Clinical Pastoral Education International · Web view2019/06/16 · Clinical Pastoral Education International (CPEI) Vision and Mission2. Introduction to Clinical Pastoral Education4

STANDARDS MANUAL

CURRENT VERSION – JUNE 16, 2019

TABLE OF CONTENTS

Clinical Pastoral Education International (CPEI)

Vision and Mission..........................................................................................................................2

Introduction to Clinical Pastoral Education.....................................................................................4

Accreditation Standards ................................................................................................................6

CPE Center Standards .....................................................................................................................8

100.1- Center Evaluation and Compliance .....................................................................................6

100.2- Educational Standards and Compliance ..............................................................................7

100.3- Evaluation Procedures and Compliance...............................................................................8

100.4- Policies and Procedures and Compliance ............................................................................9

CPE Objectives and Learning Outcomes.....................................................................................11

CPE Objectives (200-400).............................................................................................................11

CPE Learning Outcomes (200.1.1-400.1.1)...................................................................................12

CPE Supervisory Education and Standards (500)......................................................................13

Admission to CPE Supervisory Education ...................................................................................13

Supervisory Objectives and Outcomes..........................................................................................13

CPEI Professional Code of Ethics (600)......................................................................................16

CPEI Process for Handling Complaints and Grievances (700)..................................................20

Appendices ....................................................................................................................................22

Changes and Updates to Standards .............................................................................................70

Updated June 16, 2019 Page 2 of 71

VISION

To develop an academy of pastoral educators and clinicians providing excellence in pastoral care, training, and education.

OUR MISSIONThe mission of Clinical Pastoral Education International (CPEI) is to ensure excellence and relevance by: Embracing experiential and reflective methodologies in individual and group learning, Applying social sciences to pastoral care ministry, Participating in research to promote the field of pastoral care and pastoral supervision, Working cooperatively with other pastoral care and counseling cognate groups.

ACCREDITATION STANDARDS

Individuals are encouraged to review the following sources to gain a broader understanding of the requirements for accreditation of CPE Centers and for credentialing for individuals.

Accreditation Manual - Commission on Accreditation for Pastoral Education (CAPE)

Credentialing Manual - Board for Clinical Pastoral Education Supervisors & Chaplains


INTRODUCTION TO CLINICAL PASTORAL EDUCATION (CPE)The main educational purposes of CPE are to provide opportunities to aid the CPE learner in the development of pastoral identity and to master a body of interpersonal skills and academic materials related to pastoral care functions. In the process of fulfilling these purposes, the student will be able to set individualized learning goals and evaluate theological and pastoral presuppositions and procedures within the context of relationships with a supervisor, student colleagues, as well as professionals from other disciplines.

Using this experiential model of learning allows those to whom we minister to become our primary teachers. Ministry in this context is supportive and dialogical in nature. We are available to minister to persons as they struggle with issues related to sickness and health, grief and loss, meaning and value. Making use of the resources of our own life stories, our religious heritage, our understanding of human personality, systems theory, and intercultural wisdom we seek to enable persons to use their resources in coping with illness and loss.

Individual and group supervision is offered to the CPE student as opportunities to reflect on and explore issues related to their pastoral functioning and identity and to make meaning of clinical experiences and the learning process. The intent is to provide an atmosphere in which guidance, support, and freedom for learning through one's own experience may take place. Students carry significant clinical responsibilities in conjunction with the educational aspects of the program. Service and learning go together, each enriching the other.

EDUCATIONAL METHODOLOGYClinical Pastoral Education is an action/reflection/action inductive method of learning. It is about change, transition and transformation and involves peer and individual supervision as part of the action-reflection process. Supervision is an engaging encounter between a supervisor and supervisees in which reflection is utilized to review a variety of pastoral encounters and ministry reporting events. Supervisees covenant together so that growth and development occur in self-awareness, ministry competence, and theological understanding.

BRIEF HISTORICAL PERSPECTIVE OF CPEIn early 20th Century, theological education focused primarily on academic classroom learning with little emphasis on experiential learning. This changed with the initial influence of persons such as Anton Boisen and others who helped shape a new way of learning and ministry.

Anton Boisen (Minister) gave attention to listening, observing and reading of “living human documents.” He was convinced that the type of mental illness he experienced was a religious experience and because he believed that religion had a curative, problem-solving nature, he concluded that “many forms of insanity are religious rather than medical problems and that they cannot be successfully treated until they are so recognized.” Boisen defines theology as the study of religious belief—the “spiritual forces” which operate within us—rather than as a systematic statement of belief. “We have sought to determine the origin and meaning of these beliefs, their function in the individual’s life, and their implications for a general system of values.” The ultimate goal is that theology is alive: for pastors and their interlocutor.


Richard Cabot (Physician) who is actually responsible for the introduction of social work into the hospital in 1905, worked and supported a “clinical theology” and on-the-job training for ministry. “Therefore, the work of helping a patient belongs to others as well as to the doctor. It belongs to someone who can doctor his moral as well as his physical ills. A physician specializes on the body, and the minister makes his specialty the human soul. The two should co-operate. There ought to be a school somewhere which would take up the subject thoroughly, and ministers should take the course,” he stated. He believed that both theology students and physicians-in-training must have clinical experience as a part of their training. Cabot had a sophisticated professional training model in mind, in which students learn to carefully record their observations in history, diagnosis, treatment plan and goal formulation. However, in this context, Cabot has no particular interest in the relationship between mental disorder and religion.

William Keller (physician) saw the pastor primarily as “social engineer.” As such the pastor, not only holds religious values and truths, but he, with his ministry, participates in the development of a new, just and peaceful world. Keller’s argument aimed at theologians acquainted with the real life (learning by doing) and not based in rules, dogmas, and titles. Pastoral work is about social action and community work. Through him and his program, the Graduate School of Applied Religion, in the mid-1930s, the concept of supervision within the CPE training emerged. Over the years, CPE has taken a variety of shapes and divisions. This occurred in response to different theological and pragmatic ideas regarding clinical training.

Council for Clinical Training of Theological Student/Students was the first pastoral care and education organization, which was formed in January 21, 1930, in the home of Samuel Eliot, pastor of a church in Boston. The Council was originally formed in Massachusetts, but later the headquarters moved to New York City.

Institute of Pastoral Care was formed in 1944 by a group of theological educators and chaplains in the Boston. The Institute had close ties with the seminaries in the environs of Boston and nearby areas of New England.

Council for Clinical Training, a third group, emerged in the 1940s within Lutheran theological education. In 1945, a certified supervisor was installed at City Hospital in St. Louis, Missouri.

Southern Baptist Association of Clinical Pastoral Education was formed in 1957 by Dr. Wayne Oates within the context of Southern Baptist Theological Seminary in Louisville, KY.

Association for Clinical Pastoral Education, Inc was formed in October 1967, after several years of joint discussions and planning four groups merged and formed one educational organization in Kansas City, MO.

College of Pastoral Supervision and Psychotherapy was founded in 1990 in response to what many felt was a missing element of integrating pastoral education and counseling.

Clinical Pastoral Education International (CPEI) was formed in 2018 in conjunction with the American Association of Christian Counselors (AACC) in response to a couple of key issues. First, AACC recognized that a significant element of training and resources was missing in their goal to best prepare laypersons and counselors in the art and skill of caring for others. Second, the great work and history of the clinical pastoral education movement and process were recognized and affirmed, and as such, the vision was to provide an exemplary platform for educating and credentialing those who questioned where they fit in a world of ever evolving theological, social and political changes. Finally, the goal was to provide a rigorous, standardized, and reasonable credentialing process.


ACCREDITATION STANDARDSClinical Pastoral Education International’s (CPEI) accredited Centers may be established within an institution or as an independent agency and may include a wide array of settings such as, but not limited to, public and private hospitals, hospice centers, mental health centers, military, law enforcement, parishes and congregations, counseling centers, state and federal health and welfare institutions, drug rehabilitation centers, nursing home facilities, and long-term care facilities.

CPE CENTER STANDARDS

STANDARD 100.1: CENTER EVALUATION AND COMPLIANCE100.1.1 Centers will ensure that promotional and advertising materials are ethical,

honest and consistent and do not imply or guarantee credentialing or certification or employment. Materials include as a minimum the name of the institution, and the status of relationship with Clinical Pastoral Education International (CPEI) and the accrediting body, The Commission on Accreditation for Pastoral Education (CAPE).

100.1.2 Centers will ensure that a process exists for Pastoral Supervisor Continuing Professional Development (See Credentialing Manual).

100.1.3 Centers will ensure that a process exists for consultation and support is provided via a CPE Advisory Committee (AC)

100.1.4 Centers will ensure that a process exists for submitting completion of student unit reports. Submission of the report will not exceed 45 days from the close of the unit.

100.1.5 Centers will ensure that a process exits for completing and submitting the Annual Compliance Report, which must occur prior to December 31 (Appendix B-2).

100.1.6 Centers will ensure that a process exits that clearly identifies an accountable governance structure which delineates authority and responsibility for the overall direction and effectiveness of the training Center.

100.1.7 Centers will ensure the CPE program is a legally incorporated entity, i.e., non-profit, not-for-profit, for profit, LLC, etc.

100.1.8. Centers will ensure that an environment exits which is conducive to learning, i.e., furnishing, library, technology.

100.1.9 Centers will ensure that a process exits to evaluate the program from students and others, i.e., assessment, personal feedback, etc.


100.1.10 Centers must clearly identify themselves as being associated with the Clinical Pastoral Education International (CPEI) and accredited by the Commission on Accreditation for Pastoral Education (CAPE).

Centers that are affiliated and/or accredited by other organizations must identify the relationship.

100.1.11 Centers will include a statement regarding the fiscal and administrative support regarding a CPE program.

STANDARD 100.2: EDUCATIONAL COMPLIANCE

100.2.1 Centers will ensure that the supervisory staff are properly credentialed.

100.2.2 Centers will ensure that students are aware of the clinical sites available to them.

100.2.3 Centers will ensure that CPE maintains a ratio of one supervisor per student ratio of no less than three (3) and no more than nine (9).

100.2.4 Centers will include a statement describing the construct of the group, which

may include onsite and online students separately or integrated.

100.2.5 Centers will include a statement regarding an integrated curriculum that fulfils objectives and outcomes, and guidance for routine updates.

100.2.6 Centers will include a statement regarding the requirement for supervised hours. One unit of CPE is 400 hours of supervised education, which is comprised of 300 clinical/ministry hours and 100 hours of individual, group and self-study. One-half is unit of CPE is 200 hours of supervised education, which is comprised of150 clinical hours and 50 hours of individual, group and self-study.

100.2.7 Centers will include a statement recommending that all supervisory staff, and those in training participate regularly in supervisory networks for the purposes of continued education and consultation.

100.2.8 Centers will ensure that handbooks are available for CPE Students and Supervisory students, and that during a period of new student orientation that students sign a statement that they have read, understand, and agree to abide by the student handbook.

100.2.9 Centers will use a variety of insights from adult educational and supervisory models to enhance student learning.

100.2.10 Centers will ensure that students develop individual learning contracts that directly relate to the CPEI objectives for CPE and Supervisory CPE.


STANDARD 100.3: EVALUATION PROCEDURE FOR STUDENTS, SUPERVISORS, SUPERVISORS-IN-TRAINING AND TRAINING CENTERS COMPLIANCE

At a minimum the evaluations will abide by the following guidelines and/or data (Sample Evaluation Forms- Www.cpe-international.org C). All supervisors’ mid-final evaluations must contain this phrase for students to sign: I have received, read, and discussed this evaluation. I also understand that I have the right to include a supplemental statement to this evaluation regarding any disagreement or points of clarification.

100.3.1 Student Evaluation. The following information as a minimum must be included in the student evaluation.100.3.1.1: student’s demographic information, occupational background, and

religious affiliation.100.3.1.2: identification of the clinical site(s)100.3.1.3: student goals and how they addressed individual learning outcomes100.3.1.4: students evaluate their peers and supervisor

100.3.2 Supervisory StudentsThe following information as a minimum must be included in the supervisory student evaluation.100.3.2.1: demographic information, occupational background and religious

affiliation.100.3.2.2: supervisory clinical site(s)100.3.2.3: supervisory learning goals and how they addressed them.

100.3.3 Supervisors Evaluation of CPE Students The following information as a minimum must be included in the student evaluation.

Completion of CPE Students must be completed within 45 days at the conclusion of the unit(s) of education and be submitted to the respective CPE student for review and signature.

100.3.3.1: dates of the CPE unit100.3.3.2: type of unit (e.g., intensive, extended) and unit number100.3.3.3: demographic information, occupational background and religious

affiliation and role.100.3.3.4: clinical site(s)


100.3.3.5: learning goals and how they were addressed, e.g., pastoral formation/identity, pastoral competencies, pastoral reflection

100.3.4 Supervisors Evaluation of CPE Supervisory StudentsThe following information as a minimum must be included in the student evaluation.

