Beyond the “Acid Test”: A Conceptual Review and Reformulation of Outcome Evaluation in Clinical Supervision
Abstract
Introduction
Definition
The Fidelity Framework
Fidelity Dimensions and Objectives: | Reformulation of the Evaluation of Supervision: |
---|---|
A. Evaluation design Ensure that a study can properly test its hypotheses, based on the relevant theory (i.e. hypothesis validity). Addresses the question: “What is the right way to supervise”? | 1. “Do no harm”: examine for side effects of supervision and the associated therapy (e.g., Procedural evaluation: Were supervisors suitably qualified and experienced?). 2. Supervision model-development and testing: replace medical model with supervision-specific formulation; conduct better-focused evaluations (e.g., measure “active ingredients”). 3. Research question guided by model, leading to specific evaluation objectives. |
B. Training in supervision Standardise training (e.g., by using manuals) so as to meet competence criteria; monitor and boost competencies; assess adherence. Addresses the question: “Has the right supervision been done”? | 4. Manipulation check: evaluate the training of supervisors, so that adherence to the intervention can be assessed (e.g., evaluation of “structure”: frequency, duration or content of supervision) |
C. Delivery of supervision Monitor whether supervision is being provided as specified (i.e. tape sessions to check adherence and competence); attempt to control for non-specific factors; strengthen adherence. Addresses the question: “Has supervision been done right”? | 5. Intervention integrity: monitor the supervisor’s skill and interpersonal effectiveness in adhering to the intervention (process evaluation of competence and alliance). |
D. Receipt of supervision Attending to whether the supervisee (i.e. the therapist) benefits during the supervision session, as in showing signs of better understanding or greater proficiency (e.g., demonstrating a competence within an educational role-play). Addresses the question: “Did supervision result in the right outcomes”? | 6. Evaluate the successive impacts of supervision (“mini-outcomes” or mediator/mechanism evaluation: e.g., assessing if reflection or action-planning took place during supervision, using content evaluation). |
E. Enactment of supervision Extent to which the supervisee demonstrates these competencies in therapy (transfer). Addresses the question: “Did supervision result in the right therapy”? | 7. Evaluating the supervisee’s competence in providing therapy (stepwise evaluation). |
F. Effects of therapy Generalization of supervision to therapy and beyond (across people, settings and time). Monitor social context for adverse and positive reactions to therapy (e.g., heightened marital distress). Addresses the question: “Did supervision result in the right clinical outcome”? | 8. Clinical outcome evaluation (the “acid test”): effect of supervision on clients’ daily lives (e.g., symptomatic distress; interpersonal problems; social role functioning). Can include comparative outcome evaluation or “efficiency” assessments, comparing alternative supervision approaches. 9. System outcome evaluation: effect of changes in client on client’s social system (e.g., relationships; work functioning). Final step in stepwise outcome evaluation. |
Evaluation Design
1: “Do No Harm:” Client (And Supervisee) Safety Comes First
2: Evaluate Supervision-Specific Models
3. Pose A Research Question and State Related Evaluation Objectives
Training in Supervision
4. Conduct Manipulation Checks
Delivery of Supervision
5. Monitor Whether Supervision is Being Provided Competently
Receipt of Supervision
6. Evaluate Mediators and Mechanisms
Enactment of Supervision
7. Conduct Stepwise Evaluations
Effects of Therapy
8. Precise Clinical Outcome Evaluation
9. Systemic Outcome Evaluation
Discussion
Acknowledgments
References
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