Clinical Supervision in Speech-Language Pathology and Audiology

Resolution

WHEREAS, the American Speech-Language-Hearing Association (ASHA) needs a clear position on clinical supervision, and

WHEREAS, the necessity for having such a position for use in student training and in professional, legal, and governmental contexts has been recognized, and

WHEREAS, the Committee on Supervision in Speech-Language Pathology and Audiology has been charged to recommend guidelines for the roles and responsibilities of supervisors in various settings (LC 14-74), and

WHEREAS, a position statement on clinical supervision now has been developed, disseminated for both select and widespread peer review, and revised; therefore

RESOLVED, that the American Speech-Language-Hearing Association adopts “Clinical Supervision in Speech-Language Pathology and Audiology” as the recognized position of the Association.

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Introduction

Clinical supervision is a part of the earliest history of the American Speech-Language-Hearing Association (ASHA). It is an integral part of the initial training of speech-language pathologists and audiologists, as well as their continued professional development at all levels and in all work settings.

ASHA has recognized the importance of supervision by specifying certain aspects of supervision in its requirements for the Certificates of Clinical Competence (CCC) and the Clinical Fellowship Year (CFY) (ASHA, 1982). Further, supervisory requirements are specified by the Council on Professional Standards in its standards and guidelines for both educational and professional services programs (Educational Standards Board, ASHA, 1980; Professional Services Board, ASHA, 1983). State laws for licensing and school certification consistently include requirements for supervision of practicum experiences and initial work performance. In addition, other regulatory and accrediting bodies (e.g., Joint Commission on Accreditation of Hospitals, Commission on Accreditation of Rehabilitation Facilities) require a mechanism for ongoing supervision throughout professional careers.

It is important to note that the term clinical supervision, as used in this document, refers to the tasks and skills of clinical teaching related to the interaction between a clinician and client. In its 1978 report, the Committee on Supervision in Speech-Language Pathology and Audiology differentiated between the two major roles of persons identified as supervisors: clinical teaching aspects and program management tasks. The Committee emphasized that although program management tasks relating to administration or coordination of programs may be a part of the person's job duties, the term supervisor referred to “individuals who engaged in clinical teaching through observation, conferences, review of records, and other procedures, and which is related to the interaction between a clinician and a client and the evaluation or management of communication skills” ( Asha, 1978, p. 479). The Committee continues to recognize this distinction between tasks of administration or program management and those of clinical teaching, which is its central concern.

The importance of supervision to preparation of students and to assurance of quality clinical service has been assumed for some time. It is only recently, however, that the tasks of supervision have been well-defined, and that the special skills and competencies judged to be necessary for their effective application have been identified. This Position Paper addresses the following areas:

• tasks of supervision

• competencies for effective clinical supervision

• preparation of clinical supervisors

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Tasks of Supervision

A central premise of supervision is that effective clinical teaching involves, in a fundamental way, the development of self-analysis, self-evaluation, and problem-solving skills on the part of the individual being supervised. The success of clinical teaching rests largely on the achievement of this goal. Further, the demonstration of quality clinical skills in supervisors is generally accepted as a prerequisite to supervision of students, as well as of those in the Clinical Fellowship Year or employed as certified speech-language pathologists or audiologists.

Outlined in this paper are 13 tasks basic to effective clinical teaching and constituting the distinct area of practice which comprises clinical supervision in communication disorders. The committee stresses that the level of preparation and experience of the supervisee, the particular work setting of the supervisor and supervisee, and client variables will influence the relative emphasis of each task in actual practice.

The tasks and their supporting competencies which follow are judged to have face validity as established by experts in the area of supervision, and by both select and widespread peer review. The committee recognizes the need for further validation and strongly encourages ongoing investigation. Until such time as more rigorous measures of validity are established, it will be particularly important for the tasks and competencies to be reviewed periodically through quality assurance procedures. Mechanisms such as Patient Care Audit and Child Services Review System appear to offer useful means for quality assurance in the supervisory tasks and competencies. Other procedures appropriate to specific work settings may also be selected.

