Supervision learning

Student speech and language therapists

As a student studying to become a professional in a regulated profession, you have certain responsibilities. You must adhere to the HCPC guidance on conduct and ethics for students in any issues relating to supervision.

Experiences of supervision as students and NQPs will directly influence attitudes towards, beliefs about and commitment to regular supervision in the long term. Consequently, it is important for all student SLTs to receive good quality supervision from the outset of their professional careers.

To this end, it is essential that student SLTs are given information on the different functions of supervision, the roles of supervisor and supervisee, and the supervisory process during their pre-registration education. This needs to include clear guidance on how to make best use of supervision, how to ensure that NQPs access quality supervision regularly and the range of issues addressed in this document.

There are areas of overlap between how students are supervised while on placement, and how NQPs use supervision. There are also important differences, primarily around the fact that while on placement, the student is undergoing pre-registration assessment.

Newly-qualified practitioners

This section outlines the additional recommendations on supervision and support for NQPs and refers to the supervision requirements for the completion of the RCSLT NQP competency-based transitional framework.

It is strongly encouraged that all NQPs consider the importance of managerial supervision, professional supervision and professional support when applying for their first post. It is also vital that managers and employers recognise their role and responsibility in ensuring all NQPs access both forms of supervision and professional support. For safe and effective practice, the RCSLT requires NQPs to undertake a comprehensive programme of supervision and support for the first 12-18 months of employment. This will establish good working practices and help develop self-confidence in the long-term.

RCSLT recognises that it is the responsibility of the NQP and employer to ensure the supervisor that is signing-off the competencies is an SLT who is a member of the RCSLT and registered with the HCPC. The RCSLT strongly recommends that this is confirmed before the NQP commences employment.

Managerial supervision:

RCSLT recommends that managerial supervision should be at least weekly for the first three months of work and monthly thereafter. The managerial supervisor could facilitate the NQP in collecting evidence for the NQP competency framework (RCSLT, 2017) and monitoring progress.

Professional supervision:

RCSLT recommends that the professional supervisor for an NQP must be an experienced SLT in the relevant clinical area. For NQPs, professional supervision should be at least weekly during the first three months and monthly thereafter. The professional supervisor could facilitate the NQP in collecting evidence for the NQP competency framework (ibid). Professional supervision for an NQP needs to be more intensive and hands-on initially so that both supervisor and supervisee can quickly identify the NQP’s needs and already-established skills.

If the role of managerial supervisor and professional supervisor are carried out by different people who are both eligible to sign off the NQP framework, a decision needs to be made regarding how this will be monitored and signed-off. The RCSLT will only verify a completed NQP framework with the signature of RCSLT certified and HCPC registered SLTs.

It is also important that both supervisor and supervisee recognise that the evidence collected for the NQP competency framework might differ in form, content and the extent of reflection expected, depending on each individual. The NQP competency framework is a general template, but the strengths, needs and development of individuals will differ and an appreciation of this can mature within the process of effective supervision.

As an NQP, it is strongly recommended that before and/or at interview they have a conversation regarding ongoing supervision culture and practice in the organisation in which they are applying. They need to pay particular attention to costing and time allocation for both types of supervision for posts where there is no speech and language therapy management and supervision structure (e.g. the only SLT in school or private hospital setting).

The RCSLT does not recommend that recently-qualified practitioners work in independent practice, in independent organisations, as locums or undertake bank work during this transitional period without having confirmation from their employer that they will receive supervision from an HCPC registered SLT who also has certified membership of RCSLT.

The Newly Qualified Practitioners: Speech and language therapy competency framework to guide transition to certified RCSLT membership (2007) identifies a set of clear expectations and standards to structure the learning of NQPs, during their initial 12-month period of practice and evidence of readiness to transfer to certified RCSLT membership.

Speech and language therapists through their career

(including developing and specialist SLTs, SLT managers, SLTs working in public health and education)

Although supervision is strongly associated with training at a pre-qualification level, it is equally relevant to qualified SLTs at all stages in their career as it plays a central role in the maintenance and ongoing development of their knowledge, skills and practice.

