Discuss: Reflective Supervision

Home Visiting for First Time Parents - State's Children, Youth and Families Dept. has required that all home visitors receive regular reflective supervision and also provides monthly support for reflective supervisors via conference calls with consultants trained in reflective supervision. As one of the consultants, I've been imprssed by the growth among the supervisors and their insights regarding how this regularity has supported quality service provision to the families in their programs. I hope some of them join us in this discussion!

NM IDEA, Part C (Family Infant Toddler Program) providers are more consistently seeking support related to reflective supervision and providing their early intervention staff with regular supervision. A number of programs have invested in training some staff members in infant mental health/relationship-based practice principles including reflective practice principles. In part as a result of that training, these programs have seen relfective supervision as an essential component of program practice. Implementation is an ongoing challenge but there is a clear committment among a number of programs.

Can you share the benefits of reflective supervision in detail for your staff?

What does training look like?

What amount of time is involved in the process?

Hello Rose,
I work as a consultant to various state systems in NM so really cannot comment on benefits to my staff - I have invited the home visiting program supervisors to particiapte in this discussion but have not seem any sign on so far.

In terms of training, NM is also licensed to use the MI-AIMH competencies and endorsement system and we have defined reflective supervision in keeping with those competencies and training we have received over the years (go to www.nmaimh.org <endorsement materiasl> to see our definition.

We have also very much been influenced by Victor Bernstein's and Mary Claire Heffron's work on reflective supervision. Although we have regular training related to reflective supervision concepts, I am fairly certain that the supervisors would say that they learn most by providing supervision while receiving reflective supervision that supports their own skill development over time. I know that has been true for my own professinal development as well.

Home visitng programs provide weekly (either group or individual) supervision to their staff and the supervisors receive monthly superivsion support through conference calls in groups of 4-5 supervisors per consultant - we are a large rural state so conference calling has served us well.

There may be more variability in our IDEA, Part C programs in terms of time allocated for supervision. I am just getting started with some new groups with that system so will have a better idea in a few months.

Hi Again Rose,
I've remembered some evaluation comments I gathered from a group supervisors a few years ago that might answer your question about benenfits. They were asked: "Describe changes in service quality that you've noticed and attribute at least in part to your increased competence with reflective supervision?" and answered:

* The staff is now discussing families with more insight into how they interact with them as well as how they interact with their babies. They have become more aware of how their own presses can get in the way of truly observing and experiencing the family and the simple special moments that they can be a part of. They come back and now, in addition to discussing possible concerns, they are excited about sharing the times when mom and baby connect.

* Staff is able to see her role in a session beyond that of providing case management.

* As a new program I think we are still working on some of the basic issues (boundaries, etc). As mentioned, we are still pretty "green" as a group in this area of reflective practice. However, it has become apparent that staff is more aware of their responses, themselves as individuals in the work. I feel that we are making slow but steady and consistent progress. I would not want to jump ahead in this process without giving the process the time and experience that it requires.

* Staff are more willing to explore relationships with clients which results in better focus on the client's needs and less focus on staff trying to "steer" clients a certain direction. It also has allowed staff to interject less of their value system on the client.

* Staff is asking to think about cases together

* Staff are able to dialogue with one another, using the common terms that helps all of us know that we are talking about the same thing.

* Staff are becoming more aware and "honest" in recognizing their own presses and how to manage them when visiting with families as well as when communicating with each other.

*Staff ask and report on conversations with families that demonstrate increasing skill with using open ended questions, following the families agenda vs their own and using supervision to identify their own triggers work these through and come up with different ways to approach their work...I think the biggest impact is that staff make the distinction between their agenda and let that go to follow the families agenda...it is the parallel process...if I let go of my agenda as a supervisor and follow the home visitors lead...they experience what that feels like and understand how that will help them with their work with their family.

* I'm still very much in a steep learning curve in applying techniques of reflective supervision. The minimal change I would identify is that I am now more conscious of wanting to come up with reflective questions in the moment. Can't always do so.

* We are just learning the process of reflective supervision. It is too early in this process to give examples.

* Staff, including myself, are better able to identify our "presses" and, at this point in our reflective practice (we are still new at this) we are able to begin to articulate our responses to these presses. We are also currently, as a group, discussing boundaries, personal and professional.

* I am seeing qualitative changes/improvements in case reviews that are suggestive of greater awareness and reflection on the part of our staff.

I hope this helps, at least anecdotally, give you some idea of the benefits supervisors see.

Jacqui, I think that feedback such as this can assist us in thinking about the kinds of impacts we hope to see as a result of reflective supervision. Do others have similar "data?"

Is there data from research that supports the benefits of reflective supervision/mentorship? Are there studies that show staff retention or positive outcomes for children and/or families when reflective supervision was implemented?

Hi, Barbara

I have never found research on reflective supervision. I have found some studies that seem to be related ie on supervision or mentoring for new teachers, or for nurses,or for counselors that addresses some elements of RS. I think your question points to a gap in the evidence base for our work. But maybe others will know of some studies?

Dear Nancy,

Maybe other participants will weigh in on this. I'm hoping to encourage further studies so we can have data. I have personal experience that RS aids the work with families and young children. I have seen the benefits but it is anecdotal evidence, we need that evidence. Agencies accept the benefit of training and will spend their money. It is more difficult to "sell" the idea of funding reflective supervision.

Barb,

I remember a while back someone contacted me and was looking into doing some initial research. I just remembered that. I did not hear back from him, so perhaps he was unable to pursue the idea.

Anyone else? You are right, this lack is a definite barrier.

Nancy, I think that you might have been contacted by Tom Pav and Angie Tomlin of Indiana. They have been working for some time, with me when I have been able, on developing a way to gather information from people across the country who speak about or write about reflective supervision in effort to find out what key components are, etc. Tom has just requested funding for a survey of recognized RS leaders and will soon be contacting those who were identified through infant and early childhood journals, books, etc. as knowledgable about reflective supervision. He can be contacted at:
TPavkov@calumet.purdue.edu

Deb - I think that is the person who got in touch. It's good to learn the work is progressing. Also good to see yours and others' posts with some articles and research references!

