Psychological Services

Implementing a Supervision Model in Community Children’s Mental Health:

Experiences of Supervisors and Practitioners
Karen M. Sewell and Rebekah Ederer
Online First Publication, July 7, 2022. http://dx.doi.org/10.1037/ser0000685

CITATION
Sewell, K. M., & Ederer, R. (2022, July 7). Implementing a Supervision Model in Community Children’s Mental Health:
Experiences of Supervisors and Practitioners. Psychological Services. Advance online publication.
http://dx.doi.org/10.1037/ser0000685
 Psychological Services
© 2022 American Psychological Association
ISSN: 1541-1559 https://doi.org/10.1037/ser0000685

Implementing a Supervision Model in Community Children’s

Mental Health: Experiences of Supervisors and Practitioners
Karen M. Sewell1 and Rebekah Ederer1, 2
1
School of Social Work, Carleton University
2
School of Social Work, Nipissing University

Supervision of staff in the helping professions is valued and considered important for effective service
delivery, with expert consensus that the delivery of high-quality supervision strengthens the social service
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

workforce. The demands of publicly funded settings provide compelling rationale for supervision to protect
This document is copyrighted by the American Psychological Association or one of its allied publishers.

marginalized clients, while ensuring staff are supported in delivering quality services. As conceptual
frameworks, models of supervision are one way to strengthen supervision through intentionally incorpo-
rating theory, best practices, and research. Theoretically grounded and integrative, the Stop Now and Plan
(SNAP) clinical supervision model incorporates best practices, guidelines, and techniques informed by
explanatory and practice theories, and research. This article presents a qualitative study exploring the
experiences of supervisors and supervisees in children’s mental health settings implementing this model of
supervision for an evidence-based intervention. Reflexive thematic analysis was conducted using qualitative
data collected from participant interviews (N = 20) directly following the completion of a 6-month
implementation of the SNAP model of clinical supervision. Identified themes demonstrate the value of a
structured model of supervision in supporting practitioner confidence, accountability, and professional
development, while allowing supervisors to meet their responsibilities to their team and their organizations.
The challenges associated with implementing a supervision model within publicly funded settings are
highlighted, with suggestions for over coming these challenges provided.

Impact Statement
Findings from this reflective thematic analysis of qualitative interviews with supervisors and practi-
tioners following the implementation of the SNAP model of clinical supervision provide insight for
supervision in publicly funded settings.

Keywords: model of workplace-based supervision, Stop Now and Plan, implementation, publicly funded
settings, reflexive thematic analysis

Supervision of staff in the helping professions is valued and
considered important for effective service delivery (Beddoe &
Wilkins, 2019). Expert consensus is that the delivery of high-
quality supervision strengthens the social service workforce
(Akesson & Canavera, 2018); a workforce that is largely publicly
funded in many countries including the United States (U.S.
Department of Health & Social Services, n.d.), Canada (Graham
et al., 2017), and Australia (Australian Government Department of
Social Services, 2020). There are unique demands and considera-
tions of work within publicly funded settings, including clients with
multiple and complex needs, heavy caseloads, time pressures,
resource constraints, and bureaucratic tensions (Marc & Oşvat,
2013). These demands can lead to significant stress, burnout,
Karen M. Sewell https://orcid.org/0000-0002-2577-5019
Rebekah Ederer https://orcid.org/0000-0002-8630-486X
Correspondence concerning this article should be addressed to Karen M.
Sewell, School of Social Work, Carleton University, 507 Dunton Tower,
1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Ottawa, ON M5S 1V4,
Canada. Email: karen.sewell@carleton.ca
turnover, and reduced quality of care (Milne & Reiser, 2021).
This context provides compelling rationale for supervision to protect
marginalized clients, while ensuring the support for staff in deliver-
ing quality services (NASW & ASWB, 2013).
Ideally, workplace-based supervision offers practitioners oppor-
tunities for support, professional development, and administrative
oversight (Beddoe et al., 2016; Kadushin & Harkness, 2014).
Practitioner outcomes are enhanced through these three functions,
which then lead to enhanced client outcomes (Kadushin &
Harkness, 2014). While supervision in publicly funded settings
has been a noted available resource, researchers have documented
the diminishing receipt of supervision focused on professional devel-
opment (Bogo et al., 2011; Sewell et al., 2021; Wilkins et al., 2017),
including little attention paid to supervisory best practices and
evidence-based practice elements (Bailin & Bearman, 2021; Choy-
Brown & Stanhope, 2018; Schriger et al., 2020). To address concerns
of less than optimal supervision in organizational settings and
limitations to the supervision evidence-base, scholars identified the
need for articulating and evaluating models of supervision to provide
guidance for practice, including the specification of theoretical
base, policies, processes, activities, content, frequency, and training
(Beddoe et al., 2016; Carpenter et al., 2013; Hoge et al., 2014).

1
 2 SEWELL AND EDERER
Responding to these calls in the literature, this article presents a
qualitative study exploring the experiences of supervisors and super-
visees in children’s mental health settings implementing a model of
supervision for an evidence-based intervention (EBI).
Models of Supervision
Often reported, supervisors are rarely exposed to models of
supervision grounded in theory and available evidence, nor do
they have the benefits of specific, supervision training (Carpenter
et al., 2013; Egan et al., 2018; Hoge et al., 2014; Wilkins et al., 2017).
Rather, their practice is based on the supervision they have received as
students or previously within their careers. As described by Bernard
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
and Goodyear (2019), models are conceptual frameworks to guide
This document is copyrighted by the American Psychological Association or one of its allied publishers.
supervisors in a range of areas including organizational contexts,
supervisee needs and development, and therapeutic orientations.
Many models of supervision have been developed for students,
trainees, and practitioners. Yet, as Falender and Shafranske (2017)
asserted, “Scholarly opinion and writing has outpaced implementa-
tion and empirical support.” (p. 86). There is a dearth of information
regarding the models of supervision used in supervision research, a
gap also reflecting the realities of understanding model use in practice
(Pollock et al., 2017; Watkins, 2020). Following their systematic
review of clinical supervision models for allied health professionals,
Pollock et al. (2017) concluded that a specific model of supervision
could not be identified as a result of insufficient evidence. In con-
ducting a content analysis of available psychology supervision
models, researchers identified fifty-two as describing what occurs
within supervision, however, only seven (13%) were empirically
tested with the focus predominately on construct validity and structure
rather than supervisee or client impact (Simpson-Southward et al.,
2017). When it comes to the workplace-based supervision of staff,
articulation and evaluation of supervision models are emerging within
the implementation science literature.
Implementation Science and Supervision
The evidence-based movement has influenced human services
through the imperative to use the best research evidence to inform
interventions (Fixsen et al., 2009), such that governments and funders
explicitly prioritize and support the use of EBIs (Healthy People
2030, n.d.). Implementation science has evolved to inform the real-
world service delivery of EBIs through effective strategies to realize
sustainable benefits (Proctor, 2017). Workplace-based supervisors
have a role in these efforts (Birken et al., 2018; Dorsey et al., 2017).
While EBI program purveyors typically offer initial training and
consultation, workplace-based supervisors have the opportunity and
responsibility to provide guidance, practice skills, observe and moni-
tor program delivery (Bunger et al., 2017; Weisz et al., 2018).
Supervisor activities can promote skill development, including dis-
cussing interventions, role playing, and constructive feedback
(Bradley & Becker, 2021).The development and evaluation of
EBI-specific supervision models incorporating these activities can
direct workplace-based supervisors to focus on client outcomes;
program fidelity; practitioner competence; professional development;
and emotional support to ultimately enhance the supervision provided
in community-based, publicly funded settings (Hoge et al., 2014).
EBIs are well-suited environments for evaluating supervision
because of the emphasis on a culture of evaluation, specificity,
measurement of outcomes, and attention to implementation which
are often associated with EBIs. Research on intervention-specific
models of supervision is relatively recent, and predominately focused
on the development and maintenance of practitioner competence and
enhanced client outcomes ( Bearman et al., 2017; Dorsey et al., 2013,
2017), highlighted in a brief review of the available literature.
In a study of supervision within multisystemic therapy for
youth, supervision was associated with increased practitioner adher-
ence to EBI delivery, which correlated with a reduction in client
behavioral concerns (Schoenwald et al., 2009). Martino et al. (2016)
found increases in Motivational Interviewing (MI) competence for
practitioners in the Motivational Interviewing Assessment (MIA):
Supervisory Tools for Enhancing Proficiency (STEPs) supervision
group, but this did not impact client outcomes. Through training
agency supervisors in using a program-specific model to supervise
therapists in the delivery of the Child STEPs program, Weisz et al.
(2018) found therapists sustained previous levels of program fidelity
and client outcomes. Concerned with supervisory model implemen-
tation, Saldana et al. (2016) piloted the R3 model for child welfare
EBIs (i.e., Keeping Foster and Kin Parents Supported and Trained;
and Parenting Through Change). Findings demonstrated feasibility of
the model implementation supporting improved supervisor fidelity
over time, as well as model acceptability by agency leadership.
Giannopoulos et al. (2021) conducted a study of cognitive behavioral
supervision to support an EBI in addiction services. Practitioners
received three 1-hour supervision sessions which resulted in increased
self-efficacy and program fidelity in their work with clients. Together,
these evaluations within EBIs demonstrate the value of model-
specific supervision for improving practitioner outcomes. Little is
known, however, about the experiences of supervisors and practi-
tioners in implementing these models, and how these outcomes can
translate more broadly across publicly funded settings.
The SNAP Model of Clinical Supervision
As presented previously, the first author developed a clinical
supervision (CS) model as a supervision enhancement to support
the implementation of the evidence-based Stop Now and Plan
(SNAP) model for children with disruptive behavioral concerns
and their families (Sewell, 2017, 2021). The SNAP intervention
model comprises two gender-specific, systemic programs (SNAP
girls and SNAP boys; with consideration and accommodation for
transgender children) focused on self-control, problem-solving, and
emotion regulation (for details, see Augimeri, Walsh, Donato, et al.,
2018; Augimeri et al., 2014). Its evidence-base led to the SNAP
model being chosen by Public Safety Canada to replicate in 100–140
communities (Augimeri, Walsh, & Slater, 2018). In a survey of
Canadian SNAP supervisors and practitioners, participants reported
supervision occurring and valued by most participants, although the
frequency and content was highly variable (Sewell, 2020). The state
of supervision in the SNAP EBIs provided opportunities to enhance
the quality of supervision through an approach focused on the
supervisory relationship and engagement in activities supporting
competence and EBI fidelity.
The purpose of supervision within the model is to provide clients
with the best possible service through supporting staff in the
implementation of the SNAP interventions, while attending to
their emotional and educational needs (see Sewell, 2017). The
CS model provides participating supervisors the benefit of training,
 IMPLEMENTING A SUPERVISION MODEL IN COMMUNITY PRACTICE 3

