Practicum & Internship Handbook

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1 Practicum & Internship Handbook Counseling and School Psychology Department Clinical Mental Health Counseling Program Counseling and School Psychology, Southern Connecticut State University Davis Hall Room 126, 501 Crescent St., New Haven, CT Phone: Fax: URL: Last Revised:

2 Table of Contents Introduction Clinical Mental Health Counseling Program Faculty Critical s and the Mandatory Meeting Student Checklist for CMHC Practicum Student Checklist for CMHC Internship Student Preparation Direct Service and Indirect Activities Faculty Support Specific Course Information Practicum Internship Professional Considerations Special Note to Supervisors Appendices Appendix A: Appendix B: Appendix C: Appendix D: Appendix E: Appendix F: Appendix G: Appendix H: Appendix I: Appendix J: Appendix K: Clinical Mental Health Counseling Practicum / Internship Application Form Field Site Confidentiality Agreement Clinical Mental Health Counseling Field Site Contract CMHC Weekly Log Sheet CMHC Semester Log Sheet Student Performance Evaluation from Agency Supervisor CMHC Student Evaluation of Site Recording Consent Form for Adult Clients Recording Consent Form for Minor Clients Academic Recess Contract CMHC Fieldwork Overview

3 Introduction The purpose of this handbook is to provide Clinical Mental Health Counseling (CMHC) students, department faculty and agency supervisors with information about the practicum and internship courses for the CMHC program in the Counseling and School Psychology Department at Southern Connecticut State University. This material applies to all students within the CMHC Masters program, as well as those enrolled in the Sixth Year Professional Diploma program. The CMHC faculty consider practicum and internship to be the most critical experience within each student s professional preparation. The experience provides an opportunity to translate theory into practice, enhance skills learned in the classroom and to develop a professional identity. Because of the importance of this experience, there are strict rules and guidelines that must be followed by all involved parties. Students are therefore responsible for reading and understanding the information in this handbook and adhering to all rules and guidelines. We also strongly recommend that students retain their own copy of all documents submitted and related to their fieldwork experience. Clinical Mental Health Counseling Program Faculty Field Site and Clinical Mental Health Counseling Program Coordinator: Louisa Foss- Kelly, PhD, NCC, LPC Associate Professor - Phone: (203) Counseling and School Psychology Department Chair: Uchenna Nwachuku, EdD, NCC, LPC Professor - Phone: (203) Clinical Mental Health Counseling Faculty: Cheri Smith, PhD, NCC, LPC Associate Professor - Phone: (203)

4 Critical s and the Mandatory Meeting Expected Semester of Practicum Enrollment: Fall Spring Student Preparation: 1. Attend the mandatory practicum meeting in the Fall semester prior to enrollment (one year before practicum). 2. Submit the practicum application (Appendix A) by March Attend the mandatory practicum meeting in the Spring semester prior to enrollment (one year before practicum). 2. Submit the practicum application (Appendix A) by July 1. Student Checklist for CMHC Practicum Completed Task Complete all practicum pre- requisites: CSP 540, 550, 568, 595, 656 Attend Mandatory Practicum Meeting semester BEFORE enrollment in Practicum Obtain Professional Liability Insurance Submit Practicum Application to CMHC Field Site Coordinator by July 1 for Spring Semester and March 1 for Fall Semester. Application Form (Appendix A) Request permission and enroll in Practicum Course 552 & CMHC Section Attend orientation at practicum site and discuss Practicum goals with Agency Supervisor Submit Practicum Contract (Appendix C) Complete Weekly Log Sheets (Appendix D) Agency Supervisor submits Student Performance Evaluation to Seminar Instructor and to Tk- 20 as required (Appendix F) Submit Semester Log Sheet to Seminar Instructor (Appendix E) at the end of the semester Submit Student Evaluation of Site to seminar instructor (Appendix G) 4

5 Student Checklist for CMHC Internship Completed Task FIRST SEMESTER Complete all internship pre- requisites: CSP 552/553, 578, 691 Maintain Professional Liability Insurance If site is new, submit Internship Application to CMHC Program Application Form (Appendix A) Enroll in Internship course CMHC Section Submit Internship Contract (Appendix C) Complete Weekly Log Sheets (Appendix D) Agency Supervisor submits Student Evaluation to seminar instructor and to Tk- 20 as required, Student Evaluations (Appendix F) Submit Semester Log Sheet to seminar instructor (Appendix E) at the end of the semester Submit Student Evaluation of Site and Supervisor to seminar instructor (Appendix G) SECOND SEMESTER Enroll in Internship course 676 CMHC Section Sign Internship contract with Agency Supervisor (Appendix C) Complete Weekly Log Sheets (Appendix D) Agency Supervisor submits Student Evaluation to seminar instructor and to Tk- 20 as required, Student Evaluations (Appendix F) Submit Semester Log Sheet to seminar instructor (Appendix E) at the end of the semester Submit Student Evaluation of Site to seminar instructor (Appendix G) Student Preparation The Counseling and School Psychology Department requires that CMHC students follow each of the proceeding guidelines. Complete Pre- requisites The following courses are required for practicum and internship. Clinical Mental Health Counseling Practicum (CSP 552 / CSP 553) CSP 540 Understanding Individual Psychological Testing and Evaluation CSP 550 Counseling Procedures (Pre- req.: CSP 569) CSP 568 Counseling and Life Span Development CSP 595 Professional Orientation and Ethical Issues in Counseling CSP 656 Group Counseling (Pre- req.: CSP 550 & departmental permission) Departmental Permission Clinical Mental Health Counseling Internship (CSP 676) CSP 552 Counseling Practicum 5