The tasks of supervision discussed above follow:

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 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 processes.

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Competencies for Effective Clinical Supervision

Although the competencies are listed separately according to task, each competency may be needed to perform a number of supervisor tasks.

• 1.0 Task: Establishing and maintaining an effective working relationship with the supervisee.

  Competencies required:

  • 1.1 Ability to facilitate an understanding of the clinical and supervisory processes.

  • 1.2 Ability to organize and provide information regarding the logical sequences of supervisory interaction, that is, joint setting of goals and objectives, data collection and analysis, evaluation.

  • 1.3 Ability to interact from a contemporary perspective with the supervisee in both the clinical and supervisory process.

  • 1.4 Ability to apply learning principles in the supervisory process.

  • 1.5 Ability to apply skills of interpersonal communication in the supervisory process.

  • 1.6 Ability to facilitate independent thinking and problem solving by the supervisee.

  • 1.7 Ability to maintain a professional and supportive relationship that allows supervisor and supervisee growth.

  • 1.8 Ability to interact with the supervisee objectively.

  • 1.9 Ability to establish joint communications regarding expectations and responsibilities in the clinical and supervisory processes.

  • 1.10 Ability to evaluate, with the supervisee, the effectiveness of the ongoing supervisory relationship.

• 2.0 Task: Assisting the supervisee in developing clinical goals and objectives.

  Competencies required:

  • 2.1 Ability to assist the supervisee in planning effective client goals and objectives.

  • 2.2 Ability to plan, with the supervisee, effective goals and objectives for clinical and professional growth.

  • 2.3 Ability to assist the supervisee in using observation and assessment in preparation of client goals and objectives.

  • 2.4 Ability to assist the supervisee in using self-analysis and previous evaluation in preparation of goals and objectives for professional growth.

  • 2.5 Ability to assist the supervisee in assigning priorities to clinical goals and objectives.

  • 2.6 Ability to assist the supervisee in assigning priorities to goals and objectives for professional growth.

• 3.0 Task: Assisting the supervisee in developing and refining assessment skills.

  Competencies required:

  • 3.1 Ability to share current research findings and evaluation procedures in communication disorders.

  • 3.2 Ability to facilitate an integration of research findings in client assessment.

  • 3.3 Ability to assist the supervisee in providing rationale for assessment procedures.

  • 3.4 Ability to assist supervisee in communicating assessment procedures and rationales.

  • 3.5 Ability to assist the supervisee in integrating findings and observations to make appropriate recommendations.

  • 3.6 Ability to facilitate the supervisee's independent planning of assessment.

• 4.0 Task: Assisting the supervisee in developing and refining management skills.

  Competencies required:

  • 4.1 Ability to share current research findings and management procedures in communication disorders.

  • 4.2 Ability to facilitate an integration of research findings in client management.

  • 4.3 Ability to assist the supervisee in providing rationale for treatment procedures.

  • 4.4 Ability to assist the supervisee in identifying appropriate sequences for client change.

  • 4.5 Ability to assist the supervisee in adjusting steps in the progression toward a goal.

  • 4.6 Ability to assist the supervisee in the description and measurement of client and clinician change.

  • 4.7 Ability to assist the supervisee in documenting client and clinician change.

  • 4.8 Ability to assist the supervisee in integrating documented client and clinician change to evaluate progress and specify future recommendations.

• 5.0 Task: Demonstrating for and participating with the supervisee in the clinical process.

  Competencies required:

  • 5.1 Ability to determine jointly when demonstration is appropriate.

  • 5.2 Ability to demonstrate or participate in an effective client-clinician relationship.

  • 5.3 Ability to demonstrate a variety of clinical techniques and participate with the supervisee in clinical management.

  • 5.4 Ability to demonstrate or use jointly the specific materials and equipment of the profession.

  • 5.5 Ability to demonstrate or participate jointly in counseling of clients or family/ guardians of clients.

• 6.0 Task: Assisting the supervisee in observing and analyzing assessment and treatment sessions.

