Journal: Supervising Others Take a minute and think about the supervisors you have had in the workplace. What were characteristics of effective supe
Assignment: Journal: Supervising Others
Take a minute and think about the supervisors you have had in the workplace. What were characteristics of effective supervisors? As you reflect on these experiences, consider how supervision affected your ability to complete the tasks associated with your job. Also, think about how leadership styles can influence the relationship between social workers and their supervisors.
For this Assignment, review the Petrakis case study in this week’s video and note how supervisory and leadership skills are portrayed.
Assignment (4–5 paragraphs)
Complete the following Journal entry:
- Identify attributes of leadership styles and approaches that facilitate quality supervision.
- Evaluate the supervisory and leadership skills demonstrated in the Petrakis case study by identifying which supervisory and leadership skills the supervisor demonstrated.
- Explain whether the supervisor in the video demonstrated quality supervision, and why. Provide specific examples to support your evaluation.
By Day 7
Submit your Assignment.
Petrakis Family Episode 4
Petrakis Family Episode 4 Program Transcript
CINDY: She was so upset with me. She told me I was too young to be doing this job– yelled at me.
FEMALE SPEAKER: Well, what set her off?
[MUSIC PLAYING]
CINDY: She found out her son's been getting the refills on his grandmother's oxy prescription and taking the pills himself. He's also been forging her name– withdrawing money from her bank accounts.
FEMALE SPEAKER: OK. I think we need to figure out how to help the client. What's her name again?
CINDY: Helen. She also said that he's been taking valuable from his grandmother's house. What a mess. I'm so sorry.
FEMALE SPEAKER: We need to call APS.
CINDY: Oh, we can't. Helen already blames me for suggesting her son move in with his grandma in the first place. This will just make it worse.
FEMALE SPEAKER: Take it easy, Cindy.
CINDY: This is all my fault. I thought it was a good plan, I really did.
FEMALE SPEAKER: Cindy. Look, I'm your field instructor, and here comes a teachable moment, OK? Advising a client like you did was not a good idea. In fact, it was unethical. But you are not responsible for the actions that other people take.
Helen made her own choice when she decided to go along with your suggestions. Do you understand?
CINDY: Yes.
FEMALE SPEAKER: All right. Our job now is to figure out our next steps. Now, will you do that with me?
CINDY: Yeah, OK.
FEMALE SPEAKER: OK.
©2013 Laureate Education, Inc. 1
Petrakis Family Episode 4
Petrakis Family Episode 4 Additional Content Attribution
MUSIC: Music by Clean Cuts
Original Art and Photography Provided By: Brian Kline and Nico Danks
©2013 Laureate Education, Inc. 2
,
The Petrakis Family
Helen Petrakis is a 52-year-old heterosexual married female of Greek descent who says that she feels overwhelmed and “blue.” She came to our agency at the suggestion of a close friend who thought Helen would benefit from having a person who could listen. Although she is uncomfortable talking about her life with a stranger, Helen said that she decided to come for therapy because she worries about burdening friends with her troubles. Helen and I have met four times, twice per month, for individual therapy in 50-minute sessions. Helen consistently appears well-groomed. She speaks clearly and in moderate tones and seems to have linear thought progression; her memory seems intact. She claims no history of drug or alcohol abuse, and she does not identify a history of trauma. Helen says that other than chronic back pain from an old injury, which she manages with acetaminophen as needed, she is in good health. Helen has worked full time at a hospital in the billing department since graduating from high school. Her husband, John (60), works full time managing a grocery store and earns the larger portion of the family income. She and John live with their three adult children in a 4-bedroom house. Helen voices a great deal of pride in the children. Alec, 27, is currently unemployed, which Helen attributes to the poor economy. Dmitra, 23, whom Helen describes as smart, beautiful, and hardworking, works as a sales consultant for a local department store. Athina, 18, is an honors student at a local college and earns spending money as a hostess in a family friend’s restaurant; Helen describes her as adorable and reliable. In our first session, I explained to Helen that I was an advanced year intern completing my second field placement at the agency. I told her I worked closely with my field supervisor to provide the best care possible. She said that was fine, congratulated me on advancing my career, and then began talking. I listened for the reasons Helen came to speak with me. I asked Helen about her community, which, she explained, centered on the activities of the