Transcript Now doctor, isn’t it true that when a person dies in his

Legal and Ethical Issues with
Problematic Trainees
Association of Psychology Postdoctoral and Internship
Centers
Seventh Membership Meeting and Conference
Portland, Oregon
Stephen Behnke, JD, PhD
APA Ethics Office
April 17, 2009
The 2009 APA Student Ethics Writing Prize!
www.apa.org/ethics
$1000
Submissions due in December
Roundtrip to 2010 APA Convention in San Diego,
with three nights stay
Student presents winning paper at Convention
Paper is published in Ethics and Behavior
Five Thoughts
Regarding
Legal and Ethical Aspects of
Responding to Problematic
Trainees
Five Thoughts
1.The relationship among law, ethics, and
good psychology training
2.Assessment and remediation plans
3.The ethics of “Gatekeeping”
4.Resources
5.A note on the issue of stigma
Five Thoughts
I.
The relationship among law, ethics
and good psychology training
Not to be construed as legal advice
Good law, good ethics, and good
psychology training practices go
hand-in-hand
Notice and Process
Central to both law and ethics
APA Ethical Standard 7.02
Descriptions of Education and Training
Programs
Psychologists responsible for education and training
programs take reasonable steps to ensure that there is a
current and accurate description of the program content
(including participation in required course- or programrelated counseling, psychotherapy, experiential groups,
consulting projects, or community service), training goals
and objectives, stipends and benefits, and requirements
that must be met for satisfactory completion of the
program…
APA Commission on Accreditation
Guidelines and Principles for Accreditation of
Programs in Professional Psychology (2008)
Domain E: Student-Faculty Relations
4. At the time of admission, the program provides the
students with written policies and procedures
regarding program and institution requirements and
expectations regarding students’ performance and
continuance in the program and procedures for the
termination of students.
An Example of Notice:
Competency Benchmarks
Document (July 2004)
Product of the Competency Benchmarks Work
Group convened by the APA BEA in
collaboration with the Council of Chairs of
Training Councils
Competency Benchmarks Document
(July 2004)
Students and trainees in professional psychology programs (at
the doctoral, internship, or postdoctoral level) should
know—prior to program entry, and at the outset of
training—that faculty, training staff, supervisors, and
administrators have a professional, ethical, and potentially
legal obligation to: (a) establish criteria and methods
through which aspects of competence other than, and in
addition to, a student-trainee's knowledge or skills may be
assessed (including, but not limited to, emotional stability
and well being, interpersonal skills, professional
development, and personal fitness for practice)...
An Example of Notice:
Competency Benchmarks Document
This document represents the product of the
Assessment of Competency Benchmarks Work
Group convened by the APA Board of Educational
Affairs in collaboration with the Council of Chairs of
Training Councils (CCTC)…(June 2007)
Competency Initiatives in
Professional Psychology
Education Directorate
APA Website
www.apa.org/ed/graduate/competency.html
Competence as the cornerstone of ethics
Competency Initiatives in Professional
Psychology
• Culture of competence emerging
• Competency initiatives by related organizations
• APA initiatives on assessing and defining
competence
• Competency assessment toolkit for professional
psychology
• Resources related to students with competence
problems (remediation plan template)
A Note on Competency Initiatives in Professional
Psychology
APA Ethical Standard 2.05 Delegation of Work to Others
Psychologists who delegate work to employees, supervisees, or
research or teaching assistants…take reasonable steps to…(2)
authorize only those responsibilities that such persons can be
expected to perform competently on the basis of their education,
training, or experience, either independently or with the level of
supervision being provided; and (3) see that such persons
perform these services competently.
Ensure that whatever trainees are asked to do, supervising faculty
are competent to do (e.g., language)
Strong convergence between principles
in law, ethics, and training
A good working relationship with your attorneys
will help prevent situations from becoming
adversarial
Try to work with, not against, your attorneys;
educate your attorneys about what you do
Orientation of APA General Counsel:
How can we help you achieve your goals?
• Make clear to trainees in writing
what is expected of them
• Make clear to trainees what
policies apply if they fall short of
what is expected of them
• You be clear what policies apply if
trainees fall short of what is
expected of them
The Law of No Surprises
• What is expected of trainees?
• What happens if a trainee falls short of
expectations?
