Reflective Practice and Supervision: Defining and …Reflective Practice and Supervision: Defining and Connecting Elesia Hines, PsyD, HSPP Steve Viehweg, LCSW, ACSW, IMH -E® (IV),

Reflective Practice and Supervision: Defining and Connecting

Elesia Hines, PsyD, HSPPSteve Viehweg, LCSW, ACSW, IMH-E® (IV), CYC-P

Riley Child Development Center – Indiana LENDIndiana University School of MedicineRiley Hospital for Children at IU Health

Disclosures

Elesia Hines has no relevant disclosures.

Steve Viehweg is a co-author of Tackling the Tough Stuff: A Home Visitor’s Guide to Supporting Families at Risk (2016)

Objectives

• Participants will be able to… – Recognize key components and principles of

reflective practice/ consultation– Define reflective supervision/consultation and

how it differs from other forms of supervision– Explain the roles of the supervisee/participant and

the supervisor/consultant

REFLECTIVE PRACTICE

Reflection

• One of many mindfulness skills

• Allows focus on the present

• Increases awareness of one’s own feelings and responses

• Results in better decision making, increased sense of effectiveness, and enhanced ability to take in and make use of new information

Tomlin

Reflective Practice

A way of working that encourages one to:

• Think about implications of interventions while doing the work

• Slow down, filter thoughts, carefully choose words and actions

• Attain a deeper understanding of things that effect our work

• Spend time thinking about work and related experiences in order to make good decisions about future steps

Heffron & Murch, 2010

In reflective practice we:

• Think differently so we can act differently

• Apply knowledge and skills

• Integrate in a meaningful way new knowledge and strategies

Gatti, Watson, & Siegel, 2011

Tomlin

Professional Use of Self

• Being aware of your own internal experience

• Recognizing that families have experiences that may be different from yours, but are just as valid

• Being willing to consider how your experience affects your behavior with others– Recognize judgments, intolerances, wishes– Know your triggers or hot buttons, fears– Suspend certainty (Jeree Pawl)

Heffron, Ivins, & Weston, 2005

Tomlin

The more you know about another's story, the less fearsome and more human that person becomes. It is

equally true that the better we understand our own stories, the more

human we become. - Parker Palmer

Relationships

• Our work requires taking multiple perspectives – Thinking about and “holding” each family

member’s experiences and feelings– Considering contexts, cultures, communities,

individual differences

• Awareness– What do we bring to the interaction?

Presenter

Presentation Notes

“What we may not be prepared for is the emotional journey, what is awakened in response to what we see, what we hear, and what we feel as we enter into helping relationships with families and/or staff on behalf of babies, very young children and parents who courageously allow us into their lives.” Debbie Weatherston (http://preventchildabuse.org/wp-content/uploads/2016/10/The-heART-of-Reflective-Supervision-Weatherston.pdf)

Why attend to relationships?• Relationships are the vehicle through which most

important learning occurs

• Needs for relationship continue throughout our lives!

• A supportive relationship can lead to learning and growth at any age

• Very important in early childhood work: Research shows that parents who feel trust and support from a provider are more likely to be engaged and do things that are needed by their children (Daro & Harding, 1999)

Tomlin

Presenter

Presentation Notes

Pivot a little bit and talk about relationships specifically. The things that happen in relationships carry with it the possibility of learning. We want to understand that. Can you think about things you can imagine that young children learn from relationships from their parents? Good or not so good? speech (basic developmental behavior) affection and empathy (emotional kinds of things) how to comfort another person daily routines, how to take care of yourself you learn that you matter and your needs are important and should be met anytime a parent responds and teaches – my needs are valuable and should be met (and the opposite, unfortunately) kids are watching us! Happens through modeling We always want to be stepping back and thinking about overall family context. We still pay attention to this past 0-3 age. If person receives supportive relationship – that can be valuable to you even as an adult. The most hopeful thing is that change can happen in our parents, too. They can grow, learn, and change. This is a great piece of data. The idea of supporting a parent always helps a child. This is key for us as home visitors. Have you seen this data before, or do you just know it inside you? I like it when things feel right and we have science to support it!

