Rehabilitation Counseling PRACTICUM MANUAL

Rehabilitation Counseling PRACTICUM MANUAL California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 909-537-5606 Revised 01/2014

TABLE OF CONTENTS I. Overview and Welcome... 4 II. CORE Requirements for Practicum Experiences. 5 III. Course Content and Objectives... 6 IV. Practicum Course Descriptions.. 6 V Rehabilitation Counseling Defined. 6 VI. Course Objectives.... 6 VII Practicum Experience Requirements/Application... 7 VIII Working with Faculty during Practicum. 8 IX Selecting a Practicum Site.. 9 X. Criteria for Selecting Practicum Site.. 9 XI. Responsibilities for Practicum Student, Site Supervisor, and University Supervisor.. 10 XII. Evaluation Process.. 11 XIII. Verification of Liability Insurance 11 XIV. Rehabilitation Counseling Faculty.. 12 XV. Counseling vs. Social Interactions. 13 XVI. Appendix A, Practicum Application 14 XVII. Appendix B, Practicum Contract. 17 XVIII. Appendix C, Site Supervisor Evaluation of Practicum Student. 20 XIX. Appendix D, Practicum Weekly Time Sheet. 23 XX. Appendix E, Practicum Totals Time Sheet... 24 XXI. Appendix F, Audio/Videotape Consent Form.. 25 XXII. Appendix G, Student's Practicum Placement Evaluation 26 2

XXIII. Appendix H, Community Resources. 29 XXIV. Appendix I, Corrective Action Contract.... 32 XXV. Appendix J, Corrective Action Plan.. 33 3

Overview and Welcome SUPERVISED PRACTICE IN REHABILITATION The Rehabilitation Counseling faculty at California State University, San Bernardino welcomes you to your practicum classes, which are the first part of the important clinical experience of the Rehabilitation Counseling Master s program. The faculty will work with you to transition from classroom learning to application of rehabilitation counseling skills in the field. The clinical portion of the program consists of two practicum courses and three fieldwork courses. The practicum courses are completed before you begin your fieldwork experience in the community. In both practicum and fieldwork experiences, you will be working with persons with disabilities and you will be supervised by a faculty member. All of the clinical experiences in the CSUSB Rehabilitation Counseling program meet the guidelines of the Council on Rehabilitation Education (CORE). In both practicum and fieldwork/internship, you will have a regularly scheduled class in conjunction with your practice in the field. You will learn the following skills during your practica courses: Demonstrate an understanding of disability and rehabilitation during counseling. Apply new insights and understanding of rehabilitation counseling ethics and strategies during counseling sessions. Apply the dynamics of rehabilitation counseling and the rehabilitation process to real counseling experiences. Develop an understanding of the practice of rehabilitation counseling. Develop an understanding of ethics in the rehabilitation counseling process. Demonstrate interviewing skills with clients. Develop listening skills. Demonstrate therapeutic and ethical conditions toward persons and students with disabilities. Become familiar with various counseling strategies for intervention with psychological or developmental problems. Develop an understanding of diversity and multiculturalism in counseling. Demonstrate empathy toward people from diverse cultures. Demonstrate the ability to effectively use the counseling skills of empathy, nonverbal behavior, respect, genuineness, concreteness, immediacy, self-disclosure, confrontation and goal setting by working with persons with disabilities. Apply theoretical counseling concepts to counseling practice. Acquire skills necessary to evaluate one s own counseling strengths and weaknesses. 4

