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McGuinness S, Guerin S. Interprofessional supervision among allied health professionals: a systematic scoping review. J Interprof Care 2024; 38:739-758. [PMID: 38678372 DOI: 10.1080/13561820.2024.2343837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/09/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.
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Affiliation(s)
- Shona McGuinness
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
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2
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Wolford GW, Wash EJ, McMillon AR, LaCroix AN. How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:725-751. [PMID: 37624533 DOI: 10.1007/s10459-023-10276-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 08/06/2023] [Indexed: 08/26/2023]
Abstract
Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.
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Affiliation(s)
- George W Wolford
- Department of Rehabilitation Sciences, Beaver College of Health Sciences, Appalachian State University, 1179 State Farm Rd, Boone, NC, 28607, USA.
- College of Health Sciences, Midwestern University, Downers Grove, USA.
| | - Ethan J Wash
- College of Health Sciences, Midwestern University, Downers Grove, USA
| | - Ashley R McMillon
- College of Health Sciences, Midwestern University, Downers Grove, USA
| | - Arianna N LaCroix
- Department of Speech, Language, and Hearing Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, USA
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3
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Triplett NS, AlRasheed R, Johnson C, McCabe CJ, Pullmann MD, Dorsey S. Supervisory Alliance as a Moderator of the Effects of Behavioral Rehearsal on TF-CBT Fidelity: Results from a Randomized Trial of Supervision Strategies. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:254-267. [PMID: 38157131 PMCID: PMC11162559 DOI: 10.1007/s10488-023-01334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
Exposure is an important element of treatment for many evidence-based treatments but can be challenging to implement. Supervision strategies to support exposure delivery may be an important tool to facilitate the use of exposure techniques; however, they must be considered and used in the context of the supervisory alliance. The present study examined relations between supervisory alliance and fidelity to the trauma narrative (TN; i.e., imaginal exposure) component of Trauma-Focused Cognitive Behavioral Therapy. We also examined how supervisory alliance moderated the effect of behavioral rehearsal use in supervision on TN fidelity. We analyzed data from a randomized controlled trial, in which forty-two supervisors and their clinicians (N = 124) from 28 Washington State community-based mental health offices participated. Clinicians were randomized to receive one of two supervision conditions-symptom and fidelity monitoring (SFM) or SFM with behavioral rehearsal (SFM + BR). Supervisory alliance alone did not predict delivery (i.e., occurrence) or extensiveness of delivery of the trauma narrative. Client-focused supervisory alliance moderated the effectiveness of behavioral rehearsal-as client-focused alliance increased, the odds of delivering the TN also increased significantly. Future research should further investigate how to appropriately match supervision techniques with supervisory dyads and explore the interplay of alliance with supervision techniques a supervisor might employ.
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Affiliation(s)
- Noah S Triplett
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA.
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
| | - Clara Johnson
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
| | - Connor J McCabe
- Department of Psychiatry and Behavioral Medicine, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Michael D Pullmann
- UW School Mental Health Assessment, Research, and Training (SMART) Center, University of Washington, 6200 74th Street, Building 29, Seattle, WA, 98115, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
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Böhm B, Keane G, Karimet M, Palma M. What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development. Glob Ment Health (Camb) 2022; 9:491-498. [PMID: 36618724 PMCID: PMC9807002 DOI: 10.1017/gmh.2022.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide. Methods A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions. Results Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for 'psychological/counselling' and another for 'psychiatric/mhGAP' practitioners. Each grid features 22-26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality. Conclusions Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.
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Hindi AMK, Willis SC, Astbury J, Fenton C, Stearns S, Jacobs S, McDermott I, Moss A, Seston E, Schafheutle EI. Contribution of supervision to the development of advanced practitioners: a qualitative study of pharmacy learners' and supervisors' views. BMJ Open 2022; 12:e059026. [PMID: 35414562 PMCID: PMC9006828 DOI: 10.1136/bmjopen-2021-059026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To apply educational theory to explore how supervision can contribute to the development of advanced practitioners using the example of several postregistration primary care training pathways for pharmacy professionals (pharmacists and pharmacy technicians). DESIGN Qualitative semistructured telephone interviews applying Billet's theory of workplace pedagogy for interpretation. SETTING England. PARTICIPANTS Fifty-one learners and ten supervisors. PRIMARY OUTCOME Contribution of clinical and educational supervision to the development of advanced practitioners in primary care. RESULTS Findings were mapped against the components of Billet's theory to provide insights into the role of supervision in developing advanced practitioners. Key elements for effective supervision included supporting learners to identify their learning needs (educational supervision), guiding learners in everyday work activities (clinical supervision), and combination of regular prearranged face-to-face meetings and ad hoc contact when needed (clinical supervision), along with ongoing support as learners progressed through a learning pathway (educational supervision). Clinical supervisors supported learners in developing proficiency and confidence in translating and applying the knowledge and skills they were gaining into practice. Learners benefited from having clinical supervisors in the workplace with good understanding and experience of working in the setting, as well as receiving clinical supervision from different types of healthcare professionals. Educational supervisors supported learners to identify their learning needs and the requirements of the learning pathway, and then as an ongoing available source of support as they progressed through a pathway. Educational supervisors also filled in some of the gaps where there was a lack of local clinical supervision and in settings like community pharmacy where pharmacist learners did not have access to any clinical supervision. CONCLUSIONS This study drew out important elements which contributed to effective supervision of pharmacy advanced practitioners. Findings can inform the education and training of advanced practitioners from different professions to support healthcare workforce development in different healthcare settings.
