Legal, Ethical, and Professional Shared Decision Making

Lesley Manson, PsyD, Clinical Assistant Professor, Assistant Chair of Integrated Initiatives, Arizona State University

Cathy Hudgins, PhD, LMFT, LPC, Clinical Faculty Associate, Arizona State University Sue Dahl-Popolizio, DBH, OTR/L, CHT, Assistant Clinical Professor, Arizona State University David D. Clarke, MD, Assistant Director for Center for Ethics, Oregon Health & Science University,

Clinical Assistant Professor of Gastroenterology Emeritus at OHSU, and Faculty Associate at Arizona State University

Lisa Tshuma, DBH, PA-C, Associate Clinical Professor, AT Still University Robynne M. Lute, PsyD, Assistant Professor and Director of Training, Kansas City University of

Medicine and Biosciences

Session # E1

CFHA 19th Annual ConferenceOctober 19-21, 2017 Houston, Texas

PresenterPresentation NotesPlease insert the assigned session number (track letter, period number), i.e., A2a

Please insert the TITLE of your presentation.

List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.

You may acknowledge other authors who are not attending the Conference in subsequent slides.

Faculty Disclosure

The presenters of this session have NOT had any relevant financial relationships during the past 12 months.

PresenterPresentation NotesYou must include ONE of the statements above for this session.

CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or productgroup message.

The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidencebased) methods generally accepted by the medical community.

Conference ResourcesSlides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2017

Slides and handouts are also available on the mobile app.

Learning ObjectivesAt the conclusion of this session, the participant will be able to:

1. Compare and contrast codes of ethics for various members of the integrated care team and identify the common ethical principles across integrated care professionals.

2. Utilize an integrated care decision making and problem solving tool to resolve interprofessional legal, ethical, and professional challenges in integrated health care systems.

3. Apply integrated shared decision making best practices to improve patient care and safety.

PresenterPresentation NotesInclude the behavioral learning objectives you identified for this session

1. Hudgins, C., Rose, S., Arnault, S., Fifield, P. (2013). Navigating the legal and ethical foundations of informed consent, and confidentiality in IPC. Families, Systems, and Health. 31(1), 9-19.

2. Reiter, J., Runyan, C. (2013). The Ethics of Complex Relationships in Primary Care Behavioral Health. Families, Systems, & Health, 31, 20-27

3. Barry, M. & Edgman-Levitan, S. (2012). Shared decision making. The New England Journal of Medicine. 366-9.

4. Runyan, C., Robinson, P., Gould, D.A. (2013). Ethical issues facing providers in collaborative primary care settings. Families, Systems, and Health 31, 1, 1-8

5. Enck, G. (2014). Six Step framework for ethical decision making. Journal of health services research and policy. 19(1) 62-64.

Bibliography / Reference

PresenterPresentation NotesContinuing education approval now requires that each presentation include five references within the last 5 years.

Please list at least FIVE (5) references for this presentation that are no older than 5 years.

Without these references, your session may NOT be approved for CE credit.

Learning AssessmentA learning assessment is required for CE credit.

A question and answer period will be conducted at the end of this presentation.

PresenterPresentation NotesPlease incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.

This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

OverviewBrief Overview of Professional Guild Orientation

Review of Common Ethical Principles

Review of Common Integrated Care Dilemmas

Integrated Care Shared Decision Making

Practice Utilizing Specialized Tools to Guide and Resolve Legal, Ethical, and Professional Dilemmas

Questions and Answers/Discussion

Professional Guilds American Psychological Association (APA)American Medical Association (AMA)Hippocratic OathAmerican College of Health Care Executives (AHCE)American Nursing Association (ANA)American Psychiatric Association (APA)National Association of Social Workers (NASW)American Dental Association (ADA)American Pharmacists Association (APhA)American Academy of Physician Assistants (AAPA)American Association of Marriage and Family Therapists (AAMFTs)

Common Principles

Respect for Persons / Autonomy

Acknowledge a persons right to make choices, to hold views, and to take actions based on personal values and beliefs

Justice Treat others equitably, distribute benefits/burdens fairly.

Non-maleficence (do no harm)

Obligation not to inflict harm intentionally; in medical ethics the guiding maxim is to first, do no harm.

Beneficence (do good) Provide benefits to persons and contribute to their welfare. Refers to an action done for the benefit of others.

