UNLV

Department of

Educational and Clinical Studies

CounselorEducationProgram

SITESUPERVISOR

INTERNSHIPINFORMATIONGUIDELINE

DearSupervisor:

Thankyouforsupportingoneormoreofourcounselinginternsastheymovethroughtheprocessofinternship.Westrivetofindqualitysupervisionforourinternsthatwillbothchallengeandsupporttheirprofessionalgrowth.Weunderstandthisisacommitmentonyourpartandweappreciateyourcontinuedservicetotheprofession.

AsaCACREPaccreditedprogram,itisimportantthatwefollowhighstandardsofpractice.The ECS Counselor Education Programcontinuestoemploybestpracticesandsurpassthesestandardsthroughcourseworkandpracticalapplication.Inextension,wehopetoimprovethesupervisoryprocessbyprovidingvariousavenuesof informationsharingbetweenfaculty,sitesupervisorsandcounselors-in-training.

Wewouldliketoofferaguidedesignedforsupervisorsasaresourceforimprovingthesupervisioncollaboration.ThismanualwascreatedpartiallybasedonfeedbackreceivedthroughCEDsponsoredinternshipfairs,supervisiontrainings,sitevisits,andconversationswithcounselorslikeyou!Inaddition,someofthetop,nationallyrecognized,counseloreducationprogramsandaccreditationstandardswereconsulted.Includedinthispacket,youwillfindhelpfulformsandadditionalinformationregardingtheinternshiprequirements.Youprobablyhavealreadyreceivedsomeofthis informationandseenformspostedonourwebsite.Hopefullythroughthehandbook,itwillnowbeinoneplaceandeasilyaccessibleforyouandyourintern.

Asyouknow,theneedforqualitycounselorsinourcommunityisontherise.Supervisionisacornerstoneofqualityeducationforcounselors-in-training.Together,wecanhelpensuremoreindividualswithinClarkCountyandintheNevadaregionreceivequalitycounselingservicesbywellpreparedprofessionalcounselors.

Onceagain,thankyouforyourinvaluablecollaborationinthesupervisionprocess.

I.Intent of Practicum

Practicum CED 741 is designedto foster criticalthinking,relational,individualand groupcounselingskillsnecessaryfor the qualitypracticeof professionalcounseling. Placementrequiresstudentsto complete100hoursinanapprovedcommunitysettings undersupervisionfrom faculty membersandsite supervisorsfor purposesof instruction,assessmentof competency,andintegrationof fieldworkwithacademic study. Studentstypicallyspend6-10hoursperweekinvolvedindirectandindirect counselingactivitiesandindividualandgroupsupervision.HoursinPracticummust be accruedthroughoutthe 15-weeksemester. StudentsordinarilyearnPracticumcreditat a singlesite; the departmentfaculty must approverequestsfor anadditionalPracticum site (andthis is not customary).

Student Requirements

In accordancewithstandardsdevelopedby the Councilfor Accreditationof Counseling andRelatedEducationalPrograms(CACREP),Practicum consistsof a minimumof 100 hoursof supervisedcounselingactivities (usuallycompletedoverthe courseof one academicsemester). Of these, a minimumof 40hoursmust beindirectindividual counselingservices,a minimumof 10hoursmust beindirect groupcounseling services, withthe remaininghoursto beinappropriateindirectcounselingrelated activitiesas outlinedbelow:

50DirectHoursmayinclude:

•Individualcounseling(40+hours)

•Groupcounseling(10+hours)

•ClientassessmentorintakecompletedinaFacetoFaceManner

50IndirectHoursmayinclude:

•Counselorobservationofdirectclinical/counselingwork

•Individualcaseconceptualizationplanningforclientneeds

•Researchingstrategies,interventionsanddiagnosticinformationbaseduponcounselingtheories,practicesandresearch

•Documentationofcases,completinganddevelopingprogressnotes,clienthistories,creatingmastertreatmentplansandotherformsofclinicalreporting

•Groupsupervision,observationconsultationandotherclinicalmeetings,UNLVfacultysupervision,andon-sitesupervision

II.IntentofInternship

Internshipisthefinalactivityinstudents’programsandisintendedtoprovidestudents withtheopportunitytoengageinalloftheactivitiesofaregularlyemployedstaff member(counselor)inanorganizationcompatiblewiththeirprogramemphasisarea. Internshipactivitieswilltakeplaceatdepartmentallyapprovedschoolandcommunity siteswithappropriatelyqualifiedsupervisorswheretheinterncanworkwithclients appropriateforthestudent’sprogramemphasis.Inaddition,thefacultywill provideopportunitiesfordiscussionofprofessionalandethicalissuesrelatedtothe practice of counseling through a weekly on-campus seminar. Attendance at this seminar isrequiredforaminimumofonesemestercontinuesuntilallofastudent’sinternship hoursarecompleted.

