Supervision Research: Past

SUPERVISION RESEARCH:PAST AND PRESENT

ASHA CONVENTION- CHICAGODivision 11

November 2008

Presenters

Shelley Victor, Ed.D., CCC-SLPCheryl Gunter, Ph.D., CCC-SLPRose L. Allen, Ph.D., CCC-SLP/ADeanna Hughes, Ph.D., CCC-SLPJennifer Ostergren, M.A., CCC-SLPPamela Klick, M.A., CCC-SLP/LMaureen Schmitt, M.S., CCC-SLP/LErin Redle, Ph.D., CCC-SLPDaniel E. Phillips, Ed.S., CCC-SLP

HISTORY OF SUPERVISION RESEARCH

• Macro

• Micro

SUPERVISORY SKILLS

• Roberts, J. (1982) Supervisor’s decision-making

• Glaser, A. & Donnelly, C. (1988). Data –base methods of supervision in public school

SUPERVISORY EXPECTATIONS

• Dowling, S. & Wittkopp, M. (1982) Perceived supervisory needs of students

• Larson, L. (1982) Perceived supervisory needs and expectations

• Mastriano, B., Gordon, T., & Gottwald, S. (1999) Expectations of the supervisory process

• Tihen, L. (1984) Expectations of student clinicians

SUPERVISORY STYLE

• Dowling, S. (1977) The effect of two supervisory styles- conventional and teaching clinic

• Williams, A. (1994). Peer group supervision.

FOCUS ON SUPERVISEE

• Peaper, R. (1984) Students’ perceptions of supervisory conference

• Shapiro, D. (1985). Supervisee commitment and follow through behavior

• Mawdsley, B., & Scudder, R. (1988). Determine supervisee’s task maturity level

• Wagner, B., & Hess, C. (1997). How supervisees perceive supervisors’ social power

INTERPERSONAL

• Caracciolo, G. (1977) How student clinicians and supervisors perceive interpersonal conditions during supervisory conference?

• Volz, H., Klevans, D., Norton, S., & Putens, D. (1978) Effects of training on interpersonal skills of undergraduate clinicians

SUPERVISORY CONFERENCE

• Brasseur, J. (1980) Differences in videotaping during supervisory conference

• Casey, P. (1980) Use of McCrea’s Adapted system to analyze the supervisory conference

• Smith, K., & Anderson, J. (1982) Validation of supervisory conference rating scale

Supervisory conference

• Strike-Roussos, C. (1988). Use of broad questioning during conference

• Tufts, L. (1984) Content analysis of supervisory conference

• Whiteside, J. (1981) Analysis of question type during supervisory conference

PLANNING

• Peaper, R., & Wiener, D. (1984) Comparison of perceptions of clinical reports

EVALUATION PROCESS

• Anderson, C. (1978). Effect of supervisor bias on evaluation of student clinicians

TECHNOLOGY

• Facilitating clinical observation through computer technology- Shadden, B., & Aslin, . (1993)

• Audiotaped dialogue journal-Schill, M., & Swanson, D. (1993).

PROPOSAL PROCESSPRESENTATION OF RESEARCH

Professionals’ Judgments of Ethical/Unethical Scenarios

Rose L. Allen, PhD, CCC-SLP/AEast Carolina University

Greenville, NCNovember, 2008

ASHA Code of Ethics (2003)

• Preamble – The preservation of the highest standards of

integrity and ethical principles is vital to the responsible discharge of obligations by speech-language pathologists, audiologists, and speech, language, and hearing scientists.

– This Code of Ethics sets forth the fundamental principles and rules considered essential to this purpose.

Sanctions for Violations

• Reprimand• Censure• Withhold, suspend, or

revoke membership and/or Certificate of Clinical Competence

(Irwin et al., 2007, p.88)

• Other measures determined by the Board of Ethics at its discretion

• A cease and desist order may become part of any action.

Code of Ethics (ASHA, 2003)

• Four Principles of Ethics– Form the underlying moral basis for the Code of

Ethics.

• 74 Rules of Ethics– Specific statements of minimally acceptable

professional conduct or of prohibitions and are applicable to all individuals

Principles of EthicsI. Patient welfare in clinical, research, or scholarly activities.

Also, animals used in research….

II. Achieve and maintain highest level of professional competence….

III. Promote public understanding of the profession…accurate information in all communications…

IV. Relationships with colleagues, students, and members of the allied health professions…maintain harmonious relationships….

Importance of Ethics

• ASHA has placed more emphasis on ethics, and the ethical behavior of professionals in speech-language pathology and audiology.

• Evidence of this has been documented through a series of articles in The ASHA Leader over the last few years.

• Many issues are controversial, such as acceptance of manufacturer gifts, provision of services to HIV/AIDs patients.

Specific Rules that have Served for Basis of Complaints (Diefendorf, 2008)

• Principle I, Rules A,B,G, K, M– Provision of services– Referrals– Evaluate effectiveness of

services– Maintenance of records– Not charge for services

not rendered

• Principle II, Rules, A, B, E– Hold appropriate CCC or

be supervised by an individual who holds appropriate CCC

– Engage in aspects of the professions within their scope of competence

– Staff will not provide services for which they are not trained

Specific Rules that have Served for Basis of Complaints (Diefendorf, 2008)

• Principle III, Rules B, D, E, F– Not participate in activities

that constitute a conflict of interest

– Not misrepresent DX information, services rendered…or engage in any scheme to defraud..

