COLORADO CHRISTIAN UNIVERSITY

Master of Arts in Counseling (MAC)

Practicum Manual
College of Adult & Graduate Studies 7/1/2011

Counseling Practicum Manual

Introduction

This manual was written to answer basic questions regarding the MAC community counseling practicum and to establish a set of standards that can be easily read and followed. All counseling practicum students are expected to read, understand, and adhere to the contents of this document. From time to time this manual is revised to update pertinent academic, accreditation, and/or licensurerelated information. It may include new sections. Students and practicum professors are encouraged to make suggestions to the university MAC Program Coordinator about future revisions. Students will be held to the most current updated edition of the manual.

Counseling Practicum Manual

Table of Contents
Introduction ...............................................................................................................................................1 Table of Contents ......................................................................................................................................2 Practicum - CSL 514 .................................................................................................................................4 Steps For Selecting and Beginning a Practicum ........................................................................................5 Basic Practicum Requirements ..................................................................................................................6 Other Practicum Policies .......................................................................................................................6 Dual Relationships .............................................................................................................................6 Paid Site Supervision .........................................................................................................................6 Disciplinary and Professional Conduct Policy ............................................................................................7 Evaluation ..................................................................................................................................................8 Practicum Students Rights and Responsibilities ......................................................................................9 Rights .....................................................................................................................................................9 Responsibilities ......................................................................................................................................9 Practicum Professors Rights and Responsibilities .................................................................................11 Rights ...................................................................................................................................................11 Responsibilities ....................................................................................................................................11 Practicum Site Supervisors Responsibilities ..........................................................................................12 Credentials Required ...........................................................................................................................12 Responsibilities ....................................................................................................................................12 Liability Insurance ....................................................................................................................................13 Dollar Amount of Liability Coverage....................................................................................................13 Agencies Providing Coverage for Students .........................................................................................13 Frequently Asked Questions....................................................................................................................14 Appendix A ..............................................................................................................................................15 Practicum Checklist .............................................................................................................................15 Appendix B...............................................................................................................................................16 Colorado Prohibited activities - related provisions .............................................................................16 Appendix C...............................................................................................................................................19 Practicum Forms ..................................................................................................................................19 Evaluation Forms .................................................................................................................................19 Other Important Forms .......................................................................................................................19 Practicum Contract .................................................................................................................................20 Student Practicum/Internship Ethical Agreement ..................................................................................23 Site Supervisors Evaluation of Practicum/Internship Student ...............................................................24 2

Counseling Practicum Manual

Student Evaluation of Site Supervisor .....................................................................................................27 Self Assessment of Basic Helping Skills and Procedural Skills .................................................................29 Site Evaluation Form................................................................................................................................31 Practicum/Internship Client Consent Form .............................................................................................32 Audiotape/Videotape Client Consent Form ............................................................................................33 Practicum/Internship Log ........................................................................................................................34 Final Words..............................................................................................................................................35

