Supervision: Gatekeeping the Profession Module 1: The Professional Supervision Framework Module 2: The Process of Assessment Welcome to Macquarie University! The purpose of today’s workshop: o CPD to enhance supervision practice o To enable supervisors to be listed on the PsyBA’s register of supervisors o To pilot two modules from a Training Program: Psychology Supervisor Training. Outline of the Day • • • • • 9:30am Module 1 11am Morning tea 11:30am Module 2 1:30pm Lunch 2:30pm Course meetings with Supervisors. • 3:30pm Finish Psychology Supervisor Training: A competency–based Approach Modules: Content and description 1) Competency-based models of supervision: principles and applications to supervisory practice 2) Establishing SMART goals in supervision: a competency-based approach 3) Understanding your development and role as a supervisor 4) The Professional Supervision Framework 5) Supervising for the development of competencies in working with difference. 6) Supervising for the development of case-conceptualisation competencies 7) The Process of Assessment 8) Supervising to enhance metacompetencies in supervisee: Reflective Practice and scientist-practitioner attitudes Development leader (Institution) & ICTN approached for funding Associate Professor Craig Gonsalvez (University of Wollongong) South Coast ICTN Associate Professor Craig Gonsalvez (University of Wollongong) South Coast ICTN Yasmina Nasstasia & collaborators (University of Newcastle) Hunter and Coast ICTN Ros Knight (Macquarie University) Metro North and East ICTN Yasmina Nasstasia & collaborators (University of Newcastle) Hunter and Coast ICTN Dr Kathryn Nicholson Perry (University of Western Sydney) Sydney ICTN Ros Knight (Macquarie University) Metro North and East ICTN Dr Kathryn Nicholson Perry (University of Western Sydney) Sydney ICTN Thanks for Contributions • Metro North and East ICTN, particularly Carla Brogden and Andrew Rose • Dr Ann Wignall, Principle Psychologist, Northern Sydney LHD • Fiona Wilkinson, Clinical Psychologist • Lee Mowbray, Online Educational Designer PsyBA Guidelines for Supervisors • If you hold Board Approval on 30 June 2013 then you have to complete a Board approved master class by 1 July 2018 • The master class will be 6 hours face-toface on the one day. Module 1 Professional Supervision Framework Supervisory Alliance Ethical Practice Professional Practice Overview In this module participants will consider the current Professional framework of both AHPRA and APAC requirements that guide supervision. They will consider the ethics that impact action and decisions in supervision. All of this framing the central core of the Supervisory Relationship. Pre-reading • APS 2007 Code of Ethics • Barnett et al (2007) Commentaries on the ethical and effective practice of Clinical Supervision. Professional Psychology: research and practice, 38(3), 268-275 Titles – What’s in a name? • Avoid use of ….. o Supervisee o Student o Intern o “the girl here on placement” o Trainee • Use appropriate titles o Provisional Psychologist or o Psychologist if already obtained registration Correct Titles from http://www.psychologyboard.gov.au/Registration/General/FAQ.aspx • Psychologists with General registration have unrestricted rights to use the title Psychologist or Registered Psychologist, and may undertake any work using that title • Candidates undertaking Doctoral degrees who have General registration, but do not have an endorsement, may only refer to themselves as a psychologist or registered psychologist • Provisionally registered psychologists undertaking the 4+2 pathway, the 5+1 pathway or the higher degree pathway for the purpose of obtaining General registration must only use the title 'Provisional Psychologist' • A psychologist enrolled in a Board registrar program leading to an endorsement may use the title Registrar along with the area of practice e.g. Clinical Psychology Registrar • Psychologists with an endorsement may use the title associated with that area of practice e.g. Clinical Psychologist • If your registration expires but you are still within the one month grace period you can continue to use the title ‘Psychologist’ and any title related to an endorsement on your registration. Correct titles from http://www.psychologyboard.gov.au/Registration/General/FAQ.aspx When can I call myself a registrar? The title 'registrar' is not a protected title under the National Law, but titles associated with an endorsement are protected. The title may only be used by psychologists who have completed a Masters or Doctorate in an endorsed area, and are currently undertaking Board approved supervised practice (‘the registrar program') for the purpose of gaining an endorsement. You must ensure you do not use the title in such a way that it may lead a person to believe that you already have an endorsement. Examples of acceptable titles are 'Registrar - Clinical Psychology' or 'Clinical Psychology Registrar'. Correct titles from http://www.psychologyboard.gov.au/Registration/General/FAQ.aspx When can I call myself a Provisional Psychologist? Provisional Psychologists undertaking an accredited higher degree or a Board approved 4+2 internship are entitled to use the title ‘Provisional Psychologist’ while engaged in approved supervised practice. A Provisional Psychologist undertaking an accredited higher coursework degree pathway may only undertake additional practice outside university placements and use the title 'Provisional Psychologist' on Board approval. You should not use the title ‘Provisional Psychologist’ for work roles that are not psychological. Under the National Law the word ‘provisional’ is not protected but when paired with the word ‘psychologist’ it would constitute a breach of the Act if used by any person who is not registered as a Provisional Psychologist. Correct titles: according to PsyBA • Provisional psychologists undertaking an accredited higher degree or a Board approved 4+2 internship program are entitled to use the title ’provisional psychologist‘ while engaged in supervised practice undertaken for the purpose of gaining general registration. • The term 'intern' is not a protected title under the National Law, but titles associated with the profession of psychology are protected. The term 'intern' should not be used in relation to the title 'psychologist'. Correct Titles • Candidates undertaking Masters or Doctorate degrees who are fully registered, but not endorsed, must refer to themselves as 'Psychologist'. • Fully registered Psychologists have unrestricted rights to use the title 'psychologist', and may undertake any work using that title as long as they are fully registered. Supervisory Alliance • According to Milne (2009) “Most accounts of what matters in clinical supervision place the quality of the supervisory relationship at its very heart” • For Falender and Shafranske (2004) the supervisory alliance is “a central pillar” in their competency based approach