Greek Orthodox Church. She and John were married in that church and attend services weekly. She expects that her children will also eventually wed there. Her children, she explained, are religious but do not regularly go to church because they are very busy. She believes that the children are too busy to be expected to help around the house. Helen shops, cooks, and cleans for the family, and John sees to yard care and maintains the family’s cars. When I asked whether the children contributed to the finances of the home, Helen looked shocked and said that John would find it deeply insulting to take money from his children. As Helen described her life, I surmised that the Petrakis family holds strong family bonds within a large and supportive community. Helen is responsible for the care of John’s 81-year-old widowed mother, Magda, who lives in an apartment 30 minutes away. Until recently, Magda was self-sufficient, coming for weekly family dinners and driving herself shopping and to church. But 6 months ago, she fell and broke her hip and was also recently diagnosed with early signs of dementia. Through their church, Helen and John hired a reliable and trusted woman to check in on Magda a couple of days each week. Helen goes to see Magda on the other days, sometimes twice in one day, depending on Magda’s needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications. Helen says she would like to have the helper come in more often, but she cannot afford it. The money to pay for help is coming out of the couple’s vacations savings. Caring for Magda makes Helen feel as if she is failing as a wife and mother because she no longer has time to spend with her husband and children. Helen sounded angry as she described the amount of time she gave toward Magda’s care. She has stopped going shopping and out to eat with friends because she can no longer find the time. Lately, John has expressed displeasure with meals at home, as Helen has been cooking less often and brings home takeout. She sounded defeated when she described an incident in which her son, Alec, expressed disappointment in her because she could not provide him with clean laundry. When she cried in response, he offered to help care for his grandmother. Alec proposed moving in with Magda. Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John and Alec had been arguing lately, and Alec and his grandmother had always been very fond of each other. Helen thought she could offer Alec the money she gave Magda’s helper. I responded that I thought Helen and Alec were using creative problem solving and utilizing their resources well in crafting a plan. I said that Helen seemed to find good solutions within her family and culture. Helen appeared concerned as I said this, and I surmised that she was reluctant to impose on her son because she and her husband 20 SESSIONS: CASE HISTORIES • THE PETRAKIS FAMILY seemed to value providing for their children’s needs rather than expecting them to contribute resources. Helen ended the session agreeing to consider the solution we discussed to ease the stress of caring for Magda. The Petrakis Family Magda Petrakis: mother of John Petrakis, 81 John Petrakis: father, 60 Helen Petrakis: mother, 52 Alec Petrakis: son, 27 Dmitra Petrakis: daughter, 23 Athina Petrakis: daughter, 18 In our second session, Helen said that her son again mentioned that he saw how overwhelmed she was and wanted to help care for Magda. While Helen was not sure this was the best idea, she saw how it might be helpful for a short time. Nonetheless, her instincts were still telling her that this could be a bad plan. Helen worried about changing the arrangements as they were and seemed reluctant to step away from her integral role in Magda’s care, despite the pain it was causing her. In this session, I helped Helen begin to explore her feelings and assumptions about her role as a caretaker in the family. Helen did not seem able to identify her expectations of herself as a caretaker. She did, however, resolve her ambivalence about Alec’s offer to care for Magda. By the end of the session, Helen agreed to have Alec live with his grandmother. In our third session, Helen briskly walked into the room and announced that Alec had moved in with Magda and it was a disaster. Since the move, Helen had had to be at the apartment at least once daily to intervene with emergencies. Magda called Helen at work the day after Alec moved in to ask Helen to pick up a refill of her medications at the pharmacy. Helen asked to speak to Alec, and Magda said he had gone out with two friends the night before and had not come home yet. Helen left work immediately and drove to Magda’s home. Helen angrily told me that she assumed that Magda misplaced the medications, but then she began to cry and said that the medications were not misplaced, they were really gone. When she searched the apartment, Helen noticed that the cash box was empty and that Magda’s checkbook was