I have long been intrigued by this question and have been gathering and reading all that I can in an attempt to understand the existing evidence and evidence from related areas for some writing on supervision that I am in the midst of. So far I am finding that one of the most compelling pieces of evidence comes from the work of Jon Cabat Zinn and others who have shown that a mindful/reflective practice reduces stress and show biological evidence to support that. This lines up very well with the experience of many about the notion of supervision as being regulating for staff and a way for them to de-couple from the stress in which they may have been immersed during home visits. It is not too much of a stretch to connect those. there are also several good reviews of research on reflective practice in the nursing and education field and some interesting work from the mental health field happening in England. I have found no studies specifically from people doing early mental health work although everyone I read says reflective supervision is important. There is one very old study that I often cite about reflective practice in Healthy Families in an early California evaluation that showed a link between regular supervision and staff retention.

I have put together a bibliography of references on this area for a training I am doing today, I am happy to share this and would love to hear from any of you involved or who have ideas about some evaluation studies. I think we need some good studies of this specificially in infant mental health/early intervention to back up what I feel many people have come to find as an essential practice.

Thanks for hosting this important discussion.

Mary Claire

I would like to see your bibliography. It seems we often have to use studies from other fields that are close to but not exactly the kind of studies we'd like to have. I agree that studies of reflective supervision and reflective practice in infant-early childhood-family work are needed.

Hi,
There is a recent research article ...

Geller, E. & Foley, G.M. (2008). Broadening the "Ports of Entry" for Speech-Language Pathologist: A relational and reflective model for clinical supervision. American Journal of Speech-Language Pathology, 18, pp. 22-41.

This article discusses ports of entry as entre to working with supervisees. The authors present a model of traditional and relational/reflective supervision and describe behaviors for both the supervise and supervisor.

Hi Vicki,
As an SLP I'm delighted to hear about SLPs using and benefitting from reflective supervision/mentorship. I will find that article. I'm also excited to see the topic generate interest. Perhaps it will spark more research.

Thanks Linda for this discussion. It is wonderful.

I keep thinking about the research on reflective supervision question and how it relates to Infant and Early Childhood Mental Health Consultation. It seems there is an overlap and that reflective consultation is a big part if not a model for Infant and Early Childhood Mental Health Consultation. There is an article by Brennan, Bradley, Allen, Perry (2008), The Evidence Base for Mental Health Consultation in Early Childhood Settings: Research Synthesis Addressing Staff and Program Outcomes in Early Education and Development. They reviewed 26 studies of staff and program outcomes and found positive results for Early Childhood Mental Health Consultation in early childhood settings. .

Yes, in fact, I think I'm right in saying that the State of CA has decided to use the term reflective consultation or reflective facilitation instead of the term reflection supervision. (Hopefully someone directly involved in developing infant mental competencies there will correct me if I'm wrong.) One important question, then, is what common ingredients or elements exist in each of these processes that is likely to support professionals in becoming more reflective.

California has recently updated a set of guidelines for competencies and training in infant and early childhood mental health. Within that set of competencies there is a new set of competencies related to reflective supervision that we called reflective facilitation in order to avoid legal implications related to use of word supervision. in training settings has been developed. These can be downloaded from Wested.org. In these competencies we tried to elaborate on basic reflective facilitation competencies and add material that will help people providing this activity through training programs, community support groups, etc.

There is an interesting study conducted by Carollee Howes called "Pathways to effective teaching" that includes some interesting components that include reflective supervision. The study was published in Early Childhood Research Quarterly back in 2003, and was some follow up from the "Cost, Quality and Outcomes Study". What the study found was that "40% of the participants experienced reflective supervision. The participants in this study, even those with less formal education than a BA degree, were more responsive and more engaged with children than participants in tow more representative studies."The study also correlated supervision and mentoring with staying in field.

I am not certain of the other types of supervision that was included in this study, as its purpose was to find ways to develop appropriate teaching, vs what types of supervision are the most effective. It would be very interesting and useful to the field to have data to support the type of leadership, supervision, training and mentoring that is the most effective. We have ancedotal information, but very little real data about leadership; and all of its elements in early childhood.

Reflective supervision is addressed in a special issue of the Infant Mental Health Journal (Volume 28, No. 2, Mar-April 2007). The authors bridge the world of early head start and infant mental health, including rich descriptions of programs and including reflective supervision as an essential component for quality service and staff development. Authors include Tammy Mann, Hiram Fitzgerald, Brenda Jones Harden, Neil Boris, Jane Knitzer, Charles Zeanah. It is worth taking a long look at how reflective supervision is incorporated.

The Michigan Association for Infant Mental Health, along with the Texas Association for Infant Mental Health, developed a document in 2004, "Best Practice Guidelines for Reflective Supervision/Consultation." The states who have made a commitment to the MI-AIMH Endorsement process (see above) have revised and adopted this document to guide the development of reflective supervision/consultation opportunities in their states as they embraced the endorsement (revisions from New Mexico, Arizona, Kansas, Oklahoma, Minnesota). The guidelines reflect expert consensus and distinguish between administrative, clinical and reflective supervision/consultation; discuss primary objectives; discuss what the supervisor and the supervisee contribute to the process; suggest competencies for those providing reflective supervision; and list references and resources addressing reflective supervisory processes across systems and disciplines. The guidelines can be downloaded at: www.mi-aimh.org

The Tufts evaluation (Easterbrooks and Jacobs) of Touchpoints Early Care and Education training examines the difference in outcomes between those who received training in the Touchpoints Approach and those who received it along with a protocol for reflective practice that was integrated into the supervisory process of their agencies. There were significant differences between the groups in measures of parent-provider relationships (PCRS) on overall relationship and collaboration subscales, supporting the use of reflective supervision along with training in the approach.

The TP approach is, essentially, a framework for reflective practice. With early care providers it seems that reflective supervision enhances outcomes.

John, have you published outcomes? This sounds so wonderful. Debbie Weatherston

Deb,

I was referencing Ann Easterbrook and Fran Jacobs' final report on their evaluation of the training. I was not involved in the evaluation, but did help develop the training program and continue to do Touchpoints training. I believe that both Ann and Fran have published articles on this, I will send those references when I track them down.

