ACSW Conference 2008

MAKING THE CASE FOR CLINICAL SOCIAL WORK SUPERVISIONMarch 14, 2008

by

Sue Ramsden, Manager, Social Work & Spiritual CareLinda Dziuba, Coordinator, Regional Clinical Ethics ServiceMarlene Clay, Clinical Consultant, Dept of Social Work

ACSW Conference 2008

MAKING the CASE for CLINICAL SOCIAL WORK SUPERVISION: Part OneMarch 14, 2008

byLinda Dziuba, Ethics CoordinatorRegional Clinical Ethics Service

MAKING the CASE for CLINICAL SOCIAL WORK SUPERVISION

MORNING’S AGENDA1. Identifying the Need for Clinical

Supervision

2. FOCUS GROUP – Group Exercise

3. Managing the Change Process

4. Practical Steps Taken

5. Future Directions

THE CONTEXT

PRIOR to SUPERVISION:

1. Significant changes in management structure2. Change in entire management team3. No formal orientation process in place Hx – informal consultations with mgmt. & peers; informal mentoring

4. Majority of staff being hired had no prior experience in healthcare Social Work

CONTEXT #2

PRIOR to SUPERVISION:5. Numerous complaints about SWKers 6. Discussions began re: 16 hr. coverage7. Initial SWK Leadership team =

SWK ManagerSWK Assist. ManagerSWK Professional Practice Leader

for approx. 90 SWKers (15 – 20 relief)

CONTEXT #3

8. Health Professions Act9. Creation of PPL roles10. Enhanced focus on Standards of Practice, Code of Ethics, Restricted Activities11. Interest in maximizing scope of practice of all disciplines12. Renewed interest in Interprofessional Collaboration

OUTCOME of CONTEXT

1. Identified needs re: discipline practice

changes – development of protocols, guidelines

2 . Resulting in needs re: individual practice

changes

3. Staff requests for formal clinical

consultations on the rise

4. Pattern of regularly scheduling clinical

consultations for individuals & groups

SUPERVISION vs. CONSULTATION

CONSULTATION:- uptake and use of information is

optional- usually not used for performance evaluation

SUPERVISION:- accountability within the admin.

System- performance evaluation is a function

Is CONSULTATION Enough?

COMPLEX & CHALLENGING CASESACUITY & VOLUME UP

=

GREATER DEMANDS on the

SOCIAL WORK ROLE

Is CONSULTATION Enough?

COMPLEX FUNCTIONS within the

SOCIAL WORK ROLE1. COUNSELLING – CRISIS, GRIEF, ILLNESS

ADJUSTMENT, NEW DX, CHRONIC ILLNESS, CAREGIVER

SUPPORT, CONFLICT RESOLUTION, RESOURCE, END of LIFE CARE, CAREER & DISABILITY PLANNING, etc.

2. EDUCATION – DISEASE SPECIFIC, STRESS MGMT.,

LIFE SKILLS, LIFESTYLE MGMT., etc.

2. SYSTEM NAVIGATION & ADVOCACY

Is CONSULTATION Enough?

INCREASED ACCOUNTABILITYHPA

PPLs

PROFESSIONAL PRACTICE & DEVELOPMENT

PROFESSIONAL PRACTICE COUNCILon a PAR with MEDICAL ADVISORY BOARD & NURSING COUNCIL

HAD BEGUN ADMINISTRATIVE SUPERVISION WITH SELECTIVE GROUPS

IDENTIFIED NEED forCLINICAL SUPERVISON

1. ROLE RECLASSIFICATION for PPL

2. CREATION of 3rd MANAGEMENT POSITION as SUPERVISION LEAD

3. ENVIRONMENTAL SCAN - NO FORMAL HEALTHCARE SUPERVISION FOUND

4. LITERATURE REVIEW - REFLECTIVE PRACTICE

CLINICAL SUPERVISION COMPONENTS

• SUPPORT• EDUCATION• SKILL DEVELOPMENT• PERFORMANCE EVALUATION

CLINICAL SUPERVISION was designed to complement a formal ORIENTATION

PROCESS that was developed concurrently

ACSW Conference 2008

MAKING the CASE for

CLINICAL SOCIAL WORK

SUPERVISION: Part TwoMarch 14, 2008

byMarlene Clay, Clinical Consultant, Social Work

Managing the Change Process

STEP 1 – FOCUS GROUPS

STEP 2 - PHILOSOPHY OF SUPERVISION

STEP 3 – STAFF PREPARATION

STEP 4 – STAFF SURVEYS

FOCUS GROUPS

The purpose of the focus groups was two fold: a) to elicit input from staff on their

ideas about clinical supervision b) to assist the leadership team in finalizing the format for supervision Conducted 4 focus groups – 2 at FMC