  Competencies required:

  • 6.1 Ability to assist the supervisee in learning a variety of data collection procedures.

  • 6.2 Ability to assist the supervisee in selecting and executing data collection procedures.

  • 6.3 Ability to assist the supervisee in accurately recording data.

  • 6.4 Ability to assist the supervisee in analyzing and interpreting data objectively.

  • 6.5 Ability to assist the supervisee in revising plans for client management based on data obtained.

• 7.0 Task: Assisting the supervisee in development and maintenance of clinical and supervisory records.

  Competencies required:

  • 7.1 Ability to assist the supervisee in applying record- keeping systems to supervisory and clinical processes.

  • 7.2 Ability to assist the supervisee in effectively documenting supervisory and clinically related interactions.

  • 7.3 Ability to assist the supervisee in organizing records to facilitate easy retrieval of information concerning clinical and supervisory interactions.

  • 7.4 Ability to assist the supervisee in establishing and following policies and procedures to protect the confidentiality of clinical and supervisory records.

  • 7.5 Ability to share information regarding documentation requirements of various accrediting and regulatory agencies and third-party funding sources.

• 8.0 Task: Interacting with the supervisee in planning, executing, and analyzing supervisory conferences.

  Competencies required:

  • 8.1 Ability to determine with the supervisee when a conference should be scheduled.

  • 8.2 Ability to assist the supervisee in planning a supervisory conference agenda.

  • 8.3 Ability to involve the supervisee in jointly establishing a conference agenda.

  • 8.4 Ability to involve the supervisee in joint discussion of previously identified clinical or supervisory data or issues.

  • 8.5 Ability to interact with the supervisee in a manner that facilitates the supervisee's self-exploration and problem solving.

  • 8.6 Ability to adjust conference content based on the supervisee's level of training and experience.

  • 8.7 Ability to encourage and maintain supervisee motivation for continuing self-growth.

  • 8.8 Ability to assist the supervisee in making commitments for changes in clinical behavior.

  • 8.9 Ability to involve the supervisee in ongoing analysis of supervisory interactions.

• 9.0 Task: Assisting the supervisee in evaluation of clinical performance.

  Competencies required:

  • 9.1 Ability to assist the supervisee in the use of clinical evaluation tools.

  • 9.2 Ability to assist the supervisee in the description and measurement of his/her progress and achievement.

  • 9.3 Ability to assist the supervisee in developing skills of self-evaluation.

  • 9.4 Ability to evaluate clinical skills with the supervisee for purposes of grade assignment, completion of Clinical Fellowship Year, professional advancement, and so on.

• 10.0 Task: Assisting the supervisee in developing skills of verbal reporting, writing, and editing.

  Competencies required:

  • 10.1 Ability to assist the supervisee in identifying appropriate information to be included in a verbal or written report.

  • 10.2 Ability to assist the supervisee in presenting information in a logical, concise, and sequential manner.

  • 10.3 Ability to assist the supervisee in using appropriate professional terminology and style in verbal and written reporting.

  • 10.4 Ability to assist the supervisee in adapting verbal and written reports to the work environment and communication situation.

  • 10.5 Ability to alter and edit a report as appropriate while preserving the supervisee's writing style.

• 11.0 Task: Sharing information regarding ethical, legal, regulatory, and reimbursement aspects of the profession.

  Competencies required:

  • 11.1 Ability to communicate to the supervisee a knowledge of professional codes of ethics (e.g., ASHA, state licensing boards, and so on).

  • 11.2 Ability to communicate to the supervisee an understanding of legal and regulatory documents and their impact on the practice of the profession (licensure, PL 94-142, Medicare, Medicaid, and so on).

  • 11.3 Ability to communicate to the supervisee an understanding of reimbursement policies and procedures of the work setting.

  • 11.4 Ability to communicate a knowledge of supervisee rights and appeal procedures specific to the work setting.

• 12.0 Task: Modeling and facilitating professional conduct.

  Competencies required:

  • 12.1 Ability to assume responsibility.

  • 12.2 Ability to analyze, evaluate, and modify own behavior.

