Case study and Interview

To further explore the practical experience of using reflective supervision, we interviewed Jane Pray, a supervisor in one of Philadelphia’s three Nurse-Family Partnership (NFP) sites.  NFP home visit intervention for high-risk first-time mothers.  One of its core model elements is reflective supervision (RS).    An important feature of the NFP is that its well-studied and proven outcomes rely on staff retention:  the loss, mid-cycle, of a home visiting nurse, can lead to 50-75% attrition of clients.  Consequently, staff supervision models must be very focused on effective retention measures.


Because NFP programs use reflective supervision as a core element, when the NFP began in Philadelphia in 2001, the teams of supervisors and home visiting nurses trained together in the model, including reflective supervision.  Ms. Pray notes that a fresh start made it easy for the team to embrace the process.  As new staff came on over the years, they joined a team in which reflective practice was the norm.

As a supervisor, Ms. Pray notes some common experiences in RS:

·      For new staff, it can be helpful for the supervisor to integrate training and orientation needs into the reflective practice in the beginning, as the relationship is built

·      The modeling aspect of the relationship is very important – for example, in the NFP, the supervisor/supervisee relationship models the worker/client relationship in not having all the answers to issues that arise, and by helping the supervisee or client to work through difficult situations herself.

·      A common question asked by supervisors new to RS, is, “How do I provide reflective supervision and maintain my administrative, hierarchical reporting needs (such as case loads and reporting requirements)?”  In practice, RS does not exclude routine administrative supervision – rather, it provides a constructive, supportive process through which to address administrative/organizational issues.  While discipline is still part of the supervisory role, it’s integrated into the supervisory relationship.  “You have to trust that by using the process, performance will improve.” 

How staff and supervisors feel about RS

Ms. Pray remarks that  Among the nurse home visitors, there is recognition that time is needed to reflect and process the demanding work involved in providing services to high-risk mothers and their babies.   Said one staff member: “I’ll never give up my supervision time.”