Missouri Credentialing Board

MAADC I - Professional Development Contract Supervisor


 MAADC I - Professional Development Contract for  [esiggravity formid="11" field_id="3" ] 

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 [esiggravity formid="11" field_id="3" ] according to the ethical principles and code of conduct of the MCB.

[esiggravity formid="11" field_id="6" ]

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

Leave this empty:

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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