Interprofessional Training for Practice and Research in Primary Care

PART1- Due Thursday Respond to the following in a minimum of 175 words:

Review this week’s course materials and learning activities, and reflect on your learning so far this week. Respond to one or more of the following prompts in one to two paragraphs:

1. Provide citation and reference to the material(s) you discuss. Describe what you found interesting regarding this topic, and why.
2. Describe how you will apply that learning in your daily life, including your work life.
3. Describe what may be unclear to you, and what you would like to learn.

PART2- 

University of Phoenix Material

Case Study Four Worksheet

Respond to the following questions in 1,500 to 1,750 words.

1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?

2. Does this situation meet the standards set by the duty to protect statue? How might whether or not Dr. Yeung’s state includes researchers under such a statute influence Dr. Yeung’s ethical decision making? How might the fact that Dr. Yeung is a research psychologist without training or licensure in clinical practice influence the ethical decision?

3. How are APA Ethical Standards 2.01a b, and c; 2.04; 3.04; 3.06; 4.01; 4.02; and 10.10a relevant to this case? Which other standards might apply?

4. What are Dr. Yeung’s ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principle and enforceable standard, as well as legal standards and Dr. Yeung’s obligations to stakeholders?

5. What steps should Dr. Yeung take to ethically implement her decision and monitor its effects?

Reference

Fisher, C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage.

PART3- I will post part 3 Tuesday, it will consist of two power-point slides.

Reference

Psychologists responsible for education and training programs have an obligation to establish relationships of loyalty and trust with their institutions, students, and members of society who rely on academic institutions to provide the knowledge, skills, and career opportunities claimed by the specific degree program (Principle B: Fidelity and Responsibility). This requires knowledge of system change and competencies in academic program management and leadership skills (APA, 2012f; Standard 2.03, Maintaining Competence). Psychologists responsible for administering academic programs must ensure that course requirements meet recognized standards in the relevant field and that students have sufficient practicum, externship, and research experiences to meet the career outcome goals articulated by the program (Wise & Cellucci, 2014).

• Department chairs and other faculty responsible for undergraduate curricula development need to ensure that course requirements expose undergraduates majoring and minoring in psychology and students taking survey courses to the knowledge and skills considered fundamental to the discipline.
• Chairs or directors of doctoral programs claiming to produce graduates competent to conduct psychological research need to ensure that students receive education and training in research ethics and the theoretical, methodological, and statistical skills required to competently conduct psychological science in the specific fields emphasized by the program (APA, 2011b; Fisher, Fried, & Feldman, 2009).
• Psychologists responsible for professional degree programs need to ensure that course requirements and field experiences meet those required by potential employers, relevant state or professional organizations for program accreditation, internship placements where relevant, and applicable individual licensure and credentialing bodies.
• Psychologists administering internship programs must ensure that supervisory and training experiences meet the standards of the specific areas of psychological practice claimed, appropriate state and professional accreditation criteria, and state licensing board requirements (APA, 2015e).

The term reasonable steps reflects recognition that despite a program administrator’s best efforts, there may be periods during which curriculum adjustments must be made in reaction to changes in faculty composition, departmental reorganizations, institutional demands, modifications in accreditation or licensure regulations, or evolving disciplinary standards.

Interprofessional Training for Practice and Research in Primary Care

Doctoral programs in psychology will increasingly need to equip students with the skills necessary for professional practice, quality improvement and outcomes research, and team management and consulting in the integrated patient care systems of the future. Systems such as patient-centered medical homes (PCMH) and accountable care organizations (ACO) will need psychologists trained in applying patient-centered, accountability-focused, evidence-based, and team-based approaches to enhancing access to quality (Belar, 2014; DeLeon, Sells, Cassidy, Waters, & Kasper, 2015; see also the section on the Patient Protection and Affordable Care Act (ACA) in Chapter 1). Program administrators need to be aware of evolving APA accreditation requirements for externships and internships that provide trainees with opportunities to acquire direct experience and supervision in interprofessional systems of care and when appropriate documentation of specialization as a basic credential for a practicing psychologist once licensed (Standard 7.01, Design of Education and Training Programs). Compliance with Standard 7.01 will also require curricula that foster competencies in the following:

• Implementation of ACA and related health policy goals and infrastructure
• Application of team science to outcome research within integrated health organizations
• Selection and integration of evidence-based practices within an interprofessional care model
• Appropriate integrated care patient electronic record keeping and billing
• Skills facilitating consultation with medical providers on behavioral management techniques to improve patient adherence to health care regimens