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Affiliation(s)
- Ali Mawfek Khaled Hindi
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- Division of Pharmacy, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Caroline Willis
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Jayne Astbury
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | | | | | - Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- Division of Pharmacy, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Imelda McDermott
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | | | - Elizabeth Seston
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- Division of Pharmacy, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Ellen Ingrid Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- Division of Pharmacy, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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In Search of the Common Elements of Clinical Supervision: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:623-643. [PMID: 35129739 DOI: 10.1007/s10488-022-01188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
The importance of clinical supervision for supporting effective implementation of evidence-based treatments (EBTs) is widely accepted; however, very little is known about which supervision practice elements contribute to implementation effectiveness. This systematic review aimed to generate a taxonomy of empirically-supported supervision practice elements that have been used in treatment trials and shown to independently predict improved EBT implementation. Supervision practice elements were identified using a two-phase, empirically-validated distillation process. In Phase I, a systematic review identified supervision protocols that had evidence of effectiveness based on (a) inclusion in one or more EBT trials, and (b) independent association with improved EBT implementation in one or more secondary studies. In Phase II, a hybrid deductive-inductive coding process was applied to the supervision protocols to characterize the nature and frequency of supervision practice elements across EBTs. Twenty-one of the 876 identified articles assessed the associations of supervision protocols with implementation or clinical outcomes, representing 13 separate studies. Coding and distillation of the supervision protocols resulted in a taxonomy of 21 supervision practice elements. The most frequently used elements were: reviewing supervisees' practice (92%; n = 12), clinical suggestions (85%; n = 11), behavioral rehearsal (77%; n = 10), elicitation (77%; n = 10), and fidelity assessment (77%; n = 10). This review identified supervision practice elements that could be targets for future research testing which elements are necessary and sufficient to support effective EBT implementation. Discrepancies between supervision practice elements observed in trials as compared to routine practice highlights the importance of research addressing supervision-focused implementation strategies.
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Rosenberg BM, Kodish T, Cohen ZD, Gong-Guy E, Craske MG. A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation. JMIR Ment Health 2022; 9:e32430. [PMID: 35080504 PMCID: PMC8829693 DOI: 10.2196/32430] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/09/2023] Open
Abstract
Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts.
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Affiliation(s)
- Benjamin M Rosenberg
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Gong-Guy
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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8
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Meza RD, AlRasheed R, Pullmann MD, Dorsey S. Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health. Front Psychiatry 2022; 13:1072844. [PMID: 36699474 PMCID: PMC9869035 DOI: 10.3389/fpsyt.2022.1072844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Observational studies of practices used in clinical supervision-as-usual can be leveraged to advance the limited research on workplace-based supervision as an evidence-based treatment (EBT) implementation strategy. This exploratory observational study examined the presence of supervision approaches (comprised of supervision techniques) and whether these predicted clinicians' EBT technique delivery. METHODS Participants included 28 supervisors, 70 clinician supervisees, and 60 youth clients and guardians from 17 public mental health organizations. Data included audio recorded supervision-as-usual sessions over 1 year, audio recorded Trauma-focused Cognitive Behavioral Therapy (TF-CBT) treatment sessions with youth for 6 months, and youth-reported post-traumatic stress severity scores. Audio recordings of 438 supervision sessions were coded for session duration and the presence of 13 supervision techniques and intensity of their coverage. Audio recordings of 465 treatment sessions were coded for presence and intensity of coverage of TF-CBT practice elements. Agglomerative hierarchical cluster analysis examined the presence of clusters of supervision technique use, termed supervision approaches. Generalized estimating equations estimated the relation between supervision approaches and delivery of TF-CBT elements. RESULTS Two supervision approaches were identified- Supportive-Directive and Supportive- that discriminated between use of five supervision techniques. Clinicians who received a higher proportion of supportive-directive supervision sessions had greater odds of delivering the trauma narrative with a client. CONCLUSION Findings suggest that patterns of supervision techniques can be identified and may shape EBT delivery. Supervision approaches show some evidence of being tailored to individual clinicians. Implications for the development of supervision implementation strategies and future directions are discussed.
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Affiliation(s)
- Rosemary D Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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Mc Carthy V, Goodwin J, Saab MM, Kilty C, Meehan E, Connaire S, Buckley C, Walsh A, O'Mahony J, O'Donovan A. Nurses and midwives' experiences with peer-group clinical supervision intervention: A pilot study. J Nurs Manag 2021; 29:2523-2533. [PMID: 34213054 DOI: 10.1111/jonm.13404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to evaluate differences in supervisees' understanding of clinical supervision and their perceptions of organisational functioning before and after engaging in peer-group clinical supervision. BACKGROUND Protected reflective time allows discussion of complex issues affecting health care. Peer-group clinical supervision is one model of clinical supervision that could facilitate this, but it is poorly understood. METHODS A pre-post intervention pilot study was performed. The intervention was delivered over a 12-month period. Data were collected using surveys on demographic and work-related factors and experience of clinical supervision pre- and post intervention. RESULTS Adaptability increased significantly between the pre- and post surveys. The post survey data showed finding time for clinical supervision scoring lowest with open-ended comments reinforcing this. The supervisees found the sessions to offer a safe place despite initial concerns. CONCLUSION The peer-group model of clinical supervision allowed supervisees to build a rapport and trust with their colleagues and share experiences. IMPLICATIONS FOR NURSING MANAGEMENT The benefits to participating in peer-group clinical supervision traversed the individual and organisation. These data support the implementation of such sessions while addressing workload and time pressures to aid participation.
