CLINICAL SUPERVISION IMPLEMENTATION GUIDE

Clinical Supervision and Clinical Practice Guidelines

A. Overview:

Clinical supervision instructs, models, and encourages self-reflection of the supervisee’s acquisition of clinical and administrative skills through observation, evaluation, feedback, and mutual problem-solving. However, it should be understood that there might be opportunities in which the clinical supervisor chooses to give professional direction based on experience, expertise, and/or for ethical or safety concerns. Clinical supervision is delivered within the supervisor’s professional practice license and ethical standards.
Clinical supervision is provided to all treatment/clinical staff who are either employed or under contract by a provider organization such as group practices or behavioral health specialty organization or an individual provider.

  • Clinical supervisors need to meet the standards for clinical supervision as defined by their professional practice board.
  • Clinical supervisor responsibilities: provide support, consultation, and oversight of clients’ treatment to include: assessment of needs; diagnoses/differential diagnoses (MH, SA, and COD); clinical reasoning and case formulation which addresses documentation; treatment planning and implementation; refining treatment goals and outcomes; selecting interventions and supports; coordination of care; tracking and adjusting interventions. All of the above should be:
    • Continuously reviewed and adjusted according to an individual’s status, success and challenges.
    • Teaching the importance of retaining continuity throughout all documentation.
    • Ensuring plans, interventions, goals, and supports are appropriate to diagnosis.
  • Clinical Supervision assures that discharge planning starts at the initiation of treatment and is continually developed throughout treatment. The discharge plan assures ongoing support for the individual’s continued recovery and success.
  • Clinical Supervision assures that an appropriate safety and crisis management plans are in place at the onset of service delivery.
  • Clinical Supervision addresses ethics and ethical dilemmas as aligned with the appropriate professional practice board.

Clinical Supervisors will document date, duration, and the content of supervision session for their supervisee(s), which may include a professional development plan. All documents pertaining to clinical supervision will be readily available to the supervisee.

B. Staff Qualifications:

A clinical supervisor has been approved by their respective professional licensing board as having met board requirements for providing clinical supervision. Please see http://www.rld.state.nm.us/boards/default.aspx for current requirements.

C. Guidelines for Clinical Practice and Clinical Supervision

1. Introduction:

The term practice refers to the collective set of actions used to plan and deliver interventions and supports. Practice takes place in collaboration with the person(s) served and the social and service-related networks and supports available to help meet the person’s individualized and/or family needs and is guided by self-determination and individual choice. The purpose of practice is to help a person or family to achieve an adequate level of:

  • Well-being (e.g., safety, stability, permanency for dependent children, physical and emotional health),
  • Daily functioning (e.g., basic tasks involved in daily living, as appropriate to a person’s life stage and ability),
  • Basic supports for daily living (e.g., housing, food, income, health care, child care), and
  • Fulfillment of key life roles (e.g., a child being a successful student or an adult being a successful parent or employee).

2. Basic Expectations of High Quality Practice:

There are five basic functions of quality practice that must be performed for each person served to achieve the greatest benefits and outcomes. These functions listed below are foundational to quality practice and underlie all successful intervention strategies. Because these functions are essential to achieving positive results with clients served, the Behavioral Health Services-Division expects that each person served will, at a minimum, be served in a manner that consistently provides and demonstrates these core practice functions. Providing services to all clients in accordance with these practices is a top priority, and the Behavioral Health Services Division will support organizations to consistently measure their occurrence with clients served using Integrated Quality Service Reviews (iQSR), Clinical Supervision and Quality Improvement strategies based on their organization’s comprehensive and ongoing self-assessments. Agencies are encouraged to d e v e l o p strong internal clinical practice development activities including integration of the iQSR or other data-driven fidelity models.

