A Comparison of Group and Individual
Supervision Models in First Year Graduate
Clinical Education in Speech-Language
Pathology
Rhea Paul, Ph.D., CCC-SLP
Taryn Rogers, M.A., CCC-SLP
Ellen Massucci M.A., CCC-SLP
Cristina Pino, M.A., CCC-SLP
Speech-Language Pathology Department
College of Health Professions
Sacred Heart University
Sacred Heart University
College of Health Professions
SHU SLP Program Vision
The SHU Speech-Language Pathology Program aspires to
build capacity for provision of the highest quality services
provided by licensed and certified speech-language
pathologists for individuals with communication disorders
and their families in Connecticut and surrounding areas.
Through a commitment to problem-based learning,
academic excellence, innovative models of clinical
training, multidisciplinary preservice education, and
research experiences for master’s level students in speech
language pathology, SHU faculty will nurture the
development of culturally competent, collaborative
practitioners and future leaders in the profession of speechlanguage.
Why explore other clinical
supervision models?
• Cost effectiveness
• Shortages of clinical education placements
• Increase student exposure to practice patterns
students will face in their professional lives, from the
earliest stage
• Limited literature did not reveal significant
differences between outcomes of individual and
team-based models of supervision in either SLP
(Farrow et al., 2000) or in allied professions (Moore et
al., 2003),
Study Purpose: To examine the relative
efficacy of two models of supervision during
first year of SLP clinical education.
Specific Qs: Is there a significant difference based
on the supervision model (Team based vs.
traditional 1:1)experienced by first year student
clinicians in:
• The growth of student professional behavior as
measured by
• on-site supervisors
vs.
• blind experienced clinicians?
• Student satisfaction with assigned supervisory
experience?
• Client outcomes?
Supervision Models
• To test the efficacy of the model,
two types of clinical supervision
were presented during the
students’ first year:
• Team-based supervision
• Individual supervision
Team-Based Supervision
Model
• Four students are assigned to one SHU-based
supervisor who accompanies the students on their
field work placement and supervises their work
together as a team with assigned clients
• Supervision of students by ASHA certified and CT
state licensed full-time faculty and part-time
adjunct faculty
• Students are placed in either schools or skilled
nursing facilities
• Supervisor attends the field site with the students
and in consultation with an on-site clinician, assigns
and supervises their caseload and duties.
Individual Supervision Model
• One student is placed under the supervision of a
clinician based at the fieldwork site and works
alongside her/him, as would typically happen in
later stages of the graduate program.
• Supervision of student by ASHA certified and CT
state licensed community-based SLP
• Fieldwork site supervisor individually assigns and
supervises the individual student’s caseload and
duties
• Clinical placement is overseen by the Director of
Clinical Education who maintains contact with
fieldwork site supervisor throughout the placement
Individual Supervision Model
• Students were placed in Public School, Private
School, Rehab/Clinic settings 2x/week for half
days
• Clinical activities include screening, assessment,
and treatment as assigned by on-site fieldwork
supervisor
Regardless of supervision
model…
• All students will attend fieldwork site for two half
days each week for a total of ten weeks
• Each student will have at least one individual semiweekly meeting with the assigned supervisor
• All supervisory practices will follow ASHA guidelines
• All supervisors will report and confer directly with
Director of Clinical Education periodically during the
semester
Team-Based Supervision
Public Schools
Team-Based Supervision - Child
Clinical Practicum
Public Schools
Placed within four partner school districts:
-5 Elementary Schools/ KDG. Level, some 1st grade
articulation
-1 Typical Preschool
-1 Special Education Preschool
All sites are community based. All students are
identified by classroom teachers as ‘at risk’, within the
classroom.
Supervisor to Graduate Clinician ratio is 1:4.
Team-Based Supervision
Skilled Nursing Facility (SNF)
Team-Based Supervision - Adult Clinical
Practicum
Skilled Nursing Facility (SNF)
Community based skilled nursing facility
140 beds
Subacute and Long Term care residents
Subacute patients randomly selected to participate
in cognitive-linguistic screens
• Long-Term care residents identified by facility SLP to
participate in 1:1 sessions with graduate student
clinicians
• Treatment Diagnoses include: Aphasia, CognitiveCommunication Impairment, Dysarthria, Verbal
Apraxia, Dysphagia
• Supervisor to Graduate Clinician ratio is 1:4.
