MODEL LETTER OF AGREEMENT FOR CLINICAL SUPERVISION
when an outside supervisor supervises agency cases
With the agreement of the agency, the following is a letter of understanding between ______,clinical supervisor, and ______, supervisee, concerning procedures for and conduct of clinical supervision of agency cases or other privately conducted cases. In order for the outside clinical supervisor to monitor and promote the welfare of clients seen by the supervisee, as well as to promote the professional development and clinical competence of the supervisee, the supervisee and the clinical supervisor agree to the following.
The supervisor will provide clinical supervision of agency or private cases carried by the supervisee involving individual psychotherapy and counseling, couple and family therapy and counseling, and group therapy and counseling (identify the types of cases for which the outside clinical supervisor will be responsible). The agency will retain administrative responsibility for mission related directives and agency cases, but the outside supervisor will retain the right to refuse to supervise cases outside of her area of competence or when a conflict of interest may exist. An agreement will be made with the agency about issues such as participation in performance evaluations, case assignments, and adherence to agency policies.
The frequency of clinical supervision will vary with the professional experience of the supervisee, availability of other supervision, and caseload of the supervisee. A guideline is to provide one hour of clinical supervision for every 3-5 client contact hours when the supervisee is at a novice level, or one hour of clinical supervision for every 8-10 client contact hours when the supervisee is at an advancing level, or one hour of clinical supervision for every 15-20 hours of client contact when the supervisee is at an autonomous level. The outside supervisor will charge $____ per hour for clinical supervision, but the fee may be reviewed and renegotiated. The supervisee agrees to be responsible
for the agreed upon fee and the agreed upon terms of payment.
The supervisee agrees to inform the clinical supervisor of all contacts with clients in sufficient detail including what the client said and what the supervisee said, and to not withhold information from
the clinical supervisor about her/his conduct with a client. In addition, the supervisee agrees to discuss her/his reactions to clients and sessions, including the experience of being with the client and thoughts about the client. The supervisory sessions will cover issues of ethics and practice standards, the process and experience of supervision, and evaluation of the supervisee’s practice within the context of discussions of case material. If the clinical supervisor has any reason to believe at any point that the supervisee is giving care below the expected “standard of care”, she will have to act to protect the client. Such action will start with a discussion with the supervisee of the concerning issue and corrective measures, and the administrative/agency supervisor will be alerted to the concern. However, if the clinical supervisor finds that the supervisee intentionally engages in unethical practice or withholds information about misconduct from the clinical supervisor, the clinical supervisor, in concert with the administrative/agency supervisor, will have to report the misconduct to the Colorado Board of Social Work Examiners.
The supervisee agrees to provide clients with the Colorado Mandatory Disclosure Statement, and any other required disclosures, to establish a fee and payment procedure consistent with agency policy, and to arrive at an agreement about what the focus and procedures of work together will be, in a timely fashion. In addition, the supervisee agrees to maintain records in accordance with agency policies and the Record Keeping Rule of the Colorado Board of Social Work Examiners which
requires documentation of the reason for therapy or counseling, the plan for intervention, the progress made in therapy, any risk assessments conducted, and any referrals or collaborations made. Supervision discussions and directions will also be noted in the record. Agency policies regarding recording must be adhered to. These case records will be made available for review by the clinical supervisor. Process notes will be kept only for learning or as psychotherapy notes separate from the client record, since they would seriously compromise the privacy of the client. HIPAA Privacy Regulations may further protect these separated psychotherapy notes from unauthorized access.
It is agreed that both clinical supervisor and supervisee will keep records of dates and the content of the clinical supervision, noting any supervisory recommendations.
On a regular basis the clinical supervisor and supervisee agree to provide mutual feedback about the quality of the work provided by each. A formal written evaluation may be requested from the clinical supervisor at the end of their supervisory work together. Agency performance evaluations will be conducted by the administrative/agency supervisor, and may include observations from the clinical supervisor.
The clinical supervisor’s name must be disclosed to all clients, and is required on the mandatory disclosure statement.
It is agreed that on all billings to clients and third parties, services will be presented as having been provided by the supervisee.
The supervisee will provide her/his own professional liability insurance.
Any necessary medical consultation must be sought separate from the psychotherapy supervision and paid for by the supervisee when it is deemed necessary by the supervisor.
Each party agrees to immediately inform the other of any complaints or actions made against them, so that both parties may be fully informed on concerns within the community about the quality of their work.
Both parties agree to abide by the Rules and Regulations of the Colorado Board of Social Work Examiners, as well as by the Ethics and Practice Standards Statements of NASW . The highest standards of practice and ethical conduct will be maintained by both the supervisor and the supervisee.
Both parties agree that if there are any concerns about the quality of service provided or the quality of supervision provide, they will discuss those matters in detail with the other party prior to taking any action, unless the problem is so serious as to require contact with the Colorado Board of Social Work Examiners or the Professional Ethics Committee.
This letter of agreement can be terminated by either party for any reason, provided there is adequate lead time to insure the protection of the clients.
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Name of Supervisor Date
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Name of Supervisee Date