Supervision at a Distance

Ohio Psychological Association October 30, 2008

Communications & Technology Committee

Ken Drude, PhD; Audrey Ellenwood, PhD; Ky Heinlen, PhD, LPCC-S; Michael Lichstein, PhD,

Paule Steichen Asch, PhD

http://www.ohpsych.org/commtech.aspx

Learning Objectives Define distance supervision and some technical aspects

Review current literature on guidelines for supervision (distance & f2f)

Learn how the current APA Code of Ethics can be applied

Learn results of a recent survey Discuss what guidelines need to be developed to address concerns – invitation to participate

Distance Supervision

Providing clinical supervision through technology based, non-face-to-face means including the following:

Landline and cell phones Email, chat (real time online) Text messages to cell phone & Instant messages

Video teleconferencing Web pages

What is Clinical Supervision?

Interaction between supervisee and supervisor:

Discuss cases in-depth Supervisor becomes knowledgeable of critical information about a client

Instructs or models how to deal with issues

Assists in developing interventions Monitor’s students and clients progress

Types of Supervision Work supervision Training supervision Psychological umbrella supervision Mental health worker supervision Administrative supervision

*4732-13-03 of the Administrative Code

Board Requirements of Supervision - 1

Supervisor shall:• Be competent to provide services supervisee provides

• Determine the supervisee’s competencies

• Be responsible for the “psychological diagnosis, psychological prescription, and psychological client supervision of all clients.”

Board requirements of Supervision – 1

(continued)

• Keep records of supervision

• “Have direct knowledge of all clients served by his/her supervisee”

Board Requirements of Supervision - 2

Supervisor shall for training supervision:

• Schedule individual face to face supervision for no less than 5% of the weekly client contact time.

• “Have a written agreement describing the goals and content of the training experience, including clearly stated expectations”

Distinction Between Consultation & Supervision

Consultation• Consultee responsible for treatment and client

• Collegial relationship

• Consultant may have limited information

Supervision•Supervisor responsible for treatment and client•Superior-subordinate relationship•Supervisor needs to have all available client information in

General Requirements of Supervision-Competence

What is Competence?

Competence is a standardized requirement for an individual to properly perform a specific job. It encompasses a combination of knowledge, skills, and behavior utilized to improve performance. More generally, competence is the state or quality of being adequately or well qualified, having the ability and a core set of values to perform a specific role.

Competence Is …

Habitual and JudiciousInvolves: Use of communication, Knowledge, Technical skills, Clinical reasoning, Emotions and, Values

“Reflection in daily practice for the benefit of the individual and community being served.” Epstein & Hundert (2002)

APA Benchmarks of Competency

Reflective Practice Self-Assessment

Scientific knowledge-methods Relationships Individual-cultural diversity Ethical-legal standards-policy Interdisciplinary systems

APA Benchmarks Functional Competencies

Assessment, diagnosis, case conceptualization

Intervention Consultation Research/evaluation Supervision, teaching Management - administration

Current Practices in Distance Supervision

Limited documented practices, more anecdotal accounts

Telephone and e-mail most common practices

Televideoconferencing increasingly being used

Supervision Survey Demographics

Research approved by CSU IRB

Participants were solicited through a variety of mental health listservs

Invitations to participate were posted in June & July

50 people went to the survey link and

25 people completed the survey

Licensure of respondents

57.9% 31.6% 10.5%

Status of providingDistance supervison 50% currently provide

45.5% provided in the past

22.7% are considering providing

Practice of Distance Supervision

Number of supervisees: 58.8% had 1-2 17.6% had 3-4 23.5% had 5

Number of hours per week in supervision: 33.3% less than 1 hour 26.7% 1-2 hours 20% 3-4 hours 20% 5 hours

The Supervisee

Lived in & practiced in state (71.4%)

Lived outside the state & practiced in state (4.8%)

Lived outside state & practiced outside state (28.6%)

Forms of Supervision provided:

Practices Utilized in Supervision

Secure service w/encryption (46.2%)

Supervisee records sessions (15.4%)

Clients informed supervision online (38.5%)

Using Distance SupervisionAs an Adjunct to Face-to-Face

71.4% indicated they also provide some face-to-face supervision

28.6% indicated they do not see supervisee

Skills Needed to ProvideSupervision at a Distance Navigating online Basic typing and spelling skills Ability to express self in the written word

Ability to express concepts/ideas without the use of non-verbal cues

Excellent communication skills Take a course on technology skills

Practice Facility

Clinical Supervisor

•Secure two way interactive technology

• Internet based e-mail

•Chat rooms for interaction

•WEB based TV staffing sessions

•Electronic bulletin Boards for scheduling

•Encrypted services

Web based case review/electronic medical records

Chat room for discussion of case studies

Supervision via ITV

(Group or Individual)

Individual face-to-face supervision with onsite supervision

Supervisee At A Distance

Flow Chart Of Supervision At A Distance

Adapted from Miller et. al. 2008

Case DiscussionsVignettes of Distance Supervision

Key factors –Quality Supervisory Relationship Supervision enhances natural developmental process of supervisee

Use both a theoretical and experiential base to supervision

Assure a consistent and coherent technical framework for supervisees

Supervisees need to be adequately trained in the technology used for supervision.

Key factors –Quality Supervisory Relationship (Cont.)

• The selection of technologies should be based on appropriateness for clinical services, patients and supervision• Supervisors need to ensure the security of all client information• Continuous self-evaluation as well as evaluation of technology services used needs to be monitored (Miller et. al, 2008)

Cautionary statements Using Distance Supervision as an Adjunct Telepsychology supervision may

limit a supervisees level of personal contact with supervisor

Supervisees may not get time they need to grow in supervision

Problems with technology access can interfere with supervision

Confidentiality is an issue Requires the supervisee to be more self-directed

Looking ahead to guideline considerations

What components of distance supervision need to be incorporated into guidelines?