Readers might also refer to Standards 2.04, Bases for Scientific and Professional Judgments; 3.09, Cooperation with Other Professionals; 6.01 Documentation of Professional and Scientific Work and Maintenance of Records as well as Nash et al. (2013) and Rozensky (2014a, 2014 b is not kept pace with the rapid evolution and availability of online education. Distance learning using information technology raises complex questions regarding the adequacy of psychology programs to meet education and training requirements for a diverse student body from across the United States and in different countries. Psychologists administering online distance education might consider the following questions (Anderson & Simpson, 2007; Brey, 2006):

• Can the use of information technology ensure that the appropriate knowledge can be transmitted to students and that student acquisition of such knowledge can be appropriately evaluated?
• To what extent does the program meet accreditation, certification, licensure, or other requirements across different localities? Is the program description clear regarding the states or countries in which it meets such requirements (see also Standard 7.02, Descriptions of Education and Training Programs)?
• Does the use of web-based or Internet-mediated technology in higher education foster or undermine student diversity?
• Are the program admissions criteria and educational materials appropriate for the diversity of students who will apply for and be admitted into the program?
• Can experiential requirements be adequately provided, supervised, monitored, and evaluated at a distance through informational technology?
• Can the ethical values of the discipline be successfully transmitted and student ethical behavior adequately monitored through electronic media?
• Are faculty adequately trained in the use of online distance learning?

Department and program chairs and psychologists responsible for internship training programs must also ensure that prospective and current students have an accurate description of the nature of the academic and training programs to which they may apply or have been admitted. This standard of the APA Ethics Code (APA, 2010c) requires psychologists responsible for these programs to keep program descriptions up-to-date regarding (a) required coursework and field experiences; (b) educational and career objectives supported by the program; (c) current faculty or supervisory staff; (d) currently offered courses; and (e) the dollar amount of available student stipends and benefits, the process of applying for these, and the obligations incurred by students, interns, or postdoctoral fellows who receive stipends or benefits.

Standard 7.02 specifically obligates teaching psychologists to ensure that prospective and current students, externs, or interns are aware of program requirements to participate in personal psychotherapy or counseling, experiential groups, or any other courses or activities that require them to reveal personal thoughts or feelings. Many program descriptions now appear on university or institutional websites. Psychologists need to ensure to the extent possible that these websites are appropriately updated. The term reasonable steps recognizes that efforts to ensure up-to-date information may be constrained by publication schedules for course catalogs, webmasters not directly under the auspices of the department or program, and other institutional functions over which psychologists may have limited control.

• ? A psychology graduate department described itself as offering an industrial–organizational track that included paid summer placements at companies in the city in which the university is located. The required curriculum included only one class in industrial–organizational psychology taught by an adjunct professor. Other required courses for the industrial–organizational track consisted of traditional intelligence and personality test administration classes, test construction classes, and statistics courses offered by faculty in the department’s clinical and psychometric programs. For the past 2 years, the department had been able to place only one or two students in paid summer internships.

Need to Know: Language-Matching Training Experiences

The increasing language diversity of client/patient populations in the United States sometimes leads to matching bilingual graduate students with externship and internship populations for which their language skills are considered an advantage. Limiting bilingual trainees to work experiences with non-English-speaking clients or to one cultural–language group may deprive students of the broad educational training opportunities promised by the graduate or training program (Fields, 2010; see also Standard 3.08, Exploitative Relationships). Such assignments may also implicitly lead to misconceptions by bilingual and other students in the program that language competence is equivalent to multicultural treatment competence (Schwartz, Rodríguez, Santiago-Rivera, Arredondo, & Field, 2010). Faculty advisers and supervisors should actively assess bilingual students’ training needs as well as their comfort and desire to work with same-language populations to ensure these students are afforded the same quality of education, respect, and autonomy that other trainees enjoy (Schwartz et al., 2010). English-only-speaking supervisors who rely on a trainee’s language translations of sessions should also be aware that they may be providing feedback on clients that they cannot actually work with themselves (Standard 2.01b, Boundaries of Competence), and in some states, this lack of “proper” supervision might mean that the trainee is perceived to be practicing “independently” without a license (Schwartz et al., 2010).

7.03 Accuracy in Teaching

©iStockphoto.com/voinSveta

Standard 7.03a requires that teaching psychologists provide students with accurate and timely information regarding course content; required and recommended readings; exams, required papers, or other forms of evaluation; and extra-classroom experiences if required. Psychologists who provide their syllabi via the Internet or who require students to use web-based references need to keep these websites accurate and appropriately updated.

