Clinical Supervision: A Potential Implementation Strategy to Improve Implementation Climate

Abstract

Implementing evidence-based treatments (EBTs) in community mental health settings has been challenging. A positive EBT implementation climate—employees’ perception that EBT use is expected, supported and rewarded in their organization—could lead to EBT uptake. Clinical supervisors may shape their clinicians’ perceptions of their organization. This study assessed whether EBT-focused supervision and supervisor- and clinician-level factors affect EBT implementation climate. Clinicians were randomized to supervision conditions: Symptom & Fidelity Monitoring (SFM) alone or SFM + Behavioral Rehearsal (BR). Along with supervisors, they completed self-report measures at baseline and follow-up. Relationships between predictors and EBT implementation climate were examined using a two-level multilevel model with random effects at the supervisor level. Greater self-efficacy in supervising was associated with a more positive EBT implementation climate, particularly when supervision involves monitoring both client symptoms and clinician fidelity as well as incorporating role-plays. Thus, EBT-focused supervision practices combined with certain supervisor characteristics (e.g., self-efficacy) show promise—as a strategy—in facilitating a positive EBT implementation climate.