COUNSELOR EDUCATION PROGRAM MENTAL HEALTH COUNSELING CLINICAL EXPERIENCE HANDBOOK

COUNSELOR EDUCATION PROGRAM MENTAL HEALTH COUNSELING CLINICAL EXPERIENCE HANDBOOK Department of Psychology Eastern Washington University 135 Martin Hall Cheney, WA 99004 Version 9/7/2012

1 Table of Contents Counselor Education Program Background and Goals... 2 Standards for the Mental Health Counseling Program... 3 Practicum... 3 Practicum Hours... 4 Practicum Activities... 4 Site Supervisor Role in Practicum Experience... 4 Internship Hours... 5 Internship Activities... 6 Supervisor Qualifications... 6 Site Supervisor Role... 6 Internship Setting... 7 Internship Evaluation... 8 Counseling Faculty Visits... 8 APPENDICES... 9 SELF-ASSESSMENT OF COUNSELING SKILLS... 10 PRACTICUM AND INTERNSHIP WEEKLY REPORT... 11 MENTAL HEALTH PRACTICUM EVALUATION FORM... 12 QUARTERLY COUNSELING PRACTICUM LOG... 14 WEEKLY COUNSELING PRACTICUM LOG... 15 MENTAL HEALTH INTERN EVALUATION FORM... 18 QUARTERLY COUNSELING INTERNSHIP LOG... 20 WEEKLY COUNSELING INTERNSHIP LOG... 21 STUDENT COUNSELOR EVALUATION OF SITE SUPERVISOR (QUARTERLY) 22 STUDENT COUNSELOR EVALUATION OF SITE SUPERVISOR... 23 COUNSELING STUDENT PRACTICUM AND INTERNSHIP AGREEMENT... 25 MEMORANDUM OF AGREEMENT... 27

2 Supervised clinical experience is a vital component of the training of Eastern Washington University Counselor Education mental health counseling students that provides important opportunities for application and integration of knowledge and skills. Your involvement with our practicum and internship program provides an important service to the profession and to the counseling intern. This Field Supervisor Handbook is designed to serve as a guide for you as a counseling practicum and intern supervisor. The objectives of the practicum and internship reflect the training standards set forth by the Washington State Board of Education and the Council for Accreditation of Counseling and Related Educational Programs (CACREP). The counseling trainee's progress should be based on the satisfactory completion of the listed objectives. As they move toward graduation and eventual licensure, all candidates must demonstrate knowledge and skill as described within the Washington Administrative Code (WAC). Counselor Education Program Background and Goals The Counselor Education program at Eastern Washington University is dedicated to the preparation of competent professionals who possess both the knowledge and the necessary skills to do well in their first post-grad counseling position. These professionals serve a wide range of clients with considerable variability of therapeutic needs. They work in community mental health centers, child and family therapeutic centers, hospitals, rehabilitation facilities, educational institutions, child and adolescent residential treatment facilities, and other community agencies. Emphasis is placed on understanding diversity in all its forms and the systemic foundations of human growth and development. Applied research, effective training, and service partnerships with community-based and interdisciplinary delivery models are seen as essential for successful practice. The faculty and students of our program build collaborative relationships with mental health and related professionals throughout Spokane and the surrounding area. A cooperative relationship between our counselor education program and community agencies in the area allows the two systems to share ideas and resources. The supervision of the counseling intern is one of our most valued opportunities to work together. Counselor Education at EWU is part of the Department of Psychology (PSYC). Among other programs, PSYC offers a Master of Science in Applied Developmental Psychology with an emphasis in two professional areas: Mental Health Counseling and School Counseling. The curriculum reflects current knowledge of effective counseling practices within a rapidly changing society. Students acquire knowledge and skills in the following core content areas of counseling: 1) Professional Identity, 2) Social and Cultural Diversity, 3) Human Growth and Development, 4) Career Development, 5) Helping Relationships, 6) Group Work, 7) Assessment, and 8) Research and Program Evaluation. Throughout their training, students gain an awareness of sociological factors and how the environment affects their clients. In addition to core counseling topics, special emphasis is placed on subjects such as ethical and legal factors, the treatment of substance abuse and addiction, suicide prevention and crisis intervention, acceptance and inclusion of diversity in its multiple forms, understanding and prevention of violence and abuse, and other contemporary social issues.

3 The design of the Counselor Education Program is one of sequential, academically challenging course work and substantial initial skills development, with an emphasis on quality supervised field-based experiences. To this end, the program maintains the highest standards for professional counselor education, as evidenced by its ongoing accreditation, since 1986, with the Council for the Accreditation of Counselor Education and Related Programs (CACREP). CACREP is affiliated with the American Counseling Association, and its accreditation sets the standards for best practices in counselor education and national certification. In addition to their preparation for state licensure, graduates from these programs meet the requirements to become a Nationally Certified Counselor (NCC) through successful completion of the qualifying examination administered by the National Board for Certified Counselors (NBCC). The EWU Counselor Education Program is committed to the preparation of mental health counselors in a manner consistent with the Washington Administrative Code (WAC) and CACREP standards. Counselors from Eastern Washington University will: Demonstrate competence in areas indicated by the WACs. Demonstrate academic skills appropriate for a master s degree. Use counseling techniques and strategies in accordance with the goals of our professional discipline. Perform in a manner consistent with the ACA Code of Ethics, professional disciplines, and with state and federal laws. Provide leadership to communities, agencies, and the counseling profession. Maintain a plan for personal and professional development. Standards for the Mental Health Counseling Program The Nature of the Clinical Training Experience Practicum The EWU Mental Health counseling program is a full-time two-year cohort program. During their first year, the mental health counseling students complete the bulk of their didactic course work and a 100 hour practicum. Practicum can best be considered as the experiential bridge between initial academic and counseling skills training and the application of that knowledge and skill in a successful internship. Practicum places graduate students into an introductory applied learning role in which they observe established professionals and advanced graduate student interns as they carry out the varied responsibilities of professional counselors in practice. The intent is for practicum students to grow professionally as they gradually take on the counselor intern s responsibilities, preparing them for and providing a highly effective transition into the internship experience. Practicum differs from internship in several ways. First, interns are more advanced in their training than are practicum students, the latter of which have only about 2/3 of their course of study completed. By the time the new or first year spring quarter practicum students begin at your site, second year interns from our program will have completed six to nine months of clinical work and all but one academic quarter of their graduate training. Second, the number of expected on-site hours is quite different. Interns serve 20-25 hours per week for 9-11 months.

4 Practicum students are on site at their agency for 10-12 hours per week for one academic quarter beginning in late March to early June. Finally, interns have their own caseload of individual, family, and group counseling clients/consumers, while practicum students mostly shadow other counselors to gain their initial direct service experience. At the discretion of the site supervisor, practicum students may be assigned their own individual or group clients to continue seeing during the internship. Practicum Hours CACREP has different expectations for the type and level of training students receive, depending on the kind of counselor education program in which they are enrolled. To avoid confusion, a brief explanation of differences in training requirements may be helpful. For practicum, students must complete supervised experiences that total a minimum of 100 clock hours over a minimum of one 10-week academic term, which includes a minimum of 40 direct service hours. Practicum Activities Each student s agency-based practicum includes all of the following: At least 40 clock hours of direct service with actual clients that contributes to the development of counseling skills. Direct service hours at the practicum level can include shadowing a counselor, observing or participant observing in individual and/or group sessions, and co-leading group counseling experiences. A practicum student may also (and are encouraged to) observe psychoeducational or outreach experiences. These are considered to be indirect service hours unless the practicum student assists in the presentation, in which case they qualify as direct service hours. Weekly interaction that averages one hour per week of individual and/or triadic supervision throughout the practicum by a site supervisor who works in consultation with a program faculty member. An average of 1 1/2 hours per week of group supervision that is provided on a regular schedule throughout the practicum by a program faculty member. The development of program-appropriate audio/video recordings for use in supervision or live supervision of the student s interactions with clients. Evaluation of the student s counseling performance throughout the practicum, including documentation of a formal evaluation after the student completes the practicum. Practicum students will begin these requirements in the spring quarter of their first year. Students will be present at their practicum site for approximately 10 to 12 hours per week in order to fulfill the 40 direct service hours required for CACREP. Site Supervisor Role in Practicum Experience Provide a minimum of one hour of direct contact supervision (dyadic or triadic) each week. Help the trainee to become familiar with your agency setting, including introduction to staff, information on polices and procedures, and training on accurate recording procedures for clients/consumers. Provide adequate facilities for the trainee to carry out her or his assigned responsibilities, including a work space, telephone, and access to secure filing of patient/client records.

