Clinical Supervision of Mental Health Professionals Serving Youth: Format and Microskills

Original Article
  • 55 Downloads

Abstract

Clinical supervision is an element of quality assurance in routine mental health care settings serving children; however, there is limited scientific evaluation of its components. This study examines the format and microskills of routine supervision. Supervisors (n = 13) and supervisees (n = 20) reported on 100 supervision sessions, and trained coders completed observational coding on a subset of recorded sessions (n = 57). Results indicate that microskills shown to enhance supervisee competency in effectiveness trials and experiments were largely absent from routine supervision, highlighting potential missed opportunities to impart knowledge to therapists. Findings suggest areas for quality improvement within routine care settings.

Keywords

Clinical supervision Child mental health services Evidence-based practice 

Notes

Compliance with Ethical Standards

Conflict of interest

Abby Bailin, Sarah Kate Bearman, and Rafaella Sale declares that they no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Aarons, G. A., Cafri, G., Lugo, L., & Sawitzky, A. (2012). Expanding the domains of attitudes towards evidence-based practice: The evidence-based practice attitude scale-50. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 331–340.  https://doi.org/10.1007/s10488-010-0302-3.CrossRefPubMedGoogle Scholar
  2. 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(2), 88–96.  https://doi.org/10.1037/a0023537.CrossRefPubMedPubMedCentralGoogle Scholar
  3. American Psychological Association (2015). Guidelines for clinical supervision in health service psychology. The American Psychologist, 70(1), 33–46.  https://doi.org/10.1037/a0038112.CrossRefGoogle Scholar
  4. Association for Counselor Education and Supervision (2011). Best practices in clinical supervision. Retrieved from https://www.acesonline.net/resources/best-practices-clinical-supervision.
  5. Bearman, S. K., Bailin, A., & Sale, R. (2015). Supervision integrity to evidence based interventions coding system. Austin: University of Texas at Austin. Unpublished manual.Google Scholar
  6. 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.  https://doi.org/10.1007/s10488-016-0723-8.PubMedGoogle Scholar
  7. 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(6), 518–529.  https://doi.org/10.1007/s10488-013-0485-5.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bennett-Levy, J. (2006). Therapist skills: A cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34(1), 57–78.  https://doi.org/10.1017/S1352465805002420.CrossRefGoogle Scholar
  9. Bogo, M. (2015). Field education for clinical social work practice: Best practices and contemporary challenges. Clinical Social Work Journal, 43(3), 317–324.  https://doi.org/10.1007/s10615-015-0526-5.CrossRefGoogle Scholar
  10. Borntrager, C., Chorpita, B. F., Higa-McMillan, C. K., Daleiden, E. L., & Starace, N. (2013). Usual care for trauma-exposed youth: Are clinician-reported therapy techniques evidence-based? Children and Youth Services Review, 35(1), 133–141.  https://doi.org/10.1016/j.childyouth.2012.09.018.CrossRefGoogle Scholar
  11. Callahan, J. L., Almstrom, C. M., Swift, J. K., Borja, S. E., & Heath, C. J. (2009). Exploring the contribution of supervisors to intervention outcomes. Training and Education in Professional Psychology, 3(2), 72–77.  https://doi.org/10.1037/a0014294.CrossRefGoogle Scholar
  12. Carroll, K. M., & Rounsaville, B. J. (2007). A vision of the next generation of behavioral therapies research in the addictions. Addiction, 102(6), 850–862.  https://doi.org/10.1111/j.1360-0443.2007.01798.x.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Chorpita, B. F., & Weisz, J. R. (2009). Modular approach to therapy for children with anxiety, depression, trauma, or conduct problems. Satellite Beach, FL: PracticeWise, LLC.Google Scholar
  14. Cicchetti, D. V., & Sparrow, S. S. (1990). Assessment of adaptive behavior in young children. In J. J. Johnson & J. Goldman (Eds.), Developmental assessment in clinical child psychology: A handbook (pp. 173–196). New York: Pergamon Press.Google Scholar
  15. Costello, E. J., He, J., Sampson, N. A., Kessler, R. C., & Merikangas, K. R. (2014). Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey—Adolescent. Psychiatric Services, 65(3), 359–366.  https://doi.org/10.1176/appi.ps.201100518.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Davila, J., & Hajcak, G. (2012). From fractionalism to integration: Problems and possible alternatives for clinical science training. Behavior Therapist, 35, 1–4.Google Scholar
  17. Dorsey, S., Pullmann, M. D., Kerns, S. U., Jungbluth, N., Meza, R., Thompson, K., & Berliner, L. (2017). The juggling act of supervision in community mental health: Implications for supporting evidence-based treatment. Administration and Policy in Mental Health and Mental Health Services Research.  https://doi.org/10.1007/s10488-017-0796-z.Google Scholar