John H

Deb,

As I noted the study is reported in the Tufts final report. It was also reported via a poster at SRCD - Singer, J., Vele-Tabaddor, E., Ayoub, C., & Sparrow, J. (2008). The impact of reflective practice in a developmental and relational intervention on parent-early care provider relationships. Biennial Meeting of the Society for Research in Child Development, Denver, CO.

We have developed materials for both early care professionals and their supervisors based upon the Touchpoints approach to development and relationships with families. One way to view the approach is as a framework for reflective practice in that guiding principles of work with families, articulated at the beginning of the program in the mid-1990's, are applied to reflection about that work. My view is that the principles and assumptions serve as "tools of the mind" that provide a language for reflection. A number of programs around the country have applied these in their supervisory practices. The above study represents the most thorough evaluative look at this via a study with child care programs in Boston.

John H

I have been involved in a large NICHD project at the University of Nebraska for the past 5 years to look at the impact of focusing on the parent-child relationship in low income families with infants, toddlers, and preschoolers. My job was to provide reflective coaching in groups and with individual teachers and home visitors on a regular basis. The experimental group was trained in the triadic approach (PIWI) out of IL, so the reflective coaching centered on that work. A large amount of data is just now being analzyed by the research team and will be available within the next year. Principle investigators are Sue Sheridan and Carolyn Edwards. Project director Lisa Knoche attended practically all of the group coaching sessions over this extended time. She and I debriefed after nearly every session to talk about the reflective process that had to include a focus on the triadic strategies.

I continue to try to understand the relationship between a reflective process that in its purest form originates with the supervisee and his or her issues and experiences as opposed to the type of reflective practice that requires coaching around particular philosophies but has a strong reflective component.

Alice, I'm building on your comment to agree that there are many terms and approaches that refer in some way to the process of reflecting on our work with babies and families. Dathan Rush facilitated an earlier discussion on this site on coaching that you might find useful.

I am currently taking an on-line course related to infant mental health; and it did not take long to see that programs I supervise like Healthy Families Illinois, and Doula program funded by the Ounce--require and have strict guidelines related to caseload of home visitors--that lends itself to having time for quality reflective supervision.

In 2002, after 8 years of work, the Michigan Association for Infant Mental Health (MI-AIMH) launched a competency-based endorsement for professionals across disciplines and who work in many different ways with or on behalf of infants, toddlers and their families. The name of the endorsement is the MI-AIMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health. Nationally recognized for its emphasis on relationship-focused, reflective practice with children birth to three and families, the MI-AIMH Endorsement articulates the importance of reflective supervision to professional growth and development in the infant and family field. Reflection is identified as one of eight core areas of expertise required for best practice;
reflective supervision is required for earning endorsement as an infant family specialist, infant mental health specialist or infant mental health mentor. The Competency Guidelines and information about the MI-AIMH Endorsement is available on the MI-AIMH website at www.mi-aimh.org

The Competency Guidelines and Endorsement establish standards for practice that now guide professional development in 10 states. By purchasing a license to use the standards that place reflective practice and reflective supervision at the center, each state collaborative has made extraordinary commitments to bring reflective practice into their state systems, specifically to mental health, child care, early intervention and child welfare. In Michigan, new policies are in place in the Michigan Department of Health which require staff providing infant mental health home based services to meet criteria and earn endorsement. This means that the programs must offer regular, reflective supervision to home based staff. The change in policy is a dramatic example of how the Competency Guidelines and MI-AIMH Endorsement is shaping reflective practice in the infant and family field.

Challenges? Many. Who will pay for reflective supervision? Agencies providing infant mental health home based services in Michigan must pay for reflective supervision of staff with state dollars allocated for services. The Medicaid rules and regulations stipulate that home based providers must earn endorsement. Reflective supervision is seen now as an integral part of quality service and work force development. Maintaining the support for this will require well-trained practitioners who can provide reflective supervision across the state. Year-long reflective supervision groups for supervisors providing reflective supervision have been offered in Michigan since the Endorsement was launched, with continuing efforts to put reflective supervision groups in place across the state. The effort is just one of many examples of how Michigan has built and maintained support for reflective supervision.

Perhaps we should explore evidence associated with regulated professions that require supervision as a part of becoming licensed to practice. Supervision has always been an accepted (and necessary) component of becoming an effective clinician. What can we learn from other disciplines that incorporate/require this form of support to help build a knowledge base around its relevance and need in many programs/service sectors that serve young children and their families.

Thank you, Deborah for the explanation and background related to the development of MI-AIMH competencies. I came across these awhile back and wondered about how this initiative came about. It's wonderful to hear from so many of our Zero To Three colleagues on a topic that has so much relevance for work across so many sectors of the field.

This is in response to Deborah's piece about the MI endorsement system. Kansas is one of the states that has adopted that system. Our state has been strongly supportive of IMH, so that we have received state grants for the last several years to support our efforts. As we embark on endorsing Kansans utilizing the MI system, we realize that reflective supervision will be one of the biggest demands. We are in the process of setting up regional reflective supervision groups around the state that will mainly serve people who are applying for endorsement. We will utilize our initial endorsed professionals while we train more and review others' abilities to meet the MI criteria for reflective supervision. Cost will be braided through KAIMH's grant funds, programs that need the reflective supervision, and individuals.

I just wanted to add to the discussion some of the things I have been involved in with LA County to build Reflective Practice skills. As a Director at a large community mental health agency, I began by providing reflective supervision, then arranged for on-site and off-site training for supervisors in reflective supervision, and provided maintenance groups by offering reflective supervision for supervisors. California has developed its own IMH competencies and perhaps we will get someone else to speak on that situation. Mary Claire Heffron has been doing a great deal of training in California to build capacity for reflective supervisions. My concern is work force development – creating the skilled professionals to provide reflective supervision and ongoing support for reflective supervisors.

Part II- in my current professional life, I am working at a trans-disciplinary agency and we provide cross/trans-disciplinary supervision. In short the mental health staff are all in a reflective supervision group with SLP, OT and PT professionals. In addition, I am currently charged with the training of reflective supervisors at our site and run on-going supervisors groups to build our skill sets and provide continued reflective process support for supervisor.

Thanks Linda and ZTT, I am enjoying the discussion

So important! Barbara, have you developed particular approaches or materials that you'd be willing to share? Would love to hear from others of you who are taking on the job of training and supporting supervisors.

