Advanced Field Instruction: A Competency-Based

Approach

Greg Merrill, LCSWgregmerrill@berkeley.edu

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

SupporterTeacherMentor Role ModelCoach

AdministratorEvaluatorQuality

Assurance Officer

Gatekeeper

Essential Tension

Supervisee Right Client Right

To Learn To Safe,

Effective Services

What Learners Want . . .

Available, Makes Time Competent and Ethical Warm, supportive

relationship Individualized

strengths-oriented assessment

Organized and Dependable

Elicits/Facilitates knowledge

Addresses weak areas squarely but fairly

Challenges in right amount

Processes conflicts Assesses meaningfully Asks for input,

feedback and adjusts

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: novice 2: intermediate 3: advanced 3i: 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 Assessment Treatment Planning Clinical Interventions:

Selection and application

Modification of Interventions

Transition and termination

Professional use of 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 ConsultationWritten ActivitiesAudio or videotapingLive Observation or SupervisionExperiential MethodsTopical Reviews

The Triangle

Supervisor

Supervisee Client

The Supervisee’s Prism

Supervisor

Client

Supervisee’s Perceptions and Verbal

Presentation

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

High risk/High control

Allow for “natural 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 Clearly

Supervisee Self- Indicating

Efficacy 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 thatcan 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