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GETTING READY TO SUPERVISE – WHAT YOU NEED TO KNOW!PRESENTED BY:

SHELLIE BADER, M .A., CCC SLP

REGIO NAL DIRECTO R, EBS HEALTHCARE

DisclosureFinancial disclosure - NoneNon-financial disclosure◦ASHA member◦Member of STAR (State Advocate for Reimbursement) network – ASHA liaison◦CSHA Volunteer

LEARNING OUTCOMES

• Describe the ASHA guidelines and Code of Ethics as they relate to supervision and mentoring of CFs, student interns and SLPAs• Define, compare and analyze the conditions for supervision,

training and mentoring• Discuss 21st century influences on supervision/mentoring and other characteristics that influence our ability to be effective

supervisors and mentors

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ASHA on SupervisionB E S T P R A C T I C E F O R A L L S U P E R V I S O R Y E X P E R I E N C E S

A S H A C O D E O F E T H I C S

Best Practice for ALL Supervisory Experiences

11 Knowledge and Skills Needed by Supervisors (ASHA 2008)

ASHA Committee on Supervision Training -May 2016

ASHA Code of Ethics

Knowledge & Skills Needed by SLP Providing Clinical Supervision (ASHA, 2008)

A S H A ’s P o s it io n S t a t e m e n t o n S u p e r v is io n in c lu d e s 1 1 e s s e n t ia l c o r e a r e a s o f

k n o w le d g e a n d s k i l ls .

1 . P r e p a r a t io n fo r t h e S u p e r v is o r y E x p e r ie n c e

2 . In t e r p e r s o n a l C o m m u n ic a t io n a n d t h e S u p e r v is o r- S u p e r v is e e R e la t io n s h ip

3 . D e v e lo p m e n t o f t h e S u p e r v is e e 's C r it ic a l T h in k in g a n d P r o b le m - S o lv in g S k i l ls

4 . D e v e lo p m e n t o f t h e S u p e r v is e e 's C l in ic a l C o m p e t e n c e in A s s e s s m e n t

5 . D e v e lo p m e n t o f t h e S u p e r v is e e 's C l in ic a l C o m p e t e n c e in In t e r v e n t io n

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ASHA’s Knowledge and Skills for Supervision (continued)

6 . S u p e r v is o r y C o n fe r e n c e s o r M e e t in g s o f C l in ic a l Te a c h in g Te a m s

7 . E v a lu a t in g t h e G r o w t h o f t h e S u p e r v is e e B o t h a s a C l in ic ia n a n d a s a

P r o fe s s io n a l

8 . D iv e r s it y ( A b i l i t y, R a c e , E t h n ic it y, G e n d e r, A g e , C u lt u r e , L a n g u a g e , C la s s , E x p e r ie n c e , a n d E d u c a t io n )

9 . T h e D e v e lo p m e n t a n d M a in t e n a n c e o f C l in ic a l a n d S u p e r v is o r y D o c u m e n t a t io n

1 0 . E t h ic a l , R e g u la t o r y, a n d L e g a l R e q u ir e m e n t s

1 1 . P r in c ip le s o f M e n t o r in g

Consider the 11 Skill Areas: In which areas do you want to grow?

ASHA Committee on Supervision TrainingMay 2016

The Committee identified 5 broad topics that would be the basis of training for SLP supervisors: §Supervisory Process and Clinical Education§Relationship Development and Communication Skills§Establishment/Implementation of Goals§Analysis and Evaluation§Clinical and Performance Decisions

The Committee also identified specific knowledge and skills needed to supervise support personnel and others

http://w w w.asha.org /uploadedFiles/Topics-for-Supervision-Training.pdf

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Hot of the Press – New ASHA Mentor Regulations Beginning in 2020!

Clinical supervisors and Clinical Fellowship mentors will have to have a minimum of◦Nine months practice experience post-certification before

serving as a supervisor◦Two hours of professional development in the area of supervision post-certification◦CEUs available now – https://www.asha.org/professional-development/supervision-courses/

Ethical Obligations for SupervisorsA S H A 's C o d e o f E t h ic s p r o v id e s a f r a m e w o r k fo r e t h ic a l b e h a v io r o f s u p e r v is o r s

P r in c ip le o f E t h ic s I - C l ie n t w e lf a r e m u s t a lw a y s b e h e ld p a r a m o u n t

• S u p e r v is o r m u s t p r o v id e a p p r o p r ia t e s u p e r v is io n a n d a d ju s t t h e a m o u n t a n d t y p e o f s u p e r v is io n b a s e d o n t h e s u p e r v is e e 's p e r fo r m a n c e

• S u p e r v is o r e n s u r e s t h a t t h e s u p e r v is e e f u lf i l ls p r o fe s s io n a l r e s p o n s ib i l i t ie s

• M a in t a in in g c o n f id e n t ia l i t y

• D o c u m e n t in g in a n a c c u r a t e a n d t im e ly m a n n e r• C o m p le t in g o t h e r p r o fe s s io n a l a c t iv it ie s

• S u p e r v is o r h a s a n o b l ig a t io n t o in f o r m t h e c l ie n t o f t h e n a m e a n d c r e d e n t ia ls o f in d iv id u a ls in v o lv e d in t h e ir t r e a t m e n t

More ASHA Ethical ObligationsP r in c ip le o f E t h ic s I I a d d r e s s e s is s u e s o f p r o f e s s io n a l c o m p e t e n c e

