Small town living: Unique ethical challenges of rural pediatric integrated primary care

Jaques-Leonard, M. L., et al. (2021).

Clinical Practice in Pediatric Psychology,

9(4), 412–422.

https://doi.org/10.1037/cpp0000339

Abstract

Objective: The objective of this paper is to address ethical and training considerations with behavioral health (BH) services practicing within rural, integrated primary care (IPC) sites through the conceptual framework of an ethical acculturation model.

Method: Relevant articles are presented along with a description of how the acculturation model can be implemented to address ethical dilemmas.

Results: Recommendations are provided regarding practice considerations when using the acculturation model and the utility of the model for both established BH practitioners and trainees.

Conclusions: Psychologists integrated into rural IPC teams may be able to enhance their ethical practice and improve outcomes for patients and families through the use of the acculturation model. Psychologists serving as supervisors can utilize the acculturation model to provide valuable experiences to trainees in addressing ethical dilemmas when competing ethical principles are present.

Impact Statement

Implications for Impact Statement: By addressing ethical dilemmas through an acculturation model, psychologists may prevent themselves from drifting away from American Psychological Association ethical principles within the context of a multidisciplinary team while simultaneously providing valuable learning opportunities for trainees. This focus is particularly important in rural settings where access to specialty care and other resources are limited, and a psychologist may be the only licensed behavioral health provider on a multidisciplinary team.

Pediatric Emergency Department Visits for Psychiatric Care on the Rise

American Academy of Pediatrics
News Release
Published: October 14, 2011

BOSTON – Pediatric patients, primarily those who are underinsured (either without insurance or receiving Medicaid), are increasingly receiving psychiatric care in hospital emergency departments (EDs), according to an abstract presented Friday, Oct. 14, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status, and type of care received, from the National Hospital Ambulatory Medical Care Survey, between 1999 through 2007. The study, “Disproportionately Increasing Psychiatric Visits to the Pediatric Emergency Department Among the Underinsured,” found that over eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8 percent were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4 percent in 1999 to 3 percent in 2007. The underinsured group initially accounted for 46 percent of pediatric ED visits in 1999, growing to 54 percent in 2007.

The results of this study are important for several reasons. First, the data show that, as anticipated, psychiatric visits by children to emergency departments continue to increase in number and as a percentage of all patients being seen in emergency departments, said lead study author Zachary Pittsenbarger, MD. “A second, and more novel finding, is that one group in particular is increasing beyond any other socio-demographic group, and that is the publicly insured.” he said.

“It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized,” Dr. Pittsenbarger said. “This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”

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The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit www.aap.org.