Co-Creating, Implementing, and Evaluating an Evidence-Informed Supervision Framework for Practice in a Community-Based Mental Health Organization

Background: Workplace-based supervision is considered key to staff wellness, and the provision of good client care. Realizing these outcomes requires a focus on supervisory relationship development, tangible and emotional support, and ongoing professional development - referred to as clinical supervision. Noted as a trend in publicly funded mental health services, however, managerial supervision focuses on accountability and administration at the cost of investing in staff wellbeing. At a time of increased client complexity, and workforce challenges related to burnout, and turnover, fostering and supporting human resource potential toward best possible client service is critical.

The leadership of a community-based organization providing services for individuals with severe and persistent mental illness and/or substance use disorder identified the need to shift from managerial supervision to develop an evidence-informed clinical supervision framework in the provision of case management and intervention services. The objectives were to: develop a clinical supervision model and framework to guide staff in internal supervision; maximize organizational understanding of the model; train supervisors in \best practices; and evaluate the implementation, adoption, and use of the framework. We will present the process and outcomes of a four-year pragmatic utilization-focused evaluation of the supervision initiative to impact practice.

Methods: We collected quantitative and qualitative data from multiple informants (i.e., frontline staff, program managers, and directors) to iteratively support developing, adapting, and implementing the supervision model and framework. Qualitative data were collected through: (1) focus groups with leadership (k=5), frontline staff (k=3); (2) supervision competency consensus meeting using the nominal group technique (k=1); (3) supervision initiative working group meeting minutes (n=12); (4) supervision session observations (n=7). Quantitative data were collected through supervisor self-reported practice questionnaires (n=85), and repeated measures completion of the standardized Generic Supervision Assessment Tool at five time points (n=42). Qualitative audio recorded data were transcribed verbatim and analyzed with meeting minutes using NVivo and the steps of reflexive thematic analysis to identify facilitators, barriers, strengths, continuing need, and lessons learned. Quantitative data were cleaned and analyzed in SPSS using descriptive analyses, and multiple paired sample t-tests.

Results: By T2, 100% of supervisors reported providing supervision as per the model definition, with 100% providing supervision as per the model frequency and content by T4. Integrated qualitative data demonstrated the adoption of a consistent clinical supervision approach, with increased supervisory skill-level. Between T2 and T3, the largest clinical and statistically significant increase was for the goals and tasks competence subscale (M=84.6, SD=9.0) to (M= 79.8, SD=8.3), t(9) = 2.2, p < .05, which was maintained. Ongoing learning led to creating a community of practice, onboarding, mentorship, and organizational structures. Limitations relate to research in ongoing practice, impacting analyses.

Conclusion: The supervision initiative produced an organizational culture and practice of evidence-informed clinical supervision. The importance of ownership and co-creation ensured the needs of different mental health teams were met. The timeframe for adaptive organizational change required ongoing support and commitment from leadership, in addition to sustainability efforts to train new supervisors, and a forum for ongoing skill practice for all supervisors.