Supervision

Transcription

Supervision

Supervision:
Gatekeeping the Profession
Module 1: The Professional
Supervision Framework
Module 2: The Process of Assessment
Welcome to Macquarie University!
The purpose of today’s workshop:
o CPD to enhance supervision practice
o To enable supervisors to be listed on the
PsyBA’s register of supervisors
o To pilot two modules from a Training Program:
Psychology Supervisor Training.
Outline of the Day
•
•
•
•
•
9:30am Module 1
11am Morning tea
11:30am Module 2
1:30pm Lunch
2:30pm Course meetings with
Supervisors.
• 3:30pm Finish
Psychology Supervisor Training: A
competency–based Approach
Modules: Content and description
1) Competency-based models of supervision: principles and applications
to supervisory practice
2) Establishing SMART goals in supervision: a competency-based
approach
3) Understanding your development and role as a supervisor
4) The Professional Supervision Framework
5) Supervising for the development of competencies in working with
difference.
6) Supervising for the development of case-conceptualisation
competencies
7) The Process of Assessment
8) Supervising to enhance metacompetencies in supervisee: Reflective
Practice and scientist-practitioner attitudes
Development leader (Institution) & ICTN approached for funding
Associate Professor Craig Gonsalvez (University of Wollongong)
South Coast ICTN
Associate Professor Craig Gonsalvez (University of Wollongong)
South Coast ICTN
Yasmina Nasstasia & collaborators (University of Newcastle)
Hunter and Coast ICTN
Ros Knight (Macquarie University)
Metro North and East ICTN
Yasmina Nasstasia & collaborators (University of Newcastle)
Hunter and Coast ICTN
Dr Kathryn Nicholson Perry (University of Western Sydney)
Sydney ICTN
Ros Knight (Macquarie University)
Metro North and East ICTN
Dr Kathryn Nicholson Perry (University of Western Sydney)
Sydney ICTN
Thanks for Contributions
• Metro North and East ICTN, particularly Carla
Brogden and Andrew Rose
• Dr Ann Wignall, Principle Psychologist, Northern
Sydney LHD
• Fiona Wilkinson, Clinical Psychologist
• Lee Mowbray, Online Educational Designer
PsyBA Guidelines for Supervisors
• If you hold Board Approval on 30 June
2013 then you have to complete a Board
approved master class by 1 July 2018
• The master class will be 6 hours face-toface on the one day.
Module 1
Professional Supervision Framework
Supervisory Alliance
Ethical Practice
Professional Practice
Overview
In this module participants will consider the current
Professional framework of both AHPRA and
APAC requirements that guide supervision.
They will consider the ethics that impact action and
decisions in supervision.
All of this framing the central core of the
Supervisory Relationship.
Pre-reading
• APS 2007 Code of Ethics
• Barnett et al (2007) Commentaries on the ethical and
effective practice of Clinical Supervision. Professional
Psychology: research and practice, 38(3), 268-275
Titles – What’s in a name?
• Avoid use of …..
o Supervisee
o Student
o Intern
o “the girl here on placement”
o Trainee
• Use appropriate titles
o Provisional Psychologist or
o Psychologist if already obtained registration
Correct Titles
from
http://www.psychologyboard.gov.au/Registration/General/FAQ.aspx
•
Psychologists with General registration have unrestricted rights to use the title
Psychologist or Registered Psychologist, and may undertake any work using that title
•
Candidates undertaking Doctoral degrees who have General registration, but do not have
an endorsement, may only refer to themselves as a psychologist or registered
psychologist
•
Provisionally registered psychologists undertaking the 4+2 pathway, the 5+1 pathway or
the higher degree pathway for the purpose of obtaining General registration must only use
the title 'Provisional Psychologist'
•
A psychologist enrolled in a Board registrar program leading to an endorsement may use
the title Registrar along with the area of practice e.g. Clinical Psychology Registrar
•
Psychologists with an endorsement may use the title associated with that area of practice
e.g. Clinical Psychologist
•
If your registration expires but you are still within the one month grace period you can
continue to use the title ‘Psychologist’ and any title related to an endorsement on your
registration.
Correct titles
from
When can I call myself a registrar?
The title 'registrar' is not a protected title under the National
Law, but titles associated with an endorsement are
protected.
The title may only be used by psychologists who have
completed a Masters or Doctorate in an endorsed area,
and are currently undertaking Board approved supervised
practice (‘the registrar program') for the purpose of gaining
an endorsement.
You must ensure you do not use the title in such a way that it
may lead a person to believe that you already have an
endorsement.
Examples of acceptable titles are 'Registrar - Clinical
Psychology' or 'Clinical Psychology Registrar'.
Correct titles
from
When can I call myself a Provisional Psychologist?
Provisional Psychologists undertaking an accredited higher degree
or a Board approved 4+2 internship are entitled to use the title
‘Provisional Psychologist’ while engaged in approved supervised
practice.
A Provisional Psychologist undertaking an accredited higher
coursework degree pathway may only undertake additional
practice outside university placements and use the title
'Provisional Psychologist' on Board approval. You should not use
the title ‘Provisional Psychologist’ for work roles that are not
psychological.
Under the National Law the word ‘provisional’ is not protected but
when paired with the word ‘psychologist’ it would constitute a
breach of the Act if used by any person who is not registered as a
Provisional Psychologist.
Correct titles: according to PsyBA
• Provisional psychologists undertaking an
accredited higher degree or a Board approved
4+2 internship program are entitled to use the title
’provisional psychologist‘ while engaged in
supervised practice undertaken for the purpose of
gaining general registration.
• The term 'intern' is not a protected title under the
National Law, but titles associated with the
profession of psychology are protected. The term
'intern' should not be used in relation to the title
'psychologist'.
Correct Titles
• Candidates undertaking Masters or Doctorate
degrees who are fully registered, but not
endorsed, must refer to themselves as
'Psychologist'.
• Fully registered Psychologists have unrestricted
rights to use the title 'psychologist', and may
undertake any work using that title as long as
they are fully registered.
Supervisory Alliance
• According to Milne (2009) “Most accounts of
what matters in clinical supervision place the
quality of the supervisory relationship at its very
heart”
• For Falender and Shafranske (2004) the
supervisory alliance is “a central pillar” in their
competency based approach with the supervisor
bearing primary responsibility for its development
and maintenance