  18. Falender, C. A., Cornish, J. E., Goodyear, R., Hatcher, R., Kaslow, N. J., Leventhal, G., & … Grus, C. (2004). Defining competencies in psychology supervision: A consensus statement. Journal of Clinical Psychology, 60(7), 771–785.  https://doi.org/10.1002/jclp.20013.CrossRefPubMedGoogle Scholar
  19. Falender, C. A., Shafranske, E. P., & Ofek, A. (2014). Competent clinical supervision: Emerging effective practices. Counselling Psychology Quarterly, 27(4), 393–408.  https://doi.org/10.1080/09515070.2014.934785.CrossRefGoogle Scholar
  20. Garland, A. F., Accurso, E. C., Haine-Schlagel, R., Brookman-Frazee, L., Roesch, S., & Zhang, J. J. (2014). Searching for elements of evidence-based practices in children’s usual care and examining their impact. Journal of Clinical Child and Adolescent Psychology, 43(2), 201–215.  https://doi.org/10.1080/15374416.2013.869750.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., & Ganger, W. (2010). Mental health care for children with disruptive behavior problems: A view inside therapists’ offices. Psychiatric Services, 61(8), 788–795.  https://doi.org/10.1176/appi.ps.61.8.788.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., Mayberg, S., & Green, P. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124–133.  https://doi.org/10.1007/s10488-007-0152-9.CrossRefPubMedGoogle Scholar
  23. Hatcher, R. L., Wise, E. H., Grus, C. L., Mangione, L., & Emmons, L. (2012). Inside the practicum in professional psychology: A survey of practicum site coordinators. Training and Education in Professional Psychology, 6(4), 220–228.  https://doi.org/10.1037/a0029542.CrossRefGoogle Scholar
  24. 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 & Adolescent Psychology, 31(2), 155–167.  https://doi.org/10.1207/S15374424JCCP3102_02.CrossRefGoogle Scholar
  25. Hoagwood, K. E., Olin, S. S., Horwitz, S., McKay, M., Cleek, A., Gleacher, A., & … Hogan, M. (2014). Scaling up evidence-based practices for children and families in New York State: Toward evidence-based policies on implementation for state mental health systems. Journal of Clinical Child and Adolescent Psychology, 43(2), 145–157.  https://doi.org/10.1080/15374416.2013.869749.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Hogue, A., Henderson, C. E., Dauber, S., Barajas, P. C., Fried, A., & Liddle, H. A. (2008). Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 76(4), 544–555.  https://doi.org/10.1037/0022-006X.60.1.73.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Hogue, A., Liddle, H. A., & Rowe, C. (1996). Treatment adherence process research in family therapy: A rationale and some practical guidelines. Psychotherapy: Theory, Research, Practice, Training, 33(2), 332–345.  https://doi.org/10.1037/0033-3204.33.2.332.CrossRefGoogle Scholar
  28. Hurlburt, M. S., Garland, A. F., Nguyen, K., & Brookman-Frazee, L. (2010). Child and family therapy process: Concordance of therapist and observational perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 230–244.  https://doi.org/10.1007/s10488-009-0251-x.CrossRefPubMedGoogle Scholar
  29. James, I. A., Milne, D., & Morse, R. (2008). Microskills of clinical supervision: Scaffolding skills. Journal of Cognitive Psychotherapy, 22(1), 29–36.  https://doi.org/10.1891/0889.8391.22.1.29.CrossRefGoogle Scholar
  30. Jensen-Doss, A., Hawley, K. M., Lopez, M., & Osterberg, L. D. (2009). Using evidence-based treatments: The experiences of youth providers working under a mandate. Professional Psychology: Research and Practice, 40(4), 417–424.  https://doi.org/10.1037/a0014690.CrossRefGoogle Scholar
  31. Martino, S., Jr.Paris, M., Añez, L., Nich, C., Canning-Ball, M., Hunkele, K., & … Paris, M. J. (2016). The effectiveness and cost of clinical supervision for motivational interviewing: A randomized controlled trial. Journal of Substance Abuse Treatment, 68, 11–23.  https://doi.org/10.1016/j.jsat.2016.04.005.CrossRefPubMedPubMedCentralGoogle Scholar
  32. McLeod, B. D. (2001). The therapy process observational coding system for child psychotherapy. Los Angeles: University of California, Los Angeles.Google Scholar
  33. McLeod, B. D., Southam-Gerow, M. A., Tully, C. B., Rodríguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14–32.  https://doi.org/10.1111/cpsp.12020.Google Scholar
  34. McLeod, B. D., & Weisz, J. R. (2005). The therapy process observational coding system-alliance scale: Measure characteristics and prediction of outcome in usual clinical practice. Journal of Consulting and Clinical Psychology, 73(2), 323–333.  https://doi.org/10.1037/0022-006X.73.2.323.CrossRefPubMedGoogle Scholar
  35. Michael, K. D., Huelsman, T. J., & Crowley, S. L. (2005). Interventions for child and adolescent depression: Do professional therapists produce better results? Journal of Child and Family Studies, 14(2), 223–236.  https://doi.org/10.1007/s10826-005-5050-8.CrossRefGoogle Scholar
