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COVID-19 Information-APPIC FAQs

Published on Monday, March 23, 2020

FAQ #1. What is APPIC doing in response to the COVID-19 crisis? APPIC is working with the APA, CPA, ASPPB and the training communities in the Council of Chairs of Training Councils. This is a constantly changing situation and APPIC is drafting responses that training programs and trainees might find helpful. Contact APPIC Central Office if you have specific questions and need clarification. There are no specific facts or answers to questions about reduction in time/hours/clinical experience at a site.  APPIC will continue to update this information as it develops.   APPIC encourages programs to continue to meet their requirements while increasing flexibility, creativity and innovation to ensure that all trainees meet the expected competencies set by the training program.

FAQ #2. What can training programs do to ensure continuity of care for patients and clients while supporting trainee well-being? Training programs should have leave policies in place; APPIC is encouraging programs to be flexible as the crisis evolves. This is a unique and evolving situation. Programs are strongly encouraged to continue trainees on staff and continue their stipend even if they are not on site.  Interns and postdocs need to be sure to connect with their Training Director and for interns, their home doctoral program DCT to discuss their options.

FAQ #3. How do programs provide continuity of care? Telehealth is up and running at many sites. This is a good way for trainees to continue obtaining their clinical experience at practicum, internship and postdoc settings. Telehealth is being added to the AAPI and for practicum students.  Those hours can now be added under intervention hours.   HIPAA regulations are being modified and relaxed regulations by CMS and are allowing personal devices to be used but check with your insititution/training program to ensure you are following their guidlines and regulations.

FAQ #4. What if a training program has no telehealth capabilities and interns are classified as essential employees to provide care to clients and patients? APPIC strongly encourages programs to begin and expedite telehealth capabilities. HIPAA compliance is being reviewed and CMS has already released relaxed standards for HIPAA compliance including the use of personal cell, smartphones, tablets or even land line phones to allow patient contact.  Check with your local training director on what initiatives are being put in place what accommodations are available and remember these are likely to continue to change. 

FAQ #5. What training activities can continue even if trainees are not onsite? Trainees can continue participating in learning activities even though they are not on site. They can meet together by Skype, Zoom or their phone to discuss readings, participate in didactics, telesupervision for patient care, and managing professional issues such as self-care and self-awareness during this crisis.

FAQ #6. As a trainee, I have been "ordered" to not participate in face to face activities with patients by my graduate school, even to the point of being "released"  by the doctoral program from the site. What do I do? Practicum students are under the direction of the graduate school and would be best to coordinate any reduction in patient care or  release with the graduate program. Continuity of care for clients and patients would likely include some effort on the part of the trainee, typically through their onsite clinical supervisor. Interns should discuss their options with their Training Director and/or HR prior to leaving the site or at least by phone or email. Communication needs to occur between the DCT, TD and the intern. Postdocs are not under the direction of a doctoral program and are usually employees that are subject to the policies set by the site. Consulting with the Training Director should occur before choosing to leave or not appear to a training site in a manner contrary to policy/procedures.

FAQ #7. What if I am so immobilized and in fear that I just cannot be present at my training site? There are leave policies in place for most training sites or doctoral practicum training sites. Follow those policies as much as possible. Balancing one's anxiety and responsibility as a health service provider can result in conflict. Seeking support and mentorship can be very helpful, and consultation with the Training Director about any potential options is critical.

FAQ #8.  HHS HIPAA Guidelines Latest Update 3-17-2020:  https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

FAQ #9.  Can APPIC tell me how best to work with trainees to balance safety concerns and managing their distress?  Some are angry that they are required to be on site when all they want to do is leave.  Is there an answer to this concern?  There is no perfect answer as trainees and sites will continue to evolve in what is required and what is supported, as well as how CDC and local governmental guidelines evolve in different jurisdictions.  Programs across the country are utilizing a range of responses to this situation, ranging from total site closure to trainees continuing to deliver care. 

FAQ #10.  If there is a disruption in my training year will my site extend the opportunity to complete the program?  This is another evolving situation and normally APPIC supports an extension for those that can not control some variables (medical illness; family leave), though programs/institutions may also have limitations with respect to what they can offer, particularly if extensions would be lengthy (e.g., paying trainees, office space if the training year overlaps, supervision resources, etc.).  Sites and trainees are encouraged to work together on mutually beneficial solutions and are welcome to consult with APPIC about specific circumstances.

FAQ #11.  I have been accepted for an internship that begins on August 1.  Will the disruption in the training year delay my start?  This is difficult to predict at this time.  APPIC recommends you reach out to your training director to express any concerns and inquire about any anticipated need to modify the training year. 

