quality enhancing strategies

Quality Enhancing Quality Enhancing StrategiesStrategies

John Gavazzi, Psy.D., ABPPJohn Gavazzi, Psy.D., ABPP

Positive EthicsPositive Ethics

Ethics as a movement away from Ethics as a movement away from the punishment and anxiety-the punishment and anxiety-producing components of ethicsproducing components of ethics

Fulfill their highest idealsFulfill their highest ideals

A means to help interpret and apply A means to help interpret and apply ethics standardsethics standards

CompetenceCompetence

Remedial:Remedial:Acquiring and maintaining Acquiring and maintaining minimal formal qualificationsminimal formal qualifications

Positive:Positive: Striving for highest standardsStriving for highest standards

Includes self-awareness andIncludes self-awareness and

self-careself-care

Emotional competenceEmotional competence

Informed ConsentInformed Consent

Remedial: Remedial: Fulfilling legal responsibilitiesFulfilling legal responsibilities

Emphasis on signed consentEmphasis on signed consent

Positive:Positive: Working to maximize client Working to maximize client participation with goalsparticipation with goals

Understand issues related to Understand issues related to multiple relationshipsmultiple relationships

Benefits of Positive EthicsBenefits of Positive Ethics

Broadens a psychologist’s understanding Broadens a psychologist’s understanding of ethics in a broader contextof ethics in a broader context

Sensitize psychologists to ethical Sensitize psychologists to ethical implications of decisions on a daily implications of decisions on a daily

basisbasis

Benefits of Positive EthicsBenefits of Positive Ethics

Appreciate the moral values on which the Appreciate the moral values on which the APA code is basedAPA code is based

Assist psychologists in balancing Assist psychologists in balancing competing ethical demandscompeting ethical demands

Help psychologists to address systemic Help psychologists to address systemic social problemssocial problems

An Acculturation ModelAn Acculturation Model

One Application of Positive EthicsOne Application of Positive Ethics

Acculturation Acculturation

A A processprocess to change the cultural behavior to change the cultural behavior of an individual through contact with of an individual through contact with another culture. The process of another culture. The process of acculturation occurs when there is an acculturation occurs when there is an adaptation into an organization or society.adaptation into an organization or society.

Ethical Culture of PsychologyEthical Culture of Psychology

Our system of common beliefs, shared Our system of common beliefs, shared meanings, norms and traditions that meanings, norms and traditions that

distinguish psychologists as professionals.distinguish psychologists as professionals.

It is a learned set of skills, bases of It is a learned set of skills, bases of knowledge and ethical beliefs, as knowledge and ethical beliefs, as

described in our ethics code. described in our ethics code.

Acculturation as a ProcessAcculturation as a Process

Can be a complex processCan be a complex process

Some parts of a psychologist’s practice Some parts of a psychologist’s practice and lifestyle may be easily acculturated and lifestyle may be easily acculturated while others notwhile others not

Process that may continue throughout the Process that may continue throughout the education or career as a psychologisteducation or career as a psychologist

Ethical AcculturationEthical Acculturation

Identification with personal value systemIdentification with personal value system

(high vs. low)(high vs. low)

Identification with value system of Identification with value system of psychologypsychology

(high vs. low)(high vs. low)

Acculturation Model of ethical Acculturation Model of ethical trainingtraining

IntegrationIntegration SeparationSeparation

AssimilationAssimilation MarginalizationMarginalization

Higher in Higher in Professional EthicsProfessional Ethics

Higher in Higher in Personal EthicsPersonal Ethics

Lower in Lower in Personal EthicsPersonal Ethics

Lower in Professional Ethics

MarginalizedMarginalized

Matrix:Matrix: Low on professional ethicsLow on professional ethics

Low on personal ethicsLow on personal ethics

Risks:Risks: Greatest risk of harmGreatest risk of harm

Lack appreciation for ethicsLack appreciation for ethics

Motivated by self-interestMotivated by self-interest

Less concern for patientsLess concern for patients

AssimilationAssimilation

Matrix:Matrix: High on professional ethicsHigh on professional ethicsLow on personal ethicsLow on personal ethics

Risks:Risks: Developing an overly Developing an overly legalistic legalistic stancestance

Rigidly conforming to Rigidly conforming to individual individual rules while missing rules while missing broader broader issues issues

SeparationSeparation

Matrix:Matrix: Low on professional ethicsLow on professional ethics

High on personal ethicsHigh on personal ethics

Risks:Risks: Compassion overrides goodCompassion overrides good

professional judgmentprofessional judgment

Fail to recognize the Fail to recognize the unique unique role of psychologistsrole of psychologists

IntegratedIntegrated

Matrix:Matrix: High on professional ethicsHigh on professional ethics

High on personal ethicsHigh on personal ethics

Reward:Reward: Implement values in context Implement values in context of professional rolesof professional roles

Reaching for the ethical Reaching for the ethical ceilingceiling

Aspirational ethicsAspirational ethics

Quality Enhancing StrategiesQuality Enhancing Strategies

High quality psychological services High quality psychological services occurs at the intersection of our occurs at the intersection of our personal and professional lives.personal and professional lives.

