In the realm of private practice, ethical considerations take centre stage when it comes to allocating resources and deciding the order of treatment for clients. Typically, the approach involves giving priority to urgent referrals, ensuring they receive immediate psychological care, while less pressing cases are added to a waiting list for the next available appointment. Urgent referrals often include clients at risk of self-harm, those with low prevalence conditions, and individuals whose daily functioning is significantly impaired. This urgency coding method aims to address the needs of the most vulnerable clients. However, when a surge of referrals demanding urgent coding occurs, it presents a complex ethical challenge. Normal urgency cases can end up facing prolonged waiting periods.

The heart of this ethical dilemma lies in the fact that urgent referrals, while demanding immediate attention, may not be the most responsive to psychological intervention within a private practice setting. They often require more sessions, increased resource allocation, and may have additional social determinants impacting their health and recovery. Conversely, normal urgency cases, which are likely to respond well to early intervention and require fewer sessions, may deteriorate during the waiting period, affecting their overall recovery. Relying solely on urgency coding to manage waitlists could decrease the likelihood of achieving positive client outcomes across the board.

To effectively address this ethical dilemma, a nuanced approach that considers both the severity of distress (urgency coding) and the likelihood of a successful intervention (priority coding) is imperative. One valuable recommendation is conducting a comprehensive, case-specific review of referrals, assessing each one individually based on the degree of risk and protective factors. Integrating priority criteria with urgency criteria can help identify cases most likely to benefit from psychological intervention. However, it is important to recognise that initial referrals often lack contextual information, necessitating resource-intensive follow-up procedures, such as intake interviews, which may pose economic challenges within the private practice setting.

In my role as a practicing psychologist and clinical leader in a private practice with multiple locations, I am responsible for triaging the waitlist and allocating referrals to clinicians. One of the primary motivations behind the development of Katina was to address the challenge of balancing urgent and non-urgent referrals.

Before the introduction of Katina, identifying high-priority cases was a time-consuming and imprecise process. With Katina, it's like having a dependable assistant who automatically identifies clients in need of urgent review. If a prospective client self-report having thoughts of suicide, engaging in self-harming behaviours, experiencing low prevalence disorders such as schizophrenia, bipolar disorder, or eating disorders, or conditions that can significantly affect functioning, such as perinatal depression/anxiety and school refusal, they are automatically flagged for clinical review. Katina further streamlines the process by organising flagged referrals in a dedicated review section located at the top of the dashboard.

Moreover, Katina's intake form enhances our ability to gather comprehensive information right from the initial contact, aiding in the identification of priority coding factors. Clients can provide insights into contextual factors such as personal challenges, life stressors, relationships, health, work, legal and education issues. It's akin to uncovering the underlying narrative that can sometimes be overlooked when the focus is solely on identifying a specific mental health problem or diagnosis, such as depression or anxiety. Clients can also provide additional information for any other service providers involved in their care.  The inclusion of a free-text field allows clients to share supplementary information, and they can also upload referral documents.

Katina generates a comprehensive profile for each referral, consolidating the data in one location. This streamlines the review process without the need for a separate intake assessment or the arduous task of searching for scattered information in emails or folders. Within the client's profile, we can designate their status as 'Urgent', 'Urgent + Priority', or flag them for 'administrative review' to initiate follow up or to refer on to other agencies, making the placement decision process more efficient. Furthermore, we can save notes directly on the client's profile, facilitating communication and ensuring that critical information is readily accessible to the entire team. Katina also enables us to check for suitable clinicians to match the presenting issues, enhancing the overall quality of our services.

In summary, the ethical considerations of balancing referrals and waitlist prioritisation in private practice are intricate, with the need to address both urgency and the likelihood of a successful intervention. The innovative solution, Katina, streamlines this process by automating the identification of high-priority cases and providing a comprehensive intake form to gather contextual information. By consolidating all this data in one location, Katina enhances efficiency and communication, ensuring that clients receive the right level of care in a timely manner. This ethical, client-centred approach empowers clinicians and private practice owners to make well-informed decisions, ultimately improving the overall quality of care provided.