(due to staff numbers), 1 at PLC and 1 at RGH

FOCUS GROUPS cont’d

KEY QUESTIONS TO BE EXPLORED IN FOCUS GROUPS:

1. What has been your most valuable experience of Clinical Supervision?

2. What was the key ingredient for you that made the supervision valuable?

3. In planning a Clinical Supervision format, what needs to be avoided?

FOCUS GROUPS cont’d

4. From your perspective, what is the distinction between Clinical and Administrative Supervision?

5. Is there value in highlighting a role for Clinical Supervision?

FOCUS GROUPS cont’d

6. Clinical Supervision can involve a number of components. How would you value: Individual case discussions? Group case discussions? Chart reviews? Live observation or shadowing? 7. How can Clinical Supervision assist you in continuing to reflect upon your practice and professional development needs?

PHILOSOPHY OF SUPERVISION

High value placed on the importance of the clinical relationships that Social Work staff develop in their day-to-day practice.

To support Social Work staff in their work, we have committed to providing a Clinical Supervision structure that will facilitate enhanced clinical relationships and professional development.

Philosophy of Supervision cont’d

Focus group discussions reflected staff insights, awareness and investment in helping to shape the Supervision format

Out of the content of these focus groups and leadership team discussions, emerged an evolving Philosophy of Supervision statement

Values and Beliefs about Supervision

• Effective supervision is fostered within a trusting relationship between the supervisee/s and the supervisor, as well as relationships amongst group members.

• Supervision is a continual process of self-reflection, accepting that every group member is the best they can be at any moment in time.

Values and Beliefs cont’d

• Supervision is a place for receiving encouragement, support and debriefing in dealing with challenging and traumatizing practice situations.

• The supervision process needs to recognize and support that all staff have expertise to share and that we all benefit by our shared experiences.

Values and Beliefs cont’d

• The supervision format needs to foster a mutually respectful environment that encourages positive and constructive communication.

• Effective supervision requires a strong commitment to the process by all involved parties.

Supervision Guidelines

• Start simple and add enhancements as appropriate

• Group supervision as the cornerstone, recognizing the value of peer input and collaborative learning.

• Individual supervision for junior staff

• In group supervision, case discussion format will be given priority.

Supervision Guidelines cont’d

• Periodic chart reviews will be conducted for all staff outside of the group supervision format

• In individual supervision, case discussion or direct practice observation may be used.

Staff Preparation cont’d

Initial Supervision Session: Groups discussed their own operating guidelines (respect, trust, confidentiality)

Role of the supervisor within the group

i.e. performance management issues to

be addressed outside of the group

Format of supervision (case discussion, reviewing articles, exploring themes, etc)

Staff Preparation

Handed out article ‘The Value of Supervision’ to all staff in preparation for the roll out of clinical supervision groups

Some groups reviewed the article in an initial supervision session

Discussion about Clinical Supervision at Regional Social Work meeting as well as site based meetings

Clinical Supervision Survey – April 2006

Developed a survey intended to offer a snapshot in time of Social Worker’s personal evaluation of their clinical practice.

Specific objectives were:• To determine the social worker’s perception

of their current skill level • To determine the social worker’s comfort

level with the range of interventions they use with patients and families

• To assess the social worker’s comfort level with supervision

Clinical Supervision Survey Analysis – August 2006

Out of approximately 75 surveys sent out, there were 33 surveys returned

• 44% of staff felt a moderate level of comfort with having adequate opportunity for receiving encouragement, support and de-briefing in dealing with challenging and traumatizing practice issues

• 61% of staff felt a high level of comfort with their current level of self-reflection in clinical practice

Clinical Supervision Survey Analysis – August 2006 cont’d

• 36% of staff felt a moderate level of comfort with their experience of clinical supervision at this point in their career

Clinical Supervision Survey – June 2007

Follow-up survey to gather information a year later on the overall experience with clinical supervision, i.e key benefits, areas where staff feel they gained more knowledge and skill development, and any challenges and issues for staff

Supervision primarily refers to group supervision.

