Clinical Supervision I: Developing Counselors Skills. The ATTC Network 11/28/2016. Clinical Supervision I: Developing Counselors Skills

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1 Clinical Supervision I: Developing Counselors Skills Jennifer Wyatt, LMHC, MT-BC, CDP Janis Crawford, MA, LPC, ACS The ATTC Network Ten Regional Centers Four National Focus Centers SBIRT Hispanic and Latino Native American-Alaska Native Rural and Frontier Two Centers of Excellence YMSM + LGBT PPW Northwest Addiction Technology Transfer Center 1

2 WELCOME! Sign in sheet Folders Credit hours Bathrooms Breaks/lunch Mobile phones Questions Confidentiality Freedom of Movement ATTC Forms OBJECTIVES To understand the research supporting effective supervision methods To identify the roles in the supervisory relationship To increase awareness of culture in supervision To practice skills that structure clinical supervision (e.g., Feedback Model, Professional Development Plan, Supervisory Interview) To gain familiarity with available resources for clinical supervision When people feel like their doing a good job, they do COURSE OVERVIEW Content TAP 21: Counselor Competencies TIP 52 Skills Assessment using the Rubrics Feedback Model Professional Development Plan Supervisory Interview Process Didactic Demonstrations Small group tasks Skill Practice Personal Action Plan Everything we do in this model translates to teaching skills to counselors Northwest Addiction Technology Transfer Center 2

3 Name, Specialty, Job Experience, training, or interest in clinical supervision Your favorite thing to do outside of work (self-care) Setting boundaries SUPERVISOR SELF-ASSESSMENT How confident are you in your skills as a clinical supervisor right now? 2. What might help you get up to a higher number? MODEL OF SUPERVISION It is common for Clinical Supervisors to have no formal training. Motivational Interviewing skills help How might having a model be helpful to supervisors and counselors alike.? Northwest Addiction Technology Transfer Center 3

4 KEY COMPONENTS Structure Direct observation Efficiency Collaboration Researchbased Feedback Skillbuilding OUR GOALS AS SUPERVISORS Assure quality treatment for clients Create a positive work environment Characteristics of a strong team Develop effective clinical skills in counselors Clinical Supervision is defined as observing, monitoring, and evaluating the work of counselors. Support, encouragement, & education Teacher Mentor Coach Consultant Source: TIP 52, 2014, p Northwest Addiction Technology Transfer Center 4

5 A CLINICAL SUPERVISOR WEARS MANY HATS EIGHT TRUTHS EVERY SUPERVISOR SHOULD KNOW 1. The reason for supervision is to ensure quality client care; integrity. 2. Supervision is all about the relationship. 3. Culture and ethics influence all supervisory interactions relationships. 4. Be human and have a sense of humor. Source: TIP 52, 2014, pp EIGHT TRUTHS EVERY SUPERVISOR SHOULD KNOW 5. Rely on direct observation of your counselors and provide specific, objective, and balanced feedback; input from clients. 6. Have and practice a model of counseling and of supervision; have a sense of purpose. 7. Make time to care for yourself spiritually, emotionally, mentally, and physically. 8. You have a unique position as an advocate for the agency, the counselor, and the client. Source: TIP 52, 2014, pp Northwest Addiction Technology Transfer Center 5

6 Often, a parallel process exists between clinical supervision and treatment. In other words, counselors tend to interact with clients consistent with how they are treated in supervision. All activities are education. DEVELOPING YOUR INDIVIDUAL CULTURE OF SUPERVISION Handout, p. 2 TIP 52, pp GOALS OF SUPERVISION Now that you have identified what you d like to avoid and emulate, take a look at Tool 3 in TIP 52 on p The intent of this tool is to help you reach agreement with staff on the goals of supervision. Which sections might be useful in your agency? Northwest Addiction Technology Transfer Center 6

