Evidence-Based & Practical Telesupervision Digital Workshop 1.21.22

C 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.
TBHI Evidence-Based & Practical
Telesupervision Digital Workshop
Marlene M Maheu, PhD

Dr.
Marlene
Maheu
Dr. Marlene Maheu serves as the
Executive Director of the Telebehavioral
Health Institute, where she oversees
professional training in telebehavioral
health via an eLearning platform that has
served behavioral health clinicians from
109 countries.

Next, please introduce yourselves to the group: city & state; specialty; profession
Telebehavioral Health Institute https://telehealth.org

.
Today’s
Program
Sound will be muted to limit
uncontrollable distractions
Please interact in chat box at
designated times
Five-minute bio-break is scheduled at
mid-way point, and session will
conclude 5 minutes later than
scheduled
This is an interactive workshop.
Please show yourself to support the
group process and learn from each
other
LIVE CME or CE if you arrived within
15 min or start AND complete the
post-test today
Otherwise, you will receive
asynchronous course credit hours

.
Optimize Your
Learning
Prevent Interruptions
• Mute your phone, turn off texts and emails,
lock your door
• Ask your family/friends to stay away

LEARNING OBJECTIVES
3 CME or CE Hours
1. Name important knowledge, skills and attitudes
necessary for providing telesupervision
2. Outline key considerations for how to format and
structure telesupervision
3. Outline key factors to address when discussing
cases using technology
4. Name essential issues to consider including in a
telesupervision contract
5. Detail several common engagement strategies
to enhance participation in supervision

.
Telesupervision Defined
Telesupervision is defined as clinical supervision provided across
distance rather than in-person using:
• Electronic communication device
• Audio
• Video
• In real-time
• Telesupervision is (or will-soon-be regularly augmented) by
• Text-messaging
• Apps and soon, other technologies such as
• Affective computing

.
Telesupervision Types
Telesupervision is currently available as:
1. Required pre-licensure
2. Optional post-licensure
3. Mandated Post-licensure
a) Form of remediation

.
Focus on
Competencies
All ethical codes require
competence in our professional
practices
Competence in behavioral health
is NOT equivalent to competence
as a telebehavioral health
professional
Competencies have been
published and continue to be
researched in telebehavioral health

Coalition for Technology in
Behavioral Science (CTiBS)
An Interprofessional
Framework
for Telebehavioral
Health Competencies
Website: CTiBS.org

Framework for
Telebehavioral
Health Competencies
• Download your FREE copy here:
https://telehealth.org/an-
interprofessional-framework-for-
telebehavioral-health-
competencies/

CTiBS TBH Competency
Framework
7 DOMAINS
5 SUBDOMAINS
51 TELEBEHAVIORAL
COMPETENCIES
146 COMPETENCIES
A. NOVICE
B. PROFICIENT
C. AUTHORITY

7 CTiBS TBH
Competency Domains
(We will touch 5 today)
CLINICAL
TELEPRESENCE
TECHNICAL
MHEALTH
ETHICAL & EVIDENCE-BASED
LEGAL & REGULATORY
PRACTICE DEVELOPMENT

CTiBS TBH Competency Domains
(We will look at 3 today)
Clinical
Telepresence
Technical mHealth
Ethical &
Evidence-Based
Legal &
Regulatory
Practice
Development
7 Domains
Framework for
Telebehavioral
Health Competencies

r
Telesupervisor &
Telesupervisee
• About developing growth
• Knowledge
• Skills & Attitudes
• Individual vs. Group
• Expectations
Copyright 1994-2020 Telebehavioral Health Institute, LLC All rights reserved.

r
Telesupervision or
Consultation Group • Format of Group
• Structure of the Group

r
What should be considered
when initiating
telesupervision with
supervisee?
• Engagement
• Professional Development
• Communication

.
Difference between
In-Person vs
Telesupervision
• First job is to draw out answers vs
give answers
• People are experienced differently
online
• Greater potential for
miscommunication
• Need to be more active
• More reflection and open-ended
questions to be sure to get the
whole story
• More distractions for supervisor as
well as supervisee

