Remediation of Problematic Performance and/or Conduct: - Captain James A. Lovell Federal Health Care Center
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Remediation of Problematic Performance and/or Conduct:

Psychology Trainee Due Process and Grievance Policy

This document provides doctoral interns, externs, and postdoctoral residents a definition of problematic performance, a listing of sanctions and an explicit discussion of the due process and grievance procedures.  Also included are important considerations in the remediation of problems.  Interns, externs, and residents in this document will be referred to as “trainees.” 

The training program follows due process guidelines to assure the decisions are fair and non-discriminatory.  During the first week as part of the orientation process, trainees are given the Policies and Procedures manual and this material is reviewed with the Director of Training.  The manual contains written information regarding:

  • Expected performance and conduct
  • The evaluation process, including the format and schedule of evaluations
  • Procedures for making decisions about problematic performance and/or conduct
  • Remediation plans for identified problems, including time frames and consequences for failure to rectify problems
  • Procedures for appealing the program’s decisions or actions

At the end of orientation, trainees will sign this form understanding that they have read and understood these policies. 

Problematic Trainee Performance and/or Conduct: This section describes the program’s procedures for identifying, assessing, and, if necessary, remediating problematic trainee performance.

Definition of Problematic Behaviors:

Problematic behaviors are broadly defined as those behaviors that disrupt the trainee’s professional role and ability to perform require job duties, including the quality of: the trainee’s clinical services; his or her relationships with peers, supervisors, or other staff; and his or her ability to comply with appropriate standards of professional and/or ethical behavior.  Problematic behaviors may be the result of the trainee’s inability or unwillingness to (a) acquire professional standards and skills that reach an acceptable level of competency, or (b) to control personal issues or stress.

Behaviors reach a problematic level when they include one or more of the following characteristics:

  • The trainee does not acknowledge, understand, or address the problem
  • The problem is not merely a deficit in skills, which could be rectified by further instruction and training
  • The trainee’s behavior does not improve as a function of feedback, remediation, effort, and/or time
  • The professional services provided by the trainee are negatively affected
  • The problem affects more than one area of professional functioning
  • The problem requires a disproportionate amount of attention from training supervisors

Some examples of problematic behaviors include:

  • Engaging in dual role relationships
  • Violating patient confidentiality
  • Failure to respect appropriate boundaries
  • Failure to identify and report patients’ high risk behaviors
  • Failure to complete written work in accordance with supervisor and/or program guidelines
  • Treating patients, peers, and/or supervisors in a disrespectful or unprofessional manner
  • Plagiarizing the work of others or giving one’s work to others to complete
  • Repeated tardiness
  • Unauthorized absences including when not present on rotation when expected

NOTE: This list is not exhaustive.  Problematic behaviors also include behaviors discouraged or prohibited by APA’s Ethical Guidelines and VA policies and procedures, as outlined during orientation.

Remediation of Problematic Performance and/or Conduct:

It should be noted that every effort is made to create a climate of access and collegiality within the service.  The Director of Training is actively involved in monitoring the training program and frequently checks informally with trainees and supervisors regarding trainees’ progress and potential problems.  Trainees are also encouraged to raise concerns with the Director of Training as they arise.  It is our goal to help each trainee reach his/her full potential as a developing professional.  Supervisory feedback that facilitates such professional growth is essential to achieving this goal.

The Training Committee consists of psychology supervisors and staff involved in the training program planning.  The Committee meets once per month to discuss training issues and trainee performance.   Supervisors discuss skills and areas of strength, as well as concerns regarding clinical or professional performance and conduct.  Trainees also receive direct feedback from their clinical supervisors in the form of both formal and informal evaluations that occur at regularly scheduled intervals throughout the year (see the trainee handbook for the evaluation process details).  All written evaluations become a part of the trainee’s permanent file.  These records are maintained by the Director of Training and kept in a secure, locked cabinet in his/her office.  The Director of Training also communicates with graduate programs about each trainee’s progress (with the exception of post-doctoral residents).  The Director of Training retains the option of informing the trainee’s program about his/her progress at any time.  This includes both formal evaluations and informal discussions.  The trainee will be notified when any such communication occurs. 

Trainees are continuously evaluated and informed about their performance with regard to the training goals and objectives of the program.  It is hoped that trainees and supervisors establish a working professional relationship in which constructive feedback can be given and received.  During the evaluation process, the trainee and supervisor discuss such feedback and, in most cases, reach a resolution about how to address any difficulties.  Although trainees are formally evaluated at regular intervals, problematic behaviors may arise and need to be addressed at any time.

The expected level of competence as indicated in trainees’ written evaluations are as follows: By the end of rotation, interns must receive a score of 4 or greater on all competencies and residents must receive a score of 7 or greater.  For externs, evaluations need to indicate a passing grade. 