FAQ #12.  Will telehealth count for psychological interventions and assessment on the AAPI?  Yes, APPIC considers this a necessary option.  APPIC acknowledges that some sites state they are not prepared to provide videoconferencing telehealth services, but telephone contact could be used to ensure continuity of care.  Zoom has a HIPAA version; Skype for Business is HIPAA compliant.  With the relaxation in HIPAA rules, one of those should be manageable at most sites.  There are some sites, inpatient psychiatric units for instance where that might be more difficult.  There are many patients out there that have appreciated the increase in telehealth opportunities and find it extremely useful and convenient not to travel, much less expose other patients or be exposed, even when the patient is symptom free.    

FAQ #13.   I am trying to think of innovative ways besides telehealth that my interns can achieve direct contact hours. My interns participate weekly in case conferences for two hours with me. Is it possible during this time where they are not at their sites due to COVID-19 to let the case conference time count as direct service hours?

Whether and how hours “count” is defined by the entity to which they are being applied (e.g., on the AAPI, for licensure, etc.)  It is important to be aware of the various definitions and regulations concerning training experiences.  Whether or not their will be redefinitions or expanded allowances will depend on the decision of the relevant entity.  APPIC recommends directly contacting the relevant entity to ask these questions, and to review updated statements related to COVID-19 (e.g., ASPPB, APA CoA, etc.)  Telehealth services may be considered direct servce opportunities, though remember to attend to any regulations regarding the proportion of hours that must be in person.  

There are many other ways that interns are learning during this crisis. Interns can use Zoom or other videoconferencing modalities to engage in other learning activities such as case discussion or discussing articles, as well as many other activities to keep the cohort together and learning.  APPIC encourages Training Directors to be creative and to consult with colleagues about additional ideas.

FAQ #14.  What if my university president or administration sends us a memo that all students are to be removed from face to face contact and that we are to "pull" our students from the site?  Does this apply to psychology trainees at an external site?  

APPIC encourages trainees to follow the site's requirements. Please be reminded the intern has a Match agreement with the program and if they decide to follow the home universities order, then the trainee would best be advised to check with the site's HR department so they are not abandoning patients or taking a leave that has not been approved by the site.  Hopefully, most HR departments will be responsive and do what they can to make this work.  There is certainly no guarantee that this will happen at every site and of course this is rapidly changing.  Verify you are authorized not to be on site.  Remember, patients are anxious and telehealth may be what is needed for psychologists and trainees to be of assistance in this national crisis.  

FAQ #15.  My site does NOT have telehealth capabilities and has no plans to do so.  What can we do?  

APPIC encourages your site to revisit this policy.  CMS (Center for Medicare and Medicaid Services) has relaxed the rules on service delivery and will now allow telementalhealth by any cell phone, tablet, laptop or computer as well as land line phones.  

Medicare has temporarily expanded its coverage of telehealth services to respond to COVID-19.  Medicare beneficiaries can temporarily use telehealth services for common office visits, mental health counseling and preventive health screenings. This will help ensure Medicare beneficiaries are able to visit with their doctor from their home, without having to go to a doctor's office or hospital.  

FAQ #16.  What about HIPAA requirements and how patient confidentiality will need to be maintained?  

The Office for Civil Rights (OCR) at the Department of Health and Human Services has released guidance waiving penalties for potential HIPAA violations if providers making a good faith effort to provide health services use apps like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype.  Of course, efforts to maintain client/patient confidentiality continues to be a high priority.  HIPAA rules have currently been relaxed but everyone should continue making good faith efforts to maintain confidentiality. 

FAQ #17.  Will there be any consideration to waiving the direct service hour requirement for this year set by my site for successfully completing of  my training program if there is not the opportunity for interns or postdocs to remain at their current placement because of COVID-19 or the site does not have access to telehealth? I have one intern that stated she is not able to extend internship. Additionally, will there be any consideration to modifying the completion hours for internships this year if we continue to have restrictions?

APPIC wants to be clear that the training site is responsible for assessing the competency of the trainee and determining program completion requirements.  APPIC will likely not change its  stated membership requirements, which requires a membership vote. Remember that accreditation and licensure requirements are also importnt to attend to.  Licensure jurisdictions will likely make their own decision that will vary, and as some are written into law, this may be a lengthy process.  

APPIC has no "hour" requirement for trainees beyond supervision and learning activities.  APPIC requires that 25% of the trainee's activities be direct service, and telehealth would certainly help meet this requirement.  APPIC has set a 12 month, full time requirement or 24 month half-time requirement, but that has been extended in the past for some cases and reduced when special circumstances arise (Visa expiration or a short period (1-2 weeks) prior to the 12 months.  Extended or reducing the training experience should be a program decision as programs are responsible for ensuring that all trainees meet the expected competencies set by the training program usually related to the profession wide competencies.  If a program is accredited and is considering modifying it’s program completion criteira, consultation with the accrediting body is important.

