Clinical Supervisionvs. Administrative

Mary HubbardCADC-II, CAS-II, M-RAS, CCS

Clinical Supervision Clinical Supervision vs. Administrativevs. Administrative

Mary Hubbard,

CADC-II, CAS-II, M-RAS, CCS

Objectives 

• Describe components of clinical and administrative supervision

• Understand the principles of clinical supervision p

• Identify the need for an AOD clinical supervisions and its impact on the workforce

• Describe one method of Clinical Supervision

Types of Management Skills

Visionary Human Technical

FuturePulse of the C i

Understanding peopleM i i

The “How To”Understanding h “ l k”Community

Determining goals and methods to achieve Mission

MotivatingLeadingManagementClinical

the “real work”OperationsBudgetPaperwork

• Manager

– Boss

• Leader

– Coach 

Leadership Roles

– Decision Maker

– Supervisor

– Traffic Cop

– Delegator

– Facilitator

– Servant

– Role Model

– Visionary

Leadership Styles

• Autocratic – Directive

• Participative I t A t d– Input Accepted

• Democratic – Team Approach

• Laissez-Faire

Supervision - Types

• Supervision in employment setting– Supervision (management) for the purpose of

employee evaluation and performance improvement

• Supervision as part of training and developmentp– Supervision under an experienced counselor or

clinician for the purpose of increasing counseling knowledge, skills and practice

– Supervision under an experienced accountant, QA, HR director for the purpose of increasing knowledge, skills and practice in that area of expertise

Different “Hats”

• Trainer / teacher (most fundamental level)

– Most important with new counselors/employees

• Employer / manager (business role)

– Must set up clear boundaries early / contracts

• Facilitator (most delicate role)

– Facilitate movement to next levels of competence

– Facilitate self-efficacy and self-confidence

– Facilitate self-evaluation

• Colleague / fellow member of the profession

Understand the principles of clinical supervision

• Supervision is a key ingredient in counselor training

• Counselor training and competencies revolve around the 12 core functions and TAP 21 Practice Dimensions.

• Research shows that effective clinical supervision leads to improved – Clinical skills for both

– Therapeutic relationships

– Therapy outcome

Clinical Supervision – What is it? (2)

“Clinical supervision is the most appropriate

learning medium for the counselor because it

is a “learning by doing” process rather than a

distant, classroom type of experience.

Supervision provides us with an ongoing

assessment of our skills and areas of clinical

strengths and weaknesses.Powell 1980

Supervision

“Effective supervisors observe, mentor, coach, evaluate, inspire, and create an atmosphere that promotes self-motivation, learning, and professional development…..

Such supervision is key to both quality improvement and the successful implementation of consensus- and evidence-based practices”

Screening

Intake

O i t ti

Crisis Intervention

Client Education

R f l

12 Core Functions

Orientation

Assessment

Treatment Planning

Counseling

Case Management

Referral

Reports and Record Keeping 

Consultation

Professional Practice Dimensions(TAP 21-A)

The basic tasks and responsibilities that constitute the work of an addiction counselor.

I. Clinical EvaluationII. Treatment PlanninggIII. ReferralIV. Service CoordinationV. CounselingVI. Client, Family and Community EducationVII. DocumentationVIII. Professional and Ethical Responsibilities

• Respect 

• Disclosure

• Warmth

• Potency

Traits to Role Model and Mentor

• Concreteness

• Immediacy

• Genuineness 

• Empathy

• Confronting 

• Self Actualization

What are KSA’s?

A competency is comprised of:

KNOWLEDGE - what we need to know in order to develop proficiency.

SKILLS the behaviors needed forSKILLS - the behaviors needed for effective performance.

ATTITUDE - the state of mind consistent with professional practice

TAP 21-A

The Application of Supervision

• Theories, roles and models of counseling

• Development stages of counselor and supervisors

• Evidence Based Supervision

• Application to practice

• Incorporate gender and culture

• Providing group supervision

Supervision Based on Counselor’s

Level of Development

Supervision Based on Supervisor’sL l f D l tLevel of Development

See handout

Models of Supervision

Treatment-based models

Competency based models

Developmental models

Integrated models

Tailoring of the model to specific cultural and diversity factors

Range of Supervision Types

Evidence Based Supervision

Modeling

Didactic

Participatory

Reflective

Objectives 

• Describe components of clinical and administrative supervision

• Identify the need for an AOD clinical supervisions and itsclinical supervisions and its impact on the workforce

