<p> Integration Manual 2014-2015 1 </p><p>Integration and Clinical Experience Manual for EDC 720 and EDC 721</p><p>Department of Counselor Education</p><p>The College at Brockport State University of New York Integration Manual 2014-2015 2 </p><p>Table of Contents</p><p>Introduction 3 Getting Started 3 Counseling Related Procedures 3 Intake/Assessment 3 Record Keeping for Ongoing Counseling 4 Client Files 4 Progress Notes 4 Extensive Progress Note 6 Termination or End of the Semester 7 Safeguarding Client Records 8 Referrals 8 Recording Sessions 9 Clerical Procedures and Related Information 9 Office functioning 9 Scheduling 10 Counseling Tasks 10 Where to Find What 11 Session Recording Equipment 11 Professional Attire 11 Ethics 11 Overview 11 Informed Consent 12 Confidentiality 13 Client Categories and Avoiding Dual Relationships 15 Supervision 16 Definitions 16 Purpose/Function 16 Roles in Supervision 17 Conflict Resolution in Supervision 18 EDC 721: Clinical Experience in Integration 18 References 20 Appendixes Integration Manual 2014-2015 3 Introduction</p><p>The Counseling Center of The College at Brockport State University of New York provides counseling and related services to students, as well as consultation, training, and outreach in order to enhance the quality of life and learning for all members of our College community. The Counseling Center also provides a training site to graduate practicum counselors from the Department of Counselor Education, enrolled in EDC 720: Integration and Application of Basic Concepts. In that capacity, you become crucial and a valued contributor to the Counseling Center; the Counseling Center warmly welcomes you into that role.</p><p>Getting Started</p><p>The following thoughts may ease your start in your practicum experience. Remember that you are both a student and a practicum counselor. Your roles are to learn and to provide counseling services. You are not expected to know everything or to be perfect. Ask for help when you think you need it. The Counseling Center staff is very willing and able to help, as are your individual supervisors and instructor. Remember that you already know a lot. The knowledge and skills of your program so far have already been extensive and will serve you well. Your faculty knows you are ready to begin this next step. While you need to be open to learning, you also need to critically examine what you are learning. You do not learn if you uncritically model everything you observe or accept everything you are told as the truth. This experience is an opportunity for you to begin to develop your style in counseling. Supervisors and Counseling Center staff may model their approaches to counseling. Although initially you may feel less anxious modeling your supervisor's approach to counseling, it is important in your learning process to take risks and struggle with defining your style in counseling. Last but not least, take advantage of this experience as a practicum student. Once you graduate, you are more than likely to receive little clinical supervision at your work site. So benefit from being a practicum student. Soak up this experience. Take advantage of this opportunity to be supervised while you learn and grow as a counselor. Enjoy!</p><p>Counseling Related Procedures</p><p>Intake/Assessment</p><p>When a student requests services, an intake appointment is scheduled. Prior to the appointment, the client is asked to complete an Intake Questionnaire (see Appendix A). The intake questionnaire yields information on the client's psychological and educational history, and is used to screen for imminent needs (i.e.: lethality). Once the paperwork is filled out, the Counseling Center receptionist then matches the client with the counselor best suited to meet the client’s needs. The receptionist will also enter any additional pertinent client information into Electronic Medical Record System. The purpose of the intake is to obtain an understanding of the client's presenting concerns and to obtain pertinent background Integration Manual 2014-2015 4 information. This information assists the intake counselor in deciding what kinds of services seem most beneficial to the client. The intake interview is also a time to discuss with the client the issue of informed consent. As a practicum student, you will be conducting supervised intake interviews of clients seeking services to fulfill a class requirement for their Introduction to Counseling class. Once you have been cleared by our on site adjunct faculty, you will be able to conduct independent intake interviews. We will go over this procedure in class. </p><p>When a client is assigned to you, the intake counselor explains: the nature of the arrangement; the issue of recording and supervision; confidentiality and limits to confidentiality; privacy and risks to privacy; and, asks the client to complete a Permission to Tape Form (see Appendix B). The intake counselor also signs this form. After the session is complete, you will need to have the Permission to Tape Form scanned and uploaded to the client’s record in Electronic Medical Record System. The Counseling Center staff have also developed a worksheet for you to use during intake sessions (see Appendix M), which assists you in covering all the necessary intake questions.</p><p>Record Keeping for Ongoing Counseling</p><p>The Counseling Center uses an Electronic Medical Record System for all its record keeping. The individual counselor who meets with the client is responsible for writing up the intake summary, keeping case notes of each session, and completing a termination summary at the end of counseling. Any telephone calls to the client or regarding the client, and staff or non-supervision consultations regarding the client are also documented in the client's file on Electronic Medical Record System. All of your notes will need to be reviewed and signed off by the adjunct on-site faculty. The Counseling Center keeps track of statistics regarding how many students are served each academic year. As such, you will be required to fill out an Encounter Form (Appendix C) after each visit. Please check with Counseling Center staff regarding the completion of encounter forms. </p><p>Client Files Client Electronic Medical Record System files should contain the following: (1) Intake Questionnaire, (2) Written intake summary, (3) Progress Notes (Appendix D) and (4) consent forms (Appendix E) as applicable. Upon termination, files should contain the above and a Termination Summary. Please note that Consent Forms and Permission to Tape Forms will need to be scanned and uploaded to the client’s file in Electronic Medical Record System.</p><p>Progress Notes</p><p>Progress Notes must be completed in the Counseling Center and in almost all cases should be completed on the week you see your client. They are stored in Electronic Medical Record System and provide a record of events, are a means of communicating among professionals, encourage counselors to review and assess treatment, and are a legal record (Baird, 1996). Consequently, it is important that you are thoughtful about what you write in Integration Manual 2014-2015 5 your case notes. Because records may be disclosed under special circumstances (e.g., court order, client request), you should keep in mind the possibility that others might have access to your case notes. Baird (1996) suggests four tips to follow in writing case notes. First, avoid recording your emotional reactions or personal opinions about clients. Second, avoid recording unfounded or unnecessary speculation in your notes. For example, if your client seemed a bit down during a session but there is no reason from the client's history, statements or actions to suspect suicide potential, it would unwise to record something like "Client was down today but I do not think suicide potential is high." If you mention suicide, you must also assess potential for suicide carefully and document that you did so, how so, and any preventive or follow-up actions that you took, based on your assessment. If suicide risk is not elevated above normal, do not mention it. The point is to not speculate about something so serious in your notes unless you follow up your speculations during that session. Third, do not take blame. In other words, do not write in your records that you made a mistake. Fourth, do not falsify your records. If at some point in your work with a client you realize that a previous record is deficient in some way, at the time you recognize the deficiency you can make a note that you discovered something that needed to be added or changed in an earlier note. This does not mean that you change the original note. Instead, you make a separate and later note that indicates what needed to be changed or added. Seek consultation with the on- site adjunct faculty member if this should occur. In your first days at the Counseling Center, please ask to see examples of recent progress notes by professional counseling staff members in order to get a good understanding of what is expected from you in this important record keeping and thought task. Our on-site adjunct faculty will review your progress notes through the semester. When you have particular questions about your progress notes, please ask the on-site adjunct faculty to check that particular note a.s.a.p. Also, the Counseling Center professional staff are very helpful and will also provide guidance to you for your progress notes, as needed and as time allows. There are several areas of information that you are to complete on the Progress Note form. An overview with brief examples of the areas of information follows. A fuller example follows the overview. Primary Focus of Session. This section is a brief, but descriptive summary or overview of the general topics of the session/meeting. It is usually 1-3 sentences, but could be thought of as a long headline or title that sets the tone and prompts the reader what to look for in the longer sections below. Progress. This means changes that you see in your client, but also provides a framework for elaborating on the Primary Focus of Session. It includes both process and content and is written in present-tense. The changes that you observe can be within the counseling session. Example 1) Richard is beginning to express himself more openly in counseling. Example 2) Jan is shifting from using her counseling time to talk of others or abstract philosophical concepts to direct expressions of her emotions and thoughts of herself. The changes can be within the person of the client. Example 1) Richard reports he is becoming more honest with himself and more dissatisfied with his socially isolating behaviors of frequent highly critical thoughts, attitudes, and sometimes statements to others. Example 2) Jan reports feeling more confident and ready to risk attempting new relationships. Integration Manual 2014-2015 6 Example 3) Tamika appears to be becoming more introspective. At first she seemed to assume her self-criticisms were true and permanent. Now, she is realizing that they are a choice for her and she has the option of accepting herself