3/9/2013 The Well Known The WHY • To develop clinical skills • To help bridge the gap between classroom and clinical settings Of Supervision • • • • • What you may not have considered.. Why the graduate/undergraduate Establish strong relationships with universities Access to current research in the field Share your expertise Strengthen your own clinical skills Demonstrate effective interdisciplinary skills • Current theories, research, and teaching • Challenge your own clinical skills • Help guide students through the critical thinking process hi ki • Demonstrate and guide students through foundational clinical skills • Train students to be a person you would want to hire Why PE and CF Supervision? Why the students/PE/CF needs you • Again access to newest ideas • Help develop interpersonal skills with the work environment • Train someone you want to work with i k ih • • • • MENTORING, MENTORING, MENTORING Support Model of interpersonal skills A sense of stability (knowing someone is there to help) 1 3/9/2013 ASHA Supervision Competencies 1. 2. The WHO 3. Of Supervision 4. 5. • Clinical Teaching – interaction between supervisor/supervisee in any setting which furthers the development of clinical skills of students or practicing clinicians as related to changes in client behavior • Program Management‐ P M t activities that ti iti th t relate to administration or coordination of programs Valued 6) Supervisory Conference or Meetings of Clinical Teaching Teams 7) Evaluating the Growth of the Supervisee both as a clinician and a professional 8) Diversity 9) Development and Maintenance of Clinical and Supervisory Documentation 10) Ethical, Regulatory and Legal Requirements 11) Principles of Mentoring Least Valued y Being fair and impartial in y Guiding the clinician to the evaluation of the provide written feedback to the client clinician y Treating the clinician in a fair y Providing specific academic coursework and impartial manner concurrent with clinical concurrent with clinical y Encouraging the clinician to training in the question, disagree and disorder(s) express ideas y Being process‐oriented TASKS of SUPERVISION Competencies The Four Foundations • Clinical Process – interaction that takes place between the clinician and the client • Supervisory Process – interaction that takes place between the supervisor and the clinician and may be related to the behavior of the clinician or the client or to th the program in which the supervisor and clinician are i hi h th i d li i i employed • ASHA, 1978 Preparation for the Supervisory Experience Interpersonal Communication and the Supervisor‐Supervisee Relationship Development of Critical Thinking and Problem‐ Solving Development of Clinical Competence in Assessment Development of Clinical Competence in Intervention • • • • Understanding Supervision Knowledge about Supervision Application to the Practice of Supervision Professional and Personal Readiness Definitions 2 3/9/2013 Points to remember • Supervision skills can be learned • Effective supervision benefits the agency; the supervisor; the supervisee and the client on many levels • Buy‐in is important‐ Buy in is important no legal requirements for no legal requirements for training in supervision. Ohio Requirements Students Conditional Licensees‐ PE • No specific requirements listed • Must have held license in the state of Ohio for 24 out of the last 60 months • Must maintain license throughout the entire SPE experience ASHA Requirements Students ‐Supervisor Clinical Fellows ‐Mentor • Established competency in any area of practice in which the supervisor may engage. • Must hold CCC in the appropriate area • No minimum number of years being certified • Must hold current CCC‐SLP • Certification must be maintained throughout the entire CF experience Ethical Practice in Supervision • Failing to supervise the prerequisite amount. ASHA states a minimum of 25% of direct intervention and 50% of diagnostic. Medicare is different for part A and B • Rule A. Individuals shall provide all services competently. • This rule applies because the mentor has the responsibility hi l li b h h h ibili to assist the clinical fellow in the development of competent delivery of services, and ultimately has the responsibility to evaluate the clinical competence of the individual. It is wise to keep in mind that the successful completion of the CF is the final assessment for independent clinical practice. History of supervision The WHAT Of Supervision • As old as the profession • In 1978 ASHA noted there was not any uniform training or expectations for supervision • 1988 Jean Anderson published The Supervisory Process in Speech‐Language Pathology 3 3/9/2013 History Cont. Stages of Supervision • Current – Technical reports – Special interest group – Policy documents Policy documents – State licensure requirements Evaluative Stage • • • • Supervisor is the one in charge Active teaching skills Supervisor guides planning Supervisor provides lots of feedback to the supervisee Transition Stage • Start to move responsibility for case management to supervisee • Feedback begins to become more guiding • This can be an anxious stage for both hi b i f b h supervisor and supervisee • Beginning closer to evaluative stage by end closer to self‐supervision Self‐Supervision Stage • Supervisor is seen as more of a resource as needed • Lots of listening and joint problem solving The Where and When Of Supervision 4 3/9/2013 ASHA Requirements Students • 25% of Client Contact Time • 50% of Diagnostics Clinical Fellows • Minimum of 18 on site visits over 9 months • Evaluation of skills are conducted at minimum 3 conducted – at minimum 3 times over 9 months • Other activities can include: emails, phone calls, texts • Submission of CF form at the conclusion of the experience. Releasing control Responding I Interpretation i Ohio Requirements Students Conditional Licensees • No legal requirements listed • SPE Plan must be submitted within 30 days of employment. • Minimum of two visits per Minimum of two visits per month with at least one being an evaluation of skills that is documented on form • Completion and submission of SPE form at the conclusion of the SPE experience. Action Plan • Techniques and Strategies • Who will do what? How? When? • How will we know the outcome has been achieved? achieved? • Results • Date and document what occurred. Development of Growth – supervisor Supervision Protocol Marianne Malawista, Ph.D. CCC‐SLP Ohio University I. Describe Process of Supervision and Feedback Format (Week 1) A. Orientation y Tour facility y Clinic assignment dates through end of quarter ___ h h d f y Assignment/appointment deadline responsibility y Observe supervisor therapy session and discuss y Use Evaluation of Treatment Session form B. Supervision Style y Review therapy/ observation format specific to site y Ask for clinician expectations from supervisor * supervisor * y Discuss verbal feedback (Saras and Post) 2004 y Discuss written feedback * Use of Larson tool Supervisory Protocol II. Set Clear Performance Criteria ( Weeks 1& 2) A. KASA Review KASA and KASA Worksheet interface (to be completed at final conference) B. Evaluation of Treatment Session Review form – complete together to id t i.d. strengths, need, goals th d l Establish goals based on observed and/or reported needs Student responsible to meet deadlines/discuss with supervisor III. Demonstrate Reliable Observation of Student Work A. Schedule of Observation Treatment sessions: directly observe 50‐100% of each session Diagnostic sessions: Directly observe 75% ‐ 100% of each session B. Documentation of Observation Will provide written feedback : Every 2nd treatment session Every diagnostic session • Review format Face‐to face conferences will occur every day: Am – 15 minutes to review cases Pm – 20 – 30 minutes to review skills 5 3/9/2013 Supervisory Protocol y Monitor Student’s Use of Feedback A. Feedback Implementation B. Implement as agreed C Failed to implement C. Failed to implement D. A. Determine reason E. Establish corrective action and/or goal B. Goal Attainment C. Met goal(S) D. Continue practicing new skill E. Establish new goal if indicated indicated F. Failed to meet goal(s) G. Determine breakdown between feedback and application H. Apply corrective action I. Observe for change Implementation • Protocol signed and dated • Reference list attached • Goals are established for supervisee Effective Supervision • • • • Transcends a teacher‐pupil relationship Is multifaceted Is dynamic Is a great learning experience for both the supervisee and the supervisor Activity 8: • Think ABOUT one person you supervise or have supervised in the past? Answer the following questions. • 1. Which of the 4 styles is most appropriate with that supervisee ? that supervisee ? • What is your rationale? • Have you been providing the style they need? • What are 3 steps you could take to offer them a style of supervision that meets their needs? • Will you do it? STYLES • • • • Directing Coaching Supporting Delegating Valued Least Valued y Being fair and impartial in y Guiding the clinician to the evaluation of the provide written feedback to the client clinician y Treating the clinician in a fair y Providing specific academic coursework and impartial manner concurrent with clinical concurrent with clinical y Encouraging