SCHOOL COUNSELING PRACTICUM AND …...Check with your advisor, your potential site, and/or the...

Table of Contents

Item Page Deadline

Clinical Experience Planning Process 2

Step-By-Step Directions for Starting School Counseling Practicum 3

Step-By-Step Directions for Starting School Counseling Internship 4

School Counseling Practicum Log and Document Checklist 5

School Counseling Internship Log and Document Checklist 6

Clinical Experience Eligibility Form

7 If beginning Practicum and Internship I in the Fall semester – March 1st If beginning Practicum in the Spring semester – October 1st

School Counseling Practicum Agreement Form 8-10 If beginning Practicum and Internship I in the Fall semester – May 1st

If beginning Practicum in the Spring semester – December 1st

School Counseling Internship Agreement Form 11-13

Assignment of Supervisor and Qualifications of Supervisor Form 14

Reporting: School Counseling Practicum Log 15

Due Weekly Reporting: School Counseling Internship Log 15

Instructions for Performance Evaluations 16

Supervision Contract 17-18 Due by the 3rd class session

Skill Evaluation Form Practicum 19-23

Due at midterm and end of the semester Skill Evaluation Form Practicum (Professional Behavior) 24

Skill Evaluation Form Internship 25-30

Due at end of Internship I and end of Internship II Skill Evaluation Form Internship (Professional Behavior) 31

Assessment of The Clinical Experience 32-35 Due at the end of Practicum, Internship I, and Internship II

Practicum Completion Form 36 Due at the end of Practicum

Internship Completion Form 37 Due at the end of Internship I and Internship II

School Counseling Clinical Experience Permission Form 38

For information contact:

Dr. Lynne Guillot-Miller, Coordinator of the Master’s Degree Program in

School Counseling

or

Dr. Steve Rainey Master’s Practicum and Internship Coordinator

310 White Hall 150 Terrace Drive, PO BOX 5190

Kent, OH 44242-0001 (330) 672-2662 * * * * FAX (330) 672-2512

REVISED JANUARY 2017

College of Education, Health, & Human Services Counselor Education and Supervision Program

SCHOOL COUNSELING PRACTICUM AND INTERNSHIP MANUAL

CES WEBSITE: http://www.kent.edu/ehhs/ldes/CES

http://www.kent.edu/ehhs/ldes/CES

Revised January 2017 of 37

Clinical Experience Planning Process

The practicum and internship experience is an important facet of the School Counseling program. The practicum experience represents clinical experiences in which students are first exposed to clients (students) in a school setting. The internship experience represents the culmination of formal academic training in the School Counseling program. It is the opportunity students have to assume the role of professional counselor-in-training and to provide services within a school under appropriate supervision. Students can be designated a “Counselor Trainees” when they are enrolled in either the School Counseling practicum or internship courses and are receiving appropriate face-to-face supervision. The practicum and internship experiences, therefore, serve as a “testing ground” of sorts. During both practicum and internship, students have the opportunity to test the academic course work and formal training received thus far. In addition, students are challenged to practice, in the role of Counselor Trainee, the counseling theories, techniques, and procedures learned in their program.

It is important that each student is matched to a practicum and internship setting that suits their learning requirements. In order to accomplish an appropriate practicum and internship experience, considerable planning and careful preparation must be completed before the student actually begins their clinical experiences. Clinical experiences must provide the student with opportunities to engage in school counseling services, roles, and functions. Once potential practicum and internship site(s) have been located by a student, the Master’s Practicum and Internship Coordinator will verify in writing the appropriateness of the setting and supervision prior to the student beginning their practicum and internship experiences.

IMPORTANT NOTES:

Students must have completed the following prerequisite courses to be eligible for CES 6/78026: School Counseling Practicum: CES 68069: School Counseling: Orientation and Ethics; CES 67530: Counseling Theories; CES 67531: Counseling Skills and Techniques; CES 67820: Group Work: Theory and Techniques; CES 68066 Counseling Adolescents; and CES 68067 Counseling Children

Students can only have one course, CES 68068 School Counseling Program Management and Leadership remaining on the prospectus before enrolling in CES 78192: Internship I: School Counseling.

Practicum is offered in the Fall and Spring semesters.

Internship I is only offered in the Fall semester and Internship II is only offered in the Spring

semester. Practicum and internship is not offered in the summer and therefore, cannot be

completed in the summer.

What follows is a step-by-step process for students to follow in identifying and securing a clinical experience in practicum and internship. As a student, it is your responsibility to begin the process early (i.e., at least one full semester prior to the beginning of the practicum or internship experience). This means completing the Clinical Experience Eligibility Form and meeting with your CES faculty advisor to review and sign it. Your careful attention to the Clinical Experience Eligibility Form will ensure that the practicum and internship location process begins smoothly and will help assure that you identify an appropriate school. If you have questions about completing the internship materials, contact your CES faculty advisor or the CES Master’s Practicum and Internship Coordinator.


Step-by-Step Directions for Starting School Counseling Practicum

Step 1: Obtain School Counseling Practicum and Internship Manual: Read this manual thoroughly.

Step 2: Complete Clinical Experience Eligibility Form: The second step of the practicum application process is completing the Clinical Experience Eligibility Form, with the two (2) necessary accompanying documents (a) current academic transcript and (b) Student Profile with accompanying documents. Your completion of this form will assist in clarifying your needs and goals for the practicum experience and will help identify an appropriate practicum. You will need to have completed the Clinical Experience Eligibility Form (and the two necessary accompanying documents) before meeting with your CES faculty advisor. Your faculty advisor’s signature is required on the Clinical Experience Eligibility Form and will indicate that you are academically ready to begin the practicum experience at the start of the semester you have indicated.

Step 3: Meet with Faculty Advisor: The next step in the process of locating a practicum site is meeting with your CES faculty advisor and discussing your Clinical Experience Eligibility Form. It is recommended that you schedule an appointment and meet face-to-face with your CES faculty advisor early in the semester prior to the semester that you want to complete practicum. Once the Clinical Experience Eligibility Form has been reviewed by your advisor, obtain his/her signature and make a copy of the form for yourself. Discuss with your advisor ways in which to find a practicum site and market yourself as a Counselor Trainee (especially for individuals without two years teaching experience). Remember, it is your responsibility to initiate contact with potential practicum/internship sites, schedule interviews, and finalize the internship agreement – if you have any questions about your responsibilities, talk with your faculty advisor.

Step 4: Submit Completed Clinical Experience Eligibility Form to Master’s Practicum and Internship Coordinator: A copy of the Clinical Experience Eligibility Form, signed and dated by both you and your CES faculty advisor, along with the two necessary accompanying documents (i.e., current academic transcript and Student Profile), are due to the Master’s Practicum and Internship Coordinator by the dates listed in the Table of Contents of this document. Failure to submit necessary paperwork by the deadlines specified in the Table of Contents may delay (by as much as an entire semester) the commencement of your Practicum experience.

Step 5: Register yourself for CES 6/78026: School Counseling Practicum: It is up to the student to register himself/herself for the school counseling practicum course. Such sections fill up quickly so register as soon as possible because they are on a first come, first serve basis. If all of the sections are filled and you need to get into a practicum, please see the CES Program secretary to get on a Wait List. The School Counseling Practicum Wait List serves as the document to see if additional sections of practicum need to be opened or additional supervisors need to be hired. There is NO guarantee that students on the Wait List will get into a practicum. The Master’s Programs Coordinator will try hard to make this happen but such additional sections or supervisors is depending on funding, budget, and availability of qualified personnel. If the required paperwork for Practicum is not submitted by the deadlines (see Table of Contents), the student will be dropped from their practicum section.

Step 6: Contact Potential Practicum Sites: Once you have identified several potential practicum sites (as a result of conferring with your CES academic advisor or the Master’s Practicum and Internship Coordinator), it is recommended that you begin making telephone calls and scheduling appointments early in the process (i.e., at the very beginning of the semester prior to the start of your proposed practicum). When you call each school, ask to speak directly with the senior ranking school counselor and/or the building principal, inquire about the specific services provided by each school that a counseling practicum student would be able to offer (e.g., individual & group counseling), and request an on-site interview for a possible practicum experience. Make the initial contact via telephone and not via a faxed or e- mail message to the contact person. In addition, do not base a practicum agreement on a telephone interview! Schedule an on-site interview with the school contact person and meet directly with this person. Take a copy of this School Counseling Practicum and Internship Manual and your resume with you. Keep track of the schools and persons you contact and be certain you know with whom you are speaking and his/her title and position at the school. Also, (especially for those without two years teaching experience) keep in mind that this might be a potential internship site – you want to discuss the possibility of also conducting your 600 hour (two semesters) School Counseling Internship at these schools.

Step 7: Interview Guidelines: Once an interview has been scheduled, take with you a copy of your current resume and a copy of this School Counseling Practicum and Internship Manual to leave with the person with whom you interviewed. Provide that person with the name and telephone number of the Master’s Practicum and Internship Coordinator and the School Counseling Program Coordinator. Clarify that supervision must be provided by a licensed / certified school counselor who is an employee (part-time, full-time, or contracted with the school) of the school where you will conduct your practicum. In addition, the supervisor at the school must have at least two (2) years of experience as a school counselor. Follow-up the in-person interviews with telephone calls inquiring about the status of your practicum request. Don’t wait for them to call you!

Step 8: Completing and Submitting Necessary Paperwork Upon securing a practicum site, meet with the school representative where you will be undertaking your practicum experience to complete necessary paperwork. There are two CES Program forms that need to be completed (including signatures). These forms include: (1) the original School Counseling Practicum Agreement form and (2) the original Assignment of Supervisor and Qualifications of Supervisor Form. Submit these two forms along with the proof of Professional Liability Insurance Policy to the Master’s Practicum and Internship Coordinator. These forms and documents need to be completed and on file before you can begin your practicum. Failure to submit necessary paperwork by the deadlines specified in this Manual may delay (by as much as an entire semester) the commencement of your practicum experience.

Step 9: Complete State and Federal Criminal Background Checks: Please complete state and federal background checks. Check with your advisor, your potential site, and/or the Master’s Practicum and Internship Coordinator on methods for obtaining your background checks (e.g., White Hall 221, district office, etc). Results of the State and Federal Background check should be sent directly to the school or district in which you are completing practicum. Verification that the results of state and federal background checks were sent to your school will be obtained on the Supervision Contract.


Step-by-Step Directions for Starting School Counseling Internship

Step 1: Keep in mind that forms used for CES 6/68392: School Counseling Practicum CANNOT be used for CES 68192: Internship I: School Counseling or CES 68292: Internship II: School Counseling – even if you have the same supervisor!

Step 2: Obtain School Counseling Practicum and Internship Manual: Read this manual thoroughly.

Step 3: Complete Clinical Experience Eligibility Form: The third step of the internship application process is completing the Clinical Experience Eligibility Form, with the two (2) necessary accompanying documents (a) current academic transcript and (b) Student Profile with accompanying documents. Your completion of this form will assist in clarifying your needs and goals for the internship experience and will help identify an appropriate internship. You will need to have completed the Clinical Experience Eligibility Form (and the two necessary accompanying documents) before meeting with your CES faculty advisor. Your faculty advisor’s signature is required on the Clinical Experience Eligibility Form and will indicate that you are academically ready to begin the internship experience at the start of the semester you have indicated.

