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SA Journal of Industrial Psychology
On-line version ISSN 2071-0763
Print version ISSN 0258-5200
SA j. ind. Psychol. vol.37 n.1 Johannesburg Jan. 2011
Discourses regarding ethical challenges in assessments - Insights through a novel approach
Madia M. Levin; Anne Buckett
Department of Industrial and Organisational Psychology, University of South Africa, South Africa
ORIENTATION: From a pragmatic approach, a novel method called 'the town hall focus group' was utilised to provide insight into discourse regarding ethical issues in psychological assessments. This article contributes to the understanding of the practice of ethics in assessments and suggests the use of this particular method to facilitate discourse regarding ethical issues.
RESEARCH PURPOSE:To illustrate a forum where ethical discourse can occur in a practical fashion in order to deal with the diversity of situations, questions, demands and responsibilities experienced by psychologists.
MOTIVATION FOR THE STUDY: Although codes and guidelines on assessment exist, many psychologists feel that despite the existence of ethical beacons, they are often faced with challenges for which no obvious solution is evident. A need exists for ethical discourse by which psychologists grapple with unique situations through an active dialectical process.
RESEARCH DESIGN, APPROACH AND METHOD: A qualitative research approach was employed using the town hall focus group. The study was conducted with a convenience sample of 108 psychologists and practitioners.
MAIN FINDINGS: The town hall focus group method provided an opportunity and platform for ethical discourse regarding the ethical challenges experienced by psychologists.
PRACTICAL/MANAGERIAL IMPLICATIONS: This article contributes to the understanding of the practice of ethics in assessments by illustrating a platform for ethical discourse regarding ethical issues experienced in assessments. The town hall method appears to be valuable as it provides a forum to discuss ethical challenges where members are allowed to share their experiences and thus gain access to peer support, insight and shared resources.
CONTRIBUTION/VALUE-ADD: Although the focus group results are not transferable, this article proposes it as a useful method contributing to the understanding of the ethical issues and challenges experienced in assessments. The novel method applied and described facilitates peer discourse regarding ethical challenges. This method could be replicated and applied in other contexts as a means of contending with ethical challenges within a supportive environment.
Psychologists and practitioners are often confronted with unique situations and may struggle with ethical challenges (Barnett, Behnke, Rosenthal & Koocher, 2007). Within this context, there exists a need for discourse around ethical challenges in order to deal with the diversity of situations, questions, demands and responsibilities. Although ethical beacons, codes, guidelines and conventions exist, they cannot do our questioning and responding for us since ethics is frequently perceived as a grey area where there is little certainty about what is right or wrong, and as such can never be a substitute for the active process by which a psychologist struggles with unique contexts and competing demands (Pope & Vasquez, 1998).
The ethical challenges discussed were derived from a review of literature and presented to participants in a town hall focus group set-up (Zuckerman-Parker & Shank, 2008). Participants were asked to discuss the challenges and reflect on the value of the discussion. Although the ethical challenges recorded were not evaluated against the various codes of practice, this article contributes to the understanding of the practice of ethics in assessments through continuous discourse by illustrating a platform for discussion regarding ethical issues and the value gained from the experience of such a discussion as well as the discussion itself. One may argue that the experience of perceived challenges may be as a result of ignorance of the various codes or due to the complexity of the situation and further research involving critical evaluation of the findings may be valuable to gain insights into the challenges experienced by psychologists and practitioners.
This article proposes that the method described is a novel platform, which facilitates peer discourse regarding ethical challenges and demonstrates the usefulness of this method to acquire rich data whereby an understanding of ethical challenges in assessment can be enhanced. This article contributes to the understanding of the practice of ethics in assessments by illustrating a platform for discourse regarding ethical issues experienced in assessments. The town hall focus group method appears to be valuable, as it provides a forum to discuss ethical challenges where members are allowed to share their experiences and thus gain access to peer support, insight and shared resources.
A review of literature
Ethics is frequently perceived as a grey area where there is little certainty about what is right or wrong. Barnett et al. (2007, p. 7) observe that psychologists are often faced with a variety of ethical challenges for which no obvious solution is evident. Although ethical beacons such as Annexure 12 of Regulation 717 of the Health Professions Act (South Africa, 56/1974), the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2002), the Code of Practice for Psychological and Other Similar Assessment in the Workplace (Society for Industrial and Organisational Psychology of South Africa, 2006), the Guidelines and Ethical Considerations for Assessment Centre Operations (International Task Force on Assessment Centre Guidelines, 2009) and the Guidelines for Assessment and Development Centres in South Africa (Assessment Centre Study Group, 2007) serve as guides showing the path, these do not provide clear-cut answers for addressing ethically challenging situations. Pope and Vasquez (1998, pp. 17-18) state that ethics codes cannot do our questioning and responding for us and as such can never be a substitute for the active process by which a psychologist struggles with unique contexts and competing demands. Within this context, there exists a need for discourse around ethical challenges. Ethics and ethical discourse must be practical in order to deal with the diversity of situations, questions, demands and responsibilities.
Industrial and organisational psychologists apply the principles of psychology to issues related to the work situation in order to optimise individual, group and organisational well-being and effectiveness and as such aim to understand, predict and influence human behaviour within the context of the work environment (Dworkin, Van Vuuren & Eiselen, 2010; Health Professions Council of South Africa, 2011). It is this application of psychological services that sets industrial psychologists apart from other categories of psychologists. Industrial and organisational psychologists may face ethical challenges in the business and organisational environment where conflicting interests have to be juggled, such as the rights of an incumbent being assessed and the rights of the organisation considering employing him or her. Unethical behaviour is often individualised but the organisation for which an individual works can often have a constructive or corruptive influence on moral character, and although there are guidelines for managing third-party relationships regarding psychological services, psychologists may be challenged by unethical behaviour in organisations (Rossouw & van Vuuren, 2010).
Psychologists often find themselves engaged in supplying assessment and consulting services where the client may be an organisation, but the effects of the psychologist's work may have rippling consequences that affect many individuals' lives profoundly (Koocher, 2009, p. 99). The psychologist often has little control over the management of results after the assessment had taken place and feedback had been given (Koocher, 2009). Practicing psychology is built on perceived competence, professionalism and trust. Whenever a member of the profession makes him- or herself guilty of or is involved by association with unethical, irresponsible or unprofessional conduct, perceptions are changed regarding the inviolability of the profession. All other members are affected and their ability to function in a professional manner is impeded (Swanepoel, 2010).
Ethics is 'concerned with that which is deemed acceptable in human behaviour, with what is good or bad, right or wrong in human conduct in pursuit of goals and aims' (Reber & Reber, 2001, p. 251). Applied ethics is a discipline of philosophy that attempts to apply ethical theory to real-life situations. Within this context, business ethics is defined by the King II report (Institute of Directors in Southern Africa, 2002) as the principles, norms and standards that guide the conduct of an organisation's (or individual's) activities and interactions with internal and outside stakeholders. Professional ethics concerns the moral issues that arise because of the specialist knowledge that professionals attain, and how the use of this knowledge should be governed when providing a service to the public (Chadwick, 1998). The issue many industrial and organisational psychologists experience as specialists applying their knowledge in a business environment is that moral prescriptions cannot always be applied mechanically to resolve ethical issues (Cascio & Aguinis, 2005). A need exists for ethical discourse by which psychologists grapple with unique situations through an active dialectical process. Watson, Buchanan, Campbell and Briggs (2003) comment that unfortunately, ethical behaviour is often reduced during discussions as if it were charity rather than necessity.
Previously published ethical challenges include the misapplication of assessment results by an organisation after such an assessment had been conducted by the psychologist and the management of how the assessment results are being used by clients. Issues related to confidentiality, such as discussing candidates 'in the corridors', may well affect how assessors rate the candidates in subsequent assessments. Effective and proper training with regard to both conducting assessments as well as ethical practice is another issue, which may include how to deal with untrained managers who believe they are competent to conduct assessments. In addition, technology, language and culture have long since been contentious issues in assessments (Caldwell, Thornton & Gruys, 2003; Dworkin et al., 2010; Foxcroft, 2002; Howard, 1997; Knapp, Gottlieb, Berman & Handelsman, 2007; Koocher, 2009; Lievens & Thornton, 2005).