Linda, I wish I were that organized. I began these groups out of necessity about 4 years ago. Now I am running groups as a skill building and support network for supervisors. The supervisor's groups run in a parallel fashion and serve the same need as reflective supervision - nurture the nurturer

I am joining the list a little late and would like to share my predicament. I am the Director of an IMH /0 to 5 Services Program and know the benefits of reflective supervision on a personal basis. At the moment I am trying to implement and use this method for everyone in my program and find that I have difficulty with the balancing of the administrative vs. clinical supervision. My staff (5)has 1 hour (can be less than 1 hour)of treatment team (multidisciplinary meeting of other staff), 1 hour of group supervision where we might share issues, vent or get new trainings, etc, and 1 hour of clinical supervision (case specific). I find myself going in and out of the reflective piece and feel that it would be most useful to be implemented in the group supervision. I would like to hear from others how they were able to do it, tips, literature, ideas.
Thanks,
Anggelina

I think the balance Anggelina is remarking on is a common one! It seems as if the most I can do is keep working to achieve a relatively "reflective stance" in as many aspects of my work as make sense. It hasn't worked for me to try to compartmentalize administrative and reflective time very specifically.

At the same time, I can remember times in both group and individual supervision where I've said something like, "I'm needing to be pretty directive here. I have to ask you to ... because ...." I think practitioners find themselves having to flow between more- and less-reflective stances in many aspects of their work and might benefit from joining with us as we're transparent in our process of managing this dilemna.

What an interesting discussion so far! Thanks to all for your contributions about what's happening in your states or programs, about dilemmas you're facing (e.g. moving in and out of reflective/administrative supervision), training approaches you've developed, and resources this group might be interested in. Looking forward to the next several days!

This is a very "important" topic in Palm Beach County as more people have become aware of the benefits of reflective supervision.
Thanks for the opportunity!

Thak You so much Jacqui
Indeed, I find I remind myself to be more reflective and try to reframe my directives. I have to believe it takes practice.

Anggelina, you may be well acquainted to the Journal for ZERO TO THREE publication that focused on "What is Reflective Supervision?" published at the end of the 2007 year. It gives a really good overview or history of the development of interst in reflective supervision, a discussion of kinds of supervision (including reflective), case vignettes from different early childhood, child care and mental health programs, and a discussion of cultural sensitivity. If you have not read it, it would be terrific to find.

Great reference. I certainly will.

Thanks for the plug, Debbie! Here's how to get the issue:

http://www.zerotothree.org/[…]/PageServer?pagename=est_journal or dial 1 800-899-4301

In the Selected Resources section, I've included some additional pieces that have been written since 2000 and might be of interest. Others, please add your favorites and we can build a good bib.

Anggelina's dilemma is one of the most frequently posed questions about reflective supervision: how do I balance reflection with administrative needs? One way to approach it is to embrace reflection as a way of life, not just a task that one does certain hours of the day. By reflection I mean a constant attempt to be aware of one's own manner of seeing, registering and reacting to whatever is happening. It is important to note that this stance is not natural; it never becomes automatic. Our automatic habit is to react to the external environment without awareness of our own activity in making meaning of it. Learning to be reflective is a practice that is larger than supervision. Yet if one begins to internalize the reflective stance in all of life, then Anggelina's dilemma begins to disappear. The internal resistance to reflection starts to dissipate and one is not always automatically drawn to the external details. Even the administrative work becomes reflective. For this reason the groups we have led in Texas, Arizona and California are called Reflecftive Practice Groups -- not because we "practice" reflective supervision, but because we intend to make reflection a daily practice.

Hi Bill,

I have to agree with you. As part of my clinical training I learned to use reflection to sharpen my skills & apply a systemic view to my work. I've been focused on the separation, (the parts)instead of the whole (connections). It is about seeing myself included in the whole. No wonder it felt more challenging, like swimming against the current. Very good feedback!

The Iowa Department of Management Office of Empowerment has funded the University of Iowa School of Social Work National Resource Center for Family Centered Practice to develop an eight-day training on strength-based supervision for family support supervisors from a variety of program models. This month, we piloted a five hour block of training on reflective supervision. The training includes a DVD of Iowa family support staff demonstrating both traditional and reflective supervision (with discussion of the merits of both), an exercise in reflective listening, a careful look at the steps of reflective supervision, time to develop reflective questions for the participants' program model, and additional skill practice. Supervisors comment that the find reflective listening requires a lot of discipline. Some of the evaluation comments were helpful:

"Good overview on how to incorporate reflective listening into supervision in a way to assist staff in professional growth and gaining self confidence in the decisions they make in working with families. It’s a good concept to use along with traditional supervision for the most effective supervision."

"Role play was helpful to actually put to practice the strategies --harder than you think."

"Will take a lot of practice for me as I typically just put out fires and move on to the next fire."

"Everyone always talks 'reflective supervisor' but this actually put some examples and meaning behind it for me.

Lisa D'Aunno, Director of Training, University of Iowa National Resource Center for Family Centered Practice, lisa-daunno@uiowa.edu

Lisa, are any of the training approaches/materials (DVD, etc.) that you have developed available for others to review or get copies of? Do you have any initial insight about what worked particularly well in your 5-hour training? Thanks in advance for your response!

The question of where to find the evidence is very important, but the responses so far might indicate that right now it is a bit premature, since the current evidence seems neither as broad nor as deep as one might wish. Perhaps the proper question for now is: how do we hold the conversation between those who do research and those who do reflective supervision so that the research can move forwrd in ways that are both rigorous and substantive? Maybe what we need to address first are questions like what are the most important aspects, measures, outcomes, etc.? How can we set up a collaboration between clinicians and researchers that optimizes the insights of both groups? We might also bear in mind that, as in the case of say Head Start, some of the most important results of reflective supervision may not appear for a number of years. In short, the evidence we look for may not be something we can find on a literature search but something we need to contsruct.

Obviously, the question of how we begin to conceptualize and build an evidence base for reflective supervision has struck a chord. Bill, your idea of bringing clinicians and researchers together to think carefully about what we would like/need to know and how best to learn these things is intriguing. What are others' thoughts?

Linda Eggbeer

Thanks to Linda for serving as our Guest Moderator for this discussion and to all of the participants--what a rich discussion!

