Telesupervision Slides 1.21.21 Complete Version.pptx

Slides for Pediatric Telemedicine, Telehealth & Teletherapy: Practicing with Children & Adolescents course. More explanation for this slides can be found in training.telehealth.org.

1. TBHI Evidence-Based & Practical Telesupervision Digital Workshop Marlene Maheu, PhD

2. Dr. Marlene Maheu Dr. Marlene Maheu serves as the Executive Director of the Telebehavioral Health Institute, where she oversees professional training in telebehavioral health via an eLearning platform that has served behavioral health clinicians from 109 countries.

3. Next, please introduce yourselves to the group: city & state; specialty; profession

4. Optimize Your Learning Prevent Interruptions Mute your phone, turn off texts and emails, lock your door Ask your family/friends to stay away C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

5. Learning Objectives 3 CME or CE Hours Name important knowledge, skills and attitudes necessary for providing telesupervision Outline key considerations for how to format and structure telesupervision Outline key factors to address when discussing cases using technology Name essential issues to consider including in a telesupervision contract Detail several common engagement strategies to enhance participation in supervision C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

6. Telesupervision Defined Telesupervision is defined as clinical supervision provided across distance rather than in-person using: Electronic communication device Audio Video In real-time Telesupervision is (or will-soon-be regularly augmented) by Text-messaging Apps and soon, other technologies such as Affective computing C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

7. Telesupervision Types Telesupervision is currently available as: Required pre-licensure Optional post-licensure Mandated Post-licensure Form of remediation Types Topic expertise – opioids for example Telehealth – rural telehealth, hospital telehealth, pediatric, etc. Telesupervisors should go through the same training as telesupervisees Be aware of state law & interprofessional differences; avoid assumptions C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

8. To day’s Program Sound will be muted at times to limit uncontrollable distractions/Please interact in chat box – send to everyone Five-minute bio-break is scheduled at mid-way point, and session will conclude 5 minutes later than scheduled This is an interactive workshop. Please show yourself to support the group process and learn from each other LIVE CME or CE if you arrived within 15 min or start AND complete the post-test today Otherwise, you will receive asynchronous course credit hours Materials available to you for six months/Recording will be editing and posted within 7-14 days. C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

9. C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

10. Focus on Competencies All ethical codes require competence in our professional practices Competence in behavioral health is NOT equivalent to competence as a telebehavioral health professional Competencies have been published and continue to be researched in telebehavioral health C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

11. C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

12. Coalition for Technology in Behavioral Science (CTiBS) An Interprofessional Framework for Telebehavioral Health Competencies Website: CTiBS.org

13. An Interprofessional Framework for Telebehavioral Health Competencies Download your FREE copy here: https://telehealth.org/an-interprofessional-framework-for-telebehavioral-health-competencies/

14. CTiBS TBH Competency Framework

15. 7 CTiBS TBH Competency Domains (We will touch 5 today)

16. CTiBS TBH Competency Domains (We will look at 3 today) C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. 7 Domains An Interprofessional Framework for Telebehavioral Health Competencies

17. r Telesupervisor & Telesupervisee About developing growth Knowledge Skills & Attitudes Individual vs. Group Expectations Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

18. r Telesupervision or Consultation Group Format of Group Structure of the Group Teleconsultative Model? Need time to form alliance – perhaps informally get to know one another for a meeting Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

19. r What should be considered when initiating telesupervision with supervisee? Engagement Professional Development Communication Dealing with interruptions, the unexpected, inappropriate revelations Legal issues: Subpoenas and privacy of cell phones Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

20. Difference between In-Person vs Telesupervision First job is to draw out answers vs give answers People are experienced differently online Greater potential for miscommunication, outright errors, intrusions Need to be more active More reflection and open-ended questions to be sure to get the whole story More distractions for supervisor as well as supervisee Boundaries Email & texting File exchanges Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

21. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

22. Technology Basics Preferences (Email /Texting/Telephone/Video) Skills Recovery processes / Netiquette Concerns / resistance Social networking – social media policy C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

23. Technology Basics File exchanges via email, text or websites What will happen if someone else sends clinician information How someone else can easily intercept information Having equipment repaired and how their privacy could be compromised C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

24. Technology Basics Automation: Record supervision hours Remind supervisors of their state’s reporting requirements by sending regular emails prior to due dates Automatically notify supervisees of scheduled meetings and tasks Calculate paychecks C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

25. r Who to screen & prep supervisees for telesupervision? Communication skills Professional concerns Ability to follow through Any employee concerns C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

26. Screening & Prepping Potential Supervisees Develop purpose and expectations Determine tech to be used Check tech capacity Observing ethics and confidentiality Review telesupervision contract Copyright 1994-1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

27. Engaging Supervisees in Telesupervision “Opening Protocol” Ice breakers to bring focus Breakout rooms Role plays Homework Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

