliation, counselor age, SexRole Egalitarianism Scale scores, and frequency of counseling male students predict Consensual Sexuality Activity subscale scores. Permissiveness and Birth Control subscales and religious affiliation predict Sexu al Activity with Victimization scores. And Instrumentality, Birth Contro l, and the Sex-Role Egalitar ianism Scale scores predict Sexual Activity with HIV scores. 9

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CHAPTER 1 INTRODUCTION Scope More than 47% of high school students in the United States have had sexual intercourse (Eaton et al., 2008). According to the 2009 Youth Risk Behavior Surveillance conducted by the Center for Disease Control, 62.3% of 12th grade students have had sexual intercourse (Eaton, D., Kann, L., Kinche n, S., Shanklin, S., Ross, J., Hawkins, J., et al ., 2010). Sexual activity, as meas ured by having sexual intercourse within the past three months, was found to be pervasive in high school aged students. Rates increased throughout high school with 21. 4% of students in 9t h-grade, 29.1% in 10th grade, 40.3% in 11th grade, and 49.1% of students in 12th grade reporting sexual activity in the last 3 months. Furthermo re, many students report ed having had sex with more than one partner. A pproximately 8.8% of 9th grade students have had sexual intercourse with 4 or more partners, 11.7% of 10th graders, 15.2% of 11th-graders, and 20.9% of 12th-graders (Eaton et al., 2010). Millions of high school students in the United States are at risk for harmful consequences related to sexual activity. Sexual activity, especially with multiple partners, can pu t students at risk for unintended pregnancy and sexually transmitted infections. Nearly 750,000 women between the ages of 15 and 19 become pregnant each year-or approximately 42 per 1,000 women age 15-19 each year (G uttmacher Institute, 2006). The pregnancy rate in this age group had declined every year from 1990 to 2005. However, the pregnancy rate for this age group increased by three percent in 2006 and has remained steady at approximately 42 births per 1,000 women age 15-19 for the past several years (The National Campaign, 2010). Therefore, the pregnancy rate among young girls is still of 10

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concern. Despite the small decrease sinc e 1990, the United States has more teen pregnancies each year than most other devel oped countries. For example, the U.S. has twice as many teen pregnancies a year than England, Wales, and Canada and eight times as many as the Netherlands and Japan (Guttmacher Institute, 2006). Annually, more than 9 million cases of sexually transmitted infections are found in 15 to 24 year-olds. These cases among young peopl e account for 48% of all reported cases of STI (Guttmacher Institute, 2006). Bec ause rates of adolescent sexual activity and related outcomes (e.g., pregnancy and STI) rema in high, many teachers, counselors, and health providers seek solutions about how to approach matters of sexuality with youth. This study will address how high school counselors approach issues related to sexuality in their work with adolescents. Nature of the Problem The Guttermacher Institute (2010) repor ts that approximat ely 60% of teenagers engage in sexual intercourse by age 18. Student s are also likely to have a number of related concerns or problems that involve thei r sexuality, such as choosing to engage in sexual activities and selecting partners, sexual harassment or sexual violence, homosexuality (gay, lesbian, bisexual, or transgendered) or coming out, accessing and using birth control methods, sexually transmitted infections, pregnancy, and making a decision to carry to term or termina te a pregnancy. High school students may experience a vast range of issues concerning their sexuality that often come to the attention of school personnel. School couns elors are usually the school personnel called on to deal with student issues concerning sexuality. Therefor e, it is appropriate for school counselors to assist with adolescents concerns related to sexuality activity, 11

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as they are relevant to students personal an d social development. Bartlett & Portman (2002) argue the importance of school counselors participati on in sexuality education: School counselors often are only involved peripherally in school-based sexuality education. This is a resu lt of considering sexuality education within the realm of the health education content areas. However, if sexuality education seeks to assist adolescents in gaining a positive view of sexuality by providing them with information, decision-making skills and peer refusal skills, school counselors must be actively involved in sexuality education development and implementation (p. 79). Not only is it appropriate for school counsel ors to assist students with sexual issues through counseling services, school counsel ors may also help student by playing a direct role in school-bas ed sex education. Sexual development and sexual activity can affect students decision-making in many areas of their lives, including ac ademic, career, and personal or social development (Bartlett & Portman, 2002). Though it seems straightforward for school counselors to address sexualit y as part of a guidance and counseling program, the role of school counselors in dealing with students sexuality can be conf using. To approach the issue of sexuality from a developmental perspective, various interventions may be needed. School counselors can create guidance plans to address undesirable outcomes such as unwanted pregnancies, ac ademic failure or drop out due to pregnancy, contraction of sexuality transmitted infections, sex-role stereotyping, sexual harassment, discrimination based on sexuality differences, and sexual violence (Epstein et al., 2003; Klein, 1992). It also seems important for counsel ors to help students foster healthy sexual development by assisting st udents in adopting positive views of sexuality and making informed decisions. When faced with helping students with iss ues related to sexuality, school counselors ethical decision-making can be co mplex. School counselors make ethical 12

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decisions based on their knowledge of laws counseling ethics, and school policies. When issues of sexuality arise, school counselors must decide when it is appropriate to keep adolescent information confidential or when to reveal that information to parents/guardians or other school personnel. For example, ethical dilemmas related to parent requests for information have been discu ssed in the school co unseling literature (Davis & Mickelson, 1994; Glossoff & Pate 2002; Huss, Bryant, & Mulet, 2008; Isaacs 1999; Ledyard, 1998, Mitchell et al., 2002). School counselors face a difficult task in balancing ethical and legal obligations to students, parents, and the school systems (Glosoff & Pate). Because of strong cult ural mores that drive attitudes toward adolescent sexuality, a counsel ors decision to break or not break confidentiality is especially critical. School counselors ethical decision to main tain or break confidentiality has been the topic of discussion and research for more than 20 years (Bodenhorn, 2006; Davis & Ritchie, 1993; Glosoff & Pate, 2002; Herlihy et al., 2002; Huey, 1986; Huss et al., 2008; Lazovsky, 2008; Sealander, 1999; Stone & Issacs, 2003; Watson, 1990). As Remley and Herlihy (2001) suggested, Confidentiality is one of the most fundamental of all professional obligations in counseling (p. 79). Counseling is a helping process based on trust and focused on the significance and implications of an individuals life experiences (Myrick, 2 003). Myrick (2003) further defines counseling as a personal relationship that allows students to explore their thoughts, emotions, behaviors, and experiences confidentially with the assistance of a trained, professiona l counselor (p.6). Therefore, confidentiality is considered the foundation of th e counseling relationship. 13

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Hence, when confidentiality is breached, the effectiveness of counseling is compromised. The American School Counseling Associatio n (ASCA) provides ethical standards to serve as guidelines for school counselors. Ethically, counselors have the same obligation to provide confident iality for their children and adolescent clients as they would for adults. Some argue that the confid entiality rights of mi nor counseling clients are often misunderstood or disregarded (Huss et al., 2001). Research has shown that adolescents believe they should have the sa me rights to confidentiality as adults (Collins & Knowles, 1995). However, minor s do not have the same legal rights as adults. Counselors are legally obligated to minor clients parents or guardians to help protect the safety of their children (Remley & Herlihy, 2001). Therefore, counselors must balance their moral and ethical duty to pr ovide confidentiality for their minor client and the rights of the parent to know what is going on with t heir child (Baker, 2000). Some authors have argued that ethics are not always clear and therefore open to interpretation by counselors (Huey, 1986; Mitchell et al., 2002; Wagner 1981). The American Counseling Associatio ns ethical codes state that confidentiality should be broken in cases of child abuse and imminent harm to self or ot hers (ASCA, 2004). Mitchell et al. (2002) argues, Beyond t hese three primary instances where confidentiality must be broken, there is ambiguity concerning who has the right to information provided by minors in counseling sessionsneither the law nor the ethical codes provide specific and consistent guidance as to what school counselors should do in all situations where consider ations of breaches of confidentia lity are relevant (p.156). Counselors interpret and apply ethical stand ards based on their individual morals, 14

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beliefs, and attitudes (Huey, 1986). W agner (1981) suggests that counselors experience ambivalence about their obligations to student clients, their parents, and other adult stakeholders because their own val ues are more similar to the values held by the other adults than to those of the ch ild. For example, a teenager may believe that having unprotected sex with an intimate par tner is appropriate, while their parents, counselor, and other school personnel may believe this behavior is harmful and requires adult intervention. However, as a new generation of school counselors begin their careers, it is possible that the values of younger counselors may be more similar to the values of high school students than the parent s of high school students. Therefore, counselor age should be considered when ex amining counselors ethical decisionmaking. The relationship between a counselors va lues and his or her interpretation of ethics and ethical decision-making has been examined in research. For example, Lazsovsky (2008) suggests that decisions about confidentiali ty are measured against personal values, professional values, and other factors. School counselors are expected, by law, to break confidentiality in situations involving child abuse, danger to self or others, and court orders or subpoena s (Davis & Ritchie, 1993; Sealanders, 1999). However, counselors may interpre t clear and imminent danger differently. Some counselors may view situations invo lving sexual activity or promiscuity, pregnancy, or abortion dangerous (Davis & Rit chie, 1993). When ethical decisionmaking is not clear, values, attitudes, and/or beliefs can influence how dangerous counselors perceive a students behavior to be (G losoff & Pate, 2002; Isaacs, 1990). 15

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High school students engaging in sexual acti vity are at risk for pregnancy and sexually transmitted infections. T hese and other possible consequences of a teenagers sexual activity can affect his or her academic, career, and social/personal development. More research is needed to understand how a counselors values and attitudes affect his or her interpretation of ethics and ethical decision-making related to confidentiality and adolescent sexuality. Need for the Study School counselors are charged with balancing confidentiality for students and the rights of their parents (Bodenhor n, 2006; Isaacs, 1999; Mitche ll et al., 2002; Moyer & Sullivan, 2008; Stone & Isaacs, 2003). Fu rthermore, school counselors must manage responsibilities to student s, parents, teachers, and adm inistrators and local policy makers (Mitchell et al., 2002; Lazovsky, 2008, Remley & Huey, 2002). Maintaining confidentiality for students can be challe nging for school counselors because of the open nature of communication in education. Teachers, administrators, other school personnel, and parents often consult with each ot her and collaborate to meet the needs of the students they serve. Isaacs (1990) states, Counsel ors are in a precarious position because they are charged with being consultants to other educators, who may not have the same obligations to a student s privacy that the counselor does. Additionally, administrator s or other student service personnel sometimes request information about counseling sessions for appropriate reasons (p. 259). When asked for information about students by their collea gues, school counselors may not know how much information to provide (Lazovsky, 2008). When situations involving adolescents sex uality are controversial or not clear-cut (e.g., sexual intercourse, sex crimes, c ontraception, pregnancy, abortion), which they 16

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often are, counselors may not know what is legally or ethically a better decision. In these situations, school counselors rely more on their interpretations of ethical guidelines rather than legal re sponsibilitiesallowing their decision-making process to be pervious to influence by individual values and beliefs (Moyer & Sullivan, 2008). Prior studies have suggested that counselors often disagree on whether or not to break confidentiality around sexual issues (Moye r & Sullivan, 2008). These authors have proposed that counselor disagree ment as to whether or not to break confidentiality and notify parents may be due to the variation in counselor values and belief systems. Counselors beliefs or attitudes about sexuality vary according to gender, which may alter the ethical decision-making process. Counselors, like all people, are socialized within their own envir onment to have beliefs about gender and gender roles. These belief systems are implicit and individ uals are likely not aware of the specific roles and stereotypes in t heir gender schema (Stevens-S mith, 1995). Gender schema is a set of beliefs and attitudes about how ma les and females should look and behave. For example, a person with egalitarian gender role beliefs accepts gender equality and supports non-traditional gender roles for me n and women across different domains of life (King & King, 1997). Research has shown that counselors beliefs about gender are not always egalitarian in nature and counselors may have stereotypical assumptions and biases about biological sex and gender roles (Seem & Johnson, 1998; Trepal et al., 2008). Trepal and colleges (2008), in a study of counselors in tr aining, found that most counselors hold traditional gender role ex pectations and view men and women as opposites. For example, men were viewed by counselors in training as having difficulty 17

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expressing emotions aside from anger and not being able to connect to others well (Trepal et al., 2008). Because counselors may hold stereotypical views concerning men and women, it is important to understand how counselors conceptualize gender in their work with clients (Trepal, Wester, & Shul er, 2008). Counselors beliefs about gender roles and sexuality are likely to affect how they make decisions about boys and girls who engage in sexual activity. Research is needed to examine how differences in gender attitudes relate to counselors et hical decisions to maintain or break confidentiality. Gender role stereotypes can limit couns eling effectiveness (Trepal et al., 2008) and potentially may harm clients (Gillon, 2007; Wester & Trepal, 2008). Counselors stereotypical beliefs can lead them to plac e limits on the clients life choices (DeVoe, 1990; Gold & Hawley, 2001). Furthermore, counselors may make counseling decisions based on a biased assessment of the client (Seem & Johnson, 1998). For example, a counselor may ascribe to a sexual double standard, which permits men to have more sexual freedom than women. An additional example of using biased information to assess clients happens when a counselor assumes a client is heterosex ual. Traditional formal and implicit sex education in public sc hools focuses on heterosexuality and either leaves out alternative sexual ities or mentions them wit h negative connotations (BayCheng, 2003; Epstein, OFl ynn, & Telford, 2003; Klei n, 1992). Counselors may be unaware of how biases affect their ethical decision-making about students sexuality. However, because counselors decisions affect childrens lives every day it is critical to examine how their decisions are made. 18

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The study of sexuality from a historical perspective shows that sexual behavior is not universal: that is, much variety can be noted in different times and places throughout human evolution (Rathus, Nevid, & Fichner-R athus, 2005). Consider, for example, the difference between the conservative, seemingly sexually repressed, Victorian society of Europe that covered ankles of chairs and the highly sexual ruling class of ancient Rome known for its practices of oral sex, bisexual ity, bestiality, sadism and orgies (Rathus et al., 2005). Just as the members of societies in history hav e held a vast range of sexual beliefs and practices, the members of our curr ent, pluralistic society accept a variety of sexual attitudes and values (Rathus et al., 2005). For example, contemporary attitudes toward sexuality may range from the approval of premarital, casual sex with multiple partners to a steadfast belief in abstinence until marriage (Rat hus et al., 2005). Despite the variety of sexual attitudes, practices, and values in America, government funded sex education in public schools has traditionally taught abstinence only (SIECES, 2008). Abstinence only sex education puts emphasis on failure rates for contraceptives, promotes heterosexuality, leaves out gay students, and omits discussions about sexual acts other than intercourse (SIECUS, 2008). Rhatus et al. (2002) suggests, Human se xuality appears to reflect a combination of biological, social, cultural, sociocultural, and psychological factors that interact in complex ways, perhaps in combinations that are unique for each individual (Rathus et al., 2002, p.33). A school counselors indi vidual attitudes about se xuality or gender roles may affect his or her emotional and c ognitive reactions and interpretations of adolescent sexuality issues. For exam ple, when discussing an unintended pregnancy, a school counselor who is pro-life may discourage a pregnant teenager from 19

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considering abortion, or choose to break c onfidentiality and report an intended abortion to the students parents. On the other hand, a pro-choice counselor may openly discuss the clients legal rights to an abortion, provide the student with info rmation about where to obtain an abortion in their community, and choose to maintain confidentiality with their client. Just as sexuality is complex and affected by many factors, so too are attitudes about sexuality. Sexual attitudes are believed to be multidimensional (Hendrick & Hendrick, 1987). A person may have atti tudes in one area or topic that seems traditional whereas other attitudes may be n on-traditional. Often an assumption is made that an individual is eit her conservative or liberal in their views and this is not usually the case. Therefore, in studies related to sexual attitudes, a measure addressing a full-range of issues is important (Hendrick, Hendrick, & Reich, 2006). Different areas related to sexual attitudes that have been studied and include permissiveness (i.e. items about casual sex and multiple sexual partners), birth control (i.e. importance of birth control and whose res ponsibility it is), communion (i.e. merging of souls, meaningfulness of sex), and instru mentality (i.e. physical pleasure) (Hendrick et al., 2006). Additional counselor qualitie s and experiences may also be important to consider when examining ethical decision-making regar ding adolescent sexuality. Counselor characteristics such as age, ethnic backgrou nd, marital status, and years of experience may be related to how counselors view student sexual concerns. Counselors attitudes and beliefs may also be influenced by their politic al or religious affiliations. Counselors 20

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experience level with counseling students regarding sexual c oncerns may also affect their decision-making process. Although current liter ature suggests that a counselors values are important in how they make decisions, there is no re search that specifically addresses the relationship between counselors values and ethical decisions related to adolescent sexuality. What is the re lationship between a counselors values, beliefs, or attitudes and the counselors decision-making in ethi cal dilemmas specifically related to adolescent sexuality? The current study will address the relationships between ethical decisionmaking, gender, attitudes toward s gender, attitudes towards sex, counselor characteristics (i.e., age, years of experience, ethnicity, marita l status, political affiliation, and religious affiliation), and amount of time spent counseling male and female students regarding sexual concerns. Theoretical Framework Feminism will be used as a theoretical framework for this study. The major feminist influence used in the construction of this study is the idea that value-free counseling is not possible and therefore couns elors must constantly explore their own values and attitudes to assure that their beliefs are not imposed upon, nor harm, the client (Enns, 2004). This study will specific ally examine counselors attitudes towards sexuality and attitudes towards gender as well as possible relationships between attitudes and counselors ethical decision-making. Following a feminist approach, th is study focuses on gender and gender inequality (Enns, 2004; Taylor, 1998; Ti ckner, 2005). Feminism suggests that perceptions of what behaviors are appropriate for males and females are influenced by socially influenced gender-role expecta tions and gender schema (Enns, 2005). 21

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Feminists also emphasize the need for aware ness of gender-role stereotyping, sexism, and discrimination. Feminist researchers view gender as a stimulus variable that frames expectations, evaluations, and res ponse patterns (Worell & Remer, 2003, p.277). Goals of feminism include eliminating the major differences in gender roles for men and women and allowing men and women to escape from narrowly defined gender-roles (Enns, 2005; Hill & Ballo u, 2005). In studies of adolescent life events, female adolescents reported more stre ss and negative events than boys (Plunkett, Radmacher, & Moll-Phanara, 2000). Furthermore, some may argue that girls experience more conflict in adolescence than boys due to societal views of the female body (Unger & Crawford, 1992). Society may also have different expectations for boys and girls related to sexuality, chastity, or bi rth control. For example, promiscuity may be more acceptable for teenage boys while girl s may be expected to remain chaste. Girls/women also are often viewed as havin g more responsibility for birth control than boys/men. Purpose of the Study Ethical issues concerning confidentialit y faced by school counselors have been examined by researchers (B odenhorn, 2006; Davis et al., 1993, 1994; Glossoff et al., 2002; Herman, 2002; Holowiak-Urquhart et al., 2005; Isaacs et al., 1999; Lazovsky, 2008; Mitchell et al., 2002; Mitchell et al., 2003; Moyer & Sullivan, 2008; Remley, 2002; Remley & Huey, 2002; Sealander, 1999; Sto ne & Isaacs, 2003; Wagner, 1981, 1983; and Watson, 1990). However, research exam ining the ethical dilemmas related to confidentiality and adolescent sexuality are limited. Much of the existing research has examined issues of sexuality in ethical decision-making only marginally, if at all 22

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(Bodernhorne, 2006; Colins & Knowles, 1995; Davis & Mickleson, 1994; Hermann, 2002; Isaacs, 1999; Lazovsky, 2008; Moyer & Sullivan, 2008; and Wagner, 1981). The purpose of this study is to examine factors related to school counselors decisions to maintain or break confidentiality in situations involving adolescent sexuality. Specifically, this study will look at relationships bet ween high school counselors ethical decisionmaking, counselors gender, students gender, c ounselors attitudes toward gender and sexuality, counselor characteristics (i.e., age, years of experienc e, ethnicity, marital status, political affiliation, and religious affiliation), and am ount of time spent counseling male and female students regarding sexual concerns. While past literature has suggested t hat making ethical decisions about maintaining or breaking confidentiality is related to counselor beliefs and attitudes, this study will examine the relations hip quantitatively. Findings of the current study will provide new information about how ethical dec ision-making is related to counselors reported attitudes towards se xuality and gender. The gender of the counselor and the gender of the student in given scenarios will be considered factors in counselors decisions to maintain or break confidentiality. Research Questions Is there a relationship between couns elor gender, student gender, the subscales of the Brief Sexual Attit udes Scale (i.e., Permissive, Birth Control, Communion and Instrumentality), and the total score of the Sex-Role Egalitarianism Scale (SRES)? Do counselor gender and student gender pr edict ethical decision-making as measured by the Ethical Decisi on-Making Questionnaire (EDMQ)? Do counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scal e (SRES), and the st udents gender predict scores on the Ethical Decision-Making Questionnaire (EDMQ)? 23