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Affiliation(s)
- Vera Mc Carthy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sinead Connaire
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Carmel Buckley
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - Anne Walsh
- Nursing and Midwifery Planning and Development Unit, Health Service Executive, Dublin, Ireland
| | - James O'Mahony
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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10
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Giannopoulos V, Morley KC, Uribe GM, Louie E, Wood K, Teesson M, Baillie A, Haber PS. The role of clinical supervision in implementing evidence-based practice for managing comorbidity. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1909517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C. Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabriela M. Uribe
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Capp G, Watson K, Astor RA, Kelly MS, Benbenishty R. School Social Worker Voice during COVID-19 School Disruptions: A National Qualitative Analysis. CHILDREN & SCHOOLS 2021; 43:79-88. [PMID: 34812257 PMCID: PMC8600375 DOI: 10.1093/cs/cdab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 06/13/2023]
Abstract
The novel coronavirus (COVID-19) pandemic has created unprecedented impacts on our schools and society, requiring school social workers (SSWs) to attend to layered and cascading effects for students and their families. This study presents rich qualitative data from a national survey of SSWs about their personal and professional roles supporting students, families, and staff members as schools shifted to remote instruction. Findings indicate that SSWs are highly concerned about a lack of basic needs resources, including food, housing, and mental health support for students and families. SSWs highlighted the unequal effects of school closures for families without technology and Internet access as well as the difficulties providing services during the pandemic. Recovery policies should target resources to schools with the highest needs while prioritizing food, housing, mental health, and access to tools for online learning. SSWs also need additional and refined professional support to overcome their isolated roles in schools and bolster their ability to deliver online services effectively.
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12
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Schriger SH, Becker-Haimes EM, Skriner L, Beidas RS. Clinical Supervision in Community Mental Health: Characterizing Supervision as Usual and Exploring Predictors of Supervision Content and Process. Community Ment Health J 2021; 57:552-566. [PMID: 32671507 PMCID: PMC7855099 DOI: 10.1007/s10597-020-00681-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community mental health context when designing supervision-targeted implementation strategies. Future work should assess whether supervision models specific to community mental health are needed.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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13
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Tugendrajch SK, Sheerin KM, Andrews JH, Reimers R, Marriott BR, Cho E, Hawley KM. What is the evidence for supervision best practices? CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1887785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Jack H. Andrews
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
| | - Rachel Reimers
- Counseling Psychology, University of Missouri, Columbia, Missouri, USA
| | | | - Evelyn Cho
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
| | - Kristin M. Hawley
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
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14
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Guess SC, Matthew SM, Cary JA, Nelson OL, McArthur ML. Clinical supervision in veterinary medicine. J Am Vet Med Assoc 2021; 257:255-261. [PMID: 32657661 DOI: 10.2460/javma.257.3.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Caron EB, Lind TA, Dozier M. Strategies that Promote Therapist Engagement in Active and Experiential Learning: Micro-Level Sequential Analysis. CLINICAL SUPERVISOR 2021; 40:112-133. [PMID: 34248258 DOI: 10.1080/07325223.2020.1870023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Therapists' active learning increases treatment fidelity, but research is needed on supervisory strategies to engage therapists in active learning. This study used sequential analysis to examine consultant behaviors associated with increased and decreased probability of eliciting therapists' active learning. The study included 162 consultation sessions from 27 community therapists implementing Attachment and Biobehavioral Catch-up. Consultants' client discussion, information provision, and modeling were associated with reduced likelihood of active learning. Consultants' questions, engagement in active learning strategies, use of video, and silence were associated with greater likelihood of therapist active learning. These findings inform supervisors' attempts to encourage active learning.
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Affiliation(s)
- E B Caron
- Department of Psychological Science, Fitchburg State University
| | - Teresa A Lind
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Research Center (CASRC)
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware
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Reiser RP. An evidence-based approach to clinical supervision. CLINICAL SUPERVISOR 2020. [DOI: 10.1080/07325223.2020.1843097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Robert P. Reiser
- Department of Psychiatry, University of California, San Francisco, California, USA
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17
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Safety Climate Associated With Adverse Events in Nursing Homes: A National VA Study. J Am Med Dir Assoc 2020; 22:388-392. [PMID: 32698990 DOI: 10.1016/j.jamda.2020.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Adverse events in nursing homes are leading causes of morbidity and mortality, prompting facilities to investigate their antecedents. This study examined the contribution of safety climate-how frontline staff typically think about safety and act on safety issues-to adverse events in Veterans Affairs (VA) nursing homes or Community Living Centers (CLCs). DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 56 CLCs nationwide, 1397 and 1645 CLC staff (including nurses, nursing assistants, and clinicians/specialists), respectively, responded to the CLC Employee Survey of Attitudes about Resident Safety (CESARS) in 2017 and 2018. METHODS Adverse events (pressure ulcers, falls, major injuries from falls, and catheter use) were measured using the FY2017-FY2018 Minimum Data Set (MDS). Safety climate was defined as 7 CESARS domains (safety priorities, supervisor commitment to safety, senior management commitment to safety, personal attitudes toward safety, environmental safety, coworker interactions around safety, and global rating of CLC). The associations between safety climate domains and each adverse event were determined separately for each frontline group, using beta-logistic regression with random effects. RESULTS Better ratings of supervisor commitment to safety were associated with lower rates of major injuries from falls [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.11-0.97, clinicians] and catheter use (OR 0.42, 95% CI 0.21-0.85, nurses), and better ratings of environmental safety were associated with lower rates of pressure ulcers (OR 0.23, 95% CI 0.09-0.61, clinicians), major injuries from falls (OR 0.48, 95% CI 0.24-0.93, nurses), and catheter use (OR 0.55, 95% CI 0.32-0.93, nursing assistants). Better global CLC ratings were associated with higher rates of catheter use. No other safety climate domains had significant associations. CONCLUSIONS AND IMPLICATIONS Nursing homes may reduce adverse events by fostering supportive supervision of frontline staff and a safer physical environment.