CORE REQUIREMENTS FOR PRACTICUM EXPERIENCES CORE Standard D.1: Students shall have a minimum of 100 hours of supervised rehabilitation counseling practicum with at least 40 hours of direct service to persons with disabilities (not a role-play client). Practicum students should have experiences that increase their awareness and understanding of the differences in values, beliefs, and behaviors of individuals from diverse populations. CORE Standard D.1.1: The practicum shall include instructional experiences (audiovideo tapes and individual and group interaction) dealing with rehabilitation counseling concerns, and clinical experiences (on or off-campus) that facilitate the development of basic rehabilitation counseling skills. During the practicum, students will conduct interviews that will be reviewed by a supervisor. If practicum experiences are provided off-campus, there will be direct and periodic communication throughout the semester between the site supervisor and the faculty (e.g., site visits, conference calls, videoconferencing, electronic communication). Practicum activities shall be documented in logs, progress reviews, and summaries. The program faculty member responsible for practicum supervision must be a CRC. CORE Standard D.1.2: Written expectations, procedures, and policies for practicum shall be contained in a manual or other appropriate document(s) and distributed to students and supervisors. This will include the policy that the practicum is a prerequisite to the supervised rehabilitation counseling clinical internship experience. CORE Standard D.1.3: Practicum experiences shall include an average of one (1) hour per week of individual or 1½ hours per week of group (with no more than 10 students/group) supervision by a program faculty member or qualified individual working in cooperation with a program faculty member. CORE Standard D.1.4: When using distance education modalities, practicum supervision may be provided using a variety of methods such as video conferencing, teleconferencing, real time video contact, or others, as appropriate. CORE Standard D.1.5: In states that have specific practicum supervision requirements for counselor licensure, the program shall make the required supervision experiences consistent with the licensure requirements available to those students desiring to qualify for licensure. CORE Standard D.1.6: There shall be a written progress review of the performance/counseling skills of all students enrolled in a practicum. CORE Standard D.1.7: There shall be a written procedure for responding to students who do not demonstrate satisfactory practicum knowledge or clinical skills. CORE Standard D.1.8: The individual supervision of five students shall be considered to be equivalent to the teaching of one course. 5

COURSE CONTENT AND OBJECTIVES Supervised practice in the Rehabilitation Counseling master s degree program at California State University San Bernardino is designed to provide students with the opportunity for practical rehabilitation counseling experience with persons of varying ages who have various disabilities. Rehabilitation counseling, as a profession, requires graduates to be able to function as professionals upon graduation. As such, a developing rehabilitation counselor needs practical experience with various counseling approaches and techniques provided in the safety of a setting that allows for appropriate supervision and professional growth. Practicum Course Descriptions EREH 657 Practicum I Prerequisites: EREH 615 and 656 or permission of the Program Coordinator. Supervised practice in the application of counseling skills, theories and techniques working with individuals with disabilities in an agency setting. Practicum I experience includes 20 hours of related practice with individuals with disabilities. Students shall have a minimum of 50 hours of supervised rehabilitation counseling practicum. EREH 667 Advanced Practicum Prerequisites: EREH 657 or consent of instructor. Supervised practice in individual rehabilitation counseling in an agency setting. Advanced Practicum includes 20 hours of related practice with individuals with disabilities. Students shall have a minimum of 50 hours of supervised rehabilitation counseling practicum. Rehabilitation Counseling Defined The Rehabilitation Counselor in working with the individual determines and coordinates services for people with disabilities during the entire rehabilitation process. A major goal of the Rehabilitation Counselor is to assist a person with a disability to move from a position of psychological and economic dependence to one of independence. Course Objectives The following objectives identify the knowledge, dispositions and performances that are to be attained through the two Practica courses (Practicum I and Advanced Practicum). Knowledge Develop an understanding of the components of the interviewing process. 6

Become familiar with various counseling strategies for intervention with psychological or developmental problems. Apply new insights and understanding of rehabilitation counseling ethics and strategies during counseling sessions. Demonstrate an understanding of disability and rehabilitation during counseling. Demonstrate therapeutic and ethical conditions toward persons and students with disabilities. Dispositions Develop an understanding of the practice of rehabilitation counseling. Develop an understanding of ethics in Rehabilitation Counseling process. Acquire skills necessary to evaluate one s own counseling strengths and weaknesses. Performances* Demonstrate interviewing skills with clients. Develop listening skills (e.g., paraphrasing, reflection, etc.). Demonstrate the ability to effectively use the counseling characteristics of empathy, non-verbal behavior, respect, genuineness and immediacy. Develop counseling abilities through counseling experience with actual clients. Apply the dynamics of rehabilitation counseling and the rehabilitation process to actual counseling experiences. Apply theoretical counseling concepts to counseling practice. Apply critical thinking skills to transition counseling concepts to counseling practice. *Students must successfully complete Practicum I EREH 657 and Advanced Practicum EREH 667 before enrolling in Fieldwork EREH 679. PRACTICUM EXPERIENCE REQUIREMENTS / APPLICATION Practicum I and Advanced Practicum courses require a total of 100 hours (50 hours in each course) of practical experience in a facility that provides services to individuals with disabilities. Of the 50 hours in each practicum experience, 20 hours per quarter are to be in direct service to persons with disabilities (see Appendices D and E for log 7

