Transcript Competencies for Professional Geropsychology Practice

Development of a Rating
Scale to Assess
Geropsychology Practice
Competencies
Michele J. Karel, PhD
VA Boston Healthcare System
Harvard Medical School
For the CoPGTP Task Force on Geropsychology Competency Assessment:
Michele Karel, Jeannette Berman, Jeremy Doughan, Erin E. Emery, Victor Molinari,
Sarah Stoner, Yvette N. Tazeau, Susan K. Whitbourne, Janet Yang, Richard Zweig
APPIC Conference, April 18, 2009
Objectives
 Increase awareness of efforts to define
and evaluate competencies for
geropsychology practice
 Consider challenges for designing and
implementing a competency rating scale
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Utility in internship and postdoc settings
 Address ongoing challenges and
directions for work in this area
Importance of Professional
Geropsychology Training and Evaluation
 Aging population
 Workforce shortages for geriatric health care, across
disciplines
 Relatively few psychologists have formal training in
geropsychology
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Increasing numbers will be working with older adults
 How to evaluate competence, and define training
needs, for psychological practice with older adults
 How to help training programs, and post-licensure
psychologists, expand opportunities for
geropsychology training
Growth of
Professional Geropsychology
 Growing number of grad, intern, and fellowship programs
offering geropsychology training
 Growth of research, journals, professional organizations
 Several recent milestones:
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APA Office on Aging, established 1998
APA Guidelines for Psychological Practice with Older Adults (2004)
CRSPPP recognition of gero as proficiency area, 1998 and 2005
Pikes Peak Model for Geropsychology Training, 2006 National
Training Conference
 Pikes Peak Training Model* defined Attitude, Knowledge,
Skill competencies for geropsychology practice
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How to evaluate professional geropsychology
competence?
*Knight, B.G., Karel, M.J, Hinrichsen, G.A., Qualls, S.H., & Duffy, M. (in press).
Pikes Peak model for training in professional geropsychology. American
Psychologist.
Project Initiation
 Council of Professional Geropsychology
Training Programs (CoPGTP)
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Formed after 2006 Pikes Peak conference
For training programs at all levels
www.uccs.edu/~cpgtp/
 CoPGTP undertook to explore methods to
evaluate Pikes Peak competencies
 CoPGTP established a Task Force
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Agreed to start with goal of developing a
competency rating scale
Project Goals
 Develop an evaluation tool that would:
 Address the Pikes Peak geropsychology
attitude, knowledge and skill competencies
 Be useful for supervisor evaluation of trainees
 Formative and summative evaluation
 Be useful for self-evaluation by learners
 Be useful across levels of training
 Graduate practicum, internship, fellowship,
post-licensure
 Be useful to help define ongoing training goals
Pikes Peak Geropsychology Practice
Competencies
 Competency definitions informed by:
 APA Guidelines for Psychological Practice with Older
Adults (2004)
 Cube Model for Competency Development (Rodolfa et
al., 2005)
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Psychology foundational and functional competencies
develop over course of training career
 2006 Pikes Peak Conference process:
 Working groups address 6 competency domains
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(separate working groups address 4 levels of training)
Iterations of competencies lists during conference, and
afterwards via listserv discussion
Pikes Peak Competencies
 Are aspirational
 Aim to facilitate as many psychologists as possible to
work effectively with older adults, not to pose barriers
to joining the field
 Competencies are aimed at level of practice of a
newly licensed psychologist who has finished one
year of geropsychology postdoctoral training
 Competencies not geared to level of an “expert”, but
to someone who practices with wide range of older
adults, families, systems
Pikes Peak Competencies: Attitudes
 Work within one’s scope of competence
 Recognize how one’s beliefs about aging and
older adults may affect practice
 Appreciate diversity among older adults, and
interactions between age/cohort and other
aspects of individual diversity
 Seek continuing education, supervision,
consultation
Pikes Peak Competencies:
Knowledge Base
 General knowledge about adult development,
aging, and the older adult population
 Foundations of professional geropsychology
practice
 Assessment
 Intervention
 Consultation
Pikes Peak Competencies:
Skills
 Professional Geropsychology Functioning
 i.e., foundational skills applied to
geropsychology practice
 Assessment
 Intervention
 Consultation
 Note: Skills for functional domains of research, supervision, and
management are important for growth of geropsychology, but