Telebehavioral
Health
Institute
https://telehealth.org

.
Technology Basics
Preferences (Email
/Texting/Telephone/Video)
Skills
Concerns / resistance
Social networking – social media policy

.
Technology Basics
File exchanges via email, text or
websites
What will happen if someone else
sends clinician information
How someone else can easily intercept
information
Having equipment repaired and how
their privacy could be compromised

.
Technology Basics
Automation:
 Record supervision hours
 Remind supervisors of their state’s
reporting requirements by sending
regular emails prior to due dates
 Automatically notify supervisees of
scheduled meetings and tasks
 Calculate paychecks

r
Who to screen & prep
supervisees for
telesupervision?
• Communication skills
• Professional concerns
• Ability to follow through
• Any employee concerns

.
Screening
& Prepping
Potential
Supervisees
• Develop purpose and expectations
• Determine tech to be used
• Check tech capacity
• Observing ethics and confidentiality
• Review telesupervision contract

.
Engaging
Supervisees in
Telesupervision
• “Opening Protocol”
• Ice breakers to bring focus
• Breakout rooms
• Role plays
• Homework

.
Difference between
in-person vs
telesupervision
• Group Size
• Nuances are different
• Optimal group size?
• Some states limit number
to 6
• Fewer number might be
better for your style
• If you do 8, what would
have to change for you to
be effective?

.
Difference between
In-Person vs
Telesupervision
Group Size
• Be intentional about questions
• Easier to lose site of how
each person is responding to
a case
• Difficult to see faces on
screen
• Peripheral vison
• Direct Challenges
• Multi-tasking
• Technology failures

r
How does the supervisee
provide a case
conceptualization
differently in telehealth?
• #1 problem across US
• Ability to “see” the client
• Use of technology
• Verbal vs non-verbal

.
What do you need
to be aware of to
inform the
questions that you
ask supervisee?
• Moving in-person  tele
• Must understand supervisee
telepresence
• Pay attention to breathing
• Hesitations
• Stuttering
• Fidgeting
• Bunny trail
• Parallel process
• Tell me your anxiety? What
are you deflecting?

r
How to deal with
technology preferences?
• Client’s/Patient’s Preference
• Clinician’s Preference
• Ultimately – both parties

r
What is different about
using telephone for
telesupervision?
• Verbal vs non-verbal
• What are you not telling me
about the client?

.
Telephone – often
helpful for crisis
management and
direction
• More real-time
• Shorter duration
• More confined, predictable interaction
• Ask for supervisee to always
provide phone # or contact info if
not using phone (EHR)
• Can use texting as support (911)
• Observe privacy rules because
texting using iMessage or other
pre-installed texting software is
not HIPAA-compliant

.
Telephone – pick up
cues differently
• Pay attention to breathing
• More easily distracted
• Location
• Other people in room
• Public area
• Driving

.
Screening
& Prepping
Potential
Supervisees
• Structure
• Case Presentations
• Documentation – more in number and more
specific documentation
• Technology – both parties must be comfortable
with technology choices but no one should be
forced to use any technology

.
Which technology are
you now using?
• What do you
like / like less?
Now?
• Why did you
leave?
Past?

r
How do you think about
state regulations related
to telesupervision?
• Different practice definitions
• Different practice regulations
• Different mandated reporting
• Different supervision rules

.
State
Regulations
Crossing State Lines & International
Borders
• Illegal without proper registration or
licensure in the foreign state or country
• Enforcement is different in the case of
emergencies
• Enforcement is lax
• Beneficence over malfeasance
• Telesupervision is illegal over state lines
in most states
M

.
State
Regulations
Crossing State Lines & International
Borders
• Required processes & documentation
may be different from yours
• Mandatory reporting definitions and
timelines
• Abuse
• Duty to warn
• Sexual misconduct of prior
therapists
M

