Site Supervisors' Handbook Rev Summer- 2011

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Revised July 2011

University of North Florida

Handbook for Practicum
and Internship Supervisors
REVISED July 2011

CLINICAL MENTAL HEALTH COUNSELING
PROGRAM
DEPARTMENT OF PUBLIC HEALTH
BROOKS COLLEGE OF HEALTH
1 UNF DRIVE, Bldg. 39, Room 4033
Jacksonville, Florida 32224
(904) 620-2840 (904) 620-1035 FAX
2

Table of Contents
Introduction……………………………………………………………………………………………..3
Time line …………………………………………………………………………………………….. 4

A. Requirements for Mental Health Counseling Practicum and Internship …………………….5
I. Practicum……………………………………………………………………………… 5
II. Internship………………………………………………………………………………. 6
III. Counting Hours in Practicum and Internship…….………………….………………..7
Banking hours during Practicum ……………………………………….………… 8
Banking hours during Internship/Continuing Internship after term has
ended………………………………………………………………………………….8
Counting UNF group supervision hours…………………………………………...8
Multiple Sites ………………………………………………………………………. .8
Completing Internship hours at a job site ……………………………………. 8
IV. Finalizing the Practicum or Internship Placement………………………………. 9

B. Responsibilities of Site Supervisors ………………………………………………………. 10
I. Qualifications……………………………………………………………………….. 10
II. Supervision…………………………………………………………………………. 10
Being accessible to students……………………………………………………….10
Orientation to students…………………………………………………………… 10
Help the student establish individual objectives………………………………….11
Help the student obtain clients……………………………………………………..12
Help the student establish a schedule of activities………………………………12
Introduce the student to resources……………………………………………… 13
III. Providing Feedback and Direction through Audio/Video Taping………………… 13
IV. Evaluation……………………………………………………………………………....13
Contact UNF supervisor when problems arise………………………………… 14
Evaluation of supervisor and site………………………………………………….14
V. Site Supervisor Tuition Waiver……………………………………………………. 14

C. Responsibilities of UNF Supervisors ………………………………………………………. 15
A. Practicum Group Meetings ………………………………………………………. 15
B. Internship Meetings ……………………………………………………………….. 15
C. Evaluation …………………………………………………………………………. 15

D. Appendices
A. Practicum or Internship Agreement Form ………………………………………. 16
B. Practicum or Internship Statement of Understanding …………………………. 17
C. Practicum or Internship Information Sheet ……………………………………… 18
D. Practicum or Internship Learning Contract …………………………………….. 19
E. Permission to Record & Consult ………………………………………………… 20
F. Mental Health Counseling Documented Supervision Form …………………… 21
G. Site Supervisor Evaluation of Mental Health Counseling Students …………….22
H. Report of Time Distribution ………………………………………………………. 24
I. Student Evaluation of UNF Practicum or Internship Supervisor …………....... 25
J. Student Evaluation of Practicum or Internship Site Supervisor ………………. 26
K. Site Supervisor Certificate of Participation …………..................................... 27
L. Internship Remuneration…………............................................................... 28
M. Criminal Background Check Reference page ………………………………….. 29
N. Specialized Learning Contract …………………………………………………... 30
3

HANDBOOK FOR CLINICAL MENTAL HEALTH
COUNSELING PRACTICUM AND INTERNSHIP

Introduction

The Clinical Mental Health Counseling Program (CMHC) is one of 569 counseling
programs approved by the Council for the Accreditation of Counseling and Related
Educational Programs (CACREP). The majority of state licensure boards regulating
master’s level trained counselors base educational requirements upon CACREP
educational standards. The CMHC Program is a 60 credit hour program which meets the
educational requirements for licensure in the state of Florida as a Licensed Mental Health
Counselor (LMHC). The program is practitioner-oriented in the sense that students are
required to complete a demanding field experience requirement of 1,000 supervised hours
before graduation. The counseling curriculum offers a unique blend of courses to provide
the skills and knowledge necessary for becoming a competent counseling professional.
Solid academic performance and experiential mastery are required. The CMHC program
is housed in the Department of Public Health which is located within the Brooks College of
Health.

The UNF CMHC faculty members wish to extend our gratitude to you for your willingness
to serve as a site supervisor for our students. We recognize that the work you do with our
students is usually unpaid and is accomplished in addition to your regular responsibilities.

