SUBSTANCE ABUSE COUNSELING DEPARTMENT

EASTFIELD COLLEGE SUBSTANCE ABUSE COUNSELING DEPARTMENT Practicum DAAC 2366 Substance Abuse Counseling

PURPOSE Field experiences are part of all of the counseling programs with internships marking the synthesis and culmination of the academic preparation to become a professional. These provide candidates with an opportunity to demonstrate and improve knowledge and skills learned in the classroom setting. Internships provide supervised learning experiences to meet the professional needs and goals of the candidate while providing a service to the school or agency. During internships the focus is on face-to-face direct service including individual/group counseling. There are varying numbers of hours required. The Practicum provides an opportunity for students to apply counseling skills, under close supervision, in a real life work environment. As a part of the practicum the student will be expected to: 1. Practice skills learned in previous course work; 2. Receive feedback on his/her level of effectiveness in a helping relationship; 3. Share clinical counseling experiences with others in a supportive setting; 4. Learn what problems others are encountering and what solutions could be considered; 5. Share techniques that are promising; 6. Work with a variety of clients and presenting problems; 7. Experience those characteristics that are unique to different settings; e.g., schools, businesses and agencies; 8. Relate theory to practice; 9. Begin the formulation of an applied theory of counseling; 10. Research areas of professional interest; 11. Work in an ethical and professional manner; 12. Work toward professional certification/licensure requirements. In addition to providing actual counseling experiences for the student, it is anticipated that the practicum will help meet the needs of the community's businesses and agencies by providing well-trained students who can perform a variety of human services. PRACTICUM REQUIREMENTS Each student is REQUIRED to attend the ORIENTATION schedule in the campus schedule (fall, spring or summer). Before enrolling in the practicum you must have completed the following courses: DAAC 1304 Pharmacology of Addiction DAAC 2307 Addicted Family Intervention DAAC 2330 Multicultural Counseling DAAC 2341 Counseling Alcohol and Other Drug Addictions SOCI 2340 Drug Use and Abuse SCWK 1305 Group Work Intervention SCWK 1321 Orientation to Social Services SCWK 2301 Assessment and Case Management SCWK 2311 Interviewing and Counseling Theories You are required to complete 336 CLOCK HOURS at your practicum site. This averages out to about one day full-time per week, but may be acquired in smaller increments. 2

LOGS, EVALUATIONS, AND FINAL HOURS are due the last class of the semester. Unreturned field supervision evaluations will result in an I grade for that semester. The instructor reserves the right to make assignments throughout the practicum as part of the group or individual supervision sessions. The instructor also reserves the right to assign remediation work. STEPS FOR SECURING A PRACTICUM SITE In order to secure an appropriate internship site the student intern is responsible for the following: 1. Begin your search early securing an internship site is more difficult than it sounds. It is recommended that you begin your search early in the semester prior to your internship year. You should consult with the coordinator regularly during this time. Many agencies require on-site training of the intern prior to commencement of internship work. You should check with your agency about this requirement and arrange dates for your training as early as possible. A list of possible practicum and internship placements is available on the Eastfield website. 2. Make sure your site can accommodate your needs your site must agree to provide you with opportunities to complete all of your internship requirements. Most importantly, you should make sure that: a. Your site can provide you with enough contact hours to complete your requirements b. You will receive regular weekly supervision with your on-site supervisor c. Your on-site supervisor is licensed as a LMHS, LCSW, LMFT, or Licensed Chemical Dependency Counselor. If you are completing an internship in another state, you should assure that your supervisor has the appropriate license in that state. Students will not be allowed to complete an internship experience without a licensed supervisor present on site. d. You will be able to complete all course requirements specified in this handbook AND your course syllabus. 3. Complete necessary paperwork - Prior to your internship you should have an agency agreement completed with your chosen site, an initial contract, and a start date for your internship experience. All forms are attached. Many agencies require on-site training of the intern prior to commencement of clinical work. You should check with your agency about this requirement and arrange dates for your training as early as possible. 4. Interns will not be permitted to accrue internship hours prior to the start of the semester and/or prior to having all necessary paperwork completed. OBJECTIVES The primary objective of the internship is the acquisition of competence in the skills required by the work role of the counselor in a specific setting. The internship requires the Counseling candidate to: Demonstrate skills in developing a counseling relationship; Articulate a counseling approach that is consistent with personal values, and theoretical beliefs; Accurately identify client concerns and issues; Assess clients from a multicultural perspective to understand their worldview, values, family structure and behavioral norms; Demonstrate the appropriate use of assessment instruments based on a 3