  • 12.3 Ability to demonstrate ethical and legal conduct.

  • 12.4 Ability to meet and respect deadlines.

  • 12.5 Ability to maintain professional protocols (respect for confidentiality, etc.)

  • 12.6 Ability to provide current information regarding professional standards (PSB, ESB, licensure, teacher certification, etc.).

  • 12.7 Ability to communicate information regarding fees, billing procedures, and third-party reimbursement.

  • 12.8 Ability to demonstrate familiarity with professional issues.

  • 12.9 Ability to demonstrate continued professional growth.

• 13.0 Task: Demonstrating research skills in the clinical or supervisory processes.

  Competencies required:

  • 13.1 Ability to read, interpret, and apply clinical and supervisory research.

  • 13.2 Ability to formulate clinical or supervisory research questions.

  • 13.3 Ability to investigate clinical or supervisory research questions.

  • 13.4 Ability to support and refute clinical or supervisory research findings.

  • 13.5 Ability to report results of clinical or supervisory research and disseminate as appropriate (e.g., in-service, conferences, publications).

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Preparation of Supervisors

The special skills and competencies for effective clinical supervision may be acquired through special training which may include, but is not limited to, the following:

1. Specific curricular offerings from graduate programs; examples include doctoral programs emphasizing supervision, other postgraduate preparation, and specified graduate courses.

2. Continuing educational experiences specific to the supervisory process (e.g., conferences, workshops, self-study).

3. Research-directed activities that provide insight in the supervisory process.

The major goal of training in supervision is mastery of the “Competencies for Effective Clinical Supervision.” Since competence in clinical services and work experience sufficient to provide a broad clinical perspective are considered essential to achieving competence in supervision, it is apparent that most preparation in supervision will occur following the preservice level. Even so, positive effects of preservice introduction to supervision preparation have been described by both Anderson (1981) and Rassi (1983). Hence, the presentation of basic material about the supervisory process may enhance students' performance as supervisees, as well as provide them with a framework for later study.

The steadily increasing numbers of publications concerning supervision and the supervisory process indicate that basic information concerning supervision now is becoming more accessible in print to all speech-language pathologists and audiologists, regardless of geographical location and personal circumstances. In addition, conferences, workshops, and convention presentations concerning supervision in communication disorders are more widely available than ever before, and both coursework and supervisory practicum experiences are emerging in college and university educational programs. Further, although preparation in the supervisory process specific to communication disorders should be the major content, the commonality in principles of supervision across the teaching, counseling, social work, business, and health care professions suggests additional resources for those who desire to increase their supervisory knowledge and skills.

To meet the needs of persons who wish to prepare themselves as clinical supervisors, additional coursework, continuing education opportunities, and other programs in the supervisory process should be developed both within and outside graduate education programs. As noted in an earlier report on the status of supervision (ASHA, 1978), supervisors themselves expressed a strong desire for training in supervision. Further, systematic study and investigation of the supervisory process is seen as necessary to expansion of the data base from which increased knowledge about supervision and the supervisory process will emerge.

The “Tasks of Supervision” and “Competencies for Effective Clinical Supervision” are intended to serve as the basis for content and outcome in preparation of supervisors. The tasks and competencies will be particularly useful to supervisors for self-study and self-evaluation, as well as to the consumers of supervisory activity, that is, supervisees and employers.

A repeated concern by the ASHA membership is that implementation of any suggestions for qualifications of supervisors will lead to additional standards or credentialing. At this time, preparation in supervision is a viable area of specialized study. The competencies for effective supervision can be achieved and implemented by supervisors and employers.

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Summary

Clinical supervision in speech-language pathology and audiology is a distinct area of expertise and practice. This paper defines the area of supervision, outlines the special tasks of which it is comprised, and describes the competencies for each task. The competencies are developed by special preparation, which may take at least three avenues of implementation. Additional coursework, continuing education opportunities and other programs in the supervisory process should be developed both within and outside of graduate education programs. At this time, preparation in supervision is a viable area for specialized study, with competence achieved and implemented by supervisors and employers.