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Fall 2016

CLINICAL MENTAL HEALTH COUNSELING PROGRAM

Handbook for Practicum and Internship Supervisors

Brooks College of Health|Department of Public Health 1 UNF Drive|Bldg. 39|Room 4033

Jacksonville, Florida 32224 Phone: (904) 620-2840|Fax: (904) 620-1035

The UNF Clinical Mental Health Counseling Program is approved by the Council for the Accreditation of Counseling and Related Educational Programs

Table of Contents

Introduction ................................................................................................................... 1

Timetable for Practicum and Internship Activities ......................................... 2

Practicum ........................................................................................................................ 2

Internship ....................................................................................................................... 3

Counting Hours ............................................................................................................. 4 Direct Client Contact Hours ................................................................................................ 4 Non-Direct Hours ................................................................................................................ 4 Banking Hours ..................................................................................................................... 4 Counting UNF Group Supervision Hours ............................................................................ 5

The Application Process ............................................................................................ 5 Multiple Sites ...................................................................................................................... 5 Completing Hours at Their Place of Employment .............................................................. 6 Finalizing Practicum and Internship Placement.................................................................. 6

Responsibilities of Site Supervisors ...................................................................... 7 Qualifications ...................................................................................................................... 7 Supervision ......................................................................................................................... 7 Audio/ Video Taping ........................................................................................................... 7 Contact with UNF Faculty ................................................................................................... 7 Evaluation ........................................................................................................................... 7 Site Supervisor Tuition Waiver ........................................................................................... 8

Responsibilities of UNF Supervisors ..................................................................... 8 Practicum Meetings ............................................................................................................ 8 Internship Meetings ............................................................................................................ 8 Final Grade .......................................................................................................................... 9

The Practicum and Internship Experience ......................................................... 9 Liability Insurance ............................................................................................................... 9 Criminal Background Check ................................................................................................ 9 Immunization Requirement ................................................................................................ 9 Establishing a Schedule ....................................................................................................... 9 Documentation of Training Experiences .......................................................................... 10 Individual Counseling ........................................................................................................ 10 Group or Family Counseling.............................................................................................. 10 Related Responsibilities .................................................................................................... 10 Professional Associations and Memberships ................................................................... 11 Professional Development Opportunities ........................................................................ 11 Professional Counseling for Students ............................................................................... 11

Faculty ........................................................................................................................... 11

Appendix A: Background Check Information ................................................. 12

Appendix B: Agreement .......................................................................................... 13

Appendix C: Practicum & Internship Statement of Understanding ........ 14

Appendix D: Learning Contract ............................................................................ 15

Appendix E: Specialized Learning Contract ..................................................... 16

Appendix F: Permission to Record and Consult ............................................. 17

Appendix G: Documented Supervision .............................................................. 18

Appendix H: Report of Time Distribution ........................................................ 19

Appendix I: Certificate of Participation Application .................................... 20

Appendix J: Student Self Evaluation ................................................................... 21

Appendix K: Site Supervisor Evaluation ........................................................... 24

Appendix L: Student Evaluation of Site ............................................................. 27

Appendix M: Student Evaluation of UNF Practicum/Internship Instructor ..................................................................................................................... 29

C M H C P R A C T I C U M & I N T E R N S H I P

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Introduction

he Clinical Mental Health Counseling Program (CMHC) is approved by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP). The majority of state licensure boards regulating master’s level trained counselors base educational

requirements upon CACREP educational standards. The CMHC Program is a 60 credit hour program, which meets the educational requirements for licensure in the state of Florida as a Licensed Mental Health Counselor (LMHC). The program is practitioner-oriented and students are required to complete a clinical experience requirement of 1,000 supervised hours before graduation. The counseling curriculum offers a unique blend of courses to provide the skills and knowledge necessary for becoming a competent counseling professional. Solid academic performance and experiential mastery are required. The CMHC program is housed in the Department of Public Health, which is located within the Brooks College of Health. The UNF CMHC faculty members wish to extend our gratitude to you for your willingness to serve as a site supervisor for our students. We recognize that the work you do with our students is usually unpaid and is accomplished in addition to your regular responsibilities.

We have prepared this document for you in order to explain the requirements of practicum and internship for the UNF CMHC students and to provide guidelines and suggestions for site supervisors. We welcome feedback on the material contained in this document and intend to update it periodically to incorporate suggestions. If, after reading this document, you have any questions about the practicum or internship, from either your or the student’s point of view, please contact the Clinical Director, who has responsibility for oversight of all clinical field experiences.

Clinical Director Dr. Natalie Arce Indelicato

[email protected] 904.620.5318

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http://www.cacrep.org/

http://www.cacrep.org/

mailto:[email protected]


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Timetable for Practicum and Internship Activities

Time Frame Activities

Fall Semester of 1st year Students sign and submit VECHS waiver

Students complete Background check through Certified Background Check

Spring Semester of 1st year

Clinical Director conducts Practicum & Internship Orientation

Students participate in Practicum & Internship Fair

Students meet with Faculty Advisor to discuss sites

Summer Semester of 1st year

Students contact site supervisors for application and interviews

Students and site supervisor agree on placement

Students take Counselor Preparation Comprehensive Exam (CPCE)

Fall Semester of 2nd year

Students submit application for background re-check and fingerprinting

Students enroll in practicum course

Students begins clinical field experience at practicum site

Spring Semester of 2nd year

Students enroll in internship I course

Students continue clinical field experience at site

Summer Semester of 2nd year

Students enroll in internship II course

Student completes clinical field experience hours at site

Students prepare for graduation!

