TACES Presents: Development, Evaluation, and (When … · TACES Presents: Development, Evaluation, and (When Needed) ... a positive working alliance ... terminating sessions, ...

TACES Presents: Development, Evaluation, and (When Needed) Remediation of LPC Interns

Marcella Stark, Ph.D., LPC-S

Texas Christian University

[email protected]

Kate Walker, Ph.D., LPC-S, LMFT-S

[email protected]

Agenda

Morning (8:30-12:00)

Introductions and Overview

Learning Objectives

Developing a Supervision Plan

Evaluation

Lunch (12-1:30)

Afternoon (1:30-4:45)

Remediation

Documentation

Practice

Learning Objectives

Understand elements of a supervision plan and be able to develop appropriate goals and objectives.

Describe time requirements and appropriate methods for supervision.

Identify evaluation methods to assess both counselor development and effectiveness of supervision methods and techniques.

Understand administrative tasks required of LPC Supervisors.

Your Views of Supervision

How do you establish rapport?

What areas are important for counselor trainee growth?

How do you facilitate that growth?

What was your experience with LPC supervision? What would you want to do differently?

What is good supervision?

Overholser (2004) suggested that good supervision includes the following:

a positive working alliance

direct feedback to supervisees

Socratic questioning to help supervisees reach their own conclusions

assessing the needs of the supervisee and tailoring supervision accordingly

If you fail to plan, you are planning to fail.

--Benjamin Franklin

Trainees equate supervisor effectiveness with a comprehensive supervisory plan (Leddick & Dye, 1987).

“The antithesis of planning occurs when a supervisor accepts a supervisee, sets weekly appointments with the supervisee, and lets things just happen “ (Bernard & Goodyear, 2004, p. 186).

Elements of a Supervision Plan

1. Teaching, training, and consultation

2. Monitoring and accountability

3. Work design and coordination

4. Communication and linkage within agency and with external resources

--adapted from Hardcastle (1991), cited in Bernard & Goodyear’s Fundamentals of Clinical Supervision

Teaching

Case presentations (typically include video)

o Simple discussion and feedback

o Steps of particular model (e.g., Egan’s skilled helper model, stages of change)

o IPR (Kagan, 1980)

o Experiential (e.g., sandtray)

Didactic

Roleplay

Monitoring

Reported behaviors by intern

Co-counseling

Live supervision

Review of progress/case notes

Review of recorded sessions (audio)

Review of recorded sessions (video)

Work Design

Logistics – When and where will you meet? Communication with site? Triadic or group? Fee arrangements?

How will you conduct the following?

• Review of counseling competencies

• Evaluation

• Goal setting

• Monitoring

Communication with Other Entities

Develop referral resources

Share these with supervisees

Help supervisee develop skills in creating his/her own list

Activity

Describe the last time you received critical feedback or an evaluation of your clinical work.

How was the feedback delivered?

What were your reactions?

Importance of Evaluation

Determines your approach to supervision

Supervisee growth and skill building

Supervisee integration of theory into practice

Supervisee self exploration

Supervisee work satisfaction and professional identity

Difficulties with Evaluation

Sometimes viewed as a necessary evil

Supervisors are trained as counselors

Accept clients’ limitations

Respect clients’ goals

Facilitator of another’s change, not a decision maker about what change is necessary

Working conditions of supervision reflect those in therapy

How do you define clinical competence anyway?

Defining Clinical Competence

Knowledge and skill standards

Accrediting body

Regulatory bodies

Training institutions

Program values

Research

Nonspecific factors such as personal characteristics

Evaluation Criteria

Factual Knowledge

Generic clinical skills

Orientation-specific skills

Clinical judgment

Interpersonal attributes

Multicultural competence

Supervisee theory of choice

Focusing on one aspect of clinical expertise

Initial interview

Evaluation Criteria

Regardless of what criteria are chosen, the Formative and Summative evaluations

Should relate directly to these same criteria

Should be introduced early in the relationship

Should serve as teaching-learning objectives

Should be used as the basis for feedback throughout supervision

Formative Evaluation

Represents the bulk of evaluation

Stresses process and progress rather than outcome

Ongoing

All behavior is communication

Constant coding and decoding

Summative evaluation

Moment of truth – how does the trainee measure up?