6 CSP 553 Counseling Practicum Seminar CSP 578 Counseling and Assessment of Culturally Diverse Population CSP 691 Research and Evaluation in Schools and Community Agencies Departmental Permission Purchase/Maintain Liability Insurance Students must submit proof of appropriate professional liability insurance. Many professional organizations offer special low rates for liability insurance. The American Counseling Association is an example of an appropriate organization to use. Please see to learn more. Note that the CSP department does not make recommendations as to how much coverage students should obtain. Attend the Mandatory Practicum Meeting Approximately one year before enrollment, students must attend the mandatory practicum meeting. The date will be announced on the CSP listserv and will be posted on the program s bulletin board. Submit Application for Practicum/Internship Complete the Practicum/Internship Application Form. Application is always required for Practicum. Application for Internship is only required when the student wishes to work at a new/additional site. Attach supporting materials as indicated on the Application Form: o Current unofficial transcript o Professional Liability Insurance Declarations Page o Field Site Confidentiality Agreement Submit Application to the Field Site Supervisor by the required deadline: March 1 for Fall semester and July 1 for Spring semester. Select a Site Students shall use the following guidelines when choosing a practicum or internship site. Determine specific professional goals and needs to help determine student s preferred type of setting. Refer to the CMHC Field Site Binders in the main CSP office for information on both established and potential sites. Conduct general search at area agencies and providers using United Way, 211, internet searches and resources provided at the mandatory practicum meeting. Speak to advisor and/or the SCSU Field Site Coordinator for advice on choosing sites. Requirements/Expectations for the Field Site For a site to be approved, key agency personnel must: o Give the student adequate opportunity to accrue hours providing diagnosis treatment of mental and emotional disorders and related professional counseling activities. Activities cannot be limited to group or family counseling and must include sufficient number of individual psychotherapy hours to meet training needs. o Understand Connecticut State requirements for Licensure as a Professional Counselor. View the Connecticut state requirements at and other 6

7 states requirements at o Be familiar with and follow ACA and other pertinent ethical codes. View the ACA Code at center/ethics. o Provide an opportunity to make audio or video recordings of client sessions (required in practicum, preferred in internship). o Offer a designated area for student work, confidential for phone calls and counseling sessions. o Provide consistent and appropriate on- site supervision with an identified clinical supervisor approved by SCSU. Requirements/Expectations for the Agency Supervisor: The agency must provide a clinical supervisor who meets the following SCSU requirements: Have a minimum of a Masters degree in counseling or a related profession and be independently licensed by the State of Connecticut as a Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), medical doctor certified in psychiatry by the American Board of Psychiatry and Neurology, licensed psychologist, or licensed Advanced Practice Registered Nurse (APRN) certified as a clinical specialist in adult psychiatric and mental health nursing with the American Nurses Credentialing Center. Note: Effective January 2016, only LPCs may serve as agency supervisors. Have a minimum of 2 years experience as a Professional Counselor or mental health clinician. Have completed relevant training or coursework in counseling supervision; Prior experience as a clinical supervisor of university interns is preferred. Provide student with a minimum of one hour per week of regularly scheduled clinical supervision. This one designated hour must involve the designated clinical supervisor and a maximum of two supervisees. Possess knowledge of the CMHC program s expectations, requirements and evaluation procedures for students as presented in Practicum and Internship Handbook. Provide training needed for students to follow the policies and procedures of the agency. Communicate regularly with University faculty and meet with the student and a CSP faculty member on scheduled site visits. Review and sign all relevant documents and complete Student Performance Evaluations at both midterm and end of the semester for each semester of the placement. Generally, student evaluations are submitted electronically via the Tk- 20 data management system. Supervisors will receive regarding processes/procedures for submitting evaluations on Tk- 20. Secure a Site Students may use the following guidelines when securing a practicum or internship site. Contact sites to identify open positions. Attempt to speak directly to the site s internship coordinator or supervisor. If immediate contact is made, inquire about next steps and/or request to have an interview. If internship coordinator is not reached immediately, compose a personal cover letter, attach a resume, references and the CMHC Brief Fieldwork Overview form (Appendix K) and send the packet to the site internship coordinator. Follow up the mailing with a telephone call to request an interview. 7