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Practicum

Practicum is designed to provide students with practical experience in the counseling field. At this stage in their education, they will have had some experience in counseling through their courses as well as opportunities to learn about the work of counselors in different settings. During practicum, they will focus primarily on the following:

A. learning good counseling practices by observing and participating in

joint experiences. B. developing your skills by counseling in groups and individually under

close supervision.


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C. becoming familiar with various types of educational and/or mental

health agencies, services, referral sources, professional orientation, staff development, organizational development, etc.

Prerequisites for practicum include the following: MHS 6404: Theories in Clinical Mental Health Counseling MHS 6941: Clinical Counseling Skills MHS 6700: Legal, Ethical & Professional Issues in Counseling MHS 6070: Psychopathology MHS 6510: Group Counseling MHS 6428: Counseling Diverse Populations MHS 6205: Assessment and Evaluation in Mental Health Counseling MHS 6305: Career Counseling

During the one semester practicum, students will need to accumulate at least 330 hours of experience. Of the 330 hours required in practicum, at least 132 must be conducted in direct client contact. This refers to individual, group, and family counseling; and/or intake and exit interviews with clients.

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Internship

When students enter your internship, they will be close to the completion of

their master’s program. They will have had significant counseling experience in

the classroom, as well as opportunities to counsel with others and on their

own during practicum. The internship is designed to be an experience where

students can refine their skills in counseling others, while having the benefit of

supervision by more experienced professionals.

The primary tasks in internship should be to:

A. use counseling theory to guide their clinical practice;

B. counsel people with difficult issues while under supervision;

C. explore areas of personal interest such as grief counseling, counseling children, or counseling people with eating disorders; and

D. become involved in the professional community through membership

in professional associations; attendance at workshops, conferences and other staff development activities; and by participation in informal networking groups.


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Of the 670 hours to be completed by mental health counseling interns, at least 268 hours must be spent in direct contact (individual counseling sessions, assessments, intakes, etc.).

In the internship students will gain much experience working on their own, or as a colleague with other counselors at their internship site. However, they must continue in supervision with the site supervisor at a minimum of one hour each week. Table of Contents

Counting Hours

Students enrolled in both practicum and internship are responsible for maintaining a log of activities. The following guidelines have been created to assist them in the process of counting their hours.

Direct Client Contact Hours

Providing face-to-face provision of therapeutic interventions in individual, group, and family counseling

Observing your site supervisor as he or she provides individual, group and family counseling

Conducting psychosocial or intake interviews with clients

Conducting co-therapy with another counselor or supervisor

Doing crisis intervention

Providing phone consultations and home visits with underage clients’ parents or guardians.

Providing community outreach and programming

Non-Direct Hours

Attending and participating in staffing meetings

Participating in individual site supervision and on-campus group supervision

Attending professional workshops

Completing all documentation including progress notes, case summaries, and written treatment plans

Providing community outreach and programming

Banking Hours

In the interests of establishing and maintaining self-care, students are encouraged to take time off after each term. In cases where students want to continue internship at their sites over interim breaks (i.e., before the start of the spring or summer terms, winter


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or spring break), they are permitted to do so, provided that they continue weekly one hour supervision on site throughout this period, and a UNF faculty must be willing and available to consult with the student during this period. It is strongly recommended that students keep personal copies of all weekly logs and other supportive documentation (i.e. time distribution forms). With permission of the Clinical Director and Site Supervisor, students can bank site training and orientation INDIRECT hours prior to the start of their practicum. Note that providing DIRECT face-to-face therapeutic interventions (individual, group, and family counseling) is not allowed prior to starting your practicum; however, you may observe your site supervisor or other agency counselors with permission and these hours will count as INDIRECT contact hours until the start of the semester. All students are required to remain in attendance and engaged in their Internship course and at their clinical site through their last semester of the program.

Counting UNF Group Supervision Hours

Students are permitted to count the on-campus practicum and internship seminars under the category "group supervision".

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The Application Process

Students must secure a Practicum or Internship site the semester before they enroll in the Practicum or Internship course. Every spring term, a Practicum/Internship Fair will be held. All students are required to attend the Fair. Representatives or supervisors from practicum/internship sites will be invited to attend and talk about their site, the counseling population with whom they work, the therapeutic approaches they use, the supervision they provide, the qualifications they look for in a practicum student or intern, and their application and interview process and timeline.

Multiple Sites

Most students elect to complete their practicum and internship in one site. Students may complete their internship hours in more than one setting with the permission of their UNF faculty supervisor. If this is the case, students need to secure a site supervisor in each site who meets the necessary qualifications and can provide a minimum of one hour of documented supervision per week, per site.


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Completing Hours at Their Place of Employment

Students requesting permission to complete their field experience requirements at their place of employment must do the following:

(a) receive approval from the Clinical Director prior to commencing field hours

(b) establish a specialized learning contract (see Appendix E) which describes employment activities relevant to practicum and internship and specifies additional requirements if necessary

(c) find a qualified supervisor other than the person who evaluates their job performance, who will provide an hour of weekly individual supervision.

