Clinical Mental Health School Counseling Department of ... · history, a mental health history, and a psychological assessment for treatment planning and caseload management. (CMH.H2)

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Graduate Studies College of Liberal Arts & Sciences

M.S. in Counseling

Supervised Practicum Handbook

Clinical Mental Health School Counseling

Department of Education & Counseling 610-519-4620

http://www.education.villanova.edu/

Last Reviewed: January, 2019

Compliance with CACREP Standards noted in bracketed italics, where appropriate

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Table of Contents

Topic Page 1. Course Description 3

2. Course Objectives 3

- General Course Objectives

- Specific Learning Objectives

3. Course Responsibilities 4 - Villanova Practicum Student - Counseling Program - Field Site

4. Steps for Securing a Practicum Site 5

5. Course Requirements 6-7

- Hours - Counseling - Supervision

- Case Presentations - Professional and Personal Reflection - Professional and Personal Performance

6. Course Format 7-10

- Calendar of Activities - Villanova

- Description of Activities – Villanova 1. Areas of Review 2. Group Supervision of Counseling 3. Mid-term Performance Assessment

4. Final Performance Assessment 5. Course Summary and Evaluation - Calendar of Activities - Off-Site - Description of Activities - Off-Site 1. Field Placement Site Selection - Site Qualifications - Field Site Supervisor Qualifications - Site Approval 2. Orientation Packet to Field Site Supervisors 3. Site Visits by Practicum Instructor

4. Final Letter to Field Site Supervisors

5. Completed Evaluation of Student Performance 6. Student Evaluation of Field Placement Experience

7. Role Descriptions 10 1. Student 2. Faculty Instructors

3. Field Site Supervisors 8. Grading 10 9. Professional Liability 11 10. Video/Audio Recording 11-13 11. Record Keeping 13 12. Form Samples 13-36

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Course Description

The purpose of the Practicum is to provide students in counseling with their first client contact in a supervised setting. It is designed to help students begin to translate their academic understanding into actual counseling practice through direct client contact, observation, and school/ agency involvement. Students complete a pre-determined number of hours in a field setting under supervision the Faculty Instructor and a qualified Field Site Supervisor.

Course Objectives General Course Objectives

The major goal of the counseling practicum course is to help students begin to operationalize

theoretical constructs and further develop counseling skills acquired in the classroom, toward an ultimate goal of developing a style of effective practice and sense of continuity in the process of professional counseling. Weekly group supervision/ instruction, individual supervisory meetings and various assigned activities are designed to give Faculty Instructors and Field Site Supervisors the opportunity to assess the student's counseling performance in relation to client/ student goals and the professional development of the counselor- in-training.

A fundamental premise of the course is that professional counselor education is best accomplished

through both an intellectual and personal development approach. This approach contends that the counselor- client relationship is an endeavor in which the growth and development of the client depends very much upon the concurrent professionally oriented growth and development of the counselor-in-training. Thus, students’ participation and willingness to give feedback and openness to receive feedback during group supervision sessions is central to the achievement of the course goals.

Specific Learning Objectives

1. Demonstration of competence in a field assignment, including the application of a variety of counseling, psychological and educational theories and strategies appropriate to specific client situations (100 hours total including at least 40 hours of direct service, including groups). [III.F.1; IIICMH.A.5; IIISC.C.1.]

2. Demonstration of one's ability to engage effectively in a variety of professional activities relevant to effective counseling practice including record keeping, supervision, information and referral, in- service training, and staff meetings in addition to direct client/student service. [III.CMHA.5; III.CMHA.2; III.SC.A.5.; III.SC.A.2.; III.SC.A.3.]

3. Demonstration of counseling competence in a closely supervised field setting, including the application of counseling theories and strategies appropriate to specific client/ student situations. [III.CMHA.5; III.SC.A.5.]

4. Demonstration of the willingness and capacity to examine one’s own personal and professional development in relation to work with clients/students and colleagues. [III.CMHD.9; III.SC.D.1.]

5. Gain experience in the use of current professional resources in use by counselors (e.g. assessments instruments, technologies, professional literature, etc.). [III.CMHG.2; III.CMHJ.2; III.SC.H.2.]

6. Demonstration of competence in organizational development, evaluation, consultation, and team- building skills as appropriate to the Internship setting.

7. Establishment and maintenance of a positive working relationship with both faculty and field site supervisors, as well as satisfactory performance in the areas of confidentiality, punctualityand

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attendance. [III.F.2]

8. Demonstrate the ability to recognize and respond to the importance of contextual and cultural factors in working with clients/ students of diverse backgrounds or referent groups. [III.CMHE.1; III.CMHE.2; III.SC.E.1.; III.SC.E.2.; III.SC.E.3.]

9. Demonstrate active and effective participation in individual and group supervision that includes written and/or oral presentation and discussion of active practice on video or audio- tape. [III.F.4]

10. Demonstration of applied knowledge of ethical, legal and professional guidelines (ACA/ ASCA) regarding confidentiality, the counselor-client relationship, professional relationships and responsibilities, testing and research. [III.CMHA.2; III.SC.A.2.]

11. Demonstrate the ability to identify and articulate key aspects of their clinical orientation as it matches with evidence-based practices within the field. [III.CMHI.3; III.CHMJ.1.; III.SC.A.5.; III.SC.I.5.]

12. Demonstrate skill in conducting an intake interview, a mental status evaluation, a biopsychosocial history, a mental health history, and a psychological assessment for treatment planning and caseload management. (CMH.H2)

13. Demonstrate the ability to screen for addiction, aggression, and danger to self and/or others, as well as co-occurring mental disorders. (CHM.H3)

Course Responsibilities Villanova Practicum Student:

o Trainees are expected to be punctual, maintain professional work habits, and conduct their client and colleague relationships, all in accordance with ACA-aligned ethical principles, as well as the rules of the Field Site in which they are placed.

o Students are expected to adhere to the professional performance standards for the program. If students are found to not adequately meet one of these standards, they will not pass the course regardless of their current academic grade.

o Trainees are expected to follow the training plan agreed upon by both the Faculty Instructor and the Field Site Supervisor.

o Termination of the trainee experience will occur at the end of Villanova University’s spring semester.

o The Field Site can be the trainee’s place of employment. However, certain criteria must be met. First, the Field Site Supervisor should not be the student’s current supervisor. Second, the student’s responsibilities should be different from those that are already included in their job.

Counseling Program:

o The Counseling Program will provide the Field Site with suitable candidates for field placement through the Faculty Instructor.

o The Faculty Instructor retains the ultimate responsibility for assessing the quality of work of the student trainee, assigning grades and credits to students and for other decisions that affect the academic progress of students.

Field Site:

o The Field Site will hold ultimate responsibility for client and student welfare. o A trainee shall not be allowed to work after normal hours without the on-site presence of a

professional staff member. o The Field Site shall provide the trainee with a Field Site Supervisor have at least a master’s degree,

two years of experience in counseling or counseling-related activity, and hold the necessary certifications and licenses.

o The Field Site Supervisor shall meet with the trainee for a minimum of one hour per week of individual supervision. Administrative guidance shall be provided by the Field Site as needed.

o The Field Site Supervisor shall advise the trainee of the Field Site’s rules, policies and procedures.