the clinician to training in the question, disagree and disorder(s) express ideas y Being process‐oriented Competencies 6 3/9/2013 Valued Least Valued y Guiding the clinician to y Guiding the clinician to providing the client with make clinical decisions the feedback at y Being flexible and designated intervals adaptable y Providing the clinician g y Providing the clinician with with indirect feedback with indirect feedback constructive evaluative and evaluation information y Guiding the clinician to be procedure‐oriented COMPETENCIES Components of Supervision Anderson, 1988;McCrea & Brasseur, 2003 • • • • Understanding and planning the process Observing Analyzing Integrating Development of Contracts • Mutual agreement between supervisor and supervisee • Dynamic in that it must change over the life cycle of the supervisory relationship life cycle of the supervisory relationship • • • • • Lack of congruency Meeting immediate needs Determining level of expectations Learning about discrepancies Dealing with discrepancies • Rassi, 1978; Oratio, 1977 Role Discrepancies 1.Understanding/Planning • Establishing boundaries, rules and expectations • Planning for the clinical process • Planning for the supervisory process l i f h i Contracts Spell Out • Mutual expectations • Mutual responsibilities • Mutual requirements 7 3/9/2013 Contracts allow for Benefits of the Contract • • • • Reduces miscommunication Minimizes covert agendas Facilitates the orientation of the supervisee Reduces abuse of power by the supervisor Sample Contract • How many hours per week in direct supervision? • Requirement _______________ • How many of those hours will be spent observing what ? what ? • How many hours per week in indirect supervision? • How can I be reached ? • How often should we modify ? TO develop effective long‐term learning styles TO help students attain greater personal integration, effectiveness and realistic self‐appraisal TO create an TO create an atmosphere of empathetic communication TO create opportunities for students to grow as a person/clinician Goals and Assumptions • Breaking through impasses • Overcoming difficulties • Definition of problems by bringing all issues out on the table issues out on the table • Identification and investigation of an issue to arrive at a common ground • Time for differences and disagreements • • • • Time Control Assessment Generational differences Issues to Consider The Research Says • Supervisors tend to use one style even when they think they do not . McCrea & Brasseur, 2003 • Supervisors who are flexible and adaptable in terms of their styles are more effective than terms of their styles are more effective than those who use the same approach with all supervisees( Melucci, 1990). • Supervisory styles influence supervisees’ satisfaction with supervision and supervisees’ self‐efficacy 8 3/9/2013 Research Findings Cont. And That Means… • Supervisors need to facilitate the supervisory process focusing on emotions as well as problem solving. • Supervisory styles affect the behavior of those Supervisory styles affect the behavior of those being supervised (NIJ, 2003) • Our choice and use of supervisory styles affect others .. THE RIPPLE EFFECT The result…. • Without knowledge about the supervisory process and the choices and consequences of various supervisory styles, we will continue to do what we have always done ! do what we have always done ! • McCrea, 2009 CASE EXAMPLES SNF CF Supervision Externship Supervision • A skilled nursing facility calls you because they have hired a CF. You have worked in a SNF but it was years ago. You have never worked at this facility Your current position is as a this facility. Your current position is as a school SLP. The facility has indicated that they do not expect you to visit more than 2 x a month for one hour (minimum requirements of ASHA). What are the conflicts? What are some possible solutions? • A student arrives for an externship – the information that you receive is that this is a bright student (3.8). After the first week you notice that the student is constantly late – arriving either 5 minutes before or after the first client of the day. You ask the student to be prepared to take over a portion of the caseload by be prepared to take over a portion of the caseload by the 2nd week. At the beginning of the 2nd week the student indicates that they are not ready to take over clients as they would feel more comfortable observing another week. In addition, the student has asked if it is ok to miss three days at the end of the week because a friend is getting married in Florida and they are in the wedding. Conflicts ? Solutions? What Would You Do ? 9