Supervision in speech-language pathology has added a different dimension in recent years, as speech-language pathology assistants (SLPAs) have emerged as support personnel in educational and health care settings as well as in private practices. Is this supervision experience different from supervising graduate students or clinical fellows? And how can a speech-language pathologist prepare to be an effective supervisor of an SLPA?
One of the most fulfilling aspects of any satisfying relationship is reciprocity. To reciprocate is to give or take mutually, to be complementary, and derives from the Latin reciprocâre, "to move back and forth" (The American Heritage Dictionary, 1969). In the supervisory relationship between an SLP and SLPA, each person has much to give and much to receive. In order to achieve mutual respect, it is important to differentiate the roles of clinician and assistant and to be aware of what each offers to the professional relationship.
The SLPA's role is just what the job title implies—to assist, not replace, the SLP. ASHA's 2004 guidelines specify that an SLPA's tasks may be delegated only when the training, supervision, and planning are appropriate. ASHA recommends 20-40 semester credit hours in general education and 20-40 hours in technical knowledge and skills for SLPAs, a minimum of 100 hours of supervised fieldwork, and demonstration of technical proficiency and workplace behaviors; this type of training is typically available at a community college that awards an associate's degree.
The SLP's role is to supervise the SLPA appropriately using skills and knowledge that extend beyond a clinician's subject knowledge of the field and clinical expertise. A new supervisor needs knowledge about the stages and styles of supervision, the components of the supervisory process, and two essential skills of interpersonal communication—active listening and conflict management.
Stages of Supervision
Supervision in speech-language pathology progresses along a continuum of stages with appropriate styles for each stage (Anderson, 1988). When the beginning supervisee is in the Evaluation- Feedback Stage, the supervisor uses a direct and active supervisory style and gives the supervisee evaluative feedback.
In the Transitional Stage, the supervisee begins to take a more active role in problem-solving, decision-making, and evaluating. Supervisor and supervisee collaborate and, over time, interact more like colleagues. Most graduate students in communication sciences and disorders (CSD) are in the Transitional Stage.
The final stage is Self-Supervision, when the supervisee has achieved enough competency and confidence to evaluate his or her clinical behaviors accurately. Although more independent, the person at this stage still benefits from a consultative-type interaction with the supervisor and will initiate the interaction when needed. Supervisor and supervisee relate as professional peers with the supervisor engaging in joint problem-solving and making direct suggestions when appropriate. Self-supervision, as with the two other stages, may be achieved by a graduate student, a clinical fellow, or an SLP.
As Paul-Brown and Goldberg (2001) note, "The goal for supervising students and clinical fellows, in contrast to that for assistants, is clinical independence. The goal for supervising assistants is to ensure adherence to prescribed tasks."
The supervising SLP and the SLPA will probably be working primarily within the Evaluation- Feedback Stage on the continuum, according to Anderson (1988) and Dowling (2001). The SLP, being responsible for the training and monitoring of all work performed by an SLPA, will naturally use a direct and active style of supervision. Depending on the task, skill level, and experience of the SLPA, the relationship may progress to the Transitional Stage. Because SLPAs do not make independent clinical decisions, the Self-Supervision Stage is not appropriate.
It might be appropriate, however, for the SLPA to perform clerical tasks independently, create treatment materials, organize office space, and maintain files. Regardless of the task, understanding the continuum can be useful to the SLP and the SLPA when discussing the supervisory process.
Components of the Supervisory Process
The supervisory process involves more than establishing a working relationship with an SLPA and stating what is wanted. As described by Anderson (1988) and McCrea and Brasseur (2003), the components of the supervisory process are understanding the supervisory process and planning, observing/monitoring, reviewing/analyzing, and learning/integrating. Both the SLP and the SLPA are responsible for the supervisory process.
1. Understanding the Supervisory Process and Planning
Before planning the responsibilities and tasks of the SLPA, the SLP and SLPA need to understand what the supervisory process will entail for both of them. Discussing expectations can be a helpful first step, with questions such as the following:
- What do the SLPA and SLP expect of each other?
- Do both have a clear understanding of the scope of responsibilities for an SLPA and the knowledge and skills of the supervisor?
- How will the SLP prepare the SLPA for the particular work setting?
- What does the SLP want the SLPA to learn from observing the supervising SLP's treatment or the treatment by other SLPs?
- What background and training does each person bring to the setting?
- What goals do the SLPA and the SLP have for themselves?
- What is the SLPA's preferred learning style? What is the SLP's preferred teaching style?
- How will the two communicate with each other orally and/or in writing?
- What tools will be used to evaluate the SLPA's work and the SLP's supervision?