EnrollmentinInternship

InthesemesterpriortobeginningInternship,studentsshoulddiscusstheirideasabout anInternshipsiteinconsultationwithanadvisor.Thesiteshouldbeconsistentwith theirneedsandtheirprogramarea.Students in the Clinical Mental Health program are responsible for contacting a prospective site for internship.AllInternshipsitesmustbeapprovedbyCED faculty. A current list of approvedcommunity/mental healthsites is available on the ESS CED website.IfastudentisinterestedinworkingwithintheClarkCountySchoolDistrict,an applicationisforwardedtotheCCSDGuidanceandCounselingServicestoarrange placement.AnannualInternshipFairduringwhichstudentsandsitesmaybecome acquaintedtakesplaceeveryspringsemester.StudentsmustattendtheInternshipFairpriortobeginningInternship.WorkattheInternshipsitebeginsonlyafterthe studentenrollsin,andbeginsattending CED751.Enrollmentwillbeconsistentwith thoseguidelinesdescribedintheCACREPstandards.Studentsregisterforaminimum ofonecredithourofCED751eachsemesterduringwhichtheyworkasInterns.The Internshipinvolvesuptothreesemestersandaminimumtotalof600clockhoursand 240directclientcontacthours.AsInternshipisofferedforvariablecredit,students should expect to complete hours each semester commensurate with their enrollment, as follows:

•Studentsenrolledforthree(3)creditsinasemestermustcomplete600hours,

•Studentsenrolledfortwo(2)creditsinasemestermustcomplete400hours,

•Studentsenrolledforone(1)creditinasemestermustcomplete200hours.

Supervision

Thesitesupervisorconductsweeklyonehouron-sitesupervisionsessionsfocusingon thestudent’scounselingactivities.Administrativeandeducationalsupervisionisthe responsibilityofthedepartmentfaculty.Eachsemesterfacultyworkinconcertand communicatewiththeInternshipsitesupervisorregardingstudent’sperformance.Site

contactsoccurinperson,onphone,viaemailandothermechanismsonaregularbasis duringthesemester.TheInternshipseminarwillprimarilyfocusonprofessionalissues, ethicsandcounselingpractices.

StudentRequirements

The student’sinternship requires that studentscomplete600hoursfor school counselingand600for clinicalmentalhealthcounseling.Experiencesmust include:

•A minimumof 240hoursof directcontact withclients;

•Averageof 1 ½hoursof groupsupervisiona weekona regular schedule throughoutinternship;

•One hourof individualor triadicsupervisiona weekby anon-site

supervisorthroughoutinternship;

•StudentsenrollinginInternshipmust havetheircourseworkcompleted before,or concurrentlywith, theirfirst Internship semester, excluding

thosestudentscompletingtheses.

•A varietyof professionalactivitiesinadditionto directservice(i.e., record keeping,supervision,referrals,in-service,andstaff meetings);

•Audio, digitaland/orvideorecordingand/orlivesupervisionof student’s interactionswithclients;

•Supervisedexperiencesinthe useof professionalresources(i.e., assessmentinstruments,media,technologies,professionalliterature,

research andstaff trainings);

•Formalevaluationof performanceduring the internshipby a program faculty memberinconsultationwiththe site supervisor semesterby

semester;

•Opportunitiesto counselclientswith diversebackgrounds;

•Formalevaluationsof supervisorsandtheirinternshipexperience;and

•Coverageof professionalliabilityinsurance

III.Advanced Internship for Clinical Mental Health

For studentsinthe clinicalmentalhealthcounselingprogramor thosecompleting anadvancedcertificate, advancedInternship (CED 775)buildsuponthe skillsdevelopedinthe first 600hourinternshipexperienceandrequiresanadditional300clockhoursof supervisedcounselingexperienceinanorganizationcompatiblewiththeirprogram emphasisarea. Of thesehours,150clientcontact hoursarerequiredat a minimum. Overall,studentsarerequiredto accruea total of 900hoursinInternshipandAdvanced Internshipexperiences.

NOTE:Studentsareencouragedtomaintainaccurateandthoroughrecordsfor their practicumandinternshipexperiences,as the clinicalandsupervisionhoursaccrued duringinternshipmay counttowardprofessionallicensure/certification.