– Statements to the public shall provide accurate information

– Use professional standards in advertising and marketing

• Principle IV, Rules B, F, G, J– Shall not engage in

dishonesty, fraud, deceit, misrepresentation, sexual harassment…

– Statements to colleagues….shall contain no misrepresentations

– Shall not provide professional services without exercising independent professional judgment…

– Comply fully with the policies of the Board of Ethics…

Previous Research Allen & Rastatter (2005)

• Investigated how well undergraduate SLP students with no formal ethics training, and graduate SLP students, with formal ethics training, could judge ethical/unethical situations

• Survey instrument utilizing 74 scenarios• For unethical scenarios, graduate students had slightly better

scores than undergraduates for all four Principles• For ethical scenarios, undergraduates had just as good or

better judgments on scenarios related to Principles I (patient welfare) and Principle III (public understanding of the profession)

• For ethical scenarios, graduate students had better judgments for scenarios relating to Principle II (professional competence), than the other Principles

Proposed Research

• Investigate professionals’ (speech-language pathologists and audiologists) judgments of ethical/unethical scenarios

• Research Questions: – Do experienced SLPs and audiologists (those holding the

CCC) make similar judgments of ethical/unethical scenarios?

– Does length of time in profession make a difference?– How do judgments by professionals compare to judgments

by students?

Proposed Research: Methods

• The 900 members of ASHA Special Interest Division 11 (Administration and Supervision) will be participants.

• The survey, consisting of 74 ethical/unethical scenarios, will be mailed with pre-addressed postage paid envelopes.

• A reminder card will be sent to non-respondents four weeks after initial mailing.

Proposed Research: Methods

• Data will be entered into SPSS for analysis.

• Compare SLPs to Audiologists• Compare length of time in profession• Compare to previous student data

Summary

• Ethical decision making is usually a complicated process that a clinician most likely faces several times during a career (Irwin et al., 2007, p.89)

• Need ethics training modules for students as research shows that graduate students do need in-depth training in ethical decision making

• Please fill out a survey! Thank you!

ReferencesAllen, R., & Rastatter, M. (2005) Student judgments of ethical/unethical scenarios.

Perspectives on Administration and Supervision, 15(2), 12-14.

American Speech-Language-Hearing Association. (ASHA). (2003). Code of ethics (Revised). ASHA Supplement, 23, 13-15.

Diefendorf, A. O. (2008). The ASHA Board of Ethics: An update on roles, responsibilities, and educational resources. Perspectives on Administration and Supervision, 18(1), 4-9.

Irwin, D., Pannbacker, M., Powell, T. W. , & Vekovius, G. (2007). Ethics for speech-language pathologists and audiologists: An illustrative casebook. Clifton Park, NY: Thomson Delmar Learning.

Supervision of Graduate Students In University Clinics: Professional

Preparation

Pamela Klick, M.A., CCC-SLP/LMaureen Schmitt, M.S., CCC-SLP/L

Saint Xavier UniversityChicago, Illinois

ASHA Convention November, 2008

Research Components

• Preparation for supervision• Continuing education concurrent with

supervising students in the university setting• Institutional support for clinical supervisors• Strategies employed by supervisors to

facilitate students’ clinical performance

Methodology

• 1,000 surveys distributed to 100 randomly selected graduate programs accredited by Council on Academic Accreditation

• Items included open-ended questions, forced-choice items, and checklists

• Demographic Information• Anonymity preserved

Respondents

• 176 out of 1,000 surveys returned: (17% Rate of Return)

• A variety of academic and clinical positions including both full-time, part-time and adjuncts

• Experience ranged from 1 through 40 years• Number of students in graduate programs varied

from 10 to 150+• 73% indicated no affiliation with Division 11

Definition of Clinical Supervision

• Clinical Supervision, also called clinical teaching or clinical education, is a distinct area of practice in speech language pathology and it is an essential component in the education of students and the continual professional growth of speech language pathologists

ASHA Position Statement, 2008

Theoretical Assumptions

• Clinical competence occurs on a continuum from dependence to independence based on:– The overall amount of the students’ clinical experience

and level of competence– The amount of experience with specific disorders and ages– Various practicum placements

• Clinical supervision is a distinct area of practice (ASHA Position Statement, 2008)

• Training as an SLP is not equivalent to training in supervision

Supervisory Training Received Prior To Supervision

in the University Setting

0

20

40

60

80

100

120

140

Workshop

University Course

Mentoring Program

Web-Based Instruction

Experience with FormerSupervisorConference Presentation

Books

Training Session

Special Interest Div 11

Additional Means of Learning to Be a Clinical Supervisor

• “On-the-Job” training• Supervision of students in other settings

(schools, hospitals, private clinics)• Supervision of CF’s• Administrative roles in the field (Other SLP’s)• Administrative roles outside the field• Self-study• Reading the Supervisors’ Manual

Continuing Education in Supervision

86%

4%10%

Yes

No

No Response

Methods of Continuing Education in Clinical Supervision

0 20 40 60 80 100 120

Workshop

University Course

Mentoring Program

Web-Based Instruction

Experience with Former Supervisor

Conference Presentation

Books

Training Session

Special Interest Div 11

None of The Above

Additional Activities for Continuing Education in Clinical Supervision

• Collaboration with other colleagues who supervise

• Reading articles on supervision from SLP journals

• Formal CEU experiences, such as classes, workshops, conference presentations

• Scheduled meetings with clinical faculty

Formal Training in Clinical Supervision Offered by Institutions

76%

20%4%

Yes

No

No Response

Mentoring Programs for Clinical Supervisors Provided by Universities or Departments

