Case Study 4: Pre-Licensed Clinician, Inadequate Supervision, and High-Complexity Evaluations
Alex has completed all doctoral coursework and a 2,000-hour predoctoral internship and is now accruing postdoctoral supervised hours toward Minnesota licensure at a rural community clinic. Alex's board-approved supervisor is a licensed psychologist who is on site one hour per month and available by phone. The clinic's business manager wants Alex to begin conducting custody evaluations for divorcing parents and autism evaluations for Medicaid, and to sign reports as Alex Rivera, PsyD, psychologist. Alex has completed one continuing-education workshop in autism assessment and no forensic training. The clinic advertises Alex as a psychologist. Alex's supervisor says the arrangement is fine because I review reports before they go out.
1. Identify the licensure, supervision, and competence problems and state what Alex may and may not do.
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Alex must not hold out as a licensed psychologist. Minnesota licensure requires the doctoral degree, supervised experience, examinations, and Board approval; until licensed, Alex practices under a board-approved supervisor and must use an accurate title such as doctoral intern or postdoctoral resident. The supervision here is inadequate: one hour per month with phone availability is not the regular, documented, case-based supervision the Board expects, especially for complex evaluations. Alex may not independently perform custody evaluations; that requires forensic competence, training, and usually court appointment. One autism workshop does not establish competence for Medicaid autism evaluations. The clinic's advertising is misleading and must be corrected. Alex may see limited cases within competence only with adequate supervision, informed consent disclosing trainee status, and supervisor co-signature.
2. What should Alex do before seeing either type of case?
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Before accepting either referral, Alex should meet with the supervisor, review the Board's supervised-experience rules, and create a written supervision plan with weekly individual supervision, live or recorded observation as needed, and a caseload limit. Alex should obtain foundational training in autism assessment and decline custody work until formally trained and appointed. Intake consent should disclose trainee status, supervision, and limits of confidentiality. The supervisor must be available for emergencies and must review and co-sign reports. If the clinic will not change the arrangement, Alex should not accept the cases and should consider a different placement; the license application could be at risk.