20Q: Current Topics in Supervision

From the Desk of Ann Kummer

We take many courses in undergraduate and graduate school on a variety of clinical topics. During our clinical rotations, we work with several different supervisors… some good, and some not so good. Once we enter the workforce and have had a few years under our belts, we often take on the additional responsibility of supervising a student, and perhaps later, even a colleague or a group of professionals.

Supervisors are key to the dissemination of clinical knowledge and practical clinical skills to students and active professionals within our field. Yet, we rarely receive formal training in how to be an effective supervisor. We may have excellent clinical skills, yet are unable to effectively evaluate the skills of others. We may have great communication skills, yet have difficulty providing appropriate constructive feedback to others. We may know how to create a clinical evaluation report but may be lost when it comes to an evaluation report of student performance.

I recall the first practicum student that I supervised. I am sure that I was an ineffective supervisor at the time. I didn’t know what to observe and how to effectively coach my student. I didn’t know of any resources that would help me through this first-time experience. I had to learn supervisory skills on the job at the expense of my first students.

Because effective supervision is so important in our field, I am really excited about this 20Q, submitted by Dr. Carol Koch. In this article, Dr. Koch explores the current topics related to clinical supervision. She reviews three different models of supervision and discusses the professional development requirements for clinical supervisors. Finally, she discusses the content areas that meet the professional development requirements for clinical supervisors.

Dr. Carol Koch has been a practicing clinician for 34 years and has been in higher education for about 15 years. Her clinical areas of focus have been in early intervention and early childhood/preschool, with particular emphasis on children who are highly unintelligible.  Dr. Koch’s teaching and research interests have included phonetics, phonology, speech sound disorders, and phonological development of very young children. Other areas of clinical, teaching, and research interests have included pediatric feeding disorders, childhood apraxia of speech, autism spectrum disorder, family and sibling experiences with autism spectrum disorder, and the impact of trauma on child development. She is currently Professor in Communication Sciences and Disorders at Samford University in Birmingham, AL, where she also serves as the Graduate Program Director in Speech-Language Pathology. Recently Dr. Koch was recognized as an ASHA Fellow and as a Board-Certified Specialist in Child Language.

In addition, she has been actively involved in ASHA’s Special Interest Group (SIG) 10 as a member of the Coordinating Committee. She is also serving on the ASHA 2022 Convention Program Committee as the Topic Chair for Speech Sound Disorders for Children with Normal Hearing. She has also authored a book:  Koch, C. (2019).  Clinical Management of Speech Sound Disorders:  A Case-Based Approach.  Burlington, MA:  Jones & Bartlett, Inc.

As supervisors, we all want to do the best that we can for our students and for others that we supervise. We certainly want to know what best practice is for supervision, just as we want to know what best practice consists of for our clinical services. I think this article will help us to do just that.

Now…read on, learn, and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

Browse the complete collection of 20Q with Ann Kummer CEU articles at www.speechpathology.com/20Q

20Q: Current Topics in Supervision

Carol Koch

1. Why is training in supervision so important?

Clinical supervision has been identified as a distinct area of practice by the American Speech-Language-Hearing Association (ASHA).  Effective clinical supervision involves a complex and unique set of skills.  Development of this set of skills requires training beyond that which has been traditionally included in master’s degree programs.  Being a good speech-language pathologist does not necessarily correlate to being a good supervisor (Kleinhans, Brock, Bland, & Berry, 2020; Procaccini, McNamara, & Lenzen, 2017).

2. What is the history of the progression toward developing a framework for supervisory training?

In 2013, an Ad Hoc Committee on Supervision (AHCS) was appointed by ASHA.  The committee identified roles, responsibilities and explicitly defined the skill set needed to provide supervision that was based on the best available evidence and best practice.  The AHCS also recommended systematic training in supervision.  Subsequently, ASHA appointed the Ad Hoc Committee on Supervision Training (AHCST) in 2016.  The AHCST made three major recommendations:  increase advocacy and awareness for the need for training in supervision, improve accessibility to quality training for professionals, and formalize the professional development or training requirements for supervision (Procaccini, McNamara, & Lenzen, 2017).

