The Matrix

A Guide to Delivering Evidence Based Psychological Therapies and Interventions in Scotland

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Supervision and Governance

Supervision and Governance

Staff delivering psychological therapies and interventions must receive adequate, regular clinical supervision, in line with existing guidelines for the therapeutic modality and statutory regulation provided by professional organisations. This supervision should be of sufficient duration to address all ongoing clinical cases and be informed by routine clinical outcome measures. If supervision takes place in a group format, the time devoted should be appropriately extended. 

Evidence continues to accumulate that the quality of treatment and intervention provided to people who access services will be enhanced by clinical supervision of psychological therapies and intervention. This includes the potential to improve safety and best outcomes through ensuring that delivery of therapy or intervention is in line with the healthcare quality strategy and the evidence base.  

Functions of Supervision

Clinical supervision within the context of psychological therapies and interventions can provide a range of functions:  

  • Supporting decisions about clinical risk 
  • Supporting decisions about managing workload
  • Ensuring psychological therapy or intervention is delivered as described in the best available evidence base (fidelity to model)
  • Continuing to build the practitioners skills and competences
  • coaching new skills
  • restorative and wellbeing function including support for lifelong learning
  • performance management 
  • feedback 
  • Continued Professional Development (CPD)
  • Standardisation or benchmarking (QA) 
  • Code of conduct 
  • Reflective practice 

 

Different types of psychological practice require different support and not all require the range of functions included above. Coaching, for example, supports skill acquisition, promotes fidelity to the intervention and can provide a supportive role for informed and skilled psychological practice. The types of supervisory supports associated with different types of psychological practice are outlined in the table below. Clinical supervision should support the delivery of all interventions and therapies as part of enhanced and specialist practice.  This should be underpinned by routine measurement of outcome.

Developing Effective Supervisors

There is a knowledge and skills set necessary for the delivery of good quality psychological therapies supervision and being a competent therapist does not in itself equip a practitioner to be a competent supervisor. NES has worked in partnership with other organisations to develop a competence framework for Psychological Therapies Supervision

(https://www.ucl.ac.uk/pals/research/clinical-educational-and-health-psychology/research-groups/core/competence-frameworks-8). 

 

Minimum standards for delivery of clinical supervision of psychological interventions and therapies are: 

  • A qualified psychological therapist or psychological intervention practitioner with significant (supervised) experience in the delivery of the therapy or intervention in which they are providing supervision.
  • Has training which equips them with the relevant competences for delivering supervision.

 Further information on the supervision training pathways can be found here (https://www.nes.scot.nhs.uk/our-work/supervision-of-psychological-therapies-and-intervention/). 

Pathways for Supervisors

To support local services including NHS Boards/IJBs to provide supervision capacity, NES has developed a training programme which covers the essential Supervision competences: the NES Generic Psychological Therapies Supervision Competences training (known as the GSC). This is rolled out via a train the trainer model within Health Board areas and Local Psychological Therapies Training Coordinators support selection, delivery and monitor need. Further information on the supervision training pathways here (https://www.nes.scot.nhs.uk/our-work/supervision-of-psychological-therapies-and-intervention/). 

Therapy specific supervision modules build on GSC training, covering additional competences specific to supervision in the main psychotherapeutic approaches (including Cognitive Behavioural Therapy (CBT), Interpersonal Therapy (IPT) and Mindfulness based CBT and psychodynamic psychotherapy) as well as adaptations for supervising psychological interventions is available from NHS Education for Scotland (NES).

Profession specific training can be a requirement of statutory regulation e.g. British Psychological Society requirements for those supervising clinical psychologists in training. An overview of supervisory training is provided below.

Selection Criteria for Supervisor Training

Typically, staff will receive supervision from a more senior and experienced practitioner. The most experienced and senior staff may receive supervision from a peer, with access to specialist consultation where required.   In practice this means staff working in a specialist psychological practice often take on the supervision of staff in training and those working in enhanced psychological practice. However, it is now recognised that those with expertise and experience in some enhanced practice roles, such as Behavioural Activation and certificate level CBT training in adult services who have significant levels of knowledge, skills and expertise in a specific psychological intervention (2 years and/or 200 hours of delivery of the intervention) can provide effective and high quality supervision to colleagues using the same intervention, assuming organisation support and completion of the required training in supervision competences (i.e. completion of the GSC

https://www.nes.scot.nhs.uk/our-work/supervision-of-psychological-therapies-and-intervention/)

 

Competencies relating to adjusting supervision to support enhanced psychological practice are further developed by the NES Supervising Psychological Interventions module – example supervision contracts and competency assessment tools can be downloaded as part of this, but boards may wish to consider their own examples. Those delivering supervision of psychological interventions should complete this module following GSC training. 

Supervision of Supervision

Supervision of supervision is recommended for Supervisors of Psychological Interventions and Therapies. It can support safe and effective practice by supporting stepping up where required, developing supervisor competencies, monitoring delivery of supervision and maintaining links between services. 

Peer and Group Supervision

Where these types of supervision are delivered in groups, training in relation to the competences to adapt practice are described in the following training resource  Group Supervision | Turas | Learn (nhs.scot)