Thelese CLINICAL SUPERVISION

Clinical Supervision

Application Packet

Wendy T. Talley

LCSW 29588

310-600-4152 personal; 310-242-6112 office

Hours of operation is determined by the both parties!

No calls after 8pm Monday-Sunday

Due back to me by:______

Payment option __: $______

Please include payment at the time it is due!

Either the supervisor or supervisee may terminate this agreement with 5 days written notice.

INTRODUCTION

The purpose of this document is to outline the responsibilities of all parties in relation to clinical supervision. This document specifies the agreed conditions of the supervision process including the responsibilities of the supervisor and supervisee. Clinical supervision will be conducted in a manner that maintains respect, confidentiality and privacy as appropriate.

CLINICAL SUPERVISION

The purpose of supervision is to enhance the clinical social worker’s professional skills, knowledge, and attitudes in order to achieve competency in providing quality patient care. This type of supervision establishes a learning alliance between the supervisor and supervisee in which the supervisee learns therapeutic skills while developing self-awareness at the same time.

The clinical supervisor is a licensed clinical social worker (LCSW) who’s license is registered with the California Board of Behavior Sciences and has completed all required continuing education courses to be able to provide this service. A clinical supervisor’s license can be verified at www.bbs.ca.gov and click on the verification button to the left of the site. Should there be any changes or updates to the plan during the supervision a special meeting outside of a clinical session will be called and no additional cost.

Definition: (Falender & Shafanske, 2004, p.3)-Supervision is a distinct professional activity in which education and training aimed at developing science-informed practice are facilitated through a collaborative interpersonal process. It involves observation, evaluation, feedback, facilitation of supervisee self-assessment, and acquisition of knowledge and skills by instruction, modeling, and mutual problem-solving. Building on the recognition of the strength and talents of the supervisee, supervision encourages self-efficacy. Supervision ensures that clinical (supervision) is conducted in a competent manner in which ethical standards, legal prescription, and professional practices are used to promote and protect the welfare of the client, the professional, and society at large.

Liability

Although the clinical supervisor does not offer direct services to patients, they do indirectly affect the level of service offered through their impact on the supervisee. They share the responsibility for services provided to the patient and can be held liable for negligent or inadequate supervision related to negligent conduct by the supervisee.

Direct liability may be charged against the clinical supervisor when inappropriate recommendations carried out by the supervisee bring harm to the patient. Direct liability also can be charged when a supervisor assigns a task to a supervisee who is inadequately prepared to perform it. The clinical supervisor and supervisee should take supervision seriously and ensure that the services provided by the supervisee meet NASW’s Code of Ethics and standards of the social work profession. (Please see attachment)

Liability (continue)

The purpose of this supervision is to enable ______(supervisee) to satisfy the clinical supervision requirements of ______(CA Board of Behavioral Sciences). As the independent clinical supervisor, I am not responsible for the supervisee’s job performance or for the number of cases or types assigned to him/her or for other aspects of his/her job duties or employment agreement with __ (employer).

Procedural Aspects

  • Although only the information which relates to the clients is strictly confidential in supervision, the supervisor will treat supervisee disclosures with discretion.
  • There are limits of confidentiality for supervisee disclosures. These include ethical and legal violations, indication of harm to self and others (and others as specific to the setting).
  • If the supervisor or the supervisee must cancel or miss a supervision, session, the session will be rescheduled.

Objective

Clinical supervision aims to improve the quality and safety of services delivered to clients by developing clinician knowledge and skills through reflective practice to better meet the needs of the client. The specific objectives of clinical supervision are to ensure:

  • a learning culture through reflective practice.
  • Identification of knowledge and skill acquisition and gaps.
  • Identification of opportunities for staff development and support
  • Accountability processes are established to support and refine practices to enable high quality care is provided to the client.

Planned Location

A location that is quiet with minimal disruptions is preferred. Location will be determined between the clinical supervisor and supervisee.

SUPERVISOR PLAN

The supervisee for licensure has submitted his/her application to the California Board of Behavior Sciences to began receiving hours for their Advance Practice Level License as an License Clinical Social Worker (LCSW).

The supervisee will participate in a minimum of [104] weeks of face-to-face clinical supervision with a supervisor approved by the board. If applicable, the supervisee will participate in [100] hours of group supervision if a group of 2 or more is available.

The supervisee must maintain a record of supervision, including dates, time, and content of supervisory sessions, should the board or the supervisor request for verification purposes.

