Clinical Supervision: A Key Factor for Organizational Readiness for Change Among Behavioral Health Service Providers

Background and Purpose:The translation of behavioral health interventions into real world services is often undermined by organizational and provider behavior resulting in poor quality service provision. Implementation research has demonstrated that organizational readiness, which includes communication, openness to change, and stress level among providers, is a critical determinant of implementation success. During implementation efforts, organizational conditions are often in flux, which can negatively influence provider behavior. Responsive and interactive strategies are particularly important to ensure providers have access to necessary information and are open to change while minimizing their levels of stress.

Clinical supervision is one such strategy and a critical resource for organizational readiness. Frontline supervisors can calibrate providers’ learning and develop their decision-making to improve clinical practice, and ameliorate stressors that reduce practice quality. However, supervision in real world settings has been compromised by competing demands (e.g., meeting administrative requirements) and its availability in behavioral health services remains unknown. This quantitative study examined both the quantity and quality of clinical supervision among behavioral health service providers and their impact on organizational readiness to adopt a new practice.

Methods:This study recruited a sample of providers (N=273) participating in a multi-state NIMH-funded randomized controlled trial. As part of the trial, providers completed a baseline survey. For this study, organizational readiness was comprised of three constructs: communication, change and stress. Each construct was measured by a subscale of the Organizational Readiness for Change scale. Quantity of supervision was measured by hours per week and amount of time devoted to clinical practice versus administrative tasks. Quality of supervision was measured by endorsement of one of 11 “gold standard” supervision formats. Univariate analyses yielded supervision quality and quantity. Multivariate regression analyses tested the effect of supervision (quantity and quality) on organizational readiness (communication, change, and stress) holding constant providers’ years in mental health, years at organization, and caseload.

Results:Providers reported an average of 3.54 hours of supervision per week, of which 59.9% was spent on clinical practice and 41.1% on administrative tasks. Quality supervision was endorsed as available by a third of the sample (34.4%). Multivariate regression analyses indicated that hours of supervision had a positive relationship with communication (β=.25, p<.01) and change (β =.30, p<.01). Increased administrative content had a positive relationship with stress (β = .238, p<.01) and a negative relationship with communication (β =-.286, p<.01). Quality supervision had a positive relationship with communication (β =.23, p<.01) and change (β =.25, p<.01) and a negative relationship with stress (β =-.19, p<.05).

Conclusions and Implications: Findings suggest that behavioral service organizations are providing quality supervision for only a third of providers, and administrative matters consume limited time. Further, higher quality and quantity of clinical supervision enhanced organizational readiness for change. These findings contribute to understanding clinical supervision in behavioral health and its role in facilitating implementation efforts. In a policy climate in which organizations face increasing administrative burdens and diminishing resources, sacrificing clinical supervision to meet administrative demands may have negative implications for practice quality and improvement efforts.