familiarity with the validity and reliability of these instruments; Interpret data about clients regarding diagnosis and treatment; Demonstrate familiarity with and an understanding the DSM-IV classification of disorders and the various diagnostic categories (of particular importance for mental health counselors); Make recommendations for clients based on available data and develop a counseling plan; Provide individual and group counseling services from the beginning of the counseling relationship to termination; Demonstrate an ability to provide information to a group through a presentation, workshop, or classroom guidance program; Demonstrate an understanding means of evaluating professional effectiveness. Demonstrate sensitivity for legal and ethical dilemmas and conduct themselves in a professional and ethical manner at all times. Demonstrate verbal communications that are clear and concise in daily interactions with coworkers and other professionals; Engage in consultation with professionals and during interdisciplinary team meetings; Educate clients on such issues as self care, daily living skills, parenting, education and other support services; Demonstrate effective referral and collaboration skills; Write reports required by the site supervisor including progress notes and written client records; Demonstrate computer skills for word processing, specialized software application, web, email, and search of data bases; Communicate with other professionals using appropriate terminology pertaining to counseling, psychopathology, special services and psychotropic medication; TIME REQUIREMENTS The internships are associated with specific hour requirements of 336 hours. INTERNSHIP SITE SELECTION Often internships lead directly to employment. Therefore, identifying appropriate sites requires careful thought and research. When possible, candidates should interview counselors and/or internship directors at the site of interest. A variety of community sites are listed in the Internship Directory available online. If a student identifies a site that meets these criteria and which is not on the directory, they should consult program faculty for possibly adding the site. When selecting field placement sites, candidates should take the following steps: 1. Candidates should begin formulating their practicum and internship plans when they enter the program. 2. Students should plan to diversify their internship experiences in terms of counseling issues/goals, populations, and settings. 3. Candidates may wish to set up appointments to visit several sites in 4

order to make a more informed choice. 4. Field Placement sites must provide an organized and varied training experience in which candidates receive consistent, qualified, individual supervision during their placement. Candidates may not be used as clerical or support staff. Internship experiences are intended to mirror the work of the professional counselors. 5. When candidates and sites agree to work together, they should meet to discuss their specific plans. Once a student has identified a potential site they should complete their application and submit it for faculty review and program approval. Note that completion of the program depends on successful completion of each and every internship which may require a positive background check and fingerprint review. 6. Candidates should have a current resume ready to take to the site. Again, they are likely to be subjected to a background check (finger printing), or a drug screen. the intern and will not be used in the future. 8. Internship sites have the option of accepting or declining to have an intern student at their site. Therefore, candidates should make the best possible impression and conduct themselves in a professional manner when they visit sites on an informal or formal basis. Some sites offer paid positions to internship candidates before they begin their placement, but this is the exception rather than the rule. Conversely, there are some candidates who can arrange an internship as part of their work. This should be carefully considered and planned, and requires program approval. 9. Once the internship placement has been approved by the program faculty, the student and site supervisor should meet to develop clear activities in which the candidate will be expected to engage throughout the placement. 7. Interns are expected to be involved in those activities in which the regular staff is engaged. During the course of internships candidates should assume all duties of a staff counselor while they are on site (for instance, intake interviews, individual, and group counseling appropriate to their course experience). Sites that severely limit the candidates activities will lose 5

