Supervised Internship in Counseling Student Handbook · Supervised Internship in Counseling ....

Graduate Studies College of Liberal Arts and Sciences

M.S. in Counseling

Supervised Internship in Counseling Student Handbook

Clinical Mental Health Counseling School Counseling

Department of Education & Counseling 610-519-4620

http://www.education.villanova.edu/

Last Edited: August, 2017

http://www.education.villanova.edu/

1 Internship Student

Table of Contents Topic Page Course Description 2 Course Objectives

a. General Course Objectives b. Specific Learning Objectives (1-11)

2-3

Steps for Securing an Internship Site (1-8) 3-4 Course Requirements

1. Hours 2. Supervision 3. Case Presentations 4. Counseling Portfolio 5. Reflective Engagement 6. Other Assignments Required by Internship Faculty Supervisor 7. Field Site Supervisor Evaluation 8. Professional Performance Review

4-6

Course Format a. Student Activity Timeline b. Description of Activities

1. Organizational Meeting 2. Field Placement Site Selection 3. Site Qualifications 4. Site Supervisor Qualifications 5. Site Approval 6. Introductory Letter to Site Supervisors 7. Group Supervision of Counseling 8. Site Visits by Faculty Supervisor 9. Internship I Site Supervisor Evaluation Form (#11) 10. Internship I Faculty Supervisor Assessment session 11. Internship II Final Letter to Site Supervisors 12. Internship II Site Supervisor Evaluation Form (#11) 13. Student Evaluation of Field Placement Experience (#12) 14. Internship II Final Faculty Supervisor Assessment Session

6-8

Role Descriptions 1. Student 2. Faculty Internship Supervisors 3. Field Placement Site Supervisors

9

Grading 9 Professional Liability 9 Video recording in Clinical Training: Questions and Answers 10-12 Record Keeping 13 Form Samples List 13 Form Samples 13-29


Course Description

The counseling internship course is designed to give advanced students in counseling the opportunity to put the skills and knowledge they have developed throughout their counseling program into practice and continue to translate their academic understanding into actual counseling practice through direct client contact and agency involvement. Students complete a pre-determined number of hours of individual and group counseling in a field setting under supervision of the counseling faculty and qualified field placement Site Supervisors.

Course Objectives

General Course Objectives

The major goal of the counseling Internship course is to provide students the opportunity to apply their theoretical knowledge and practical skills to specific client cases within a professional counseling setting. Weekly group supervision/ instruction, individual supervisory meetings and various assigned activities are designed to give internship supervisors and faculty the opportunity to assess the student's counseling performance in relation to client goals and the professional development of the counselor-in- training. A fundamental premise of the course is that professional counselor education is best accomplished through both an intellectual and personal development approach. This approach contends that the counselor-client relationship is an endeavor in which the growth and development of the client depends very much upon the concurrent professionally oriented growth and development of the counselor-in-training. Thus, students’ participation and willingness to give feedback and openness to receive feedback during group supervision sessions is central to the achievement of the course goals (Class Participation Evaluation Form).

Specific Learning Objectives

1. Demonstration of competence in a field assignment, including the application of a variety of counseling, psychological and educational theories and strategies appropriate to specific client situations (600 hours total including at least 240 hours of direct service, including groups). [III.G.1; IIICMH.A.5; IIISC.C.1.]

2. Demonstration of ones ability to engage effectively in a variety of professional activities relevant to effective counseling practice including record keeping, supervision, information and referral, in-service training, and staff meetings in addition to direct client/ student service. [III.G.4.]

3. Demonstration of counseling competence in a closely supervised field setting, including the application of counseling theories and strategies appropriate to specific client/ student situations. [III.G.4.]


4. Demonstration of the willingness and capacity to examine one’s own personal and professional development in relation to work with clients/ students and colleagues. [III.CMHD.9; III.SC.D.5.]

5. Gain experience in the use of current professional resources in use by counselors (e.g. assessments instruments, technologies, professional literature, etc.). [II.F; III.G.4.]

6. Demonstration of competence in organizational development, evaluation, consultation, and team-building skills as appropriate to the Internship setting.

7. Establishment and maintenance of a positive working relationship with both faculty and field site supervisors, as well as satisfactory performance in the areas of confidentiality, punctuality and attendance. [III.CMH.A.3;III.CMH.B.1; III.SC.A.3; III.SC.B.1]

8. Demonstrate the ability to recognize and respond to the importance of contextual and cultural factors in working with clients/ students of diverse backgrounds or referent groups (CACREP A.5, C.1).

9. Demonstrate active and effective participation in individual and group supervision that includes written and/or oral presentation and discussion of active practice on video or audio- tape. [III.G.5]

10. Demonstration of applied knowledge of ethical, legal and professional guidelines (ACA/ ASCA) regarding confidentiality, the counselor-client relationship, professional relationships and responsibilities, testing and research. [II.G.1.J; III.CMH.B.1; III.SC.B.1]

11. Demonstrate the ability to identify and articulate key aspects of their clinical orientation as it matches with evidence-based practices within the field. [II.G.8.E]

Steps for Securing an Internship Site

1. Identify one or several locations to complete your internship (to obtain a site that is far in

distance from VU, obtain permission first from program coordinator). Tips on identifying sites: a. Seek several possible locations and obtain contact information of the counselors, or b. Obtain a list of sites from the main office, SAC 302, or from your faculty advisor, or c. Consult with 2nd year counseling students currently completing their internships d. If above actions are not successful, consult with the current field placement coordinator

(Jennifer Carangi, at 610-519-8038, or [email protected]) 2. Sites that are considered ‘available’ or appropriate for you to contact are those that meet the

requirements set forward in this handbook. 3. After obtaining site contact information, contact a site, indicate your status as a master-level

Villanova counseling student, and formally inquire as to their interest and availability for taking an internship student. Move to the next site if this one is not available. You will need to call multiple sites, and multiple times. This is standard.


4. If the supervisor and site meet the requirements, ask what they require from you to formalize the process. Utilize and complete the necessary paperwork found in the appendix of this document according to the deadlines.

5. Clearances: school counselors need all clearances. CMHC students can delay applying for clearances until they commit to a particular agency and they are told by that agency what clearances are needed. See Form # 3 Clearance Information.

