Episode 21: Ethics and Skills for Psychologist as Supervisor-Post-Doctoral Supervision

Podcasts 21, 22, and 23 will provide supervisors and supervisees with an understanding of the skills and 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.  

In this episode, John's guest is John Jay Mills, Ph.D., ABPP, a psychologist and professor at Indiana University of Pennsylvania.

At the end of the podcast series the participants will be able to:

1.  Describe essential factors involved in ethically sound and effective supervision;
2.  List or identify the State Board of Psychology requirements for post-doctoral supervision;
3.  Explain ways to improve supervisee's level of competence, self-reflection, and professionalism; &
4.  Identify strategies to comply with the Pennsylvania State Board of Psychology regulations on supervision of post-doctoral trainees. 

The associated SlideShare presentation can be found here.

Link to the YouTube Video here.

PA § 41.33. Supervisor requirements

PA § 41.32. Experience qualifications to become a psychologist

Verification of Post-doctoral Experience from the Pennsylvania State Board of Psychology

Impressions of Misconduct: Graduate Students’ Perception of Faculty Ethical Violations in Scientist-Practitioner Clinical Psychology Programs.

January, Alicia M.; Meyerson, David A.; Reddy, L. Felice; Docherty, Anna R.; Klonoff, Elizabeth A.
Training and Education in Professional Psychology, Aug 25 , 2014

Abstract

Ethical conduct is a foundational element of professional competence, yet very little is known about how graduate student trainees perceive ethical violations committed by clinical faculty. Thus, the current study attempted to explore how perceived faculty ethical violations might affect graduate students and the training environment. Of the 374 graduate students in scientist-practitioner clinical psychology programs surveyed, nearly a third (n = 121, 32.4%) reported knowledge of unethical faculty behavior. Students perceived a wide range of faculty behaviors as unethical. Perception of unethical faculty behavior was associated with decreased confidence in department faculty and lower perceived program climate. Implications of these findings are discussed and recommendations offered.

The entire article is here, behind a paywall.

Joint Chiefs' Chairman Wants Military to Rethink Ethics Training

By Julian E. Barnes
The Wall Street Journal
Originally published March 27, 2014

The military needs to rethink how it teaches character and ethics, eschew staid briefing slides and avoid disciplining subordinates via email, the nation's top uniformed officer said Thursday.

Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, visited the U.S. Naval Academy and the U.S. Military Academy this week, as part of a series of talks emphasizing the need to focus on ethics. In meetings with students, Gen. Dempsey made clear that he thinks the military talks about sexual harassment, sexual assault and ethics in a way that is too abstract.

"The issue of ethics is personal and to be persuasive, it has to be relational," Gen. Dempsey said in an interview Thursday. "It can't be an issue of abstract values; you have to bring them to life."

The entire story is here.

Mental Health: Parity Yes, Providers No

By Ben Hartman
Contributing Writer, MedPage Today
Originally published February 7, 2014

Demand -- for both facilities and providers -- has long outpaced supply in the field of mental health, but recent moves to increase funding for mental health services combined with innovative delivery systems may reverse that trend.

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But money is not the only issue: many PCPs lack the needed psychiatric training, according to Jaseu Han, MD, residency director of the combined family medicine/psychiatry program at the University of California Davis Health System.

"There has to be a behavioral component to all residencies. There is a ton of talk about the value of patient-physician interactions, but the residents are not receiving psychiatric training. If you look at internal medicine, Ob/Gyn, pediatrics, and family medicine, they don't get anything. There is no requirement during residency to get any mental health experience."

The entire story is here.

Editorial note: This article points out another reason psychologists with advanced training and supervision in psychopharmacology can bridge the gap as prescribing psychologists.

Please listen the Psychologists and Prescriptive Authority: Where are we now? podcast

Fewer Hours for Doctors-in-Training Leading To More Mistakes

By Alexandra Sifferlin
Time
Originally published March 26, 2013

Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

The entire article is here.

Clinical Psychologists’ Firearm Risk Management Perceptions and Practices

Andrea Traylor, James H. Price, Susan K. Telljohann, Keith King, and Amy Thompson

J Community Health. 2010 February; 35(1): 60–67.
Published online 2010 January 22.
doi:  10.1007/s10900-009-9200-6

Abstract

The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.

The entire article is here.

Thanks to Dan Warner for this article.

Effective and Ineffective Supervision

Nicholas Ladany, Yoko Mori, and Kristin E. Mehr
The Counseling Psychologist
January 2013 41: 28-47
First published on May 23, 2012

Abstract


Although supervision is recognized as a significant tenant of professional growth for counseling and psychotherapy students, the variability of the effectiveness, or ineffectiveness, of supervision has come under scrutiny in recent times. Our sample of 128 participants shed light on the most effective (e.g., encouraged autonomy, strengthened the supervisory relationship, and facilitated open discussion) and most ineffective (e.g., depreciated supervision, performed ineffective client conceptualization and treatment, and weakened the supervisory relationship) supervisor skills, techniques, and behaviors. Moreover, effective and ineffective behaviors, along with best and worst supervisors, were significantly differentiated based on the supervisory working alliance, supervisor style, supervisor self-disclosure, supervisee nondisclosure, and supervisee evaluation. Implications for supervision competencies and supervisor accountability are discussed.

The entire article can be found here.

A presentation by Nicholas Ladany on effective supervision can be found in the PowerPoint Vault on this blog.