EVALUATIONS The college and on-site supervisor will collaborate in the evaluation of the candidate. Internships are graded on a satisfactory/unsatisfactory basis. A satisfactory grade is earned if the candidate: Completes all experiences agreed to in the field experience agreement and the course syllabus; Participates in and is prepared for the supervision sessions; Competently completes all course requirements and assignments including those for hours; Demonstrates good interpersonal relationships with clients and co-workers; Demonstrates a willingness to address personal issues or professional limitations by following the recommendations of the faculty or site supervisor; Demonstrates counseling and related skills consistent with their training. SUPERVISORY EVALUATION Faculty supervisors, site supervisors, and internship students work collaboratively throughout the semester to assess the student s performance and monitor his/her progress. Feedback to students is a continuous process and student progress is documented in final semester evaluations. Each professional providing supervision to internship candidates must complete evaluation forms at the end of the student s field experience. Site supervisors are expected to review their evaluations with students before submitting the evaluation form to the Faculty Supervisor. It is strongly recommended that students use this same evaluation process to compare self-ratings and supervisors ratings. Supervisors are also encouraged to write specific strengths and weaknesses in space provided since this gives university supervisors areas where they can intervene for improvement. EVALUATION OF PROGRESS At the mid-point of the practicum or internship experience, supervisors and students will be expected to evaluate students progress and make any necessary adjustments to the goals and objectives that were developed at the start of the field experience. It is essential that supervisors engage in ongoing assessment of the student s performance. If there are any problems with the student s performance, the supervisor is expected to communicate this to the student and the practicum/internship coordinator. A remediation plan will be developed by the supervisor and student and submitted to the student s instructor. 6

Table of Contents 1. Syllabus (Available online via Start Here Tab) 2. Recommended Practicum Site List (Available online via Start Here Tab) 3. Student Application (must be Notarized) 4. Professional Liability Insurance Enrollment Form 5. Code of Ethics Statement 6. Placement Contract 7. Training Station Agreement 8. Site Visit (Completed online via Assignment Tab) 9. Final Internship Evaluation Form (Completed by Site Supervisor) 10. Student Evaluation of Practicum Site (Completed by Student) 11. Practicum Student Self Evaluation Objectives (Completed by Student) 12. Time Sheets- KSA-12 Core Functions Record (Completed online via Assignment Tab) 13. Seminar Reports (Completed online via Assignment Tab) 14. Bi-Weekly Supervision (Completed online via Assignment Tab) 15. Bi-Weekly Journal (Completed online via Assignment Tab ) 16. Resume (Submitted online via Assignment Tab) 17. Degree Plan (Submitted online via Assignment Tab) 7

EASTFIELD COLLEGE SUBSTANCE ABUSE COUNSELING DEGREE PROGRAM DAAC 2366 PRACTICUM STUDENT APPLICATION Last Name: First: Middle Initial: Home Address: Date of Birth: Age: Student ID #: Current Employer: Work Phone #: Practicum Placement Site: Address: On-Site Supervisor: On-Site Supervisor (Email): Phone #: Credentials: 1. Have you completed at least 24 credit hours of prerequisites in DAAC and/or SCWK prefixed courses, with a minimum of 9 credit hours (135 clock hours) in DAAC prefixed course? DAAC 1304 Pharmacology of Addiction, DAAC 2307 Addicted Family Intervention, DAAC 2330 Multicultural Counseling, DAAC 2341 Counseling Alcohol and Other Drug Addictions, SOCI 2340 Drug Use and Abuse, SCWK 1305 Group Work Intervention, SCWK 1321 Orientation to Social Services, SCWK 2301 Assessment and Case Management, SCWK 2311 Interviewing and Counseling Theories Yes No (If you answer no, you are not eligible to enroll in this course.) a. If part of education completed at another training institution, list courses below and provide copies of certificates or transcripts. Title of Course Specific/Related Education Date(s) Clock Hours 2. Do you have or have you applied for Counselor Trainee status with the Department of Human Services (DSHS)? Yes No (If no, please understand that the application must be obtained and submitted to TCADA before applying for testing.) 8

