Advertisement

Ethical Challenges Unique to the Primary Care Behavioral Health (PCBH) Model

  • Christine N. RunyanEmail author
  • Stephanie Carter-Henry
  • Stacy Ogbeide
Article

Abstract

The interprofessional nature of the Primary Care Behavioral Health (PCBH) model invites potential conflicts between different ethical guidelines and principles developed by separate professional disciplines. When the foundational model of care and training on which ethical principles were developed shifts, the assumptions underlying the guidance also shifts, revealing gaps and mismatches. This article reviews the extant literature in this realm, and proposes a more unifying set of ethical guidance for interprofessional, integrated primary care practice. We discuss common ethical dilemmas unique to the PCBH model through case examples, and then apply the newly proposed ethical guideline model to these cases to illustrate how the newly proposed model can be efficient and effective navigating these dilemmas.

Keywords

Primary care behavioral health model Ethical issues in primary care Interprofessional competencies Ethical model 

Notes

Compliance with Ethical Standards

Conflict of interest

Christine N. Runyan, Stephanie Carter-Henry, and Stacy Ogbeide declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

No animal or human studies were carried out by the authors for this article.

References

  1. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073.CrossRefGoogle Scholar
  2. American Medical Association. (1995–2016). AMA’s code of medical ethics. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page. Accessed 5 Apr 2017.
  3. American Medical Association Principles of Medical Ethics. (2000). In: Council on ethical and judicial affairs. Code of medical ethics: Current opinions, 2000–2001. xiv th edn, Chicago: American Medical Association.Google Scholar
  4. University of Massachusetts Medical School, Office of Student Affairs. (2016–2017). Student handbook. Retrieved from http://www.umassmed.edu/studentaffairs/student-handbook/section-nine-student-health-and-wellness/sensitive-medical-and-counseling-care-of-students-by-faculty-and-residents/. Accessed 5 Apr 2017.
  5. Hodgson, J., Mendenhall, T., & Lamson, A. (2013). Patient and provider relationships: Consent, confidentiality, and mistakes in integrated primary care settings. Families, Systems, & Health, 31, 28–40. doi: 10.1037/a0031771.CrossRefGoogle Scholar
  6. Ivey, L., & Doenges, T. (2013). Resolving the dilemma of multiple relationships for primary care behavioral health providers. Professional Psychology: Research and Practice, 44, 218–224. doi: 10.1037/a0033149.CrossRefGoogle Scholar
  7. Kanzler, K., Goodie, J., Hunter, C., Glotfelter, M., & Bodart, J. (2013). From colleague to patient: Ethical challenges in integrated primary care. Families, Systems, & Health, 31, 41–49. doi: 10.1037/a0031853.CrossRefGoogle Scholar
  8. Kinman, C. R., Gilchrist, E. C., Payne-Murphy, J. C., & Miller, B. F. (2015). Provider- and practice-level competencies for integrated behavioral health in primary care: A literature review. Prepared by Westat under Contract No. HHSA 290-2009-00023I. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  9. Laabs, C. A. (2007). Primary care nurse practitioners’ integrity when faced with moral conflict. Nursing Ethics, 14, 795–809. doi: 10.1177/0969733007082120.CrossRefPubMedGoogle Scholar
  10. Nash, J. M., Khatri, P., Cubic, B. A., & Baird, M. A. (2013). Essential competencies for psychologists in patient centered medical homes. Professional Psychology: Research and Practice, 44, 331–342. doi: 10.1037/a0033106.CrossRefGoogle Scholar
  11. Nash, J. M., McKay, K., Vogel, M. E., & Masters, K. S. (2012). Functional roles and foundational characteristics of psychologists in integrated primary care. Journal of Clinical Psychology in Medical Settings, 19, 93–104. doi: 10.1007/s10880-011-9290-z.CrossRefPubMedGoogle Scholar
  12. Ramos, F., Brehmer, L., Vargas, M., Trombetta, A., Silveira, L., & Drago, L. (2015). Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil. Nursing Ethics, 22, 428–439. doi: 10.1177/0969733014538890.CrossRefPubMedGoogle Scholar
  13. Reiter, J., Dobmeyer, A., & Hunter, C. L. (2017). The Primary Care Behavioral Health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings. doi: 10.1007/s10880-017-9499-6 CrossRefGoogle Scholar
  14. Reiter, J., & Runyan, C. (2013). The ethics of complex relationships in primary care behavioral health. Families, Systems, & Health, 31, 20–27. doi: 10.1037/a0031855.CrossRefGoogle Scholar
  15. Robinson, P. J., & Rickard, J. A. (2013). Ethical quandaries in caring for primary care patients with chronic pain. Families, Systems, & Health, 31, 52–59. doi: 10.1037/a0031952.CrossRefGoogle Scholar
  16. Runyan, C., Robinson, P., & Gould, D. (2013). Ethical issues facing providers in collaborative primary care settings: Do current guidelines suffice to guide the future of team based primary care? Families, Systems, & Health, 31, 1–8. doi: 10.1037/a0031895.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Family Medicine and Community HealthUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Departments of Family and Community Medicine and PsychiatryUniversity of Texas Health Science CenterSan AntonioUSA

Personalised recommendations