3%

65%

32%

Yes

No

No Response

Persons Responsible for Mentoring Clinical Supervisors

0

5

10

15

20

25

30

35

40

45

Number of Respondents

Department Chair

Clinic Director

Colleague Within University

Colleague Outside University

Former Supervisor

Other

Informal Program

Strategies That Supervisors Ranked Most Valuable in Clinical Education of Students

0 10 20 30 40 50 60 70

Verbal Feedback

Written Feedback

Video Feedback

Modeling

Student Self-Evaluation

Co-Treatment

Role Play

Rating Scales

Active Listening

Reflective Journaling

Student Suggestions

Students Restating Suggestions

Amount of Professional Development Funds

0 10 20 30

$0 - $200

$201 - $500

$501 - $1,000

$1,001 - $1,500

$1,501 - $2,000

$2,000+

Means of Institutional Support for Clinical Supervisors

• Offering workshops, seminars & courses specific to clinical supervision

• Initial & ongoing training for supervision at individual sites

• Regular meetings for clinical supervisors to exchange ideas and discuss issues

• Provide a mentoring program• Journal and/or book club on supervision

Other Possible Supports

• Better financial support for attendance at conferences and workshops

• Financial support for membership in Division 11

• Periodic review and feedback by the Clinic Director/Coordinator

• Collaboration with supervisors at other institutions

• Increased value of clinical supervision

Agreement with Certification of Clinical Supervisors

58%

9%

33% Yes

No

No Response

Additional Comments on Certification of Supervisors

• Concern about losing off-campus supervisors for external practica

• Concern about losing part-time on-campus supervisors

• Too demanding of time and money• Need more information on the requirements• Distinction noted between mandated

continuing education and certification

Conclusions

• A majority of supervisors (76%) received professional preparation through interactions or experiences with a former supervisor.

• A majority of current supervisors (86%) participate in formal and/or informal continuing education activities relative to supervision.

More Conclusions

• A majority of supervisors (72%) receive some financial support for continuing education activities that may or may not include education specifically in supervision.

• Approximately 59% of the supervisors supported certification of clinical supervision at some level.

SUPERVISORY PRACTICES IN SPEECH-LANGUAGE PATHOLOGY GRADUATE TRAINING PROGRAMS

Daniel E. PhillipsAuburn University

ASHA 2008 Chicago

Supervision• Supervised experience in treating individuals with

communication problems is necessary for students to learn the skills to become clinical providers (McAllister & Lincoln, 2004).

• The goal of supervision is to provide the type of supervisory practice that is appropriate to the “student’s level of knowledge, experience, and competence” according to ASHA (ASHA, 2005).

• The purpose of supervision is to lead the student clinician to levels of competency and independence (McCrea & Brasseur, 2003).

Determining Supervision Type• The supervisor must first know the student’s level of

functioning (Perkins & Mercaitis, 1995).

• Early models of supervision employed assessment of clinical, academic, personal attributes, and confidence levels to determine the competency level of student clinicians (Anderson, 1988).

• The type of supervision was then determined by the results of the assessment (Shriberg et al., 1975; Anderson, 1988; Mawdsley & Scudder, 1989).

• A formal assessment may not be conducted routinely (Smith and Anderson, 1982; Dowling, 2001; McCrea & Brasseur, 2003; Brasseur, McCrea, & Mendel, 2005; Zylla-Jones, 2006).

Purpose

• The purpose of this study was to explore current practices of supervision in speech-language pathology graduate training programs in Alabama.

The study was guided by the following questions:

1. How do supervisors determine the level of clinical independence of student clinicians before clinic practicum begins?

2. How do supervisors determine the type of supervision used with each student clinician?

3. Does the level of supervisory satisfaction vary based on the level of supervisor training?

Methodology• A qualitative research methodology was used

• A standardized open-ended interview process was used to gather the data.

• Interviews were conducted with a total of 11 supervisors at each of the 5 Speech-Language Pathology graduate training programs in Alabama

• Each supervisor completed an informed consent form prior to the interview.

• Each interview was audio recorded and verbatim transcriptions were completed.

The interviews determined:

• The method of supervision used by clinical educators

• How the level of independence of the student clinician is determined

• How clinical educators determine the level and type of supervision

• The level of satisfaction with current supervisory methods of clinical educators

Participants

• Full-time clinical educators with a Master’s degree and CCC in Speech-Language Pathology

• All had at least 3 years experience as a clinical supervisor in a university setting (the range was 3 to 34 years with an average of 12 years).

• All had worked as clinicians before becoming a supervisor ( the range was 5 to 17 years with an average of 10 years).

Data was collected primarily in the areas of:

• Understanding the supervisory process– Styles or Types of supervision– Interpersonal skills of students– Anxiety of students– Use of Goals and Objectives– Supervisory training

• Planning the supervisory and clinical process– Pre-practicum assessment of student clinicians

Data Analysis• Inductive content analysis was used to “determine

consistencies and meaning from the data.” (Patton, 2002)

• The data was coded, categorized, classified, and labeled to determine themes and patterns.

• Finding the patterns and themes within the data helped answer the research questions.

Conclusions• The pre-practicum assessment occurs

through individual conferences.

• Clinical educators do not supervise all students the same.

• Supervisory type changes as students progress.

Conclusion One

• The pre-practicum assessment occurs through individual conferences.