6. Make sure you have both (the student and the Site Supervisor) ‘interviewed’ one another and that you are a good match, preferably in a face-to-face interview—you should seek a site that will challenge you to apply a myriad of new skills and gain new knowledge of new populations. Look for a supervisor who is experienced, passionate about the profession of counseling and excited to supervise you actively.

7. A site is not considered “Approved” until you have received a signed (by your particular internship Faculty Instructor) copy of the “Field Placement Authorization Form. If you are unsure whether the site meets the specifications contact your Internship Faculty Instructor.

8. Students should not attend the first Internship Course Meeting of the semester without having received prior approval of their site.

9. Acquisition of internship hours ends at the close of the Internship II semester.

Course Requirements Students will be evaluated according to the following 8 requirements:

1. Hours: Students participating in the Internship Course will be required to devote a total of 600 hours (minimum) over two semesters to internship activities, in accordance with the Internship Student Agreement (see Form Samples in Appendix). A minimum 240 of these hours must be direct service to clients/students, including experience leading groups/classroom guidance.

Minimum hours using 14 week semesters Activity Per Week Per Semester (14 wks) Total (Intern. I & II) Direct service including groups 8.57 120 240 Internship-related activity 9.79 137 274 Individual Supervision on site 1 14 28 Internship Class (V.U.) 2 28 56 Individual Meeting with Internship Instructor (V.U.)

1 2

Total 21.36 300 600 Note: Hours may be acquired from the beginning of Internship I until the end of the Internship II semester. Students are not permitted to engage in acquiring internship hours prior to the beginning of Internship I unless those hours are “required training” hours designated by the field site.


2. Supervision: 1. Field Site:

a. Individual Supervision: Students shall receive one hour of uninterrupted individual supervision per week with their designated field placement Site Supervisor.

2. University: a. Individual Meeting with Internship Instructor: Each student will meet

individually with the designated Villanova Internship instructor during the semester.

1. 1hr a semester/2sem. = 2 hrs b. Internship Class: Students shall participate in two hours of class per week

with the Villanova Internship Instructor during the Internship semesters. 1. 2hrs. wk/14 wks/2sem. = 56 hrs

3. Case Presentations: Case presentations shall be defined as formal presentations for Individual and Group Supervision of client/ student cases being worked with by students at their field placements. All students will complete formal professional presentations. The professor of the course will outline the particular requirements for this assignment in the course syllabus. 4. Counseling Portfolio Depending upon the Faculty Instructor, students may be required to produce a portfolio summarizing their experiences during the internship. The professor of the course will provide a detailed outline of the particular requirements for this assignment in his/her syllabus. 5. Reflective Engagement Students in an experiential course should take every opportunity to prepare intrapersonal reflections on the process as research has made clear this is a critical element of counselor development. Particular course requirements for reflective assignments will be explicit in your individual course syllabi. 6. Other Assignments Required by Internship Faculty Instructor: These will be determined and explicitly described within the student’s individual syllabus. 7. Field Site Supervisor Evaluation A satisfactory performance evaluation must be acquired from the field Site Supervisor Evaluation in order to pass CHR 8850 and advance to CHR 8851. A copy of this form will be shared with each field Site Supervisor early in the semester, and each field Site Supervisor is requested to return the form to the Faculty Instructor at midterm and during the final week of classes of each semester of the internship. Students are required to complete this evaluation on


themselves AND have their Site Supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. 8. Professional Performance Review This review will be completed by the Faculty Instructor based on the items outlined in the Professional Performance Review Policy. Students are expected to adhere to the professional performance standards for the program. If students are found to not adequately meet one of these standards, they will not pass the course regardless of their current academic grade.

Course Format Student Activity Timeline

Specific Activity When Completed

Application and Site Search March preceding internship Application for CHR Internship (# 1) submitted Application approved; begin placement search Site Search Site Selection completed--Schools Spring preceding internship Site Selection completed—CMH Spring/Summer preceding internship Internship Supervisory Activities Villanova Supervisor Letter to Field Supervisors Within first two weeks of Internship Group Supervision with Case Presentations Weekly Site Visit or discussion with Villanova Supervisor Midpoint of 1st semester Evaluation Process: Mid-term Evaluation by Site Supervisors Final weeks of 1st semester Mid-term Villanova Supervisor Evaluation & Meeting Final weeks of 1st semester Final Letter to Site Supervisors Final 3 weeks of internship Completed Final Evaluation from Site Supervisors Final 3 weeks of internship Completed Final Evaluation from Site Supervisors Final 2 weeks of internship Final Villanova Supervisor Student Evaluation & Meeting Final 2 weeks of internship

Internship forms #1 through #5 must be completed and submitted to your Internship Faculty Supervisor Professor by June 1 (School) and August 1(CMH). If you do not have a site 2 weeks prior to the start of your class, you will not be allowed to begin the internship experience.

Description of Activities

1. Orientation to Internship: Conducted by the Practicum Instructors during the February/ March preceding a student’s fall internship for the purpose of informing students of the course requirements and fielding questions. If they haven’t already, students will complete the Application for Internship form at to solidify their intention to participate. 2. Field Placement Site Selection: Each student assumes the responsibility for locating and securing his or her own field placement site. Most counties require school counseling interns to


register their desires by April 1st and therefore school counselors will begin this process early. Instructor assistance with site selection will be provided as needed in addition to the previously utilized sites held with Jen Carangi. 3. Site Qualifications: Field placement sites for the Internship characteristically consist of public and private schools, community service agencies, hospitals, public schools, or institutions of higher learning which offer guidance, mental health, or preventive counseling services in both individual and group settings. Final determination as to the suitability of all field placement sites rests with the Faculty Instructor. 4. Site Supervisor Qualifications: Field placement Site Supervisors must have at least a master’s degree and at least two years of experience in counseling or counseling-related activity. They also need to have relevant certifications or licensure in their field. Final determination as to the suitability of the site supervisor rests with the Faculty Instructor. 5. Site Approval: Internship students must have prior approval from the Faculty Instructor before committing to a field placement site. Requests for site approval will be considered upon receipt of the following completed/signed documents:

(1) Registration Form (2) Signed Site Supervisor Agreement (3) Signed Student Agreement (4) Site Supervisor Training & Experience Form (5) Field Placement Authorization Form

Faculty Instructor approval of field placement sites will be indicated on the Field Placement Description/Authorization Form. Sites shall not be considered approved until this process is complete. To facilitate this process, these forms should be sent directly to the Faculty Instructor who is instructing your Internship I course.

