CLINICAL SUPERVISION

This is direct observation of a supervisee’s work by a supervisor during a client interaction for the purpose of giving feedback. This can occur in an office based clinical setting, on a home visit, in a group, co-working with a client, when viewing a video recording of a session or in an office whilst a staff member is on the telephone. This form of supervision gives the supervisor a clear understanding of the supervisee’s skills, experience and approach enabling feedback to be very specific. Care needs to be taken to ensure this form of supervision is provided in a positive, respectful and constructive way, keeping with the general principles already outlined for any clinical supervision.

This occurs as a regular, structured meeting/discussion between the supervisor and supervisee. It may include case discussion, reflective practice, setting and monitoring learning goals, sharing information/knowledge and/or teaching skills. The clinical supervisor is usually more experienced than the supervisee but may be a peer for more experienced staff (AHP4-6) if this suits the supervisee’s needs. Feedback is a critical component of supervision to ensure there is a two-way interaction between the supervisor and supervisee.

The frequency and location of these sessions are agreed in the supervision plan and are prioritised and protected by both the supervisor and supervisee. They should occur in an appropriate, confidential environment and may include face-to-face, telephone, videoconference or online discussion.

This can take many forms and be effective for a range of outcomes and clinical groups. It can provide an opportunity for supervisees to experience mutual support, share common experiences, solve complex tasks, learn new behaviours, and participate in informal training, increase communication, confidence and insight. Group supervision can also enable participants to discuss and learn about cases or approaches that they would otherwise not have been exposed to, hear about a range of perspectives, get feedback from others and feel comfortable to ask questions and express concerns.

The evidence suggests groups should meet weekly for at least 11⁄2 hours with five to eight participants (Li et al 2008) however this may not always be achievable. It may be more appropriate to meet monthly for a longer time frame. Norms, objectives and roles within the group should be set at the outset and outcomes and processes should be evaluated regularly.
Group supervision may be facilitated by a senior clinician or coach or a peer group may elect to rotate the chairperson role. When the group is facilitated by a designated chair, it is their role to ensure the group remains on task, everyone has the opportunity to contribute, the structure is followed and achieves positive outcomes.

Group supervision provides a forum for facilitated open discussion, sharing and learning between a group of clinicians and may include case discussion, topics of interest, inter-professional collaboration and team work activities. It is usually led by a clinical supervisor or facilitator and may occur face-to-face or via phone, online or videoconference.

This occurs between two or more experienced AHPs, with a maximum of five (5) participants recommended. It may include consultation, problem solving, reflective practice and clinical decision making. Peer supervision does not require a supervisor to have more experience or knowledge than the supervisee. It refers to a reciprocal learning relationship through the utilisation of skill, experience and knowledge available within the group of peers which fosters and encourages mutual benefits, self-directed learning and the giving and receiving of feedback.

It can provide a forum to share diverse knowledge and experiences and complements more formal methods of supervision.
There are a number of risks associated with peer supervision including maintaining quality and effectiveness of the process, understanding boundaries and limitations of the relationship, lack of leadership causing tension in the relationship and focusing on solutions and advice rather than mutual learning and reflection.

By having established processes, templates and training to follow, peer supervision becomes more effective. Peer supervision may be conducted amongst internal colleagues or with external peers from different organisations. When peer supervision works well, participants meet on a regular basis, set norms and expectations, follow an agreed structure, respect each other as equals and nominate a rotating facilitator for each session.