WELCOME TO WELCOME TO THE GEORGIA SCHOOL : THE GEORGIA SCHOOL :

20152015

©CLINICAL CLINICAL SUPERVISION SUPERVISION For For TheThe LONG HAUL LONG HAUL

SHELDON L. SHELDON L. ROSENZWEIG, ROSENZWEIG, M.A., LPC, CCS M.A., LPC, CCS & &

CARL SHANTZIS, Ed.D.CARL SHANTZIS, Ed.D.

PURPOSE of today* is to:PURPOSE of today* is to:

ADVOCATEADVOCATE for current & future supervisorsfor current & future supervisors

ENGAGEENGAGE in the ‘supervisory conversation ’

ENHANCE ENHANCE knowledge & skill of Clinical Supervisors knowledge & skill of Clinical Supervisors

PARTICIPATEPARTICIPATE in learning activities in learning activities

* (* (As developed by D. Powell & endorsed by IC&RC, AODA, Inc.)As developed by D. Powell & endorsed by IC&RC, AODA, Inc.)

DISCLAIMERDISCLAIMER

CompletionCompletion of this training of this training does notdoes not implyimply that you have obtained mastery that you have obtained mastery of competencies needed for the of competencies needed for the position of Clinical Supervisor.position of Clinical Supervisor.

CompletionCompletion of this training of this training does notdoes not implyimply that you are ready to that you are ready to successfully sit for the IC&RC,AODA, successfully sit for the IC&RC,AODA, Inc. Clinical Supervisor written Inc. Clinical Supervisor written examination.examination.

CLINICAL SUPERVISION:______________ We work in a profession faced with challenges: Meeting financial; ethical;

legal & credentialing requirements and demands of management. Sound business practices help ‘insure’ quality TX.

Clinical _______________________ is shared.

Supervision provides an effective way to monitor staff performance, behavior & professional growth.

Supervisors have an ethical & legal responsibility to supervise.

Supervision is an avenue of communicating/monitoring the ongoing changes in our work.

Clinical supervision provides a rich opportunity to develop professionally & personally.

Clinical supervision improves morale, care & outcomes.

SUPERVISION is …• An _______________…

• ____________… by a senior/experienced/credentialed member of the profession

• A ________________… that extends over time

• ________… of evaluating/monitoring/consulting/coaching

• Serving… as _______________

• Guided… by ________________

Bernard & Goodyear, 1998 / Rosenzweig & Shantzis 2014

SHARED CLINICAL SUPERVISION ASSUMPTIONS

The number one task of supervision is

to ______________ well being.

The supervisor is ____ ____________ than the supervisee.

Counselor performance is monitored through ______ &/or ______ observations.

GUIDING PRINCIPLES

The goal of supervision is to help a person be a better worker … not necessarily a better person.

A Clinical Supervisor’s most important task(s) are

protecting the consumer & ensuring the highest quality of service delivery.

Remember: You are not their therapist.

“It’s what you learn after you know it all that counts.” Earl Weaver

________ ________…

…is a legal principle that holds that individuals who have control & authority over others will be held accountable for the negligence of those under their control.

…The degree that the supervisor will be held responsible is directly proportional to the amount of control the supervisor has over the supervisee.

________ _________ occurs when:

…damage to a client results from a dereliction in carrying out one’s supervisory responsibility for the supervisee’s work

…from giving inappropriate ________ to the supervisee to the detriment of the client

…from failing to _________ carefully to the supervisee’s report about a client

…or… from _____________ tasks to a counselor who was not up the demands of the task!

The professional code:

!

4 MAJOR CONSIDERATIONS

For ethical decision making…

1. Autonomy

2. Beneficence

3. Non malfeasance

4. Justice & fairness

William L. White, Critical Incidents: Ethical Issues in Substance Abuse Prevention and Treatment

THERE ARE REAL DIFFERENCES…

• Unethical

• Illegal

• Immoral

Black Grey White

It is It is not

Right Wrong

Always Never

All None

CONFLICTS of INTEREST

Test:The Rule of Arms Length… ___ ______?

