This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Appendices

Appendix 1

1. Case Conceptualisation

Issues relevant to conceptualising and assessing the presenting problem and the client's needs.

  • What is the presenting problem?
  • What other issues or problems need to be considered?
  • What strengths and "non-problems" need to be noticed?
  • What are the client's expectations regarding outcome and methods of intervention?
  • Who else has a stake in this intervention (family members, friends, professionals) and in what ways are they influencing the problem, client or practitioner?
  • What contextual issues are relevant (manner of referral, agency, client's current life events, etc)?
  • What cultural issues are relevant (ethnicity, class, gender, sexuality, religion, age, etc)?
  • What formal or informal history taking or assessment are appropriate? Is specialised assessment needed?
  • Is formal diagnosis required? If so, how and what?
  • What legal issues (such as notification of abuse) or policies (such as managing suicide risk) are relevant?
  • What are the practitioner's strengths in case conceptualisation? Are these being acknowledged?
  • What method of cultural assessment was used? How effective was this method?
  • What cultural factors did you take into account when planning the work?

Although this is a detailed list of questions the supervisor and supervisee will need to identify and agree upon which parameter of the 'triangle' they wish to work with during their supervised session. If the supervision is 'patient-centred' the focus of the supervision may be upon the client's strengths and weaknesses, issues or problems that have arisen, or the client's views and expectations, etc. Alternatively, if the supervision is 'practitioner-centred' consideration may be given to 'who the practitioner is working with', the 'experiences of the practitioner', or 'what issues arise from their viewpoint'. Process-led supervision may examine the cultural issues that affect the dynamics of interaction. The choice of questions you use, and the way in which you phrase them will need to be tailored to meet the aims of the clinical supervisory session.

2. Planning and contracting

Identifying the appropriate clinical goals; and methods; negotiating and contracting the goals and the structure and methods of intervention with the client.

  • Which issues should be addressed and in what order?
  • What are the appropriate goals for care?
  • What are the appropriate methods for delivery of care?
  • Who should participate in delivering care?
  • What needs to be done to engage the patient in the care giving process?
  • What formal or informal contracts are in place?
  • What are the practitioner's strengths in planning and contracting skills? Are these being acknowledged?

3. Case management

Issues relevant to the ongoing implementation and revision of the care plan.

  • What are the current plans/goals?
  • What has been achieved? (What went well?)
  • Were there any problems?
  • What needs to be done differently?
  • Do the goals or methods need to be reconsidered?
  • What preparation is needed for future care?
  • What are the practitioner's strengths in case management skills? Are these being acknowledged?

4. Case administration

The relevant policies and procedures for case administration.

  • What files and case notes need to be kept? When? What form? How? Legal or policy requirements?
  • What communication is needed with others? When? What form? How?
  • What formal reports (e.g. court reports) are required? When? What form? How?
  • What resources (space, equipment, etc.) are required? How should they be acquired?
  • What safety or insurance matters need attention?
  • What are the practitioner's strengths in case administration skills? Are these being acknowledged?

5. Skills and knowledge

  • What skills and knowledge are needed for appropriate assessment and care with this client?
  • Does the practitioner have all of these? If not, when, where and how will these be gained?
  • What are the practitioner's strengths in skills and knowledge? Are these being acknowledged?

6. Professional conduct

Ethical and professional issues, principles and practices.

  • What aspects of the professional code of conduct are particularly important in working with this client?
  • Is the practitioner working in partnership with this client? Has the patient had access to relevant information? (i.e., formal reports)
  • Is the practitioner's use of touch and boundaries appropriate and ethical?
  • Has informed consent been obtained for the planned care?
  • Is confidentiality being appropriately maintained?
  • Is the practitioner generally conducting himself or herself in a professional manner (style of dress, punctuality, respectful tone when discussing clients, etc)?
  • What are the practitioner's strengths in professional conduct? Are these being acknowledged?

