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Ringing the changes in staff supervision
I’ve written before about Tony Morrison’s materials on staff supervision, and one of the most powerful pieces of information he produced is a survey by McKeown (cited in Morrison 2005 p.61) about the factors that helps families receiving social work support. McKeown identified four factors:
- The characteristics of the client;
- The worker’s relationship with the client;
- The method of intervention used;
- Degree of hope expressed by the client about change.
If you ask participants to identify the most significant they’ll often point to the bottom two. That’s probably because people will think what’s the point of workers employing their professional therapeutic interventions if they don’t work, and secondly participants will remember the old social work adage about ‘the client has got to want to change’. In actual fact it was the first two factors that are overwhelmingly the most important. So a combination of understanding the person you’d working with, their history, their position in society, together with a good empathic relationship between worker and client are the key factors that McKeown found brought about change.
So why is this important? Well it provides a focus for supervision sessions by guiding us as to what supervision should be trying to achieve. It highlights what is important.
The important factors for service users
Let’s think about what those two most important of McKeown’s factors are all about:
- The characteristics of the client – that’s about who they are, their income, housing, physical and mental health and well-being. So the worker’s ability to observe and assess should be part of the focus of supervision sessions. So much of supervision is often about – what have you done with this service user, or what are you going to do, but before any action plans, finding out about the person is a basic first step. How good are your observation skills? How good are the observational skills of our workers?
- The worker’s relationship with the client is the second of those McKeown factors. What picture of the relationship between the worker and client do you as a supervisor have? In a care home situation you may well get lots of opportunities to see them working together, but if you are supervising workers in community settings you may only rarely see the two in action. What kind of a relationship would you want to see? A relationship in which the client is entirely dependent on the worker, and where the worker decides everything? Or a relationship that is a genuinely collaborative one, where judgemental attitudes are avoided, and where the worker shows empathy without being overwhelmed by the service user’s needs. I don’t think supervision can be about creating or moulding the perfect worker, but it should be about encouraging effective working. The evidence from McKeown’s survey is that knowing about the service user, and working well with them is the major part of bringing about change for the better.
Which brings me onto a campaign by Time to Talk who have produced a set of training materials that could be used as part staff supervision on the subject of stigma and mental health. How does this link with McKeown’s research? Well what the campaign materials include is a short film of service user’s experiences. What the film explores is the importance of staff attitudes and how that is fundamental to a good relationship between worker and service user, and acknowledging that discrimination does take place. That’s why showing the film in the workplace would be a good place to start in exploring these difficult emotional areas. We cannot assume that staff attitudes will always be positive and empathetic. The campaign materials are based on a wide range of research into perceived attitudes of staff which picked up some key themes which could be the focus of supervision, whether in a group or individual session:
- Service users wanting as far as possible to be equal partners – working with the worker to achieve goals in a care plan, and their expertise in their problems being used as a resource not a barrier;
- Less emphasis on mental health diagnosis, particularly where there are some stigmatising attitudes to certain diagnoses (such as personality disorder).Service users welcomed an approach that looked at the whole person;
- The threat of coercion, implied or explicit, hindered open working relationships;
- Service users wanted a more optimistic view of their future, one that encouraged recovery and achieving potential. Where staff were openly pessimistic about someone’s future it held the service user back.
When you look at these findings there’s one interesting message. All of these themes are essentially about human attitudes. It goes back to where I started this article. What is it that’s most important to service users with mental health problems? Is it having a worker who is very knowledgeable about mental health issues, and expert in a range of treatments and therapies, or is it someone they can get along with, someone who values them and the contribution they can make? The research findings above give us an answer! These are things that are difficult to measure but it doesn’t mean they shouldn’t be addressed. If a staff supervisor is wanting to get the best out of their workers it is important that they can explore the relationship between worker and client.
The supervision triangle
Look at this diagram to consider something else that goes on in supervision that’s perhaps not always obvious.
The supervision session explores how the worker and service user relate to each other, but what’s the relationship like between the worker and the supervisor? We need that to be an effective relationship as well. The two relationships should mirror each other. Think again about those research findings and what the service user says is important. These could well be things that workers value as well in terms of their relationship with their supervisor:
- Collaborative working;
- Being encouraged in achieving potential;
- Not being subject to coercion;
- Being seen as whole person.
Morrison T 2005 Staff Supervision in Social Care Pavilion
David Beckingham – QCS Expert Mental Health Contributor