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Watkins CE. The Psychotherapy Supervisor as an Agent of Transformation: To Anchor and Educate, Facilitate and Emancipate. Am J Psychother 2020; 73:57-62. [PMID: 31902226 DOI: 10.1176/appi.psychotherapy.20190016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this review was to answer the question, What do supervisors actually do in promoting transformative change in the beginning therapist supervisee? New therapist trainees, lacking treatment skills and a sense of "therapist identity," are prone to experience self-doubt, feel anxious and demoralized, and think of themselves as impostors. Psychotherapy supervision can be helpful and encouraging to beginning therapists in their process of development. METHODS Using Mälkki and Green's concepts of liminality, edge emotions, and boundary confusion as framework, the author examines the pivotal role of the supervisor in striving to create a transformative supervision space. RESULTS The author identifies and elaborates on three transformative streams of supervisory action-to anchor and ground, to educate and facilitate, and to liberate and emancipate. The constituents of each action stream are also identified. CONCLUSIONS Psychotherapy supervisors serve foremost as agents of transformation, their chief objective being to actuate and actualize a transformative process of therapist development. The crucial processes by which supervisors achieve that transformative objective reside in the three streams of supervisory action. Accordingly, psychotherapy supervision is best conceptualized as a transformative learning pedagogy.
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Affiliation(s)
- C Edward Watkins
- Department of Psychology, University of North Texas, Denton, Texas
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Alfonsson S, Lundgren T, Andersson G. Clinical supervision in cognitive behavior therapy improves therapists’ competence: a single-case experimental pilot study. Cogn Behav Ther 2020; 49:425-438. [DOI: 10.1080/16506073.2020.1737571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sven Alfonsson
- Department of Clinical Neuroscience Karolinska Institutet & Stockholm Health Care Services, Centre for Psychiatry Research, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Tobias Lundgren
- Department of Clinical Neuroscience Karolinska Institutet & Stockholm Health Care Services, Centre for Psychiatry Research, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience Karolinska Institutet & Stockholm Health Care Services, Centre for Psychiatry Research, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Avortri GS, Nabukalu JB, Nabyonga-Orem J. Supportive supervision to improve service delivery in low-income countries: is there a conceptual problem or a strategy problem? BMJ Glob Health 2019; 4:e001151. [PMID: 31673434 PMCID: PMC6797347 DOI: 10.1136/bmjgh-2018-001151] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 12/24/2022] Open
Abstract
Supportive supervision is perceived as an intervention that strengthens the health system, enables health workers to offer quality services and improve performance. Unfortunately, numerous studies show that supervisory mechanisms in many low-income countries (LICs) are suboptimal. Further, the understanding of the concept and its implementation is still shrouded in misinterpretations and inconsistencies. This analysis contributes to a deeper understanding of the concept of supportive supervision and how reorganisation of the approach can contribute to improved performance. The effectiveness of supportive supervision is mixed, with some studies noting that evidence on its role, especially in LICs is inconclusive. Quality of care is a core component of universal health coverage which, accentuates the need for supportive supervision. In the context of LICs, it is imperative for supportive supervision to be implemented as an on-going approach. Factors that affect supportive supervision encompass cultural, social, organizational and context dimensions but the capacity of majority of LIC to address these is limited. To this end, we underscore the need to review the supportive supervision approach to improve its effectiveness, and ensure that facility-based supervision embodies as many of the envisioned qualities as possible. We thus make a case for a stronger focus on internal supportive supervision where internal refers to health facility/unit/ward level. Inherent in the approach is what we refer to as ‘supervisee initiated supportive supervision’. The success of this approach must be anchored on a strong system for monitoring, data and information management at the health facility level.
