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McGuinness S, Guerin S. Interprofessional supervision among allied health professionals: a systematic scoping review. J Interprof Care 2024; 38:739-758. [PMID: 38678372 DOI: 10.1080/13561820.2024.2343837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
Clinical supervision typically occurs between clinicians who are trained in the same discipline, and this assumption is present across much of the relevant literature. However, the use of interprofessional supervision (IPS), wherein clinicians do not share the same discipline, has increased in recent years. As IPS increases in usage, it is key that the implications of this approach are explored. In order to map the existing evidence, a scoping review was conducted to explore what is known about the use of IPS across five allied health professions (psychology, speech and language therapy, occupational therapy, physiotherapy and social work). A systematic literature search of four electronic databases was conducted, with 27 articles meeting the inclusion criteria. The data were analyzed using thematic synthesis. Six key themes were identified relating to factors impacting the appropriateness of IPS, necessary steps in the IPS process, and impacts of IPS for clinicians. Limited application of standardized tools and theoretical frameworks within the existing research was highlighted. The findings identified within this review present a broad overview of the existing research relating to IPS, which can be used to inform future research in this area.
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Affiliation(s)
- Shona McGuinness
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
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Pallikkuth R, Kumar TM, Dictus CT, Bunders JFG. Empowerment of Lay Mental Health Workers and Junior Psychologists Online in a Task-Shared, Rural Setting in Kerala, India. Int J Health Policy Manag 2024; 13:7566. [PMID: 39099511 PMCID: PMC11270621 DOI: 10.34172/ijhpm.2024.7566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Patients with severe mental health issues who live in isolated rural areas are difficult to reach and treat. Providing effective treatment is difficult because mental health problems are complex and require specialized knowledge from a range of professionals. Task-sharing with lay mental health workers (LMHWs) has potential but requires proper training and supervision to be effective. This article reports on the challenges and facilitators experienced in empowering LMHWs in their role, with the help of a technology supported supervision group. The study sought to understand the functioning of the Empowering Supervisory Group (ESG) in the context of junior psychologists and LMHWs in rural India, and investigate how they experienced it by exploring challenges, lessons and empowerment. METHODS Qualitative analysis of interviews with the 22 ESG participants and their supervisors. RESULTS A total of three discrete phases of supervision were identified where supervisors responded to the changing needs of the group. This began with building trust at a baseline level, tackling issues with competence and autonomy and finally experiencing meaning and impact through self-determination. The experience of empowerment even in an online setting was very beneficial given the challenges of working in rural areas. CONCLUSION Empowerment based supervision of LMHWs and junior psychologists online enables a level of engagement that positions them to engage in community mental health practices with greater independence and confidence.
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Affiliation(s)
- Rekha Pallikkuth
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - T. Manoj Kumar
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
- Mental Health Action Trust, Calicut, India
| | - Claudia T. Dictus
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
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McDonough JH, Rhodes K, Procter N. Impact of clinical supervision on the mental health nursing workforce: a scoping review protocol. BMJ Open 2024; 14:e078765. [PMID: 38531589 PMCID: PMC10966816 DOI: 10.1136/bmjopen-2023-078765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Mental health nurses work in potentially unpredictable, stressful and complex environments that can lead to burn-out and high staff turnover. Clinical supervision is a formal and professional agreement between two or more people that aims to strengthen individuals' competencies and organisational strengths. Effective clinical supervision has been noted as a method of reducing workplace issues within mental health nursing, but there is not currently a synthesis of evidence in this area. The key objective of this scoping review is to identify, map and analyse the available evidence reporting on the impact of clinical supervision on workforce outcomes for mental health nurses. METHODS A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension method will be conducted exploring clinical supervision for mental health nurses. A search for academic literature from Medline, CINAHL, Embase and PsycINFO will be combined with grey literature sourced through Google to identify potentially relevant studies. Studies identified by the search strategy will be managed using Covidence, and two authors will screen all identified articles. Reference lists of included studies will be handsearched to identify any potentially relevant studies missed by the search strategy. ANALYSIS A summary tool including predefined categories (such as author, date published, workforce outcome measured) will be used to summarise the included studies in this scoping review. Additionally, a narrative synthesis approach will be used to report the outcomes of included studies and provide further analysis. ETHICS AND DISSEMINATION This scoping review protocol described research that will use secondary analysis of publicly available information, and therefore, does not require ethics approval. The findings of this research will be disseminated through publication in a peer-reviewed academic journal and relevant conference presentations.