3. Basic Functions of High Quality Practice:

This practice framework sets forth the actions/functions used by frontline practitioners to partner with a person receiving services to bring about positive life changes that assist the person by maintaining successes and managing challenges as they occur. Typical activities in practice include engaging the client and other key stakeholders in a connected, unifying effort through teamwork and fully understanding the person, their needs and environment. It also includes collaboratively defining results to be achieved, selecting and using intervention strategies and supports, resourcing and delivering planned interventions and supports, and tracking and adjusting intervention strategies until desired outcomes are achieved.

The basic functions of quality practice are:

  • Engaging Service Partners
  • Assessing and Understanding the Situation
  • Planning Positive Life-Change Interventions
  • Implementing Services
  • Getting and Using Results

4. The Practice Wheel: A Practice Model Defines the Principles and Organizing Functions Used by Practitioners

The practice framework also encompasses the core values and expectations for providing services. The framework functions to organize casework and service delivery, to guide the training and supervision of staff, and clarifies quality measures and accountability. Basic practice functions are illustrated in the “practice wheel” diagram below. The practice wheel can be utilized to guide supervision by providing a framework and expectations for working with persons receiving services. For example, supervision and training could progress along the practice wheel with each function as a topic of focus to strengthen and operationalize expectations.

Basic Functions Supporting Good Practices

5. Clinical Supervision as a Foundation For Strong Clinical Practice:

Clinical Supervision is the foundation for assuring consistent, high quality practice. It provides a mechanism for clinical practice improvement at both an individual staff level as well as at the organizational level.

6. Individual Practitioner Level Supervision:

The Clinical Supervision for individual frontline practitioners should consistently:

  • Provide support, consultation, and oversight of clients’ treatment to include assessment of needs; diagnoses/differential diagnoses (MH, SA, and COD); clinical reasoning and case formulation, to include documentation; treatment planning and implementation; refining treatment goals and outcomes; selecting interventions and supports; coordination of care; tracking and adjusting interventions.
    • All of which should be continuously reviewed and adjusted according to an individual’s status, success and challenges. Teach the importance of retaining continuity throughout all documentation.
    • Ensure plans, interventions, goals, and supports are appropriate to diagnosis; and, aligned with the supervisee’s theoretical orientations
    • Use parallel process where the supervisee’s development is being addressed alongside the emerging clinical issues.
  • Address the supervisee’s steps to insure an individual’s active involvement at all levels and that the individual voice and choice are clearly represented and documented.
  • Assure that discharge planning starts at the initiation of treatment and is continually developed throughout treatment. The discharge plan assures ongoing support for the individual’s continued recovery and success.
  • Assure that an appropriate safety and crisis management plans are in place at the onset of service delivery.
  • Address ethics and ethical dilemmas as aligned with the appropriate professional practice board.

7. Group Level Supervision:

In addition to reinforcing multi-disciplinary teaming, group supervision can serve as a good teaching/training venue in which provider trends are highlighted (e.g. engagement, population profiles, and the presenting severity/types of disorders, theoretical orientation and case conceptualization.) The Clinical Supervisor’s experiences in group supervision can also inform and strengthen the work of the entire team through the use of a recognized Clinical Practice Improvement model.

8. Organizational Level Benefits of Clinical Supervision:

  • Assures high quality treatment for individuals.
  • Creates clearly defined treatment goals which are measurable and time limited
  • Assures the treatment plan is a living, working document with the individual.
  • Ensures proper documentation of care and can help with program integrity issues
  • Ensures staff are trained and properly implementing Evidenced-based Practices.
  • Ensures fidelity to evidenced based practice models ( e.g. Multisystem Therapy, Integrated Dual Diagnosis Treatment, Substance Abuse Matrix model)
  • Improves staff development and employee retention
  • Provides a risk management tool (e.g. Reduction of critical incidence)

9. Organizational Expectations:

Agencies are expected to have policies and procedures that assure that:

  • Clinical Supervision is conducted in a manner that ensures adequate attention to each supervisee and quality oversight for the cases;
  • Clinical Supervision occurs frequently and follows a structured process that includes individual & group, clinical oversight, and regular access to supervisors;
  • Both individual and group clinical supervision occurs multiple times during any month with documentation to evidence that clinical supervision has occurred accordingly.
  • All individual practitioner’s, group practices’ and facilities’ Quality Improvement Program should have a Clinical Practice Improvement program that:
    • Utilizes the findings from its Clinical Supervision to the improve the provider performance;
    • Addresses care planning consistent with: wraparound planning approaches; system of care principles; and, a recovery philosophy.
    • Includes process improvement approaches, relevant data collection, fidelity measures and data for outcome monitoring.
    • Has a review protocol should examine strengths and improvements in the following areas:
      • Engagement
      • Teamwork
      • Assessment & understanding
      • Outcomes & goals
      • Intervention planning
      • Resources
      • Adequacy of interventions
      • Tracking and adjustment

10. Guiding Values and Principles of Practice

The Behavioral Health Services Division, Human Services Department and the New Mexico Behavioral Health Collaborative hold the following values and principles for practice in the provision of services to all individuals, youth and families served within the public behavioral health system:

  • Individual/family-driven, individualized and needs-based
  • Developmentally appropriate
  • Inclusive of family or natural supports
  • Offers an array of services & supports
  • High quality
  • Community-based.
  • Culturally and linguistically aware and accepting
  • Use of early identification and intervention
  • Integrative approach
  • Trauma responsive
  • Strength-based
  • Outcome based
  • Least restrictive
  • Recognize perseverance and resiliency/ trauma informed

11. State Monitoring of Clinical Practice and Clinical Supervision

Medicaid funded and state funded agencies who wish to use non-independently licensed providers will need to submit the Supervisory Certification Attestation Form. Contact (BILS4NILS.BHSD@state.nm.us). A staff roster must accompany the attestation with each independent and nonindependent provider listed. For the supervisors, please include a letter from
the licensing Board designating them as supervisors (LCSW or LISW) or their most recent CEUs in supervision that accompanied their last license renewal (LPCC.) Once approved, the provider will need to submit their Supervisory Certification notice to the MCO’s and Medicaid so that they can render services.

Each time the provider brings on a new non-independently licensed provider, or changes supervisors, they will need to submit an updated roster (with all the columns filled out). For Supervisors, please include a letter from the licensing Board designating them as supervisors (LCSW or LISW) or their most recent CEU’s in supervision that accompanied their license renewal (LPCC).

12. Clinical Supervision Documentation:

The organization’s documentation will include:

  • Policies that describe the provider’s clinical supervision of all treatment staff including their Human Resources requirements for the clinical supervisor (credentials, job description, skill sets, training requirements and schedules).
  • Procedures will include:
    • A template that documents when and how clinical supervision is provided to individuals and multidisciplinary teams in individual and group settings;
    • Annual training plan for all staff that provide treatment services.
    • Backup contingency plans for periods of clinical supervisor staff turnover.

13. Clinical Practice Improvement:

The organization’s Quality Improvement Program must have a Clinical Practice Improvement component that:

  • Addresses care planning consistent with holistic and comprehensive care planning, system of care principles and, a recovery and resiliency philosophy;
  • Examines the provider’s strength and weaknesses in the clinical care functions of: engagement, teamwork, assessment & understanding, outcomes & goals, intervention planning, resources, adequacy of intervention, and tracking & adjustment;
  • Includes process improvement approaches, relevant data collection, fidelity measures and data for outcome monitoring;
  • Evaluates the outcomes of its clinical interventions and develops improved strategies.

14. Technical Assistance from the State:

  • State staff will monitor agencies for compliance with this clinical supervision requirement should the need arise.
  • Dedicate resources and personnel (i.e., state employees or contracted clinicians) to provide technical assistance in identifying acceptable and appropriate policies and procedure through the Supervisory Certification process.
  • Explore use of telehealth video conferencing as a tool in clinical supervision.
  • Provide Clinical Reasoning and Case Formulation training and consultation to Clinical Supervisors.
  • Provide training and supports for supervising specific to those working in integrated settings and teams.