Qualitative and Quantitative Perspectives on the Value of Supervision to Support Fidelity

Background: Research in social work and related disciplines has increased the evidence base supporting various interventions. However, evidence does not always lead to full implementation and sustainability of these interventions. Vulnerable populations can only benefit from these advances in research when interventions are implemented with fidelity. Published literature and replication studies provide minimal information on fidelity of interventions in research and practice. Moreover, individual and organizational factors that influence implementation of interventions are frequently not well described or tested as they relate to fidelity. 

Methods:The purpose of this explanatory sequential mixed study was to understand how specific supervision strategies related to fidelity of Family Connections (FC), a child maltreatment prevention intervention. The quantitative data for the study were drawn from a survey of case workers across eight community based organizations implementing FC in New York City. Survey data from 32 workers, including responses to the Implementation Leadership Scale (ILS; Aarons, Ehrhart, & Farahnak, 2014) was linked to case review fidelity scores (n = 112). A General Linear Mixed Model with bootstrapped standard errors was used to determine the association between the ILS and fidelity, controlling for worker characteristics.  Follow up individual interviews with nine workers were conducted to contextualize the quantitative results and gather additional perspectives on leadership and its relation to fidelity. 

Results: Results from the study suggest that various aspects of supervision, including supervisors’ perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of efforts to support a worker’s ability to learn and use FC. In the quantitative portion of this study, perceptions of supervisor proactiveness were positively related to fidelity scores (B = 5.58, p = .005), as well as perceptions of supervisor perseverance (B = 5.23, p = .03), whereas supervisor knowledge was negatively related to fidelity scores (B = -7.17, p= .005). In interviews with workers, workers responded to a question about what they saw as the most important factor for supporting fidelity of FC. Six of the nine case planners spoke about supervision as the most important factor. Further responses revealed supervision themes related to the positive role of supervisors in case discussions, brainstorming strategies in case consultations, providing encouragement and reinforcement of skills, knowledge of FC components, and supporting documentation and timeline adherence in cases.  

Implications: Findings from this study emphasize the importance of supervision in child maltreatment prevention, but extend the practice implications by connecting perceptions of supervision practices directly to average case planner fidelity scores. Quantitative results suggest that the more proactive and perseverant a supervisor is in supporting a case worker, the more likely the case worker is to implement FC with fidelity. Qualitative results corroborate these findings, but also suggest that the availability of a supervisor and the ongoing reinforcement of advanced skills like interpreting caregiver assessment scores and case planning development may require ongoing supervisory support. Selected limitations of the study included worker turnover, lower than anticipated response rate, and fidelity measurement restrictions.