COUN226 Lecture 7: Week 7 Lecture
19 May 2018
School
Department
Course
Professor
COUN226 Ethical & Professional Issues in Counselling
Lecture 7 – Competence Dr Karen Whalley
Overview
• Competence
• What is Supervision?
• Models of Supervision
• Supervisory Relationship
• Legal Aspects of Supervision
• Risk Management
Competence
Competence
• Having and maintaining the skills needed to practice in the field
–Sound knowledge of services being provided, & tools, techniques
and theories being used
–Not static but ongoing as new research & theory emerge
• Only provide psychological/counselling services in which they are
competent
• Core competencies vs specific competencies
• Professional codes of ethics on competence have common themes
–Example: AHPRA (Australian Health Practitioners Professional
Regulation Authority -> Psychology Board of Australia)
–Adopted APS Code of Ethics
–APS Code B.1: Competence
Perspectives on Competence
• Counsellors/Psychologists practice only within the boundaries of
competence, based on:
–Education
–Training - keep up to data
–Supervised experience
–Professional credentials
–Appropriate professional experience
Assessment of Competence
Assessment approaches are most effective when they integrate both
formative and summative evaluations:
Formative assessment: a developmentally informed process that
provides useful feedback during one’s training and throughout
one’s professional career
○
Summative assessment: an end point evaluation typically
completed at the end of a professional program or when applying
for registration
○
•
Developing or Upgrading Skills
Work with colleagues or professionals who have more experience •
Seek consultation before moving outside the areas in which you have
received education and training
•
Learn new skills by attending conferences and conventions, reading
books and professional journal articles, taking additional courses, and
participating in workshops that combine didactic work with supervised
practice
•
APS Professional Development Requirements
Activity Point Allocation
Workshop 1 pt per hour
Professional Course 1 pt per hour
Conference 1 pt per hour
Symposium/lecture 1 pt per hour
Video & audio resources 1 pt per hour
Internet-based learning 1 pt per hour
Reading articles 1 pt per hour
Relevant postgrad studies 30 pts per year
Supervision 1 pt per hour
*Need 60 PD points over a 2-year period to be a member of APS
Making Referrals
• When:
–Counselors become aware that they do not have skills to offer client
needed services
–Counselors do not possess the competency for effective service
• How:
–Have knowledge of type and calibre of service available in your
community
• Who:
–Client must agree that problem exists and be willing to work with
referral
Ethical Issues in Training Therapists Training programs have an ethical
responsibility to:
–Establish clear selection criteria ( for admission to program)
–Provide exposure to major contemporary counselling theories
–Teach students strengths and limitations of theories
–Combine academic and personal learning
–Screen candidates to protect public from incompetent practitioners
–Teach range of skills to work with diverse clients
–Provide training in ethics
Evaluating the Character and Psychological Fitness of Trainees
• Interpersonal behaviors of trainees have a direct bearing on their clinical
effectiveness, so these factors must be taken into consideration in the
evaluation process
• Character
–Honesty and integrity with which a person deals with others
• Psychological fitness
–Emotional or mental stability necessary to practice safely and
effectively
–Fitness can be evidenced by:
• Presence of personality adjustment
• Absence of psychological disorder
• Appropriate use of substances
Gatekeeper Role of Faculty in Promoting Competence
The academic faculty in a professional program generally has a
gatekeeper’s role, protecting consumers by identifying and intervening
with graduate students who exhibit problematic behaviors
•
The gatekeeper role is addressed in the ethics codes of most
professional organisations
•
When a student has good grades but demonstrates substandard
interpersonal behavior indicating serious unresolved conflicts,
intervention is required
•
Dismissal from a program is a measure of last resort •
Registration and Specific Professional Bodies
Verification of qualifications •
Sets minimum standards •
Does not assure quality practice •
Governs professional practice •
Highlights uniqueness of an occupation •
Restricts both use of title and practice of occupation •
In Australia, the use of the title of Counsellor is not restricted •
Australian Health Practitioner Regulation Agency
Aboriginal and Torres Strait Islander Health Practice •
Chinese Medicine •
Chiropractic •
Dental •
Medical •
Medical Radiation Practice •
Nursing & Midwifery •
• Occupational Therapy
• Optometry
• Osteopathy
• Paramedicine(late 2018)
• Pharmacy
• Physiotherapy
• Podiatry
• Psychology
APS Code
B.1.2. Psychologists only provide psychological services within the
boundaries of their professional competence.
This includes, but is not restricted to:
(a) working within the limits of their education, training, supervised
experience and appropriate professional experience;
(b) basing their service on the established knowledge of the discipline and
profession of psychology;
(c) adhering to the Code and the Guidelines;
(d) complying with the law of the jurisdiction in which they provide
psychological
services; and
(e) ensuring that their emotional, mental, and physical state does not impair
their ability to provide a competent psychological service.
PACFA Code
Objectives: This Code has been designed to:
–Establish the ethical framework for the practice of counselling
and psychotherapy;
–Identify the principles, attitudes and behaviours required for
ethical practice;
–Provide clients and the wider community
–with clear and accessible information on the expected ethical
standards in counselling and psychotherapy;
–Establish standards of practice that will support safe, high
quality
services for clients; and
•
Develop the capacity of those who work to the Code to reflect on •
the ethical dimension of their practice and to make responsible ethical
decisions in complex circumstances.
•
PACFA Code of Ethics
• 2. Work to high professional standards
a. Practitioners deliver competent services that aim to meet clients’ •
desired outcomes. •
b. Practitioners give careful consideration to the limitations of their
training, experience and competence and work within these limits.
They provide information on other services and referral options if they
are not able to meet the client’s needs or if the client requires
additional services in parallel with or instead of counselling or
psychotherapy. In particular, onward referral is recommended when a
client has a serious mental health issue and the Practitioner has
concerns that treatment from other mental health professionals may
be required.
•
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
•
children and young people; •
couples and families; and •
groups with particular characteristics or special needs •
d. Practitioners monitor and maintain their fitness to practice at a level
that enables them to provide safe and effective services. In particular:
Practitioners do not practice if intoxicated.
•
They do not practice if unfit for practice due to health impairment or
personal circumstances.