Completion of Supervisory Student evaluations must be completed within 45 days at the conclusion of the unit(s) of education and be submitted to the supervisory student for review and signature.

100.3.4.1: dates of the CPE unit100.3.4.2: type of unit (e.g., resident, intensive, extended, supervisory) and

unit number100.3.4.3: demographic information, occupational background and religious

affiliation and role.100.3.4.4: clinical site(s)100.3.4.5: learning goals and how they were addressed., 100.3.4.6: peer group and supervisory network.

STANDARD 100.4: POLICIES AND PROCEDURES COMPLIANCE

Each CPE Center will include, at a minimum, in the student and supervisory handbooks, policies and procedures addressing the following:

100.4.1 an admissions policy that does not discriminate against race, gender, age, faith group, national origin, sexual orientation, or disability.

100.4.2 a financial policy that describes fees, payment schedules, refunds, stipends, scholarships, stipends, cancellations, etc.

100.4.3 a policy describing the process for addressing complaints, grievances and the investigation and resolution process as related to the CPEI Code of Professional Ethics,

100.4.4 a policy outlining the process for the maintenance and custody of records which addresses as a minimum confidentiality, custody and release of records, which are consistent with CPEI’s Code of Professional Ethics. As a minimum the following records must be retained for a minimum of five (5) years.100.4.4.1: Application face sheet and application materials.100.4.4.2: Student and supervisor evaluations.100.4.4.3: Copies of disciplinary actions, complaints or grievances filed.100.4.4.4: Copies of student’s signatures indicating that they have read,

understand and agree with the Student Handbook.


After a period of five (5) years all student materials will be destroyed with the exception of the face sheet, any written request(s) for release of information, and a record of completed units.

100.4.5 a process for handling and responsibility to maintain personal copies of personal and supervisory evaluations.

100.4.6 a policy describing the process for discipline, dismissal and withdrawal of students.

100.4.7 a policy addressing student rights and responsibilities.

100.4.8 a policy identifying formal written agreements that specify the relationship and operational functions with agencies in which CPE students may be assigned or affiliated. At a minimum the agreements should specify:100.4.8.1: the name and accreditation of the training Center, and a brief

introduction of the CPE supervisor 100.4.8.2: brief description of the requirements and expectations of the

agency and the training supervisor100.4.8.3: authorization to visit patients, parishioners or clients100.4.8.4: access to appropriate clinical records and informed consent

with regard to the use of student materials100.4.8:5: agreement by the student to abide by center policies protecting

confidentiality and rights of clients/patients/parishioners.

100.4.9 a policy outlining the process for the completion of training in the absence of a supervisor.

100.4.10 a policy for Centers making use of audio/video technology. At a minimum, the procedures should include the risks and benefits in using technology, confidentiality, and the planned learning formats (synchronous and asynchronous), etc. 100.4.10.1: Synchronous learning formats are required for individual and

group supervision. 100.4.10.2: Asynchronous learning formats may be used for discussion forums

and other online learning methods, i.e., didactic and reading materials.

100.4.11 a policy describing the maintenance of records in the event that a training Center closes.

100.4.12 a policy defining the process to protect against copyright and software license

infringements.

100.4.13 a policy outlining the requirements for students and supervisors to maintain professional liability.


CPE LEARNING OBJECTIVES (200-400) The CPE Center will focus on three primary areas: pastoral formation, pastoral reflection, and pastoral competencies.

PASTORAL FORMATION LEARNING OBJECTIVES (200)Focuses on self-awareness and the ability to integrate insights from theology and social sciences to enhance one’s personal and pastoral identity and formation.

PF 200.1 To develop self-awareness for personal and professional growth. PF 200.2 To develop awareness of how one’s beliefs, attitudes, strengths, limitations,

values and assumptions affect one’s pastoral ministry. PF 200.3 To develop sensitivity, openness, and respect for the recipients of pastoral care

and applying the insights from the social sciences.PF 200.4 To increasingly exercise personal and pastoral leadership and authority.

PASTORAL REFLECTION LEARNING OBJECTIVES (300)Focuses on the ability to effectively use the peer groups well as group and individual supervision for the integration of personal and pastoral development and functioning.

PR 300.1. To utilize individual and group supervision for personal and professional growth and the capacity to evaluate one's pastoral ministry.

PR 300.2 To develop the ability make use of the peer group for support, dialogue, consultation, and feedback as a means of integrating personal and professional characteristics and competencies into one’s pastoral ministry.

PASTORAL COMPETENCE LEARNING OBJECTIVES (400) Focuses on matters of pastoral care skill development.

PC 400.1 To develop the capacity to conduct pastoral/spiritual assessments and appropriate pastoral interventions.

PC 400.2 To demonstrate awareness of one's pastoral presence in interdisciplinary relationships and develop the capacity to communicate orally and in writing to contribute to the plan of care.

PC 400.3 To gain knowledge of and abide by ethical principles in the practice of one’s ministry and serve as an advocate for persons in need.


PC 400.4 To develop pastoral care skills as a means of providing pastoral care to individuals and groups from diverse cultural, ethnic, gender, and religious backgrounds.

CPE LEARNING OUTCOMES

PASTORAL FORMATION LEARNING OUTCOMES (200)200.1.1 Students possess the ability to assess/process life events and relationships

that influence and inform one’s view of self and their personal and professional functioning.

200.2.1 Students possess the ability to assess/process their embedded theology, personality traits, personal and professional functioning and world view as they seek to provide non-anxious presence to others.

200.3.1 Students possess the ability to appreciate the worth and value of all individuals and to be a non-judgmental empathetic presence to all in need of pastoral care.

200.4.1 Students possess the ability to appropriately exercise personal and pastoral leadership and authority as the need dictates.

PASTORAL REFLECTION LEARNING OUTCOMES (300)300.1.1 Students possess the ability to seek the consultation and feedback from their

supervisor and peer group as they process dynamic issues that arise out of their personal and professional functioning.

300.2.1 Students possess the ability to reflect on their pastoral functioning through group dynamics and to understand that the group functioning illustrates to the supervisor and peers how one does pastoral care with others.

PASTORAL COMPETENCE LEARNING OUTCOMES (400)400.1.1 Students possess the ability to utilizes a spiritual assessment tool that will

clearly communicate spiritual needs and pastoral interventions to medical and other staff with a need to know.

400.2.1 Students possess the ability to function as a team member with all disciplines represented in the clinical environment without losing objectivity due to being too close.

400.3.1 Students possess the ability to function ethically and stand in the gap when needed after first discerning both sides of an issues and ensuring that triangulation does not occur.


400.4.1 Students possess the ability to function in a professional manner that respects diversity and the pluralistic society in which one practices.

500-CPE SUPERVISORY EDUCATION AND STANDARDS

ADMISSION TO CPE SUPERVISORY EDUCATIONIndividuals admitted to supervisory education will meet the following criteria:

A bachelor’s degree and a graduate theological degree from an accredited institution. For educational equivalencies (See Www.cpe-international.org B-Credentialing Manual for Educational Equivalences).

Four units (1600 hours) of clinical pastoral education (CPE). (See Www.cpe-international.org B-Credentialing Manual for Educational Equivalences).

Exceptions: Persons having a bachelor’s degree and a graduate theological degree from an accredited institution and having completed supervisory training in another credentialing organization, i.e., AAMFT, AAPC, etc., and remains in good standing, will be considered on an individual basis with a minimum of two units (800 hours) of CPE.

Personal maturity and a record of professional competence.

Completion of a Supervisor Candidate Application.

Interview and acceptance into Supervisory Educational program.

SUPERVISORY CREDENTIALING (CERTIFICATION)See Credentialing Manual for the Board for Chaplains and Supervisors (BCS) for detailed information on certification requirements.

SUPERVISORY EDUCATION CURRICULUM See www.cpe-international.org

CPE SUPERVISORY OBJECTIVES AND OUTCOMES

SUPERVISORY AWARENESS (SA)Supervisory Awareness is designed to increase one’s self-awareness as a supervisor, the ability to establish and understand the interactive dynamics involved in a supervisory alliance, and to integrate one’s understanding human development into a supervisory theory.


http://www.cpe-international.org/

SA 500.2.1 To demonstrate use of one’s personality, religious and cultural history as a teaching resource in shaping a personal supervisory style.

SA 500.2.2 To demonstrate the use of one’s strengths and limits and personal history as teaching tools and as resources in shaping one’s supervisory style.

SA 500.2.3 To demonstrate awareness of the supervisor-student power imbalance and to know to use it for learning purposes.

SA 500.2.4 To demonstrate awareness of a supervisory alliance and issues related to transference and counter-transference and anxiety and learning, resistance, parallel process.

SA 500.2.5 To demonstrate an awareness of the supervisory literature, which includes, but is not limited to a review of human development, adult learning, clinical supervision, etc.

SA 500.2.6 To demonstrate an awareness of cultural, ethnic, gender and religious traditions an ability to supervise out of this awareness.

SUPERVISORY KNOWLEDGE (SK)Supervisory knowledge is designed to increase one’s knowledge of adult learning theory, group dynamics and process, and one’s ability to integrate this knowledge into a supervisory theory.

SK 500.3.1 To be knowledgeable about admissions interviews and selection of students.

SK 500.3.2 To develop and articulate an integrated theory of personality that supports one’s concept of pastoral supervision.

SK 500.3.3 To develop and articulate an understanding of adult learning relevant to the supervision of individuals and groups.

SK 500.3.4 To articulate a theory of group process and dynamics as related to CPE Supervision, which will result in the development of the group’s pastoral formation, pastoral reflection and pastoral competencies.

SK 500.3.5 To articulate a knowledge of CPE’s history as a foundational and experiential learning practice.

SUPERVISORY SKILLS (SS) Supervisory skills are designed to increase one’s skills the development and administation of a supervisory program, to consider cultural and theological experiences within the supervisory relationship and to confidently evaluate students’ growth and development in patoral reflection, pastoral formation, and pastoral competencies.


SS 500.4.1 To demonstate the ability to design, implement and manage a Center of supervised clinical pastoral education according to the educational principles of adult experiential-clinical learning.

SS 500.4.2 To demonstrate the ability to employ diverse clinical educational methods and can provide examples of assisting diverse students in taking responsibility to formulate a plan of learning and to evaluate the results of the learning experience.

SS 500.4.3 To articulate an understanding of individual students’ through awareness of the student's cultural and religious history, sensitivity to the student's psychological and psychosocial patterns, and respect for the student's individual learning style.

SS 500.4.4 To demonstrate the ability and flexibility to respond to individual students, using a wide range of supervisory methods and strategies.

SS 500.4.5 To supervise students’ pastoral work, giving attention to unique patterns of personal and pastoral development, including the ability to assist students’ movement toward a pastoral identity, the ability to practice pastoral reflection and develop pastoral competencies.

SS 500.4.6 To evaluate students’ performance and growth per the requirements of CPEI Standards.

SS 500.4.7 To demonstrate supervisory skills consistent with CPEI’s Code of Professional Ethics.

SS 500.4.8 To demonstrate the skills to write evaluations that highlight students’ growth, pastoral awareness, pastoral identity, and pastoral competencies.


600 CPEI CODE OF PROFESSIONAL ETHICS

PURPOSE OF THE CODE OF PROFESSIONAL ETHICSThe CPEI Code of Professional ethics has the following purposes in mind:

To set forth the ethical obligations for Clinical Pastoral Education Supervisors, Associate CPE Supervisors, CPE Supervisor Candidates (henceforth referred to as Pastoral Supervisors) and Chaplains.

To identify ethical considerations relevant to Pastoral Educators, CPEI students, chaplains. To serve as an ethical guide designed to assist individuals in constructing a course of action

that best serves Pastoral Educators and Chaplains. To provide the basis for processing inquiries and ethical concerns.

PERSONS IMPACTED BY CODE OF PROFESSIONAL ETHICSPersons operating under the auspices of Clinical Pastoral Education International (CPEI) and the Credentialing Commission – Board of Clinical Pastoral Education Supervisors and Chaplains are expected to adhere to the following Code of Professional Ethics.

COMMON ETHICAL STANDARDS FOR PASTORAL SUPERVISORS AND CHAPLAINS

In Relationship with Ecclesiastical and Professional Institutions (600)

600.1 Maintain good standing in their faith group.600.2 Abide by the professional practice and/or teaching standards of the credentialing

organization, and the institution in which are part of. 600.3 Do not directly or by implication claim professional qualifications that exceed actual

qualifications or misrepresent an affiliation with any institution.600.4 Maintain current and adequate Professional Liability Insurance or ensure that one is

adequately protected under one’s employer.

In Relationship with Self, Other Professionals and the Community (601)

601.1 Represent accurately one’s professional qualifications and affiliations.601.2 Exercise good stewardship of resources entrusted to their care and employ sound

financial practices. 601.3 Respect the opinions, beliefs and professional endeavors of colleagues and

professionals. 601.4 Seek advice and counsel of other professionals whenever it is in the best interest of

those being served and make referrals when appropriate. 601.5 Provide expertise and counsel to other professionals in advocating for best practices

in pastoral care and pastoral supervision.