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o All other professionals at the Field Site may be used in an adjunct capacity for training or supervision.

o The Field Site shall provide suitable opportunities for observation and other on-site activities, totaling at least 72 hours over the course of the semester.

o The Field Site shall have appropriate supervision of all services and shall retain full responsibility for the Field Site’s administration and delivery of service.

Steps for Securing a Practicum Site

1. Identify one or several locations that are in the area to complete your practicum (to obtain a site that

is far in distance from VU, obtain permission first from a practicum faculty instructor). Tips on identifying sites:

a. Seek several possible locations and obtain contact information of the counselors via internet, or b. Obtain a list of sites from the main office, SAC 302, or from your faculty advisor, or c. Consult with 2nd year counseling students currently engaged in their field experiences, to

obtain possible site suggestions d. Discuss placement possibilities with your Orientation Instructor or the Spring Practicum

Faculty Instructor 2. Sites that are considered ‘available’ or appropriate for you are those that:

a. will comply with your course requirements (see handbook) b. will provide a supervisor who meets course requirements (see handbook)

3. After obtaining site contact information, contact a site, indicate your status as a master-level Villanova counseling student, and formally inquire as to their interest and availability for taking a counseling practicum student. Move to the next site if this one is not available. You may need to call multiple sites, multiple times. This is standard.

4. Upon speaking with them, if they ask for your transcripts, resume, an interview, comply with the request and send requested materials.

5. If the supervisor and site meet the requirements, ask what they require from you, to formalize the process.

6. Lastly, apply for all your clearances (e.g., fingerprinting) as required for your practicum (see "Clearances" below)

7. To consider before accepting a site: a. If you are unsure whether the site meets the specifications, obtain permission from your

practicum instructor, your Orientation Instructor, or the field site coordinator, as well as referring to the required forms.

b. Make sure you have both (you the student and the Field Site Supervisor) ‘interviewed’ one another and that you are a good match, preferably in a face-to-face interview—you should seek a site that will challenge you to apply myriad new skills and gain new knowledge of new populations. Look for a supervisor who is experienced, passionate about the profession of counseling and excited to actively supervise you.

8. If you do not have your paperwork completed and submitted to the professor of your practicum course by the first day of class, you will not be allowed to begin the practicum experience and will be required to drop the course. This will extend your degree program by an additional year.

Clearances Below are links for the five clearances needed to complete all required school field experiences. A clinical site may require clearances. Please apply TODAY as the process can take up to a month to complete. Once you get all five

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clearances back, please make a copy of each and give the copies to Jennifer Carangi, Field Placement Coordinator, in 302 SAC. If questions, contact Jen at: [email protected]. Clearances needed for any school field experience (EDU or CHR students): □ Act 34 PA State Police Background check: https://epatch.state.pa.us/Home.jsp. This clearance can be done online using a credit card. □ Act 151 Child Abuse Clearance: http://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/form/s_001762.pdf . This clearance must be filled out and mailed in with a money order. □ Act 114 FBI fingerprinting: www.pa.cogentid.com/index_pde.htm. Register for this clearance online and then you make an appointment at a fingerprint site to have the fingerprints taken. Once you are done, if you send Jenifer Carangi, Field Placement Coordinator, a copy of your fingerprint ID # (PAE….), so that she can access the site and print a copy of your results. We also recommend that you have a copy of the results sent to you so you retain the original.

□ Arrest/Conviction Report:http://www.portal.state.pa.us/portal/server.pt/community/background_checks_(act_114)/7493. This form just needs to be signed and handed in. □ TB Test can be done at the Villanova Health Center or through your family doctor. For the test, they will administer the test on your arm and you must return to the doctor 3 days later to have the results read. Fingerprinting sites close to Villanova are listed below (each is less than 3 miles from Villanova).

Delta T Group 950 Haverford Road Suite 200 Bryn Mawr, PA 19010 By appointment only ca11484-381-3108 Mon-Thurs 10:00 am to 3:00pm www.delta-tgroup.com/

Staffing Plus, Inc. 551 W. Lancaster Ave Haverford, PA 19041 By appointment only 610-525-4000 Monday through Friday 9:00am to 4:00 pm www.staffmgplus.com

Course Requirements Hours: Students participating in the Practicum Course will be required to devote a total of 100 hours during one semester to practicum activities, in accordance with the schedule provided below; at least 40 hours need to be in direct service.

1. University Based [III F2, F3]

a. Group supervision (2 hrs per wk/14 wks) = total of 28 hours b. Individual meeting/s with VU instructor as needed

2. Field Placement [III F2, G5]

a. Direct service with actual clients contributing to counseling skills 40 hours b. Practicum related activity 18+ hours c. Individual supervision (1 hr per wk/14 wks.) 14 hours

Total 100 hours

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Counseling: Field-site:

a. Counseling: Students will complete a minimum of 72 hours of counseling and other site related

activities in an approved field placement. The specific nature of their counseling activity depends upon the nature of their field placement. Due to their early stage of training, these counseling hours may include co-counseling and observation with an experienced staff counselor at the field placement site. [III F1]

Supervision: 1. University:

a. Individual Supervision: Faculty will contact the practicum student’s site supervisor bi-weekly to assess the student’s progress. [III F2]

b. Group Supervision: Students shall participate in two hours of group supervision per week (28 total

hours) with the Faculty Instructor during the Practicum class session. [III F3]

2. Field-site:

a. Individual Supervision: Students will engage in one hour of uninterrupted individual supervision per week (14 total hours) with their designated Field Site Supervisor. [III F2]

Case Presentations: Case presentations shall be defined as formal presentations for Individual and Group Supervision of cases being worked with by students at their field placement. (An example “Case Presentation Outline” is provided in the list of forms.) All students will complete formal professional presentations. The professor of the course will outline their particular requirements for this assignment in his/her syllabus.

Professional & Personal Reflection Whether through journals, discussion boards, or group interaction, students should be prepared to engage in deliberate reflective activities on both the professional and personal aspects of their experience. Each Faculty member will state their particular requirements for this element in their syllabus.

Field Site Supervisor Evaluation A satisfactory performance evaluation must be acquired from the Field Site Supervisor in order to pass the Practicum Course and advance to Internship. A copy of this form will be shared with each Field Site Supervisor early in the semester, and each Field Site Supervisor is requested to return the form to the Faculty Instructor during the middle of the semester and final week of the practicum course

Course Format (General- will depend on instructor)

Calendar of Activities – Villanova

Specific Activity When Completed

–Course overview Class 1 –Areas of Review Classes 2 through 3

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–Orientation to the counseling process Class 3 –Group supervision of counseling Classes 3-14 –Individual supervision of counseling Scheduled Individually –Mid-term individual performance evaluation Class 7 –Final performance assessment Between 13th & 14th classes

Description of Activities – Villanova

1. Areas of Review: Initial classes will address critical professional topics relevant to students’ placements. Professors will utilize this time to help students practice applying theoretical approaches to the counseling process.

2. Group Supervision of Counseling: All students enrolled in the Counseling Practicum course will

meet each week for group supervision of counseling as outlined in the Calendar of Activities above. Group supervision will typically consist of case presentations and other site-relevant activities. The specific schedule for and number of case presentations and other activities will be determined by the Faculty Instructor.

3. Bi-weekly Consultation: The Site Supervisor and the course Instructor will retain bi-weekly

communication through both the methods mentioned here as well as a brief survey sent to the site supervisor seeking feedback updates on the student.