IV.InternshipSiteCriteria

•The Internshipsite must providea widerangeof experiencesthat allow the studentto becomefamiliarwithbothdirectclientcontact andother professionalactivitiesconsistentwiththe roleof a professionalinthe organization.

•The missionof the Internshipsite shouldbeconsistentwiththe Department’sphilosophyandalsowiththe student’sprogramemphasis.

• Clientsservedat the site shouldbeappropriatefor the programemphasis.

•The site must beableto provideadequateregularsupervision(supervisor onsite anda minimumof onehourof individualsupervisioneachweek).

•The site must providethe opportunityfor studentsto earnthe necessary

hoursof bothdirectclientcontact andotheron-site hoursto fulfilltheir Internshiphourrequirements(approximately33%of the intern’stime in directclientcontact).

•The Internshipsite must bewillingto allowstudents to recordtheirworkat the site viaeithervideoor audiotape.

•Settings needto beavailable withprivacyandsufficientspacefor

equipment(e.g. TV monitors,tapingdevices).

•Settings needto beavailable for smallgroupworkwithprivacyandspace for equipment.

•Technologiessuchas audio,video,andtelecommunicationsequipment

aremadeavailable.

•Settingswithobservationaland/orotherinteractivesupervisioncapabilities areavailablefor livesupervision.

•Proceduresthat ensurethe client’sconfidentialityandlegalrights are

establishedandpracticed.

V.FieldSupervisorCriteria

Clinical Mental Health CounselingSupervisorsmust:

•HoldNationalBoardCertificationas a ProfessionalCounselor(NCC);or...

•Hold Certificationas a Rehabilitation Counselor(CRC);or...

•Hold a master’sor doctoraldegreeinCounseling,Psychologyor Clinical SocialWork; or closelyrelatedfieldsas approvedby the CEDfaculty.

•Holdan advanced degreeinmentalhealthnursingor psychiatry;

•Havetwo yearsof counselingrelatedprofessionalexperience

School CounselingSupervisorsmust:

•Holda master’sdegreeinschoolcounselingor closelyrelatedfield

•Havetwo or moreyearsof schoolcounselingexperience

•HoldState or Nationalcredentialsas a schoolcounselor

•Both School and Clinical Mental Health Supervisors must have knowledge of the program’stheoretical foundations, expectations,

requirementsand evaluation proceduresfor students

VI.EvaluationofSupervisorsandSites

Internshipsites andsupervisors willbeevaluatedonceeachyear. Continuationas an approvedsite andsupervisorwoulddependoncontinuedcompliancewiththe Program’srequirementsfor Internship,includingattendanceat the InternshipFair conductedby the departmentannually, continuedethicalandprofessionalconduct, continuedsupportto the professionalphilosophyof the ECS CED Programandfavorable studentevaluations.The site evaluationswillbecomposedof a formalstudent evaluationandinformationgainedfrom the site visits.Followingthe evaluation,the program may reassessthe approvedstatus for sites andsupervisors.

VII.TrainingofSupervisors–InternshipFair

An InternshipFair willbeconductedeachyearto conveyandclarifyanychangesinInternshiprequirements.AllnewandcontinuingInternshipsites must send representativesto participateinorderto continueingoodstandingas anInternshipsite.

Additionalinformationcoveredduringa CEDInternshipFair includesstandardsof practice,developinga supervisoridentity,andmodelsof supervisionpractice.Belowis a briefreviewhighlightingthesethreeareas.

StandardsofPractice

Supervisorsneedto followthe guidelinesoutlinedwithinCACREPstandards.

The CounselorEducation Program at UNLV adheresto thestandardsof andis accreditedby the Councilfor Accreditationof CounselingandRelatedEducational Programs(CACREP)whichwasformedin1981as a corporateaffiliateof ACA.

•The missionof CACREPis to promotethe advancementof qualityeducational programofferings inthe preparationof professionalcounselors.

•UNLV-The ECS CounselorEducation Program offers the followingprograms:

–M.S. inClinicalMentalHealthCounseling

–M.Ed. inSchoolCounseling

–AdvancedGraduateCertificate inAddictionStudies

–AdvancedGraduateCertificateinMentalHealthCounseling

–B.S. inHumanServices (Pre-Professional) Counselingandfour Minors CoreAreasof ourGraduateCounselingStudentExperienceinclude:

•ProfessionalOrientationandEthicalPractice

•Social Justice andCulturalDiversity

•HumanGrowth andDevelopment

•CareerDevelopment

•HelpingRelationships

•GroupWork andGroupCounseling

•Assessment andAppraisal

•ResearchandProgramEvaluation

CoreClinicalFaculty

Our CED faculty memberswhoprovidepracticumor internshipsupervisionmust have:

•A doctoraldegreeand/orappropriateclinicalpreparation,preferablyfrom an accreditedcounseloreducationprogram.