•
They seek the advice of their supervisor or line manager if their fitness
to practice becomes impaired and, if necessary, they withdraw from
practice until their fitness to practice returns. Arrangements for
ongoing access to counselling or
•
psychotherapy should be made for clients who are affected. •
e. Practitioners maintain their competence for clinical practice by: •
Having regular formal supervision in order to monitor and review their
work with clients; keeping up to date with the latest knowledge and
responding to changing circumstances through continuing professional
development; and
•
reflecting on their practice through personal development activities
and dialogue with colleagues
•...
• http://www.pacfa.org.au/wp-content/uploads/2017/11/PACFA-
Code-of- Ethics-2017.pdf
•
Case Example
A couple makes an appointment with Ellen, a counsellor with 10 years
experience in private practice. This couple is requesting sex therapy, and the
initial assessment suggests that they have accurately identified the major
difficulty in their relationship. In fact, the sexual dysfunction they describe is
very common and usually responsive to therapy.
Ellen had no formal courses in sex therapy in graduate school, but she has
read several books on the topic and attended a 2 day workshop on the topic
9 months ago. Ellen also has a colleague with extensive training and
experience in this area who is willing to supervise her for this case.
In this situation, can Ellen consider herself competent to offer professional
services to this couple?
What is Supervision?
Supervision
Clinical supervision: an intervention that is provided by a senior
member of the profession to a junior member of that same profession
•
Can involve a number of processes:
–One counsellor having direct control and authority over
another
–Counsellor giving input to a colleague regarding a specific case
•
Supervisors:
–Are responsible for welfare of supervisees
–Are indirectly responsible for the clients served by supervisees
–May have responsibility to an agency where supervised
practice occurs to ensure quality services are provided
–May serve as gatekeepers to the profession
•
Formal relationship to discuss your work and ensuring you have
adeuqate threaputic relatinship, it’s a supportive space to reflect your
job, assitance in professional development, trusting relationship
relargding work related concerns
-
Not;
Someone watching over your shoulder
○
•
Formal Supervision
This occurs when there is planned contact •
Needs to be priority •
For continuing professional development •
Both supervisor and supervisee have prepared for this meeting •
Express purpose of:
–Discussion of professional issues
–Planning subsequent interventions
•
–Planning projects
–Generating feedback
Planned contact ensures supervision time is a priority and not
something that occurs “whenever things slow down”
•
Allows sufficient opportunity for preparation •
Other Supervision Types
• Group
–Regular group meetings of counsellors/psychologists
–Leader/chair is generally appointed
–A member provides an overview of a case
–Feedback and discussion follows by group members
–For ethical reasons, work supervisor should not attend
• Peer
–Peers provide review of cases of their colleagues
–May be more or less formal
Supervision during training
• A process that involves a supervisor overseeing the professional work of a
trainee with four major goals to:
1. Promote supervisee growth and development - improve yoursel
2. Protect the welfare of the client
3. Monitor supervisee performance and to serve as a gatekeeper for the
profession
4. Empower the supervisee to self-supervise and carry out these goals as an
independent professional
Consultation
Like supervision, involves a tripartite relationship between the
consultant, consultee and client
•
Increasingly common in schools, agencies and other settings •
Consultant does not have administrative authority over another
counsellor
•
Cannot be held accountable for what the counsellor/consultee
ultimately does
•
The counsellor/consultee can choose to accept or ignore the advice
provided
•
To avoid possible legal issues, a consultant should not meet:
–With the client for whom they are providing advice
–Regularly with the counsellor/consultee
•
Methods of Supervision
• Self-report
• Process notes
• Audio recording
• Video recording
• Live supervision
Models of Supervision
Historical Development
• Phase 1 – Psychoanalytic model
• Phase 2 – Counselling models
• Phase 3 – Developmental & Social models
Psychoanalytic Model
In early days of Freud, supervision was informal •
Small groups gathered to train, discuss and review each others’ client
work
•
With advent of formal training, a focus on “personal analysis”
developed
•
Distinction later occurred between “personal analysis” and
“supervisory or control analysis”
–Functions now carried out by different people
–Supervisor’s function was to teach
–Personal problems referred to personal analyst
•
Counselling Models
Developed in 1950’s with advent of counselling orientations other than
psychodynamic
•
Linked to counselling roots •
Took on counselling names
–Person-Centred supervision
–Rational-emotive supervision
•
Approach based almost exclusively on counsellor’s theory •
Emphasis on skills •
Taping sessions •
Supervision in small groups using group process as a learning
mechanism
•
Peer supervision •
Developmental and Social Role Models
• Movement away from clinical models tied to counselling orientations
• Educational and psycho-social models emerged
• Emphasis on:
–Roles/tasks of supervisors
–Learning stages of supervisees
Developmental Models
• Work on premises similar to models of developmental psychology
• People move through distinct stages
• Each stage is characterized by tasks and demands to be fulfilled before
transition to the next stage
Social Role Models
Supervisor and supervisee adopt certain relationships towards one
another
•
Attempts to define:
–What supervisors and supervisees do within supervision
–What tasks are performed by whom
•
Tasks are the behavioural side of a role •
Role is person-centred
–Teacher/Pupil
•
Task is action-centred
–To teach/learn
•
Supervisory Relationship
Supervisor’s Role
Responsible for detecting symptoms of burn out, transference, hidden
agendas in supervisee
•
Sessions over a period of time should include:
–Evaluation
–Education
–Administration
–Support
•
Established professional who can help open doors in the organization
and community
–Key experiences & networks
•
Supervisory Relationships
Ideally based upon trust and mutual understanding •
Supervisor is primary source of support on the job •
Establishing good communication forms a solid foundation for work
together
•
Discuss your thoughts about supervision •
If not sufficiently clear about expectations, initiate
discussion about this
•
Draw upon supervisor’s support, knowledge and expertise à
enhances learning and reduces stress
•
Intern Characteristics
Be open to feedback and instruction •
Eager to learn •
Inquisitive and energetic •
Knowledgeable •
Realistic about own skills and knowledge •
Willing to take risks in order to gain new skills and knowledge •
Appropriately assertive •
Take responsibility for own learning •
Demonstrate initiative •
Be a good listener, observer and communicator •
Styles of Supervision
• Cherniss & Egnatios (1977) identified five supervisory styles:
–Didadic-Consultative; Superviee acknowledges skills but supervisiors
has last say
–Insight-oriented; ask questions to allow superviee to think things
through
–Feelings-oriented; question enotional responses to clients
–Laizzez-faire; leaves alone unless superviee seeks out help
–Authoritative; closely observe and evaluate perfromance
Focus in Supervision
• Different focus points within supervision:
–Traditional; emphasis on the model above
–Person-centred; more values of empathy and posiitve regard,
supervior encourage to step into shoe of supervioee
• Necessary elements
–Warmth
–Trust
–Genuineness
–Confidentiality
–Respect
Use of Time
Develop an agenda – helpful to provide a day or so in advance •
Prepare written summaries of important issues to be discussed •
Set priorities:
–“What issues in my work currently concern me most?”
–“What are the time-sensitive issues that need my supervisor’s
attention now?”
•
Your supervisor may wish to discuss specific issues:
–Certain case
–New project .....
•
Issues for Consideration
Your work with clients - supervisor relatinship centreed appoin clients•
Projects that you have been assigned •
Work and interactions with colleagues •
Understanding your responsibilities to the agency/company •
Professional values and ethics •
Personal reactions, feelings, attitudes and biases as they relate to your
work
•
Supervisory relationship itself •
Fears and Barriers
Concerns about having work scrutinized •
Not meeting supervisor’s expectations •
Having work criticized •
Experiencing your supervisor as:
–Overly critical
–Unavailable
–Far younger
–Vastly different background
–Different personality styles
•
Some supervisors are eager for feedback whilst others are less open to
suggestions
•
Questions to Discuss
What are the implications of this discussion for improving my future
work?
•
What will I do in my next contact with this client? •
How will I relate to this particular staff member in
the future?
•
How will I handle myself in the next meeting? •
How will I approach the next task in
completing the project?
•
Receiving Feedback
Crucial yet potentially difficult aspect of supervisory relationship •
Feedback can be difficult to receive •
Internal and external factors can influence your ability to
receive feedback:
–Easier to receive when it matches self-perception –
Internalizing feedback requires time and reflection
•
Easier to receive if the source is trusted •
Try not to become defensive •
Respond to unfair feedback •
Mandatory Supervision Requirements
As an ACA registered counsellor you must complete 10 hours of
supervision per calendar year
•
Suggested ratio is 1 hour of supervision for every 20 hours of client
contact time
•
Ideally, full-time counsellors should receive supervision once per week
(but not < once per month)
•
Supervisor must be registered or recognised by ACAàACA College of
Supervisors register on ACA webpage
•
Legal Aspects of Supervision
Legal Aspects of Supervision
Informed consent •
Confidentiality and its limits •
• Liability
–Direct liability: can be incurred when the actions of supervisors
are the cause for harm
–Vicarious liability: pertains to the responsibilities supervisors
have to oversee the actions of their
supervisees
•
Informed Consent in Supervision
The standard of practice is to incorporate clear informed consent material
for supervisees, both orally and in writing
It is beneficial to discuss the rights of supervisees from the beginning of the
supervisory relationship
When supervisees learn what they can expect in all aspects of their
supervision and what they need to do to achieve success, supervisees are
empowered to:
Express expectations
Make decisions
Become active participants in the supervisory process
The Supervision Contract
A supervision contract should contain:
–Supervisor’s qualifications, position in workplace
–Methods to be used in supervision
–Responsibilities and requirements of supervisor & supervisee
–Policies pertaining to confidentiality and privacy
–Risks and benefits
–Evaluation of performance
–Complaint procedures and due process
–Professional development goals
–Duration of the supervision contract
Risk Management
Risk Management Practices for Supervisors
Don’t supervise beyond your competence •
Evaluate and monitor supervisees’ competence •
Be available for supervision consistently •
Formulate a sound supervision contract •
Maintain written policies •
Document all supervisory activities •
Consult with appropriate professionals •
Risk Management Practices for Supervisors
Maintain a working knowledge of ethics codes, legal statutes, and
licensing regulations
•
Use multiple methods of supervision •
Have a feedback and evaluation plan •
Verify that your professional liability insurance covers you for
supervision
•
Evaluate and screen all clients under your supervisee’s care •
Establish a policy for ensuring confidentiality •
Incorporate informed consent in practice •
Video - IVF
-
Week 7 Lecture
Thursday, 19 April 2018
10:22 PM
COUN226 Ethical & Professional Issues in Counselling
Lecture 7 – Competence Dr Karen Whalley
Overview
• Competence
• What is Supervision?
• Models of Supervision
• Supervisory Relationship
• Legal Aspects of Supervision
• Risk Management
Competence
Competence
• Having and maintaining the skills needed to practice in the field
–Sound knowledge of services being provided, & tools, techniques
and theories being used
–Not static but ongoing as new research & theory emerge
• Only provide psychological/counselling services in which they are
competent
• Core competencies vs specific competencies
• Professional codes of ethics on competence have common themes
–Example: AHPRA (Australian Health Practitioners Professional
Regulation Authority -> Psychology Board of Australia)
–Adopted APS Code of Ethics
–APS Code B.1: Competence
Perspectives on Competence
• Counsellors/Psychologists practice only within the boundaries of
competence, based on:
–Education
–Training - keep up to data
–Supervised experience
–Professional credentials
–Appropriate professional experience
Assessment of Competence
Assessment approaches are most effective when they integrate both
formative and summative evaluations:
Formative assessment: a developmentally informed process that
provides useful feedback during one’s training and throughout
one’s professional career
○
Summative assessment: an end point evaluation typically
completed at the end of a professional program or when applying
for registration
○
•
Developing or Upgrading Skills
Work with colleagues or professionals who have more experience
•
Seek consultation before moving outside the areas in which you have
received education and training
•
Learn new skills by attending conferences and conventions, reading
books and professional journal articles, taking additional courses, and
participating in workshops that combine didactic work with supervised
practice
•
APS Professional Development Requirements
Activity
Point Allocation
Workshop
1 pt per hour
Professional Course
1 pt per hour
Conference
1 pt per hour
Symposium/lecture
1 pt per hour
Video & audio resources
1 pt per hour
Internet-based learning
1 pt per hour
Reading articles
1 pt per hour
Relevant postgrad studies
30 pts per year
Supervision
1 pt per hour
*Need 60 PD points over a 2-year period to be a member of APS
Making Referrals
• When:
