CLEAR's 24th Annual Conference:
21st Century Regulation: 
"Show Me" What Works



·Kansas City, Missouri·
·September 30 - October 2, 2004·

2004 Conference Session Presentations:

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Thursday, September 30, 2004

8:00 a.m. - 11:00 a.m.
Pre-Conference Workshops:
 Show Me the Validity
This session provides an overview of the entire examination development process. The focus will be on establishing and demonstrating validity for each phase of the examination program. Specifically, individuals will hear presentations on Job Analysis, Item Writing, Test Development, Establishing a Passing Standard, and Scoring/Equating and Scaling. Each presentation will provide essential information to be used in establishing an effective chain of validity evidence. Time for questions and answers will be provided.
Speakers: Reed Castle, Director of Research and Development, Schroeder Measurement Technologies, Inc.
Julia M. Leahy, Director, Assessment Services, Chauncey Group International, a division of Capstar
Paul Naylor, Psychometric Consultant
Robert C. Shaw, Jr., Program Director, Applied Measurement Professionals, Inc.
Anthony Zara, Vice President, Professional Licensing and Certification, Pearson VUE

Show Me How to Get Past the MCQs: New Opportunities in Measurement
This interactive session on performance assessment provides (1) an overview of various assessments using standardized patients and computerized simulation exercises to assess problem solving, critical thinking, communications, and other complex skills that may critically impact clients' safety and welfare; (2) a demonstration of various formats, including their administration, scoring and standard setting; and (3) opportunities to create and try out computer-administered simulation problems and/or standardized patient simulations, with scoring protocols, and to consider options for determining the minimum (passing) standard. This workshop will be of value to participants at both novice and intermediate levels.  
Speakers: Carol O'Byrne, OSCE Manager, Pharmacy Examining Board of Canada
Lila Quero-Munoz, Consultant, InsideTesting
Alison Cooper, Manager of Examination Operations, Canadian Alliance of Physiotherapy Regulators
Frank Hideg, National Board of Chiropractic Examiners Board of Directors, Chair, Practical Testing Committee
Paul Townsend, Director of Practical Testing Research and Development, National Board of Chiropractic Examiners
Mark Christensen, Director of Testing, National Board of Chiropractic Examiners
Karen S. Flint, Director, Internal Development and Systems Integration, Applied Measurement Professionals
Jaime Walla, Research Associate, Applied Measurement Professionals
Bibliography Handout
Video Clip 1, Video Clip 2

11:00 a.m. - noon
Orientation to CLEAR
This is an opportunity for all annual meeting attendees to learn more about the structure, function, mission, and products of CLEAR. How can CLEAR assist you? Bring your questions and get the answers.
Speakers: Clare Delaney, President, CIEMS
Charlie Barner, President, Regulatory Agency Management Systems, Inc.

1:00 – 2:00 p.m. Opening Session
"Agency Enforcement Programs: Protecting the Public Interest"
Speaker: Julianne D’Angelo Fellmeth, Center for Public Interest Law
Julianne D’Angelo Fellmeth is the Administrative Director of the Center for Public Interest Law (CPIL) at the University of San Diego School of Law. She team-teaches regulatory law courses; supervises the Center’s clinical program; and edits the Center’s legal journal, the California Regulatory Law Reporter, which covers the activities of 25 major California occupational licensing boards. She plays an active role in California’s regulation of business, professions, and trades with an emphasis on the health care professions.