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Affiliation(s)
- Gertrude Sika Avortri
- Health Systems and Services Cluster, World Health Organization, Inter-Country Support Team for Eastern and Southern Africa, Harare, Zimbabwe
| | | | - Juliet Nabyonga-Orem
- Health Systems and Services Cluster, World Health Organization, Inter-Country Support Team for Eastern and Southern Africa, Harare, Zimbabwe
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21
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Sørvoll M, Obstfelder A, Normann B, Øberg GK. Management and dissemination of professional expertise: Physiotherapists’ perceptions of the supervision of dedicated aides working with children with cerebral palsy. CLINICAL SUPERVISOR 2019. [DOI: 10.1080/07325223.2019.1596855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marit Sørvoll
- Department of Health and Care Sciences, The Arctic University of Norway, The University of Tromsø, Tromsø, Norway
| | - Aud Obstfelder
- Institute of Health Sciences, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Gjøvik, Norway
| | - Britt Normann
- Department of Health and Care Sciences, The Arctic University of Norway, The University of Tromsø, Tromsø, Norway
- Department of Physiotherapy, Nordland Hospital Trust, Bodø, Norway
| | - Gunn Kristin Øberg
- Department of Health and Care Sciences, The Arctic University of Norway, The University of Tromsø, Tromsø, Norway
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22
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Newman DS, Simon DJ, Swerdlik ME. What we know and do not know about supervision in school psychology: A systematic mapping and review of the literature between 2000 and 2017. PSYCHOLOGY IN THE SCHOOLS 2018. [DOI: 10.1002/pits.22182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel S. Newman
- School of Human Services, School Psychology ProgramCollege of Education, Criminal Justice, and Human Services, University of CincinnatiCincinnati Ohio
| | - Dennis J. Simon
- NSSEO Timber Ridge Therapeutic Day School (Retired)Arlington Heights Illinois
| | - Mark E. Swerdlik
- School Psychology Program, Department of Psychology, College of Arts and Sciences, Illinois State UniversityNormal Illinois
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Pullmann MD, Lucid L, Harrison JP, Martin P, Deblinger E, Benjamin KS, Dorsey S. Implementation Climate and Time Predict Intensity of Supervision Content Related to Evidence Based Treatment. Front Public Health 2018; 6:280. [PMID: 30338253 PMCID: PMC6180155 DOI: 10.3389/fpubh.2018.00280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/11/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Children infrequently receive evidence-based treatments (EBTs) for mental health problems due to a science-to-practice implementation gap. Workplace-based clinical supervision, in which supervisors provide oversight, feedback, and training on clinical practice, may be a method to support EBT implementation. Our prior research suggests that the intensity of supervisory focus on EBT (i.e., thoroughness of coverage) during workplace-based supervision varies. This study explores predictors of supervisory EBT intensity. Methods: Participants were twenty-eight supervisors and 70 clinician supervisees. They completed a baseline survey, and audio recorded supervision sessions over 1 year. Four hundred and thirty eight recordings were coded for supervision content. We chose to explore predictors of two EBT content elements due to their strong evidence for effectiveness and sufficient variance to permit testing. These included a treatment technique (“exposure”) and a method to structure treatment (“assessment”). We also explored predictors of non-EBT content (“other topics”). Mixed-effects models explored predictors at organizational/supervisor, clinician, and session levels. Results: Positive implementation climate predicted greater intensity of EBT content coverage for assessment (coefficient = 0.82, p = 0.004) and exposure (coefficient = 0.87, p = 0.001). Intensity of exposure coverage was also predicted by more time spent discussing each case (coefficient = 0.04, p < 0.001). Predictors of greater non-EBT content coverage included longer duration of supervision sessions (coefficient = 0.05, p < 0.001) and lower levels of supervisor EBT knowledge (coefficient = −0.17, p = 0.013). No other supervisor- or clinician-level variables were significant predictors in the mixed effects models. Conclusion: This was the first study to explore multi-level predictors of objectively coded workplace-based supervision content. Results suggest that organizations that expect, support and reward EBT are more likely to have greater intensity of EBT supervision coverage, which in turn may positively impact clinician EBT fidelity and client outcomes. There was evidence that supervisor knowledge of the EBT contributes to greater coverage, although robust supervisor and clinician factors that drive supervision are yet to be identified. Findings highlight the potential effectiveness of implementation strategies that simultaneously address organizational implementation climate and supervisor practices. More research is needed to identify mechanisms that support integration of EBT into supervision.
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Affiliation(s)
- Michael D Pullmann
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Leah Lucid
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Julie P Harrison
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Prerna Martin
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Esther Deblinger
- CARES Institute, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States
| | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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Waltman SH, Hall BC, McFarr LM, Creed TA. Clinical Case Consultation and Experiential Learning in Cognitive Behavioral Therapy Implementation: Brief Qualitative Investigation. J Cogn Psychother 2018; 32:112-127. [PMID: 32746401 DOI: 10.1891/0889-8391.32.2.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There has been an increased emphasis on the implementation of cognitive behavioral therapy (CBT) to community mental health (CMH) systems due to its broad efficacy. Previous research has highlighted the importance of ongoing consultation in this process. The current study clarifies the role and process of clinical case consultation in the implementation of CBT to CMH from the consultants' perspective. Trainers from two large-scale implementation initiatives (n = 27) were surveyed regarding their strategies used in the consultation process. Historically, researchers have focused on trainees who view relational variables as the most effective elements of consultation; however, in the current study, trainers perceived experiential learning as being the most effective consultation strategy for helping CMH clinicians learn CBT. Other aspects of consultation such as case conceptualization and practice sample review are discussed in terms of their relative perceived utility in raising CMH clinician's competency to treat comorbid patients.
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Affiliation(s)
- Scott H Waltman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania .,Warrior Resiliency Program, Brooke Army Medical Center, San Antonio, Texas
| | | | | | - Torrey A Creed
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Friedberg RD. Best practices in supervising cognitive behavioral therapy with youth. World J Clin Pediatr 2018; 7:1-8. [PMID: 29456927 PMCID: PMC5803561 DOI: 10.5409/wjcp.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/16/2017] [Accepted: 01/07/2018] [Indexed: 02/06/2023] Open
Abstract
Clinical supervision of cognitive behavioral therapy (CBT) with youth ensures better patient care and fosters trainees' professional development. However, often insufficient attention is directed toward disseminating best practices in supervision of CBT with youth. This Therapeutic Advances contribution aims to communicate the core content of supervision. Additionally, the key supervisory practices associated with CBT with youth are described. Supervisory outcomes are summarized and recommendations for supervisory practices are made.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Palo Alto, CA 94304, United States
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26
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Dorsey S, Kerns SEU, Lucid L, Pullmann MD, Harrison JP, Berliner L, Thompson K, Deblinger E. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implement Sci 2018; 13:19. [PMID: 29368656 PMCID: PMC5784597 DOI: 10.1186/s13012-017-0708-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials. METHODS Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels. RESULTS Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level. CONCLUSIONS Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness. TRIAL REGISTRATION NCT01800266 , Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results]).