FAQ #18.  What if I accepted an internship or postdoc that requires me to cross the border between the U.S. and Canada?

APPIC has been working with APA, APAGS, and CPA on improving communication and factual information about the ability of psychology trainees to cross the border.  APPIC will continue to support those that need advice about crossing the border, but until the COVID-19 situation is better resolved, crossing the boarder will likely be difficult. If an intern is unable to present to an internship site, please remember that  APPIC requires a request to be released from the match agreement.  Both Postdocs and interns should continue to stay in touch with their future placement sites, and interns should also remain in contact  with their home doctoral program if you are an intern.  

FAQ #19.  Can supervision be provided by telehealth?  

Telesupervision is often considered equivalent to face to face supervision, but some regulatory bodies may have specific limits (<50%). Regulartory boards may consider modifications or exceptions to this, but such decisions would be at their discretion.     

FAQ #20.   Most of our sites are busy developing telehealth capabilities to improve patient care while helping to ensure staff safety. One question that has come up is whether it is permittable to have an intern provide telehealth from their own home. There are obviously many things to consider (confidentiality, crisis situations, not having a supervisor in the next room, etc.). Some of our supervisors are not comfortable with this arrangement and do not want to risk their license while other are more flexible. Is this something that APPIC/APA would allow?

Flexibility and creativity are working for many sites.  Relaxation of HIPAA regulations and many states relaxing the rules for providing telehealth is occurring.  There are many considerations when delivering telehelath, including confidentiality, visibility of what is in the background, etc. Telehealth guidelines available from APA may be helpful to reference..There is great variability among sites as to how telehealth is being employed, with some doing so from home.  This is a decision for individual training programs and their host institutions to make.

FAQ #21.  If some sites within my consortium internship move toward allowing interns to work from home, but other sites cannot (for instance in-patient or primary care), how might that be handled?

The difference across settings is definitely a challenging issue.  You may wish to discuss with all sites in the consortium to articulate how they are following current CDC guidelines in their individual setting.   The program could also consider options for potential flexibility, including re-ordering rotations, on-site modifications, or the option of delaying their training and extend the internship or find an alternate telehealth opportunity for them that will keep them moving forward.

FAQ #22.  With several states putting stay-at-home orders in place, has there been any discussion of allowing telepsychology across state borders?

There has been a significant change in telehealth requirements, and changes are ongoing and frequent. Currently, it appears that these rules have been relaxed but of course this is a jurisdictional regulatory concern and it is best to check with your particular State Board of Psychology regarding current regulations and any modifications that have been made.  Most telehealth requirements for health care have been extended across state borders and not restricting those services, but again, it is best to check with the state board and if a trainee that is not licensed it would be important that your supervisor is clearly aware of the situation and agrees to continue their supervision.  There are some telehealth informed consent documents available on the APA website that may also be useful to review.
 

FAQ #23.  What do I do if as a trainee do not feel safe going to work at my training site?

APPIC encourages trainees to be sure to consult with their HR department, TD and DCT before making a final decision about what they need to do.  It is important that trainee's safety is the priority and that if a site is requiring trainees to report that CDC guidelines are followed for social distancing, PPE is available when patient contact at a site where COVID-19 is present and trainees are considered a priority to ensure their safety when those guidelines are "not" possible.  Telehealth, telesupervision and teletraining is in the works at most sites but it will take time to get these up and running.  When trainees do not feel safe, it is important that their concerns are addressed by the training site given their level of "authority" in a training site may be limited to feeling powerless to speak up.  Trainees may want to review filing a grievance, not out of punishing the site, but because their concerns are not being addressed and this mechanism may protect them from retailiation and it is highly unlikely your TD is going that way but in a crisis, rumors and misinformation are rampant.  TDs for the most part are doing their best to protect the safety of trainees even though it may not be readily apparent, it is highly likely happening as quickly as possible behind the scenes.  Communication is important and fanning the flames with rumors and innuendos, do not help.  Please be kind to each other.  

FAQ #24.  I am curious if, given the unprecedented situation, we could shift our hour requirement to meet the licensing board where we reside - and if so, can you provide any guidance as to how to ensure I am providing appropriate notification to maintain our membership with APPIC?

APPIC does list a minimum for school psychology trainees.  This does not apply to clinical or counseling trainees who are not located in a school setting.  APPIC does not mention an hours requirement for clinical or counseling internships.  APPIC does have a requirement for 12 months, full time or 24 months, half time.  APPIC defers to the internship program to be flexible during this unprecedented time.  It is the program's responsibility to ensure that ALL of your successful trainees meet the expected competencies set by the program.  Most licensing boards do not have an hours requirement, but some do.  APPIC requires programs to ensure their graduates are eligible for licensure in the jurisdiction in which the program resides, so this question may be asked of the state board.  However, it is doubtful they can answer that if it is in a regulation or law regulated by the legislature.  I would expect, but cannot guarantee that a state board would be flexible.  I anticipate the state board would, but given we have no idea where this situation is going, will it be another 2 weeks, 2 months, 12 months?  Once the peak has passed and does not resurge, I think there will be more answers.  In the meantime APPIC is being supportive and trusting of programs to do the right thing, keep trainees safe, continue the training program in some form that allows safety through telehealth, virtual meetings, etc.  