•Relevantprofessionalexperienceandcompetency.

•Relevanttrainingandsupervisionexperience.

UNLVAffiliatedSite Supervisors

A site supervisormust:

•Havea minimumof a master’sdegreeincounselingor a relatedfieldincluding professionalcounselingcredentials.

•Havea minimum of 2 yearsof pertinentprofessionalexperienceinthe areain whichthe studentis completingclinicalinstruction.

•Haveknowledgeof the program’sexpectations,requirementsandevaluation proceduresfor students.

•Readthis manual.

ClinicalInstructionEnvironment

The clinicalinstructionenvironment must:

•Providesettingswithprivacyandsufficientspacefor students/internsto counsel anduse equipment(e.g. TV monitors,tapingdevices).

•Providesettingsfor smallgroupworkwithprivacyandspace for equipment, technologiessuchas audio, digital, video,andtelecommunicationsequipment.

•Providesettingswithobservationaland/orotherinteractivesupervision capabilities.

•Provideproceduresthat ensurethe client’sconfidentialityandlegalrights.

•RECORDINGCLIENTSESSIONSAUDIO/VIDEOORDIGITAL/ELECTRONICTAPING

–In accordancewithCACREPstandardsfor counselingsupervision,Practicumand Internshipstudentsmust haveopportunitiesto tapecounselingcontact withclients.This involves audio/digital/electronic/videoor othermediumusedfor taping individuals/consultation/intakeandgroupcounselingsessions. Site placements that do not allow for tapingwillnot beconsideredandstudentswillbeplacedinothersettings. Studentsareresponsiblefor meetingthe tapingexpectationsestablishedby Practicum andInternshipinstructors.

StudentInternshipRequirements(seeprevioussection)

In additionto the requirementslistedpreviously:

•Studentsarerequiredto schedule,attendandremindsupervisorsregarding individualappointmentswithsupervisors.

•Attend trainingsas required by the site.

•Demonstrateprofessionalworkplacebehavior

othis includestimelyarrivalfor appointments,promptattentionandfollow throughto site tasks anddemonstrateprofessionalattendanceand communicationskills

DevelopingaSupervisorIdentity

SupervisionDefined

What is supervision?

•Supervisionincounselingis differentfrom administrativesupervision

•It is the relationshipbetweenanexpertmentorwitha novicecounselor

•Teachingandfeedbackto helpthe internmovealongthe developmental continuum

•Supervisorssharingtheirskillsandabilities

•Personalityaffects supervision

•Other ideas?

Accordingto the Associationfor CounselorEducationandSupervision,“clinical supervisionincludesthe supportiveandeducativeactivitiesof the supervisor designedto improvethe applicationof counselingtheoryandtechniquedirectly toclients.”Received10/15/12

SupervisorCharacteristics

Reflectonyourlevelof knowledge,skills,andexperienceineachof the followingareas:

•Experienceandeffectivenessas a counselor

•Trainingas a supervisor

•Abilityto managemultipletasks andrelationships

•Multiculturalawareness

•Sensitivityto superviseedevelopment

•Abilitybothto supportandchallenge

•Ability to be“present”witha supervisee SupervisoryRelationshipGoals

•Trust andrespectbetweenthe supervisorandsupervisee

•Clarityof expectations,regularfeedback,confrontationandevaluationmethods

•Non-defensiveresponseto supervisee’snegativefeedback

•Videotapingor livesupervisionto enhancesupervisoryeffectivenessand accountability

•The amountof time andsensitivitygivento the supervisee’sdevelopmental needs,andencouragementof appropriateautonomy

ModelofSupervisionPractice

At UNLVwerealizethat supervisorsmay utilize a variety of models of supervision.The framework provided in The Discrimination Model (Bernard.J., 1979)aresomething the Counselor Education Program faculty applyandusewithstudentsinmanyof the clinicalpreparationcourses.We hopethis is usefulto youas wellinyourpractice.

The Discrimination Model

Janine Bernard (1979)

•This modelwasdevelopedbasedonthe supervisoryapproachbeing determinedby the individualtrainingneedsof differentsupervisees.