Linda, can you comment on the definition of reflective supervision that you have used and how it compares to the one we've posted as a starter definition in our Wiki?

This is such a rich discussion. I wonder if there is any research in the fields of mental health, which has used this form of supervision for many years.I like Bill's idea of bringing together clinicians and researchers. I am sure that the brain research could add something to this conversation. What is it about about two people or a group helping each other as they struggle to grow?

Be happy to. I see that Jonathan has re-posted it! When I first looked at it, I noticed the differences in language from what we typically use to describe the process. We talk about reflective supervision as "a relationship for learning." It affords the opportunity to explore with another - on a regular basis - the feelings, personal values, knowledge base, and behavior that come into play in work with babies and families. The centerpiece involves the capacity to combine our disciplinary expertise with the ability to create strong relationships with important adults in the baby's life. The goal of supervision is to improve practice and that, of course, can mean many things.

Before going on too long (and I certainly can!), I'd like to invite my ZTT colleagues and others to jump in.

Linda, I think that ZERO TO THREE, "league" and others could facilitate a meeting between key clinicians and researchers who could talk together and in the process frame questions that would lead to better understanding reflective practice and to building a collaborative research effort that might result in an evidence base that could inform practice and reassure funders. A two day meeting might be fruitful, with key people - clinicians who have knowledge and experience in reflective practice as well as researchers with a commitment to the infant and early childhood mental health field. I remember having conversations with Emily about a meeting place in Wisconsin, Wingspread-span??, that groups apply to for funding such a group gathering. It invited reflection and small group conversations as I recall. I agree with Bill's remarks about reflective practice becoming part of one's approach to life and also know that it takes time and attention and support to become "reflective" personally and professionally. If we want to build an evidence base for RS, we, the practitioners, will need to be partners in the process and perhaps get the process started. I like your ideas, both Linda and Bill.

You have a good memory, Debbie! It's the Wingspread Conference Center in Racine, WI. Would indeed be a perfect place to meet, relax and take the time to think carefully about this important topic. Alternatively, maybe we could set up a time for an initial get-together at the NTI in Dallas in early Dec. Just an idea!

I love this discussion. NTI in Dallas will be a good place to flesh out this important topic.

Hi, Everyone,
What a great discussion! Thank you, Linda.

I've been immersed in writing the intro to an edited book (Gilkerson and Heller)that ZERO TO THREE will be publishing on Reflective Supervision. I found it intriguing to write a short section on "Reflective Supervision and The Brain". After describing mirror neurons and the excitement/growing literature since their discovery a mere 13 years ago, this is part of what I wrote yesterday: "While the research has not yet been done, there is little doubt that between people engaged with one another in reflective supervision, as between monkeys and researchers, and between children and parents, mirror neurons are activated, underlying their empathic, and concentrated exchanges of substance. It also seems likely that the research about co-regulation, ruptures and repairs (Tronick, ; ) will play an important role; when a supervisee is anxious, the experience of being in effective reflective supervision is as a salve on a wound. To date, while there is a substantial literature on mental health supervision and reflective supervision, there has been a paucity of research in the former and almost none in the latter. Nonetheless, clinicians from across the field of zero through five who have experienced it agree on its effectiveness and power. Perhaps during the next decade the neuronal bases for the patterns and processes that occur in reflective supervision will yield novel research pathways."

Now, wouldn't pictures of our brains lighting up and sounds of our neurons firing be a super cool way of studying what's happening at a biological level as we sit there concentrating on cases?!!?
Best to all, Rebecca

A whole new frontier, Rebecca! I think we can all "see" it through your words!

Rebecca, it is interesting to me to think about reflective supervision in terms of the words, "emotion regulation" or "co-regulation of emotions". Isn't that what happens as we are invited to have and express our feelings to someone within a trusting reflective supervisory relationship? "Of course" we might say when we step back and think about the exchange - our own "emotion regulation". We refer pretty easily to "emotion regulation" or "co-regulation" as a function of the parent-child relationship and a mark of competency. Many incorporate this into their work with parents and infants/young children. Responsive parents help infants and very young children learn to regulate their emotions, again within the protective parent-child relationship. We might also talk about "emotion regulation" as a component of the work that takes place between practitioner and parent in infant mental health home based work as parents have and share feelings about the infant, their role as parent, past and present relationship experiences, etc. and in that relationship begin to "co-regulate emotions" - calm down, get centered, understand where the feelings are coming from, find words that hold and contain. It makes sense that we use this phrase when examining reflective supervision, too. I am eager for the book to be out.

In one of the discussion starters posted by Linda, the question is posed about what steps, large or small, have been taken to help staff consider more carefully how they function in their work. As a direct service provider working within an organization that does not offer reflective supervision, I try to help create an atmosphere of reflective practice. When I present about a particular family I'm working with at a staff meeting, I try to model the kind of introspective thinking found within a reflective practice model. I strive to share what I'm thinking, feeling and reacting to, along with how I'm acting with a client family. I believe that as practitioners, we can have impact upon our places of employment. In fact, I believe it is my responsibility to do so given the parallel process that occurs between management and direct staff. In this way, I seek what I need to grow most. My hope is that I am simultaneously modeling reflective practice so that others might feel safe and encouraged to do so. It is here that we learn and support one another--and in turn, gift our families with a parallel experience.

I'm interested in hearing from others who do not receive reflective supervision. What have you done to impact your work environments? To meet your personal growth needs?

Thanks,

Kim

Kim's comment and question offers so much to our discussion! Her willingness and committment to take a reflective stance in her work even when reflective superivison is not offered is a great example of a "little BIG step". I often encounter people who feel the lack of support in their agencies is an insurmountable obstacle to reflective practice. Kim's example shows that is does not have to be. I think there is a wonderful synergy that occurs when you are able to be reflective with colleagues. I also know that no one can be prevented from practicing reflectively in their work and having that reflection enhance their profesisonal growth and the quality of their interactions. It would be good to hear from others who are in situations to Kim's.

Jacqui, I think I had the same reaction to Kim's comments that you did. And, Kim, if you don't mind, I'd like to ask what type of program you're in (child care, other?), how you came to think in this way, and what has been the reaction of your colleagues (management and direct service) as you have shared your work with them?