sheets). Practicum experiences shall include an average of one (1) hour per week of individual or 1½ hours per week of group (with no more than 10 students/group) supervision by a program faculty member or qualified individual working in cooperation with a program faculty member. The student is encouraged to select different sites for each practicum experience. Students must complete the Practicum Application (see Appendix A) at the end of the quarter prior to the first Practicum experience. The application is to be submitted to the Program Coordinator who will provide final authorization for enrollment into the Practicum I and Advanced Practicum courses. A copy is to also be provided to the faculty supervising your practicum class. Students must also complete the Practicum Application prior to admittance into the Advanced Practicum course. The same application is to be used for both courses. Successful completion of EREH 615 and EREH 656 are required prior to admission into Practicum I and successful completion of EREH 657 is required prior to admission into Advanced Practicum. Successful completion of both Practicum I and Advanced Practicum is required before admission into the Fieldwork course. For purposes of critique and evaluation, audiotaped and/or videotaped individual and/or group sessions will be required for Practicum I; videotaped individual and/or group sessions will be required for Advanced Practicum. Intake type interviews will not fulfill these requirements. Students have the responsibility for following agency and program procedures, both for securing permission to tape and insuring the confidentiality of the obtained tape (see Appendix F). Students are encouraged to have a CRC site supervisor during the entire Practicum experience. Working with Faculty during Practicum During both practicum experiences, you will be a student working with a CSUSB Rehabilitation Counseling Faculty Member. This Faculty Member will work with you to establish your community involvement. It is important for students to pre-arrange all community observations and counseling in agencies with their professor. You will have a site supervisor assigned to you at the agency. A Practicum Contract (see Appendix B) must be signed between the student, the agency representative, and the university supervisor. The student will work with the site supervisor and the university supervisor in the final determination of learning objectives for the Practicum experiences. Students needing special accommodations during any part of their Clinical Experiences are to contact the Program Coordinator. Students are expected to demonstrate ethical behavior during their practicum and community visitations. Students will be evaluated (see Evaluation Section, page 11; 8

also, Appendices C and G for more details) in accordance with university and program requirements for successful completion of the Practicum experiences. Any areas of significant deficiencies will be addressed through a Corrective Action Plan that is developed in collaboration with the university supervisor, site supervisor, and the student. (See Appendix I & J.) A copy of the Code of Ethics for Rehabilitation Counseling can be found on the Commission on Rehabilitation Counselor Certification (CRCC) website at http://www.crccertification.com/pages/crc_ccrc_code_of_ethics/10.php. The CRCC phone number is 847-944-1325, which is located in Schaumburg, Illinois. SELECTING A PRACTICUM SITE Students and the Faculty Supervisor will discuss possible practicum sites; however, students are responsible for securing placement. To secure a practicum site, the student should begin by arranging an on-site interview with the potential practicum supervisor. The student should provide a personal resume to the agency. The interview process provides an opportunity for both the student and the agency to clearly delineate their expectations for the practicum experience. If the agency representative believes that the student's and the agency's particular experiences or expectations are mismatched, the placement may be declined. When this occurs, the student must seek another placement site. CRITERIA FOR SELECTING PRACTICUM SITE Agency Selection: 1. Agencies should be selected that have a primary function of serving people with disabilities; this may also include agencies that serve the socially disadvantaged. 2. Agencies should have a broad variety of rehabilitation services that are designed to serve persons with disabilities. 3. Agencies should be recognized in the community as a viable agency with appropriate accreditation (if it exists for that agency). 4. Agencies should be able to provide assurances that they can provide adequate and appropriate opportunities for the student to work with people with physical, mental, psychological, chemical dependency / addicition, and social disabilities. Qualifications of Site Supervisor: Supervisor qualifications include: 1. Appropriate academic training at the Master's or Doctorate level. 2. Work experience that will provide the practicum student with a proper orientation to the field of rehabilitation. 3. An interest and willingness to become a part of an academic training program. 4. Flexibility of schedule that allows the necessary time required for training and supervising practicum as part of the supervisor's daily activities. 9