structure, and tools to engage in supervision as per supervision
best practices which specifically align with the intervention deliv-
ered by the practitioners they supervise. The CS model builds upon
the empirically established importance of the supervisory relation-
ship (Beinart, 2014; Kadushin & Harkness, 2014; Tangen &
Borders, 2016; Watkins, 2017), as the mechanism of supervisory
input in learning and performance. The model presupposes that
the relationship is central to enacting competencies required for
delivering the SNAP intervention with fidelity, to realize beneficial
client outcomes. Theoretically grounded and integrative, the CS
model incorporates best practices, guidelines and techniques
informed by explanatory and practice theories, and research. Pro-
viding direction for supervisors and setting the stage for evaluation,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Within the CS model, the dimension of structure comprises
supervision standards outlining supervisory training, a resource
commitment for biweekly individual supervision, and the comple-
tion of a contract prompting a focus on the supervisory relationship,
expectations, and responsibilities. Expertise is an articulation of
supervisor competencies to support practitioner competence, with
supervisor self-assessment directing training and consultation.
Process specifies the semistructured supervisory session format
outlining best practice activities and content. This format directs
a check-in for collaboratively setting the agenda and attending to
the relationship, goal setting and review, skill practice, review of
work, client discussions and conceptualization, administrative
tasks, and solicitation of feedback (Accurso et al., 2011; Borders,

the CS model operationalizes supervision within the SNAP inter- 2014; Dorsey et al., 2013; Milne et al., 2011). A feasibility study
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ventions through the dimensions of structure, expertise, and process; examining the implementation of the CS model in six SNAP
with supervisory training, consultation, and tools (see Figure 1). sites (n = 6 supervisors, n = 21 practitioners) established partial

Figure 1
The SNAP Model of Supervision

Note. SNAP = Stop Now and Plan. From “Theoretically Grounded, Evidence-Informed Clinical Supervision
for the SNAP programs: A Model in Development,” by K. M. Sewell, 2017, The Clinical Supervisor, 36(2), pp.
340–359 (https://doi.org/10.1080/07325223.2017.1352549). Copyright 2017, Taylor & Francis Ltd. Reprinted
by permission of Taylor & Francis Ltd, http://www.tandfonline.com.
 4 SEWELL AND EDERER

demand, acceptability, implementation, proof of concept related Table 1

to increasing practitioner competence, while documenting chal- Supervisor and Practitioner Demographic Characteristics
lenges to practicality (Sewell, 2021).
Supervisors, % Practitioners, %
Characteristics (n = 6) (n = 14)
The Present Study
Demographic characteristics
The first author (Sewell, 2021) assessed the feasibility of the Age
SNAP CS model based on postquestionnaire data, in addition to 25–29 years old — 35.7 (5)
30–34 years old 16.7 (1) 42.9 (6)
pre–post competency and supervision ratings collected during the 6- 35–39 years old — 7.1 (1)
month study period. To build on this work, the present study’s 40–44 years old 16.7 (1) —
purpose was to gain a richer, more an in-depth understanding of 45–49 years old 16.7 (1) —
the experiences of participants in implementing the SNAP CS model 50–54 years old 16.7 (1) —
55–64 years old 16.7 (1) 7.1 (1)
of clinical supervision in publicly funded children’s mental health
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Missing 16.7 (1) 7.1 (1)

settings. The following research questions guided this study: (a)
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Gender as self-identified
What are the experiences of supervisors and practitioners in Female 100 (6) 85.7 (12)
implementing the SNAP CS model of supervision to support their Male — 14.3 (2)
work? and (b) How do participants report their practice was Race/ethnicity as self-identified
White 66.7 (4) 35.7 (5)
impacted as a result of their supervision during the study? Black 16.7 (1) 35.7 (5)
Indigenous peoples 16.7 (1) 14.3 (2)
Guyanese Indian Canadian — 7.1 (1)
Method South Indian — 7.1 (1)
Professional characteristics
Within a pragmatist research paradigm concerned with highlight- Experience in children’s mental health (years)
ing experiences and the consequences of inquiry (Kaushik & Walsh, < 1 year — 21.4 (3)
2019; Morgan, 2014), reflexive thematic analysis (RTA) was con- 1–2 years — 21.4 (3)
ducted using qualitative data collected from participant interviews 3–5 years 16.7 (1) 28.6 (4)
directly following the completion of the feasibility study. RTA is an 6–10 years — 14.3 (2)
11–15 years 33.3 (2) 0 (0)
appropriate approach given it is a flexible method that allows for > 15 years 50.0 (3) 14.3 (2)
considering the data both inductively and deductively to generate Highest level of education completed
meaning and identify central concepts (Braun & Clarke, 2019). The College — 21.4 (3)
study was approved by the first author’s doctoral university research Undergraduate university 50.0 (3) 35.7 (5)
Masters university 50.0 (3) 42.9 (6)
ethics board. Professional discipline
Given the importance of reflexivity and subjectivity in RTA, we Social work 50.0 (3) 71.4 (10)
located ourselves as researchers. The first author (Karen M. Sewell) Psychology 16.7 (1) 7.1 (1)
is social work academic with an extensive practice background and Child and youth work 16.7 (1) 14.3 (2)
research interest in supervision, along with a solid understanding of Other 16.7 (1) 7.1 (1)
the supervision literature with which she approached the data.
Additionally, she developed the CS model as part of her doctoral
research. At the time of writing this article, the second author Data Collection
(Rebekah Ederer) was in her final research placement in a Master
of Social Work program. She had limited experience of supervision, The first author conducted phone interviews following a 12-
allowing for an “outsider” perspective to augment the analysis. question semistructured interview guide, with slightly different
questions and prompts for supervisors and practitioners. Interviews
ranged in time between 12 min and 40 min, with an average time of
Participants 21 min. All questions were open-ended, for example, What can you
Directly following each participating site’s completion of the tell me about your experiences in implementing the CS model? Did
feasibility study requirements, all active study participants were the supervision you receive change as a result in implementing the
purposively sampled for the interviews. The first author sent recruit- CS model, and if so, how? What processes supported your supervi-
ment information via email. In addition to the inclusion criteria for the sion (practice)? What processes were problematic for your super-
original feasibility study (i.e., being employed at a community-based vision (practice)?. Interviews were audio-recorded and transcribed
organization with a Canadian SNAP affiliate site; being a supervisor verbatim. All interviews were conducted prior to beginning the
or practitioner; and actively implementing the SNAP intervention at data analysis.
the time of the feasibility study), participants had to complete the
feasibility study. Eligible participants were offered $10 coffee cards
Data Analysis
as compensation. Twenty participants (n = 6 supervisors, n = 14
practitioners) representing all six sites in the feasibility study con- We followed Braun and Clarke’s six steps of RTA (Braun &
sented to take part in the qualitative interviews. The sample represents Clarke, n.d., 2006, 2019). For the first step, we familiarized our-
a 100% response rate for supervisors and 67% for practitioners. selves through multiple readings of the interview transcripts. We
Participant recruitment and interviews occurred between March and separately coded the data set during step two, comparing our codes
December 2019. See Table 1, for sample demographic characteristics. to guide reflexive discussions and enhance our understanding of the
 IMPLEMENTING A SUPERVISION MODEL IN COMMUNITY PRACTICE 5

