Slides - APPIC

Informal Problem Consultation
Quality and Competency
Problem Themes
Performance concerns:
Competency Problems – Skills
Competency Problems – Attitude
Competency Problems – Knowledge
Inappropriate Relationships
Policy Violations
Other issues:
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
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
Adjustment to new site
Separation from established support
Status change (advanced student to
Personal life events/changes
Necessary Step
Reconnaissance and 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
Monitor early and often
These steps are often sufficient to manage many problems.
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
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)
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
Important Processes
Ongoing meetings of faculty/staff for review
Consultation from other training personnel
Consideration of possible alternative actions
External consultation
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?
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?
Provide thorough due
process guidelines
and FOLLOW them
Make expectations
clear from the outset
Identify problems
early (no favor)
Provide rationale for
Be aware of the
consequences of
failure to act
Consult colleagues
(internal, external)
Additional Tips
Monitor in multiple ways
Keep the lines of communication open
Inform relevant parties (DCT / Training Team)
Stay informed of current practices
Use APPIC’s Informal Problem Consultation Service
as a resource
Managing Trainnee
Needs & Requests
FOLLOW your policies and
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
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?
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
Staff / Intern / Postdoc
Filing of Informal Problem Consultation
Consultation Services for IPC
Filing of Formal Complaint (ASARC)
Decision on Formal Complaint
Member Vignettes
Interesting Situations
Member Discussion
Training Resources
By Subject
For Trainers
Reference Lists
[email protected] (will refer
you to IPC after brief consult)

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