The core research problem of this article relates to the fact that psychologists are expected to act ethically and to preserve the welfare and rights of those affected by their actions especially when conducting assessments (Koocher, 2009, p. 98). When inconsistency is confronted, psychologists may proactively seek to resolve these problems while trying to avoid causing injury. However, sometimes psychologists must reactively attempt to mitigate harm resulting from their work, whether as a result of immoral conduct or certain ethical moderators.
The objective of this article is to focus on five such challenges, namely, (1) the (mis)application of assessment centre results, (2) confidentiality, (3) using people who are not properly trained, (4) issues related to technology, language and culture as well as (5) research regarding assessments. From a pragmatic approach, this article attempts to provide insight into the identified ethical challenges faced by psychologists by utilising a novel method to facilitate ethical discourse called 'the town hall focus group' (Zuckerman-Parker & Shank, 2008). A gathering of industrial and organisational psychologists was asked to debate these ethical issues and challenges in assessments. Not only did the study provide insight in terms of their reaction to the ethical challenges experienced, but it also illustrated the complexity of both the challenges as well as the interaction experienced between the various systems during the different stages of the assessment process.
This article contributes to the understanding of the practice of ethics in assessments by illustrating a platform for discourse regarding ethical issues experienced in assessments. The town hall focus group method (Zuckerman-Parker & Shank, 2008) appears to be valuable as it provides a forum to discuss ethical challenges where members are allowed to share their experiences and thus gain access to peer support, insight and shared resources. This method is a novel platform, which facilitates peer discourse regarding ethical challenges and demonstrates its usefulness to gather rich data whereby an understanding of ethical challenges in assessment can be enhanced.
The following section discusses the research design and methodology followed, which includes a description of the research participants and a discussion of the data collection method, comprising focus group discussions, to examine the ethical challenges experienced by psychologists when conducting assessments. The findings are presented, followed by a discussion of the results. These results are presented as broad thematic categories, and relevant literature is used as an interpretive framework. The consequences of decisions taken as well as suggestions for actions to oppose and mitigate the effects of the ethical problems that were encountered are explored. The article concludes with an evaluation of the impact of the dynamics of the research method as a forum to explore the experienced ethical issues and challenges and to deal effectively with these.
Research design
In order to set the stage for the research framework, it is necessary to explain the research approach, the epistemological and ontological position of this research as well as the paradigm, all of which have determined the research design and methodology followed.
Research approach
As this research is of a qualitative nature where a varied set of contexts and meanings are important and included, the interpretivist paradigm is appropriate (Banks, 2007). This allows for methodology where data is interpreted and the subjectivity of the investigator is taken into account. Indeed an in-depth understanding of the phenomenon being studied is possible only through the interpretations of those experiencing it (Shah & Corley, 2006). According to the interpretivist paradigm, this is especially appropriate where data is collected by means of open ended questioning techniques. These techniques allow for the fact that participants' interpretations of their reality mean that people may differ in the way that they respond to similar situations and allow participants control over which aspects they may consider more important (Gale, 1989; Shah & Corley, 2006).
A pragmatic interactionist perspective was followed in this research endeavour focusing on the belief that the reality or ontology to be studied consists of subjective experiences that, from an epistemological viewpoint, are intersubjective and interactional. Pragmatic philosophy focuses on the development of the self and the objectivity of the world within the social realm and that the individual exist in relation to others with shared meanings. This philosophy is intended to address the needs of living human beings (Miller, 1982; Webb, 2007). This is supported by interactionist philosophy that studies individuals and the way they act within society and derives social processes from human interaction (Athens, 2010; Iovino, 1991). A pragmatic interactionist perspective emphasises the uncovering of being from the perspective of the shared practical experiences of humans and the way the world is revealed to this experiencing entity within a realm of things. The pragmatic perspective focuses principally on the research question or problem and applies all approaches to understanding the problem. As such, data collection and analysis methods are chosen as those most likely to provide insight into the question (Mackenzie & Knipe, 2006). The research, on which this article is based, was exploratory in order to investigate the ethical challenges experienced by psychologists conducting assessments. Additionally, the consequences of decisions taken, as well as suggestions for actions to oppose and mitigate the effects of the ethical problems encountered, were explored.
Research strategy
The qualitative research approach adopted required the use of a method, in this case the town hall focus group, which relies on the subjective relationship between researcher and subjects, as well as between subjects, in order to obtain the rich and descriptive data necessary to explain the subjective reasons and meanings behind the reality (TerreBlanche & Durrheim, 1999, p. 6).
Focus groups have played a critical role in qualitative research since first mentioned as a market research technique in the 1920s (Kitzinger, 1994; Morgan, 2010). The grouping is purposeful in that it debates particular questions in order to explore the specific issue. In the case of the current research, the grouping consisted of industrial and organisational psychologists and practitioners who have a specific interest to purposively discuss and explore the issue of ethical challenges experienced during psychological assessments.
The town hall focus group method holds many benefits, such as being an economical, fast and efficient method for obtaining data from multiple participants (Krueger & Casey, 2000). The feature that distinguishes focus groups most is the use of group interaction to generate rich descriptive research data (Kitzinger, 1994). Another advantage is the socially orientated environment, where the sense of belonging to a group can increase the participants' sense of safety and cohesiveness and help them to share information (Krueger & Casey, 2000; Peters, 1993; Vaughn, Schumm & Sinagub, 1996). Additionally, the interaction that occurs can yield important data and provide a setting where the participants can discuss problems and provide possible solutions (Duggleby, 2005). Traditional best practice for the conduct and procedural aspects of focus group research advocates, for example, that the ideal size is between six to eight participants (Freeman, 2006). However, Morgan and Bottorff (2010) argue that there are many different options when conducting focus groups and for each research project investigators need to select a way of using focus groups that match the goals of the project. According to Zuckerman-Parker and Shank (2008), research practices may sometimes be extended by virtue of circumstance. They describe the inception and development of the town hall focus group, a focus group consisting of large numbers of participants divided into natural groupings with intragroup and intergroup interaction. Historically, the term 'town hall' was used in reference to its place in history for a regular gathering of people who met for the purpose of discussing matters of importance (Bryan, 2003). Participants sat together in natural groups. Instead of having a focus group with six to eight individuals, the town hall focus group consisted of six to eight groups of between four and eight individuals each. Each member was encouraged to first contribute within the team and then each team would put forward their ideas or position.
This grouping of individuals is advantageous as it makes the focus group more manageable since the teams replace the role of the individuals in a traditional focus group. The fact that there were groups did not; however, inhibit individuals to speak out of team context if they felt they wanted to add something to the discussion. The process involved intergroup and intragroup interaction whereby participants discussed a topic of interest within the same group and it was then debated between groups. In terms of intragroup functioning, participants were comfortable in their ad hoc teams making the process less stressful for them, while the intergroup functioning allowed for the identification of salient points that cut across all teams (Zuckerman-Parker & Shank, 2008).
Research method
Town hall focus group discussions were conducted in order to explore selected ethical challenges experienced by psychologists conducting assessments, to look at the consequences of decisions made as well as suggestions for actions to oppose and mitigate the effects of the ethical problems encountered.
Research setting
The study was conducted at two branch events of the Society for Industrial and Organisational Psychology of South Africa (SIOPSA). Increasingly, psychologists are faced with ethical challenges when conducting assessments or when providing assessment results. Continuous professional development emphasises regular sessions focusing on topics addressing ethical issues.
Entrée and establishing researcher roles
SIOPSA regional branch management requested two sessions focussing on ethical issues in assessment. Participation by attendees was voluntary and the participants were informed of the overall process, and it was implemented with due consideration of the impact on the participants. The study was evaluated in terms of research-related ethical considerations and the potential impact on participants was mitigated by ensuring that all information was treated as confidential, and participants remained anonymous. Ethical considerations included, amongst others, the respect accorded to participants and the rights of the participants, such as the right to confidentiality and anonymity (Mayer, 2008).
