Week 1 Homework Assignment (Ethical Issues in Clinical Supervision)

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  • #4536
    Patricia Burke
    Keymaster

    As stated in the lesson, as a clinical supervisor, you are responsible for the actions and inactions of the clinicians and staff you supervise. This is known as the legal concept of respondeat superior and the doctrine of vicarious liability. Take five minutes right now to write down your immediate, gut reactions to this legal concept and ethical doctrine. Don’t edit your reactions. Just write down your thoughts and emotional reactions. This is for you. You will not be asked to share any reactions that you do not feel comfortable sharing with the class.


    Homework Questions

    Question 1

    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?

    Question 2

    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?

    Question 3

    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?


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    #16380
    dsinskie
    Participant

    Question 1
    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?
    This is truly a scary concept. I started out as a crisis supervisor and at least then, I participated in their training, I was with my team daily, I read their documentation, and we had routine case reviews and education. And I was much less experienced myself, so I don’t think I was as aware of the liability as I am now. Now, I supervise 4 individuals working in the jail system who I haven’t trained, and I don’t see them daily. It’s very different. They also have differing levels of credentials/licensure and experience. Although, I have learned that the number of years someone has in the field doesn’t equal less liability.
    Question 2
    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?
    1. I have had the opportunity to resume peer supervision recently as well as sharing an office building with another licensed individual who is willing to engage in peer supervision on occasion. I feel this is a good strategy to determine what any reasonable prudent person would do in certain situations. Also, its beneficial for my own self-care.
    2. The agency I provide supervision for has an individual development plan attached to the annual review. I use this as well as trying to develop an annual training plan that covers a lot of the topics such as boundaries, confidentiality, ethics and more.
    3. Honestly, I stopped doing supervision for about a year due to specific concerns. I’m glad to be clinically supervising again. I would do well to attend to thorough documentation. I would like to have a supervision note that has topics on the top and can check off which ones were discussed.
    Question 3
    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?
    I don’t think we have ever had a real discussion around this. We do have bi-monthly QI meetings and I complete a monthly supervision report which describes any issues or commendations for each supervisee. It’s a good topic to bring up!

    #16401
    CHELSEA SPEAR
    Participant

    Question 1
    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?

    Answer- To be honest, it is something that creates anxiety for me. I pride myself on adhering highly to ethical standards and though I also strive to be the best clinical supervisor I can be, at the end of the day I do not have control over another’s behavior. This anxiety does not overwhelm for the most part, though, as it just fuels me to be sure I am keeping detailed documentation and providing the best clinical supervision possible.

    Question 2
    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?
    Answer:
    1. vicarious liability fuels me to ensure that my staff are adequately trained. In addition to helping them secure outside training, I also implement training as a part of my weekly group supervision
    2. I have become an over the top documenter of any potential supervisory issues. This has enabled me to feel more secure in knowing that if anything were to occur, I have enough to support that I was doing my job ethically
    3. I have increased direct in vivo supervision as well as regular quality assurance calls to clients to make sure that

    Question 3
    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?
    Answer:
    Honestly, my agency does not do the best job of giving me space to manage the responsibility of vicarious liability. I do not let this deter me, however, and I continue to push back and link the need for me to provide increased clinical supervision as necessary for ethical client care as a whole.

    #16426
    melissa cormier
    Participant

    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?

    My views on this have shifted throughout my career. When I was a new supervisor, this was terrifying. As I became more comfortable with both my clinical skills and as a supervisor,my ability to seek out others advice grew. If there is a sticky case with one of the clinicians I am supervising, I often seek out peer consultation. I also take my time with decisions now and feel more comfortable slowing down the process of making decisions to make sure we are headed in the safest direction, weighting out different factors. I feel strongly that we have a responsibility to others in our field to offer support, challenge each other, and hold each other accountable for a high ethical and clinical standard. I now enjoy helping younger clinicians process challenging cases and also enjoy more peer consultation for my own clinical practice.

    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?

    Peer support is an extremely important strategy. I am fortunate to work with a very seasoned clinical team and trust their judgement. I often will seek out multiple clinicians if it is a particularly challenging case to make sure I am getting adequate feedback and support before I make a decision.