Step 4: Meet with Faculty Advisor: The next step in the process of locating an internship site is meeting with your CES faculty advisor and discussing your Clinical Experience Eligibility Form. It is recommended that you schedule an appointment and meet with your faculty advisor early in the semester prior to the semester that you want to complete internship. Once the Clinical Experience Eligibility Form has been reviewed by your advisor, obtain his/her signature and make a copy of the form for yourself. Discuss with your advisor ways in which to find an internship site and market yourself as a Counselor Trainee (especially for individuals without two years teaching experience). This last topic of discussion may not have to take place if you will be using the practicum site as your internship site.

Step 5: Submit Completed Clinical Experience Eligibility Form to Master’s Practicum and Internship Coordinator: A copy of the Clinical Experience Eligibility Form, signed and dated by both you and your CES faculty advisor, along with the two necessary accompanying documents (i.e., current academic transcript and Student Profile), are due to the Master’s Practicum and Internship Coordinator by dates listed in the Table of Contents of this document. Failure to submit necessary paperwork by the deadlines specified in the Table of Contents may delay (by as much as an entire year) the commencement of your Internship experience.

Step 6: Contact Potential Internship Sites: Once you have identified several potential internship sites (as a result of conferring with your CES academic advisor), it is recommended that you begin making telephone calls and scheduling appointments early in the process (i.e., at the very beginning of the semester prior to the start of your proposed internship). When you call each school, ask to speak directly with the senior ranking school counselor and/or the building principal, inquire about the specific services provided by each school that a counseling intern would be able to offer (e.g., individual & group counseling), and request an on-site interview for a possible internship experience. Make the initial contact via telephone and not via a faxed or e-mail message to the contact person. In addition, do not base an internship agreement on a telephone interview! Schedule an on-site interview with the school contact person and meet directly with this person. Take a copy of this School Counseling Practicum and Internship Manual and your resume with you. Keep track of the schools and persons you contact and be certain you know with whom you are speaking and his/her title and position at the school. NOTE: This step may not need to be completed if you are using the same internship site and supervisor as you did during your practicum.

Step 7: Interview Guidelines: Once an interview has been scheduled, take with you a copy of your current resume and a copy of this School Counseling Practicum and Internship Manual to leave with the person with whom you interviewed. Provide that person with the name and telephone number of the Master’s Practicum and Internship Coordinator and the School Counseling Program Coordinator. Clarify that supervision must be provided by a licensed / certified school counselor) who is an employee (part-time, full-time, or contracted with the school) of the school where you will be conducting your internship. In addition, the supervisor at the school must have at least two (2) years of experience as a school counselor. Follow-up the in-person interviews with telephone calls inquiring about the status of your internship request. Don’t wait for them to call you! Even if you used the same site for practicum – such a discussion with your potential internship site supervisor is beneficial.

Step 8: Completing and Submitting Necessary Paperwork: Upon securing an internship site, meet with the school representative where you will be undertaking your internship experience to complete necessary paperwork. There are two CES Program forms that need to be completed (including signatures). These forms include (1) the original School Counseling Internship Agreement form and (2) the original Assignment of Supervisor and Qualifications of Supervisor Form. Submit these two forms along with proof of your Professional Liability Insurance Policy to the Master’s Practicum and Internship Coordinator. These forms and documents need to be completed and on file before you can begin your practicum. Failure to submit necessary paperwork by the deadlines specified in this Manual may delay (by as much as an entire year ) the commencement of your practicum experience.

Step 9: Complete State and Federal Criminal Background Checks: Please complete state and federal background checks. Check with your advisor, your potential site, and/or the Master’s Practicum and Internship Coordinator on methods for obtaining your background checks (e.g., White Hall 221, district office, etc). Results of the State and Federal Background check should be sent directly to the school or district in which you are completing internship. Verification that the results of state and federal background checks were sent to your school will be obtained on the Supervision Contract.

Step 10: Enrollment in School Counseling Internship Course: The Master’s Practicum and Internship Coordinator will clear students to enroll in CES 68192: Internship

I: School Counseling (3 credit hours) the first semester of internship and CES 68292: Internship II: School Counseling (3 credit hours) the second semester of internship. Enrollment will only take place when all required paperwork has been completed and submitted to the Master’s Practicum and Internship Coordinator.

Step 11: Attend CES 68192: Internship I: School Counseling

Step 12: Attend CES 68292: Internship II: School Counseling


School Counseling Practicum Log and Document Checklist

This checklist represents all of the major forms that are to be completed during the School Counseling

Practicum. However, this checklist does not include any additional requirements found in the course syllabus. It is the student’s responsibility to keep the course instructor up-to-date on all paperwork. It is also the student’s

responsibility to ensure that the course instructor initials this checklist in the appropriate box upon submission of documents. Keep this form in the student’s file at all times and update it weekly. Student’s Name: ____________________________________________________________________________________ CRN and Semester: ___________________________ Instructor ______________________________________________

**As the student submits the log/document, please provide the date and initial on the appropriate line. This ensures all paperwork is submitted and the file is complete at the end of the semester**

Logs and Weekly Activity Reports

Week 1: __________________ Documents for Registration

Week 2: __________________ Week 3: __________________ Week 4: __________________ Week 5: __________________ Week 6: __________________ Week 7: __________________ Week 8: __________________ Week 9: __________________ Week 10: _________________ Week 11: _________________ Week 12: _________________ Week 13: _________________ Week 14: _________________ Week 15: _________________ Week 16: _________________

Clinical Eligibility Form: __________________________ Student Profile: ________________________________ Academic Transcript: ____________________________

Other Semester Documents

SCON Practicum Agreement Form: ________________ Assignment of Supervisor & Qualification: ___________ Liability Insurance: ________Expiration Date: ________ Supervision Contract: ____________________________ Assessment of Clinical Experience: _________________ Practicum Completion Form: ______________________

Skill and Professional Behavior Evaluations Midterm by Site Supervisor: ______________________ Final by Site Supervisor: __________________________ Midterm by Instructor: __________________________ Final by Instructor: _____________________________


This checklist represents all of the major forms that are to be completed during the School Counseling Internship. However, this checklist does not include any additional requirements found in the course syllabus.

It is the student’s responsibility to keep the course instructor up-to-date on all paperwork. It is also the student’s responsibility to ensure that the course instructor initials this checklist in the appropriate box upon submission of documents. Keep this form in the student’s file at all times and update it weekly.

School Counseling Internship I and II Log and Document Checklist


This Clinical Experience Eligibility Form is for… Practicum Internship I Internship II ______

Anticipated Date of Starting Practicum: / /

Date Practicum was Completed: N/A ___or D a t e _______/ ____/ Anticipated Date of Starting Internship: N/A ___or D a t e _______/ ____/

Date Submitted to Master’s Practicum and Internship Coordinator Date _______/ ____/ _______

Master’s Practicum and Internship Coordinator’s Initials: ______________

This form is Due March 1st if starting Practicum or Internship I in the Fall Semester or October 1st if starting practicum in the Spring Semester.

Read all directions carefully before completing the form.

NOTE: Separate forms must be used for practicum and internship – this form is NOT to be updated for internship. Type or print neatly all information on this form.

I. IDENTIFYING INFORMATION

Name: Banner ID #:

Local Address:

Permanent Address:

Telephone Number(s):

E-Mail Address:

II. ATTACH A CURRENT ACADEMIC TRANSCRIPT: This is available from the Registrar’s Office or through FlashLIne and should include all courses completed to this date.

III. SCHOOL COUNSELING COURSES CURRENTLY IN PROGRESS: List all courses in which you are currently enrolled. Include courses you are now taking, or will be taking prior to practicum or internship, and for which you have not received a final grade. You will need to verify the completion of all prerequisites for practicum or internship.

IV. CLINICAL EXPERIENCE SETTING PREFERENCE: This is used while discussing possible internship settings and experiences with your CES faculty advisor. Rate your 1st, 2nd, and 3rd preference:

Grades K – 4 Grades 5 – 8 Grades 9 – 12

V. EXPLAINATION OF PREFERED INTERNSHIP SETTINGS: Explain (on a separate sheet of paper) your reasons for the selections you made in section IV above.

VI. STUDENT PROFILE or Résumé This information should be in the form of a separate, typewritten, double-spaced resume addressing the following areas as they relate to your aspirations as a professional school counselor.

Experience Relevant to School Counseling: Describe paid or volunteer activities through which you have gained experience helpful to a school counseling setting. This is general, so consider any experiences that demonstrate your potential to work with people, such as a residence hall advisor, crisis hotline volunteer, or other related activities.

Post-Graduation Plans: Indicate your employment aspirations, plans for further study, or other expectations that have a bearing on your professional future as a counselor.

Describe what goals or educational objectives you hope to accomplish through your clinical experience. What strengths do you take with you into this clinical experience? What areas are you aware of that need further work? Specify if you are interested in certain client groups or specific treatment approaches.

For Internship ONLY: describe what you have learned from your practicum experience and what are the aspects of your practice that you need to work more on based on your practicum experience.

Student’s Signature: Date: _________/ ___ /

CES Faculty Advisor’s Signature: Date: _________/ ___ /

Accompanying Documents Needed: (1) Current & Original Academic Transcript, and (2) Student Profile or Résumé.

Clinical Experience Eligibility Form


Directions: This agreement is to verify for the University, the Practicum Site, and the Counselor Trainee the expectations of the practicum experience and to document that all parties have agreed to take part in this experience. The Practicum Site, the University, and the Counselor Trainee should receive a copy of the completed form for

their records. This agreement MUST be completed and signed by all appropriate parties, and submitted to the Master’s Practicum and Internship Coordinator by May 1st

if starting Practicum in the Fall Semester or December 1st if starting Practicum in the Spring Semester.

This agreement between the Counselor Education and Supervision (CES) Program at Kent State University and

of is for the purpose of identifying responsibilities (School Name) (City and State)

assumed in the provision of appropriate supervision for School Counseling Student

(Counselor Trainee Name)

while he/she is enrolled in the School Counseling Practicum course for . (Semester and Year of Practicum Experience)

General Policies 1) The central purpose of this agreement is the formal education of students in preparation for practice as a licensed school counselor.

2) This agreement shall remain in effect for the duration of the student’s practicum experience at the school specified above. Termination of this agreement prior to the successful completion of practicum requires the consultation of the assigned site practicum supervisor, school representative, Practicum Instructor, Master’s Practicum and Internship Coordinator at the University, the student’s faculty advisor, and the student.

3) The practicum experience is typically a voluntary arrangement with no financial remuneration required by the University or school for services provided in the course of fulfilling practicum duties; however, some schools may offer stipends to Counselor Trainees.

4) Duration of practicum is typically for one academic semester (approximately 16 weeks total), exclusive of vacations. Once all necessary paperwork and completed forms have been submitted to the Master’s Practicum and Internship Coordinator by the deadline specified in this Manual, and the Master’s Practicum and Internship Coordinator has determined that the proposed practicum site and expected experiences are appropriate for fulfilling both CES School Counseling program and state licensure eligibility requirements, the student will enroll for 4 credit hours in the Practicum in School Counseling course for the semester he/she is undertaking the practicum experience.

5) Practicum hours shall be in accordance with school work hours and shall total a minimum of 8 clock hours per week for a minimum total of 100 clock hours. Of the 100 clock hours needed, 40 must be in direct and face-to-face service to students/clients. Of the 40 direct hours, a minimum of 20 hours must be individual counseling and a minimum of 10 hours must be small group counseling (not classroom guidance).