8 Tips for Interviewing at a Site: Students should approach the practicum or internship site interview as a regular job interview and gather or prepare the following: o A resume and list of references. o CMHC Brief Fieldwork Overview form. o A small professional portfolio (optional). o A list of ideas and questions related to how this placement might prove mutually beneficial to the student and the site. o A list of goals the student wishes to accomplish through this experience. o A hard copy of this handbook, so that the student can clearly present and explain University expectations, especially those affecting the Agency Supervisor o A copy of the practicum/internship application and contract ready for completion, should the site personnel and student choose to move forward with placement. Secure SCSU Approval of the Site Once a potential site is identified, submit all documentation to the CMHC Field Site Supervisor to secure program approval. Students may not begin working at the site until all required documents have been submitted and the student has received notification that the placement is approved. Students may never see clients prior to the first class meeting of the semester Complete/Submit the Field Site Contract Prior to accrual of any fieldwork hours, the student must work with the Agency Supervisor to complete a Field Site Contract. This contract must be submitted to the SCSU Field Site Supervisor. Enroll in Courses Prior to registration, request departmental permission for the course. Register early for the appropriate courses as designated on the student s course sequence and approved by the student s advisor. For Practicum: CSP 552 (3 credits) and CSP 553 (3 credits). For Internship: CSP 676 (3 credits). Note: Seats in the Practicum/Internship courses are limited. Enrollment priority is given to those who submit all materials (i.e., Application Form) by the designated deadlines. Start Practicum / Internship Students are expected to attend the field site s regular employee or intern orientation. Students generally begin and end their practicum and internship experiences following SCSU s academic calendar. However a student may practice continuously through an academic recess if the student is given permission by the site and the Academic Recess Contract is signed and submitted to the Field Site Supervisor prior to the academic recess (See appendix J). 8

9 Direct Service and Indirect Activities Fieldwork will be a combination of work with clients and related activities, as well as learning administrative tasks. Direct services are defined as contact with clients during which the student directly conducts or participates in the provision of counseling. Indirect hours include services or professional activities performed while at one s field site that do not require direct client contact. Supervision hours are composed of faculty or on- site supervision. The student is responsible for completing weekly logs documenting direct and indirect service hours. The Agency Supervisor is required to sign each weekly log. At the end of the semester, the student will submit a final semester log, also signed by the Agency Supervisor. These logs will be reviewed by the 553/676 seminar instructor, who will then place the logs in the student s fieldwork file. Students must retain personal copies of all of these documents. DIRECT SERVICES Individual counseling Performing client sessions involving the assessment and/or treatment of specific mental and emotional disorders. Family/couples counseling Performing family or couples sessions involving the assessment and/or treatment of specific mental and emotional disorders. Group Counseling Co- leading or independently leading a psychotherapy group. Diagnostic Interviewing Use of specific assessment tools and clinical skills to identify an appropriate DSM- 5 diagnosis and identify a client s initial needs. Testing and Assessment Administration and/or interpretation of counseling assessments; Includes provision of interpretive summaries to clients. Career Counseling Counseling that includes client career or vocational development. Co- Therapy Actively participating in co- therapy with individuals or groups (not simply observing) INDIRECT ACTIVITIES Observation Observing on- site staff member performing psychotherapy. Telephone or Contacts Making direct contact with clients that is not face to face. Referrals Linking client to supplemental or supportive services. Clinical Documentation Writing case notes, treatment plans, and treatment summaries or other written reports for the formal medical record. Case Consultation Working directly with other mental health professionals regarding clients. Staff Meetings Attending clinical and/or administrative meetings with agency staff. Professional Development Activities Attending professional counseling trainings, workshops or conferences. Clinical Supervision (counted as indirect): On- site individual clinical supervision Weekly, face- to- face regularly scheduled supervision regarding skills development and client care; Provided by the Agency Supervisor. On- site group supervision All formal group supervision provided at the field site. University Supervision Individual supervision with faculty supervisor (Only Practicum) and field work seminar (Both Practicum and Internship) 9

10 Faculty Support Expectations for SCSU Field Site Coordinator The SCSU Field Site Coordinator is a faculty member assigned to coordinating and supervising practicum and internship sites through the CMHC program. Below is a list of expectations for the SCSU Field Site Coordinator when supervising a CMHC practicum or internship student. Facilitate communication between University and field placement site. Be available for consultation with both Agency Supervisors and students. Visit the Agency Supervisor and the student at the internship site at least once during the semester and engage in phone or contact as needed. Expectations for Practicum Faculty Supervisors (CSP 552) The Practicum Faculty Supervisor is expected to: Conduct individual supervision meeting weekly on campus throughout the semester. Describe course requirements, including mandatory audio or video- recording review, on the course syllabus. Focus on student counseling skills development such as microskills and interviewing strategies (in contrast, clinical diagnostic and treatment issues are the main focus of on- site supervision).. Immediately contact the SCSU Field Site Coordinator should any problems or changes in relation to the student, site or University occur. Evaluate the student and discuss that evaluation with him/her; assign a final grade Expectations for Practicum and Internship Seminar Instructors (CSP 553/676) The Practicum or Internship Seminar Instructor is expected to: Conduct class meeting every week throughout the semester. Establish course requirements via the course syllabus. Immediately contact the SCSU Field Site Coordinator should any problems or changes in relation to the student, site or University occur. Evaluate the student and discuss that evaluation with him/her; assign final grade for CSP 553 or CSP 676. Evaluation of Instructors and Field Sites Students will complete SCSU teaching evaluations for instructors of CSP 552/553 or 676. They will also evaluate their Field Site (Appendix G). Field Site evaluations will be made available to other students during the Field Site selection process. 10