We have prepared this document for you in order to explain the requirements of practicum
and internship for the UNF CMHC students and to provide guidelines and suggestions for
site supervisors. We welcome feedback on the material contained in this document and
intend to update it periodically to incorporate suggestions. If, after reading this document,
you have any questions about the practicum or internship, from either your or the
student’s point of view, please call one of the individuals below:

Dr. Tes Tuason
Director of Clinical Field Experiences, 904.620.1611, e-mail ttuason@unf.edu, fax
904.620.1035

Dr. Sharon Wilburn
Program Director, 904.620.1434, e-mail swilburn@unf.edu, fax 904.620.1035

Dr. Lynne Carroll
Professor, 904.620-2840, e-mail lcarroll@unf.edu, fax 904.620.1035

Dr. Cindy Scott
Associate Professor, 904.620.1432, e-mail cscott@unf.edu, fax 904.620.1035

Dr. Richmond Wynn
Assistant Professor, 904.620.4345, e-mail rwynn@unf.edu, fax 904.620.1035
4

Timetable for Practicum or Internship Activities
Time Frame Activity

Semester prior to practicum UNF Director of Clinical Field Experiences conducts P/I orientation
Or internship for students
Student meets with Faculty Mentor to discuss sites
Student contacts potential site supervisors for
interviews
Student & site supervisor agree on placement

Prior to beginning practicum Student and site supervisor sign Agreement form
Or Internship Student and site supervisor sign Statement of Understanding
Student submits application for background check
Student takes the CPCE the semester after Practicum, before
Internship
Student automatically obtains professional liability insurance

Beginning of Term Student submits above forms to UNF Faculty Supervisor for P/I
Site supervisor conducts orientation for student at site
Student and site supervisor establish individual objectives
Student and site supervisor establish work schedule
UNF supervisor reviews individual objectives
Student begins work at site

Throughout term Student meets regularly with UNF supervisor for individual
supervision
Student meets with UNF supervisor for group supervision
Student continues work at site
Student maintains log of activities

Middle of term Site supervisor completes mid-term evaluation
Student submits mid-term evaluation to UNF supervisor
UNF supervisor confers with site supervisor regarding
student progress

End of term Student completes Report of Time Distribution
Site Supervisor signs Report of Time Distribution
Site Supervisor completes evaluation of student and
recommends grade
Student completes evaluation of site supervisor
Student submits Certificate Request to Site Supervisor
Student completes evaluation of UNF supervisor
Student completes Evaluation of site and submits to
UNF Faculty Supervisor
Student submits Report of Time Distribution and site
supervisor’s evaluation to UNF supervisor
UNF supervisor assigns grade
Site Supervisor submits to UNF completed Certificate Request
(If applicable)
UNF Faculty supervisor submits the Report of Time Distribution,
Student’s site evaluation, and Agreement form to Director of
Clinical Field Experiences
Student makes copies of all forms submitted for P/I

Note. An Internship/Practicum Fair is held in the Spring term of every year, in early February.
5

A. Requirements for Mental Health Counseling Practicum and Internship
Practicum and internship represent opportunities for students to put into practice the
skills and knowledge that they have gained in the classroom. As such, it represents
the real world of counseling more closely than any other aspect of the CMHC
program. These field experiences give students the chance to practice and hone
their skills while under the protection of ample supervision, both on site and in the
university. We are grateful to you that you help us provide our students with
supervision, mentoring, and support for their growth in the field of counseling.

I. PRACTICUM, MHS 6800

Practicum is designed to provide students with practical experience in the counseling
field. At this stage, they will have had some experience in counseling through their
courses as well as opportunities to learn about the work of counselors in different
settings. During practicum, they will focus primarily on the following:

A. learning good counseling practices by observing and participating in
joint experiences.

B. developing skills by counseling in groups and individually under close
supervision

C. becoming familiar with various types of educational and/or mental
health agencies, services, referral sources, professional orientation,
staff development, organizational development, etc.

