Responsibilities involved in the CAB mentoring relationship

FAB Clinicians Candidate Members are working towards independent Clinical Animal Behaviour (CAB) accreditation.  Therefore, many of them seek out some form of supervision or mentoring through FAB Clinicians Certificated Members to help gain the practical experience necessary for accreditation and to ensure they are practising within their competence.  This sometimes leads to confusion over who is responsible to whom while clinical practice is being supervised in some way.

Realistically, supervisors do not usually get to oversee a case directly from the start to finish when the mentee takes the lead (i.e. acting as the ‘primary clinician’).  Although it may be best practice to do so, it often becomes expensive for the mentee if a supervisor were involved in person at all stages of a case.  This means a supervisor cannot always intervene in the moment if something goes awry in the behaviour management of an animal.  So who is ultimately responsible for the case?

How can supervision be defined?

Human psychology and healthcare practitioners  see supervision as a collaborative activity for both in the relationship; a process to reflect deeply on the mentee's work to enable them to grow into the best clinician they can be.  Clinicians meet regularly in various forms to consider their practice with the intention of learning, development of professional skills and providing high quality, safe care to patients, as well as being the opportunity to discuss specific cases in depth.  It should be noted that often in these fields ‘clinical supervision’ is differentiated from ‘line management’, where a manager can be held professionally accountable for the faults of their staff, although both will often coexist for a developing clinician.

RCVS has definitions for ‘supervision’ and ‘direction’ in their guidance for on how vets, RVNs and students in each role should work with each other, as well as when certain tasks can be delegated to another within the restrictions of the Veterinary Surgeons Act 1966 and in what contexts depending on how professionally competent a practitioner is .  Although there are moves underway to update the veterinary legislation, currently many of these activities are assumed to usually occur between individuals all employed as part of the same veterinary practice.  So in the veterinary context, line management is very much intertwined with forms of supervision.  For reference:

  1. 'direction' means that the veterinary surgeon instructs the veterinary student, veterinary nurse or student veterinary nurse as to the tasks to be performed, but is not necessarily present;
  2. 'supervision' means that the veterinary surgeon is present on the premises and able to respond to a request for assistance if needed;
  3. 'direct, continuous and personal supervision' means that the veterinary surgeon or veterinary nurse is present and giving the student his/her undivided personal attention (i.e. for minor surgery).

Do these definitions work for clinical animal behaviour supervision?

The RCVS definitions cannot necessarily be applied to the clinical animal behaviour world.  Our industry is qualitatively different, so the role of mentoring/supervision between accredited CABs (‘mentors’) and those working towards accreditation (‘mentees’) is very different to the relationship between for instance a registered veterinary nurse and a student veterinary nurse.  Unlike the veterinary world, a behaviour 'procedure' or treatment is lengthy – lasting several weeks to even a few years.  So CAB mentors cannot always be physically present or nearby to help mentees and the animals they are managing when needed throughout the course of the procedure (unlike a vet delegating to a nurse within the same practice).  Therefore, perhaps we more need to take our lead from the human healthcare sector?

What does supervision look like?

Supervision or mentoring can take many forms.  Sometimes supervision is direct and live, where both the mentor and the mentee are physically together in person with the animal and their carers.  Sometimes this direct supervision can occur over many months from the start to finish of a case; or sometimes supervision is just present during the initial consultation.  Sometimes supervision or mentoring is more remote, where the mentee just asks general case type questions of the mentor.  Other times cases may be reviewed in a recorded video, or cases may be ‘acted out’ between the mentor and mentee in a role-play format.  Mentoring can be one-to-one or in a group setting.

Who the mentor are themselves can vary: Certificated Members; other ABTC CABs; Fellows or Diplomates of various veterinary behaviour colleges; general behaviour and training practitioners; veterinary professionals; human psychologists/therapists; or even general life/business coaches.  Often mentoring can occur between peers, e.g. between Certificated Members.  Clearly the skillset, type of experience and the form of the supervision will vary between these individuals.

A note on veterinary referral or delegation for a behaviour case: who is responsible for the animal?

The owner is legally responsible for their animal’s day-to-day welfare and should recognise when they should take their animal to the vet.  Thus, responsibility for the actual implementation of any professionally recommended treatment plan falls to the owner. 

