1
|
Singla DR, Fernandes L, Savel K, Shah A, Agrawal R, Bhan A, Nadkarni A, Sharma A, Khan A, Lahiri A, Tugnawat D, Lesh N, Naslund J, Patel V. Scaling up the task-sharing of psychological therapies: A formative study of the PEERS smartphone application for supervision and quality assurance in rural India. Glob Ment Health (Camb) 2024; 11:e20. [PMID: 38572256 PMCID: PMC10988170 DOI: 10.1017/gmh.2024.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/28/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024] Open
Abstract
Measurement-based peer supervision is one strategy to assure the quality of psychological treatments delivered by non-mental health specialist providers. In this formative study, we aimed to 1) describe the development and 2) examine the acceptability and feasibility of PEERS (Promoting Effective mental healthcare through peER Supervision)-a novel smartphone app that aims to facilitate registering and scheduling patients, collecting patient outcomes, rating therapy quality and assessing supervision quality-among frontline treatment providers delivering behavioral activation treatment for depression. The PEERS prototype was developed and tested in 2021, and version 1 was launched in 2022. To date, 215 treatment providers (98% female; ages 30-35) in Madhya Pradesh and Goa, India, have been trained to use PEERS and 65.58% have completed the supplemental, virtual PEERS course. Focus group discussions with 98 providers were examined according to four themes-training and education, app effectiveness, user experience and adherence and data privacy and safety. This yielded commonly endorsed facilitators (e.g., collaborative learning through group supervision, the convenience of consolidated patient data), barriers (e.g., difficulties with new technologies) and suggested changes (e.g., esthetic improvements, suicide risk assessment prompt). The PEERS app has the potential to scale measurement-based peer supervision to facilitate quality assurance of psychological treatments across contexts.
Collapse
Affiliation(s)
- Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Katarina Savel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Ravindra Agrawal
- Addictions and Related Research Group, Sangath, Goa, India
- Sangath Bhopal Hub, Bhopal, India
- Antarman Centre for Psychosocial Wellbeing, Panjim, Goa, India
- Manipal Hospital, Panaji, Goa, India
| | | | - Abhijit Nadkarni
- Addictions and Related Research Group, Sangath, Goa, India
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Awiagah SK, Dordunu R, Hukporti N, Nukunu PE, Dzando G. Barriers and Facilitators to Clinical Supervision in Ghana: A Scoping Review. SAGE Open Nurs 2024; 10:23779608241255263. [PMID: 38784649 PMCID: PMC11113047 DOI: 10.1177/23779608241255263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/26/2023] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Background Clinical supervision involves the professional relationship between an experienced and knowledgeable clinician and a less experienced clinician in which the experienced clinician provides support toward the skills development of the less experienced one. The concept, structure, and format of clinical supervision vary in various jurisdictions and is influenced by the availability of resources, the training needs of supervisees, and organizational structures. Aim The aim of this scoping review was to explore, map out and synthesize the available literature on the facilitators and barriers to clinical supervision in Ghana. Methods The methodological framework developed by Arksey and O'Malley and modified by Levac et al. for scoping reviews, and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used to ensure a coherent and transparent reporting of literature. A systematic search was conducted in PubMed, CINAHL, Scopus, Medline, and Google Scholar using key words and key terms. Articles published between January 1, 2000, and February 28, 2023, were included in the review. Results The initial search across all the databases yielded 208 results. Two independent reviewers completed both the title and abstract, and full text screenings. A third reviewer helped to resolve all discrepancies that arose during the screening process. The review included 20 articles and generated four themes: clinical supervision as a collaborative effort, feedback mechanism, training and adaptation, and challenges with implementation. Conclusion Findings from this review highlight that healthcare professionals in Ghana valued clinical supervision. However, the implementation of clinical supervision is faced with individual and systemic challenges. There is the need for on-going collaboration between educational and clinical institutions to develop modalities that promote clinical supervision in Ghana.
Collapse
Affiliation(s)
| | - Rebecca Dordunu
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana
| | - Nelson Hukporti
- The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK
| | - Promise Edem Nukunu
- Department of Allied Health Professions, King Graduate school, Monroe College, USA
| | - Gideon Dzando
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
| |
Collapse
|
3
|
Hildebrand-Burke C, Davey C, Gwini S, Catania L, Kazantzis N. Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial. Psychother Res 2024; 34:41-53. [PMID: 37963351 DOI: 10.1080/10503307.2023.2267166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients' homework completion and only rarely have considered the role of therapist competence. METHODS The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale - Revised (HRS-II); (c) pre-post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (Mage = 19.61, SD = 2.60). RESULTS Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship. CONCLUSIONS The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.