I'm sorry there are no hard and fast answers and APPIC trusts the training programs to make the best decision for the situation that is facing them. 

FAQ #25.  Can my site and/or providers at home provide telehealth services?

In most jurisdictions, check with yours, psychologists may practice telehealth without any special certification, training, or notice to their jurisdiction's Board Of Psychology.  It is expected providers/sites adhere to the same practice standards applicable to traditional or in-person settings.  Texas State Board of Examiners of Psychologists has published a set of guidelines for the practice of telepsychology that might be helpful for you or your setting to read and follow, but these guidelines are not rules. When practicing telehealth, make sure you are familiar with the technology being used, and make sure the patient or client understands the limitations of telehealth as part of the informed consent process.

Generally, licensees would also be required to use a HIPAA compliant method when providing telehealth services under normal circumstances. However, the Office for Civil Rights at the Department of Health and Human Services has indicated that it will not be enforcing HIPAA rules for telehealth communications against providers who in good faith, use non-HIPAA compliant non-public facing remote communication apps or services to deliver services to patients during the COVID-19 nationwide public health emergency. However, TPA encourages members to only use these options as a last resort.

In short, licensees who are comfortable with these basic steps are free to provide telehealth services in most jurisdictions so long as they think it appropriate for a particular patient or situation. If you are interested in learning more about how to safely and ethically provide telehealth services, the National Register of Health Service Psychologists has published a video on its website entitled A Practical Guide to Providing Telepsychology with Minimal Risk.

FAQ #26.  Can I supervise interns or postdoctoral residents electronically?

Many jurisdictions and accrediting agencies have specific guidelines for the amount of time allowed.  Many jurisdictions are suspending those limits during the crisis.  This usually takes time either through the legislative process or the governor suspending speicific rules.  In general, APPIC has followed APA CoA recommendations on 50%.  APPIC encourages training programs to consult with their jurisdictional authority for clarification but allows programs, in this moment of crisis, to make a good faith effort and ensure trainee and public safety.  

FAQ #27.  I am a Training Director and I am getting joint letters from Directors of Clinical Training (DCTs) that are telling me to remove my (their) trainees from any patient contact.  I want to be collaborative and trainees safety has always been the most important consideration at my site.  Why are the DCTs writing these kind of letters as the one I received bordered on bullying and telling me how best to protect my trainees?  

This is an unprecended crisis and everyone is scared and concerned about others that are not always in a position of power to freely make their own decisions.  It is likely the letter's intent was to ensure they are doing everything they can do to keep their "students" safe.  They are likely not pointing at you or telling you what to do, they are likely wanting to communicate and make sure you are aware there is some evidence to support your position as TD and to keep trainees safe.  We are all in this together and it is important to keep trainees safe, provide a safe environment for their training and continue patient care.  Telehealth from home is the new safe standard.  Everyone is concerned about confidentiality but rules have been lessened (see FAQ's above).  Inpatient units are struggling and trainees are caught in the middle of wanting to continue their program but press the TD to be open and transparent about how they are working to keep the trainees safe.  We must work together and emails and letters do not always convey the intent in which it was meant.  Clarify, communicate, assume they want what you want, safe environment, reduced patient contact, increased telehealth or alternate placement for trainees during the duration of this crisis.  A vaccine will take care of a lot of this, but that is not present day reality.  

FAQ #28.  I am a trainee at a hospital in the inpatient psychiatric lock-up unit.  I am scared and I am confused about the ever changing rules on PPE.  What should I do if I have a concern about my safety?

This setting, along with rehab inpatient and forensic (prisons and jails), are struggling with this crisis.  It's admirable that you stay, but your safety should come first.  Before you leave or quit, it would be important to contact the hospital's OSH (Occupational Safety & Healh) to discuss your concerns.  It is true that CDC continues to update their guidelines and it is hoped this is based on science and not the shortage of PPE, which we think is true.  In addition to OSH, discuss your concerns with the TD.  Discuss your concerns with your colleagues and supervisors to see if they have similar concerns.  Consider filing a grievance if there is no response from the TD.  Consider filing an Informal Problem Consultation (IPC) with APPIC.  Ideally, this is resolved with the TD taking action.  If not, use those other options.  Trainees must speak up while going through the different channels could result in an improvement in the site's adherance to CDC while protecting trainees. 

