Who Wants Feedback? Effects of Transformational Leadership and Leader-Member Exchange on Mental Health Practitioners' Attitudes Toward Feedback

Psychometric evaluation of a pragmatic measure of clinical supervision as an implementation strategy

BACKGROUND

Valid and reliable measurement of implementation strategies is essential to advancing implementation science; however, this area lags behind the measurement of implementation outcomes and determinants. Clinical supervision is a promising and highly feasible implementation strategy in behavioral healthcare for which pragmatic measures are lacking. This research aimed to develop and psychometrically evaluate a pragmatic measure of clinical supervision conceptualized in terms of two broadly applicable, discrete clinical supervision techniques shown to improve providers' implementation of evidence-based psychosocial interventions-(1) audit and feedback and (2) active learning.

METHODS

Items were generated based on a systematic review of the literature and administered to a sample of 154 outpatient mental health clinicians serving youth and 181 community-based mental health providers serving adults. Scores were evaluated for evidence of reliability, structural validity, construct-related validity, and measurement invariance across the two samples.

RESULTS

In sample 1, confirmatory factor analysis (CFA) supported the hypothesized two-factor structure of scores on the Evidence-Based Clinical Supervision Strategies (EBCSS) scale (χ2=5.89, df=4, p=0.208; RMSEA=0.055, CFI=0.988, SRMR=0.033). In sample 2, CFA replicated the EBCSS factor structure and provided discriminant validity evidence relative to an established supervisory alliance measure (χ2=36.12, df=30, p=0.204; RMSEA=0.034; CFI=0.990; SRMR=0.031). Construct-related validity evidence was provided by theoretically concordant associations between EBCSS subscale scores and agency climate for evidence-based practice implementation in sample 1 (d= .47 and .55) as well as measures of the supervision process in sample 2. Multiple group CFA supported the configural, metric, and partial scalar invariance of scores on the EBCSS across the two samples.

CONCLUSIONS

Scores on the EBCSS provide a valid basis for inferences regarding the extent to which behavioral health providers experience audit and feedback and active learning as part of their clinical supervision in both clinic- and community-based behavioral health settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04096274 . Registered on 19 September 2019.

Transformational leaders’ approach to overcapacity: A study in correctional institutions

This research attempts to examine the effect of transformational leadership (TL) on job satisfaction (JS) and job performance (JP) mediated by leader-member exchange (LMX) at all correctional officers in West Java. The quantitative method is adopted by conducting a questionnaire survey on all officers in the West Java area, with a total of 215 respondents. The questionnaire was done through the Google Forms platform and distributed in a time-lagged method. The sample of respondents who were interviewed was obtained through a purposive sampling technique, namely taking samples with certain considerations. The data in this study was then analyzed using Structural Equation Modeling (SEM), which was assisted by the AMOS program. The findings revealed that TL has a large impact on JS, JP, and LMX, whereas LMX has a significant impact on JS and JP. This study contributes to the literature by linking TL, LMX, JS, and JP. It examines and analyzes how and why TL and LMX can affect JS and JP.

The antecedents of leader-member-exchange (LMX) relationships in African context: the influence of the supervisor’s feedback delivery-tactic

Purpose

The current paper aims to analyse the antecedents of leader–member exchange relationships (LMX) by specifically focusing on the influence of the supervisor’s feedback delivery tactic.

Design/methodology/approach

This study uses qualitative research methods with primary interviews as the main data source. Primary interviews with 40 managers from top supermarkets in Nigeria, South Africa and the UK were undertaken.

Findings

The authors found that both high-quality positive feedback and constructive criticisms produced the same feelings – more positive interpersonal relationships with their supervisors, higher levels of commitment to their organisations, higher job satisfaction and thus, high-quality LMX relationships. Where criticisms were delivered without greater interpersonal treatment, feedback was perceived as negative, and participants revealed lack of job satisfaction, lack of commitment to their organisations, poor interpersonal relationship with their supervisors, high turnover intent and thus low-quality LMX relationship.

Originality/value

To the best of the authors’ knowledge, the current paper is one of the first studies to highlight the consequences of different feedback delivery tactics on subsequent LMX quality particularly in African context. The authors specifically develop a process-based model of enhancing high-quality LMX, which shows the role of the supervisor’s feedback delivery tactic in the process. The authors also develop a process-based model that illustrates how negative/unconstructive feedback could result in a low-quality LMX. Finally, to the best of the authors’ knowledge, this paper is also one of the first to offer a comparative assessment between African and British (the UK) empirical settings and highlight some interesting dynamics concerning LMX quality and role of supervisor’s feedback delivery tactic.

"I see your punitive measure and I raise you a person-centered bar": Supervisory Strategies to Promote Adoption of Person-Centered Care

Person-centered care remains a high priority within community mental health services. Clinical supervision is an embedded resource for professional development and promotion of high quality care. This study examined supervisory strategies during the implementation of person-centered care planning (PCCP) across two northeastern US States. A criterion sample of supervisor-provider teams participated in qualitative interviews (N = 34) and direct observation from 2016 to 2017. Modified grounded theory analyses were conducted and three supervisory strategies were identified. Supervisory attunement to providers (knowing their audience), active collaborative engagement with providers (practicing together), and infusing reminders and opportunities for feedback (chipping away) were critical strategies to engage providers in adopting PCCP. These strategies changed providers' practice patterns by improving supervisors' calibration to dynamic contextual and individual needs during implementation and communicating supervisors' expectations of PCCP enactment. Workplace-based clinical supervision holds promise as a key intervention point to embed high quality care.

The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review

BACKGROUND

First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders' access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes.

METHODS

A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks.

RESULTS

Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership's positive relationship with providers' EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers' role in implementation.

CONCLUSIONS

Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation.

TRIAL REGISTRATION

This review was not registered.