1 Toto, I’ve a Feeling We’re Not in the Office Anymore! The Mobile Workforce PCPA Conference...

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Toto, I’ve a Feeling We’re Not in Toto, I’ve a Feeling We’re Not in the Office Anymore!the Office Anymore!

The Mobile WorkforceThe Mobile Workforce

PCPA ConferencePCPA ConferenceOctober 7, 2010October 7, 2010

Christopher M. Owens, M.A., LPC Christopher M. Owens, M.A., LPC Pasquale J. Russoniello, M.A.Pasquale J. Russoniello, M.A.

Drexel University College of MedicineBehavioral Healthcare Education

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ObjectivesObjectives

List benefits and barriers of mobile List benefits and barriers of mobile services, from the perspective of services, from the perspective of supervisor and supervisee. supervisor and supervisee.

Discuss supervisory issues to consider Discuss supervisory issues to consider when working in a program with staff when working in a program with staff who are often working off-site. who are often working off-site.

Describe strategies and technologies to Describe strategies and technologies to overcome supervisory barriers/issues overcome supervisory barriers/issues with an increasingly mobile workforce. with an increasingly mobile workforce.

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The Mobile WorkforceThe Mobile Workforce

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What is a “Mobile Workforce?”What is a “Mobile Workforce?”

A program, facility, agency, employee, etc. that A program, facility, agency, employee, etc. that does not necessarily have “typical” office hours, does not necessarily have “typical” office hours, as much of the work entails being “in the field” or as much of the work entails being “in the field” or “off site.”“off site.”

This may also include workers who do not work This may also include workers who do not work in the “central” office where most agency in the “central” office where most agency programming occurs. programming occurs. May not work at the same site or same times as the May not work at the same site or same times as the

supervisor(s)supervisor(s)

Other definitions or examples?Other definitions or examples?

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Who’s Part of a Mobile Workforce Who’s Part of a Mobile Workforce in the Mental Health Field?in the Mental Health Field?

Case managersCase managers Resource coordinatorsResource coordinators Family based therapistsFamily based therapists Therapeutic Staff Therapeutic Staff

SupportsSupports Mobile therapistsMobile therapists Peer support specialistsPeer support specialists Recovery coachesRecovery coaches Behavioral specialistsBehavioral specialists

School counselorsSchool counselors Fee for service Fee for service

therapiststherapists Skills trainersSkills trainers Employment Employment

specialistsspecialists Job coachesJob coaches SupervisorsSupervisors Others?Others?

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Why Do We Need Why Do We Need a Mobile Workforce?a Mobile Workforce?

Research has clearly shown that “meeting Research has clearly shown that “meeting people where they are” can have people where they are” can have significant impact:significant impact: More accurate diagnoses and assessmentMore accurate diagnoses and assessment

A more clear “case conceptualization”A more clear “case conceptualization”

Reduced barriers to accessReduced barriers to access Travel, time, logisticsTravel, time, logistics

Improved dynamics/rapportImproved dynamics/rapport

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Mobile Services:Mobile Services:

Benefits and BarriersBenefits and Barriers

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Small Group DiscussionSmall Group Discussion

In small groups, come up with answers to the In small groups, come up with answers to the following questions:following questions:

From the perspective of the From the perspective of the superviseesupervisee, what , what are some benefits to are some benefits to providingproviding mobile services? mobile services? What are some of the barriers?What are some of the barriers?

As the As the supervisorsupervisor, what are some benefits to , what are some benefits to providing providing andand managingmanaging a program that a program that provides mobile services? What are some of the provides mobile services? What are some of the barriers?barriers?

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Supervisee: BenefitsSupervisee: Benefits

FlexibilityFlexibility Autonomy (Freedom!!!)Autonomy (Freedom!!!) Reimbursements (travel, food)Reimbursements (travel, food) Travel = decompression timeTravel = decompression time Diversity in activitiesDiversity in activities

Never boring!Never boring! Helping people in natural environmentsHelping people in natural environments Peer support, camaraderiePeer support, camaraderie NetworkingNetworking Smaller caseloadsSmaller caseloads

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Supervisee: BarriersSupervisee: Barriers

TravelTravel Isolation – “the stepchild”Isolation – “the stepchild” Lack of recognitionLack of recognition ResourcesResources SafetySafety Access to supervision and trainingAccess to supervision and training CommunicationCommunication WorkspaceWorkspace

