Quality Enhancing Strategies
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This document discusses strategies for enhancing quality in psychology. It discusses positive ethics as focusing on fulfilling high ideals rather than punishment. Competence involves maintaining qualifications but also striving for the highest standards. Informed consent aims to maximize client participation. An acculturation model shows how psychologists integrate personal and professional ethics codes. High quality occurs at the intersection of personal and professional lives. As risk increases, greater attention to strategies like consultation, empowered collaboration, documentation, and redundant protections is needed.
Quality Enhancing Strategies
- 1. Quality Enhancing Strategies John Gavazzi, Psy.D., ABPP
- 2. Positive Ethics Ethics as a movement away from the punishment and anxiety-producing components of ethics Fulfill their highest ideals A means to help interpret and apply ethics standards
- 3. Competence Remedial: Acquiring and maintaining minimal formal qualifications Positive: Striving for highest standards Includes self-awareness and self-care Emotional competence
- 4. Informed Consent Remedial: Fulfilling legal responsibilities Emphasis on signed consent Positive: Working to maximize client participation with goals Understand issues related to multiple relationships
- 5. Benefits of Positive Ethics Broadens a psychologist’s understanding of ethics in a broader context Sensitize psychologists to ethical implications of decisions on a daily basis
- 6. Benefits of Positive Ethics Appreciate the moral values on which the APA code is based Assist psychologists in balancing competing ethical demands Help psychologists to address systemic social problems
- 7. An Acculturation Model One Application of Positive Ethics
- 8. Acculturation A process to change the cultural behavior of an individual through contact with another culture. The process of acculturation occurs when there is an adaptation into an organization or society.
- 9. Ethical Culture of Psychology Our system of common beliefs, shared meanings, norms and traditions that distinguish psychologists as professionals. It is a learned set of skills, bases of knowledge and ethical beliefs, as described in our ethics code.
- 10. Acculturation as a Process Can be a complex process Some parts of a psychologist’s practice and lifestyle may be easily acculturated while others not Process that may continue throughout the education or career as a psychologist
- 11. Ethical Acculturation Identification with personal value system (high vs. low) Identification with value system of psychology (high vs. low)
- 12. Acculturation Model of ethical training Higher in Professional Ethics Higher in Personal Ethics Lower in Personal Ethics Lower in Professional Ethics Integration Separation Assimilation Marginalization
- 13. Marginalized Matrix: Low on professional ethics Low on personal ethics Risks: Greatest risk of harm Lack appreciation for ethics Motivated by self-interest Less concern for patients
- 14. Assimilation Matrix: High on professional ethics Low on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to individual rules while missing broader issues
- 15. Separation Matrix: Low on professional ethics High on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
- 16. Integrated Matrix: High on professional ethics High on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
- 17. Quality Enhancing Strategies High quality psychological services occurs at the intersection of our personal and professional lives. Paraphrase from “The Courage to Teach” Parker J. Palmer
- 18. Link to Moral Principles Beneficence : Welfare of the patient Nonmaleficence : Avoiding harm Autonomy : Respect for patient decision-making
- 19. Quality Enhancing Strategies As the legal risks, the possibility of treatment failure, or patient complexity increases, the greater the level of attention should be given to quality enhancing strategies.
- 20. Quality Enhancing Strategies Consultation Empowered Collaboration Documentation Redundant Protections
- 21. Consultation Technique oriented information Emotional reactions Reduction of emotional turmoil Thinking through solution together
- 22. Consultation Write down issues in advance Need to be open and honest Be willing to admit mistakes or clinical errors
- 23. Empowered Collaboration Empowered collaboration builds upon informed consent and attempts to maximize patient involvement in all essential elements of treatment The patient becomes more actively involved in the process of psychotherapy. Greater commitment leads to better outcomes.
- 24. Empowered Collaboration Empowering psychologists respect a patient’s autonomy and decision making skills about the goals of treatment, process of treatment, and life choices. Examples of tough decisions and ambivalent patients
- 25. Documentation: Legal Purposes Required by insurers, State Board of Psychology, APA Ethics Code, etc. A record of treatment for future providers Useful risk management tool
- 26. Documentation: Quality Enhancing Dialogue with self and patient regarding process and goals of treatment Means to identify pertinent clinical issues Procedure to document progress
- 27. Redundant Protections Multiple layers of information in order to provide the highest level of care Another health care provider Psychological testing or screening device Family member or significant other Consultation
- 28. Redundant Protections Lack of progress in treatment Patient who presents as complex High risk for self-abuse, self-harm
- 29. Why Redundant Protections? Avoid errors in judgment Obtain essential information Promote greater chance of success
- 30. Transparency Implement quality enhancing strategies with as much transparency as possible.
- 31. Vignettes
- 32. Important Issues What factors make this a potentially difficult patient or situation for you? What would your emotional reaction be to the content of this scenario?
- 33. Important issues How would you use a consultation? In what ways would empowered collaboration be of use? Are there any issues related to documentation? Can you think of any redundant protections?