Rehabilitation and Mental Health School Counseling Clinical Practice … Update Sept... · August...

August20181

M.A.DegreeinCounselingProgramRehabilitationandMentalHealth

SchoolCounseling

ClinicalPracticeManualForStudents&Faculty

2018-2019

PracticumSERP594InternshipSERP593

DepartmentofDisability&PsychoeducationalStudies

CollegeofEducationUniversityofArizonaPOBox210069Tucson,AZ

85721-0069

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TableofContents

Part I: Introduction 3PurposeoftheManual,3SupervisedClinicalPracticeCoursework,3MentalHealth,Rehabilitation,andSchoolCounselingDefined,4

Part II: Requirements and Procedures 5

SecuringaClinicalSite,5PracticumRequirements,8 InternshipRequirements,10ExampleClinicalPlacementSites,11

Part III: Roles and Responsibilities 12

CounselingStudentResponsibilities,12SiteSupervisorResponsibilities,13UniversityFacultySupervisorResponsibilities,14

Part IV: University Policies 16

DiscriminationandSexualHarassment,16 GraduateStudentGrievances,16

Part V: Glossary of Commonly Used Terms 17 Part VI: Forms 20

FormA:AgencySiteAgreement,21FormA1:SchoolSiteAgreement,23FormB:ClientConsent,25FormB1:ClientConsentSpanish,26FormC:ActivityLog,27FormC1:SchoolCounselingWeeklyActivityLog,28FormD:CounselingSessionSelf-Reflection,29FormE:RecordingCritique,30FormF:StudentEvaluationofSiteSupervisorandSite,31FormG:SiteSupervisorEvaluationofStudent,32FormH:UniversityFacultySupervisorEvaluationofStudent,34

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PartI:IntroductionPurposeoftheManual

The purpose of the Clinical PracticeManual is to provide informationaboutthecontext,objectives,activities,andresponsibilitiesoftheclinicalpracticecomponentoftheCounselingProgramcurriculumatTheUniversityofArizona.Theguidelinesin thisManual are intended to be flexiblebecause clinicalpractice situationsmaydiffer, yet not so flexible that the integrity of the clinical experience iscompromised. Differences can be due to the uniqueness of each student, each agency setting,each agency supervisor and each client. Nevertheless, thisManualwill provide specificguidelines,expectations,andprocedurestoensureconsistencyandstructuretoPracticumandInternship clinicalexperiences.AdditionalclarificationcanbeprovidedbytheassignedPracticumor InternshipUniversity FacultySupervisor.

SupervisedClinicalPracticeCourseworkSupervisedclinicalpracticecourseworkincludesPracticumand Internship.Bothareamongthemost importantprofessionalpreparationactivities inwhichstudentsparticipate.Practicumisa100-hourclinicalexperience,whileInternshipisa600-hourclinicalexperience.StudentscompleteoneortwoPracticumcourses,dependingonspecialization,andone600-hourInternship.Theobjectiveofclinicalpracticecourseworkistoprovidestudentsan opportunitytodevelopcounselingskillsthroughclinicalexperience,reflection,andsupervision.Endorsingthescholar-practitionermodelofgraduatetrainingincounseling,theclinicalcourseworkintheCounselingProgramatTheUniversityofArizonaisablendofacademicandappliedlearningalongwithstructuredsupervision.The requirements for PracticumandInternship are basedontheaccreditationstandardsestablishedbytheCouncilforAccreditationofCounselingandRelatedEducationprograms(CACREP).PracticumandInternshipmustbecompletedunder thesupervisionofanexperiencedSiteSupervisor.TheSiteSupervisor must hold a Master’s degree in Counseling, or a related field; have a minimum of twoyears ofpertinentprofessionalexperience;andistrainedincounselingsupervision.StudentsarealsosupervisedbyaUniversityFaculty Supervisorassigned to thePracticumor Internshipcourse, orsupervised by a doctoral student working under the supervision of a University Facultymember.TheCounselingProgramemphasizesethicaldecision-makingskills.DuringPracticumandInternship,studentsadheretorelevantlegalandethicalstandards,includingthemostrecentAmericanCounselingAssociation (ACA) Codeof Ethics, Commission onRehabilitation Counselor Certification(CRCC) CodeofProfessional Ethics, AmericanMental Health Counselors Association (AMHCA) Codeof Ethics, and AmericanSchool Counseling Association (ASCA) Code of Ethics. In addition, thefederally-mandated HIPPA law and its guidelinesmustbeadheredtoinanethicalmanner.Anethiccodeviolationmayresultinastudent’sexpulsion fromtheCounselingProgram.

Whenindoubt,aCounselingProgramstudentwillseekguidancefromtheSiteSupervisorand/ortheUniversityFacultySupervisor,notapeer

SiteSupervisorquestionshouldbedirectedtotheUniversityFacultysupervisor

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MentalHealth,Rehabilitation,andSchoolCounselingDefinedMentalHealthCounselingMentalhealthcounselorsarehighly-skilledprofessional counselorswhoprovide flexible, consumer-orientated therapies.Theycombinetraditionalpsychotherapywithaproblem-solvingapproachthat createsadynamicandefficientpath for changeandproblem resolution.Mentalhealth counselorsoffer a full rangeofservices,including:

• Assessmentanddiagnosis• Psychotherapy• Treatmentplanning• UtilizationReview(UR)inagencieswithoutmedicalpersonnel• Briefandsolution-focusedtherapiesforindividuals[adultandbirthto18],families,couples,groups• Licitandillicitsubstanceabusetreatment• Treatmentevaluationandresearch• Referralandconsultationservicesamongmultipledisciplinesforintegratedcare• Psychoeducationalandpreventionprograms• CrisisManagement

Foradditionalinformation:AmericanMentalHealthCounselorsAssociation(AMCHA)athttp://www.amhca.org

RehabilitationCounselingRehabilitationcounselorsassistindividualswithaddressingphysical,mental,developmental,cognitive,and emotionaldisabilitiesinordertoachievetheirpersonal,professional,andindependentlivinggoalsinthemost integratedsettingpossible.RehabilitationCounselorsengageinacounselingprocesswhichincludescommunication,goalsetting,and beneficialgrowthorchangethroughself-advocacy,psychology,vocational,andsocialandbehavioral interventions.Rehabilitationcounselorsofferafullrangeofservices,including:

• Assessmentandappraisal• Diagnosisandtreatmentplanning• Vocationalcounseling• Individualandgroupcounselinginterventionsfocusedonfacilitatingadjustmentstothe

medicalandpsychosocialimpactofdisability• Casemanagement,referral,andservicecoordination• UtilizationReview(UR)inagencieswithoutmedicalpersonnel• Programdevelopmentandevaluation,research,andimplementationofevidence-based

andbest practices• Interventionstoremoveenvironmental,employment,andattitudinalbarriers• Consultationservicesamongmultiplepartiesandregulatorysystems• Jobanalysis,jobdevelopment,andplacementservices,includingassistancewithjob

accommodations• Consultationregardingaccesstorehabilitationtechnology

Foradditionalinformation:CommissiononRehabilitationCounselorCertification(CRCC)http://www.crccertification.com/

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SchoolCounselingProfessionalschoolcounselorsprovideculturally-competentservicestostudents,parents/legalguardians,school staff,andthecommunityacrossthespectrumofeducation(K-12,college,university).Theydosointhefollowing areas:

• SchoolGuidanceCurriculum:providestructuredlessonsdesignedtohelpstudentsachievedesired competenciesandprovidestudentswiththeknowledgeandskillsappropriatefortheirdevelopmental levels.

• IndividualStudentPlanning:coordinateongoingsystemicactivitiesdesignedtohelpstudentsestablish immediatepersonalgoalsanddevelopfutureplans.

• ResponsiveServices:offerpreventionand/orinterventionactivitiestomeetstudents'immediateand futureneeds.Theseneedscanbenecessitatedbyeventsandconditionsinwhichthestudentlives,theschoolclimate,andculture.Meetingthoseneedsmayrequireanyofthefollowing

o Individualorgroupcounselingo Consultationwithparents,teachers,othereducators,andserviceproviderso Referralstootherschoolsupportservicesorcommunityresourceso Peerhelpingorsupporto Psycho-educationo Interventionandadvocacyatthesystemiclevel

Foradditionalinformation:AmericanSchoolCounselingAssociation(ASCA)athttp://www.schoolcounselor.org/

PartII:PoliciesandProceduresSecuringaClinicalSite

Practicum and Internship are opportunities for students to gainexperienceworkingwithin a spectrumofclinicalsettings. StudentsarestronglyencouragedtoregularlydiscusspotentialplacementsiteswiththeMs.CameliaShaheed([email protected]),theClinicalPlacementCoordinatoraswellaswithCounselingProgramFacultyandfellowstudentsastheyprogressintheCounselingProgram.Topromotethebesteducationalopportunityforeachstudent,aclinicalplacementsitemustbepre-approvedbytheClinicalPlacementCoordinatorbeforeastudentconsidersitasaplacement.Approvalisbasedontheagency’sprovisionofadultandchild/familymentalhealth,rehabilitationorschoolcounselingservices,qualificationsofthepotentialSiteSupervisor,andotherguidelines.TheproceduresforlocatingandsecuringaclinicalsiteforPracticumorInternshipareasfollows:1. TopPriority:CommunicationbetweentheSiteSupervisorandtheUniversityFacultySupervisoris

essentialforthegraduatestudent’seducationalandprofessionalgrowth.Forthatreason,theSiteSupervisor-UniversityFacultySupervisorrelationshiphaspriorityovertheSiteSupervisor-studentrelationship.TheSiteSupervisorandUniversityFacultySupervisormayscheduleasitevisitduringthesemester.Theywillmaintaincontactatthestart,middle,andendofthesemesterorasindicatedbythestudent’sperformance.Thecontactsensureissuesareaddressedinatransparent,timely,andproactivemanner.Transparencyonthepartofthestudentcannotbeoverstressed,regardlessoftheissueoritsresolution.ProfessionalismduringPracticuminfluencesInternshipopportunities,which,inturn,influencespost-graduateemploymentopportunities.TheUniversityFacultySupervisorwillmaintainHIPPAandFERPAstandardsunlessthestudentprovideswrittenconsenttoreleaseany

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privateinformation.

