1. 1 Clinical Supervision in the CTN: Availability, Content, and Impact on Counselors Lori J. Ducharme, Hannah K. Knudsen, J. Aaron Johnson & Paul M. Roman The University of Georgia CPDD 2005

2. 2 Overview Two major problems confront the addiction treatment field today: –Bridging the research-to-practice gap; –Curbing burnout and turnover among clinicians. Counselors are vital to both service delivery and the adoption of evidence-based practices. Effective clinical supervision may have important impacts in both areas, by providing mentoring and instrumental support for counselors, and ensuring fidelity in service delivery. However, little research has been conducted on the availability of clinical supervision and its effects.

3. 3 Research Questions What is the availability and content of formal clinical supervision in community treatment programs? What impact does high-quality clinical supervision have on four counselor outcomes: innovativeness, job satisfaction, burnout, and turnover intention?

4. 4 Study Design All community treatment programs (CTPs) in NIDA’s Clinical Trials Network (CTN) were invited to participate in this study –Face-to-face interviews with CTP administrators –Interviews asked about the availability and content of formal clinical supervision programs, along with detailed organizational data –92% response rate among CTPs (N=240 treatment units) 1,643 addiction counselors within CTPs were sent surveys about their perceptions of clinical supervision, their work environment, and receptivity to innovation –Mail questionnaires –61% response rate among counselors surveyed (N=996) –No systematic response bias identified

5. 5 Clinical Supervision Programs 81% of CTPs had formal CS programs –Defined as programs in which senior clinicians were formally assigned to supervise junior counselors No significant organizational differences between CTPs with and without CS programs –No differences in org size, accreditation, facility type, services offered, or turnover rates However, there was significant variation in the structure of CS programs within the CTN

6. 6 Clinical Supervision Programs Requirements for clinical supervisors: –70% of CTPs required certification in addiction treatment –Only 16.4% required training in clinical supervision Compensation for supervisors: –66% provided a reduced caseload and additional compensation for clinical supervisors One-on-one contact: –Average counselor:supervisor ratio of 6:1 –Range of 0.5 to 20 hrs/week of direct supervision (mean = 6.5 hrs/week)

7. 7 Clinical Supervision Programs

8. 8 How does clinical supervision impact counselor performance? Using counselor survey data, structural equation models were estimated for each of 4 outcomes: –Innovativeness 7 items on counselors’ receptivity to new ideas –Job satisfaction / organizational commitment 7 items on work-related affect –Emotional exhaustion Subset of items from Maslach Burnout Inventory –Turnover intention 4 items on intent to quit

9. 9 Predictor Variables Key predictor = quality of clinical supervision –12 items on counselors’ assessment of supervisors’ training, knowledge, skill, and ability to help with client problems Models also included working conditions and counselor characteristics as predictors: –Work conditions: Autonomy (3 items), procedural justice (6 items), distributive justice (4 items), caseload size, percent time in direct client contact (versus meetings, paperwork) –Counselor characteristics: Certification status, education (Master’s vs. other), tenure in program, recovering status, gender, race, age, annual salary

10. 10 Impacts on Innovativeness BBB Autonomy.163*Caseload: 11-35 patients §.134 Female.213* Procedural justice -.077Caseload: 36+ patients §.144 Age.001 Distributive justice.104Certified in addictions.086 Nonwhite.155 Clinical supervision.171*Master’s or higher.253* Tenure-.003 % Direct care-.044Recovering.088 Earnings-.033 § Small caseload (10 or fewer patients) is the reference group. *p<.05; **p<.01 Model explained 11.7% of total variance in counselor scores on innovativeness.

11. 11 Impacts on Job Commitment BBB Autonomy.142**Caseload: 11-35 patients § -.129 Female.108 Procedural justice.335**Caseload: 36+ patients § -.084 Age.026 Distributive justice.273**Certified in addictions.125 Nonwhite.053 Clinical supervision.185**Master’s or higher -.016 Tenure.011 % Direct care-.009Recovering.134 Earnings.016 § Small caseload (10 or fewer patients) is the reference group. *p<.05; **p<.01 Model explained 62.2% of total variance in counselor scores on job commitment.

12. 12 Impacts on Burnout BBB Autonomy-.146*Caseload: 11-35 patients §.124 Female.051 Procedural justice -.321**Caseload: 36+ patients §.278* Age.113* Distributive justice -.184*Certified in addictions -.013 Nonwhite-.004 Clinical supervision.126*Master’s or higher.081 Tenure.003 % Direct care-.043Recovering-.042 Earnings.077 § Small caseload (10 or fewer patients) is the reference group. *p<.05; **p<.01 Model explained 29.9% of total variance in counselor scores on emotional exhaustion.

13. 13 Impacts on Intent to Quit BBB Autonomy-.112*Caseload: 11- 35 patients §.190* Female-.177* Procedural justice -.262**Caseload: 36+ patients §.145 Age-.142* Distributive justice -.223**Certified in addictions -.110 Nonwhite.129 Clinical supervision -.080 (N.S.) Master’s or higher.139 Tenure-.132** % Direct care-.009Recovering.017 Earnings-.017 § Small caseload (10 or fewer patients) is the reference group. *p<.05; **p<.01 Model explained 43.1% of total variance in counselor scores on turnover intention.

14. 14 Conclusions The nature and content of clinical supervision varies across treatment programs. However, “good” clinical supervision – i.e., conveying experience, mentoring, and instrumental support – has beneficial effects on counselors. Net of various work characteristics and personal credentials, supportive supervision significantly increased job commitment and counselor innovativeness. –Findings regarding inverse effects of supervision on burnout require further study. –Effects on intent to quit may be mediated by commitment. These findings suggest that enhancing the quality and quantity of formal clinical supervision may have positive effects on counselor retention as well as their receptivity to new treatment practices. “Good” supervision thus supports both the research-to-practice agenda as well as the stabilization of the clinical workforce.

15. 15 The authors gratefully acknowledge the support of research grant R01DA14482 from the National Institute on Drug Abuse. For more information about this and related research, visit the National Treatment Center Study online at: www.uga.edu/NTCS