SUPERVISION RESEARCH:PAST AND PRESENT
ASHA CONVENTION- CHICAGODivision 11
November 2008
Presenters
Shelley Victor, Ed.D., CCC-SLPCheryl Gunter, Ph.D., CCC-SLPRose L. Allen, Ph.D., CCC-SLP/ADeanna Hughes, Ph.D., CCC-SLPJennifer Ostergren, M.A., CCC-SLPPamela Klick, M.A., CCC-SLP/LMaureen Schmitt, M.S., CCC-SLP/LErin Redle, Ph.D., CCC-SLPDaniel E. Phillips, Ed.S., CCC-SLP
HISTORY OF SUPERVISION RESEARCH
• Macro
• Micro
SUPERVISORY SKILLS
• Roberts, J. (1982) Supervisor’s decision-making
• Glaser, A. & Donnelly, C. (1988). Data –base methods of supervision in public school
SUPERVISORY EXPECTATIONS
• Dowling, S. & Wittkopp, M. (1982) Perceived supervisory needs of students
• Larson, L. (1982) Perceived supervisory needs and expectations
• Mastriano, B., Gordon, T., & Gottwald, S. (1999) Expectations of the supervisory process
• Tihen, L. (1984) Expectations of student clinicians
SUPERVISORY STYLE
• Dowling, S. (1977) The effect of two supervisory styles- conventional and teaching clinic
• Williams, A. (1994). Peer group supervision.
FOCUS ON SUPERVISEE
• Peaper, R. (1984) Students’ perceptions of supervisory conference
• Shapiro, D. (1985). Supervisee commitment and follow through behavior
• Mawdsley, B., & Scudder, R. (1988). Determine supervisee’s task maturity level
• Wagner, B., & Hess, C. (1997). How supervisees perceive supervisors’ social power
INTERPERSONAL
• Caracciolo, G. (1977) How student clinicians and supervisors perceive interpersonal conditions during supervisory conference?
• Volz, H., Klevans, D., Norton, S., & Putens, D. (1978) Effects of training on interpersonal skills of undergraduate clinicians
SUPERVISORY CONFERENCE
• Brasseur, J. (1980) Differences in videotaping during supervisory conference
• Casey, P. (1980) Use of McCrea’s Adapted system to analyze the supervisory conference
• Smith, K., & Anderson, J. (1982) Validation of supervisory conference rating scale
Supervisory conference
• Strike-Roussos, C. (1988). Use of broad questioning during conference
• Tufts, L. (1984) Content analysis of supervisory conference
• Whiteside, J. (1981) Analysis of question type during supervisory conference
PLANNING
• Peaper, R., & Wiener, D. (1984) Comparison of perceptions of clinical reports
EVALUATION PROCESS
• Anderson, C. (1978). Effect of supervisor bias on evaluation of student clinicians
TECHNOLOGY
• Facilitating clinical observation through computer technology- Shadden, B., & Aslin, . (1993)
• Audiotaped dialogue journal-Schill, M., & Swanson, D. (1993).
PROPOSAL PROCESSPRESENTATION OF RESEARCH
Professionals’ Judgments of Ethical/Unethical Scenarios
Rose L. Allen, PhD, CCC-SLP/AEast Carolina University
Greenville, NCNovember, 2008
ASHA Code of Ethics (2003)
• Preamble – The preservation of the highest standards of
integrity and ethical principles is vital to the responsible discharge of obligations by speech-language pathologists, audiologists, and speech, language, and hearing scientists.
– This Code of Ethics sets forth the fundamental principles and rules considered essential to this purpose.
Sanctions for Violations
• Reprimand• Censure• Withhold, suspend, or
revoke membership and/or Certificate of Clinical Competence
(Irwin et al., 2007, p.88)
• Other measures determined by the Board of Ethics at its discretion
• A cease and desist order may become part of any action.
Code of Ethics (ASHA, 2003)
• Four Principles of Ethics– Form the underlying moral basis for the Code of
Ethics.
• 74 Rules of Ethics– Specific statements of minimally acceptable
professional conduct or of prohibitions and are applicable to all individuals
Principles of EthicsI. Patient welfare in clinical, research, or scholarly activities.
Also, animals used in research….
II. Achieve and maintain highest level of professional competence….
III. Promote public understanding of the profession…accurate information in all communications…
IV. Relationships with colleagues, students, and members of the allied health professions…maintain harmonious relationships….
Importance of Ethics
• ASHA has placed more emphasis on ethics, and the ethical behavior of professionals in speech-language pathology and audiology.
• Evidence of this has been documented through a series of articles in The ASHA Leader over the last few years.
• Many issues are controversial, such as acceptance of manufacturer gifts, provision of services to HIV/AIDs patients.
Specific Rules that have Served for Basis of Complaints (Diefendorf, 2008)
• Principle I, Rules A,B,G, K, M– Provision of services– Referrals– Evaluate effectiveness of
services– Maintenance of records– Not charge for services
not rendered
• Principle II, Rules, A, B, E– Hold appropriate CCC or
be supervised by an individual who holds appropriate CCC
– Engage in aspects of the professions within their scope of competence
– Staff will not provide services for which they are not trained
Specific Rules that have Served for Basis of Complaints (Diefendorf, 2008)
• Principle III, Rules B, D, E, F– Not participate in activities
that constitute a conflict of interest
– Not misrepresent DX information, services rendered…or engage in any scheme to defraud..