Relationships in I/EC Work

Relationships that matter in early childhood work include:

• Parent-child• Parent-provider• Provider-supervisor

Presenter

Presentation Notes

We’re looking at a variety of relationships. Often focused on parent-child – in first steps, you want parents to be part of work with child, learning things you’re teaching. Your relationship with parent is also important The last relationship I think about is with you and a supervisor you may have supervision is valuable and something we often don’t get enough of (make sure people know what you’re talking about) – expected, guaranteed that you will spend time with supervisor on a regular basis and talking about your work Let’s think it through… supervision helps us a lot we all agreed that when we support a parent, they’re better with their child why is it not true for us? We need support to do our work and that’s supervision administrative – is your quarterly report done? It’s important and we need to get our stuff done supervision that is more about professional development

Parallel Process

“Describes the interlocking network of relationships between supervisor,

supervisees, families, and children”


Parallel Process

Parent-Child

Professional-Parent

Supervisor-Professional

Tomlin & Viehweg, 2016

Presenter

Presentation Notes

How many people know this term? This idea came from psychotherapy How one relationship affects another. What is the connection between relationships? We want to understand this as all being connected to each other, they affect each other This can happen in current relationships and past relationships have you ever had an experience where you met someone and they reminded you of someone? if you think about it, you’re realizing it’s coming from a different relationships past experience carrying into forward

Why attend to parallel process?

“The success of all interventions will rest on the quality of provider-family relationships, even when the relationship itself is not the focus of the intervention.”

Kalmanson & Seligman, 1992, p. 48

Presenter

Presentation Notes

We understand that our interventions, al the good stuff we do, it really is going to work best if we’re doing from a perspective of a high quality relationship with a parent and child. it fuels the parents’ learning the relationship is critical. Let’s think about how we do that – how we form relationships. We want parents to do things with their children to form the parent-child relationship

Through increased understanding and awareness of parallel process, the practitioner…

• Takes time to consider what has been done, said, felt, and thought

• Increases the ability to respond with empathy, attunement, and support

• Slows down (and helps the family slow down)• Considers other possible meanings and responses• May be better able to restore disruptions in

relationships

Source: What is Reflective Practice? By Tina Dorow, LCSW. Illinois Children’s Mental Health Partnership Reflective Practice Guide

Key Components of Reflective Practice

• Contemplation• Self-awareness• Curiosity• Professional/personal development• Compassion

Presenter

Presentation Notes

Questioning what you think of and do with families as well as what you have not thought about or done with families Questioning and examination is done in the spirit of curiosity, a desire to do one’s best, and to help the family do their best Individual reflection is done in the spirit of acceptance and forgiveness. Self-reflection accepts that one's experiences influence one's worldview and choices AND that this worldview is never comprehensive or complete but is constantly being updated based on one's encounters with others, mistakes made, and repair of those mistakes. Practitioners are constantly evolving, just as family members are evolving as they learn about one another and gain new perspectives and empathy for one another.

REFLECTIVE SUPERVISION/CONSULTATION

Presenter

Presentation Notes

Debbie Weatherston: How do we do this work, month after month, year after year? How do we maintain relationships with families and/or staff over long periods of time, offer guidance and support, keep our spirits up and restore the balance if we are discouraged or face crises while working in very intimate ways with the infants and families referred? http://preventchildabuse.org/wp-content/uploads/2016/10/The-heART-of-Reflective-Supervision-Weatherston.pdf

Types of supervision

• Administrative supervision– Focused hiring, training, oversight of paperwork,

explanation and enforcement of agency rules and policies, monitoring of productivity and staff evaluation.

• Clinical supervision/consultation– May be a necessary requirement for licensure in a given

discipline; most likely includes many or all of the administrative objectives as well as:

• Review of casework; review, discuss and evaluate diagnostic impressions, treatment planning, intervention strategies and clinical progress; give guidance/advice and teach.

Reflective Supervision/Consultation

• “A collaborative partnership for professional growth that improves program quality and practice by cherishing strengths and partnering around vulnerabilities to generate growth.” (Shahmoon-Shanok, 1991)

• Or more, simply, “a relationship for learning”

You Can’t Do This Alone

RS/C includes a reflective component that allows the participant to have time and support to:

• Consider his or her own responses to the work

• Link those responses back to previous experiences

• Consider how those responses may guide future action

• Wonder about what is happening for the parents and baby/child

• Consider a variety of possible links between all of these factors

(Heffron & Murch, 2010; Shahmoon-Shanok, 2010; Weatherston & Barron, 2010)

Tomlin & Viehweg, 2016

Reflection, Reflective Supervision

• Use of reflection, especially with a trusted supervisor or mentor, can build skills, combat barriers to relationships, and protect the provider

• “We need reflective supervision to save our patients from ourselves” (David Peters)

Primary Objectives of Reflective Supervision/Consultation

• Acknowledgement that very young children have unique developmental and relational needs

