I would like to hire a new graduate working toward his/her licensing hours. If he/she is working for me and I’m the identified supervisor on site, is he/she technically working under my license? If so, do I need to inform my malpractice company? Increase my coverage? In addition, can I bill any insurance company for this clinician’s work? What else am I not considering?
Taking on supervisees presents a number of inherent risks, given that supervisors are legally and ethically responsible for the work product of their supervisees. The good news is that these risks are manageable.
One way prospective supervisors can reduce the level of risk is to obtain formal training in providing supervision in order to increase one’s competence. This includes being knowledgeable about any regulations or requirements of supervision in one’s jurisdiction, as well as guidelines related to best practices in supervision (e.g., APA Guidelines for Clinical Supervision in Health Service Psychology, 2014).
Some states have specific requirements related to who can provide formal supervision and what form it must take, which can often be found by reviewing the regulations posted on the psychology licensing board’s website.
Another way to minimize risk is to be very careful in selecting supervisees at the outset. This includes ensuring that the supervisee has the requisite skills, training and temperament to be able to competently and effectively work with the types of clients and issues typically seen in the practice.
Prospective supervisors should talk with references and past supervisors when possible, review background check reports and confirm that no previous complaints have been filed against the supervisee. Some questions to consider would include: Can this supervisee get along well with others? Can he/she comply with the practice policies and procedures? How is he/she with attention to detail and careful documentation?
The next risk management strategy is to be extremely diligent in the oversight and monitoring of the supervisee. Talk with the supervisee about areas where closer guidance and development might be needed. Clarify each party’s expectations in the beginning in terms of the supervisory relationship and what is expected of the supervisee as a provider in the practice.
Develop an employment agreement or contract in which the supervisee agrees that he/she will follow all applicable ethical and legal requirements and will bring to the supervisor’s attention any clinical dilemmas, adverse outcomes, legal questions etc. This agreement should also specify the frequency and mode (e.g., video or audio recordings, live supervision, notes etc.) of supervision, as well as standards and procedures that will be used to evaluate the supervisee.
In addition, this agreement should clarify expectations for billing and compensation, particularly given that many third party payers (i.e., federally funded programs and private insurance companies) do not provide reimbursement for clinical services delivered by trainees or unlicensed clinicians.
It is important to check with the insurance companies and government programs to determine whether and to what extent the supervisor can bill for the supervisee’s clinical services. If billing for services provided by trainees is not allowed, then the agreement should specify how the supervisee will be compensated.
Finally, it is extremely important that the supervisor ensures adequate professional liability coverage throughout the course of the supervision and beyond. This includes coverage for both the supervisor and the supervisee.
It is not uncommon for claims against the supervisee to also name the supervisor. The supervisor would need to check with his/her malpractice insurance provider to clarify that supervision is covered under the policy’s definition of practicing psychology.
Many professional liability insurance providers consider supervision a normal part of the practice of psychology and include coverage for anyone for whom the insured psychologist is legally responsible, but it is important to confirm that. If that is the case, then there may not be a need to modify one’s policy when providing supervision.
But this does not mean the supervisee is automatically covered and, given that the supervisor can be liable for the supervisee’s action, requiring that the supervisee also has professional liability coverage is critical.
This can take several forms:
First, the supervisor can require that the supervisee is insured under his/her own individual policy and most professional liability providers make available specific coverage options or packages for students, post-doctoral fellows, etc.
This is frequently the preferred option for supervisors in private practice who bring on supervisees. One disadvantage of this option is that the supervisor loses control of the coverage once the supervisee leaves the practice. If the supervisee lets his/her insurance lapse, the supervisor would likely be the target of any lawsuit.
A second option is for the supervisor to add the supervisee to his/her policy as an employee, giving the supervisor more control over the coverage, because only the supervisor can renew the policy. This gives the supervisor the security of knowing the supervisee will be covered if a malpractice lawsuit or board complaint is filed after the supervisee has left the practice.
The supervisor can also consider increasing his/her coverage for licensing board defense, given the higher risks associated with supervisees providing clinical services. Depending on your carrier, each individual named on the insurance policy may have his/her own policy limits, so that a claim against one named insured would not diminish the coverage limits of another named insured.
Finally, a third option is that both the supervisor and supervisee (and all clinicians) are covered on the agency’s or employer’s overall professional liability policy. In this case, it would be important to seek clarification regarding whether the coverage continues even after the supervisor and/or supervisee leaves.
Providing clinical supervision is a necessary and worthwhile investment of time that ensures the continued delivery of quality mental health care for future generations. Though it presents unique risks, there are also many benefits for both the supervisor and supervisee, if these risk management strategies are prudently incorporated.
Amanda D. Zelechoski, J.D., Ph.D., ABPP, risk management consultant with The Trust, is a clinical/ forensic psychologist, an attorney and associate professor of psychology at Valparaiso University. Her email is: firstname.lastname@example.org. Dan Taube, J.D., Ph.D., risk management consultant with The Trust, is a psychologist and past professor at the California School of Professional Psychology-San Francisco. His email address is: email@example.com. Joe Scroppo, Ph.D., J.D., risk management consultant with The Trust, is a forensic psychologist and attorney in Woodmere, N.Y. His email address is: firstname.lastname@example.org.