Our top tips for providing compliant, effective, and supportive supervision (plus a freebie)!
Many school-based Speech-Language Pathologists will find themselves in a supervisory position at some point in time. Check out our tips below to make the experience compliant, supportive, and effective!
Know the Requirements
This is arguably the most important part of supervision. Credentialing and licensing bodies have outlined the ethical practices and procedures required for supervision. These procedures and policies vary state by state. Here are some examples of outlined areas of regulations.
Supervision Duration requirements
The majority of states have a statement on how much to supervise. Something to note is this is the bare minimum requirement and there are times where you will have to increase the supervision efforts (more on that in a bit). Here are a few examples:
Missouri Department of Secondary and Elementary Education requires direct supervision for each initial contact between the SLPA/student and 1 hour per week after.
Minnesota Department of Health outlines the supervision requirements based on the amount of days into the supervision, e.g. for the first 90 days, the SLP must supervise 30% of events.
Direct VS Indirect Requirements
Several states have breakdowns on direct vs indirect supervision requirements. Direct supervision is observation of the SLPA performing services (this is LIVE, some states have specifications if teletherapy is acceptable for this or not). Some examples of indirect supervision include review of documentation and/or supervisory meetings. ASHA has a breakdown of direct vs. indirect supervision. However, they defer to state regulations when they apply such as in Colorado SLPA supervision requirements.
Years post-grad and amount of slpas under your license
ASHA requires that SLPAs be supervised by an SLP that has completed two years of supervision after ASHA certification.
Another area to be mindful of is the amount of individuals a therapist can supervise. Texas, for example, does not allow for an SLP to supervise more than 4 SLPAs/interns at one time.
As of late, continuing education has become a regulated aspect of supervision. Several states have mandated guidelines BUT one of the most notable requirements is ASHA's requirement that SLPs complete 10 CEUs prior to or concurrent with the first supervision experience.
WHOSE CASELOAD IS IT?
I had a colleague that would stop me any time I would say "the SLPAs caseload" (shout out to Liesl) and she was 100% accurate. This is your caseload. This caseload is under YOUR license and that's why being an expert in the regulations in your state is so very crucial. It's important to play an active role in the supervisory process to ensure that intervention is effective, necessary, and what modifications may be required.
The Initial Meeting
Regardless of if you've supervised your SLPA the year prior, your SLPA has years of experience, or you both are brand new to this experience, you'll want to start with an initial meeting.
Topics to address:
Scope of Practice
This isn't necessary annually but I typically review the scope of practice with the SLPA my initial time working with that SLPA. Oftentimes, the reason I do this is that the school district will make requests that are outside of the SLPAs scope. In every single supervision experience I've had, an administrator has tried to get the SLPA to attend an impromptu meeting, complete Medicaid billing forms, write progress notes, etc. Confirm that your SLPA feels comfortable with stating his or her scope in these circumstances because many school staff members are unaware of the differences between the two scopes.
Something that I have experienced is that many SLPAs may not be aware of exactly how much he or she is supposed to be supervised. Laying it out there gives the SLPA transparency around your role and protects both parties.
Feedback on support preferences
Once I discuss the supervision requirements and scope of practice, I then ask some questions specific to the supervisee's needs: how do you prefer feedback? what populations do you feel really comfortable with? what populations are you most nervous about? This will help you provide a very individualized supervisory experience.
Finally, I end the meeting by going through the caseload with the SLPA. I typically do this when going over the schedule. This can help you both identify any flags with grouping, students that may need extra supervisory support, material needs, etc.
Ongoing Support Tips
One of my motivations in founding The Therapist Support Network is to address the expense and difficulty in material sourcing for large and varied caseloads. Identifying materials for a caseload of 50 is a tall order and, as the supervisor, you'll want to assist your SLPA and confirm an effective intervention material bank is made readily available for him/her. Some examples include plenty of books for quick intervention strategy for all populations, a Therapist Support Network membership (shameless plug lol), demonstration on the use of a whiteboard, adding on to your license of materials on TPT, quick grab reinforcements etc.
SLPA specific feedback: It is important to provide SLPA specific feedback, particularly in the first few months of supervision. As the school year expands on or you supervise your SLPA for multiple years, service-specific feedback may not be necessary each session BUT praise on service can assist with rapport building. When completing your supervision-specific CEUs, you will most likely hear great tips for providing feedback, such as utilizing the sandwich approach (positive, negative, positive) or self-monitoring forms. One thing I encourage is to replace the "good session today" with "I really liked the reinforcement you used today"--keep the praise as specific as possible.
Caseload specific feedback: Caseload specific feedback is a crucial part of supervision and is one of your largest jobs as the SLP. You'll notice in the SLPA Scope of Practice that SLPAs are unable to refer for other services, provide clinical interpretation, or modify a treatment plan and so it is crucial that the supervising SLP be familiar with the caseload and recommend modifications, etc as appropriate.
Again looking at the SLPA Scope of Practice, SLPAs are unable to "participate in formal parent conferences, case conferences, or any interdisciplinary team without the presence of the supervising SLP or other designated SLP". I have worked with many schools that push back on this. However, asking an SLPA to represent you in a meeting is outside of his or her scope of practice.
it's ok to directly intervene when you need to
I had a student added to my caseload, who was supposed to be seen under the SLPA model, who had a very severe case of Childhood Apraxia of Speech. I worked directly with this student for several months, with my SLPA assisting, prior to transitioning that student to the SLPAs schedule. Why? Because I had specific training and experiences that I knew could jumpstart and expedite progress.
In addition, there are circumstances when caseloads are overwhelming, populations are outside of the SLPAs scope, etc and you will have to step in and justify the increase in supervision and/or the need for you to become the direct intervention provider.
document, document, document
I'm going into my 6th year of supervision and I have yet to have to prove any sort of supervision to any credentialing or licensing body, but I can!
It is so important to document both direct and indirect supervisory activities. One reason for this is for record-keeping should an audit take place, in addition to helping you keep track of the percentage of supervisor activities you've completed that month. When you supervise more than one SLPA, this becomes increasingly difficult to keep track of.
Another thing to be mindful of is that it is within the SLPAs scope of practice to "seek employment only in settings in which direct and indirect supervision are provided on a regular and systematic basis by an ASHA-certified and/or licensed SLP." Routine documentation of what you're doing allows the SLPA to be in compliance with his or her obligations, as well.
I personally document the following: a general percentage area of supervision each month, any sort of supervisory meetings and what was discussed, and then a breakdown per student per month (this last one is how I give feedback specific to the student but some districts or platforms offer a spot for this).
Here's both an excel file and Google file (forced copy so you can modify and relocate) of the Record of Supervision I keep. Feel free to download, modify, and utilize as desired!
Supervision of a school-based SLPA can be a very rewarding experience for both parties and the students involved, in addition to being a wonderful way to address service provision in areas of provider shortage.
Wishing you a wonderful supervisory experience! -Elise
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