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Supervisor: BenefitsSupervisor: Benefits

Recovery Paradigm, Strengths basedRecovery Paradigm, Strengths based Evidence-based practicesEvidence-based practices Better quality of careBetter quality of care Better outcomes Better outcomes Improved consumer satisfaction and Improved consumer satisfaction and

functioning functioning 24-hour availability24-hour availability Meeting holistic needsMeeting holistic needs

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Linkage and referralsLinkage and referrals Cost-effectiveCost-effective Alternatives to residential placements Alternatives to residential placements Forces “in-vivo” skill development for Forces “in-vivo” skill development for

staffstaff Smaller caseloads per staff person Smaller caseloads per staff person

(hopefully!)(hopefully!) Multidisciplinary treatment team Multidisciplinary treatment team Difficult to micromanageDifficult to micromanage

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Field SupervisionField Supervision Provides opportunities for supervisor to Provides opportunities for supervisor to

accompany staff and provide immediate accompany staff and provide immediate feedback on their skillsfeedback on their skills

Supports staff in translating skills taught Supports staff in translating skills taught in formal training and applying them in in formal training and applying them in real practicereal practice

Generates creative alternatives in Generates creative alternatives in working with challenging circumstancesworking with challenging circumstances

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Supervisor: BarriersSupervisor: Barriers

Limitation of services, e.g. time-limited Limitation of services, e.g. time-limited mobile servicesmobile services

No-showsNo-shows Coordination of servicesCoordination of services Contested boundaries of responsibilityContested boundaries of responsibility

““Who’s in charge here anyway?”Who’s in charge here anyway?” ““Too many cooks spoil the broth” Too many cooks spoil the broth” Professional rivalriesProfessional rivalries

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Supervisor: BarriersSupervisor: Barriers

Lack of resourcesLack of resources Un-reimbursed services that are providedUn-reimbursed services that are provided Buy-in from communityBuy-in from community Developmental needs of staffDevelopmental needs of staff

And…last but not least,And…last but not least,

all those issues around supervision…all those issues around supervision…

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Mobile Mobile Services:Services:

Supervisory Supervisory IssuesIssues

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Typical Challenges to Typical Challenges to Supervising a Mobile WorkforceSupervising a Mobile Workforce

Can I adjust my own values and beliefs Can I adjust my own values and beliefs regarding supervision to match the needs of a regarding supervision to match the needs of a mobile workforce?mobile workforce?

How do I balance my roles, especially when How do I balance my roles, especially when managing people in the field?managing people in the field?

Is it possible to prevent staff from feeling as Is it possible to prevent staff from feeling as though they are working in isolation?though they are working in isolation?

Are there ways to improve the supervisees’ Are there ways to improve the supervisees’ sense of attachment to the program or agency sense of attachment to the program or agency as a whole?as a whole?

What can be done about the need for continuing What can be done about the need for continuing education/training?education/training?

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How can we communicate more effectively?How can we communicate more effectively? How can I get a moment of peace? I am “on call” How can I get a moment of peace? I am “on call”

all the time!all the time! What can be done about the high rates of staff What can be done about the high rates of staff

turnover?turnover? What do I about people who take advantage of What do I about people who take advantage of

the autonomy given to them?the autonomy given to them? How in the world can I possibly ensure that How in the world can I possibly ensure that

paperwork is done properly and on time?paperwork is done properly and on time?

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Supervision itself!Supervision itself! How often should we have it?How often should we have it? Should we do group or individual? Should we do group or individual? What do we discuss during formal supervision?What do we discuss during formal supervision? We don’t have time for supervision!We don’t have time for supervision! We have supervision set up, but:We have supervision set up, but:

No one seems to want to participate.No one seems to want to participate. Some don’t even bother to show up.Some don’t even bother to show up. Some staff do paperwork during group supervision.Some staff do paperwork during group supervision. Supervision is always filled with people running out Supervision is always filled with people running out

of the room to handle phone calls.of the room to handle phone calls.

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General Suggested General Suggested PracticesPractices

andand

Incorporating Incorporating TechnologyTechnology

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Suggested Practices: Suggested Practices: Complete a Self-AssessmentComplete a Self-Assessment

Looking BackLooking Back What were some supervisory What were some supervisory

behaviors that were most helpful behaviors that were most helpful

to you as the person being supervised?to you as the person being supervised? What were some behaviors of the supervisor What were some behaviors of the supervisor

that you thought were unhelpful or worse?that you thought were unhelpful or worse? What did you learn from that experience that What did you learn from that experience that

you try to use now in your role as supervisor?you try to use now in your role as supervisor?