601.6 Seek to establish collaborative relationships with other community leaders, pastoral relationships and healthcare professionals.

601.7 Advocate for changes that would honor spiritual values and promote healing. 601.8 Communicate sufficient information to other professional members and/or pastoral

supervisors while respecting the privacy of those being served. 601.9 Ensure that personal behavior does not impair the ability to fulfill professional

responsibilities or bring dishonor to the profession. 601.10 Clearly distinguish between statements made or actions taken as a private individual

and those made as a member or representative of CPEI or the Board for Clinical Pastoral Education Supervisors and Chaplains.

601.11 Monitor for signs of impairment-emotionally, physically, mentally and spiritually and take the appropriate steps to address such signs.

In Advertising (602)

602.1 Represent one’s competencies, education, training, and experience relevant to their practice of pastoral care, education and supervision in an accurate manner.

602.2 Do not use any professional identification (business cards, letterhead, Internet or telephone directory, etc.) that is false, misleading, fraudulent or deceptive.

602.3 List and claim as evidence only degrees, certification and credentials that are earned from recognized educational institutions and/or training Centers.

In Research (603)

603.1 Engage only in research within the boundaries of their competence.603.2 Ensure that research activities involving human participants are aware of the

research question, design and implementation. 603.3 Adhere to informed consent, including a clear and understandable explanation of the

procedures, a description of the risks and benefits, and the duration of the desired participation.

603.4 Inform all participants of the right to withdraw consent and to discontinue involvement at any time.

603.5 Maintain sensitivity to the cultural characteristics of participants when conducting research.

603.6 Maintain confidentiality of all research participants and inform participants of any limits of that confidentiality.

603.7 Use any information obtained through research for professional purposes only.603.8 Exercise professional ethics in attributing sources in their research and writing

thereby avoiding plagiarism. 603.9 Report research data and findings accurately.

In Relationship to the Social Media (604)Pastoral Supervisors and chaplains are aware that Social Media (for example, Internet, text messaging, e-mail, Twitter, Facebook, blogs, YouTube, LinkedIn, as well as all other forms of electronic/digital communication) influences and informs our daily life and work. We recognize that the World Wide Web records everything that is posted anywhere anytime and retains this information indefinitely.


604.1 Recognize that the CPEI Code of Professional Ethics applies to the use of Social Media.

605.2 Engage in honest and respectful communication both professionally and personally in all Social Media activity.

605.3 Maintain a clear professional identity and refrain from developing inappropriate Social Media relationship with students, other individuals.

605.4 Do not speak formally or informally on behalf of CPEI or The Board for Clinical Pastoral Education Supervisors and Chaplains when engaging in personal Social Media activity unless authorized to do so.

605.5 Be mindful of the privacy and confidentiality of students and others, and not engage in the use of Social Media in any way, which may pose as a conflict of interest or a breach of another’s privacy and confidentiality.

ETHICAL STANDARDS FOR PASTORAL SUPERVISORS

In Relationships with Students and/or Clients (606)Pastoral Supervisors understand that “students, clients, patients or parishioners” (refer to the sametype of persons served and will be used interchangeably throughout this document) and describesany individual to whom they are providing pastoral supervision or pastoral care.

606.1 Speak and act in ways that honor the dignity and value of every individual.606.2 Provide care and supervision that is intended to promote the best interest of students

and clients and to foster strength, integrity, learning, and healing. 606.3 Demonstrate respect for the cultural and religious values of those they serve and

refrain from imposing their own values and beliefs on those served. 606.4 Acknowledge the imbalance of power in the student and client relationship and

refrain from exploitation of that imbalance. 606.5 Avoid or correct any conflicts of interest or appearance of conflicting interest(s). 606.6 Refrain from any form of exploitative behavior, sexual misconduct, sexual

harassment or sexual assault in relationships with students and clients. 606.7 Refrain from any form of harassment, coercion, intimidation or otherwise abusive

words or actions in relationships with students and clients. 606.8 Safeguard the confidentiality of students and clients when using materials for

educational purposes or written publication. 606.9 Respect the confidentiality of information entrusted to them by students and clients

when communicating with family members or significant others except when disclosure is required for necessary treatment, granted by client permission, for the safety of any person or when required by law.

606.10 Ensure that all student application materials be maintained confidentially.saved in a file, ensure that file is properly locked. If saved electronically, ensure that a confidential password is used.

606.11 Understand the limits of their individual expertise and make referrals to other professionals when appropriate.

606.12 Provide clear expectations regarding responsibilities, appointment schedules, fees and payments.


606.13 Complete all final evaluations for students according to the standards established by CPEI.

606.14 Do not represent the ability to provide supervision beyond one’s appropriate level of education and credentialing.

606.15 Monitor for signs of impairment-emotionally, physically, mentally and spiritually and take the appropriate steps to address such signs.

Video/Audio/Distance Learning Center Standards (607)

607.1 The use of technology (computers, webcams, etc.) are accepted as an industry standard in a variety of professional disciplines, to include Clinical Pastoral Education Centers. Pastoral Supervisors choosing to make use of such a method are to ensure, at a minimum, that participants are knowledgeable as to what is required for participation, how to utilize the required programming, persons are informed when sessions are recorded, and address matters of confidentiality. In addition, the risks and benefits of such use need to be identified.

607.2 Pastoral Supervisors are authorized to use cameras and/or other technological equipment to record individual and/or group peer sessions for supervision and training purposes only. Recorded data will be maintained only to serve the purpose of supervision and/or credentialing after which it will be destroyed.

607.3 Pastoral Supervisors will safeguard client rights and confidentiality of recorded mediums through the use of maintaining the recordings in a secure setting as well as ensure the participants and Pastoral Supervisor review and sign a “Consent to Audio or Video Tape” Form (See below).

Consent to Audio or VideoClinical Pastoral Education Session

I, __________________________________ give my consent for Clinical Pastoral Education (CPE) sessions to be audio/video- taped for supervisory and educational purposes. I understand the tapes may be reviewed in individual and/or small peer group supervision sessions, or credentialing purposes for the person supervising my Clinical Pastoral Education Center. The guidelines of the audio/video-taping procedure, supervision, and confidentiality have been explained to me. The audio/video-tapes will be erased upon the completion of the credentialing process for those supervising my Clinical Pastoral Education experience.

(Name of Supervisor) _____________________________________ who is providing is involved in a CPEI approved supervisory program and affiliated with the following training Center ________________________________________. As part of the training s/he is required to tape some sessions. S/he is being supervised by _______________________________________, who can be reached at__________________ (phone) or ___________________________________(email).

CPE Student’s Name and SignatureNAME: ______________________________________________________________________SIGNATURE: _________________________________________________________________DATE: _______________________________________________________________________Person Supervising Clinical Pastoral Education


NAME: ______________________________________________________________________SIGNATURE: _________________________________________________________________DATE: _______________________________________________________________________700 PROCESS FOR HANDLING COMPLAINTS AND GRIEVANCESThe purpose is to provide a comprehensive mechanism for handling complaints and grievances within the CPEI community. Each accredited CPEI educational Center will develop their specific guidelines for handling complaints and grievances.

Members of the CPEI community are required to maintain the highest level of personal, professional, moral, and ethical standards. When moral and ethical standards are in question, the following provides guidance for engaging the person(s) and resolving the issue(s). These engagements are expected to be redemptive and problem-solving in intent and nature.

DEFINITIONS (700.1)700.1.1 A complaint is an informal issue of a perceived conflict, which

should be resolved at the lowest level.

700.1.2 A grievance is a formal concern that is presented in writing and signed and involves an alleged violation related to the CPEI Code of Professional Ethics. The grievance must specify the standard or process that is an alleged violation.

GUIDING PRINCIPLES (700.2)700.2.1 Issues are encouraged to be resolved at an informal level, face-to-face, and in a

spirit of collegiality and mutual respect.

700.2.2 Issues that are unable to resolved in the informal level can be elevated in a written and signed formal grievance, which must identify the specific CPEI Code of Ethics Standard allegedly violated.

700.2.3 Confidentiality is of upmost importance. Persons involved in an investigation, mediation, fact finding, and record keeping shall respect the confidentiality of all parties as far as possible without impeding the pursuit of truth or violating state laws.

700.2.4 Persons that have a bias or conflict of interest will be removed from any aspect of a grievance process.

COMPLAINT (INFORMAL) (700.3)CPEI encourages persons to resolve concerns informally, face-to-face, and in a spirit of collegiality and mutual respect.

GRIEVANCE (FORMAL) (700.4)


700.4.1 Use of the formal grievance procedure is limited to circumstances in which all efforts to resolve the issue have been exhausted at the informal level and must involve a specific alleged violation of CPEI Code of Ethics Standard.

700.4.2 A formal grievance must be submitted in writing and signed. It must also identify the specific CPEI Code of Ethics Standard that has been allegedly violated.

700.4.3 The grievance will be filed with the Ethics Chair for CPEI.

700.4.4 All steps involved in this process will be recorded.

INVESTIGATION AND RESOLUTION PROCESS (700.5)700.5.1 The ethics chair and an appointed consultant will conduct an initial inquiry via

a telephone or internet live-connection within 30 days of the filed grievance to determine if the alleged conduct were in response to a CPEI Code of Ethics Standard and if an agreeable resolution can be reached.

700.5.2 If a resolution has not been reached, the Ethics Chair will appoint a mediator to facilitate discussion between the parties involved. This will occur within 30 days of the initial inquiry’s final action. If an agreeable solution is reached the matter will be settled.

700.5.3 If mediation does not bring resolution to the issue, a formal review panel will be initiated. The Chair of the Ethics Committee will appoint a 3-person panel and invite all parties involved to participate, at their own expense. After hearing the evidence and deliberating the Panel shall decide:700.5.3.1. that no violation occurred.700.5.3.2 that no violation occurred, but there were concerns that needed to

be addressed. If this occurs the following steps are available for theHearing Panel.

700.5.4 Actions by Hearing Panel might include:700.5.4.1 Admonishment. A written statement issued that acknowledges the

CPEI Code of Ethics Standard was violated, and that continued education that addresses the ethical standard be required.

700.5.4.2 Probation. The person found guilty of an ethical violation will be monitored for a period to ensure that s/he remains compliant. Continued education may also be a requirement or other requirements set forth by the Panel.

700.5.4.3 Suspension. If the person found guilty of an ethical violation does not understand the seriousness of the violation and/or fails to take responsibility for their actions the panel can suspend the individual for periods of 3 to 12 months based on the nature and consequences of the violation.

700.5.4.4 Removal of Credentials. The individual who refuses to accept responsibility for the violation and demonstrates no remorse shall


have his/her credentials removed. The actions of the Hearing Panel are final.

APPENDICES

Appendix A – CPE Applications Appendix A-1: CPEI Student Application Appendix A-2: CPEI Supervisory Application

Appendix B – Program Evaluation and Compliance Report Forms Appendix B-1: Completion of Student Unit Report Appendix B-2: CPE Center Annual Compliance Report Appendix B-3: Onsite Mentor / Coordinator Assessment Form Appendix B-4: CPE Student Assessment of Learning Experience

Appendix C – Student and Supervisor Evaluation Forms Appendix C-1: Student Mid Unit Evaluation (Sample) Appendix C-2: Student Final Evaluation (Sample) Appendix C-3: Supervisor’s Narrative Final Evaluation of Student Appendix C-4: Supervisor’s Likert Scale Final Evaluation of Student Appendix C-5: Supervisor’s Narrative Evaluation for Supervisory Student Appendix C-6: Supervisor’s Likert Scale Evaluation for Supervisory Student

Appendix D – Sample CPE Internship Interagency Memorandum of Agreement

Appendix E – Sample Curriculum Appendix E-1 Sample CPE Curriculum Appendix E-2: Sample Supervisory Curriculum

Appendix F – Sample CPE Resident/Intern Training Agreement

Appendix G – Sample Student/Supervisor Agreements Appendix G-1: Sample Student/Supervisor Disclosure Agreement Appendix G-2: Sample#1 MOU Between Training Supervisor and Supervisory

Students Appendix G-3: Sample#2 MOU Between Training Supervisor and Supervisory

Students



Appendix A-1CPEI CPE APPLICATION

APPLICANT DEMOGRAPHICSName (Last, First, MI): Marital Status: Single Married Divorced

Street/P.O. Box:

City, State, Zip:

Email: Email:

Cell: Business:

FAITH GROUP AFFILIATIONName of Faith Group/Religious Affiliation: Ward & Stake, Presbytery, Diocese,

Conference, Association, Synod, etc.

Ordination: Yes No Date of Ordination:

EDUCATION DEGREE / DATECollege:

Graduate:

Graduate:

Other:

PREVIOUS CLNICAL PASTORAL EDUCATIONCENTER SUPERVISOR DATES


REFERENCES EMAIL PHONE

ESSAYS, RESUME & SIGNATURE1. Personal History. A description of your life story, including important events, relationships with people who have been significant to you, and the impact these events and relationships have had on your development. Describe your family of origin and your current family relationships.

