Each curriculum of the Rhode Island RS Series is typically delivered by more than one trainer, at least one of whom is the primary trainer. All primary trainers have achieved endorsement via The Rhode Island Association for Infant Mental Health Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Early Childhood Mental Health^® (Rhode Island-IECMH-Endorsement^®) or are endorsement eligible but have not yet pursued/obtained this designation. The aim of endorsement is to foster shared language and understanding of IECMH across disciplines via, among other things, ongoing professional development in the service of improving outcomes for infants, young children, and their families (McCormick & Eidson, 2000). The Rhode Island RS Series has been approved by the Rhode Island’s Infant Mental Health Association to ensure participants can use the RS Series to support their endorsement applications if desired. Secondary trainers are typically postdoctoral clinical psychologists who are involved in an infant/early childhood specialty training program affiliated with an academic medical center and who receive supervision from primary trainers. Given this structure, secondary trainers are poised to become primary trainers once eligible for endorsement and the original curricula developers have observed trainers’ competencies adhering to the training content, structure, and process. Currently, all trainers are affiliated with Bradley Hospital’s Early Childhood Collaborative (ECC), of which the authors are members. To date, trainers have all been psychologists, but trainers can come from a variety of infant and early childhood disciplines. There are regular opportunities for trainers to receive individual and/or group RS about their training experience. Also, while the curricula are typically delivered by more than one person so as to model reflective interactions and allow for the opportunity for reflection on process, all curricula can be delivered by only one primary trainer. If there is only one trainer, ensuring opportunities for reflection about the trainer’s experience and having support for technology needs may be useful.

The first curriculum in the series, Foundations of RS, is an 8-hour training that can be delivered in one full day or broken down into multiple training sessions. It can be implemented in-person and virtually. To ensure the same core set of content is provided (i.e., fidelity), there is a standard set of slides with semi-scripted speaker notes that presenters can modify for their unique style. The sequence and primary content of the home visiting and ECE adaptations are nearly identical although slide visuals, speaker note examples, and activities vary somewhat to be relevant for the setting and participants. The content has been delivered with an audience of supervisors only, or with both supervisors and supervisees.

In the first part of the training, the focus is on RS theoretical underpinnings and definitional issues. To this end, RS is grounded within broader IECMH principles (e.g., the parallel process, relationship-centered practices, reflective functioning, diversity-informed tenets). Next, RS is defined, highlighting that a reflective approach to supervision often combines administrative, clinical (or other relevant content-focused supervision), and reflective components. Finally, Figure 1 describes the interrelated nature of the core characteristics of RS (i.e., regularity, collaboration, and reflection), the functions RS serves for its participants, the specific skills reflective supervisors use, and the unique contribution that each member of the dyad makes to the RS process and relationship.

The heart of the training is the focus on making RS skills tangible for all participants, whether they are providing, or receiving, RS. Thus, this section of the training starts with Figure 2 and describes the three primary goals of a supervisory session or supervisory interaction (i.e., Affirming, Holding, and Slowing, Broadening the Story, and Guiding and Focusing). It is made clear from the outset that these goals apply to all interactions between a supervisor and supervisee, not just during a full supervision session. This is especially important because this training is provided within ECE and this setting is less likely, on average, to have regular, protected time for supervision than other IEC settings (e.g., home visiting, mental health). Subsequently, Figure 3 provides details on the multiple, specific skills that can be used to achieve these goals.

Goals and skills are modeled and practiced in several ways. First, there is a video-based model of a whole session using the above-referenced video series by Drs. Heffron and Murch (2012). After watching and discussing an RS interaction, two common applications of reflective supervisory skills, collaborative problem solving (i.e., a process for collaborative decision-making when a supervisee introduces content) and spotlighting (i.e., a process for collaborative decision-making when a supervisor introduces content, for example, about performance-related concerns) are taught, modeled, and practiced. To provide models of these applications, videos of trainers engaging in short collaborative problem solving and spotlighting moments are shared and processed in a facilitated large group discussion. Following these video-based models and discussions, participants practice these skills in small groups (when in person) or breakout rooms (when virtual) via scaffolded role play scenarios.

Finally, there are several experiential activities interspersed throughout the training that allow participants to experience components of the reflective stance or “way of being” associated with RS. For example, a guided imagery exercise is utilized to help participants think through the ways their internal experience (i.e., their physical sensations, their feelings, and their thoughts) can be a guide to understanding the work and the relationships involved in the work. Experiential activities are always followed by opportunities for reflection (e.g., individual written reflection, small and large group discussion). In addition to having participants experience key reflective elements, these experiential activities help maintain engagement and attend to differences in learning styles among participants. And, because activities always end with a large group discussion facilitated by a trainer, it also provides an opportunity for participants to see trainers model reflective skills in action.

