INTERVENING WITH TRAINEES NOT ATTAINING

PROFESSIONAL COMPETENCY

CCPTP MIDWINTER MEETING

SAVANNAH, GEORGIA

FEBRUARY 6, 2009

Linda Forrest, Ph.D.University of Oregon

forrestl@uoregon.edu

Nancy S. Elman, Ph.D.University of Pittsburgh (EMERITUS)

elman@pitt.edu

Workshop Overview

• Update on progress since 2006 CCPTP presentation

• Opportunity to engage in difficult conversations and challenges across the training ecology

What’s New Since 2006

• Products/Publications• Workgroups• New Topics Being Studied• New Research Underway

Taskforce on Students with Competence Problems

• Community of scholars grows• Diverse group representing all levels• Scholarship expands• Focus on:

– Improving terminology– Generating data– Developing remediation template– Increasing capacity for difficult dialogues

New Product Updates

• CCTC communication between graduate programs & internships– recommendations for model statement

• Trainee Remediation Plan Template– Plan being circulated among training councils– Review & feedback requested

Publication Updates

• Professional Psychology: Research & Practice– Special Section: Assessment of Competence– Volume 38(5), October, 2007

• Recognizing, assessing & intervening with problems of professional competence (Kaslow et al.)– covers definitions, preparing the system, self

assessment, remediation, diversity, communication across system, confidentiality

• New terminology: Problems w/ professional competence (Elman & Forrest)

Publication Updates

• Training and Education in Professional Psychology– Special Section: Editor, Kathy Bieschke– Systemic Approaches to Trainees with

Professional Competence Problems

• Volume 2 (4), November 2008

Publication Updates• TEPP Special Section - Three articles - Ecological Model (Forrest, Elman & Miller) - Problem Solving Model (Wester,

Christianson, Fouad & Santiago-Rivera) - Legal Risk Management (Gilfoyle, APA

Counsel)• Two Responses

- Chair of APPIC (McCutcheon)- Director of APA Ethics Office (Behnke)

Volume 2 (4), November 2008

Workgroup Updates

• CoA Accreditation Assembly: Impact of FERPA/HIPAA Regulations on Addressing Trainees with PPC (2008)

• Assessment of Competencies Benchmark Workgroup (2006)

• BEA Competency Assessment Workgroup (2007)

• ASPPB Workgroup on Practicum Competencies

New Topic Update

• Intersection of diversity with faculty deliberations• Research shows great variation across faculty • Continuum of faculty conceptualizations from

color blind to context/culture attentive• More variation expressed by faculty who

attempted to integrate context-attentive strategies than faculty who ascribed to color-blind approach

(Shen Miller, Forrest & Elman, in press; Miller, 2008; Shen-Miller, Forrest & Burt, under review)

New Research Updates

• Student Sample– training to intervene with peer– understanding of ethical & legal responsibilities– program climate for intervening with peer– individual decision making– evaluation of student’s actions and impact – ENCOURAGE YOUR STUDENTS TO PARTICIPATE

• TDs Sample – Faculty actions that help or hinder efforts to address

trainees with competence problems– PLEASE PARTICIPATE

Developing Appropriate Remediation Plans

• Trainee Remediation Plan Template – Goal: Tool to help faculty address

remediation comprehensively– Work-in-progress: Seeking feedback as you

review now or if you use it– Send feedback to us or Cathi Grus at APA

Effective Remediation• It’s All in the Timing! • Remediation model in place FIRST• Policy lines up w/ local and national

standards• Review APA website for competencies,

benchmarks, assessment toolbox• Base remediation policy in

COMPETENCY language• Educate others about importance of

remediation in advance

Effective Remediation(cont.d)

• Don’t wait - Start early

• Develop remediation with the student

• Use remediation template as guide

• Commit to being in difficult conversations

• Clarify that student understands

• Seek remediation actions that match specific competencies of concern

Effective Remediation(cont.d)

• Focus: Meeting competency benchmarks– Translate problems into competency language– Include all competencies that apply– Describe expectations for performance

• Describe trainee & faculty actions

• Determine assessment methods

• Plan includes date certain for review

Effective Remediation(cont.d)

• If trainee disagrees with plan, require written description of disagreement

• Plan signed by all persons involved• At time of summative eval,

– Determine if each benchmark has been met– Develop next steps (continuation, modification, due

process/grievance)– If student disagrees with next steps, require written

description of disagreement

• FOLLOW THROUGH TO CONCLUSION• Consultation helps!!!