• Three types of conferences:– presentation of the client by the clinician– presentation of the clinician to the supervisor– a pre-practicum assessment using a form

Level of clinical independence determined primarily by

• Primary consideration was placed on the clinical information provided by the student

• The level of clinical independence was determined primarily by– Manner– Organization– Accuracy– Completeness

Behaviors and Abilities of the supervisee that may affect supervision• Anxiety• Interpersonal skills• Learning style

• Self awareness and self-assessment– Secondary considerations– Recognized as important but were not assessed

Pre-practicum clinical independence level

• Only two of the eleven clinical educators interviewed used a formal assessment before clinic.

• All eleven of those interviewed stated it was important or very important.

Pre-practicum recommendations• Create and pilot a pre-practicum assessment guideline

form • Contain elements important to supervisors and those

found in literature review

• Important information should be included but time efficiency is critical

• Knowledge, Skills, Abilities, and Behaviors

• A formative assessment to systematically and proactively lead by self-assessment and self awareness.

Conclusion Two

• Clinical educators, with and without training, do not supervise all students the same

• Supervisory type focused on the “individual needs” or ”the individual skill level” of the student.

Supervisors use different styles

• With different student clinicians– determining the

differences between two students at the same point in graduate training and supervising the two differently.

• For different levels of clinical independence– supervising the same

clinician who performed at two different levels of clinical independence with two separate clients

Conclusion Three

• Supervisory style changes as students progress– Beginning of practicum-The supervisor determines

the level of clinical independence. – Based on that estimation the level and type of

supervision is determined. – The first one or two sessions of therapy are observed. – The clinical level and type of supervision are either

confirmed or modified based on the student’s performance.

Supervision changes• # 1

– If the student is unable to adequately conduct the therapy session then supervision will be modified

– If the student demonstrates greater independence than estimated and is able to accurately analyze and explain treatment results and goals then…

• # 2– Supervisors were more direct with students that are in the beginning

levels of clinic training.

– The supervisors are also likely to demonstrate therapy for those clinicians who

• Have had no previous clinical experience• Have high anxiety toward conducting therapy• Demonstrate a low level of clinical competence.

Supervision changes• # 3

– The supervisors explained that as the students progress during the semester they generally

• provide less direct instruction • direct style changes to a collaborative style• begin asking questions aimed to

– increase problem solving and – critical thinking skills

• # 4– The supervisors described using a consultation

method for students• performing at an independent level of clinical skill • about to begin an off-campus internship

Supervisors change over time

• Supervisors described a more direct style of supervision when they first began supervising– The first few years the style of supervision was

more direct and observations were more critical

– After one to three years the style became less direct and comments more positive.

Summary

• A pre-practicum assessment occurs by a conference with the student, with criteria.

• Clinical independence level is estimated based on the manner, organization, accuracy, and completeness of the presentation.

• Supervisors do not supervise all clinicians the same but base it on the needs of the student.

• Supervisors do not use the same type of supervision the entire semester but change or modify the style

• Supervisors need more training in methods of supervision

Why did these supervisors not fit the description of the literature?

Clinical experience & Progress of the Discipline

Recommendations• Training-Education in

supervision• Developing a needs

assessment for clinical educators

• Develop a guideline pre-practicum assessment

• Closing the gap (class to clinic)

• Further research• Develop newer models

of clinical education

Infusing Research into Clinical Practice

ByJacqueline Kotas, M.A., CCC-SLP

Deanna M. Hughes, Ph.D., CCC-SLPSan Diego State University

Communications Clinic

The Job: Clinical education must provide the skills needed to evaluate and implement therapeutic techniques which are

based on sound theoretical research (Brinton & Fujiki, 2003; Gillam & Gillam, 2006).

The Challenges:• Graduate students begin their programs with varying levels of

competence in their ability to evaluate and apply research to clinical practice.

• Academic faculty cannot assume all of the educational burden for providing instruction in research-based clinical practices

• The scope of clinical practice continues to broaden, and new technologies are introduced making it difficult for academic programs to provide adequate education (Golper, 2007).

Given these challenges, how can we develop the knowledge base which will allow our students to be efficient consumers of research?

The First Step

Meet the “Researcher of the Month” Researcher and article selected by the supervisors Articles from peer-reviewed journals represented a variety of disorders and age rangesTheoretical as well as clinical articles were selected

Discuss the article during one staffing each monthSupervisors were encouraged to use the Gillam and Gillam, 2006, PICO method as a framework for the discussionDiscussions were not “micromanaged” as each supervisor had the freedom to draw their own conclusions/interpretations

Quantitative Outcomes

Graduate students were given a brief survey about their participation in the project which contained nine questions separated into three distinct areas to evaluate a) the articles b) the discussions held by the supervisors and c) personal reflection of learning by the students.

A majority of the students agreed that the articles did review evidence-based practices applicable for differing populations.

Discussion held by supervisors were positive for facilitating research into clinical education

Gillam and Gillam article was the most helpful in bridging the EBP to the clinical realm. Perhaps, because it was an additional reading of an article presented in an academic course

Qualitative Outcomes

Graduate Students

“Brainstorm ideas for my current clients”“Nice mix of articles”“Great to talk about the articles in staffing”“Only pick one article”“Should be tailored to my current client”“Concerned with the time commitment”“Supervisors assume we learn specific therapy

techniques in class and faculty assume we learn them in clinic”

Qualitative Outcomes

Supervisors“Great to read articles out of my comfort zone”

“Led to spontaneous discussions about specific clinical techniques”

“Challenging to include supervisors that have primary work sites in the community equally in the project”

Future Directions

Replicate for an additional semester

Allow students to choose the articles

Tailor articles to specific supervisors for the age range

Supervisors will continue to share conclusions/discussions

More involvement with academic faculty

Articles and Acknowledgements

We would like to thank the graduate students, supervisors, academic faculty, clinic director, and clients and families

ArticlesAustermann, S. (2007). Current directions in treatment for apraxia of speech: Principles of motor

learning. Neurophysiology and Neurogenic Speech and Language Disorders, 3-6.