•
•
•
•
Team-Based Clinical Schedule:
School
Each supervisor/student group is placed at two
schools per week:
• one to two school children per session
• possible caseload total of 8-16 school children
per week
Each school is visited once a week, for a three hour
total block:
• ½ hour pre-meeting; ½ hour post meeting
• 2 hours direct therapy time; four ½ hour sessions
Team-Based Clinical Schedule:
SNF
• Clinical Site visited 2x/week
• 2.5 – 3.0 hours per day
• 15 min. group pre-meeting
• Individual Session Primary Patient (30-45
minutes)
• Individual Session Secondary Patient (30-45
minutes)
• Group Clinical Activity ( 45 minutes)
• 15 min. group post meeting
Team-Based Clinical
Schedule: SNF (cont’d)
• Activities completed as a group:
• Orientation to facility
• Review of Medical Charts for patients identified for 1:1
treatment sessions
• Dysphagia Treatment – Carryover of feeding and swallowing
strategies for long-term residents with dysphagia
• Dysphagia Assessment – Clinical Bedside Evaluation of longterm care patients
• Cognitive-Linguistic Screenings of subacute and long-term
care patients
Activities completed as individual graduate clinicians:
• Individual treatment sessions with primary and secondary
patients
• Cognitive-Linguistic Screening of subacute and long-term care
patients if primary and/or secondary patient is unavailable
17
Group Feedback
Group Feedback
Schools
• Pre-meeting:
-To review an group targeted objectives for the day (Ex.
behavior management strategies; data collection
method, cueing hierarchy, etc), and to discuss any last
minute questions/concerns
• Session:
-Graduate clinicians get children from classrooms (work
with school based SLP to set caseload, schedule, and
therapy space), and return at end of session
-Supervisor has individual session plan to refer to
throughout supervision
-Written feedback pertaining to individual session and
targeted group objective, for each graduate clinician
-When needed, supervisor able to model therapy
technique
Group Feedback
Schools (cont’d)
• Post meeting:
• All feedback discussed with group members
• targeted group objectives
• individual sessions
• All graduate clinicians benefit from experiences of their group
members
• common themes relevant for all first year graduate clinician
• input/questions discussed as a group
• group feedback distributed to all graduate clinicians
• feedback specific to a particular graduate clinician distributed
(ex. loudness level)
• Group and individual objectives for next session are discussed
• graduate clinicians responsible for completing SOAP notes and
session plans
Feedback: SNF
(GROUP FEEDBACK)
Pre-meeting:
Review daily schedule and group activity; discuss questions related
to planned treatment sessions (e.g., discuss methods to facilitate
pt.’s participation / performance, cueing strategies, etc.); review
general feedback and trends in clinical documentation
(INDIVIDUAL FEEDBACK)
Individual Treatment Sessions:
Graduate clinicians meet assigned patient for bedside treatment
sessions. Supervisor rotates between graduate clinicians to observe
and provide individualized, written feedback of session. Modeling
of treatment techniques, cueing strategies incorporated into
session as needed.
Session Plans and SOAP notes are reviewed and individualized,
written suggestions for editing of clinical documentation provided
weekly.
Feedback: SNF
• Dysphagia Treatment: Mealtime Treatment Sessions in Dining
Room Setting
• Clinical Bedside Dysphagia Evaluation
• Administration of Cognitive-Communication Screening Tools
Graduate clinicians and clinical supervisor in one treatment area.
Direct supervision provided for 100% of the clinical experience.
Graduate clinicians are provided with ‘real-time’ feedback and
discussion during clinical experience. Questions are fielded from
the students and responses are shared with the group as a whole.
Admitted
(GROUP FEEDBACK)
• Group Clinical Activity
22
Supervisory Meetings:
Schools
• Students meet individually with supervisor to review:
• individual lesson plans;
• SOAP notes; and
• progress summaries
• Students meet individually with supervisor for:
• Mid-term and Final evaluations
• Students meet individually with supervisor to discuss
specific aspects of student performance that do not
pertain to other students’ clinical experience
Supervisory Meetings:
SNF
• Individual student meetings scheduled at start of
semester to review:
• Weekly session plans
• SOAP notes
• Development and execution of treatment session
• Additional 1:1 meetings scheduled as needed
throughout the semester
• 1:1 Midterm and Final Evaluations scheduled
Study Participants
• 32 first year graduate students, along with one of their
clients, participated in this study.