3. Misdemeanor or Felony Convictions? Yes No If yes, please explain each conviction. Failure to disclose convictions on the official Licensure Application may lead to denial of licensure/internship. Conviction Date Punishment Drug/Alcohol Related Yes No 4. Have you been released from parole/probation supervision within the last year or are you currently under supervision? Yes No 5. Length of sobriety? Year(s) Month(s) Treatment(s) Date(s) 6. List paid or volunteer employment in the alcohol and drug abuse counseling field only. List your most current experience first. Additional sheets may be attached if necessary. If you have no experience, please mark non-applicable (N/A). Year(s) Month(s) N/A Facility Date(s) Address Number & Street City, State, & Zip Code Immediate Supervisor Your title Major duties 9

7. Do you have liability insurance? Yes No I ATTEST THAT ALL THE INFORMTION LISTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT INTENTIONALLY FALSE OR MISLEADING STATEMENTS ON THIS APPLICATION WILL RESULT IN MY BEING DECLARED INELIGIBLE FOR PLACEMENT IN A CLINICAL TRAINING INSTITUTION AND/OR HAVING THE DESGNATION OF COUNSELOR INTERN ASSIGNED TO ME. ALL INFORMATION ON THE APPLICATION IS CONFIDENTIAL AND WILL BE USED FOR PLACEMENT PURPOSES AND/OR COUNSELOR INTERN DESIGNATION ONLY. Please print name Signature Date SUBSCRIBED and sworn to before me this day of,. Notary public in and for County, State of Texas, my certificate expires. Notary Public (Seal) 10

Professional Liability Insurance for Students Responsibility. As your student responsibilities increase, so does the chance of you being named in a lawsuit, regardless of the charges. Frivolous and unjustified claims are commonplace in today s courts. Professional Liability insurance is a necessary safeguard for any student healthcare professional. Vulnerability. A lawsuit could end your career and cripple you financially. Professional Liability insurance could help protect you from professional and financial devastation as soon as you re threatened in a law suit. Pays 1,000,000/3,000,000 Professional Liability Coverage 1,000,000/ 3,000,000 Professional Liability protection on covered claims arising from real or alleged negligence. The insurance company may pay up to $1,000,000 per incident or up to a total of 3,000,000 for all covered incidents, regardless of the number of claims of persons involved. Additional protection with Supplement Liability Coverage By adding supplement liability coverage, subject to the terms of the insurance certificate, you are covered for bodily injury and property damage occurrences not related to your professional duties. If you have passed your licensing examination and are licensed or registered do not use this form. Please contact the administrator for appropriate enrollment form indicating your professional status. Check Type of Student Student Recreational Therapist Student Rehabilitation Therapist Student Rehabilitation Student Substance Abuse Counselor Student Occupational Therapist Student Social Worker Other Explain and include a copy of the curriculum on a separate sheet of paper. Last Name: First Name: School ID. Number: Address (Home) City: State: Zip: Daytime Phone Number: Full Name of School: Address of School: City: State: Zip: Scheduled Date of Graduation: Month Yr: Allied Health Insurance I understand that I am not covered by this insurance if I am any of the following: physician, surgeon, dentist, nurse midwife, chiropractor, podiatrist, osteopath, psychiatrist, attorney, accountant, financial advisor, investment consultant, or real estate or insurance agent or broker. I understand that these professionals occupations are excluded from coverage. I understand that the insurance will not apply to any partner, principal or owner of a residential overnight facility. The insurance described herein is subject to the terms, conditions and exclusions of the insurance certificate. Once the completed application has been approved and the premium has been received you will become a member of the Lone Star Health Care Purchasing Group. Located and Domiciled in Texas and obtain the insurance coverage afforded through the Group Policy on an annual term. This application is subject to the underwriter s approval. Your completion of this application and premium payment does not bind coverage or obligate the insurance company to issue you insurance coverage. Coverage will become effective following the receipt of your acceptable application and premium payment. Your application cannot be processed unless it is completed in its entity. The application is subject to the company s underwriting rules. I declare the information contained in the application is true and that no material facts have been suppressed or misstated. I understand that incorrect information could void the protection. Any person who knowingly and with intent of defraud any insurance company or any other person files an application for insurance containing any false information, or conceals, for the purpose of misleading, information concerning any fat material thereto commits a fraudulent insurance act. Limits of Liability 1,000,000 each incident/ $3,000,000 aggregate Premium 1 year $ 18.13 Coverage is effective the date your enrollment form and payment are received and accepted in our offices. Signature Date 11

