brightways consultation model

‍Brightways Consultation Model

One of Brightways values is that our staff is just as important as our clients. As we are always evolving to improve the care for our clients, we endeavor to do the same for our staff. One way we have valued our clinicians has been to provide an experienced clinician for them to meet with to support their development and success. The meeting was called supervision as it was loosely related to what happens when someone is pursuing licensure; they collect supervision hours. While providing supervision to the clinicians, the practice group found that supervision time was an efficient time to communicate administrative topics. It was introduced as being necessary for treatment to occur, so these topics were included in supervision. Eventually, our practice grew to where we couldn’t identify what our staff needed. At that point we made supervision mandatory and without knowing it, changed the meeting from the concept of a clinician receiving supervision, like in graduate school to a clinician being overseen by a supervisor. Requiring attendance at these meetings was the first step towards shifting the power away from a collaborative relationship, which is necessary for a clinician to feel safe when receiving support.

This model of support provided to the clinicians is called the Supervision Model. The Supervision Model (SM) has dual purposes. It serves the needs of the clinicians as well as the organization, however the power differential interferes with the support that a clinician receives because they don’t have control over whether they meet, the content of what they discuss or even whether they going to be corrected during that time or not.

The Supervision Model has benefits and disadvantages, but the organization benefits far more than clinicians.

Benefits:
1. Ensures that every clinician is accountable for performance.
2. Ensures that clinician’s make time to receive support and guidance.
3. The organization uses it to communicate administrative corrections.
4. The organization uses it to coordinate group initiatives.
5. Clinicians can receive clinical training during this time.

Disadvantages:
1. It supports the organization more than the clinician.
2. Assumes a one size fits all approach
3. If no one has anything to discuss it is a loss of resources for clients, clinicians, and the organization.
4. The supervisor is only as effective as the self-reported information that the clinician provides.
5. Clinicians aren’t assigned supervisors based on their developmental needs. They are assigned based on organizational structure.
6. A clinician might fear retaliation if they need the supervisor to improve.
7. Clinicians may not feel safe to open up about client care issues because support and correction is co-mingled in the meeting.
8. Since the clinicians can’t choose, they may be assigned a supervisor that isn’t a good fit.  This only benefits the organization, and the clinician may leave because they don’t like their supervisor.
9. Clinicians become dependent on one person for support.
10. A clinician may not feel supported by the meeting which was the original purpose of it.

Over the last 7 years, Brightways has used the Supervision Model (SM) and while it has been easy to implement, we have experienced first-hand every weakness of it. In learning from these experiences over time and receiving feedback from past and present clinicians, we have created an improved model. It is called the Consultation Model (CM). The CM has the same goals as the SM, however, it takes a different approach. Unlike the SM, the CM provides the clinician a choice of who they would meet with, autonomy to decide how often they would like to meet and creates a safe place where clinicians can be transparent and free from potentially being corrected while being vulnerable and transparent about their needs. By offering this, the CM nurtures internal behavior strengths that positively impact job satisfaction and performance. By offering choice, autonomy, and safety, the CM avoids disrupting the connection a clinician has with their internal behavioral strengths that impact satisfaction and performance.

Intrinsic Motivation: Most individuals have an intrinsic desire to excel and take pride in their work. This motivation comes from within; not from oversight and it pushes them to perform well, regardless of external factors.

Self-Esteem and Identity: People often tie their self-worth and identity to their work. Doing a good job reinforces positive self-perception and boosts self-esteem. Even when they’re struggling, the desire to maintain a positive self image drives them to improve.

Social Expectations: Social norms and expectations play a significant role. People want to meet societal standards and fulfill their roles effectively. Falling short can lead to feelings of disappointment or guilt. A clinician is more likely to discuss these difficulties and receive support in a safe space; separate from performance evaluations.

Sense of Accomplishment: Achieving goals and contributing meaningfully provides a sense of accomplishment. Even if they’re not currently performing well, individuals strive for that feeling of achievement.

Professionalism and Integrity: Many people value professionalism and integrity. They want to uphold their reputation and demonstrate commitment to their work, regardless of immediate outcomes.

Besides supporting clinicians to foster a greater connection with internal strengths, Consultants seek to increase the clinician’s engagement by offering different options such as repeating scheduled consultations, drop ins and regularly scheduled group consultations. They also encourage clinicians to form peer consultation groups, or even find a peer to consult with when needed.

This builds self-efficacy and a better support system for the clinician. Consultants also focus on building relationships with clinicians to increase engagement. They initiate conversations, stop by offices, run team meetings, facilitate a positive culture and social events with staff.

In summary, when clinicians are given choice, autonomy and safety, they will connect with intrinsic motivation, self-esteem, a sense of accomplishment, and professional integrity. The SM infringes on the connection with these behavioral strengths while CM fosters reliance on them.

There are benefits and disadvantages to the Consultation Model. The benefits always help the clinicians and sometimes help the organization, but the disadvantages only apply to the organization. They include:

Benefits:
1. Allows clinicians to connect to intrinsic self-motivation.
2. Because it is a safe place clinicians will be more transparent which leads to more growth opportunities and better performance.
3. Increased dedicated time for clinical consultation.
4. Clinicians are more engaged in learning because they initiate it.
5. Time is used efficiently because the clinician brings a topic to discuss.
6. More clients can be seen because some clinicians will only use consultation as needed.
7. It is adaptable to more learning styles because it supports multiple methods of support such as group supervision, peer consultations and drop-in support.
8. More opportunities for support for clinicians due to increased options.
9. Clinicians will pick the support that best serves them, which increases job satisfaction.
10. Consultants, (previously Supervisors) will enjoy clinical content and not performance evaluations in their meetings with the clinician.
11. Consultants, (previously Supervisors) will enjoy meeting with clinicians because the clinicians will be more motivated because they chose to be there and will have a topic to be discussed.
12. Clinicians won’t leave Brightways because they don’t like their “Supervisor”.
13. It lessens the negative effects of a poor performing supervisor because clinicians can choose not to meet with them and pursue another form of support.

Disadvantages:
1. We need a new approach to manage performance.
2. We need a new approach to promote group initiatives.
3. We need a new approach to discuss admin errors.
4. Fair allocation of consultation time.
5. No assurance that clinicians will make time for development.
6. No control over the content discussed in consultations.
7. Costly investment.
8. Lack of clarity around how to use Team meetings.