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Fall Renewal Supervisor MAADC II 9718 wostripe

Mentoring and Clinical Supervision Agreement and Professional Development Contract -

Mentoring and Clinical Supervison Agreement

Adapted from Stiehl, R. and Bessey, B. (1994)

I, , a MCB Qualified Supervisor, agree to work with .

MCB Qualified Supervisor includes an individual who holds a CRADC, CRAADC, CCJP, CCDP, CCDP-D, RADC, RADC-P, LPC, LCSW, or Licensed Psychologist and has completed the MCB Clinical Supervision Training. This cannot be an immediate family member. (This form covers both the Mentoring and Clinical Supervision Agreement and Professional Development Contract).

Step 1: Agree to work together

Agree on working together toward improving the supervisee’s counseling skills

Step 2: Define and agree on learning goals

The learning goals must be clearly defined, and there needs to be agreement to work together to help the supervisee attain proficiency in the skills chosen

Step 3: Understand the value of the goals

The supervisee needs to understand the value of achieving the agreed upon goals

Step 4: Break goals into manageable parts

The overall goals need to be broken down into parts such as: a) the knowledge, b) the skills, c) the attitudes necessary to attain proficiency

Step 5: Pick styles and methods of learning

The supervisor needs to elicit from and negotiate with the supervisee his or her preferred styles and methods of learning

Step 6: Observe and evaluate

How progress will be observed and evaluated needs to be discussed and agreed upon

Step 7: Provide feedback

The supervisor needs to know how to give feedback which guides, corrects, and at the same time encourages

Step 8: Demonstrate competency and celebrate

An outcome demonstration of the newly acquired skill which confirms success needs to be designed, followed by a celebration of the accomplishment

Professional Development Contract

Purpose, Goals and Objectives of Supervision:

Monitor and promote welfare of clients seen by Supervisee
Promote development of Supervisee’s professional identity and competence by using the tools learned in the Clinical Supervision: Building Chemical Dependency Counselor Skills Training
Oversee Supervisee’s entrance and advancement in the credentialing process
Ensure ethical standards are maintained

Supervision Methods:

Face to face sessions
Supervisee attending trainings (both in-service/outside)
File and documentation review
Use of forms learned during clinical supervision training (Rubrics, Competency Rating Form, PDP, etc…)
Preparing the case presentation when applying for certification

Evaluation of Supervisee:

Feedback will be provided during each face to face session
A formal evaluation will be conducted every 90 days using the Competency Rating Forms and Professional Development Plan to identify improvement areas

Supervisee Responsibilities:

Maintain ethical guidelines and professional standards
Improve personal knowledge, skills and attitude by following the Professional Development Plan and advice of supervisor
Attend trainings to stay current in the field
Perform all duties while keeping the client’s best interest in mind

We agree, to the best of our ability to uphold the guidelines specified in the supervision contract and to manage the supervisory relationship process according to the ethical principles and code of conduct of the MCB. Signing this form covers both the Mentoring and Clinical Supervision Agreement and the Professional
Development Contract.

Supervisor Printed Name:

Supervisor Clinical Supervision Training Certificate Number (NOT credential number):

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Missouri Credentialing Board https://missouricb.com

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October 12, 2018 7:59 am CST

Fall Renewal Supervisor MAADC II 9718 wostripe Uploaded by Stacey Langendoerfer - MOCredentialingBoard@gmail.com IP 173.22.130.239