Thank you ladies, for your very kind words. Linda, I am an LCSW by training (via Michigan State University) and I work with service members and their families (0-5) in a home-visitation program. I have also recently begun to teach in an interdisciplinary Infant Preschool Mental Health certificate program at a local university. I believe I came to think this way as a result of being exposed to reflective supervision in my early learning experiences and since then have been fortunate enough to have amazing colleagues who personify reflective practice (they really "get it"). I participate in a professional grass roots organization called "Earliest Relationships Network: Mental Health Providers for Infants, Toddlers & Their Families" which meets monthly and provides an opportunity to think reflectively. Once the experience of exploring how we think and feel in the context of safe relationships is had, it becomes the blueprint for the professional (and the developing human). Like a plant seeking light for optimal growth, I have actively sought out and create opportunity to understand myself and the relationships I experience. My experience with other's receptivity, whether management or direct providers) is varied--as is my willingness to risk being vulnerable (this is directly correlated with feeling safe or not myself). Mostly though, people engage in the process and are appreciative. Some join in their own reflective journey. Others are not ready and remain closed. Irregardless, relationships and new-found understanding are forged, enabling us to be more fully present and engaged with those we work with.

On a basic level (if that's possible?), I'd be interested in hearing folks reactions to what was a starter definition we offered here a few months back. What are differences/simlarities. It's nice seeing so many examples here. Thanks!

Wiki link: http://community.fpg.unc.edu/[…]/wiki_reflective-supervision

Starter References: http://community.fpg.unc.ed[…]html#reflective-supervision

I have been eading with ineest all ha has bern posted so far in this discussion. It sounds to me as if most of you who are already using this mthod are engaged in dialogue with peopl ho are in the infant mental health and early outreach programs. Reflective supervison seems to me to be the only way to maintainn good comunication with families as well as between team members in such settings--support is the key factor for families and practitioners, and reflective supervison sounds to me like the best way in which to provide that for everyone involved.

I have been reading with interest all that has been posted so far in this discussion. It sounds to me as if most of you who are already using this method are engaged in dialogue with people who are in infant mental health and early outreach programs. Reflective supervison seems to me to be the only way to maintain good communication with families as well as between team members in such settings--support is the key factor in success for families as well as practitioners, and reflective supervison sounds to me like the best way to provide that for everyone involved.
I particularly appreciated Mr. Schaffer's comments on "reflective practice." I am a lab school mentor in a community college two year degree program for Early Childhood Professionals. My speciality is infants, with a minor in toddlers! Students come to the environment that I have created to observe practices that they are learning about in their classes and to spend much more time practicing what they have learned and are learning. As a model and a mentor, reflective practice is about the only way that I have found to do this work--I just did not know what to call it before! My co-teacher, the students, the babies and I all engage in daily observations and conversations about our practices in the classroom and the results that we either achieve or do not achieve. We focus on intention. We focus on being present. We focus on reflection. The quality of the relationships we all have with the children and parents, not to mention each other, has improved immensely since I began to be transparent with the students about this process. Their ability to critically think has been challenged, exercised, and produced much more insightful and in-depth analyses of the environment and the experiences that are there for the infants. The relationships that exist within our small community have become more equal in terms of power and privilege. Students have been more willing to take risks and to challenge me and each other in our process. This has been stimulating for me, and I think that the graduates go into the community with a set of skills that will serve them well in every setting. Getting to this point has not been easy, and primarily it required me to examine myself and to allow myself to let go of control. We all still work very hard, and way too many hours (which seems to be a common thread in this profession) but the outcome is very rich, and it is clear how much the students appreciate knowing about and experiencing reflective practice.

I apologize for subjecting everyone to my extremely poor typing skills in that first start. I wanted to re-read a few comments before continuing and had not yet edited what I had tried to write.

No apology necessary, Kathy! I've read your posting several times and thought how fortunate your students are to have the opportunity to engage with you in such a pivotal time in their preparation. They will surely want and try to find this kind of experience in their ongoing work. You express so clearly what you see happening for all the adults supporting the children in your lab school. I was particularly interested in your saying that you have to allow yourself to give up some control.

I appreciate hearing about establishing reflective supervision in a pre-service training program in early childhood education. The findings I referred to earlier in the discussion, and I do agree with the comment that the research base on this is thin at best, support the notion that reflective supervision enhances the effect of training for child care providers. This may be different for people from disciplines in which such supervision is more typically embedded. For training at the Master's level in ECE, I think it essential that graduates be prepared to provide reflective supervision. The family and personal work involved in caring for other people's children is much improved when this occurs, but it is not standard in that field as it may be for home visiting, early intervention or other more clinical settings.

Hi everyone:

This has been very interesting reading for me on all levels. I am curious to know for those of you providing reflective supervision what kind of training, if any, you have had in RS? I am an education team leader for Early Head Start and have been for the past 1 1/2 years. I have the ZTT Reflective Supervision: A Relationship for Learning (a training video-tape package), the ZTT journal on RS and attended a one hour training on reflective supervision 5 years prior to the role I am in now. We did get the opportunity to have Victor Bernstein come and spend five days over a two month period with our program about four years ago, but the focus was a little different. Prior to my current position, I provided direct services as a family educator for 0-3 and pregnant moms in a home-based option. I know how isolated the work can be for home based and appreciate the value of reflective supervision. It is important for me to do it well, so it becomes valuable time for staff. At this point I still feel pretty inadequate. So, did you receive training (formally, informally, self-taught)or did you just jump in and hope for the best?

Also what are your parameters when it come to reflective supervision? Is the focus strictly around children and families or is it about any topic that impedes an employees' work? The one hour training I attended at an EHS conference referred to the latter, but I want to know what is best practice?

Carrie, You are so brave to ask this. I hope there are more that will be brave enough to answer. Many of us feel inadequate despite years of experience, training, and finding our own style. I consider myself a hybrid that is open to whatever type of group I have and their needs. Linda, Thank you for your reference to the earlier discussion on coaching. My hybrid reflective supervision sometimes includes some of that. I'm a big believer in reflective practice, but find that sometimes people just don't know how to do that. Over months of experience they may learn and put it to good use. For some, it may never work. We have to be brave enough to look at each other's styles non-judgmentally, I think.

