"Clinical Supervision (Professional Support) Policy"
Clinical Supervision (Professional Support) Policy & Guidance January 2007 LDEV003 v1.0 January 2007 Document control Document Ref No. LDEV003 Clinical Supervision (Professional Support) Title of document Policy & Guidance Author’s name Carole Waskett Clinical Supervision & Professional Support Author’s job title Facilitator Dept / Service Learning & Development Department Doc. Status V1.0 Based on Clinical Supervision Guidance Document 2003 Signed off by BPCT Joint Professional Leads Publication Date January 2007 Next review date January 2011 Distribution Trust wide / Internet Has a Race Equality An REIA screening of the policy has determined Impact Assessment been that it is not relevant to the General Duty completed? Consultation Version Date Consultation Draft 1 October 2006 Issued to Service Provision Directorate : Assistant Directors, Heads of Clinical Services, Senior managers, and Professional Leads for consultation Draft 2 November Issued to PCT Policy Approval Group 2006 (representatives from all Directorates in PCT) for consultation Final December Ratified by BPCT Joint Professional Leads 2006 Group Clinical Supervision (Professional Support) Policy & Guidance Page 2 of 15 Carole Waskett LDEV003 v1.0 January 2007 Contents 1.0 Scope of this document, definition of clinical supervision 4 2.0 Introduction 4 3.0 Aims of Supervision 5 4.0 Functions of Supervision 5 5.0 Existing Arrangements 5 6.0 Mandatory Supervision 5 7.0 The Process of Clinical Supervision: 6 a. Supervision Register 6 b. Establishing Supervision Partnerships 6 c. Agenda of a Supervision Session 7 8.0 Roles & Responsibilities 8 a. Supervisor 8 b. Supervisee 8 9.0 Confidentiality 9 a. Exceptions to Confidentiality Agreement 9 b. Notes & Confidentiality 9 10.0 References 10 Appendix 1 Contract for Clinical Supervision Appendix 2 Record Sheet Appendix 3 Clinical Supervision for Child Protection/Child in Need Workers Clinical Supervision (Professional Support) Policy & Guidance Page 3 of 15 Carole Waskett LDEV003 v1.0 January 2007 1.0 Scope of this Document This guidance has been produced primarily for all clinical staff working within nursing, health care science, and allied health professions who are employed by Bolton Primary Care Trust. This includes assistant and support staff. However the guidance may also be useful to other clinical staff groups such as dentists, dental nurses, counsellors, clinical psychologists and doctors. Clinical staff employed by independent contractors are welcome to use the guidance; however it is recommended that they access suitable training prior to setting up a clinical supervision scheme. For staff who are not directly employed by the PCT, there will normally be a charge for training provided via the Learning & Development Department of the Service Provision Directorate. Definition of Clinical Supervision: ‘An exchange between practicing professionals to enable the development of professional skills’ (Butterworth and Faugier 1994) 2.0 Introduction Clinical Supervision is a vital element in achieving and maintaining organizational health, and will contribute to the core values of Bolton Primary Care Trust. Most clinical professional bodies advocate its use, eg. Nursing (1); Podiatry (2); Occupational Therapy (3); Speech & language therapy (4); Art therapy (5) Physiotherapy (6). It has a key supporting role to the implementation of the KSF (7). Butterworth J & Woods, D (8) state: “participating in clinical supervision in an active way is a clear demonstration of an individual exercising their responsibility under clinical governance. Organizations have a responsibility to ensure that individual clinicians have access to appropriate supervision and support in the exercise of their joint and individual responsibilities.” In the Healthcare Commission Standards for Better Health, Core Standard C5b (9) requires that ‘clinical care and treatment are carried out under supervision and leadership’. There are three main strands or types of supervision for clinician practitioners: • line management, • professional standards monitoring or teaching, • professional support. Clinical Supervision (Professional Support) Policy & Guidance Page 4 of 15 Carole Waskett LDEV003 v1.0 January 2007 This document makes the assumption that the first two of these are already being practiced; it therefore focuses on the third: professional support. Protected time for clinical supervision is a right for all grades of clinical and support staff. Practitioners receiving regular preceptorship should finish their preceptorship period before accessing clinical supervision. 3.0 Aims of Supervision • To continually improve the quality of service to patients /clients • To continually improve the individual practitioner’s satisfaction with and commitment to professional work • To maintain the highest standards of support for professionals in the Trust in accordance with the requirements of their professional bodies. 4.0 Functions of Supervision The principal functions of the supervision process are: • To facilitate the ongoing professional development of the supervisee • To give practitioners the opportunity regularly to discuss and explore issues to do with their professional life, in confidence • To be a primary source of support for supervisees, recognizing the considerable demands of their jobs • To maintain safe boundaries for the protection of the supervisee, their patients/clients, and the organization • To provide regular constructive feedback to both supervisee and supervisor. 