–Counselors become aware that they do not have skills to offer client
needed services
–Counselors do not possess the competency for effective service
• How:
–Have knowledge of type and calibre of service available in your
community
• Who:
–Client must agree that problem exists and be willing to work with
referral
Ethical Issues in Training Therapists Training programs have an ethical
responsibility to:
–Establish clear selection criteria ( for admission to program)
–Provide exposure to major contemporary counselling theories
–Teach students strengths and limitations of theories
–Combine academic and personal learning
–Screen candidates to protect public from incompetent practitioners
–Teach range of skills to work with diverse clients
–Provide training in ethics
Evaluating the Character and Psychological Fitness of Trainees
• Interpersonal behaviors of trainees have a direct bearing on their clinical
effectiveness, so these factors must be taken into consideration in the
evaluation process
• Character
–Honesty and integrity with which a person deals with others
• Psychological fitness
–Emotional or mental stability necessary to practice safely and
effectively
–Fitness can be evidenced by:
• Presence of personality adjustment
• Absence of psychological disorder
• Appropriate use of substances
Gatekeeper Role of Faculty in Promoting Competence
The academic faculty in a professional program generally has a
gatekeeper’s role, protecting consumers by identifying and intervening
with graduate students who exhibit problematic behaviors
•
The gatekeeper role is addressed in the ethics codes of most
professional organisations
•
When a student has good grades but demonstrates substandard
interpersonal behavior indicating serious unresolved conflicts,
intervention is required
•
Dismissal from a program is a measure of last resort •
Registration and Specific Professional Bodies
Verification of qualifications •
Sets minimum standards •
Does not assure quality practice •
Governs professional practice •
Highlights uniqueness of an occupation •
Restricts both use of title and practice of occupation •
In Australia, the use of the title of Counsellor is not restricted •
Australian Health Practitioner Regulation Agency
Aboriginal and Torres Strait Islander Health Practice •
Chinese Medicine •
Chiropractic •
Dental •
Medical •
Medical Radiation Practice •
Nursing & Midwifery •
• Occupational Therapy
• Optometry
• Osteopathy
• Paramedicine(late 2018)
• Pharmacy
• Physiotherapy
• Podiatry
• Psychology
APS Code
B.1.2. Psychologists only provide psychological services within the
boundaries of their professional competence.
This includes, but is not restricted to:
(a) working within the limits of their education, training, supervised
experience and appropriate professional experience;
(b) basing their service on the established knowledge of the discipline and
profession of psychology;
(c) adhering to the Code and the Guidelines;
(d) complying with the law of the jurisdiction in which they provide
psychological
services; and
(e) ensuring that their emotional, mental, and physical state does not impair
their ability to provide a competent psychological service.
PACFA Code
Objectives: This Code has been designed to:
–Establish the ethical framework for the practice of counselling
and psychotherapy;
–Identify the principles, attitudes and behaviours required for
ethical practice;
–Provide clients and the wider community
–with clear and accessible information on the expected ethical
standards in counselling and psychotherapy;
–Establish standards of practice that will support safe, high
quality
services for clients; and
•
Develop the capacity of those who work to the Code to reflect on •
the ethical dimension of their practice and to make responsible ethical
decisions in complex circumstances.
•
PACFA Code of Ethics
• 2. Work to high professional standards
a. Practitioners deliver competent services that aim to meet clients’ •
desired outcomes. •
b. Practitioners give careful consideration to the limitations of their
training, experience and competence and work within these limits.
They provide information on other services and referral options if they
are not able to meet the client’s needs or if the client requires
additional services in parallel with or instead of counselling or
psychotherapy. In particular, onward referral is recommended when a
client has a serious mental health issue and the Practitioner has
concerns that treatment from other mental health professionals may
be required.
•
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
•
children and young people; •
couples and families; and •
groups with particular characteristics or special needs •
d. Practitioners monitor and maintain their fitness to practice at a level
that enables them to provide safe and effective services. In particular:
Practitioners do not practice if intoxicated.
•
They do not practice if unfit for practice due to health impairment or
personal circumstances.
•
They seek the advice of their supervisor or line manager if their fitness
to practice becomes impaired and, if necessary, they withdraw from
practice until their fitness to practice returns. Arrangements for
ongoing access to counselling or
•
psychotherapy should be made for clients who are affected. •
e. Practitioners maintain their competence for clinical practice by: •
Having regular formal supervision in order to monitor and review their
work with clients; keeping up to date with the latest knowledge and
responding to changing circumstances through continuing professional
development; and
•
reflecting on their practice through personal development activities
and dialogue with colleagues
•...
• http://www.pacfa.org.au/wp-content/uploads/2017/11/PACFA-
Code-of- Ethics-2017.pdf
•
Case Example
A couple makes an appointment with Ellen, a counsellor with 10 years
experience in private practice. This couple is requesting sex therapy, and the
initial assessment suggests that they have accurately identified the major
difficulty in their relationship. In fact, the sexual dysfunction they describe is
very common and usually responsive to therapy.
Ellen had no formal courses in sex therapy in graduate school, but she has
read several books on the topic and attended a 2 day workshop on the topic
9 months ago. Ellen also has a colleague with extensive training and
experience in this area who is willing to supervise her for this case.
In this situation, can Ellen consider herself competent to offer professional
services to this couple?
What is Supervision?