Common Dilemmas Legal, Ethical, and Professional Issues

Consent

Confidentiality

Mandated Reporting / Reporting Guidelines

Risk Manageme

nt

Roles and Responsibilities / Scope of Practice

Dual Relationships

Medical Records /

Documentation

Personality Consideratio

ns

Treatment Planning

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Panel

PresenterPresentation NotesELI am not a counselorCindi used motivational interviewing on him

KCKC- righting reflex and directing problem solving is in our nature as physicians, uncomfortable with silence, extrovert-Cindi gave me a look the other day to stop talking

HCHard to see how this will save you time in the beginning but learning it actually does save time.Concern- Take more timeSpend time to learn techniques

Integrated Ethical, Legal, and Professional Decision-Making Chart

Motives: Why ask question? What is happening? Were motivations good? Was there harm?Benefits and burdens?

Behaviors (refrain from interpretation):What happened?What is happening?Was there respect for autonomy? Challenge the definition of autonomy to include personal, cultural, community, and familial viewpoints).Was the person/situation treated equitably?

Legalities:Legal considerations StatutesRegulations Policies & procedures

Confidentiality:Who What When WhereWhy Need

Scope of Practice:Limitations StrengthsRoles & Responsibilities

Practice Ethics:Specific standards Recommendations

Professional:Cultural Power Business Financial concerns?

Consequences & Outcomes:What has happened as a result? What would I like to happen? What will happen?Was there harm? Good?What can I control/do?

Additional Info:

? ? ?

Other Challenges To Consider: GenderTreat and StreetTime / Time to ReportTo Assess or Not To Assess Is that a question?New vs Established Any Changes to Clinical Decision Making Employee Considerations Others?

What I Know

Others Involved

Integrated Decision

Motives

Why ask question, what is happening?

Behaviors

What did you do? What is happening?

Legalities

Legal Considerations

Confidentiality

Who, what, when, where, why

Scope of Practice

Limitations or strengths

Practice Ethics

Specific standards or recommendations, SEE BELOW

Professional

Cultural concerns? Power? Business concerns?

Consequences/Outcomes

What happened? What would I like to happen? What will happen?

Group Work

Group Case Review Presentation

In Practice: Plan the When, Where, Why, & How1. Huddles / Immediate Consultation2. Regular Staffings to Review & Simulations3. Safety/ Reporting Box (Ready Resource)4. Culture Supporting Consultation & Acceptance5. Culture of Trust (Professionals and Patients)6. Practice Interprofessional Education & Training7. Interprofessional Practice Competencies and

Trainings

Session Evaluation

Use the CFHA mobile app to complete the evaluation for this session.

Thank you!

PresenterPresentation NotesThis should be the last slide of your presentation

Legal, Ethical, and Professional Shared Decision Making

Lesley Manson, PsyD, Clinical Assistant Professor, Assistant Chair of Integrated Initiatives, Arizona State University

Cathy Hudgins, PhD, LMFT, LPC, Clinical Faculty Associate, Arizona State University Sue Dahl-Popolizio, DBH, OTR/L, CHT, Assistant Clinical Professor, Arizona State University David D. Clarke, MD, Assistant Director for Center for Ethics, Oregon Health & Science University,

Clinical Assistant Professor of Gastroenterology Emeritus at OHSU, and Faculty Associate at Arizona State University

Lisa Tshuma, DBH, PA-C, Associate Clinical Professor, AT Still University Robynne M. Lute, PsyD, Assistant Professor and Director of Training,

Session # E1

CFHA 19th Annual ConferenceOctober 19-21, 2017 Houston, Texas

PresenterPresentation NotesPlease insert the assigned session number (track letter, period number), i.e., A2a

Please insert the TITLE of your presentation.

List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.

You may acknowledge other authors who are not attending the Conference in subsequent slides.

Legal, Ethical, and Professional Shared Decision MakingFaculty DisclosureConference ResourcesLearning ObjectivesAt the conclusion of this session, the participant will be able to:Bibliography / ReferenceLearning AssessmentOverviewProfessional Guilds Common Principles Common Dilemmas Slide Number 11Slide Number 12PanelIntegrated Ethical, Legal, and Professional Decision-Making ChartMotives: Behaviors (refrain from interpretation):Legalities:Confidentiality:Scope of Practice:Practice Ethics:Professional:Consequences & Outcomes:Additional Info: Other Challenges To Consider: Slide Number 25Group WorkGroup Case Review Presentation In Practice: Plan the When, Where, Why, & HowSession EvaluationLegal, Ethical, and Professional Shared Decision Making