It is ideal for this type of focus group to have a moderator team (Krueger & Casey, 2000). The authors were involved throughout as facilitators and moderators. The authors are registered industrial and organisational psychologists, one with a Masters degree and one with a PhD in industrial and organisational psychology. In this case, the moderators were responsible for facilitating the discussion, encouraging the members to participate and requesting overly talkative members to let others speak. The moderators presented the focus group participants with stimulus material (a presentation on ethical definitions, concepts and issues) as well as a series of ethical challenges and asked the participants to respond.
Mintzberg (1979, p. 113) observed that qualitative research methods provide the richness of knowledge necessary to explore a phenomenon or experience. For a qualitative research study, sample composition and size is important in order to capture and explore, not measure, a range of attitudes and perceptions. Qualitative research samples are purposive and as such deliberately skewed. Interested members of SIOPSA were invited to attend a discussion on ethical challenges in assessments. The context provided an opportunity to explore the ethical challenges experienced by psychologists and practitioners and the way these issues can be addressed from a pragmatic perspective. Everyone who attended and participated related personal perceptions and experiences of perceived challenges. The focus was not to verify the validity of these perceptions but rather to facilitate discussion of experienced ethical challenges. It was indicated that this would be for research purposes and it resulted in a convenience sample which included 60 registered industrial and organisational psychologists, 7 psychometrists, 3 psychometrists in training, 5 intern psychologists, 4 students and 29 interested practitioners.
Recording of data
The focus group discussions lasted approximately one and a half hours. It was tape-recorded and detailed notes were kept to capture responses. The subgroups were not taped individually as the focus was on the issues presented by the intergroup and discussed intragroup. The reasoning was that the town hall focus group process involved intergroup and intragroup interaction whereby participants discussed a topic of interest within the same group, which was then debated amongst groups. To ensure confidentiality, the details of the primary tasks and biographical data on individual participants will not be provided.
Data collection and analysis
The intragroup discussions, which was presented by intergroup members to the collective, served as the raw data. Potter (2002, p. 149) refers to the researcher as 'the most sophisticated analytical device around' and as such the researcher as instrument in qualitative research directs the data gathering and interpretation of findings. Because of the inseparable relationship between data collection and data analysis in qualitative research, interpretation begins to take place during the collection of the data (De Vos, Strydom, Fouché & Delport, 2002). However, using various sources and techniques to obtain information enabled the researcher to verify the explanations, thus contributing to the validity of the qualitative process (De Vos et al., 2002; Krueger & Casey, 2000). These sources and techniques included audiotapes of the discussions, notes taken by the moderators and items recalled by the moderators. A data saturation point was reached in terms of the information obtained and the conclusions drawn which made the collection of more data appear to have no additional interpretive worth (Sandelowski, 2008; Saumure & Given, 2008). Because of its contextual nature, there are limits to the transferability of the findings but some generalisation based on these conclusions is possible.
As a first phase, the data was analysed using tape-based analysis, described by Onwuegbuzie, Dickinson, Leech and Zoran (2009, p. 4) as a process wherein the researcher listens to the recordings of the group discussion and then creates an abridged transcript. This type of analysis is helpful because the researcher can focus on the research question and only transcribe the portions that would assist in better understanding of the phenomenon of interest. In addition, note-based analysis was utilised where the focus group notes and summary comments from the moderators were analysed. Secondly, conversation analysis is utilised to look at how participants communicate with each other. Morgan (2010) explains that the goals of the research should guide the collection and analysis of the data yet often a great deal of focus group research is conducted for substantive and practical purposes, where little attention is given to the analysis of the dynamics of interaction in those groups. However, the importance of interaction in focus groups should not be overlooked as it can provide significant insights. Thus, interaction in focus groups produces the data, and the interaction itself can also be the data. Examining how participants interact versus only looking at what is said will yield richer data and enhance meaning. We contend, as did Myers and Macnaghten (1999) who used conversation analysis with focus groups, that conversation analysis is a useful method to employ with focus group data (Onwuegbuzie et al., 2009).
Strategies employed to ensure quality data
Qualitative researchers are challenged to verify the rigour, quality and trustworthiness of their research. The value of qualitative research needs to be appraised against a range of evaluative criteria available. All evaluative criteria require research to be coherent, as well as show evidence of systematic work and integrity with emphasis on relevance and contribution. Terms such as validity and reliability are commonplace as quality criteria in quantitative research approaches but their definitions become inadequate when applied within a qualitative paradigm, where the efforts of the researcher are an intricate part of the qualitative research process (Shah & Corley, 2006). A number of techniques have been employed including purposive sampling, protecting confidentiality, transcribing focus group sessions, including process and observation notes, iteratively analysing data, and member reflections with participants to allow for discussion, feedback and confirmation of the study's findings (Shah & Corley, 2006; Tracy, 2010). These strategies have been used to ensure the quality, credibility, transferability, dependability, confirmability and trustworthiness of data. Because of the variability of qualitative research perspectives, Ballinger (2006) points out the need to link our choice of evaluation criteria to epistemology and suggests four considerations to reflect upon depending on the qualitative research perspectives:
systematic and careful research conduct
relevant interpretation
the role played by the researcher.
In this research, a relativist ontological position values more reflexive modes that demonstrate the possibility of multiple understandings and interpretations. Whilst still emphasising reflexivity and the way the research account is co-constructed, coherence was achieved by including member checks (participant validation) and triangulation in order to emphasise the trustworthiness of the account. Systematic and careful research conduct is supported by a detailed description of the method and evidence from the literature. Relevant interpretation was achieved by offering an account of the ethical challenges experienced, which included some verbatim quotes as well as offering interpretations backed by relevant theoretical references to strengthen the argument. Participants were involved collaboratively by reading and discussing the analysis. Whilst it is not claimed that this validates the study, this involvement does strengthen the argument and supports the ethical requirements. Finally, in the realist tradition, objectivity and a transparent methodological account is key when considering the role of the researcher. In contrast, when focussing reflexively on how the researchers' presence and positioning have influenced the research process and its outcomes, different perspectives have been highlighted. While researchers inclined to relativism (Ballinger, 2006; Bochner, 2001; Richardson, 1992) also argue for rigour and systematic work, they appreciate and highlight the value of using creative presentations to demonstrate the impact of social discourses.
According to Cameron (2005), focus groups do not produce findings that can be generalised to a wider population, although it can be expressed in impressionistic rather than numerical terms. In place of precise numbers or percentages, the general trends and feelings are typically provided. The findings are presented in the next section, followed by a discussion of both the substantive as well as methodological process conclusions. These findings are discussed with reference to relevant literature and telling examples from the data are used to strengthen the arguments. The findings are reported in terms of the discussion that was structured around the ethical challenges presented. The discussion of the findings is presented according to themes that emerged as a result of a higher level of conceptualisation.
The literature review identified many ethical challenges faced by psychologists. The researchers chose to present five of these to participants for discussion. Due to time constraints not all ethical challenges were discussed in equal depth (illustrating perhaps the need for more events liked these where such issues could be discussed at length). The challenges are presented in this section, illustrated by quotes from the transcripts. As advised by Wilkinson (2004), individuals' quotes or conversational quotes between participants are included. Statements represent the views of participants and not necessarily that of the authors.
It was difficult for participants to agree on the importance of one ethical challenge over another. Participants were asked to rank the five identified issues in order of importance from 1 to 5, with 1 being most important. However, no consensus was found. In fact, one participant ranked several of the challenges all as number one, perhaps showing how important all of those were to that participant, so much so, that they could not choose. Therefore the findings are presented in no particular order of importance. The discussion in the next section is presented in the sequence of the themes that manifested as a result of debating the identified ethical challenges and the meaning created through the research and conceptualisation.
Ethical challenge 1: [Mis]application of assessment centre results
Participants were presented with the first ethical challenge and asked to contemplate how assessment results are used and applied in organisations and the management thereof. The majority of participants agreed that the misapplication of assessment results is a completely unacceptable practice and against the law. This sparked a heated debate regarding whether it is at all possible to manage the way assessment results are applied. One participant suggested that a needs analysis should be conducted to establish what the assessment results would be used for. Another suggested that a disclaimer be written in the report stating the purpose and the limitations of the results. This was supported by several other participants with one participant verbalising it as 'mak[ing] the purpose clear ... [there should be] agreement and understanding with the client before commencement' (Focus Group 2, Johannesburg, 05 May 2010).