The vet is responsible for overseeing the healthcare of any animals registered with their practice.  A vet may refer on the management of an animal’s reported behaviour problem to another vet who specialises in behaviour, or they may delegate the management to a non-vet CAB.  In the case of delegation to a non-veterinary professional, the vet remains legally responsible for assessing and treating interactions between the physical and behaviour health of the animal, including any prescription of medication.

It is the CAB’s job to keep the animal’s vet in the loop about their behaviour assessment, proposed treatment and the animal’s response to the treatment, along with any ongoing changes to their behaviour assessment and treatment advice.  The CAB must never take on a behaviour case without prior written veterinary referral/delegation.  Any veterinary referral/delegation can only ever be given in good faith, based on what the vet knows of the behaviourist and what the behaviourist has told the vet of their stipulated level of expertise and experience, plus the quality of their ongoing communications to the vet about the case. The behaviourist is expected to practise within the limits of the personal and professional competence.  If the vet acts in good faith, any professional mistakes made by the behaviourist will be the behaviourist’s own responsibility.

Managing a behaviour case is very much a team process and effective communication between the veterinary surgeon and behaviour team is essential to ensure the best outcome.  Thus, if a mentee were to become the primary clinician in a case after it had been referred to the mentor, then the vet (and the owner!) need to first consent to this change and to be made aware of exactly what that mentoring relationship looks like, how much the supervising clinician will play a role in the case, as well as what the mentee’s capabilities are.  Likewise right at the start, the mentor and mentee need to have a very clearly laid out written set of expectations of their respective roles within a mentoring relationship and how a behaviour case should be managed within that relationship.

Who pays who?

Money and contracts inevitably have an impact on deciding who is responsible for what within clinical practice.  Sometimes no money may ever be exchanged in the provision of behaviour advice or mentoring, so there may not be a written T&Cs about such a relationship or service.  However, even when there is an informal arrangement, there is almost always some sort of verbal agreement or set of expectations.  Practitioners still have a duty of care and best practices to uphold.  Plus of course sadly there is still potential for informal, unwritten arrangements to be brought to court.  So let us consider the different options.

a) For the provision of clinical animal behaviour services

The primary question is who does the animal carer pay for the provision of the clinical animal behaviour services?  Normally it is whoever the vet referred the case to in the first place.  So a common question within a mentoring relationship is who is going to ‘source’ the case – mentor or mentee?

For example, if the owner has initially engaged the mentor and signed up to the mentor’s terms and conditions, then the owner would legally come to the mentor first if anything were to go amiss during the behaviour care.  This would be true even if the mentee actively took part in the provision of the behaviour services and the wrongdoing was a direct result of the mentee’s actions (whether the mentee paid the mentor or vice versa).

Subsequently, the mentor could hold their mentee responsible, but it would be dependent on what the terms of the mentoring contract were.  The same would be true for the reverse example if the animal owner was originally referred to the mentee and so was the mentee’s client.

b) Within the mentoring relationship

Currently in CAB supervision, more often than not, the mentee pays the mentor/supervisor.  Essentially, this mentoring fee boils down to either be paying for: 1. the mentee to be exposed to the mentor’s cases in some way; or 2. for the time the mentor spends sitting in on or discussing the mentee’s cases/work.  This is a very common financial arrangement in the human clinical psychologist sector too.

There are an increasing number of opportunities for Candidates to join mentoring schemes while employed in a behaviour-related role within a large organisation, such as animal welfare charities.  Some of these arrangements are again reflected in the human healthcare sector, where a developing clinician paid by an organisation has both line managers and clinical supervisors.  Both the line manager and clinical supervisor may be employed by the same organisation in more senior capacities, but have very different roles and relationships with the developing clinician, although inevitably they may well collaborate together on occasion.  

A third model may be an apprenticeship-type model, where mentees learn on the job effectively as part of the mentor’s own business.  In these circumstances, particularly where many CABs run very small businesses, often as self-employed sole traders, it is very difficult to differentiate a line manager and a clinical supervisor role.  One possible solution, again taking from the human sector, would be to run these apprenticeship training schemes in collaboration with education providers.  There are a few partnerships or small companies made up solely of behaviour and training practitioners.  Perhaps more professional structures like this could grow with time and so would have greater capacity to train and employ those working towards CAB accreditation.

