Under Part 3 of the Health Practitioners Competence Assurance Act 2003 (the Act), the Psychologists Board is required to oversee a system providing for Competence Reviews and Competence Programmes. These reviews and programmes are not disciplinary in nature. A review is for the purpose of assessing a psychologist's current competence, and is therefore evaluative and educational in nature. Competence Programmes may be made to apply generally (e.g., the Board's prescribed Continuing Competence Programme) or in respect to any specified class or classes of psychologists who hold or apply for annual practising certificates. The following information addresses the more specific situation when an individualised programme is ordered as a result of Competence Review.
There has to be significant concern about a psychologist's standard of competence to trigger a Competence Review. Most requests for reviews are initiated by way of a "Section 34 Notice" coming from a psychologist's professional colleagues and/or employer. A review may also be carried out following a recommendation by a Professional Conduct Committee, or by notification from the Health and Disability Commissioner.
The Act enables the Board to carry out a Competence Review on a psychologist whether or not there is reason to believe that psychologist's competence may be deficient; or whether or not the Board receives a notice under section 34.
Promptly after receiving a Notice under section 34, the Board must make inquiries into, and may review the competence of a psychologist who holds a current practising certificate.
Where appropriate, a Competence Review Committee (CRC) will be appointed by the Board to carry out a Competence Review. The CRC will consist of two psychologists who are competent, have good interpersonal skills, and have some knowledge of performance and educational assessment relevant to the scope of practice of the psychologist being reviewed. The psychologist being reviewed will be told about the substance of the Board’s concerns and the activities that will be used to assess their competence. These activities may include reviewing written work and files and interviews with the psychologist, as well as other commonly accepted assessment tools. This practical component of the review may take from half a day to a full day or more depending on the breadth of the competence concerns or problems. The Board has developed guidelines to assist CRC members and guidelines for the psychologist undergoing the review. The Board meets the costs of a Competence Review, except for the psychologist's personal costs (which are their rersponsibility).
Within a month of conducting the Competence Review, the CRC submits a report of their findings to the Board. If the Committee has determined that the psychologist does not meet the required standard of competence, then the Board must make one or more of the following orders:
That the psychologist undertakes an individually prescribed Competence Programme. If this is the case, the Board works (as much as possible) with the psychologist to develop a programme to address the concerns identified in the review. This will include specific objectives and educational activities and an agreed process of reporting or reassessment at the end of the programme. The programme may also include the appointment of a Board-approved supervisor. The psychologist meets the cost of completing the Competence Programme.
That one or more conditions be included in the psychologist's scope of practice.
That the psychologist sits a specified examination or assessment.
That the psychologist be counselled or assisted by one or more nominated persons.
If you are a health practitioner you may inform the Board if you believe that another psychologist may pose a risk of harm to the public by practising below the required standard of practice. [Refer s 34(1)] The Board has adopted a best practice guideline entitled What To Do If You Have Concerns About Another Psychologist that may assist. Whenever a psychologist resigns or is dismissed from his or her employment for reasons relating to competence, their employer must promptly give the Board's Registrar written notice of the reasons for that resignation or dismissal. [Refer section 34(3)] No civil or disciplinary proceedings lie against any person in respect of the above, unless the person has acted in bad faith.
If the Board assesses a risk of serious harm to the public because the psychologist is practising below the required standard of competence, the Board can suspend the psychologist's practising certificate or alter the psychologist's scope of practice by altering the health services the psychologist is permitted to perform or including any conditions that the Board considers appropriate.
The HPCA Act requires the Board to oversee a system providing for Competence Reviews and Competence Programmes. Competence Reviews and Programmes are not disciplinary in nature. A review is to assess the practitioner's competence, and is therefore evaluative and educational in nature. A Competence Programme is remedial in nature. The Board believes that both should be as consultative and supportive as possible. Above all else, a system of reviews and programmes promoting openness, transparency, and good faith is intended.