data. In step three, we collectively generated initial themes. Step four
involved reviewing the themes across the data set. We then named
and defined the themes in step five. The final step involved writing
the findings. We engaged in multiple methods to enhance trustwor-
thiness, including regular peer debriefing with reflexivity discus-
sions, maintaining an audit trail, and memoing (Nowell et al., 2017).
We met twice weekly through our 6-week analysis period. We used
the memos we kept individually to guide our discussions regarding
thoughts and questions about the data. We had explicit conversa-
tions about power differences between the researchers, especially
considering the student status of RE. The memos served as a prompt
to encourage and explore our differing perspectives to further
engage each other and the data to nuance our findings. While not
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overall structure and relevant activities, influenced their practice and
work with clients.
Aspects of the Model as Transformational
Many participants described how aspects of the CS model,
including regularly scheduled sessions, predictable format, role
playing with supervisors, and watching videos of their practice,
increased accountability, promoted use of reflection in practice,
heightened awareness of competence, increased collaboration, and
contributed to their motivation to engage in self-care. For some, the
influence was far reaching. One supervisor described how the
structured nature of the CS model transformed the way that they

reviewed by others, we used our audit trail to document our research

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undertook supervision which allowed for greater depth in under-

decisions which we revisited regularly throughout the analysis
process.
Findings
All study participants reported on their experiences implementing
the CS model over a period of 6 months, and how these experiences
influenced their practice. We identified three themes within the data
which are depicted with their subthemes in Table 2. We named
themes using direct participant quotes, followed by a brief descrip-
tion of their meaning.
“Important for Supervisors to Follow a Model”:
The Value of Structured Supervision
Many participants commented on the value the structure of the
SNAP model brought to their work, and how they felt this was an
important way to approach supervision; in the words of one
practitioner, supervision became “more intentional” (P14). Benefits
were described by both supervisors and practitioners. Some super-
visors described how the structure of the model enhanced their
consistency in delivering supervision which in turn enhanced
worker accountability. Practitioners highlighted the value of con-
sistent supervision, both in terms of frequency and knowing what to
expect. Many described how aspects of the model, including its
Table 2
A Summary of Findings
standing their team members and the clients they served, stating,
“this model allowed me to see areas for growth of staff : : : I don’t
believe that I would have been so structured and been able to do
[supervision] as effectively if I did not have this model” (S05). Other
supervisors described a smaller change and saw the model as an
enhancement of their previous supervisory practices. One supervisor
said, “the model was very similar to what I was already doing. It was
just a little bit more organized and a little bit more formal” (S20).
Many practitioners noted the change in the structure of supervi-
sion under the CS model. Some thrived with a more structured
approach, as noted by one practitioner, “it was nice to know that
every other week it’s coming up, kind of thing. Having the structure,
it was more predictable. When we talked, I knew what to expect”
(P12). Some described an enhanced experience, shifting the focus of
supervision, “[previously it was] disjointed supervision, really not
feeling like it was giving you any type of direction based on your
questions specific to SNAP : : : It wasn’t really focusing on your
job” (P08). Others found the more structured approach difficult to
adapt to and feared missing out on casual supervisory exchanges
they were used to, problematically described by one practitioner,
“I need to ask this question : : : it’s like okay we only have this date
at this time so we’re going to wait for supervision for that” (P16).
Many practitioners commented on how CS model activities
contributed to their professional development and were transforma-
tional for their overall practice. Some noted that engaging in these
activities was uncomfortable, yet they had the biggest impact on
their work: “I definitely think the role play and watching videos were
the parts I didn’t like the most : : : it sounds scary, and you don’t
want to do it, but it is helpful in the long term” (P07).