•Basedon3 skillsets and3 supervisoryroles

ThreeRolesof the Supervisor

•Supervisoras Teacherrole

•Instruct, model,evaluate

•Supervisoras Counselorrole

•Facilitatesupervisee’sself explorationandreflection

•Supervisoras Consultantrole

•Collaborativeapproachto shareresponsibilityfor learningand development

•Encouragesuperviseeto trust theirownthoughtsandinsights

ThreeFocus Areasof Supervision

•InterventionSkills

•non-verbals

•feelingreflections

•paraphrasing

•What else?

•ConceptualizationSkills

•What is the coreissue?

•Patterns

•Emergingthemes

•PersonalizationSkills

•Supervisee’s ability to becomfortablewiththeir ownfeelings,values, attitudes

•What mightbeblockingtheirabilityto providethe best counselinginthe

moment?

Below is a sampleform to befilledout whenofferingfeedbackto aninternregardingtheir directclientcontact counselingskills.Providingwrittenfeedbackcanbehelpfulfor the internto seeandlearnfrom. Written feedbackalsocanprovidethe supervisorwitha track recordof internperformance.Over time, patternsof internabilitiescanbe highlighted.

DiscriminationModelFeedbackForm

SKILL SETFEEDBACK

Interventions
Conceptualization
Personalization

The followingsignaturessignifythat feedbackwasgivenanddiscussedbetweenthe supervisorandintern.

SupervisorSignature:Date:

Intern Signature:

Date:

Supervisiontraininginformationwasguidedby the followingresources:

Bernard,J.M., & Goodyear,R.K. (2004). Fundamentalsofclinicalsupervision 3rd. Ed.

Boston: Pearson

Fall, M. & Sutton, J.M. (2004).Clinicalsupevision:A handbookfor practitioners. Boston: Pearson.

Baird,B.N. (1999).The internship,practicum, andfield placement handbook:A guide forthe helpingprofessions. 2nded. NewJersey:PrenticeHall.

Neufeldt,S.A. (1999).Supervisionstrategiesfor thefirst practicum. 2nded. Alexander, VA. AmericanCounselingAssociation.

The next section includesforms that areusedby students, facultyand site supervisors duringpracticum,internship and/or advanced internship.

Forms include:

Site Placement Agreement Form

Faculty Consultation with Site Supervisors Guide

Student Learning Contract Form

Consent to Counsel Children Sample Guide

Site Supervisor Evaluation of Intern Form

Intern Evaluation of Site Supervisor Form

/ Department of Educational and Clinical Studies – Counselor Education Program

This agreement form must be triplicated and one copy returned to the Student’s Campus Internship Supervisor before the Student may begin practicum/internship. Other copies of this agreement will be kept by the On-Site Supervisor and the Student. This contract is for the entire practicum/internship period unless the Student’s practicum/ internship responsibilities change significantly.

Purpose:

The purpose of this agreement is to provide a qualified graduate student with a practicum/ internship experience in the field of counseling.

The Institutional Program agrees:

  1. To assign an Institutional faculty liaison (Campus Internship Supervisor) to facilitate communication between Institution and site;
  1. To provide the site the following information about the student named above: name of student, level of academic preparation, resume;
  1. To notify the student that he/she must adhere to the administrative policies, rules, standards, schedules and practices of the site;
  1. That the Campus Internship Supervisor shall be available for consultation with both site supervisor and student and shall immediately contact the site should any problem or change in relation to student or Institution occur; and
  1. That the Campus Internship Supervisor is responsible for the assignment of a field work grad based, in part, on the recommendation of the internship site supervisor.

The Site agrees:

  1. To assign a practicum/ internship site supervisor who has appropriate credentials, experience, time and interest for training the student intern;
  1. To provide opportunities for the student to engage in a variety of counseling activities under supervision and for evaluating the student’s performance (suggested counseling experiences included in this Supervision Manual on pages___);
  1. To provide the student with adequate work space, telephone, office supplies and staff to conduct professional activities;
  1. To provide supervisory contact which involves examination of student work using audio/visual tapes, observation, and/or live supervision; and
  1. To provide written evaluation of student based on criteria established by the Institutional Program.

______(Site Supervisor) will be the primary practicum/internship site supervisor. Training activities will be provided for the student in sufficient amounts to allow an adequate evaluation of the student’s level of competence in each activity.

______(Campus Internship Supervisor) will be the faculty liaison with whom the student and practicum/ internship site supervisor will communicate regarding progress, problems and performance evaluations.

