Guarding The Gate:
How to Effectively
Create and Utilize a
Remediation Plan
Christina Carroll-Pavia, Ph.D.
California State University, Fullerton
Brigid Cahill, Ph.D.
University of Rochester
Frances Diaz, Psy.D.
University of California, Irvine
Jenny Lybeck-Brown, Ph.D.
University of Missouri -Colu mbia
2012 ACCTA Conference
October 2, 2012
Baltimore, Maryland
Alternative Presentation Titles:
Remediation is Not a Four-Letter Word:
How to Facilitate an Optimal Process
Creating Awesome Remediation Plans for
Not-So-Awesome Trainees
Remediation Plans Suck,
But Sometimes So Do Your Trainees
Today We Will Cover…
• Introductions
• Learning Objectives
• When to Create a Remediation Plan
• How to Create a Remediation Plan
• Remediation in a Diverse World
• Protecting Yourself and Others
• Discussing a Remediation Plan with Relevant Parties
• Dealing with the Outcomes of a Remediation Plan
• Useful References
By the End, We Hope You Will…
…gain knowledge of how and when to initiate, construct, and
evaluate progress of a trainee remediation plan, including how to
maximize use of your existing evaluation systems and training
program procedures.
…learn about resources available to assist and support you during a
remediation process.
…increase your understanding of the potential impact of a
remediation process on the trainee, the training cohort, the
supervisor and training staff, and yourself.
…learn strategies for maintaining positive relationships with trainees
and staff, and for appropriate self-care during a remediation process.
Please Check Any Activities You Would
Prefer Doing to a Remediation Plan
.
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Get a root canal.
Road trip with a carful of
teenagers.
Chew glass.
Run naked through
campus.
Nothing, remediation
plans are an easy part of
my job as TD.
ACCTA Survey Results
n=62 (thank you!)
• 58% had put at least one trainee on a remediation
plan
• Average of two plans (range 1-5 plans)
• 77% felt the most recent plan was successful overall
• 56% felt it had a positive impact
• 3% felt it had a negative impact
• 41% felt it had both positive and negative impacts
Variables TDs Consider
• From the ACCTA survey
• Client welfare
• Trainee response to informal feedback
• Trainee inability to pass their internship if no plan is
implemented
• Gatekeeper responsibility
• Difficulty distinguishing between growth edges and
deficiencies
When to Implement a
Remediation Plan
• Clinical performance is subpar – client welfare is at
stake
• Interpersonal behavior is problematic for the agency
• Trainee is not on track to reach the goals necessary
for completion of training experience
• When your due process guidelines say to!
Considering not implementing a plan?
Here are others’ regrets:
• 31% of ACCTA members surveyed regretted not
implementing a plan for at least one trainee
• Reasons include:
• Difficulties supporting the trainee’s graduation, job
search, sense of ‘awkwardness’ at the end of training
• Lost opportunity for the trainee to grow and change
• Recognition that TD’s (or staff’s) inexperience or
discomfort interfered with trainee growth
possibilities
How to Construct a Remediation Plan
Within the guidelines of your own Due Process . . .
• Clearly define problems using concrete, behavioral
terms (tie to evaluation items/competencies)
• Consider issues of diversity when conceptualizing
trainee competence issues and in remediation plan
development
― Brigid’s example
• Brainstorm options of how to remediate problem
within training team (include supervisor who raised
concern as appropriate)
― Consider what is do-able, both for the trainee and the system
― Make sure no one is doing all the work (trainee, supervisor, etc.)
― Be creative, think outside the box
How to Construct a Remediation Plan
• Get input from the trainee about proposed
solutions
― Increases buy-in
― Allows for solutions trainers might not have
considered
― Allows for personalization to trainee’s learning style,
cultural background, etc.
― Trainee input is not automatically part of the plan but
can be a helpful addition
• Be as behavioral and concrete as possible
regarding expectations for change and how
this progress will be measured
• Include deadlines and dates for assignments
and re-evaluation
Written Plan Should Include:
• Behavioral descriptions of problem behaviors
• “Trainee is not able to articulate a conceptualization based
on theory. Trainee is generally not able to describe why s/he
chose a particular intervention or what the goal was.
Trainee’s interventions are generally micro-skills (reflection
and validation).”
• Behavioral expectations for desired outcomes
• “Come to supervision prepared with at least one client’s
history and a recording cued to a particular event in the
session. Review videotapes of your sessions – at least two
full ones a week – identifying your interventions and
intentions.”
More of What the Written Plan
Should Include
• The support the program will offer
• “Model reflective practice
• Encourage use of supervision to increase reflective practice
• Provide immediate feedback when positive changes are
observed”
• The limitations on the trainee’s workload
• “In order to create time in trainee’s schedule to fully
participate in this remediation, (trainee activity) will be
eliminated, giving trainee five hours per week of flexible time
to dedicate to the aforementioned activities.”