Supervision
Clinical supervision: an intervention that is provided by a senior
member of the profession to a junior member of that same profession
•
Can involve a number of processes:
–One counsellor having direct control and authority over
another
–Counsellor giving input to a colleague regarding a specific case
•
Supervisors:
–Are responsible for welfare of supervisees
–Are indirectly responsible for the clients served by supervisees
–May have responsibility to an agency where supervised
practice occurs to ensure quality services are provided
–May serve as gatekeepers to the profession
•
Formal relationship to discuss your work and ensuring you have
adeuqate threaputic relatinship, it’s a supportive space to reflect your
job, assitance in professional development, trusting relationship
relargding work related concerns
-
Not;
Someone watching over your shoulder
○
•
Formal Supervision
This occurs when there is planned contact •
Needs to be priority •
For continuing professional development •
Both supervisor and supervisee have prepared for this meeting •
Express purpose of:
–Discussion of professional issues
–Planning subsequent interventions
•
–Planning projects
–Generating feedback
Planned contact ensures supervision time is a priority and not
something that occurs “whenever things slow down”
•
Allows sufficient opportunity for preparation •
Other Supervision Types
• Group
–Regular group meetings of counsellors/psychologists
–Leader/chair is generally appointed
–A member provides an overview of a case
–Feedback and discussion follows by group members
–For ethical reasons, work supervisor should not attend
• Peer
–Peers provide review of cases of their colleagues
–May be more or less formal
Supervision during training
• A process that involves a supervisor overseeing the professional work of a
trainee with four major goals to:
1. Promote supervisee growth and development - improve yoursel
2. Protect the welfare of the client
3. Monitor supervisee performance and to serve as a gatekeeper for the
profession
4. Empower the supervisee to self-supervise and carry out these goals as an
independent professional
Consultation
Like supervision, involves a tripartite relationship between the
consultant, consultee and client
•
Increasingly common in schools, agencies and other settings •
Consultant does not have administrative authority over another
counsellor
•
Cannot be held accountable for what the counsellor/consultee
ultimately does
•
The counsellor/consultee can choose to accept or ignore the advice
provided
•
To avoid possible legal issues, a consultant should not meet:
–With the client for whom they are providing advice
–Regularly with the counsellor/consultee
•
Methods of Supervision
• Self-report
• Process notes
• Audio recording
• Video recording
• Live supervision
Models of Supervision
Historical Development
• Phase 1 – Psychoanalytic model
• Phase 2 – Counselling models
• Phase 3 – Developmental & Social models
Psychoanalytic Model
In early days of Freud, supervision was informal •
Small groups gathered to train, discuss and review each others’ client
work
•
With advent of formal training, a focus on “personal analysis”
developed
•
Distinction later occurred between “personal analysis” and
“supervisory or control analysis”
–Functions now carried out by different people
–Supervisor’s function was to teach
–Personal problems referred to personal analyst
•
Counselling Models
Developed in 1950’s with advent of counselling orientations other than
psychodynamic
•
Linked to counselling roots •
Took on counselling names
–Person-Centred supervision
–Rational-emotive supervision
•
Approach based almost exclusively on counsellor’s theory •
Emphasis on skills •
Taping sessions •
Supervision in small groups using group process as a learning
mechanism
•
Peer supervision •
Developmental and Social Role Models
• Movement away from clinical models tied to counselling orientations
• Educational and psycho-social models emerged
• Emphasis on:
–Roles/tasks of supervisors
–Learning stages of supervisees
Developmental Models
• Work on premises similar to models of developmental psychology
• People move through distinct stages
• Each stage is characterized by tasks and demands to be fulfilled before
transition to the next stage
Social Role Models
Supervisor and supervisee adopt certain relationships towards one
another
•
Attempts to define:
–What supervisors and supervisees do within supervision
–What tasks are performed by whom
•
Tasks are the behavioural side of a role •
Role is person-centred
–Teacher/Pupil
•
Task is action-centred
–To teach/learn
•
Supervisory Relationship
Supervisor’s Role
Responsible for detecting symptoms of burn out, transference, hidden
agendas in supervisee
•
Sessions over a period of time should include:
–Evaluation
–Education
–Administration
–Support
•
Established professional who can help open doors in the organization
and community
–Key experiences & networks
•
Supervisory Relationships
Ideally based upon trust and mutual understanding •
Supervisor is primary source of support on the job •
Establishing good communication forms a solid foundation for work
together
•
Discuss your thoughts about supervision •
If not sufficiently clear about expectations, initiate
discussion about this
•
Draw upon supervisor’s support, knowledge and expertise à
enhances learning and reduces stress
•
Intern Characteristics
Be open to feedback and instruction •
Eager to learn •
Inquisitive and energetic •
Knowledgeable •
Realistic about own skills and knowledge •
Willing to take risks in order to gain new skills and knowledge •
Appropriately assertive •
Take responsibility for own learning •
Demonstrate initiative •
Be a good listener, observer and communicator •
Styles of Supervision
• Cherniss & Egnatios (1977) identified five supervisory styles:
–Didadic-Consultative; Superviee acknowledges skills but supervisiors
has last say
–Insight-oriented; ask questions to allow superviee to think things
through
–Feelings-oriented; question enotional responses to clients
–Laizzez-faire; leaves alone unless superviee seeks out help
–Authoritative; closely observe and evaluate perfromance
Focus in Supervision
• Different focus points within supervision:
–Traditional; emphasis on the model above
–Person-centred; more values of empathy and posiitve regard,
supervior encourage to step into shoe of supervioee
• Necessary elements
–Warmth
–Trust
–Genuineness
–Confidentiality
–Respect
Use of Time
Develop an agenda – helpful to provide a day or so in advance •
Prepare written summaries of important issues to be discussed •
Set priorities:
–“What issues in my work currently concern me most?”
–“What are the time-sensitive issues that need my supervisor’s
attention now?”
•
Your supervisor may wish to discuss specific issues:
–Certain case
–New project .....
•
Issues for Consideration
Your work with clients - supervisor relatinship centreed appoin clients•
Projects that you have been assigned •
Work and interactions with colleagues •
Understanding your responsibilities to the agency/company •
Professional values and ethics •
Personal reactions, feelings, attitudes and biases as they relate to your
work
•
Supervisory relationship itself •
Fears and Barriers
Concerns about having work scrutinized •
Not meeting supervisor’s expectations •
Having work criticized •
Experiencing your supervisor as:
–Overly critical
–Unavailable
–Far younger
–Vastly different background
–Different personality styles
•
Some supervisors are eager for feedback whilst others are less open to
suggestions
•
Questions to Discuss
What are the implications of this discussion for improving my future
work?
•
What will I do in my next contact with this client? •
How will I relate to this particular staff member in
the future?
•
How will I handle myself in the next meeting? •
How will I approach the next task in
completing the project?
