Clinical Supervision: by Dr. Nola Veazie, CADC-II

Introduction

Embedded in supervision is the role of the supervisor, as a motivator, who encourages subordinates to carry out the organization’s plans and policies at the operational level.  Clinical supervision, however, focuses on the intervention from a senior member who cultivates knowledge and experience in a junior member of the profession.  According to Bernard and Goodyear (2004), clinical supervision foments a relationship that is evaluative in nature, extends over a period of time, and enhances the professional functioning of clinicians. Moreover, SAMHSA’s Treatment Improvement Protocol No 52 (2009) posits that clinical supervision provides a bridge between what counselors learn in the classroom and their clinical practice.  As a result, clinical supervisors are tasked with translating theory to practice. Regardless of which operational definition we use, clinical supervision is an essential part of the development of new and seasoned counselors.

The Substance Use Disorder profession (SUD), as does the counseling field in general, strives to balance the provision of great services, implement sophisticated interventions, and cultivate evidence-based knowledge in newly assigned personnel. This balancing act is accomplished primarily by clinical supervisors who are often saddled with administrative duties, tasked with the responsibility of maintaining staff morale, while ensuring that subordinates stay on task.  How do overworked SUD professionals manage these tasks and provide great clinical supervision? A question many supervisors in the field ask themselves.

An imperative question relates to what clinical supervision really entails. Not understanding the importance of clinical supervisors in the workplace can lead to confusion, stress, and ill-prepared staff. Thus, newly assigned SUD professionals often feel overwhelmed due to a lack of appropriate or sustained level of clinical training. This pervasive deficiency in clinical oversight can adversely affect the supervisor-mentee relationship.  Hence, this potential clinical deficit can leave newly assigned counselors floundering to learn new skills from ill-equipped peers or overwhelmed seasoned counselors who lack supervisory experience. This perpetuates misinformation used to treat clients in the throes of substance use disorder and can lead to poor quality of care, program failure, problems with retention, and low morale.  What can we do to remedy the problem?  In order to answer this question, we must first define the role of the clinical supervisor.

Role of the Clinical Supervisor

Clinical supervisors wear many hats in the organization.  According to the Substance Abuse and Mental Health Service Administration (SAMHSA), the most important hat is a hybrid that encompasses the roles of the teacher-coach-mentor-consultant.  The literature on clinical supervision outlines the synergy between these roles and demonstrates how professionals in the SUD field embody these roles. Each role is interdependent and offers a holistic approach to staff development.  The following is a synopsis of each role: 

1. The role of the teacher is to identify learning needs and gaps that present as opportunities for professional development.  In turn, the clinical supervisor assist the trainee to develop professional competence, which is periodically assessed to determine if the trainee has met agreed upon milestones.
2. The role of the consultant is to monitor performance and provide potential solutions by encouraging dialogue.  The supervisor-consultant constantly assesses programmatic needs and how staff perform key tasks. Moreover, the supervisor acts as a fiduciary that ensures the clinical integrity of the program and the wellbeing of the client.
3. The role of the coach is to provide support, morale building, and encouragement.
4. The mentor models professional behaviors, clinical expertise, and quality care for the mentee to follow. In turn, mentees model these behaviors for their clients and other counseling professionals.

Quality of Care

Recidivism or the return to substance abuse following or completing addiction treatment is of great concern.  Some researchers estimate that between 40 and 60 percent of individuals relapse after treatment.  Moreover, according to statistics reported in 2019 by the National Institute on Drug Abuse (NIDA) the recidivism rate among individuals living in California was approximately 46.5 percent. These numbers are staggering and begs the question: Is there a nexus between quality of care and recidivism?  In other words, is recidivism a result of poor quality of care?  It is commonly known that recidivism is a part of the disease process; however, we also know that a number of other elements play a significant role in relapse.  Delineating each element is beyond the scope of this article and it is not the intended purpose of the article.  Thus, we will focus on the role of supervision in ensuring quality of care and best-practice interventions in mitigating or reducing recidivism.

In the introduction I mentioned that the role of a clinical supervisor is to pass on new knowledge to junior counselors.  What does this mean?  These professionals interpret and impart information and skills-based knowledge to newly assigned subordinates.  This knowledge is passed on through experience or education and is the theoretical or practical understanding of a subject.  Experienced clinical supervisors are better equipped to interpret and translate theory/evidence-based knowledge into clinical best practice for addiction counselors who are new to the field.  This does not imply that more experienced SUD professionals do not require continued training and supervision to enhance their professional skills.  In fact, client retention, decreased recidivism, and overall program success depends on a cadre of well-trained individuals.

Helping Clinical Supervisors

Clinical supervision is a daunting task and therefore those performing such duties require nurturing.  Prioritizing training and supporting the people who are the teacher-coach-mentor-consultants to newly assigned staff requires a concerted effort by everyone involved in the process. We can begin by understanding and implementing the following: 1) Clinical supervision and administrative supervision are very distinct processes.  2) While administrative supervisors further the organization’s mission and vision, clinical supervisors integrate program goals with evidence-based clinical skills to further clinical practice.  3) Clinical supervisors sharpen their ethical decision-making skills in order to address ethical dilemmas that arise in course of providing counseling.  4) Supervision and staff development are a must if you are a new clinical supervisor 5) Supervisors provide mentorship to others and should also receive mentoring.

In conclusion, clinical supervision is at the heart of providing quality care for individuals suffering from addiction.  Creating a pathway to ensure appropriate provision of care begins by placing properly trained clinicians in positions of supervision. Organizations that invest in current and future clinical supervisors will ensure a return on their investment in the following ways:

1. Better quality of  treatment interventions
2. More tools to appropriately measure outcomes
3. Professional, succinct, evidence-based and accurate clinical documentation 
4. Proper risk management to mitigate potential harm to client
5. Decreased recidivism and increased successful program completion