6. Introductory Letter to Site Supervisors: During the first two weeks of Internship I, the Faculty Instructor will send the Site supervisors an introductory letter, which will outline the purpose, goals, and schedule of the course as well as a copy of the Internship Manual. In addition, the supervisor will receive a copy of the Evaluation of Student Performance form that he or she will be asked to complete at the end of the semester. 7. Group Supervision of Counseling: All students enrolled in the Internship course will meet each week for group supervision of counseling as outlined in the Calendar of Activities. Group supervision will typically consist of at least two case presentations done in accordance with the procedure outlined in the respective subsection of the Case Presentations section of


this manual. The specific schedule for supervision and number of case presentations will be determined by the Faculty Internship Supervisor.

8. Site Visits by faculty instructor: The faculty instructor will visit with each site in order to gather a firsthand perspective for the student’s experience, to offer support to the Site Supervisor, and gain feedback regarding progress and problems to date. These visits will be scheduled directly between the faculty instructor, and students will not be expected to attend these meetings unless their Site Supervisor requests their presence. 9. Internship I Site Supervisor Evaluation: Students are required to complete this evaluation on themselves AND have their Site Supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. The student will bring these forms to his/her meeting (#10) with the faculty instructor. 10. Internship I faculty instructor Assessment Session: Students will meet individually with the faculty instructor for the purpose of performance appraisal and supervision. The meeting will address student progress toward fulfillment of course requirements as well as student progress in professional performance and counseling skill development. 11. Internship II Final Letter to Site Supervisors: Near the end of the Internship course, the faculty instructor will send a letter to all Site Supervisors, thanking them for their participation and their completion and submission of the Evaluation of Student Performance form, and soliciting their general feedback regarding the Internship experience. 12. Receipt of Internship II Site Supervisor Evaluation Form: This is to be completed in the same manner as the “Internship I Site Supervisor Evaluation” (# 9 above). 13. Student Evaluation of Field Placement Experience: In preparation for their final supervision session with the faculty instructor, students are to complete the Student Evaluation of Field Placement Experience form. This completed form should be brought to the final supervision session, where the effectiveness of the field placement will be discussed. 14. Internship II faculty instructor Assessment Session: During the last two weeks of the Internship II semester, students will meet individually with the faculty instructor for the purpose of performance appraisal and evaluation of the field placement site. Specific requirements for this session will be arranged by your faculty instructor.


Role Descriptions 1. Student: The major expectations for students participating in the Counseling Internship course are to participate fully and to take seriously the pursuit and achievement of the learning goals set forth in the Specific Learning Objectives section of this manual. 2. Faculty Internship Instructor: The Faculty Instructor retains the ultimate responsibility for assessing the quality of academic work of the student trainee, assigning grades and credits to students and for other decisions that affect the academic progress of students. Responsibilities include the following:

1. Approval of course syllabus 2. Approval of field placement sites/supervisors 3. Ongoing information to field placement Site Supervisors 4. Oversight of the delivery of Internship course activities 5. Observation of each student’s counseling activities through Audio/ Video 6. Provision of group and individual supervision 7. Monitoring student effort and progress toward fulfillment of course objectives 8. Completion of site visits for student supervisees 9. Collection and maintenance of student supervisees’ paperwork

3. Field Placement Site Supervisor: The Field Site will hold ultimate responsibility for client and student welfare. Field placement Site Supervisor responsibilities and expectations are defined in the Site Supervisor Agreement provided in the Form Samples section of this handbook.

Grading

A student’s grade for each semester of the Internship will be awarded according to their faculty instructor’s syllabus.

Professional Liability Students who are enrolled in the Counseling Practicum course are entitled to Villanova University’s medical malpractice liability coverage. The limits of that coverage are $1,000,000 – per claim. There is added security in having individual liability coverage in addition to this group coverage, and CACREP requires that each student enrolled in practicum or internship purchase individual professional liability insurance; students will need to show proof of this to their instructors. There are good, affordable policies available for students who desire additional coverage. ACA offers free liability insurance to student members, which includes: 1 million per claim; 3 million aggregate; free attorney help line for consultation. [III M]


Video recording in Clinical Training: Questions and Answers

Villanova University Clinical Mental Health Practicum and Internship students are asked to video record their counseling sessions with clients for supervisory use. This document is intended to answer common questions of supervisors and trainees when utilizing video recording in clinical training. Who will see video recordings of client sessions? We suggest that on site supervisors and supervisees review some portion of a video recorded counseling session each week in supervision to enhance supervisory effectiveness. In the supervisee’s/student’s class, each student periodically presents his or her clinical work in formal case presentations throughout the semester. During these presentations, students are required to present a portion of a video recorded session for supervisory feedback from classmates and the Professor. How are video recordings stored? The videos should be kept locked in secure location at the site (behind 2 locks) and be de-identified in some way so as to further protect the identity of the client. With improved technology, clinicians can record directly to digital video on a computer and have the data password protected and encrypted. Must trainees video recorded their client sessions? We highly encourage the use of video over audio recordings since audio recordings cannot capture the nonverbal communication of counselor or client. However, audio recordings may be used in place of video recordings if absolutely necessary. If the supervisor and/or training facility would like the trainee to audio rather than video record sessions, then the supervisor must put this in writing in a letter to the Practicum/ Internship Instructor.

How often must trainee’s video record? Trainees must video (or audio if necessary) all 1:1 counseling sessions in which they are the counselor. The exceptions to this are: when video or audio recording is clinically counter indicated; such as, clients with a history of abuse and/or paranoid ideation, or when the client does not give consent to record. If the supervisor and/or training facility will not allow the trainee to record every session, then the trainee may record a minimum of 4 counseling sessions for use in class presentations. However, the supervisor must put this in writing in a letter to the Practicum/ Internship Instructor. What happens to the video recordings? After the video recording has been viewed in supervision it should be deleted.


