Supervision in Occupational Supervision in Occupational TherapyTherapy

Tanya PughTanya Pugh

Occupational TherapistOccupational Therapist

Supervisor and SuperviseeSupervisor and Supervisee

Sweeny et al 2001 p 427 explain there is Sweeny et al 2001 p 427 explain there is confusion in occupational therapy confusion in occupational therapy concerning clinical supervision that is concerning clinical supervision that is based from :-based from :-

“…“…..the lack of training in supervision, a lack ..the lack of training in supervision, a lack of exposure to theoretical models of of exposure to theoretical models of supervision, an absence of adequate role supervision, an absence of adequate role models and a lack of awareness of models and a lack of awareness of effective supervisory strategies”effective supervisory strategies”

Why ask the question?Why ask the question?

Is there a difference between supervision Is there a difference between supervision “styles” in different professions? “styles” in different professions?

Are we confused about the type of “supervision” Are we confused about the type of “supervision” we practice?we practice?

What is the COT position concerning What is the COT position concerning supervision?supervision?

What is clinical supervision?What is clinical supervision? Can Occupational Therapists practice “clinical Can Occupational Therapists practice “clinical

supervision” supervision” Proposed a framework to assist therapists in Proposed a framework to assist therapists in

choosing a model of supervisionchoosing a model of supervision

AssumptionsAssumptions

““Supervision” is valuable vital Supervision” is valuable vital Continuous professional developmentContinuous professional development AccountabilityAccountability Imbedded in our profession - Ethics and Professional Imbedded in our profession - Ethics and Professional

Conduct (2005), states all therapists will participate in Conduct (2005), states all therapists will participate in supervision.supervision.

““5.4.4. Occupational Therapy personnel shall be supported 5.4.4. Occupational Therapy personnel shall be supported in their practice and development through a regular in their practice and development through a regular professional supervision within an agreed structure or professional supervision within an agreed structure or model”model” Pg 16Pg 16

COTCOT

as made a number of statements:- as made a number of statements:-

““A professional relationship which ensures A professional relationship which ensures good standards and encourages professional good standards and encourages professional development”development” 19901990

““Supervision is not the equivalent of Supervision is not the equivalent of performance review and responsibility for performance review and responsibility for work carried out”work carried out” 19971997

COT continued COT continued

Defined professional and clinical (day-to-day) supervisionDefined professional and clinical (day-to-day) supervision

““is concerned purely with occupational therapy, is concerned purely with occupational therapy, professional specific matters”professional specific matters”

““It may incorporate professional development, particular It may incorporate professional development, particular skills or knowledge, or quality and standards of practice, skills or knowledge, or quality and standards of practice, when these are explicit to occupational therapy”when these are explicit to occupational therapy”

““is related to an individual’s practice, and be dependent is related to an individual’s practice, and be dependent upon the role they hold”.upon the role they hold”.

2006 p1-22006 p1-2

COT continuedCOT continued

Three main functions:Three main functions:

ManagementManagement

EducationEducation

SupportSupport

Is this tripartite function recommended by Is this tripartite function recommended by the COT “clinical supervision”?the COT “clinical supervision”?

What is Clinical supervision?What is Clinical supervision?

Butterworth (1995)Butterworth (1995) ““Clinical supervision is an exchange between practising Clinical supervision is an exchange between practising

professionals to enable development of professional professionals to enable development of professional skills”.skills”.

Bond & Holland (2001 p12)Bond & Holland (2001 p12) ““Clinical supervision is the regular, protected time for Clinical supervision is the regular, protected time for

facilitation, in-depth reflection on clinical practice….facilitation, in-depth reflection on clinical practice….....The The process of clinical supervision should be continued process of clinical supervision should be continued throughout the person’s career, whether they remain in throughout the person’s career, whether they remain in clinical practice or move into management, research or clinical practice or move into management, research or education”. education”.

What is Clinical supervision?What is Clinical supervision?

Bullman & Schutz (2004 p 85)Bullman & Schutz (2004 p 85) “ “The expectation of clinical supervision is a practitioner The expectation of clinical supervision is a practitioner

would develop a different perspective on his or her work would develop a different perspective on his or her work and identify alternative approaches to practice”. and identify alternative approaches to practice”.

Howaston-Jones (2004 p 38)Howaston-Jones (2004 p 38) ““Clinical supervision is a designated reflective exchange Clinical supervision is a designated reflective exchange

between two or more professionals in a safe and between two or more professionals in a safe and supportive environment which critically analyses practice supportive environment which critically analyses practice through normative, formative and restorative means to through normative, formative and restorative means to promote and enhance the quality of care”.promote and enhance the quality of care”.