6) The practicum experience must be representative of a professional school counselor – with an emphasis on basic counseling skills / techniques. That is, during the practicum experience, the counselor trainee must utilize the CACREP (2009) standards.

7) Students cannot begin accruing clock hours towards practicum requirements until all agreement forms have been signed by all parties (i.e., CES faculty advisor, site/school supervisor, Master’s Practicum and Internship Coordinator, and Counselor Trainee), have been submitted in a timely fashion (according to deadlines specified in this Practicum and Internship Manual) to the Master’s Practicum and Internship Coordinator, and the practicum setting and experience have been determined to be appropriate by the Master’s Practicum and Internship Coordinator. The earliest that students can begin accruing practicum hours is the first day of the academic semester in which he or she is enrolled in practicum. Vacations and holidays shall be observed according to the University calendar, unless otherwise agreed upon by the University representative, school, and student.

8) Students who are engaged in school practicum-related activities and are enrolled in the school counseling practicum course, are required to attend weekly practicum class sessions. Exceptions to this must be approved jointly by the School Counseling Practicum Instructor and Master’s Practicum and Internship Coordinator, and methods for fulfilling all practicum requirements must be clarified before the beginning of the practicum experience.

9) It is important to note that School Counseling Counselor Trainees may wish to complete their internship experience after they complete their practicum at the same site/school as their practicum. However, the Counselor Trainee, the Master’s Practicum and Internship Coordinator, and the site/school supervisor must agree to do this. Any of these three parties may nullify this agreement. The major difference between the School Counseling Practicum and the School Counseling Internship are as follows:

Practicum is a 3 credit hour course to be completed over one semester with 100 hours of experience (40 hours of which are direct student contact) and Internship I (3 credit hours) and Internship II (3 credits hours) total a 6 credit hour experience to be completed over two semesters with 600 hours of experience (240 hours of which are direct student contact).

There are six courses that must be completed before entering Practicum (School Counseling: Orientation and Ethics, Counseling Theories, Counseling Skills and Techniques, Group Work: Theory and Technique, Counseling Children, and Counseling Adolescents). Students can only have Program Management and Leadership remaining on the 48 semester hour prospectus before entering CES 68192: Internship I: School Counseling. All coursework must be completed before entering CES 68292: Internship II: School Counseling.

Practicum is an opportunity to PRACTICE therapeutic skill building, relating to students, and working through the therapeutic process while Internship is an opportunity to serve in the role and function of a professional School Counselor.

School Counseling Practicum Agreement Form


Responsibilities of the University

The University agrees to:

1) Assume full responsibility for the administrative duties associated with the academic requirements of the School Counseling Practicum, including approval of the practicum site and experience, maintaining on-going and direct communication with school representatives, ensuring that Counselor Trainees are academically ready to begin the practicum experience, and grading.

2) Provide information regarding the CES School Counseling program and curriculum in order that the school may properly plan and execute assignments and supervision. Specifically included are student data, university calendar, student handbook, and this Practicum and Internship Manual.

3) Designate one CES faculty member each academic semester to serve as the Practicum Instructor for the student and to communicate directly with the site/school supervisor. The practicum instructor will facilitate 2.5 hours of group supervision on a weekly basis (this group consists of the practicum instructor and no more than six students) and one hour of weekly individual or triadic supervision to students. The role of the Practicum Instructor and the Master’s Practicum and Internship Coordinator will be that of a consultant; the designated site/school supervisor will assume legal responsibility for all students seen by the Counselor Trainee.

Responsibilities of the School

The School agrees to:

1) Designate one staff person as site/school supervisor with appropriate graduate degree and a school counseling license / certificate. This person must be an employee (part-time, full-time, or contracted with the school) of the School where the practicum will be conducted. In addition, the school supervisor must be a professional practicing as a licensed / certified school counselor for at least two years. The designated site/school supervisor will assume legal responsibility for the welfare of all students seen by the Counselor Trainee.

2) Develop work assignments and tasks for the Counselor Trainee commensurate with the CES program objectives and accreditation standards (e.g., CACREP), in consultation with the Practicum Instructor and Master’s Practicum and Internship Coordinator.

3) Ensure that at least 40 clock hours are devoted to direct, face-to-face service to students and offer audio/video taping access or, in the absence of taping, live observation or co-counseling. Within these 40 hours, a minimum of 10 small group counseling hours (not classroom guidance) must be accrued but shall not exceed 20 hours of groupcounseling.

4) Provide opportunities for the Counselor Trainee to engage in the provision of services representative of basic skills needed to conduct face-to-face counseling to students.

5) Students are not to engage in off-site services (e.g., home-based counseling, transportation of students, etc.).

6) Provide the minimum face-to-face supervisory requirements of one (1) hour per week or for every 8 hours of overall service the counselor trainee provides.

7) Complete the student evaluation materials in a timely fashion.

8) Inform the University of School policies and procedures that are relevant to the experience of students.

9) Provide appropriate working conditions and physical arrangements for the practicum, such as desk space for completing paperwork, access to a telephone, and office space in which to meet with students/clients privately. In addition, provide a clinical instruction environment that is conducive to modeling, demonstration, and training and is accessible to the counselor trainee. The clinical instruction environment includes all of the following:

settings for individual counseling with assured privacy and sufficient space for appropriate equipment (for example, TV monitoring and taping);

settings for small-group work with assured privacy and sufficient space for appropriate equipment;

necessary and appropriate technologies that assist learning, such as audio, video, and telecommunications equipment;

settings with observational and/or other interactive supervision capabilities; and

procedures that ensure that the client’s confidentiality and legal rights are protected.

10) Maintain close communication with the University in relation to practicum activities through available means such as field supervisor meetings, correspondence with the Master’s Practicum and Internship Coordinator, on-site visits by the Practicum Instructor, and telephone contacts.

11) Monitor student performance and report to the University Practicum Instructor and/or Master’s Practicum and Internship Coordinator if difficulties in performance, ethics or other practicum related activities arise.

12) Allow the practicum student to attend weekly practicum class.

Responsibilities of the Student / Counselor Trainee

1) The Counselor Trainee enroll in the Practicum for School Counseling course for one semester (3 semester hours) and will attend all classes/seminars for School Counseling practicum for the entire length of the practicum experience. Within this class, 2.5 hours of group supervision will be provided and students will be actively participating in this experience. In addition to the class / seminar, students will receive one hour per week of individual or triadic supervision from the practicum instructor.

2) The Counselor Trainee will complete a weekly School Counseling Practicum and Log and will submit the originals on a weekly basis to the Practicum Instructor, and copies to the site/school supervisor.

Revised JANUARY 2017 of 37

3) The Counselor Trainee must complete duties assigned and at hours scheduled at the practicum site, according to the agreement established between the student and school representative. This includes reporting directly to site/school supervisor regarding client issues during regularly scheduled supervision sessions and as needed (e.g., in response to client crisis/emergency issues).

4) Counselor Trainees are expected to conduct themselves in a professional manner throughout the entirety of the practicum experience. This means up-holding and abiding by the most current revision of the American Counseling Association's Code of Ethics and Standards of Practice and ethical codes provided by the American School Counseling Association.

5) Counselor Trainees are responsible for seeing that all paperwork related to the practicum is completed in a timely fashion (i.e., according to deadlines specified in this Manual and in Practicum class) and on file.

6) The student will ensure that the practicum site and assigned site supervisor receive a copy of the University calendar, student handbook, and this Practicum and Internship Manual.

7) The student will ensure that the Practicum Site and Master’s Practicum and Internship Coordinator receive copies of the completed School Counseling Practicum

Agreement form and the Assignment of Supervisor and Qualifications of Supervisor Form by May 1st if starting Fall Semester or December 1st if starting Spring Semester. The student will also be certain that the Mid-semester and Final Skill and Professional Behavior Evaluations, Assessment of the Clinical Experience, and the Practicum Completion Form are properly completed and placed in the student’s practicum file.

8) The student must purchase professional liability insurance and provide proof of current coverage throughout the practicum experience.

The signatures below indicate that each person understands the Practicum requirements for the School Counseling Master’s degree Program at Kent State University. The signatures also represent each person’s agreement to uphold his or her respective responsibilities outlined in this School Counseling Practicum Agreement Form.

The School Counseling Practicum will begin (month/year) / and conclude (month/year) / for a total of weeks.

School Representative (preferably the Principal):

Printed: Signed:

Title: Date: / /

School Name & Address:

Practicum Student Name Printed: Signed: Date: / /

Master’s Practicum & Internship Coordinator: Signed: Date: / /


School Counseling Internship Agreement Form

Directions: This agreement is to verify for the University, the Internship Site, and the Counselor Trainee the expectations of the internship experience and to document that all parties have agreed to take part in this experience. The Internship Site, the University and the Counselor Trainee should receive a copy of the completed form for their records. This agreement MUST be completed and signed by all appropriate parties, and submitted to the Master’s Practicum and Internship

Coordinator by May 1st if starting Fall and December 1st if changing sites for Internship II.

This agreement between the Counselor Education and Supervision (CES) Program at

Kent State University and of is for the purpose of identifying (School Name) (City and State)

responsibilities assumed in the provision of appropriate supervision for School Counseling Student

(Counselor Trainee Name)

while he/she is enrolled in the School Counseling Internship course for . (Semester(s) and Year(s) of Internship Experience)

General Policies

1) The central purpose of this agreement is the formal education of students in preparation for practice as a licensed school counselor.

2) This agreement shall remain in effect for the duration of the student’s internship experience at the school specified above. Termination of this agreement prior to the successful completion of internship requires the consultation of the assigned site internship supervisor, school representative, Internship Instructor, Master’s Practicum and Internship Coordinator at the University, the student’s faculty advisor, and the student.

3) The internship experience is typically a voluntary arrangement with no financial remuneration required by the University or school for services provided in the course of fulfilling internship duties; however, some schools may offer stipends to Counselor Trainees.

4) Internship is a two-semester experience (e.g., Internship I in the fall semester then Internship II in the spring semester). Once all necessary paperwork and completed forms have been submitted to the Master’s Practicum and Internship Coordinator by the deadline specified in this Manual, and the Master’s Practicum and Internship Coordinator has determined that the proposed internship site and expected experiences are appropriate for fulfilling both CES School Counseling program and state licensure eligibility requirements, the student will be cleared to enroll in the Internship I: School Counseling for the semester he/she is beginning the internship experience.

5) Internship hours shall be in accordance with school work hours and shall total a minimum of 20 clock hours per week for a minimum total of 600 clock hours. Of the 600 clock hours needed, 240 must be in direct and face-to-face service to students, other school personnel regarding students, or parents.

6) The internship experience must be representative of the role and function of a professional school counselor. That is, during the internship experience, Counselor Trainees must utilize the current CACREP academic standards. It is critical that students receive a wide variety of experiences during their internship – students from the Kent State University, School Counseling master’s degree program have completed all CACREP core curriculum standards prior to the start of internship.