Counseling Practicum Manual

Counseling Practicum - CSL 514

At Colorado Christian University, Counseling Practicum has been developed to provide the student with a closely supervised counseling experience to facilitate initial development as a professional counselor. The practicum should foster: a. Basic counseling skills; b. An understanding of how personality and individual relational styles may influence human relationships; c. The ability to conceptualize human problems; d. Professional counseling skill development such as interviewing, diagnosis, testing, treatment planning, etc.; e. Social and professional responsibility in accordance with the ethical codes of the profession; f. Knowledge of human differences. This practicum is a planned, field-based clinical experience where a student works with clients under supervision at a community agency. The Community Practicum site supervisor must meet the following requirements: a. Have a minimum of a Master's degree in Counseling or a related profession with equivalent qualifications, including appropriate professional license(s); b. Have adequate post-licensure clinical experience in the program area in which the student is completing clinical instruction. c. Be willing to provide 1 hour of weekly supervision with the practicum student at the site. d. Be willing to communicate with the University Practicum Professor every two weeks. e. Have knowledge of the Program's expectations, requirements, and evaluation procedures for students. f. Be willing to attend supervisor training/workshop offered by CCU. In general, students begin their practicum experience in the second semester of the Masters degree program. The required prerequisite courses for practicum are listed below. The practicum student and site supervisor work in collaboration on the site. The site supervisor is to meet at least one hour weekly with the practicum student for individual and/or triadic supervision. The university Practicum Professor serves as the faculty supervisor and will make contact with the site supervisor by phone or email every two weeks during the semester, along with providing supervision and instruction to the student at the scheduled class time. According to CACREP standards, students must have both on-site and faculty supervision. The practicum class hours will count only as group faculty supervision hours, not on-site supervision. Students are responsible for keeping accurate records of each type of supervision. A practicum log is provided to help students accurately track their hours. This log should be submitted electronically to the practicum professor for review as requested during the semester. At the end of each semester, a paper copy of the log must be signed by the site supervisor and submitted to the practicum professor by the student.

Counseling Practicum Manual

Steps For Selecting and Beginning a Practicum

1) In order to begin practicum, you must first have successfully completed the required courses listed below. CSL 510 Group Processing CSL 620 Counseling Services and Methods CSL 621 Theories of Personality and Counseling 2) Next, you must attend a mandatory meeting the semester prior to beginning your field placement. These meetings will be announced via email and flyers, so be sure to look for this information. It is the students responsibility to read his or her CCU emails in order to be informed of these mandatory meetings. If you are not able to attend the mandatory meeting, it is your responsibility to notify the Center Clinical Coordinator in advance and attend an alternate center meeting if possible. 3) Once you have attended the mandatory practicum meeting, you can then begin looking for practicum sites. Please refer to the list of approved sites posted on the MAC website and provided at the practicum meeting. Students should contact their Center Clinical Coordinator or the MAC Program coordinator with any questions as they go through the process of securing a practicum site. The MAC Program coordinator can be reached at 303-963-3430 or jfrance@ccu.edu.

Note: It is strongly recommended that students make plans for their practicum shortly after the Practicum Meeting. Most sites require one or more interviews, many are highly competitive with other graduate counseling programs, and some begin choosing students early.

4) Once a site is secured, students must compile all of the required paperwork. All manuals, forms, and evaluations are available online at the MAC website. Students are expected to download these documents and be familiar with them. 5) When the student has compiled all required paperwork, he/she emails or faxes (303-301-8430) all paperwork to the MAC Program Coordinator by the first day of practicum class. The student who fails to submit all required paperwork to the MAC Program Coordinator by the first day of class will receive a 48 hour warning. If the student fails to submit the required paperwork within 48 hours, the MAC Program Coordinator will withdraw the student from practicum class for the semester. Please see Appendix A for a Practicum checklist.

Counseling Practicum Manual

Note: Students who are withdrawn from CSL 514 Practicum because they failed to turn in their required paperwork will have to retake the class in a later semester which may result in having to delay his/her graduation date.

Basic Practicum Requirements

The COMMUNITY PRACTICUM is 100 hours taken during the second semester in the program. These 100 hours include the following: Direct Service: A minimum of 40% of the 100 hours (i.e., a minimum of 40 hours, to include face-to-face, individual & group counseling, testing, and/or consultation). Indirect Service: The remainder of the 100 hours (i.e., approximately 60 indirect hours to include report writing, agency meetings, supervision, bi-monthly faculty supervision sessions, professional development, staff meetings, and in-services). Supervision: (This is part of the indirect service.) Required weekly interaction with an average of one hour per week of individual and/or triadic (no more than two students at a time) supervision, throughout the 100 hours. Students are not allowed to begin collecting hours at their practicum sites until the first day of classes. Since faculty supervision is essential to the practicum process, students are required to attend the first practicum class in order to understand the expectations for the practicum. If a student needs to continue collecting hours at his or her practicum site at the end of the semester, he or she must submit a course extension request and must have approval from his or her practicum professor. Students are NOT allowed to carry over any extra hours into internship.

