Clinical Social Work Journal

, Volume 46, Issue 4, pp 271–280 | Cite as

The Availability of Supervision in Routine Mental Health Care

  • Mimi Choy-BrownEmail author
  • Victoria Stanhope
Original Paper


Clinical supervision is an embedded resource for practice quality in community mental health organizations. Supervision has been found to increase provider competence and decrease stress. In addition, supervision has been associated with service user outcomes including decreased depressive symptoms. However, little is known about the availability and nature of supervision in real world settings. The primary aims of this study were to identify available supervision and the extent to which contextual factors are related to that availability. The data source for this study was a multi-state and multi-site (N = 14) NIMH-funded trial survey of providers (N = 273). Supervision was measured by hours per week (quantity) and by utilization of best practice activities (content). Univariate, Chi square, independent samples t-tests, and ANOVA analyses were used to assess supervision content and quantity and to examine subgroup differences. Participants reported an average of 2.17 h of supervision per week and 28.6% of participants endorsed best practice content. Supervision quantity varied significantly across sites (p < 0.05) and program type (p < 0.05) while content did not. Individual role within the organization had a significant relationship with reported supervision content (p < 0.001). In these settings, staff in organizations are exercising discretion in how to utilize supervision within the available time. Supervision time also varied by program type, increasing with the intensity of services. Findings demonstrate that reports of availability vary according to position within the organization and the intensity of services within a given program type. Implications for workforce development, access to quality services, and implementation of evidence-based practices are discussed.


Clinical supervision Mental health services Agency-based supervision 



This research was supported by Grant funding from the National Institute of Mental Health (F31MH110120-01A1 Examining Supervision as an Implementation Strategy to Improve Provider Adoption of Evidence-Based Practice & R01MH099012 Person-Centered Care Planning and Service Engagement).