Themes
Important for supervisors to follow
a model: The value of structured
supervision
The challenge is getting it all
done: Navigating the realities
of publicly funded settings
Made them vulnerable:
Accommodating unique
characteristics
Subthemes
Aspects of the model as
“transformational”
Promoted collaboration and
enhanced clinical focus
Contribution to confidence,
professional development, and
competency focus
Commitment to different program
areas and high case loads
Regular contact and informal
supervision
Navigating ongoing relationships
Buy in and adjustment to the model
Meeting supervisory needs
Promoted Collaboration and Enhanced Clinical Focus
Practitioners often described how the CS model promoted collabo-
ration with their supervisors and enhanced their clinical focus. Some
practitioners described how the model improved communication,
which led to a clearer focus within supervision on how to approach
challenging clinical situations with clients. Referencing the ways the
CS model promoted collaboration, one worker said, “there was that
constant feedback on both sides [between practitioner and supervisor],
and communication” (P14). Another relayed a conversation with her
supervisor about a challenging session with a client,
[my supervisor said] if you can give an explanation that makes sense,
then she [supervisor] was like, okay, that’s your perspective, and this is
your report, and this is your client, and this is the work you’re doing,
 6 SEWELL AND EDERER
I see how you got there, so you know the client best, and she really
respects that and I think that’s really important. (P11)
A few supervisors explicitly stated that the CS model was “more
directed, and it was more clinically focused” (S03) than their
previous supervision. The enhanced clinical focus prompted by
client conceptualization and outcome review seemed to benefit
practitioners, providing clarity for their clinical practice. One worker
said, “it was really good to have [supervisors] clinical input.
Particularly, I think it was a good problem-solving type of time,
so it really informed, clinically, how I should go forward with the
cases” (P18). Some practitioners directly translated supervisory
experiences to working with clients, as noted by one participant,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
“I used to hate role plays as well but now I actually do it a lot more
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with more clients” (P07).
Contribution to Confidence, Professional
Development, and Competency Focus
Many practitioners and supervisors noted an improvement in
confidence, professional development, and competency focus
under the CS model. A supervisor referenced this occurring
through supervisory activities, considered a “mix of validating
and challenging” (S02). Another described how the role-playing
aspect of SNAP was an effective tool for supervisors to reframe
difficult client interactions and improve worker confidence, “I think
it gave them a lot more confidence [role playing] and also really
helped them because it was about something that had gone kind of
sideways. It really helped them to process the situation” (S01).
Some practitioners described how engaging in supervision follow-
ing the model changed their confidence levels, ultimately contrib-
uting to their professional development.
I’ve never really been open to the idea either of having live supervision
or recorded supervision. So, having SNAP being recorded sessions, it
was actually kind of nice to see things that went really well, things that
didn’t, and then you could talk it out of how you could do things
differently. (P06)
Most supervisors further described how the CS model enabled
them to provide more competency focused supervision, in turn
nurturing a competency focus within their team. “We did goal
rating every week, so we all had a competency rating form that we
used every week to talk about, here’s our goal for SNAP, our
SNAP competency goal” (S04). Practitioners described how the
focus on competency made feedback feel practical and helped them
not feel “judged” or “guilty” about receiving constructive
feedback.
I like constructive feedback : : : I didn’t feel I was being judged. I think
that it had that kind of growth measurable focus where this is what we’re
looking at. So it wasn’t about a style in general, it was about a
competency in general. (P08)
And this approach to competencies translated into their work, as
noted by one practitioner,
being able to reflect on your competencies : : : I think that having the
opportunity to do that in supervision or otherwise, is obviously going to
impact your work because you’re going to be more conscious of it and
more focused on it. (P11)
“The Challenge Is Getting It All Done”:
Navigating the Realities of Publicly Funded Settings
Participants noted the challenge of balancing supervision with
the fast-paced environment and “competing demands” (P18) that are
the reality of so many publicly funded settings. While valuing
supervision, at some point during their interviews, almost all
participants described challenges related to working in their settings
that required accommodating high caseloads, commitments to other
program areas and organizational tasks, multiple meetings, and
navigating ongoing relationships.
Commitment to Different Program Areas and
High Caseloads
There were two dimensions to this subtheme, one related to
being pulled in different directions, at times needing to choose
between supervision and assigned work. The second dimension
refers to the need to discuss these work demands in supervision
which at times meant not being able cover all outlined CS model
activities.
Most supervisors and many practitioners highlighted the
demands of the job, and how these demands either made
scheduling difficult or interfered with the intended frequency of
supervision. Having multiple different teams to supervise meant
one supervisor did not always meet as regularly as she would
have liked, “because it’s dividing my time, I’m in two different
program areas : : : The job is different so it’s separating out the two
: : : They both require a lot of time” (S4). For practitioners raising
workload issues, finding time to meet with their supervisor was
reported to be problematic as they felt it took time away from their
other responsibilities, including time with clients. As shared by one
practitioner,
All of the things that we have to do—treatment plans, preparing for
group, having individual sessions with parents and children. There is a
lot to do, so trying to find time [for supervision] was sometimes difficult
: : : we also had agency things. (P15)
A couple of practitioners reported the time commitment was not
initial seen as useful, with one noting, “Taking that time off from
somewhere, and adding it into supervision, you don’t see the
benefits of it except in the next few months” (P14). The benefits
which surfaced over time related to getting support for the
clinical work, as well as managing the demands of the job.
When it came to engaging in all supervisory activities, a couple
of the supervisors and practitioners commented on prioritizing
their time together based on high caseloads, and the need to
engage in pressing discussions related to client work. One supervi-
sor reported, “we did a lot of case management : : : . Some weeks, I
had planned to do more competency-based feedback, but there were
bigger issues happening” (S01). If reprioritizing did not occur, a
couple of practitioners found following the model at those times
was not particularly helpful, “felt like some things were, like, part
of conversations were shorter in order to fit other things that, maybe
in that particular session, weren’t as necessary” (P11). A couple of
supervisors also spoke about the time requirements to prepare for
video review which meant they did not participate in this activity
as frequently as they would have liked. This was particularly true
for these supervisors when organizational demands were high, as
 IMPLEMENTING A SUPERVISION MODEL IN COMMUNITY PRACTICE 7

one shared, “sometimes it’s hard to keep up with the videos, in terms
of reviewing them and going through the adherence and then
providing feedback and then sitting with the staff to go through
parts” (S02).
Regular Contact and Informal Supervision
Participants from most of the teams raised the structure of their
teams and the nature of their work as being conducive to regular
contact through meetings and opportunities for brief informal
supervisory discussions outside of formal supervision sessions.
Participants wanted to highlight that SNAP teams meet regularly
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
multiple roles, turnover, ongoing relationships, team dynamics, and
supervisors as the face of the organization.
Turnover meant supervisors were sometimes required to take on
frontline roles when teams were short staffed. This had an impact
on supervision, as stated by one supervisor, “I think where the
challenge is in the SNAP [CS] model is I’m not always watching
the video because sometimes I’m running groups” (S04). As shared
by one worker, having ongoing relationships crossing multiple roles
has the potential to be beneficial within the supervisory
relationship, “I worked with my supervisor as a colleague : : :
We worked together for 3 years before she became a supervisor
: : : we know how each other work” (P09). The opposite can also
impact supervision, although the CS model including the contract

to discuss aspects of their work, including agency information,

was noted as helpful by some participants in defining roles and
This document is copyrighted by the American Psychological Association or one of its allied publishers.

