Supervision across professions:
Results of a survey of
Psychologists and Social Workers
practicing interprofessional
supervision in Aotearoa NZ
Fiona Howard, Liz Beddoe Department of Psychology and School of Social Work,
Counselling and Human Services
University of Auckland
NZPsS & NZCCP Joint Conference 2012
This paper:
Interprofessional Supervision (IPS) – defined
The context for IPS
Potential advantages/limitations of IPS
Results of our study
Conclusions and recommendations
Context for IPS in Aotearoa
Changes in regulatory context:
Growth of accountability culture
Health Practitioners Competency Assurance Act (HCPAA, 2003)
Recognition of impacts on worker well-being
Health and Safety in the Workplace Amendment Act (2003)
NZ Psychological Society’s Institute of Clinical Psychology and the College of Clinical Psychology.
Social Workers Registration Board and the Aotearoa NZ Assoc. of Social Workers
Context for IPS in Aotearoa
Growth of supervision:
More health professions engaging
Potential for resource limits within certain
professions, e.g. nurses.
Educational programmes in supervision
Diverse approaches to supervision:
Specific therapeutic programmes being taken by more diverse professional groups
Peer, group, cultural and team supervision – these are often IP in nature
Potential advantages of
IPS
Delivering expert resources to diverse
groups
Promoting collaboration and cooperation
between professions - potential to
improve teamwork (Mullarkey, 2005)
Enhanced learning that occurs between
professionals - greater understanding of
the specific contributions of different
professional groups
Potential advantages…
Promoting different perspectives, increased creativity, wider knowledge, and prevention of becoming complacent and critical thinking (Townend, 2005)
IPS participants more able to think broadly, became more familiar with the problems of colleagues, both subordinate and superior and better able to take into account alternative arguments when making professional decisions (Zorga, 2002).
More challenging as opposed to the ‘high support/low challenge’ type of peer review – greater stimulation, job satisfaction.
Potential Disadvantages
‘Turf sensitivities’
Disempowerment of supervisee
Townend, 2005:
Misunderstandings due to professional role and training differences
Absence of shared theories and language, absence of empathy for organizational issues,
Anxiety and fear of revealing weaknesses.
Limitation on potential content
Loss of autonomy/potency of professional groups
Questions of interest:
What is the nature of IPS in NZ?
Why are Psychologists and Social Workers selecting supervisors of a different profession?
For what purposes?
What are the advantages and disadvantages in doing so?
What are some of the issues and special aspects of interdisciplinary supervision needing further examination?
What would be our recommendations for IPS practice?
Method
Internet questionnaire designed (SurveyMonkey)
Distributed to 2 professions (Psychology and Social Work) via e-letters, emails and website advertising
Participants responded voluntarily as s’ee, and/ or s’ors
Results analysed for significance where relevant
Qualitative answers also examined
Our sample (S’ors and
S’ees):
81% female, 19% Male
69% European, 19% Maori, 4% Pacific,
3% Asian, 13% other
72% SW’s, 28% Psychologists
40%worked in hospitals/health settings,
28% Private practice,
28% Community NGO,
20% Govt depts/crown agencies,
2.5% Schools
Level of seniority
0 10 20 30 40 50
Academic
Manager/Prof lead
Team lead
Supervisor
Principal
Senior practitioner
Basic grade-mid range
Bar 1
Age Yrs of experience
0 20 40 60 80
Under 20
20-24
25-29
30-34
35-39
40-44
45 & over
0 10 20 30 40
<1yr
1-2yr
3-4yr
5-8yr
9-12yr
13-16yr
17-20
>20yr
Years o
f exp
erien
ce
Bar 1
More facts about sample
Type: Peer and hierarchical relationships were
just as likely in each profession (59%
Psychologists , 49% SWs in peer)
Accountability: Supervisors assumed clinical
responsibility for 35.1% of SW s’ees, but only
4.5% of Psychologist s’ees.
Adjunctive: SW s’ees more likely to have IPS
as their only form of supervision (47.8%),
compared to psychologist s’ees (36.4%)
Frequency: Majority of s’ees receive IPS once
a month (63%), 15.5% fortnightly, 6% weekly
Our sample – S’ors
50% of s’ors had 1-2 s’ees, 25% had 3-5, 14% had 6-9, 10% had 10-19 s’ees
Majority had attended courses >1day(90%)
50% no official qualification
16% had post-grad certificate or diploma
21% of s’ors assumed clinical responsibility for s’ee’s work
For what reasons did s’ees
chose IPS?
