Study Points

Clinical Supervision for Mental Health Professionals in Florida

Course #76830 - $20 • 4 Hours/Credits

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. Individuals who wish to supervise interns and other practitioners must work within the limits of their competence and practiced techniques.

    ETHICAL ISSUES

    Individuals who wish to supervise interns and other practitioners must work within the limits of their competence and practiced techniques. Supervisors should be qualified to hold the position, either by demonstrating the ability to supervise or by receiving training [1]. The National Association of Social Workers (NASW), the American Psychology Association (APA), the American Association for Marriage and Family Therapy (AAMFT), and the American Counseling Association (ACA) all include standards in their respective code of ethics that require mental health professionals to work within their limits of knowledge [14,15,16,17]. While this is most clear in work with clients, it also pertains to work with other practitioners or interns as a supervisor. When using technology in their work and for supervisory purposes, mental health professionals should have the required knowledge and tools to use the technology safely and competently. When an individual uses new techniques, tools, or plans to provide services, he or she should seek additional education or supervision from a more experienced practitioner [14,15,16,17].

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  2. Mental health practitioners who accept the role of supervisor also accept the responsibility of

    ETHICAL ISSUES

    Mental health practitioners who accept the role of supervisor also accept the responsibility of helping to further the professional development of their supervisees. This includes providing supervisees with opportunities for learning, giving evaluations promptly, and providing constructive feedback during sessions. Lack of timely feedback is reported to be one of the main ethical complaints against supervisors [1]. Supervisees who are not performing at an acceptable level should first be given a plan for improvement. If a poor evaluation is given, it should not come as a surprise to the supervisee; rather, it should be the result of not meeting the terms of a previously discussed plan [1].

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  3. If a supervisee is not performing at an acceptable level, the supervisor's first step is to

    ETHICAL ISSUES

    Mental health practitioners who accept the role of supervisor also accept the responsibility of helping to further the professional development of their supervisees. This includes providing supervisees with opportunities for learning, giving evaluations promptly, and providing constructive feedback during sessions. Lack of timely feedback is reported to be one of the main ethical complaints against supervisors [1]. Supervisees who are not performing at an acceptable level should first be given a plan for improvement. If a poor evaluation is given, it should not come as a surprise to the supervisee; rather, it should be the result of not meeting the terms of a previously discussed plan [1].

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  4. The risk of establishing a dual relationship between the supervisor and therapist is increased because

    ETHICAL ISSUES

    The risk of establishing a dual relationship of supervisor and therapist is increased because many strategies used in supervision are derived from strategies used in therapy [2]. Teaching supervisees how to use such strategies in clinical sessions and working through personal issues can result in a blurring of boundaries. Studies show that supervision is less effective for the supervisee when the supervisor takes on a therapist role rather than using deliberate instruction of new skills. One of the most significant grievances that supervisees have about supervisors is regarding the dual relationship of supervisor and therapist [2,19].

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  5. Supervisors have the responsibility to ensure that clients are informed when students, interns, or individuals in trainings are providing client services.

    ETHICAL ISSUES

    Supervisors have the responsibility to ensure that clients are informed when students, interns, or individuals in trainings are providing client services [1,14,15,17]. Clients have the right to choose a more experienced practitioner if they do not feel comfortable receiving services from an individual in training [1]. Failure to inform a client could result in legal action against the supervisor or supervisee [1].

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  6. Which of the following statements regarding marketing and payment issues is TRUE?

    ETHICAL ISSUES

    There are specific payment and advertisement issues faced by supervisors and supervisees. First, supervisees are not allowed to advertise their services. Payments for services must be made directly to the supervisor or the agency at which the supervisee is working. Any business cards with the supervisee's name should make their status as an intern, trainee, or student clear. It should not appear that an uncredentialed individual provides services independently [1].

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  7. Supervisors may be exposed to charges of direct liability if their action or inaction is found to have caused injury to a client.