2. Religious Development: A description of the development of your religious life, including events and relationships that affected your faith and currently inform your belief system.

3. Ministry Account: An account of an incident in which you were called to help someone, including the nature of the request, your assessment of the need, what you did, and a summary evaluation. If you had previous CPE, include information in pastoral conversation (verbatim) format.

Resume/ CV: Attach a copy of your resume or CV:

Acknowledgement and Signature: I certify that all information in this application is factually true, complete, and honestly presented. I understand that I may be subject to disciplinary action, including admission revocation or program expulsion, should the information I have certified be false. I hereby give permission to the CPEI center to which I am applying to contact my references about matters pertaining to this current application.

I understand that my printed signature constitutes my electronic signature.

Printed Name: Date:

Appendix A-2


CPEI Supervisory Education Application

Applicant Information Name: Marital Status:

Address: Street/P.O. Box: City/State/Zip:

Personal Email:

Work Email:

Home Phone:

Cell Phone:

Work Phone:

Denomination/Faith Group Information

Name of Faith Group/Religious Affiliation: Ward & Stake, Presbytery, Diocese, Conference, Association, Synod, etc.

Ordained? YES NO

Date of Ordination:

Education

Degree & Year

College:

Seminary:

Graduate Study:

Previous Clinical Pastoral Education

Date Center Supervisor


References and Addresses (name, telephone, city, email)

Denomination/Faith Group:

Academic:

Other:

See Clinical Pastoral Education International Credentialing Manual for Entrance RequirementsPersonal History. Demonstrate your awareness of how significant relationships and events have helped to shape your life and the ways you envision functioning as a supervisory candidate.

Theological Development: Briefly describe your theological journey and development.

Vocational History: Attached a CV/Resume

Supervisory Aspiration: Briefly describe your interest in Supervisory Education and your ultimate goals as a CPE Supervisor.

Acknowledgement and Signature: I certify that all information in this application is factually true, complete, and honestly presented. I understand that I may be subject to disciplinary action, including admission revocation or program expulsion, should the information I have certified be false. I hereby give permission to the CPEI center to which I am applying to contact my references about matters pertaining to this current application.

I verify that if sending in this application electronically it constitutes my electronic signature.

Signature: Date:


Appendix B-1

Completion of Student Unit ReportSubmit This Report Form with 45 Days of Unit Completion

Name of CPE Center

Address of CPE Center (P.O. Box /Street/City/State)

Telephone

Email

Dates of CPE Unit

Supervisor(s) Conducting CPE Name of CPE Supervisor(s) Student Name Type of Unit Clinical Site

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other: Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:


Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:

Extended

Intensive

Supervisory

Hospital

Hospital

Congregation/Parish

Other:


Appendix B-2Annual Compliance Report

Submit This Report Form Annually, Prior to December 31

Name of CPE Center

Address of CPE Center (P.O. Box/Street/City/State)

Telephone

Email

Dates of CPE Unit(s)

Affiliated CPE Staff (Name) Credential of CPE Supervisor ☐ Candidate

☐ Associate Supervisor☐ Supervisor

☐ CPE Candidate☐ CPE Associate Supervisor☐ CPE Supervisor



Check List of Annual Compliance Check (Yes) for Compliance

Check No for Non-Compliance- Provide a Comment/ Explanation

Student unit completion reports were submitted within 45 days of unit completion. (If not, please explain.)Comment:

☐ Yes☐ No

Credentialing fees are up to date for CPE staff. (If not, please explain.)Comment:

☐ Yes☐ No

Annual accreditation fees are up to date. (If not, please explain.)Comment:

☐ Yes☐ No

Student final evaluations were submitted within 45 days of unit completion. (If not, please explain.)Comment:

☐ Yes☐ No

Advisory Committee (AC) was consulted during the year. (If not, please explain.)Comment:

☐ Yes☐ No


The student handbook is current and includes all required policies and procedures outlined in the CPEI Standards. (If not, please explain.)Comment:

☐ Yes☐ No

Changes in supervisory staff have been communicated to CAPE. (If not, please explain.)Comment:

☐ Yes☐ No

Required continuing education hours for all supervisory staff have been met. (If not, please explain.)Comment:

☐ Yes☐ No

As Applicable: Clinical Internship Agency Affiliate Agreements have been maintained for all students assigned outside the primary agency (Institution). (If not, please explain.)Comment:

☐ Yes☐ No

As Applicable: Professional liability insurance is maintained by all supervisors, students and tiers. (If not, please explain).Comment:

☐ Yes☐ No

Formal complaints or ethical violations brought against the CPE supervisory staff and subsequent resolutions have been communicated to CAPE. (If not, please explain).Comment:

☐ Yes☐ No


Appendix B-3

ONSITE MENTOR/COORDINATOR ASSESSMENT

Thank you for partnering with Clinical Pastoral Education International by providing your investment and support to a CPE student. Please complete the form and review with the student/supervisee. Ensure signatures are attached and email a copy to the student. It is the student’s responsibility to ensure it is properly submitted to the CPE Supervisor.

These forms can be provided both mid-unit and during the final week of the CPE Unit.

Date of Completion: Supervisor’s Name: Student’s Name: Clinical Site:

I. Please evaluate the student’s performance by placing an (X) by the phrase that best describes the student’s abilities related to the following competencies and expectations.

5- Exceeded 4- Met 3- Partially Met 2- Minimally Met 1- Deficiencies NA-Not Observed

RELATIONSHIPS WITH PATIENTS, CLIENTS, STAFF, ETC: 5 4 3 2 1 NAEasily establishes working and collaborative relationships.Recognizes personal issues that affect one’s pastoral care.Demonstrates the ability to exercise non-anxious presence in emotionally charged circumstances.Accepts individuals in a nonjudgmental way.Demonstrates the ability to track with patient/clients by using, open-ended questions and listening for conversational themes.KNOWLEDGE OF AND APPLIED PASTORAL CARE SKILLS: 5 4 3 2 1 NADemonstrates understanding and sensitivity related to gender, class, race, etc.Possesses the ability to assess systems and navigate family dynamics.Demonstrates the ability to provide non-anxious presence.Exercises the ability to be a compassionate presence to family and staff during a patient’s dying process.

Demonstrates the ability to set aside personal and religious agenda(s).Demonstrates the ability to use appropriate pastoral intervention, services, and to provide a pastoral presence.5- Exceeded 4- Met 3- Partially Met 2- Minimally Met 1- Deficiencies NA-Not Observed

RESPONSE TO SUPERVISOR: 5 4 3 2 1 NAForms working relationship with Mentor/On Site Coordinator.Seeks consultation and advice for challenging issues.Handles feedback well.Demonstrates ability to receive feedback and handles it well.PERSONAL AND PROFESSIONAL CONDUCT: 5 4 3 2 1 NAConveys confidence.Recognizes personal issues that affect one’s pastoral care.Demonstrates the ability to navigate the clinical setting and handle multiple requests for pastoral care and presence.Demonstrates the ability to share pastoral/spiritual assessments with


interdisciplinary/organizational staff while maintaining appropriate confidentiality.Behaves ethically and responsibly with clients, colleagues, and others.Demonstrates the ability to follow organizational policies and procedures.Additional Comments or Recommendations: The student is making program toward completion of the required 300 hours. YES NO

By entering your name via a keypad, mouse, or other device constitutes your signature, acceptance, and agreement as if actually signed by you in writing and has the same force and effect as a signature affixed by hand.

Mentor/Coordinator’s Signature Date

Student’s Signature Date


Appendix B-4CPE Student Learning Experience Assessment

This evaluation provides your Supervisor and the CPE Center a way to learn about your CPE experience and assists in ongoing quality assurance and improvement. Please complete this form and return it after receiving your final evaluation.

Dates of CPE Unit:

Supervisor’s Name:

Total number of units of CPE Completed:

Please use the following scale for your answers and feel free to add comments.

1 – Somewhat Positive 2 – Mostly Positive 3 – Very Positive4 – N/A

Personal Learning and Ministry Development: This unit of CPE provided me opportunity to:

1 2 3 N/A

Develop my personal and pastoral identity.

Comments:

Increase my awareness of how my ministry impacts others.

Comments:

Develop my ability to reflect upon and critically analyze my theology or theological heritage.

Comments:

Develop my pastoral care skills in making initial pastoral visits.

Comments:

Develop my pastoral skills in working with and ministering to persons from diverse faith and cultural backgrounds.

Comments:

Foster my ability to evaluate my own ministry.

Comments:

Increase my ability to make use of the behavioral/social sciences.

Comments:

CPE Program: I felt (1) somewhat positive / (2) mostly positive / (3) very positive about:

1 2 3 N/A

The orientation to CPE and my clinical / ministry duties.

Comments:

The diverse pastoral care opportunities provided to me.

Comments:


The didactic material used for this unit.

Comments:

The group /peer experience.

Comments:

The learning environment, i.e., furnishing, technology used, etc.

Comments:

The opportunity to pursue my areas of interest in the clinical / ministry setting.

Comments:

Quality of Supervision: I felt (1) somewhat positive / (2) mostly positive / (3) very positive about:

1 2 3 N/A

Individual supervision.

Comments:

Group Supervision.

Comments:

My supervisor’s professional behavior.

Comments:

Confidence in my supervisor’s skills and knowledge.

Comments:

Additional Comments:

Thanks for your assistance in providing this feedback. If needed, is it acceptable to use your comments in the CPE Student’s final evaluation? YES NO

PLEASE RETURN TO (Email is the preferred method):


Appendix B-4CPE STUDENT MID-UNIT EVALUATION FORMAT

Student:

Supervisory Student:

Training Supervisor:

Dates of CPE Unit:

Type of Unit:

Personal

1. Present yourself (age, marital status, cultural or ethnic background, etc.)

2. Describe your clinical setting and your assignment(s) in that setting, e.g., on-call, initial visits, etc.

Pastoral Formation/Pastoral Reflection/Pastoral Competencies

3. State your learning goals and provide a statement of how you are progressing with each one. Do your learning goals need to be modified? If so, how would you recommend they be modified to meet your learning needs?

4. Discuss what you are learning about yourself, i.e., integration of personal history and pastoral functioning; pastoral identity, pastoral authority).

5. Briefly describe your relationship with your peers. Are you receiving what you need from them? If not, what more do you need?

6. Briefly describe your relationship with your CPE Supervisor. Are you receiving what you need? If not, what more do you need?

7. Briefly describe the relationship with your supervisor at your ministry site. Are you receiving what you need? If not, how do you plan on addressing your concerns with your supervisor?

Appendix B-2Updated June 16, 2019 Page 36 of 71

CPE STUDENT FINAL EVALUATION FORMAT

Student:



Dates of CPE Unit:

Type of Unit:

Personal

1. Present yourself (age, marital status, cultural or ethnic background, etc.)

2. Describe your clinical setting and your assignment(s) in that setting, e.g., on-call, initial visits, etc.

Pastoral Formation/Pastoral Reflection/Pastoral Competencies

3. Identify your learning goals.

4. Identify progress that you made in each of your learning goals. Provide examples.

5. Describe how your personal strengths and limitations are utilized in your ministry. Be sure and give attention to your personal story and insights gained from your genogram and the impact it has on your personal and pastoral identity and pastoral competencies.

6. State your understanding of how this learning experience has challenged, confirmed and/or changed your embedded/deliberate theologies. Provide examples.

7. Identify (first names are acceptable) each of your peers and provide a brief description of your relationship with them. What have you learned about yourself from each of your peers?

8. As applicable - evaluate the relationship with your clinical site mentor/coordinator. Describe how you made use of your supervisor at your ministry site. Did you experience any problems? If so, please identify.

9. Evaluate your relationship with your CPE Supervisor. How have you used supervision? What have you learned about the way you relate to authority figures?

10. What are your future learning goals and how do you envision working toward them?

11. Identify key elements in this CPE experience that facilitated your learning and your development.

Appendix C-3Supervisor’s Final Narrative Evaluation for CPE Students


Student:



Dates of CPE Unit:

Type of Unit:

This evaluation is a confidential document containing observations and reflections of the student named above and their educational experience during this unit of Clinical Pastoral Education. It will only be released by with the student’s written permission. This evaluation should be read in conjunction with the student’s final self-evaluation in order to receive a full picture of the educational process which was engaged.

Certification

I certify that has successfully met the requirements for one unit of Clinical Pastoral Education as certified by Clinical Pastoral Education International (CPEI)).

Introduction of the Student

Student’s Clinical Assignment(s)

CPE Program Description

Description of Student’s Learning Goals


Scoring Rating (Please use the following rating scale and assign a number to each competency below).

Supervisor Evaluation Legend

The following evaluation is based on the CPEI Outcomes for Pastoral Formation (2001.1-200.1.3), Pastoral Reflection (300.1.1-300.1.2), and Pastoral Competence (400.1.1-400.1.4), which can be found in the CPEI Standards Manual.

