Ethical Challenges in the Provision of Stepped Care for Eating Disorders in the United States: Current Status and a Guiding Framework for Clinician Implementation.

Regardless of their specialty, psychologists in the United States are likely to encounter patients with eating disorders (EDs) in their everyday professional practice. Though specialized ED treatment is recommended, individuals with EDs frequently present to non-ED specialists, which necessitates the provision of accessible pathways to integrated, evidence-based ED treatment within the stepped-care model. Although stepped care is designed to prioritize efficiency and patient autonomy, economic factors related to the U.S. health care system and limited availability of information for practicing psychologists severely complicate accessibility. The purpose of this article is to (a) review structural- and individual-level challenges that psychologists are likely to experience when providing ED treatment and referrals and (b) provide practicing psychologists with recommendations for ethical implementation and delivery of stepped ED care. These recommendations are rooted in the guiding principles of the American Psychological Association's Ethics Code, namely, (A) beneficence and nonmaleficence, (B) fidelity and responsibility, (C) integrity, (D) justice, and (E) respect for people's rights and dignity (American Psychological Association, 2017), and are organized into a practical tool to aid in decision making. By applying these recommendations in everyday practice, both generalists and specialists can enhance their ethical decision making in the interest of their patients with EDs. A nonexhaustive list of resources for guidance on ED care, insurance navigation, and referral-making is also provided. Public Significance Statement: This article explains the ethical challenges that practicing psychologists in the United States face when helping patients with eating disorders to access the type of treatment they need. The article also provides a tool that psychologists can use to help them make ethical decisions with their patients while facing these challenges. [ABSTRACT FROM AUTHOR]