The Role of Staff Supervision in Changing Offender Behavior Kimberly Gentry Sperber, Ph.D.

Key Definitions Evidence-Based Practice: A practice that has been shown to work through use of scientific research. Fidelity: The extent to which an intervention is delivered as designed.

The Gap Between Research and Practice Average time from research to routine practice = 17 YEARS Our clients shouldn’t have to wait that long Public safety shouldn’t have to wait that long

What Are the Barriers? Individual –Individual Practitioners Organizational –Strategic Planning –Readiness Assessment –Infrastructure Training/Supervision IS Systems Quality Improvement –Culture Systemic –Policy/Regulations –Funding –Stigma –Central Repository of Research

Myth Busting MYTH #1 Implementation = Training MYTH #2 Implementation is a one-time event

What is Implementation? Strategic Plan Readiness Assessment Project Management Change Management Hiring Practices Staff Training Staff Supervision Staff Evaluation Monitoring Fidelity –Continuous Quality Improvement –Evaluation

Ensuring Fidelity The Role of Supervisors

Typically Underestimate Time and Effort Needed To: Train Implement Achieve fidelity to the model

Broader than Training Need a mechanism to accomplish: –Acceptance of change –Means to incorporate change –Reinforced at all levels of system

Occasional Quotes from Trainees “I was told I have to be at this training. I have no idea why I am here.” “I’m just here to get my 30 hours/CE’s/ mandatories done” “That won’t work at my site/with our clients/within the time we have.”

Do One-Shot Trainings Work? 15 hour training on MI Pre-training baseline audiotape Helpful Responses Questionnaire

Self-Report Participants over-inflated their skills of using MI after the training Use of MI declined with time following the training (about 50%) Skills were about ¼ of proficient

Training Plus Coaching OUTCOMES % of Participants who Demonstrate Knowledge, Demonstrate New Skills in a Training Setting, and Use new Skills in the Classroom TRAINING COMPONENTS Knowledge Skill Demonstratio n Use in the Classroom Theory and Discussion 10%5%0%..+Demonstrat ion in Training 30%20%0% …+ Practice & Feedback in Training 60% 5% …+ Coaching in Classroom 95% Joyce and Showers, 2002

Staff Supervision Staff supervision is a “formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance [client]… care in complex … situations.” Modified from Department of Health, 1993

Supervision – What Is It? Intervention provided by a senior staff member to a junior staff member Relationship is evaluative and extends over time Has the purposes of: –Enhancing professional functioning of the junior staff person –Monitoring the quality of professional services offered to clients –Serving as a gatekeeper of those who are to enter the profession (Bernard & Goodyear, 2004)

Elements of Supervision Administrative Supervision – focus is on adherence to policy/procedures, documentation requirements, utilization requirements, etc. Educational Supervision – focus is on teaching staff new skills to increase competence in working with offenders. Supportive Supervision – focus is on promoting and maintaining positive working relationships.

Supervision – A Balancing Act Administrative versus educational supervision –Administrative supervision has traditionally dominated in correctional treatment programs Particularly true for supervision of non- clinical staff –Both are important –Time invested should be equitable

Evidence Supporting Supervision Conditions –Manual Only –14 hour Workshop –Workshop + Feedback –Workshop + Coaching –Workshop + Feedback + Coaching All had initial Skill Acquisition Miller, et. al., A Randomized Trial of Methods to Help Clinicians Learn Motivational Interviewing. Journal of Consulting and Clinical Psychology (2004)

Four Months Later Conditions –Manual Only –14 hour Workshop –Workshop + Feedback –Workshop + Coaching –Workshop + Feedback + Coaching Could not Detect Who had Training Only condition that maintained benefit after 4 Months

CBT Study Conditions –Manual Only –Manual + Web-based Training (40 hours) –Manual + Training + Supervision (observation and feedback) Sholomskas, et. al., We don’t Train in Vain: Three Strategies of Training Clinicians in CBT. Journal of Consulting and Clinical Psychology (2005)

CBT Study Conditions –Manual Only – No Transfer –Manual + Web-based Training (40 hours) - Modest Transfer –Manual + Training + Supervision (observation and feedback) - Proficient

Sholomskas, et. al., 2005 “ Face to face training followed by supervision may be essential for effective technology transfer and raises questions about whether practitioners should feel competent to administer an empirically- supported treatment on the basis of reading a manual alone.”

Supervisory Strategies for Enhancing Training Transfer Communicate expectations prior to training Demonstrate involvement of training content – integrated (clinical and staff meetings, paperwork, etc.) Hold learner accountable for applying content in work (rewards/sanctions)

Supervisory Strategies for Enhancing Training Transfer Demonstrate and Model the skills Provide learning and practice opportunities Integrate learning objectives into performance appraisal Observe and provide feedback and coaching Booster training sessions Provide reinforcement

Data Sources Documentation review Case consultation/staffing Direct observation Videotaped observation Audiotaped observation Co-facilitation

Fidelity, Supervision, Emotional Exhaustion, and Staff Retention Aarons et al. (2009): –Staff who received ongoing consultation for fidelity in the EBP group had significantly lower turnover than staff receiving ongoing consultation in the TAU group. –Staff in EBP also demonstrated less emotional exhaustion

Current State of Program Discuss your current assessment of staff in providing evidence-based practices What are the challenges in achieving staff proficiency? How do you currently handle change management? What changes could facilitate improvement in supervision?

Small Group Discussion What barriers would supervisors face in trying to implement some of the strategies discussed so far? What are some potential solutions? What is one idea that could be easily implemented within the near future?

What is the Product of Supervision? New/enhanced knowledge and/or skill Competence Improved morale/retention Stable programming and consistency Improved client retention and outcomes

Organizational Requirements for Effective Supervision Supervisors trained and competent in evidence-based practices Supervisors trained on how to supervise and coach staff Infrastructure that allows for (and requires) supervision –Supervisors given time to supervise –Supervisors held accountable for supervision

Challenges Strength of conceptual understanding of the EBP to be measured Resources Setting priorities Understanding/skill sets required for educational versus supportive versus administrative supervision

Conclusions Many agencies are allocating resources to selection/implementation of EBP with no evidence that staff are adhering to the model. There is evidence that fidelity directly affects client outcomes. There is evidence that internal evaluation processes directly affect client outcomes. Therefore, agencies have an obligation to routinely assess and assure fidelity to EBP’s. Requires a formal supervision infrastructure to routinely monitor fidelity performance.