2:30 – 3:30 p.m. Concurrent Sessions
 Broadcasting Live: Really Open Your Board Meetings!
This session will explore means to open board meetings to a wider audience than typically attends an open, public meeting. The presenters will offer a visual simulation of an actual board meeting and discuss technical requirements for offering a public meeting over the Internet using streaming audio and video. They will also describe the value to stakeholders, practical uses of the technology, user friendliness of this type of offering, and the political issues that surround further opening meetings to the public.
Speakers: Ken Bishop, Executive Director, Missouri State Board of Accountancy
Marilyn Taylor Williams, Division Director, Missouri Division of Professional Registration

Ten Year Review of CBT
This session will review CBT testing over the last ten years. It will describe real world issues that have been encountered during the start up, operation, and vendor transition of large or small CBT programs. Important considerations include the conduct of a feasibility study and subsequent planning, management commitment, finances, marketing, program administration, and unintended consequences of CBT.
Speakers: Casey Marks, Director, Testing Services, National Council of State Boards of Nursing
Gerry Piskorski, Director of Certification Activities, American Society for Clinical Pathology
Anthony Zara, Vice President, Testing Services, Pearson VUE

Putting Your Best Foot Forward: Intake Solutions to Wipe Out Your Backlog
This session will address case handling from the start of the investigation process. The manner in which the intake process is handled builds the foundation for efficient functioning of an investigations team and is the cornerstone that will facilitate high levels of customer satisfaction. Success at intake and throughout the investigative process is achieved through timely and ongoing communication, clarification of issues, and identification of potential resolutions. We will show how the investigative process can be re-engineered using existing resources to produce positive effects on productivity and staff morale.
Speaker: Karen Puckrin, Investigator, Investigations and Hearings Department, College of Nurses of Ontario

Health Issues Roundtable
Participants will engage in discussion regarding ongoing and emerging healthcare issues from the regulatory consumer protection perspective.  Roundtable discussions in the past have included workforce shortages, expanding scopes of practice, liability issues, pain management, and other hot issues.  Participants will have the opportunity to introduce discussion topics related to the regulation of health care professionals, as well as discuss continuing issues on workforce shortages, licensing of students, and discipline.

Commitment to Ongoing Excellence: Evidence-Based Regulation
Beginning in 1998, the NCSBN Board of Directors established a groundbreaking performance measurement system for nursing regulators that incorporated data collected from internal and external sources and utilized identification of best practices and benchmarking strategies.  Come hear about the process and methods used to establish an outcomes-based evaluation system for nursing regulators and the best practices identified as a result.
Speaker: Kathy Apple, Executive Director, National Council of State Boards of Nursing

When Certification Replaces Licensure: Show Me Accreditation
This session will show how certification programs developed by a variety of vendors for one profession can successfully be used by regulatory agencies for licensure purposes.  Examples from food safety, nurse aides, and construction will be provided.  The importance of accreditation in this model will also be explored.
Speakers: Roy Swift, Program Director, American National Standards Institute
Linda Waters, Vice President, Professional Services, The Chauncey Group International, a Capstar company
Cynthia Woodley, Vice President, Operations, Professional Testing, Inc.

Generational Issues and How They Affect the Disciplinary Process
We now live in a time when there are four distinct generations in the workplace. Each generation has different characteristics and exhibits distinct differences in how they respond to adversity. Because of these differences, one size in discipline no longer fits all. Where remediation and probation may work for one generation, only removal from practice will get the attention of another. Reflection and introspection may make a difference in one generation’s practice, but only shame and public humiliation gets response from another generation. This session will focus on developing defensible but creatively different methods of sanctioning licensees for the same offense while ensuring learning occurs so the offense is not repeated by the licensee and providing for effective public protection.
Speaker: Donna Mooney, Director of Discipline, North Carolina Board of Nursing

Autonomous Boards Roundtable: Covering Your Assets – Are You Losing Your Licensure Fees to Your State Government?
Nationwide state survey results will be shared relating to the protection of autonomous board funds from supplementing state budget shortfalls. Successes and failures will be illustrated. Can you afford not to attend?
Speaker: Ken Bishop, Executive Director, Missouri State Board of Accountancy
Panelists: Mack Smith, Executive Secretary, Kansas Board of Mortuary Arts
Lori Scheidt, Executive Director, Missouri Board of Nursing