FAQ #29.  I was informed by my TD that the hospital has determined that ALL employees are essential.  I was informed that means that the interns and postdocs could be reassigned to other duties such as screening patients in a tent outdoors, checking vitals for employees entering the hospital or other duties as assigned.  This does not sound like training, is this possible?

It is not uncommon for hospitals in a crisis to determine that ALL employees are essential and they are required to report to a workpool.  Most times, there is an "opt-out" that you can submit or your TD can submit on your behalf.  This is standard at many health care sites in preparation and reaction to a crisis, usually a weather emergency, but this time a pandemic.  Hospitals are following their policies for their response to a crisis. Trainees are likely exempt from this workpool but these type of "orders" are generally sent to everyone employed at the site.  Discuss this possibility with your TD as this should be a voluntary experience and not a mandated on for psychology trainees.

FAQ #30.  These are very intense and strange times but I am confident that as a future psychologist this will only better my capacity to speak hope and peace into chaos and crisis. I am a fourth year doctoral student who was recently placed for my doctoral internship in the academic year forthcoming. While I am grateful for APPIC's communication to sites and students, I find there is little clarification as to the implications the pandemic carries with those student interns looking to onboard as early as this summer. Has there been directive sent to sites as to the security of our internship positions? Are there considerations and/or conversations we should be having as students with our sites as the pandemic persists.  Any directive would be enormously helpful! 

APPIC has not sent out any specific directive to programs about their start dates or modifying requirements for completion as of 4/5/2020.  APPIC is deferring to the member programs and encouraging flexibility, creativity and innovation in order to keep trainees safe and provide quality training.  

This is an ever changing situation and the APPIC Board continues to monitor the situation especially as it continues to spread and impact trainees.   It is strongly encouraged to check with your new Training Director.  APPIC hopes this will resolve soon, but the board is also aware there will likely be delays at many sites and hopefully they will inform their trainees asap if there are any adjustments made that are different than what was originally identified.

FAQ #31.  What is an essential employee?

APPIC is aware that there are a variety of definitions by different organizations.  Usually, essential employees are so designated most often at hospitals, but many sites including college counseling centers have this designation that is used typically for, full-time employees at a site to better prepare and respond to a crisis, usually weather related. The current crisis is unusual and that essential designation even though it has benefits such as continuing pay and benefits for those that are most affected by it such as employees that need additional time for repairing their home or illness so they are not "discharged" or "removed" from the site's payroll.  So on one hand, that is a good thing.  On the other, it has caused some concerns for trainees who felt they were not essential to the site and that they were trainees without extended leave or sick benefits.  Both true, but psychological services in this crisis could certainly be deemed essential.  However, trainees should not be put into an unsafe environment even if other options cannot be found.  So, speaking to essential, in a broad definition, it is a good thing and as my hospitals declared at the very beginning of the crisis, "all employees are now classified as E1 (Essential, with 1 meaning they are allowed back at the hospital without being barred by local authorities) and bad because it increases exposure both to yourself and to your patients.  

FAQ #32.  Has all Psychological Assessment been suspended?

No.  There are many sites that continue to provide psychological testing/assessment during the crisis.  Psychology trainees need this experience and many sites have adapted new telehealth psychological assessments provided by many of the test publishers.  Some sites are using full PPE and sanitizing after each administration, others are using Zoom Pro or Skype for Business and others are reducing their psychological assessments in the hopes the return will be soon.  Here is a resource that TDs and trainees may find helpful regarding psychological testing:  https://www.apa.org/topics/covid-19/psychological-assessment-training

FAQ #33.  Will my Internship or Postdoc be Delayed due to the crisis?

APPIC has not made any recommendation regarding programs delaying their starts especially since many programs are moving forward and will graduate their current interns/postdocs and are expecting trainees to be on site as scheduled.  There are likely to be some sites that will possibly consider a delay.  Trainees may wish to keep their Training Director up to date on their own situation and expectations for beginning the training program.  APPIC, at this time, encourages patience and understands the need to make decisions, but the situation is likely to change in the next couple of months and making a decision today may be irrelevant on June 1.  

FAQ #34.  As a Training Program, we are struggling with the assessment piece.  We are not currently conducting assessments, as everyone has pivoted towards telehealth.  My priority as the Training Director is assuring that each intern has 2000 hours, 500 of which are direct clinical contact hours.  Our requirement for assessment is 10 total assessment reports, 5 of which must be integrative.  However, I believe that is our own standard, and not a standard put forth by APPIC or accreditation.  My interpretation of the information APPIC, CCTC, and APA CoA have distributed is that I would be supported to suspend that requirement for our current cohort, accept whatever completed assessment hours have been conducted (no intern has 0, and most are at least 50% or greater with regards to this requirement), and document the decision to waive this requirement in each intern’s file.  I would notify APPIC and APA CoA of this plan, as well as coordinate with training directors at each intern’s respective institutions.  Is my understanding, interpretation of guidance, and/or plan off base from an APPIC perspective?

