Implicit Values in Clinical and Training Contexts

 

Eliciting implicit values is a key component of clinical work and training in values-based practice. As such it is a common theme running through the four skills areas of values-based practice

Raised awareness of values is explicitly about eliciting values that are to a greater extent or lesser extent outside our everyday awareness

  • Reasoning about values is aimed at ‘expanding our values horizons’
  • Knowledge of values seeks to draw on research and narrative evidence of the values likely to be in play in a given kind of situation
  • Communication skills include skills for eliciting values notably that most consistently neglected values category, strengths (the StAR values of Strengths, Aspirations and Resources)

The training manual, Whose Values? A Workbook gives many suggestions and worked examples of ways of eliciting values through each of these skills areas either separately or (as they are best used in practice) together.

The extended case histories of Essential Values-based Practice (chapters 4 – 7) provide illustrations the importance of these skills clinically including the impact of raised awareness of clinicians’ own values (in values-based practice ‘clinician’s values matter too’).

Kim Woodbridge-Dodd’s work with a Home Based Treatment Team

A powerful example of the importance of raising awareness of implicit values is provided by a training session run in the early days of values-based practice by Kim Woodbridge-Dodd with a Home Treatment Team working in East London.

The team in question had established what they believed was a patient-centered approach to their work. This was their shared explicit value. When they heard about the work on values then being developed at the Sainsbury Centre for Mental Health they approached Kim (as the first author of Whose Values?) through the Centre about providing them with training in values-based practice.

From Explicit to Implicit Values with the Team

Kim agreed but said she would like to start by sitting in on one of their routine case review meetings to hear more about their work and how they went about it. As the meeting progressed Kim noted for each comment as it was made, its content (what the comment was about) and the perspective from which it was made (did it reflect the perspective of a team member, of the patient, or of a carer).

Frequency of Perspective
The results came as a considerable surprise to the team when Kim fed them back in their first training session. Despite the team’s explicit commitment to a patient-centered approach the comments in the case review meeting came very largely from the perspective of team members. Second came carers’ perspectives. Last and almost zero came comments that reflected patients’ perspectives.

Subject frequency
The content of the comments similarly was heavily weighted to the priorities of the team with medication and symptoms topping the list while issues like accommodation and money came right at the end. This is important for patient-centered care since it had been known (at the time) for over a decade from the ground breaking work of the sociologist David Pilgrim (see below), that what matters to people with mental health issues is not medication and symptoms but practical day-to-day issues including accommodation and money.

The surprise felt by the team when they saw how different their implicit values were from their explicit commitment to patient centered care provided a powerful springboard for their subsequent training in values-based practice.

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