as less than perfect. The changes can be external behaviors, told to you in sessions. Example 1) Richard has begun realizing and actively stopping his line of thoughts when critical of others. As a result, he has begun to feel more confident in himself. Example 2) Jan volunteered to help with a theater production. She is excited that others have reached out to her, spent time talking with her, and have invited her to spend more time with them. Example 3) Tamika reports feeling happier, more self-accepting. She got a B on a recent test and found that she did not dwell on the imperfection of the grade. She saw the grade as a measure of her subject and test taking skill in a given moment, rather than as a measure of her self-worth. MSE (mental status exam/observation). This section is your observation of your client’s mental, emotional, and physical wellness in your session/meeting. The kinds of things usually written include client’s mood, physical appearance, level of insight, whether or not he/she was cooperative and/or engaged in counseling and any lethality issues. A partial example would be, “Richard appeared tired, and less well-kempt than usual. His mood could be described as mildly lethargic, yet he was pleasant and engaged in the session.” “Jan was comfortably well dressed. She was relaxed, eager, and motivated for her work in counseling. She appeared energetic and engaged in the session”. If a client has discussed any issues re: to danger to self or others, you would note that in this section. Plan. This section can be a description of actions your client intends to take and/or descriptions of helpful actions that you intend take in future sessions. An example might include, “Follow up appointment in one week. Discuss case with Dr. Duffy re: possible psychiatric evaluation” or “Jan plans to continue spending time with her old friends, while continuing to be open to other new friends in her life,” or “Tamika plans to continue counseling for about four more weeks, until the end of the semester.” Statements of your continued actions might include, “Writer will continue to monitor Richard’s anxiety and depression levels and watch for any signs of deterioration,” or “Continue reflecting to Tamika every time she verbalizes negative thoughts and feelings about herself”. </p><p>An Extensive Progress Note </p><p>This is an example of a session addressing potential imminent danger. While this example is not in Electronic Medical Record System Schedule format, it does provide you with an idea of the areas that are covered in a progress note. Progress Note</p><p>Primary Focus of Session: Follow up session to address recent relationship break-up. Most of session spent assessing suicidal ideation and planning for safety. </p><p>Progress: John came into session emotionally upset, and reported that he and his long-time girlfriend had recently broken up. States it was primarily her decision, and that he wanted to try and work things out. He reported feeling sad, angry, and hopeless. Verbalized wanting to “sleep forever” and wondered what she would feel like if he “was no longer here”. Writer Integration Manual 2014-2015 7 asked client if he was having thoughts of killing himself, and John admitted that he was feeling so awful, he wanted to escape. Further processing revealed he has been thinking about taking “as many pills as I can find” in an attempt to end his pain and most likely, his life. Writer asked client to talk about what pills he would take, and how many. He said that he did not know what pills, but that was the way he would do it if he were to act on his suicidal thoughts. Furthermore, he reported that he does not have access to any pills at home, but that he thought about going to the store and buying a bunch of over the counter medications. Writer assessed protective vs. risk factors, which revealed that John has never had any prior suicide attempts and he has never seriously considered it to be an option. Although he is markedly distressed over the loss of his girlfriend, he has no history of mental illness, and no one in his family has ever attempted suicide that he knows of. He has a number of good friends he feels he can talk to, as well as, a great relationship with his brother and his parents. Risk factors include current ideation, occasional alcohol abuse, and recent loss. When discussing the future, however, John was able to talk about upcoming holidays and looking forward to graduating in May. </p><p>We established a plan for his safety between today’s meeting and our next meeting, which is scheduled for next Thursday. In the plan, John agreed not to make any attempt to acquire pills or any other means of suicide. He is able to guarantee his safety in our plan, but also realizes that he is going through a dangerous time. John also agreed that his use of alcohol puts him more at risk. He has agreed not to drink alcohol between now and our next meeting. Additionally, if he finds that he begins to have persistent thoughts of suicide between now and the next time we meet, he will contact the Counseling Center, if during the day, and the Suicide Hotline, if outside of business hours. He explained that there is no chance that he will have contact with his girl friend over the next few days, so that will not be an issue to possibly increase his thoughts of suicide. Early in our conversation, he seemed quite down, discouraged, and worried for himself. By the end of our conversation, he seemed to have found his some of strength and hope again. I asked Darlene Schmitt, Counseling Center Director, to hear our assessment and safety plan before John left. She met with us and concurred that the plan sounded effective for his safety until the next time we meet and that the plan may need to be continued, added to, or altered at that meeting, depending on how John has progressed and how his life situation may have changed up to that time. </p><p>MSE: John was casually attired, yet somewhat disheveled. He presented as tearful, with sad mood and appropriate affect. Although he verbalized some suicidal ideation, John does not have a clear intent to suicide. By the time we completed our safety plan, he reported feeling “better” and appeared a little less distraught. </p><p>Plan: John agreed to contact CC, or Lifeline if he has any further thoughts of harming himself. He is amenable to the safety plan, which we will re-visit at our next appointment. It will be important to continue to establish a relationship based in empathy and UPR, as John seemed to respond well to his therapeutic relationship with me. I will continue to monitor his safety and a new non-self-harm agreement may be necessary at that time. He is planning ongoing counseling with me at the Counseling Center, throughout the near future. Integration Manual 2014-2015 8 Termination or End of the Semester</p><p>As a part of its on-going evaluation of services, all clients are asked to complete a Client Satisfaction Form (Appendix F) during selected weeks of the semester. The secretaries will ask clients to complete the surveys during those weeks. Additionally, Practicum Counselors should ask their clients to complete this form during their last sessions and request that clients give their completed evaluations to the Center secretary. Several options exist of what to recommend to clients who need to continue in counseling. If it is your and your supervisor's opinion that the student needs to continue in counseling, you may refer the student to another Counselor Education Practicum Counselor for the following semester, to an off campus resource, or to a Counseling Center staff member. The recommendations you make should be documented in the termination summary. The Termination Summary is a form for you to indicate factual information such as date of intake, date last seen, how many session, etc. Additionally, you are to summarize the work that was done with the client. Your summary should include major topics addressed, changes or decisions that your client seemed to make through counseling, why and how the two of you ended, aspects of your work that seemed particularly helpful and aspects that did not seem as helpful, and issues that you most expect your client might need or want to address with his or her next counselor. You may also discuss types of information to include on this form with Counseling Center staff and your supervisor. </p><p>Safeguarding Client Records</p><p>You will likely have intake worksheets and notes that you took during sessions, which need to be placed in your mailbox until you can enter the information in the Electronic Medical Record System. DO NOT LEAVE WORKSHEETS OR FILES OUT ON DESKS OR TABLES UNATTENDED. UNDER NO CIRCUMSTANCES ARE YOU TO TAKE A FILE OR WORKSHEETS OUT OF THE CENTER. Furthermore, you may not write client notes outside of the Counseling Center. Most of the information regarding clients is kept on the Electronic Medical Record System and it is equally important that you protect the access to the System. You must close the Electronic Medical Record System when you are not at your computer, even if you were just going to step away “for a moment”. Not protecting the clients’ files is a breach of client confidentiality and is unethical. Practicum counselors who fail to keep client files protected may receive an “unsatisfactory” in EDC 720 and EDC 721 and be removed from the course. Furthermore, you will need to report the breach to the client. Safeguarding any client records that you have is very important. For example, your class notebook should be carefully maintained so it is not lost or misplaced, if you keep notes on your clients and/or from supervision. Please do not use client’s full name on any notes that leave the Counseling Center. You should mark clearly on the outside of your notebook that the material is confidential and request that it be returned to you unopened. State on the front cover -- If Found Please Return to (your name and address). In your writings for class and in supervision, the identity of the clients should be disguised via pseudonyms or false initials. In addition, information should be relatively general in order to safeguard against Integration Manual 2014-2015 9 discovery of the client's identity via association with specific events. Of course, maintaining the confidential possession of your videos of counseling sessions is critically important. Do not review your videos in front of anyone other than your individual and group supervisors, CC staff, on-site adjunct faculty, or your fellow students. You must also password protect your SD cards and/or computers that contain client videos. Only you should know the password! If you share a computer with a family member, you will need to create a separate user account so that your family members cannot access your assignments or videos. At the end of the semester, please destroy or carefully delete all video files. You will sign a statement attesting that you have properly destroyed all files containing private client information.