What is clinical supervision?
Clinical supervision isn’t new, having been used for many years in a variety of healthcare settings, including mental health. Clinical supervision is a formal mechanism through which individual and professional development occurs by the worker reflecting and learning with the supervisor. People who receive clinical supervision have jobs that are emotionally demanding, in the case the of the Fulfilling Lives South East (FLSE) project supporting people with significant trauma histories and/or multiple and complex needs (MCN).
A key piece of learning from the FLSE Perspectives Project and Perspectives Project: Part 2 work was how statutory mental health professionals could support non-specialist client-facing workers to safely hold high levels of risk. This blog shares learning and aims to illustrate the important role that clinical supervision can play, or could play, in providing a form of mental health specialist support via the worker to clients with a coexisting condition. In building confidence and knowledge in workers to understand the complex nature of this client group, develop appropriate methods for risk taking and sharing risk, managing worker wellbeing, and navigating complex systems when advocating for clients.
In what ways can clinical supervision help non-specialist frontline workers?
- Feeling connected
Working in a role providing support to clients experiencing MCN on a one-to-one basis can be an isolating experience for the worker. The danger of vicarious trauma is more likely in this type of role when in your day-to-day work you are surrounded by complex trauma. Not having a space where you can discuss feelings and emotions that the work might be bringing up for you is an unsustainable approach that will lead to workers having to take time off sick. Clinical supervision offers a space for workers to process the emotional aspect of the work and understand the interplay in the client worker relationship. Being able to talk about what comes up when supporting clients to recognise transference and how this can conflict with your own attachment styles is vitally important.
- Confidence and knowledge
Clinical supervision equips non-specialist client-facing workers with a framework of language that gives knowledge and confidence when adjusting to different audiences and situations. It can help workers advocate for clients using language that statutory mental health workers will recognise and listen to, as well more authoritative robust language to explain the risks and consequences of not responding to the needs of the client.
Additionally, clinical supervision supports workers to facilitate and lead multi-agency meetings that illustrate to partners trauma understanding and this helps other agencies work in the same way, modelling what good can look like when a multidisciplined team approach is adopted to working with complex needs clients.
Another way in which workers’ development of communication is important, is learning through clinical supervision how to interpret the client’s language as well as gauging what language is appropriate to use in response to a variety of situations that can and will arise when supporting MCN clients.
- Innovative, flexible, new approaches
Services can be risk averse which stifles creative approaches to working with MCN clients. Working with this client group requires new approaches and time to build the vital relationships that set the foundations for positive support work to take place. Training staff to have the confidence, knowledge, and skills to work in this way is key to working in a trauma informed way. Non-specialist client-facing workers having the opportunity to discussion innovative ideas in clinical supervision where thinking can be refined, and potential risks can be identified, and mitigation strategies can be worked though. Is incredibly valuable and reassuring for a worker to know that a specialist is endorsing their case planning and now leaving the worker exposed to holding the risk alone.
- Wellbeing and burnout
While clinical supervision is not therapy, it can be used for times when workers are triggered and to think about why that may be. Sometimes these discussions do not happen with managers until the worker has to go off sick and the reason for absence must be disclosed. Clinical supervision offers a regular slot in a worker’s diary where the focus won’t be frontline operational priorities, rather a time to talk with someone who isn’t part of their day-to-day working life. This protected time affords the worker safety to disclose issues and feelings resulting from the nature of the intense client work. Any sense of uneasiness around disclosing feelings that may be perceived as weakness or make the worker feel shame is diminished by the containing space provided through clinical supervision.
- Feeling valued
One of the main impacts that clinical supervision has is it gives a message to staff that the organisation genuinely cares about them and their work. Staff are aware that clinical supervision is something that professionals with specialist qualifications receive, so it sends a signal that the organisation is treating the vital work they do with seriousness. There is often a sense that non-specialist frontline workers are regarded as professionals with a small ‘p’. This kind of investment in staff is validating making workers feel that their role in the support system and the contribution they make is being rewarded by the organisation looking after their wellbeing and professional development.
Why we need to protect our workers?
The current headwinds buffeting third sector healthcare settings are some of the most difficult we have faced. The system is more stretched than ever, the number of people requiring support continues to grow as the level of complexity people are presenting with increases. Coupled with staff shortages and reduced funding the sector is producing a workforce that is stressed, under pressure and poorly supported. Of course, the Covid-19 pandemic has amplified these long-standing issues in the system, while at the same time creating an opportunity to embed clinical supervision in the sector. Giving meaningful professional support and development to non-specialist client-facing workers would be a decisive and welcome contribution to the system.
To read more about how clinical supervision can benefit client-facing workers providing intensive support to clients with MCN, please read ‘The effectiveness of clinical supervision for workers supporting people experiencing multiple disadvantage’. Written by Juliet Hough, and independent researcher, published on the FLSE website in January 2021, the research found that the provision of regular one-to-one clinical supervision was highly beneficial to workers and to the FLSE programme. It was critical to workers trauma informed practice, and in supporting their well-being in the following areas: Increased workers’ understanding and skills around providing trauma informed care, helped workers to successfully advocate for support from other services, helped to protect staff from burnout and compassion fatigue, reduced sickness absence and staff turnover, benefited the people being supported
For further reading about how clinical supervision can play a vital role in our wider communities, please read an academic paper, ‘Could clinical supervision help us to support increasingly complex needs in the community?’ The paper is a collaboration between Kerry Dowding, FLSE Research and Evaluation Officer, and, Juliet Hough, an independent researcher. First published online 15th February 2022, this paper presents qualitative research exploring the benefits of clinical supervision for workers supporting people experiencing multiple disadvantages. The paper illustrates how clinical supervision supported worker wellbeing, lessened compassion fatigue, and created space for workers to think creatively, manage risk and develop trauma-informed and reflective practice.
Locally, the FLSE team have taken a deep dive into the ways in which clinical supervision has supported our Practice Development team as they trial new ways to engage with people experiencing MCN. We wanted to see to what extent clinical supervision could provide a form of specialist mental health support to clients, via the practice development workers. Read more here https://www.bht.org.uk/wp-content/uploads/2022/06/PP_clinicalsup_FINAL_21062022.pdf
Alan Wallace, Systems Change Officer
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