Off-Campus Supervision: Twelve Balls in the Air and Clinical Education Too!

1. Off-Campus Supervision: Twelve Balls in the Air and Clinical Education Too! Seton Hall University October 28, 2010 Elizabeth McCrea, Ph.D, CCC-SLP Indiana University Wren Newman, SLP.D., CCC-SLP Nova Southeastern University

2. We welcome you…. • We join the faculty at Seton Hall in appreciation of YOU! • We hope to provide you with information that will enhance your supervisory experience

3. Audience • How many of you are students? • How many of you supervise: • Graduate Students • SLPAs • Clinical fellows • Other professionals • Support staff

4. Topics to be covered: • Current state of supervision in the field • Individual differences and the supervisory process • Components of Supervision – the continuum, supervision style • Understanding the process so it works for you • Ethical aspects of supervision

5. We will begin with the juggling… Issues in Clinical Education (McAllister, 2005) • You come to supervision at a time of tremendous change • Changes in workplaces of SLPs –demands to increase productivity, complex cases, need to increase family involvement • More “business model” mindset in clinical service provision • Standards required by accrediting bodies, licensing boards and professional associations (ASHA standards – CFCC)

6. Increased focus on specialization-sites may feel population is not diverse enough for student training. • Traditional setting is increasingly rare, students need to be trained in teaming, working with other professions and in different settings. • More SLPs work part-time - creates need for flexible placements. Per diem mindset – how does it impact the supervisor’s commitment to the supervisee? • Will we accept that competence can be developed and demonstrated in a range of ways?

7. Now, • Continued use of possibly “outdated” approaches to clinical education • Preparation and support for clinical educators • Challenge of the standards with regard to critical thinking and formative assessment means that clinical educators can no longer consider observation and evaluation as their primary tasks. • Supervisors must understand the process of supervision and clinical education, their role in it, and be prepared to use both elements to meet needs of students.

8. Individual differences/diversity • There is a lack of research on the effects of multiple group memberships and supervision (there is actually little research on supervision and individual differences). • We are all members of multiple groups (gender, ethnicity, spiritual, etc). • There can be differences in background, values, appearance, race, gender, age, sexual orientation.

9. Gender differences • Supervisees frequently have different expectations of male and female supervisors. • Differences are noted in communication patterns. • Men interrupt women more than women interrupt men.

10. Gender differences continued… • Both male and female supervisors are more likely to tell their female supervisees what to do (Granello, Beamish & Davis, 1997). • Supervisees may have different expectations of male and female supervisors (Borders & Leddick, 1987).Expectation - female supervisor more nurturing or communicate a greater sense of caring than male supervisors. • Expectation of male supervisors - rely less on relationship variables and focus more on the supervisee's actions.

11. Racial/Ethnic Differences • Perception is that this difference is becoming less of an issue • Can result in lack of understanding of individual academic needs, part of which are the same among all students and part of which are unique to each particular culture. • Of primary concern - can difference result in negative impact on the professional growth and skill development progress of the supervisee (Arkin, 1999).

12. Persons with Disabilities and Supervision • Supervisors are required to reasonably accommodate supervisees with disabilities unless the disability results in undue hardship to either. • In general, reasonable accommodation is a work modification that provides the individual with a disability an equal opportunity to apply for or perform the essential functions of a job. • Under ADA, an undue hardship is present when it would be significantly difficult for the business to reasonably accommodate the supervisee. • The question is – how do you define reasonable?

13. Persons with Disabilities and Supervision Continued • Supervisors may find themselves facing liability if there is unequal treatment of supervisee with a disability. • May include feelings by the individual with a disability of behaviors of exclusion or hostile treatment. • In many cases, individuals who need help, do not ask for it. Could be hesitant to ask for accommodation for fear of negative perceptions relating to their work.

