Category: Psychologically Informed Environment

Clinical Supervision and how it can support the work of non – specialist client facing workers

Fulfilling Lives South East

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

Authors:

Alan Wallace, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Alan.Wallace@bht.org.uk

For more information sign up to our newsletter:

https://bht.us6.list-manage.com/subscribe?u=b43e61c311da27ad5194daffe&id=148d2193de

Journeys towards a Psychologically Informed Environment (PIE)

Fulfilling Lives South East

There is a growing interest in the support sector to operate Psychologically Informed Environments (PIE) and to adopt trauma informed practice, but this is hard to do. In this blog we reflect on Brighton & Hove City Council’s (BHCC) PIE journey that Fulfilling Lives South East (FLSE) supported with experts in this field and what we learnt from the experience.

What sparks collaborations?

After conversations between the FLSE team and BHCC about changes to language and policy seemed to stall in the face of detailed revisions and large authorisation processes, the FLSE team decided to re-group and re-evaluate priorities. We reflected that we actually wanted to support larger-scale changes beyond the immediate policy in question and that we were passionate about encouraging PIE and trauma informed practices across the service.

We shared these reflections openly with the BHCC managers and this unlocked a different mode of conversation. We were able to discuss broader principles and values of the department and we found this was a much more open dialogue, welcomed by both ourselves and the BHCC team.

What happened in the journey – ‘How about a mystery shop?’

In a meeting that followed sharing our reflections, a volunteer said: ‘how about we do a mystery shop?’ He reassured the groups that this was a learning opportunity, with an established process which had been carried out in the Hastings Housing Department to support their service development too. The BHCC Managers embraced this opportunity and a month later we were training up volunteers to carry out a mystery shop and conduct environment assessments of the housing customer service centre.

To find out more about mystery shopping please read our toolkit here. The learning from these activities was shared at both a managers’ level and with the whole department. These meetings and presentations were co-produced and co-delivered with people who have lived experiences of multiple and complex needs (MCN) and we highlighted positives as well as areas we felt could be developed. Paired with this, BHCC housing managers made time for staff to reflect on the learning and share hopes and aspirations for the Department. They wanted staff to have space for de-brief and dialogue.

The BHCC Housing Department was starting to shape its vision and plans for the future using the learning from the mystery shop and environment assessment paired with staff feedback.

Following this, the Department reached out to Dr Peter Cockersell to support with staff training in PIE and trauma informed approaches. Peter is a leading expert in this field and one of the co-authors of the national guidance on PIE. Peter worked in collaboration with FLSE, partnering with volunteers and experts by experience to design the training which was then delivered by the team. This programme saw over 100 staff participate in training across the whole of the BHCC Housing Department.

Following this, in late 2020/early 2021, the Department released its revised strategy, which included a commitment to becoming a department that operates as a PIE.

Covid-19 has obviously put all housing departments under huge strains, and we hope that as the world takes steps to recover from the pandemic that the BHCC team can have space to revisit this work and time for non-crisis activity.

What impact did this have?

Having the mystery shopping exercise and environment assessment as the foundation for this partnership, centred the voice of lived experience and helped to shape BHCC’s plans for the future around the service-user.

One volunteer who was key to shaping FLSE’s involvement in the partnership shared their reflections on this work:

“So my interest in the work was to do with the fact that the first time I was homeless I went through the system, and it was decided that they had no duty of care. So I just wanted to see if the system had changed or not.

I do think that the majority of the staff [at the council] were very open minded.  The few staff members who did object at first did eventually came around after we managed to convince them that the work was about testing the system and not them.

I don’t know about all the staff, but I do remember one lady who said that as a result of the mystery shops that she had re-evaluated the way she worked, and that after it, when she was meeting with people she made sure that she had some water and tissues in case they were needed.”

Learning

Based on the learning and values of the Project, there are golden threads that run through all of our systems change work. We share these below as useful starting point for anyone looking to spark or support a journey of change similar to the one we reflect on above.

  • Drivers for change: At FLSE we have found it useful to reflect on and write down what drives all our efforts and partnership work. These are a useful reminder on a challenging day about why you do the work. 
  • Guiding principles: We have worked to certain values, principles and practices and this has helped shape what we do as much as how we do it. For FLSE, these have been:
    • Co-production
    • Trauma-informed practice
    • Naming Multiple and Complex Needs (and multiple disadvantage)
    • Using project management tools to guide activity
  • Building trust: Making concerted efforts to build trust between all stakeholders who need to be involved in a PIE journey or further systems change activity is crucial.  We’ve learnt that this is a bedrock of all good partnership working and when we have built trust effectively, this has led to the most impactful outcomes.

Author:

Rebecca Rieley, Systems Change Lead

For further information about Fulfilling Lives work in this area, please contact:

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

For more information sign up to our newsletter:

https://bht.us6.list-manage.com/subscribe?u=b43e61c311da27ad5194daffe&id=148d2193de