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ETHICS TRAINING AND COMPETENCIES
ОглавлениеPrior to the late 1970s, many applied psychology graduate programs (clinical psychology, school psychology) required little formal coursework in professional ethics (Welfel, 2012). Ethics was often taught in the context of supervised practica and internship experiences, a practice Handelsman (1986) labeled “ethics training by ‘osmosis’” (p. 371). A shortcoming of this approach is that student learning is limited by supervisor awareness and knowledge of ethical-legal issues and the types of situations encountered in the course of supervision (Handelsman, 1986). Consensus now exists that ethics, legal aspects of practice, and a problem-solving model need to be explicitly taught during graduate training (Dailor & Jacob, 2010; Haas et al., 1986; Tymchuk, 1985). Both the NASP and the APA graduate program preparation standards require coursework in professional ethics. Furthermore, in School Psychology: A Blueprint for Training and Practice (Ysseldyke et al., 2006), prepared by a task force composed of leaders in the field, knowledge of the ethical and legal aspects of professional practice was identified as a foundational competency for school psychologists, one that permeates all aspects of the provision of services (also see NASP’s Model for Comprehensive and Integrated School Psychological Services, 2020).1
In the 1980s, psychology trainers began to ask, “What should be the goals of ethics education in psychology?” (Haas et al., 1986; Kitchener, 1986); “What are the desired cognitive, affective, and behavioral ‘ethics competencies’ for school psychologists?” More recently, trainers have raised these questions: “How do school psychology students and practitioners gain competence, and ultimately expertise, in ethical decision making?” (Dailor & Jacob, 2010) “How do they gain a sense of themselves as ethical professionals?” (Handelsman et al., 2005, p. 59); and “How should ethics be taught?” A number of goals for ethics training have been suggested in the literature. An emerging picture of desired competencies includes these:
Competent practitioners are sensitive to “the ethical components of their work” and are aware that their actions “have real ethical consequences that can potentially harm as well as help others” (Kitchener, 1986, p. 307; also Welfel & Kitchener, 1992).
Competent psychologists have a sound working knowledge of the content of codes of ethics, professional standards, and law pertinent to the delivery of services (Fine & Ulrich, 1988; Welfel & Lipsitz, 1984).
Competent practitioners are committed to a proactive rather than a reactive stance in ethical thinking and conduct (Tymchuk, 1986). They use their broad knowledge of codes of ethics and law along with ethical reasoning skills to anticipate and prevent problems from arising.
Skilled practitioners are able to analyze the ethical dimensions of a situation and demonstrate a well-developed “ability to reason about ethical issues” (Kitchener, 1986, p. 307). They have mastered and make use of a problem-solving model (Jacob et al., 2021; de las Fuentes & Willmuth, 2005; Tymchuk, 1981, 1986).
Competent practitioners recognize that a system of ethical rules and ideals develops in the context of a specific culture, and they are sensitive to the ways their own values and standards for behavior may be similar to or different from those of individuals from other cultural groups. They “strive to understand the manner in which culture influences their own view of others and other’s view of them” (Ortiz et al., 2008, p. 1721; also APA, 2017a; K. Kelly et al., 2019).
Competent psychologists are aware of their own feelings and beliefs. They recognize that personal feelings, beliefs, and values influence professional decision making (Knapp, Gottlieb et al., 2017; Koocher & Keith-Spiegel, 2016).
Competent practitioners do their best to engage in positive ethics; that is, they strive for excellence rather than meeting minimal obligations outlined in codes of ethics and law (Knapp, VandeCreek et al., 2017).
Competent practitioners appreciate the complexity of ethical decisions and are tolerant of ambiguity and uncertainty. They acknowledge and accept that there may be more than one appropriate course of action (de las Fuentes & Willmuth, 2005; Kitchener, 2000).
Competent practitioners have the personal strength to act on decisions made and accept responsibility for their actions (de las Fuentes & Willmuth, 2005; Kitchener, 1986).
Two paradigms describe how students and school psychology practitioners develop ethical competence: the acculturation model (Handelsman et al., 2005) and a stage model (Dreyfus, 1997). Handelsman et al. (2005) described ethics training of psychology graduate students as a dynamic, multiphase acculturation process.2 They suggested that psychology, as a discipline and profession, has its own culture that encompasses aspirational ethical principles, ethical rules, professional standards, and values. Students develop their own “professional ethical identity” based on a process that optimally results in an adaptive integration of personal moral values and the ethics culture of the profession. Trainees who do not yet have a well-developed personal sense of morality, and those who do not understand and accept critical aspects of the ethics culture of psychology, may have difficulty making good ethical choices as psychologists.
The stage model describes a process whereby practitioners progress through five levels (Dreyfus, 1997). Novice practitioners are rules-bound and slow to make decisions. With some experience in applying rules of practice, advanced beginners become more capable of identifying multiple aspects of a complex situation and taking context into account, but they are still focusing on technical mastery of their skills. Competent practitioners are better able to identify key elements of a situation, see relationships among elements, recognize subtle differences between similar situations, balance skills and empathy, and consider the long-term effects of their decisions. However, because they are more skilled in considering relevant elements, competent practitioners are at times overwhelmed by the complexity of real-world problems. Practitioners who are proficient recognize situational patterns and subtle differences more quickly, and they are able to prioritize elements in decision making more effortlessly. Proficient practitioners may not be conscious of the knowledge and thinking processes that provide the foundation for their choices. Finally, because of many experiences with diverse situations, experts are able to rely on past decisions to inform future decisions, base decisions on subtle qualitative distinctions, and often have an intuitive grasp of what needs to be done without extensive analyses. Based on their review of research on the acquisition of expertise, Ericsson and Williams (2007) suggested that expertise is acquired by early supervised practice coupled with deliberate practice over an extended period of time, usually 10 years.
