APA Accredited Internship in Clinical and Counseling Psychology

Procedures for Responding to Inadequate Performance by an Intern

I.                    Definitions

A.     Inadequate Performance is defined as a deficit in professional functioning which is reflected in one or more of the following ways:

1.      An inability and/or unwillingness to acquire and integrate professional standards into one’s repertoire of professional behavior:

2.      An inability to acquire professional skills in order to reach an acceptable level of competency and/or an inability to control personal stress; and/or;

3.      Excessive emotional reactions which interfere with professional functioning.

                  B. Criteria which link this definition of inadequate performance to particular professional behaviors are incorporated into competency-based evaluation forms which are completed by supervisors at several intervals during the internship.

                  C.  An “intern who has a problem” refers to an intern whose behaviors, attitudes, or characteristics which, while of concern and receiving remediation, are perceived to be expected or not excessive for professionals in training. 

Problems typically become identified as “Inadequate Performance” when they include one or more or the following characteristics:

 1. the intern repeatedly and chronically does not acknowledge, understand, or address the problem when it is identified.

                     2.  the problem is not merely a reflection of a skill deficit which can be rectified by academic or didactic training.

3.  the quality of services delivered by the intern is sufficiently negatively affected.

4.  the problem is not restricted to one area of professional functioning.

5.  a disproportional amount of attention by training personnel is required and/or;

6.  the trainee’s behavior does not change as a function of feedback, remediation efforts, and/or time.

7. the intern is unable/unwilling to carry out expected program responsibilities.

8.  the intern is not able to successfully complete exit criteria.

9.  staff members and peers identify the intern as having repeated difficulties relating to others professionally.

II.         Remediation

            A.  Several possible and perhaps concurrent courses of action to remediate  identified performance deficits include, but are not limited to:

1.  increased supervision, either with the same or other supervisors.

2.  change in the format, emphasis, and/or focus of supervision.

3.  recommendation/requirement of personal therapy when the problems are psychological in nature.  The parties should clarify the manner in which therapy contacts will be used in the intern evaluation process.

4.  reduction of the intern’s clinical or workload and/or the requirement of specific academic coursework.

5.  recommendation, when appropriate, of a leave of absence and/or a second internship at another setting.

            B.  When a combination of the above interventions do not, after a reasonable time period, rectify the inadequacies, or when the trainee seems unable or unwilling alter his/her behavior, the training program may need to take more formal action, including such actions as:

1.  giving the intern a limited endorsement, specifying those settings in which he/she could function adequately.

2.  communicating to the intern and academic department/program that the intern has not successfully completed the internship.

3.  recommending and assisting in implementing a career shift for the intern, and/or,

4.  terminating the intern from the internship training program.

        All the above steps need to be adequately and appropriately documented in ways that are consistent with due process procedures which are outlined explicitly in the following section of this manual.

III.       Due Process Procedures

            A.  General Guidelines:  Due process insures that decisions made by programs about interns are not arbitrary or biases, requires that programs identify specific evaluative procedures which are applied to all intern trainees, and provide appropriate appeal procedures to the intern so he/she may challenge the program’s action.  General due process guidelines include:

1.  presenting interns, in writing, with the programs expectations related to professional functioning.

2.  stipulating the procedures for evaluation, including when evaluations are conducted and how they are related to professional functioning.

3.  articulating the various procedures and actions involved in making decisions regarding inadequate performance.

4.  communicating, early and often, with graduate programs about any suspected difficulties with interns, seeking input from these academic programs on how to address such difficulties.

5.  instituting, with the input and knowledge of the graduate program, a remediation plan for identified inadequacies, including a time frame for expected remediation and consequence of not rectifying the inadequacies.

6.  providing a written procedure to the intern which describes how the intern may appeal the program’s action.  Such procedures should be included in the program’s handbook and made available to the intern at the beginning of the internship.

7.  insuring that interns have sufficient time to respond to any action taken by the program.