    LEGAL ISSUES

    Supervisors may be exposed to charges of direct liability if their action or inaction is found to have caused injury to a client. For example, direct liability can occur when supervisors are negligent in their duties and do not properly plan and supervise client outcomes. Also, as supervisors are required to have sufficient knowledge of clients, direct liability can occur if the supervisor gives inaccurate or inappropriate advice, which is then used in therapy to the detriment of the client. This is also true if the supervisor did not fully understand the supervisee's description of the client's needs because they failed to listen carefully. Similarly, direct liability can occur if the supervisor gives tasks to the supervisee that are inappropriate for his or her level of skill. Supervisors should have good knowledge of the abilities of their supervisees and should not assign tasks outside of supervisees' training and ability [1,19].

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  8. Supervisor direct liability can occur when

    LEGAL ISSUES

    Supervisors may be exposed to charges of direct liability if their action or inaction is found to have caused injury to a client. For example, direct liability can occur when supervisors are negligent in their duties and do not properly plan and supervise client outcomes. Also, as supervisors are required to have sufficient knowledge of clients, direct liability can occur if the supervisor gives inaccurate or inappropriate advice, which is then used in therapy to the detriment of the client. This is also true if the supervisor did not fully understand the supervisee's description of the client's needs because they failed to listen carefully. Similarly, direct liability can occur if the supervisor gives tasks to the supervisee that are inappropriate for his or her level of skill. Supervisors should have good knowledge of the abilities of their supervisees and should not assign tasks outside of supervisees' training and ability [1,19].

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  9. Supervisors who believe that clients are not receiving adequate care are required to act to protect the client. This includes

    LEGAL ISSUES

    As mentioned, clients deserve the same standard of care regardless of whether they receive service from a licensed practitioner or from interns, students, or trainees. Supervisors who believe that clients are not receiving adequate care are required to act to protect the client. This includes thoroughly investigating complaints that clients may make about supervisees [1].

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  10. In the State of Florida, individuals wishing to be qualified supervisors must

    REGULATORY ISSUES

    In the State of Florida, there are several requirements one must meet in order to become a qualified supervisor, according to the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling. Individuals wishing to be qualified supervisors must have taken a graduate-level academic course in supervision and a continuing education course in supervisory training that meets the requirements of rule 64B4-6.0025 (which regulates continuing education hours). Candidates must also be an AAMFT-approved supervisor or have taken a post-graduate training course for field instructors in clinical social work (for Qualified Supervisors for Clinical Social Work and Mental Health Counselor Interns) [5]. In addition, Qualified Supervisors for Clinical Social Work must have at least four years of clinical social work experience, two of which can be earned during a post-Master's clinical internship. Qualified Supervisors for Marriage and Family Therapy Interns and Mental Health Counselor Interns must have five years of clinical experience, two of which may be earned during a post-Master's clinical internship [18].

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  11. Florida Rule 64B4-2.002 states that interns will be credited for the time of supervision if the intern

    FLORIDA LAW PERTAINING TO INTERNS AND SUPERVISORS

    Rule 64B4-2.002 states that interns will be credited for the time of supervision if the intern received at least 100 hours of supervision in no less than 100 weeks, provided at least 1,500 hours of face-to-face psychotherapy with clients, and received at least one hour of supervision every two weeks [5].

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  12. Which of the following statements regarding group supervision is FALSE?

    FLORIDA LAW PERTAINING TO INTERNS AND SUPERVISORS

    Interns may receive group supervision; however, each hour of group supervision must alternate with an hour of individual supervision. Group supervision must be conducted with all participants present in-person. Individual supervision is defined as one qualified supervisor supervising no more than two interns, and group supervision is defined as one qualified supervisor supervising more than two and up to a maximum of six interns per group [5].

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  13. Which of the following is an example of a competency-based model of supervision?

    EFFECTIVE SUPERVISION MODELS

    The Substance Abuse and Mental Health Services Administration (SAMHSA)'s Treatment Improvement Protocol (TIP) series outlines several effective supervision models, including [19]:

    • Competency-based models (e.g., microtraining, the Discrimination Model, and the Task-Oriented Model) focus primarily on the skills and learning needs of the supervisee and on setting goals that are specific, measurable, attainable, realistic, and timely (SMART). They construct and implement strategies to accomplish these goals. The key strategies of competency-based models include applying social learning principles (e.g., modeling role reversal, role playing, and practice), using demonstrations, and using various supervisory functions (teaching, consulting, and counseling).

