MN Board of Psychology 2019

MN Board of Psychology 2019


(warm calming music) – Welcome to the Minnesota Board of Psychology’s
2019 spring conference. Our agenda for this part
of the presentation, we’re gonna talk
about the mission, composition, and
duties of the board. So kind of why we do
the things that we do. Then we’ll look at documentation
that’s related to the postdoctoral
supervised experience. Hopefully at the end of this
you’ll be able to identify things that should be going
into your supervision file, and your supervision logs, and make the whole point of
this conference is to make this part of the conference is to
make a smoother application process for the applicants, and the licensees, and I think that we can do that
by explaining our processes, telling you what the board
is really looking for when we have these different documents, and making sure that
as you’re aware, you can start
including those things, or continue to include. – And we’re also gonna just
make this a conversation. So we’re gonna be talking
about ways to try to make what you do match what
the board requires, but we are in no way
establishing rules. So there’s your qualification. – That’s right, yeah. If you have questions
about the actual rule, we’ll refer you to the rules, and statutes themselves. So then after that we’ll
talk about the general postdoctoral
supervision concerns. So what are the common things that we see that
hold applications up? And then finally we’ll talk
a little bit about some specific areas of opportunities, things that you could include
in supervision files that will really make that a
process of applying for your postdoc go much smoother. So the mission of the board, Minnesota Board of Psychology
protects the public through licensure, regulation, and
education to promote access to safe, competent, and ethical
psychological services. The board members really
believe in this mission, and how all of our work
derives from being connected to this mission about protecting
the public through licensure, regulation, and education. So this particular presentation
is gonna hit on all three of those categories. Licensure, obviously we’re
talking about supervision here. Regulation, we do have the
regulatory component with regards to the complaint review
process, and then education because one of our
real goals here is to just bring some light, some sunlight to
what the board does, and really help foster a
conversation between us, and the community, and get us all on the same page. So the composition of
the board by the numbers, we have 11 board members. They’re appointed
by the governor. They serve three year terms. We have eight
psychologist members. We have three public members. We have many committees. The ones we’ll go, I’ll let you know is
application review committee, complaint review committee,
rules, legislative, administrative, and PRE testing. This time I didn’t forget
the the rules committee. They all do important work, and they’re all staffed, or they’re all staffed
by board members. They all have at least
two professional members, and one public member. So that’s common to all of our
boards that we like to have the expertise of
our professionals that can drive our decisions, but also the public members
serve a really important role in making sure that our mission to protect the
public is fulfilled. So these are the
duties of the board. This is all outlined in statute. We’re the gatekeeper of the
profession through licensure. We regulate the
practice of psychology. We issue renew licenses,
and collect fees, and we provide an avenue for
the public to file a complaint if they’ve had what they believe to be a service that isn’t
provided competently, and then educate the board, and educate the public
about board rules. Do you want to do? Alright, so we’ll start
with postdoctoral, documenting postdoc supervision. So improper, or inadequate
supervision is the seventh most reported reason for disciplinary
action by licensing boards. You know, is anybody surprised
by this in this room? Yeah, some people are. So that’s pretty high up on the order of
disciplinary things. Things that are
gonna be above it are like boundaries issues, or incompetent practice, but seven is, is quite up there, and so that’s why this topic
is especially important, because we want to try, and educate the supervisors, and supervisees to avoid some of the potential
actions that could happen. – So I want to… How do I put that? I want to put this in a context. Think about what supervision is, the postdoc year of supervision. I think people
finish their degree, they’ve finished their
pre-doctoral internship, and they’re to hit
the ground running. They’re very confident, they feel really good, and they really
want to get started, but there’s still another
year of training that our profession has said
people need to have. So I really want you to think
about that postdoc year as the final year of training. So for people who take on
the role of supervisor, you’re taking on
the responsibility
for this applicant, or this supervisee’s last
year of development in their identity as a psychologist, and in their ability to provide
the kind of psychological services in a competent
way that we want to see, and then for the applicant, or the supervisee, this is your last chance to
have this kind of safety net while you’re doing practice, and it’s really about figuring out what’s
left for you to develop. So it’s not just a year where
you’re gonna hit the ground, and do practice, and that’s it. You’re ready to go. It really is another
year of development. So everything that
we talk about, we want you to think
about it in those terms. – Right. So, you know, what is a
postdoc supervised experience? Under the statutes, and oh, I forgot to mention, one of the challenges
that I’m gonna try, and challenge myself to do is
not to speak in lawyer talk, and legal language
as much as I can. You know, I am a
recovering attorney, so I will slip into that
every once in a while, but I’m really gonna try, and talk in plain
language as much as I can. So under the rules
post doc post degree supervised experiences paid, or volunteer experience that
has professional oversight by a primary supervisor, and then you know, meets the
requirements of statutes, and rules that we have
around supervision, and supervision is
the documented in
person consultation that can be interactive, visual,
electronic communication, designed for supervision
for licensing purposes. – And it really has two
goals that postdoc year. For the supervisor, you’re providing the supervision to help the
psychologist develop. So it’s their final
year of training, but you’re also supposed to be
providing clinical oversight for the work that
they do so that we are protecting the public. – Right, and so, you know,
really to to drive, I think that point home is we really take
the word of the supervisor, attesting that the person
is competent to practice by themselves very
seriously with the board, and that’s, you know, what
we’re gonna talk about here. So how much post degree
experiences required? One full year of full, or the full time, or the equivalent part time. So that’s 12 months. The time work can be paid, or unpaid doesn’t really matter, but it has to be 1,800 hours
that you accrue in a timeframe that’s no less than 12 months, and then we have no more
than 60 months here. So our statute allows us
some flexibility to for our applicants to have life happen, to step away from the practice
of psychology if they would like to to do some
things like that, and still be eligible for
licensing down the road. We need one hour of primary
supervision per week. Let’s just put that into
like real simple terms. If the supervisee sees
one client for one hour, they need to have one hour of primary supervision
for that week. If they have 20 hours, they still only need one hour. If they have 21 hours, they need two hours
of supervision. The board never is, requires you to have more
than two hours of supervision, and we cap the number of
hours that count per week, at 50 hours per week. However I would just
encourage supervisors to say, if you feel like your
supervisee needs additional supervision during that week, there is nothing that
prevents you from providing additional supervision. If they’re having tough cases, or if there’s a you know,
other reasons that you want to have three hours of supervision, we just don’t require
it as the board. – Alright, so there’s where
your role as clinical oversight becomes really important. If you feel like this
political situation, or this supervisee
needs additional hours
of supervision in order for you to
feel comfortable, because it’s your license
they’re practicing under. If that service is
gonna be competent, then you can go ahead, and provide that
additional supervision. I also want to keep in mind, I know in some sites where
people are doing their postdocs, they’re working more
than 50 hours a week, and while we don’t require
that you have more than two hours a week of supervision, the supervisee’s work
is on your license, and if something goes wrong, it’s your license that
will be looked at, and so you want to make sure that the clinical
oversight you’re providing, that you feel okay that
it’s enough, right? – Right, so there’s a difference
between what we’re gonna require them to
demonstrate to us, and what you might feel
comfortable having them do, and then, so the primary
supervisor has to be either a doctoral level psychologist, or a master’s level psychologist who was licensed prior to 1991. October 1st, 1991. The second hour is loosened
up a little bit about who can provide that supervision. This person, we call if
the primary supervisor can either do a second hour of individual
with themselves, or if they want to try, and steer the supervisee to get an additional skillset
from another provider, they can do that as well. That person then becomes
the designated supervisor, and the designated supervisors
is a behavioral professional. Any of those people can
serve as a supervisor for the psychologist for
that second hour, but only doctoral licensed
psychologist for the first hour, or the master’s
level that qualify. – So I just want to put
this in simple terms, so not the legalees, and not all the details. So if you’re doing your postdoc, you have to do 1,800 hours, and it has to be a year. There’s leeway to make that
more flexible so that it can be, you can use more than a
year’s amount of time, but you have to get 1,800 hours. You basically, if you’re
working full time, you have to get two hours
a week of supervision, so, and one of those
hours needs to be with a doctoral level psychologist basically with some minor
exceptions built in. So and the point
of that I believe is about helping you develop. If you’re a supervisee, helping
a supervisee, developing an identity as a psychologist, and doing
psychological practice, but there’s also then the
opportunity to have another supervisor rather than the same
supervisor so that they can develop additional expertise, or can be supervised
by someone that, like in a group
setting for example. So the first hour needs to be individual one on
one face to face, or using the equivalent of
FaceTime, or Google Duo, because you can do
tele supervision, but one hour individual with
a doctoral level psychologist, and the second hour has the
option to include another licensed behavioral
health professional, and it can be in group rather
than individual settings. – Yep. So, and then the last point
we want to make about this documentation pieces that the
supervisee you know, there needs to be continuing
supervision as
described above after the point that they
complete their postdoc. So basically there’s
two different statuses. You’re either licensed
in independent practice, you don’t need to be supervised, not licensed, need
to be supervised. Alright, so let’s talk about what the board expects
from supervisors. So the board expects that
the supervisor understands, and abides by the requirements,
and statute, and rule. We also require, so for competency
we also require the competent provision
of supervision. So obviously in your
regular practice, when you’re providing
some kind of service, the rules require that you do
that in a competent manner. When you’re supervising somebody who’s providing
psychological services, you need to be competent, not only in the area
that the supervisee is providing services, but also in supervision, and there are board rules about
how to develop competencies, and I’ll let you look those up to figure out you
know, what those are. – Basically just like any other clinical
practice that you would do, we want you to be competent
to provide supervision. So way back in the day
when I was in grad school, I had to take a
class in supervision. We had a practicum
in supervision, providing supervised service
to people earlier in their training cycle was
part of my internship. So those are the kinds of
things that we might be looking for for you to say, okay, that’s a
competency that I have. – Right, right, absolutely, and so then what the board
expects of supervisors is that they document the total hours
of supervision provided, and also document the total
hours of time where the supervisee worked under
the licensee’s supervision, and this goes back to you
know, if you don’t document it, it didn’t happen, you know? – Right, I think
some people get, if I’m gonna be at, like in some settings
there’s a primary supervisor, and then there’s someone we
call a designated supervisor, and this is where
we get confused with
the legal language, and kind of the common
use of the term. So technically legally
designated supervisor means the primary supervisor said you, you’ll go do that supervision, but in reality what
often happens is, they’re assigned by
someone in administration, or some other variation of that, but when you take on the
role of primary supervisor, we’re expecting that you’re
gonna be the person that’s gonna make sure it all happens
according to the way it’s supposed to happen. The licensee also
has to do that, but we don’t want to want
supervisors to be off the hook for making sure, because you’re the person that
that supervisee is turning to for guidance, you’re the one that needs to
be providing oversight to make sure that the rules
are being followed. So with a designated
supervisor then, if you’re responsible for the
entire supervised experience, because you’ve taken on the
role of primary supervisor, it’s important for you to
talk with the other people who are doing supervision, because for example, there may be particular
areas of development that a particular supervisee
