Supervisory Strategies to Promote the Delivery of Person-Centered Care in Behavioral Health Settings

Background:  Person-centered care is a central element of quality behavioral health service provision. An emerging evidence-based intervention (EBI), person-centered care planning (PCCP), has operationalized the practice changes required in behavioral health settings. However, the adoption of EBIs such as PCCP is also determined by organizational contextual factors such as leadership and opportunities for learning during supervision time. In these settings, direct supervisors have significant opportunities to influence day-to-day practice through their combined clinical and administrative oversight, but less is understood about mechanisms between those providers and their direct supervisors that improve EBI adoption.  Using the Normalization Process Theory as a sensitizing theory to examine implementation process, this study examined supervisory strategies to embed PCCP into routine practice in the context of behavioral health settings. 

Methods: This sequential mixed methods study design used quantitative data to inform criterion sampling of supervisors with maximum variation on supervisor and supervisee ratings of their implementation leadership. In-depth qualitative interviews (N = 34) with both supervisors (N = 12) and their supervisees (N = 22) and direct observation of each supervisor were conducted. Interviews were transcribed and co-coded in Atlas.ti by two researchers with supervisory experience. Interview data were triangulated with observation data to identify confirming and disconfirming evidence.  Analyses employed a modified grounded theory approach and constant comparative analyses.   Strategies for rigor were employed throughout data collection and analyses. 

Results: Three supervisory strategies to improve provider adoption were identified: knowing your audience, chipping away, and practicing together.  Critical to supervisors’ capacity to motivate staff was their ability to attune to their audience and their direct engagement with the EBP and their supervisees.  Informal availability, a positive supervisory relationship, and the infusion of consistent reminders supported the engagement and motivation of providers to adopt the new practice. Additionally, supervisors’ ability to accurately calibrate their interactions with providers to dynamic contextual and individual needs improved the credibility of the supervisor, and subsequently elevated their priorities and feedback for providers.  This aided providers’ buy-in, competency, and ongoing understanding of the required practice change. 

Conclusions and Implications: Findings contribute practice-based knowledge from a critical segment of the behavioral health workforce about how interactions between supervisors and supervisees can support practice change.  Particular supervision strategies facilitated provider engagement in the posited critical mechanisms to embed a new practice in the Normalization Process Theory such as making sense of the practice change in their work.  Targeting these supervisory activities during an implementation effort holds promise as an effective implementation strategy to build provider buy-in and adoption. In addition, findings have implications for the development of effective and pragmatic supervisory models to support quality practice.