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Indiana University of Pennsylvania
Department of Counseling
Child Group Practicum
Planning Manual
Summer 2010 – COUN 669
Dr. Holly Branthoover, Ed.D., Practicum Coordinator
Compiled & Revised Fall 2009
Committee Members: Dr. Holly Branthoover Moore & Dr. Lorraine J. Guth
1
Overview of Group Practicum
Welcome to your Group Practicum experience! It is the Department’s hope that you will learn a
great deal during this, your first opportunity to counsel ―real‖ clients in a group setting. The
Department takes planning for this experience seriously, as the Practicum is a crucial time of
group counseling skill development. This Pre-Practicum Planning Manual is designed to give
you all the information that you need in order to successfully secure a Practicum site.
A. Catalog Description: The catalog description for COUN 669 – Group Counseling Practicum
(Child) is the same for both community and school counseling majors. The catalog description is
as follows, ―An experientially based course in which counselors in training learn how to manage
group counseling experiences involving children (ages 5-12). This supervised clinical experience
draws upon the knowledge, theories, and skills presented in COUN 629, Group Procedures.‖
Prerequisites are COUN 617 and COUN 629.
While the faculty supervisors (course instructors) will have different syllabi for this course, much
of it will be identical. All students, regardless of the section, will have the same required hours,
summative assignment, and necessary forms to complete for the Practicum experience.
However, each faculty supervisor will also have her/his own course requirements.
B. Objectives: Again, regardless of whether you are a community or school counseling major,
the objectives of this course are identical. The practicum is designed to provide an opportunity
for students to develop and demonstrate mastery of relationship building skills as well as specific
counseling skills and techniques appropriate to group counseling. Students will provide group
counseling and will complete 10 hours of direct service with clients.
This group practicum will provide counselors in training with opportunities to plan, organize,
implement, and evaluate all aspects of the group counseling experience that are designed to meet
the developmental and variant needs of children. Upon completion of this supervised clinical
experience, counseling students will be able to:
1. describe the interplay between child development theory, group counseling theory and
the inherent implications for group work;
2. describe various group counseling philosophies, theories, models, processes, and
techniques as they apply to working with children;
3. apply legal, ethical, and moral standards of acceptable conduct in their work with
children;
4. develop an ethically sound rationale for conducting groups, and specify types of
problems that are particularly suited to group counseling.
5. understand the differences and similarities between and among various types of child-
centered groups (task, psychoeducational, counseling and therapy groups.);
6. understand the nature of groups and the human dynamics that effect change within
groups;
7. recognize the teaching-learning functions of groups in helping children to grow
personally, socially, cognitively, and physically;
8. plan, organize, implement, and evaluate child-centered counseling groups, including:
a. structuring specialized groups as to content and purpose as well as group
membership composition,
b. Coordinating and sequencing a client’s participation in both group counseling
sessions,
c. Demonstrating an ability to use some of the core leadership skills (e.g. blocking,
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linking, rounds, tracking, group processing).
d. Describing current research related to group counseling and specific issues groups
that are the focus of their implemented groups with children.
e. Developing a system of evaluation to determine the effectiveness or impact on the
client of each session and the group experience as a whole.
f. Develop skills and strategies for consulting with caregivers and service providers
regarding specific issues related to child needs, including skills in facilitating
psychoeducational groups for parents and teachers.
9. develop and utilize counseling facilitative skills and understandings that will help
children to
a. feel safe and secure within their groups;
b. learn new and more responsible ways to manage life problems;
c. advance to a status within their groups where they not only receive help, but can
provide assistance to others commensurate with their abilities; and
d. apply what they have learned to life situations outside of the group experience.
10. describe group leadership styles and their potential impact on child groups of various
ages and stages.
understand the ASGW standards of practice and their applicability to their own training.
C. Overview of Requirements: Students completing their Practicum must complete a
minimum of 10 direct contact hours with clients. Because you enroll in a separate Individual
Practicum experience, all hours in the Group Practicum must be group direct contact.
D. Additional Requirements:
Complete appropriate paperwork prior to the start of Practicum
Secure a Practicum Site and return the Practicum Site Information Form, Practicum
Contract, Checklist for Site Supervisor Qualifications, the Affiliation Agreement,
and the copy of Receipt for Clearances to the Practicum Coordinator.
