NSW Department of Health (2018). NSW Drug and Alcohol Clinical Supervision Guidelines.
1. Definition and Purpose of Clinical Supervision
This section provides a working definition of clinical supervision as it applies throughout these Guidelines. It also outlines the common benefits of clinical supervision from the perspective of organisations and staff.
1.1 What is Clinical Supervision?
Agreeing a definition is never easy, and indeed the literature offers an extensive range of definitions for the term clinical supervision. In addition, the views of workers in the field about the meaning of clinical supervision are somewhat variable. However, there are some common themes, and three key purposes for clinical supervision emerge, it is a:
- Tool for workforce development – that is, through discussion of research findings and reflection on current practice, it provides an opportunity for the development of the worker’s professional identity, skills and knowledge, and awareness of the impact of personal attitudes and issues on clients.
- Mechanism for quality assurance and clinical safety – that is, it is part of a suite of activities designed to ensure that services to clients are appropriate, safe and effective, and to identify and address any concerns or breaches in a constructive manner, in an appropriately formal but confidential setting.
- Means of providing professional support and debriefing – workers, reportedly benefit from a formal forum where they can debrief aspects of their work and gain support to manage any personal impact. This can be even more necessary in the Drug and Alcohol field where the work can be particularly complex and demanding.
There is no single definition of clinical supervision that is more correct than any other, and D& A service policies already include definitions that are considered appropriate for the local context. Nonetheless it is important to include a definition in these Guidelines in order to engender a shared sense of meaning.
For the purposes of these Guidelines, clinical supervision is defined as:
A formal and ongoing arrangement between one worker and a (generally) more experienced practitioner whereby the clinical practice of the worker is reviewed and discussed in confidence for the purposes of:
- Further developing the worker’s professional identity and clinical practice skills and knowledge
- Ensuring workers are operating within relevant clinical, organizational, ethical and professional boundaries
- Monitoring and supporting the worker’s wellbeing and coping capacity in relation to their work
1.2 Benefits of Clinical Supervision
As discussed earlier, the evidence-based knowledge about the benefits of clinical supervision is somewhat limited, and comprehensive, reliable evaluation studies have yet to be undertaken in the field. Notwithstanding these limitations, the available evidence does suggest that clinical supervision:
- Is commonly valued by managers and practitioners
- Can facilitate the acquisition of complex clinical skills
- Is associated with higher levels of job satisfaction or morale, where it is perceived to be of high quality
- Can support staff retention
There is a wealth of anecdotal knowledge and theorising in the literature and resources pertaining to clinical supervision, and findings from these, and from the consultations held within NSW commonly suggest that the following benefits are likely:
For the organisation/service:
- It contributes to workforce development
- It contributes to quality assurance and to maintaining clinical safety
- It provides a mechanism for ensuring that professional boundaries and codes of ethics are being complied with in the delivery of services to clients
- It ensures that individual workers are operating within agreed treatment modalities
- It provides a level of assurance that new or inexperienced workers are receiving appropriate support, learning and guidance in developing their role
- It provides a level of assurance that more experienced staff are being exposed to new ideas, reflecting on their current practices, and where appropriate, are being challenged and stretched in relation to their clinical practice
For the worker receiving clinical supervision:
- It provides a mechanism for support and debrief and for managing workplace stress
- It provides an opportunity for coaching and professional guidance, for enhancing skills, identifying new ways of working with clients and identifying areas of further skill development
- It provides a confidential mechanism through which they can reflect on and raise any issues related to their practice
- It can validate their work clinical skills and contribute to increasing confidence in their work with clients
- It can prevent workers operating outside appropriate boundaries with clients
- It can contribute to increased job satisfaction, reduced stress and prevention of burnout.
2. Roles and Responsibilities
This section provides guidance about the roles and responsibilities of the three key parties involved in clinical supervision – supervisors, supervisees and managers. It also outlines the responsibilities of all three in upholding the ethical and professional codes of conduct that are applicable in the clinical supervision process.
5.1 Supervisors
The common responsibilities of supervisors are to:
- Ensure they are clear about the organisational goals, the supported treatment modalities of the D&A Service, and any relevant codes of conduct or ethical standards applicable to those they are supervising. Ensure that their supervision practice is in line with all of the above.
- Ensure that supervisees are clear at the outset about the purpose of supervision, what is expected of them, and the role of the supervision, the parameters of confidentiality, and the appropriate mechanisms for addressing any difficulties or concerns about the clinical supervision practice.
- Work with supervisees to agree on goals for supervision sessions, and put in place processes for regular review of progress.