11 Specific Course Information PRACTICUM CMHC Counseling Practicum provides an opportunity to demonstrate counseling skills under close supervision in a community setting. The primary goal of practicum is to develop skills in individual, group or family counseling in a professional setting. This is accomplished by combining a student s counseling skills and personal style into an effective therapeutic approach and enhancing the student s growth as a person and as a professional counselor. Students should also make a concerted effort to engage clients of various ethnic populations, both genders and different age groups. Format and Content of Practicum 1. CSP 552 Students perform selected professional counseling activities that would be expected of a regularly employed clinician in a community setting. One hour individual or dyadic supervision by a program faculty member is required. Pre- requisites: CSP 540, 550, 568, 595, 656 and departmental permission. Schedule fall and spring semesters. 3 credits. The student is required to meet one hour per week for one semester with a faculty member to process individual and group sessions. The focus of CSP 552 supervision is on student counseling skills development such as microskills and interviewing strategies. (In contrast, clinical issues are the focus of on- site supervision). The meeting time for CSP 552 supervision is negotiated between the faculty member and the student. However if schedules conflict, the needs of the faculty member take priority over the needs of the student. See instructor syllabi for additional requirements. 2. CSP 553 The seminar provides an opportunity for practicum students to meet together weekly in a group supervision setting, to integrate field experiences and discuss topics of professional interest. Pre- requisites: CSP 540, 550, 568, 595, 656 and departmental permission. Schedule fall and spring semesters. 3 credits. Within this seminar, students will discuss issues occurring in their practicum, consult with each other concerning problem- solving strategies and review legal and ethical standards in counseling. See instructor syllabi for additional requirements. Required Hours for Practicum Students are required to spend a minimum of 100 hours on site during practicum. Forty of these hours should be considered direct service hours (e.g., face- to- face counseling/psychotherapy) and the remaining 60 indirect hours (e.g., staff meetings, clinical documentation, other activities at the field site). These hours are MINIMUM requirements. All activities must be documented in order to receive credit for field site work and meet licensure standards. Practicum Experiences: DIRECT SERVICE INDIRECT ACTIVITIES Minimum Time Requirement 40 hours total 60 hours total 11

12 Practicum Objectives As part of the practicum experience, there are general skills that the student will learn. These include: General Skills: To experiment with a variety of counseling techniques To examine one s personal style of interpersonal interactions Practice skills learned in previous courses, including diagnosis, treatment, and documentation Relate theory to practice Become effective in a helping relationship, under close supervision Discuss the experience with others in a supportive setting Learn what problems others are encountering and what solutions could be considered Discuss techniques that are successful Research areas of individual interest Work with a variety of clients Experience those forces that are unique to different settings Evaluate student s professional growth Specific Skills: 1. Develop procedures for meeting with clients 2. Establish a safe and accepting environment by establishing rapport with the client 3. Elicit information from the client 4. Recognize and understand the content presented by the client 5. Articulate the client s problems, diagnostic formulation and case conceptualization 6. Distinguish the discrepancies in the cognitive and affective messages of the client 7. Transmit understanding of the affective and cognitive messages to the client 8. Distinguish the client s needs from one s own needs as a counselor in training 9. Learn to establish appropriate boundaries with clients 10. Utilize appropriate therapeutic techniques 11. Describe key state and federal laws, policies, procedures and regulations as they affect clients Grading In Practicum, the student is enrolled in two courses (CSP 552 and 553) and therefore receives two grades. The CSP 552 grade will be determined by the faculty supervisor. It will include both an analysis of the quantitative and qualitative aspects of the student s experience and performance. The CSP 553 grade will be determined by the faculty seminar instructor. The final grade will be based on: The student fulfilling the required service hours How well the student s goals and objectives have been met The Agency Supervisor s evaluation Any other course requirements, as indicated on course syllabi 12