treatment planning, group facilitation, and paperwork requirements.

ensuring a clinical focus in supervisory sessions.
For some, this meant that at times the content outlined in the
Supervisor expertise influenced practitioner response to differing
Process dimension of the model was covered in group contexts.
relationships. A practitioner noted that turnover has meant different
A couple of supervisors commented on how their group meetings
supervisors with different levels of knowledge about the EBI,
impacted the individual supervision sessions and adherence to the
“we’ve been through a few supervisors. This one was really in
CS model, “So, the problem in terms of implementing was : : : we
tune to what SNAP was : : : It was definitely more helpful [for
would often have discussions, case reviews, that sort of thing,
supervision in being] program specific” (P08). One supervisor spoke
outside of a planned supervision, because we talk about cases
about how team dynamics and members who did not participate in
and stuff in our team meetings” (S02). This time together also
the feasibility study trying to persuade others,“I strongly feel that
led a few of the practitioners to comment on the need for reduced
there was some pressure there for the two others not to do it” (S03).
frequency in meeting for supervision, “then you can speak to more
This supervisor went on to share that this had an impact on one
of your overall work instead of the day-to-day stuff because
staff member who was “actually avoiding, and would cancel
you’re meeting almost constantly throughout meetings just in
supervision, and just not reschedule it.” Organizational and team
general that you have” (P09). The need for individualized
dynamics also influenced another team, with staff engaging in
supervision to complement the group meetings, however, was
nonhelpful interactions distracting from some of the clinical and
also clearly articulated. One supervisor stated, “I don’t think I
development focus of the CS model. This supervisor of this team
would have seen [areas for growth] in a group setting in terms of
shared, “one person who had a lot of complaints, I said, let’s move
a team meeting, and I would have not seen it if I was just doing 5
away from some of the complaints and let’s just focus on your
minutes here and there” (S05).
work” (S04).
When it came to implementing the CS model, the availability and
proximity to their teams meant some supervisors adopted an open-
door policy. This was welcomed by their team members, and meant “Made Them Vulnerable”: Adapting
that immediate concerns were addressed promptly, as exemplified in and Accommodating
the words of this practitioner,
While it was clear that the CS model was beneficial for super-
Because the set-up in our office is we’re all in the one office together, visors and practitioners in the study, participants also described the
and [our supervisor] is quite open to us just coming to her with any kind need to adapt to a new way of approaching supervision, noting that
of questions or anything as they come up so most things are dealt with in “buy-in” was crucial. In addition, the competency focus, observa-
the there and then. (P13) tion of work, and skill practice elements of the CS model raised
vulnerabilities and required flexibility within the structured model in
Supervisors spoke about readjusting this practice, retaining an open-
adjusting the supervision process to accommodate the unique
door policy for emergencies and urgent matters, but asking team
characteristics of practitioners and supervisors in order to meet
members to save content which was not urgent for supervision
their needs.
sessions. Initially, this was met with some resistance by certain
practitioners, however, when effective, this was more efficient for
supervisors, “it cut down when I do my team time, my team Buy in and Adjustment to the Model
administration time, it was a way I could redirect the things
Similarities existed between the previous supervisory practice
appropriately into an individualized supervision conversation, espe-
on a couple of teams, whereas for the others, individual formal
cially when it was related to skill development of a staff” (S03).
supervision was novel. Regardless, the CS model was considered a
new approach that required attention and staff “buy-in” by all
supervisors and most practitioners; in the words of one supervisor,
Navigating Relationships
“you have to sell them that it will be useful” (S05). In fact, some
While this subtheme was less reflective of the entire data set practitioners on two teams refused to participate in the study or
than others, important contributions from participants illuminate engage in supervision as per the CS model, although indications
some of the realities of engaging in a structured model of supervi- from these staff and their supervisors suggested this was related to
sion with staff in publicly funded settings. These realities include organizational factors or preconceived ideas rather than the
 8 SEWELL AND EDERER
information provided by the supervisors. One participant shared
insight for why this might have been the case, “I think from an
employee perspective, for people who don’t have a lot of supervi-
sion experience, it sounds like ‘I’m being monitored’” (S04). Clarity
and preparation in the presentation of the CS model, and in begin-
ning a new practice of supervision generally, were lacking for some
participants. This was evidenced in a quote by one practitioner, “all
of a sudden you have it introduced it’s like, what, what are we
doing? I think it’s getting it up and running and getting people
comfortable and familiar with it” (P08). It was through being
open that practitioners realized benefits from the model, “I wasn’t
really sure about it : : : At first, I thought it was a little too structured
maybe or too much content that needed to be discussed, but really,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
in the end I quite appreciated it” (P06). One supervisor shared
This document is copyrighted by the American Psychological Association or one of its allied publishers.
considerations for others interested in implementing the model,
really think through how they want to present it with their team, to spend
a lot of time on that contracting process and make sure that it’s a really
organic conversation and that they are really understanding from their
staff, how do you want to participate in this? What does it look like?
What are your apprehensions? And that they spend time and work with
the people that they have to figure out how to address those challenges,
because certainly, some people, took a lot longer to get on board than
others. (S01)
Supervisors’ qualities and their approach to the CS model
contributed to practitioners’ responses to its implementation. The
most noteworthy of these supervisor qualities included being
knowledgeable, open, nonjudgmental, encouraging, and a good
listener. These qualities encouraged vulnerability and engagement
in supervision,
[my supervisor] had a lot of experience in that, so it wasn’t me trying to
navigate it on my own. I could call on her expertise to really help me in
those areas : : : I didn’t feel judged by her, so I really did kind of lay it
on the line. (P18)
Furthermore, across multiple supervisory activities, it was evi-