– Statements to the public shall provide accurate information
– Use professional standards in advertising and marketing
• Principle IV, Rules B, F, G, J– Shall not engage in
dishonesty, fraud, deceit, misrepresentation, sexual harassment…
– Statements to colleagues….shall contain no misrepresentations
– Shall not provide professional services without exercising independent professional judgment…
– Comply fully with the policies of the Board of Ethics…
Previous Research Allen & Rastatter (2005)
• Investigated how well undergraduate SLP students with no formal ethics training, and graduate SLP students, with formal ethics training, could judge ethical/unethical situations
• Survey instrument utilizing 74 scenarios• For unethical scenarios, graduate students had slightly better
scores than undergraduates for all four Principles• For ethical scenarios, undergraduates had just as good or
better judgments on scenarios related to Principles I (patient welfare) and Principle III (public understanding of the profession)
• For ethical scenarios, graduate students had better judgments for scenarios relating to Principle II (professional competence), than the other Principles
Proposed Research
• Investigate professionals’ (speech-language pathologists and audiologists) judgments of ethical/unethical scenarios
• Research Questions: – Do experienced SLPs and audiologists (those holding the
CCC) make similar judgments of ethical/unethical scenarios?
– Does length of time in profession make a difference?– How do judgments by professionals compare to judgments
by students?
Proposed Research: Methods
• The 900 members of ASHA Special Interest Division 11 (Administration and Supervision) will be participants.
• The survey, consisting of 74 ethical/unethical scenarios, will be mailed with pre-addressed postage paid envelopes.
• A reminder card will be sent to non-respondents four weeks after initial mailing.
Proposed Research: Methods
• Data will be entered into SPSS for analysis.
• Compare SLPs to Audiologists• Compare length of time in profession• Compare to previous student data
Summary
• Ethical decision making is usually a complicated process that a clinician most likely faces several times during a career (Irwin et al., 2007, p.89)
• Need ethics training modules for students as research shows that graduate students do need in-depth training in ethical decision making
• Please fill out a survey! Thank you!
ReferencesAllen, R., & Rastatter, M. (2005) Student judgments of ethical/unethical scenarios.
Perspectives on Administration and Supervision, 15(2), 12-14.
American Speech-Language-Hearing Association. (ASHA). (2003). Code of ethics (Revised). ASHA Supplement, 23, 13-15.
Diefendorf, A. O. (2008). The ASHA Board of Ethics: An update on roles, responsibilities, and educational resources. Perspectives on Administration and Supervision, 18(1), 4-9.
Irwin, D., Pannbacker, M., Powell, T. W. , & Vekovius, G. (2007). Ethics for speech-language pathologists and audiologists: An illustrative casebook. Clifton Park, NY: Thomson Delmar Learning.
Supervision of Graduate Students In University Clinics: Professional
Preparation
Pamela Klick, M.A., CCC-SLP/LMaureen Schmitt, M.S., CCC-SLP/L
Saint Xavier UniversityChicago, Illinois
ASHA Convention November, 2008
Research Components
• Preparation for supervision• Continuing education concurrent with
supervising students in the university setting• Institutional support for clinical supervisors• Strategies employed by supervisors to
facilitate students’ clinical performance
Methodology
• 1,000 surveys distributed to 100 randomly selected graduate programs accredited by Council on Academic Accreditation
• Items included open-ended questions, forced-choice items, and checklists
• Demographic Information• Anonymity preserved
Respondents
• 176 out of 1,000 surveys returned: (17% Rate of Return)
• A variety of academic and clinical positions including both full-time, part-time and adjuncts
• Experience ranged from 1 through 40 years• Number of students in graduate programs varied
from 10 to 150+• 73% indicated no affiliation with Division 11
Definition of Clinical Supervision
• Clinical Supervision, also called clinical teaching or clinical education, is a distinct area of practice in speech language pathology and it is an essential component in the education of students and the continual professional growth of speech language pathologists
ASHA Position Statement, 2008
Theoretical Assumptions
• Clinical competence occurs on a continuum from dependence to independence based on:– The overall amount of the students’ clinical experience
and level of competence– The amount of experience with specific disorders and ages– Various practicum placements
• Clinical supervision is a distinct area of practice (ASHA Position Statement, 2008)
• Training as an SLP is not equivalent to training in supervision
Supervisory Training Received Prior To Supervision
in the University Setting
0
20
40
60
80
100
120
140
Workshop
University Course
Mentoring Program
Web-Based Instruction
Experience with FormerSupervisorConference Presentation
Books
Training Session
Special Interest Div 11
Additional Means of Learning to Be a Clinical Supervisor
• “On-the-Job” training• Supervision of students in other settings
(schools, hospitals, private clinics)• Supervision of CF’s• Administrative roles in the field (Other SLP’s)• Administrative roles outside the field• Self-study• Reading the Supervisors’ Manual
Continuing Education in Supervision
86%
4%10%
Yes
No
No Response
Methods of Continuing Education in Clinical Supervision
0 20 40 60 80 100 120
Workshop
University Course
Mentoring Program
Web-Based Instruction
Experience with Former Supervisor
Conference Presentation
Books
Training Session
Special Interest Div 11
None of The Above
Additional Activities for Continuing Education in Clinical Supervision
• Collaboration with other colleagues who supervise
• Reading articles on supervision from SLP journals
• Formal CEU experiences, such as classes, workshops, conference presentations
• Scheduled meetings with clinical faculty
Formal Training in Clinical Supervision Offered by Institutions
76%
20%4%
Yes
No
No Response
