1. Session # D3A
Friday, October 11, 2013 – 3:30- 4:10 (40 minutes)
The Four Box Approach to Resolving Ethical Dilemmas in Primary Care Behavioral Health Practice
Christine Nicole Runyan, Ph.D., ABPP,
University of Massachusetts Medical School
Jeffrey T. Reiter, Ph.D., ABPP,
Health Point Clinics, Seattle, WA
Patricia Robinson, Ph.D.
Mountainview Consulting Group, Inc., Zillah, WA
Collaborative Family Healthcare Association 15th Annual Conference
October 10-12, Broomfield, Colorado U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
I/We currently have or have had the following relevant financial relationships (in any amount) during the past 12 months:
Book royalties: New Harbinger
Book royalties: Gilford
Book royalties: Springer
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest.
Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. Objectives Participants will be able to
Name ethical dilemmas that occur somewhat often in delivery of PCBH services
Describe and apply the four box method as a model for considering ethical dilemmas using case studies
Practice using the four box model in small groups with their own ethical scenarios
Include the behavioral learning objectives for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. Common Ethical Dilemmas in Delivery of Primary Care Behavioral Health Services
The Context makes a difference: Specialty vs PC
The Model makes a difference: Specialty Psychotherapy vs PCBH
See Handout: Table 1

5. Ethical Guidance AMA APA, AASW
Family Systems and Health Special Issue, March 2013
Jonsen, Siegler, & Winslade (2002). Clinical Ethics, Fifth Edition

6. The Four Boxes or Four Topics Method: Case Analysis / Four Topics
I. Medical Indications
II. Patient Preference
III. Quality of Life
IV. Contextual Features
See Handout: Table 2

7. Skill Practice Review Case
Use Four Boxes / Topics to assess for ethical issues and identify a course of action
Report to large group in 10 minutes:
Case description
Key Box / Topic
Ethical Issue(s)
Recommended Course of Action

8. Learning Assessment
What is the name of a practical tool that members of the PCMH may use in making ethical decisions arising in the course of delivery of PBCH services?
The Four Box Tool (or Four Topics Method)
(Jonsen, Siegler, & Winslade)
Name one common ethical quandary in primary care behavioral health practice.
Multiple relationships, patient autonomy, confidentiality
Attention Presenters:
Please incorporate 3-5-minutes of audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

9. Session Evaluation Thank you!
Please complete and return the evaluation form to the classroom monitor before leaving this session.
Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference