1 using supervision a presentation by bruce d. hartsell, lcsw lecturer california state university,...

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USING SUPERVISION

A Presentation by

Bruce D. Hartsell, LCSW

Lecturer

California State University, Bakersfield

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Why study supervision?

a. To become better supervisees. b. To facilitate better service. c. To produce better client outcomes. d. To reduce risk.

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Purposes of Supervision

a. Protect the public b. Develop professionals c. Support professionals d. Manage the work e. Promote accountability

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Functions of supervision (Kadushin)

a. administration b. education c. supportive leadership

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Definition of Supervision

? ? ?

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Policy Bases of Supervision

a. Ethical b. Legal c. Professional d. Institutional

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Ethical Requirements – NASW

a. 1.04 Competence. . . within the boundaries of . . . supervised experience . . .

b. 3.07 Administration . . . resources . . . to provide appropriate staff supervision .

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Ethical Requirements - Kohlberg

Stage 4 – societal norms Stage 5 – universal principles Stage 6 – claims of all individuals Not Stage 1 – what one can get away with

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Legal Requirements

a. Business and Professions Code, Chapter 14, Article 4

- “. . . supervised course of study . . .”

- “responsibility for, and control of”

b. CCR Title 16, Division 18

Unprofessional conduct -

- aid or abet unlicensed practice

- permits one under “supervision or control”

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Professional Requirements

a. Based in ethics b. Based in history

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Institutional Requirements

a. Based in ethics b. Based in professional norms c. Based in law - work must be supervised by MSW - must meet at least 1.5 hours per week FOR SUPERVISION

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Recommendations

Decide on your own purposes for supervision.

Decide what ethical principles will guide your supervision.

Evaluate the fit between your purposes and your ethics.

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What distinguishes supervision, consultation, and collaboration?

a. Supervision includes responsibility for the quality of the work and authority over the work.

b. Supervision involves a fiduciary duty to the supervisee and to the client.

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Distinctions -

c. Supervision requires monitoring and evaluation of the work.

d. Consultation does not involve authority although it implies expertise and therefore responsibility.

e. Collaboration involves parallel work without authority or responsibility for the work of the other.

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Contexts of Supervision (Kadushin)

a. community b. profession c. organization d. department e. supervisor-supervisee

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Significance (Kadushin)

a. The work of an organization must be organized.

b. Financial accountability to the community must be maintained.

c. Policy accountability to the community must be maintained.

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Significance --

d. Management needs information from staff.

e. Because what we do is not directly observable, supervision allows oversight.

f. The results of what we do are often not easily evident.

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Significance --

g. The agency provides the clients, and the clients have little choice.

h. Supervision is part of professional socialization.

i. Professional activity is not controlled by professional organizations.

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Significance --

j. Supervision shares responsibility for decisions.

k. The demands of the job require supportive supervision.

l. Social worker personalities and values do not strongly oppose supervision.

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Three Types of Supervision

Administrative Educational Supportive

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Tasks of Administrative Supervision

recruiting and selecting staff inducting and placing the worker planning work delegating work monitoring, reviewing, and evaluating work

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Administrative Tasks -

coordinating work sharing information upwards, downwards,

and laterally advocating change buffering change

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Six Functions of Leadership (Adair)

planning initiating controlling supporting informing evaluating

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Management Tasks (Drucker)

set objectives organize motivate and communicate measure develop people

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Educational Supervision

Facilitates learning– Knowledge– Skills– Values

Applies learning theory– Connects new to known– Connects theory to practice

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Supportive Supervision

Instrumental issues – – information– skills– structures– facilities

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Supportive Supervision --

Personal issues – emotional support– recognition– reassurance– encouragement– approval– commendation– catharsis– desensitization

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Focuses of Supervision - I

People Problem Place Process Personnel

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Focuses of Supervision - II

theory content interpersonal process intrapersonal process

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Focuses of Supervision - III

Philosophy Theory Technique

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Roles and Models

Supervisor as manager, teacher, counselor Developmental models Discrimination model Integrated (eclectic) model Interactional model Theory-specific models Reflection

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Developmental Model

1. relationship building, goal setting, and contracting the conditions of supervision

2. fluctuation between roles as counselor and teacher as skill deficits and stresses arise

3. collegial role in response to growing expertise and confidence

4. consultant role as the supervisee becomes self-directed and independent

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Another Developmental Model (Loganbill)

stagnation confusion integration

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Some dimensions of development

need for structure need for direct feedback need for didactic instruction need for supervisor support

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Discrimination Model(Bernard & Goodyear)

three foci – – process skills – conceptualization skills– personalization skills

three supervisor roles – – teacher– counselor– consultant

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Integrated (Eclectic) Model

Variously conceived in the literature Intensional inclusion of more than one

psychological theory May include one orientation to supervision

and another to treatment

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Interactional Model (Shulman)

Preliminary Phase – Tuning In Beginning Phase

– Contracting– Clarifying Purposes– Specifying Roles– Establishing Authority

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Interactional --

Middle Phase – Work Phase– Session tuning in– Session Contracting– Elaboration– Empathy– Sharing Feelings

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Interactional --

Middle Phase – Continued– Showing Vulnerability– Demanding Work– Pointing Out Obstacles– Sharing Data– Session Ending

Ending and Transition Phase

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Theory-specific Models

psychodynamic behavioral cognitive technical eclecticism

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Reflection

guided questioning assumes that increased awareness leads to

increased skill

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Recommendations

Choose models Discuss models with your supervisor Agree on one or more models Use the agreed-on models Evaluate use of the models

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Steps in the Supervision Process

determine what the supervisee needs to learn

determine how the supervisee learns determine which case will best facilitate

that learning prepare to apply the learning

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Supervision Steps --

apply the learning review the experience provide feedback reevaluate learning needs repeat the process

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Characteristics of a Good Supervision Meeting

involves preparation and planning by both parties

has a shared objective focuses on the work of the supervisee gives priority to the critical self-analysis of

the supervisee

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Meeting Characteristics --

provides helpful feedback occurs in the context of a facilitative

learning process is consistent with good teaching-learning

theory and practice provides follow through and connection to

the next meeting

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Recommendation

Develop an agenda for a typical

supervision meeting.

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Content of a Supervision Session

Follow up on previous assignments Identification of learning needs Review of cases Interventions within supervision session Recommendations for action outside of

supervision

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Diversity Issues

Diversity influences . . . a. the experience of problems b. the description of problems c. approaches to solving problems d. perception of helpers

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The Diversity Triangle

Client

Supervisor Supervisee

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Supervisor Duties to Clients(Falvey)

a. Assure client welfare b. Assure informed consent for treatment c. Assure informed consent for

supervision d. Manage confidentiality and its limits e. Manage availability to clients

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Supervisor Duties to Supervisee (after Falvey)

a. Select supervisee b. Assess supervisee competence c. Orient supervisee d. Develop individualized supervision plan e. Obtain informed consent for supervision

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Duties --

f. Assign cases g. Monitor cases h. Document monitoring i. Schedule and meet regularly for

supervision j. Document supervision

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Recommendation

Consider what duties you have to your client.

Consider what duties you have to your supervisor.

Does your client have duties to you?

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The Duty – Negligence Issue

A supervisor has a fiduciary duty to the supervisee and to the client.

The duty involves meeting the standard of care – what a reasonably prudent professional would do in the same situation.

Failure to meet the duty may constitute negligence, which is actionable in court.

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Negligence involves

a. Duty b. Breach c. Cause d. Damage . . . as shown by preponderance of evidence

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Examples of Supervisor Negligence (Falvey)

a. failing to adequately plan the supervisee’s work

b. giving inappropriate advice to the supervisee

c. failing to get adequate information about a client

d. assigning tasks that the supervisor knew or should have known the trainee was not qualified to perform

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Vicarious Liability

Others may be legally liable for your acts or omissions.– Your supervisor– Your agency administrator– Your seminar instructor– Other school officials

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Supervisor - Supervisee Relationship Problems

unmatched expectations fear of disclosure supervision outside expertise boundary issues with clients boundary issues in supervisory relationship

