Supervision in Occupational Therapy

1. Supervision in Occupational Therapy Tanya Pugh Occupational Therapist Supervisor and Supervisee

2. Sweeny et al 2001 p 427 explain there is confusion in occupational therapy concerning clinical supervision that is based from :- “…..the lack of training in supervision, a lack of exposure to theoretical models of supervision, an absence of adequate role models and a lack of awareness of effective supervisory strategies”

3. Why ask the question? • Is there a difference between supervision “styles” in different professions? • Are we confused about the type of “supervision” we practice? • What is the COT position concerning supervision? • What is clinical supervision? • Can Occupational Therapists practice “clinical supervision” • Proposed a framework to assist therapists in choosing a model of supervision

4. Assumptions • “Supervision” is valuable vital • Continuous professional development • Accountability • Imbedded in our profession - Ethics and Professional Conduct (2005), states all therapists will participate in supervision. “5.4.4. Occupational Therapy personnel shall be supported in their practice and development through a regular professional supervision within an agreed structure or model” Pg 16

5. COT • as made a number of statements:- • “A professional relationship which ensures good standards and encourages professional development” 1990 • “Supervision is not the equivalent of performance review and responsibility for work carried out” 1997

6. COT continued Defined professional and clinical (day-to-day) supervision • “is concerned purely with occupational therapy, professional specific matters” • “It may incorporate professional development, particular skills or knowledge, or quality and standards of practice, when these are explicit to occupational therapy” • “is related to an individual’s practice, and be dependent upon the role they hold”. 2006 p1-2

7. COT continued • Three main functions: • Management • Education • Support

8. Is this tripartite function recommended by the COT “clinical supervision”?

9. What is Clinical supervision? Butterworth (1995) • “Clinical supervision is an exchange between practising professionals to enable development of professional skills”. Bond & Holland (2001 p12) • “Clinical supervision is the regular, protected time for facilitation, in-depth reflection on clinical practice…...The process of clinical supervision should be continued throughout the person’s career, whether they remain in clinical practice or move into management, research or education”.

10. What is Clinical supervision? Bullman & Schutz (2004 p 85) • “The expectation of clinical supervision is a practitioner would develop a different perspective on his or her work and identify alternative approaches to practice”. Howaston-Jones (2004 p 38) • “Clinical supervision is a designated reflective exchange between two or more professionals in a safe and supportive environment which critically analyses practice through normative, formative and restorative means to promote and enhance the quality of care”.

11. There is no one clear definition of clinical supervision • There are different perspectives • There are different functions • This may explain the present confusion concerning range of interconnected types of supervision

12. The features and underpinning philosophy of clinical supervision • Each individual has the right to choose their supervisor • Clinical supervision should never be forced upon an individual and there should be mutual consent • All parties hold equal status • The process should be person centred and not organisational or corporate objected • There should be a set of ground rules mutually agreed

13. The features and underpinning philosophy of clinical supervision • All parties have a right to express their feelings, opinions and anxieties without fear of ridicule • Should be centred around the individual • Clinical supervision should be confidential with the ground rules • Notes should be available to both parties and should remain confidential

14. So can Occupational Therapists Practice Clinical Supervision?

15. Biomedical Biopsychosocial Social Paternalistic Locus of control for the supervisee Humanistic Frame of reference Operational Supervision Professional supervision Clinical supervision Models Cognitive Proctors Three Function Developmental Friendship Approaches by the supervisor Heron’s Learning styles John’s framing Core skills Reflection on action and in action Reflective practice Learning cycles Clinical reasoning Government policy Organisationaltargets Professionalbodies Direction of education Individual’s aspirations Influences on the final decision on which type of supervision is used

16. Challenges • The term clinical supervision should not be used to describe sessions that have function described by COT • Supervision / clinical supervision mean different things to different professions • The title of clinical supervision should be replaced by personal development sessions

17. references • Bond, M. & Holland, S. (2001) Skills of clinical supervision for nurses. Open university press. • Clouder, L. (2000) reflective practice: realising the potential Physiotherapy Vol 86(10) p 517-521 • College of Occupational Therapists (2003). Professional Standards for Occupational Therapy Practice. The College of Occupational Therapists: London • College of Occupational Therapists (2005). Code of Ethics and Professional Conduct. The College of Occupational Therapists: London • Commission for Health (2004) National Staff Survey HMSO • Driscoll, J. (2000) Practising clinical supervision. A reflective approach. Bailliere Tindall • Driscoll, J. and Teh, B. (2001) The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice. Journal of orthopaedic nursing Vol 5 p 93-103 • Holloway, E. (1987) Developmental models of supervision: is it development? Professional psychology: research and practice. Vol 1893) p 209-216 • Hopkins, H and Smith, H (1994) Willard and Spackman’s Occupational Therapy. Lippincott Company London • Howaston-Jones, I. (2003) Difficulties in clinical supervision and long life learning. Nursing standard Vol 17913) p 37-41 • Jasper, M. (2003) Beginning reflective practice foundations in nursing and health care. Nelson Thornes Ltd

18. references • Johns, C. (2004) 2nd Edition Becoming a reflective practitioner. Blackwell Publishing • Johns, C. & Freshwater, D. (2005) Transforming nursing through reflective practice. Blackwell Publishing • Ooijen, E. (2003) Clinical supervision made easy. Churchill Livingstone • RCN Institute (2000) Realising clinical effectiveness and clinical governance through clinical supervision. Radcliffe Medical press • Roberts, A (2002) Advancing practice through continuing professional education: the case for reflection. . British journal of Occupational Therapy Vol 65(5) p237-240 • Smith, G. (2000) Friendship within clinical supervision: A model for the NHS. [on line] http://www.clinical-supervision.com/Geo%20cardiff%20presentation%20notes.htm (accessed on 8th March 2006) • Spouse, J. & Redfern, L. (2000) Successful supervision in Health care practice. Blackwell science • Sweeny, G. Webley, P. & Treacher, A. (2001a) Supervision in Occupational Therapy, part 1: the supervisor’s anxieties. British journal of Occupational Therapy Vol 64(7) p 337-345 • Sweeny, G. Webley, P. & Treacher, A. (2001b) Supervision in Occupational Therapy, part 2: the supervisee’s dilemma. British journal of Occupational Therapy Vol 64(8) p 380-386 • Sweeny, G. Webley, P. & Treacher, A. (2001c) Supervision in Occupational Therapy, part 3: Accommodating the supervisor and supervisee. British journal of Occupational Therapy Vol 64(9) p 426-431 • Unsworth, C. (2004) Clinical reasoning: how do pragmatic reasoning, worldview and client-centredness fit? British journal of Occupational Therapy Vol 67(1) p 10-19