The SLP then needs to plan the specific tasks of a particular unit of time (e.g., the coming week). After developing a plan sheet, the clinician determines which tasks will require direct supervision (i.e., in view) and which will require indirect supervision (e.g., review of records). Time is set aside at the end of the week for a supervisory conference so the SLP and the SLPA can review and analyze the week's events and plan for the next week. The SLPA's notes for each day are included on the plan sheet as a reminder of agenda items for the conference.
If the SLPA will work directly with clients, both the SLP and SLPA may decide that planned observations of one another may be helpful. Regarding assistants' observations of SLPs, Dowling (2001) noted: "The observation of another person allows supervisees to watch a successful interaction and to think about ways to incorporate these behaviors into their own work...While watching, supervisees will benefit from recording or charting the behaviors they are being guided to observe." The SLPA might record and then observe and evaluate his or her own work according to specific observation guides.
A guided observation sheet with specific questions (e.g., what did the clinician or assistant do when the client gave an incorrect response?) can help the observer describe specific aspects of the session without leaping to evaluative or judgmental conclusions. A second type of worksheet allows for a more general observation and can list activities that went well and those that didn't.
The SLP needs to know that the type of feedback given to an assistant affects the way in which it is received. For example, if the SLP uses the first worksheet, he or she will be offering descriptive feedback that the SLPA may receive in an objective manner. If the clinician chooses to give evaluative feedback—as on the second worksheet—the SLPA may react positively, defensively, or negatively. She or he may also feel relieved to receive immediate evaluation and direct guidance. If the assistant is the observer, the SLP can discover what the SLPA is learning from supervision and also receive suggestions for improvement.
ASHA's 2004 guidelines recommend a minimum total of 30% direct and indirect supervision for the first 90 days. This recommendation would mean that in a 40-hour work week, 12 hours of supervision would be necessary. The guidelines also specify that direct and documented supervision of patient or client contact time is required for at least 20% of the actual weekly contact time for the SLPA and indirect supervision for at least 10% of the actual contact time. Depending on the skill level of the SLPA as well as specific client needs, the SLP may decide that additional observation, guidance, and monitoring are needed.
After the initial 90-day period, the minimum recommended requirement is 20% supervision, at least 10% of which is direct. In terms of a 40-hour week, eight hours of supervision would be required, including at least four hours of direct supervision. The SLP may adjust the amount of supervisory time based on assigned tasks, the assistant's skills, and caseload demands. Because state requirements may differ from ASHA guidelines, SLPs need to check their state's laws and regulations and adhere to state regulations where differences exist.
A regularly scheduled conference at the end of the week gives both parties a chance to digest and review the past week and then decide what—if anything—to change for the following week. Setting an agenda for this conference can be helpful so that both will know what to expect.
It is helpful to have notes from the past week to guide the discussion during the conference. The SLPA should be prepared to review sessions and/or tasks that were successful as well as those areas in which more input from the SLP is needed. Discussing the supervisory process also is important. Possible questions include:
- What did the SLPA find helpful and not helpful in terms of supervisory feedback?
- What strengths and/or areas for improvement did the clinician or the assistant identify?
- What treatment techniques, clients, or non-clinical tasks do the SLPA or SLP need to discuss further?
The last component in the supervisory process involves integrating past learning to future planning. Tasks, assignments, and timelines can then be listed for the following week. This aspect of the process then returns to the first component—planning.
Active Listening and Conflict Management
Active listening and conflict management are two skills that help an SLP achieve reciprocal communication and responsible supervision. Although active listening, perhaps more than any other skill, affects interpersonal communication, it might be the skill used least when most needed.
The manner in which an SLP listens to an SLPA can affect the outcome of any conflict. Pickering (1987) offers two lists of behavioral skills that can help SLPs examine their responses in an interaction and decide whether they were listening with empathy or with criticism. "Empathy...means listening as a receiver rather than as a critic and responding in accepting rather than in evaluative ways" (Pickering 1987, p. 217).
Professional conflicts can occur between the SLP and a variety of people—the client, the client's family, other members of the client's team, a graduate student extern, or an SLPA. To determine one's conflict style, the SLP can take one of several questionnaires available online. According to Hocker and Wilmot (1991), typical responses to conflict are: avoiding a conflict or confrontation altogether, competing with the other person for control of the conflict, or collaborating with the other person for mutual problem-solving. If the SLP uses a collaborative approach and does not blame the SLPA, the assistant is less likely to become defensive and use competitive tactics.
SLPAs have much to offer SLPs. In addition to increasing the efficiency of the SLP's clinical services and relieving the clinician of some time-consuming non-clinical responsibilities, they can offer SLPs the opportunity to expand their professional responsibilities. After acquiring the needed knowledge and skills and beginning the supervisory process, SLPs can come to realize that much is to be gained from a successful, reciprocal relationship with an SLPA.
This article is a revised version of a book chapter listed in the references on line.