PSA6669 - SECTION 9: ETHICAL CONSIDERATIONS
There are several key ethical principles related to the psychosocial assessment process. While more experienced clinicians have likely gained a degree of familiarity with some of the principles in other courses on ethics, there are some ways that these concepts are constructed just a little differently when it comes to the assessment process.
One of the most important principles is tied up with the purpose of the assessment, namely gathering sufficient information that the clinician can initiate changes that will create a benefit to clients. Intrinsic in this principle is the client’s right to informed consent.
This principle is concerned with an obligation to involve the client in important decisions at all times, and, before moving forward in any aspect of treatment, assuring that the client has been fully informed of the involved decisions – as well as any possible consequences that might arise - and has consented to the decisions.
While the concept of informed consent is more typically thought of as concerning decisions about what treatment approaches to use, in fact concern for informed consent must be present even as information is being gathered early in the assessment process. The very act of providing personal, and sometimes painful, information about one's life, one's history, and one's challenges, can have potentially serious emotional and psychological consequences for some clients.
Clinicians have obligations to prepare clients for these possibilities before the assessment process begins – and get consent from those clients before proceeding forward.
Informed consent requires three elements: adequate information on which to base the consent, capacity for making the decision, and freedom from coercion. [President’s Commission for the study of ethical problems in medicine and biomedical and behavioral research. Making Healthcare Decisions. Washington DC: U.S. Government Printing Office, 1982.]
Without informed consent, the practitioner should not engage the individual or family unit in the psychosocial assessment process. It is the practitioner’s responsibility to ensure that all three elements of informed consent are met.
If the practitioner has any doubts about whether the person comprehends the decisions to which they are being asked to consent, the person's ability to make a decision of informed consent, or whether the client is freely consenting – without coercion - to the process, then the practitioner should delay the intervention. Under these conditions, it is often helpful for the clinician to discuss his/her concerns with a supervisor or professional peer group before proceeding.
The practitioner needs to be aware that the person(s) seeking the psychosocial assessment is in the disadvantaged position. The practitioner needs to be aware of the motivating factors that may be influencing the person to seek the psychosocial assessment, and protect the well being of the client if those motivational factors create the potential for harm.
It is the practitioner’s responsibility to ensure that all persons seeking this service are treated equally. Each person needs to be afforded the same level of attention and respect as any other. The practitioner should be careful not to discriminate because of personal bias, social or financial status, or cultural background.
The practitioner is responsible for keeping confidential all information related to the individual. Some practitioners feel that it is permitted to discuss cases so long as the person is not identified by name. However, there are instances where the details of the assessment are so unique or so highly publicized that the individual may be recognized without the identifying information. The best practice for a practitioner is not to discuss any aspects of any psychosocial assessment in any forum that is not clinically appropriate.
The practitioner is obligated to use prudent clinical judgment in evaluating the information obtained in the psychosocial assessment process so that the individual is protected from negative or derogatory labels. For example, persons who have chronic pain are often not prescribed sufficient medication to treat the pain. This may lead to what could be perceived as “drug seeking behaviors”, with clients subsequently being labeled in a pejorative way.
Underlying or undiagnosed illness or aspects of the treatment intervention may cause impaired cognition that could be mistaken as an indicator of substance abuse. Practitioners need to take care that persons are not stigmatized as “addicts”, “abusers” or “mentally ill” when the behavior is related to other conditions.
The practitioner needs to be mindful of any conflicts of interest. These often arise due to multiple relationships or economic gain. It is the practitioner’s responsibility to identify these potential areas of conflict of interest and to seek consultation to resolve the conflict. If the conflict can not be resolved, then the person should be referred to another practitioner.
Practitioners need to especially aware of how they are perceived by persons seeking their services. If a practitioner inquires about a service or goods, the person may perceive this inquiry as a solicitation. Practitioners should avoid even the appearance of conflict of interest. Likewise, the practitioner should not use information gained in the psychosocial assessment process for personal financial or social gain.
Practitioners also need to be aware of the possibility that the person(s) may engage in some degree of concealment of information, minimization of behavior practices such as substance abuse, or deliberate deception. Practitioners should be alert to possible illegal acts that may result from the psychosocial assessment.
For example, if a client comes for an assessment in preparation for making a live organ donation, there is a risk that financial motivation may be present. The practitioner should not act in the role of police, but there needs to be awareness of this possibility. Another area where this might be a problem is in adoptions.
While it is widely understood that practitioners should at no time engage in sexual contact with a person being assessed, the practitioner also needs to have a heightened sense of awareness about what might be perceived by persons of another culture as sexual advances. Practitioners should know and follow their specific disciplines’ Code of Ethics.
The culmination of the assessment process is the development of a treatment plan, outlining specific interventions to improve the well being of the client. The practitioner is ultimately responsible for working with the individual to develop realistic goals that are relevant, measurable and attainable.
The interventions related to the goal(s) also need to be relevant and result in observable progress. Goals need to be specific so that efforts are focused and there is no doubt about what is to be done. Specific defines the what, why and how. Goals also need to be clear and easy to accomplish.
A global goal of “getting healthy” is difficult to measure, but losing 2 pounds per month or exercising 30 minutes per day are examples of specific goals. Specific goals need to be measurable and represent observable progress. There need to be concrete criteria for measuring progress, including target dates and a clear action plan.
Goals need to attainable. There is no point in identifying goals that have already been met, or those that could never be met.
It is sometimes necessary to break down larger goals into their parts and work on one part at a time. Task analysis skills are helpful in separating large goals into logical steps. Goals need to be realistic. There needs to be some commitment and effort needed to achieve the goal. Goals need also to be timely. The time line needs to be measurable, attainable and realistic.
More information on how to develop S.M.A.R.T. goals can be found at : http://www.goal-setting-guide.com/smart-goals.html .
While the development of appropriate goals that attend to the client's treatment needs is an ethical issue, it is also a clinical issue. The next section will be concerned with treatment plan development from a clinical perspective.