5. Sufficient experience and/or education in area of counseling or interpersonal relationships to provide practicum students with insight in interviewing and/or counseling techniques. 6. Familiarity with the working relationship with other community agencies. RESPONSIBILITIES FOR PRACTICUM STUDENT, SITE SUPERVISOR, AND UNIVERSITY SUPERVISOR Student Responsibilities: 1. Maintain regular attendance schedule and complete all assignments. 2. Conform to agency rules, regulations, and standards. 3. Demonstrate an awareness of personal skills and limitations by taking initiative when appropriate, yet seeking assistance when necessary. 4. Keep a log of all activities and reactions. The log should include: (a) date and number of hours spent at the practicum site. (b) description of activities (e.g., interviewing, personal or vocational counseling, interaction with staff and other professionals, planning, in service training, utilization of community resources, placement activities, attendance at conferences, workshops, observing similar activities of Rehabilitation Counselors and any other job duties performed). (c) weekly personal reaction to activities performed (Appendix D). 5. Establish personal objectives to be met during the practicum experience (see Appendix B, Practicum contract). 6. Provide an evaluation report of the practicum experience. 7. Abide by the CRCC Code of Ethics. Site Supervisor Responsibilities: Agencies should assign one staff member to direct the practicum experience. This supervisor may assign the student to other professional staff in the agency but is responsible for making sure the student's assignments best meet the needs of the student and the agency. The practicum site supervisor is responsible for planning, assigning practicum duties, observing and monitoring the student s work performance as well as setting up priorities in terms of work tasks. On-site supervision includes: 1. Assign work according to the student's level of competence based on the student's education, experience level, and objectives. 2. Schedule weekly conferences to review the work of the student and to monitor work performance. This enables both the student and supervisor to modify the practicum experience to meet the needs of both parties. 3. Communicate with the University Supervisor if any problems arise and give feedback regarding the student s quality of work. 10

4. Abide by the ethical standards of the Rehabilitation Counseling profession and/or the ethical standards of the primary professional organization of the agency supervisor. 5. Completion of final evaluation of student's work. University Supervisor Responsibilities 1. Review progress of the practicum student on a regular basis. 2. Provide written progress reports to student. 3. Contact practicum Site Supervisor at least twice within the quarter. 4. Reserves the right of final retention or dismissal of the student, and agrees to withdraw the student from the practicum site when the student's practice and/or behavior does not meet minimum standards of the Agency and is so requested by the Agency Supervisor. EVALUATION PROCESS The student's performance during the practicum is evaluated by the site supervisor and university supervisor. After the practicum objectives have been delineated, the student will be evaluated at the end of the quarter. Other scheduled evaluations may be performed at the request of any of the three parties. If a student is deemed to be proceeding in an unsatisfactory manner in a Practicum course, a report will be prepared by the University Supervisor summarizing both the points of concerns and a specific action plan for remediation, including specific recommendations, behavioral outcomes, and deadlines for review that offer a realistic opportunity for the student to experience an ultimately successful practicum experience. Successful completion of the Corrective Action Plan is required in order for the student to receive a passing grade in the Practicum course. (See Appendices C, G, J, & I.) VERIFICATION OF LIABILITY INSURANCE Provide a copy of the face sheet of the professional liability insurance coverage that includes policy number and dates of coverage. Professional liability insurance must be in place at the time of the application for Practicum I and Advanced Practicum. 11

REHABILITATION COUNSELING FACULTY Dr. Connie McReynolds, CRC, PVE, Psychologist, Program Coordinator Email: cmcreyno@csusb.edu Phone No: (909) 537-5453 Office Location: COE 120 Dr. Margaret Cooney, CRC Email: mcooney@csusb.edu Phone No: (909) 537-5662 Office Location: COE 240 Dr. Joseph Turpin, CRC, Professor Emeritus Email: jturpin@csusb.edu Phone No: (909) 537-5680 Office Location: COE 233 Dr. Dwight Sweeney Email: dsweeney@csusb.edu Phone No: (909) 537-5689 Office Location: COE 236 Ms. Susan Senior, CRC, Adjunct Instructor Email: susan_senior2000@yahoo.com Phone: 424-207-0498 Mr. Robert Bayne, CRC, Adjunct Instructor Email: r.bayne2@verizon.net Phone: 909-717-2694 Office Location: COE 232 Ms. Katherine Barnes, CRC, Adjunct Instructor Email: Kat-anne@att.net Phone: 951-662-6056 Office Location: COE 232 Mr. Robert Nunez, CRC, Adjunct Instructor Email: rjnunez@csusb.edu Phone: 909-921-5671 Office Location: COE 120 12