Why Use Video recording in Supervision? Research shows that video recording in clinical training and supervision has steadily increased since its first conception in the 1960s. Social and cognitive psychology research on memory suggests that clinical supervision that solely depends on second-hand reporting of session events may be limited. This is because second-hand reporting and audio recordings of session material are often not able to adequately shed light on the nonverbal behavior exhibited by the client and counselor and the trainee’s memory of session events is often biased. Video recording allows a supervisor to view the session material as it happened during the session so as to provide more effective supervision and counseling training (see Haggerty & Hilsenroth, 2011). Consistent with this, research suggests that structured training that utilizes video recording yields superior supervisory and client outcomes (Diener et al., 2007; Fernandez-Liria et al., 2010; Hilsenroth et al., 2006; Town et al., 2012). Moreover, traditional counseling supervision often generates a great deal of uncertainty for the supervisor, and viewing the trainee’s sessions on video help the supervisor to feel more confident with his or her assessment of the client (Grotjahn, 1955). How Do Supervisors use Video recording in Supervision? One common technique is the “stop-frame” technique wherein supervisor and supervisee stop the recording at specific moments to collaboratively explore, on a microscopic level, what is transpiring in that moment of the session, to examine the counselor’s intentions of an intervention, and the effect of the intervention on the client in the moment. Binder (1999; see also Hilsenroth et al., 2006) outlines strategies for using video recorded sessions for supervision. The basis for his strategies utilizes ‘anchored instruction’ (Binder, 1993), that is, what is learned is linked in meaningful ways to specific situations, that the knowledge is gained through the supervisee’s active involvement in a manner that encourages memorization and comprehension, and that the knowledge is acquired in a context that is as similar as can be to the conditions of actual practice. Binder uses supervisees’ recorded sessions to examine in detail specific clinician–client interactions as examples of larger themes and therapeutic processes. He also explains that the use of the video recorded material should be prepared by arranging specific training tasks during supervision such as looking for particular technique and process patterns. Binder advocates for supervisors to spend time focusing on the supervisee’s experiences, thought processes and behaviors while watching the video. When providing feedback to the supervisee, he suggests the supervisor be particular about noting what specifically the supervisee did that was desirable rather than making global non-specific positive comments (Henry et al., 1993). This allows the supervisee to understand what he or she did right and why. In a cognitive–behavioral sense, the supervisor is shaping adaptive therapeutic technique in the supervisee (see Haggerty & Hilsenroth, 2011).


How are ethical concerns regarding video recording addressed? Confidentiality and ethical issues are prominent when video recording counseling sessions. In fact, one of the reasons why video is not used more often may be due to concerns for the client’s confidentiality. Confidentiality is always of the utmost concern for clinicians. Without it being safeguarded, the client may feel exploited and insecure (Haggerty & Hilsenroth, 2011). Is Informed Consent Needed? When video recordings are going to be used it is imperative that the clinician get written informed consent from the client. The consent should state what purposes the video will be used for, who will be viewing the recording (i.e. supervisor and/or supervision group) and how the recording will be secured and kept confidential. Villanova students are given a sample form to use but agencies may use their own forms that meet these aforementioned requirements. When video recording is not mandated and is optional in the agency, it should be made clear that it is the client’s choice to be video recorded and if the client does not wish to be recorded then he or she may be assigned to a licensed clinician on staff. Clients who agree to be video recorded should be made aware that if they were to become uneasy with being video recorded at any point in their treatment it will be discontinued by the clinician. Clients should also be made aware that if they request past recordings to be destroyed the recordings will be destroyed or deleted. How do I address videotaping with clients? Videotaping should be discussed, and if consent is given, start, in the first session of counseling. We do not find that waiting to video record helps either the novice counselor or the client. Clinicians need to be cognizant of the power differential that exists and what being video recorded may mean to clients (Aveline, 1992), and thus explore the meaning of this with clients. The use of video can be explored as part of the treatment process as any other responsible exploration of the frame and therapeutic process during the course of treatment. Rather than avoid an issue we should strive to use such issues to better explore and understand the therapeutic relationship and process (Haggerty & Hilsenroth, 2011). The clinician should explain that video is used for training purposes and the clinician is supervised by a licensed supervisor.

How recordings transported to Villanova University for supervisory feedback?

When transporting recordings to Villanova for supervisory purposes only, students are instructed to carry video recordings behind two locks at all times and delete them immediately after use. Recordings should be kept on site at all other times. ____ Supervisor Initial ____ Supervisee Initial


Record Keeping Students participating in the Internship course will be required to maintain selected written records related to their counseling activities, including (but not limited to) case progress notes, A/V recording authorization, and exchange/release of information authorization.

Form Samples List

Following is a copy of all forms that students participating in the Internship course will need. They can be used and duplicated as necessary. Other example documents are included for reference.

TITLE PAGE _______________________________________________________________________

1. Clearance Requirement Information 14

2. Application for Supervised Internship Experience 15

3. Site Supervisor Agreement 16

4. Student Agreement 17

5. Site Supervisor Training and Experience 18

6. Field Placement Authorization Form 19

7. Weekly Activity Record 20

8. Consent for Audio-Visual Recording 21

9. Class Participation Evaluation Form 22

10. Evaluation of Student Performance 23-25

11. Student Evaluation of Field Site 26-30


Graduate Program in Counseling Supervised

Internship

Clearance Requirement Information Below are the links for the four clearances needed for school counselors to complete all required field experiences. Clinical mental health students should check with their agency to see which clearances are needed. Please apply SOON i as the process can take up to a month to six weeks, to be completed. Your clearances are good for the length of time you are at Villanova and do NOT have to be redone yearly. Once you get all four clearances back, please make a copy of each and give the copies to Jennifer Carangi, Field Placement Coordinator, in 302 SAC. If you have any questions, don’t hesitate to contact Jennifer at [email protected]. Thank you.

