Current Supervision Practices Research Articles

Health services supervision in a protracted crisis: a qualitative study into supportive supervision practices in South Sudan

BackgroundThe health system in South Sudan faces extreme domestic resource constraints, low capacity, and protracted humanitarian crises. Supportive supervision is believed to improve the quality of health care and service delivery by compensating for flaws in health workforce management. This study aimed to explore the current supervision practices in South Sudan and identify areas for quality improvement.MethodsThe study employed qualitative approaches to collect and analyse data from six purposefully selected counties. Data were collected from 194 participants using semi-structured interviews (43 health managers) and focus group discussions (151 health workers). Thematic content analysis was used to yield an in-depth understanding of the supervision practices in the health sector.ResultsThe study found that integrated supportive supervision and monitoring visits were the main approaches used for health services supervision in South Sudan. Supportive supervision focused more on health system administration and less on clinical matters. Although fragmented, supportive supervision was carried out quarterly, while monitoring visits were either conducted monthly or ad hoc. Prioritization for supportive supervision was mainly data driven. Paper-based checklists were the most commonly used supervision tools. Many supervisors had no formal training on supportive supervision and only learned on the job. The health workers received on-site verbal feedback and, most times, on-the-job training sessions through coaching and mentorship. Action plans developed during supervision were inadequately followed up due to insufficient funding. Insecurity, poor road networks, lack of competent health managers, poor coordination, and lack of adequate means of transport were some of the challenges experienced during supervision. The presumed outcomes of supportive supervision were improvements in human resource management, drug management, health data reporting, teamwork, and staff respect for one another.ConclusionSupportive supervision remains a daunting task in the South Sudan health sector due to a combination of external and health system factors. Our study findings suggest that strengthening the processes and providing inputs for supervision should be prioritized if quality improvement is to be attained. This necessitates stronger stewardship from the Ministry of Health, integration of different supervision practices, investment in the capacity of the health workforce, and health infrastructure development.

‘If we weren’t reflecting, we would be like robots’: The case for thinking aloud in social work supervision

Thinking aloud is presented as a qualitative research and practice tool that enhances critical reflection and learning when it is applied in supervisor–supervisee dyads. Aotearoa New Zealand’s statutory child protection organisation, Oranga Tamariki (OT), has been openly criticised in reports damning ineffective social work practice regarding child and family assessments, cultural competency and critical practice. But what is really going on inside OT? Working alongside OT social workers, the authors explored ways to build critical reflection, resilience and well-being amongst supervisors and supervisees. Critical reflection was used as the methodological lens in this supervision study. The authors examine data collected from six supervisor–supervisee dyads participating in a thinking aloud process. Supervision recordings were analysed for reflective capacity, skills and current supervision practices in OT. Thinking aloud promoted a co-constructed space for supervisors and supervisees to critically reflect on their relationship together and their practice discussions in supervision. Using thematic analysis, four themes were generated from the thinking aloud discussions: the supervision agenda; supervisor skills; supervisory relationship and thinking aloud in supervision. These themes highlighted the significance of thinking aloud in providing deeper analysis and feedback on the quality of supervision and the skills used in the session. Reflective supervision is fundamental towards critical reflection and ethical social work practice. Within child protection services, it is crucial that social workers maintain a practice focus in robust decision-making effecting children and qualitative research supports this practice. Thinking aloud provides the basis for supervisors and supervisees to develop their skills together and ensure critical and accountable practice.

403 Can supervision support implementation of evidence-based practices in substance use disorder treatment programs? A qualitative analysis of organizational and environmental contexts in Arkansas