may still need, and if you guys
aren’t communicating, then that may never happen. So we’re wanting you to
work together as a team, just like a clinical
team might work together. – Absolutely, and I would say, you know, the board understands that especially
larger organizations, the primary supervisor
may not get to choose who they designate, right, and an administrator may say
this is a group supervision that we want this
supervisee to go to. That doesn’t preclude the
supervisor from saying that is the person that I also designate as the designated supervisor, and in thinking of it that way, so that there’s not
a miscommunication, a misunderstanding between us, and the in the licensee. Dr. McCloud covered
the the communication, and how key that is for the primary
supervisor to collaborate, and control really that
primary communication, and then finally a routine, you know, responsibility
for all of the professional experience that occurs
underneath that supervision. So clinically responsible
for what that supervisee does when you’re supervising them. – Okay, so for… How many of you in
here are supervisors? How many of you in
here are supervisees? Okay, so we have mostly
a room of supervisors. So we expect that
people who are, so your supervisees ought
to know these things, but as a supervisor you kind
of have to keep tabs on that, and make sure that
they’re up on that. It’s one of the ways that we’re
enculturating people to pay attention to their board
statutes and rules. So we want to make sure that
applicants know all of the rules and statutes. How many have you
read the rules, and statutes prior to
applying for your license? Nice, nice, okay. I teach a class of fourth
year doctoral students, and they hardly have
looked at that at all, until they get in my class. Yeah, you go ahead. – Okay, so in addition to just
knowing what the rules are, and having an
understanding of that, we need the supervisee to
document the total hours worked, as well as the hours of
supervision that they received. Now the second one,
this third point, this isn’t something
that’s required, but it’s really is, I
think, a best practice, and so we wanted to highlight
it from that perspective, is as your supervised
experience changes, like let’s say you move from one postdoc
experience to another, or you’re doing a rotation, if you let the board know that you finished
with one experience, the board can then start
the work of verifying that experience from that supervisor, and catalog that away
on your application, so that at the time that you’re
all finished with the work that you’re doing, there’s less verification
for us to do. It just kind of helps us smooth
that licensing process out, and make it a
little bit quicker, and then it is the
applicant’s responsibility to demonstrate how they met
the licensing requirements, and this goes back
to the documentation
comment that I made, as how do you demonstrate
that you met the requirements? One of the easiest ways is to provide the documentation
of the supervision and of the hours
that you worked, and so that’s one of the
real key reasons why it’s important to really keep good documentation
about this experience, both from the supervisee,
and the supervisor, and then again, continuing
to be supervised after completing the
postdoctoral hours, and maintaining that supervision until the license is granted. – So this is one of the areas
I think that can be kind of tricky for folks. They feel like completed
my 1,800 hours. I did my one year, I’ve got all my
requirements met, so I’m gonna submit that, but now I can go
ahead and practice, and you want to be really
careful that you’re not doing what is called practicing
psychology without a license. So until you’re licensed,
you have to be supervised. There’s still some gray area
in there in terms of what level of supervision, and in general, what we’re
suggesting is that you continue the same level of supervision that you’ve had until
you get your license. That’s your safest bet. There are some people
who change their job title to mental
health practitioner, and follow DHS guidelines. Just make sure that
you’re doing it that way, if that’s the route
you’re gonna go. – Absolutely, absolutely. So let’s talk about the types
of documents that we get from supervisees and supervisors. So supervisees, they
complete the application, which includes documenting
all of the postdoc experience that they have. If they have a change in
their postdoc experience, they submit a
supervision amendment. That can be for something as
simple as I took this job, and I thought it was
gonna be 12 months, and I was gonna
work a 22,000 hours, and instead I worked
for 16 months, and 2,400 hours. Well, we need to know, you know, what you’re submitting
for that work, and so we have an amendment
form that you can fill out that applicants can fill out, to let us know
about that change, so that we can know what to
expect from the supervisor. And then the final thing is
just to respond to any requests for additional information, and documents that
we might ask for. From the supervisors, we require that they complete
the supervision attestation in a timely manner. This is one thing that can
hold up the licensing process, that the supervisor doesn’t
submit the verification, or attestation that we request, and that’s something that we’re
really focusing on in terms of trying to get the applicant through the application process, as quickly as we can with
maintaining the standards, and then again, responding to
the additional documentation, or information requests. So if something isn’t clear, we will ask you
about what we think, what’s unclear to us. – So one of the things we’re
trying to do is make the application process as
seamless as possible, and take as little
time as possible. So the things that
we’re talking about, and that we’re gonna go into
more depth on is how do you keep that process
going smooth and fast, and if you’re doing
all of these things, providing the documentation, making sure that
those things match up, and for supervisors that, that when you get the email
from the board that says, please go to this link, and fill out this form, that you take 10
minutes out of your day, that day, and get it done, then that keeps the application
going in the process. So technically if is there, there’s no glitches, or hiccups, then it can be within 30
days, the license is done, and think about that. If you have to continue
supervision at the
same level until your license happens, you want to do as
much possible upfront, not to slow that process down, because that kind of
supervision is expensive. – Alright, and I’ll say that, you know, once we have the
documentation that we need, it takes about two weeks, two weeks to three weeks
for us to move that licensee through the two final reviews that we need to do
for their application. So once we have the documents, we’re able to get that
through pretty quick. So I wanted to go through
some documents that we use, as the board staff to try, and verify, and certify a
postdoctoral experience. So these are the two sheets
that you would have picked up at the table back here. The first one looks
somewhat like this. This is called our
supervision amendment form. We use this form anytime
somebody wants to change some aspect of their postdoc. So we ensure that the applicant
submits information that’s relevant to their experience, that might’ve changed since
they last communicated with the board about their experience. As you can see, there’s a lot
of information for them to fill out here. I draw your attention
to a specific duties. So this is where they write
out what exactly they’ve done, and that it’s the
practice of psychology. So as board staff, we need to know that
what they’re asking
to have counted is actually the practice
of psychology. There’s a definition, and the definitions of
what the practice is, and that’s hyperlinked there, and so you can go and look, and kind of use those
keywords to describe what your experience actually was. – So what you don’t want to put there is postdoctoral
fellowship, or postdoctoral residency, because those words don’t
appear anywhere in the practice act as defining the
practice of psychology. So go look at the words of
how our statute defines the practice of psychology, and make sure those
words appear there. – That’s right. So like if you’re
providing psychotherapy, if you’re doing assessments, anything like that. – Teaching a class. – Teaching a psychology class. Those are all in the definition of the practice of psychology. Make sure that you know, those things make it into
into the description. So then we ask if the applicant
wants this information, or these hours that
they completed counted. So in order to count they must be the
practice of psychology, and then, so if they, if
somebody says no in this part, then we ask them to
go to the next box, which says is that, you know, could that be that
experience be considered the practice of psychology? So there are a lot of
exemptions to the practice act, and there is a lot of let’s
say scope overlap where it’s, it wouldn’t be called the
practice of psychology that an LPCC does something, but our scope of practice
overlaps in that person might have an LPCC license. – And there’s a of examples. So if many times people have
a master’s level licensed LPCC, LMFT, LICSW, and if they’re working
under that license, then that would be one of the
times that even though the duties of the job also
fit the definition of the practice of psychology, they’re practicing under
one of those exemptions, and we just want
them to tell us what, which exemption are
you doing that under? Because remember,
you’re not supposed to practice without a license, or without adequate supervision. – Right, and so
that’s a great point, and you know, essentially
we’ve put this in here, this little box to make sure
that not only is it clear to us which exemption you know,
if an applicant’s asking for it to be exempt, why they believe it’s exempt, but also gets the
applicant to think about, you know makes the choice about whether it is an
exempt activity or not. So those are the documents
that we have with applicants, and on the backside you’ll see
that there’s a big space for you to write why you’re
asking for the change. I would just say
provide the reason that you’re making the change, and leave it at that. We’ll contact you if we have
more questions about it. – And just because
there’s a big space there, does not mean you have
to fill it in really, it could just be one sentence, or even the clause
just to explain why. – Right, yeah, it could just be, you know, in the example
that I gave previously, I ended up working extra months, and I have 2,400 hours
now instead of 2,000. Done. – I was working under
an LPCC license. – Yep, done. It doesn’t need to be you
know, a narrative about everything that happened
with that experience. So now let’s talk about the
documentation that we have as it relates to what we
get from the supervisor. So staff reviews the
supervision attestation, which is the other
document that you have. It’s a two page document, and we ask supervisors
to fill these out, and to get these back to us. Now, I just want to say a little
bit about a process change that we’ve had in
the last little bit. I think it’s almost a year now. So we treat this attestation
by the supervisor very similarly to the way we treat a transcript from a university. That’s how seriously we take
the word of the supervisor. So for instance, if an applicant tells
us that they graduated from The University
of St. Thomas, and maybe even they send
us their transcript, that’s all well, and good, but we don’t accept
that as primary source. We require the university to
send us a transcript directly to verify that. So we look from the
supervisee’s perspective, we look at the total hours that they say that
they’re working. From the supervisor’s
perspective, we ask many more questions of
the supervisor to make sure that the experience that
this applicant had was an experience that meets
our requirements. – So one of the things I would
ask you to do is take a look at the items on the
attestation form, because you as a supervisor, these are the things that
you have to attest to for each of your supervisees, attest to the board that
these things happen, and it kind of outlines
exactly what you’re supposed to have been doing during
that supervisory year. – Absolutely, and you know,
you can just see the questions that we ask, and if
you were to just, I think take these questions, and kind of apply them to
your supervisory relationship, you would end up being pretty, you know, having a pretty
good set of documents that you could competently tell the board that this person’s
ready to practice. – So I know attestation
has a legal meaning, but basically what you’re
saying is I promise that this really did happen? – Right. – If there was ever a question that we need to see,
did it really happen? One of the rules, I know I was taught in training, if you don’t document,
then it didn’t happen. So you need to be documenting
supervision along the way. So one of the things that I do, I enter, actually I enter all
my supervisees as a patient in our electronic
health record system, and I use a procedure
called supervision, and it gets documented in
the electronic health record. I have a note form
that I fill out very similarly to
a progress note, where I just make a
real brief summary of what we talked about. I have checkboxes
to make it fast, because I don’t write
a big long narrative of what we’ve said, talk about topics
that we covered, and then anything that the
supervisee is gonna do as a followup from our meeting. So that your
documentation is there, and I can run a quick
report in my EHR. It gives me all the
dates that we met, the times that we met. I say we met for an hour. In my notes I’ll say we met
for an hour face to face at this office, that location. So I’m documenting
that have happened. – Absolutely. So this form is what we use, and we also provide some, you know, we understand
that people get sick, people go on vacation, things like that, and so we provide some boxes in the bottom to
kind of tell us, you know, if supervision
was missed for one week, that’s not gonna be
the end of the world. Just let us know
that it happened, and if that was made
up when it was made up, or you know, if somebody else
provided that supervision, who that person was. – So I have a sub, a supervision sub that I use. So this is another doctoral
level psychologist, and if for some reason I’m sick, or I’m out of town, or I’m at a conference, my supervisee continues
