Ethical and Legal Guidance for Mental Health Practitioners Who Wish to Conduct Research in a Private Practice Setting

Mental health practitioners, even when they have research training, rarely contribute to the scientific literature. One reason for this may be that they need help addressing the ethical and legal issues they encounter as they contemplate undertaking research in a clinical practice setting. To address that need, we offer several types of guidance for conducting research in a private practice setting in a way that meets high ethical and legal standards. We describe the situations in which ethical review of a research proposal by a federally registered institutional review board (IRB) is legally required, and identify alternate mechanisms that practitioners can use to obtain an ethical review when a formal IRB review is not required by law. We discuss legal and ethical requirements of conducting single-case studies in a practice setting. We provide a rationale, and free and inexpensive options, for obtaining a formal certificate of training in human subjects research. And we offer guidance for obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from research participants. We conclude with a brief discussion of other legal and professional issues to consider when conducting research in private practice.     

Assessment of ADHD: differences across psychology specialty areas

Child psychologists are frequently involved in the assessment of ADHD symptoms among school-aged youth. There is limited information regarding the extent to which psychologists adhere to recommended assessment practices and whether differences exist in assessment strategies among psychologists from different specialty areas (clinical, counseling, and school) and/or who practice in different settings (university, school, or outpatient clinic). A 3 (specialty area) x 3 (employment setting) between-groups design is used wherein 230 child psychologists completed surveys regarding diagnostic practice. Psychologists differ in adherence with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) diagnostic criteria, use of clinical interviews, and type of behavior observation. Only 15% of psychologists report using multiple methods consistent with recommended standards of best practice. Differences between groups of psychologists indicate that the diagnosis of ADHD in children is influenced by the type of psychologist conducting the evaluation and the setting in which the evaluation is conducted.     

Qualitative Cancer Genetic Counseling Research, Part I: Ethnography in a Cancer Clinic

This is a report of the experience of several months' ethnographic research by a genetic counselor researcher in a cancer treatment clinic. One goal of the exercise was to directly experience a method of qualitative research known as ethnography, which relies heavily on participant-observation, in an applied clinical setting. Another goal was to explore a previously undescribed research area in the genetic counseling literature, namely, the meaning of cancer and cancer treatment for affected individuals and their support companions. Here we report on a personal account of the experiences of conducting and publishing the research. The preliminary analysis and results of this field experience are published elsewhere (Peters et al. (2001) J Genet Counsel 10(2):151–168.). These initial findings support the feasibility of genetic counselors, who are trained in specific social science methodologies, to conduct qualitative research pertinent to genetic counseling practice.This work was completed at the University of Pittsburgh before employment at the National Cancer Institute (NCI) and does not represent the views of the NCI, the National Institutes of Health, the Department of Health and Human Services, or the Federal Government     

Implementing the Boulder Model of Training in a Psychology Training Clinic

The scientist–practitioner (S–P) model of training has guided professional psychology in the United States for nearly six decades. However, since its inception, the model has been hotly debated and implementation of the model has been chronically problematic. One counseling psychologist who is working as both a faculty member and psychology training clinic director describes how scientific principles can be retained in a practice setting. He overviews the Boulder model of training, provides a brief review of the psychology training clinic (PTC), describes his current work setting and unique faculty appointment, and outlines five strategies for integrating science and practice in applied clinical settings. He also highlights how embracing the Boulder model has promoted a strong professional identity and presents the PTC as a model professional home for S–Ps.     

Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series studies, with multiple observations both before and after treatment, is that they enrich our design palette by providing the discipline another way to expand its empirical reach to practice settings and its subject matter to the contingencies of individual change. This article is a user's guide to conducting empirically respectable case-based time-series studies in a clinical practice or laboratory setting.     

A systems analysis of a failure to test the effectiveness of waiting-list group therapy.

This nonexperimental effectiveness study attempted to evaluate the utility of a brief waiting-list group. The setting was a university clinic providing treatment for an inner-city population. Health delivery and staff dynamics made it difficult to conduct clinical research in this treatment-oriented setting. The nonrandom design allowed for patient choice, with few clients attending more than two group sessions, thus decreasing its impact. Managed-care pressures decreased staff cooperation with our research objectives, resulting in very low return rates in testing and follow-up data. A social systems analysis, highlighting staff and institutional ambivalence, is used to understand the failure to adequately test the effectiveness of waiting-list group therapy. Recommendations are offered to investigators who contemplate conducting clinical research with limited resources.     

Computerized encounter registers in primary care research: Is there a gold standard?

Computer technology as well as the need to conduct research in primary care settings, has stimulated the creation in the U.S. of information networks linking private physicians' offices and other primary care practice sights. These networks give rise to several problems which have philosophic interest. One is a “numerator problem” created by the difficulty in primary care of using the more complicated or invasive diagnostic technologies commonly employed in tertiary care research. Another is a “denominator problem” arising from the difficulties in determining which and how many patients constitute the population from which a practice is drawn. Finally, this mode of research raises questions about the social construction of medical reality and how “objective” medical truth is actually based on carefully selected patient experience. All these questions combine to challenge the “gold standard” view on medical research: the idea that some sorts of medical knowledge are epistemologically privileged and can serve as a bench-mark to determine whether new data are valid.     