were not included in Pikes Peak core competencies for practice
with older adults
Pikes Peak Competencies:
Settings of Care
 Geropsychologists should be able to deliver services
effectively in range of (at least 2) settings, such as:
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Outpatient mental health services
Outpatient primary care/medical settings
Inpatient medical service
Inpatient psychiatric service
Long-term care settings including nursing homes, assisted
living facilities, home care, day programs
Rehabilitation settings
Hospice
Others
CoPGTP Competency Evaluation
Task Force Methodology
 ~Monthly conference calls, 9/07 to 7/08
 Reviews of relevant, informing materials
 Small working groups define “behavioral anchors” for
each competency domain
 Iterative reviews of all scale items by larger group
 Group discussion, selection, editing of:
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Rating scale/anchors and vignette
Introduction to the evaluation tool
 Task Force and other CoPGTP members try out the
scale to evaluate: a student, oneself, or both
Informing Materials:
Psychology Competencies Assessment
 Guiding principles and recommendations for the
assessment of competence
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(Kaslow et al., 2007 and other publications of APA
Task Force on Assessment of Competence)
 Assessment of Competency Benchmarks Work
Group
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A developmental model for defining and measuring
competence in professional psychology
Joint effort of APA BEA and CCTC
 The Practicum Competencies Outline
 Hatcher & Lassiter (2007), workgroups of ADPTC and
CCTC
Informing Materials:
Geropsych Competency Assessment
 Example of evaluation tools used in various
geropsychology practicum, internship, and
postdoctoral programs
 Also, examples of competencies and evaluation
methods from:
 Medicine – ACGME Outcome Project, 2000
 Geriatrics, Palliative Care, Geriatric Social Work,
Geriatric Psychiatry
Delineation of Geropsychology
Knowledge and Skill Competencies
 Each Pikes Peak competency domain (e.g.,
foundational geropsychology skills) is defined by 3-8
specific competencies (e.g., ethical practice,
appreciation of diversity, self-reflection…)
 We aimed to further specify each of these
competencies with behavioral anchors
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How would you know it if you saw it (in oneself or
another)?
e.g., what does it really mean to “Relate effectively and
empathically with older adults clients, families, and
other stakeholders in a range of professional roles and
settings?”
 This approach leads to a very long evaluation tool!
Example: Delineating one of the
foundational skill competencies
B. Professional Geropsychology Functioning – Foundational
SKILLS -- The psychologist/trainee is ABLE TO:
5. Relate Effectively and Empathically
N I A P
a. Use rapport and empathy in verbal and nonverbal behaviors to
facilitate interactions with older adults, families, and care teams
b. Form effective working alliance with wide range of older clients,
families, colleagues, and other stakeholders
c. Communicate new knowledge to patients and families, adjusting
language and complexity of concepts based on the patient and
family’s level of sensory and cognitive capabilities, educational
background, knowledge, values, and developmental stage
d. Demonstrate awareness, appreciation, and respect for older patient,
family, and team experiences, values, and conceptual models
e. Demonstrate appreciation of client and organizational strengths, as
well as deficits and challenges, and capitalize on strengths in
planning interventions
f. Tolerate and understand interpersonal conflict and differences
within or between older patients, families, and team members, and
negotiate conflict effectively
E
Example: Delineating one of the
assessment skill competencies
B. SKILLS – The psychologist/trainee is ABLE TO:
2. Utilize Screening Instruments
N I A P E
a. Utilize screening tools for mood, cognition, substance use,
personality, and other clinical issues to guide and inform
comprehensive assessment
b. Evaluate age, educational, and cultural appropriateness of
assessment instruments
c. Consider reliability and validity data in using standardized
instruments with older adults
d. Assess older adult’s ability to provide informed consent for
psychological evaluation
e. Recognize sensory impairments and makes environmental
modifications accordingly
f. Consider impact of medical conditions and medications on test
performance
g. Make specific and appropriate recommendations, based on testing
results, to inform treatment planning
Evaluation of Attitudes
 Pikes Peak attitudes for competent
geropsychology practice are embedded in the
foundational skills
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E.g., self-reflection re: biases/discomforts,
awareness of limits of one’s competence, seeking
consultation, seeking continued education
 Attitudes are specified in tool’s introduction
 For now, attitudes not evaluated separately
 Perhaps they should be? How?
