Preparing to Effectively Supervise the SLP-Assistant

TSHA Annual Convention

San Antonio, Texas

February 22, 2008Rosario R. Brusniak

Preparation

Are you ready to supervise?

• What are the state guidelines for SLP-Assistant supervision?

– Supervisors must have 3 years of professional experience

– Supervisors cannot supervise more than 4 SLP-Interns and/or SLP-Assistants

– See §741.44 and §741.64 of Board rules

Preparation

Remember that SLP-Assistants DO NOT have their own caseloads

SLP-Assistants provide therapy for the caseload of their supervising SLP(s)

SLP-Assistants are tied to the caseload of their SLP supervisor(s)

SLP-Assistants may have more than one supervisor, but each completes a SRS – Supervisory Responsibility Statement

PreparationSRS need not be submitted annually if the

SLP-Assistant and SLP supervisor remain the same, however, if the SLP-Assistant or SLP supervisor change, then the board must be notified in writing

SRS must be approved by the board prior to supervision taking place

The board can fax acceptance or denial of the SRS to a designated FAX phone number

Preparation

Review Code of Ethics and Duties and responsibilities of all license holders

Up to date information on both SLP-Assistants and SLP supervisors can be found on the SBESPA website and looking for Live-On Line Search Verification

Documentation of SLP-Assistant direct and indirect supervision must be kept

Knowledge and SkillsASHA 2002 – Knowledge and Skills for

Supervisors of Speech-Language Pathology Assistants

17 knowledge and skills have been identified:1. Select and assign appropriate patients2. Determine the nature of supervision for SLP-

Assistant3. Maintain an effective relationship with SLP-

Assistant4. Direct SLP-Assistant in following screening

protocols

Knowledge and Skills5. Demonstrate and participate with SLP-Assistant

in the clinical process6. Direct SLP-Assistant in addressing the specific

treatment plans developed by SLP7. Direct SLP-Assistant in maintaining clinical

records8. Interact with SLP-Assistant in planning and

executing supervisory conferences9. Provide feedback to SLP-Assistant10. Assist SLP Assistant in developing skills of

verbal reporting to SLP

Knowledge and Skills11. Assist SLP-Assistant in selecting, preparing treatment materials/environment12. Share information re: ethical, legal, regulatory and reimbursement issues13. Model and facilitate professional conduct14. Direct SLP-Assistant in implementation of research procedures, in-service training15. Train SLP-Assistant to check and maintain clinical equipment16. Assist SLP-Assistant in using appropriate language when interacting with clients/patients

Preparation

Be sure SRS has been approved and that you have confirmation (fax; written from the board)

Be sure if there is a Clinical Deficiency Plan to complete it as soon as possible with the required 100% supervision

Note dates of license renewal for all SLP-Assistants as well as your own license

Monitor Continuing Education Units (CEUs)

Preparation

In the school setting

– meet with the respective school administrators and special education staff to outline specific information regarding duties, limitations of the SLP-Assistant license

– set up a procedure to contact you regarding initial referrals, re-evaluations and ARD/IEP meetings (leave business card)

-- meet with school personnel to inquire about specific programs used for documentation, etc.

Setting up the Supervision Plan

Does the SLP-Assistant have the necessary prerequisite computer skills and knowledge to collect and document data

Sit down with SLP-Assistant and investigate clinical skills they bring to the job; training they would need to work with particular types of disorders, working with adults vs. working with children; behavioral and attention problems, etc.

Setting up the Supervision PlanNine Areas of Knowledge for all graduate students:1. Articulation2. Fluency3. Voice and Resonance4. Receptive and Expressive Language5. Hearing6. Swallowing7. Cognitive Aspects of Communication8. Social Aspects of Communication9. Communication Modalities

Setting up the Supervision PlanReview current caseload/projected caseload

Determine which cases to be seen by SLP-Assistant – frequency, therapy time and include associated information

Review goals and objectives for all clients

All initial contact for all clients is made by SLP supervisor (can include diagnostic)

Prepare a weekly schedule for the SLP-Assistant

Setting up the Supervision Plan

Alternate direct therapy observations during the week to make sure that you observe the SLP-Assistant with all clients

Remember all clients be notified that services will be provided by SLP-Assistant

Plan weekly to meet for supervisory conferences (can be via e-mail; phone calls, weekly group conferences and individual conferences)

Setting up the Supervision PlanMaintain a reasonable therapy caseload – be guided by what is reasonable, ethical.-- be guided by information available

regarding current workloads se: ASHA’s resource guide – A Workload Analysis Approach for Establishing Speech-Language Caseload Standards

-- remember that the care and treatment of each client is ultimately your responsibility

Research in Supervision

Supervisory effectiveness was found to be better when structured accountability (e.g. a written agreement/contract) is introduced into the supervisory conferences.

