Supervised Internship in Counseling Student Handbook

8/13/2019 Supervised Internship in Counseling Student Handbook

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Graduate Studies

College of Liberal Arts and Sciences

M.S. in Counseling

Supervised Internship in CounselingStudent Handbook

Clinical Mental HealthSecondary SchoolElementary School

Department of Education & Counseling610-519-4620

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

Spring 2011

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


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Table of Contents

Topic Page

Course Description 3 Course Objectives

a. General Course Objectives b. Specific Learning Objectives

3

Course Responsibilitiesa. Villanova Internship Student b. Counseling Programc. Field Site

4

Steps for Securing an Internship Site 5 Course Requirements

a. Hours b. Supervisionc. Case Presentationsd. Counseling Portfolioe. Journal Writingf. Site Placement Supervisor Evaluation

6

Course Formata. Student Activity Timeline b. Description of Activities

i. Organizational Meetingii. Field Placement Site Selection

iii. Site Qualificationsiv. Site Supervisor Qualificationsv. Site Approval

vi. Group Supervision of Counselingvii. Introductory Letter to Site Supervisors

viii. Site Visits by Faculty Supervisorix. Internship I Site Supervisor Evaluationx. Internship I Faculty Supervisor Assessment sessionxi. Final Letter to Site Supervisors

xii. Receipt of Completed Site Supervisor Evaluationxiii. Student Evaluation of Field Placement Experiencexiv. Internship II Final Faculty Supervisor Assessment Session

7

Role Descriptionsa. Student b Faculty Internship Supervisorsc. Field Placement Site Supervisors

9

Grading 9 Professional Liability 9 Video/Audio Recording 9 Record Keeping 10 Form Samples List 10 Form Samples 11-26


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Course Description

The counseling internship course is designed to give advanced students in counseling the

opportunity to put into practice the skills and knowledge they have developed throughout their counseling

program 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 ofcounseling, psychological and educational theories and strategies appropriate to specificclient situations.

2.

Demonstration of ability to engage effectively in a variety of professional activities relevantto effective counseling practice including record keeping, supervision, information andreferral, in-service training, and staff meetings in addition to direct client service.

3. Demonstration of counseling competence in a closely supervised field setting, including theapplication of counseling theories and strategies appropriate to specific client situations.

4. Demonstration of the willingness and capacity to examine one‘s own personal and professional development in relation to work with clients and colleagues.

5. Gain experience in the use of current professional resources in use by counselors (e.g.assessments instruments, technologies, professional literature, etc.) (CACREP CMH C.3).


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6. Demonstration of competence in organizational development, evaluation, consultation, andteam-building skills as appropriate to the Internship setting (CACREP C.2).

7. Establishment and maintenance of a positive working relationship with both faculty and fieldsite supervisors, as well as satisfactory performance in the areas of confidentiality, punctuality and attendance.

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

9. Demonstrate active and effective participation in individual and group supervision thatincludes written and/or oral presentation and discussion of active practice on video or audio-tape.

10. Demonstration of applied knowledge of ethical, legal and professional guidelines (ACA)regarding confidentiality, the counselor-client relationship, professional relationships andresponsibilities, testing and research (CACREP CMH A.4).

11. Demonstrate the ability to identify and articulate key aspects of their clinical orientation as itmatches with evidence-based practices within the field (CACREP CMH A.2).

Course Responsibilities

Villanova Internship Student:o Trainees are expected to be punctual, maintain good professional work habits, and conduct their

client and colleague relationships in accordance with ethical principles and the rules of the FieldSite in which they are placed.

o Trainees are expected to follow the training plan agreed upon by both the Faculty Supervisor andthe field supervisor.

o Termination of the trainee experience will occur at the end of Villanova University‘s springsemester.

o The Field Site can be the trainee‘s place of employment. However, certain criteria must be met.First, the field supervisor should not be the student‘s current supervisor. Second, the student‘sresponsibilities should be different from those that are already included in their job.

Counseling Program:1. The Counseling Program will provide the Field Site with suitable candidates for field placement

through the Faculty Supervisor.2. The Faculty Supervisor retains the ultimate responsibility for assessing the quality of work of the

student trainee, assigning grades and credits to students and for other decisions that affect theacademic progress of students.