As all SLTs develop and diversify in terms of area of specialism and roles, their supervision needs to change. They will not only require different approaches to their own supervision, they will also take on the role as a supervisor in relation to other SLT and non-SLT staff.

Development in supervision has been written about extensively in the literature identifying four levels to the supervisory relationship, each with its own unique features (Stoltenberg & Delworth, 1987):

• Level 1: Childhood – Novice
• Level 2: Adolescence – Journeyman
• Level 3: Early adulthood – Independent craftsman
• Level 4: Full maturity – Master craftsman

Over the course of their career, a supervisee typically moves from a position of high dependence on the supervisor to more autonomy, self-awareness, self-confidence and flexibility. At this later stage, supervision is not viewed so much in terms of acquiring more knowledge, but in terms of allowing knowledge to be deepened and integrated.

In terms of the role of the supervisor, s/he needs to transition from providing a clearly structured, supportive learning environment to offering a more collegial relationship with a focus on listening to deeper meanings and wider implications.

This progression is not always linear for every practitioner. They may find themselves at different levels at different times in relation to different aspects of their role. Equally, they can find themselves moving back a level or two at significant transition points (e.g. when they take on a new position or role).

Returners to practice

HCPC returning to practice requirements apply to anyone who has not practised for more than two years. This is the case whether you are unregistered and want to apply for re-admission, or whether you are still on the register but not practising.

These returners are required by HCPC to undergo a period of updating knowledge and skills. This period of updating varies from 30-60 days, depending on the length of time they have been out of practice and can be made up of any combination of supervised practice, formal study or private study.

‘Supervised practice’ is practising under the supervision of a registered professional, either as an SLT or as an SLTA. In order to complete a period of supervised practice, you need to identify a supervisor.

According to HCPC your supervisor must: (ibid, p.4):

• Be on the relevant part of the HCPC register;
• Have been in regulated practice for at least the previous three years; and
• Not be subject to any fitness to practise proceedings or orders (i.e. they must not be cautioned, or subject to ‘conditions of practice’).

HCPC requires that your supervisor should only supervise those activities which are within their own scope of practice (ibid). This is so that your supervisor can provide relevant input and guidance, and also to ensure that both you and your supervisor are practising safely and effectively.

For more information see:

HCPC (2017) Returning to practice

The minimum requirement of frequency and duration of supervision needs to be met by all practitioners. However, RCSLT recognises that returning to practice is a time when practitioners are likely to require a greater intensity of supervision and support, while they update their knowledge and skills. Should a higher level of supervision be required, this needs to be negotiated between supervisee and supervisor on the basis of individual learning needs.

Speech and language therapy support workers

The term support worker is used throughout this document to include all members of the speech and language therapy support workforce.

RCSLT (2009) has a policy statement on the education and training for support workers. This stipulates that the qualified SLT holds the ethical and legal ‘duty of care’ for the client and consequently for the standard of duties delegated to a support worker.

The HCPC states:

“You must continue to provide appropriate supervision and support to those you delegate work to”

All clinical decisions concerning the client are therefore the responsibility of the qualified SLT, including client selection for therapy, admission to the caseload and discharge from the service. A therapist must therefore always be responsible for the work undertaken by a support worker.

It is fully acknowledged by the RCSLT that the SLT may not always have line management or responsibility for support workers and that this responsibility is likely to be determined by local protocols and staffing structures.

This guidance stipulates that there must be a system in place for support workers to access regular managerial and professional supervision and professional support. Both forms of supervision must comply with RCSLT best-practice guidance for minimum frequency.

Managerial supervision of support workers has a key role to play in:

• Supporting the development of individuals, in line with personal need and service requirements.
• Ensuring consistency and quality in the delivery of services.
• Helping individuals to meet statutory obligations.
• Ensuring clarity about roles and expectations.