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Suzanne E. U. Kerns
- University of Denver, Graduate School of Social Work, Craig Hall, Room 471, 2148 S. High St, Denver, CO 80208 USA
| | - Leah Lucid
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Michael D. Pullmann
- Division of Public Behavioral Health and Justice Policy, University of Washington School of Medicine, 2815 Eastlake Ave E, Suite 200, Seattle, WA 98102 USA
| | - Julie P. Harrison
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, University of Washington School of Medicine, 401 Broadway, Suite 2027, Seattle, WA 98122 USA
| | - Kelly Thompson
- Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Esther Deblinger
- CARES Institute, Rowan University School of Osteopathic Medicine, 42 E. Laurel Road, UDP, Suite 1100, Stratford, NJ 08084 USA
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Leggat SG, Phillips B, Pearce P, Dawson M, Schulz D, Smith J. Clinical supervision for allied health staff: necessary but not sufficient. AUST HEALTH REV 2018; 40:431-437. [PMID: 26412691 DOI: 10.1071/ah15080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/01/2015] [Indexed: 11/23/2022]
Abstract
Objectives The aim of the present study was to explore the perspectives of allied health professionals on appropriate content for effective clinical supervision of staff. Methods A set of statements regarding clinical supervision was identified from the literature and confirmed through a Q-sort process. The final set was administered as an online survey to 437 allied health professionals working in two Australian health services. Results Of the 120 respondents, 82 had experienced six or more clinical supervision sessions and were included in the analysis. Respondents suggested that clinical supervision was beneficial to both staff and patients, and was distinct from line management performance monitoring and development. Curiously, some of the respondents did not agree that observation of the supervisee's clinical practice was an aspect of clinical supervision. Conclusions Although clinical supervision is included as a pillar of clinical governance, current practice may not be effective in addressing clinical risk. Australian health services need clear organisational policies that outline the relationship between supervisor and supervisee, the role and responsibilities of managers, the involvement of patients and the types of situations to be communicated to the line managers. What is known about the topic? Clinical supervision for allied health professionals is an essential component of clinical governance and is aimed at ensuring safe and high-quality care. However, there is varied understanding of the relationship between clinical supervision and performance management. What does this paper add? This paper provides the perspectives of allied health professionals who are experienced as supervisors or who have experienced supervision. The findings suggest a clear role for clinical supervision that needs to be better recognised within organisational policy and procedure. What are the implications for practitioners? Supervisors and supervisees must remember their duty of care and ensure compliance with organisational policies in their clinical supervisory practices.
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Affiliation(s)
- Sandra G Leggat
- Health Services Management, La Trobe University, Bundoora, Vic. 3086, Australia
| | - Bev Phillips
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia. Email
| | - Philippa Pearce
- Department of Physiotherapy, Ballarat Health Services, Ballarat, Vic. 3350, Australia. Email
| | - Margaret Dawson
- Allied Health, Ballarat Health Services, Ballarat, Vic. 3350, Australia. Email
| | - Debbie Schulz
- East Grampians Health Service, Ararat, Vic. 3377, Australia. Email
| | - Jenni Smith
- Northern Health, Epping, Vic. 3076, Australia. Email
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Alfonsson S, Parling T, Spännargård Å, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cogn Behav Ther 2017; 47:206-228. [PMID: 28929863 DOI: 10.1080/16506073.2017.1369559] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists' competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists' competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists' competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.
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Affiliation(s)
- Sven Alfonsson
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden.,b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Thomas Parling
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
| | - Åsa Spännargård
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
| | - Gerhard Andersson
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden.,c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden
| | - Tobias Lundgren
- a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden
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How Supervisees on a Foundation Course in CBT Perceive a Supervision Session and what they Bring Forward to the Next Therapy Session. Behav Cogn Psychother 2017; 46:302-317. [PMID: 28903793 DOI: 10.1017/s1352465817000558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees' perspective. AIMS The aim of the study was to acquire knowledge from the supervisees' perspective as to what in particular in the supervision process contributes to the therapy process. METHOD Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants' written diaries after supervision and therapy sessions. RESULTS Analyses of supervisees' experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was 'doing the right thing' was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. CONCLUSIONS The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.
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Sewell K. Theoretically grounded, evidence-informed clinical supervision for the SNAP programs: A model in development. CLINICAL SUPERVISOR 2017. [DOI: 10.1080/07325223.2017.1352549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karen Sewell
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Miller A, Robb M. Transformative phases in el duende process painting art-based supervision. ARTS IN PSYCHOTHERAPY 2017. [DOI: 10.1016/j.aip.2017.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Davys AM, O'Connell M, May J, Burns B. Evaluation of professional supervision in Aotearoa/New Zealand: An interprofessional study. Int J Ment Health Nurs 2017; 26:249-258. [PMID: 27616563 DOI: 10.1111/inm.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Abstract
The evaluation of professional supervision has been a focus for discussion in the supervision literature over past decades. A review of the literature in this area, however, suggests that evaluation has been differently defined, variously addressed, and a range of outcomes reported. The present study reports the findings of the first stage of a three-stage study of evaluation in professional supervision in Aotearoa/New Zealand. Experienced practitioners from the four professions of counselling, mental health nursing, psychology, and social work were interviewed to explore how evaluation in professional supervision is understood and actioned in practice. Twenty four semistructured interviews were conducted with supervisees, supervisors, and managers from each of the identified professions. The findings from these interviews indicate that a majority of participants applied some form of evaluation to their supervision arrangement. These evaluations, however, did not reflect an overarching organizational or professional culture of formal evaluation, but rather, an individualized ad-hoc process initiated by one or both of the participants (supervisor and supervisee). These evaluations focussed predominantly on the process, rather than the outcomes, of supervision. While many respondents expressed interest in a formal process for evaluating supervision, a number of concerns were also raised. These concerns included a lack of evaluation skills and resource, the potential for formal evaluation to have a negative impact on the supervision relationship, the importance of maintaining the boundaries of confidentiality, and a wariness regarding the possible use of any information gathered.
