Practicum and CFY Supervision

Mentors have influence that lasts beyond the term of intensive contact because new CCC-holders subsequently mentor and supervise others. Thus, mentors are the key to a successful certification program and provide invaluable services to the public and the professions.

~ASHA http://www.asha.org/docs/html/ET2007-00279.html

Hi Everyone,

How do you recruit graduating S-LP students when you are not able to offer the required supervision? I would appreciate any feedback you have.

I have written before about how regions are addressing the shortage of S-LPs. An example is to partner with universities to recruit CFY candidates. I have also mentioned how one region has paid two students a bursary to attend graduate school and then return to the region to serve as S-LPs, starting with a practicum and then their CFY. Super! So, what is the YA-BUT?

Who will supervise?

The people I am advocating for right now do not have a Speech-Language Pathologist nearby – they called me to ask about the possibility of using telepractice to supervise. In one situation, the student or supervisor would have to make a 6 hour round trip for each on-site supervision experience. Other situations may require air-travel.

Telepractice is the closest distance between two points – it connects S-LPs with people who need them.

How Can Telepractice Change our Communities?

When telepractice is implemented for direct observation and accepted as on-site supervision for CFY employees and practicum students, we can systematically infuse new SLPs into communities that have no one else to help them. Moving forward, these same CFY employees would eventually earn their CCCs and be able to help with the future supervision of SLPAs, practicum students, and CFY employees who would find their way to the communities that once went without us. We would grow our capacity to serve. We, as a profession, would reach the need and turn it into nurtured communities of communicators who are engaged in their lives.

What are the Supervising Requirements?

As I sought information about supervising requirements and telepractice, I learned more about our responsibilities. The following information is from this link: http://www.asha.org/members/international/caslpa/ClinicalFellowship.htm

The clinical fellowship supervisor must complete no less than 36 supervisory activities spaced uniformly throughout the clinical fellowship. The supervisor must complete at least 18 on-site observations (one hour = 1 on-site observation). At least 6 on-site observations must be accrued during each third of the experience (up to 6 hours may be accrued in one day). In addition to direct observation, the clinical fellowship supervisor must complete 18 other monitoring activities, at least 6 per segment.

One suggestion I have is to enable flexible scheduling for the supervising SLP, who may not live nearby. He or she could visit the region for a couple or few days at a time to provide a big dose on on-site support. This would be especially valuable in work settings such as acute care in hospitals and in jobs that require visits to people’s homes, where the telepractice technology may not be easily accessible. Video taping sessions also captures the skills, character, and spark of the supervisee. During my own CFY, my supervisor worked (close by) at a hospital an hour away so she called me every day at 5:00 pm for a review and planning chat. This was very helpful; yet, meeting face to face via telepractice would have been a great value-add. In addition, I am sure she would have appreciated the opportunity to watch video-clips of me with my patients and clients, rather than have to take a day away from her busy schedule so frequently to visit me. As she was in private practice, a day away from her caseload was costly for her. Now days, software enables people to interact as well as to share charts, reports, and video messages on-line. You can even have an on-line fax server and electronic signatures these days. Trees are happy and people are connected.

The link from above also mentioned that the supervising activities may include:

conferring with the clinical fellow concerning clinical treatment strategies
monitoring changes in clients’ communication behaviors
evaluating the clinical fellow’s clinical records, including a) diagnostic records, b) treatment records, c) correspondence, d) plans of treatment, and e) summaries of clinical conferences (These activities may be conducted by correspondence.)
monitoring the clinical fellow’s participation in case conferences
evaluating the clinical fellow on the basis of consultation with professional colleagues and employers
evaluating the clinical fellow’s work on the basis of consultation with clients and their families
monitoring the clinical fellow’s contributions to professional meetings and publications, as well as participation in other professional growth opportunities

Telepractice is an effective medium for the above responsibilities in our work environments, such as schools and out-patient clinics.

Are there Exceptions to the Rule? Great news!

The Clinical Certification Board (CCB) might consider modifications to the supervisory requirement as per this excerpt from http://www.asha.org/members/international/caslpa/ClinicalFellowship.htm:

Alternate Mechanism for Supervision

The CCB recognizes that under certain circumstances alternative mechanisms may be necessary to meet the clinical fellowship supervision requirements. A request to use an alternative method to meet clinical fellowship supervision requirements must be submitted in writing to the CCB. The request must include a detailed outline explaining the type, length, and frequency of each alternative supervisory activity and the reason for the alternative. For example, if the request is for the use of videotapes instead of direct observations, the fellow must specify the length of each videotaped session, how often the videotapes will be made, and the total number of such videotapes. The request and the detailed outline of the proposed alternate supervisory program must be approved by the CCB before initiation of the clinical fellowship.

