Supervision and Support

Supervision is a professional relationship and activity which focuses on the development and practice of clinical knowledge and skills (i.e.,competencies). Supervision is a process that takes place between the supervisor and supervisee(s) and includes activities such as observation, self-assessment, evaluation, feedback, instruction, modeling, and collaborative problem solving.

• Supervision is required by the Community Health Aide Program Certification Board (CHAPCB) and is defined in the CHAPCB Standards and Procedures. Per the Standards and Procedures:
  • All BHA/Ps, regardless of level, must be supervised by a qualified master's-level clinician to provide services.
  • You will receive two kinds of ongoing supervision: administrative and clinical.

Administrative Supervision addresses issues related to the overall management of the BHA program at your organization. These may include:

• Overall management of the program structure, staff, funds, and reporting requirements.
• Workplace expectations.
• Policies about work-related employee behavior.
• Timekeeping and attendance policies.

For some BHA/Ps, your administrative supervisor is the same person who provides you with clinical supervision.

Clinical Supervision supports you as you learn and provide quality client services. It can only be provided by a qualified behavioral health professional designated by your THO. Supervisors must be licensed behavioral health clinicians or master's-level behavioral health professionals. Clinical supervision activities may include:

• Evaluation of your skills as a behavioral health provider. In addition to an evaluation completed by your supervisor, this often includes opportunities for self-assessment, where you provide feedback about your perceived level of knowledge and skills within your scope of practice.
• Teaching you about and having you practice specific interventions to ensure that you are trained appropriately before you use the intervention with a client (e.g., motivational interviewing for tobacco cessation).
• Modeling ethical standards and positive practice.
• Ensuring that you are practicing within your scope of practice and certification level.
• Supporting your progress to achieving certification as a BHA I, II, or III or BHP, including discussing the application of your training or coordinating activities for your practicum.
• Documenting the topics of your supervision and areas of skill that you are working to develop. Notes on these activities are kept by your clinical supervisor in a private employee file, though you are encouraged to keep your own notes during supervision sessions as well.
  • BHA/P supervisees are advised to create and maintain a central file to track supervision hours, practicum activities, completed trainings, and other requirements that contribute to certification. Documents that summarize certification requirements and forms to help you track your progress can be found on the Alaska Community Health Aide Program website .

Effective and productive supervision involves collaboration between you and your supervisor. Supervisors and BHA/Ps should all be open to feedback and recommendations.

During supervision sessions, you should:

• Be prepared to present a case, discuss a client, or describe a situation that you need assistance with.
• Work to build a good relationship with your supervisor.
• Help your supervisor learn about local ways, community values, and family priorities, such as subsistence.

During supervision, your supervisor should:

• Be prepared for and have the skills to guide you through training, mentoring, consultation, and monitoring by your THO.
• Take time to clarify your scope of practice and ensure that you understand what services you can provide, procedures and protocols you should follow, and the paperwork you will need to complete.
• Seek to identify your needs and professional development goals.
• Respect your strengths, honor your service, and promote the activities you are doing well.
• Be committed to excellence and understanding.

Supervision is an opportunity for you to gain support and education and to develop your counseling and treatment skills. It can help you expand your thinking and grow in new areas. An important area of development for all behavioral health providers is managing work stress. Your supervisor is there to help you navigate through the challenges and manage personal difficulties or triggers. Supervision can also help you:

• Identify, accept, and respond to the challenges you face in your practice.
• Let go of issues beyond your control.
• Redefine or reframe past experiences if necessary.
• Talk about how your work affects you.
• Improve communication.
• Be mindful and stay in the present (which is an important skill for providing good service to your clients).

For each client encounter, both the BHA/P and the clinical supervisor are responsible for making sure clinical supervision and oversight requirements are met (see CHAPCB Standards 2.40.010. Supervision of Behavioral Health Aides and Behavioral Health Practitioners). Key aspects of the requirements are outlined below.

There are three levels of clinical supervision: direct, indirect, and general. The level of supervision you are provided with is based on your training, experience, and certification level.