3. What are the new professional development requirements for supervision?

There has been a very important shift toward providing more consistent, structured, intentional training for clinical supervisors.  ASHA has established a strategic framework for organizing and creating training options to support clinical educators and supervisors. Clinicians who are going to supervise either a graduate clinician or a clinical fellow must complete 2 hours of professional development in the area of clinical supervision and clinical instruction.  This must be completed one time after being awarded the CCC and is required to be reported to ASHA (ASHAa, n.d.).  Additionally, a supervisor must have at least 9 months of clinical experience post-CF to supervise.

4. Are there different professional development requirements for the supervision of graduate clinicians, clinical fellows (CF), or speech-language pathology assistants (SLPA)?

The professional development requirements are the same for supervisors of graduate clinicians, CFs, and students in an Assistant program. However, for supervising SLPAs, ASHA recommends 2 years of experience post getting CCC, and 10 hours of CE.

5. How often must supervisors seek professional development to be able to supervise?

Fulfillment of the professional development requirement is only required once and then must reported to ASHA. The status of this professional development will be confirmed by university programs prior to assigning graduate clinicians to clinical supervisors (ASHAb, n.d.)

6. What are the course content areas that are approved to meet the professional development requirements for clinical supervision?

ASHA has identified the following content areas for meeting the professional development requirements for supervision:

• Knowledge and skills specific to clinical education, mentoring, and supervision of undergraduate students, graduate students, audiology externs, clinical fellows, and support personnel such as SLPAs
• Ethical issues related to clinical education and supervision
• Supervisory processes and models of supervision, adult learning styles, teaching techniques, roles and responsibilities of clinical educator and student
• Research and evidence-based practice in supervision, relationships, and communication skills
• Management and instructional processes including defining expectations, goal setting, and responding to legal and ethical issues
• Techniques to demonstrate recognition and access to appropriate accommodations for staff and students with disabilities
• Demonstrating the use of technology for remote supervision and clinical instruction and use of case simulations
• Role of clinical educator in use of simulations and standardized patients
• Establishment and implementation of goals with supervisees that reflect growth in critical thinking and problem solving
• Observation techniques including collecting and interpreting session data
• Providing objective feedback that motivates and supports improved performance; adjusting supervisory and teaching style based on level of supervisee
• Analysis and evaluation related to clinical instruction and how data supports identifying areas and targets for improvement
• Clinical and performance decisions related to modeling and guiding supervisee in ethical dilemmas, regulatory guidance, payment and reimbursement, and reflective practice techniques
• Creating and implementing plans for improvement
• Multi-cultural and cross-linguistic uses in the supervisory process
• Interprofessional education and practice related to supervision and clinical education (ASHA, n.d.)

7. What competencies are considered to be key in effective supervisory practice?

ASHA has created a self-assessment tool for the competencies in supervision.  This is an excellent tool for identifying areas of strength in supervision as well as areas for which a supervisor may seek additional professional development. The five broad topic areas of knowledge and skills for the competencies are:

• Supervisory process and clinical education
• Relationship development and communication
• Establishment and implementation of goals
• Analysis and evaluation
• Clinical and performance decisions

For more specific knowledge and skills in each area, refer to the Self-Assessment of Competencies in Supervisions which can be accessed at: https://academy.pubs.asha.org/wp-content/uploads/2019/05/Self-Assessment-of-Competencies-in-Supervision.pdf

8. Are there tools available for assessing competencies in clinical supervision?

Yes, the ASHA Self-Assessment of Competencies in Supervision is an excellent tool!  This can be accessed at: https://academy.pubs.asha.org/wp-content/uploads/2019/05/Self-Assessment-of-Competencies-in-Supervision.pdf

9. What training resources are currently available for professional development in the area of clinical supervision?

ASHS has resources related to supervision in the Practice Portal which can be accessed at https://www.asha.org/practice-portal/ as well as through SIG 10 and SIG 11.  The Council for Academic Programs in Communication Sciences and Disorders (CAPCSD) also has resources and training modules available.  There are a wealth of resources available at https://www.capcsd.org/elearning-courses/

10. I’ve heard many terms being used for supervisors.  Is there one particular term that ASHA has identified as the preferred term?

