University of Minnesota - Twin Cities, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
New York University, 1 Washington Square North, New York, NY, 10011, USA.
Adm Policy Ment Health. 2022 Jul;49(4):623-643. doi: 10.1007/s10488-022-01188-0. Epub 2022 Feb 7.
The importance of clinical supervision for supporting effective implementation of evidence-based treatments (EBTs) is widely accepted; however, very little is known about which supervision practice elements contribute to implementation effectiveness. This systematic review aimed to generate a taxonomy of empirically-supported supervision practice elements that have been used in treatment trials and shown to independently predict improved EBT implementation. Supervision practice elements were identified using a two-phase, empirically-validated distillation process. In Phase I, a systematic review identified supervision protocols that had evidence of effectiveness based on (a) inclusion in one or more EBT trials, and (b) independent association with improved EBT implementation in one or more secondary studies. In Phase II, a hybrid deductive-inductive coding process was applied to the supervision protocols to characterize the nature and frequency of supervision practice elements across EBTs. Twenty-one of the 876 identified articles assessed the associations of supervision protocols with implementation or clinical outcomes, representing 13 separate studies. Coding and distillation of the supervision protocols resulted in a taxonomy of 21 supervision practice elements. The most frequently used elements were: reviewing supervisees' practice (92%; n = 12), clinical suggestions (85%; n = 11), behavioral rehearsal (77%; n = 10), elicitation (77%; n = 10), and fidelity assessment (77%; n = 10). This review identified supervision practice elements that could be targets for future research testing which elements are necessary and sufficient to support effective EBT implementation. Discrepancies between supervision practice elements observed in trials as compared to routine practice highlights the importance of research addressing supervision-focused implementation strategies.
临床监督对于支持基于证据的治疗（EBT）的有效实施至关重要，这一观点已被广泛接受；然而，对于哪些监督实践要素有助于实施效果，我们知之甚少。本系统评价旨在生成一个经验支持的监督实践要素分类法，这些要素已在治疗试验中使用，并被证明可以独立预测 EBT 实施的改善。监督实践要素是通过两阶段、经验验证的蒸馏过程确定的。在第一阶段，系统评价根据以下标准确定了具有有效性的监督方案：(a)纳入一项或多项 EBT 试验，以及 (b)在一项或多项二次研究中与 EBT 实施的改善独立相关。在第二阶段，采用混合演绎-归纳编码过程对监督方案进行分析，以描述 EBT 中监督实践要素的性质和频率。在 876 篇已确定的文章中，有 21 篇评估了监督方案与实施或临床结果之间的关联，代表了 13 项独立的研究。对监督方案的编码和蒸馏产生了 21 个监督实践要素分类法。使用最频繁的要素是：审查被监督者的实践（92%；n=12）、临床建议（85%；n=11）、行为排练（77%；n=10）、启发（77%；n=10）和保真度评估（77%；n=10）。本研究确定了监督实践要素，可作为未来研究的目标，以测试哪些要素是支持有效 EBT 实施所必需和充分的。与常规实践相比，试验中观察到的监督实践要素之间的差异突出了研究解决以监督为重点的实施策略的重要性。