Friday, October 1, 2004

7:30 – 8:30 a.m. Early-Bird Session
Show Me an Evidential Approach to Assessment Design
Evidence Centered Design (ECD) is a framework for assessment design that emphasizes the evidential value of potential test tasks to the conclusions to be made about examinees.  Following such a framework is intended to result in a more precise understanding of the construct of interest for the assessment, greater opportunity to expand the types of tasks that are most relevant to the test purpose, and the building of a strong construct validity argument for the design and assembly of final assessment.  This session will include an overview of the ECD framework and a comparison of aspects of this method to traditional approaches through discussion of design steps as applied in real projects.
Speakers: Michael Rosenfeld, Principal Research Scientist, Educational Testing Service
 F. Jay Breyer, Managing Principal, The Chauncey Group International
 David Williamson, Research Scientist, Educational Testing Service
Barbara Showers, Director, Office of Examinations, Wisconsin Department of Regulation and Licensing
Discussion Notes

8:30 - 10:00 a.m.
Global Trends Impacting the Future of Professional Regulation
Keynote address: Marjorie Peace Lenn is the Executive Director of the Center for Quality Assurance in International Education which is dedicated to monitoring quality issues in the globalization of higher education and the professions and provides assistance in the development and improvement of quality assurance systems throughout the globe. She has been appointed as an advisor to the US government on trade in education services. She consults extensively with intergovernmental organizations and participates in forums on globalization issues of higher education and the professions.

10:30 a.m. – noon Concurrent Sessions
 Show Me What Works to Change the Way We’ve Always Done It
Nebraska has worked through a multi-year and multi-profession project to redesign its regulatory system. Panel members will use a talk show format to discuss lessons learned from the Nebraska Credentialing Reform project such as overcoming program inertia, developing a creative mindset, and building enthusiasm for change. "Nebraska Credentialing Reform" is an award-winning study to develop a process for identifying key factors (indicators) that suggest when changes in regulations for targeted professions might be appropriate. The study recommendations have been used extensively in Nebraska to document basic principles leading toward a simplified and flexible regulatory system. Innovative approaches to fee structure, compliance assurance, defining the level of regulation, improved communication, and quality assurance are underway. Audience members will have the opportunity to question panelists on ways to upgrade and improve aspects of their regulatory systems.
Speakers: Ally Dering-Anderson, Nebraska Pharmacist Association, Public Health Clinic Formulary Advisory Committee
Charlene Kelly, Section Administrator, Credentialing Division, Nebraska Department of Health and Human Services Regulation and Licensure
Mary Maahs Becker, Health Program Manager, Administrative Services Division, Nebraska Department of Health and Human Services Regulation and Licensure

ADA: Let Us Show You What Works  
 This session will present a hypothetical case study with elements drawn from real life situations and actual accommodation requests.  The presentation will demonstrate processing, reviewing, and decision-making for test accommodation requests in keeping with the needs of examinees with disabilities and without jeopardizing exam integrity and security. Throughout the presentation, the speakers will reference CLEAR's recently revised document "The Americans with Disabilities Act:  Information for Credentialing Examinations" to illustrate the process for considering test accommodation requests. The session will provide an opportunity for active discussion of challenging ADA cases that members of the audience have experienced.
 Speakers: Rina Sjolund, Assistant Vice President, ACT
 Shelby Keiser, President, Keiser Consulting
Fae Mellichamp, Senior Psychometrician, Professional Testing, Inc.

To Err Is Human – What Do We Do Now?
Combining the elements of health care system safety and the model of a diversion program, a new program has been developed to ensure early identification of quality problems and cooperation between licensing boards and hospitals to assess, monitor, and improve practitioner effectiveness. Learn about the precepts of the Practitioner Remediation and Enhancement Partnership from a state where it really works, and get more information on all thirteen pilot states, including problems and potential solutions in implementation and program results in improving communication and practice.
Speakers: Mary P. "Polly" Johnson, Executive Director, North Carolina Board of Nursing
Mark R. Speicher, President, OptiMed Resources

International Roundtable
Participants will have the opportunity to consider continuing and emerging international issues that have potential impact on local regulatory matters.  Developing networks for timely information dissemination and the practicalities of how information on international trends assists in wise policy process will be particular foci.

