1. A Comparison of Group and Individual Supervision Models in First Year Graduate Clinical Education in Speech-Language Pathology
Rhea Paul, Ph.D., CCC-SLP
Taryn Rogers, M.A., CCC-SLP
Ellen Massucci M.A., CCC-SLP
Cristina Pino, M.A., CCC-SLP
Speech-Language Pathology Department
College of Health Professions
Sacred Heart University

2. Sacred Heart University College of Health Professions

3. SHU SLP Program Vision
The SHU Speech-Language Pathology Program aspires to build capacity for provision of the highest quality services provided by licensed and certified speech-language pathologists for individuals with communication disorders and their families in Connecticut and surrounding areas. Through a commitment to problem-based learning, academic excellence, innovative models of clinical training, multidisciplinary preservice education, and research experiences for master’s level students in speech language pathology, SHU faculty will nurture the development of culturally competent, collaborative practitioners and future leaders in the profession of speech-language.

4. Why explore other clinical supervision models?
Cost effectiveness
Shortages of clinical education placements
Increase student exposure to practice patterns students will face in their professional lives, from the earliest stage
Limited literature did not reveal significant differences between outcomes of individual and team-based models of supervision in either SLP (Farrow et al., 2000) or in allied professions (Moore et al., 2003),

5. Study Purpose: To examine the relative efficacy of two models of supervision during first year of SLP clinical education.
Specific Qs: Is there a significant difference based on the supervision model (Team based vs. traditional 1:1)experienced by first year student clinicians in:
The growth of student professional behavior as measured by
on-site supervisors
vs.
blind experienced clinicians?
Student satisfaction with assigned supervisory experience?
Client outcomes?

6. Supervision Models
To test the efficacy of the model, two types of clinical supervision were presented during the students’ first year:
Team-based supervision
Individual supervision

7. Team-Based Supervision Model
Four students are assigned to one SHU-based supervisor who accompanies the students on their field work placement and supervises their work together as a team with assigned clients
Supervision of students by ASHA certified and CT state licensed full-time faculty and part-time adjunct faculty
Students are placed in either schools or skilled nursing facilities
Supervisor attends the field site with the students and in consultation with an on-site clinician, assigns and supervises their caseload and duties.

8. Individual Supervision Model
One student is placed under the supervision of a clinician based at the fieldwork site and works alongside her/him, as would typically happen in later stages of the graduate program.
Supervision of student by ASHA certified and CT state licensed community-based SLP
Fieldwork site supervisor individually assigns and supervises the individual student’s caseload and duties
Clinical placement is overseen by the Director of Clinical Education who maintains contact with fieldwork site supervisor throughout the placement

9. Individual Supervision Model
Students were placed in Public School, Private School, Rehab/Clinic settings 2x/week for half days
Clinical activities include screening, assessment, and treatment as assigned by on-site fieldwork supervisor

10. Regardless of supervision model…
All students will attend fieldwork site for two half days each week for a total of ten weeks
Each student will have at least one individual semi-weekly meeting with the assigned supervisor
All supervisory practices will follow ASHA guidelines
All supervisors will report and confer directly with Director of Clinical Education periodically during the semester

11. Team-Based Supervision Public Schools

12. Team-Based Supervision - Child Clinical Practicum Public Schools
Placed within four partner school districts: -5 Elementary Schools/ KDG. Level, some 1st grade articulation -1 Typical Preschool -1 Special Education Preschool All sites are community based. All students are identified by classroom teachers as ‘at risk’, within the classroom. Supervisor to Graduate Clinician ratio is 1:4.

13. Team-Based Supervision Skilled Nursing Facility (SNF)

14. Team-Based Supervision - Adult Clinical Practicum Skilled Nursing Facility (SNF)
Community based skilled nursing facility
140 beds
Subacute and Long Term care residents
Subacute patients randomly selected to participate in cognitive-linguistic screens
Long-Term care residents identified by facility SLP to participate in 1:1 sessions with graduate student clinicians
Treatment Diagnoses include: Aphasia, Cognitive-Communication Impairment, Dysarthria, Verbal Apraxia, Dysphagia
Supervisor to Graduate Clinician ratio is 1:4.