  1. Accurso, E. C., Taylor, R. M., & Garland, A. F. (2011). Evidence-based practices addressed in community-based children’s mental health clinical supervision. Training and Education in Professional Psychology, 5, 88–96. Scholar
  2. Bambling, M., King, R., Raue, P., Schweitzer, R., & Lambert, W. (2006). Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16, 317–331. Scholar
  3. Bearman, S. K., Schneiderman, R. L., & Zoloth, E. (2017). Building an evidence base for effective supervision practices: An analogue experiment of supervision to increase EBT fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 44, 293–307. Scholar
  4. Bearman, S. K., Weisz, J. R., Chorpita, B. F., Hoagwood, K., Ward, A., Ugueto, A. M., & Bernstein, A. (2013). More practice, less preach? The role of supervision processes and therapist characteristics in EBP implementation. Administration and Policy in Mental Health and Mental Health Services Research, 40, 518–529. Scholar
  5. Beidas, R. S., Edmunds, J. M., Cannuscio, C. C., Gallagher, M., Downey, M. M., & Kendall, P. C. (2013). Therapists’ perspectives on the effective elements of consultation following training. Administration and Policy in Mental Health and Mental Health Services Research, 40, 507–517. Scholar
  6. Berger, C., & Mizrahi, T. (2001). An evolving paradigm of supervision within a changing health care environment. Social Work in Health Care, 32(4), 1–18. Scholar
  7. Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th edn.). New Jersey: Pearson.Google Scholar
  8. Bogo, M., & McKnight, K. (2006). Clinical supervision in social work. The Clinical Supervisor, 24, 49–67. Scholar
  9. Bogo, M., Shlonsky, A., Lee, B., & Serbinski, S. (2014). Acting like it matters: A scoping review of simulation in child welfare training. Journal of Public Child Welfare, 8, 70–93. Scholar
  10. Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33, 26–44. Scholar
  11. Carpenter, J., Webb, C. M., & Bostock, L. (2013). The surprisingly weak evidence base for supervision: Findings from a systematic review of research in child welfare practice (2000–2012). Children and Youth Services Review, 35(11), 1843–1853. Scholar
  12. Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 647–652. Scholar
  13. Choy-Brown, M. (2016). Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: Advancing efficient methodologies through community partnerships and team science. Implementation Science, 11(Suppl 1), 85.Google Scholar
  14. Choy-Brown, M., Stanhope, V., Tiderington, E., & Padgett, D. (2015). Unpacking clinical supervision in transitional and permanent supportive housing: Support or scrutiny? Administration & Policy in Mental Health & Mental Health Services Research, 43(4), 546–554.CrossRefGoogle Scholar
  15. Dill, K., & Bogo, M. (2009). Moving beyond the administrative: Supervisors’ perspectives on clinical supervision in child welfare. Journal of Public Child Welfare, 3, 87–105. Scholar
  16. Dorsey, S., Kerns, S. E., Lucid, L., Pullmann, M. D., Harrison, J. P., Berliner, L., & Deblinger, E. (2018). Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implementation Science. Scholar
  17. Dorsey, S., Pullmann, M. D., Deblinger, E., Berliner, L., Kerns, S. E., Thompson, K., & Garland, A. F. (2013). Improving practice in community-based settings: A randomized trial of supervision—study protocol. Implementation Science, 8(89), 1–11. Scholar
  18. Ellis, M. V., Berger, L., Ayala, E. E., Swords, B. A., & Siembor, M. (2013). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42, 434–472. Scholar
  19. Evans, T. (2011). Professionals, managers and discretion: Critiquing street-level bureaucracy. The British Journal of Social Work, 41, 368–386. Scholar
  20. Gleacher, A. A., Nadeem, E., Moy, A. J., Whited, A. L., Albano, A. M., Radigan, M., & Hoagwood, K. E. (2011). Statewide CBT training for clinicians and supervisors treating youth: The New York State evidence-based treatment dissemination center. Journal of Emotional and Behavioral Disorders, 19, 182–192. Scholar
  21. Henggeler, S., & Schoenwald, S. (1998). Multisystematic therapy supervisor manual: Promoting quality assurance at the clinical level. Charleston: MST Institute.Google Scholar
  22. Henggeler, S., Schoenwald, S., Liao, J., Letourneau, E., & Edwards, D. (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, 155–167. Scholar
  23. 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. Scholar
  24. Hoge, M. A., Migdole, S., Farkas, M. S., Ponce, A. N., & Hunnicutt, C. (2011). Supervision in public sector behavioral health: A review. The Clinical Supervisor, 30, 183–203. Scholar
  25. Hoge, M. A., Morris, J. A., Daniels, A. S., Stuart, G. W., Huey, L. Y., & Adams, N. (2007). An action plan for behavioral health workforce development: A framework for discussion. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.Google Scholar
  26. Hoge, M. A., Wolf, J., Migdole, S., Cannata, E., & Gregory, F. X. (2016). Workforce development and mental health transformation: A state perspective. Community Mental Health Journal, 52, 323–331. Scholar
  27. Institute of Medicine. (2015). Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. Washington, DC: The National Academies Press.Google Scholar