• All students were assigned to a fieldwork placement, either in
a school or preschool or in a skilled nursing facility.
• All student clinicians, as well as their selected clients, gave
informed consent to participate.
• Once assigned to fieldwork sites, students were assigned to
either:
• a team-based supervision model, in which a SHU
supervisor, working with a team of 4 students, attended the
field site with the students and in consultation with an onsite clinician, assigned and supervised their caseload and
duties (N=16)
Or
• an individual supervision model, in which one student was
assigned to a clinician based at the fieldwork site, who
individually assigned and supervised the individual
student’s caseload and duties (N=16)
Outcome Measures
• Professional Behavior Scale Ratings
(Appendix 1) to assess experienced
clinicians’ ratings of student clinicians’
professional behavior
• Supervisory Evaluation scores to assess
student clinicians’ satisfaction with
supervisory experience
• Change in client scores from pre- to
post-semester on a standard clinical
measure.
Supervisory Ratings: Professional Behavior
• Professional behavior was measured by ratings on a
Professional Behavior Scale (see Appendix 1).
• Supervisor ratings:
• All students were rated by their supervisors (either team-based
or one-to-one) on the PBS early in the semester, and at the
final week of the semester.
• Blind ratings:
• Students collected (with their own and client consent) 10
minute videos of their intervention sessions; one during the first
weeks of the semester, and one during the last week.
• Two clinicians with over ten years of SLP experience were
each randomly assigned two of these videos for each of 20
student clinician participants; they were not told whether the
video came from early or late in the semester, or what type of
supervision (team or one-to-one) the student experienced.
• Inter-rater reliability was collected for 20% of this sample; the
interclass correlation coefficient was .75 (good; Cicchetti,
1994)
Appendix 1: Professional Behaviors Rating Form
SUPERVISOR: Professional Behaviors Rating Scale
Professional
Behavior Area
Professional Behavior Standard
Final Score
Time management
/Stress management
1.
2.
3.
4.
Meets deadlines for assignments, fieldwork assignments/notes
Prioritizes multiple roles and responsibilities in order to be successful in all
Demonstrates coping strategies to maintain focus on priorities
Demonstrates caring for self as appropriate to the situation
0
0
0
0
1
1
1
1
2
2
2
2
Interpersonal
communication
5.
6.
7.
8.
9.
10.
11.
12.
13.
Concise
Assertive
Use of language and non-verbal body language appropriate to context
Listens actively
Maintains eye contact
Attends to speaker
Provides feedback constructively
Displays positive attitude using body posture and affect that communicates interest
Actively seeks feedback and modifies behavior accordingly
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
Written
communication
14.
Demonstrates correct grammar, spelling, punctuation, and formatting for written
assignments
Concise
Well organized
Information relevant to topic and includes supporting details and or evidence
Use of person-first, neutral language
Neat clean appearance and wears clothing, jewelry, make-up appropriate to context
0
0
0
0
0
0
1
1
1
1
1
1
2
2
2
2
2
2
0
1
2
0
0
0
1
1
1
2
2
2
0
0
0
0
1
1
1
1
2
2
2
2
0
0
0
1
1
1
2
2
2
0
1
2
Professional
presentation
Initiative /
Commitment to
learning
15.
16.
17.
18.
19.
Self assessment
27.
28.
29.
Creativity
30.
Self-starts projects, tasks, programs
Identifies relevant course resources to direct own learning
Demonstrates curiosity and eagerness for obtaining new information, skills, and
professional behaviors
Changes behaviors, skills, and attitudes in response to new learning
On time for classes, meetings, fieldwork
Adheres to attendance policy
Informs faculty, supervisor, peers, and or clients in timely and appropriate manner if
absence or lateness is necessary
Fulfills commitments
Completes projects/assignments without prompting
Identifies strengths and weaknesses and identifies strategies and methods to improve
weaknesses
Generates multiple strategies for intervention plans or assignments that are unique
Cooperation and
teamwork
Ethics
31.
32.
33.
34.
