Course excerpt from Clinical Supervision for Healthcare Professionals
Technology can be a valuable asset in clinical supervision. It can also, however, detract from both treatment and supervision if the technology itself becomes the focus due to novelty – or worse to poorly functioning technology. As technology use becomes more common and the technical aspects are resolved, it may become a standard part of supervision.
The American Psychological Association recommends, “Supervisors should use live observation or audio or video review techniques whenever possible, as these are associated with enhanced supervisee and client/patient outcomes.” Memory and cognitive processing, as well as the supervisee’s biases and self-protective distortions, affect the supervisee’s self-report, making live or recorded supervision more objective and thus more effective than the supervisee’s recall of treatment (APA, 2014). Self-report is easy; there is no equipment to manage, no explanations to give the patient, and no concerns about HIPAA issues. But it is not the most effective means of supervision.
The practice setting may not have two-way mirrors or other ways to provide synchronous supervision during a therapy session. However, improved technology can provide new methods for supervision that benefit both therapists and supervisors. For example, remote access is available through teleconferencing technology. Therapists who previously had to travel to visit a supervisor can link electronically for virtual supervision. Therapy sessions can be livecast, with the supervisor providing input to the therapist via an earpiece or text. Videotaping also allows for review of a therapy session after the fact, when the therapist and supervisor have had time to mentally review the session.
Telesupervision works for many disciplines. Chipcase (2014) found it effective when used in conjunction with face-to-face clinical supervision for occupational therapists, physical therapists, and speech-language pathologists. Most therapists reported satisfaction with telesupervision as long as it was not the sole means of supervision. As expected, there are barriers to this type of supervision. Low bandwidth and erratic connectivity can make sessions difficult. Ambient noise can be an issue; multiple cameras and microphones can often compensate for audio problems. Chipcase noted that “cyclical problem solving” by supervisors and supervisees improved the learning experience.
Research has found that live video consultation increases positive client outcomes when a therapist is learning a new evidence-based treatment strategy. While phone consultation is helpful, live video consultation had a small but significant advantage over telephone-only consultation (Funderburk, 2014). Rousmaniere (2016) reports the efficacy of remote live supervision using internet videoconferencing. The supervisee could be in another part of the same building as the supervisor, or in another city. Equipment needed includes a computer, webcam, and external microphone (wired or wireless). It is important that sound quality be maximized so all conversation is clearly understood. Rousmaniere noted that this equipment would cost less than $250 total from an electronic retail store.
Most national professional organizations now approve the use of technology for supervision: telephone or video conferencing and recording, Skyping, text messaging, and other forms of technology to make the process more convenient and efficient. The American Association of Marriage and Family Therapists approves the use of technology for supervision and mentoring as long as it is secure and meets AAMFT ethical standards in their Code of Ethics. The organization says that it added technology provisions for the following reasons: “requested by members, fits contemporary standards, assists with access for distance difficulties, and enhances philosophical fit between MFT trainees and supervisors” (AAMFT, 2014).
The American Psychological Association recommends that psychotherapists be aware of and follow any relevant laws and regulations in regard to practice and technology as well as supervision and technology (APA, 2014). It is important for any technology system to meet HIPAA standards. The rewards are worth the investment of time and money. A study of pediatric mental health services found HIPAA-compliant video teleconferencing allowed direct patient care in a familiar setting for children and families in rural areas. The number of children served increased as early identification spotted children in need of services through remote screenings (Schroepfer, 2014).
- Research carefully any technology used for client information or communication. HIPAA compliance rules may change over time, and not all companies providing technology services keep up with healthcare regulations. Videoconferencing has the highest risk. Ask for guarantees of safety for protected health information under HIPAA. If the vendor is not fluent in the latest HIPAA requirements, find another vendor (Gurung, 2015).
Telesupervision does not work for every client. Chipcase (2014) reported that therapists working with children found that many children liked the idea of being “on television.” But some patients do not understand or like technology involved in treatment sessions. Some patients will not be able to give informed consent. It is important to communicate clearly the reason telesupervision is being used. For example, “My supervisor is an expert in helping people with your diagnosis. Her feedback could be very helpful for us both.” Written consent forms should be used. The patient should have the right to decline further telesupervision activity at any time (Rousmaniere, 2016).
Likewise, not all supervisees are appropriate for remote live telesupervision. During telesupervision, the supervisee must split attention between the patient and the feedback given (via earpiece or on a screen) by the supervisor. A supervisee who is very anxious or has attention issues may have problems focusing on the session. Rousmaniere discusses the supervisee who becomes confused or lost, and then follows the supervisor’s suggestions without processing the implications for future practice. Not all supervisors are effective in telesupervision, either. Telesupervision is recommended for experienced supervisors who are comfortable using technology and can manage the divided attention required for effective supervision and client treatment.
Clinical Supervision for Healthcare Professionals is a 3-hour online continuing education (CE) course that will outline best practices in psychotherapy supervision and review the structure of the supervisory relationship. Topics presented include developmental models of supervision, goals of the supervisory experience, ethics and risk management in the supervision process, using technology in supervision, and diversity awareness training for the supervisee. The vital and, at times, challenging relationship between supervisor and supervisee will be discussed and compared to the therapy relationship. The important topic of self-care of both the supervisee and the supervisor will be presented. A review of the type and structure of performance evaluations will be included, along with information about successful termination. Although this course is primarily written for psychotherapists, many of the essential facets of supervision apply to other disciplines such as occupational therapy and social work. Use this information to further your own competency as a clinical supervisor. Course #30-92 | 2017 | 48 pages | 20 posttest questions
CE Credit: 3 Hours
Learning Level: Intermediate