Under direct supervision:

• You will consult with your clinical supervisor each time before performing a service for a client.
• Your clinical supervisor is available to consult with you while you are performing the service (in person, on the phone, or through instant messaging or another distance communication technology).
• Your clinical supervisor reviews the outcome of your services during or soon after you provide them.
• One model for this level of supervision could include a comprehensive review of your plans to meet with clients early in the week, then a review of the status of each case with your supervisor at the end of the week. The exception would be when an emergency arises, at which time you would contact your supervisor immediately.

Under indirect supervision:

• You continue to consult with your clinical supervisor in advance to plan for providing the specific service for your client.
• Your supervisor may be available for consultation as needed, but will not be directly monitoring your session.
• You routinely review the outcome of services you provide with your clinical supervisor.
• This level of supervision could include a comprehensive review of your plans to meet with clients early in the week and a review of the outcomes with your supervisor at the end of the week. If an emergency arises, you would contact your supervisor immediately.

Under general supervision:

• Your supervising clinician has consulted with you and authorized you to perform activities specified in the treatment plan independently.
• Your activities are within the scope of your practice and certification.
• You will report the activities to your clinical supervisor, who will review them and provide guidance and feedback as needed.
• For this level of supervision, you would plan for and conduct your sessions with clients, providing services that your supervisor has previously authorized. During your weekly supervision session, you would summarize important updates about your clients and discuss planned interventions and next steps in their treatment plans.

When a BHA/P provides direct client services, it means that a clinical supervisor has authorized a treatment plan that specifies what interventions and/or services will be carried out by a specific provider, including BHA/Ps. In this case, although the BHA/P provides the service as described in the treatment plan, the services are subject to being reviewed by the supervisor.

When a BHA/P is providing outreach services (including initial contacts, community organization work, and community-based education and prevention activities), it means that the clinical supervisor has authorized the BHA/P to perform these services within their scope of practice.

Given the geographic distance between rural Alaskan communities, you will likely receive clinical supervision both onsite and through distance telecommunications. Distance methods of supervision include writing, email, telephone calls, video teleconferencing (VTC), and instant messaging (IM).A clinical supervisor living outside your village will periodically visit you in your village. How often your supervisor comes will depend on community needs and regional policies and resources.Even if you do not see your supervisor in person, you should be in contact with your supervisor on a weekly basis via telephone, email, or communications through your record management system.

Clinical supervision may include activities such as:

• Reviewing documentation related to the client's health record.
• Discussing client care options.
• Helping with community activities, such as health fairs.
• Teaching you how to prepare for and conduct community activities.
• Learning about cultural ways and discussing how they can be therapeutic to clients.
• Observing or reviewing your counseling sessions with clients.
• Modeling and providing training on methods for communicating with clients.
• Telling stories to discuss case and demonstrate treatment examples.
• Relating cultural beliefs and practices to your services.
• Role playing scenarios to demonstrate and practice specific counseling strategies (e.g., open-ended questions, paraphrasing, active listening).

You will have regularly scheduled individual supervision meetings with your clinical supervisor. The frequency of your supervision will vary depending on your case load, certification level, supervision requirements, and organizational policies.

Part of supervision includes an evaluation of your knowledge, skills, and abilities (also known as"competencies") as these relate to your BHA/P job duties. The Knowledge and Skills Checklist is a tool that has been developed specifically for BHA certification, training, and development. To become certified at any level (BHA I, II, or III or BHP), you must demonstrate a high level of competency in each category assessed on thechecklist. The Knowledge and Skills Checklist can be found on the ANTHC BHA website.

You are encouraged to use the Checklist to complete a self-assessment early in your career as a BHA/P. The self-assessment will tell you what knowledge and skill areas you are expected to develop before certification and also help you identify personal strengths and areas to focus on for professional development. Prior to certification, you will complete an updated evaluation with your supervisor; the summary of this evaluation will be submitted with your certification application.

When using the Knowledge and Skills Checklist, you will be evaluated on competencies for your Skill Level, which is based on the level of certification you are working towards. It is expected that your skill level will increase as you develop and grow at different certification levels. At the same time, it is likely that you will receive less intensive supervision and oversight.

