Supervision
Functions of a Supervisor
You, the supervisor, wear several important “hats.” You facilitate the integration of CHW self-awareness, care team integration, and development of knowledge and skills; and you improve functional skills and professional practices. These roles often overlap and are fluid within the context of the supervisory relationship. Hence, the supervisor is in a unique position as an advocate for the agency, the CHW, and the client. You are the primary link between administration and front-line staff, interpreting and monitoring compliance with agency goals, policies, and procedures and communicating staff and client needs to administrators. Central to the supervisor’s function is the alliance between the supervisor and supervisee.
Your roles as a supervisor in the context of the supervisory relationship include:
Teacher: Assist in the development of community health knowledge and skills by identifying learning needs, determining CHW strengths, promoting self-awareness, and transmitting knowledge for practical use and professional growth. Supervisors are teachers, trainers, and professional role models.
Consultant: Bernard and Goodyear (2004) incorporate the supervisory consulting role of case consultation and review, monitoring performance, counseling the CHW regarding job performance, and assessing CHWs. In this role, supervisors also provide alternative case conceptualizations, oversight of CHW work to achieve mutually agreed upon goals, and professional gatekeeping for the organization and discipline (e.g., recognizing and addressing CHW impairment).
Coach: In this supportive role, supervisors provide morale building, assess strengths and needs, suggest varying clinical approaches, model, cheer-lead, and prevent burnout. For entry-level CHWs, the supportive function is critical.
Mentor/Role Model: The experienced supervisor mentors and teaches the supervisee through role modeling, facilitates the CHW’s overall professional development and sense of professional identity, and trains the next generation of supervisors.
Best Practices in Supportive Supervision
Supportive supervision is a type of skilled and reflective supervision. It is designed to foster supportive and collaborative problem solving between the supervisor and the supervisee. The model encourages reflection on one’s own work, acknowledges the emotional intensity of serving others, and encourages a healthy and safe climate for staff. Supportive supervision requires guidance, mentoring, and coaching of CHWs to ensure adherence with practice guidelines and delivery of quality care. Most importantly, supportive supervision calls for teamwork between the supervisor and supervisee to accomplish common goals. In the supportive supervision model, the supervisor creates a supportive environment for the CHW by helping them solve problems, working with them on skills enhancement, and always improving the quality of their daily work activities. Supportive supervision involves acknowledging and addressing the CHW’s workplace stress and concerns. It does not involve providing therapy or getting deeply involved in the personal life of the CHW.
- Establish a regular and protected time for supervision. Finding time communicates to everyone in the system that supervision is critical for our work with children and families. Protecting staff time for reflection encourages individuals to carry the lessons learned through the reflective process into their daily work.
- Share the power. Have an ongoing dialogue with your supervisees about the structure, content, process, timing, and tone of supervision. This offers an opportunity for staff to reflect on what type of supervisory relationship they would like to have and how to negotiate needs together. Ask staff to consider with you how you can work together to respond to a complex situation. This can provide your staff with an opportunity to consider different viewpoints within a system and reinforce teamwork.
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Accentuate the positives among your staff and in the work that they do. Staff need to be reassured about their knowledge and expertise. A non-“top down” approach to supervision gives staff the feeling that they are a valuable member of a team. Staff may feel encouraged to reflect on their own professional competencies and goals.
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Try to listen without judging what your staff is experiencing. How it is affecting their mood, concentration, motivation, ability to connect with others and the demands on you?. What are their emotional reactions to what they experience? Often our own agenda overshadows another’s very real human experience, preventing us from seeing the important pieces of the picture.
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Model healthy ways to manage conflict. By creating a safe and professional space where staff can talk about conflict, you help each other to understand better the roots of problems and strategize about how to address them.
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Make time for reflection inside and outside of supervision. Reflection allows us to consider our reactions, responses and options. Taking time to non-judgmentally consider how effective our response was in a past situation can help prepare us for similar situations in the future.
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Remember that you are not alone. Call on the resources available to you in your agency, community, extended network or your own supervisors. Staff will work more effectively when they have the support that they need, and so will supervisors.
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Establish healthy boundaries. Know your time and content boundaries. This is emotional work, and self-care is essential for you and your supervisee. When you become available to staff in more emotional ways, you will need to take time for yourself to rejuvenate, reflect, and make time for your own supervision and support.
Supervision Structures
Supervisors will find it most effective to use multiple formats, including individual supervision, group supervision, and case review/conference style supervision as described in the MA Department of Mental Health’s Supervision Manual. The Massachusetts Department of Public Health recommends that a full-time CHW supervisor should have no more than 7-8 supervisees if she/he is also expected to manage administrative, clinical or fiscal responsibilities. Three different supervision structures are described below.
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Individual Supervision. One-on-one supervision is essential for all staff to discuss performance, challenges, successes, and to provide support for CHWs who are working with diverse clients with varied and profound health and social barriers. CHWs should meet individually 1-2 times a month with their supervisor. Cases need to be reviewed in both individual and group supervision.
