a competency based to supervision: basic skills material projects pages/south coast... · 1 a...

PresenterAssoc Prof Craig Gonsalvez

A Competency‐Based Approach to Supervision:

Basic Skills

Training Material

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A competency-based approach to supervision: Basic skills

Craig Gonsalvez

Wollongong, May 2013

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Overview Day

Session 1: 9.00 am to 10.30 am Coffee break

Session 2: 11.00 am to 12.30 pm LUNCH break

Session 3: 1.30 pm to 3.00 pm Tea break

Session 4: 3.30 to 4.30 pm

Assoc Prof C Gonsalvez School of Psychology, University of Wollongong

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Overview Day

Session 1: Competency-based approaches to clinical supervision Small group activity: Establishing supervision plans

Session 2: Video review techniques to conduct supervision Small group activity focusing on skills training

Session 3 The emotion graph video review technique

Session 4 Attitude-value competencies in peer supervision

Objective for Workshop

Enhance understanding of competency models of supervision Principles

Implications for practice

Demonstrate two important competencies Designing a competency bases supervision plan

Use of videotapes to facilitate skills competencies

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1. Competency-based approaches

The competency revolution

Pedagogy AND model of supervision

Major impact on psychology training

Major impact across disciplines

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1.2 Supervision models

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Psychotherapy Theory

Psychotherapy Theory

Psychodynamic

Person-centred

CBT supervision

Systemic, Family, Narrative

Developmental Models

Developmental Models

Stage models

Process models

Life span models

Social Role Models

Social Role Models

Discrimination model

Structural Approach to Supervision

Others

Competency-based ModelsCompetency-based Models

Competency-based approach

Objectives Approach to Supervision


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1.2 Psychotherapy-based models: CT vs CT Supervision

Cognitive Therapy Cognitive Therapy Supervision

Mood check Check in

Agenda setting Agenda setting

Bridge from previous therapy session Bridge from previous supervision sess.

Inquiry about primary problems Inquiry regarding previous cases

Review of homework Review of homework

Prioritisation and coverage of agenda Prioritisation and coverage of agenda

Assignment of new homework Assignment of new homework

Use of capsule summaries Capsule summaries by supervisor

Client feedback on T’s conceptualisation

Supervisee feedback on Srconceptualisation

7Liese & Beck, 1997

1.3 Developmental models

Dominated supervision theory and practice

Therapists progress through distinct stages

Need for developmentally appropriate strategies

Implications for therapists and supervisors

Criticisms: Lack of consensus, overly general

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1.4 Competency Models: Characteristics

Start with the end in mind

Output rather than an input model

Atomistic in its conceptualisation of competence; “task-analytic” approach

Criterion based: notionally absolute

Emphasis on demonstration/measurement

Desirable: evidence-based, transparent

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2.1 Competence: Definition

Sufficiency of a broad spectrum of personal and professional abilities relative to a given requirement(Falender & Shafranske, 2004)

Unique assemblages of discrete clinical abilities that incorporate the specific knowledge, skills, values, emotions, etc., required to perform the specific professional activity (Falender & Schafranske, 2007)

May be easier to identify in its absence (Kitchener, 2000*)

Not the absolute or ideal standard of performance.

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2.1 Competeny: Definition

Competence: Overall/global capability of an individual’s professional performance

Competency: Discrete component or aspect of competence

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2.1 Competency-based models:

An approach that “explicitly identifies the skills, knowledge and values that form a clinical competency and develops learning strategies and evaluation procedures to meet criterion referenced competence standards in keeping with evidence based practice…” (Falender et al., 2007)

Include clear specification of competencies for each developmental level and behavioural anchors to make clear what this means in practice (E.g. Falender et al., 2004; The Objectives Approach to Supervision (Gonsalvez et al., 2002)

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2.1 Stages of competence

Stage Descriptions1 Unskilled, incompetent

2 Novice, beginner

3 Advanced beginner, intermediate

4 COMPETENT

5 Proficient

6 Expert, master

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Most approaches adopt a developmental approach involving 5-6 stages (e.g., Dreyfus, 1982 (1989?); James et al., 2007*)

2.2 Competency approaches: What’s new?

What is old:

The notions of competence and competency

Objectives-based approaches to curriculum development

The use of final ‘exit’ examinations to assess professional competence

What is new:

Taxonomies of competencies

Stronger theoretical frameworks and paradigms

Applying implications to training

Methods for ecologically valid, routine assessment of competencies

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2.2 Competency movement: History

2002: Competencies Conference: Future Directions in Education and Credentialing. (Sponsored by Association of Psychology Postdoctoral and Internship Centers, and APA) Aim: to address core competencies expected of

graduates of professional education and training programs in psychology.