The Knowledge and Skills Checklist has a total of 10 categories. Each category has subcategories with specific competencies defined. The 10 categories include:

• Working with others.
• Screening and assessment.
• Planning services.
• Providing services.
• Linking to community resources.
• Community education and advocacy.
• Cultural competency and individualizing care.
• Documenting.
• Professional and ethical practice.
• Professional development.

It is a good idea to review the Knowledge and Skills Checklist, especially when you are seeking certification. Ask your supervisor to assist you in identifying areas where you can grow. This will help you stay focused on a development plan and make becoming certified less stressful.

BHA/P Development
	BHA Trainee	BHA-I	BHA-II	BHA-III	BHP
Typical Developmental Level	Beginning proficiency	Basic proficiency	Intermediate proficiency	Advanced proficiency	Independent
Skill Level	Is learning the basic skill	Has developed the basic skill	Has intermediate skill; recognizes when to seek assistance	Has advanced skill	Uses the advanced skill flexibly
Supervision/Structure Required	Extensive and close; high	Frequent; moderately high	Occasional; moderate	Less frequent; minimal	Less frequent; minimal

Regular supervision is important to help you do a good job and it is a good practice for risk management. During supervision, you may:

• Discuss events related to clients on your caseload by describing what happened during sessions or meetings.
• Talk about yourself and how working with a client has affected you.
• Ask questions and explore new ideas.
• Learn about how to apply a concept in your work setting.
• Discuss your career goals and training needs.
• Seek guidance on areas that you need to improve to become certified or to maintain your certification.

Supervision will be most effective if you and your supervisor can be open and honest with each other.

Clinical support team meetings help you stay connected with your team. They may be used to provide training or clinical supervision. They provide opportunities for you to discuss client cases and gather other perspectives for developing recommendations.

Meetings typically include several BHA/Ps (either at the same location or connecting in from different locations in their region) and the clinical supervisor. They often take place via teleconference or videoteleconference.

Case presentations are an important part of clinical support team meetings. During these meetings, you will verbally summarize and present information about or ask for guidance on individual client cases.

• Identify the client by a “client number” if there is a counseling file open. Provide the client’s age, gender, and other important descriptors. If your client does not have a file number, you may consider using the client's initials or using a "fake name" for the case presentation.
• Provide the purpose of the case presentation (e.g., review assessment findings, discuss possible interventions, develop a treatment plan, or discuss challenging aspects of the client's treatment).
• Give a summary of the client situation that may include:
  • Services or treatment history (if any).
  • Family members and support.
  • School activity and support.
  • Community activity and support.
  • Legal issues (if any).
  • Observed and/or reported behaviors that are clinically relevant.
• Include presenting problems or clinical needs, such as:
  • Those identified by the client and/or caregiver.
  • Goals identified in the treatment plan.
  • Resource and/or referral needs.
• Consult about or request specific recommendations related to client care, such as treatment planning, referrals to other agencies, progress towards treatment goals, or discharge.

Ask your employer and clinical supervisor about confidentiality and privacy requirements in team meeting settings; the practice of confidentiality and privacy may vary depending on how the employers of the team members are connected.

Document. Clinical support activities related to individual client cases should be documented in the client’s record as informational notes.

Good, culturally relevant supervision benefits you, your clients, and your community. Clinical supervision should involve working together with your supervisor to:

• Discuss client care options with respect to local customs and resources.
• Conduct community events that are appropriate for Alaska Native ways of life.
• Provide culturally relevant services.

You may face the challenge of dealing with a supervisor who is not local or familiar with cultural customs. In such cases, you may need to take a teaching role in this area to help your supervisor build awareness. You can educate your supervisor on local values and activities and introduce them to community Elders and leaders. This may also include informing your supervisor about topics such as:

• The importance and benefits of subsistence activities.
• Seasonal cycles that affect subsistence and work schedules (such as hunting, fishing, and collecting berries).
• The meaning of ceremonies, like potlatches.

