Principles of TCOM Supervision

CommunityDataRoundtable.org

Principles of TCOM SupervisionFrom program level to clinician level (and Back Again!)


Agenda− Fundamental Concepts of TCOM Supervision (40 minutes)− Break (10 minutes)− Case Examples (40 minutes)

CommunityDataRoundtable.orgWho we are − Dr. April D. Fernando is a

Policy Fellow at Chapin Hall

− 10 years experience implementing TCOM systems across the country

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− Dr. Dan Warner is the Executive Director of

Community Data Roundtable

− 5 years implementing TCOM system

CommunityDataRoundtable.orgTCOM and Supervisors

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Concrete Goals

Frontline StaffSupervisorsLeadership

Devise Clinical StrategyEnsuring Implementation of

StrategyImplement Clinical Strategy

Capture CANS InformationEnsure data is accurately captured

Review data on clinical realities and outcomes

Supervisors implement the clinical vision, and collect information about clinical reality.


Person-Centered Care

A collaborative process between the person and their supports (including formal supports such as the clinician, case worker or case manager) that results in the development and implementation of an action plan to assist the person in achieving their unique, personal goals.

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CommunityDataRoundtable.orgSome guiding questions

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How can large care systemskeep their focus on the person?

How does measurement assist collaboration?

What are some guidance principles through all levels of TCOM analysis: with clients, with our staff, and with leadership?


A Focus on Action

Interlinked Feedback loops

Collaborative Data Review

Good Clinical =

Good Scoring

Critical reflection/Culturally

responsive 5 Principles of TCOM

Supervision


A Focus on Action

− TCOM tools measure what needs to get done.

− As you score it, you are focusing actions that will follow.

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Needs

No action needed 0

Watchful, waiting 1

Action needed 2

Intensive, or immediate 3

Strengths

‘Centerpiece’ Strength 0

Helpful Strength 1

Available Strength 2

No Strength available 3

− When reviewing, we are asking “what needed to get done?” & “What was done?” & “What are we doing next?”

− This is true for individuals, for staff, for programs, and for systems


TCOM Reports:

Towers of Action

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A Focus on Action



Good Clinical =

Good Scoring



Supervision

CommunityDataRoundtable.orgPrinciples of Interlocking Feedback Loops

− Feedback is a relational process.− Feedback loops provide an

opportunity for resilience to develop in a system.

− Feedback loops are positive (amplifying) and negative (counteracting) effects or changes – both of which are necessary, creating patterns over time that help systems to thrive.

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Interlinked feedback loops

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TCOMTool

TCOMTool

TCOMTool

CommunityDataRoundtable.orgEveryone should look at the data together

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A Focus on Action



Good Clinical =

Good Scoring



Supervision


Collaboration with the person in need

− Active participation and empowerment

− All parties have access to the same information and information is shared readily between them

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https://storage.googleapis.com/media.financialsocialwork.com/2016/05/35931274-social-worker-helping-family-take-control-of-their-money-1200x801.jpg


TCOM Collaboration


Talk through the story together

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9 year-old female

CommunityDataRoundtable.orgCollaboration for aggregate data review

• Look at numbers together• Front line, supervisors, stakeholders,

consumers• Ask questions

• Of the numbers• Of what they might mean

• State what you see out loud• Write-down observations• Track your observations over time

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A Focus on Action



Good Clinical =

Good Scoring



Supervision


Rating is clinical work− Rather than thinking that rating items is a reductive process, consider

rating as:− a clinical clarification process: How is a need impacting functioning? Are

supports needed?− a consensus building tool: How can everyone’s perspective be expressed and

integrated? How can we agree on where we are and where we want to be?− a marker along the pathway of care: What is the rating saying about the

current therapeutic relationship? The process of change? When should the rating be changed?

− an opportunity to fully represent the individual and/or family: How can we make better decisions about our systems with information on the needs and strengths about the individuals our systems are supposed to serve?

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CommunityDataRoundtable.orgYou score what you do.

− If a score doesn’t make sense … let’s investigate.− Was it a miss-scoring?

− So what was getting done?− Or was it correct scoring, and we’re

learning something about our program?

− In the graph to the right we learned− People experience themselves as a

part of faith communities that are not as relevant as they believed.

− Those who do discharge are more likely to have this strength than those that don’t.

Does wraparound make you question your faith!? ;-)

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0102030405060708090

100

Religious/Spiritual

Loss of Religious Strengths

Initials Continueds Discharges


A Focus on Action



Good Clinical =

Good Scoring



Supervision

CommunityDataRoundtable.orgA ‘Color Blind’ ANSA

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CommunityDataRoundtable.orgCulturally Reflective Practice− Reflective practice is about

recognizing and critically engaging our own subjectivities in the context of relating across cultural boundaries.

− It means examining our own social and cultural identities and the power and privilege we have because of these identities.

− Requires that we engage with the political and ideological nature of practice and knowledge production and consider the implications of these for those we aspire to work with.

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Clinician’s Maps

Supervisor’sMaps

Theory Personal

FAMILYMAPS

• Separations & Reunions• Trauma• Disorienting Anxieties• Cultural Identities

Migration/Acculturation

• Community• School• Work• Religion

Ecological Context

SOCIAL JUSTICE(discrim

ination, racism)

• Ideals• Meanings• Timings• Transitions

Family Life Cycle

• Nuclear/Extended Family• Connections• Hierarchies• Communication Styles

Family Organization

CULT

URAL

DIV

ERSI

TY(v

alues

, beli

efs)

Latino Families in Therapy (2nd ed., p. 38) by Celia J. Falicov, 2014, New York, NY: Guilford Press.

Multicultural and

Multi-layered


BREAK10 Minutes

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SUPERVISION FROM THE SYSTEM AND DOWN

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Average Impact

Needs/Strengths Profile

Program Dashboards

Raw Data

Individual Client Reports


EXAMPLE 2From system to client

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[Details coming]− 32459 (case that gets worse over time, high needs) − 32681 (moderate case, gets worse)− 31034 (a client who gets better)

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EXAMPLE 1From client to clinician

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CommunityDataRoundtable.orgAn individual client

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Filtering up to the clinician and the level of care

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CommunityDataRoundtable.orgTool Level v. Client Level Analyses

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Looking at one clinician


Thank you!

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A Focus on Action



Good Clinical =

Good Scoring


responsive

Principles of TCOM Supervision

Documents

Transcript of Principles of TCOM Supervision