Competencies in the Supervisory Alliance
The competencies required to address the supervisory
alliance include the following • Interpersonal skills:
– the ability to communicate
– understanding the experience of the self and that of the
supervisee (perspective taking)
– the ability to experience and express empathy, to provide
support, to trust
– the ability to reflect on one's behaviour and its impact on
others
– the ability to identify alliance strain, rupture, and
countertransference
From Falendar & Shafranske (2004)
Competencies in the Supervisory Alliance
•
Values:
– integrity-in-relationship
– ethical values-based practice
– appreciation of diversity
– science-informed practice
•
Knowledge:
– of the literature regarding alliance
– knowledge and skill in performing and teaching
metacommunication through multiple learning strategies
(e.g. instruction, demonstration, role-playing, and
critiquing)
From Falendar & Shafranske (2004)
The Good and the Bad
Author
Good supervisor
Poor supervisor
Campbell, J. (2006)
Essentials of clinical
supervision
Attempts to be helpful and
genuinely invested in
supervision
Unavailable, inconsistent,
inconsiderate, dogmatic, closed,
prejudiced, intolerant, inflexible,
arrogant, critical, disinterested,
disorganised, neglectful,
untrustworthy, poor boundaries
Falendar and Shafranske
(2008) Casebook for
clinical Supervision: a
competency based
approach
Friendly, warm, trusting, open,
flexible, interpersonally
sensitive, task orientated,
sensitive to developmental
needs
Emphasises short comings of
trainee, inflexible, intolerant,
defensive, uninterested in training
to improve supervisor skills
Knapp & VandeCreek
(2012) Practical Ethics for
Psychologists
Has both technical skills(clinical
skills, broad knowledge base,
provide helpful feedback) and
interpersonal skills (self
confidence, acceptance of
supervisee, warm, supportive),
are invested in supervisory
process
Lack technical skills and
interpersonal skills (poor
communication, unreliable,
unavailable)
Ethical issues in Supervision
Ethical Practice
• Ethics – refers to values, how we ought to behave and what
constitutes proper conduct
• Standards of practice for psychologists are detailed in the
Australian Psychological Society Code of Ethics (2007) and
guidelines
– http://www.psychology.org.au/Assets/Files/APS-Code-of-Ethics.pdf
• The national licensing board - The Psychology Board of
Australia (PsyBA) - has adopted the APS Code of Ethics for
the profession.
• In your role as a supervisor it is also important to adhere to
Code of Ethics (2007) and include this in supervision
APS Guidelines on Supervision
• The APS recently revised (Feb 2013)
their Guidelines on Supervision
Ethical issues for supervisors (adapted
from APS Guidelines on Supervision)
Standard B.1. Competence
•
•
•
Psychologists only provide psychological services within the
boundaries of their professional competence.
Psychologists who provide supervision know about: (a) the
ethical, legal and regulatory requirements of psychologists; (b) a
range of supervision methods and techniques; and (c) the
competencies expected of psychologists.
Psychologists understand that supervision oriented to the
development of competencies is concerned with acquiring
specific knowledge, practising relevant skills, and alignment of
attitudes and values appropriate to, and consistent with, the
profession of psychology (Falender et al., 2004).
Standard B.6. Delegation of professional tasks.
•
•
•
•
Psychologists who delegate tasks to assistants, employees,
junior colleagues or supervisees that involve the provision of
psychological services:
(a) take reasonable steps to ensure that delegates are aware of
the provisions of this Code relevant to the delegated professional
task; ...
(e) oversee delegates to ensure that they perform tasks
competently.
Psychologists ensure that supervisees, especially provisionally
registered psychologists, have access to the most recent edition
of the Code and the Guidelines
Standard B.3. Professional responsibility.
Psychologists provide psychological services in a responsible manner. Having regard to
the nature of the psychological services they are providing, psychologists:
(a) act with the care and skill expected of a competent psychologist;
(b) take responsibility for the reasonably foreseeable consequences of their conduct;
(c) take reasonable steps to prevent harm occurring as a result of their conduct;
(d) provide a psychological service only for the period when those services are necessary
to the client;
(e) are personally responsible for the professional decisions they make;
(f) take reasonable steps to ensure that their services and products are used appropriately
and responsibly;
(g) are aware of, and take steps to establish and maintain proper professional boundaries
with clients and colleagues; and
(h) regularly review the contractual arrangements with clients and, where circumstances
change, make relevant modifications as necessary with the informed consent of the client.
Supervisors of provisionally registered psychologists or registrars are aware that
they may ultimately need to make a judgement about the competence of their
supervisee(s).
They may need to decide whether the supervision requirements for registration have
been met, and whether the supervisee is ready to practise unsupervised and
sufficiently prepared to enter the profession. Similar judgements often need to be
made by field supervisors about placement students or supervisees looking to attain
area of practice endorsement or APS College membership.
Supervisors alert supervisees to their competing professional roles associated with
learning and evaluation.
Responsibility for monitoring and evaluating the performance of the supervisee lies with
the supervisor who raises any issues of competence as they become apparent, and
does not wait until the end of the supervision contract or arrangement to raise them.
Any issues of impairment, whether temporary or enduring, are addressed by the
supervisor subject to the Psychological Board of Australia’s mandatory reporting
requirements (2011a).
Standard A.4. Privacy.
•
•
•
•
Psychologists avoid undue invasion of privacy in the collection of information.
This includes, but is not limited to not requiring supervisees or trainees to
disclose their personal information, unless self-disclosure is a normal
expectation of a given training procedure and informed consent has been
obtained from participants prior to training.
Refer to Guidelines on confidentiality (2007)
Refer to Guidelines for managing professional boundaries and multiple
relationships (2008).
Psychologists attend to the power differential between the supervisor and
supervisee. Psychologists establish a professional relationship which allows
the supervisee to be prepared to reveal difficulties or areas of weakness, or
express differences of opinion to the supervisor, and not withhold salient
information from the supervisor.
