Overview: TIP 52 Clinical Supervision and Professional Development of the Substance Abuse Counselor

Overview: TIP 52 Clinical Supervision and Professional Development of the Substance Abuse Counselor Christine Tronge, MSW, LCSW Clinical Standards Coordinator Dept. of Drug and Alcohol Services DADS

Definitions of Supervision CSAT, 2007, p. 3 Powell & Brodsky, 2004, p. 11 Social Influence Process Occurs Over Time Ensure Quality Care Team Building Create Cohesion Resolve Conflict Shape Agency Culture Teach/Monitor Ethics Diversity Value Supervision is a disciplined, tutorial process wherein principles are transformed into practical skills.

Supervision has Four Overlapping Foci Administrative Evaluative Supportive Clinical Powell & Brodsky, 2004, p.11 This is on the test!!!

Roles of the Clinical Supervisor Coach Teacher The Relationship Mentor Consultant

Elements of Success.

Central Principles of Clinical Supervision Essential Part of all Clinical Programs Central organizing activity Integrates Program Mission Goals Treatment Philosophy Clinical Theory Evidenced-Based Practices Enhances Staff Retention Primary means of improving Workforce Retention Job Satisfaction

http://talentedapps.wordpress.com/2008/04/11/job-satisfaction-model-for-retention/

What is the main reason employees leave? Try not to take it personally Hear it for what it s worth Take it into consideration as a potential factor

No. 1 Reason People Quit Their Jobs A Gallup poll of more 1 million employed U.S. workers concluded that the No. 1 reason people quit their jobs is a bad boss or immediate supervisor. Source: http://webcenters.netscape.compuserve.com/whatsnew/package.jsp?name=fte/quitjobs/quitjobs

Central Principles of Clinical Supervision It s A Right To receive good clinical supervision Regardless of skill or experience level Should be tailored to an individual's needs This is on the test!!!

Central Principles of Clinical Supervision Administration Must Support Clinical Supervision needs to be part of the fabric and fundamental belief system of the organization

Central Principles of Clinical Supervision Relationship is the Crucible In which ethical practice is developed and reinforced.

Central Principles of Clinical Supervision Clinical Supervision A skill that has to be developed in and of itself Good clinicians often get promoted to supervisors A good clinical supervisor Keeps client needs in mind Organizational needs Always keeps learning!

Central Principles of Clinical Supervision Maintain Your Balance Must balance the administrative responsibilities with the clinical supervision tasks. Sometimes these roles compliment and sometimes they conflict.

Central Principles of Clinical Supervision Treatment Facility Program s Response to Cultural Needs Supervisor s Response to Counselor Counselor s Response to Client Cultural Competence There are layers of cultural competence

Cultural Competence Proficiency Competence Pre-Competence Blindness Incapacity Destructiveness http://www.nccccurricula.info/framework/b3.html Cross, et. al. 1989

The Layers of Culture Outer Rings are the visible layers of culture Fundamental Beliefs Values Behavioral Norms Behavior Artifacts http://www.managingchange.com/bpr/bprcult/3culture.htm Inner Rings are the hidden feelings of culture

Central Principles of Clinical Supervision Successful EBP implementation depends on: Training Monitoring Encouraging

Central Principles of Clinical Supervision Gatekeeping Supervisors are responsible for: Maintaining Professional Standards Safeguarding the welfare of clients Recognizing and addressing impairment

Time for an Exercise

Intermission Time Stretch your legs Drink Something Refreshing

Now a word about pitfalls

Problems and Resources Buy in from Staff Success! Buy in from Administration

However, some staff may be resistant to supervision Remember all staff deserve and need supervision You need supervision as well Our field is ever changing and ever growing It is a risk management tool Resistance is an expression of ambivalence about change and not a personality defect of the counselor.