13 INTERNSHIP Following the practicum and pre- requisite courses, students will pursue an internship. The goal of the internship is to further develop and refine the skills developed during practicum. Moreover, the internship should provide the student with the full range of counselor responsibilities appropriate to the setting. Students should give careful consideration to the type of internship site and should discuss the placement with their advisor or the SCSU Field Site Coordinator. During internship, students assume increasing levels of responsibility for a range of counseling activities. As with the practicum, agency supervisors serve as mentors, meeting at least one hour per week for individual supervision. Format and Content of Internship CSP 676 A full or part time supervised counseling internship experience in a community setting, providing counseling services and other human services for children or adolescents. Emphasizes the practical application of counseling skills, theories and knowledge. Includes weekly seminar. Pre- requisites: CSP 552, 553 and departmental permission. Scheduled fall and spring semesters. 3 credits. Within this seminar, students will discuss issues occurring in their internship, consult with each other concerning problem solving strategies and review legal and ethical standards in counseling. The internship does not include weekly individual supervision by a program faculty member, but other components of the internship are similar to those of the practicum (e.g., seminar format and content, log requirement, contract and registration procedures). Students are expected to maintain a log of internship experiences using the same format as the practicum log. See instructor syllabi for additional requirements. Required Hours for Internship Students are required to spend a minimum of 600 hours on site during the entire two semester internship. Two hundred and forty of these hours should be considered direct service hours (e.g., counseling individuals and groups) and the remaining indirect hours (e.g., faculty/staff meetings). These hours are typically part- time (approximately 20 hours a week) across two semesters. Please remember that these hours are the MINIMUM requirements that you must perform. In many situations, you will go well over these requirements. However, you must document all activities in order to receive credit for your work. This is required for your class, your certification and your eventual licensure. Students are required to complete 600 hours of internship, with 240 of those hours being direct services. Internship Experiences: DIRECT SERVICE INDIRECT ACTIVITIES Minimum Time Requirement 240 hours total 360 hours total 13

14 Internship Objectives As part of the internship experience, there are general skills that the student will learn. These include: General Skills: To expand skills from other courses Relate theory to practice Evaluate professional growth and career goals Consult with other professionals Gain increased understanding of administrative and technical tasks under the purview of a counselor Acquire greater knowledge of and experience a variety of intervention strategies Gain understanding of diversity and multicultural issues and needs Expand knowledge of technology in counseling Function as a professional counselor at an approved site Specific Skills: In addition to the practicum skills, internship students are expected to master: 1. Have a clear view of their goals, objectives and expectations for the internship. 2. Be able to identify and seek out support systems. 3. Understand the concept of privileged communication, including confidentiality. 4. Maintain professional conduct during coursework and the internship experience (appropriate dress, decorum). 5. Seek supervision whenever there is any doubt or confusion regarding the ethical or legal requirements. 6. Have a clear perspective of role definition. 7. Make a commitment of time for professional meetings and sessions with agency supervisors as well as other appropriate activities. 8. Maintain a weekly and semester log of internship hours. 9. Engage in the supervisory process by constructing an agenda of issues, problems and questions that need to be addressed and that will contribute to professional growth. 10. Conduct a self evaluation at the end of each semester of internship. Grading The student s final grade will be determined by the CSP 676 instructor. It will include both an analysis of the quantitative and qualitative aspects of the student s experience and performance. The final grade will be based on: The student fulfilling the required service hours How well the student s goals and objectives have been met The Agency Supervisor s evaluation Any other course requirements, as indicated on course syllabi 14

15 Professional Considerations Ethical Guidelines: As a student and professional in Counseling, students are required to follow a professional code of ethics. Students must read, understand, and use these ethical guidelines. Additionally, students must adhere to state and federal laws and the regulations of the host agency. However, because the resolution of many ethical dilemmas is not always clear, students should consult faculty and agency supervisors about any ethically unclear situations that arise at the site. If the situation is urgent, students should immediately contact the Agency Supervisor and faculty supervisor or seminar instructor. If it is a non- urgent ethical question, students should bring the question to supervision meetings. Selected Ethics Codes: American Counseling Association: American Mental Health Counselors Association: National Board of Certified Counselors: codeofethics.pdf Confidentiality: In accordance with the ethical principles of ACA, state and federal law and field site regulations, students must maintain strict client confidentiality at all times. Students are required to read, understand and sign the SCSU Field Site Confidentiality Agreement (see appendix B). When video or audio- recording, students are required to submit adult or minor Recording Consent Forms (see appendix H & I) as well as other additional recording releases required by the field site. Note that confidentially is a part of the informed consent process. Students are responsible for informing clients of procedures in counseling and the role of the professional counselor (including one s status as a practicum or internship student) at or before the first counseling session. Limits to confidentiality should be addressed and defined in a developmentally appropriate manner. This confidentiality also involves the use of client initials or pseudonyms for all CMHC coursework. Other key aspects of confidentiality are located in the ethical codes listed above. As a reminder, students should NEVER discuss clients with unauthorized personnel. Audio and Video- Recording: Audio and/or video- recordings of counseling sessions during field experience are for the sole purpose of development, review, reflection and refinement of professional counseling skills. These audio and/or video- recordings are for graduate level instructional purposes only. The CSP department highly values and strongly encourages audio or video- recording at all practicum and internship sites. While we understand that recording is not always possible, recording is generally required in practicum and preferred in internship. For those sites where recording is possible, the CSP department has developed the following guidelines for the audio and/or video- recording of individual and group sessions by graduate Practicum and Internship students: Any recording of counseling sessions by graduate practicum and internship students is to be used for supervision purposes only. Such recordings are to be used for review by the Agency Supervisor, SCSU Practicum Faculty Supervisor, and/or fellow students enrolled in field work 15