Please evaluate the student’s performance by placing an (X) by the phrase that best describes the student’s abilities related to the following competencies and expectations.

Fully Meets Outcomes: 4 Mostly Meets Outcomes: 3

Partially Meets Outcomes: 2 Beginning to Meet Outcomes: 1

Not Started on Outcome: 0

Pastoral Formation and Identity (PF): Objective: PF 200.1 To develop self-awareness for personal and professional growth. 4 3 2 1 0

Outcome: 200.1.1: Students possess the ability to assess/process life events and relationships that influence and inform one’s view of self and their personal and professional functioning.

Briefly describe how the student has demonstrated and growth (experience, process, challenges, struggles) related to this learning objective/outcome.

Pastoral Formation and Identity (PF): Objective PF 200.2: To develop awareness of how one’s beliefs, attitudes, strengths, limitations, values and assumptions affect one’s pastoral ministry. 4 3 2 1 0

Outcome: 200.1.2: Students possess the ability to assess/process their embedded theology, personality traits, personal and professional functioning and world view as they seek to provide non-anxious presence to others.

Briefly describe how the student has demonstrated and growth (experience, process, challenges, struggles) in this competency.

Pastoral Formation and Identity (PF): Objective: PF 200.3: To develop sensitivity, openness, and respect for the recipients of pastoral care and applying insights from the social sciences. 4 3 2 1 0

Outcome: 200.1.3: Students possess the ability to appreciate the worth and value of all individuals and to be a non-judgmental empathetic presence to all in need of pastoral care.



Pastoral Formation and Identity (PF): Objective: PF 200.4: To increasingly exercise personal and pastoral leadership and authority. 4 3 2 1 0

Outcome: 200.1.4: Students possess the ability to appropriately exercise personal and pastoral leadership and authority as the need dictates.


Pastoral Reflection (PR): Objective: PR 300.1: To utilize individual and group supervision for personal and professional growth and the capacity to evaluate one's pastoral ministry. 4 3 2 1 0

Outcome 300.1.1: Students possess the ability to seek the consultation and feedback from their supervisor and peer group as they process dynamic issues that arise out of their personal and professional functioning.


Pastoral Formation and Identity (PF): Objective PR 300.2: To develop the ability make use of the peer group for support, dialogue, consultation, and feedback as a means of integrating personal and professional characteristics and competencies into one’s pastoral ministry. 4 3 2 1 0

Outcome 300.1.2: Students possess the ability to reflect on their pastoral functioning through group dynamics and to understand that the group functioning illustrates to the supervisor and peers how one does pastoral care with othersBriefly describe how the student has demonstrated and growth (experience, process, challenges, struggles) in this competency.

Pastoral Competence (PC): Objective: PC 400.1: To develop the capacity to conduct pastoral/spiritual assessments and appropriate pastoral interventions. 4 3 2 1 0

Outcome 400.1.1: Students possess the ability to utilizes a spiritual assessment tool that will clearly communicate spiritual needs and pastoral interventions to medical and other staff with a need to know.


Pastoral Competence (PC): Objective PC 400.2: To demonstrate awareness of one's pastoral presence in interdisciplinary relationships and develop the capacity to communicate orally and in writing to contribute to the plan of care. 4 3 2 1 0


Outcome 400.1.2: Students possess the ability to function as a team member with all disciplines represented in the clinical environment without losing objectivity due to being too close.


Pastoral Competence (PC) Objective PC 400.3: To gain knowledge of and abide by ethical principles in the practice of one’s ministry and serve as an advocate for persons in need. 4 3 2 1 0

Outcome 400.1.3: Students possess the ability to function ethically and stand in the gap when needed after first discerning both sides of an issues and ensuring that triangulation does not occur.


Pastoral Competence (PC) Objective PC 400.4: To develop pastoral care skills as a means of providing pastoral care to individuals and groups from diverse cultural, ethnic, gender, and religious backgrounds. 4 3 2 1 0

Outcome 400.1.4: Students possess the ability to function in a professional manner that respects diversity and the pluralistic society in which one practices.


Peer Group and Supervision 4 3 2 1 0

How has the person used the peer group for support, dialogue and feedback in a way which will assist her/him in integrating personal characteristics into the pastoral role?

Briefly describe the student’s peer group- Comments:

Individual Supervision 4 3 2 1 0

How has the person used the individual supervision for support, dialogue and feedback in a way which will assist her/him in integrating personal characteristics into the pastoral role?

Comments:


Summary: CPE Supervisor what recommendations would you give this person in terms of his/her expressed learning and goals (present and future)?

Comments:

SummaryThis evaluation reflects the student’s ability to engage the standards, objectives and expected outcomes for Clinical Pastoral Education as set forth by the Standards for Clinical Pastoral Education International (CPEI). The student has had the opportunity to review this final evaluation and is free to add an addendum to this document. This document will be on file with the center for three years in accordance with CPEI Standards and will not be released to anyone without permission. Site members for CAPE accreditation may have access to confirm compliance with policies.

I understand that by entering my name constitutes my signature and agreement and it has the same force and effect as a signature affixed by hand.

Student’s Signature: Date:

Supervisor’s Signature: Date:

Supervisory Student’s Signature (as applicable): Date:


Appendix C-4

FINAL EVALUATION – SUPERVISOR’S REPORT

FOR CPE STUDENTS (LIKERT EVALUATION)

CLINICAL PASTORAL EDUCATION

Accredited by: The Commission on Accreditation for Pastoral Education (CAPE)

Student:

Supervisor:

Student Unit:

Dates of Unit:

Completion Status:

Type of Unit (Intensive or Extended):

This evaluation is a confidential document containing observations and reflections of the student named above and their educational experience during this unit of Clinical Pastoral Education. It will only be released with the student’s written permission. This evaluation should be read in conjunction with the student’s final self-evaluation in order to receive a full picture of the educational process which was engaged.

CertificationI certify that has successfully met the requirements for one unit of Clinical Pastoral Education as certified by Clinical Pastoral Education International (CPEI).

Introduction of Student

Program StructureA CPE unit/group consists of student interns who have been selected from an application and interview process. A unit requires 400 hours of supervised education to complete. Up to 300 hours of the student intern’s time is in the clinical setting where they respond to pastoral and spiritual care needs of patients, family members, staff and others. The remaining 100 hours include the following: A gathering time for spiritual leadership, feedback and re-connecting purposes Didactic presentations in pastoral theology and pastoral practice Verbatim reports (case studies) Healthcare and community resource presentations Reading seminars Group time for interpersonal relationship issues Individual supervision time with the CPE supervisor.


Individual Supervisory Sessions


The following evaluation is based on the CPEI Outcomes for Pastoral Formation (2001.1-200.1.3), Pastoral Reflection (300.1.1-300.1.2), and Pastoral Competence (400.1.1-400.1.4), which can be found in the CPEI Standards Manual.

Please evaluate the student’s performance by placing an (X) by the phrase that best describes the student’s abilities related to the following competencies and expectations.

Fully Meets Outcomes: 4 Mostly Meets Outcomes: 3

Partially Meets Outcomes: 2 Beginning to Meet Outcomes: 1

Not Started on Outcome or NA: 0

PASTORAL FUNCTIONING CPEI Outcomes 4 3 2 1 0

Ability to center self and engage a patient/client with confidence.

PF 200.1.1 PF 200.3.1

Ability to make a pastoral/spiritual assessment based on the patient/client’s perceived ability at the time of the visit.

PC 400.1.1

Ability to use appropriate pastoral intervention, services, and to provide a pastoral presence.

PC 200.3.1

Ability to chart spiritual assessment effectively fulfilling Joint Commission standards.

PF, 200.4.1 PC 400.1.1 PC 400.2.1

Ability to set aside personal and religious agenda(s). PC 200.3.1

Ability to follow organizational policies and procedures. PF 200.4.1 PC 400.4.1

Ability to navigate the clinical setting and handle multiple requests for pastoral care and presence.

PC 200.2.1PC 200.4.1

Ability to incorporate new clinical processes into pastoral functioning.

PC 200.4.1PF 400.3.1

INTERDISCIPLINARY FUNCTIONING CPEI Outcomes 4 3 2 1 0

Ability to participate in collaborative decision making and problem solving with other caregiving professionals.

PC 400.2.1

Ability to consult, collaborate and communicate with other caregiving professionals

PC 400.2.1


Demonstrates the ability to debrief with staff/leaders/others after crisis events.

PF 200.2.1PR 300.1.1PC 400.2.1

Ability to be relational with staff/leaders/others while keeping appropriate boundaries.

PF 200.4.1 PC 400.3.1

Ability to share pastoral/spiritual assessments with interdisciplinary/organizational staff while maintaining appropriate confidentiality.

PC 400.1.1 PC 400.2.1

GROUP DYNAMICS CPEI Outcomes 4 3 2 1 0

Ability to enter into personal processing and to be able to identify and as appropriate acknowledge personal issues during group and individual supervision.

PR 300.1.1

Ability to be pastoral with peers. PR 300.1.1

Ability to be direct with peers. PF 200.4.1 PR 300.1.1

Ability to give and receive feedback during group time. PR 300.1.1

Ability to seek clarification and navigate confrontation within group.

PF 200.4.1PR 300.1.1

Ability to be present for others without having personal issues interrupt or usurp their processing.

PF 200.4.1PR 300.1.1

EDUCATIONAL FUNCTIONING CPEI Outcomes 4 3 2 1 0

Ability to complete the unit educational requirements. PF 200.1.1 PF 200.2.1 PF 200.4.1

Ability to engage the didactic material for learning purposes.

PF 200.1.1 PF 200.2.1 PF 200.4.1

As appropriate, ability to chart effectively in the electronic medical records.

PF 200.4.1 PC 400.1.1 PC 400.2.1

Ability to establish appropriate personal and professional learning objectives for the unit.

PF 200.4.1

Ability to provide devotional material relevant to the CPE process.

PF 200.2.1 PF 200.4.1

Ability to engage process education and utilize the Action/Reflection/Action model of learning.

PF 200.2.1 PF 200.4.1


SELF-REFLECTION/AWARENESS CPEI Outcomes 4 3 2 1 0

Ability to exercise non-anxious presence in emotionally charged circumstances.

PF 200.2.1 PF 200.4.1 PR 300.2.1 PC 400.4.1

Demonstrates the ability to be conversant with past hurts and disappointments on a personal/professional level.

PF 200.2.1 PF 200.4.1 PR 300.2.1 PC 400.4.1

Ability to engage shadow self. PF 200.1.1 PF 200.4.1 PR 300.1.1

Ability to understand and engage one’s own personality traits.

PF 200.1.1 PF 200.4.1 PR 300.1.1

Ability to understand and process family of origin issues. PF 200.1.1 PF 200.4.1 PR 300.1.1

Ability to possess a clear sense of ministry or spiritual direction.

PF 200.1.1 PF 200.4.1 PR 300.1.1

ENGAGING PATIENTS/CLIENTS CPEI Outcomes 4 3 2 1 0

Ability to track with patient/clients by using, open-ended questions and listening for conversational themes.

PF200.1.1 PF 200.3.1 PF 200.4.1 PR 300.1.1

Ability to become a patient/client advocate when/if needed.

PF 200.1.1 PF 200.3.1PF 200.4.1 PR 300.1.1 PC 400.3.1

Ability to stay focused on the patient/client when family members/friends seek to interject into the pastoral conversation.

PF 200.3.1 PF 200.4.1

Ability to facilitate patient/client processing. PF 200.3.1 PF 200.4.1

Ability to allow the patient to tell their story without interjecting personal events that may parallel a life event.

PF 200.1.PF 200.2.1PF 200.3.1PF 200.4.1


THEOLOGICAL/SPIRITUAL REFLECTION CPEI Outcomes 4 3 2 1 0

Ability to self-reflect theologically and spiritually patient/client visits or crisis events.

PF 200.2.1

Ability to assess and evaluate embedded and deliberate theology in self and others.

PF 200.2.2 PF 200.3.1 PF 200.4.1

Ability to provide sacramental and religious rites as requested.

PF 200.2.1 PF 200.3.1 PF 200.4.1

Ability to inquire about theological and spiritual symbols to better understand their meaning.

PF 200.2.1 PF 200.3.1 PF 200.4.1 PR 300.1.1 PR 300.1.2

Ability to remain present for patients/clients with various faith perspectives.

PF 200.2.1 PF 200.3.1 PF 200.4.1

SYSTEMS DYNAMICS & AWARENESS CPEI Outcomes 4 3 2 1 0

Ability to assess systems and navigate family dynamics. PF 200.2.1 PF 200.3.1 PF 200.4.1

Ability to remain calm and focused during family struggles.

PF 200.2.1PF 200.3.1 PF 200.4.1

Ability to communicate family dynamics to healthcare staff effectively.

PF 200.2.1 PF 200.3.1 PF 200.4.1

Ability to establish a pastoral bond with families in crisis situations.