missing two checks. Helen determined that Magda was robbed, but because she did not want to frighten her, she decided not to report the crime. Instead, Helen phoned the pharmacy and explained that her mother-in-law, suffering from dementia, had accidently destroyed her medication and would need refills. She called Magda’s bank and learned that the checks had been cashed. Helen cooked lunch for her motherin-law and ate it with her. When a tired and disheveled Alec arrived back in the apartment, Helen quietly told her son about the robbery and reinforced the importance of remaining in the building with Magda at night. Helen said that the events in Magda’s apartment were repeated 2 days later. By this time in the session Helen was furious. With her face red with rage and her hands shaking, she told me that all this was my fault for suggesting that Alec’s presence in the apartment would benefit the family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec would never be in this trouble if I had not told Helen he should be permitted to live with his grandmother. Helen said she should know better than to talk to a stranger about private matters. Helen cried, and as I sat and listened to her sobs, I was not sure whether to let her cry, give her a tissue, or interrupt her. As the session was nearing the end, Helen quickly told me that Alec has struggled with maintaining sobriety since he was a teen. He is currently on 2 years’ probation for possession and had recently completed a rehabilitation program. Helen said she now realized Alec was stealing from his grandmother to support his drug habit. She could not possibly tell her husband because he would hurt and humiliate Alec, and she would not consider telling the police. Helen’s solution was to remove the valuables and medications from the apartment and to visit twice a day to bring supplies and medicine and check on Alec and Magda. After this session, it was unclear how to proceed with Helen. I asked my field instructor for help. I explained that I had offered support for a possible solution to Helen’s difficulties and stress. In rereading the progress notes in Helen’s chart, I realized I had misinterpreted Helen’s reluctance to ask Alec to move in with his grandmother. I felt terrible about pushing Helen into acting outside of her own instincts. My field instructor reminded me that I had not forced Helen to act as she had and that no one was responsible for the actions of another person. She told me that beginning social workers do make mistakes and that my errors were part of a learning process and were not irreparable. I was reminded that advising Helen, or any client, is ill-advised. My field instructor expressed concern about my ethical and legal obligations to protect Magda. She suggested that I call the county office on aging and adult services to research my duty to report, and to speak to the agency director about my ethical and legal obligations in this case. In our fourth session, Helen apologized for missing a previous appointment with me. She said she awoke the morning of the appointment with tightness in her chest and a feeling that her heart was racing. John drove Helen to the emergency room at the hospital in which she works. By the time Helen got to the hospital, she could not 21 SESSIONS: CASE HISTORIES • THE PETRAKIS FAMILY catch her breath and thought she might pass out. The hospital ran tests but found no conclusive organic reason to explain Helen’s symptoms. I asked Helen how she felt now. She said that since her visit to the hospital, she continues to experience shortness of breath, usually in the morning when she is getting ready to begin her day. She said she has trouble staying asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more forgetful than she has ever been. Her back is giving her trouble, too. Helen said that she feels like her body is one big tired knot. I suggested that her symptoms could indicate anxiety and she might want to consider seeing a psychiatrist for an evaluation. I told Helen it would make sense, given the pressures in her life, that she felt anxiety. I said that she and I could develop a treatment plan to help her address the anxiety. Helen’s therapy goals include removing Alec from Magda’s apartment and speaking to John about a safe and supported living arrangement for Magda.
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The Clinical Supervisor
ISSN: 0732-5223 (Print) 1545-231X (Online) Journal homepage: https://www.tandfonline.com/loi/wcsu20
Models and Methods in Hospital Social Work Supervision
Goldie Kadushin , Candyce Berger , Carlean Gilbert & Mark de St. Aubin
To cite this article: Goldie Kadushin , Candyce Berger , Carlean Gilbert & Mark de St. Aubin (2009) Models and Methods in Hospital Social Work Supervision, The Clinical Supervisor, 28:2, 180-199, DOI: 10.1080/07325220903324660
To link to this article: https://doi.org/10.1080/07325220903324660
Published online: 10 Nov 2009.
