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INTERVENING WITH TRAINEES NOT ATTAINING PROFESSIONAL COMPETENCY. CCPTP MIDWINTER MEETING. SAVANNAH, GEORGIA FEBRUARY 6, 2009. Linda Forrest, Ph.D. University of Oregon [email protected] Nancy S. Elman, Ph.D. University of Pittsburgh (EMERITUS) [email protected]

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ccptp midwinter meeting

CCPTP MIDWINTER MEETING

SAVANNAH, GEORGIA

FEBRUARY 6, 2009

slide3

Linda Forrest, Ph.D.

University of Oregon

[email protected]

Nancy S. Elman, Ph.D.

University of Pittsburgh (EMERITUS)

[email protected]

workshop overview
• Update on progress since 2006 CCPTP presentation

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

WorkshopOverview
what s new since 2006
What’s New Since 2006
  • Products/Publications
  • Workgroups
  • New Topics Being Studied
  • New Research Underway
taskforce on students with competence problems
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
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
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 updates1
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 updates2
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
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
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
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
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
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
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 d1
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 d2
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!!!
slide19

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

Exosystem

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

Mesosystem:

Interactions among colleagues, peers,

faculty and supervisors

Microsystem:

Direct interaction with peers, students,

supervisors, advisor, instructors

Trainee

Graphic Courtesy of Christiane Oilar Blanco-Vega

microsystem trainees
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
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
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
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
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
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/

resources1
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
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
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 conversations1
Communication: The Art of Difficult Conversations
  • Embrace both stories …the “and” vs. the “but”
  • Map the contributionacross 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
vignettes
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
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
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
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
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
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
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
TAKE HOME POINTS REMINDER
  • IMPORTANCE OF AN ECOSYSTEMIC PERSPECTIVE
  • GET AHEAD OF THE PROBLEM

NOT BEHIND IT!!

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