• Whether a particular trainee is meeting
program expectations
• The status of a particular trainee in the
program vis-à-vis a remediation plan
• Be thoroughly familiar with the
process your program has set forth
• Follow your process carefully
• Document that you have followed
your process
• Program faculty speak with one, not
multiple, voices regarding process
Wester, S. R., Christianson, H. F., Fouad, N.
A., & Santiago-Rivera, A (2008).
Information processing as problem solving:
A collaborative approach to dealing with
students exhibiting insufficient competence.
Training and Education in Professional
Psychology, 2, 193-201.
APA Ethics Code
Principle C: Integrity
Psychologists seek to promote accuracy,
honesty, and truthfulness in the science,
teaching, and practice of psychology…
An interesting article from the
Montana Kaimin
A Quotation
"We are our own worst enemies. In the
guise of being humane, we fail to tell
students the truth."
Professor Nabil F. Haddad
Chair, Department of Psychology
University of Montana
Beware of the “rubber band”
response to problematic
trainees
How far is your rubber band
stretched?
Gilfoyle, N. (2008). The legal exosystem: Risk
management in addressing student
competence problems in professional
psychology training. Training and Education
in Professional Psychology, 2, 202-209.
Five Thoughts
II.
Assessment and Remediation
The Notion of “Problematic” Entails an
Assessment
Every problem has a history and a context
McCutcheon, S.R. (2008). Addressing
problems of insufficient competence during
the internship year. Training and Education
in Professional Psychology, 2, 210-214.
A Question:
How much of the variance belongs to
whom/where?
Assess at individual and system levels
Forrest, L., Elman, N., & Miller, D. (2008).
Psychology trainees with competence problems:
From individual to ecological conceptualizations.
Training and Education in Professional
Psychology, 2, 183-192.
Beware of the “pot pourri,”
“kitchen sink” and “more is
better” approaches to
remediation plans
Write a focused remediation
plan
Tie the remediation plan to your assessment
of the problem
A trainee’s remediation plan
follows from
an assessment of the trainee’s deficits
that follows from
the program’s identification of
competencies required for successful
completion of the program
Three Assessment-related Questions:
• How does a program assess a trainee’s
competence?
• Do we ever really know what our trainees
are doing?
• At the outset of the training program,
would we ever consider assessing a trainee’s
“baseline ethical understanding”
Baseline Ethical Understanding
•
•
•
•
•
Contact outside of sessions?
Contact after therapy ends?
Accepting gifts?
Disclosing personal information to client?
Self disclosures on the Internet?
Tie the remediation plan to your
assessment of the problem
A Question:
Which aspect of your trainee’s problem or
challenge will this aspect of your
remediation plan address?
Tie the remediation plan to your
assessment of the problem
Focus on behaviors that need to change
rather than diagnoses
Remediation Plan Template
www.apa.org/ed/graduate/competency.html
APA Ethical Standard 7.04:
Student Disclosure of Personal Information
Psychologists do not require students or supervisees to disclose
personal information in course- or program-related activities,
either orally or in writing, regarding sexual history, history of
abuse and neglect, psychological treatment, and relationships with
parents, peers, and spouses or significant others except if (1) the
program or training facility has clearly identified this requirement
in its admissions and program materials or (2) the information is
necessary to evaluate or obtain assistance for students whose
personal problems could reasonably be judged to be preventing
them from performing their training- or professionally related
activities in a competent manner or posing a threat to the students
or others.
A cautionary note regarding
therapy as an aspect of
remediation
APA Ethical Standard 7.05
Mandatory Individual or Group Therapy
(a)When individual or group therapy is a program or
course requirement, psychologists responsible for
that program allow students in undergraduate and
graduate programs the option of selecting such
therapy from practitioners unaffiliated with the
program.
(b)Faculty who are or are likely to be responsible for
evaluating students' academic performance do not
themselves provide that therapy.
Five Thoughts
III.
The Ethics of “Gatekeeping”
Training as “Gatekeeping”
Gatekeeping involves:
1) A passage between
2) Two or more places with the
3) Authority to allow passage, or not, and the
4) Responsibility for that decision.
An Ethical Dilemma in Training
Principle A: Beneficence and Nonmaleficence
vs
Principle E: Respect for People’s Rights and Dignity
Benefiting/Not harming the client
vs.