4. Mid-term Performance Assessment: At approximately the 7th week into the semester, the progress

of each Practicum student shall be assessed by the Faculty Instructor and the Field Site Supervisor. This assessment shall consider students’ specific progress toward the fulfillment of the stated course requirements as well as general progress in the area of counseling skill development. [III F5]

5. Final Performance Assessment: During the last two to three weeks of the semester, the progress of

each Practicum student shall be assessed by the Faculty Instructor and informed through the Field Site Supervisor. This assessment shall consider students’ overall progress toward the fulfillment of the stated course requirements.

6. Course Summary and Evaluation: The final class session will offer students an opportunity to

reflect on their Practicum experience and supervision, to formally evaluate its usefulness to them, and to offer recommendations for improving the course. [III F5]

Calendar of Practicum-Related Activities

Specific Activity When Completed Practicum Orientation Fall semester preceding Practicum, during the

Orientation Course Field Placement Site Selection Fall semester preceding Practicum

Submit Completed Paperwork to your Practicum instructor

December 1st

Orientation Packet to Field Site Supervisor 2nd week of Practicum semester

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Consultation with site supervisor Biweekly/Ongoing

Receipt of Completed Mid-Semester Field Site Supervisor Evaluation

Week 7-8 of Practicum semester

Final Letter to Field Site Supervisors Final 2 weeks of Practicum semester

Receipt of Completed Field Site Supervisor Evaluations.

By date of final week of Practicum semester

Student Evaluation of Field Placement Experience By date of final individual supervision/performance evaluation

Description of Practicum-Related Activities

1. Field Placement Site Selection: Each student assumes the responsibility for locating and securing his or her own field placement site over during the semester preceding the spring Practicum.

a. Site Qualifications: Field placement sites for the practicum characteristically consist of public

schools, community service agencies, hospitals, or institutions of higher learning which offer guidance, mental health, or preventive counseling services in both individual and group settings. Final determination as to the suitability of all field placement sites rests with the Faculty Instructor.

b. Site Supervisor Qualifications: Field Site Supervisors must have at least a master’s degree, two years

of experience in counseling or counseling-related activity, and hold the necessary certifications and licenses. Final determination as to the suitability of site supervision rests with the Faculty Instructor. Note: School counseling supervisors must be certified or licensed school counselors in the state. in which their school is located. [III C1, C2, C3]

d. Site Approval: Practicum students must have prior approval before committing to a field placement

site. The Practicum Instructor (of the practicum course you are enrolled in) will consider requests for site approval upon receipt of the following completed/signed documents:

(1) Field Placement Description/ Authorization form (2) Practicum Student Agreement (3) Practicum Field Site Supervisor Agreement (4) Site-Supervisor Training & Experience Form

Faculty Instructor approval of field placement sites will be indicated on the Field Placement Description/ Authorization form. Sites shall not be considered approved until this process is complete. Paperwork is due on December 1st. No student will be allowed to take the class without a site. It is up to the practicum instructor’s discretion if a if a student can find a placement in between December 1st and the first day of class but under no circumstances can the student start the course without a site.

2. Orientation Packet to Field Site Supervisors: At the beginning of the spring semester of Practicum, the

Faculty Instructor will send Field Site Supervisors an introductory letter, which will outline the purpose, goals, and schedule of the course, as well as a copy of the Practicum Student Manual. In addition, the Field Site Supervisor will receive a copy of the Final Evaluation of Student Performance form that he or she will be asked to complete at end of the semester. [III C3]

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3. Site Consultation by Practicum Faculty Instructor: During each semester of the Practicum course, the student’s designated Faculty Instructor with consult with the site supervisor on a bi-weekly basis.

4. Final Letter to Field Site Supervisors: Near the end of the Practicum course, the Faculty Instructor will

send a letter to Field Site Supervisors, thanking them for their participation and their completion and submission of the Evaluation of Student Performance form, and soliciting their general feedback regarding the Practicum experience.

5. Receipt of Completed Evaluation of Student Performance Forms: Field Site Supervisors are requested to

return completed Evaluation of Student Performance forms by the scheduled date of each student’s final individual supervision/performance appraisal meeting. Students will inform their Field Site Supervisors of this date, and forms may be returned via the student or directly to the Faculty Instructor [IIIG6].

6. Student Evaluation of Field Placement Experience: In preparation for their final supervision session with

the Faculty Instructor, students are to complete the Student Evaluation of Field Site form. This completed form should be brought to the final supervision session, where the effectiveness of the field placement will be discussed.

Role Descriptions

1. Student: The major expectations for students participating in the Counseling Practicum course are to

participate fully and to take seriously the pursuit and achievement of the learning goals set forth in the Specific Learning Objectives section of this manual.

2. Faculty Practicum Instructors: Responsibilities include the following:

1. Approval of course syllabus 2. Approval of field placement sites/supervisors 3. Provision of orientation and ongoing information to Field Site Supervisors 4. Oversight of the delivery of Practicum course activities 5. Observation of each student’s counseling activities through A/V 6. Provision of group and individual supervision 7. Monitoring student effort and progress toward fulfillment of course objectives 8. Completion of site visits for student supervisees 9. Collection and maintenance of student supervisees’ paperwork

3. Field Site Supervisor: Field Site Supervisor responsibilities and expectations are defined in the Practicum

Contract provided in the Form Samples section of this handbook.

Grading Each Faculty Instructor will provide an outline of their grading policies within their course syllabus.

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Professional Liability Students who are enrolled in the Counseling Practicum course are entitled to Villanova University’s medical malpractice liability coverage. The limits of that coverage are $1,000,000 – per claim. There is added security in having individual liability coverage in addition to this group coverage, and CACREP requires that each student enrolled in practicum or internship purchase individual professional liability insurance; students will need to show proof of this to their instructors. There are good, affordable policies available for students who desire additional coverage. ACA offers free liability insurance to student members, which includes: $1 million per claim; $3 million aggregates; free attorney help line for consultation. [III M]

Video/Audio Recording

All clients in counseling sessions to be recorded must give prior written authorization for the recording to occur. It shall be the responsibility of the Practicum student to ensure that written client authorization for audio/video recording is on file in each client’s record. If client is under 18, parental consent is required. If not available at the site, audio/video recording forms and instructions will be provided by the Faculty Instructors (An example form is included in the Form Samples section of this document.). All clinical mental health counseling sessions should be taped, preferably with video. [III F.4]

Video recording in Clinical Training: Questions and Answers

Villanova University students are asked to video record their counseling sessions with clients for supervisory use. This document is intended to answer common questions of supervisors and trainees when utilizing video recording in clinical training.

Who will see video recordings of client sessions? We suggest that site supervisors and supervisees review some portion of a video recorded counseling session each week in supervision to enhance supervisory effectiveness. In the supervisee’s/student’s class, each student periodically presents his or her clinical work in formal case presentations throughout the semester. During these presentations, students are required to present a portion of a video recorded session for supervisory feedback from classmates and the Professor.

How are video recordings stored? The videos should be kept locked in secure location at the site (behind 2 locks) and be de-identified in some way so as to further protect the identity of the client. With improved technology, clinicians can record directly to digital video on a computer and have the data password protected and encrypted.

Must trainees video recorded their client sessions? We highly encourage the use of video over audio recordings since audio recordings cannot capture the nonverbal communication of counselor or client. However, audio recordings may be used in place of video recordings if absolutely necessary. If the supervisor and/or training facility would like the trainee to audio rather than video record sessions, then the supervisor must communicate this to the Internship Instructor.

