Welcome to Treatment Supervision
This chapter will provide a broad overview of Treatment Supervision and specifics on when it is required for each service and role.
This guide will be updated from time to time. For a list of updates, see Updates to this Chapter below.
Treatment Supervision, formerly called "Clincal Supervision" means supervision of services to clients. As well-defined by Mn Statute 245I: "Treatment Supervision must focus on each client's treatment needs and the ability of the staff person under treatment supervision to provide services to each client." While some providers may require certain minimum frequency of supervision contacts, generally, Treatment Supervision frequency and duration should be based on the needs of individual providers and people who receive services.
Scheduling Supervision
Treatment Supervision will be scheduled for each client coinciding with the Treatment Plan update for clients continuing services. Ad hoc supervision may occur at any time when a need for consultation or problems arise, as identified by provider staff, or as identified in a Progress Review.
Treatment Supervision is Interactive
245I.06 Subd. c says: "a treatment supervisor must provide treatment supervision to a staff person using methods that allow for immediate feedback, including in-person, telephone, and interactive video supervision." Emails, text messages, TabsTM system messages, review of documents, or other written methods without interaction with provider staff do not qualify as Treatment Supervision.
Specific requirements for services and roles are defined below.
Each direct service provider must have a Supervision Plan. This is the Career Plan. Contents of the Career Plan should include the clinical elements for staff development and growth identified by the Treatment Supervisor.
Treatment Supervision requirements for services are generally not prescriptive. Certain roles have prescriptive requirements and those are detailed below.
ARMHS and CTSS
No specific frequency and duration is specified for these services. Rather, 245I requires that:
Treatment Supervision must focus on each client's treatment needs and the ability of the staff person under treatment supervision to provide services to each client, including the following topics related to the staff person's current caseload:
- a review and evaluation of the interventions that the staff person delivers to each client;
- instruction on alternative strategies if a client is not achieving treatment goals;
- a review and evaluation of each client's assessments, treatment plans, and progress notes for accuracy and appropriateness; ;
- instruction on the cultural norms or values of the clients and communities that the license holder serves and the impact that a client's culture has on providing treatment;
- evaluation of and feedback regarding a direct service staff person's areas of competency; and
- coaching, teaching, and practicing skills with a staff person.
This description should characterize all Treatment Supervision.
Behavioral Health Home Services
Behavioral Health Home Services are not a mental health service. BHH is supervised by the Integration Specialist, who is a Registered Nurse. When BHH clients received mental health services at Accend, supervision should be conducted jointly by the mental health Treatment Supervisor and the Integration Specialist with all service providers present. No specific frequency and duration of supervision is defined by DHS policy.
EIDBI
The EIDBI Policy Manual describes Treatment Supervision as follows (note that one hour per month is recommended, not required):
All EIDBI providers must ensure they provide and receive supervision that aligns with their enrollment requirements, including variances.
DHS recommends each level II and III provider receive one hour of clinical supervision per month or additional supervision as required by the EIDBI provider’s enrolled level or professional license/board.
Clinical supervision frequency and intensity should be based on the needs of individual EIDBI providers and people who receive services.
Obervation and Direction by QSP with a short debrief following the session is a preferred method of supervising EIDBI services.
Psychotherapy
Licensed Psychotherapists do not require Treatment Supervision to provide Psychotherapy, except as determined necessary by the Clinical Director (Adult or Children's Services).
Clinical Trainees must receive Treatment Supervision at the frequency and duration required by the specific board governing the license the Trainee is seeking.
Targeted Mental Health Case Management
The MHCP Manual says: "All case managers and CMAs [Case Management Associates], except licensed mental health professionals, must receive ongoing clinical supervision at least monthly." It does not define a minimum duration for this supervision. The duration should be determined by the number of client cases requiring review in a given month.
If not listed below, specific role requirements for Treatment Supervirsion are not required.
| Service Category |
Role |
Treatment Supervision (or Observation & Direction) Requirements |
| ARMHS and CTSS |
Practitioner Qualifying by Work Experience (at least 2000 hours) |
Treatment supervision at least once per week until they have accumulated 4,000 hours of experience |
| ARMHS |
Mental Health Worker |
In the first 2,000 hours of work must at a minimum consist of:
(1) monthly individual supervision; and
(2) direct observation twice per month
Having accumulated 2000 hours of experience, the Worker qualifies as a Practitioner by virtue of experience above
|
ARMHS |
Certified Peer Specialist I |
Monthly individual clinical supervision by a mental health professional during the first 2,000 hours of work
18 hours of documented field supervision by a mental health professional or mental health practitioner during the first 160 hours of contact work with members and at least six hours of field supervision quarterly during the following year
|
| EIDBI |
Level I Provider qualifying with a variance |
Observation and direction from a qualified supervising professional (QSP) at least once per month until meeting 2,000 hours of supervised clinical experience. |
| EIDBI |
Level II Provider qualifying with a variance |
Observation and direction from a qualified supervising professional (QSP) or Level I provider at least twice per month until meeting 1,000 hours of supervised clinical experience |
| Psychotherapy and Clinical Professional |
Intern |
Supervision as defined by the agreement with the placing educational institution. |
| Psychotherapy and Clinical Professional |
Clinical Trainee |
Supervision Requirements defined by the applicable Board, most commonly:
For LGSWs the Minnesota Board of Social Work
For LPCs the Minnesota Board of Behavioral Health and Therapy
For LMFTs the Minnesota Board of Marriage and Family Therapy |
| Targeted Mental Health Case Management |
Case manager with at least 2,000 hours of supervised experience in the delivery of services to adults with mental illness |
Regular ongoing supervision and clinical supervision totaling 38 hours per year of which
at least one hour per month must be clinical supervision, with
the remaining 26 hours of supervision may be provided by a case manager with two years of experience |
| Targeted Mental Health Case Management |
Case Manager Trainee
(CM without 2,000 hours of supervised experience in the delivery of services to adults with mental illness |
At least one hour per week until the requirement of 2,000 hours of experience is met |
| Targeted Mental Health Case Management |
Case Manager Associate
(Case Manager without at least a Bachelor's degree) |
Follow Clinical Supervision requirements for Case Managers above, and
At least five hours of mentoring per week from a case management mentor |
Agenda for Formal (Scheduled) Treatment Supervision
Treatment Supervision must focus on each client's treatment needs and the ability of the staff person under treatment supervision to provide services to each client. It should focus on specific clients, and include all providers of services to that client.
