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INTERVENING WITH TRAINEES NOT ATTAINING PROFESSIONAL COMPETENCY

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.

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INTERVENING WITH TRAINEES NOT ATTAINING PROFESSIONAL COMPETENCY

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  1. INTERVENING WITH TRAINEES NOT ATTAINING PROFESSIONAL COMPETENCY

  2. CCPTP MIDWINTER MEETING SAVANNAH, GEORGIA FEBRUARY 6, 2009

  3. Linda Forrest, Ph.D. University of Oregon forrestl@uoregon.edu Nancy S. Elman, Ph.D. University of Pittsburgh (EMERITUS) elman@pitt.edu

  4. • Update on progress since 2006 CCPTP presentation • Opportunity to engage in difficult conversations and challenges across the training ecology WorkshopOverview

  5. What’s New Since 2006 • Products/Publications • Workgroups • New Topics Being Studied • New Research Underway

  6. 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

  7. 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

  8. 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)

  9. 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

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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!!!

  19. 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

  20. 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

  21. 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

  22. 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

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

  24. 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

  25. 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/

  26. 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

  27. 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?

  28. 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.

  29. 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

  30. QUESTIONS?

  31. 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!!

  32. 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??

  33. 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??

  34. 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??

  35. 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??

  36. 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??

  37. 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.

  38. TAKE HOME POINTS REMINDER • IMPORTANCE OF AN ECOSYSTEMIC PERSPECTIVE • GET AHEAD OF THE PROBLEM NOT BEHIND IT!!

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