Commitments ranged from:

Type 1 – Clinical procedures – implementation and/or change of a therapy technique

Research in SupervisionType 2 – Clinical process administration –

planning, data gathering, lesson plans

Type 3 – Supervisory procedures regarding the conferences, focus of therapy, etc.

Type 4 – Supervisory Process Administration, planning, analysis or evaluation phrase of the supervisory conference

Type 5 Academic Information-Teaching Function – securing specific information

Research in Supervision

McCreedy article “Supervision of SLP-Assistants as a Reciprocal Relationship”

Stages of Supervision

• Evaluation-Feedback Stage – beginning, where SLP has direct and active supervisory role

• Transitional Stage – supervisee takes a more active role in problem solving

Research in Supervision

• Self Supervision – SLP-Assistant is asked to evaluate clinical behaviors accurately

Components of the Supervisory Process1. Understanding the Supervisory Process

and Planning2. Observing/Monitoring3. Reviewing and Analyzing4. Learning/Integrating

Research in Supervision

Active Listening and Conflict ManagementActive listening affects interpersonal

communication.Hocker and Wilmot – typical responses to

conflict are:• Avoiding a conflict or confrontation• Competing with the other person for

control• Collaborating for mutual problem solving

Research in SupervisionMcCreedy article – Comparison of conflict tactics

in the supervisory processThree different tactics:• Avoidance Tactics – uses semantic focus, topic

avoidance, abstractness, simple denial• Competitive Tactics – uses hostile joking, hostile

questioning, prescription, faulting, avoids responsibility

• Collaborative Tactics – uses problem solving, empathy/support; accepting responsibility; disclosure

Other Supervisory Considerations

Learning Styles

• Modalities – visual; auditory, tactile-kinesthetic and multimodality

• Thinking styles – concrete, abstract, random; analytical, global

• Personalities – acts as a filter includes: directing; influencing, steady and conscientious

Other Supervisory Considerations

• Expressions – Linguistic; Spatial; Mathematical/Logical; Body/Kinesthetic; Interpersonal; Mechanical; Musical; Natural

• Personality types

Keirsey’s Temperament Types (4)

• Guardians – demand responsibility, duty

• Idealists – support and encourage others

Other Supervisory Considerations

• Artisans – troubleshoot, respond to crises and negotiate

• Rationals – demand a high level of expertise and high standards of competency

Dr. Gary Smalley and Dr. John Trent – base their personality types on animals:

• Lion – is independent, strong willed, leader; wants you to be efficient, to the point

Other Supervisory Considerations

• Otter – outgoing, responsive, warm compassionate, wants you to be stimulating and interesting

• Golden Retriever – is calm, easy-going, dependable, quiet and wants you to be cooperative and pleasant

• Beaver – is analytical, self-disciplined, organized wants you to be accurate and precise

Training Clinical SkillsProvide supervision in a variety of ways –

one on one; videotapes; small group session

Periodically gather data to evaluate effectiveness

Identify on a weekly basis clinical therapy needs of the SLP-Assistant

Maintain the 1 hour direct/1 hour indirect supervision requirement

Training Clinical Skills

• SLP supervisor cannot fill in for another SLP supervisor

• Utilize formal SLP-Assistant evaluation Forms via ASHA, TSHA and handout

• If new to the supervisory process locate a SLP supervisor Mentor who has experience with this process and meet with them on a routine basis

Training Clinical Skills

Set up realistic collaborative goals for SLP-Assistant

Contact graduate programs in Texas for additional resources regarding forms they may use in their graduate training programs

Look on TSHA and ASHA website for CEUs in supervision

Representation at ARD/IEP mtgs

SBESPA has specific guidelines on when a SLP-Assistant may represent speech pathology

SLP-Assistant must:

• Have written documentation of approval from the licensed board SLP supervisor

• Have three years experience in the school setting as a SLP-Assistant

Representation at ARD/IEP mtgs• Have written approval of SLP for students

seen by the SLP-Assistant but only reports progress and new goals/objectives already developed by the SLP supervisor

• Discontinue the ARD/IEP meeting if questions or changes to the document arise

• Use the correct title of SLP-Assistant or Speech Pathology Assistant on the paperwork

Representation at ARD/IEP mtgs

The SLP Supervisor prior the ARD meeting must:

• Notify parents of students that services will be provided by SLP-Assistant and that SLP-Assistant will represent speech pathology at meeting (important to develop a form/letter that can be used)

• Develop the new IEP goals and objectives• Maintain undiminished responsibility