Act 34 PA State Police Background check Act 151 Child Abuse Clearance Act 114 FBI fingerprinting TB Test can be done at the Villanova Health Center or through your family doctor.

i School counselors begin earlier than agency counselors due to the earlier deadlines established by various school districts. All school placements MUST be secured by April 1, which means starting the search by January at the latest. School counselors MUST have all legal and health clearances in place at the start of the search as they must be submitted with the school placement requests. Agency placements may continue into the summer and clearances are not necessarily required; it depends on the client population and agency requirements.

mailto:[email protected]

https://epatch.state.pa.us/

https://www.compass.state.pa.us/cwis/public/home

https://www.compass.state.pa.us/cwis/public/home

https://pacogentid.3m.com/index.htm


Villanova University- Graduate Program in Counseling Supervised Internship

Application for Supervised Internship in Counseling (Form #1)

Name:_________________________________________________ Today’s Date: ___________________

Villanova ID# _____ Email address: _______

Local Address: _______ _________

Home Telephone:_________________ Work Telephone:_______________ Cell Phone______________

I wish to begin Internship during the Fall, 20____________ semester: ________

In case of emergency, please contact:______________________________ Phone#:_______________ Program: Clinical Mental Health __________ School Counseling __________

List grades in the following required courses you have completed: General *Lab in Counseling Skills ______ *Laboratory in Group Dynamics______ *Counseling Theory & Practice______ Research & Evaluation ______ *Ethics & Prof. Orientation ______ Human Growth and Development______ Lab in Counseling Diverse Population______ Lifestyle and Career Dev.______ Assessment and Appraisal______

School *Practicum in School______ *School Counseling Orientation ______ Consultation Processes______ Therapeutic Strategies______________ Adolescent Counseling Interventions______ Special Ed. For Counselors & Teachers______ Clinical Mental Health *Practicum in Clinical Mental Health Couns. ______ *Clinical Mental Health Counseling Orientation______ Community Resources and Crisis Intervention______ Psychopathology______ Prevention ______ Family Counseling ______ Substance Abuse ______ Courses with * are required prior to field experiences.

Current GPA: _______ Total number of credit hours completed by beginning of Internship I: _____ List required courses to be taken prior to Internship I and when you plan to take them: ________________________________________________________________________________________________

______________________________________________________________________________________

List courses that you plan to take during the internship: ________________________________________________________________________________________ Please list your 3 preferences for a placement site below: (FIT on one page) School/Agency Prospective Supervisor Telephone 1._______________________________________________________________________________________

2._______________________________________________________________________________________

3._______________________________________________________________________________________


Villanova University- Graduate Program in Counseling Supervised Internship Form # 2

Field Site Supervisor Agreement (03/14)

As the Site Supervisor for ______________________________________________, I agree:

1. That I possess the necessary qualifications to supervise the named intern in his or her identified areas of responsibility within my organization (minimum: master's degree and at least 2 years post masters experience in counseling or counseling-related activity, have been with the site for at least one year, and hold appropriate certifications/ licenses for this work. For school counseling internships, a certified school counselor.). 2. That I will provide at least one hour per week of direct, individual supervision to the above named counseling intern, in forms including but not limited to: case discussion and feedback; critique of and advisement on counseling skills, counseling philosophy and technique, intervention design and implementation, problem resolution and work attitudes. 3. That the site will be able to provide the intern with the required internship hours (600 total; 240 of which will be direct client/student contact). 4. That I will provide a supportive, learning-oriented environment, which affords the counseling intern opportunities for professional counseling activity and experience in giving and receiving feedback related to that professional activity. 5. That I will introduce and orient the counseling intern to this professional setting, making sure that he/she understands its organization, role expectations and policies & procedure (including record keeping requirements for counseling activity). 6. That I will be reasonably available to assist the counseling intern outside of the weekly supervision hour (if needed) in the performance of his/her assigned responsibilities and I understand that a trainee shall not be allowed to work after normal hours without the on-site presence of a professional staff member. 7. That I will encourage the counseling intern to participate in those professional activities that will maximize his/her learning as well as his/her effectiveness in this professional setting. 8. That I will help facilitate the video recording of the intern’s counseling activity during the experience for use during group supervision conducted by the faculty instructor.

a. Please provide your initials here designating that you agree: 9. That I will complete the brief “Villanova Counseling Site Supervisor Training Module” online (This will be shared with you by the instructor.). 10. That I will meet at this setting with the counseling intern’s faculty instructor once during the internship to discuss the nature of the Internship placement and student’s progress in the placement. 11. That I will complete one mid-term and one final Internship Student Evaluation each semester to assess the student’s skill level and progress on learning goals.

Supervisor Name/Title: ______________________________________________________

Date: __________________________________Signature__________________________________


Villanova University- Graduate Program in Counseling- Supervised Internship Form # 3

Student Agreement (10/15)

1. As a Counseling Intern in a professional setting, I hereby attest that I have read and understand the American Counseling Association Code of Ethics, and will practice my counseling in accordance with these standards. Further, I will assume the responsibility for promoting my growth toward becoming a professional counselor by agreeing to initiate and/or participate in the Internship Objectives. 2. I understand that I am expected to be punctual, maintain good professional work habits, and conduct my client/ student and colleague relationships in accordance with ethical principles and the rules of the Field Site in which I am placed. 3. I understand that the Field Site can be my place of employment only if 1) the Field Supervisor is not my current supervisor, and 2) my responsibilities are qualitatively different from those that are already included in my current position. I also understand that the termination of my internship/ supervisory experience will occur at the end of Villanova University’s spring semester. 4. I will complete a minimum of 600 hours of Internship activity in accordance with the following:

a. Provide direct counseling (as defined by ACA) service to clients (240 hours at minimum) b. Conduct on-site, internship-related activity c. Receive weekly individual supervision from Site Supervisor d. Receive weekly group supervision from faculty instructor e. Attend individual meetings (2) with faculty instructor

Please note: The academic calendar includes many more “days off” than any school or agency. This includes fall, winter, and spring break. Plan on continuing your internship work as long as your school or agency is open for business as you would if you were an employee. Any extended breaks from your internship should be discussed with both your professor and your site supervisor.