• Describe one method of Clinical Supervision

Critical Issues Supervisees Need for Professional Integration

Competence (skill and technique)Emotional Awareness (know oneself, aware of feelings, countertransference)Issues of autonomy (self-directedness)Issues of identity (theoretical consistency)Issues of respect for individual differencesIssues of respect for individual differences (tolerance, non-judgmental acceptance of others)Issues of purpose and direction (structuring a therapeutic direction, setting appropriate goals)Issues of personal motivation (awareness of the satisfactions and personal meanings inherent in counseling)Issues of professional ethics

Critical Issues Supervisees Must Address for Professional Integration

• Issues of purpose and direction (structuring direction, setting appropriate goals)

• Issues of personal motivation• Issues of personal motivation (awareness of the satisfactions and personal meanings inherent in work)

• Issues of professional ethics

Tangible Benefits of Supervision

Improved service to clientsHigher practitioner job satisfactionLess burnoutDecreased staff turnoverDecreased staff turnoverLower administration costsNew skills learntImproved staff communicationImproved client outcomes? – needs research

Objectives 

• Describe components of clinical and administrative supervision

• Identify the need for an AOD clinical supervisions and itsclinical supervisions and its impact on the workforce

• Describe one method of Clinical Supervision

Motivational Interviewing:A Definition

Motivational interviewing is

a person-centered,

directive

method of communication

for enhancing intrinsic motivation to change

by exploring and resolving ambivalence.

David by Michelangelo

Performance Evaluation/MI Way 

1. Ask what they like about their style, what are they doing well?

2. Reflect and confirm strengths you agree with

3. Ask what do they see they need to improve on?on?

4. Reflect and confirm what you agree with.

5. Add your thoughts on two specific things you would like work on over the next --- time

6. Ask them what they think about your thoughts.

The 8 Stages of Learning M.I.

1. Overall Spirit

2. Client-centered InterviewingSkills (OARS)

3. Recognizing Change Talk

4. Eliciting Change Talk (ECT)g g ( )

5. Rolling With Resistance

6. Consolidating Commitment

7. Developing A Change Plan

8. Transition and Blending With Other Methods

Miller, W. R., & Moyers, T. B. (2006). Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions

How do you learn MI?

1. Take a 2 -3 day class (www.mhsinc.org/calendar) or www.motivationalinterviewing.org

2. Read more - Tip 35: Enhancing p gMotivation for Change in Substance Abuse Treatment www.samhsa.gov

3. Practice using the spirit and skills

4. Practice with feedback (coding, consultation)

TOOL Box

• Individual Style – Yours

• Individual style – Theirs

• Learning Style

• Decision Making procedure

• Evaluation tools

• Systematic Supervision

• Clarity of differences

Professional Self-Evaluation

• Is my style working?

• Is my management/ supervision effective?

C I di t h ill d ll?• Can I predict who will do well?

• What can I do to get better results?

• How can I improve my approach?

Would This Be Said?• Excellent manager

• Excellent counselor/clinician/supervisor

• Helps staff learn and grow

• Models highest ethics

L d b l• Leads by example

• Demands excellence, not perfection

• Takes care of his/her people

• Is humble

• Has character and integrity

• What is the norm?

• Is it related to work?

• Is there a power difference?

• Do they feel free to say

• Always consider the liability

• Always consider the long‐term 

• Always consider the effect

Ethically - am I allowed to..?Questions to ask…

• Do they feel free to say no?

• Would I do it with everyone?

• What level of supervision are they in?  Does that change the answer?

• Always consider the effect on the client

• Always consider the effect on the supervision relationship

What Counts?

40% of outcome is related to the client

Stages of change

Setting

15% of outcome is related to technique/skilltechnique/skill

35% of outcome is related to the therapeutic relationship

The rest is related to extra ordinary factors

Questions?

Full WRM-TA CCS Course• Describe one definition of clinical supervision

• Describe counselor competencies

• Identify two models of clinical supervision

• Strategies and tools for clinical supervisors to use to help a counselor to develop and grow.

• Utilize MI for assessment and evaluation tools

• Define the ethics of supervision

• 24 hours/three days

• BBS, APA and AOD approved

• Instructors: MH, AOD and Medical

How MHS provides CCS

1. Required Training in MI and Clinical Supervision

2. Required direct observation – video tape supervision review in individual and group supervision

3 All levels of leadership are in monthly3. All levels of leadership are in monthly supervision (Senior VP, VP, and Program Manager)

4. Individual coaching, supervision or mentoring if needed.

5. (Parallel Process – Isomorphic Process)

How to access MHS workshops and courses

• To discuss a CCS course in your area contact Mary Hubbard @ mhubbard@mhsinc.org

• To attend the courses/workshops on MHS calendar go to http://www.mhsinc.org/calendar