Standard C.3. Conflict of interest.
•
•
•
Psychologists refrain from engaging in multiple relationships. The
process of selecting and agreeing to enter a supervisory
relationship is undertaken carefully and thoughtfully, paying close
attention to any potential multiple relationships.
Potential conflicts of interest are identified, considered and
appropriately resolved either at the initial stages of supervision,
or at the earliest stage when they become apparent.
Psychologists do not provide a counselling or psychometric
testing and assessment service to a supervisee.
Standard C.4. Non-exploitation.
• Psychologists do not exploit their relationships with their
assistants, employees, colleagues or supervisees.
• Psychologists do not engage in sexual activity with their
supervisee (Bernard & Goodyear, 2009).
• Refer to Guidelines on the prohibition of sexual
relationships with clients (2007).
Ethics refers to either . . .
– the minimum standard (the legal or mandatory floor
adopted by the profession); or
– voluntary efforts to live out high moral ideals
• The floor approach is an incomplete view of ethics as most
psychologists want to do more than just avoid being
punished, they want to have a positive impact on others
and to excel in their profession (Knapp & VandeCreek,
2012)
Principles of Ethical Practice
• These principles, identified by Ross (1930/original
republished in 1998), Kitchener (1984), Beauchamp
& Childress (2009) and others are created by
theorists to aid in guiding professional action. They
provide a framework to use when considering the
ethical dilemmas that arise in supervision.
• Five principles or “ethical intuitions” are applicable to
psychologists in their supervisory and clinical roles.
• Autonomy
• Beneficence
• Fidelity
• Justice
• Non-maleficence
Each principle linked to its definition and a way it may be
identified in supervision
Principle
Definition
In supervision
Autonomy
individuals have rights to freedom
of action and choice
Increasing right to autonomy of supervisee as
they become more experienced
Beneficence
actions taken should do good,
using knowledge to promote
human welfare
Need to take into account welfare of client,
supervisee and involved others
Fidelity
being faithful to promises made
Supervisors need to consider what they can
reasonably offer to supervisee during
contracting process
Justice
ensuring that people are treated
fairly
Supervisor may need to consider what is
equitable if supervising more than one student
Non-maleficence
striving to prevent harm
In supervision needs of supervisee and client
may conflict
Principles of Ethical Practice
• While these principles are generally to be
followed, “at times it may be impossible to follow
one ethical principle without violating another”
(Knapp & VandeCreek (2012), p 23)
• Supervisors may need to identify the applicable
principles of ethics and identify a course of
action that might give greater weight to one
principle but takes account of the others
Ethical Decision Making
Haas & Malouf (2005) describe a process of ethical decision making:
o Does a relevant, professional, legal or social standard exist?
o Is there a reason to deviate from the standard?
o What are the ethical dimensions of the issue?
o Can a primary ethical dimension be specified?
o Consult and review codes of ethics: review literature and consider ethical
principles
o Generate a list of possible actions
o Does the new course of action appear to satisfy the needs / preferences
of the affected parties?
o Does the course of action present any new ethical problems?
o Can the course of action be implemented?
o Implement the course of action.
Case studies for discussion
1. You become increasingly concerned that your supervisee has
mental health difficulties. She comes to you in an agitated state
and starts to tell you about what is happening for her, seemingly
being unable to contain the material any longer. She discloses
that she has self harmed in the past. She states, “it has just been
a bad day”.
2. A supervisee offers you tickets to a play that is sold out. You had
previously mentioned that you were unable to get seats for this
play. Your supervisee explains that his mother has two tickets
that she is unable to use and he offers them to you.
•
In groups, discuss what principles of ethics are relevant and how
might they inform your decision making and the course of action you
take?
Adapted from Scaife (2001) and Falender & Shafranske (2008)
Professional Practice
Informed consent with supervisees
• Informed consent provides the opportunity to clarify goals,
methods, structure and purpose of supervision
• Written agreements with supervisees minimise the risk of
any misunderstandings
• The agreement should clearly specify
o
o
o
o
o
o
o
o
The nature of the supervisory relationship
The type of services to be provided
Anticipated length and frequency of supervision
Limits to privacy
Fees and related policies
OH&S representatives contact details
The terms of termination of the supervisory relationship
Record keeping obligations of both parties e.g. log book, supervision
notes
o Back up procedures for supervisee in emergencies
o State the means used to evaluate the supervisee e.g. audio or video
recording, case presentations
Documentation / Log books
Australian Psychology Accreditation Council Accreditation Standards
(Ver 10 June 2010) p. 54
Log Book - 5.1.17
On commencing the 5th year, every postgraduate professional coursework student must
commence a single log book of practica, casework and supervision experiences. The log book
must detail the nature and hours of all placement or other practica undertaken (internal and
external), as well as the dates, nature and hours of supervision, with group supervision clearly
differentiated from individual (i.e. one-on-one) supervision and the log book clearly specifying
the nature of client work undertaken. Supervisors are required to regularly endorse, by
signed notation, that the log book is a true reflection of the practica undertaken and log
books must be available for inspection by APAC if requested during an audit or accreditation
assessment. The log book should be carried over into the 6th and subsequent years of
professional postgraduate training and a copy retained by the AOU for a period of ten years
following the graduation of the student which can be inspected by APAC or the Registration
Board on request. A final check of the log book must be a requirement of the course and this
check must be confirmed by the signature of the/a primary supervisor on the log book itself.
Informed consent
with patients of supervisees
• See APS Guidelines on Supervision 4.2 and 4.3
4.3 Supervisees ensure that they have obtained informed consent from clients to
allow them to disclose clients’ relevant personal information to their supervisor
• Supervisees must inform patients of the supervised nature
of the relationship and provide the name of their supervisor
• This include informing clients of what sort of details will be