Mentoring Programs for Clinical Supervisors Provided by Universities or Departments
3%
65%
32%
Yes
No
No Response
Persons Responsible for Mentoring Clinical Supervisors
0
5
10
15
20
25
30
35
40
45
Number of Respondents
Department Chair
Clinic Director
Colleague Within University
Colleague Outside University
Former Supervisor
Other
Informal Program
Strategies That Supervisors Ranked Most Valuable in Clinical Education of Students
0 10 20 30 40 50 60 70
Verbal Feedback
Written Feedback
Video Feedback
Modeling
Student Self-Evaluation
Co-Treatment
Role Play
Rating Scales
Active Listening
Reflective Journaling
Student Suggestions
Students Restating Suggestions
Amount of Professional Development Funds
0 10 20 30
$0 - $200
$201 - $500
$501 - $1,000
$1,001 - $1,500
$1,501 - $2,000
$2,000+
Means of Institutional Support for Clinical Supervisors
• Offering workshops, seminars & courses specific to clinical supervision
• Initial & ongoing training for supervision at individual sites
• Regular meetings for clinical supervisors to exchange ideas and discuss issues
• Provide a mentoring program• Journal and/or book club on supervision
Other Possible Supports
• Better financial support for attendance at conferences and workshops
• Financial support for membership in Division 11
• Periodic review and feedback by the Clinic Director/Coordinator
• Collaboration with supervisors at other institutions
• Increased value of clinical supervision
Agreement with Certification of Clinical Supervisors
58%
9%
33% Yes
No
No Response
Additional Comments on Certification of Supervisors
• Concern about losing off-campus supervisors for external practica
• Concern about losing part-time on-campus supervisors
• Too demanding of time and money• Need more information on the requirements• Distinction noted between mandated
continuing education and certification
Conclusions
• A majority of supervisors (76%) received professional preparation through interactions or experiences with a former supervisor.
• A majority of current supervisors (86%) participate in formal and/or informal continuing education activities relative to supervision.
More Conclusions
• A majority of supervisors (72%) receive some financial support for continuing education activities that may or may not include education specifically in supervision.
• Approximately 59% of the supervisors supported certification of clinical supervision at some level.
SUPERVISORY PRACTICES IN SPEECH-LANGUAGE PATHOLOGY GRADUATE TRAINING PROGRAMS
Daniel E. PhillipsAuburn University
ASHA 2008 Chicago
Supervision• Supervised experience in treating individuals with
communication problems is necessary for students to learn the skills to become clinical providers (McAllister & Lincoln, 2004).
• The goal of supervision is to provide the type of supervisory practice that is appropriate to the “student’s level of knowledge, experience, and competence” according to ASHA (ASHA, 2005).
• The purpose of supervision is to lead the student clinician to levels of competency and independence (McCrea & Brasseur, 2003).
Determining Supervision Type• The supervisor must first know the student’s level of
functioning (Perkins & Mercaitis, 1995).
• Early models of supervision employed assessment of clinical, academic, personal attributes, and confidence levels to determine the competency level of student clinicians (Anderson, 1988).
• The type of supervision was then determined by the results of the assessment (Shriberg et al., 1975; Anderson, 1988; Mawdsley & Scudder, 1989).
• A formal assessment may not be conducted routinely (Smith and Anderson, 1982; Dowling, 2001; McCrea & Brasseur, 2003; Brasseur, McCrea, & Mendel, 2005; Zylla-Jones, 2006).
Purpose
• The purpose of this study was to explore current practices of supervision in speech-language pathology graduate training programs in Alabama.
The study was guided by the following questions:
1. How do supervisors determine the level of clinical independence of student clinicians before clinic practicum begins?
2. How do supervisors determine the type of supervision used with each student clinician?
3. Does the level of supervisory satisfaction vary based on the level of supervisor training?
Methodology• A qualitative research methodology was used
• A standardized open-ended interview process was used to gather the data.
• Interviews were conducted with a total of 11 supervisors at each of the 5 Speech-Language Pathology graduate training programs in Alabama
• Each supervisor completed an informed consent form prior to the interview.
• Each interview was audio recorded and verbatim transcriptions were completed.
The interviews determined:
• The method of supervision used by clinical educators
• How the level of independence of the student clinician is determined
• How clinical educators determine the level and type of supervision
• The level of satisfaction with current supervisory methods of clinical educators
Participants
• Full-time clinical educators with a Master’s degree and CCC in Speech-Language Pathology
• All had at least 3 years experience as a clinical supervisor in a university setting (the range was 3 to 34 years with an average of 12 years).
• All had worked as clinicians before becoming a supervisor ( the range was 5 to 17 years with an average of 10 years).
Data was collected primarily in the areas of:
• Understanding the supervisory process– Styles or Types of supervision– Interpersonal skills of students– Anxiety of students– Use of Goals and Objectives– Supervisory training
• Planning the supervisory and clinical process– Pre-practicum assessment of student clinicians
Data Analysis• Inductive content analysis was used to “determine
consistencies and meaning from the data.” (Patton, 2002)
• The data was coded, categorized, classified, and labeled to determine themes and patterns.
• Finding the patterns and themes within the data helped answer the research questions.
Conclusions• The pre-practicum assessment occurs
through individual conferences.
• Clinical educators do not supervise all students the same.
• Supervisory type changes as students progress.
Conclusion One
• The pre-practicum assessment occurs through individual conferences.