TITLE 25 PART 1 CHAPTER 140 SUBCHAPTER I Texas Administrative Code HEALTH SERVICES DEPARTMENT OF STATE HEALTH SERVICES HEALTH PROFESSIONS REGULATION LICENSED CHEMICAL DEPENDENCY COUNSELORS RULE 140.423 Professional and Ethical Standards a) This subsection applies to counseling records of a LCDC's private practice. Documentation of professional services rendered in another setting shall be created and maintained in accordance with any legal requirements for documentation applicable to the particular setting in which they were provided. (1) The counselor shall establish and maintain a record for every client at the time of initial service delivery. The client record shall include: (A) client identifying information; (B) assessment results, including a statement of the client's problems and/or diagnosis; (C) plan of care; (D) documentation of all services provided, including date, duration, and method of delivery; and (E) a description of the client's status at the time services are discontinued. (2) The counselor shall maintain a record of all charges billed and all payments received. (3) All entries shall be permanent, legible, accurate, and completed in a timely manner. (4) All documents and entries shall be dated and authenticated. Authentication of electronic records shall be by a digital authentication key. (5) When it is necessary to correct a record, the error shall be marked through with a single line, dated, and initialed by the counselor. (6) The counselor shall protect all client records and other client-identifying information from destruction, loss, tampering, and unauthorized access, use or disclosure. Electronic client information shall be protected to the same degree as paper records and shall have a reliable backup system. (7) The counselor shall comply with all applicable state and federal laws relating to confidentiality, including the requirements of Texas Health and Safety Code, Chapter 611 (relating to Mental Health Records) and Code of Federal Regulations, Title 42, Part 2 (relating to Confidentiality of Alcohol and Drug Abuse Patient Records). (8) The counselor shall not deny clients access to the content of their records except as provided by law, including Texas Health and Safety Code, 611.0045 (relating to Right to Mental Health Record). (9) Client records shall be kept for at least five years. Records of adolescent clients shall be kept for at least five years after the client becomes eighteen years of age. (b) This subsection applies to an LCDC in private practice using the internet or telephone to provide chemical dependency counseling services. (1) The counselor must reside in and perform the services from Texas. (2) The department maintains its authority to regulate the counselor regardless of the location of the client. (3) The counselor is subject to the applicable laws of other states and countries where the client may reside or receive services by electronic means. Such laws may limit the counselor's practice. (4) The counselor's provision of services by electronic medium must comply with Code of Federal Regulations, Title 42, Part 2 (relating to Confidentiality of Alcohol and Drug Abuse Patient Records), Texas Health and Safety Code, Chapter 611 (relating to Mental Health Records), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as applicable. (5) The counselor must be able to verify the identification of the client and ensure the client's appropriate age. (6) If a counselor uses the Internet as the electronic means by which counseling is provided or transfers data through the Internet, the counselor must comply with the following: (A) data may only be transferred using at least a 128-encryption; (B) e-mail communication is restricted relating to client information and documentation; and 12

