WORKING WITH CHILDREN: AN ETHICS FRAMEWORK FOR HEALTH PROFESSIONALS - - PowerPoint PPT Presentation

WORKING WITH CHILDREN: AN ETHICS FRAMEWORK FOR HEALTH PROFESSIONALS

“AN OUNCE OF PRACTICE IS WORTH MORE THAN TONS OF PREACHING”

Mahatma Gandhi

ACKNOWLEDGEMENT: ETHICS IN THE TIME OF COVID-19 WHAT YOU WILL LEARN FROM THIS PRESENTATION: ▪ A CONCEPTUAL UNDERSTANDING OF ETHICS ▪ APPLICATION OF ETHICS IN PROFESSIONAL PRACTICE WHAT YOU WILL BE ABLE TO DEVELOP: ▪ AN INDIVIDUALISED ETHICS FRAMEWORK RELEVANT TO YOUR PROFESSIONAL PRACTICE

PART 1: CONCEPTUAL UNDERSTANDING

SHAKING THE DUST OFF ETHICS

ETHICS IS CONCERNED WITH WHAT IS GOOD FOR INDIVIDUALS & SOCIETY DEFINED AS A MORAL PHILOSOPHY OR CODE OF MORALS PRACTICED BY AN INDIVIDUAL OR A GROUP ETHICS IS A BRANCH OF PHILOSOPHY THAT “INVOLVES SYSTEMATISING DEFENDING & RECOMMENDING CONCEPTS OF RIGHT AND WRONG BEHAVIOUR” EXAMPLE OF ETHICS: CODES OF CONDUCT FOR ALLIED HEALTH PROFESSIONALS ETHICS REFLECT AIMS & STANDARDS OF PROFESSION & PROMOTE INTROSPECTION

ETHICS, MORALS & PRINCIPLES …

ETHICS = RULES PROVIDED BY AN EXTERNAL SOURCE – FOR EXAMPLE THE HEALTH PROFESSIONS COUNCIL OF S.A MORALS = INDIVIDUAL’S OWN PRINCIPLES REGARDING RIGHT & WRONG – BASED ON THEIR ASSUMPTIONS, VALUES AND BELIEFS PRINCIPLES = A MORAL RULE OR BELIEF THAT GUIDES YOUR ACTIONS

ETHICS, MORALS & PRINCIPLES …

ETHICS ARE ABOUT REALITY AND ALSO ABOUT HOW THE WORLD SHOULD BE EXAMPLE: BELIEF: LIFE IS SACRED (ALSO A VALUE) PRINCIPLE: TERMINATION OF PREGNANCY IS WRONG & IMMORAL (ALSO MORALITY). ASSUMPTION: A FOETUS IS A FULL HUMAN WITH RIGHTS BEFORE BIRTH ETHICS: A PROFESSIONAL MAY NOT IMPOSE THEIR BELIEFS ON A CLIENT WHO IS REQUESTING AN ABORTION WITHIN THE PROVISIONS OF THE LAW CODE OF CONDUCT: DEFINES HOW A PERSON REQUESTING A TERMINATION SHOULD BE TREATED

WHAT’S IN YOUR ETHICS TOOLBOX?

PERSONAL ETHICS (SOCIALISATION) YOUR RELIGIOUS, SOCIAL & CULTURAL BELIEFS; BELIEFS ABOUT GENDER, HUMAN SEXUALITY, JUSTICE ETC. VIRTUE ETHICS (AM I GOOD) HOW YOU LIVE YOUR LIFE – WHAT YOU BELIEVE IT MEANS TO BE A “GOOD PERSON” – YOUR CRITERIA FOR JUDGING OTHERS MEAT OR NOT? CHARITY OR NOT? SPIRITUAL DISCIPLINE OR NOT? KEEPING YOUR WORD (INTEGRITY) OR NOT?

WHAT’S IN YOUR ETHICS TOOLBOX?