2. ThestudentwillobtainaLevelOneFingerprintClearancecard(LevelOne,IVPfingerprintclearancecard)thefirstsemesterofgraduatestudy,whichisvalidsix(6)years.Thislevelof clearanceismandatedbyschoolsandmanyclinicalagencies,especiallythosethatserveunder-agechildrenor vulnerableadults.Forexample,theIVPLevelOnefingerprintcardismandatoryforschoolplacements,SchoolCounselorcertificationapplications,and/orcounselingchildrenoradultswithsevereandpersistentmentalillness.InthecaseofSchoolCounselingCertification,anyothercardwillresultindenialoftheapplication.Caution:theinitialLevelOneFingerprintClearanceCardapplicationtakesatleast4weeksandarenewaltakeslonger.Additionally,somegovernmentalagencies (VA, American IndianNations)maycomplete their own background checkpriortotheplacementregardlessofthestudent’spossessionofaLevelOneFingerprintClearance.http://www.azdps.gov/services/fingerprint/https://www.azed.gov/wp-content/uploads/PDF/InformationforFingerprintClearanceCard.pdf

ThestudentwillpurchaseStudentLiabilityInsurance,validforone(1)year,fromaprofessionalorganizationaminimumoftwoweekspriortothestartofPracticumorInternship.Theliabilitypolicymustcovereachdayoftheclinicalplacementexperience.Thepolicywillincludethestudent’sname,policynumber,andpolicyexpirationdate.ProfessionalorganizationssuchasACA,ARCA,AMHCA,ASCA,CRCCorHPSOofferStudentLiabilityInsurance.ASCAStudentLiabilityInsuranceinsuresschoolcounselingplacementsnotmentalhealthplacements.ACAinsurancecoversallrehabilitationcounseling,schoolcounseling,andmentalhealthplacements.ACAcoverage:https://www.counseling.org/membership/aca-and-you/students

3. Thestudentcanreviewthelistofsamplesitesinthenextsection. The list, whileinexhaustive,

facilitatesadiscussionduringtheinitialmandatoryconsultationwiththeClinicalPlacementCoordinator.Some agenciesdonotdeal o n l y w i t h t h e C l i n i c a l P l a c em e n t C o o r d i n a t o r d u e t o specificrequirements.Students are,therefore, stronglyencouraged toconsultwiththeClinicalPlacementCoordinator to discuss placement options and procedures.Studentsshouldfeelfreetonetworkwithpeers,graduates,andcommunityprofessionalstoidentifyagencieswhichdovetailwiththeircareerinterestsandgoals.

4. ThestudentwillmeetwiththeassignedFacultyAdvisortodevelopaCourseSequencePlanforthesemesterthatPracticumandInternshipwillberegisteredfor.Someagenciesfilltheirplacementrostersoneyearin advance,othersonesemesterinadvanceandothersafewweeksbeforeaterm.Placementsarecompetitive.EachCounselingProgramstudentcompeteswithotherProgramstudents,studentsfromotheruniversities,studentsfromotherclinicaldisciplines.TheearlierthestudentmeetswiththeClinicalPlacementCoordinator,thebettertheplacementoutcomes.ThisisespeciallytruewhenastudentdesirestoplaceinaruralcommunityoroutsideTucson,AZ.Note:Clinicalplacementscannotalwaysbetailoredtostudentwishes.

5. Thestudentwillcheckemailatleastonceperday.WhentheClinicalPlacementCoordinatorintroducesa student toapotentialplacement, the studentwill respond to that emailwithin 24hours and address all requests re latedto i t promptly.Note:ThestudentwillmaintaincontactwiththeClinicalPlacementCoordinatoraminimumofonceeveryweekandwillmaintaintheemailtrailuntiltheSiteAgreementissigned.Theprocesscanotherwisequicklybecomefrustratingand

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stressful.

6. WhenthestudentfindsaplacementsitewithouttheClinicalPlacementCoordinator’sassistance, thestudentwill i n t r oduce the ClinicalPlacement Coordinator,viaemailandwiththestudentincopy,t o theprospectiveSiteSupervisor.TheClinicalPlacementCoordinatorwillreturntothestudentwithadecisionabouttheappropriatenessofthesiteasaplacement.Allplacementsareconsidered“pending”untiltheClinicalPlacementCoordinatorstatesotherwise.

7. Whenthestudentseeksaplacementathis/hercurrentplaceofemployment,theClinicalPlacementCoordinator mustbeadvisedbeforethestudenttakesanyaction.Thestudentmust completea placement in a di f ferent departmentandundera di f ferent supervisor toqual i fy for a placementat a current placeof employment.W h e n t h e s t u d e n t i s a b l e t o m e e t t h a t g u i d e l i n e , t h e s t u d e n t w i l l i n t r o d u c e t h e C l i n i c a l P l a c em e n t C o o r d i a n t o r , v i a em a i l a n d w i t h t h e s t u d e n t i n c o p y , t o t h e p r o s p e c t i v e s u p e r v i s o r .

8. Whenthestudenthasbeenintroducedtoasite,thestudentwillscheduleaninterviewwiththecontactperson.Aspartoftheinterviewprocess,thestudentwill:

I. Reviewtheagency’swebsiteforinformationaboutitanditsservicesII. Generatequestionsrelatedtotheagency’sservicecontinuumorphilosophyIII. Bringacurrentresumeandascheduleofavailabledaysandtimes.Placementsitesarenotobliged

toworkaroundstudentschedulesIV. Preparetoanswerquestionsdirectlyandsuccinctly,yetinformatively.Interviewersoftenlook

athowthoughtfulandcohesivearesponseismorethantheaccuracyofitV. ApproachanddressfortheplacementinterviewasajobinterviewVI. Disclose potential conflicts of interest or the appearance of conflictsofinterestwiththe

placementagency.Thisincludespreviousorcurrentrelationshipsbetween supervisors,clients, or other agency employees. Thesemust be discussed with the University FacultySupervisorpriortothestudent’splacementintheagency.

VII. Discussspecificaccessneeds.VIII. ThanktheSiteSupervisorforthemeeting,andsendathankyounote.

9. WhentheClinicalPlacementCoordinatorapprovestheplacementandthesiteacceptsthestudent,

thestudentandSite Supervisor complete the SiteAgreementor School SiteCounselingContract.SiteAgreements andSchool SiteCounselingContractsarecompletedpersemesterandthesignatures(e.g.,SiteSupervisor,student)andsignaturedatesshouldonlyreflectasinglesemesterperiod,andallsignaturesmustbeoriginal(notelectronic).“Tasks”sectionshouldbewell-developed.Allsectionsshouldbecompletedandsignedormarked“N/A”whereappropriate. ThestudentwillbringtheformtothefirstclassdayofPracticumorInternship.

10. Studentswillnotworkattheoutsidetheformalsemesterstartandenddates.Shouldthestudent

decidetodoso,thestudentdoessoindependentlyofTheUniversityofArizonaasa community“volunteer” or a paid employee. The StudentLiabilityInsuranceisvoidfor“volunteer”roles.

11. Thestudentwillfollowsiterulesandregulations;ACA,CRCC,AMHCA,and/orASCAethicalstandards

andcodes;federalHIPPAregulationsregardinghealthinformationprivacy;andFERPAregulationsregardingotherCounselingProgramstudentsplacedatthesamesite.ConsistentwiththeACAand

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CRCCCodeofEthics,SiteandFacultySupervisorsendorsesupervisees(CounselingProgramstudents)forcertification,licensure,employment,orcompletionofanacademicortrainingprogramonlywhentheybelievethatsuperviseesarequalifiedfortheendorsement.Regardlessofqualifications,SiteandFacultySupervisorsdonotendorsesuperviseeswhomtheybelievetobeimpairedinanywaythatwouldinterferewiththeperformanceofthedutiesassociatedwiththeendorsement.

12. WhenastudentmustterminateaplacementpriortotheSiteAgreement’sorSchoolSiteContract’s

enddate,thestudentwilldothefollowingpriortotermination:I. ScheduleameetingwiththeUniversityFacultySupervisortodiscussconcerns.II. Ifterminationispursued,thestudentwillalerttheSiteSupervisoroftheintentiontoterminatetheplacementviaaformalresignationletterofferingthestandardtwo-weeknotice.TheSiteSupervisormaywaivethetwoweeksather/hisdiscretion.Thetwo(2)weeknoticeisanethicalandprofessionalobligationnecessaryforthecoordinationofclientre-assignmentandseamlesscontinuityofcare.