Utilize an appropriate Informed Consent Form.
Maintain a Practicum Log that provides a tally of hours and activities completed during
the Practicum.
Complete the Narrative Reflection Paper the Summative Assignment for the Practicum.
Attend weekly supervision with the Site Supervisor.
Attend an average of 1.5 hours of group supervision per week throughout the
semester and 1 hour weekly individual or triadic supervision, during the weeks your
group is meeting, with your Faculty Supervisor.
Complete the Evaluation of Site Supervisor Form
Ensure that Site Supervisor completes the Performance Evaluation
E. Site and Site Supervisor Requirements:
Sites:
An appropriate site can provide an opportunity for you to meet in a group with clients for
a minimum of 10 hours. In home counseling is not permitted.
Sites must permit videotaping or audiotaping of counseling sessions.
Sites must assign an appropriate Site Supervisor to be a liaison between the Practicum
student, the Faculty Supervisor, and the Site.
A student’s place of employment may be an appropriate Practicum placement, if all
requirements for Practicum can be accommodated by the place of employment.
3
Site Supervisor Qualifications:
For school counselors, an appropriate Site Supervisor is one with a minimum of a
master’s degree in school counseling, is certified by the PA Department of Education,
and has the time and interest to supervise the practicum student.
For community counselors, an appropriate Site Supervisor is one with a minimum of a
master’s degree in counseling (or closely related field) and has the time and interest to
supervise the practicum student.
There is a two year minimum experience requirement for Practicum Site Supervisors.
This experience must be post-masters degree.
Please be aware, no site placement is guaranteed until it is approved by the Practicum
Coordinator.
4
Pre-Practicum Planning
Students must follow the following steps in order to have a successful Practicum.
Step 1: Students Receive:
Attend Practicum Meeting 1. Practicum Planning Timeline
2. Practicum Planning Manual
Step 2: Eligibility Requirements Include:
Review Handbook and Eligibility 1. Successful completion of COUN 617 & COUN 629.
Requirements
Step 3: 1. Review site requirements specified in the Practicum Planning
Site Selection Manual.
2. Learn about Practicum sites that seem most appropriate in
satisfying the Practicum requirements and meeting your personal
and professional goals. A database is available to help with
choices.
3. Select your top choice as a Practicum site and contact the site for
an informal interview. Be prepared to do the following:
Provide a copy of the Site Supervisor letter and your résumé to
agency or school personnel.
State why you want to explore Practicum opportunities at their
site.
Determine if the site can meet the Practicum requirements.
Determine if there is a mutual agreement for placement. If not,
complete an Affiliation Agreement with the site.
Work with the site supervisor to complete the Practicum Site
Information Form, the Practicum Contract and the Checklist
for Site Supervisor Qualifications.
Work with the site supervisor to create an appropriate
Informed Consent Form. (Sample Included)
Step 4: Due to COET by Specified Date Due to Dr. B by Specified Date
Submit Required Paperwork 1. Proof of Insurance* 1. Practicum Site
2. Child Abuse Information Form*
Clearance* 2. Practicum
3. Criminal Contract*
Background 3. Checklist for Site Supervisor
Check* Qualifications*
4. Act 114 (Federal) 4. Affiliation Agreement and/or
5. TB Test Results Receipt for Affiliation
6. Receipt for clearances* Agreement*
5. Copy of Receipt for
* for community students Clearances*
Step 5: Site is approved by Practicum Student notified via IUP email.
Coordinator.
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Required Paperwork
Student Liability Insurance
Liability insurance may be purchased through any appropriate insurance carrier.
Liability insurance limits of 1 million: 3 million are required by the university.
Listed below are two options often used by counseling students.
1. HPSO Professional Liability Insurance
1-800-982-9491
http://www.hpso.com
$29.00 per year for students
2. American School Counselor Association Insurance
Administered by National Professional Group
1-888-301-2722
http://asca.lockton-ins.com/pl
$18.00 per year for students
Clearances (if required by site)
1. Criminal Record Check – May be done online via the PA State Police at
https://epatch.state.pa.us/Home.jsp or via mail and the attached form. Cost is
$10.00.
