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
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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
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What Learners Resent . . .
(Nelson & Friedlander, 2001)
 Disorganized +/or
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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,
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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
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1:
2:
3:
3i:
novice
intermediate
advanced
expert
 Key “Structures” or
Variables
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Level of Motivation
Level of Autonomy
Level of Self and
Other Awareness
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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
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 Clinical Interventions:
Selection and
application
 Modification of
Interventions
 Transition and
termination
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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
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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
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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
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 High risk/High control
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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
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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
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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
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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,
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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
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(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
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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
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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