Gillam, S.L., & Gillam, R.B. (2006). Making evidence-based decisions about children language intervention in schools. Language, Speech, and Hearing Services in Schools, 37, 304-315.

 Gillam, R.B., Loeb, D.F., Hoffman, LM., Bohman, T., Champlin, C.A., Thibodeau, L., et al. (2008).

The efficacy of Fast ForWard language intervention in school-age children with language impairment: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119.

Meinzer, M., Djundja, D., Barthel, G., Elbert, T., & Rockstroh, B. (2005). Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke, 1462-1466  

Turkstra, L. (2005). Looking while listening and speaking: Eye-to-face gaze in adolescents with and without traumatic brain injury. Journal of Speech, Language, and Hearing Research, 48, 1429-1441.

 Yavas, M., & Goldstein, B. (1998). Phonological assessment and treatment of bilingual speakers. American Journal of Speech-Language Pathology, 7(2), 49-60.

WORKING ALLIANCE, SUPERVISORY STYLES/ROLE AND SATISFACTION WITH

SUPERVISION OF SPEECH-LANGUAGE PATHOLOGISTS DURING THEIR FIRST YEAR OF PROFESSIONAL SERVICE

JENNIFER A. OSTERGREN, Ph.D.California State University, Long Beach

A dissertation submitted to Claremont Graduate University.Funded in part by a grant from ASHA Special Interest Division 11 (Administration and

Supervision)

Background/Rationale• New SLPs participate in supervised practice immediately following graduate

training– Required Professional Experience (RPE) for California licensure– Clinical Fellowship (CF) for ASHA certification

• According to Ramos-Sanchez et al (2002) negative supervision experiences and decreased satisfaction with supervision can influence:

– Clinical Performance– Career Choice– Career Satisfaction

• Majority of studies on supervision in speech-language pathology are more than 20 years old (McCrea & Brasseur, 2003; Ostergren, 2006)

• The field has changed greatly over the past 20 years (McAllister, 2005a; McAllister, 2005b; McCrea & Brasseur, 2003)

• Little empirical research exists addressing supervision during this first year of professional service

– Past research primarily addresses graduate students (McCrea & Brasseur, 2003; Ostergren, 2006)

• Nature and type of supervision differs for graduate students vs. those completing CFs/RPEs (ASHA, 2007f; California Speech-Language Pathology and Audiology Board, 2007)

Study Foundation• Current study utilized the key themes of past

research relative to:– Working Relationships (ASHA, 1985, 2008a, 2008c; Bernard & Goodyear, 1989;

Efstation, Patton & Kardeth, 1990; Holloway, 1987, 1995; McCrea & Brasseur, 2003)

– Satisfaction with Supervision (Friedlander & Hulse-Killacky, 2005; Ramos-Sanchez, et al, 2002)

– Supervisory Styles (Clemente, 2006; Culatta & Seltzer, 1976, 1977; Friedlander & Ward, 1984; Joshi & McAllister, 1998; Roberts & Smith, 1982)

– Supervisory Role (Anderson, 1988; ASHA, 1985, 2008a, 2008c; Clemente, 2006; McCrea and Brasseur, 2003)

Applied to the first year of professional service

Study Objectives• To describe the supervision experiences of

individuals engaged in their first year of professional service, given– Working alliance with their supervisor– Supervisory styles and predominant role assumed by their

supervisor – Satisfaction with supervision

• To describe how key variables and demographic factors (supervisor, setting, and supervisee) influence above

Participants

• 262 Individuals Surveyed – Randomly selected from 524 SLPs in California completing a

Required Professional Experience (RPE)

• 50% Response Rate (133/262)– 18 returned surveys not analyzed, given:

• 11 blank surveys• 7 completing RPE only in audiology (not speech-language pathology)

• Total of 115 surveys analyzed

Results – Participants• 94% female• Average age of was 30

– 64% between the ages of 24-28

• All were completing RPE (as required by the California SLPAB) – 93% were also completing an ASHA CF

• Average of 6.70 months at RPE– Total months at RPE, ranged from 2-12 months

• Average “Clinical” Self-Efficacy (on a scale of 1-4) was 3.24 (sd = .65)– Based on responses to a modified version of the General Perceived Self-

Efficacy Scale (GSE) (Jerusalem & Schwarzer, 2007).