ASHA has not identified a preferred term, at this time.  Rather, ASHA has provided thoughtful consideration of the various terms that have been utilized.  Supervisor – one who oversees.  Clinical instructor – one who teaches students about clinical processes. Preceptor – one who instructs, trains, and supervises (ASHA, 2018).

11. Anderson’s model for the continuum of supervision is one guide for the progression of the supervisory process.  How would you summarize that model?

Anderson’s continuum of supervision model highlights the stages of supervision that students move through as they gain experience.  The continuum of stages of evaluation-feedback, transitional, and self-supervision reflect student progression from interdependence to independence in clinical performance.  As the student progresses, the amount and type of involvement by the supervisor changes.  Direct supervision decreases as student independence increases.  Key components for supervisors to facilitate this process include the following:  understanding the supervisory process, planning, observing, analyzing, and integrating. Understanding the supervisory process includes discussing the process, understanding the roles of supervisor and supervisee, and sharing expectations and objectives.  Planning involves planning for the clinical process as well as for the supervisory process.  Observing involves the gathering of objective data of the client and the clinician by both the supervisor and the graduate clinician.  Analyzing involves the examination and analysis of the data in terms of the changes made by the client and the graduate clinician. Lastly, integration includes the integration of information from all components throughout the supervisory process for the purposes of assessment and goal setting (ASHAc, n.d).

12. I am familiar with end-of-semester student evaluations.  How can the evaluative process be utilized to enhance student clinician learning and performance?

Improving clinical skills of student clinicians is a primary focus for clinical educators. Involving student clinicians in the process of evaluating their own clinical performance is one very powerful way to facilitate clinical learning, self-awareness, and self-evaluation.  Through a collaborative effort, the clinical instructor and student clinician can engage in the student advancing through the stages of Anderson’s model of supervision.  In this model, the student clinician analyzes their own performance but also incorporates feedback and suggestions from the clinical instructor. As a result of this collaborative process, the student clinician becomes more aware of analyzing clinical strengths as well as needs.  This self-awareness and analysis is an important element in developing clinical independence. 

The collaborative process of ongoing feedback would inform more formal and structured mid- and end-of-semester evaluations.  As a result of direct clinical observation, video analysis of recorded sessions, journal reflections, active listening, informal chats, and supervisory conferences, the student clinician and the clinical instructor can review and analyze performance, identify areas for growth for which goals are established, and celebrate successes as a means of affirming strong clinical performance. 

This type of guided collaboration allows the student clinician the opportunity to appreciate multiple perspectives, calibrate their own self-evaluation, increase accountability, as well as grow clinically.  Supervision based on collaboration can promote learning in addition to providing a model for the need for continued improvement and professional development.

In order to provide the graduate clinician the opportunity to learn and grow in a clinical setting, utilizing a mid-semester clinician self-evaluation allows the clinical instructor and the student clinician ample opportunity to collaborate and set new goals for growth during the remaining half of the semester. Student clinicians should be involved in analyzing their performance and setting goals for growth in order to become more independent and closer to performing in the self-supervision stage.

13. Please explain the model in which adult experiential learning theory and Bloom’s taxonomy are integrated.  This is very interesting to me.

Walden and Gordon-Pershey (2013) have developed a model of clinical supervision that integrates adult experiential learning and Bloom’s taxonomy. The adult experiential learning aspect of this framework emphasizes the continuum of ways in which adults respond to learning experiences.  The continuum of responses includes the following: non-learning responses, non-reflective learning responses, and reflective learning responses.  Non-learning responses indicate that there is very little to no learning occurring.  Non-reflective learning responses indicate that the learner is at a level of practice or memorization.  In clinical work, the supervisee is imitating and repeating what is demonstrated by the supervisor. Reflective learning responses indicate contemplation, reflection, responsibility for own learning. 

