1、Legal and Ethical Issues with Problematic TraineesAssociation of Psychology Postdoctoral and Internship CentersSeventh 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 Submiss
2、ions due in DecemberRoundtrip to 2010 APA Convention in San Diego, with three nights stayStudent presents winning paper at ConventionPaper is published in Ethics and Behavior,Five ThoughtsRegardingLegal and Ethical Aspects of Responding to Problematic Trainees,Five ThoughtsThe relationship among law
3、, ethics, and good psychology training Assessment and remediation plans The ethics of “Gatekeeping” Resources A note on the issue of stigma,Five ThoughtsI. The relationship among law, ethics and good psychology trainingNot to be construed as legal advice,Good law, good ethics, and good psychology tr
4、aining practices go hand-in-hand,Notice and ProcessCentral 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 o
5、f the program content (including participation in required course- or program-related 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
6、 program,APA Commission on Accreditation Guidelines and Principles for Accreditation of Programs in Professional Psychology (2008),Domain E: Student-Faculty Relations4. At the time of admission, the program provides the students with written policies and procedures regarding program and institution
7、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
8、 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 knowprior to program entry, and at the outset of trainingthat faculty, training staff, supervisors,
9、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-trainees knowledge or skills may be assessed (including, but not limited to, emotional stability and
10、well being, interpersonal skills, professional development, and personal fitness for practice).,An Example of Notice:Competency Benchmarks DocumentThis document represents the product of the Assessment of Competency Benchmarks Work Group convened by the APA Board of Educational Affairs in collaborat
11、ion with the Council of Chairs of Training Councils (CCTC)(June 2007),Competency Initiatives in Professional Psychology Education Directorate APA Websitewww.apa.org/ed/graduate/competency.htmlCompetence as the cornerstone of ethics,Competency Initiatives in Professional Psychology Culture of compete
12、nce emergingCompetency initiatives by related organizationsAPA initiatives on assessing and defining competenceCompetency assessment toolkit for professional psychologyResources related to students with competence problems (remediation plan template),A Note on Competency Initiatives in Professional
13、Psychology APA Ethical Standard 2.05 Delegation of Work to Others Psychologists who delegate work to employees, supervisees, or research or teaching assistantstake reasonable steps to(2) authorize only those responsibilities that such persons can be expected to perform competently on the basis of th
14、eir 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 be
15、tween principles in law, ethics, and training A good working relationship with your attorneys will help prevent situations from becoming adversarialTry to work with, not against, your attorneys; educate your attorneys about what you doOrientation of APA General Counsel: How can we help you achieve y
16、our goals?,Make clear to trainees in writing what is expected of themMake clear to trainees what policies apply if they fall short of what is expected of themYou be clear what policies apply if trainees fall short of what is expected of them,The Law of No SurprisesWhat is expected of trainees? What
17、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-vis a remediation plan,Be thoroughly familiar with the process your program has set forthFollow your process carefullyDocument that you
18、 have followed your processProgram 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 compet
19、ence. Training and Education in Professional Psychology, 2, 193-201.,APA Ethics Code Principle C: IntegrityPsychologists 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
20、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 traineesHow far is your rubber band stretched?,Gilfoyle, N. (2008). The legal exosystem
21、: Risk management in addressing student competence problems in professional psychology training. Training and Education in Professional Psychology, 2, 202-209.,Five ThoughtsII. Assessment and Remediation,The Notion of “Problematic” Entails an Assessment,Every problem has a history and a context,McCu
22、tcheon, 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 levelsForrest, L., Elman, N., & Miller, D. (2008)
23、. 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 plansWrite a focused remediation plan,Tie the rem
24、ediation plan to your assessment of the problemA trainees remediation plan follows from an assessment of the trainees deficits that follows from the programs identification of competencies required for successful completion of the program,Three Assessment-related Questions:How does a program assess
25、a trainees competence?Do we ever really know what our trainees are doing?At the outset of the training program, would we ever consider assessing a trainees “baseline ethical understanding”,Baseline Ethical UnderstandingContact outside of sessions?Contact after therapy ends?Accepting gifts?Disclosing
26、 personal information to client?Self disclosures on the Internet?,Tie the remediation plan to your assessment of the problemA Question:Which aspect of your trainees problem or challenge will this aspect of your remediation plan address?,Tie the remediation plan to your assessment of the problemFocus
27、 on behaviors that need to change rather than diagnosesRemediation 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-r
28、elated 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 admi
29、ssions 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
30、 students or others.,A cautionary note regarding therapy as an aspect of remediation,APA Ethical Standard 7.05 Mandatory Individual or Group Therapy,When individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and gra
31、duate programs the option of selecting such therapy from practitioners unaffiliated with the program. Faculty who are or are likely to be responsible for evaluating students academic performance do not themselves provide that therapy.,Five ThoughtsIII. The Ethics of “Gatekeeping”,Training as “Gateke
32、eping”Gatekeeping involves:1) A passage between2) Two or more places with the3) Authority to allow passage, or not, and the4) Responsibility for that decision.,An Ethical Dilemma in TrainingPrinciple A: Beneficence and Nonmaleficence vs Principle E: Respect for Peoples Rights and DignityBenefiting/N
33、ot 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 c
34、ohortWould you refer a close friend or family member to this individual?,Beware of thePromoveatur ut AmoveaturPrinciple,The ethics of feedback in the gatekeeping processA return to notice and process,APA Ethical Standard 7.06 Assessing Student and Supervisee Performance,(a) In academic and superviso
35、ry 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
36、of their actual performance on relevant and established program requirements.,Commission on Accreditation Guidelines & Principles (2008),Domain E: Student-Faculty Relations4. Students receive, at least annually, written feedback on the extent to which they are meeting the programs requirements and p
37、erformance 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 corre
38、ctive 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 institutions regulations and local, state, and federal statutes regarding due process and fair treatment of students.,A signif
39、icant 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 E
40、thical 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:,B
41、eware of the impulse to be helpful and do good,Five ThoughtsIV. Important Resources,Important Resources APA Ethics Code (www.apa.org/ethics) APA Education Directorate (www.apa.org/ed) Association of Psychology Postdoctoral and Internship Centers (appic.org) APA Guidelines: Multicultural guidelines;
42、Guidelines for working with older adults; Guidelines for psychotherapy with lesbian, gay, and bisexual clients. (www.apa.org) Your jurisdictions statutes and regulations Council of Chairs of Training Councils (www.psychtrainingcouncils.org/) Association of Directors of Psychology Training Clinics (w
43、ww.adptc.org) Association of State and Provincial Psychology Boards (ASPPB.org),Five ThoughtsV. A Note on the Issue of Stigma,The Americans with Disabilities ActDisability that substantially limits a major life activity Can complete essential requirements of program with “reasonable accommodations”D
44、oes not require change in nature of program, lowering program standards, undue expense,APA Office on Disability Issues in PsychologyAnju Khubchandani (202) 336-6038How disability-friendly is your program?,A Question:Do you view working with a trainee with a disability primarily as an imposition or a
45、s an opportunity?,National Association of Law Students with Disabilitieswww.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,S
46、econd Final Observation:Consider responding to problematic trainees as a competence in an of itselfWho 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 co
47、nsider: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 APPICs Seventh Membership Meeting and Conference!(202) 336-5930 sbehnkeapa.org,