Finalizing Practicum and Internship Placement

Students must schedule to meet with their site supervisor to finalize the details of their placement prior to the first week of the semester. Faculty reserve the right to de-register or administratively withdraw students who do not comply with this requirement. During the planning meeting with the site supervisor for practicum or internship placement, students will need to complete several forms to turn in to the UNF supervisor at the second meeting of the term. These forms, which are in the Appendix, include the following:

1. Agreement Form. This form includes the name and address of the

agency and requires the signatures of the site supervisor. (See Appendix B).

2. Statement of Understanding. This form is a reminder that supervisors

are ultimately responsible for safeguarding clients, and therefore have the option of removing students from practicum or internship when necessary (See Appendix C).

3. Learning Contract. As a collaborative effort between supervisor and

supervisee, a description, in behavioral terms, of specific objectives that the supervisee intends to accomplish during your practicum or internship should be developed. The site supervisor should review these objectives at the beginning and end of each semester since he or she will be responsible for the evaluation of their completion. The student’s UNF supervisor will review the objectives, as well, and return the form to following the first or second meeting of the term (see Appendix D).

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Responsibilities of Site Supervisors

Qualifications

Supervisors must have a master’s degree in counseling or a related profession with equivalent qualifications, including appropriate certifications and/or licenses. Supervisors must also have a minimum of two years of pertinent professional experience. Supervisors must have completed relevant training in counseling supervision. (Supervisor qualifications in CACREP, Sec. III, C, 1, 2, & 4). Site supervisors are asked to fill out an online supervisor profile provided by the Clinical Director prior to beginning supervision.

Supervision

Supervisors are expected to provide at least one hour of individual supervision a week, throughout the students field experience. Additionally, students may participate in group supervision with 3 or more practicum students or interns. It will be important for supervisors to review students’ counseling skills throughout the practicum or internship, through video, audio, or direct observation. (See Appendix F for a sample Permission to Record and Consult form). Students are also required to document their site supervision each week by completing the Documented Supervision form (See Appendix G).

Audio/ Video Taping

Site supervisors must agree to provide appropriate training, and ensure that students are able to tape (audio or video) their sessions with clients, provided consent forms (see Appendix F) have been completed with clients and appropriate steps have been taken to ensure the client’s confidentiality (e.g., removing any identifying information in the written case, using pseudonyms, etc.).

Contact with UNF Faculty

Please feel free to telephone or email the UNF supervisor and/or the Clinical Director at any time to discuss students. If an individual student appears to lack appropriate skills to complete the practicum or internship, we would like to have this feedback immediately. The UNF supervisor and the Clinical Director both have the responsibility to take corrective action when a student has problems at the site. Likewise, we hope you will let us know when students have gone above and beyond the call of duty with their practicum or internship; we all enjoy hearing about student successes! The UNF supervisor and/or the Clinical Director will initiate contact with you via telephone, email, and site visits to follow up on student progress.

Evaluation

Supervisors are responsible for evaluating students’ performance in writing to be submitted to the UNF practicum/internship supervisor at the midterm and


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at the end of the semester. Students also complete self-evaluations as well as evaluations of their site and campus supervision. Please see Appendix J for links to these evaluations.

Site Supervisor Tuition Waiver

As a means of thanking you for your service, UNF offers you opportunities to take courses tuition-free. For every 300-clock hours of student practicum or internship, which you have supervised, you will be able to register for up to six semester hours of courses in a given semester. The number of practicum or internship hours is recorded on the Report of Time Distribution form (See Appendix H). You can request a fee waiver for the semester desired by submitting a Certificate of Participation Application (See Appendix I) to UNF’s Clinical Director. The Clinical Director will forward this Certificate of Participation Application for necessary signatures and then submit it to Office of Educational Field Experiences.

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Responsibilities of UNF Supervisors

Practicum Meetings

During practicum, students will enroll in the practicum course, which meets weekly in small groups of up to six students. The purpose of these meetings is as follows:

1. to share information among students regarding best practices and solutions

to problems and issues;

2. to learn innovative ideas to deal with specific issues from the presentation of case studies;

3. to review legal and ethical issues that may arise at the site;

4. to review relevant literature and /or current topics that would impact all

members of the group;

5. to learn to conduct an assessment, formulate a diagnosis and appropriate treatment plans, and provide professional counseling to facilitate treatment goals.

6. to discuss information regarding licensure, certification, continuing

education, professional organizations, and other practical considerations.

Internship Meetings

During internship, students will enroll in the internship course, which meets


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weekly in groups of no more than twelve students. During these sessions, the focus will be on individual and group supervision of students’ counseling skills, discussion of current topics in counseling, and in developing skills in counseling-related areas. Students are required to bring recorded client sessions (audio-tape or video-tape) for case presentations in group supervision. Students will have opportunities to work with their supervisor or another faculty member on special activities such as supervision, research, training, writing, or making presentations at conferences and workshops.