Regarding the follow-up questions on contracting and feedback, this participant stated that a contract should be signed, which should also regulate the feedback sessions. One participant suggested that the purpose of the contract is to safeguard the psychologist (from practices outside of his or her control). One group suggested 'alerting the client to the law' (Focus Group 1, Pretoria, 16 Sept. 2010) and the legal implications of misusing assessment results. It was agreed that informed consent from the applicants should be obtained (preferably in writing). Another participant stated that one should have 'clarification from the onset' (Focus Group 1, Pretoria, 16 Sept. 2010) regarding any expectations from both the psychologist and the client's side. It was suggested that a disclaimer could be included which would 'contextualise your position, responsibilities and power' (Focus Group 2, Johannesburg, 05 May 2010).
In terms of feedback, it should be made clear that ethically, some form of feedback is required. One participant pointed out that there are financial implications for the client and as such feedback should ideally be contracted from the start. Several participants discussed the fact that it would be ideal to be able to see the process through from start to finish. However, consultants are often contracted to assist with a particular part and can only advise on other related parts. A participant promoted 'soft feedback for clients' (Focus Group 2, Johannesburg, 05 May 2010) explaining that it should be faceto-face, honest, as detailed as possible but gentle and focusing on the competencies specific to the assessment. One group stated that the results a client (in this case an organisation) gets should be managed. Thus, a client should get an interpreted report and never the raw scores. One participant called for a 'filtered written report' explaining that this implied an interpreted 'report specific to the purpose ... a subtle version' (Focus Group 1, Pretoria, 16 Sept. 2010). If possible, the managers should not be privy to more information than the individuals who were tested.
A debate ensued regarding who the client may be: is it the person being assessed or is it the organisation requesting the results? Consensus could not be reached, however most felt that contractually it could be the organisation ('they pay our salary') (Focus Group 1, Pretoria, 16 Sept. 2010); however, as psychologists we have an ethical obligation to both the organisation and those being tested. A group of participants suggested defining who the client is in terms of a primary and secondary client. The main priority would be the primary client (organisation) but not neglecting the secondary client (candidate).
A heavily discussed topic concerned the education of clients with regard to assessments. A participant felt it necessary to:
'inform our clients of the purpose and what it can and doesn't do ... educate clients about why you are using the assessment and that it is... only part of a whole process'.
(Focus Group 2, Johannesburg, 05 May 2010)
It was felt that there should be some basic training on the shelf life of a report's results and of the way to read the reports (even if narrative interpreted reports are used). A participant added that one could perhaps ask for proof of training from whoever would be using the results to ascertain their competence with regard to interpreting assessment results. In terms of the previously mentioned secondary client, the assessed candidate should also be educated and know what rights he or she has. A participant commented that 'it is our responsibility to educate clients' (Focus Group 2, Johannesburg, 05 May 2010).
Ideally, the assessment results should be used in conjunction with other information such as performance and interview data in order to form a holistic view. Another participant commented that reports should not be emailed to clients. It was debated that these days it is common practice to email reports, particularly where psychologists have built trusted relationships with clients educated on assessment practices. However, ideally no report should be provided to any client without discussion regarding the content.
Ethical challenge 2: Confidentiality
With regard to confidentiality, most participants felt strongly that it is a very important ethical obligation. It was discussed that labour law and the policies and procedures of the relevant organisations should inform this aspect. In terms of what to do when results are being discussed out of context, it was suggested that documents should be password protected and that we 'need to protect info' (Focus Group 1, Pretoria, 16 Sept. 2010). Another participant suggested that a confidentiality clause should be added to the documents and managers should be educated with regard to the implications of their actions.
When should assessment results be discussed? One participant suggested that the results of assessment should only be discussed after it has been integrated and finalised and it should only be 'discussed in an evaluation context' (Focus Group 1, Pretoria, 16 Sept. 2010). Several affirmed this and, according to one adamant participant: 'Don't discuss results or candidates prior to final decision and outside the proper forum' (Focus Group 1, Pretoria, 16 Sept. 2010). Assessment practitioners should not discuss results during assessment sessions or 'in the corridors' (Focus Group 2, Johannesburg, 05 May 2010) but one participant speculated whether this is not possibly as a result of the culture of the organisation where assessments are taking place. A participant stated that it should be contracted beforehand who will see the results. Another participant said that this should ideally include the candidate and the sponsoring organisation's management members.
'Training and standardisation' (Focus Group 2, Johannesburg, 05 May 2010) was suggested to manage assessment practices and the dissemination of sensitive assessment results. One participant said to 'pull managers back in and remind of best practice' was necessary (Focus Group 1, Pretoria, 16 Sept. 2010). Another participant mentioned that 'professionalism and sensitivity should be emphasised at all levels' and suggested that when results are shared illegally or irresponsibly a step would be to 'discuss it with the person, if no reaction you have to escalate the matter to a more senior level' (Focus Group 1, Pretoria, 16 Sept. 2010).
Ethical challenge 3: Using people who are not properly trained or only partially trained
The issue of training is one that came up in many of the other identified topics and as such it was discussed in the different contexts where it was seen as appropriate. It was suggested that more learnerships could be introduced to advance training with regard to ethical assessment practices as it was felt that 'competence is critical' (Focus Group 2, Johannesburg, 05 May 2010).
Regarding the role that training could play, it was suggested that proper training 'maintains standards, quality, control and best practice' and that ideally 'training should be ongoing' (Focus Group 2, Johannesburg, 05 May 2010). One respondent reminded the groups that test publishers prescribe minimum training for their tests but suggested that as part of continuous professional development training should be 'life-long' (Focus Group 1, Pretoria, 16 Sept. 2010). Another participant emphasised the importance of 'experience in relation to a [specific] test'(Focus Group 1, Pretoria, 16 Sept. 2010). It was suggested that recapping the purpose and procedures of assessment before each session and through regular discussion of assessment, could enhance the quality of the assessors and inter-rater reliability. It was suggested that this could be accomplished through 'peer review and feedback from expert practitioners' (Focus Group 1, Pretoria, 16 Sept. 2010).
With regard to who should receive training it was agreed that all parties involved should receive some form of training. Several of the participants discussed that proper training of managers should minimise inappropriate discussion of results - 'they are informed of the importance of confidentiality and of ethical issues' and 'inform manager of the severity of his actions' and of 'what legal implications are' (Focus Group 2, Johannesburg, 05 May 2010). With proper training, the implications of results being taken out of context or the fact that it may influence subsequent assessment of the candidates may be eliminated. It was also felt that 'continuous evaluation, quality assurance and re-registration' should be used to manage the quality of assessment practitioners (Focus Group 2, Johannesburg, 05 May 2010). Another participant stated that the candidate should also be educated regarding confidentiality and informed of his consent to the assessment.
Dealing with managers who feel competent to conduct assessments on their own proved to be a sensitive issue as it was acknowledged that companies devise their own tests for assessments. These tests and assessments may be entirely appropriate where, for example, specific technical skills are required. It was suggested that, as psychologists, we need to interpret the results within a behavioural context but that we should be 'assertive' and explain the 'Health Professions Council of South Africa's (HPCSA) regulations and labour law' to clients (Focus Group 1, Pretoria, 16 Sept. 2010). If unethical practices are taking place these should be reported to the labour court or HPCSA and, as consultants, one participant felt that 'we should refuse to work with them' (Focus Group 1, Pretoria, 16 Sept. 2010).
Ethical challenge 4: Technology, language and culture
It was felt by participants that this is a topic warranting a lengthy discussion on its own merit. Technology in assessment provides mobility and is increasingly playing a role because 'companies want to cut costs' (Focus Group 2, Johannesburg, 05 May 2010). However, 'authenticity is still questioned' (Focus Group 2, Johannesburg, 05 May 2010) and there is some concern regarding whether we can be sure in cases where tests are taken remotely whether the intended candidate is indeed the one completing the assessment. One group of participants mentioned that assessments utilising technology should not be used in isolation and that the issue of confidentiality within this context is also very important. Measures should be taken to ensure confidentiality as there exists a 'higher risk of breaking confidentiality' and that any implementation of technological assessment should be 'hacker-resistant' and password protected (Focus Group 1, Pretoria, 16 Sept. 2010).
