帝王会所

Policy No. 7.9.01 Definition of Problematic Behavior:

Problematic behavior is defined broadly as an interference in professional functioning, which is reflected in one or more of the following ways: 

• An inability or unwillingness to acquire and integrate professional standards into one鈥檚 repertoire of professional behavior
• An inability to acquire professional skills to reach an acceptable level of competency
• An inability to manage personal stress, strong emotional reactions, and/or psychological distress which interfere with professional functioning. 

Procedures: 

• It is the professional judgment of a supervisor/staff member as to when a clinician-in-training鈥檚 behavior raises concerns. Consultation with other staff members is encouraged and consultation with the TD is required to determine if the clinician-in-training's behavior is problematic.
  • Clinicians-in-training might exhibit behaviors, attitudes, or characteristics which, while of concern and requiring remediation, are not unexpected or excessive for professionals in training and do not rise to the level of problematic behavior. 
• Problematic behavior is typically identified when the behaviors include one or more of the following characteristics:
  • The clinician-in-training does not acknowledge, understand, or address the problem when it is identified by the supervisor or another staff member.
  • A significant skill deficit that is negatively impacting clinical work.
  • The quality of services delivered by the clinician-in-training is significantly negatively affected.
  • The problem is not restricted to one area of professional functioning.
  • A disproportionate amount of attention from training personnel is required.
  • The clinician-in-training鈥檚 behavior does not change as a function of feedback, remediation efforts, training, and/or time.  

Policy No. 7.9.02 Procedures for Responding to Inadequate Performance by a Clinician-in-Training:

If a clinician-in-training receives a 鈥�1鈥� (performs inadequately, requires frequent and close supervision and monitoring of basic and advanced tasks) or a 鈥�2鈥� (shows beginner-level competence in routine tasks, requires significant supervision and close monitoring in carrying out advanced tasks) from any of the evaluation sources in any  categories of evaluation, or if a staff member has concerns about a clinician-in-training鈥檚 behavior (e.g., ethical or legal violations, professional incompetence) the following procedures will be initiated:

Procedures: 

• The staff member will consult with the TD to determine if there is reason to proceed with remediation and/or if the behavior in question is being rectified.
• If a staff member brings a concern to the TD is not the clinician-in-training鈥檚 primary supervisor, the TD will consult with the primary supervisor.
• The TD may meet with the Director to discuss the concerns and possible courses of action to be taken to address the issue.
• The TD, primary supervisor, and the Director may meet to discuss possible courses of action.
• When a decision has been made by the Director or the TD about a clinician-in-training鈥檚 training or status within the agency, the TD will inform the clinician-in-training in writing and will meet with the clinician-in-training to review the decision. This meeting may include the clinician-in-training鈥檚 primary supervisor. Any formal action taken by the Training Program may be communicated in writing to the clinician-in-training鈥檚 academic department. This notification indicates the nature of the concern, and the specific alternatives implemented to address the concern.
• The clinician-in-training may choose to accept the conditions or may choose to challenge the action.  See the Policy 7.8.07 for procedures for challenging an action. 

Policy No. 7.9.03 Remediation and Sanction Options:

It is important to have meaningful ways to address problematic behavior once identified. In implementing remediation or sanction interventions, the training staff must be mindful of the needs of the clinician-in-training, the clients involved, members of the training cohort, the training staff, and other agency personnel. Remediations and sanctions should begin at the lowest level deemed appropriate. 

Procedures: 

The remediation plan should be constructed with sensitivity to the developmental level of the clinician-in-training and the seriousness of the concern. The plan may include any of the interventions listed below, singly or in combination.  

Verbal Warning: 

• The clinician-in-training is given verbal feedback emphasizing the need to discontinue the inappropriate behavior being addressed.
  • This verbal warning will be noted in the clinician-in-training's file.
  • Consideration may be given to removing the notation of this verbal warning at the end of the training period by the TD, in consultation with the supervisor of the clinician-in-training and Director.
    • If it remains in the file, documentation will include how the concern was addressed and/or resolved.

Written Acknowledgement: 

• Written feedback to the clinician-in-training that formally acknowledges the following:
  • The TD is aware of, and concerned with, the performance rating and/or the problematic behavior.
  • The concern has been brought to the attention of the clinician-in-training
  • The TD will work with the clinician-in-training to rectify the concern.
  • The behavior associated with the rating is not significant enough to warrant more serious action.
• The written acknowledgement will be noted in the clinician-in-training's file.
  • Consideration may be given to removing the notation of the written acknowledgement at the end of the training period by the TD, in consultation with the clinician-in-training鈥檚 supervisor and Director.
  • If it remains in the file, documentation will include how the concern was addressed and/or resolved.

Written Warning: 

• This is a letter that indicates the need for the clinician-in-training to discontinue an inappropriate action or behavior and/or address an unsatisfactory performance rating.  This letter will contain the following:
  • A description of the clinician-in-training鈥檚 unsatisfactory performance
  • Actions needed by the clinician-in-training to correct the behavior
  • The timeline for correcting the problem
  • What action will be taken if the problem is not corrected
  • Notification that the clinician-in-training has the right to request a review of this action
• A copy of this letter will be kept in the clinician-in-training鈥檚 file.
  • Consideration may be given to removing this letter at the end of the training period by the TD, in consultation with the clinician-in-training鈥檚 supervisor and Director.
  • If it remains in the file, documentation will include how the concern was addressed and/or resolved.

Schedule Modification: 

• This is a time-limited, remediation-oriented, closely supervised period of training designed to return the clinician-in-training to a more fully functioning state. Modifying a clinician-in-training鈥檚 schedule is done to assist the clinician-in-training in responding to personal reactions to environmental stress, with the full expectation that the clinician-in-training will complete the traineeship/internship. This period will include more closely scrutinized supervision conducted by the regular supervisor in consultation with the TD. Several possible and perhaps concurrent courses of action may be included in modifying the schedule. This process will be documented in the clinician-in-training's file. These include but are not limited to:
  • Increasing the amount of supervision, either with the same or other supervisors
  • Change in the format, emphasis, and/or focus of supervision
  • Recommending personal therapy aimed at addressing the behaviors of concern (a list of community practitioners and other options will be made available)
  • Altering the clinician-in-training鈥檚 clinical or other workload
  • Requiring specific didactic and/or academic coursework
• The length of the modification will be determined by TD in consultation with the primary supervisor, ADT, and the Director. The termination of the schedule modification period will be determined, in discussion with the clinician-in-training, by the TD in consultation with the primary supervisor, ADT, and the Director.

Probation: 

• This is a time-limited, remediation-oriented, more closely supervised training period.  The purpose of probation is to assess the clinician-in-training's ability to complete their training and return to a more fully functioning state. 
• Probation is a time when the TD systematically monitors the degree to which the clinician-in-training addresses, changes and/or otherwise improves the behavior associated with the inadequate rating. This process will be documented in the clinician-in-training's file.
• The clinician-in-training is informed of the probation in writing. The statement will include but is not limited to:
  • The specific behaviors associated with the unacceptable rating or problematic behavior
  • Recommendation(s) for rectifying the concern
  • The time frame for the probation during which the concern is expected to be ameliorated
  • The procedures to ascertain whether the concern has been appropriately rectified
• If the TD determines that there has not been sufficient improvement in the clinician-in-training鈥檚 behavior to remove the Probation or Modified Schedule, then the TD will discuss with the primary supervisor, ADT and the Director possible courses of action to be taken. 
• The TD will communicate in writing to the clinician-in-training that the conditions for revoking probation or modified schedule have not been met.  This notice will include the course of action the TD has decided to implement.  These may include continuation of the remediation efforts for a specified time or implementation of another alternative.
• Additionally, the TD will communicate to the Director, and the academic department, that if the clinician-in-training鈥檚 behavior does not change, the clinician-in-training will not successfully complete the traineeship/internship.

Suspension of Direct Service Activities: 

• This action requires determination that the welfare of the clinician-in-training鈥檚 clients or consultees has been jeopardized.
• Direct service activities will be suspended for a specified period as determined by the TD, in consultation with the Director. This will be documented in the clinician-in-training's file and their academic department will be informed.
• At the end of the suspension period, the clinician-in-training鈥檚 primary supervisor, in consultation with the TD, will assess the clinician-in-training鈥檚 capacity for effective functioning and determine when or if direct service can resume. 

Administrative Leave:

• This involves the temporary withdrawal of all responsibilities and privileges at CPS.
• If this or other remediation attempts interfere with the successful completion of the training hours needed for completion of their training, this will be noted in the clinician-in-training鈥檚 file and the clinician-in-training鈥檚 academic program will be informed.
  • The TD will inform the clinician-in-training of the effects the administrative leave will have on the clinician-in-training鈥檚 stipend and accrual of benefits, as applicable. 

Dismissal from CPS: 

• This involves the permanent withdrawal of all agency responsibilities and privileges.
• When specific interventions do not, after a reasonable time, rectify the problematic behavior or concerns and/or the clinician-in-training is unable or unwilling to alter their behavior, the TD, ADT, and Director will discuss the possibility of termination from CPS.
  • Dismissal would be invoked in cases of severe or repeated violations of applicable professional ethical codes, standards, or laws, CPS Policies and Procedures, when imminent physical or psychological harm to a client is a factor, or the clinician-in-training is otherwise unable to complete their training with CPS.
• When a clinician-in-training has been dismissed, the TD will communicate to the clinician-in-training鈥檚 academic department that the clinician-in-training has not successfully completed the training program.  

Policy No. 7.9.04 How to Appeal or Challenge a Decision to Remediate a Clinician-in-Training鈥檚 Behavior:

If a clinician-in-training does not agree with any of the notifications, remediation or sanctions, or with the handling of a grievance, the following appeal procedures should be followed:

Procedures:

• The clinician-in-training should file a formal appeal in writing, with all related documents, with the Director. The clinician-in-training must submit this appeal within five workdays from the notification, remediation, sanction, or handling of a grievance that they are appealing.
• Within three workdays of receipt of a formal written appeal from a clinician-in-training, the Director will consult with the TD and the Clinical Director to decide whether to implement a Review Panel or respond to the appeal without a Panel being convened.
• If a clinician-in-training is filing a formal appeal in writing to disagree with a decision that has already been made by the Review Panel and supported by the Director, then that appeal is reviewed by the Director in consultation with the TD and Clinical Director.  The Director will determine if a new Review Panel should be formed to reexamine the case, or if the decision of the original Review Panel is upheld. 
• If the clinician-in-training wants to further challenge a decision made by the Director and/or Review Panel, they may contact OHIO Human Resources or the OHIO Ombudsperson.