to work full time, and she needs to have
that hour of individual, and the hour, and
a half of group. That’s the way we
do it at our clinic, and so I have other people
who are gonna step in for me, and do those things. Doctoral level supervisor for
the one on one face to face, and that set up ahead of time, and then that becomes
part of the documentation. So while I may not have met
with her every single week for that one hour, I know that someone did, and if for some reason
that person can’t, then I’m gonna try to make
that up the next week, and do extra supervision
the following week. What we don’t want
to see is weeks, and weeks of no individual
supervision by someone who qualifies as a
primary supervisor. – That’s right, yeah. So now that we’ve talked
a little bit about, you know, the documents
that the board staff uses, and what we’re kind
of looking for, let’s talk about what staff
does when we can’t certify the postdoc supervision as
meeting our requirements. So I’m just gonna give
a brief history of this. The board has the authority to review the
supervised experience, but not a good use of
the board member’s time to come once a month, and just review supervision. We might not get any other
business done that week. So the board then delegates to
staff the ability to review, and approve applicants, and their supervision, and get them licensed. It really helps us
get people licensed in between board meetings, but the caveat is that
we’re not psychologists. The staff knows there’s not
a psychologist on staff. If we’re going to
approve supervision, it has to fit in our nice
little neat box that the board members have given to us, and says that if it’s like this, then absolutely it
meets the requirement, and you guys can license them. We don’t as staff feel
comfortable working
on the margins, and making you know, judgment
calls about whether something meets the requirement or not. So those things then we have
to try and resolve them if it’s at the margins, and again, the board, and the application review
committee meet once a month. So we try, and do all of this work in
between those time periods so that if the board, or a committee does
need to make a decision, that they have all of the
documentation that they need in order to make a decision
at that meeting, so that we don’t hold up
the licensing process. – So if it fits in a box, it’s– – Yep. – It’s sped through the process. – Sped through the process. So what can slow
down the process? Okay, supervisors that are
in the attestation listing supervision hours worked
that are less than what the applicant is claiming. So for instance, if the applicant says that
they worked 1,800 hours, and the supervisor
said it was 1,200, well, you know,
we have an issue. What happened with
the 600 hours? Did the supervisor just
make a clerical error in writing that down? Could be, or you know, was
there some work that was done by the applicant that
the supervisor didn’t
know was happening? And so we need to
kind of sort that out. You know, the reverse is
something that we can handle. If the supervisee says
it was 1,200 hours, and the supervisor says
it was 1,400 hours, not a problem, because we know that at least those 1,200
hours were supervised. So the attestation by the
supervisor has ambiguous information about
supervision hours. So one of the examples
that I give is, they say they didn’t
designate a supervisor, but then they list the person who provided
designated supervision, and so we’re not clear. Was that designated supervision? You know, did they
actually designate it? – This is an example of where
psychologists can get trapped by legal language. So did you designate
another supervisor? What does it say, right? And so you may not
have designated, okay, I pick you to do it. It may actually have been an
administrator in your clinic that said this person’s gonna
do the designated supervision, you’re gonna do the primary. So technically, because
we’re honest people, and we want to tell the truth, some people will say, no, I didn’t designate. Somebody else did, but that’s somebody else
that isn’t on there. So really it’s about, did you know there was
a designated supervisor? Were you aware of them, were you’re
collaborating with them? Were you working together
to develop this supervisee? Those are the kinds of things that that question’s
trying to get at. Was there a
designated supervisor? – Right, exactly. Oh, so then a applicant
fails to describe in adequate detail, their duties. This goes back to
the fellowship thing. – The fourth one then is that
sometimes what happens in some clinics is the
supervisee will start, let’s say on September 1st, but the first supervision
meeting doesn’t
happen until some later time period, let’s say September 15th. So there’s two weeks in
there where there was not supervision provided. We just want an
explanation of that. That needs to make some sense. If they weren’t seeing any
clients until later on when the supervision took place, then that’s not a problem. If they started seeing
clients day one, but it took two weeks for
them to get supervision, then that’s a problem. So just think about when is
your supervisee going to be actually seeing clients? I have my supervisees for
most of their first month. They’re shadowing me, and actually every time
they’re shadowing me, they’re with me in the session. I’m supervising them
in that meeting. I’m there with them. We have the ability to
then debrief about that. So those times count, even though it’s not
a supervision session. – Right, and so what I would
say about that is that, there are valid reasons for
people to start a program that they wouldn’t get
supervision for, you know, up to four weeks. The department of corrections
has a four week training program that they put their
psychologists through, before they can see clients. We just, as the board, we need to have that
just explained to us in a manner that makes sense, that I wasn’t seeing clients, I was doing a training program. This was when I
started seeing clients. So this is when
supervision started. There’s nothing wrong. There’s absolutely
nothing wrong with that. We just, if we don’t
get that explanation, then we wonder, you know, we want to make sure that
that experience is supervised. – So then what happens is it
just slows the process down, because then we
have to turn around, and ask for that information, wait for it to come back in, and so even if
everything’s cool, it’s just takes longer. – Absolutely, and that’s what
we’re trying to avoid here. So here’s what we do when
we’re trying to resolve these issues with either an
applicant and supervisee. We request additional
attestations. So we’ll send these
attestations out to supervisors. They’ll submit them. Maybe there’s something that wasn’t clear
from their submission. So we’ll go back and say, you know, you wrote down that you supervised
12 hours of work. Did you mean that you
provided 12 hours? You know, did you
mean you provided 12
hours of supervision, or did they really
only work for 12 hours? And so we’ll try
and clear it up, and we’ll be pretty clear
about what is missing without telling people what they
need to put in there, and then if through a couple
of back and forths with this, we can’t quite get a grasp
that the supervision experience clearly meets our requirements, what we’ll do is we’ll
request supervision logs, and the supervision file. So at that point, what we’re gonna try, and do is say, okay, maybe you’re not understanding the questions that we’re asking. So we’re just gonna match
the documents and go through, and and give you credit for
what meets our requirements, and then figure out
if there’s something that doesn’t meet
our requirements, then that would go to the
application review committee to to kind of review. – So one of the things
that people think happens is after they finish
their doctoral program, remember in practicum
and internship you had to log your hours, you had to log how many
testing hours you did, how many direct
client contact hours, how many hours of supervision, those logs, it’s important
for you to continue those logs through the postdoc experience so that you have
that kind of record. Remember, if you don’t document it can be argued that
it didn’t happen, and then as supervisors, I think it’s really important
to keep tabs on your supervisee doing that, keeping those kinds of logs, and keeping them up to date. It’s way easier to do a log as
you go than it is at the end of the year to look back, and say, okay, what did we do? So one of the things I’ve done
to make that process simple is we’ve created a Google
spreadsheet so it can be shared, and it can be live. I put my supervisees, they’re responsible
for recording the data. So date of supervision, who it was with, how long it was, from what time to what time, what type of supervision? Individual, primary, group,
designated, those kinds of things are logged
on that spreadsheet, and then my job as supervisor
is to periodically go in, and verify that what’s being
entered there matches up with what I’m documenting
from what I’m doing. – Right. And absolutely, that
is a best practice to do that in real time, you know, to try and make
sure that you’re communicating with your supervisees. So you’re on the same page about what supervision
is happening, what took place. You know, to make
sure that those hours are being documented. So if we can’t through these, through these methods,
if we can’t you know, resolve any of the issues, or we can’t certify
all of the experience, and that’s the other thing
that I didn’t mention. If we’re gonna certify
the experience as staff, we have to certify all of it, or we have to take
it to the ARC, because we can’t say, okay, they have enough
hours that count, but then there’s these, you know, seven or eight weeks, whatever that don’t
meet our requirements, but we’re gonna just
count the ones that do, we have to take it to the ARC
to make sure we know what to do with those. – ARC is Application
Review Committee. – Thank you. So then the application
review committee, I won’t go into much
detail about this. We take any files
that we can’t certify to an application
review committee. There are two doctoral
psychologists, and a public member
that review these files, and they have a range
of decision points
that they can make. If they can’t, if the ARC, the application review
committee decides that it’s you know, a pretty major issue, and they feel like
it needs to go to the complaint
resolution committee, or if the conduct described in
all of the documents that we received from the applicant
and the supervisee show that it is completely out of whack
with what the state requires, or if there’s boundaries,
violations, or other things, then some of those
will go directly to the complaint
resolution committee, but it’s very rare that
those do go there these days. So then we do have
a that coming up. So I will just say that there
is a lot of tools that the CRC has to understand what
happened during that experience. So general postdoctoral
supervision concerns, and specific opportunities. So we’ve gone through
quite a few of these, but just to, you know, make sure that we
drive the point home. You know, starting the
postdoc before all the degree requirements are met, is not something that
can be done in Minnesota. So you need to have finished
everything you need to do for your doctoral degree in order to start
accruing postdoc hours. Supervisors deferring
responsibility… – Oh, I’ll do that. That’s where I think
this actually was, if you look back at the
history of supervision in the development of a
profession of psychology, and then as licensure
came to be known, I think it was kind of put, the onus was put on
the applicant to make
sure they met all of their required hours
to become licensed, and psychology, and the
practice of psychology has evolved from that, so that we didn’t use to
have to document supervision, not when I was trained, but now we do it. There’s an expectation that
you’re documenting that. There’s also an expectation
that you are taking responsibility that they’re
meeting the requirements. So if you’re gonna take on the
role of primary supervisor, you’re providing oversight, and kind of administrative
oversight to make sure they’re meeting the requirements. You’re also providing
true clinical oversight. So I’m gonna skip to that
one since we’re on it. True clinical oversight. So there are some situations
where for example, a primary supervisor will be
hired by a clinic to supervise a postdoc that’s in that clinic, but the primary supervisor is not an employee
of that clinic. So it’s just a contract to
provide that supervision. If you’re in that
kind of a situation, you need to make sure that you
have what we consider to be true clinical oversight. You need to have access to the
records of the clients that your supervisee is seeing, and you need to have the
opportunity to directly observe the work of your supervisee. So it’s to observe a session, to listen to recordings, you can’t just meet
for one hour a week, and say, I did my thing. That’s all I’m responsible for. It’s a lot more than that. – Absolutely. So another thing that we see
that’s a common pitfall that elongates the the
application process, is people are missing that
second hour of supervision, some weeks or maybe all weeks. And then also just
the supervisors not communicating together. So it’s demonstrated in the
paperwork that there wasn’t a lot of communication between
the primary supervisor, and the designated supervisor, and so that is you know, problematic from the
board’s perspective. – It’s kind of
like two therapists working with the same client. You would want to make sure
you talk to each other. – Right. And then finally, reducing the level
of supervision after the 1,800
hours are completed, or not having
supervision at all, and continuing to practice. So finally, specific
opportunities for
this group is you know, make sure that if the
supervision doesn’t start at the time of employment, or within, you know,
a week or so, a week, or two of that, that you
explained to the board when you submit your application,
why that is. Make sure you’re starting
your postdoc after you’ve completed all the
requirements for your degree. You know really, from the
applicant’s perspective, making sure that you as an
applicant understand who your primary supervisor is, and having only those people
listed on the application, because sometimes we will
get designated supervisors, and when we send
them the primary
supervision at testation, it comes back very
confusing for us, and causes a lot of spinning
the wheels on our part. And then I would just say,
