Interprofessional supervision in social work and psychology in Aotearoa New Zealand

The requirement of professional supervision within the health, justice and social service sector in New Zealand has increased greatly since the advent of the Health Practitioners Competency Assurance Act (HCPA 2003). As supervision is seen as a key vehicle for continuing development of professional skills, the demand for trained and competent supervisors has increased, with the resultant gap between demand and provision. One solution to this is for practitioners to seek supervision from a suitably matched professional outside the discipline. The limited literature on the practice of interprofessional supervision (IPS), suggests both advantages and limitations. This article presents the results of a survey (N=243) of social workers and psychologists practising IPS in Aotearoa New Zealand. The survey examined the rationale for seeking IPS, attention to function, and the perceived advantages and limitations for the supervisor and supervisee alike. Respondents receiving IPS reported a variety of reasons for seeking it including, but not most importantly, the lack of availability of same-profession supervisor. Respondents believed the advantages included the usefulness of different approaches/perspectives and an increase in knowledge and creative thinking. Disadvantages included that aspects of the supervisee role were not able to be adequately addressed and a lack of shared theories or language. The practice more adequately provided for the formative and restorative functions than normative despite some having IPS as their only form of supervision. Recommendations therefore include ensuring the purpose of IPS is well clarified at the outset; that it is not a standalone practice for less experienced practitioners; that professional guidelines are appropriately flexible to provide for the varied and justifiable rationales and that programmes for appropriate preparation for IPS be developed. Further research is needed, however, to further clarify the specific agenda for seeking IPS including those for whom it is not a preferred or satisfactory approach. There is considerable debate in the literature about the role and function of supervision in the health and helping professions. Definitions, guidelines and policies differ according to the context in which it is practised (Davys & Beddoe 2010; Milne 2009). Ferguson’s (2005) definition provides a useful brief description as a starting point: Professional supervision is a process between someone called a supervisor and another referred to as the supervisee. It is usually aimed at enhancing the helping effectiveness of the person supervised. It may include acquisition of practical skills, mastery of theoretical or technical ISSUE 25(4), 2013 AOTEAROA NEW ZEALAND SOCIAL WORK PAGE 25 knowledge, personal development at the client/therapist interface and professional development. (Ferguson, 2005, p.294) Recent developments within the health and social service sector in New Zealand, prompted by policy at government level, have resulted in an upsurge in interest and practice of professional supervision. In New Zealand the Health Practitioners Competence Assurance Act (HCPA 2003) has led to greater uptake of supervision among health professions (see for example, Paulin 2010). This legislation aims to protect the public by ensuring that health practitioners are competent to practise. Since its implementation many professions have developed guidelines for supervision as a mechanism to promote ethical, safe practice and professional development. Professional bodies typically specify that supervision must be with someone of the same discipline. Beyond allied health, professions that have not traditionally engaged in supervision in New Zealand such as police, clergy and specialist teachers have also begun to use supervision as a vehicle for support, dealing with the increasing complexities of their work, and critical reflection on practice (Davys & Beddoe 2010). As a consequence of this growth in interest and uptake, professional bodies have set requirements for supervision and educational programmes for supervisors. There can be obstacles in terms of those at senior levels being willing, able and resourced to move into the roles of supervisors for their junior colleagues (Rains 2007). As a result of the pressure on resources of available supervisors, some have engaged with different professional groups for supervision. Interprofessional supervision (IPS) is a growing practice (Bogo, Paterson, Tufford, & King 2001) yet from our review of the literature it appears to be under-researched. The extent of this in New Zealand is unknown, but in the USA, Berger and Mizrahi (2001) surveyed 750 hospitals and found traditional social work supervision by a senior social worker had decreased and interprofessional arrangements had increased. In her survey of social workers in Ontario, Canada, Hair (2012) found that 36%of participants had supervision provided by a variety of professionals including nurses (9%), psychologists (5%), psychiatrists (3%) and other disciplines (20%). This was despite the majority of respondents reporting the need for same-profession supervision. While Ferguson (2005) has covered the broad functions of supervision in the definition above, at its simplest level, IPS involves two or more practitioners from different professions meeting for supervision to achieve a common goal of protecting the welfare of the client (Townend 2005). This involves supervision between members of different professions where the supervisee’s learning goals include the development of competencies held by the supervisor. However, exploration of the concept of interprofessionality in a more general sense reveals aims more broad than the enhancement of one party’s expertise. Interprofessionality often aims to foster the development of a cohesive practice between professionals from different disciplines. More broadly, interprofessional education (IPE) has been the subject of considerable development over the past decade. Reeves, et al (2010: 232) define IPE as: An IPE intervention was defined as occurring when members of more than one health and/ or social care profession learn interactively together, for the explicit purpose of improving interprofessional collaboration and/or the health/wellbeing of patients/clients. Interactive learning requires active learner participation, and active exchange between learners from different professions. PAGE 26 AOTEAROA NEW ZEALAND SOCIAL WORK ISSUE 25(4), 2013 Through interprofessional activities within a team, for example, reconciliation of professional differences and opposing views may be enabled as enhanced interaction and knowledge sharing promotes more positive relations (Hudson 2002). Interprofessional supervision thus may be seen as developing within this broader movement to foster interprofessionality. Typically, same-discipline supervision will address the range of formative (to do with learning and development), normative (to do with ethics and standards of practice) and restorative (dealing with the emotional effects and stress of the work) functions usually attributed to supervision (Inskipp and Proctor 1993). In IPS the supervisor and supervisee may have paired so as to be matched according to competencies related to a specific role. Davies, Tennant, Ferguson, and Jones (2004) provide an example in the United Kingdom where an interprofessional supervision strategy was introduced to support all staff working in a unit with clients who had a dangerous and severe personality disorder. The programme involved the training in and implementation of selected supervision models perceived to be appropriate for the practitioners and their work. Alternatively, mental health practitioners might seek supervision from someone from a different profession for the ‘psychotherapy’ aspect of their role. These forms of supervision may take a strong developmental focus on clinical skill building (Mullarkey, Keeley, & Playle 2001) and are less likely to cover matters specific to the supervisee’s professional discipline, for example, role identity or development. However, there may also be a desire for IPS based solely on practitioner choice, including criteria such as a preferred approach to supervision, or practice, or a pre-existing relationship of respect. Practitioner preference for IPS may be more likely to occur in the experienced professional where professional identity and maturity are coupled with greater awareness of areas in need of extension. The element of free choice exercised in such supervision relationships may be of significance in terms of perceived satisfaction and this may be an area for further study (O’Donoghue 2012). IPS may also be a more common practice in small or rural communities, where potential dual relationships prohibit profession-matched supervision or there may be a shortage of trained supervisors (Crago & Crago 2002). The community may lack specialist supervisors in, for example, family therapy, or where practitioners seek advice and guidance on working across cultural differences. Specific cultural advice from a knowledgeable cultural expert may be sought where practitioners provide services to users who are culturally different to themselves (Howard, Burns, & Waitoki 2007). In these instances the primary aim is to build the cultural competence of the supervisee to work safely cross-culturally. There are many questions as to how IPS works where there are significant differences in theoretical orientation, approach or training background between supervisor and supervisee. The small amount of extant literature provides some interesting results suggesting both advantages and disadvantages of supervision between different disciplines.