Supervision at a Distance Ohio Psychological Association October 30, 2008 Communications & Technology Committee Ken Drude, PhD; Audrey Ellenwood, PhD; Ky Heinlen, PhD, LPCC-S; Michael Lichstein, PhD, Paule Steichen Asch, PhD

Learning Objectives Define distance supervision and some technical aspects Review current literature on guidelines for supervision (distance & f2f) Learn how the current APA Code of Ethics can be applied Learn results of a recent survey Discuss what guidelines need to be developed to address concerns – invitation to participate

Distance Supervision Providing clinical supervision through technology based, non-face-to-face means including the following: Landline and cell phones , chat (real time online) Text messages to cell phone & Instant messages Video teleconferencing Web pages

What is Clinical Supervision? Interaction between supervisee and supervisor: Discuss cases in-depth Supervisor becomes knowledgeable of critical information about a client Instructs or models how to deal with issues Assists in developing interventions Monitor’s students and clients progress

Types of Supervision Work supervision Training supervision Psychological umbrella supervision Mental health worker supervision Administrative supervision * of the Administrative Code

Board Requirements of Supervision - 1 Supervisor shall: Be competent to provide services supervisee provides Determine the supervisee’s competencies Be responsible for the “psychological diagnosis, psychological prescription, and psychological client supervision of all clients.”

Board requirements of Supervision – 1 (continued) Keep records of supervision “Have direct knowledge of all clients served by his/her supervisee”

Board Requirements of Supervision - 2 Supervisor shall for training supervision: Schedule individual face to face supervision for no less than 5% of the weekly client contact time. “Have a written agreement describing the goals and content of the training experience, including clearly stated expectations”

Distinction Between Consultation & Supervision Consultation Consultee responsible for treatment and client Collegial relationship Consultant may have limited information Supervision Supervisor responsible for treatment and client Superior-subordinate relationship Supervisor needs to have all available client information in

General Requirements of Supervision-Competence What is Competence? Competence is a standardized requirement for an individual to properly perform a specific job. It encompasses a combination of knowledge, skills, and behavior utilized to improve performance. More generally, competence is the state or quality of being adequately or well qualified, having the ability and a core set of values to perform a specific role.jobknowledgeskillsbehavior abilityrole

Competence Is … Habitual and Judicious Involves: Use of communication, Knowledge, Technical skills, Clinical reasoning, Emotions and, Values “Reflection in daily practice for the benefit of the individual and community being served.” Epstein & Hundert (2002)

APA Benchmarks of Competency Reflective Practice Self-Assessment Scientific knowledge-methods Relationships Individual-cultural diversity Ethical-legal standards-policy Interdisciplinary systems

APA Benchmarks Functional Competencies Assessment, diagnosis, case conceptualization Intervention Consultation Research/evaluation Supervision, teaching Management - administration

Current Practices in Distance Supervision Limited documented practices, more anecdotal accounts Telephone and most common practices Televideoconferencing increasingly being used

Supervision Survey Demographics Research approved by CSU IRB Participants were solicited through a variety of mental health listservs Invitations to participate were posted in June & July 50 people went to the survey link and 25 people completed the survey

Licensure of respondents 57.9% 31.6% 10.5%

Status of providing Distance supervison 50% currently provide 45.5% provided in the past 22.7% are considering providing

Practice of Distance Supervision Number of supervisees: 58.8% had % had % had 5 Number of hours per week in supervision:  33.3% less than 1 hour  26.7% 1-2 hours  20% 3-4 hours  20% 5 hours

The Supervisee Lived in & practiced in state (71.4%) Lived outside the state & practiced in state (4.8%) Lived outside state & practiced outside state (28.6%)

Forms of Supervision provided:

Practices Utilized in Supervision Secure service w/encryption (46.2%) Supervisee records sessions (15.4%) Clients informed supervision online (38.5%)

Using Distance Supervision As an Adjunct to Face-to-Face 71.4% indicated they also provide some face-to-face supervision 28.6% indicated they do not see supervisee

Skills Needed to Provide Supervision at a Distance Navigating online Basic typing and spelling skills Ability to express self in the written word Ability to express concepts/ideas without the use of non-verbal cues Excellent communication skills Take a course on technology skills

Practice Facility Clinical Supervisor Secure two way interactive technology Internet based Chat rooms for interaction WEB based TV staffing sessions Electronic bulletin Boards for scheduling Encrypted services Web based case review/electronic medical records Chat room for discussion of case studies Supervision via ITV (Group or Individual) Individual face- to-face supervision with onsite supervision Supervisee At A Distance Flow Chart Of Supervision At A Distance Adapted from Miller et. al. 2008

Case Discussions Vignettes of Distance Supervision

Key factors – Quality Supervisory Relationship Supervision enhances natural developmental process of supervisee Use both a theoretical and experiential base to supervision Assure a consistent and coherent technical framework for supervisees Supervisees need to be adequately trained in the technology used for supervision.

Key factors – Quality Supervisory Relationship (Cont.) The selection of technologies should be based on appropriateness for clinical services, patients and supervision Supervisors need to ensure the security of all client information Continuous self-evaluation as well as evaluation of technology services used needs to be monitored ( Miller et. al, 2008 )

Cautionary statements Using Distance Supervision as an Adjunct Telepsychology supervision may limit a supervisees level of personal contact with supervisor Supervisees may not get time they need to grow in supervision Problems with technology access can interfere with supervision Confidentiality is an issue Requires the supervisee to be more self- directed

Looking ahead to guideline considerations What components of distance supervision need to be incorporated into guidelines?