dent that the supervisor’s approach and lead in supervision was
reflected in practitioners’ perspectives. When one supervisor
provided rationale for not following part of the CS model, a
couple of practitioners also provided reasons in their interviews,
noted by one of the practitioners, “I didn’t want to role play
just because I find it easier doing it in the moment and from the
heart or whatever” (P12). The opposite was also true. One of the
supervisors shared the need for practitioners to gain comfort in
role playing, which was mirrored by one of their team members,
not many people I know where [role playing and watching your work] is
a natural comfort zone : : : This is your time where you can really have
that one-on-one and break things down and do it. Keep an open mind to
the different tools or the different ways she is going to push you out of
your comfort zone. (P10)
Meeting Supervisory Needs
First and foremost, practitioners shared the importance they
placed on supervision and the desire for supervision to be focused
on their needs, “Supervision is not a time to get off topic. It really
should have a plan and out of that I should be left with some tasks or,
I should be left with some positive and constructive feedback.”
(P08). This practitioner contrasted individual sessions with their
group meetings, “this supervision model was more about your
growth than the team’s growth so it’s more specific about you
and what you were doing and how that could improve and what
skills you needed.” And, it was in the context of these individual
sessions that practitioners could bring forth their struggles, “your
own personal concerns : : : that you are dealing with. You would
have that privacy” (P15).
In terms of meeting the different developmental levels of practi-
tioners (e.g., new, experienced), most supervisors spoke to the
flexibility inherent in the CS model which allowed for individually
tailoring aspects of supervision, including competency and profes-
sional development goals. One supervisor stated,
I have two veteran staff, who’ve been doing it a long time. I have
another staff who did a placement [with the SNAP developers], so
knows SNAP really well. So, there are other aspects that she’s maybe
focusing on. Then, I have one brand new to SNAP and to this role here.
So, I think in that way it was a nice way to support each at every
level. (S02)
In contrast, another supervisor highlighted the fact that the CS
model was not a panacea,
one person in particular wasn’t super participatory : : : She would just
express whatever I said, but didn’t really engage in the process. And so,
part of that issue is she’s very near to retirement : : : I found that a bit
challenging. (S01)
When it came to supervisors meeting their responsibilities, they
clearly noted how the CS model further enhanced their work. One
supervisor who was relatively new labeled the model a “leveraging
tool,” reporting that,
My team had been there for a long time. They were rigid and set in their
ways : : : it was a really great tool to say : : : this is the expectation or
requirement you have agreed to do it : : : I found that was an in. (S01)
Another spoke to the documentation required in the CS model,
and how that better enabled her to engage in performance manage-
ment, “It was also helpful in terms of when we had a staff who
perhaps wasn’t meeting expectations, I was able to go back to that
paperwork” (S05). Overall, however, in the words of one supervisor,
“It has given a nice framework that fits well, of course, with SNAP
and what my intention, certainly as a supervisor, what I want to
accomplish in supervising and supporting staff” (S02). Interestingly,
being part of the research study connected to implementing the CS
model involving training and consultation was a form of support for
supervisors in their work and contributed to the overall assessment
of the CS model “ I really appreciated being able to work through
everything and ask my questions” (S02).
Discussion
Our findings demonstrate the value a structured model of super-
vision can bring to supporting practitioner confidence, accountabil-
ity, and professional development, while allowing supervisors to
meet their responsibilities to their team and their organizations. Our
study also highlights the challenges associated with implementing
a supervision model within publicly funded settings where
employees are often faced with high case loads, multiple commit-
ments, and navigating ongoing relationships (Marc & Oşvat, 2013;
Milne & Reiser, 2021). Ultimately, our findings indicate the need
for a delicate balance between structure and flexibility in supervision
 IMPLEMENTING A SUPERVISION MODEL IN COMMUNITY PRACTICE
based on the characteristics of supervisors and practitioners, and the
demands of the organization.
Not surprisingly, as found in the CS model feasibility study
(Sewell, 2021), our study reflected the themes of beneficial struc-
ture, including predictability and consistency, as well as increased
clinical and competence focus within supervision. The additional
detail provided by participants’ experiences confirm the guidance
provided by following the CS model of supervision and offer
insights to enhance practice, policy, and research.
Identified supervisory best practices (Accurso et al., 2011;
Borders, 2014; Dorsey et al., 2013; Milne et al., 2011) are integrated
in the CS model. Training coupled with the systematic, structured
approach to supervision within the model promoted supervisors’ use
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
of these best practices, many of which participants attributed to their
This document is copyrighted by the American Psychological Association or one of its allied publishers.
development of competence and professional growth. Participants
considered behavioral rehearsal through role playing, and observa-
tion of work, with constructive feedback to be the most beneficial
in this regard. Yet, reluctance and apprehension to engage in these
active learning strategies was common for participants in our study.
Through their relationship and understanding of team members,
supervisors are well positioned to acknowledge, explore, and work
through these responses with their supervisees (Choy-Brown,
2021). Participants also provided insight into how the competency
focus built into the CS model through goal setting and evaluation in
supervision allowed for specific, useful feedback to guide their work
with clients. This is encouraging considering the association
between an awareness of competence and enhanced practitioner
outcomes (Tugendrajch et al., 2021). Participants noted, however,
time for engaging in all activities each supervision session was an
issue when complex situations arose on caseloads. Prevalent in other
studies of supervision in practice (Accurso et al., 2011; Bailin et al.,
2018; Dorsey et al., 2017), case conceptualization is crucial in
supporting study practitioners’ work. Additional research evaluating
the use of supervision models, including case conceptualization and
other activities can provide direction regarding required frequency
and corresponding value.
The CS model is based on one-to-one supervision, different than
many of the group supervision modalities described within the
implementation science literature (Saldana et al., 2016;