Notifications normally come from other health practitioners (including other psychologists), supervisors, employers (especially where the psychologist has resigned or was dismissed for reasons relating to competence), the Health and Disability Commissioner, or from a Professional Conduct Committee. The Board can also initiate a review without having received any notification.
A referral must be made by written notice to the Board, setting out the reasons why the psychologist may pose a risk of harm to the public by practising below a required standard of competence.
Competence notifications are screened by the Board’s Parts 3 & 4 Committee (under due delegation) with reference to the Board’s adopted Decision Guidelines Relating to Parts 3 & 4 of the HPCA Act.
A Competence Review Committee will be appointed by the Board. The committee will normally consist of two psychologists, one of whom is practising in the same area or specialty as the psychologist being reviewed. Where cultural issues are a source of concern the committee will normally include cultural expertise. In special circumstances, the committee may co-opt others for specific expertise or advice. Suitable reviewers will be competent, have good interpersonal skills, and have some knowledge of performance and educational assessment. The psychologist being reviewed is informed of the names and qualifications of the proposed committee members. The psychologist may request a change in the proposed membership if he or she perceives a conflict of interest or has other sound reasons. Such requests will be carefully considered, but may not be granted.
The Board will give notice to the psychologist giving sufficient particulars to inform him or her of the following:
The substance of the concerns, and the grounds on which the Board has decided to carry out a review.
Information relevant to his/her competence that is in the Board's possession.
The terms of reference for the Competence Review. This will give the detail of the review’s focus, and the activities to be undertaken in order to assess competence. Reviews may include activities such as reviewing written work and files and interviews with the practitioner. The psychologist is given a reasonable opportunity to make written submissions and be heard (oral submissions) on the matter, either personally or by his/her representative. If heard personally, the psychologist is entitled to the presence of selected support persons.
If any other competence issues are identified during the course of the Competence Review which would normally be serious enough to warrant concern, these are to be notified to the Board by the Competence Review Committee. If other matters that pose a risk to patient safety are discovered during the course of the review (even if outside of the terms of reference) these must also be conveyed to the Board.
Once the committee has been given the terms of reference, it meets (by teleconference if necessary) to discuss how the review will be carried out and how/which of the assessment tools will be applied to the specific situation. The committee decides the precise assessments and activities that need to take place after considering any submissions by the psychologist. It is anticipated that examples may include file reviews, direct observation, case scenarios, interviews, and other discussions with the psychologist. The HPCA Act specifies that the review (and any subsequent Competence Programme) may also inspect any of the clinical records of the psychologist.
The psychologist is notified of these specific activities, and a suitable time and place is arranged with the psychologist and any other necessary parties. This practical component of the review may take from half a day to a full day (or more) depending on the breadth of the problem. This practical component must also give the psychologist an opportunity to be heard on the matter, either personally or by his or her representative. The psychologist is entitled to the presence of a support person of his or her choice.
Within a month of conducting the review, the committee submits a written report to the Board with a recommendation that the psychologist either meets or does not meet the required standard of competence.
The Board’s Parts 3 & 4 Committee then considers the Competence Review Committee’s report. If it has been determined that the psychologist does not meet the required standard of competence, then the P3&4 Committee must make one or more of the following orders:
That the psychologist undertakes a Competence Programme;
That one or more conditions be included in the psychologist’s scope of practice;
That the psychologist sit a specified examination or assessment;
That the psychologist be counselled or assisted by one or more nominated persons.
Reviewers sign a confidentiality agreement in which they undertake not to disclose any personal or health information obtained about the psychologist or his or her clients except as legally required during the course of the review. In addition, where specific cases are included in the report or discussed with the P3&4 Committee, no client identifying information is included. If client consultations are observed the client must be requested to sign a consent form prior to the consultation.
Where the psychologist being reviewed is employed in a hospital or health institution it may be desirable that the relevant clinical director and the psychologist's supervisor be informed. Aspects of the review such as reviewing patient records and interviewing colleagues often require others in the workplace to be aware of the review. However, privacy concerns mean that, excepting those who must be notified of a review in accordance with section 35 of the Act, the Board does not release information about a psychologist being reviewed without the permission of the psychologist. Circumstances of risk or harm may override these constraints.
