Piloting a Supervision Model for an Evidence-Supported Treatment: A Multiple Case Study

Background/Purpose:  Supervision of staff is considered an important social work function to support workers, theorized to enhance client outcomes.  However, empirical support has lagged behind scholarly opinion. Calls have been made for articulating models of supervision, as well as evaluating these models for their contribution to client and worker outcomes, and adherence and fidelity to evidence-supported treatments (ESTs).  Supporting a Canadian national expansion of two ESTs for children with disruptive behavior and their families (i.e., SNAP Boys and SNAP Girls), a clinical supervision (CS) model has been proposed.  Theoretically grounded and integrative, the CS model incorporates best practices, guidelines and techniques. Providing direction, the CS model operationalizes supervision through the dimensions of structure, expertise, and process; with training and tools to support the implementation. 

This paper reports on the CS model pilot.  An exploratory, qualitative, instrumental multiple case study was conducted for purposes of:  1) looking into “the black box of supervision” to understand delivery and adoption of the model; and 2) determining if the model is acceptable, applicable, and feasible for supervisors in the study sample. The main research question guiding this inquiry was: What are the experiences of SNAP supervisors in implementing a theoretically grounded, evidence-informed practice model in their clinical supervision of staff within the ESTs?

Methods:  The cases were bound by a 3-month pilot at a children’s mental health agency.  Each case represented a site with an MSW-level supervisor following the CS model with staff members, as per regular frequency. The convenience sample of three sites was purposefully selected for variation in supervisor experience. Research ethics board approval was obtained.

Multiple sources of data (i.e., Post Supervision Records, n=64; and interview transcripts, n=3) were collected to solicit feedback on sessions, and experiences adopting the model. The analyses included quantitative and qualitative description, categorical aggregation, direct interpretation, establishing patterns and assertions. Research team members analyzed the sources of data both within and across cases, allowing for methodological and researcher triangulation. An audit trail was maintained, including memos and description of the research process.

Findings:  Findings provide insight into the implementation of the CS model, understanding supervisors’ experiences, and determining acceptability and applicability.  Two supervisors demonstrated a comprehensive adoption including: supervisory contracts, theoretical discussions, and competency-skill integration. Based on real-world challenges and impacting feasibility, the third supervisor was only able to minimally adopt the model. All supervisors agreed that implementing the model of CS was acceptable and applicable. The most discussed areas were the enhanced focus and structure of sessions, contributing to program fidelity. Challenges related to adjustment and the additional time commitment. 

Conclusion/Implications:  The study supports the assertion that the proposed CS model was adopted, and deemed to be acceptable, and appropriate, while future refinements can enhance these implementation outcomes including feasibility. Implications for the ESTs, further supervision model evaluation, and practice adoption will be shared. Contributions to the field of supervision include a Canadian, agency-based perspective; articulation of a model of supervision; and experiences in adopting this model - setting the stage for evaluating supervision outcomes.