Counseling vs. Social Interactions Comparison Social 1. Informal and chatty as related to the event. Counseling 1. More formal and structured with boundaries made clearer. 2. Conversation goes two ways. 2. Focus of conversation more on client. 3. Often more intimate and personal. 3. More professional; messages are clear and goal-directed. 4. Use of common social graces and colloquial conversational phases. 4. Use of "counseling" language to facilitate the process of self-control and issue resolution. 5. Conversations may occur randomly. 5. Time, place, and frequency limited. 6. More feeling-oriented; no particular goals in mind. 6. Deliberate statements that focus on thoughts, feelings, behavior, and goals. 7. Conversation may be fleeting and shift from person to person. 7. Client is primary focus with consideration for impact and efficient use of time. 8. Outcomes random and not planned. 8. Goals set for each interaction with specific methods offered to reach client's goal. 9. Friendship ongoing. 9. Time-limited with payment often involved in contractual arrangements. 13

APPENDIX A California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM PRACTICUM APPLICATION Deadlines for Application: Fall - May 15, Winter - November 1, Spring - February 15 Name Address City State Zip Phone (home/cell) (work) Email University ID Number Application for: Winter Spring Fall Year: Core Courses: (please indicate grade received) Practicum I Prerequisites (successful completion required). EREH 615 EREH 656 Advanced Practicum Prerequisites (successful completion required). EREH 657 Verification of liability insurance must be attached to this application. Provide a copy of the face sheet of the professional liability insurance coverage that includes policy number and dates of coverage. Professional liability insurance must be in place at the time of the application for Practicum I and Advanced Practicum. No student will be permitted to enroll in Practicum without such documentation. 14

List previous experiences at human service agencies: Page 2 Name of Agency Dates Responsibilities List the practicum site for the quarter for which you are registering. You must have a site prior to being permitted to register for practicum class. (Please enter the year) Winter EREH 667 Spring EREH 657 Name of Site: Site Address: City State Zip: Phone: Name of the site Supervisor: Contact information for Supervisor: Phone (if different from above): Email: Registration Commitment: By signing: 1. I certify that I will have completed all prerequisite course work and that I am eligible to take the course. 15

2. I accept the responsibility for registering as indicated. I realize that failure to do so on my part deprives another student of the opportunity to register for the course that my slot may be given to another student. 3. If conditions arise so that registration is not possible, I will notify the Program Coordinator immediately. Signature Date 16

APPENDIX B California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 Rehabilitation Counseling Practicum Contract Student's Name Phone (home/cell) (work) Quarter: Fall Spring Year: Credit hours: Winter Summer Site Name: Site Address: City State Zip: Phone: This contract is entered into between, site supervisor for (Site Supervisor's Name), a practicum student from (Student's Name) California State University San Bernardino, College of Education, Rehabilitation Counseling Program as represented by:. (University Supervisor's Name) The site supervisor agrees to assume responsibility for assisting the student in conducting activities related to his/her practicum experience. These activities are defined between the student and the College of Education and are agreed to by the site supervisor. The university supervisor agrees to be available for consultation with the site supervisor either personally or by phone and to make on-site visits. 17

Practicum Learning Objectives The student is to select five potential practicum objectives from the following list. Upon selection of the formal Practicum site, the student will initiate a meeting with the Site Supervisor to discuss the student s prospective learning objectives. The student, in conjunction with the Site supervisor, will finalize at least three of the objectives that will best match the agency s needs with the student s desired objectives. Observe intake interviews with clients. Develop listening skills. Observe group sessions. Develop counseling abilities through observing counseling with actual clients. Observe one-on-one counseling sessions with various counselors. Attend staff meetings. Develop an understanding of the practice of rehabilitation counseling. Develop an understanding of ethics in Rehabilitation Counseling process. Attend and participate in case staffing, as appropriate Develop an understanding of the components of the interviewing process. Become familiar with the policies and procedures of the agency. Observe and be held to the same agency standards as staff. Student will gain new insights and understanding of rehabilitation counseling ethics and strategies during counseling sessions through observation and discussion after the session with appropriate staff. Other: 18

