Special ethical considerations for behavioral health consultants in the primary care setting.

Abstract

The growing movement of integrating behavioral health services in medical settings aims to increase ease of access to behavioral health services. Behavioral health consultants (BHCs), who are embedded within primary care clinics, provide a variety of psychological services (screening, brief interventions, and referral to specialized treatment settings) in a novel manner relative to traditional outpatient behavioral health treatment. These alterations in service delivery present unique ethical challenges to effective patient care in primary care behavioral health (PCBH) practice. This article discusses potential ethical dilemmas and challenges that are faced in PCBH. Confidentiality, privacy and informed consent are discussed, given the complex level of communication within primary care clinics. The potential for having multiple relationships with coworkers is reviewed. The need for BHC's to provide sufficient clinical intervention and assessment, and how these may be limited in scope in BHC practice, is discussed. Finally, the complexity of obtaining competence for practice in primary care is explored. We discuss how ethical guidelines apply to this work, and also aim to address where further clarity is needed and context-based ethical decision-making is warranted. Case studies are provided to help illustrate the novel challenges faced by BHCs in integrated medical settings. Public Significance StatementWe describe how psychologists working in primary care settings can experience unique ethical challenges in their clinical practice, relative to those in more traditional clinical settings. We provide ethical considerations and guidance for psychologists working in primary care in the areas of confidentiality, multiple relationships, intervention, assessment and competence.

Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care

“…Existing research suggests that virtual interactive learning methods can still be effective and result in similar educational gains as in-person ( 61 , 62 ); however, future research would need to determine if other strategies need to be considered to achieve success in provider education via virtual platforms. Similarly, there have been advances in understanding how to navigate the ethical considerations associated with an integrated team approach to patient care ( 63 , 64 ); however, continued attention to the ethical considerations within these contexts is also necessary.…”