Practical Ethics in Behavioral Health One Individual at a Time Debra Burock, Ph.D., CCP Disclosure Statement: I have no real or perceived conflicts of interest that relate to this presentation. www.nhsonline.org

Why do we take Ethics seminars? Licensure Requirement Interest Shades of Gray We’re unethical?

Risks Leading to Unethical Decisions Organizational Culture Hierarchical pressure Groupthink Burnout

The Evidence Nuremburg Dialysis ‘God Squads’ Milgram

Zimbardo – Prison Study Discussion

“Ethics change with technology.” ― Larry Niven, N-Space Social Media Reality Shows/Daytime TV EHR’s

Ethics – Compliance - Quality HIPAA disclosures Treatment Planning

Ethical Decision Making 6 Steps (Curtis, L.C. & Hodge, M. (1995) Ethics Committees Root Cause Analysis Consultation

6 Steps of Ethical Decision Making (Curtis, L.C. & Hodge, M. (1995) Identify the problem Identify the ethical issues raised Review relevant guidelines/regulations etc. Obtain consultation Identify and list possible responses and consequences Decide on the best course of action Adapted from: Curtis, L.C. & Hodge, M. (1995). Ethics and boundaries in community support services: New Challenges. New Directions for Mental Health Services, 66, 43-60.

Ethics Committees .

Consultation Form Adjudicatory Mediation Consultation

Root Cause Analysis Application for Ethics 5 Whys What processes allowed for the ethical dilemma? What can be done to prevent it from happening again?

Small Group Exercise Choose 2 ethical dilemmas ID the ethical challenges in the dilemmas What are the compliance and quality issues related to the challenge? How significant is the liability related to the challenge? Who could you consult with? What are 2 ways you could address the challenge to reduce risk to all parties?

Ethical Dilemmas Level of Care Child Abuse Reporting Prescribing practices Gifts from staff

Discussion What are the signs of ethical collapse in an organization? How can you prevent making unethical decisions? Are there irresolvable ethical problems?

Questions and Comments? Debra Burock dburock@nhsonline.org 412-214-9020