And even more…
• Description of what consequences of failure would
be
• “Sanctions for unsuccessful remediation in any area
may include one or more of the following:
• provision of such feedback in formal end-of-year evaluations
• refusal to provide future letters of recommendation
• additional restrictions on provision of services or professional
activities
• probation
• termination from (internship/practicum/postdoc)”
• Dates for when the follow up review(s) will happen
CONSULT! CONSULT! CONSULT!
• Internal Management Structure
• Can provide checks & balance
• ACCTA
• Can provide support and samples
• APPIC
• Will provide a space for you to verify that you have
provided trainee with opportunity for due process
• APA/CoA
• Additional source of support if concerns regarding
impact on accreditation
CONSULT! CONSULT! CONSULT!
• International Office
• Internal trainees & impact on Visa Status (home
program will also support this process)
• ADA
• Ensure that trainee has access to this information &
have been included in the processes as appropriate
• HR
• Verify that HR due process policies align with training
policies
Discussing with The Primary Supervisor
• Discuss the need for a RP
• Discuss each of your roles in the process
• who will construct plan, deliver it, how does the process work
• Help Supr manage their reactions; countertransference
• Schedule follow-up meetings
• Discuss possible interventions. What is Supr willing to
do?
• Support Supr in giving difficult feedback (e.g., articles,
modeling, role play). Remind them: this is part of our role
• Discuss possible barriers in the supervision relationship
• Be sure you’re both on the same page
Dealing with Ruptures in the
Supervision Relationship
• Acknowledge this may be inevitable
• Be aware the power differential in supervisory
relationship becomes very salient (best for supervisor to
acknowledge this)
• Give trainee invitation and time to process reactions to
the process
• Balance between validation of reactions/pain and belief in and
support of the process & program supervisors
• Try to keep primary supervisor out of the “bad guy” role
as much as possible
• Example
• A well-executed process can ultimately strengthen
relationships – just not always in the beginning!
Impact on Supervisors
• Privacy concerns impact ability to discuss specifics
• Management of other interns’ anxiety or concerns
• Supervisor’s guilt & not knowing how to help
• Managing degrees of reactions
• Anger, disappointment, desire to do more, sadness,
concern, etc.
• Impact of their reaction on your relationship with
them & role as TD
Discussing with The DCT
• Contact DCT early in the process. At the latest—once
you’ve decided that RP is necessary
• Identify aspects that are possible general program
feedback vs. trainee specific concerns
• Clearly define expectations
• Forms of communication, tracking of progress, what
information will be shared
Discussing with The DCT
• Share your thoughts and tentative plans
• Ask DCT for feedback, ideas, and suggestions
• Inquire about DCT’s prior experience with this
trainee
• Inquire about the academic program’s procedure/
response policy for students on a RP
• Emphasize shared desire to help student be
successful and shared role as gatekeepers for the
profession
• Keep DCT informed about any progress or declines
Discussing with The Trainee
• Hopefully, not totally a surprise—start giving feedback early
• Decide who is the best messenger in earlier stages
• TD should likely be involved once the RP is formalized
• Be comfortable with the role of the “bad guy” to allow the
supervisor to remain a safe person
• Explain how you’ve gotten to this place, and why you are
initiating a RP
• Own any part that may be yours. Model accepting feedback
• Emphasize your desire for the intern to be successful,
including after they leave internship
Discussing with The Trainee
• RP is formalized feedback, plus information to support
trainee in being successful
• Provide as many specific examples as possible. Use
behaviorally-based and competency-based language
• Tell them who knows what and who doesn’t
• Explain what happens next and the evaluation process
• Prepare them to be involved in the development of the RP
(if appropriate)
• Inform them about contact with DCT (should be outlined in
due process of training manual)
• Remind them to review their due process and grievance
procedures in their manual
Discussing with The Trainee
• Help them identify sources of support (intern cohort,
academic program peers, personal friends/family, personal
therapist)
• Be open to questions
• Be ready for a variety of intern reactions. Provide empathy,
normalization, but remain firm
• Encourage them to talk with the other trainees, other staff, if
needed and desired
• Schedule initial meeting and follow-up evaluation meetings
with TD and primary supervisor
• Emphasize your desire for the intern to be successful (Again)
Caring for the Cohort
• Can be difficult because of privacy and personnel
rules/considerations
• Ambiguity and privacy considerations can increase cohort
anxiety (“Am I next?”)