Must be clear criteria

Supervisee must be aware of criteria

Summative evaluations may become stressful if there is a disconnect

What have you used?

By what standards have you been evaluated?

So what are the counseling competencies?

One example taken from F. Thomas’s (2012) Solution-Focused Supervision

Case Management: Writing consistent case notes, complying with ISD/agency policies

Therapeutic Relationships: Conveying warmth, respect; use of self

Perceptual Competencies: Ability to observe patterns, see nonverbal behavior, distinguish content/process, self-awareness

Conceptual Competencies: Ability to think within the assumptions of your model, ability to base clinical work (goals, interventions, termination) on model/theory, ability to incorporate idiosyncratic, gender, and cultural aspects

Participatory Competencies: Changing your approach when stuck, controlling when exchanges are nonproductive or chaotic, terminating sessions, follow through with homework

Domains of Stoltenberg & McNeill’s (2009) IDM

Intervention skills

Assessment techniques

Interpersonal assessment

Client conceptualization

Individual differences (both cultural and personality)

Theoretical orientation

Treatment plans and goals

Professional ethics

Others?

Those endorsed by ACA and other professional organizations

o Advocacy Competencies

o ALGBTIC Competencies

oCareer Counseling Competencies

oMultcultural Competencies

See http://counseling.org/knowledge-center/competencies

Favorable Evaluation Conditions (Bernard & Goodyear, 2014, p. 226-229)

Respect power differential in relationship

Clarity in role (expectations) & structure by both parties

Evaluation specifics discussed in advance

Address, attend to, and explore defensiveness & individual differences

Mutual & continuous process

Need a competent and reliable administrative structure

Avoid prejudging

Continue to vicariously mentor through your own professional development

Honor & monitor the relationship

Unfavorable Conditions for Supervision

Dismissal and lack of awareness of the trainees’ thoughts and feelings

Lack of empathy and support

Not providing comfort and/or safety in supervision

All support or all challenge

Expression of anger toward supervisee

Moody

Unwilling to share responsibility for supervision

Inappropriate self-disclosure

Supervisors Must…

Remember supervision is an unequal relationship

Provide clarity if a dual role exists

Will supervisor be making decisions regarding supervisee’s job or academic progress?

Who will be privy to supervisee’s progress?

Clarify supervisee roles and expectations

Address supervisee resistance openly

Teach supervisee how to receive corrective feedback

Supervisors Must

Address individual differences openly

Involve the supervisee in determining what is to be learned

Supervise in a supportive administrative structure

Be organized!

Avoid making quick evaluations

Foster an atmosphere of competence rather than recognizing stars and focusing on initial impressions

Supervisors Must

Invite feedback and model continuing education

Always keep an eye to the relationship

Keep a plan in place in case of personality incompatibility

It is the supervisee’s right to trust the supervisor

Enjoy Supervising!!!

Remember

Supervision is voluntary!

Your supervisees have a real life!

Confusion is normal and “not knowing” is a prerequisite for arriving at new insights

Supervision is a safe place

You give your supervisees permission to challenge = Growth

The Evaluation Process (Bernard & Goodyear, 2014, pp. 230-241)

Supervision Contract – negotiate

Methods of evaluation – choose multiple methods

Choosing evaluation instruments

Attend to developmental process

Feedback messages are seen in terms of both clarity and context

Encourage self-assessment

Subjective – intuition (similar, familiar, priorities)

Evaluation Instruments

See examples in Dropbox folder

Most commonly used: Likert scale or anchored rubric and some open-ended questions

SPAI

Evaluation criteria based on five categories

1. Skill development (interventions)

2. Case conceptualization

3. Personalization (as defined by Bernard’s (1979) Discrimination Model)

4. Professional issues

5. Supervision skills (for the supervisee)

(Fall & Sutton, 2004)

SPAI

Evaluation scale example

A. I have not been trained in using this skill

B. I seldom use this skill

C. I use this skill often

D. This is a skill that does not fit my model/style

E. I am comfortable using this skill

F. I am uncomfortable using this skill

G. I would like additional information and training on this skill

(Fall & Sutton, 2004)

Consequences of Evaluation

Job choice or promotion

Anxiety

Stress on the supervisory relationship

Negative evaluation

Require more documentation

Possibility of an appeal

Legal issues

Chronic Issues with Evaluation

Dual roles

Peer evaluation as administrative evaluation?

