Clinical Supervision vs.

Administrative

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

Clinical Supervision vs. 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
Future Pulse of the C Community i Determining goals and methods to achieve Mission

Human
Understanding people M i i Motivating Leading Management Clinical

Technical
The How To Understanding h real l work k the Operations Budget Paperwork

Leadership Roles
Manager
Boss DecisionMaker Supervisor TrafficCop Delegator

Leader
Coach Facilitator Servant RoleModel Visionary

Leadership Styles
Autocratic
Directive

Participative
Input I t Accepted A t d

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 p development

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 selfmotivation, learning, and professional development.. Such supervision is key to both quality improvement and the successful implementation of consensus- and evidence-based practices

12 Core Functions
Screening Intake O i t ti Orientation Assessment TreatmentPlanning Counseling CaseManagement CrisisIntervention ClientEducation R f Referral l ReportsandRecord Keeping Consultation

Professional Practice Dimensions (TAP 21-A)

The basic tasks and responsibilities that constitute the work of an addiction counselor. I. Clinical Evaluation II. Treatment Planning g III. Referral IV. Service Coordination V. Counseling VI. Client, Family and Community Education VII. Documentation VIII. Professional and Ethical Responsibilities

Traits to Role Model and Mentor

Respect Disclosure Concreteness Immediacy Genuineness Warmth Potency Empathy Confronting SelfActualization

What are KSAs?

A competency is comprised of: KNOWLEDGE - what we need to know in order to develop proficiency. SKILLS - 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 Counselors Level of Development

Supervision Based on Supervisors Level Development L l of fD l t 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 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 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 (awareness of the satisfactions and personal meanings inherent in work) Issues of professional ethics

Tangible Benefits of Supervision

Improved service to clients Higher practitioner job satisfaction Less burnout Decreased staff turnover Lower administration costs New skills learnt Improved staff communication Improved client outcomes? needs research

Objectives
Describe components of clinical and administrative supervision Identify the need for an AOD clinical 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

PerformanceEvaluation/MIWay
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? 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 Interviewing Skills (OARS) 3. Recognizing Change Talk g Change g Talk ( (ECT) ) 4. Eliciting 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 p 35: Enhancing g Motivation 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? Can C I predict di t who h will ill d do well? ll? 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 Leads by example l Demands excellence, not perfection Takes care of his/her people Is humble Has character and integrity

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

Whatisthenorm? Isitrelatedtowork? Isthereapower difference? Dotheyfeelfreetosay no? WouldIdoitwith everyone? Whatlevelofsupervision aretheyin?Doesthat changetheanswer?

Alwaysconsiderthe liability Alwaysconsiderthelong term Alwaysconsidertheeffect ontheclient Alwaysconsidertheeffect onthesupervision relationship

What Counts?
40% of outcome is related to the client Stages of change Setting 15% of outcome is related to technique/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 monthly 3. 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 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 g Offenders to Change g US Dept Justice www.nicic.org Tip 35: Enhancing Motivation for Change in Substance Abuse Treatment
www.samhsa.gov 800-729-6686

Resources
http://www.treatment.org/Taps/tap21/T AP21Toc.html Technical Assistance Publication (TAP) TAP 21- Addiction Counseling Competencies: The Knowledge, Knowledge Skills, and Attitudes of Professional Practice TIP 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. Littrell, Litt ll J J. M M., L Lee-Borden, B d N N., & L Lorenz, J J. A 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 To Increase Supervision Competence Follow structure and formats Design systems to increase organization of supervision Assign Level I counselors

Characteristics

Level 1

Level 2

Is anxious regarding role Is nave about assuming the role of supervisor Is focused on doing the right thing May overly respond as an expert Is uncomfortable providing direct feedback Shows confusion and conflict Sees supervision as complex and Provide active multidimensional supervision of the Needs support to maintain motivation supervision Overfocused on counselors deficits Assign Level 1 and perceived resistance counselors May fall back to being a therapist with the counselor

Level 3

Is highly motivated Can provide an honest self-appraisal of strengths and weaknesses as Comfortable with all supervisor levels Is comfortable with evaluation process Provides thorough, objective feedback

Source: Stoltenberg, Delworth, & McNeil, 1998

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Counselor Developmental Levels

Developmental Level Characteristics 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 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 Supervision Skills Development Needs Provide structure and minimize anxiety Supportive, address strengths first, then weaknesses Suggest approaches Start connecting theory to treatment 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 Supervisee directed Focus on personalprofessional integration and career Supportive Change agent Techniques Observation Skills training Role playing Readings Group supervision Closely monitor clients

Level 1

Level 2

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

Peer supervision Group supervision Reading

Source: Stoltenberg, Delworth, & McNeil, 1998

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