If the trainee fails to meet these expectations at the time of the written evaluation, or at any time a supervisor observes serious deficiencies which have not improved through ongoing supervision, procedures to address problematic performance and/or conduct would be implemented.  These include:

1. Supervisor meets with Director of Training and/or full Training Committee to assess the seriousness of trainee’s deficient performance, probable causes, and actions to be taken. As part of this process, any deficient evaluation(s) are reviewed. 
2. After a thorough review of all available information, the Training Committee may adopt one or more of the following steps as appropriate:
A. No further action is warranted.
B. Informal Counseling – The supervisor(s) may seek the input of the Training Committee and/or the trainee’s graduate program and decide that the problem(s) are best dealt within ongoing supervision.
C. Formal Counseling – This is a written statement issued to the trainee which includes the following information:
  • A description of the problematic behavior(s)
  • Documentation that the Training Committee is aware of and concerned about the problematic behavior(s) and has discussed these with the trainee
  • A remediation plan to address the problem(s) within a specified time frame. Remediation plans set clear objectives and identify procedures for meeting those objectives.  Possible remedial steps include but are not limited to:
    • Increased supervision, either with the same or other supervisors
    • Additional readings
    • Changes in the format or areas of emphasis in supervision
    • Recommendation or requirements of personal therapy, including clear objectives which the therapy should address
    • Recommendation or requirement for further training to be undertaken
    • Recommendation or requirement of a leave of absence (with time to be made up at no cost to the institution)

The trainee is also invited to provide a written statement regarding the identified problem(s).  As outlined in the remediation plan, the supervisor, Director of Training, and the trainee will meet to discuss trainee’s progress at a specified reassessment date.  As part of this process, the Training Director will contact the trainee’s graduate program to notify them that the trainee requires a remediation plan and will see the program’s input to the plan (with the exception of post-doctoral residents).  The Director of Training documents the outcome and gives written notification to the trainee and supervisor(s).  VA office of Academic Affiliations (OAA) and the facility Assistant Chief of Service, Education will also be notified when a remediation plan has been implemented and may be utilized by the program for further consultation. 

D. Probation Notice – This step is implemented when problematic behavior(s) are deemed to be more serious by the Training Committee and/or when repeated efforts at remediation have not resolved the issue. The trainee will be given written statement that includes the following documentation:

  • A description of any previous efforts to rectify the problem(s)
  • Notification of and/or consultation with the trainee’s graduate program regarding further courses of action (with the exception of post-doctoral residents)
  • Specific recommendations for resolving the problem(s)
  • A specified time frame for the probation during which the problem is expected to be rectified and procedures for assessing this.

Again, as part of this process, the trainee is invited to provide a written statement regarding the identified problem(s).  As outlined in the probation notice, the supervisor(s), Director of Training, trainee, and a representative from the trainee’s graduate program (optional) will meet to discuss the trainee’s progress at the end of the probationary period.  The Director of Training documents the outcome and gives written notification to intern, supervisor, the graduate program, and the facility Chief of Human Resources.

 

E. Termination – If a trainee on Probation has not improved sufficiently under the conditions specified in the Probation Notice, termination will be discussed by the full Training Committee as well as with the trainee’s graduate program, VA OAA, and the facility HR Chief. A trainee may choose to withdraw from the program rather than being terminated.  The final decision regarding the trainee’s passing is made by Director of Training and Chief of Psychology, based on the input of the Committee and other governing bodies, and all written evaluations and other documentation.  This determination will occur no later than the May Training Committee meeting.  If it is decided to terminate the internship/fellowship/externship, the trainee will be informed in writing by the Director of Training that he/she will not successfully complete the internship/fellowship/externship.  The trainee and his/her graduate program (with the exception of post-doctoral residents) will be informed of the decision in writing no later than May 31st
 
3. At any stage of the process, the trainee may request assistance and/or consultation; please see section below on grievances. Trainees may also request assistance and/or consultation outside of the program.  Resources for outside consultation include:

VA Office of Resolution Management (ORM) –

Department of Veterans Affairs

Office of Resolution Management (08)

810 Vermont Avenue, NW, Washington DC 20420

1-202-501-2800 or Toll Free 1-888-737-3361

http://www4.va.gov/orm/

This department within the VA has responsibility for providing a variety of services and programs to prevent, resolve, and process workplace disputes in a timely and high quality manner.  Services and programs include:

  • Prevention: programs that insure that employees and managers understand the characteristics of a healthy work environment and have the tools to address workplace disputes.
  • Early Resolution: ORM serves as a resource for the resolution of workplace disputes.  ORM has been designated as the lead organization for workplace alternative dispute resolution (ADR) within VA. This form of mediation available to all VA employees.  Mediation is a process in which an impartial person, the mediator, helps people having a dispute to talk with each other and resolve their differences.  The mediator does not decide who is right or wrong but rather assists the persons involved create their own unique solution to their problem.  VA mediators are fellow VA employees who have voluntarily agreed to mediate workplace disputes.  They are specially trained and skilled in mediation techniques and conflict resolution.  In electing to use mediation, an employee does not give up any other rights.
  • Equal Employment Opportunity (EEO) Complaint Processing
Association of Psychology Postdoctoral and Internship Centers (APPIC): APPIC has established both an Informal Problem Consultation process and a Formal Complaint process in order to address issues and concerns that may arise during the internship training year.

http://appic.org/Problem-Consultation

Informal Problem Consultation (IPC)
Jason Williams, Psy.D. (720) 777-8108
Chair, APPIC Board of Directors

Formal Complaints
Elihu Turkel, Ph.D.
Chair, APPIC Standards and Review Committee
turkel@lij.edu

APA Office of Program Consultation and Accreditation:

750 First Street, NE

Washington, DC 20002-4242

(202) 336-5979

http://www.apa.org/ed/accreditation

Independent legal counsel

Please note that union representation is not available to interns as they are not union members under conditions of their VA term-appointment.