• To schedule an MI or gender class in your area contactTo schedule an MI or gender class in your area contact Colleen Marshall cmarshall@mhsinc.org

• To attend the WRM-TA school for Counselors contact Alma Linares at alinares@mhsinc.org

• For any of the above call 858-583-2600- training department- Lorena Duarte @ lduarte@mhsinc.org

More Information

www.motivationalinterviewing.org

A guide for Probation and Parole: Motivating Offenders to Change g g– US Dept Justice www.nicic.org

Tip 35: Enhancing Motivation for Change in Substance Abuse Treatmentwww.samhsa.gov800-729-6686

Resources

http://www.treatment.org/Taps/tap21/TAP21Toc.htmlTechnical Assistance Publication (TAP) TAP 21- Addiction Counseling Competencies: The KnowledgeCompetencies: The Knowledge, Skills, and Attitudes of Professional PracticeTIP – Treatment Improvement Protocol: Knowledge Application Programs

Resources

Gallon s. (2205) Clinical Supervision Training manual Portland Oregon Norwest Frontier ATTC

James Maddux, Ph.D. and Jonathan Mohr, Ph.D.

Southern Coast ATTC

Powell D revised edition (2005), Clinical Supervision in AOD Counseling: Principals, Models and Methods. New York: Lexington Books

References and Resources

• Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nd ed.). Boston: Allyn and Bacon.

• Cox, L.J. Interactive Evaluations: Some Process-Oriented Questions for the Supervisor, in Practical Applications in Supervision. Pg 3-85.Litt ll J M L B d N & L J A• Littrell, J. M., Lee-Borden, N., & Lorenz, J. A. (1979). A developmental framework for counseling supervision. Counselor Education and Supervision, 19, 119-136.

• Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model. The Counseling Psychologist, 10, 3-42.

References and Resources

• Rodenhauser, P. (1994). Toward a multidimensional model for psychotherapy supervision based on developmental stages. Journal of Psychotherapy Practice and Research, 3, 1-15.

• Stoltenberg, C. D. & Delworth, U. (1987). Supervising counselors and therapists. San Francisco: Jossey and Bass.

• Watkins, C. E. (1995a). Psychotherapy supervision in the 1990s: Some observations and reflections. American Journal of Psychotherapy, 49, 568-581.

• Watkins, C. E. (1995b). Psychotherapy supervisor and supervisee: Developmental models and research nine years later. Clinical Psychology Review, 15 647-680.

 Supervisor Developmental Model

Developmental Level Characteristics

To Increase Supervision Competence

Level 1

• Is anxious regarding role • Is naïve about assuming the role of

supervisor • Is focused on doing the “right” thing

May overly respond as an “expert” • Is uncomfortable providing direct

feedback

• Follow structure and formats

• Design systems to increase organization of supervision

• Assign Level I counselors

Level 2

• Shows confusion and conflict • Sees supervision as complex and

multidimensional • Needs support to maintain motivation • Overfocused on counselor’s deficits

and perceived resistance • May fall back to being a therapist with

the counselor

• Provide active supervision of the supervision

• Assign Level 1 counselors

Level 3

• Is highly motivated • Can provide an honest self-appraisal of

strengths and weaknesses as supervisor

• Is comfortable with evaluation process • Provides thorough, objective feedback

• Comfortable with all levels

Source: Stoltenberg, Delworth, & McNeil, 1998

TIP 52, Page 11 

Counselor Developmental Levels

 

Developmental Level

Characteristics Supervision Skills Development Needs

Techniques

Level 1

Focuses on self Anxious, uncertain Preoccupied with performing the right

way Overconfident of skills Overgeneralizes Overuses a skill Gap between conceptualization, goals,

and interventions Ethics underdeveloped

Provide structure and minimize anxiety

Supportive, address strengths first, then weaknesses

Suggest approaches Start connecting theory to

treatment

Observation Skills training Role playing Readings Group

supervision Closely monitor

clients

Level 2

Focuses less on self and more on client Confused, frustrated with complexity of

counseling Overidentifies with client Challenges authority Lacks integration with theoretical base Overburdened Ethics better understood

Less structure provided, more autonomy encouraged

Supportive Periodic suggestion of

approaches Confront discrepancies

Introduce more alternative views

Process comments, highlight countertransference

Affective reactions to client and/or supervisor

Observation Role playing Interpret

dynamics Group

supervision Reading

Level 3

Focuses intently on client High degree of empathic skill Objective third person perspective Integrative thinking and approach Highly responsible and ethical counselor

Supervisee directed Focus on personal-

professional integration and career

Supportive Change agent

Peer supervision Group

supervision Reading

Source: Stoltenberg, Delworth, & McNeil, 1998

TIP 52, Page 10