CONSEQUENTIAL ETHICS (ACTIONS & INACTIONS) WHAT IMPACT IS MY BEHAVIOUR HAVING ON THE WORLD AND OTHERS? IS IT DOING MORE GOOD OR HARM? PEOPLE? ENVIRONMENT? DEONTOLOGICAL OR DUTY ETHICS (REASON) WHAT DO MY ETHICAL PRINCIPLES TELL ME TO DO? WHAT DO I OWE? WHAT AM I RESPONSIBLE FOR? HOW DO I DECIDE BETWEEN CONFLICTING DUTIES?

PART 2: UNPACKING ETHICS – THE FOUNDATIONS OF OUR PRACTICE

GENERAL ETHICAL PRINCIPLES

UNIVERSALLY ACCEPTED PRINCIPLES FOR ALL ENDEAVOURS ▪ JUSTICE – FAIRNESS & EQUITABLE DISTRIBUTION OF CARE/RESOURCES ▪ BENEFICENCE – DOING RIGHT THING FOR PATIENT ▪ NON-MALEFICENCE – DOING NO HARM (INTENTIONAL OR NOT)

GENERAL ETHICAL PRINCIPLES

▪ ACCOUNTABILITY – ACCEPT RESPONSIBILITY & CONSEQUENCES ▪ FIDELITY – KEEPING ‘PROMISES’ – HIGH STANDARDS ▪ AUTONOMY – PATIENT SELF- DETERMINATION ▪ VERACITY – BEING TRUTHFUL WITH THE PATIENT

7 INTERNATIONAL ETHICAL PRINCIPLES FOR WORKING WITH CHILDREN

1.VALUE & RESPECT EACH CHILD AS UNIQUE 2.UPHOLD RELATIONSHIP OF CHILD WITH OTHERS & INTERDEPENDENCY

7 INTERNATIONAL ETHICAL PRINCIPLES FOR WORKING WITH CHILDREN

3.FACILITATE: OPTIMAL GROWTH DEVELOPMENT & POTENTIAL 4.HELP: PREVENT, PROTECT TREAT, REMEDIATE

7 INTERNATIONAL ETHICAL PRINCIPLES FOR WORKING WITH CHILDREN

5.USE INFORMATION APPROPRIATELY: PRIVACY CONFIDENTIALITY RIGHT TO INFO 6.OPPOSE: DISCRIMINATION OPPRESSION EXPLOITATION

7 INTERNATIONAL ETHICAL PRINCIPLES FOR WORKING WITH CHILDREN

• 7. MAINTAIN:

PERSONAL & PROFESSIONAL INTEGRITY KNOWLEDGE & SKILLS DEVELOPMENT CO-OPERATION WITH COLLEAGUES MONITOR SERVICE QUALITY CONTRIBUTE TO DEVELOPMENT OF SERVICES & POLICY

THE HIERARCHY OF ETHICS THE SOUTH AFRICAN CONSTITUTION & THE BILL OF RIGHTS SOUTH AFRICAN LAWS - LEGISLATION SPECIFIC PROFESSIONAL CODES OF CONDUCT AND ETHICS

PROFESSION-SPECIFIC ETHICS

INFORMED CONSENT CONTRACTS & RECORDS SCOPE OF PRACTICE IDENTIFYING WHO THE CLIENT IS DUAL RELATION- SHIPS PSYCHOMETRY/ ASSESSMENTS CONFIDENTIALITY SUPERVISION CONTINUED PROFESSIONAL DEVELOPMENT

SPECIAL MENTION: AGES OF CONSENT FOR S.A CHILDREN

TO TREATMENT: 12 TO SEX: 16 TO ABORTION: ANY AGE TO CONTRACEPTIVES: 12 TO HIV TEST: 12 TO OWN ADOPTION: 10

CONTEMPORARY ETHICS

PROFESSIONAL BOUNDARIES PERSONAL DISCLOSURE TO CLIENTS DIVERSITY COMPETENCE (“CULTURAL SENSITIVITY”) GENDER DIVERSITY “SPECIAL NEEDS” YOUNGSTERS MULTI- DISCIPLINARY TEAM-WORK

ELECTRONIC COMMUNICATION & SOCIAL MEDIA “TELE-THERAPY”?