Students do their Practicum in the middle of their academic program and
would have taken all of these prerequisites:

MHS 6404: Theories in Clinical Mental Health Counseling
MHS 6941: Clinical Counseling Skills
MHS 6700: Legal, Ethical & Professional Issues in Counseling
MHS 6070: Psychopathology
MHS 6510: Group Counseling

During the one semester of Practicum, students will need to accumulate at
least 100 hours of experience. Of the 100 hours required, at least 40 must be
conducted in direct client contact, which refers to individual, group, and family
counseling; and/or intake and exit interviews with clients. Students are
encouraged to obtain 10 of 40 hours of direct service in a group setting.
Students enrolled in Practicum attend weekly group supervision on campus for
2 hours and receive one additional hour of individual or triadic supervision from
a faculty member. Students must be supervised by the site supervisor for
a minimum of 1 hour per week. This supervision must take the form of
feedback and direction based on direct observation, audio-tapes, or
video-tapes.
6

II. INTERNSHIP, MHS 6830

Internship is taken by students close to the completion of their master’s program.
They will have had significant counseling experience in the classroom, as well as
opportunities to counsel with others and on their own during their practicum. The
internship is designed to be an experience where students can refine their skills
in counseling others, while having the benefit of supervision by more
experienced professionals. Their primary tasks in internship will be to:

a. adopt a counseling theory to guide their clinical practice;

b. counsel people with difficult issues while under supervision;

c. explore areas of personal interest such as grief counseling,
counseling children, or counseling people with eating disorders;
and

d. become involved in the professional community through
membership in professional associations; attendance at workshops,
conferences and other staff development activities; and by
participation in informal networking groups.

Internship is scheduled over the last three (3) semesters of graduate study.

Term 1: 300 hours (3 credit hours)
300 total, 120 hours of direct client contact,
about 25 hours in a group setting
Approximately 20 hours per week

Term 2: 300 hours (3 credit hours)
300 total, 120 hours of direct client contact,
about 25 hours in a group setting
Approximately 20 hours per week

Term 3: 300 hours (3 credit hours)
300 total, 120 hours of direct client contact,
about 25 hours in a group setting
Approximately 20 hours per week

Students would have completed the following courses prior to the beginning of
internship:

MHS 6404: Theories in Clinical Mental Health Counseling
MHS 6486: Human Development Across the Lifespan
MHS 6941: Clinical Counseling Skills
MHS 6401: Advanced Counseling*
MHS 6510: Group Counseling
MHS 6070: Psychopathology
MHS 6700: Legal and Ethical Issues in Counseling
7

MHS 6428: Counseling Diverse Populations*
MHS 6205: Assessment and Evaluation in Mental Health Counseling
MHS 6305: Career Counseling
MHS 6800: Practicum

*MHS 6401 (Advanced Counseling) & MHS 6428 (Counseling Diverse
Populations) may be taken concurrently with the first semester of Internship.

Of the 900 hours to be completed by mental health counseling interns, at
least 360 hours must be spent in direct contact (individual counseling
sessions, assessments, intakes, etc.). Students are strongly encouraged to
devote 75 of those 360 hours to group and/or family counseling. Students
enrolled in internship are required to attend weekly group supervision on
campus for 3 hours. Students at this stage should be able to work more
on their own, but they must still be supervised by the site supervisor for
a minimum of 1 hour per week, in the form of feedback and direction
based on direct observation, audio-tapes, or video-tapes.

III. COUNTING HOURS IN PRACTICUM AND INTERNSHIP

Students enrolled in both practicum and internship are responsible for maintaining a
log of activities. The following guidelines have been created to assist them in
the process of counting their hours.

Direct client contact hours typically consist of the following:

• Providing face-to-face provision of therapeutic interventions in
individual, group, and family counseling

• Observing the site supervisor as he or she provides individual, group
and family counseling

• Conducting psychosocial or intake interviews with clients

• Conducting co-therapy with another counselor or supervisor

• Doing crisis intervention

• Providing phone consultations and home visits with underage clients’
parents or guardians.
Non-direct hours typically consist of the following:

• Attending and participating in staffing meetings

• Participating in individual site supervision and on-campus group
supervision

• Attending professional workshops
8

• Completing all documentation including progress notes, case
summaries, and written treatment plans