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Managing SuperviseesManaging Supervisees How do I view supervisees How do I view supervisees

as a whole?as a whole? Do I recognize their Do I recognize their

strengths?strengths? What What specificspecific behaviors in behaviors in

individuals that I supervise individuals that I supervise do I perceive as being most do I perceive as being most problematic? problematic?

Where do I feel most Where do I feel most “stuck”?“stuck”?

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Examining My RoleExamining My Role When problems are presented, do I conduct When problems are presented, do I conduct

any self-analysis to examine my role in them?any self-analysis to examine my role in them? What has worked What has worked wellwell for me in dealing with for me in dealing with

problematic behaviors? problematic behaviors? What do I do well overall? What could I do What do I do well overall? What could I do

better?better? How can we improve our supervisory How can we improve our supervisory

process?process?

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Suggested Practices: Suggested Practices: SupervisionSupervision

All supervision All supervision needs to have needs to have

clear procedural clear procedural and behavioral and behavioral expectations.expectations.

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Suggested Practices: SupervisionSuggested Practices: Supervision

Regularly scheduled supervisionRegularly scheduled supervision Time blocked out – same time, every timeTime blocked out – same time, every time Group vs. individualGroup vs. individual

There are benefits to doing both!There are benefits to doing both! ““Meet them where they are”Meet them where they are”

For individual supervision, why not meet For individual supervision, why not meet somewhere convenient for the supervisee?somewhere convenient for the supervisee?

For group supervision, bring your team together at For group supervision, bring your team together at a central site, or rotate sites each time group a central site, or rotate sites each time group supervision is to occur.supervision is to occur.

In vivo observationIn vivo observation Peer chart reviewsPeer chart reviews

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Suggested Practices:Suggested Practices:Incorporating the Mobile Worker into the AgencyIncorporating the Mobile Worker into the Agency

At minimum, we want to avoid isolation.At minimum, we want to avoid isolation. Inclusion at agency meetingsInclusion at agency meetings Group supervisionGroup supervision

Central locale, or rotation of sites Central locale, or rotation of sites

Committees – social, birthday, chart review, new Committees – social, birthday, chart review, new projects, etc.projects, etc.

Team buildingTeam building Retreats, picnics, activities, exercisesRetreats, picnics, activities, exercises

Celebration eventsCelebration events

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Suggested PracticesSuggested Practices

Accept that your role as supervisor will often Accept that your role as supervisor will often come with supervisees needing your guidance come with supervisees needing your guidance at all hours of the day (and night!).at all hours of the day (and night!). If possible, rotate shifts with other supervisors for on-If possible, rotate shifts with other supervisors for on-

call duty.call duty.

Create and expect adherence to administrative Create and expect adherence to administrative processes and other tasks, i.e. handling processes and other tasks, i.e. handling paperwork, training requirements, etc.paperwork, training requirements, etc.

Use support from HR or your supervisors, Use support from HR or your supervisors, especially when handling problematic behaviors especially when handling problematic behaviors or issues.or issues.

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Suggested PracticesSuggested Practices

Use consumer satisfaction data or Use consumer satisfaction data or interview consumers about their interview consumers about their experiences with the supervisee(s).experiences with the supervisee(s).

Create flexible boundaries for your Create flexible boundaries for your separate roles.separate roles. i.e. Generally keep administrative issues or i.e. Generally keep administrative issues or

supervisee problem behaviors separate from supervisee problem behaviors separate from clinical supervision.clinical supervision.

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Suggested Practices: SupervisionSuggested Practices: Supervision

Unscheduled Unscheduled supervisionsupervision Open door or “Pop-in Open door or “Pop-in

as needed”as needed” TelephoneTelephone Peer support/feedbackPeer support/feedback

Staff meetingsStaff meetings PurposefulPurposeful Planned in advancePlanned in advance Clear expectationsClear expectations

Use technology as Use technology as appropriateappropriate TelephonesTelephones EmailEmail TextingTexting IMIM ChatChat DiscussionDiscussion RecordingRecording VideoconferencingVideoconferencing WebcamWebcam

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Use of Use of TechnologyTechnology