PracticumRequirements

ThePracticumrequirementis100clockhours,40ofwhichmustbedirectclient/schoolstudenthoursinprofessionalcounselingactivitiescontributingdirectly tothestudents’professional counselingskilldevelopment.AsprerequisitestoPracticum,studentsmustsuccessfullycompletethefollowingfoundationalcourses:

1. CounselingTheory(SERP525)2. CounselingSkillsandTechniques(SERP546)3. eitherPrinciplesinRehabilitation(SERP565)orIntroductiontoSchoolCounseling(SERP506)

*GroupCounseling(SERP547)mustbetakenpriortoorconcurrentwith Practicum,andmoreadvancedcounseling skill courses suchasAssessmentinCounseling(SERP562),DiagnosisandTreatmentofMentalHealthDisorders(SERP579B)andCounselingwithCouplesandFamilies(SERP597C)arerequiredpriortoInternship,whichisthefinalcourseinthecurriculum.*RMHandSCstudentsregisteredforGroupCounseling(SERP547)mayberequiredtocompleteaparticipatorygroupcounselingexperience.Insuchcases,theinstructorofrecordwillprovidestudentswiththerelevantinformationonthatcomponent.Aspartofthe 40directclient/studenthours,thestudentmayactastheprimaryfacilitatororco-facilitatoringroupandfamilytherapies.Note:co-facilitationdoesnotapplytoindividualtherapy.Shadowing,a trainingmethod,cannotmeetthe40-hourrequirementofdirectclientcontacthours.Examplesofdirectclient/studentcounseling activitiesincludeindividual,group,couplesandfamilycounseling;intakeassessments;crisiscaremanagement;advocacy;andcommunityeducation.Toensurethedevelopmentofindividualandfamilyorcouplescounselingandassessmentskills,amaximumof16hoursofgroupcounselingmayapplytowardthemandatory40client/studenthourrequirement.Thestudentmayparticipateinmorethan16hours,butcannotapplymorethan16tothe40direct-hourrequirement. A s t u d e n t m u s t b e o b s e r v e d b y a q u a l i f i e d s t a f f m emb e r f o r g r o u p f a c i l i t a t i o n s k i l l s b e f o r e t h e s t u d e n t canaccumulategrouphoursindependently.Dependingonspecialization,studentsintheCounselingProgrammayberequiredtocompleteoneortwoPracticumcourse:

! TheSchoolCounselingSpecializationrequirementis twoPracticumcourses:(1)one ina

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mentalhealthsetting, and(2)anotherinaschoolsetting.! TheRehabilitationCounselingSpecializationrequirementisonePracticuminarehabilitation

andmentalhealthsetting,unlessthestudentreceivesRSAfundingthathasadditionalstipulations.

! TheRehabilitationCounselingSpecializationandArizonaStateRSATrainingGrantrequirementisonePracticuminamentalhealthsetting.TherehabilitationcomponentiswaivedaslongasthestudenthasworkedaminimumofoneyearasaVocationalRehabilitationCounselorbeforebecomingdegree-seeking.

! TheRehabilitationCounselingSpecializationandFederalRSATrainingGrantrequirementmayincludeeitheroneortwoPracticumcoursesdependingonthegrant.TherequirementsvaryforvariousFederalRSATrainingGrants,andthestudentshoulddiscussthePracticumrequirementwiththeirUniversityFacultyAdvisor.

Tosuccessfullypasspracticum,studentsmustcomplete100clockhoursoveraminimumofa16-weekregularacademictermor10-weeksummerterm,andadheretothefollowingrequirements:

1. Thestudentwillmaintainanaveragecaseloadof4ongoingclientsasassignedbytheSiteSupervisor,unlesstheagencyhasanalternativestructureregardingcaseloads.

2. Thestudentwillconductanaverageof4counselingsessionsperweek,approximatelyone-hourinlength,unlessshortersessionsareindicatedforclientneeds,service,orinterventionmethodology.

3. The studentwill audio and/or video record at least six (6) counseling sessionsunlessdirectedotherwisebytheUniversityFacultySupervisor.Writtenclientpermissionismandatoryfortherecordinganditsreviewduringsiteanduniversityfacultysupervisionsessions.TheClinicalPracticeManualhasconsent forms for adult clients, legalguardians of adult clients, parents, and p a r e n t s o r legal guardians of thoseunder 18yearsofage. Recordingswill adhere to the limits specifiedintheconsentdocumentsandagencypolicies. StudentsandUniversityFacultysupervisorsprotectallinformationaccordingtofederalHIPPAandFERPA confidentialityregulationsduringthespanofeachplacement.Recordingsaredestroyedper thedirectionoftheUniversityFacultySupervisor.

4. Thestudentwillplayandcritiquecounselingsessionrecordingsduringsiteand facultysupervisionsessionsforfeedbackoncounselingskilldevelopment.SiteSupervisorsmayattend the student’s session insteadofreviewing recordings. StudentsandUniversityFacultysupervisorsprotectallinformationaccordingtofederalHIPPAandFERPAconfidentialityregulationsacrossthespanofeachplacement.

5. The studentwill participate in anaverageof1.0hour perweekof individual or triadicsupervision (2 students)withtheSiteSupervisorandanaverageof1.0hourofindividualortriadicsupervisionwiththeUniversityFacultySupervisor,orUniversityDoctoralCandidateSupervisoractinginthatcapacity.ArizonaRSAstudentswillmeetwith thedesignatedRSAUniversityFacultySupervisor,UniversityPracticumClinicalSupervisor,orUniversityDoctoralCandidateSupervisoractinginthatcapacity.

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6. Thestudentwillparticipatein1.5hoursperweekofgroupsupervisionwiththeUniversity

FacultySupervisororUniversityDoctoralCandidateSupervisoractinginthatcapacity.ArizonaRSAstudentswillmeetwiththedesignatedRSAUniversityFacultySupervisororUniversityDoctoralCandidateSupervisoractinginthatcapacity.

InternshipRequirements

Studentscompleteone600-hourInternshipexperience,typicallyduringthestudent’sfinalsemesterintheCounselingProgramandatasitecongruentwiththestudent’sprofessionalgoals.Studentsmustcompleteallcoursework,orhaveonlyonecourseremaining,whenregisteringforInternship.Inotherwords,thestudentwillhavecompletedaminimumof75%ofthetotalrequiredcourseworkfortheMaster’sdegreeinCounseling.Furthermore,thestudentmustsuccessfullypassPracticumwithoutincidentbeforeInternship.DifferencesbetweenInternshipandPracticum:

1. Length2. Responsibility3. Intensity4. Recording-free,unlessstipulatedbytheUniversityFacultySupervisor5. Nogrouphoursrestriction6. Students are expected to demonstrate professionalcompetenceacrossabroadspectrumof

advancedcounselingskills.WhenastudentisemployedatanagencythatmaybeanappropriateclinicalplacementsiteforInternship,thestudentmustalerttheUniversityFacultyAdvisorofhisorherinterestinapplying thatworkexperiencetowardtheInternshiprequirements.ThestudentwillwaitfortheUniversityFacultyAdvisor’s decisionbeforetakingfurtheraction.Iftherequestisapproved:

1. 32of40weeklyemploymenthourswill counttowardtheInternshipand2. Thestudentwillspendtheremaining8hoursperweekcounselingclientsin

a. adifferentsetting andb. counselingadifferentclientpopulationandc. underthesupervisionofadifferentSiteSupervisor

StudentsmustcarryStudentLiabilityInsuranceandtheFingerprintClearanceCardperpage6,point#2directionsofthisManual.Tosuccessfullypasstheinternship,studentswillcomplete600clockhoursoverathe16-weekacademicterm,andadheretothefollowing:1. Ofthe600clockhours,aminimumof240directclient/studenthourswillbeinprofessional

counselingactivitiesdirectlycontributingtotheenhancementofthestudent’sprofessionalcounselingskills.Aspartofthe240direct client/studenthours, the studentmayactas theprimary facilitatororco-facilitator ingroupor family therapies.Note: co-facilitation does not

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apply to individual therapy. Shadowingcannotmeet the240-hour requirement.Examplesofdirect client/student counseling activities include, but arenot limited to individual, group, andfamily& couples therapies; intakeassessment;casemanagement;advocacy;andcommunityeducation.

2. Thestudentwillparticipatein1.0hourperweekofindividualortriadicsupervisionwiththeSite

Supervisorandanother1.5hoursperweekofgroupsupervisionwiththeUniversityFacultySupervisor.ArizonaRSAstudentswillmeetwiththedesignatedArizonaRSAUniversityFacultySupervisor.

3. ThestudentwillmaintainanongoingcaseloadasassignedbytheSiteSupervisor.4. Thestudentwillconductcounselingsessionsapproximatelyone-hourinlength,unlessshorter

sessions areindicatedforclientsortheinterventionmethodology.5. Thestudentwillengageinavarietyofprofessionalcounselingactivities(record-keeping/notation,

assessmentinstruments,supervision,groupclientprogressreviews,informationandreferral,in-serviceandclinicalstaffmeetings,etc.).

ClinicalPlacementSiteExamples

Manyofthesiteslistedbelowhavespecificqualificationrequirements.AllsitesshouldbediscussedwiththeClinicalPlacementCoordinatorinadvance.AmphitheaterPublicSchoolsArizonaCenterfortheBlind&VisuallyImpaired(Phoenix)ArizonaSchoolfortheDeaf&Blind(AmericanSignLanguagerequired)BeaconGroupCasaDeVidaCatalinaFoothillsSchoolDistrictCODAC(Internship)DES/RSADIRECTFocusEmploymentServicesGilbertSchoolDistrict*HelpingAssociatesInc.(CasaGrande)IndianOasisUnifiedSchoolDistrictLaPazCounseling(Parker,LakeHavasu)*LasFamiliasCounselingAgency(Internship)MaranaSchoolDistrict*NCADD(Phoenix,Groupexperience)OfficeofSpecialEducationandRehabilitativeServices(OSERS)PageUnifiedSchoolDistrict*ParadiseValley*PhoenixSchoolDistricts*PascuaYaquiTribalHealth*SaffordPublicSchools*SahuaritaUnifiedSchoolDistrict*SunnysideUnifiedSchoolDistrict*

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TucsonUnifiedSchoolDistrict*TheUniversityofArizonaDisabilityResourceCenter(SummerPracticum,thenFallInternship)VailUnifiedSchoolDistrict*

*SchoolCounselingstudents,visittheArizonaDepartmentofEducation(ADE)websiteforadditionalinformationonallArizonaschooldistricts:http://www.ade.state.az.us/.

