This is an agreement between Supervisee and Dr. Ashley Stephens, Licensed Clinical Social Work Supervisor, of The Crane & The Bull, Corp.

The purpose of supervision is to assist supervisee in gaining clinical licensure in the field of social work.

Frequency of supervision has been agreed upon to be weekly until supervision is no longer wanted or needed, or until supervisee has become fully licensed. Supervision will occur via group if possible, and individual if not.

In the state of Texas, per the Texas Administrative Code (TAC), Title 22, Part 34, Chapter 781, Subchapter C, Rule §781.404, a9:

“(A) Supervision toward licensure or specialty recognition may occur in one-on-one sessions, in group sessions, or in a combination of one-on-one and group sessions. Session may transpire in the same geographic location, or via audio, web technology or other electronic supervision techniques that comply with HIPAA and Texas Health and Safety Code, Chapter 611, and/or other applicable state or federal statutes or rules.

(B) Supervision groups shall have no fewer than two members and no more than six.”

Supervisor’s definition of supervision: Supervision is a professional relationship between a supervisor and supervisee in which the supervisor directs, monitors and evaluates the supervisee's social work practice while promoting development of the supervisee's knowledge, skills and abilities to provide clinical social work services in an ethical and competent manner.

Responsibilities of the Supervisor include but are not limited to:

1.     The supervisor will meet the qualifications as outlined in TAC and maintain licensure for the duration of the supervision.

2.     The supervisor will monitor the performance of the person supervised and provide regular, documented individual or group consultation, guidance, and instruction that is specific to the clinical social work services being performed with respect to the clinical skills and competencies of the person supervised in accordance with TAC.

3.     The supervisor will assume full responsibility for the social work activities of the supervisee set forth in the regulations for the duration of the supervision or until terminated.

4.     The supervisor will evaluate the supervisee's knowledge and document minimal competencies in the areas of an identified theory base, application of a differential diagnosis, establishing and monitoring a treatment plan, development and appropriate use of the professional relationship, assessing the client for risk of imminent danger, understanding the requirements of law for reporting any harm or risk of harm to self or others, and implementing a professional and ethical relationship with clients.

5.     The supervisor will ensure that the supervisee is practicing within the scope of the supervisee’s supervision.

6.  The supervisor will ensure the supervisee has read and is knowledgeable about the state and federal laws related to reporting requirements and emergency procedures for high risk or abused clients, as well as confidentiality and privileged communication.

7.  If there is cause to interrupt supervision, the supervisor will, within a reasonable period of time before termination of supervision, provide the supervisee with notice to avoid or minimize any harmful effect on the supervisee or their clients.

8.  The supervisor will conduct supervision as a process distinct from personal therapy or didactic instruction.

9.  The supervisor will be available outside of scheduled supervision for consultation and/or emergency situations.

10.  The supervisor will make a reasonable effort to ensure the supervisee’s competence to practice.

11.  The supervisor will immediately report to the Board any unethical practice performed by the supervisee, in accordance with TAC.

12.  The supervisor will remain up-to-date on the changes related to BHEC and TAC, and will communicate these changes as soon as they are known and understood.

Supervisor Duties:

The supervisor agrees to provide clinical supervision to the supervisee for a minimum of one hour per week, except for vacation, sick, or other time off as scheduled. In Texas, for every 30 hours of clinical social work provided, 1 hour of supervision is required.

Responsibilities of the Supervisee include but are not limited to:

1.     The supervisee will read, understand and intend to comply with TAC.

2.     The supervisee will establish and execute a supervisory contract for supervision before beginning to provide clinical social work services as a supervisee in social work and before counting hours toward LCSW licensure.

3.     The supervisee will participate in supervision with a goal of increasing competency in clinical practice and attend supervision on the agreed upon basis.

4.     The supervisee will be prepared to discuss with the supervisor the diagnosis/case conceptualization and treatment of each client as well as problems in the supervisee’s clinical milieu.

5.     The supervisee will provide samples of diagnostic assessments and treatment plans which are representative of the variables of gender, age, diagnosis, length of treatment and treatment method within the client population seen by the supervisee as requested.

6.     The supervisee will avoid engaging in activity for which the supervisee lacks competency, training, education, supervision and which may compromise client safety and wellbeing.

7.     The supervisee will refrain from representing himself or herself as an independent, autonomous practitioner or licensed clinical social worker.

8.  Supervisees will inform clients in writing of the supervisee's status and the supervisor's name, professional address, and phone number.

9.  The supervisee will not supervise the provision of clinical social work services provided by another person.

10.  The supervisee will remain up-to-date on the changes related BHEC and TAC.

11.  The supervisee will reach out to the supervisor outside of scheduled supervision to consult or in emergency situations, as needed.

12.  The supervisee will ensure that supervision occurs a minimum of one hour weekly.

Supervisee Duties:

I agree to be consistently engaged in my supervision, to attend supervision on time and be prepared to discuss personally salient aspects of my experience, to complete all client documentation in a timely manner, to log all supervision experiences, and to act at all times in an ethical manner with clients.

We agree, to the best of our ability, to uphold the guidelines specified in this supervision contract and to manage the supervisory relationship and supervisory process according to the ethical principles of the field of social work.

This is an agreement between Supervisee and Ashley Stephens, Licensed Clinical Social Work Supervisor, of Apela Licensure Supervision & Counseling, PLLC.