• Three types of conferences:– presentation of the client by the clinician– presentation of the clinician to the supervisor– a pre-practicum assessment using a form
Level of clinical independence determined primarily by
• Primary consideration was placed on the clinical information provided by the student
• The level of clinical independence was determined primarily by– Manner– Organization– Accuracy– Completeness
Behaviors and Abilities of the supervisee that may affect supervision• Anxiety• Interpersonal skills• Learning style
• Self awareness and self-assessment– Secondary considerations– Recognized as important but were not assessed
Pre-practicum clinical independence level
• Only two of the eleven clinical educators interviewed used a formal assessment before clinic.
• All eleven of those interviewed stated it was important or very important.
Pre-practicum recommendations• Create and pilot a pre-practicum assessment guideline
form • Contain elements important to supervisors and those
found in literature review
• Important information should be included but time efficiency is critical
• Knowledge, Skills, Abilities, and Behaviors
• A formative assessment to systematically and proactively lead by self-assessment and self awareness.
Conclusion Two
• Clinical educators, with and without training, do not supervise all students the same
• Supervisory type focused on the “individual needs” or ”the individual skill level” of the student.
Supervisors use different styles
• With different student clinicians– determining the
differences between two students at the same point in graduate training and supervising the two differently.
• For different levels of clinical independence– supervising the same
clinician who performed at two different levels of clinical independence with two separate clients
Conclusion Three
• Supervisory style changes as students progress– Beginning of practicum-The supervisor determines
the level of clinical independence. – Based on that estimation the level and type of
supervision is determined. – The first one or two sessions of therapy are observed. – The clinical level and type of supervision are either
confirmed or modified based on the student’s performance.
Supervision changes• # 1
– If the student is unable to adequately conduct the therapy session then supervision will be modified
– If the student demonstrates greater independence than estimated and is able to accurately analyze and explain treatment results and goals then…
• # 2– Supervisors were more direct with students that are in the beginning
levels of clinic training.
– The supervisors are also likely to demonstrate therapy for those clinicians who
• Have had no previous clinical experience• Have high anxiety toward conducting therapy• Demonstrate a low level of clinical competence.
Supervision changes• # 3
– The supervisors explained that as the students progress during the semester they generally
• provide less direct instruction • direct style changes to a collaborative style• begin asking questions aimed to
– increase problem solving and – critical thinking skills
• # 4– The supervisors described using a consultation
method for students• performing at an independent level of clinical skill • about to begin an off-campus internship
Supervisors change over time
• Supervisors described a more direct style of supervision when they first began supervising– The first few years the style of supervision was
more direct and observations were more critical
– After one to three years the style became less direct and comments more positive.
Summary
• A pre-practicum assessment occurs by a conference with the student, with criteria.
• Clinical independence level is estimated based on the manner, organization, accuracy, and completeness of the presentation.
• Supervisors do not supervise all clinicians the same but base it on the needs of the student.
• Supervisors do not use the same type of supervision the entire semester but change or modify the style
• Supervisors need more training in methods of supervision
Why did these supervisors not fit the description of the literature?
Clinical experience & Progress of the Discipline
Recommendations• Training-Education in
supervision• Developing a needs
assessment for clinical educators
• Develop a guideline pre-practicum assessment
• Closing the gap (class to clinic)
• Further research• Develop newer models
of clinical education
Infusing Research into Clinical Practice
ByJacqueline Kotas, M.A., CCC-SLP
Deanna M. Hughes, Ph.D., CCC-SLPSan Diego State University
Communications Clinic
The Job: Clinical education must provide the skills needed to evaluate and implement therapeutic techniques which are
based on sound theoretical research (Brinton & Fujiki, 2003; Gillam & Gillam, 2006).
The Challenges:• Graduate students begin their programs with varying levels of
competence in their ability to evaluate and apply research to clinical practice.
• Academic faculty cannot assume all of the educational burden for providing instruction in research-based clinical practices
• The scope of clinical practice continues to broaden, and new technologies are introduced making it difficult for academic programs to provide adequate education (Golper, 2007).
Given these challenges, how can we develop the knowledge base which will allow our students to be efficient consumers of research?
The First Step
Meet the “Researcher of the Month” Researcher and article selected by the supervisors Articles from peer-reviewed journals represented a variety of disorders and age rangesTheoretical as well as clinical articles were selected
Discuss the article during one staffing each monthSupervisors were encouraged to use the Gillam and Gillam, 2006, PICO method as a framework for the discussionDiscussions were not “micromanaged” as each supervisor had the freedom to draw their own conclusions/interpretations
Quantitative Outcomes
Graduate students were given a brief survey about their participation in the project which contained nine questions separated into three distinct areas to evaluate a) the articles b) the discussions held by the supervisors and c) personal reflection of learning by the students.
A majority of the students agreed that the articles did review evidence-based practices applicable for differing populations.
Discussion held by supervisors were positive for facilitating research into clinical education
Gillam and Gillam article was the most helpful in bridging the EBP to the clinical realm. Perhaps, because it was an additional reading of an article presented in an academic course
Qualitative Outcomes
Graduate Students
“Brainstorm ideas for my current clients”“Nice mix of articles”“Great to talk about the articles in staffing”“Only pick one article”“Should be tailored to my current client”“Concerned with the time commitment”“Supervisors assume we learn specific therapy
techniques in class and faculty assume we learn them in clinic”
Qualitative Outcomes
Supervisors“Great to read articles out of my comfort zone”
“Led to spontaneous discussions about specific clinical techniques”
“Challenging to include supervisors that have primary work sites in the community equally in the project”
Future Directions
Replicate for an additional semester
Allow students to choose the articles
Tailor articles to specific supervisors for the age range
Supervisors will continue to share conclusions/discussions
More involvement with academic faculty
Articles and Acknowledgements
We would like to thank the graduate students, supervisors, academic faculty, clinic director, and clients and families
ArticlesAustermann, S. (2007). Current directions in treatment for apraxia of speech: Principles of motor
learning. Neurophysiology and Neurogenic Speech and Language Disorders, 3-6.