5 Determine an appropriate sequence of activities for the trainee. The University can recommend a desired sequence of activities, but the site supervisor is the one who must match the training needs of the student with the needs and parameters of the agency and its consumers. Report any concerns immediately to the University supervisor. The greatest problems occur in clinical experiences when the feedback reported to the trainee and the information provided to the University supervisor throughout the year are either neutral or positive, but much later feedback from the field supervisor expresses dissatisfaction. A field supervisor may be attempting to give a trainee maximum opportunity to improve. However, if the trainee does not improve it may be more difficult for the University supervisor to effectively intervene late in the clinical experience. Report any behavior considered unusual, inappropriate, or disconcerting as soon as possible. Inform the trainee of rules, policies, and procedures of your setting. This is particularly critical in ethical/legal areas such as substance abuse, pregnancy, suicide attempts, and child abuse. It is also important, however, for the trainee to be aware of policies regarding working hours, parking, and other employee regulations. Assist the trainee in finding direct service hour client experiences as described above. Help the trainee to locate other important resource persons within your setting. Provide regular written and/or oral feedback to the student and University supervisor. Rate the trainee on all learning and professional objectives at the end of the experience using the forms provided in the appendices, and write an appropriate letter of recommendation for the intern. Internship Hours The Mental Health Counseling internship at Eastern Washington University requires a minimum of 900 clock hours of supervised experience in an appropriate setting, which includes a minimum of 360 direct service clock hours. CACREP requires the 900 hours specifically because we are a Mental Health Counseling program, not a Community Agency Counseling program. CACREP approved Community Agency Counseling programs require only 600 hours of internship, including 240 hours of direct service. Thus interns from programs such as ours are required to have longer internships or serve more hours at their agency per week than others. Most interns from our program serve for nearly a full calendar year. They are interns at their respective sites for four successive academic quarters beginning in early summer, and average about 20 hours per week until late May/early June of the following year. A few students serve in educational sites that request only three academic quarters, and those interns hours per week increase to 25. Interns, who complete their required hours prior to that time, are expected to continue to serve at the agency until the academic year is closed, unless they are released from their internship obligations by mutual agreement of their on-site supervisor and the supervising member of the EWU counseling faculty. Most interns are able to work straight through the year, but the program requests a two-week leave of absence for interns during the winter holiday season unless it presents a hardship to the agency.

6 Internship Activities The internship provides an opportunity for the student to perform, under supervision, a variety of counseling activities that a professional counselor is expected to perform. The student s internship includes all of the following: Prior to beginning work in their first year Practicum, all Mental Health Counseling students must complete finger print background check and be cleared by the Washington State Patrol and the Federal Bureau of Investigation in accordance with RCW 43.43.830 for the State of Washington. No student will be allowed to accept an internship until this requirement is completed. As described above, 900 hours of supervised experience, 360 hours of which must be direct service with clients. Direct service is defined as individual counseling, group counseling, sitting in on sessions with a more experienced counselor, and classroom presentations or seminars presented by the intern; Weekly interaction of one (1) hour per week of individual or triadic supervision (supervisor with two supervisees at most) throughout the internship, performed by the designated site supervisor. An average of one and one half (1 ½) hours per week of group supervision provided on a regular schedule throughout the internship, usually performed by a program faculty member; Becoming familiar with a variety of professional activities in addition to direct service (e.g., record keeping, supervision, information and referral, in-service and staff meetings); Development of program-appropriate audio and/or videotapes of the student s interactions with clients for use in supervision; and Gaining supervised experience in the use of a variety of professional resources such as assessment instruments, technologies, print and non-print media, professional literature, and research. Supervisor Qualifications The EWU Mental Health Counseling program requires that all practicum and internship students be directly supervised by a licensed mental health counselor, licensed psychologist or psychiatrist, or a licensed clinical social worker. In some educational settings, the supervisor may be a Nationally Certified Counselor but is not required to be a licensed counselor in Washington State. A qualified supervisor at any internship site must have: 1. A minimum of a master s degree in counseling or a related profession with equivalent qualifications, including appropriate certifications and/or licenses; 2. A minimum of two (2) years of pertinent professional experience in the program area in which the student is completing clinical instruction; and 3. Knowledge of the program s expectations, requirements, and evaluation procedures for students. Site Supervisor Role 1. Provide a minimum of one hour of direct contact supervision (dyadic or triadic) each week. 2. Help the intern to become a part of your agency setting.

7 3. Provide adequate facilities for the intern to carry out her or his counseling responsibilities, including a workspace, telephone, and access to secure filing of patient/client records. 4. Determine an appropriate sequence of activities for the intern. The University can recommend a desired sequence of activities, but the site supervisor is the one who must match the training needs of the intern with the needs and parameters of the agency and its consumers. 5. Report any concerns immediately to the University supervisor. The greatest problems occur in internships when the feedback reported to the intern and the information provided to the University supervisor throughout the year are either neutral or positive, but much later feedback from the field supervisor expresses dissatisfaction. A field supervisor may be attempting to give an intern maximum opportunity to improve. However, if the intern does not improve it may be more difficult for the University supervisor to effectively intervene late in the internship experience. Report any behavior considered unusual, inappropriate, or disconcerting as soon as possible. 6. Inform the intern of rules, policies, and procedures of your setting. This is particularly critical in ethical/legal areas such as substance abuse, pregnancy, suicide attempts, and child abuse. It is also important, however, for the intern to be aware of policies regarding working hours, parking, and other employee regulations. 7. Assist the intern in finding clients and in gaining the time, space, and materials required to work with those clients. 8. Help the intern to locate other important resource persons within your setting. 9. Provide regular written and/or oral feedback to the internship student and University supervisor. 10. Rate the intern on all learning and professional objectives at the end of the internship use the forms provided in the appendices, and write an appropriate letter of recommendation for the intern. Internship Setting An effective clinical instruction environment, on- or off-campus, uses modeling, skills demonstration, and other training techniques. The intern s clinical instruction environment should include all of the following: 1. Settings for individual counseling with assured privacy and sufficient space for appropriate equipment (for example, TV monitoring and taping); 2. Settings for group work with assured privacy and sufficient space for appropriate equipment; 3. A work space with a telephone and access to secure filing for patient/client records; 4. Appropriate technologies that assist learning, such as audio, video, and telecommunications equipment; 5. Settings with observational and/or other interactive supervision capabilities; 6. Procedures that ensure that the client s confidentiality and legal rights are protected; and 7. Ideally, opportunities for interns to counsel clients who represent the ethnic and demographic diversity of their community.