  36. Milne, D. L. (2009). Evidence-based clinical supervision: Principles and Practice. Oxford: Wiley.Google Scholar
  37. Nadeem, E., Gleacher, A., & Beidas, R. S. (2013). Consultation as an implementation strategy for evidence-based practices across multiple contexts: Unpacking the black box. Administration and Policy in Mental Health and Mental Health Services Research, 40(6), 439–450.  https://doi.org/10.1007/s10488-013-0502-8.CrossRefPubMedPubMedCentralGoogle Scholar
  38. National Association of Social Workers Association of Social Work Boards. (2013). Best practice standards in social work supervision. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=GBrLbl4BuwI%3D&portalid=0.
  39. Ng, R. M. K. (2005). Cognitive therapy supervision: A pilot study. Hong Kong Journal of Psychiatry, 15, 122–126.Google Scholar
  40. Painter, K. (2009). Legislation of evidence-based treatments in public mental health: analysis of benefits and costs. Social Work in Public Health, 24(6), 511–526.  https://doi.org/10.1080/19371910802679135.CrossRefPubMedGoogle Scholar
  41. Psychology Board of Australia. (2010). Guidelines for approved training programs in psychology supervision. Retrieved from http://www.psychologyboard.gov.au/documents/default.aspx?record=WD10%2F2888&dbid=AP&chksum=1dpuysJYbQPnpwcFZr0unw%3D%3D.
  42. Reiser, R. P., & Milne, D. L. (2013). Cognitive behavioral therapy supervision in a university-based training clinic: A case study in bridging the gap between rigor and relevance. Journal of Cognitive Psychotherapy, 27(1), 30–41.  https://doi.org/10.1891/0889-8391.27.1.30.CrossRefGoogle Scholar
  43. Roth, A. D., & Pilling, S. (2007). A competence framework for the supervision of psychological therapies. Retrieved from http://www.ucl.ac.uk/CORE/.
  44. Schoenwald, S. K., Chapman, J. E., Kelleher, K., Hoagwood, K. E., Landsverk, J., Stevens, J., & … Rolls-Reutz, J. (2008). A survey of the infrastructure for children’s mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 84–97.  https://doi.org/10.1007/s10488-007-0147-6.CrossRefPubMedGoogle Scholar
  45. Schoenwald, S. K., Mehta, T. G., Frazier, S. L., & Shernoff, E. S. (2013). Clinical supervision in effectiveness and implementation research. Clinical Psychology: Science and Practice, 20(1), 44–59.  https://doi.org/10.1111/cpsp.12022.Google Scholar
  46. 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.  https://doi.org/10.1037/a0013788.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Smith, A. M., & Jensen-Doss, A. (2017). Youth psychotherapy outcomes in usual care and predictors of outcome group membership. Psychological Services, 14(1), 66–76.  https://doi.org/10.1037/ser0000115.CrossRefPubMedGoogle Scholar
  48. Smith, M. M., McLeod, B. D., Southam-Gerow, M. A., Jensen-Doss, A., Kendall, P. C., & Weisz, J. R. (2017). Does the delivery of CBT for youth anxiety differ across research and practice settings? Behavior Therapy, 48(4), 501–516.  https://doi.org/10.1016/j.beth.2016.07.004.CrossRefPubMedGoogle Scholar
  49. Stewart, R. E., & Chambless, D. L. (2007). Does psychotherapy research inform treatment decisions in private practice? Journal of Clinical Psychology, 63(3), 267–281.  https://doi.org/10.1002/jclp.20347.CrossRefPubMedGoogle Scholar
  50. Stice, E., Butryn, M. L., Rohde, P., Shaw, H., & Marti, C. N. (2013). An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behaviour Research & Therapy, 51(12), 862–871.  https://doi.org/10.1016/j.brat.2013.10.003.CrossRefGoogle Scholar
  51. Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting & Clinical Psychology, 77(5), 825–834.  https://doi.org/10.1037/a0016132.CrossRefGoogle Scholar
  52. Watkins, C. J. (2011). Does psychotherapy supervision contribute to patient outcomes? Considering thirty years of research. The Clinical Supervisor, 30(2), 235–256.  https://doi.org/10.1080/07325223.2011.619417.CrossRefGoogle Scholar
  53. Webster-Stratton, C. H., Reid, M. J., & Marsenich, L. (2014). Improving therapist fidelity during implementation of evidence-based practices: Incredible years program. Psychiatric Services, 65(6), 789–795.  https://doi.org/10.1176/appi.ps.201200177.CrossRefPubMedGoogle Scholar
  54. Weisz, J., Bearman, S. K., Santucci, L. C., & Jensen-Doss, A. (2017). Initial test of a principle-guided approach to transdiagnostic psychotherapy with children and adolescents. Journal of Clinical Child & Adolescent Psychology, 46(1), 44–58.  https://doi.org/10.1080/15374416.2016.1163708.CrossRefGoogle Scholar
  55. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., & Gibbons, R. D. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282.  https://doi.org/10.1001/archgenpsychiatry.2011.147.CrossRefPubMedGoogle Scholar
  56. Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7(1), 54–65.  https://doi.org/10.1080/14733140601185274.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Educational PsychologyThe University of Texas at AustinAustinUSA

Personalised recommendations