5.0 Existing arrangements In some areas group or peer supervision or other arrangements may be in existence. These arrangements should be reviewed regularly by participants and their managers. If they are useful to and effective for participants they should be protected. However, in addition all staff retain the option to access one-to-one supervision from the Trust register if they wish. 6.0 Mandatory supervision Clinical supervision is mandatory under the professional standards of some disciplines (e.g. counsellors, psychologists, art therapists) and this policy supports any such requirement. It is also mandatory for all staff working in areas of child protection, who must use the recording sheet in Appendix 3. Clinical Supervision (Professional Support) Policy & Guidance Page 5 of 15 Carole Waskett LDEV003 v1.0 January 2007 Some form of individual clinical supervision is mandatory in the second year of employment for staff who are on a formal band 5-6 accelerated progression programme. This can be arranged locally, or via the Trust register (see Band 5-6 Accelerated Progression Policy for further details) Clinical supervision is currently optional for all other staff. However, it is highly recommended and supported by senior managers that all clinical staff should access clinical supervision at least once a quarter. 7.0 The Process of Clinical Supervision a) Supervisor Register 1). A register of approved supervisors will be established. This will be accessible on the Intranet, and in paper form in all departments. 2).Supervisors will volunteer to be on the register. They will have attended an approved training course (either in-house or externally). Supervisors on the register must have their own regular supervision. They may also attend regular skills groups to maintain and top up their skills and benefit from mutual support. 3).Supervisors will agree with their line manager the number of supervisees they are willing to take on. This will normally be a maximum of three at any one time. 4).The normal frequency of supervision for each supervisee is six one- hour sessions per year. Four sessions per year should be considered a minimum. b) Establishing supervision partnerships 1). The potential supervisee will contact their choice of supervisor from the register. The supervisor may be from any discipline, not necessarily the supervisee’s own, and need not necessarily be senior to the supervisee. The supervisor should not be the supervisee’s line manager, professional lead, or anyone with whom they work closely. It is also wise not to choose someone working in a distant location because of using unnecessary travelling time. 2). If the supervisor has a space available, an initial meeting is arranged. 3). If a suitable supervisor cannot be found with a space available, the potential supervisee may have to go on a waiting list. In the meantime the failed request for supervision should be recorded and sent to the Trust’s clinical supervision facilitator to monitor need. Clinical Supervision (Professional Support) Policy & Guidance Page 6 of 15 Carole Waskett LDEV003 v1.0 January 2007 4). The supervisee opts in remotely following this meeting, if they choose to do so. 5). The partners then agree to meet roughly bimonthly for four sessions. The fourth session will be a review session at which either party can disengage, or both can agree to continue. Regular reviews will continue throughout the life of the partnership. 6). A contract is agreed between supervisor and supervisee (a copy can be found at appendix 1). This should be adhered to unless either party wishes to opt out or negotiate a change. 7). The line managers of both partners should be kept informed of the dates and times of supervision sessions. 8). Notes may be written and kept by the supervisee if wished. The supervisor will only keep notes (agreed and signed by the supervisee) in exceptional circumstances (see section 9B). 9). A record will be kept of the date, time and venue only, for each session, signed by both parties; this can be found at Appendix 2. The record will be forwarded every three sessions to the clinical supervision facilitator and either the line manager or the professional lead (if the supervisee is professionally accountable to a professional lead rather than their line manager) for audit purposes. c) The Agenda of a supervision session This should be set by the supervisee, who will prepare for the session in advance. Issues may include: 1). Casework 2). Development of the supervisee’s professional skills, strengths and abilities 3). Work on the supervisee’s intended professional development 4). Reflection on the supervisee’s experiences of and feelings about their work 5). ‘Free thinking time’ about work 6). Feedback on the supervisee’s use of and expectations of supervision. Clinical Supervision (Professional Support) Policy & Guidance Page 7 of 15 Carole Waskett LDEV003 v1.0 January 2007 8.0 Roles and Responsibilities a) Roles and Responsibilities – Supervisor 1). Prioritise supervision sessions and maintain reliability 2). Establish a safe, private environment with no interruptions 3). Establish time boundaries 4). Maintain a positive non-judgmental attitude 5). Help the supervisee explore and clarify thinking 6). Participate in clear, constructive 2-way feedback 7). Balance their responsibilities to the supervisee, patients and the Trust. 