7) Students cannot begin accruing clock hours towards internship requirements until all agreement forms have been signed by all parties (i.e., CES faculty advisor, site/school supervisor, Master’s Practicum and Internship Coordinator, and Counselor Trainee). The forms need to be submitted in a timely fashion (according to deadlines specified in this Practicum and Internship Manual) to the Master’s Practicum and Internship Coordinator, and the internship setting and experience is determined to be appropriate by the Master’s Practicum and Internship Coordinator. The earliest that students can begin accruing internship hours is the first day of the academic semester in which he or she is enrolled for internship. Vacations and holidays shall be observed according to the University calendar, unless otherwise agreed upon by the University representative, school, and student.

8) Students who are engaged in school counseling internship-related activities and are enrolled in a school counseling internship course and are required to attend weekly internship class sessions.

9) It is important to note that School Counseling Counselor Trainees may have completed their practicum experience at the same site/school as they wish to complete their internship. However, the Counselor Trainee, the Master’s Practicum and Internship Coordinator, and the site/school supervisor must agree to do this. Any of these three parties may nullify this agreement.

Responsibilities of the University The University agrees to:

1) Assume full responsibility for the administrative duties associated with the academic requirements of the School Counseling Internship, including approval of the internship site and experience, maintaining on-going and direct communication with school representatives, ensuring that Counselor Trainees are academically ready to begin the internship experience, and grading.

2) Provide information regarding the CES School Counseling program and curriculum in order that the school may properly plan and execute assignments and supervision. Specifically included are student data, university calendar, student handbook, and this Practicum and Internship Manual.


3) Designate one CES faculty member each academic semester to serve as the Internship Instructor for the student and to communicate directly with the site/school supervisor. The Instructor will lead and facilitate weekly school internship class sessions (2.5 hours weekly) to which all Counselor Trainees are required to attend, and are available for consultation with the site/school supervisor and students throughout the duration of internship. The role of the Internship Instructor and the Master’s Practicum and Internship Coordinator will be that of a consultant; the designated site/school supervisor will assume legal responsibility for all students seen by the Counselor Trainee.

Responsibilities of the School

The School agrees to:

1) Designate one staff person as site/school supervisor with appropriate graduate degree and a school counseling license / certificate. This person must be an employee (part-time, full-time, or contracted with the school) of the School where the internship will be conducted. In addition, the school supervisor must be a professional practicing as a licensed / certified school counselor for at least two years. The designated site/school supervisor will assume legal responsibility for the welfare of all student clients seen by the Counselor Trainee.

2) Develop work assignments and tasks for the Counselor Trainee commensurate with the CES program objectives and accreditation standards (e.g., CACREP), in consultation with the Internship Instructor and Master’s Practicum and Internship Coordinator.

3) Ensure that internship hours shall be in accordance with school work hours and shall total a minimum of 20 clock hours per week for a minimum total of 600 clock hours. Of the 600 clock hours needed, 240 must be in direct and face-to-face service to students, other school personnel regarding students, or parents.

4) Provide opportunities for the Counselor Trainee to engage in the provision of services representative of basic skills needed to conduct face-to-face counseling to students.

5) Students are not to engage in off-site services (e.g., home-based counseling, transportation of students, etc.).

6) Provide the minimum face-to-face supervisory requirements of one (1) hour for every 20 hours of overall service the student provides.

7) Complete the student evaluation materials in a timely fashion.

8) Inform the University of School policies and procedures that are relevant to the experience of students.

9) Maintain close communication with the University in relation to internship activities through available means such as field supervisor meetings, correspondence with the Master’s Practicum and Internship Coordinator, on-site visits by the Internship Instructor, and telephone contacts.

10) Provide appropriate working conditions and physical arrangements for the internship, such as desk space for completing paperwork, access to a telephone, and office space in which to meet with students/clients privately. In addition, provide a clinical instruction environment that is conducive to modeling, demonstration, and training and is accessible to the counselor trainee. The clinical instruction environment includes all of the following:

settings for individual counseling with assured privacy and sufficient space for appropriate equipment (for example, TV monitoring and taping);

settings for small-group work with assured privacy and sufficient space for appropriate equipment; necessary and appropriate technologies that assist learning, such as audio, video, and telecommunications equipment;

settings with observational and/or other interactive supervision capabilities; and

Procedures that ensure that the client’s confidentiality and legal rights are protected.

11) Monitor student performance and report to the University Internship Instructor and/or Master’s Practicum and Internship Coordinator if difficulties in performance, ethics or other internship related activities arise.

12) Allow the student intern to attend weekly internship class.

Responsibilities of the Student / Counselor Trainee

1) The Counselor Trainee will be enrolled in Internship I then Internship II and will attend all classes/seminars for School Counseling Internship for the entire length of the internship experience.

2) The Counselor Trainee will complete a weekly School Counseling Internship Log and will submit the originals on a weekly basis to the Internship Instructor, and copies to the site/school supervisor.

3) The Counselor Trainee will complete duties assigned and at hours scheduled at the internship site, according to the agreement established between the student and school representative. This includes reporting directly to site/school supervisor regarding client issues during regularly scheduled supervision sessions and as needed (e.g., in response to client crisis/emergency issues).

4) Counselor Trainees will be expected to conduct themselves in a professional manner throughout the entirety of the internship experience. This means up-holding and abiding by the most current revision of the American Counseling Association's Code of Ethics and Standards of Practice and ethical codes provided by the American School Counseling Association.

5) Counselor Trainees are responsible for seeing that all paperwork related to the internship is completed in a timely fashion (i.e., according to deadlines specified in this Manual and in Internship class) and on file.

6) The student will ensure that the internship site and assigned site supervisor receive a copy of the University calendar, student handbook, and this Practicum and Internship Manual.


7) The student will ensure that the Internship Site and Master’s Practicum and Internship Coordinator receive copies of the completed School Counseling Internship

Agreement form and the Assignment of Supervisor and Qualifications of Supervisor Form by May1st if starting Fall Semester or December1st if changing Internship sites for the Spring Semester. The student will also be certain that the Mid-semester (at the completion of Internship I) and Final (at the completion of Internship II) Skill and Professional Behavior Evaluations, Assessment of the Clinical Experience, and the Internship Completion Form are properly completed and placed in the student’s internship file.

8) The student must purchase professional liability insurance and have proof of current coverage throughout the internship experience.

The signatures below indicate each person understands the Internship requirements for the School Counseling Master’s degree Program at Kent State University. The signatures also represent each person’s agreement to upholding his or her respective responsibilities outlined in this School Counseling Internship Agreement Form.

Internship I: School Counseling will begin (month/year) / and conclude (month/year) / for a total of weeks.

Internship II: School Counseling will begin (month/year) / and conclude (month/year) / for a total of weeks.

School Representative (preferably the Principal):

Printed: Signed:

Title: Date: / /

School Name & Address:

Practicum Student: Printed: Signed: Date: / /

Master’s Practicum & Internship Coordinator: Signed: Date: / /


Directions: Please type or print CLEARLY all requested information. This form is to be completed at or about the time the School Counseling Practicum Agreement Form or the School Counseling Internship Agreement Form is completed and the original submitted to the Master’s Practicum and Internship Coordinator by May1st

for Practicums or Internships beginning in the Fall semester and December 1st for Practicum and any Internship changes in the Spring semester. NOTE: This form is not to be used twice – separate Assignment of Supervisor Forms is to be used for practicum and internship (even if the Counselor Trainee maintains the same supervisor for both practicum and internship).

Name of School Counseling Counselor Trainee:

School Name:

Assigned Supervisor Contact Information (or attach business card):

Name:

Address:

Phone Number (with area code): ( )

E-Mail Address:

Current Job Title:

LICENSURE INFORMATION

Type of License State & Department Issuing Licensure License # / ID & Expiration Date

CERTIFICATION INFORMATION

Type of Certification State & Department Issuing Certification Certification # / ID & Expiration Date

EDUCATIONAL/ACADEMIC INFORMATION

Highest Degree Earned Major / Program of Study

This Assignment of Supervisor Form being used for:

Practicum: . This Practicum will extend for hours a week for weeks, totaling at least 100 clock hours of service, of which a minimum of 40 clock hours are devoted to direct, face-to-face service. Minimum face-to-face supervision hours to be provided each week =1 hour of individual supervision for every 8 work hours. The site/school supervisor will assume full and direct legal responsibility for all clients seen by the student intern.

Internship: . This Internship will extend for hours a week for weeks, totaling at least 600 clock hours of service, of which a minimum of 240 clock hours are devoted to direct, face-to-face service. Minimum face-to-face supervision hours to be provided each week =1 hour of individual supervision for every 20 work hours. The site/school supervisor will assume full and direct legal responsibility for all clients seen by the student intern.

* Please attach a brochure of the school.

Site Supervisor’s Signature: Date: / /

Printed Site Supervisor’s Name: Date: / /

Student Name: Date: / /

Master’s Practicum & Internship Coordinator’s Signature: Date: / /

Assignment of Supervisor and Qualifications of Supervisor Form


REPORTING WEEKLY PRACTICUM AND INTERN LOGS

I. Weekly Practicum Log: A copy of the School Counseling Practicum Log can be downloaded at http://www.kent.edu/ehhs/ldes/ces/documents Students are required to turn in their completed logs (with signatures) weekly to their Practicum instructor.

I. Weekly Internship Log: A copy of the School Counseling Internship Log can be downloaded at http://www.kent.edu/ehhs/ldes/ces/documents Students are required to turn in their completed logs (with signatures) weekly to their Internship instructor.

http://www.kent.edu/ehhs/ldes/ces/documents

http://www.kent.edu/ehhs/ldes/ces/documents


It is expected that open communication between the counselor trainee, the site supervision, the course instructor, and the Master’s Practicum and Internship Coordinator is maintained. In order to maintain communication, foster counselor trainee development, and maintain high standards of the School Counseling program and profession, a formal evaluation procedure has been developed. Please see the below evaluation procedures:

Practicum To be completed by the site supervisor:

Complete the Supervision Contract at the start of practicum. Use this form as needed to meet, add, or modify counselor trainee goals.

Complete the Skill Evaluation Form (both for skills and professional behavior) for practicum at mid-semester.

Complete the Skill Evaluation Form (both for skills and professional behavior) for practicum at the end of the practicum experience (e.g., at the end of the semester).

To be completed by the course instructor / supervisor:

Complete the Skill Evaluation Form (both for skills and professional behavior) for practicum at mid-semester. Complete the Skill Evaluation Form (both for skills and professional behavior) for practicum at the end of the practicum experience (e.g., at the end of the

semester).

To be completed by the student:

Complete the Assessment of Clinical Experience form.

Internship I

To be completed by the site supervisor:

Complete the Supervision Contract at the start of Internship I. Use this form as needed to meet, add, or modify counselor trainee goals.

Complete the Skill Evaluation Form (both for skills and professional behavior) for Internship I at the end of Internship I.

Internship II

To be completed by the site supervisor:

Complete the Supervision Contract at the start of Internship I. Use this form as needed to meet, add, or modify counselor trainee goals.

Complete the Skill Evaluation Form (both for skills and professional behavior) for Internship II at the end of Internship II.

To be completed by the student:

Complete the Assessment of Clinical Experience form.

Instructions for Performance Evaluations


This contract serves as verification and description of the counseling supervision provided by

(supervisor), to

(supervisee), Counselor Trainee enrolled in (course

title and # ) at Kent State University for the semester.