PF 200.2.1 PF 200.3.1PF 200.4.1

Ability to assess behavioral dynamics within a family system.

PF 200.2.1 PF 200.3.1PF 200.4.1

Ability to assess the impact stage of grief upon family functioning.

PF 200.2.1 PF 200.3.1 PF 200.4.1

CRISIS FUNCTIONING CPEI Outcomes 4 3 2 1 0

Ability to provide non-anxious presence. PF 200.2.1PF 200.3.1 PF 200.4.1


Ability to defuse/debrief with staff after a major crisis or trauma event.

PF 300.1.1 PR 300.2.1 PC 400.2.1

Ability to function effectively with local authorities during a crisis or traumatic event.

PF 200.2.1 PF 200.3.1 PF 200.4.1

Ability to be present during a mass casualty event and function as a team member event.

PF 300.1.1 PR 300.2.2 PC 400.2.1

GRIEF AND LOSS CPEI Outcomes 4 3 2 1 0

Ability to be a compassionate presence to family and staff during a patient’s dying process.

PF 200.2., PF 200.3.1 PF 200.4.1

Ability to process the impact stage of grief with family members and staff.

PF 200.2., PF 200.3.1 PF 200.4.1

BEHAVIORAL ASSESSMENT CPEI Outcomes 4 3 2 1 0

Ability to assess psycho-social dynamics in patients and family members.

PF 200.2.1PF 200.3.1 PF 200.4.1 PR 3001.1 PR 300.2.1 PC 400.2.1

Awareness of personality issues that may affect patient/client’s functioning.

PC 200.1.1 PR 300.1.1

Peer Group and Supervision 4 3 2 1 0

How has the person used the peer group for support, dialogue and feedback in a way which will assist her/him in integrating personal characteristics into the pastoral role?

Identify each peer by initials or first names, the peer’s faith//religious affiliation, location of the peer’s clinical settings.

Briefly describe how the CPE student interacted with his/her peer group.

Individual Supervision 4 3 2 1 0


How has the person used the individual supervision for support, dialogue and feedback in a way which will assist her/him in integrating personal characteristics into the pastoral role?

Comments:

Summary: As a CPE Supervisor what recommendations would you give this person in terms of his/her expressed learning and goals (present and future)?

Comments:



Student’s Signature: Date:




Appendix C-5

CPE SUPERVISOR’S NARRATIVE EVALUATION REPORT



Dates of CPE Unit:

This evaluation is a confidential document containing observations and reflections of the supervisory student named above and their educational experience during this unit of Clinical Pastoral Education. It will only be released by with the student’s written permission. This evaluation should be read in conjunction with the student’s final self-evaluation in order to receive a full picture of the educational process which was engaged.

Certification

I certify that has successfully met the requirements for one unit of Supervisory Education as certified by Clinical Pastoral Education International (CPEI)).

Introduction of the Supervisory Student

CPE Supervisory Description

Scoring Rating (Please use the following rating scale and assign a number to each competency below).

The following evaluation is based on the CPEI Supervisory Objectives and Outcomes for Supervisory Awareness (SA 500.2.1-500.2,6), Supervisory Knowledge (SK 500.3.1-500.3.4), and Supervisory Skills (SS 500.4.1-500.4.8) which can be found in the CPEI Standards Manual.

Please evaluate the one’s by placing an (X) by the phrase that best describes the supervisory student’s abilities related to the following competencies and expectations.

Supervisory Awareness (SA) - is designed to demonstrate one’s self-awareness as a supervisor, the ability to establish and understand the interactive dynamics involved in a supervisory alliance, and to integrate one’s understanding human development into a supervisory theory.

SA 500.2.1: To demonstrate use of one’s personality, religious and cultural history as a teaching resource in shaping a personal supervisory style. 4 3 2 1 0

Briefly describe how the supervisory student has demonstrated growth and development related to this learning objective/outcome.


SA 500.2.2: To demonstrate the use of one’s strengths and limits and personal history as teaching tools and as resources in shaping one’s supervisory style. 4 3 2 1 0


SA 500.2.3: To demonstrate awareness of the supervisor-student power imbalance and to know to use it for learning purposes. 4 3 2 1 0


SA 500.2.4: To demonstrate awareness of a supervisory alliance and issues related to transference and countertransference and anxiety and learning, resistance, parallel process.

4 3 2 1 0


SA 500.2.5: To demonstrate an awareness of the supervisory literature, which includes, but is not limited to a review of human development, adult learning, clinical supervision, etc. 4 3 2 1 0


SA 500.2.6: To demonstrate an awareness of cultural, ethnic, gender and religious traditions an ability to supervise out of this awareness. 4 3 2 1 0


Supervisory Knowledge (SK) – is designed to increase one’s knowledge of adult learning theory, group dynamics and process, and one’s ability to integrate this knowledge into a supervisory theory.SK 500.3.1: To be knowledgeable about admissions interviews and selection of students. 4 3 2 1 0


.

SK 500.3.2: To develop and articulate an integrated theory of personality/human development that supports one’s concept of pastoral supervision. 4 3 2 1 0



SK 500.3.3: To develop and articulate an understanding of adult learning relevant to the supervision of individuals and groups. 4 3 2 1 0


SK 500.3.4: To articulate a theory of group process and dynamics as related to CPE Supervision, which will result in the development of the group’s pastoral formation, pastoral reflection and pastoral competencies.

4 3 2 1 0


SK 500.3.5: To articulate a knowledge of CPE’s history as a foundational and experiential learning practice. 4 3 2 1 0

Supervisory Skills (SS) – is designed to increase one’s skills the development and administation of a supervisory program, to consider cultural and theological experiences within the supervisory relationship and to confidently evaluate students’ growth and development in patoral reflection, pastoral formation, and pastoral competencies.

SS 500.4.1: To demonstate the ability to design, implement and manage a programof supervised clinical pastoral education according to the educational principles of adult experiential-clinical learning.

4 3 2 1 0


SK 500.4.2: To demonstrate the ability to employ diverse clinical educational methods and can provide examples of assisting diverse students in taking responsibility to formulate a plan of learning and to evaluate the results of the learning experience.

4 3 2 1 0


SK 500.4.3: To articulate an understanding of individual students’ through awareness of the student's cultural and religious history, sensitivity to the student's psychological and psychosocial patterns, and respect for the student's individual learning style.

4 3 2 1 0


SK 500.4.4: To demonstrate the ability and flexibility to respond to individual students, using a wide range of supervisory methods and strategies. 4 3 2 1 0



SK 500.4.5: To supervise students’ pastoral work, giving attention to unique patterns of personal and pastoral development, including the ability to assist students’ movement toward a pastoral identity, the ability to practice pastoral reflection and develop pastoral competencies.

4 3 2 1 0

SK 500.4.6: To evaluate students’ performance and growth per the requirements of CPEI Standards. 4 3 2 1 0

SK 500.4.7: To demonstrate supervisory skills consistent with CPEI’s Code of Professional Ethics. 4 3 2 1 0


SK 500.4.8: To demonstrate the skills to write evaluations that highlight students’ growth, pastoral awareness, pastoral identity, and pastoral competencies. 4 3 2 1 0

Briefly describe how the supervisory student has demonstrated growth and development related to this learning objective/outcome

Supervisory Network and Other CommentsDescribe the supervisory network and other comments as how one used it for support, dialogue and feedback in a way which will assist one in integrating personal and professional characteristics, knowledge and skills into the role as a supervisor?




Supervisory Student’s Signature Date:


Appendix C-6

CPE SUPERVISOR’S LIKERT SCALE EVALUATION OF SUPERVISORY STUDENTS

Accredited by: The Commission on Accreditation for Pastoral Education (CAPE)

Supervisory Student

CPE Training Supervisor:

Student Unit:

Dates of Unit:

Completion Status:

This evaluation is a confidential document containing observations and reflections of the supervisory student named above and their educational experience during this unit of Clinical Pastoral Education. It will only be released with the student’s written permission. This evaluation should be read in conjunction with the student’s final self-evaluation in order to receive a full picture of the educational process which was engaged.

CertificationI certify that has successfully met the requirements for one unit of Clinical Pastoral Education Supervisory Education as certified by Clinical Pastoral Education International (CPEI).

Introduction of Student

Unit Structure


The following evaluation is based on the CPEI Supervisory Objectives and Outcomes for Supervisory Awareness (SA 500.2.1-500.2,6), Supervisory Knowledge (SK 500.3.1-500.3.4), and Supervisory Skills (SS 500.4.1-500.4.8) which can be found in the CPEI Standards Manual.

Please evaluate the one’s by placing an (X) by the phrase that best describes the supervisory student’s abilities related to the following competencies and expectations.

COMPETENT IN SELF AS A PASTORAL SUPERVISOR CPEI Outcomes 4 3 2 1 0

Ability to use one’s strengths, limitations and personal history to inform one’s supervisory style.

SA 500.2.2


Articulates an awareness of individual students cultural and religious history, sensitivity to the student's psychological and psychosocial patterns, and respect for the student's individual learning style.

SS 500.4.3

Demonstrates the ability to respond to individual students while using a wide range of supervisory methods and strategies.

SS 500.4.4

Demonstrates the ability to use of one’s personality, religious and cultural history as a teaching resource in shaping a personal supervisory style.

SA 500.2.1

Demonstrates an awareness of power imbalance in supervision and uses it for a positive learning environment.

SA 500.2.3

Assesses the supervisory relationship related to issues of transference, countertransference, resistance, etc. and supervises them as a positive learning experience.

SA 500.2.4

COMPETENT IN THEORETICAL BASED PASTORAL SUPERVISION CPEI Outcomes 4 3 2 1 0

Articulates an understanding of and practice of pastoral supervision based on the knowledge of the professional literature relating to the field of clinical supervision.

SA 500.2.5SK 500.3.4

Articulates a theoretical model of human development which is congruent with one’s practice of supervision.

SA 500.2.5SA 500.3.2SK 500.3.4

Demonstrates a theoretical model of adult learning which is congruent with one’s practice of supervision.

SK 500.3.3

Articulates a theoretical model of group dynamics relevant to one’s practice of pastoral supervision.

SK 500.3.3SK 500.3.4

Demonstrates the ability to integrate one’s theology and pastoral supervision.

SA 500.2.1

COMPETENCE IN THE IMPLEMENTATION AND PRACTICE OF PASTORAL SUPERVISION

CPEI Outcomes 4 3 2 1 0

Assesses student readiness to engage in clinical pastoral education.

SK 500.3.1.

Integrates the practice of pastoral supervision which is consistent with one’s theology.

SA 500.2.1


Demonstrates awareness of the cultural and gender contexts of diversity and its implications for the practice of supervisory relationships

SA 500.2.6

Uses group learning dynamics in the relationships and practice of pastoral supervision.

SK 500.3.3SK 500.3.4

Articulates a knowledge of CPE’s history as a foundational and experiential learning practice.

SK 500.3.5

Develops and organizes CPE programs based on appropriate the educational principles of adult experiential-clinical learning.

SS 500.4.1

Demonstrates the ability to evaluate students’ performance and growth.

SS 500.4.6SS 500.4.8

Understands and applies clinical ethics to one’s pastoral supervisory practice.

SS 500.4.7

Demonstrates effective management of a CPE Center.SS 500.4.1

Develops a variety of CPE resources for learning.SS 500.4.2

Demonstrates the ability to supervise students’ pastoral work, giving attention to unique patterns of personal and pastoral development, including the ability to assist students’ movement toward a pastoral identity, the ability to practice pastoral reflection and develop pastoral competencies.

SS 500.4.5

SUPERVISORY NETWORK AND OTHER COMMENTS

Describe the supervisory network and other comments as how one used it for support, dialogue and feedback in a way which will assist one in integrating personal and professional characteristics, knowledge and skills into the role as a supervisor?






Appendix D

CPE INTERAGENCY MEMORANDUM OF AGREEMENT

Clinical Pastoral Education (CPE) is a form of chaplaincy internship which meets the continuing educational needs for clergy and laity training in pastoral care. The purpose of the training is to foster and improve pastoral care skills as well as personal and pastoral awareness and identity. Successful completion of this program is designed to result in an improved understanding of the complex needs of human beings in spiritual crisis, and improved skills and competency in responding to persons in need.

Accreditation Information: Clinical Pastoral Education International (CPEI) is accredited by the Commission on Accreditation for Pastoral Education (CAPE).

CPE Requirements: Clinical Pastoral Education International (CPEI) requires students have a clinical site, i.e., health care facility, parish, correctional institution, etc. in which s/he is intensively engaged in ministry. These standards further require that a CPE program be conducted by a Credentialed CPE Supervisor in an accredited training program where acts of ministry can be carefully examined in both group and individual supervision.

A unit of CPE consists of 400 hours (300 clinical hours and 100 individual and group training).

CPE Interns are expected to carry student professional liability insurance and have a current background check. If these services are provided by your organization that is perfectly acceptable; however, if not, the CPE intern would need to provide evidence.

