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By Dr Rebecca Mathews MAPS, APS Research Officer, David L Stokes MAPS, Manager - Professional Issues and Leah Collins, APS Research Assistant

Over the past 16 months the Department of Health and Ageing (DoHA) has provided funding to the APS to develop a set of practice management standards for psychologists. Practice management standards differ from competency standards: the latter focusing on evaluating the ability of professionals to undertake their role, whereas, practice management standards assess the context in which professionals provide their services. This context reflects the ethical values and expectations adopted by the profession, as well as standards and values that underpin best service delivery.

Having such standards provides a range of benefits for both psychologists and members of the public. For psychologists the benefits include the development of a common understanding and expectation of psychology service delivery, offering a baseline measure for evaluating a practice, and developing higher levels of quality and safety. For the public it means quality assurance and increased confidence in psychologists as service providers.

The development of the Private Practice Management Standards (PPMS) brings the profession of psychology in line with many other professions where evidence of such standards is required and where, in some cases, accreditation of private services occurs on the basis of compliance with these standards. A number of factors have been taken into account in the development of practice management standards for psychology that determined the content of the standards and the process of their evaluation. The following factors were considered.

  • Practice standards should be relevant to psychologists in private practice across all specialty areas and geographical locations.
  • Overlap with documents already developed by the APS, including codes of conduct and programs of professional development, should be limited.
  • Psychologists in private practice must be able to evaluate their compliance with the Standards. That is, performance on the Standards must be measurable.

The completion of this project in February 2006 led to a final set of standard areas and standards that were presented to the DoHA. Standard areas and standards are presented in Table 1. These areas were considered crucial to good psychological service delivery and are areas in which specific examples and measurable performance indicators have been identified and can be further developed.

Although for some professions management standards form part of a practice accreditation process, the primary aim for the development of management standards for psychology was the development of guidelines for best practice. Therefore, a self-evaluation, or an evaluation by a peer, was seen to be an effective alternative to a formal accreditation process. With this in mind a Self-Assessment Instrument was developed which allowed psychologists to consider their performance on each of the Standards using a set of performance indicators developed to reflect their compliance on each Standard. The Self-Assessment Instrument was designed to promote best practice management of private psychology services by introducing and describing appropriate management standards as recommendations for best practice. The document aimed to educate and motivate psychologists to improve their current management standards. A copy of the Self-Assessment Instrument will be made available to members on the APS website once approval of the final report is received from DoHA.

The development of the Private Practice Management Standards

Development of the Standards involved several phases. A search of the literature was conducted, including current management standards for other professions (health and non-health), to inform preparation of the original standard areas and standards. Within each standard area a set of specific Standards and corresponding performance indicators to evaluate each of the Standards was developed. APS members in private practice were recruited to assist in the development and validation of these Standards. The process for member feedback included a survey, piloting of the Standards in a range of private practices and ongoing consultation. In selecting members to participate in the development of the Standards it was important that the group covered the range of psychology specialties, population locations (e.g., rural, metropolitan) and Australian States and Territories. Approximately 50 APS members were invited to participate in the project. Forty-six members agreed to take part and 23 of these were assigned to the survey group and 23 to the pilot group.

STANDARD AREAS AND STANDARDS FOR PRIVATE PSYCHOLOGY PRACTICES

PPMS survey

A survey instrument was developed which included the rationale for the development of practice management standards, the six standard areas, and their associated Standards and performance indicators. Participants were asked to rate on a three-point likert-type scale whether each Standard was ‘essential', ‘desirable' or ‘irrelevant'. In addition, participants completed a five-point compliance scale allowing them to indicate to what extent they believed they complied with each standard (0%, 25%, 50%, 75% or 100%). General feedback was also sought. Twenty-two participants (9 male and 13 female) returned a completed survey.

Feedback from the survey group informed the further development of the Standards, and the development of a Self-Assessment Instrument, which included a set of performance indicators for each Standard. The Self-Assessment Instrument was piloted with a second group of psychologists in private practice for a period of six months.

PPMS pilot study

The pilot group completed the Self-Assessment Instrument at three time intervals. Two participants dropped out prior to the first assessment. At the first assessment period, 21 of the Self-Assessment Instruments were returned (100% response rate), 20 at the second self-assessment period (95% response rate) and 19 at the third self-assessment period (91% response rate). At the onset of the pilot study the group was comprised of 14 women (67%) and 7 men (33%) whose ages ranged between 31-70 years. Population classifications and State and Territory locations are presented in Table 2. The psychological specialisations represented by the pilot group are presented in Table 3.

In addition to the survey and pilot process, a consultative process occurred involving a consultative committee made up of members of the Division of Independent Professional Practice, and a number of academics teaching clinical practice, who provided feedback and final endorsement of the Standards and the Self-Assessment Instrument.

POPULATION CLASSIFICATIONS AND STATE AND TERRITORY LOCATIONS OF THE PILOT GROUP

PSYCHOLOGY SPECIALTY AREAS OF THE PILOT GROUP AT THE FIRST SELF-ASSESSMENT 

Summary of the developmental process

The results of the survey, the pilot group and ongoing consultations demonstrated that many practice management requirements identified in the Standards were already in place in many psychology services. These include standards such as the financial obligation and the physical requirements of a private psychology practice. However, other areas of practice management, such as evaluation of the service, frequently failed to meet compliance with the Standards but were readily improved once service providers became aware of the importance of maintaining the Standards. In addition, other areas showed only small improvements and may require the provision of further education and support from the APS in order to achieve compliance. Some barriers in implementing the Standards were identified. In particular, pilot group feedback indicated that some of the Standards and Performance Indicators were difficult to implement in rural or remote areas because there may be a lack of access to appropriate facilities and services.

Overall, participant responses about the PPMS were positive. Eighty-one per cent of respondents believed the concept of self-assessment to be an appropriate means for evaluating private practice management standards for psychologists. Suggestions for alternative assessment methods were made by participants including an accreditation process by an independent assessor, and a set of criteria specific to rural and remote practices. Ninety-four percent of respondents believed it worthwhile for the APS to initiate a private practice accreditation program.

Conclusions

The APS believes the final set of Standards and corresponding performance indicators are appropriate, effective and workable in a psychology private practice setting and have made a number of recommendations to DoHA regarding the further development of the Standards. Recommendations include:

  • Involvement of the Psychologist Registration Boards needs to occur in any implementation of the Standards to ensure that the Private Practice Management Standards (PPMS) reach the entire psychology workforce and become the expected standard of service provision.
  • The guidelines should be developed into an information booklet and a self-assessment instrument and made readily available to psychologists.
  • Promotion of the PPMS for Psychologists should occur through APS communications such as InPsych and the website. Marketing beyond the scope of the APS membership to support consistency across the psychology profession is needed.
  • Educational modules and training workshops on the PPMS should be developed as either face-to-face or web-based interactive presentations.
  • There should be an additional review of the Standards to ensure that they are achievable in rural and remote areas For example, a set of essential, non-negotiable Standards may be identified that are considered applicable to all serviceproviders (e.g. privacy and confidentiality), while additional Standards, applicable to urban and regional areas specifically, may be identified and act as an adjunct to the essential Standards of practice.
  • The Standards should be reviewed and updated at least every five years. This will take into account changes in legislative requirements and professional practice issues that impact on psychology services.

We hope that in the coming months the Self-Assessment Instrument will be made available to members and will be seen as a valuable resource to be used as both a guide in the development of a private psychology service and an evaluation of current management practices.