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Group Supervision. Group supervision is not an alternative to individual supervision but recommended as a supplement. Groups can be used to inform and coach on programmatic, administrative, and clinical issues. When working through specific cases and scenarios, there is a significant benefit to having peer workers in the room together for team building and mentorship of less experienced CHWs. Some programs use group supervision as a way to increase supportive supervision. For example, a mental health clinician can lead group supervision session in order to offer behavioral health specific support. This role would be an additional supervision position if the CHW supervisor does not have a background in behavioral health.
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Case Reviews/Conferences. These meetings take place with other members of the care team including medical and behavioral health clinicians. The case review model gives CHWs a chance to add to the knowledge and observations about a patient and to articulate their expertise and unique perspective.
Conducting Supervision
The underlying agreement between supervisors and supervisees includes the premise that supervisees depend on the skills and expertise of supervisors to guide them. Respect for the different roles that supervisors and supervisees play in the supervisory relationship is a key factor in successful supervision.
To maintain objectivity in supervision, it is important to:
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negotiate a supervision contract with mutually agreeable goals, responsibilities, and time frames
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provide regular feedback to supervisees on their progress toward these goals
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establish a method for resolving communication and other problems in the supervision sessions so that they can be addressed
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identify feelings supervisees have about their clients that can interfere with or limit the process of professional services.
Confidentiality: Supervisors must ensure that all client information be kept private and confidential except when disclosure is mandated by law. Supervisees should inform clients during the initial interview that their personal information is being shared in a supervisory relationship. Supervisors also have an obligation to protect and keep the supervisory process confidential and only release information as required by the regulatory board to obtain licensure or if necessary, for disciplinary purposes.
Competency: Supervisors should be competent and participate in ongoing continuing education and certification programs in supervision. Supervisors should be aware of growth and development in community and public health practice and be able to implement evidence-based practice into the supervisory process. Supervisors should also be aware of their limitations and operate within the scope of their competence. When specialty practice areas are unfamiliar, supervisors should obtain assistance or refer supervisees to an appropriate source for consultation in the desired area.
Contracting for Supervision: In situations in which an agency may not have a person with the knowledge and experience to provide supervision, a supervisee may contract for supervision services outside the agency to qualify for certification. Supervisees should contact the regulatory board in their jurisdictions in advance of contracting to confirm whether such a practice is permitted and confirm the documentation required from the supervisor. The time frame required for the supervision period should also be confirmed.
Contracting for outside supervision can be problematic and may place a supervisor at risk. If the supervisee is paying for the services, he or she can dismiss the supervisor, especially if disagreements or conflicts arise. The supervisee can also blame the supervisor if there is failure in the certification process. In addition, the supervisor may encounter case management conflicts between the supervisee and the agency. Development of a contractual agreement among the CHW, the supervisor, and the employing agency is essential in preventing problems in the supervisory relationship. The agreement should clearly delineate the agency’s authority and grant permission for the supervisor to provide clinical supervision.
Evaluation responsibilities, periodic written reports, and issues of confidentiality should also to be included in the agreement. Supervisors and supervisees should also sign a written contract that outlines the parameters of the supervisory relationship. Frequent written progress reports prepared by the supervisor should be required and, if appropriate, meet the ongoing standards established by jurisdictions and agency requirements.
Leadership and Role Model: Supervisors play a key role in the professional development of their supervisees. The actions and advice of the supervisor are keenly observed by supervisees, and consequently, influence much of the supervisee’s thinking and behavior. Teaching is an important function of the supervisor, who models the behavior the supervisee will emulate. Supervisors should create a learning environment in which supervisees learn about the internal and external environments in which they work as well as the environments in which their clients find themselves each day.
Self-Care: It is crucial for supervisors to pay attention to signs of job stress and address them with their supervisees and themselves. Supervisors should provide resources to help supervisees demonstrating symptoms of job stress and make outside referrals as necessary. Peer consultation can be helpful to supervisors and supervisees in such cases.
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Resources
Supportive Clinical Supervision: Enhancing Well-being and Reducing Burnout through Restorative Leadership
https://www.goodreads.com/book/show/55459627-supportive-clinical-supervision
Positive Supervision: MA Association of Community Health Workers
https://machw.org/employers/supervision/
Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings
An Action Guide on Community Health Workers (CHWs): Guidance for the CHW Workforce
https://nachw.org/wp-content/uploads/2020/07/NACDD/Natl41_NewEnglandCECouncil_ActionGuide_2013.pdf
Best Practices in Social Work Supervision
https://www.socialworkers.org/LinkClick.aspx?fileticket=GBrLbl4BuwI%3D&portalid=0
Top 5 Components of “Good Enough” Supervision
The Strength-Based Clinical Supervision Workbook: A Complete Guide for Mental Health Trainees and Supervisors
https://www.amazon.com/Strength-Based-Clinical-Supervision-Workbook-Supervisors-ebook/dp/B0B5VRC68Z