One participant felt that the assessment process should still be supervised even if technology is used. Several suggestions were made with regard to managing the integrity of the assessment process when using technology such as 'controlling access to assessments' and having a 'verification process' such as by means of individual usernames and passwords (Focus Group 1, Pretoria, 16 Sept. 2010). One participant said that this is why she feels an assessment centre is ideal as issues can be contained, although this is not always a cost-efficient option for companies (Focus Group 1, Pretoria, 16 Sept. 2010). It was mentioned that in South Africa additional issues may exist regarding 'sound internet technology and band-width' which could limit access to technology and the use of assessments in this context (Focus Group 2, Johannesburg, 05 May 2010).
One participant suggested that the 'instructions should be clear' and very thorough since the use of technology in assessments may imply that there is not an assessor nearby to ask if one does not understand (Focus Group 1, Pretoria, 16 Sept. 2010). It was mentioned that 'technical literacy' could be an issue with regard to 'lower levels' in an organisation and could impact the results of an assessment (Focus Group 1, Pretoria, 16 Sept. 2010). One participant emphasised that technology has indeed increased efficiency but that we must ensure 'that candidates being assessed are not compromised because of unfamiliarity with technology' (Focus Group 1, Pretoria, 16 Sept. 2010). He further warned that 'over-reliance on technology is not enough' and 'without the skill and time actually using real observation', the quality is reduced. 'We are professionals who must enhance the interpretation of results with our professional skills of observing.' (Focus Group 1, Pretoria, 16 Sept. 2010)
A debate ensued regarding the use of tests across different language groups and whether the argument that English is the language of business is sufficient in warranting testing in English. It was suggested that tests should be 'specifically suited to appropriate norms' (Focus Group 2, Johannesburg, 05 May 2010). One participant suggested that as long as 'tests focus on the inherent job requirements' and not on the person, testing is appropriate for any culture (Focus Group 1, Pretoria, 16 Sept. 2010). It was suggested that a translator should be provided and in cases of confusion, a translator could help. This; however, sparked protestations regarding the accuracy of the translation and the control that you as a supervising psychologist may have over the meaning that a translator imparts. A participant said that it is very important to 'determine the language and culture and choose the most suitable test and have alternatives' when testing candidates from different cultural groups and languages (Focus Group 1, Pretoria, 16 Sept. 2010).
Ethical challenge 5: Research
One group of participants stated that research into assessments is important 'to maintain science and fair and ethical use' (Focus Group 2, Johannesburg, 05 May 2010). A participant stated that test development is an important part of research into assessment, as it should also 'ensure quality' (Focus Group 1, Pretoria, 16 Sept. 2010). Another participant supported this claim suggesting a responsibility on the part of test publishers to help with research.
A suggestion was made that research should be done into assessment practices in general in order to 'get rid of or put pressure on practitioners who give industrial and organisational psychology a bad name' (Focus Group 1, Pretoria, 16 Sept. 2010). In order to conduct ethical research, all practitioners should get clients to sign documentation containing 'ethical guidelines summaries, purpose of assessment, [and] that they have the right to contact the HPCSA' (Focus Group 2, Johannesburg, 05 May 2010) and that this documentation must mention that the results can be used for research purposes. One participant suggested that particular areas in need of more research were issues related to 'diversity [and] tests that aren't standardised' (Focus Group 1, Pretoria, 16 Sept. 2010). The conducting of research and capturing of data must be done in a 'standardised, consistent and objective manner' and should 'follow well-reputed research methodology' (Focus Group 2, Johannesburg, 05 May 2010).
The main objective of this article was to provide insight into several identified ethical challenges faced by psychologists by utilising a novel method called 'the town hall focus group'. Ethics codes cannot do our questioning and responding for us and do not provide easy and clear answers (Pope & Vasquez, 1998), and as such ethical discourse should be practical in order to address ethical issues and challenges in assessments. The discussion by the participants provided constructive information and in line with this, several themes crystallised relating to the challenges experienced, suggested actions to manage the challenges as well as the usefulness of a discussion forum. The following discussion and conclusions are presented based on these identified themes supported by the literature that contributed to the validity of the findings.
The town hall focus group method
The first contribution relates to the method of the research. After the discussion was concluded, the researchers were approached by several of the attendees who indicated their appreciation and enjoyment of the discussion. One person related that she had had to resign from a previous company where she had been repeatedly requested to commit unethical acts, such as to manipulate assessment results and other practices. Another participant stated that he felt a need for a forum, which meets regularly, dealing with these issues.
The purpose was to illustrate a forum where discourse regarding ethics could be had in a practical fashion in order to deal with the diversity of challenges, questions, demands and responsibilities experienced by psychologists. The focus group succeeded in this purpose and therefore makes a contribution to science and also had social value as a result of the peer support that was experienced. Traditionally, the objective of focus groups is to give the researcher an understanding of the participants' perspective on the topic being discussed (Wong, 2008). It is an important finding that the contribution made by the study is not just to be found in the results but in the actual town hall focus group method followed. The aim of the research was to gain insight into several identified ethical challenges faced by psychologists as well as to illustrate a method that provides psychologists with an opportunity for ethical discourse. This forum afforded psychologists the opportunity to gain an understanding of each other's perspective on the topic of addressing ethical issues and challenges in assessments.
Halcomb, Gholizadeh, Digiacomo, Phillips and Davidson (2007) report that the less sensitive the topic, the larger the group could be. Arguably the issue of ethics and ethical conduct is sensitive but participants commented that they experienced the focus group as beneficial and supportive. This may be due to the fact that participants were surrounded by fellow psychologists and practitioners, who are also confronted with similar ethical challenges and allowed for the discussion of practical experiences, which could contribute positively to the struggles with unique ethical contexts (Pope & Vasquez, 1998). The benefit lies in both the opportunity for, and experience of the dialogue as well as the actual discussions had. Having groups within groups allowed participants to share their insights despite the size of the larger group.
The common interest of the groups resulted in like-minded individuals who provided a supportive environment in which to air ideas. According to Kitzinger (1994) the feature that distinguishes the focus group method is that rich descriptive data is generated through the group interaction and the town hall focus group provoked much interaction. Although ethical codes and guidelines exist, many psychologists felt that they are often still faced with challenges and feel the need for ethical discourse. Several participants indicated their appreciation and enjoyment of the forum and stated the need for a regular opportunity to deal with these issues. Their appreciation was for the opportunity for members to share their experiences and thus gain access to peer support, insight and shared resources. Safety in numbers makes some people more likely to consent to participate. In addition being with others who share similar experiences encourages participants to express and clarify their views.
When group dynamics work well participants engage in interaction which is both complementary (such as sharing common experiences) and argumentative (questioning, challenging and disagreeing with each other) (Kitzinger, 1994). Kitzinger describes this interaction as follows:
[p]articipants do not just agree with each other. They also misunderstand one another, question one another, try to persuade each other of the justice of their own point of view and sometimes they vehemently disagree.
(Kitzinger, 1994, p. 113)
Group members supported and/or questioned each other's statements and viewpoints, both intergroup and intragroup. There were lively discussions and a diversity of opinions arose. The value gleaned from the interaction between members was invaluable in terms of exploring the issues through the experiences of the participants. Participants provided an audience for each other and encouraged a variety of exchanges. As an example the anecdotes of actual experiences told much more than what people know theoretically. During the focus groups individual participants illustrated their concerns by relaying experiences in order to illustrate what they meant. In this sense focus groups reveal a dimension of understanding that often remains untouched by other methodologies (Kitzinger, 1994).
There are situations such as the one described here, where the town hall focus group might be a very useful data collection strategy. It is however critical for the researcher to be aware of the additional burden and responsibility by virtue of the size of the group. A characteristic of any focus group is the pivotal role of the researcher in promoting group interaction and focusing the discussion on the topic at hand (Cameron, 2005). The researcher acts as moderator, drawing out the range of views and understandings within the group, and facilitating interaction and disagreement between participants. It is also the researcher's role to scrutinise the data and disseminate the information to a larger audience.