Guidelines for training in the ethical conduct of scientific research

Historically, scientists in training have learned the rules of ethical conduct by the example of their advisors and other senior scientists and by practice. This paper is intended to serve as a guide for the beginning scientist to some fundamental principles of scientific research ethics. The paper focuses less on issues of outright dishonesty or fraud, and more on the positive aspects of ethical scientific behavior; in other words, what a scientist should do to maintain a high level of ethical conduct in research. There are a number of fairly specific rules, guidelines, or commonly accepted operating principles that have evolved for the ethical conduct of science. In order to discuss this code of ethics, this paper is divided into sections dealing with specific areas of scientific ethics. These areas are: data collection and storage, ownership of data, confidentiality, communication, authorship, collaboration, the peer review system, and rules of dealing with ethical complaints. Illustrative case histories are presented to provide examples of the type of ethical dispute or problem being discussed. If scientific trainees learn the accepted rules of behavior that govern the conduct of science, ethical problems that arise out of ignorance, misunderstanding, or poor communication can be avoided.     

Alan E. Kazdin: Award for Distinguished Scientific Applications of Psychology

Presents Alan E. Kazdin, the 2011 winner of the American Psychological Association Award for Distinguished Scientific Applications of Psychology. "For outstanding and pathbreaking contributions to the understanding of the development, assessment, and treatment of psychopathology. Alan E. Kazdin's theoretically innovative, methodologically rigorous, and scientifically informed research has significantly advanced knowledge of child and adolescent psychopathologies such as depression and conduct problems. His writings on research strategies and methods have set a high standard for rigor in the field. His work and his ideas have had an enormous impact on the science, practice, and teaching of psychology, and his research has strengthened assessment and treatment of children and adolescents in scientific and clinical settings. His passion, energy, wisdom, and wit have inspired countless colleagues and students over the years, and his work will no doubt continue to do so for many generations to come." (PsycINFO Database Record (c) 2011 APA, all rights reserved).     

Pediatrician/Psychologist Collaboration: Opportunities for Clinical Child Psychologists

In the United States, pediatricians prescribe the majority of medications used to treat children with psychological disorders, such as ADHD. However, because pediatricians have limited background in psychology or psychiatry, opportunities exist for properly trained clinical child psychologists to assist pediatricians in assessing and treating youngsters with psychological disorders. Psychologists with additional training in psychopharmacology can make even greater contributions by helping pediatricians select and monitor appropriate medications. This paper reviews models of consultation that are especially relevant to psychologists who seek to expand their practice by consulting with pediatricians. Consultant-centered models seem most appropriate in private practice settings, but institutionally employed psychologists have opportunities to also utilize some system-centered approaches. Examples of methods in which pediatric clinical psychologists and child psychologists with psychopharmacology training can assist pediatricians in treating a child with ADHD are discussed.     

Offender interviewing in custodial settings: Understanding validity,value and veracity issues

The purpose of this scoping literature review was to identify trends regarding validity, value and veracity issues when conducting (qualitative) interviews with offenders in custodial settings. We selected for review works from electronic databases in SAGE, Springer, and Taylor and Francis by using e-journals, Google Scholar and the behavioural science database, PsycINFO. The inclusion criteria for our studies were based on whether sources addressed offender interviewing as a wellspring of information, but excluded those that focused solely on the acquisition of clinical information (at the expense of focusing on validity, value and veracity issues). We utilised the content analysis approach to identify themes/ patterns in the research findings. Key findings suggest that offenders with impression management motivations deceive and manipulate in their research interview presentations. When gathering data from inmates in custodial care settings, best practice includes cross-checking offender interview data against other sources of evidence and taking into account the context in which they are serving their sentences.     

Ethics and the Social Dimension of Research Activities

This study identifies some of the ethical issues that arise in the everyday practice of researching in collecting interactional data. A form of conceptualizing ethics in research is proposed as awareness of the social dimension of research practices and their transformative nature. The collection of ethnographic data—including interviewing, observing, audiovisual recording, and other methods—is achieved by means of social interactions that necessarily imply issues of face, relevance, appropriateness, politeness, and identity, to name a few. Research activities have an impact on both the setting and the participants in the study, in fact, they become part of the setting studied. At times, participants may be using the research activity for their own ends. It is important for researchers to be aware of and responsible for the impact they have on the setting under study. Some ethical problems encountered conducting actual research activities are discussed as an illustration: issues related to negotiation of consent in semipublic settings and to the protection of informants’ anonymity. The actual resolution of these problems is presented as research findings from the everyday practice of doing research. Systematic reflection on the social and interactional dimension of how ethical decisions are taken during actual research activities could make legislation on the protection of research participants and ethical guidelines more realistic and useful.     

