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Holding From Afar: The Protective Effect of Virtual Reflective Supervision/ Consultation (V-RSC) During the Pandemic

May 31, 2022

Jennifer A. Willford, Slippery Rock University; Robert T. Gallen, University of Pittsburgh; and Teagan Cruz, Haley Hensler, Mohamad Khalaifa, MiKaila Leonard, Elizabeth Wernert, and Meredith Willard, Slippery Rock University


Reflective supervision/consultation (RSC) is a relationship-based form of professional development for the infant and early childhood mental health (IECMH) workforce. A critical context for effective RSC is the quality of the reflective alliance between supervisor and supervisee. Their “way of being” together is inclusive of safe, caring, and consistent relationships and serves as a source of resilience for providers. This article describes the impact of a 1-year project in which 49 IECMH supervisors participated virtually in small RSC training groups during the COVID-19 pandemic. Supervisors experienced significant improvements in positive emotions and work engagement, with concurrent decreases in ruminative thinking and negative work experiences. Supervisors reported that many factors played a role in their positive experience within RSC training, with the relationships with supervisors and fellow group members as critical to positive outcomes.

Reflective supervision/consultation (RSC) aims to provide infant and early childhood mental health (IECMH) providers with experiences that promote learning, maintain fidelity to intervention models, increase the quality of IECMH services, and support provider well-being (Heffron et al., 2016). These outcomes are facilitated within the context of the reflective alliance, which is defined as “the quality of the relationship developing between supervisee and supervisor [which] is of the utmost importance” (Alliance for the Advancement of Infant Mental Health, 2018, p. 7). The foundation for reflective practice and learning is the formation of a safe and welcoming space with a trusted mentor (Heffron & Murch, 2010). RSC is different from other types of supervision (e.g., administrative and clinical), because it extends beyond the content of IECMH work to consider how one’s thoughts, feelings, and reactions affect the work and personal experiences of the supervisee (Frosch et al., 2019). The reflective supervisor and supervisee, within the context of the reflective alliance, discuss difficult and sensitive topics while providing care and consideration for both the supervisee and the families for whom they provide care.

Within the context of the reflective alliance the dyad works to build and engage reflective capacity—the ability to understand one’s own and others’ mental states (Parlakian, 2001). Reflective capacity allows for comprehension of the reasoning for an individual’s intentions and perspective-taking by imagining their needs, desires, feelings, beliefs, and goals (Fonagy & Allison, 2012). Engaging reflective capacity includes an effort to reexperience emotional events, evaluating aspects of these events to gain an understanding of the emotions provoked, and using this understanding toward professional and personal growth (Alexander et al., 2012). RSC promotes positive outcomes in IECMH providers, in part, due to the coexamination of one’s thoughts, feelings, actions, and reactions that result from working closely with young children and their families (Eggbeer et al., 2007).

The role of an IECMH provider is inherently difficult and can have a negative effect on provider well-being. For example, the IECMH workforce experiences exposure to stress, adversity, and trauma vicariously through their direct work with at-risk children and families (Paradis et al., 2021). This exposure can be thought of as an “occupational hazard” of IECMH work. Such exposure can place the IECMH workforce at increased risk for vicarious trauma (Sutton et al., 2022), compassion fatigue (Rivera-Kloeppel & Mendenhall, 2021), secondary traumatic stress (Sprang et al., 2021), and burnout (Sprang et al., 2007). (See Table 1.) Shea et al. (2016) reported that frequent and recurrent exposure to child and family trauma can have a cumulative and negative effect on IECMH provider well-being.

Table 1. Potential Risks Encountered by the IECMH Workforce

In addition to the usual difficult nature of this work, the COVID-19 pandemic has the potential to increase these risks within the IECMH workforce (Paradis et al., 2021). Although the effect of the pandemic on IECMH is not fully understood to date, providers experienced many changes, including a reduction in the opportunity to interact directly with families in need, as well as the need to provide services using virtual modalities (e.g., telehealth). Illinois recently reported that the majority (85%) of early intervention providers reported a disruption in meeting with families during COVID-19; the number of sessions delivered and the number of children per caseload decreased significantly. In addition, work limitations during the COVID-19 pandemic led to a reduction in provider confidence: Only 28% of providers reported high confidence with telehealth, as well as a perceived lack of buy-in from caregivers (Roberts et al., 2022). Given the risks to IECMH work, identifying protective factors to promote resilience is important for maintaining fidelity and benefits of IECMH services, reducing turnover in the workforce, reducing stress, and enhancing the well-being of IECMH providers.

Photo: shutterstock/SeventyFour

The reflective supervisor and supervisee, within the context of the reflective alliance, discuss difficult and sensitive topics while providing care and consideration for both the supervisee and the families for whom they provide care.

Resilience has been defined as the capacity for positive adaptation when exposed to adverse experiences (Masten, 2014; Narayan et al., 2018). Masten (2014) described resilience as “ordinary magic” that stems from personal attributes, context, and supportive relationships. Efforts to identify sources of “ordinary magic” or resilience that counteract or protect against risk are ongoing. For example, Narayan et al. (2018) identified 10 benevolent childhood experiences (BCEs) that describe favorable childhood experiences, including the experience of relationships with others reflecting love, predictability, and support. The presence of more BCEs predicted lower posttraumatic stress disorder symptoms and fewer stressful life events during pregnancy (Narayan et al., 2018); lower odds of psychological distress in homeless parents (Merrick et al., 2019); and lower depressive symptoms, perceived stress, and less loneliness in college students during the COVID-19 pandemic (Doom et al., 2021). Both Masten’s “ordinary magic” and the research on BCEs highlight the importance of access to interpersonal relationships that are responsive, sensitive, safe, and consistent for promoting resilience. These findings evoke hope for the development and implementation of IECMH systems that create experiences of benevolence, including love, predictability, and support for children, families, and the IECMH workforce (Merrick & Narayan, 2020).

There are parallels between the reflective alliance developed within RSC and the construct of benevolence as resilience. RSC gives IECMH providers the relational experience and practice that increases the quality of care provided to families (Heller et al., 2013). IECMH provider participation in RSC is associated with increased employee satisfaction, improved mental health, and increased quality of care (Frosch et al., 2019). RSC is associated with an increase in job satisfaction as well as a decrease in burnout and secondary traumatic stress (Harker et al., 2016). Bernstein and Edwards (2012, p. 297) described this protective benefit, stating that RSC “helps early childhood practitioners cope with the stress and feelings of being overwhelmed that often result when working with vulnerable families and children.” The present article describes the effect of providing 1 year of RSC by means of a virtual delivery format (V-RSC) to IECMH supervisors during the COVID-19 pandemic. The purpose of this project was to determine whether the experience of participating in V-RSC groups would have a positive effect on IECMH supervisors’ well-being and engagement at work. We were also interested in learning from supervisors what they thought was effective within their RSC group experience.

Photo: shutterstock/addkm

Although the effect of the pandemic on infant and early childhood mental health is not fully understood to date, providers experienced many changes, including a reduction in the opportunity to interact directly with families in need.

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