_____ is the non-abuse of power

• You may ________ power… when there is none to assume.

• Those you “are helping” may _______ power to you … that you may not really have.

• The more intimate the situation… _____ ________ power that may be

_________.

HERE COME…

5 BAD ______

_____________: That Allow For Unethical Behavior *

• …that what I’m doing is really not unethical, illegal or immoral.

• … that there are times when the end justifies the means.

• … that what I’m doing is important to the welfare of the organization and the organization would support it.

• … that I’m expected (by my organization, peers, colleagues) to do this; or …it’s the norm.

• … that no one will ever know or find out. *Based upon Management Values In Perspective,Warren Schmidt & Barry Posner, 1999

When in doubt… ____ _______.

_____: OUR FIELD LOOKED LIKE

75% of workforce was over 40 years of age

Only 50 - 55% of direct service staff were CD credentialed The average reported case load was: 29

20% of all work-time was reported as dedicated to paper work

Annual turnover in management was almost 50%

Counselors turned over jobs every 2 years…

What/how are the aforementioned…

impacted by

_______________?

SUMMARY QUIZKY

What are the 5A’s of being a quality supervisor?

• A ble• A ble• A ble• A ble• A ble

THE 5 A’s of Supervision…

A: ________: open, receptive, trusting,

non-threatening

A________: easy to approach &

speak with freely, there for you

A________: knowledgeable & skilled

A________: pleasant, friendly, reassuring

A________: to self, clients, organization…

The ______________supervisory weaknesses:

Difficulty in exercising management authority Poor decision making Not giving constructive feedback Unable to advocate on behalf of staff Insufficient time allocated for staff needs (-) Personal qualities (rigid, loud, insensitive,

overwhelmed, impatient, unrealistic) Lack of supervisory knowledge, skills & experience ________ __ ________ crisis

Poor Supervisors:

______________ & expect change…

____________ & expect problems to be resolved…

_____________ to target one worker

And… ____________________________________

DIFFERENCES BETWEEN ADMINISTRATIVE SUPERVISION & CLINICAL SUPERVISION

Administrative supervisors aim to maintain healthy functioning of the organization and to accomplish the organization’s mission.

Administrative supervisors are responsible for firing, promoting, scheduling, raising salaries & other personnel duties.

Administrative supervisors focus on productivity, workload management, & accountability.

Administrative supervisors make decisions in terms of benefit or harm to the organization/system, not individuals (clients/staff?).

• Clinical Supervisors target helping supervisees to develop skills, overcome obstacles, increase competency, & to practice ethically.

• Clinical supervisors focus on the supervisee’s activities with clients.

• Clinical supervisors make suggestions and provides corrective feedback concerning cases.

• Clinical supervisors provide ongoing evaluation as to the fitness of the supervisee to continue preparation or to practice independently.

DIFFERENCES BETWEEN ADMINISTRATIVE SUPERVISION & CLINICAL SUPERVISION (continued)

WELCOME TO WELCOME TO THE GEORGIA SCHOOL : THE GEORGIA SCHOOL :

20152015

©CLINICAL CLINICAL SUPERVISION SUPERVISION For For TheThe LONG HAUL LONG HAUL

SHELDON L. SHELDON L. ROSENZWEIG, ROSENZWEIG, M.A., LPC, CCS M.A., LPC, CCS & &

CARL SHANTZIS, Ed.D.CARL SHANTZIS, Ed.D.

SUPERVISION• There is need to learn/grow as a professional

• There is a need/must for there to be someone to whom you can bring any question, any concern, any issue, or any confidence, related to professional practice.

• There is need to document your competence/actions

• There is need for accountability

• There is need for/to…???

___________ for CLINICAL SUPERVISION

Supervisors can become a counselors therapist… blurring tasks & expectations

Excessive familiarity can lead to boundary violations

Judgementalism & authoritarianism by the supervisor

Poor supervision as a counselor, begets poor supervision as a promoted counselor

Supervisor & counselor burnout

High levels of staff turnover

Confusion between clinical supervision & case management

• Too many “_______”• Unrealistic ___________• Unrealistic ________ ________• Becoming an “_________”• Serving the need of the organization

rather than the consumer/client• Lack of written _______ ___________• ___________ not teaching• Other…

Competent, well thought of CLINICANS don’t necessarily make competent well thought of SUPERVISORS.