The importance of one ethical challenge over another
The individuals and groups within the town hall focus groups were unable to agree on the importance of one ethical challenge over another. This is perhaps indicative of the subjectivity from whence ethical challenges are viewed. Different ethical approaches may influence how important one considers an ethical challenge to be and how one balances law and practice to address and solve the challenge. The utilitarian approach states that the best ethical action is one that does the least harm and produces the greatest balance of good over harm. The rights approach proclaims that the best ethical action is the one that best protects and respects the moral rights of those affected. There is also the fairness or justice approach, which advocates treating all human beings equally or, if unequally, then fairly, based on some defensible standard or the common good approach where the preferred action is one that contributes to the general welfare of everyone. Lastly, the virtue approach argues for ethical decisions and actions that are consistent with certain ideals that provide for the full development of our humanity (Holbrook, 1994; Hursthouse, 2003; Lind, 1992; Rallapalli, Vitell & Barnes, 1998).
Misapplication of assessment results
Regarding the application of assessment results in organisations, most participants agreed that the misapplication of assessment results is a completely unacceptable practice and against the law. Regarding contracting consent and confidentiality, participants discussed that a contract is valuable in order to regulate the feedback sessions, safeguard the psychologist and to obtain informed consent.
Consent and acknowledgement
In terms of consent, it is not enough to simply get an acknowledgement from clients. Fisher (2008a) agrees that it would be misleading to call an 'acknowledgement' a 'consent'. Psychologists need clients to not only acknowledge but also accept what the assessment will involve, as it will have consequences regarding confidentiality. Fisher (2008a) argues that it is especially important for clients to understand the limits that consent puts on confidentiality. The American Psychological Association Ethics Code (APA, 2002), for example, uses the term 'confidentiality' in two contexts whereby psychologists have to begin by obtaining the client's informed consent (explaining the limits of confidentiality), and psychologists may disclose information at any time by obtaining the client's appropriate consent.
Defining who the client is
The aforementioned information has implications regarding the weighing of the interests of the organisation against that of the assessment candidate. Consensus could not be reached in the focus group regarding who the client may be: is it the person being assessed or is it the organisation requesting the results? Shealy, Cramer and Pirelli (2008) argue that legal, professional, ethical and practical issues may impact the answer. Contractually it may be the organisation; however, ethically, there is an obligation to both the organisation and those being tested. Fisher (2009a) concludes the speculation regarding who the client is by stating that it is a distraction from more important ethical questions. By requiring a singular answer, the question obscures the fact that psychologists have ethical obligations toward every party in a case. Identifying the client(s) simply clarifies the nature of the relationships and understanding of the accompanying ethical obligations. Fisher (2009a) suggests that psychologists adopt an alternative ethical question by rather asking what the ethical responsibilities are to each of the parties.
Educating clients regarding assessment practice
A greatly discussed topic during the focus groups concerned the education of clients with regard to assessments. Limitations exist on psychological assessment practices that can affect the welfare of the client. These are problems that reflect the expectations of clients concerning what they should or could get from a psychological assessment, its cost and what information they should receive (Lezak, 2002). During the focus group, it was found that participants feel that clients should be educated as to the purpose of the assessment and what it can and cannot do. Ideally the assessment results should be used in conjunction with other information, such as performance and interview data, in order to form a holistic view.
In terms of feedback, one participant suggested that the results of assessment should only be discussed after it has been integrated and finalised. According to Michaels (2006), the final report is often the only communication about an evaluation and it is powerful since it will form the basis on which employment decisions are made, which may have a life-changing impact. He further cautions that, because the psychological report is often given immense weight, care must be taken to ensure such report is completed with due respect to the ethical obligations involved. Some ethical decisions such as the wording of reports or what data to include are less straightforward.
Most participants felt strongly that confidentiality is a very important ethical obligation. Pipes, Blevins and Kluck (2008) illustrate the complications that can arise in discussing confidentiality because the term 'consent' is used as a catchall by psychologists to mean two quite different things about confidentiality. Firstly, consent is an acknowledgement of confidentiality's limits and secondly that it means that the candidate being assessed consents to the disclosure of specific information. Pipes et al., (2008) suggested that only the latter should be called consent. Fisher (2008b) states that clients should be advised regarding the laws that limit confidentiality and then limit disclosure to the extent legally possible.
Professional training and competence
The issue of training is one that came up several times during the focus group discussion. The context of discussion varied between professional training and registration, competence and knowledge regarding ethical conduct. Several of the participants discussed that proper training should eliminate unethical practices such as inappropriate discussions of results. With proper training, the implications of results being taken out of context or the fact that it may influence subsequent assessment of the candidates may be eliminated. For the purposes of this discussion, the focus is on professional competence as well as ethical conduct, since both are considered to have a significant impact on clients.
The evaluation of competence is important and in an evolving state eagerness to complete assessments and deliver results, can present a situation that hampers effective screening and intervention (Kaslow et al., 2007; Lichtenberg et al., 2007). Johnson, Elman, Forrest, Robiner, Rodolfa and Schaffer (2008) recommend the consideration of both formal (legislation) and informal (routine professional association gatherings) mechanisms for enhancing communication regarding competence. Ethics codes encourage collegiality, communication and cooperation among psychologists to facilitate a comprehensive approach to addressing competence problems. They further advocate increased cooperation with professional organisations and accrediting bodies to develop standardised, valid and reliable measures of competence.
Fisher (2009b) argues that psychologists are responsible for ensuring that tasks (delegated or not) are performed competently. For staff members who interact with clients or who have access to confidential client information, technical competence may not suffice. Psychologists who want to provide the best protection for clients can offer staff training that encourages ethical conduct and promotes technical competence. It may thus be advisable to provide ethics training even for the client.
Challenges regarding technology, language and culture
Participants felt that the topics of technology, language and culture, warranted a lengthy discussion on their own merit. Leung and Barnett (2008) state that there is a great need for culturally sensitive and appropriate psychological assessment where relevant issues include competence of administrators, test selection, adaptation and translation, administration, application and assessment result interpretation. As professionals it is our duty to carefully consider which assessments are appropriate, given the differences in clients' technical ability, culture and language. Paterson and Uys (2005) highlight that in some cases instruments are selected because they offer the latest technology even though they may not yet be classified. Koocher (2007) discusses increasing patterns of delivering services over substantial distances by electronic means, which forces the re-evaluation of thinking about ethically appropriate ways to fulfil our mission of using psychology to advance human health and welfare.
The aim of this article was to provide insight, by means of a town hall focus group, into several identified ethical challenges faced by psychologists. Insight regarding the complexity of the ethical issues in assessments was provided. More broadly, this article contributes to the understanding of the practice of ethics in assessments and it suggests the use of a particular method.
A major contribution of this article relates to the method of the research. After the discussions had been concluded, the researchers were approached by participants who expressed a need for a forum that meets regularly and which deals with these issues. The town hall method appears to be valuable by providing a forum to discuss ethical challenges as experienced by psychologists, where members are allowed to share their insights and thus gain access to valuable peer support, insight and shared resources.
Participants mentioned additional ethical challenges for possible debate, and these are supported by the literature. Issues include using assessments that are not classified and thus have questionable credibility, ways to deal with undue influence from management and related to that, whether we as industrial and organisational psychologists are assertive enough regarding ethical assessment practices. A review of literature also identified insisting on job analysis before conducting assessments (Eurich, Krause, Cigularov & Thornton, 2009), the way results are communicated (Lezak, 2002), and the format of feedback, as well as making ethical decisions (Reynolds, Leavitt & DeCelles, 2010; Rossouw & van Vuuren, 2010). The implication for practice is the identification of the need for more events like this town hall focus group where such issues could be explored and debated. These challenges are also identified as issues for future research.
In conclusion, despite the limitations of focus group results, the town hall focus group method is suggested as a useful method to be used in research of this kind and contributes to the understanding of the ethical issues and challenges experienced in assessments. The novel method applied and described facilitates peer discourse regarding ethical challenges. This method could be replicated and applied in other contexts as a means of contending with ethical challenges within a supportive environment.
Acknowledgements Author competing interests
The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this paper.
Authors' contributions
A.B. and M.M.L. were responsible for project design and conducted the focus group sessions. M.M.L. wrote the manuscript.