8.  using input from multiple professional sources when making decisions or recommendations regarding the intern’s performance, and

9.  documenting, in writing and to all relevant parties, the action taken by the intern’s performance, and

            B.  Specific Procedures

If an intern receives a rating of “inadequate for an intern in training” from any of the evaluation sources, the intern will be defined as “inadequate” and the following procedures may be initiated:

1.  the TC (Training Committee) will meet with the individual supervisors to discuss the rating and determine what action needs to be taken to address the issues reflected by the rating.

2.  the intern will be notified, in writing, if any formal review is occurring and the TC will receive any information or statement from the intern related to his/her response to the rating.

3.  in discussing the inadequate rating and the intern’s response, if available, the TC may adopt any one or more of the following methods or may take any other appropriate action.  It may issue a:

a.  “Acknowledgment Notice” which formally acknowledges that:

                                    (1) the TC is aware of and concerned with the rating.

                                    (2) the rating has been brought to the attention of the intern,

                                    (3) the TC will work with the intern to rectify the problem or skill deficits addressed by the rating, and

                                    (4) the behaviors associated with the rating are not significant enough to warrant more serious action at this time.

b.  “Probation,” is defined as a relationship such that the TC, through the   supervisors, monitors, for a specific length of time, the degree to which the intern addresses, changes and/or otherwise improves the behavior associated with the inadequate rating.  The probation notice is a written statement to the intern and includes:

                                    (1) the actual behaviors associated with the inadequate rating,

                                    (2) the specific recommendations for rectifying the problem,

                                    (3) the time frame for the probation during which the problem is expected to ameliorated, and,

                                    (4) the procedures designed to ascertain whether the problem has been appropriately rectified, or

                                    (5) take no further action.

            C.  The TD will then meet with the intern to review the probationary conditions.

                  The intern may choose to accept the conditions or may choose to challenge the action.  The procedures for challenging the action are presented in section  IV.B.1 of this document.

             D.  If either the Acknowledgment Notice or the Probation Action occurs, the TD will inform the intern’s home university, indicating the nature of the inadequate rating, the rationale for the TC action, and the action taken by the TC.  The intern shall receive a copy of the letter to the home university.

            E.  Once the Acknowledgment Notice or Probation Action is issued by the TC, it is expected that the status of the rating will be reviewed no later than the next formal evaluation period or, in the case of probation, no later than the time limits identified in the probation statement.

            F.  If the rating has been rectified to the satisfaction of the TC, the intern, sponsoring university and other appropriate individuals will be informed and   no further action will be taken.

IV.       Situations in Which Grievance Procedures are Initiated

            A.  There are three situations in which grievance procedures can be initiated:

1.  When the intern challenges the action taken by the TC (Intern Challenge).

2.  When the TC is not satisfied with the intern’s action in response to the TC action (Continuation of the Inadequate Rating), or

3.  When a member of the VTCC staff initiates action against an intern (Intern Violation).

            B.  Each of these situations, and the course of action accompanying them, is described below:

                        1.  Intern Challenge:  If the intern challenges the action taken by the TC as described in II and III above, he or she must, within 10 days of receipt of the TC’s decision, inform the TD, in writing, of such a challenge.

a.  The TD will then convene a Review Panel (RP) consisting of two staff members selected by the TD and two staff members selected by the intern.  The intern retains the right to hear all facts with the opportunity to dispute or explain his or her behavior.

b.  A review hearing will be conducted, chaired by the TD, in which the challenge is heard and the evidence presented. 

                                         Within five days of the completion of the review hearing, the  RP will submit a report to the Director of VTCC, including any recommendations for further action.  Decisions made by the RP will be made by majority vote.  Decisions made by the RP will be made by majority vote.  The intern will be informed of the recommendations.

c.  Within five days of receipt of the recommendation, the Director of VTCC will either accept the RP’s action, reject the RP’s action and provide an alternative, or refer the matter back to the RP for further deliberation.  The RP then reports back to the Director within 10 days of the receipt of the Director’s request for further deliberation.  The Director will then make a final decision regarding what action is to be taken.

d.  Once a decision has been made, the intern, sponsoring university, and other appropriate individuals shall be informed in writing of the same action taken.