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DefinitionsDefinitions

TelehealthTelehealth - “The use of telecommunication technology - “The use of telecommunication technology to provide access to health assessment, diagnosis, to provide access to health assessment, diagnosis, intervention, consultation, supervision, education, and intervention, consultation, supervision, education, and information across distance.” information across distance.” (Miller, et al, 2009)(Miller, et al, 2009)

……or if you prefer,or if you prefer,

Telemental healthTelemental health - is an intentionally broad term - is an intentionally broad term referring to the provision of mental health and substance referring to the provision of mental health and substance abuse services from a distance via the use of the abuse services from a distance via the use of the internet and other asynchronous or social relationship internet and other asynchronous or social relationship environments for interactions between mental health environments for interactions between mental health professionals and their patients and families. professionals and their patients and families. (American (American Telemedicine Association, 2009)Telemedicine Association, 2009)

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TelephonesTelephones

Quick and easy to useQuick and easy to use MobilityMobility Access/familiarityAccess/familiarity In the momentIn the moment

““Check in” Check in” ““Quick question”Quick question”

1-1 Supervision1-1 Supervision Group supervision via Group supervision via

teleconferenceteleconference

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EmailEmail

AsynchronousAsynchronous En masse communicationEn masse communication

i.e. Administrative informationi.e. Administrative information Quick Q&AQuick Q&A Out of office accessOut of office access Creating a “paper” trail Creating a “paper” trail

read receiptsread receipts Secured networksSecured networks

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TextingTexting

Quick and brief Quick and brief communicationcommunication Check insCheck ins Basic Q&ABasic Q&A

MobilityMobility Works well in times when Works well in times when

phone calls are not phone calls are not feasiblefeasible

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IM, Chat, DiscussionIM, Chat, Discussion

Instant Instant MessagingMessaging Real timeReal time Multi-taskingMulti-tasking Individual Individual

attentionattention

Chat RoomsChat Rooms Real timeReal time Multi-taskingMulti-tasking Group Group

conversationconversation Multiple Multiple

perspectivesperspectives

Topic based Topic based or case or case consultationconsultation

Discussion BoardsDiscussion Boards AsynchronousAsynchronous Group orientedGroup oriented ““Assignments”Assignments” Topic basedTopic based Allows for Allows for

expression and expression and receipt of ideasreceipt of ideas

Ongoing trainingOngoing training Increase in Increase in

knowledge baseknowledge base

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Videotapes – Digital RecordingVideotapes – Digital Recording

Next best thing to in vivo observationNext best thing to in vivo observation Less effect on dynamics than observerLess effect on dynamics than observer Cataloguing database of growthCataloguing database of growth Cost continues to decreaseCost continues to decrease Selection in segmentsSelection in segments Individual or group supervisionIndividual or group supervision

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VideoconferencingVideoconferencing

Allows others to participate fully Allows others to participate fully (audio and visual) with others (audio and visual) with others across distanceacross distance

SynchronousSynchronous Multiple groups and sitesMultiple groups and sites Generally good quality A-VGenerally good quality A-V Easy to use with simple instructionEasy to use with simple instruction

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WebcamWebcam

Allows others to participate fully (audio Allows others to participate fully (audio and visual) with others across distanceand visual) with others across distance

Much less costly than VCMuch less costly than VC SynchronousSynchronous Individual or group useIndividual or group use

Skype, Yahoo, GoogleSkype, Yahoo, Google Easy to install and useEasy to install and use

What does it look like?What does it look like?

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Video CaptureVideo Capture

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““Pay Attention to that Pay Attention to that Boss Behind the Curtain!”Boss Behind the Curtain!”

None of the previously mentioned None of the previously mentioned technologies can truly replace face-to-face technologies can truly replace face-to-face supervision. However, at minimum, they supervision. However, at minimum, they can supplement supervision efforts, can supplement supervision efforts, especially for the mobile workforce. especially for the mobile workforce.

Consider using available technologies in Consider using available technologies in combinations to enhance what you already combinations to enhance what you already do!do!

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Telehealth: ConsiderationsTelehealth: Considerations

Ethics Ethics Confidentiality, informed consentConfidentiality, informed consent

Supervision for licensureSupervision for licensure Familiarity with technologyFamiliarity with technology

Acceptance and willingness to use technologyAcceptance and willingness to use technology

Cost and quality of technologyCost and quality of technology Nonverbal cuesNonverbal cues Frequency of formal supervision with technologyFrequency of formal supervision with technology

Relationship dynamicsRelationship dynamics

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Real Problems, Real PracticesReal Problems, Real Practices

What challenges or What challenges or problems do you face that problems do you face that we haven’t yet discussed?we haven’t yet discussed?