The Practicum Student/Intern will spend _____ hours per week at the Internship site. At least 40 percent of the hours spent will involve direct client contact. The Practicum Student/Intern will participate in at least one hour per week of face-to-face, individual supervision with the on-site supervisor(s) indicated on this form. The Practicum Student/Intern will meet weekly for 1½ hours of group supervision. The supervision time requirement may increase if the student is participating in an intensified practicum/internship. The Practicum/Intern will also meet with the Campus Internship Supervisor as required by the graduate program in which the student is enrolled.

The Practicum Student/Intern will complete the Internship Activity Records as a means of accounting for hours spent in counseling, supervision, training and other professional activities. These forms will be signed off each term by the on-site supervisor.

The Practicum Student/Intern will obtain malpractice liability insurance, and will be informed about personal injury liability provided by the agency/school site. In addition, the Intern will complete the Insurance Liability Form and return it to the Campus Internship Supervisor.

All graduate program documentation and supervision activities, including evaluations of the site and supervision and attendance at on-campus supervision meetings, will be completed as required by the graduate program in which the Practicum Student/Intern is enrolled.

Projected Beginning Date:Ending Date

Course number and (number of credits) to be earned for this contracted period:

1st term2nd term

3rd term4th term

Projected hours per week: MondayThursday

TuesdayFriday

WednesdaySaturday

Sunday

Projected client contact hours per week:

Individual Group Couples FamilyOther

The On-Site Supervisor(s) will provide at least one hour per week of face-to-face individual supervision. This supervision time requirement may increase if the student is participating in an intensified practicum/internship. At the end of each term, the On-Site Supervisor will complete an evaluation of the Student’s progress/work through completed in evaluation forms included in this manual, and will discuss the evaluation with the Practicum Student/Intern.

Campus Internship Supervisor will meet with the Practicum Student/Intern as outlined in the graduate program course description and will assist the Intern and On-Site Supervisor in coordinating the Intern’s placement and fulfillment of graduate program requirements. Campus Internship Supervisor will maintain communication with the On-site Supervisor(s) over the course of the Practicum Student’s/Intern’s placement.

Site Supervisor #1: ______Date

Site Supervisor #2: ______Date

Student:Date

Campus Internship Supervisor:Date

ECS Counselor Education Program

Faculty Consultation with Site Supervisors

Below are common topics that faculty and site supervisors review regarding intern progress.

1.Whatspecifictypeofcounselinghastheinternbeeninvolvedin?(Individual,group,classroomguidance)Amountoftimeinvolvedwitheach.

2.Whataretheintern’sstrengthsandweaknesses?

3.Howmanyhoursaweekistheinternhere?

4.Istheinternassertiveandseekout/requestthingstodo?

5.Hastheinterninitiatedanyspecialproject(s)?

6.Howwelldoestheinterninteractwithstudents/clients?Withthestaff?

7.Howwelldoestheinterninteractwithparents?(Ifapplicable)?

8.Doestheinterncompletetasksinatimelymanner?

9.Istheinternhereontime? Iftheinternissickorlatedoessheorhenotifyyouinatimelymanner?

10.Anyrecommendations?Areastoimprove?

ECS Counselor Education Program

School or Clinical Mental Health Counseling

Student Learning Contract

I submitthefollowinglearninggoalstobecompletedaspartofPracticum/Internshipbytheterminationofthefall/spring/summersemesterintheyearof .

  1. ______
  2. ______
  3. ______
  4. ______
  5. ______

Signed:______

(Student) (Date)

Signed:______

(Site Supervisor) (Date)

Signed:______

(Faculty Supervisor) (Date)

Final review:

___All goals completed

___Partial goals completed

___No goals complete

Explanation:

ECS Counselor Education Program

~Sample~
ConsentFormforCounselingChildren

YourchildhasbeenidentifiedaspotentiallybenefitingfrommeetingwithaUNLVCounselingInternship/Practicumstudent,andwehopethatyouwillallowyourchildtoparticipateinthisopportunity.CounselingPracticumstudentsprovidesupportforandintervenewithchildrenwhoarehavingdifficultiesand/orgettingintroubleatschool,communityand/orathome.TheUNLVInternship/PracticumstudentwhowillbemeetingwithyourchildiscompletingaSupervisedCounselingInternship/Practicum,whichisacourseincounselingrequiredforallmasters-leveldegreecandidatesinthisfieldofstudy.

Bysigningbelow,youindicateyourwillingnessandconsenttohaveyourchildmeetwithaUNLVCounselingInternshipstudentandyourconsenttothepracticingstudents’limitedtapingofsessions.Thetapes/recordingsareusedforsupervisorypurposesonly betweentheUNLVsupervisor, Site supervisor,andtheInternshipstudentandaredeletedofallinformationattheendofeachsemester.