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Do counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scale (SRES), the students gender, counselor characteristics (i.e., age, y ears of experience, ethnicity marital status, political affiliation, religious affiliation), frequency of counseling female students regarding sexuality, and frequency of counseling male students re garding sexuality predict scores on the Ethical Decision-Making Questionnaire (EDMQ)? List of Variables Independent Variables Counselor gender as reported by participants Student gender manipulated in Ethi cal Decision-Making Questionnaire Counselor sexual attitudes measured by The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006) Counselor attitudes about gender measured by The Sex-Role Egalitarianism Scale Short Form KK (King & King, 1997) Counselor characteristics (i.e., age, years of experience, ethni city, marital status, political affiliation, and religious aff iliation) as reported by participants. Frequency of counseling male students regar ding sexual concerns as reported by participants. Frequency of counseling female students re garding sexual concerns as reported by participants. Dependent Variable Counselor ethical decision-making meas ured by The Ethical Decision-Making Questionnaire Definition of Terms The following are selected terms as they are used in this study. ADOLESCENT. Person experiencing the time period between onset of puberty and adulthood (Rathus, Nevid, & Fichner-Rathus, 2002). CONFIDENTIALITY. A situation in which one has been entrusted with the secrets or private affairs of another (Baker, 2000, p. 75). 24

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GENDER. Culturally constructed beliefs and atti tudes about the traits and behaviors of females and males (Worell & Re mer, 2003, p. 10). GENDER ROLES. Gender roles are culturally cons tructed beliefs and attitudes about the traits and behaviors that society c onsiders appropriate for females and males (Worell & Remer, 2003, p. 10 & 15). GENDER ROLES STEREOTYPES. Gender role stereotypes include beliefs about men and women in limited roles and often includi ng traditional role perspectives of men and women being viewed as opposites (King & King, 1997, Worell & Remer, 2003). GENDER ROLE EGALITARIANISM. Gender Role Egalitarianisms can be defined as possessing contemporary beliefs of gender role equality and acceptance of non-traditional gender roles fo r men and women across different domains of life (King & King, 1997). PROFESSIONAL SCHOOL COUNSELOR. A state-certified school guidance counselor currently employed in a school. SEX (BIOLOGICAL). A descriptive and biologically based variable that is used to distinguish two categories of individuals: females or males (Worell & Remer, 2003, p. 10). SEXUALITY. The ways in which we experience and ex press ourselves as sexual beings (Rathus, Nevid, & Fichner-R athus, 2002, p. 5). SEXUAL ATTITUDES. Beliefs one holds about sexuality and sexual behaviors (Hendrick & Hendrick, 1985; Hendrick, Hendrick & Reich, 2006). SEXUAL ACTIVITY. "The oral, anal, or vaginal penetrati on by, or union wit h, the sexual organ of another or the anal or vaginal penetration of another by any other object; however, sexual activity does not include an act done for a bona fide medical purpose (Flo rida Statute 800.04). Overview of the Rema inder of the Study Chapter 1 presented an introduc tion to the present study. Chapter 2 includes a review of the relevant literature. The methodology is described in Chapter 3. The results of the study are presented in Chapter 4. Chapter 5 includes a summary, a discussion of the results and implications, and well as recommendations for future research. 25

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CHAPTER 2 REVIEW OF RELATED LITERATURE Presented in this chapter is a review of t he literature relevant to this study. The first section of this chapter includes a review of ethics and laws related to confidentiality, conceptual literature, and a re view of the relevant survey research. The next section includes literature on adolescent sexuality, legal issues, and sex education. The final section includes a review of literature on gender, gender attitudes, studies on counselor gender beliefs, and information about gender roles for boys and girls. Confidentiality The confidentiality section of the literature review includes ACA and ASCA ethics related to confidentiality, informed consent, l egal issues such as parents rights, FERPA, and privileged communication. This will be fo llowed by conceptual lit erature related to school counselors and confidentiality with mi nor clients, including advice for school counselors, and then a review of the survey research studying school counselor ethics and confidentiality. Ethical Guidelines The American School Counseling Associatio n (ASCA) provides ethical standards for school counselors. According to the ethical standards preamble, Each person has a right to privacy and thereby the right to expect the counselor-student relationship to comply with all laws, policies and ethical st andards pertaining to confidentiality in the school setting (ASCA, 2004, p.1). ASCA provides ethical standards for school counselors; however ethical standards do not include relevant laws and policies. School counselors are therefore required to find and interpret this information on their own. Relevant confidentiality laws ma y include the Family Educational Rights and 26

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Privacy Act (FERPA), child abuse, duty to warn laws, and privileged communication. Policies could include local school board policies or the policies set by a school counselors employer. Huey (1986) enc ouraged counselors to follow local school policies to the extent that the policies did not countermand a counselors principal responsibility to the client. This may be di fficult as some administrators may not fully understand school counselor ethical standards (Herlihy, 2002). As a result, the school counselor may have to choose between following professional ethics and lo cal policies. ASCAs ethical standards require school co unselors to inform students of the limits of confidentiality and fo r school counselors to ke ep information confidential unless disclosure is required to prevent clear and imminent danger to the student or others when legal requirements demand that confidential information be revealed (ASCA, 2004, p.1). Yet counselors may inte rpret the level of danger in student behavior differently. Huey (1986) stated that interpretation of ethical standards is a function of the counselors personal values, beliefs, and attitudes (p.321). These personal attributes may influence the risk perceiv ed in a students behavior (Glosoff & Pate, 2002). Although research suggests that counselor values are relevant to counselor decision-making about confidentiality, the ex isting research does not fully explore the relationship, especially in terms of issues re lated to adolescent sexuality. The current study will address this relationship. School counselors are often required to collaborate with a minors parents or guardians. ASCA ethical code st ates, The professional school counselor has a primary obligation to the student, who is to be treated with respect as a unique individual (ASCA, 2004, p.1). Yet, school counselor s must also respect the rights and 27

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responsibilities of parents (ASCA, 2004) School counselors are encouraged to collaborate with parents, providing accurate, comprehens ive, and relevant information to help students reach their potential (ASC A, 2004, p.3). School counselors are expected to provide confidentia lity for their clients, treat the minor clients with respect, collaborate with parents, and provide information to parents about their child all at the same time. These occasionally opposing ob ligations can be challenging for many counselors. Ethical standards can place school counselors in a difficult situation that requires balancing the rights of students and their parent s. Ethical dilemmas related to parent requests for information have been discussed in the school counselor literature (Davis & Mickelson, 1994; Glossoff & Pate; Isaacs, 1999; Ledyard, 1998, Mitchell et al., 2002). For example, Isaacs (1999) wrote, High sc hool counselors have to navigate the tricky waters between confidentiality that t eenagers demand and parents rights to govern their children with full knowledge of important issues their ch ildren are facing (p. 259). According to Glosoff and Pate, ethically, counselors are expected to provide confidentiality for their minor clients, yet legally minors have no right to keep secrets from their parents (2002, p. 3). No American studies were found explori ng students beliefs about confidentiality and school counselors providing information to their parents. However, Collins and Knowles (1995) surveyed 559 (13 to 18-year-o ld) students attending Australian private schools. They found that adolescents believed they should have the same rights to confidentiality as adults. However, students su rveyed also indicated that parents should be informed about issues such as sexuality, pregnancy, and sexual abuse. Students in 28

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this study wanted privacy but also ack nowledged that parents should be informed in some situations. Not only are the ethics and la ws concerning minors rights to privacy in conflict, minors themselves may hold conflict ing opinions about their rights and desires for privacy from their parents. Ethical Decision-Making Recommenda tions for School Counselors School counselors interpretations of ethical codes are influenced by their personal attitudes, values, and beliefs (Moyer & Sullivan, 2008; Wagner 1981). School counseling ethical standards address counselor values: The professional school counselor (1) is conscious of her own atti tudes, beliefs, and values, (2) respects the values of her clients, and (3) avoids impos ing her own beliefs ont o the client (ASCA, 2004). However, counselors may become c onfused about their responsibilities to adolescent clients, parents/guardians, or ot her authorities due to the fact that the counselors own attitudes and values are more likely similar to other adults than their adolescent clients attitudes and values (Wagner, 1981). For this reason, counselors must consider their own personal and professional values when dealing with minor confidentiality (Lazovsky, 2008) In addition to being aware of ones own attitudes and values, school counselors should also consider the values of the community in which they work (Daivs & Ritchie, 1993). For ex ample, some communities might oppose a counselor giving students information about birth control or abortion. In addition to requests for information from parents, other educators may also request counselors to reveal informati on about students. School counselors are vulnerable to breaching confidentiality in part due to their close contact with teachers, administrators, and other school staff (Isaacs, 1990; Lazovsky, 2008; Wagner, 1990; Watson, 1990). Counselors have served as c onsultants to school staff for several 29

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decades (Hoskins, Astramovich, & Smith, 2007). The ASCA model highlights how school counselors can use consultation with parents and school staff to support student academic achievement, personal-social growth, and career development (ASCA, 2003). Consultation with other school staff is often collaborative and based on open communication (West & Idol, 1993). In additi on to consulting with individual staff members, school counselors also participate in conjoint collaborative consultation, such as child study teams or student assistant t eams (Hoskins, Astramov ich, & Smith, 2007). While collaborating to help students, teachers and administrators may request school counselors to reveal information that the st udent expected to remain confidential. School counselor may find themselves having to negotiate maintaining confidentiality and collaboration with other educ ation professionals. Advice on dealing with ethical dilemmas is found in school counse ling literature. Watson (1990) offered the following recommendat ions to assist school counselors in dealing with ethical dilemmas: (1) attend in service trainings that explore ethical dilemmas using scenarios, (2) seek professi onal support and consultation at the school district level, and (3) counselors should plan for ethical dilemmas and establish relationships where educators understand the et hical standards of counseling. Baker (2000) suggests the following steps to making ethical decisions: (1) identify the dilemma, (2) clarify ones values about the i ssue, (3) refer to the appropriate ethical code, (4) determine the nature and dimensions of the dilemma (5) generate possible plans of action, (6) consider consequences of all options, and (7) implement a course of action. 30

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Mitchell, Disque, & Robertson (2002) offe red school counselors suggestions for reacting to parents who requested informa tion about counseling sessions. School counselors are encouraged to use listening skills with parents, allowing them to express their concerns and also reframing their childs seeking help outside of the family as part of his or her growth towards maturity and independence. School counselors may also ask for the students consent to share specific information with his or her parents or offer ideas for sharing information with parent s. School counselors may also suggest that the parent speak to their child direct ly and offer ideas for how they might approach the child. Another suggestion is for the sch ool counselor to medi ate a session with the student and the parents together. If parents continue to dema nd information, the school counselor will then have to choose between breaking confidentiality and refusing to provide the parent with the desired informati on (Mitchell et al., 2002). Counselors are also encouraged to consult with colleagues when in conflict about student confidentiality and parent requests. Additional strategies for protecting minors confidentialit y are found in literature. Glosoff and Pate (2002) suggest counsel ors become knowledgeable about laws and ethical codes and aware of policies and procedur es at ones place of work. Counselors are encouraged to stay current with profe ssional development and to prevent breaches by educating parents, students, and school staff about c onfidentiality. Isaacs (1999) recommends counselors consult with peers, s eeking ways to protect confidentiality, participation in professional development, request inservice with updated information about policies and laws, obtain liability insurance, and education others about confidentiality in counseling. Moyer and Sullivan (2008) suggest counselors seek 31

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ethical training, become aware of laws, ethics, and local policies, to consult with other counselors, and to consider consequences to breaking and maintaining confidentiality. Huss et al. (2008) recommended profession al school counselors use management agreements with students, parents, and school administrator s to create an environment that is ethical and collaborative. Huss et al. further recommended that counselors share information about confidentialit y with parents through a vari ety of methods including websites, emails, and printed media such as newsletters, public meetings and personal interactions. Laws Protecting Confidentiality The Family Educational Rights and Privacy Act (FERPA), also referred to as the Buckley Amendment, is federal l egislation protecting the priv acy of student records and parental rights to records. The United States government Family Policy Compliance Office states, according to FERPA, Parent s or eligible students have the right to inspect and review the students educati on records maintained by the school ( http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html retrieved 9/10/2008). However, parental rights do not include counse lors personal logs or case notes used as memory aid or treatment guide. Personal notes excluded by FERPA are not shared with others at the school except for someone filling in for or taking the place of the original counselor (Baker, 2000, p.78) http://www.doh.state.fl.us/Fa mily/School/privacy/Ferpa.pdf retrieved 9/10/2008). Although counselors are not re quired by law to share per sonal counseling notes with parents, they are expected to collaborate with parents. In addition to FERPA, privileged communication laws are also related to minors rights to confidentiality. Pr ivileged communication protects information shared between 32

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a client and certain professionals (Remley & Herlihy, 2001). A j udge cannot order the professional to share the c onfidential information. Although there are some variances from state to state, professionals granted pr ivileged communication included attorneys, medical physicians, clergy, psychologists, and so cial workers (Remley & Herlihy, 2001). Mental health counselors have been granted varying degrees of privileged communication in most states that license counselors (Remle y & Herlihy). Additionally, some states have legislation that protec ts information shared between a student and a school counselor. For example, Act 287 in Pennsylvania requires the student to give consent for a school counselor to reveal confidential information (Baker, 2000). However, school counselors in most st ates do not have privileged communication (Remley & Herlihy). Without legal protec tion for information shared between school counselors and students, school counselors mu st depend on ethics and local policies to guide their confidentiality decis ions. Studies on Ethical Decision-Making Wagner (1981) surveyed 569 school counsel ors in Pennsylvania and New York (120 elementary, 212 middle, 237 high/seco ndary) to compare different grade level counselors beliefs and practi ces concerning confidentiality of their student clients. Counselors were asked to respond to st atements about confidentiality using the following response categories: strongly agree, mildly agree, mildly disagree, and strongly disagree. A chi-squared analysis was used to compare the different grade level counselors agreement. Secondary school counselors (i.e. middle and high school) were more protective of student confidentiality than elementary school counselors. So as children grow older schoo l counselors feel less re sponsibility to the parents and more to the student client. Secondar y counselors also omitted more survey 33

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questions than the elementary counselors (espec ially questions addressing legal issues and communication with parents and state aut horities) which suggests that they experienced more conflicts related to student confidentiality. Wagner suggests that secondary school counselors may deal with mo re challenging conflicts because their clients are older. Although Wagn er did not report any survey questions directly related to adolescent sexuality, she included se xuality in the discussion: More advanced sexual behavior among adolescents would incr ease the probability of counseling issues that relate to birth control, pregnancy, abortion, and VD (Wagner, 1981, p. 209). Davis and Mickelson (1994) surveyed 165 Wi sconsin school counselors (45 elementary, 38 middle school, and 62 high school) on ethical and legal decision-making. Davis & Mickelson presented 31 ethical and l egal dilemmas and asked participants to indicate the strength of their agreement or disagreement with counselors actions described in the scenario (strongly agree, mildly agree, mildly di sagree, or strongly disagree). The researchers defined a dilemma as difficult for school counselors if less than 50% of participants corre ctly agreed or disagreed wit h the counselor in the scenario (according to school counseling et hics and Wisconsin laws ). Of the seven identified as difficult six in cluded legal and ethical issues concerning student privacy and confidentiality and parental rights to informa tion about their children. In this survey, only one dilemma addressed adolescent sexuality. The scenario included a 13-year-old female student who was engaged in sexual ac tivity. The counselor in the scenario broke confidentiality against the wishes of the student and informed the students parents. In Wisconsins state law, parents have a right to know this information and counselors are obligated by law to report this to authorities. However, only 23% of 34

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middle school counselors and 13% of high sc hool counselors strongly agreed with the counselor. Thirty-three percent of mi ddle school counselors and 24% of high school mildly agreed, 26% of middl e school and high school counsel ors mildly disagreed, and 18% of middle school counselors and 37% of high school counselors strongly disagreed. Davis and Mickelson (1994) infe rred from participants responses to the dilemmas that school counselors are more aw are of professional ethics than state and federal laws. The researchers also sugges ted that when local po licies disregarding students rights are supported by parents and the community, school counselors may believe that they are legal. Isaacs (1999) surveyed 627 public school counselors (411 elementary, 71 middle, and 145 high school counselors) in eight Florida school districts to determine in what situations counselors would consider breaking confidentiality. Isaacs found that counselor judgment of when to breach conf identiality is determined in part by the degree of dangerousness of the perceived behavior and the age of the student (p.261). Isaacs concluded that counselors were more protective of conf identiality of older students and were more uncertain in predicti ng their decisions to break or maintain confidentiality for older students behavior. Several of the scenarios depicted in Isaacss survey addressed adolescent sexuality. Of the high school counselors surveyed, 34.7% indicated they were likely to break confidentiality if an ol der student revealed they were planning to have an abortion the next day and 50% would likely breach conf identiality if it wa s a younger student. Forty-nine percent of high school counselors indicated they would likely break confidentiality if a student revealed he or she was engaging in unprotected sex with 35

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more than one partner and nearly 89% percent would break confidentiality if a 14-yearold, HIV positive student had mu ltiple sexual part ners. Thirty-sev en percent of high school counselors would refer a student to an outside agency for help on contraceptive information and approximately 78% indicated they would refer a student to an outside agency for help on contraceptive information if asked Fifty-seven percent would offer advice on contraceptives to a student who asked me for help. And 2% of high school counselors would drive a student to an abortion appointment if asked. Stone and Isaac (2003) surveyed 425 school counselors (36% elementary, 24% middle, 40% high school) immedi ately after the April 1999 s hootings at Columbine High School. The initial survey was administer ed in March 1999 in Isaacs study. The authors compared the differences in school c ounselors attitudes before and after the shootings. Overall, school counselors partici pating in the May sample were less likely to breach confidentiality than t hose who were surveyed in March. School counselors in the second sample also reported more responsi bility to their student clients than to their adult parents. The authors sugge sted that the school counse lors attitudes changed to be more protective of student confidentia lity because school counselors recognized after Columbine that providing confidentia lity can increase students willingness to ask for help or report forthcoming vi olence. Statistically significant differences (Chi-squared analysis) between the March and May samples were found for several of the scenarios involving adole scent sexuality. Fewer high school counselors in the second sa mple were willing to break confidentiality for the scenario of a 17-year-old sneaking out to meet boyfriend/girl friend: 9% indicated they were likely to break confidentiality in first sample and 7% were likely to break 36

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confidentiality in the second sample. For the scenario describing a 17-year-old planning to have an abortion the next day, 41% of t he March sample were likely to break confidentiality, while only 36% of the second sample indicated they were likely to break confidentiality. Also, in the May sample there was an increase in the percentage of high school counselors reporting they were likely to offer abortion c linic information to 11 and 14 year old students who asked. The authors reported an increase from 15% to 31% for an 11-year-old student and 24% to 40% for a 14-year-old student. Bodenhorn (2006) explored ethical decision-maki ng in a survey of Virginia public school counselors. Participants included 92 counselors (26 element ary, 29 middle and 37 high school); 82 were female and 8 were male. Common (i.e., those encountered frequently and recently) and challenging ethical dilemmas were identified. The most common dilemmas reported by the participa nts included student confidentiality of personal information revealed in counseling ( 67% participants reported this as a recent and frequent dilemma) and student records (36%), harm to self or others (33%), and parental rights to information (22%). Thr ee of these were also found to be the most challenging: confidentiality of personal disclosures (46%), harm to self or others (45%), and parental rights (33%). A ll of the common and challenging dilemmas presented in the study could relate to adol escent sexuality; however, sc enarios involving adolescent sexuality were not directly presented. In addition to identifying common and chal lenging ethical dilemmas, Bodenhorn surveyed counselors about their education in ethics. More than 50% of counselors reported having taken a course in ethics in their masters level program. Forty-six percent reported participating in formal continuing education on ethics while 72% had 37

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read articles on ethics. Only 41% had a c opy of counseling ethical code and only 8% reported frequently using the ethical code. No information was provided on how the counselors ethical education related to their responses to the ethical dilemmas. Moyer and Sullivan (2008) surveyed 204 middle and high school counselors in the United States to determine how the fre quency, intensity, and duration of risk-taking behaviors influences counselors decisions to break confidentia lity and report student behaviors to parents (p. 236). The resear chers manipulated the age (13 and 15) and gender (male and female) of the student depicted in the survey vignette. Regression analysis showed that counselor age and years of experiences were not significant. However, Moyer & Sullivan found that counselors were more likely to break confidentiality as the intensity, frequency, and durati on of risk-taking behaviors increased. Sexual behaviors items in cluded a student in a monogamous sexual relationship, a student in a homosexual relationship, and a student having multiple sexual partners. Counselors rated these sexual behaviors as less ethical to break confidentiality than other behavior domains included in the survey (i.e. alcohol, substance abuse, self-mutilation, suicidal behavior, and antisocial behavior) and more ethical to break confidentiality than smok ing behaviors. A Bonferroni post-hoc analysis of the sexual behaviors items showed that counselors are more protective of student confidentiality for older male and female students and more willing to break confidentiality with younger male and female students. No differences were noted between counselors decisions to break conf identially for male and female students of the same age. 38

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School counselors in other parts of the wo rld also face ethical dilemmas related to maintaining student confidentiality. Laz ovsky (2008) surveyed 195 school counselors in Israel about their decisions and reasons to break or maintain confidentiality. Dilemmas presented included three major categories: dangerous unlawful, and personal or family. Two of the dilemmas pres ented in the survey related to adolescent sexuality: Included in the dangerous situations cat egory An HIV-positive student engages in sex with multiple par tners without disclosing her condition but takes care not to infect her partners and A 14-year-old gi rl reveals her sexual exploits, including having sex with a 21-year-old was included in the personal and family information. Nearly 71% of counselors surveyed would main tain confidentiality wit h the HIV positive student with only 29% breaking confidentiality. Approxim ately 36% of counselors indicated they would maintain confidentia lity with the 14-year-old while 63% would break confidentiality. Counselors did not agree on their decisions to break confidentiality. In only 4 of the 18 dilemmas more than 75% of counselors agreed to break or keep confidentiality. The reas ons given by counselors were qualitatively analyzed with an inductive content analysis us ing a step classification system. In addition to the lack of consensus in making decisions, counselors also offered varied reasons for their decisions. Ne ither of the sexual scenario s included a male student, therefore varying the gender of students in the dilemmas could improve the usefulness of study findings. Research on school counselors and c onfidentiality has suggested that counselors feel more responsibility to the parents of younger students and provide more confidentiality to older students (Moyer & Sullivan, 2008; Wagner, 1981). School 39