5. I will provide direct counseling service to clients/ students that are assigned to me. The counseling format may include individual, family, marital, vocational, group, and/or assessment. I will document these services in accordance with school/agency policy and in compliance with any standards set forth by the faculty instructor, such as video tapes, in-depth case study, a daily log, group program, etc. 6. I will become familiar with the system within which I am placed, including organizational structure, technology, funding sources, client referral/screening/intake processes, treatment philosophy, administrative procedures, services offered and service follow-up procedures. 7. I will become familiar with other key organizations and individuals, which support the mission of my Internship setting (e.g., intake sources, referral sources, volunteer groups, licensing agencies), and I will utilize all resources available (e.g., reading materials, in-service training programs, observations of other staff members with clients, participation in simulated (role-play) counseling sessions, learning about tests that the organization uses, etc.) to maximize my understanding of and effectiveness in the professional setting in which I am placed. 8. I will strive to develop positive working relationships with staff members and other persons/agencies affiliated with my Internship setting, and will seek their assistance when necessary. I will, whenever possible, attend and participate in staff functions, such as staff meetings, case review sessions, in-service training, etc. 9. During the semester of my Internship, I will be prepared to present videotaped sessions of my counseling activity to the supervision group and/or the faculty instructor in accordance with the established case presentation format. Student Name: Date: _______________

Student Signature: ____________________________



Form # 4 Site Supervisor Training and Experience

We would like to keep on file a record of the training and experience of each field placement Site Supervisor. Students, please ask your Site Supervisor to complete this form. Name (First, last) __________

Job Title ______

Name of institution or agency________________________________________________________________

Address of institution or agency (include zip) ____________________________________________________

______________________________________________________________________________________

Work telephone number ______ FAX

Email address

Education: College Degree/Year Title of Program

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Professional Experience:

Position Organization Dates ___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Current Licenses/Certifications:

Type State Date ___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Describe any training (e.g., courses/workshops) you have received in clinical supervision: ___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Name of Villanova student(s) to be supervised:


Graduate Program in Counseling

Supervised Internship Form # 5

Field Placement Authorization Form (03/14)

Reminder: faculty instructor approval of field placement sites will be indicated on the Field Placement Description/Authorization Form. Sites shall not be considered approved until this process is complete. To facilitate this process, these forms should be sent directly to the faculty instructor who is instructing your Internship I course.

DEADLINES: Complete and submit forms #1 through 5 by the following dates:

If you do not have a site 2 weeks prior to the start of your class, you will not be allowed to begin the internship experience.

JUNE 1st –School Counselors TO: The professor of your fall intern course JULY 1ST – Clinical MH Counselors TO: The professor of your fall intern course

Student: Date: Field Placement Name and Location:

Name: _________________________________________________________________ Location address:_________________________________________________________

Description of Field Placement (Include: organization purpose or mission, services provided, clients served, anticipated duties as an intern):

Field Placement Authorization

____ Form #1 Application for Supervised Internship Form ____ Form #2 Signed Site Supervisor Agreement ____ Form #3 Signed Student Agreement ____ Form #4 Completed Site Supervisor Training & Experience form ____ Form #5 Field Placement Authorization Form (this one) ____ Pg. 10-11 Student & Supervisor Signed Video Recording in Clinical Training ____ Special agreements/contracts as required by the field placement site

I hereby authorize the use of above named organization as An Internship placement site for the above- named student. This authorization is contingent upon the site’s continued ability to meet the terms set forth in the Site Supervisor Agreement. ________________________________________ ________________________ Villanova Faculty Instructor Date



Form #6

Weekly Activity Record

Counseling Intern:_____________________________ Week of: to _________

General Activity Summary

Activity Hours

# hours of individual counseling (direct hours):

# hours of group counseling (direct hours):

# hours of family/couples counseling (direct hours):

# hours of clinical preparation/record-keeping:

# hours spent in case-related contact with staff/ professional agencies/individuals:

# hours of site-related administrative activity:

# hours spent in placement-related workshops, trainings, seminars:

# hours of individual supervision on site:

# hours of group supervision on site (including case staffing):

Total Number of hours at the field placement for the week: # hours spent in internship class (CHR 8850; maximum 2 hours per week):

Total (COMBINED) Number of internship hours to date (all weeks):

Supervisor Initials:

Supervisor Comments (if needed): _________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________



Form #7 (Example) Consent for Audio-Visual Recording

01/11

EXAMPLE Note: A copy must be signed by each person participating in the counseling session to be recorded. The parent or legal guardian must sign a copy for each participating minor.

I, the undersigned, authorize the video/audio recording of my group/individual counseling sessions with the following counselor-in-training: . I understand that the recorded sessions will be used only for the purpose of counselor training, and that they will be viewed only by the above-named student counselor, the Practicum/ Internship faculty and the student counselors enrolled in the Practicum/ Internship Supervision Group. I have been informed that the viewing focus will be on the counselor him or her-self, in an effort to evaluate his or her skills as a professional. I understand that my full name will not appear on the tape or any other materials; I further understand that the recorded sessions will be protected during travel and erased/destroyed upon the student counselor’s completion of the Practicum/Internship course.

____ ______

Client Name

Client Signature Date

____ ______ Parent/Legal Guardian Signature for Minor Client Date

Counselor Signature Date


Villanova University- Graduate Program in Counseling Form #10

Class Participation Evaluation Form (01/11)

Student: Total (5-15):

Date:

Strong (3) Needs Development (2) Unsatisfactory (1) Listening Actively and respectfully

listens to peers and instructor

Sometimes displays lack of interest in comments of others

Projects lack of interest or disrespect for others

Preparation Arrives fully prepared with all assignments completed, notes on reading, observations, and questions

Arrives unprepared or with only superficial preparation

Exhibits little evidence of having read or thought about assigned material

Quality of contributions

Comments are relevant and reflect understanding of: assigned readings; previous remarks of other students; and insights about material

Comments sometimes irrelevant, show lack of preparation, or indicate lack of attention to previous remarks of other students

Comments reflect little understanding of either the discussion or previous remarks in class.