The purpose of supervision is to assist supervisee in gaining clinical licensure in the field of social work.

Frequency of supervision has been agreed upon to be weekly until supervision is no longer wanted or needed, or until supervisee has become fully licensed. Supervision will occur via group if possible, and individual if not.

In the state of North Carolina, per the North Carolina Statutes NCGS 90B-4 and NORTH CAROLINA ADMINISTRATIVE CODE TITLE 21 OCCUPATIONAL LICENSING BOARDS CHAPTER 63 SOCIAL WORK CERTIFICATION:

“(d) Each associate licensee must be supervised as set forth in G.S. 90B-7(f) and receive on-going appropriate supervision as defined in Rule .0211(a)(2) of this Chapter until the qualifying examination has been passed and the Licensed Clinical Social Worker license is issued.

(2) Appropriate supervision shall mean supervision by a MSW who is also a Licensed Clinical Social Worker and who is in good standing with the Board. A supervisor disciplined by any professional credentialing body or professional organization by legal order, or who has been found by legal order to have violated the provisions of an occupational licensing Board may not provide supervision to an associate licensee without the written permission of the Board. The Licensed Clinical Social Worker Associate’s (LCSWA) clinical social work supervisor shall have an additional two years of clinical social work experience post LCSW licensure.”

Responsibilities of the Supervisor include but are not limited to:

1.     The supervisor will meet the qualifications as outlined in NC statutes and maintain licensure for the duration of the supervision.

2.     The supervisor will monitor the performance of the person supervised and provide regular, documented individual or group consultation, guidance, and instruction that is specific to the clinical social work services being performed with respect to the clinical skills and competencies of the person supervised in accordance with NC statutes.

3.     The supervisor will assume full responsibility for the social work activities of the supervisee set forth in the regulations for the duration of the supervision or until terminated.

4.     The supervisor will evaluate the supervisee's knowledge and document minimal competencies in the areas of an identified theory base, application of a differential diagnosis, establishing and monitoring a treatment plan, development and appropriate use of the professional relationship, assessing the client for risk of imminent danger, understanding the requirements of law for reporting any harm or risk of harm to self or others, and implementing a professional and ethical relationship with clients.

5.     The supervisor will ensure that the supervisee is practicing within the scope of the supervisee’s supervision.

6.  The supervisor will ensure the supervisee has read and is knowledgeable about the state and federal laws related to reporting requirements and emergency procedures for high risk or abused clients, as well as confidentiality and privileged communication.

7.  If there is cause to interrupt supervision, the supervisor will, within a reasonable period of time before termination of supervision, provide the supervisee with notice to avoid or minimize any harmful effect on the supervisee or their clients.

8.  The supervisor will conduct supervision as a process distinct from personal therapy or didactic instruction.

9.  The supervisor will be available outside of scheduled supervision for consultation and/or emergency situations.

10.  The supervisor will make a reasonable effort to ensure the supervisee’s competence to practice.

11.  The supervisor will immediately report to the Board any unethical practice performed by the supervisee, in accordance with NC statutes.

12.  The supervisor will remain up-to-date on the changes related to NC Social Work Board and NC statutes and will communicate these changes as soon as they are known and understood.

Supervisor Duties:

The supervisor agrees to provide clinical supervision to the supervisee. In North Carolina, “(3) Appropriate supervision shall be that which is provided on a regular basis, conducted no less than once every two weeks, with at least one hour of supervision during every 30 hours of experience. A minimum of 100 hours of supervision is required” in no less than 2 years.

Responsibilities of the Supervisee include but are not limited to:

1.     The supervisee will read, understand and intend to comply with NC Statutes.

2.     The supervisee will establish and execute a supervisory contract for supervision before beginning to provide clinical social work services as a supervisee in social work and before counting hours toward LCSW licensure.

3.     The supervisee will participate in supervision with a goal of increasing competency in clinical practice and attend supervision on the agreed upon basis.

4.     The supervisee will be prepared to discuss with the supervisor the diagnosis/case conceptualization and treatment of each client as well as problems in the supervisee’s clinical milieu.

5.     The supervisee will provide samples of diagnostic assessments and treatment plans which are representative of the variables of gender, age, diagnosis, length of treatment and treatment method within the client population seen by the supervisee as requested.

6.     The supervisee will avoid engaging in activity for which the supervisee lacks competency, training, education, supervision and which may compromise client safety and wellbeing.

7.     The supervisee will refrain from representing himself or herself as an independent, autonomous practitioner or licensed clinical social worker.

8.  Supervisees will inform clients in writing of the supervisee's status and the supervisor's name, professional address, and phone number.

9.  The supervisee will not supervise the provision of clinical social work services provided by another person.

10.  The supervisee will remain up-to-date on the changes related the NC Social Work Board and NC Statutes.

11.  The supervisee will reach out to the supervisor outside of scheduled supervision to consult or in emergency situations, as needed.

Supervisee Duties:

I agree to be consistently engaged in my supervision, to attend supervision on time and be prepared to discuss personally salient aspects of my experience, to complete all client documentation in a timely manner, to log all supervision experiences, and to act at all times in an ethical manner with clients.

We agree, to the best of our ability, to uphold the guidelines specified in this supervision contract and to manage the supervisory relationship and supervisory process according to the ethical principles of the field of social work.