    • Treatment-based supervision models train to a particular theoretical approach to counseling, incorporating evidence-based practice into supervision and seeking fidelity to and adaptation of the theoretical model. Motivational interviewing, cognitive-behavioral therapy, and psychodynamic psychotherapy are three examples. These models emphasize the counselor's strengths, seek to demonstrate the supervisee's understanding of the theory and model taught, and incorporate the approaches and techniques of the model. The majority of these models begin with articulating their treatment approach and describing their supervision model based upon that approach.

    • Developmental models understand that each counselor goes through different stages of development and recognize that movement through these stages is not always linear and can be affected by changes in assignment, setting, and population served.

    • Integrated models, including the Blended Model, begin with the style of leadership and articulate a model of treatment, incorporate descriptive dimensions of supervision, and address contextual and developmental dimensions in supervision. They address both skill and competency development and affective issues, based on the unique needs of the supervisee and supervisor. Finally, integrated models seek to incorporate evidence-based practices into counseling and supervision.

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  14. Treatment-based supervision models begin with the style of leadership and articulate a model of treatment, incorporate descriptive dimensions of supervision, and address contextual and developmental dimensions into supervision.

    EFFECTIVE SUPERVISION MODELS

    The Substance Abuse and Mental Health Services Administration (SAMHSA)'s Treatment Improvement Protocol (TIP) series outlines several effective supervision models, including [19]:

    • Competency-based models (e.g., microtraining, the Discrimination Model, and the Task-Oriented Model) focus primarily on the skills and learning needs of the supervisee and on setting goals that are specific, measurable, attainable, realistic, and timely (SMART). They construct and implement strategies to accomplish these goals. The key strategies of competency-based models include applying social learning principles (e.g., modeling role reversal, role playing, and practice), using demonstrations, and using various supervisory functions (teaching, consulting, and counseling).

    • Treatment-based supervision models train to a particular theoretical approach to counseling, incorporating evidence-based practice into supervision and seeking fidelity to and adaptation of the theoretical model. Motivational interviewing, cognitive-behavioral therapy, and psychodynamic psychotherapy are three examples. These models emphasize the counselor's strengths, seek to demonstrate the supervisee's understanding of the theory and model taught, and incorporate the approaches and techniques of the model. The majority of these models begin with articulating their treatment approach and describing their supervision model based upon that approach.

    • Developmental models understand that each counselor goes through different stages of development and recognize that movement through these stages is not always linear and can be affected by changes in assignment, setting, and population served.

    • Integrated models, including the Blended Model, begin with the style of leadership and articulate a model of treatment, incorporate descriptive dimensions of supervision, and address contextual and developmental dimensions in supervision. They address both skill and competency development and affective issues, based on the unique needs of the supervisee and supervisor. Finally, integrated models seek to incorporate evidence-based practices into counseling and supervision.

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  15. The choice of supervision model should be guided by the

    EFFECTIVE SUPERVISION MODELS

    The choice of supervision model should be guided by the supervisee, particularly how he or she best learns and receives feedback, and by the setting in which provision of services is taking place. Supervisees may benefit from different models of supervision in different stages of their professional development, but supervisors often maintain the same approach to supervision regardless of the needs of supervisees or the setting [2]. Objective observation of supervisors who report modifying supervision style to match supervisees indicates that supervisors are less accommodating than they believe they are [2]. Because supervisors have been found to be inaccurate when describing their own behaviors and styles in supervision, the validity of studies that use the supervisor's opinions to rate the effectiveness of supervision styles has sometimes been brought into question [2].

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  16. What are the two main categories of supervision styles?

    EFFECTIVE SUPERVISION MODELS

    Two main supervision styles have been identified: authoritative and facilitative. Various teaching styles may be organized into these two categories (Table 1) [2,13].

