supervision across professions - home | nzccp

Supervision across professions:

Results of a survey of

Psychologists and Social Workers

practicing interprofessional

supervision in Aotearoa NZ

Fiona Howard, Liz Beddoe Department of Psychology and School of Social Work,

Counselling and Human Services

University of Auckland

NZPsS & NZCCP Joint Conference 2012

This paper:

Interprofessional Supervision (IPS) – defined

The context for IPS

Potential advantages/limitations of IPS

Results of our study

Conclusions and recommendations

Context for IPS in Aotearoa

Changes in regulatory context:

Growth of accountability culture

Health Practitioners Competency Assurance Act (HCPAA, 2003)

Recognition of impacts on worker well-being

Health and Safety in the Workplace Amendment Act (2003)

NZ Psychological Society’s Institute of Clinical Psychology and the College of Clinical Psychology.

Social Workers Registration Board and the Aotearoa NZ Assoc. of Social Workers


Growth of supervision:

More health professions engaging

Potential for resource limits within certain

professions, e.g. nurses.

Educational programmes in supervision

Diverse approaches to supervision:

Specific therapeutic programmes being taken by more diverse professional groups

Peer, group, cultural and team supervision – these are often IP in nature

Potential advantages of

IPS

Delivering expert resources to diverse

groups

Promoting collaboration and cooperation

between professions - potential to

improve teamwork (Mullarkey, 2005)

Enhanced learning that occurs between

professionals - greater understanding of

the specific contributions of different

professional groups

Potential advantages…

Promoting different perspectives, increased creativity, wider knowledge, and prevention of becoming complacent and critical thinking (Townend, 2005)

IPS participants more able to think broadly, became more familiar with the problems of colleagues, both subordinate and superior and better able to take into account alternative arguments when making professional decisions (Zorga, 2002).

More challenging as opposed to the ‘high support/low challenge’ type of peer review – greater stimulation, job satisfaction.

Potential Disadvantages

‘Turf sensitivities’

Disempowerment of supervisee

Townend, 2005:

Misunderstandings due to professional role and training differences

Absence of shared theories and language, absence of empathy for organizational issues,

Anxiety and fear of revealing weaknesses.

Limitation on potential content

Loss of autonomy/potency of professional groups

Questions of interest:

What is the nature of IPS in NZ?

Why are Psychologists and Social Workers selecting supervisors of a different profession?

For what purposes?

What are the advantages and disadvantages in doing so?

What are some of the issues and special aspects of interdisciplinary supervision needing further examination?

What would be our recommendations for IPS practice?

Method

Internet questionnaire designed (SurveyMonkey)

Distributed to 2 professions (Psychology and Social Work) via e-letters, emails and website advertising

Participants responded voluntarily as s’ee, and/ or s’ors

Results analysed for significance where relevant

Qualitative answers also examined

Our sample (S’ors and

S’ees):

81% female, 19% Male

69% European, 19% Maori, 4% Pacific,

3% Asian, 13% other

72% SW’s, 28% Psychologists

40%worked in hospitals/health settings,

28% Private practice,

28% Community NGO,

20% Govt depts/crown agencies,

2.5% Schools

Level of seniority

0 10 20 30 40 50

Academic

Manager/Prof lead

Team lead

Supervisor

Principal

Senior practitioner

Basic grade-mid range

Bar 1

Age Yrs of experience

0 20 40 60 80

Under 20

20-24

25-29

30-34

35-39

40-44

45 & over

0 10 20 30 40

<1yr

1-2yr

3-4yr

5-8yr

9-12yr

13-16yr

17-20

>20yr

Years o

f exp

erien

ce

Bar 1

More facts about sample

Type: Peer and hierarchical relationships were

just as likely in each profession (59%

Psychologists , 49% SWs in peer)

Accountability: Supervisors assumed clinical

responsibility for 35.1% of SW s’ees, but only

4.5% of Psychologist s’ees.

Adjunctive: SW s’ees more likely to have IPS

as their only form of supervision (47.8%),

compared to psychologist s’ees (36.4%)

Frequency: Majority of s’ees receive IPS once

a month (63%), 15.5% fortnightly, 6% weekly

Our sample – S’ors

50% of s’ors had 1-2 s’ees, 25% had 3-5, 14% had 6-9, 10% had 10-19 s’ees

Majority had attended courses >1day(90%)

50% no official qualification

16% had post-grad certificate or diploma

21% of s’ors assumed clinical responsibility for s’ee’s work

For what reasons did s’ees

chose IPS?