Central Agency Administrators Roundtable: Regulatory Activities that Work
This session will deal with activities that are being used by central agency administrators as a result of legislation and the need to reduce costs and achieve administrative efficiencies. The panel will initially focus on the following topics: equalization of disciplinary actions across programs, cost allocation methodology for centralized agencies, utilization of staff across regulatory programs, and standardization of administrative processing procedures. Other topics will be discussed in an open forum setting.

1:30 – 3:00 p.m. Concurrent Sessions
 Improving Quality: Regulation vs. Error Reduction – Can We Coexist?
In many states, a hospital's peer review system gives the physicians (and other providers) and the hospital confidentiality in the handling of problems, including serious medical errors. Hospitals and others argue that this helps improve the systems used in hospitals to provide care; others argue that it only protects those who should be subject to liability claims and does nothing in the long run to improve systems, as exemplified by increasing medical errors. Who is right?
Speakers: Rudolph Freeman, Jr., Vice President of Medical Affairs, Riverside Medical Center
Linda Siderius, Partner, McConnell Siderius Fleischner Houghtaling & Craigmile LLC
Mark Speicher, Project Consultant, Citizen Advocacy Center
Francis W. Pedrotty, Senior Assistant Attorney General, Richmond, Virginia, Director, Health Professions Unit

Show Me What Globalization Means for Credentialing Programs
This session will present the implications of global credentialing including developing and implementing a credentialing program across multiple nations based on a practice analysis, jurisdictional eligibility requirements, cross-border reciprocity and mobility of professions, and telepractice.  The speakers will describe their experiences working in professions such as respiratory therapy, psychology, and veterinary medicine.
Speakers: John R. Boyce, Executive Director, National Board of Veterinary Medical Examiners
Brian Stagner, Clinical Associate Professor, Department of Psychology, Texas A & M University
Homer Rodriguez, Executive Director, Latin American Board for Respiratory Care

Eliminating Anecdotal-Based Sanctions: An Empirical Approach
This session will provide participants with an overview of the methodologies and initial findings of a sanction reference study by the Virginia Board of Health Professionals. As a result of this study, it put in place a system that allows boards to sanction licensees using a common set of factors that may have been significant for the respective boards, at the same time neutralizing irrelevant factors.
Speakers: Neal Kauder, President, Visual Research, Inc.
Elizabeth A. Carter, Executive Director, Virginia Boards of Optometry and Veterinary Medicine, Department of Health Professions

Investigator Roundtable
Join a discussion on key issues for investigators. Topics at this roundtable will include the duty to report for both licensees and facilities and resulting confidentiality issues and dealing with highly sensitive investigations such as sexual misconduct.
Speaker: Pamela Twombly, Regulatory Investigative Supervisor, Virginia Department of Health Professions

3:30 - 5:00 p.m. Concurrent Sessions
 Economic Impact: Immigration Policy and Role of the Regulator
A global marketplace, shifting or decreasing workforces, and multiple pressures on maintaining stable economics have increased the need to ensure a broad-based skilled workforce. Nations are looking to their immigrant populations and making modifications that capitalize on the use of internationally educated professionals. This presentation will examine emerging changes in immigration policy and their potential impact on regulators as gatekeepers to entry to practice.
 Speakers: Randel Johnson, Vice President, Labor, Immigration and Employee Benefits, US Chamber of Commerce
Robert Shearer, Director, Health Human Resources Strategies Division, Health Canada

Multiple Tracks to Licensure: Show Me the Way
Regulatory bodies are faced with challenges in determining whether an individual or an entity is qualified.  In Texas, the Social Worker Board has developed an alternate method, portfolio evaluation, for determining whether candidates can demonstrate necessary competencies although unable to pass the required licensure examination.  Ontario currently provides an alternate method for public accountant licensee applicants to demonstrate required competencies and is working toward a new model for regulating public accounting.  Three different accounting bodies may be granted licensing and other regulatory powers if they meet necessary standards, subject to continuing oversight.  This session will highlight the experience gained, lessons learned, and challenges posed by these new regulatory processes.
Speakers: Andrew Marks, Executive Director, Texas Board of Social Worker Examiners
Peter LaFlair, Registrar, Public Accountants Council for the Province of Ontario