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Affiliation(s)
- Joshua Henry McDonough
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Rhodes
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nicholas Procter
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Triplett NS, AlRasheed R, Johnson C, McCabe CJ, Pullmann MD, Dorsey S. Supervisory Alliance as a Moderator of the Effects of Behavioral Rehearsal on TF-CBT Fidelity: Results from a Randomized Trial of Supervision Strategies. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:254-267. [PMID: 38157131 PMCID: PMC11162559 DOI: 10.1007/s10488-023-01334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
Exposure is an important element of treatment for many evidence-based treatments but can be challenging to implement. Supervision strategies to support exposure delivery may be an important tool to facilitate the use of exposure techniques; however, they must be considered and used in the context of the supervisory alliance. The present study examined relations between supervisory alliance and fidelity to the trauma narrative (TN; i.e., imaginal exposure) component of Trauma-Focused Cognitive Behavioral Therapy. We also examined how supervisory alliance moderated the effect of behavioral rehearsal use in supervision on TN fidelity. We analyzed data from a randomized controlled trial, in which forty-two supervisors and their clinicians (N = 124) from 28 Washington State community-based mental health offices participated. Clinicians were randomized to receive one of two supervision conditions-symptom and fidelity monitoring (SFM) or SFM with behavioral rehearsal (SFM + BR). Supervisory alliance alone did not predict delivery (i.e., occurrence) or extensiveness of delivery of the trauma narrative. Client-focused supervisory alliance moderated the effectiveness of behavioral rehearsal-as client-focused alliance increased, the odds of delivering the TN also increased significantly. Future research should further investigate how to appropriately match supervision techniques with supervisory dyads and explore the interplay of alliance with supervision techniques a supervisor might employ.
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Affiliation(s)
- Noah S Triplett
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA.
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
| | - Clara Johnson
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
| | - Connor J McCabe
- Department of Psychiatry and Behavioral Medicine, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Michael D Pullmann
- UW School Mental Health Assessment, Research, and Training (SMART) Center, University of Washington, 6200 74th Street, Building 29, Seattle, WA, 98115, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Box 351525, 119A Guthrie Hall, Seattle, WA, 98195, USA
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Rabie S, Poudyal A, King A, Ndwandwa ES, Marais A, Andersen L, Joska J, Sikkema K. A Supervision Framework for Task-Shared Mental Health Workers: Implications for Clinical Trials and Beyond. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300092. [PMID: 38050095 PMCID: PMC10749652 DOI: 10.9745/ghsp-d-23-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
The rise in task-shared interventions that address the mental health treatment gap in low- and middle-income countries (LMICs) has highlighted the need for additional support and supervision of nonspecialist mental health workers (NHWs). The supervision of NHWs in most resource-limited settings is still primarily disorganized, without clear guidelines that provide the necessary structure for supervision. The need for supervision is even greater for NHWs working in the context of trauma, not only to provide training and ensure adequate delivery of care but also to provide support to minimize the psychological impact of their work. In South Africa, women face intersecting epidemics of HIV, intimate partner violence, and sexual trauma. This syndemic highlights the importance of integrating mental health treatment in HIV care, especially in settings like South Africa, where mental health services are limited. In this context, our group developed and is evaluating the effectiveness of ImpACT+, a task-shared coping intervention to improve clinical and mental health outcomes among HIV-infected women with sexual trauma in South Africa. We describe the ImpACT+ supervision model that is currently being implemented in the context of a hybrid effectiveness-implementation clinical trial. Combining experiences from clinical psychology, task-shared interventions, and trauma-informed care, the supervision model integrates formal elements of clinical supervision into categories that are suitable for use in task-shared trauma interventions in low-resource settings. To the best of our knowledge, such a trauma-informed supervision approach has not been widely documented in the literature, particularly in task-shared interventions in LMICs. In this article, we describe the ImpACT+ intervention, provide an overview of the supervision model, and provide illustrative examples of how the supervision model has been implemented.