discussed with supervisors, where these discussions will
occur, what will happen to audio or video recordings of
sessions
• Placement settings may provide formal consent forms for a
supervisee’s client to complete, otherwise consent should
be documented by the supervisee
Confidentiality
•
Confidentiality is the obligation to protect the privacy of patient
information
•
Supervisees are also entitled to a degree of privacy
•
Regarding privacy, supervision contracts should address:– who will have access to information about the supervisee’s work
performance, personal disclosures and supervisors’ assessments
– which types of records will be kept regarding the supervision
– what will happen to supervisors records and to recordings submitted for
review e.g. who is responsible for erasing or disposing of electronically
recorded clinical material)
•
Supervisees who have had documented issues in prior
placements should be aware that a University “may release
information about such student progress to the supervisor in
accordance with relevant privacy legislation and policies”
(Sourced from ww.mq.edu.au/policy/docs/practical_placements/policy.html)
Group supervision - Pros
• Less costly in terms of money and supervisors time
(Bernard & Goodyear, 2009)
• Supervisees exposed to greater breadth of client
characteristics and presenting problems
• Input from a broader range of colleagues
• Personal support from group membership and a source of
normalising supervisees’ experiences
• Opportunity to observe and experience group process
Group Supervision - Cons
• Diminished confidentiality is a concern as the number
of people who have access to information is
increased (Bernard & Goodyear, 2009).
• A group may not offer adequate time for attending to
all the needs of members
• Unaddressed groups dynamics (such as competition,
jealousy, resentment) can diminish the value of
supervision
• Interpersonal conflict amongst group or gossip
outside of the group can be problematic
• Multicultural issues can be neglected or mismanaged
• Thomas (2010) suggests these issues can be
minimised by awareness and appropriate intervention
by a skilled supervisor
Ethical decision making in
group supervision
Proctor (2008) proposes the following points which will
influence ethical decision making in a group context:•
•
•
•
•
•
•
•
Who has the highest call on the supervisor’s duty of care at any
particular time – client, supervisee, group members, organisation?
Is there urgency in respect to one or more of these stakeholders?
Is there time to seek consultation?
To whom should any communication be addressed in the first place?
Should this always include telling the supervisee concerned before
anyone else?
Can it be done publicly in the group – maintaining authenticity,
respect and empathic understanding?
Has it been established that private meetings may be held between
supervisor and members – for any reason? Or in special
circumstances? Will arrangements be made privately or in the
group?
Have I clarified for myself my grounds for concern and my purpose in
addressing any stakeholder?
Case discussion
You are consulted by the group supervisor in the following vignettes.
What questions might you raise with the supervisor and develop some
choices of action that the supervisor could choose between.
1. A group supervisor has a small group of four supervisees, all from the same
training course. One of the supervisees has written him a letter saying that she
and one of the male supervisees, also in the supervision group, are having a
relationship and intend to move in together in the next few weeks. She wants
to know if this will affect their being in the same supervision group – they find
the group very helpful and desperately want to remain in it.
2. A group supervisor has a group of three supervisees. Two of the supervisees,
Jack and Jill, have taken to supervision well and use it effectively to learn and
reflect on their client work. Joanna on the other hand seems to drain the
group’s energy. She takes every opportunity to talk about herself, her past, her
difficult times at home. She relates this to almost all the cases brought by the
others. Last supervision session Jill exploded and said that Joanna should take
this to personal counselling instead of dumping it on the group.
Vignettes adapted from Proctor (2008)
Dual / Multiple relationships
• The supervisor and supervisee relationship is
complex and serious consideration is required when
members enter into additional roles.
• Campbell (2000) suggests that dual and multiple
relationships are inherent in the supervisory position
so it is not a question of how to avoid them in
supervision but how best to manage them
• Additional roles may include
–
–
–
–
–
friendship
collaboration on research or projects
publications
presentations
discussions of topics that are unrelated to supervision (e.g. personal
problems of either individual)
– incidental or planned interaction outside of formal meetings
– line manager
Dual / Multiple relationships
• A supervisor may often be the line manager or the supervisee
may be professionally accountable to supervisor. How can
this impact on the supervisory relationship?
• Multiple relationships between supervisor and supervisee can
involve subtle, boundary issues. Supervisors must not allow a
supervisory relationship to become a counselling relationship.
Even recommending to supervisees that they seek
counselling to resolve issues that are having a negative
impact on their work with clients may strain the supervisory
relationship. The focus in supervision must remain on the
welfare of the clients.
• While social encounters make the work atmosphere more
enjoyable, the objectivity of a supervisory relationship may be
compromised by a friendship and the social relationship may
not be entirely voluntary on the part of the supervisee (Knapp
& VandeCreek, 2012)
Decision making model for
relationships with supervisees
•
•
•
•
•
•
•
•
•
To what extent would engaging in this relationship or connection meet the
needs of the supervisee? How would this individual likely benefit?
To what extent would it meet my needs? How might I benefit?
Are the needs in question primarily personal or professional?
What could go wrong if I decided to do this? What harm could result and to
whom?
What is the worse-case scenario and how likely is it to occur? If it did occur
what could be done to ameliorate the negative or harmful effects?
What are the unique characteristics of this individual and of our particular
relationship?
What particular vulnerabilities or needs do I have that have the potential to
create a blind spot for me in objectively evaluating this decision?
From whom did the initiative for this connection come? If the idea was mine
(supervisor) to what extent is that individual likely to feel free to decline,
given my relationship with him or her?
What are the alternatives? What risks and benefits do they pose?
From Thomas (2010)