you know, all of these things, we’re just trying to
smooth out the pathway, because at each board
meeting we have a section, it’s one of my favorite parts, where we report to the full
board about the number of people that we’ve licensed from since the
last board meeting, and I can tell you
our staff loves it when those lists are long. It feels really good to have
a lot of people licensed in that last timeframe. It feels really good to have,
you know us feel like we’re making a difference in terms
of getting competent providers out into the world that can help Minnesotans
with their mental health, and we really,
really value that, and what we’re trying to do
here is to just make sure that everybody is on the same page, and minimize that time
that it takes for them, for applicants to get licensed. – So, really what he’s saying
is that the board staff, and I believe board
members as well, we really want to make
this process work. Everyone’s intentions
are really good. There are statutes and rules
that have to be followed, and we’re trying to see
how to make it work, and where along the way
do people hit glitches, that we can help smooth out
by talking about it more. So now we have questions. – Now we have time
for questions. – And we have an open mic. – Don’t be afraid. Yes. – Can you come to the mic? – Come to the mic. – We need you to
come to the mic, because we’re recording it, and we want to be able
to capture the questions, and the answers on
the video recording. Yeah? – So I worked in a setting
where it may be the case that a trainee will come, and not really intend to
practice in Minnesota, and then after a time they
may get a job in Minnesota. So they would not have
submitted anything to the board, and the reason I’m asking this, it sounds as though someone
should actually submit an application early on in
their post-doctoral year. Is that correct? – Well, so they don’t have to, people don’t have to submit
an application until they’re ready to apply for licensing. – The reason I asked
this question is you
are talking about a document about amending. So what would they be amending? – Sure, so that’s
a great question. In order to sit for one
of the examinations, the EPPP or the PRE, we have to have an application
that’s complete on file. So at that point in time, somebody might fill
out information about
their experience, and give us the documents
related to taking the exam. If they happen to fill out the
information related to their postdoc supervision, right? Then they would need to amend that part of the
application with us. – So for example, a postdoc at the beginning
of the year say they want to take the EPPP a
couple of months in, because we know the research
shows that the closer to your coursework you take the EPPP, the greater the probability
that you’re gonna pass it. So they want to take
it during that year. So they fill out all
the bubbles align, and they pay their fee, and they hit submit, but they’re at that point, they’re not reporting true
numbers for their postdoc. They’re reporting an
estimate for that. So at the end of
their postdoc year, then they want to go back, and file an amendment so that
it more accurately reflects, because otherwise once
they’ve passed those exams, and they hit whatever button
that says, okay, I’m ready, and it goes to the supervisor, if they said 1,800 hours, and I’m, well, if
they say 2,000 hours, and I say 1,836, that’s gonna be a glitch
that slows it down. So they need to get
the accurate numbers in at the end of the year, if they started it early. – But if somebody is doing this after the fact that’s
perfectly acceptable? – Then they would just report
what they actually worked at that point in time. – Second question? What does the board consider, well done supervisory
documentation, I mean by the supervisor? – The board doesn’t
clarify that. So my recommendation is that
you look at DHHS guidelines for what they’re requiring. I mean the board has kind of
some things about you have to, it’s just some language
in their own rule I think, but it’s not like bullet points. Like what I said I do, right? But I developed what I do based on reading the
statute and rule. So you’re basically saying that whether it was
group, or individual, how long it lasted, what the date was, where you met, that it was face to face, or tela supervision, those kinds of things, and then kind of a
really vague summary of what you talked about. – And I would say that if you
look at what the test date, the questions that we’re asking, if you have documentation to
back up all of the things that you say yes to, yeah. – Like for example, if I’m talking with
one of my supervisors, they have a client who
has suicidal ideation, we’re gonna be
talking about that. I’m also gonna document
that in their record, because that’s one of the
things that DHS requires. So there’s kind of additional documentation that
you could have. – Right. Thank you for those questions. Other questions please? – I was going to write it down, but I’ll just ask it quick. Could you explain the difference
between question five, and six on the supervisory form? – Yeah, yeah, absolutely. – Because I’m reading them and they sound like
the same thing. – We had that same
question this morning. – So question five just
says, as the supervisor, I understand how
much my supervisees’ working under my supervision. And I’m sorry? – On the supervisor attestation
form questions five and six. It’s on the back I think. – And then that you
also provided the
supervision necessary for that number of
hours in that week. That’s basically
getting towards, you know, you really are, you really have a grasp on what the supervisee is
doing on your license, and then question number
six is getting toward, getting at the individual
one on one supervision that’s required of the
primary supervisor. So remember we said that there’s two different
types of supervision, of two different
hours of supervision, and that the first hour has to be by the
primary face to face, which can include the
Google Duo or FaceTime– – And Individual not an
individual, not group. – And individual not group. So that’s the difference
between those. Does that make sense? – I’m sorry, I was
actually talking about the additional
information questions. I did not clarify, I apologize. Numbers five and six that
talk about when you missed an hour due to illness
or something. – Yep, so yeah. – They sound like the
same questions to me. – So these are
additional information. So what you do is you look
at question number five, and if you can say
yes most of the time, but there are a few exceptions, then you go down to
the corresponding box, and write in kind of what
the narrative is about, you know, about that. – So third week of September
we missed supervision. I was out of town
at a conference, my colleague filled in, my colleagues credentials are. – Right. Or you know,
supervisor got sick, or supervisee got
sick on Friday. Friday’s our normal day
that we have supervision. We had supervision on Monday, the next Monday. – Or two hours the
following Friday. – Right, exactly. Any other, oh yes? Great. – I have a couple of questions. One is a followup to that, and has to do with the label
designated supervisor versus when you are out
of town, or sick, and someone steps in for you. What is the correct label for what you were
referring to as a sub? – I would say, because I’m the
primary supervisor, it needs to be somebody
who meets the criteria, or qualifications of
a primary supervisor. So it needs to be someone
who basically has a doctoral degree in psychology. – So I understand
the qualifications, but what labels should we
use on the form if we’re referring to them, because designated sounds a
little bit different than that, or is it also a designated? – So what I would just do is if, I wouldn’t actually label them. I would just, I mean, in the box you can
just fill out this person with this credential
supervised that week. – Don’t get too hung
up on the legalese. – Yeah. – Okay, or if it
was multiple weeks, because I were fortunate
to have vacation. – I was on maternity leave a couple of people,
six weeks, seven weeks, and so and so filled in
for me fulfilling the role. You could say
fulfilling the role, the primary supervisor
if you want it to. – And then I’m just verifying, is the case that you can have a makeup supervision
hour the next week. I guess I didn’t
understand that. So you can have, you could have zero one week, and four hours the next, and still count both weeks? – What we would not want to
see is that to be the practice for the entire year. – Okay, but occasionally? – Can’t do four hours
a month at one time. – And then you also said
they shouldn’t be calling, if they have a
postdoctoral fellowship, they should not
label it as such. – No, no, no, no, no. That’s only for the purposes
of sorry, describing, yeah. So we want to make sure that
what they’re doing is the practice of psychology. So what they call themselves
is a different question. How they describe what they
do on that form for us, or when they complete their
application is important for us to know that they’re actually
practicing psychology, right? So just saying postdoctoral
fellowship doesn’t describe the psychological services
that they’re providing. – Got it, and then you also
mentioned that it might have related to this, you said something about
teaching the class, and that that is the
practice of psychology, but not, it is that, or is
that not something you can also be supervised on? – It is. – It is, and research? – And research, yes. – Okay, so anything counts
towards supervision. – If it is in that definition of what is the
practice of psychology, if you’re getting supervision while you’re doing those things, and it’s for those things, then you can count those. That’s correct. – And that is, if you look
at describe in detail, there’s a little citation there, and if you just went to that
citation on the statutes, you’d see all the things that
listed out by the legislature that constitute the
practice of psychology. – Thank you. – Alright. – I just want a
clarifying question, because when I was
going through the super, the licensure process, it was anything over 40
you needed a second hour of supervision, right? Is that no longer the
case from the board? – 2018’s legislature changed
that part of the statute. It now says the board can no
longer require more than two hours a week of supervision, and I think it even
says 50 hours total, or something like that. – That’s rule. So, yeah. So the board can
no longer require more than two hours in a week, except if they’re
allowing makeup of a missed week hour or hours, and then only, so if you work, let’s say 60 hours, the board by that statute can
only require the applicant have two hours of
supervision that week, but only 50 of those hours will
count toward the licensing, meeting the licensing criteria, and as a supervisor, if they’re working 60 hours, you may feel that you would like to see them more
for supervision, but we’re not
requiring a third hour. – Okay, thank you. – Hi, I’m wondering about
how to kind of like designate multiple supervisors in
a training experience. Like if you had
separate supervisors
supervising just like distinct clinical experiences, would that be like two
primary supervisors, or would that be one
primary, and one designated? – So the statutes and rule
are unclear on that particular kind of situation. I’m actually chair of
the rules committee, and that’s one of the issues
that we’re looking at trying to create some clarity around those kinds of
training situations. We were aware that there are
training situations where you could have four, or
five supervisors, and you’re not gonna meet with
them all on the same week. You’re gonna meet with them at
different times depending on what your rotation is
that particular week. What we’re hoping for is that
there’s some way that we can clarify having one person
kind of overseeing that this supervisee is meeting the
requirements that they’re supposed to meet. And we know that we want
them to have one hour of supervision that’s from
a doctoral level licensed psychologist each week. – Okay, great. – That’s really you
know, getting at the, we don’t want this, that experience to
happen in silos, where the supervisors aren’t
communicating with each other, to make sure that the individual is well rounded and competent. – And so we wouldn’t want that
supervisor to get is a kind of hodgepodge of an
experience for the year. We want those people to be
training that individual. – Just so I’m
understanding like, would it look inappropriate
if you had like two primary supervisors for two, six months periods of time, or would you want to see one primary supervisor
for 12 months? – You could have five for
six months if you wanted, but we’re not saying
you can’t do that. We’re saying this
is the minimum. – Okay, okay, gotcha, and then could you speak a
little bit about what you’ve referred to as like
the tele supervision, or like the use of Google Duo, or something like that to
facilitate the individual? – So it’s face to face. It has to be video, and audio in real time. So FaceTime qualifies, and if you’re not using
Apple products, Google Duo, I’m told by students is the most HIPAA compliant
platform for that, and you need to make sure
that what you’re doing is that the platform you’re
using is HIPAA secure. – And that qualifies
as just the one, like an individual
supervision block, right? – As long as you
can see each other, and it’s in real time. What we don’t want is for
the supervisee to record themselves talking
about a client, send that recording
to their supervisor, and the supervisor then
record themselves talking, giving them feedback
about that client, and then sending that. That’s not in real time. – Okay, okay, thank you. – Looks like we have one here. – That might be outside the
scope of what you had in mind, but can you say anything about consultation for
licensed psychologist? – What in regards to
consultation for license? – Like many people do get consultation after
getting the license, and probably should, and any of those elements
that you’ve reviewed, which of those do you think
would be most applicable, and which would not? – So I guess one way
that I’d answer that is consultation is fabulous. Everyone should be doing it, and you need a
consultation group that you can be honest with, and that will be
honest with you, and not just give you the
answer that you’re seeking. I think that there’s a
pretty high you know, we see that people
who have rigorous, and active consultation
groups you know, have better outcomes for their you know,