PartIII:RolesandResponsibilitiesCounselingStudentResponsibilities

1. WhenthestudentsattendsthefirstdayofPracticumorInternship,thestudentwillbringthe

*PlacementPacket’sthreedocuments:a. SiteAgreementorSchoolSiteContract,signedbythestudentandSiteSupervisorb. CopyoftheStudentLiabilityInsurancePolicy(oneyear)c. CopyofLevelOneIVPFingerprintClearancecard(sixyears)

*StudentscannotlegallyorethicallymeetwithclientsuntilthePlacementPacketisdeliveredtotheUniversityFacultySupervisor.RSAStudents(notFederalRSAGrantrecipients):MentalhealthpracticumandInternshipPlacementPacketaresenttoLizPinaFigueroa,ProgramCoordinator([email protected]).ArizonaRSAstudentswhocompleteInternshipatanRSAsitedoesnotrequireStudentLiabilityInsurance.2. ThestudentmusthaveaccesstotheSiteSupervisorinpersonorviaphone.ASite Supervisor,or

back-upsupervisor,mustbeeitherpresentoravailableviatelephoneatalltimes.Studentscannotbetheonlyindividualsatasite.Ifall staff leave the building, the studentmust leave or temporarilyrelocate to another building wherestaffispresent.ThestudentshoulddiscussthispointwiththeSiteSupervisoratthestartofplacementto avoid issues.

3. Within the community, placementsarejobsaswellasanacademiccourse.Studentsrepresent

themselves,theUniversity,andtheCounselingProgram.Itisthestudent’sresponsibilitytodressandtobehavepertheagency’sconductpolicies,andascommonsensewoulddictate.Whenindoubt,thestudentwillseekguidancefromtheSiteSupervisor.

4. Promptnessandreliabilityareprofessionalbehaviors.Thestudentshouldbevigilantandproactivein

thisareatoavoidno-shows,absences,orlatearrivals.Suchbehaviorcanbelabeledasanethicalorproceduralviolationbytheagencyand/ortheSiteSupervisor.

StudentsmustdiscussandscheduleholidayandothertimeawaywiththeSiteSupervisor,carefultofollowtheone-weeknoticestandardforaneventorholiday,andmustcoordinatecoverageandaddressresponsibilitiesforthetimeaway.Unlessotherwiseagreedupon,studentswilladheretotheagencyscheduleofoperation.

Whenanunplannedabsenceprecludesadvancenotice,thestudentwill notifytheSiteSupervisorimmediately.AbsencesduetoillnessshouldbeaddressedwiththeSiteSupervisor.Ifnecessary,studentswillscheduleanalternatetimetocompletethemissedhours.

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5. Thestudentwillconformtositerulesandregulations,andtorelevantethicalandconfidentiality

standardsofthefollowingorganizations:ACA,ASCA,CRCC,AMHCA,HIPPA,andFERPA.

6. ThestudentwillnotifytheUniversityFacultySupervisorimmediatelyif,foranyreasonduringtheplacement,thestudentcannotperformtheessentialfunctionsofthePract icumor Internship;ifthestudenthasconcernsregardingtheplacementorSiteSupervisor;orifthestudentreceivesconstructivefeedbackfromtheSiteSupervisor.Thestudentwilldiscloseallinformationrelevanttoher/hisprofessionaldevelopmentatthesite,eveninthehope“somethingwillchange.”

7. Thestudentwillrespondnon-defensivelyandconstructivelytosummativeandformativefeedback

regardlessofitssource–SiteSupervisor,UniversityFacultySupervisor,allsiteemployees,orotherstudents.ThestudentunderstandstheneedfortransparencybetweentheSiteSupervisorandtheUniversityFacultySupervisororUniversityDoctoralCandidateSupervisortoensureissuesareaddressedinatimelyandproactivemanner.

8. ThestudentwillmaintainanaccurateActivity Logofd i rect and ind i rect siteactivities,and

supervisionhours(siteandfacultysupervisionareindirecthours).9. ThestudentwillensuretheSiteSupervisorsubmitstheActivityLogandtheSiteSupervisorEvaluation

ofStudentatthemid-termandendthesemester.ThestudentwilldiscusstheevaluationswiththeUniversityFacultySupervisor.

10. The student will submitthe Student Evaluation of SiteandSite Supervisor.11. The studentwill attendallscheduledsupervisionmeetingsatthesiteandattheuniversity.Whenever

possible,thestudentwillreschedulemeetingsinadvance.Thestudentwilladheretoallsupervisionrequirements.Thestudentwillreceiveandsolicitfeedbackoncounselingskillperformanceinallthoseformats.

SiteSupervisorResponsibilitiesSiteSupervisorsmustmeetthefollowingcriteriaassupervisors:AminimumofaMaster’sdegreeincounselingorarelated professionwithequivalentqualifications, includingappropriatestatelicensesand/orcertifications;andaminimumoftwoyearsofprofessionalexperienceinthespecializationinwhichthestudentisp laced.

Responsibilities:1. TheSiteSupervisororients thestudent to theagency, staff,agencygoals,agencymission,and

chainofcommandwhenneedingsupervisorysupport;anddesignatesanofficewithnecessaryequipment forthestudenttoadequatelyconductcounselingsessionsandtodocumentclientsessions.

2. TheSiteSupervisorandthestudentwilldevelopaPracticum/Internshipscheduleandgoalsatthestartofplacement.

August201814

3. TheSiteSupervisormeetswiththestudent individuallyor inatriad(2students)fora minimumofonehourperweekforsupervisiontodiscussprogressandlearningneeds. The superv i so r may s i t i n on ses s ions o r rev iew sess ion record ings .

4. TheSiteSupervisorreviewsandinitialstheActivityLog.

5. If, forany reasonduring theplacement, theSiteSupervisorbelieves the studentisunabletoperformessentialplacementfunctions,basedonconsistentdirectand indirectobservationsandassessments,theSiteSupervisorwillimmediatelynotifytheUniversityFacultySupervisor.Ifissuespersist,thestudent,SiteSupervisor,andUniversityFacultySupervisorwilldevelopandimplementaRemediationPlan.

6. TheSiteSupervisorwill completestudentmid-termandfinalperformanceevaluationsanddiscusseseachwith the student. T h e f o rm s aremailed,emailed,orgiventothestudentforUniversityFacultySupervisorreview.

13.TheSiteSupervisorsupportstheprofessionaldevelopmentofthestudentbyproviding information

aboutavailablelearningopportunitiessuchasconferences,workshopsandtrainings.

UniversityFacultySupervisorResponsibilities

1. Review,sign,anddatethestudent’sPlacementPacketsothestudentcandownloaditintoD2L.

2. ContacttheSiteSupervisorregardingstudentprogressatthestart,middle,andendofthesemesterandasindicatedbythestudent’sprogress(viaconferences,phonecalls,andemails).

3. ContinuouslyassessstudentperformanceandcommunicatewithSiteSupervisorsregardingemergentissues.InconsultationwiththestudentandSiteSupervisor,developaRemediationPlanifapersistentorseriousissuerequiresformalintervention.

4. Facilitateandsupportthestudent’sprofessionaldevelopmentasneededandbyintroducingresources,workshops,curricula,andcounselingarticlesrelatedtofieldexperienceneeds.

5. Scheduleandfacilitategroupsupervisionwherestudentsdiscussclinicalexperiences,learnfromoneanother, acquireideasfortreatmentplanningandcaseconceptualization,andreceiveandsolicitfeedbackfromone another.

6. EngageinongoingassessmentofstudentperformanceandcommunicatewiththeSiteSupervisorregardingissues.InconsultationwiththestudentandSiteSupervisor,willdevelopaRemediationPlanifapersistentorseriousissuerequiresformal intervention.

7. EnsurePracticum/Internshipformsaresubmittedinatimelymanner.Requestthatstudentsupdateformsasinformationchanges.

8. Monitor,review,andinitialtheActivityLog,includingthedistributionofdirect/indirecthours.

9. Schedule,ifneeded,anon-siteorientationwithnewSiteSupervisorstoensureunderstandingof

August201815

theplacementrequirements.10. Obtainevidenceofthestudent’sperformancethroughdirectobservation(ifauthorized),

recordings,andSiteSupervisorfeedback.Providethestudentwithtimely,objective,andclearfeedbackasneededandviatheUniversityFacultySupervisorEvaluationoftheStudent.

11. Reviewthemid-termandfinalSiteSupervisorEvaluationofStudentandtheStudentEvaluationofSite&Supervisorandwiththestudent.

12. MaintainHIPPAandFERPAprivacyguidelinesregardinghealthandeducationinformation,unlessthe studentprovideswrittenconsent.

13. DeterminestudentfinalgradesandsubmitthemasrequiredbytheUniversityofArizona.

PartIV:UniversityPolicies

DiscriminationandSexualHarassmentAstudentwhobelievesheorshehasexperienceddiscriminationorsexualharassmentshouldcalltheAffirmativeActionOfficeat621-9449.Thestudentwillbereferredtoanindividualwithexpertiseintheseareasfor confidentialadviceonhandlingthesituationorfilingawrittencomplaint.Studentswithdisabilitieswhowould like informationonUniversitypolicieswithregardtotheAmericanswithDisabilitiesAct(ADA)shouldcontacttheDisabilityResourceCenter(DRC)viatelephone520-621-3268,oremail–[email protected]://drc.arizona.edu/formoredetails.StudentsareencouragedtoaccesstheAffirmativeActionhomepageforinformationondiscrimination,includingsexualharassment,andtheADA.