Student Responsibilities: 1. Conduct oneself in accordance with the CRCC Code of Ethics and meet the standards for quality service as specified by the practicum site. 2. Be responsible for hours at the practicum site and maintain the mutually agreed upon time schedule. (Minimum of 5 hours per week, 50 hours per quarter) 3. Comply with the rules and regulations of the practicum site and support the philosophy and objectives of the Agency and the department in which the experience is being obtained. 4. Be responsible for audio taping and video taping counseling sessions (not intake interviews) as required in both Practicum courses and following proper confidentiality procedures. 5. Be responsible for submitting daily/weekly log of practicum experiences as required by course syllabi. Site supervisor responsibilities: 1. Provide the student with an orientation to the agency, and establish goals and experiences for the student's internship. 2. Provide the student with opportunities to engage in a variety of rehabilitation counseling activities under supervision such as (client contacts, attend staff meetings, make contacts with other cooperating agencies, record case notes, contact employers, and have involvement with all aspects of rehabilitation services). 3. Hold weekly conferences with the student to review progress, provide supervision, and establish continuing goals for the practicum experience. 4. Complete the Evaluation Form and review with the student as a final feedback on the progress of the student. 5. Provide the student with adequate physical facilities in which to work. 6. Be available for conferences with the University Supervisor as scheduled. 7. Consult with the University Supervisor if there is a problem with the student. The Agency Supervisor may refuse to continue the clinical experience when a student's practice and/or behavior do not meet the minimum standards of the Agency. University Supervisor responsibilities: 1. Review progress of the practicum students on a regular basis. 2. Consult practicum Site Supervisor as needed. 3. Reserves the right of final evaluation of student competence in Practicum courses. 4. Agrees to withdraw the student from the practicum site when the student's practice and/or behavior do not meet minimum standards of the Agency and such action is requested by the Agency Supervisor. Student's signature Date Site Supervisor's signature Date University Supervisor s signature Date 19

APPENDIX C California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM Site Supervisor Evaluation of Practicum Student At the end of this course, please send the completed evaluation form to the class instructor via the mailing address that was provided by the student. Quarter/Year Name of Student Practicum Site Site Supervisor Phone University Supervisor Directions: Please indicate the degree each competency has been demonstrated using the provided scale: Definition of Rating Terms: Excellent: Always performs above the minimum requirements and shows outstanding aptitude and application of techniques and concepts of Rehabilitation Counseling Average: Meets minimum requirements in a satisfactory manner; performs as might be expected of a Rehabilitation Counseling graduate student. Poor: Occasionally fails to meet minimum requirements in a satisfactory manner; performs at a level below that expected of a Rehabilitation Counseling graduate student. N/A: Not Applicable 1. Work Performance- Student demonstrates the ability to: 1.1 Organize information for records or reports 1.2 Provide clarity and accuracy in records and reports 1.3 Carry out instructions or directions Excellent Average Poor N/A 20

1.4 Completes assigned tasks 1.5 Plan and organize work 1.6 Be flexible in adapting to work situations 1.7 Show initiative in presenting and developing new ideas 1.8 Work under pressure and use personal stress management strategies 1.9 Show skill in handling special assignments 1.10 Recognizes the importance of individual differences and diverse cultures in counseling 1.11 Knows and consistently adheres to established professional codes of ethics 1.12 Students seeks out opportunities for observations and ways to participate in agency activities as appropriate 2. Response to Supervision - Student demonstrates the ability to: 2.1 Develop a positive and respectful relationship with supervisor 2.2 Consults with supervision for assistance 2.3 Use supervisory help in performance of work 2.4 Appropriately express feelings in supervisory conferences 2.5 Be prompt and prepare for conferences with supervisor 2.6 Constructively accepts praise, feedback, and ideas for improvement Excellent Average Poor N/A 3. Acceptance of Professional Role Student demonstrates the ability to: 3.1 Accepts professional responsibility 3.2 Forms a positive relationship with other professionals in the agency/facility staff members (e.g., teamwork) 3.3 Forms a positive relationship with other professionals in the community 3.4 Respects and follows agency/ facility policies and procedures 3.5 Demonstrates potential to make a positive professional Contribution in the human services field. 3.6 Demonstrates professional identity through appropriate dress and demeanor. Excellent Average Poor N/A 21

