Exploring Clinical Supervision to Support Evidence Implementation in Community-Based Child and Youth Mental Health Organizations
Creators: name: Courtney, Darren
name: Cunningham, Jessie
name: Greenblatt, Andrea
name: Sewell, Karen
name: Barwick, Melanie
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Social and Behavioral Sciences

description: Clinical supervision involves formal relationship-based education and training that is work-focused and manages, supports, develops, and evaluates clinical work1. Clinical work can include assessment, education, treatment, case management and appropriate discharge of clients in clinical settings. Research has demonstrated clinical supervision to have a significant impact on client outcomes; Bambling and colleagues found supervision to increase working alliance, symptom reduction, treatment satisfaction, and treatment completion in clients with depression2. Clinical supervision is also a critical organizational function supporting the implementation of evidence-based interventions (EBIs)3–5 by ensuring internal validity during efficacy and effectiveness trials of the EBI and sustaining new practices beyond the initial trial field6. The growing interest in leveraging supervision as an implementation strategy (7,8) has prompted a focus on clinical supervision in implementation science; a special issue of the journal The Clinical Supervisor addresses “how supervision “typically” operates and how it might “optimally” promote EBI implementation” 6, p.1. Most families and youth access mental health support from community-based organizations9, yet supervision practices within CYMH are understudied10. Further, evidence indicates that supervision within CYMH is not always delivered effectively or consistently10. As a result, we cannot guarantee that youth and families receive the best care possible. The proposed scoping review explores this issue in the context of routine practice in community-based child and youth mental health (CYMH) provider organizations. Knowing how clinical supervision typically happens can support EBI implementation efforts that often require fidelity assessment, measurement-based care, and clinical oversight5,11. Successful EBI implementation relies on structures, workflows, processes, digital systems, and people that help an organization operate efficiently. The Active Implementation Frameworks process model (AIF)3–5 describes these organizational functions as implementation drivers (see Fig 13–5). Implementation drivers are needed to develop, improve, and sustain the ability of organizations to implement innovations as intended, as well as create an enabling context for new ways of work. Three types of implementation drivers are common among successfully implemented interventions (See Fig 1, used with permission5). Drivers address competency, organization, and leadership3–5: (1) Competency drivers focus on organizational functions that support clinicians in changing their practice, including the provision of supervision (i.e., selection of staff, pre-service and in-service training, supervision, and coaching); (2) Organization drivers are the systems and processes that create an environment facilitative of successful implementation (i.e., evaluation, facilitative administration, system intervention, and decision support data systems); (3) Leadership drivers serve as a foundation for other drivers and ensure that leaders use appropriate strategies to engage staff and address barriers as they arise3–5. Competency and organization drivers with leadership activities are in service to fidelity to achieve socially significant outcomes. EBI fidelity refers to the extent to which an EBI is delivered as intended by its developers. Best practice supervision guidelines differ across mental health disciplines. Yet, all CYMH organizations ideally provide supervision to ensure accountability to their clients to achieve the best possible clinical outcomes12 and to meet accreditation standards13. Supervision is often understood as encompassing administrative and clinical components. Administrative supervision focuses on caseload management and documentation, while clinical supervision focuses on professional development, client-counsellor, and supervisor-supervisee relationships14. Effective supervision includes a supervisory contract, a strong supervisory alliance, performance evaluation, and client outcomes evaluation14. Both types of supervision are essential for routine practice and EBI implementation. Supervision is a key driver in EBI implementation15 because it improves clinicians’ delivery of EBIs through evidence-based supervision strategies, e.g., fidelity evaluation16,17. For instance, Martino and colleagues8 demonstrated that a competency-based approach to supervision for motivational interviewing (MI) increased clinicians’ adherence and competence in delivering MI in a multisite Hybrid Type 2 effectiveness-implementation randomized controlled trial. Similarly, Choy-Brown18 found supervision critical to engaging providers in adopting person-centred care planning in community mental health agencies. Supervision best practices are typically identified in the context of EBI implementation research, and it is unclear to what extent they are delivered effectively and routinely in CYMH organizations14,19. This gap may be due to unique constraints within community settings where staff training and supervision structures are very different than in academic settings10. For instance, Shriger and colleagues10 demonstrated that the more supervisees for whom community mental health supervisors were responsible, the more supervision sessions were laden with administrative content (vs. clinical content). Other evidence points to a lack of time, competing supervisor demands, supervisor-supervisee trust, and ineffective leadership and organizational support as barriers to supervision delivery. Supervision delivered by external staff and disciplines has also proven a challenge20. A preference among some mental health professionals for ad hoc, crisis-oriented supervision has also been a barrier to regularly scheduled supervision21. PREVIOUS REVIEWS We conducted preliminary searches in April-May 2023 and January 2024 to explore existing reviews in APA Psych articles, APA PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Google Scholar, and hand-searched reference lists. Initial searches yielded reviews on clinical supervision within community and non-community mental health settings, including children, youth, and adult populations. Reviews also identified work focused on clinical supervision best practices. Reviews focused on various themes including supervision definitions, standards, and training, the relationship between supervision strategies and client and provider outcomes, and a comparison of supervision guidelines across health professions. For instance, Hoge and colleagues found supervision to be ill-defined with existing standards largely shaped by accreditation criteria, professional associations, or state-specific regulations rather than an overarching framework13. The closest work to what we propose is that of Milne and colleagues22, who reviewed studies that applied rigorous research designs and manipulated supervision in some way (i.e., recording the supervisee or direct observation). Milne’s studies were from the learning disabilities field, occurred within residential settings, and were not specific to youth. The authors developed a supervision model based on their research and compared it to existing literature. Focusing specifically on supervision in EBI implementation, two reviews comprehensively synthesized what is known about best practices to date: Choy-Brown and colleagues23 identified common elements of supervision across EBI study trials and developed a taxonomy of 21 supervision practice elements. They noted the ongoing need to compare supervision elements within EBI implementation trials with those common in routine practice. Tugendrajch and colleagues24 reviewed professional supervision guidelines for psychologists, counsellors, and social workers and identified 17 common elements. No supervision element was found universally in all studies, and no studies included all elements. Surprisingly missing from the literature is a comprehensive scoping review that maps the routine clinical supervision landscape in the child and youth mental health sector and compares supervision best practices (defined below) with routine mental health care. Our review aims to understand potential misalignments between best and routine practices within community-based child and youth mental health supervision. Findings will support quality clinical care and elucidate how to optimize supervision as an essential implementation strategy.
This protocol is an addendum to the original protocol with the addition of a revised search strategy.