•
Receiving Feedback
Crucial yet potentially difficult aspect of supervisory relationship •
Feedback can be difficult to receive •
Internal and external factors can influence your ability to
receive feedback:
–Easier to receive when it matches self-perception –
Internalizing feedback requires time and reflection
•
Easier to receive if the source is trusted •
Try not to become defensive •
Respond to unfair feedback •
Mandatory Supervision Requirements
As an ACA registered counsellor you must complete 10 hours of
supervision per calendar year
•
Suggested ratio is 1 hour of supervision for every 20 hours of client
contact time
•
Ideally, full-time counsellors should receive supervision once per week
(but not < once per month)
•
Supervisor must be registered or recognised by ACAàACA College of
Supervisors register on ACA webpage
•
Legal Aspects of Supervision
Legal Aspects of Supervision
Informed consent •
Confidentiality and its limits •
• Liability
–Direct liability: can be incurred when the actions of supervisors
are the cause for harm
–Vicarious liability: pertains to the responsibilities supervisors
have to oversee the actions of their
supervisees
•
Informed Consent in Supervision
The standard of practice is to incorporate clear informed consent material
for supervisees, both orally and in writing
It is beneficial to discuss the rights of supervisees from the beginning of the
supervisory relationship
When supervisees learn what they can expect in all aspects of their
supervision and what they need to do to achieve success, supervisees are
empowered to:
Express expectations
Make decisions
Become active participants in the supervisory process
The Supervision Contract
A supervision contract should contain:
–Supervisor’s qualifications, position in workplace
–Methods to be used in supervision
–Responsibilities and requirements of supervisor & supervisee
–Policies pertaining to confidentiality and privacy
–Risks and benefits
–Evaluation of performance
–Complaint procedures and due process
–Professional development goals
–Duration of the supervision contract
Risk Management
Risk Management Practices for Supervisors
Don’t supervise beyond your competence •
Evaluate and monitor supervisees’ competence •
Be available for supervision consistently •
Formulate a sound supervision contract •
Maintain written policies •
Document all supervisory activities •
Consult with appropriate professionals •
Risk Management Practices for Supervisors
Maintain a working knowledge of ethics codes, legal statutes, and
licensing regulations
•
Use multiple methods of supervision •
Have a feedback and evaluation plan •
Verify that your professional liability insurance covers you for
supervision
•
Evaluate and screen all clients under your supervisee’s care •
Establish a policy for ensuring confidentiality •
Incorporate informed consent in practice •
Video - IVF
-
Week 7 Lecture
Thursday, 19 April 2018 10:22 PM
COUN226 Ethical & Professional Issues in Counselling
Lecture 7 – Competence Dr Karen Whalley
Overview
• Competence
• What is Supervision?
• Models of Supervision
• Supervisory Relationship
• Legal Aspects of Supervision
• Risk Management
Competence
Competence
• Having and maintaining the skills needed to practice in the field
–Sound knowledge of services being provided, & tools, techniques
and theories being used
–Not static but ongoing as new research & theory emerge
• Only provide psychological/counselling services in which they are
competent
• Core competencies vs specific competencies
• Professional codes of ethics on competence have common themes
–Example: AHPRA (Australian Health Practitioners Professional
Regulation Authority -> Psychology Board of Australia)
–Adopted APS Code of Ethics
–APS Code B.1: Competence
Perspectives on Competence
• Counsellors/Psychologists practice only within the boundaries of
competence, based on:
–Education
–Training - keep up to data
–Supervised experience
–Professional credentials
–Appropriate professional experience
Assessment of Competence
Assessment approaches are most effective when they integrate both
formative and summative evaluations:
Formative assessment: a developmentally informed process that
provides useful feedback during one’s training and throughout
one’s professional career
○
Summative assessment: an end point evaluation typically
completed at the end of a professional program or when applying
for registration
○
•
Developing or Upgrading Skills
Work with colleagues or professionals who have more experience •
Seek consultation before moving outside the areas in which you have
received education and training
•
Learn new skills by attending conferences and conventions, reading
books and professional journal articles, taking additional courses, and
participating in workshops that combine didactic work with supervised
practice
•
APS Professional Development Requirements
Activity Point Allocation
Workshop 1 pt per hour
Professional Course 1 pt per hour
Conference 1 pt per hour
Symposium/lecture 1 pt per hour
Video & audio resources 1 pt per hour
Internet-based learning 1 pt per hour
Reading articles 1 pt per hour
Relevant postgrad studies 30 pts per year
Supervision 1 pt per hour
*Need 60 PD points over a 2-year period to be a member of APS
Making Referrals
• When:
–Counselors become aware that they do not have skills to offer client
needed services
–Counselors do not possess the competency for effective service
• How:
–Have knowledge of type and calibre of service available in your
community
• Who:
–Client must agree that problem exists and be willing to work with
referral
Ethical Issues in Training Therapists Training programs have an ethical
responsibility to:
–Establish clear selection criteria ( for admission to program)
–Provide exposure to major contemporary counselling theories
–Teach students strengths and limitations of theories
–Combine academic and personal learning
–Screen candidates to protect public from incompetent practitioners
–Teach range of skills to work with diverse clients
–Provide training in ethics
Evaluating the Character and Psychological Fitness of Trainees
• Interpersonal behaviors of trainees have a direct bearing on their clinical
effectiveness, so these factors must be taken into consideration in the
evaluation process
• Character
–Honesty and integrity with which a person deals with others
• Psychological fitness
–Emotional or mental stability necessary to practice safely and
effectively
–Fitness can be evidenced by:
• Presence of personality adjustment
• Absence of psychological disorder
• Appropriate use of substances
Gatekeeper Role of Faculty in Promoting Competence
The academic faculty in a professional program generally has a
gatekeeper’s role, protecting consumers by identifying and intervening
with graduate students who exhibit problematic behaviors
•
The gatekeeper role is addressed in the ethics codes of most
professional organisations
•
When a student has good grades but demonstrates substandard
interpersonal behavior indicating serious unresolved conflicts,
intervention is required
•
Dismissal from a program is a measure of last resort •
Registration and Specific Professional Bodies
Verification of qualifications •
Sets minimum standards •
Does not assure quality practice •
Governs professional practice •
Highlights uniqueness of an occupation •
Restricts both use of title and practice of occupation •
In Australia, the use of the title of Counsellor is not restricted •
Australian Health Practitioner Regulation Agency
Aboriginal and Torres Strait Islander Health Practice •
Chinese Medicine •
Chiropractic •
Dental •
Medical •
Medical Radiation Practice •
Nursing & Midwifery •
• Occupational Therapy
• Optometry
• Osteopathy
• Paramedicine(late 2018)
• Pharmacy
• Physiotherapy
• Podiatry
• Psychology
APS Code
B.1.2. Psychologists only provide psychological services within the
boundaries of their professional competence.
This includes, but is not restricted to:
(a) working within the limits of their education, training, supervised
experience and appropriate professional experience;
(b) basing their service on the established knowledge of the discipline and
profession of psychology;
(c) adhering to the Code and the Guidelines;
(d) complying with the law of the jurisdiction in which they provide
psychological
services; and
(e) ensuring that their emotional, mental, and physical state does not impair
their ability to provide a competent psychological service.