Reason S’ee S’or
Lack of appropriate s’or available
in my profession
34.3 22
Lack of available (location/region) 12.4 11.9
The s’or possesses skills &
knowledge I would like to develop
52.4 71.6
Cultural 18.1 8.3
Previous positive relationship 22.9 30.3
S’or understands work context 42.9 23.9
Primary purpose of IPS
Purpose S’ee S’or
Gen oversight of clinical competence 46.8 25
Ensuring cultural
competence/awareness
20.7 3.7
Support and personal reflection 66.7 42.6
Develop specialised skills 32.4 28.7
Advantages of IPS for s’ee S’ee S’or
Usefulness different approach 76 90
Increases my knowledge 65 78
Facilitates creative thinking 61 65
More creative outcomes 45 60
Enhances understanding other prof.
groups
44 61
Enhances own discipline skills 41 47
Helps me question my institutional
approach
34 43
Positive effect on teamwork 25 60
Advantages of IPS for s’or
Advantages %
Provided greater challenge to my
disciplinary knowledge
81
Increased learning about process of sup 72
Learning about alternative work
contexts
72
Other 22
How is IPS different?
‘…more challenging”
„I take the values of the profession into
account and think about SW values and
how/if these compliment each other”
“I have to ensure I am knowledgeable in
terms of s‟ee professional body and
requirements”
“More empowering, learning theory
models and less risk of „expert‟ problems”
Continued…
“I pace things slower, more careful about checking out interpretations…feel more in need of accurate evidence of their work (audios, videos of work)”
“Am providing more emotional support and opportunity for self reflection and venting. Am providing less by way of education and teaching of theory, models, recommended reading.”
“Over the years I‟ve been greatly helped by these various groups knowledge and experience - its been a real bonus, and I use what I‟ve learned with other consultees”
Supervision functions
Inskipp and Proctor (1993)
NORMATIVE
Professional and ethical conduct
Effective practice. Evaluation of trainees
(gate keeping)
FORMATIVE
The learning and development of supervisee
RESTORATIVE
Emotional effects of the work.
Support, stress management, well-being
RESTORATIVE
Emotional effects of the work.
Support, stress management, well-being
NORMATIVE
Professional and ethical conduct
Effective practice. Evaluation of trainees
Disadvantages for s’ees
0102030405060708090
100R
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S'e
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Dif
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S'e
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dis
em
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S'e
e n
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reveal
do
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fam
eth
ics
Mis
un
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sta
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Tim
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nt
s'ors
S'ees
Other Disadvantages – S’ors
“S‟ee‟s lack of models and therefore clarity in how to approach issues, resulting in a more directive sup process as opposed to collaborative learning, development and support for change”
“Sometimes needs to be technical or specialist knowledge, e.g. nursing, which I just don‟t have. Consultee ends up educating me so I can be helpful - slows things down for them”
Other Disadvantages – S’ors
„At times there is role confusion as the s‟ee
sees me as the same level as her manager”
„Needing to be careful not to „colonise‟ the s‟ee with a social justice way of being and a social work approach to the discussion”
“I think that what I can offer is limited by the fact that I don‟t share their discipline. I‟m less able to help with things like merit progression, interpretation of their code, advanced training in their discipline, etc…”
Under what circumstances
does IPS work effectively?
“…on senior level, when s‟ee is confident within his own profession…”
“When both are clear about purpose…and the limitations. When there are opportunities to discuss specific issues within own profession…”
“…competent s‟or, aware and respectful of difference, diversity. Comfortable with various approaches,” “…mutual respect…”
Under what circumstances
does IPS work effectively?
“the ability to challenge without bias”
“There is no contamination from interpersonal office politics and dynamics at times when supervision has need a place to look at those issues and re-think strategies..”
“It is good for me because I am more open with someone who is more neutral”
“When s‟or IS NOT IMMEDIATE DIRECT REPORT”
Dealing with differences in
codes of ethics? (Themes) 1. Open discussion of code of ethics including
differences and similarities (48/100 answers)
2. Not a problem experienced, primarily as respondents felt the codes of ethics were very similar or differences not significant (25/100)
3. Would refer to prof bodies, managers, other supervisors (12/100)
4. No codes of ethics or refer to organisational ‘codes of conduct’ as a code of ethics (10/100)
5. See ethical adherence as the individuals’ or organizations’ responsibility (7/100)
Under what circumstances
should you not do IPS?
