Cargando…

Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health

BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for org...

Descripción completa

Detalles Bibliográficos
Autores principales: Dorsey, Shannon, Kerns, Suzanne E. U., Lucid, Leah, Pullmann, Michael D., Harrison, Julie P., Berliner, Lucy, Thompson, Kelly, Deblinger, Esther
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784597/
https://www.ncbi.nlm.nih.gov/pubmed/29368656
http://dx.doi.org/10.1186/s13012-017-0708-3
_version_ 1783295476889550848
author Dorsey, Shannon
Kerns, Suzanne E. U.
Lucid, Leah
Pullmann, Michael D.
Harrison, Julie P.
Berliner, Lucy
Thompson, Kelly
Deblinger, Esther
author_facet Dorsey, Shannon
Kerns, Suzanne E. U.
Lucid, Leah
Pullmann, Michael D.
Harrison, Julie P.
Berliner, Lucy
Thompson, Kelly
Deblinger, Esther
author_sort Dorsey, Shannon
collection PubMed
description BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials. METHODS: Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels. RESULTS: Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level. CONCLUSIONS: Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness. TRIAL REGISTRATION: NCT01800266, Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results]) ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-017-0708-3) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5784597
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-57845972018-02-07 Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health Dorsey, Shannon Kerns, Suzanne E. U. Lucid, Leah Pullmann, Michael D. Harrison, Julie P. Berliner, Lucy Thompson, Kelly Deblinger, Esther Implement Sci Research BACKGROUND: Workplace-based clinical supervision as an implementation strategy to support evidence-based treatment (EBT) in public mental health has received limited research attention. A commonly provided infrastructure support, it may offer a relatively cost-neutral implementation strategy for organizations. However, research has not objectively examined workplace-based supervision of EBT and specifically how it might differ from EBT supervision provided in efficacy and effectiveness trials. METHODS: Data come from a descriptive study of supervision in the context of a state-funded EBT implementation effort. Verbal interactions from audio recordings of 438 supervision sessions between 28 supervisors and 70 clinicians from 17 public mental health organizations (in 23 offices) were objectively coded for presence and intensity coverage of 29 supervision strategies (16 content and 13 technique items), duration, and temporal focus. Random effects mixed models estimated proportion of variance in content and techniques attributable to the supervisor and clinician levels. RESULTS: Interrater reliability among coders was excellent. EBT cases averaged 12.4 min of supervision per session. Intensity of coverage for EBT content varied, with some discussed frequently at medium or high intensity (exposure) and others infrequently discussed or discussed only at low intensity (behavior management; assigning/reviewing client homework). Other than fidelity assessment, supervision techniques common in treatment trials (e.g., reviewing actual practice, behavioral rehearsal) were used rarely or primarily at low intensity. In general, EBT content clustered more at the clinician level; different techniques clustered at either the clinician or supervisor level. CONCLUSIONS: Workplace-based clinical supervision may be a feasible implementation strategy for supporting EBT implementation, yet it differs from supervision in treatment trials. Time allotted per case is limited, compressing time for EBT coverage. Techniques that involve observation of clinician skills are rarely used. Workplace-based supervision content appears to be tailored to individual clinicians and driven to some degree by the individual supervisor. Our findings point to areas for intervention to enhance the potential of workplace-based supervision for implementation effectiveness. TRIAL REGISTRATION: NCT01800266, Clinical Trials, Retrospectively Registered (for this descriptive study; registration prior to any intervention [part of phase II RCT, this manuscript is only phase I descriptive results]) ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13012-017-0708-3) contains supplementary material, which is available to authorized users. BioMed Central 2018-01-24 /pmc/articles/PMC5784597/ /pubmed/29368656 http://dx.doi.org/10.1186/s13012-017-0708-3 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Dorsey, Shannon
Kerns, Suzanne E. U.
Lucid, Leah
Pullmann, Michael D.
Harrison, Julie P.
Berliner, Lucy
Thompson, Kelly
Deblinger, Esther
Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title_full Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title_fullStr Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title_full_unstemmed Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title_short Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health
title_sort objective coding of content and techniques in workplace-based supervision of an ebt in public mental health
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784597/
https://www.ncbi.nlm.nih.gov/pubmed/29368656
http://dx.doi.org/10.1186/s13012-017-0708-3
work_keys_str_mv AT dorseyshannon objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT kernssuzanneeu objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT lucidleah objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT pullmannmichaeld objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT harrisonjuliep objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT berlinerlucy objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT thompsonkelly objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth
AT deblingeresther objectivecodingofcontentandtechniquesinworkplacebasedsupervisionofanebtinpublicmentalhealth