2. PA Child Abuse History Clearance – Use the attached form. Cost is $10.00.
3. Federal Criminal History Record – This is new requirement under Act 114 of
2006. It applies to work in schools, only for all experiences starting after April 1,
2007. The cost is $40.00 and procedures are outlined at
www.coe.iup.edu/teach_ed. Your application can be made online at
www.pa.cogentid.com. See attached memo.
TB test (school counseling students only or if required by the site)
1. See attached information form
6
Indiana University of Pennsylvania
College of Education and Educational Technology
Teacher Education Office Memorandum
To: All Teacher Education Candidates and Educator Preparation Program Candidates
From: Dr. Thomas J. Meloy, Associate Dean for Teacher Education
Subject: New PA Requirements for Criminal History Background Reports
Date: March 27, 2007
On March 13, 2007, the Pennsylvania Department of Education posted information to its website located at
www.pde.state.pa.us regarding amendments to Act 114 of 2006, Section 111 of the Public School Code that
become effective April 1, 2007. The resulting changes to the requirements for criminal history background
checks affect all teacher education candidates and candidates enrolled in our advanced programs that require
field experiences in public school settings. In brief, candidates must now have the following three clearances
in place as a condition for any placement or employment in the public schools:
1. The Pennsylvania State Police Request for Criminal Records Check (Act 34).
2. The Child Abuse History Clearance (Act 151).
3. The Federal Criminal History Record (Act 114).
The Act 34 and Act 151 clearances have been required for some time. The Act 114 clearance, referred to as
the Federal Fingerprinting Requirement, is new. Our educational partner, ARIN IU 28, is one of the approved
fingerprinting sites, and has agreed to work with us to help our candidates and education faculty secure this
new clearance. The specific procedures and calendar for the fingerprinting will soon be posted to the Teacher
Education website located at: www.coe.iup.edu/teach_ed . Candidates should check this site regularly for up-
to-date information about the new clearance requirements. It is your responsibility to be aware of and to
follow all program, teacher education, and PDE requirements.
If you are scheduled for a field experience after April 1, 2007, you are required to make application for the
new clearance. Your application can be made online at the Cogent Systems’ website located at
www.pa.cogentid.com . Print a copy of your completed application and bring it to the Teacher Education
Office. We are required to have proof of your application or proof of your clearance on file before
authorizing you to proceed with any field placement. You will also need to have the application in hand when
you go to a fingerprinting site. We have already received calls from some of our school partners indicating
that they will not permit pre-student teachers, student teachers, or interns to enter their buildings without
proper clearances.
7
Tuberculosis Testing Information
For students in the school counseling program, it is a requirement of the Pennsylvania
Department of Education to have proof of a negative tuberculosis test prior to any placement in a
school district. There are two options for getting this testing:
1. You may go to any general practitioner of your choice, either electing to self-pay or
utilize your private health insurance benefits.
2. If you are unable to pay for the testing, testing is available at no charge from the
Allegheny County Health Department at the following two locations.
Allegheny County Health Department
Forbes Medical: 3441 Forbes Avenue Pittsburgh, PA
412-578-8062
Hours: 9:00AM – 4:00PM, Monday through Friday
**Do not park in Arby’s or CVS or your car will be towed
Lawrenceville: 3901 Penn Avenue Pittsburgh, PA
412-578-8084
Hours: 8:30AM – Noon; 1:00PM – 4:00PM,
Monday through Friday
Parking is on street
Pechan Health Center
Call for information. 724-357-2550 Costs vary depending on whether you have paid the student
health fee.
8
Group Counseling Practicum
Site Supervisor Letter
_______________
date
Dear ___________________________:
I am currently completing my master’s degree in elementary school counseling at Indiana
University of Pennsylvania (IUP). To improve my knowledge and skills, I am required to
complete a group counseling practicum. These experiences are under the direct supervision of
____________________, an IUP faculty member. _________________ will provide weekly
group and individual or triadic supervision sessions over the course of this experience.
I would appreciate your cooperation in allowing me to work with students/clients in your setting.