PACFA Code
Objectives: This Code has been designed to:
–Establish the ethical framework for the practice of counselling
and psychotherapy;
–Identify the principles, attitudes and behaviours required for
ethical practice;
–Provide clients and the wider community
–with clear and accessible information on the expected ethical
standards in counselling and psychotherapy;
–Establish standards of practice that will support safe, high
quality
services for clients; and
•
Develop the capacity of those who work to the Code to reflect on •
the ethical dimension of their practice and to make responsible ethical
decisions in complex circumstances.
•
PACFA Code of Ethics
• 2. Work to high professional standards
a. Practitioners deliver competent services that aim to meet clients’ •
desired outcomes. •
b. Practitioners give careful consideration to the limitations of their
training, experience and competence and work within these limits.
They provide information on other services and referral options if they
are not able to meet the client’s needs or if the client requires
additional services in parallel with or instead of counselling or
psychotherapy. In particular, onward referral is recommended when a
client has a serious mental health issue and the Practitioner has
concerns that treatment from other mental health professionals may
be required.
•
c. Practitioners give careful consideration to whether they are
competent to work with particular client groups including:
•
children and young people; •
couples and families; and •
groups with particular characteristics or special needs •
d. Practitioners monitor and maintain their fitness to practice at a level
that enables them to provide safe and effective services. In particular:
Practitioners do not practice if intoxicated.
•
They do not practice if unfit for practice due to health impairment or
personal circumstances.
•
They seek the advice of their supervisor or line manager if their fitness
to practice becomes impaired and, if necessary, they withdraw from
practice until their fitness to practice returns. Arrangements for
ongoing access to counselling or
•
psychotherapy should be made for clients who are affected. •
e. Practitioners maintain their competence for clinical practice by: •
Having regular formal supervision in order to monitor and review their
work with clients; keeping up to date with the latest knowledge and
responding to changing circumstances through continuing professional
development; and
•
reflecting on their practice through personal development activities
and dialogue with colleagues
•...
• http://www.pacfa.org.au/wp-content/uploads/2017/11/PACFA-
Code-of- Ethics-2017.pdf
•
Case Example
A couple makes an appointment with Ellen, a counsellor with 10 years
experience in private practice. This couple is requesting sex therapy, and the
initial assessment suggests that they have accurately identified the major
difficulty in their relationship. In fact, the sexual dysfunction they describe is
very common and usually responsive to therapy.
Ellen had no formal courses in sex therapy in graduate school, but she has
read several books on the topic and attended a 2 day workshop on the topic
9 months ago. Ellen also has a colleague with extensive training and
experience in this area who is willing to supervise her for this case.
In this situation, can Ellen consider herself competent to offer professional
services to this couple?
What is Supervision?
Supervision
Clinical supervision: an intervention that is provided by a senior
member of the profession to a junior member of that same profession
•
Can involve a number of processes:
–One counsellor having direct control and authority over
another
–Counsellor giving input to a colleague regarding a specific case
•
Supervisors:
–Are responsible for welfare of supervisees
–Are indirectly responsible for the clients served by supervisees
–May have responsibility to an agency where supervised
practice occurs to ensure quality services are provided
–May serve as gatekeepers to the profession
•
Formal relationship to discuss your work and ensuring you have
adeuqate threaputic relatinship, it’s a supportive space to reflect your
job, assitance in professional development, trusting relationship
relargding work related concerns
-
Not;
Someone watching over your shoulder
○
•
Formal Supervision
This occurs when there is planned contact •
Needs to be priority •
For continuing professional development •
Both supervisor and supervisee have prepared for this meeting •
Express purpose of:
–Discussion of professional issues
–Planning subsequent interventions
•
–Planning projects
–Generating feedback
Planned contact ensures supervision time is a priority and not
something that occurs “whenever things slow down”
•
Allows sufficient opportunity for preparation •
Other Supervision Types
• Group
–Regular group meetings of counsellors/psychologists
–Leader/chair is generally appointed
–A member provides an overview of a case
–Feedback and discussion follows by group members
–For ethical reasons, work supervisor should not attend
• Peer
–Peers provide review of cases of their colleagues
–May be more or less formal
Supervision during training
• A process that involves a supervisor overseeing the professional work of a
trainee with four major goals to:
1. Promote supervisee growth and development - improve yoursel
2. Protect the welfare of the client
3. Monitor supervisee performance and to serve as a gatekeeper for the
profession
4. Empower the supervisee to self-supervise and carry out these goals as an
independent professional
Consultation
Like supervision, involves a tripartite relationship between the
consultant, consultee and client
•
Increasingly common in schools, agencies and other settings •
Consultant does not have administrative authority over another
counsellor
•
Cannot be held accountable for what the counsellor/consultee
ultimately does
•
The counsellor/consultee can choose to accept or ignore the advice
provided
•
To avoid possible legal issues, a consultant should not meet:
–With the client for whom they are providing advice
–Regularly with the counsellor/consultee
•
Methods of Supervision
• Self-report
• Process notes
• Audio recording
• Video recording
• Live supervision
Models of Supervision
Historical Development
• Phase 1 – Psychoanalytic model
• Phase 2 – Counselling models
• Phase 3 – Developmental & Social models
Psychoanalytic Model
In early days of Freud, supervision was informal •
Small groups gathered to train, discuss and review each others’ client
work
•
With advent of formal training, a focus on “personal analysis”
developed
•
Distinction later occurred between “personal analysis” and
“supervisory or control analysis”
–Functions now carried out by different people
–Supervisor’s function was to teach
–Personal problems referred to personal analyst
•
Counselling Models
Developed in 1950’s with advent of counselling orientations other than
psychodynamic
•
Linked to counselling roots •
Took on counselling names
–Person-Centred supervision
–Rational-emotive supervision
•
Approach based almost exclusively on counsellor’s theory •
Emphasis on skills •
Taping sessions •
Supervision in small groups using group process as a learning
mechanism
•
Peer supervision •
Developmental and Social Role Models
• Movement away from clinical models tied to counselling orientations
• Educational and psycho-social models emerged
• Emphasis on:
–Roles/tasks of supervisors
–Learning stages of supervisees
Developmental Models
• Work on premises similar to models of developmental psychology
• People move through distinct stages
• Each stage is characterized by tasks and demands to be fulfilled before