Paraphrase from “The Courage to Teach”Paraphrase from “The Courage to Teach”

Parker J. PalmerParker J. Palmer

Link to Moral PrinciplesLink to Moral Principles

BeneficenceBeneficence: Welfare of the patient: Welfare of the patient

NonmaleficenceNonmaleficence: Avoiding harm: Avoiding harm

AutonomyAutonomy: Respect for patient : Respect for patient

decision-makingdecision-making


As the legal risks, the possibility of As the legal risks, the possibility of treatment failure, or patient treatment failure, or patient

complexity increases,complexity increases,

the greater the level of attention should the greater the level of attention should be given to quality enhancing be given to quality enhancing

strategies.strategies.


ConsultationConsultation

Empowered CollaborationEmpowered Collaboration

DocumentationDocumentation

Redundant ProtectionsRedundant Protections


Technique oriented informationTechnique oriented information

Emotional reactionsEmotional reactions

Reduction of emotional turmoilReduction of emotional turmoil

Thinking through solution togetherThinking through solution together


Write down issues in advanceWrite down issues in advance

Need to be open and honestNeed to be open and honest

Be willing to admit mistakes or clinical Be willing to admit mistakes or clinical errorserrors


Empowered collaboration builds upon Empowered collaboration builds upon informed consent and attempts to maximize informed consent and attempts to maximize patient involvement in all essential elements patient involvement in all essential elements of treatmentof treatment

The patient becomes more actively involved The patient becomes more actively involved in the process of psychotherapy. Greater in the process of psychotherapy. Greater commitment leads to better outcomes.commitment leads to better outcomes.


Empowering psychologists respect a Empowering psychologists respect a patient’s autonomy and decision making patient’s autonomy and decision making skills about the goals of treatment, process skills about the goals of treatment, process of treatment, and life choices.of treatment, and life choices.

Examples of tough decisions and Examples of tough decisions and ambivalent patientsambivalent patients

Documentation: Legal PurposesDocumentation: Legal Purposes

Required by insurers, State Board of Required by insurers, State Board of Psychology, APA Ethics Code, etc.Psychology, APA Ethics Code, etc.

A record of treatment for future providersA record of treatment for future providers

Useful risk management toolUseful risk management tool

Documentation: Quality EnhancingDocumentation: Quality Enhancing

Dialogue with self and patient regarding Dialogue with self and patient regarding process and goals of treatmentprocess and goals of treatment

Means to identify pertinent clinical issuesMeans to identify pertinent clinical issues

Procedure to document progressProcedure to document progress


Multiple layers of information in order to Multiple layers of information in order to provide the highest level of careprovide the highest level of care

Another health care providerAnother health care provider

Psychological testing or screening devicePsychological testing or screening device

Family member or significant otherFamily member or significant other



Lack of progress in treatmentLack of progress in treatment

Patient who presents as complexPatient who presents as complex

High risk for self-abuse, self-harmHigh risk for self-abuse, self-harm

Why Redundant Protections?Why Redundant Protections?

Avoid errors in judgmentAvoid errors in judgment

Obtain essential informationObtain essential information

Promote greater chance of successPromote greater chance of success

TransparencyTransparency

Implement quality enhancing strategies with Implement quality enhancing strategies with as much transparency as possible.as much transparency as possible.

VignettesVignettes

Important IssuesImportant Issues

What factors make this a potentially difficult What factors make this a potentially difficult patient or situation for you?patient or situation for you?

What would your emotional reaction be to What would your emotional reaction be to the content of this scenario?the content of this scenario?

Important issuesImportant issues

How would you use a consultation?How would you use a consultation?

In what ways would empowered collaboration In what ways would empowered collaboration be of use?be of use?

Are there any issues related to documentation?Are there any issues related to documentation?

Can you think of any redundant protections?Can you think of any redundant protections?

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