14. Essential Function • The question – if we provide an education to an individual who has a disability who may not be hired, is there a liability? • Council of Academic Programs in Communication Sciences and Disorders • http://www.capcsd.org/proceedings/2007/talks/EFslides.pdf

15. Four Distinct Generations • Generation Why (Under 25) - students Born 1982 – 2000 Between 5 – 10% of current workforce • Generation X (25 – 45) Born 1962 – 1982 Between 40 – 45% of current workforce • Baby Boomers (45 – 62) Born 1945 – 1962 Between 40 – 45% of current workforce • Traditionalist (62+) Born 1925 – 1945 Between 5 – 10% of current workforce

16. Age Demographic – ASHA Membership • 34 and younger 23.6% (Generation X) • 35 – 44 29.2% • 45 – 54 25.7% (Baby Boomers) • 55 – 64 17.5% • 65 and older 4.1% (Traditionalists) • http://www.asha.org/uploadedFiles/research/memberdata/2008MemberCounts.pdf

17. Generational Differences • Skills that dominate the differences • Interpersonal and intrapersonal workplace interactions • Ethics, personal organization and work habits • Time management • Teamwork and communication • Anger management; reasoning and problem solving

18. How do the differences present? • Interpersonal and intrapersonal workplace interactions • Ethics, personal organization and work habits • Time management • Teamwork and communication • Anger management; reasoning and problem solving

19. Differences and supervision… • Failing to discuss cultural issues in supervision may lead to miscommunications, misunderstandings, "hidden" agendas, assumptions, and disconnections between supervisors and supervisees.

20. Strategies • Initiate discussion of culture and cultural differences early in the supervisory relationship. • Give supervisees the chance to work with supervisors of diverse cultural backgrounds. • Use a variety of personnel in the agency for multicultural training. • Discuss how unintentional racism may arise in supervision.

21. A Little Historical Perspective • Supervisors manage and direct the process • Process is often predicated upon evaluation activities • Supervisees assume a respondent role • Supervisor’s perception of their behavior within the supervisory process is not always accurate • Supervisors often feel real world pressures

22. Supervision and the Implications for ASHA Standards • Formative assessment of clinical practicum • Evaluation of critical thinking, decision-making, and problem solving skills • On-going across the length of the training program, i.e., not static, but developmental • Implied increasing supervisee competence AND independence • Variable intensity of supervision per student • Implied direct involvement of supervisee

23. Formative Assessment • Formative assessment occurs when supervisee’s skills, values, reflective and analytical abilities are a focus of development by both supervisor and supervisee • The challenge of the standards is to develop a process and correlate skills that support formative assessment

24. Formative Assessment…An Example • Competence in administration of the Oral and Written Language Scales will be demonstrated by: 1. Reading the protocol manual 2. Successful practice test administration X 5 3. Administration of test to client X 3 4. Accurate scoring of test X 3 5. Complete written narrative summary of test scores and analysis X 3 6. Mediation with supervisee throughout

25. Summative Assessment • More traditional • Use of tests and quizzes in courses • Written comprehensive exams • PRAXIS Exam

26. Critical Thinking • Complexity of thought • Two primary theoretical “schools” 1. Direct 2. Infusionist

27. Moses and Shapiro (1996) • Levels of thinking 1. Dichotic 2. Early logical decision-making 3. Later logical decision-making 4. Truth is relative (requires analysis and critical thinking)

28. What we need is a process that will facilitate both critical thinking and formative assessment.

29. Definition • Supervision is a (clinical) teaching process that consists of a variety of patterns of behavior, the ap-proptiateness of which depends upon the needs, expectations, competencies, and philosophy of the supervisor and the supervisee and the specifics of the situation. Anderson, 1988 • Supervision is never the same • Supervision is much more than evaluation

30. Tasks of Supervision • 1985 Position Statement of Clinical Supervision • 13 Tasks of Supervision which include teaching, modeling of professional practice, conduct, and analysis of behavior. • 81 associated competencies distributed across these tasks • Evaluation as a primary supervisory mission has limited visibility within the tasks • 2008 revisions/extensions include Position Statement, Technical Report and Knowledge and Skills documents

31. Derivation of the Model • Education • Business Management • Counseling • Social Work • Adult Learning • Cross-cultural and gender literature

32. Continuum of Supervision • Continuum visually displays the notion that super-vision is a dynamic, not a static process • Supervisees move along it as the dynamics in the definition change • Supervisors adapt their process to compliment the development of the supervisee

33. The Continuum of Supervision and Appropriate Styles

34. Three Stages of the Continuum • Evaluation-Feedback • Transitional Stage • Self-Supervision Stage

35. Phase I-Understanding • Arguably, the most important phase of the process • Prepares both the supervisor and supervisee to communicate accurately and participate meaningfully together in the clinical education process • Tools to implement this phase include a variety of questionnaires which help understand needs and expectations, previous experiences of both parti-cipants • 10 Generic Abilities