Gillam, S.L., & Gillam, R.B. (2006). Making evidence-based decisions about children language intervention in schools. Language, Speech, and Hearing Services in Schools, 37, 304-315.
Gillam, R.B., Loeb, D.F., Hoffman, LM., Bohman, T., Champlin, C.A., Thibodeau, L., et al. (2008).
The efficacy of Fast ForWard language intervention in school-age children with language impairment: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119.
Meinzer, M., Djundja, D., Barthel, G., Elbert, T., & Rockstroh, B. (2005). Long-term stability of improved language functions in chronic aphasia after constraint-induced aphasia therapy. Stroke, 1462-1466
Turkstra, L. (2005). Looking while listening and speaking: Eye-to-face gaze in adolescents with and without traumatic brain injury. Journal of Speech, Language, and Hearing Research, 48, 1429-1441.
Yavas, M., & Goldstein, B. (1998). Phonological assessment and treatment of bilingual speakers. American Journal of Speech-Language Pathology, 7(2), 49-60.
WORKING ALLIANCE, SUPERVISORY STYLES/ROLE AND SATISFACTION WITH
SUPERVISION OF SPEECH-LANGUAGE PATHOLOGISTS DURING THEIR FIRST YEAR OF PROFESSIONAL SERVICE
JENNIFER A. OSTERGREN, Ph.D.California State University, Long Beach
A dissertation submitted to Claremont Graduate University.Funded in part by a grant from ASHA Special Interest Division 11 (Administration and
Supervision)
Background/Rationale• New SLPs participate in supervised practice immediately following graduate
training– Required Professional Experience (RPE) for California licensure– Clinical Fellowship (CF) for ASHA certification
• According to Ramos-Sanchez et al (2002) negative supervision experiences and decreased satisfaction with supervision can influence:
– Clinical Performance– Career Choice– Career Satisfaction
• Majority of studies on supervision in speech-language pathology are more than 20 years old (McCrea & Brasseur, 2003; Ostergren, 2006)
• The field has changed greatly over the past 20 years (McAllister, 2005a; McAllister, 2005b; McCrea & Brasseur, 2003)
• Little empirical research exists addressing supervision during this first year of professional service
– Past research primarily addresses graduate students (McCrea & Brasseur, 2003; Ostergren, 2006)
• Nature and type of supervision differs for graduate students vs. those completing CFs/RPEs (ASHA, 2007f; California Speech-Language Pathology and Audiology Board, 2007)
Study Foundation• Current study utilized the key themes of past
research relative to:– Working Relationships (ASHA, 1985, 2008a, 2008c; Bernard & Goodyear, 1989;
Efstation, Patton & Kardeth, 1990; Holloway, 1987, 1995; McCrea & Brasseur, 2003)
– Satisfaction with Supervision (Friedlander & Hulse-Killacky, 2005; Ramos-Sanchez, et al, 2002)
– Supervisory Styles (Clemente, 2006; Culatta & Seltzer, 1976, 1977; Friedlander & Ward, 1984; Joshi & McAllister, 1998; Roberts & Smith, 1982)
– Supervisory Role (Anderson, 1988; ASHA, 1985, 2008a, 2008c; Clemente, 2006; McCrea and Brasseur, 2003)
Applied to the first year of professional service
Study Objectives• To describe the supervision experiences of
individuals engaged in their first year of professional service, given– Working alliance with their supervisor– Supervisory styles and predominant role assumed by their
supervisor – Satisfaction with supervision
• To describe how key variables and demographic factors (supervisor, setting, and supervisee) influence above
Participants
• 262 Individuals Surveyed – Randomly selected from 524 SLPs in California completing a
Required Professional Experience (RPE)
• 50% Response Rate (133/262)– 18 returned surveys not analyzed, given:
• 11 blank surveys• 7 completing RPE only in audiology (not speech-language pathology)
• Total of 115 surveys analyzed
Results – Participants• 94% female• Average age of was 30
– 64% between the ages of 24-28
• All were completing RPE (as required by the California SLPAB) – 93% were also completing an ASHA CF
• Average of 6.70 months at RPE– Total months at RPE, ranged from 2-12 months
• Average “Clinical” Self-Efficacy (on a scale of 1-4) was 3.24 (sd = .65)– Based on responses to a modified version of the General Perceived Self-
Efficacy Scale (GSE) (Jerusalem & Schwarzer, 2007).
