Informal P roblem Consultation

1. Informal Problem Consultation Quality and Competency

2. Problem Themes • Performance concerns: • Competency Problems – Skills • Competency Problems – Attitude • Competency Problems – Knowledge • Inappropriate Relationships • Policy Violations • Other issues: • Illness • Pregnancy • Discrimination

3. Context Matters • The identification of a trainee’s behavior as problematic needs to involve an analysis of the context. • Is there a structural mismatch between: • Philosophy of the site and the trainee’s orientation • Skills and competencies of the trainee and the demands of the site.

4. Context of the Problem • A number of personal contextual factors in the life of the trainee need to be considered • Adjustment issues to new setting (not site) • Adjustment to new site • Separation from established support systems • Status change (advanced student to equal) • Personal life events/changes

5. Necessary Step • Reconnaissanceand identification of concerns • Gather information over time • Observe response to setting, training experience and feedback • Identify areas of concern verbally and in writing • express concerns as hypotheses and define problem behaviors in concrete and specific terms • Monitor early and often • These steps are often sufficient to manage many problems.

6. Processes • Importance of documentation and written due process • Written due process/grievance procedures (generally in the training handbook) • Review with interns during orientation • Also helpful to have self-care information in the handbook • Follow written procedures carefully when problems arise • Keep clear documentation • Consult with your HR Department

7. Processes Continued • Discussion and consultation when concerns persists • Discuss interventions and next steps with all relevant training personnel • Such discussion should consider:1. Actual behaviors of concern (e.g., nature, frequency, severity) • 2. Settings in which the behaviors occur • 3. Negative consequences of the behaviors • 4. Trainee’s response to feedback • Review of these questions can be time consuming and stressful • Important to thoroughly explore the behaviors in question, full range of interventions, and effects of interventions on all concerned • Interventions should be directly relevant, precise, and well articulated (see remediation section)

8. Process Continued • Implementation and review • Implement intervention plans • Review progress and response to interventions • Communicate with all relevant parties • Provide ongoing feedback • Document all problem behaviors and changes in behavior

9. Important Processes • Ongoing meetings of faculty/staff for review • Consultation from other training personnel • Consideration of possible alternative actions • External consultation

10. Vignette - Competency A current intern is one month into your internship program. She came very highly recommended and based on her application materials it looked as though she would be a strong fit. Since she began the program, she has begun to show some difficulty meeting the demands of her placement. She meets with each of her clients as scheduled but audio recordings reveal that she is somewhat hesitant in her sessions and has difficulty articulating her case conceptualizations and proposed interventions. Her documentation is sometimes late and contains a moderate number of errors. When her primary supervisor attempts to address these concerns, the intern demonstrates anxiety and promises she will work harder and do better. What do you do?

11. Vignette – Ethical Issue Your clinic serves children and families. Intern A has been providing therapy services to a school-aged child who is enrolled at the local elementary school. Intern B is the parent of young child who is also a student at that particular school. You receive an irate call from the parent of the child in treatment saying that Intern B divulged the fact that the family was receiving services and now all of the car pool parents know. What do you do?

12. Tips • Provide thorough due process guidelines and FOLLOW them • Make expectations clear from the outset • Identify problems early (no favor) • Provide rationale for change • Be aware of the consequences of failure to act • Consult colleagues (internal, external)

13. Additional Tips • Inform relevant parties (DCT / Training Team) • Stay informed of current practices • Use APPIC’s Informal Problem Consultation Service as a resource • Monitor in multiple ways • Document • Keep the lines of communication open

14. Managing TrainneeNeeds & Requests FOLLOW your policies and procedures Try to be as flexible as possible Make it clear that not everything can be predicted but the program will respond when new issues arise Negotiate in good faith Consult IPC for support and questions

15. Vignette - Pregnancy An incoming intern contacts you the day after Match Day to report that she is pregnant and due to deliver two months after the internship starts. She would like to take 12 weeks of maternity leave. How do you respond?

16. Legal Issues and Due Process • Simple and easy to understand • Written and communicated to each intern/trainee/post doc at the time he/she begins the internship or post doc • Applied uniformly and in a timely fashion to all such problem or substandard interns/trainees/post docs and to any intern/trainees/post docs complaints about the actions of training program staff • Applied to all serious performance, conduct, and ethical problems of interns/trainees

17. Staff / Intern / Postdoc COMPLAINTS Filing of Informal Problem Consultation Consultation Services for IPC Filing of Formal Complaint (ASARC) Decision on Formal Complaint

18. Member Vignettes • Interesting Situations • Member Discussion

19. APPIC TRAINING RESOURCESwww.appic.org • Training Resources • By Subject • For Trainers • Reference Lists • appic@appic.org (will refer you to IPC after brief consult)