Schoenwald et al., 2009; Weisz et al., 2018). Participants in this
study raised practitioner vulnerability, providing support for indi-
vidualized supervision given the importance of the supervisory
relationship as a “safe base” (Beinart, 2014), and the mechanism
for performance and learning which holds tension between chal-
lenge and comfort (Starr et al., 2013). Providing further rationale for
individual supervision, previous research associated effective treat-
ment delivery with the supervisor’s ability to tailor supervision to
the level of supervisee knowledge and skill (Pilling & Roth, 2014).
This is particularly salient given the diverse workforce represented
in this study, the SNAP programs (Sewell, 2020), and publicly
funded mental health settings more broadly (Bailin et al., 2018;
Choy-Brown & Stanhope, 2018; Dorsey et al., 2017). While new
and experienced practitioners experience beneficial outcomes of
supervision, our findings support models with the flexibility to tailor
supervision to the unique developmental needs of practitioners. New
practitioners, or those new to the EBI, may need additional supports
in learning the intervention, whereas experienced workers may need
support in maintaining or further developing their competence, and
9
in their work with more challenging clients, as well as with
organizational stressors.
While individual supervision serves an important function, as our
participants shared, so does the role of team meetings, and informal
supervision. These additional supervision modalities occur regu-
larly, and support practitioners in their clinical work (Choy-Brown,
2021; Choy-Brown & Stanhope, 2018; Dorsey et al., 2017). Dedi-
cating resources, or as supervisors in the study reported, reconfigur-
ing limited available resources, to balance these complementary
individual and group modalities would best serve practitioners in
their work. Reviewing frequency and supervisory content at the
organization level can promote the best use of dedicated supervisory
resources. Resources, however, are an issue in publicly funded
settings. As found in our study, supervisors take on a multitude of
roles. When staffing shortages occur, supervisors often take on
practitioner responsibilities in providing direct service which creates
additional strain and time demands reducing their availability to
other staff (Tullberg & Boothe, 2019). Given research associated
turnover with high caseloads and a lack of support, including
supervision (Beidas et al., 2016), adequate resources dedicated to
both staffing and supervision are required to provide the best
possible service to clients. While not definitive, research supports
the link between supervision and client outcomes (Bambling et al.,
2006; Keum & Wang, 2021; Schoenwald et al., 2009), further
justifying this resource commitment.
While active implementation strategies are crucial for the adoption
of EBIs (Bunger et al., 2017; Powell & Beidas, 2016; Proctor et al.,
2013), implementing a model of supervision to support this work
must also attend to these strategies as well as implementation
facilitators and barriers. Study participants’ experiences support
the use of a range of such strategies, including assessing readiness,
increasing buy-in, identifying and addressing barriers, further plan-
ning for the implementation, tailoring the model to meet affiliate
site’s needs, identifying “early adopters” to share successes and
trouble shoot problems (Kirchner et al., 2020; Powell et al.,
2015). As the findings from our study demonstrate, the supervisory
dyad is embedded in and influenced by the larger organizational
culture and structure. And this is a particularly important consider-
ation in publicly funded settings, where supervisory relationships
evolve as they span long periods of time and roles (e.g., peer transition
to supervisory position, committee membership) and are also influ-
enced by the participants’ relationships to the agency as a whole.
Resistance can be built over time, and union considerations dictate
how performance is managed. Clearly presenting the CS model for
practitioners, including the theoretical and evidence-informed under-
pinnings, positioning supervision as a resource rather than “monitor-
ing,” transparently addressing evaluation, discussing the benefits of
the active learning strategies, and inviting discussion around concerns
can support the planning and implementation processes.
While the CS model was developed explicitly for a children’s
mental health program, and our findings relate to supervision as
per the model in this context, the findings can be examined for
transferability to other publicly funded settings serving adolescent
and adult populations. Future research exploring the implementation
of supervision models across publicly funded settings serving a
range of populations is needed, as is further evaluation of these
models with respect to implementation, and outcomes for practi-
tioners, clients, and the organizations providing these services.
 10 SEWELL AND EDERER
Limitations
While all eligible supervisors participated in this qualitative study,
there was a portion of eligible practitioners (33%) who chose not to
complete interviews. This may represent a participant bias and impact
the transferability of study findings. Furthermore, participating super-
visors were not asked about their previous supervisory training, nor
whether they engaged in supervision as per a model prior to im-
plementing the CS model for this study. While they were asked about
changes to their practice as a result of implementing the CS model, the
influence of previous training or other models is unknown. As earlier
noted in the Methods section, the first author has extensive supervi-
sion practice experiences and developed the CS model as part of her
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
doctoral education. This prolonged engagement with the topic en-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
hances credibility yet introduces the possibility of researcher bias.
This influence of bias was explored through both authors indepen-
dently coding, generating and searching for themes while engaging in
peer debriefing and reflexivity discussions to come to understand and
address issues of power. As earlier noted, we engaged in addition
methods to further enhance credibility and trustworthiness.
Conclusion
Practitioners in publicly funded settings serve marginalized cli-
ents while managing challenging and often stressful workplace
demands. Supervision contributes to practitioner outcomes, which
can ultimately protect and best serve their clients. Finding mechan-
isms to incorporate best practices and evidence in supervision has
the potential to enhance practitioners’ competence, confidence, and
professional development, as well as provide support for difficult
work environments. The SNAP CS model is one example of a
structured approach meeting the supervisory needs of participants in
this study. These participants’ valuable experiences of implement-
ing the model, along with evidence and understanding from imple-
mentation science, provide insight and guidance for supervisors,
EBI developers, and policy makers.
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Received August 7, 2021
Revision received March 25, 2022
Accepted May 11, 2022 ▪