• P r o fe s s io n a ls s h o u ld o n ly e n g a g e in t h o s e a s p e c t s o f t h e p r o fe s s io n t h a t a r e

w it h in t h e ir s c o p e o f c o m p e t e n c e

• S u p e r v is o r s s h o u ld s e e k t r a in in g in t h e a r e a o f e f f e c t iv e s u p e r v is o r y p r a c t ic e s t o d e v e lo p t h e ir c o m p e t e n c e in t h is a r e a

• S u p e r v is o r s a ls o h a v e t h e r e s p o n s ib i l i t y t o e n s u r e t h a t c l ie n t s e r v ic e s a r e p r o v id e d c o m p e t e n t ly b y s u p e r v is e e s w h e t h e r t h e y a r e s t u d e n t s , c l in ic a l

fe l lo w s , o r p r a c t ic in g c l in ic ia n s

• T r e a t m e n t d e le g a t e d t o c l in ic a l fe l lo w s , s t u d e n t s , a n d o t h e r n o n p r o fe s s io n a ls m u s t b e s u p e r v is e d b y a c e r t i f ie d s p e e c h - la n g u a g e p a t h o lo g is t

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What would you do?Yo u s u p e r v is e s o m e o n e ( a C F o r S L P A ) w h o w o r k s p a r t t im e in

a s c h o o l d is t r ic t a n d th e n a ls o w o r k s in a p r iv a te c l in ic a f t e r s c h o o l h o u r s . In th e c l in ic , s h e is a s s ig n e d a c l ie n t w h o h a p p e n s to a ls o b e o n h e r c a s e lo a d a t h e r s c h o o l . S e r v ic e s in

th e c l in ic a r e b e in g fu n d e d b y th e fa m ily ’s h e a lth in s u ra n c e . T h e fa m ily is th r i l le d b e c a u s e th e y h a v e b e e n p le a s e d w ith h e r

s e r v ic e s . T h e c l in ic m a n a g e r h a s to ld h e r i t is f in e to s e e th e c h i ld s in c e s e r v ic e s a r e n o t b e in g p a id b y th e d is t r ic t . T h e

th e ra p is t a n d h e r s c h o o l d is t r ic t le a d S L P w o n d e r i f t h is w o u ld b e c o n s id e re d is a c o n f l ic t o f in t e r e s t .

DefinitionsS U P E R V I S I O N / C O A C H I N G / M E N T O R I N G / T R A I N I N G

T H E S U P E R V I S I O N C O N T I N U U M

SupervisionA S H A d e f in e s t h e s u p e r v is o r y p r o c e s s

◦ Supervision can be broadly defined as overseeing and directing the work of others. However, clinical supervisors do m ore than oversee the w ork of the student clinician .They teach specific skills, clarify concepts, assist w ith critical thinking, conduct perform ance evaluations, m entor, advise, and m odel professional behavior (Council of Academ ic Program s in Com m unication Sciences and Disorders [CAPCSD], 2013).

◦ In regards to CFs, ASHA prim arily uses the term “supervision” in the context of defining the required direct supervisory hours. O therw ise, ASHA now uses the term “CF M entor” rather than CF Supervisor.

◦ For SLPA Supervisors, ASHA states that, “ The supervising SLP is responsible for designing and im plem enting a supervisory plan that ensures the highest standard of quality care … The am ount and type of supervision required should be consistent w ith the skills and experience of the SLPA… Treatm ent … rem ains the responsibility of

the supervisor.”

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Coaching and MentoringC o a c h in g - M e r r ia m - W e b s t e r d e f in it io n : in s t r u c t in g o r t r a in in g

M e n t o r in g – M e r r ia m - W e b s t e r d e f in it io n : p r o v id in g t r u s t e d g u id a n c e a n d c o u n s e l in g

ASHA discusses the critical importance of the unique skills of coaching and mentoring…

…and that most of us have never learned how to be an effective mentor or coach!

Mentoring and Coaching SkillsIn fo r m a t io n fo r C l in ic a l F e l lo w s h ip ( C F ) M e n t o r in g S L P s

h t t p :/ / w w w .a s h a .o r g / C e r t i f ic a t io n / C F S u p e r v is o r s /

As a m entor, your prim ary role is to provide guidance and support to your m entee

based on his or her unique developm ental needs. At different points in the relationship, you w ill take on som e or all of the follow ing roles:

◦ Coach/Advisor

◦ Source of Encouragem ent/Support◦ Resource Person

◦ Cham pion◦ Devil’s Advocate

Who do we Supervise? Who do we Mentor?

Speech Language Pathology AssistantsClinical FellowsStudents, Paraprofessionals and Other Professionals

Do we differentiate for different situations and people?

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The Continuum of Supervision(Jean Anderson, The Supervisory Process, 1988)

Evaluation Feedback StageSupervisor/Mentor has dominant role

What type of person is seen in this stage?◦beginning grad student, SLPA or CF◦clinician who is new to a role or caseload◦someone unprepared or overwhelmed

Transitional StageWe begin to view the clinician as a participantThey can begin to make some decisionsNo longer totally dependent and growing◦ fe e ls / b e h a v e s a s t h o u g h c o m p e t e n t a n d k n o w le d g e a b le

W h a t t y p e o f p e r s o n is s e e n h e r e ?

◦ S o m e o n e w h o is le a r n in g t o a n a ly z e t h e c l in ic a l s e s s io n s & h e r / h is o w n b e h a v io r

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Self-Supervision StageClinician has become as an independent problem solverRelationship becomes more of a peer interaction

W h a t t y p e o f m e n t e e is s e e n h e r e ?