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Supervisor - Supervisee Relationship Problems --

games supervisee discomfort with power

differential supervisor discomfort with power

differential organizational/structural barriers

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Problems in Client-Helper Relationships

inadequate understanding inadequate rapport unclear contract unrealistic expectations lack of progress boundary problems

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Boundary Problems

Strong feelings Extended sessions Inappropriate communication Off-hours phone calls Inappropriate gift giving

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Boundary Problems --

Inappropriate home visits Overidentifying Loans, barter, and sale of goods or services Inappropriate self disclosure Touching

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Responses to Client-Helper Relationship Problems

Identify the problem. Define the problem. Define appropriate behavior. Develop strategies to implement

appropriate behavior. Implement strategies. Evaluate strategies.

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Levels of Informed Consent (Falvey)

a. client consent to treatment by the supervisee

b. client consent to supervision c. supervisor consent to assume

responsibility d. supervisee consent to supervision e. institutional consent to comply with

supervision standards

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Special issues with students (Falvey)

a. Those involved in selection must exercise due diligence.

b. The training institution must warn field agencies of known risks. (Altamonte v New York Medical College)

c. Responsible people must share known risks.

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Issues with Students --

d. Faculty members supervising academic seminars have a duty to exercise authority and control over students.

e. The school may have vicarious liability. f. Status as a trainee does not provide an

exemption from the duty to meet the standard of care.

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Considerations in assigning clients (Falvey)

a. competencies and limitations of the supervisee

b. complexity of the case c. supervisee caseload numbers and

complexity d. supervisor competencies and limitations e. supervisor time for supervision

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Documents to Demonstrate Proper Supervision (after Falvey)

a. emergency contact information b. supervisee profile c. plan for supervision d. supervision agreement e. caseload supervision log sheet f. supervision progress notes g. initial clinical summary h. termination summary

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Recommendations to Reduce Risk (after Falvey)

a. Meet with each client during the screening and assignment process.

b. Orient supervisees to informed consent, dual relationship, and other ethical issues.

c. Require audio recordings on a structured basis.

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To Reduce Risk --

d. Review recordings. e. Regularly ask about personal reactions

to clients. f. Document and follow up

recommendations. g. Do not allow client contact or

supervision after hours.

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Recommendations to Avoid Dual Relationships (Falvey)

a. Do not supervise current or former clients.

b. Do not supervise current or former family members, friends, sexual partners, or business associates.

c. Avoid social activities with supervisees that may blur roles or impair objectivity.

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To Avoid Dual Relationships --

d. Limit self-disclosure to that necessary for supervision.

e. Avoid behavior or comments that could be interpreted as romantic or sexual.

f. Identify personal feelings and obtain consultation.

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Two more hints for self protection

a. If most people wouldn’t understand, you probably shouldn’t do it.

b. If you can’t make yourself look good when you explain your actions on the evening news, don’t do it.

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Responses to Client-Helper Relationship Problems

Identify the problem. Define the problem. Define appropriate behavior. Develop strategies to implement

appropriate behavior. Implement strategies. Evaluate strategies.

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May a supervisor supervise outside of expertise?

What is expertise?

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Elements of Expertise (after Oliver)

a. acceptable training in the field b. appropriate licensure c. substantial relevant experience d. sound use of knowledge, skills, and

principles e. familiarity with and rational basis for

rejecting alternative views

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Expertise --

f. opinions based on evidence g. opinions consider contradictory and

absent data h. logical reasoning process i. adherence to professional values and

ethics

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A Basic Evaluation Scheme

1. Does not recognize or ignores relevant information.

2. Minimally recognizes relevant information.

3. With coaching, can begin to apply relevant information to situations.

4. Can identify and apply relevant information in simple situations.

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Evaluation Scheme --

5. Can identify and apply relevant information in complex situations.

6. Can identify and apply relevant information from more than one perspective to complex situations.

7. Can identify and apply relevant information from several perspectives to complex situations.

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Evaluation Scheme --

8. Can identify and apply relevant information from several perspectives to complex situations, and can clearly explain the merits of each perspective in relation to the field of knowledge.

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Recommendation

Complete a needs assessment. Prioritize learning needs. Incorporate those priorities in the learning

agreement.