Collapse
Affiliation(s)
- Craig Hildebrand-Burke
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - StellaMay Gwini
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Lisa Catania
- University of Melbourne, Melbourne, VIC, Australia
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Melbourne, VIC, Australia
- Beck Institute for Cognitive Behavior Therapy, Philadelphia, PA, USA
| |
Collapse
|
4
|
Lakeman R, Happell B, Hurley J, Sullivan D. The Impact of an Online Post-Graduate Interdisciplinary Mental Health Programme on Graduates' Confidence and Practice. Issues Ment Health Nurs 2023:1-6. [PMID: 37418705 DOI: 10.1080/01612840.2023.2224874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
This study aimed to examine the experiences of graduates of online interdisciplinary postgraduate mental health programmes in Australia. The program was delivered in 6-week terms. Seven graduates from diverse backgrounds were interviewed about their experiences with the course and its impact on their practice, confidence, professional identity, views on mental health service users, and their motivation for additional learning. The interviews were recorded and transcribed and underwent thematic content analysis. The graduates reported an increase in confidence and knowledge after completing the course, which led to a change in their views and attitudes towards service users. They appreciated the examination of psychotherapies and motivational interviewing, and applied their newly acquired skills and knowledge in their practice. The course was found to have improved their clinical practice. This study highlights a departure from traditional pedagogical approaches in mental health skill acquisition, as the entire program was delivered online. There is a need for further research to determine who might benefit most from this mode of delivery and to verify the competencies acquired by graduates in real-world situations. Online mental health courses are a feasible option and have been positively received by graduates. To enable graduates to participate in transforming mental health services, systemic change and recognition of their capabilities, particularly those from non-traditional backgrounds, is required. The results of this study suggest the potential for online postgraduate programs to play a significant role in transforming mental health services.
Collapse
Affiliation(s)
- Richard Lakeman
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - John Hurley
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| | - Dan Sullivan
- Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
| |
Collapse
|
5
|
Christofferson ES, Anthony LG, Hutaff-Lee C, Leopold DR, Smith T, Stiles AA, Tenenbaum R, Whitney N, Glover J. A Psychology Internship Clinical Supervision Rotation: from Discomfort and Doubt to Meaning and Mastery. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023:10.1007/s40596-023-01774-w. [PMID: 37052779 DOI: 10.1007/s40596-023-01774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Affiliation(s)
| | - Laura G Anthony
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Christa Hutaff-Lee
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | | | | | | | | | | | - Jenna Glover
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
6
|
Tulleners T, Campbell C, Taylor M. The experience of nurses participating in peer group supervision: a qualitative systematic review. Nurse Educ Pract 2023; 69:103606. [PMID: 36989698 DOI: 10.1016/j.nepr.2023.103606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/16/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
AIM This systematic review will identify, appraise, and synthesise the best available qualitative studies exploring nurses' experiences of peer group supervision. The review purpose draws from the synthesised evidence recommendations to enhance policy and implementation of peer group supervision in practice. BACKGROUND Clinical Supervision is increasing in acceptance as a means of professional and best practice support in nursing. Peer group supervision is a non-hierarchical, leaderless model of clinical supervision delivery and is an option for implementation by nursing management when prioritising staff support with limited resources. This systematic review will provide a synthesis of the qualitative literature regarding the nursing peer group supervision experience. Understanding the experience of peer group supervision from those participating may provide constructive insights regarding implementation of this practice to benefit both nurse and patient driven outcomes. DESIGN Included are peer reviewed journals focused on nurses' experiences of participating in peer group supervision. Participants are registered nurses of any designation. Qualitative articles, written in English and relating to any area of nursing practice and/or speciality are included. The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement were used to guide the review. Two investigators independently screened titles, abstracts and selected full text studies describing the experience of peer group supervision. Pre-designed data extraction tools were utilised, and the review followed the Joanna Briggs Institute qualitative meta-aggregation approach with a hermeneutic interpretive analysis. RESULTS Results identified seven studies that met the inclusion criteria. A total of 52 findings that described the experiences of nursing peer group supervision are synthesised into eight categories. Four overarching synthesised findings resulted: 1. facilitating professional growth 2. trusting the group 3. professional learning experience and 4. shared experiences. Benefits such as sharing of experiences whilst receiving feedback and support were identified. Challenges identified related to group processes. CONCLUSIONS The paucity of international research into nursing peer group supervision poses challenges for nurse decision makers. Significantly, this review provides insight into the value of peer group supervision for nurses regardless of clinical context and setting. The ability to share and reflect with nursing peers enhances both personal and professional aspects of practice. The worth of the peer group supervision model varied across studies however the outcomes provided important insights into facilitating professional growth, enabling a space to share experiences and reflect, and to build teams where trust and respect develops in groups.