16 All recordings and recording transcripts should be treated as personal health information (per HIPAA Privacy Rule) and should be kept locked and secure at the field site when not under review. Recordings can only be transported (from site to SCSU) when they are coded and no identifying information is present on the recording or case. All recordings are to be erased immediately after completion of supervisory review. Such audio and/or video- recording will be completed only with the full knowledge and approval of the client(s), Agency Supervisor and agency administration. A signed release form (Appendix H & I) must be on file with the Agency Supervisor prior to any audio and/or video- recording of student counseling sessions. In addition, students must sign the Field Site Confidentiality Agreement (Appendix B) which further outlines obligations and responsibilities around confidentiality during field site placement. Personal Challenges: Because personal issues may impact one s clinical work, many counselors in training choose to seek personal counseling. Students at SCSU are eligible for counseling services through SCSU Counseling Services. (203) Note that if a student chooses to use SCSU Counseling Services as a field site, they must seek counseling services elsewhere. In this circumstance, Counseling Services will provide a referral to other local counseling practitioners. Supervision and Feedback: A crucial component of the practicum and internship process is constructive feedback. Students will receive extensive feedback from peers, agency supervisors and faculty supervisors. Because personal qualities, including openness and flexibility, impact one s counseling effectiveness, there will be times when feedback addresses personal as well as professional skills. Students must understand and monitor personal reactions to criticism and develop a healthy and constructive way to deal with potentially negative feedback. Supervision Preparation: Students must take an active role in supervision sessions. Students must come to each supervision session fully prepared. This includes completing all requisite paperwork and/or assignments (e.g., readings, research), preparing a list of specific questions for the supervisor, and reviewing video and/or audio recordings of sessions prior to supervision. Special Note to Supervisors We deeply appreciate the time and energy that you have committed to our students. Should you have additional questions or need for support, please feel free to contact the Field Site Coordinator or any of the CMHC faculty at any time. It is our pleasure to help you in any way possible. 16

17 Appendix A DEPARTMENT OF COUNSELING AND SCHOOL PSYCHOLOGY Clinical Mental Health Counseling Practicum / Internship Application Form Directions: This form and documentation of professional liability insurance must be completed and returned to the SCSU Field Site Coordinator no later than the deadline for the term in which you enroll in this clinical experience. Remember you also must register for this course through the registrar at the appropriate time. Note that submission of the appropriate forms does not guarantee enrollment in this class. A separate form is required for each practicum or internship course that you take. Be sure to retain personal copies of all formal documentation. Application Deadlines: Fall: 3/1 Spring: 7/1 Clinical Experience (check one): Practicum Internship Semester of Practicum/Internship (indicate one): Fall Spring 1. Complete your current contact information below. Name: Home Phone: Address: Cell Phone: 2. Indicate what semester you took each of the following courses and the grades earned in each course. Only check those courses you have completed. Remember to attach an unofficial transcript to this document. CSP 552- CSP 553- CSP 550- CSP 568- CSP 578- CSP 595- CSP 656- CSP 691- Have you received below a B in any course? No Yes

18 3. What type of population or geographical location are you seeking for your site? 4. If you have secured a site, complete the information below on the selected agency site in which you will be working. Name of Agency: Address: Phone: Agency s Internship Coordinator or Contact Person: 5. If applicable, complete the information below on your selected Agency Supervisor and ATTACH A COPY OF YOUR AGENCY SUPERVISOR S RESUME OR CV. Note: you must have ONLY ONE designated clinical supervisor. Name: Highest Degree: Doctoral Degree in Title: Masters Degree in Credentials: Type of Licensure/License Number: Number of years as a mental health clinician: Type of supervision training (i.e., seminars, formal coursework): Phone: I have read and understand the policies and procedures regarding confidentiality of client information and records management and the 2005 ACA Code of Ethics. I am aware that client confidentiality is protected by Federal regulations and am also aware of the penalties of non- compliance with these regulations and of noncompliance with the ACA Code of Ethics for case/record management and professional conduct while studying in the Southern Connecticut State University counseling program or serving as a counseling practicum or intern student. I am also aware that these laws, standards and policies are applicable to me after termination of study or employment. I further understand that these laws, standards and policies must be followed to protect the welfare of counseling clients, the university, and related institutions. 6. Sign below indicating that all of the information included is true to the best of your knowledge. Signature of Student CMHC approval to take course granted? yes no CMHC approval of site granted? yes no Signature of CSP Faculty

