Transcript Reflective Consultation: A Conceptual Framework for Research and Implementation

Reflective Consultation: A Conceptual Framework for Research and Implementation
Ann E. Bailey, M.A., Mary Harrison, Ph.D., Christopher L. Watson, Ph.D., and Karen Storm, Ph.D.
Overview and Background Significance
Inputs
• Reflective practice is a form of ongoing professional development that takes place
either one-to-one or in a group and is usually led by a supervisor within the agency
or an outside consultant (Mann, Boss, & Randolph, 2007; Wightman, et al., 2007).
In the specific model used here called Reflective Supervision/Consultation, the
supervisor creates a safe space for staff to reflect on and learn from their own
work through an ongoing, collaborative process with a trusted mentor or
supervisor (Heffron & Murch, 2010).
• Minnesota’s Maternal, Infant, and Early Childhood Mental Health (MIECHV) project
employed a tiered system of mentoring. Using the Reflective
Supervision/Consultation model, Minnesota Department of Health (MDH) staff
members supported infant mental health (IMH) consultants who were hired by 19
sites across the state. The IMH consultants in turn used the model to support county
program supervisors in their supervisory role and to support home visitors in their
work building relationships with at-risk families to improve the development of
infants and toddlers. Minnesota’s MIECHV Project sought to increase the capacity
statewide for a Reflective Supervision/Consultation model to support and sustain
the work of home visitors with families at risk.
• Reflective supervision/consultation is theorized to foster supervisor and
practitioner self-awareness, reflective functioning, and perspective taking
resulting in improved self-regulation, increased job satisfaction, and reduced
burnout. Our evaluation addressed the effectiveness of the capacity-building efforts
and the self-reported impact of reflective consultation on supervisors and home
visitors and their work.
MIECHV funding for home visiting programs for atrisk families
Minnesota Department of Health (MDH) mentors
and infant Mental Health Consultants (IMHCs) to
support local programs
Evaluation staff at the Center for Early Education &
Development (CEED) at the University of
Minnesota
Activities
MDH staff provide an initial training in reflective
practice (RP) and infant mental health for local
program directors, supervisors and home visitors
to establish a foundational understanding of
reflective practice
IMHCs provide ongoing support by conducting
regular one-to-one RP sessions with supervisors
for 18 months
Goals of the Overall Evaluation
Evaluation Goals:
1) Study the strength of relationships between factors that both influence
implementation of reflective practice and are affected by adoption of reflective
practice
2) Understand perceptions about the intervention; and inform the MDH in order to
improve the mentoring system.
3) Describe the growth in reflective practice as a result of the intervention.
Theoretical Approach to
Supervision/Consultation::
IMHCs partner with supervisors in co-facilitating
several group RP sessions for home visitors in their
programs
Supervisors provide regular RP sessions for the
home visitors in their programs
DIRECTIVE
Supervisor
as
expert
Nature of the
relationship between
supervisor,
interventionist, and
client:
Interventionist
as
expert
Evaluation
Semi-structured interviews with state
mentors, local program directors, and
supervisors explore whether state support is
adequate to implement and sustain RP
Surveys asked home visitors about the
support they are receiving to implement RP
Leadership Self Assessment explored local
program directors leadership style and the
extent to which they applied a reflective
leadership approach
Working Alliance Inventory (WAI-SR)
measured the degree to which supervisors
and home visitors perceived the existence of
good working relationships for implementing
RP
Kentucky Mindfulness Survey (KIMS)
measured the degree to which supervisors
and home visitors perceived themselves as
reflective
Maslach Burnout Inventory (MBI) recorded
the level of burnout and perceptions of
accomplishments at work reported by
supervisors and home visitors
Local program directors developed a
reflective leadership style
Supervisors and home visitors gained
knowledge and skills in reflective
practice, including mindfulness and
therapeutic alliance, and received
ongoing support in their use of
reflective practice
MDH established adequate support
for implementation of reflective
practice at the local program level
Supervisors and home visitors
experienced a reduction in emotional
exhaustion and depersonalization
and an increase in their sense of
accomplishment.
Implementation of reflective practice
was successfully expanded and
institutionalization in local home
visiting programs throughout the
state
Families with risk factors experienced
more effective home visiting services
resulting in improved benchmark
outcomes
Implementation Strategy:
Knowledge-oriented:
“Here’s what to do”
Prescriptive:
Guidance of expert
• The interviews with supervisors and home visitors supported the claim that the
implementation of reflective practice reduced burnout among home visitors.
Home visitors reported:
• Feeling supported in this model
• Participation in this model helped relieve stress through the ability
to share challenges with the consultant and peers
• Appreciating time to contemplate personal accomplishments in
their work
• Repeated measures ANOVAs showed no change in burnout scores or sub-scale
scores for both the supervisors and the home visitors across the three data
collection points.
• More time may be needed to show change in MBI. Length of the
intervention was less than two years in some areas and shorter in
others.
• The MBI is not a direct measure of reflective practice. It measures
behaviors that one would expect to change as a person becomes
more reflective.
• Variance in amount of with reflective practice at sites, within home
visitors, and within supervisors made change hard to measure.
Some Twin Cities sites have been practicing for eight years or more,
while other sites were completely new to reflective practice.
As part of the discussion and contextualization of the findings, the Conceptual
Framework was developed to help illustrate the differences between more
traditional types of supervision in the field and the emerging Reflective Practice
model of Reflective Supervision/Consultation.
PROBLEM-FOCUSED
Supervisor Interventionist
Case
as
Consultation
as
mentor
with Peers
mentor
Client
Client
Hypothesized change process
between interventionist and client:
Results and Discussion
Outcomes
Solution-oriented:
“Have you tried this?”
Problem-Solving:
Exploration of solutions
REFLECTIVE
Supervisor as
Reflective
Partner
Facilitated
reflective case
consultation
Interventionist
as Reflective
Partner
Client
Multiple Perspectives-Oriented:
“I wonder. . .”
Mutual Curiosity:
Exploring the meaning of behaviors to support reflective
functioning and new patterns of interaction
The case presented here is an evaluation study made possible by the Affordable Care Act of 2010 as the creator of the Maternal, Infant, Early Childhood Home Visiting Program (MIECHV), with funding and
administration from the US Department of Health and Human Services: Health Resources and Services Administration (USSDHHS/HRSA) and is being conducted in partnership with the Minnesota Department of Health.