Fall 2014
Supervision in Care Management: Managing Quality

Peer Supervision in the GCM practice: a model of support and resource sharing

About the Author

Debra Drelich, LMSW, ACSW, CMC, is the founder of New York Elder Care Consultants, LLC, (a Geriatric Care management and consultation firm that provides assessment, care planning, implementation of service, and ongoing monitoring of the elderly). She has worked in every facet of the senior care industry. Prior to starting New York Elder Care Consultants, Ms. Drelich directed two Senior Apartment Communities and the Private Geriatric Care Management department of the Hebrew Home at Riverdale. She served for two terms as President of the New York Chapter of NAPGCM and on the executive committee of NAPGCM   In the Fall of 2013, she was invited to serve as the eldercare expert for the NY Times Booming Blog, with a focus of the subject of senior housing.

Debbie Drelich, LMSW, ACSW, CMC, GCM Fellow

A geriatric care manager working as a solo practitioner or in a small private practice needs professional support for both simple and more challenging cases. This is true for beginners, as well as well more seasoned care managers. Unarguably, the life of a GCM involves the probability that conflicts arise daily — at all hours — and ethical dilemmas abound. Where can the GCM turn for refuge of an “objective” voice offering knowledge, resources, and most of all supervision? Our NAPGCM listserv reflects the fact that many GCMs experience a sense of loneliness and are seeking the need for direction and affirmation. While it may offer opinions, thoughts, and resources especially for the newer GCMs, advanced practitioners need something more tangible to measure quality assurance and accountability. One alternative is that an advanced GCM can secure paid 1:1 supervision from their professional discipline (i.e. nursing, social work) or they can seek a group of like-minded professionals. Peer supervision is an excellent support model especially for problem-solving, reducing isolation, and stress reduction. This model of reciprocal learning that comes from the mutual sharing of resources and direct clinical evaluation and feedback can provide exactly what GCMs need without the formal supervision of an “expert” paid supervisor.  The forum of the group potentially provides the collective wisdom of a number of peer professionals rather than one expert, which can enhance problem-solving.

An effective peer supervision group must be formed with a clear structure. The group can either be composed of members who are of similar level of expertise or mixed, although a homogeneous composition might be more valuable to a more seasoned member. This factor, among others, is important to consider when inviting a new member to join the group. Frequency and meeting mode (in-person or telephone) needs consensus and consistency. An agenda for each session should be collaboratively created and a facilitator appointed; the latter can be either fixed, rotated, or one or two group members may naturally evolve into this role. The agenda should have time for a clinical case presentation and the sharing of resources. Each member would be scheduled for a Case Presentation, and a skilled facilitator would need to be mindful during a case presentation that all members have the opportunity to speak and that no particular group member monopolizes the entire meeting. Roles would need to be defined as relates to scheduling, record keeping, and communication.  Most important would be confidentiality and trust; the group must be a “safe place” where members can openly speak about their businesses and cases without fear of competition or judgment. If the group is to become a true peer supervision group, there must be commitment on the part of the members to regularly attend the group, to bring cases to the group for feedback, as well as to facilitate when appropriate.

My own personal need for a peer supervision group came at a time when I was transitioning to a full-time private practice six years ago from being a staff member, supervisor, and department head in a large geriatric institution. I immediately felt a need for support when faced with a large number of clinically complex cases.  The New York chapter’s regular educational meetings and listserv offered excellent opportunities to interact and call upon many wonderful experienced colleagues, but I felt that I needed something more. I learned that there was one peer supervision group existing but that had closed its membership.   It was during an “if only there was” conversation with a colleague, that I heard there was a recently formed peer supervision group that would be happy to welcome a new member. Upon attending the first meeting, it became immediately obvious that this group was composed of a mixture of experienced practitioners, all with different strengths, length of practice (though all have been in practice for over 5 years minimum) serving clients in different geographic locations, and all potential competitors.  However, there was an underlying mutual respect.  In time, additional members were invited to join, and a structure that encouraged more equal participation / responsibility was developed.  The hosting of the meetings is now rotated amongst more of the members, and all who participate bring items so that the host is not overburdened with food preparation.

Two years later, the meetings have evolved into a safe and supportive environment, meeting every four to six weeks, with calls and emails circulating ad hoc when members need additional support or information on resources.   The group now utilizes a “doodle” poll to survey everyone’s availability, as a time saver in scheduling meetings.  The meetings themselves have fostered camaraderie, warm relationships, and cross-referring of cases when appropriate. While many chapters have a long-standing telephonic peer supervision group, there is something uniquely special about this more intimate group mode that ultimately helps to ameliorate the loneliness of being a solo practitioner.

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