whether they get into some disciplinary trouble
or complaints. – There’s no requirement by
the board and statute of rule about around consultation. What we do know is that if you find yourself in a
sticky clinical situation, that when you seek consultation, and document that consultation, and create that kind of
paper trail for being making clinical wise decisions under
consultation from colleagues, you’re kind of taking
care of yourself. – Maybe I should clarify, more specifically, there is
a responsibility when you are supervising under supervisor, what are the areas
of responsibility, or how are they divvied up? For instance, the examples
that you just said, somebody is in a sticky situation. Six consultations appropriately. Who is responsible and unwell? – Oh, I think she’s asking. Are you asking just
so I can clarify. Are you asking that if somebody, if for instance, you’re in a sticky
clinical situation, and you go to a
consultation group, you may get bad advice from
the consultation group? – Consultation is
not always in group. You can also seek individual. So it’s not a group,
or individual, and not whether
it’s good or bad, but basically ultimately
who is responsible? Is the supervisor, that’s the person who
is signing off, okay? If you are seeking consultation, which as you said, we are encouraging
to for people to do, whether it’s sticky
situation, or not, but let’s say something does
turn out not as well as you would like it to be, who is ultimately responsible? – So you’re asking a
legal question really, and so I’m not
giving legal advice by answering your question. I just want to be real clear about that I speak
psychologyese. – [Audience Member] That’s
a complaint to the board. That’s what I’m talking about. – So whoever’s
the providers were saying this is a
licensed provider, that licensed provider has
clinical responsibility. If you seek informal
consultation, I can imagine an attorney, and they give you advice that turns out not
to have been helpful, or to be the
opposite of helpful. I can imagine an
attorney taking that, and saying, yeah, we’re gonna
make that the person you consulted with responsible, but ultimately it’s your license that you’re seeing
that client under. So ultimately there’s some
responsibility that’s on you. If, however, what you did was you paid someone
for consultation, then they’re providing
a psychological service. So they’re responsible for
the advice they gave you, but you’re still responsible
for what you did. – Thank you. – There may be some smarter
people in the room here than me, but my understanding is that consultants have
some protection, and it falls back on
the actual provider, but the question that I had, and I apologize if
it’s in statute, but if we’re working
on 50 minute hours, is that considered
an hour supervision, or how does that work? – Oh, I love that question. – [Audience Member] Actually,
now it’s 45 minutes. – Actually yeah,
the 60 minute hours, 53 minutes minimum, right? 53 minutes at least. – You want to take this one? – The rules process is gonna
probably try to get greater clarity on that issue. The rules with the rules process
we’re in is probably gonna try to get greater
clarity on that. Sometimes it’s better
not to have such clarity. – But there have
been requests for it. So we do have, let’s see, two questions. What is the best way
to document hours outside of the attestation form? When will this be submitted? – I think if you have it, how many of you use
electronic health records? How many of you have the
energy supervisees in there and document it that way? It’s really easy, because you’re already
doing it for your clients. It’s on your schedule that you’re see meeting
there for supervision. Just turn it into an appointment
with a procedure code, and then it’s in there. So you need to be able
to show when you met, how long you met for, and in general that you
were covering topics like what the statute, and rule says. So, and it’s not gonna ever be requested unless there
are glitches and hiccups. In other words, if the hours that you report
don’t match with the hours that your supervisee reports
in a way that undercuts it, then they’re gonna probably
request those logs. – Can you come to the
microphone please? – Google spreadsheets. Google sheets, and share it so that you both
have the same record. You’re both doing it. You’re ultimately
responsible for its accuracy. So don’t just rely on
your supervisee to do it, and then accept that. They might enter
the data initially, but you have to verify that
it’s there at some point. I lock it at some point. – And this is that question
is in regard to if you don’t have electronic health records, how do you use Google sheets? Yeah, okay, and then
the next question, oh, the other question was
when will this be submitted? So at the end of the
supervisory experience, at the time that the
applicant tells the board, this is my supervisor, these are the hours I did. At that point we
contact the supervisor to complete the attestation, and tell us what the applicant
did under their supervision. – And you have to
actually report the hours. So how can you have a count
of those hours if you didn’t actually count them? – Right, and that’s why we’re
talking about making sure that you’re doing
that in real time with the counting those hours. Okay, does it count as
supervision if you observe them, into IE interview
versus they observe you? – This is one of those great
things about it, isn’t it? This is what makes it fun to
be on the board of psychology, because you get all these things you didn’t think about, right? I think bottom line
you have to go back, and look at what’s the
point of supervision? It’s about the development
of the supervisee, and it’s about clinical oversight for
the people they’re seeing, protecting the public basically. So I would have a hard time
if they’re just watching me, and they’re not doing anything. Like when my
supervisees shadow me, I’m having them co-facilitate. I’m turning to them
in the session. I may invite them into that
session in a way that we have a conversation about what
we’re just witnessing, or I’ll say, do you have any
questions for this person? And so I’m getting
an opportunity to
observe that with a client that I had
been working with. So it’s not the same as they’re just sitting
there watching me. – Second question, what
should be included in a supervisor’s log of supervision. Statute and rules
don’t define that. – So it’s what do you
need a CYA, right? – Absolutely. – What do you need? If there’s ever a question, what do you want
to have to present? And that’s what you
need to be keeping. – Great. – I may be at the
wrong conference, and asking something that’s
not to be covered here today. – Could you speak up
a little bit please? – Okay. What I’m hearing a lot about
the rules and regulations, and the way to quantify the
experience by the supervisor, and by for the supervisee. What about the
qualitative experience? What about is that, you know what if you’re a
supervisor who really feels that you’re responsible for someone
who is not doing a good job, what if you’re a supervisee
who feels that their supervisor is not treating them fairly, or as being too critical, or not available enough? We get the numbers, we get the hours, but what about the actual
clinical competence that we’re looking for at the
end of the experience? – So I think it’s
really good question, and I don’t think
it’s out of line to be asking that here at all. So thank you for asking. So it’s two questions. One is about kind
of development, the development
of the supervisee. How do you provide a really quality
experience as a supervisor? And the other question, just to make sure I understand
is what can supervisees do if they feel like
they’re being mistreated? Alright, so that
was the easy one. If a supervisee feels that
they’re being mistreated, well first of all, we want them to be able to have a conversation
with that supervisor. In some situations, they might not feel
safe to do that. So if there’s another
colleague that they can talk to to make some decisions
about what they want to do, they always can
then call the board, and file a formal
complaint, right? So it’s kind of the same process
as if a client was feeling like they were being
mistreated by a psychologist. Same thing. So in terms of development, I think it really is important
as we take on the role of being supervisors that we think
about what’s our clinical, or what’s our orientation
as a supervisor? You know, I kind of have a
developmental perspective. I add some feminism
in there with that, and I’m very much a cognitive
behavioral psychologist. So that becomes a big
part of what I’m doing. I’m really wanting supervisees to develop us in
that postdoc year. I’m hoping they’re at a place
where they kind of have the clinical nuts and bolts down, and I’m wanting them really
to begin to kind of observe themselves in action, be able to be aware of
themselves in the moment, and to use their sense of self, and their experience of
a client to inform the interventions that they select
at that particular time. So that’s how I work, but how many of you
have actually given
some thought to how do you help supervisees who
are in their postdoc year, take that next step in their development in
becoming a psychologist, and really be
intentional about that? – I just want to
clarify just one thing. So you’ve been talking about having the supervisees
keep a log, supervisors keep a log, but then also the
shared document, is essentially the that
all the same things? So the supervisee
is keeping log, you’re just going in, and verifying it in real time, and all that’s needed? – Yeah, it’s one log. I actually can just run a
report in my EHR also to help me verify that that
log is accurate. If I’m gonna use that log, I want to make sure it matches
with what I know I did. – And then one of the things
that I think often comes up is we do a lot of observation work. So let’s say we’re sitting
in on a clinical interview, we’re jumping in with questions
if we feel like they need to be asked, what does that, does that count
towards supervision, or is the supervision, and the discussion about
that interview afterwards, where’s sort of
the line for that? – I would count that. – [Audience Member] Okay. – And that shouldn’t be the
only thing that ever happens in supervision if
you’re really looking at the development
of the supervisee. – Hi, I just wanted to clarify. I thought I heard you say, and just wanted to make
sure I heard FaceTime, and Google Duo are
HIPAA compliant. Those are the ones that we have, that I’ve had students research, and they’re the ones
that they’ve said are the most HIPAA compliant. Okay, so we’re safe using those? – I don’t use client names
when we’re using those. – The board doesn’t
regulate HIPAA, and whether something
is HIPAA compliant, and we don’t take a position on what is or is
not HIPAA compliant. – [Audience Member]
Oh, okay, thank you. – Any other questions? Alright, well thank you
very much everybody. This was a great conversation. (audience applauding) – So before I launch
into this part, I do want to just
say a couple things. So the first one is that some of the questions
that you’re asking, there’s some really great
books out there for that, and I’m gonna just suggest that you do a little
looking for that. There’s a book I think
it’s by Carol Falander. I am not, I’m not 100%
sure on that author, because sometimes
I conflate them, but it’s called “Getting the
Most Out of Your Supervision”, and it’s a great book
for supervisees to look, at to think about how well they
could use their supervisor. So if a supervisee’s unhappy with the supervision
they’re getting, or not sure how to get it, I think that’s a great text. There’s books on forms for
how to document supervision, and really recently, the APA came out with a series
of supervision texts that are by theoretical orientation, and that’s sort
of a new addition, because most of the other texts are more meta theories
from my perspective. That’s the language I use when
I talk about supervision is the meta theories. So I encourage you to
take a look at that, because I think there’s a great body of
literature out there. Okay. The other thing that I thought
about this morning when I was listening to the first part, was that when you become a
psychologist you don’t do it, because you want to
write case notes, and right, and when you become
a supervisor you don’t do it, because you want to keep
track of all the numbers, and do this stuff, and yet this is a really
important part of it. So I’m glad that you’re
here to talk about it, because we all want to support supervisees
in getting licensed, and that’s really what we’re
trying to do today is to help everyone help their
supervisees get licensed, and get licensed efficiently. So I’m Selena Reninger, and I am the chair of the
application review committee, which is one of the committees
for the board of psychology, and I well I’m gonna
talk a little bit about what our committee
does, and our roles. Mr. Devin Gilchrist is our
public member of the committee, and Dr. Brett Walden
is a psychologist member of the committee, and up until just recently Dr. Michael Bruner worked
on our committee, and I’ve been the
chair for about a year, which was about how long I’ve been on the
board of psychology. So these are the charges
of our committee. So the first one is to review
coursework for applicants who are graduating from programs
that are not APA accredited. So I don’t know about you, but when I went
through this process, every applicant had to have
their coursework evaluated, and that might have
been your situation too. Now if a student comes from
an APA accredited program, it’s automatically accepted. We don’t review it, we just assume it’s appropriate, but for anyone coming from a
non APA accredited program, we need to look
at their syllabi, and so that’s one of the
tasks of this committee, and I’m assuming this committee
did a ton of that before. We don’t get as much. That’s a smaller, I see that as a little
bit smaller part of our work right now. The other part that we do is reviewing
applications when there’s, when the staff at the board
cannot authorize what is turned in for supervision, the documentation is off in
some way, and this committee will review that, and make decisions about it. So the two things that can
happen is the supervision report is inconsistent with the law, or the supervision
reported by the supervisor, and the supervisee don’t match. So we’ve talked a little bit about that earlier
in the program, and I’m gonna repeat a little