1. Lack of specialist expertise and knowledge (31/93)
2= Personal qualities of the supervisee (21/93)
2= Practice outside the scope/ with unclear clinical accountability (21/93)
3= Supervisee has no other supervision (11/93)
3= Conflicts of interest/ boundaries (11/93)
4. New workers, trainees, inexperienced workers (10/93)
How does IPS influence your
interactions with clients?
Unconscious, countertransferential processes
Enhance understanding of effective strategies, adds to toolbox
Increases understanding of clients world view
More mindful of different disciplines perspectives
No difference
‘More sure of my work with Maori’
Support and management of client base
Richer in practice/value base
Steps to prepare for IPS?
0 20 40 60 80 100 120
Discuss nature of sup
Clarify limits know/skill
Discuss shared approaches
Clear acct., responsibility
Discuss power diff
Regular Evaluation
Discuss diffs approach
Discuss diff ethics
%
Limitations of study
Many different types/purposes of IPS
combined, e.g. clinical/managerial
Difficult to compare groups meaningfully
Sample size differences
Qualitative aspects of study not yet fully
analysed
Recommendations for IPS
Clarify purpose or goals of supervision. Detailed learning contract.
Clarify competencies, technical skills, knowledge, values, language and areas of mismatch
Discuss the limits of this and where else s’ee will satisfy un-matched needs
Draw up a clear contract that clearly defines parameters of supervision including who else is involved in the supervision
Plan and carry out regular evaluation of the supervision relationship especially attending to areas of no-go, discomfort, what's not being talked about…
Recommendations for IPS
Education about IPS, reading, attend workshop, supervision or consultation.
Familiarise self with everyday work, codes of ethics, practice standards, agency requirements and so forth
Clearly define what s’ee wants out of each topic on agenda (to avoid diffuse focus)
Specify confidentiality clearly.
Clarify process for dealing with unsafe practice, or problems in the relationship.
An agreement to develop an open honest relationship where both parties benefit
Normative, formative,
restorative balance
0
0.5
1
1.5
2
2.5
S'ees
ratings
s'ors
ratings
Rating
Normative
Formative
Restorative
Interprofessional
supervision in Aotearoa
New Zealand: Experiences
in two professions
Paper #80
Fiona Howard, Liz Beddoe and
Aqeela Mowjood Departments of Psychology and School of Social
Work, Counselling and Human Services
University of Auckland
This paper:
Interprofessional Supervision (IPS) – defined
The context for IPS
Potential advantages/limitations of IPS
Results of our study
Conclusions and recommendations
Context for IPS in Aotearoa
Changes in regulatory context:
Growth of accountability culture
Recognition of impacts on worker well-being
Health Practitioners Competency Assurance Act (HCPAA, 2003)
NZ Psychological Society’s Institute of Clinical Psychology and the College of Clinical Psychology.
Social Workers Registration Board and the Aotearoa NZ Assoc. of Social Workers
Health and Safety in the Workplace Amendment Act (2003)
Context for IPS in Aotearoa
Growth of supervision:
More health professions engaging
Potential for resource limits within certain
professions, e.g. nurses.
Educational programmes in supervision
Diverse approaches to supervision:
Specific therapeutic programmes being taken by more diverse professional groups
Peer, group, cultural and team
Potential advantages of
IPS
Delivering expert resources to diverse
groups
Promoting collaboration and cooperation
between professions - potential to
improve teamwork (Mullarkey, 2005)
Enhanced learning that occurs between
professionals - greater understanding of
the specific contributions of different
professional groups
Potential advantages…
Promoting different perspectives, increased creativity, wider knowledge, and prevention of becoming complacent and critical thinking (Townend, 2005)
IPS participants more able to think broadly, became more familiar with the problems of colleagues, both subordinate and superior and better able to take into account alternative arguments when making professional decisions (Zorga, 2002).
More challenging as opposed to the ‘high support/low challenge’ type of peer review – greater stimulation, job satisfaction.
Potential Disadvantages
‘Turf sensitivities’
Disempowerment of supervisee
Townend, 2005:
Misunderstandings due to professional role and training differences
Absence of shared theories and language, absence of empathy for organizational issues,
Anxiety and fear of revealing weaknesses.
Limitation on potential content
Loss of autonomy/potency of professional groups
Questions of interest:
Why are Psychologists and Social Workers selecting supervisors of a different profession
For what purposes?
What are the advantages and disadvantages in doing so?
What are some of the issues and special aspects of interdisciplinary supervision needing further examination?
Aims of the study:
To investigate the extent and nature of the
practice of interprofessional in the
Psychology and Social Work disciplines.