with the supervisor bearing primary responsibility for its development and maintenance Competencies in the Supervisory Alliance The competencies required to address the supervisory alliance include the following • Interpersonal skills: – the ability to communicate – understanding the experience of the self and that of the supervisee (perspective taking) – the ability to experience and express empathy, to provide support, to trust – the ability to reflect on one's behaviour and its impact on others – the ability to identify alliance strain, rupture, and countertransference From Falendar & Shafranske (2004) Competencies in the Supervisory Alliance • Values: – integrity-in-relationship – ethical values-based practice – appreciation of diversity – science-informed practice • Knowledge: – of the literature regarding alliance – knowledge and skill in performing and teaching metacommunication through multiple learning strategies (e.g. instruction, demonstration, role-playing, and critiquing) From Falendar & Shafranske (2004) The Good and the Bad Author Good supervisor Poor supervisor Campbell, J. (2006) Essentials of clinical supervision Attempts to be helpful and genuinely invested in supervision Unavailable, inconsistent, inconsiderate, dogmatic, closed, prejudiced, intolerant, inflexible, arrogant, critical, disinterested, disorganised, neglectful, untrustworthy, poor boundaries Falendar and Shafranske (2008) Casebook for clinical Supervision: a competency based approach Friendly, warm, trusting, open, flexible, interpersonally sensitive, task orientated, sensitive to developmental needs Emphasises short comings of trainee, inflexible, intolerant, defensive, uninterested in training to improve supervisor skills Knapp & VandeCreek (2012) Practical Ethics for Psychologists Has both technical skills(clinical skills, broad knowledge base, provide helpful feedback) and interpersonal skills (self confidence, acceptance of supervisee, warm, supportive), are invested in supervisory process Lack technical skills and interpersonal skills (poor communication, unreliable, unavailable) Ethical issues in Supervision Ethical Practice • Ethics – refers to values, how we ought to behave and what constitutes proper conduct • Standards of practice for psychologists are detailed in the Australian Psychological Society Code of Ethics (2007) and guidelines – http://www.psychology.org.au/Assets/Files/APS-Code-of-Ethics.pdf • The national licensing board - The Psychology Board of Australia (PsyBA) - has adopted the APS Code of Ethics for the profession. • In your role as a supervisor it is also important to adhere to Code of Ethics (2007) and include this in supervision APS Guidelines on Supervision • The APS recently revised (Feb 2013) their Guidelines on Supervision Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard B.1. Competence • • • Psychologists only provide psychological services within the boundaries of their professional competence. Psychologists who provide supervision know about: (a) the ethical, legal and regulatory requirements of psychologists; (b) a range of supervision methods and techniques; and (c) the competencies expected of psychologists. Psychologists understand that supervision oriented to the development of competencies is concerned with acquiring specific knowledge, practising relevant skills, and alignment of attitudes and values appropriate to, and consistent with, the profession of psychology (Falender et al., 2004). Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard B.6. Delegation of professional tasks. • • • • Psychologists who delegate tasks to assistants, employees, junior colleagues or supervisees that involve the provision of psychological services: (a) take reasonable steps to ensure that delegates are aware of the provisions of this Code relevant to the delegated professional task; ... (e) oversee delegates to ensure that they perform tasks competently. Psychologists ensure that supervisees, especially provisionally registered psychologists, have access to the most recent edition of the Code and the Guidelines Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard B.3. Professional responsibility. Psychologists provide psychological services in a responsible manner. Having regard to the nature of the psychological services they are providing, psychologists: (a) act with the care and skill expected of a competent psychologist; (b) take responsibility for the reasonably foreseeable consequences of their conduct; (c) take reasonable steps to prevent harm occurring as a result of their conduct; (d) provide a psychological service only for the period when those services are necessary to the client; (e) are personally responsible for the professional decisions they make; (f) take reasonable steps to ensure that their services and products are used appropriately and responsibly; (g) are aware of, and take steps to establish and maintain proper professional boundaries with clients and colleagues; and (h) regularly review the contractual arrangements with clients and, where circumstances change, make relevant modifications as necessary with the informed consent of the client. Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Supervisors of provisionally registered psychologists or registrars are aware that they may ultimately need to make a judgement about the competence of their supervisee(s). They may need to decide whether the supervision requirements for registration have been met, and whether the supervisee is ready to practise unsupervised and sufficiently prepared to enter the profession. Similar judgements often need to be made by field supervisors about placement students or supervisees looking to attain area of practice endorsement or APS College membership. Supervisors alert supervisees to their competing professional roles associated with learning and evaluation. Responsibility for monitoring and evaluating the performance of the supervisee lies with the supervisor who raises any issues of competence as they become apparent, and does not wait until the end of the supervision contract or arrangement to raise them. Any issues of impairment, whether temporary or enduring, are addressed by the supervisor subject to the Psychological Board of Australia’s mandatory reporting requirements (2011a). Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard A.4. Privacy. • • • • Psychologists avoid undue invasion of privacy in the collection of information. This includes, but is not limited to not requiring supervisees or trainees to disclose their personal information, unless self-disclosure is a normal expectation of a given training procedure and informed consent has been obtained from participants prior to training. Refer to Guidelines on confidentiality (2007) Refer to Guidelines for managing professional boundaries and multiple relationships (2008). Psychologists attend to the power differential between the supervisor and supervisee. Psychologists establish a professional relationship which allows the supervisee to be prepared to reveal difficulties or areas of weakness, or express differences of opinion to the supervisor, and not withhold salient information from the supervisor. Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard C.3. Conflict of interest. • • • Psychologists refrain from engaging in multiple relationships. The process of selecting and agreeing to enter a supervisory relationship is undertaken carefully and thoughtfully, paying close attention to any potential multiple relationships. Potential conflicts of interest are identified, considered and appropriately resolved either at the initial stages of supervision, or at the earliest stage when they become apparent. Psychologists do not provide a counselling or psychometric testing and assessment service to a supervisee. Ethical issues for supervisors (adapted from APS Guidelines on Supervision) Standard C.4. Non-exploitation. • Psychologists do not exploit their relationships with their assistants, employees, colleagues or supervisees. • Psychologists do not engage in sexual activity with their supervisee (Bernard & Goodyear, 2009). • Refer to Guidelines on the prohibition of sexual relationships with clients (2007). Ethics refers to either . . . – the minimum standard (the legal or mandatory floor adopted by the profession); or – voluntary efforts to live out high moral ideals • The floor approach is an incomplete view of ethics as most psychologists want to do more than just avoid being punished, they want to have a positive impact on others and to excel in their profession (Knapp & VandeCreek, 2012) Principles of Ethical Practice • These principles, identified by Ross (1930/original republished in 1998), Kitchener (1984), Beauchamp & Childress (2009) and others are created by theorists to aid in guiding professional action. They provide a framework to use when considering the ethical dilemmas that arise in supervision. • Five principles or “ethical intuitions” are applicable to psychologists in their supervisory and clinical roles. • Autonomy • Beneficence • Fidelity • Justice • Non-maleficence Each principle linked to its definition and a way it may be identified in supervision Principle Definition In supervision Autonomy individuals have rights to freedom of action and choice Increasing right to autonomy of supervisee as they become more experienced Beneficence actions taken should do good, using knowledge to promote human welfare Need to take into account welfare of client, supervisee and involved others Fidelity being faithful to promises made Supervisors need to consider what they can reasonably offer to supervisee during contracting process Justice ensuring that people are treated fairly Supervisor may need to consider what is equitable if supervising more than one student Non-maleficence striving to prevent harm In supervision needs of supervisee and client may conflict Principles of Ethical Practice • While these principles are generally to be followed, “at times it may be impossible to follow one ethical principle without violating another” (Knapp & VandeCreek (2012), p 23) • Supervisors may need to identify the applicable principles of ethics and identify a course of action that might give greater weight to one principle but takes account of the others Ethical Decision Making Haas & Malouf (2005) describe a process of ethical decision making: o Does a relevant, professional, legal or social standard exist? o Is there a reason to deviate from the standard? o What are the ethical dimensions of the issue? o Can a primary ethical dimension be specified? o Consult and review codes of ethics: review literature and consider ethical principles o Generate a list of possible actions o Does the new course of action appear to satisfy the needs / preferences of the affected parties? o Does the course of action present any new ethical problems? o Can the course of action be implemented? o Implement the course of action. Case studies for discussion 1. You become increasingly concerned that your supervisee has mental health difficulties. She comes to you in an agitated state and starts to tell you about what is happening for her, seemingly being unable to contain the material any longer. She discloses that she has self harmed in the past. She states, “it has just been a bad day”. 2. A supervisee offers you tickets to a play that is sold out. You had previously mentioned that you were unable to get seats for this play. Your supervisee explains that his mother has two tickets that she is unable to use and he offers them to you. • In groups, discuss what principles of ethics are relevant and how might they inform your decision making and the course of action you take? Adapted from Scaife (2001) and Falender & Shafranske (2008) Professional Practice Informed consent with supervisees • Informed consent provides the opportunity to clarify goals, methods, structure and purpose of supervision • Written agreements with supervisees minimise the risk of any misunderstandings • The agreement should clearly specify o o o o o o o o The nature of the supervisory relationship The type of services to be provided Anticipated length and frequency of supervision Limits to privacy Fees and related policies OH&S representatives contact details The terms of termination of the supervisory relationship Record keeping obligations of both parties e.g. log book, supervision notes o Back up procedures for supervisee in emergencies o State the means used to evaluate the supervisee e.g. audio or video recording, case presentations Documentation / Log books Australian Psychology Accreditation Council Accreditation Standards (Ver 10 June 2010) p. 54 Log Book - 5.1.17 On commencing the 5th year, every postgraduate professional coursework student must commence a single log book of practica, casework and supervision experiences. The log book must detail the nature and hours of all placement or other practica undertaken (internal and external), as well as the dates, nature and hours of supervision, with group supervision clearly differentiated from individual (i.e. one-on-one) supervision and the log book clearly specifying the nature of client work undertaken. Supervisors are required to regularly endorse, by signed notation, that the log book is a true reflection of the practica undertaken and log books must be available for inspection by APAC if requested during an audit or accreditation assessment. The log book should be carried over into the 6th and subsequent years of professional postgraduate training and a copy retained by the AOU for a period of ten years following the graduation of the student which can be inspected by APAC or the Registration Board on request. A final check of the log book must be a requirement of the course and this check must be confirmed by the signature of the/a primary supervisor on the log book itself. Informed consent with patients