UCLA

Although there is a substantial evidence base of interventions to treat child and adolescent mental health conditions, these interventions remain underused in community mental health settings. Increasingly, clinical supervision has gained attention as an opportunity for promoting use of interventions supported by research. At the interpersonal level, supervisors are well-positioned to support ongoing skill development of therapists through such strategies as role plays, skill modeling, and performance feedback. Supervisors are also well-positioned to impact therapists’ experience of the organizations in which they work. This is particularly important given the high stress, burnout, and organizational turnover characteristic of community mental health agencies. Specifically, supervisors are “middle managers,” interfacing both with upper-level management and frontline workers. This position affords the opportunities to facilitate communication from the top down and bottom up.Acknowledging the potential influence of supervisors on the organizations in which they work and on the individual therapists they oversee, this dissertation examined supervisor impact on therapist experience of their work environment (i.e., organizational climate) and on therapist use of practices supported by research. The first study aimed to examine the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. An understanding of the potential impact of the supervisor on therapist perceptions of organizational climate could inform additional interventions to positively influence climate and facilitate improvement in the quality of care delivered. The second study examined supervision strategies that create a sense of accountability informed by a model from the organizational management literature in which accountability is fostered by behaviors that strengthen links between prescriptions (directives to perform a behavior), events (contexts in which the behavior can be performed) and identity (personal qualities and skills). Informed by this model, the second study aimed to identify the presence of supervision accountability strategies and investigate the association between accountability strategies and therapist follow through use of a therapeutic practice identified during supervision in the subsequent treatment session. As a first step in capitalizing on supervision to improve client outcomes, it is important to determine how supervision influences therapist behavior during treatment by directly testing supervision strategies.