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  17. Inexperienced practitioners have been found to benefit more from directive styles of supervision.

    EFFECTIVE SUPERVISION MODELS

    In one literature review, inexperienced practitioners were found to benefit more from directive styles of supervision. They also preferred supervisors who offered clear answers and more opportunities for practice. Inexperienced practitioners also preferred supervisors who were enthusiastic, showed interest in the supervisee, were dynamic and energetic, and who gave the practitioners a good model of a clinician [2]. Experienced practitioners preferred the same type of clear direction when learning new skills or when working with clients who presented more severe problems [3]. Regardless of the level of experience of the practitioner, a supportive supervisory relationship was deemed to be important to supervisees [2].

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  18. All of the following have been identified as preferred behaviors of supervisors, EXCEPT:

    EFFECTIVE SUPERVISION MODELS

    Preferred Behaviors

    • Creating a climate and relationship that is nurturing, supportive, interactive, welcoming, and safe enough for open disclosure of information by both parties

    • Being respectful and empathic, validating, demonstrating concern for supervisee welfare, and showing an interest in and listening to supervisee's input and issues

    • Facilitating the processing of emotional material, the gaining of insight and creativity, and creating a "space for thinking"

    • Demonstrating an interest in, and valuing of, supervision

    • Showing enthusiasm, dynamism, and energy

    • Being available, punctual, and accessible for supervision and advice on crisis management

    • Encouraging the supervisee to take increasing responsibility for their professional practice and professional development

    • Empowering supervisee, by affirming rights and strengths and establishing a process of informed decision making

    • Encouraging supervisee to take an active, rather than passive, role in supervision sessions

    • Being flexible, adapting style of supervision to the specific needs of the supervisee and the type of casework, and allowing increased autonomy and self-direction with increased experience of supervisee

    • Addressing process issues within supervisory relationship, seeking feedback, and regularly evaluating own performance as a supervisor

    • Adhering to boundaries and avoiding dual-relationship issues

    • Identifying, in association with the supervisee, the core skills, knowledge, attitudes, and competencies required for professional practice

    • Identifying, with the supervisee, the supervisee's strengths and weaknesses relating to core skills, knowledge, attitudes, and competencies, and developing goals for improvement

    • Focusing on specific, concrete examples of supervisee's clinical activities

    • Clearly describing specific skills to be learned and demonstrating their use

    • Providing constructive, nonjudgmental feedback (verbal and written) in a clear but sensitive manner, with specific, concrete suggestions for improvement

    • Providing a competent model as a clinician, and demonstrating and communicating high levels of clinical skills, knowledge, and ethical practice

    • Using a range of instructional methods, including information giving, providing guidance, modeling, audiovisual demon­stration, observation of supervisee practice (direct, taped, case-descriptions, reports), and providing opportunities for practice and problem solving

    • Negotiating a clear contract prior to the onset of supervision, and specifying bound­aries, tasks, roles, and responsibilities of supervisor and supervisee in supervision

    • Negotiating format, goals, methods, frequency, duration, content, and type of supervision, roles/responsibilities, and accountability of both parties

    • Negotiation methods of record keeping, methods and timing of evaluation and feedback, review dates, nature and timing of reporting (if any) to external authorities, professional indemnity issues, legal reporting requirements, and duration of supervision commitment

    • Setting an agenda for the supervision session, in consultation with the supervisee, and linking content to the supervision contract

    Non-Preferred Behaviors

    • Allowing administrative issues to dominate sessions, leaving insufficient time for clinical supervision

    • Telling rather than suggesting or exploring, or dominating the sessions

    • Providing guidance or feedback in a vague, unclear manner

    • Avoiding contentious or challenging issues

    • Having a laissez-faire approach, lacking direction and guidance, failing to provide feedback and targets for change, and providing inadequate structure to sessions

    • Creating a hierarchical rather than collegial atmosphere

    • Becoming competitive with the supervisee

    • Setting unrealistic or unclear goals and expectations or failing to specify goals