Other Practicum Policies

Personal Counseling and Dual Relationships
As stated in the MAC manual, students are required to receive a minimum of (5) individual or group counseling sessions with a licensed therapist prior to starting their internship experience. The value of this therapeutic process is integral to your professional development as well as affording you the opportunity to experience what it is like to be a client. At times, students may seek services from a licensed therapist or from an agency that is an approved practicum site. To maintain the value of the counseling relationship, students should seek out CCU-approved site supervisors who are not their current or former therapists. Also, students should seek out CCU-approved practicum sites that are different from the agencies where students have received any counseling services.

Paid Site Supervision

As part of the practicum/internship process, students are required to receive weekly supervision from a CCU-approved site supervisor. As part of professional training, it is common practice for those seeking licensure to pay for supervision. It is not common practice for students in training to pay for supervision during their academic training. Therefore, CCU-approved sites/supervisors are not allowed to request 6

Counseling Practicum Manual

compensation for their supervisory services. If such a situation happens, students should notify the MAC Program Coordinator immediately. There is one exception when a student might elect to pay for supervision. This occurs when there is no one at a particular sight qualified or available to provide weekly supervision. In the rare case this might happen, students are allowed to contract with a licensed mental health professional who is not employed by the site. This supervisor, however, must agree to the terms of the supervision contract and must be approved in advance by the Center Clinical Coordinator in your geographical location.

Disciplinary and Professional Conduct Policy

Faculty, training staff, and clinical supervisors have a professional and ethical responsibility to: 1) Evaluate the interpersonal competence and emotional well being of student trainees who are under their supervision, and who provide services to clients and consumers 2) Ensure, insofar as possible, that the trainees who complete their programs are competent to manage future relationships (e.g., client, collegial, professional, public, scholarly, supervisory, teaching, etc.) in an effective and appropriate manner 3) Not automatically approve program completion for students with issues or problems (e.g., cognitive, emotional, psychological, interpersonal, technical, and ethical) that may interfere with professional competence to other programs, the profession, employers, or the public at large because of this commitment. Because of this ethical responsibility, a student will not be allowed to begin practicum if there are any current concerns about professional competency. Please refer to the Professional Competency policy in the MAC student manual for more details.

Students may be given a failing grade for Counseling Practicum if any of the following apply:
1) More than (1) one absence during scheduled class meetings per semester. 2) Failing to get all forms for the class signed by all appropriate parties, scanned, and uploaded to the appropriate drop box in the course shell. Students that do not complete and upload their forms will fail the course. Due dates for forms are clearly stated in the course shell. 3) Inadequate, incomplete, or unacceptable Case Study presentations (as determined by the Practicum Professor/Faculty Supervisor). 4) Disciplinary actions that are the result of unprofessional/unethical conduct either at the Practicum site or in the classroom and/or failure to comply with directions and consultation given by either the Faculty Supervisor or any Site Supervisor. All disciplinary problems will be documented on a Professional Development Form. 5) If the Faculty Supervisor determines that the students current emotional, mental or physical status compromises the integrity of the Practicum experience or potentially places the student or others in harms way or in an unduly vulnerable position. All such cases will be brought to the attention of the Dean. 7

Counseling Practicum Manual

6) If there is a question or concern of competency in areas such as (but not limited to): a. interpersonal and professional competence (e.g., the ways in which a student relates to clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories) b. self-awareness, self-reflection, and self-evaluation (e.g., knowledge of the content and potential impact of one's own beliefs and values on clients, peers, faculty, allied professionals, the public, and individuals from diverse backgrounds or histories) c. openness to processes of supervision (e.g., the ability and willingness to explore issues that either interfere with the appropriate provision of care or impede professional development or functioning) d. resolution of problems or issues that interfere with professional development or functioning in a satisfactory manner (e.g., by responding constructively to feedback from supervisors or program faculty; by participating in personal therapy in order to resolve problems or issues). 7) If any of the above criteria are applicable, students may be subject to the Professional Competency policy and guidelines found in the MAC Student Manual.