Witness Credibility: Dream or Nightmare
When dealing with witnesses, at each stage of the investigative process the investigator, attorney, or board member must assess the credibility of the witness. There is more to it than a "feeling." Identify how to evaluate the witness using behavioral observations, case facts, and other supporting data. This session will also address ways to deal with a witness when a credibility issue does arise so all may not be lost!
Speakers: David Monahan, Assistant Attorney General, Office of the Attorney General, Massachusetts
Terri Wellman, Board Member, North Carolina Board of Nursing
Earnest Atkins, Investigator-in-Charge, Criminal Investigations Section, Virginia Department of Professional and Occupational Regulation

Regulatory Models Explained: Mexico
Attendees will learn about the regulatory approach in Mexico. This session will allow those present to pose questions and learn more about regulatory practices.
Speaker: Víctor Everardo Beltrán Corona, Director General of Professions, Office of the Secretary of Public Education, Mexico
Transcript of Presentation

Saturday, October 2, 2004

7:30 – 8:30 a.m. Early-Bird Sessions
The Case of the Repeating Licensure Examination Candidate: Psychometric, Legal, and Policy Issues
Depending on the jurisdiction and/or licensure program, a candidate may be limited by policy in the number of times they may sit for the examination. This session will focus on the considerations emerging from limitations on examination attempts and what works best in balancing the issues. These include the interests of public protection, fairness to the candidate, and item exposure across examination forms in the Internet Era where examination security and the intellectual property rights of licensure examination program sponsors are being threatened by examinees.
Speakers: Mary Browne, Program Director, Professional Examination Service
Julia Works, Atkinson & Atkinson

Supervision for State Regulatory Concerns
 Two different types of supervision are often part of state regulatory requirements in mental health licensing acts: supervised professional experience from a training perspective to become licensed and supervision as a requirement of a stipulated agreement with a disciplined licensee. This session will provide supervisory paradigms, based on the public protection mission of regulation, that work in practice.
Speakers: Mary Hayes, President, AMFTRB, Associate Professor, Graduate School of Professional Psychology, University of St. Thomas
James Verser, Treasurer, AMFTRB, The Private Practice of Marriage and Family Therapy
Waymon R. Hinson, Member-at-large, AMFTRB, Chair, Department of Marriage and Family Therapy, Abilene Christian University
Daniel Lord, Past President, AMFTRB, Program Director MSFT, Division Chair, Friends University
Lois Paff Bergen, Executive Director, Association of Marital and Family Therapy Regulatory Boards

8:30 – 10:00 a.m. Concurrent Sessions
 Effective Use of Limited Resources
In this age of cost cutting and/or outsourcing, governmental agencies are constantly seeking alternatives to increase productivity and reduce cost without decreasing the overall quality of the service they provide to practitioners and the public that they serve. This session will examine multiple techniques used in several settings to accomplish these objectives. The session will include a discussion of self-assessment/quality assurance programs and the subcontracting of the total licensure process (application, testing, disciplinary databases checks, and the actual issuing of licenses).
Speakers: Bill Marcus, Deputy Attorney General State of California (ret.), Administrative Law Judge State of California, part-time, Professor, law and ethics, UCSD School of Pharmacy
Lori Tinkler, Executive Vice President, Applied Measurement Professionals
Teresa Holder, Director of Computer Services, Georgia Real Estate Commission

Test Piracy and Security in a Wired World
Detecting, prosecuting, and preventing test piracy in an internationally wired world requires new test security policies and procedures.  This session will examine current problems, practices, cases, and solutions from the perspective of the IT industry, an attorney, and a CBT network provider.
Speakers: Thomas Abram, Partner, Vedder, Price, Kaufman & Kammholz
Cyndy Fitzgerald, Senior Director, Test Security Services, Caveon
Rory Rorabaugh, Vice President, LaserGrade Computer Testing
Julie Wineberg, Vice President, Client Services, Pearson VUE

