Supervision & Coaching

Current Status of Supervision
Supervision involves a relationship in which one individual, the supervisor, has responsibility for the work and the work life of the supervisee. Changes in the mental health field over the last few decades have created a compelling argument for increasing the supervision of services: care is increasingly provided in the community where workers receive less observation and have more autonomy; the clinical and social complexity of individuals and families has increased; and services and service systems are also much more complex.

While the need for supervision of mental health services has increased, there is considerable evidence that the amount of supervision being provided has declined substantially. To contain costs, provider organizations have eliminated many supervisory positions; supervisors are often assigned to oversee the work of a very large number of staff members, while carrying their own caseload; and the focus of supervision has become heavily oriented toward administrative and compliance issues, with less attention to the quality of care. New supervisors infrequently receive training on best practices in supervision.

The Case for Supervision
From a workforce development perspective, there is a strong case to be made for training of supervisors and promoting supervision in mental health organizations: supervisors are among the most stable part of the workforce in that they have lower rates of turnover than frontline staff; they have significant influence over the practice of staff engaged in service delivery; they serve as a bridge from agency administration to the direct care staff; and supervisor “buy-in” is essential in implementing new agency policies or service models. 

Functions of Supervision
Despite a recent decline, there is a strong history of supervision in the mental health field. The work has largely been conducted by mental health professional associations and academic training programs. The social work and psychology disciplines have been particularly strong in this area. 

While there are many different models of supervision, there is general agreement that good supervision includes a focus on: the appropriateness and quality of care provided; administrative oversight of the worker and the work he or she provides; support for the worker; and professional development of the worker, which includes performance appraisals. For a specific worker, these functions might be fulfilled by one or more supervisors.

The Outcomes of Supervision 
Published reports on the effectiveness of supervision are highly varied with respect to whether they use reliable and valid data and control potentially confounding variables. The literature contains many anecdotal reports regarding supervision effectiveness; a large number of studies that measure outcomes of supervision, but lack controlled designs; and a small number of studies that have adequate methodological controls. Taken as a whole, findings suggest that receiving supervision increases supervisee competence, job satisfaction, and job retention; and that training supervisors increases their competence and job satisfaction. Well-designed studies of supervision conducted as part of the implementation of evidence-based practices, such as Multisystemic Therapy (MST), suggest that supervision can increase client and family engagement, adherence to prescribed treatment, satisfaction with treatment, and clinical outcomes (Henggeler et al., 2002; Schoenwald, Sheidow & Chapman, 2009).

Supervision Competencies
Within the mental health field, there has been a relatively recent resurgence of interest in strengthening supervision. As part of this trend, a number of professional organizations have developed, disseminated, and promoted various forms of supervision competencies and standards. These organizations include the American Psychological Association and the National Association of Social Workers. The American Board of Examiners in Clinical Social Work (ABE) has not only issued standards for supervision, but also offers a process by which individuals in the profession can become certified in the specialty of Clinical Social Work Supervision. Other groups have developed specialized competencies and standards regarding the supervision of peer specialists. Links to these publications and processes can be found in the Resources section below.

Models of Supervision
There are varied models of supervision. These are typically described in textbooks geared for professionals; particularly those working in academic training programs. Some of the best-known authors and their texts are referenced in the Resources section below. 

The Addiction Technology Transfer Center (ATTC) Network has developed a set of competencies, online courses and in-person trainings on supervision that are highly regarded. While not specific to mental health, the majority of the content is applicable to the process of supervision in mental health settings. 

Faculty members from the Yale Department of Psychiatry have developed the Yale Program on Supervision, which focuses specifically for the public behavioral health sector. The Yale model uses an implementation science framework that combines: (a) consultation to organizations to strengthening policies, procedures, and structures related to supervision; followed by (b) training of staff at all levels of the organization in supervision best practices. 

Coaching
The concept of coaching is related to, but somewhat distinct from, supervision. It involves a structured process in which a coach uses strategies to help a worker improve their skill and job performance. Coaches can be employees of the agency or consultants from outside the agency. In contrast to supervisors, coaches usually do not have authority over the employee or responsibility for their work. The noted physician and author Atul Gawande wrote: ““The concept of a coach is slippery. Coaches are not teachers, but they teach. They’re not your boss…but they can be bossy” (Gawande, 2011).

There are many models of coaching. Most include many of the following elements: assessing the worker’s needs; planning the coaching intervention; teaching skills to the worker; modeling the skills; observing the worker; promoting worker reflection on their experience; giving feedback; and engaging the worker in problem solving.

With respect to problem solving during coaching, the GROW model is a popular approach for helping a worker analyze a situation and select next steps. The GROW acronym stands for: What are your Goals? What is the Reality of the situation? What are your Options? What is the Way forward?

Resources & References

Coaching

Gawande, A. Top athletes and singers have coaches. Should you? The New Yorker. October 3, 2011. Accessed online August 29, 2019.
https://www.newyorker.com/magazine/2011/10/03/personal-best

The GROW Model of Coaching and Mentoring
https://www.mindtools.com/pages/article/newLDR_89.htm

Competencies, Standards and Certification

The American Board of Examiners in Clinical Social Work (ABE)
https://abecsw.org/about-abe/

ABE Clinical Social Work Supervision Certification
https://abecsw.org/bcd-application-csw-supervision-part-1/

American Psychological Association. (2014). Guidelines for Clinical Supervision in Health Service Psychology. 
https://www.apa.org/about/policy/guidelines-supervision.pdf

National Association of Social Workers, Association of Social Work Boards. Best Practice Standards in Social Work Supervision.
https://www.socialworkers.org/LinkClick.aspx?fileticket=GBrLbl4BuwI%3D&portalid=0

Models

Addiction Technology Transfer Centers (ATTC) Network. Clinical Supervision Foundations Course
http://healtheknowledge.org/course/index.php?categoryid=56

Campbell, J. (2011). Essentials of Clinical Supervision. New York: Wiley. 

Hoge, M. A., Migdole, S., Cannata, E., & Powell, D. J. (2014). Strengthening supervision in systems of care: Exemplary practices in empirically supported treatments. Clinical Social Work Journal, 42, 171–181. 
https://link.springer.com/article/10.1007/s10615-013-0466-x

Kadushin, A., & Harkness, D. (2014). Supervision in Social Work (5th ed). New York: Columbia University Press.

Shulman, L. (2010). Interactional Supervision (3rd ed). Washington, DC: NASW Press.

Yale Program on Supervision
www.supervision.yale.edu

Outcomes of Supervision

Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Clinical Child and Adolescent Psychology, 31(2), 155-167. 

Schoenwald, S. K., Sheidow, A. J., & Chapman, J. E. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77(3), 410-421.

Supervision of Peer Specialists

BRSS TACS, Supervision of Peer Workers
https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/brss-209_supervision_of_peer_workers_overview_cp6.pdf

International Association of Peer Supporters (iNaps), Supervision Resources
https://www.inaops.org/supervision-resources