The study aimed to survey views on the
rationale for, advantages and disadvantages
of, and recommendations for optimal
practice of interprofessional supervision.
We hope the findings will inform best
practice guidelines and educational
endeavours with respect to this practice.
Method
Internet questionnaire designed (SurveyMonkey)
Distributed to 2 professions (Psychology and Social Work) via e-letters, emails and website advertising
Participants responded voluntarily as s’ee, and/ or s’ors
Results analysed for significance where relevant
Qualitative answers also examined but not as yet analysed
Our sample (S’ors and
S’ees):
81% female, 19% Male
69% European, 19% Maori, 4% Pacific,
3% Asian, 13% other
72% SW’s, 28% Psychologists
40%worked in hospitals/health settings,
28% Private practice, 28% Community
NGO, 20% Govt depts/crown agencies,
2.5% schools
Level of seniority
0 10 20 30 40 50
Academic
Manager/Prof lead
Team lead
Supervisor
Principal
Senior practitioner
Basic grade-mid range
Bar 1
Age Yrs of experience
0 20 40 60 80
Under 20
20-24
25-29
30-34
35-39
40-44
45 & over
0 10 20 30 40
<1yr
1-2yr
3-4yr
5-8yr
9-12yr
13-16yr
17-20
>20yr
Years o
f exp
erien
ce
Bar 1
More facts
Peer based and hierarchical relationships were
just as likely in each profession (59%
Psychologists and 49% SWs in peer)
Supervisors assumed clinical responsibility for
35.1% of SW s’ees, but only 4.5% of
Psychologist s’ees.
SW s’ees more likely to have IPS as their only
form of supervision (47.8%), compared to
psychologist s’ees (36.4%)
Majority of s’ees receive IPS once a month
(63%), 15.5% fortnightly, 6% weekly
Our sample – S’ors
50% of s’ors had 1-2 s’ees, 25% had 3-5, 14% had 6-9, 10% had 10-19 s’ees
Majority had attended courses >1day(90%)
50% no official qualification
16% had post-grad certificate or diploma
21% of s’ors assumed clinical responsibility for s’ee’s work
For what reasons did s’ees
chose IPS?
Reason S’ee S’or
Lack of appropriate s’or available
in my profession
34.3 22
Lack of available (location/region) 12.4 11.9
The s’or possesses skills &
knowledge I would like to develop
52.4 71.6
Cultural 18.1 8.3
Previous positive relationship 22.9 30.3
S’or understands work context 42.9 23.9
How did it come about
that you have taken up
IPS?
Requested of me (25)
Reputation (e.g. specialist skills) (25)
Interest/experience in supervision (10)
Expectation of the role (7)
Previous relationship (5)
Share work context (4)
Primary purpose of IPS
Purpose S’ee S’or
Gen oversight of clinical competence 46.8 25
Ensuring cultural
competence/awareness
20.7 3.7
Support and personal reflection 66.7 42.6
Develop specialised skills 32.4 28.7
Advantages of IPS for s’ee S’ee S’or
Usefulness different approach 76 90
Increases my knowledge 65 78
Facilitates creative thinking 61 65
More creative outcomes 45 60
Enhances understanding other prof.
groups
44 61
Enhances own discipline skills 41 47
Helps me question my institutional
approach
34 43
Positive effect on teamwork 25 60
Advantages of IPS for s’or
Advantages %
Provided greater challenge to my
disciplinary knowledge
81
Increased learning about process of sup 72
Learning about alternative work
contexts
72
Other 22
How is IPS different?
‘…more challenging”
„I take the values of the profession into
account and think about SW values and
how/if these compliment each other”
“I have to ensure I am knowledgeable in
terms of s‟ee professional body and
requirements”
“More empowering, learning theory
models and less risk of „expert‟ problems”
Continued…
“I pace things slower, more careful about checking out interpretations…feel more in need of accurate evidence of their work (audios, videos of work)”
“Am providing more emotional support and opportunity for self reflection and venting. Am providing less by way of education and teaching of theory, models, recommended reading.”
“Over the years I‟ve been greatly helped by these various groups knowledge and experience - its been a real bonus, and I use what I‟ve learned with other consultees”
Supervision functions
Inskipp and Proctor (1993)
NORMATIVE
Professional and ethical conduct
Effective practice. Evaluation of trainees
(gate keeping)
FORMATIVE
The learning and development of supervisee
RESTORATIVE
Emotional effects of the work.
Support, stress management, well-being
RESTORATIVE
Emotional effects of the work.