    • Insisting that supervisee works in exactly the same manner as supervisor, being overly restrictive with respect to methods, or failing to permit sufficient autonomy

    • Being overly critical and failing to point out strengths, achievements, and improvements

    • Being too busy and/or cancelling supervision sessions or being unavailable to give advice for managing crises

    • Being arrogant, self-interested, egocentric, or defensive

    • Being vague, distracted, inattentive, pre­occupied, disinterested, unempathic, or insensitive to supervisees' concerns

    • Having inadequate professional knowledge or skills (or failing to demonstrate or com­municate adequate clinical competence)

    • Unethical supervisory behavior, including breach of client/supervisee confidentiality, sexual harassment, and formation of dual relationships

    • Becoming the therapist in relation to personal issues

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  19. The primary goal of clinical supervision is to

    RESPONSIBILITIES IN THE SUPERVISORY RELATIONSHIP

    The role of a supervisor is of utmost importance in the development of the supervisee's ethical practice. He or she can also be considered a gatekeeper to the profession and must maintain professional standards while also being sure that clients are receiving the best care. Because of the importance of this role, new supervisors may find it beneficial to find a mentor. A talented clinician does not always take to his or her new role as supervisor easily [19]. The SAMHSA TIP series provides helpful reminders for supervisors [19]:

    • The reason for supervision is to ensure quality client care. The primary goal of clinical supervision is to protect the welfare of the client and ensure the integrity of clinical services.

    • Supervision is all about the relationship. As in counseling, developing the alliance between the counselor and the supervisor is the key to good supervision.

    • Culture and ethics influence all supervisory interactions. Contextual factors, culture, race, and ethnicity all affect the nature of the supervisory relationship. Some models of supervision have been built primarily around the role of context and culture in shaping supervision.

    • Be human and have a sense of humor. As role models, you need to show that everyone makes mistakes and can admit to and learn from these mistakes.

    • Rely first on direct observation of your counselors and give specific feedback. The best way to determine a counselor's skills is to observe him or her and to receive input from the clients about their perceptions of the counseling relationship.

    • Have and practice a model of counseling and of supervision; have a sense of purpose. Before you can teach a supervisee knowledge and skills, you must first know the philosophical and theoretical foundations on which you, as a supervisor, stand. Counselors need to know what they are going to learn from you, based on your model of counseling and supervision.

    • Make time to take care of yourself spiritually, emotionally, mentally, and physically. Again, as role models, counselors are watching your behavior. Do you "walk the talk" of self-care?

    • You have a unique position as an advocate for the agency, the counselor, and the client. As a supervisor, you have a wonderful opportunity to assist in the skill and professional development of your staff, advocating for the best interests of the supervisee, the client, and your organization.

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  20. Contextual factors, culture, race, and ethnicity all affect the nature of the supervisory relationship.

    RESPONSIBILITIES IN THE SUPERVISORY RELATIONSHIP

    The role of a supervisor is of utmost importance in the development of the supervisee's ethical practice. He or she can also be considered a gatekeeper to the profession and must maintain professional standards while also being sure that clients are receiving the best care. Because of the importance of this role, new supervisors may find it beneficial to find a mentor. A talented clinician does not always take to his or her new role as supervisor easily [19]. The SAMHSA TIP series provides helpful reminders for supervisors [19]:

    • The reason for supervision is to ensure quality client care. The primary goal of clinical supervision is to protect the welfare of the client and ensure the integrity of clinical services.

    • Supervision is all about the relationship. As in counseling, developing the alliance between the counselor and the supervisor is the key to good supervision.

    • Culture and ethics influence all supervisory interactions. Contextual factors, culture, race, and ethnicity all affect the nature of the supervisory relationship. Some models of supervision have been built primarily around the role of context and culture in shaping supervision.

    • Be human and have a sense of humor. As role models, you need to show that everyone makes mistakes and can admit to and learn from these mistakes.

    • Rely first on direct observation of your counselors and give specific feedback. The best way to determine a counselor's skills is to observe him or her and to receive input from the clients about their perceptions of the counseling relationship.

