Best Practice Parameters Promotes Good Practice and Stimulates Discussion Within Trauma Community

Elana Newman, Tulsa, Oklahoma, USA

At the midyear meeting in Stockholm in June, the ISTSS board of directors approved the dissemination of the best practice parameters. These parameters address current ideas about best practice in implementing trauma-focused clinical and organizational interventions, research, teaching and training. They are not a binding code but intended as a means to provide guidance and suggestions to trauma professionals regarding their work in the field. These guidelines, posted on the members section of the ISTSS Web site, are meant to promote the welfare and autonomy of those who receive clinical services or participate in trauma research. The major principles underlying these parameters are the values of avoiding harm and maximizing positive outcome in all contexts. Other related values include protecting the dignity of the trauma survivor in every context and creating practices that promote choice and control, whenever possible and appropriate, among survivors and professionals as a counterpoint to lack of choice often inherent in exposure to traumatic life events.

In 2000, the ISTSS board of directors commissioned a task force to formulate best practice parameters that would promote good practice and stimulate discussion and exchange of information within the traumatic stress community. These practice parameters were reviewed, critiqued, edited and improved upon by individual board members, pro bono legal counsel and ISTSS members (both at a conference presentation in 2003 and via the Web in February-March 2005). Task force members who worked on these guidelines at various points include Lucy Berliner, Eve Carlson, Jon Conte, Christine Courtois, Constance Dalenberg, Steve Frankel, Danny Kaloupek, Elana Newman (chair), Jane Perrin, Anne Pratt and Mary Beth Williams.

Questions Asked About Best Practice Parameters

• Aren’t these repetitive with other practice guidelines and codes? Why bother? These parameters were written to reflect the varying situations and diversity of our members’ professional and volunteer roles in the field of traumatic stress. As many members commented, these practice parameters are consistent with most European and North American countries’ medical ethical codes and mental health professional societies or licensing codes, though the ISTSS parameters have a bit more emphasis given toward trauma-specific issues. Although many of our members are licensed or accredited by these bodies, a good number of members may not be—hence, the need for practice parameters was deemed important.
   
• Why not make an enforceable code? Very few scientific organizations investigate or adjudicate ethical issues because enforceable practice parameters open the society to great administrative and legal costs. Given that ISTSS is not a credentialing society and members represent diverse fields throughout the world, an enforceable code is not viable. The parameters’ tone encourages professionals to engage in the best practice possible but not to dictate a particular practice perspective. These parameters can help educate and engage with others but will not be enforced because they are not a code.
   
• Why not provide specific comments on forensic work? Two members suggested a specific section on legal issues. Given the international context and multidisciplinary nature of ISTSS membership, this is not viable now.

What next? ISTSS will review these parameters in the future and update as needed. For now, the parameters will serve as a continued catalyst for improving trauma-related practice and continue open dialogue about how best to serve the field. Share this information with colleagues.

Several members wanted more emphasis in human rights, forensics, conflict of interest, and client access to records in the parameters. Though the parameters did not emphasize all of these issues, the ISTSS task force encourages members to continue this discussion by writing articles about these topics for StressPoints, and discussing and engaging in debate about these issues at conferences, in Special Interest Groups and in e-mail groups. Raise your concerns and perspectives with colleagues so that ISTSS members can assist one another in promoting and improving best practice in the field.

View the Best Practice Parameters on the members section at http://www.istss.org/source/Pages/uViewPage.cfm?section=unknown&Page_Num=27.

Elana Newman is associate professor of psychology at the University of Tulsa and the new president-elect of ISTSS.