Competence
Reviews and Competence Programmes arising from Reviews
Index of Questions and
Answers about Competence Reviews and Programmes
Policies
and Procedures of the Competence Review Process
Legal
Liability and Privacy Issues
Competence
Programmes
Questions and
Answers
Why
introduce competence reviews and competence programmes?
The HPCA Act (2003) requires the Board to oversee a system providing for
Competence Reviews ("Reviews") and Competence Programmes
("Programmes"). Programmes may be made to apply generally or in
respect to any specified class or classes of psychologists who hold or apply
for annual practising certificates. The following section addresses the more
specific situation when individual Programmes are directed as a result of
Reviews.
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 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.
Who
might ask a psychologist to be reviewed?
-
Professional colleagues, other health practitioners,
including other registered psychologists providing general oversight,
including supervision;
-
Employers (e.g. DHBs, CYFS, Department of Corrections, GSE,
etc.), especially if the psychologist resigns or is dismissed for
reasons relating to competence;
-
The Board itself;
-
Health and Disability Commissioner and Professional Conduct
Committees.
How
does someone request a review?
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.
How are
the review requests screened?
Review will not be carried out if the notice is considered
frivolous or vexatious. The following factors increase the probability of underlying incompetence, and thus a need for
a Review:
-
A pattern of poor standards of care or competence –
several instances, or one instance over a sustained period,
-
The magnitude of the mistakes, including the size of the
suspected deficit, and the possible degree of serious departure from normal
safe and accepted standards of practice,
-
The 'at risk' group includes psychologists working in a
professionally isolated environment (e.g., in a rural setting, working
alone in private practice, not affiliated with any professional body;
lacking regular or any supervision) and
those working at the outer boundaries of, or beyond, their scope of
practice and training.
Incompetent practice also may be the result of gradually
evolving illness or disability.
The following factors decrease the likelihood of the Board deciding on a Review:
-
Whether the matter would be more appropriately dealt with by
other agents such as the Privacy Commissioner or the Courts, and does not
directly relate to professional or clinical competence,
-
Situations more appropriately dealt with by Professional
Conduct Committees or the Health and Disability Commissioner.
In short, Reviews are not randomly
undertaken. Reviews arise from concerns about whether the psychologist’s
competence is such that there may be risk of harm to the public.
Who does
the review?
A Competence Review Committee (“Committee”) will be appointed.
This will consist of two registered psychologists - preferably one of
who is practising in the same area or specialty as the psychologist
being
reviewed. Where cultural issues are the source of concern, the Committee should
include cultural expertise. In special circumstances, the Committee may co-opt
others for specific expertise or advice. Suitable reviewers will need to be
clinically 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 Committee. The psychologist
may
request a change if he or she perceives a conflict of interest or has
other reasons for requesting a change to the Committee membership. Such requests will be carefully considered, but may not be
granted.
How does
the review proceed?
The Board will give a 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 Review. This will give the
detail of where the Review will focus, and the activities in order to
assess competence. Reviews may include activities such as reviewing written
work, files, and interviews with the Practitioner, as well as commonly
accepted assessment tools. The
psychologist
is then 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 Review which would normally by serious enough to warrant concern,
these are to be notified to the Board. 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 Review 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 Act specifies that the Review (and any subsequent Programme)
may also inspect any of the clinical records of the
psychologist
.
The
psychologist
is notified of these specific activities,
and a suitable time for and place of these 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
depending on the breadth of the problem and both members of the Committee must be
involved. This practical component
must also give the psychologist an opportunity to be heard on the matter,
either personally or by his or her representative. Once again, the
psychologist
is entitled to the presence of a support person of his or her choice.
What can
a review decide?
Within a month of conducting the Review, the Committee
submits a written
report to the Board with a recommendation that the psychologist either,
-
does meet the required standard of competence for a
registered psychologist, or
-
does not meet the required standard of competence for a
registered psychologist.
What
happens once the review has been completed?
The Board then considers the Committee’s report.
If the Committee has determined that the Practitioner does not meet required
standard of competence, then the Board 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.
What
are the confidentiality requirements of Reviewers?
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
Board, 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.
Who
knows that a competence review is taking place?
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, e.g. ACC,
HDC, Director General of Health and the psychologist's employer, 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
matters of privacy or confidentiality.
Who
knows the outcome of the competence review?
If the Review determines that the psychologist does not meet
required standards of competence, and the Board issues orders concerning
competence, within five (5) working days, the following must be given a copy of
these orders:
-
the
psychologist,
-
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, e.g.
ACC, HDC, Director General of Health and the psychologist's employer (if
any).
What
if the psychologist fails to take part in a review?
If the Board is unable to conduct or complete a 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".
What
information does the person making the referral get?
When referrals are made for a
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.
What
conditions can be placed on a practitioner pending a review?
Section
39 enables the Board the authority to order the interim suspension of an
APC 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 Practitioner poses
a risk of serious harm to the public through practising below the required
standard of competence.
Who
pays for the competence review?
The Board meets the costs of a
competence review.
How
is a competence programme developed?
A 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 an educational or clinical
Supervisor to guide the psychologist through the educational, clinical, or
practical activities required.
The Board drafts the requirements
for the Programme based on the Review report, input from Chair of the
Committee and
discussions with any other appropriate educational providers, and any Programme
Supervisor.
What
will be included in a competence programme?
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 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 Board 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 Board’s 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 Board
covers the cost of any additional Review.
Who
might become a competence programme supervisor?
The
guiding criteria for appointment as an educational or clinical 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 and 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.
Who
pays for the costs of completing a competence programme?
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.
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