Supervision

Supervision.  This is a frequently misunderstood term.  There are different sorts of supervision with specific conditions that are required to be present, to be in compliance with NC law or insurance contracts.  

Some of the different types of supervision I provide include:

clinical supervision through contracts with the Psychology Board for Licensed Psychologist, Provisional; Licensed Psychological Associate; and the soon to be enacted Licensed Behavior Analyst (HB 1157, which may be considered by the NC legislature again in 2013).

clinical supervision through the Licensed Professional Counseling Board for the Licensed Professional Counselor Associate

ancillary supervision to professional and paraprofessional providers who are contract employees of Behavioral Health, PLLC

training supervision for candidates for BCBA and certificants with the BCaBA

 

When it is allowed by regulation or by statute, supervision is provided by telecommunication.  Skype, FaceTime, and other systems are available.  Even Skype and FaceTime are encrypted at the same level of privacy as a telephone call or fax, which are accepted means of communicating clinical material.  If you have concerns about whether telecommunication is allowed or available for your situation, please contact me directly.  The NC Psychology Board now allows for supervision to be provided by electronic means. Please see the NC Psychology Board Statement on Supervision by Electronic Means.

 

The following are some different sorts of supervision and the situations in which these occur. 

 

Ancillary to or Incident To Supervision

"Ancillary to" or "Incident  to" occurs when a licensed professional is the provider of the service, but another professional may assist.  For example, "Incident to" occurs when a physician charges the insurance company for the visit, but the nurse may do things like take the blood pressure, weight, etc.  It is clear to the patient that the visit is with the doctor and the services of the nurse are merely "incident to" the services of the physician.  This concept has been expanded to include the services of an attending physician and a resident in training in a hospital.  In the surgical suite, the level of supervision may be "over the shoulder" - meaning the attending is present so close they are literally watching over the shoulder of the resident.  (Both doctors must be employed by the same organization in this case.)  In another example, in an office practice, a psychologist may use a psychology technician to administer a psychological test (but must bill the services as 96102); done properly the psychologist explains to the patient that he or she needs the results from the test which will be administered by the psychometrist.  If there is any problem he or she will be nearby and can come to assist.  The psychologist will also check in with the patient at the end of the session to make sure the patient has no questions.  (If asked the patient will state the psychologist was the provider and he/she used a technician to administer the test.)  In addition, the technician must be an employee of the psychologist or both are employed by the same organization.  When "incident to" rules are followed, the rendering provider may bill for the services even if there were component services provided by someone else that were "incident to" the services of the rendering provider.  

Ancillary to is an arrangement in which the licensed professional is responsible for all services provided and is assisted by another who provides services under the supervision of the licensced provider, but the financial arrangement which characterizes "incident to", is not necessarily present.  For example, a BCBA may provide services under conditions which define "ancillary to" and he or she may bill directly for the services.  In "ancillary to" it may also be the case that the unlicensed indiviudal will provide services for which the licensed provider will bill, as in the case of a paraprofessional providing in-home services of behavior analysis when the program is supervised by a licensed provider.  In "ancillary to" the service code used by the paraprofessional is typically unique, and it is clearly understood by the payor that only supervised services are provided by the paraprofessional and only professional services are provided by the licensed provider (which are billed using a separate code.)  In "ancillary to" the conditions that define the ability to practice are indepenent of the conditions that define ability to particiapte in any particular third party reimbursement program.  In the case of a Licensed Psychologist billing for the services of a psychometrist (under Medicare) or in the case of a Licensed Behavior Analyst billing for the services of a Tutor (under TRICARE), there is a special billing code used to indicate the services provided directly by the professional and directly by the paraprofessional. 

A non licensed person may provide services as the supervisee of a licensed provider (when employed by or contracted by the licensed provider or when both are employed by /contracted by the same organization) in an "ancillary to" or "incident to" relationship, but any other form of supervision is not sufficient to allow the practice of a nonlicensed person in North Carolina.  Most insurances do not allow "incident to" or ancillary services.  Exceptions are many programs that allow Psychologist/Behavior Analysts to supervise the work of in home therapy assistants and bill the service using a special billing code for this purpose.

 

Clinical Supervision

Clinical Supervision is provided to a licensed provider so he or she may legally practice.

"Supervision is characterized as an interactive educational experience between the [supervised provider] and the supervisor. This relationship: a) is evaluative and hierarchical, b) extends over time, and c) has the simultaneous purposes of enhancing the professional functioning of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for those who are to enter the particular profession (Bernard and Goodyear, 2008)." - (APA Commission or Accreditation, 2007; revised July 2009)

Supervision is required at certain stages of the professional development of all mental health professionals.  In North Carolina, Licensed Psychological Associates (LPA's) are required to receive supervision as long as they practice.  The supervision for LPA's is at three levels, depending on the number of years of previous supervised practice.  I have assisted a number of LPA's to move to the highest degree of independent practice (Level 3) in which he or she is required to meet with a supervisor only one time a month.  I have a special sympathy for high functioning and seasoned LPA's who require supervision at any level, while less experienced master's level mental health providers require no supervision after they become licensed.

In North Carolina, supervision is required for one year at the post doctoral level for all psychologists as part of obtaining an unrestricted license to practice.  Some psychologists are able to meet this supervision requirement in a formal post doctoral program.  However, I do not know of any such formal programs in the Charlotte area.  I am also very sympathetic to the plight of doctoral graduates in psychology, who find it difficult to obtain the required supervised experience and any relevant work in a Catch-22 dilemma.  (They can not find work because they are not licensed at the independent level, and they can not get licensed because they can not find a work setting in which they can gain supervised experience.)  To add insult to this injury, there is often a rather step fee charged for supervision, especially when one considers it may occur at a once a week frequency.  This can be quite a burden when one is either stuck with this expense in perpetuity (LPA) or unable to find appropriate work due to not having an unrestricted license (LP).

Licensed Behavior Analysts must recieve supervision from either a Licensed Psychologist or Licensed Psychological Associate with expertise in the area of Behavior Analysis.  Under HB 1157 Licensed Behavior Analysts may provide ancillary to or incident to supervision to paraprofessionals such as Tutors, In Home Therapy Assistants, and others as is the common practice in service delivery of Applied Behaivor Analysis.  The exact details of the number of hours per month or per hours of service delivery have not yet been formulated by the Psychology Board.

I have the 45 hours of supervision specific training requried by the Licensed Professional Counseling Board to provide supervision for LPCA practitioners.

If you are a psychologist - provisional status, licensed psychological associate, or licensed professional counselor associate in need of supervision at any level, but especially if you are stuck in the dilemma of needing weekly supervision, please feel free to contact me.  I have assisted a number of early career psychologists through this trying stage of professional development.  The goal of all supervision is to help the supervised provider obtain highest level of independence and autonomy possible.  I currently have supervision contracts with 8 LPA's and 2 LPC-A's. 

 

Training Supervision

Some types of supervision may be provided so that a professional can obtain Certification or Credentials with a specialty board or other organization.  Such supervision must follow the rules of the organization providing the credential such as the Behavior Analysis Certification Board, but even if Training Supervision is provided by a licensed provider (unless the services are "ancillary to"), this does not allow for practice by an unlicensed provider.