Reason S’ee S’or

Lack of appropriate s’or available

in my profession

34.3 22

Lack of available (location/region) 12.4 11.9

The s’or possesses skills &

knowledge I would like to develop

52.4 71.6

Cultural 18.1 8.3

Previous positive relationship 22.9 30.3

S’or understands work context 42.9 23.9

Primary purpose of IPS

Purpose S’ee S’or

Gen oversight of clinical competence 46.8 25

Ensuring cultural

competence/awareness

20.7 3.7

Support and personal reflection 66.7 42.6

Develop specialised skills 32.4 28.7

Advantages of IPS for s’ee S’ee S’or

Usefulness different approach 76 90

Increases my knowledge 65 78

Facilitates creative thinking 61 65

More creative outcomes 45 60

Enhances understanding other prof.

groups

44 61

Enhances own discipline skills 41 47

Helps me question my institutional

approach

34 43

Positive effect on teamwork 25 60

Advantages of IPS for s’or

Advantages %

Provided greater challenge to my

disciplinary knowledge

81

Increased learning about process of sup 72

Learning about alternative work

contexts

72

Other 22

How is IPS different?

‘…more challenging”

„I take the values of the profession into

account and think about SW values and

how/if these compliment each other”

“I have to ensure I am knowledgeable in

terms of s‟ee professional body and

requirements”

“More empowering, learning theory

models and less risk of „expert‟ problems”

Continued…

“I pace things slower, more careful about checking out interpretations…feel more in need of accurate evidence of their work (audios, videos of work)”

“Am providing more emotional support and opportunity for self reflection and venting. Am providing less by way of education and teaching of theory, models, recommended reading.”

“Over the years I‟ve been greatly helped by these various groups knowledge and experience - its been a real bonus, and I use what I‟ve learned with other consultees”

Supervision functions

Inskipp and Proctor (1993)

NORMATIVE

Professional and ethical conduct

Effective practice. Evaluation of trainees

(gate keeping)

FORMATIVE

The learning and development of supervisee

RESTORATIVE

Emotional effects of the work.

Support, stress management, well-being

RESTORATIVE



NORMATIVE



Disadvantages for s’ees

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Other Disadvantages – S’ors

“S‟ee‟s lack of models and therefore clarity in how to approach issues, resulting in a more directive sup process as opposed to collaborative learning, development and support for change”

“Sometimes needs to be technical or specialist knowledge, e.g. nursing, which I just don‟t have. Consultee ends up educating me so I can be helpful - slows things down for them”


„At times there is role confusion as the s‟ee

sees me as the same level as her manager”

„Needing to be careful not to „colonise‟ the s‟ee with a social justice way of being and a social work approach to the discussion”

“I think that what I can offer is limited by the fact that I don‟t share their discipline. I‟m less able to help with things like merit progression, interpretation of their code, advanced training in their discipline, etc…”

Under what circumstances

does IPS work effectively?

“…on senior level, when s‟ee is confident within his own profession…”

“When both are clear about purpose…and the limitations. When there are opportunities to discuss specific issues within own profession…”

“…competent s‟or, aware and respectful of difference, diversity. Comfortable with various approaches,” “…mutual respect…”



“the ability to challenge without bias”

“There is no contamination from interpersonal office politics and dynamics at times when supervision has need a place to look at those issues and re-think strategies..”

“It is good for me because I am more open with someone who is more neutral”

“When s‟or IS NOT IMMEDIATE DIRECT REPORT”

Dealing with differences in

codes of ethics? (Themes) 1. Open discussion of code of ethics including

differences and similarities (48/100 answers)

2. Not a problem experienced, primarily as respondents felt the codes of ethics were very similar or differences not significant (25/100)

3. Would refer to prof bodies, managers, other supervisors (12/100)

4. No codes of ethics or refer to organisational ‘codes of conduct’ as a code of ethics (10/100)

5. See ethical adherence as the individuals’ or organizations’ responsibility (7/100)


should you not do IPS?