Impact on class Comments frequently help move conversation forward

Comments sometimes advance conversation, but sometimes do little to move it forward

Comments do not advance the conversation or are actively harmful to it

Frequency of participation

Actively participates at appropriate times

Sometimes participates but at other times is “tuned out”

Seldom participates and is generally not engaged

Comments:

John Immerwahr, Copyright License: http://creativecommons.org/licenses/by-sa/3.0/us/

i. Class participation deserving of an A grade will be strong in most categories; Participation that is strong in some categories but needs development in others will receive a B; a grade of C reflects a need for development in most categories; D work is typically unsatisfactory in several categories; and F work, unsatisfactory in nearly all.

http://creativecommons.org/licenses/by-sa/3.0/us/

http://creativecommons.org/licenses/by-sa/3.0/us/


Site Supervisor Performance Evaluation of Students in Clinical Mental Health

(Form #11a) Students are required to complete a self-evaluation (using this form) AND have their Site Supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. Note to Site Supervisor: Please give the student at least one “2” or below and VERY FEW “5’s.” Please feel free to contact the faculty instructor with questions or problems regarding this task. Thank you for your assistance. Student: _____ Site:__________________________________ Supervisor: _____ Evaluation ¨ Midterm ¨ Final 1 = Far below expectations—needs significant improvement 2 = Below expectations—needs some improvement 3 = Acceptable—meets standards at average level for students (the majority of trainees will fall here) 4 = Above expectations—performs above expectations for students/is a strength 5 = Far exceeds expectations—performs well beyond average for students/excels in this area NA= Not applicable or not enough information to form a judgment I. Ethical Awareness and Conduct:

Adherence to applicable legal standards 1 2 3 4 5 NA Adherence to professional ethical standards 1 2 3 4 5 NA Ability to identify and resolve ethical dilemmas 1 2 3 4 5 NA

II. Professional Behaviors:

Is punctual at internship site 1 2 3 4 5 NA Presents a professional image with all contacts (i.e., face to face, email, etc.) 1 2 3 4 5 NA Interacts appropriately and professionally with staff at site 1 2 3 4 5 NA Consults with personnel as appropriate 1 2 3 4 5 NA Applies relevant record keeping standards as appropriate to the site 1 2 3 4 5 NA

III. Supervision Behaviors:

Seeks supervision when appropriate 1 2 3 4 5 NA Able to establish effective supervisory relationship 1 2 3 4 5 NA Is receptive to constructive feedback 1 2 3 4 5 NA

Actively seeks constructive feedback 1 2 3 4 5 NA

Makes appropriate changes following feedback 1 2 3 4 5 NA

IV. Personal Characteristics:

Demonstrates a willingness to learn 1 2 3 4 5 NA Exhibits emotional stability 1 2 3 4 5 NA Demonstrates adaptability and flexibility 1 2 3 4 5 NA Recognizes limitations 1 2 3 4 5 NA Is aware of professional strengths and areas of growth 1 2 3 4 5 NA Exhibits an awareness of and respect for appropriate interpersonal boundaries 1 2 3 4 5 NA Demonstrates maturity in interactions with clients and staff 1 2 3 4 5 NA


V. Counseling Skills:

Please indicate the percentage of the following modalities that you are using to rate counseling skills. Percentages should equate to 100%. ______ Co-counseling ______ Student self-report ______ Live observation ______ Viewing video-taped sessions ______ Listening to audio-taped sessions ______ Other (please indicate source: ______________________________)

Comprehends complex problems and solutions 1 2 3 4 5 NA Establishes and maintains rapport with clients 1 2 3 4 5 NA Demonstrates the ability to identify and draw upon client strengths and resources in case conceptualization and interventions 1 2 3 4 5 NA

Ability to gauge the needs of the client 1 2 3 4 5 NA Matches client needs to therapeutic goals and interventions 1 2 3 4 5 NA Establishes, works toward, and assesses counseling goals 1 2 3 4 5 NA Approaches clients in a therapeutically genuine manner 1 2 3 4 5 NA Conveys an empathic understanding to the client (including nonverbally) 1 2 3 4 5 NA Effectively identifies and responds to a variety of client emotions 1 2 3 4 5 NA Works effectively with clients from diverse cultural backgrounds 1 2 3 4 5 NA Effectively engages in the termination process 1 2 3 4 5 NA Appropriately makes referrals 1 2 3 4 5 NA

VI. Program (Clinical Mental Health) Specific Knowledge and Skills:

A. Knowledge of: Client population 1 2 3 4 5 NA Role of the counselor 1 2 3 4 5 NA Site and community client resources 1 2 3 4 5 NA Diagnostic criteria for mental and emotional disorders 1 2 3 4 5 NA Treatment modalities and placement criteria within the continuum of care 1 2 3 4 5 NA

B. Skills: Advocates appropriately for clients 1 2 3 4 5 NA Promotes client understanding of and access to community resources 1 2 3 4 5 NA Demonstrates skill in screening for addiction, aggression, danger to self and/or others, as well as co-occurring mental disorders 1 2 3 4 5 NA

Demonstrates skill in conducting mental health assessment practices (intake, MSE, biopsychosocial, psychological assessment) for treatment planning and caseload management

1

2

3

4

5

NA

Is able to conceptualize an accurate diagnosis of disorders presented by a client and discuss the differential diagnosis with supervisor/colleagues 1 2 3 4 5 NA

Demonstrates appropriate use of the DSM-5 to describe the symptoms and clinical presentation of clients and apply appropriate treatment approaches

1

2

3

4

5

NA

Demonstrates appropriate use of culturally responsive (individual, couple, family, or group) modalities for counseling

1

2

3

4

5

NA

Uses the principles and practices of diagnosis, treatment, referral, and prevention of mental and emotional disorders to initiate, maintain, and terminate counseling

1

2

3

4

5

NA


V. What are the strengths of the student as an intern? VI. What areas need further development? VII. What recommendations would you make to enhance this student’s development? Supervisor’s Signature: Date: ___________________ Student’s Signature: Date: ___________________

Supervisors Please Make a Copy for Your Files


Performance Evaluation of School Counseling Student

by Field Site Supervisor

Form #11b Evaluation of Student Performance

Students are required to complete a self-evaluation (using this form) AND have their site supervisor complete the evaluation; then, using the designated supervision time, review both evaluations WITH the Site Supervisor. Note to Site Supervisor: Please give the student at least one “2” or below and VERY FEW “5’s.” Please feel free to contact the faculty supervisor with questions or problems regarding this task. Thank you for your assistance.

