This book is offered as a practical resource to help psychologists learn and apply the APA Ethical Principles of Psychologists and Code of Conduct.In three concise sections,
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How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.
Competence means the ability to perform according to the standards of the profession. Pope and Brown (1996) described competence as involving three factors: knowledge, technical skills, and emotional competence.Generally, psychologists' graduate programs and supervised experiences will have helped them acquire the necessary knowledge and technical skills, and their mastery of the content for the psychology licensing examination will have furthered their goal of becoming knowledgeable. Typically, psychologists' areas of competent practice are derived from the content of their graduate programs, practica, internships, and other supervised experiences, subject to some kind of external control. After becoming licensed and with some experience, most psychologists feel comfortable stating that they are competent in certain areas of practice, such as in the treatment and assessment of adults, health psychology, neuropsychology, or another domain of practice. It may be helpful to consider competence from the standpoint of Bloom' s taxonomy (see Table 3.1.A).Furthermore, some psychologists are specialists in that they have received more training, experience, and expertise in a certain domain of practice through additional supervision, course work, or postdoctoral training. Psychologists may, for example, have received a diplomate from the American Board of Professional Psychology or a certificate from the College of Professional Psychology. Specialists typically spend a large portion of their time working in their area of specialty. Most psychologists are unlikely to earn specialty standing in more than two areas of practice, since the very nature of being a specialist involves having a large portion of one' s practice dedicated to work in that specialty.Psychologists are best able to contribute to the public welfare when they view competence as a dynamic and interactive factor. Remember the risk management formula:At first appearance it looks like competence is identical to the individual therapy factors or personal skill inventory described in Section 1. However, Clinical risk = (P x C x D) TF In this formula, P = patient risk characteristics; C = context; D = disciplinary consequences; and TF = therapist factors. 61 Section 3: APPLICATIONS OF THE RISK MANAGEMENT MODELcompetence is not a fixed entity but varies according to the unique needs of your patients, context of treatment, and your life circumstances. For example, psychologists with a very strong personal skill inventory will be able to work well with a wide range of patients. However, even those psychologists may apply it with patients or in situations beyond their range of effectiveness and increase their risk of practicing incompetently. On the other hand, psychologists with more limited personal skill inventories may be aware of their limitations and consequently select patients or situations carefully and ensure that their skills will be applied where the likelihood of success is high. Again, look at competence from the standpoint of Bloom' s taxonomy (see ...
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