“the right to be heard” consumer and practitioner rights regarding complaints about health and...
TRANSCRIPT
“The Right to be Heard”Consumer and practitioner rights regarding complaints
about health and social services
Deborah Sauvage (BArts, BSocWk (Hons))
PhD Candidate, School of Human Services and Social Work, Griffith University Brisbane Australia
Social Work Social Development Conference 2012: Action and ImpactStockholm, Sweden
Theme: Human Rights and Social EqualityWednesday 11th July 2-3.30pm
Overview
• Social Work values are oriented towards actions which improve health and wellbeing.
• Yet, if we were able to audit all of the services provided internationally in the history of our profession, we would find that a proportion of our actions and those of other health services have been problematic, and/or caused harm.
• In such cases, our identity, and regulatory structures must grapple with the ultimate human right – the right to complain, to protest, and be heard, and responded to.
Trust and integrity in helping professions
• “There is a long-standing tradition dating back as least as far as the Hippocratic Oath, that the integrity and trustworthiness of the practitioner is assured by the profession and can be assumed by the consumer/client”
(Gabriel, 2005, p.73)
Natural Justice – a Human Right?
• Natural justice, or “the right to be given a fair hearing and the opportunity to present one’s case…and a decision by an unbiased decision maker” is not assured for all in a semi-regulated industry.
(AASW 1999, p.28)
An Australian research study
Project Title: “Decision making about complaints regarding counselling, psychotherapy and casework:
individual experiences in a semi-regulated industry”
• An under-researched area in Australia and other parts of the world.
• Conducted by Phd student Deborah Sauvage from Griffith University, Brisbane.
• Exploratory, qualitative study using Interpretive Phenomenological Analysis (IPA) method
• focused on decision making experiences regarding complaints about counselling, psychotherapy and casework in Australia.
The research questions
Three research questions were asked:-
1. How do complainants, respondents and third parties describe, reflect on and understand their past experiences of decision making processes regarding complaints about counselling, psychotherapy or casework?
2. What do the perspectives and experiences of complainants, respondents and third parties indicate about dynamics of structural and relational power associated with complaints about counselling, psychotherapy or casework?
3. What specific changes need to be made by the industry to effectively address the needs of various parties involved in complaints about counselling, psychotherapy or casework?
What were the complaints about?
• The terms ‘counselling’, ‘psychotherapy’, ‘therapy’, and ‘case work’ were defined broadly for the purposes of this research. Although there are models which clearly and meaningfully differentiate these activities in theory and practice, for many consumers, it is difficult to define where counselling, therapy, and casework, begin and end.
• Therefore, for the purposes of this research, complaints were regarding the conduct of a range of qualified or unqualified practitioners who represented themselves in a ‘helping’ role that was perceived as counselling, psychotherapy, or casework, which involved interpersonal interaction from a position of expertise and power and which invoked trust.
• …where harm was alleged to have occurred.
What types of allegations?
• Confidentiality and privacy breaches• Inability to provide file records needed for sexual
assault court proceedings• inaccurate medico-legal reports – child custody,
adoptions • false repressed sexual abuse memory therapy• sexualised conduct, sexual relationships• Creation of dependence/over-servicing• Mind control and coercion (advice to sever
relationships, stop taking medications etc) • inappropriate mental health care• induced fatal psychosis due to psychologically
damaging extreme activities in group programs• Induced psychosis – unskilled regression• failure to prevent assault of client by another client
of the service during program• Inappropriate massage of client with history of
severe sexual abuse• incompetent practice – favouritism which resulted in
punitive outcomes for clients e.g. eviction• Complaint from client displaying multiple
personalities- stating symptoms worse after treatment
• Demeaning language/use of name
• inappropriate personal boundaries with clients• rape after administering prescription drugs• rape and assault while client in custody• Neglect, physical and sexual assault while in
institutional care• smoking marijuana with clients• supplying alcohol to minors who were clients• Negligent casework resulting in death/abuse of
minors in care• Taking sides with one party in couple therapy – not
addressing psychological abuse• Sexual relationships with prisoner clients• Sexually provocative standard of dress• Writing assessment reports for those related to
practitioner• Romantic relationship with father of child client• Quoting bible scriptures as method of grief
counselling• Representing self as psychologist when not
registered• negligent record keeping• culturally inappropriate/racist practice
What occupations were complained about?
The occupations complained about included:- • Case Worker • Counsellor • Family Therapist • Group Program Facilitator • Relationship Counsellor • Pastoral Counsellor• Psychoanalyst • Psychiatrist • Psychologist • Psychotherapist • Self Development Counsellor • Social Worker • Team Leader • Therapist • Youth Worker
Participants had made decisions regarding between 1 and many thousands of complaints (for some Complaint Managers this was over a 20 - 30 year career).
Where were participants located?