Being a New Supervisor Learn Ask Get to know Your organizations P&P s HR Regulations/Rules/Laws Your supervisees: Goals, Interests, Strengths, Needs Methods to reduce stress, address competing priorities Facilitate staff conflict resolution For 3 months to learn your new role Ask often, How am I doing? Ask, How can I improve my performance? Ask for regular supervision of your supervision Your staff, the agency s mission & culture Your colleagues internal and external to your organization Contract Develop contractual relationship with your staff Create clear goals and methods of supervision Get Training In supervisory procedures and methods Find a mentor Shadow a skilled, respected supervisor

This is on the test!!! Models of Clinical Supervision Competency- Based Models Treatment Based Models Developmental Models Integrated Models

Competency-Based Models

Treatment-Based Models Train to a particular model, theory Incorporate EBP s Model Emphasize Counselor Strengths, Understanding Teach approaches and techniques

Developmental Models Counselor Supervision 1 2 3 Has levels of Counselor Development: 1, 2 and 3 Describes Counselor Characteristics at each level Indicates supervisory skills needed to meet that stage Outlines techniques used to help facilitate the Counselor achieve higher proficiency Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 1 Counselor Characteristics Focuses on self Anxious, uncertain Preoccupied with performing the right way Overconfident of skills Overuses a skill Gap between conceptualization, goals and interventions Ethics underdeveloped Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 1 Supervision Skills Developmental Needs Provide structure and minimize anxiety Supportive, address strengths first, then weakness Suggest approaches Start connecting theory to treatment Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 1 Techniques Observation Skills training Role playing Readings Group supervision Closely monitor clients and interventions Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 2 Counselor Characteristics Focuses less on self and more on client Confused, frustrated with complexity of counseling Overidentifies with client Challenges authority Lacks integration with theoretical base Overburdened Ethics better understood Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 2 Supervision Skills Developmental Needs Less structure provided, more autonomy encouraged Supportive Periodic suggestion of approaches Confront discrepancies Introduce more alternative views Process comments, highlight countertransference Affective reactions to client and/or supervisor Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 2 Techniques Observation Role playing Interpret dynamics Group supervision Reading Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 3 Counselor Characteristics Focuses intently on client High degree of empathic skill Objective third-person perspective Integrative thinking and approach Highly responsible and ethical Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 3 Supervision Skills Developmental Needs Supervisee Directed Change agent Supportive Focus on personal/professional integration and career Source: Stolenberg, Delworth, & McNeil, 1998

Clinical Supervision Developmental Level 3 Techniques Peer supervision Group supervision Reading Source: Stolenberg, Delworth, & McNeil, 1998

Integrated Models Including the Blended Model Style of Leadership Incorporate descriptive dimensions of supervision Model of Tx Skill & Competency Development Affective Issues Unique Needs

Developmental Models Supervisor Supervision

Time for an Exercise

Ethical & Legal Issues Direct and Vicarious Liability Dual Relationships/Boundary Concerns Informed Consent Confidentiality Supervisor Ethics

Supervisor Liability Direct Dereliction of supervisory responsibility E.g.,.not making a reasonable effort to supervise. Vicarious This is on the test!!! Can be held liable for damages incurred as a result of negligence in the supervisory process

Ethics/Legal Decision Tree

Burnout/Fatigue Monitoring Counselor Clinical Performance 5 Observe Remember to always address burnout and compassion fatigue 4 3 Regular Evaluation Provide regular formative and summative evaluation 2 1 Contract Have a written supervisory contract with each supervisee Develop a or methods of observing clinical work Develop an IDP Utilize an Individual Development Plan (IDP) to set goals

The Supervisory Contract Should include: Purpose, Goals and Objectives Logistics Policies: ethical, institutional, etc. Methods of observation Outcome measures Each parties responsibilities

The Purpose for the Contract is: Monitor and ensure client welfare Facilitate professional development Evaluate job performance

Professional Development Time Limited 3 months? Common Goal Setting Specify Observation Methods Individual Development Plan Skills to be Learned Areas of Improvement Identify Strengths Professional Resource Development

Evaluation of Counselors Two Main Types Ongoing Status Report Formative Are we addressing the skills or competencies you want to focus on? How do we assess your current knowledge and skills and areas for growth and improvement? Formal Rating Summative Performed Annually Assessing overall job performance Fitness for the job Focus on overall strengths, limitations and areas of improvement How does the counselor measure up?