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Affiliation(s)
- Stephan Rabie
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Aisha King
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
- Department of Community Health and Health Policy, School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Esona-Sethu Ndwandwa
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Adele Marais
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lena Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kathleen Sikkema
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, USA
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Kasongo B, Mukalay A, Molima C, Makali SL, Chiribagula C, Mparanyi G, Karemere H, Bisimwa G, Macq J. Community perceptions of a biopsychosocial model of integrated care in the health center: the case of 4 health districts in South Kivu, Democratic Republic of Congo. BMC Health Serv Res 2023; 23:1431. [PMID: 38110919 PMCID: PMC10726631 DOI: 10.1186/s12913-023-10455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Biopsychosocial care is one of the approaches recommended in the health system by the WHO. Although efforts are being made on the provider side to implement it and integrate it into the health system, the community dynamic also remains to be taken into account for its support. The objective of this study is to understand the community's perceptions of the concept of integrated health care management according to the biopsychosocial approach (BPS) at the Health Center of a Health District and its evaluation in its implementation. METHODS This cross-sectional study was done in six Health Areas belonging to four Health Districts in South Kivu, DRC. We conducted 15 semi-directive individual interviews with 9 respondents selected by convenience, including 6 members of the Development Committees of the Health Areas, with whom we conducted 12 interviews and 3 patients met in the health centers. The adapted Normalization MeAsure Development (NoMAD) tool, derived from the Theory of the Normalization Process of Complex Interventions, allowed us to collect data from November 2017 to February 2018, and then from November 2018 to February 2019. After data extraction and synthesis, we conducted a thematic analysis using the NoMAD tool to build a thematic framework. Six themes were grouped into three categories. RESULTS Initially, community reports that the BPS approach of integrated care in the Health Centre is understood differently by providers; but then, through collective coordination and integrated leadership within the health care team, the approach becomes clearer. The community encouraged some practices identified as catalysts to help the approach, notably the development of financial autonomy and mutual support, to the detriment of those identified as barriers. According to the community, the BPS model has further strengthened the performance of health workers and should be expanded and sustained. CONCLUSIONS The results of our study show the importance of community dynamics in the care of biopsychosocial situations by providers. The barriers and catalysts to the mechanism, both community-based and professional, identified in our study should be considered in the process of integrating the biopsychosocial model of person-centered health care.
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Affiliation(s)
- Bertin Kasongo
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
- School of Public Health (ESP), University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | - Abdon Mukalay
- School of Public Health (ESP), University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Christian Molima
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Samuel Lwamushi Makali
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Christian Chiribagula
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Gérard Mparanyi
- Faculty of Pharmaceutical Sciences and Public Health, Official University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Hermès Karemere
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique (ERSP), Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
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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.
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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
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Meza RD, AlRasheed R, Pullmann MD, Dorsey S. Clinical supervision approach predicts evidence-based trauma treatment delivery in children's mental health. Front Psychiatry 2022; 13:1072844. [PMID: 36699474 PMCID: PMC9869035 DOI: 10.3389/fpsyt.2022.1072844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Observational studies of practices used in clinical supervision-as-usual can be leveraged to advance the limited research on workplace-based supervision as an evidence-based treatment (EBT) implementation strategy. This exploratory observational study examined the presence of supervision approaches (comprised of supervision techniques) and whether these predicted clinicians' EBT technique delivery. METHODS Participants included 28 supervisors, 70 clinician supervisees, and 60 youth clients and guardians from 17 public mental health organizations. Data included audio recorded supervision-as-usual sessions over 1 year, audio recorded Trauma-focused Cognitive Behavioral Therapy (TF-CBT) treatment sessions with youth for 6 months, and youth-reported post-traumatic stress severity scores. Audio recordings of 438 supervision sessions were coded for session duration and the presence of 13 supervision techniques and intensity of their coverage. Audio recordings of 465 treatment sessions were coded for presence and intensity of coverage of TF-CBT practice elements. Agglomerative hierarchical cluster analysis examined the presence of clusters of supervision technique use, termed supervision approaches. Generalized estimating equations estimated the relation between supervision approaches and delivery of TF-CBT elements. RESULTS Two supervision approaches were identified- Supportive-Directive and Supportive- that discriminated between use of five supervision techniques. Clinicians who received a higher proportion of supportive-directive supervision sessions had greater odds of delivering the trauma narrative with a client. CONCLUSION Findings suggest that patterns of supervision techniques can be identified and may shape EBT delivery. Supervision approaches show some evidence of being tailored to individual clinicians. Implications for the development of supervision implementation strategies and future directions are discussed.
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Affiliation(s)
- Rosemary D Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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