1. Lack of specialist expertise and knowledge (31/93)

2= Personal qualities of the supervisee (21/93)

2= Practice outside the scope/ with unclear clinical accountability (21/93)

3= Supervisee has no other supervision (11/93)

3= Conflicts of interest/ boundaries (11/93)

4. New workers, trainees, inexperienced workers (10/93)

How does IPS influence your

interactions with clients?

Unconscious, countertransferential processes

Enhance understanding of effective strategies, adds to toolbox

Increases understanding of clients world view

More mindful of different disciplines perspectives

No difference

‘More sure of my work with Maori’

Support and management of client base

Richer in practice/value base

Steps to prepare for IPS?

0 20 40 60 80 100 120

Discuss nature of sup

Clarify limits know/skill

Discuss shared approaches

Clear acct., responsibility

Discuss power diff

Regular Evaluation

Discuss diffs approach

Discuss diff ethics

%

Limitations of study

Many different types/purposes of IPS

combined, e.g. clinical/managerial

Difficult to compare groups meaningfully

Sample size differences

Qualitative aspects of study not yet fully

analysed

Recommendations for IPS

Clarify purpose or goals of supervision. Detailed learning contract.

Clarify competencies, technical skills, knowledge, values, language and areas of mismatch

Discuss the limits of this and where else s’ee will satisfy un-matched needs

Draw up a clear contract that clearly defines parameters of supervision including who else is involved in the supervision

Plan and carry out regular evaluation of the supervision relationship especially attending to areas of no-go, discomfort, what's not being talked about…


Education about IPS, reading, attend workshop, supervision or consultation.

Familiarise self with everyday work, codes of ethics, practice standards, agency requirements and so forth

Clearly define what s’ee wants out of each topic on agenda (to avoid diffuse focus)

Specify confidentiality clearly.

Clarify process for dealing with unsafe practice, or problems in the relationship.

An agreement to develop an open honest relationship where both parties benefit

Normative, formative,

restorative balance

0

0.5

1

1.5

2

2.5

S'ees

ratings

s'ors

ratings

Rating

Normative

Formative

Restorative

Interprofessional

supervision in Aotearoa

New Zealand: Experiences

in two professions

Paper #80

Fiona Howard, Liz Beddoe and

Aqeela Mowjood Departments of Psychology and School of Social

Work, Counselling and Human Services

University of Auckland

This paper:

Interprofessional Supervision (IPS) – defined

The context for IPS

Potential advantages/limitations of IPS

Results of our study

Conclusions and recommendations


Changes in regulatory context:

Growth of accountability culture

Recognition of impacts on worker well-being

Health Practitioners Competency Assurance Act (HCPAA, 2003)

NZ Psychological Society’s Institute of Clinical Psychology and the College of Clinical Psychology.

Social Workers Registration Board and the Aotearoa NZ Assoc. of Social Workers

Health and Safety in the Workplace Amendment Act (2003)


Growth of supervision:

More health professions engaging

Potential for resource limits within certain

professions, e.g. nurses.

Educational programmes in supervision

Diverse approaches to supervision:

Specific therapeutic programmes being taken by more diverse professional groups

Peer, group, cultural and team

Potential advantages of

IPS

Delivering expert resources to diverse

groups

Promoting collaboration and cooperation

between professions - potential to

improve teamwork (Mullarkey, 2005)

Enhanced learning that occurs between

professionals - greater understanding of

the specific contributions of different

professional groups

Potential advantages…

Promoting different perspectives, increased creativity, wider knowledge, and prevention of becoming complacent and critical thinking (Townend, 2005)

IPS participants more able to think broadly, became more familiar with the problems of colleagues, both subordinate and superior and better able to take into account alternative arguments when making professional decisions (Zorga, 2002).

More challenging as opposed to the ‘high support/low challenge’ type of peer review – greater stimulation, job satisfaction.

Potential Disadvantages

‘Turf sensitivities’

Disempowerment of supervisee

Townend, 2005:

Misunderstandings due to professional role and training differences

Absence of shared theories and language, absence of empathy for organizational issues,

Anxiety and fear of revealing weaknesses.

Limitation on potential content

Loss of autonomy/potency of professional groups

Questions of interest:

Why are Psychologists and Social Workers selecting supervisors of a different profession

For what purposes?

What are the advantages and disadvantages in doing so?