    Taking my time is another strategy I use frequently. There are very few decisions that need a rapid response in the moment. Giving myself time to challenge my thinking, review facts, process with other clinicians, and review documentation and or other material (such as code of ethics) is now part of my clinical decision making strategy.

    I also will consult with legal is I am unsure. We have wonderful legal council that has been extremely helpful to consult when a decision feels a bit messy.

    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?

    Part of my clinical role at my agency, is to make sure we have a process in place where clinicians (including myself) feel supported and clinical managers feel supported as well. We offer group supervision and individual supervision. We offer all clinician training through out the year as well. I also meet twice a month with all my clinical managers as a group to discuss clinician issues and offer support to each other. Supervision is key in offering high quality clinical work. We could always do more and I look for opportunities to increase clinical conversations whenever possible.

    #16431
    Esther Cyr
    Participant

    1. What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor? The idea of taking on vicarious liability is very frightening to me. I can guide supervisee’s but have no control over whether the individual will follow through with recommendations or behave ethically towards clients.

    2. Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?
    1. When supervising staff I follow-up at the next supervision on any recommendations or actions taken as a result of the previous supervision. 2. I consult with a consultant when in doubt about recommendations regarding a case. 3. I keep staff informed of new information and give them an opportunity to ask questions.

    3. How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking? My CEO meets with me regularly and gives me an opportunity to inform her of any dilemma’s or potential dilemma’s either myself or staff may be facing. I keep the CEO updated on any questions about either legal or ethical issues the agency may be subject because of staff issues with clients. The agency has access to legal attorneys and they are consulted when the CEO or myself are unsure. Staff are included in the problem solving process and educated on presenting issue. The agency seeks to educate staff, there are regular and annual trainings to support staff development.

    #16432
    Nichole Gulowsen
    Participant

    Question 1: What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?

    Honestly, the idea that I am accepting responsibility for the actions and inactions of others that I supervise is scary. I attempt to hold myself to a relatively high standard when it comes to ethics (thanks to an amazing supervisor I had in the past who also prided herself on ethics) and while I may advise a supervisee to take certain action, there is no guarantee at the end of the day they are going to follow said advice (i.e., inaction); that is kind of a scary thought.

    Question 2: Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?

    (1) “document, document, document” – this was a mantra instilled in me during my school years! As noted above, while I may advise a supervisee to take certain action, they may decide otherwise and that is where, I feel, documentation is key in that if something should transpire as a result of their inappropriate actions or inaction, I have documentation of what I recommended. (2) “supervision of the supervision” – this was something mentioned in the lesson materials. While I perhaps do not do this as consistently as I should, I have on several occasions sought the opinions of others RE: recommendations I have made or am thinking of making. (3) I honestly cannot think of a third strategy that I employ to manage this ‘sense of responsibility’ aside from maybe ensuring I engage in appropriate self-care?

    Question 3: How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?

    I am actually in private practice and currently sub-contract with an agency to provide supervision to their case managers. As a sub-contractor, there is little to no support from the agency as far as managing legal and/or ethical responsibilities of vicarious liability, which is another reason why I emphasize documentation …. as well as possessing liability insurance coverage! ????

    #16433
    Sindee Gozansky
    Participant

    Question 1
    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor? It’s a huge amount of added responsibility but also a risk that I’m aware I’m taking on, in order to best serve my supervisee and their clients. I also feel anxiety around that, but try to keep in mind that the vicarious liability responsibility comes as an expectation with the extra experience and training needed to be a clinical supervisor and it keeps me from taking the task lightly. Understanding the importance of vicarious liability is something I can model for my supervisees to help them realize the gravity of their own liability for clients.
    Question 2
    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way?
    1) I currently request a supervisees who have had issues or need greater oversight to complete more thorough paperwork in terms of a supervisee agenda prior to our meeting, so that they prepare with greater care and organization and I have access to more details about their cases.
    2) I encourage master’s level interns to videotape sessions when consent is given in order to provide greater in the moment supervision and assess for issues.
    3) I engage in peer supervision and supervision of supervision to help me see any blind spots, process cases and issues, and consult as needed.
    Question 3
    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking? I’m in private practice but my master’s level interns are from USM so there is support from the student’s advisor and internship instructor, with whom I meet once or twice during their internship. I also attend regular trainings and engage in ongoing professional development in issues of supervision. I found my prior experience in agency work to be lacking in adequate supervisory support.