How often must trainee’s video record? Trainees must video (or audio if necessary) all 1:1 counseling sessions in which they are the counselor. The exceptions to this are: when video or audio recording is clinically counter indicated; such as, clients with a history of abuse and/or paranoid ideation, or when the client does not give consent to record. If the supervisor and/or training facility will not allow the trainee to record every session, then the trainee may record a minimum of 4 counseling sessions for use in class presentations. However, the supervisor must communicate this to the Internship Instructor.

What happens to the video recordings? After the video recording has been viewed in supervision it should be deleted.

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Why Use Video recording in Supervision? Research shows that video recording in clinical training and supervision has steadily increased since its first conception in the 1960s. Social and cognitive psychology research on memory suggests that clinical supervision that solely depends on second-hand reporting of session events may be limited. This is because second-hand reporting and audio recordings of session material are often not able to adequately shed light on the nonverbal behavior exhibited by the client and counselor and the trainee’s memory of session events is often biased. Video recording allows a supervisor to view the session material as it happened during the session so as to provide more effective supervision and counseling training (see Haggerty & Hilsenroth, 2011). Consistent with this, research suggests that structured training that utilizes video recording yields superior supervisory and client outcomes (Diener et al., 2007; Fernandez-Liria et al., 2010; Hilsenroth et al., 2006; Town et al., 2012). Moreover, traditional counseling supervision often generates a great deal of uncertainty for the supervisor, and viewing the trainee’s sessions on video help the supervisor to feel more confident with his or her assessment of the client (Grotjahn, 1955).

How Do Supervisors use Video recording in Supervision? One common technique is the “stop-frame” technique wherein supervisor and supervisee stop the recording at specific moments to collaboratively explore what is transpiring in that moment of the session, to examine the counselor’s intentions of an intervention, and the effect of the intervention on the client in the moment. Binder (1999; see also Hilsenroth et al., 2006) outlines strategies for using video recorded sessions for supervision. The basis for his strategies utilizes ‘anchored instruction’ (Binder, 1993), that is, what is learned is linked in meaningful ways to specific situations, that the knowledge is gained through the supervisee’s active involvement in a manner that encourages memorization and comprehension, and that the knowledge is acquired in a context that is as similar as can be to the conditions of actual practice. Binder uses supervisees’ recorded sessions to examine in detail specific clinician–client interactions as examples of larger themes and therapeutic processes. He also explains that the use of the video recorded material should be prepared by arranging specific training tasks during supervision such as looking for particular technique and process patterns. Binder advocates for supervisors to spend time focusing on the supervisee’s experiences, thought processes and behaviors while watching the video. When providing feedback to the supervisee, he suggests the supervisor be particular about noting what specifically the supervisee did that was desirable rather than making global non-specific positive comments (Henry et al., 1993). This allows the supervisee to understand what he or she did right and why. In a cognitive–behavioral sense, the supervisor is shaping adaptive therapeutic technique in the supervisee (see Haggerty & Hilsenroth, 2011).

How are ethical concerns regarding video recording addressed? Confidentiality and ethical issues are prominent when video recording counseling sessions. In fact, one of the reasons why video is not used more often may be due to concerns for the client’s confidentiality. Confidentiality is always of the utmost concern for clinicians. Without it being safeguarded, the client may feel exploited and insecure (Haggerty & Hilsenroth, 2011).

Is Informed Consent Needed? When video recordings are going to be used it is imperative that the clinician get written informed consent from the client. The consent should state what purposes the video will be used for, who will be viewing the recording (i.e. supervisor and/or supervision group) and how the recording will be secured and kept confidential. Villanova students are given a sample form to use but agencies may use their own forms that meet these aforementioned requirements. When video recording is not mandated and is optional in the agency, it should be made clear that it is the client’s choice to be video recorded and if the client does not wish to be recorded then he or she may be assigned to a licensed clinician on staff.

Clients who agree to be video recorded should be made aware that if they were to become uneasy with being video recorded at any point in their treatment it will be discontinued by the clinician. Clients should also be made aware that if they request past recordings to be destroyed the recordings will be destroyed or deleted.

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How do I address videotaping with clients?

Videotaping should be discussed, and if consent is given, start, in the first session of counseling. We do not find that waiting to video record helps either the novice counselor or the client. Clinicians need to be cognizant of the power differential that exists and what being video recorded may mean to clients (Aveline, 1992), and thus explore the meaning of this with clients. The use of video can be explored as part of the treatment process as any other responsible exploration of the frame and therapeutic process during the course of treatment. Rather than avoid an issue we should strive to use such issues to better explore and understand the therapeutic relationship and process (Haggerty & Hilsenroth, 2011). The clinician should explain that video is used for training purposes and the clinician is supervised by a licensed supervisor.

How recordings transported to Villanova University for supervisory feedback? When transporting recordings to Villanova for supervisory purposes only, students are instructed to carry video recordings behind two locks at all times and delete them immediately after use. Recordings should be kept on site at all other times. Supervisor Initial Supervisee Initial

Record Keeping

Students participating in the Practicum course will be required to maintain selected records related to their on- site activities as designated by the placement site and the Field Site Supervisor.

Form Samples

Following is copy of all forms that students participating in the Practicum course will need, and a few that may or may not be utilized by your particular Faculty Instructor. They can be used and duplicated as necessary. The forms provided are as follows: Form # Form Page # 1 Statement of Intent to Participate in Supervised Practicum 14 2 Field Placement Description/Authorization Form 15 3 Student Agreement 16 4a Field Site Supervisor Agreement for Clinical Mental Health Student 17-18 4b Field Site Supervisor Agreement for School Counseling Student 19-20 5 Field Site Supervisor Training and Experience 21 6 Weekly Activity Record 22 7 Transportation of Personal Information Agreement 23 8 Informed Consent (Example) 24 9 Consent for Audio-Visual Recording (Example) 25 10 Case Presentation Form (Example) 26 11 Class Participation Evaluation Form 27 12a Evaluation of Clinical Mental Health Student Performance by Field Site

Supervisor 28-30

12b Evaluation of School Counselor Performance by Field Site Supervisor 31-33 13 Student Evaluation of Field Site 34 14 Counseling Skills Scale – Global Ratings 35-36

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Villanova University- Graduate Program in Counseling SUPERVISED PRACTICUM

Statement of Intent to Participate in Counseling Practicum (11/13) Form # 1

Year: Semester Advisor:

Student Name: Date:

Telephone: Email:

Emergency Contact Person: Phone:

Practicum you plan to participate in:

Supervised Practicum in Clinical Mental Health Counseling

Supervised Practicum School Counseling. Level(s) (e.g., middle):

Anticipated Practicum Field Placement Site:

1. If site is determined, list below:

Organization:

Location:

Supervisor Name and Phone Number:

Nature of Service(s) Provided

2. If site is not yet determined, list what placement type you are pursuing?

Time frame and nature of prior counseling-related experiences: Time frame (e.g., months/years):

Description of work (e.g., suicide hotline worker):

Questions or Comments:

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Forms 2, 3, 4, & 5 are due to your Practicum Instructor by December 1st h

Field Placement Description/Authorization Form

(11/13) Form # 2

Student: Date:

Field Placement Name:

Description of Field Placement (Include: organization purpose or mission, services provided, clients served, anticipated duties as an intern):

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Field Placement Authorization

Signed Student Agreement Signed Field Site Supervisor Agreement Completed Field Site Supervisor Training & Experience form Special agreements/contracts as required by the field placement site Field placement authorization (this form) submitted to the student’s Practicum instructor.