PURPOSE, GOALS, & OBJECTIVES

Monitor and ensure welfare of clients seen by supervisee

Promote development of supervisee’s professional counselor identity and competence

Fulfill academic requirement for supervisee’s practicum or internship

Fulfill requirements in preparation for supervisee’s pursuit of counselor licensure (when applicable)

CONTEXT OF SERVICE

One (1) clock hour of individual supervision weekly

Supervision will revolve around counseling conducted with students seen at (name of school)

Individual supervision will be conducted on (day of the week), from to (time).

The supervisor will be adhering to specific models of supervision along with using progress notes and tape review.

METHOD OF EVALUATION

Feedback will be provided by the supervisor during each session, and a formal evaluation, using the program’s standard evaluation of student client skills, will be conducted at mid-term and at the conclusion of the semester. A narrative evaluation may also be provided at mid-semester and at the conclusion of the semester as an addendum to the objective evaluations completed.

Specific feedback provided by supervisor will focus on supervisee’s demonstrated counseling skills, professional behavior, and documentation. Supervisee will evaluate supervisor at mid-semester and at the close of the semester, using the program’s standard evaluation form for

evaluating supervisors. A narrative evaluation may also accompany the objective evaluations.

DUTIES AND RESPONSIBILITIES OF SUPERVISOR

Examine students presenting complaints and intervention methods

View tapes of supervisee’s counseling sessions outside of regularly scheduled supervision sessions

Sign off on all student documentation

Challenge supervisee to justify approach and techniques used

Monitor supervisee’s basic attending skills

Support supervisee’s development as counselor

Present and model appropriate directives Intervene when student welfare is at risk

Ensure that ethical guidelines are upheld

Maintain weekly supervision case notes

DUTIES AND RESPONSIBILITIES OF SUPERVISEE

Uphold ethical guidelines

Review counseling session tapes in preparation for weekly supervision

Be prepared to discuss all student cases; have student files, current and completed student case notes, and counseling session tapes ready to review in weekly supervision sessions

Justify case conceptualizations made and approach and techniques used

Complete case notes and place in appropriate student files

Consult with field placement staff and supervisor in case of emergency

Implement supervisory directives in subsequent sessions

Supervision Contract


SUPERVISOR’S SCOPE OF COMPETENCE (IF APPLICABLE)

PROCEDURAL CONSIDERATIONS

Supervisee’s written case notes, treatment plans, and videotapes will be reviewed and evaluated in each session

Issues related to supervisee’s professional development willbe discussed Sessions will be used to discuss issues of conflict and failure of either party to abide by directives outlined here in contract. If concerns of either party are

not resolved in supervision, the practicum instructor and/or Dr. Lynne Guillot-Miller will be consulted.

In the event of emergency, supervisee is to contactsupervisor at

SPECIFIC GOALS FOR THE SUPERVISEE

1)

1)

2)

3)

4)

5)

We agree, to the best of our ability, to uphold the directives specified in this supervision contact and to conduct our professional behavior according to the ethical principles of our professional association.

Supervisee: Date:

Supervisor: Date:

Verification of Submission of Federal/State Background Checks

My signature serves as verification that the above named student (supervisee) has submitted a copy of their Federal/State Background Checks to our school.

Signature of School Administrator (Principal, Vice-Principal, etc.)


Skill Evaluation Form: School Counseling Practicum

Student Name: Banner ID:

Person Completing Evaluation: Title:

Instructions:

Clearly write your score in the far right column titled “Score”. Place and “X” in the “Score” column if the standard was not observed. When this form is completed, turn it into the CES course instructor for data entry. Course instructor will turn in form to the CES Administrative Assistant at

the end of the semester.

Items scored as 3 and 4 are considered acceptable. It is not expected that students receive a score of “5” on any of the items in this evaluation because they are considered to be beyond what is expected at this point in their development. If any items are scored as 1 or 2, the instructor should discuss specific concerns with the student and ways the student can improve.

Standard 1 2 3 4 5 Score

1.D. Self-care strategies appropriate to the counselor role

The student cannot verbalize a need for self-care

The student cannot verbalize strategies for self- care

The student can verbalize self-care strategies but does not or cannot implement the strategies

The student integrates self-care strategies but not continually

The student continually integrates and adapts new self-care strategies

5.B. Counselor characteristics and behaviors that influence helping processes

5.b.1. Empathy

The verbal and behavioral expression by the student does not attend to and detract significantly from the client

When the student responds they do so in such a way that it subtracts noticeable affect from the communications of the client

The expressions of the student are essentially interchangeable with those of the client in that they express the same affect and meaning

The responses of the student add noticeably to the client in such a way to express feeling levels deeper then those expressed by the client

The student’s responses add significantly to the feeling and meaning of the client expression and when the client is in ongoing deep self- exploration, the student remains immediate to that experience

5.b.2. Unconditional Positive Regard

Does not show ANY ability to suspend judgmental thinking, value clients as individuals, and think positively about them

Shows one of three of the following qualities; suspend judgmental thinking, value clients as individuals, and think positively about them

Shows two of three of the following qualities; suspend judgmental thinking, value clients as individuals, and think positively about them

Shows three of the following qualities (but not consistently across clients); suspend judgmental thinking, value clients as individuals, and think positively about them

Student is ABLE to show consistently across clients the ability to suspend judgmental thinking, value clients as individuals, and think positively about them

5.b.3. Congruence

Is incongruent among, self, thoughts, and actions

Is aware of incongruence among self, thoughts, and actions

Begins to take action in client sessions to be more congruent in their experience of the client

Takes regular action in client sessions to be more congruent in their experience of the client

Demonstrates consistent congruence among self, thoughts, and actions

5.C. Essential interviewing and counseling skills

5.c.1. Establishing Relationships

Shows no pattern for establishing a counseling relationship

Starts counseling relationship with introduction but w/o structured ethical introduction (professional disclosure, fees, cancellation, orientation, confidentiality, informed consent, questions)

Starts counseling relationship with introduction but misses many components of a structured ethical introduction (professional disclosure, fees, cancellation, orientation, confidentiality, informed consent, questions)

Starts counseling relationship with introduction but misses a few components of a structured ethical introduction (professional disclosure, fees, cancellation, orientation, confidentiality, informed consent, questions)

Demonstrates a complete process of establishing a counseling relationship with a complete ethical introduction (professional disclosure, fees, cancellation, orientation, confidentiality, informed consent, questions)



5.c.2. Attending Does not practice attending behavior

Shows some inaccurate and inconsistent attending behaviors; visual contact, verbal tracking, vocal qualities, body language

Attending behavior is accurate but inconsistent; visual contact, verbal tracking, vocal qualities, body language

Attending behavior is mostly consistent and accurate; visual contact, verbal tracking, vocal qualities, body language

Attending behavior is accurate and complete

5.c.3. Questions Asks few questions or the questions do not appear to follow any logical pattern; does not verbally track client

Uses unintentional pattern of questions and does not follow logical pattern of client verbal tracking

Selects open and closed ended questions appropriately; does not follow client verbal tracking

Selects open and closed ended questions appropriately and mostly tracks client

Include questions appropriately; using closed and open ended questions and closely follows verbal tracking

5.c.4. Observation Skills

Makes no use of observation skills

Demonstrates some observational skills but does not show immediacy in response to the client

Uses observation skills but rarely uses immediacy in presenting them to the client

Uses appropriate observation skills with occasional immediacy

Uses appropriate observation skills and is able to show immediacy with them when working with a client

5.c.5. Encouraging Makes no use of encouraging skills

Rarely uses encouraging comments to client

Uses primarily non- verbal or minimal encouragers with client

Uses a range of encouragers (head nods, uh-huh, keywords, and short statements with client)

Intentionally uses a range of appropriate/timely encouraging skills with a client

5.c.6. Paraphrasing

Paraphrases w/o intentionally using any of the four dimensions; sentence stem, keywords, essence, and check- out

Paraphrases and misses key points in client verbal tracking and components of the four dimensions

Paraphrases getting key verbal tracking but missing check-out and use of key words

Paraphrases w/ check- out but lacks full breath of the client story

Paraphrases using sentence stem, keywords, essence, and check-out

5.c.7. Summarizing

Summarizes w/o intentionally using any of the four dimensions; sentence stem, keywords, essence, and check- out

Summarizes and misses key points in client verbal tracking and components of the four dimensions

Summarizes getting key verbal tracking but missing check-out and use of key words

Summarizes w/ check- out but lacks full breath of the client story

Summarizes using sentence stem, keywords, essence, and check-out

5.c.8. Ending a Session

Makes no use of skills to end a session

Summarizes end of session; there is little process other than to explain parts of what happened in the session; student assigns homework w/o client involvement

Summarizes end of session; includes check- out with client. student may or may not assign homework but w/o client involvement

Summarizes w/ checkout, may miss one of the following components; client strengths and continuity plan for next session. May or may not assign homework and does so with client involvement

Does complete summary, check- out, strengths, and continuity plan with client as part of summary

5.c.9. Reflection of Feelings

Does not reflect feelings

Attempts to reflect feelings but does so inaccurately

Reflects feelings inconsistently with varying levels of appropriateness

Consistently reflects feelings appropriately

Consistently reflects feelings appropriately and integrates it into

B.1. Demonstrates the ability to apply and adhere to ethical and legal standards in school counseling.

B.1.a. Confidentiality

Inappropriately reveals private information to select others

Always maintains appropriate confidentiality

B.1.b. Boundaries Has serious boundary problems with students

Has minor boundary problems with students

Has no boundary problems with students


Standard 1 2 3 4 5 Score B.1.c. Record Keeping

Appropriate records are not kept

Records are kept infrequently, inaccurately and sloppily

Records are kept well except for lapses in two areas (e.g., timely and neatly)

Records are kept well except for lapses in one area (e.g., timely and neatly)

Records are kept accurately and neatly at all times.

B.1.d. Areas of Competence

Consistently counsels students outside many areas of expected developmental level

Often counsels students outside many areas of expected developmental level

Sometimes counsels students outside a few areas of expected developmental level

Rarely counsels students outside any areas of expected developmental level

Never counsels students outside any areas of expected developmental level

B.1.e. Counseling Minors

Always disregards student development and fails to inform care givers appropriately

Often disregards student development and fails to inform care givers appropriately

Sometimes disregards student development or fails to inform care givers appropriately

Rarely disregards student development or fails to inform care givers appropriately

Never disregards student development or fails to inform care givers appropriately

B.1.f. Testing & Evaluation

Does not use nor understand testing & evaluation

Rarely uses or often misuses testing and evaluation instruments

Sometimes uses or sometimes misuses testing and evaluation instruments

Usually uses testing and evaluation instruments appropriately

Always uses testing and evaluation instruments appropriately

B.2. Demonstrates the ability to articulate, model, and advocate for an appropriate school counselor identity and program.

B.2.a. Counselor identity

Does not articulate demonstrate an understanding of school counseling demeanor

Articulates and demonstrates a minimal understanding of school counseling demeanor

Can often articulate and demonstrate a professional-identity as a school counselor

Often presents to other school professionals as a professional SC

Always presents to other school professionals as a professional SC

B.2.b. SC model Is unaware of school counseling program models

Is aware of models but is unable to perform/design any parts of a program

Is aware of models and is able to perform/design some of the parts of a program

Is aware of models and is able to perform/design most of the parts of a program

Is aware of models and is able to perform/design all of the parts of a program

B.2.c. SC Advocacy Never talks to anybody about the benefits of school counseling programs

Talks to a select few people about the benefits of school counseling programs

Talks to a select group of people about the benefits of school counseling programs

Talks to many groups of people about the benefits of school counseling programs

Talks to all groups of people about the benefits of school counseling programs

D.1. Demonstrates self-awareness, sensitivity to others, and the skills needed to relate to diverse individuals, groups, and classrooms.