◦ A C F la te in th e ex p e r ie n ce w h o is p r im a rily fu n c t io n in g in d e p e n d e n t ly a n d a c ts w ith in b o u n d a rie s o f ex p e rt ise

◦ S o m e o n e w h o ca n a n a ly ze se ss io n s a s w e ll a s c lin ica l a n d p ro fe ss io n a l b e h a v io r

◦ G ra d stu d e n ts a n d S L PA s m a y h a v e so m e o cca s io n s to fu n c t io n a t th is sta g e

What kinds of activities are you supporting?

Have you checked in on all these activities?L e s s o n p la n n in g a n d m a t e r ia ls

T h e r a p e u t ic in t e r v e n t io n s k i l ls

A s s e s s m e n t a n d r e p o r t w r it in g

D o c u m e n t a t io n

O t h e r w o r k lo a d r e s p o n s ib i l i t ie s

◦ P a p e rw o rk sp e c if ic to th e e m p lo y e r◦ M a n a g in g S c h e d u le s

◦ E th ica l d e c is io n s ◦ P a re n t, te a c h e r a n d co m m u n ity in te ra c t io n s a n d co n su lta t io n

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Supervision and Mentoring Roles and ResponsibilitiesC L I N I C A L F E L L O W SS T U D E N T I N T E R N S

S P E E C H L A N G U A G E PA T H O L O G Y A S S I S TA N T S

Get Organized and Prepared

Get to know your new CF, SLPA or student internKnowledge and Skills ChecklistEstablish informal goals for the supervisory/ mentoring periodRefer to goals periodically to assure progress and update as needed

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Clinical FellowsA S H A d e f in e s t h e C l in ic a l F e l lo w s h ip E x p e r ie n c eC l in ic a l F e l lo w M e n t o r s h ip R o le s a n d R e s p o n s ib i l i t ie s

C F S k i l l s I n v e n t o r y

What does “Clinical Fellowship” mean?A transition period between being a student and being an independent provider of speech and language services

A mentored professional experience after completion of academic coursework

http://w w w.asha.org /certification/Clinical-Fellowship/

Roles and Responsibilities of the MentorMaintain CCCs and state licensureFulfill minimum supervision hours (full time)

◦ 6 h o u r s d ir e c t s u p p o r t d u r in g e a c h t h ir d o f C F s e g m e n t

◦ ( E a c h s e g m e n t is 3 m o n t h s fo r a f u l l t im e t h e r a p is t )

◦ 6 h o u r s o f in d ir e c t s u p p o r t d u r in g e a c h o f C F s e g m e n t

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State Licensure Requirements

Be sure to become familiar with your state licensure requirements for first year SLPs, including timelines, responsibilities and commitments of both the new SLP and the supervisor, as well as documentation.Visit ASHA’s website for specifics for each state!https://www.asha.org/advocacy/state/

Provide meaningful mentoring and feedbackP e r fo r m o n g o in g c o l la b o r a t iv e e v a lu a t io n ( C l in ic a l F e l lo w s h ip

S k i l ls In v e n t o r y )

C o m p le t e a n d s u b m it C l in ic a l F e l lo w s h ip R e p o r t a n d R a t in g F o r m w it h in 4 w e e k s o f c o m p le t io n o f c l in ic a l fe l lo w s h ip y e a r

http://w w w.asha.org /uploadedFiles/CFSISLP.pdf

http://w w w.asha.org /uploadedFiles/SLP-CF-Report-Rating-Form .pdf

Clinical Fellow Critical Skills Inventory and Rating Form18 SKILLS IN FOUR AREAS

R a n k e d a t t h e e n d o f e a c h

s e g m e n t◦ E va lu a t io n

◦ Tre a tm e n t◦ M a n a g e m e n t

◦ In te ra c t io n

RATING FORM 1 –5C o n s id e r in g t h e fo l lo w in g fa c t o r s :

◦ A c c u ra c y◦ C o n s iste n c y

◦ In d e p e n d e n c e

◦ S u p e rv is o ry G u id a n c e

A n in t e r a c t iv e c o l la b o r a t iv e p r o c e s s b e t w e e n t h e C l in ic a l F e l lo w a n d M e n t o r

H o w w i l l y o u c o l la b o r a t e w h e n c o m p le t in g t h is e v a lu a t io n ?

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Student CliniciansA S H A S U P E R V I S O R R E Q U I R E M E N T S

F I R S T T I M E S U P E R V I S O R S O F S T U D E N T S

T I P S F O R W O R K I N G W I T H S T U D E N T S

Supervising Student Clinicians - ASHA• Current ASHA CCC’s (no minimum number of years!)

• Direct supervision 25% for each client" T h e a m o u n t o f s u p e r v is io n m u s t b e a p p r o p r ia t e t o t h e s t u d e n t 's le v e l o f k n o w le d g e , e x p e r ie n c e , a n d c o m p e t e n c e . S u p e r v is io n m u s t b e s u f f ic ie n t t o e n s u r e t h e w e lfa r e o f t h e c l ie n t / p a t ie n t ."

Tips for First-Time Supervisors of Student Clinicians

• Obtain necessary approvals from your facility and from EBS• Work with the EBS Leadership to attain

knowledge of your responsibilities as a supervisor, according to the agreement between your facility, the university and EBS• Make sure you have an appropriate office or

treatment space that will available to the graduate student

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More Tips for Student Supervision• C o m m u n ic a t e w it h y o u r w o r k s it e a b o u t t h e ir

r e q u ir e m e n t s a n d o r ie n t a t io n p r o c e s s fo r g r a d u a t e

s t u d e n t s◦ ID badges, background checks, other paperwork to com plete?◦ W hat facility-w ide orientation needs to be done in advance?

◦ W hat is expected on the first day?◦ W hat kind of departm ent orientation do graduate students

receive?

