Recent "Ask an Expert" Submissions

Below are some recent questions submitted to our expert team.

What are the steps to moving to a more clinically-oriented supervision approach?

The Question:

"I am the director of a large, publically-funded inner city treatment program and have been required by the state to establish a consistent supervision program for our agency. Our staff includes ten full-time counseling positions with a broad range of professional experience and education, from entry-level addiction staff to licensed social workers and professional counselors. Until now, employees have received primarily administrative supervision with an emphasis on meeting job performance requirements. The agency needs to make the supervision more clinical in nature. What are the steps to moving to a consistent clinical supervision approach?"

The Response:

Moving from a focus on administrative supervision to an approach that simultaneously emphasizes the clinical aspects of service delivery is an enormously important step. Quality of care for clients and families depends on a clinically oriented supervisory process. However, to effectively implement such a transition there are a number of steps that must be taken by organizations:

  1. Talk with agency staff about the planned change: Agency leaders are first encouraged to meet with all staff (direct care, middle managers, administrators, etc.) to discuss with them the intent to broaden the supervisory focus in an effort to ensure quality of care. One strategy is to convene an all staff meeting where the agency’s management team conveys a clear message that the enhanced clinical focus is also intended to serve as a support to staff in their challenging jobs. The meeting can be an opportunity for staff to discuss their reactions and fears about the new agency direction. If managed well, this dialogue will enhance staff receptivity to the change process.
  2. Make treatment plans a central focus of supervisory sessions: Treatment plans are supposed to guide the delivery of care, but too often they are viewed as an administrative task that has little bearing on services provided. Ask your supervisors to follow this simple rule: when discussing a client with a supervisee the treatment plan should be a central focus. It should be in the room for both the supervisor and supervisee to review and discuss. This might seem awkward to staff at first, but the accuracy, relevance, and timeliness of treatment plans will gradually improve and the focus will shift during supervision to the clinical aspects of care.
  3. Ask your supervisors to observe what supervisees do: Supervisors’ knowledge about what supervisees do with clients comes almost exclusively from what supervisees tell them. Shaping what supervisees do requires first hand knowledge about how they practice. To gather this knowledge have your supervisors increasingly use two strategies:
    • Direct Observation: This is the most effective way to build staff practice skills and monitor performance. It can occur with the supervisor in the same room or in an adjacent room observing the delivery of care. Observing staff providing services in community settings can also be invaluable.
    • Providing Treatment Jointly: This allows the supervisor and supervisee to work together as co-facilitators during group sessions, family sessions, or providing services to an individual. Supervision of the supervisee can occur before and after the client and family interactions. Supervisor modeling of desired behaviors can have a profound impact on shaping what supervisees do.

In summary, transitioning towards a model of supervision where the clinical aspects of care are emphasized is extremely important but also very complicated. To effectively make this transition consider these three strategies: (a) communication with staff about the planned changes; (b) ensure that your supervisors make treatment plans a central focus of any client discussions, and (c) have supervisors directly observe the work of staff with clients or provide services jointly. Ensuring a clinical focus in supervision will help an agency ensure a person-centered approach to treatment, enhance quality of care, and foster improved outcomes for their clients.