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counselors do not agree on whether or not to maintain or break confidentiality given a variety of scenarios (Davis and Mickelson, 1994; Lazovsky, 2008). Furthermore, the conflict and ambiguity increases with ol der students (Issacs, 1999; Wagner, 1981). School counselors decisions to break or main tain student confidentiality is also related to how dangerous they perceive the student behavior to be (Issacs, 1999; Moyer & Sullivan, 2008). Scenarios involving adolescent sexuality are especially challenging to school counselors and require further in vestigation (Davis and Mickelson, 1994; Herman, 2002; Lazovsky, 2008). Past research on school counselors and confidentiality has excluded issues of adolescent sexuality or only in cluded them marginally. So me researchers have used scenarios only depicting students of one gender and none have compared counselor responses for boys vs. girls as a primary research question. Studies found in the literature surveyed both male and female counselors but did not compare their responses. The current study will present scenarios involving adolescent sexuality exclusively. Furthermore, the study will examine gender of counselor and students as a factor in whether or not school coun selors break confidentiality. Sexuality Literature This section will include perspecti ves on human sexuality and adolescent sexuality and sexual attitudes Also included are school counselors concerns about adolescent sexuality, legal issues relat ed to adolescent sexual ity, and sexuality education in American public schools. General Definitions and Theories Rathus et al. (2002) defines sexuality as The ways in which we experience and express ourselves as sexual be ings (p. 5). A persons sexuality is influenced by many 40

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factors, including biological (genes, hormones), psychological (perception, emotions, personality), social (attitudes), cultural (mo rals, customs) and sociocultural (rewards, punishment, modeling) (Rathus et al.). Thes e influences interact and combine in ways that create sexual ities unique to each person (Rathus et al.). Sexual attitudes and behaviors are multidimensional as are the fa ctors that influence attitudes and behaviors (Hendrick & Hendrick, 1985). Examples of studies of gender differences in sexual attitudes can be found in the literature. Hendri ck and Hendrick (1985) examined ge nder differences in sexual attitudes. Using factor analysis, Hendrick & Hendrick found eight factors of sexual attitudes: sexual permissiveness, sexual responsibility, sexual communion, sexual instrumentality, sexual conv entionality, sex avoi dance, sexual control, and sexual power. Sexual permissiveness is associated with acceptable of casual sex outside of a committed relationship and wanting sex with multip le partners. Sexual responsibility is measured by behaviors such as using birth control. Sexual idealism is associated with seeing sexual communion as merging of souls or the closest form of human interaction where as instrumentality deals with a person focusing on their own pleasure in sex. Sexual conventionality is concerned with se xual behaviors such as masturbation, homosexuality, and sex toys. Sexual contro l deals with planning and keeping emotions in check. Sexual power is associated with the relationship between sexual acts and the power one feels. In a study of 800 college students, differences in sexual attitudes between male and female respondents were found in 72 out of 102 items. Hendrick & Hendrick found that females reported to be more responsible, conventional, and idealistic (communion). Males were reporte d to be more permissive, instrumental, and 41

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control and power oriented. Hendrick & Hendr icks models of sexual attitudes will be used in the current study. In three studies of college students, Hendr ick, Hendrick, & Reich (2006) used two new brief versions of their sexuality scale to assess gender differences in sexual attitudes. The brief sexual attitudes scale uses four factors: permissiveness, instrumentality, birth control, and communion In each of the three studies, men more strongly endorsed permissiveness and instrument ality. However males and females attitudes were not significantly different fo r birth control or communion. In the 1985 study, women had displayed more responsible attitudes towards birth control and more strongly endorsed the spiritual connection aspects (i.e., communion) of sex. The results show a shift towards men and women feeling a shared responsibility for birth control. Counselor Sexual Values Counselors are encouraged to explore thei r own values and how those values influence ethical decision-making. Student s and school counselors are likely to have different values concerning premarital sex, ca sual sex, and sex with multiple partners. Many of Americans sexual attitudes deriv e from religious teac hing and psychoanalytic theories (Frienze et al., 1978). For exampl e, some counselors may have traditional religious values about sexuality and may view premarital sex as an inappropriate sexual behavior (Wilson, 1995). Others may have more liberal views seeing casual sex or sex with multiple partners as more acceptable. Ford & Hendrick (2003) surveyed 318 m ental health and marriage and family counselors about their sexual values for se lf and clients as we ll as which sexual behaviors the counselors would feel uncom fortable addressing with clients. Fifteen percent of counselors repor ted sexual crimes (i.e., rape, sexual abuse, abuse 42

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perpetrators, and pedophiles) and 10% repor ted unsafe sex as being the most personally uncomfortable sexual issue wit h which they deal. When asked how they manage the most personally unc omfortable clinical situat ions, 40% of counselors reported they would refer cli ents, 25% would discuss the i ssue with their client, and 18% would consult with a peer or supervisor. Ford & Hendrick found that the counselors participating in this study differed in t heir sexual values depending on their gender, religious involvement, and political affiliation. For example, female counselors reported more comfort with sexual orientation iss ues while male counselors appeared to be more comfortable with non-normative sexual behaviors (e.g., group sex or sadomasochism). While Ford & Hendrick examined sexual va lues of mental health and marriage and family counselors, similar studies have not been undertaken with school coun selors. School Counselors Concerns about Adolescent Sexuality Adolescence is a period of physical, emotional, and cognitive growth that offers adolescents opportunities for sexual exploration and self development as well as risks to their mental and physical wellbeing (Bak er, 2005). Educators and school counselors are concerned about risks adolescents face re lated to sexuality, such as the objectification and sexualization of girls, sexually transmitted infections, sexual harassment, sexual violence and rape. Each of these concerns will be discussed in this section, beginning with the se xualization of girls. Today, adolescents are exposed to ster eotypical images and messages about girls and women from the mass media, their family, and their peers. According to Choate & Curry (2009), girls are sexualized and devalued when they are seen as sexual objects to be admired. The sexualization of girls can hinder academic achievement and limit their opportunities for education and ca reers (APA, 2007; Choat e & Curry, 2009). 43

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Girls who internalize sexual messages ma y be more likely to tolerate sexual harassment and could become victims of sexual crimes (Choate & Curry, 2009). Objectification of the female body can lead women to habitual body monitoring and can increase a womans feelings of shame and anxiety as well as mental health risks such as depression, eating disorders or sexual problems (Fredrickson & Roberts, 1997). Body objectification has also been linked with weaker sexual self-efficacy as measured by being able to act on ones own sexual de sires and to protect oneself from unwanted sexual risks (Impett, Sc hooler, and Tolman, 2006). Adolescent pregnancies are a major concern of educators and school counselors. The National Campaign to Prevent Teen and Unplanned Pregnancies reported health, educational, and economic risks associated with teen parenting (Retrieved on 10/24/2009 from http://www.thenationalc ampaign.org/default.aspx ). Adolescent pregnancies bring health risks to mother and child: anemia and high blood pressure for the mother and pr emature birth, low birth wei ght, and other health issues for the baby (Retrieved on 10/24/2009 from http://www.thenationalc ampaign.org/why-itmatters/pdf/health.pdf ). Teen parents may also drop out of school prematurely or forego higher education. Only 40% of teenagers who become parents before their 18th birthday graduate from high school compared to 75% of peers from similar backgrounds (Retrieved on 10/24/2009 from http://www.thenationalc ampaign.org/why-itmatters/pdf/education.pdf ). Children born to teen mothers are more likely to live in poverty than children born to older mot hers and more than 60% of unmarried teen mothers become depended on public assistance dur ing the first five years after the child is born ( http://www.thenationalcampaign.org/wh y-it-matters/pdf/introduction.pdf ). 44

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Additionally, teen parents are challe nge by balancing their own personal developments with the needs of their childre n (DAndrea, 1994). School counselors may use interventions to prevent teen pregnancy, interventions to help teens deal with and make decisions about pregnancies, and to help teens with educational and personal concerns after a pregnancy (Goodyear, 2002). Kiselica & Pfaller (1993) offer a framework for school counselors to help teenage parents. Kiselica and Pfaller encourage counse lors to examining their own beliefs and stereotypes held about teen parents to prevent their prej udices from hindering the counseling relationship. They recommend school counselors identify teen parents for counseling services, establish rapport, and address teen parent educational, career, and personal concerns through counseling. Additionally, Kiselica and Pfaller recommend counselors make referrals in the community to serve needs of teen parents that cannot be met within the school counseling program. Student sexual harassment is another conc ern to school counselors. Sexual harassment can have many har mful effects on students, including feelings of being exploited, devalued, angry, power-le ss, embarrassed and depressed (Rowell & McBride, 1996). The Office of Civil Rights cl assified sexual harassment in schools as sexual discrimination under title IX of the Education Amendments of 1972 (Chaves, 2000). Title IX and court cases like t he 1999 Davis v. Monroe County Board of Education (in which the school board had to pay financial damages for student on student sexual harassment that occurred at school) legally compel school counselors and educators to serve as advocates against sexual harassment (Stone, 2000). Male and female students can be victims and perpetra tors of sexual harassment (Gutek & 45

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Done, 2001). However most reports are of females being victim ized (Gutek & Done, 2001). Additionally, sexual minorities are al so victims of sexually harassment (DePaul, Walsh, & Dam, 2009; GLSEN, 2007). Student on student sexual harassment has existed in our schools for many decades and has become an issue of public conc ern in recent years. Despite public attention, sexual harassment has been only marginally addressed in school counseling literature. School counselors may work to prevent sexual harassment as well as intervene when it occurs (Chaves, 2000; Ro well & McBride, 1996). When sexual harassment does occur, school counselors must work to provide support for the victim and intervention to the harassment. Ho wever, intervening can become more complicated if the victim requests conf identiality and do not wish to be named (Stone, 2000). Legal Issues Pertaining To Adolescent Sexuality Counselors may feel confused and uncomfortable dealing with i ssues related to adolescent sex and sex crimes (Mitchell & Rogers, 2003). Mitchell & Rogers propose that school counselors difficulty may par tially be due to confusion about what differentiates statutory rape, rape, and sexual abuse as well as their ethical and legal obligations for each situation (Mitchell & R ogers). Mitchell & Rogers suggest this confusion may be a result of lack of training in specific laws related to sex crimes. School counselors working with adolescent s should be aware of the relevant sex laws in their state. For ex ample, in the state of Flori da, 16 and 17-year-old minors are legally permitted to consent to sexual ac tivity with people aged 16 to 23. Other age pairings are crimes. For exampl e, it is a felony crime fo r a twenty-four year old to engage in sexual activity with minors 17-yearsold or younger and any sexual act with a 46

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partner less than 16 is a felony (Florida St atute 800.044 and 800.045). Furthermore, it is considered child abuse when a person 21 y ears of age or older impregnates a child under age 16 year (Florida Statut e 827.04). Sexual activity is also considered child sexual abuse in Florida if t he perpetrator is in a parental or caretaker role. Every state has similar laws to address the protec tion of minors from sexual abuse. While the law requires school counselors to report child abuse, professional ethics compel them to break confidentialit y in cases of clear and imminent danger. Counselors are encouraged to examine their own values, beliefs, and experiences and how they influence their eval uation of what is consider ed dangerous behaviors (Glossoff & Pate, 2002; Issacs, 1999). A counselors per sonal values and experiences can affect how she perceives adolescent sexual behaviors or situations. For example, Mitchell & Rogers (2003) argue that statut ory rape is non-forced, mutually consenting intercourse where the state has decl ared an inappropriate age discr epancy between partners and denied legal consent. There are no grounds for the assumption of imminent danger in such cases, even if the partnership were to continue in the future. School counselors are mandated to report child abuse; however, c ounselor as not required to report rape or statutory rape (Mitc hell & Rogers, 2003). School counselors may also struggl e with confidentiality dilemmas when a student has experienced sexual violence. Rape is a crime that has occurred in the past and does not constitute imminent danger (Mitchell & Rogers, 2003). The counselor does not have the right to report this crime as that right belongs to t he minor victim or their parent/guardian. The school counselor ma y not have to report rape to authorities; 47

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however, they may feel compelled to s hare this information with the adolescents parents. Students may not know the laws related to age of consent, legal age differences for a teens partner, and statutory rape. They may reve al information about their sexual activity and age of their sexual partner(s) to a school counsel or without knowing that the counselor may have to break confidentiality. In some states, sex between a minor and an older partner may be considered child ab use and counselors are required to report the behavior (Mitchell & Rogers, 2003). Some counselor may avoid inquiring about the age of sexual partners to avoid the responsibilit y of reporting. Yet, if the law requires reporting this information then it should be included in informed consent procedures (Mitchell & Rogers, 2003). Students may ask school counselors for advice or information concerning contraceptives or pregnancy. School counsel ors need to know the legal issues relevant to adolescent sexuality in regar ds to access to contraceptives and abortion. Half of the states in America allow minors over 11 years-old to seek contraceptive services without parental consent (Guttmacher In stitute, 2008). Florida law, however, allows minors to receive contraceptive information or services without parental consent only if they are pregnant, have been pregnant, are married, or are in need of birth control to prevent health hazards (Florida Statute 743.065 ). A pregnant minor can make medical decision related to her pregnancy and can make medica l decisions for her child but requires parental consent for unrelated medical issues (Florida statut e 743.065). In all states, including Florida, minors may give consent for examinations and tr eatments of sexually transmitted infections (Florida Statute 384. 30; Guttmacher Institute, 2008). The 48

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Parental Notice of Abortion act in Florida requires physicians to inform a parent or legal guardian of minors (under 18-years-old) prio r to the inducement or termination of a pregnancy (Florida Statute 390.01114). Minors may petition a circuit or judicial circuit court for a waiver to the parent notification. The court may award a waiver if the minor is deemed mature enough to make the decision to terminate her pregnancy or if there is evidence of child abuse or sexual abuse to the minor by the parents or legal guardians. All of the Florida Statutes cited were retrieved on 3/15/2008 from http://www.leg.state.fl.us/statutes According to Florida Statutes, 16 and 17-ye ar-old teens are legally allowed to consent to sexual activity, obtain treatment for sexually transmitted infections, get pregnant, make medical decisions about their pregnancy and on behalf of their child, but they cannot seek contraceptives without parental consent. Additionally, they can choose to have an abortion with parental notification and without parental consent. Yet, without their parents, they cannot legally obt ain contraceptives that could prevent pregnancy, STIs, and the need for an abortion. Some counselors may view these laws as inconsistent or may have values and beliefs that are contrary to the laws. Their beliefs and values may effect a counselors decisions to give advice and information and maintain or break confidentiality. ASCA provides information on disclosu res involving sexually transmitted infections: In absence of state legislat ion expressly forbid ding disclosure, [the professional school counselor] considers the ethical responsibility to provide information to an identified third party who, by his/her relationship with the student, is at a high risk of contracting a disease that is commonly known to be communicable and fatal (ASCA, 49

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2004, p. 1). According to ASCA, the c ounselor should recommend that the student notify the partner and avoid hi gh-risk behaviors (such as intercourse without a condom). If the student refuses to tell his or her par tner, the school counselor should seek consultation from public health agencies to find options for informing the partner. Counselor may feel conflicted in cases like this one, where others are at risk and they are unable to help them without breaching confidentiality. Sex Education In recent decades, the US government has funded abstinence only until marriage sex education through three sources: Adolesc ent Family Life Act (also known as Title XX of the Public Health Service Act), Title V Welfare Reform Act, and CommunityBased Abstinence Education. Abstinence only education receiv ed nearly 1.3 billion dollars between 2001 and 2009 (USA Today, May 12th, 2009). Abstinence only education emphasizes failure rates for contra ceptives and promotes sexual activity within a heterosexual, monogamous marriage as being the only practice leading to a healthy and happy life (SIECUS, 2008). Although there is social and political support for a more comprehensive sex education program, there currently no approved federal funding dedicated to these programs (Advocates for Youth, 2008). Criticism of abstinence only sex educati on can be found in the literature. For example, abstinence only education program s suggest that sexual actssuch as petting, oral sex, and mastur bationthat do not lead to reproduction are immoral or wrong (Bay-Chen, 2003; Epstein, OFlynn, & Telford, 2003; Unger & Crawford, 1992). Sex education often focuses on anatomy and negative consequences, leaving out desire and pleasure (Unger & Crawford, 1992). Abstinence only education also teaches abstinence until heterosexual marriage, leav ing out gay students (Bay-Chen, 2003; 50

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Bartlett & Capuzzi, 2002; Epstein et al, 2003, Fine & McClelland, 2007; Unger & Crawford, 1992). Furthermore, abstinence only education either omits information on condoms and birth control methods or focuse s on their deficiencies as protective methods (Bay-Chen, 2003). A 2007 federal ly funded study of abstinence programs showed they were not effective in delay ing teen sex, nor teen pregnancy (Jayson, 2009). The Sexuality Information and Education Council of the United States (SIECUS) supports a comprehensive based sex educati on program for all. SIECUS (2004) defines sexuality education as a lifelong process of acquiring information and forming attitudes, beliefs, and values about such import ant topics as identity, relationships, and intimacy (SIECUS, 2004, p.12). Furthermore, SIECUS believes that all people have the right to comprehensive sexuality education that addresses the socio-cultural, biological, psychological, and spiritual dimensions of sexuality by providing information; exploring feelings, values and attitudes ; and developing communication, decisionmaking, and critical-thinking skills (SIECUS 2004, p.12). In addition to SIECES, numerous professional organiza tions support a comprehensive sex education, including the American Psychological Asso ciation, American Academy of Pediatrics, Society for Adolescent Medicine, American Medical Asso ciation, and the National Association of School Psychologists. In the spring of 2009, the United States President, Barak Obama, initiated a national shift away from abstinence only education to teen pregnancy prevention by proposing a budget of nearly $178 million for prevention, including $110 million for community based programs (Jayson, 2009). Obama's proposed budget for 2010 51

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allocates $178 million for teen pregnancy prevention with the $110 million directed towards community-based programs. Three-f ourths of the funding is for programs with documented success in delaying teen sex, incr easing contraceptive use and/or reducing teen pregnancy while one-fourth is intended fo r new programs (Jayson, 2009). If approved, the new plan could provide adolescents with access to a more comprehensive sexuality education. Howe ver, with most of the funding going to community-based programs, it is not known how schoolbased sexuality education will be affected. Support for school counselors involvement with sex education in schools can be found in the literatur e over the past 30 years (Barle tt & Portman, 2002; Barnes & Harrod, 1993; Dycus & Costner, 1990; Kell y, 1971; Pietrofesa, 1976). Barlett & Portman (2002) argue that school counselors possess the established relationships and expertise to positively impact school-based sex education. School counselors could become leaders in their schools to help students develop and accept their sexual identities (DePaul, Walsh, & Dam, 2009). Furthermore, school counselors can also facilitate school communities in discussions about different sexual orientations (DePaul, Walsh, & Dam, 2009). To become a leader in sex education in schools, counselors must consider theories of adolescents and adol escent sexuality. Theories of adolescence and sex education both often focus on t he concept of risks (Gilbert, 2007) Adults are concerned about teens risks of sexual har assment and sexual violence, risks of contracting a STI or having an unplanned pregnanc y. Gilbert (2007) proposes viewing risks as part of natural development and growing up. Accordi ng to Gilbert, Sex e ducation is larger 52

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than information, affirmation or prohibition. In its address to the most intimate aspects of life---love, loss, vulnerability, power friendship, aggressionsex education is necessarily entangled in the adolescents effort s to construct a self, find love outside the family, enjoy ones newly adult body; in short, various relationships that might cautiously be called development (p.49). She argues that sex, with or without protection, can come from an adolescents needs to be want ed and search for companionship. Gilbert (2007) encourages adults to view adolescents as sexual beings who have the right to experience the risks of sexuality and to wo rk towards creating an environment where adolescents can explore their curiosities with thoughtfulness and care. According to Gilbert this requires adults to examine their own beliefs about adolescents, sexuality, and what it means to become an adult. Many topics can be considered in ex ploring adolescent sexuality and school counselors attitudes toward sexuality, including definitions and perspectives of sexuality, legal issues, and se x education. Adolescent sexual behaviors can be viewed as both a normal part of growing up and as risks for har m and negative consequences. Gender Gender roles are culturally constructed beliefs and attitudes about the traits and behaviors that society considers appropriate for females and males (Worell & Remer, 2003, p. 10 & 15). People lear n about gender roles from birt h and exhibit preference for stereotypical gender characteristics and behaviors at a young age (Powlishta, Sen, Serbin, Poulin-Dubois, & Eichstedt, 2001). Theories of gender role development include both cognitive and social factors (Powlishta et al., 2001; Unger & Crawford, 1992). Cognitive theories explain gender role development by a childs tendency to place new information into mental categories (Powlishta et al., 2001). Children learn to 53

