ACSW Conference 2008

1. ACSW Conference 2008 • MAKING THE CASE FOR • CLINICAL SOCIAL WORK • SUPERVISION • March 14, 2008 • by • Sue Ramsden, Manager, Social Work & Spiritual Care • Linda Dziuba, Coordinator, Regional Clinical Ethics Service • Marlene Clay, Clinical Consultant, Dept of Social Work

2. ACSW Conference 2008 • MAKING the CASE for • CLINICAL SOCIAL WORK • SUPERVISION: Part One • March 14, 2008 • by • Linda Dziuba, Ethics Coordinator • Regional Clinical Ethics Service

3. MAKING the CASE for CLINICAL SOCIAL WORK SUPERVISION • MORNING’S AGENDA • Identifying the Need for Clinical • Supervision • FOCUS GROUP – Group Exercise • Managing the Change Process • Practical Steps Taken • Future Directions

4. THE CONTEXT • PRIOR to SUPERVISION: • Significant changes in management • structure • Change in entire management team • 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

5. CONTEXT #2 • PRIOR to SUPERVISION: • Numerous complaints about SWKers • Discussions began re: 16 hr. coverage • Initial SWK Leadership team = • SWK Manager • SWK Assist. Manager • SWK Professional Practice Leader • for approx. 90 SWKers (15 – 20 relief)

6. CONTEXT #3 • 8. Health Professions Act • 9. Creation of PPL roles • 10. Enhanced focus on Standards of • Practice, Code of Ethics, Restricted • Activities • Interest in maximizing scope of • practice of all disciplines • Renewed interest in Interprofessional • Collaboration

7. OUTCOME of CONTEXT • Identified needs re: discipline practice • changes – development of protocols, guidelines • 2 . Resulting in needs re: individual practice • changes • Staff requests for formal clinical • consultations on the rise • Pattern of regularly scheduling clinical • consultations for individuals & groups

8. 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

9. Is CONSULTATION Enough? • COMPLEX & CHALLENGING CASES • ACUITY & VOLUME UP • = • GREATER DEMANDS on the • SOCIAL WORK ROLE

10. Is CONSULTATION Enough? • COMPLEX FUNCTIONS within the • SOCIAL WORK ROLE • COUNSELLING – CRISIS, GRIEF, ILLNESS ADJUSTMENT, NEW DX, CHRONIC ILLNESS, CAREGIVER • SUPPORT, CONFLICT RESOLUTION, RESOURCE, END of LIFE CARE, CAREER & DISABILITY PLANNING, etc. • EDUCATION – DISEASE SPECIFIC, STRESS MGMT., • LIFE SKILLS, LIFESTYLE MGMT., etc. • SYSTEM NAVIGATION & ADVOCACY

11. Is CONSULTATION Enough? • INCREASED ACCOUNTABILITY • HPA • PPLs • PROFESSIONAL PRACTICE & DEVELOPMENT • PROFESSIONAL PRACTICE COUNCIL • on a PAR with MEDICAL ADVISORY BOARD & NURSING COUNCIL • HAD BEGUN ADMINISTRATIVE SUPERVISION WITH SELECTIVE GROUPS

12. IDENTIFIED NEED forCLINICAL SUPERVISON • ROLE RECLASSIFICATION for PPL • CREATION of 3rd MANAGEMENT POSITION as SUPERVISION LEAD • ENVIRONMENTAL SCAN - • NO FORMAL HEALTHCARE SUPERVISION FOUND • LITERATURE REVIEW - • REFLECTIVE PRACTICE

13. CLINICAL SUPERVISION COMPONENTS • SUPPORT • EDUCATION • SKILL DEVELOPMENT • PERFORMANCE EVALUATION • CLINICAL SUPERVISION was designed to complement a formal ORIENTATION • PROCESS that was developed concurrently

14. ACSW Conference 2008 • MAKING the CASE for • CLINICAL SOCIAL WORK • SUPERVISION: Part Two • March 14, 2008 • by • Marlene Clay, Clinical Consultant, Social Work

15. Managing the Change Process • STEP 1 – FOCUS GROUPS • STEP 2 - PHILOSOPHY OF SUPERVISION • STEP 3 – STAFF PREPARATION • STEP 4 – STAFF SURVEYS

16. 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

17. KEY QUESTIONS TO BE EXPLORED IN FOCUS GROUPS: What has been your most valuable experience of Clinical Supervision? What was the key ingredient for you that made the supervision valuable? In planning a Clinical Supervision format, what needs to be avoided? FOCUS GROUPS cont’d

18. From your perspective, what is the distinction between Clinical and Administrative Supervision? Is there value in highlighting a role for Clinical Supervision? FOCUS GROUPS cont’d

19. 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? FOCUS GROUPS cont’d

20. 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

21. 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 Philosophy of Supervision cont’d

22. 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 about Supervision

23. 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

24. 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. Values and Beliefs cont’d

25. 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

26. 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. Supervision Guidelines cont’d

27. 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 cont’d

28. 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 Staff Preparation

29. 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 – April 2006

30. 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

31. 36% of staff felt a moderate level of comfort with their experience of clinical supervision at this point in their career Clinical Supervision Survey Analysis – August 2006 cont’d

32. 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 – June 2007

33. 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

34. 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

35. Opportunity to expand/enhance knowledge and skills Opportunity to address systemic issues Clinical Supervision Survey Analysis – November 2007 cont’d

36. ACSW Conference 2008 • Making the Case for Clinical Social Work Supervision: Part Three • March 14, 2008 • By • Sue Ramsden, Manager, • Social Work & Spiritual Care

37. 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

38. Step Four – Re-classification of PPL role Step 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

39. 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?

40. 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.) Practical Steps

41. 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?

42. 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?

43. 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?

44. 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?

45. 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 What’s Next?

46. 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

47. 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 Overall Successes

48. Questions? Making the Case for Clinical Social Work Supervision