10. Professional Standards of Care in Mental Health Practice
Advisory Notice: The following advisory constitutes a general discussion of the issues that may arise when a licensee provides professional services. The discussion is intended to alert practitioners to questions and concerns that they may want to consider with their legal counsel, if necessary, and is not to be construed as a directive or other requirement to take any particular action. The Advisory cannot be used as the basis for a charge of professional misconduct. The statements are generally based upon statutory and regulatory provisions relating to the practice of psychology, social work, creative arts therapy, marriage and family therapy, mental health counseling, and psychoanalysis, but are not legal interpretations of any of these provisions. The citations to the provisions are included to add clarity to the discussion.
The issue of "evidence-based" or "empirically-based" practice has recently received a great deal of attention in the mental health literature and policy statements from a variety of professional and governmental organizations have been formulated on this subject. This issue has stimulated a great deal of discussion and debate about how to define "best treatment practices" within the health and mental health professions.
The Boards for Psychology, Mental Health Practitioners, and Social Work have chosen to prepare this Practice Alert on this topic to elucidate some of the key concepts as they relate to licensed practice in New York.
The Office of the Professions licenses and regulates health and mental health professions with the aim of protecting the public and ensuring the maintenance of professional standards of care. Practitioners, not procedures, are licensed. As such, it is the professional who must ultimately exercise professional judgment based upon the person's knowledge, training, and experience in determining how to intervene with those individuals who seek assistance. A manual, data base, or research study cannot substitute for the practitioner's contemporaneous assessment of the client's needs, abilities, and functional status. Thus, best treatment practice can be viewed as an integration of the current treatment literature with the professional's judgment and experience regarding the unique factors that will impact a particular client's course of care over time. Research should inform practice, but it cannot replace professional judgment given our current state of knowledge.
Professional Standards of Care in Mental Health Practice
This Practice Alert is a general discussion of the practice issues a licensee may be faced with in those situations in which concerns about best treatment practice, including evidence based practice, vis-à-vis their professional practice are raised. Practitioners are advised that this discussion serves as a guideline not as a directive or mandate to pursue a course of action. This Alert is based on a review of professional misconduct complaints lodged against psychologists in New York State, the majority of which warranted no formal disciplinary action. However, information about some of the licensees' actions and/or inactions regarding ethical and legal standards of practice may be useful to others to avoid courses of action which may lead to complaints regarding professional standards of care.
Licensed health or mental health professionals in the State of New York are individuals who have met the regulatory requirements for licensure and provide services within their scopes of practice. The regulations governing the practice of these professions in New York set a standard of care which requires competent and adequate provision of care to the public (see Part 29 of the Rules of the Board of Regents on Unprofessional Practice and Section 6509 of Title VIII of the Education Law on Professional Misconduct). Compliance with the Rules of the New York State Board of Regents and State law is designed to promote good practice.
Practitioners should be aware of the efforts within and outside of the profession to make practitioners accountable to their clients/patients by using treatments/interventions discussed in the research literature as being effective. The concern is not new; research has been ongoing for at least 50 years.
The scientific base for the practice of health and mental health services is undisputed. Indeed those licensed to practice in New York State have met the regulatory requirements to engage in practice, which include coursework in theoretical models, research methodologies and practice models for assessment, consultation, diagnosis, and intervention/treatment, as well as having completed various supervised training requirements in the provision of these services.
There is no universally agreed upon consensus on what constitutes "evidence" in evidence based practice (e.g. case based vs. experimental studies; evidence from efficacy trials as opposed to clinical experience and expertise; process therapies which emphasize practitioner competency/skills/qualities, therapeutic alliance vs. specific techniques). All types of evidence may be important in making professional decisions.
This includes but is not limited to the following recommendations:
- As an informed practitioner, exercise professional judgment when providing professional services.
- Become familiar with the body of rules governing the practice of the professions in New York State.
- Be sensitive to professional ethics.
- Stay abreast of current issues in the health and mental health literature, especially the literature in your area(s) of expertise.
- Critically evaluate the context, including source, application, and results, of publicized findings regarding issues.
- Be aware of the issues concerning best practice, empirically supported treatments, and evidence based practice by taking courses, attending conferences/workshops, etc. to maintain continuing professional competence.
- Be aware of the usual and customary practice in an area.
- Know the boundaries of and utility of interventions chosen.
- Know the limitations/restrictions of patient characteristics as benefiting from empirically supported treatments to determine whether the recommended treatment is applicable.
- Make efforts to insure culturally competent practices which reflect knowledge of the impact of diversity on human behavior.
- Document your professional decisions about appropriate client care needs in your records, demonstrating your awareness of ethical and legal codes of professional practice.
- When you select treatments, be appropriately trained to implement these treatments competently.
- Regardless of the policies, practices or contracts with third party payers or other outside external agencies and entities, know that treatment decisions are ultimately the responsibility of the practitioner.