Collapse
|
7
|
Andreucci-Annunziata P, Mellado A, Vega-Muñoz A. Telesupervision in Psychotherapy: A Bibliometric and Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16366. [PMID: 36498438 PMCID: PMC9735903 DOI: 10.3390/ijerph192316366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/25/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: This systematic review supported by a bibliometric analysis identified quantitative and qualitative empirical studies that allowed us to respond to the objective of identifying and discussing the scope and limitations of the clinical-psychotherapeutic supervision in virtual modality or telesupervision. (2) Methods: The articles were selected according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the eligibility criteria proposed by the PICOS strategy (population, interventions, comparators, outcomes, and study design) based on 396 records of scientifically identified articles in the Journal Citation Report databases of the Web of Science. (3) Results: The literature review stages allowed the selection of three articles, which were added three others that were already included in a previous review, to enrich the analysis and discussion. The results of the present review highlighted aspects of nonverbal communication, alliance, comfort, preference, trust, and construction of professional identity, among others, both considering only the telesupervision format and comparing it with traditional face-to-face supervision. (4) Conclusions: The contributions that these results are providing to the understanding of the scope and limitations of the practice of telesupervision are discussed, also considering its interference in the construction of the professional identity of supervisors and supervisees.
Collapse
Affiliation(s)
- Paola Andreucci-Annunziata
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago 8330507, Chile
| | - Augusto Mellado
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago 8330507, Chile
| | - Alejandro Vega-Muñoz
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago 8330507, Chile
- Escuela de Doctorado, Universidad Rovira i Virgili, 43007 Tarragona, Spain
| |
Collapse
|
8
|
Patel V, Naslund JA, Wood S, Patel A, Chauvin JJ, Agrawal R, Bhan A, Joshi U, Amara M, Kohrt BA, Singla DR, G. Fairburn C. EMPOWER: Toward the Global Dissemination of Psychosocial Interventions. FOCUS 2022; 20:301-306. [PMID: 37021040 PMCID: PMC10071408 DOI: 10.1176/appi.focus.20220042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Even before the COVID-19 pandemic, the needs for care of persons with mental illness remained largely unmet worldwide, testifying to the inadequacy of current approaches to mental health care and their unsuitability for the rising demand. One hurdle to improved access to quality care is the reliance on expensive specialist providers, particularly for the delivery of psychosocial interventions. This article describes EMPOWER, a not-for-profit program that builds on the clinical science demonstrating the effectiveness of brief psychosocial interventions for a range of psychiatric conditions; implementation science demonstrating the effectiveness of delivery of these interventions by non-specialist providers (NSPs); and pedagogical science demonstrating the effectiveness of digital approaches for training and quality assurance. The EMPOWER program leverages digital tools for training and supervising NSPs, designing competency-based curricula, assessing treatment-specific competencies, implementing measurement-based peer supervision for support and quality assurance, and evaluating impacts to enhance the effectiveness of the delivery system.
Collapse
Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Sheena Wood
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anushka Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Joshua J. Chauvin
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Ravindra Agrawal
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anant Bhan
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Udita Joshi
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Margaux Amara
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Brandon A. Kohrt
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Daisy R. Singla
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Christopher G. Fairburn
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| |
Collapse
|
9
|
Beckman M, Alfonsson S, Rosendahl I, Berman AH, Lindqvist H. A Behavior-based Coding Tool for Assessing Supervisors' Adherence and Competence: Findings From a Motivational Interviewing Implementation Study. Clin Psychol Psychother 2022; 29:1942-1949. [PMID: 35727807 DOI: 10.1002/cpp.2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/11/2022]
Abstract
Supervision seems to be an essential part of therapist training, and thus also of implementing evidence-based practices. However, there is a shortage of valid and reliable instruments for objective assessment of supervision competence that include both global measures and frequency counts of behavior - two essential aspects of supervisory competence. This study tests the internal consistency and inter-rater reliability of an assessment tool that includes both these measures. Additionally, strategies and techniques used by ten supervisors in 35 Motivational interviewing supervision sessions are described. Codings were conducted after two separate coding training sessions. The internal consistency across the global measures was acceptable (α = 0.70; 0.71). After the second training, the inter-rater reliabilities for all frequency counts were in the moderate to good range, except for two that were in the poor range; inter-rater reliability for one of the four global measures was in the moderate range, and three were in the poor range. A prerequisite for identifying specific supervisor skills central to the development of therapist skills, teaching these skills to supervisors, and performing quality assurance of supervision, is to create instruments that can measure these behaviors. This study is a step in that direction.