Allowing trainees to make their own mistakes, an
inevitable and important part of their development
Gatekeeping involves considering and
balancing multiple ethical responsibilities:
To the public
To the trainee
To the profession
To your program
To the other trainees in the cohort
Would you refer a close friend or family member to this
individual?
Beware of the
Promoveatur ut Amoveatur
Principle
The ethics of feedback in the
gatekeeping process
A return to notice and process
APA Ethical Standard 7.06
Assessing Student and Supervisee Performance
(a) In academic and supervisory relationships,
psychologists establish a timely and specific process
for providing feedback to students and supervisees.
Information regarding the process is provided to the
student at the beginning of supervision. (emphasis
added)
(b) Psychologists evaluate students and supervisees on
the basis of their actual performance on relevant and
established program requirements.
Commission on Accreditation Guidelines & Principles
(2008)
Domain E: Student-Faculty Relations
4. …Students receive, at least annually, written feedback on the extent to
which they are meeting the program’s requirements and performance
expectations. Such feedback should include:
(a) Timely, written notification of all problems that have been noted and
the opportunity to discuss them;
(b) Guidance regarding steps to remediate all problems (if remediable);
and
(c) Substantive, written feedback on the extent to which corrective
actions are or are not successful in addressing the issues of concern.
In all matters relevant to the evaluation of students’ performance,
programs must adhere to their institution’s regulations and local, state,
and federal statutes regarding due process and fair treatment of students.
A significant challenge in
training:
When should the program
intervene and what intervention
is most appropriate at that time?
When should the program intervene and
what intervention is most appropriate at
that time?
Primarily remediation or
discipline?
Your answer will have implications for your
process
APA Ethical Standard 3.05:
Multiple Relationships
Multiple multiple relationships exist
within training programs,
rendering an appropriate response
complicated
Multiple relationships can get in the way of
implementing a good remediation plan
A potential impediment to
responding to problematic trainees:
Beware of the impulse to be
helpful and do good
Five Thoughts
IV.
Important Resources
Important Resources
1) APA Ethics Code (www.apa.org/ethics)
2) APA Education Directorate (www.apa.org/ed)
3) Association of Psychology Postdoctoral and Internship
Centers (appic.org)
4) APA Guidelines: Multicultural guidelines; Guidelines for
working with older adults; Guidelines for psychotherapy
with lesbian, gay, and bisexual clients. (www.apa.org)
5) Your jurisdiction’s statutes and regulations
6) Council of Chairs of Training Councils
(www.psychtrainingcouncils.org/)
7) Association of Directors of Psychology Training Clinics
(www.adptc.org)
8) Association of State and Provincial Psychology Boards
(ASPPB.org)
Five Thoughts
V.
A Note on the Issue of Stigma
The Americans with Disabilities
Act
• Disability that substantially limits a major life
activity
• Can complete essential requirements of
program with “reasonable accommodations”
Does not require change in nature of program,
lowering program standards, undue expense
APA Office on Disability Issues
in Psychology
Anju Khubchandani
(202) 336-6038
How disability-friendly is your program?
A Question:
Do you view working with a
trainee with a disability
primarily as an imposition or
as an opportunity?
National Association of Law
Students with Disabilities
www.nalswd.org
Final Observations
First Final Observation:
FERPA
(Family Educational Rights and Privacy Act)
Rarely an impediment to a good
faith, reasonable disclosure to
others in an educational institution
with a need to know
Second Final Observation:
Consider responding to problematic
trainees
as a competence in an of itself
Who in your training program has this
competence?
“To the extent we become better teachers, students will become
better professionals” McCutcheon, 2008
Third Final Observation:
An important subject to consider:
Legal and Ethical Aspects of
Responding to Problematic
Faculty Members and
Supervisors
“To the extent we become better teachers, students will become
better professionals” McCutcheon, 2008
Fourth Final Observation:
Get students involved and
active in professional
associations!
Fifth and Final Observation:
APA Convention in Toronto
Saturday, 4-5:50pm, Room 801B
Thinking Together:
APA and ASPPB Explore Where
Ethics and Licensure Converge
Thank You,
APPIC, for including the APA Ethics
Office in APPIC’s
Seventh Membership Meeting and
Conference!
(202) 336-5930
[email protected]