Wow! What a fabulous discussion. I feel like a fat cat trying to digest a big meal. I was struck my Bill Schafer's comment re: our need to likely construct a framework for evidence-based research regarding reflective practice "since the current evidence seems neither as broad or as deep as one might wish." In trying to organize the amount of comments that have come in thus far, I see the breadth and depth of reflective practice spanning a wide array. While holding onto the definition provided of reflective practice providing a place to "explore the feelings, personal values, knowledge base, and behavior" that come into play with our work with babies and families, I tried to play with organizing some of the comments thus far to see how they faired with the definition. I took some liberty to come up with some categories...(please forgive me if you feel I wasn't accurate in representing your comments...this is meant to provide the 'gist' of the broad array of meanings and they likley have my twist on them mixed-in).
Reflective practice provides:
1- A relational format for Nurturing the Nurturer (Barbara Stroud and Rebecca Shahmoon- Shanock) wherein the clinician is "held" in an emotional environment which may include mirroring, warmth, and engagement intended to build a safe place for sharing personal, emotional processes in a non-judgmental way; responsiveness is modeled
2- A relational format for identifying our "presses" and articulating our responses to these presses (Jacqui van Horn) wherein the clinician builds an internal holding environment within oneself to contain 'countertransference' reactions and regulate his or her own arousal reactions
3- A relational format for modeling a parallel process of transparency that can be fostered in the facilitator-clinician relationship that parallels the clinician-family relationship by sharing thoughts, feelings & reactions, and actions taken with a family (Kim Flowers, Kathy Stroh)
4- A relational format for experiencing ruptures and repairs (Rebecca Shahmoon-Shanock)where conflict can be expressed and resolved
5- A relational format for model integrity where the reflective practice is also linked to proper use of a clinical model (John Hornstein's comments on Touchpoints and Alice Eberhart-Wright comments on reflective coaching linked with the triadic approach [PIWI])
6- A relational format for forging boundary spanning and cross-disciplinary training (Barbara Stroud, Kim Flowers)
7- A relational format for inspiring critical thinking where ideas and concepts can be challenged (Kathy Stroh)
8- An internal attitude and way of being in the world where one practices the art of seeing, registering, and reacting to what is occurring in real-world, real-time events with intentionality (Bill Schafer)
9- A relational format for critical thinking emerges wherein a meta-analysis of existing clinical models are evaluated up against real-world, real-time complexities in understanding an infant/family's neurodevelopmental needs across multiple dimensions(Connie Lillas)

By ordering these different comments in a particular way, I was playing with the notion that the various nuances listed above could reflect a type of breadth and depth in and of themselves. Perhaps developing the use of one's clinical self across an array of regulatory, emotional, theoretical/clinical competency, and critical thinking levels might be a way to also look at these reflective processes through a developmental lens, showcasing various levels of complexity.
 
My last association went to Buysse (and co-author's) wonderful provision of a definition of 'evidence based practice' which holds the tension between balancing existing research, professional wisdom, and family values - and defines it as a process. It seems to me that a similar part-to-whole framework about reflective practice is essential in order to "hold" the nuances and many ways that reflection unfolds between persons and within individuals. By using a part-to-whole conceptual framework, we could hold the most global picture of the vast variety of processes and also account for the potential details of developing each part and aspect of reflective practice.

I think I've done enough digesting for the time being and I love opportunity to be included in the discussion.

Kudos, Connie - what a brilliant summary that provides a way to organize an intensive examination of the reflective supervision process, broad and deep (to use Bill's words), respectful of the details and the complexity. The introduction of a developmental framework is really thoughtful. It has been my experience that we follow a developmental line in our ability to be reflective about our work and reflective about ourselves. I am not sure this has been well articulated and is something that could be useful for those just beginning in infant-family work, as well as those who have had years in the field. I also love your respect for cross-discipinary work.

I also resonate with the idea of a developmental path along which the motivation and skills for reflection unfold. I think we would all agree that as the infant/family field has developed in all its multidisciplinary "splendor," it has benefitted immeasurably from the perspectives of the mental health professionals who have been such an important part of it. Here we've heard from other folks from a variety of backgrounds working in a variety of settings who seem to be identifying essentially the same elements (and benefits) of a reflective stance to their work and that of those they supervise or have some responsibiity for. Their developmental trajectory, however, is quite different from those who come to the work as mental health practitioners and their work in early intervention, child care, child welfare, etc. calls for them to be creative and determined about seeing that reflection guides the work - perhaps for the first time. And, of course, this process of reflection looks different from place to place. Sooo - is it a useful exercise for us to try to identify its elemental characteristics regardless of setting, disciplines involved, or type of service?

Yes, Linda, I do think that it is useful to tease out the elemental characteristics so that when we talk about this with folks from other arenas, we can be certain that they will develop an understanding of it that is rooted in a common source, a common language. It would also unify the infant/family practice field. But there will be different "flavors" or supervision that come about depending on the setting or role, just like "curry" has a general set of qualities that make it recognizable to everyone, but it also has variations that reflect specific regions or preferences. It would be helpful to have our "own" definition as a field so that we can explain the process in a distinct way, rather than describing how it is like or not like other familiar processes (counseling, clinical supervision, and so on).

Thank you, Alice, for your kind words. I feel a little out of my league when reading other people's comments, but I desire to be excellent and a strong source of support to staff, so they in turn can be excellent in their work with children and families. I cannot grow or improve if I don't ask. I, too, am hoping others will respond to my questions. I appreciate your willingness to share and to be honest with me.

Carrie, I'll try to respond to your question asking, "... what kind of training, if any any, you have had in RS?" This is my own personal and specific answer to your question, and should not in any way be taken as a recommendation, or even a suggestion, about the kind of training necessary to do this work.

For several years while I was teaching toddlers in a laboratory preschool I received weekly reflective supervision. This was not initally directly connected to my work as a teacher, but something I "fell into" while searching for direction for my own professional development. This was many years ago, and to my knowledge, no one was using term "RS", and neither were we. The work we did was specifically focused on helping me to become more reflective and "present" in my work with very young children, and it met many of the criteria for RS that other respondents have mentioned. In time, I began to incorporate refelctive work into my "training" and supervision of student teachers. Time with my own supervisor then focused both on my work with children and parents and on the "reflective supervision" I was providing teachers. I was an apprentice. That work was certainly intense, but I'll leave it to you and others to decide whether or not it meets the criteria for "formal training."