Child’s Name

Counseling Intern’s Name

Date Parent/Guardian Signature

Date

SignatureofSiteSupervisor

ECS Counselor Education Program

SiteSupervisorEvaluationof

Intern Performance

Student:Date:

Site Supervisor Name:

Term: _____ Fall _____ Spring _____ Summer _____ Year _____

Intern’s final term at site?YesNo

The site supervisor should complete this form at the end of each term. Two domains of intern competence are listed below along with specific items in each domain. Circle the number to the right of each item that best describes your perceptions of the intern’s skills compared to other individuals you have trained at the same level of professional development. If you do not feel you can adequately evaluate an item, please leave it blank or choose IOor NR(explained below). If the current evaluation is for the intern’s final term at the site, it should be treated as a summative evaluation. (The term “client” as used herein refers to any person receiving services including clients/students, parents, consultees, teachers or patients.)

IO=InadequateOpportunitytoObserve;NR=NotRelevanttotheSetting

ProfessionalSkillCompetency / ClearlyDeficient / ClearlyClearlyAdequateExcellent / IO / NR
1.Willinglyassumesresponsibility. / 12 / 345 / IO / NR
2.Establishesandmaintainsfacilitativeworkingrelationshipswithstaff. / 12 / 345 / IO / NR
3.Sharesskillsandcompetencieswithpeersandsupervisors. / 12 / 345 / IO / NR
4.Sharesweaknesseswithstaffinordertoimproveandisawareofskilland/orabilitylimitations. / 12 / 345 / IO / NR
5.Relatesappropriatelytonon-clientcommunitymembers. / 12 / 345 / IO / NR
6.Behavesprofessionally(e.g.punctuality,demeanor,dress,language,etc.). / 12 / 345 / IO / NR
7.Organizesandrecognizesimplicationsofcasematerial. / 12 / 345 / IO / NR

Intern PerformanceEvaluationForm page 2 of 3:

8.Accuratelyevaluatesowncounselingsessionperformance. / 1 / 2 / 3 / 4 / 5 / IO / NR
9.Behavesethicallyandresponsiblywithclients,colleaguesandadjunctagencies. / 1 / 2 / 3 / 4 / 5 / IO / NR
10.Knowslegalrightsofclients. / 1 / 2 / 3 / 4 / 5 / IO / NR
11.Knowslegalaspectsofcounseling. / 1 / 2 / 3 / 4 / 5 / IO / NR
12.Participatesinstaffin-servicetraining. / 1 / 2 / 3 / 4 / 5 / IO / NR
13.Showscommitmenttoprovidingserviceatsite. / 1 / 2 / 3 / 4 / 5 / IO / NR
14.Managestimewell. / 1 / 2 / 3 / 4 / 5 / IO / NR
15.Followsthroughonprofessionalcommitments. / 1 / 2 / 3 / 4 / 5 / IO / NR

IO=InadequateOpportunitytoObserve;NR=NotRelevanttotheSetting

CaseManagementSkillCompetency / ClearlyDeficient / ClearlyClearlyAdequateExcellent / IO / NR
1.Knowsandusescommunityresources. / 12 / 345 / IO / NR
2.Appropriatelyusesreferralwithinandoutsidethesite. / 12 / 345 / IO / NR
3.Responsiblyschedulesandmeetswithclients. / 12 / 345 / IO / NR
4.Keepsadequateandtimelyclientrecords. / 12 / 345 / IO / NR
5.Consultswithotherstaffregardingclientneeds. / 12 / 345 / IO / NR
6.Fulfillsadministrativeresponsibilitiesoftheposition. / 12 / 345 / IO / NR
7.Understandscomponentsofspecifictreatment/goals/serviceplans,includingIEP’sandrelatedclient/studentplanningtools. / 12 / 345 / IO / NR

Intern PerformanceEvaluationForm page 3 of 3:

Basedonyour experience, whatare the intern’s major strengths?

Suggestionsfor future professional development:

Other comments?

Date

Signature of Site Supervisor

Date

SignatureofCounseling Intern

*MysignatureindicatesthatIhavereadanddiscussedtheabovematerialwithmyinternshipsupervisor.

Itdoesnotindicatemytotalorpartialagreementwiththeevaluation.

ECS Counselor Education Program

COUNSELING INTERN’S

EVALUATIONOFSITESUPERVISOR

The intern should complete this form at the end of each term.