• Providing community outreach and programming

A. BANKING HOURS DURING PRACTICUM
While enrolled in practicum, students are NOT permitted to accumulate and
bank clinical hours toward internship after they have accrued the 100 required
hours. Students are also not permitted to begin accumulating hours prior to
enrollment in practicum.
B. BANKING HOURS DURING INTERNSHIP/CONTINUING INTERNSHIP
AFTER THE TERM HAS ENDED.
In the interests of establishing and maintaining self-care, students are
encouraged to take time off after each term. In cases where students want to
continue internship at their sites over interim breaks (i.e., before the start of the
fall term, winter or spring break), they are permitted to do so, provided that they
continue weekly one hour supervision on site throughout this period, and
a UNF faculty must be willing and available to consult with the student
during period. These hours may be "banked" and applied towards internship
the following semester. “Banked hours” should not exceed 50 hours at any one
interim break. It is strongly recommended that students keep personal copies of
all weekly logs and other supportive documentation (i.e. time distribution
forms).
C. COUNTING UNF GROUP SUPERVISION HOURS
Students are permitted to count the on-campus internship seminar (under the
category "group supervision") in internship only.
D. MULTIPLE SITES
Most students elect to complete their practicum and internship in one site.
Students may complete their internship hours in more than one setting with the
permission of their UNF faculty supervisor. If this is the case, students need to
secure a site supervisor in each site who meets the necessary qualifications
and can provide a minimum of one hour of documented supervision per week,
per site.

E. COMPLETING PRACTICUM/INTERNSHIP HOURS AT THEIR JOB SITE

Practicum/internship students requesting permission to complete their field
experience requirements at their place of employment must do the following:

(a) receive approval from the Director of Clinical Field Experiences prior to
commencing field hours
(b) establish a “specialized learning contract” (See Appendix N) with the
Director of Clinical Field Experiences which describes employment activities
9

relevant to practicum/internship and specifies additional requirements if
necessary
(c) find a qualified supervisor other than the person who evaluates their job
performance, who will provide an hour of weekly one-on-one supervision.

IV. FINALIZING THE PRACTICUM & INTERNSHIP PLACEMENT
Students must schedule to meet with their site supervisor to finalize the
details of their placement prior to the first week of the semester. During
this planning meeting, several forms need to be completed by the student
and the site supervisor, and these need to be turned in by the student to
their UNF supervisor. These forms, which are in the Appendix, include
the following:

1. Practicum or Internship Agreement Form. This form includes the
name and address of the agency and requires the signatures of
the site supervisor and the supervisor’s director or head of the
agency (See Appendix A).

2. Practicum or Internship Statement of Understanding. This form
is a reminder that supervisors are ultimately responsible for
safeguarding clients and therefore have the option of removing
students from practicum or internship when necessary (See
Appendix B).

3. Practicum/Internship Information Sheet. This form includes
information which the UNF supervisor will use to reach the site
supervisor and the student at home, work, and at the practicum or
internship site (See Appendix C).

4. Practicum/Internship Learning Contract. With assistance from
the site supervisor, this form describes, in behavioral terms,
specific objectives that the student intends to accomplish during
practicum or internship. The site supervisor should review these
objectives with the student since he or she will be responsible for
evaluating the completion of them. The UNF supervisor will review
the objectives, as well, and return the form to the student following
the first or second meeting of the term (See Appendix D).

5. Liability Insurance. Students are not required to purchase
professional liability insurance while they are enrolled in the
program. The Brooks College of Health provides umbrella coverage
for all students involved in clinical training, with a professional
liability insurance of a minimum of $1,000,000 personal/$3,000,000
professional limits.

6. Criminal Background Check. Students are required to apply for
and pass a criminal background check and finger printing before
beginning clinical work in the community. The background check
10

must be completed once a year once they have started doing their
clinical work. They cannot begin practicum or internship client
contact until they have cleared the University sanctioned background
check. Please refer to Appendix M for additional information
regarding background checks.

7. Other requirements for some sites. Students are made
aware that some sites, have additional requirements for their
practicum students and interns before beginning work at their site,
such as immunizations for select diseases, additional background
checks and fingerprinting, particular certifications, scheduled
orientation and additional documentations.

B. Responsibilities of Site Supervisors
I. QUALIFICATIONS

Site supervisors must have a master’s degree in counseling or a
ACREP, Sec. III, C, 1, 2, & 4).

II. SUPERVISION

The site supervisor is expected to provide at least one hour of
individual supervision a week, throughout the P/I experience.
Additionally, the site supervisor may provide group supervision with 3
or more practicum students or interns. It will be important for the
supervisor to review counseling skills throughout the practicum or
internship, through video, audio, or direct observation. (See Appendix
E for a sample “Permission to Record and Consult” form). Students
are also required to document their site supervision each week by
completing the Documented Supervision form (see Appendix F).