GraduateStudentGrievances

TheUniversityofArizona’sgraduatestudentgrievancepolicyandprocedurescanbefoundathttp://grad.arizona.edu/Catalog/Policies/Grievance_Policy.php

August201816

PartV:GlossaryofCommonlyUsedTermsABBHE:ArizonaBoardofBehavioralHealthExaminers,boardwhichreviewsapplicationsforstatelicenseapplicationstopractice.ACA:AmericanCounselingAssociation.AMHCA:AmericanMentalHealthCounselorsAssociation.ASCA:AmericanSchoolCounselingAssociation.ARCA:AmericanRehabilitationCounselingAssociation.Includesrehabilitationcounselingpractitioners,educators,andstudentsconcernedwithimprovingthelivesofpeoplewithdisabilities.Itsmissionistoenhance the development of peoplewith disabilities throughout their life span and to promoteexcellencewithin therehabilitationcounselingprofession.ArizonaRSAStudents(AzRSA):ArizonaRehabilitationServicesAdministrationstudentemployees,whoworkforafullyearatAzRSAbeforetheyareeligibletoreceivefulltuitionfortheMACounselingdegree.ArizonaRSAUniversityFacultySupervisor:TheUniversityfacultywhoactsasgeneraladvisortoandoverseesAzRSAstudentPracticumandInternship.CACREP:CouncilforAccreditationofCounselingandRelatedEducationPrograms.TheCounselingProgramaccreditationforClinicalRehabilitationandMentalHealthCounselingbeganFallsemester2015.Client/SchoolStudent:AnindividualservedbytheCounselingstudentatadesignatedplacementsiteinrehabilitation,mentalhealth,orschoolsettings.Co-facilitation: An active and experiential Practicum and Internshipmethodwhich allows a studentand a site professionaltoparticipatetogetherincouples,family,orgrouptherapyactivities.Individualtherapyactivitiesareexcludedfromthiscategory.Thestudentisnotshadowing.Sitehoursspentinco-facilitationareappliedtoward thePracticumandInternshipminimumdirecthourrequirements.CourseSequencePlan:Therecommendedcoursesequence,foreachsemester,asdevelopedbythestudentand thestudent’sassignedFacultyAdvisor.NottobeconfusedwiththeformalPlanofStudy.CRC:AnationalCertifiedRehabilitationCounselorcertification,notalicense.CRCC:TheCommissiononRehabilitationCounselorCertification.DirectHours:PracticumandInternshipface-to-faceclienthourscontributingdirectlytoprofessionalcounselingskill development.Practicum-40of100hours,Internship-240of600hours.ClinicalExperience:APracticumorInternship.ClinicalPlacement Consult: Consult with the ClinicalPlacement Coordinator f o r Practicum andInternshipplacements.ClinicalPlacementCoordinator:AnArizona-licensedpractitionerwhoassistsCounselingProgramstudentswithPracticumandInternshipplacements.FERPA: Family Educational Rights and Privacy Act. A federal law protecting the privacy of studenteducation recordsinallschoolsthatreceivefundsunderanyU.S.DepartmentofEducationprogram.FERPA gives parents certain rightswith respect to their children's education records,iftheyareunder18. FERPArestrictsfacultyandstafffromsharinganyinformationregardingastudentwithoutthatstudent’swrittenconsent.Ifthestudentisover18,buthasalegalguardian,thelegalguardianmustprovideconsenttoreleaseorshareprotectedinformation.HIPPA: Health Insurance Portability and Accountability Act universal p rivacy guidelines. Ofimportancearetheconfidentialityofandtransferabilityofclientinformation,hardcopyandelectronic,asrelated tocareprovision.AgenciesdemonstratecompliancebyprovidingaccesstoHIPPApoliciesandproceduresandbyprovidingstafftraining.IndirectHours:PracticumandInternshiphourswhicharenotdirecthours.Examplesinclude,butarenotlimitedto,siteanduniversitysupervision,training,shadowing,recommendedon-sitereadingor

August201817

documentation,and communityin-servicesandworkshopsrelatedtotheplacement.ForPracticum,indirecthoursare60of100hoursperPracticum.ForInternship,indirecthoursare360of600hours.Internship: 600 hours of clinical practice experience, 2 4 0 o f wh i c h mu s t b e c l i e n t c o n t a c t h o u r s .Schoolcounselingstudentscompleteinternshipsinacademic,notmentalhealth,settings.LAC:State’sLicensedAssociateCounselor,whichprecedesLPC.CannotactasaPrimarySiteSupervisordue to “Associate” status.LevelOneFingerprintClearance:Typicallyissuedbyeachstate’sDepartmentofPublicSafety,thiscardis requiredwhenworkingwith children or vulnerable adults. It reflects a “passed”backgroundcheckandisvalidforsix(6)years.Initialapplicationstakeaminimumof4weeksandrenewalstakes longer.Studentsmustensurecontinuouscoverageforplacements.Manyagenciesrequirethisclearanceevenifchildrenandvulnerableadultsarenotserved.Otheragenciesinsistontheirownclearancedirectlypriortotheplacement’sstartdate.NRCA:NationalRehabilitationCounselingAssociation,whichrepresentsrehabilitationcounselorswhopracticeinavarietyofsettings:privatenon-profitagencies,hospitalmedicalsettings,educationalprograms,private-for-profitbusinesses,state/federalagencies,privatepractice,unions,andothers.PlacementPacket:TheSchoolContractorSiteAgreement,LiabilityInsurancePolicy,andLevelOneFingerprintClearanceCard.StudentsmaynotmeetwithclientsuntilthispacketisreceivedandapprovedbytheassignedFacultySupervisor.PlanofStudy(POS):AformalplandevelopedbetweentheCounselingProgramstudentandassignedFacultyAdvisor. TheplanissubmittedtotheGraduateCollege. NottobeconfusedwiththeinformalCourseSequencePlan.Practicum:100hoursofclinicalpracticeexperience,40ofwhichmustbeclientcontacthours.Astudenthastheoptionofcompletingoneortwo(2)Practicumdependingonthestudent’splanofstudy.SchoolCounselingstudents,however,mustcompleteoneschoolcounselingandonementalhealthpracticum.Primary Site Supervisor: The primary Practicum or Internship supervisor of record at a placementsite for a specified term. This individual possesses theminimum experience o f t w o y e a r s andpossesses necessary p r o f e s s i o n a l , n o t a s s o c i a t e , license(s) and/or certification(s).Shadowing:Apassivefieldexperiencetrainingmethodthatinvolvesobservation,notparticipation,ofa clinicalactivity.Th is typeof training cannotbeapplied toward thePracticumandInternship directhourrequirements,butcanbeappliedtonon-directhourrequirements.SiteSupervisor.State-licensedsitesupervisorofrecord(LPC,LISAC,LMFT,LMSW,LISW).Student:Formallyparticipatesinlearningactivitiesduringformalacademicsemesters,andunder thedirectsupervisionofUniversityFaculty.StudentLiability Insurance:Mandatory liability coveragepurchased fromACA,ARCA,AMHCA,ASCA,CRCCor HPSO for field experiences,annuallyrenewed. Counseling Program students cannot meetwith clients/students without th is .Studentmustensure continuouscoverageforthedurationofeachplacement.TriadicSupervision:Siteoruniversitysupervisioncomposedoftwo(2)studentsandone(1)supervisor.UniversityFacultyAdvisor:FacultyassignedtoeachstudentforthedurationoftheMaster’sdegree. UniversityFacultySupervisor:FacultyoverseeingaPracticumorInternshipcoursefor adesignatedsemester.Volunteer:Aprivateandpersonaldecisiontodonatetimetoacommunityagency,whichexcludestheUniversityofArizonaandexistsexclusivelybetweenthevolunteerandtheagencywherethevolunteerworktakesplace.Volunteerhours cannotbeappliedtowardPracticumorInternship.Liabilitypoliciesarevoidduringvolunteerworksincethe person is n o t “student”norreceivingfacultyoversight.

August201818

PartVI:FormsFormA:AgencySiteAgreement,21FormA1:SchoolSiteAgreement,23FormB:ClientConsent,25FormB1:ClientConsentSpanish,26FormC:ActivityLog,27FormC1:SchoolCounselingWeeklyActivityLog,28FormD:CounselingSessionSelf-Reflection,29FormE:TapeCritique,30FormF:StudentEvaluationofSiteSupervisor&Site,31FormG:SiteSupervisorEvaluationofStudent,32FormH:UniversityFacultySupervisorEvaluationofStudent,34

August201821

UniversityofArizonaCounselingProgram

Department ofDisabilityandPsychoeducationalStudiesCollegeof EducationP.O.Box210069Tucson,AZ85721-0069

FORMA:SITEAGREEMENTSemester:____________Year:_______

□100-HourPracticum□Internship:Hours:_________________□CheckBoxifFederalRSAGrantPlacementStudent:

Name: Phone:

UAEmail:@email.arizona.edu

Site: Phone:

Student’sPlacementAddress:___________________________________________________________________________________________________

PrimarySiteSupervisor

Name: Title: License(s)&

Degree(s): Certification(s):

Phone: Email:

Back-UporSecondarySiteSupervisor

Name: Title: License(s)&

Degree(s): Certification(s):

Phone: Email:

StudentSiteTasks:(specify)

StudentSiteDays&Hours:

StudentProfessionalLiabilityInsurance:(coverstheFULLsemester)ATTACHPOLICYEACHSEMESTER

Company: Policy#: ExpirationDate:

LevelOneFingerprintClearanceCard:(coverstheFULLsemester)ATTACHFRONTCARDCOPYEACHSEMESTER

Issuer: Card#: ExpirationDate:

***Agreement***

Thissitewillprovidethisstudentwith1.)ongoingclientsandtheopportunitytorecordsessionsbetweenthefollowingdatesand2.)clinicalsupervisionatleastone(1)hourweekly.

Signed:

PrimarySiteSupervisor Date Student Date

Signed:

Back-UporSecondarySiteSupervisor Date UniversityFacultySupervisor Date

August201820

AttachmenttoSiteAgreementFORSITESUPERVISOR

Itisunderstoodthat:Priortoplacementatthesiteandpriortocounselingclients,thestudentwillhavemetallUniversityrequirementstodoso.

StudentswillonlycompleteSite/SchoolAgreementswithsitesandSiteSupervisorswhoarepre-approvedbytheCounselingProgramFieldExperienceCoordinatorandUniversityFacultySupervisor.

Ifforanyreasonduringtheplacement,thestudentorSiteSupervisorhasareasontobelievethestudentisunabletoperformessentialsitefunctions,thatpersonwillnotifytheUniversitySupervisorimmediately.