7 SUPERVISOR ETHICS 1. Uphold the highest professional standards of the field. 2. Seek professional help (outside the work setting) when personal issues interfere with clinical and/or supervisory functioning. 3. Conduct themselves in a manner that models and sets an example for the agency mission, vision, philosophy, wellness, recovery, and consumer satisfaction. Source: TIP 52: 2014, pp. 17. SUPERVISOR ETHICS 4. Reinforce zero tolerance for interactions that are not professional, courteous, and compassionate. 5. Treat supervisees, colleagues, peers, and clients with dignity, respect, and honesty. 6. Adhere to the standards and regulations of confidentiality as directed by the field in both supervisory and counseling relationships. Source: TIP 52, 2014, pp. 17. LEGAL ISSUES IN SUPERVISION Direct Liability Vicarious Liability Supervisory Vulnerability TIP 52, p. 13 TIP 52, p. 14 TIP 52, p. 14 Northwest Addiction Technology Transfer Center 7

8 Documentation is unquestionably a crucial risk-management tool for clinical supervisors and is no longer optional in supervision. Legal precedents suggest that organizations are both ethically and legally responsible for quality control of their work, and the supervision evaluation, documentation, and record-keeping systems are a useful and necessary part of that professional accountability (TIP 52, p. 113). TOOLS TO DOCUMENT SUPERVISION Tool 9 Initial Supervision Sessions Checklist TIP 52, pp Tool 10 Supervision Note Sample TIP 52, p. 115 Initial Supervisory Sessions on pp How might these forms be useful to you? Carefully consider where, and for how long, you will store supervision records. TIP 52, p 113: APA recommends Northwest Addiction Technology Transfer Center 8

9 SUPERVISION & COUNSELING Clinical Supervision is different from Administrative Supervision and Counseling. Clinical Supervision emphasizes improving counselor skills and performance. Administrative Supervision focuses on agency rules and procedures. Counseling addresses personal growth outside the work environment. Let s take a closer look on p. 24 of TIP 52. DIRECT & INDIRECT OBSERVATION Indirect Observation Commonly used Includes verbal reports and reviewing written documentation Information is filtered through the counselor s perspective Direct Observation Increasingly common with EBPs Includes live observation of groups and audio/video recording services Results in thorough understanding of treatment and counselor s abilities METHODS & TECHNIQUES OF CLINICAL SUPERVISION TIP 52, PP Northwest Addiction Technology Transfer Center 9

10 AUDIO OR VISUAL RECORDING Permission is needed from clients and counselors. See TIP 52 pp for ideas. This step likely requires legal counsel to ensure compliance with HIPAA, 42 CFR Part 2, and applicable state laws. GROUP EVALUATION STEMS for clients to provide feedback 1. One specific skill I learned in this group that will support my recovery is 2. The thing I liked best about this group was 3. This group would be better for me if 4. The current needs I have that were not addressed in this group are PREPARING COUNSELORS FOR DIRECT OBSERVATION (TIP 52, P. 38) 1. Acknowledge and understand the clients and/or counselors anxiety. 2. Listen reflectively to concerns without being dismissive or ignoring the anxiety; noting that these feelings are common may help normalize the counselor s concerns. 3. Clearly state the value of direct observation and reinforce the idea that such methods are part of how we do business at this agency. Northwest Addiction Technology Transfer Center 10

11 PREPARING COUNSELORS FOR DIRECT OBSERVATION (TIP 52, P. 38) 4. Keep the door open with the clients and counselors to continue to address their concerns and feelings as part of their normal clinical or supervisory process. 5. Help the counselor to allay clients anxiety or concerns by coaching the counselor through methods for presenting the direct observation methods to the client. DEFINITION OF FEEDBACK An overt response, verbal or nonverbal, that gives specific and subjective information to a person about the impact of their behavior in a particular situation. OBJECTIVE OF FEEDBACK To transmit reliable information so that persons receiving it can establish a data bank from which to change behavior if they choose to do so. THE SUPERVISEE S CONFIDENCE AND EFFICACY ARE CORRELATED WITH THE QUALITY AND QUANTITY OF FEEDBACK PROVIDED BY THE SUPERVISOR. Source: TIP 52, p. 18 Research on Feedback Northwest Addiction Technology Transfer Center 11

