Reflective Supervision: What We Know and What We Need to Know to Support and Strengthen the Home Visiting Workforce

This report seeks to build understanding of how to support and strengthen the home visiting workforce using reflective supervision. It summarizes knowledge and gaps in the research in home visiting and adjacent fields, and in related measures and materials (i.e., trainings, resources, strategies). It also introduces a conceptual model that views reflective supervision as operating within a complex home visiting system.

A companion report focuses on home visitor professional well-being.

Research is limited on reflective supervision in any field, making it difficult to generalize findings to the home visiting context. The current literature typically pertains to infant and early childhood mental health, and focuses on providers with formal training and/or advanced degrees in mental health-related fields.

Existing research is mostly conceptual, descriptive, or correlational, limiting the ability to make causal inferences about reflective supervision’s impact on staff, program, and family outcomes. Results from a few studies suggest that reflective supervision may enhance supervisee self-efficacy, reflective practice, and job satisfaction. However, because no studies used a control or comparison group, there is no certainty that reflective supervision caused these improvements compared to other factors, such as time or experience on the job.

More than 40 trainings exist on reflective supervision, but they vary greatly in depth and breadth. Eleven self-report and observational measures evaluate some element of reflective supervision, but none have been well validated.

The new conceptual model of reflective supervision in home visiting depicts how five categories of key elements are hypothesized to influence outcomes for staff, programs, and families. It also shows that outcomes depend on organizational and staff engagement in reflective supervision. The model offers a framework for considering and defining reflective supervision in home visiting and contributing to evidence-informed strategies and resources to support implementation.

The project team completed a literature review of 53 journal articles/pieces of gray literature to understand how home visiting and adjacent fields, such as infant mental health and child welfare, address aspects of reflective supervision.

The team created a conceptual model of reflective supervision informed by the literature review findings; a review of existing conceptual models and relevant theories; and engagement with local program staff, MIECHV awardees, Tribal MIECHV grantees, home visiting model representatives, training and technical assistance providers, and project consultants.

The project team conducted an environmental scan to assess the availability and characteristics of trainings, resources, strategies, and measures related to reflective supervision.

The home visiting field should develop a consensus definition of reflective supervision that specifies key elements and is supported by research evidence. Ideally, a definition would incorporate the perspectives of home visiting practitioners, researchers, and policy makers to ensure that its elements are feasible, acceptable, relevant, and useful in the home visiting context.

The field should establish validated measures of reflective supervision for research and practice that are appropriate for diverse communities and workplace populations. Measures are needed to assess reflective supervision implementation quality, to examine change in quality over time in response to interventions, and to test whether and how reflective supervision is associated with intended outcomes.

The field should further specify and test the conceptual model of reflective supervision using methods that prioritize the diverse perspectives of the home visiting workforce. In particular, there is a need to identify elements of reflective supervision that influence outcomes. Rigorous study designs and methods are needed to identify the pathways through which reflective supervision achieves proximal, intermediate, and distal outcomes. Future efforts should aim to understand what elements of reflective supervision work best for whom and in what contexts.

Trainings in reflective supervision should be rigorously designed and evaluated, ideally by using valid measures. Training developers should state clear and realistic goals, use training methods that are likely to help achieve those goals (e.g., methods that are consistent with principles of adult learning and training transfer), and evaluate fidelity of training implementation and outcomes.

West, A., Madariaga, P., & Sparr, M. (2022). Reflective supervision: What we know and what we need to know to support and strengthen the home visiting workforce (OPRE Report No. 2022-101). Office of Planning, Research, and Evaluation; Administration for Children and Families; U.S. Department of Health and Human Services.