Supervisee self disclosure
Any supervisory technique requiring self disclosure represents a
“double-edged ethical sword” according to Thomas (2010)
• Self disclosure in the context of supervision provides an opportunity
for personal and professional growth, enhancing competency.
Supervisees gain insight of any unresolved personal issues and
develop an improved self awareness of any potential problems that
may compromise their clinical objectivity and effectiveness.
• Alternatively, self disclosure in individual or group supervision may
represent an invasion of privacy. Failure to obtain informed consent
to participation in training with clear awareness of all requirements is
another ethical problem. Introducing personal information into the
supervisory alliance creates potential for a dual relationship (i.e.
supervisor – supervisee, therapist – client). Crossing the boundary
between therapy and supervision creates a poor role model for
supervisees who are learning to clarify boundaries with their clients.
Consideration of Diversity
• Diversity includes ethnicity, culture, gender, age,
sexual orientation, and disability
• Ethical approach to supervision needs to include
consideration of these factors in relation to client
groups, services and the supervisor’s and
supervisee’s own experiences and values
• Consideration of diversity issues is crucial to
supervision
Power differences in supervision
Common transference themes in supervision include:
•
•
•
•
•
•
•
admiration
the wish to please
attraction
a desire to emulate the supervisor
fear of criticism
intimidation / resentment
feelings of being “seen through or diagnosed”
• The supervisor bears the ethical responsibility for
monitoring and addressing transference and
countertransference reactions occurring in supervision.
Power differences in supervision
• Supervisors are liable for the work of their supervisees, they
have authority to establish requirements and dispense
meaningful consequences for noncompliance
• “Ethically and legally the principle of do no harm to the client
must prevail . . . Supervisors should be aware that in the end,
they will be responsible for the supervisee’s overall actions
with clients. This responsibility is referred to as vicarious
liability” (Campbell, 2000, p 158)
• Recent Psychology Tribunal decision highlighted the
responsibilities of supervisors – see HCCC v Dene and
Donnelly (no:2) [2010] NSWPST 4
www.austlii.edu.au/au/cases/nsw/NSWPST/2010/4.html
• Ethically responsible supervision involves ensuring that the
supervisor holds professional indemnity insurance
covering their supervisory role, supervise within the
boundaries of their competence, document supervision
carefully, consult with colleagues as needed and keep up
to date with evolving ethical standards and legal
developments
• Consulting relationships generally involve a less potent
power differential than in supervision
• Power dynamics are not static in the supervisory
relationship – it is the supervisor’s ethical responsibility to
attend to the evolution of power dynamics in the
supervisory relationship
• As Campbell (2006) notes that “as the supervisee matures
professionally, supervision becomes more consultative in
nature”. It can be argued that “once a client, always a
client”, that claim is not made about supervisees.
Sexual contact in supervision
• Is consent even possible in the context of a
relationship of unequal power?
• What impact do sexual relationships with
supervisees have on other supervisees or
employees? What does this demonstrate to
supervisees about ethical standards?
• Ethics code and guidelines do not specifically
comment on sexual contact with former
supervisees – what issues need consideration?
Sexual contact in supervision
• APS Code of Ethics (2007):C.4.2. Psychologists do not exploit their relationships
with their assistants, employees, colleagues or
supervisees.
• APS Guidelines on Supervision (2013)
3.9 Psychologists do not engage in sexual activity with
their supervisees (Bernard & Goodyear, 2009)
• APA Ethics Code (2010) :7.07 Sexual Relationships with Students and
Supervisees Psychologists do not engage in sexual
relationships with students or supervisees who are in
their department, agency, or training centre or over
whom psychologists have or are likely to have
evaluative authority.
Final Thought
• No amount of professional experience or
education makes us immune to error
• Practicing and supervising ethically requires
ongoing effort and commitment to stay abreast of
changes
• “Our objectivity and effectiveness are vulnerable
to personal stressors and clinical challenges . . .
When compromised, they are only as good as
the safety net we construct around ourselves in
our work. Supervision and consultation are
cornerstones of this safety net” (Thomas, 2010, p. ix)
Module 2
The Process of Assessment
Types of Assessment
Assessment Procedures
Managing underperformance
Managing Impairment
Overview
In this module, participants will consider
the types of assessment necessary in
supervision, the procedures that safe
guard them and strategies to manage
under performance as well as outcomes
that require their gatekeeping actions.
Pre-reading
Jacobs, S.C., Huprich, S.K., Grus, C.L., Cage, E.A., Elman, N.S.,
Forrest, L., Schwartz-Mette, R., Shen-Miller, D.S., Van Sickle,
K.S. & Kaslow, N.J. (2011). Trainees with professional
competency problems: Preparing trainers for difficult but
necessary conversations. Training and Education in Professional
Psychology, 5(3), 175-184.
Functions of Supervision
Supervision serves various functions:
1.
Normative – monitoring and ensuring client well
being, and monitoring and evaluating supervisee
competence (summative feedback)
2.
Formative – educating and guiding supervisee’s
professional practice (e.g. facilitate supervisee’s
learning)
3.
Restorative – supporting supervisee’s personal
and professional well-being (e.g. provision of
emotional support)
Supervision = Development + Assessment
•
Supervisors can occasionally be troubled by the evaluative
component of supervision as it is not compatible with their
professional identity as a helping professional, that is one
who is a facilitator of change not a decision maker about what
change is necessary (Bernard & Goodyear , 2009)
•
“Supervision frequently serves two broad and at times
competing functions or purposes - development and
assessment of a supervisee. Development functions include
mentoring, support, guidance, and teaching. Assessment
functions include appraisal, evaluation, feedback and ‘gatekeeping’. The requirements of these two broad functions can
be potential sources of professional, ethical and legal
challenges to psychologists and the profession of psychology
in general (Bernard & Goodyear, 2009; Falender &
Shafranske, 2004; Milne 2009)”
•
– from APS 2013 Guidelines on Supervision
The Assessment Context
•
1)
2)
3)
4)
It is easier to provide negative assessment material to a
supervisee if the system is supportive:
The University and workplace procedures and guidelines
have been adhered to
A realistic attitude for the need for occasional negative
evaluation is supported by the institution and the institution
accepts responsibility for producing competent trainees
Workloads allow you to address concerns appropriately
A supervisor’s action has been supported by the institution
(Jacobs et al, 2011)
•
Feedback forms promote focus on competency
Favourable conditions for assessment
Bernard and Goodyear (2009) propose the following conditions
that can make assessment a more positive experience:
 Supervisors must remember that supervision is an unequal relationship
 Clarity: supervisors need to state clearly their administrative and clinical
roles
 Address supervisee defensiveness openly
 Address individual differences openly
 Evaluation should be a mutual and continuous process
 Avoid making premature evaluations of supervisees
 Allow supervisees to witness the professional development of supervisors
(e.g. inviting and using feedback from supervisees, sharing continuing
education experiences and new ideas the supervisor has recently been
exposed to)
 Supervisor maintains a relationship with supervisee that is positive and
supportive, professional but not personal
 Only those who enjoy supervising should supervise
Formative Feedback
• Formative assessment is the process of facilitating skill
acquisition and professional growth through direct
feedback
• Formative evaluation stresses the process and
progress of professional competence, rather than
outcome
• Supervisors are more comfortable with formative
feedback and this type of evaluation represents the
bulk of the supervisor’s feedback according to Bernard
& Goodyear (2009)
Formative Feedback
An evidence-based protocol for providing constructive
developmental feedback:• Invite and facilitate the supervisee to self review
• Express appreciation of their efforts and achievements and
awareness of challenges
• Provide data based feedback (timely, specific and concrete,
examples and consequences on client/supervisee) on
performance “gaps”
• Invite their response to your feedback (& LISTEN)
• Their ideas for practice improvement
• Comment on their ideas and add your own
• Invite their response to your ideas
• Collaboratively plan their practice development
• Review the feedback process
• Follow up next session
From Wilson & Armstrong (2009)
Log book
The documentation of supervision is “an essential risk
management strategy” according to Thomas (2010)
• Electronic logbooks are now commonly in use, and students will
continue to use the spreadsheet from their Clinic placement
across all field placements. This is where all client contact and
supervision hours are to be documented. APAC requires the
logbook to be “reflective”, so make sure the supervisee and
supervisor regularly comment on the progress of supervision
sessions. Supervisors must complete the Electronic Logbook
Declaration form to document the hours that have been
accumulated at the completion of the placement.
• If a supervisee has not used the electronic logbook, then two
forms of records need to be kept:
o Log Book Daily Activity Sheets and
o Supervision Session Summary Sheets.
Log Book - Example
NAME OF STUDENT: Jane Doe
SUPERVISOR: Mark Goodfellow
AGENCY: Anxiety Disorders Clinic, Atlantis
NB: 1=Total hours claimed for the date specified; 2= Practicum hours not otherwise specified, ie not included under columns G,H, I and J; Totals appear at bottom of sheet
DATE
WEEK
1
PLAC
HRS1
04-Jun-10
Activity
One Individual Therapy Session - JJ
Assessment (IQ)
Ward rounds
Seminar
Supervision (MG)
Preparation, documentation, miscellaneous
Prac Hrs
NOS2
CLIENT WORK
SUPERVISIO
Ct. popn FACE-TO-FACE HOURS N HOURS
Group
Adult
Adult
Individual
Group
SUPERVISION
Individual
STUDENT'S COMMENTS
Log approved by
Supr (date)
1
1
1
1
1
good help with client…
2.5
7.5
2
07-Jun-10
Individual Therapy Session - JJ
Individual Therapy Session - MB
Co-therapist in Anxiety Group, Session 1
Supervision MG
Adult
Adult
Adults
1
1
2
2.5
1
7.5
11-Jun-10
learning about tolerating uncertainty
MG Jun 9
Initial Session CC
Individual Therapy Session - AC
Group Supervision (Supervior, ZP)
Adult
Adult
1.5
1
1.5
3.5
7.5
3
14-Jun-10
Individual Therapy Session - JJ
Individual Therapy Session - MB
Co-therapist in Anxiety Group, Session 1
Supervision MG
7.5
Adult
Adult
Adult
1
1
2
2.5
1
Helpful discussion of implementing panic surfing
MG, Jun 16
Summative Feedback
•
•
•
•
•
Summative feedback is a more formal process that ensures the
supervisor’s accountability to the supervisee, the academic and
clinical training programs, and the profession, ultimately safe
guarding the public (Falender & Shafranske, 2008)
Summative evaluation typically involves ratings of performance
in a given competency.
Summative feedback occurs at the mid-point and end of a field
placement
A competency based approach emphasises clear objectives
throughout the training process and identifies the requisite
knowledge, skills and values in particular competencies
One of these competencies is the development of self
assessment and reflection. See Module 6 for in depth
discussion of reflective practice in supervisee.
APAC Requirements on Summative
Feedback
From Australian Psychology Accreditation Council Accreditation Standards
Ver 10 June 2010:
• 5.3.27 At the beginning of each placement the student and supervisor
must complete and sign a supervision contract stating the objectives for
the placement including the range of activities to be covered and the skill
base to be developed. This form should be approved and signed by the
placement coordinator.
• 5.3.28 Once approximately half the placement has been completed, an
interim review should be conducted which involves the student and
supervisor reviewing progress, the student’s performance and the extent
to which the placement objectives are being met. A copy of this review
should be given to the placement coordinator and any action that is
required as a result should be taken. Placement reviews must be held on
file by the AOU and be made available for inspection by APAC if
requested.
APAC Requirements on Summative
Feedback
• 5.3.29 At the end of the placement the supervisor must
complete a final assessment and make a
recommendation whether the student has completed
the placement to an acceptable level, whether further
time should be spent on that placement because the
student has not yet met requirements, or whether the
student has failed to meet the required standards and
is not likely to do so with further work. The final
decision regarding whether the student has passed or
failed the placement should be made by the placement
coordinator in full consultation with the field supervisor.
Summative Assessment Forms
Several of the summative feedback forms
used in placements are available in online
survey format, and this is the preferred
method for submission (links to forms are
provided below).