Evaluation
The following will be used in the evaluation of the practicum student: (Please submit in the course shell. Do not give physical copies to your professor) 1) Completion of assignments by practicum student: a. Summary of practicum hours log b. Written case presentations c. Verbal case presentations d. Final Self Evaluation e. Evaluation of practicum students site supervision f. Evaluation of Site 2) Site Supervisors Mid-term and Final evaluations 3) Practicum faculty supervisors evaluation of performance based on: a. The practicum students regular attendance at practicum meetings/sessions b. The practicum students written summaries, reports/logs, and journal c. The practicum students participation in practicum meetings/sessions d. The practicum students presentation of case studies e. Communications with the Site Supervisor 4) Practicum faculty supervisors will complete a Counselor Competency Assessment at the end of each semester to assist in determining the students ability and fit for the counseling profession. This assessment, combined with any other input regarding each students professional development, will be utilized to determine if each student is eligible to move forward in the program.

Counseling Practicum Manual

Practicum Students Rights and Responsibilities

Rights
1) The student has a right to know the criteria for evaluation in the course and to receive progress evaluations from the faculty practicum supervisor [instructor] on a regular, systematic basis. 2) The student has a right to know the expectations and procedures of the faculty practicum supervisor. 3) The student has a right to expect regular supervision and feedback in the management of cases as scheduled by the site supervisor and professional counseling staff. 4) The student has a right to know the procedure for handling emergencies. 5) The student has a right to ask questions regarding the counseling process and the correct handling of cases. 6) The student has a right to have the Practicum rules and guidelines of the School of Adult and Graduate studies MAC program explained fully.

Responsibilities
1) The practicum student is responsible for securing a practicum site interview. 2) The practicum student is responsible for notifying the faculty supervisor, site supervisor, and MAC Program Coordinator of any changes of address (street, city and state), phone numbers, or schedules affecting on-site contact hours, etc. 3) The practicum student is responsible for preparing for class meetings with the faculty practicum supervisor. The student must attend class at the scheduled times unless other arrangements have been mutually agreed upon by the practicum professor. 4) The practicum student is responsible for notifying the practicum professor of any conflicts or situations that may cause an absence from the practicum class. According to Licensure Regulations in some states and CACREP Standards, no more than one (1) absence from practicum class will be allowed. More than one absence will result in automatic failure of practicum. In extenuating circumstances (i.e., death of a family member, serious illness of the student or immediate family member), the student must file an academic petition before or at the next class meeting attended. 5) The student is responsible for turning in (and keeping copies of) all evaluations to the practicum professor (submit to course shell), who then gives these evaluations to the MAC Program Coordinator to place in the students file. 6) The student is responsible, upon assignment at a practicum site, for asking the site supervisor about the format, guidelines and procedures staff use for client record keeping. The practicum student is expected to abide by the required procedures and site requirements. 7) The practicum student is responsible for providing clients with a quality experience. 8) The practicum student is responsible for promptly keeping appointments with clients. In the event of illness or emergency, the practicum student must notify the client and the site supervisor of any change in appointments. 9) The practicum student is responsible for informing the practicum professor and site supervisor of any problems with cases or client emergencies. 10) The practicum student is responsible for seeking supervisory help with cases where the student questions his or her own effectiveness. For instance, the student may recognize that the present problem, values, race, sexual orientation, etc. of the client is impacting on the ability to be helpful and request supervision to address this difficulty. 11) The practicum student is responsible for requesting additional supervision if needed. 9

