1. Reflective Supervision: How to Be and What to Do Learning & Development in the Practice of Reflective Supervision Andrea Foote, PsyD, IMH-E (IV)® Jordana Ash, LCSW, IMH-E (IV)® Colorado Behavioral Health Care Council, September 2012

2. Why’d we start this way? Reflective practice is cornerstone of clinical practice for administration, supervisors, clinicians, other practitioners. –Without it we are acting without full awareness of the vast majority of information and communication available to us Mindfulness and self awareness can be seen as the foundation for the reflective relationship Reflection as the foundation for safety & learning

3. Plan for today Explore the concepts & foundations of reflective supervision Links to Triple Aim Administrative, clinical & reflective supervision Small group discussion –BREAK (4:00-4:15 ish) How do you know it’s working? Dyadic Experience Wrap up

4. Video

5. 5 Definition Reflective supervision is an ongoing communication process that regulates and understands the flow of emotion, information and experience. Reflective supervision occurs between two or more individuals whereby the developing relationships serve as the vehicle for acceptance, trust and respect and a mindful service delivery The supervisor is a trained, skillful and experienced professional who creates a safe space from which a supervisee can learn and reflect about their work. Janet Dean, LCSW 2010

6. How to be & What to do Key Concepts in Reflective Supervision o Regularity o Consistent meeting time o No interruptions o Slowing down o Containment o Partnering with supervisee to regulate anxiety & emotions o Serves the purpose of being able to reflect rather than react o Remembering what was brought before

7. How to be & What to do Key Concepts in Reflective Supervision o Inquiry o Curiosity o Embracing complexity o Wondering together & tolerating now knowing o Cultural Considerations of the work o Direct advocacy & teaching, not just process o Reflection o Bringing awareness o Paying close attention to the supervisee’s thoughts, feelings & distractions o Experiences finding one’s own answers o Exploring what’s missing ?

8. How to be & What to do Key Concepts in Reflective Supervision o Reciprocity and Collaboration o Jointly setting the agenda o Trust that what comes forward is what needs to be looked at o Emotionally available supervisor/ emotionally open supervisee o Parallel Process o What happens between supervisor & supervisee is information about what is happening for supervisee & client, and client & child.

9. Safety & Learning in Reflective Supervision A nurse's perspective

10. Safety & Learning in Reflective Supervision Foundation for dealing with vicarious trauma, reducing burnout, fighting turnover Insurance policy: practitioners are aware of what’s being acted out non-consciously or through lack of awareness with clients: Enactment is our unresolved behavior patterns acted out Pays off administratively and clinically. 10

11. Critical Distinctions or A Relationship for All Kinds of Learning Administrative –Performance Evaluations –Productivity –Agency/Organizational Expectations Clinical –Case formulation –Diagnosis and Treatment Goals –Transference & Counter-transference Reflective

12. 12 Compelling Forces Reflective supervision strives to continuously integrate compelling forces such as reflection and direct advocacy. The provision of attuned guidance is measured by the need to stay in inquiry.

13. Table Talk Conversation o What is your current experience with reflective supervision in your organization or practice? o What aspects of a RS practice would be most challenging to implement? o Which messages about RS would resonate most in your organization?

14. Break

15. Supporting Reflective Supervision: why should agencies & organizations invest? o What’s the research out there? o Impacts of physical health o Minimizing effects vicarious trauma o In children & adults, increased self-regulation o Connection community and family supports o Staff retention/ staff morale o Knowledgeable and effective practitioners

16. What might it take? Video

17. Some Practice Considerations o Group o Community Infant Program Model/adapted from NCTSN o Anxieties & inadequacies minimized o Increases relational capacity o Team resilience o Peer o Facilitated/non-facilitated o Small cluster o Case consultation o Consulting to a Clinical Team o Promoting a team culture o Job descriptions/interviews o New employees

18. Today’s Reflection Supervision Experience Confidentiality Respect of each other’s process and starting place Heighten your awareness around how you are with another in a supervisory 1:1 interaction Notice your own tendencies _________________ Each person will practice each role About 10 minutes a turn (we will let you know)

19. RS Experience Reflections o Getting centered o What did you notice? o How did that feel/ compare to other supervisory experiences? o How might this kind of supervision support your work? o What else do you need to know?

20. Resources o Reflective Supervision Rating Scale o Informing agency practice o Introduction to new supervisees o Quality Checks o Research o Resource List o CoAIMH Teach-In (www.coaimh.org)www.coaimh.org

21. Wrap up How to be & What to do Q & A What’s next for RS Some last thoughts Jordana Ash jash@mhpcolorado.org Andrea Foote afoote@mhpcolorado.org