October 21, 2022

Increasing supervision quality with measurement-based care

How can clinical supervisors use progress monitoring to improve the quality and efficiency of their supervision?

For anyone managing a group of therapists, maintaining quality clinical supervision in your practice is one of the most important responsibilities you have. Supervision is how you mitigate risk, help your therapists grow their competencies, and ensure that clients are receiving the care they need. In short, supervision keeps you in touch with what’s happening in your practice. 

It’s no surprise that one of the questions we get most frequently from group practice owners is, “Can I use the data we’re gathering with Blueprint to improve my supervision practices?” 

Contemporary models of clinical supervision view progress monitoring as an essential component of quality supervision - we asked measurement-based care (MBC) expert Dr. Antoinette Giedzinska to help us explain how.

Measurement-Based Care is a breakthrough in the supervisory model

According to Dr. Giedzinska, MBC offers a crucial third perspective that supervisors aren’t getting with conventional supervision. 

Antoinette Giedzinska, Ph.D.

“People talk about self-report data being flawed, which is true,” she says. “Patients - and supervisees - will tell you what they think you want to hear sometimes. If you don't have the data, you just have that one self-report. The data can either affirm the observation, or it can bring up inconsistencies.”

Novice clinicians are developing a range of skills, and may not have the ability to identify the most pressing issues.

“If you think about psychotherapy,” she says,  “there's definitely a skill component, but there's an art to it as well. In this way, supervision is often based on just listening and paying attention. But as supervisors, having measurement-based care data to support the process can help to substantiate your own observations about the developing skills of your supervisee.”

How to talk with supervisees about Measurement-Based Care

Although MBC facilitates better supervision, it can be intimidating for new clinicians. 

“A lot of times,” Dr. Giedzinska says, “clinicians are afraid that they're going to find out that they're not as good as a clinician as they thought they were.”

This phenomenon is completely expected and normal. There are ways to introduce MBC data usage to supervisees that make them feel more comfortable, though. Dr. Giedzinska recommends that supervisors normalize MBC by treating it like any other clinical tool instead of establishing it as the central component of supervision.

“If you think about it,” she says, “Clinicians have really diverse tool chests, right? They work with a lot of different tools: their skills, their listening, and their knowledge of formulation of ideas and theories of change. Measurement-based care scale is nothing more than another clinical tool.”

The use of MBC data in supervision can also be normalized by connecting it to the training new clinicians received in graduate school.

“When you were doing your training with the one-way mirror, you had the class watch you do therapy. And then after the therapy session, they gave you feedback. Measurement-based care is just one more line of feedback.”

Finally, supervisors should emphasize that clinical work is based on research, and the data isn't personal.

“The supervisor could say: hey, if we were medical doctors studying diabetes and we did glucose measurements every week on our patients because we gave him a new medication, we’d be monitoring change. ‘Is the glucose level responding well to the medicine?’. But if the sugar level increased after a week of using the medication, as doctors, we wouldn’t say, ‘Oh my God, what's wrong with me?’ Instead, we’d talk about what they're doing. Are they, are they sneaking snacks? Are they taking it every day at the right time? It's the same thing with measurement-based care.”

What to look for in the data

There are a few key metrics supervisors should keep an eye on when working with novice clinicians. Therapeutic alliance is one- and Dr. Giedzinska emphasizes the importance of both client and clinician regularly filling out the assessment.

“If there is a disconnect, that's an opportunity. It's not punitive. It's an opportunity to explore what it is the therapist is seeing and thinking that might be different than what the patient is feeling.”

She also encourages supervisors to keep an eye on their supervisee's caseload trends.

“What a supervisor needs to do is look at trends. What are the trends? What is the extent of the change? What is the difference overall? Are patients making big drops and improvements? Is it a steady change? How long is it taking them to get there?”

Assorted Tips

One of Dr. Giedzinska’s most important tips is that supervisors shouldn’t give the data too much power. Don’t let it tell you that your supervisees are bad therapists, she says, but do let it guide your conversations.

“Clinicians should not assume that the data is a direct representation of their skillset,” she says. “It’s not a report card.”

Finally, Dr. Giedzinska believes in celebrating progress whenever possible.

“If they are making strides and their patients are consistently improving - the clinician thinks that they're improving and the clients say that they're improving and the data substantiates that they're improving- I think you need to celebrate that. Tell them: You're doing a great job! Look at this!”