28. Difference between in-person vs telesupervision Group Size Nuances are different Optimal group size? Some states limit number to 6 Fewer number might be better for your style If you do 8, what would have to change for you to be effective? Look for red flags: what might they be? Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

29. Difference between In-Person vs Telesupervision Group Size Be intentional about questions Easier to lose site of how each person is responding to a case Difficult to see faces on screen Peripheral vison Direct Challenges Multi-tasking Technology failures Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

30. r How does the supervisee provide a case conceptualization differently in telehealth? #1 problem across US Ability to “see” the client Use of technology Verbal vs non-verbal Using metaphors Ask for added documentation Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

31. What do you need to be aware of to inform the questions that you ask your supervisee? Telepresence Modeling/Stimulus value Be sure you can see their eyes – avoid glare/Glasses clean? Pay attention to breathing (panic, masturbation?) Hesitations/pauses (other people-scan room? Safety words? Poor connection – require better connectivity?) Stuttering/Fidgeting Bunny trails Parallel process Tell me your anxiety? What might you be deflecting? Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

32. r How to deal with technology preferences? Client’s/Patient’s Preference Clinician’s Preference Ultimately – both parties C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

33. r What is different about using telephone for telesupervision? Verbal vs non-verbal What are you not telling me about the client? Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

34. Telephone – often helpful for crisis management and direction More real-time Shorter duration More confined, predictable interaction Ask for supervisee to always provide phone # or contact info if not using phone (EHR) Can use texting as support (add “911” if emergency) Observe privacy rules because texting using iMessage or other pre-installed texting software is not HIPAA-compliant Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

35. Telephone – pick up cues differently Pay attention to breathing More easily distracted Location Other people in room Public area Driving Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

36. Screening & Prepping Potential Supervisees Structure Case Presentations Documentation – more in number and more specific documentation Technology – both parties must be comfortable with technology choices but no one should be forced to use any technology Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

37. Which technology are you now using? Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

38. r How do you think about state regulations related to telesupervision? Different practice definitions Different practice regulations Different mandated reporting Different supervision rules C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

39. State Regulations Crossing State Lines & International Borders Illegal without proper registration or licensure in the foreign state or country Enforcement is different in the case of emergencies Enforcement is lax Beneficence over malfeasance Telesupervision is illegal over state lines in most states M C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

40. State Regulations Crossing State Lines & International Borders Required processes & documentation may be different from yours Mandatory reporting definitions and timelines Abuse Duty to warn Sexual misconduct of prior therapists M C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

41. How to Identify Your Legal & Regulatory Requirements as a Telesupervisor? State licensing boards Use any search engine – look for equivalent of business and professions code Best source for information about legal and regulatory requirements Center for Connected Health Policy https://www.cchpca.org/ WeAreMotivo https://wearemotivo.com/online-clinical-supervision-rules/ C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

42. How to Identify Your State Regulations As a supervisor, you must comply with both your own and your supervisee’s regs NASW – require compliance with the more stringent of the two Board can change regs overnight Document fully – keep informed Copy/paste them into your documents with screenshots and dates Be an advocate C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

43. C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. International Practice

44. Steps to Take for International Practice Write to licensing boards Contact foreign embassy Seek legal advice Contact malpractice carrier C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

45. Ethical Considerations Same as In-Person Except for Documentation C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

46. Documentation Training Research Forms Telesupervision agreement Telesupervision notes Malpractice carrier C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

47. Documentation Resources to Reference Consensus documents Validated research Supervision & consultation records C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

48. Making Referrals Refer to colleagues who have had documented telehealth training supervision or experience C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

49. Telesupervision Contract Required by many leading national associations Required by many states Intent and purpose of telesupervision Logistics & expectations Mandatory disclosures – per state Mandatory reporting – per state No driving – liability for you C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

50. Telesupervision contract Confidentiality and privacy – maintaining HIPAA compliance Expectations: how to prep for Telesupervision Supervisees experience & qualifications for teletherapy C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

51. Telesupervision contract Copyright 1994-2022 Telebehavioral Health Institute, LLC All rights reserved. Special opportunities and difficulties Synchronous versus asynchronous Telesupervision Addressing confusion, anxiety How to provide feedback in telesupervision Addressing technology failures Lack of dedicated workspace

52. Malpractice insurance for telepractice can be quite different from in-person supervision C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

53. Malpractice Carriers (Liability Insurance) American Professional Agency , Inc. Covers many different behavioral professions, independent and group practices Direct: [phone] Office: [phone] (x2235) Gallagher Telehealth companies P: 630-694-4268 |Toll Free: 855.840.1046|F: 630.694.4401 C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

54. Telesupervision Technology Teams (Microsoft) Zoom WebEx Specialized tech Group Chat What do you use? Why? What did you use and leave? Why? C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