Results-Setting

64.9

22.8

15.8

7.94.4

0.90

10

20

30

40

50

60

70

Private orPublic School

MedicalSetting

PrivatePractice

Other Non-ProfitOrganization

UniversityClinic

Per

cen

t F

req

uen

cy

Results - Ethnicity

70.8

8.8 6.3 5.3 4.4 1.8 0.9 0.90

10

20

30

40

50

60

70

80

Caucasian AsianAmerican

Prefer Not toState

Latino/Latina MixedEthnicity

PacficIslander

AfricanAmerican

NativeAmerican

Perc

en

t F

req

uen

cy

Results - Similarity with Supervisor• Similarities

– 76% were similar in ethnicity to their supervisor– 88% were similar in gender to their supervisor

• Differences– 77% were different in age from their supervisor

• Of these, 72% had supervisors that were older

Results – Perceptions About Supervisor’s Evaluation

72.6

25.7

1.8 00

10

20

30

40

50

60

70

80

Independent Adequate withSupport

Emerging Minimal/Not Begun

Perc

en

t F

req

uen

cy

If your RPE supervisor were to rate your clinical performance to date, he/she would likely rate your clinical skills as: 1 2 3 4 Minimal/ Emerging Adequate with Support Independent Not Begun

Results – Agreement with Evaluation

49.6

44.3

1.7 0.90

10

20

30

40

50

60

Srongly Agree Agree Disgree Strongly Disagree

Pe

rce

nt

Fre

qu

en

cy

Would you agree that the above evaluation of your clinical skill is accurate given your clinical performance during your RPE thus far: 1 2 3 4 Strongly Disagree Disagree Agree Strongly Agree

Results - Mentor StatusWould you describe your RPE supervisor as a mentor to you? No

Yes

79.1

19.1

0

10

20

30

40

50

60

70

80

90

Yes No

Pre

cen

t F

req

uen

cy

KEY FINDINGSSupervisory Role and Styles

Working AllianceSatisfaction with Supervision

Most and Least Valuable Aspects of Supervision

SATISFACTION WITH SUPERVISION

Satisfaction - Defined• Would you recommend your RPE supervisor to

someone interested in completing an RPE in the future?– Yes or No

• 4-point Satisfaction Scale– 1 = very dissatisfied– 4 = very satisfied

• Overall how satisfied are you with your RPE in general?

• Overall how satisfied are you with your RPE supervisor?

Results – Satisfaction• Participants largely satisfied with their supervisor

– Scale of 1-4, average = 3.31 (sd = .76)

• Participants largely satisfied with their RPE in general– Scale of 1-4, average = 3.30 (sd = 0.84)

• 86% would recommend their supervisor to someone else interested in a RPE

• Demographic variables not significantly and strongly related to satisfaction with supervision (including mentor status)

Results – Satisfaction Measures

• BOTH working alliance (Efstation, Patton & Kardeth, 1990) and supervisory style (Friedlander & Ward, 1984) significantly and positively correlated with satisfaction measures

• Anderson (1998) roles (direct/active, collaborative, and consultative) not significantly and strongly correlated with satisfaction measures

Supervisory Role & Supervisory Styles

Role and Styles - DefinedRole:• Anderson’s Continuum Model of Supervision (Anderson, 1988)

– Direct/Active, Collaborative, and Consultative Roles – 3-point Frequency Rating

• 1 = Most frequently utilized by my supervisor• 3 = Least frequently utilized by my supervisor

Style: • Given responses to a modified version of the Supervisory Styles

Inventory (SSI) (Friedlander & Ward, 1984) – Three Sub-Scales of Supervisory Behaviors:

• Interpersonally Sensitive subscale (e.g., intuitive, committed, resourceful)• Attractive subscale (e.g., friendly, trusting, positive)• Task-Oriented subscale (e.g., goal oriented, structured, practical)

– 4-point Frequency Rating• 1 = Never• 4 = Always

Results - Supervisory ROLE• Primarily either a collaborative or consultative

supervisory role reported – 48% reported collaborative role “frequently utilized”– 36% reported consultative role “frequently utilized”

• Demographic variables not significantly and strongly related to supervisory role

Results - Supervisory STYLES

• All three subscales of the SSI used relatively frequently

– Most frequently reported was the Attractive Supervisory Style (e.g., friendly, flexible, trusting, warm, open, positive, and supportive)

• Demographic variables not significantly and strongly related to supervisory style

• Exception to this was for an Attractive supervisory style – A moderate amount of the variance in the Attractive subscale

was predicted given a participant’s agreement with a perceived supervisor’s evaluation

3.47

3.28

3.04

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

3.6

Attractive Interpersonally Sensitive Task Oriented

Me

an

Sc

ore

s

Frequency Ratings for Subscales of the SSI (Scale of 1-4; 4=Always, 1 = Never)

WORKING ALLIANCE

Working Alliance - Defined• Dynamic relationship between the supervisor and

supervisee (Efstation, Patton & Kardash, 1990; Ladany, Walker & Melincoff, 2001; Patton & Kivlinghan, 1997)

• Given responses to a modified version of the Supervisory Working Alliance Inventory (SWAI) (Efstation, Patton & Kardeth, 1990) – Supervisee/supervisor relationship characteristics

• For example:– My supervisor makes the effort to understand me– I feel free to mention to my supervisor any troublesome feelings I might have

about him/her– My supervisor helps me to stay on track

– 4-point Frequency Rating• 1 = never• 4 = always

Results - Working Alliance• Relatively strong working alliance with supervisor reported

– On a scale of 1-4, average = 3.22 (sd = .54)

• Supervisory styles from the SSI (Friedlander & Ward, 1984) had the greatest influence on working alliance

– In particular, styles of supportive, trusting, practical, thorough, open, and goal oriented predicted a moderately strong amount of the variance in working alliance

• Anderson (1988) roles (direct/active, collaborative, and consultative) not significantly and strongly related to the working alliance

• Demographic variables not significantly and strongly related working alliance (including mentor status)

MOST AND LEAST VALUABLE ASPECTS OF SUPERVISION

Most and Least Valuable Aspects of Supervision - Defined

• Open Ended Questions– How would you describe the relationship with your RPE

supervisor?– What elements of this relationship do you find most

valuable?– What elements of this relationship do you find least

valuable?