4. Add any other information that could clarify your responses or provide additional insight into this student's qualifications. (Printed Name of Site Supervisor) (Site Supervisor's Signature & Date) (Printed Name of Student) (Student's Signature & Date) *Please return form to the university supervisor. 22

APPENDIX D California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM PRACTICUM WEEKLY TIME SHEET (Insert New Form link Here) 23

APPENDIX E California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM Practicum Total Time Sheet (Insert New Form link Here) 24

APPENDIX F California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM Audio/videotape Consent Form Date: I understand this counseling and/or assessment experience will be completed with a Rehabilitation Counseling student in the California State University San Bernardino Rehabilitation Counseling Program. I understand this Rehabilitation Counseling student is working under the direct supervision of (University Supervisor) at CSUSB, who can be reached at ( ). I understand all information I provide will be kept confidential and will be destroyed upon completion of the course. I understand I may withdraw from this educational experience at any time, without consequence to me for doing so and I understand that I may ask questions anytime during the experience. Client s Signature Rehabilitation Counseling Student s Signature Rehabilitation Counseling Student s Printed Name 25

APPENDIX G California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM Student's Practicum Placement Evaluation Student s Name Quarter Year Placement Site Site Address City Site Phone Site Supervisor Type of Clientele University Supervisor A. Please rate your site on the following areas from 1 (very poor) to 5 (very good). 1. Adequate assistance in meeting university requirements. 1 2 3 4 5 2. Staff acceptance of you as a counselor trainee. 1 2 3 4 5 3. Support and cooperation of the administrative staff. 1 2 3 4 5 4. Physical facilities (space to work in, phone...). 1 2 3 4 5 5. Flexibility of site in meeting student s and client s needs. 1 2 3 4 5 6. Site requirements were reasonable. 1 2 3 4 5 B. Please rate your Site Supervisor on the following areas from 1 (infrequently) to 5 (frequently). 1. Supervisor offered constructive criticism. 1 2 3 4 5 2. Supervisor provided support when needed. 1 2 3 4 5 3. Supervisor provided assistance and/or referred you to someone who could. 1 2 3 4 5 4. Supervisor allowed adequate time for individual supervision. 1 2 3 4 5 5. Supervisor helped me understand integration of theory and practice. 1 2 3 4 5 6. Over-all evaluation of supervision. 1 2 3 4 5 26

Additional comments: 1. What did you especially like or dislike about the site or your supervision? 2. Please describe how the practicum was a learning experience for you? 3. What kind of supervision did you have? (e.g., listening to tapes, direct observation, group supervision, other). 27

4. How would you characterize your Site Supervisor s style of supervision? (e.g., positive reinforcement, concentration on counselor dynamics, criticism, no criticism, other?). 5. Do you wish to make any comments regarding the site supervisor evaluation? 6. Other comments: Student Name Date * Please return one copy to the university supervisor. 28

APPENDIX H California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM Community Resources The student is responsible for locating a practicum site; however, the Program Coordinator or faculty supervisor may provide you with some assistance. All practicum sites need final approval of the Program Coordinator. During both practicum classes, you will be supervised in the field by the site supervisor. Your faculty instructor may also conduct a site visit. Students may complete a portion of the practicum experiences at their employment sites; however, students will be required to engage in new learning activities appropriate to the practicum experience. The following are some of the community sites that students have used in the past for both practicum and fieldwork experiences. This is not an exhaustive or all inclusive listing. 1. California Dept. of Rehabilitation, San Bernardino Office 464 W 4th St Ste 152 San Bernardino, CA, 92401-1412 Ph: (909) 383-4401, (909) 885-0028 (TTY) 2. California Dept. of Rehabilitation, Riverside Office 464 W 4th St Ste 152 3130 Chicago Avenue, Riverside, CA, 92507-3445 Ph: (951) 782-6650, (951) 682-0143 (TTY) 3. California Dept. of Rehabilitation, Inland Empire District Offices, Palm Desert Office 73-720 Fred Waring Drive, Suite 102 Palm Desert, CA 92260-2564 Ph: (760) 674-0262, (760) 674-0266 (TTY) 4. California Dept. of Rehabilitation, Inland Empire District Offices, Temecula Office 27555 Ynez Road, Suite 310 Temecula, CA 92591-4678 Ph: (951) 693-4451, (951) 693-4468 (TTY) 29