• Form “a safe relationship for learning”

• Provide an intentional partnering relationship

• Use process as the approach to problem-solving

• Promote ‘professional use of self’

• Provide a safe place to explore issues of culture and diversity (Stroud, 2010)


Presenter

Presentation Notes

Acknowledgement that very young children have unique developmental and relational needs and that we are biologically ‘wired’ to be aroused in their presence; working with young children and their families is relationship-based, which requires us to engage our emotions as well as our intellect; the past affects the present. Form “a safe relationship for learning where strengths are supported and vulnerabilities are partnered.” Rebecca Shamoonh-Shanok Provide an intentional partnering relationship between the supervisor/consultant and practitioner which promotes the relationship between the practitioner and the child, the practitioner and the parent, and the parent and the child (parallel process as an organizing principle–“Do unto others as you would have others do unto others.” Jeree Pawl 1998). Provide a validating, partnering relationship that offers a ‘holding environment’ for “learning that our own feelings and behaviors are important sources of information and have a major impact upon interventions.” Alicia Lieberman Use process as the approach to problem-solving; create a shared process of inquiry using open-ended questions to facilitate the supervisee’s own insights and reflections, rather than solution-focused advice-giving; facilitate the ability to “tolerate ambiguity and embrace complexity.” Heffron & Murch Promote ‘professional use of self’—“All the ways in which the quality of the professional’s interactions with the client can influence the intervention outcomes.” Heffron & Murch Provide a safe place to explore issues of culture and diversity–a relationship to discuss issues of difference across race/ethnicity, gender, individuals with disabilities, religious belief, class, educational status and professional culture. Stroud (2010)

Building Blocks of Reflective Supervision/Consultation

• Reflection

• Collaboration

• Regularity(Parlakian 2001)

Reflection

• Stepping back and taking the time to wonder what the experience really means• What does it tell us about the family?• What does it tell us about ourselves?

• Allows us to examine our thoughts and feelings and the experience

• Can help us identify the best interventions for the family

Collaboration• Emphasizes sharing the responsibility and control of power

• Allows supervisors and mentors a chance to learn from (and teach) staff

• Allows supervisors to recognize opportunities to share responsibility and decision-making

• Characterized by reciprocal expectations of each partner

• Open communication

Regularity

• Should have a reliable schedule and sufficient time must be allocated

• Should be protected from cancellation and rescheduling

• Supervision is an investment in the professional development of staff• It takes time to build a trusting relationship and to

discuss ideas, thoughts, and emotions

Supervisee/Participant Role

• Arrives on time and remains open and emotionally available• Comes prepared to share the details of a

particular situation, home visit, assessment, experience or dilemma

• Asks questions that encourage thinking more deeply about one’s own work with very young children and families and also oneself.

Supervisee/Participant Role

• Increases awareness of the feelings experienced in response to one’s work and in the presence of an infant or very young child and parent(s)/caregivers• As the supervisee is ready and able, shares those

feelings with the supervisor/consultant

Supervisee/Participant Role• Allows the supervisor/consultant to provide support and

takes responsibility for telling the supervisor what kind of support feels helpful

• Remains curious and open to new interpretations of and possibilities for the work

• Suspends critical or harsh judgment of self and of others

• Reflects on supervision/consultation session to enhance professional practice and personal growth

Supervisor/Consultant Role

• Active listening and thoughtful questioning (supervisee does this as well)

• Help the participant to answer his/her own questions

• Provide support and knowledge needed to guide the decision-making process


• Provide an empathetic, nonjudgmental ear• Difficult issues can be discussed without fear

of judgement, disclosure, or ridicule• Respect each participant’s pace/readiness to

learn and reflect


• Listen for the emotional experiences that the participant is describing when discussing the case or response to the work– Ex: anger, impatience, sorrow, confusion,

ambivalence, pleasure, etc.– Wonders about, names, and responds to these

feelings with appropriate empathy


• Invite the participant to have and talk about feelings awakened in the presence of an infant or very young child and parent(s)• Wonder about, name and respond to those feelings

with appropriate empathy

• Maintain a shared balance of attention on infant/toddler, parent/caregiver and supervisee


• Encourage exploration of thoughts and feelings that the supervisee has about… – The work with very young children and families – One’s response(s) to the work– The experience of supervision/consultation– How the experience might influence his/her work

with infants/toddlers and their families

What does this look like?

How do I get it?