55. r Ethical Considerations Follow the law State & Federal Mandates Confidentiality Competencies Consultation C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

56. r What are the relevant standards for telesupervision? Ethical standards (codes) Clinical (or treatment) standards Administrative standards Technical standards C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

57. r Ethics codes & standards for telesupervision AAMFT, AMHCA, both APAs ACA, NBCC NAADAC NASW Technology Standards JCAHO, COA, CARF, URAC C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

58. National Associations Ethical codes from national associations all are relevant to Telesupervision, whether or not they mention the word “Telesupervision” C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

59. How do you create culturally responsive telesupervision?

60. Cultural Responsiveness /Diversity How might  cultural responsiveness manifest online more than than in-person? More easily mask linguistic ability – may need to ask more questions Could more readily be using adaptive devices Geographic access may belie religion or culture May see more of personal environment May see other people in household C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

61. r Research on telesupervision Martin, Lizarondo & Kumar (2018) SAMHSA TIP 60 (2015) Tarlow, McCord, Nelson & Bernhard (2020) C 1994-2022 Telebehavioral Health Institute, LLC All rights reserved.

62. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

63. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

64. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

65. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

66. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

67. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

68. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

69. Benefits: Going from In-Person to Telesupervision Flexibility in scheduling Extends accessibility Access to SMEs for consultation Collaborative tools Individual & group telesupervision C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

70. Delivery: from In-Person to Telesupervision Professional liability Synchronous vs. asynchronous delivery Deciding on individual vs. group supervision Factors that influence quality & effectiveness REFERENCE: C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

71. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

72. From the research: There are 8 factors that influence the quality & effectiveness of telesupervision Supervisee characteristics Supervisor characteristics Supervision characteristics Supervisory relationship Communication strategies Prior face-to-face contact Environmental factors Technological considerations C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

73. r Telesupervisory Activities Case presentation Consultation with SME Ethical deliberation Skills development Case management C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

74. Creating Group Telesupervision Agreement Video camera: on vs. off Attendance: on-time vs. late Environment: quiet vs. loud Participation: engaged or silent Connection: present vs. absent Respect: valuing members vs. not C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

75. Addressing Privacy & Confidentiality Privacy vs. Confidentiality Privacy is the individual’s legal right to control the dissemination of information Confidentiality is professional’s legal duty to protect an individual’s privacy We cannot guarantee 100% privacy when using technology HIPAA-Compliant Video Platforms Ethical Mandates Legal Obligations M C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

76. r Where can you easily and inexpensively find the evidence base for telesupervision? PubMed Google Scholar Research Gate Traditional library C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

77. Handling Emergencies – How to develop my supervisee? Protocols for handling emergencies Critical thinking skills Look for warning signs of: Suicidality Homicide Impairment Sexuality Anger Instill an understanding that mandatory reporting is THE SAME as for in-person care Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

78. Documenting Emergency Procedures How will your telesupervisee handle? Behavioral emergency: homicide threat, abuse… Medical emergency: fainting, asthma attack, suicide attempt, physically unresponsive… C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

79. r What are evidence-based approaches to handling clinical emergencies? Duty to warn Mandatory reporting Impairment C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

80. COVID & Telesupervision We conclude by offering structure and content suggestions for a four-session intensive workshop to provide trainees and supervisors alike with a telepsychology “primer” prior to providing services. In particular, we suggest training clinics adopt telepsychology best practice guidelines rather than adopt the mindset of implementing a temporary solution for providing services during the pandemic.  Baier, A. L., & Danzo, S. (2021, January 14). Moving Toward a New Era of Telepsychology in University Training Clinics: Considerations and Curricula Recommendations. Training and Education in Professional Psychology. Advance online publication. http://dx.doi.org/10.1037/tep0000359 C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

81. What would you say/do do if…

82. Eavesdropper? C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

83. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

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87. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

88. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

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90. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

91. What would you say if Shanika called to report that her client signaled her for help and she froze. She didn’t know how to best respond. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

92. What would you encourage Shanika to say or do? C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

93. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

94. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

95. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

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98. Considerations when other people are available in the home Evaluate clinical need Consider boundary issues Is it appropriate for the clinical plan? Does it involve safety? How can Shanika control the exchange? Are they friendly or hostile? C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

99. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

100. Handling Potentially Violent Intruders Which is the best option in most circumstances? Welcome, then include the guest as part of the session Stop the session and ask the client what they want to do Ignore the family member and see what develops "in vivo” Stop the session, excuse yourself, terminate the session and consider calling the police. Document well. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

101. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

102. r The Business of Telesupervision Advertising Commerce Partnerships Practice C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

103. r Other issues to consider as a telesupervisor … Interpreting assessments Experiential activities Nonverbal messages C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

104. Stay in touch  Telehealth.org [email protected] 619-255-2788