Finally, there are a small but slowly growing number of opportunities for CABs to be employed within a veterinary practice, whether as part of a general practice or a specialist behaviour referral practice.  A CAB within such a practice would solely see the clients of that practice.  In such a setup, one could argue that the CAB’s role could more easily fall within the current RCVS guidance about the vet-led team.  Employing an in-house behaviourist may become an increasingly popular idea for vet practices, particularly if the proposed legislative changes for paraprofessionals and regulation for the behaviour industry were to come into effect .

Ethical considerations and everyone’s duty of care

Regardless of the details of contracts, employment and the veterinary referral process, all of us as practitioners have a wide-ranging duty of care – whether we are a vet, mentor or mentee.  This duty of care is primarily to the animal and its welfare, but also to other animals, those within its household, the veterinary professionals and paraprofessionals associated with its care, plus often the wider public.  We all primarily want to maximise animal welfare and public safety, as well as support each other in our professional (and often personal) development.  We are all bound by a professional Code of Conduct (well several in fact !).  To whom does the mentor owe ethical priority if these responsibilities towards the animal and the mentee conflict?

Perhaps the mentor’s first responsibility is to their mentee for the quality of their supervision.  However, it could be argued that the mentor cannot be held responsible for the quality of the clinical behaviour practice if they are not the actual ones delivering all of the practice.  Therefore, the mentee is the active ‘primary clinician’ responsible for the case, while the mentor is simply the ‘supervising clinician’.  The mentee’s actions and advice are their own, even when under a mentor’s guidance and when the mentor may be in the presence of the animal.

Nonetheless, part of the mentoring process and responsibility is to guide the mentee towards the best standards of practice and to help them recognise the limits of their own professional competence and how to gradually expand on them.  The mentor is responsible for creating a safe space in which their mentee can grow.

Recognising a mentee’s own fitness to practise

I believe the mentor’s responsibility doesn’t end with guiding the mentee’s professional development.  The mentor should also be there to support and reflect with their mentee when they may feel emotionally or personally overwhelmed by a case (which can be for any number of reasons).  

CAB mentors are not human psychotherapists and mentees need to be made aware of this at the start of a mentoring relationship.  Nonetheless, mentors can be available to provide peer support and then sensitively point the mentee towards other sources of appropriate help.  Meanwhile, mentors can help mentees recognise how certain clinical cases could be sensitively managed while one’s own personal fitness to practise is compromised, referring on when necessary.

What if the mentee is not receptive to their mentor’s recommendations?

At the end of the day, the weight of the responsibility for ensuring the mentee’s work meets professional standards will primarily rest with themselves.  However, careful consideration should occur when a mentee consistently works against their mentor’s advice in a way that contravenes animal welfare in the cases being supervised (plus any potential future animals that may fall under the mentee’s care).  For serious malpractice, the mentor then has a direct duty of responsibility to the animal, people involved and wider public to report these issues in some way as per our professional Code of Conduct.  The question is who to?  This would be hugely dependent on each individual and each case, as well as the severity of the issues.  

In summary...

Legally if something goes wrong with the behaviour care of an animal, it likely boils down to who the animal owner has a contract with for the provision of the clinical behaviour services.  Normally this means who the behaviour case was originally referred to by the animal’s vet.  Ethically, the mentee is responsible for the management of all cases under their care, while the mentor is responsible for the mentee’s professional development.  However, if the mentee repeatedly acts against their mentor’s advice, or if there is an immediate critical threat to the welfare of their mentee, an animal under their care, or a member of the public, then the mentor is duty-bound to report their mentee’s actions to the appropriate authorities, whether that be (in escalating order of severity): the animal’s referring vet or owner, the mentee’s line manager or education provider, FAB Clinicians (or a similar membership body), ASAB-Acc, ABTC, RCVS, RSPCA, local governing authority, or police.

So how do we maximise animal welfare while fostering the mentoring relationship?

  1. Embrace the vet-led team approach
  2. Only practise within your competence (including mentors!)
  3. Everyone get insured to the max
  4. Perform risk assessments at every turn
  5. Employ a good lawyer and set out clear expectations on both sides of the mentoring relationship from the get go (everyone works differently!)
  6. Be mindful, supportive, listen, collaborate and grow together