Bloom’s Taxonomy features six cognitive processes that are central to learning:  remember, understand, apply, analyze, evaluate, and create. When adult experiential learning responses are overlaid with Bloom’s cognitive processes, remembering and understanding may result in non-learning responses. While apply, analyze, evaluate, and create will promote higher-level cognitive processes and learning responses. The resulting worksheet can be found in the article by Walden & Gordon-Pershey (2013).

14. Tell me more about “deliberate supervision”?

Deliberate supervision is a way of approaching supervision that involves the following:  planning for the teaching and learning experience, providing feedback that facilitates growth and development, and utilizing questions to facilitate critical thinking and clinical problem-solving.  The model is designed to plan experiences that will promote clinical growth and critical thinking along a developmental trajectory in incremental steps.

15. The learning vector model has been utilized in the context of clinical supervision.  What is the learning vector model?

The learning vector model depicts the acquisition of knowledge across many domains (basic human communication, communication/swallowing disorders, principles of assessment and treatment, evidence-based practice), skills (prevention, assessment, intervention, oral and written communication), and the degree of direct instruction needed by the student. And, lastly, the model reflects the degree to which a student is demonstrating professional development from novice to mature.  The stages of development in this model include:  exposure, acquisition, and integration.  During the exposure stage, supervisors will provide a high level of support, direct instruction, and modeling.  During the acquisition stage, the student clinician will begin demonstrating new skills, require less instruction and coaching, and will begin to demonstrate some autonomy.  In the final stage, integration, the clinician has begun demonstrating some level of mastery of skills, some independence in clinical decision making, planning, and performance. (Kleinhans, Brock, Bland, & Berry, 2020).

16. What considerations must be made in clinical supervision that is student-centered but provided in a patient-centered setting?

In a clinical setting in which the focus is on patient-centered care, specific considerations must be made to effectively implement a student-centered learning experience. An important balance must be created to meet the health care needs of the client/family as well as the learning needs of the graduate student clinician.  Therefore, specific considerations must be made for:

1. The target outcome for the graduate student clinician
2. The competencies and skills needed for graduate clinicians to eventually practice at the top of the professional license, and
3. Balancing the obligations to both the clients/patients and the graduate student clinician.

(Adamovich, 2008)

17. Tell me more about the target outcome for the graduate clinician?

The target outcomes for a graduate student clinician will vary depending on the setting, population, and level of the clinician’s clinical training.  The goals or outcomes for the clinical experience should be developed collaboratively with the clinical instructor and the graduate clinician.   For example, in a school setting, an outcome might be that the graduate clinician independently administers a standardized assessment for articulation and complete the scoring and analysis accurately.  This provides the graduate clinician with a very tangible goal for the semester and guides the learning experiences in a very intentional manner (Adamovich, 2008).

18. Tell me more about the desired behaviors that provide the foundation for student clinicians to grow and perform at the top of their professional license.

Clinical decision-making is a critical behavior and skill for student clinicians to develop.  The ability to make appropriate and accurate clinical decisions efficiently is critical for professionals to function as independent practitioners.  However, this can be a difficult outcome for student clinicians to achieve during clinical practicum assignments.  The clinical instructor must be skilled at facilitating student clinician clinical decision making while also protecting their ethical commitment to the client or patient. The ASHA Code of Ethics provides guidance for allowing graduate clinicians to participate in the decision-making process without jeopardizing the safety of the patient or client.  A facilitating approach is suggested in which the clinical instructor and graduate clinician discuss the clinical situation, discuss the outcomes of specific decisions, and allow the graduate student to make the decision.  The clinical instructor facilitates the process and discussion and can provide feedback to the graduate clinician regarding the appropriateness of the decision.  Ultimately, the clinical instructor either validates the suggestion as appropriate or discusses the implications and guides the graduate clinician to a different clinical decision.  This facilitative technique allows the student to be actively engaged in clinical problem-solving and develop an awareness of the relevant information for shaping a clinical decision (Adamovich, 2008).

19. What advice would be beneficial to support supervisors in balancing their obligations to the graduate clinician and their clients/patients?