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recognize similarities and differences between themselves and others, labeling themselves as male or female, and dev elop a preference for characteristics and behaviors that they perceive as associat ed with their own gender. Social learning theory suggests children develop gender roles by receiving reinforcement for gender typical behaviors, punishment for gender atypical behavio r, and by observing gender models (Frienze et al., 1978; Powlishta et al., 2001; Unger & Crawford,1992). Bems gender schema theory explains the acquisition of sex roles (gender roles) using both social learning and cognitive-devel opment theories (Bem, 1981). Schema is a cognitive framework or c oncept that organizes and guides a persons perceptions. Children learn beliefs about gender appr opriate behaviors and gender related associations from their culture. They apply this organizational framework, or gender schema, to evaluate and incorporate new info rmation. Using schemas allows people to interpret large amounts of information but can lead to stereotypes due to a preference for attending to information t hat confirms our pre-existing beliefs. According to Bem, children may initially view a certain characteri stic as different for males and females, but eventually categorize the charac teristic as male or female For example, a child may see boys as stronger than girls but eventually categorize men as strong and women as being the opposite-weak Gender roles become a part of a persons self concept and their self-esteem becomes reliant on how faithfully they adhere to societys gender role expectations (1981). Traditional gender roles exhibit unequal power between men and women, distributing more power and fr eedom to men (Shearer, Host erman, Gillen & Lefkowitz, 2005). King and King (1997) devel oped the Sex-Role Egalitar ianism Scale (SRES) to 54

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measure gender role attitudes. The sex-role egalitarianism construct is bidirectional and includes beliefs about women and beliefs about men. According to King and King, a person with egalitarian gender role beliefs would not have objections to a woman in a stereotypical male career or to a man in a stereotypic al female role. The SRES measures gender attitudes in five domains: marital, parental, educational, employment, social-interpersonal-heterosexual roles. In a study of university undergraduate st udents, Burnett, Anderson, & Heppner (1995) found that male and female indi viduals who exhibit more masculine characteristics (i.e. decisi veness, independence, and compet itiveness) reported greater self-esteem than those possessing less masculin e traits. Burnett, Anderson & Heppner view these findings as evidence that American society is biases towards traditional male characteristics. However, despite this bias towards masculine charac teristics, restricted gender roles can also have a negative or harmful affect on the lives of men. Socially constructed features of masculinity may include views of men as strong and silent, tough and aggressive, not needing help, a sexual stud (sex without meaningful relationships), anti-sissy (a voiding feministic traits and homosexuality), and being powerful and successful through competitio n (Forbes, 2003; Gillon, 2007; Good & Sherrod, 2001). Restricted gender roles and gender stereotypes such as these listed can limit a mans personal development and mental health. Research has linked problems such as restricted emotional awareness and expressi on and problems with interpersonal relationships to traditiona l gender beliefs of m en (Good, Robertson, ONeil, Fitzgerald, Stevens, DeBord, Bartel s, & Braveman, 1995; Wisch, Mahalik, Hayes and Nutt, 1995). Role conflict for the male gender has been linked to a variety of social 55

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and mental problems including depression, sexually aggressive attitudes, fear of intimacy, and poor self care (Enns, 2004). For these reasons, school counselors are encouraged to help male adolescents to challenge the norm of conventional masculinity and help them to advance thei r self-awareness and development (Forbes, 2003, p. 148). Restricted gender roles and gender stereotypes can have negative impacts on academic, career, and personal-social devel opment of girls (Choate, 2009). For example, Kopper and Epperson (1996) found a positive relationship between psychological distress (i.e. weak ego strength, passive aggressiveness, and dependency) in women and traditiona l gender role orientations. Examples of socially constructed characteristics of femininity include emotional, home-or iented, devotes self to others, considerate, gentle, need for secu rity, and likes children (Unger & Crawford, 1992). Women are also expected to be passi ve, dependent, unintelligent, and inferior to men (Frienze et al, 1978). Research on gender roles and girls includes attention to the objectivity and sexualization of girls (as discussed previously in chapter 2) as well as academic and career concerns. Researchers encourage school counselors to examine their own beliefs about womens roles, to assist girl s and women in tackling gender stereotypes in the education system, and to help girls choos e careers that have traditionally been pursued by men (Bartholomew & Schnorr, 1994; DeVoe 1990). Gender role attitudes are pertinent to understanding sexual behavior (Shearer, Hosterman, Gillen & Lefkowitz, 2005). For example, acceptance of traditional gender role attitudes can place men and women in ri sky situations. Men may feel compelled to 56

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adhere to the stereotype of m an as sexual adventures while women adhering to women as passive may defer important sexual decis ions (i.e. which sexual behaviors to engage in, birth control, etc) to their partners (S hearer et al, 2005). Seve ral different sexual stereotypes are commonly associated with wo men, including views of women as less interested in sex then men, women as gate keepers to mens sexual desires, women as sexual objects, or sexual victims (Frienze et al, 1978). Sexual attitudes and stereotypes are relevant to the current study in two signi ficant ways. First, high school students are likely to experience social pressures to co nform to sexual stereotypes and may bring these sexual concerns to t he attention of their school counselor. Secondly, school counselors interactions with adolescents and their decision-making are also likely to be influenced by gender attitudes and stereotypes (Gold & Hawley, 2001). The importance of including ge nder issues in counselor preparation is required by CACREP standards and counseling ethics by ACA and ASCA and is also recognized in counselor educator literature (Daliluk, Stein, & Bockus, 1995; Gold, 2001; StevensSmith, 1995). Gender aw areness is crucial for multi-cultural competence in counseling and is essential because a counselors bel iefs about men and women affect the way they work with clients (Gol d & Hawley, 2001; Stevens-Smith, 1995). People may be unconscious of their beliefs about gender and unaware of how these beliefs affect their interactions with others. It is important for counselors and counselors-in-training to become alert to their own gender role biases in order to work more effectively with clients (Gold & Hawley, 2001; Seem & Johnson, 1998; Trepal, Wester & Shuler, 2008). A counselor who disregards or is unaware his or her own beliefs about gender may hamper the counseling process in severa l ways. When gender differences are 57

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disregarded, the counselor may place limits on the clients life options (DeVoe, 1990), impose his or her gender beliefs onto the cli ent (Daniluk, Stein, & Bockus, 1995), or direct counseling services based on inaccurate client assessments (Gold & Hawley, 2001; Seem & Johnson, 1998; Trepal, Wester, & Shuler, 2008). Studies Related to Counselor Gender Beliefs Seem & Johnson (1998) explored gender bias in counselors-in-training with an open response survey. Participants included 210 graduate counseling students enrolled in programs in t he east and Midwest America. Ninety-two percent of participants in this study were White and approximately 72% of participants were female. Participants responded to two case vignettes were used. The first case was a female gender role description in which a m an or woman client reported conflict about whether to stay home or wo rk outside the home. The second case was a male gender role description in which a male or female client reported conflict about whether to pursue a graduate degree or to follow his/her current partner s desire to get married and start a family. Participants were asked to write a description of the clients problem including hypotheses of the underlying issues issues to discuss in counseling, and treatment goals. Content analyses and Chi-squared analyses were used to determine gender bias. Results showed that male and female participants focused on different issues for the male and female clients s hown in the vignette about graduate school vs. marriage and children. Gender of counselors in training was insignificant for the vignette about the married parent wanting to stay home. However, participants did describe different issues when asked to describe counseling goals for the male or female client. Seem & Johns on concluded that gender bias is found in counselors in training, especially when tradition al gender roles are violated. 58

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Gold & Hawley (2001) studied gender role attitudes of 17 male and 75 female counselor education students at a southern university. Participants completed Bems Sex Role Inventory and King & Kings Sex Ro le Egalitarianism Scale. ANOVAS were used to compare the mean T-scores of male and female respondents. Gold & Hawley expected counselor education students, as compared to university students of other disciplines, to report more androgynous beliefs on the SRI and to report more egalitarian beliefs on the SRES. However, t he results showed that counseling students possessed traditional sex role orientations and traditional attitudes toward gender that were similar to those held by the general po pulation. Gold & Hawley recommended that counseling students and professi onals become more aware of their own gender role biases and how they affect their interaction with clients. Trepal, Wester & Shuller (2008) surveyed 29 counselors in training at a Midwest university in the United Stat es. Twenty-one of the participants were female, 8 male, and the majority of participants were White/Cauc asian. Participants completed a Q-sort, categorizing and ranking gender role characteristics as a perceived feminine trait or perceived masculine trait (Trepal, Wester & Shuller, 2008, p.149). Counselors-intraining also participated in an interview about their ranking of items and their opinions about masculinity and femininity A PQMethod analysis of the Q-sorts resulted in four factor groupings including traditional perspectives (i.e. emotional, homemaker, verbal, caregiver sorted as most feminine while agg ressive, dominant, stoic and protective were sorted as most masculine), su rvivor/competitor perspective (i.e. flexible, resilient, strong, and verbal were considered most fe minine while distant, aggressive, dominant, and inhibited were most masculine), emotiona l/physical perspective (i.e. sensitive, 59

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caregiver, emotional, and protective were most feminine while stoic, strong, distant and dominant were masculine), and internal/external processing (i.e. sensitive, verbal, and homemaker were sorted most feminine while independent, stoic, protector were sorted most masculine). Trepal, Wester, & Shuller concluded that counselors-in-training serving as participants in this study perceived male and female roles in traditional ways with men and women as opposites. The Q-sort method does not allow for generalization of the result of this study. However, the study does suggest need for further examination of counselor gender beliefs and stereotypes and the effect it has on counselor decision-making. Simon, Gaul, & Myrna (1992) studied client gender and sex roles as predictors of counselors impressions and expectations for their clients. Participants included 15 Counseling Psychology doctoral students, functi oning as clinic counseling staff, and one Licensed Psychologist. The counselors parti cipating in the study interacted with real clients at a university counseling center. Counseling clients comp leted the Personality Attributes Questionnaire as a measure of self-reported masculinity and femininity. Counselors completed the Impact Message Invent ory to assess their impressions of the clients. Counselors were found to perceiv e clients displaying highly gender-typical characteristics as having more social skills and as more likely to experience positive outcomes from counseling (Simon, Myrna, & Heatherington, 1992). One older study examined sex role stereotypes of school c ounselors. WetmoreFoshay, ONeill, & Foster ( 1981) asked 173 school counselors in Nova Scotia to rate traits of a healthy male, fema le and adult. Results showed that female counselors were more likely to use traditional masculine trai ts to describe a healthy person in each 60

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category, while male counselors rated healthy men and healthy adults with similar traits and used less traditionally masculine traits to describe a healthy woman. This shows that bias towards masculinity exists not only in the United States, but in other parts of the world as well. In studies using samples of counsel ors-in-training, participants reported traditional gender roles views (Gold & Hawle y, 2001; Trepal, Wester & Shuler, 2008) and showed bias against clients displaying nont raditional gender role behavior (Seem & Johnson, 1998). While several researchers have studied gender beliefs of counselors in training (Seem & Johnson, 1998; Trepal, Wester, & Shuler, 2008), research on the gender beliefs of practicing school c ounselors is very limited. Current research shows that restrict ed gender roles, gender stereotypes, and gender bias can have limiting or negative effects on people lives (Bem 1981, Burnett, Anderson, & Heppner, 1995; Choate, 2009; Enns, 2009; G ood et al., 1995; Kopper & Epperson, 1996; Wisch, Mahalik, Hayes and Nu tt, 1995). Gender attitu des also affect the counseling process (Gold & Hawley, 200 1; Seem & Johnson, 1998; Simon, Myrna, & Heatherington; Trepal, West er & Shuler, 2008; WetmoreFoshay, ONeill, & Foster, 1981). Additionally, gender role beliefs can affect a persons sexual decision-making (Shearer et al., 2005). Because counselors and counselors in training are vulnerable to gender stereotypes and gender bias, it is impo rtant to study how gender attitudes are related to ethical decision-making. The current study will address limitations in existing literature in several ways. While previous studies address adolescent se xuality only marginally, the current study will focus exclusively on this type of student behaviors and will include a variety of 61

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situations. The current study will also fo cus specifically on high school students and counselors as they are more likely to deal with sexuality than elementary and middle school. The current study will examine the relationships between ethical decisionmaking and counselor gender, student gender, counselors sexual attitudes, and counselors gender role attitudes. This study will determine if gender or attitudes can be used to predict decision-making. This study will also consider counselor characteristics (i.e., age, years of experience, ethnicity, marital status, polit ical affiliation, and religious affiliation), and amount of time spent couns eling male and female students regarding sexual concerns. These characteristi cs and counseling experiences may provide new directions for research in the area of ethical decision-making regarding adolescent sexuality. The next chapter includes the methodolog y used in the current study. Study hypotheses, variables, sample and samp ling procedures are included. Also, questionnaires used will be de scribed. 62

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CHAPTER 3 METHODOLOGY The current study examined high school counselors ethical decision-making regarding breaking or maintaining confidentialit y when working with adolescent clients in situations involving sexuality. The current study explored influences on ethical decisions. More specifically, the study determined if there are relationships between counselors decision-making and counselor s gender, student gender, counselors attitudes towards gender, counselors sexual attitudes, counselor characteristics (i.e., age, years of experience, ethnicity, marital status, political affiliation, and religious affiliation), and amount of time spent couns eling male and female students regarding sexual concerns. Relevant Variables The current study included seven main independent variables including counselor gender and student gender. Couns elor attitudes towards gender were measured by the total score of King & Kings (1997) Sex-Role Egalitarianism Scale. Four independent variables, counselor sexual attitudes, were measured by the four subscales of Hendrick, Hendri ck, and Reichs (2006) Brief Sex ual Attitudes Scale. Eight additional variables (i.e., age, years of experience, ethnicity marital status, political affiliation, religious affiliation, frequency of counseling male students regarding sexual concerns and frequency of counseling female students regarding sexual concerns) were reported by participants in the demographics questionnaire. Counselor ethical decisionmaking was measured by the Ethical De cision-Making Questionnaire, which was created for use in this study. Factor analysis was used to divide the items of the Ethical Decision-Making Questionnaire into meaningful subscales. 63

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Sampling Procedures and Data Collection Methods The population included high school guidance counselors currently employed in schools in Florida. Practicing high school counselors in Florida were recruited to participate in this study through email. The American School Counselor Association membership directory was used to gather em ail addresses of potential participants. School counselors were also emailed at t heir workplace email addresses listed on high school webpages. Participants were sent an initial request via email and one to two reminder emails. Additionally, recruitment informati on was also distributed through the department list serve of one school counselor education program in Florida to recruit alumni members or doctoral students who are practicing sc hool counselors. Contacts were made directly to school counselors workplace emails and to the counselor preparation program in order to expand the sa mple and to recruit school counselors who may not be members of professiona l school counselor organizations. Potential participants were emailed an invita tion to participate in the study. A link was provided to an internet based survey at http://www.counselingtechnology.net Participants were randomly assigned either t he male or female vignette form of the EDMQ. Counselingtechnology.net protected the anonymity of su rvey participants in by preventing the access of indi viduals IP addresses and preventing the tracking of users through cookies. Confidentiality was prot ected in several ways. Access to data collected on counselingtechnolgy.net is pa ssword protected. Counselingtechnology also uses SSL data encryption. Additio nally, no identifying information was gathered from participants. The study proposed to use multiple r egression analyses to determine whether counselor gender or student gender predicted t he subscales of the Ethical Decision64

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Making Questionnaire. Multiple regression analyses was also conducted to determine if counselor gender, student gender, the Sex-Role Egalitarianism Scale total score, and the subscales of the Brief Sexual Attit udes Scale (Permissiveness, Birth Control, Communion, and Instrumentality) predict the subscales of the Ethical Decision-Making Questionnaire. Finally, multiple regression analyses was used to de termine if counselor gender, student gender, the Se x-Role Egalitarianism Scale total score, the subscales of the Brief Sexual Attitudes Scale (Permi ssiveness, Birth Cont rol, Communion, and Instrumentality), Counselor characteristics (i.e., age, years of experience, ethnicity, marital status, political affiliation, and religio us affiliation), and amount of time spent counseling male and female students regarding sexual concerns predict the subscales of the Ethical Decision-Making Questionnaire. In the use of multiple regression, Cohen (1992) bases desired sample size on effect size at power = .80 and a given level of probability. For a multiple regression study with seven predictor variables, a medium effect size, power = .80, and pr obability = .05, the sample size should be 97 individuals. Cohen also indicates an ANOVA for four gr oups with a medium effect size, power=.80, and probability=.05, the sample size s hould be 45 individuals per group. One hundred one female counselors responded to the survey and 60 male counselors responded. However, one male a nd one female did not answer any of the items beyond selecting their gender and were c onsequently not included in the study. Three counselors did not indicate present nor recent experience working with high school students. Theref ore, they were also removed fr om the sample. The resultant sample for this study included 58 male counselors and 99 female counselors. 65

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Hypotheses The following null hypotheses were evaluated in this study. HO1: There is no relationship between counselor gender student gender, the subscales of the Brief Sexual Attitudes Scale (i.e., Permissive, Birth Control, Communion and Instrumentality), and t he total score of the Sex-Role Egalitarianism Scale (SRES). HO2: Counselor gender and student gende r do not predict the Consensual Sexual Activity subscale of the Ethi cal Decision-Making Questionnaire (EDMQ). HO3: Counselor gender and student gender do not predict the Sexual Activity with Victimization subscale of the Ethical Decision-Ma king Questionnaire (EDMQ). HO4: Counselor gender and student gender do not predict the Sexual Activity with HIV subscale of the Ethical Decision-Making Questionnaire EDMQ. HO5: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scal e (SRES), and the students gender do not predict scores on the Consensua l Sexual Activity subscale of the Ethical DecisionMaking Questionnaire (EDMQ). HO6: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scal e (SRES), and the students gender do not predict scores on the Sexual Activity with Victimization subscale of the Ethical Decision-Making Questionnaire (EDMQ). HO7: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scal e (SRES), and the students gender do not predict scores on the Sexual Activity with HIV subscale of the Ethical DecisionMaking Questionnaire (EDMQ). HO8: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scale (SRES), the students gender, counselor characteristics (i.e., age, y ears of experience, ethnicity marital status, political affiliation, and religious affiliation), frequency of counseling female students regarding sexuality, and frequency of counseling male students regarding sexuality do not predict scores on the Cons ensual Sexual Activity subscale of the Ethical Decision-Making Questionnaire (EDMQ). HO9: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score 66

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on the Sex-Role Egalitarianism Scale (SRES), the students gender, counselor characteristics (i.e., age, y ears of experience, ethnicity marital status, political affiliation, and religious affiliation), frequency of counseling female students regarding sexuality, and frequency of counseling male students regarding sexuality do not predict scores on the Sexual Activity with Victimization subscale of the Ethical Decision-Making Questionnaire (EDMQ). HO10: Counselor gender, the subscales of t he Brief Sexual Attitudes Scale (i.e., Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitarianism Scale (SRES), the students gender, counselor characteristics (i.e., age, y ears of experience, ethnicity marital status, political affiliation, religious affiliation), frequency of counseling female students regarding sexuality, and frequency of counseling male students regarding sexuality do not predict scores on the Sexual Activity with HIV subscale of the Ethical DecisionMaking Questionnaire (EDMQ). Instruments Four instruments were used in this study These instruments include two existing assessments used in prior research: The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006) and The Sex-Role Egalitarianism Scale Short Form KK (King & King, 1997). The third instrument, t he Ethical Decision-Making Questionnaire (EDMQ) was designed for the current study, based on existing measures. The final questionnaire was used to obtain parti cipants demographical information. Ethical Decision-Making Questionnaire (EDMQ) The dependent variable for the current study is counselor ethical decision-making. The ethical decision-making questionnaire was created for this study using items from questionnaires from several studies, including, The Confidentiality and Minors Questionnaire (Isaacs, 1999; Stone & Is aacs, 2003), The Minors Confidentiality Questionnaire (Lazovsky, 2008); and Moyer & Sullivans survey (2008). The Minors Confidentiality Questionnaire (Lazovsky, 2008) was based on questionnaires used by Stone & Isaacs (2003) and Davis & Mickelson ( 2003). Moyer & Sullivans survey was based on a survey by Rae et al. (2002). These questionnaires were created based on 67

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legislative mandates and court decisions concerning managing confidential student information. All of the questi onnaires items not pertaining to sexuality were omitted from the item pool to create the EDMQ. While past quest ionnaires have included items on a range of risk-taking situations, the new questionnaire focu sed specifically on sexual behaviors. The EDMQ assessed a counselors ethical decision-making in given scenarios involving adolescent sexual ity. The EDMQ presented a vignette describing either a male or female high school student, nam ed Jamie, requesting to see the school counselor about a personal conc ern. One of Jamies par ents contacts the school counselor and wants to know what was discuss ed in a recent counseling session. The EDMQ also included 13 items depicting situat ions involving sexual behavior that Jamie might reveal to the counselor. The EDMQ in cludes five response options: It is very likely that I would maintain confidentiality, It is somewhat likely that I would maintain confidentiality, I am not cert ain what I would do in this sit uation, It is somewhat likely that I would reveal the informa tion to the parent, and It is ve ry likely that I would reveal the information to the parent. Previous studies have used response options that mention breaking or breaching confidentiality. The word reveal was used instead of break or breach to reduce possible social desirability. Four items in the EDMQ were created by modifying two items from The Minors Confidentiality Questionnaire (Lazovsky, 2008) These items include a scenario about a sexual active HIV student and a scenario describing a 14-year-old student having a sexual relationship with an older partner. The HIV scenario was expanded to include one item where the student takes care not to affect partners and one item depicting 68