of supervisees • See APS Guidelines on Supervision 4.2 and 4.3 4.3 Supervisees ensure that they have obtained informed consent from clients to allow them to disclose clients’ relevant personal information to their supervisor • Supervisees must inform patients of the supervised nature of the relationship and provide the name of their supervisor • This include informing clients of what sort of details will be discussed with supervisors, where these discussions will occur, what will happen to audio or video recordings of sessions • Placement settings may provide formal consent forms for a supervisee’s client to complete, otherwise consent should be documented by the supervisee Confidentiality • Confidentiality is the obligation to protect the privacy of patient information • Supervisees are also entitled to a degree of privacy • Regarding privacy, supervision contracts should address:– who will have access to information about the supervisee’s work performance, personal disclosures and supervisors’ assessments – which types of records will be kept regarding the supervision – what will happen to supervisors records and to recordings submitted for review e.g. who is responsible for erasing or disposing of electronically recorded clinical material) • Supervisees who have had documented issues in prior placements should be aware that a University “may release information about such student progress to the supervisor in accordance with relevant privacy legislation and policies” (Sourced from ww.mq.edu.au/policy/docs/practical_placements/policy.html) Group supervision - Pros • Less costly in terms of money and supervisors time (Bernard & Goodyear, 2009) • Supervisees exposed to greater breadth of client characteristics and presenting problems • Input from a broader range of colleagues • Personal support from group membership and a source of normalising supervisees’ experiences • Opportunity to observe and experience group process Group Supervision - Cons • Diminished confidentiality is a concern as the number of people who have access to information is increased (Bernard & Goodyear, 2009). • A group may not offer adequate time for attending to all the needs of members • Unaddressed groups dynamics (such as competition, jealousy, resentment) can diminish the value of supervision • Interpersonal conflict amongst group or gossip outside of the group can be problematic • Multicultural issues can be neglected or mismanaged • Thomas (2010) suggests these issues can be minimised by awareness and appropriate intervention by a skilled supervisor Ethical decision making in group supervision Proctor (2008) proposes the following points which will influence ethical decision making in a group context:• • • • • • • • Who has the highest call on the supervisor’s duty of care at any particular time – client, supervisee, group members, organisation? Is there urgency in respect to one or more of these stakeholders? Is there time to seek consultation? To whom should any communication be addressed in the first place? Should this always include telling the supervisee concerned before anyone else? Can it be done publicly in the group – maintaining authenticity, respect and empathic understanding? Has it been established that private meetings may be held between supervisor and members – for any reason? Or in special circumstances? Will arrangements be made privately or in the group? Have I clarified for myself my grounds for concern and my purpose in addressing any stakeholder? Case discussion You are consulted by the group supervisor in the following vignettes. What questions might you raise with the supervisor and develop some choices of action that the supervisor could choose between. 1. A group supervisor has a small group of four supervisees, all from the same training course. One of the supervisees has written him a letter saying that she and one of the male supervisees, also in the supervision group, are having a relationship and intend to move in together in the next few weeks. She wants to know if this will affect their being in the same supervision group – they find the group very helpful and desperately want to remain in it. 2. A group supervisor has a group of three supervisees. Two of the supervisees, Jack and Jill, have taken to supervision well and use it effectively to learn and reflect on their client work. Joanna on the other hand seems to drain the group’s energy. She takes every opportunity to talk about herself, her past, her difficult times at home. She relates this to almost all the cases brought by the others. Last supervision session Jill exploded and said that Joanna should take this to personal counselling instead of dumping it on the group. Vignettes adapted from Proctor (2008) Dual / Multiple relationships • The supervisor and supervisee relationship is complex and serious consideration is required when members enter into additional roles. • Campbell (2000) suggests that dual and multiple relationships are inherent in the supervisory position so it is not a question of how to avoid them in supervision but how best to manage them • Additional roles may include – – – – – friendship collaboration on research or projects publications presentations discussions of topics that are unrelated to supervision (e.g. personal problems of either individual) – incidental or planned interaction outside of formal meetings – line manager Dual / Multiple relationships • A supervisor may often be the line manager or the supervisee may be professionally accountable to supervisor. How can this impact on the supervisory relationship? • Multiple relationships between supervisor and supervisee can involve subtle, boundary issues. Supervisors must not allow a supervisory relationship to become a counselling relationship. Even recommending to supervisees that they seek counselling to resolve issues that are having a negative impact on their work with clients may strain the supervisory relationship. The focus in supervision must remain on the welfare of the clients. • While social encounters make the work atmosphere more enjoyable, the objectivity of a supervisory relationship may be compromised by a friendship and the social relationship may not be entirely voluntary on the part of the supervisee (Knapp & VandeCreek, 2012) Decision making model for relationships with supervisees • • • • • • • • • To what extent would engaging in this relationship or connection meet the needs of the supervisee? How would this individual likely benefit? To what extent would it meet my needs? How might I benefit? Are the needs in question primarily personal or professional? What could go wrong if I decided to do this? What harm could result and to whom? What is the worse-case scenario and how likely is it to occur? If it did occur what could be done to ameliorate the negative or harmful effects? What are the unique characteristics of this individual and of our particular relationship? What particular vulnerabilities