    • Have and practice a model of counseling and of supervision; have a sense of purpose. Before you can teach a supervisee knowledge and skills, you must first know the philosophical and theoretical foundations on which you, as a supervisor, stand. Counselors need to know what they are going to learn from you, based on your model of counseling and supervision.

    • Make time to take care of yourself spiritually, emotionally, mentally, and physically. Again, as role models, counselors are watching your behavior. Do you "walk the talk" of self-care?

    • You have a unique position as an advocate for the agency, the counselor, and the client. As a supervisor, you have a wonderful opportunity to assist in the skill and professional development of your staff, advocating for the best interests of the supervisee, the client, and your organization.

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  21. Who has the responsibility to properly document supervisory sessions?

    RESPONSIBILITIES IN THE SUPERVISORY RELATIONSHIP

    Both the supervisor and the supervisee have the responsibility to properly document supervisory sessions, as well as to provide the necessary documentation required by administrative and human resources (HR) personnel, including emergency contact information and profiles for each supervisee, a supervisory logging sheet, supervision notes, and case reviews [19]. Supervisors are also responsible for informal and formal evaluations of their supervisees [19].

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  22. Upon the completion of supervisory hours (or termination of the supervisory relationship), Florida law requires qualified supervisors to complete the Verification of Clinical Experience form.

    RESPONSIBILITIES IN THE SUPERVISORY RELATIONSHIP

    Upon the completion of supervisory hours (or termination of the supervisory relationship) as required by the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, qualified supervisors must complete the Verification of Clinical Experience form, available at https://floridasmentalhealthprofessions.gov/forms/clinical-exp-verification.pdf.

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  23. The general recommendation to supervisors using electronic devices in supervision is to always use cloud storage with client or supervisee information.

    ELECTRONIC DELIVERY SYSTEMS FOR SUPERVISION

    The general recommendation to supervisors using electronic devices in supervision is to avoid using cloud storage with client or supervisee information. If cloud storage must be used, supervisors should encrypt documents, use strong passwords, and use cloud storage that is HIPAA compliant. Use of cloud storage should be disclosed to clients and supervisees [28]. HIPAA-approved cloud storage websites include [28]:

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  24. Which of the following issues commonly encountered in the supervisory relationship is influenced by culture?

    CHALLENGES IN SUPERVISION

    Common issues in the supervisory relationship (e.g., gifts, touch, eye contact, medication compliance, choice of vocabulary) are all influenced by culture. Rather than adhering to a rigid theoretical approach when dealing with these issues, it is best to seek out their cultural meaning on a case-by-case basis. Enlist the expertise of a cultural informant, if one is available. This person is generally from the same culture as the supervisee, is not an active participant in the therapy, and functions as a consultant to the professional by interpreting or identifying culture-specific issues. The Department of Health and Human Services and the SAMHSA, among other organizations, offer trainings in cultural competence. A list of these courses is available online at https://www.samhsa.gov/section-223/cultural-competency/resources.

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  25. Practitioners who choose to be clinical supervisors typically bill supervisees for the supervisory hour, usually charging the same fee they would charge for a clinical session with a client.

    BUSINESS ASPECTS OF SUPERVISION

    When a clinical supervisor is not available as part of employment, interns may be required to arrange to hire a supervisor on their own. Practitioners who choose to be clinical supervisors typically bill supervisees for the supervisory hour, usually charging the same fee they would charge for a clinical session with a client. This fee reflects the use of the supervisor's time and expertise. First, and perhaps most importantly, supervisors are responsible for all clients seen by a supervisee. As mentioned, supervisors can be held liable for harm to clients because of the actions or inactions of the supervisee. In addition, the supervisor must be available to help the supervisee and/or client in emergency situations or in order to ensure the best possible care of a client. Supervisors are also responsible for completing continuing education hours in order to become and remain a supervisor. Being a supervisor is an important responsibility, takes time and preparation, and can potentially have legal consequences for the supervisor.

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  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.