At mid-placement review CYPRS is
completed:
https://uowpsych.us.qualtrics.com/SE/?SID=SV_ebRFp7Rm3pT4Bvf

At end of placement review CYPRS is
completed:
https://uowpsych.us.qualtrics.com/SE/?SID=SV_26x2u5ZfEBkLKvP
CΨPRS – Clinical Psychology
CΨPRS – Clinical Psychology
Clinical Neuropsychology form
Clinical Neuropsychology form
Organisational Psychology form
Quick Quiz
1.
2.
3.
Evaluation aimed at fostering development is
known as _________ assessment.
Evaluations made as a judgement of professional
competence are known as ___________
assessment.
The gatekeeper role in supervision serves what
function?
A. Normative
B. Restorative
C. Formative
Assessment of your Supervision
Assessment of the supervision you
provide can be achieved by:
• Feedback from supervisee – both formative and
summative
• Student’s on-line evaluation of placement
https://macquariehs.qualtrics.com/SE/?SID=SV_0unPbyPoGWPG7Q0
• Supervision of your supervision (individual or
group)
• Consultation groups focussing on supervision
• Utilising rating scales such as Tasks / Changes in
Supervision (from University of Queensland)
Managing Underperformance
& Impairment
Inherent requirements of psychologists
UWS developed a series of inherent requirement statements for the Master of
Psychology (Clinical Psychology). These statements specify the course requirements for
student admission and progression and are clustered under seven domains consisting
of:
1. ethical behaviour - complying with conduct required to maintain provisional registration as a
psychologist
2. behavioural stability - being receptive and responding appropriately to constructive feedback,
managing own emotional state in order to be able to develop and maintain an appropriate
relationship with a diverse range of clients
3. legal - complying with legal requirements regarding all aspects of practice, complying with the
requirement for student registration with the Australian Health Professional Registration
Authority (AHPRA)
4. communication
- verbal: collecting information from clients by asking questions during
assessments, explaining a treatment plan to a client, discussing the client's
progress with other professionals
- non verbal: recognising and responding to non-verbal cues indicating a
change in the emotional state of a client during placements. recognising and
responding to non-verbal cues in classroom situation
- written: constructing an essay to required academic standards including
appropriate referencing of sources, preparing clinical reports which are
appropriate to the purpose and audience, and completed in a timely manner
Inherent requirements of psychologists
5. cognition - ability to apply academic knowledge to practice during placements, for example through
developing and testing hypotheses, developing treatment plans and then conducting individual sessions
for clients based upon this, literacy skills including conveying a spoken message accurately and effectively
in a clinical setting during placements, numeracy skills including accurately scoring and interpreting
psychological test data while on placement, paraphrasing, summarising and referencing producing
accurate, concise and clear documentation while on placement in the clinical setting which meets legal
and professional requirements
6. relational skills - rapidly building rapport with a client in order to engage them in a clinical assessment
while on placement, effectively managing difficulties arising in the therapeutic relationship while on
placement
7. reflective skills – identifying when a clinical issue is outside one's scope or expertise, or when one's
practice may be affected by an impairment
Also as many of the activities associated with the professional practice of a registered psychologist are time
sensitive, the capacity to perform certain activities within specified time limits is required to reduce or avoid
risks to patient safety and wellbeing.
(Developed from Johnson, A., Allan,T., Phillips,K., Azzopardi,T., Dickson,C., Goldsmith,M & Hengstberger-Sims, C.
(2011). Inherent Requirements of Nursing Education (IRONE), UWS School of Nursing & Midwifery and Student Equity
& Disability Services).
Sourced from
http://www.uws.edu.au/ir/inherent_requirements/inherent_requirements_for_master_of_psychology_clinical_psychology
Definitions
• According to Scaife (2001) there are 3 categories of
difficulties supervisees may demonstrate: 1. Incompetence (professional unsuitability)
2. Impairment (personal incapability)
3. Unethical practice (malpractice, professional
misconduct)
• Incompetence, impairment and unethical behaviour are
not mutually exclusive and may overlap. The
terminology used regarding students who “are not
measuring up” has been the source of much
controversy over the past 20 years (Pelling et al, 2009).
Incompetence
Incompetence is defined as when supervisees have never
shown a level of competent professional functioning
• Elman and Forrest (2007) recommend using a more
behaviourally focussed term - “problems of professional
competence” - as this captures the following three
elements
a.
there is a problem with performance
b.
a professional standard, and
c.
a focus on competence.
Problems of professional competence
• Problems in professional competence may be identified in
one or more competency domains that are key to effective
functioning
• Kaslow et al. (2007) describe two categories of
competencies
– foundational (e.g. professionalism, reflective practice / selfassessment, scientific knowledge and methods,
relationships, ethical and legal practice, individual and
cultural diversity, interdisciplinary systems), and
– functional (e.g. assessment / diagnosis / conceptualization,
intervention, consultation, research / evaluation, supervision
/ training, management / administration).
Managing incompetence
• Refer back to supervision agreement
• Extend the placement with the
following:
• Role plays
• Use of video
• Didactic techniques – teaching
• Observation of supervisor
• Education / assigned reading
• Return to the Clinic for remediation
• Repeat placement in a new agency
MQ Policy on Failure
Supervisors do not “Fail” a student, the Placement Coordinator is
responsible for this decision.
•
“All placements are graded as Satisfactory or Unsatisfactory by the
Placement Co-ordinator. Supervisors do not grade Students, this
is the responsibility of the University. The decision is based on
information supplied by the Supervisor, the written work submitted
and the standard reached where problem areas have been
identified.”
From Macquarie University, Clinical Psychology 2013 Field Placement Manual
•
“The final decision regarding whether the student has passed or
failed the placement should be made by the placement coordinator
in full consultation with the field supervisor (and with oversight
from the course chair where required).”
From Macquarie University, Clinical Neuropsychology 2013 Field Placement Manual
Impairment
• Impairment means a physical or mental impairment,
disability, condition or disorder (including substance
abuse or dependence) that detrimentally affects or is
likely to detrimentally affect the persons’ capacity to
practise the profession (Health Practitioner Regulation
National Law (ACT) - SECT 5)
• Impairment refers to diminished functioning after
reaching an adequate level of professional competence
(Sullivan, 2009; Scaife, 2001)
Unethical practice
Unethical practice is when registered practitioners have not
performed in accord with the professions code of ethics,
potentially resulting in notifiable conduct
Notifiable Conduct means the registered practitioner has:
•
practiced whilst intoxicated by alcohol or drugs (so that their capacity to
exercise reasonable care and skill is compromised);
•
engaged in sexual misconduct in connection with the practice of the
practitioners profession;
•
placed the public at risk of substantial harm in the practitioner’s practice
of the profession because the practitioner has an impairment; or
•
placed the public at risk of harm because the practitioner has practiced
the profession in a way that constitutes a significant departure from
accepted professional standards.
Mandatory Reporting
Psychology Board of Australia (PsyBA) has a core role of protecting the
public. To this end the PsyBA investigates concerns raised about individual
psychologists through the “notification” system.
• This process is managed through the Regional Boards of the PsyBA in the
respective States and Territories in collaboration with AHPRA. Except in