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Sandelowski, M. (2008). Theoretical saturation. In L.M. Given (Ed.), The Sage encyclopaedia of qualitative methods, vol. 1, (pp. 875-876). Thousand Oaks: Sage. [ Links ]
Saumure, K., & Given, L. M. (2008). Data saturation. In L.M. Given (Ed.), The Sage encyclopaedia of qualitative methods, vol. 1 (pp. 195-196). Thousand Oaks: Sage. [ Links ]
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Correspondence to:
Madia Levin
Postal address: PO Box 392, UNISA
Pretoria 0003
South Africa
Email: firstname.lastname@example.com
Received: 08 Dec. 2010
Accepted: 30 Sept. 2011
Published: 16 Nov. 2011
© 2011. The Authors. Licensee: AOSIS OpenJournals. This work is licensed under the Creative Commons Attribution License.


text:
At the OSUCCC – James, we work to make the billing process as seamless as possible. Learn more about accepted insurance plans, your bill and how to receive financial assistance below.
Insurance Plans
OSUCCC – James facilities and providers accept most insurance plans. You can refer to the full list of insurances we accept to see if your plan is accepted.
Before you schedule an appointment or procedure, always check with your insurance carrier to determine your policy's benefits and any pre-visit requirements. As a patient, it is your responsibility to ensure you are covered for any services you receive and to provide accurate insurance information to facilitate the billing process. In general, bills will be submitted to the primary insurance carrier. When applicable, the bills will be submitted to a secondary insurer. The patient will then receive a bill with any remaining portion that is the patient's responsibility.
If you do not have insurance or are underinsured, please see the Financial Assistance options below that are available to you.
Your Bill
After your care and treatment at the OSUCCC – James, you will receive one bill (excluding anesthesia services), which will include both physician and facility fees.
In general, bills will be submitted to the primary insurance carrier. When applicable, the bills will be submitted to a secondary insurer. The patient will then receive a bill with any remaining portion that is the patient's responsibility.
Insurance plans vary greatly in what they will pay for and what portion of care is the patient's responsibility. Your insurance may require that you meet an annual deductible and/or require that you pay a percentage of the bill rather than just an office visit co-payment. If you have any questions about your coverage, contact your insurance provider directly.
Please let us know as soon as possible if you do not have health insurance or you anticipate that you cannot pay your bill in full by calling one of our financial counselors at 614-293-0860.
For help understanding the parts of your bill, review our billing fact sheet. If you have questions about your bill or would like to pay by phone, don't hesitate to call us at 800-678-8037.
Hospital Fees
The OSUCCC – James is committed to providing high-quality, individualized cancer care and treatment. The charges at OSUCCC – James reflect the level of medical care available at Ohio's only fully dedicated cancer hospital and research institute.
We are committed to providing care to all patients, regardless of their ability to pay. Patients who have no insurance or those who are unable to pay their medical bills should learn more about the financial aid options available before your appointment.
Financial Assistance
At the OSUCCC – James, a financial counselor is available to help you:
- Understand your insurance benefits, including co-pays, deductibles, out of pocket expenses and covered services
- Learn about assistance programs for the uninsured or under insured
- Connect with the Medical Center and OSUP billing departments
- Learn about Medicaid eligibility
- Connect with the social worker and medication assistance representative if you need help with the costs of your care
If you are concerned about paying for your care, we encourage you to talk to our financial counselors by calling 614-685-5509 to talk about payment options, assistance programs and other resources that might be available to you, or complete a financial assistance application.
Help with Cost of Prescription Medicines
The Patient Assistance Program (PAP) provides free or reduced-cost medicines to patients with limited income available to purchase prescribed medicines.
Eligible patients include those who are:
- Uninsured and not eligible for any public health program.
- Medicare-insured without prescription benefits.
- Waiting for approval for their application for public health assistance.
Patients may be referred by nurses, doctors, social workers, case managers, patient care resource managers or other staff members.PAP staff are available Monday through Friday from 8:30 a.m. to 4:30 p.m. at 614-293-0394.

subset: commoncrawl


text:
The GiFiles,
Files released: 5543061
The Global Intelligence Files
On Monday February 27th, 2012, WikiLeaks began publishing The Global Intelligence Files, over five million e-mails from the Texas headquartered "global intelligence" company Stratfor. The e-mails date between July 2004 and late December 2011. They reveal the inner workings of a company that fronts as an intelligence publisher, but provides confidential intelligence services to large corporations, such as Bhopal's Dow Chemical Co., Lockheed Martin, Northrop Grumman, Raytheon and government agencies, including the US Department of Homeland Security, the US Marines and the US Defence Intelligence Agency. The emails show Stratfor's web of informers, pay-off structure, payment laundering techniques and psychological methods.
Re: DISCUSSION YEMEN/US/CT- How America finally caught up with Anwar al-Awlaki
Released on 2012-10-16 17:00 GMT
|2011-10-02 13:45:44
Anwar al-Awlaki
though if they got Asiri, JSOC vs. Asiri is not as stark of a contrast.
From: "Sean Noonan" <firstname.lastname@example.com>
To: "Analyst List" <firstname.lastname@example.com>
Sent: Sunday, October 2, 2011 6:43:59 AM
Subject: DISCUSSION YEMEN/US/CT- How America finally caught up with
Anwar al-Awlaki
The capabilities and resources of JSOC vs. the capabilities and resources
of Faisal Shahzad, or at best Nidal Hassan
From: "Sean Noonan" <email@example.com>
To: "The OS List" <firstname.lastname@example.com>
Sent: Sunday, October 2, 2011 6:41:23 AM
Subject: Re: [OS] YEMEN/US/CT- How America finally caught up with Anwar
more. CBS seems to have got some of this information prior to the
Telegraph, though the latter had more details. Again apologies for
September 30, 2011 6:37 PM
Al-Awlaki strike plan included jets, special ops
David Martin
(CBS News)
WASHINGTON - U.S. military and intelligence forces have been tracking
Anwar al-Awlaki for years. On Friday, they found him and killed him.
Awlaki, who apparently inspired the Fort Hood major who killed 13 service
members and whose ties to al Qaeda may go back as far as the 9/11
hijackers, was tracked down leaving a funeral in Yemen and killed by a
rocket fired from a U.S. drone aircraft.
Who was Anwar al-Awlaki?
CBS News national security correspondent David Martin reports the hunt for
Awlaki was code-named "Objective Troy" and had been in high gear for
A CIA drone finally got him, but that was only the tip of a much larger
military operation. Missiles fired by the drone took out Awlaki's vehicle.
That made the American-born cleric the first U.S citizen to be targeted
and killed as a terrorist.
A senior defense official said, "a very bad man just had a very bad day."
President Obama seemed to have no qualms about Awlaki's American roots.
"Awlaki was the leader of external operations for al Qaeda in the Arabian
Peninsula," Mr. Obama said after Friday's attack. "In that role, he took
the lead in planning and directing efforts to murder innocent Americans."
Obama: Awlaki death a "Major blow" to terror
Samir Khan, another American member of al Qaeda in the Arabian Peninsula
and two passengers were also killed. But Awlaki was the main target. He
had narrowly escaped an earlier drone strike the week after the Bin Laden
raid, and this time the U.S. was taking no chances.
His hideout in a remote Yemeni town was under continuous surveillance and
the pattern of his daily routine monitored.
Harrier jets flying from an amphibious carrier off the coast were ready to
take a shot if the CIA drone missed. There was even an option for sending
in Marine Ospreys with Special Operations Forces to collect any
intelligence left after the strike, but that was never used. It was all
part of a secret buildup which has occurred in and around Yemen as that
country emerged as home to one of al Qaeda's most active branches.
"This is further proof that al Qaeda and its affiliates will find no safe
haven anywhere in the world," Mr. Obama said.
Since the bin Laden raid last May, the U.S. has killed seven other senior
al Qaeda operatives in Pakistan, Somalia and Yemen. Awlaki is number 8.