Modifying Course Content or Requirements

This standard also recognizes that syllabi may sometimes include an unintentional error, required readings may become unavailable, changes in institutional scheduling may create conflicts in dates set for exams, and many times, psychologists have valid pedagogical reasons for changing course content or requirements at the beginning or middle of a semester. For example, a professor may find that assigned readings are too difficult or not sufficiently advanced for the academic level of students in the class. In such instances, it would be appropriate for professors to modify course reading requirements as long as materials are available to students and they are given sufficient time to obtain and read the materials. Similarly, in response to constraints imposed by publishers, bookstores, other professors, or the institution, psychologists may rightly need to modify required texts or exam schedules.

Modifications to course content or requirements do not violate this standard as long as students are made aware of such modifications in a clear and timely manner that enables them to fulfill course requirements without undue hardship. However, a professor who has neither discussed nor specified how students will be evaluated until the last week of class or one who fails to update an old syllabus that does not reflect the current content of the course would be in violation of this standard.

Standards prescribing the nature of information that teachers should provide raise legitimate concerns about academic freedom. At the same time, in many ways, teaching is a “process of persuasion” where instructors are in the unique socially sanctioned and desired role of systematically influencing the knowledge base and belief systems of students (Friedrich & Douglass, 1998). Standard 7.03b reflects the pedagogical obligation of psychologists to share with students their scholarly judgment and expertise along with the right of students to receive an accurate representation of the subject matter that enables them to evaluate where a professor’s views fit within the larger discipline.

The narrowness or breadth of information required to fulfill this standard will depend on the nature of the course. For example, a psychologist who presented readings and lectures only on psychodynamic theories of personality would be presenting accurate information in a course by that name but inaccurate information if teaching a general survey course on theories of personality. A professor who has been teaching the same material for 20 years when such material is considered obsolete in terms of the discipline’s recognized standards would be providing students inaccurate information about the current state of the subject matter.

• In his first year of teaching, an assistant professor prepared a syllabus for an undergraduate developmental psychology course that drew largely on required readings from books by well-known developmental theorists. He carefully planned weekly quizzes, a midterm exam, and a term paper requiring a critique of several journal articles. Students performed very poorly on the first two quizzes and did not seem to be involved in class discussions. The professor learned that for reasons unknown to the department chair, the dean’s office had assigned this class as a “non-major” section. The students were therefore not as prepared as had been anticipated because, unlike psychology majors, most had not taken an introductory psychology course. The psychologist decided to modify the curriculum to ensure that students received a basic foundation in developmental psychology. He rush-ordered a basic developmental psychology text, extended the date of the midterm, and changed the topic of the term paper to a review of sections of the originally assigned books. He distributed a revised syllabus detailing the changes and gave the students the option of using the first two quizzes as extra credit.

7.04 Student Disclosure of Personal Information

This standard requires psychologists to respect the privacy rights of students and supervisees. In many instances, information about students’ or supervisees’ sexual history; their personal experience of abuse or neglect; whether they have or are currently receiving psychotherapy; and their relationships with relatives, friends, or significant others is outside the legitimate boundaries of academic or supervisory program inquiry.

With two exceptions, Standard 7.04 prohibits psychologists from requiring students or supervisees to disclose such information.

Clear Identification of Requirements

Teaching and supervisory psychologists may require disclosure of information about sexual experiences, history of abuse, psychological treatment, or relationships with significant others only if the admissions and program materials have clearly identified that students or supervisees will be expected to reveal such information if admitted to the program. The requirement for advance notification includes programs that explore countertransference reactions during supervisory sessions if questions about such reactions will tap into any of the categories listed above. Clear and advance notification about the types of disclosures that programs require will allow potential students to elect not to apply to a program if they find such a requirement intrusive or otherwise discomforting.

Interference With Academic Performance or Self-Harm or Other Harm

The standard also recognizes that there are times when students’ personal problems may interfere with their ability to competently perform professionally related activities or pose a threat of self-harm or harm to others. In such instances, psychologists are permitted to require students or supervisees to disclose the personal information necessary to help evaluate the nature of the problem, to obtain assistance for the student or supervisee, or to protect others’ welfare.

• A psychologist supervising a third-year clinical student’s work at the university counseling center was growing increasingly concerned about the sexual nature of verbal exchanges the student reported having with one of her undergraduate clients. The psychologist also suspected from one of the student’s comments that she had been meeting with the client outside of the counseling sessions. Concerned that the student might be in violation of Standards 3.05, Multiple Relationships, or 10.05, Sexual Intimacies With Current Therapy Clients/Patients, the supervisor asked the student whether she had been seeing the client socially. When she responded yes, the psychologist probed further to find out if she was having a romantic relationship with the client.
• ? A student came to see a professor during office hours to discuss his poor grade on the midterm exam in a graduate course on human sexuality. The professor asked the student if he might be doing poorly in the course because of anxieties about his own sexuality.