• Participants were interviewed from four of the seven Australian States and Territories, and from a
range of occupations, organisation types, qualifications and /or training. • To protect anonymity, demographic information about participants is not provided.
• Pseudonyms are used, all occupation and organisation names are replaced with de-identified generic terms - “practitioner”, “formal complaint body”, ‘informal complaint process” etc.
Who participated?
0
5
10
15
Number of Participants N = 22
Third PartyComplainant
RespondentPractitioner
Complaint Manager
• Twenty-two participants were interviewed, 6 Third-Party Complainants, 5 Respondents and 11 Complaint Managers.
• These interviews produced 330,000 words, or 460 pages of data, which was coded into themes and recommendations.
• The main perspective on decision making represented in the data was Complaint Managers (50% of data).
Key themes in decision making
1) Expectation Management - “constant re-evaluation of what is presumed, reasonable or possible”
2) Impact - Psychological Trauma – “lasting substantial distress and harm”
3) Cultural, Relational and Structural Power Dynamics- “influence through accepted norms, within relationships and within structures of authority”
4) Futility and/or Fatalism– “useless in achieving the required purpose” - “no control and no point”
5) Interpersonal Champions and Sources of Sanctuary- “those who hold clearly superior interpersonal skills”- “a protected space or refuge”
6) Depersonalising the personal- “striving for neutrality”
7) Subjective Lenses - “beliefs and experiences, not a fixed external reality”- “a filter used to form a view and focus on particular features”
Research Findings
The key themes in the findings from the study related to:-
1. IMPACT
2. POWER - 1) Cultural 2) Relational 3)Structural
3. NEEDS
Impact
Complaints had considerable, often underestimated impacts on those involved
Major themes
1. Layering of Psychological, Interpersonal and Systemic Trauma
2. Costs Risks and Barriers
3. Emotions
4. Expectation Management
5. Futility and Fatalism
Exceptions
7. Learning and Growth
Power – 1) Cultural Power
Cultural power, (norms and accepted practice) was the major theme in findings regarding power, as expressed in the following sub-themes:-
Major themes
1. A history of a lack of robust accountability
2. Un-owned power
3. Low ethics literacy
4. Avoidant and adversarial approaches to conflict
5. Dehumanisation and disempowerment
Exceptions
1. Examples of constructive, functional responses to complaints
Power - 2) Relational Power
Relational power was revealed as another major form of power involved in complaint matters:
Major themes
1. Grooming and breaches of relational boundaries
2. Relational strategies to survive conflict
3. Relational safety and modes of communication
4. Relational support from family, friends, supervisors, others
Power – 3) Structural Power
Structural power dynamics had a significant impact on complaints:
Major themes1. Problematic management supervision and lack of resources2. Disempowerment associated with client-hood3. Untimely responses to complaints4. Narrow focus for assessment and gatekeeping5. The power of status, credibility6. The power of legal roles and protocolsExceptions7. Examples of strategies to address structural power imbalances
Needs
Participants expressed a range of needs in relation to dealing more effectively with complaints:
Major themes1. Legislated jurisdiction/accountability2. Increased ethics literacy3. Specialist not generalist knowledge, roles and resources4. Interpersonal champions and sources of sanctuary5. Dedication to a humanized approach6. Neutrality and impartiality, not depersonalisation7. Conditions for restoration, reparation, growth and learningExceptions8. Unclear how to meet needs9. Risks of over regulation
Reconceptualisations and Reforms
• Clearly the social work profession and other health professions hold considerable power to help, and also to harm
• Our professional values need closer inspection – complexities around our conceptualisations of client self determination and autonomy and client consent.
• More explicit management of power is needed
• A human rights approach, congruent with anti-oppressive practice, requires legislators and leaders to ensure there is a right to be heard for complainants as well as respondents
Recommendation 1
1) Effective legislation is required
Recommendation 2
2) Specialist knowledge and training is needed to manage complaints
Recommendation 3
3) Clear complaint management roles must be defined and resourced
Recommendation 4
4) A humanized, ‘enquiry’ approach is better
Recommendation 5
5) A range of elements are needed in each unique case
Elements recommended for complaint management
Protocols to effectively assess
and manage vexatious
complaints
Specialised knowledge and independence of
those who hear and sanction
A problem solving approach not just a ‘breached or not’
approach
Flexible, contextual
‘enquiry’ approach rather than
‘investigation’ Public awareness of cases/ risks -
Ethics literacy for practitioners and
consumers
Accessible information re:
complaint avenues and practice
standards
Non-therapeutic care within support
networks
TherapeuticSupport - specialist
skills required
Advocacy role - specialist support
with preparation of complaint /
responses to complaint
Legislative jurisdiction
- Power to hear, supervise,
rehabilitate, sanction, protect
public
Elements recommended for complaint management
More information?
Contact:-
Deborah Sauvage
Griffith University
Brisbane Australia
Thankyou for listening…