I hereby authorize the use of above named organization as a Practicum placement site for the above-named student. This authorization is contingent upon the site’s continued ability to meet the terms set forth in the Field Site Supervisor Agreement.

Villanova Faculty Instructor Date

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Student Agreement (11/13) Form # 3

1. As a Counseling Practicum student in a professional setting, I hereby attest that I have read and understand

the American Counseling Association Code of Ethics, and will practice my counseling in accordance with these standards. Further, I will assume the responsibility for promoting my growth toward becoming a professional counselor by agreeing to initiate and/or participate in the following Practicum objectives.

Hours:

Students participating in the Practicum Course will be required to devote a total of 100 hours during one semester to practicum activities, in accordance with the schedule provided below.

1. University Based [III F2, F3]

a. Group supervision (2 hrs per wk/14 wks) = 28 hours b. Individual supervision

2. Field Placement [III F1, F5]

a. Direct service with actual clients contributing to counseling skills = 40 hours b. Practicum related activity = 18+ hours c. Individual supervision (1 hr per wk/15 wks.) = 14 hours

Total 100 hours

2. I will provide counseling service to individuals and groups that are assigned to me. I will document these

services in accordance with school/agency policies and in compliance with any standards set forth by the Faculty Instructor, such as video tapes, in-depth case study, a daily log, etc.

3. I will become familiar with the system within which I am placed, including administrative procedures,

organizational structure, client referral/screening/intake processes, philosophy, services offered and service follow-up procedures.

4. I will become familiar with other key organizations and individuals, which support the mission of my

Practicum setting and I will utilize all resources available (e.g., reading materials, in-service training programs, observations of other staff members with clients, participation in simulated (role-play) counseling sessions, learning about tests that the school/agency uses, etc. to maximize my understanding of and effectiveness in the professional setting in which I am placed.

5. I will strive to develop positive working relationships with staff members and other persons/agencies

affiliated with my Practicum setting, and will seek their assistance when necessary. I will, whenever possible, attend and participate in staff functions, such as staff meetings, case review sessions, in-service training, etc.

7. During the semester of my Practicum, I will be prepared to present videotaped sessions of my counseling

and counseling related activity to the supervision group and/or the Faculty Instructor.

Student Name: Date

Student Signature:

17

Villanova University- Graduate Program in Counseling Supervisor Agreement Practicum Form

Clinical Mental Health Counseling (11/13) Form # 4a

As the Site Supervisor for , I agree:

1. That I possess the necessary qualifications to supervise the named intern in his or her identified areas of responsibility with my organization (minimum: master’s degree and 2 years post master experience in counseling or counseling-related activity and have been with the site for at least one year). Initial

2. That I will provide at least one hour per week of direct, individual, supervision to the above-named

counseling practicum student, in forms including but not limited to: case discussion and feedback; critique of and advisement on counseling skills, counseling philosophy and technique, intervention design and implementation, problem resolution and workattitudes. Initial

3. Supervisor must provide supervisee with at least 40 clock hours of direct service with actual clients that

contributes to the development of counseling skills. At least 15 of these 40 hours must consist of the above- named supervisee conducting 1:1 individual socioemotional counseling with a client that is appropriate for a beginning trainee. The remaining “direct service” activities may consist of individual or group counseling and/or observation of counseling activities. Initial

4. Supervisor agrees to complete a supervision contract collaboratively with supervisee regarding the goals of

supervision, tasks/activities that will be used to reach these goals, and methods of assessment, in the beginning of supervision and to periodically review this contract with the supervisee. Initial

5. That I will provide a supportive, learning-oriented environment, which affords the counseling practicum

student opportunities for professional counseling activity and experience in giving and receiving feedback related to that professional activity. Initial

6. Supervisors agree to give theoretically grounded supervision and to explicitly discuss the supervisor’s

theoretical orientation and how this is similar or different than the supervisees emerging theoretical orientation. Initial

7. That I will introduce and orient the counseling practicum student to this professional setting, making sure

that he/she understands its organization, role expectations and policies & procedure (including record keeping requirements for counseling activity). Initial

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8. That I will be reasonably available to assist the counseling practicum student outside of the weekly supervision hour (if needed) in the performance of his/her assigned responsibilities. Initial

9. That I will encourage the counseling practicum student to participate in those professional activities that will

maximize his/her learning as well as his/her effectiveness in this professional setting. Initial

10. That I will allow the practicum student to video or audio tape his or her individual counseling sessions for

training purposes, only as long as the client gives written consent. Initial

11. That I will listen to tapes of the practicum student’s counseling sessions as one activity during supervision

and give feedback to the practicum student on his or her counseling techniques and ability to form relationships with clients. Initial

12. That the placement site will provide a HIPAA compliant area in which to store the practicum student’s

counseling tapes. Initial

13. That I will supervise the practicum student in ethical guidelines and compliance related to confidentiality,

paper work, competence, etc. Initial

14. That I will be in bi-weekly contact with the practicum student’s faculty Supervisor regarding the practicum

student’s progress. This will consist of completing a three -item questionnaire of the practicum student’s progress and emailing it to the faculty supervisor every other week with password protection. If any behavioral or clinical concerns arise regarding the practicum student’s performance I agree to notify the faculty supervisor as soon as possible on or before the bi weekly reports, whichever comes first. Initial

15. That I will complete one mid-term and one final Practicum studentship Student Evaluation to assess the

student‘s skill level and progress on learning goals, review this evaluation with the student, and return the evaluation to the practicum instructor. Initial

Supervisor Name/Title*: Date:

Signature: *If a secondary supervisor is assigned, both supervisors must sign this form.

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Villanova University- Graduate Program in Counseling Supervisor Agreement

Practicum Form School Counseling

Form #4b Field Site Supervisor Agreement

(11/13) As the Site Supervisor for , I agree:

1. That I possess the necessary qualifications to supervise the named intern in his or her identified areas of responsibility with my organization (minimum: master's degree and 2 years post master experience in school counseling and have been with the site for at least one year).

Initial please

2. That I will provide at least one hour per week of direct, individual, supervision to the above-named counseling practicum student, in forms including but not limited to: case discussion and feedback; critique of and advisement on counseling and instructional skills, counseling philosophy and technique, intervention design and implementation, problem resolution, work attitudes and program planning.

Initial please

3. That I am a certified (or licensed) school counselor within the state I practice. A secondary supervisor may be assigned for up to ½ hour of supervision per week, who meets the requirements for certification and agrees to the terms of supervision presented here.

Initial please

4. That I will provide my supervisee with at least 40 clock hours of direct service with actual clients which include some of the following: individual socio-emotional counseling with a client that is appropriate for a beginning trainee, small group counseling (psycho-educational or counseling groups), parent consultations/meetings, academic/career advising or planning, and/or classroom instruction.

Initial please

5. That I will complete a supervision contract collaboratively with supervisee regarding the goals of supervision, tasks/activities that will be used to reach these goals, and methods of assessment, in the beginning of supervision and to periodically review this contract with the supervisee.

Initial please

6. That I will provide a supportive, learning-oriented environment, which affords the counseling practicum student opportunities for professional counseling activity and experience in giving and receiving feedback related to that professional activity. Initial please

7. That I will give theoretically grounded supervision and to explicitly discuss the supervisor’s theoretical

orientation and how this is similar or different than the supervisees emerging theoreticalorientation. Initial please

8. That I will introduce and orient the counseling practicum student to this professional setting, making sure that he/she understands its organization, role expectations and policies & procedures (including record keeping requirements for counseling activity).

Initial please

9. That I will be reasonably available to assist the counseling practicum student outside of the weekly supervision hour (if needed) in the performance of his/her assigned responsibilities.

Initial please

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10. That I will encourage the counseling practicum student to participate in those professional activities that will maximize his/her learning as well as his/her effectiveness in this professional setting.

Initial please

11. That I will allow the practicum student to video or audio tape his or her individual counseling sessions for training purposes only as long as the client (and parent/guardian, if under 18) gives writtenconsent.

Initial please

12. That I will listen to a section of at least one tape of the practicum student’s counseling sessions (or observe sessions in person) as one activity during supervision and give feedback to the practicum student on his or her counseling techniques and ability to form therapeutic relationships with clients.

Initial please

13. That I will supervise the practicum student in ethical guidelines and compliance related toconfidentiality, paper work, competence, etc. Initial please

14. That I will be in biweekly contact with the practicum student’s Faculty Instructor regarding the

practicum student’s progress. This will consist of completing a three-item questionnaire of the practicum student’s progress and emailing it to the faculty instructor every other week with password protection. If any behavioral or clinical concerns arise regarding the practicum student’s performance I agree to notify the faculty instructor as possible on or before the bi weekly reports, whichever comes first. Initial please

15. That I will complete one mid-term and one final Practicum Student Evaluation (as provided by the faculty Instructor) to assess the student’s skill level and progress on learning goals, review this evaluation with the student, and return the evaluation to the practicum instructor. Initial please

Supervisor(s) Name/Title*:

Signature: Date: *[If a secondary supervisor is assigned both supervisors must sign this form]

21

Villanova University- Graduate Program in Counseling

SUPERVISED PRACTICUM

Field Site Supervisor Training and Experience

(11/13) Form # 5

We would like to keep on file a record of the training and experience of each field placement site supervisor.

Please complete this form and return it to the Faculty Instructor.

Field Site Supervisor Name (First, last, initial)

Job Title

Name of institution or agency

Address of institution or agency (include zip)

Work telephone number FAX

email address

Education:

College / Degree /Year Title of Program

Professional Experience(s):

Position / Organization / Dates

Current Licenses/Certifications:

Typ e/ State / Date

Name of Villanova student(s) to be supervised:

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Villanova University- Graduate Program in Counseling

Supervised Internship

Form #6 Weekly Activity Record

Counseling Student: Week of: to

General Activity Summary

Activity Hours # hours of individual counseling:

# hours of group counseling:

# hours of family/couples counseling:

# hours spend in other counseling hours (name type of counseling here):

Total direct hours

# hours of clinical preparation/record-keeping:

# hours spent in case-related contact with staff/ professional agencies/individuals: # hours of site-related administrative activity: (school: lesson planning, behavior management programming, 504, IEP, etc.)

# hours spent in placement-related workshops, trainings, seminars:

# hours of individual supervision on site: # hours of group supervision on site (including case staffing):

Total indirect hours at the site:

# hours spent in practicum class (CHR 8682; maximum 2 hours per week): Total hours this week (add direct and indirect hours):

Supervisor Initials:

Supervisor Comments (if needed):

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Practicum In Counseling Clinical Mental Health & School Counseling

Transportation of Personal Information Agreement (12/14) Form # 7

I (print name) understand that audio or video recordings of client interactions entail personal information and need to be handled with the utmost confidentiality. My signature below indicates that I understand and agree to the following:

1. Recordings need to be kept in a secure location at the practicum site (behind 2 locks) and de-

identified in some way so as to further protect the identity of the client. 2. When transporting recordings to Villanova for supervisory purposes only, students are

instructed to carry video recordings behind two locks at all times and delete them immediately after use. Recordings should be kept on site at all other times.

3. Informed consent is needed prior to recording.

Signature:

Date:

Course Instructor:

24


Informed Consent (Example) (11/13) Form # 8

(This is an example form. Particulars will need to be adjusted according to the counseling setting.)

As a client receiving services by a master's level student in the Counseling Program at Villanova University, my foremost priority is offering you the help you need. In order to ensure that you receive quality assistance, we want you to know the specific rights you have as a client and what you can expect from the counseling process.

You have the right:

1. To be helped by your counselor in training with the issues which concern you 2. To work with the counselor in training in deciding what goals to pursue in counseling and how to

pursue them 3. To ask questions or voice concerns regarding counseling techniques or your progress incounseling 4. To experience an atmosphere of safety and trust in which you are free to be yourself and express what

bothers you most 5. To refuse any counseling recommendation, technique, or service 6. To access your records 7. To request a different counselor in training should you experience difficulties with you current

counselor in training, after you make efforts to work out those difficulties

Counseling services are confidential. We are mandated by state law to break confidentiality if we have any suspicion that you are a danger to yourself or to someone else. All counselors in training are graduate students under direct supervision.

Regular sessions are important to your progress in counseling. Therefore, we make weekly sessions available to you. We ask you to commit to weekly sessions, to be on time for those sessions, and to notify us 24 hours in advance should you be unable to attend your scheduled session.

By signing your name below, you indicate that you have read the above information, that you understand it, and that you have had the opportunity to ask your counselor in training any questions you might have.

Client: Date:

Signature of Witness: Date

25


Consent for Audio-Visual Recording (11/13) Form # 9

(EXAMPLE)

Note: A copy must be signed by each person participating in the counseling session to be recorded. The parent or legal guardian must sign a copy for each participating minor.

I, the undersigned, authorize the video/audio recording of my group/individual counseling

sessions with the following counselor-in-training: . I understand that the recorded sessions will be used only for the purpose of counselor training, and that they will be viewed by the above-named counselor in training. The Practicum/ Internship Faculty Instructor and the student counselors enrolled in the Practicum/ Internship Supervision Group may also view a small segment (10 minutes) of the tape for supervision purposes. I have been informed that the viewing focus will be on the counselor him or her-self, in an effort to evaluate his or her skills as a professional. I understand that my full name will not appear on the tape or any other materials; I further understand that the recorded sessions will be erased upon the named counselor in training’s completion of the Practicum/ Internship course.

Client Name

Client Signature Date

Parent/Legal Guardian Signature for Minor Client Date

Counselor Signature: Date

26


Case Presentation Outline (Example) (11/13) Form # 10

The specifics of a case presentation will differ for each professor. This is a very basic and general guide.

Client (Pseudonym): Counselor-in-training:

Date: Presented Previously: Yes No

Note: For cases presented previously, only provide information in 1-4 below that is new or revised or otherwise pertinent to this presentation.