7. Professional identity

Issues relevant to the development of the practitioner's professional identity (sense of self as a competent practitioner).

  • What stage has the practitioner reached in their professional identity development? What are their needs at this stage (within and outside supervision)?
  • Have the practitioner's developmental milestones been acknowledged and given appropriate credit?
  • Are there any signs of burnout?
  • Does the practitioner perceive that they have sufficient expertise and legitimacy to work with this client in this way?

8. Self

Practitioners are not robots. Their sense of self as a person and their values, background and lifestyle all affect their work with clients. Although it is unethical for personal therapy to occur in supervision, it is often appropriate to address the practitioner's "self" issues in terms of their practice and care delivery.

  • What are the practitioner's strengths in their use of "self" in practice? Are these being acknowledged?
  • In what ways do the practitioner's
    • Own values and attitudes
    • Cultural positions (ethnicity, class, gender, sexuality, age, religion, disability, etc)
    • Past experiences (positive ones and problems)
    • Current context (living arrangements, stress, etc) influence the practitioner's work (with this client or in general)? Do these need attention?
  • Is the practitioner experiencing any conflict between their personal values and beliefs and the requirements of their professional role?
  • In what ways do the practitioner's "self" issues influence their responsiveness to supervision?

You may wish to refer to Section two of the module Transcultural Communication and Health Care Practice by Charles Husband and Edwin Hoffman and examine further the issues of 'self' by reading about 'social identity'.

9. Caring relationship

Issues relevant to ensuring an optimal relationship between the practitioner and the client.

  • What are the strengths of the caring relationship? Are these being acknowledged?
  • What needs to be addressed to establish and maintain a safe and appropriate caring relationship?
  • What process issues need to be addressed (for example, cultural sensitivity, cultural knowledge)?
  • In what ways are the practitioner's or the client's race, class, gender, sexuality, age, religious beliefs or disability impacting on the caring relationship? Do these need to be addressed?
  • Are there any other issues that need to be addressed?
  • Reflect upon the verbal and non-verbal interaction; Identify words used which seem different or unusual to you?

10. Supervisory relationship

Issues relevant to ensuring an optimal relationship between the supervisor and practitioner both for discussing the presenting case and for general supervisory functions.

  • Has a clear and appropriate supervisory relationship been established and maintained?
  • Is there safety and clarity concerning accountability and evaluation issues?
  • Is it personally and organisationally safe and appropriate for the practitioner and supervisor to discuss this case in supervision?
  • What supervision methods are appropriate to this case, given the practitioner's professional development?
  • What are the strengths of the supervisory relationship? Are these being acknowledged?
  • Are there any other issues in the supervisory relationship that might impede supervision of this case (such as contextual or cultural issues)?
  • What cyclic (complementary or symmetrical) patterns have developed within the relationship? What changes are needed to interrupt any unhelpful cycles?

Cyclic patterns

MacKinnon [1986] describes a complementary pattern of "systemic stupidity" in which the supervisor develops an "intelligent" and ideal-generating role while the practitioner develops a stupid passive role.

11. Systems relationships

Issues relevant to the helpful or unhelpful influence of other sub-systems which interact with the client, the practitioner or the supervisor.

  • Which relevant professionals and members of the client's family and friendship network should be involved in some way?
  • Are there any professionals or members of the client's network involved in care giving who should not be involved? Are boundaries needed?
  • Who is discussing the care with the client? How are their comments affecting the client's response to care? Is intervention needed?
  • Are any professional subsystems or individuals impeding the work of the practitioner (either generally or with this client)? Is intervention needed?
  • Are any professional subsystems (such as those who the supervisor is accountable to for their supervision) impeding the work of the supervisor with this practitioner (either generally or with this client)? Is intervention necessary?
  • What are the practitioner's strengths in working the broader system? Are these being acknowledged?
  • Is the practitioner working in partnership with other agencies