OBJECTIVES/GOALS: Supervision is a promising strategy for supporting high-fidelity implementation of evidence-based practices (EBPs) in substance use disorder (SUD) settings. In this study, we explore current supervision practices in community SUD programs and identify organizational and environmental factors that shape them. METHODS/STUDY POPULATION: We interviewed 25 leaders and counselors at 8 community SUD programs in Arkansas, and 16 leaders at external stakeholder organizations (e.g., regulators, payers, licensing boards). Interview guides were based on the i-PARIHS framework. Interviews were conducted on Zoom or phone, lasted ~1 hour, and were recorded and transcribed. Below we outline findings based on preliminary analyses; full thematic analyses will be completed before presentation. RESULTS/ANTICIPATED RESULTS: Participants generally recognized the importance of utilizing EBPs and supporting their use through supervision. Counselors professional backgrounds and training vary substantially, necessitating continuing education and supervision. However, different professional, licensing and regulatory standards create a complex web of requirements and practices. Supervisors typically require clinical experience, but are rarely trained in supervision. They are internal or external to the organization, and provide individual or group supervision. Supervisors most often rely on case summaries and chart reviews, sometimes on direct observations and role-playing, and rarely (one program) on session recordings. Supervision goals are broad, and while EBP use is encouraged, it is rarely the focus of supervision. DISCUSSION/SIGNIFICANCE: To enhance supervision in community SUD settings and improve implementation of EBPs, new supervision strategies need to fit the various norms, expectations, and standards (e.g., professional, regulatory) that characterize community SUD programs, their workforce, and their environments.

Experiences of United States genetic counseling supervisors regarding race/ethnicity in supervision: A qualitative investigation.

While addressing culture in supervision is important, research suggests genetic counseling supervisors are unsure how to discuss it within the supervisory relationship. This study explored the perceptions of genetic counselor supervisors from the United States regarding how their supervisors approached racial/ethnic differences in their supervisory relationships when they were students, effects on those relationships, and subsequent influences on their supervision practices. Nine genetic counselors who self-identified as White/Caucasian, and nine who self-identified as racial/ethnic backgrounds other than White/Caucasian, were purposively recruited to participate in semi-structured phone interviews. Questions explored participant perceptions of how their supervisors approached racial/ethnic differences in supervision, effects on those supervisory relationships, and influences of their experiences as students on their current supervision practice. Thematic analysis revealed four major themes, with most participants agreeing that (1) recognition of race/ethnicity in supervision was limited as a student and in their current supervision practices; (2) supervisors vary in their comfort discussing race/ethnicity; (3) prior student supervision experiences of racial/ethnic differences have limited effects on current supervision practice; and (4) supervisors desire more training in how to approach conversations around race/ethnicity. Further professional discussions about the role of race/ethnicity in the supervisory relationship and training in addressing the cultural context in supervision are needed.

The need for data-informed clinical supervision in substance use disorder treatment

ABSTRACTEffective clinical supervision is necessary for high-quality care in community-based substance use disorder treatment settings, yet little is known about current supervision practices. Some evidence suggests that supervisors and counselors differ in their experiences of clinical supervision; however, the impact of this misalignment on supervision quality is unclear. Clinical information monitoring systems may support supervision in substance use disorder treatment, but the potential use of these tools must first be explored. First, the current study examines the extent to which misaligned supervisor–counselor perceptions impact supervision satisfaction and emphasis on evidence-based treatments. This study also reports on formative work to develop a supervision-based clinical dashboard, an electronic information monitoring system and data visualization tool providing real-time clinical information to engage supervisors and counselors in a coordinated and data-informed manner, help align supervisor–counselor perceptions about supervision, and improve supervision effectiveness. Clinical supervisors and frontline counselors (N = 165) from five Midwestern agencies providing substance abuse services completed an online survey using Research Electronic Data Capture software, yielding a 75% response rate. Valid quantitative measures of supervision effectiveness were administered, along with qualitative perceptions of a supervision-based clinical dashboard. Through within-dyad analyses, misalignment between supervisor and counselor perceptions of supervision practices was negatively associated with satisfaction of supervision and reported frequency of discussing several important clinical supervision topics, including evidence-based treatments and client rapport. Participants indicated the most useful clinical dashboard functions and reported important benefits and challenges to using the proposed tool. Clinical supervision tends to be largely an informal and unstructured process in substance abuse treatment, which may compromise the quality of care. Clinical dashboards may be a well-targeted approach to facilitate data-informed clinical supervision in community-based treatment agencies.