19 Appendix B DEPARTMENT OF COUNSELING AND SCHOOL PSCYHOLOGY Field Site Confidentiality Agreement Name of student: Practicum or Internship: Semester/year of field site experience: In accordance with American Counseling Association Code of Ethics, state law, and HIPPA regulations, I agree to abide by the following standards covering client audio and/or video recordings: I will not label my audio/video recording with any client identifying information. I will know where my audio/video recording is at all times. When possible, I will keep my audio/video recording in a locked location. Under no circumstance will I show or share client audio/video recording with anyone other than designated field site employees or SCSU faculty. Should I fail to comply with the above standards, I understand that I will be subject to consequences as determined by the SCSU faculty, which may include termination of the internship or expulsion from the Clinical Mental Health Counseling program. I understand and agree to the above listed standards. Student Signature Printed Name of Student

20 Appendix C DEPARTMENT OF COUNSELING AND SCHOOL PSYCHOLOGY Clinical Mental Health Counseling Field Site Contract This agreement is made on between and the Counseling and (date) (field site) School Psychology Department at Southern Connecticut State University. The agreement verifies that will be working during semester(s) of the (practicum or internship student) (semesters) school year for approximately per week. (year) (# hrs) The Practicum Site agrees to: Give the student adequate opportunity to accrue hours providing diagnosis treatment of mental and emotional disorders and related professional counseling activities. Understand Connecticut State requirements for Licensure as a Professional Counselor. Be familiar with and follow ACA and other pertinent ethical codes. Become familiar with all of the guidelines and expectations for site experiences, as described in the Practicum and Internship Handbook. Provide an opportunity to make audio or video recordings of client sessions (required in practicum, preferred in internship). Offer a designated area for intern work, confidential for phone calls and counseling sessions. Requirements of an Agency Supervisor: Have a minimum of a Masters degree in counseling or a related profession and be independently licensed by the State of Connecticut as a Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), medical doctor certified in psychiatry by the American Board of Psychiatry and Neurology, licensed psychologist, or licensed Advanced Practice Registered Nurse (APRN) certified as a clinical specialist in adult psychiatric and mental health nursing with the American Nurses Credentialing Center. Have a minimum of 2 years experience as a Professional Counselor or mental health clinician. Have completed relevant training or coursework in counseling supervision; Prior experience as a clinical supervisor of university interns is preferred.

21 Provide student with a minimum of one hour per week of regularly scheduled clinical supervision. This one designated hour must involve the designated clinical supervisor and a maximum of two supervisees. Possess knowledge of the CMHC program s expectations, requirements and evaluation procedures for students as presented in Practicum and Internship Handbook. Provide training needed for students to follow the policies and procedures of the agency. Communicate regularly with University faculty and meet with CSP faculty on scheduled visits. Review and sign all relevant documents and complete student evaluations The SCSU Department of Counseling and School Psychology agrees to provide a Field Site Coordinator. For practicum, SCSU will also provide a Practicum Faculty Supervisor for each student. Their responsibilities will be: SCSU Field Site Coordinator (both Practicum and Internship) Facilitate communication between University and field placement site. Consult with both SCSU faculty and agency supervisors and students as needed. Visit the Agency Supervisor and the student at the internship site at least once during the semester and have phone contact during the semester as needed. Faculty Supervisor (only for Practicum) Conduct class meeting on campus every week throughout the semester. Establish course requirements via the course syllabus. Focus on student counseling skills development such as microskills and interviewing strategies (in contrast, clinical issues are the main focus of on- site supervision). Immediately contact the University SCSU Field Site Coordinator should any problems or changes in relation to the student, site or University occur. Evaluate the student and discuss that evaluation with him/her. Submit grade for CSP 552. All parties agree that the following practicum activities will be included in the training that the student receives on site: DIRECT SERVICES Individual counseling Performing client sessions involving the assessment and/or treatment of specific mental and emotional disorders. Family/couples counseling Performing family or couples sessions involving the assessment and/or treatment of specific mental and emotional disorders. Group Counseling Co- leading or independently leading a psychotherapy group. Diagnostic Interviewing Use of specific assessment tools and clinical skills to identify an appropriate DSM- 5 diagnosis and identify a client s initial needs. Testing and Assessment Administration and/or interpretation of counseling assessments; Includes provision of interpretive summaries to clients. Career Counseling Counseling that includes client career or vocational development. Co- Therapy Actively participating in co- therapy with individuals or groups (not simply observing)

22 INDIRECT SERVICES Observation Observing on- site staff member performing psychotherapy. Telephone or Contacts Making direct contact with clients that is not face to face. Referrals Linking client to supplemental or supportive services. Clinical Documentation Writing case notes, treatment plans, and treatment summaries or other written reports for the formal medical record. Case Consultation Working directly with other mental health professionals regarding clients. Staff Meetings Attending clinical and/or administrative meetings with agency staff. Professional Development Activities Attending professional counseling trainings, workshops or conferences. Clinical Supervision (counts as indirect): On- site individual clinical supervision Weekly, face- to- face regularly scheduled supervision regarding skills development and client care; Provided by the Agency Supervisor. On- site group supervision All formal group supervision provided at the field site. University Supervision Individual supervision with faculty supervisor (Only Practicum) and field work seminar (Both Practicum and Internship) Identification of Agency Supervisor and SCSU Field Site Coordinator: will be the sole practicum Agency Supervisor provided by the agency. The training (Agency Supervisor) activities (reviewed below) will be provided for the student in sufficient amounts to allow an adequate evaluation of the student s level of competence in each activity. Dr. Louisa Foss- Kelly will be the Field Site Coordinator with whom the student and Agency Supervisor will communicate regarding progress, concerns, and performance evaluations. Signature of Practicum Student Signature of Agency Supervisor Signature of SCSU Field Site Coordinator

