APPIC Board of Directors: COVID-19 Statement #2 (Published 3/31/2020)

APPIC Training and Education Community,

We continue to hear from many of you seeking support and guidance about challenges encountered during the COVID-19 pandemic. As this crisis continues to evolve, we would like to outline some guiding principles to be considered by those involved in making decisions about psychology training, and provide some recommendations relevant to recent concerns raised by trainees and Training Directors.

Principles to Consider in Decision-Making About Potential Training Modifications

• Inherent power differential for trainees: Trainees may reasonably feel less able to advocate for themselves or make decisions in line with their interests.
• Resource differential for trainees: Trainees often have fewer financial resources than faculty/staff and thus fewer choices available (e.g., fewer financial reserves, smaller allotments of paid/sick leave, lesser healthcare benefits, etc.). 
• Disproportionate professional risk for trainees: Relative to faculty/staff, trainees have potential to incur greater career risk and/or experience negative consequences for electing not to adhere to institutional policies and/or expressing concern about them. 

Training Directors and institutional leadership are strongly encouraged to consider whether those without the power and resources of faculty/staff should bear the same responsibilities and burdens as faculty and staff characterized as “essential employees”.
 

Current APPIC Recommendations

Current APPIC Recommendations

1. Employ/Prepare for the use of telehealth immediately.
   APPIC strongly recommends the implementation of telehealth services when and where possible. Telehealth offers solutions to numerous concerns through 1) serving the interests of patients through continued care or avoiding delay of care, 2) reducing risk to students of potential exposure and concerns about exposure, and 3) contributing to efforts to mitigate community spread of COVID-19.  APPIC recognizes that telehealth may not be a viable option for all training sites/settings and at the same time strongly encourages all sites to carefully and thoroughly explore and consider whether telehealth service delivery, even if solely via telephone rather than videoconference, can be implemented as an alternative to in-person trainee delivery of health services. 
    
2. Consider Work-From-Home options immediately.
   APPIC strongly recommends programs consider options for trainees to engage in as many training activities as possible from home. Examples include didactics, research activities, or potentially telehealth services, among other activities relevant to their competency development.  Such options may assist with mitigating multiple concerns about risk, exposure and community spread.  To the extent feasible, programs that require trainees to be on site are encouraged to consider offering options for modified schedules (e.g., partial or complete work-from-home plans).

3. Adhere to CDC guidelines.
   When trainees are on site, it is essential that sites adhere to CDC guidelines (CDC) in addition to local, state, and national recommendations.
    
4. Attend to APPIC membership criteria.
   All APPIC member programs should stay in compliance with APPIC membership criteria. In this context, some relevant membership criteria include Membership Criteria #2 (the Training Director is responsible for maintaining the integrity of the program), # 5 (the Training program involves exposure to a range of direct clinical services including assessment, intervention, and consultation), and #12 (all programs have documented due process procedures that include a grievance mechanism for concerns raised by trainees). It is important for trainees to recognize that although the power differential does exist, so do formal mechanisms to express their concerns. Finally, member programs are encouraged to consult with APPIC if concerns arise regarding an inability to stay in compliance; APPIC will partner with you in strategizing how to best support your trainees and your program.
    
5. Prioritize training over service delivery.
   APPIC encourages Training Directors to preserve prioritization of training over service delivery needs.  This issue may become particularly relevant in institutions that consider redeployment of personnel to meet other system needs.  Training Directors are encouraged to advocate that trainee time be spent engaged in relevant training activities to advance competency development and support completion of program requirements. 

6. Preserve and protect trainee stipends, benefits, and leave.
   For trainees whose work is disrupted by COVID-19, APPIC encourages sites to make every effort to preserve wages and job security, continuation of benefits, as well as paid time off.
    
7. Maintain the Match Agreement.
   Interns are placed at APPIC member training sites via the Match agreement. Per this agreement, interns and sites intending to separate need to be mutually “released” from the match by the APPIC Chair. For programs, failure to follow these procedures may result in a formal review by APPIC and potentially affect APPIC membership status. For students, reneging on the Match agreement may result in an inability to participate in future APPIC Matches and required disclosure of reneging on a future AAPI.
    