Field Site:o The Field Site will hold ultimate responsibility for client and student welfare.o A trainee shall not be allowed to work after normal hours without the on-site presence of a

professional staff member.o The Field Site shall provide the trainee with a field supervisor who has obtained the minimum of

a Master‘s degree in a mental health field (e.g., counseling, social work, psychiatry) with twoyear ‘s post- degree experience. Supervisors must be employed for at least one year in a site thathas been established for at least three years.

o The field supervisor shall meet with the trainee for a minimum of one hour per week ofindividual supervision. Administrative guidance shall be provided by the Field Site as needed.

o The field supervisor shall advise the trainee of the Field Site‘s rules, policies and procedures.


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o All other professionals at the Field Site may be used in an adjunct capacity for training orsupervision.

o The Field Site shall provide suitable opportunities for client contact and other on-site activities,totaling 600 hours over the course of the two-semester internship.

o The Field Site shall have appropriate supervision of all client services and shall retain fullresponsibility for the Field Site‘s administration and delivery of service.

Steps for Securing an Internship Site

1. Identify one or several locations to complete your internship (to obtain a site that is far in distancefrom VU, obtain permission first from program coordinator). Tips on identifying sites:

a. Seek several possible locations and obtain contact information of the counselors via internet,or

b. Obtain a list of sites (Internship Site Directory) from the main office, SAC 302, or from yourfaculty advisor, or

c. Consult with 2nd year counseling students currently completing their internshipsd. If above actions are not successful, consult with the current field placement coordinators

(School Counselors: Jennifer Carangi, at 610-519-8038, or [email protected];

Clinical Mental Health Counselors: Carol Thon at 610-519-5593, [email protected])

2. Sites that are considered ‗available‘ or appropriate for you are those that: a. will comply with your course requirements (see handbook) b. will provide a supervisor who meets course requirements (see handbook)

3. After obtaining site contact information, contact a site, indicate your status as a master-level Villanovacounseling student, and formally inquire as to their interest and availability for taking a clinical mental

health internship student. Move to the next site if this one is not available. You may need to call

multiple sites, multiple times. This is standard.

4. Upon speaking with them, if they ask for your transcripts, resume, or an interview, comply with therequest and send requested materials.

5. 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 to this document

according to the deadlines.

6. Clearances: school counselors need all clearances and should apply as soon as they are accepted intothe program. 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

7. To consider before accepting a site:a. If you are unsure whether the site meets the specifications, obtain permission from your

internship instructor or program coordinator utilizing the required forms.

b. Make sure you have both (you 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 myriad 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.

Course Requirements

Hours:

Students participating in the Internship Course will be required to devote a total of 600 hours over two semesters tinternship activities, in accordance with the Internship Student Agreement (see Form Samples in Appendix).

mailto:[email protected]:[email protected]:[email protected]://artscistore.vuad.villanova.edu/users/cthon/CHR/[email protected]://artscistore.vuad.villanova.edu/users/cthon/CHR/[email protected]://artscistore.vuad.villanova.edu/users/cthon/CHR/[email protected]:[email protected]


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Supervision:

1. Field Site: (Note: Field Site is consistent term used throughout)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 Supervision: Each student will meet individually with the designated VillanovaInternship supervisor during the semester.

b. Group Supervision: Students shall participate in two hours of group supervision per weekwith the Villanova Internship Supervisor during the Internship semesters.

Case Presentations:

Case presentations shall be defined as formal presentations for Individual and Group Supervision of client(s)cases being worked with by students at their field placements. All students will complete formal professional presentations. The professor of the course will outline their particular requirements for this assignment in theirsyllabus.

Counseling Portfolio

Depending upon the course instructor, students may be required to produce a portfolio summarizing theirexperiences during the internship. The professor who requires the portfolio will outline his/herrequirements in detail. The professor of the course will outline their particular requirements for thisassignment in their syllabus.

Journal Writing

Students in an experiential course should take every opportunity to prepare intrapersonal reflections onthe process as research has made clear this is a critical element of counselor development. Particularcourse requirements for journals will be explicit in your individual syllabus.

