Ethics is concerned with the basis for moral judgments of “right” and “wrong” and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision‐making when there is a sense of moral conflict or ambiguity about the “right” course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress’ four principles framework (respect for autonomy, beneficence, non‐maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants.
In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision‐making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision‐making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health.
There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic‐based screen‐and‐refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources.
We conducted semi‐structured interviews with healthcare and community partners at two timepoints (n = 65) to investigate start‐up and ongoing implementation experiences, including continuing challenges.
Results highlighted common within‐clinic and clinic‐community coordination challenges across diverse settings as well as promising practices supported by the two frameworks. In addition, we identified ongoing implementation challenges that face efforts to integrate these approaches and to translate screening results into activities that help children and families.
Assessing the existing service referral coordination infrastructure of each clinic and community in early implementation is critical to screen‐and‐refer practice as this influences the continuum of supports available to meet family needs.
ResumenIntroducción a la Sección Especial: Hacer lo ‘correcto:’ Asuntos éticos en la salud mental infantil y en la temprana niñezética, salud mental infantil y en la temprana niñez, código de ética
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