1 Ethical Issues in Supervision- Supplemental Handout June, 20, 2015 John A. Jay Mills, Ph.D., ABPP; Samuel Knapp, Ed.D., ABPP Program Description This workshop will provide supervisors and supervisees with an understanding of the ethical issues surrounding supervision including the Pennsylvania State Board of Psychology s Regulations dealing with postdoctoral supervision. The workshop will review the basic requirements for ethical supervision, common pitfalls, and give supervisors an understanding of the requirements that must be met for obtaining post doctoral supervision. Learning Objectives At the end of the program the participants will be able to 1. Describe essential factors involved in ethically sound and effective supervision; and 2. List or identify the State Board of Psychology requirements for post doctoral supervision. This workshop fulfills the requirement of the State Board of Psychology that every post doctoral supervisor after December 15, 2015 must have a course in supervision. Supervision and the APA Ethics Code Psychologists and Their Relationships with Supervisees: Psychologists delegate work to supervisees only if they are competent to perform the assigned tasks and if their performance is monitored (2.05); inform supervisees ahead of time of the nature of their services so the supervisees can make an informed decision about accepting the relationship (3.11); inform supervisees of the standards for feedback (7.06a) and evaluate them based on their actual performance (7.06b). Psychologists take reasonable steps to protect their supervisees from harm (3.04), exploitation (3.08), and do not have sex with them (7.07). Psychologists avoid delegating responsibilities to supervisees when there is a risk of a multiple relationship that could lead to the loss of objectivity or exploitation (2.05). Supervisees Relationships with their Patients: Also supervisees must inform clients/patients of the supervised nature of the relationship (10.01c). Other: Psychologists do not promote the use of assessment by unqualified persons, except trainees (9.07). One of the ways that psychologists can achieve competency in a field is through supervision (2.02a).
2 Standards of the State Board of Psychology Definitions Primary supervisor: A currently licensed psychologist having primary responsibility for directing and supervising the psychology resident Psychology intern: A student participant in an internship as part of a doctoral degree program in psychology or a field related to psychology Psychology Resident: An individual who has obtained a doctoral degree and is fulfilling the supervised experience requirement for license, or an applicant for licensure who is continuing training under 41.31 (4) (relating to educational qualifications Psychology Trainee: A psychology intern or psychology resident 49 PA Code 41.1 Secondary (or delegated) Supervisor: The regulations of the State Board of Psychology have inconsistent definitions of the term secondary supervisor. One section states that the secondary or delegated supervisor has to be licensed. However, the regulations also state that the delegated supervisor must hold a current license, certificate or registration from a health related board within the Bureau of Professional or Occupational Affairs or a person who is exempt from licensure under section 3 (4) (8) of the act. This could include unlicensed counselors, social works, drug and alcohol counselors, pastoral counselors and others. Standards in 41.32 Hours and Time: At least 12 months and 1,750 hours. No more than 45 hours per week, but no less than 15 hours a week, minimum of 6 consecutive months. If there are two or more work settings (not the same agency), then the supervisee needs to get a minimum of 15 hours at each location and a minimum of two hours of supervision a week at teach location. Content: 50% in diagnosis, assessment, therapy, other interventions, supervision or consultation and receiving supervision or consultation. The remaining required hours may be obtained by teaching with in organized psychology program preparing practicing psychologists Time Limits: All experience within 10 calendar year period from getting the degree. Waivers made on a case by case basis, including reasons of health What Does not Qualify: No credit where psychology resident acts independently, such as a qualified member of another recognized profession Waivers: Waivers can be granted under unusual circumstances
3 Standards in 41.33 (a) (b) Qualifications of primary supervisor: (1) licensed, (2) no active suspension or revocation by licensing board, (3) qualified in area of service by supervisee (4) own, employed by or in contract status of organization that employs resident; (5) after December 15, 2015 have a course in supervision; (6) no dual relationship with supervisee (not related by blood or marriage, not have treated supervisee, no dual relationship). Primary supervisors may delegate 1 hour per week to a secondary supervisor Qualifications of secondary supervisor: licensed in any health care profession or qualified member of another recognized profession Obligations: 1. Reviews issues of practice and ethics with supervisee 2. Meet an average of 2 face to face hours per week 3. Ensure that resident status is known to client/patients or third parties 4. Maintain notes for 10 years (or until supervisee is licensed); 5. quarterly reports Standards in 41.33 (6) ( c) The requirements of the State Board of Psychology agree with the APA Ethics Code. Standards in 41.33 (6) ( c) APA Ethics Code By 2015 have a course in supervision develop with the psychology resident objectives to be achieved during 7.06 supervision Be accessible to the psychology resident for consultation and to