.
How to Identify Your
Legal & Regulatory
Requirements as a
Telesupervisor?
• State licensing boards
• Use any search engine – look for
equivalent of business and
professions code
• Best source for information about
legal and regulatory requirements
• Center for Connected Health Policy
• https://www.cchpca.org/
• WeAreMotivo
• https://wearemotivo.com/online-
clinical-supervision-rules/

.
How to Identify
Your State
Regulations
• As a supervisor, you must comply
with both your own and your
supervisee’s regs
• NASW – require compliance with
the more stringent of the two
• Board can change regs overnight
• Document fully – keep informed
• Copy/paste them into your
documents with screenshots and
dates
• Be an advocate

International Practice

.
Steps to Take for
International Practice
• Write to licensing boards
• Contact foreign embassy
• Seek legal advice
• Contact malpractice carrier

.
Ethical Considerations Same as In-Person
Except for Documentation

.
Documentation
Training
Research
Forms
Telesupervision agreement
Telesupervision notes
Malpractice carrier

.
Documentation Resources to Reference
 Consensus documents
 Validated research
 Supervision & consultation
records

.
Making Referrals
Refer to colleagues who have had
documented telehealth
training
supervision or
experience

.
Telesupervision
Contract
• Required by many leading national
associations
• Required by many states
• Intent and purpose of telesupervision
• Logistics & expectations
• Mandatory disclosures – per state
• Mandatory reporting – per state
• No driving – liability for you

.
Telesupervision
contract
• Confidentiality and privacy –
maintaining HIPAA compliance
• Expectations: how to prep for
Telesupervision
• Supervisees experience &
qualifications for teletherapy

.
Telesupervision
contract
• Special opportunities and
difficulties
• Synchronous versus
asynchronous Telesupervision
• Addressing confusion, anxiety
• How to provide feedback in
telesupervision
• Addressing technology failures
• Lack of dedicated workspace

Malpractice insurance for telepractice can be quite different from in-
person supervision

.
Malpractice
Carriers (Liability
Insurance)
• American Professional Agency , Inc.
• Covers many different behavioral
professions, independent and group
practices
• Direct: (631) 750-2083
• Office: (800) 421-6694 (x2235)
• Gallagher
• Telehealth companies
• P: 630-694-4268 |Toll Free:
855.840.1046|F: 630.694.4401

.
Telesupervision
Technology
• Teams (Microsoft)
• Zoom
• WebEx
• Specialized tech
• Group Chat
• What do you use?
• Why?
• What did you use and leave?
• Why?

r
Ethical Considerations
• Follow the law
• State & Federal Mandates
• Confidentiality
• Competencies
• Consultation

r
What are the relevant
standards for
telesupervision?
• Ethical standards (codes)
• Clinical (or treatment)
standards
• Administrative standards
• Technical standards

r
Ethics codes &
standards for
telesupervision
• AAMFT, AMHCA, both APAs
• ACA, NBCC
• NAADAC
• NASW Technology Standards
• JCAHO, COA, CARF, URAC

.
National
Associations
• Ethical codes from
national associations all
are relevant to
Telesupervision, whether
or not they mention the
word “Telesupervision”

How do you
create culturally
responsive
telesupervision?

.
Cultural
Responsiveness
/Diversity
• How might cultural responsiveness
manifest online more than than in-
person?
• More easily mask linguistic ability – may
need to ask more questions
• Could more readily be using adaptive
devices
• Geographic access may belie religion or
culture
• May see more of personal environment
• May see other people in household

r
Research on
telesupervision
• Martin, Lizarondo & Kumar
(2018)
• SAMHSA TIP 60 (2015)
• Tarlow, McCord, Nelson &
Bernhard (2020)

.
From the research:
There are 8 factors
that influence the
quality &
effectiveness of
telesupervision
1. Supervisee characteristics
2. Supervisor characteristics
3. Supervision characteristics
4. Supervisory relationship
5. Communication strategies
6. Prior face-to-face contact
7. Environmental factors
8. Technological considerations