From: "Sean Noonan" <email@example.com>
To: email@example.com
Sent: Sunday, October 2, 2011 6:36:36 AM
Subject: [OS] YEMEN/US/CT- How America finally caught up with Anwar
*was up some time last night CDT. my apologies for formatting
How America finally caught up with Anwar al-Awlaki
The capture of a low-level errand-runner was the key breakthrough that led to
the al-Qaeda leader's death, report Adam Baron and Majid al-Kabsi in Sana'a,
Colin Freeman and Sean Rayment, Defence Correspondent
Anwar al-Awlaki was killed by a US drone in the lawless Yemeni
mountains Photo: SITE/EPA
6:00AM BST 02 Oct 2011
As he sat by a roadside eating what would be his last ever breakfast,
Anwar al-Awlaki could have been forgiven for being in upbeat mood. Some 18
months after Washington had given him arguably the ultimate terrorist
accolade by putting him on a list of people authorised for assassination,
he was still hiding in the lawless Yemeni mountains where neither his own
government nor US drone strikes could seem to reach him.
Then, as he and his comrades chewed dates and drank traditional Yemeni
tea, a high-pitched buzz above them signalled yet another drone strike -
this time one that found its mark.
Details of how the US finally managed to track down al-Qaeda's chief
mouthpiece to the West can be revealed today by The Sunday Telegraph,
which has learned that the key breakthrough came when CIA officials caught
a junior courier in Awlaki's inner circle. The man, who is understood to
have been arrested three weeks ago by Yemeni agents acting for the agency,
volunteered key details about Awlaki's whereabouts which led to Friday's
drone strike as his convoy drove through the remote province of Jawf, 100
miles east of the capital, Sana'a. Told he faced either a harsh prison
term or the chance of a new life outside terrorism, the prisoner gave the
vital clues that led to the most significant blow against al Qaeda since
Osama bin Laden's death.
"The CIA lifted a courier a few weeks ago and he started talking," said
one senior Western intelligence officer. "The senior al-Qaeda players
never give up anything, but the junior ones always talk. The interrogation
methods are very sophisticated - there are no thumbscrews or water
boarding involved.
"It's all about striking deals and making the individual understand that
his life as a terrorist is now over, and offering him alternatives. The
information they gleaned enabled the CIA to mount an intelligence-led kill
"Operation Troy" then swung into motion, with Awlaki put under
surveillance for two weeks by the CIA and Joint Special Operations
Command, the elite special forces unit that carried out the raid to kill
bin Laden in Pakistan in May. Concern about striking him out in the open,
rather than in an area where civilians could also be hit, apparently
delayed the operation until Friday.
The method by which US intelligence found out Awkali's whereabouts mirrors
the way they caught both bin Laden and the former Iraqi leader, Saddam
Hussein. Both fugitives likewise deployed counter-surveillance techniques,
avoiding using mobile phones and regularly moving home, but likewise
relied on couriers to pass messages and serve their everyday needs. Such
"gophers" would not necessarily be privy to inner circle discussions, but
would nonetheless know the all-important details of where their masters
were hiding out.
"It was essentially the same modus operandi as the bin Laden kill op,"
said the intelligence officer. "The CIA managed to get someone close to
him who could provide information about his location and movements. Once
they had that established, he was an easy target."
The strike followed an intensification of CIA activity in Yemen, amid
mounting concern that Al Qaeda in the Arabian Peninsula, the terror
movement's local franchise, was becoming a bigger threat to the West than
al-Qaeda's longer-established outfits in Pakistan and Afghanitan. Awlaki,
who held dual US-Yemeni citizenship and preached via the internet in
English, was of particular concern because of his apparent ability to
inspire "home-grown" attackers in the West. Among those who claim to have
been influenced by him are Major Nidal Hasan, who killed 13 people in a
rampage at the Fort Hood military base in Texas, Faisal Shahzad, who tried
to set off a car bomb in New York's Times Square, and Roshonara Choudhry,
the London student who stabbed the MP Stephen Timms in his surgery.
In the months ahead of Operation Troy, the US had ramped up its
drone-strike capacity in the region, installing unmanned Predator aircraft
in bases in Saudi Arabia, Oman, the United Arab Emirates, and Djibouti, a
Gulf of Aden port statelet that has served as a US counter-terrorism base
since 2004.
According to yesterday's Washington Post, the CIA also created a new
dedicated unit known as YSD, or the Yemen-Somalia Department, where dozens
of agents analyse raw intelligence with a view to targeting al-Qaeda
Operation Troy involved aircraft and drones from Djibouti and a
newly-built CIA drone base thought to be in Saudi Arabia, which borders
northern Yemen.
Saudi's royal rulers are among AQAP's sworn enemies, and are thought to
have provided the CIA with intelligence gleaned from clans in the area
where Awlaki was killed.
How decisive a blow Awlaki's death will prove to AQAP remains unclear. The
movement's master bombmaker, Ibrahim Hassan al-Asiri, who provided the
sophisticated devices for last year's parcel bomb plot, is understood not
to have been in the convoy. And given that Awlaki's major role in al-Qaeda
was in his YouTube broadcasted messages, rather than as a planner of
actual operations, he may continue to inspire from beyond the grave.
Additional reporting: Philip Sherwell in New York
Sean Noonan
Tactical Analyst
Office: +1 512-279-9479
Mobile: +1 512-758-5967
Strategic Forecasting, Inc.
Sean Noonan
Tactical Analyst
Office: +1 512-279-9479
Mobile: +1 512-758-5967
Strategic Forecasting, Inc.
Sean Noonan
Tactical Analyst
Office: +1 512-279-9479
Mobile: +1 512-758-5967
Strategic Forecasting, Inc.
Sean Noonan
Tactical Analyst
Office: +1 512-279-9479
Mobile: +1 512-758-5967
Strategic Forecasting, Inc.


text:
Colorful Friends Card
SUPPLIES: Cardstock: (Pure Poppy, New Leaf, Orange Zest, white) Papertrey Ink; (Great Lakes, Snapdragon) Bazzill Basics Paper; (yellow) Michaels Transparency sheet: Papertrey Ink Clear stamp: (sentiment from Healing Wings set) Skipping Stones Design Dye ink: (black) Tool: (circle punch) Marvy Uchida Finished size: 4 1/2" x 5 1/2"
1 Make card from transparency sheet.
2 Circle-punch cardstock, adhere to transparency sheet, and trim into square.
3 Adhere panel to cardstock square; stamp sentiment.
4 Adhere panel to card with foam tape.
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text:
Real World article
(written from a Production point of view)
(written from a Production point of view)
Star Trek: The Visual Dictionary is a reference book produced by Dorling Kindersley. The book features information from Star Trek, Star Trek: The Next Generation, Star Trek: Deep Space Nine, Star Trek: Voyager, Star Trek: Enterprise and the first ten films, from Star Trek: The Motion Picture to Star Trek Nemesis. The foreword is written by John de Lancie.
Summary Edit
- Publisher's description
- Boldly go where no Trekkie has gone before. "Star Trek the Visual Dictionary" is the final frontier. Charting each and every one of the the voyages of the starship Enterprise. Its mission: to explore everything Star Trek, strange new worlds (and old ones), to seek out every character, ship and series, to boldly go where no book has gone before. Covering all of the six television series, with full coverage of favourite characters such as Spock, Bones, Scotty and Uhura, and full-colour pictures of ships that would make James T. Kirk proud, this is the ultimate guide to "Star Trek" for any Trekkie. Don't be a Vulcan – live long and prosper with "Star Trek the Visual Dictionary".
- Excerpts of copyrighted sources are included for review purposes only, without any intention of infringement.
External linkEdit
- The Visual Dictionary at Memory Beta, the wiki for licensed Star Trek works
Community content is available under CC-BY-NC unless otherwise noted.


text:
Check it out.
Here's another one.
I suppose I should say a word or two to get you to click. Both involve automata and probability, but in rather different ways. I know the suspense must be killing you by now -- all the answers are only a click away!..
UPDATE II: That first paper has a mistake, discovered by Dana Angluin and Lev Reyzin. It has been pulled from submission. The mistake seems fixable and possibly already fixed. Developing...
UPDATE III: (Dec. 13, 2009) A new paper is up by Dana Angluin, David Eisenstat, Lev Reyzin and yours truly. Among other results, it shows that learning DFAs in the way I suggested (by sampling random ones and invoking AdaBoost) is impossible since one can embed parity in random DFAs.
Wednesday, July 8, 2009
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