bit of that in this talk. I think that’s okay, because I think it really helps
us kind of internalize it, and keep it all clear. The third area that we would do, and we’ve done this really infrequently is
review a waiver or variants. There are times when applicants
can ask for a waiver, or variants to the law, and that’s something
that we would review, but I’m not gonna
talk about that today, because it’s so infrequent. We typically meet on the same
day that the board meets, and the board meets
10 times a year. So we meet 10 times a year. Our meetings are 8:00
a.m. to 9:15 a.m. right before the board meetings, which start at 9:30. We do schedule additional
meetings as needed, and we have done that. We’re really, I would say, I’ve been super appreciative
to this committee, because everyone really wants to help applicants get through, and so we’ve done that when
we know that our docket is too big to get through in
our hour, and 15 minutes, we’ve just added an
additional meeting, and then these
meetings are open, and so you could come, and see how we think
about these things. It’s very transparent. We talk very openly about
how we’re thinking about the decisions we’re making, where we see the problems are, how we’re using ethics, and law to direct us. And applicants can come. So when an applicant is in a situation
where they’re getting, you know, as Robin calls it,
the hiccups and glitches, or whatever she calls them, that we’re the people
that look at that. Applicants can come, and see how we’re
thinking about their work. The other thing that I want
to make sure I say is that we don’t know whose
application we’re reviewing. These are blind reviews, and we don’t know
who’s the supervisor in these situations either. So if there’s an issue with a disagreement
between the applicant, and the supervisor, we have no idea whose
application we’re reviewing. If we think that we
might know the person, if there’s something in
there that we know about, or recuse’s us
where we might think we might know the person, we just recuse ourselves
from the conversation. I think I’ve had to do
that once in the year that I’ve been here. Okay, so the first
thing I’ll talk about. Oh I guess the only other
thing that I would say is we really hope the new forms also
are gonna streamline things. We would love to have less work, and to have it be
better for everybody, the supervisors,
and the supervisees, and we hope the forms
are gonna be helpful. Okay, so when we do
coursework review, basically what happens is the
applicant will decide which of their courses in their
transcript fit into the various parts that are required by law, the various content areas, and then they fill
out a document that says this course here, this course there, and then they submit the
syllabus to the board, and then that comes to us, and we review it. I’m telling you this, because as a supervisor, if you have a supervisee
in this situation, you might want to help
them with that task. It might be helpful to get two minds together
looking at that. There are some common errors
that happen in that process, and it slows things down. How do I want to say this? So I think that there is a grid, there’s a document that tells
applicants what might be good courses to fit in those areas, and what courses might not be
good courses in those areas. It’s really helpful to use that, and the committee uses that as
well to direct our thinking, and this part of the law, very much mirrors the APA
accreditation guidelines. So most programs that aren’t
accredited are still trying to meet the APA guidelines in some
ways so that they know that licensing laws are
looking for that. And so most current grads are
gonna have coursework that fit in these areas. Sometimes I’ve seen
a few recently for
people who graduated maybe 20 years ago, and then they might
be missing something, and so that becomes an issue, but in any case, some of the common misses
I’ll tell you about is not including psychometric
coursework. So you need one credit
of psychometrics, one of statistics, and one of research and design, and many, many people
have more than that, particularly in research,
design, and statistics, but the psychometric piece is
often the part where people leave something out, or they put in a
statistic scores, but it’s not actually
psychometrics. Another course that sometimes
people will put in the psychometrics area
that’s incorrect is an applied assessment course, and this category’s not
about the application, it’s about measurement theory. So that’s one area. Another area that we see
a fair amount of kind of, I don’t know if people
get, it’s kinda… The language is confusing I
think sometimes to people, but it’s called the application
of psychological principles to problem identification, and to problem solution, and sometimes people swap that. So problem identification of
course is a diagnostic scores, or an assessment
course of some kind, and problem solution
might be a theory course, or a skills course, and sometimes people flip those, and it would be lovely if we could just fix
that for the applicant, and say, we’re just gonna
flip them, but we can’t. The way it works is that the
applicant has to say what courses they want to go where, because it’s their degree, and they, we can’t
decide for them where they wanna put the course. So usually what happens in
those instances is that we will ask the board staff to give
them a clue where the issue lies so that they
can fix that error. Let’s see, okay. So that’s coursework review, and now the other area that
we spend a lot of our time on, and this is what I
think the first part of the conversation was about, is when supervision is
inconsistent by statute or rule, and I’ll give you some of
the issues that we run into, and that we end up discussing, and I’ll say that
when this committee, which was, I think we were all
pretty new about a year ago, we really spent a lot of time
trying to make sense of this, and we’ve kind of come
to some conclusions, and now we’re much
more efficient in making decisions
about these things. But these are some of
the errors that we see, or issues, I guess issues that I would say we see
when it comes to us. So board staff, if there’s maybe three weeks
of supervision that isn’t 100% in compliance with law, they don’t send that onto us. They deal with that themselves. Once it goes beyond three weeks, then it comes to our committee. So that’s an initial bar, and that was something that
we decided seems reasonable from our perspective in
terms of maintaining the law. These were some of the errors. So phone supervision. Now tele supervision is allowed, we’ve talked about
that earlier today, but that is different
than phones supervision. It has to be video,
audio, synchronous. So sometimes people have
done phone supervision, particularly like one example was there was
really bad weather, and people were in
distances far away. And so we were very happy that they did the
phone supervision. It wasn’t that we weren’t, we thought that was terrible. We thought that was a good
plan given the situation, it just doesn’t meet the law, and so we couldn’t count those
hours during the week that that’s the kind of
supervision that happened, because it happened
for several weeks. So if that was a
onetime occurrence, that would have been
a different situation, but it went on
for several weeks. So that’s one example. Another is really inconsistent
primary supervision. So this was one. Kind of look through
my notes on charts, and this is not… For the ones that we review, something like this
is not so uncommon, although it might be
surprising to you, like 35 weeks of no
primary supervision. It’s very hard to make the
case that that was good oversight for the
clinical practice. And so then we have to make
decisions about what to do, and in this instance, it was also 19 weeks with the
designate was inadequate too, in terms of the frequency. Another problem that will
sometimes come up is that the designated supervisor was not
given appropriate oversight. So the primary, and the designate never talked. They were completely separate, and that just kinda comes to
our attention somehow when the way the paperwork is filled out, and then the board
looks at it, the staff, and they’re like, this
doesn’t seem right, and so then it comes to us, and we have to make some
decisions on whether it actually met the criteria
for supervision. Occasionally when the primary
supervisor needs to be away, they will appoint
a non psychologists
to cover as primary. Again, we’re very happy that people are wanting
supervision to occur. Again, it doesn’t meet the
requirements for licensure, and the profession, and so these are challenges, because we really
want to support people for doing the right thing, and we can’t count those hours. Now, nothing really
happens beyond that. We just don’t count the hours
in those situations, okay? So let’s say only cases that
exceed a reasonable threshold come to our committee. Let’s see, what else
do I want to say? I think that’s probably it. Alright, now another
area is inconsistency between the applicant report, and the supervisor report, and so how do you know
which one is right? So the example I gave this
morning was that my supervisor put in different dates for me when I did
this many years ago, or one of my
supervisors did that, and so the board came back, and said, well,
what was accurate? And I asked her, well why
did you put those dates? And she said, well, I estimated. So I want to encourage
you not to estimate. This is, so nothing
bad came of it. It just delayed my
licensure a little bit, but don’t estimate really, I mean I think we’re talking
that we didn’t use to have to track in the detail
that we are now. We are tracking in
much more detail, and it’s considered
best practice. So we want to make sure you know the dates,
the hours reported, and the amount of supervision
that you document. So how many hours
were they working, how many hours
did you supervise, when did you start doing that? Now potential outcomes. I think this is important
for you to know, because if your supervisee
runs into a glitch, you can help them
not panic about that. I think as a supervisee,
it’s stressful, and scary when you feel
like it’s not working right, or you’re think you’re
gonna get in trouble, or you think there’s a problem. So here’s what can happen after our committee
looks at things. We might approve all the hours, and then everything’s fine. We might approve
part of the hours. So if some of the hours don’t
meet the requirements enough, we’ll just say
don’t count those, but count these, and I will say that sometimes people have a lot
of extra hours, so we might even not
approve some hours, but they still meet the 1,800, and they’re fine, and then sometimes we’ll
deny that experience. That experience
like doesn’t count, because it really isn’t in
consistent with the law. So these decisions either result
in a completed application, the person moves through, or they need to keep
getting supervision, and oftentimes the time between
the application coming in, and the time that we review it, they’ve continued to accrue
hours and supervision, and some of the times that’s
sufficient to get them where they need to go, if there’s some kind of issue. The other outcome
could be a referral to the complaint
resolution committee. So I want to talk a
little bit about that too. So you will know
for your supervisees kind of how we think about that. First of all, applicants are
typically not referred to the complaint resolution committee. During the year that I’ve
been chairing this committee, and working with the committee, we’ve not referred one applicant to the complaint
resolution committee. So I haven’t yet seen a
situation where we have thought that that was a thing
we wanted to do, or it made sense to do. And I’m not sure that I have
yet been able to conceive of an idea of when
we would do that, because at least
from my perspective, I very much think the supervisor is responsible for
the supervisee’s work. So when there’s at least in the context of
supervision reporting, when there’s an issue, I look to the supervisor
to be providing oversight, and guidance around that. So there are other things
that supervisees could do that would go to the complaint
resolution committee, but not this particular area, and so the other thing
is the supervisor, if we think there’s an issue with how supervision
was happening, there’s some clue in there
that that’s happening in a way that’s kind of problematic, sometimes we’ll have the
supervisor be given notice of rules through Mr. Sans. So he’ll contact them,
call them, or write them, and give them a heads up
on a part of the rules. Like, yes, this came in
front of this committee, and here’s some things
you might want to know, and that’s usually for
a more minor issue. We just want them
to be up to date, and then supervisors
are infrequently referred to complaint
resolution committee. My memory was like somewhere
between one and three, and I was told this morning
it was two in the last year. So there were two supervisors
that we reviewed that referred to complaint
resolution committee, and the reasons that we were
referred them to the complaint resolution committee fall
into these categories. So either we had reason to
believe that the supervisor was gonna continue to provide
inadequate supervision, and we wanted to find a
way to deal with that. So sometimes I guess I’m trying to figure out how
to talk about this, but I would say that
sometimes the way in which a supervisor completes
the application, suggest that that
there might continue to be problems with
the supervision. And so there’s that, and then the other one is
reason to believe that the supervisor did not
take on responsibility actually for supervision, is that again, this is
sometimes how the supervisor completed the form, and what they said, you get the idea that they
didn’t really understand that they were responsible
for the oversight of the supervisory work, and so a lot of times this
falls in the categories of failure to meet, or failure to designate someone
else who is appropriate to do that supervision. Failure to take the
responsibility for that, when you choose to be a primary, then you are taking
responsibility for
that full oversight including the designate. That’s a significant
part of the guidelines. So that is what I have, and I think if
there’s questions, we can go ahead and take those. – Two quick questions. One, when you have a
primary supervisor, and a delegated supervisor, how do you recommend that they
document that communication? – Hmm, that’s a good question. Do you have a
recommended answer. I have thoughts about that. I mean, I would just
