How to keep 'innovative practise to aid engagement' safe

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How to keep 'innovative practise to aid engagement' safe

Post by maven » Sun Sep 14, 2008 9:38 pm

I've had a few interesting conversations over the last few days about the difference between innovative practise to help engage hard to reach client groups and the kind of issues thrown up as malpractise when service users make complaints to regulatory bodies.

The context

There are incrasing moves to take therapy out into the community to engage 'hard to reach populations' such as drug users, new young mothers, ethnic minorities, care leavers, those involved in gang culture, etc who might not make it into traditional CMHT, CTPLD or CAMHS. Psychologists are now involved in more innovative projects to help engage those who traditional services miss, and that means doing sessions in the community - in clients' homes and local centres, in cafes and shopping centres. Some projects are also based around the interests of clients - music, dance, art or crafts, technology, etc. But this way of working seems less 'safe' than the traditional session in a health centre. So how can we embrace this new culture whilst keeping ourselves safe professionally?

The question

I've been asked "how can it be safe to go and play pool or have a McDonalds with a client, or go into the shopping centre with them to face a social phobia, when there are malpractise reprimands from the BPS for cases like Andrew Walton who met a client in a pub?"

I do think there are some key points to differentiate the two.

Good practise to engage clients:

- is done with forethought and planning
- is agreed with your supervisor
- gives consideration to appropriate boundaries
- is based on the client's preference
- is managed in a way that makes the client feel safe and in control
- is done in a way that the location aids the treatment, or at least does not impair it
- is offered as part of an agreed protocol (these are normally inherent to the service if the target population are clients who have not been able to access conventional treatment settings

It would be likely to be considered malpractise if:

- any alcohol was consumed by either party (even more so with any form of drugs)
- the client was invited to the home of the therapist (with the exception of visiting consulting rooms within the home of a therapist in private practise, which are used and insured for the purposes of treatment) or the client was invited to non-treatment related social events in the private life of the therapist
- there was any sexual content to the relationship between therapist and client (eg flirting, touch that could be interpreted as inappropriate, removal of clothing, etc)
- the setting was chosen by the therapist for their own convenience, particularly if it was not suitable for therapy (eg if the client wished for privacy, but the therapist chose a public place)
- the therapist bought gifts for the client or gave them money*, or if they solicited money or gifts from the client, or entered into any business with the client (eg sold or bought items, rented property, entered into a contract, etc).
- the arrangements were kept secret from the supervisor and/or employing organisation of the therapist (or even worse, the client is asked to keep any aspect secret)

Its common sense really when you think about it, but I hope that this wiki helps get people thinking. Please do add any further content that would expand this topic.

*the rule of thumb with accepting gifts is that to be accepted by an individual clinician they must be worth less than five pounds and be ephemeral in nature (eg a card, flowers, chocolates, something home made without monetary value). Apart from this it could be something donated to the service as a whole, which is done via official channels (eg providing toys for a children's play area, redecorating a waiting room, fundraising for new materials). A clinician must never accept a gift that has any financial value, eg an item of jewellery, money, a DVD, etc.

Note: If you have a suggestion about how to improve or add to this wiki please post it here. If you want to discuss this post please post a new thread in the forum. There is information about the structure, rules and copyright of the wiki here.

Content checked by qualified Clinical Psychologist on 25.6.16

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