Works effectively with others
Assists in the learning of others
Collaborates with others
Adheres to ASHA Code of Ethics
0
0
0
0
1
1
1
1
2
2
2
2
Safety
35.
1
2
36.
37.
38.
39.
40.
41.
42.
43.
Adheres to safety policy and procedures of the environmental context; responds
calmly in urgent situation.
Establishes rapport with clients
Able to focus on client and client’s needs vs. own
Maintains professional boundaries
Demonstrates client-centered family-centered perspective in practice
Uses self-reflection and applies self-knowledge to relationships
Initiates clarification of job, role, and performance expectations
Questions and seeks guidance when un-sure
Initiates establishment of professional development goals in supervision and
establishes methods to accomplish them
Gives respectful and timely feedback to faculty/supervisor
Able to assume multiple roles in response to the needs of the situation
Adapts to changes in the environment, routine, schedule, or needs
Demonstrates respect for cultural differences
Uses neutral, non-judgmental language
Questions rather than assumes
0
Therapeutic
relationships
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
0
0
0
0
0
0
1
1
1
1
1
1
2
2
2
2
2
2
Dependability
Supervisory / faculty
relationships
Flexibility
Cultural competence
20.
21.
22.
23.
24.
25.
26.
44.
45.
46.
47.
48.
49.
Student Satisfaction:
Supervisory Evaluation
• Each student rated her supervisory
experience at the end of the semester,
using the Supervisor Evaluation Form.
• Total scores from each form were
summed
• Total scores were compared for the two
groups of students; those experiencing
• team-based supervision
and
• 1:1 supervision
Appendix 2: Student Supervisory Evaluation
1. RANK ORDER (1, 2 OR 3) each of the following descriptions of supervisory behavior, given your perceptions
about which clinical supervision role your supervisor utilizes most frequently.
1 = least frequently utilized
2 = sometimes utilized
3 = frequently utilized
Write the number that best applies. PLEASE USE EACH DESCRIPTOR ONLY ONCE.
_____ My supervisor takes the dominant role in our supervision interactions. His/her interactions with me are
primarily in directing
activities in accomplishing clinical and supervision tasks and to evaluate my performance.
_____ My supervisor and I share the responsibilities of our supervision interaction. His/her interactions with me are
primarily to work
jointly with me toward accomplishing clinical and supervision tasks and to jointly evaluate my performance.
_____ I take the dominant role in supervision interactions. My supervisor’s interactions with me are primarily to
provide me the necessary
support and/or resources which allow me to accomplish clinical and supervision tasks and to evaluate my own
performance.
2. Please indicate the frequency with which each of the following behaviors were shown by your supervisor.
Circle the number 1–4 (1-Never, 2-Sometimes, 3-Frequently, 4-Always)
I feel comfortable working with my supervisor. 1 2 3 4
My supervisor welcomes my explorations about a client’s behavior. 1 2 3 4
My supervisor makes the effort to understand me. 1 2 3 4
My supervisor encourages me to talk about my work with clients in ways that are comfortable for me. 1 2 3 4
My supervisor is tactful when commenting about my performance. 1 2 3 4
My supervisor encourages me to formulate my own intervention with the client. 1 2 3 4
My supervisor helps me to talk freely. 1 2 3 4
My supervisor stays in tune with me during supervision. 1 2 3 4
I understand client behaviors and treatment techniques similar to the way my supervisor does. 1 2 3 4
I feel free to mention to my supervisor any troublesome feelings I might have about him/her. 1 2 3 4
My supervisor treats me like a colleague in our supervision sessions. 1 2 3 4
During supervision sessions I am more curious than anxious when discussing with my supervisor. 1 2 3 4
In supervision, my supervisor places high priority on our understanding the client’s perspective. 1 2 3 4
When correcting my errors with a client, my supervisor offers alternative ways of intervening. 1 2 3 4
My supervisor helps me work within a specific treatment plan with my clients. 1 2 3 4