A. Clinical Social Work areas:

  • Engagement
  • Assessment
  • Diagnosis
  • Treatment (types of milieu)
  • Client-centered advocacy
  • Evaluation
  • Consultation
  • Law and Ethics
  • Reporting Laws
  • Community Resources
  • Clinical Supervision

B. The supervision sessions will include the following aspects :

  • Case discussion and review
  • Provision of appropriate references
  • Articulation of theory and practice
  • Review and understanding of Diagnostic Disorders
  • Development of professional self in the profession

C. The clinical supervisor must:

  • Develops supervisory relationship and establish emotional tone. Identifies and addresses strains or ruptures in the supervisory relationship.
  • Ensures a high level of professionalism in all interactions. Clearly distinguishes and maintains the line between supervision and therapy.
  • Challenges and problem solves with supervisee.
  • Evaluate the supervisee’s knowledge and document minimal competencies in the areas of an identified theory base, application of a differential diagnosis, establishing and monitoring a treatment plan, development and appropriate use of the professional relationship, assessing the client for risk of imminent danger, and implementing a professional ethical relationship with clients and colleagues.
  • Provide individual or group, or individual and group (if applicable), face to face supervision.
  • Maintain documentation of supervision, including date, time, and content of supervisory sessions. Supervisor’s notes may be shared with the supervisee at the supervisor’s discretion and at the request of the supervisee.
  • Identifies and builds upon supervisee strengths as defined in competency assessment.
  • Discusses and ensures understanding of all aspects of the supervisory process in this document and the underlying legal and ethical standards from the onset of supervision.

D. The supervisee must:

  • Upholds and adheres to National Association Social Worker (NASW) Code of Ethics.
  • Is prepared to present integrated case conceptualization that is culturally competent.
  • Brings to supervision personal factors, transference, countertransference, and parallel process, and is open to discussion of these.
  • Identifies goals and tasks to achieve in supervision to attain specific competencies.
  • Identifies specific needs relative to supervisor input.
  • Identifies strengths and areas of future development.
  • Understands the liability of the supervisor with respect to supervisee practice and behavior.
  • Discloses errors, concerns and clinical issues as they arise.
  • Provides feedback weekly to supervisor on supervision process.
  • Responds nondefensively to supervisor feedback.
  • Consults with supervisor and/or employer in all cases of emergency regarding clients.

Clinical Supervision Plan for Master Level Social Workers

WRITTEN AGREEMENT/APPLICATION

SUPERVISEE INFORMATION:

Name: ______License No.:______

Address:______

______

City:______State:______Zip Code:______

Phone (home):______(cell):______

Email:______

Employer Information:

Name of Agency:______

Agency Address:______

Agency Phone:_(_____)______-______Fax: _(____)______-______

Supervisor’s Name & Title:______

SUPERVISOR INFORMATION:

Name:___Wendy Talley____ License No.:______25988___

Employer:__Private Practice-Thelese Consulting Group, LLC

Address:__6080 Center Dr., Suite 600; Los Angeles, CA 90045___

Phone: ___310-600-4152___ Email: ___

Website: www.kwessentialservices.com

PAYMENT ARRANDGEMENTS FOR 1 HOUR SESSIONS:

Monthly $400

**All financial transactions can be completed by Cashier Checks (bank or money order), make it not to Thelese Consulting Group, LLC or Cash. No personal checks please.

**All payments are due at the first of each month. If you are doing Bi-weekly payments it will due the beginning of every two weeks.

All monies are used to buy materials, and transportation of the clinician to request site for supervision. If supervision is done at my personal home it will also include refreshments.

Mode of Supervision (face to face, email, etc):______

Start date of supervision:__/___/____ Projected completion date:__/__/___

Hours per week of clinical practice:__1__ Frequency of sessions:__1/ week___

Hours of Individual sessions:__1___ Hours of group sessions ______

(if applicable)

***All supervision occurs outside of paid work hours. If you are an employee of the Department of Veteran’s Affairs, veterans as client cannot be utilized in clinical supervision with the identified supervisor because of conflict of interest.

The contract may be revised at the request of supervisee or supervisor. The contract will be formally reviewed at quarterly intervals and more frequently as indicated. Revisions will be made only with consent of supervisee and approval of supervisor. We, ______(supervisee) and __Wendy Talley, LCSW___

(supervisor) to follow the directives laid out in this supervision contract and to conduct ourselves in keeping with our National Association Social Worker (NASW) Code of Ethics, laws and regulations.

I have read the Clinical Supervision contract above and all documents attached (including the confidentiality and communication and privacy statements) and agree to the contract above. Note you can cancel your contact within 5 days of the date signed, thereafter any cancellation will require a full month payment less than $50.

Supervisee’s Signature

______

Printed name

______

Date of signature & Time

**Must include a copy of supervisee’s current ACSW license with this form. Also include a copy of the job description for the clinical social work practice in which you will be supervised. Either the supervisor or supervisee may terminate this agreement with 5 days written notice.

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