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Models and Methods in Hospital Social Work Supervision
GOLDIE KADUSHIN University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
CANDYCE BERGER University of Texas at El Paso, El Paso, Texas, United States
CARLEAN GILBERT Loyola University School of Social Work, Chicago, Illinois, United States
MARK DE ST. AUBIN University of Utah, Salt Lake City, Utah, United States
This is the first qualitative study of the perceptions of hospital-based social work supervisees regarding their hospital supervision. Seventeen social workers were recruited using a national listserv and snowball sampling techniques. According to the perception of the clinical social workers participating in the study, hospital social work supervision is organizationally driven rather than worker-focused. Implications for social work education and research are discussed.
KEYWORDS hospital, managed care, models of supervision, organizational re-structuring
INTRODUCTION
Social work supervision has played an important but changing role in the development of the profession. Supervisors are agency managers who have been delegated authority to maintain the job performance of supervisees. In assuming this responsibility, the supervisor performs educational, adminis- trative, and supportive functions in a positive relationship with the supervisee.
Address correspondence to Goldie Kadushin, Professor, Helen Bader School of Social Work, University of Wisconsin-Milwaukee, PO Box 786, Milwaukee, WI 53201. E-mail: [email protected]
The Clinical Supervisor, 28:180–199, 2009 Copyright # Taylor & Francis Group, LLC ISSN: 0732-5223 print=1545-231X online DOI: 10.1080/07325220903324660
180
The long-term objective of supervision is to prepare the supervisee to deliver effective, efficient services to clients, consistent with the agency’s mandate and professional practice standards (Kadushin & Harkness, 2002; Tsui, 2005). The administrative function of supervision is to organize the work of the supervi- sees to achieve agency objectives. This is the basic supervisory function. Edu- cational or clinical supervision improves the knowledge and skills of workers within the mandate of the agency. Supportive supervision reduces job-related stress and fosters worker self-awareness to cope with stress (Bogo & McKnight, 2005; Kadushin & Harkness, 2002; Tsui, 2005). These functions apply to any supervisor in any social work agency.
This paper focuses on social work supervision in hospitals. The sustainability of supervision in hospital settings is threatened by the elimina- tion of middle management and supervisory positions in favor of leaner, cost-effective structures. This reorganization reflects the influence of mana- ged care and capitated methods of financing that are reducing the hospitals’ access to revenue (Berger & Mizrahi, 2001; Globerman, McKenzie-Davies, & Walsh, 1996; Weissman & Rosenberg, 2002; Schmid, 2002). Consistent with these findings, a recent survey of licensed health care social workers reported increased job stress in the context of reduced access to supervision (Center for Health Workforce Studies, 2006).
The influence of managed care and capitated financing systems on hos- pital supervision has not been examined by social work researchers since 1996, the last year of data collection in a longitudinal study conducted by Ber- ger and her colleagues (Berger, Robbins, Lewis, Mizrahi, & Fleit, 2003; Berger & Mizrahi, 2001; Berger et al., 1996.) The existing research is also limited by an exclusive focus on the perceptions of supervisors. No research has examined hospital supervision from the perspective of the supervisee. An understanding of the supervisee’s views is necessary to inform the profession of unmet worker needs for oversight, support, and education in the social work health care labor force (Center for Health Workforce Studies, 2006). To begin to address this gap in the literature, a pilot study was conducted to answer the following question: What are the perceptions of supervisees about the current models and functions of social work supervision in hospitals? The hospital agency was the setting for this pilot study because previous research on super- vision in health care has been hospital-based, providing a knowledge base for the development of the study questions and instruments.