8). Maintain complete confidentiality except under specified circumstances (below Section 7d) 9). Behave professionally, with a commitment to support, maintain and update their supervision skills regularly. 10). Undertake their own supervision regularly (if a supervisor on the register does not attend either a supervision interest group or 1:1 supervision for a continuous period of 6 months without good reason – e.g. long-term sick leave – they will be removed from the register). 11). Inform the Trust CS facilitator of any structural or other serious issues or any requests for further training, bearing confidentiality rules in mind. b) Roles and Responsibilities – Supervisee 1). Use clinical supervision to aim higher and maximize the use of their strengths, abilities and skills 2). Prioritise supervision sessions and maintain reliability 3). Identify practice/professional issues for discussion 4). Aim to develop ability to share issues and explore interventions that are useful 5). Participate in clear, constructive 2-way feedback 6). Inform the Trust CS facilitator of any structural or other serious issues. Clinical Supervision (Professional Support) Policy & Guidance Page 8 of 15 Carole Waskett LDEV003 v1.0 January 2007 9.0 Confidentiality In order to promote trust, transparency and quality of practice, the supervisor is bound by an agreement to treat any proceedings in supervision sessions as strictly confidential. The supervisor will not discuss anything said in supervision with anyone else, including line managers, except as in section a) below. a) Exceptions to confidentiality agreement The following are exceptions to the confidentiality agreement: 1). Supervisors must maintain their skills. This will entail involvement in a skills group and/or 1:1 supervision of supervision work. During these activities supervisors will not use supervisees’ names or identifying features. However they may discuss supervision issues and practice. 2). All supervisors will have their own supervision. This will be for any of their own work including their supervision work. 3). All supervisors and supervisees have free access to confidential consultation with the Trust Clinical Supervision facilitator about any issue. In all the following circumstances the supervisor should discuss the issue and proposed actions with their supervisee and work collaboratively with them to deal with the issue if possible. They should also consider consulting their own supervisor or if necessary the Trust CS facilitator to discuss action. It will often be necessary to use careful judgment on a case-by-case basis: 4). If the supervisor is concerned about the well-being of the supervisee and the supervisee is unable/unwilling to take appropriate action 5). If the supervisor is concerned about malpractice or harm to patients 6). If there are legal issues, e.g. Child Protection, Terrorism or serious crime, or the law otherwise requires it. b) Notes and Confidentiality The supervisee may choose to take notes at any time. If they do, the notes will be the property of the supervisee. However, if the exceptional issues in 9a, 4-6 above, arise within supervision sessions, careful notes must be taken by the supervisor at each session in which these issues are discussed. These notes may be requested by the employer or subpoenaed by a court of law. The notes should be dated and written clearly and factually, preferably by supervisor and supervisee together, and signed by both parties. Clinical Supervision (Professional Support) Policy & Guidance Page 9 of 15 Carole Waskett LDEV003 v1.0 January 2007 A copy should be kept securely by both parties. Should notes be requested by a legitimate party, this request must dealt with via the Complaints & Litigation Manager. 10.0 References (1) Nurses & Midwives Council website, (2006) Advice Sheet on Clinical Supervision: “Clinical supervision should be available to registrants throughout their careers, clinical supervision is an important part of clinical governance” (2) Hill, K., Professional Practice Officer, Society of Chiropodists & Podiatrists, personal statement: “The professional body sets as a standard for clinical practice the need for clinical supervision and it is built into the practice accreditation scheme” – Guidance to be published February 2007. (3) British Association of Occupational Therapists; Core Standards for Occupational Therapy Practice, Lifelong Learning, recommends that all Occupational Therapists are supervised. (4) Royal College of Speech & Language Therapists website (2006): “the RCSLT encourages Speech & Language therapists to monitor the effectiveness of their practice through clinical audit, outcome measurement and clinical supervision.” (5) British Association of Art Therapists, 2002 document; “All State Registered Art Therapists are required by the Statement of Conduct of the British Association of Art Therapists Code of Ethics to undertake supervision as a requirement of their remaining State Registered.” (6) Chartered Society of Physiotherapy (2005) ‘A Guide to Implementing Clinical Supervision’, p.2: “Both the CSP