East Carolina University
 
College of Allied Health Sciences
Department of Addictions and Rehabilitation Studies


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Clinical Supervision Guide and Forms

All forms are to be completed electronically (i.e. on the computer) and by the practicum or intern student, faculty supervisor (FS), doctoral student supervisor (DSS), or field site supervisor (FSS) and emailed to FS and DSS.  Specific emailing instructions are on each form. All graduate student interns and doctoral students are supervised by FSs and FSSs.

  • Practicum and Internship Manuals: Students are responsible for giving a copy of the Practicum or Internship Manual to the FSS via email or printed copy.  Students print out the last sign-off signature page (see separate file for printing this one page under "supervision forms") of appropriate manual and have the FS or DSS and FSS sign the last page. Signatures indicate supervisors have read the manual and agree to their supervisor roles for the students' field experience. Give the signed last page to the FS. The FS will give signed page to REHB secretary to convert to pdf. format and place in REHB electronic file.

Forms Used After Each Counseling Session

  • Client Feedback for Counselor Form - E: Client gives feedback after each counseling session on printed form. Student later converts client's responses to electronic version of form.
  • Counselor Self-Review of Counseling Session Form - E: Student reflects on each counseling session on this form.
  • Practicum Supervision Log Form - Supervisors (doctoral, faculty and field-site) document supervision sessions, hours, and interventions on this form.  At the completion of Practicum the form is given to the faculty member teaching the course.
  • Internship Supervision Log Form - Supervisors (faculty and field-site) document supervision sessions, hours, and interventions on this form.  At the completion of Internship the form is given to the faculty member teaching the course.
  • Counseling Session Feedback FormE (CSF – E): Optional form completed by FS/DSS periodically on segments of counseling session tapes & client files. Student receives a copy and one copy for student file. The tick marks are only necessary for the microskills indicated by an asterisk. Mark the "needs improvement", "Acceptable", "Very Good", or "Not Observed" categories for all items including the microskills. (Optional form depending on the faculty teaching Practicum or Internship).

Forms Used for Mid-Term or Final Evaluation

  1. Supervisee Evaluation of Supervision Form - Practicum Doctoral Supervisor
  2. Supervisee Evaluation of Supervision Form - Practicum Faculty Supervisor
  3. Supervisee Evaluation of Supervision Form  - Practicum Field Site Supervisor
  4. Supervisee Evaluation of Supervision Form - Internship Faculty Supervisor
  5. Supervisee Evaluation of Supervision Form - Internship Field Site Supervisor



Forms Students are Responsible for Initiating

   1.  Practicum and Internship Manuals (send to FSS & last page signatures)

  1. SACC Counseling Practicum Manual
  2. SACC Internship Manual

   2.  Field Site/Supervisor Information for Practicum Form- E (FSSIF-E)
   
   3.  Field Site/Supervisor Information for Internship Form - E (FSSIF-E): 

   4.  Consent for Audio/Video Taping Form

   5.  Client Feedback for Counselor Form E

   6.  Counselor Self-Review of Counseling Session Form – E

   7.  Supervisor Evaluation of Supervisee Form – E (send to FSS)

   8.  Supervisee Evaluation of Supervision Form – E (SESF)

  1. Supervisee Evaluation of Supervision Form - Practicum Doctoral Supervisor
  2. Supervisee Evaluation of Supervision Form - Practicum Faculty Supervisor
  3. Supervisee Evaluation of Supervision Form  - Practicum Field Site Supervisor
  4. Supervisee Evaluation of Supervision Form - Internship Faculty Supervisor
  5. Supervisee Evaluation of Supervision Form - Internship Field Site Supervisor

   9.  Practicum Supervision Log Form

   10.  Internship Supervision Log Form

   11. Master Practicum Hours Summary Sheet E

   12. Master Internship/Supervision Hour Summary Sheet - E

   13. Social Media Guidelines


Forms Faculty are Responsible for Initiating

  1.  Practicum Supervision Log Form
  2.  Internship Supervision Log Form
  3.  Counseling Session Feedback Form- E (CSF)
  4. Supervisor Evaluation Forms – E (SES)

 Case Recording Forms

  1. Assessment Summary
  2. Case Progress Notes