Additional information and forms can be located at: https://www.cpe-international.org/professional-liability-resources.html

https://www.cpe-international.org/student-background-search.html

BENEFIT TO YOUR ORGANIZATION We value the working relationship with various institutions, e.g., hospitals, hospices, congregations, law enforcement agencies, etc. and commend our CPE students as Interns to your clinical training site. CPE SUPERVISORY STAFF AGREES:

To design, implement and supervise the training of the CPE students in accordance with the CPEI Standards To engage in regular group and individual supervision with each CPE student. To work closely with the Onsite Mentor/Coordinator regarding the student’s ministry and performance and

respond to any questions or concerns that may surface. To maintain all confidential materials brought to group or individual supervision abiding by the Code of

Professional Ethical Practices as described in the CPEI Standards.

CPE STUDENT AGREES: To participate in weekly classes, individual supervision, written and reading requirements and ministry

assignments. To abide by the guidelines, procedures, policies, etc. as outlined by the Clinical Site, the CPE Program, and the

CPEI Standards. To maintain confidentiality with regards to any material, names and personal matters brought from the

placement setting. To expect no financial remuneration or employment status during his/her internship. However, this not does

prohibit the student from receiving a salary as an employee, or the clinical internship (ministry) setting negotiating with the student for compensation or employment.

To abide by agency policy and/or state requirements as it relates to reporting of ethical/legal issues such as: suicidal or homicidal behavior, or child abuse.

To provide evidence of Professional Liability Insurance.


https://www.cpe-international.org/student-background-search.html

https://www.cpe-international.org/professional-liability-resources.html

ONSITE MENTOR/COORDINATOR AGREES: To provide resources to ensure the CPE Intern has what he/she needs to be successful. To provide an opportunity for the CPE student to have a wide variety of pastoral care opportunities for growth

and development. To provide routine feedback to the CPE student for his/her personal and professional growth. To discuss with the Intern any concerns or questions that may surface as to the student performance, while

recognizing that this is a learning/training opportunity. To communicate to the CPE Supervisor any concerns or questions. To complete a final written assessment for the Intern at the conclusion of the CPE unit.

SIGNATURES OF ALL PARTIES

By entering your name via a keypad, mouse, or other device constitutes your signature, acceptance, and agreement as if actually signed by you in writing and has the same force and effect as a signature affixed by hand. (Signature and Date required).

I have read the affiliation agreement and agree to what has been set forth –Sign and Date.


Mentor/ Coordinator Date Return to the CPE Supervisor with Signatures.


Appendix E-1Sample CPE Curriculum

Curriculum and didactic topics vary based on the needs of the students. A list of proposed curriculum topics is proposed below.

Pastoral Formation (PF) - focuses on matters of personal functioning, pastoral identity and pastoral authority. Individuals will also give attention to and awareness of the use of self in pastoral relationships.

Methods of Self-Reflection The Theological Significance of Personal Narrative Ministry and Personhood Framing Pastoral Identity: Authority, Power and Limits Individuality and Pastoral Function Personal Integrity in Pastoral Functioning

Pastoral Reflection (PR) - Focuses on the ability to effectively utilize adult experiential clinical learning for obtaining personal and educational goals, reflect upon one’s religious heritage, utilize the peer group and make effective use of supervision and feedback for personal and pastoral development and functioning.

Elements of Theological Reflection The Uses of Consultation and Referral

Pastoral Competence (PC) - focuses on matters of pastoral care/counseling skill development and knowledge from theology and social science; the ability to conduct a pastoral/spiritual assessment; the ability to establish a pastoral bond with persons from a variety of social, cultural and religious perspectives, and the ability to function as a competent interdisciplinary team member.

Human Development and Personality Theologies of Suffering and Evil Diversity Issues and Pastoral Care Gender and Sexuality Issues in Ministry Crisis Intervention and Theory Models of Spiritual/Pastoral Assessment Principles of Ethical Decision Making Integration of Theory and Practice Building and Maintaining a Pastoral Alliance Across cultures Active Listening Pastoral Conversation The Nature of Helping Relationships Pastoral Role within the Helping Team The Nature of Effective Interdisciplinary Relationships Models of Leadership and Collaboration Conflict Resolution Ritual and Religious Resources in Pastoral Care Models of Pastoral Care Grief and Loss

Appendix E-2


Sample Supervisory CPE Curriculum

Supervisors and those involved in the Supervisory Track should continually be on a life-long learning curve. Therefore, in addition to the various reading requirements for each area below, the following sources are non-negotiable. They must be read and the insights integrated into one’s practice of supervision.

Unit 1- Focus Developing Self as a Supervisor, the Understanding Human Development and an Integrated Theory of Supervisory Practice.

To demonstrate the use of one’s strengths and limits and personal history as teaching tools and as resources in shaping one’s supervisory

To demonstrate an awareness of the supervisory literature, which includes, but is not limited to a review of human development

To be knowledgeable about admissions interviews and selection of students. To develop and articulate an integrated theory of personality that supports one’s concept of pastoral

supervision. To articulate a knowledge of CPE’s history as a foundational and experiential learning practice To articulate an understanding of individual student through awareness of the student's cultural and religious

history, sensitivity to the student's psychological and psychosocial patterns, and respect for the student's individual learning style.

To supervise students’ pastoral work, giving attention to unique patterns of personal and pastoral development, including the ability to assist students’ movement toward a pastoral identity, the ability to practice pastoral reflection and develop pastoral competencies.

To evaluate students’ performance and growth per the requirements of CPEI Standards. To demonstrate supervisory skills consistent with CPEI’s Code of Professional Ethics To demonstrate the skills to write evaluations that highlight students’ growth, pastoral awareness, pastoral

identity, and pastoral competencies

Recommended Reading: Bowen, M. (1985). Family therapy in clinical practice, New York: Jason Aronson, DeBeers, J., & Killen, P. (1999). The Art of Theological Reflection. Eckstein, R. & Wallerstein, R. (2nd ed). (1972). The teaching and learning of psychotherapy. Erikson, E. (1963). Childhood and society/ Fosskett, J. & Lyall, L. (1988). Helping the helpers: Supervision and Pastoral Care. Friedman, E. (1985). Generation to generation: Family process in church and synagogue. Gilligan, C. (1982). In a different voice. Jacobs, D., David, P., & Meyer, D. (1997). The supervisory encounter: A guide for teachers of psychodynamic

psychotherapy and psychoanalysis. McGoldrick, M., & Gerson, R. (3rd ed.). (1985). Genograms: Assessment and Intervention. Oates, W. (1987). Behind the masks: Personality disorders in religious behavior. Patton, J. (2009). Ministry to theology: Pastoral reflection. Polhy, K. (2016). Transforming the Rough Place: The Ministry of Supervision. Steere, D. (2002). The Supervision of Pastoral Care. Stone, H.W., & Duke, J. O. (3rd ed.). (2013). How to think theologically.

Assignments: Develop a human development theory of supervision, which is integrated into one’s concept of pastoral

supervision. Present supervised experiences with one’s CPE Supervisor and Supervisory peer group for feedback Interview and select students for a unit of CPE To identify means of helping students to learn about their personality and developmental history


To demonstrate a knowledge of CPE’ Developmental history

Unit 2- Focus is on Gaining Cultural Sensitivity, Group Dynamics, and Learning Theory

To demonstrate awareness of the supervisor-student power imbalance and to know to use it for learning purposes.

To demonstrate awareness of a supervisory alliance and related issues transference and countertransference and anxiety and learning, resistance, parallel process.

To demonstrate use one’s personality, religious and cultural history as a teaching resource in shaping a personal supervisory style.

To develop and articulate an understanding of adult learning relevant to the supervision of individuals and groups.

To articulate a theory of group process and dynamics as related to CPE Supervision, which will result in the development of the group’s pastoral formation, pastoral reflection and pastoral competencies.

To demonstate the ability to design, implement and manage a program of supervised clinical pastoral education according to the educational principles of adult experiential-clinical learning

To demonstrate the ability to employ diverse clinical educational methods and can provide examples of assisting diverse students in taking responsibility to formulate a plan of learning and to evaluate the results of the learning experience.

To articulate an understanding of individual student through awareness of the student's cultural and religious history, sensitivity to the student's psychological and psychosocial patterns, and respect for the student's individual learning style.

To demonstrate the ability and flexibility to respond to individual students, using a wide range of supervisory methods and strategies.


To evaluate students’ performance and growth per the requirements of CPEI’s Standards. To demonstrate supervisory skills consistent with CPEI’s Code of Ethics

Assignments: Develop a theory of adult experiential learning and group dynamics, which is integrated into one’s concept of

pastoral supervision. Present supervised experiences with one’s CPE Supervisor and supervisory peer group for feedback Demonstrate the ability to employ diverse clinical educational methods, and can provide examples of assisting

diverse students in taking responsibility to formulate a plan of learning and to evaluate the results of the learning experience

Articulate awareness to establish a meaningful supervisory alliance and the ability to identify issues of transference and countertransference and anxiety and learning, resistance, parallel process.

Describe how to make use of one’s personality, religious and cultural history as a teaching resource in shaping a personal supervisory style.

Recommending Reading: Etchegoyan, H. R., Transference and Counter-Transference: A Testimony, “Transference and

Countertransference Today. Faimberg, H., “Well, you’d better ask them”: The countertransference position at the

Crossroads. Fainstein, A., Countertransference: A Contemporary approach from the River Plate Region Geltner, P., Emotional Communication: Countertransference Analysis and the Use of Feeling in

Psychoanalytic Technique, New York: Routledge, 2013. Hemenway, J. E. (1996). Inside the circle. Knowles, M. & Knowles, H. Introduction to group dynamics.


Knowles, M. (1973). The adult learner. Knowles, M. (1980). The mmodern ppractice of adult education: From pedagogy to andragogy. Mezirow, J. (1990). Fostering critical reflections in adulthood: A guide to transformative and emancipatory

learning. Cooper-White, P. (2004). Shared Wisdom: Use of the Self in Pastoral Care and Counseling.

Unit 3- Focused on the Integration of Theology and the Practice of Supervision

Objectives to be addressed in the first unit: To demonstrate an awareness of cultural, ethnic, gender and religious traditions an ability to supervise out of

this awareness. To demonstrate the ability to employ diverse clinical educational methods and can provide examples of

assisting diverse students in taking responsibility to formulate a plan of learning and to evaluate the results of the learning experience.


To evaluate students’ performance and growth per the requirements of CPEI Standards. To demonstrate supervisory skills consistent with CPEI’s Code of Ethics To demonstrate the skills to write evaluations that highlight students’ growth, pastoral awareness, pastoral

identity, and pastoral competencies

Recommending Reading: Alexander, E. (2011). Black Fire: One hundred tears of African American

Pentecostalism. Choop, R. (1986). The Praxis of suffering. Cobb, J.B., & Griffin, D.R. (1976). Process theology: And introductory exposition, Dottolo, A. L., & Ellyn K. (2016). Whiteness and white privilege in psychotherapy. Falender, C.A., Shafranske, E. P., & Falicov, D.J. (2014). Multiculturalismm and diversity in clinical supervision:

A competency-based approach. Gerkin, C. (1984). The Living Human Document. Haskins, J., & Butts, H. (1973). The psychology of black language. Hauerwas, St., & Jones, G. (1989). Why narrative? Readings in narrative theology. Howard, G. (1995). Caribbean theology, preparing for the challenges ahead. Johnson, E. A. (2009). She who is: The mystery of God in feminist theological discourse. Nouwen. H. (2013). The Wounded Healer. Tillich, P. (1952). The courage to be. White, J. L., & Parham, T.A. (1990). The Psychology of Blacks: An African- American Perspective

Assignments: Develop a theology of pastoral supervision Demonstrate the ability to focus on theological issues, theological integration, and religious traditions in

supervising students Present supervised experiences with one’s CPE Supervisor and Supervisory peer group for feedback


Appendix F

Sample CPE Resident/Intern Agreement for Training

CPE is conducted as an “education for ministry experience.” This document and acceptance into the _______________________ CPE Program, authorizes you to visit patients as a Chaplain Intern or Chaplain Resident, to be informed of their situation (physically, spiritually, emotionally, psychologically, and sociologically), to write progress notes in the patient’s record, and to write materials that would be most beneficial to your educational process based on your visits under the direct supervision of an assigned CPE Supervisor, Associate CPE Supervisor or a Supervisor Candidate. Intern/Resident Initials:

Confidentiality is basic to professionalism and any communication regarding patients outside your professional treatment and/or training circles is prohibited, except as required for the safety of patients, families or others. Breech of this standard of professional confidentiality is determined by the hospital management and may result in your immediate termination.

As part of my participation in CPE, at a facility ____________________I may have access to protected health information (“PHI”), personnel information, and proprietary business information (collectively referred to as “Confidential Information”) that is regarded as highly confidential and may not be disclosed except as permitted or required by law and by Facility policies and procedures.

I understand that:

I am obligated to hold Confidential Information in the strictest confidence and not to disclose such information to any person or in any manner which is inconsistent with applicable law or the policies and procedures of Facility.