Final Grade

The UNF supervisor will evaluate students’ performance as shown in their participation in group supervision and the seminar. Additionally, with recommendations from site supervisors, the UNF supervisor will assign a final grade. Students will receive a letter grade in practicum, and a grade of Pass/Fail in internship.

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The Practicum and Internship Experience

Liability Insurance

Students are not required to purchase professional liability insurance while they are enrolled in the program. The Brooks College of Health provides umbrella coverage for all students involved in clinical training, with a professional liability insurance of a minimum of $1,000,000 personal/$3,000,000 professional limits.

Criminal Background Check

Students are required to apply for and pass a criminal background check and finger printing before beginning clinical work in the community. They cannot begin practicum or internship client contact until they have cleared the University required background check. Please refer to Appendix A for additional information regarding background checks.

Immunization Requirement

If your site requires students to be immunized for select diseases before beginning work, they may receive these services at Student Health at UNF, which can typically provide these immunizations at a lower cost than they would incur in the community. Contact information for Student Health Services: http://www.unf.edu/dept/shs/ Bldg. 39A, Room 2098, Phone: (904) 620-2900.

Establishing a Schedule

Whether in practicum or internship, it is important that students work closely with site supervisors to establish a reliable schedule. It is recommended that

http://www.unf.edu/dept/shs/


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students plan to work at their site at least one full day and several part time days per week. Students are encouraged to keep track of agency meeting times and events that supervisors think are important for them to attend and make a special effort to participate, even if they occur on a “non- practicum/internship” day. Students are also encouraged to stay with their schedule as closely as possible, and always give advance notice if they have to rearrange it.

Documentation of Training Experiences

Students are required to keep a daily record of their activities and the time spent on each, throughout their practicum and internship experiences. The daily log will be helpful when they meet with their site or university supervisor to discuss their counseling cases and related activities. Additionally, at the conclusion of practicum or internship, students will use the log to summarize the various activities on the Report of Time Distribution form (See Appendix H).

Individual Counseling

Students are encouraged to work with clients that they see over a period of time, rather than concentrating only on crisis intervention. They have been advised to ask their supervisor for advice on how the site deals with issues such as scheduling appointments, intake interviews, consent forms, reminder calls to clients, etc.

Students have also been advised to concentrate on following a theory, or theories, or a model that they have learned and has been found to be empirically effective when counseling individuals. Students are reminded that their practicum and internship experiences are meant to be for learning and practice as they assimilate information and develop their professional identity as a counselor. It is expected that site supervisors will help students as they try out different counseling approaches by providing them with helpful feedback.

Group or Family Counseling

Students should plan to spend a portion of their direct contact hours working with groups and/or families. It is important that they spend time observing and co-leading groups before working on their own. Students are aware that different agencies may follow specific formats when working with multiple clients or families.

Related Responsibilities

Students know that their practicum or internship will consist of much more than individual and group counseling. They expect that much time will be spent on tasks such as developing treatment plans, writing comprehensive case notes, and consulting with counselors in other agencies. Additionally, they expect to make case presentations, join ongoing discussion groups, or do outside reading in


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specific areas.

Professional Associations and Memberships

Students are encouraged to join local, state and national professional associations as a compliment to their academic and clinical training. Through membership in professional organizations, students expect to meet professional counselors, learn about job opportunities, and form lasting professional bonds. Relevant organizations include the following: Florida Mental Health Counseling Association, American Counseling Association, and American Mental Health Counselors Association.

Professional Development Opportunities

As students become more involved in practicum or internship, they become increasingly aware that their professional education is just beginning, and that it is likely to continue. Luckily, every year, dozens of interesting and helpful workshops are presented in Jacksonville or the surrounding area. Supervisors should advise students on training that will be particularly helpful to their professional development. Participation in professional development activities can be included in students’ non-client-contact practicum or internship hours.

Professional Counseling for Students

While individual counseling for each student is not required, students are strongly encouraged to participate in their own personal therapy, especially while participating in Practicum and Internship. To most students, being in the program is the best time to explore and possibly resolve one’s personal concerns. The UNF Counseling Center, located in Founders Hall, Building 2, provides individual counseling at no additional cost to students.

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Faculty

Natalie Arce Indelicato, Ph.D., Assistant Professor & Clinical Director, [email protected]

Cynthia Scott, Ph.D., Associate Professor, [email protected]

Tes Tuason, Ph.D., Professor, [email protected]

Richmond D. Wynn, Ph.D., Assistant Professor & Program Director, [email protected]






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Appendix A: Background Check Information

A background check will be required of all students in their first semester as part of their educational program, and will be re-checked the following fall prior to beginning Practicum and Internship. The initial background check and re-check is necessary for field experiences that include, but are not limited to practicum, internship, or other types of experiential learning either directly involving or in agencies serving children, the elderly, patients, or other vulnerable populations.

NOTE: The background check must be done through the vendor approved by the Brooks College of Health, Castle Branch at https://portal.castlebranch.com/UC00

In order to complete your background checks: 1. Sign a VECHS waiver agreement form, before you apply for a background check. This form, along with

the Student Instructions: UNF COH Portal Instructions 2016 document is located in the Background Check tab on the CMHC Blackboard site.