Identification, education and training, and assessment of competencies within professional psychology

2005: Cube model, an outcome of the conference


2003: Taskforce convened by APA Board of Educational Affairs Report on needs for, models of, and challenges in

competency assessment Report on guiding principles of competency assessment

2005/2006: Creation of the Competency Benchmarks Work Group by APA Drafts, Consultation with workgroups, public comment,

revisions

2007: Practicum competencies outline (Hatcher & Lassiter, 2007) by Directors of psychology training clinics


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2009: Outcome from the 2006 working group --Competency Benchmarks paper (Fouad et al.,)

Rodolfa’s cube model adopted but restructured to yield 3 new competencies: professionalism, teaching, and

advocacy

15 core competencies defined 7 foundational competencies

8 functional competencies


For each of 15 core competency At 3 developmental levels of education and training Readiness for practicum

Readiness for internship

Readiness for entry to practice

Identifies essential components and behavioural indicators for each of these levels


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2.3 Competency Models

The Competency cube (Rodolfa, 1995)

3-D model

Foundational competencies

Functional competencies

Developmental stages

The Objectives-based approach (OBAS) 3-D model (Gonsalvez et al., 2002)

Competency domains

Competency types


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2.3: Classification: The 3D model


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2.3: Classification: Foundational Competencies

1. Professionalism

2. Reflective Practice/Self-Assessment/Self-Care

3. Scientific Knowledge and Methods

4. Relationships

5. Individual and Cultural Diversity

6. Ethical Legal Standards and Policy

7. Interdisciplinary systems

2.3: Classification: Functional Competencies

1. Assessment

2. Intervention

3. Consultation

4. Research and evaluation

5. Supervision

6. Teaching

7. Administration

8. Advocacy


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2.3 The OBAS Grids

Competency domains Assessment

Intervention

Professional Issues

Competency types


See supervisor toolkit, page..

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2.3 Competency types

Topographical structure: Competencies and metacompetencies

Competencies KNOWLEDGE

Demonstrate knowledge of empirical literature governing cognitive therapy

SKILLS

ability to fluently conduct a diagnostic assessment

ATTITUDE-VALUES

Openness to formative feedback

RELATIONSHIP

Establish and maintain a working alliance

Gonsalvez et al., 2002 29


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2.3 Metacompetencies

Topographically at a deeper level, underpin higher order competencies

Knowledge, skills, attitudes and relationship capabilities to advance KSAR competencies reflective practice capabilities

the scientist-practitioner mind set

unconditional positive regard30

3. Implications

Training and Supervision

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3. Implications

More new developments! Why bother?

Major impact Wide implications for psychology and other professions

Within psychology : Training & Supervision

Potential and promise

Options:

Get on the wagon

Get run over/left behind

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3.1 Implications for training

Identification, definitions, and ordering of competencies into taxonomies for professions Implications could be a restructuring of

boundaries, roles and functions among professions and within a profession (e.g., specialisations – PBA take on number of endorsements; IAPT implications for practice of CBT)

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Specialisation A

Specialisation B

Specialisation X

Specialisation Y


Change from input-based criteria to Professional qualifications (e.g., 4 years)

Course content (e.g., assessment, psychopathology..)

Supervision requirements (e.g., 180 hours)

To output-based criteria Demonstration of evidence-based therapy for anxiety disorders

Examination to demonstrate professional competence

Current models Combination of input and output criteria

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Dynamic rather than a static standard One could attain it and lose competence

The maintenance of competence is a career-long pursuit (e.g., PsyBA requirement for 5-year refresher

courses in supervision)

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3.1 Implications: Assessment

Greatest impact in the area of assessment Emphasis on demonstration (rather than inferred,

implied or expected attainment) of competencies

Ecologically valid (e.g., fewer knowledge-based examination formats, more ‘integrative’ tasks)

Final clinical examinations (e.g., OSCE)

Redefines meaning of pass/fail grades

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Introduction of lists/matrices of competencies Proliferation of domains & competencies

More comprehensive accreditation processes

Emphases on transparency, due-process, objectivity of assessments

More systematic monitoring to satisfy auditing requirements

Consequences:

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What are the implications for supervision?

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3.2 Implications for supervision

Implications for all aspects of supervision: Planning, conducting, assessment, and evaluation

For supervision and supervisor

Changes to the dynamic within the supervisory dyad

Focus on measurement and benchmarking Discrimination among supervision programs

Standards to evaluate satisfactory and unsatisfactory supervisory practices

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3.2 Implications: Assessment

Greatest impact in the area of assessment Emphasis on demonstration (rather than inferred,

implied or expected attainment) of competencies for supervisor Experience does not beget expertise (Sr training)

Emphasis on summative assessments for trainees

Focus on ecologically valid supervision methods (e.g., fewer knowledge-based examination formats,

more ‘integrative’ tasks)

Redefines meaning of pass/fail grades41


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Intrusion of a third entity in the supervision room!