or needs do I have that have the potential to create a blind spot for me in objectively evaluating this decision? From whom did the initiative for this connection come? If the idea was mine (supervisor) to what extent is that individual likely to feel free to decline, given my relationship with him or her? What are the alternatives? What risks and benefits do they pose? From Thomas (2010) Supervisee self disclosure Any supervisory technique requiring self disclosure represents a “double-edged ethical sword” according to Thomas (2010) • Self disclosure in the context of supervision provides an opportunity for personal and professional growth, enhancing competency. Supervisees gain insight of any unresolved personal issues and develop an improved self awareness of any potential problems that may compromise their clinical objectivity and effectiveness. • Alternatively, self disclosure in individual or group supervision may represent an invasion of privacy. Failure to obtain informed consent to participation in training with clear awareness of all requirements is another ethical problem. Introducing personal information into the supervisory alliance creates potential for a dual relationship (i.e. supervisor – supervisee, therapist – client). Crossing the boundary between therapy and supervision creates a poor role model for supervisees who are learning to clarify boundaries with their clients. Consideration of Diversity • Diversity includes ethnicity, culture, gender, age, sexual orientation, and disability • Ethical approach to supervision needs to include consideration of these factors in relation to client groups, services and the supervisor’s and supervisee’s own experiences and values • Consideration of diversity issues is crucial to supervision Power differences in supervision Common transference themes in supervision include: • • • • • • • admiration the wish to please attraction a desire to emulate the supervisor fear of criticism intimidation / resentment feelings of being “seen through or diagnosed” • The supervisor bears the ethical responsibility for monitoring and addressing transference and countertransference reactions occurring in supervision. Power differences in supervision • Supervisors are liable for the work of their supervisees, they have authority to establish requirements and dispense meaningful consequences for noncompliance • “Ethically and legally the principle of do no harm to the client must prevail . . . Supervisors should be aware that in the end, they will be responsible for the supervisee’s overall actions with clients. This responsibility is referred to as vicarious liability” (Campbell, 2000, p 158) • Recent Psychology Tribunal decision highlighted the responsibilities of supervisors – see HCCC v Dene and Donnelly (no:2) [2010] NSWPST 4 www.austlii.edu.au/au/cases/nsw/NSWPST/2010/4.html • Ethically responsible supervision involves ensuring that the supervisor holds professional indemnity insurance covering their supervisory role, supervise within the boundaries of their competence, document supervision carefully, consult with colleagues as needed and keep up to date with evolving ethical standards and legal developments • Consulting relationships generally involve a less potent power differential than in supervision • Power dynamics are not static in the supervisory relationship – it is the supervisor’s ethical responsibility to attend to the evolution of power dynamics in the supervisory relationship • As Campbell (2006) notes that “as the supervisee matures professionally, supervision becomes more consultative in nature”. It can be argued that “once a client, always a client”, that claim is not made about supervisees. Sexual contact in supervision • Is consent even possible in the context of a relationship of unequal power? • What impact do sexual relationships with supervisees have on other supervisees or employees? What does this demonstrate to supervisees about ethical standards? • Ethics code and guidelines do not specifically comment on sexual contact with former supervisees – what issues need consideration? Sexual contact in supervision • APS Code of Ethics (2007):C.4.2. Psychologists do not exploit their relationships with their assistants, employees, colleagues or supervisees. • APS Guidelines on Supervision (2013) 3.9 Psychologists do not engage in sexual activity with their supervisees (Bernard & Goodyear, 2009) • APA Ethics Code (2010) :7.07 Sexual Relationships with Students and Supervisees Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training centre or over whom psychologists have or are likely to have evaluative authority. Final Thought • No amount of professional experience or education makes us immune to error • Practicing and supervising ethically requires ongoing effort and commitment to stay abreast of changes • “Our objectivity and effectiveness are vulnerable to personal stressors and clinical challenges . . . When compromised, they are only as good as the safety net we construct around ourselves in our work. Supervision and consultation are cornerstones of this safety net” (Thomas, 2010, p. ix) Module 2 The Process of Assessment Types of Assessment Assessment Procedures Managing underperformance Managing Impairment Overview In this module, participants will consider the types of assessment necessary in supervision, the procedures that safe guard them and strategies to manage under performance as well as outcomes that require their gatekeeping actions. Pre-reading Jacobs, S.C., Huprich, S.K., Grus, C.L., Cage, E.A., Elman, N.S., Forrest, L., Schwartz-Mette, R., Shen-Miller, D.S., Van Sickle, K.S. & Kaslow, N.J. (2011). Trainees with professional competency problems: Preparing trainers for difficult but necessary conversations. Training and Education in Professional Psychology, 5(3), 175-184. Functions of Supervision Supervision serves various functions: 1. Normative – monitoring and ensuring client well being, and monitoring and evaluating supervisee competence (summative feedback) 2. Formative – educating and guiding supervisee’s professional practice (e.g. facilitate supervisee’s learning) 3. Restorative – supporting supervisee’s personal and professional well-being (e.g. provision of emotional support) Supervision = Development + Assessment • Supervisors can occasionally be troubled by the evaluative component of supervision as it is not compatible with their professional identity as a helping professional, that is one who is a facilitator of change not a decision maker about what change is necessary (Bernard & Goodyear , 2009) • “Supervision frequently serves two broad and at times competing functions or purposes - development and assessment of a supervisee. Development functions include mentoring, support, guidance, and teaching. Assessment functions include appraisal, evaluation, feedback and ‘gatekeeping’. The requirements of these two broad functions can be potential sources of