Clinical Supervision Survey Analysis -November 2007

Out of approximately 80 surveys sent out to staff, 45 were returned• 76% of staff who responded found supervision

to be beneficial• 64% of staff felt they had gained more

knowledge and skills to apply in their daily practice

• 69% of staff felt they have adequate opportunity for receiving encouragement and support in dealing with complex situations through the supervision process

Clinical Supervision Survey Analysis – November 2007 cont’d

Supervision Themes• An opportunity to debrief difficult and complex

cases• Team building• Receive support• Share resources• Develop different strategies, hear other

perspectives• Appreciate support, not critique and criticism

Clinical Supervision Survey Analysis – November 2007 cont’d

• Opportunity to expand/enhance knowledge and skills

• Opportunity to address systemic issues

ACSW Conference 2008

Making the Case for Clinical Social Work Supervision: Part Three

March 14, 2008

By

Sue Ramsden, Manager, Social Work & Spiritual Care

Practical Steps

Step One – SW Leadership Team Involvement

Step Two – Philosophy of Supervision – What does this mean for us as SW leaders and what does it mean for staff?

Step Three – Discussions with Senior Administration about the importance of clinical supervision for Social Work staff

Practical Steps

Step Four – Re-classification of PPL roleStep Five – Supervision – what does this mean

in terms of time/cost to the system? Request by Senior Admin to Cost Out Supervision

Step Six – Engage Staff in Conversations about Clinical Supervision

Step Seven – Staff Preparation (focus groups, surveys, article, etc.)

Practical Steps

Step Eight – Assignment of temporary & permanent staff to supervision groups

Step Nine – Supervision of Supervision – Setting Time for this in our Leadership Team meetings

Step Ten – Ongoing Evaluation of the process – what about casual staff, how do we incorporate 7day/week or night positions?

Practical Steps

Step Eleven – Increased Accountability for SW Leaders

Step Twelve - New Issues (documentation, adjustment of supervisors to groups, being asked to supervise staff from other areas, etc.)

What’s Next?

• Documentation – what is required from the supervisor’s perspective? Do we need the patient’s name, unit #, etc?

• Consultation with Legal Services re Documentation

• Development of a Form for Supervision/Documentation

• Going with the process (hard for task focused individuals)-allowances that it is new for all and all groups are different

What’s Next?

• Identifying what does support mean to our staff?

• How does supervision fit within the performance evaluation process?

• How do we provide clinical supervision to our new casual staff? (when you’re new, you need the opportunity to discuss cases and issues, even more than when you’re a senior staff)

What’s Next?

• The challenges of providing clinical supervision to casual/relief staff (not everyone works on the same day) & to those positions that work only at night or on 7 day/week rotations

• How to ensure that new Leadership Team members have the credentials to be able to supervise (attendance at Clinical Supervision courses and registry as clinical supervisors with ACSW)?

What’s Next?

• Supervision for the Supervisors

• What is the point at which we can’t take on more staff to supervise?

• Invites the question is this the right Leadership Model for our Department?

• 7 day/week positions offer new challenges

What’s Next?

• Making the case that Department based social workers have access to clinical supervision (vs. peer consultation) which will assist them in their practice

• Staying current in the field

• Support for our Leadership Team – clinical supervision is one of many other duties

Overall Successes

• Clinical Supervision is a part of our daily work

• Case consultations have increased• Fewer complaints about staff• Staff feel better prepared to deal with

clinical issues• Recognition by Senior Management in

the CHR that this is important for Social Workers

Overall Successes

• More attention to Best Practices

• Allows themes to emerge for training – clinical issues in one area, often in another area

• Greater sense of competence amongst our staff

• Enhanced support for staff

• Higher morale

Making the Case for Clinical Social Work Supervision

Questions?