How should ethics be taught? As Franeta noted, “instruction merely in codes of ethics cannot substitute for professional ethics education” (2019, p. 127). In the field of school psychology, growing professional support exists for a planned, multilevel approach to training in ethics and law (Conoley & Sullivan, 2002; Dailor & Jacob, 2011; Welfel, 2012). Tryon (2000) and others (Dailor & Jacob, 2011) recommended that formal coursework in ethics and law be required at the beginning of graduate training to prepare students to participate in discussions of ethical and legal issues throughout their program. Because many aspects of school-based practice are regulated by law as well as ethics, we recommend integrated rather than separate instruction in ethics and law; furthermore, key concepts, such as privacy, informed consent, and confidentiality, have roots in both ethics and law. A foundational course can introduce students to broad ethical principles, codes of ethics, the major provisions of school law pertinent to practice, and an ethical-legal decision-making model. In addition, Handelsman et al. (2005) recommended that early coursework include activities to heighten self-awareness of personal values and beliefs. For example, they suggested asking students to write an ethics autobiography in which they reflect on their own values, as well as those of their families and cultures of origin, and consider what it means to be an ethical professional (p. 63; also Bashe et al., 2007). (For a discussion of methods in teaching ethical and legal issues in school psychology, see Jacob et al., 2021, and Welfel, 2012).
A foundational course in ethics and law can provide opportunities for students to apply what they are learning about the ethical-legal aspects of practice by role-playing difficult situations and analyzing case incidents (Dailor & Jacob, 2010). Empirical evidence from the field of medical ethics indicates that case analysis, particularly with discussion, results in improved moral reasoning (Eckles et al., 2005; S. Smith et al., 2004). However, while such foundational coursework provides a critically important underpinning for subsequent training, it is not sufficient to achieve desired practitioner competencies in ethics and law. If students have only one course in ethics and law, they may not be prepared to apply this knowledge across various domains of practice. In order for students to progress beyond the stage of advanced beginner, discussion of ethical-legal issues associated with diverse situations and professional roles must be a component of coursework in assessment, academic remediation, behavioral interventions, counseling, and consultation. For this reason, Tryon (2000) recommended that all graduate program course instructors discuss ethical issues related to their specialty areas.
Supervised field experiences provide a vitally important opportunity for students to apply their knowledge to multiple real-world situations (Harvey & Struzziero, 2008). With appropriate supervisory support, internship is “a prime time to develop ethical frameworks that will be useful throughout a professional career” (Conoley & Sullivan, 2002, p. 135). Field- and university-based supervisors consequently have a special obligation to model sound ethical-legal decision making and to monitor, assist, and support supervisees and early-career practitioners as they first encounter real-world challenges (Conoley & Sullivan, 2002; Harvey & Struzziero, 2008; K. Kelly et al., 2019).
Although growing professional support exists for a planned, multilevel approach to graduate preparation in ethics, Dailor and Jacob (2011) surveyed a nationally representative sample of public school psychology practitioners and found that only 24% of the 208 respondents reported receiving multilevel university ethics training that included coursework in ethics, discussion of ethical issues in multiple courses, and supervised discussion of ethical issues in practica and internships.
Based on a meta-analytic study of the effectiveness of ethics education instruction in the sciences, Watts et al. (2017) found that ethics instruction has sizable benefits to participants and that those benefits appear to hold up over time. However, few empirical investigations of the effectiveness of formal ethics training have appeared in the psychology literature (Franeta, 2019; Welfel, 2012). Baldick (1980) found that clinical and counseling interns who received formal ethics training were better able to identify ethical issues than interns without prior coursework in ethics. Tryon (2001) surveyed school psychology doctoral students from APA-accredited programs and found that students who had taken an ethics course and those who had completed more years of graduate study felt better prepared to deal with the ethical issues presented in the survey than those who had not taken an ethics course and who had completed fewer years of graduate education. Student ratings of their preparedness to deal with ethical issues were positively associated with the number of hours of supervised practicum experience completed. Dailor and Jacob (2011) found an association between the types of university training school psychology practitioners had received and their preparedness to handle ethical issues on the job, with those who had received multilevel university preparation in ethics reporting higher levels of preparedness to handle ethical issues. Preparedness was not associated with degree level (doctoral or nondoctoral) or years of experience on the job (five or fewer years versus more than five years).
Several studies, however, have reported a gap between knowledge of the appropriate course of action and willingness to carry out that action (Bernard & Jara, 1986; T. S. Smith et al., 1991; Tryon, 2000). Even when practitioners can identify what ought to be done, many would choose to do less than they believe they should (Bernard & Jara, 1986). Thus, at this time, additional research is needed to identify the types of ethics training that are most effective in developing the skills and necessary confidence for psychologists to take appropriate actions in ethically difficult situations (Tymchuk, 1985; Welfel, 2012).