Results-Setting
64.9
22.8
15.8
7.94.4
0.90
10
20
30
40
50
60
70
Private orPublic School
MedicalSetting
PrivatePractice
Other Non-ProfitOrganization
UniversityClinic
Per
cen
t F
req
uen
cy
Results - Ethnicity
70.8
8.8 6.3 5.3 4.4 1.8 0.9 0.90
10
20
30
40
50
60
70
80
Caucasian AsianAmerican
Prefer Not toState
Latino/Latina MixedEthnicity
PacficIslander
AfricanAmerican
NativeAmerican
Perc
en
t F
req
uen
cy
Results - Similarity with Supervisor• Similarities
– 76% were similar in ethnicity to their supervisor– 88% were similar in gender to their supervisor
• Differences– 77% were different in age from their supervisor
• Of these, 72% had supervisors that were older
Results – Perceptions About Supervisor’s Evaluation
72.6
25.7
1.8 00
10
20
30
40
50
60
70
80
Independent Adequate withSupport
Emerging Minimal/Not Begun
Perc
en
t F
req
uen
cy
If your RPE supervisor were to rate your clinical performance to date, he/she would likely rate your clinical skills as: 1 2 3 4 Minimal/ Emerging Adequate with Support Independent Not Begun
Results – Agreement with Evaluation
49.6
44.3
1.7 0.90
10
20
30
40
50
60
Srongly Agree Agree Disgree Strongly Disagree
Pe
rce
nt
Fre
qu
en
cy
Would you agree that the above evaluation of your clinical skill is accurate given your clinical performance during your RPE thus far: 1 2 3 4 Strongly Disagree Disagree Agree Strongly Agree
Results - Mentor StatusWould you describe your RPE supervisor as a mentor to you? No
Yes
79.1
19.1
0
10
20
30
40
50
60
70
80
90
Yes No
Pre
cen
t F
req
uen
cy
KEY FINDINGSSupervisory Role and Styles
Working AllianceSatisfaction with Supervision
Most and Least Valuable Aspects of Supervision
SATISFACTION WITH SUPERVISION
Satisfaction - Defined• Would you recommend your RPE supervisor to
someone interested in completing an RPE in the future?– Yes or No
• 4-point Satisfaction Scale– 1 = very dissatisfied– 4 = very satisfied
• Overall how satisfied are you with your RPE in general?
• Overall how satisfied are you with your RPE supervisor?
Results – Satisfaction• Participants largely satisfied with their supervisor
– Scale of 1-4, average = 3.31 (sd = .76)
• Participants largely satisfied with their RPE in general– Scale of 1-4, average = 3.30 (sd = 0.84)
• 86% would recommend their supervisor to someone else interested in a RPE
• Demographic variables not significantly and strongly related to satisfaction with supervision (including mentor status)
Results – Satisfaction Measures
• BOTH working alliance (Efstation, Patton & Kardeth, 1990) and supervisory style (Friedlander & Ward, 1984) significantly and positively correlated with satisfaction measures
• Anderson (1998) roles (direct/active, collaborative, and consultative) not significantly and strongly correlated with satisfaction measures
Supervisory Role & Supervisory Styles
Role and Styles - DefinedRole:• Anderson’s Continuum Model of Supervision (Anderson, 1988)
– Direct/Active, Collaborative, and Consultative Roles – 3-point Frequency Rating
• 1 = Most frequently utilized by my supervisor• 3 = Least frequently utilized by my supervisor
Style: • Given responses to a modified version of the Supervisory Styles
Inventory (SSI) (Friedlander & Ward, 1984) – Three Sub-Scales of Supervisory Behaviors:
• Interpersonally Sensitive subscale (e.g., intuitive, committed, resourceful)• Attractive subscale (e.g., friendly, trusting, positive)• Task-Oriented subscale (e.g., goal oriented, structured, practical)
– 4-point Frequency Rating• 1 = Never• 4 = Always
Results - Supervisory ROLE• Primarily either a collaborative or consultative
supervisory role reported – 48% reported collaborative role “frequently utilized”– 36% reported consultative role “frequently utilized”
• Demographic variables not significantly and strongly related to supervisory role
Results - Supervisory STYLES
• All three subscales of the SSI used relatively frequently
– Most frequently reported was the Attractive Supervisory Style (e.g., friendly, flexible, trusting, warm, open, positive, and supportive)
• Demographic variables not significantly and strongly related to supervisory style
• Exception to this was for an Attractive supervisory style – A moderate amount of the variance in the Attractive subscale
was predicted given a participant’s agreement with a perceived supervisor’s evaluation
3.47
3.28
3.04
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
3.6
Attractive Interpersonally Sensitive Task Oriented
Me
an
Sc
ore
s
Frequency Ratings for Subscales of the SSI (Scale of 1-4; 4=Always, 1 = Never)
WORKING ALLIANCE
Working Alliance - Defined• Dynamic relationship between the supervisor and
supervisee (Efstation, Patton & Kardash, 1990; Ladany, Walker & Melincoff, 2001; Patton & Kivlinghan, 1997)
• Given responses to a modified version of the Supervisory Working Alliance Inventory (SWAI) (Efstation, Patton & Kardeth, 1990) – Supervisee/supervisor relationship characteristics
• For example:– My supervisor makes the effort to understand me– I feel free to mention to my supervisor any troublesome feelings I might have
about him/her– My supervisor helps me to stay on track
– 4-point Frequency Rating• 1 = never• 4 = always
Results - Working Alliance• Relatively strong working alliance with supervisor reported
– On a scale of 1-4, average = 3.22 (sd = .54)
• Supervisory styles from the SSI (Friedlander & Ward, 1984) had the greatest influence on working alliance
– In particular, styles of supportive, trusting, practical, thorough, open, and goal oriented predicted a moderately strong amount of the variance in working alliance
• Anderson (1988) roles (direct/active, collaborative, and consultative) not significantly and strongly related to the working alliance
• Demographic variables not significantly and strongly related working alliance (including mentor status)
MOST AND LEAST VALUABLE ASPECTS OF SUPERVISION
Most and Least Valuable Aspects of Supervision - Defined
• Open Ended Questions– How would you describe the relationship with your RPE
supervisor?– What elements of this relationship do you find most
valuable?– What elements of this relationship do you find least
valuable?