</p><p>Referrals</p><p>On-Campus. The Counseling Center can work with the Health Center regarding students with health concerns that impact their emotional and/or academic functioning. Referrals to the Health Center include assessments for possible psychotropic medication (e.g., depression, anxiety), eating disorders and other physical health concerns. Staff in the Health Center can prescribe psychotropic medication and will manage students on such medications. Please review the Counseling Center’s protocol for medication referrals. If you think a client has an immediate need for medication, consult with one of the on-site adjunct faculty regarding how to proceed. In the course of work with your client, you may find it beneficial to refer your client to additional resources on campus. There are a number of other on-campus referrals listed in the Brockport Undergraduate Catalog under Student Services that may be of benefit to your client. </p><p>Off-Campus Referrals. Counseling Center professional staff, your individual supervisors, and your instructor can help you in identifying appropriate off-campus referral sources. Always take care in deciding which other professionals to recommend. Your recommendation may equal your endorsement of the other professionals’ actions to your client.</p><p>Recording Sessions</p><p>Although your client has signed permission for you to record your sessions, it is reasonable to review this permission with your client when starting the tape the first time. You can approach this subject by saying something like, "Before we get started I wanted to review with you the fact that I am a graduate student from the Department of Counselor Education. I record my meetings with clients and play brief portions (usually 10 minutes) of some recordings in supervision. The focus of supervision is my work and how I can be helpful to you. Unless you have questions about this, I’ll turn on the video camera and we can get started." Please keep in mind that your client may be as nervous about recording. If you are nervous and sound uncertain or hesitant when you talk about recording with your client, your client will feel the same way about recording. If you are confident and act as if recording is just something you do, your client will most likely have no difficulty with recording the session. If your client has questions about the recording, answer them openly and honestly, emphasizing the fact that the recording is beneficial for you so that you can be the best Integration Manual 2014-2015 10 counselor you can be for your clients. Normally, if your client does not want to be recorded, then you cannot see the client and must have the client re-assigned to a staff counselor. This may mean the client will need to wait until a staff counselor has an opening. Discuss the incident as needed with your supervisor, instructor, and the onsite adjunct faculty. You may make compromises in the recording of sessions, if absolutely necessary, but for the good of your learning and service, try not to. Examples include agreeing to use a client’s video in individual, but not group supervision, or to let a client tell you after a session if there is any particular part they would not want you to play in supervision. In extreme situations (i.e. you are the only person available to see a client in an urgent situation) you may agree not to record if the client is very highly concerned with being recorded for supervision. Inform your instructor if you make compromises in recording and seek your instructor’s permission as soon as possible after you have agreed with a client not to tape in an unusual situation. As a side note to taping, previous practicum counselors have found that keeping the same client on the same set SD card is more helpful organizationally (i.e., in reviewing your work for assignments or self monitoring) than keeping clients of a certain date on a set of videos. Remember, once you have placed videos on your SD card, you need to password protect the video files.</p><p>Clerical Procedures and Related Information</p><p>Office Functioning</p><p>The Counseling Center is open Mondays through Thursday, 8:00 a.m. to 9:00 p.m. and Friday, 8:00 a.m. to 5:00 p.m.; appointments are scheduled with Counseling Center Staff from 9:00 a.m. to 4:00 p.m. In order to accommodate Counselor Education counseling practicum students and clients, clients will be seen on Monday, Tuesday, Wednesday, and Thursday evenings between 6:00 p.m. and 9:00 p.m. </p><p>Scheduling</p><p>The Counseling Center secretarial staff schedules all clients. Because of the shortage of rooms, once a student is assigned a client and a room, it is important not to switch rooms or times at the last minute. If you need to cancel a session, call the Counseling Center (395-2207) at least 24 hours in advance, except in cases of illness or emergency. This will give sufficient time to contact the client. At that time, inform the secretarial staff whether you plan to see the client at some other time during the week (this, of course, will depend on your and your client's schedules and the availability of a counseling room) or will see the client at the same time the following week. If you want to leave a message for the Counseling Center secretary regarding scheduling after hours, clip your message to the front of the Counselor Education Practicum Students' Schedule Book. You may also call the next day and talk with the secretary directly. If you need to contact a client, you may use the phone in any of the counseling offices. For on campus calls, dial the last four digits of the client's phone number. For an off campus call, dial 9 and then the telephone number. If you should need to call a client and you find Integration Manual 2014-2015 11 yourself leaving a message, identify yourself by name, rather than by your relationship as counselor, or by your work setting at the Counseling Center. [If you need to make a personal call (even local), you must use a calling card.] Note in the file your phone contact with your client. Any messages left for you will be paper clipped to the front of your charts.</p><p>Counseling Tasks</p><p>When a client has been assigned to you, the Counseling Center secretarial staff will call you at home and leave a message to that effect. You must call the Center to confirm that you received the message. Plan to arrive 1/2 hour early. Often parking is difficult to find and you will need to allow time to find a parking space and time to walk to the Center. Arriving early also allows you time to collect and ready yourself, review your client's file, and set up recording equipment. You should check equipment prior to the session to ensure that it is ready and working. Please begin and end sessions on time. Because of high demand for rooms, if you allow your session to run past the hour, expect that the person needing the room next may interrupt you. If you are scheduled at a certain time and the room is occupied, first check with the secretarial staff to see if there has been any misunderstanding, then knock and let the counselor know that you are scheduled and need the room for that hour. A 50-minute hour is recommended. This allows you time to gather your case file, recording equipment, with enough time for the next counselor to set up before the hour. Be sure to leave the room as you found it. If you are the last person scheduled for a room, be sure to turn off the lights and put away equipment. </p><p>Progress notes must be completed in the Counseling Center. If the counseling room you are using is scheduled for another student, you may write up your case notes in the computer bay area. Never complete your case notes at the front desk or where other clients can see the records. While it is best to complete your case notes the same day as your sessions, in some cases, it may not be possible. When this happens, you may return within the week to complete your notes, however, be sure to enter bullet points regarding the session into Electronic Medical Record System or place your hand written notes in your mailbox. Leaving some basic information in your absence will assist Counseling Center staff in the event that your client comes in for crisis counseling before you had a chance to write your full note.</p><p>Where to Find What</p><p>Counseling Center. The Counseling Center is located in Hazen Hall in the corridor between Health Promotions and the Health Center. Keys. The professional and secretarial staff all has keys to all the offices and will open rooms for you as needed. Files. Active “hard copy” files are kept in filing Cabinet A. Inactive files are kept in filing Cabinet C. It is essential that all confidential material be secured in such a manner before leaving the building. Most of the client files are in the Electronic Medical Record System System. It is your responsibility for maintaining accurate and timely client notes. Furthermore, close out of the Electronic Medical Record System when you are away from the computer. Integration Manual 2014-2015 12 Schedules. Staff and intern schedules are computerized. Center Forms . All forms are kept at the front desk. Forms pertinent to Counselor Education practicum students are as follows: Release of Information Form, Consent to Tape Form, Client Evaluation Form, and the Student Referral Form. Counsel ing session recordings and informational tapes on specific client concerns. Recordings of individual counseling conducted by Counseling Center staff and informational videos on specific client concerns are available for you to review. Please ask one of the on-site adjuncts if you are interested in viewing one. Sample counseling sessions must be listened to in the Counseling Center. Videos on counseling issues may be taken out of the Center. Please sign out and sign back in any media that you borrow. Supplies . Supplies such as pencils, pens, tablets etc. are kept in the waiting room in a cabinet opposite the bathroom.</p><p>Session Recording Equipment</p><p>As a practicum student you are required to record all your counseling sessions. Sessions are recorded on SD cards using a camera. Computers are used to play back the sessions. The cameras are user-friendly, but if you need assistance, please see one of the onsite adjunct faculty members.</p><p>Professional Attire</p><p>As a Counselor Education Practicum Student, you are a professional. So, please dress professionally. Wear clothing that will help establish an atmosphere conducive to a serious, working relationship. Carefully consider your appearance and the impression it creates. Dress professionally at all times that you are at the Center, whether you have clients scheduled that day or not. If you are not dressed appropriately, you will be asked to leave for the day.