Counseling Practicum Manual

12) The practicum student is responsible for following any directives given by the faculty or site supervisor regarding interventions with a client. If the student has any questions about the ethical nature of directives, they should consult with their faculty supervisor or the Dean. 13) The practicum student is required to video/audio tape 2 counseling sessions per semester for review and presentation to the faculty practicum supervisor and peers. These tapes must be kept secure to protect the clients confidentiality. 14) The practicum student is responsible for having each client sign a release for taping and putting this release in the clients file. 15) The practicum student is responsible for explaining the nature of the counseling relationship to clients. It is essential that the client understand that the student is an intern, not licensed professional. The practicum student should inform the client that there will be a limited number of sessions. The practicum student must also explain the taping procedure, supervision, and any other conditions under which the student is working. CCU provides a Client Consent Form to facilitate this process. Students must have each client complete and sign this form and it should be retained in the clients file at the field site. 16) The practicum student is responsible for adhering to the Ethical Standards of the American Counseling Association (ACA) and the Colorado Prohibited Activities Statute in Appendix B. The ACA Code of Ethics is available online at: http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx. 17) The practicum student is responsible for awareness of legal and ethical issues related to counseling (e.g., confidentiality and privilege, duty to warn, malpractice, negligence).

Important Note! Students should keep copies of their Practicum Log, Evaluation Forms, and Course Syllabi because you may need these as you apply for licensure in the future or attempt to transfer your licensure to a different state.

10

Counseling Practicum Manual

Practicum Professors Rights and Responsibilities

Rights
1. The Practicum Professor has the right to determine the expectations and requirements of the practicum. 2. The Practicum Professor has the right to expect the students regular and punctual attendance in practicum classes. 3. The Practicum Professor has the right to evaluate the students performance based on the stated criteria of the practicum section in which the student is enrolled. 4. The Practicum Professor has the right to reprimand students whose behavior is not consistent with the Ethical Standards of the American Counseling Association and the policies and procedures set forth by the Master of Arts in Counseling Program at Colorado Christian University. 5. The Practicum Professor has the right to determine the assignment and/or reassignment of cases based on the interaction with the Practicum Site Supervisor, the students skill level, and the presenting problem.

Responsibilities
1. The Practicum Professor is responsible for clearly stating expectations, requirements, and grading criteria. 2. The Practicum Professor is responsible for providing feedback to practicum students regarding their skill development and course grade at regular intervals during the semester. 3. The Practicum Professor is responsible for informing the practicum student, at the earliest possible time, if work is not satisfactory and to detail specific behavioral expectations that can lead to improvement. 5. The Practicum Professor is responsible for acting as the first point of contact between the university and the practicum site and should be available to communicate with the site supervisor as needed. 6. The Practicum Professor is responsible for collecting and discussing Student and Site Supervisor evaluations, Practicum Hours Log and any other required forms, and forwarding them to the MAC Program Coordinator to include in the students file. 7. The Practicum Professor is responsible for completing the Counselor Competency Scale for the student at the end of the semester and forwarding it to the MAC Program Coordinator to include in the students file.

11

Counseling Practicum Manual

Practicum Site Supervisors Responsibilities

Credentials Required
The Community Practicum site supervisor must have a minimum of a Master's degree in Counseling or a related profession with equivalent qualifications, including appropriate professional license(s); and adequate post-licensure clinical experience in the program area in which the student is completing clinical instruction. In addition, the site supervisor must be willing to meet the practicum student one hour weekly for individual or triadic supervision, and must have knowledge of the Program's expectations, requirements, and evaluation procedures for students.

Responsibilities
1. The site supervisor is responsible for providing opportunities for the student to engage in a variety of counseling activities under supervision and to evaluate the students performance. 2. The site supervisor is responsible for providing settings for the practicum student to conduct individual and group counseling sessions with assured privacy and sufficient space for appropriate equipment. 3. The site supervisor is responsible for providing necessary and appropriate technology that assists with learning. 4. The site supervisor is responsible for providing one-to-one and/or triadic supervision, which involves some examination of student work using audio/video tape observation, and/or live supervision (Note: Supervision should include weekly interaction with an average of one hour per week.) 5. The site supervisor is responsible for completing Colorado Christian Universitys counseling student mid-term and final evaluation forms and for reviewing these evaluations with the practicum student. 6. To make supervision more effective, we ask the site supervisor to allow our students to video or audio tape sessions with consenting clients. These tapes will further the effectiveness of the evaluation of students counseling skills. Consent forms for clients are available online at the MAC website.