Obstacles to research in residential juvenile justice facilities: recommendations for researchers

Federal, state, and local initiatives to improve the treatment and outcomes for young people in the juvenile justice system prompt the need for additional research. Despite the call for empirical data, researchers encounter numerous obstacles when initiating and conducting studies in detention and post-adjudication facilities. These obstacles are often only briefly mentioned in publications, but they can interfere with researchers' desires and abilities to conduct studies in these settings. This paper reviews legal, ethical, and methodological challenges to successfully conducting research in detention and residential post-adjudication placements, including selecting and accessing appropriate facilities, obtaining institutional review board approval, seeking parental permission and youth assent, reporting child abuse and neglect, responding to participants' threats to harm self or others, working effectively with facilities, juvenile justice system-related attrition, and the dissemination of research findings. Recommendations are presented to help investigators anticipate obstacles when designing and executing research protocols to prevent interference and to encourage ethical responses and successful study completion.     

Research in Emergency and Critical Care Settings: Debates,Obstacles and Solutions

Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words “emergency department”, “critical care”, “research”, “consent”, and “ethics” as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

Evaluation of the Effectiveness and Transportability of Panic Control Treatment in a Private Practice Setting: Acute and Long Term Effects

Effectiveness studies have demonstrated the transportability of panic control treatment (PCT) to a variety of settings. The present study examined the acute and long-term effects of PCT in a private practice setting and explored correlates of treatment outcome. Participants (69% female, mean age = 34.8, SD = 8.8 years) were 100 consecutive private practice referrals who entered treatment for panic disorder. Using intent-to-treat analyses, 72% of patients were panic-free and 44% of patients achieved high end state functioning (HESF) at posttreatment. At 1-year follow-up, 75% of patients were panic-free and 55% of patients achieved HESF. Lower levels of agoraphobic avoidance when accompanied (MI-ACM), less misinterpretation of bodily sensations, and less frequent panic attacks at pretreatment were the strongest predictors of treatment outcome at follow-up. Pre-posttreatment changes in trait anxiety were most strongly associated with treatment response. Results support PCT as an effective, durable treatment and add to the body of evidence supporting the generalizability of PCT from research to real-world service settings.     

Ethical Issues and Guidelines for Conducting Data Analysis in Psychological Research

Psychologists are directed by ethical guidelines in most areas of their practice. However, there are very few guidelines for conducting data analysis in research. The aim of this article is to address the need for more extensive ethical guidelines for researchers who are post–data collection and beginning their data analyses. Improper data analysis is an ethical issue because it can result in publishing false or misleading conclusions. This article includes a review of ethical implications of improper data analysis and potential causes of unethical practices. In addition, current guidelines in psychology and other areas (e.g., American Psychological Association and American Statistical Association Ethics Codes) were used to inspire a list of recommendations for ethical conduct in data analysis that is appropriate for researchers in psychology.     

The search for evidence: Psychoanalytic practice and the male imaginary

In this paper, I will attempt to discuss the future of psychoanalytic practice in the wake of the National Institute of Health and Clinical Excellence’s (NICE) embrace of ‘evidence’-based practice. In 2005, NICE, whose task is to regulate the provision of health care across the National Health Service, adopted positivistic evidence-based protocols as the sole proof of the effectiveness of psychotherapy. Despite the success over the past 40?years of psychoanalytic and humanistic therapies in primary care and psychotherapy departments of psychiatric hospitals, NICE insists on restricting therapy, to those who can claim effectiveness as a result of using the data from client questionnaires commonly described as ‘outcome measures’ and it has gone on to promoting new modalities many of which have been imported from the States. As a consequence, most of the provision of psychotherapy in the public sector currently, whether as part of the National Health Service or the voluntary sector, has embraced evidence-based practice’ and many training organisations are promoting it, which will, in time, have an effect on private practice. I use some of the threads of the work of the feminist psychoanalyst Irigaray and others to understand this turn to positivistic science and how it can be understood as an instance of the retrenchment of the ‘male imaginary’ and a re-installation of the values of detachment and mastery. I query whether there are some problems within current theory, practice and institutionalisation which interfere with the emergence of a more progressive psychoanalytic practice.     

Human Rights,Cultural Pluralism,and International Health Research

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.     

Four observations about “six domains of research ethics”

Stimulated by Kenneth Pimple's "Six Domains of Research Ethic", this paper examines four aspects of the responsible conduct of research and scientists' social responsibilities. I argue that scholars and decision-makers concerned with the responsible conduct of research should take notice of the rapidly growing body of scholarship on the social organization of science and the behavior of scientists, integrating that work with ethical principles. Of particular concern are the increasing heterogeneity and interdisciplinary of research, the ambivalences in the practice of peer review, the social tensions of research life, and the heightened concern for social and economic returns from federal research investments. In all, the paper echoes and develops Pimple's call for integrative thinking about the responsible conduct of research.