8 Internship Evaluation Students formally evaluate their internship experience at its conclusion, including their supervisors and what they have learned in counseling practice and in supervision. A formal evaluation of the student s performance during the internship is conducted by the site supervisor in consultation with a program faculty member. Perhaps no other single procedure generates more anxiety for the student counselor than the supervisor's evaluation of their performance. This makes the evaluation a powerful technique for change. EWU asks site supervisors to evaluate student counselor performance at the end of each quarter, but does not limit the number of evaluations to these three or four occasions. Of course, most student counselors make satisfactory to excellent progress and completion of the evaluation may be used as a vehicle to acknowledge competent performance. For more routine evaluation, the University provides a Self-Assessment of Counseling Skills form (Appendices, Page 9) which contains the essential components of the supervisee's performance to be addressed, along with the Tape Rating Form, which includes a section to identify specific strengths and weaknesses and to make comments. For some student counselors there may be a greater need for formal evaluation. If that is the case, the prudent site supervisor seeks consultation from the University supervisor. Serious deficiencies in the student counselor should be noted as early in the supervision process as they become evident. The student should receive both verbal and written notice of the supervisor s concerns. This evaluation should also include specific guidelines for corrective action. Counseling Faculty Visits Because our intention is to build and maintain strong working relationships with supervisors and their agencies, a counselor education faculty member will visit with each supervisor at least once each academic quarter at a time convenient to both. Counselor education faculty will also offer orientation, assistance, consultation, and professional development opportunities to site supervisors as requested. Note: The Mental Health Counseling program requires students to be covered by professional liability insurance while enrolled or participating in practicum, internship, or other field experiences.

9 APPENDICES PRACTICUM RELATED FORMS

10 SELF-ASSESSMENT OF COUNSELING SKILLS Counselor Name Date Rating (least to best) 1. Ability to establish rapport, a working relationship with client 1 2 3 4 5 2. Facilitative skills (e.g., warmth, primary empathy, 1 2 3 4 5 genuineness, concreteness, etc.) 3. Challenging skills (e.g., self-disclosure, advanced empathy, 1 2 3 4 5 confrontation, immediacy, etc.) 4. Ability to facilitate client self-exploration of strengths, 1 2 3 4 5 limitations, and concerns 5. Ability to help client explore feelings about purposes 1 2 3 4 5 of counseling and counseling interventions 6. Ability to conduct intake session 1 2 3 4 5 7. Ability to conduct closure sessions 1 2 3 4 5 8. Ability to make referrals 1 2 3 4 5 9. Knowledge of interpersonal dynamics 1 2 3 4 5 10. Knowledge of counseling theories 1 2 3 4 5 11. Expertise in counseling techniques (specify) 1 2 3 4 5 12. Expertise with particular clients and issues (e.g. suicide, career) 1 2 3 4 5 13. Ability to identify themes, patterns of behavior 1 2 3 4 5 14. Ability to model counseling skills 1 2 3 4 5 15. Ability to respond with flexibility 1 2 3 4 5 16. Ability to integrate data about client into comprehensive 1 2 3 4 5 case conceptualization

11 PRACTICUM AND INTERNSHIP WEEKLY REPORT (Can be used at your discretion during supervision) Intern Date The supervisor meets with the Internship student once per week for one hour. Prior to this meeting the student fills out the first portions of this report and the supervisor adds comments pertinent to the week's accomplishments. I. Activities completed: II. Individual counseling sessions: identify consumers/clients by initials. Note purpose of each session and techniques used. Use back of page or additional sheets if necessary. III. Group counseling sessions: note goals and procedures used along with a statement of effectiveness. IV. Supervisor Comments: Supervisor Signature