Field Site Supervisor Evaluation

A satisfactory performance evaluation must be acquired from the field Site Supervisor according to thecriteria listed in the Field Site Supervisor Evaluation form. A copy of this form will be shared with eachfield Site Supervisor early in the semester, and each field Site Supervisor is requested to return the formto the Faculty Supervisor during the final week of classes of each semester of the internship.

Student Activity Timeline

Specific Activity When Completed

A. Application and Site Search:

1. Organizational Meeting January preceding internship

2. Application for CHR Internship (# 1) submitted January preceding internship

3. Application approved; begin placement search January preceding internship

B. Site Search:

4. Site Selection completed--Schools Spring preceding internship

Site Selection completed — CMHC Spring/Summer preceding internship

(Registration Form and requisite internship forms #2 through #5 completed and submitted to field

placement coordinators Carangi/Thon by April 1 and August 1 respectively.)


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C. Internship Supervisory Activities:

5. Villanova Supervisor Letter to Field Supervisors Within first two weeks

6. Group Supervision with Case Presentations Weekly

7. Site Visit or discussion with Villanova Supervisor Midpoint of 1st semester

D. Evaluation Process:

8. Mid-term Evaluation by Site Supervisors Latter half of 1st semester

9. Mid-term Villanova Supervisor Evaluation Latter half of 1st semester

10. Final Letter to Site Supervisors Final 3 weeks of semester

11. Completed Final Evaluation from Site Supervisors Final 3 weeks of semester

12. Student Evaluation of Field Experience Final 2 weeks of semester

13. Final Villanova Supervisor Student Assessment Final 2 weeks of semester

Description of Activities

1. Organizational Meeting: Conducted by the Faculty Supervisor in the last several weeks before theend of the spring semester preceding a student‘s internship for the purpose of information students

planning to participate in Internship in the fall about course requirements. Students will complete an

Application form at this meeting to solidify their intention to participate.

2. Field Placement Site Selection: Each student assumes the responsibility for locating and securing hisor her own field placement site. All school placements MUST be secured by April 1st and therefore

school counselors will begin the process by January at the latest. Instructor assistance with site

selection will be provided as needed in addition to the Internship Site Directory.

3. Site Qualifications: Field placement sites for the Internship characteristically consist of communityservice agencies, hospitals, public schools, or institutions of higher learning which offer guidance,

mental health, or preventive counseling services in both individual and group settings. Finaldetermination as to the suitability of all field placement sites rests with the Faculty Supervisor.

4. Site Supervisor Qualifications: Field placement Site Supervisor s must have at least a master‘s degreeand three years of experience in counseling or counseling-related activity. Final determination as to

the suitability of site supervision rests with the Faculty Supervisor.

5. Site Approval: Internship students must have prior approval from the Faculty Supervisor beforecommitting 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 Supervisor approval of field placement sites will be indicated on the Field PlacementDescription/Authorization Form. Sites shall not be considered approved until this process is complete. To facilitate this process, these forms should be sent to either Ms. Carangi for school counselors or Ms.

Thon for CMH Counselors. Their mailboxes are in SAC 302. Each coordinator will confer with your

particular Faculty Supervisor to authorize approval for your sites.


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6. Introductory Letter to Site Supervisors: During the first two weeks of Internship I, the FacultySupervisor 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 as the end of the semester.

7. Group Supervision of Counseling: All students enrolled in the Internship course will meet each weekfor 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

and number of case presentations will be determined by the Faculty Internship Supervisor.

8. Site Visits by Faculty Supervisor: During each semester of the Internship course, the FacultySupervisor may visit 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 Supervisor, and students will not be

expected to attend these meetings unless their Site Supervisor requests their presence.

9. Internship I Site Supervisor Evaluation: The student will bring this form, after it is completed by theSite Supervisor, to his/her meeting (#10) with the Faculty Supervisor.

10. Internship I Faculty Supervisor Assessment Session: Students will meet individually with the FacultySupervisor 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

nonacademic counseling skill development.

11. Internship II Final Letter to Site Supervisors: Near the end of the Internship course, the FacultySupervisor will send a letter to all Site Supervisors, thanking them for their participation and theircompletion and submission of the Evaluation of Student Performance form, and soliciting their

general feedback regarding the Internship experience.