2. Submit the VECHS waiver agreement form to the Clinical Director.

3. Go to https://portal.castlebranch.com/UC00

4. Click on “place order” and select Mental Health Counseling (UA 39: Initial Background check, future focus, finger print)

5. You will be asked to give your contact information and other personal identifying information needed for

security compliance purposes.

6. The cost of the comprehensive initial screen is $100.80.

7. In your second fall semester, you will repeat the first three steps and select UA39r for your background recheck. The cost of the recheck is $15.80.

NOTE: Information revealed by a background check may:

Prohibit participation in the required practicum and internship. Inability to participate in these required field experiences will jeopardize successful completion of the program.

Prohibit sitting for post-graduate national examinations for licensure, certification, or post-graduate internships.

Please direct questions regarding background check results to the Clinical Director, Dr. Natalie A. Indelicato, [email protected], 904.620.5318.

https://portal.castlebranch.com/UC00

https://portal.castlebranch.com/UC00



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Appendix B: Agreement

☐Practicum Semester: ________ Year: ________ |☐Internship Semester: ________ Year: ________

Student Information

Name: ___________________________________ N#: ______________________________________

Address: _

City: ________ State: Zip:

Home/Cell Phone: Work Phone:

Email: __

Site Information

Agency: _

Site Supervisor:

Site Supervisor Credentials (degree, licensure, certification):

Address: _

City: _______ _ State: Zip:

Phone: _

Email: _________________________________

Anticipated Schedule

Start Date: _ End Date:

Day

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours per week

Time

____________________________________________________________ ____________________________

Student Signature Date

________________________________________________________________ ____________________________

Site Supervisor Signature Date


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Appendix C: Practicum & Internship Statement of Understanding

I acknowledge that my primary obligation, as a practicum or internship student, is to do no harm to my clients. I therefore agree to maintain ethical behavior per professional standards outlined in the American Counseling Association (ACA) Code of Ethics at all times during this field experience. I further acknowledge that my UNF and site supervisors are legally and ethically obligated to protect my clients from potential harm as much as possible through their supervision and review of my performance. In the event that any of my supervisors have reason to believe that I may harm my client through unethical or incompetent behavior, they have the right and responsibility to take immediate action. Such action may include removing me, temporarily or permanently, from the practicum or internship.

____________________________________________________________ ____________________________


________________________________________________________________ ____________________________



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Appendix D: Learning Contract

Students, in consultation with site supervisor and/or UNF practicum/internship instructor, will choose projects or activities to complete during practicum or internship. Describe the projects or activities in terms of measurable objectives below. The UNF supervisor will review and approve the objectives at the beginning of the semester and review them again with students at the end of the semester. The site supervisor will describe the degree of accomplishment of the objective, will sign below, and return this form to the UNF supervisor at the conclusion of practicum or internship with the student’s final evaluation.

Student Objectives (beginning of the semester) Site Supervisor’s Evaluation of Objectives

(end of the semester) 1.

2.

3.

4.

5.

Agreement to student objectives (beginning of semester):

____________________________________________________________ ____________________________


________________________________________________________________ ____________________________


Review of student objectives (end of semester): ____________________________________________________________ ____________________________


________________________________________________________________ ____________________________



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Appendix E: Specialized Learning Contract

Requirements for Completion of Practicum and/or Internship at Employment Setting

A. Receive approval from the Director of Clinical Field Experiences prior to commencing field hours.

B. Establish a “specialized learning contract” with the Clinical Director which describes employment activities relevant to practicum/internship and specifies additional requirements if necessary.

C. Obtain consent of an on-site supervisor who will provide weekly one-hour supervision (other than the person responsible for the evaluation of your job performance).

D. Submit your job description from your employment site.

E. Retain a copy of written approval for your own records.

Concise description of job activities; which are applicable to Practicum/Internship

Hours per week:

List non-employment-related activities (e.g. special learning project)

Hours per week:

_______________________________________________________________ ____________________________


________________________________________________________________ ____________________________

UNF Clinical Director Signature Date

________________________________________________________________ ____________________________



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Appendix F: Permission to Record and Consult

I, the client (or parent or guardian), consent to the recording of my counseling sessions for purposes of professional consultation with the goal of helping improve the counselor’s effectiveness. This recording may be done by video and/or audio taping.

This consent is being given in regard to the professional services provided by the counselor named below. I understand that I will be given counseling even if I choose not to sign this authorization. I understand that even if I sign this authorization, I may ask for the recording to be turned off or erased at any time during my sessions. All audio and videotapes will be kept in a safe location and will be destroyed at the end of the semester.

