The Provision of Neuropsychological Services in Rural/Regional Settings: Professional and Ethical Issues

Abstract

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service

“…It is important to note that when assessment was sourced elsewhere, the rate of completion was much lower than completion of referrals by the OYH NPU (56% vs 80%, respectively). Furthermore, the average waiting time between referral and assessment within our service is lower than that reported for other outpatient neuropsychological services (approximately three months vs six months, respectively; Allott & Lloyd, 2009; Bodin et al., 2007). We believe that one of the main reasons for there being a waiting list is that there is a higher demand for the service than what the OYH NPU is resourced to complete.…”

Concept analysis: lack of anonymity

“…). Similarly, other individuals may intentionally or unintentionally cross personal and professional boundaries of the professional (Allott & Lloyd , Miedema et al . ).…”

“…Interconnectedness may influence, yet is distinctly different from, boundaries. There are positive and negative consequences of being known and interconnected in a community (Bodor 2008, Allott & Lloyd 2009, Heaton & Black 2009, Akfert 2012). In addition, the analysis makes the distinction between lack of anonymity and privacy (Brooks et al 2012).…”

“…In managing the boundaries, a professional may choose to cross a personal or professional boundary to affect a positive outcome and demonstrate support for others (Alexander & Charles 2009, Graham & Liddle 2009, MacConnell et al 2012. Similarly, other individuals may intentionally or unintentionally cross personal and professional boundaries of the professional (Allott & Lloyd 2009, Miedema et al 2009). For example, a client who shows up uninvited at the home of a therapist is intentionally crossing professional boundaries.…”

Juggling personal life and professionalism: Ethical implications for rural school psychologists

“…In an earlier publication, Hargrove () discussed confusion of the role of psychologists, isolation, and burnout as issues frequently experienced by rural psychologists. Furthermore, issues related to competence, dual relationships, and confidentiality have also been identified as specific ethical concerns (Allott & Lloyd, ). These three areas (competence, dual relationships, and confidentiality), as they pertain to rural schools, will now be explored in more detail.…”