• Most and least valuable aspect questions subjected to a content and theme analysis

Results – MOST Valuable• 94% of participants responded to this question

– 52% of responses fell into one of three themes:

• Supervisor’s Expertise (24%)– “I value her 20+ years of experience”– “She is a good resource for materials and practical experience” – “Her many years of experience”

• Supervisor’s Openness and Approachability (19%)– “I never feel that I can’t talk to her about anything”– “She is available to answer my questions when I need her” – “I find it comfortable and easy to call on her at any time”

• Nature of Supervisor’s Feedback (Positive) (9%)– “Her concrete suggestions”– “Excellent written feedback on sessions/clients”– “She is very encouraging to me….she also gives excellent feedback on report

writing”

Results – LEAST Valuable• 77% of participants responded to this question

– 47% of comments fell into one of two themes:

• Limited Interactions with Supervisor (29%) – “My supervisor is very busy and has a full schedule so it is difficult for her to

see me actually doing therapy”– “She is in a different district and we are hardly in contact when she is on-site” – “She is very busy and we don’t have time to consult regarding our clients”

• Nature of Supervisor’s Feedback (Negative) (18%) – “She suggests things that I don’t have time to implement”– “My supervisor has a tendency to be overly critical at times,” – “The intensity of criticism is … overwhelming”– “She is critical and very picky,”– “At times the solutions to certain situations are presented to me without my

clinical opinion being taken into consideration”

Cautions and Limitations• Potentially Biased Nature of Sample

– Future studies will be needed to address potential biasing of responses• Completely anonymous survey• Retrospective study (immediately following RPE)

• Perceptions vs. Actual Performance– Future studies are needed to assess actual behaviors of supervisors in relation

to supervisee perceptions AND actual performance of supervisees in relation to supervisor behaviors

• Supervisor/Supervisee Dyads– Future studies are needed to compare responses of supervisees to those of

supervisors in a given dyad

• Measurements of Mentor Status– Future studies are needed utilizing a continuous variable for mentor status,

including definitions of the term “mentor”

References• American Speech-Language-Hearing Association. (1985). Clinical supervision in

speech-language pathology and audiology. Asha, 27, 57-60.• http://www.asha.org/about/publications/leader-online. • American Speech-Language-Hearing Association. (2007f). Membership and

certification handbook of the American Speech-Language-Hearing Association (For Speech-Language Pathology). Retrieved June 10, 2008, from http://www.asha.org/about/membershipcertification/handbooks/slp/slp_standards.htm.

• American Speech-Language-Hearing Association. (2008a). Clinical supervision in • speech-language pathology [Technical Report]. Available at

http://www.asha.org/policy. • American Speech-Language-Hearing Association. (2008c). Knowledge and skills • needed by speech-language pathologists providing clinical supervision.

[Knowledge and Skills]. Available at http://www.asha.org/policy. • Bernard, J., & Goodyear, R. (1998). Fundamentals of clinical supervision (2nd ed.).

Needham Heights, MD: Allyn & Bacon.

References• California Speech-Language Pathology and Audiology Board (2007). Laws and • regulations relating to the practices of speech-language pathology and audiology.

Retrieved June 10, 2008, from http://www.slpab.ca.gov/board_activity/laws_regs/index.shtml.

• Clemente, C. (2006). The relationship between perceived supervisory roles, styles and working alliance and students’ self-efficacy in speech-language pathology practicum experiences. Ann Arbor, MI: UMI Microfilm.

• Culatta, R., & Seltzer, H. (1976). Content and sequence analysis of the supervisory session. Asha, 18, 523-526.

• Culatta, R., & Seltzer, H. (1977). Content and sequence analysis of the supervisory session: A report of clinical use. Asha, 523-526.

• Efstation, J., Patton, M., & Kardash, C. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37(3), 322-329.

• Fernando, D., & Hulse-Killacky, D. (2005). The relationship between supervisory styles to satisfaction with supervision and the perceived self-efficacy of master's-level counseling students. Counselor Education and Supervision, 44(4), 293-305.

References• Friedlander, M., & Ward, L. (1984). Development and validation of the supervisory

styles inventory. Journal of Counseling Psychology, 31(4), 541-557.• Holloway, E. (1987). Developmental models of supervision: Is it developmental?.

Professional Psychology: Research and Practice, 18(3) 209-216.• Holloway, E. (1995). Clinical supervision: A systems approach. Thousand Oaks, CA:

Sage.• Jerusalem, M., & Schwarzer, R. (2007). The General Self-Efficacy Scale (GSE). • Retrieved June 10, 2008, from http://userpage.fu-berline.de/health/engscal.html. • Joshi, S., & McAllister, L. (1998). An investigation of supervisory style in speech • pathology clinical education. The Clinical Supervisor, 17(2), 141-155.• Ladany, N., Walker, J., & Melincoff, D. (2001). Supervisory style: Its relation to the

supervisory working alliance and supervisor self-disclosure. Counselor Education and Supervision, 40(4), 263-275.

• McAllister, L. (2005a). Issues and innovations in clinical education. Advances in Speech-Language Pathology, 7(3), 138-148.

References• McAllister, L. (2005b). Issues, innovations, and calls to action in clinical education:

A response to Kathard, Lincoln and McCabe, Rose, Cruice, Pickering, Van Dort, and Stansfield. Advances in Speech-Language Pathology, 7(3), 177-180.

• McCrea, E., & Brasseur, J. (2003). The supervisory process in speech-language pathology and audiology, Boston, MA: Pearson Education.