(C) the counselor must provide technical backup for system problems by providing a phone number to the client to call for technical support and a contingency plan for the client when a technical problem occurs. (7) The counselor must provide services using audio or video in real time. (8) The counselor must provide a description of all services offered to the client in writing and describe who is appropriate for the services. The description must include: (A) a grievance procedure and provide a link to the department for filing a complaint when using the Internet and the toll-free number for the department when counseling by telephone; (B) the counselor's credentials, education level, and training; (C) a link to the licensure verification page when using the Internet and the toll-free number for the department when counseling by telephone; (D) the difference between electronic counseling and traditional counseling; and (E) the potential risk regarding clinical issues, security and confidentiality. (9) Services may only be offered by licensed chemical dependency counselors. (10) The counselor must provide an emergency contact person and phone number and emergency procedures to the client in writing. (c) This subsection applies to any person licensed, certified, or registered under this subchapter. (1) A licensee shall not discriminate against any client or other person on the basis of gender, race, religion, age, national origin, disability, sexual orientation, or economic condition. (2) A licensee shall maintain objectivity, integrity, and the highest standards in providing services to the client. (3) A licensee shall: (A) in addition to complying with any other applicable reporting requirements, promptly report to the department any suspected, alleged, or substantiated incidents of abuse, neglect, or exploitation committed by oneself or another licensee under this subchapter; (B) unless otherwise prohibited by law, promptly report to the department violations of Texas Occupations Code, Chapter 504 (relating to Chemical Dependency Counselors), or rules adopted under the Act, including violations of this subchapter by oneself or another licensee; (C) recognize the limitations of the licensee's ability and shall not offer services outside the licensee's scope of practice or licensure or use techniques that exceed the person's license authorization or professional competence. In the course of treating the substance abuse/dependence issues of a client, the licensee may independently address family issues, cooccurring mental health issues and physical and sexual abuse issues of a client if the counselor demonstrates: (i) 45 hours of education in each area; and (ii) 2,000 hours of clinically supervised postlicensure work experience by a qualified professional; and (D) make every effort to prevent the practice of chemical dependency counseling by unqualified or unauthorized persons. (4) A licensee shall not engage in the practice of chemical dependency counseling if impaired by, intoxicated by, or under the influence of chemicals, including alcohol. (5) A licensee shall uphold the law and refrain from unprofessional and unethical conduct. In so doing, the licensee shall: (A) comply with all applicable laws, regulations, and orders; (B) not make any claim, directly or by implication, that the person possesses professional qualifications, licensure, or affiliations that the person does not possess; (C) include, as applicable, their current credentials when signing all professional documents; (D) not mislead or deceive the public or any person; and (E) refrain from any act that might tend to discredit the license or profession. (6) A licensee shall: (A) report information fairly, professionally, and accurately to clients, other professionals, the department, and the general public; 13

(B) maintain complete, accurate, and appropriate documentation of services provided; (C) not submit or cause or allow to be submitted to a client or third party payer a bill for services that were not provided or were improper, unreasonable, or medically or clinically unnecessary, with the exception of a missed appointment for which notice has been given that a charge will be assessed, and as permitted by law concerning third party billing; and (D) provide responsible and objective training and supervision to interns and subordinates under the LCDC, CCS, or CTI's supervision. This includes properly documenting supervision and work experience and providing supervisory documentation needed for licensure. (7) In any publication, a licensee shall give written credit to all persons or works that have contributed to or directly influenced the publication. (8) Licensees shall respect a client's dignity, and shall not engage in, or permit their employees or supervisees to engage in, any action that may injure the welfare of any client or person to whom the licensee is providing services. The licensee shall: (A) make every effort to provide access to treatment, including advising clients about resources and services, taking into account the financial constraints of the client; (B) remain loyal and professionally responsible to the client at all times, disclose the counselor's ethical code of standards, and inform the client of the counselor's loyalties and responsibilities; (C) not engage in any activity that could be considered a professional conflict, and shall immediately remove oneself from such a conflict if one occurs; (D) terminate any professional relationship or counseling services that are not beneficial, or are in any way detrimental to the client; (E) always act in the best interest of the client; (F) not abuse, neglect, or exploit a client; (G) not engage in a sexual, personal, or business relationship with a client or a member of the client's immediate family (including any client receiving services from the licensee's employer) for at least two years after the client's services end; (H) not request a client to divulge confidential information that is not necessary and appropriate for the services being provided; (I) not offer or provide chemical dependency counseling, supervision, or related services, nor meet with a client, in settings or locations which are inappropriate, harmful to the client or others, or which would tend to discredit the profession of chemical dependency counseling; and (J) refrain from using any method or engaging in any conduct that could be considered coercive or degrading to the client or another, including, without limitation, threats, negative labeling, or attempts to provoke shame or humiliation. (9) A licensee shall protect the privacy of all clients and shall not disclose confidential information without express written consent, except as permitted by law. The licensee shall remain knowledgeable of and obey all state and federal laws and regulations relating to confidentiality of chemical dependency treatment records, and shall: (A) inform the client, and obtain the client's consent, before tape-recording the client or allowing another person to observe or monitor the client; (B) ensure the security of client records; (C) not discuss or divulge information obtained in clinical or consulting relationships except in appropriate settings and for professional purposes which clearly relate to the case, to the extent authorized by law; (D) avoid invasion of the privacy of the client; (E) provide the client his/her rights regarding confidentiality, in writing, as part of informing the client in any areas likely to affect the client's confidentiality; and (F) ensure the data requested from other parties is limited to information that is necessary and appropriate to the services being provided and is accessible only to appropriate parties. (10) A licensee shall inform the client about all relevant and important aspects of the professional relationship between the client and the licensee, and shall: (A) in the case of clients who are not their own consenters, inform the client's parent(s) or legal 14