1. Case history/situation:

2. Counseling status (# of sessions, frequency of sessions, group/individual, volunteer/resistant client, etc.):

3. Presenting Problems & Strengths:

4. Sociocultural Influences:

5. Intervention:

a. Intervention or Treatment Themes

b. Intervention or Treatment Plan

i. Theoretical Modality (link to Evidence Based Practice) ii. Goals (long and short term)

iii. Expected Process of Intervention iv. Techniques to be Utilized v. Identified Evidenced-Based Practices for all above (i. – iv.).

c. Expectations Concerning Outcome of the Intervention or Approach

d. Future Directions or Goals

6. Topic of recorded session segment to be presented:

7. Specific issues/questions for group feedback: a. b. c.

27


Class Participation Evaluation Form

(11/13) Form # 11

This form is an example only, and may or may not be utilized by your particular instructor.

Student: Total (5-15):

Date:

Nature of Participation

Strong (3) Needs Development (2) Unsatisfactory (1)

Listening Actively and respectfully listens to peers and instructor

Sometimes displays lack of interest in comments of others

Projects lack of interest or disrespect for others

Preparation Arrives fully prepared with all assignments completed, notes on reading, observations, and questions

Arrives unprepared or with only superficial preparation

Exhibits little evidence of having read or thought about assigned material

Quality of contributions

Comments are relevant and reflect understanding of: assigned readings; previous remarks of other students; and insights about material

Comments sometimes irrelevant, show lack of preparation, or indicate lack of attention to previous remarks of other students

Comments reflect little understanding of either the discussion or previous remarks in class.

Impact on class Comments frequently help move conversation forward

Comments sometimes advance conversation, but sometimes do little to move it forward

Comments do not advance the conversation or are actively harmful to it

Frequency of participation

Actively participates at appropriate times

Sometimes participates but at other times is “tuned out”

Seldom participates and is generally not engaged

Comments:

John Immerwahr, Copyright License: http://creativecommons.org/licenses/by-sa/3.0/us/

i. Class participation deserving of an A grade will be strong in most categories; Participation that is strong in some categories but needs development in others will receive a B; a grade of C reflects a need for development in most categories; D work is typically unsatisfactory in several categories; and F work, unsatisfactory in nearly all.

28

Site Supervisor Performance Evaluation of Students in Clinical Mental Health

(Form #12a) Students are required to complete a self-evaluation (using this form) AND have their Site Supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. Note to Site Supervisor: Please give the student at least one “2” or below and VERY FEW “5’s.” Please feel free to contact the faculty instructor with questions or problems regarding this task. Student: Site:__________________________________ Supervisor: Evaluation: Midterm Final 1 = Far below expectations—needs significant improvement 2 = Below expectations—needs some improvement 3 = Acceptable—meets standards at average level for students (the majority of trainees will fall here) 4 = Above expectations—performs above expectations for students/is a strength 5 = Far exceeds expectations—performs well beyond average for students/excels in this area NA= Not applicable or not enough information to form a judgment I. Ethical Awareness and Conduct:

Adherence to applicable legal standards 1 2 3 4 5 NA Adherence to professional ethical standards 1 2 3 4 5 NA Ability to identify and resolve ethical dilemmas 1 2 3 4 5 NA

II. Professional Behaviors:

Is punctual at internship site 1 2 3 4 5 NA Presents a professional image with all contacts (i.e., face to face, email, etc.) 1 2 3 4 5 NA Interacts appropriately and professionally with staff at site 1 2 3 4 5 NA Consults with personnel as appropriate 1 2 3 4 5 NA Applies relevant record keeping standards as appropriate to the site 1 2 3 4 5 NA

III. Supervision Behaviors:

Seeks supervision when appropriate 1 2 3 4 5 NA Able to establish effective supervisory relationship 1 2 3 4 5 NA Is receptive to constructive feedback 1 2 3 4 5 NA Actively seeks constructive feedback 1 2 3 4 5 NA Makes appropriate changes following feedback 1 2 3 4 5 NA

IV. Personal Characteristics:

Demonstrates a willingness to learn 1 2 3 4 5 NA Exhibits emotional stability 1 2 3 4 5 NA Demonstrates adaptability and flexibility 1 2 3 4 5 NA Recognizes limitations 1 2 3 4 5 NA Is aware of professional strengths and areas of growth 1 2 3 4 5 NA Exhibits an awareness of and respect for appropriate interpersonal boundaries

1 2 3 4 5 NA Demonstrates maturity in interactions with clients and staff 1 2 3 4 5 NA

29

V. Counseling Skills:

Please indicate the percentage of the following modalities that you are using to rate counseling skills. Percentages should equate to 100%. ______ Co-counseling ______ Student self-report ______ Live observation ______ Viewing video-taped sessions ______ Listening to audio-taped sessions ______ Other (please indicate source: ______________________________)

Comprehends complex problems and solutions 1 2 3 4 5 NA Establishes and maintains rapport with clients 1 2 3 4 5 NA Demonstrates the ability to identify and draw upon client strengths and resources in case conceptualization and interventions

1 2 3 4 5 NA

Ability to gauge the needs of the client 1 2 3 4 5 NA Matches client needs to therapeutic goals and interventions 1 2 3 4 5 NA Establishes, works toward, and assesses counseling goals 1 2 3 4 5 NA Approaches clients in a therapeutically genuine manner 1 2 3 4 5 NA Conveys an empathic understanding to the client (including nonverbally) 1 2 3 4 5 NA Effectively identifies and responds to a variety of client emotions 1 2 3 4 5 NA Works effectively with clients from diverse cultural backgrounds 1 2 3 4 5 NA Effectively engages in the termination process 1 2 3 4 5 NA Appropriately makes referrals 1 2 3 4 5 NA

VI. Program (Clinical Mental Health) Specific Knowledge and Skills:

A. Knowledge of: Client population 1 2 3 4 5 NA Role of the counselor 1 2 3 4 5 NA Site and community client resources 1 2 3 4 5 NA Diagnostic criteria for mental and emotional disorders 1 2 3 4 5 NA Treatment modalities and placement criteria within the continuum of care

1 2 3 4 5 NA B. Skills:

Advocates appropriately for clients 1 2 3 4 5 NA Promotes client understanding of and access to community resources 1 2 3 4 5 NA Demonstrates skill in screening for addiction, aggression, danger to self and/or others, as well as co-occurring mental disorders

1 2 3 4 5 NA

Demonstrates skill in conducting mental health assessment practices (intake, MSE, biopsychosocial, psychological assessment) for treatment planning and caseload management

1

2

3

4

5

NA

Is able to conceptualize an accurate diagnosis of disorders presented by a client and discuss the differential diagnosis with supervisor/colleagues

1 2 3 4 5 NA

Demonstrates appropriate use of the DSM-5 to describe the symptoms and clinical presentation of clients and apply appropriate treatment approaches

1

2

3

4

5

NA

Demonstrates appropriate use of culturally responsive (individual, couple, family, or group) modalities for counseling

1

2

3

4

5

NA

Uses the principles and practices of diagnosis, treatment, referral, and prevention of mental and emotional disorders to initiate, maintain, and terminate counseling

1

2

3

4

5

NA

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V. What are the strengths of the student as an intern?

VI. What areas need further development?

VII. What recommendations would you make to enhance this student’s development?

Supervisor’s Signature: Date:

Student’s Signature: Date:

Supervisors Please Make a Copy for Your Files

31

Performance Evaluation of School Counseling Student by Field Site Supervisor

Form #12b Evaluation of Student Performance

Students are required to complete a self-evaluation (using this form) AND have their site supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. Note to Site Supervisor: Please give the student at least one “2” or below and VERY FEW “5’s.” Please feel free to contact the faculty instructor with questions or problems regarding this task. Thank you for your assistance.