The Reflective Supervision (RS): Skill Development Workshop is a multi-month curriculum designed to deepen supervising professionals’ knowledge of RS and cultivate specific RS skills and strategies. Supervisors who have completed the Foundations of RS curriculum are eligible to enroll in this workshop. This workshop can be implemented as a 6-12-month series that meets monthly (in person or virtually) for 1.5-2 hours. As detailed in Table 1, enrollment in these workshops is aligned along professional disciplines (e.g., separate groups for ECE and home visiting professionals). Furthermore, supervisors participate in the Workshop as a cohort in order to build engagement, cohesion, safety, and trust within a consistent group of participants and facilitators; thus, new supervisors are unable to join past the initial session(s).

The RS: Skill Development Workshop has three primary components: participant supportive check-in, facilitated discussion about RS foundational readings, and a group-based reflective consultation experience. The supportive check-in provides an opportunity for group members, who come from different organizations, to talk about their experience as a supervisor since the last workshop and serves the function of building community and reducing isolation. The curriculum has a core set of readings (the exact reading list varies based on the length of the group and the setting); as new publications are added to the RS cannon, they are evaluated as possible additions or substitutions to the reading list. The reading list is selected to support the core elements of the Foundations of RS curriculum, with an emphasis on how supervisors can build trusting relationships through RS, utilize specific skills and strategies, and appreciate different perspectives and identities. During the discussion of the readings, the group facilitator(s) take care to highlight the main content points, engage group members to share about how the content applies to their experience and goals as a supervisor, and encourage a dialogue about how they can bring the content back to their setting and supervisees. In addition to readings, the curricula have supplemental activities that highlight additional skills, strategies, or aspects of the RS stance, many of which have been adapted from appendices in Heller and Gilkerson (2009). Finally, specific activities (e.g., using a social identity wheel – a visual representation of defined social identities - to facilitate discussion about self and other identities within RS) and readings (e.g., Stroud, 2010; Wilson & Barron, 2022) maintain a focus on diversity-informed RS.

The third component of the RS: Skill Development Workshop is a group reflective consultation experience, called the Reflecting Team. Though Reflecting Teams are used in many forms of supervision, this particular model of Reflecting Team is credited to Judy Semonoff, LICSW, one of the developers’ reflective consultants. The Reflecting Team follows a set structure: 1) one group member brings some clinical, supervisory, or other IEC professional content for the rest of the team’s attention and focus; 2) a group facilitator guides this individual in a discussion that aims to affirm the individual’s experience, slow down the process, broaden the story, and explore the individual’s multiple reactions to, and relationships within, the work; 3) the group facilitator opens the discussion to the rest of the group to offer a single reflective and non-directive question, comment, or image about their thoughts, emotions, and reactions to the discussion thus far with the hopes the story broadens even further; and 4) additional conversation between the group facilitator and individual to guide the discussion towards closure (not necessarily a solution, per se). Throughout this structure, the members of the Reflecting Team must rely on many RS skills; they cannot jump in to share a comment or idea until it is their turn, they must prioritize and choose only one reflection to share, and they must decide how to phrase their statement, image, or question in a reflective (not directive) way. Throughout, the group facilitator helps the group maintain the structure and process to ensure that all group members both experience and practice this way of discussing a supervisory concern, clinical need, or system dilemma.

The Reflective Supervision (RS): Advanced Skill Development Workshop is designed for supervisors who have completed the RS: Skill Development Workshop. To date, it has only been implemented with home visiting supervisors as a monthly, year-long experience, but a similar workshop is under development for ECE supervisors. Comparable to the RS: Skill Development Workshop, participants must be enrolled by the initial workshop session(s) in order to build engagement, cohesion, safety, and trust among the participants and facilitator(s), and the RS: Advanced Skill Development Workshop process is enriched by enrollment of supervisors from different agencies. Eligibility for the RS: Advanced Skill Development Workshop was collaboratively determined with funders to ensure participants had enough exposure to and practice with RS before moving on to a more advanced experience.

