Ann E. Bailey, M.A., Mary Harrison, Ph.D., Christopher L. Watson, Ph.D., and Karen Storm, Ph.D. Reflective Consultation: A Conceptual Framework for Research and Implementation Overview and Background Significance Reflective practice is a form of ongoing professional development that takes place either one-to-one or in a group and is usually led by a supervisor within the agency or an outside consultant (Mann, Boss, & Randolph, 2007; Wightman, et al., 2007). In the specific model used here called Reflective Supervision/Consultation, the supervisor creates a safe space for staff to reflect on and learn from their own work through an ongoing, collaborative process with a trusted mentor or supervisor (Heffron & Murch, 2010). Minnesota’s Maternal, Infant, and Early Childhood Mental Health (MIECHV) project employed a tiered system of mentoring. Using the Reflective Supervision/Consultation model, Minnesota Department of Health (MDH) staff members supported infant mental health (IMH) consultants who were hired by 19 sites across the state. The IMH consultants in turn used the model to support county program supervisors in their supervisory role and to support home visitors in their work building relationships with at-risk families to improve the development of infants and toddlers. Minnesota’s MIECHV Project sought to increase the capacity statewide for a Reflective Supervision/Consultation model to support and sustain the work of home visitors with families at risk. Reflective supervision/consultation is theorized to foster supervisor and practitioner self-awareness, reflective functioning, and perspective taking resulting in improved self-regulation, increased job satisfaction, and reduced burnout. Our evaluation addressed the effectiveness of the capacity-building efforts and the self-reported impact of reflective consultation on supervisors and home visitors and their work. Goals of the Overall Evaluation Evaluation Goals: 1) Study the strength of relationships between factors that both influence implementation of reflective practice and are affected by adoption of reflective practice 2) Understand perceptions about the intervention; and inform the MDH in order to improve the mentoring system. 3) Describe the growth in reflective practice as a result of the intervention. Families with risk factors experienced more effective home visiting services resulting in improved benchmark outcomes Results and Discussion The interviews with supervisors and home visitors supported the claim that the implementation of reflective practice reduced burnout among home visitors. Home visitors reported: Feeling supported in this model Participation in this model helped relieve stress through the ability to share challenges with the consultant and peers Appreciating time to contemplate personal accomplishments in their work Repeated measures ANOVAs showed no change in burnout scores or sub-scale scores for both the supervisors and the home visitors across the three data collection points. More time may be needed to show change in MBI. Length of the intervention was less than two years in some areas and shorter in others. The MBI is not a direct measure of reflective practice. It measures behaviors that one would expect to change as a person becomes more reflective. Variance in amount of with reflective practice at sites, within home visitors, and within supervisors made change hard to measure. Some Twin Cities sites have been practicing for eight years or more, while other sites were completely new to reflective practice. As part of the discussion and contextualization of the findings, the Conceptual Framework was developed to help illustrate the differences between more traditional types of supervision in the field and the emerging Reflective Practice model of Reflective Supervision/Consultation. The case presented here is an evaluation study made possible by the Affordable Care Act of 2010 as the creator of the Maternal, Infant, Early Childhood Home Visiting Program (MIECHV), with funding and administration from the US Department of Health and Human Services: Health Resources and Services Administration (USSDHHS/HRSA) and is being conducted in partnership with the Minnesota Department of Health. MIECHV funding for home visiting programs for at- risk families Semi-structured interviews with state mentors, local program directors, and supervisors explore whether state support is adequate to implement and sustain RP Kentucky Mindfulness Survey (KIMS) measured the degree to which supervisors and home visitors perceived themselves as reflective Maslach Burnout Inventory (MBI) recorded the level of burnout and perceptions of accomplishments at work reported by supervisors and home visitors Inputs Activities Outcomes MDH established adequate support for implementation of reflective practice at the local program level Working Alliance Inventory (WAI-SR) measured the degree to which supervisors and home visitors perceived the existence of good working relationships for implementing RP Surveys asked home visitors about the support they are receiving to implement RP Leadership Self Assessment explored local program directors leadership style and the extent to which they applied a reflective leadership approach Evaluation MDH staff provide an initial training in reflective practice (RP) and infant mental health for local program directors, supervisors and home visitors to establish a foundational understanding of reflective practice IMHCs provide ongoing support by conducting regular one-to-one RP sessions with supervisors for 18 months Supervisors provide regular RP sessions for the home visitors in their programs IMHCs partner with supervisors in co-facilitating several group RP sessions for home visitors in their programs Local program directors developed a reflective leadership style Implementation of reflective practice was successfully expanded and institutionalization in local home visiting programs throughout the state Supervisors and home visitors experienced a reduction in emotional exhaustion and depersonalization and an increase in their sense of accomplishment. REFLECTIVE Theoretical Approach to Supervision/Consultation:: PROBLEM-FOCUSED DIRECTIVE Client Nature of the relationship between supervisor, interventionist, and client: Hypothesized change process between interventionist and client: Implementation Strategy: Supervisor as expert Prescriptive: Guidance of expert Problem-Solving: Exploration of solutions Mutual Curiosity: Exploring the meaning of behaviors to support reflective functioning and new patterns of interaction Knowledge-oriented: “Here’s what to do” Solution-oriented: “Have you tried this?” Multiple Perspectives-Oriented: “I wonder...” Supervisor as Reflective Partner Facilitated reflective case consultation Interventionist as Reflective Partner Supervisor as mentor Interventionist as mentor Case Consultation with Peers Client Interventionist as expert Client Minnesota Department of Health (MDH) mentors and infant Mental Health Consultants (IMHCs) to support local programs Evaluation staff at the Center for Early Education & Development (CEED) at the University of Minnesota Supervisors and home visitors gained knowledge and skills in reflective practice, including mindfulness and therapeutic alliance, and received ongoing support in their use of reflective practice