5. California Dept. of Rehabilitation, Inland Empire District Offices Victorville Office 15415 W. Sand Street, Second Floor Victorville, CA 92392-2313 Ph: (760) 243-6024, (760) 245-4127 (TTY) 6. Jerry Pettis Veterans Administration Medical Center 11201 Benton St. #232VR Loma Linda, CA 92357, Ph: (909) 825-7084 7. Salvation Army Adult Rehabilitation Center 363 South Doolittle Avenue San Bernardino, CA 92408 Ph: (909) 889-9605 8. Goodwill Industries 8120 Palm Lane San Bernardino, CA 92410 Ph: (909) 885-3831 9. Provisional Accelerated Learning (PAL) Center 2450 Blake Street San Bernardino, CA, 92407 Ph: (909) 887-7002 10. California State University, San Bernardino Services to Students with Disabilities, 5500 University Parkway San Bernardino, CA, 92407 Ph: (909) 537-5238, (909) 537-7230 TDD 11. University of California, Riverside Services to Students with Disabilities 900 University Ave. Riverside, CA 92521 Ph: (951) 827-1012 12. Chaffey College Services to Students with Disabilities 5885 Haven Avenue Rancho Cucamonga, CA 91737-3002 Ph: (909) 652-6000 30

13. Community Colleges, San Bernardino Valley College Services to Students with Disabilities 701 So. Mt. Vernon Ave. San Bernardino, CA 92410 Ph: (909) 384 8952 14. Riverside Community College Department of Students Services with Disabilities (DSPS) Moreno Valley Campus 16130 Lasselle Street Moreno Valley, CA, 92551 Ph: (951) 571-6100 15. Workforce Development Center 1151 Spruce St Riverside, CA Ph: (951) 955-3100 16. The Other Place (DASH) Developing Aging Solutions with Heart, Inc. 306 W. Colton Ave. Redlands, CA, 92375-1570 Ph: (909) 798-1667 17. Braille Institute 70251 Ramon Road Rancho Mirage, CA, 92270 Ph: (760) 321-1111 18. One-Step Workshop 141 N. Arrowhead, #3 San Bernardino, CA Ph: (909) 381-3063 31

APPENDIX I California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 REHABILITATION COUNSELING PROGRAM CORRECTIVE ACTION PLAN FOR IMPROVEMENT OF PRACTICUM SKILLS Name of Student Practicum Site Site Supervisor Phone University Supervisor When a student is deemed to be proceeding in an unsatisfactory manner in a Practicum course, a report will be prepared by the University Supervisor summarizing both the points of concerns and a specific action plan for remediation, including specific recommendations, behavioral outcomes, and deadlines for review that offer a realistic opportunity for the student to experience an ultimately successful practicum experience. Successful completion of this Plan is required in order for the student to receive a passing grade in the Practicum course. By signature below, the student is agreeing to the Action Plan as stipulated in Form J and attached to this contract. Student s Signature Practicum Site Supervisor Signature University Supervisor Signature Program Coordinator Date Date Date Date 32

APPENDIX J California State University San Bernardino College of Education Department of Educational Psychology & Counseling 5500 University Parkway San Bernardino, CA 92407 (909) 537-5606 Points of concern/remediation: 1. 2. 3. REHABILITATION COUNSELING PROGRAM Corrective Action Plan Recommendations/steps the student must take for behavior outcomes: 1. 2. 3. Plan will be reviewed every (days, weeks, etc.) Deadline for behavior changes: Successful completion of this Corrective Action Plan is required in order for the student to receive a passing grade in EREH course. By signing below, the student is agreeing to the Corrective Action Plan as stipulated. (Attach to Appendix I) Student s Signature Practicum Site Supervisor Signature University Supervisor Signature Program Coordinator Signature Date Date Date Date 33