StudentswillpurchaseProfessionalLiabilityInsuranceandprovideacopytotheSiteSupervisorandtheFieldExperienceCoordinator,unlessotherwiserequiredperClinicalManualinstructions.Thecopymustincludestudentname,insurancecompanyname,insurancepolicynumberandpolicyexpirationdate,andwillcoverthefullterm.AllthesewillbeenteredontheSite/SchoolAgreement.

Studentswillnotactas“students”outsidetheformalsemesterbeginandenddates.Thestudentmay“volunteer”outsidetheformalsemester,withoutUniversityresponsibilityandoversight.Liabilityinsurancemaynotcovervolunteeractivities.

StudentswillidentifyaprimarySite/SchoolSupervisorandwhenavailableasecondarySite/SchoolSupervisor,oneofwhomwillbeon-siteoravailableviatelephoneatalltimeswhenthestudentisworkingatthesite.

TheSiteSupervisorandstudentwillnothaveadualrelationship.Conflictsofinterestortheappearanceofconflictofinterestwillbeavoided.Anyprevious/currentrelationshipsbetweensupervisors,clients,otheremployeesortheagencyandthestudentwillbediscussedwiththeUniversityFacultySupervisorpriortothestudent’splacementatthesite/school.

TheSiteSupervisorwillprovideorientationtothesite;andweeklysupervision,individuallyorintriad(twostudents+SiteSupervisor);andofficespacewithnecessaryequipmentforheCounselingprogramstudenttoadequatelycompleteanddocumentclientsessions.TheSiteSupervisorwillalerttheUniversityFacultySupervisor,withoutdelay,regardinganyissuethestudentreceivesconstructivefeedbackabout.Thatinformationwillbeusedtofacilitateprofessionalgrowthforthatstudentaswellasthatstudent’speers.Whenfacultydoesnotknowimmediately,facultycannothelpimmediately.

StudentswillhavefourongoingcounselingclientsassignedbytheSiteSupervisor.When/ifaclientdiscontinuesparticipationanotherclientwillbeimmediatelyassigned.Ifgrouptherapyisofferedclients,thestudentwillfacilitateorco-facilitateatleastoneweeklygroup.

Studentswillconductatleastfourweeklyindividualcounselingsessionswithclients(approximatelyone-hourinlengthunlessclientfunctioningwouldindicateshortersessionsaremoreappropriatefortheclient).

Studentswillrecordsomecounselingsessionswithclientwrittenpermission.Studentswilladheretothelimitsspecifiedinthesignedconsentdocumentandwilldeletetherecordingwithintwoweeks.

StudentswillmeetweeklywiththeUniversityFacultySupervisortoreviewcounselingrecordings.ThestudentwillmeetwithotherstudentsandaUniversityFacultySupervisorweeklyforatleast1.5hours.Duringthemeetingthestudentmaypresentarecordingorconductacasepresentation.AllclientinformationwillbehandledperHIPPAandFERPAconfidentialityguidelinesbyfacultyandstudents.

Studentswillworkwiththeirclientsonlyonsitepremisesandwillneverbeon-sitealone.

StudentswillnotenterclienthomesunaccompaniedbytheSiteSupervisororadesignatedrepresentative.

Studentswillnottransportclientsinsitevehiclesorpersonalvehicles.

Studentswillbeformallyevaluated,mid-termandatendofterm,bytheSiteSupervisorviatheevaluationform.SiteSupervisorswillmeetwithstudentstorevieweachevaluation.ThestudentswillgivetheevaluationstotheUniversityFacultySupervisor.TheevaluationswillbeconsideredbytheUniversityFacultySupervisorwhengivinggrades.

Studentswillkeepaweeklylogreflectingallactualhoursandtypeofcounselingactivitiesperformed.TheSiteSupervisorandUniversityFacultySupervisorwillreviewandinitialthelog.LoghourswillnotpredatetheSite/SchoolAgreement.

TheUniversityFacultySupervisorwillbeavailabletothestudentandAgencySupervisorsforconsultationregardingtheplacement experienceduringtheacademicterm.

August201821



FORMA1:SCHOOLSITEAGREEMENT

Semester:___________Year:___________

□100-HourPracticum□Internship:Hours:____________□CheckBoxifFederalRSAGrantPlacement

StudentName:

StudentAddress: Zip:

StudentEmail:

StudentHomePhone: CellPhone:

SchoolName:

SchoolAddress: Zip:

Principal Email:

SiteSupervisor:

SiteSupervisorPhone: Email:

StartDate: EndDate:(onesemesteronly)

DaysatSite HoursatSite

StudentProfessionalLiabilityInsurance:(coverstheFULLsemester)ATTACHPOLICYEACHSEMESTER

Company: Policy#: ExpirationDate:

LevelOneFingerprintClearanceCard:(coversFULLsemester)ATTACHFRONTCARDCOPYEACHSEMESTERIssuer: Card#: ExpirationDate:

*IagreetoacceptthisUniversityofArizonaPracticum/Internshipstudent.IunderstandmyroleasSiteSupervisorandthatitincludeslivesupervisionandaminimumof onehourperweekofindividualsupervision:

SiteSupervisorSignature:

*ThePracticum/InternshipstudenthasmypermissiontocompleteaPracticum/Internshipat: School

underthesupervisionof: SiteSupervisor

PrincipalSignature: Date:

StudentSignature: Date:

UniversityFacultySupervisorSignature: Date:

August201822

AttachmenttoSchoolSiteCounselingContractFORSITESUPERVISOR

Itisunderstoodthat:Priortoplacementatthesiteandpriortocounselingclients,thestudentwillhavemetallUniversityrequirementstodoso.

StudentswillonlycompleteSite/SchoolAgreementswithsitesandSiteSupervisorswhoarepre-approvedbytheCounselingProgramFieldExperienceCoordinatorandUniversityFacultySupervisor.

Ifforanyreasonduringtheplacement,thestudentorSiteSupervisorhasareasontobelievethestudentisunabletoperformessentialsitefunctions,thatpersonwillnotifytheUniversitySupervisorimmediately.

StudentswillpurchaseProfessionalLiabilityInsuranceandprovideacopytotheSiteSupervisorandtheFieldExperienceCoordinator,unlessotherwiserequiredperClinicalManualinstructions.Thecopymustincludestudentname,insurancecompanyname,insurancepolicynumberandpolicyexpirationdate.AllthesewillbeenteredontheSite/SchoolAgreement.

Studentswillnotactas“students”outsidetheformalsemesterbeginandenddates.Thestudentmay“volunteer”outsidetheformalsemester,withoutUniversityresponsibilityandoversight.Liabilityinsurancemaynotcovervolunteeractivities.

StudentswillidentifyaprimarySite/SchoolSupervisorandwhenavailableasecondarySite/SchoolSupervisor,oneofwhomwillbeon-siteoravailableviatelephoneatalltimeswhenthestudentisworkingatthesite.

TheSiteSupervisorandstudentwillnothaveadualrelationship.Conflictsofinterestortheappearanceofconflictofinterestwillbeavoided.Anyprevious/currentrelationshipsbetweensupervisors,clients,otheremployeesortheagencyandthestudentwillbediscussedwiththeUniversityFacultySupervisorpriortothestudent’splacementatthesite/school.

TheSiteSupervisorwillprovideorientationtothesite;weeklysupervision,individuallyorintriad(twostudents+SiteSupervisor;andofficespacewithnecessaryequipmentforheCounselingprogramstudenttoadequatelycompleteanddocumentclientsessions.TheSiteSupervisorwillalerttheUniversityFacultySupervisor,withoutdelay,regardinganyissuethestudentreceivesconstructivefeedbackabout.Thatinformationwillbeusedtofacilitateprofessionalgrowthforthatstudentaswellasthatstudent’speers.Whenfacultydoesnotknowimmediately,facultycannothelpimmediately.

StudentswillhavefourongoingcounselingclientsassignedbytheSiteSupervisor.When/ifaclientdiscontinuesparticipating,anotherclientwillbeimmediatelyassigned.Ifgrouptherapyisofferedclients,thestudentwillfacilitateorco-facilitateatleastoneweeklygroup.

Studentswillconductatleastfourweeklyindividualcounselingsessionswithclients(approximatelyone-hourinlengthunlessclientfunctioningwouldindicateshortersessionsaremoreappropriatefortheclient).

Studentswillrecordsomecounselingsessionswithclientwrittenpermission.Studentswilladheretothelimitsspecifiedinthesignedconsentdocumentandwilldeletetherecordingwithintwoweeks.

StudentswillmeetweeklywiththeUniversityFacultySupervisortoreviewcounselingrecordings.ThestudentwillmeetwithotherstudentsandaUniversityFacultySupervisorweeklyforatleast1.5hours.Duringthemeeting,thestudentmaypresentarecordingorconductacasepresentation.AllclientinformationwillbehandledperHIPPAandFERPAconfidentialityguidelinesbyfacultyandstudents.

Studentswillworkwiththeirclientsonlyonpremisesandwillneverbealoneatthesite.

StudentswillnotenterclienthomesunaccompaniedbytheSiteSupervisororadesignatedrepresentative.

Studentswillnottransportclientsinsitevehiclesorpersonalvehicles.

Studentswillbeformallyevaluated,mid-termandatendofterm,bytheSiteSupervisorviatheevaluationform.SiteSupervisorswillmeetwithstudentstorevieweachevaluation.ThestudentswillgivetheevaluationstotheUniversityFacultySupervisor.TheevaluationswillbeconsideredbytheUniversityFacultySupervisorwhengivinggrades.

Studentswillkeepaweeklylogreflectingallactualhoursandtypeofcounselingactivitiesperformed.TheSiteSupervisorandUniversityFacultySupervisorwillreviewandinitialthelog.LoghourswillnotpredatetheSite/SchoolAgreement.