professional, ethical and legal challenges to psychologists and the profession of psychology in general (Bernard & Goodyear, 2009; Falender & Shafranske, 2004; Milne 2009)” • – from APS 2013 Guidelines on Supervision The Assessment Context • 1) 2) 3) 4) It is easier to provide negative assessment material to a supervisee if the system is supportive: The University and workplace procedures and guidelines have been adhered to A realistic attitude for the need for occasional negative evaluation is supported by the institution and the institution accepts responsibility for producing competent trainees Workloads allow you to address concerns appropriately A supervisor’s action has been supported by the institution (Jacobs et al, 2011) • Feedback forms promote focus on competency Favourable conditions for assessment Bernard and Goodyear (2009) propose the following conditions that can make assessment a more positive experience: Supervisors must remember that supervision is an unequal relationship Clarity: supervisors need to state clearly their administrative and clinical roles Address supervisee defensiveness openly Address individual differences openly Evaluation should be a mutual and continuous process Avoid making premature evaluations of supervisees Allow supervisees to witness the professional development of supervisors (e.g. inviting and using feedback from supervisees, sharing continuing education experiences and new ideas the supervisor has recently been exposed to) Supervisor maintains a relationship with supervisee that is positive and supportive, professional but not personal Only those who enjoy supervising should supervise Formative Feedback • Formative assessment is the process of facilitating skill acquisition and professional growth through direct feedback • Formative evaluation stresses the process and progress of professional competence, rather than outcome • Supervisors are more comfortable with formative feedback and this type of evaluation represents the bulk of the supervisor’s feedback according to Bernard & Goodyear (2009) Formative Feedback An evidence-based protocol for providing constructive developmental feedback:• Invite and facilitate the supervisee to self review • Express appreciation of their efforts and achievements and awareness of challenges • Provide data based feedback (timely, specific and concrete, examples and consequences on client/supervisee) on performance “gaps” • Invite their response to your feedback (& LISTEN) • Their ideas for practice improvement • Comment on their ideas and add your own • Invite their response to your ideas • Collaboratively plan their practice development • Review the feedback process • Follow up next session From Wilson & Armstrong (2009) Log book The documentation of supervision is “an essential risk management strategy” according to Thomas (2010) • Electronic logbooks are now commonly in use, and students will continue to use the spreadsheet from their Clinic placement across all field placements. This is where all client contact and supervision hours are to be documented. APAC requires the logbook to be “reflective”, so make sure the supervisee and supervisor regularly comment on the progress of supervision sessions. Supervisors must complete the Electronic Logbook Declaration form to document the hours that have been accumulated at the completion of the placement. • If a supervisee has not used the electronic logbook, then two forms of records need to be kept: o Log Book Daily Activity Sheets and o Supervision Session Summary Sheets. Log Book - Example NAME OF STUDENT: Jane Doe SUPERVISOR: Mark Goodfellow AGENCY: Anxiety Disorders Clinic, Atlantis NB: 1=Total hours claimed for the date specified; 2= Practicum hours not otherwise specified, ie not included under columns G,H, I and J; Totals appear at bottom of sheet DATE WEEK 1 PLAC HRS1 04-Jun-10 Activity One Individual Therapy Session - JJ Assessment (IQ) Ward rounds Seminar Supervision (MG) Preparation, documentation, miscellaneous Prac Hrs NOS2 CLIENT WORK SUPERVISIO Ct. popn FACE-TO-FACE HOURS N HOURS Group Adult Adult Individual Group SUPERVISION Individual STUDENT'S COMMENTS Log approved by Supr (date) 1 1 1 1 1 good help with client… 2.5 7.5 2 07-Jun-10 Individual Therapy Session - JJ Individual Therapy Session - MB Co-therapist in Anxiety Group, Session 1 Preparation, documentation, miscellaneous Supervision MG Adult Adult Adults 1 1 2 2.5 1 7.5 11-Jun-10 learning about tolerating uncertainty MG Jun 9 Initial Session CC Individual Therapy Session - AC Group Supervision (Supervior, ZP) Preparation, documentation, miscellaneous Adult Adult 1.5 1 1.5 3.5 7.5 3 14-Jun-10 Individual Therapy Session - JJ Individual Therapy Session - MB Co-therapist in Anxiety Group, Session 1 Preparation, documentation, miscellaneous Supervision MG 7.5 Adult Adult Adult 1 1 2 2.5 1 Helpful discussion of implementing panic surfing MG, Jun 16 Summative Feedback • • • • • Summative feedback is a more formal process that ensures the supervisor’s accountability to the supervisee, the academic and clinical training programs, and the profession, ultimately safe guarding the public (Falender & Shafranske, 2008) Summative evaluation typically involves ratings of performance in a given competency. Summative feedback occurs at the mid-point and end of a field placement A competency based approach emphasises clear objectives throughout the training process and identifies the requisite knowledge, skills and values in particular competencies One of these competencies is the development of self assessment and reflection. See Module 6 for in depth discussion of reflective practice in supervisee. APAC Requirements on Summative Feedback From Australian Psychology Accreditation Council Accreditation Standards Ver 10 June 2010: • 5.3.27 At the beginning of each placement the student and supervisor must complete and sign a supervision contract stating the objectives for the placement including the range of activities to be covered and the skill base to be developed. This form should be approved and signed by the placement coordinator. • 5.3.28 Once approximately half the placement has been completed, an interim review should be conducted which involves the student and supervisor reviewing progress, the student’s performance and the extent to which the placement objectives are being met. A copy of this review should be given to the placement coordinator and any action that is required as a result should be taken. Placement reviews must be held on file by the AOU and be made available for inspection by APAC if requested. APAC Requirements on Summative Feedback • 5.3.29 At the end of the placement the supervisor must complete a final assessment and make a recommendation whether the student has completed the placement to an acceptable level, whether further time should be spent on that placement because the student has not yet met requirements, or whether the student has failed to meet the required standards and is not likely to do so with further work. The final decision regarding whether the student has passed or failed the placement should be made by the placement coordinator in full consultation with the field supervisor. Summative Assessment Forms Several of the summative feedback forms used in placements are available in online survey format, and this is the preferred method for submission (links to forms are provided below). At mid-placement review CYPRS is completed: https://uowpsych.us.qualtrics.com/SE/?SID=SV_ebRFp7Rm3pT4Bvf At end of placement review CYPRS is completed: https://uowpsych.us.qualtrics.com/SE/?SID=SV_26x2u5ZfEBkLKvP CΨPRS – Clinical Psychology CΨPRS – Clinical Psychology Clinical Neuropsychology form Clinical Neuropsychology form Organisational Psychology form Organisational Psychology form Organisational Psychology form Quick Quiz 1. 