Student: Site:

1 = Far below expectations—needs much improvement, a concern 2 = Below expectations—needs some improvement, a concern 3 = Acceptable—meets standards at average level for interns (majority of trainees fall here) 4 = Above expectations—performs above expectations for interns 5 = Far above/exceeds expectations—performs well beyond most counseling students NA= Not applicable or not enough information to form a judgment

I. Ethical Awareness & Professional Conduct:

Adherence to ethical and legal standards as defined by site and ASCA standards

1 2 3 4 5 NA

Adheres to confidentiality standards as defined by site and ASCA standards 1 2 3 4 5 NA

Consults with appropriate personnel about ethical issues 1 2 3 4 5 NA

Is punctual and reliable 1 2 3 4 5 NA

Interacts appropriately and professionally with others at site 1 2 3 4 5 NA

Accurate record keeping according to ASCA and site guidelines 1 2 3 4 5 NA

Comments:

II. Professional Knowledge, Receptivity, and Skills:

A. Knowledge, Skills: Knowledge of client population 1 2 3 4 5 NA Knowledge of school counselor role 1 2 3 4 5 NA Knowledge of school and community client resources 1 2 3 4 5 NA Knowledge of evidenced-based counseling theories and skills as appropriate to the school setting and client population. 1 2 3 4 5 NA

Demonstrates skills in responding to clients’ unique developmental levels and sociocultural traits (race/ethnicity; disability status; gender; SES) 1 2 3 4 5 NA

Demonstrates skill in assessing and referral for client needs (e.g., addiction, aggression, eating disorders, depression, danger to self/or others, etc.) 1 2 3 4 5 NA

Demonstrates appropriate use of evidenced-based culturally responsive (individual, couple, or group) modalities for initiating, maintaining, and terminating counseling

1

2

3

4

5

NA

Demonstrates an understanding and ability to create, implement, and manage an effective classroom guidance lesson 1 2 3 4 5 NA

Demonstrates effective, evidenced-based group counseling skills 1 2 3 4 5 NA Demonstrates skills in academic advising and planning 1 2 3 4 5 NA Demonstrates skills in career and/or college planning at individual, small group, and classroom levels

1

2

3

4

5

NA

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Counselor actions/interventions are premised on data (e.g., needs’ Assessments, truancy or achievement data, disciplinary records)

1

2

3

4

5

NA

Counselor interventions are evidenced-based in nature and systematically assessed for impact or effectiveness

1

2

3

4

5

NA

Comments:

B. Relational/Counseling Skills Comprehends complex problems and solutions 1 2 3 4 5 NA Able to build rapport with all clients 1 2 3 4 5 NA Demonstrates empathy—visibly 1 2 3 4 5 NA Accurately reflects session content 1 2 3 4 5 NA Accurately and comfortably reflects feelings 1 2 3 4 5 NA Tailors skills & interventions culturally to fit client 1 2 3 4 5 NA Maintains appropriate boundaries with clients, colleagues, and staff 1 2 3 4 5 NA

Comments:

C. Personal Characteristics:

Demonstrates a willingness to learn 1 2 3 4 5 NA Displays a sense of self confidence 1 2 3 4 5 NA Exhibits emotional stability 1 2 3 4 5 NA Demonstrates adaptability 1 2 3 4 5 NA Recognizes personal limitations 1 2 3 4 5 NA

Comments:

III. Interactions and Consultations with Coworkers/Other Professionals/Families, Etc.:

Consults with appropriate persons 1 2 3 4 5 NA

Provides valuable information to client/client’s family, teachers, administrators, etc.: 1 2 3 4 5 NA

Effectively, clearly conveys information 1 2 3 4 5 NA Presents self professionally 1 2 3 4 5 NA

Comments:

IV. Response to Supervision:

Actively seeks critical feedback 1 2 3 4 5 NA Receives critical feedback well 1 2 3 4 5 NA Changes behaviors following feedback 1 2 3 4 5 NA Demonstrates the ability to recognize his or her own limitations as a school counselor and seeks supervision and additional information/education as appropriate.

1

2

3

4

5

NA

33

Comments:

V. Identify one of the students’ greatest strengths?

VI. Identify one area for growth.

VII. Would you recommend this student in moving on to the next career level (e.g., for practicum students, on to

an internship, or for internship students, on to full employment as a school counselor)?

YES NO

If no, please explain:

Supervisor’s Signature: Date:

Supervisor’s Printed Name:

Supervisors Please Make a Copy for Your Files

34


Student Evaluation of Field Site

(11/13) Form # 13

1. Student: Semester: , 20

2. Site:

3. Supervisor Name: Title:

4. Student On-Site Responsibilities:

5. % of time spent providing direct service to clients: %

6. Percent of on-site time engaged in clinical support work (clinical training, case staffing, treatment planning, clinical supervision): %

7. Percent of on-site time spent engaged in administrative tasks: %

8. Type and frequency of on-site supervision received:

9. Quality of on-site supervision received:

10. Overall assessment of the value of this practicum experience for you:

11. Would you recommend placement of another Villanova graduate student inthis practicum site? Why or why not?

35

Student Name: Date:

Counseling Skills Scale- Global Ratings

Skill Domain

Ratings 2 1 0 -1 -2 NN

Highly developed: helpful, well-timed,

and consistentlywell- performed

Well developed: helpful and well-timed when performed, but

not consistently smooth

Developing skills: somewhat helpful but

too many missed opportunities

Continue practice: not helpful or well-timed,

or no skill existent when it should be

Major adjustment needed: not at all

helpful or well-timed

Not performed, but not necessary;

(an)other skill(s) within this “grouping” used

to effectively meet this grouping’s goals

Shows Interest and Appreciation

2 1 0 -1 -2 NN

Skills: Body Language and Appearance; Minimal Encouragers; Vocal Tone; Evoking; & Punctuating Client Strengths

COMMENTS:

Encourages Exploration 2 1 0 -1 -2 NN

Skills: Questioning; Requesting Concrete and Specific Examples; Paraphrasing: and Summarizing

COMMENTS:

Deepens the Session 2 1 0 -1 -2 NN

Reflecting Feeling; Using Immediacy; Observing Themes and Patterns; Challenging /Pointing out Discrepancies; and Reflecting Meaning and Values

COMMENTS:

Encourages Change 2 1 0 -1 -2 NN

36

Skills: Determining Goals and Outcomes; Using Strategies for Creating Change; Considering Alternatives and their Consequences; Planning Action and Anticipating Possible Obstacles

COMMENTS:

Develops Therapeutic Relationship

2 1 0 -1 -2 NN

Consistently engages in caring manner with client, by demonstrating such core conditions as genuineness and authenticity, warmth, and acceptance, respect and positive regard, and empathy.

COMMENTS:

Manages the Session 2 1 0 -1 -2 NN

Opens and ends session smoothly. Begins work on counseling issues in a timely way. Structures session, directing client naturally through opening, exploration, deeper understanding, creating change, and closing.

COMMENTS:

OVERVIEW COMMENTS ON COUNSELING SKILLS:

TOTAL SCORE:

Documents

Clinical Mental Health School Counseling Department of ... · history, a mental health history, and a psychological assessment for treatment planning and caseload management. (CMH.H2)