Gatekeeping in the Mental Health Professions

Alicia M. Homrich, Kathryn L. Henderson, Alicia M. Homrich, Kathryn L. Henderson

• Publisher: American Counseling Association
• Year: 2018
• Print ISBN: 9781556203282
• eBook ISBN: 9781119535126
• Edition: 1
• Topic: Education
• Subtopic: Professional Development

This book guides graduate faculty and supervisors in effective gatekeeping by bringing together the body of professional performance standards for multiple mental health fields and providing best practices, tools, and templates for use with trainees. Following an introduction to the professional, ethical, and legal issues involved in gatekeeping, the authors discuss contextual factors that can affect trainee functioning. Topics addressed include strategies for assisting low-performing trainees, faculty and supervisor roles, professional collaboration, evaluating trainee performance, designing remediation plans, documentation, and prevention and early intervention. Text features include "Notes From the Field, " "On the Legal Side, " and "What Would You Do?" to enhance understanding of the material.

" Gatekeeping in the Mental Health Professions presents a treasure trove of rigorous scholarship and practical recommendations for addressing one of the most vexing challenges that clinical educators and supervisors face—dealing with the problematic personal issues, interpersonal behavior, or unprofessional conduct of a student/trainee. From admission to graduate school through licensing for independent practice, the authors provide policies, procedures, contracts, and sample dialogues that are compassionate, mindful of students' varying developmental stages, and respectful of due process. This authoritative text will help to fulfill the fundamental responsibility of every clinical educator and supervisor to protect our profession and the clients we serve."
— Anne Marie "Nancy" Wheeler, JD, and Burt Bertram, EdD, Coauthors, The Counselor and the Law

"This unique and valuable contribution to the field covers all aspects of gatekeeping, a term frequently discussed but sometimes not practiced. As the experts in this volume point out, mental health educational programs are ethically bound to ensure that their graduates are competent. This book not only discusses gatekeeping responsibilities but also provides useful ways to practice and document them. This must-read text is thorough, interesting, and critically important."
— Samuel T. Gladding, PhD, Wake Forest University

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*Reproduction requests for material from books published by ACA should be directed [email protected]

Chapter 1

Introduction to Gatekeeping

Alicia M. Homrich

The term gatekeeping is thought to have first originated in the arena of communications wherein an editor or editorial board determined which information or news stories would be pursued and which would be shelved (Kerl & Eichler, 2005). Gatekeeping was a point of control that advanced or deterred progression through the publication process. This activity is akin to the credentialing process, through which an individual prepares for and applies for entry into a profession, documenting satisfactory achievement of the requisite training in knowledge and skills and the professional qualities necessary to be recognized as a full practitioner. In all cases, approval of an individual to enter a profession is sanctioned by appointed senior practitioners with professional experience and the credentials to make such a determination. Within the context of the allied mental health professions, multiple scholars have defined the term gatekeeping as the ongoing responsibility of faculty members and clinical supervisors to monitor trainee progress and appropriateness to enter professional practice.

The Purposes of Gatekeeping

The two primary purposes of gatekeeping are to protect the integrity of the clinical professions and to prevent harm to clientele receiving services from incompetent clinicians (Brear, Dorrian, & Luscri, 2008). A secondary goal of gatekeeping is to consider the best interests of others, be it the trainee, the training community, the clinical or educational setting, or the population at large (Brear & Dorrian, 2010). Bodner (2012) noted that an additional responsibility of gatekeeping is to uphold professional standards, including the principles of beneficence, nonmaleficence, fidelity, personal dignity, and justice, as described in most ethics codes of the clinical professions.

The charge to the professions' gatekeepers is to enforce gatekeeping policies and procedures in order to reduce the incidence of advancing poorly or marginally suited trainees through graduate training and onto licensure in a clinical profession without intervention. This phenomenon was defined by Gaubatz and Vera (2002) as gateslipping. They found that clinical training programs that implemented formalized gatekeeping practices “reduce the number of deficient students who slip through programs' gates (i.e., graduate without remedial attention)” (p. 296). Thoughtful gatekeeping practices protect the public and the clinical professions from inept practitioners.