12 MENTAL HEALTH PRACTICUM EVALUATION FORM (Copy this form as needed) Student Name: Site: Print or type legibly. Review Read By: Date: Student s Signature Review Read By: Date: Site Supervisor Reviewed By: Date: Name of Faculty Advisor/Supervisor Reviewed By: Date: Program Coordinator Overall Evaluation Score = Please evaluate the student s preparation for internship in each area using the following scale: 1 = Poor; 2 = Fair; 3= Good; 4 = Very Good; 5 = Excellent. Professional Competence Circle one: 1. Understanding of professional ethics. 1 2 3 4 5 Enthusiasm for working with people. 1 2 3 4 5 Responsibility in meeting obligations. 1 2 3 4 5 On time & prepared for practicum experience. 1 2 3 4 5 Adaptability for change. 1 2 3 4 5 Professional appearance/presentation. 1 2 3 4 5 Professional attitude. 1 2 3 4 5 Demonstrates competence and understanding 1 2 3 4 5 of case conceptualization. Establishes appropriate effective working 1 2 3 4 5 relationships with others. Completed assigned projects or tasks. 1 2 3 4 5 Sets and maintains appropriate boundaries 1 2 3 4 5 Understands client content 1 2 3 4 5 Understands client meaning 1 2 3 4 5 Responds to client s feelings effectively 1 2 3 4 5 Demonstrates congruence and genuineness 1 2 3 4 5 Understands the client and demonstrates 1 2 3 4 5

empathy Appropriate use of non-verbal communication 1 2 3 4 5 Appropriate use of self-disclosure 1 2 3 4 5 Use of Supervision Actively seeks and is prepared for supervision. 1 2 3 4 5 Ability to receive positive feedback. 1 2 3 4 5 Ability to receive corrective feedback. 1 2 3 4 5 Brings concerns to supervisor. 1 2 3 4 5 Meets responsibilities to peers. 1 2 3 4 5 Other Observations: 13

14 QUARTERLY COUNSELING PRACTICUM LOG Department of Counseling, Educational, and Developmental Psychology Eastern Washington University Student: Quarter: Year: Item/Week Date Direct Service Individual, Family & Couples Counseling Small Group Counseling Psychoeducational Presentations Consultation Case Management Other Total Direct Service Indirect Service Individual SV Staff Meeting Group SV University Documentation/ Records/Casenotes Training Community Outreach Other Total Indirect Service Total Hours 1 2 3 4 5 6 7 8 9 10 11 Qtr. Total All Qtrs. Total CACREP requirements are 100 total hours of which 40 hours must be direct service. Current Quarter: Direct Hours Indirect Hours Total Hours Cumulative for all quarters: Direct Hours Indirect Hours Total Hours Signature of Supervisor/Instructor Signature of Student Date Date

15 WEEKLY COUNSELING PRACTICUM LOG Department of Counseling, Educational, and Developmental Psychology Eastern Washington University Student: Week: Year: Item/Week Day M T W TH F Week Totals Direct Service Individual, Family & Couples Counseling Small Group Counseling Psychoeducational Presentations Intakes Case Management Other Total Direct Service Indirect Service Individual SV Staff Meeting Group SV University Documentation/ Records/Casenotes Training Community Outreach Other Total Indirect Service Total Hours

16 Current Quarter: Direct Hours Indirect Hours Total Hours Cumulative for all quarters: Direct Hours Indirect Hours Total Hours Signature of Supervisor/Instructor Signature of Student Date Date

INTERNSHIP RELATED FORMS 17

18 MENTAL HEALTH INTERN EVALUATION FORM (Copy this form as needed) Student Name: Site: Print or type legibly. Review Read By: Date: Student s Signature Review Read By: Date: Site Supervisor Reviewed By: Date: Name of Faculty Advisor/Supervisor Reviewed By: Date: Program Coordinator Overall Evaluation Score = Please evaluate the student s preparation for internship in each area using the following scale: 1 = Poor; 2 = Fair; 3= Good; 4 = Very Good; 5 = Excellent. Professional Competence Circle one: Understanding of professional ethics. 1 2 3 4 5 Enthusiasm for working with people. 1 2 3 4 5 Responsibility in meeting obligations. 1 2 3 4 5 On time & prepared for practicum experience. 1 2 3 4 5 Adaptability for change. 1 2 3 4 5 Professional appearance/presentation. 1 2 3 4 5 Professional attitude. 1 2 3 4 5 Demonstrates competence and understanding 1 2 3 4 5 of case conceptualization. Establishes appropriate effective working 1 2 3 4 5 relationships with others. Completed assigned projects or tasks. 1 2 3 4 5 Sets and maintains appropriate boundaries 1 2 3 4 5 Understands client content 1 2 3 4 5 Understands client meaning 1 2 3 4 5 Responds to client s feelings effectively 1 2 3 4 5 Demonstrates congruence and genuineness 1 2 3 4 5 Understands the client and demonstrates 1 2 3 4 5 empathy Appropriate use of non-verbal communication 1 2 3 4 5 Appropriate use of self-disclosure 1 2 3 4 5 Use of Supervision