client/patients 2.05; 3.04, 3.08 of the psychology resident to answer questions and respond to concerns Be responsible to each client/patient for psychology services provided by the 2.05; 3.04; 3.08 psychology resident Be authorized to interrupt or terminate the services being provided by the 2.05; 3.04; 3.08 psychology resident to a client/patient and, if necessary, to terminate the supervisory relationship Observe client/patient sessions of the psychology resident or review verbatim 7.06 records of these sessions on a quarterly basis At least quarterly... apprise the psychology about areas of progress and needed 7.06 improvement... Assist the psychology resident in working with professionals in other 2.05 disciplines as indicated... Ensure that the psychology resident has access to multidisciplinary consultation, 2.05 as necessary Monitor the supervision provided by any delegated supervisor 2.05 At the conclusion of the period of supervision, evaluate the psychology 7.06
4 resident s level of professional competence... Informed Consent Recommendations for Supervisees: Components of Agreement (Sutter et al., 2002; Thomas 2007) Supervisors background: including areas of expertise, supervisory methods, such as observation, test reviews, report reviews, etc., Supervisor s responsibilities which may examples of situations that supervisees must bring to their supervisors such as: disputes with clients or therapeutic impasses, allegations of unethical behavior by clients regardless of how apparently absurd; threats of complaints or lawsuits; any life endangering behaviors or threats; any departure from standard rules- even if apparently justified under unique circumstances; clinical errors; contacts with clients outside of therapy even if unavoidable; any mandated reporting situation. Supervisees should also require adherence to APA Ethics Code and the Green Book (State Board requirements). Potential Supplemental Requirements (if remedial work is required, such as additional reading, additional supervision or even personal therapy- if made explicit before hand as a possibility) Policies including adherence to APA Ethics Code, state laws, and institutional rules; Process of Documenting Supervision: general statement of what is documented and how; Financial Policies, payment policies (including how to be paid and malpractice insurance details and any benefits); Evaluation: details on how employees are supervised and also complaint procedures and due process: Professional Development Goals: ideally generated with the supervisee Endorsement (agreement to complete verification forms to get licensed; including early identification of problems that could prevent them from completing such forms) Duration and Termination of Agreement, including circumstances that could lead to the early termination (noncompliance with agreement, misrepresentation or concealment of clinical information; violations of ethical standards, inadequate job performance such as excessive tardiness or absenteeism, etc.) BE SURE TO GO OVER THE GREEN BOOK (State Board regulations)
5 Sample Agreement Jay Mills, Ph.D,, being a licensed psychologist with expertise in treating children, do hereby agree to supervise, Samuel Knapp, Ed.D., starting on August 1, 2013 to July 31, 2014 for the purpose of getting supervision needed to qualify to become licensed as a psychologist in the State of Pennsylvania. I am qualified as the supervisor as I have no current disciplinary complaints against me and I am qualified in the area in which I am supervising Dr. Knapp. There is no dual relationship that would prohibit this supervisory relationship. Dr. Knapp will be hired as an independent contractor and will receive 40% of all revenues generated from his professional work which will include psychological and psychoeducational assessments, vocational assessments, and counseling and psychotherapy. He will purchase his own malpractice insurance. Office space and secretarial assistance will be provided consistent with agency policy. Dr. Knapp will disclose his trainee status to all clients/patients. Dr. Knapp agrees to work an average of 40 hours a week for one year. The agency policies on vacation, sick leave, and holidays will apply. Dr. Knapp agrees to adhere to the APA Ethics Code, APA standards and guidelines, and standards of the Pennsylvania State Board of Psychology, and all office policies. Dr. Knapp agrees to inform the supervisor of all relevant information obtained in assessment, counseling or therapy related to patient welfare including aggressive or suicidal ideation, serious threats to property, suspicions of child abuse, or other circumstances likely to harm patients or third parties. Documentation will be in accordance with agency policies and state and federal laws. All records will belong to the agency upon the termination of this agreement. As supervisor, I agree to adhere to the Standards of the State Board of Psychology for postdoctoral supervisees and to complete the requirements and forms necessary for Dr. Knapp to become licensed as a psychologist in Pennsylvania. This includes two hours of face to face supervision by myself (or 1 hour by myself and 1 hour by a delegated supervisor to be named), I will provide learning opportunities that will meet the standards of the State Board of Psychology and provide quarterly evaluative reports consistent with those requirements. Remedial work, if any, will be discussed early and Dr. Knapp will be given the opportunity to correct any deficiencies. Either party has the right to terminate this agreement given two weeks notice, except that Dr. Knapp may be dismissed for cause including a breach of the APA Ethics Code, the regulations of the State Board of Psychology, or agency policies.