12 TOOLS FOR PROVIDING FEEDBACK Clear, specific, frequent, and informative feedback is essential to successful clinical supervision. Some tools that might assist: Group Counselor Skills Observation Sheet Individual Session Counselor Skills Observation Sheet Counselor Competency Assessment: TIP 52, pp Other forms: TIP 52, p. 122 CONFIRM MUTUAL UNDERSTANDING Seeking permission to present feedback increases the chances it will be heard and understood. In sensitive situations, there is a temptation to proceed too quickly to get past the discomfort of providing feedback. Note this tendency and avoid premature assumptions of comprehension. Asking the counselor to respond to the information shared will give you a sense of their understanding. ELICIT PROVIDE ELICIT ELICIT Existing knowledge Interest Permission PROVIDE Information in small chunks Affirmation Autonomy support ELICIT Reactions Additional questions Next steps Northwest Addiction Technology Transfer Center 12

13 MI-Inconsistent I am the expert on why and how clients should change. I collect information about problems. I rectify gaps in knowledge. I just need to tell them clearly what to do. Miller & Rollnick, 2013, p 138 ASSUMPTIONS UNDERLYING INFORMATION EXCHANGE MI-Consistent I have some expertise, and clients are experts on themselves. I find out what information clients want and need. I match information to client needs and strengths. Advice that champions client needs and autonomy can be helpful. ELICIT PROVIDE ELICIT AS A FEEDBACK MODEL PRACTICE THE EPE FEEDBACK MODEL Groups of 3: Supervisor, Counselor, Observer Structure of rounds: 10 minutes: Practice using the Feedback Model. Observers use Feedback Model: Role Play Feedback for your Colleagues. 5 minutes: Debrief within your small groups. Switch roles. Each person will have an opportunity to play each role. Northwest Addiction Technology Transfer Center 13

14 Supervisors What was it like to try out the EPE Feedback Model? Counselors What was this feedback experience like for you? Observers What positives did you notice? TAP 21 represents the industry standard for effective Substance Use Disorder Counseling. Competency Definition: A behavior comprised of requisite knowledge, skills, and attitudes that plays an essential role in the practice of substance use disorder counseling. Provides a definition of expected job performance of a fully proficient substance use disorder counselor. Assists Clinical Supervisors in establishing clear goals. Look at page iii in TAP 21. Northwest Addiction Technology Transfer Center 14

15 Addiction Counseling Competencies TAP 21 Section 1: Transdisciplinary Foundations Section 2: Professional Practice Dimensions TRANSDISCIPLINARY FOUNDATIONS Understanding Addiction Treatment Knowledge Application to Practice Professional Readiness PROFESSIONAL PRACTICE DIMENSIONS Clinical Evaluation Treatment Planning Referral Service Coordination Counseling Client, Family, & Community Education Documentation Professional & Ethical Responsibilities Northwest Addiction Technology Transfer Center 15

16 Addiction Counseling Competencies (TAP 21) Practice Dimension: Clinical Evaluation Screening Competency 24: Establish Rapport Knowledge Skills Attitudes Source: Janet Carter, RADACT THE RUBRICS for assessing counselor performance Rubrics are a description of expected behavior at distinct stages along the continuum of a counselor s development. 1=Awareness 2=Initial Application 3=Competent Practice 4=Mastery ILLUSTRATION OF RUBRICS: Reflections from Motivational Interviewing 1 Awareness: Describes characteristics of simple and complex reflections 2 Initial application: Uses simple and some complex reflections 3 Competent practice: Increasing use of complex reflections with clients 4 Mastery: Complex reflections used to cultivate Change Talk & soften Sustain Talk Northwest Addiction Technology Transfer Center 16

