Missouri Credentialing Board

MAADC I - Professional Development Contract Supervisor


 MAADC I - Professional Development Contract for   

THIS FORM MUST BE SIGNED BYA 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.

Please enter your Clinical Supervision Training Certificate Number (not credential number):   

Leave this empty:

Signature arrow
Missouri Credentialing Board https://missouricb.com
Signature Certificate
Document name: MAADC I - Professional Development Contract Supervisor
lock iconUnique Document ID: 786dfc8c91aa4e2148f2aaf4eca5e3da1906e4d4
Timestamp Audit
2017-05-22 08:33:48 CSTMAADC I - Professional Development Contract Supervisor Uploaded by Stacey Langendoerfer - MOCredentialingBoard@gmail.com IP 71.51.221.41