The RS: Advanced Skill Development Workshop has three components. Consistent with the RS: Skill Development Workshop, it continues to provide multiple opportunities for supervisors to practice RS skills through the elements of a supportive check-in and participation in the Reflecting Team. In addition, a third element is that each member sets specific skills-based goal(s) and identifies a practice-based activity to help them achieve progress towards their goal(s). The practice-based activities include: sharing a video-recorded supervisory session for feedback, leading a discussion about a reading/other RS related professional media they identify, or facilitating a Reflecting Team. After completing their practice-based activity, each participant has an additional meeting with a workshop facilitator that provides an opportunity for deeper reflection on the experience and the identification of ongoing skill-building goals. Facilitator-led discussion about readings and other media are used in an emergent fashion as the group identifies conceptual areas for continued focus or a group member chooses a facilitated group content discussion as their practice-based activity.

Key moments of planning, development, and adaptation as aligned with the REP framework, are illustrated in Table 2. We share this history to demonstrate the ways that multiple funding mechanisms and collaborators came together over time to identify the need for RS training (pre-conditions), to implement an initial RS training by national trainers and later develop the Rhode Island RS Series (pre-implementation), to implement and adapt the Rhode Island RS Series (implementation), and to establish sustainable funding for ongoing implementation (maintenance and evolution).

In 2010, like many states, Rhode Island benefitted from federal funds via the Patient Protection and Affordable Care Act. This funding was awarded to the Rhode Island Department of Health (DOH) to establish Rhode Island’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grant program. Since that time, the Rhode Island DOH has developed a systems-level vision that promotes the implementation of three evidenced-based home visiting (EBHV) models with fidelity. This systems-level vision includes the funding of myriad professional development opportunities for home visiting professionals, including training focused on the provision of high-quality supervision. A review of local resources by the Rhode Island DOH indicated that Rhode Island did not have local capacity to provide training in RS. Thus, in 2013, Rhode Island leveraged available state and federal funds to fill this critical gap and provided an initial statewide RS training for IEC program supervisors and other individuals invested in infant and early childhood systems; this training was delivered by nationally recognized experts, Drs. Heffron and Murch. In 2014, the Rhode Island DOH turned to local partners, Bradley Hospital’s Early Childhood Collaborative (ECC), to further build RS infrastructure, funding the ECC to develop and implement the Rhode Island RS Series. The ECC, of which the authors are affiliated, is a group of professionals dedicated to the promotion, prevention, and treatment of early childhood mental health and is also affiliated with the Warren Alpert Medical School of Brown University. ECC members span the professional continuum and include licensed mental health professionals, developmental psychologists, postdoctoral fellows, and research staff. The subgroup most involved in the development of these curricula are licensed clinical psychologists and clinical psychology postdoctoral fellows.

By 2015, two of the three RS curricula (Foundations of Reflective Supervision, Reflective Supervision: Skill Development Workshop) were implemented for home visiting professionals for the first time. Since this time, the Rhode Island DOH has continuously provided funding for this work for home visiting professionals via a blend of state and federal funds. Following implementation of the series with Rhode Island’s home visiting professionals, the ECC leveraged existing relationships and utilized program evaluation data to raise awareness of these curricula and their impact. In 2019, the Foundations of RS curricula was adapted for and delivered within the ECE community due to funding by a Rhode Island Preschool Development Grant Round 1 subcontract. Also in 2019, the third curricula (Reflective Supervision: Advanced Skill Development Workshop) was developed and implemented after home visiting supervisors began requesting to participate in the RS: Skill Development Workshop for the third and fourth times. When enhanced financial support became available during and following the COVID-19 pandemic (e.g., American Rescue Plan Act of 2021), additional funding allocated to the ECC allowed for further refinement of the RS curricula for ECE, including adaptation and delivery of the RS: Skill Development Workshop for ECE professionals. The series for ECE professionals is now sustainably funded as part of the state’s infant and early childhood mental health consultation program via a blend of state and federal funds.

The ECC started developing the curricula in 2014. One intentional decision was to use the same language and substantive content that was introduced during the initial training delivered in 2013 in all subsequent trainings. This approach ensured that people within and across organizations implementing RS in Rhode Island had received consistent information and had shared vocabulary, regardless of when they took the training, thus promoting continuity over time. This is one approach for infusing RS throughout organizations and systems, which has been coined “getting RS in the bricks” (Heffron & Murch, 2010). The national experts who delivered the initial training in Rhode Island, Drs. Heffron and Murch, had recently published a book and associated video training series and thus these materials were key for content development of the Foundations in RS curriculum. To ensure that no major RS concepts, skills, or strategies were missing, the ECC curricula developers triangulated the concepts, skills, and strategies in the Heffron & Murch texts (2010, 2012) with other RS compilations (e.g., Heller & Gilkerson, 2009) and key infant mental health writing (e.g., Pawl, 1995a; Pawl, 1995b; Weatherston, 2000). This review process led to the development of Figure 1 (a visual portrayal of the multiple layers of RS) and the list of RS skills we utilized in initial training implementations. These key reference sources also served as the standard reading list for the RS: Skill Development Workshop to further promote consistency of content and generalization of skill development.