I further understand that to improve counseling techniques, my counselor will be consulting with the supervisor of this agency, a UNF faculty supervisor, as well as other counselor graduate trainees. Portions of the recording may be viewed in these consultations. I therefore authorize any of the supervisors and graduate trainees to observe or have access to information relating to my treatment. It is understood that these professionals and their students are bound by state laws and by professional rules about client privacy. Printed name:

(Client or parent/guardian)

Signature: ___________________________________________ Date: ______________________

I, the counselor, have discussed the issues above with the client (and/or his or her parent or guardian). My observations of this person’s behavior and responses give me reason to believe that this person is fully competent to give informed and willing consent. Printed name:

(Counselor)

Signature: _____________________________________________ Date: _____________________


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Appendix G: Documented Supervision

Student name: Total time:

Functions Reviewed

☐ Assessment ☐ Case management ☐ Case review ☐ Client education ☐ Client follow up

☐ Client orientation ☐ Consultation ☐ Community Education

☐ Crisis Intervention ☐ Evaluation

☐ Family counseling

☐ Group counseling ☐ Individual counseling ☐ Intake ☐ Outreach

☐ Referral ☐ Reports/ Record keeping

☐ Screening ☐ Treatment Planning

☐ Written communication

☐ Other:

Issued Discussed

Recommendations for Student

_______________________________________________________________ ____________________________


________________________________________________________________ ____________________________



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Appendix H: Report of Time Distribution

☐Practicum Semester: ________ Year: ________ |☐Internship Semester: ________ Year: _______

Student name: Site:

An exact report of the number of hours the student spent in the Counseling Practicum or Internship experience is required for the student’s record as well as for the site supervisor’s record. Site supervisors receive free tuition for every 300 hours of student practicum or internship.

* 1-hour credit is assigned for group sessions consisting of 6 or fewer members; an additional 15 minutes credit is assigned for each additional client group member.

Direct Hours Indirect Hours Supervision Hours Total Hours

Family Counseling __________

Case Staffing __________

Individual Site __________ Campus __________

* Group Counseling __________

Documentation/

Record Keeping __________

Individual Counseling __________

Outreach __________

Group Site __________ Campus __________

Intake / Screening __________

Professional Development __________

Observation __________

Research __________ Other: __________

Other: __________

Outreach __________ Other: __________

Subtotal:

_______________________________________________________________ ____________________________


________________________________________________________________

Site Supervisor Printed Name & Credentials

________________________________________________________________ ____________________________



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Appendix I: Certificate of Participation Application

The Certificate of Participation allows the Site Preceptor to exempt the tuition fee for up to six hours during one term of instruction at any State University in Florida.

The holder will be required to pay all current fees applicable at the time of registration except tuition fees.

The certificate does not guarantee admission to the University.

The Certificate of Participation will not be issued without the site preceptor’s social security number and home address.

Only an original certificate application will be accepted. A scanned or faxed copy is NOT acceptable.

Given the confidential information that is included on this application, it can be placed in a sealed envelope and mailed directly to the Faculty Clinical Director at the address below.

Dr. Natalie Arce Indelicato University of North Florida | Department of Public Health

1 UNF Drive | Jacksonville, FL 32224 The certificate application will be routed for signatures and reported to the Office of Educational Field Experiences at the end of the semester of supervision. Allow a minimum of 4-6 weeks for processing. The official Certificate of Participation will be mailed to the home address reported on the certificate application. Do not contact the Office of Educational Field Experiences with questions. All correspondence should be directed to the Clinical Director, Dr. Natalie Arce Indelicato, [email protected] or (904) 620-5318.

I certify that I served as a field site preceptor and supervised an intern as follows:

Name of Student: Program: Clinical Mental Health Counseling

Term/Dates of Supervision: Total # of Hours:

Agency: _

Address: _ City: State: Zip:

Business Phone: Fax: __ E-mail: _____________________

Site Preceptor’s Name: Social Security Number:

Home Address: _

City: __________ State: Zip: Home Phone:

_________________________________________ ______________________ Site Preceptor Date

__________________________________________ ______________________ Clinical Director, Clinical Mental Health Counseling Date

__________________________________________ ______________________ Department Chairperson Date



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Appendix J: Student Self Evaluation

Student name ________________________________

Site ________________________________________ Supervisor __________________________________

☐Practicum - Semester: _________ Year: _______ |☐Internship - Semester: _________ Year: ________

☐Mid Term ☐Final Using the following scale, please evaluate yourself by choosing the appropriate number in the scales below:

5 - EXCELLENT: Always performs above the minimum requirements and shows outstanding aptitude and application of skills and concepts of mental health counseling. 4 - GOOD: Always meets minimum requirements in a satisfactory manner and performs at a level above that normally expected of a practicum/Internship student. 3 - AVERAGE: Usually meets minimum requirements in a satisfactory manner; performs as might be expected of a practicum/Internship student. 2 - FAIR: Occasionally fails to meet minimum requirements in a satisfactory manner; performs at a level somewhat below that expected of a practicum/Internship student. 1 - POOR: Usually fails to meet minimum requirements in a satisfactory manner; performs at a level considerably below that expected of a practicum/Internship student. NA/NB - NOT APPLICABLE/NO BASIS: Item/ question is not applicable to the setting or duties of the practicum/Internship student; there is no basis for which to evaluate the practicum/Internship student for the item in question.

1a. Rate your general counseling skills 5 4 3 2 1 NA/NB Displays sensitivity toward others Demonstrates foundational counseling skills (e.g., builds rapport, shows accurate empathy, reflects feelings, attends, paraphrases and summarizes)

Demonstrates an ability to facilitate client's involvement and choice Demonstrates self-awareness Demonstrates the ability to facilitate client's decisions-making and personal responsibility

Demonstrates the ability to use the Code of Ethics and display ethical conduct

Overall rating of counseling skills

1b. Comments


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2a. Rate your success in forming/ maintaining effective relationships

5 4 3 2 1 NA/NB With Clients: Is able to create effective therapeutic relationships (e.g., helpful, respectful, non-judgmental)

With Supervisors: Is able to ask for assistance, receive feedback and constructive criticism, accept assignments, etc.

