John G. MehmUniversity of Hartford

Models of Training in Supervision and Consultation: A Sampler

Friday, January 21, 2011

A Model of Doctoral Training in Consultation

CPS 670: Consultation in Healthcare Delivery Systems: Case Perspectives

Two 1-credit courses in consultation

CPS 671: Consultation in Healthcare Delivery Systems: Systems Perspectives

The Consultation Dilemma

Training in psychological consultation often places the doctoral student in a particularly challenging situation:

• A trainee is placed prematurely in the role of expert.

• Referral questions often range from the extremely difficult to the impossible.

What to Do?

Is it possible to develop competencies in consultation before the student becomes a full-fledged expert?

Is there more to being a consultant than just being an expert?

What is the best sequence for development of competencies in consultation?

APA (2007) Guidelines

Consulting is important to the effectiveness of many (if not all) practicing psychologists to greater or lesser degrees.

Completing a doctoral program in psychology does not [necessarily] prepare one to provide the best possible consulting services.

There is a body of knowledge and skills unique to this particular application of psychology.

American Psychological Association. (2007). Guidelines for education and training at the doctoral and postdoctoral levels in consulting psychology and organizational consulting psychology. American Psychologist, 62(9), 980-992.

APA (2007) Guidelines

Three relevant areas of competency for consulting practice:

(I) Individual (G) Group (O) Organization / system / intersystem

American Psychological Association. (2007). Guidelines for education and training at the doctoral and postdoctoral levels in consulting psychology and organizational consulting psychology. American Psychologist, 62(9), 980-992.

Consultation Competencies (Fouad et al., 2009)

The ability to provide expert guidance or professional assistance in response to a client’s needs or goals

Three major tasks Role of Consultant Addressing Referral Questions Communication of Findings

Three developmental milestones Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Role of Consultant: Readiness for Internship

Essential Component:

Knowledge of the consultant’s role and its unique features as distinguished from other professional roles (such as therapist, supervisor, teacher)

Behavioral Anchors: Articulates common and distinctive roles of

consultant Compares and contrasts consultation,

clinical, and supervision roles

Essential Component:Knowledge of and ability to select appropriate means of assessment to answer referral questions

Behavioral Anchors: Implements systematic approach to data

collection in a consultative role

Identifies sources and types of assessment tools

Addressing Referral Questions:Readiness for Internship

Communication of Findings:Readiness for Internship

Essential Component:Identifies and acquires literature relevant to unique consultation methods (assessment and intervention) within systems, clients, or settings

Behavioral Anchor: Identifies appropriate interventions based on

consultation assessment findings

Clinical Consultation CourseCourse Overview

What is consultation? What is a healthcare delivery system? What are the modes and processes of

consultation? What is the role of the psychologist as

a consultant in a healthcare delivery system?

Which consultation skills are essential?

What Is Consultation?

A process whereby one individual (the consultee)

who has responsibility for providing a service to others (the clients)

voluntarily seeks assistance from another person (the consultant)

who is believed to possess some special expertise

which will help the consultee provide a better service to his/her clients.

(Orford, 1992)

Key Characteristics of Consultation

It is a triadic relationship: consultant, consultee, and

client

It is voluntary It is focused on improving service The consultant utilizes his/her

expertise

The Consultation Relationship (Caplan, 1970)

The consultation relationship differs from a supervisory or educational relationship:

While the consultant is an expert, the consultee is the customer in charge of the relationship

The Consultation Relationship (Caplan, 1970)

Consultee has no obligation to follow the consultant’s advice

Consultant has no responsibility for the consultee’s work

The relationship between consultant and consultee tends to be collaborative

Goals of Consultation

Main goal: to improve the consultee’s performance (rather than improve his/her insight or sense of well-being).

Secondary goal: to improve the consultee’s ability to function without the consultant when similar situations are encountered in the future.

What Skills are Needed to be an Effective Consultant?