BURN-OUT & COMPASSION FATIGUE – SELF CARE

PART 3: APPLICATION - ETHICAL PRACTICE IN ACTION

“TO PRACTICE ISN’T TO DECLARE I AM BAD. TO PRACTICE IS TO DECLARE THAT I CAN BE BETTER.” DAN HEATH

PROFESSION VS A JOB?

REQUIRES EXTENSIVE TRAINING REQUIRES INTELLECT & APPLICATION PROVIDES AN IMPORTANT SERVICE TO SOCIETY OFFERS LATITUDE IN EXERCISING SKILLS & JUDGEMENT - POWER IS LARGELY DONE IN PRIVATE THE RELATIONSHIP BETWEEN PROFESSIONAL & CLIENT NEEDS TO BE ETHICAL & REGULATED

A QUICK DETOUR: DELIBERATE PRACTICE

ETHICS ‘BORING OR INTIMIDATING’ ☺ IF LINKED TO PRACTITIONER PERFORMANCE & CLIENT OUT- COMES THEY COME ALIVE PROF ACTIVITY EMPHASISING SKILLS & KNOWLEDGE DEVELOPMENT + RIGOROUS SELF- EXAMINATION = QUALITY INTERVENTION MORE LIKELY TO BE CONSCIOUS & ETHICAL

RESEARCH INTO THE EFFECTIVENESS OF PSYCHOTHERAPISTS IDENTIFIES THE CLINICIAN AS ACCOUNTING FOR A GREATER PERCENTAGE OF EFFECTIVENESS IN RELATION TO CLIENT OUTCOMES THAN DOES THE TREATMENT MODALITY THE DEGREE TO WHICH A PROFESSIONAL ENGAGES IN DELIBERATE PRACTICE ESPECIALLY HAS BEEN FOUND TO BE SIGNIFICANTLY RELATED TO OUTCOMES IN PSYCHOTHERAPY, TEACHING & MEDICINE

WHAT MAKES FOR DELIBERATE PRACTICE?

❑SUPERVISION ❑REVIEW OF AUDIOVISUAL RECORDINGS (ALONE & WITH PEERS) ❑LIVE SUPERVISION ❑READING JOURNALS & LITERATURE ❑FOCUSED LEARNING IN SPECIFIC MODELS OF INTERVENTION ❑TRAINING WORKSHOPS

WHAT MAKES FOR DELIBERATE PRACTICE?

❑REVIEWING PAST SESSIONS ❑WRITTEN PLANS FOR FUTURE SESSIONS ❑CASE DISCUSSION WITH COLLEAGUES ❑VIEWING MASTER VIDEOS ❑READING CASE EXAMPLES ❑TENDING TO SELF-CARE & EMOTIONAL NEEDS

DILEMMAS IN PRACTICE: THE ETHICS TRIANGLE

BEST INTERESTS/ GREATER GOOD

SELF OTHER

ETHICAL DECISION – MAKING A 6 STEP MODEL

❑ STEP 1 OBSERVATION ❑ STEP 2 IDENTIFICATION ❑ STEP 3 CONSULTATION ❑ STEP 4 BALANCE ❑ STEP 5 ACTION ❑ STEP 6 REFLECTION

ETHICAL DECISION – MAKING A 6 STEP MODEL

STEP 1: OBSERVATION RECOGNIZE ETHICAL ISSUE/ EVENT DEFINE CHARACTERISTICS COMMIT TO RESOLVE IDENTIFY WHO IS RESPONSIBLE CONSULTS CODES ACKNOWLEDGE YOUR FEELINGS & BIASES STEP 2: IDENTIFICATION IDENTIFY STAKE HOLDERS IDENTIFY WHO HAS AN INTEREST IN THE ISSUE PINPOINT APPLICABLE ETHICAL PRINCIPLES ASCERTAIN CULTURAL SYSTEMS INVOLVED