2. 3. Evaluation aimed at fostering development is known as _________ assessment. Evaluations made as a judgement of professional competence are known as ___________ assessment. The gatekeeper role in supervision serves what function? A. Normative B. Restorative C. Formative Assessment of your Supervision Assessment of the supervision you provide can be achieved by: • Feedback from supervisee – both formative and summative • Student’s on-line evaluation of placement https://macquariehs.qualtrics.com/SE/?SID=SV_0unPbyPoGWPG7Q0 • Supervision of your supervision (individual or group) • Consultation groups focussing on supervision • Utilising rating scales such as Tasks / Changes in Supervision (from University of Queensland) Managing Underperformance & Impairment Inherent requirements of psychologists UWS developed a series of inherent requirement statements for the Master of Psychology (Clinical Psychology). These statements specify the course requirements for student admission and progression and are clustered under seven domains consisting of: 1. ethical behaviour - complying with conduct required to maintain provisional registration as a psychologist 2. behavioural stability - being receptive and responding appropriately to constructive feedback, managing own emotional state in order to be able to develop and maintain an appropriate relationship with a diverse range of clients 3. legal - complying with legal requirements regarding all aspects of practice, complying with the requirement for student registration with the Australian Health Professional Registration Authority (AHPRA) 4. communication - verbal: collecting information from clients by asking questions during assessments, explaining a treatment plan to a client, discussing the client's progress with other professionals - non verbal: recognising and responding to non-verbal cues indicating a change in the emotional state of a client during placements. recognising and responding to non-verbal cues in classroom situation - written: constructing an essay to required academic standards including appropriate referencing of sources, preparing clinical reports which are appropriate to the purpose and audience, and completed in a timely manner Inherent requirements of psychologists 5. cognition - ability to apply academic knowledge to practice during placements, for example through developing and testing hypotheses, developing treatment plans and then conducting individual sessions for clients based upon this, literacy skills including conveying a spoken message accurately and effectively in a clinical setting during placements, numeracy skills including accurately scoring and interpreting psychological test data while on placement, paraphrasing, summarising and referencing producing accurate, concise and clear documentation while on placement in the clinical setting which meets legal and professional requirements 6. relational skills - rapidly building rapport with a client in order to engage them in a clinical assessment while on placement, effectively managing difficulties arising in the therapeutic relationship while on placement 7. reflective skills – identifying when a clinical issue is outside one's scope or expertise, or when one's practice may be affected by an impairment Also as many of the activities associated with the professional practice of a registered psychologist are time sensitive, the capacity to perform certain activities within specified time limits is required to reduce or avoid risks to patient safety and wellbeing. (Developed from Johnson, A., Allan,T., Phillips,K., Azzopardi,T., Dickson,C., Goldsmith,M & Hengstberger-Sims, C. (2011). Inherent Requirements of Nursing Education (IRONE), UWS School of Nursing & Midwifery and Student Equity & Disability Services). Sourced from http://www.uws.edu.au/ir/inherent_requirements/inherent_requirements_for_master_of_psychology_clinical_psychology Definitions • According to Scaife (2001) there are 3 categories of difficulties supervisees may demonstrate: 1. Incompetence (professional unsuitability) 2. Impairment (personal incapability) 3. Unethical practice (malpractice, professional misconduct) • Incompetence, impairment and unethical behaviour are not mutually exclusive and may overlap. The terminology used regarding students who “are not measuring up” has been the source of much controversy over the past 20 years (Pelling et al, 2009). Incompetence Incompetence is defined as when supervisees have never shown a level of competent professional functioning • Elman and Forrest (2007) recommend using a more behaviourally focussed term - “problems of professional competence” - as this captures the following three elements a. there is a problem with performance b. a professional standard, and c. a focus on competence. Problems of professional competence • Problems in professional competence may be identified in one or more competency domains that are key to effective functioning • Kaslow et al. (2007) describe two categories of competencies – foundational (e.g. professionalism, reflective practice / selfassessment, scientific knowledge and methods, relationships, ethical and legal practice, individual and cultural diversity, interdisciplinary systems), and – functional (e.g. assessment / diagnosis / conceptualization, intervention, consultation, research / evaluation, supervision / training, management / administration). Managing incompetence • Refer back to supervision agreement • Extend the placement with the following: • Role plays • Use of video • Didactic techniques – teaching • Observation of supervisor • Education / assigned reading • Return to the Clinic for remediation • Repeat placement in a new agency MQ Policy on Failure Supervisors do not “Fail” a student, the Placement Coordinator is responsible for this decision. • “All placements are graded as Satisfactory or Unsatisfactory by the Placement Co-ordinator. Supervisors do not grade Students, this is the responsibility of the University. The decision is based on information supplied by the Supervisor, the written work