LITERATURE REVIEW
Hospital Reorganization: Impact on Social Work Hospital Supervision
Many theories explain the relationship between the hospital and the environ- ment (Netting, Kettner, & McMurtry, 2004) or those ‘‘external conditions
Hospital Social Work Supervision 181
that may affect the organization’’ (Schmid, 2002, p. 133). The merits of different theories are still debated, but all theories assume environmental circumstances influence organizational processes (Schmid, 2002). In particular, the immediate or task environment is assumed to affect organizational strategies and struc- tures (Schmid, 2002; Netting et al., 2004). The task environment includes patient populations, revenues, in-kind resources, competitive institutions, and federal and state regulators (Netting et al., 2004; Schmid, 2002).
In the early 1980s, health care delivery and funding underwent a radical change in the United States with the introduction of a Medicare capitated payment system for hospital care. Capitated payment is a form of managed care. Managed care can be defined as a payment and health care delivery sys- tem that regulates, monitors, and coordinates resources to contain costs and increase efficiency. Introduced into the United States to reduce spiraling health care spending in the early 1980s, managed care is now the dominant arrangement in both public and private sectors.
Because a capitated payment system transfers risk from payer to provi- der, the Medicare prospective payment system reduced hospital revenues. Aware of the risk of cost-shifting, private and public third-party payers also adopted managed care payment and delivery procedures. Hospitals were confronted with an unstable, rapidly changing environment in which fierce competition for scarce resources and patients existed. In this context, the- ories predict that organizations will revise strategies and structures to reassert control over actors in the task environment (Schmid, 2002).
Hospitals responded by developing alliances with multi-hospital sys- tems, merging with competitive institutions, and separating functions into independent, decentralized programs or teams (Lee & Alexander, 1999; Bazzoli, Dynan, Burns, & Yap, 2004; Weil, 2003). The effect of hospital reor- ganization was to reduce operating costs by consolidating management and duplicative services. However, this strategy also eliminated the positions of middle managers and social work directors who provided supervision, decreasing institutional resources to support this function (Kadushin & Harkness, 2002; Weissman & Rosenberg, 2002).
A government-mandated managed care program implemented in the 1990s in Canadian hospitals is suggestive of the effect of hospital restructuring on social work supervision. The introduction of managed care was the impetus for the dismantling of Canada’s hospital social work departments. Social work supervision decreased in the absence of an administrative structure (e.g., social work directors and supervisors). Canadian hospital workers organized peer groups to provide clinical and supportive consultation but they had no access to formal supervision (Globerman et al., 1996; Globerman, White, & McDonald, 2002; Globerman, White, Mullings, & McKenzie-Davies, 2003; Michalski, Creighton, & Jackson, 1999). While this research is specific to the Canadian health care system, it is suggestive of the potential impact of mana- ged care and hospital restructuring on worker access to formal supervision.
182 G. Kadushin et al.
Kadushin and Harkness (2002) hypothesize that clinical and supportive supervision, which are resource-intensive, non-revenue-generating functions, may be assigned a low priority by hospitals impacted by managed care. They suggest, however, that because administrative supervision directly benefits the organization, it may be the sole form of supervision recognized by hospi- tals within an environment of cost containment (Kadushin & Harkness, 2002).
Models of Social Work Supervision
Models of social work supervision can be differentiated by levels of agency control. At one extreme is the ‘‘casework model’’ or scheduled one-on-one individual social work supervision, which is based on high levels of admin- istrative accountability. At the other extreme is the autonomous practice model, which is characterized by professional autonomy of the supervisee. Between these extremes on the continuum of administrative accountability are group, team, and peer supervision models (Bogo & McKnight, 2005; Kadushin & Harkness, 2002; Tsui, 2005).
Individual supervision is the most widely used model of supervision, particularly for unlicensed or inexperienced (less than two to six years of practice in the same setting) workers (Kadushin & Harkness, 2002). It is delivered in a one-on-one tutorial session scheduled weekly for at least an hour. The demands of time and effort required by this model may be challen- ging to hospital-based social work supervisors who have corporate or wide- ranging administrative responsibilities.
Group supervision is the second most widely adopted model of supervision. It is characterized by the presence of a formal social work supervisor who performs the functions of supervision—administrative, educational, and supportive—in a group format. Group supervision is a supplement to, not a substitute for, casework supervision.