D.1.a. Diversity awareness w/individuals

Shows disrespect for individuals with differences

Shows some respect for, but is reluctant to work with students with differences

Shows some respect for, and is willing to work with students with differences

Shows great respect for, and is willing to work with students with differences

Shows great respect for, and eagerly works with students with differences

D.1.b. Diversity awareness w/groups

Shows disrespect for groups with differences

Shows some respect for, but is reluctant to work with groups of students with differences

Shows some respect for, and is willing to work with groups of students with differences

Shows great respect for, and is willing to work with groups of students with differences

Shows great respect for, and eagerly works with groups of students with differences



D.2. Provides individual and group counseling and classroom guidance to promote the academic, career, and personal/social development of students.

D.2.a. Career Does not address career counseling issues

Has minimal skills and rarely addresses career issues

Has moderate skills and sometimes addresses career issues

Has good skills and addresses career issues

Has excellent skills and addresses career issues

D.2.b. Academic Does not address academic issues

Has minimal skills and rarely addresses academic issues

Has moderate skills and sometimes addresses academic issues

Has good skills and addresses academic issues

Has excellent skills and addresses academic issues

D.2.c. Does not address Has minimal skills Has moderate skills and Has good skills and Has excellent skills and Personal/Social personal/social and rarely sometimes addresses addresses addresses Development development addresses personal/social personal/social personal/social

issues personal/social development issues development issues development issues

development issues

D.4. Demonstrates Does not Recognizes signs Assesses or manages Provides a thorough / Provides a thorough / the ability to use recognize signs of of suicide but suicide risk in a basic or comprehensive comprehensive procedures for suicide does not or does shallow manner, assessment of suicide assessment of suicide assessing and not adequately risk; comprehensively risk; comprehensively managing suicide assess or manage manages suicide risk manages suicide risk risk. risk with short and long with short and long

term goals for term goals for

treatment – though is treatment

apprehensive and/or needs great amounts of supervision

D.5. Demonstrates the ability to recognize his or her limitations as a school counselor and to seek supervision or refer clients when appropriate.

D.5.a. Recognizes Sees no Sees limitations Sees only obvious Sees most limitations Sees all limitations and personal limitations limitations of only after limitations without and acts appropriately acts appropriately

themselves supervisor points supervision them out

D.5.b. Seeks Avoids supervision Comes to Comes to supervision Comes to supervision Comes to supervision supervision when supervision willingly but unprepared willingly and prepared eagerly and prepared appropriate unprepared and

only after prompting

D.5.c. Refers when Never make Does not Usually recognizes the Usually recognizes the Always recognizes the appropriate & H.4. referrals recognize when need for referrals and need for referrals and need for referrals and Makes appropriate referrals are makes them after makes them makes them referrals to school needed, but prompting independently independently and/or community makes them after resources. prompting N.1. Works with parents, guardians, and families to act

Does not participate in this activity

Reluctantly works with P/G but only after prompting

Willing works with P/G but only after prompting

Willing works with P/G Eagerly works with P/G

on behalf of their children to address problems that affect student success in school.



N.1. Works with parents, guardians, and families to act on behalf of their children to address problems that affect student success in school.




Willing works with P/G Eagerly works with P/G

CES 1. Ability to structure a session intentionally

Never Rarely Sometimes Often Always

CES 2. Integrates multiple micro-skills fluidly


For Supervisors completing evaluation on practicum students (Check One):

Based on the above standards, this student has met the skills requirement for a practicum student. Based on the above standards, this student has not met the skills requirement for a practicum student.

Student Signature: Date:

Evaluator’s Signature: Date:

NOTE: As an addition to this evaluation, supervisors may include a written summary, list of recommendations, etc. and attach it to this form.




Instructions: Please place a check in the appropriate box. When this form is completed, turn it into the CES course instructor for data entry. The course instructor will turn in the form to the CES Administrative Assistant at

the end of the semester.

Professional behavior is expected of all CES students during class, at their site, and while working with other students on class assignments. If a student’s professional behavior is deemed as questionable, programmatic remediation may need to occur. If any item is marked as 1-3, please inform the CES Master’s Programs Coordinator and remediation will be determined. In Section B, if any of the Professional Behaviors are not “always” done (meaning NEVER not done), please inform the CES Master’s Programs Coordinator (and remediation will be determined. However, there are multiple levels of severity of professional behavior and remediation could occur even if there was only one correction.

All scores contribute to the overall grade in this course.

Section A: Professional Behavior

Never Occurs After Multiple Corrections

Occurs After Multiple

Corrections

Occurs After Few

Corrections

Occurs After One

Correction

Always occurs

Not Applicable

1 2 3 4 5 X

Dresses Appropriately Is on time for appointments Is on time to site Interacts with colleagues in a professional manner Interacts with office staff in a professional manner Has professional demeanor on telephone with clients/parents Completes record keeping in a timely manner Treats clients with respect in waiting areas Comes to site on agreed dates and times Calls to report inability to come to site in a timely and professional manner Comes prepared for supervision Assists colleagues when appropriate and needed Follows site guidelines / policies Accepts feedback Comes prepared for client sessions Takes initiative on projects when appropriate Has proper personal hygiene

Section B: Professional Behavior Serious Concern Always

Discusses client cases only in appropriate settings Maintains client confidentiality through proper record handling Is respectful of all clients regardless of any differences Complies with supervisor directions Seeks supervision when needed

For Site Supervisors completing evaluation on practicum students (Check One):

Based on the above standards, this student has met the skills requirement for a practicum student. Based on the above standards, this student has not met the skills requirement for a practicum student.



Content in this evaluation taken from Ivey & Ivey (2008); Carkhuff, (1972); and Stoltenberg, McNeill, & Delworth (1998).


Skill Evaluation Form: School Counseling Practicum Professional Behavior Form


Student Name: _________________________________________________________________________________ _Banner ID: ________________ ______


Instructions:

Clearly write your score in the far right column titled “Score”. Place and “X” in the “Score” column if the standard was not observed. When this form is completed, turn it into the CES course instructor for data entry. Course instructor will turn in form to the CES Administrative Assistant at the

end of the semester.

Items scored as 4 - 5 are considered acceptable. If any items are scored as 1 or 2, the instructor should discuss specific concerns with the student and ways the student can improve.


1.D. Self-care strategies appropriate to the counselor role

The student cannot verbalize a need for self-care

The student cannot verbalize strategies for self- care

The student can verbalize self-care strategies but does not or cannot implement the strategies

The student integrates self- care strategies but not continually

The student continually integrates and adapts new self-care strategies

5.B. Counselor characteristics and behaviors that influence helping processes

5.b.1. Empathy The verbal and behavioral expression by the student does not attend to and detract significantly from the client

When the student responds they do so in such a way that it subtracts noticeable affect from the communications of the client

The expressions of the student are essentially interchangeable with those of the client in that they express the same affect and meaning

The responses of the student add noticeably to the client in such a way to express feeling levels deeper then those expressed by the client

The student’s responses add significantly to the feeling and meaning of the client expression and when the client is in ongoing deep self- exploration, the student remains immediate to that experience

5.b.2. Unconditional Positive Regard

Does not show ANY ability to suspend judgmental thinking, value clients as individuals, and think positively about them

Shows one of three of the following qualities; suspend judgmental thinking, value clients as individuals, and think positively about them

Shows two of three of the following qualities; suspend judgmental thinking, value clients as individuals, and think positively about them

Shows three of the following qualities (but not consistently across clients); suspend judgmental thinking, value clients as individuals, and think positively about them

Student is ABLE to show consistently across clients the ability to suspend judgmental thinking, value clients as individuals, and think positively about them

5.b.3. Congruence Is incongruent among, self, thoughts, and actions

Is aware of incongruence among self, thoughts, and actions

Begins to take action in client sessions to be more congruent in their experience of the client

Takes regular action in client sessions to be more congruent in their experience of the client

Demonstrates consistent congruence among self, thoughts, and actions

5.C. Essential interviewing and counseling skills

5.c.1. Establishing Relationships

Shows no pattern for establishing a counseling relationship

Starts counseling relationship with introduction but w/o structured ethical introduction (professional disclosure, cancellation, orientation, confidentiality, informed consent, questions)

Starts counseling relationship with introduction but misses many components of a structured ethical introduction (professional disclosure, cancellation, orientation, confidentiality, informed consent, questions)

Starts counseling relationship with introduction but misses a few components of a structured ethical introduction (professional disclosure, cancellation, orientation, confidentiality, informed consent, questions)

Demonstrates a complete process of establishing a counseling relationship with a complete ethical introduction (professional disclosure, cancellation, orientation, confidentiality, informed consent, questions)

Skill Evaluation Form: School Counseling Internship I and II



5.c.2. Attending Does not practice Shows some Attending behavior is Attending behavior is Attending behavior is attending behavior inaccurate and accurate but mostly consistent accurate and complete

inconsistent inconsistent; visual and accurate; visual attending behaviors; contact, verbal contact, verbal visual contact, verbal tracking, vocal tracking, vocal tracking, vocal qualities, body qualities, body qualities, body language language language

5.c.3. Questions Asks few questions or the Uses unintentional Selects open and Selects open and Include questions questions do not appear to pattern of questions closed ended closed ended appropriately; using follow any logical pattern; and does not follow questions questions closed and open does not verbally track logical pattern of appropriately; does appropriately and ended questions and client client verbal tracking not follow client mostly tracks client closely follows verbal

verbal tracking tracking 5.c.4. Observation Makes no use of Demonstrates some Uses observation Uses appropriate Uses appropriate Skills observation skills observational skills skills but rarely uses observation skills observation skills and

but does not show immediacy in with occasional is able to show

immediacy in presenting them to immediacy immediacy with them

response to the the client when working with a

client client 5.c.5. Encouraging Makes no use of Rarely uses Uses primarily non- Uses a range of Intentionally uses a

encouraging skills encouraging verbal or minimal encouragers (head range of

comments to client encouragers with nods, uh-huh, appropriate/timely

client keywords, and short encouraging skills with

statements with a client

client) 5.c.6. Paraphrasing Paraphrases w/o

intentionally using any of Paraphrases and misses key points in

Paraphrases getting key verbal tracking

Paraphrases w/ check-out but

Paraphrases using sentence stem,

the four dimensions; client verbal tracking but missing check- lacks full breath of keywords, essence, sentence stem, keywords, and components of out and use of key the client story and check-out essence, and check-out the four dimensions words

5.c.7. Summarizing Summarizes w/o Summarizes and Summarizes getting Summarizes w/ Summarizes using intentionally using any of misses key points in key verbal tracking check-out but sentence stem, the four dimensions; client verbal tracking but missing check- lacks full breath of keywords, essence, sentence stem, keywords, and components of out and use of key the client story and check-out essence, and check-out the four dimensions words

5.c.8. Ending a Makes no use of skills to Summarizes end of Summarizes end of Summarizes w/ Does complete Session end a session session; there is little session; includes checkout, may miss summary, check-out,

process other than to check-out with client. one of the following strengths, and

explain parts of what student may or may components; client continuity plan with

happened in the not assign homework strengths and client as part of

session; student but w/o client continuity plan for summary

assigns homework involvement next session. May or w/o client may not assign involvement homework and does so with client involvement

5.c.9. Reflection of Does not reflect feelings Attempts to reflect Reflects feelings Consistently reflects Consistently reflects Feelings feelings but does so inconsistently with feelings feelings appropriately

inaccurately varying levels of appropriately and integrates it into

appropriateness case conceptualization



B.1. Demonstrates the ability to apply and adhere to ethical and legal standards in school counseling.