Trainee

Microsystem:Direct interaction with peers, students, supervisors, advisor, instructors

Mesosystem:Interactions among colleagues, peers, faculty and supervisors

ExosystemLicensure, accreditation, gate-keeping requirements, evaluation, remediation and dismissal policies, professional competency standards, legal statutes, court cases

Macrosystem:Cultural beliefs about being a psychologist and training practices to become a psychologist. Social blueprint such as attitudes about race/ethnicitygender/sexual orientation/disability

Multi-system Interactions

Graphic Courtesy of Christiane Oilar Blanco-Vega

Microsystem: Trainees

• Revise curriculum• Make sure trainees know ethical responsibilities

and how to live them.• Review relevant standards in Ethics Code• Teach scholarship on competence problems• Train for difficult conversations• Provide opportunities to practice• Model transparent interventions – if we can’t do

it how can we expect trainees to do it! • Create prevention for profession

Mesosystem: Chairs & Deans

• Administrators hate to be surprised• That’s when they are less supportive • Educate/share ecological framework• Discuss best practices at each level of ecology• Identify potential complications in advance• Obtain consensus on following the policies and

the risks of not• Stay current w/ policy changes: local & national• Review & revise policies together

Exosystem: Attorneys

• Remember courts continue to support faculty judgments of dismissal if handled properly

• Discuss program policies with attorneys in advance

• Clarify university or local policies/ laws affecting program’s options

• Educate attorney about psychology training & share relevant articles (e.g., Gilfoyle, 2008)

• Establish and agree upon sequence and timing of notification/consultation

Exosystem: Dynamic Policies

• Stay current w/ policy changes– University policy– Ethics Code – Accreditation– National policy (e.g., FERPA & HIPAA)– State regulations– Court cases

FERPA as Example• Family Education Rights & Privacy Act• Protection of student records - Current

modifications in wake of campus tragedies• Requires a significant ARTICULABLE threat &

rational basis • Allows sharing of records under some

circumstances: Check local definition • Provide notice of need to share in program

handbook• Obtain appropriate signed releases in advance• Consent now part of APPI application

Resources

• Elman, Springer & Baker (2008). The Impact of HIPAA/FERPA Regulations on Addressing Trainees with Problems of Professional Competence.

Symposium presented at the APA Commission on Accreditation Annual Assembly

Available at www.apa.org/ed/accreditation/

Resources

• Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA)And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records

– Document produced by US Department of Health & Human Services & Department of Education

– Distributed November, 2008; Effective February 2009

Macrosystem: Current Economic Conditions

• Competence problems are labor-intensive.• What if:

– fewer faculty doing more?– community agencies less willing to supervise?– overworked supervisors less willing to

address competence problems?– fewer accredited/paid internships?– universities more fearful of lawsuits?

Communication: The Art of Difficult Conversations

• Tips on effective learning conversations with the identified trainee, other trainees, faculty, administrators, & attorneys.

• Stone, D., Patton, B., & Heen, S. (1999). Difficult conversations: How to discuss what matters most. New York: Penguin.

Communication: The Art of Difficult Conversations

• Embrace both stories …the “and” vs. the “but”• Map the contribution across the system…not

the blame• Explore what happened: “learning conversation”• Explore how identity and feelings are involved• Create a problem-solving dialogue• Keep standards in mind• Invent creative options/solutions

QUESTIONS?

Vignettes

• Divide into 10 groups, 5 vignettes

• Identify volunteer recorders

• Discuss questions or role play; observe, notice ideas, reactions, solutions (25 minutes)

• Large group report back (20 minutes)

• COFFEE BREAK!!

Student on Remediation

• Competencies of concern: professionalism, self assessment, relationships

• Concerns identified across settings• Remediation includes:

– tasks to address each competency domain– strategies for evaluation– timeline & consequences

• Midyear evaluation shows no progress• Student continues to be in denial/blame others

• What do you do??

Peers Act Unprofessionally

• Student on remediation plan• Faculty did not consider impact on other

students• Other students express concern via gossip &

other unprofessional behavior • Faculty recognize unhealthy nature of situation &

agree action is needed

• What do you do??

Troublesome Faculty Member

• Faculty member has close working relationship with student on remediation

• Faculty member undermines remediation– over focuses on student’s strengths– avoids giving negative feedback– communicates that all is well, no concern

• At next faculty meeting, faculty member wants to soften & restructure remediation

• What do you do??

Letter to Chair/Dean

• Student names seriously disturbed peer• Letter writer expresses concerns:

– Peer disrupts other students’ training– Concern about client care– Concern faculty not doing enough

• Frustrated/turning to Chair/Dean for help• Chair/Dean sends copy of letter to you &

requests meeting• Student identified in letter on remediation

• What do you do??

U. Attorney Rejects Dismissal Recommendation

• Strong case for dismissal– Followed policy/Excellent documentation– Provided opportunity to remediate– Student unable to meet competencies– Program has followed due process policies

• Faculty vote to dismiss• Attorney does not support decision

– Budget before state legislature – Fear of front page negative publicity

• What do you do??

WHAT NEXT?

• We encourage you to use this knowledge and practice as a catalyst to: – Explore challenges with your faculty– Create new or review/modify existing policies– Develop curriculum to educate trainees – Educate others in the ecosystem – Develop relationships across the training

ecosystem to sustain the process when needed.

TAKE HOME POINTS

REMINDER

• IMPORTANCE OF AN ECOSYSTEMIC PERSPECTIVE

• GET AHEAD OF THE PROBLEM

NOT BEHIND IT!!