  28. Kadushin, A., & Harkness, D. (2002). Supervision in social work (4th edn.). New York: Columbia University Press.Google Scholar
  29. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs: Prentice Hall.Google Scholar
  30. Laschober, T. C., de Tormes Eby, L. T., & Sauer, J. B. (2012). Clinical supervisor and counselor perceptions of clinical supervision in addiction treatment. Journal of Addictive Diseases, 31, 382–388. Scholar
  31. Lipsky, M. (2010). Street-level bureaucracy: Dilemmas of the individual in public services. New York: Russell Sage Foundation.Google Scholar
  32. Martino, S., Ball, S. A., Gallon, S. L., Hall, D., Garcia, M., Ceperich, S., & Hausotter, W. (2006). Motivational interviewing assessment: Supervisory tools for enhancing proficiency. Salem: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University.Google Scholar
  33. Milne, D., & Dunkerley, C. (2010). Towards evidence-based clinical supervision: The development and evaluation of four CBT guidelines. The Cognitive Behaviour Therapist, 3, 43–57. Scholar
  34. Milne, D., & Reiser, R. P. (2011). Observing competence in CBT supervision: A systematic review of the available instruments. The Cognitive Behavioral Therapist, 4, 89–100. Scholar
  35. Milne, D. L. (2009). Evidence-based clinical supervision: Principles and practice (1st edn.). Chichester: Wiley.Google Scholar
  36. Milne, D. L., & Reiser, R. P. (2017). A manual for evidence-based CBT supervision. Hoboken: Wiley.Google Scholar
  37. Mor Barak, M., Travis, D., Pyun, H., & Xie, B. (2009). The impact of supervision on social work outcomes: A meta analysis. Social Service Review, 83, 3–32. Scholar
  38. Mosley, J. E., & Smith, S. R. (2018). Human service agencies and the question of impact: Lessons for theory, policy, and practice. Human Service Organizations: Management, Leadership & Governance, 42, 113–122. Scholar
  39. National Association of Social Work & Association of Social Work Boards. (2012). Best practice standards in social work supervision. Retrieved from
  40. National Association of Social Work Insurance Trust. (2004). Supervisor beware: Reduce your risk for vicarious liability. Retrieved from
  41. New York State Education Department. (2017). LCSW license requirements. Retrieved from
  42. New York State Office of Mental Health. (2007). Assertive Community Treatment Guidelines. Retrieved from
  43. Noelle, M. (2003). Self-report in supervision. The Clinical Supervisor, 21(1), 125–134. Scholar
  44. Rapp, C. A., Etzel-Wise, D., Marty, D., Coffman, M., Carlson, L., Asher, D., & Holter, M. (2010). Barrier to evidence-based practice implementation: Results of a qualitative study. Community Mental Health Journal, 46, 112–118. Scholar
  45. Salas, E., Tannenbaum, S. I., Kraiger, K., & Smith-Jentsch, K. A. (2012). The science of training and development in organizations: What matters in practice. Psychological Science in the Public Interest, 13, 74–101. Scholar
  46. Schoenwald, S., Mehta, T., Frazier, S., & Shernoff, E. (2013). Clinical supervision in effectiveness and implementation research. Clinical Psychology: Science and Practice, 20, 44–59. Scholar
  47. Schoenwald, S., Sheidow, A., & Chapman, J. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Counseling and Clinical Psychology, 77, 410–421. Scholar
  48. Sewell, K. (2017). Theoretically grounded, evidence-informed clinical supervision for the SNAP programs: A model in development. The Clinical Supervisor, 36, 340–359. Scholar
  49. Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115. Scholar
  50. Shulman, L. (1993). Interactional supervision. Washington, D.C.: National Association of Social Workers Press.Google Scholar
  51. Stanhope, V., Tondora, J., Davidson, L., Choy-Brown, M., & Marcus, S. (2015). Person-centered care planning and service engagement – A study protocol. Trials, 16(180), 1–11.Google Scholar
  52. Substance Abuse and Mental Health Services Administration. (2012). Behavioral health, United States (HHS Publication No. [SMA] 13-4797). Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  53. Substance Abuse and Mental Health Services Administration. (2013). Report to congress on the nation’s substance abuse and mental health workforce issues. Rockville: Substance Abuse and Mental Health Services Administration.Google Scholar
  54. Supervision Competency Workforce Initiative. (2009). Enhancing supervisory skills in Connecticut’s behavioral health workforce. Retrieved from
  55. Whitaker, T., Weismiller, T., & Clark, E. (2006). Assuring the sufficiency of a frontline workforce: A national study of licensed social workers. Executive Summary. Washington, DC: National Association of Social Workers.Google Scholar
  56. Whitley, R., Gingerich, S., Lutz, W. J., & Mueser, K. T. (2009). Implementing the Illness Management and Recovery program in community mental health settings: Facilitators and barriers. Psychiatric Services, 60, 202–209. Scholar
  57. Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52, 546–553. Scholar
  58. Worthen, V. E., & Lambert, M. J. (2007). Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counsel Psychotherapy Research, 7, 48–53. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Minnesota School of Social WorkSt. PaulUSA
  2. 2.NYU Silver School of Social WorkNew YorkUSA

Personalised recommendations