• Most and least valuable aspect questions subjected to a content and theme analysis
Results – MOST Valuable• 94% of participants responded to this question
– 52% of responses fell into one of three themes:
• Supervisor’s Expertise (24%)– “I value her 20+ years of experience”– “She is a good resource for materials and practical experience” – “Her many years of experience”
• Supervisor’s Openness and Approachability (19%)– “I never feel that I can’t talk to her about anything”– “She is available to answer my questions when I need her” – “I find it comfortable and easy to call on her at any time”
• Nature of Supervisor’s Feedback (Positive) (9%)– “Her concrete suggestions”– “Excellent written feedback on sessions/clients”– “She is very encouraging to me….she also gives excellent feedback on report
writing”
Results – LEAST Valuable• 77% of participants responded to this question
– 47% of comments fell into one of two themes:
• Limited Interactions with Supervisor (29%) – “My supervisor is very busy and has a full schedule so it is difficult for her to
see me actually doing therapy”– “She is in a different district and we are hardly in contact when she is on-site” – “She is very busy and we don’t have time to consult regarding our clients”
• Nature of Supervisor’s Feedback (Negative) (18%) – “She suggests things that I don’t have time to implement”– “My supervisor has a tendency to be overly critical at times,” – “The intensity of criticism is … overwhelming”– “She is critical and very picky,”– “At times the solutions to certain situations are presented to me without my
clinical opinion being taken into consideration”
Cautions and Limitations• Potentially Biased Nature of Sample
– Future studies will be needed to address potential biasing of responses• Completely anonymous survey• Retrospective study (immediately following RPE)
• Perceptions vs. Actual Performance– Future studies are needed to assess actual behaviors of supervisors in relation
to supervisee perceptions AND actual performance of supervisees in relation to supervisor behaviors
• Supervisor/Supervisee Dyads– Future studies are needed to compare responses of supervisees to those of
supervisors in a given dyad
• Measurements of Mentor Status– Future studies are needed utilizing a continuous variable for mentor status,
including definitions of the term “mentor”
References• American Speech-Language-Hearing Association. (1985). Clinical supervision in
speech-language pathology and audiology. Asha, 27, 57-60.• http://www.asha.org/about/publications/leader-online. • American Speech-Language-Hearing Association. (2007f). Membership and
certification handbook of the American Speech-Language-Hearing Association (For Speech-Language Pathology). Retrieved June 10, 2008, from http://www.asha.org/about/membershipcertification/handbooks/slp/slp_standards.htm.
• American Speech-Language-Hearing Association. (2008a). Clinical supervision in • speech-language pathology [Technical Report]. Available at
http://www.asha.org/policy. • American Speech-Language-Hearing Association. (2008c). Knowledge and skills • needed by speech-language pathologists providing clinical supervision.
[Knowledge and Skills]. Available at http://www.asha.org/policy. • Bernard, J., & Goodyear, R. (1998). Fundamentals of clinical supervision (2nd ed.).
Needham Heights, MD: Allyn & Bacon.
References• California Speech-Language Pathology and Audiology Board (2007). Laws and • regulations relating to the practices of speech-language pathology and audiology.
Retrieved June 10, 2008, from http://www.slpab.ca.gov/board_activity/laws_regs/index.shtml.
• Clemente, C. (2006). The relationship between perceived supervisory roles, styles and working alliance and students’ self-efficacy in speech-language pathology practicum experiences. Ann Arbor, MI: UMI Microfilm.
• Culatta, R., & Seltzer, H. (1976). Content and sequence analysis of the supervisory session. Asha, 18, 523-526.
• Culatta, R., & Seltzer, H. (1977). Content and sequence analysis of the supervisory session: A report of clinical use. Asha, 523-526.
• Efstation, J., Patton, M., & Kardash, C. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37(3), 322-329.
• Fernando, D., & Hulse-Killacky, D. (2005). The relationship between supervisory styles to satisfaction with supervision and the perceived self-efficacy of master's-level counseling students. Counselor Education and Supervision, 44(4), 293-305.
References• Friedlander, M., & Ward, L. (1984). Development and validation of the supervisory
styles inventory. Journal of Counseling Psychology, 31(4), 541-557.• Holloway, E. (1987). Developmental models of supervision: Is it developmental?.
Professional Psychology: Research and Practice, 18(3) 209-216.• Holloway, E. (1995). Clinical supervision: A systems approach. Thousand Oaks, CA:
Sage.• Jerusalem, M., & Schwarzer, R. (2007). The General Self-Efficacy Scale (GSE). • Retrieved June 10, 2008, from http://userpage.fu-berline.de/health/engscal.html. • Joshi, S., & McAllister, L. (1998). An investigation of supervisory style in speech • pathology clinical education. The Clinical Supervisor, 17(2), 141-155.• Ladany, N., Walker, J., & Melincoff, D. (2001). Supervisory style: Its relation to the
supervisory working alliance and supervisor self-disclosure. Counselor Education and Supervision, 40(4), 263-275.
• McAllister, L. (2005a). Issues and innovations in clinical education. Advances in Speech-Language Pathology, 7(3), 138-148.
References• McAllister, L. (2005b). Issues, innovations, and calls to action in clinical education:
A response to Kathard, Lincoln and McCabe, Rose, Cruice, Pickering, Van Dort, and Stansfield. Advances in Speech-Language Pathology, 7(3), 177-180.
• McCrea, E., & Brasseur, J. (2003). The supervisory process in speech-language pathology and audiology, Boston, MA: Pearson Education.