What are some of the issues and special aspects of interdisciplinary supervision needing further examination?

Aims of the study:

To investigate the extent and nature of the

practice of interprofessional in the

Psychology and Social Work disciplines.

The study aimed to survey views on the

rationale for, advantages and disadvantages

of, and recommendations for optimal

practice of interprofessional supervision.

We hope the findings will inform best

practice guidelines and educational

endeavours with respect to this practice.

Method

Internet questionnaire designed (SurveyMonkey)

Distributed to 2 professions (Psychology and Social Work) via e-letters, emails and website advertising

Participants responded voluntarily as s’ee, and/ or s’ors

Results analysed for significance where relevant

Qualitative answers also examined but not as yet analysed

Our sample (S’ors and

S’ees):

81% female, 19% Male

69% European, 19% Maori, 4% Pacific,

3% Asian, 13% other

72% SW’s, 28% Psychologists

40%worked in hospitals/health settings,

28% Private practice, 28% Community

NGO, 20% Govt depts/crown agencies,

2.5% schools

Level of seniority

0 10 20 30 40 50

Academic

Manager/Prof lead

Team lead

Supervisor

Principal

Senior practitioner

Basic grade-mid range

Bar 1

Age Yrs of experience

0 20 40 60 80

Under 20

20-24

25-29

30-34

35-39

40-44

45 & over

0 10 20 30 40

<1yr

1-2yr

3-4yr

5-8yr

9-12yr

13-16yr

17-20

>20yr

Years o

f exp

erien

ce

Bar 1

More facts

Peer based and hierarchical relationships were

just as likely in each profession (59%

Psychologists and 49% SWs in peer)

Supervisors assumed clinical responsibility for

35.1% of SW s’ees, but only 4.5% of

Psychologist s’ees.

SW s’ees more likely to have IPS as their only

form of supervision (47.8%), compared to

psychologist s’ees (36.4%)

Majority of s’ees receive IPS once a month

(63%), 15.5% fortnightly, 6% weekly

Our sample – S’ors

50% of s’ors had 1-2 s’ees, 25% had 3-5, 14% had 6-9, 10% had 10-19 s’ees

Majority had attended courses >1day(90%)

50% no official qualification

16% had post-grad certificate or diploma

21% of s’ors assumed clinical responsibility for s’ee’s work

For what reasons did s’ees

chose IPS?

Reason S’ee S’or

Lack of appropriate s’or available

in my profession

34.3 22

Lack of available (location/region) 12.4 11.9

The s’or possesses skills &

knowledge I would like to develop

52.4 71.6

Cultural 18.1 8.3

Previous positive relationship 22.9 30.3

S’or understands work context 42.9 23.9

How did it come about

that you have taken up

IPS?

Requested of me (25)

Reputation (e.g. specialist skills) (25)

Interest/experience in supervision (10)

Expectation of the role (7)

Previous relationship (5)

Share work context (4)

Primary purpose of IPS

Purpose S’ee S’or

Gen oversight of clinical competence 46.8 25

Ensuring cultural

competence/awareness

20.7 3.7

Support and personal reflection 66.7 42.6

Develop specialised skills 32.4 28.7

Advantages of IPS for s’ee S’ee S’or

Usefulness different approach 76 90

Increases my knowledge 65 78

Facilitates creative thinking 61 65

More creative outcomes 45 60

Enhances understanding other prof.

groups

44 61

Enhances own discipline skills 41 47

Helps me question my institutional

approach

34 43

Positive effect on teamwork 25 60

Advantages of IPS for s’or

Advantages %

Provided greater challenge to my

disciplinary knowledge

81

Increased learning about process of sup 72

Learning about alternative work

contexts

72

Other 22

How is IPS different?

‘…more challenging”

„I take the values of the profession into

account and think about SW values and

how/if these compliment each other”

“I have to ensure I am knowledgeable in

terms of s‟ee professional body and

requirements”

“More empowering, learning theory

models and less risk of „expert‟ problems”

Continued…

“I pace things slower, more careful about checking out interpretations…feel more in need of accurate evidence of their work (audios, videos of work)”

“Am providing more emotional support and opportunity for self reflection and venting. Am providing less by way of education and teaching of theory, models, recommended reading.”