The introduction of group supervision is ideally preceded by worker preparation for the change and agreement by the staff. The advantages of the group modality are conservation of time and resources; lateral peer learn- ing; and sharing and normalization of job-related stress (Bogo & McKnight, 2005; Kadushin & Harkness, 2002; Sulman, Savage, Vrooman, & McGillivray, 2004; Tsui, 2005).
Peer supervision is supervision led by a peer group; in this situation, no supervisory oversight or authority exists. All participants hold equal status in terms of accountability and responsibility for their own practice. The purpose of peer group supervision is to provide educational=clinical supervision through case conferences and the exchange of clinical expertise and guidance. Peer supervision is a supplement to, or a substitute for, educational= clinical supervision (Brashears, 1995; Barretta-Herman, 1993; Hardcastle, 1991; Kadushin & Harkness, 2002; Sulman et al., 2004; Tsui, 2005). Team supervision is led by a team leader who may or may not be a social worker.
Hospital Social Work Supervision 183
In team supervision, intradisciplinary workers may exercise autonomy, collectively make decisions about work assignments, case dispositions, perfor- mance checks, and professional development, providing educational=clinical guidance and oversight and allocating work assignments. The supervisor is a team member but retains administrative accountability for team performance (Kadushin & Harkness, 2002; Tsui, 2005). On interdisciplinary teams, the leader may be a physician, nurse, or other medical professional who assumes super- visory authority over the other team members (Kadushin & Harkness, 2002).
The question of the prevalence of supervision models in hospital-based social work has generally been ignored by social work research. Berger and Mizrahi (2001) examined supervision from the perspective of supervisors in a national sample of hospitals in 1992, 1994, and 1996. They found that in the early to late 1990s, individual and group supervision were the most frequent models (these models were collapsed into the category ‘‘formal supervision’’). Peer supervision (consultation) was the second-most frequent model. The use of non-social work supervision significantly increased over all time periods.
Health care social workers speculate that as hospitals restructure and eliminate social work managers and departments, the resources to support the traditional individual supervision model will decline. Workers will have to take the initiative in finding support for supervision outside the hospital or by creating group or peer models that use collective resources efficiently. The caution is the need for thoughtful planning, implementation, and a mechanism for training and evaluation to accumulate research to inform the profession regarding the efficacy of innovative supervision models (Berger & Mizrahi, 2001; Kadushin & Harkness, 2002).
METHODOLOGY
This qualitative study was implemented using telephone focus group interviews. Focus groups have been widely used as a data collection method in qualitative research, and growing evidence supports the efficacy of telephone focus groups or ‘‘telegroups’’ as an alternative to face-to-face focus groups (Cooper, Jorgensen, & Merritt, 2003; Appleton, Fry, Rees, Rush, & Cull, 2000). Using the Society for Social Work Leadership in Health Care membership as a sampling frame, researchers employed purposive and snowball sampling techniques. Social work directors=managers were contacted by electronic mail using the organization’s listserv. The e-mail explained the purpose and method of the study and encouraged social work directors=managers to share the attached flyer with their staffs. Inclusion= exclusion criteria were as follows: graduate-level social work staff (i.e., MSW, PhD, DSW); 50% currently employed in an inpatient or outpatient hospital setting; one or more year working in clinical practice; at least one year of experience in the current setting; and English-speaking.
184 G. Kadushin et al.
Eligible staff members e-mailed the Principal Investigator (PI) to indicate their willingness to participate. The PI responded to the e-mail and screened the subject for eligibility. If he or she qualified for the study, the PI sent an electronic version of the consent form that was approved by the institutional review boards (IRBs) of every member of the research team. A waiver of signature for consent was obtained from the IRBs in order to ensure anonym- ity of the participants. In developing the focus groups, every attempt was made to ensure that subjects from the same setting did not participate in the same focus group to prevent voice identification.
The PI contacted the individuals by phone to discuss the study, answer questions, and confi
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