One of the requirements for this experience is that I videotape or audiotape a minimum of 10
hours of group counseling sessions in order to receive feedback on my counseling skills. It is
understood that the recordings will be confidential and only reviewed for supervisory purposes.
Campus supervision consists of an average of 1.5 hours per week of group supervision and 1.0
hour per week of individual or triadic supervision. The client’s last name and other identifying
demographics will not be used on the recording or in supervision discussions. Once campus
supervision is completed, the recordings will be erased.
In addition to my campus supervision, I am requesting that your agency provide a site
supervisor. Site supervisors are asked to assign appropriate clients, provide an adequate setting to
see clients, and assist with any agency regulations/required paperwork. In addition, site
supervisors are required to provide a minimum of 1.0 hour weekly administrative supervision
that may also include clinical supervision.
This course extends from _______ through_________. If you have any questions or concerns,
please call Dr. Holly Branthoover, Practicum Coordinator at 412-841-9784 or via email at
holly.branthoover@iup.edu.
Thank you for your cooperation,
____________________________________ ______________________________
Practicum student’s name Phone number
9
Group Counseling Practicum
Site Supervisor Letter
_______________
date
Dear ___________________________:
I am currently completing my master’s degree in community counseling at Indiana University of
Pennsylvania (IUP). To improve my knowledge and skills, I am required to complete a group
counseling practicum. These experiences are under the direct supervision of
____________________, an IUP faculty member. _________________ will provide weekly
group and individual or triadic supervision sessions over the course of this experience.
I would appreciate your cooperation in allowing me to work with students/clients in your setting.
One of the requirements for this experience is that I videotape or audiotape a minimum of 10
hours of group counseling sessions in order to receive feedback on my counseling skills. It is
understood that the recordings will be confidential and only reviewed for supervisory purposes.
Campus supervision consists of an average of 1.5 hours per week of group supervision and 1.0
hour per week of individual or triadic supervision. The client’s last name and other identifying
demographics will not be used on the recording or in supervision discussions. Once campus
supervision is completed, the recordings will be erased.
In addition to my campus supervision, I am requesting that your agency provide a site
supervisor. Site supervisors are asked to assign appropriate clients, provide an adequate setting to
see clients, and assist with any agency regulations/required paperwork. In addition, site
supervisors are required to provide a minimum of 1.0 hour weekly administrative supervision
that may also include clinical supervision.
This course extends from ________ through________. If you have any questions or concerns,
please call Dr. Holly Branthoover, Practicum Coordinator at 412-841-9784 or via email at
holly.branthoover@iup.edu.
Thank you for your cooperation,
____________________________________ ______________________________
Practicum student’s name Phone number
10
COUN 669: Group Counseling Practicum (Child)
Indiana University of Pennsylvania
Practicum Site Information Form
Name ___________________________________________________
Mailing address ___________________________________________
___________________________________________
Home telephone (_______)-______________
Work telephone (_______)-______________
E-mail address ________________________
Practicum site ____________________________________________
Address of site _____________________________________________
______________________________________________
Name of on-site supervisor ____________________________________
Title ________________________________________
Phone number ________________________________________
Site supervisor’s Email _______________________________________
Clientele served by this agency? ____________________________
Have you secured appropriate liability insurance to cover you for the duration of the semester?
__________yes ____________no
** You are not permitted to participate in this practicum without liability insurance.
Please read the following statement. A signature will indicate your consent:
Ethical violations can results in a termination of the practicum experience at any time.
I understand and will adhere to the ethical standards of the American Counseling Association
(ACA).
Signature_________________________________________________
Date _________________
11
Checklist for Site Supervisor Qualifications
Please complete the following information for the site supervisor:
1. Name: _________________________________________
2. Job Title: _________________________________________
3. Site: _________________________________________
4. Site Address: _________________________________________
_________________________________________
______________________________________________
5. Contact Phone Number: _________________________________________
6. Contact Email: _________________________________________
7. Degree Information:
a. Highest Degree Earned: ____________________________________
b. Course of Study: ____________________________________
8. License/Certification Information:
a. Type of License/Certification: __________________________
b. State of Issuance: __________________________
c. License/Certification # and Expiration: __________________________
9. Years of Experience: __________________________
_____________________________ ______________
Student Signature Date
_____________________________ ______________
Site Supervisor Date
___________________________________ ______________
Community Administrator or School Administrator Date
(if site is location of employment)
12
Group Practicum Contract
This agreement is made on __________ by and between the Department of Counseling,
date
Indiana University of Pennsylvania, and ____________________________. This
Site
agreement, to accept Practicum Student ________________________, will be effective
from _____________ to ______________ for ________ hours per week.