Consent Agreements: Let Us Show You How It Can Work
There is a growing trend in both Canada and the United States that involves the use of Consent Agreements to resolve disciplinary issues. The use of such Agreements results in a major shift in how cases are investigated and the organizations’ regulatory responsibilities. Involved in this shift is a move from a disciplinary approach to a more facilitative low-level resolution approach. This session will use case studies to demonstrate how Consent Agreements can be used in a variety of cases, such as drug and alcohol addiction, substandard practice, and intentional misconduct. In addition, the presentation will focus on the importance of the development of policies and procedures to support the process.
Speakers: Rhonda O’Hagan, Competence Assurance Coordinator, Saskatchewan Registered Nurses Association
Al Augustine, Attorney at Law, Augustine, Kern & Levens, LTD

Legal Issues Roundtable
Participants representing all roles of the licensing community will discuss legal issues relative to the work of the professional licensing boards.  Topics may include the separation of investigation, prosecution, and adjudication functions; due process; Internet issues; public access to disciplinary histories; and other issues of interest to participants.
Faye Lemon, Director of Enforcement, Virginia Department of Health Professions

10:30 – 11:30 a.m. Concurrent Sessions
 How Inclusive Is Your Website for Individuals with Special Needs?
So you got Public License Look Up and Renewals up on your website. Great! But does it serve citizens with special needs equally well? Given the number of citizens with varying degrees of physical disabilities and the growing number of immigrants from non-English speaking countries, you might want to take a second look! Agencies pay a lot of attention to "Special Needs" for examination centers but often overlook their websites, which have far greater public reach. This session will explore understanding ADA 508 and W3C accessibility standards, how usability of public websites can drive up adoption rates and save you money, how websites can serve visually or physically handicapped people, implications of "Language of Choice" offerings on public websites, demonstration of tools used to aid disabled citizens, and the "Accessibility Index."
Speakers: Helen Maskery, President, Maskery and Associates
Michael B. Short, Webmaster, New York Department of Civil Service

You’ve Been Shown: Now It’s Your Turn to Ask Questions About Testing
During the CLEAR Conference you will have an opportunity to be a part of many sessions that show you what works and what does not work in the "Show Me" State of Missouri and across the United States and Canada.  The purpose of this session is to give you an opportunity to ask practical questions about testing to a panel of experts.  Inside your registration packet will be a brief survey where you can check what questions are on your mind or write in additional questions.  Conference attendees will return this sheet to the CLEAR Registration desk, and the panel of experts will address the questions of most interest and controversy.
Speakers: Carol Morrison, Assistant Vice President, Examinee Support Services, National Board of Medical Examiners
Rose McCallin, Director, Office of Examination Services, Division of Registrations, Colorado Department of Regulatory Agencies
Elizabeth Witt, Senior Statistician, American Board of Emergency Medicine

Proactive Public Protection: Risk-Based Approach
Risk assessment strategies have allowed some agencies to anticipate risk and better protect the public. By measuring risk and developing a more proactive approach, the likelihood of a future infraction is reduced. This is a better alternative to the traditional reactive approach of simply waiting for a complaint to be submitted. Now, new tools are available to graphically analyze mountains of enforcement history and turn it into useful information in seconds. This session will explore traditional risk assessment methods and procedures, how data visualization tools can reveal hidden information in your existing database, what agencies can do to be more proactive, and how success can be measured.
Speakers: Tom Gottlieb, Vice President Licensing Solutions, VERSA Systems Ltd.
Derek Jakovich, Director, Licensing and Enforcement Division, Bureau of Food and Drug Safety, Texas Department of Health

Calling All Board Members
Board members, staff, and attorneys are invited to this interactive roundtable discussion. Bring your questions and we will endeavor to answer them in this lively session.