With good communication, it is possible to negotiate and reach agreement on complex issues, such as ethical differences between Alaska Native traditional ways and Western behavioral health practices.

• Some of the most effective BHA/Ps have learned to blend traditional and Western ways of practice with help from their supervisors.
• Remember that both perspectives have value.
• Consulting with a supervisor can help you see connections you may have missed, such as why a client acts in a certain way.

Good supervision involves listening by both supervisors and BHA/Ps. Listening should go beyond words, with attention to voice, expression, and intuition.

Supervision can take place in different settings, including in an office, on a walk, or on a bank by the river. Regardless of where your supervision takes place, it is your responsibility to make sure any information you talk about remains private and confidential (i.e., other people should not be able to hear what you are saying or talking about). If you cannot ensure the privacy of your client's information at a given location, you should wait to talk until you are in a more private location.

You are one member of a larger community of helpers. You can call on other providers to help you with different clients, depending on their needs.

When working with other providers, it is important to pay close attention to confidentiality and privacy requirements. These may change depending on:

• The provider with whom you are working.
• The purpose for sharing information.
• The relationship between your employers.
• The potential family relationship of the provider to the client.

For more information on Privacy and Confidentiality, see Chapter B-4: Confidentiality and Release of Information.

Community of Helpers
Provider Type	Role	How They Can Help You
Behavioral Health Aide/Practitioner (BHA/P)	A certified person in the village who can help you with a client’s behavioral health needs.	Can provide a wide variety of help, including support, advice, and backup.
Community Health Aide/Practitioner (CHA/P)	A certified person in the village who can help you with a client who has medical needs.	Can help tend to a client’s medical issues, which may overlap with behavioral health needs. Examples include certain illnesses and conditions, domestic violence, suicide attempts, or self-harm.
Village Police Officer (VPO)orTribal Police Officer (TPO)	A village-based public safety person who is hired by the tribal organization or community. Generally does not carry a weapon.	Can provide general security for the community, including enforcement of curfews.
Village Public Safety Officer (VPSO)	A village-based public law enforcement person who is hired by the State Troopers or Alaska Native corporation. Generally carries a nonlethal weapon.	Can help in any emergency, life-threatening situation, or other situation where you feel the need to enforce the safety of the community. Can provide you with connections to state law enforcement if needed. Will also likely have some prevention duties, such as leading D.A.R.E. classes in schools.
BHA/P Clinical Supervisor	A certified or licensed person responsible for supporting, consulting with, and clinically supervising you.	Can help you with any questions you have and work with you to determine a plan for how to best help your clients.
Certified Chemical Dependency Counselor	A certified counselor skilled at working with people who have substance abuse or addiction problems.	Can provide you with information on leading substance abuse groups or counseling a person with substance abuse or addiction issues.
Physician Assistant (PA) or Nurse Practitioner (NP)	A non-physician medical provider licensed to diagnose and treat patients.	Provides medical services, including trauma care and the prescription of medications. Can help with many situations, include when clients have depression or medication issues.
Physician (M.D. or O.D.)	A licensed medical professional who has expertise in evaluating, diagnosing, and treating primary health issues.	Can tend to more complex client medical issues.
Psychologist	A mental health professional who has completed a Ph.D. program in psychology, studying behavior and mental processes.	Can help clients needing formal psychological testing. May also provide evaluation, assessment, or diagnosis of your clients. You may be asked to follow recommendations written after a psychologist has seen a client.
Psychiatrist	A licensed physician with specialized training in behavioral health needs.	May engage clients in psychotherapy. May be involved with evaluation, assessment, and diagnosis of your clients. Most often will be involved when the client needs psychotropic medications.
Elder	A person in the community known for wisdom, life experiences, and a wealth of cultural knowledge.	Can support you in your work and provide advice and encouragement. May be able to participate in client care activities and community education.
Community Member	Any school staff member, faith-based leader, advisor, mentor, or culture bearer who offers traditional knowledge on the community system, customs, and ways.	May support your motivation and skills. May provide advice, coaching, direction, and recommendations. Can provide client referrals. Can help with community wellness events, educational workshops, and circles.