12

Counseling Practicum Manual

Liability Insurance
Students enrolled for Practicum and Internship in the MAC program must have Liability Insurance throughout the duration of their placements. A copy of the Liability Insurance Face Page must be turned into the MAC Program Coordinator by the first day of the semester. The student is responsible for maintaining current student liability insurance throughout their field placements and for making sure that a copy of the updated policy is on file with the MAC Program Coordinator. Until the face page copy is in the students file, the student will not be allowed to collect hours at the practicum site.

Dollar Amount of Liability Coverage

The University requires counseling students to purchase liability coverage in the amount of $1,000,000$3,000,000 (minimum) annually. Students who have purchased a lesser amount of insurance must contact the insurance provider and raise coverage to $1,000,000/$3,000,000 per year.

Agencies Providing Coverage for Students

American Counseling Association Insurance Trust, Inc http://www.acait.com 800-347-6647 American Professional Agency http://www.americanprofessional.com/student/index.htm 800-421-6694 or 631-691-6400 American Psychological Association Insurance Trust http://www.apait.com 877-637-9700 NOTE: The American Counseling Association is now providing insurance for students as part of its membership benefits. CCU encourages students to be involved with this professional organization. Some frequently asked questions about this option are listed below: Question: As a masters level student member of ACA, how do I obtain proof of insurance to turn into my program? In order to obtain Evidence of Insurance, the student must update their student program level status by contacting the ACA Member Service Department at 800-347-6647/703-823-9800, ext. 222 (M-F, 8 am 7 pm, ET). Question: Am I covered for student activities beyond practicum and internship? Yes. The coverage of the policy has not changed from when students were required to pay for it. Students are covered for any program related activity including (but not limited to): site visits, practice sessions, interviews, pre-practicum activities, practicum, and internship. If there is any question about whether a particular activity is covered, please contact the ACA Insurance Trust at 800-347-6647/703-823-9800, ext. 284. Question: Who do I contact if I have any further questions? The ACA Insurance Trust at 800-347-6647/703-823-9800, ext. 284 is glad to talk to you at any time. 13

Counseling Practicum Manual

Frequently Asked Questions

1. Will I be assigned a practicum site, or do I obtain my own practicum position? Students are responsible for obtaining their own practicum. CCU has set up a number of Practicum sites that you can call to set appointments for interviews with. Students are also welcome to investigate Practicum possibilities on their own, but they must be approved by the MAC faculty professor in your geographical location prior to your start date. 2. When can I begin my practicum? After all completed and approved practicum paperwork is in the possession of the MAC Program Coordinator. This paperwork must be completed (with all signatures required) and submitted at least one week prior to the start of Practicum class. Students should NOT see any clients prior to the first Practicum class, in which many of the issues that you may face initially will be discussed. You may not begin your practicum placement and no practicum hours will be counted until all paperwork is submitted to the MAC Program Coordinator. 3. Must the supervisor at my practicum be a Licensed Professional Counselor? In the state of Colorado, supervisory rules do not specifically state that supervision must be done by a licensed professional counselor. However, your practicum will need to be supervised (on-site) by a licensed therapist (LPC, LMFT, LCSW, Psychologist). This fulfills the CACREP requirements as well. Students are responsible for determining the licensure requirements of their respective states. 4. How many hours must I spend at my practicum? Completion of Practicum requires a total of 100 logged hours of time on the practicum site. 5. Can I be employed at a paid counseling experience or mental health job and count that as my practicum experience? Most Practicum placements are not paid positions. However, if a paid practicum position is obtained, students may do their practicum at that site provided permission is granted by the MAC Program Coordinator. In order to prevent a dual-relationship, students who are currently employed in a counseling field will need to obtain supervision that is separate from your agency supervisor. 6. What if I need more than one semester to finish the required 100 practicum hours? If a student does not complete the required 100 practicum hours in the spring semester, they can file a course extension request with the approval of their practicum professor and complete the hours in the summer. 7. What if I get more than 100 practicum hours? Can I carry these over to count for internship hours? CACREP clearly states that practicum hours CANNOT be carried over into internship. If a student gets more than 100 practicum hours, they can keep track of this on their hours log sheet and use it in their resume or other personal experience records.