All documentation related to the remediation and counseling process becomes part of the trainee's permanent file with the Psychology Division.  These records are maintained by the Director of Training and kept in secure, locked cabinets in his/her office.

Unethical or Illegal Behavior

Any illegal or unethical conduct by a trainee must be brought to the attention of the Director of Training as soon as possible.  Any person who observes or suspects such behavior has the responsibility to report the incident.  The Director of Training will document the issue in writing, and consult with the appropriate parties, depending on the situation (see description below).

Infractions of a very minor nature may be resolved among the Director of Training, the supervisor, and the trainee, as described above. 

Examples of significant infractions include but are not limited to:

  1. Violation of ethical standards for the discipline, for the training program, or for government employees.
  2. Violation of VA regulations or applicable Federal, state, or local laws.
  3. Disruptive, abusive, intimidating, or other behavior that disturbs the workplace environment or that interferes or might reasonably be expected to interfere with veteran care. Disruptive behaviors include profane or demeaning language, sexual comments or innuendo, outbursts of anger, throwing objects, serious boundary violations with staff or veterans, inappropriate health record entries, and unethical, illegal, or dishonest behavior.

Depending on the situation and the time sensitivity of the issues, the Director of Training may consult with the Training Committee to get further information and/or guidance.  Following review of the issues, the Training Committee may recommend either formal probation or termination of the trainee from the program.  Probationary status will be communicated to the trainee, his or her graduate program (with the exception of post-doctoral residents), VA OAA, APA, and/or APPIC in writing and will specify all requisite guidelines for successful completion of the program.  Any violations of the conditions outlined in the Probation Notice will result in the immediate termination of the intern from the program. 

The Director of Training may also consult with the Associate Chief of Staff for Mental Health, Human Resources, regional counsel, other members of hospital leadership (e.g., Privacy Officer, Safety Officer, EEO Officer, Chief of Staff, Facility Director, etc.), VA OAA, APA, APPIC, and/or the trainee’s graduate program in situations where there may be an ethical or criminal violation.  Such infractions may be grounds for immediate dismissal.  In addition, the Director of Training may immediately put the trainee on administrative duties or on administrative leave while the situation is being investigated.   Under certain circumstances, the training program may be required to alert our accrediting body (APA) and/or other professional organizations (e.g., APPIC, state licensing boards) regarding unethical or illegal behavior on the part of a trainee.  If information regarding unethical or illegal behavior is reported by the trainee’s graduate program, the training program may have to follow their policies and procedures regarding clinical duties, probation, and/or termination.

As described in the previous section on remediation of problematic performance and/or conduct, at any stage of the process, the trainee may request assistance and/or consultation outside of the program and utilize the resources listed above.

All documentation related to serious infractions becomes part of the trainee's permanent file with the Psychology Division.  These records are maintained by the Director of Training and kept in secure, locked cabinets in her/his office.

TRAINEE GRIEVANCE PROCEDURE

This section details the program's procedures for handling any complaints brought by trainees.

  1. If a trainee has a grievance of any kind, including a conflict with a peer, supervisor, or other hospital staff, or with a particular training assignment, the trainee is first encouraged to attempt to work it out directly.
  2. If unable to do so, he or she would discuss the grievance with the Director of Training, who would meet with the parties as appropriate.**
  3. If still unable to resolve the problem, the trainee, supervisor, and Director of Training would then meet with the Chief of Psychology, who would intervene as necessary.
  4. A meeting with all the involved parties would be arranged within two weeks of notification of the Chief of Psychology. The Chief of Psychology serves as a moderator and has the ultimate responsibility of making a decision regarding the reasonableness of the complaint. 
  5. The Chief of Psychology would make a recommendation of how to best resolve the grievance. Within one week of the meeting, a written notification of this recommendation will be forwarded to all parties by the Chief of Psychology.
  6. If a mutually satisfying resolution cannot be achieved, any of the parties involved can move to enlist the services of two outside consultants such as a psychologist unaffiliated with the program, but familiar with training issues.
  7. The consultants would work with all involved individuals to mediate an acceptable solution. The Director of Training will implement this step in the grievance procedure as soon as a request is made in writing.
  8. The consultants would meet with the involved parties within one month of the written request. The two consultants and the Chief of Psychology would then make a final decision regard how to best resolve the grievance. 
  9. All parties, as well as the trainee's graduate program, would be notified of the decision in writing within one week. This decision would be considered binding and all parties involved would be expected to abide by it. 

 

**Please note: if an intern has an issue with the Director of Training that he or she is unable to work out directly, the intern would discuss the grievance with the Chief of Psychology, who would then meet with the trainee and Director of Training, as appropriate.