36. 10 Generic Abilities • Commitment to learning • Interpersonal skills • Communication skills • Effective use of time and resources • Use of constructive feedback • Problem solving • Professionalism • Responsibility • Critical thinking • Stress management

37. Phase II-Planning • Clinical education cannot take place haphazardly if it is to produce good outcomes • Foundation upon which all future action in the process is built • Needs to occur with a focus on the client, the supervisee AND the supervisor • Develop professional development goals for supervisee and supervisor

38. Sample SLP Supervisee Clinical Development Goals • I will increase my wait time between stimuli presentation and provision of additional cues to 15 seconds by the end of next session. • I will demonstrate accurate data collection skills by increasing reliability between data collected on-line and data taken from a taped replay to .90. • I will provide accurate reinforcement and concrete feedback, according to schedule, in every Tx session.

39. Sample SLP Supervisee Supervisory Process Goals • I will provide a rationale for pre-selection of diagnostic procedures based on case history information • Each week, I will use self-analysis of my clinical performance to determine my effectiveness in achieving my clinical development goal(s) • I will contribute to the agenda for supervisory meetings.

40. Sample Audiology Student Clinical Development Goals • I will increase my speed for completion of routine middle-ear measures to five minutes • I will identify three strategies for managing false-positive responses • I will successfully implement three techniques for obtaining Speech Reception Thresholds in pediatric patients.

41. Supervisor Supervisory Process Goals • I will provide written feedback regarding diagnostic testing to supervisee once a week (technical skill). • I will use data to support my observational feedback to supervisee during conferences (technical skill). • I will use self-analyses as tools to understanding my question-asking behavior during meetings with supervisees (technical skill). • I will objectify my feedback relative to at risk student performance that is a barrier to changing the behavior (process skill).

42. Phase III-Observation • Observation is not supervision or evaluation. • Purpose is to collect objective and comprehensive data in such a way that events can be reconstructed validly enough to be analyzed. • Observation without data collection is not scientific. • Observation is not a passive/interpretive activity but rather an ACTIVE one for both supervisor and supervisee.

43. Tools to Support Observation • Tallies of targeted behavior(s) • Rating scales (with some qualification) • Verbatim transcripts • Selected verbatim transcripts • Interactive analysis systems developed for use in speech-language pathology and audiology • 10 Generic Abilities (includes professional behaviors and critical thinking skills and requires students to become involved in the analysis of their own behavior)

44. Phase IV-Analysis • Distills raw observational data so that it is useable and can provide direction for feedback. • Organizes observational data so that it can be used to draw conclusions about what happened in the teaching-learning process between supervisee and/or supervisor. • Builds a bridge between observation and evaluation of behavior.

45. Phase IV-Integrating • Communication between supervisor and supervisee, usually in a conference. • More than provision of feedback; it is a time for integrating of all four previous phases. • Based on the analysis of observational data. • Time when supervisor behavior and style is most critical. • Results in renewed planning for ongoing growth of client, supervisee, and supervisor.

46. …More Integration • It is in this phase that the supervisor begins to share the responsibility for analysis with the supervisee by first modeling and then engaging the student in utilization of observational data to answer a varietyof question types: broad vs. narrow. • This is the phase in which supervisee self-analysis is fledged and then, developed to facilitate movement across the continuum.

47. Supervisory Styles • Direct-Active Style • Collaborative Style • Colleagueship

48. Direct vs. Indirect Verbal Style Contrast Direct: Your speech and language in the session today was “cluttered”. Your used “OK” 35 times in a 12 minute session and you used it as a filler, as a tag question, and in response to your client’s behavior. As a result, your verbal model for your client was ineffective and confusing. Indirect: I counted 35 times in a 12 minute task that you used “OK”. What do you think this means? What conse- quences might this behavior have?

49. Direct vs. Indirect Verbal Style Contrast Direct: Your rate of speech in the session today was too fast and was one of the reasons contributing to your client’s lack of success. It was too fast and did not permit him the processing time that he needed to understand you and/or the task. Indirect: Listen to the tape of your session. React to the rate of your speech and language; provide data that supports your conclusion. How do you think it affected your client?

50. Supervisor Competence-Technical Skill • Knowledge and skill to support clinical best practice • Ability to assess supervisee needs • Ability to help supervisees to establish client and professional development goals • Knowledge of strategies/tools to facilitate behavior change and professional growth • Ability to measure change in both client and supervisee