With Staff: Is able to work as a member of a team (when appropriate), is accepted personally and socially by staff, able to participate effectively in staff meetings

2b. Comments

3a. Rate your General Work Habits

5 4 3 2 1 NA/NB Plans and organizes work effectively Expresses self orally and in writing Produces high quality, neat, accurate work Maintains adequate case records

3b. Comments

4a. Rate your Personal Traits and Attitudes 5 4 3 2 1 NA/NB Possesses emotional stability and maturity Shows good judgment and common sense Learns quickly Shows resourcefulness and originality Reliable and dependable Shows interest and enthusiasm for the work Maintains professional appearance Conscious about professional behavior and identity

4b. Comments


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5a. Rate your Potentialities

5 4 3 2 1 NA/NB Accomplishes assigned tasks with a minimum of supervision Profits from previous experiences Recognizes own strengths and weaknesses Shows initiative in pursuing areas of growth Makes appropriate decisions Identifies with the profession of mental health counseling Shows evidence of potential to become a fully qualified mental health counselor.

5b. Comments

6a. Rate your level of mastery for each of the following areas: 5 4 3 2 1 NA/NB DSM-5 Formulates accurate diagnostic impressions Clinical Counseling Skills: (e.g. builds rapport, shows empathy, reflects feelings, attends, paraphrases, summarizes)

Counseling process: Handles resistance to change, understands process vs. content, formulates and implements therapeutic interventions

Code of Ethics and Ethical Conduct: Behaves in a professional and ethical manner

Treatment Planning: Coordinates and implements a sound treatment plan

Community Resources: If applicable, makes optimum use of available support/referral services

Career Counseling: If applicable, facilitates clients’ movement toward career goals and using referral resources in this respect.

Assessment: Conducts appropriate assessments, reviews assessment information to determine appropriate treatment plans, and when applicable, interprets assessment results to an individual and/or family members

Consultation: Consults with appropriate others while maintaining confidentiality

Case Conceptualization: Is able to develop strategies to help the client progress in treatment

Goals: Is able to help facilitate client's goals and their achievement 6b. Comments

7a. Overall Evaluation 5 4 3 2 1 Summary of remarks and performance. Overall evaluation on the basis of the previously rated factors.

7b. Comments


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Appendix K: Site Supervisor Evaluation

Student name ________________________________

Site ________________________________________ Supervisor __________________________________


☐Mid Term ☐Final Using the following scale, please evaluate the student intern by choosing the appropriate number in the scales below:

5 - EXCELLENT: Always performs above the minimum requirements and shows outstanding aptitude and application of skills and concepts of mental health counseling. 4 - GOOD: Always meets minimum requirements in a satisfactory manner and performs at a level above that normally expected of a practicum/Internship student. 3 - AVERAGE: Usually meets minimum requirements in a satisfactory manner; performs as might be expected of a practicum/Internship student. 2 - FAIR: Occasionally fails to meet minimum requirements in a satisfactory manner; performs at a level somewhat below that expected of a practicum/Internship student. 1 - POOR: Usually fails to meet minimum requirements in a satisfactory manner; performs at a level considerably below that expected of a practicum/Internship student. NA/NB - NOT APPLICABLE/NO BASIS: Item/ question is not applicable to the setting or duties of the practicum/Internship student; there is no basis for which to evaluate the practicum/Internship student for the item in question.

1a. Rate the student intern’s general counseling skills 5 4 3 2 1 NA/NB Displays sensitivity toward others Demonstrates foundational counseling skills (e.g., builds rapport, shows accurate empathy, reflects feelings, attends, paraphrases and summarizes)

Demonstrates an ability to facilitate client's involvement and choice Demonstrates self-awareness Demonstrates the ability to facilitate client's decisions-making and personal responsibility

Demonstrates the ability to use the Code of Ethics and display ethical conduct

Overall rating of counseling skills 1b. Comments


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2a. Rate student intern’s success in forming/ maintaining effective relationships 5 4 3 2 1 NA/NB With Clients: Is able to create effective therapeutic relationships (e.g., helpful, respectful, non-judgmental)

With Supervisors: Is able to ask for assistance, receive feedback and constructive criticism, accept assignments, etc.

With Staff: Is able to work as a member of a team (when appropriate), is accepted personally and socially by staff, able to participate effectively in staff meetings

2b. Comments

3a. Rate student intern’s General Work Habits

5 4 3 2 1 NA/NB Plans and organizes work effectively Expresses self orally and in writing Produces high quality, neat, accurate work Maintains adequate case records

3b. Comments

4a. Rate student intern’s Personal Traits and Attitudes 5 4 3 2 1 NA/NB Possesses emotional stability and maturity Shows good judgment and common sense Learns quickly Shows resourcefulness and originality Reliable and dependable Shows interest and enthusiasm for the work Maintains professional appearance Conscious about professional behavior and identity

4b. Comments


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5a. Rate student intern’s Potentialities

5 4 3 2 1 NA/NB Accomplishes assigned tasks with a minimum of supervision Profits from previous experiences Recognizes own strengths and weaknesses Shows initiative in pursuing areas of growth Makes appropriate decisions Identifies with the profession of mental health counseling Shows evidence of potential to become a fully qualified mental health counselor.

