Exploring Supervision in Practice within an Evidence-Based Intervention for Children and Families

Background/Purpose:  SNAP (Stop Now and Plan) is the emotion-regulation, self-control, and problem-solving strategy which is the foundation of two gender-specific model programs for children aged 6 to 11 with severe disruptive behaviors. With a well-established evidence-base, these programs have been selected as a social innovation being scaled up in a nationwide expansion. A proposed model of supervision has been developed to support this expansion, with an upcoming evaluation to determine if adding this enhancement increases worker competence leading to increased program adherence and fidelity. However, little is known about the current supervision in practice within these programs. Determining the profile of supervision can serve to inform broader Evidence Supported Treatment (EST) implementation efforts. 

 A cross-sectional, descriptive study is presented to provide clarity regarding the practice of supervision within the SNAP ESTs as defined by both workers and supervisors. The research questions included: 1) What are the self-reported demographic characteristics of supervisors and workers within the SNAP EST affiliate programs?; 2) What is supervision in practice in terms of modality, frequency, duration, and content within these programs?; and 3) What supervisory content is perceived to be valuable for the work of staff?  Research ethics approval was obtained.

Methods:  Non-probability, purposive sampling was utilized, targeting the population of SNAP workers (n=73) and supervisors (n= 20) within the Canadian SNAP affiliate sites.  Participants completed electronic surveys designed to elicit demographic information as well as practices related to supervision. Descriptive statistics were conducted to provide a demographic profile of the SNAP workforce, as well as supervision related to modality, frequency and content/activities, and perceived value. Bivariate analyses (i.e., independent t-tests and chi-square tests) were conducted to determine differences between groups.

Results:  The response rate for supervisors was 85.0% (n= 17), and workers was 50.7% (n= 37). Survey results speak to diverse educational backgrounds and experience of both supervisors and workers. Workers and supervisors reported that supervision is regularly occurring, and through multiple modalities. Both groups value many “best practices” for supervision, specifically those that were client and therapeutically oriented. A clinical focus was not actually occurring in supervision for half the sample, impacting supervisors’ ability to fulfill their oversight roles, as well as understanding and connecting clinical and staffing needs. The group of least reported activities relate to worker competence, an area closely tied to improved practice and effective implementation of ESTs. Over 75% of the workers report not reviewing case reports, nor discussing live supervision, nor watching video of sessions, nor reviewing client outcomes.

Conclusion/Implications: The results provide an understanding of the SNAP workforce and supervision in practice. The value of supervision is clear, whereas content and activities vary. Supervision is predominately occurring, yet there is room for enhancing the quality of supervision through a stronger focus on worker competence. This suggests additional information, supervisory tools, and training focused on “best practices” to support the knowledge and skill-base of workers. Continuing to enhance the knowledge-base about supervision in actual practice moves the field closer to being able to effectively evaluate supervision.