TheUniversityFacultySupervisorwillbeavailabletothestudentandAgencySupervisorsforconsultationregardingtheplacement experienceduringtheacademicterm.

August201823


DepartmentofDisabilityandPsychoeducationalStudiesCollegeofEducation,P.O.Box210069

Tucson,Az.,85721

FORMB:CLIENTCONSENTSemester:____________Year:__________

Site:_______________________

□100-HourPracticum□Internship:Hours:_________________□CheckBoxifFederalRSAGrantPracticumUniversityCounselor-in-Trainingwillreadthisforminitsentiretytoclients.Whencounselingminorsinschoolsettings,theUniversitycounselor-in-Trainingwillreadandsignthe“MinorChildinSchoolRecordingConsentForm”.Youhavebeenreferredto:___________________________________________forthepurpose(s)of_________________________ UniversityCounselor-in-Training_________________________________________________________________________________________.

GUIDINGPRINCIPLES

Youcanexpectthefollowingfromme,yourUniversityCounselor-in-Training:1. Ibelievepeoplehavetheabilitytoaddressanyissueandworktowardmeetingpersonalgoals.2. Iwillhelpyoubylisteningcarefullytoyouandbyhelpingyoulistenbettertoyourself.3. Iwillnotjudgeyouortellyouwhattodo.Iwillcollaboratewithyouinasafeenvironment.4. Iwillhelpyouexplorewaystoreachyourpersonalgoals.

CONFIDENTIALITYIwillreviewthecontentofsomeofoursessionswithmyUniversityFacultySupervisorforthepurposesofimprovingmycounselingskillsinindividualsupervisionorinsmallgroupsessions.EveryonewhohearstheinformationisboundbythesamelegalobligationsIamboundby.Noinformationidentifyingyouwillbesharedduringsupervisionsessions.AllpersonalinformationisconfidentialandmaintainedatthisagencyUNLESS:

1. YougiveyourWRITTENpermissiontoreleaseSPECIFICinformationtoaperson,agency,orothergroup.2. Yousayyouintendtowillfullyharmyourselforsomeoneelse.3. Yousayyouintendtoharmorareharmingachild,elderlyperson,oranyotherperson.4. Youviolateanyagencyagreementsorcontractsyouarerequiredtomeetwhileyoureceiveservicesfromthisagency.5. Youareonprobation,onparole,undercourtorder,orfacingpendingcourtaction.Imaybelegallyobligatedtoshare

informationwithanyonesupervisingorassistingyouinthosecapacitieswhileyoufulfillyourlegalresponsibilities.

RECORDINGSWithyourpermission,Iwillrecordsomeofoursessionswiththeintentofimprovingmycounselingskills.Therecordingswillnotincludeinformationidentifyingyou,suchasyourfullname.Pleaseinitialbelowifyouconsenttotherecordingofsomeofoursessions.______Iconsenttoberecorded.Imayrevokemyconsentinwritingatanytimeexcepttotheextentthatactionhasbeentakenthereon.Iunderstandtherecordingsofthesessionswillbeuploadedtoasecuresitewheretheywillbeautomaticallydeletedthree(3)yearslater.IreleaseTheUniversityofArizonaanditsundersignedrepresentative,actingundertheauthorityofTheUniversityofArizona,fromanyandallclaimsarisingoutofsuchtapingandrecordingforsupervisionpurposesonly,asisauthorizedbyTheUniversityofArizona.______Ideclinetoberecorded.ClientSignature:___________________________________________________________ Date:____________ LegalGuardian/LegalRepresentativeSignature:__________________________________ Date:____________ UniversityCounselor-in-TrainingSignature:_____________________________________ Date:____________

August201824

UniversidaddeArizonaProgramadeMaestríaenConsejería(PMC)

DepartamentodeEstudiosenDiscapacidadyPsico-educacionalesFacultaddeEducación,P.O.Box210069Tucson,AZ.,85721

FORMAB1:CONSENTIMIENTODELCLIENTESemestre:____________Año:__________

Sitio:_______________________100-HorasdePracticumInterno:Horas:_________ MarquesiescolocaciónporBecaFederalRSA

ElConsejeroen-Entrenamientodel(PMC),deberáleerestaformaensutotalidadalosclientes.ParamenoresdeedadqueesténdentrodelsistemaescolarelConsejeroen-Entrenamientodeberáleeryfirmarlaformade“ConsentimientoparaGrabaraMenoresdeEdad”.Ustedhasidodesignadoa:_____________________________paraelpropósitode_____________________________________. Consejeroen-Entrenamiento

PRINCIPIOSFUNDAMENTALESLafilosofíadelConsejeroen-Entrenamiento:

1. Creoquelapersonatienelacapacidaddeafrontarcualquierproblemaylacapacidaddetrabajarparaalcanzarsusmetas.

2. Leayudareescuchandoatentamente.Leayudareaescucharseaustedmismo.3. Nolejuzgare,nilediréloquedebehacer.Leayudareaqueseencuentreenunambienteseguro.4. Leayudareaqueexploremanerasdecomoalcanzarsusmetas.

CONFIDENCIALIDAD

Yovoyarepasarelcontenidodealgunasdenuestrassesionesconmisupervisor,ProfesordelaUniversidad,conelpropósitodemejorarmishabilidadesenconsejería,bajosupervisiónindividualoensesionesengrupospequeños.Todosaquellosqueescuchenelcontenido,estánvinculadoslegalmente.Ningunainformaciónqueloidentifiqueausted,serácompartidadurantelosrepasosbajosupervisión.TodalainformaciónpersonalesconfidencialyresguardadaenestaagenciaAMENOSQUE:

1. Ustedde,PORESCRITO,permisodecomunicarinformaciónESPECIFICA,aalgunapersona,agencia,uotrogrupo.2. Ustedhayadichoqueintentalastimarse,oaalguienmás.3. Ustedhayadichoqueintentalastimaroestálastimandoaunmenor,aunapersonaenvejecienteoaalguienmás.4. Ustedhavioladolosacuerdoscuandoestaba(oestárecibiendo)serviciosdeestauotraagencia.5. Ustedestáenlibertadcondicional,bajoordenjudicial,obajoacciónjudicialpendiente.Elestudianteuniversitario

enentrenamientoestáobligadolegalmenteacompartirinformaciónconcualquierpersonaqueleestésupervisandooasistiendoaustedmientrascumpleconsusresponsabilidadeslegales.

GRABACIONES

Consuautorización,yovoyagrabaralgunasdenuestrassesionesconelpropósitodemejorarmishabilidadesdeconsejero.Lasgrabacionesnoincluyensusdatospersonalesqueloidentificaausted(comosunombrecompleto).Porfavor,marqueconsusinicialesenelcasillero,autorizandograbaralgunasdenuestrassesiones.____Consientoparasergrabado.Ypuedorevocarmiconsentimientoporescritoencualquiermomentoexceptocuandosehayanadoptadolasmedidas.Yoentiendoquelasgrabacionesseráncargadasaunsitiosegurodondeautomáticamenteserándestruidasentres(3)años.YoabsuelvoalaUniversidaddeArizonayaalrepresentanteabajofirmante,actuandobajolaautoridaddelaUniversidaddeArizona,decualquierreclamaciónquesurjadeestasgrabacioneshechasúnicamenteconelpropósitodesupervisión,comoestáautorizadoporlaUniversidaddeArizona.____Noconsientoparasergrabado.

FirmadelCliente:___________________________________________________________ Fecha:____________ FirmadelGuardiánLegal/RepresentanteLegal:__________________________________ Fecha:____________ FirmadelEstudianteUniversitario-en-Entrenamiento:_____________________________________ Fecha:____________

August201825


DepartmentofDisabilityandPsychoeducationalStudiesCollegeofEducationP.O.Box210069Tucson,AZ85721-0069

FORMC:ACTIVITYLOG

Semester:_______________Year:__________________

□100-HourPracticum □Internship:Hours:____________□CheckBoxifFederalRSAGrantPlacementStudentName:_________________________________ AgencySite:____________________________SiteSupervisor[Print]:____________________________SiteSupervisorSignature:____________________________________Fora100-hourpracticumanda600-hourinternship,aminimumof40practicumhoursand240internshiphoursmustbedirectclientcontacthours.Examplesofdirecthoursinclude,butarenotlimitedtoindividual,group,andcouples&familycounseling;intakeassessments;crisiscaremanagement;advocacy;andcommunityeducation.Examplesofindirecthoursinclude,butarenotlimitedtosupervision,management,administration,orotheraspectsofcounselingservicesancillarytodirectclientcontact.Nomorethan16hoursofgroupcounselingmayapplytothe40direct-hourrequirementforpracticum.Studentsmustbeobservedbyqualifiedsitestafffortwo(2)groupsessionspriortoindependentgroupfacilitation.

Date DirectwithClients

DirectwithGroup

SiteSupervision

UniversitySupervision

OtherIndirect

ActivityDetails SiteSup.Initials

Univ.Initials

TOTALS:||||||

August201826



FORMC1:SchoolCounselingWeeklyActivityLogSemester:___________Year:__________

□100-HourPracticum □Internship:Hours:____________□CheckBoxifFederalRSAGrantPlacementStudent:_____________________________ Site:_______________________________DIRECTIONS:

1. Recordthedatesofeachweekatthesitewhereindicated.2. Recordthetotalnumberofhoursperweekforeachactivityundertheappropriatecolumn.3. Totalthenumberofhoursfortheweekandindicateatthebottomofeachcolumnintheweeklytotalsrow.4. Attheendofthemonth,totalthehoursspentineachactivitybyaddingthehoursacrosseachactivityandindicatethetotalinthe

monthlytotalscolumn.Carryoverlastmonth’stotal,addittothismonth’stotal,andindicateinthecumulativetotalcolumn.5. Getyoursitesupervisor’ssignature.Makeacopyofthisformforyourrecords,andsubmitittoyouruniversitysupervisortokeep

inyourpermanentfile.ACTIVITIES

*Examples

Week1From:To:

Week2From:To:

Week3From:To:

Week4From:To:

MonthlyTotals

CumTotal

Administrative

Clerical,scheduling

IndividualStudentPlanning

Individualcounseling,academicadvising

ResponsiveServices

Familyconsultation,Agencyreferral,Groupcounseling

SchoolGuidancecurriculum

Lessonplanning/prepClassroomguidancelessons

SystemSupport

Conferences,workshops,504/IEPmeetings,etc.