5b. Comments

6a. Rate student intern’s level of mastery for each of the following areas: 5 4 3 2 1 NA/NB DSM-5: Formulates accurate diagnostic impressions Clinical Counseling Skills: (e.g. builds rapport, shows empathy, reflects feelings, attends, paraphrases, summarizes)

Counseling process: Handles resistance to change, understands process vs. content, formulates and implements therapeutic interventions

Code of Ethics and Ethical Conduct: Behaves in a professional and ethical manner

Treatment Planning: Coordinates and implements a sound treatment plan

Community Resources: If applicable, makes optimum use of available support/referral services

Career Counseling: If applicable, facilitates clients’ movement toward career goals and using referral resources in this respect.

Assessment: Conducts appropriate assessments, reviews assessment information to determine appropriate treatment plans, and when applicable, interprets assessment results to an individual and/or family members

Consultation: Consults with appropriate others while maintaining confidentiality

Case Conceptualization: Is able to develop strategies to help the client progress in treatment

Goals: Is able to help facilitate client's goals and their achievement 6b. Comments

7a. Overall Evaluation 5 4 3 2 1 Summary of remarks and performance. Overall evaluation on the basis of the previously rated factors.

7b. Comments


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Appendix L: Student Evaluation of Site

Note: To improve quality of education and training at practicum/internship sites, generalized feedback of student experiences may be shared with site supervisors.

Student name ________________________________

Site ________________________________________ Supervisor __________________________________


Please rate your experiences in each of the following areas and provide any additional comments you wish to share.

Scoring

5 = Excellent 4 = Good 3 =Average 2 = Fair 1 =Poor NA/NB= Does not apply/ No basis for which to respond to item.

1a. Orientation

5 4 3 2 1 NA/NB Time provided for orientation Comprehensiveness of orientation Overall quality of orientation

1b. Comments 2a. Supervision

5 4 3 2 1 NA/NB Regular scheduling of supervision (at least 1 hr. per week) Focus of supervision was primarily clinical in nature w/ administrative supervision as needed

Appropriateness of supervision for my needs Effectiveness of feedback from supervisor Supervisor provided feedback on observed/ taped sessions Availability of supervisor beyond scheduled appointments Support from supervisor Supervisor was interested in my growth as a counselor Overall quality of supervision

2b. Comments


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3a. Learning Experience

5 4 3 2 1 NA/NB Opportunity to work with clients Clinical assignments were appropriately determined based upon student's level of development

Suitability of tasks/ duties Workload was appropriate for the number of hours scheduled per week

Overall quality of learning experience(s)

3b. Comments 4a. Professionalism

5 4 3 2 1 NA/NB Personal treatment/ respect as a professional Sense of inclusion by site's staff/ faculty Respect for my clinical insights and training/ education/ experience

Overall rating of professionalism

4b. Comments Please provide any additional comments, feedback, thoughts, etc. about your site.


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Appendix M: Student Evaluation of UNF Practicum/Internship Instructor


5 - EXCELLENT: Always performs above the minimum requirements. 4 - GOOD: Always meets minimum requirements in a satisfactory manner and performs at a level above that normally expected of a professor. 3 - AVERAGE: Usually meets minimum requirements in a satisfactory manner. 2 - FAIR: Occasionally fails to meet minimum requirements in a satisfactory manner. 1 - POOR: Usually fails to meet minimum requirements in a satisfactory manner. NA/NB - NOT APPLICABLE/NO BASIS: Item/ question is not applicable to the setting or duties of the practicum/Internship supervisor; there is no basis for which to evaluate the practicum/Internship supervisor for the item in question.

My UNF practicum/internship instructor: 5 4 3 2 1 NA/NB Provided me information regarding expectations and requirements of internship

Helped me learn how to conceptualize clients in their entirety Helped me identify and work with my personal issues as they arose in internship

Helped improve my understanding of group dynamics and differences between group and individual counseling skills

Modeled effective facilitation and counseling skills Helped reinforce avoiding potentially unethical behaviors at my internship site (speaking poorly about clients with peers, etc.)

Reviewed my recordings/ observed me working with a client Offered helpful feedback about my recorded or live sessions Provided a framework for case presentations Provided opportunities for peer consultation/ group supervision concerning client issues or case presentations

Led small group discussions pertaining to issues relevant to all internship students

When applicable, provided information related to post-graduate issues (e.g., registered internship, licensure, continuing education, and professional organizations)

When necessary, advocated for me to receive appropriate clinical supervision on site

When applicable, assisted with problems that arose at the internship site, and/or helped me acquire another internship


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5 4 3 2 1 NA/NB When/ if necessary, provided opportunities for individual consultation regarding issues concerning internship

Allowed students to contribute input regarding the emphasis and direction of class discussion

Provided relevant resources for internship students' interests Provided information about opportunities to participate in community, agency, or school professional development activities

Overall evaluation of UNF internship supervisor

Please provide any additional comments, concerns, etc.

handbook for practicum and internship supervisors - unf.edu site... · handbook for practicum and...

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