submitted and the standard reached where problem areas have been identified.” From Macquarie University, Clinical Psychology 2013 Field Placement Manual • “The final decision regarding whether the student has passed or failed the placement should be made by the placement coordinator in full consultation with the field supervisor (and with oversight from the course chair where required).” From Macquarie University, Clinical Neuropsychology 2013 Field Placement Manual Impairment • Impairment means a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect the persons’ capacity to practise the profession (Health Practitioner Regulation National Law (ACT) - SECT 5) • Impairment refers to diminished functioning after reaching an adequate level of professional competence (Sullivan, 2009; Scaife, 2001) Unethical practice Unethical practice is when registered practitioners have not performed in accord with the professions code of ethics, potentially resulting in notifiable conduct Notifiable Conduct means the registered practitioner has: • practiced whilst intoxicated by alcohol or drugs (so that their capacity to exercise reasonable care and skill is compromised); • engaged in sexual misconduct in connection with the practice of the practitioners profession; • placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or • placed the public at risk of harm because the practitioner has practiced the profession in a way that constitutes a significant departure from accepted professional standards. Mandatory Reporting Psychology Board of Australia (PsyBA) has a core role of protecting the public. To this end the PsyBA investigates concerns raised about individual psychologists through the “notification” system. • This process is managed through the Regional Boards of the PsyBA in the respective States and Territories in collaboration with AHPRA. Except in NSW where notifications are dealt with by a separate health professional (Psychology) council and the Health Care Complaints Commission • Voluntary notifications about psychologists can be made by anyone • Under the National Registration and Accreditation Scheme (NRAS) there is a mandatory obligation on any registered health professional (including provisional psychologists), employer or education provider who forms a reasonable belief that another practitioner has engaged in notifiable conduct to make a report to AHPRA • In 2011/12 AHPRA received 44 mandatory notifications and 367 voluntary notifications about psychologists • In 2010/11 AHPRA received 428 mandatory notifications across 10 professions, of these 7 notifications were about students Source: InPsych (APS Bulletin), April 2013, pg 26-27 HEALTH PRACTITIONER REGULATION NATIONAL LAW (NSW) - SECT 55 Unsuitability to hold general registration (1) A National Board may decide an individual is not a suitable person to hold general registration in a health profession if (a) (b) (c) (d) (e) (f) (g) (h) in the Board’s opinion, the individual has an impairment that would detrimentally affect the individual’s capacity to practise the profession to such an extent that it would or may place the safety of the public at risk; or having regard to the individual’s criminal history to the extent that is relevant to the individual’s practice of the profession, the individual is not, in the Board’s opinion, an appropriate person to practise the profession or it is not in the public interest for the individual to practise the profession; or the individual has previously been registered under a relevant law and during the period of that registration proceedings under Part 8, or proceedings that substantially correspond to proceedings under Part 8, were started against the individual but not finalised; or in the Board’s opinion, the individual’s competency in speaking or otherwise communicating in English is not sufficient for the individual to practise the profession; or the individual’s registration (however described) in the health profession in a jurisdiction that is not a participating jurisdiction, whether in Australia or elsewhere, is currently suspended or cancelled on a ground for which an adjudication body could suspend or cancel a health practitioner’s registration in Australia; or the nature, extent, period and recency of any previous practice of the profession is not sufficient to meet the requirements specified in an approved registration standard relevant to general registration in the profession; or the individual fails to meet any other requirement in an approved registration standard for the profession about the suitability of individuals to be registered in the profession or to competently and safely practise the profession; or in the Board’s opinion, the individual is for any other reason: (i) not a fit and proper person for general registration in the profession; or (ii) unable to practise the profession competently and safely. Procedure for mandatory notification Procedure for mandatory notification Procedure for mandatory notification Procedure for mandatory notification Procedure for mandatory notification Complaints & Notifications Anyone can make a complaint, but it must be in writing. • Health Care Complaints Commissions, New South Wales Level 13, 323 Castlereagh Street (corner of Hay St) Sydney NSW 2000 Ph: (02) 9219 7444 Toll Free in NSW 1800 043 159 TTY service for the hearing impaired: (02) 9219 7555 Email: hccc@hccc.nsw.gov.au • Australian Health Practitioner Regulation Agency (AHPRA) https://www.ahpra.gov.au/Notifications-and-Outcomes/Conduct-Health-andPerformance/Make-a-Notification.aspx Note there are different forms and addresses dependent on if you are a member of the public making a voluntary notification or if you are a health practitioner making a mandatory notification to AHPRA • Liaise with the supervisee’s Placement Co-ordinator at any time during the placement if you have concerns that your supervisee is not able to meet the required goals and standards of the placement. Cases for discussion • Supervisee struggling with whether supervisors conduct is unethical / notifiable • Dealing with supervisee who has recently commenced placement and is wearing short skirts and plunging neck lines • Supervisee who continually arrives late for supervision sessions and becomes defensive when you broach these issues References American Psychological Association (2010). Ethical principles of psychologists and code of conduct (2002, Amended June1, 2010). Australian Psychological Society. (2007). Code of ethics. Melbourne, Vic: Author. Australian Psychological Society. (2013). Guidelines on Supervision. Melbourne, Vic: Author. Barnett et al (2007) Commentaries on the ethical and effective practice of Clinical Supervision. Professional Psychology: research and practice, 38(3), 268-275. Beauchamp, T.L. & Childress, J. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press. Bernard, J.M. & Goodyear, R.K. (2009). 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