The statement indicates that it recognizes that there are certain circumstances that require alternate considerations, such as video-taping for direct observations. Watching video tapes is one aspect of telepractice (store and forward). Telepractice also involves real-time (live) support for immediate feedback, coaching, and collaborating.

What about Practicum Students?

Story: Two grad students are attending school in the states, then returning home to Canada to complete their last practicum before accepting their CFY jobs with that school district (what a dream to hire two Speech-Language Pathologists at once). The school district’s remaining SLP, who would have supervised, has left.

Choice #1: Without supervision, those grad students can not do their practicum there, nor their CFY for that matter. The children will likely go without S-LP support during their childhood and deal with the impact of the S-LP’s absence.

Choice #2: Connect a qualified and passionate SLP with these students via telepractice. Maybe there could also be modified expectations for same-location visits, if those were mandated, such as a flexible visit schedule. The outcome? Two more qualified and passionate new SLPs join our task force to grow smiles, mend spirits, and engage children in their lives.

I attached some information about supervising practicum students. Again, when you read it, consider how even the direct, real time supervision could be supported with telepractice. The information below is available at this link: http://www.asha.org/certification/slp_standards.htm#Std_IV-C

Standard IV-E: Supervision must be provided by individuals who hold the Certificate of Clinical Competence in the appropriate area of practice. The amount of supervision must be appropriate to the student’s level of knowledge, experience, and competence. Supervision must be sufficient to ensure the welfare of the client/patient.

Implementation:

Direct supervision must be in real time and must never be less than 25% of the student’s total contact with each client/patient and must take place periodically throughout the practicum. These are minimum requirements and should be adjusted upward if the student’s level of knowledge, experience, and competence warrants. A supervisor must be available to consult as appropriate for the client’s/patient’s disorder with a student providing clinical services as part of the student’s clinical education. Supervision of clinical practicum must include direct observation, guidance, and feedback to permit the student to monitor, evaluate, and improve performance and to develop clinical competence.

What about Cost?

Good question – what IS the cost of a generation of children who live without SLP support. If you believe in what our presence does for children’s lives, what do you believe our absence means to them? Our absence is a reality for thousands of communities, adults, and children.

In regards to technological costs, there are different levels of expenses depending on the equipment used:

1. Traditional telehealth involves business-class videoconferencing systems, such as from Polycom and Bell. There are document and video conferencing cameras that enable you to look at the same document and/or at each other.
2. Mixed solutions combine multiple types of easily accessible and often free technology. Examples include instant messaging services like MSN or Skype AND a shared desk top application. The main cost is a web camera and a headset with microphone for both the supervisor and the supervisee, which can be bought at business and department stores.
3. Fully integrated on-line software provides an interface that has video-conferencing, video-recording and viewing, documentation, and activity tools that are accessible with a login and password. The main cost is a web camera and a headset with microphone for both the supervisor and the supervisee, which can be bought at business and department stores.

Numbers two and three require a newer computer with high speed internet and access to good bandwidth. I have researched the specifications that produce quality on-line connections: http://tinyeye.wordpress.com/2009/01/13/tinyeye-requirements-for-online-speech-therapy/

Again, the telephone; inter-office mail; on-line fax servers; and an organized system with clear communication can be freebees that bring value to the experience. In addition to being time and cost-efficient because of reduced travel (and potentially loss of time at work for the supervisor), they are also ‘greener’ solutions.

Share your Voice, Shape your Profession

Live Forum: Supervision and Clinical Fellowship (CF) Experience

Division 11, Administration and Supervision is sponsoring an upcoming live forum event on Thursday, July 16, 2009, 8:00-10:00 p.m. ET. During these “office hours,” these experts will be available to answer your questions on mentorship/supervision during the CF:

Shelley Victor, EdD, CCC-SLP, Program Professor at Nova Southeastern University
Melanie Hudson, MA, CCC-SLP, EBS Healthcare

http://www.asha.org/events/liveforumevent.htm

Goals vs Rules

Goals and rules are helpful for organizing, guiding, and informing. The difference is that goals inspire progress for the future, while rules enforce boundaries of the past. As a community of people who chose a helping profession, let’s aim for progress. We are the solution.

Note:

In addition to following the mandate of your national association, please double check your state and provincial licensing and supervision requirements:

United States: http://www.asha.org/advocacy/state/default.htm

Canada: http://www.caslpa.ca/english/contact/province2.asp

Articles on supervising and mentoring:

http://www.audiologyonline.com/articles/article_detail.asp?article_id=2044

http://www.flasha.org/handouts/227Hudson.pdf

If a school district in your area needs Speech-Language Pathologists, please let me know by email as we at TinyEYE can help!

I look forward to continuing the conversation with you.