• C o m p le t e a n y n e c e s s a r y p a p e r w o r k v e r i f y in g y o u r p r o fe s s io n a l c r e d e n t ia ls

• E B S w i l l w o r k w it h y o u t o a s s u r e a l l o f t h e s e r e q u ir e m e n t s a r e m e t a t y o u r s i t e

More Tips for Student Supervision

• C la r i f y e x p e c t a t io n s a b o u t t h e a m o u n t o f t im e t h e s t u d e n t w i l l s p e n d a t y o u r s it e ( e . g . , n u m b e r o f

d a y s a w e e k , n u m b e r o f h o u r s , n u m b e r o f w e e k s )

• C o n t a c t t h e u n iv e r s it y p la c e m e n t c o o r d in a t o r t o a s k q u e s t io n s a b o u t c o m m u n ic a t io n b e t w e e n y o u a n d t h e u n iv e r s it y p r o g r a m o n c e t h e g r a d u a t e s t u d e n t is p la c e d , in c lu d in g :

◦ type and frequency of contact◦ num ber of site visits by university coordinator

◦ system s for addressing any problem s◦ benchm arks and assessm ent for student progress

Supervising SLPAsA S H A S C O P E O F P R A C T I C E , E T H I C S A N D S L PA R E Q U I R E M E N T SG U I D E L I N E S F O R S U P E R V I S I O N

W H A T C A N S L PA S D O ? W H A T C A N ’ T T H E Y D O ?

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ASHA and SLPAs TodayT h e S L PA S c o p e o f P r a c t ic e w a s p u b l is h e d in 2 0 1 3

◦ h t t p :/ / w w w .a s h a .o r g / p o l ic y / S P 2 0 1 3 - 0 0 3 3 7 /

A S H A ’s s u p p o r t o f t h e S L PA s is im p r o v in g e a c h y e a r, in r e c o g n it io n o f

t h e v it a l r o le S L PA s p la y in t h e f ie ld

◦ A s s o c ia te s P ro g ra m – A S H A M e m b e rs h ip fo r S L PA s

◦ In t h e A S H A ’s 2 0 1 7 P o l ic y A g e n d a , A S H A s u p p o r t s t h e a d o p t io n o f

m o d e l l ic e n s in g la n g u a g e a n d t h e im p le m e n t a t io n o f a s e r v ic e

c o n t in u u m t h a t d e f in e s t h e c r e d e n t ia ls a n d c o m p e t e n c y

r e q u ir e m e n t s fo r S L PA s

◦ h ttp :/ / w w w .a s h a .o rg /a s s o c ia te s /

ASHA Recommended Minimum Qualifications“ T h e S L PA m u st co m p le te a n a p p ro v e d co u rs e o f a ca d e m ic stu d y, f ie ld w o rk u n d e r th e s u p e rv is io n o f a n A S H A -c e rt if ie d a n d /o r lic e n s e d S L P, a n d o n -th e -jo b tra in in g s p e c if ic to S L PA re s p o n s ib ilit ie s a n d w o rk p la c e b e h a v io rs .”

T h e a ca d e m ic co u rs e o f stu d y m u st in c lu d e o r b e e q u iva le n t to :

◦ a n a s s o c ia te 's d e g re e in a n S L PA p ro g ra m o r◦ a b a c h e lo r 's d e g re e in a s p e e c h -la n g u a g e p a th o lo g y o r co m m u n ica t io n d is o rd e rs

p ro g ra m

a n d

◦ s u c c e s sfu l co m p le t io n o f a m in im u m o f o n e h u n d re d (1 0 0 ) h o u rs o f s u p e rv is e d f ie ld w o rk e x p e r ie n c e o r

◦ its c lin ica l e x p e r ie n c e e q u iva le n t a n d d e m o n stra t io n o f co m p e te n c y in th e s k ills

re q u ire d o f a n S L PA

ASHA Code of Ethics• Revised in 2014 to include guidance for SLPAs and their supervisors• SLP supervisor is responsible for ensuring ethical conduct of the

SLPA • It is imperative that an ASHA-certified SLP appropriately

supervise the SLPA, because the supervising SLP retains full legal and ethical responsibility for students, patients, and clients served by the SLPA.

http://w w w.asha.org /Practice/ethics/Speech-Language-Pathology-Assistants/

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ASHA advisesAppropriate training and supervision of SLPAs is to be provided by SLPs w ho hold ASHA's Certificate of Clinical Com petence (CCC) in Speech-Language Pathology

Activities m ay be assigned only at the discretion of the supervising SLP and should be constrained by the Scope of Practice for SLPAs (CA regulations are aligned w ith ASHA)

The best interest and protection of the consum er should be param ount at all tim es

The purpose of the SLPA should not be to increase or reduce the caseload size for SLPs, but rather to assist SLPs in m anaging their existing caseloads

SLPAs should not have full responsibilities for a caseload or function autonom ously

SLPs m ust inform consum ers w hen services are provided by support personnel

(ASHA , 2013)

ASHA’s Guidelines for the SLP’s Qualifications and Responsibilities for Supervising SLPAs• Current ASHA CCC + 2 years of experience• 10 hours of CEs in supervision prior to or concurrent with the first supervision experience• 20% direct support for the first 90 days and then support for every

client at least every 60 days• 100% direct support for medically fragile clients• No more than 2 full time SLPAs per supervisor

SLPA Scope of Practice• Definition: The range of responsibility (e.g., type of patients or

caseload and practice guidelines that determine the boundaries within which a physician, or other professional, practices) (McGraw-Hill Concise Dictionary of Modern Medicine)

• SLPA scope of practice is defined by ASHA and by individual states• Stepping outside of the scope of practice can create a legal issue