Promotion to a supervisory position as a reward can be…

Pay clinicians well because they are worth it.

Don’t assume that good ________ will be good _____________.

TOP REASONS FOR _____ ______• Sexual impropriety ( %)

• Incorrect Tx ( %)

• Breach of confidentiality ( %)

• Incorrect diagnosis ( %)

• Assorted others (over %)

DOCUMENTATION

Document No Less Than…

_____ you meet (date, time, amount of time)

_____ was discussed ( client issue, strategy, etc.)

_____ the supervisee is to do as next steps

______ to problems

_____ you will meet again (follow up/follow thru)

What you learned/should know about client case notes… applies to _____________ notes.

• S_________: Quotes from the counselor.

• O_________: Data collected by you.

• A_________: Include any indications of progress or lack of progress on the IDP.

• P____________: Recommendations for follow up…next steps

CASE NOTES: ____________

• Case notes & charts are public records & can _________________.

• Do not write anything down that you do not want _____________________.

• Good case notes are a part of ethical & professional development.

• Case notes document the quality of services & can/will be used to determine _________________________.

• __________ leave out important information or change diagnosis to help client receive insurance…

this is fraud.

• Use ___________ descriptors and avoid emotions or subjective impressions.

• Write clearly, accurately, and succinctly, in ______ .

• Initial & draw a single line through a ___________.

• ____________ the supervisee as to what the policy is and expectations are.

• Be ___________. Do not give extended quotes or detailed descriptions.

• ___ ____write disparaging statements about the clients, their lifestyle, parentage, cultural or racial origin, or diagnosis.

• _____ to complete notes immediately after seeing the client.

• __________ keep client files in locked places.

• Computers and other electronic devices must be determined to be ________ by the site or agency.

• Do not discuss clients on ______________.

If you must say something make it coded to the party you are discussing it with… as in…

• Be ___ ___ _____ on record keeping requirements and procedures, laws, and regulations.

• Follow _______ rules and regulations when applicable.

• As supervisor… __________ ________ ______ of supervisee’s progress notes, intakes, charting, or other client documentation is recommended.

DO THE RIGHT THING

IF YOU ARE IN COURT… (EEOC, Civil, Non-Agency Review Board, etc.)

ALWAYS… ALWAYS… ALWAYS

Legal & Ethical Issues

‘Physical touch’ is one aspect of the legal & ethical issues that we face as Clinical Supervisors.

Remember unethical … isn’t necessarily illegal.

A Clinical Supervisor has legal liability for the actions of a Counselor under their supervision if …

The supervisor therefore has a legal responsibility to make a ‘reasonable effort to supervise’,

The key ethical legal issue faced in supervision is… _______________________________________… which

means…

At every supervisory session… do you ask your counselor: “_______ ____ _____ _________…

…has anything happened that might put you in a different light with any clients/patients?

…are there concerns ________ about any of your clients/patients?

…are any clients/patients _____________________________?

…have you failed to maintain client/patient _______________ in any way?

…is there anything a client/patient shared with you that gives you ‘_____________________________’?

A Supervisor must:

• Have a clearly defined _________of supervision, especially regarding high-risk cases

• Have a ____________format for supervisees to

describe & conceptualize problems• Carefully _________treatment plans, especially crisis

management contingencies• __________ their feedback/directives & maintain a

written summary of recommendations• __________________ the supervisee’s clinical &

administrative work

_________ in particular have defined a ‘standard of care & practice in supervision’ as a result of malpractice cases by accepting the testimony of _________ in the field.

Does the supervisor…

• have the _______ to perform the requisite supervisory functions?

• make ‘____________________’ to supervise?

More…Supervisory __________…&… does the agency have a formalized

process for providing feedback & (ongoing) evaluations to counselors?