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greater risk of harm in which the student does not take precautions to avoid infecting partners. The scenario descr ibing the 14-year-old was changed to depict a legal age pairing (16-year-old and a 21-year-old part ner) and a second item was written to depict an illegal age pairing (15-year-old and a 21-year-old partner). Three items from Moyer & Sullivans ( 2008) surveyed were modified to create four items in the EDMQ. The student name was changed in an item describing the student in a homosexual relationship and in an item describing a student having sexual intercourse with a steady partner. Moyer and Sullivans item about a student having multiple sexual partners was expanded to in clude a second item depicting more risk of harm with the student having unprotected sexual intercourse with multiple partners. Three additional items were developed by modifying items from Stone (1999) and Stone & Isaacs (2003) Confidentia lity with Minors Questionnaire. The Confidentiality with Minors Q uestionnaire includes multiple ve rsions of the same items changing only the age of the student. The age of the student was changed when the items were altered for the EDMQ to use a consistent age of 16 years old (legally old enough to consent to sex in Florida). The a bortion item was modified to include an item where Jamie requests the locati on of an abortion clinic to allow the same item to be used for both the male and female Jamie. The items describ ing a student seeking contraceptive or birth control advice or information were changed to one item about a student wanting condoms. Condoms were used instead of birt h control in order to use the same item for both gender versions in the EDMQ. The items describing a student sneaking out of the house to meet their boy/girlfriend were changed to show more risk of harm by stating that the student is sneaking out to have sex. The final two items 69

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were created by the researcher for the cu rrent study based on current literature on adolescent sexuality. These items include situations in which the student is being sexually harassed at school and the student reports being raped two months ago. Following the methods used by Moyer and Sullivan (2008), t he gender related language used in the vignette of the current study was changed to create two forms of the EDMQ. One version depicts a female student and the second version describes a male student. The 13 items are identical in both versions of the EDMQ, only the gender of the student in the vignettes is differen t. The two forms were assigned randomly to participants. A pilot study of the EDMQ was conduct ed to assess the clarity of directions, format, and items and to determine the appr oximate amount of time required to complete the questionnaire. The EDMQ was completed (in hard copy format) by 15 graduate students currently practicing as school counselors through an internship and 1 doctoral student who was serving as a group super visor to the interns. Additionally, two school counselor educators were consulted about the structure of the EDMQ. Following the results of the pilot study and judges comments, the questionnaire was updated: typos and grammatical errors were corrected, one item was dropped, and the age of the student was removed from the begi nning of the vignette and placed in as a note prior to the items instead. The one item depicting a 15-year-old Jamie was moved to the end of the questionnaire to reduce the confusion of Jamies age in the other items. Additionally, the gender language in individ ual items was changed so that the exact same items could be used for the male and female student forms. 70

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The Brief Sexual Attitudes Scale Four of the independent vari ables in the current study came from the subscales of The Brief Sexual Attitudes Scale, including Permissiveness, Birth Control, Communion, and Instrumentality (Hendrick, Hendr ick, & Reich, 2006). This scale is a shorter version of The Sexual Attitudes Sc ale (Hendrick & Hendrick, 1987). Both the original and the brief versions were design ed to assess several dimensions of sexual attitudes in a single measure. The Brief Se xual Attitudes Scale has four subscales, each with a different number of items. The scale has a total of 23 items. Items are Likert-type 5-point scales rangi ng from (A) strongly agree wit h statement to (E) strongly disagree with the statement. The Sexual Attitudes Scal e provided scores for each subscale by assigning numerical values to res ponses A, B, C, D, and E. A lower score on each of the subscales usually indicates a greater tendency of correspondence to the aspect of sexual attitudes measured by the subscale. However, the scoring was reversed for the current study with 1 being assigned to A ( Strongly disagree with the statement ) and 5 assigned to A ( Strongly agree with the statement ) and then dividing by the number of items to find a mean subscale score. The full-scale score was not used. The Brief Sexual Attitudes Scale includes four subscales Permissiveness, Birth Control, Communion, and Instrumentality (Hendrick, Hendr ick & Reich, 2006). The Permissiveness subscale included ten items and assesses a persons attitudes towards casual, game playing style of sex. Sa mple items include The best sex is with no strings attached and I do not need to be committed to a person to have sex with him/her. The Birth Control s ubscale (formerly called Sexual Practices) included three items and measures attitudes about birth contro l responsibility. For example, A woman should share responsibility for birth control. The Communion subscale included five 71

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items measuring attitudes related to the em otional meaning of sex. Sample items include Sex is the closest form of co mmunication between two people and Sex is a very important part of life. The Instrumentality subscale focuses on physical pleasure. A sample item includes Sex is primarily t he taking of pleasure from another person. Hendrick, Hendrick, & Reich (2006) found high internal consistency for all four scales of the brief version. Cronbachs al phas for each scale were as follows: Permissiveness=.93, Birth C ontrol=.84, Communion=.71, and Instrumentality=.77. Subscale intercorrelations were low: t he correlation between the Permissiveness and Instrumentality scales was .41 while correla tions between the other combinations of scales were .19 or lower. Test-retest correlations for the four subscales include Permissiveness=.92, Birth Cont rol=.57, Communion=.86, and In strumentality=.75. All alphas for the shorter version of the scale we re similar to (or bette r than) those for the original, longer version of the scale. Construct validity was established through several recent studies correlating the Brief Sexual A ttitudes Scale with other measures including the Love Attitudes Scale, short form (Hendrick et al., 1998), The Relationship Assessment Scale (Hendrick, 1988), The Co mmitment Scale (Lund, 1985), and the Self-Disclosure Index (Miller et al., 1983). The brief scale was found to have enhanced psychometric properties compared to the longer version. Alpha reliability coefficients ranged from .70 to .95 (Hendric k, Hendrick, & Reich, 2006) Sex-Role Egalitarianism Scale An additional independent variable came from King & Kings Sex-Role Egalitarianism Scale (SRES) short form KK (1997). The SRES measures attitudes toward the equality of women an d men in five different cont ent areas, including marital, parental, employment, educational, and social-i nterpersonal-heterosexual. The short 72

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form has a total of 25 items, including, five it ems from each of the five content domains represented in the longer version. Items ar e Likert-type 5-point scales ranging from strongly agree to strongly disagree with an undecided or no opinion center. Items were scored so that higher scores signify more ega litarian beliefs. When using the shorter twenty-five item versions, only the total scale scores are used. Higher total scores indicate more egalitarian beliefs and lower scores are less egalitarian. The short forms of the SRES contain item s in five content domains related to adult life. A sample item in the Marita l Domain is The husband should be the head of the family. The Parent Domain includes th e item It is more appropriate for a mother, rather than a father, to change their babys diapers. A sample from the Employment Domain includes It is wrong for a man to enter a traditionally female career. A sample item from the Social-Inter personal-Heterosexual Domain includes A person should be more polite to a woman than to a man. T he final Educational domain includes the item Home economics courses should be as acc eptable for male students as for female students. King & King (1997) used classical test -theory approach, item -response theory, and multifaceted generalizability pr ocedures to assess reliability of the different SexRole Egalitarianism scales. Samples included high school and college students, police officers, and participants who have subs tance abuse problems or problems with violence. The internal consistency reli ability alphas were .94 and .92 for Forms BB and KK. The stability alphas were .88 and the equi valence coefficient wa s .87. Additional studies by King & King estimated Form BBs internal consistency to be .94 and Form KK at .93 and .97. The short forms also had high correlations to the lo nger version. A G73

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study was conducted showing that forms of the long version are interchangeable. Itemresponse analyses revealed that most of the SRES items were more accurate for responses at the lower end and could more effectively divide participants with lower levels of egalitarianism. King & King (1997) used convergent, di scriminant, and nonmological methods to validate the SRES. Several studies showed t hat SRES responses were not significantly influenced by social desirability. Studies providing discriminant vali dity found that there is no relationship between the SRES and the Bem Sex Role Inventory (which measures masculinity, femininity, and androgyny) as well as the SRES and the Spence & Helmriechs (1978) Personal Attributes Questionnaire (which measures gender related traits). Two studies showed some conver gence between the SRES and the Attitudes Toward Women Scale (Spence & Helmreich, 1972) However, they do measure slightly different constructs. While the AWS looks only at attitudes towards women, the SRES considers views about women an d beliefs about men. Addi tional studies have also used the SRES as a predictor for atti tudes towards domestic conflict and violence. Demographic Information Participants completed a questionnaire regarding demographic data. Demographic information collected in the study was determined by relevant literature, feminist theory, and past studi es. Demographic data collec ted for this study included participant gender as an indepen dent variable. Additional demographic data collected and used as independent variables include par ticipant age, years of experience as a school counselor, race/ethnicity, political affiliation, religious affiliation, frequency of counseling male students regar ding sexual concerns, and frequency of counseling female students regarding sexual c oncerns. To verify partici pant eligibility for the study, 74

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information about the grade level of students worked with in the past five years, and grade levels of students work ed with in the current year was also collected. Procedures Before beginning the internet-based surv ey, participants read and electronically signed an informed consent. Participants were informed of the sensitive and personal nature of the assessment questions. Participants were asked to complete four sections of the survey. First, participants comple ted an ethical decision-making questionnaire. Second, participants completed King & Kings (1997) Sex-Role Egalit arianism Scale. Third, participants completed Hendrick, Hendrick, & Reichs (2006) Brief Sexual Attitudes Scale. Finally, participants co mpleted a demographic qu estionnaire. The expected time required to complete all four questionnaires wa s approximately 40 minutes. However, multiple participants reported actual completion ti me closer to 10 to 15 minutes. Data Analyses The dependent variable for this study is counselors ethical decision-making based on counselor responses to the Ethica l Decision-Making Questionnaire. Factor analysis was used to create three sub scales of the Ethical Decision-Making Questionnaire. Two of the independent variables, counselor gender and student gender, are dichotomous having two categories: male and female. Approximately half of the participants received the female vigne tte version of the EDMQ, while the other half received the male version. Seven independent variables are all continuous: attitudes towards gender, Permissiveness Se xual Attitudes, Birth Control Sexual Attitudes, Communion Sexual Attitudes, Inst rumentality Sexual Attitudes, counselor age, and years of experience. Addition al independent variables based on counselor 75

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characteristics and reported frequencies (i.e ., ethnicity, marital status, religious affiliation, political affiliation, and t he frequencies of counseling male and female students regarding sexual concerns) are categorical. Descriptive statistics for study variables were calculated. To address the first research question, Pearson correlations were used to look at relationships between counselor gender, student gender, the scores on the sexual a ttitudes subscales (i.e., Brief Sexual Attitudes Scale), and gender role attitudes. To address the second through tenth research questions, the data was analyzed using multiple linear regression to determine if these independent variables ca n be used to predict counselor ethical decision-making. Separate regression analyses were conducted for each of the subscales in the EDMQ. 76

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CHAPTER 4 RESULTS This chapter presents the re sults of the web-based su rvey administered to high school counselors in Florida. The depende nt variables addressed in the survey concerned the ethical decision-making of hi gh school counselors to given scenarios involving adolescent sexual ity. The independent variab les include counselor sexual attitudes, attitudes towards gender, c ounselor gender, student gender, counselor characteristics (i.e., age, years of experience, ethnicity, marita l status, political affiliation, and religious affiliation) and frequency of counseling male and female students regarding sexual concerns. Information about the participant s is reported first, followed by reliability information and factor analysis on the Ethical Decision-Making Questionnaire, descriptive dat a, and then results of correlations and regression analyses. Demographic Characteristics Participants included high school counsel ors employed in Florida schools. Ninety-nine participants were female (63%) and 58 were male (37%). The mean age of the participants was 44.66 ( SD =12.24). Participants age ranged from 23 to 73. One participant did not report age. Participants were asked for information concerning the number of years they had worked as a sc hool counselor and the grade levels they served. The mean years of experience as a school counselor was 10.06 ( SD = 8.21). Participants years of experience ranged from 1 to 40 years. Two participants did not report their years of experience. For t he purpose of data analysis, male counselor gender is recorded as zero and female counselor gender as one. 77

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The web-based survey at www.counselortechnology.net divided the one hundred fifty-seven participants into four groups Group one included 29 male counselors responding to a female student vignette ( 18.5%), group two included 29 male counselors responding to a male student vi gnette (18.5%), group three included 49 female counselors responding to a female st udent vignette (31.2%), and group four had 50 female counselors responding to a male student vignette (31.8%). ANOVA was conducted to determine if there were signi ficant differences in age or years of experience between the four groups of partici pants. Differences between groups were not significant for counselor age F(3,152) = .634, p =.594, nor years of counseling experience F(3,151) = 1.401, p = .245. Participants were asked to endorse as many ethnicities as they thought appropriate to describe themselves from a lis t including Asian, African-American/Black, Caucasian/White, Latino/Hispanic, Native-A merican, and other. A total number of 19 participants (12.2%) identified as African-American/Black, 122 (78.2%) as Caucasian/White, 14 (9.0%) as Latino/Hispanic, and 1 (0.6%) as Native American. Only two participants elected to indicate more than one ethnicity: one participant indicated both African-American/Black and Latino/Hispanic and one participant indicated both African-American and Native American. In addition, one participant selected Caucasian/White and typed in Middle Ea stern. This individual was included in the Caucasian/White ca tegory described above. Additional demographic information colle cted included personal relationship status (e.g., marital), political affiliation, and religious affiliation. One hundred thirteen participants indicated they were currently married or in a lifelong commitment (72.9%), 78

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15 were committed but not married (9.7%), 7 we re dating (4.5%), 20 were not currently involved (12.9%), and 2 omitt ed this item. Seventy-two participants reported Democrat as their political affiliation (46.5%), 38 Republican (24.5%), 39 Independent (25.2%), 6 selected Other (3.9%), and 2 declined to answer. Eighty-one participants selected Christian/Protestant as their religious aff iliation (51.9%), 40 Cathol ic (25.6%), 14 Jewish (9.0%), 1 Buddist (0.6%), 9 Agnostic (5.7%), 5 Atheist (3.2%), 6 selected Other (3.8%), and 1 participant omitted this item. Participants were asked to select the grade levels in which they have worked within the past five years fr om the following list of opt ions: Pre-K and Elementary, Middle School (6th, 7th, 8th grade), 9th grade, 10th grade, 11th grade, 12th grade, and College or Adult. Twenty-six participant s indicated experience with Pre-K and Elementary students (16.6% ), 52 with Middle School (33.1%), 149 with 9th grade (94.9%), 150 with 10th grade (95.5), 154 with 11th grade (98.1), 151 with 12th (96.2%), and 41 with Adult or College (26.1% ). Participants were also asked to select the grade levels in which they are working in the curre nt school year. Five participants indicated that they were working with Pre-K and Elem entary students in the current school year (3.2%), 15 with Middle School (9.6%), 123 with 9th grade (78.3%), 122 with 10th grade (77.7%), 121 with 11th grade (77.1%), 125 with 12th grade (79.6%), and 22 with College or Adult (14.0%). The population of interest to this study was counselors with recent experience working with high school students (e.g. grades 9-12). Three respondents were omitted from the study because they did not indicate high school experience during the past five school years. 79

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Participants were asked to report their frequency of counseling male and female students concerning issues related to sexuality or sexual behavior. Fifty-seven (36.3%) of participants indicated they counseled ma le students regarding se xuality or sexual behavior Rarely to never, 53 (33.8%) repo rted A few times per school year, 30 (19.1%) Once or twice a mont h, 11 (7.0%) Weekly, and 6 (3.8%) Daily. Twentyone participants (13.4%) indicated they counseled female students regarding sexuality or sexual behavior Rarely to never, 57 (36.3%) reported A few times per school year, 44 (28.0%) Once or twice a month, 26 (16.6%) Weekly, and 9 (5.7%) Daily. Analyses to determine whether or not there were differences in frequency of counseling students between male and female counselors were not conducted because of small cell size. Participants were also asked to repor t how often they consult with other professionals about ethical decision-making. Eleven participants (7.1%) indicated they consult with other professionals regarding ethi cal decision-making Rarely to never, 43 (27.6%) reported A few times per school year 34 (21.8%) Once or twice a month, 44 (28.2%) Weekly, and 24 (15.4%) Daily. One participant omitted th is item. Analyses to determine whether or not there were di fferences in frequency of consultation between male and female counselors were not conducted because of small cell size. The Ethical DecisionMaking Questionnaire Factor and reliability analyses were used to identify useful and meaningful scales from the 13 items on the Et hical Decision-Making Questionnaire. The EDMQ utilized a five point Likert type responses including It is very likely that I would maintain confidentiality (5), It is somewhat likely that I would maintain confid entiality (4), I am uncertain what I would do in this situation (3 ), It is somewhat likel y that I would reveal 80

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the information to the parent (2), and It is ve ry likely that I would reveal the information to the parent (1). The first steps of the analysis incl uded a Principal Components factor analysis using Varimax Rotation and reliabi lity analysis using Cronbachs Alpha as a measure of internal consistency and reliability. The initial factor analysis indicated there were three factors within the Ethical Decision-Making Ques tionnaire that accounted for 65.47% of the variance. Ins pection of the scree plot provided a visual to examine and assess the viability of the three factor solution. The three factor solution of the 13 items loaded on one and only one factor with acceptable factor loadings at above .30 (Guertin & Bailey, 1970). Table 4.1 presents the items and factor loadings for each of the subscales identified in the Ethi cal Decision-Making Questionnaire. The calculated Chronbacs alpha ( =.879) for the total scale score of the Ethical Decision-Making Questionnaire indicated a fairly high level of internal consistency. Item to total correlations were all positively related. No items were reversely coded. The first subscale was named Consensual Sexual Ac tivity (Consensual) and was defined as sexual behaviors that a 16 year-old adolesce nt willingly agrees to do, that are legal, and/or do not likely involve imminent harm (i.e ., or would not be perceived as a serious risk). The calculated Cronbachs alpha for the Consensual subscale was =.896. The second subscale was named Sexual Activity with Victimization (Victimization) and consisted of seven items. The Victimization subscale had a calc ulate Cronbachs alpha of =.720 and was defined as sexual behaviors or situations in which the student is likely to be perceived has being harmed in some way or is unlawful. The third subscale to emerge from the factor analysis consisted of two items and had a calculated Cronbachs alpha of =.778. The third subscale was na med Sexual Activity with HIV 81

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(HIV) and was defined as sexual behaviors enacted by an individual with the Human Immunodeficiency Virus. Sexual activity with HIV could likely be viewed as possible harm to sexual partners. The mean score for the Consensual Sexual Activity subscale was 3.80 (SD = 1.05). The mean score for the Sexual Activity with Victimiz ation subscale was 1.94 (SD = .94). The mean score on the Sexual Activity with HIV subscale was 1.96 (SD = 1.16). For all three subscales, scores ranged from 1 v ery likely to reveal to 5 very likely to maintain confidentiality. Based on these mean scores, participants reported being more likely to maintain student confidentiality for situations described in the Consensual Sexual Activity subscale. Participants also reported being more likely to reveal information to the parent when presented items related to the Sexual Activity with Victimization and Sexu al Activity with HIV subscale s. Frequency information for participant responses to the Ethical Deci sion-Making Questionnaire is presented in Table 4.2. Group one included 29 male counselors responding to a female st udent vignette. Group two included 29 male counselors res ponding to a male student vignette. Group three included 49 female counselors responding to a female student vignette. Group four included 50 female counselors responding to a male student vignette. For group one, the mean score for the Consensual Sexual Activity subscale was 3.62 (SD = 1.18) group two had a mean of 3.55 (SD = 1.24), group three had a mean of 3.93 (SD.98), and group four had a mean score of 3.93 (SD = .88). For group one, the mean score for the Sexual Activity with Victimization subscale was 1.71 (SD = .80) group two had a mean of 2.01 (SD = 1.06), group three had a mean of 2.06 (SD = 1.00), and group four 82

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had a mean score of 1.91 (SD = .88). The mean score on the Sexual Activity with HIV subscale for group one was 1.61 (SD = .88) group two had a mean of 1.84 (SD = 1.27), group three had a mean of 1.99 (SD = 1.05), and group four had a mean score of 2.18 (SD = 1.31). ANOVA was used to determine if there were significant differences between the four groups based on the Ethical Decision-Making Questionnaire subscale scores (i.e., Consensual Sexual Activity, Sexual Activity with Victimization, and Sexual Activity with HIV). Group differences were not signifi cant for any of the three scales. For Consensual Sexual Activity subscale, F = 1.378 (3,153), p = .252. For the Sexual Activity with Victimization subscale, F = 90 (3,153), p = .445. And for the Sexual Activity with HIV subscale, F = 1.58, p = .197. Additional ANOVA were used to determine if there were differences between the four groups based on the subscales scores of the Brief Sexual Atti tudes Scale or the total scale score of the Sex-Role Egalitar ianism scale. Analyses showed that the differences between the four groups were si gnificant for the Sex-Role Egalitarianism scale, F = 2.726 (3, 153), p = .046. Differenc es between groups were not significant for Birth Control, Communion, and Instrumentality. Group differences for Permissiveness were approaching significance, F = 2. 656, (3, 153), p = .051. Hypothesis Testing Hypothesis 1 stated: There is no relationship between counselor gender, student gender, the subscales of the Brief Sexual Attitudes Scale (i.e., Permissive, Birth Control, Communion and Instrumentality) and the total score of the Sex-Role Egalitarianism (SRES). Two-tailed Pearson correlations were used to determine if any of the main independent variables were related to each other. Correlational analysis revealed 83