1. Have an organized and flexible approach to problem-solving.

2. Have solid clinical skills (esp. mood, substance abuse, and cognitive disorders).

3. Be a good communicator.4. Understand the consultation process.5. Understand cultural diversity.6. Be familiar with crisis intervention. 7. Think in terms of organizations & systems.

Consultant provides organized approach to assist clinician work with client to:

Gain an intellectual understanding of the circumstances.

Express feelings. Explore coping resources. Reopen/expand social support network. Set reasonable goals (which can be

achieved and reinforced).

Consultation example: Crisis intervention

Organizational Consultation CourseIssues from I-G-O model

1. How can an individual function more effectively within an existing organization or system of care?

2. How can a group (team, department, division) function more effectively within an existing organization or system of care?

3. How can the organization or system of care make positive changes to function more effectively overall?

Management-administration Competencies

(Fouad et al., 2009)

Manage the direct delivery of services and/or the administration of organizations, programs, or agencies

Four major tasks Management Administration Leadership Evaluation of Management and Leadership

Benchmarks for three developmental milestones Readiness for Practicum Readiness for Internship Readiness for Entry to Practice

Management: Readiness for Internship

Essential Component:Participates in management of direct delivery of services (DDS); responds appropriately in management hierarchy

Behavioral Anchors: Responds appropriately to managers and

subordinates Manages DDS under supervision, e.g., scheduling,

billing, maintenance of records Identifies responsibilities, challenges, and

processes of management

Administration: Readiness for Internship

Essential Component:Knowledge of and ability to effectively function within professional settings and organizations, including compliance with policies and procedures

Behavioral Anchors: Articulates approved organizational polices and

procedures Completes reports and other assignments promptly Complies with record-keeping guidelines Demonstrates understanding of quality

improvement (QI) procedures in direct delivery of services, basic management of direct services, QI procedures

Leadership: Readiness for Internship

Essential Component:Recognition of own role in creating policy, participation in system change, and management structure

Behavioral Anchors: Articulates agency mission and purpose and its

connection to goals and objectives Implements procedures to accomplish goals and

objectives

Evaluation of Management and Leadership:

Readiness for Internship

Essential Component:

Able to develop and prepared to offer constructive criticism and suggestions regarding management and leadership of organization

Behavioral Anchor: Identifies strengths and weaknesses of

management and leadership of organization Provides input appropriately, participates in

organizational assessment

Referral Questions:What are Common Organizational Issues?

1. Communication2. Decision-making 3. Conflict resolution4. Cultural diversity5. Transition of leadership6. Implementing change7. Responding to environmental events (external

threats)8. Workplace deviance (internal threats)9. Professional image10. Teamwork

3 Core Issues for Teaching Organizational Consultation

Excellence Leadership Decision-making

7 Good Questions for Understanding Organizations

What is viewed as excellence in the organization?

What values do the leaders reinforce?

How are decisions made?

How are individual differences (sex, ethnicity, status) treated?

How is underperformance handled?

How loyal are employees?

How is leadership developed?

4 Important Functions of Leaders

1. Leaders are needed to provide strategic direction and vision to organizations.

2. They engage in motivation and coaching behaviors.

3. They enforce and interpret organizational policies.

4. They are important in obtaining resources for groups.

Leadership Development and Career Growth:Where does discomfort arise?

ExecutiveLeadership

Skills

Technical Skills

Entry level

Supervisory

Managerial

growth

Discomfort Zone

Three Procedures forMaking Decisions

1. Consensus (100% approval)

2. Simple majority (> 51% approval)

---------------------------------3. Everything else (?

% approval)

So, do I need an MBA, too?

Datar, Garvin, & Cullen (2010)Rethinking the MBA: Business

Education at a Crossroads

According to business school deans and business leaders, even MBAs lack these essentials:

sufficient leadership development a "global mindset" skill in navigating organizational realities