                        2.  Continuation of Inadequate Rating:  If the TC determines that there has not been sufficient improvement in the intern’s behavior to remove the inadequate rating under the conditions stipulated in the probation, then a formal Review Panel (RP) will be convened.

a.  The TC will communicate, in writing, to the intern that the conditions for revoking the probation have not been met.  The TC may then adopt any one of the following methods or take any other appropriate action.  It may issue a:

(1) continuation of the probation for a specified time period.

(2) suspension whereby the intern is not allowed to continue engaging in certain professional activities until there is evidence that the behavior in question has improved,

(3) communication which informs the intern that the TC is recommending to the Director of VTCC that the intern will not, if the behavior does not change, successful complete the internship, and/or

(4) communication which informs the intern that the TC is recommending to the Director of VTCC that the intern be terminated immediately from the internship program.

b.  Within 5 working days of receipt of the TC’s determination the intern may respond to the TC’s action by:

                                          (1) accepting the action, or

                                          (2) challenging the TC’s action.

c.  If a challenge is made, the intern must provide the TD, within 10 days, with information as to why the intern believes the TC’s action is unwarranted.  A lack of reasons by the intern will be interpreted as complying with the TC’s sanction.

d.  If the intern challenges the TC’s action, a RP will be formed consisting of the TD, two staff members selected by the TD, and two staff members selected by the intern.

e.  A RP hearing will be conducted, chaired by the TD, in which the challenge is heard and the evidence presented.  Within 10    days of the completion of the RP hearing, the RP shall communicate its recommendation to the intern and to the Director of VTCC.  Decisions by the RP will be made by majority vote.

f.  Within 5 days of receipt of the recommendation, the Director of VTCC will either accept the RP’s action, or refer the matter back to the RP for further deliberation.  The RP will then report back to the Director within 10 days of receipt of the Director’s request for further deliberation.  The Director then makes a final decision regarding what action is to be taken.

g.  Once a decision has been made, the intern, sponsoring university, and other appropriate individuals shall be informed in writing of the action taken.

                        3.  Intern Violation:  Any staff member of VTCC may file in writing, a grievance against an intern for any of the following reasons:

                                    a.  unethical or legal violations of professional standards or laws,

                                    b.  professional incompetence, or

                                   c.  infringement on the rights, privileges or responsibilities of others.

d.      In the event of a, b, or c above the following procedure will be followed:

(1) The TD will review the grievance with 2 members of the TC and determine if there is reason to proceed and/or if the behavior in question is in the process of being rectified.

(2) If the TD and TC members determine that the alleged behavior in the complaint, if proven, would not constitute a serious violation the TD shall inform the staff member who may be allowed to renew the complaint if additional information is provided.

(3) When a decision has been made by the TD and the other 2

                                                TC members that there is a probable cause for deliberation by the RP, the TD shall notify the staff member and request permission to inform the intern.  The staff member shall have 5 days to respond to the request and shall be informed that failure to grant permission may preclude further action.  If no response is received within 5 days or permission to inform the intern is denied, the TD and the 2 TC members shall decide whether to proceed with the matter.

(4) If the intern is informed, a RP is convened consisting of the

                                                TD, 2 members selected by the staff member, and 2 members selected by the intern.  The RP receives any relevant information from both the intern and staff member as it nears its deliberations.

(5) A review hearing will be conducted, chaired by the TD in which the complaint is heard and the evidence is presented.  Within 10 days of the completion of the review hearing, the RP shall communicate its recommendation to the intern and to the Director of VTCC.  Decisions by the RP shall be made by majority vote.

(6) Within 5 days of receipt of the recommendation, the

                                                 Director of VTCC will either accept the RP’s recommendation, provide alternative action, or refer the matter back to the RP for further deliberation.  The RP then reports back to the Director within 10 days of the receipt of the Director’s request for further deliberation. The Director then makes a final decision regarding what action is to be taken.

(7) Once a decision has been made, the intern, staff member, sponsoring university, and other appropriate individuals are informed in writing of the action taken.