Purpose
The purpose of this agreement is to provide a qualified graduate school counseling student
practicum experience in his/her field of expertise.
The Department of Counseling agrees to:
1. Assign a Faculty Supervisor to facilitate communication between the University
and site.
2. Ensure the Practicum Student has met all qualifications necessary to begin the
Practicum.
3. Notify the student that he/she must adhere to the administrative policies, rules,
standards, schedules, and practices of the site.
4. Ensure that the Faculty Supervisor be available for consultation with both Site
Supervisor and Practicum Student during the semester.
5. Take responsibility for the assignment (in consultation with the site supervisor) of
the Practicum final grade.
The Counseling Practicum Site agrees to:
1. School Counselor Setting:
Assign an on-site supervisor who has a minimum of a master’s degree in school
counseling with two years experience post-masters, is certified by the PA
Department of Education, and the time and interest to supervise the practicum
student.
OR
Community Counseling Setting:
Assign an on-site supervisor who has a minimum of a master’s degree in
counseling (or closely related field) with two years experience post-masters, and
the time and interest to supervise the student intern.
2. Provide supervisory contact of at least one hour per week, which minimally
involves administrative supervision and may also include counseling supervision.
3. Provide an opportunity for the Practicum Student to engage in supervised group
13
counseling for a minimum of 10 hours.
4. Maintain contact with the University Supervisor throughout the Practicum
experience.
5. Provide an appropriate working environment to conduct professional activities.
Counseling must take place on-site, not in client’s homes.
6. Provide opportunities for the student to record counseling sessions for the purpose
of supervision.
The Practicum Student’s primary Site Supervisor will be:
Name: ________________________________________________________________
Address: _______________________________________________________________
Email:__________________________ Phone: _________________________
The Faculty Supervisor will be:
Name: ______________________________________________________________
E-mail:__________________________ Phone:_________________________
_____________________________________ Date: _____________
Practicum Site Supervisor
_____________________________________ Date: _____________
Counseling Program Practicum Coordinator
14
INFORMED CONSENT FORM
COUN 669 – Group Counseling Practicum
I, _____________________, grant my permission to have my counseling sessions with
practicum students videotaped. I realize the purpose of such taping and observation is solely for
training purposes of graduate school counseling students and viewing these videotapes will be
restricted to the IUP faculty supervisors and graduate counseling students in the same class. I
understand that my identity and all taped material will be kept strictly confidential. Upon review
of these tapes for supervision and grading purposes, the tapes will be erased (no later than
___________________).
I am aware, however, that there are several circumstances where confidentiality does not apply.
First, should I give reason for others to think I am in danger of harming myself or someone else,
I am aware my counselor would have to take steps necessary to prevent such injuries. Second,
my counselor would need to report instances of child abuse he/she is made aware of as required
by Pennsylvania state law. Third, if I am involved in court litigation, the counselor may be
subpoenaed to testify in court. Forth, I can give permission for the counselor to release
information to a specified person/agency.
I have read the above and understand its contents. I thus grant permission for the videotaping to
take place. If you have any questions, you can contact the faculty supervisors,
___________________________________.
Signature of Client _________________________________________ Date:____________
Signature of Parent/Guardian __________________________________ Date: ___________
Signature of Witness _________________________________________ Date:____________
Those who may view tapes:
_____________________
_____________________
_____________________
_____________________
15
CAREGIVER RELEASE FORM
Group Member Name: ____________________ Grade: ______ Date of Birth: _______
Caregiver Name: ________________________________________________________
Address: _________________________________________________________________
Phone (primary): __________________________ Phone (secondary): ___________________
The purpose of this form is to seek written consent from caregivers and from the respective students to
participate in a group at school. This group would be led/co-led by a student from the Department of
Counseling at Indiana University of Pennsylvania (IUP), which requires its students to complete an
advanced group practicum course.