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Affiliation(s)
| | | | - Janet May
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
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Alfonsson S, Spännargård Å, Parling T, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Syst Rev 2017; 6:94. [PMID: 28490376 PMCID: PMC5425973 DOI: 10.1186/s13643-017-0486-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees' competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. METHODS This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees' patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. DISCUSSION This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016046834.
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Affiliation(s)
- Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Åsa Spännargård
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64, Stockholm, Sweden
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White E. Claims to the benefits of clinical supervision: A critique of the policy development process and outcomes in New South Wales, Australia. Int J Ment Health Nurs 2017; 26:65-76. [PMID: 28093885 DOI: 10.1111/inm.12292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
The historical development of clinical supervision has been variously interpreted in the international literature. Creditable evidence has accumulated, particularly over the past two decades, to show that clinical supervision has a positive demonstrable effect on supervisees. However, comparatively little research evidence has entered the public domain on any effect that clinical supervision might have on other nominated outcomes. In Australia, developments in clinical supervision were recently prompted by initiatives at national and state levels. Since 2010, lead agencies for these have sought feedback from professional bodies and organizations on a number of inter-related draft policy documents. The present article tracked changes over time between the draft and final versions of these documents in New South Wales, and reviewed the original sources of literature cited within them. The strength of evidence upon which the final published versions were reportedly predicated was scrutinized. Upon examination, claims to the wider benefits of clinical supervision were found to be unconvincingly supported, not least because the examples selected by the agencies from the international literature and cited in their respective documents were either silent, parsimonious, or contradictory. Many claims remain at the level of folklore/hypothetical propositions, therefore, and stay worthy of rigorous empirical testing and faithful public reporting. Such investigations have been acknowledged as notoriously difficult to conduct. The present article identified noteworthy examples in the contemporary literature that signpost robust ways forward for empirical outcomes-orientated research, the findings from which might strengthen the evidence base of future policy documents.
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Affiliation(s)
- Edward White
- Osman Consulting Pty Ltd, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Personal Social Services Research Unit, The University of Manchester, Manchester, UK
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Watkins CE. On Principles of Educational Change and Principled Action in Psychotherapy Supervision. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9355-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Creaner M, Timulak L. Clinical supervision and counseling psychology in the Republic of Ireland. CLINICAL SUPERVISOR 2016. [DOI: 10.1080/07325223.2016.1218812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
AbstractIn this Introduction to the Special Issue of the Cognitive Behaviour Therapist on clinical supervision we start by highlighting the unmet and overdue need for coherent organizational systems to support, guide and develop clinical supervisors. We identify a seven-step, cyclical model that describes how such a system might work, with particular reference to CBT supervision. These steps start with conceptualization (e.g. definition of CBT supervision) and complete the problem-solving cycle with evaluation (e.g. corrective feedback). We provide an overview of typical research and development activity for each part of this model to illustrate how a sound supervision infrastructure might best be developed. The SOS model provides a systematic approach to indicate the organizational conditions under which CBT supervision might flourish.
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Bell T, Dixon A, Kolts R. Developing a Compassionate Internal Supervisor: Compassion-Focused Therapy for Trainee Therapists. Clin Psychol Psychother 2016; 24:632-648. [DOI: 10.1002/cpp.2031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/21/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Tobyn Bell
- Greater Manchester West Cognitive Behaviour Therapy Training Centre; Greater Manchester UK
| | - Alison Dixon
- Manchester Mental Health and Social Care Trust; Greater Manchester UK
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Introduction to the Special Issue of tCBT: supporting and guiding our supervisors. COGNITIVE BEHAVIOUR THERAPIST 2016. [DOI: 10.1017/s1754470x16000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Supervision is probably the single most effective method for helping therapists to develop competence, capability and a professional identity (Falender & Shafranske, 2004; Callahan et al. 2009; Watkins & Milne, 2014). Supervision is also perceived by supervisees as the main influence on their practice (Lucock et al.2006), and has been recognized by governments as an essential component of mental health services in the 21st century (e.g. Care Quality Commission, 2013). Paradoxically, supervisors themselves may receive inadequate support and guidance. This is an unacceptable strategic and moral oversight, one which presumably undermines the fidelity of CBT while increasing burnout: in one survey, 82% of participating supervisors expressed dissatisfaction over their support arrangements (Gabbay et al. 1999). Recent surveys of CBT supervisors indicate that despite an overall sense of satisfaction with supervision, considerably more can be done to support supervisors in terms of developing improved supervisory and training materials (Reiser & Milne, 2016). The phrase ‘something does not compute’ sums up this paradox succinctly (Watkins, 1997, p. 604).
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Waltman SH. Model-Consistent Cognitive Behavioral Therapy Supervision: A Case Study of a Psychotherapy-Based Approach. J Cogn Psychother 2016; 30:120-130. [PMID: 32755911 DOI: 10.1891/0889-8391.30.2.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a great need for training in cognitive behavioral therapy (CBT) for community clinicians who work in public mental health systems where resources are low and demands are high. Researchers have found that simply attending intensive CBT workshops will not result in adherent or competent CBT being delivered, rather ongoing CBT supervision/consultation has been found to be associated with the best training outcomes. Psychotherapy-based approaches to supervision have recently received some attention for their value in providing experiential learning. What follows is a case example of a community clinician who had little previous training in CBT and following an intensive training and 16 weeks of CBT supervision had substantial gains in her CBT adherence and competency ratings. Recommendations such as the value of experiential learning are discussed.
