Toto, I’ve a Feeling We’re Not in the Office Anymore! The Mobile Workforce

1. Toto, I’ve a Feeling We’re Not in the Office Anymore!The Mobile Workforce PCPA Conference October 7, 2010 Christopher M. Owens, M.A., LPC Pasquale J. Russoniello, M.A. Drexel University College of Medicine Behavioral Healthcare Education

2. Objectives • List benefits and barriers of mobile services, from the perspective of supervisor and supervisee.     • Discuss supervisory issues to consider when working in a program with staff who are often working off-site.   • Describe strategies and technologies to overcome supervisory barriers/issues with an increasingly mobile workforce.    

3. The Mobile Workforce

4. What is a “Mobile Workforce?” • A program, facility, agency, employee, etc. that does not necessarily have “typical” office hours, as much of the work entails being “in the field” or “off site.” • This may also include workers who do not work in the “central” office where most agency programming occurs. • May not work at the same site or same times as the supervisor(s) • Other definitions or examples?

5. Case managers Resource coordinators Family based therapists Therapeutic Staff Supports Mobile therapists Peer support specialists Recovery coaches Behavioral specialists School counselors Fee for service therapists Skills trainers Employment specialists Job coaches Supervisors Others? Who’s Part of a Mobile Workforce in the Mental Health Field?

6. Why Do We Need a Mobile Workforce? • Research has clearly shown that “meeting people where they are” can have significant impact: • More accurate diagnoses and assessment • A more clear “case conceptualization” • Reduced barriers to access • Travel, time, logistics • Improved dynamics/rapport

7. Mobile Services:Benefits and Barriers

8. Small Group Discussion • In small groups, come up with answers to the following questions: • From the perspective of the supervisee, what are some benefits to providing mobile services? What are some of the barriers? • As the supervisor, what are some benefits to providing andmanaging a program that provides mobile services? What are some of the barriers?

9. Supervisee: Benefits • Flexibility • Autonomy (Freedom!!!) • Reimbursements (travel, food) • Travel = decompression time • Diversity in activities • Never boring! • Helping people in natural environments • Peer support, camaraderie • Networking • Smaller caseloads

10. Supervisee: Barriers • Travel • Isolation – “the stepchild” • Lack of recognition • Resources • Safety • Access to supervision and training • Communication • Workspace

11. Supervisor: Benefits • Recovery Paradigm, Strengths based • Evidence-based practices • Better quality of care • Better outcomes • Improved consumer satisfaction and functioning • 24-hour availability • Meeting holistic needs

12. Supervisor: Benefits • Linkage and referrals • Cost-effective • Alternatives to residential placements • Forces “in-vivo” skill development for staff • Smaller caseloads per staff person (hopefully!) • Multidisciplinary treatment team • Difficult to micromanage

13. Supervisor: Benefits • Field Supervision • Provides opportunities for supervisor to accompany staff and provide immediate feedback on their skills • Supports staff in translating skills taught in formal training and applying them in real practice • Generates creative alternatives in working with challenging circumstances

14. Supervisor: Barriers • Limitation of services, e.g. time-limited mobile services • No-shows • Coordination of services • Contested boundaries of responsibility • “Who’s in charge here anyway?” • “Too many cooks spoil the broth” • Professional rivalries

15. Supervisor: Barriers • Lack of resources • Un-reimbursed services that are provided • Buy-in from community • Developmental needs of staff And…last but not least, all those issues around supervision…

16. Mobile Services:Supervisory Issues

17. Typical Challenges to Supervising a Mobile Workforce • Can I adjust my own values and beliefs regarding supervision to match the needs of a mobile workforce? • How do I balance my roles, especially when managing people in the field? • Is it possible to prevent staff from feeling as though they are working in isolation? • Are there ways to improve the supervisees’ sense of attachment to the program or agency as a whole? • What can be done about the need for continuing education/training?

18. Typical Challenges to Supervising a Mobile Workforce • How can we communicate more effectively? • How can I get a moment of peace? I am “on call” all the time! • What can be done about the high rates of staff turnover? • What do I about people who take advantage of the autonomy given to them? • How in the world can I possibly ensure that paperwork is done properly and on time?

19. Typical Challenges to Supervising a Mobile Workforce • Supervision itself! • How often should we have it? • Should we do group or individual? • What do we discuss during formal supervision? • We don’t have time for supervision! • We have supervision set up, but: • No one seems to want to participate. • Some don’t even bother to show up. • Some staff do paperwork during group supervision. • Supervision is always filled with people running out of the room to handle phone calls.

20. General Suggested PracticesandIncorporating Technology

21. Suggested Practices: Complete a Self-Assessment • Looking Back • What were some supervisory behaviors that were most helpful to you as the person being supervised? • What were some behaviors of the supervisor that you thought were unhelpful or worse? • What did you learn from that experience that you try to use now in your role as supervisor?

22. Managing Supervisees How do I view supervisees as a whole? Do I recognize their strengths? What specific behaviors in individuals that I supervise do I perceive as being most problematic? Where do I feel most “stuck”? Suggested Practices: Complete a Self-Assessment

23. Suggested Practices: Complete a Self-Assessment • Examining My Role • When problems are presented, do I conduct any self-analysis to examine my role in them? • What has worked well for me in dealing with problematic behaviors? • What do I do well overall? What could I do better? • How can we improve our supervisory process?