17 Counselor Developmental Levels: TIP 52, Fig 2, p. 10 STRATEGIES Note that the levels are a general progression. Counselors may be at different stages in different parts of their jobs. What are your strategies for working with counselors on different developmental levels? From the scenario provided in the handout: 1. List the counselor s areas of strength and concern. 2. Using TAP 21, identify as many applicable competencies as you can. 3. As a group, prioritize the top 2 competencies to address first. 4. Use the Rubrics to rate the counselor on the 2 Competencies. 5. Share with the larger group. Northwest Addiction Technology Transfer Center 17

18 EXCELLENT WORK TODAY! Tomorrow we will complete a Professional Development Plan for Mark, and practice the Supervisory Interview. Welcome Back: Day 2 Sign in sheet Breaks/lunch Mobile phones Questions Evaluations ATTC Forms WHAT WE DID YESTERDAY... Defined and characterized Clinical Supervision Examined how culture impacts supervision Reviewed research on direct observation Practiced using the EPE Feedback Model Used the TAP 21 and the Rubrics Northwest Addiction Technology Transfer Center 18

19 WHAT WE WILL DO TODAY... Discuss the importance of affirming language Complete the Professional Development Plan Practice the Supervisory Interview Discuss methods to assess progress and resources to accommodate learning styles Prepare a Personal Action Plan AFFIRMING LANGUAGE Creating a positive work environment for staff members is one role of Clinical Supervisors. We noted that a parallel process often exists; that is, the way the supervisor treats the counselors influences the way counselors treat the clients. Northwest Addiction Technology Transfer Center 19

20 GUIDING LANGUAGE PRINCIPLES Person First Individualized Scientifically accurate Promotes recovery and hope Continuously examined Connects people rather than isolates Informed by Broyles, Binswanger, & Jenkins et al (2014) THE SUPERVISOR S CHALLENGE We need a conceptual model to help us: Understand the work of the counselor Present our observations in a way that supports the counselor s development of clinical skills Translate our observations into learning strategies Competency Let s review Definition: A behavior comprised of requisite knowledge, skills, and attitudes that plays an essential role in the practice of substance use disorder counseling. Provides a definition of expected job performance of a fully proficient substance use disorder counselor. Assists Clinical Supervisors in establishing clear goals. Northwest Addiction Technology Transfer Center 20

21 Addiction Counseling Competencies (TAP 21) Section 1: Transdisciplinary Foundations Section 2: Professional Practice Dimensions TRANSDISCIPLINARY FOUNDATIONS Understanding Addiction Treatment Knowledge Application to Practice Professional Readiness PRACTICE DIMENSIONS Clinical Evaluation Treatment Planning Referral Service Coordination Counseling Client, Family, & Community Education Documentation Professional & Ethical Responsibilities Northwest Addiction Technology Transfer Center 21

22 Addiction Counseling Competencies (TAP 21) Practice Dimension: Clinical Evaluation Screening Competency 24: Establish Rapport Knowledge Skills Attitudes Source: Janet Carter, RADACT A Rating System using competencies and rubrics: Increases mutual understanding of job performance expectations Improves reliability and objectivity of our assessment of counselor performance Identifies benchmarks for improvement Provides specific KSAs for enhancing proficiency in competencies Translates competencies into potential learning objectives THE PROFESSIONAL DEVELOPMENT PLAN Breaking KSAs into learning steps is the key to becoming proficient in the TAP 21 competencies. Look for a progression of improvement, not immediate success. Northwest Addiction Technology Transfer Center 22

23 KNOWLEDGE, SKILLS, AND ATTITUDES KSAs are the essential elements of a competency. They break competencies down into successive and manageable steps. A counselor may not need to address every KSA in their Professional Development Plan, but might focus on one or two in particular. The Professional Development Plan is individualized to the needs of the counselor, just as a Treatment Plan is tailored for each client. THE PROFESSIONAL DEVELOPMENT PLAN EVALUATING PROGRESS Rating proficiency is a subjective activity. We must move beyond superficial impressions and into identifying specific and observable evidence. Our supervisory work must include direct observation of counselors at work. The initial performance rating becomes the baseline for measuring future progress. Northwest Addiction Technology Transfer Center 23