Evaluation of a youth agency's supervision practices: A mixed-method approach

This research presents the findings from an evaluation and organizational development initiative that was requested by a Canadian youth agency working in a large urban setting. A team of four researchers affiliated with the Center for Research on Educational and Community Services (CRECS) at the University of Ottawa conducted the evaluation. The purpose of the evaluation was to identify the supervision needs and challenges of coordinators and front line staff, assess the efficiency of the current supervision practices, and evaluate the supervisors’ and supervisees’ satisfaction with these current practices. A literature review was performed to help provide a clear definition of ‘supervision’ and the different professional roles it encompasses. Additionally, research evidence pertaining both to what contributes to supervision efficacy and supervisor competency was reviewed to distill the most robust findings in the existing literature. The lines of evidence consisted of a document and file review, an online employee survey, group discussions (i.e. focus groups), and interviews with key informants. The results of the evaluation helped the research team formulate recommendations to the agency for the development of enhanced supervision practices across its various service areas.

YESTERDAY, TODAY AND TOMORROW: IS SOCIAL WORK SUPERVISION IN SOUTH AFRICA KEEPING UP?

The recruitment and retention strategy of the Department of Social Development (2006:23)postulates that there is a “lack of structured supervision and poor quality supervisors, whothemselves also lack capacity to conduct professional supervision” in South Africa. Pieterse(1961), one of the first authors on supervision in South Africa, made similar claims close tofive decades ago. These two comments give rise to the question: has social work in SouthAfrica been practising supervision over the past five decades beyond historical bureaucraticdiscourses, and has it engaged with changing global, local and personal contexts to develop andsustain critically responsive practices? In other words: is social work supervision in SouthAfrica keeping up with the times? By addressing this question, this paper seeks to respond tothe call of the recruitment and retention strategy document (Department of SocialDevelopment, 2006) to evaluate current supervision practices. In this attempt the paper reportson research, drawing on an historical analysis of the international and local development ofsocial work supervision and on a case study of current supervision practices in an NGOenvironment, in order to recommend a context-specific conceptual framework for futuresupervision practices. This paper thus aims to examine the interplay between the historicaldevelopment, current practices and future challenges of social work supervision

The use of theoretical models in psychology supervisor development research from 1994 to 2010: A systematic review.

Training in supervision is becoming an increasingly important component of professional psychology programs. To assist students in developing supervisory competencies, knowledge of relevant research and effective training methods is required and, ideally, such knowledge should be derived from an empirical literature comprising good quality, theory-based research. To evaluate the nature of the empirical literature on supervisor development, a systematic review was conducted to determine the extent to which theoretical models have been used in this literature. Psyclnfo, Medline, CINAHL, and ERIC were searched for articles published between 1994 and 2010. Initially 3,248 abstracts were reviewed, 25 of which met the criteria of being empirical, focused on supervisor development, and having participants with graduate training in counselling or professional psychology. Of these studies, only half drew upon models of supervisory development in the conceptualisation, design, or interpretation of the research study. The most often used model was Watkins' Supervisor Complexity Model (Watkins, 1990, 1993, 1994). Approximately one third of studies examined the influence of past training and experience in supervision on current supervision practices. For competency-based training in supervision to advance, the theoretically informed evidence base needs to be greatly expanded, and much more research is needed that explicitly applies and/or evaluates models of supervisory development.Keywords: practicum supervision, professional supervision, clinical psychology, counselling psychology, systematic reviewClinical supervision has two main purposes: to ensure the integrity of clinical services and to develop service provision competence in the supervisee (Falender & Shafranske, 2004). Although many definitions of clinical supervision have been proposed, Milne's (2007) refinement of Bernard and Goodyear's widely cited work (2004) is the most comprehensive and detailed presented thus far in the literature:The formal provision, (i.e., sanctioned by relevant organisation/s) by senior/qualified health practitioners (or similarly experienced staff), of an intensive education (general problem solving capacity; developing capability) and/or training (competence enhancement) that is casefocused and which supports, directs, and guides (including restorative and/or normative topics, addressed by means of professional methods, including objective monitoring, feedback and evaluation) the work of junior colleagues (supervisees).In Canada, competency in supervision is required for licensure by some provincial or territorial regulatory bodies (see http:// www.cpa.ca/documents/MRA.pdf). Similarly, the American Psychological Association (APA) has stated that clinical supervision should be regarded as a distinct professional competency (American Psychological Association, 2006). Clinical supervision is also recognised as a key component of prelicensure training in Canada, as accreditation of professional psychology graduate programs requires doctoral students to have instruction in clinical supervision, and internship accreditation requires that interns acquire knowledge and skills in supervision (Canadian Psychological Association, 2011). As the provision of supervision is likely to be a component of future practice for many professional psychologists, graduate programs should provide training in supervision that is, ideally, built on a solid evidence base, as is the case in other areas of professional training (Hunsley & Barker, 2011).Current perspectives on graduate training in professional psychology emphasise a competency-based approach, with competency being broadly defined as the knowledge, skills, and values required to practice effectively (Falender et al., 2004). The task for educators, then, is to identify the knowledge, skills, and values that constitute a required competency such as supervision and, further, to effectively train students and professionals to develop the competency. …