transition to the next stage
Social Role Models
Supervisor and supervisee adopt certain relationships towards one
another
•
Attempts to define:
–What supervisors and supervisees do within supervision
–What tasks are performed by whom
•
Tasks are the behavioural side of a role •
Role is person-centred
–Teacher/Pupil
•
Task is action-centred
–To teach/learn
•
Supervisory Relationship
Supervisor’s Role
Responsible for detecting symptoms of burn out, transference, hidden
agendas in supervisee
•
Sessions over a period of time should include:
–Evaluation
–Education
–Administration
–Support
•
Established professional who can help open doors in the organization
and community
–Key experiences & networks
•
Supervisory Relationships
Ideally based upon trust and mutual understanding •
Supervisor is primary source of support on the job •
Establishing good communication forms a solid foundation for work
together
•
Discuss your thoughts about supervision •
If not sufficiently clear about expectations, initiate
discussion about this
•
Draw upon supervisor’s support, knowledge and expertise à
enhances learning and reduces stress
•
Intern Characteristics
Be open to feedback and instruction •
Eager to learn •
Inquisitive and energetic •
Knowledgeable •
Realistic about own skills and knowledge •
Willing to take risks in order to gain new skills and knowledge •
Appropriately assertive •
Take responsibility for own learning •
Demonstrate initiative •
Be a good listener, observer and communicator •
Styles of Supervision
• Cherniss & Egnatios (1977) identified five supervisory styles:
–Didadic-Consultative; Superviee acknowledges skills but supervisiors
has last say
–Insight-oriented; ask questions to allow superviee to think things
through
–Feelings-oriented; question enotional responses to clients
–Laizzez-faire; leaves alone unless superviee seeks out help
–Authoritative; closely observe and evaluate perfromance
Focus in Supervision
• Different focus points within supervision:
–Traditional; emphasis on the model above
–Person-centred; more values of empathy and posiitve regard,
supervior encourage to step into shoe of supervioee
• Necessary elements
–Warmth
–Trust
–Genuineness
–Confidentiality
–Respect
Use of Time
Develop an agenda – helpful to provide a day or so in advance •
Prepare written summaries of important issues to be discussed •
Set priorities:
–“What issues in my work currently concern me most?”
–“What are the time-sensitive issues that need my supervisor’s
attention now?”
•
Your supervisor may wish to discuss specific issues:
–Certain case
–New project .....
•
Issues for Consideration
Your work with clients - supervisor relatinship centreed appoin clients•
Projects that you have been assigned •
Work and interactions with colleagues •
Understanding your responsibilities to the agency/company •
Professional values and ethics •
Personal reactions, feelings, attitudes and biases as they relate to your
work
•
Supervisory relationship itself •
Fears and Barriers
Concerns about having work scrutinized •
Not meeting supervisor’s expectations •
Having work criticized •
Experiencing your supervisor as:
–Overly critical
–Unavailable
–Far younger
–Vastly different background
–Different personality styles
•
Some supervisors are eager for feedback whilst others are less open to
suggestions
•
Questions to Discuss
What are the implications of this discussion for improving my future
work?
•
What will I do in my next contact with this client? •
How will I relate to this particular staff member in
the future?
•
How will I handle myself in the next meeting? •
How will I approach the next task in
completing the project?
•
Receiving Feedback
Crucial yet potentially difficult aspect of supervisory relationship •
Feedback can be difficult to receive •
Internal and external factors can influence your ability to
receive feedback:
–Easier to receive when it matches self-perception –
Internalizing feedback requires time and reflection
•
Easier to receive if the source is trusted •
Try not to become defensive •
Respond to unfair feedback •
Mandatory Supervision Requirements
As an ACA registered counsellor you must complete 10 hours of
supervision per calendar year
•
Suggested ratio is 1 hour of supervision for every 20 hours of client
contact time
•
Ideally, full-time counsellors should receive supervision once per week
(but not < once per month)
•
Supervisor must be registered or recognised by ACAàACA College of
Supervisors register on ACA webpage
•
Legal Aspects of Supervision
Legal Aspects of Supervision
Informed consent •
Confidentiality and its limits •
• Liability
–Direct liability: can be incurred when the actions of supervisors
are the cause for harm
–Vicarious liability: pertains to the responsibilities supervisors
have to oversee the actions of their
supervisees
•
Informed Consent in Supervision
The standard of practice is to incorporate clear informed consent material
for supervisees, both orally and in writing
It is beneficial to discuss the rights of supervisees from the beginning of the
supervisory relationship
When supervisees learn what they can expect in all aspects of their
supervision and what they need to do to achieve success, supervisees are
empowered to:
Express expectations
Make decisions
Become active participants in the supervisory process
The Supervision Contract
A supervision contract should contain:
–Supervisor’s qualifications, position in workplace
–Methods to be used in supervision
–Responsibilities and requirements of supervisor & supervisee
–Policies pertaining to confidentiality and privacy
–Risks and benefits
–Evaluation of performance
–Complaint procedures and due process
–Professional development goals
–Duration of the supervision contract
Risk Management
Risk Management Practices for Supervisors
Don’t supervise beyond your competence •
Evaluate and monitor supervisees’ competence •
Be available for supervision consistently •
Formulate a sound supervision contract •
Maintain written policies •
Document all supervisory activities •
Consult with appropriate professionals •
Risk Management Practices for Supervisors
Maintain a working knowledge of ethics codes, legal statutes, and
licensing regulations
•
Use multiple methods of supervision •
Have a feedback and evaluation plan •
Verify that your professional liability insurance covers you for
supervision
•
Evaluate and screen all clients under your supervisee’s care •
Establish a policy for ensuring confidentiality •
Incorporate informed consent in practice •
Video - IVF
-
Week 7 Lecture
Thursday, 19 April 2018 10:22 PM
Document Summary
Overview: competence, what is supervision, models of supervision, supervisory relationship, legal aspects of supervision, risk management. Competence: having and maintaining the skills needed to practice in the field. Sound knowledge of services being provided, & tools, techniques and theories being used. Not static but ongoing as new research & theory emerge: only provide psychological/counselling services in which they are competent, core competencies vs specific competencies, professional codes of ethics on competence have common themes. Perspectives on competence: counsellors/psychologists practice only within the boundaries of competence, based on: Assessment approaches are most effective when they integrate both formative and summative evaluations: Formative assessment: a developmentally informed process that provides useful feedback during one"s training and throughout one"s professional career. Summative assessment: an end point evaluation typically completed at the end of a professional program or when applying for registration. Work with colleagues or professionals who have more experience.