12. Receipt of Completed Site Supervisor Evaluation Form: Site Supervisors are requested to returncompleted Evaluation of Student Performance forms by the scheduled date of each student‘s f inal

individual assessment meeting. Students will inform their Site Supervisors of this date, and forms

may be returned via the student or directly to the Faculty Supervisor.

13. Student Evaluation of Field Placement Experience: In preparation for their final supervision sessionwith the Faculty Supervisor, 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. Final Faculty Supervisor Assessment Session: During the last two weeks of the Internship IIsemester, students will meet individually with the Faculty Supervisor for the purpose of performance

appraisal and evaluation of the field placement site. Specific requirements for this session will be

arranged by your Faculty Supervisor.


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Role Descriptions

1. Student: The major expectations for students participating in the Counseling Internship course areto participate fully and to take seriously the pursuit and achievement of the learning goals set forthin the Specific Learning Objectives section of this manual.

2. Faculty Internship Supervisors: Responsibilities include the following:

1. Approval of course syllabus2. Approval of field placement sites/supervisors3. Provision of orientation and ongoing information to field placement Site Supervisors4. Oversight of the delivery of Internship course activities5. Observation of each student‘s counseling activities through A/V6. Provision of group and individual supervision7. Monitoring student effort and progress toward fulfillment of course objectives8. Completion of site visits for student supervisees9. Collection and maintenance of student supervisees‘ paperwork10.

3. Field Placement Site Supervisor: Field placement Site Supervisor responsibilities and expectationsare defined in the Site Supervisor Agreement provided in the Form Samples section of thishandbook.

Grading

A student‘s grade for each semester of the Internship will be awarded according to their Faculty

Supervisor ‘s syllabus.

Professional Liability

Students who are enrolled in the Counseling Internship course are entitled to the 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, though not

required, the purchase of individual professional liability insurance coverage by students enrolled in the

Counseling Internship course is encouraged. There are some 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.

Video/Audio Recording

All clients in counseling sessions to be recorded must give prior written authorization for the

recording to occur. It shall be the responsibility of the Internship student to insure that written client

authorization for audio/video recording is on file in each client‘s record. If not available at the site,

audio/video recording forms and instructions will be provided by the Internship supervisors. All

counseling sessions must be taped, preferably with video.


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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.

Appendix

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.

1. Application for Supervised Internship in Counseling2. Registration Form3. Clearances4. Site Supervisor Agreement5. Student Agreement6. Training and Experience of Field Placement Supervisors7. Field Placement Description/Authorization Form8. Weekly Activity Record9. Consent for Audio-Visual Recording10. Case Presentation Outline11. Case Presentation Assessment12. Class Participation Evaluation Form13. Evaluation of Student Performance by Field Placement Site Supervisor14. Student Evaluation of Field Site


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Villanova University- Graduate Program in Counseling

Supervised Internship Form # 1

Application for Supervised Internship in Counseling

(Due at the Internship Orientation Meeting in late January prior to the start of a fall internship.)

Name:_ ____________________________________________ Today‘s Date: ________ ____

Villanova ID#________________________ Email address: ___________________________Local Address:___________________________________________________________

Home Telephone:______________ Work Telephone:______________ Cell Phone______________

I wish to begin Internship during which semester: Fall, 20_____ Spring, 20_____

Program: ____Clinical Mental Health ____Elementary School ____Secondary School

List grades in the following required courses you have completed:

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:

_________________________________________________________________________________

Please list your 3 preferences for a placement site below: (FIT on one page)

School/Agency Prospective Supervisor Telephone

1._______________________________________________________________________

2._______________________________________________________________________

3. _______________________________________________________________________

General

*Lab in Counseling Skills ______

*Laboratory in Group Dynamics______

*Counseling Theory & Practice______

Research & Evaluation or Statistics______

*Ethics in Counseling______

Human Growth and Development______

Lab in Counseling Diverse Population______

Lifestyle and Career Development______

Assessment and Appraisal______

School*Practicum in Elem/Sec. School______

*School Counseling Orientations______Consultation Processes______Therapeutic Strategies or Adolescent CounselingInterventions______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______

Courses with * are required prior to field experiences.