• Address the elephant to the extent possible, especially if
intern is dismissed or significantly restricted
• Cohort may have a sense of what’s going on, but not know
what to do
• From their own experience of the intern
• Intern may confide in peers (or choose not to)
• From the consequences of RP
• Through centralized scheduling processes
Caring for the Cohort
• May need to just acknowledge generically that the
staff is making/has made efforts to support someone
who is struggling
• May help to talk with intern to see what, if anything s/he has disclosed to
peer group (supervisor may have more access to this)
• Take into consideration the intern’s relationships with his/her peer group
• Different interns may have different awareness of what is going on
• Possibly provide outside facilitator to help them
process
• RPs can direct a lot of supervisory time and energy
toward one intern. Don’t forget to attend to the other
trainees in general
Discussing with Non-training Staff
• Be attentive to privacy issues
• Solicit examples of behaviors (positive & negative) in specific
areas
• Emphasize both the caring for trainee and duty as gatekeepers
• Emphasize that decisions were made by a team, based on
patterns of behavior or extreme violations
• Encourage a united front. Ask others to trust the process/team
• Invite questions, but know that you may not be able to provide
certain details
• Acknowledge mixed feelings about the process or the results
• Publically support the primary supervisor and the Training
Team
What was the most difficult part of the
process of implementing the plan?
• Dealing with the trainee’s reactions
• Having to deliver difficult feedback (the plan itself, dismissal)
• Dealing with the reactions of the rest of the staff/
Finding enough support from colleagues
• The amount of time and emotional energy involved
• Creation of the plan itself (esp. using behaviorallybased language)
• Following proper policies and due process procedures (UCC,
HR, ADA)
ACCTA Survey, n =32
DOCUMENT!
• EVERYTHING!
• Document meetings
• Communication with intern and supervisors
• Begin the documentation early on to help determine
if you are moving in the direction of a formal
remediation plan
• Storage of documentation – if involves ADA or
protected information may need to work with HR to
protect information storage
Outcomes
• When the trainee has met the goals
• Acknowledge and celebrate!
• Notify academic program
• Document
• When the trainee has not made sufficient progress:
• Follow your evaluation/due process guidelines
• Consult, consult, consult with APA, academic
program, HR
• Document
• Consider what is a ‘success’
Separation
• In the event that you move towards separation:
• CONSULT and work closely with HR, the home
program, & APPIC
• Consider a leave of absence…no not for you!
(depending on factors contributing to challenges)
Caring for Yourself
• Model good ethics, but also human fallibility
• Keep your expectations for yourself and your trainee
reasonable
• Pace yourself. It’s a process that will likely go on for
several weeks, if not longer
• Own your part, but don’t take too much responsibility for
intern’s shortcomings
• Seek support from peers (ACCTA listserv!, local TDs, DCT)
• Seek support from your Director and other staff
• As much as possible, present a united front. Try to avoid
potential for splitting
Caring for Yourself
• Don’t do it all yourself. Include your training team (and the
trainee, if appropriate) in the creation of the RP
• examples of problems, ideas for consequences/training tasks
• Schedule follow-up appts and time to craft plans and
evaluation documents well in advance
• Use existing examples (check website, ask peers)
• Consult with APA, APPIC, HR, campus legal reps, etc. for more
serious concerns
• Continue to participate in your regular self-care routines
(exercise, sleep, nutrition, etc.)
• After all is said and done, consider possible changes in your
process, policies, procedures, etc. for the future
Selected References & Why We Chose Them
Forrest, L., Elman, N, Gizara, S, & Vacha-Haase, T. (1999). Trainee impairment: A
review of identification, remediation, dismissal, and legal issues. The
Counseling Psychologist, 27, 627-686.
Good summary of the literature on remediation plans. Also, good discussion of intersection
between impairment and ADA issues.
Hoffman, M. A., Hill, C. E., Holmes, S. E., & Freitas, G. F. (2005). Supervisor
perspective on the process and outcome of giving easy, difficult, or no
feedback to supervisees. Journal of Counseling Psychology, 52, 3-13.
Nice exploration of different factors involved in supervisors’ decisions to give or not to give
feedback to doctoral interns in APA-approved UCCs. Includes supervisors’ assessments
about the short- and long-term outcomes of their decisions.
Jacobs, S. C., Huprich, S. K., Grus, C. L., Cage, E. A., Elman, N. S., Forrest, L.,
Schwartz-Mette, R., Shen-Miller, D. S., Van Sickle, & K. S., Kaslow, N. J.
(2011). Trainees with professional competency problems: Preparing
trainers for difficult but necessary conversations. Training and
Education in Professional Psychology, 5, 175-184.
Great discussion of barriers trainers encounter when addressing competency issues including
suggestions for overcoming these obstacles.
Selected References & Why We Chose Them
McAdams, C. R., & Foster, V. A. (2007). A guide to just and fair remediation of
counseling students with professional performance deficiencies.
Counselor Education and Supervision, 47, 2-13.
Nice summary of legal cases involving due process and remediation. Includes guidelines
about how to make due process/remediation congruent with legal requirements.
Miller, D. S. S., Forrest, L., & Elman, N. S. (2009). Training directors’
conceptualizations of the intersection of diversity and trainee
competence problems: A preliminary analysis. The Counseling
Psychologist, 37, 482-518.
Interesting qualitative study that provides recommendations for increasing the complexity
and frequency of discussions of cultural variables within the context of trainee competency
issues.
•Q & A/ Discussion
Thank you for your attendance and
your attention!
Please don’t forget to complete your
program evaluation!