It is a different time and APPIC appreciates your thoughtfulness regarding flexibility and creativity.  Psychological Assessment is required by APPIC (and APA).  However, psychological assessment includes intake interviews where patients are assessed for their need for treatment; diagnostic possibilities and assessment of stability.  So the trainees are likely completing the "global" requirement for assessment, but your program has advertised that the trainees are required to complete a specific number of integrated psychological reports and assessments.  It is not unusual, given this current crisis, that many programs are having to make some adjustments and APPIC fully supports this temporary adjustment.  It would be important to inform trainees that this standard set by the program, is being suspended due to the crisis and that it would be important for trainees to continue to seek additional experience either through practice/reading etc until the time they can gain that practice under supervision or at least with consultation depending on their next level of work/training experience.  

FAQ #35.  I am very concerned and anxious to begin the new training year for psychology trainees given the current state of the crisis and use of telehealth. I'm concerned we will be able to start internship or postdoc training while universities are still not allowing students on campus, in addition to all the requirements for orientation and "onboarding" requiring fingerprints and approval for access to intranet resources at our site. While we can provide online education and orientation, I have a concern the dynamics of training will change substantially. I’m not comfortable with supervising someone with little experience at a distance that I have only met for a brief interview during the application and interview process.  What suggestions does APPIC have for normalizing this experience for psychology trainees?

It is a new "normal".  If programs were starting today there is every reason to believe they would continue to learn the nuances of online teaching/training and continue to improve that process.  Of course, everyone is hoping for a return to some semblance of normalcy, but as of today, April 23, 2020, it is an unknown variable that all programs will have to begin giving serious consideration.  There will be direct experiences that will continue to need modification and innovation.  Online training by APA using telehealth is an 8 hour training module that should be considered as part of the orientation.  Group meetings and training for interns and postdocs with the TD can be done virtually as well as clinical supervision and patient/client treatment.  Everyone is learning substantially new skills and adapting to the nuances of telehealth and what is missing when direct observation of a client/patient is not available.  Adaptation and fluidity will be helpful.  Everyone will continue to be required to be ethical and protect client information the same as before.  Everyone will be required to meet the goals, objectives and competencies set by the program.  In some cases, this will not be a challenge but in many settings and some skills will continue to be a challenge and require innovation.  Psychological testing can be done online and abbreviated measures will need to be used in many cases.  There will be better testing of patients to reduce exposure to COVID-19 and there will still be a need to provide clinical services while staying safe using PPE when required by CDC standards.  It will certainly not be at the same level of learning and quality as the current "gold" standard, but this crisis is calling for adaptation to a "new" world.  Psychology is in the best position to make this adaptation.   Psychology training will continue and the need for psychologists to provide clinical services has never been greater.

FAQ #36.  How will we begin phasing in "in-person" psychological services as jurisdictions are now beginning to call for relaxing stay at home orders?

APA is working on guidelines of returning to in-person clinical services similar to what is being developed for elective surgery protocols for ensuring safety to the general population.  The process might include specific precautions approved at individual settings and would likely include:  Individual-level precautions including use of PPE when required; Screening requirements for patients prior to arrival or admission at the site; Limiting risk during in-person clinical interactions with social distancing and when using testing protocols that cleaning and disinfection of protocols and instruments are applied before and after each administration.  APPIC believes more information will continue to be discovered as the management of contact and airborne concerns are addressed by CDC and the contanment of contact as much as possible knowing that in-person psychological assessment and treatment will follow but ONLY with appropriate cautions and standards that are acceptable to ensure the safety of trainees and patients.

FAQ #37.  I am anxious about immigrating to another country to begin my training.  Yesterday an executive order was signed by the U.S. president limiting immigration.  How will this affect my crossing the border to begin my training program?

Good news for psychology trainees! The U.S. President did sign the Executive Order, but it only applies to those seeking a green card. It seems as if all non-immigrant visas are exempt, including F, J, H1-B, TN, etc. Of course, there is no absolute gurantee that is the case.  This likely may impact some foreign psychologists not living in the US who are trying to become permanent residents (but only for 60 days (4/23/2020) for now), but not for psychology interns or postdocs.  https://www.washingtonpost.com/immigration/coronavirus-trump-immigration-suspension/2020/04/22/4f0efdb8-84c1-11ea-ae26-989cfce1c7c7_story.html 

FAQ #38.  I am an intern located out of state and will need to move to another state to begin my internship.  That state currently requires a 14 day quarantine before beginning work, what do I do?  