Rating Scale
 Developmental rating scale
 Novice, Intermediate, Advanced, Proficient, Expert
 Scale anchors conceptually complex
 Adapted definitions from Hatcher and Lassiter (2007)
 Included in anchor definitions how much
supervision/consultation likely needed
 Provided vignette and approach to that case to
illustrate each level of competence
 Instructions to rate each Pikes Peak competency, not
each behavioral specifier (but can if desired)
Rating Scale
Abbreviated scale anchors, printed on each page:
 N = Novice: Possesses entry-level skills; needs intensive
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supervision
I = Intermediate: Has a background of some exposure and
experience; ongoing supervision is needed
A = Advanced: Has solid experience, handles typical
situations well; requires supervision for unusual or
complex situations
P = Proficient: Functions autonomously, knows limits of
ability; seeks supervision or consultation as needed
E = Expert: Serves as resource consultant to others, is
recognized as having expertise
Rating Scale
 Expected ratings vary considerably through
levels of training
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Practicum: Novice through Advanced
Internship: Novice through Proficient
Fellowship and post-licensure: Intermediate
through Expert
 Ideally, usable to evaluate a trainee, AND to
evaluate oneself
Introduction to the Evaluation Tool
 Reviews:
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Purpose of tool
Pikes Peak competencies as aspirational
Application across range of geropsychology practice and
training settings
Instructions for use
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Including that evaluation should include the learner's
perspective (self-assessment), observation of the learner's
work, and regular supervision involving case discussion
Psychologists and trainees conducting self-assessments can
evaluate their training and supervision needs in each area
Definition of rating scale anchors, and illustration of its use
through a case vignette
Piloting the Evaluation Tool
 Asked CoPGTP members, and ourselves, to
complete the tool to evaluate a student or oneself
 13 responses
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6 CoPGTP members (other than us)
4 Task Force members
3 from Task Force members’ students/staff
 Used tool to:
 4 to evaluate a student
 5 to evaluate oneself
 2 evaluated oneself and a student
 2 provided general feedback without specifying
Asked for Feedback:
 Asked folks to answer these questions:
 How did you use the tool (to evaluate a student, or
yourself?)
 What was your general impression of using the tool?
 Was the introduction to the tool clear…?
 Was the rating scale (Novice, Intermediate, Advanced,
Proficient, Expert) understandable…?
 Was the length of the tool a problem? Did it adequately
address breadth/depth of geropsychology
competencies?
 What do you think the best use of this tool will be?
 Do you expect to use this tool? In what way?
 Any other feedback?
Feedback
 Most felt tool is very long, but worth it
given attention to breadth and depth
 A few felt it was too long for practical
purposes
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(Challenge – how to cut?)
 Most felt introduction was clear, but
needed clarification not to rate each
specifier
 Most liked the NIAPE rating scale
Feedback
 Concerns raised about the scale included:
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Does it apply as well to knowledge as skills?
Does it work as well for practicum level training where
students may be novices in most areas?
Is Expert rating too “loaded” (people not comfortable using
that term?)
Can scale capture development over time?
 If/how best to evaluate attitudes
 Suggestion to have summary page
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Strengths
Areas for growth
Ongoing training goals
Use of the Scale to Date
 Disseminated to CoPGTP training programs
and APA 12-2 and 20, PLTC listservs
 Programs (grad, intern, and postdoc) are
starting to use the tool for:
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Initial training needs assessment with students
Mid-year/final supervisory evaluations
Student self-evaluation (encouraging
“metacompetence”)
Use of the Scale to Date
 Tool being used by some for program self-
study and development
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Defining training program objectives
Evaluating, in discussion with students and
supervisors, how well program is addressing each
competency domain
Helping to evaluate competence of new
geropsychology supervisors and define their
training goals
 Being used in community/CE education
programs on geropsychology
Uses for Intern/Postdoc Training
 Along with APA standards, can help define
rotation/track training objectives
 Gero evaluation scale is rotation/track specific, and
adjunctive to training program’s more general
evaluation tools
 Extremely helpful for initial training needs
assessment because students come in with widely
varying previous gero experience
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Clinical, academic, research
 Can tailor initial training plan and review over course
of the training year/rotation
 It is additional work at evaluation time for supervisor
and student – not clear how strong a barrier this may
pose
Study-in-the-Works
 Aims: Examine utility and validity of the rating scale,
initially for self-evaluation purposes
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Which competencies rated as most vs least welldeveloped?
Do self-rated competencies relate to years of training
or practice?
To settings and major activities of practice?
What feedback is provided after completing the scale?
 Planning on-line survey
 Of psychologists who work with older adults and
geropsychology graduate, intern, posdoc students
 Eventually, plan longitudinal study of supervisory
evaluations of developing geropsychologists
Concerns/Challenges
 Will clinicians see such a tool as helpful or somehow
restrictive to practice?
 Will supervisors/learners use such a long evaluation
tool (even if can pick and choose domains of
relevance)?
 Can competencies be reduced/streamlined?
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Can we boil down further “core” competencies? Are
some more essential than others? (??)
May vary across settings/populations of older adults
 Will tool be useful as self-evaluation, self-study aid?
 Can competency ratings be linked to training
resources?
Opportunities/Future Directions
 Helpful for initial training needs assessment with a
student, to guide training plan
 May help to develop on-line version, then select only
domains that are relevant to training program, rotation
 Useful as guide to developers of CE programs?
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Develop organized, sequential CE offerings?
 Ultimately, plan to link competencies to training resources
and opportunities
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Working to keep such list updated at CoPGTP website
 Expand toolbox of gero competence evaluation tools
 Largest challenge - how to expand interest in, and
opportunities for, training in professional geropsychology