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We are very good at taking care of others… but how well do we prioritize care of ourselves and our colleagues?

Posted By Natalie Levkovich, Sunday, March 10, 2013

As the name of our association proudly declares, Collaborative Family Healthcare Association has always seen the patient & family as integral to collaborative care. Long before the language of Patient-Centered Medical Home seeped into our lexicon, CFHA endorsed the centrality of the patient, the family and the community as determinants in the health of the population. Through research, policy and practice, CFHA has steadfastly advocated for the universal adoption of the values and practices that integrate a patient-centered perspective into the delivery of care. Effective adoption of this perspective requires providers to be proficient, efficient, present, compassionate and empathic in the practice of their profession.

So, as providers collaborate with patients, families and colleagues, what impact does their daily experience have on them as individuals, on their practice, on their families? As they offer support to their patients, absorb their stories, apply their professional judgment and implement empirically-supported interventions to help patients reflect on their goals and adopt more effective problem solving strategies, who helps the provider to reflect on the impact their work has on them? CFHA blogs and presentations have been devoted to the needs of family caregivers. What about the needs of professionals? Regrettably, in many if not most settings, little attention is paid or time set aside for clinical or reflective supervision.

Reflective supervision (RS) is particularly well suited to address the impact that repeated exposure to vulnerable patients and stressed environments has on the practitioner. RS seeks to embed reflective practice in the supervisory experience as a way to model parallel process and the inter-relatedness of all the relationships involved in collaborative care, including those of providers with supervisors as well as providers with patients/families and colleagues.
Reflective supervision
Reflective supervision is particularly well suited to address the impact that repeated exposure to vulnerable patients and stressed environments has on the practitioner.

In fact, the supervisory relationship should mirror the desired relationship between provider and patient. RS specifically attends to the emotional content of the work and how providers’ emotional responses directly affect the care they deliver. RS practices involve establishing an expectation of regularity, emotional safety, validation and collaboration that includes a supervisor guiding the supervisee, in the context of case review, to examine his/her own feeling and values and how to use that self-awareness to serve the best interests of the client.

While the mode and nomenclature of RS grew out of early childhood services, the importance of reflective practice as a critical component of effective practice is also noted in literature about education and supervision of healthcare practitioners (see Patricia McClure’s article "Reflection on PRACTICE) Growing evidence of the importance and efficacy of RS for identifying and reducing burnout, vicarious trauma and secondary traumatic stress is resulting in its gradual spread to other fields of human service. To learn more, read a brief but excellent white paper that outlines the practices and values of RS as a trauma-informed practice and provides additional references. Further, The National Child Traumatic Stress Network endorses RS as a critical component of preventing and addressing secondary traumatic stress among workers who are affected by repeated exposure to their clients’ traumatic histories, see here.

CFHA has begun to include sessions on trauma and trauma-informed practice in recent conferences. The Adverse Childhood Experiences Study was discussed at several sessions during the 2012 Annual Conference in Austin, TX. Now, as we continue to expand our audience and partnerships, the time has come for CFHA to integrate the needs of providers, beyond self-care, into our education and advocacy for strengthening systems of collaborative care. I hope that CFHA will take up the cause of making supportive supervision both a provider right and a necessity when striving for the gold standard in health care. Our 2013 Annual Conference in Denver presents an opportunity to advance this conversation. As the conference committee considers workshop proposals to accept and plenary speakers to invite, they should include clinical supervision as a priority. I challenge the conference planners and prospective presenters to consider this question with the same thoughtful approach that CFHA devotes to all of its work.

              See here, for an example of Reflective Supervision relevant to an integrated care setting.


Natalie Levkovich

Natalie Levkovich is a CFHA Board Member and was a co-chair of the 2011 CFHA conference in Philadelphia.  She has served as the executive of the Health Federation of Philadelphia (HFP) for nearly three decades. HFP is the SE Pennsylvania network for community health centers that provides comprehensive primary care to nearly 300,000 low income and underserved individuals per year. Under her leadership, HFP has experienced remarkable growth through the development of many innovative, collaborative initiatives such as the integration of behavioral health in primary care, including widespread implementation of a sustainable clinical, payment and professional development model.

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Sean T. Hearn says...
Posted Monday, March 18, 2013
I like this. It sounds somewhat like Balint groups. I think it would prevent burnout and actually enable us to provide better care for our patients not just globally as practitioners but in minute by minute interactions with patients. It will make us hear them better as we hear ourselves better. S.T.Hearn MD
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Sharon Bursky says...
Posted Thursday, June 27, 2013
I really enjoyed reading your post and I agree with you. Majority of the supervision I have personally experienced is less reflective and much more directive. The reflective supervision seems so valuable in working with these types of patients and families. Providing care to our patients and the supervision we receive should be more of an isomorphic process, as you described above. You discuss how the supervision relationship should mirror the working relationship we have with our clients. What a productive way for supervisors to model collaboration for clinicians who are working with families and the medical system. I agree that this type of supervision would surely reduce burnout and the potential for secondary traumatic stress.
Thank you for posting.
Sharon Bursky, M.A., LMFT
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