My supervisor helps me stay on track during our meetings. 1 2 3 4
I work with my supervisor on specific goals during supervisory sessions. 1 2 3 4
3. Please indicate your perception about each of the following statements as they pertain to your supervisor.
Circle the number 1–4 (1-Never, 2-Sometimes, 3-Frequently, 4-Always)
I can manage to solve difficult clinical problems if I try hard enough. 1 2 3 4
If someone opposes me in a clinical situation, I can find the ways and means to get what I need. 1 2 3 4
I am certain that I can accomplish my goals as a clinician. 1 2 3 4
I am confident that I could deal efficiently with unexpected events that may arise while working with clients. 1 2 3 4
Thanks to my resourcefulness I can handle unforeseen clinical situations that may arise. 1 2 3 4
I can solve most problems that may arise while working with clients. 1 2 3 4
I can remain calm when facing difficulties with a client because I rely on my coping abilities.1 2 3 4
When I am confronted with a problem while working with a client I can find several solutions. 1 2 3 4
If I am in trouble in a situation, I can think of a good solution. 1 2 3 4
I can handle whatever comes my way. 1 2 3 4
4. Overall how satisfied are you with your supervision in general? (circle one)
1 2 3 4 (1-Very Dissatisfied, 2-Mostly Dissatisfied, 3-Mostly Satisfied, 4-Very Satisfied)
5. If your supervisor were to rate your clinical performance to date, he/she would likely rate your clinical skill
development as:
(circle one)
1 2 3 4 (1-Minimal/Not Begun, 2-Emerging, 3-Adequate with Support, 4-Independent)
6. Would you agree that the above evaluation of your clinical skill development is accurate given your clinical
performance? (circle one)
1 2 3 4 (Strongly Disagree, Disagree, Agree, Strongly Agree)
Client Outcomes: Presence
of positive change
• Each student clinician was asked to do a
pre/post assessment of the client
participating in the study, using the same
measure
• Measures included:
•
•
•
•
Mini-mental State Exam
CELF-5
PLS-5
Kindergarten Language Benchmark Assessment
• Pre/post scores were compared
• Assigned to ‘showed positive change’ or not
status
Results: Professional Behavior
Pre-Supervision
Results: End of semester ratings of
Professional Behavior: NSD
Supervisor Ratings
Blind Ratings
Results: Student evaluation of
Supervisory Experience: NSD
Results: Client Outcomes:
NSD
Supervision Type
Team-based
1:1
Client Outcome
Showed positive change on
assessment measure*
8
10
No positive change on
assessment measure*
6
5
*Pre/post assessment measures included CELF-5, PLS-5, Mini-mental State Exam, Kindergarten
Language Benchmark Assessment
The chi-square statistic is 0.279. The p-value is .59737. The result is not significant at p <
.05.
Conclusions
• Students provided with 1:1 and teambased clinical supervision during a first year
practicum experience:
• Approximately equivalent levels of
growth in professional behaviors.
• Approximately equivalent levels of
satisfaction with their supervisory
experience
• Similar client outcomes
• Team-based supervision seems a viable
option for supervisory practice in first year
clinical education.
What makes this supervisory
model unique?
Allows for a more “real-life” clinical experience
Students must learn to adapt to schedule changes
Opportunity to interact with interdisciplinary team members
Practical training for student clinicians entering these
clinical environments in their 3rd, 4th, and 5th semesters.
• Feedback relevant to all students can be shared as a
group
• Individual feedback shared with all students as a peer
learning opportunity
• Fosters collaboration between graduate student clinicians
•
•
•
•
Testimonials…
Our Community Partners…
“Can you come more days a week?”
“Can we add another school for your group to work
with?”
(School Staff and Administrators)
“It’s fantastic to have the continuation of services for
residents who are no longer eligible for billable SLP
services”
(SNF Staff and on-site SLPs)
Our Supervisors…
“I love teaching students in the living environment of
the public schools as they learn first-hand the positives
and the negatives of the setting. I am also amazed at
the many language-learning opportunities that occur
frequently in a setting where children spend the
majority of their waking hours.”
- Arlyne Russo, Ph.D, CCC-SLP
Adjunct clinical supervisor
Our students…
"Group supervision gave me the opportunity to
embrace other's perspectives and grow as a
collaborator, and future speech-language pathologist.
Through the support and feedback of both my
classmates and supervisor each week, I was able
to further develop my clinical and interpersonal skills.
These experiences have taught me to never
underestimate the power of learning from one's peers,
as each individual perspective has something
valuable to offer."
- Victoria Annese (Second Semester Graduate Student)