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Villanova University- Graduate Program in Counseling Supervised Internship

Form # 2

Registration Form

Name: ___________________________________ ID # ________________________

Semester: _______, 20_____ Email address:__________________________________

Address:________________________________________________________________

Villanova Advisor________________________

Home Phone:______________Work Phone:_______________Cell Phone:__________

Courses to be completed during the internship semesters:

___________________________________ ________________________________

___________________________________ ________________________________

Placement Site:

Name___________________________________________________________________

Address__________________________________________________________________

________________________________________________________________________

Nature of Service______________________________________________________________

Supervisor____________________________________________________

Telephone___________________________ Email__________________________


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Graduate Program in Counseling


Clearances

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 TODAY i as the process can take up to a month 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: https://epatch.state.pa.us/Home.jsp □ Act 151 Child Abuse Clearance:

www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/form/s_001762.pdf

□ Act 114 FBI fingerprinting: https://www.pa.cogentid.com/index_pde.htm

□ 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 variousschool districts. All school placements MUST be secured by April 1, which means starting the search by January atthe latest. School counselors MUST have all legal and health clearances in place at the start of the search as theymust be submitted with the school placement requests.

Agency placements may continue into the summer and clearances are not necessarily required; it dependson the client population and agency requirements.

mailto:[email protected]:[email protected]:[email protected]://epatch.state.pa.us/Home.jsphttps://epatch.state.pa.us/Home.jsphttps://epatch.state.pa.us/Home.jsphttp://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/form/s_001762.pdfhttp://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/form/s_001762.pdfhttps://www.pa.cogentid.com/index_pde.htmhttps://www.pa.cogentid.com/index_pde.htmhttps://www.pa.cogentid.com/index_pde.htmhttps://www.pa.cogentid.com/index_pde.htmhttp://www.dpw.state.pa.us/ucmprd/groups/webcontent/documents/form/s_001762.pdfhttps://epatch.state.pa.us/Home.jspmailto:[email protected]


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Supervised Internship

Form # 4

Field Site Supervisor Agreement

(03/11)

As the Site Supervisor for ______________________________________________, I agree:

1.

That I possess the necessary qualifications to supervise the named intern in his or her identifiedareas of responsibility with my organization (minimum: masters degree and 3 years post mastersexperience in counseling or counseling-related activity and have been with the site for at least oneyear. 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 abovenamed 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 I will provide a supportive, learning-oriented environment, which affords the counselingintern opportunities for professional counseling activity and experience in giving and receiving

feedback related to that professional activity.

4. That I will introduce and orient the counseling intern to this professional setting, making sure thathe/she understands its organization, role expectations and policies & procedure (including recordkeeping requirements for counseling activity).

5. That I will be reasonably available to assist the counseling intern outside of the weeklysupervision hour (if needed) in the performance of his/her assigned responsibilities.

6. That I will encourage the counseling intern to participate in those professional activities that willmaximize his/her learning as well as his/her effectiveness in this professional setting.

7. That I will help facilitate the recording of the intern‘s counseling activity during the experiencefor use during group supervision conducted by the Faculty Supervisor.

8. That I will meet at this setting with the counseling intern‘s Faculty Supervisor once during theinternship to discuss the nature of the Internship placement and student‘s progress in the placement.

9. That I will complete one mid-term and one final Internship Student Evaluation to assess thestudent‘s skill level and progress on learning goals.

Supervisor Name/Title: ______________________________________________________

Date: __________________________________Signature______________________________


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Student Agreement

(03/11)

1. As a Counseling Intern in a professional setting, I hereby attest that I have read and understand theAmerican Counseling Association Code of Ethics, and will practice my counseling in accordancewith 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 followingInternship objectives.

2. I will complete a minimum of 600 hours of Internship activity in accordance with the following:a. Provide direct counseling service to clients b. Conduct on-site, internship-related activityc. Receive weekly individual supervision from Site Supervisord. Receive weekly group supervision from Faculty Supervisore. Attend individual meetings (2) with Faculty Supervisor

3. I will provide direct counseling service to clients that are assigned to me. The counseling format mayinclude individual, family, marital, vocational, group, and/or assessment. I will document theseservices in accordance with school/agency policy and in compliance with any standards set forth bythe Faculty Supervisor, such as video tapes, in-depth case study, a daily log, group program, etc.

4. 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.