Regarding the development of experiential activities, the developers drew from RS sources (e.g., appendices in Heller & Gilkerson, 2009) and other professional development experiences; these were integrated and adapted to align with RS content as necessary. For the development of RS: Skills Development Workshop and RS: Advanced Skill Development Workshop, the Reflecting Team became the key experiential component. The additional experiential components in RS: Advanced Skill Development Workshop (i.e., sharing a supervision video, leading a resource discussion, leading a reflecting team) are focused on practicing some common applications of RS skills that supervisors may utilize during individual and group supervision experiences within their organizations as additional strategies for “getting RS in the bricks” (Heffron & Murch, 2010).

The curricula have undergone an iterative process of refinement since their initial development, primarily based on feedback from participants and trainers after each implementation cycle. All implementation efforts surrounding these curricula included a small program evaluation component, which allowed for limited collection and analysis of participants’ experiences with the curricula. Specifically, participants completed surveys that included quantitative and qualitative questions asking about their satisfaction with and perspective on each of the training experiences. Using formative feedback to guide ongoing adaptations is prevalent in many disciplines and frameworks that intersect with curricula development, including the REP implementation science framework (Kilbourne et al., 2007). In this adaptation process, all formative feedback was discussed, and next steps were determined in a collaborative work group comprised of the primary and secondary trainers currently delivering aspects of the Rhode Island RS Series. In addition to these feedback loops, the collaborative workgroup stayed abreast of new developments in the field (e.g., the Reflective Interaction Observation Scale [RIOS; Watson et al., 2016]) and collectively have attended numerous RS professional development opportunities (e.g., RIOS^™ 1: Using the RIOS^™ Framework for Reflective Supervision, Minnesota; Reflective Supervision in Early Education and Care, Massachusetts). This content was discussed within the collaborative workgroup, with a focus on identifying training content or process components that might warrant inclusion.

Although small adaptations have always been made based on this iterative process (e.g., minor changes to didactic content, substitution of readings), four circumstances pushed forward more substantive changes. First, specific funding was obtained in 2019 to adapt the curricula to be applicable for ECE settings, furthering additional adaptations to the curricula and incorporating content for an additional IEC professional discipline. Second, the inclusion of secondary trainers starting in 2020 brought new eyes and energy to the content and structure of the curricula. These trainers-in-training were less familiar with RS and therefore experienced the curricula both as learners and facilitators. In some instances, they were simultaneously having their first experiences with individual and/or group RS. Through this lens, they were able to pinpoint parts of the didactic content that would benefit from adaptation as well as content for which an experiential activity could punctuate a point to deepen learning. Third, the COVID-19 pandemic led to a quick pivot towards adapting a previously in-person delivery modality to a fully virtual modality and an examination of presentation length, activities, and content. Fourth, concurrent with trainers’ increased awareness of considering RS within a diversity-informed lens, there has been considerable examination of the content (at both micro and macro levels) in order to increase the specificity with which the curricula attend to the incorporation of social identity, power, privilege, and social justice within the supervisory relationship.

The Foundations of RS curriculum has undergone three substantial revisions. Two of these revisions focused on structure and delivery modality, not content. First, the overall length of Foundations of RS was reduced, and technological adaptations were made (e.g., use of break out rooms, word clouds) to make the curricula acceptable in a virtual modality. Second, more experiential and practice-based activities for participants were added over time; this included the development of additional video-based models and activities that are applicable for supervisees as well as supervisors.

The third change was a substantive content revision, focused on restructuring the way key RS skills and strategies are introduced, modeled, and practiced. After several years of defining, modeling, and practicing the original list of RS skills (e.g., Heffron & Murch, 2010; see Initial Content Development for more information), this section was revised in 2022. The aim of the revision was to enhance trainees’ learning about concrete supervisory practices following a concern voiced by trainers that the original list and mode of presentation was not facilitating optimal integrative comprehension (e.g., based on observation of trainees during large group discussion and practice opportunities). To this end, a subset of trainers (N = 3) independently sorted the individual skills into categories. Although discrete categorization of skills was an impossible task, two consensus Venn diagrams were agreed upon (see Figures 2 and 3). These Venn diagrams were presented to and confirmed with the remaining trainers at the time (N =3). In our workgroup, we also compared these Venn diagrams to other RS frameworks in the field (e.g., the RIOS, Watson et al., 2016) to ensure that they were not inconsistent. These Venn diagrams of RS skills are now a key feature of our training series.

