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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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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 |
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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 |
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