5. I will become familiar with other key organizations and individuals, which support the mission of myInternship 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, observationsof other staff members with clients, participation in simulated (role-play) counseling sessions, learningabout tests that the organization uses, etc. to maximize my understanding of and effectiveness in the professional setting in which I am placed.

6. I will strive to develop positive working relationships with staff members and other persons/agenciesaffiliated 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.

7. During the semester of my Internship, I will be prepared to present videotaped sessions of mycounseling activity to the supervision group and/or the Faculty Supervisor in accordance with the

established case presentation format.

Student Name: Date:

Student Signature:


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Site Supervisor Training and Experience

We would like to keep on file a record of the training and experience of each field placement SiteSupervisor. Students, please ask your Site Supervisor to complete this form (or attach a vita).

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 When

Current Licenses/Certifications:

Type State Date

Name of Villanova student(s) to be supervised:


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Graduate Program in Counseling


Field Placement Authorization Form(03/11)

YOU MUST COMPLETE AND SUBMIT YOUR PAPERWORK BY JUNE 1st (school) orAUGUST 1

ST (Clinical MH)

(To be completed by student and submitted to Coordinator Jennifer Carangi for School Counseling orCarol Thon for CMHC Counseling in 302 SAC mailboxes or directly in G44 Mendel offices).

Student:__________________________________________ Date:_______________________

Field Placement Name and Location:

Name: _________________________________________________________________

Location address:_________________________________________________________

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

---------------------------------------------------------------------------------------------------------------------

Field Placement Authorization

____ Form #1 Supervised Internship in Counseling Registration Form

____ Form #2 Field Placement Authorization Form (this one) ____ Form #3 Signed Site Supervisor Agreement ____ Form #4 Signed Student Agreement ____ Form #5 Completed Site Supervisor Training & Experience form ____ 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 setforth in the Site Supervisor Agreement.

________________________________________ ________________________Villanova Faculty Supervisor Date


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Supervised Internship Form #8

Weekly Activity Record

Counseling Intern:_____________________________ Week:______________________

Counseling Summary

Case ID or Group ID # Sessions # No-Shows # Cancellations #Terminations

General Activity Summary

# hours of individual counseling:________

# hours of group counseling:________

# hours of family/couples counseling:________

# hours of clinical preparation/record-keeping:________

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

# hours of site-related administrative activity:__(school: lesson planning, behavior management programming, 504, IEP, etc.)

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

# hours of individual supervision on site:________

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

Total Number (#) hours “on the clock” at the field placement:________

Supervisor Initials: ______________

Supervisor Comments (if needed): ________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________


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Supervised Internship Form #9

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 SupervisionGroup. I have been informed that the viewing focus will be on the counselor him or her-self, inan effort to evaluate his or her skills as a professional. I understand that my full name will notappear on the tape or any other materials; I further understand that the recorded sessions will beerased upon the named 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


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Supervised Internship Form #10 (Example)

Case Presentation Outline

The specifics of a case presentation will differ for each professor. This is a very basic and general guide.

Client:___________________________ Counselor-in-training:_____________________________

Date:_______________________ Presented Previously: Yes____ No____

Note: For cases presented previously, distinguish information in 1-4 below that is new or revised orotherwise pertinent to this presentation.

1. Case history/situation:

2. Counseling status (# of sessions, frequency of sessions, group/individual, volunteer/resistant client,etc.):

3. Presenting Problems & Strengths:

4. Socio-cultural influences

5. Intervention:a. Theoretical Framework

a. Link to evidence based practice b. Goals (Long-term & short-term)

c. Techniques (Please address each skill that you use. Ensure relationship to theory and goals.)

d. Future Directions

6. Topic of recorded session segment to be presented:

7. Specific issues/questions for group feedback:


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Supervised Internship

Form #11

Case Presentation Assessment

Needs High

Attention Adequate Quality

Written Presentation Content:

1. Comprehensiveness 1 2 3 Each category contains relevant information directly

pertaining to the case.

2. Relevance of audio-visuals 1 2 3Segment directly pertains to the questions being asked, iscontinuous enough to allow peers to gain an understanding

of the client, and is understandable.

3. Quality of questions 1 2 3 Most questions are specific, are related to the treatment

plan, and are clearly articulated.

Oral Presentation:

1. Organization 1 2 3 Presenter uses the framework, illuminates the written

information, and presents systematically.