B.1.a. Confidentiality Inappropriately reveals private information to select others

Always maintains appropriate confidentiality

B.1.b. Boundaries Has serious boundary problems with students

Has minor boundary problems with students

Has no boundary problems with students

B.1.c. Record Keeping Appropriate records are not kept

Records are kept infrequently, inaccurately and sloppily

Records are kept well except for lapses in two areas (e.g., timely and neatly)

Records are kept well except for lapses in one area (e.g., timely and neatly)

Records are kept accurately and neatly at all times.

B.1.d. Areas of Competence

Consistently counsels students outside many areas of expected developmental level

Often counsels students outside many areas of expected developmental level

Sometimes counsels students outside a few areas of expected developmental level

Rarely counsels students outside any areas of expected developmental level

Never counsels students outside any areas of expected developmental level

B.1.e. Counseling Minors

Always disregards student development and fails to inform care givers appropriately

Often disregards student development and fails to inform care givers appropriately

Sometimes disregards student development or fails to inform care givers appropriately

Rarely disregards student development or fails to inform care givers appropriately

Never disregards student development or fails to inform care givers appropriately

B.1.f. Testing & Evaluation

Does not use nor understand testing & evaluation

Rarely uses or often misuses testing and evaluation instruments

Sometimes uses or sometimes misuses testing and evaluation instruments

Usually uses testing and evaluation instruments appropriately

Always uses testing and evaluation instruments appropriately

B.2. Demonstrates the ability to articulate, model, and advocate for an appropriate school counselor identity and program.

B.2.a. Counselor identity

Does not articulate demonstrate an understanding of school counseling demeanor

Articulates and demonstrates a minimal understanding of school counseling demeanor

Can often articulate and demonstrate a professional-identity as a school counselor

Often presents to other school professionals as a professional SC

Always presents to other school professionals as a professional SC

B.2.b. SC model Is unaware of school counseling program models

Is aware of models but is unable to perform/design any parts of a program

Is aware of models and is able to perform/design some of the parts of a program

Is aware of models and is able to perform/design most of the parts of a program

Is aware of models and is able to perform/design all of the parts of a program

B.2.c. SC Advocacy

Never talks to anybody about the benefits of school counseling programs

Talks to a select few people about the benefits of school counseling programs

Talks to a select group of people about the benefits of school counseling programs

Talks to many groups of people about the benefits of school counseling programs

Talks to all groups of people about the benefits of school counseling programs



D.1. Demonstrates self- awareness, sensitivity to others, and the skills needed to relate to diverse individuals, groups, and classrooms.

D.1.a. Diversity awareness w/individuals

Shows disrespect for individuals with differences

Shows some respect for, but is reluctant to work with students with differences

Shows some respect for, and is willing to work with students with differences

Shows great respect for, and is willing to work with students with differences

Shows great respect for, and eagerly works with students with differences

D.1.b. Diversity awareness w/groups

Shows disrespect for groups with differences

Shows some respect for, but is reluctant to work with groups of students with

Shows some respect for, and is willing to work with groups of students with

Shows great respect for, and is willing to work with groups of students with

Shows great respect for, and eagerly works with groups of students with differences

D.2. Provides individual and group counseling and classroom guidance to promote the academic, career, and personal/social development of students.

D.2.a. Career Does not address career counseling issues

Has minimal skills and rarely addresses career

Has moderate skills and sometimes addresses career

Has good skills and addresses career issues

Has excellent skills and addresses career issues

D.2.b. Academic Does not address academic issues

Has minimal skills and rarely addresses academic

Has moderate skills and sometimes addresses academic

Has good skills and addresses academic issues

Has excellent skills and addresses academic issues

D.2.c. Personal/Social Development

Does not address personal/social development issues

Has minimal skills and rarely addresses personal/social

Has moderate skills and sometimes addresses personal/social

Has good skills and addresses personal/social development

Has excellent skills and addresses personal/social development issues

D.3. Designs and implements prevention and intervention plans related to the effects of

(a) atypical growth and development, (b) health and wellness, (c) language, (d) ability level, (e) multicultural issues, and (f) factors of resiliency on student learning and development.

D.3.a. Designs & Implements intervention plans for atypical growth/dev

Does not address atypical growth and development

Has minimal skills and rarely addresses atypical growth and

Has moderate skills and sometimes addresses atypical growth and

Has good skills and addresses atypical growth and development

Has excellent skills and addresses atypical growth and development

D.3.b. Designs & Implements intervention plans for health/wellness

Does not address health and wellness

Has minimal skills and rarely addresses health

Has moderate skills and sometimes addresses health and

Has good skills and addresses health and

Has excellent skills and addresses health and wellness

D.3.c. Designs & Implements intervention plans for language

Does not address language issues

Has minimal skills and rarely addresses language

Has moderate skills and sometimes addresses language

Has good skills and addresses language issues

Has excellent skills and addresses language issues

D.3.d. Designs & Implements intervention plans for ability level

Does not address ability level of students

Has minimal skills and rarely addresses ability level of students

Has moderate skills and sometimes addresses ability level of students

Has good skills and addresses ability level of students

Has excellent skills and addresses ability level of students

D.3.e. Designs & Implements intervention plans for multicultural issues

Does not address multicultural issues

Has minimal skills and rarely addresses multicultural issues

Has moderate skills and sometimes addresses multicultural issues

Has good skills and addresses multicultural issues

Has excellent skills and addresses multicultural issues



D.3.f. Designs & Implements intervention plans for resiliency

Does not address resiliency issues

Has minimal skills and rarely addresses resiliency issues

Has moderate skills and sometimes addresses resiliency issues

Has good skills and addresses resiliency issues

Has excellent skills and addresses resiliency issues

D.4. Demonstrates the ability to use procedures for assessing and managing suicide risk.

Does not recognize signs of suicide

Recognizes signs of suicide but does not or does not adequately assess or manage risk

Assesses or manages suicide risk in a basic or shallow manner,

Provides a thorough / comprehensive assessment of suicide risk; comprehensively manages suicide risk with short and long term goals for treatment – though is apprehensive and/or needs great amounts of supervision

Provides a thorough / comprehensive assessment of suicide risk; comprehensively manages suicide risk with short and long term goals for treatment

D.5. Demonstrates the ability to recognize his or her limitations as a school counselor and to seek supervision or refer clients when appropriate.

D.5.a. Recognizes personal limitations

Sees no limitations of themselves

Sees limitations only after supervisor points them out

Sees only obvious limitations without supervision

Sees most limitations and acts appropriately

Sees all limitations and acts appropriately

D.5.b. Seeks supervision when appropriate

Avoids supervision

Comes to supervision unprepared and only after prompting

Comes to supervision willingly but unprepared

Comes to supervision willingly and prepared

Comes to supervision eagerly and prepared

D.5.c. Refers when appropriate & H.4. Makes appropriate referrals to school and/or community resources.

Never make referrals

Does not recognize when referrals are needed, but makes them after prompting

Usually recognizes the need for referrals and makes them after prompting

Usually recognizes the need for referrals and makes them independently

Always recognizes the need for referrals and makes them independently

H.3. Analyzes assessment information in a manner that produces valid inferences when evaluating the needs of individual students and assessing the effectiveness of educational programs.


Looks at test scores but does not understand them

Looks at test scores and interprets them accurately with several corrections

Accurately interprets test scores with minimal corrections

Accurately interprets test scores independently

H.5. Assesses barriers that impede students’ academic, career, and personal/social development.

H.5.a. Assesses barriers to Academic progress

Does not recognize barriers

Recognizes barriers, but does not assess

Recognizes barriers and can assess with extensive assistance

Recognizes barriers and can assess with minimal assistance

Recognizes barriers and can assess independently

H.5.b. Assesses barriers to Career progress






H.5.c. Assesses barriers to Personal/Social progress






J.1. Applies relevant research findings to inform the practice of

Does not participat e in this

Looks at research but does not understand them

Looks at research and develops programs with extensive assistance

Uses research to develop programs with minimal

Uses research to develop programs independently



N.1. Works with parents, guardians, and families to act on behalf of their children to address problems that affect student success in school.




Willing works with P/G independently

Eagerly works with P/G independently

N.3. Consults with teachers, staff, and community-based organizations to promote student academic, career, and personal/social development.


Reluctantly works with F/S but only after prompting

Willingly works with F/S but only after prompting

Willingly works with F/S independently

Eagerly works with F/S independently

N.4. Uses peer helping strategies in the school counseling program.


Reluctantly works with peer programs but only after prompting

Willing works with peer programs but only after prompting

Willing works with peer programs independently

Eagerly works with peer programs independently

N.5. Uses referral procedures with helping agents in the community (e.g., mental health centers, businesses, service groups) to secure assistance for students and their families.


Reluctantly works with community but only after prompting

Willing works with community but only after prompting

Willing works with community independently

Eagerly works with community independently

P.2. Plans and presents school-counseling-related educational programs for use with parents and teachers (e.g., parent education programs, materials used in classroom guidance and advisor/advisee programs for teachers).


Reluctantly presents but only after prompting

Willing presents but only after prompting

Willing presents independently

Eagerly presents independently

CES 1. Ability to structure a session intentionally


CES 2. Integrates multiple micro-skills fluidly


For Site Supervisors completing evaluation on Internship I students (Check One):

Based on the above standards, this student has met the skills requirement for an Internship I student. Based on the above standards, this student has not met the skills requirement for an Internship I student.

For Site Supervisors completing evaluation on Internship II students (Check One):

Based on the above standards, this student has met the skills requirement for an Internship II student. Based on the above standards, this student has not met the skills requirement for an Internship II student.







Instructions:

This form is to be completed at the end of Internship I and Internship II. When this form is completed, turn it into the CES course instructor for data entry. The course instructor will turn in the form to the CES Administrative

Assistant at the end of the semester.

Please place a check in the appropriate box. Professional behavior is expected of all CES students during class, while working at their site, and while working with other students on class assignments.

If a students professional behavior is deemed as questionable, programmatic remediation may need to occur. If any item is marked as 1-3, please inform the CES Master’s Programs Coordinator and remediation will be determined. In Section B, if any of the Professional Behaviors are not “always” done (meaning NEVER not done), please inform the CES Master’s Programs Coordinator and remediation will be determined. However, there are multiple levels of severity of professional behavior and remediation could occur even if there was only once correction.

All scores contribute to the overall grade in this course.