Collapse
Affiliation(s)
- Maria Beckman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Sven Alfonsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Ingvar Rosendahl
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Anne H Berman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden.,Department of Psychology, Clinical Psychology, Uppsala University, Sweden
| | - Helena Lindqvist
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Sweden
| |
Collapse
|
10
|
Teichman Y, Berant E, Shenkman G, Ramot G. Supervisees' perspectives on the contribution of supervision to psychotherapy outcomes. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yona Teichman
- Baruch Ivcher School of Psychology Reichman University Herzliya Israel
| | - Ety Berant
- Baruch Ivcher School of Psychology Reichman University Herzliya Israel
| | - Geva Shenkman
- Baruch Ivcher School of Psychology Reichman University Herzliya Israel
| | - Guy Ramot
- Baruch Ivcher School of Psychology Reichman University Herzliya Israel
| |
Collapse
|
11
|
In Search of the Common Elements of Clinical Supervision: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:623-643. [PMID: 35129739 DOI: 10.1007/s10488-022-01188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
The importance of clinical supervision for supporting effective implementation of evidence-based treatments (EBTs) is widely accepted; however, very little is known about which supervision practice elements contribute to implementation effectiveness. This systematic review aimed to generate a taxonomy of empirically-supported supervision practice elements that have been used in treatment trials and shown to independently predict improved EBT implementation. Supervision practice elements were identified using a two-phase, empirically-validated distillation process. In Phase I, a systematic review identified supervision protocols that had evidence of effectiveness based on (a) inclusion in one or more EBT trials, and (b) independent association with improved EBT implementation in one or more secondary studies. In Phase II, a hybrid deductive-inductive coding process was applied to the supervision protocols to characterize the nature and frequency of supervision practice elements across EBTs. Twenty-one of the 876 identified articles assessed the associations of supervision protocols with implementation or clinical outcomes, representing 13 separate studies. Coding and distillation of the supervision protocols resulted in a taxonomy of 21 supervision practice elements. The most frequently used elements were: reviewing supervisees' practice (92%; n = 12), clinical suggestions (85%; n = 11), behavioral rehearsal (77%; n = 10), elicitation (77%; n = 10), and fidelity assessment (77%; n = 10). This review identified supervision practice elements that could be targets for future research testing which elements are necessary and sufficient to support effective EBT implementation. Discrepancies between supervision practice elements observed in trials as compared to routine practice highlights the importance of research addressing supervision-focused implementation strategies.
Collapse
|
12
|
Geiling A, Knaevelsrud C, Böttche M, Stammel N. Psychological distress, exhaustion, and work-related correlates among interpreters working in refugee care: results of a nationwide online survey in Germany. Eur J Psychotraumatol 2022; 13:2046954. [PMID: 35401951 PMCID: PMC8986238 DOI: 10.1080/20008198.2022.2046954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Due to language barriers, interpreters are crucial for refugee care in the countries of resettlement. However, interpreters are often faced with distressing working conditions, such as precarious work circumstances, lack of supervision, or exposure to their clients' traumatic experiences. Recent studies examining interpreters' mental health focussed primarily on secondary traumatic stress. The present study aimed to gain a better understanding of psychological distress and exhaustion among interpreters in refugee care by examining these factors in the work context as well as their possible work-related correlates. METHOD An online survey was carried out in Germany, which included several standardized questionnaires regarding distress, work- and client-related exhaustion, job satisfaction, and trauma exposure (BSI-18, CBI, JSS, HTQ, PCL-5). Interpreters were recruited primarily through psychosocial treatment centres and interpreter pools in Germany. RESULTS In total, 164 interpreters were included in the analyses. The participants showed increased psychological distress, and around 7% screened positive for posttraumatic stress disorder (PTSD). In an exploratory regression analysis, younger age (β = -.25, p = .004) emerged as correlate of psychological distress, whereas dissatisfaction with payment (β = -.21, p = .04) and a higher amount of traumatic content (β = .22, p = .001) were associated with work-related exhaustion, and dissatisfaction with recognition was associated with client-related exhaustion (β = -.35, p = .001). CONCLUSION The results point to increased stress levels among interpreters for refugees. Moreover, they indicate that interpreters' distress is primarily correlated with work-related circumstances, thus suggesting the need for a greater work-related support structure for interpreters.