    #16434
    Patricia Burke
    Keymaster

    Posted for Beth Andrews

    Question 1

    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor? While it is uncomfortable to know that I could have liability for the actions of others, I feel that entering this field required an acceptance of that inevitability. Other fields may not carry as much risk, but this is what I chose, and what I love. Someone else carried vicarious liability for me when I was beginning, and now I do that for others. It is scary, but also something that must happen.

    Question 2

    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way? 1) Acceptance: If I choose to be in this field, and be a supervisor, accept the risk, and do my best to be prepared. 2) Consultation: While I do not have my own supervisor, I meet with colleagues regularly, to discuss case questions and get their perspectives, which occasionally includes risks or pitfalls I may not have thought of on my own. 3) Check, check and re-check my work and my instincts.

    Question 3

    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking? I no longer work for an agency, but when I did, I was in a situation where I felt unsupported by my boss. Initially, I felt I had nowhere to turn with my concerns, but I was able to speak to others and got the support I needed to correct the situation. I appreciated the acknowledgement of the potential risk, and the support I received to mitigate it.

    #16435

    1) Awareness question:
    For me, the experience of being a supervisor has been heavy at times but also rewarding. I take this role very seriously, and due to that, I have actually stopped supervising for the past 5 years. I did not feel I had adequate supports (my own supervision, being on the cutting edge on the field, increased risks in our populations) to sustain my work and supervisees. I am looking at taking on that duty again – and this reading has validated my choices, now and in the past.
    What I loved about supervision was its’ complexity and impact on others. Watching supervisees grow and change professionally was very rewarding. I know that by doing this supervisory work, I am also helping “30 – 40 – 50” clients, their families and their worlds by supporting the counselor – makes a positive dent in their world☺
    2) Strategies question:
    I put a lot of structure in my supervision for clarity within the supervisory relationship. My disclosure statement gets longer every year, especially with more play therapy and technology information regarding the supervisory relationship. I sent an intake form to the supervisee with the request that they return it the first time. Supervisees needed to document their own liability insurance as well as their strengths, challenges and goals. We reviewed these goals and the supervisory relationship periodically (informally) and yearly(formally) to continue our professional structure. Having structure helped the counselor remember their professional obligations and improvement while they were engaged in working day-to-day “in the trenches.” Having structure also helped me to manage my responsibilities as their supervisor.
    I would also engage in regular supervision-of-supervision on a regular basis. EXTREMELY IMPORTANT for me to reduce negative impacts of vicarious traumatization and the increased responsibility of managing their high risk clientele.
    3. Agency support question.
    Agencies can support with regular supervision-of-supervision, standardized documents and helping their supervisors be cutting edge in professional information. Agencies can send their staff to trainings and workshops, especially by sending more than one staff member to increase sharing and communication of information within the agency.
    My agency is very supportive financially about trainings and when staff returns from workshops, information is shared among the staff for a positive benefit to all. They promote a culture of learning and shared common language regarding our professional work.

    #16615
    Matthew Fein
    Participant

    Question 1
    What is it like for you to know that you have taken or might take on the duty and responsibility of vicarious liability as a clinical supervisor?
    It makes me aware of the accountability I must have in supervising others. It also makes me aware of what I need to find out regarding my role, resources, and how to protect myself.
    Question 2
    Describe 3 strategies you have already employed or have thought about employing to manage this sense of responsibility so it doesn’t impact your clinical and supervisory work negatively and/or does impact your work in a positive way? It
    I have professional liability insurance. It informs how I supervise others, which is already in place. The responsibility of my role is mostly a given considering the ethical framework of the profession. It makes me proactive in seeking out resources within the organization. I’m fairly new to this organization and to a the role of supervising more than master’s students, so this lesson has certainly helped.

    Question 3
    How does your agency support/not support you to manage the legal and ethical responsibility of vicarious liability and how can you advocate for more support if it is lacking?

    I have some liability insurance through the organization. Having already encountered some concerns in the first month of being employed here, I don’t think the organization is as responsive as they could be. I am not sure who the legal counsel is, but I don’t think there should be an intermediary between myself and that person.

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