Missouri Credentialing Board

MAADC II Mentoring & Clinical Supervision/Professional Development Contract 818


Mentoring and Clinical Supervision Agreement for

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

THIS FORM MUST BE SIGNED BY A MCB QUALIFIED SUPERVISOR

(This cannot be an immediate family member)

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

AND

MAADC II  - Professional Development Contract for

THIS FORM MUST BE SIGNED BY A MCB QUALIFIED SUPERVISOR

( This cannot be an immediate family member)

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

 I agree, to the best of my ability to uphold the guidelines specified in the supervision contract and to manage the supervisory relationship process for according to the ethical principles and code of conduct of the MCB.

AND

We agree, to the best of our ability to uphold the agreement outlined above and to manage the supervisory relationship process according to the ethical principles and code of conduct of the MCB.

Applicant's Name:

Supervisor's Name:

Supervisor's Training Certificate Number (Not credential number):

Leave this empty:

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Document name: MAADC II Mentoring & Clinical Supervision/Professional Development Contract 818
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August 1, 2018 1:15 pm CSTMAADC II Mentoring & Clinical Supervision/Professional Development Contract 818 Uploaded by Stacey Langendoerfer - MOCredentialingBoard@gmail.com IP 173.22.130.239