Transcript Slide 1
Advanced Field Instruction:
A Competency-Based
Approach
Greg Merrill, LCSW
[email protected]
School of Social Welfare, UC Berkeley
Modest Goals for Today
Examine field instruction methods in all
phases of the process (assessment,
planning, educational intervention,
appraisal, evaluation) that promote and
ascertain student competency
acquisition
Learn through vignette-base discussion
Field Instruction is . . .
“a distinct professional activity in which education
and training at developed science-informed
practice are facilitated through a collaborative
interpersonal process. It involves observation,
evaluation, feedback, and facilitation of
supervisee self-assessment, and the acquisition
of knowledge and skills by instruction, modeling,
and mutual problem solving . . .”
(Falendar & Shafranske, 2004, p. 3)
Essential Responsibilities
Engage the supervisee in a professional
relationship
Assess the supervisee
Create a learning contract with clear
expectations and objectives
Teach/Instruct/Facilitate development
Provide ongoing feedback
Monitor/Observe
Remain responsible legally and ethically
Evaluate the supervisee
Essential Roles
Supporter
Administrator
Teacher
Evaluator
Mentor
Quality
Role Model
Assurance
Officer
Gatekeeper
Coach
Essential Tension
Supervisee Right
To Learn
Client Right
To Safe,
Effective
Services
What Learners Want . . .
Available, Makes Time
Addresses weak areas
Competent and Ethical
squarely but fairly
Challenges in right
amount
Processes conflicts
Assesses meaningfully
Asks for input,
feedback and adjusts
Warm, supportive
relationship
Individualized
strengths-oriented
assessment
Organized and
Dependable
Elicits/Facilitates
knowledge
What Learners Resent . . .
(Nelson & Friedlander, 2001)
Disorganized +/or
Distracted = Ignored
No Time + Not a
priority = No
relationship
Pulls authoritarian rank
Lectures at length
Shares own clinical
stories at length
Overly supportive or
overly challenging
Too abstract
Too directive
Blames, pathologizes,
doesn’t own his/her
part of problems
Doesn’t see
developmental context
or environmental
factors
Poor boundaries
Needs to be idealized
Does not welcome
input, Defensive
Unclear feedback,
evaluation
Learner-Based Assessment
Assess knowledge, skills, and attitudes that are
innate or have already been acquired
Assess knowledge, skills, and attitudes that will
need development to achieve desired
professional goals and competencies
Assess how the knowledge, skills, and attitudes
can most effectively be developed and most
logical sequencing
The Integrated Development Model
Stoltenberg, McNeil, & Delworth (1998)
Levels of
Development
1:
2:
3:
3i:
novice
intermediate
advanced
expert
Key “Structures” or
Variables
Level of Motivation
Level of Autonomy
Level of Self and
Other Awareness
?
Red Flags
Need to be the expert/be right/in charge
Need to fix or rescue
Distorted or illogical thinking
Externalization of blame onto others
Defensiveness, insecurity, hostility
Discomfort with emotional topics and
expression of feelings, extreme anxiety
Disorganization
Judgment and boundary problems
Selecting Competency Areas
Engagement
Professional use of
Assessment
Treatment Planning
Clinical Interventions:
Selection and
application
Modification of
Interventions
Transition and
termination
self
Collegial relations
and team
participation
Documentation
Legal and ethical
guidelines
Human diversity
competencies
Develop a Learning
Agreement
Based upon Assessment
Of Student
Of competencies needed for entry level work
Clearly Identifies
Goals
Roles
Teaching Tools
Knowledge, Skill, and Attitudinal Domains
Select Diverse Teaching Tools
Case Review/Case Consultation
Written Activities
Audio or videotaping
Live Observation or Supervision
Experiential Methods
Topical Reviews
The Triangle
Supervisor
Supervisee
Client
The Supervisee’s Prism
Supervisor
Supervisee’s
Perceptions and Verbal
Presentation
Client
Supervision Agenda
Check-in
Agenda Setting (Collaborative)
Clinical Case Review
Consultation
Other Strategies (Direct Observation)
Topical Discussion
Documentation
Summarize and Evaluate Session
Recommended Appraisal
Practices
Specify timed learning and competency
objectives
Give regular (formative) feedback with
appropriate strength
Observe in multiple ways and gather
multiple data points
Give written (summative) evaluation with
appropriate strength
Provide specific examples of behavior
that conflicts with expected professional
competencies and specific parameters of
expected behaviors
Common Types of
Interventions
Facilitative: creates warm relational climate
Modeling: demonstrates, provides
observational learning opportunities
Confrontive: directly challenges
Conceptual: integrates abstract with real;
analyzes and links
Prescriptive: gives direct guidance; provides
rationale and “how to”
Catalytic: stirs things up; evokes change
Effective Feedback Principles
Affirm strengths (4:1 ratio)
Attempt to elicit self-corrective feedback
Frame weaknesses developmentally
when indicated (normalize)
Focus on a specific behavior or pattern
and link back to competencies
Provide specific behavioral suggestions
Asks student to respond, comment
Variables Affecting Feedback
“Dose” Determination
Intern’s level of development and
experience
Intern’s level of sensitivity and preferred
communication preferences (attend to
diversity factors)
Instructor’s delivery style
Response to previous related feedback
Degree of concern about client welfare,
intern’s competence