(School name) _______________________________ has identified your child as a candidate for such a
group that will be led or co-led by an IUP student enrolled in the Counseling program. This group is
voluntary. With your permission, group will be conducted by ___________________________________
(IUP student) and co-led by _____________________ (identify this person). The purpose of this group is
to ________________________________. Benefits to participation include ______________________
______________________________________________, and the group leaders will take every
reasonable precaution to protect group members from harm. The group members are expected to attend
each group session and be involved in the activities and discussion of the group.
The group will begin on ______________ and end on ________________. They will meet ___ time(s)
per week during the school day.
The IUP student is required to audiotape and/or videotape the group sessions as part of the IUP course.
These audiotapes and videotapes will be watched/listened to by the school supervisor, the IUP faculty
supervisor (Dr. John McCarthy—724-357-3807), and other graduate students in the IUP course for both
educational and supervisory purposes. All audiotapes and videotapes will be erased at the completion of
your child’s involvement in the group.
The IUP student will be discussing their groups in supervision with both the school and the IUP
supervisor and other graduate students in the IUP course. As part of the IUP course, the IUP student is
also required to submit summaries about the group sessions to the IUP faculty supervisor. These
summaries will be shredded at the end of the academic semester (May 2010).
Though confidentiality of group members cannot be guaranteed by fellow group members, all information
about your child will be handled in a confidential manner by the group leaders. Exceptions to
confidentiality will be:
1. Duty to Warn: For any person determined to be at risk of harm to self or to others, all appropriate
warning or reporting procedures will be followed.
2. Regarding Minors: Counselors (including counseling students in training) adhere to the Pennsylvania
Child Welfare Agency’s legal duty to
report any suspicion of neglect, physical, or sexual abuse of minors.
3. Release of Information Agreements: Information will be released to third parties (school
personnel, family members, etc.) only at the student’s or parent’s request and after a Release of
Information has been signed by the student and parent or guardian.
This consent may be revoked by notifying the school supervisor, ______________________________
(person’s name) and will be considered revoked no earlier than the date of request. This consent will
expire automatically after 90 days from the date on which it is signed, or upon fulfillment of the above
purposes.
16
If you have any questions regarding this form, please call the school supervisor,
___________________________________________ (name), at ___________________________.
Caregiver: Your signature below indicates your permission for your child to participate in this
group.
________ [IUP Counseling Student] Initial to indicate that the student and Parent/Guardian received a
signed copy of the release form.
_________________________________ ________________________
Student Signature (if 14 years old or older) Date
___________________________________ ________________________
Caregiver Signature Date
___________________________________ ________________________
IUP Student Signature Date
___________________________________ ____________________
School Supervisor Signature Date
17
Group Practicum
Performance Evaluation
Name of Student: Name of Agency:
Name of Supervisor completing form:
Mid-Term Evaluation
Final Examination
Directions: Please evaluate the student’s performance according to the following 100 point
scale. Place the corresponding number on the blank provided to the left of each topic area. If
desired, please add additional comments at the end of the form or on letterhead. Please review
the completed form with the student and provide feedback regarding strengths and areas
requiring growth. The student will submit the evaluation to the faculty instructor.
Rating Scale:
90%-100% = Student well exceeds expectations of masters level student
80%- 89% = Student meets expectations of a masters level student
70%- 79% = Student exhibits less than expected performance and requires improvement
70% and below = Student exhibits unsatisfactory performance
N/A = Student is not involved in this activity at this time
________PROFESSIONAL BEHAVIOR: punctuality, attendance, dress, conduct, uses time
effectively, initiative, positive work attitude, active participation, and collegial interactions with
peers and supervisors.
________ ETHICAL BEHAVIOR: adheres to ethical standards, clearly articulates limits of
confidentiality with group members, demonstrates knowledge of duty to warn, acts in the best
interest of group members, and demonstrates appropriate professional boundaries.
________ SUPERVISION: Seeks supervision when needed, attends scheduled supervision,
properly prepared for clinical supervision, accepts and responds to supervision, demonstrates
openness to constructive feedback and guidance, and synthesizes counseling performance across
group sessions. Student expressed needs/concerns as needed to help improve his/her clinical
experience. Communication skills are evident.
