Training Practicum Supervisors in the Community

1. Training Practicum Supervisors in the Community Deborah Lewis, Ph.D. NCSPP Mid-winter Conference January, 2007

2. Discussion Presumptions • That institutions are developing practicum supervisors in the community in private practice, agencies, hospitals, etc. (only or in addition to In-house clinics). • Typical model is that most practicum supervisors are not paid (open for discussion). • Thinking long-term (several years out). The initial set-up of sites is not the only issue. • Interested in developing supervisor competence and decreasing supervisor attrition/burnout. • Approaching this as a developmental process for supervisors, students and the institution.

3. Discussion Presumptions • Practicum experiences are an integral part of the overall training of graduate students and should be incorporated into the curriculum. • Good supervision matters in preparing psychologists. • Training departments should have the active support of their institution and faculty and the respect of students and community. • There are particular skills necessary for a DOT/DPT. • Developing and maintaining supervisors is very time intensive and the process is worthy of that expenditure.

4. Context of the discussion • Qualitative reflections on a successful process at Argosy University/Phoenix that developed over several years. • About the art of directing clinical training. • I am a member of a three person training team (which developed over time from one person), a six member training committee and a twelve member faculty that is active in the training process.

5. First you need good people and a commitment • The process of clinical training involves: clients, students, supervisors, faculty, training team members and agencies. It is a complex and dynamic process involving more than just the DOT/DPT. A training team or committee will work better than one person alone. • The process requires training team members to: enjoy community involvement, manage complex interpersonal, inter-agency issues, handle conflict, perform gatekeeping functions, develop policy, stay abreast of laws and regulations regarding supervision (advocacy).

6. Developing Good Supervisors • Do not assume psychologists know how to supervise. • Supervision is a particular skill, different from teaching, therapy or administration. Someone may be great clinician or administrator, but not a great supervisor. • Many supervisors: • Have never had a formal course in supervision. • Have not had any formal training or continuing education in supervision (some states require this, some do not). • Have never been supervised in supervising. • Have, as their only model of supervision, how they were supervised as a trainee years before.

7. Developing Good Supervisors • Developing into a good supervisor is a process parallel in many ways to becoming a therapist: it takes time and specific training. • It also takes time to learn about supervisors. Some will be better with advanced students, some with new students, certain types of students, etc. and this can all change over time. • It is helpful to offer basic teaching and resources specifically on supervision (National Register Report, articles on supervision, specific training of models of supervision).

8. Helping Supervisors • Understand what is an appropriate developmental level for a first year practicum student, second year, etc. Remind supervisors we all knew next to nothing when we started. Students need practice in basic skills. (ADPTC paper) • Differentiating developmentally appropriate non-competence from problematic. • Setting up structures for supervisors to develop and exchange ideas to remediate supervisory problems and to cultivate competency (time for supervisors to meet each other & meet with faculty).

9. Helping Supervisors • Role modeling a competency, skill based developmental learning process with supervisors that they can translate to work with the students. • Accurately evaluate students (supervisors are reluctant to gate-keep, faculty needs to lead). Often supervisors need support in documenting a poor evaluation, even when very deserved. • Utilize faculty with supervisory experience or very experienced supervisors as mentors or educators for new or less able supervisors. • Have an identified faculty member to go to for help.

10. Helping Supervisors • Participate actively with the practicum site (on-going site visits, on-going communication, designating them clinical adjunct faculty, etc.) . • Help them understand the requirements of the program (comprehensive exams, taping, supervision, APA, ADA & FERPA issues). • Understand their own liability and risks and manage them well without undue anxiety (consulting, training, let them know they are not alone as supervisors or as practitioners).

11. Appreciating Supervisors Offering payment or in-kind such as: • Free continuing education, • Free classes/auditing/re-specialization • In-services at their site • Database access & library resources • Access to assessment materials • Clinical adjunct faculty status • Support as part of a larger network (for supervision & practice) • Faculty consulting/supervisor mentoring • Allowing them influence (Put them on advisory boards)

12. Using NCSPP competency areas (+some) in supervisor training • NCSPP Competency Areas • Relationship • Assessment • Intervention • Research & Evaluation • Diversity • Consultation & Education • Management & Supervision • Ethics • Advocacy • Other Issues related to state requirements • Domestic Violence

13. Relationship, Assessment & Intervention • Talking to supervisors about NCSPP competency areas lets them know the areas we are trying to develop in students • Most psychology students are already good at relationship in general, expectations can be high • Some supervisors prefer to emphasize either therapy interventions or assessment. Playing to your supervisor strengths is beneficial.

14. Research & Evaluation • Practicum sites can be great places for students to gather research data, perform surveys. • Supervisors can be ideal dissertation or research project committee members. • Need to notify them of consent and institutional review board requirements. • Need to clarify publication credit rules, etc.

15. Consultation & Education • Often mutually beneficial for students to perform in-services/training to sites (sometimes as class assignments). • Students can create consultation proposals that fill needs of practicum sites (program models). • Students or supervisors can address the school regarding information about the practicum site (population, types of interventions, orientation).

16. Management & Supervision • Many psychologists (4 of 20 U.S. Dept. of Labor Statistics) are in private practice. • More psychologist are in supervisory, management and administrative roles (many learned on-the-job). • Important issues in running a private practice (finances, insurance panels, billing etc.) are often not part of the curriculum but can be learned at the practicum sites.