15. Team-Based Clinical Schedule: School
Each supervisor/student group is placed at two schools per week:
one to two school children per session
possible caseload total of 8-16 school children per week
Each school is visited once a week, for a three hour total block:
½ hour pre-meeting; ½ hour post meeting
2 hours direct therapy time; four ½ hour sessions

16. Team-Based Clinical Schedule: SNF
Clinical Site visited 2x/week
2.5 – 3.0 hours per day
15 min. group pre-meeting
Individual Session Primary Patient (30-45 minutes)
Individual Session Secondary Patient (30-45 minutes)
Group Clinical Activity ( 45 minutes)
15 min. group post meeting

17. Team-Based Clinical Schedule: SNF (cont’d)
Activities completed as a group:
Orientation to facility
Review of Medical Charts for patients identified for 1:1 treatment sessions
Dysphagia Treatment – Carryover of feeding and swallowing strategies for long-term residents with dysphagia
Dysphagia Assessment – Clinical Bedside Evaluation of long-term care patients
Cognitive-Linguistic Screenings of subacute and long-term care patients
Activities completed as individual graduate clinicians:
Individual treatment sessions with primary and secondary patients
Cognitive-Linguistic Screening of subacute and long-term care patients if primary and/or secondary patient is unavailable

18. Group Feedback

19. Group Feedback Schools
Pre-meeting:
-To review an group targeted objectives for the day (Ex. behavior management strategies; data collection method, cueing hierarchy, etc), and to discuss any last minute questions/concerns
Session:
-Graduate clinicians get children from classrooms (work with school based SLP to set caseload, schedule, and therapy space), and return at end of session
-Supervisor has individual session plan to refer to throughout supervision
-Written feedback pertaining to individual session and targeted group objective, for each graduate clinician
-When needed, supervisor able to model therapy technique

20. Group Feedback Schools (cont’d)
Post meeting:
All feedback discussed with group members
targeted group objectives
individual sessions
All graduate clinicians benefit from experiences of their group members
common themes relevant for all first year graduate clinician
input/questions discussed as a group
group feedback distributed to all graduate clinicians
feedback specific to a particular graduate clinician distributed (ex. loudness level)
Group and individual objectives for next session are discussed
graduate clinicians responsible for completing SOAP notes and session plans

21. Feedback: SNF (GROUP FEEDBACK) Pre-meeting: (INDIVIDUAL FEEDBACK)
Review daily schedule and group activity; discuss questions related to planned treatment sessions (e.g., discuss methods to facilitate pt.’s participation / performance, cueing strategies, etc.); review general feedback and trends in clinical documentation
(INDIVIDUAL FEEDBACK)
Individual Treatment Sessions:
Graduate clinicians meet assigned patient for bedside treatment sessions. Supervisor rotates between graduate clinicians to observe and provide individualized, written feedback of session. Modeling of treatment techniques, cueing strategies incorporated into session as needed.
Session Plans and SOAP notes are reviewed and individualized, written suggestions for editing of clinical documentation provided weekly.

22. Admitted Student Day: SP12
Feedback: SNF
(GROUP FEEDBACK)
Group Clinical Activity
Dysphagia Treatment: Mealtime Treatment Sessions in Dining Room Setting
Clinical Bedside Dysphagia Evaluation
Administration of Cognitive-Communication Screening Tools
Graduate clinicians and clinical supervisor in one treatment area. Direct supervision provided for 100% of the clinical experience.
Graduate clinicians are provided with ‘real-time’ feedback and discussion during clinical experience. Questions are fielded from the students and responses are shared with the group as a whole.
Admitted Student Day: SP12

23. Supervisory Meetings: Schools
Students meet individually with supervisor to review:
individual lesson plans;
SOAP notes; and
progress summaries
Students meet individually with supervisor for:
Mid-term and Final evaluations
Students meet individually with supervisor to discuss specific aspects of student performance that do not pertain to other students’ clinical experience

24. Supervisory Meetings: SNF
Individual student meetings scheduled at start of semester to review:
Weekly session plans
SOAP notes
Development and execution of treatment session
Additional 1:1 meetings scheduled as needed throughout the semester
1:1 Midterm and Final Evaluations scheduled