Need to Know: Supervision of Trainees With Disabilities

The field of rehabilitation psychology is increasing the discipline’s familiarity with reasonable accommodations and training requirements for students with disabilities (Americans with Disabilities Act [ADA], 1990; Falender, Collins, & Shafranske, 2009). The nascent status of the field leaves unexplored potentially prejudicial beliefs held by supervisors that may unintentionally lead to inequities and inadequacies in the training experiences of graduate students with disabilities enrolled in psychology practitioner programs. For example, there is no empirical support for the assumption that a trainee with disabilities cannot perform the essential functions of a psychologist or that this individual is at a disadvantage in establishing a therapeutic alliance with clients/patients (Taube & Olkin, 2011).

Supervision competencies in the area of disability require familiarity with the ADA, models of ableness, and influence of multiple minority statuses and group histories of oppression on the perspectives of individuals with disabilities. Supervisors will also need to acquire the skills to neither over- nor underattend to a supervisee’s disability, support necessary adaptations to clinical tools, and create a safe environment for supervisees to discuss issues relevant to their disability that may emerge in their clinical or supervisory settings (Cornish & Monson, 2014).

Digital Ethics: Disclosure of Student Personal Information Through Social Media

Teaching psychologists may use Facebook, Twitter, blogs, chat rooms, and other forms of social media to engage students in discussions regarding academic material or university events. However, students may sometimes use these sites to share or link to information about themselves or other students that describes sexual behaviors, family relationships, or other personal information. Faculty access to such information may be inconsistent with the goal of Standard 7.04, which is to protect students from disclosing personal information that may unfairly influence evaluation of their academic performance (Standard 7.06b, Assessing Student and Supervisee Performance). Psychologists who utilize electronic media for instructional purposes should clarify in advance restrictions on the type of information that can be posted on these sites. Instructors should also educate students on their responsibilities and strategies to avoid privacy violations that may emerge when academic sites are linked to other sources of personal information. Furthermore, faculty should develop procedures for removing such information if it appears. If a situation arises and faculty are concerned that becoming aware of such information may bias their evaluation of student performance, they should seek consultation while at the same time protecting the student’s identity (Standards 4.04b, Minimizing Intrusions on Privacy; 4.06, Consultations).

7.05 Mandatory Individual or Group Therapy

Standard 7.05a addresses the privacy rights of psychology students enrolled in programs that require individual or group psychotherapy. During the commenting period for the revision of the current APA Ethics Code, a number of graduate students raised concerns about revealing personal information (a) in the presence of other students in required group therapy or experiential courses and (b) to therapists in required individual psychotherapy if the therapist was closely affiliated with their graduate program. In response to these concerns, this standard requires programs that have such requirements to allow students to select a therapist unaffiliated with the program.

Standard 7.05a does not prevent programs from instituting a screening and approval process for practitioners outside the program whom students may see for required psychotherapy. It is sound policy for programs to ensure that required individual or group therapy is conducted by a qualified mental health professional. In addition, in some programs, the therapeutic experience may be seen as one facet of training about a particular form of psychotherapy, and the program is entitled to require students to select a private therapist who conducts treatment consistent with the program’s training goals.

Postdoctoral Training

This standard does not apply to postdoctoral programs, such as postgraduate psychoanalytic programs, that require a training analysis with a member of the faculty. These advanced programs, unlike graduate programs, are optional for individuals who seek specialized training beyond a doctoral degree in psychology, and a decision not to enroll in such programs because of therapy requirements does not restrict opportunities to pursue a career in professional psychology.

This standard is designed to protect the integrity and fairness of evaluations of student academic performance. Whereas Standard 7.05a protects a student’s right to keep personal information private from program-affiliated practitioners, Standard 7.05b protects the student from grading or performance evaluation biases that might arise if a faculty member who serves as the student’s psychotherapist is also involved in judging his or her academic performance. This standard pertains not only to faculty who might teach a course in which a student who is in therapy with them might enroll but also to faculty who may be involved in decisions regarding passing or failing of comprehensive exams, advancement from master’s-level to doctoral-level status, training supervision, and dissertation committees. As indicated by the cross-reference to Standard 3.05, Multiple Relationships, serving in the dual roles of therapist and academic evaluator can impair the therapist’s objectivity when knowledge gained from one role is applied to the other, or it can undermine treatment effectiveness when students are afraid to reveal personal information that might negatively affect their academic evaluations.