NSW where notifications are dealt with by a separate health professional
(Psychology) council and the Health Care Complaints Commission
• Voluntary notifications about psychologists can be made by anyone
• Under the National Registration and Accreditation Scheme (NRAS) there
is a mandatory obligation on any registered health professional (including
provisional psychologists), employer or education provider who forms a
reasonable belief that another practitioner has engaged in notifiable
conduct to make a report to AHPRA
• In 2011/12 AHPRA received 44 mandatory notifications and 367 voluntary
notifications about psychologists
• In 2010/11 AHPRA received 428 mandatory notifications across 10
professions, of these 7 notifications were about students
Source: InPsych (APS Bulletin), April 2013, pg 26-27
HEALTH PRACTITIONER REGULATION
NATIONAL LAW (NSW) - SECT 55
Unsuitability to hold general registration
(1) A National Board may decide an individual is not a suitable person to hold general registration in a
health profession if
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
in the Board’s opinion, the individual has an impairment that would detrimentally affect the individual’s capacity to
practise the profession to such an extent that it would or may place the safety of the public at risk; or
having regard to the individual’s criminal history to the extent that is relevant to the individual’s practice of the
profession, the individual is not, in the Board’s opinion, an appropriate person to practise the profession or it is not in
the public interest for the individual to practise the profession; or
the individual has previously been registered under a relevant law and during the period of that registration
proceedings under Part 8, or proceedings that substantially correspond to proceedings under Part 8, were started
against the individual but not finalised; or
in the Board’s opinion, the individual’s competency in speaking or otherwise communicating in English is not
sufficient for the individual to practise the profession; or
the individual’s registration (however described) in the health profession in a jurisdiction that is not a participating
jurisdiction, whether in Australia or elsewhere, is currently suspended or cancelled on a ground for which an
adjudication body could suspend or cancel a health practitioner’s registration in Australia; or
the nature, extent, period and recency of any previous practice of the profession is not sufficient to meet the
requirements specified in an approved registration standard relevant to general registration in the profession; or
the individual fails to meet any other requirement in an approved registration standard for the profession about the
suitability of individuals to be registered in the profession or to competently and safely practise the profession; or
in the Board’s opinion, the individual is for any other reason:
(i) not a fit and proper person for general registration in the profession; or
(ii) unable to practise the profession competently and safely.
Procedure for mandatory notification
Complaints & Notifications
Anyone can make a complaint, but it must be in writing.
• Health Care Complaints Commissions, New South Wales
Level 13, 323 Castlereagh Street (corner of Hay St) Sydney NSW 2000
Ph: (02) 9219 7444
Toll Free in NSW 1800 043 159
TTY service for the hearing impaired: (02) 9219 7555
Email: hccc@hccc.nsw.gov.au
• Australian Health Practitioner Regulation Agency (AHPRA)
https://www.ahpra.gov.au/Notifications-and-Outcomes/Conduct-Health-andPerformance/Make-a-Notification.aspx
Note there are different forms and addresses dependent on if you are a member of
the public making a voluntary notification or if you are a health practitioner making a
mandatory notification to AHPRA
• Liaise with the supervisee’s Placement Co-ordinator at any
time during the placement if you have concerns that your
supervisee is not able to meet the required goals and
standards of the placement.
Cases for discussion
• Supervisee struggling with whether supervisors
conduct is unethical / notifiable
• Dealing with supervisee who has recently commenced
placement and is wearing short skirts and plunging
neck lines
• Supervisee who continually arrives late for supervision
sessions and becomes defensive when you broach
these issues
References
American Psychological Association (2010). Ethical principles of psychologists and code of conduct (2002, Amended June1, 2010).
Australian Psychological Society. (2007). Code of ethics. Melbourne, Vic: Author.
Australian Psychological Society. (2013). Guidelines on Supervision. Melbourne, Vic: Author.
Barnett et al (2007) Commentaries on the ethical and effective practice of Clinical Supervision. Professional Psychology: research and practice, 38(3), 268-275.
Beauchamp, T.L. & Childress, J. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.
Bernard, J.M. & Goodyear, R.K. (2009). Fundamentals of Clinical supervision, 4th Edition. Ohio: Pearson.
Campbell, J. (2000). Becoming an effective supervisor: A workbook for counselors and psychotherapists. New York: Routledge.
Campbell, J. (2006). Essentials of Clinical Supervision. New Jersey: John Wiley & Sons.
Carroll, M. & Gilbert, M.C. (2006). On Being A Supervisee: Creating Learning Partnerships. Victoria: PsychOz.
Elman, N. S., & Forrest, L. (2007). From trainee impairment to professional competence problems: Seeking new terminology that facilitate effective action.
Professional Psychology: Research and Practice, 38, 501–509
Falender, C.A. & Shafranske, E.P. (2004). Clinical Supervision: A Competency-Based Approach. Washington: American Psychological Association.
Falender, C.A. & Shafranske, E.P. (2008). Casebook for Clinical Supervision: A Competency-Based Approach. Washington: American Psychological Association.
Falender, C.A., Collins, C.J. & Shafranske, E.P. (2009). “Impairment” and performance issues in clinical supervision: After the 2008 ADA Amendments Act. Training
and Education in Professional Psychology, 3(4), 240-249.
Haas, L.J. & Malouf, J.L. (2005). Keeping up the good work: A practitioner’s guide to mental health ethics (4th ed.). Sarasota: Professional Resource Exchange.
Jacobs, S.C., Huprich, S.K., Grus, C.L., Cage, E.A., Elman, N.S., Forrest, L., Schwartz-Mette, R., Shen-Miller, D.S., Van Sickle, K.S. & Kaslow, N.J. (2011).
Trainees with professional competency problems: Preparing trainers for difficult but necessary conversations. Training and Education in Professional Psychology,
5(3), 175-184.
Kaslow, N. J., Rubin, N. J., Forrest, L., Elman, N. S., Van Horne, B. A., Jacobs, S. C., . . . Thorn, B. E. (2007). Recognizing, assessing, and intervening with
problems of professional competence. Professional Psychology: Research and Practice, 38, 479–492.
Kitchener, K.S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling
Psychologist, 12, 43-55.
Knapp, S.J. & VandeCreek, L.D. (2012). Practical Ethics for Psychologists: A Positive Approach. Washington: American Psychological Association.
Milne, D. (2009). Evidence-Based Clinical Supervision. West Sussex: BPS Blackwell.
Proctor, B. (2008). Group Supervision: A Guide to Creative Practice (2nd Ed). London: Sage.
Ross, W.D. (1998). What makes right acts right? In J. Rachels (Ed.), Ethical theory (pp. 265-285). New York: Oxford University Press. (Original work published
1930).
Scaife, J. (2001). Supervision in the Mental Health Professions: A Practitioner’s Guide. East Sussex: Brunner-Routledge.
Sullivan, B. (2009). Supervision as Gate-keeping: Managing professional competency problems in student supervisees. In N. Pelling, J. Barletta and P. Armstrong
(Eds.), The Practice of Clinical Supervision. Sydney: Australian Academic Press.
Thomas, J.T. (2010). The Ethics of Supervision and Consultation: Practical Guidance for Mental Health Professionals. Washington: American Psychological
Association.
Wilson, K. & Lizzio, A. (2009). Processes and interventions to facilitate supervisee’s learning. In N. Pelling, J. Barletta and P. Armstrong (Eds.), The Practice of
Clinical Supervision. Sydney: Australian Academic Press.

Supervision

Transcription

Similar documents

Detasseling corn

Brochure - cg world

OKOTOKS • HOLY TRINITY ACADEMY

AAA Kempinski Hotel, Vilnius

Clivet P-Matic for WLHP

planningAND development - myOrangeLadder

Ava-Maria Iesha Thomas - Coady International Institute

writing job descriptions

Manual - Backyard Pool Superstore

The Unveiling - Therapeutic Speakeasy