14

Counseling Practicum Manual

Appendix A
Practicum Checklist

Read the MAC Student Manual and the Practicum Manual and be familiar with its contents. Students are responsible for all information contained in the manual. Be sure you have completed all of the courses required to begin Practicum. Attend the MANDATORY Practicum Orientation Meeting. Complete the following CCU paperwork, including the appropriate signatures, and turn it in or fax it to the MAC Program Coordinator at (303) 301-8430:

Practicum/Internship Contract Student Practicum/Internship Ethical Agreement

Obtain a copy of your Liability Insurance Face Sheet (coverage at least $1 million/$3 million) and turn it in or fax it to the MAC Program Coordinator at (303)301-8430.

Note: All of the above paperwork is due at least one week prior to the start of Practicum class. If you do not comply you may be asked to drop CSL 514 Counseling Practicum. NO practicum hours may be counted toward your degree until these forms have been turned in.

15

Counseling Practicum Manual

Appendix B
Colorado Prohibited activities - related provisions
Colorado Revised Statutes: 12-43-222

16

Counseling Practicum Manual

17

Counseling Practicum Manual

18

Counseling Practicum Manual

Appendix C
Practicum Forms
Practicum/Internship Contract
This form is a contract between the student, the University, and the practicum site. It must be signed by the student, the Dean, and the site supervisor.

Student Practicum/Internship Ethical Agreement

To be signed after reading the ACA Code of Ethics and the Colorado Prohibited Activities (Appendix B).

Evaluation Forms
Site Supervisors Evaluation of Practicum/Internship Student
This evaluation of the student is to be filled out and signed by the site supervisor at mid-term and at the end of the semester of practicum. The student must collect this signed form and turn it in to the Practicum Professor at mid-term and the end of the semester.

Student Evaluation of Site Supervisor

This evaluation of the practicum site supervisor is to be filled out by the student and turned in to the Practicum professor at the end of the semester of practicum.

Self Assessment of Basic Helping Skills and Procedural Skills

This self evaluation form is to be filled out by the student and turned in to the Practicum professor at the end of the semester of practicum.

Site Evaluation Form

This evaluation of the practicum site is to be filled out by the student and turned in to the Practicum professor at the end of the semester of practicum.

Other Important Forms

Practicum/Internship Client Consent Form (CCU or Agency Form)
This consent must be signed by EVERY client prior to you seeing them for any type of service. Keep in client file at the site for client records.

Audiotape/Videotape Client Consent Form (CCU or Agency Form)

This consent must be signed by EVERY client prior to you video or audio taping a counseling session. Keep in client file at the site for client records.

Practicum/Internship Log
This electronic file should be used weekly to record all practicum and supervision hours. It should be submitted electronically on a monthly basis to the Practicum Professor for review. At the end of each semester, this form should be printed and signed by the Site Supervisor, Practicum Professor, and student.

19

Counseling Practicum Manual

Practicum Contract

20

Counseling Practicum Manual

21

Counseling Practicum Manual

22

Counseling Practicum Manual

Student Practicum/Internship Ethical Agreement

Colorado Christian University STUDENT PRACTICUM/INTERNSHIP ETHICAL AGREEMENT

Directions: Student is to complete this form in duplicate and submit a copy of this agreement to the university Clinical Coordinator.