ETHICAL DECISION–MAKING A 6 STEP MODEL

STEP 3: CONSULTATION TO OBTAIN INFORMATION & ASSISTANCE BRAINSTORM POSSIBLE SOLUTIONS IDENTIFY CONSEQUENCES DISCUSS – INVOLVE CLIENT IN DECISION MAKING IF APPROPRIATE STEP 4: BALANCE LINK: CONNECT BEHAVIOUR AND OPTIONS TO CODES/PRINCIPLES & VIRTUES/VALUES WEIGH THESE UP ASK WHAT CAN BE DONE TO INCREASE CLIENT AUTONOMY

ETHICAL DECISION–MAKING A 6 STEP MODEL

STEP 5: ACTION PREPARE & PLAN FOR IMPLEMENTATION OF SOLUTION COMMIT TO WHEN YOU WILL ACT IDENTIFY CONSEQUENCES OF INACTION ACT STEP 6: REFLECTION REFLECT ON PROCESS & SOLUTION IDENTIFY & RATE OUTCOMES DETERMINE WHAT YOU WOULD LIKE TO DO DIFFERENTLY IN FUTURE IDENTIFY YOUR NEEDS – EG: TRAINING?

CHALLENGES TO MAINTAINING ETHICAL PRACTICE

“IF WE DON’T CHANGE DIRECTION, WE’LL END UP WHERE WE’RE GOING”

PROF IRWIN COREY

CHALLENGES TO ETHICAL PRACTICE

WHAT WE FACE ▪ COVID, POVERTY & INEQUALITY ▪ OVERWHELMING NEED & LIMITED RESOURCES ▪ TOP-HEAVY BUREAUCRACIES WHICH LACK ACCOUNTABILITY ▪ A CULTURE OF VIOLENCE ▪ CORRUPTION & STATE CAPTURE ▪ FAKE NEWS & MISINFORMATION WHAT WE NEED TO DO ▪ THINK CRITICALLY ▪ PROTECT THE MOST VULNERABLE FIRST ▪ TOLERATE MORAL AMBIGUITY ▪ ACCEPT ETHICS ALIGNMENT IS AN ONGOING PROCESS

SELF-COMPLETE ETHICS FRAMEWORK TO ASSIST YOU IN DOING A PERSONAL AND PROFESSIONAL AUDIT

MY PROFESSION & SCOPE OF PRACTICE THE SETTINGS I WORK IN CODE/S OF CONDUCT I WORK UNDER WHO IS MY CLIENT/ CLIENT SYSTEM? S A CONSTITUTION LAWS & REGULATIONS I WORK UNDER ACTS HPCSA SACSSP BHF GUIDING ETHICS

• GENERAL ETHICAL PRIINCIPLES
• INTERNATIONAL ETHICAL

PRINCIPLES FOR PAEDIATRIC WORK

• PROFESSION-SPECIFIC ETHICS
• CONTEMPORARY ETHICS

MY PERSONAL ETHICS & POTENTIAL BIASES: DIVERSITY COMPETENCE What I need to work on DELIBERATE PRACTICE How do I implement THE ETHICS TRIANGLE Greater Good Me Other/s ETHICAL ISSUES I FREQUENTLY ENCOUNTER CHALLENGES TO MY ETHICAL PRACTICE: PERSONAL: ENVIRONMENTAL

SOUTH AFRICAN LEGISLATION & REGULATIONS RELEVANT TO HEALTH PROFESSIONALS’ ETHICAL CONDUCT

Health Professions Act: Ethical Rules Of Conduct – for all practitioners registered with the Health Professions Council Of South Africa Social Service Professions Act: Social workers, auxiliary social workers, child care workers etc. S A Council For Educator’s Act / teacher unions and associations Children’ Act & Amendments School’s Act Protection Of Personal Information Act Criminal Law (Sexual Offences And Related Matters) Act Professional Bodies/ Association’s Codes Of Conduct: SAASWIPP (social workers); OTASA (occupational therapists) PSYSSA (psychologists); SASLHA (speech, language and hearing therapists) OTHER: Individual Medical Scheme’s regulations Board Of Health Care Funders Code of Conduct and regulations

VANESSA RICHARDS

SOCIAL WORKER: CLINICAL & FORENSIC SERVICES M.A CLIN SOC SCI

vrich1@absamail.co.za 082 451 4465