The Role of the Gatekeeper

Gatekeepers are the persons responsible for ethically monitoring trainees' progression through gatekeeping checkpoints prior to endorsing them for independent professional practice. In the clinical professions, educators and supervisors serve in this role both before and after trainees receive a degree. Gatekeeping is one responsibility expected of supervisors and/or faculty members who have oversight of trainees. Gatekeeping is an aspect of the assessment and evaluation processes incumbent on every supervisor and professor who has a role in preparing future clinicians. Gizara and Forrest (2004) described gatekeepers as quality control agents for the clinical training experience because they determine the readiness and fit of candidates for their particular profession. Gatekeepers institute evaluative procedures, deliver feedback aimed at improvement, provide trainees with the opportunity to respond to and address concerns, and take responsibility for deciding whether and when to permit trainees to continue to the next phase of the training process or to stop their progression for the purpose of remediating behaviors of concern (Gaubatz & Vera, 2002; Ziomek-Daigle & Christensen, 2010). Gatekeepers act to “ensure that those who graduate are capable of interacting with clients, colleagues, and the community in an ethical and competent manner” (J. Miller & Koerin, 2002, p. 1) and “control the access of impaired, unethical or incompetent counselors to clients, thereby protecting clients who are likely to be at a highly vulnerable stage of their lives” (Bhat, 2005, p. 399). The trainee's ability and/or willingness to achieve the requisite competencies of a given clinical profession predicts his or her progression through the various gatekeeping checkpoints across the training process (see Figure 1.1).

Figure 1.1 Gatekeeping Checkpoints

Use these points for evaluating personal behavior and professional conduct to determine continuation of clinical training.

Most educators and supervisors in clinical programs are energized by the prospect of training individuals to become competent, ethically practicing professionals. This enthusiasm and commitment applies to training programs across the behavioral health fields, including the professions of mental health counseling; marriage and family therapy; psychology; social work; and specialized practice fields such as school counseling, school psychology, rehabilitation counseling, or neuropsychology. Whether professors in academic programs, faculty supervising students in practicum or internship courses, field site clinicians engaged in supervisory experiences with graduate students, or supervisors of postdegree trainees obtaining experience in fulfillment of licensure requirements, clinical trainers have one thing in common: the opportunity to influence the development of clinical knowledge, skills, and professionalism in novice members of the profession. In legal terms, this role is known as the respondeat superior (see On the Legal Side 1.1): the professional responsible for the actions of trainees (Wheeler & Bertram, 2015).

Inherent in the position of respondeat superior are multiple professional obligations. According to Saccuzzo (1997), these duties include monitoring the training and supervisory processes to:

1. protect the welfare of current and future clients (patients) from harm by ensuring that they receive effective treatment, that their rights are protected, and that they are treated with dignity and respect;
2. protect the welfare of the student or supervisee;
3. protect the well-being of other trainees or colleagues who may be affected by the individual student or supervisee;
4. protect the integrity of the clinical professions by graduating and endorsing for licensure only those practitioners who demonstrate the competencies necessary to be effective practitioners; and
5. protect the trustworthiness and reputation of the program, institution, or agency (although not a direct duty of respondeat superiors, this secondary influence is often the concern of administrators and other affiliates of the institution, such as alumni).

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On the Legal Side 1.1

A Latin term, respondeat superior means “let the master answer or respond.” This legal doctrine holds that a person such as an employer or a supervisor is legally responsible for the wrongful acts of those over which he or she has charge, such as an employee or supervisee. Essentially, when the respondeat superior premise is invoked in a legal proceeding, a plaintiff will look to hold both the employer and the employee liable. There is no national standard for respondeat superiors. Because states create their own standards for the doctrine, different jurisdictions use different tests to prove the responsibility of the respondeat superior (Cornell Law School Legal Information Institute, 2017). Clinical supervisors of predegree and prelicensed counselors can be identified as respondeat superiors, which means that they can be held legally responsible for the actions of their supervisees (Saccuzzo, 1997; Wheeler & Bertram, 2015).

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These responsibilities also converge to inform the direction of activities and procedures known as gatekeeping.