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SLPA Scope of PracticeDirect supervision required for:• Client activity involving medically fragile patients• New screening or treatment activity that has not yet been

performed by the SLPA in direct client care

Indirect supervision for completion of:• Screening or treatment that has previously been performed and observed to be done competently• Clerical tasks

• Other non-client care activities

What CAN SLPAs Do?• S c r e e n w it h o u t in t e r p r e t a t io n

• D ir e c t t r e a t m e n t fo l lo w in g t r e a t m e n t p la n s o f s u p e r v is in g S L P

• D o c u m e n t a t io n o f c l ie n t p r o g r e s s

• A s s is t w it h a s s e s s m e n t ( p r e p a r in g m a t e r ia ls , d o c u m e n t a t io n o n ly )

• A c t a s in t e r p r e t e r w h e n c o m p e t e n t t o d o s o

• C le r ic a l d u t ie s

• M a in t e n a n c e o f e q u ip m e n t

What CAN’T SLPAs Do?• Provide counseling or advice• Sign any formal document in lieu of the SLP• Discharge clients• Make referrals• Disclose confidential information• Represent him/herself as SLP• Conduct evaluations

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What Else CAN’T SLPAs Do?• Interpret data• Alter treatment plans• Perform tasks without express knowledge of the supervising SLP• Participate in parent conferences, case conferences, or interdisciplinary team conferences without the SLP

Start on the Right Foot…• G e t t o k n o w y o u r S L PA !

• S e t r e g u la r c o n fe r e n c e t im e s

• E n c o u r a g e a c t iv e p a r t ic ip a t io n in e s t a b l is h in g m u t u a l ly a g r e e d u p o n g o a ls fo r t h e c a s e lo a d

• D is c u s s y o u r e x p e c t a t io n s fo r t h e S L PA ’s r e s p o n s ib i l i t ie s a n d jo b e x p e c t a t io n s

• Hours, • Dress code

• Facility policies• Docum entation

• M aterials

SLPAs and the ASHA Associates ProgramE t h ic a l O b l ig a t io n s o f S L PA s w h o a r e a f f i l ia t e s a g r e e t o :

• P e r fo r m t h e ir jo b s s o le ly w it h in t h e a p p r o p r ia t e s c o p e o f r e s p o n s ib i l i t ie s d e s c r ib e d in t h e A S H A S c o p e o f P r a c t ic e fo r S L PA s

• P e r fo r m o n ly t h o s e t a s k s a s s ig n e d b y a s u p e r v is in g S L P

• W o r k o n ly u n d e r t h e s u p e r v is io n o f a n A S H A c e r t i f ie d S L P

• A d h e r e t o a l l a p p l ic a b le s t a t e o r lo c a l la w s a n d r u le s r e g u la t in g t h e p r o fe s s io n a n d le a r n a n d a d h e r e t o a l l a p p l ic a b le c o d e s o f e t h ic s a n d c o d e s o f

p r o fe s s io n a l c o n d u c t t o w h ic h t h e s u p e r v is o r is s u b je c t

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Let’s Test your Knowledge about Supervision –Chat with your group and decide

1. Must clients be informed of the qualifications of those providing the clinical service?

2. What level of supervision must be provided to SLPAs?3. Are services provided by SLPAs, graduate students and CFs

billable for Medicaid, insurance and private payers?4. Can a graduate student work as a speech-language pathology

assistant while in graduate school? How would this impact supervision?

Question #1M u s t c l ie n t s b e in fo r m e d o f t h e q u a l i f ic a t io n s o f t h o s e p r o v id in g t h e c l in ic a l

s e r v ic e ?

• In d iv id u a ls s h a l l n o t m is r e p r e s e n t t h e ir c r e d e n t ia ls , c o m p e t e n c e , e d u c a t io n , t r a in in g , e x p e r ie n c e , o r s c h o la r ly o r r e s e a r c h c o n t r ib u t io n s ( A S H A C o d e o f

E t h ic s , P r in c ip le o f E t h ic s I I I , R u le A )

• In v it e c l ie n t q u e s t io n s r e g a r d in g q u a l i f ic a t io n s o f in d iv id u a ls p r o v id in g p r o fe s s io n a l s e r v ic e

• P r o v id in g t h is in fo r m a t io n f u l ly a n d a c c u r a t e ly p r o m o t e s a f u l le r u n d e r s t a n d in g o f t h e p r o fe s s io n

Question #2 Use Good Clinical Judgem ent!

W h a t le v e l o f s u p e r v is io n m u s t b e p r o v id e d t o S L P A s ?

• B e s u r e t o le a r n t h e r e g u la t io n s fo r y o u r s t a t e !

• A S H A r e c o m m e n d s 2 0 % d ir e c t s u p e r v is io n d u r in g t h e f i r s t 9 0 d a y s , a n d t h e n o n c e e v e r y 6 0 d a y s p e r c l ie n t

• U lt im a t e r e s p o n s ib i l i t y fo r c l ie n t w e lfa r e r e m a in s w it h t h e c e r t i f ie d in d iv id u a l

• S u p e r v is io n m a y n e e d t o e x c e e d m in im u m r e q u ir e m e n t s s o s u p e r v is in g

c l in ic ia n is c o n f id e n t r e g a r d in g c l ie n t o u t c o m e s

• S u p e r v is o r is r e s p o n s ib le t o in t e r v e n e i f t h e r e is a n y q u e s t io n r e g a r d in g t h e q u a l it y o f t h e c a r e b e in g p r o v id e d

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Question #3Are services provided by SLPAs, grad students, and CFs billable for M edicaid, insurance and private payers?