</p><p>Ethics Overview</p><p>The Counseling Center staff is guided in their professional activities by the ethical standards of the American Counseling Association (ACA) and the American Psychological Association. Please review ACA’s guidelines as you begin the semester. While not all ethical standards are identical for all professions, they do share basic principles. Listed below are publications that offer ethical guidelines for several of the leading professional organizations. American Counseling Association (2014). ACA code of ethics and standards of practice. Alexandria, VA: Author. American College Personnel Association (2006). Statement of ethical principles and standards. Alexandria, VA: Author. American Mental Health Counselors Association (2010). AMHCA Code of Ethics. Alexandria, VA: Author. American School Counselor Association (2011). Ethical standards for school counselors. Alexandria, VA: Author. The nature of the services provided to clients by the Counseling Center requires a Integration Manual 2014-2015 13 confidential relationship between client and Center staff/counseling practicum students. Clients must feel secure in the knowledge that their privacy is fully respected in order to feel free to seek help. Not only the content of counseling, but also the fact that a client has come to the Center must be regarded as confidential. </p><p>Informed Consent</p><p>The ethical principle of informed consent means that clients have a right to be informed about treatment, assessment, or other services they will receive before they agree to participate in those services. This principle requires that in order to ensure informed consent clients must be given certain information in a manner and language that they can understand. Clients should be aware of the qualifications of the person providing the treatment. In the case of Counselor Education practicum students, clients should know that the treatment provider is a supervised graduate student. If requested, clients may be given the name and the qualifications of the Counselor Education Intern's supervisor and have an opportunity to meet with the supervisor if they wish. The course instructor/group supervisor can suffice for this purpose, as that instructor may be easiest to contact. If interested, clients may know the nature of the supervision, including the frequency of the supervision and the activities it entails (e.g., reviewing case notes, listening to sessions, individual and/or group format). When referring a client to a Counselor Education practicum student, the intake counselor discusses the nature of supervision, the taping requirement, and receives client permission for such a referral. Client acceptance of this referral is documented via signature on the Consent to Recording form. The frequency and duration of treatment sessions should be explained. Clients are typically seen on a weekly basis, for 50 minutes. Counselor Education Practicum Students should inform their clients that they provide services only for the current semester. The client's responsibilities for participating in treatment should be made clear. For example, the client is expected to attend scheduled appointments on time and notify the Center in advance if an appointment must be canceled (with 24 hour notice, except in cases of illness or emergency). The intake counselor discusses the informed consent with the client. Confidentiality should be explained, including the nature and limits to confidentiality. The first page of the sample Intake Questionnaire spells out confidentiality and its limitations. Clients are requested to read and document their understanding via their signature. If clients have any questions regarding confidentiality, they are directed to discuss their questions with the intake counselor. While any questions about their counseling may be answered in their intake meeting, clients’ questions and concerns about their use of counseling normally come up throughout their time in counseling and so you should address your clients’ questions and concerns as they come up during their counseling with you.</p><p>Confidentiality</p><p>Release of information . No one outside Student Health Services/Counseling Center, your supervisor or instructor, and your peers (within confidential contexts) is to be given any client information without the explicit, signed permission of the client. The only exceptions to this are if the client is in imminent danger of harming him or herself or others, or if there are any suspicions of child abuse. See front office staff, director, or onsite adjunct faculty for the correct Integration Manual 2014-2015 14 form and procedure for your client to give permission for you to release information on her or his behalf to persons or entities outside of Health Services/Counseling Center, supervision or your instructor. All letters concerning clients initiated by Counselor Education Practicum Students are to be read and countersigned by their supervisor. A copy of all correspondence concerning a client should be entered in the client's file. If someone calls or comes into the office claiming to have the client's permission to discuss his or her case or see the records, you would not discuss the case, share records, or even acknowledge that the person is a client unless you have written, signed permission from the client in question. If problems arise, you can cope with an insistent or demanding person by saying something like, "I'm sorry but I can’t share any information unless I have signed permission from the possible client in question”. Note that this statement does not acknowledge that the individual in question is a client. It merely says that a release of information form is required to share information. If the person in question does not accept this explanation, refer that person to your supervisor or a Counseling Center professional staff member. If unauthorized persons attempt to obtain client information notify your supervisor as soon as possible. You may, of course listen to a caller’s concerns and may help him or her think through those concerns without giving any client information. For example, perhaps a mother means to call you to let you know that she fears that her daughter is at risk of self-harm. She may begin by asking for information that you cannot give regarding her daughter as your client. If you, however, listen to her concerns for her daughter, letting her know that you take her concerns seriously and will follow-up to help her daughter, whether or not her daughter is a client, and will even call her back after following-up, this may be what she actually wanted, rather than information from you in the first place.</p><p>Exceptions to confidentiality . The essence of confidentiality is that clients have the right to determine who will have access to information about them and their counseling sessions. There are occasions in which information about clients may or must be shared with others. There are several exceptions to the rule of confidentiality that may be relevant to your clients: a) cases of abuse (if client is under 18 and a victim of abuse; if client is a perpetuator of abuse of a minor child), b) cases in which clients are dangerous to themselves, c) cases in which clients intend harm to others, and d) certain legal proceedings in which case notes and other records have been subpoenaed. You will inform clients of exceptions to confidentiality during the intake. Clients sign that they have read and understood the exceptions to confidentiality.</p><p>Privileged communication . Privileged communication is a legal term referring to the rights of individuals to withhold information requested by a court. The client "holds" the legal right of privilege. This means it is the client's decision, rather than the counselor's, to waive privilege and allow information to be disclosed. The counselor's responsibility is to protect the client's privilege whenever applicable. Thus, unless the client has voluntarily waived privileges or the courts have specifically ordered otherwise, the counselor has a duty to assert the client's privilege and not release information. There are legal exceptions to client privilege and the courts have determined that in certain circumstances counselors must release information whether or not the client would agree. The exceptions to client privilege follow. Please note: you should not face any of the following or other difficult legal and ethical decisions alone. Rather, you should consult with your supervisor, Counseling Center professional staff, and/or Integration Manual 2014-2015 15 your instructor regarding the decision.</p><p>Abuse. New York State law requires that mental health professionals report suspected child abuse. An abused child means a child under 18 years of age who is neglected, physically or sexually abused. Further, if you are working with a parent, custodian or guardian of a child under 18 years of age, who you suspect of abusing that child, you are required to report the suspected abuse. You must report suspected abuse orally within 24 hours. A written report of the suspected abuse must be filed within 48 hours after the verbal report. As a Counselor Education Intern, if you suspect abuse, you must consult immediately with the on-site adjunct faculty member. </p><p>Danger to self . When clients are considered to be at risk of harming themselves, counselors are obligated to take measures to prevent such harm. If clients recognize the danger and are willing to go along with protective measures for their own benefit, confidentiality is usually not a problem. The counselor simply has the client complete the required release of information forms, and then takes the necessary steps to ensure the client's safety. This may require voluntary hospitalization or other protective measures. It becomes more complicated when a client is not willing to comply with the counselor's recommendations regarding safety. In these situations, the counselor may have to take steps to seek involuntary hospitalization or pursue some other treatment option to ensure safety. If you are concerned about your client's potential for self-harm, consult with the on-site adjunct faculty. Consult while your client is still in session with you. The issue of consultation can be introduced by saying something like, "I see that you have strong thoughts of killing yourself and have a plan of how you might do that. I am very worried for your safety. In order for me to be of the best help to you that I can be, I want to consult with another of our staff members to help think through planning for your safety.” Contact the secretary and tell her that you have a client in potential imminent danger and need to speak with one of the professional counselors. Do not leave the client unattended in the office! Later, when writing your case notes, carefully document steps taken to ensure client safety. If time and the situation allows, you may go ahead and work through a non-self-harm agreement with your client, as you are the counselor who has at least begun to establish a therapeutic relationships with your client, then consult with a professional staff member to help you and your client confirm the adequacy of the plan you’ve made.