“Over the years I‟ve been greatly helped by these various groups knowledge and experience - its been a real bonus, and I use what I‟ve learned with other consultees”

Supervision functions

Inskipp and Proctor (1993)

NORMATIVE



(gate keeping)

FORMATIVE

The learning and development of supervisee

RESTORATIVE



RESTORATIVE



NORMATIVE



Normative, formative,

restorative balance

0

0.5

1

1.5

2

2.5

S'ees

ratings

s'ors

ratings

Rating

Normative

Formative

Restorative

Disadvantages for s’ees

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100R

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no

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dressed

S'e

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relu

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s'ors

S'ees


“S‟ee‟s lack of models and therefore clarity in how to approach issues, resulting in a more directive sup process as opposed to collaborative learning, development and support for change”

“Sometimes needs to be technical or specialist knowledge, e.g. nursing, which I just don‟t have. Consultee ends up educating me so I can be helpful - slows things down for them”


„At times there is role confusion as the s‟ee

sees me as the same level as her manager”

„Needing to be careful not to „colonise‟ the s‟ee with a social justice way of being and a social work approach to the discussion”

“I think that what I can offer is limited by the fact that I don‟t share their discipline. I‟m less able to help with things like merit progression, interpretation of their code, advanced training in their discipline, etc…”



“…on senior level, when s‟ee is confident within his own profession…”

“When both are clear about purpose…and the limitations. When there are opportunities to discuss specific issues within own profession…”

“…competent s‟or, aware and respectful of difference, diversity. Comfortable with various approaches,” “…mutual respect…”



“the ability to challenge without bias”

“There is no contamination from interpersonal office politics and dynamics at times when supervision has need a place to look at those issues and re-think strategies..”

“It is good for me because I am more open with someone who is more neutral”

“When s‟or IS NOT IMMEDIATE DIRECT REPORT”

Dealing with differences in

codes of ethics? (Themes) 1. Open discussion of code of ethics including

differences and similarities (48/100 answers)

2. Not a problem experienced, primarily as respondents felt the codes of ethics were very similar or differences not significant (25/100)

3. Would refer to prof bodies, managers, other supervisors (12/100)

4. No codes of ethics or refer to organisational ‘codes of conduct’ as a code of ethics (10/100)

5. See ethical adherence as the individuals’ or organizations’ responsibility (7/100)


should you not do IPS?

1. Lack of specialist expertise and knowledge (31/93)

2= Personal qualities of the supervisee (21/93)

2= Practice outside the scope/ with unclear clinical accountability (21/93)

3= Supervisee has no other supervision (11/93)

3= Conflicts of interest/ boundaries (11/93)

4. New workers, trainees, inexperienced workers (10/93)

How does IPS influence your

interactions with clients?

Unconscious, countertransferential processes

Enhance understanding of effective strategies, adds to toolbox

Increases understanding of clients world view

More mindful of different disciplines perspectives

No difference

‘More sure of my work with Maori’

Support and management of client base

Richer in practice/value base

Steps to prepare for IPS?

0 20 40 60 80 100 120

Discuss nature of sup

Clarify limits know/skill

Discuss shared approaches

Clear acct., responsibility

Discuss power diff

Regular Evaluation

Discuss diffs approach

Discuss diff ethics

%

Limitations of study

Many different types/purposes of IPS

combined, e.g. clinical/managerial

Difficult to compare groups meaningfully

Sample size differences

Qualitative aspects of study not yet fully

analysed


s’ors

Clarify purpose or goals of supervision. Detailed learning contract.

Clarify competencies, technical skills, knowledge, values, language and areas of mismatch

Discuss the limits of this and where else s’ee will satisfy un-matched needs

Draw up a clear contract that clearly defines parameters of supervision including who else is involved in the supervision

Plan and carry out regular evaluation of the supervision relationship especially attending to areas of no-go, discomfort, what's not being talked about…

Continued…

Education about IPS, reading, attend workshop, supervision or consultation.

Familiarise self with everyday work, codes of ethics, practice standards, agency requirements and so forth

Clearly define what s’ee wants out of each topic on agenda (to avoid diffuse focus)

Specify confidentiality clearly.

Clarify process for dealing with unsafe practice, or problems in the relationship.

An agreement to develop an open honest relationship where both parties benefit

supervision across professions - home | nzccp

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