24. All supervision needs to have clear procedural and behavioral expectations. Suggested Practices: Supervision

25. Suggested Practices: Supervision • Regularly scheduled supervision • Time blocked out – same time, every time • Group vs. individual • There are benefits to doing both! • “Meet them where they are” • For individual supervision, why not meet somewhere convenient for the supervisee? • For group supervision, bring your team together at a central site, or rotate sites each time group supervision is to occur. • In vivo observation • Peer chart reviews

26. Suggested Practices:Incorporating the Mobile Worker into the Agency At minimum, we want to avoid isolation. • Inclusion at agency meetings • Group supervision • Central locale, or rotation of sites • Committees – social, birthday, chart review, new projects, etc. • Team building • Retreats, picnics, activities, exercises • Celebration events

27. Suggested Practices • Accept that your role as supervisor will often come with supervisees needing your guidance at all hours of the day (and night!). • If possible, rotate shifts with other supervisors for on-call duty. • Create and expect adherence to administrative processes and other tasks, i.e. handling paperwork, training requirements, etc. • Use support from HR or your supervisors, especially when handling problematic behaviors or issues.

28. Suggested Practices • Use consumer satisfaction data or interview consumers about their experiences with the supervisee(s). • Create flexible boundaries for your separate roles. • i.e. Generally keep administrative issues or supervisee problem behaviors separate from clinical supervision.

29. Unscheduled supervision Open door or “Pop-in as needed” Telephone Peer support/feedback Staff meetings Purposeful Planned in advance Clear expectations Use technology as appropriate Telephones Email Texting IM Chat Discussion Recording Videoconferencing Webcam Suggested Practices: Supervision

30. Use of Technology

31. Definitions • Telehealth - “The use of telecommunication technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, education, and information across distance.” (Miller, et al, 2009) …or if you prefer, • Telemental health - is an intentionally broad term referring to the provision of mental health and substance abuse services from a distance via the use of the internet and other asynchronous or social relationship environments for interactions between mental health professionals and their patients and families. (American Telemedicine Association, 2009)

32. Telephones • Quick and easy to use • Mobility • Access/familiarity • In the moment • “Check in” • “Quick question” • 1-1 Supervision • Group supervision via teleconference

33. Email • Asynchronous • En masse communication • i.e. Administrative information • Quick Q&A • Out of office access • Creating a “paper” trail • read receipts • Secured networks

34. Texting • Quick and brief communication • Check ins • Basic Q&A • Mobility • Works well in times when phone calls are not feasible

35. Instant Messaging Real time Multi-tasking Individual attention Chat Rooms Real time Multi-tasking Group conversation Multiple perspectives Topic based or case consultation IM, Chat, Discussion • Discussion Boards • Asynchronous • Group oriented • “Assignments” • Topic based • Allows for expression and receipt of ideas • Ongoing training • Increase in knowledge base

36. Videotapes – Digital Recording • Next best thing to in vivo observation • Less effect on dynamics than observer • Cataloguing database of growth • Cost continues to decrease • Selection in segments • Individual or group supervision

37. Videoconferencing • Allows others to participate fully (audio and visual) with others across distance • Synchronous • Multiple groups and sites • Generally good quality A-V • Easy to use with simple instruction

38. Webcam • Allows others to participate fully (audio and visual) with others across distance • Much less costly than VC • Synchronous • Individual or group use • Skype, Yahoo, Google • Easy to install and use • What does it look like?

39. Video Capture

40. “Pay Attention to that Boss Behind the Curtain!” • None of the previously mentioned technologies can truly replace face-to-face supervision. However, at minimum, they can supplement supervision efforts, especially for the mobile workforce. • Consider using available technologies in combinations to enhance what you already do!

41. Telehealth: Considerations • Ethics • Confidentiality, informed consent • Supervision for licensure • Familiarity with technology • Acceptance and willingness to use technology • Cost and quality of technology • Nonverbal cues • Frequency of formal supervision with technology • Relationship dynamics

42. What challenges or problems do you face that we haven’t yet discussed? What do you do that works effectively for your program to overcome some of these challenges or barriers? Do you have any other questions that have not been addressed? Real Problems, Real Practices

43. Reminders • The purpose of your job is to support the well-being of those you serve (employee and consumer). • Know how to do the job of your supervisees. • Encourage staff to use peer supports. • Modeling is the most effective learning tool. • Successful endeavors require planning, organization, resources, action, time, and persistence.

44. Helpful References • Kanz, J.E. (2001). Clinical supervision.com: Issues in the provision of online supervision. Professional Psychology: Research and Practice, 32(4), 415-420. • Lindblad-Goldberg, M., Dore, M. M., & Stern, L. (1998). Creating Competence from Chaos A Comprehensive Guide to Home-based Services. New York: W. W. Norton. • Miller, T.W., Morgan, R.D., & Wood, J.A. (2009). A telehealth technology model for information science in rural settings. In: A. Dwivedi(Ed.). Handbook of Research on IT Management and Clinical Data Administration in Healthcare. Hershey, PA: IGI Global.

45. Helpful References • Miller, T. W., Miller, J. M., Burton, D. B., Sprang, R. & Adams, J. (2003).Telehealth: A model for clinical supervision in allied health. The Internet Jounal of Allied Health Sciences and Practic. 1(2), 1-8. Retrieved from http://ijahsp.nova.edu • Reese, R. J., Aldarondo, F., Anderson, C. R., Lee, S-J, Miller, T. M., & Burton, D. (2009). Telehealth in clinical supervision: A comparison of supervision formats. Journal of Telemedicine and Telecare, 00, 1-6. • Shulman, L. (1992). Interactional Supervision. Washington, DC: NASW Press. (8th printing 2005)

46. Helpful References • Sorlie, T., Gammon, D., Bergvik S., & Sexton, H. (1999). Psychotherapy supervision face-to-face and by videoconferencing: A comparative study. British Journal of Psychotheraapy, 15(4) 452-462. • Wood, J. A. B., Miller, T. W., & Hargrove, D. S. (2005). Clinical supervision in rural settings: A telehealth model. Professional Psychology: Research and Practice, 36(2), 173-179.