Collapse
Affiliation(s)
- Angelika Geiling
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Research Department, Zentrum Überleben, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.,Research Department, Zentrum Überleben, Berlin, Germany
| | - Nadine Stammel
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
13
|
What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development. Glob Ment Health (Camb) 2022; 9:491-498. [PMID: 36618724 PMCID: PMC9807002 DOI: 10.1017/gmh.2022.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide. METHODS A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions. RESULTS Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for 'psychological/counselling' and another for 'psychiatric/mhGAP' practitioners. Each grid features 22-26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality. CONCLUSIONS Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.
Collapse
|
14
|
Tugendrajch SK, Sheerin KM, Andrews JH, Reimers R, Marriott BR, Cho E, Hawley KM. What is the evidence for supervision best practices? CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1887785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Jack H. Andrews
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
| | - Rachel Reimers
- Counseling Psychology, University of Missouri, Columbia, Missouri, USA
| | | | - Evelyn Cho
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
| | - Kristin M. Hawley
- Clinical Psychology, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
15
|
Sewell KM, Kao D, Asakura K. Clinical supervision in frontline health care: A survey of social workers in Ontario, Canada. SOCIAL WORK IN HEALTH CARE 2021; 60:282-299. [PMID: 33593244 DOI: 10.1080/00981389.2021.1880532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Researchers have documented diminishing staff supervision in health care settings, while noting the complexity and dynamic nature of health care systems. A secondary data analysis of a survey of the Ontario Association of Social Workers (N=666) explored the contemporary receipt of different types of supervision in frontline health care. Most social worker participants were involved in supervision, receiving administrative and supportive supervision. Only 52% engaged in clinical supervision, even though most spent over 50% of work time with clients with complex needs. Factors related to the receipt of clinical supervision included setting, experience, gender, and availability of clinical practice leaders.
Collapse
Affiliation(s)
- Karen M Sewell
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Kenta Asakura
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| |
Collapse
|
16
|
Watkins CE, Vîşcu LI, Cadariu IE. Psychotherapy supervision research: On roadblocks, remedies, and recommendations. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2021. [DOI: 10.1080/13642537.2021.1881139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- C. Edward Watkins
- Department of Psychology, University of North Texas, Denton, TX, USA
| | | | | |
Collapse
|
17
|
Preventing harm related to CBT supervision: a theoretical review and preliminary framework. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Like any treatment, cognitive behavioural therapy (CBT) may have negative as well as positive outcomes, and the same is true of CBT supervision. This is recognized in definitions of supervision, which prioritize helping supervisees to ‘do no harm’ to their patients. Client harm is associated with personal distress in supervisees (therapists), such as burnout, resulting in sub-standard therapy which causes harm to patients. Some supervisors have contributed to the supervisees’ distress, and consequently to patient harm. Harm may also arise from other staff members, or from situational factors that impact negatively on various aspects of the healthcare environment. At a more distal level, the host organization may create a context that allows such problems to go unchecked (e.g. a failure to train or support supervisors adequately). It follows that a large-scale framework is necessary to fully understand and address this multi-dimensional and systemic context for harm. Therefore, this theoretical review sketches out a preliminary ‘infidelity framework’ in order to classify ten types of problem behaviour that commonly contribute to harm that is linked to supervision. Drawing on related frameworks and neighbouring literatures, the infidelity framework also offers an understanding of the typical antecedents and consequences of each of these ten behaviours. This generic functional analysis leads to examples of evidence-based CBT supervision that might prevent or rectify harm.
Collapse
|
18
|
Watkins CE. What do clinical supervision research reviews tell us? Surveying the last 25 years. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
19
|
Markey K, Murphy L, O'Donnell C, Turner J, Doody O. Clinical supervision: A panacea for missed care. J Nurs Manag 2020; 28:2113-2117. [DOI: 10.1111/jonm.13001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
| | - Louise Murphy
- National University of Ireland Galway Galway Ireland
| | - Claire O'Donnell
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
| | | | - Owen Doody
- Department of Nursing and Midwifery Faculty of Education and Health Sciences University of Limerick Limerick Ireland
| |
Collapse
|