</p><p>Intent to harm others . A second situation in which counselors may be required to break confidentiality is when a client makes explicit threats or statements of intent to harm another person. This situation is commonly known in the profession as the Tarasoff case. The Tarasoff case is based on an incident in which a client told a therapist he wanted to harm a specific person. The therapist believed the client was serious and took steps to pursue involuntary commitment, but did not directly warn the intended victim. Several months later, the client, who had since dropped out of therapy, killed the person he had earlier threatened to harm. The therapist was then sued for damages for not having warned the victim. The principle of “duty to warn” evolved from this case. The key point to remember is that if you have client who seriously intends to harm another person, you may be required to take every reasonable step necessary to Integration Manual 2014-2015 16 warn the intended victim and responsible authorities such as the police. On rare occasions, this will mean that information about the client is divulged without the client's permission. If you are concerned about a client's threat to harm another person, consult with the on- site adjunct faculty member before your client leaves, then as soon as possible with your instructor and supervisor. Follow the same procedure as outlined under Danger to Self .</p><p>Legal proceedings and court orders . In rare occasions, it is possible that you may be forced to reveal information about a client if a court orders you to. If someone requests your records other than the client, it is advisable to do everything you can to not release the information without the client's written and signed consent. Contact the client and explain the situation and request that the client give you permission to release information. If a court order requires it, the records must be released even if the client has not signed a waiver of confidentiality. Be sure that before you release information without a client's permission, you have in fact been ordered to do so by the court. Merely receiving a letter from an attorney indicating that your records have been requested does not constitute a court order and you are not, therefore, required to comply. You should know that a subpoena to appear before a court is not the same as a court order demanding records. If you should receive a subpoena to appear without a specific order to produce your records, you should protect the client's privilege and not release records unless specifically ordered to by the court. In light of this possibility, Baird (1996) advises that counselors do the following. First, clients should be informed of this possibility at the start of counseling, which in this case clients are informed during the intake. Second, counselors should, of course, be careful of what they record in their case notes. </p><p>Client Categories and Avoiding Dual Relationships</p><p>The clients you will serve may come from the following categories: 1) students from EDC 301: Introduction to Counseling, who are completing a Introduction to Counseling Helping Relationship Experience, 2) any student who has come to the Counseling Center seeking assistance, or 3) other clients volunteering for counseling as a personal growth experience with an EDC graduate student counselor (e.g., perhaps they heard of this opportunity through a presentation by you or one of your peers and came seeking to work with you or another EDC graduate student counselor). Other than Introduction to Counseling clients, clients will most often be screened through an intake appointment with a professional staff member. There is a potential for dual relationships with any client, especially other EDC graduate students. Dual relationships should be avoided whenever possible. Therefore, if you discover that you have a dual relationship with a client (i.e., friendship, kinship, a current class together, a previous class together in which you became close or very well known to each other, or significant work place interaction), inform your client or the Counseling Center office staff of the difficulty so that your client can be scheduled with another counselor. When possible we would like to avoid any inconvenience to clients in such situations. Therefore, as soon as you are aware of the potential for a dual relationship, contact the Counseling Center front office staff and explain the issue so that the client can be reassigned to another counselor before their first session. Integration Manual 2014-2015 17 Evaluation</p><p>The on-site adjunct faculty will be evaluating you on several occasions. They will evaluate your areas of strength and areas of improvement in client intake sessions (see Appendix J). They will also be evaluating your client notes and general professionalism on site (See Appendix K). The EDC 720 instructor and you will each assess your professional dispositions at the beginning and the end of the semester (see Appendix L) and your conceptualization skills (various assignments).</p><p>Tracking You are responsible for tracking your hours for EDC 720 and EDC 721. You will be instructed where (excel worksheets uploaded to TK20) to track your hours. Regardless of the format used, you will track your direct and indirect hours for the length of the semester. Appendix N represents a sample log and instructions for categorizing your time spent in the Counseling Center or preparing for clients. Please note: you must accrue a minimum of 10 hours per week for the length of the entire semester, which will exceed a total of 100 hours. You must also earn a minimum of 40 direct client hours. Direct hours are typically accrued through individual and group counseling and by facilitating psychoeducation sessions.</p><p>Supervision</p><p>As a student enrolled in EDC 720: Integration and Application of Basic Concepts, you are also enrolled in EDC 721: Clinical Experience for Integration. EDC 721 provides you with your clinical supervision experience. Supervision is an important and central aspect of your learning experience. It is a time when you receive feedback, support and modeling about counseling and counselors. </p><p>Definitions</p><p>While several definitions of supervision exist, all the definitions point to the interpersonal nature of the supervisory relationship, and the educational and emotional aspects of learning how to be a counselor. The following are representative of the definitions of supervision in the counseling and psychotherapy field:</p><p>An intensive, interpersonal focused one-to-one relationship in which one person is designated to facilitate the development of the therapeutic competence in the other person. (Loganbill, Hardy, & Delworth, 1982, p. 4)</p><p>A process in which the supervisor struggles to discover how he can best assist the counselor in establishing adequate and effective relationships with his clients. (Kell & Mueller, 1966, p. 18)</p><p>An intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional Integration Manual 2014-2015 18 functioning of the junior member(s), monitoring the quality of professional service offered to the clients, she, he or they see(s), and serving as a gatekeeper for those who are to enter the particular profession. (Bernard & Goodyear, 1992, p. 4)</p><p>Supervision Purpose/Function</p><p>Bradley (1989) outlines three main purposes of counselor supervision: 1) facilitation of the counselor's personal and professional development, 2) promotion of counselor competencies and, 3) promotion of accountable counseling services and programs. The first purpose of supervision is a dual one -- to promote counselor personal and professional growth. Facilitation of personal development is vital to the development of a counselor. Wrenn (1962) stated, "The counselor, as a person, is the most important single factor in counseling. He needs to understand himself psychologically in order to be effective in helping others" (p. 168). Learning and growing as a counselor "is both an emotional and intellectual experience, and of the two, the emotional part is the most crucial. Important learning occurs in situations in which one's feelings are engaged" (Altucher, 1967, p. 165). Thus, examination of oneself in the role of counselor is vital to growth as a counselor. Consequently, supervision should provide an atmosphere in which the counselor can self-initiate personal development. An important purpose of counselor supervision is the facilitation of professional development. For the counselor, this includes the acceptance of the name and image of the profession as part of one's self-concept; commitment to, and a clear perception of the professional role and function; commitment to the goals of the institution in which counseling services are performed and; recognition and appreciation of the significance of the profession for individuals, groups, institutions and society as a whole. A foremost purpose of counselor supervision is the promotion of counselor competencies. This promotion incorporates helping the counselor acquire, improve and refine the skills required by the counselor role and function. For beginning counselors this includes the development of core counseling skills, the beginning ability to case conceptualize (how and why those skills apply to a particular person’s situation), and the development of a personal approach to counseling. The final function of supervision is the promotion of accountable counseling services and programs. Counselors must be able to explain their functions, evaluate their services and share the findings with the public. Additionally, this function involves accountability for the effectiveness of the counselor and of counseling. According to Bernard and Goodyear (1992) supervision specifically encompasses the following areas: 1. Monitoring of client care (the supervisor's paramount responsibility) [In light of your supervisor’s responsibility to assist you with client care, you should keep your supervisor aware of each of your clients general situations and the major aspects of your work with each of them]. 2. Development of therapeutic and case management skills. 3. Socialization of the supervisee into the profession; helping the supervisee develop a professional identity via role modeling. 4. Evaluation of performance. 5. Gatekeeping or regulating who is appropriate to enter the profession and who ought not to continue. 6. Administrative tasks/issues such as paperwork, programming concerns, etc. Integration Manual 2014-2015 19 </p><p>Roles in Supervision</p><p>Supervisors may play different roles in supervision. There are elements of counseling in supervision. The supervisory relationship embodies in varying degrees support, empathy, trust and challenge. This is similar to counseling. For example, a supervisee may address personal concerns in supervision, as they relate to client care (e.g., counselor behaviors, thoughts, or feelings that are seemingly provoked by a client). A supervisor should also say so if she or he thinks that a supervisee is having a personal reaction to a client that hinders his or her effectiveness or if the counselor’s personal concerns seem to be interfering with client care in some other way. If a counselor’s personal concerns seem to impair the counselor’s work, the supervisor may make a referral for individual counseling. Counseling can then address the issues that are impairing performance. So, while supervision may be highly therapeutic, it is focused on client care. Your role in supervision entails a number of adjustments and risks on your part. First, accept that some anxiety in supervision is unavoidable and normal. As an intern, you may feel anxious about your supervisory sessions. As accepting, encouraging and respectful as your supervisor may be, you are being evaluated, and this may create discomfort. Awareness of this reality in advance reduces some of the anxiety about being anxious, and you may then find it easier to deal with supervision. Remember, change is often scary. Supervision involves taking risks on your part. It is only then that you will grow as a counselor. This, most likely means, that the things you find the most scary or difficult to do or to discuss, may be the most important feelings, thoughts, or behaviors to explore in supervision. Recognize that trust in your supervisor is an important aspect of your supervisory relationship. There are many aspects of trust, and both you and your supervisor contribute to its development. In an openly, trusting relationship, the supervisee would be expected to say "I disagree" as often as the supervisor. As a beginning counselor you have the right to expect and the responsibility to contribute to a trusting relationship. You are developing your therapeutic judgment. Therefore, it is right to say so when you disagree, while remaining respectful of your supervisor’s experience and expertise. Clarify for yourself what you need most from supervision. Review your tapes. Analyze your present skills, attitudes and knowledge, and the feedback you have received, and determine what you need to learn about yourself and your skills as a counselor. Your list of learning goals will undoubtedly grow and change as you grow and change as a counselor. Your advanced assessment can, nonetheless, help you and your supervisor clarify your initial direction within supervision. Generally, you know best what you need. </p><p>Conflict Resolution within Supervision</p><p>It is the responsibility of both you and your supervisor to discuss any tension or conflict you believe is occurring in the supervisory relationship. An implication of Moskowitz and Rupert's (1983) study, however, was that supervisors may not be aware of conflict or tension within the supervisory relationship with you. Therefore, if you are not feeling heard by your supervisor or do not believe you are receiving enough feedback, for example, you should take the initiative for bringing this issue up for discussion in supervision. It is your supervisor's Integration Manual 2014-2015 20 responsibility to be open to such a discussion. If the conflict is resolved successfully, such a discussion can result in an improved supervisory relationship and new learning for both you and your supervisor. If you do not believe that the conflict has been resolved to your satisfaction, however, you have two options available to you. The first is to raise the issue for discussion again with your supervisor. The second is to talk to your EDC 720 instructor about your concerns. At that point, you and your instructor can decide how to best proceed to resolve your concerns.</p><p>EDC 721: Clinical Experience in Integration</p><p>Supervisors are Counselor Education faculty, Counseling Center professional staff and/or EDC 885: Supervision of Counseling post-master’s degreed students. It is your responsibility to contact your assigned supervisor immediately upon assignment. Your supervisor and you will schedule a time to meet for weekly supervision. You will meet once a week with your supervisor for one hour. During that time you review your recorded counseling sessions. Your individual supervisor will provide you with ongoing feedback during each supervision session. Further, your supervisor will also conduct a formal evaluation of you at the end of the semester. This form is to be completed by your supervisor and discussed with you. The instructor will use the form as part of his or her evaluation of your performance during EDC 720. The form is completed and stored in TK20 and is used as a record for CACREP to demonstrate that Counselor Education students are evaluated during practicum. </p><p>EDC 721 Forms</p><p>There are two evaluation forms for EDC 721. The first evaluation form is the instrument that your individual supervisor will use to conduct his or her formal evaluation of you at the end of the semester. Make sure that you familiarize yourself with form at the beginning of the semester. Doing so will help you identify the expectations of your EDC 720 instructor’s and your EDC 721 supervisor’s expectations are regarding your counseling performance. This form is located in TK20 and a sample can be found in Appendix H. Integration Manual 2014-2015 21 The second form evaluates your supervision experience. As a student, you are asked to evaluate your clinical supervisor and your supervision experience. You are to fill out the form and discuss your evaluation with your supervisor. Both you and your supervisor sign the form. You are to give the form to your supervisor. This form is located in Appendix I.References</p><p>Altucher, N. (1967). Constructive use of the supervisory relationship. Journal of Counseling </p><p>Psychology, 14,165-170.</p><p>Baird, B. N. (1996). The internship practicum, and field placement handbook. Upper Saddle </p><p>River, NJ: Prentice Hall.</p><p>Bradley, L. J. (1989). (2nd Ed.). Counselor supervision: Principles, process and practice. </p><p>Muncie, IN: Accelerated Development, Inc.</p><p>Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision. Boston: Allyn </p><p> and Bacon.</p><p>Kell, B. L., & Mueller, W. J. (1966). Impact and change: A study of counseling relationships. </p><p>New York: Appleton-Century-Crofts.</p><p>Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model. The </p><p>Counseling Psychologist, 10, 3-42.</p><p>Moskowitz, S. A., & Rupert, P. A. (1983). Conflict resolution within the supervisory </p><p> relationship. Professional Psychology: Research and Practice, 14, 632-641.</p><p>Wrenn, C. G. (1962). The counselor in a changing world. American Personnel and Guidance </p><p>Journal. Integration Manual 2014-2015 22 Integration Manual 2014-2015 23 Integration Manual 2014-2015 24 Integration Manual 2014-2015 25 Integration Manual 2014-2015 26 Integration Manual 2014-2015 27 Integration Manual 2014-2015 28 Integration Manual 2014-2015 29 Integration Manual 2014-2015 30 Integration Manual 2014-2015 31 Integration Manual 2014-2015 32 Integration Manual 2014-2015 33 Integration Manual 2014-2015 34 Integration Manual 2014-2015 35 Integration Manual 2014-2015 36 Integration Manual 2014-2015 37 Integration Manual 2014-2015 38 Integration Manual 2014-2015 39 Integration Manual 2014-2015 40 Appendix H Semester: Year: Date of Evaluation: Student Counselor: Supervisor:</p><p>Evaluation Guidelines and Expectations Clinical supervisors use this form to evaluate the student’s counseling performance during practicum in the following areas: Domains of Competence, Characteristics of Counselors, Essential Interviewing and Counseling Skills, and Supervision. The performance rating scale is: (1) Unacceptable: Demonstrated lack of understanding of the skill and lack of ability that detracted from work with clients; or student did not demonstrate this behavior in appropriate situations (2) Developing: Demonstrated minimal understanding of the skill and struggled to use it consistently or effectively with clients (3) Proficient: Consistently demonstrated understanding of the skill and the ability to use it effectively with clients in basic counseling situations (4) Exemplary: Demonstrated comprehensive understanding of the skill and ability to apply the skill effectively with clients in complex and nuanced counseling situations Not Observed: In the recorded sessions provided, the student did not present an opportunity to observe this behavior Please check the number that best represents your evaluation. The comment sections are for the supervisor to address specific strengths and areas of concern. By the end of the practicum semester, the Department expects students to be at the Proficient level (3) or beyond for each of the items, with the exception of those identified as “advanced techniques”. </p><p>Domains of Competence Domain 1 Connecting and Engaging Client 1. Listens for and responds to 1 2 3 4 Not Observed content or information 2. Listens for and responds to 1 2 3 4 Not Observed feelings 3. Listens for and responds to 1 2 3 4 Not Observed congruence 4. Listens for and responds to 1 2 3 4 Not Observed absence 5. Listens for and responds to 1 2 3 4 Not Observed inference 6. Listens for and responds to 1 2 3 4 Not Observed presence Integration Manual 2014-2015 41 7. Listens for and responds to 1 2 3 4 Not Observed resistance Domain 2 Assessment 8. Effectively assesses clients’ 1 2 3 4 Not Observed symptoms 9. Identifies clients’ stages of 1 2 3 4 Not Observed change/ readiness for change</p><p>10. Identifies clients’ needs, 1 2 3 4 Not Observed strengths, and resources (CACREP SC.CPI.C.3) 11. Identifies the theme of the 1 2 3 4 Not Observed clients’ narrative 12. Demonstrates the ability to use 1 2 3 4 Not Observed procedures for assessing and managing suicide risk (CACREP: CC.CPI.D.4)</p><p>13. Develops appropriate 1 2 3 4 Not Observed therapeutic goals with clients (CACREP: CC.CPI.D.2) Domain 3 Therapeutic Relationship and Alliance 14. Listens empathetically 1 2 3 4 Not Observed 15. Demonstrates respect and 1 2 3 4 Not Observed acceptance of all clients 16. Conveys unconditional 1 2 3 4 Not Observed positive regard for client 17. Provides hope 1 2 3 4 Not Observed 18. Provides on-going goal 1 2 3 4 Not Observed alignment 19. Develops and maintains a 1 2 3 4 Not Observed therapeutic alliance with clients Domain 4 Clients’ Cognitive Schemas 20. Assesses client view of self 1 2 3 4 Not Observed 21. Assesses client view of others 1 2 3 4 Not Observed</p><p>22. Assesses client view of the 1 2 3 4 Not Observed world 23. Explores client belief systems, 1 2 3 4 Not Observed attitudes, thoughts, and behaviors Integration Manual 2014-2015 42 24. Demonstrates an 1 2 3 4 Not Observed understanding of the effect of oppression on clients’ presenting issues</p><p>25. Recognizes the impact of 1 2 3 4 Not Observed client schemas on treatment</p><p>26. Provides appropriate clinical 1 2 3 4 Not Observed conceptualizations (CACREP: CC.CPI.D.5) 27. Assists clients in challenging 1 2 3 4 Not Observed and altering distorted perceptions Domain 5 Addressing and Managing Clients’ Emotional States 28. Demonstrates an 1 2 3 4 Not Observed understanding of the relationship between affective expression, internal feelings, emotional states, and their role in treatment progress</p><p>29. Encourages clients to express 1 2 3 4 Not Observed emotions 30. Therapeutically works with 1 2 3 4 Not Observed clients’ emotions 31. Demonstrates skills in helping 1 2 3 4 Not Observed clients cope with personal and interpersonal problems, as well as skills in crisis intervention in response to personal, educational, and community crises (CACREP: CC.CPI.D.3) Domain 6 Addressing and Resolving Client Ambivalence (Advanced Techniques) 32. Recognizes client ambivalence 1 2 3 4 Not Observed</p><p>33. Develops effective strategies 1 2 3 4 Not Observed for dealing with ambivalence</p><p>34. Holds clients accountable for 1 2 3 4 Not Observed progress in counseling 35. Helps clients maintain a 1 2 3 4 Not Observed therapeutic focus Domain 7 Paradoxical Interventions (Advanced Techniques) Integration Manual 2014-2015 43 36. Is able to neutralize clients’ 1 2 3 4 Not Observed negativistic comments about the counseling process</p><p>37. Is able to energize or 1 2 3 4 Not Observed stimulate an immobilized client</p><p>38. Is able to use tranquilizing 1 2 3 4 Not Observed techniques (permission, postponement, prohibition, or persuasion) to interrupt dysfunctional behaviors</p><p>39. Is able to use challenging 1 2 3 4 Not Observed techniques (prediction, prescription, proportionality, and positive provocation) to disengage clients from problematic behaviors Characteristics of Counselors (CACREP: II.G.5.b) Cognitive Domain 40. Demonstrates a love of 1 2 3 4 Not Observed learning and seeks out professional development</p><p>41. Reflects upon experiences to 1 2 3 4 Not Observed enrich practice of counseling</p><p>42. Values the complexity and 1 2 3 4 Not Observed ambiguity inherent in the counseling process</p><p>43. Demonstrates the ability to 1 2 3 4 Not Observed apply and adhere to ethical and legal standards in clinical mental health counseling (CACREP CMHC.F.B.1) 44. Applies multicultural 1 2 3 4 Not Observed competencies to counseling involving case conceptualization, diagnosis, treatment, referral, and mental and emotional disorders (CACREP CMHC.CPI.D.2; CC.CPI.D.1) Emotional Domain Integration Manual 2014-2015 44 45. Continuously engages in self- 1 2 3 4 Not Observed reflection 46. Emotionally receptive for 1 2 3 4 Not Observed increasing self-awareness: non-defensive and open to feedback 47. Attends to own emotional 1 2 3 4 Not Observed well-being as demonstrated through congruence, authenticity, and honesty (CACREP: II.G.1.d) 48. Appropriately recognizes 1 2 3 4 Not Observed transference and counter- transference</p><p>49. Appropriately uses 1 2 3 4 Not Observed transference and counter- transference in session</p><p>50. Demonstrates awareness of 1 2 3 4 Not Observed own feelings in sessions 51. Demonstrates awareness of 1 2 3 4 Not Observed client process in session 52. Demonstrates awareness of 1 2 3 4 Not Observed own process in session 53. Maintains sufficient self 1 2 3 4 Not Observed control to remain objective and avoids imposing own values/feelings on the client</p><p>54. Demonstrates the ability to 1 2 3 4 Not Observed recognize his or her own limitations as a clinical mental health counselor and to seek supervision or referral clients when appropriate (CACREP: CMHC.CPI.D.9)</p><p>Relational Domain 55. Possesses strong 1 2 3 4 Not Observed relationship skills 56. Uses self effectively as a 1 2 3 4 Not Observed therapeutic tool Integration Manual 2014-2015 45 57. Have a deep respect for 1 2 3 4 Not Observed clients’ rights for self determination and self directed change</p><p>58. Create a safe 1 2 3 4 Not Observed environment for challenging and addressing sensitive issues 59. Demonstrates individual 1 2 3 4 Not Observed and culturally appropriate nonverbal attending behaviors (facial expression, body language, eye contact, voice tone)</p><p>60. Demonstrates respect 1 2 3 4 Not Observed and sensitivity to diverse clients Essential Interviewing and Counseling Skills (CACREP: II.G.5.c) 61. Explains the nature & 1 2 3 4 Not Observed objectives of counseling when appropriate</p><p>62. Is relaxed and 1 2 3 4 Not Observed comfortable in session 63. Uses silence effectively 1 2 3 4 Not Observed within sessions 64. Paraphrases and reflects 1 2 3 4 Not Observed accurately 65. Summarizes accurately 1 2 3 4 Not Observed 66. Responds at client’s level 1 2 3 4 Not Observed of communication (uses language appropriate to and consistent with the developmental level of the client)</p><p>67. Demonstrates an 1 2 3 4 Not Observed awareness of timing in the use of counseling skills 68. Uses immediacy 1 2 3 4 Not Observed effectively Integration Manual 2014-2015 46 69. Gives meaningful and 1 2 3 4 Not Observed relevant feedback within session</p><p>70. Demonstrates flexible 1 2 3 4 Not Observed openness to modifying session focus as needed (CACREP: CMHC.DA.F.3)</p><p>71. Termination of session is 1 2 3 4 Not Observed timely and provides a wrap up Supervision 72. Prepared for supervision 1 2 3 4 Not Observed 73. Accepts feedback from 1 2 3 4 Not Observed supervisor 74. Demonstrates use of 1 2 3 4 Not Observed feedback in the future counseling sessions</p><p>75. Uses supervision to learn 1 2 3 4 Not Observed about counseling and self 76. Demonstrates an 1 2 3 4 Not Observed understanding of counseling supervision models, practices, and processes (CACREP: II.G.1.e; CMHC.F.A.5) 77. Exhibits a balance 1 2 3 4 Not Observed between self-assuredness and awareness of the value of supervision</p><p>78. Exhibits professional 1 2 3 4 Not Observed values 79. Trusts own insights and 1 2 3 4 Not Observed acts on relevant intuitive hunches</p><p>80. Conveys a respect for the 1 2 3 4 Not Observed power of counseling and its limits</p><p>81. Overall, exhibits the 1 2 3 4 Not Observed behavior and attitudes of a competent, professional counselor Integration Manual 2014-2015 47 Summary Comments and Suggestions 82. Please describe areas of particular strength. Please describe any areas in particular that need improvement and provide suggestions for improvement.</p><p>Evaluation:  Meets Competency  Does Not Meet Competency</p><p>Check here to certify supervisor and student counselor reviewed evaluation. </p><p>Student Counselor Signature: ______Date: ______</p><p>Supervisor Signature: ______Date: ______</p><p>References The items for the Domains of Competence & Characteristics of Counselors were based on the concepts shared in Mozdzierz, G. J., Peluso, P. R., Lisiecki, J. (2010). Principles of counseling and psychotherapy: Learning the essential domains and nonlinear think of master practitioners. New York: Routledge. Other items were based in part from the following sources: Hutchinson, D. (2012). The essential counselor: Process, skills, and techniques. (2nd ed.). Thousand Oaks, CA: Sage Publications. Ivey, A. E., Ivey, M. B. & Zalaquett, C. P. (2010). Intentional interviewing and counseling. (7th Ed.). Pacific Grove, CA: Brooks/Cole. Seligman, L. (2009). Conceptual skills for mental health professionals. Upper Saddle River, NJ: Pearson Education, Inc Integration Manual 2014-2015 48 Integration Manual 2014-2015 49 Integration Manual 2014-2015 50 </p><p>Appendix K Integration Manual 2014-2015 51 Electronic Medical Record System Notes Rubric Student Name: Evaluator: </p><p>1 2 3 4 Standard Code Unacceptable Developing Proficient Exemplary Demonstrates the CC.CPI.D.4 Inconsistently Inconsistently Consistently Demonstrates ability to use SC.CPI.D.4 demonstrates the demonstrates the demonstrates the exemplary ability to use procedures for MH.CPI.D.6 ability to use ability to use ability to use procedures for assessing assessing and procedures for procedures for procedures for and managing suicide managing suicide risk. assessing and assessing and assessing and risk (i.e., asks about managing suicide managing suicide managing suicide thoughts of suicide/ risk; misses critical risk (i.e., asks about risk (i.e., asks about homicide, and asks clues. thoughts of suicide/ thoughts of suicide/ about risk & protective homicide, but does homicide, but does factors); does not miss not ask about not ask about critical clues for suicide protective factors); protective factors); risk. Is able to remain does not miss does not miss calm and connected to critical clues for critical clues for client once a risk is suicide risk. suicide risk. detected.</p><p>Collaborates with the CCF3 Does not attempt to Make attempts to Effectively Effectively, efficiently, postsecondary collaborate or is collaborate with the collaborates with and successfully community to assist unsuccessful in postsecondary the postsecondary collaborates with the students, and uses collaborating with the community (with community to assist postsecondary postsecondary postsecondary mixed results) to students, and uses community to assist community resources community to assist assist students, and postsecondary students, and uses to improve student students, and uses uses postsecondary community postsecondary learning and postsecondary community resources to community resources to development. community resources resources to improve student improve student to improve student improve student learning and learning and learning and learning and development. development. development. development. Assesses and interprets CCH1 Does not, or Inconsistently Effectively assesses Effectively assesses and postsecondary student incorrectly, assesses assesses or and interprets interprets postsecondary needs, recognizing and interprets interprets postsecondary student needs and uniqueness in culture, postsecondary postsecondary student needs and effectively and languages, values, student needs; does student needs; attempts to address efficiently addresses the backgrounds, and not recognize inconsistently the needs; needs; effectively abilities. uniqueness in culture, recognizes effectively recognizes uniqueness languages, values, uniqueness in recognizes in culture, languages, and backgrounds; culture, languages, uniqueness in values, and does not recognize values, and culture, languages, backgrounds; client's unique backgrounds; values, and effectively recognizes abilities; does not inconsistently backgrounds; client's unique abilities; address needs nor recognizes client's effectively uses client's uniqueness differences in unique abilities; recognizes client's as a strength in the providing services. attempts to address unique abilities; process of providing needs and uses client's services. differences while uniqueness as a providing services. strength in the process of providing services. Integration Manual 2014-2015 52 Knows the etiology, MH.CPI.C.2 Does not know or Knowledge is Demonstrates Demonstrates accurate the diagnostic process incorrectly utilizes inconsistent and accurate knowledge knowledge of the and nomenclature, the etiology of and application is of the etiology, the etiology, the diagnostic treatment, referral, and diagnostic processes inconsistent diagnostic process process and prevention of mental for treatment, and nomenclature, nomenclature, disorders referral, and treatment, referral, treatment, referral, and prevention of mental and prevention of prevention of mental disorders; uses mental disorders disorders; appliance nomenclature accurate knowledge inappropriately towards efective client service Applies current MH.CPI.D.7 Does not adhere to Inconsistently Consistently adheres Consistently adheres to record-keeping record-keeping adheres to record- to record-keeping record-keeping standards related to standards keeping standards standards standards; exceptional clinical mental health attention to necessary counseling. detail Selects appropriate MH.A.H.1 Selects inappropriate Selects appropriate Selects appropriate Selects appropriate comprehensive assessments for assessments for assessments for assessments for assessment diagnosis and diagnosis and diagnosis and diagnosis and treatment interventions to assist treatment planning; treatment planning treatment planning; planning; demonstrates in diagnosis and lacks awareness of with assistance; demonstrates exceptional awareness treatment planning, cultural bias in the lacks awareness of sufficient awareness of cultural bias in the with an awareness of implementation and cultural bias in the of cultural bias in implementation and cultural bias in the interpretation of implementation and the implementation interpretation of implementation and assessment protocols interpretation of and interpretation of assessment protocols interpretation of assessment assessment assessment protocols. protocols protocols Demonstrates skill in MH.A.H.2 Conducts an intake as Inconsistently Consistently Demonstrates collecting the an inquiry rather than demonstrates skill demonstrates skill in exceptional skill in necessary information in a natural (i.e., forgets to ask conducting an conducting an intake in an intake interview, conversant manner; pertinent questions, intake interview, a interview, a mental a mental status misses important does not use natural mental status status evaluation, a evaluation, a questions (i.e., conversation to evaluation, a biopsychosocial history, biopsychosocial lethality, medication, gather information, biopsychosocial a mental health history, history, a mental prior forgets components history, a mental and a psychological health history, and a hospitalizations); of the intake) in health history, and a assessment for psychological misses important conducting an psychological treatment planning and assessment for information shared intake interview, a assessment for caseload management. treatment planning and by client during the mental status treatment planning The counselor is able to caseload management. intake; fails to evaluation, a and caseload gather the information demonstrate biopsychosocial management. The in a natural conversant empathy; fails to history, a mental counselor is able to manner; asks follow-up develop an health history, or a gather the questions that assist relationship with the psychological information in a with identifying client; uses assessment for natural conversant differential diagnoses, inappropriate treatment planning manner; selects selects appropriate assessment; treatment and caseload appropriate assessments; treatment plans are inconsistent management, but is assessments; plans are consistent with client/ counselor connected with treatment plans are with client/ counselor goals. client and hears consistent with goals. what client shares. client/ counselor goals. Screens for addiction, MHH3 Neglects to screen for Inconsistently Consistently screens Consistently screens, aggression, and danger addiction, aggression, screens for for addiction, with exceptional ease, to self and/or to others, danger to self and/or addiction, aggression, danger for addiction, as well as co-occurring to others, and/or co- aggression, or co- to self and/or to aggression, danger to mental disorders. occurring mental occurring mental others, and co- self and/or to others, disorders. disorders; occurring mental and co-occurring mental consistently screens disorders. disorders for danger to self or Integration Manual 2014-2015 53 others</p><p>Applies the assessment MHH4 Does not assess the Inconsistently Consistently Consistently assesses of a client’s stage of client’s stage of assesses the client’s assesses the client’s the client’s stage of dependence, change, dependence, change, stage of stage of dependence, change, or or recovery to or recovery to dependence, dependence, change, recovery and determine the determine the change, or recovery or recovery and demonstrates appropriate treatment appropriate treatment or inconsistently consistently applies exceptional skills in modality and modality and applies the findings the findings to applying the findings to placement criteria placement criteria to determine the determine the determine the within the continuum within the continuum appropriate appropriate appropriate treatment of care. of care treatment modality treatment modality modality and placement and placement and placement criteria within the criteria within the criteria within the continuum of care continuum of care continuum of care Demonstrates MHL1 Demonstrates Demonstrates Demonstrates Demonstrates appropriate use of inappropriate use of inconsistent use of consistent use of exceptional knowledge, diagnostic tools, diagnostic tools, diagnostic tools, diagnostic tools, and consistent use of including the current including the current including the including the diagnostic tools, edition of the DSM, to edition of the DSM, current edition of current edition of including the current describe the symptoms to describe the the DSM, to the DSM, to edition of the DSM, to and clinical symptoms and describe the describe the effectively describe the presentation of clients clinical presentation symptoms and symptoms and symptoms and clinical with mental and of clients with mental clinical presentation clinical presentation presentation of clients emotional and emotional of clients with of clients with with mental and impairments. impairments. mental and mental and emotional impairments. emotional emotional impairments. impairments. Is able to MHL2 Demonstrates a lack Demonstrates Demonstrates Demonstrates conceptualize an of ability to limited ability to consistent ability to exceptional ability to accurate multi-axial conceptualize an conceptualize an conceptualize an conceptualize an diagnosis of disorders accurate multi-axial accurate multi-axial accurate multi-axial accurate multi-axial presented by a client diagnosis of disorders diagnosis of diagnosis of diagnosis of disorders and discuss the presented by a client disorders presented disorders presented presented by a client differential diagnosis and discuss the by a client and by a client and and discuss the with collaborating differential diagnosis discuss the discuss the differential diagnosis professionals. with collaborating differential differential with collaborating professionals. diagnosis with diagnosis with professionals. collaborating collaborating professionals. professionals. Uses referral SCN5 Demonstrates a lack Demonstrates a Demonstrates Demonstrates procedures with of ability to use limited ability to use consistent ability to exceptional ability to helping agents in the referral procedures referral procedures use referral use referral procedures community (e.g., with helping agents with helping agents procedures with with helping agents in mental health centers, in the community in the community helping agents in the the community (e.g., businesses, service (e.g., mental health (e.g., mental health community (e.g., mental health centers, groups) to secure centers, businesses, centers, businesses, mental health businesses, service assistance for students service groups) to service groups) to centers, businesses, groups) to secure and their families. secure assistance for secure assistance for service groups) to assistance for students students and their students and their secure assistance for and their families. families. families. students and their families. Integration Manual 2014-2015 54 Integration Manual 2014-2015 55 Integration Manual 2014-2015 56 Integration Manual 2014-2015 57 Integration Manual 2014-2015 58 Integration Manual 2014-2015 59 Integration Manual 2014-2015 60 Appendix N</p><p>Weekly Activity Report for Integration M T W R F S/S Total this Pre Total for the week vio Semester us Tot al Direct Service Activities Direct Service: Interaction with clients that includes the application of counseling, consultation, or human development skills. Individual Counseling 0 0 Group Counseling 0 0 Psychoeducational Activities 0 0 Consultation regarding clients 0 0 Participation in intakes 0 0 Other (e.g., crisis response) 0 0 Total Direct Hours 0 0 0 0 0 0 0 0 Indirect Service Activities Group Supervision 0 0 Individual Tape Supervision 0 0 Observation of intakes 0 0 Preparation for counseling sessions 0 0 Class assignments related to client 0 0 service Professional development 0 0 Case notes and record keeping 0 0 Other (specify) 0 0</p><p>Total Indirect Hours 0 0 0 0 0 0 0 0 Integration Manual 2014-2015 61 Direct and Indirect Service Time is counted in quarter hour intervals o 15 minutes = .25 hours</p><p> o 16-30 minutes = .50 hours</p><p> o 31-45 minutes = .75 hours</p><p> o 45-60 minutes = 1.0 hours</p><p>Direct Service Activities According to CACREP 2009 Standards, direct service is defined as “interaction with clients that includes the application of counseling, consultation, or human development skills…working directly with clients (p. 35). Before counting your time as direct service, was the time spent:  Working directly with a client?  Providing a Counseling Center Professional Counselor with help about a client?  Facilitating a psychoeducational group Individual Counseling Only 1 client in the room. Group Counseling More than 3 clients in the room. Psychoeducational Activities 1 or more attendees in the room. Consultation regarding You providing another counselor with information about their clients client (e.g., you counseled a colleague’s client for an emergency visit or client was reassigned). Participation in intakes You conducted an intake session with an individual client. Other Not typically used. Ask before placing hours in this area. Indirect Service Activities Indirect service includes time spent preparing for your work with clients. Such tasks may include receiving information or receiving consultation from other counselors about your clients, preparing for an individual or group session, writing case notes, conceptualizing your clients’ cases (including many assignments for EDC 720) Count your time as indirect service if:  No clients were in the room Group Supervision Class time: check the syllabus for the amount of time you should be counting each evening. Individual Tape Supervision Time with your EDC 721 Tape Supervisor Observation of intakes You witness a professional staff member conducting an intake with an actual client. Preparation for counseling Reading client files, your notes, preparing handouts for client, sessions talking with on-site adjuncts about clients, etc. Class assignments related to Tape Transcripts, papers about clients client service Professional development Attending a conference or other professional training for counselors Case notes and record Entering information into Electronic Medical Record System Integration Manual 2014-2015 62 keeping Other Not typically used. Ask before entering information in this area.</p>