6 When Things Go Wrong It does not happen frequently, but at times psychologist will encounter psychology residents who have competence problems: 1. Identify early 2. Be specific--- give examples 3. Clarify how to remediate in as objective terms as possible 4. Monitor and give feedback on progress Problems Wants to become licensed without a postdoctoral years of supervision because attended school in a state that allows two years of predoctoral supervision Received supervision in a state that allows supervisees to pay their supervisors directly Attended a foreign (not Canadian) University Program not accredited by APA/CPA (or ASPPB/NR) Percentage of hours in direct service below 50%. Total number of hours in other services causes direct service to go below 50% Did not stay at location for 6 months minimum Did not receive an average of two hours of face to face supervision each week. Did not inform patients or third parties of their supervised status Reimbursement for services provided as a member of another licensed profession Common Questions How many supervisees can on supervisor supervise? Do reports sent out of the office have to be cosigned by a supervisor? What teaching could qualify for the supervisory hours?
7 Create a Waiver The Board must approve waivers based on unusual circumstances ahead of time. The general goal in asking for waivers is to ensure that as many of the Board requirements can be met as possible and to ensure that the twin goals of supervision are met: That is, the psychological resident is growing professionally and that the patients are being protected. What conditions could the psychology resident propose to the Board that would maximize the chances of having this arrangement acceptable? A psychology resident has a deep interest in specializing in the assessment and treatment of individuals interested in gender change. However, in her area of the state she can find no psychologist who is willing or competent to supervise her. However, there is a licensed clinical social worker who is willing to do so. A psychology resident lives in a very rural area of Pennsylvania and can get supervision at a local community mental health center which has no psychologist on staff (one psychologist consults at a satellite clinic 1 day a week, but does not have the time to accept responsibility for the supervision of the resident). The resident could get supervision from a licensed marriage and family therapist and could participate in group supervision meetings led by a psychiatrist. References American Psychological Association (2105). Guidelines for clinical supervision in health service psychology, American Psychologist, 70, 33-46 Mills, J. A. (2012 February). Termination of supervision requires planning. The Pennsylvania Psychologist, 1, 10. Mills, J. A. & Chasler, J. K. (2012). Establishing priorities in the supervision hour. Training and Education in Professional Psychology, 6 (3), 160-166. Pennsylvania State Board of Psychology Regulations. Retrieved from http://www.dos.pa.gov/professionallicensing/boardscommissions/psychology/pages/board- Laws-and-Regulations.aspx#.VWXTFkbNuk5 Sutter, E., McPherson, R. H., & Geeseman, R. (2002). Contracting for supervision. Professional Psychology: Research and Practice, 33, 495-498. Thomas, J. T. (2007). Informed consent through contracting for supervision: Minimizing risks, enhancing benefits. Professional Psychology: Research and Practice, 38, 221-231..
8 Review Questions 1. An individual who is fulfilling the supervised experience requirements for licensure is called a a. psychology trainee b. psychologist in residence c. qualified member of an exempt profession d. nationally registered provider 2. Dr. Jane Doe worked as a psychology resident under supervision for 40 hours a week for three months. May she count those hours toward her licensing experience? 3. Dr. Jane Doe worked as a psychology resident under supervision for 15 hours a week for six months. May she count those hours toward her licensing experience? 4. Dr. Jane Doe worked as a psychology resident under supervision for 15 hours a week for three months. May she count those hours toward her licensing experience? 5. Dr. Nakasone worked for 50 hours a week in his post doctoral residency program. According to the State Board of Psychology, he may count only 45 of those hours toward the postdoctoral requirements TRUE FALSE 6. A psychologist resident lives in a very rural area of Pennsylvania and found an agency that can provide most, but not all, of the conditions for supervision. According to the regulations of the State Board of Psychology, a. The psychology resident simply cannot get licensed b. The psychology resident should try to get the best supervision she can and then ask the Board for a waiver after it is completed c. The psychology resident can ask the Board for a waiver of some of the conditions of supervision and offer a detailed supervision plan for approval ahead of time. d. None of the above 7. After completing all of the required supervisory hours, but before actually getting a license, a psychology resident may practice a. under the supervision of another psychologist b. in an accredited hospital c. In an accredited college d. All of the above 8. Dr. Mary Smith wants to supervise her niece (her sister s daughter) for licensing. Do the regulations of the State Board of Psychology permit this?