• Ostergren, J. (2006). Clinical supervision in speech-language pathology: Profiles and
• perceptions. Unpublished paper.• Patton, M., & Kivlinghan, D. (1997). Relevance of the supervisory alliance to the
counseling alliance and to treatment adherence in counselor training. Journal of Counseling Psychology, 44(1) 108-115.
• Ramos-Sanchez, L., Esnil, E., Riggs, S., Wright, L., Goodwin, A., Touster, L., et al.(2002). Negative supervisory events: Effects on supervision satisfaction and supervisory alliance. Professional Psychology: Research and Practice, 33(2), 197-202.
• Roberts, J. E., & Smith, K. J. (1982). Supervisor-supervisee role differences and consistency of behavior in supervisory conferences. Journal of Speech and Hearing Research, 25, 428-434.
Contact Information
• For questions regarding this study, please contact:Jennifer A. Ostergren, PhDDepartment of Communicative DisordersCalifornia State University, Long Beach1250 Bellflower BoulevardLong Beach, CA [email protected]
Development and Validation of a Professionalism Scale
for Speech Language Pathology Students
Pam Mitchell, Ph.D. CCC-SLP1
Erin Redle, Ph.D. CCC-SLP2,1
Kate Krival, Ph.D.CCC-SLP1
Lisa Audet, Ph.D. CCC-SLP1
Kent State University1
Cincinnati Children’s Hospital Medical Center2
THANK YOU
This work is supported by a grant from SID 11
Background
• Professionalism is a critical component of practice in speech language pathology
• Difficult to establish an agreed upon definition (Wear & Kuczewski, 2004)
• Now a required measure for ASHA certification; no agreed upon measure of professionalism– Challenge for students and supervisors
Objectives
1. Develop a scale to assess aspects of personal dispositions and professional behavior in speech language pathology graduate students
2. Design and conduct a validation study on the scale developed
Research Questions
1. What are key aspects of professional behavior and personal dispositions in students majoring in speech language pathology?
2. What valid and reliable indicators can be utilized as a Professionalism Scale for preservice programs in speech language pathology to assess student dispositions and professional behavior relevant to acquisition of ASHA certification competencies?
Overview of the Scale Development
Professionalism Scale
Phase 1: Defining Professionalism
Phase 2: Expert Review
Phase 3: Field Testing
Phase 1
Professionalism Scale
Phase 1: Defining Professionalism
Phase 2: Expert Review
Phase 3:Field Testing
Phase 1
• Participants– Clinical supervisors with at least 5 years of
experience– Purposeful sampling
• Geography• Clinical settings
Phase 1: Methodology
Data collection– Qualitative methodology– n~ 10– Semi-structured interview guide – Interviews completed by all investigators– Interviews transcribed in Word and transferred to
NVivo for coding
Phase 1: Methodology
Data Reduction: Content Analysis (Patton, 2002; Berg, 2004)
• Free coding• Code reduction and codebook development• Data recoded with final set of codes• Frequency counts obtained for final codes
• Multiple investigators will recode for triangulation
Preliminary Results of Coding
• Appropriate dress• Appropriate conversational topics• Recognizing one’s own limitations• Critical thinking in clinical situations• Asking supervisor relevant questions• Comfort with asking questions• Interaction with patients/students• Interaction with family members
Preliminary Results of Coding
• Flexibility• Honesty• Showing initiative• Time management• Timeliness• Willingness to learn• Documentation
– Quality– Timeliness of documentation
Scale Development
• Initially 30-50 items • Developed from qualitative results, expert
opinion, and previous research• Response measure is a 7 point Likert-scale
Phase 2:
Professionalism Scale
Phase 1: Defining Professionalism
Phase 2: Expert Review
Phase 3: Field Testing
Phase 2: Methodology
Participants• Professional experts (n=5-10)
– Clinical supervisors from around country– Purposeful sampling
• Advanced graduate students (n=5-10)– Various schools around Ohio– Purposeful sampling
Phase 2: Methodology
• Professionals and students provided with a modified version of the scale
• Asked to indicate level of agreement regarding the validity of each item for measuring professionalism as well as the clarity of each item
• Also provided with open ended questions regarding missing scale items, administration burden
SCALE STATEMENT(e.g. The student is dressed appropriately for
clinical setting)
Please indicate if the meaning of this question was clear to you?
Yes No
1 2 3 4 5
Phase 2: Data Analysis
• Frequency counts of Likert-statement items• Subjectively reviewed all data including
statements for clarity, suggestions for additional items
• SCALE WILL BE REVISED AS NEEDED
Phase 3
Professionalism Scale
Phase 1: Defining Professionalism
Phase 2: Expert Review
Phase 3:Field Testing
Phase 3: Methodology
Participants• Supervisors and graduate students from
multiple universities– Goal is even distribution between the two
• Will collect basic demographic data, including clinical setting
Phase 4: MethodologyData Analysis• Missing data and item distribution
– Descriptive statistics
• Item-total correlation– Individual to total Pearson correlation
• Factor analysis/Principle Component Analysis– Exploratory factor analysis
• Internal consistency– Cronbach’s
Future Research
• Concurrent validity– Determine how professionalism compares to
other measures of success for students
• Sensitivity to measure growth and development of students over time
Contact Information
• Erin Redle– [email protected]
• Pam Mitchell– [email protected]
• Kate Krival– [email protected]
• Lisa Audet– [email protected]
FUTURE OF SUPERVISION RESEARCH
• Questions???
Top Related