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several significant relationships among the independent variables. Counselor gender was related to the Permissiveness subscale of the Brief Sexual A ttitudes Scale, r = .163, n = 157, p <.05 and the Sex-Role Egalitarian total sca le score, r = .213, n = 157, p<.01. The Permissiveness subscale of the Br ief Sexual Attitudes Scale was related to the Instrumentality subscale of the Brief Sexual Attitudes Sc ale, r = .263, n = 157, p<.01 and the total scale score of the Se x-Role Egalitarianism Scale, r=.296, n = 157, p<.01. The Birth Control subscale of the Brief Se xual Attitudes Scale was related to the Communion subscale of the Brief Sexual A ttitudes Scale, r = .296, n = 157, p<.01 and the total scale score of the Sex-Role Egalitari anism Scale, r = .157, n = 157, p<.05. See Table 4-3. Two-tailed Pearson correlations were also used to determine if any of the main independent variables were related to the dependent variables (i.e., the subscales of the Ethical Decision-Making Questionnaire). Counselor gender was related to the Consensual Sexual Activity subscale of the Ethical Decision-Making Questionnaire, r = .161, n = 157, p<.05. The Permissiveness subscale was significantly related to all three subscales of the Ethical Decision-Making Ques tionnaire: Consensual Sexual Activity, r = .204, n = 157, p<.05, Sexual Activity with Victimizati on, r = .239, n = 157, p<.01, and Sexual Activity with HIV, r = .165, n = 157, p<.05. These results are presented in Table 4-3. Additional two-tailed Pearson correlations were used to determine if any of the counselors characteristics, such as age, or frequency of counseling male and female students were related to the dependent variable s. Counselor age was related to the Consensual Sexual Activity subscale: r = -. 173, n = 156, p<.05. Reported frequency of 84

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counseling males regarding sexual concerns was also related to the Consensual Sexual Activity subscale, r = -.159, n = 157, p<.05. See Table 4-4. Multiple linear regression analyses were conducted to determine if counselor gender, student gender, the four subscales of the Brief Sexual Attitudes Scale (i.e., Promiscuity, Birth Control, Communion, and Instrumentality) the total score on the SexRole Egalitarianism Scale, other counselor characteri stics (i.e., age, years of experience, ethnicity, marital st atus, religious affiliation, and political affiliation), and time spent counseling male and female students regarding sexuality predicted the three Ethical Decision-Making Questionnaire subs cales (i.e., Consensual Sexual Activity, Sexual Activity with Victimization, and Sexual Activity with HIV). The subscale scores and the total score of the Brief Sexual A ttitudes Scale were calculated by summing across individual responses to each item and di viding by the number of items in each subscale or total scale. Promiscuity, Bi rth Control, Communion, and Instrumentality subscale scores, and the SRES total scale sco re were used as independent variables. Counselor gender was reported by participants in two ways: participants were asked to select their gender before beginn ing their survey and as confirmation of gender the first item of the survey asked them to indicate their gender. Counselor characteristics and time spent counseling male and female student s were reported by participants in the demographics questionnaire. The students gender was depicted by the vignette to which the participants responded. Approximatel y half of the male participants, and one half of the female participants, were di rected by www.counselingtechnology.net to a vignette depicting a male student and one half were directed to a vignette depicting a female student. A probability level of p=.05 was used as the criteria for rejecting or not 85

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rejecting the null hypotheses and the data was checked to assure all assumptions were met and collinearity with was wit hin acceptable ranges. The variance inflation factor (VIF) had a range of 1.00 to 1.178, thus i ndicating that multic ollinearity was not problematic. Hypothesis 2 stated: Counselor gender and student gender do not predict the Consensual Sexual Activity subscale of the Ethical Decision-Making Questionnaire (EDMQ). The regression model including couns elor gender and student gender as predictors of Consensual Se xual Activity subscale scores was not significant (R=.161,R2=.026, R2 adj = .013, F (2, 154) = 2.056, p=.132). However, counselor gender was significant (T=2.022, p=.045). As a re sult, the null hypotheses for student gender was not rejected while the null hypothesis fo r counselor gender was rejected. Tables 45 and 4-6 illustrate the result s of the regression analysis fo r Hypothesis 2. Hypothesis 3 stated: Counselor gender and student gender do not predict the Sexual Activity with Victimization subscale of the Ethical Decision-Making Questionnaire (EDMQ). The regression model indicated that counselor gender and student gender do not predict scores on the Sexual Activity with Victimization subscale (R=.063,R2=.004, R2 adj = .-009, F (2, 154) = .307, p= .736). As a result, the null hypotheses for counselor gender and student gender were not rejected. Tables 4-7 and 4-8 illustrate the results of the regression analysi s for Hypothesis 3. Hypothesis 4 stated: Counselor gender and student gender do not predict the subscale scores of the Sexual Activity with HIV subscale of the Ethical Decision-Making Questionnaire (EDMQ). The regression model indicate d that counselor gender and student gender do not predict score s on the Sexual Activity with HIV subscale of the 86

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Ethical Decision-Making Questionnaire (R=.173,R2=.030, R2 adj = .017, F (2, 153) = 2.374, p=.097). As a result, the null hy potheses for counselor gender and student gender were not rejected. Tables 4-9 and 4-10 illustrate the result s of the regression analysis for hypothesis 4. Hypothesis 5 stated: Counselor gender, the subscale s of the Brief Sexual Attitudes Scale (i.e., Permissi veness, Birth Control, Commu nion, and Instrumentality), the total score on the Sex-Ro le Egalitarianism Scale (S RES), and the students gender do not predict scores on the Consensual Sexual Activity subscale of the Ethical Decision-Making Questionnaire (EDMQ). A stepwise multiple regression procedure was used to identify the best model Results of the one step model indicated the total scale score of the Sex-Role Egalitarianism Sc ale predict scores on the Consensual Sexual Activity subscale of the EDMQ (R=.228,R2=.052, R2 adj = .046, F (1, 155) = 8.494, p=.004). The one step model accounted for 4.6% of the variance. As a result the null hypothesis was not rejected for Permissi veness, Birth Control, Communion, Instrumentality, and student gender. The nu ll hypothesis was rejected for the total score on the Sex-Role Egalitarianism Scale. Tables 4-11 and 4-12 illustrate the results of the regression analysis for Hypothesis 5. Hypothesis 6 stated: Counselor gender, the subscale s of the Brief Sexual Attitudes Scale (i.e., Permissi veness, Birth Control, Commu nion, and Instrumentality), the total score on the Sex-Ro le Egalitarianism Scale (S RES), and the students gender do not predict scores on the Sexual Activity with Victimization subscale of the Ethical Decision-Making Questionnaire (EDMQ). A stepwise multiple regression procedure was used to identify the best model. Result s of the one step model indicated only the 87

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Permissiveness subscale predicted the Sexual Activity with Victimization subscale of the EDMQ (R=.239, R2=.057, R2 adj=.051, F (1, 155) = 9.424, p = <.003. The one step model accounted for 5.7% of the variance. As a result the null hypothesis was not rejected for Birth Control, Communion, Inst rumentality, Counsel or Gender, and Student Gender. The null hypothesis was rejected fo r Permissiveness. Tables 4-13 and 4-14 illustrate the results of the regres sion analysis for hypothesis 6. Hypothesis 7 stated: Counselor gender, the subscale s of the Brief Sexual Attitudes Scale (i.e., Permissi veness, Birth Control, Commu nion, and Instrumentality), the total score on the Sex-Ro le Egalitarianism Scale (S RES), and the students gender do not predict scores on the Sexual Activity with HIV subscale of the Ethical DecisionMaking Questionnaire. A stepwise multiple regression procedure was used to identify the best model. Results of t he three step model indicated the Instrumentality subscale, the Birth Control subscale, and the total score of the Sex-Role Eg alitarianism Scale predicted the Sexual Activity with HI V subscale of the EDMQ (R=.359, R2=.129, R2 adj=.112, F (1, 152) = 8.043, p = <.05. The one step model accounted for 6.7% of the variance. As a result the null hypothes is was not rejected for Permissiveness, Communion, Counselor Gender, and Student Gender. The null hy pothesis was rejected for Instrumentality, Birth Control, and the Sex-Role Egalitarianism Scale. Tables 4-15 and 4-16 illustrate the result s of the regression analysis for hypothesis 7. Hypothesis 8 stated: C ounselor gender, the subscales of the Brief Sexual Attitudes Scale (i.e.,Permissiveness, Birth Control, Communion, and Instrumentality), the total score on the Sex-Role Egalitar ianism Scale (SRES) the students gender, counselor characteristics (i.e., age, years of experience, ethnic ity, marital status, 88

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political affiliation, and religious affiliat ion), frequency of counseling female students regarding sexuality, and frequency of counse ling male students regarding sexuality do not predict scores on the Consensual Sexual Ac tivity subscale of the Ethical DecisionMaking Questionnaire (EDMQ). A stepwise multiple regre ssion procedure was used to determine the best model for predicting each EDMQ subscale. Results of the four step model indicated religious affiliation, counselor age, the total score of the Sex-Role Egalitarianism Scale, and the frequency of counseling males regarding sexual ity were predictors of the Consensual Sexual Activity subscale of the EDMQ (R=.370, R2=.137, R2 adj=.113, F (1, 145) = 5.185, p = <.05). The four step model accounted for 11.3% of the variance. Tables 4-17 and 418 illustrate the results of the regression analyses. Hypothesis 9 stated: C ounselor gender, the subscales of the Brief Sexual Attitudes Scale (i.e., Permi ssiveness, Birth Control, Co mmunion, and Instrumentality), the total score on the Sex-Role Egalitar ianism Scale (SRES) the students gender, counselor characteristics (i.e., age, years of experience, ethnic ity, marital status, political affiliation, and religious affiliat ion), frequency of counseling female students regarding sexuality, and frequency of counse ling male students regarding sexuality do not predict scores on the Sexual Activity with Victimization subscale of the Ethical Decision-Making Questionnaire (EDMQ). Results of the two step model indicated religious affiliation and Birt h Control were predictors of the Sexual Activity with Victimization subscale (R=.342, R2=.117, R2 adj=.105, F (1, 147) = 4.589, p = <.05). The two step model accounted for 11.7% of the variance. Tables 4-19 and 4-20 illustrate the results of the r egression analyses. 89

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Hypothesis 10 stated: Counselor gender, the subscale s of the Brief Sexual Attitudes Scale (i.e., Permissi veness, Birth Control, Commu nion, and Instrumentality), the total score on the Sex-Role Egalitar ianism Scale (SRES) the students gender, counselor characteristics (i.e., age, years of experience, ethnic ity, marital status, political affiliation, religious affiliation), frequency of counseling female students regarding sexuality, and frequency of counse ling male students regarding sexuality do not predict scores on the Sexual Activity with HIV subscale of the Ethical DecisionMaking Questionnaire (EDMQ. The two step model indicated that Birth Control and the total score for Sex-Role Egalitarianism Sc ale predicted the Sexual Activity with HIV subscale (R=.316, R2=.100, R2 adj=.088, F (1, 146) = 10.051, p = <.05). The two step model accounted for 10% of the variance. T ables 4-21 and 4-22 illustrate the results of the regression analyses. ANOVA was used to further examine t he relationship between scores on the Ethical DecisionMaking Questionnaire based on the reported religious affiliation. The first three groups included Ch ristian-Protestant, Cathol ic, and Jewish. Religious affiliations selected by fewer participants (i.e., Hindu, Buddists, Muslim, Agnostic, Atheist, and other) were combined to create a fourth group for the analysis. Results indicated significant differences between the religious groups for the Consensual Sexual Activity subscale, F = 2.883 (3, 152), p =.047 and the Sexual Activity with Victimization subscale, F = 7.021 (3, 152), p =.000. Diffe rences on the Sexual Activity with HIV subscale were not significant. Multiple comparisons Bonferroni post hoc analyses were conducted to learn more about the specific differences between different religious affiliations. For the Consensual Sexual Activity subscale, differences between 90

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participants reporting ChristianProtestant and Other affilia tions were significant with Christian-Protestants being less likely to maintain confidentiality fo r consensual sexual activity. For scores on the Vi ctimization subscale, Christian-Protestants reported being statistically more likely to reveal the info rmation than Catholics and those with affiliations in the Other group. Summary The total scale score of the Sex-Role Eg alitarianism Scale predicted scores on the Consensual Sexual Activity subscale of the EDMQ. The Permissiveness subscale predicted the Sexual Activity with Victim ization subscale of the EDMQ. The Instrumentality subscale, the Birth Control s ubscale, and the total score of the Sex-Role Egalitarianism Scale predicted the Sexual Activity with HI V subscale of the EDMQ. However, no more than 11% of variance accounted for in Ethical Decision-Making subscale scores was based on counselor gender, student gender, sexual attitudes measured by the four subsca les of the Brief Sexual A ttitudes Scale, and gender attitudes measured by the total score on the Sex-Role Egalit arianism scale. When additional counselor characteristics and frequency of counseling male and female students was included as possible in dependent variables, religious affiliation, counselor age, and the frequency of counse ling males regarding sexuality helped predict scores on the Consensual Sexual Acti vity Subscale. Religious affiliation was helpful in predicting the Sexual Activity with Victimization subscale scores. However, no additional variables helped to predict Sexual Activity with HIV. 91

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Table 4-1. Factor Loadings for the Ethical Decision-Making Questionnaire Factor 1 Factor 2 Factor 3 7 Jamie is having sexual intercourse .909 with a steady partner. .849 11 Jamie is having a homosexual relationship. 5 Jamie is having sexual intercourse .784 with multiple partners. 2 Jamie wants to know where to get .776 free condoms. 8 Jamie is sneaking out of the house at .742 night to have sex with a steady partner. 9 Jamie is having unprotected sexual .662 intercourse with multiple partners. 3 Jamie wants directions to an abortion .588 clinic. 13 Jamie is having sex with a 21 year old .810 partner (assuming Jamie is 15). 1 Jamie is having sex with a 21 year-old .706 partner. 12 Jamie reports having been raped two .667 months ago. 10 Jamie is being sexually harassed at .666 school. 4 Jamie is HIV positive and having sexual .851 intercourse with multiple partners, but takes care not to infect partners. 6 Jamie is HIV positive and having unprotected .851 sexual intercourse with mu ltiple partners. 92

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Table 4-2. Frequency of participants re sponses to EDMQ with percentage of participants selecting each response choice. Item (A) (B) (C) (D) (E) 7 Jamie is having sexual intercourse 62.8 21.2 1.9 7.1 7.1 with a steady partner. 11 Jamie is having a homosexual 73.1 12.8 5.1 1.9 7.1 relationship. 5 Jamie is having sexual intercourse 40.8 24.2 7.6 14.6 12.7 with multiple partners. 2 Jamie wants to know where to get 70.7 17.8 3.2 5.1 3.2 free condoms. 8 Jamie is sneaking out of the house at 35.9 23.7 9.0 21.8 9.6 night to have sex with a steady partner. 9 Jamie is having unprotected se xual 24.2 17.2 13.4 25.5 19.7 intercourse with multiple partners. 3 Jamie wants directions to an abortion 28.2 18.6 21.8 14.7 16.7 clinic. 13 Jamie is having sex with a 21 y ear old 6.5 3.9 9.0 15.5 65.2 partner (assuming Jamie is 15). 1 Jamie is having sex with a 21 year-old partner. 12 Jamie reports having been raped two 3.2 3.8 7.1 13.5 72.4 months ago. 10 Jamie is being sexually harassed at 6.4 4.5 3.8 22.3 63.1 school. 4 Jamie is HIV positive and having sexual 12.8 4.5 19.2 17.9 45.5 intercourse with multiple partners, but takes care not to infect partners. 6 Jamie is HIV positive and hav ing 5.8 1.9 14.7 11.5 66.0 unprotected sexual intercourse with multiple partners. 93

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Table 4-3. Pearson product-moment corre lations between continuous variables Variables Bir Com Per Ins SRES CSA SAV HIV Bir Com .296** Per .023 -.138 Ins -.014 -.020 .263** SRES .264** .157* .296 .012 CSA -.042 -.044 .204 .090 .228** SAV -.114 -.052 .239** -.007 .077 .451** HIV -.161 -.132 .165* .165* .226** .439** .398** *p < .05, **p < .01, two-tailed test Abbreviations used in table: Birth Cont rol (Bir), Communion (Com), Permissiveness (Per), Instrumentality (Ins), Sex Role Egal itarianism Scale (SRE S), Consensual Sexual Activities (CSA), Sexual Activity with Victimizat ion (SAV), Sexual Activity with HIV (HIV). Table 4-4. Additional Pearson product-moment correlations Variables CSA SAV HIV Counselor Age -.173* .022 -.013 Counseling Females .006 -.028 .039 Counseling Males -.159* -.067 .006 *p < .05, **p < .01, two-tailed test 94

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Table 4-5. Model Summary for Hypothesis 2 R R2 R2adj R2 Fchg df p Model .161 .026 013 .026 2.056 2,154 <.132 Table 4-6. Coefficients Hypothesis 2 Step Var B T p Bivariate r Partial r Step1 CoGender .348 .161 2.022 .045 .161 .161 StudGender .026 .013 .159 .874 .012 .013 Table 4-7. Model Summary for Hypothesis 3 R R2 R2adj R2 Fchg df p Model .063 .004 -. 009 .026 .307 2,154 <.736 Table 4-8. Coefficients Hypothesis 3 Step Var B T p Bivariate r Partial r Step1 CoGender .121 062 .776 .439 .062 .062 StudGender -.016 -.009 -.107 .915 -.009 -.009 Table 4-9. Model Summary for Hypothesis 4 R R2 R2adj R2 Fchg df Model .173 .030 .017 .030 2.374 2,153 <.097 Table 4-10. Coefficients Hypothesis 4 Step Var B T p Bivariate r Partial r Step1 CoGender .359 .149 1.870 .063 .149 .150 StudGender -.208 -.090 -1 .124 .263 -.089 -.091 Table 4-11. Model Summary for Hypothesis 5 R R2 R2adj R2 Fchg df Model .228 .052 .046 .052 8.494 2,153 <.004 Table 4-12. Coefficients Hypothesis 5 Step Var B T p Bivariate r Partial r Step1 SRES .646 .228 2.915 .004 .228 .228 95

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Table 4-13. Model Summary for Hypothesis 6 R R2 R2adj R2 Fchg df p Model .239 .057 051 .057 9.424 2,155 <.003 Table 4-14. Coefficients Hypothesis 6 Step Var B T p Bivariate r Partial r Step1 Permissiveness .280 239 3.070 .003 .239 .239 Table 4-15. Model Summary for Hypothesis 7 R R2 R2adj R2 Fchg df p Model .359 .129 112 .046 8.043 2,152 <.005 Table 4-16. Coefficients Hypothesis 7 Step Var B T p Bivariate r Partial r Step1 Step2 Step3 Instrumentality SRES Birth Control .409 .562 -.420 .142 .178 -.223 2.884 2.303 2.836 .004 .023 .005 .226 .179 -.161 .226 .183 -.224 Table 4-17. Model Summary for Demograp hic Information & Consensual subscale R R2 R2adj R2 Fchg df p Model .370 .137 113 .031 5.185 2,145 <.024 Table 4-18. Coefficients for Demographi c Information & Consensual subscale Step Var B T p Bivariate r Partial r Step1 Step2 Step3 Step4 Religious Age SRES FreqMales .107 -.014 .494 -.171 .228 -.164 .174 -.178 2.852 -2.071 2.101 -2.277 .005 .040 .037 .024 .228 -.166 .216 -.141 .228 -.168 .171 -.186 Table 4-19. Model Summary for Demographic Information & the Victimization subscale R R2 R2adj R2 Fchg df Model .342 .117 .105 .028 4.589 1,147 <.034 96

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Table 4-20. Coefficients Demographic Inform ation & the Victimiz ation subscale Step Var B T p Bivariate r Partial r Step1 Step2 Religious BirthControl .123 -.246 3.818 -2.142 .000 .034 .299 -.139 .299 -.174 Table 4-21. Model Summary for Demograp hic Information & the HIV subscale R R2 R2adj R2 Fchg df p Model .316 .100 088 .062 10.051 1,146 <.002 Table 4-22. Coefficients for Demographi c Information & the HIV subscale Step Var B T p Bivariate r Partial r Step1 Step2 SRES BirthControl .597 -.466 2.416 -3.170 .017 .002 .195 -.188 .195 -.254 97

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CHAPTER 5 DISCUSSION As summarized in chapters 1 and 2, counselors ethical decision-making has been discussed in the literature and addressed in multiple studi es. However, counselor decision-making regarding adolescent sexual ity has been examined only marginally. This study examined possible relationshi ps between students gender, counselors gender, gender attitudes, sexual a ttitudes, counselor characteri stics (i.e., age, years of experience, ethnicity, marital status, political affiliation, and religious affiliation), frequency of counseling male and female st udents, and high school counselors ethical decision-making regarding adolescent sexualit y. Findings of t he current study will provide new information about how ethical dec ision-making is related to counselors reported attitudes towards sexuality and gender as well as additional counselor characteristics and practices. Discussion of Findings Findings related to the Ethical Decisi on-Making Questionnaire subscales will be discussed first. Next, relati onships between gender, gender atti tudes, sexual attitudes, counselors characteristics, frequency of couns eling and ethical decision-making will be discusses. This will be followed by sections on implications for practice, theory, and research. Ethical Decision-Making: Consensu al, Victimization, and HIV Participants in the study reported being more likely to reveal information to parents for situations involving se xual activities in which the students sexual activity is perceived as victimization (or illegal) and for sex ual activity involving HIV. Conversely, counselors in the current study reported being more likely to maintain confidentiality for 98