Summary

• Relationship is the foundation for reflective supervision and consultation

• All growth and discovery about the work and oneself takes place within the context of this trusting relationship

• Much like the real work for children and families takes place between sessions, we too learn when we pause and reflect on the work

“Stepping back from the immediate, intensive experience of hands-on work and taking the time to wonder what the experience really means.”

Parlarkian, R., 2001

IMH IN INDIANA

Indiana’s IMH Endorsement• Competency-based credential for the infant and early childhood

workforce

• Endorsement indicates that the holder is knowledgeable and has skills and experience in supporting infants and young children and their families.

• Four categories that include all infant-toddler workers

• Managed by the Alliance for the Advancement of Infant Mental Health (MI) and implemented by Infancy Onward – Indiana’s IMH Assoc

• 27 state IMH associations are part of the Endorsement to date (plus 2 international associations – Ireland and Australia)

• Active research being conducted

EndorsementInfant Family Associate

Infant Family Specialist

Infant Mental Health Specialist

Infant Mental Health Mentor: Clinical, Policy, or Research Faculty

Education CDA or Associate’ s or 2 years early childhood experience

Master’s or Bachelor’s degree

Master’s or postgraduate degree

Master’s, postgraduate, doctorate, postgraduate, MD, OD, JD

Work Experience

2 years in the infant, early childhood, and family field

2 years in the infant, early childhood, and family field

2 years post-Master’s providing infant mental health services

3 years post Master’s in infant, early childhood, and family field

Indiana Examples

Healthy Families workers, child care provider, Early Head Start home visitor

First Steps provider, Infant Toddler Specialist, Early Head Start workers and Head Start teacher, DCS workers, nurses

Community Mental Health Center therapists, private practice providers, nurse practitioners

University Faculty, physicians, judges

Resources

State: Infancy Onward (https://www.infancyonward.org/)

National: Alliance for the Advancement of Infant Mental Health (https://www.allianceaimh.org/)

National: Zero to Three (https://www.zerotothree.org/)

International: World Association for Infant Mental Health (https://www.waimh.org/)

https://www.infancyonward.org/

https://www.allianceaimh.org/

https://www.zerotothree.org/

https://www.waimh.org/

Online RS/C Groups

To sign up for a group, please contact Becky Gee with Infancy Onward:

[email protected]

Thank you!!

Elesia Hines – [email protected]

Steve Viehweg – [email protected]

Please be sure to complete the survey!

mailto:[email protected]

mailto:[email protected]

References and Recommended Readings

• Gatti, S.N., Watson, C.L., & Siegel, C.F. (2011). Step back and consider: Learning from reflective practice in infant mental health. Young Exceptional Children, 14, 32-45.

• Heffron, M.C., Ivins, B., & Weston, D.R. (2005). Finding an authentic voice-Use of self: Essential learning processes for relationship-based work. Infants & Young Children, 18(4), 323-336.

• Heffron, M. C, & Murch, T. (2010). Reflective supervision and leadership in infant and early childhood programs. Washington, DC: ZERO TO THREE.

• Kalmanson, B., & Seligman, S. (1992). Family-provider relationships: The basis of all interventions. Infants & Young Children, 4(4), 46-52.

• Parlakian, R. (2001). Look, listen, and learn: Reflective supervision and relationship-based work. Washington, DC: ZERO TO THREE.

References and Recommended Readings

• Scott Heller, S., & Gilkerson, L. (Eds.). (2009). A practical guide to reflective supervision. Washington, DC: ZERO TO THREE

• Shahmoon-Shanok, R. (1991). The Supervisory relationship: Integrator, resource and guide. Zero to Three 12(2), 16-19.

• Shahmoon-Shanok, R. (2010). Reflective supervision and practice. Zero to Three, 31(2), 4–5.

• Weatherston, D.J. & Barron, C. (2009). What does a reflective supervisory relationship look like? In S. Heller & L. Gilkerson (Eds.), A practical guide to reflective supervision (pp. 61-80). Washington, DC: ZERO TO THREE.

• What is Reflective Practice? By Tina Dorow, LCSW. Illinois Children’s Mental Health Partnership Reflective Practice Guide. Accessed at http://icmhp.org/wordpress/wp-content/uploads/2016/01/ReflectivePracticeGuideR04-03-15.pdf

http://icmhp.org/wordpress/wp-content/uploads/2016/01/ReflectivePracticeGuideR04-03-15.pdf

Documents

Reflective Practice and Supervision: Defining and …Reflective Practice and Supervision: Defining and Connecting Elesia Hines, PsyD, HSPP Steve Viehweg, LCSW, ACSW, IMH -E® (IV),