JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

Supervision Vital for speech-language pathology Abigail Lewis and Joanne MacDonald

The health landscape is rapidly changing with health professionals needing to adapt to new and emerging environments, while still providing quality health care. Access to appropriate supervision can enable the workforce to deliver high-quality health care by supporting the development of knowledge and clinical skills in supervisees, thus improving client outcomes and reducing clinician stress and burnout. Recently, Speech Pathology Australia has been emphasising the importance of supervision for speech-language pathologists with new publications and website resources. Empirical evidence of the benefits of clinical supervision specifically for speech-language pathologists is largely lacking in the literature. This paper draws on relevant literature from other professions to build a case for the need for all practising speech- language pathologists (SLPs) to receive regular clinical supervision. From this literature a framework for undertaking supervision has been constructed, recommending a focus on reflection and relationships. Key points support SLPs in their implementation of supervision, to optimise the benefits and outcomes. A future article will more specifically explore supervision for students. T he Australian health workforce is faced with significant challenges: a predicted shortfall of staff, Australia’s ageing and changing population, reduced access to health care for some groups, changing models of health care concomitant with shifts in funding, and a substantially increased number of student placements required for the training of new generations of professionals. Government modelling has predicted a significant shortfall across all disciplines by 2025 (Crettenden et al., 2014; Mason & Department of Health and Ageing [DHA], 2013), arising from a number of factors including: the ageing

workforce; increasing numbers of part-time staff; and the longer training required to prepare professionals for increasingly complex roles (Crettenden et al., 2014; Mason & DHA, 2013; May, 2015). To compensate, substantially increased numbers of health students have been enrolled into university courses (Health Workforce Australia, 2013), leading to the need for increased clinical placements in the workforce and an influx of young graduates also requiring support and supervision (Speech Pathology Australia [SPA], 2014a). Meanwhile, Australia’s population is ageing, experiencing more chronic disease, and thus requiring increased multidisciplinary involvement and more preventative health care (Mason & DHA, 2013). The model of western health care is shifting from a medical to a biopsychosocial model, increasing the focus on quality of life (Bakas et al., 2012), and the expectation that the health workforce engage in a relationship focused client-centred approach to delivering services (Borrell-Carrió Suchman, & Epstein, 2004). This model of service delivery requires sophisticated interpersonal skills and an understanding of the therapeutic relationship: mindful openness to the client’s experiences and emotions; empathy; self-awareness; and management of the power imbalance in the relationship (Borrell-Carrió et al., 2004). The client – health care worker relationship is central to intervention (King, 2009b). The health and disability sectors are transitioning rapidly to activity-based funding models (Eagar, 2011; National Disability Insurance Scheme [NDIS], n.d.). This move away from block funding for services provides incentive for patients to be discharged sooner (Eager, 2011). The roll out of the National Disability Insurance Scheme means clients have funding to purchase required services from providers, further increasing the significance of the client – health care worker relationship, as complex negotiations around services and health care decisions are tackled. An additional outcome of this change is a dramatic increase in the number of private practitioners, with over 50% of speech-language pathologists (SLPs) now working in private practice (Hutchinson, 2015) and increasing numbers of new graduates moving directly into private practice. While many of these pressures have long been predicted (McAllister, 2005), they occur in the context of Australians continuing to expect quality health care services from highly trained professionals. How can the workforce deal with these challenges and continue to provide quality care? Mason and DHA (2013) suggest that “a continued focus on allied health networking, adequate supervision and

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS SUPERVISION REFLECTION PRACTISING SPEECH- LANGUAGE PATHOLOGISTS

Abigail Lewis (top) and Joanne MacDonald

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology