Doug Allen DASA Youth Treatment Grant Director Clinical Supervision Infusion Project

John Taylor Chief, Office of Program About the project services Who should participate in this training? Michael Langer Any youth treatment agency that desires to implement a clinical supervision program. Supervisor, Prevention Those who have attended the Clinical Supervision I and II will have priority. and Treatment Services How will it serve my agency? Agencies will receive high quality training and coaching for a period of six months that David Jefferson Adolescent Treatment will assist their program in implementing a clinical supervision model. Programs with Coordination Manager existing supervision programs can also benefit by using the training to enhance their program. What is my commitment? . The Executive Director must be committed to the process. . Identified program staff must have times and resources to participate in the training and mentoring. . Agencies must commit to at least six months of coaching. The coach will perform at least one onsite visit per month and provide monthly telephone and email support. . Program staff and coach will participate in a two-day immersion workshop to strategize and develop a work plan. Who is providing the training? . DASA has contracted with the Northwest Frontier Addiction Technology Transfer Center (NFATTC) to provide the training and ongoing technical assistance, and the RMC Research Corporation to help with data collection and outcomes process. How do I apply? . Agency director fills out this application and submits to David Jefferson, DASA Adolescent Treatment Coordination Grant Program Manager, at the address below. . Participation is limited to six programs. . Applications are due January 3, 2008.

DASA – David Jefferson Post Office Box 45330 Olympia, Washington 98504-5330 Phone: (360) 725-3814 E-mail: [email protected] When will agencies be notified of their acceptance? ▪ Applications will be reviewed promptly and agencies notified by January 10, 2008. If I have questions? ▪ Please call David Jefferson at the above phone number.

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DASA Youth Treatment Grant Clinical Supervision Infusion Project Application

Please complete the following application and include a cover letter written by the agency director that describes your commitment to the project.

Agency Information Telephone/E-mail/Fax

Agency Name: Telephone:

Primary Contact: E-mail:

First Name: Fax:

Last Name:

Street:

City:

Zip Code:

1. Have your staffed been trained in Clinical Supervision?

2. Please describe your current Clinical Supervision Program.

3. Will your staff have sufficient time to participate in this project and what steps will you take to ensure they do have the time?

4. Please describe your programs capacity and readiness to undertake this project.

5. What are the primary reasons you want this training?

6. What benefits and barriers do you foresee?

7. Please project what a success would look like, one year from this date.

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