• It depends on the payer for services! Be sure to check w hat is acceptable in the facility w here that person is providing services

• Third-party payers m ay be specific about the supervision required in order to receive reim bursem ent for services

• ASHA Code of Ethics recognizes the professional know ledge of various service providers, as long as we are ensuring appropriate supervision

• Client welfare and the quality of service rem ains the responsibility of the certified supervisor

• Supervisors m ust keep abreast of all reim bursem ent policies, rules, and regulations

• M edicaid services are usually not reim bursed but check w ith your state regulations!

But…

Question #4C a n a g r a d u a t e s t u d e n t w o r k a s a s p e e c h - la n g u a g e p a t h o lo g y a s s is t a n t w h i le

in g r a d u a t e s c h o o l?

• R o le s / r e s p o n s ib i l i t ie s m u s t n o t b e c o n f u s e d

• S L PA s h a v e l im it e d s c o p e o f p r a c t ic e a n d m u s t n o t p r o v id e c l in ic a l s e r v ic e s t h a t r e q u ir e t h e u n iq u e k n o w le d g e , s k i l ls , a n d ju d g m e n t o f a S L P

• G r a d u a t e s t u d e n t s c a n p r o v id e b r o a d r a n g e o f s e r v ic e s w h e n a p p r o p r ia t e ly s u p e r v is e d

• C a n b e d if f ic u lt i f s t u d e n t is g iv e n a p r a c t ic u m a s s ig n m e n t in h is / h e r w o r k

s e t t in g

Are you ready to be a supervisor or mentor?

Think about how you’ve mentoring or supervisory experiences up until now -• Have you ever been an “informal” supervisor?• Have you participated in the ASHA STEP Mentor

Program?• Have you completed any other supervisory training prior to this one?• What skills would you need to develop in order to supervise and be a mentor?

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Research Supports the Value of Training to be a Supervisor• Research indicates that supervisors who engage in supervisory

conferences/meetings without formal supervisory training tend to dominate talk time, problem solving, and strategy development Culattaand Seltzer (1976), Irwin (1975, 1976), McCrea (1980), Roberts and Smith (1982), and Strike-Roussos (1988, 1995)• They tend to use the same direct style of supervision with all

supervisees regardless of their knowledge or skill levels, and without regard for the supervisee's learning style, which can lead to passive supervisee involvement and dependence on the supervisor J.L. Anderson 1988

Supervision is an Important Commitment and Responsibility • Evaluate your own behaviors in the supervisory

process • Develop a personalized quality assurance

mechanism to ensure accountability • Make a decision to improve as a supervisor! Promotes job satisfaction, self-fulfillment,

ethical behavior, and prevents burnout D o w lin g , 2 0 0 1

What does Research tell us about our OWNCommunication? • E f f e c t iv e c o m m u n ic a t io n s t y le w a s s h o w n t o a f fe c t t h e s u p e r v is e e s '

w i l l in g n e s s t o p a r t ic ip a t e in c o n fe r e n c e s , s h a r e id e a s a n d fe e l in g s , a n d p o s it iv e ly c h a n g e c l in ic a l b e h a v io r s

• W h e n s u p e r v is e e s p e r c e iv e h ig h le v e ls o f u n c o n d it io n a l p o s it iv e r e g a r d ,

g e n u in e n e s s , e m p a t h ic u n d e r s t a n d in g , c o n c r e t e n e s s , t h e ir c l in ic a l b e h a v io r s c h a n g e in p o s it iv e d ir e c t io n s Ghitter 1987, as cited in M cCrea & Brasseur, 2003

• S o m e p o t e n t ia l b a r r ie r s t o c le a r a n d a c c u r a t e c o m m u n ic a t io n

• A g e , g e n d e r, s o c ia l a n d e co n o m ic sta tu s , a n d c u ltu ra l/ lin g u ist ic b a c k g ro u n d

• W e w ill lo o k a t g e n e ra t io n a l a n d c u ltu ra l d iffe re n c e s

You’re an SLP – how’s YOUR communication?!

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Constructive FeedbackH O W T O E F F E C T I V E L Y T E A C H , C O A C H , M E N T O R A N D C O M M U N I C A T E

Providing Constructive FeedbackThink about what type of feedback you like to get…

…and what type of feedback you typically give!

Constructive Feedback is• Helpful • Practical• Productive• Useful• Valuable• Timely

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Five Principles of Constructive Feedback (Duffy 2013)1. Set realistic goals

-share your expectations -ask the supervisee if there are any particular areas he/she would like to receive feedback on

Five Principles of Constructive Feedback (Duffy 2013)2 . G a u g e s u p e r v is e e e x p e c t a t io n s o f f e e d b a c k

- a s k h o w t h e y w e r e p r o v id e d w it h fe e d b a c k in t h e p a s t

- w a s i t h e lp f u l t o t h e m

- r e a c h a g r e e m e n t o n t h e fo r m a t o f g iv in g a n d r e c e iv in g fe e d b a c k a n d t h e f r e q u e n c y

- d is c u s s h o w y o u w o u ld l ik e t o r e c e iv e fe e d b a c k f r o m t h e s u p e r v is e e

Five Principles of Constructive Feedback (Duffy 2013)

3 . G a t h e r in f o r m a t io n o n w h a t y o u r m e n t e e k n o w s a n d h a s d o n e

-Yo u n e e d a c c u r a t e in fo r m a t io n o n w h ic h t o b a s e y o u r fe e d b a c k

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Five Principles of Constructive Feedback (Duffy 2013)