…teach the tenets & legal and ethical standards of the profession?

…maintain adequate documentation of the supervision of the supervision process?

Court rulings have pointed to several common legal & ethical errors that occur in supervision.

Confusing supervision with ‘case management’…

Focusing on client’s needs rather than the Supervisee’s development…

Relying on the Supervisor’s clinical skills in supervision, thereby turning supervision into therapy with a Supervisee…

Adopting a laissez-faire attitude with supervision, hence it occurring on a sporadic basis…

Conducting quasi-casual case conferences & crisis-management supervision…

Using one’s supervisory power inappropriately.

Supervisory _______________

The legal criterion for malpractice is a breach of duty, that is, of one’s fiduciary responsibility to protect the welfare of another…

Although only two percent (02%) of psychotherapeutic malpractice claims in 1998 were due to a failure to supervise a counselor…

There is growing concern that supervisors are to be held accountable for the actions of their supervisees.

Confidentiality & Its Limits:

Breaches of confidentiality are one of the top 5 charges in successful lawsuits against psychotherapists.

In Roe vs. the State Board of Psychology (1995) the court ruled that it was the Supervisor’s responsibility… to train the Supervisee in the limits of confidentiality.

Tarasoff vs. Regents of the University of California has been used as the standard for duty to warn. Pesce vs. J.Sterling Morton High School (1987) lays out guidelines for mandatory child abuse reporting.

The 2003 implementation of the HIPPA standards established new guidelines that limit confidentiality. A competent supervisor is conversant in HIPPA!

Court rulings have emphasized that

____________________ must know :

The qualifications of their Supervisor.

Critical patient information related to

performance of their clinical duties.

The logistics of treatment…

Insurance reimbursement procedures.

Required record keeping.

The risks & benefits of alternatives to treatment.

Many courts have ruled that the Supervisor has the responsibility to oversee the counseling relationship between a Supervisee & a client.

Ignorance of the nature of that relationship is no longer an acceptable excuse for a Supervisor.

The courts expect the Supervisor to confront the Supervisee about any allegations of impropriety.

Document recommendations & actions taken.

Supervisors must question client whenever feasible & clinically viable. Place a critical incident report in the Supervisee’s file pending resolve.

Supervisors are expected to consult with colleagues.

Supervisors are expected to report the allegation to investigative services, state boards, & relevant ethics committees.

Supervisors should…_______the Supervisee’s clients whenever possible.

have Supervisees review & sign the code of ethics of the counseling profession ______________.

regularly audiotape or videotape counseling sessions conducted by Supervisees & ___________________ all recommended actions.

ITEMS FOR INCLUSION:

An individualized development/training plan (IDP) for the Supervisee

The schedule, format, duration, roles, responsibilities, goals & objectives of supervision

Information on the Supervisor's training & model of supervision

Emergency & crisis-management procedures, including the availability of 24/7 coverage in the event of a clinical emergency

Clarification of roles of an academic supervisor (if any)

A ratio of the number of clients to the number of supervision hours (see the 20 :1ratio)

Formative, summary evaluations, disciplinary procedures, due process, rights of the supervisee & sanctions

Supervisee Selection, Assignments & Documentation

It is imperative that the Supervisor protect the clients welfare by:

• Knowing the clinical competencies & limitations of their supervisees…

• Assessing the complexity of client issues prior to assigning cases to a supervisee… • Determining whether the supervisee is adequately trained to assume the case… • Ensuring that the supervisee does not have too many cases to be able to provide proper services to clients…

• Protecting the supervisee from having too many difficult-to-treat cases in their caseload…

• Identifying & resolving learning & personal problems that may compromise the supervisee’s effectiveness…

• Ensuring that there is sufficient supervision time for the cases assigned…

• Having deep knowledge of the skills & history of the counselors hired.

The professional code:

!

DISCLAIMERCompletion of this training does not imply

that you have obtained mastery of the competencies needed for the position of Clinical Supervisor.

Completion of this training does not imply that you are ready to successfully sit for the IC&RC,AODA, Inc. Clinical Supervisor written examination.