Student: ___Site: ________________________________

1 = Far below expectations—needs much improvement, a concern 2 = Below expectations—needs some improvement, a concern 3 = Acceptable—meets standards at average level for interns (majority of trainees fall here) 4 = Above expectations—performs above expectations for interns 5 = Far above/exceeds expectations—performs well beyond most counseling students NA= Not applicable or not enough information to form a judgment

I. Ethical Awareness & Professional Conduct:

Adherence to ethical and legal standards as defined by site and ASCA standards

1 2 3 4 5 NA

Adheres to confidentiality standards as defined by site and ASCA

1 2 3 4 5 NA

Consults with appropriate personnel about ethical issues 1 2 3 4 5 NA

Is punctual and reliable 1 2 3 4 5 NA

Interacts appropriately and professionally with others at site 1 2 3 4 5 NA

Accurate record keeping according to ASCA and site guidelines 1 2 3 4 5 NA

Comments:

II. Professional Knowledge, Receptivity, and Skills:

A. Knowledge, Skills: Knowledge of client population 1 2 3 4 5 NA Knowledge of counselor role 1 2 3 4 5 NA Knowledge of site and community client resources 1 2 3 4 5 NA Knowledge of evidenced-based counseling theories and skills as appropriate to the school setting and client population. 1 2 3 4 5 NA

Demonstrates skills in responding to clients’ unique developmental levels and sociocultural traits (race/ethnicity; disability status; gender;

1 2 3 4 5 NA

Demonstrates skill in assessing and referral for client needs (e.g., addiction, aggression, eating disorders, depression, danger to self/or

1 2 3 4 5 NA

Demonstrates appropriate use of evidenced-based culturally responsive (individual, couple, family, or group) modalities for initiating, maintaining, and terminating counseling

1

2

3

4

5

NA

Demonstrates and understanding and ability to create, implement, and manage an effective classroom guidance lesson 1 2 3 4 5 NA

Demonstrates effective, evidenced-based group counseling skills 1 2 3 4 5 NA Demonstrates skills in academic advising and planning 1 2 3 4 5 NA Demonstrates skills in career and/or college planning at individual, small group, and classroom levels

1

2

3

4

5

NA

Counselor actions/interventions are premised on data (e.g., needs’ Assessments, truancy or achievement data, disciplinary records)

1

2

3

4

5

NA


Counselor interventions are evidenced-based in nature and systematically assessed for impact or effectiveness

1

2

3

4

5

NA

Comments:

B. Relational/Counseling Skills Comprehends complex problems and solutions 1 2 3 4 5 NA Able to build rapport with all clients 1 2 3 4 5 NA Demonstrates empathy—visibly 1 2 3 4 5 NA Accurately reflects session content 1 2 3 4 5 NA Accurately and comfortably reflects feelings 1 2 3 4 5 NA Tailors skills & interventions culturally to fit client 1 2 3 4 5 NA Maintains appropriate boundaries with clients, colleagues, and staff 1 2 3 4 5 NA

Comments:

C. Personal Characteristics:

Demonstrates a willingness to learn 1 2 3 4 5 NA Displays a sense of self confidence 1 2 3 4 5 NA Exhibits emotional stability 1 2 3 4 5 NA Demonstrates adaptability 1 2 3 4 5 NA Recognizes personal limitations 1 2 3 4 5 NA

Comments:

III. Interactions and Consultations with Coworkers/Other Professionals/Families, Etc.:

Consults with appropriate persons 1 2 3 4 5 NA Provides valuable information to client/client’s family, teachers, administrators, etc.: 1 2 3 4 5 NA

Effectively, clearly conveys information 1 2 3 4 5 NA Presents self professionally 1 2 3 4 5 NA

Comments:

IV. Response to Supervision:

Actively seeks critical feedback 1 2 3 4 5 NA Receives critical feedback well 1 2 3 4 5 NA Changes behaviors following feedback 1 2 3 4 5 NA Demonstrates the ability to recognize his or her own limitations as a school counselor and seeks supervision and additional information/education as appropriate.

1

2

3

4

5

NA

Comments:


V. Identify one of the students’ greatest strengths. ___________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

VI. Identify one area for growth. ______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

VII. Would you recommend this student in moving on to the next career level (e.g., for internship

students, on to full employment as a school counselor)?

_____YES _____NO

If no, please explain: ____________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Supervisor’s Signature: ____________________________________ Date: __________ _______

Supervisor’s Printed Name: _________________________________

Supervisors Please Make a Copy for Your Files


Villanova University

Supervised Internship in Counseling Form #12

Student Evaluation of Field Site (03/11)

1. Student: Semester: _______________, 20____

2. Site:_______________________________________________________________________ 3.

Supervisor Name:____________________________ Title:

4. On-Site Responsibilities:

5. Percent of time spent providing direct service to clients/ students: % Comments:

6. Percent of on-site time spent doing clinical support work (training, case staffing, treatment planning, clinical supervision, consulting with teachers) % Comments:

7. Percent of on-site time spent doing administrative tasks __________% Comments:

8. Type and frequency of on-site supervision received:

9. Assessed quality of on-site supervision received:

10. Overall assessment of the value of this internship experience for you:

11. Would you recommend placement of another Villanova graduate student in this internship site? Why or why not?



Form # Internship Prospectus

Please complete this form for each semester you are at your internship, even if you are staying at the same site. This form must be completed in collaboration with your site supervisor. Concisely outline your proposed field experience. The prospectus should make clear your chief responsibilities and the approximate allocation of time. You may take advantage, however, of new opportunities when they arise, after consulting with your faculty instructor. Specifically, please list the various duties you will perform at the site. Indicate the approximate time you and your site supervisor expect that you will devote to each activity (e.g., individual counseling, group counseling, team meetings, case management, crisis counseling, classroom guidance, career planning, outreach, etc.). Please note that an internship student should engage in all the possible activities appropriate for their training level that a full-time staff member of the agency performs in order to gain the maximum professional experience possible. Brief Description of Internship Activity Approximate Hours Per Week

Student Signature Date

Site Supervisor Signature Date

Villanova Faculty Supervisor Date

Supervised Internship in Counseling Student Handbook · Supervised Internship in Counseling ....

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