Need to Know: Ethical Criteria for Mandatory Personal Psychotherapy (MPP)

The training goal of program-mandated personal psychotherapy (MPP) is to maximize therapeutic efficacy through self-awareness that heightens appreciation of the therapeutic relationship and client/patient vulnerability and minimizes the possibility of harming clients or acting in ways that are not in their best interests (Norcross, 2005). However, due to the diversity of theoretical frameworks for clinical care and the paucity of empirical data to support its efficacy in comparison to other training models, the value of MPP remains contested. One issue is whether imposing psychotherapy on well-functioning trainees who display no pathological behavior and feel no need for treatment is consistent with the ethical practice of psychotherapy, including respect for client/patient autonomy and obligation to terminate treatment when the client/patient does not need health services (Ivey, 2014; Principle E: Respect for People’s Rights and Dignity; Standards 3.10, Informed Consent; 10.01, Informed Consent to Therapy; 10.10, Terminating Therapy). Below are useful guidelines for programs requiring MPP (see Ivey, 2014, for an excellent summary):

• The requirement must be justified by the nature and training objectives of the program (Standard 7.01, Design of Education and Training Programs).
• The MPP requirement as well as the risks and benefits and planned safeguards should be clear in application materials (Standard 7.02, Descriptions of Education and Training Programs).
• There should be no multiple relationships between therapists and trainee–clients, and trainees should have some choice in selecting a psychotherapist (Standards 3.05, Multiple Relationships; 7.05, Mandatory Individual or Group Therapy).
• Students should be provided with financially feasible alternatives to ensure affordable treatment without undue hardship (Principle D: Justice).
• ? A clinical psychology program that required first-year graduate students to receive 1 year of individual psychotherapy had a referral list of 20 “approved” independent practitioners in the area that students could select as their therapist. The program often drew on these same practitioners as adjunct professors to teach required courses when regular faculty were on sabbatical.

7.06 Assessing Student and Supervisee Performance

Psychologists establish academic and supervisory relationships of trust with students and supervisees based on fair processes of evaluation that provide students and supervisees with the opportunity to learn from positive and negative feedback of their work (Principle B: Fidelity and Responsibility). As in other domains of psychological activities, supervisors need to be familiar with the knowledge base for models of enhancing and monitoring the professional functioning of supervisees (APA, 2012f; Standards 2.01, Competence; 2.03, Maintaining Competence). Under Standard 7.06a, psychologists must inform students and supervisees (a) when and how often they will be evaluated, (b) the basis for evaluation (e.g., performance in exams, attendance, implementation of various phases of research, summaries of client/patient sessions, and administration and interpretation of psychological assessments), and (c) the timing and manner in which feedback will be provided.

Providing specific information about student evaluation at the beginning of the process is especially important for the supervision of clinical work, psychological assessment, or research because these supervisory activities are often less uniformly structured than classroom teaching.

Group Supervision

Group supervisees can benefit from the multiple input, support, and shared experiences of their peer colleagues while also learning how to provide effective feedback and gain initial competencies required for their own future skills as supervisors. Psychologists engaged in group supervision must develop competencies in creating a safe environment for group discussion and disagreement and for clarifying the roles of supervisor and supervisees. At the beginning of the supervision, they need to clarify the purpose of group supervision and how responsibilities and supervisee evaluation differ from those under individual supervision. For example, most students will be unfamiliar with the unique learning experiences and responsibilities of group supervisees, which include providing feedback to one another, both formally and informally, at specified periods in a respectful manner; preparing case presentations and questions on group materials prior to each meeting; refraining from discussing material about an absent supervisee; and maintaining the confidentiality of group discussions, including information pertaining to other group members, their clients, and specific training sites (see Smith, Cornish & Riva, 2014, for additional details).

• ? A psychology professor teaching a graduate course in statistics used a midterm and final exam to evaluate students. The professor delayed returning the midterm, telling the students they should not worry because most of them would do very well. When she returned the graded midterms during the last week of class, most students were shocked to discover they had received Cs and Ds on the exam. Many felt the delay caused them to miss opportunities to learn what aspects of course material they had misunderstood and to prepare adequately for the final.
• ? A student in a PhD program in school psychology had a second-year externship in a residential school for students with severe emotional disorders. The school psychologist serving as her on-site supervisor relied on “countertransference” techniques to train his externs. Each time the student asked her supervisor for specific information on how her work with student