Supervisor Perspectives on the Appeal, Ease, and Usefulness of Evidence-Based Clinical Supervision Strategies in Community Mental Health Care

Background and Purpose:

Evidence suggests clinical supervision is a critical inflection point for leaders to shape providers’ practice behavior and ensure clients’ positive mental health outcomes. However, evidence-based clinical supervision strategies are rarely observed in community mental health care, and little is known about potentially malleable drivers of this gap. This convergent mixed methods study examined supervisors’ perspectives of the appeal, ease, and usefulness of evidence-based clinical supervision strategies.

Methods:

A purposive sample of 37 supervisors who were providing clinical supervision for providers in community mental health settings were recruited to participate in an electronic supervision rating task, followed by a 90-minute semi-structured interview on zoom. Building on a published taxonomy, each participant rated the appeal, ease, and usefulness of twenty evidence-based clinical supervision strategies using a 5-point Likert-type scale. During subsequent qualitative interviews, participants described the reasoning behind their ease, appeal, and usefulness ratings, as well as barriers and facilitators to implementation of the evidence-based clinical supervision strategies. Descriptive statistics demonstrated the extent to which each EBCSS was rated as appealing, easy, and useful. Rapid qualitative analysis yielded deep insight into supervisors’ rationales for their ratings, as well as expanded potential determinants of EBCSS use. Findings from each method were merged to inform interpretation.

Results:

Participating supervisors had worked in mental health services for an average of 11.5 years (SD=6.3) and as a supervisor for 6.6 years (SD=5.7). The majority of participants were social workers (55%), women (67.5%), and white (80%). The top three rated evidence-based clinical supervision strategies for ease, appeal, and usefulness were supportive listening, attending to the supervisory alliance, and using elicitation across all three scales. Participants viewed these strategies as ‘natural’ extensions of clinical practice as compared to the lowest rated strategies of using: fidelity assessment, teaching tools, and feedback tools. Supervisors described these latter strategies as ‘forced’ and akin to adding even more documentation to therapeutic care. Role play was rated high in usefulness and ease, but lowest in appeal, which was further confirmed and expanded in qualitative data. Supervisory use of feedback informed by supervisees’ live or recorded clinical interactions or client symptom data had low ratings of ease in part due to the reliance on infrastructure to collect the data and lack of available time beyond the billable hour to integrate their evaluation and feedback.

Conclusions and Implications:

Findings demonstrate evidence of supervisor-identified barriers to the integration of evidence-based clinical supervision strategies with demonstrated positive improvements for provider practice and client mental health outcomes. These findings can inform effective and efficient efforts to promote and integrate evidence-based public mental health care by providing key supervision foci for further intervention – either to generate supervision-focused strategies to fit within appealing strategies already in use (e.g., elicitation) or ameliorate existing barriers to integration of evidence-based clinical supervision strategies (e.g., supervisor buy-in, agency infrastructure). Further development of supervision strategies that are in alignment with community mental health practice is needed to leverage the high potential of this already embedded resource for promoting evidence-based care.