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consensual sexual behaviors with victimization and/or HIV. This finding supports past studies in which counselors decisions to break or maintain confidentiality related to the perceived dangerousness of the behavior (Isaacs, 1999; Moyer & Sullivan, 2008). It is very likely that counselors in the current study perceived more risk or harm associated with the sexual behaviors involving victimiz ation and HIV and were thus, more likely to reveal information to their parents. The Victimization subscale of the EDMQ described ongoing sexual relationships with older partners. More t han half of the counselors in th is study reported being likely or very likely to break confidentiality and re veal a lawful sexual partnership between a 16 year-old student and a 21 year-old partner. According to Florida Statute 800.044, any sexual act with a partner less than 16 is a felony. Mo re than 80% of counselors reported being likely or very likely to reveal the unlawful sexual partnership between a 15 year-old student and a 21 year-old partner. This researcher did not know whether or not the counselors knew the relevant sex laws or if they were ma king their decisions based on other factors such as their interp retation of ethics, perceived harm to the student, or other attitudes and beliefs. The HI V subscale included it ems that indicated possible harm to the students sexual par tners by passing on a dangerous virus. Additionally, a wide percepti on of our society today is that living with HIV can have many medical, financial, and social complicat ions. The counselors in this study may have reported more willingness to reveal this information to the parent out of a desire to both assist the student and to protect the students current and future sexual partners. Additional findings related to each of the three subscales of the ethical decision-making 99

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dependent variables (i.e., consensual sexual acti vity, sexual activity with victimization, and sexual activity with HIV) will be discussed in the remainder of the chapter. Gender, Attitudes Toward Gender and Ethical Decision-Making Previous research on school counselors ethical decision-making has marginally addressed differences between male and female counselors decision-making for male and female students. Moyer & Sullivan (2008) compared decision-making for middle and high school male and female students regar ding a variety of risk taking behaviors. In their study, differences for male and female high school students in the sexual behaviors domain were not significant. Differences between male and female counselors were not discussed. Similar to Moyer and Sullivan, the current study was designed to determine whether counselors diffe red in ethical decision-making according to students gender. In regard to sexual be haviors, this study found evidence that counselor gender is related to ethical decis ions for consensual sexual activity, with female counselors showing more support for maintaining confidentiality. No evidence was found to support the theory that counsel ors make ethical decision for male and female adolescents differently. However, differences were observed between male and female counselors regarding their views on gender roles. Differences between male and female participants on the Sex-Role Egalitarianism sca le were statistically significant. These findings showed that female counselors r eported more egalitarian gender role attitudes than did male counselors. For example, female counselors more strongly agreed with statements on the Sex-Role Egal itarianism Scale such as w omen can handle job pressures as well as men can and more strongly disagreed with statements such as a woman should not be Presi dent of the United States Past research has shown that 100

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gender attitudes affect the counseling proc ess (Gold & Hawley, 2001; Seem & Johnson, 1998; Simon, Myrna, & H eatherington; Trepal, Wester & Shuler, 2008; WetmoreFoshay, ONeill, & Foster, 1981) and that counselors beliefs about gender are not always egalitarian (Seem & Johnson, 1998; Tr epal et al., 2008). The findings of the current study also indicated that male and female counselo rs hold different views of sex-role egalitarianism. T he results of this study, although male and female counselors may not make decision differently for ma le and female students, they do report differences in attitudes towards gender, with women expressing more support for egalitarianism. In this study, counselors gender attit udes (as measured by total scores on the Sex-Role Egalitarianism Scale) were related to their ethical decision-making when consensual sexual activity or HIV-related dilemmas were considered. Counselors with more egalitarian attitudes repor ted a greater likelih ood to maintain confidentiality for adolescents consensual sexual activities. Those counselors with less egalitarian views were less likely to maintain confidentiality. In addition, counselors with more egalitarian views of gender are less likely to reveal se xual activity with HIV and counselors with less egalitarian views are more likely to reveal sexual activity with HIV. Theorists have suggested that school counselors interactions with adolescents and their decisionmaking are likely to be influenced by gender a ttitudes and stereotypes (Gold & Hawley, 2001). The results of this study partially supported this theor y. However, more information is needed to understand why counselors with more equal views of sex-roles for men and women are more protective of confidentiality in situations involving adolescent sexuality. Therefore, more research is needed to clarify the relationship 101

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between gender attitudes and school counselor decision-making regarding adolescent sexuality. Counselors Sexual Attitudes and Ethical Decision-Making Permissiveness (i.e., acceptance of casual sex and multiple partners) and birth control (i.e., support for birth control use and dual responsibility) sexual attitudes (as measured by the Brief Sexual Attitudes Scale) were related to counselors ethical decision-making. However, different areas of sexual attitudes predicted different subscales of the Ethical Decision-Making Q uestionnaire. Because no known research has examined the relationship between sexual attitudes and counselors ethical decision-making regarding adolescent sexuality, new ideas and theories are needed to explain the current stud ys findings. Counselors reporting more permi ssive sexual attitudes were less likely to reveal sexual activities with victimization and counselors with less permissive attitudes are more likely to reveal sexual activity with victimization. Lifestyles supporting permissiveness (i.e., acceptance of casual or game playing style of sex) could be perceived as involving more risk (i.e., more exposure to sexually transmitted infections) than sexual lifestyles with fewer partners or se x activity within committed partnerships. Perhaps counselors who are more supporti ve of sexual permissiveness are less alarmed by riskier sexual acti vities, such as adolescents wit h older sexual partners, and therefore were less likely to report that they would reveal informati on. More study is needed to fully understand this relationship. Counselors who reported more focus on the physical pleasur e associated with sex (i.e., higher scores on the Instrumentality subscale) are less likely to reveal sexual activity with HIV. Counselors who report ed less support for instrumentality are more 102

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likely to reveal sexual activity with HI V. Previous research has found sexual instrumentality negatively related to both altr uistic love and self-d isclosure (Hendrick, Hendrick & Reich, 2006). Perhaps, conver sely, counselors who have sexual attitudes less focused on their own physical pleasure are more likely to be concerned about casual sex in others, espec ially those of a minor age or with HIV. Because a relationship between instrumentality and counselors decision-making regarding adolescent sexuality has not been addressed in the prior literat ure, this finding requires more examination. Counselors with more supportive views on bi rth control responsibility were more likely to reveal adolescent sexual activity invo lving victimization. The study also showed that counselors who reported more support of birth control re sponsibility, a belief that birth control is a responsible part of se xuality and that both men and women should share responsibility for it, were less likely to rev eal sexual activity with HIV. Birth control can be considered a protective measure against HIV (and other STIs) as well as control to prevent undesired reproduction. Revealing sexual activity that involves students being victimized can also be seen as a protective measure to prevent the student from harm by allowing for parental intervention and support. Revealing sexual activity with HIV could be seen as a pr otective measure to both protect the student and their sex ual partners and to prevent spread of a serious illness. However, the results of this study show ed a negative relationship between birth control attitudes and the decision to keep sexual acti vity confidential, which may seem counterintuitive. One might have expected for counselors who strongly support protective measure such as birth control responsibility to be more prot ective of students sexual 103

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health as well. However, in this study, c ounselors with stronger birth control attitudes were less likely to reveal sexual behaviors with HIV despite that one of the HIV related scenarios depicted a student with HIV having unprotected sexual intercourse with multiple partners. Therefor e, the relationship between couns elors perceptions of birth control and decisions concer ning HIV is a surprising finding and requires further investigation. Other Counselor Characteristics, Freque ncy of Counseling, & Ethical DecisionMaking Past research has found that counselor age and years of experiences were not significant predictors of counselors ethical decision-making (Bordenhorn, 2006). However, in the current study, counselor age was significantly related to their views on consensual sexual activities. A negative relationship showed that younger school counselors reported being more likely than older school counselors to maintain confidentiality for students r egarding consensual sexual activities. Decisions to maintain confidentiality are likely based on t he counselors evaluation of the perceived danger in the behavior, the per ceived need for parental inte rvention, and the ethical responsibility of duty to warn. Previous theories have also proposed t hat counselors experience uncertainty about their obligations to st udent clients and their parents bec ause their own values are more similar to the values held by the ot her adults than to those of the minors with whom they work (Wagner, 1981). However, in contrast, this finding could suggest that school counselors who are closer in age to adolescents have more similar values and beliefs related to sexual behaviors. Although this finding was statistically significant, it did not account for much of the variance. Therefore, the relationship between 104

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counselors age and their decision making for adolescent sexual activity remains unclear. Researchers have theorized that school co unselors interpretations of ethical codes and ethical decision-making are influe nced by their personal attitudes, values, and beliefs (Moyer & Sullivan, 2008; Wagner 1981). However, past research on ethical decision-making has not addressed the re lationship between individual counselor characteristics such as religious affiliation, marital status, political affiliation and their ethical decision-making. When examining thes e three characteristics, the current study found significant relations only between religi ous affiliation and ethical decision-making. It is likely that counselors morals, va lues, and beliefs are associated with their religion. Therefore, religi ous beliefs likely influence ethi cal decision-making regarding adolescent sexuality. Results of this study showed that religious affiliation was related to counselors views on consensual sexual activity and sexual activity that involves victimization. Analyses revealed that counselors reporting Ch ristian-Protestant affiliation are less likely to maintain confidentiality than counselors associated with other religions (i.e., Hindu, Buddist, Muslim, Agnost ic, Atheist, and other). Possible individual differences could be attributed to sexual attitudes and views based in, or associated with, these different religious beliefs. A ttitudes about adolescent consensual sexual behaviors may be more conservative in Christ ian-Protestant religions as compared to the other religions. For example, findings of the current study showed that counselors reporting affiliation with different religions differed significantly on sexual attitudes related to permissiveness. Counselors from other religions (i.e., Hindu,Buddist, Muslim, 105

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Agnostic, Atheist, and other) expressed more support for permissiveness than counselors affiliated with Chri stian-Protestants, Catholic s, and Jewish religions. Counselors with Christian-Protestant aff iliation were significantly less likely than their peers from other religious backgrounds to mainta in confidentiality for the consensual sexual activities. However, for sexual activities involving possible victimization, Christian-Prot estant counselors were more likely to reveal the behaviors than both Catholic affiliated c ounselors and counselors affiliated with Other religious groups. Because of the correlational nature of the current study, it is not known why counselors of Christian-Protestant faith would be more likely to break confidentiality for situations of victimization, so further invest igation of this finding is recommended. Previous studies have not considered re lationships between ethical decisionmaking and the frequency of counseling male and female students regarding sexual issues. Frequency of counseling male st udents regarding sexualit y was negatively related to counselors decisions concerning adolescent consensual sexuality activity. Counselors who reported counseling male students regarding sexual concerns less often are more likely to maintain conf identiality for students regarding consensual sexual activities. Conversely, those who report counseling males regarding sexuality more often are less likely to maintain c onfidentiality. The frequency of counseling females was not significantly related to et hical decision-making. These findings are intriguing and have not been addressed in the lit erature. It is not known why frequency of counseling males was significant while counseling girls was not, thus warranting further investigation of this finding. 106

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Implications for Practice Counselors in this study reported fr equent counseling of male and female students regarding sexual concerns thus reinfo rcing the relevance of the study topic. More than 50% of participants reported counseling female students regarding sexual issues at least once a month or more oft en. More than 30% of participants reported counseling male students once a m onthly or more. It is im portant for school counselors to assist students with sexual issues through counseling services and play an active role in school-based sex education. Balancing ethical and legal obligations related to students, parents, and the school systems is difficult for c ounselors (Glosoff & Pate). Counselors may not be sure what is legally or ethically the best choice in situations involving adolescents sexu ality (Moyer & Sullivan, 2008) School counselors need to be well informed about sexual consent la ws and mandatory reporti ng policies. When dealing with ethical decision-ma king regarding adoles cent sexuality, school counselors may benefit from cons ultation and collaboration with health care professionals working in the schools. When available, school nurse s or other highly trained professionals may have valuable kno wledge and expertise in human sexuality, reproduction, and sexuality transmitted infect ions. However, this option may be restricted based on common practices of sch ools staffing infirmaries with individuals who lack college degrees and have limited tr aining and medical expertise. School employees may also be restri cted in how they can assi st students regarding sexual concerns by conservative school board polic ies (e.g. abstinence only education). To prepare school counselors for t he demands of ethical decision-making, counselor educators might include more opport unities for discussions, case studies, and role play to educate counselors-in-traini ng about ethical decision-making regarding 107

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sexual behaviors. Courses in human sexual ity may be very helpful for counselor-intraining to learn more about their own sexual attitudes as well as sexual issues that may concern students. Counselors-in-training and practicing counselors may also need assistance in keeping up to date on laws re garding sexual behavior and counselors duties and obligations regardi ng reporting sexual behaviors such as unlawful age pairings, sexual harassment, and rape. School counselors are encouraged to stay current through individual research, dist rict wide inservices, and opportunities for continued education through prof essional counseling associ ation memberships. Counselors-in-training and practicing counselors are also encouraged to explore their own gender attitudes and how they may a ffect their counseling relationships and decisions, especially when coun seling students with different values. Gender attitudes were defined in this study as believing in egalitarianism between men and women in the domains of marital, parental, employm ent, social-interpersonal, and educational domain. Counselors should explore their own attitudes in these areas. Other aspects of gender attitudes, such as stereotypes, coul d also be explored. Personal reflection, research, workshops, and consultation may be used. Implications for Theory Theorists of counselor ethical decision-making have suggested that counselors interpretations of ethical codes and their decis ions to break or maintain confidentiality are influenced by their personal attitudes, va lues, morals, and beliefs (Glosoff & Pate, 2002; Huey, 1986; Isaacs, 1990; Lazsovsky, 2008; Moyer & Sullivan, 2008; & Wagner, 1981). The current study findings support t he proposition that counselors attitudes towards gender role egalitarianism is rela ted to ethical decision-making regarding adolescent consensual sexuality activity and sexual activities with HIV. So although 108

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counselor and student gender did not prove to be related to counselors ethical decisions, gender attitudes about gender roles were related to their decision making. The results of this study also support t he theory that different kinds of sexual attitudes (i.e., permissiveness and birth cont rol) are related to counselor ethical decision-making for adolescent sexuality in volving victimization and other sexual attitudes (i.e. instrumentality and birth control) to sexual acti vity involving HIV. It is unknown why the sexual attitudes addressed in this study were not significantly related to consensual sexual activities. Different religions and the belief systems they dictate often support different beliefs about sexual behavior. This st udy showed a relationship between counselor decision-making and religious affiliation. Ther efore, this study s upports the theory that religious beliefs may influence ethical decisio ns to maintain or break confidentiality regarding adolescent sexual ity. Theories related to ethical decision-making and adolescent sexuality could include more detaile d explanation of specific religious beliefs held by members affiliated wit h different religions. The current study was guided by a Femini st theoretical framework. Feminist theories often focus on gender and gender i nequality (Enns, 2004; Taylor, 1998; Tickner, 2005). This study examined differ ences in ethical decision-making based on gender but found that st udent gender did not predict counsel ors decisions to maintain or break confidentiality. However, female counselors reported being more likely than male counselors to maintain student confident iality for consensual sexual activity. In addition, gender differences were found for gender role attitudes with female counselors reporting more approval of men in ster eotypical female roles and females in 109

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stereotypical male roles. Aims of femini sm include eradicating the key differences in gender roles for men and women and allow both genders to live their lives outside of narrowly defined gender-role expectations (Enns, 2005; Hill & Ballou, 2005). Results of the current study show that male counselors may hold stereotypical views of male and female gender roles, though their views were not related to ethical decision-making. Limitations Generalizability of the results of this study will be limited in a number of ways. This study was conducted in only one state of the U.S. and results in other geographic areas of the country could be different. It is possible t hat school counselors in other states and regions of the Un ited States may hold different attitudes about gender and sexuality as well as consider ethical decisions differently. Laws also vary by state. Therefore, it would be beneficial to replicat e the study in other areas to improve the generalizabilty of the study findi ngs. Also, the counselors who participated in this study were volunteers. Counselors who volunteer may have different attitudes and decisionmaking processes from those who chose to not volunteer. In addition, the sample size was smaller than desired. It is possible that with a larger sample size, more relationships could have been detected. This study was conducted in the month prior to statewide comprehensive testing. Alt hough high school counselors are very busy throughout the entire school year, this may have been an especially demanding time. Research studies surveying school counsel ors often have poor response rates and more research to improve counselor res ponse rate is needed (Bordenhorn, 2006). The Ethical Decision-Making Questionnair e format provides only a limited amount of background informa tion on the student described in the vignette. Although the vignettes do not describe the ethnicity of the student, the nam e Jamie is a name 110

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most commonly found in White/Caucasian ethnic group. It is not known if counselors decision-making would be different for st udents of with different racial/cultural backgrounds. Furthermore, the questionnaire does not provide the students history of risk-taking behaviors, grades and other ac ademic information, social-personal characteristics, or family background and social support. This information or details may likely have affected the school counselor s decisions to break or maintain confidentiality. The construction of the Ethical Decision-Making Questionnaire may have limited the results of this study. Although the web-based survey included an item asking the frequency that school counselors consult about ethical decision-making, the Ethical Decision-Making Questionnaire response choi ces did not include consultation as an option. Many counselors may seek consulta nt before making a decision to maintain or break confidentiality in situations involvi ng sexual behaviors. Counselors are also likely to collaborate with the student allowing the student to reveal the information to the parents either on their own or with the counselors assistan ce. A number of counselors emailed the researcher to discuss part of th e study. Several participants reported that they always work with the student to share information with parents. In addition, several male high school counselors reported that they were unable to participate in the study due to the response options omitting an item that allowed them to suggest working with the student to share the information or fa cilitating a meeting between the student and parent. The Ethical Decision-Making Questionnaire is not yet a well validated scale. The questionnaire was piloted with counselors-intraining. It may be beneficial to broaden 111

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the scope of expert opinion on the measure and consider changes that can improve its use. In consultation with measurement ex perts, changes to be considered may include altering the responses choices, the selection of items, or the use of subscales. An additional limitation to t he current study is the possibility that social desirability may contribute to counselor responses. School counselors are trained to know that confidentiality is an important foundation of the counseli ng foundation. Counselors may overestimate their likeliness to maintain conf identiality when in real situations they may be more likely to break confidentiality. Th is study is based on self report and it is unknown how counselors would actually respond in real life situations similar to those described in the questionnaires. Recommendations for Research Future research in examining the sexual ethical decision-making of school counselors may be beneficial in se veral areas. Surveying counselors in other regions of the country could expand t he generalizability of the study. Making changes to the Ethical Decision-Making Questionnaire to include more case study information about the student or offering different response ch oices could expand the study and help to detect additional relationships between or among the variables. Future research is needed to further ex plore the relationships between decisionmaking and attitudes towards gender and sexuality in more deta il. Different definitions of attitudes towards gender and sexual atti tudes could be examined. This study examined counselors views on gender roles t hat are appropriate for men and women in five domains of life including marital, par ent, employment, social-interpersonal, and educational. Future studies could examine gender bias or gender stereotypes more specifically. Additionally, relationships bet ween counselors sex-types (e.g., masculine, 112

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feminine, androgynous) and decision-making c ould be examined. Sexual stereotypes based on gender (e.g. man as the sexual st ud, women as the chastity gatekeepers) could also be studied further in relation to ethical decision-making and adolescent sexuality. The current study examined sexual atti tudes related to permissiveness (e.g. casual, game playing type of sexual rela tionships), communion (e.g. the spiritual aspects of sex), instrumentalit y (e.g. the physical aspects of sex), and birth control (e.g. shared responsibility by men and women). Future studies could consider different definitions of sexual attitudes, possibly in cluding specific views towards adolescent sexuality. The sexuality meas ure used in the current study was written in first person and focused on the counselors sexual views for themselves. Focusing on sexual views directly related to adolescents could help explore this topic further. Studies also might further examine the relationships between counselor ethical decision-making regarding adolescent sexualit y and counselor characteristics such as religious affiliation, counselor age, and the frequency of counseling male students. For example, instead of only including religious af filiations, future research could include exploration of how specific religious beliefs or teachings about sexuality are related to ethical decision-making regarding adolescent sexuality. Becaus e the current study found different results than previous studies looking at counselor age and decisionmaking, it is important to fu rther examine this relationship. Future research including time spent counseling male students regarding sexual concerns could possibly include examination of specific topics discu ssed during sessions and how experience discussing these topics relates to decis ion-making for future students. 113

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The current study examined many possible variables related to counselor ethical decision-making regarding adolescent sexualit y. However, only a small amount of variance was explained using the variables in the current study. Therefore, future studies may also benefit from considering additional independent variables to help understand counselors decision-making regar ding adolescent sexuality. Research could include examination of the influenc e of school administration or political environments. Some school administrators and school board officials establish policies that affect counselors decisions to mainta in and break student conf identiality, decisions to report sexual crimes, as well as decisions to provide information related to sexuality. Studies could survey school leaders and c ounselors about policies related to student confidentiality and student sexuality. Finally, while this study addressed maintain ing student confidentiality or revealing information to a parent, future research in the area of confidentiality could explore maintaining student confidentiality versus s haring information with school staff. The decision making process as whether to maintain or break confidentiality to a parent may be different than when considering shari ng information with other school staff. Research could include decisions about student information related to sexuality as well as other domains such as family rela tionships and experiences, student health, academic information, peer relations hips, and legal issues. Summary In summary, this study investigated rela tionships between high school counselors ethical decision-making, gender, gender role attitudes, sexual attitudes, counselor characteristics (i.e., age, year s of experience, ethnicity, re ligious affiliation, political affiliation, marital status), and time spent counseling male and female students 114