The Process of Gatekeeping

Clinical trainees are expected to progress through a series of gates or checkpoints, as illustrated in Figure 1.1, that are carefully placed across the training experience to substantiate attainment or demonstration of competencies in three domains: acquired knowledge, execution of clinical skill, and demonstration of personal behaviors or professional conduct appropriate for a practicing clinician. Fundamental to this process are the procedures of monitoring and evaluating trainee development to ascertain whether expected levels of performance have been achieved to support continued advancement toward graduation, licensure, and eventual independent professional practice (Brear et al., 2008; Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015). The process of gatekeeping also incorporates engagement in activities that support trainee development or remedy stalled progress. Gatekeeping may also involve stopping a trainee from graduating or gaining licensure in his or her chosen profession (Koerin & Miller, 1995) because of an inability or lack of willingness to meet standards or professional expectations. Multiple processes are involved in gatekeeping and are the topics featured in this book.

The Mandate for Gatekeeping

All clinical professions reference the obligation of preventing inept practitioners from entering into the profession primarily to protect clients from harm. This mandate is identified by multiple governing bodies within each professional group and extends to all members of the profession. In the realm of preprofessional preparation, the gatekeeping obligation is typically fulfilled by clinical faculty and supervisors serving as respondeat superiors accountable for overseeing the training process and trainees. The responsibilities of gatekeeping include monitoring, evaluating, and determining which trainees can appropriately enter the given profession while remediating or stopping those who cannot. Where and how this mandate is explained or defined across the clinical professions varies.

Professional Associations' Codes of Ethics

General expectations for gatekeeping are addressed in the ethics codes of the four primary clinical professions: the American Counseling Association (ACA), American Psychological Association (APA), National Association of Social Workers (NASW), and American Association for Marriage and Family Therapy (AAMFT).

Above all, professional ethics uphold the standards of beneficence and nonmaleficence: striving to do no harm and protect the rights and welfare of those with whom counselors and therapists interact, especially clients. Standards in professional ethics also identify some criteria for professional demeanor and behavior for members of their respective organizations beyond the competencies of having the knowledge and skills to practice effectively. Most ethical standards delineate or infer that students and supervisees will adhere to the same ideals as professional members. Chapter 7 provides examples of these expectations.

The general tenets of ethics codes stipulate the role of the gatekeeper for members who are educators or supervisors; however, the amount of detail varies considerably across the four major mental health professions. For example, the APA Ethical Principles of Psychologists and Code of Conduct (APA, 2017c) states in Standard 7.04(2) that psychologists do not disclose personal information about trainees except when

the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

Other APA standards address timely assessment and feedback processes; however, they do not specifically address the role or responsibility of respondeat superiors in training positions to protect clients or the profession from inappropriate trainees via the gatekeeping process. Bodner (2012) extrapolated the ethical principles that she believed apply to gatekeeping practices in psychology.

The NASW Code of Ethics (NASW, 2017) details the obligation of social workers to address their own impairment or the impaired, incompetent, or unethical conduct of colleagues—as do all clinical professions' ethics codes; however, the ethical standards are very vague in reference to trainees and include only that “social workers who function as educators...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Preface
• About the Editors
• About the Contributors
• Acknowledgments
• Chapter 1: Introduction to Gatekeeping
• Chapter 2: Critical Terminology in Gatekeeping
• Chapter 3: Challenges and Strategies in Addressing Problematic Trainees
• Chapter 4: Trainee Development and Factors Affecting Behavior
• Chapter 5: Faculty and Supervisor Roles in Gatekeeping
• Chapter 6: Collaboration During Gatekeeping
• Chapter 7: Informing Trainees About Gatekeeping Policies
• Chapter 8: Standards for Personal Behavior and Professional Conduct
• Chapter 9: Evaluating Trainee Professional Performance
• Chapter 10: Designing Remediation Plans and Interventions
• Chapter 11: Documentation in Gatekeeping
• Chapter 12: Preventing Problematic Behavior in Trainees
• Appendix A Ethical Mandates for Gatekeeping Practices in Clinical Training and Supervision
• Appendix B Sample Appeals Process From a Published Student Handbook
• Appendix C Sample Correspondence Following Up a Remediation Planning Meeting
• Appendix D Sample Professional Pledge for Entering Students
• Appendix E Sample Verification of Understanding Agreement (Informed Consent)
• Appendix F Sample Supervision Contracts
• Appendix G Sample Documentation of Student Behavior and Faculty Action
• Appendix H Sample Student Progress Evaluation Rating Form and Accompanying Rubric for Evaluating Multiple Students
• Appendix I Sample Strategies for Reinforcing Professionalism at Transition Points in a Graduate Program
• References
• Index
• End User License Agreement