put it in your notes. – [Audience Member] Like
the supervision notes? – The supervision notes. Yup, yup. – That’s the appropriate
place to do that as well? – Yes, yeah. I mean, I often think of this
as particularly for teams where there are multiple
supervisors involved, and then there’s like a
training person that oversees, that’s the other place
that that could happen at. Like say there’s monthly
supervisor meetings. You might want to keep notes
from those monthly supervisor meetings that this is when
the supervisors got together, and all talked about the
supervisees in these ways, but if it’s just two of you, and you check in monthly, or something that I
would just document it in your regular notes. – Would you do that in each of the individual
like medical record files? – So that’s the
way I would do it. I think about what are the
things that supervision does that it serves
like a propulsion. So it can be possible, and there would be a supervisee
that you have that really has some challenges and then they have
designated supervisor, even that designated supervisor
and you and them work pretty closely together to
make sure you’re helping that person overcome
those challenges, or coming up with a plan
that helps them out. If that’s what he’s saying, and if you’re not documenting
that along the way, then you’re really
leaving yourself at risk. So think of documentation
not just as, okay, what is the board want, but what do you need to be
doing to make sure that you’re able to say what you did
if you were ever asked. – And then the last question, if you have two
primary supervisors, and they each have a designated
supervisor maybe that they’re working with at
a different rotation, would both of the
primary supervisors
would fill out one of those attestation forms? Is that right? And then so they might each
have half of the hours? – Yes. – So together that
they would, got it. – We can add, board? – Yeah. – And make sure that
that equals ADA. – So this may not
be your question, but more of a comment. So it sounds like then if we’re working with a
postdoctoral supervisee, they’re still on site with
us as they’re getting their documentation together. It sounds like it makes a lot
of sense for us to be sitting down with them, and completing the
paperwork together, right? To make sure that
we’ve got this, that it is consistent. I mean it just seems like that
would make the most sense, or is there concerns about that? Is that part of what
you’re looking for, to make sure, that
what I remember, and what my supervisee
remembers of the same? – So, okay. So what I would say is, doing that in real time, as the supervision occurs is
probably the best practice. Not necessarily sitting down, and filling the
application out together, because we are trying to, you know, make sure
that the experiences… It shouldn’t be the conversation
at the end shouldn’t be the first time that you have
a conversation about what supervision was provided. – Right, but that’s
makes sense to make sure, like what date did
you say you started? Yes, that’s the date that I have that you said you
started, right? And then that way when we’re
not surprised then hearing back that it wasn’t consistent. – So I would say that I, so I think like we’re talking about two related
intersecting thing. So like formative, ongoing, yes. You want to be continually
checking hours, and authorizing them,
and making sure, and then at the end you’re
gonna do some summative stuff, but I also have said that
anyone I’ve ever supervised, I will not send
anything to the board. This is before I
was on the board. I would not send anything to
the board until we sat down, and made sure our
numbers matched, and I just think
that’s a good practice, because it sets your
supervisee up for success, and then you can make sure
that you’re in agreement. The other thought
that I was having that is this piece that we are, I feel like we’ve kind of kinda talk toward
without really naming, but it has come up in
some of the questions, and that is, you know, we are all assuming that when
you do your postdoc year, and you’re supervising them, that they’re gonna
successfully complete, and then you’re going to attest, and I think there are times
when that doesn’t happen, and so that becomes a challenge, and so I do want
to encourage folks to look at also your
supervision contracts, and clearly outlining what you are going to do if
someone is not successful, and what you, what
due process things you have in place
for that person, because when you take
them on as a supervisee, they are expecting that you’re
going to sign off on the end. And unless that is clear up
front what processes you have for when it’s not going well, or you don’t think
they’re performing well, it’s better to have
them know in advance what you’re then going to do, the limits of your willingness
to attest to someone will be, and what you’re going to do
when you’re not able to do that, and so there’s also literature
out there about that, about how to write
good contracts, and what should be in them, and how to name that, and I think that’s very helpful
in these situations too. So I don’t know, there was just a few comments
that made me think about that. Yeah? – Hi, just wanted to ask
one more clarifying point, and I know this was said, and I actually just
looked it up too. I just really want to make
sure I’m right here that, so somebody who is a licensed
psychologist received their, became a licensed
psychologist prior to 1991. They would count, they would be able to provide
post degree supervision for a doctoral psychologist. Just to double check. – So the question is that
date that you looked up? I think it’s October I saw. – [Audience Member] I
think it’s August 1st. – Sorry, August 1st, 1991? Yes. So if they’re at the masters
level psychologist was licensed prior to that date, and they’re competent in
the practice area they’re supervising as well as
competent in supervision, they can provide supervision
under the statutes in rules. – [Audience Member]
Okay, thank you. – A lot of caveats. – Alright, anything else? Okay. – Alright, thank you very much. – Thank you. (audience applauding) – So my name is Scott Fischer, and I am the chair of one of the complaint
resolution committees, and I’m going to talk today a
little bit about the role of the complaint resolution
committees in supervision cases, and before getting into some of the specific
information about supervision, it’s worth knowing a little bit, getting a general overview of this complaint
resolution committees, or CRCs and how they work. So the task of the CRC is to handle any
complaints about a rule, or statute violation by
a licensed psychologist, or by an applicant, or anybody else in the
practice of psychology, and the first step if the CRC
gets a complaint is what’s called a triage process, and that means that the
complaint resolution committee looks at the written complaint, and makes some decision
about whether it has merit, whether we want to
go forward with that, and learn more about it. Many of those, many of those complaints
are dismissed at that point, and what that means is that
it’s very possible that some of you have had complaints
against your license that you never knew about. They would have been dismissed at a very early
point by the CRC. If the complaint has merit, we would gather
more information, and the committee has the option
of scheduling a conference with the psychologist, and at that point, the committee would meet
with the psychologist. Many people choose to
have a lawyer present, because the investigation is
more serious at that point, and then make a decision about how to move forward
with the case, and there’s several options. So one of them is it
could be dismissed. So even though we thought it
was serious enough to bring the psychologist in, and talk with them, it may be that after hearing
their side of the story, it makes sense to
dismiss the complaint. Sometimes the committee, and the psychologist come to what’s called an agreement
for corrective action, and that means that
there’s an agreement that a violation occurred, and that something
needs to be done about that to ensure
public protection, and bring the
psychologist up to speed. That is an action that
is not considered to be a disciplinary action, and sometimes that matters, because people are concerned about being on insurance panels, and they don’t want to have to report that they’ve
been disciplined. However, it is a
public document, and it is something that could be accessed through
the board’s website. Finally the committee could
decide to move forward with disciplinary action, and that’s the more, the most serious outcome, and discipline could be, you know, at the most severe under revocation of
someone’s license, there could be less severe discipline such as
a public reprimand, or an order restricting
somebody’s license, you know, say that they’re
not allowed to do supervision, or not allowed to
do certain things, or that they themselves
need to be supervised. So I said the committee would
move forward with discipline, and I said it that way, because the committee by itself can’t approve a
disciplinary action. They can come to an agreement
for corrective action, but for discipline to occur, it has to be voted
on by the full board. So the committee would bring that as a motion
to the full board, and usually the board would
approve the committee’s motion, but that is not always the case. If the board votes to
discipline a psychologist, there is recourse after that. So there is an appeals process, which is actually a little bit, a little bit Byzantine, a little bit complicated, and beyond the scope
of this presentation, but just know that
there is a due process, and appeals process
from that point forward. So, I’ll talk a little bit
about the kinds of complaints that the complaint resolution
committee tends to get regarding supervision. So we’ve had some complaints
about boundary issues. So supervisors
trying to establish personal relationships
with supervisees, being too casual in
their supervision, wanting to borrow money
from their supervisees, those kinds of things, which is really not
only is it a legal, and ethical problem, it seems not, not a very smart
course of action. So another kind of complaint
that we’d get would be, would be on on unauthorized, or unsupervised practice, and I can talk, one of the case examples that I’ll give you a
little bit later is, is about that, and I think you’ll
understand that one better, and another is
inadequate supervision. That should be other
than applicant. So that includes some of the
things that we were talking about earlier today about not receiving the
right number of hours, but it could also include
inadequate clinical supervision. Alright, so one of the things
that’s in that I think, is gonna be important
to understand all
the material that I talk about going forward is
some history of the board of psychology enforcement of
supervision requirements, because it really was quite
controversial a few years ago, and we’ve done a lot
of things to I think, smooth that process out. So for many years the board
was not very well equipped to check supervision hours. So perhaps there would be a discrepancy between
the supervisor, and the applicant, but it never came to
the board’s attention, and so there might be problems, but we weren’t aware of them. We got better at tracking, and checking those things, and began to discover, you know, a fair
number of problems, most of which were not major, but were worth looking at, and a lot of them were people not receiving enough
supervision hours, not receiving sort of the
right apportionment of hours, so they weren’t
getting two every week. Concerns about
designated supervisors. So it was good that those things were coming to the
board’s attention, but we didn’t have any other
process at that point to resolve those things except the complaint
resolution committee, and so what was happening is these things were
going to the CRC, and we were dealing with a
lot of supervision complaints, and this was very unpopular among the community
of psychologists. The fact of it was very few of these people
were disciplined, and very few even
came before a CRC, but they were aware that
there was a complaint. It was very stressful
for a lot of applicants. It felt heavy handed. It’s like my uncle Al, who wants tried to fix his
carburetor with a hammer. He did other stuff too, but that’s a different
conference I think. So when that came
to our attention, we made some efforts to come
up with some other tools that weren’t hammers to deal
with these problems. And when Sans came on
as executive director, that was one of the things that he really took
a lot of action on, and so now we have
a lot of other ways to deal with complaints, and prevent these
things from happening without them going to the CRC, and we talked about
some of those earlier. One of them is attestation. The other one I
just call leeway. So, you know, we talked
earlier about board staff. If it’s fewer than three, three weeks where the
supervision is inadequate, they just let it go. They just send it to the ARC
rather than take more action. We’re doing more
things like this, so education conferences about
supervision requirements, and then people know the rules, and we have fewer
infractions of the rules. The supervision log that we
looked at earlier today is on the board’s website. So sort of a more
informal education, and so what that means is
that the complaint resolution committees are not dealing with very many supervision
complaints, or the same kinds of supervision
complaints that they were dealing with just
a few years ago. So in a few minutes I’m going to give you
some hypothetical cases, typical sorts of cases
that the CRC deals with, but before getting into those, it’s worth talking about some
of the principles that would guide our resolution of
supervision complaints, or really any complaints. So I think it’s helpful. It’s a good exercise to sort
of put yourself in the place of being a complaint
resolution committee member, and having to think about how to deal with some
of these complaints. What are some of the principles
that you’re looking at? So the first one is
that public protection is central to our mission. That’s really kind
of the bottom line. That is what we’re looking for. Another principle
that’s important for
people to understand is that actual harm isn’t
required for a violation. So if somebody violated the law, there was very likely
the potential for harm. And that is important
to the board. We’re not the Supreme court, so we’re not guided by precedent