This RS professional development series would not have been developed nor implemented if not for direct actions by individual visionaries within multiple state agencies in Rhode Island. This began with the Rhode Island DOH prioritizing RS in the development of its home visiting infrastructure and continued with the multiple state agencies involved in the PDG grant who prioritized the funding of RS professional development as part of its strategic goals in ECE. For example, in building Rhode Island’s home visiting infrastructure, a system analysis conducted by the Rhode Island DOH indicated that the state did not have the infrastructure to offer and implement professional development regarding RS to the EBHV models, despite RS being a requirement of some models. After identifying this need, the Rhode Island DOH brought in national experts (Drs. Heffron and Murch) to lead the first RS training and utilized interagency partnerships to make this training accessible to a broad range of IEC professionals and leaders. Furthermore, the Rhode Island DOH explicitly used this training as an opportunity to identify additional champions by inviting IEC leaders from multiple agencies to a post-training conversation about how to build local infrastructure to continue this initial investment. In many ways, these champions and prioritization of RS implementation in Rhode Island preceded the ECC’s involvement. However, the ECC curricula developers nurtured relationships with these champions over time, both prior to and during development and implementation of the Rhode Island RS Series.

Although the ECC was solely responsible for the design, development, and adaptation of the curricula, this work would not have been possible without the direct engagement and involvement of state agency partners whose involvement ranged from (a) providing funding, (b) being a collaborative planning partner around recruitment and outreach, and (c) outlining and disseminating a full set of participant requirements to the workforce. This type of long-term implementation and system-building collaboration truly benefits from strong working relationships built on trust and sense of mutual endeavor, as is true of all IEC work.

Rhode Island is small, with multiple opportunities for IEC professionals to interact and collaborate on shared visions and projects. Thus, some of the formative relationships were in place prior to initiation of the work on RS training development and implementation. For example, members of the ECC and the multiple state agency partners had worked together on other collaborative projects (e.g., integration of developmental screening in pediatric primary care, development of the state’s infant and early childhood mental health consultation program in ECE) prior to and concurrent with the Rhode Island RS series development and implementation. However, as with any project that spans a decade, individual people within organizations change and relationships must be nurtured. For both home visiting and ECE implementation efforts, regularly scheduled collaborative planning meetings (at least monthly, and sometimes more frequently) supported synergy across projects and strengthening of relationships over time. The ECC also maintained state agency partners’ direct engagement in system building by regularly presenting program evaluation data; this provided opportunities to engage in the refinement process and collaboratively think through data-driven adjustments to implementation.

The development, implementation, and adaptation of the Rhode Island RS Series has been funded for approximately a decade by multiple state agencies that have leveraged a myriad of local and national funding sources. This is due predominantly to individual champions who prioritized RS in the allocation of resources as well as the long-term nurturance of collaborative relationships. It was also because, in large part, the ECC can report on what the curricula have accomplished (or not accomplished) and support these assertions with program evaluation data. Put simply, evidence-based decision-making was important for generating buy-in and engagement, which in turn has supported further state funding and sustainability efforts. Indeed, our collaborators directly told us that they value an evidence-based approach to decision-making.

For example, at multiple stages of implementation and adaptation, program evaluation data was used to bolster continued support for the Rhode Island RS Series. The ECC proposal to utilize funds to adapt and pilot the curricula for ECE professionals incorporated program evaluation data from home visiting implementation that showed implementation feasibility, acceptability, and initial signs of effectiveness for improving trainees’ RS capacities. Further, when the state received funds to support the ECE workforce in the wake of the pandemic, the ECC again utilized program evaluation data from pilot implementation to advocate for continued funding of the curricula’s implementation with ECE professionals. Through access to data, state agency partners have a clearer picture of how training efforts are impacting the IEC workforce, allowing for evidence-based practice and policy decision-making. Importantly, the use of empirical data has the potential to not only inform decision-making about how IEC professionals are trained in RS in Rhode Island; this also is relevant for other state and national decision-makers who are considering implementing RS professional development opportunities. Every state or institution is likely in a different stage of advocacy for RS professional development, necessitating individualized plans for how, when, and with whom data is used. For example, state decision-makers who have not yet prioritized RS professional development among many workforce needs might benefit from data syntheses about the effectiveness of RS for the workforce before discussing which RS professional development approaches might be acceptable, feasible, and effective at training that state’s workforce.