PROGRAM SELF-ASSESSMENT AND QUALITY IMPROVEMENT

The Internship Training Program is committed to program self-assessment and quality improvement. The Directors, PITC and current intern class have the basic responsibility for program self-assessment and quality improvement. The program is evaluated in an on-going manner by both faculty and interns participating in the program. The Directors and PITC review intern evaluations of the internship experience and their suggestions for improvements. The PITC meets periodically to review the status of the program and any opportunities for improvement. The PITC is responsible to ensure the goals and objectives of the Internship Program are being met and opportunities for improvement considered. Informal evaluation of the internship is a continuing on-going process. Interns are encouraged to bring up issues, concerns, and suggestions for improvement throughout the year to their supervisors, members of the PITC, the Training Directors, and to the Chief Intern. The Directors meets briefly with the interns at the beginning of each weekly intern seminar to discuss possible concerns. Mid-year and at the completion of the program, interns meet with the Directors to provide a more detailed evaluation of the internship. This includes a description of the primary activities of each rotation, including aspects of the rotation found to be most beneficial and suggestions for improving rotations. The interns are also asked to include suggestions for improving the training program overall. Particular attention is paid to diversity of cases and volume, supervision, facility resources, and on-site seminars.

Grievance Procedures

The grievance procedures allow interns to seek resolution of complaints about faculty actions or policies that could not be resolved by direct methods. Possible issues include, but are not limited to, poor technical supervision, inadequate or unavailable supervision time, excessive workload, evaluations perceived as unfair, conflict over scientific ownership, or disagreement with internship policies and procedures. Under most circumstances, appeal to the Directors or PITC is not an appropriate initial step in dealing with problems in the internship program. Interns are first encouraged to express their concerns and dissatisfactions to the faculty involved. However, policy complaints and issues involving possible sexual harassment could be brought directly to the Directors, Executive Committee, or PITC. All grievance matters will be treated as confidential to the extent possible and all parties to the action will be so advised. Please note, however, that such matters are not privileged communication in the eyes of a court of law.

An intern who disagrees with the supervisor's evaluation may refuse to sign the evaluation and submit a written rebuttal, and/or may inform the Directors or the PITC about the nature of the disagreement.

If other grievances should occur, they will be handled in the following way:

Generally, interns would first take issues to their primary supervisor at the site where they are training. If the issue cannot be resolved at that level, a complaint must be filed with the Training Directors, who will gather information from the relevant student(s) and faculty member(s). If the grievance is filed against one of the Directors, the Executive Committee will appoint a replacement for the Director to administer the grievance process. In all other instances, the Training Directors will act as mediator to attempt to resolve the grievance. If mediation fails and the relevant intern(s) and/or faculty member(s) are not satisfied with the response of the Directors, the next level for appeal is the full PITC. At this point, written materials will be requested from the intern and supervisor (or from the Training Directors, in the case of grievance(s) regarding internship policies). If the grievance still cannot be resolved to the satisfaction of the intern(s), faculty or Training Directors at this level, appeal can be made to the Internship Chief Psychologist and Director of Graduate Education for the UCSD Department of Psychiatry to resolve the matter. The final, binding arbitrator is the Chair of the UCSD Department of Psychiatry.

It is also possible to bring any issue up at one of the Internship Self Study meetings (scheduled at least twice each year).

The grievance procedures of the UCSD Psychology Internship Training Program may not supersede grievance procedures of the university. These guidelines do not preclude attempted resolution of difficulties by adjudication at a school or university level. The intern class can pursue grievances without fear of retribution.

Probation Procedures for Serious Skill and/or Knowledge Deficits:

One of the purposes of the internship year is for interns to identify and remedy gaps in their knowledge and experience. The internship program attempts to help interns identify these areas and provide guidance on how they might improve their skills through additional readings, experiences, or rotation placements. A serious skill or knowledge deficit, however, may be identified during the internship year. If a clinical supervisor determines that an intern is not performing at a satisfactory level of competence, the clinical supervisor is expected to discuss this with the intern, to increase his/her supervisory guidance and to direct the intern to other appropriate resources (e.g, didactics, additional therapy or assessment experiences, etc.). At this point, no formal communication with the Internship Directors is required. However, the clinical supervisor should note in writing to the intern what concerns led to the discussion and remedial steps which were proposed.

Occasionally, the problem identified may persist and continue to be of sufficient seriousness that the intern may not receive credit for the internship unless that problem is remedied. Any time when this is the case, the problem must be brought to the attention of the Directors and the Executive Committee. The memoranda developed in the initial communication of the problem to the intern should be included in the communication to the Directors. The following procedures will be followed at this point:

1) The Directors will review all pertinent data, interview the intern and supervisor involved, and bring the issue to the Executive Committee, which will vote to make one of four recommendations: (a) No action required; (b) corrective action short of probation; (c) probation for a specified length of time; (d) immediate dismissal from the program.

2) The Executive Committee may require an intern placed on probation to carry out a specific remedial action, take a particular rotation, or issue guidelines for the type of rotation the intern should choose to remedy such a deficit.

3) The intern, the intern's supervisor, and the Executive Committee together draw up a contract specifying the kinds of remedial activities, knowledge, skills and behavior that are necessary for the intern to develop in order to remedy the identified problem.