guardian(s) of circumstances that might influence the professional relationship; (B) not enter into a professional relationship with members of the counselor's family, close friends or associates, or others whose welfare might be jeopardized in any way by such relationship; (C) not establish a personal relationship with any client (including any individual receiving services from the licensee's employer) for at least two years after the client's services end; (D) neither engage in any type or form of romantic or sexual behavior with a client (including any individual receiving services from the licensee's employer) for at least two years after the client's services end nor accept as a client anyone with whom they have engaged in romantic or sexual behavior; and (E) not exploit relationships with clients for personal gain. (11) A licensee shall treat other professionals with respect, courtesy, and fairness, and shall: (A) refrain from providing or offering professional services to a client who is receiving chemical dependency treatment and/or counseling services from another professional, except with the knowledge of the other professional and the consent of the client, until treatment and/or counseling services with the other professional ends; (B) cooperate with the department, professional peer review groups or programs, and professional ethics committees or associations, and promptly supply all requested or relevant information, unless prohibited by law; and (C) ensure that the person's actions in no way exploit relationships with supervisees, employees, students, research participants or volunteers. (12) Prior to providing treatment and/or counseling or substance abuse services, a licensee shall inform the client of the licensee's fee schedule and establish financial arrangements with a client. The counselor shall not: (A) charge exorbitant or unreasonable fees for any service; (B) pay or receive any commission, consideration, or benefit of any kind related to the referral of a client for services; (C) use the client relationship for the purpose of personal gain, or profit, except for the normal, usual charge for services provided; or (D) accept a private professional fee or any gift or gratuity from a client if the client's services are paid for by another funding source, or if the client is receiving treatment from a facility where the licensee provides services (unless all parties agree to the arrangement in writing) Source Note: The provisions of this 140.423 adopted to be effective September 9, 2008, 33 TexReg 7520 Print Name Signature Date 15

EASTFIELD COLLEGE SUBSTANCE ABUSE COUNSELING PLACEMENT CONTRACT The following Contract is mutually agreed upon in order to clarify the joint and separate responsibilities between hereinafter referred to as the Agency, and Eastfield College, hereinafter referred to as the College, by which the parties will provide field instruction in Substance Abuse Counseling for selected students of the College. This Contract supersedes any previous contract or agreement, verbal or written, entered into between the College and the Agency for the purpose of the Alcohol and Drug Abuse Counseling Practicum. SECTION I It is mutually agreed that: 1. The purpose of the Substance Abuse Counseling placement with the Agency is to provide opportunities for learning and to enable the students to meet the requirements for Practicum for Licensed Chemical Dependency Counselor (LCDC) as set by the Texas Certification Board of Addiction Professionals (TCBAP) and Texas Department of State Health Services. 2. The Agency will have the right to reject any student who, in the Agency s judgment, does not meet its criteria for acceptance and to set the total number of students the Agency is willing to accept for placement. 3. The Agency through the Field Instructor(s) will provide input to the College s Substance Abuse Counseling Curriculum and the College is responsible for maintaining adequate structure to consider the utilization of such input. SECTION II The Agency agrees to: 1. Accept Substance Abuse Counseling training as an integral part of its operation with statue and recognition and include participation in the overall Agency program and activities as appropriate to the objectives of practicum requirements. The Agency will provide the students such cases, client contract, access to records and other information within the Agency, as appropriate to meet the objectives of field instruction and practicum requirements, including both a variety of direct service experiences and experiences with the organizational functioning of the Agency. 2. Appoint a professional staff with LCDC or approved other professional such as LMSW, LPC, psychologist or physician who demonstrates commitment to practice and to 16