.
Benefits: Going
from In-Person to
Telesupervision
• Flexibility in scheduling
• Extends accessibility
• Access to SMEs for consultation
• Collaborative tools
• Individual & group telesupervision

.
Delivery: from
In-Person to
Telesupervision
• Professional liability
• Synchronous vs. asynchronous
delivery
• Deciding on individual vs. group
supervision
• Factors that influence quality &
effectiveness
• REFERENCE:

r
Telesupervisory
Activities
• Case presentation
• Consultation with SME
• Ethical deliberation
• Skills development
• Case management

.
Creating
Group
Telesupervision
Agreement
• Video camera: on vs. off
• Attendance: on-time vs. late
• Environment: quiet vs. loud
• Participation: engaged or silent
• Connection: present vs. absent
• Respect: valuing members vs. not

.
Addressing
Privacy &
Confidentiality
• Privacy vs. Confidentiality
• Privacy is the individual’s legal right to
control the dissemination of information
• Confidentiality is professional’s legal duty
to protect an individual’s privacy
• We cannot guarantee 100% privacy when
using technology
• HIPAA-Compliant Video Platforms
• Ethical Mandates
• Legal Obligations
M

r
Where can you easily and
inexpensively find the evidence
base for telesupervision?
• PubMed
• Google Scholar
• Research Gate
• Traditional library

.
Handling
Emergencies –
How to develop my
supervisee?
• Protocols for handling
emergencies
• Critical thinking skills
• Look for warning signs of:
• Suicidality
• Homicide
• Impairment
• Sexuality
• Anger
• Instill an understanding that
mandatory reporting is THE SAME
as for in-person care

.
Documenting
Emergency Procedures
How will your telesupervisee
handle?
• Behavioral emergency: homicide
threat, abuse…
• Medical emergency: fainting,
asthma attack, suicide attempt,
physically unresponsive…

r
What are evidence-
based approaches to
handling clinical
emergencies?
• Duty to warn
• Mandatory reporting
• Impairment

.
COVID & Telesupervision
We conclude by offering structure and content suggestions for a four-session
intensive workshop to provide trainees and supervisors alike with a
telepsychology “primer” prior to providing services. In particular, we suggest
training clinics adopt telepsychology best practice guidelines rather than adopt
the mindset of implementing a temporary solution for providing services during
the pandemic.
Baier, A. L., & Danzo, S. (2021, January 14). Moving Toward a New Era of
Telepsychology in University Training Clinics: Considerations and Curricula
Recommendations. Training and Education in Professional Psychology.
Advance online publication. http://dx.doi.org/10.1037/tep0000359

What would
you say/do
do if…

Eavesdropper?

What would you say if
Shanika called to report
that her client signaled
her for help and she
froze.
She didn’t know how to
best respond.

What would you
encourage Shanika to
say or do?

.
Considerations when other people
are available in the home
Evaluate clinical need
Consider boundary issues
Is it appropriate for the clinical plan?
Does it involve safety?
How can Shanika control the exchange?
Are they friendly or hostile?

.
Handling Potentially Violent Intruders
• Which is the best option in most circumstances?
• Welcome, then include the guest as part of the session
• Stop the session and ask the client what they want to do
• Ignore the family member and see what develops "in vivo”
• Stop the session, excuse yourself, terminate the session and consider calling
the police. Document well.

r
The Business of
Telesupervision
• Advertising
• Commerce
• Partnerships
• Practice

r
Other issues to consider
as a telesupervisor …
• Interpreting assessments
• Experiential activities
• Nonverbal messages

Stay in touch 
Telehealth.org
contact@telehealth.org
619-255-2788

Evidence-Based & Practical Telesupervision Digital Workshop 1.21.22

More Related Content

Similar to Evidence-Based & Practical Telesupervision Digital Workshop 1.21.22

More from Connor Swofford

Recently uploaded

Evidence-Based & Practical Telesupervision Digital Workshop 1.21.22

Editor's Notes