If the review determines that the psychologist does not meet required standards of competence, and the P3&4 Committee issues orders concerning competence, within five (5) working days the following must be given a copy of these orders:
any employer of the psychologist,
any person who works in partnership or association with the psychologist.
If the review determines that the psychologist never posed, or no longer poses, a risk of harm to the public, then the Board promptly informs all agents who have been previously informed of the review.
If the Board is unable to conduct or complete a Competence Review because the psychologist fails to respond adequately to the Notice, then the Act states that the Board "has reason to believe that the psychologist fails to meet the required standard of competence".
When referrals are made for a Competence Review, the person making the referral is given information about the review process and advised that this is not a disciplinary process, and that the psychologist’s competence may be reviewed. The person is informed that if problems are found, the psychologist will be required to undergo a Competence Programme.
Section 39 of the HPCA Act gives the Board the authority to order the interim suspension of a psychologist’s practising certificate or inclusion of conditions on the psychologist's scope of practice before or after a review or assessment. This may be ordered where there are reasonable grounds to believe that the psychologist poses a risk of serious harm to the public by practising below the required standard of competence.
The Board meets the costs of a Competence Review. The psychologist is, however, responsible for any personal costs (e.g., travel).
A Competence Programme should be:
designed to fill the gaps in skill of the psychologist as described in the Competence Review Committee's report,
developed to include specific objectives and educational activities and an agreed process of reporting or reassessment at the end of the process,
developed to ensure that the programme is feasible.
When necessary, this may include the appointment of a supervisor to guide the psychologist through the educational, clinical, or practical activities required.
The Board’s P3&4 Committee drafts the requirements for the programme based on the Review report, input from Chair of the Competence Review Committee, and discussions with any other appropriate educational providers and any programme supervisor.
A programme may include the following details:
Specific measurable objectives for the programme.
Details of educational activities the psychologist should participate in to meet these objectives (e.g., specified courses, audits, individual study, practice enhancement activities).
The specific skills required of and tasks to be performed by any programme supervisor when it is considered that the programme is sufficiently extensive or complex to warrant such an appointment.
The method for assessing whether the programme’s objectives have been met. Depending on the magnitude of the original problems, assessment might vary from simple reporting (e.g., that a specified educational activity has been completed along with a description of the learning that occurred and how that has been implemented in practice), to monthly supervisor’s reports followed by a repeat review.
The date by which the programme should be completed.
As far as possible, the Board works collaboratively to discuss the proposed programme with the psychologist concerned to ensure that it is feasible and acceptable. The P3&4 Committee approves the programme, and an order containing the details of the programme is sent to the psychologist concerned (and to the supervisor where one is appointed) within twenty (20) working days of approval.
If a further review is required at the completion of the programme, whenever possible one or more of the original reviewers carries out the review. The supervisor is not normally part of the review team.
The guiding criteria for appointment as a Competence Programme supervisor are the following:
Be a peer working in the same broad scope as the psychologist concerned,
Possess good facilitation and interpersonal skills,
Have had significant previous experience as a psychology educator or supervisor,
Be competent and have recognised experience in the area of concern,
Be acceptable to the psychologist concerned.
The Board selects any supervisor after discussions with the psychologist, other relevant education providers or professional organisations (e.g., New Zealand Psychological Society or the New Zealand College of Clinical Psychologists), and cultural advisors where necessary. The frequency and method of meetings (e.g., face to face, via telephone) between the supervisor and the psychologist is specified in the programme, as are the activities to be carried out.
Payment of costs of the Competence Programme is the responsibility of the psychologist undergoing the programme. Any supervisor is paid directly by the psychologist undertaking the programme, and a standard contract is available from the Board to formalise the relationships between the supervisor and psychologist.