Since then, I have had the good fortune to talk with and observe in action some supervisors whom I consider to be among the best in the business. Watching and listening to them as they work has been informative, enlightening - and humbling! What I have learned from them has been invaluable.

The graduate degree in which I now teach requires students to participate in a weekly reflective group. As a co-leader of this group I have felt the need to receive reflective supervision myself, and to continue to grow my own capacity for reflection. Fortunately, our state infant mental health coalition sponsors a quarterly reflective practice/supervision group. We meet for a day-and half each time. For me, participation in this kind of group feels essential.

I suspect this only partially answers your question, but I hope it helps.
  

Carrie,
I wanted to echo Bill's comments and add a little, too.

I came to Reflective Supervision first in a child care program run by someone who understood the importance of taking a step back to look at the work and the relationships; she also understood that regularity and frequency were components to the "holding" environment that, over time, would build the trust necessary to tackle conflicts. It was understood that this would be all the more necessary because it was a residential program for teen mothers. After years passed, I worked in another program that did not have reflective supervision. I lasted a year. A few years later I had the privelege of working in an infant toddler program that used reflective supervision as the main vehicle for promoting understanding of our very relationship-based model. An evaluation of our program showed that most of the staff, when asked how they learned what they needed to know about caring for children and families in the model we were using, said that they learned it and got good at it in the process of supervision.

During this time, I also took courses that incorporated reflective practice into the learning and teaching methods, which was an important complement to the experiences I was having with my supervisor at work. I would call both of these my "formal training" because I was learning in a reflective way from people who had an exceptional understanding of the process of reflective supervision and the opportunities it provides in a child care setting. Although they may have been taught something of the process in coursework themselves, most of them identified that it is receiving (and then providing) supervision that taught them how to do it.

And I am still struggling and learning...I think that means we are both right on target!

Oh! I meant to answer your last question, too.

In my experience,after a few meetings of venting about personal issues, people naturally bring their discussion around to children and families. If they don't, I open with an observation of something wonderful I saw happening and then ask, "What do you think you did to help that happen that way?"

Everything is valid for supervision, but there comes a point when you wonder if they are circling around something that is too difficult to talk about.

I'd just like to add a couple of thoughts to this wonderful discussion about training in reflective practice. It is very timely for me, having just started a new position at MN Dept of Health called "Reflective Practice Consultant", charged with promoting reflective practice in PH home visiting across the state.

Bill Shafer's comment about the moment-to-moment "practice" of reflection, reminds us to think of professional development as "ongoing experience in relationship" rather than "training", just as we think about the parent's ongoing experience in relationship as opposed to parent training.

The experience over time of being held, or contained, by the trusted supervisor (or home visitor), is what brings about the growing capacity to be reflective in the moment with the parent (or child).

I'd like to encourage us to keep a place in our dialogue about professional development for Infant Observation. This method of "training" allows folks working with parents and their young children a chance to view themselves and their work in a clearer, deeper way. By observing a typically developing parent-child pair weekly over a year or so, new insights and understanding blossoms. Reflection happens! And in the context of a small, intimate seminar led by an experienced facilitator/container, exploration of the experience brings profound new learning.

The emphasis on relationship over time is costly, and runs against the current in our fast-fix world. As we seek the quiet pools of the moment, we also find the strong current of this reflective process. For what we have in front of us at any one moment is what we will/can address-- whether that is a parent and child, a team of staff, or a whole state's system. One step at a time... all together!

Thank you all for this enriching conversation.

Infant-parent observation, over time, with opportunity to share what I saw with another or others has been key to my development toward reflective practice, too. It was an important component of Selma Fraiberg's early training of practitioners in infant mental health and one we adopted to be a component in the delivery of IMH services through community mental health programs, in graduate certificate and non-credit IMH programs in Michigan (other places, too). To be able to observe and talk with another was a very concrete first step for me and an initial competency. A second was learning to truly listen - to what parents and infants/young children told me with words and without words. Sometime later, I began to listen to myself - what was awakened in me as I listened to families- that was pretty revolutionary for someone from early childhood and human development. This took place in a safe and trusting relationship with a reflective consultant and team. A third step was learning to wonder about what I saw and heard, again with the opportunity to share this with another/others. It meant to be quiet, to really think about behaviors, to think about my emotional churnings - the sorrow, the anger, the ambivalence, the anxiety. That required a lot of time and risk and trust. A fourth step, maybe taken at the same time as learning to wonder, was to allow myself to respond, at first to have an emotional response, to name it and then to think about it. How might my own emotional responses inform my understanding of an infant and family? How could this lead to better understanding myself?- important questions - the process was and is complex and requires a great deal of reflective support. Eventually, I began to feel more confident about being reflective, but continue to need the experience of being with another/others to process what I see and hear, feel and wonder about. I agree with something said earlier that reflective practice is not an isolated skill, but a way of being (or something to try for).

I am eager to refine the developmental steps that Linda asked about - although we may enter at different points - it may not be a straight line, rather, circles or loops. We have many people who could help guide this. I hope we might have the opportunity in a variety of ways. Thanks for this interesting venue to reflect!

This is really to add a resource:

Best Practice Guidelines for Reflective Supervision/Con sultation that were developed and refined by leaders in a number of state infant mental health affiliates who are involved with the MI-AIMH Endorsement. The guidelines include brief overview of administrative, clinical and reflective supervision styles; primary objectives; guides for the supervisor and supervisee; and a list of references and suggested resources www.mi-aimh.org

With Julia's and Debbie's recent postings, I wonder if this group would be willing to create a succinct (is this really possible?!) list of core experiences that we believe are likely to support any infant/family professional to become more reflective in her/his work. For now, let's concentrate on professionals already working with infants and toddlers.

I'll start with the opportunity to talk with at least one other person about my fundamental beliefs about child-rearing, particularly in the first 3 years.

I hope everyone will join in. You're welcome to restate the question if you'd like!

I am a Licensed Social Worker in the state of Ohio and work for an agency that provides a Head Start program -- I am looking for training in Reflective Supervision -- preferably with the opportunity to earn CEU's -- any suggestions??