Direct Versus Indirect Supervision of Fellows Covering Football Events: A Survey of Fellows and Program Directors

The Accreditation Council for Graduate Medical Education (ACGME) program requirements mandate "adequate supervision," of residents, but there is little guidance for sports medicine fellowship directors regarding the transition from direct to indirect supervision of fellows covering football games. We sought to gather evidence of current supervision practices in the context of injury outcomes. Fellows and program directors of ACGME-accredited sports medicine fellowship programs were invited to complete an online survey regarding their experience and current supervision practice at football games. Criteria for transition to autonomy and desired changes in supervision practice were elicited. Player safety was quantified by noting the number of field-side emergencies, whether an attending was present, and whether better outcomes might have resulted from the presence of an attending. A total of 80 fellows and 50 program directors completed the online survey. Direct supervision was lacking in about 50% of high school games and 20% of college games. A resulting cost in terms of player safety was estimated to apply to 5% of serious injuries by fellows' report but less than 0.5% by directors' report. Written criteria for transitioning from direct supervision to autonomy were the exception rather than the rule. The majority of fellows and directors expressed satisfaction with the current level of supervision, but 20% of fellows would prefer more supervision through postgame review. Football games covered by fellows are often not directly supervised. Absence of an attending affected the outcomes of 5% or less of serious injuries. Transition to autonomy does not usually require meeting written criteria. Fellows might benefit from additional off-site supervision.

Bus Supervision Deployment Strategies and Use of Real-Time Automatic Vehicle Location for Improved Bus Service Reliability

Bus service reliability has long been a top concern for transit agencies and their customers. Improving service reliability, however, has not been easy to accomplish. The use of appropriate recovery times, improved operator training, and better street supervision has produced limited results. Supervision deployment strategies and the use of real-time automatic vehicle location (AVL) information are investigated to improve current supervision practices and enhance bus service reliability. The Chicago (Illinois) Transit Authority's real-time AVL pilot project for Route 20 Madison is the case study for evaluation of the effectiveness of real-time AVL to improve reliability. A simulation model of the route was developed on the basis of archived AVL data and was used to predict the effects on service reliability when real-time AVL information is used in bus supervision. A week-long experiment was carried out both to verify the model and to address the feasibility and scalability of the system. The main conclusion is that real-time AVL does indeed have great potential to improve service reliability. Service restoration strategies previously impossible to execute are now feasible because of this new information stream. However, many obstacles remain to networkwide implementation, including the supervision communications structure and manpower deployment questions. The flood of information into a central control center must also be addressed. Automation techniques and exception-based reporting are strategies to deal with the problem of information overload.

Integrating Diversity Dimensions in Supervision

Interviews were conducted with 10 ethnic minority AAMFT (American Association for Marriage and Family Therapy)-approved supervisors about how they address intersections of diversity in clinical supervision activities. Using Consensual Qualitative Research methodology, three areas of importance emerged from participants: supervisors' initiative in integrating diversity, the impact of social location on current supervision practices, and the need for mentoring the next generation of therapists. The results are discussed in the service of promoting more inclusion of diversity issues in the supervisory process. Implications for supervision practices and ways to meet the diversity standards and core competencies of AAMFT are discussed.