Use the following agenda for Client-SpecificTreatment Supervision and doccument it in the Treatment Supervision form for the client. Do not duplicate this information in the progress note. Rather write "see supervision form."
Treatment Progress
- Plan updates and Progress reviews due. Provider being supervised should have completed all due items (assessments, plans, and progress reviews) prior to the supervison session.
- Are individuals receiving services at the levels defined by the Plan? (Use the Service Summary tool) and within the scope of the service?
- What progress, if any, has this client made?
- What treatment resources are you using?
- Do you have a copy of the resource?
- What parts have been most useful?
- What skills from the resource has the client learned?
- Are there any barriers to meeting treatment/service goals?
- How can we make the new/temporary goal to overcome that barrier?
- If this is a progress review, does this client need an updated treatment plan based on our supervision today?
Action Items
Action Items are a powerful tool in an integrated care model. Each Treatment Client Treatment Supervision session should include a review of Action Items, including those existing for progess and new action items indicated as needd by the recent FA/HWA update.
Action items are not limited to health concerns. They should include all referrals and action items needed for healthcare, mental health services, housing, substance abuse treatment, vocational and educational supports needed and a variety of other needs.
General Supervision
If general supervision is needed in the session (for any of the following), cover these topics and document them in a supervision progress note:
- Disengaged clients. Explore reasons for disengagement, examine strategies for re-engaging or needs for starting the closing process. Examine whether or not the provider needs additional referrals as a result of disengaged clients.
- Overdue Items: what assessments, plans and reviews are overdue? Why?
- New referrals: efforts to contact and engagement.
- What other clinical concerns do you want to discuss today about clients you are serving?
- What concerns were identified today that need to be addressed in Administrative Supervision?
- What action steps need to be taken after today’s Treatment Supervision, who is responsible, and what are the deadlines?
Ad Hoc Treatment Supervision
Treatment Supervision may aslo occur ad hoc when a particular need or question arises. In this case, a Treatment Supervision form is unnecessary, but the Treatment Supervisor should document this as Treatment Supervising Client Specific and the provider staff as receiving Treatment Supervised Client Specific.
Documenting Treatment Supervision
Treatment Supervisors should document Treatment Supervision and ask the employee to document as well, whenever they interact with direct service providers regarding a client, using these note types found in the Clinical Professional Service Category:
Supervisor: Treatment Supervising Client Specific
Supervisee: Treatment Supervised Client Specific
Additionally, for for formal scheduled supervision, this should be documented using the template Client Specific Treatment Supervision found in the context of the client>document>client forms>treatment supervision. When using this form, the progress note may simply reference the form and need not contain any additional content.
For brief interim interactions, both supervisor and supervisee should include details in the progress note and the treatment supervision is not necessary.
Scheduling and Tracking Treatment Supervision
Formal Treatment Supervision should be driven by the Due Items list.It should occcur:
Each time assessments and plans are updated, and
In conjunction with each Progress Review.
We are developing a centralized scheduling system for this supervision to assure compliance with this schedule, identifying the client cases requiring Treatment Supervision and the individual providers who should attend. More information on this will follow.
Clinical Review of Assessment and Planning
Also considered a Treatment Supervision activity is Clinical Review of Assessment and Plan . While not a supervision of staff activity, this is defined in statute as an esential element of Treatment Supervision thusly:
Rule 245I requires that the Treatment Supervisor "must ensure that all diagnostic assessments, functional assessments, level of care assessments, and treatment plans completed by a clinical trainee or mental health practitioner contain documentation of approval by a treatment supervisor within five business days of initial completion by the staff person under treatment supervision."
For our purposes, this standard shall apply to all services.
Client-Specific Clinical Consultation
Use this service type when consulting with fellow licensed professionals and supervisors on a case. If meeting interactively with direct provider staff, even on a case you do not normally supervise, use Treatment Supervising.
>> Minnesota Statute 245I.06: Treatment Supervision
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
April 29, 2023:
Resource link to Mn Statute 245I added.
April 6, 2023:
Chapter first published.
May 11, 2023:
Ad Hoc Treatment Supervision language added.
Statutory language added that Treatment Supervision must be done using interactive methods.
Use of Client-Specific Clinical Consultation clarified.
April 16, 2024:
Action Items language added as an essential part of Treatment Supervision.