Actively seeks and is prepared for supervision. 1 2 3 4 5 Ability to receive positive feedback. 1 2 3 4 5 Ability to receive corrective feedback. 1 2 3 4 5 Brings concerns to supervisor. 1 2 3 4 5 Meets responsibilities to peers. 1 2 3 4 5 Other Observations: 19

20 QUARTERLY COUNSELING INTERNSHIP LOG Department of Counseling, Educational, and Developmental Psychology Eastern Washington University Student: Quarter: Year: Item/Week Date Direct Service Individual, Family & Couples Counseling Small Group Counseling Psychoeducational Presentations Consultation Case Management Other Total Direct Service Indirect Service Individual SV Staff Meeting Group SV University Documentation/ Records/Casenotes Training Community Outreach Other Total Indirect Service Total Hours 1 2 3 4 5 6 7 8 9 10 11 Qtr. Total All Qtrs. Total * CACREP requirements are 900 total hours of which 360 hours must be direct service. Current Quarter: Direct Hours Indirect Hours Total Hours Cumulative for all quarters: Direct Hours Indirect Hours Total Hours Signature of Site Supervisor Signature of Student Signature of Mental Health Program Co-ord Date Date Date

21 WEEKLY COUNSELING INTERNSHIP LOG Department of Counseling, Educational, and Developmental Psychology Eastern Washington University Student: Week: Year: Item/Week Day M T W TH F Week Totals Direct Service Individual, Family & Couples Counseling Small Group Counseling Psychoeducational Presentations Consultation Case Management Other Total Direct Service Indirect Service Individual SV Staff Meeting Group SV University Documentation/ Records/Casenotes Training Community Outreach Other Total Indirect Service Total Hours

22 STUDENT COUNSELOR EVALUATION OF SITE SUPERVISOR (QUARTERLY) Name of Intern: Supervisor: Period Covered: DIRECTIONS: Gave time and energy in observing tapes and reviewing cases. Recognized and encouraged further development of my strengths and capabilities. Provided suggestions for developing my and effective counseling styles. Gave me useful feedback when I did something wrong. Gave me useful feedback when I did something well. Explained his/her criteria for evaluation clearly and in behavioral terms. Focused on both verbal and nonverbal behavior in me and in my clients. Helped me define and maintain ethical behavior in counseling and case management. Encouraged me to engage in professional behavior. Maintained confidentiality in material discussed in supervisory sessions. Comments/Suggestions: Please mark the corresponding box that represents the number which best represents how you feel about the supervision received during your practicum/internship over the past quarter. 1 Poor 2 Fair 3 Acceptable 4 Adequate 5 Good 6 Excellent

23 STUDENT COUNSELOR EVALUATION OF SITE SUPERVISOR Name of Intern: Supervisor: Period Covered: DIRECTIONS: At the completion of the internship experience, the student counselor is to make an evaluation of the supervision received. Circle the number which best represents how you, the student counselor, feel about the supervision received during your practicum/internship. Poor Adequate Good 1. Gave time and energy in observing tapes 1 2 3 4 5 6 and reviewing cases. 2. Accepted and respected me as a person. 1 2 3 4 5 6 3. Recognized and encouraged further development 1 2 3 4 5 6 of my strengths and capabilities. 4. Gave useful feedback when I did something well. 1 2 3 4 5 6 5. Provided me the freedom to develop flexible 1 2 3 4 5 6 and effective counseling styles. 6. Encouraged and listened to my ideas and 1 2 3 4 5 6 suggestions for developing my counseling skills. 7. Provided suggestions for developing my 1 2 3 4 5 6 counseling skills. 8. Helped me to understand the implications and 1 2 3 4 5 6 dynamics of the counseling approaches I used. 9. Encouraged me to use new and different 1 2 3 4 5 6 techniques. 10. Helped me to define and achieve specific 1 2 3 4 5 6 concrete goals for myself during internship. 11. Gave me useful feedback when I did something 1 2 3 4 5 6 wrong. 12. Allowed me to discuss problems I encountered 1 2 3 4 5 6

24 in my internship setting. 13. Paid attention to both my clients and me. 1 2 3 4 5 6 14. Focused on both verbal and nonverbal behavior 1 2 3 4 5 6 in me and in my clients. 15. Helped me define and maintain ethical behavior 1 2 3 4 5 6 in counseling and case management. 16. Encouraged me to engage in professional 1 2 3 4 5 6 behavior. 17. Maintained confidentiality in material discussed 1 2 3 4 5 6 in supervisory sessions. 18. Dealt with both content and affect when 1 2 3 4 5 6 supervising. 19. Focused on the implications, consequences 1 2 3 4 5 6 and contingencies of specific behaviors in counseling and supervision. 20. Helped me organize relevant case data in 1 2 3 4 5 6 planning goals and strategies with my client. 21. Helped me to formulate a theoretically sound 1 2 3 4 5 6 rationale of human behavior. 22. Offered resource information when I requested 1 2 3 4 5 6 or needed it. 23. Helped me develop increased skill in critiquing 1 2 3 4 5 6 and gaining insight from my counseling tapes. 24. Allowed and encouraged me to evaluate myself. 1 2 3 4 5 6 25. Explained his/her criteria for evaluation clearly 1 2 3 4 5 6 and in behavioral terms. 26. Applied his/her criteria fairly in evaluating 1 2 3 4 5 6 my counseling performance. Comments/Suggestions:

25 COUNSELING STUDENT PRACTICUM AND INTERNSHIP AGREEMENT Students must submit this signed form to the university supervisor before beginning the counseling practicum and internship experience. A copy will be provided for the site supervisor. A. I attest that I have read and understand the American Counselor Association Code of Ethics and will practice my counseling in accordance with these standards. I further understand that any breach of this code or any unethical behavior on my part will be placed in my record and could result in the termination of the Internship experience. B. I understand that my responsibilities include keeping my field and university supervisors informed regarding my Practicum and Internship experience. C. I understand that I will not be issued a passing grade until I have demonstrated a specified minimal level of counseling knowledge and skills, and submitted the required documentation to the university supervisor. D. I understand that I must be at the Practicum and Internship site during all scheduled times unless I have prior permission from both the field and university supervisors. In the event of illness or family emergency I will immediately contact both the field and university supervisors. E. I understand that a part of my experience includes the taping of clients during counseling sessions and reviewing those tapes before submitting them to the university supervisor. I am aware that I cannot complete the Internship without meeting this requirement. I agree to provide the tapes and to treat those tapes in a confidential and responsible manner. F. I understand that I must maintain a log of my counseling Practicum/Internship experience. Entries in this log should include: date, time, and nature of contact or task. I will log all counseling related contacts and duties. This documentation will be submitted to the university supervisor at the completion of my Practicum/Internship experience. G. I understand that I must keep a record of my weekly contact with my site supervisor. I will document the date, time, and brief description of what we did during our supervision meeting (e.g., case staffing, reviewing of tapes, and discussion of agency procedures). This documentation will be submitted to the university supervisor at the completion of my Practicum and Internship experience. H. I understand that I will develop a portfolio to be reviewed by my site supervisor and university supervisor and will be used for evaluation purposes. The portfolio will be my professional property, which I may use in applying for counseling positions. I. I understand that at the completion of my Practicum and Internship experience, my field supervisor will submit a letter of evaluation to my university supervisor. This letter will be a frank evaluation of my counseling strengths and areas of needed improvement. J. I understand that I must provide documentation of professional liability insurance for my

26 counseling activities prior to beginning working with student volunteers or clients. Student Signature Site Supervisor Signature University Supervisor Signature Mental Health Program Coordinator Signature Date Date Date Date

27 MEMORANDUM OF AGREEMENT This AGREEMENT made and entered into this day of, by and between the DEPARTMENT OF COUNSELING, EDUCATIONAL AND DEVELOPMENTAL PSYCHOLOGY, COLLEGE OF EDUCATION AND HUMAN DEVELOPMENT, EASTERN WASHINGTON UNIVERSITY, (hereinafter referred to as the UNIVERSITY) and (hereinafter referred to as the AGENCY). WITNESSETH: WHEREAS, the UNIVERSITY provides an academic program in Counseling and periodically desires to have its clients receive internship experiences by utilization of the facilities and personnel of the AGENCY; and WHEREAS, the AGENCY provides counseling services; and WHEREAS both the UNIVERSITY and the AGENCY are committed to the goal of providing the highest quality counseling personnel: NOW, THEREFORE, in consideration of the foregoing and in further consideration of the mutual benefits of such a program of internship, the parties to this Agreement agree that the PROGRAM shall be covered by and subject to the following conditions: MUTUAL RIGHTS AND RESPONSIBILITIES 1. There will be no discrimination with regard to race, creed, color, sex, age, national origin or the presence of any sensory, mental, or physical handicap in the selection, assignment, and education of these clients; 2. Autonomy of the UNIVERSITY and AGENCY will be observed at all times; 3. Visits by the UNIVERSITY staff to the AGENCY for the purposes of planning and evaluating the University Program, discussing Counseling Trainee performance, and arranging for additional educational experiences will be welcome. These visits will be scheduled with the AGENCY at a mutually agreeable time; 4. The AGENCY shall be insured; 5. The Counseling Trainee(s) shall be required to follow all rules, regulations, and procedures of the AGENCY as required of an AGENCY employee. These shall be made available to the Counseling Trainee through the AGENCY S designated Site Supervisor; 6. The Counseling Trainee and the AGENCY staff shall strive to conduct themselves in accordance with the Code of Ethics of the American Counseling Association, and with the law of the state in which the AGENCY is located; 7. Publication by Counseling Trainee or UNIVERSITY staff of any material based on the educational experience at the AGENCY will require prior approval of the AGENCY and the UNIVERSITY; and 8. Removal of a Counseling Trainee from the Program may be executed by either the AGENCY or the UNIVERSITY, immediately if deemed necessary. In every case of removal, mutual agreement by each party will be the goal. 9. Each party will indemnify and hold each other harmless from loss/damage caused by the other party.