What percentage of development is due to supervision? Does this affect evaluation?

Did the supervisor teach the skills they are trying to evaluate?

Are evaluations based on skill development or the relationship between the supervisor and supervisee?

To what extent is supervision reflecting licensure requirements and client needs?

Chronic Issues with Evaluation

Subjective obstacles

Similarity and dissimilarity

Age, appearance, life cycle stage, stressors

Liking and not liking

Familiarity and first impressions

Egocentric bias – what is important to you?

Rater inconsistencies (superior, average, inferior)

Communicating Formative Feedback

Clear

Owned

Regular

Balanced

Specific

Communicating Summative Evaluations

Should contain no surprises

Provide material for the next period of time until the next summative evaluation

Problems occur when:

Supervisor’s style of communication is clouded

Process is ambiguous

Criteria is ambiguous

Supervisor is uncomfortable with the responsibility of the evaluation

Inadequate amount of formative evaluation

Relationship issues

Special Evaluation Issues

Impairment

Incompetence

Remediation

Note: Remediation will be covered in more detail in our course ‘Gatekeeping and Remediation’

Evaluation of Supervision

See examples in Dropbox folder

These types of evaluations can be done periodically to get feedback from supervisees

Helpful to gauge effectiveness

Great discussion starters

Gatekeeping

When Remediation is Needed

Nope, you can’t just fire your supervisee.

Impairment v. incompetence

§681.93. Supervisor Requirements (e)(4)

If a supervisor determines that the LPC Intern may not have the counseling skills or competence to practice professional counseling under a regular license, the supervisor shall develop and implement a written plan for remediation of the LPC Intern.

Problematic Behavior (Lamb et al., 1991)

Supervisee does not acknowledge or understand

Not a simple skill deficit

Has potential ethical or legal consequences

Negatively affects services and spans several areas of professional functioning

Does not improve with feedback, remediation, or time

Supervisor spends a disproportionate amount of time addressing the issue/supervisee

Professional Development Plans

See examples in Dropbox folder

Time Requirements

§681.92. Experience Requirements (Internship) (g) requires

A minimum of four hours per month (averaging once per week)

of face-to-face or live Internet webcam supervision

in individual (up to two Interns) or group (three or more) settings

for each week the intern is engaged in counseling

Don’t get carried away!

No more than 50% of the total hours of supervision can be live Internet webcam supervision

No more than 50% of the total hours of supervision may be received in group supervision.

No more than 50% of the total hours of group supervision may be live Internet webcam supervision.

Info for Supervised Experience Documentation Form

the inclusive dates of the supervised experience and the total number of hours of practice;

the number of hours of weekly face-to-face supervision given to the applicant, the total number of supervisory hours received by the applicant in the experience, and the types of supervision used

the types of clients seen and counseling methods used;

the supervisor's evaluation of the applicant's counseling skills and competence for independent or private practice

Administrative Tasks of LPC-Ss

Initial and final paperwork

Supervisory Agreement w/ copy of supervisor’s renewal card attached

Supervised Experience Documentation Form

Ongoing Supervision Log

Maintain and sign a record(s) to document the date of each supervision conference and document the LPC Intern's total number of hours of supervised experience accumulated up to the date of the conference.

The record shall reflect the site where the hours were accrued and the content of the session.

And the scary part . . .

§681.93(e) The full professional responsibility for the counseling activities of an LPC Intern shall rest with the intern's board approved supervisor(s). If the LPC Intern receives disciplinary action by the board the supervisor may also be subject to disciplinary action.

(1) The supervisor shall ensure that the LPC Intern is aware of and adheres to Subchapter C of this chapter (relating to Code of Ethics).

So what do I do first?

Expectations that need to be discussed in the initial supervisory session:

1. Identify the supervisee’s supervision goals. Collaborate to determine areas for professional growth

2. Discuss supervisee contribution—how might supervisee prepare for supervision?

3. Formal and informal evaluation; provide copy of evaluation instrument.

4. Structure and nature of supervision sessions.

Roleplay

an initial supervisory session

Don’t forget to document!

Enter the mock supervisory session you just had into your

supervision log.

Questions?

Assessment

????