4) Once an intern has been placed on probation, and a learning contract has been written and adopted, the intern may or may not move to a new rotation placement. Any new placement will be carefully chosen by the Executive Committee and the intern to provide a setting to work on the identified problems. In some instances, an intern and supervisor may feel it would be to the intern's benefit to remain in the current placement.

5) The intern and supervisor report to the Directors on a regular basis, as specified in the contract (not less than once each month) as to the intern's progress.

6) The intern's probationary status is communicated to the intern's home academic program and a copy of the learning contract is sent to the Academic Training Director.

7) The intern may be removed from probationary status with the approval of the Executive Committee when the intern's progress in resolving the problem(s) specified in the contract is sufficient. The intern will only be removed from probationary status if the intern's performance is at the appropriate level to receive credit for the internship.

8) If the initial recommendation was immediate dismissal, or if the intern is not making sufficient progress to receive credit for the internship, the Executive Committee and Directors will so inform the intern immediately.

9) The dismissal decision is made by the majority vote of the Executive Committee based on all available data with particular attention to the intern's fulfillment of the learning contracts drawn up for the probationary status.

Whenever possible, probationary and disciplinary actions will be carried out within the framework of the Internship Program. However, this may not always be possible. An infraction could automatically trigger intervention by external persons or agencies.

Any time the intern, by action of the Executive Committee, is dismissed from the program, he/she may appeal this decision to the full PITC through to the Chair of the Department of Psychiatry, according to the sequential procedures described in the grievance policy.

Students Judged to be Impaired:

An intern will not be continued in active status in the program when the competency of the student to perform in the program is or could reasonably be expected to be impaired due to an apparent medical, mental, emotional, physiologic, pharmacologic, or substance abuse condition. In the event that a supervisor suspects that a student may have one or more conditions that are interfering with his/her internship activities, the following steps will be taken.

1) The supervisor will meet first with the Directors to discuss the matter.

The Directors will call a meeting of the intern (if possible), and supervisor. Any identified problems and proposed remedial action, (e.g., according to the "Skills Deficit" procedures, above) or other action deemed appropriate, will be presented in writing to the intern by the Directors.

3) The student will be allowed two weeks to respond to the identified problems and proposed actions if he/she chooses, and to request a reconsideration hearing before the Executive Committee. The student may select any consenting representative (including another intern) to appear with him/her before the Executive Committee.

4) The Executive Committee will then decide on a course of action to be followed, specified in writing and signed by the intern. If it is determined necessary to refer to student for psychological assessment, the referral will be made to a qualified psychologist who has not had personal or professional connection with the Internship Program. A list of at least three acceptable choices would be made available to the intern who would be allowed to make the final selection.

5) The intern is responsible for any costs incurred in the required assessment.

6) Depending on the results of the psychological assessment, the intern may be asked to a) take a leave of absence, the length to be determined by the Executive Committee, in order to attempt to improve/resolve the problem (with lost hours to be completed upon return through an extension of the internship year); or b) resign from the program. The Executive Committee may also recommend to the student that he/she secure medical care or psychotherapy, at his/her own expense.

7) At the end of the agreed upon time of leave and/or other specified progress evaluation, the Executive Committee would once again meet to decide if the criteria have been met, and whether or not the student should be retained in the program. To determine the student's fitness to remain in the program, the Executive Committee may require the intern to authorize the Executive Committee to obtain any and all records relating to the alleged mental and/or physical condition, including that individual's personal medical, psychiatric and or psychological records.

8) If, at any point, during the process, the intern fails to comply with any of the requirements of the evaluation, rehabilitation or remediation, the intern may be dismissed from the program without regard to academic standing, status of research, or any other consideration.

9) The intern may elect to resign from the program without submitting to the psychological assessment, the leave of absence, or the specified remediation/ rehabilitation plan. In such a case, the intern would be informed in writing that readmittance to the Internship Program at any future time is not an option. A copy of that letter would be placed in the intern's confidential file. The intern would be designated as having resigned from the program while not in good standing.

Illegal or Unethical Behavior:

The program is bound by the Ethical Principles of Psychologists and Code of Conduct set forth by the American Psychological Association (APA, 2002, and included in the internship training manual). In addition, we are bound by other ethical and professional principles promulgated by APA. Any serious breach of any part of these principles is grounds for dismissal from the program without further qualification, regardless of quality of clinical work, research or other internship achievement.

Under no conditions are interns permitted to treat clients without supervision. Interns also are not permitted to privately engage in any professional activities within or outside the program institutions without prior approval of the PITC. Failure to obtain proper approval may jeopardize the intern's standing in the program.

Illegal or unethical conduct by an intern should be brought to the attention of the Director of Internship Training in writing. Any person who observes such behavior, whether staff or intern, has the responsibility to report the incident.

Infractions of a very minor nature may be dealt by the Director of Internship Training, the supervisor, and the intern. A written record of the complaint and action become a permanent part of the intern's file.

Any significant infraction or repeated minor infractions must be taken up by the Executive Committee, after the written complaint is submitted to the Training Director. After a careful review of the case, the Executive Committee will recommend either probation or dismissal of the intern. Recommendation of a probationary period must include specific guidelines including a time frame and periodic reporting to the Executive Committee, as described in the probationary policy procedures. A violation of the probationary contract would necessitate the termination of the intern's appointment in the UCSD/VA Psychology Internship Program.