Category: Dissemination / Implementation

Symposium

Workplace-Based Clinical Supervision and Evidence-Based Therapy: The What and How of Supervision

Saturday, November 18
12:00 PM - 1:30 PM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: Supervision | Trauma | Implementation
Presentation Type: Symposium

Background: Workplace-based clinical supervision in public mental health is an underutilized resource for supporting evidence-based treatments (EBTs)1 despite the fact that it may offer a cost-effective way to support clinician fidelity to EBT.  However, very little is known about the content and techniques used2 ; particularly in the context of EBT implementation3.  


Methods: Workplace-based supervisors in children’s public mental health settings audiorecorded supervision sessions over the course of one year, when supervising EBT. Data come from objective coding of these audiofiles. Participants were 28 supervisor, and their 98 clinician-supervisees. All were trained in the EBT of focus (Trama-focused CBT; TF-CBT) as part of a Washington State-funded initiative. The coding measure captured extensiveness  (1-7 rating) of 27 domains (14 content areas (e.g., exposure, homework ) and 13 supervision techniques (e.g., clinical suggestions, behavioral rehearsal, modeling). Coder reliability was excellent (ICC= .87).


Results: Content areas that occurred in > 50% of the sessions were exposure (81%), engagement (92%), trauma history (78%), coping skills (76%), caregiver challenges that impacted treatment (62%), assessment (54%) and psychoeducation (60%). Techniques that occurred in > 50% of the sessions were information gathering (97%), teaching (93%), providing clinical suggestions (86%), and fidelity/adherence check (64%). Infrequently occurring techniques were behavioral rehearsal (16%), progress note review (6%), review of actual practice (5%), assigns additional training/learning (5%), and reviews suggestions (5%). Most content and techniques occurred at low intensity.


 Conclusions: Findings suggest that workplace-based clinical supervisors are indeed covering EBT content; but potentially at a lower intensity than may be needed to fully support clinician fidelity.  Supervisors were less likely to use more “active” supervision techniques that are common in efficacy trials (role play, modeling, review recommendations), and when used, were used at low intensity. 


1.         Schoenwald SK, Mehta TG, Frazier SL, Shernoff ES. Clinical supervision in effectiveness and implementation research. Clin Psychol Sci Pract. 2013;20(1):44-59. doi:10.1111/cpsp.12022.


2.         Accurso EC, Taylor RM, Garland AF. Evidence-based practices addressed in community-based children’s mental health clinical supervision. Train Educ Prof Psychol. 2011;5(2):88-96. doi:10.1037/a0023537.


3.         Dorsey S, Pullmann MD, Deblinger E, et al. Improving practice in community-based settings: a randomized trial of supervision – study protocol. Implement Sci. 2013;8:89. doi:10.1186/1748-5908-8-89.

Shannon Dorsey

Associate Professor
University of Washington

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