2. Completeness 1 2 3 All segments are touched on sufficiently.

3. Timing 1 2 3 Presenter is knowledgeable of time frame and utilizes it as

recommended.

4. Response to feedback 1 2 3 Presenter listens attentively, utilizes the time to gather as

much feedback as possible (follow-up questions), and lets the

group know if he/she needs something different from the

group.

Recommendations/Comment:


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Villanova University- Graduate Program in Counseling Form #13

Evaluation of Student Performance by Field Placement Supervisor Note to Site Supervisor: Please complete the following evaluation of the named intern‘s performance during the currentsemester with your agency, and return it to the Faculty Supervisor either through the student, the mail or email during the 3 rd to last week of the internship semester. Please feel free to contact the Faculty Supervisor with questions or problemsregarding this task. Thank you for your assistance.

Intern: _____________________________ Site: __________________________ Due on: ____________

1 = Far below expectations — needs much improvement, a concern2 = Below expectations — needs some improvement, a concern3 = Acceptable — meets standards at average level for interns (the majority of trainees will fall here) 4 = Above expectations — performs above expectations for interns5 = Far above/exceeds expectations — performs well beyond average for interns NA= Not applicable or not enough information to form a judgment

I. Ethical awareness & conduct:

Knowledge of ethical guidelines (general and on-site) …. 1 2 3 4 5 N/A

Behavior is consistent w/ethical guidelines …………… 1 2 3 4 5 N/A

Consults with others about ethical issues ……………… 1 2 3 4 5 N/A

Is punctual in class and at Internship site, stays full time... 1 2 3 4 5 N/A

Comments: _________________________________________________________________________________

___________________________________________________________________________________________

II. Professional knowledge, receptivity, and skills:

A. Knowledge, skills:

Knowledge of client population ……………………… 1 2 3 4 5 N/A

Knowledge of role of counselor ……………………… 1 2 3 4 5 N/A

Knowledge of ref erral/local community resources …… 1 2 3 4 5 N/A

Successful with diverse (racially/SES, etc.) clientele …… 1 2 3 4 5 N/A

Comments: _________________________________________________________________________________

_____________________________________________________________________________________

B. Relational/Counseling skills

Comprehends complex problems and solutions ……… 1 2 3 4 5 N/AAble to build rapport with all clients …………………… 1 2 3 4 5 N/A

Demonstrates empathy —visibly …………………… 1 2 3 4 5 N/A

Accurately reflects session content …………………… 1 2 3 4 5 N/A

Accurately and comfortably reflects feelings………… 1 2 3 4 5 N/A

Tailors skills & interventions culturally to fit client …… 1 2 3 4 5 N/A

Comments: _________________________________________________________________________________

___________________________________________________________________________________________


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III. Interactions and Consultations with Coworkers/other professionals/families, etc.:

Consults with appropriate persons ………………… 1 2 3 4 5 N/A

Provides valuable information to client/client‘s family: 1 2 3 4 5 N/A

Effectively, clearly conveys information ……………… 1 2 3 4 5 N/A

Presents self professionally and confidently …………… 1 2 3 4 5 N/A

Comments: ________________________________________________________________________________

___________________________________________________________________________________________

IV. Response to Supervision:

Actively seeks critical feedback ……………………… 1 2 3 4 5 N/A

Receives critical feedback well ……………………… 1 2 3 4 5 N/A

Changes behaviors following feedback ………………… 1 2 3 4 5 N/ADemonstrates awareness of personal strengths & weaknesses 1 2 3 4 5 N/A

V. Notable Strengths Observed in Intern’s Performance:

VI. Notable Areas for Improvement Observed in Intern’s Performance:

VII. Has the Intern satisfactorily fulfilled your expectations in his/her assigned role?

VIII. May this evaluation be shared with the named intern?

Supervisor Signature: ____________________________________ Date: ____________


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Villanova University

Supervised Internship in Counseling Student Evaluation of Field Site

Form #14 (03/11)

1. Student: Semester: _______________, 20____

2. Site:_______________________________________________________________________

3. Supervisor Name:____________________________ Title:___________________________

4. On-Site Responsibilities:

5. % 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 thisinternship site? Why or why not?

Supervised Internship in Counseling Student Handbook

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