1. I hereby attest that I have read and understood the American Counseling Association ethical standards and will practice my counseling in accordance with these standards. Any breach of these ethics or any unethical behavior on my part will result in my removal from practicum/internship and a failing grade, and documentation of such behavior will become part of my permanent record. 2. I agree to adhere to the administrative policies, rules, standards, and practices of the practicum/internship site. 3. I understand that my responsibilities include compliance with practicum/internship supervision expectations and keeping my supervisor(s) informed regarding my practicum/internship experiences. 4. I agree to inform the university Internship Professor or Clinical Coordinator of any noncompliance issues on the part of my practicum/internship site supervisor(s). 5. I understand that I will not be issued a passing grade in practicum/internship unless I demonstrate the specified minimal level of counseling skill, knowledge, and competence and complete course requirements.

Signature ____________________________________________ Date ________________________________________________

23

Counseling Practicum Manual

Site Supervisors Evaluation of Practicum/Internship Student

24

Counseling Practicum Manual

25

Counseling Practicum Manual

26

Counseling Practicum Manual

Student Evaluation of Site Supervisor

27

Counseling Practicum Manual

28

Counseling Practicum Manual

Self Assessment of Basic Helping Skills and Procedural Skills

29

Counseling Practicum Manual

30

Counseling Practicum Manual

Site Evaluation Form

31

Counseling Practicum Manual

Practicum/Internship Client Consent Form

Colorado Christian University Practicum/Internship Client Consent Form

I, ________________________________, give my informed consent to enter into mental health and/or substance abuse treatment with ________________________________, who has informed me that he/she is a student in the Master of Arts (MAC) in Counseling Program at Colorado Christian University (CCU). I am fully aware that the student status of the above named individual indicates that my therapist is in training and will be discussing details of my case with supervisors at this clinic and with students and professors in the MAC program at CCU. My signature below indicates that: 1) I have been fully informed regarding the information noted above, 2) I understand my participation as a client is strictly voluntary and that I can withdraw from treatment at any time, and 3) I understand that my therapist will take reasonable care to attempt to keep all identifying information confidential, but that it is possible some identifying information may be inadvertently shared with MAC students and professors at times. Client: ________________________________________________ Date: _______________ (If client is a minor or unable to sign) Parent/Guardian: ______________________________________ Date: _______________

Practicum/Internship Student:_____________________________ Date: _______________

32

Counseling Practicum Manual

Audiotape/Videotape Client Consent Form

Colorado Christian University Practicum/Internship Audiotape/Videotape Client Consent Form

My signature below authorizes my therapist, _____________________________________, to audiotape or videotape my sessions for training purposes. I have previously signed the Colorado Christian University Practicum/Internship Client Consent form. My signature below also documents my consent for these tapes to be reviewed by supervisors at this clinic and by students and professors in the Master of Arts in Counseling program at Colorado Christian University. I fully understand that this audiotaping and/or videotaping may compromise the confidentiality of some identifying information.

Client Signature: ________________________________________ Date: _____________ (If client is a minor or unable to sign) Parent/Guardian: ______________________________________ Date: _____________

Practicum/Internship Student:_________________________________ Date: ____________

33

Counseling Practicum Manual

Practicum/Internship Log

34

Counseling Practicum Manual

Final Words
Dear Student, Thank you for taking the time to carefully read this manual. If you have more detailed questions, you can refer to the CAGS student manual and the MAC student manual. You can also contact the MAC Program Coordinator, the Center Clinical Coordinator in your geographical location, or your Internship Professor. The MAC web site is also available for you to download electronic copies of all the Practicum forms. These forms are updated regularly to comply with new accreditation standards so be sure to download the most recent versions. We hope you have an exciting and growth-producing Practicum experience and remember we are here to assist you in any way we can. Sincerely, The MAC faculty and staff

35