25. Study Participants
32 first year graduate students, along with one of their clients, participated in this study.
All students were assigned to a fieldwork placement, either in a school or preschool or in a skilled nursing facility.
All student clinicians, as well as their selected clients, gave informed consent to participate.
Once assigned to fieldwork sites, students were assigned to either:
a team-based supervision model, in which a SHU supervisor, working with a team of 4 students, attended the field site with the students and in consultation with an on-site clinician, assigned and supervised their caseload and duties (N=16) Or
an individual supervision model, in which one student was assigned to a clinician based at the fieldwork site, who individually assigned and supervised the individual student’s caseload and duties (N=16)

26. Outcome Measures
Professional Behavior Scale Ratings (Appendix 1) to assess experienced clinicians’ ratings of student clinicians’ professional behavior
Supervisory Evaluation scores to assess student clinicians’ satisfaction with supervisory experience
Change in client scores from pre- to post-semester on a standard clinical measure.

27. Supervisory Ratings: Professional Behavior
Professional behavior was measured by ratings on a Professional Behavior Scale (see Appendix 1).
Supervisor ratings:
All students were rated by their supervisors (either team-based or one-to-one) on the PBS early in the semester, and at the final week of the semester.
Blind ratings:
Students collected (with their own and client consent) 10 minute videos of their intervention sessions; one during the first weeks of the semester, and one during the last week.
Two clinicians with over ten years of SLP experience were each randomly assigned two of these videos for each of 20 student clinician participants; they were not told whether the video came from early or late in the semester, or what type of supervision (team or one-to-one) the student experienced.
Inter-rater reliability was collected for 20% of this sample; the interclass correlation coefficient was .75 (good; Cicchetti, 1994)

29. Student Satisfaction: Supervisory Evaluation
Each student rated her supervisory experience at the end of the semester, using the Supervisor Evaluation Form.
Total scores from each form were summed
Total scores were compared for the two groups of students; those experiencing
team-based supervision
and
1:1 supervision

31. Client Outcomes: Presence of positive change
Each student clinician was asked to do a pre/post assessment of the client participating in the study, using the same measure
Measures included:
Mini-mental State Exam
CELF-5
PLS-5
Kindergarten Language Benchmark Assessment
Pre/post scores were compared
Assigned to ‘showed positive change’ or not status

32. Results: Professional Behavior Pre-Supervision

33. Results: End of semester ratings of Professional Behavior: NSD
Supervisor Ratings
Blind Ratings

34. Results: Student evaluation of Supervisory Experience: NSD

35. Results: Client Outcomes: NSD

36. Conclusions
Students provided with 1:1 and team-based clinical supervision during a first year practicum experience:
Approximately equivalent levels of growth in professional behaviors.
Approximately equivalent levels of satisfaction with their supervisory experience
Similar client outcomes
Team-based supervision seems a viable option for supervisory practice in first year clinical education.

37. What makes this supervisory model unique?
Allows for a more “real-life” clinical experience
Students must learn to adapt to schedule changes
Opportunity to interact with interdisciplinary team members
Practical training for student clinicians entering these clinical environments in their 3rd, 4th, and 5th semesters.
Feedback relevant to all students can be shared as a group
Individual feedback shared with all students as a peer learning opportunity
Fosters collaboration between graduate student clinicians

38. Testimonials… Our Community Partners… “Can you come more days a week?”
“Can we add another school for your group to work with?”
(School Staff and Administrators)
“It’s fantastic to have the continuation of services for residents who are no longer eligible for billable SLP services”
(SNF Staff and on-site SLPs)

39. Our Supervisors…
“I love teaching students in the living environment of the public schools as they learn first-hand the positives and the negatives of the setting. I am also amazed at the many language-learning opportunities that occur frequently in a setting where children spend the majority of their waking hours.”
- Arlyne Russo, Ph.D, CCC-SLP
Adjunct clinical supervisor

40. Our students…
"Group supervision gave me the opportunity to embrace other's perspectives and grow as a collaborator, and future speech-language pathologist. Through the support and feedback of both my classmates and supervisor each week, I was able to further develop my clinical and interpersonal skills. These experiences have taught me to never underestimate the power of learning from one's peers, as each individual perspective has something valuable to offer." - Victoria Annese (Second Semester Graduate Student)