- Enter into any required formal contractual arrangements in relation to the provision of clinical supervision services, including with the organisation and with individual supervisees. Examples of contracts between services and supervisors can be found at Appendices 4 and 5.
- Facilitate a safe and trusting environment for clinical supervision sessions
- Ensure that clinical supervision have structure, and work toward achievements in all three of the purpose areas identified earlier. This will require the initiation of processes whereby the supervisee cam review and reflect on their clinical practice, identify areas of concern, explore new ways of working, identify development needs and debrief issues of concern.
- Validate good practice and provide feedback where appropriate
- Challenge practice that is inappropriate, or which does not fit with the agreed treatment modalities of the Service, and facilitate the development of sound clinical skills and ethical practice.
- Work within the agreed boundaries of confidentiality and take responsibility for reporting any serious issues to line managers, and for informing supervisees when such a circumstance arises.
- Share their own knowledge, experience and skills with supervisees.
- Take responsibility for ensuring they provide clinical supervision only within the limits of their expertise.
- Participate in any agreed monitoring or reporting mechanisms related to the provision of clinical supervision.
- Contribute to evaluation of clinical supervision programs as required by the D&A service.
- For externally contracted supervisors, where general concerns arise in relation their clinical supervision (that is, not concerns related to individual supervisees) take steps to address these issues with the appropriate manager, not with supervisees. Examples of such concerns include issues related to the agreed clinical modalities or work practices of the service, or the contractual arrangements. In the event that an external supervisor considers their own professional views are inconsistent with those of the organisation, or in the event of any conflict of interest, take appropriate steps to terminate the contract.
5.2 Supervisees
In reality, workers have a range of different values and attitudes towards the idea of clinical supervision, along the spectrum from positive to negative, often related to their professional background, or their previous experience of clinical supervision. This inevitably results in some workers being willing, responsive participants, and others being reluctant or even resistant. Notwithstanding this, participation in clinical supervision is expected of all workers in D&A services and they also have responsibilities related to this.
The common responsibilities of supervisees include:
- Negotiate arrangements for clinical supervision, in line with organisational polices or procedures, and with line management approval.
- Ensure regular attendance as agreed with the organisation, and in line with local policies
- Work with the supervisor to agree the goals of clinical supervision, and agree ways of working together.
- Undertake an appropriate level of preparation for clinical supervision sessions, for example preparation of case review material and completion of any agreed homework.
- Actively participate in all sessions.
- Take action in relation to any development needs identified through clinical supervision.
- Maintain any records related to clinical supervision sessions as set out in local policies or procedures.
- Resolve any difficulties or concerns with supervision through appropriate processes, for example in the first instance by discussing the matter with the supervisor, and if the matter remains unresolved, taking it up with the line manager and/or appropriate others within the service. In circumstances in which concerns have not been resolved through these processes, workers should refer to the applicable grievance or complaints procedure.
- Contribute to evaluation of clinical supervision programs as required by the D&A service.
- For group supervision, comply with the parameters of confidentiality that are agreed by the group.
5.3 Managers
Because clinical supervision is a formal organisational arrangement, managers play a key role in its implementation. The common responsibilities of managers include:
- Ensure staff are aware of the D&A service’s policy and procedures related to clinical supervision, and the expectations of their participation.
- Ensure that all relevant staff can access clinical supervision. This includes making any changes in the workplace required to enable staff to attend, for example rostering arrangements, making transport available, establishing group supervision arrangements, making meeting rooms available etc.
- Where an external supervision model is in operation, recruit and arrange contracts with appropriate clinical supervisors and ensure attention to key issues such as insurance requirements and criminal record checks. Where internal supervision models operate, ensure compliance with any formal agreements.
- Ensure clinical supervisors are appropriately briefed. This will be particularly important for external supervisors to ensure they are oriented to the requirements of the D&A service, including the supported treatment modalities and any relevant codes of ethics or conduct. It may also be helpful for supervisors to be informed about any related policies and procedures, for example in relation to managing suicide risk, violent or intoxicated clients, guidelines for home visiting etc. Managers need to also keep supervisors informed of any changes in policies or treatment practices in a timely manner.
- Where an internal supervision model is in operation, ensure that staff are made aware of the processes for engaging a supervisor and undertake any necessary approval processes as prescribed in local policies/procedures.
- Take reasonable steps to ensure that workers have an element of choice in selection of a clinical supervisor.
- Comply with any organisational reporting requirements in relation to clinical supervision, for example reporting attendance numbers and frequency, and associated costs and resources.
- Participate in and/or take responsibility for regular review and evaluation of clinical supervision programs.
- Take reasonable steps to resolve any concerns raised by supervisees in relation to their clinical supervision.
