3/9/2016. Establishing Clinical Standards and Building a Network to Support Ethical Decision Making. Clinical Standards.

Transcription

1 Establishing Clinical Standards and Building a Network to Support Ethical Decision Making Linda A. LeBlanc, PhD Trumpet Behavioral Health The context Applied behavior analysis in a large human services setting In-home programming, school consultation, center-based programming Majority of direct contact hours by non-bcbas Hundreds of employees (~90 BCBAs) with varied backgrounds, cultures, and training experiences operating in 10 different states Clinical Team Roles Our Locations Multi Division Clinical, Operational, Financial Oversight Regional Director Single Division Clinical, Operational, Financial Oversight Clinical Director Supervisory/Training responsibility (In divisions of appropriate scale) Senior Clinician Divisional administrative & operational coordination Support Service Manager Supervisory clinical staff (BCBA/BCaBAs) Clinician Associate Clinician Program implementation (Hourly Staff) Therapist 4 Clinical Standards Goals and Objectives Create best practices and systems for implementation Effective, easy to access, intuitive Create opportunities to connect across divisions and buy-in from teams Create multiple exemplars for establishing pivotal repertoires clinical decision-making problem-solving resource seeking 1

2 Process for Establishing Standards Identify critical areas Identify critical processes related to mission Determine optimal standards Gather and integrate current iterations Compare to best practice recommendations Develop manuals and tools Disseminate and train Evaluate practice (ease, utility) and revise accordingly Our Critical Areas Processes w/in Area Functional Behavioral Preference Curricular Intellectual and Adaptive Co-morbidity of Family Functioning Make it accessible Tools!! Sample Clinical Standards Functional Behavioral Best Practice guidelines Links to critical literature Templates to tailor Data sheets, graphs, protocols Training resources and opportunities 2

3 Trumpet FBA Process Functional Behavioral Tools! Descriptive Initial Contact Informant Function- Based Treatment Functional Analysis Functional Behavioral Tools! Best Practices FBA Functional Behavioral 3

4 Data Collection 4

5 Clinical Standards Intervention Interface with Consumers Data Collection and Progress Monitoring Transition Planning Ethics Supervision Training and Performance Management Where does ethics show up? Interface with Consumers Consent for services, confidentiality Fees and financial arrangements Functional Behavioral Data Collection Collection of ongoing data and use to guide decisions Intervention Conditions for success and barriers to implementation Right to effective treatment; evidence-based treatment Supervision 5

6 Morality and Ethics Personal Ethics and morality are the result of our experiences and produce loosely formed rules. Professional Ethics are governed by explicit rules and guidelines for conduct given the nature of our profession. For many at the entry level, this is their first encounter with professional ethics so they are likely to rely on personal ethics and morality. Common Issues and Core Problems Dual role/personal relationships with families Stimulus control (e.g., in their home, interacting positively with their children,) Mandated reporting and dangerous situations Aversive situations produce avoidance No rule control Non-behavior analysts in the organization don t know our codes of conduct Marketing, business, entry level staff Solutions? We can t solve this with more rules!!!! Too many scenarios and most are unexpected Escape and avoidance prohibit discussion Need to create a system for Culture of active discussion Ethical problem solving repertoires Reinforcement for asking and reporting Ethics Network - Purpose Proactively establish the highest standards of professional conduct Handle ethical dilemmas swiftly as they arise Build capacity for ethical conduct at all levels Facilitate open and proactive discussion of professional and ethical issues Develop effective and ethical problem-solving Ethics Network 6

7 Monthly Talking Points Talking Points & Discussion Talking Points & Discussion Talking Points & Discussion 7

8 Take Home Points Ethicality is multi-faceted and multidetermined Build proactive systems and reinforce talking about things before they come up Teach mediating repertoires to ensure success in the situations for which you couldn t plan Systems approach to building resources and clinical excellence Focus on process and functional analysis of successful repertoires Make it easy to do things well!!! Contact me at: lleblanc@tbh.com 8