SiteSupervision

UniversitySupervision

Other

WeeklyTotals(addeachcolumn)

*itemsinboldcounttowarddirectcontacthoursStudent’sSignature__________________________________________ Date______________SiteSupervisor’sSignature____________________________________ Date______________UniversityFacultySignature___________________________________ Date_____________

August201827


Department ofDisabilityandPsychoeducationalStudiesCollegeof EducationP.O.Box210069

Tucson,AZ85721-0069FORMD:COUNSELINGSESSIONSELF-REFLECTION

Semester:________Year:__________ 100-HourPracticum Internship:Hours____ CheckBoxifFederalRSAGrantPlacement

Student:_______________________________ ClientInitials:_________Description:Self-reflectionandevaluationisanessentialwaytoimprovehowyouconductacounselingsession.Inadditiontotrackingsessioncontent,itisimportanttoidentifytheintentionaluseofcounselingskills.Thefollowingarepromptsforself-reflectionfollowingasession.

Whatweregoalsofthesession?

Whatweregeneralimpressionsaboutthesession?

Whatwerethemainthemesofthesession?

ExamplesofCounselingSkills SkillsUsedYes/No

CommentsAboutIntentionalUseofCounselingSkills

Facilitatingcollaborativegoalsetting

Reviewingprevioussessioncontent

Attendingtoverbal/non-verbalbehaviors

Askingopen-endedquestions

Paraphrasing

Summarizing

Encouraging

Reflectingfeeling

Conveyingempathy

Reframingmeaning(alternativeinterpretations)

Applyingsilence

Usingconfrontation

Affirmingclientstrengths

Providinginformationtoadvanceclientgoals

Establishingappropriateboundaries

Otherskills:

August201828



FORME:RECORDINGCRITIQUESemester:______________Year:_____________

□100-HourPracticum□Internship:Hours:_________□CheckBoxifFederalRSAGrantPlacement

Student:_______________________________________________ ClientInitials:_________

Summaryofsessioncontent:

Intendedgoals:

Commentonpositivecounselingskillsandbehaviors:

Commentonareasofcounselingpracticewhichneedimprovement:

Commentoncounselor-clientdynamicswhichareofconcern:

Suggestion(s)forfurthercounselingwiththisclient:

August201829



FORMF:STUDENTEVALUATIONofSITESUPERVISOR&SITESemester:__________Year:_________

□100-HourPracticum□Internship:Hours:_______□CheckifFederalRSAGrantPlacement

Student:

Site&SupervisorName(s):

Selectaresponse:SA:StronglyAgreeA:AgreeD:DisagreeSD:StronglydisagreeNA:Notapplicable SA A D SD NA

1. Sitewasanappropriateplacement.

2. Sitewassafe,andIwasnotleftaloneonthepremises.

3. Siteofficeorcounselingspacewasavailable.

4. Assignedclientswereappropriatetomycounselingskilllevel.

5. SitetaskswereconsistentwithskillslearnedincounselingclassandsupervisionmeetingswiththeUniversityFacultySupervisor.

6. SiteSupervisordemonstratedprofessionalcounselingknowledge,behavior&attitude[scheduled/keptmeetings,behavedethically,etc.].

7. SiteSupervisor,orback-up,wasreadilyaccessible;andrespondedinatimelymanner.

8. SiteSupervisorassigned/delegatedreasonableandappropriatepracticum/internshipresponsibilitiesandmadetasksclear.

9. SiteSupervisorreviewedmywork/tapesandofferedtimelyandhelpfulfeedbackregardingcounselingstrategiesandframeworkforunderstandingclientneeds.

Describeaspectsofthesiteexperienceyouvalued.

Describeaspectsofthesiteexperienceyouvaluedleast.

Describechangesyouwouldmaketoimprovefutureexperiencesatthissite.

Additionalcomments:

August201830



FORMG:SITESUPERVISOREVALUATIONOFSTUDENT(Mid-Term&Semester’sEnd)

Semester:____________Year:____________________

□100-HourPracticum□Internship:Hours:_________□CheckBoxifFederalRSAGrantPlacement

(2pages) StudentName:________________________________Site:___________________________SiteSupervisor(print):_______________________________Ratethestudentaccordingtothefollowingscale…

Unacceptable MarginallyAcceptable

Acceptable VeryGood

Superior Notapplicable

1. Functionedwithoutclosesupervisionandapproachedproblemsproactivelyand/orcreatively.

1 2 3 4 5 N/A

2. Dependable,areliableteammember,flexibleinmeetingworksiteneeds.

1 2 3 4 5 N/A

3. Receivedandimplementedfeedbackconstructively.

1 2 3 4 5 N/A

4. Demonstratedgrowth[increasedskillandknowledge]andincreasedindependence.

1 2 3 4 5 N/A

5. Completedtotalnumberofhours/daysasscheduled.

1 2 3 4 5 N/A

6. Developedpositiverelationshipswithagencystaffandwithcommunityserviceorresourceproviders.

1 2 3 4 5 N/A

7. Adheredtoexemplaryethicalandlegalstandards.

1 2 3 4 5 N/A

8. Recognizedowncounselinglimitationsandsoughtsupervision&/orreferredindividualsasindicated.

1 2 3 4 5 N/A

9. Demonstratedtact,self-awareness,sensitivitytoothers,andanabilitytorelatetodiversepopulations.

1 2 3 4 5 N/A

10. Usedstrategiesreflectingsensitivitytoculture(diversity,equity),learningstyles,developmentalstage,gender,specialneeds,andsocio-economicbackgrounds.

1 2 3 4 5 N/A

11. Providedeffectiveindividualandgroupcounselingandguidancetopromotepersonal,interpersonal,professionaldevelopment.

1 2 3 4 5 N/A

12. Demonstratedabilitytoassessandmanage:intakeinterview[includestakinghistory],suiciderisk,psychosocialandmedicalstatus,mentalstatus,serviceplanning,dischargeplanning.

1 2 3 4 5 N/A

August201831

13. Selectedandappropriatelyusedassessments/tooltoevaluateclientpresentation,progress,career,personal,andsocialdevelopment.

1 2 3 4 5 N/A

14. Formental/behavioralconditions:Appliedknowledgeregardingstagesofdependence,stagesofchange,andstagesofrecoverytoimplementtheappropriatetreatmentmodalityandplacementcriteriawithinthecarecontinuum.

1 2 3 4 5 N/A

15. Participatedinconferencesandconsultationsreflectingprinciples&competenciesinprevention,education,learning,diagnosis,treatment,referrals,etc.throughouttheservicecontinuum.

1 2 3 4 5 N/A

PLEASEPROVIDEADDITIONALCOMMENTSBELOW:

SupervisorName&Signature Date

August201832



FORMH:UNIVERSITYFACULTYSUPERVISOREVALUATIONOFSTUDENTSemester:_______________Year:___________

□100-HourPracticum □Internship:Hours:____________□CheckBoxifFederalRSAGrantPlacement

StudentName:_________________________________ ProfessionalBehavior:InthecourseofeachPracticumandInternship,studentprofessionalbehaviorisassessed.Thisisanongoingevaluationwhichoccursuntiltheendofthesemester.Severalobservablebehavioralcategoriesareconsideredtobeanintegralpartofstudentprofessionalfunction.

Pleaseratethestudentonthefollowingscale: UnacceptableMarginallyAcceptable Acceptable Good Superior N/A

1 2 3 4 5 N/A

ProfessionalBehavior: 1. Preparesandsubmitsallcoursepaperwork(includes

placement)inatimely,organized,andlegiblemanner. 1 2 3 4 5 N/A

2. Demonstratesdependability(punctuality,follow-throughwithcommitments,etc.).

1 2 3 4 5 N/A

3. Dressesappropriately. 1 2 3 4 5 N/A4. Recognizesownlimitationsandseekshelpwhennecessaryand

appropriate. 1 2 3 4 5 N/A

5. Participatesinprofessionaldevelopmentactivities. 1 2 3 4 5 N/A6. Demonstratesknowledgeofprofessionalorganizations,their

preparationstandards,andcredentialsrelevanttopractice.1 2 3 5 5 N/A

IntrapersonalBehavior: 7. Accepts,provides,andutilizesfeedback. 1 2 3 4 5 N/A8. Displaysmatureandappropriatebehavior. 1 2 3 4 5 N/A9. Demonstratesabilitytofunctionindependently. 1 2 3 4 5 N/A10. Exhibitsusualandcustomaryjudgmentanddiscretioninboth

studentandprofessionalactivities. 1 2 3 4 5 N/A

11. Presentsagenerallypleasant,open,andnon-hostileattitude. 1 2 3 4 5 N/A

InterpersonalBehavior: 12. Cooperateswithandisrespectfulofothers. 1 2 3 4 5 N/A13. Gives,receives,andutilizesfeedbackeffectively. 1 2 3 4 5 N/A14. Developsandmaintainspositiverelationshipswithpeersand

faculty. 1 2 3 4 5 N/A

15. Developsasatisfactoryworkingrelationshipwithsupervisors. 1 2 3 4 5 N/A16. Communicatesappropriatelyandeffectively. 1 2 3 4 5 N/A17. Demonstratesethicalresponsibility. 1 2 3 4 5 N/A18. Adaptswelltonewsituations. 1 2 3 4 5 N/A

MajorstrengthsofSupervisee:

AreastoRefine:

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