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Quality Enhancing Strategies John Gavazzi, Psy.D., ABPP
Positive Ethics <ul><li>Ethics as a movement away from the punishment and anxiety-producing components of ethics </li></ul...
Competence <ul><li>Remedial: Acquiring and maintaining  minimal formal qualifications </li></ul><ul><li>Positive: Striving...
Informed Consent <ul><li>Remedial:  Fulfilling legal responsibilities </li></ul><ul><li>Emphasis on signed consent </li></...
Benefits of Positive Ethics <ul><li>Broadens a psychologist’s understanding of ethics in a broader context </li></ul><ul><...
Benefits of Positive Ethics <ul><li>Appreciate the moral values on which the APA code is based </li></ul><ul><li>Assist ps...
An Acculturation Model One Application of Positive Ethics
Acculturation  <ul><li>A  process  to change the cultural behavior of an individual through contact with another culture. ...
Ethical Culture of Psychology <ul><li>Our system of common beliefs, shared meanings, norms and traditions that distinguish...
Acculturation as a Process <ul><li>Can be a complex process </li></ul><ul><li>Some parts of a psychologist’s practice and ...
Ethical Acculturation <ul><li>Identification with personal value system </li></ul><ul><li>(high vs. low) </li></ul><ul><li...
Acculturation Model of ethical training Higher in  Professional Ethics Higher in Personal Ethics Lower in  Personal Ethics...
Marginalized <ul><li>Matrix: Low on professional ethics </li></ul><ul><li>Low on personal ethics </li></ul><ul><li>Risks: ...
Assimilation <ul><li>Matrix:   High on professional ethics </li></ul><ul><li>Low on personal ethics </li></ul><ul><li>Risk...
Separation <ul><li>Matrix: Low on professional ethics </li></ul><ul><li>High on personal ethics </li></ul><ul><li>Risks: C...
Integrated <ul><li>Matrix: High on professional ethics </li></ul><ul><li>High on personal ethics </li></ul><ul><li>Reward:...
Quality Enhancing Strategies <ul><li>High quality psychological services occurs at the intersection of our personal and pr...
Link to Moral Principles <ul><li>Beneficence : Welfare of the patient </li></ul><ul><li>Nonmaleficence : Avoiding harm </l...
Quality Enhancing Strategies <ul><li>As the legal risks, the possibility of treatment failure, or patient complexity incre...
Quality Enhancing Strategies <ul><li>Consultation </li></ul><ul><li>Empowered Collaboration </li></ul><ul><li>Documentatio...
Consultation <ul><li>Technique oriented information </li></ul><ul><li>Emotional reactions </li></ul><ul><li>Reduction of e...
Consultation <ul><li>Write down issues in advance </li></ul><ul><li>Need to be open and honest </li></ul><ul><li>Be willin...
Empowered Collaboration <ul><li>Empowered collaboration builds upon informed consent and attempts to maximize patient invo...
Empowered Collaboration <ul><li>Empowering psychologists respect a patient’s autonomy and decision making skills about the...
Documentation: Legal Purposes <ul><li>Required by insurers, State Board of Psychology, APA Ethics Code, etc. </li></ul><ul...
Documentation: Quality Enhancing <ul><li>Dialogue with self and patient regarding process and goals of treatment </li></ul...
Redundant Protections <ul><li>Multiple layers of information in order to provide the highest level of care </li></ul><ul><...
Redundant Protections <ul><li>Lack of progress in treatment </li></ul><ul><li>Patient who presents as complex </li></ul><u...
Why Redundant Protections? <ul><li>Avoid errors in judgment </li></ul><ul><li>Obtain essential information </li></ul><ul><...
Transparency <ul><li>Implement quality enhancing strategies with as much transparency as possible. </li></ul>
Vignettes
Important Issues <ul><li>What factors make this a potentially difficult patient or situation for you? </li></ul><ul><li>Wh...
Important issues <ul><li>How would you use a consultation? </li></ul><ul><li>In what ways would empowered collaboration be...
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Quality Enhancing Strategies

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Part of a presentation in June 2010.

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Quality Enhancing Strategies

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

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