I acknowledge that I may not review any Confidential Information of a friend, relative, staff member, volunteer or any other person unless I am required to do so as part of my official duties. I will not discuss or allow to be displayed Confidential Information of any type in the proximity of any individual who does not have the right to know. This includes conversations in public places, allowing computer screens to be inappropriately visible, and leaving printed material where it may be openly viewed.

All Confidential Information obtained from Facility systems remains the property of Facility regardless of physical location or method of storage unless otherwise specified by Facility in writing.

If I believe that information confidentiality or security may be compromised in any way, either intentional or accidental, I shall contact my direct supervisor and/or the Facility Privacy Officer or Compliance Officer.

My confidentiality obligation continues indefinitely, including after my participation in the Program at Facility has ended.

Access, attempted access, or release of Confidential Information without the right and need to know for successful completion of Program duties will be considered a breach of confidentiality. I understand that any unauthorized disclosure Confidential Information will constitute irreparable harmless without adequate remedy as to the Facility and such disclosure may further violate certain laws or professional licensing requirements or standards. Disclosure may also be grounds for immediate disciplinary action up to and including termination of my participation in the Program at Facility, and/or legal action.

Intern/Resident Initials:

You have received and reviewed the Student Handbook and the CPEI Standards governing Clinical Pastoral Education as provided you during your orientation. You have had opportunity to review the policies and CPEI Standards with your supervisor during orientation and now understand their importance for you as a Chaplain Intern/Resident.



In all of your activities during your Chaplain Internship/Residency, I agree that I have received a copy of the CPEI Standards and _____________________ (specific organizational standards) and agree to function professionally and within the Code of Professional Ethics.


I understand that my continuing participation in the program is contingent upon making satisfactory progress in the delivery of pastoral care to patients, families, and staff and in making satisfactory progress in using the program’s educational opportunities for my personal and professional growth. I understand that the supervisory staff will assess my progress throughout the CPE unit and if, in their judgment, I fail to make satisfactory progress as a chaplain or student, I may be terminated from the CPE program. I agree to abide by their decisions regarding my continuing participation in the program.


I understand and agree to the conditions of this Agreement for Training.

_____________________________________ __________________

Signature of Chaplain Resident/Intern Date

_____________________________________ ___________________

Signature of Primary CPE Supervisor Date


Appendix G-1Sample CPE Supervisor / Student Disclosure Agreement

Supervisor Contact Information Supervisor Educational/Certification Qualifications

Accreditation Status Training Center

Supervisor’s Model of Pastoral Supervision

Ethical IssuesAll information obtained in supervision will remain confidential. However, as a student you are also bound by the requirements of your training site and/or state requirements regarding the need to report certain actions such as: suicidal or homicidal behavior, or child/elder abuse. It is important that you understand the requirements in your setting, know the proper channels when reporting such incidents, and keep me informed as your training supervisor. You are also bound to protect patient/client/parishioner confidential information under the Health Insurance and Portability Act (HIPPA).

At no time will I assume the role as your personal counselor, but will be happy to provide appropriate referrals. It is not unusual, at times, for CPE students to seek personal therapy while completing their training.

I adhere to CPEI’s Code of Professional Ethics.

Social Media – Students and training supervisor(s) need to exercise caution when participating in social media so as to not disclose confidential information related to CPE. Therefore, it is the decision of this CPE Supervisor to not accept students’ invitations to participate in social media outlets, i.e., Facebook, as long as the student is actively participating in training.

Methods of Evaluation As your supervisor, I will provide formative feedback in each supervisory session (group and individual). A formal

summative evaluation will be provided at the end of each unit for those completing an Intensive Unit. Students completing an Extended Unit will receive a formative evaluation at Mid-Unit.

CPE students are expected to complete a formal summative evaluation at the conclusion of each unit (Intensive and Extended).

The summative evaluation will consist of a narrative portion, and may include a Likert Scale as well.

Supervisory CandidatesSupervisory Candidates may be involved in the CPE process, and assigned to students through part of their learning experience. These are individuals who have completed a minimum of four units of CPE, and have demonstrated the level of maturity and expertise to participate in a supervisory training program.

You may be assigned to one of these individuals for individual supervision; however, I will remain in close contact with these individuals.


Duties and Responsibilities of Supervisor Create a safe environment for learning to take place. Maintain current knowledge of CPEI Standards. Review verbatim and other reports of student’s ministry during supervisory sessions. Monitor student’s pastoral functioning, pastoral reflection, and pastoral competencies. Support student’s development as a pastoral care/pastoral counseling provider. Focus on supervisee’s strengths and encourage the development of limitations. Ensure that all ethical and legal guidelines are upheld. Complete student’s summative evaluation at the end of each unit according to CPEI Standards. Provide, as requested, referral sources for therapists to student, but will not function as the student’s therapist. Provide a certificate for completion of training and fulfillment of all financial responsibilities. Work closely with the clinical/specialized ministry setting mentor/onsite coordinator regarding the student’s ministry

and performance and respond to any questions or concerns that may surface. Respect and maintain all confidential materials brought to group or individual supervision.

Duties and Responsibilities of CPE Student Participate regularly and on time in supervision (group and individual). Come prepared to discuss matters related to personal and professional development as a pastoral care provider. Regularly participate in group supervision by sharing personal, pastoral, and professional concerns for feedback. Take responsibility for identifying learning goals, as well as topics for discussion in supervision. Complete a thoughtful and reflective weekly reflection. Share verbatims and other agreed upon methods of clinical work for review in supervision. Consult immediately with field placement supervisor and clinical supervisor in cases of emergencies. Implement supervisory directives. Abide by the guidelines, procedures, policies, etc. of the Clinical Site and the CPE Program as outlined in the CPE

Handbook. Expect no financial remuneration or employment status during his/her internship. However, this not does prohibit

the student from receiving a salary as an employee, or the clinical internship (ministry) site negotiating with the student for compensation or employment.

Abide by agency policy and/or state requirements as it relates to reporting of ethical/legal issues such as: suicidal or homicidal behavior, or child abuse.

Complete summative narrative evaluation, and possible Likert Scale evaluation, at the end of each unit. Ensure that tuition is paid prior to or during the first week of training. Exceptions to this must be approved. Understand that no CPE credit, certificate or final evaluation will be submitted until all tuition for unit has been paid

in full. Agree to purchase background check if required and not provided for. Uphold all ethical and legal guidelines. Maintain Confidentiality. I understand that specific patient/family cases will be presented to my CPE Supervisor for

educational/supervision/consultation purposes. Even in those cases, I understand the importance of maintaining as much confidential information as possible.

o I am obligated to hold Confidential Information in the strictest confidence and not to disclose such information to any person or in any manner which is inconsistent with applicable law or the policies and procedures of Facility.

o I acknowledge that I may not review any Confidential Information of a friend, relative, staff member, volunteer or any other person unless I am required to do so as part of my official duties. I will not discuss or allow to be displayed Confidential Information of any type in the proximity of any individual who does not have the right to know. This includes conversations in public places, allowing computer screens to be inappropriately visible, and leaving printed material where it may be openly viewed.

o All Confidential Information obtained from Facility systems remains the property of Facility regardless of physical location or method of storage unless otherwise specified by Facility in writing.

o If I believe that information confidentiality or security may be compromised in any way, either intentional or accidental, I shall contact my direct supervisor and/or the Facility Privacy Officer or Compliance Officer.

o My confidentiality obligation continues indefinitely, including after my participation in the CPE program has ended.


Access, attempted access, or release of Confidential Information without the right and need to know for successful completion of Program duties will be considered a breach of confidentiality. I understand that any unauthorized disclosure Confidential Information will constitute irreparable harmless without adequate remedy as to the Facility and such disclosure may further violate certain laws or professional licensing requirements or standards. Disclosure may also be grounds for immediate disciplinary action up to and including termination of my participation in the Program at Facility, and/or legal action.

Supervisor’s Signature Date



Appendix G-2Sample #1 Memorandum of Understanding Between

Training Supervisor and Supervisory Students



Date:

Supervisory Unit:

Memorandum of Understanding

It is the objective of this mentored process that open communication exists for learning purposes. This (1st, 2nd, 3rd, 4th) unit will focus on IAW CPEI Standards and Certification Requirements.

1. I, (supervisory student) agree to notify (training supervisory) of supervisory issues and keep in touch for consultative and reflection purposes.

2. I, ( supervisory student ) agree to write student final evaluations and have them reviewed by the (training supervisor). After approval, I, ( supervisory student ) agree the final student evaluation will be signed by three parties: myself, my training supervisor and the CPE student).

3. I, (supervisory student) will complete a unit self- evaluation, and agree to submit to the (training supervisor) for his/her evaluation of my work.

Supervisory Mentorship: As your mentor, I, (training supervisor) agree to be available for consultation and reflection at your ( supervisory student ) request.

In the event that an emergency arises or that I am unable to continue with your supervision for some unknown reason, the following (training supervisor) will oversee your work.

Financial Agreement: I, ( supervisory student ) agree to pay the contract fee of for this unit of supervisory education. If specific arrangements are requested, please outline them below.

I agree to pay the amount of on or before .

SIGNATURE/DATE: SIGNATURE/DATE:

Training Supervisor Supervisory Student


Appendix G-3

Sample #2 Memorandum of Understanding Between Training Supervisor and Supervisory Students

This Memorandum of Understanding (MOU) is entered into between (Training Supervisor/Organization) and (Supervisory Student/Organization) for the purposes of conducting CPEI Supervisory Education for the period of: .

( CPE Organization/Institution ) is an approved Clinical Pastoral Education International (CPEI) educational site and is accredited by the Commission on Accreditation for Pastoral Education (CAPE).

1. Administrative Items. The Supervisory Student or Organization/Institution’s duties, term of engagement, fees, etc. are set forth below, which may be amended in writing from time to time as approved by all parties.

The supervisory student and/or organization/institution agrees to the following:

(a) Acknowledges that s/he is free to enter into this MOU, and that this engagement does not violate the terms of any agreement between the supervisory student and any third party. The supervisory student is expressly free to perform services for other parties except for entering into an agreement or provide CPE services with another supervisor or agency.

(b) To pay travel costs (mileage, meals and lodging) for onsite visits from the Training Supervisor and all expenses related to telephone, internet, and audio/video connections related to training.

(c) To carry professional liability insurance relative to any service performed as a CPE supervisory student.

(d) Acknowledges that the supervisory student is not an employee, partner, agent of, or joint venturer with (CPE Training Supervisor/Accredited CPE Center ) for any purpose. (supervisory student) shall have no claim against (CPE Training Supervisor/Accredited CPE Center for vacation pay, sick leave, retirement benefits, social security, worker’s compensation, health or disability benefits, unemployment insurance benefits, or employee benefits of any kind.

(e) To pay the contract fee of for this unit of supervisory education. If specific payment arrangements are requested, please outline them below.

I agree to pay the amount of on or before .

2. Supervisor-in-Training Duties and Responsibilities

I, (supervisory student) agree the following:

(a) To read and abide by the CPEI Standards, Credentialing, and Accreditation Manuals as well as any resources provided by the Training Supervisor.

(b) To abide by the CPEI Code of Professional Ethics.

(c) To review all requirements for supervisory education, including the timeline for completion of Supervisory Education.


(d) To make use of the required CPEI forms.

(e) To participate regularly in a Supervisory Consortium

(f) To meet regularly with my training supervisor.

(g) To ensure that all CPE Students as well as my supervisory evaluation are completed within 45 days of the close of unit, or sooner as required by your CPEI Training Supervisor.

(h) To not provide CPE credit, a final evaluation, or certificate until tuition has been paid in full.

(i) To contact my training supervisor immediately should an emergency or supervisory issue arise with a CPE student(s).

Training Supervisor: As your training supervisor, I, (training supervisor) agree to be available for consultation and reflection at your ( supervisory student ) request.

In the event that an emergency arises or that I am unable to continue with your supervision for some unknown reason, the following (training supervisor) will oversee your work.

SIGNATURE/DATE: SIGNATURE/DATE:

Training Supervisor Supervisory Student


CHANGES AND UPDATES TO CPEI STANDARDS

CHANGE #- REF. DATE CHANGES (FROM / TO)

#1- 100.4.4. 2/27/19 a policy outlining the process for the maintenance and custody of records which addresses as a minimum confidentiality, custody and release of records, which are consistent with CPEI’s Code of Professional Ethics. As a minimum the following records must be retained for a minimum of three years - five (5) years.

After a period of three years - five (5) years all student materials will be destroyed with the exception of the face sheet, any written request(s) for release of information, and a record of completed units.

#2- All Doc. 2/28/19 Phrase- CPE Programs changed to CPE Centers.

#3- Appendices 6/7/19 Appendices updated


Documents

Clinical Pastoral Education International · Web view2019/06/16 · Clinical Pastoral Education International (CPEI) Vision and Mission2. Introduction to Clinical Pastoral Education4