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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. ACSW Conference 2008.

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acsw conference 2008
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
acsw conference 20081
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
making the case for clinical social work supervision
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
the context
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
context 2
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)
context 3
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
outcome of context
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
supervision vs consultation
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
Is CONSULTATION Enough?
  • COMPLEX & CHALLENGING CASES
  • ACUITY & VOLUME UP
  • =
  • GREATER DEMANDS on the
  • SOCIAL WORK ROLE
is consultation enough1
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
is consultation enough2
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
identified need for clinical supervison
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
clinical supervision components
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 20082
ACSW Conference 2008
  • MAKING the CASE for
  • CLINICAL SOCIAL WORK
  • SUPERVISION: Part Two
  • March 14, 2008
  • by
  • Marlene Clay, Clinical Consultant, Social Work
managing the change process
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
focus groups cont d
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
focus groups cont d1
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
focus groups cont d2
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
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
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

Philosophy of Supervision cont’d
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 about Supervision
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
values and beliefs cont d1
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
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
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.

Supervision Guidelines cont’d
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 cont’d
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

Staff Preparation
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 – April 2006
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
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 careerClinical Supervision Survey Analysis – August 2006 cont’d
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 – June 2007
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
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
acsw conference 20083
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
practical steps1
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
practical steps2
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 steps3
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
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?
what s next1
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?
what s next2
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?
what s next3
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?
what s next4
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?
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
overall successes1
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