Support, stress management, well-being
NORMATIVE
Professional and ethical conduct
Effective practice. Evaluation of trainees
Normative, formative,
restorative balance
0
0.5
1
1.5
2
2.5
S'ees
ratings
s'ors
ratings
Rating
Normative
Formative
Restorative
Disadvantages for s’ees
0102030405060708090
100R
ole
no
t
ad
dressed
S'e
e
relu
cta
nt
Dif
f th
eo
ry
lan
gu
ag
e
S'e
e
dis
em
po
wer
S'e
e n
ot
reveal
do
ub
t
un
fam
eth
ics
Mis
un
der
sta
nd
ing
s
Tim
e
ineff
icie
nt
s'ors
S'ees
Other Disadvantages – S’ors
“S‟ee‟s lack of models and therefore clarity in how to approach issues, resulting in a more directive sup process as opposed to collaborative learning, development and support for change”
“Sometimes needs to be technical or specialist knowledge, e.g. nursing, which I just don‟t have. Consultee ends up educating me so I can be helpful - slows things down for them”
Other Disadvantages – S’ors
„At times there is role confusion as the s‟ee
sees me as the same level as her manager”
„Needing to be careful not to „colonise‟ the s‟ee with a social justice way of being and a social work approach to the discussion”
“I think that what I can offer is limited by the fact that I don‟t share their discipline. I‟m less able to help with things like merit progression, interpretation of their code, advanced training in their discipline, etc…”
Under what circumstances
does IPS work effectively?
“…on senior level, when s‟ee is confident within his own profession…”
“When both are clear about purpose…and the limitations. When there are opportunities to discuss specific issues within own profession…”
“…competent s‟or, aware and respectful of difference, diversity. Comfortable with various approaches,” “…mutual respect…”
Under what circumstances
does IPS work effectively?
“the ability to challenge without bias”
“There is no contamination from interpersonal office politics and dynamics at times when supervision has need a place to look at those issues and re-think strategies..”
“It is good for me because I am more open with someone who is more neutral”
“When s‟or IS NOT IMMEDIATE DIRECT REPORT”
Dealing with differences in
codes of ethics? (Themes) 1. Open discussion of code of ethics including
differences and similarities (48/100 answers)
2. Not a problem experienced, primarily as respondents felt the codes of ethics were very similar or differences not significant (25/100)
3. Would refer to prof bodies, managers, other supervisors (12/100)
4. No codes of ethics or refer to organisational ‘codes of conduct’ as a code of ethics (10/100)
5. See ethical adherence as the individuals’ or organizations’ responsibility (7/100)
Under what circumstances
should you not do IPS?
1. Lack of specialist expertise and knowledge (31/93)
2= Personal qualities of the supervisee (21/93)
2= Practice outside the scope/ with unclear clinical accountability (21/93)
3= Supervisee has no other supervision (11/93)
3= Conflicts of interest/ boundaries (11/93)
4. New workers, trainees, inexperienced workers (10/93)
How does IPS influence your
interactions with clients?
Unconscious, countertransferential processes
Enhance understanding of effective strategies, adds to toolbox
Increases understanding of clients world view
More mindful of different disciplines perspectives
No difference
‘More sure of my work with Maori’
Support and management of client base
Richer in practice/value base
Steps to prepare for IPS?
0 20 40 60 80 100 120
Discuss nature of sup
Clarify limits know/skill
Discuss shared approaches
Clear acct., responsibility
Discuss power diff
Regular Evaluation
Discuss diffs approach
Discuss diff ethics
%
Limitations of study
Many different types/purposes of IPS
combined, e.g. clinical/managerial
Difficult to compare groups meaningfully
Sample size differences
Qualitative aspects of study not yet fully
analysed
Recommendations for IPS
s’ors
Clarify purpose or goals of supervision. Detailed learning contract.
Clarify competencies, technical skills, knowledge, values, language and areas of mismatch
Discuss the limits of this and where else s’ee will satisfy un-matched needs
Draw up a clear contract that clearly defines parameters of supervision including who else is involved in the supervision
Plan and carry out regular evaluation of the supervision relationship especially attending to areas of no-go, discomfort, what's not being talked about…
Continued…
Education about IPS, reading, attend workshop, supervision or consultation.
Familiarise self with everyday work, codes of ethics, practice standards, agency requirements and so forth
Clearly define what s’ee wants out of each topic on agenda (to avoid diffuse focus)
Specify confidentiality clearly.
Clarify process for dealing with unsafe practice, or problems in the relationship.
An agreement to develop an open honest relationship where both parties benefit