24 QUANTIFIABLE MEASURES Number of articles read Attending a workshop Earning 3 hours of college credit Watching 3 recorded counseling sessions Reviewing 4 clinical records Speaking with 2 colleagues once per week Writing and reviewing 7 treatment plans NOW LET S TRY ONE Get into your groups from yesterday. Bring TAP 21, Rubrics, and your notes for reference. You ve already chosen two competencies to address. Select a group writer with legible handwriting, as another group will need to read your plan later on. Choose one competency: Complete a knowledge and a skill component for this competency. Make sure to complete all sections, including signatures, and dates for re-observation and completion. KEEP IT SIMPLE. FEEDBACK Now trade your PDP with another group. Read through the Plan and discuss the following: 1. How is it SMART (e.g., Specific, Measureable, Attainable, Realistic, Timely)? 2. What do you like about the Plan? 3. What might make the plan stronger? 4. Are all of the sections completed? Remember that you are reviewing what represents a group s best work. Remember to highlight strengths. Select a spokesperson to share your feedback. Northwest Addiction Technology Transfer Center 24

25 BLOOM S TAXONOMY & THE RUBRICS Find the handout titled, Bloom s Proficiency Levels & Rating Scales. 1. Model for learning used heavily in education 2. Used in developing the rubrics 3. Helpful in developing PDPs and treatment plans LEARNING STYLES & METHODS Learning is more effective when we use multiple methods. We need a broad repertoire of learning strategies and resources at our disposal, so we can tailor the Professional Development Plan to fit the preferences and strengths of the counselor. What methods and resources might you use in your PDPs? PULLING IT ALL TOGETHER: THE SUPERVISORY INTERVIEW The Supervisory interview is a structured communication process with a clearly defined purpose: To enable the counselor to improve job performance with a focus on skill development. Create an atmosphere that facilitates: Two-way feedback Teaching Learning Evaluation Northwest Addiction Technology Transfer Center 25

26 DISCUSSION 1. What methods do you use to focus your clinical supervision meetings? 2. What benefits might there be to having an agenda? Take a look at TIP 52, page 29: Structuring the Initial Supervision Sessions SUPERVISORY INTERVIEW See pp in the handout packet. SUPERVISORY INTERVIEW PRACTICE Groups with whom you worked to develop your PDP: Supervisor, Counselor, Observer Structure of rounds: 10 minutes: Practice the Supervisory Interview. Observers use the Supervision Agenda handout as a guide to provide feedback to your colleagues. 5 minutes: Debrief within your small groups. Switch roles. Each person will have an opportunity to play each role. Use the scenario from which you developed your Professional Development Plan to practice your way through the Supervisory Interview. Northwest Addiction Technology Transfer Center 26

27 How did you use the Supervisory Interview structure during the practice? How might you use this structure in your work as a Clinical Supervisor? Whether you are promoted to a supervisory role within your current agency, or you accept a supervisory position at another agency, there are some tips for getting started on pp. 6-7 in TIP 52. Establishing a New Approach for Clinical Supervision 3 roles: Walt: Clinical Supervisor Al: CDP with 5 years sobriety and 3 years of counseling experience Carrie: MSW with 6 years of clinical experience Northwest Addiction Technology Transfer Center 27

28 POSSIBLE STEPS TO IMPLEMENT THE CLINICAL SUPERVISION MODEL 1. Provide copies of the TAP 21 to your counselors. 2. Discuss this training with your staff. 3. Introduce the Rubrics. 4. Ask for feedback on the current clinical supervision model. 5. Discuss methods to improve counselor performance/learning strategies and clinical supervision. What are some other steps? KEY COMPONENTS Structure Direct observation Efficiency Collaboration Researchbased Feedback Skillbuilding PERSONAL ACTION PLAN 1. Locate the handout titled, Personal Action Plan. 2. Take a few minutes to reflect on the information and experiences you ve had during this training. 3. Complete the Personal Action Plan and share it at your tables. 4. Share with the large group. Northwest Addiction Technology Transfer Center 28

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