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Affiliation(s)
- Scott H Waltman
- Beck Initiative, Aaron T. Beck Psychopathology Research Center, University of Pennsylvania
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Nadeem E, Gleacher A, Beidas RS. Consultation as an implementation strategy for evidence-based practices across multiple contexts: unpacking the black box. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:439-50. [PMID: 23716145 DOI: 10.1007/s10488-013-0502-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.
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Affiliation(s)
- Erum Nadeem
- Department of Child and Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY, 10016, USA,
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An examination of behavioral rehearsal during consultation as a predictor of training outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:456-66. [PMID: 23616234 DOI: 10.1007/s10488-013-0490-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. Recorded consultation sessions (N = 104) were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed.
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Goodyear RK. Supervision As Pedagogy: Attending to Its Essential Instructional and Learning Processes. CLINICAL SUPERVISOR 2014. [DOI: 10.1080/07325223.2014.918914] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Beidas RS, Cross W, Dorsey S. Show Me, Don't Tell Me: Behavioral Rehearsal as a Training and Analogue Fidelity Tool. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:1-11. [PMID: 25382963 DOI: 10.1016/j.cbpra.2013.04.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behavioral rehearsal, when a trainee engages in a simulated interaction with another individual, is an underutilized but potentially cost-effective and feasible solution for two difficult questions in implementation science: how to improve training, a commonly used implementation strategy, and how to feasibly measure fidelity using analogue methods in community settings. This paper provides practical information on how to develop and use behavioral rehearsal for both of these purposes to implementation researchers. Therefore, we focus on development and use of behavioral rehearsal as a training and analogue fidelity tool in the context of three illustrative studies.
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Best D, White E, Cameron J, Guthrie A, Hunter B, Hall K, Leicester S, Lubman DI. A Model for Predicting Clinician Satisfaction with Clinical Supervision. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.856227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ellis MV, Berger L, Hanus AE, Ayala EE, Swords BA, Siembor M. Inadequate and Harmful Clinical Supervision. COUNSELING PSYCHOLOGIST 2013. [DOI: 10.1177/0011000013508656] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two studies were conducted to revise and empirically test Ellis’s framework for inadequate and harmful supervision, and to determine the occurrence of inadequate and harmful clinical supervision from the supervisees’ perspective. For Study 1, we delineated 10 criteria for minimally adequate clinical supervision and defined inadequate and harmful supervision by differentiating self-identified and de facto supervision for each. Ratings from 34 supervision experts were used to generate a taxonomy of 16 de facto inadequate and 21 de facto harmful supervision descriptors. Because harmful supervision was distinct from, yet subsumed by, inadequate supervision, we revised the taxonomy and definitions accordingly. In Study 2, the occurrence of inadequate and harmful supervision was assessed for 363 supervisees; 93.0% were currently receiving inadequate supervision and 35.3% were currently receiving harmful supervision. Over half of the supervisees had received harmful clinical supervision at some point. Implications for research, training, and practice are discussed.
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Beidas RS, Edmunds JM, Cannuscio CC, Gallagher M, Downey MM, Kendall PC. Therapists perspectives on the effective elements of consultation following training. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:507-17. [PMID: 23435832 PMCID: PMC3676714 DOI: 10.1007/s10488-013-0475-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA,
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An anatomy of CBT training: trainees’ endorsements of elements, sources and modalities of learning during a postgraduate CBT training course. COGNITIVE BEHAVIOUR THERAPIST 2013. [DOI: 10.1017/s1754470x13000160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study examines trainees’ evaluations of a postgraduate CBT training course to determine which aspects are perceived as having the greatest effect on competence. A course evaluation was completed by three cohorts (n = 73) of a yearlong master's-level CBT training course, and statistical comparisons were conducted to examine the perceived impact of discrete aspects of training. There were significant differences between endorsements of the impact of various aspects of the learning experience. Overall, supervision was perceived to have a greater influence on trainees’ competence than clinical instruction. Interactions with trainers were given the highest rating, followed by learning from personal reflection and peer interactions. The varied aspects of extensive CBT training were perceived by students to be differentially effective in enhancing CBT skills. Supervision was perceived to have the strongest impact on competence, and trainees’ own reflections on their practice in preparation for supervision perceived as an important contributor to supervision's efficacy. The relatively low rating of peer-related learning suggests acceptability for distance training (e.g. internet-based), which excludes peer interaction found in traditional training. Due to limitations inherent in study design, only tentative conclusions can be offered. Further research involving more rigorous hypothesis testing is recommended.
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Dorsey S, Pullmann MD, Deblinger E, Berliner L, Kerns SE, Thompson K, Unützer J, Weisz JR, Garland AF. Improving practice in community-based settings: a randomized trial of supervision - study protocol. Implement Sci 2013; 8:89. [PMID: 23937766 PMCID: PMC3751139 DOI: 10.1186/1748-5908-8-89] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/31/2013] [Indexed: 11/29/2022] Open
Abstract
Background Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes. Methods/Design The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment. Discussion This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes. Trial registration ClinicalTrials.gov NCT01800266
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Affiliation(s)
- Shannon Dorsey
- Department of Psychology, University of Washington, 335 Guthrie Hall, Seattle, WA 98195, USA.
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Veilleux JC, Sandeen E, Levensky E. Dialectical Tensions Supervisor Attitudes and Contextual Influences in Psychotherapy Supervision. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2013. [DOI: 10.1007/s10879-013-9245-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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