Dr Sonya Wallbank Consultant Clinical Psychologist Senior Research Fellow

1. Restorative Clinical Supervision Dr Sonya Wallbank Consultant Clinical Psychologist Senior Research Fellow ‘Restoring Professional’s capacity to think’

2. Overview • Background of the Restorative Model of Clinical Supervision (Wallbank, 2011) • Relationship to current supervisory practices • Research evidence from the NHS Midlands and East Restorative Supervision programme • Impact assessment of the model • Insights into how it works • Restoring capacity to think

3. Background • Model derived from working with Midwives and Doctors in 2007 • Designed to support professionals working in complex clinical environments – Evidence based model • Model informed by pilot work with over 200 professionals • Reduces stress and burnout whilst protecting and enhancing compassion satisfaction (pleasure you derive from doing your job).

4. Literature around Clinical Supervision • Clinical Supervision = umbrella term with little clarify around function and purpose (Buus and George, 2009) • Evidence around effectiveness limited to specialist groups e.g. Mental health nurses • Often delivered by dual roles professionals e.g. supervisor also manager • Very little literature around appropriate, specific strategies (Howard, 2008)

5. In relation to current supervision Clinical Supervision focus Professional Families Clinical work External relationships Management Risk Organisation

6. In relation to current supervision Child Protection Supervision focus Professional Families Clinical work External relationships Management Risk Organisation

7. In relation to current supervision Restorative Supervision HV implementation plan – “emphasis on increasing the autonomy of the professional” Professional Families Clinical work External relationships Management Risk Organisation

8. Why there was a need? • Studies prompted by anecdotal evidence of complaints within services, low morale, retention and long term sickness • Boorman (2009): • NHS loses 10 million working days each year due to sickness absence • Stress and or related health problems largest course of NHS workers sickness • Over 80% of NHS staff feels that their state of mind affects patient care

9. How stress affects behaviour LATENESS FEELING OVERWHELMED ABSENCE RELUCTANCE TO ENGAGE IN CERTAIN SITUATIONS RELATIONSHIP DIFFICULTIES LACK OF MOTIVATION DIFFICULTY IN MAKING THE RIGHT DECISION BURNOUT AND COMPASSION FATIGUE

10. When we are under pressure-we revert to type

11. Why there was a need? • Numerous child death reviews and high profile safeguarding reports (CQC, 2009) recognised the need for strong leadership and support via supervision: “...managers must recognise anxiety undermines good practice. Staff supervision and the assurance of good practice must become elementary requirements in each service” (DCSF, 2009: 4).

12. Impacting Children and Families • Differs from current models of supervision as emphasis is on the resilience of the professional • Underpinned by key theories: Motivational interviewing, Solihull Approach and Leadership • Increases professional autonomy • Encourages leadership behaviours • Professionals are more able to consider the impact they have on others- builds reciprocity especially with Organisations

13. Background research - participants Studies undertaken 2007-2012 1865 Participants 58 Trusts across UK

14. Latest programme results Key: 22 or less Low 23-31 Average 31+ High

15. Impacting Children and Families Supervisor

16. Programme learning • Process of Supervision (Wallbank, 2011)

17. Feedback from participants • “I have been able to develop my role beyond what even I thought was possible”- my sense of self has increased and my confidence CPT Warwickshire • “I feel that the staff are calmer to be around and there is reduced negativity which is much better for the students” Team Leader

18. Impact assessment • Inappropriate workplace behaviours being challenged and moved forwards within teams rather than needlessly burdening management • Organisational attachment improved – the way in which individuals identify and work collaboratively with their employers • Sickness levels and turnover of staff reduced • Capacity to engage with other professionals increased • Health behaviours of professionals improved

19. Impact assessment • Effective professionals who understand their boundaries of work – where responsibilities end • Increase in engagement skills so that other professionals support the families needs • Less of emergency response to families needs and more thinking through of what needs to be done • Overall, a calmer workforce who can think

20. Some insight into the programme •  1. Sparkling Moment • Can you think of a time during the last year where you have felt you sparkled. • It could be the way a client made you feel or someone you work with. It could be because you were working well. • Perhaps you felt you were using your skills, making a difference, making good connections or perhaps you simply felt fulfilled in the work you were doing at that moment.