legally, or officially, but we do really, we do value consistency, and so the CRC, the CRC’s aim to resolve cases in a pretty consistent
way over time, and between the two committees. So there are actually two
complaint resolution committees, and each takes half
of the complaints that the board receives, and one of the
reasons for that is, because there’s enough
complaints to warrant that, but another one is that there
might be a case where the complaint was against
a psychologist on one of the committees, or against one of
their close colleagues, and we need to have
another committee then take a look at that case. So the two committees, while they don’t meet together, or conferred directly board
staff are present at both of the committee CRC one, and two meetings. And we do aim for consistency. As we talked about earlier, applicants and
licensees are expected to know the law and rules. That sounds obvious, but it’s not uncommon
for people to come in, and tell us they just
didn’t know our rule, and tell us that it as
though that were a defense, and so it’s really
important to us that they know these things, and finally we try to keep
in mind that things happen, and that can sound flippant, but I actually mean it
in a really serious way. That for each of the two
complaint resolution committees, two of the three members
are psychologists, and when I’m
listening to the case, I think it’s really important
to imagine that you’re on the other side of the table, and the person
facing the complaint, and to think about the
person’s circumstances, and if those things
might’ve happened to you, how it might’ve played out, and I think if you can’t
summon that level of humility, it’s probably not a
good committee for you. So there’s a certain amount
of compassion that we try to bring to the situation. We try to look at the specific
circumstances, things happen. So here’s some challenges
that come up for the CRCs in handling these cases. One is that there are
a lot of gray areas. I think particularly with some
of the supervision issues, there’s just a lot of numbers. Did this person
receive the right number of hours of supervision? Well, alright, so they
missed four weeks. That’s not that bad. How about six? How about nine? You know, at what point do
you really start to care? So I think gray
areas come up a lot. You know that you can also
see gray areas in some of the boundary kinds of
complaints, right? Anybody could have a bad day, could make an
insensitive comment. How bad does it have to be before we’re concerned
about public protection, and want to take action? Those are hard questions. The second is what
is the right remedy? So sometimes you could have a, you can have
identical violations, but a complaint resolution
committee would really would handle them in completely
different ways. So, for example, imagine that you had a
complaint about a supervisor, and the supervisor
it was learned, canceled a lot of meetings
with their supervisee, would come in late,
was inattentive, didn’t respond in
a timely manner to requests by the supervisee. There were a lot of problems. Now imagine that you
bring the person in, they acknowledge those problems. They tell you that they were having an episode
of major depression, that they’re now
taking medication, and seeing a therapist, and doing a lot better, and that they’re consulting
with a colleague, and they’re sort
of being monitored either maybe by colleague, or through HPSP, or some way to make sure
that they have their mental illness under control. Well, perhaps there wouldn’t
be disciplined in that case, but if there was, the remedy would likely
to be a, you know, maybe a psychological
evaluation. We might want to hear from
their treatment providers. They could be referred to HPSP. Now imagine the same facts. This time the
psychologist comes in, and meets with the committee, and says, first of all, the supervisee is lying. All three of them are lying. Second, I don’t
know those rules, and they’re not very
important to me, because I know how
to do supervision, and third, that’s
all I have to say. You laugh… So that’s a case where you’d
handle that very differently. First, there would certainly be some discipline in that case. There might be a public
record reprimand. There might be a restriction on their practice
about supervision. So you can see two situations
where the facts that bring them in are the same thing, and yet the remedy in the way
the CRC deals with it might be completely different. That’s the reason
we do a conference, and that’s one of the
challenges that we have. Conflicting accounts, you know, I think especially in
supervision you may have a supervisee saying one thing, and the supervisor
saying another thing, and we have to determine
who to believe, and anybody who’s done
any research on how good psychologists are at determining
who’s telling the truth knows we’re not
good, we’re not good, we’re not any better
than anybody else. And you want to
keep that in mind. So that can be very challenging, and our standard is
it’s what’s called preponderance of the evidence. So we can take action if we
believe it is more likely than not that somebody violated
a rule or statute. So that’s really different
than criminal court where it’s on beyond a reasonable doubt. So trying to figure out has
that burden of preponderance been met is a real challenge. How much should they have known? You know, I think we don’t
really see too many applicants in the CRC at all, but what standard
would you hold them to as far as knowing the rules, and the rules, and the statutes regarding
supervision in particular, the practice of
psychology in general? Some standard,
they can’t come in, and say, I knew nothing, but I think you think about
it a little bit differently than you would somebody who’d
been in practice for 20 years. Okay, so I’m gonna give you
a few case examples that are, none of these are real cases, but they’re similar
to real cases, or I’ve mixed some facts around. They’re definitely
representative of the kinds of supervision cases that
we would see in the CRC. So here’s the first one. So this is a unlicensed
practice case. So imagine that an individual applied to the
board 10 years ago, and they got the
required supervision, but then they failed
their EPPP a few times, and their application has
been inactive since that time, and they report that they’re
getting continued supervision, but they’re no longer an
applicant of the board, and so they do not
meet that exception for an applicant of the board, and therefore
they’re technically
practicing psychology without a license, because they’re not a
licensee, or an applicant. We’ll go forward, and we can talk about these
later if people are interested. Here’s another one. So this is a case of
inadequate supervision. So an applicant reports that
they received only one hour of supervision from their
supervisor per week, and that was it, and they didn’t know
they needed more. The supervisors
asked about this. Delays responding to the
board for several months, and then says the applicant
actually received two hours as required by the law. When asked about
the discrepancy, the supervisor
says that one hour was spent in
administrative tasks, such as answering calls, and checking on
insurance claims. So that’s a case
where the supervision was very much inadequate, and you have a supervisor
who is perhaps evasive, and that might change the way that you think about that case. Here’s a closer call. So imagine a situation where
the applicant didn’t receive the required two hours of
supervision per week on six occasions over the
course of one year. On two weeks, the supervisor was on vacation. On one week, they were both at a conference. On one week the
supervisee was ill, and on two weeks they can’t
remember what happened anymore. They don’t have a record of it. So those kinds of
cases are interesting. If you think back to the point
that I made about gray areas, you know, that’s not great, and it’s not great that they didn’t have a record
of those two weeks. On the other hand, is it really a public
protection issue? And on the other other hand, is it kind a slippery slope
to even more serious problems? So those kinds of cases
can be challenging. So here’s, we’ve talked
mostly today about supervision hours
and requirements, but here’s a case
of boundary issues. So imagine that you have
a case where two female supervisees complained that
their supervisor, male, made inappropriate comments
beginning in the last three months of their
supervision period, and they both acknowledge the
supervisor was competent, and helpful, and respectful
throughout their supervision experience through
the first nine months, and there were no incidents. They both described similar
experiences including comments on their appearance, jokes about clients being
sexually attracted to them, and once commenting that if an applicant was
not a supervisee, he might pursue an
affair with her. So those are, I mean it’s obviously
an infraction. It’s something that there’s
gonna be action taken, but the details become
really important. We would want to know what happened in those
last three months. The credibility issue that I talked about earlier
is maybe less important, because we have two
people coming forward, making similar allegations. So those kinds of boundary
issues come up at times. So at this point, what I would like to do is
open it up for questions about the CRC’s role, or any comments about
these scenarios, or failing that, if people have any
other questions about
the earlier parts of the presentation. We’ve got a little
bit of time left for all of that, I think. Sam just whispered
good luck with that before I read the question. I don’t even know
if I want this one. Oh, we’ll try it. Do you foresee insurance
CMS changes not allowing for training services to be billed, reducing the availability of
postdoc training opportunities? Dr. McCloud is whispering that she’s going to
get me off the hook on this one. Go for it. – Okay, so this is not
important position. It’s obviously about kind
of what’s happening to the profession as a whole, and if you follow with
the American Psychological Association is doing, they’re actually working with
CMS to get trainees funded, their services funded
through Medicare. It’s a big push
that they’re doing. So Minnesota is one of the few
states where we actually do have trainees that
can get compensated. So I don’t think they’re gonna back away from what’s happening, if anything, it’s gonna
keep moving even more. – That’s helpful. Thank you. – You mentioned that the
board has been in a transition over the past couple of years, and doing things differently, and I just wanted to publicly
thank you guys for that, because I think it’s
made a real difference. (audience applauding) – You’re welcome. I personally would
take about 1% credit, and I think Sam should get
a lot of credit for that. So if you want to applaud again. You could do that for him. (audience applauding) – Would you please repeat
again when a case is dismissed, is it, or is it not
in the public domain? – Great question. It is not. – [Audience Member] Thank you. – Another question? – This is back to
supervision hours, and primary supervisors. I think you gave
this information, but just wanted to
confirm if that, if you have like four separate
rotations over a year, it’s okay to switch the primary
supervisor for each time that you have that as
long as they all add up? – As long as they have
primary supervision, it’s fine to rotate who the primary is
during that time frame. They just have to know they’re
the primary so that they know that they’re in charge
of collaborating with the designated supervisors
at that point in time, and that they’re willing to fill out the
attestation forms for us. – And that they have
kept accurate records of start and stop dates, and numbers of hours that match with what the supervisee
has documented. – Got it, thank you. – The one example of practicing
without a license for health reasons or whatnot, what would be a response
of the board to that? – To the example
case that I gave? – Oh, say for because of a
health reasons or whatnot, the supervision
wasn’t continued, and the person continued to
practice for a period of time. What would some of
them scenarios for? – So you’re saying that the
person was under supervision, the supervisor had
health issues, and the– – The supervisee. – The supervisee
had health issues? – [Audience Member] But
continued to practice, because of difficulties
scheduling, and other demands. – So are you saying that they
didn’t receive supervision during that time, or that they’re? – [Audience Member]
That’s correct. – Okay, and how is that
related to health issues? They had difficulty scheduling, and getting to supervision? – Right, right. – So I’m really cautious about
commenting on what might be a real case, when we don’t have
all the facts. What I would say
is that in general, a person who has enough time, and enough health
to be practicing
psychology would also be expected to save
some of that time, and energy for supervision. I would also say that the things happen
principal may be operative, and that we would want to
hear about their specific situation before
making any decision. – Alright well,
thank you Dr. Fisher. (audience applauding) – I just want to say a
couple of closing comments. So I’ve been the
chair of the board since the beginning
of this year, 2019. I’ve been on the board
now for two years, and as I’ve watched the
sport grow and evolve, one of the things that strikes
me most is that first of all, the staff behind the scenes, while there’s been some
change, some turnover, Sam came on as
executive director, there’s been turnover in staff
who process applications. The people who do
the investigations
of the complaints are really dedicated to getting
facts before the board, and my goal is, the way I look at our board is we have a lot of
really smart people, and if we get the right
information in front of us, I trust that we’re
going to together, make some wise decisions, and that’s kind of the
direction this board is going. But all of the
psychologists on the board, we’re your colleagues, and we’re the people that
the governor has said, we want you to regulate
your profession. So having psychologists do that, I believe is really,
really important. So don’t forget that piece, and be nice to our staff, because they work really hard. (audience applauding) – Thank you. If you just turn in
your evaluation sheets
to staff members. They will give you
your certificate. Thank you everybody. Have a great day.

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