8. Consult with APPIC regarding problem situations and concerns.
   Trainees are encouraged to advocate for themselves to the extent possible by utilizing the various mechanisms available to them. Options include informal mechanisms to discuss concerns, utilizing the training program’s due process and grievance policies, utilizing the agency’s or organization’s formal grievance policies (e.g., Human Resources), filing an Informal Problem Consultation (IPC) IPC Consult , contacting APA’s Office of Program Consultation and Accreditation (OPCA) or CPA’s Registrars related to Accreditation, and requesting assistance and advocacy from their home academic programs. Training Directors struggling with balancing trainee safety with patient care needs/site policies may also request assistance via an IPC and contacting OPCA or CPA.

Additional Comments

1. Selection and Timing of Potential Modifications or Protections
   APPIC acknowledges that different geographical areas are in different stages of risk with respect to COVID-19, and the appropriate timing of potential modifications or protections may be informed by the stage of a given local area. In addition to being aware of the “hot spots” (areas hardest hit) concerns have grown about asymptomatic individuals who may spread the virus without their awareness. APPIC encourages Training Directors to consider guidance from relevant local and national authorities in determining which potential modifications to employ as well as when and how to employ them. Psychology interns remain a vulnerable group and APPIC suggests transparent dialogue between Training Directors, trainees, and academic Directors of Training (for interns), while keeping our decision-making principles in mind.
2. Psychologists and Psychology Training in Medical Settings
   In understanding the particular challenges in medical settings, it may be helpful to recognize that the ethical obligations and principles common to psychologists (e.g., duty to safeguard welfare and rights of both patients and trainees) differ from those of physicians (e.g., duty to treat patients despite conditions of personal risk).  In navigating potential tensions and “culture clash” in medical settings, the principle of respect is encouraged as a guide to conduct and communication.  Educating oneself and one’s medical colleagues about these differences may assist in generating understanding for such differences of perspective (e.g., see AMA Code of Medical Ethics Guidance in a pandemic; https://www.ama-assn.org/delivering-care/public-health/ama-code-medical-ethics-guidance-pandemic).  Furthermore, relative to the discipline of psychology, the discipline of medicine may be less accustomed to considering the power differential inherent in training.  Should a Training Director feel an institution’s policies and procedures raise ethical concern, the APA Ethics Code standard for Conflicts Between Ethics and Organizational Demands warrants application (i.e., “If the demands of an organization with which psychologists are affiliated or for whom they are working are in conflict with this Ethics Code, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code.”). APPIC recognizes that such reasonable steps may not always result in changed circumstances or the desired outcome.

We welcome feedback from our members and stakeholders, and appreciate any additional ideas that you have for managing challenges in your programs. Please feel free to reach out to our Executive Director, Dr. Jeff Baker (jeffbaker@appic.org), with any specific questions or concerns. We deeply appreciate your commitment to training and will continue to collaborate with you as we weather this storm.

Respectfully,

The APPIC Board of Directors

Useful Links

• A webinar for Training Directors is being jointly hosted by APPIC and APA on Wednesday, April 1^st at 3 p.m. EST/12 p.m. PST. Register here.
• APPIC information: APPIC - COVID-19 FAQs
• APPIC Statement (3/21/2020): 3/21/2020 Statement
• APPIC Informal Problem Consultation (IPC) process is an option for trainees, internship and fellowship directors, and doctoral program directors to obtain confidential consultation from an APPIC Board Member. Click here to initiate an IPC.
• APA CoA information:  APA - Response to COVID-19 Outbreak
• CCTC Statement: CCTC Statement
• CPA: CPA - COVID-19 Resources

_______________________________________________________________________________________________

APPIC Training and Education Community (Published 3-21-2020),

We have received many queries regarding how to respond to the consequences of the COVID-19 public health crisis and its impact on psychology training. There is great diversity among our member sites and the impact of COVID-19 on operations (e.g., total closure, business as usual, integration of telehealth services, etc.). Therefore, it is difficult to have one set of recommendations for all our member sites that addresses site-specific complexity in light of APPIC membership criteria. We realize that many of our constituents are experiencing significant anxiety and uncertainty in managing the challenges of COVID-19. APPIC encourages sites to tailor their programs to meet the needs of patients/clients, to facilitate trainees’ educational goals and requirements, and to consider the physical and emotional wellbeing of staff and trainees.