23 Appendix D CMHC Weekly Log Sheet Name: Course: CSP 553 CSP 676 I or II Site: Week of / / to / / Major Task M T W R F TOTAL Individual Counseling Family/Couples Counseling Group Counseling Diagnostic Interviewing Testing and Assessment Career Counseling Co- therapy DIRECT SERVICE TOTAL Observation Telephone or Contacts Referrals/Case Management Case Notes & Report Writing Case Consultation Staff Meetings Professional Development On- Site Individual Sup. On- Site Group Supervision Faculty Individual Supervision Supervision University Group Supervision INDIRECT SERVICE TOTAL Signature of Student Signature of Agency Supervisor SEMESTER TALLIES (incl. this week) Direct: Indirect: TOTAL:

24 CMHC Semester Log Sheet Appendix E Name: Course: CSP 553 CSP 676 Site: Week of / / to / / Major Task DIRECT SERVICES TOTAL INDIRECT SERVICES TOTAL Signature of Student Signature of Agency Supervisor Printed name Agency Supervisor Signature of CSP Seminar Instructor

25 Appendix F DEPARTMENT OF COUNSELING AND SCHOOL PSYCHOLOGY Student Performance Evaluation for CMHC Practicum and Internship Directions: This form is to be completed by the Agency Supervisor at mid- term and semester end and given to the Practicum or Internship Seminar Instructor. Rating Scale Name of Graduate Student: : Midterm Evaluation Final Evaluation Practicum or Internship: Name of Agency Supervisor: Name / Address of Site: 1 Does not meet criteria at an acceptable level 3 Meets criteria at an acceptable level, consistent with basic agency expectations for students 5 Meets criteria consistently above agency expectations Intra/Interpersonal Professional Behavior 1. Openness to new ideas Flexibility Cooperative with others Willingness to accept and use feedback Awareness of own impact on others Ability to deal with conflict Ability to accept personal responsibility Ability to express feelings effectively and appropriately Attention to ethical and legal considerations Initiation and motivation Ethics 1. Demonstrates the ability to apply and adhere to ethical and legal standards in clinical mental health counseling Professional Competence 1. Demonstrates the ability to recognize his or her own limitations as a clinical mental health counselor and to seek supervision or refer clients when appropriate 2. Provides only those services and applies only those techniques for which she/he is qualified by education, training and experience

26 Administration 1. Applies knowledge of public mental health policy, financing, and regulatory processes to improve service delivery opportunities in clinical mental health counseling 2. Applies current record- keeping standards related to clinical mental health counseling Assessment 1. Demonstrates the ability to use procedures for assessing and managing suicide risk Demonstrates skill in conducting an intake interview, a mental status evaluation, a biopsychosocial history, a mental health history, and a psychological assessment for treatment planning and caseload management 3. Screens for addiction, aggression, and danger to self and/or others, as well as co occurring mental disorders 4. Applies the assessment of a client s stage of dependence, change, or recovery to determine the appropriate treatment modality and placement criteria within the continuum of care 5. Demonstrates appropriate use of diagnostic tools, including the current edition of the DSM, to describe the symptoms and clinical presentation of clients with mental and emotional impairments 6. Is able to conceptualize an accurate multi- axial diagnosis of disorders presented by a client and discuss the differential diagnosis with collaborating professionals 7. Differentiates between diagnosis and developmentally appropriate reactions during crises, disasters, and other trauma- causing events Counseling Skills 1. Establishes relationships in such a manner that a therapeutic working alliance can be formed 2. Creating appropriate structure and maintaining professional boundaries Understanding context understanding the uniqueness of client s story elements and their underlying meanings 4. Responding to feelings identifying client affect and addressing those feelings in a therapeutic manner 5. Congruence genuineness; external behavior consistent with internal affect Establishing and communicating empathy Non- verbal communication Immediacy staying in the here and now Timing responding at the optimal moment Intentionality clearly responding with clinical intention Self- disclosure skillful and carefully- considered for a specific therapeutic purpose Demonstrates awareness of power differences in the therapeutic relationship and manages these differences therapeutically 13. Creates a safe clinical environment Uses the principles and practices of diagnosis, treatment, referral, and prevention of mental and emotional disorders to initiate, maintain, and terminate counseling 15. Provides appropriate counseling strategies when working with clients with addiction and co- occurring disorders

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