4 . A c t im m e d ia t e ly

- P r o v id e fe e d b a c k ( p o s it iv e & n e g a t iv e ) a s c lo s e a s p o s s ib le t o t h e e v e n t in p r a c t ic e t o h a v e t h e g r e a t e s t e f fe c t ( D o n a ld s o n a n d C a r t e r, 2 0 0 5 )

- S it u a t io n a l fe e d b a c k is n o t a lw a y s r e c o g n iz e d a s fe e d b a c k b y t h e s u p e r v is e e

- M a k e it c le a r a t t h e o u t s e t t h a t fe e d b a c k t a k e s p la c e r e g u la r ly in c l in ic a l s i t u a t io n s t o c la r i f y t h e f u n c t io n o f fe e d b a c k

- C o n s id e r y o u r t im in g

Five Principles of Constructive Feedback (Duffy 2013)5. Be specific

-Use specific descriptive terms about what was right and how it impacts the therapy session and/or client-Reference mentee’s learning outcomes-Give details

Nonverbal Communication• Non-verbal communication is as important as verbal communication

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The “Sandwich” Feedback Technique• Provide positive info 1st and last , areas for improvement in the

middle - Sandwich Model ( C ly n e s a n d R a f t e r y , 2 0 0 8 ; W a ls h , 2 0 1 0 )

Negative Feedback• You’ll need to wisely and sensitively gauge each person/situation• Encourage your mentee to self-assess and express thoughts before you. This allows you to gauge whether s/he has insight about the

challenges you observed• Consider providing it first• If the mentee is anticipating bad news, they often fail to hear the

positive messages of the feedback (Hathaway, 1997). • By discussing areas of improvement first with proactive solutions, your mentee can then listen to and absorb the positive message

Honing your Feedback SkillsüProviding constructive feedback is the only way to help someone who is underperformingüOffer feedback early and consistently üIdentify problems areas early so that you can ensure there is sufficient time and guidance to do something about themüProvide written feedback

- c h o o s e y o u r w o r d s c a r e f u l ly- in c lu d e s p e c if ic s- u s e a p o s it iv e t o n e a n d p o s it iv e s t a t e m e n t s

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Supervision in the 21st CenturyCULTURAL CONSIDERATIONS, GENERATIONAL DIFFERENCES AND REMOTE SUPERVISION

Cultural and Linguistic Considerations•Consider culturally based behaviors, values, and belief systems•Recognize that behavior may be influenced by culture to develop a better understanding of variations among people•Resources for cultural competence awareness may be obtained through ASHA and/or literature review

Generational Differences• Supervisors and mentors need to be

prepared to understand and accommodate attitudes and behaviors that may differ from their own• Generational characteristics can

lead to miscommunication and misunderstandings in interactions with clients and supervisors

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Four Generations in the WorkplaceTraditionalists

◦ Born 1900 – 1045◦ Raised by parents that survived the Great Depression

Baby Boom ers◦ Born 1946 – 1964

◦ Promised the “American Dream”

Generation X◦ Born 1965 – 1980◦ The first generation that will not do as well financially as their parents

M illennials◦ Born 1981 – 2000

◦ Grew up more sheltered as parents strived to protect them from the evils of the world

TraditionalistsWork Ethic and Values

◦ Expect others to honor commitments and behave responsibly◦ Value good attitude, knowledge and loyalty

Work is…◦ An obligation

Keys to Working W ith Traditionalists

◦ They want to know procedures so they can follow the rules◦ Consider their feelings – like a personal touch

Com m unication and M entoring◦ Respect their experience – fit approach and feedback into what worked for them in the past◦ Communication in a more formal, logical way

◦ “No news is good news”

Baby BoomersWork Ethic and Values

◦ Heavy focus on work as an anchor in lives; question authority◦ Value personal fulfillment/gratification; risk-takers

Work is…◦ An exciting adventure

Keys to Working W ith Boom ers

◦ They need to know that their work matters and how it fits into the big picture◦ Don’t take criticism well, need flexibility and attention

Com m unication and M entoring◦ Speak openly and directly with friendly rapport◦ Follow-up, check in without micro-managing

◦ Appreciate praise

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Generation XWork Ethic and Values

◦ Care more about work/life balance than advancement◦ Value casual work environment, technology, diversity

Work is…◦ A difficult challenge

Keys to Working W ith Gen X’ers

◦ They want independence in the workplace and informality◦ They want to have fun at work and like technology

Com m unication and M entoring◦ Straight talk, present facts using informal communication style with a focus on results◦ Present yourself as an information provider rather than “boss”

◦ Need constructive feedback to be more effective

MillennialsWork Ethic and Values

◦ High expectations of managers to assist and mentor them◦ Thrive in collaborative environment; want to enhance skills

Work is…◦ A means to an end

Keys to Working W ith M illennials

◦ Like to be part of team, work with friends, be treated respectfully◦ Help them navigate work and family issues; provide variety

Com m unication and M entoring◦ Challenge them, respect them and encourage them to explore new avenues◦ Be careful about the words you use and how you say things

◦ Provide structure, supervision and recognition for them and their heroes

What would you do?A 35 year-old mentor is having difficulty with her new CF, who is about 55 years old. The CF frequently questions recommendations, rarely asks for assistance and has made mistakes in some of these situations, and is occasionally sarcastic about the “young” mentor’s leadership knowledge and experience. What would you suggest to the mentor? What would you suggest to the CF?

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Remote SupervisionWhy is this a hot topic?• To develop clinical competencies with current technology for effective instruction and guidance

Who can we support remotely?

Clinical Fellows? SLPAs? Graduate Students?How can we provide mentoring remotely?