9 9. Dr. Mary Smith wants to supervise her niece (the daughter of her brother-in-law and sister-in-law) for licensing. Do the regulations of the State Board of Psychology permit this? 10. In other to count supervision hours, a supervisor must do all of the following EXCEPT a. Develop objectives to be achieved during supervision b. Be accessible to the resident for consultation c. Be responsible to each client or patient for the services being provided d. Observe a video tape of the psychology resident 11. In order to count supervision hours, a supervisor must do all of the following EXCEPT a. Interrupt services of the supervisee if necessary b. Produce quarterly reports of supervisee progress c. Always get multidisciplinary consultations d. Monitor the supervision of any delegated supervisor 12. Starting in December 2015, who must have a minimum of a 3 hour course in supervision or complete a supervision course in a doctoral degree program? a. Practicum supervisors b. Internship supervisors c Post-doctoral supervisors d. All of the above 13. Dr. Maria Rodriguez wants to accept a post-doctoral supervised position in the facility where her mother is the Chief Executive Officer. If they were to evaluate this position, the State Board of Psychology would be most likely to focus on what aspect of this relationship: a. Whether she had informed consent b. Whether there was a multiple relationship c. Whether the principle of nonmaleficence was upheld d. All of the above 14. Dr. Michael Doe gave his supervisor a card for the holidays; it cost about $2.50. Dr. John Doe gave his supervisor a gift for the holidays that cost about $200. If they were to evaluate these events, the State Board of Psychology would be most likely to focus on what aspect of this relationship? a. Whether she had informed consent b. Whether there was a multiple relationship c. Whether the principle of nonmaleficence was upheld d. Whether the event involved fees, honoraria, favors or gifts 15. Jane Smith is the secondary supervisor for a post doctoral supervisee. Do the regulations say that she also has to be a licensed psychologist?
10 16. A primary or secondary supervisor must a. Have a doctoral degree in psychology b. Be licensed for at least five years c. Own, be an employee of, or in contract status with the entity employing the psychology resident d. All of the above 17. A supervisor has 4 psychology residents. Does this violate any regulation of the State Board of Psychology? 18. At the conclusion of supervision, the supervisor must assess the supervisees level of professional competence in the areas of: a. Assessment and diagnosis b. Evaluation of programs c. Cultural and individual diversity d. All of the above TE: Below the numbers in bold refer to the section of the regulations where the answers can be found (green book). A doctoral degree in psychology must be from a program that, within (19) year (s) from the awarding of the degree, was accredited by APA/CPA or designated by ASPPB/NR ( 41.31 (1)). For those starting their post doctoral year after December 6, 2010, a post doctoral year of supervised experience must be at least (20) hours ( 41.32 (1) (i)). No more than (21) hours can be counted as supervised experience per week ( 41.32 (1) (ii)). For post doctoral supervision, at least (22) per cent of the experience shall consist of providing services in diagnosis, assessment, therapy, other interventions or consultation and no more than (23) of the hours should be in teaching or research. ( 41.32 (1) (iii)). The supervised experience can only be counted toward licensing if it lasts for at least (24) months ( 41.32 (1) (v) (A)). Supervisors must meet with psychologist with trainees at least (25) hour(s) a week ( 41.33 (a) (5)) but up to (26) hour(s) may be allocated to another supervisor. ( 41.32 (3) (ii). The supervisor needs to evaluate the supervisee and apprise him or her of their progress and areas that need improvement at least (27) ( 41. 33 (c) (7)). If a candidate fails their examination for the first time, they may reapply and take any portion of the examination after (28) month(s) but within (29) year(s) after the first examination date ( 41.42 (a)). The supervisor must
11 maintain records of the supervisory sessions until the psychology resident obtains a license or (30) years, whichever is greater. Answers 1 a 2 3 4 5 TRUE 6 C 7 D 8 9 10 D 11 C 12 C 13 B 14 D 15 16 C 17 18 D 19 One 20 1750 21 45 22 50 23 ½ 24 6 25 2 26 1 27 Quarterly 28 6 29 2 30 10