Focusing in on Tele-Supervision
Carol C. Dudding, PhD, CCC-SLP
Director of the Speech-Language Pathology Program
Department of Communication Sciences and Disorders
James Madison University
Tele-supervision, or e-supervision, refers to the use of two-way digital video conferencing technologies for the purpose of clinical supervision. With tele-supervision, clinical instructors can provide supervision at a distant site. It has proven beneficial in reinforcing relationships between the graduate student clinician and university programs and off-campus supervisors. People engaged in e-supervision must be aware of and adhere to all ASHA requirements for supervision and certification as well as state requirements. State requirements for student supervision may differ from those of ASHA (2008).
Building Clinical Program Capacity
Persistent personnel shortages in speech-language pathology and audiology present a multi-faceted problem that calls for innovative approaches. One approach is to increase the supply of qualified professionals by expanding graduate program capacity and thereby increasing the number of graduates. However, the limited availability of off-campus clinical placement opportunities is often cited as an obstacle to graduate program expansion (ASHA, 2007). Additionally, graduate programs in communication sciences and disorders (CSD) are facing an increase in the number of non-traditional students, many of whom work full time and are enrolled in or desire to enroll in distance education programs. Whether enrolled in distance education programs or on-campus programs, students may seek clinical training at sites that are geographically remote from the college campus and that have limited access to certified professionals who can provide supervision. Along with expansion of clinical training programs comes an increased demand on personnel and financial resources.
Tele-supervision has the potential to allow for expansion of clinical placements in a cost- and time-efficient manner. Tele-supervision increases the number of practicum sites by allowing students to be placed within broader geographic regions and at sites that do not have sufficient onsite supervision. Tele-supervision also eliminates the costs and time associated with travel to off-campus placements and allows clinical supervisors to supervise multiple students from a central location (Dudding & Justice, 2004). Recent applications of web-based supervision have allowed university programs to hire part-time supervisors to work from their homes (Carlin, 2012).
Models of Tele-Supervision
Tele-supervision may involve live supervision of the student-client interaction. Tele-supervision can also take the form of web-conferencing in which supervisors and supervisees jointly share their insights outside of the clinical session as part of a consultative and/or mentoring model. Both of these models are considered synchronous in that the supervisor and supervisee communicate in real-time. "Store and forward" models are less common in CSD. Such models allow supervisors to review data, video, and/or test results at a time removed from the clinical interaction. The supervisor then provides feedback to the supervisee asynchronously, such as through e-mail.
In establishing a tele-supervision model, one should consider the type of supervision required (e.g., live supervision), applicable state and federal regulations (e.g., state licensure boards and ASHA certification requirements), confidentiality and security needs (e.g., compliance with Health Insurance Portability and Accountability Act of 1996 [HIPAA] requirements), as the well as the type of videoconferencing equipment and technical support available. For a complete discussion of privacy and security issues, refer to Cohn and Watzlaf (2011).
Costs associated with videoconferencing vary widely according to the quality of the video-audio signal, peripheral devices, security features, and network requirements.
Videoconferencing technologies employed in e-supervision can be classified within three categories: (a) desktop/web-conferencing, (b) dedicated teleconferencing, and (c) mobile technologies. Desktop/web-conferencing technologies commonly employ a web-camera, microphone, computer, and hosting system such as Skype. These systems are generally low- to-no-cost. They vary in terms of the quality of the audio-video image and may lack security and privacy features. Dedicated teleconferencing systems can range in price from $5,000 per unit to more than $300,000 for an immersive telepresence system. Such systems typically offer superior audio-video quality, allow for control of the distant camera, and provide a stronger level of encryption. Emerging mobile technologies are available on smartphones and tablets at no additional cost to the user. While they currently lack security and a high quality audio-video signal, they offer widespread accessibility and general ease of use.
Different technologies require different levels of technical support. That is, dedicated teleconferencing systems generally require a more advanced level of technical and network support than mobile or web-conferencing systems. It is essential to consider the equipment, network capacity, and technology support available at both the on-campus and off-campus site when one is establishing a tele-supervision model.
Tele-supervision has been used to provide live supervision of graduate student clinicians in off-campus clinical placements, employing both dedicated videoconferencing and web-conferencing technologies. Dudding (2004) indicated no significant difference in the perceptions of speech-language pathology graduate students regarding the effectiveness of traditional versus e-supervision models using dedicated videoconferencing technologies. One student indicated that videoconferencing was "a terrific tool for supervision when practically speaking, you know, your supervisor cannot be onsite [sic] with you. Then you get the same level of supervision" (Dudding, 2006, p. 51). A recent study exploring supervisor and supervisee satisfaction using web-conferencing technologies (i.e., webcams) supported earlier findings of satisfaction with e-supervision (Carlin, 2012). Overall benefits of tele-supervision include the students’ increased feelings of autonomy, convenience and flexibility in scheduling, and adaptability to the needs of the student (Dudding & Justice, 2004). Limitations in tele-supervision include technology failures and limited ability to observe student graduate clinicians as they (a) provide services within classrooms and (b) interact with other professionals (Carlin, 2012; Dudding & Justice, 2004).
Tele-supervision can be successfully implemented to address issues of limited clinical capacity while ensuring a high-quality supervisory experience. Careful consideration should be given to the tele-supervision model, equipment selection, network configurations, and security and privacy protections, as well as to availability of technological support.
American Speech-Language-Hearing Association. (2007). Speech-Language Pathology Education Summit proceedings.
American Speech-Language-Hearing-Association. (2008).Clinical supervision in speech-language pathology [Technical report].
Carlin, C. H. (2012). The use of e-supervision for graduate students who are enrolled in student teaching practicum. Unpublished manuscript.
Cohn, E., & Watzlaf, V. (2011). Privacy and Internet-based telepractice. Perspectives on Telepractice, 2, 26–37. doi:10.1044/tele1.1.26
Dudding, C. C. (2006). Distance supervision: An update. Perspectives on Administration and Supervision, 16(1), 16–18. doi:10.1044/aas16.1.16
Dudding, C. C. (2004). Perceptions of the use of videoconferencing for supervision: Differences among graduate students (Doctoral dissertation, University of Virginia).
Dudding, C. C., & Justice, L. (2004). A model for e-supervision: Videoconferencing as a clinical training tool. Communication Disorders Quarterly, 25(3), 145–151.
Other ASHA Resources
American Speech-Language-Hearing Association Special Interest Group 18: Telepractice
New 5 minute video on Telepractice
American Speech-Language-Hearing-Association (2005). Speech-language pathologists providing clinical services via telepractice: Technical Report [Technical Report].
Capacity Building resources
This article first appeared in the December 2012 issue of Access Academics and Research.