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To Infinity and Beyond: A Journey Towards Reflection Sarah Oo Maria Yolanda Wigozki Debbie Weatherston Lynn Kosanovich Kate Whitaker
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To Infinity and Beyond:A Journey Towards Reflection
Sarah Oo Maria Yolanda WigozkiDebbie WeatherstonLynn Kosanovich Kate Whitaker
Who are we?
How did we come to this journey?
Who are you?
What brings you to this session?
What we will cover in this session
• Background - Setting
• Review definition of Reflective Supervision/Practice
• How we implemented Reflective Supervision/Practice in theCommunity Health Improvement Department at MGH Chelsea
• HFA’s vision for Reflective Supervision going forward
• Open discussion – questions, answers, feedback
• 2 miles north of Boston – 2 square miles• 37,000+ - population• 62% Latino• 23% living in poverty (48% of children)• Gateway city: Central America, Nepal, Bosnia, Somalia,
Afghanistan, Iraq, Syria, Northern, & Western Africa
Chelsea Massachusetts
MGH Mission Statement:Guided by the needs of our patients and their families, we aim to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and to improve the health and well-being of the diverse communities we serve.
Community Health Improvement 45 community health workers
25 countries / 21 languages
Access to hospital servicesManaging chronic diseasesMedication adherenceNavigate patients to appointments (specialty, cancer, etc.)Community resources
Patients with:• History of trauma• Extreme poverty • Isolation• Low literacy• Language barriers• Social determinants of health
CHWs – shared life experience
Newly arrived immigrants and refugees High risk young parents Survivors of domestic and community violenceSubstance use disorders/ mental health
Across the Life SpanParallel Process
Healthy Families America
6 HFA Home Visitors (Spanish, Portuguese, Somali, Swahili, Arabic)
1 Fatherhood Coordinator
• First time parents or• First time parents in this country• 2 or more significant risk factors:
• Extreme poverty• Isolation• Cognitive challenges• Medically complicated baby• Trauma history• Domestic violence• Depression
Reflective Supervision/Consultation - What is it?
Reflective supervision/consultation (RSC) is distinct due to the shared exploration of the parallel process. That is, attention to all of the relationships is important, including the ones between practitioner and supervisor, between practitioner and parent, and between parent and infant/toddler. It is critical to understand how each of these relationships affects the others. Of additional importance, reflective supervision/consultation relates to professional and personal development within one’s discipline by attending to the emotional content of the work and how reactions to the content affect the work. Finally, there is often greater emphasis on the supervisor/consultant’s ability to listen and wait, allowing the supervisee to discover solutions, concepts and perceptions on his/her own without interruption from the supervisor/consultant.
The primary objectives of reflective supervision/consultation include the following:
• Form a trusting relationship between supervisor and practitioner
• Establish consistent and predictable meetings and times• Ask questions that encourage details about the infant, parent,
and emerging relationship• Remain emotionally present• Teach/guide• Nurture/support• Apply the integration of emotion and reason• Foster the reflective process to be internalized by the
supervisee• Explore the parallel process and allow time for personal
reflection• Attend to how reactions to the content affect the process
Creating the Vision at MGH Chelsea
• Slowing down• Learning• Saw directly how well Reflective Supervision
worked with HFA staff• Seeing the trauma in staff• Seeing the burnout• Seeing staff leaving• Valuing relationships
Leap Of Faith
• Phone call with Sarah/Kate
• Kate bringing it back to Lynn
• Lynn and Kate bringing in Debbie
Setting the Stage – Readiness
Anonymous survey of staff
• Where does your energy (commitment/skill/??) come from to do this work?• Are you comfortable thinking about/speaking out loud things that you are struggling with or
things about your job that you do not know?• Do you feel as though you can grow at work? What would that growth mean to you/look like
to you?• How do you know when you are dysregulated? What do you notice?• How are others impacted when you are dysregulated? • What happens when you come to a complete stop? • What do you notice when you are very still? • What do you need in order to allow this to happen?• What thoughts or feelings do you become aware of in this quiet space? • What happens when the noise or chatter stops? • Why might this quiet experience be helpful to you in your work?• How do we move on from sharing others’ distress (sympathy) to understanding without
sharing others’ distress (empathy)?• What resources do we have for when we don’t have a clue about how to proceed?
Setting the Stage – Readiness (con’t)
Survey Responses
“I am not always sure there is time and space for these conversations as we are needing to be productive.”
“Growth for me would be being able to integrate my emotions and my experience so I can feel less anxious or worried about work.”
“When I am overwhelmed, I notice that I cannot think clearly. I feel confused and anxious.”
“When I am dysregulated, I lose focus, drop balls and miss deadlines. I bring my work stress home to my family.”
Setting the Stage – Readiness (con’t)
Survey Responses
“When I am dysregulated, my desk gets messy and I accumulate paperwork and I get irritated and do not communicate well.”
“When I slow down, I am more focused and can organize my work. I feel more calm.”
“I need to remember to take time to reflect and remember things that bring me joy.”
“It would help me to be able to share more fully so I did not feel alone.”
“A trusting and non-judgmental environment is key.”
All staff day long session with all staff -• Off-site• Basic overview• Mirroring actual reflective conversation
One day session with only managers -• All agenda plans changed• Truly engaged in reflective conversation• Real honesty • Emotions
Setting the Stage – Readiness (con’t)
Providing the Tools
• Training for managers on Reflective Supervision• Actual specific language• Role Plays• Practice• Conversations about specific staff challenges• Planning how to do this – what would it take?• Concrete homework – “One reflective conversation
over next month”
Culture Change
• New management structure
• Part of every interview
• In every report / write up
• “We believe in……”
• “One of our core values that we are most excited about….”
Practice
• Once a month sessions with Debbie
• Role modeling
• Skype call
• Snacks
• Adult coloring books
• Close physical contact
Caretaking/Self Care
• Start every management meeting with personal check-in while eating lunch together
• Role model leaving early• Threw away recent management retreat
agenda - spent the day team-building• Encourage vacations/days off• Family medical leave – instead of leaving• Culture of trust and humility• Acceptance
Perseverance
• Even in busy times• Slowing down• Making it a habit • Different managers’ styles of supervision• Managers’ feedback
“I feel as though I am better able to support my staff”
• Staff feedback“I never imagined working in a place like this”
• Continue asking reflective questions
Why is “the Chelsea Project” so important for HFA?
• Chelsea could serve as a model for replication for HFA supervisors
• Infant Mental Health Endorsement is now available in almost 27 states
• Endorsement & Reflective Supervision go hand-in-hand
HFA is moving towards reflective practice
for supervisors
Initial Replication Ideas
HFA & Alliance Partnership
• Plan to work with small groups of interested supervisors (8-10)
• Offer an initial face-to-face training and reflective supervision experience (both)
• Alliance staff could then offer RS via technology for 12 months & beyond
• This would make monthly supervision affordable ($25 -$30 per 1.5 hour session)
• Offer new opportunities for multiple HFA staff to be endorsed (direct services staff)
• Offer more formal linkages to IMH for sites located in an Alliance State
• Offer connections to non-Alliance states as well
If you are interested…?We can provide YOU with the support
and self care that you are worthy of!
• Contact Kate Whitaker ([email protected])
• Lynn Kosanovich ([email protected])
Questions and Answers
Feedback
Contact Information:
Debbie Weatherston - [email protected]
Lynn Kosanovich - [email protected]
Kate Whitaker - [email protected]
Sarah Oo - [email protected]
Maria Yolanda Wigozki - [email protected]