Professional supervision must be provided by the registered practitioner working with the support worker and must include consideration of:

• The level of experience and understanding of the support worker relevant to the task being delegated.
• Assessment of the support worker’s competence relevant to the delegated task.
• The complexity of the delegated task(s).
• The stability and predictability of the client’s health status.
• The environment or setting in which the delegated task is to be performed and the support infrastructure available.
• Availability of and access to support from an appropriate registered professional.

This may incorporate elements of direction, guidance, observation, joint working, discussion, exchange of ideas and co-ordination of activities, but the overarching three functions of supervision need to be maintained.

An identified process for recording all supervision and professional support needs to be agreed by all parties. An identified process for regular review and evaluation of the SLTA’s performance is essential.

If for any reason a support workers designated supervisor is not able to provide the agreed level of supervision (e.g. maternity leave, long-term sickness), another state-registered SLT must be assigned to supervise as soon as possible. When the supervising therapist is absent from a setting where the support worker is working, there must be an identified contact, in case of query or emergency.

Frequently asked questions

Accessing supervision

1. I am a sole practitioner/the only SLT in my place of work. How can I access good quality supervision?

If you are working outside of a large organisation, and don’t have a formal supervision structure, you may need to be more proactive in accessing regular supervision and support.

2. I am already stretched in my working day, how can I justify prioritising supervision over seeing service users?

Supervision is important to service-user safety. This has been highlighted in a number of recent health service reviews, for example, the Winterbourne View Hospital final report includes a recommendation that service-providers “should provide effective and appropriate leadership, management, mentoring and supervision”(Department of Health (2012, Winterbourne View Hospital: Department of Health review and response p. 54).

Supervision can “help ensure that people who use services and their carers receive high quality care at all times from staff who are able to manage the personal and emotional impact of their practice” (CQC, 2013, p. 5) and that “clinical supervision has been associated with higher levels of staff effectiveness” (p. 6).

Supervision is also an essential part of adhering to the HCPC standards that SLTs must adhere to.

3. Is there a minimum frequency or duration for supervision based on experience?

Newly qualified practitioners (NQPs) require more frequent supervision – every week during their first three months, and every month thereafter.

The recommendations for frequency and duration for all other practicing SLTs and assistants are the same, regardless of experience – every 4 – 6 weeks.

4. I need more supervision sessions than my department provides, but I’ve been told it’s not possible to increase the number of sessions available. What should I do?

Explain the reasons for the required increase – has there been a temporary change in circumstances, or have you taken on new responsibilities?

Identify the risks of not receiving more supervision, and present these in written format. If these approaches don’t work, you could consider setting up a peer supervision group or self-funding external supervision.

5. I am an experienced therapist; who is suitable to supervise me?

A range of different supervisors can be accessed for different purposes e.g.

• Your line manager for managerial supervision
• A colleague from the same or different health profession for professional supervision
• 1:1 or small group supervision

Reflect on who/what have you found helpful in the past.

Explore personal networks and groups (e.g. CENs, RCSLT advisers, ASLTIP groups).

Consider setting up a peer supervision arrangement.

Consider looking outside SLT and accessing another health professional.

6. Do I really need supervision? Having worked as an SLT for a number of years I have developed a style of working with which I am content.

Supervision is essential as a place for exploring personal and emotional reactions to work. These occur regardless of levels of experience or length of time working.

However experienced you are, it’s always useful to have a place where you can reflect with a colleague on your style of working in order to review and develop.

It may help to:

a) Access supervision training to explore the scope of supervision practice and personal relevance.

b) Experience robust supervision practice from a skilled external supervisor to help you to reflect on this

c) Discuss with peers to find out more about their supervision arrangements and what it offers them.

Quality of supervision

7. How do I make sure that the quality of the relationship I have with my supervisor/supervisee is maintained?

The following can help:

• Clear contracting
• Regular review opportunities
• Open and transparent communication
• Attend training, in order to have an understanding of different models and approaches.
• Consider changing supervisor if the relationship is not working; look at local or trust policy for information regarding choice of supervisors.

8. Does my supervisor have to be my line manager?

Typically your managerial supervision will be provided by your line manager, who may or may not be an SLT.

Your professional supervision should be provided by someone who is not your line manager where possible.

9. I feel as a more senior SLT I am expected to know more than I do. I’m worried that providing supervision will expose any gaps in my knowledge and undermine my authority with less experienced therapists.

Some people think supervision is solely about competency and checking or supporting competency in NQPs, it can be construed as indicating lack of confidence or competence issues in senior SLTs.

Being a supervisor is not necessarily about having the answers – it is about supporting the supervisee in their thinking through of an issue or topic.

It is possible that a supervisor may/may not know more about a topic than a supervisee.

It is important that as an experienced SLT you support a culture at work in which supervision is regarded as essential and as part of clinical governance in keeping practitioners and patients safe.

Consider taking this issue to your own professional supervision to explore further.

10. How do I ensure that I am working within a strong supervision culture and feel adequately supported by colleagues?

Before you accept a role, ask at interview about the Trust/organisation/department’s philosophy towards supervision.

Make a mind map to reflect on the supervision/support systems available to you.

Use your supervision to have a dialogue about how you are receiving support and what changes you might need to make.

Remember supervision and professional support is a necessity and a right.

11. My colleagues think supervision is only needed for issues related to difficult clinical situation or for times of stress at work. How do I help them to see that supervision has a far wider application?

Send them a link to these web pages:

Have supervision as a standing item on the staff meeting agenda to protect regular time for developing awareness and giving it the importance it deserves at a whole service level.

Share your personal experiences of supervision and how it has helped you to stay safe, develop professionally and supervise others.

Organise departmental training on supervision for all staff to change culture around supervision and/or signpost further training.

12. I work in a department in which supervision is seen as a perk for more junior therapists and not for more senior SLTs. What should I do?

Supervision is essential to SLTs at all stages of their careers – signpost your colleagues to Information on supervision section 6.3 (p. 26) for information on supervision throughout your career.

Have supervision as a standing item on the staff meeting agenda to protect regular time for developing awareness and giving it the importance it deserves at a whole service level.

Share your personal experiences of supervision and how it has helped you to stay safe, develop professionally and supervise others.

Organise departmental training on supervision for all staff to change culture around supervision and/or signpost further training.

Training

The Care Quality Commission (2013) provides supporting information and guidance on supporting effective clinical supervision.

SLTs who offer supervision should have the appropriate skills, qualifications, experience and knowledge to undertake the role. Sources of training to develop your knowledge and skills include:

Via your employer

• Many NHS speech and language therapy departments and larger independent speech and language therapy companies offer courses as part of their professional development package. Ask your manager if another course is due or if the department could develop a training day.
• If you’re working independently, you might be able to join in a course run by a local NHS speech and language therapy department – it’s worth asking.
• NHS employees can also check what is available through Continued Professional and Personal Development (CPPD) contracts and online portals.

If the training is not currently available, consider flagging it directly with your training department; it may prompt them to commission the training.

Universities

• Practice educator training at universities may include some information relevant to supervision of practicing clinicians.
• Some universities offer post-registration CPD courses e.g. modules in professional development or evaluation and reflection in practice, often include some critical appraisal of the relevant literature and supervision models etc.
• Universities training students regularly include information about post-qualification clinical supervision. They might be interested in running a training event for more experienced practitioners.

Training providers

• A number of training providers offer generic supervision training, others may offer bespoke supervision training for SLTs. Search online for “supervision training for health professionals” or “supervision training for speech and language therapists”.
• Look in the Bulletin adverts section – supervision courses appear there several times a year.
• Follow @RCSLT on twitter or look out for emails from CENs, for updates on relevant courses.
• Contact the RCSLT Information Officer for signposting to local or national training providers.

Other professions

• Other professions also have well-developed supervision structures. You may be able to access their training courses e.g. British Association for Counselling and Psychotherapy (BACP) accredited courses.

Articles

Dawson, M., Phillips, B., & Leggat, S. (2013). Clinical supervision for allied health professionals: a systematic review. Journal of allied health, 42(2), 65-73.