• Ostergren, J. (2006). Clinical supervision in speech-language pathology: Profiles and

• perceptions. Unpublished paper.• Patton, M., & Kivlinghan, D. (1997). Relevance of the supervisory alliance to the

counseling alliance and to treatment adherence in counselor training. Journal of Counseling Psychology, 44(1) 108-115.

• Ramos-Sanchez, L., Esnil, E., Riggs, S., Wright, L., Goodwin, A., Touster, L., et al.(2002). Negative supervisory events: Effects on supervision satisfaction and supervisory alliance. Professional Psychology: Research and Practice, 33(2), 197-202.

• Roberts, J. E., & Smith, K. J. (1982). Supervisor-supervisee role differences and consistency of behavior in supervisory conferences. Journal of Speech and Hearing Research, 25, 428-434.

Contact Information

• For questions regarding this study, please contact:Jennifer A. Ostergren, PhDDepartment of Communicative DisordersCalifornia State University, Long Beach1250 Bellflower BoulevardLong Beach, CA [email protected]

Development and Validation of a Professionalism Scale

for Speech Language Pathology Students

Pam Mitchell, Ph.D. CCC-SLP1

Erin Redle, Ph.D. CCC-SLP2,1

Kate Krival, Ph.D.CCC-SLP1

Lisa Audet, Ph.D. CCC-SLP1

Kent State University1

Cincinnati Children’s Hospital Medical Center2

THANK YOU

This work is supported by a grant from SID 11

Background

• Professionalism is a critical component of practice in speech language pathology

• Difficult to establish an agreed upon definition (Wear & Kuczewski, 2004)

• Now a required measure for ASHA certification; no agreed upon measure of professionalism– Challenge for students and supervisors

Objectives

1. Develop a scale to assess aspects of personal dispositions and professional behavior in speech language pathology graduate students

2. Design and conduct a validation study on the scale developed

Research Questions

1. What are key aspects of professional behavior and personal dispositions in students majoring in speech language pathology?

2. What valid and reliable indicators can be utilized as a Professionalism Scale for preservice programs in speech language pathology to assess student dispositions and professional behavior relevant to acquisition of ASHA certification competencies?

Overview of the Scale Development

Professionalism Scale

Phase 1: Defining Professionalism

Phase 2: Expert Review

Phase 3: Field Testing

Phase 1

Professionalism Scale

Phase 1: Defining Professionalism

Phase 2: Expert Review

Phase 3:Field Testing

Phase 1

• Participants– Clinical supervisors with at least 5 years of

experience– Purposeful sampling

• Geography• Clinical settings

Phase 1: Methodology

Data collection– Qualitative methodology– n~ 10– Semi-structured interview guide – Interviews completed by all investigators– Interviews transcribed in Word and transferred to

NVivo for coding

Phase 1: Methodology

Data Reduction: Content Analysis (Patton, 2002; Berg, 2004)

• Free coding• Code reduction and codebook development• Data recoded with final set of codes• Frequency counts obtained for final codes

• Multiple investigators will recode for triangulation

Preliminary Results of Coding

• Appropriate dress• Appropriate conversational topics• Recognizing one’s own limitations• Critical thinking in clinical situations• Asking supervisor relevant questions• Comfort with asking questions• Interaction with patients/students• Interaction with family members

Preliminary Results of Coding

• Flexibility• Honesty• Showing initiative• Time management• Timeliness• Willingness to learn• Documentation

– Quality– Timeliness of documentation

Scale Development

• Initially 30-50 items • Developed from qualitative results, expert

opinion, and previous research• Response measure is a 7 point Likert-scale

Phase 2:

Professionalism Scale

Phase 1: Defining Professionalism

Phase 2: Expert Review

Phase 3: Field Testing

Phase 2: Methodology

Participants• Professional experts (n=5-10)

– Clinical supervisors from around country– Purposeful sampling

• Advanced graduate students (n=5-10)– Various schools around Ohio– Purposeful sampling

Phase 2: Methodology

• Professionals and students provided with a modified version of the scale

• Asked to indicate level of agreement regarding the validity of each item for measuring professionalism as well as the clarity of each item

• Also provided with open ended questions regarding missing scale items, administration burden

SCALE STATEMENT(e.g. The student is dressed appropriately for

clinical setting)

Please indicate if the meaning of this question was clear to you?

Yes No

1 2 3 4 5

Phase 2: Data Analysis

• Frequency counts of Likert-statement items• Subjectively reviewed all data including

statements for clarity, suggestions for additional items

• SCALE WILL BE REVISED AS NEEDED

Phase 3

Professionalism Scale

Phase 1: Defining Professionalism

Phase 2: Expert Review

Phase 3:Field Testing

Phase 3: Methodology

Participants• Supervisors and graduate students from

multiple universities– Goal is even distribution between the two

• Will collect basic demographic data, including clinical setting

Phase 4: MethodologyData Analysis• Missing data and item distribution

– Descriptive statistics

• Item-total correlation– Individual to total Pearson correlation

• Factor analysis/Principle Component Analysis– Exploratory factor analysis

• Internal consistency– Cronbach’s

Future Research

• Concurrent validity– Determine how professionalism compares to

other measures of success for students

• Sensitivity to measure growth and development of students over time

Contact Information

• Erin Redle– [email protected]

• Pam Mitchell– [email protected]

• Kate Krival– [email protected]

• Lisa Audet– [email protected]

FUTURE OF SUPERVISION RESEARCH

• Questions???