_______ UTILIZATION OF RESOURCES: Seeks information about the agency policies,
procedures and resources, gains knowledge of population, seeks information about best practice
interventions for specific populations, and seeks and takes opportunities for skill growth and
learning.
______ BASIC COUNSELING SKILLS (RELATIONSHIP BUILDING/BASIC SKILLS):
ability to establish rapport and respond appropriately to group members, demonstrates
effective listening skills, and communicates genuineness, empathy, and respect.
18
_______ ADVANCED GROUP COUNSELING SKILLS: assists group members in goal
setting/achievement, develops rationale for use of therapeutic interventions, manages challenging
group issues such as resistance, effectively uses advanced group counseling skills such as
linking, drawing out, cutting off, holding, shifting, or deepening the focus, appropriate use of
exercises or activities, and adequately paces the group sessions.
_______ GROUP STAGE SKILLS: identifies group stages, understands the role of the group
leaders at each stage, uses interventions appropriate to the group stage, and manages group norm
development at each stage.
_______ CONTENT AND PROCESS SKILLS: understands the difference between content
and process in group sessions and is able to effectively address both during sessions.
_______CONSULTATION: Seeks parent/guardian consultation appropriately. Consultation
interactions are professional and effective.
_______ THEORY BASE: demonstrates an understanding of counseling theories as they apply
to group counseling and is able to implement them appropriately in group sessions.
_______ CRISIS: demonstrates good judgment and problem solving skills with unexpected
client or agency circumstances, such as client suicidal behaviors, injury, death, threats of
violence, or other emergency situations.
_______ CROSS CULTURAL COMPETENCIES: accepts group members from diverse
backgrounds with respect, openness, and dignity and makes direct efforts to improve knowledge
of diverse client populations. Addresses multicultural issues in an ethical manner if/when they
are relevant to the group. Demonstrates self-awareness of own values/beliefs as well as biases so
they do not have a deleterious impact on clients.
_______ DOCUMENTATION: demonstrates effective and accurate technical and clinical
writing of group paperwork. Submits materials in a timely manner.
_______ Specific Goals as Identified at the outset of the group practicum –
Other/overall comments:
Supervisor Signature: ______________________ Date:____________
Student Signature:______________________________Date:____________
19
Evaluation of Site Supervisor
Site-Based Practicum Experience
The purpose of this form is twofold: 1) to provide feedback to the Department about your on-site supervision
experience; and, 2) to encourage communication between the Practicum Student and the Site Supervisor.
Name of Site Supervisor: _________________________________________________________________
Period Covered: _____________________________ to _________________________________________
Directions: Circle the number which best represents how you feel about the supervision received. After the form is
completed, the Supervisor may suggest a meeting to discuss the evaluation.
Poor Adequate Good NA
1. Gives time and energy in discussing 1 2 3 4 5 6 0
cases.
2. Recognizes and encourages further 1 2 3 4 5 6 0
development of my strengths and capabilities.
3. Provides useful feedback 1 2 3 4 5 6 0
4. Provides the freedom to develop 1 2 3 4 5 6 0
flexible and effective counseling styles.
5. Is spontaneous and flexible in 1 2 3 4 5 6 0
supervisory sessions.
6. Helps me to define and achieve 1 2 3 4 5 6 0
specific, goals for myself and the client.
7. Encourages and listens to my ideas 1 2 3 4 5 6 0
and suggestions for developing
my counseling skills.
8. Helps me define and maintain ethical 1 2 3 4 5 6 0
and professional behavior.
9. Maintains confidentiality in 1 2 3 4 5 6 0
material discussed in supervisory sessions.
10. Deals with both content and affect 1 2 3 4 5 6 0
when supervising.
11. Offers resource information when 1 2 3 4 5 6 0
needed.
12. Explains his/her criteria for evaluation 1 2 3 4 5 6 0
clearly and applies it fairly when evaluating
my counseling performance
Additional Comments and/or Suggestions:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_________________________________________________________________
_________________________ ___________________________________________
Date Student
20
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