If the quarantine is required, interns can choose to move early BUT most programs have begun to restructure their "on-boarding" process to take up the first week or two which might include going to the site for fingerprinting, etc.  If PPE is used, this should not be a problem given you are likely an essential employee and the site will make arrangements for keeping you (and their patients) safe from infection.  Programs are strongly encouraged to begin developing their on-boarding/orientation via remote connections.  It is likely that many, if not most, states will not allow interstate treatment where supervisors are not located in the same jurisdiction as the trainee/patient.  Programs should check with the local licensing board to ensure they are operating within the current regulations for telehealth as jurisdictions have a diffrences on what is allowed for licensed providers and trainees under the supervision of "their" licensed providers.  This will again require creativity, innovation and communication about best practice, what is allowed legally and ethically.  Many programs will be able to continue telehealth and many jurisdictions are now beginning to modify their requirements.  It is important to take actions to ensure the safety of both trainees and patients receiving direct clinical service.  CDC guidelines, PPE are considered essential when social distancing is not feasable (ie inpatient services, forensic services, neuropsych or rehab services).  If programs are requiring incoming psychology trainees to be quarantined for a specific amount of time, it would be important that the program begin the stipend on that day.  

FAQ #39.  Does APPIC have any restrictions on face to face contact for psychology trainees?

It is early (May 1, 2020) to prescribe how programs are to restrict or remove any restrictions for patient care.  APPIC understands there are over 1000 training sites and each one should be responsible for making this kind of a decision while protecting psychology trainees, patients/clicents, and anyone at the training site.  The site is encouarged to follow CDC and institutional requirements for PPE, social distancing and treatment of clients/patients.  It is expected that at some point, face to face contact with patients will return to previous levels, some sites will need to reduce restrictions slower than others.  Some sites have managed to continue to provide patient treatment via telehealth and will likely continue to offer that option when possible, especially as long term effects of the virus are still unknown as well as concerns about a returning spike.  

FAQ #40.  Can a doctoral program deny or prevent their students from attending a psychology internship if they have direct patient care?

Doctoral programs authorize/verify a student's preparation for internship.  APPIC defers to the DCT at the psychology doctoral program to verify readiness.  The doctoral program can set any standard they want for their students eligibility to apply to any site.  However, if a student has accepted an internship with the DCT's approval and now wants to renege on the APPIC Match Agreement, the student must be released from the APPIC Match Agreement.  APPIC makes the final decision on release including consequences, if any, for not adhering to the APPIC Match Agreement which has been signed by the doctoral program; the applicant and the internship site.  All must participate in the final release with APPIC having the final approval. The crisis is bringing new challenges and APPIC will be sensitive to anyone's request to be released, but for now, APPIC encourages patience as the situation develops prior to requesting a release.  If a site is following CDC guidelines and is appropriately providing PPE, psycholgy trainees will likely be involved in direct patient care at some point.

FAQ #41.  APPIC Recommendations: Competencies

Competencies: Training programs must be prepared for, and plan for, ensuring that trainees are able to achieve program aims and competencies despite potential disruptions resulting from the effects of COVID-19 (see below). APA, APPIC, and CPA have all recently supported programs being flexible in achieving their goals.

FAQ #42.  APPIC Recommendations:  Disruption Contingencies

Disruption Contingencies: Training programs should develop a contingency plan for significant interruption in training with their incoming cohort(s). Training directors are responsible to ensure adequate resources (financial, personnel) to actualize the specific components of the plan. Similarly, training directors need to collaborate with administrators and/or Human Resources departments to ensure that trainee stipends, benefits, and leave are protected.

FAQ #43.  APPIC Recommendations:  Communication

Communication: We strongly encourage training programs to contact their incoming cohorts including the home doctoral programs for those with interns. Training directors might reiterate their commitment to working with their matched interns or selected fellows, and clarify any potential impact of the pandemic on the expected training sequence (e.g., delayed start date, lack of availability of previous offered rotations, increased proportion of telehealth-based services, etc.). Repeated communication with all parties may be required as the situation evolves and the anticipated start date of the training year gets closer.

FAQ #44.  APPIC Recommendations:  Training Agreements

Training Agreements: 

a) We want to remind training programs, incoming interns, and doctoral programs of Match Policies that emphasize that position agreements between incoming interns and internship programs are considered binding to the extent that it is a professional commitment, barring extreme and rare circumstances. If either party is unable to honor the Match agreement, they will need to be released from the Match by the APPIC Chair. This process can be initiated by filing an IPC.  

b) Similarly, the APPIC Postdoctoral Selection Guidelines emphasize that position agreements between incoming postdoctoral residents and programs are considered binding to the extent that it is a professional commitment. Applicants and programs need to openly communicate about these “circumstances” and endeavor to work towards a mutual resolution. Consultation is available through filing an IPC.