The Relationship Between Level of Training and Accuracy of Violence Risk Assessment

by A. R. Teo, S. R. Holley, M. Leary, and D. E. McNeile
Psychiatric Services
Psychiatric Services 2012; doi: 10.1176/appi.ps.201200019

Objective  Although clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians’ evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists with those performed by psychiatric residents. It also examined the potential of a structured decision support tool to improve residents’ risk assessments.

Methods  The study used a retrospective case-control design. Medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N=38) for 52 patients and by attending psychiatrists (N=41) for 249 patients. Trained research clinicians, who were blind to whether patients later became violent, coded information available at hospital admission by using a structured risk assessment tool—the Historical, Clinical, Risk Management–20 clinical subscale (HCR-20-C).

Results  Receiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (area under the curve [AUC]=.70), whereas assessments by residents were no better than chance (AUC=.52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC=.67) close to that of attending psychiatrists.

Conclusions  Having less training and experience was associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

The full article is here.

New generation of virtual humans helping to train psychologists

American Psychological Association Press Release
Originally published August 3, 2012

New technology has led to the creation of virtual humans who can interact with therapists via a computer screen and realistically mimic the symptoms of a patient with clinical psychological disorders, according to new research presented at the American Psychological Association’s 120^th Annual Convention.

“As this technology continues to improve, it will have a significant impact on how clinical training is conducted in psychology and medicine,” said psychologist and virtual reality technology expert Albert “Skip” Rizzo, PhD, who demonstrated recent advancements in virtual reality for use in psychology.

Virtual humans can now be highly interactive, artificially intelligent and capable of carrying on a conversation with real humans, according to Rizzo, a research scientist at the University of Southern California Institute for Creative Technologies. “This has set the stage for the ‘birth’ of intelligent virtual humans to be used in clinical training settings,” he said.

Rizzo showed videos of clinical psychiatry trainees engaging with virtual patients called “Justin” and “Justina.” Justin is a 16-year-old with a conduct disorder who is being forced by his family to participate in therapy. Justina, the second and more advanced iteration of this technology, is a sexual assault victim who was designed to have symptoms of post-traumatic stress disorder.

The entire press release is here.

Patient information breach confirmed

Officials: Staffer copied confidential data at Reading Hospital for training purposes

By Dan Kelly and Ron Devlin
The Reading Eagle
Originally published May 18, 2012

Reading Hospital's medical records system was breached recently by an employee who copied sensitive patient information and used it for training purposes, hospital officials confirmed Thursday.

Medical test results, diagnoses, prescribed medications and other data legally classified as Protected Health Information on 12 patients was made public without the hospital's knowledge or the patients' consent.

Susan Heffner, privacy officer for the hospital, said it was the hospital's first breach of patient health information.

"This was old school," Heffner said. "Someone made paper copies of records."

The entire story is here.

Does Medicine Discourage Gay Doctors?

By Pauline W. Chen, M.D.
The New York Times - Well
Originally published April 26, 2012

During my surgical training, whenever the conversation turned to relationships, one of my colleagues would always joke about his inability to get a date, then abruptly change the subject. I thought he might be gay but never asked him outright, because it didn’t seem important.

But one morning, while we working at the nurses’ station with several of the other doctors-in-training, I realized it was important, because at the hospital, he really couldn’t be himself.

That morning, one of the senior surgeons stormed over. He had found one of his patients feeling slightly short of breath, no doubt because of an insufficient dose of diuretic overnight.

“Which of you idiots,” he growled at us, “gave my patient a homosexual dose of diuretic?”

The entire story is here.

8 Breach Prevention Tips: Action Items Based on Lessons Learned

By Howard Anderson

Govinfosecurity.com

Originally published February 8, 2012

What can be learned from the more than 390 major breaches affecting more than 19 million individuals that have been reported as a result of the federal HIPAA breach notification rule? Plenty, breach prevention experts say.

Here are eight key breach-prevention insights from information security thought-leaders:

1. Don't Forget Risk Assessments

The details of the biggest breaches last year "make it painfully clear that inadequate, if any, HIPAA security risk analysis took place prior to the breaches," says Dan Berger, CEO at Redspin.

2. Encrypt Mobile Devices, Media

"Even though encryption is what's referred to as an addressable standard in the HIPAA security rule - which means it's not actually mandated in all cases - I don't see any reason why information shouldn't be encrypted in all cases on portable media and devices," says Robert Belfort, partner at the law firm Manatt, Phelps & Phillips LLP. "That's one step that organizations can take that can address a very significant share of the types of breaches that are occurring."

3. Beef Up Training

"People have to be trained to understand the policies of the organization, and they have to be trained about common-sense safeguards that they can follow to avoid breaches or the misuse of information," Szabo stresses.

4. Conduct Internal Audits

In addition to training, an important step toward addressing internal breach threats is to conduct audits of records access, Belfort says.

5. Monitor Business Associates

About 22 percent of major breaches, including many of the largest incidents, have involved business associates. As a result, it's essential to work with vendor partners to ensure they're taking adequate breach prevention steps.

The rest of details are here.

In the Resources section of this blog, there is a White Paper on Preventing a Data Breach and Protecting Health Records – One Year Later: Are You Vulnerable to a Breach? by Kaufman, Rossin & Co. to augment these security issues.

APA's Guidelines on Multiculturalism

Multicultural Guideline