education to assume a day-to-day working relationship with the College s Field Instructor and to act as On-site Supervisor(s) for the students(s) and will allot said staff member(s) sufficient time for planning, supervision, evaluation, and to gain familiarity with the College s program. 3. Furnish in writing to the College any exceptional criteria it considers necessary for selection of students placed with the Agency. 4. Inform the College of any difficulties a student is having which might result in termination of the placement or a failing grade. The Agency will be responsible for documenting any student difficulties and efforts to deal with them. 5. Provide the use of existing office space, including privacy for interviewing, and such equipment, supplies, and clerical assistance as are necessary to the accomplishment of the learning tasks and the student s responsibilities in the Agency. 6. Inform the college of any change in policies, procedures, and/or staffing that might affect the quality or nature of field instruction. 7. Make time available to Field Instructor(s) for participation in periodic workshops and seminars. 8. Provide the College with the Agency s standards and regulations for personnel. Students will be subject to such rules and regulations of the Agency as are congruent with educational objectives of Field Experience. 9. Retain responsibility for services to its clients. SECTION III The College agrees to: 1. Assume responsibility for the selection of students to be placed with the Agency, and provide the Agency, prior to placement, information about the student s academic achievement, previous work experience, and a brief autobiography. The College agrees to endeavor to select students for Placement who meet any exceptional criteria specified by the Agency. 2. Honor a written request by the Agency, detailing the reason or cause, to relieve a student of his/her field placement responsibilities if such a student is found unsuitable for his/her assignment, or if unusual circumstances within the Agency dictate termination of the practicum experience. 17

3. Conduct periodic workshops and seminars for On-site Supervisors which will include new developments in Substance Abuse Counseling education, practice and information on the overall functioning and management of the Substance Abuse Counseling Program in the College. 4. Provide On-site Supervisors with a statement of the educational objectives of Practicum experience, explanation of the various forms required for Practicum, a copy of clinical learning activities and work with them in developing the kinds of learning experiences to which the student should be exposed. 5. Assume responsibility for the overall quality of the student s education in the Substance Abuse Counseling Program and for the administration of the field instruction program in relation to the educational requirements of the Substance Abuse Counseling Program and the College. 6. Be responsible for the cooperation with the Agency in maintaining standards in preparing students for placement to assure the quality of service required by the Agency. SECTION IV Terms of the contract: 1. This Agreement will become effective on the day of. 2. This Contract will remain valid until canceled by either or both of the Parties hereto. In the event that there is no mutual agreement concerning cancellation, then either Party may give written notice of cancellation to the other Party and this Contract will be canceled effective thirty (30) days after receipt of such notice. FOR the faithful performance of the terms of the Contract, the Parties hereto, in their capacities as stated, affix their signatures and blind themselves. EASTFIELD COLLEGE By: Title: Date: Agency By: Title: Date: Student Signature Date 18

Dallas County Community College District Internship/ Practicum/ Cooperative Education Training Station Agreement Program Information: College: Course: Rating Period: Year: Today s Date: Major: Degree Plan Field: Student Information: Name: Home Phone: Work Phone: E-mail: Job Title: Sponsor Firm: Evaluating Supervisor: Title: E-mail: Phone: Address City/ Zip Training Station Agreement: Three participants- student, supervisor and instructor/ coordinator- in this Internship/ Practicum/ Cooperative Education venture will cooperate to determine the learning objectives toward which the student will work. Each semester a student enrolls in Internship/ Practicum/ Cooperative Education it is necessary that new learning objectives be identified. Achievement of the objectives will be part of the basis for the credit and the evaluating supervisor on the job site each semester. The supervisor assists with the evaluation of the student performance. The instructor/ coordinator determine the students final grade. The Student agrees to abide by the guidelines of the Internship/ Practicum/ Cooperative Education program. Evaluating Supervisor Date Student Date Instructor Coordinator Date (Practicum) 19