There is no one clear definition of clinical There is no one clear definition of clinical supervision supervision

There are different perspectives There are different perspectives There are different functionsThere are different functions

This may explain the present confusion This may explain the present confusion concerning range of interconnected types concerning range of interconnected types of supervisionof supervision

The features and underpinning The features and underpinning philosophy of clinical supervisionphilosophy of clinical supervision

Each individual has the right to choose their Each individual has the right to choose their supervisorsupervisor

Clinical supervision should never be forced upon Clinical supervision should never be forced upon an individual and there should be mutual an individual and there should be mutual consentconsent

All parties hold equal statusAll parties hold equal status The process should be person centred and not The process should be person centred and not

organisational or corporate objected organisational or corporate objected There should be a set of ground rules mutually There should be a set of ground rules mutually

agreedagreed

The features and underpinning The features and underpinning philosophy of clinical supervisionphilosophy of clinical supervision

All parties have a right to express their All parties have a right to express their feelings, opinions and anxieties without feelings, opinions and anxieties without fear of ridicule fear of ridicule

Should be centred around the individualShould be centred around the individual Clinical supervision should be confidential Clinical supervision should be confidential

with the ground ruleswith the ground rules Notes should be available to both parties Notes should be available to both parties

and should remain confidentialand should remain confidential

So can Occupational Therapists Practice So can Occupational Therapists Practice Clinical Supervision?Clinical Supervision?

Biomedical Biopsychosocial Social

Paternalistic Locus of control for the superviseeHumanistic

Frame of reference

Cognitive

Operational Supervision

FriendshipDevelopmental Proctors Three Function

Clinical supervision

Models

Approaches by the supervisor

Heron’s

Reflection on action and in action

John’s framing

Core skills

Clinical reasoningLearning cycles

Reflective practice

Learning styles

Organisational targets Professional bodies Direction of education Individual’s aspirationsGovernment policy

Influences on the final decision on which type of supervision is used

Professional supervision

Challenges Challenges

The term clinical supervision should not be The term clinical supervision should not be used to describe sessions that have used to describe sessions that have function described by COTfunction described by COT

Supervision / clinical supervision mean Supervision / clinical supervision mean different things to different professionsdifferent things to different professions

The title of clinical supervision should be The title of clinical supervision should be replaced by personal development replaced by personal development sessionssessions

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Practice. The College of Occupational Therapists: LondonPractice. The College of Occupational Therapists: London College of Occupational Therapists (2005). Code of Ethics and Professional Conduct. The College of Occupational Therapists (2005). Code of Ethics and Professional Conduct. The

College of Occupational Therapists: LondonCollege of Occupational Therapists: London Commission for Health (2004) National Staff Survey HMSOCommission for Health (2004) National Staff Survey HMSO Driscoll, J. (2000) Practising clinical supervision. A reflective approach. Bailliere TindallDriscoll, J. (2000) Practising clinical supervision. A reflective approach. Bailliere Tindall Driscoll, J. and Teh, B. (2001) The potential of reflective practice to develop individual Driscoll, J. and Teh, B. (2001) The potential of reflective practice to develop individual

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Publishing Publishing Ooijen, E. (2003) Clinical supervision made easy. Churchill LivingstoneOoijen, E. (2003) Clinical supervision made easy. Churchill Livingstone RCN Institute (2000) Realising clinical effectiveness and clinical governance through clinical RCN Institute (2000) Realising clinical effectiveness and clinical governance through clinical

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Sweeny, G. Webley, P. & Treacher, A. (2001a) Supervision in Occupational Therapy, part 1: the Sweeny, G. Webley, P. & Treacher, A. (2001a) Supervision in Occupational Therapy, part 1: the supervisor’s anxieties. supervisor’s anxieties. British journal of Occupational Therapy British journal of Occupational Therapy Vol 64(7) p 337-345 Vol 64(7) p 337-345

Sweeny, G. Webley, P. & Treacher, A. (2001b) Supervision in Occupational Therapy, part 2: the Sweeny, G. Webley, P. & Treacher, A. (2001b) Supervision in Occupational Therapy, part 2: the supervisee’s dilemma. supervisee’s dilemma. British journal of Occupational Therapy British journal of Occupational Therapy Vol 64(8) p 380-386 Vol 64(8) p 380-386

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