What do you do that works What do you do that works effectively for your program effectively for your program to overcome some of these to overcome some of these challenges or barriers?challenges or barriers?

Do you have any other Do you have any other questions that have not questions that have not been addressed?been addressed?

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RemindersReminders

The purpose of your job is to support the well-The purpose of your job is to support the well-being of those you serve (employee and being of those you serve (employee and consumer).consumer).

• Know how to do the job of your supervisees.Know how to do the job of your supervisees.

• Encourage staff to use peer supports.Encourage staff to use peer supports.

• Modeling is the most effective learning tool. Modeling is the most effective learning tool.

• Successful endeavors require planning, Successful endeavors require planning, organization, resources, action, time, and organization, resources, action, time, and persistence.persistence.

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Helpful ReferencesHelpful References

Kanz, J.E. (2001). Kanz, J.E. (2001). Clinical supervision.com: Issues in the Clinical supervision.com: Issues in the provision of online supervision. provision of online supervision. Professional Psychology: Professional Psychology: Research and Practice, 32(4), 415-420.Research and Practice, 32(4), 415-420.

Lindblad-Goldberg, M., Dore, M. M., & Stern, L. (1998). Lindblad-Goldberg, M., Dore, M. M., & Stern, L. (1998). Creating Competence from Chaos A Comprehensive Creating Competence from Chaos A Comprehensive Guide to Home-based Services. Guide to Home-based Services. New York: W. W. New York: W. W. Norton.Norton.

Miller, T.W., Morgan, R.D., & Wood, J.A. (2009). A Miller, T.W., Morgan, R.D., & Wood, J.A. (2009). A telehealth technology model for information science in telehealth technology model for information science in rural settings. In: A. Dwivedi(Ed.). Handbook of Research rural settings. In: A. Dwivedi(Ed.). Handbook of Research on IT Management and Clinical Data Administration in on IT Management and Clinical Data Administration in Healthcare. Hershey, PA: IGI Global.Healthcare. Hershey, PA: IGI Global.

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Miller, T. W., Miller, J. M., Burton, D. B., Sprang, R. & Miller, T. W., Miller, J. M., Burton, D. B., Sprang, R. & Adams, J. (2003).Telehealth: A model for clinical Adams, J. (2003).Telehealth: A model for clinical supervision in allied health. supervision in allied health. The Internet Jounal of Allied The Internet Jounal of Allied Health Sciences and Practic. 1(2), 1-8. Health Sciences and Practic. 1(2), 1-8. Retrieved from Retrieved from http://ijahsp.nova.eduhttp://ijahsp.nova.edu

Reese, R. J., Aldarondo, F., Anderson, C. R., Lee, S-J, Reese, R. J., Aldarondo, F., Anderson, C. R., Lee, S-J, Miller, T. M., & Burton, D. (2009). Telehealth in clinical Miller, T. M., & Burton, D. (2009). Telehealth in clinical supervision: A comparison of supervision formats. supervision: A comparison of supervision formats. Journal of Telemedicine and Telecare, 00, 1-6.Journal of Telemedicine and Telecare, 00, 1-6.

• Shulman, L. (1992). Shulman, L. (1992). Interactional Supervision. Interactional Supervision. Washington, DC: NASW Press. (8Washington, DC: NASW Press. (8 thth printing 2005) printing 2005)

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Sorlie, T., Gammon, D., Bergvik S., & Sexton, Sorlie, T., Gammon, D., Bergvik S., & Sexton, H. (1999). H. (1999). Psychotherapy supervision face-to-Psychotherapy supervision face-to-face and by videoconferencing: A comparative face and by videoconferencing: A comparative study. study. British Journal of Psychotheraapy, 15(4) British Journal of Psychotheraapy, 15(4) 452-462.452-462.

Wood, J. A. B., Miller, T. W., & Hargrove, D. S. Wood, J. A. B., Miller, T. W., & Hargrove, D. S. (2005). Clinical supervision in rural settings: A (2005). Clinical supervision in rural settings: A telehealth model. telehealth model. Professional Psychology: Professional Psychology: Research and Practice, Research and Practice, 36(2), 173-179.36(2), 173-179.

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