• Videos (direct)

• E-mail• Phone

• Instant messaging/texting

• Face Time (direct)• Video conferencing (direct)

Benefits of Remote Supervision• Provides supervisee with greater access to highly qualified supervisors• Increases the quality and amount of support• Can provide immediate feedback to specific situations• Broadens clinical and work opportunities in remote clinical settings or where local supervisors are not available• Makes scheduling easier• Makes better use of supervisor’s time• Reduces travel time and expenses

Limitations of Remote Supervision• Limited availability of needed technology• Inability to demonstrate/model therapy techniques with the client• Audio quality may reduce the supervisor’s ability to

discriminate speech errors when observing• Inability to know clients on mentee’s caseload• Reduces opportunities for informal and spontaneous

interactions and feedback

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Consider these Factors• Can some supervision be provided remotely?• What technological resources are available on both ends?• Is there a cost to set up the needed technology?• Why is remote supervision being considered?• How can you get to know client situations if you don’t see them all

in person?

Resources Available to Supervisors• A S H A ’s S L PA S u p e r v is io n FA Q - h t t p :/ / w w w .a s h a .o r g / a s s o c ia t e s / S L PA - FA Q s /

• A S H A ’s C F M e n t o r FA Q - h t t p s :/ / w w w .a s h a .o r g / C e r t i f ic a t io n / C F S u p e r v is o r s /

• A S H A ’s S t u d e n t S u p e r v is io n FA Q - h t t p s :/ / w w w .a s h a .o r g / s lp / s u p e r v is io n FA Q s /

• C o n s id e r jo in in g S p e c ia l In t e r e s t G r o u p 1 1 : A d m in is t r a t io n a n d S u p e r v is io n

• C o n t in u e t o s e e k c o n t in u in g e d u c a t io n o p p o r t u n it ie s t h a t a r e u n iq u e s o y o u c a n c o n t in u e t o g r o w !

• Ta lk t o c o l le a g u e s w h o h a v e s u p e r v is e d in t h e p a s t – t h e y o f t e n h a v e s t r a t e g ie s a n d r e s o u r c e s s o y o u d o n ’t h a v e t o r e in v e n t t h e w h e e l!

Keys to SuccessSTRATEGIES USED BY THE BEST MENTORS

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Key Thoughts and Suggestions• S e t s c h e d u le fo r m e e t in g s a n d o b s e r v a t io n s s o y o u g e t t o k n o w t h e c a s e lo a d

• A s k y o u r m e n t e e a b o u t t h e ir s t r e n g t h s / a r e a s o f n e e d

• D e v e lo p c o m m o n o b je c t iv e s w it h t o g e t h e r

• D e t e r m in e t o g e t h e r h o w y o u r m e n t e e c a n e a s i ly, q u ic k ly a n d a c c u r a t e ly g e t g u id a n c e a n d s u p p o r t

• B e fa m il ia r w it h p a p e r w o r k r e q u ir e m e n t s o f t h e fa c i l i t y, y o u r s t a t e a n d A S H A

• C o m p le t e a l l p a p e r w o r k in a t im e ly m a n n e r

And Remember that…Each mentee is unique, with different strengths and

weaknesses!

It is your job, your responsibility, your commitment to help that person grow professionally so that they have the skills and independence necessary for the

next stage of their career!

Be Prepared with an Action Plan1. What unexpected challenges have you experienced or do you anticipate arising in supervision?2. How can you manage those challenges?3. What is your action plan? Consider some ideas that you can implement

immediately to improve your mentoring/supervisory experience!

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R e fe re n c e s

• A m e r ic a n S p e e c h - L a n g u a g e a n d H e a r in g A s s o c ia t io n ; C l in ic a l S u p e r v is io n in S p e e c h -L a n g u a g e P a t h o lo g y Te c h n ic a l R e p o r t ( 2 0 0 8 )

• A m e r ic a n S p e e c h - L a n g u a g e a n d H e a r in g A s s o c ia t io n , I s s u e s in E t h ic s : E t h ic a l I s s u e s

R e la t e d t o C l in ic a l S e r v ic e s P r o v id e d b y A u d io lo g y a n d S p e e c h - L a n g u a g e P a t h o lo g y S t u d e n t s ( 2 0 1 3 )

• A m e r ic a n S p e e c h - L a n g u a g e a n d H e a r in g A s s o c ia t io n ; I s s u e s in E t h ic s : R e s p o n s ib i l i t ie s o f In d iv id u a ls W h o M e n t o r C l in ic a l F e l lo w s in S p e e c h - L a n g u a g e P a t h o lo g y ( 2 0 1 3 )

• A m e r ic a n S p e e c h - L a n g u a g e a n d H e a r in g A s s o c ia t io n , K n o w le d g e , S k i l ls a n d T r a in in g

C o n s id e r a t io n fo r In d iv id u a ls S e r v in g a s S u p e r v is o r s ( 2 0 1 3 )• W e s t M id la n d F a m ily C e n t e r – G e n e r a t io n a l D if fe r e n c e s C h a r t

• C a l i fo r n ia S p e e c h L a n g u a g e P a t h o lo g y & A u d io lo g y & H e a r in g A id D is p e n s e r ’s B o a r d w e b s it e a n d d o c u m e n t s

• A m e r ic a n S p e e c h - L a n g u a g e a n d H e a r in g A s s o c ia t io n , Te le - S u p e r v is io n ; D u d d in g , C a r o l ;

C a r l in , C h a r le s ; 2 0 1 2 A S H A C o n v e n t io n

Comments and Questions

C o n t a c t In fo r m a t io n :

S h e l l ie B a d e r, M A , C C C - S L P

S h e l l ie .b a d e r @ e b s h e a lt h c a r e .c o m

4 2 4 - 6 4 5 - 4 8 3 2