NameofCounselorIntern:

NameofSite:

NameofSiteSupervisor:

License/CertificationofSiteSupervisor:

Beginningand Ending Dates ofEvaluation:to

Instructions:Thisformistobeusedbythestudentinterntoevaluatetheperformanceofthesitesupervisor.Theformshouldbecompletedattheendofeachsemesterofplacement.Thisevaluationmustbecomplete,signed,andturnedin to the Internship Coordinatortoreceiveagradeforeachsemester’sPracticum/InternshipSeminar.Internsareencouragedtosharetheinformationonthisformwiththeirsitesupervisor.

PoorAvg.Good N/A

1.Givestimeandenergyinobservingandsupervising. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
2.Acceptsandrespectsmeasaperson. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
3.Recognizesandencouragesfurtherdevelopmentof / 1 / 2 / 3 / 4 / 5 / 6 / N/A
mystrengthsandcapabilities.
4.GivesmeusefulfeedbackwhenIdosomethingwell. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
5.Providesmethefreedomtodevelopflexibleand / 1 / 2 / 3 / 4 / 5 / 6 / N/A
effectivecounselingstyles.
6.Encouragesandlistenstomyideasandsuggestions1 / 2 / 3 / 4 / 5 / 6 / N/A
fordevelopingmycounselingskills.
7.Providessuggestionsfordevelopingmycounselingskills. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
8.HelpsmetounderstandtheimplicationsanddynamicsofthecounselingapproachesIuse. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
9.Dealswithbothcontentandprocess. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
10.Isspontaneousandflexibleinsupervision. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
11.Helpsmetodeviseandachievespecificconcrete / 1 / 2 / 3 / 4 / 5 / 6 / N/A
goalsduringtheinternshipexperience.
12.GivesmeusefulfeedbackwhenIdosomethingwrong. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
13.Paysattentiontobothmyconcernsandmyclients’ / 1 / 2 / 3 / 4 / 5 / 6 / N/A
concerns.

COUNSELING INTERN’SEVALUATIONOFSITESUPERVISOR page 2 of 2:

14.Focusesonbothverbalandnonverbalbehaviorinmeand1 / 2 / 3 / 4 / 5 / 6 / N/A
myclients.
15.Helpsmedefineandmaintainethicalbehavior. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
16.Encouragesmetoengageinprofessionalbehavior. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
17.Maintainsconfidentialityinregardtomaterialdiscussed / 1 / 2 / 3 / 4 / 5 / 6 / N/A
insupervision.
18.Helpsmeapplycounselingtheorytopractice. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
19.Helpsmeinplanninggoalsandstrategieswithmyclients. / 1 / 2 / 3 / 4 / 5 / 6 / N/A
20.Helpsmeformulateatheoreticallysoundrationaleof / 1 / 2 / 3 / 4 / 5 / 6 / N/A

humanbehavior.

21.Offersandencouragesmetouseavarietyofresource1 23 45 6N/A information.

22.Helpsmedevelopincreasedskillincritiquingandgaining1 23 45 6N/A insightfromcounselingsessions.

23.Explainscriteriaforevaluationclearly.1 23 45 6N/A

24.Appliescriteriafairlyinevaluation ofmycounselingskills1 23 45 6N/A and performance.

ADDITIONALCOMMENTS:Thissectionmaybeusedtoprovideadditionalinformationonlowratings,andtonotespecificstrengthsofthesupervisor.

Pleasemakesurethefollowingiscompletewithsignatureanddate:

______Date ______

Counseling Intern Signature

ECS Counselor Education Program

Supervision Protocol Timeline

Improving the internship supervision process includes an ongoing collaboration between university faculty and site supervisors. Below is a checklist of activities to be performed during the semester of intern placement.

When appropriate, faculty members and administrative personnel will note deadlines on the CED Student Website advise students during internship labs and send out student advisory memos.

Please note: It is the intern’s responsibility to turn in the completed form for their permanent file in the department office.

Timeline / Task to be completed / Date Accomplished / Intern Signature / Site Supervisor Signature
Week 1 / Placement is agreed upon and communicated between: site administration, site supervisor, faculty supervisor, and intern.
Week 1 / Contact information is shared between site supervisor, faculty supervisor, and intern. Contact information includes but is not limited to: address, phone, additional phone number for emergencies if needed, email, pager, etc.
Week 3 / Student learning goals are formalized, signed by the site supervisor, and turned into the faculty supervisor. Learning goals may fall into one of the following “best practices” categories: formalizing theoretical orientation, working on specific individual or group counseling skills, improving leadership and advocacy skills.