Prescription of competency frameworks for supervisees and supervisors

Emphasis on summative assessments change the supervisor-supervisee dynamic

Emphasis on evaluation often includes evaluation of supervisor and supervision

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Lack of consensus in terms of whether changes would deliver better outcomes

Unease about a new paradigm of thinking, teaching, assessing Increased caution and leniency regarding assessments?

Exasperation about new demands and pace of change “When you are about to get used to a process, it

changes!”

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4. Practice applications

Is there a simple, workable competency-based model for supervision?

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Need for a simple model to help transition

Focus on 2 key supervisor competencies

Designing CDPs for supervision

Using videotapes in supervision

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3 STEPS

Swap the counsellor’s hat for a teacher’s/coach’s hat (role)

Design a ‘teaching-plan’ for the supervision placement

Follow best-practice pedagogic guidelines for executing, monitoring and evaluating the supervision plan

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4. Practice applicationsGonsalvez et al., 2002

In prosecuting steps 2 and 3, make 3 simple adjustments Content is not restricted to information, facts and data,

but includes perception and emotion

Important learning outcomes are not ‘knowledge’ but skills, attitude-values and relationship attributes

Supervision methods and tools will need to change to fit processing of new content (not for cognitive processing)

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4. CDP for Supervision: Implementation

Content and Learning ActivitiesMethods and Techniques

Formative FeedbackSummative Assessments and Reports

Evaluation of Supervision

1. Overarching Considerations and Processes

Influence of Professional StakeholdersEffects of Developmental Stage

Individual Resources and ConstraintsCross-cultural Effects

Contextual Resources and Constraints

2. Helping Supervisees

Formulate Competencies

3. CDP for Supervision: Finalising Competencies

Formulating SMART CompetenciesFoundational and Functional Competencies

Knowledge, Skills, Attitude-value, Relationship CompetenciesMetacompetencies

Competency-based developmental plan (CDP) for supervision

Gonsalvez, C.J. (2013). Establishing Supervision Goals and Formalising a Supervision Agreement: A Competency‐based Approach.

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4.1 Supervision plans

In supervision, it is helpful to think of competencies as “SMART” learning outcomes

Specific, rather than general

Measurable

Appropriate (developmentally), tailored to the individual

Recommended (e.g., consistent with recommendations of accrediting/professional bodies)

Time-wise: achievable given constraints of time, personnel and placement context


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4.1 Diagnostic assessment competency

Knowledge: Ability to articulate diagnostic and differential diagnostic criteria for the subtypes of mood disorders

Skills: Trainee able to conduct a diagnostic interview in a fluent and time-efficient manner

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4.1 Diagnostic assessment competency

Relationship: Ability to conduct the diagnostic interview in an interpersonally sensitive manner

Attitude: to diagnostic labels and DSM classification, to persons with diagnostic labels and so forth

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4.1 Socratic dialogue competency

Knowledge: Can describe and define the technique. Can make relevant distinctions between Socratic vs. open-ended and rhetorical questions, .....

Skill: Ability to demonstrate how to use Socratic dialogue in a given situation

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4.1 Socratic dialogue competency

Relationship: Able to tailor Socratic dialogue to a variety of interpersonal situations

Attitude-value: Appreciative and respectful vs. sceptical and cynical about the technique

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4.2 Designing a competency-based developmental plan (CDP)

for supervision

Small group activity

See handout 1

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Small group activity

Supervision Plan 1 Get all to read activity

Address questions; then break into groups

Activity takes about 30 mins including clarifications with Sarah the trainee

Options for group: assign knowledge, skills, attitude-values to different groups

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Small Group Activity

Consider the agenda of supervision objectives for a typical trainee seeking a placement in your agency under your supervision. Draw a pie-chart with the slices of the pie representing percentage of supervision time you think should be allocated to the 4 types of supervision objectives.

For each objective type, identify two or three key methods that you would prefer to use.

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Reflective analysis

Formulation of the supervision plan as important as The most important competency within the competency

framework

Blueprint, master plan,

Formulation for therapy

Key messages about supervision in general

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4.3 Reflective analysis

What are some important benefits of designing competency based plans (CDP) for supervision?

What are some of the common problems and barriers of designing CDPs?

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Supervision plans

Best practice criteria

See handout

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