Implementing a clinical supervision system

After years of training clinical supervisors, I am now often asked to provide “advanced training” for a growing cadre of trained and credentialed supervisors. When asked to do advanced training, I am at times at a loss in knowing what to suggest and am reminded of the old joke about how to get to Carnegie Hall (“practice, practice, practice”).

I am focusing my attention these days on how addiction treatment organizations can implement an effective clinical supervision system. Here are my suggested steps for improving an agency’s clinical supervision program.
1. Management needs to be clear as to the organization’s goals of supervision, differentiating between administrative and clinical supervisory tasks. Far too often these two functions are blurred and supervisors find themselves caught between their administrative and clinical supervisory roles. Management should assess the organization’s readiness for a clinical supervision system. 2. The selection of supervisors is a critical step. In most organizations, this happens by default—the most senior counselor gets assigned the job without the agency realizing that just because a person is a good counselor this does not necessarily qualify him/her to be a clinical supervisor. Management should be familiar with the competencies outlined in the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Technical Assistance Publication (TAP) 21A ( Competencies for Substance Abuse Treatment Clinical Supervisors) as well as national and state credentialing requirements.
The competency of the supervisor is critical to the successful implementation of the clinical supervision system. A supervisor’s job is complex and time-intensive and requires knowledge and skills in many areas. Management should ask several questions about potential supervisors, including:
• Has the person had formal training and is he/she credentialed in counseling and clinical supervision? • Has the person received high-quality supervision of his/her own clinical skills? • What is the person’s current relationship with staff? 3. The next step is to create a team from within the agency to implement the change, linking management, supervisors, and counseling staff to ensure internal communication and support. The team should be composed of individuals who are committed to high-quality care and supervision, are familiar with the process of supervision, and have clinical backgrounds. 4. Support from senior management is absolutely essential, both verbally and in writing, to the change team, to all levels of management, and to line staff. Senior management needs to provide a rationale to staff for clinical supervision. 5. Management and staff should have TAP 21A as well as TAP 21 ( Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice). All should identify their skills and areas needing growth. 6. Management and supervisors should hold a one-to-two hour meeting with all clinical staff to present the supervision system and how the agency will implement it. 7. Supervisors should be trained in the policies, procedures, and techniques of clinical supervision. Unfortunately, supervisors are often blamed but seldom trained. Credentialing bodies typically require at least a 30-hour class on supervision. Management needs to ensure that all supervisors receive this training before proceeding to implementation. 8. If your agency has many departments and personnel, it is often helpful to pilot the supervision system in selected units of the organization. This occurs at the discretion of management and members of the change team. 9. Individual supervision sessions with each counselor in the implementation plan will help determine their training needs. The first task of the supervisor is to establish with the counselor an individual development plan (IDP). Supervisors should allocate one to two sessions with each counselor over the first month of supervision to write the IDP. There are several examples of an IDP, including in my book Clinical Supervision in Alcohol and Drug Abuse Counseling. Rating scales provide a baseline from which to begin supervision. To start, it is helpful for the clinical supervisor to directly observe the counselor in action with a client before providing feedback and mutually establishing a baseline rating for the counselor. IDPs need to be completed by both supervisors and counselors. It is useful to have both parties sign the IDP to show mutual agreement as to the counselor’s goals and objectives for the next 3 to 12 months. 10. The supervisor and counselors should establish a plan by which all counselors will be directly observed in counseling (assuming the agency’s preferred method is direct observation). A weekly rotation schedule is written for the observation of each counselor over the first three months. If desired by all parties, it is often helpful to begin the dialogue with counselors individually, moving to the more efficient system of weekly group supervision sessions whenever practical. 11. Staff needs to understand that the new supervision is not the agency’s “flavor of the month,” so staff does not see this as something that will go away over time. Far too often, staff believes that the winds of change will blow whenever management goes away to the next seminar. Staff needs to see that supervision will be conducted on a regular basis and that the system is here to stay. 12. Staff members need to receive regular formative and summative feedback and at least quarterly reviews of their IDPs. Through the observation, the supervisor and counselor can discuss the skills and growing needs of each counselor. Learning goals are ongoing as continued observation leads to further suggestions for improving performance. 13. Documentation is critical to supervision. Various forms exist for this purpose and should include: the times of meetings and observation; a brief statement of the content of the clinical session observed; review procedures; feedback provided; and mentoring and teaching offered. 14. Incentive plans can be developed to encourage counselors to become seriously involved in their professional development. 15. Because staff members leave over time and new personnel join the team, management needs to work with the evolving team to create an atmosphere of “this is the way we do business here.” Consistency over time is critical to maintaining the supervision system. The clinical supervision model should be written into staff manuals to ensure the continuation of the supervision system.

David J. Powell, PhD, is President of the International Center for Health Concerns, Inc. His e-mail address is djpowell2@yahoo.com.