Section A: Professional Behavior Never Occurs After Multiple Corrections

Occurs After Multiple

Corrections

Occurs After Few

Corrections

Occurs After One Correction

Always occurs

Not Applicable

1 2 3 4 5 X

Dresses Appropriately Is on time for appointments Is on time to site Interacts with colleagues in a professional manner Interacts with office staff in a professional manner Has professional demeanor on telephone with clients/parents

Completes record keeping in a timely manner Treats clients with respect in waiting areas Comes to site on agreed dates and times Calls to report inability to come to site in a timely and professional manner

Comes prepared for supervision Assists colleagues when appropriate and needed Follows site guidelines / policies Accepts feedback Comes prepared for client sessions Takes initiative on projects when appropriate Has proper personal hygiene

Section B: Professional Behavior Serious Concern Always

Discusses client cases only in appropriate settings Maintains client confidentiality through proper record handling Is respectful of all clients regardless of any differences Complies with supervisor directions Seeks supervision when needed

For Site Supervisors completing evaluation on Internship I students (Check One):

Based on the above standards, this student has met the skills requirement for an Internship I student. Based on the above standards, this student has not met the skills requirement for an Internship I student.

For Site Supervisors completing evaluation on Internship II students (Check One):

Based on the above standards, this student has met the skills requirement for an Internship II student. Based on the above standards, this student has not met the skills requirement for an Internship II student.

Student Signature: Date: Evaluator’s Signature: Date:

Content in this evaluation taken from Ivey & Ivey (2008); Carkhuff, (1972); and Stoltenberg, McNeill, & Delworth (1998).

Skill Evaluation Form: School Counseling Internship Professional Behavior


Name of Student: Date: / /

Name of On-Site Supervisor: Total Number of Hours:

School Name: This Assessment is in Regards to: Practicum OR Internship

This evaluation is for the purpose of providing feedback to the school supervisor, the school, and the University regarding student perceptions of the clinical experience. This instrument is designed as a guide to facilitate the sharing of the most significant perceptions and impressions which occur throughout each clinical experience. As a Counselor Trainee and a beginning professional, you are urged to complete this instrument completely and honestly. You should already have begun this kind of critical sharing with your field supervisor, others in the School, and your faculty practicum or internship instructors. Your response can aid your own professional development, and your assessment will significantly help the School and the University be more responsive to student needs.

NOTE: The form titled “Counselor Trainee’s Assessment of the Clinical Experience” is used for both the school counseling practicum and the school counseling internship. 1. Complete the rating form as follows:

X - It is not possible to assess this item. 1 - Extremely dissatisfied: Desired behavior or condition was seldom present. 2 - Somewhat dissatisfied: Desired behavior or condition was often absent.

3 - Somewhat satisfied: Desired behavior or condition was sometimes absent. 4 - Moderate satisfaction: Desired behavior or condition was frequently present. 5 - Indicates complete satisfaction or an extremely positive response with the item. Where behavior is referred to, the behavior was always present when

appropriate.

2. Provide written comments regarding those items for which you have a special concern.

I. The Clinical Experience Process

1

Was there sufficient information about this clinical experience prior to actually starting the experience?

X 1 2 3 4 5

Comment:

2

Did you feel the kind of setting provided was appropriate to your needs and interests?

X 1 2 3 4 5

Comment:

3

Was orientation at the school sufficient when the course you are in now (practicum or internship) began?

X 1 2 3 4 5

Comment:

4

Overall, did the faculty instructor meet his/her responsibilities for this clinical experience?

X 1 2 3 4 5

Comment:

5

During this clinical experience process, did you feel that you were treated as an individual with respect for your own special circumstances?

X 1 2 3 4 5

Comment:

6

Was the school adequately prepared for your arrival? X 1 2 3 4 5

Comment:

Assessment of Clinical Experience


II. The School Setting

1

Was interaction with other counselors and related disciplines sufficient? X 1 2 3 4 5

Comment:

2

Did the school provide you with agreed upon working conditions? X 1 2 3 4 5 Comment:

3

Overall, did you feel the school attached sufficient importance to your clinical experience?

X 1 2 3 4 5

Comment:

III. Professional Development

1

Did the experience acquaint you with the operation of a school counseling program? X 1 2 3 4 5

Comment:

2

Did this clinical experience improve your capacity to work with people in a helping relationship?

X 1 2 3 4 5

Comment:

3

Did this clinical experience acquaint you with resources available in the school? X 1 2 3 4 5

Comment:

4

Did this clinical experience significantly increase your knowledge of the role and functions of school counselors?

X 1 2 3 4 5

Comment:

5

Did this clinical experience significantly increase your knowledge of the specific problems in the school, e.g., poverty, substance abuse, mental health issues, anger management, child abuse, and so on?

X

1

2

3

4

5

Comment:

6

Rate your general level of satisfaction with the amount and kind of counseling activity you were assigned?

X 1 2 3 4 5

Comment:

7

Was there a sufficient diversity of learning activities? X 1 2 3 4 5

Comment:

8

Were there opportunities to be part of the larger school such as attending staff meetings, in-•service training, and so on?

X 1 2 3 4 5

Comment:


9

Did this school experience help you understand and use professional record keeping procedures?

X 1 2 3 4 5

Comment:

IV. Direct Supervision

1

Did your supervisor stimulate professional counselor identity? X 1 2 3 4 5

Comment:

2

Did your supervisor help you feel accepted and respected as a person? X 1 2 3 4 5

Comment:

3

Did your supervisor help in demonstrating professional relationships with staff members at the site?

X 1 2 3 4 5

Comment:

4

Did your supervisor meet with you for supervision at established times and for the agreed upon time?

X 1 2 3 4 5

Comment:

5

Did your supervisor assist in conceptualizing your clients? X 1 2 3 4 5

Comment:

6

Did your supervisor help clarify objectives for your counseling sessions? X 1 2 3 4 5

Comment:

7

Did your supervisor help organize relevant case data in planning procedures for working with your clients?

X 1 2 3 4 5

Comment:

8

Did your supervisor guide you in generating your own solutions to problems faced with clients?

X 1 2 3 4 5

Comment:

9

Did your supervisor provide you with useful feedback regarding your counseling skills?

X 1 2 3 4 5

Comment:

10

Did your supervisor help you focus on how your personal style influenced clients? X 1 2 3 4 5

Comment:

11

Did your supervisor adequately reinforce the development of your strengths and capabilities?

X 1 2 3 4 5

Comment:


12

Did your supervisor help you use appraisal instruments constructively in counseling? X 1 2 3 4 5

Comment:

13

Was your supervisor helpful in critiquing your report writing? X 1 2 3 4 5

Comment:

14

Did your supervisor allow and encourage you to evaluate your work with clients? X 1 2 3 4 5

Comment:

Student’s Signature: Date: / /


School Counseling Practicum Completion Form

The following signatures indicate that_____________________________________________satisfactorily fulfilled the expectations (Name of Student Intern)

of the School Counseling Practicum experience.

_______________________________________ ________________________________________ ______________ Student Name (Print) Student’s Signature Date _______________________________________ ________________________________________ ______________ On-site Supervisor (Print) On-site Supervisor’s Signature Date _______________________________________ ________________________________________ ______________ School Counseling Instructor (Print) School Counseling Instructor’s Signature Date

___________________________________________________________ ______________ Master’s Practicum and Internship Coordinator Signature Date

Total

1. Individual Counseling Hours

2. Group Counseling Hours

3. Total # of Direct Service Hours (Line 1 + Line 2)

4. Individual Supervision Hours

5. ALL Non-direct Service Hours (EXCLUDING supervision)

6. Total # of Non-direct Service Hours (Line 4 + Line 5)

7. Total # of Direct and Non-direct Service Hours (Line 3 + Line 6)

8. Total Hours of Group Supervision from Group Supervision/Class Attendance Log

9. Total Hours of Class Instruction from Group Supervision/Class Attendance Log

10. Total Hours of Supervision (Line 4 + Line 8)

TOTAL (Line 7 + Line 8 + Line 9)


School Counseling Internship Completion Form

The following signatures indicate that_________________________________________satisfactorily fulfilled the expectations of the (Name of Student Intern)

Internship experience and met all requirements of the School Counseling Master’s degree internship.

Site Name and Address:

Internship I Internship II Total

1. Individual Client Contact Hours

2. Group Counseling Contact Hours

3. Classroom Guidance

4. Consultation: Family

5. Consultation: Teacher/Administrator

6. Consultation: Counselor

7. Direct Service Other

8. Total # of Direct Service Hours (Line 1 + Line 2 + Line 3 + Line 4 + Line 5 + Line 6 + Line 7)

9. Individual Supervision Hours

10. All Non-Direct Service Hours (excluding Supervision)

11. Total # of Non-Direct Hours (Line 9 + Line 10)

12. Total # of Direct and Non-Direct Service Hours (Line 8 + Line 11)

13. Total Hours of Group Supervision from Group Supervision/Class Attendance Log

14. Total Hours of Class Instruction from Group Supervision/Class Attendance Log

15. Total Hours of Supervision (Line 9 + Line 13)

16. Total (Line 12 + Line 13 + Line 14)

Internship I _______________________________________ ________________________________________ ____________________ Student Name (Print) Student’s Signature Date

_______________________________________ ________________________________________ ____________________ Site Supervisor Name (Print) Site-Supervisor’s Signature Date

_______________________________________ ________________________________________ ____________________ Internship I Instructor Name (Print) Internship I Instructor’s Signature Date

Internship II _______________________________________ ________________________________________ ____________________ Student Name (Print) Student’s Signature Date

_______________________________________ ________________________________________ ____________________ Site Supervisor Name (Print) Site-Supervisor’s Signature: Date

_______________________________________ ________________________________________ ____________________ Internship II Instructor Name (Print) Internship II Instructor’s Signature Date

______________________________________________________________________ _____________________ Master’s Practicum and Internship Coordinator Signature Date


School Counseling Clinical Experience Permission Form

______________ (Counselor Trainees Name) is currently completing requirements for the practicum or internship part of the master’s degree in School Counseling at Kent State University. The purpose of this practicum or internship is to develop and refine counseling skills and interventions in working with school age children. In order to complete the criteria for this course, individual and/or group counseling sessions must take place. To facilitate the evaluation of the supervisee’s skills and provide training supervision, these sessions will be audio / video taped. Selected tapes may be reviewed by the on-site supervisor (a licensed school counselor) at your child’s school and will be reviewed by the course instructor from the University, , a doctoral student supervisor (if applicable)_____________________________, and members of the School Counseling Practicum OR School Counseling Internship course at the University. The school district will maintain legal responsibility for services to students in its schools. Audio/videotapes are erased after they have been used for supervisory purposes

Your student’s records are maintained as confidential according to the provisions of state and federal laws and ethical guide lines

of the school counseling profession. Exceptions to confidentiality include if your student may be at risk of harm to self or others

including child/dependent adult abuse. Another exception to confidentiality is that records may be court-ordered or subpoenaed by a

court of law without client/guardian consent

The course at Kent State University runs from until .

Print Name of School: ______________________________________________________________________________________

Print Name of Child: ______________________________________________________________________________________

I, ________________________(Print Name of Parent or Legal Guardian), grant permission for my child / legal dependent to

receive counseling from (Print Name of Counselor Trainee) in her / his role as a graduate student enrolled in a School

Counseling Practicum or School Counseling Internship course through Kent State University.

Signature of Parent or Legal Guardian: ___________________________________________________Date: _____/_____/

Signature of On-Site Supervisor at My Child’s School: ____________________________________Date: _____/_____/

Signature of Principal at My Child’s School:________________________________________________Date: _____/_____/

Signature of the Kent State University Instructor: __________________________________________Date: _____/_____/

Title of Course Student is enrolled: _________________________________________________________________________

SCHOOL COUNSELING PRACTICUM AND …...Check with your advisor, your potential site, and/or the...

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