and the Health Professions Council consider [clinical supervision] as an appropriate and valuable CPD activity.” (7) DoH (2004); The NHS Knowledge & Skills Framework and the Development Review Process. (8) Butterworth J & Woods, D; (1998): Clinical Governance & Clinical Supervision; working together to ensure safe and accountable practice. School of Nursing Midwifery & Health Visiting, University of Manchester (9) DoH (2004) ‘Standards for Better Health’, Standard C5b, p.11 Clinical Supervision (Professional Support) Policy & Guidance Page 10 of 15 Carole Waskett LDEV003 v1.0 January 2007 Appendix 1 Contract for Clinical Supervision This agreement is made between: Supervisor . . . . . . . . . . . . . . . . . . . And Supervisee . . . . . . . . . . . . . . . . . On Date . . . . . . . . . . . . . . We agree that: 1. We will meet for 1 hour approximately every two months unless otherwise agreed. 2. We will keep to agreed appointments and time boundaries. Privacy will be respected and interruptions avoided. 3. We will meet at ____________________________(venue) unless otherwise agreed. 4. If either of us is unable to attend a booked appointment we will inform the other as soon as possible. 5. We will review the process, and usefulness of the supervision to the supervisee, frequently or on the request of either party. 6. Initially we will meet four times as a trial period. We can then agree to continue if desired by both parties. 7. We will discuss and agree contact parameters outside the formal sessions if the supervisee requires additional contact for a particular issue. Responsibilities and accountability 1. The purpose of supervision/consultancy is to develop and maintain a trusting professional relationship in which supervisee and supervisor collaborate to help the supervisee to do his/her best work. 2. This is a consultancy relationship. This means that the supervisor is not accountable for client work. The supervisee chooses what issues to bring to supervision and retains all responsibility for their work. Clinical Supervision (Professional Support) Policy & Guidance Page 11 of 15 Carole Waskett LDEV003 v1.0 January 2007 3. The supervisor contracts to be positive and constructive in meeting the supervisee’s supervision requirements. 4. The supervisor will act ethically and responsibly where there are concerns about the supervisee’s practice and wellbeing, or the supervisee’s clients/patients’ treatment and wellbeing. Should there be a need to involve an external body, the supervisor will do everything possible to involve the supervisee, and maintain a relationship of trust and transparency. Confidentiality 1. The supervisor has regular supervision of supervision practice and may discuss any issue of supervision practice at any time with the supervision group, supervisor or Trust CS facilitator. These are professional relationships governed by confidentiality, used to help the supervisor work effectively and be more useful to the supervisee. The supervisee will not be named in these conversations, and every effort will be made to maintain confidentiality. 2. Other than in exceptional circumstances, any notes or other documentation made about the supervisee are freely available to the supervisee at any time. Any letters or emails about the supervisee will be copied to the supervisee. All documentation about the supervisee held by the supervisor will be kept securely. 3. Other than in exceptional circumstances (see Policy, section 9a, 4-6) the supervisor will respect the supervisee’s confidentiality completely. This contract may be reviewed and changed at any time by agreement with both parties. A copy should be kept by both parties. Clinical Supervision (Professional Support) Policy & Guidance Page 12 of 15 Carole Waskett LDEV003 v1.0 January 2007 Appendix 2 RECORD OF 1:1 CLINICAL SUPERVISION SESSIONS Date Venue Signed Please keep this record for every supervision session and send an electronic copy to the line manager/professional lead and to the clinical supervision facilitator (Carole.email@example.com) after every three sessions. Name/signature of Supervisee………………………………………………………………………… Name/signature of Supervisor………………………………………………………………. For supervisor only: I confirm that I am accessing my own supervision on a regular basis Signed: ……………………………………………………………………….. Clinical Supervision (Professional Support) Policy & Guidance Page 13 of 15 Carole Waskett LDEV003 v1.0 January 2007 Appendix 3 CLINICAL SUPERVISION – CHILD PROTECTION/CHILD IN NEED Date _____________________________ FAMILY COMPOSITION Surname _____________________________________________ Names Date of birth M/F School ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Address_______________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ _____________ GP ____________________________________ HV/SN _________________________________ Level of Vulnerability ____________________ Other agencies involved ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Clinical Supervision (Professional Support) Policy & Guidance Page 14 of 15 Carole Waskett LDEV003 v1.0 January 2007 SUPERVISION No Issues Discussed ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Action Plan Action Actioned by Timescale Review Date ______________________________ Clinical Supervision (Professional Support) Policy & Guidance Page 15 of 15 Carole Waskett