FAQ #45.  APPIC Recommendations:  Start Date Flexibility                      

Start Date Flexibility: Program start delays could be caused by personal factors including problems moving, difficulty finding a place to live, or needing to care for ill family members. Should an incoming intern or fellow be granted a delayed start date, their training plan should be modified in writing so that all parties are clear about the adaptations and the adjusted start and end dates of the training program.

FAQ #46.  APPIC Recommendations:  Resources

Resources: Training programs should develop a plan to manage delays and overlap in internship and fellowship cohorts given the above-mentioned potential scenarios.  Considerations might include space, supervisory resources, issues with their funding source, onboarding, orientation, and public health precautions.   

FAQ #47.  My University/Training Site is considering discontinuing the psychology training program as part of their concern about the budget and a "hiring freeze".  What should I do as the Training Director?

APPIC continues to monitor and to date (5/21/2020) about six programs have contacted APPIC for assistance about data on justifying the existence of a training program.  APPIC first reminds training programs that they or a representative at their site, signed a Match Agreement for internships or made verbal offers to a postdoc.  APPIC expects programs to honor this match agreement or offer given these are psychology trainees and not permanent employees.  A disruption to the health care work force is NOT to the benefit of the general population.  Health and Human Services has determined that psychologists, as mental health providers, are essential workers and discourage any additional hurdles to those pursuing their career in providing patient care services.  In addition, psychology training programs provide essential treatment resources to residents of the community in which the site is located.  If one counseling center releases 5 psychology interns, using the minimum requirements for service delivery, that is 50 hours of patient care services NOT delivered each week.  That is a substantial reduction in mental health services for that campus alone.  If a site wants to save money, APPIC requests they consider making this change for the next training cycle.  This removes the disruption of those current committed trainees as the site will NOT participate in the next match cycle.  The site can continue their membership in APPIC and would be classified as withdrawing until their financial situation stabilizes or the site makes the decision to close permanently.  This is the right thing to do.  Do NOT disrupt trainees' lives, adhere to your match and/or offer to that trainee so they can continue their quest to become a psychologist and provide care to others.    The reduction of financial commitment to these training programs (institutions) will save little for the site, given someone at the site will need to pick up the time required to continue direct service either by telehealth or in person visits which are beginning to return.  Training Directors are encouraged to contact APPIC for assistance with addressing this new COVID-19 caused crisis, but defers to the program to make that decision, as many of these are likely in the exploration stage and APPIC does NOT want to be heavy handed to the detriment of the program, but we will, if requested.  APPIC advises this important information:  #1. Psychology trainees provide low cost, high quality psychological services to the site's population.  #2. Not honoring the match/offer agreement will not save the site money this year, if a court or mediator determines the site must pay the salary of that trainee, the benefits, relocation expenses, and interview expenses required of the trainee.  #3.  Please wait until the following year when the training program can choose to NOT be in the match or be committed to an agreement.  This allows the program to maintain membership and to honor their agreement.  #4.  The match agreement is considered a binding agreement that requires APPIC to release both the site and the trainee.  The document signed by the program requires arbitration mediation which is much more expensive than paying the stipend for this next year.  #5.  Psychology training programs enhance work satisfaction for other providers/supervisors and removing the opportunity to engage in training may result in the loss of current employees that will be expensive to replace.  

If program's would like consultation, please complete the IPC form on the www.appic.org website and APPIC will provide assistance.  

The document for honoring match/offer agreements can be found HERE.

FAQ #48.  One of my incoming trainees has requested to work from home for the entire training year due to his immunocompromised condition and family members that also have medical concerns.  Would APPIC allow such an arrangement?

APPIC appreciates the opportunity for input.  APPIC requires the training program to ensure that ALL graduates of their internship training program meet the expected goals, objectives and competencies set by the program.  There are many trainees having their careers put on hold as a result of this virus and the unknown expected outcomes.  The trainee and the program have some important questions to review.  APPIC has no rules against an online training program and expects that ALL trainees would be able to complete their training virtually given the level of technology that exists and the health concerns.  #1.  The intern may wish to defer their internship for one year and not be required to go through another match.  This has to be approved by the trainee, the TD (you) and the DCT at the home doctoral program.  APPIC has the final say on the approval.  #2.  The intern may wish to start the year remotely and as the virus hopefully subsides or a vaccine is developed, may wish to return at that time. #3.  The intern may wish to resign from the internship and wait until next year to restart the match process in hopes of finding a different site.  APPIC would likely not fully support this request without additional justification.  

If the program can make it work, remote training could be a possibility.  It would be advised that this decision is revisited on a monthly basis without pressuring the individual to report on site, but to keep both you and the trainee on the same page.  It would likely be required by your HR department that a medical diagnosis signed by the treating physician be provided to HR (not to you or anyone in the training program) that clearly states this is medically necessary.  That last part is for fairness and equity to other trainees.