Supervision is Inherently Unequal Supervisee s Confidence and Efficacy=Quality and Quantity of Feedback by Supervisor (Bernard & Goodyear, 2004) Good Feedback is Frequent Clear Consistent SMART (Powell & Brodsky, 2004) This is on the test!!!

Ways To Evaluate (Powell & Brodsky, 2004)

Supervision by Direct Observation SHOULD BE THE STANDARD One of the most effective Monitors counselor s performance Ensures quality care Other Methods of Observation: Audio Recording Process Recording Two-way mirrors Video Recording

Direct Observation Is the desired form, though, historically it has been the exception in substance abuse counseling. But why? (Powell & Brodsky, 2004)

Direct Observation Preferable Although historically direct observation has been the exception; evidence, ethical and legal considerations support that direct observation is preferable. (Powell & Brodsky, 2004)

Direct versus Indirect Supervision DIRECT METHODS Live observation Audio taping Video taping One-way mirrors INDIRECT METHODS Process recording/verbatims Case consultation Verbal reports Written file review Role Playing Co-Facilitating/Modeling

Least Desirable Feedback: Unannounced Supervision Vague Feedback Perfunctory Feedback Indirect Feedback Hurtful Delivery (Powell & Brodsky, 2004)

Seek Input from Clients

Difference Between Supervision and Therapy What supervision is not: Personal growth Creating behavioral changes Affective processes Resolving personal issues Fixing the counselor (See pages 24-26)

Clinical Supervision is: Facilitating counselor growth Improving client care Enhancing clinical proficiency Ensuring compliance Based on counselor needs As well as based on agency s needs And agency s mission

Balancing Clinical & Administrative Tips for balancing these two functions: Be clear which hat you re wearing and when Be aware of your biases & values as they may affect your opinions Delegate administrative functions that you need not necessarily perform (e.g., Human Resources, Financial and/or Legal, etc.) Seek input from other to ensure your objectivity and maintain perspective

The supervisory session.

Finding the time to do Clinical Supervision

Suggestions to get started: Begin an implementation process incrementally Start by scheduling a session with each counselor Add observational components next Conduct group supervision Use a variety of methods: Individual, Group and Peer 1. Develop a plan 2. Start slow 3. Build from there 4. It WILL all come together

Like in counseling there must be a paper trail, likewise, in clinical supervision you MUST have a paper trail.

Documenting Supervision Develop and implement a Clinical Supervision Policy & Procedure Create a Supervision Contract Use an IDP or Individual Development Plan Suggest utilization of the Supervision Sessions Checklist Utilize Supervision Notes As needed conduct a Risk Management Review Complete a Supervisory Interview Observations Implement a process of Counselor Competency Assessments Likewise allow counselors to provide you with feedback Use a Case Consultation Form for supervisory feedback Audi or Video taping: Develop a P&P, as well as a consent! Reference pages 101-126 in the TIP 52 Handbook Examples of each of the above are provided

A Good Clinical Supervision Record INCLUDES: Supervisor-Supervisee Contract signed by both parties Brief summary of supervisee s experience, training & learning needs The current IDP Summary of all supervisory sessions Notation of cancelled or missed supervision sessions Progressive discipline steps taken Any significant problems encountered & how they were resolved Supervisor s clinical recommendations to supervisee s Relevant case notes and impressions

Structuring the Initial Supervisory Session

Transference and Countertransference in Clinical Supervision

Now a word about Burn Out and Compassion Fatigue

Primary Source for Presentation

Additional Sources

Additional Web Resources ATTC Clinical Supervision Tools http://www.attcnetwork.org/explore/priorityareas/wfd/getready/cstools.asp ATTC MI Toolkit for Clinical Supervision http://www.nattc.org/explore/priorityareas/science/blendinginitiative/miastep/research.asp TAP 21: Addiction Counseling Competencies http://store.samhsa.gov/product/tap-21-addiction-counseling-competencies/sma13-4171 Best Practices in Clinical Supervision http://www.acesonline.net/wp-content/uploads/2011/10/aces-best-practices-in-clinicalsupervision-document-final.pdf

Thank you for attending; I hope you found this helpful! Don t forget to complete your evaluations and the test!!!