Feedback “Dosing” Options
Low risk/Low control
Allow for “natural
High risk/High control
consequences”
Offer information
Offer a weak
suggestion
Offer a strong
suggestion
Make a direct order
Intervene directly
with client
Three Levels of Feedback
Coaching
Disagreeing
Setting a Limit
Evaluation of Competence
You may not be unfairly harsh to a
student based on his/her level of
education, experience (both life and
professional), and development
You also may not “pass” or “endorse” a
student who poses ethical or legal risks
to the public or the profession
Students have due process rights if their
performance is negatively appraised
Conflict Resolution in
Instructional Relationships
It is the instructor’s responsibility to address
conflict and model appropriate conflict
resolution behaviors
Intern has the responsibility and power to
influence
Instructor style may be a contributing factor to
conflicts and problems
Conflict may be a parallel process
Patience, frustration tolerance required
Reflective listening for underlying intention,
unmet needs, and diversity factors imperative
Wise Perspectives on Working
with Conflict
(Nelson, Barns et al, 2008)
Be open to conflict and
interpersonal processing
– see as part of role
Acknowledge own
shortcomings and model
learning from mistakes
Assume a developmental
approach
Discuss evaluation and
conflict early on
Create strong alliance
Accentuate supervisee
strengths
Provide timely feedback
Contextualize conflicts in
light of development and
environment
Empathize with
supervisee’s perspective
See parallel process
“Self-coach”
Consult
“I think that there is a developmental
stage when a supervisee wants to
disagree with their supervisor and
needs to, when they’re really sort of
testing their own frame of
reference. . . And that we need to
support that . . . And we don’t want
them to be sponges, we really want
them to go in their own direction.”
-- participant in Nelson et al study, 2008
Principles of Evaluation
Review the process with students at beginning,
midpoint, and just prior to evaluation
Anticipate and discuss related anxiety
Link all feedback to explicit learning objectives
and competencies
Use specific behavioral descriptors vs. global
attributions; choose language carefully
Summarize strengths, efforts, and improvement
with areas of developmental need with balance
Recommend desired behaviors and methods
Elicit input
Dissatisfying Evaluations
Not completed on time
(or ever)
Student self-evaluation
overvalued
Too global or vague,
insufficient detail
Overly detailed, key
points unclear
Problem areas not
contextualized
Language harsh,
inflammatory
Imbalanced – overlooks
significant areas and
overly focuses on others
Biased – distorts, does
not accurately represent
or reveal whole picture
Raises new concerns
never before discussed:
SURPRISE!
Evaluation not sufficiently
discussed, no request for
input
No bidirectionality
Essential Tension
Promotion of
Supervisee SelfEfficacy
Clearly
Indicating
Concerns
Irremediable Learners:
Impaired or incompetent?
Impairment: refers to a previously
competent student whose performance
regresses below acceptable levels
Incompetence: refers to a student who
has never obtained baseline competency
Gatekeeping
“If we do not believe the [intern] has
the knowledge and skills to safely
and beneficially serve the public,
we must NOT issue misleading
credentials or statements of
qualifications.”
(From Kocher et al in Falendar and
Sharanske, 2008, p. 167)
Lamb et al’s criteria for
impairment (1987)
(a) an inability and/or unwillingness to acquire and
integrate professional standards into one’s
repertoire of professional behavior;
(b) an inability to acquire professional skills to
reach an acceptable level of competency;
(c) an inability to control personal stress,
psychological dysfunction and/or excessive
emotional reactions that interfere with
professional behavior
p.598
A problem advances to an
impairment when . . .
(a) the intern does not acknowledge, understand, or
address the problem when it is identified
(b) the problem is not merely a reflection of a skill
deficit that
can be rectified by academic or didactic training,
(c) the quality of services delivered by the intern is
consistently negatively affected,
(d) the problem is not restricted to one area of
professional functioning,
(e) a disproportionate amount of attention by training
personnel is required, and/or
(f) the intern’s behavior does not change as a
function of feedback, remediation efforts, and/or
time.
(Lamb et al, 1987, p. 599)
Common Presentations
Severe Disorganization
Routinely late or absent, unreliable follow-through
Problematic documentation
Severe Blocks to Empathy
Cannot engage clientele appropriately
Unconsciously overtly judgmental
Hostile Defensiveness, Argumentation
Reflexively opposes authority
All-or-nothing thinking related to being right
Poor Boundaries and Judgment
Crosses lines
Fails to inform or misrepresents work
Remediation Options
Frank discussion with student
Contact school immediately and request
meeting
Meeting of all concerned parties
Written memorandum or evaluation
Probationary plan with specific behavioral
targets, plans of action, and timelines
Termination of placement
Direct intervention with client, if needed
Transitional Tasks
Consolidating Skill
Summarizing Progress and Growth
Appreciating
Identifying Next Steps for Continued
Development
Re-defining Relationship Needs, Roles,
Expectations, and Boundaries
Moving Toward Consultation