21. Feeding back •  How did you feel discussing this with your partner? • How do you feel now reflecting back on this experience? • Appreciative enquiry= appreciating what you do well rather than focusing your energy on eliminating what you do badly.

22. Changing the ‘nothing can be done’ •  Example Problem – Coping with the increasing demands of the role • Why is this difficult?- never enough time • Restorative Supervision session • Acknowledgement of the demands • Reality vs. Perception • Ways of working that interfere with productivity • Support to manage upwards • Support to change behaviour • Verbalising difficulties more likely to lead to change

23. Restoring ability to think? • Over-secretion of stress hormones adversely affects brain function, • It prevents the brain from laying down a new memory, or from accessing already existing memories. • Sustained stress can damage the hippocampus , the part of the limbic brain which is central to learning and memory. • During a perceived threat, e.g. Stress reaction the adrenal glands immediately release adrenalin. After a few minutes cortisol is released • Once in the brain, cortisol remains much longer than adrenalin, where it continues to affect brain cells.

24. Memory Loss • Cortisol also interferes with the function of neurotransmitters, the chemicals that brain cells use to communicate with each other • Short term memory loss is the first casualty from age-related memory loss following a lifetime of stress • Long term corisol that is not used up by cells leaves a physiological marker-turning to fat deposits

25. The difference the programme makes • Restorative supervision – calms the brain and slows the person’s thinking – less cortisol=capacity to store and retrieve memory is increased • Next phase study is to measure cortisol and glucose levels to determine physiological and health behaviour changes

26. Contact information Sonya Wallbank W: www.restorativesupervision.org.uk E: s.wallbank@nhs.net T: 07906 272807

27. References • Buus, N., & Gonge, H. (2009). Empirical studies of clinical supervision in psychiatric nursing: A systematic literature review and methodological critique. International Journal of Mentional Health Nursing, 18, 250-264. • Department of Health (2009) NHS Health and Wellbeing: The Boorman Review. London. • Howard, F. (2008) Managing stress or enhancing wellbeing? Positive’s Psychology contribution to clinical supervision. Australian Psychologist, 43, (2), 105-113. • Wallbank, S., & Hatton, S. (2011). Evaluation of Clinical Supervision delivered to Health Visitors and School Nurses. Community Practitioner. 2011; 84(7): 21-5. • Wallbank, S. (2007). Staff responses to professionally experienced miscarriage, stilbirth and neonatal loss (Doctoral Thesis). University of Leicester: Leicester. • Wallbank, S. (2010). Effectiveness of individual clinical supervision for midwives and doctors in stress reduction: findings from a pilot study. Evidence-based Midwifery, 8.28-34. • Wallbank, S. (2012). Health Visitor Needs: National Perspectives from the Restorative Clinical Supervision Programme. Community Practitioner, 85, 4. • Wallbank, S., & Hatton, S., (2011). Reducing burnout and stress: the effectiveness of clinical supervision. Community Practitioner, 84,7.

28. Key Learning Points • The Restorative Supervision Model (Wallbank, 2007) has been shown to be effective in reducing stress, burnout and increasing the capacity of professionals to manage their clinical case loads. • The model has been piloted, tested and is currently being rolled out across Health Visiting services in the West Midlands as well as other areas in the Country. • The model is different from usual models of clinical supervision within services as it is evidence-based with the emphasis on the resilience of the professional to interact with their organisation, management team, clients and external agencies. • Reducing cortisol levels within professionals increases their brain function and capacity to think. • The Restorative model enables the professional to be calmer, clearer, realistic and focused as to their key priorities. • More information can be found at www.restorativesupervision.org.uk