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concerning sexual issues. Participant s completed the Ethical Decision-Making Questionnaire, The Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006), the Sex-Role Egalitarianism Scale (King & King, 1997) and a demographic questionnaire. Findings showed that counsel or gender was related to ethical decision making for consensual sexual activities Student gender was not significant in predicting Ethical Decision-Making. Resu lts of the data analyse s indicated that counselors religious affiliation, counselor ag e, sex-role egalitarianism Scale scores, and amount of time spent counseling male students concerning sexu ality predict the likelihood that counselors maintain conf identiality around adolescents consensual sexuality activity. Sexual attitudes relat ed to permissiveness and birth control as well as religious affiliation predicted counselors decisions related to adolescents sexual activity involving victimization. Finally, sexual attit ude related to the instrum entality of sex, birth control attitudes, and sex-role egalitariani sm predict counselors decision-making for adolescent sexual activity involving HIV. The results of study have expanded the lit erature on student confidentiality related to adolescent sexuality. New relationshi ps between ethical decisions to break or maintain confidentiality have been explored. However, balanc ing student confidentiality and parent rights continue to be a challe nging area for school counselors. Confidentiality related to adol escent sexuality requires furt her study by researchers and further consideration by c ounselors and counselor educator s. School counselors have a significant role to play. They have oppor tunities to help students explore options and make decisions about their sexual health and sexual behaviors. School counselors also have opportunities to collabor ate with students, parents, educ ators, and health care 115

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workers to provide adole scents with the information and support they need for healthy sexual development and decision-making. It is important for counselors to explore their own values and attitudes related to sexu ality and gender, to study ethics related to confidentiality, and to keep updated on laws related to sexual consent and mandatory reporting to guide decision-making regar ding adolescent sexuality. 116

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APPENDIX A ETHICAL DECISION-MAKING QUESTIONNAIRE (EDMQ) FEMALE STUDENT Jamie is a female high school student who requested to see you-her school counselor. As you and Jamie begin to talk, she seems somewhat reserved and mentions that she has some concerns about confidentiality. You explain the limits of confidentiality in counseling. During the course of your conv ersation, Jamie admits to some sexual risktaking situations. One of Jamie's parent s calls you the next day concerned about Jamie. The parent believes Jamie is hiding something. Jamie mentioned that she talked with the school counselor and the parent wants to know what you talked about. Please consider specific sexual behaviors t hat are unknown to Jamies parents. Please consider if you would mainta in confidentiality or reveal the information in each of the following situations by choosing one options below. If Jamies age is not stated in the questi on, assume Jamie is 16-years-old. 1. Jamie is having sex with a 21 year old partner. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 2. Jamie wants to know wher e to get free condoms. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 3. Jamie wants directions to an abortion clinic. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 4. Jamie is HIV positive and having sexual in tercourse with multiple partners, but takes care to not infect partners. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 117

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5. Jamie is having sexual intercourse with multiple partners. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 6. Jamie is HIV positive and having unprotected sexual intercourse with multiple partners. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 7. Jamie is having sexual intercourse with a steady partner. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would re veal the information to the parent 8. Jamie is sneaking out of the house at night to have sex with a steady partner. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 9. Jamie is having unprotected sexual intercourse with multiple partners. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 10. Jamie is being sexually harassed at school. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 118

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11. Jamie is having a homosexual relationship. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 12. Jamie reports having been raped two months ago. (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 13. Jamie is having sex with a 21 year old partner (assuming Jamie is 15). (A) It is very likely that I would maintain confidentiality (B) It is somewhat likely that I would maintain confidentiality (C) I am not certain what I would do in this situation (D) It is somewhat likely that I woul d reveal the information to the parent (E) It is very likely that I would reveal the information to the parent 119

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APPENDIX B ETHICAL DECISION-MAKING QUESTIONNAIRE (EDMQ) MALE STUDENT VERSION Jamie is a male high school student who reques ted to see you-his school counselor. As you and Jamie begin to talk, he seems somewhat reserved and mentions that he has some concerns about confidentiality. You explain the limits of confidentiality in counseling. During the course of your conv ersation, Jamie admits to some sexual risktaking situations. One of Jamie's parent s calls you the next day concerned about Jamie. The parent believes Jamie is hiding something. Jamie mentioned that he talked with the school counselor and the parent w ants to know what you talked about. Please consider specific sexual behaviors t hat are unknown to Jamies parents. Please consider if you would mainta in confidentiality or reveal the information in each of the following situations by choosing one options below. If Jamies age is not stated in the questi on, assume Jamie is 16-years-old. 1. Jamie is having sex with a 21 year old partner. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 2. Jamie wants to know wher e to get free condoms. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 3. Jamie wants directions to an abortion clinic. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 4. Jamie is HIV positive and having sexual in tercourse with multiple partners, but takes care to not infect partners. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 120

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5. Jamie is having sexual intercourse with multiple partners. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 6. Jamie is HIV positive and having unprotected sexual intercourse with multiple partners. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 7. Jamie is having sexual intercourse with a steady partner. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 8. Jamie is sneaking out of the house at night to have sex with a steady partner. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 9. Jamie is having unprotected sexual intercourse with multiple partners. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 10. Jamie is being sexually harassed at school. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 121

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11. Jamie is having a homosexual relationship. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 12. Jamie reports having been raped two months ago. (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 13. Jamie is having sex with a 21 year old partner (assuming Jamie is 15). (F) It is very likely that I would maintain confidentiality (G) It is somewhat likely that I would maintain confidentiality (H) I am not certain what I would do in this situation (I) It is somewhat likely that I would reveal the information to the parent (J) It is very likely that I would re veal the information to the parent 122

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APPENDIX C BRIEF SEXUAL ATTITUDES SCALE (H ENDRICK, HENDRICK, & REICH, 2006). Listed below are several statements that reflect different attitudes about sex. For each statement fill in the response on the ans wer sheet that indicates how much you agree or disagree with that stat ement. Some of the items re fer to a specific sexual relationship, while others refer to general attitudes and beliefs about sex. Whenever possible, answer the questions with your curr ent partner in mind. If you are not currently dating anyone, answer the questions with your most recent pa rtner in mind. If you have never had a sexual relationship, ans wer in terms of what you think your responses would most likely be. For each statement: A = Strongly agree with statement B = Moderately agree with the statement C = Neutral neither agree nor disagree D = Moderately disagr ee with the statement E = Strongly disagree with the statement 1. I do not need to be committed to a person to have sex with him/her. 2. Casual sex is acceptable. 3. I would like to have sex with many partners. 4. One-night stands are so metimes very enjoyable. 5. It is okay to have ongoing sexual relati onships with more than one person at a time. 6. Sex as a simple exchange of favo rs is okay if both people agree to it. 7. The best sex is with no strings attached. 8. Life would have fewer problems if people could have sex more freely. 9. It is possible to enjoy sex with a person and not like that person very much. 10. It is okay for sex to be just good physical release. 11. Birth control is part of responsible sexuality. 12. A woman should share responsibility for birth control. 13. A man should share respons ibility for birth control. 123

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14. Sex is the closest form of communication between two people. 15. A sexual encounter between two people de eply in love is the ultimate human interaction. 16. At its best, sex seems to be the merging of two souls. 17. Sex is a very im portant part of life. 18. Sex is usually an intensive, almost overwhelming experience. 19. Sex is best when you let yourself go and focus on your own pleasure. 20. Sex is primarily the taking of pleasure from another person. 21. The main purpose of sex is to enjoy oneself. 22. Sex is primarily physical. 23. Sex is primarily a bodily function, like eating. Note The BSAS includes the inst ructions shown at the top. The items are given in the order shown. The BSAS is usually part of a battery with items num bered consecutively. For purposes of analyses, we have A=1 and E= 5. (The scoring may be reversed, so that A = strongly disagree, etc. ) A participant receives four subscale scores, based on the mean score for a particular subscale (i.e., we add up the 10 items on Permissiveness and divide by 10). An overall scale score is really not useful. Items Scoring Key 1-10 Permissiveness 11-13 Birth Control 14-18 Communion 19-23 Instrumentality 124

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APPENDIX D SEX-ROLE EGALITARIANISM SCALE (KING & KING, 1997) Sample Items Marital Domain The husband should be t he head of the family. Things work out best in a marriage if a husband stays away from the housekeeping tasks. Parental Domain It is more appropriate for a mo ther, rather than a father, to change their babys diapers. Keeping track of a childs activities should be mostly the mothers task. Employment Domain It is wrong for a man to enter a traditionally female career. Women can handle job pressure as well as men can. Social-Interpersonal-Heterosexual Domain A woman should be careful not to appear smarter than the man she is dating. A person should be more polite to a woman than to a man. Educational Domain Home economics courses should be as acceptable for male students as for female students. Choice of college is not as impor tant for women as for men. 125

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APPENDIX E DEMOGRAPHICS QUESTIONNAIRE 1. What is your gender: Female Male 2. What is your ethnicity (select all that apply): White/Caucasian African-American/Blac k Asian Native-American Latino/Hispanic Other:_____________ 3. Please select all of the grade levels of students you have worked with in the past five years:_______ _____________________ ____________________________ 4. Please select the grade levels of st udents you are working with in the current school year: _______________________ _______________________________ 5. Please indicate your age: _________ 6. Please indicate the number of years y ou have worked as a school counselor: ___ 7. Please indicate your current marital status: Married (or life-long commitment) In a committed relationship Dating No current involvement 8. Please indicate your political affiliation: Democrat Republican Independent Other:_____________ 9. Please indicate your religious affiliation: Christian Protestant (Denomination____ __________) Catholic Jewish Hindu Buddhist Muslim Agnostic Atheist Other:_____________ 10. How often do you counsel female students about problems or concerns related to sexual behaviors or sexuality? 126

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Daily Weekly Once or twice a month A few times per school year Rarely to never 11. How often do you counsel male students about problems or concerns related to sexual behaviors or sexuality? Daily Weekly Once or twice a month A few times per school year Rarely to Never 12. How often do you consult with counsel ors or other profe ssionals when dealing with ethical decision-making? Daily Weekly Once or twice a month A few times per school year Rarely to Never 127

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APPENDIX F INFORMED CONSENT Dear Participant: High school counselors are often faced with et hical dilemmas. Some of these dilemmas deal with situations involving adolescent sexuality (e.g. age of consent, pregnancy, abortion, sexual harassment). A common challenge is deciding when to maintain student confidentiality and when to share student information with their parents. I am a doctoral student in the School of Human Development and Organizational Studies in Education (pur suing a degree in School Coun seling) and a full time highschool counselor. I am conducting resear ch on school counselors ethical decisionmaking for situations involving adolescent sexuality and possible relationships with gender, attitudes toward gender, and atti tudes towards sexuality. You have been invited to participate in the pilot study because you are a practicing high school counselor. Your participation in this st udy is voluntary. T here are no anticipated risks to participation in this study. Your participation can help ex pand the knowledge about high school counselors ethical-decis ion making for situations involving adolescent sexuality. As a token of appreciation for your participation, you may choose to access a summary of literature on adolesc ent sexuality and ethical decision-making, including tips for making decisio ns about student confidentiality. You are entirely free to withdraw your consent to parti cipate and/or to discontinue participation in the study at any time without any consequence to you. As a participant in this study you will be as ked to read a short vignette that presents a high school student revealing sexual risk taki ng behaviors to you as his/her high school counselor. You will then be asked to re spond to 14 scenarios describing different sexual behaviors or situations revealed by the student in the given vignette. Other participants may respond to the same or a different vignette. The vignettes and scenarios used in this study were developed fr om reviews of the pr ofessional literature of school counselor ethical decision-ma king and adolescent sexuality. Each scenario/vignette is a hypothetical composit e and does not and is not meant to present description of an actual student. Next y ou will be asked to answer items about your personal attitudes/beliefs about sexuality and gender roles. These items are sensitive in nature and could possible cause personal disco mfort to some individuals. Finally, you will be asked to complete a demogr aphics questionnaire. Confidentiality will be maintained within t he limits of law. Your name will not be revealed in any subsequent dissemination of the results of this study, including presentations at profe ssional meetings or public ations in professio nal journals. Your name will not be identified in my dissertati on manuscript. Your name or personal contact information will not be associated with your responses in any way. I am happy to share the results of the study with all participant s after it is completed. The study should be complete by August 2010. If you have further questions regarding 128

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this study or if you would like to receive an electronic copy of the results, please feel free to contact me at (352) 671-6010 ( kimberlymartindonald@yahoo.com ) or my faculty advisor, Dr. Sondra Smith-Adcock at (352) 237-4332. Questions regarding the rights of research participants may be directed to the Un iversity of Florida Institutional Review Board at (352) 392. If you agree to participate please indicate below. You may print and retain a copy of the informed consent for your own records. Kimberly Martin-Donald I have read the procedures described above. I vol untarily give my consent to participate in this study of high school counselors ethical decision-making. (Participant will be asked to click to continue to the survey items) 129

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LIST OF REFERENCES Abbing, H.D.C. (1996). Adolescent sexual ity and public policy: A human response. Politics and the Life Sciences ,15, 314-316. Advocates for Youth (2008). Responsible education about life (REAL) act Retrieved from http://www.advocatesforyouth.org/real.htm American School Counseli ng Association. (2004). Ethical standards for school counselors. Retrieved from http://www.schoolcounselor.org/files/ethical%20standards.pdf American Psychological Association (2007). Gu idelines for psychological practice with girls and women. American Psychologist 62, 949-979. Baker Jr., J.L. (2005). Accountability issues in adolescent sexuality. Sexual Science 46. Baker, S.B. (2000). School counseling for the twenty-first century (3rd ed.). Upper Saddle River, New Jersey: Prentice-Hall. Barnes, N.D. & Harrod, S.E. (1993). Teen pregnancy preventi on: A rural model using school and community collaboration. S chool Counselor 41,137-141. Bartholomew, C.G. & Schorr, D.L. (1994) Gender equity: Suggestions for broadening career options of female students. School Counselor 41, 245-256. Bartlett, J.R. & Portman, T.A. (2002). Sexuality educat ion and the public schools. Sexuality Counseling (pp. 63-84). New York: Nova Science. Bay-Cheng, L.Y. (2003). The trouble of t een sex: The construction of adolescent sexuality through school-based sexuality education. Sex Education, 3 61-74. Bem, S. (1981). Gender schema theory: A cognitive ac count of sex typing. Psychological Review, 88, 354-364. Bodenhorn, N. (2006). Explor atory study of common and c hallenging ethical dilemmas experienced by professional school counselors. Professional School Counseling 10, 195-202. Burlew, L.D. & Capuzzi, D. (2002). Sexuality c ounseling: Introduction, de finitions, ethics, and professional issues. Sexuality Counseling (pp.3-16). New York: Novia Science. Burnett, J.W., Anderson, W.P., & Heppner, P.P. (1995). Gender roles and self-esteem: A consideration of environmental factors. Journal of Counseling & Development, 73, 323-326. 130

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Chaves, L. (2000). Responding to public school peer sexual harassment in the face of Davis v. Monroe county board of education. Brigham Young Univer sity Education & Law Journal, 2, 287-306. Choate, L. & Curry, J.R. (2009). Addressing the sexua lization of girls through comprehenisive programs, advocacy, and systemic change: Implications for professional school counselors. Professional School Counseling 12, 213-222. Cocca, C.E. (2002). From welfare queen to exploited teen: Welfare dependency, statutory rape, and moral panic. NWSA Journal 14, 1-25. Cohen, L. (1992). A power primer. Psychological Bulletin 112 (1), 155-159. Collins, N., & Knowles, A. D. (1995). Adolescents' attit udes towards confidentiality between the school counselor and the adolescent client. Australian Psychologist, 30, 179-182. DAndrea, M. (1994). The fam ily development project: A comprehensive mental health counseling program fo r pregnant adolescents. Journal of Mental Health Counseling 16, 184-195. Danice, K.E., Kann, L., Kinchen, S., Shanklin, S., Ross, J., Hawkins, J., et al. (2008, June 6). Youth risk behavior surve illance-United States, 2007 Retrieved from http://www.cdc.gov/HealthyYout h/yrbs/pdf/yrbss07_mmwr.pdf Daniluk, J.C., Stein, M., & Bockus, D. (1995). The ethics of inclusion: Gender as a critical component of counselor training. Counselor Education and Supervision 34, 294-307. Davis, J.L. & Mickelson, D.J. (1994). School Counselors: Are you aware of ethical and legal aspects of counseling? School Counselor 42 5-14. Davis, T. & Ritchie, M. (1993) Confidentiality and the school counselor: A challenge for the 1990s. School Counselor 41(1), 23-31. DePaul, Jillian, Walsh, Mary E., & Dam, Um a C. (2009). The role of school counselors in addressing sexual or ientation in schools. Professional Sc hool Counseling 12, 300-308. DeVoe, D. (1990). Feminist and nonsexist c ounseling: Implications for the male counselor. Journal of Counseling & Development 69 33-36. Dycus, S. & Costner, G.M. ( 1990). Healthy early-adolescent development (11-13 year olds): Implementing a human sexuality curriculum for seventh graders. E lementary School Guidance & Counseling 25, 46-53. 131

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Hermann, M. A. (2002). A study of legal issues encounter ed by school counselors and perceptions of their preparedness to respond to legal challenges. Professional School Counseling 6, 12-19. Hess, B.B. & Ferr ee, M.M. (1987). Analyzing Gender Newbury Park, CA: Sage Publications, Inc. Hill, M., & Ballou, M. (2005). From the past toward the future. Women & Therapy 28, 161-163. Holowiak-Urquhart, C., Taylor, E.R. (2005). W hen theory collides with practice: One day in the life of a middle school counselor. Professional School Counseling 9 88-92. Hopkins, B.R. & Anderson, B.S. (1990). The counselor and the law Alexandria: VA: American Association for C ounseling and Development. Hoskins, W., Astramovich, R., & Smith, S. (2007). School counseling consultation: A comparison of parent, teacher and conjoint modalities. Guidance & Counseling 21, 152-159. Huey, W. (1986). Ethical concerns in school counseling. Journal of Counseling & Development 64, 321-322. Huss, S. Bryant, A. & Mulet, S. (2008). Managing the quagmire of counseling in a school: Bringing the parents onboard Professional School Counseling 11, 362267. Impett, E.A., Schooler, D., & Tolman, D.L. (2006). To be seen and not heard: Femininity ideology and adolescent girls sexual health. Archives of Sexual Behavior 35, 129-142. Isaacs, M. (1999). School counsel ors and confidentiality: Factor s affecting professional choices. Professional School Counseling 2 258-267. Jackson, C.M., Snow, B., Boes, S., Phillips, P., Powell-Stanard, R., Painter, L., et al. (2002). Induction the transformed school counselor into the profession. T heory into Practice 41, 177-186. Jayson, Sharon (2009). O bama budget shifts money fr om abstinence-only sex education. USA Today May 12th, 2009. Kelly, G. (1971). Group guidance on sex education. Personnel & Guidance Journal 49, 809-814. 134

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Trepal, H.C., Wester, K.L., & S huler, M. 2008). Counselors-in-training perceptions of gendered behavior Family Journal 16, 147-154. Turner, S., Conkel, J., Starkey, M., Landgraf, R., Lapan, R., Si ewert, J., et al. (2008). Gender differences in Holland vocational personality types: Implications for School Counselors. Professional School Counseling, 11, 317-326. Unger, R., K. (2001). Handbook of the psychol ogy of women and gender New York: John Wiley & Sons, Inc. Unger, R.K., & Crawford, m. (1992). Women and gender: A feminist psychology Philadelphia: Temple University Press. Wagner, C. (1981). Confidentialit y and the School Counselor. T he Personnel and Guidance Journal 59, 305-310. Wagner, C. (1983). Confidentiality: To tell or not to tell. Elementary School Guidance & Counseling, 17, 261-267. Watson, C. H. (1990). Gossip and the guidance counselor: An ethical dilemma School Counselor, 38, 34-39. West, J.F. & Idol, L. (1993). T he counselor as consultant in the collaborative school. Journal of Counseling & Development 71, 678-683. Wilson, S.M. & Medora, N.P. (1990). Gender comparison of college students attitudes toward sexual behavior. Adolescence 25, 615-628. Wisch, A., Mahalik, J.R., Haye s, J.A., & Nutt, L. (1995). The impact of gender role conflict and counseling technique on p sychological help seeking in men. Sex Roles 33, 77-89. Worell, J. & Remer, P. (2003). Feminist perspectives in therapy (2nd ed.). Hoboken, New Jersey: John Wiley & Sons, Inc. 138

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139 BIOGRAPHICAL SKETCH Kimberly Martin-Donald graduated from the University of Florida in 2000 with a Bachelor of Science degree in Psychology. In 2005, she graduated with a Specialist in Education degree and began her ca reer as a school counselor. In 2010, she graduated from the University of Flor ida for the third time and received a Doctor of Philosophy. She currently lives in Ocala, Florida with her husband and their two rather large bichon fries dogs. She works as a high school counse lor in Marion County. She enjoys digital scrapbooking, traveling, reading supernatural novels, dining out with her family, and spending quiet evenings watching televi sion at home with her husband.