Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health

Abstract

BackgroundWorkplace-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.MethodsData 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.ResultsInterrater 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.ConclusionsWorkplace-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 registrationNCT01800266, 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])Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0708-3) contains supplementary material, which is available to authorized users.

The Availability of Supervision in Routine Mental Health Care

“…In addition, respondents indicated that they spent an additional 1.5 hours per week on average in supervision focused on administrative content. These findings differ in total quantity and percentage of time devoted to clinical content when compared to previously reported findings of about 50 minutes every other week (Dorsey et al, 2018). Findings here suggest an adequate amount of supervision time as compared to NYS clinical licensing standards (New York State Education Department, 2017) or CT requirements for supervisory contact that require one hour per 40 hours of clinical contact (Supervision Competency Workforce Initiative, 2009).…”

“…Elements of evidence-based, best practices in supervision have been articulated in the behavioral health literature and include observation of actual practice (i.e., live supervision with a supervisor providing feedback in vivo), use of direct observation or session recordings (Milne & Reiser, 2011), and use of client feedback and outcomes (Worthern & Lambert, 2007) to inform the supervision process. Despite the established utility and expectation of supervision, knowledge of best practice supervision availability for providers working in community mental health services remains limited (Dorsey et al, 2018). Evidence for supervision effectiveness is even less robust in non-behavioral health settings (e.g., child welfare) (Carpenter, Webb, & Bostock, 2014).…”

“…In addition, the 2004 National Social Work Workforce study reported decreased supervision and increased workload (Whitaker, Weismiller, & Clark, 2006). While some recommendations on how to bolster supervision to ensure safe and effective care have been made, questions remain about whether supervision is an available resource for clinical practice improvement in routine services (Dorsey et al, 2018; Hoge, Migdole, Cannata, & Powell, 2014). Knowledge is limited about routine supervision practices, the use of best practice content, the quantity of supervision time devoted to clinical practice, and supervision models that are effective in integrating best practices into usual care (Dorsey et al, 2013).…”

Reciprocal leadership in clinical supervision comes of age

“…In the back seat of this metaphorical tandem, the supervisee is therefore equally clearly depicted as a follower. A recent study examining workplace‐based supervision endorsed such leadership as crucial in driving CS outcomes (Dorsey et al., ).…”

“…managing the session, agenda‐setting, teaching), relating these to linked ratings of the effect such behaviours have on the supervisee. Similarly, coding what is said in supervision (content evaluation) also appears promising as a methodology to evaluate feedback practices and leadership within CS (Dorsey et al., ).…”