The APPIC Board wishes to support our stakeholders in developing adaptations to training programs that work for your site and your trainees, while also being mindful of APPIC membership criteria, APA/CPA accreditation criteria, and state and provincial requirements for licensure.

Internship and Postdoctoral Fellowship Directors:

• It is okay to be creative with how you manage this crisis!
• Consult with regulatory bodies when necessary (e.g., licensing boards).
• Reach out to the academic Directors of Training of your interns’ home graduate programs.
  • Ask how you can best support their students.
  • Ask if their institutions have any specific regulations for their students.
  • Tell them what changes and accommodations you are making to the training experiences within your program (e.g., on-site or remote telemental health).
• If your interns and fellows are not able to provide clinical services in any capacity because the site is closed, we recommend brainstorming ways your trainees can use the time to engage in other meaningful professional development activities (e.g., conducting program evaluations, online telemental health training, etc.)
• Reach out to colleagues to learn of and share any proposed activities for training staff (e.g., webinars on telemental health, free clinical training resources, etc.).
• Utilize the APPIC Membership Listserv to communicate with colleagues at other sites.

Doctoral Interns and Postdoctoral Fellows:

• We empathize with your anxiety at this time—talk to your site’s Director of Training and your academic program’s Director of Training.
• Remember that the organizations responsible for the accreditation of doctoral, internship, and postdoctoral programs, as well as state and provincial psychology licensing boards, want to increase our workforce of competent psychologists, not shrink it!
• These organizations (APA, CPA, CoA, ASPPB, and APPIC) are motivated to work together, and with you, to get through this crisis! They recently met and collaboratively crafted this document which may also be found on the APPIC website: Psychology Training and Education Joint COVID-19 Statement
• We assure you that APPIC will continue to collaborate to support the training of the next generation of health service psychologists.
• We highly recommend that you communicate with your home doctoral program for support, to communicate how your site is adjusting your internship training, and to answer your questions about how internship training changes may impact any graduation requirements.

Academic Directors of Doctoral Training Programs

• Reach out to the Training Directors of internship sites where you have students.
  • Ask how the site is responding to the COVID-19 pandemic in terms of protection of the health and safety of your students.
  • Share what you are doing in your program and with your practicum students to address these issues; this information may be helpful for Training Directors to consider and to possibly incorporate at their sites.
  • If it is within your purview, inform the Training Director if your institution has flexibility in adjusting the internship hours required for graduation requirements.
  • Ask how you can support them.
• Reach out to your students who are on internship.
  • Ask how their sites are managing the pandemic and prioritizing their health and safety in addition to their training and clinical care.
  • Highlight that they should not put themselves at increased risk of exposure in order to accrue hours as usual.
  • Ask how you can support them (e.g., informing the site of your own institution’s policies).
  • Remind them to engage in self-care.

Here are some APPIC initiatives and resources that may be useful for all members of the training community:

• In the spirit of collaboration, APPIC is partnering with the Council of Chairs of Training Councils (CCTC; a forum of education and training groups in professional psychology) to collect and share resources and solutions in a central online location.
• We are actively working with our partners at Liaison and Time2Track to consider updating how phone and telemental health hours can be counted on the AAPI. Stay tuned for further details!
• We have added an FAQ section to our website: APPIC Covid-19 FAQ
• APPIC listservs are a good avenue to dialog with other members of our community.
• APPIC’s Informal Problem Consultation (IPC) process is an option for trainees, internship and fellowship directors, and doctoral program directors to obtain confidential consultation from an APPIC Board Member. Click here to initiate an IPC.
• The following links may also be helpful:
  • APPIC information APPIC - COVID-19 FAQs
  • APA CoA information - APA - Response to COVID-19 Outbreak
  • CPA - CPA - COVID-19 Resources

We look forward to continuing to work together with you as we weather this crisis. APPIC recognizes that the unprecedented nature of this situation contributes to uncertainty and the absence of a clear path forward. We will share information with you as it becomes available and as more specific directions emerge. We are all in this together! Please feel free to reach out to us with specific questions or concerns. Be well and stay safe!

The APPIC Board of Directors