17. Issues of Diversity & Cultural Competence • Recruit supervisors for diversity. Ask them. Be clear that you perceive their diversity as a plus. • Recruit sites for diverse clientele. • Specifically train supervisors in cultural competence. Do not assume they are familiar with diversity issues. Do not assume they are “open” to working with diverse students. • Consider policies that promote bi-lingual/bi-cultural training (that appreciate the strengths of supervisors and students).

18. Issues of Ethics and Law • Keep supervisors informed of new laws, rules, codes & state board regulatory processes to: • “Up the bar” in the community, • To have consistent teaching for students, • Do not assume supervisors know or practice what you expect students to know or practice. • Keeping supervisors “in the loop” with information is a win-win. They are more informed and the school is the go-to place for information. • It’s hard to keep abreast of all the information.

19. Advocacy & state requirements • It may be important for program faculty/training departments to stay aware of and deal directly with legislative & board regulations regarding supervision. • If the state requires continuing education for licensure, offer it. (Getting APA sponsorship approval helps). You can also sponsor other organizations to offer needed training. • If the state requires continuing education to supervise, offer it.

20. Seeing the “Bigger picture” • Often, supervisors initially think that being a supervisor is only about training students and of “them” doing something for “us”. • Helping supervisors understand that they are doing a great service, but also we are providing for them helps maintain sites: • Scrutiny (institution & student) tends to increase quality and growth • Networking (not being alone especially in private practice-being part of a community) • Information (Keeping supervisors abreast)

21. Using Feedback Constructively • Collecting data on supervisors from faculty site visits, DOT/DPT, students, monitor student outcomes and then act on the information • Gather information on “remediation” attempts for students and for sites • Getting supervisor feedback into the curriculum planning loop (allowing influence) • Showing supervisors the student outcome data so they can use the information

22. Dealing with problems: an opportunity • Maintaining close ties with the sites will allow earlier detection of difficulties. Early intervention is better. • Most difficulties have interpersonal components (even if they involve skill deficits). • Interpersonal conflicts are complex and often come from resentment about unmet expectations/failure to follow through. Students are anxious, supervisors have expectations, and that is fertile ground for conflict. • If you already have a working relationship with a supervisor, if you have made supportive gestures before a problem arises, you have a better chance of maintaining the site even with a serious student or supervisor problem.

23. Training students helps the supervisors and the program • Training students in being good “supervisees” (which includes when and how to handle problematic supervisors) • How to address issues with supervisor • How to address site issue with faculty (practicum seminars are ideal) • How to take an issue to DOT/DPT

24. Training students helps the supervisors and the program • Training students in supervision helps them understand the process of supervision (and things will be better in the future when alumni begin to supervise). • Prepare students well for the first practicum (basic skills of interviewing, assessment). • Try and have a process where students who are not ready for practicum postpone it.

25. Making good matches • Know the students (get information on their strengths/weaknesses/personality style) before the match process. • Some supervisors are good with certain types of students. If the “matching process” can include supervisor styles and student styles in addition to training needs & wants, Some supervisors are good with certain types of students. If the “matching process” can include supervisor styles and student styles in addition to training needs & wants-some problems may be thwarted. Matching by student wants is not enough. • Understand the site settings and site needs.

26. Maintaining Practicum Sites • Try & have enough sites that you don’t need to keep poor or unwilling supervisors. Some sites cannot or should not be salvaged. • Don’t overload supervisors with too many students, all the challenging students or too much paperwork for the program. • Use secondary supervisors when appropriate (other certified or licensed professionals).

27. Maintaining Practicum Sites • Have clear, written, published policies regarding practicum requirements for students and supervisors that are readily available. • Have clear deadlines and be consistent. • Consider websites or other ways to have training manuals, exam manuals, logs of hours.

28. Monitoring Supervision • Practicum seminars are helpful in monitoring student progress through supervision. • Comprehensive exams that have tapes or use of tapes in classes can help determine if students are progressing in their skills with supervision. • Site visits are very useful (documentation by faculty is helpful especially over time & with multiple students)

29. Gatekeeping is part of the job • Take documented, remedial actions with students who perform poorly on sites (involve the site). • Be willing to consider taking more serious actions with student’s act egregiously or who do not change, such as dismissal. (clear, written, published policies). • If the supervisor acts egregiously, be willing to consider options with a student including pulling a student from a site or even legal/board action for serious conduct of a supervisor.

30. Keeping supervisors happy, involved & developing • Training and workshops (Address supervision, ethics, cultural competence, supervision and the needs of supervisors for state licensure). • Email and ongoing communication, free stuff and the training to use it (databases, access to inform practice with research, library resources, classes, auditing class sessions, having them guest lecture). • Free food when they come for training • In-services for sites

31. Tips on keeping supervisors happy, involved & developing • Faculty consulting • Faculty interaction • Clinical adjunct status (some are also adjunct) • Time for networking among supervisors (panel/small group discussions/lunches) • Site visits (being heard, being part of the process, time to learn). • Their first invitation to school shouldn’t be the APA site visit

32. Some Resources • Hatcher, R. & Lassiter, K. (2004). The Association of Directors of Psychology Training Clinics (ADPTC) Practicum Competencies Workgroup, Report on Practicum Competencies. • O’Donohue, W. (1999). Management and Administration Skills for the Mental Health Professional (Practical Resources for the Mental Health Professional) Academic Press. • Sacuzzo, D. (2003) National Register Psychologist’s Legal Update: Liability for Failure to Supervise Adequately: Let the Master Beware (There are two parts). • Texts on Supervision Models (Developmental Models) • State rules and regulations governing supervision