The supervising clinician should always inform clients/patients regarding the graduate clinician’s role and the supervisory relationship.  It should also be clearly communicated to the client/patient and family that the experienced, supervising clinician guides all clinical activities and decisions.  As the clinical instructor facilitates clinical learning, opportunities should be provided for connecting theory to clinical practice.  This allows the student clinician to develop critical thinking and clinical problem-solving.  This cycle of applying theory to practice to inform and then execute clinical decisions between the clinical instructor and the graduate student clinician allows for student-centered learning while maintaining a high level of patient-centered care (Adamovich, 2008).

20. What are the supervision guidelines for tele-supervision?

Supervision is a critical part of the clinical education process for graduate clinicians.  As such, supervision is a distinct area of practice for which ASHA has identified the following tasks of supervision:

1. Establishing and maintaining an effective working relationship with the supervisee;
2. Assisting the supervisee in developing clinical goals and objectives;
3. Assisting the supervisee in developing and refining assessment skills;
4. Assisting the supervisee in developing and refining clinical management skills;
5. Demonstrating for and participating with the supervisee in the clinical process;
6. Assisting the supervisee in observing and analyzing assessment and treatment sessions;
7. Assisting the supervisee in the development and maintenance of clinical and supervisory records;
8. Interacting with the supervisee in planning, executing, and analyzing supervisory conferences;
9. Assisting the supervisee in the evaluation of clinical performance;
10. Assisting the supervisee in developing skills of verbal reporting, writing, and editing;
11. Sharing information regarding ethical, legal, regulatory, and reimbursement aspects of professional practice;
12. Modeling and facilitating professional conduct; and
13. Demonstrating research skills in the clinical or supervisory process.

The tasks of supervision must be integral to the clinical education process in all work settings and populations served, including tele-practice and tele-supervision.  Tele-supervision has become more widely practiced for a variety of reasons.  The most frequently stated rationale for the use of tele-supervision has been to provide quality supervision in rural areas in order to improve graduate clinician access to qualified supervision in off-campus placements.  Tele-supervision is recognized as a viable means of supervision in order to increase off-campus placements in rural settings as well as to increase the diversity in these off-campus placements.  (Laughran, L., & Sackett, J., 2015).

More recently, tele-supervision has been utilized to provide supervision and services for patients and clients unable to attend in-person services due to the global pandemic. Telepractice has increased access to services.  Tele-supervision has supported graduate clinicians during clinical experiences that might not have been available without the tele-supervision option. 

The tasks of supervision remain central to clinical education.  Whether the graduate clinician is providing services face-to-face in a university clinic, a school setting, a hospital, a long-term care facility, or via telepractice, the tasks of supervision must be implemented to support the education and professional growth of the graduate clinician.

References

Adamovich, S. (2018).  Clinical supervision: Student-centered learning meets patient-centered care.  Retrieved from https://www.asha.org/articles/clinical-supervision-student-learning-meets-patient-centered-care

ASHAa (n.d.).  Professional development requirements for the 2020 audiology and speech-language pathology certification standards. Retrieved from asha.org.

ASHAb (n.d.) Supervision requirements for clinical educators and clinical fellowship mentors. Retrieved from asha.org.

ASHAc (n.d.). Clinical education and supervision. Retrieved from asha.org.

ASHA (2018). Clinical supervision: Student-Centered Learning Meets Patient-Centered Care. Retrieved from www.asha.org.

Kelinhans, K.A., Brock, C., Bland, L.E. & Berry, B.A. (2020).  Deliberate supervision: Practical strategies for success. Perspectives of the ASHA Special Interest Groups, 5, 206-215.

Procaccini, S.J., McNamara, K.M. & Lenzen, N.M. (2017). Leading the way with supervision training: Embracing change and transforming clinical practice.  Perspectives of the ASHA Special Interest Groups, 2(11), 42-46.

Walden, P.R. & Gordon-Pershey, M. (2013). Applying adult experiential learning theory to clinical supervision: A practical guide for supervisors and supervisees. Perspectives of the ASHA Special Interest Groups, 23(3), 121-144.

Zylla-Jones, E. (2006).  Using mid-semester student self-evaluations to improve clinical performance.  Perspectives of the ASHA Special Interest Groups, 16(2), 8-12.