28 RESPONSIBILITIES OF THE UNIVERSITY The UNIVERSITY assumes responsibility for the academic preparation of the Counseling Trainee and guarantees that the Counseling Trainee shall have satisfactorily completed such preparation prior to being assigned to the Practicum and Internship Program. 1. The UNIVERSITY shall appoint an Academic Coordinator/Supervisor of the Internship Program to act as liaison between the Parties and to arrange the schedule of Counseling Trainee assignments in cooperation with the AGENCY; 2. The UNIVERSITY will provide the AGENCY with each Counseling Trainee s resume including information regarding level of preparation and prior experience, and will provide materials for the evaluation of the Counseling Trainee; 3. The UNIVERSITY will ensure that all Counseling Trainees will be cleared by the Washington State Patrol and the Federal Bureau of Investigation in accordance with RCW 43.43.830 for the State of Washington and will notify AGENCY personnel of their clearance. Should either of these checks not be confirmed for a candidate prior to the beginning date for counseling clinical experience, it is understood that the candidate will not have unsupervised access with clients until cleared; 4. The UNIVERSITY will ensure that the student carries his or her own health insurance. In the event of an emergency, the AGENCY will provide emergency treatment with the student bearing the cost of such care. The UNIVERSITY will provide required follow-up if the student is exposed to infectious disease during the training experience. 5. The UNIVERSITY retains the responsibility for the determination of the Counseling Trainee s final grade for the Practicum or Internship experience; and 6. The UNIVERSITY will provide written notice of the Counseling Trainee s assignments thirty (30) days in advance, except where otherwise arranged. RESPONSIBILITIES OF THE AGENCY 1. The AGENCY shall designate a Site Supervisor to act as liaison with the UNIVERSITY, to provide for supervision of the Counseling Trainee in accordance with academic and CACREP standards, and to provide the Counseling Trainee and the UNIVERSITY with feedback on the Counseling Trainee s performance regarding the following: A. Intake Interviewing B. Individual Counseling C. Career Counseling D. Assessment Measures/Interpretation E. Report Writing F. Consultation G. In-service Presentation H. Psycho/Education Activities I. Group Counseling J. Case Conferences/Staff Presentations K. Research L. Special Population

2. The AGENCY shall ensure the designated Site Supervisor must be fully certified AGENCY personnel and have a minimum of two years of professional experience in the role of AGENCY counselor as described in the Washington State Laws Relating to Counseling, 18.19 RCW, WAC 246-810-534 (11/99). The AGENCY will provide a student case load appropriate to the Counseling Trainee s level and ability and of adequate size and variety to help expedite the educational experience; 3. The AGENCY shall provide learning experiences, such as attendance at seminars, workshops, and training and use of library facilities, as available and appropriate if no cost to the AGENCY is incurred; 4. The AGENCY shall provide the Counseling Trainee with practical experience as required; 5. The AGENCY supervisor shall provide at least one hour per week of direct contact supervision (either individual or triadic) for the Counseling Trainee; 6. The AGENCY will evaluate the Counseling Trainee s professional competencies, and will notify the UNIVERSITY as soon as possible of any problems arising with the Counseling Trainee or Program; 7. The AGENCY shall notify the UNIVERSITY at least thirty (30) days in advance of any changes that will affect the AGENCY S ability to provide a Practicum or Internship experience as outlined in paragraphs 1 through 5 above; 8. The AGENCY shall have responsibility for the care rendered its students, but will not be responsible for non-performance, illegal acts, or malpractice on the part of the Counseling Trainee; and 9. The AGENCY and site supervisor will provide a general orientation for the Counseling Trainee and the UNIVERSITY staff covering the rules, regulations, procedures, facilities, and equipment of the AGENCY. This contract supersedes previous contracts and is the complete and final agreement. No amendments may be made unless in writing. Once executed and signed by the appropriate officials representing each party, this Agreement shall be for the term of one year and thereafter from year to year unless terminated in writing by either party with ninety (90) days prior notice. 29

30 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed on the day, month, and year first above written. ATTEST: AGENCY BY: Site Supervisor BY: Agency Director (if needed) EASTERN WASHINGTON UNIVERSITY BY: EWU, Mental Health Internship Coordinator BY: EWU, Department Chair, PSYC Please sign and return to the INTERNSHIP COORDINATOR. An executed copy will be returned to the AGENCY.