Philippa Pearce, Bev Phillips, Margaret Dawson, Sandra G. Leggat, (2013)“Content of clinical supervision sessions for nurses and allied health professionals: A systematic review”, Clinical Governance: An International Journal, Vol. 18 Issue: 2, pp.139-154,

Pollock A., Campbell P., Deery R., Fleming M., Rankin J., Sloan G. & Cheyne H. (2017) A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals. Journal of Advanced Nursing 73(8), 1825–1837.

Martin P, Copley J, Tyack Z (2013) Twelve tips for effective clinical supervision based on a narrative literature review and expert opinion. Medical Teacher 36(3) DOI 10.3109/0142159X.2013.852166

Dawson, M., Phillips, B., & Leggat, S. G. (2012). Effective clinical supervision for regional allied health professionals – the supervisee’s perspective. Australian Health Review, 36(1), 92-97.

Kilminster, S., Cottrell, D., Grant, J., & Jolly, B. (2007). AMEE Guide No. 27: Effective educational and clinical supervision. Medical teacher, 29(1), 2-19.

Saxby, C., Wilson, J., & Newcombe, P. (2015). Can clinical supervision sustain our workforce in the current healthcare landscape? Findings from a Queensland study of allied health professionals. Australian Health Review, 39(4), 476-482.

Simpson, S. & Sparkes, C. (2008). Are you getting enough? – (1) Supervision in Context. Speech & Language Therapy in Practice, Spring Edition, 30.

Simpson, S. & Sparkes, C. (2008). Are you getting enough? – (2) Supervision models and barriers. Speech & Language Therapy in Practice, Summer Edition, 18-19.

Simpson, S. & Sparkes, C. (2008). Are you getting enough? – (3) The supervision process. Speech & Language Therapy in Practice, Autumn Edition, 18 – 19.

Simpson, S. & Sparkes, C. (2008). Are you getting enough? – (4) From supervisee to supervisor. Speech & Language Therapy in Practice, Winter Edition, 18-19.

Sparkes, C. & Simpson, S. (2013). Supporting robust supervision practice. Bulletin, February, Pg22-23. .

Diana W. L. Ho & Tara Whitehill Clinical supervision of speech-language pathology students: Comparison of two models of feedback International Journal of Speech-Language Pathology Vol. 11 , Iss. 3,2009

Van der Gaag, Anna (2013) Professionalism: drawing new lines in the sand January 2013, Pg 16.

Books

Driscoll, J. (2000). Practising clinical supervision: a reflective approach. Bailliere Tindall

Hawkins P. and Shohet, R. (2006). Supervision in the Helping Professions (3rd Edition). Milton Keynes, O.U.P.

Inskipp, F. and Proctor, B. (1993). Making the Most of Supervision. Part 1. Cascade Publications.

Proctor, B. (2000). Group Supervision: A Guide to Creative Practice. Sage.

Schuck, C. and Wood, J. (2011). Inspiring Creative Supervision. Jessica Kingsley Publishers.

Shohet, R. (2008). Passionate Supervision. Jessica Kingsley Publishers.

Shohet, R. (Ed) (2011). Supervision as Transformation: A passion for learning. Jessica Kingsley Publishers.

Syder, D. & Levy, C. (1998). Supervision in Syder, D. (Ed), Talking about Aphasia, Winslow Press.

Tudor, K. & Worrall, M. (2004). Freedom to Practice: Person-Centred Approaches to Supervision. PCCS Books, Ross-on-Wye.

Tudor, K. & Worrall, M. (2007). Freedom to Practice Volume 2: Developing Person-Centred Approaches to Supervision. PCCS Books, Ross-on-Wye.

Online resources

• HCPC guidance for supervisees and supervisors
• ASHA Clinical Supervision in Speech-Language Pathology technical report (2008)
• NHS Education for Scotland Support and Supervision – Resources, tips and examples to help you integrate support and supervision into everyday practice, as part of your own and others professional and career development.
• The Superguide: A handbook for supervising allied health professionals (2012) – Developed to promote the widespread provision of high quality supervision across adult and children’s social care in New South Wales (Australia) with application to a wider workforce.