Ethical and Legal Issues in Integrated Care Settings: Case Examples From Pediatric Primary Care

There is a growing recognition that integrated primary care (IPC) services can address longstanding sociodemographic disparities in access to and utilization of behavioral health services. At the same time, there has been increasing attention to the complex ethical and legal considerations that can emerge for psychologists working in these interdisciplinary settings. There are challenging ethical dilemmas that arise when providing services to youth and their caregivers involved in IPC services. Unfortunately, although some ethical guidelines and case illustrations relevant to IPC are available, very few focus on the pediatric IPC context. The purpose of this article is to examine salient ethical and legal dilemmas that may emerge in pediatric IPC practice. These issues are examined through the use of 4 case illustrations that collectively address issues related to consent for services among pediatric populations, confidentiality, scope of practice for the pediatric IPC psychologist, and multiple relationships. We apply an adapted ethical decision-making framework (Kanzler, Goodie, Hunter, Glotfelter, & Bodart, 2013) to highlight practice points drawn from each of these cases. Throughout this article, we reference the American Psychological Association’s 2010 ethics code and 2015 guidelines for primary care practice competencies, while highlighting clinical practice points and directions for future research. We also discuss similarities and differences between the American Psychological Association (APA, 2010) and American Medical Association (AMA, 2012) ethics codes and standards of care.