Being accessible to students. Particularly in the beginning of their
practicum or internship, most students are nervous, unsure of what to
expect, and uncertain about their own counseling skills. They will
appreciate the opportunity to consult with their supervisor several times
during the week to clarify problems, obtain feedback and advice, and to
get reassurance. As the term progresses and the student becomes
more confident, less frequent supervision, which is at least one hour of
individual supervision a week, may be in order.

Orientation to students. It is important that the students gain a clear
understanding of the organization, services, and structure of the
agency in which they will work for several months. This orientation may
include:

1. A tour of the facility, with an emphasis on the offices or classrooms where
the student will spend significant time

2. Introductions to other staff members in the facility, particularly teachers or
11

other counselors who will be in frequent contact with the student.

3. An introduction to the administrators of the facility

4. When appropriate, an introduction to students or clients of the facility

5. A detailed explanation of the services of the agency or school, including the
types of services that the student will be expected to provide

6. An explanation as to how the site deals with issues such as scheduling
appointments, intake interviews, consent forms, reminder calls to clients,
etc.

7. An explanation of the rules and regulations of the agency which would affect
the student. Information regarding insurance requirements, hours of
operation, dress codes and other behavioral requirements, and policies
regarding treatment of students or clients.

Help the student establish individual objectives for the practicum
or internship. During the practicum or internship, students will mostly
be expected to do counseling, seeing clients over a period of time,
rather than concentrating on crisis intervention. While counseling
individuals and groups, please help the students try out different
counseling theories and styles by providing them with helpful feedback.
Please help them learn and practice as they assimilate information and
develop their professional identity as a counselor.

Students are expected to do individual and group counseling, complete
intake interviews, assessments, and treatment planning, as well as learn
skills such as writing comprehensive case notes, and consulting with
counselors in other agencies, preparing case presentations, and joining
on-going discussion groups. In addition, most students will choose to
focus on developing skills in one or more particular areas. In order to
develop these skills, the students may need to do reading, attend
seminars, observe other counselors work with a given population, and
have intensive opportunities to work with a particular group under
supervision. Examples of individual projects would include working with
victims of abuse, or persons with addictions; developing skill using a
particular approach such as play therapy, guided imagery; or developing
an ancillary skill such as program administration, grant writing, training or
teaching, or supervision. Site supervisors can help students focus on
areas of particular interest, which might be started during practicum and
further developed during internship. Working with the site supervisor,
students are required to list objectives on a “Learning Contract” (see
Appendix D).

Help the student obtain clients. In order for students to acquire the
experience they need, they must rely on the site supervisor to help them
obtain clients. In Practicum, students need at least 40 contact hours
with clients, where 10 of the 40 needs to be in a group setting. In
12

Internship they need 360 contact hours (120 hours per semester) and
75 of those (25 per semester) must be in a group setting. If for any
reason it appears that the student will not be able to gain the required
number of direct contact hours during the semester, the site supervisor
should contact the UNF supervisor immediately.

Whenever possible, it is beneficial to provide opportunities for students
to work with clients representing cultural diversity, various ages, and
different concerns and diagnoses. It is understood however, that the
scope of students’ work will vary according to the services offered by the
agency as well as the readiness of the student to perform various tasks.

Help the student establish a schedule of activities. Whether in
practicum or internship, students are encouraged to work closely with
you to establish a reliable schedule at your site. They are asked to keep
track of agency meeting times and events that you think are important
for them to attend. They are asked to stay with this established schedule
as closely as possible, and are asked to always give advance notice if
they have to rearrange it. In Practicum, students work about 10 hours
a week, so we suggest that students work one full day or two partial
days per week. In Internship, students work about 20 hours a week,
which may translate to 3 full days or 5 partial days. In order for the
student to maximize the field experience and to obtain the required
number of contact hours, it is helpful to map out a detailed plan of
activities for each day.
13

Introduce the student to resources of the school or agency and the
community, including books, workshops, professional meetings,
etc. Practicum and internship can provide excellent opportunities for
students to explore the professional world of counseling beyond the
actual work that is accomplished with clients. Site supervisors, who
usually have many years’ experience working in the field, can introduce
the student to a variety of resources. Books and tapes that are used
professionally or with clients can help a student begin to develop his or
her personal library. Students are encouraged to attend staff meetings
and as many professional development workshops that they can
manage financially. Local professional organizations are an excellent
way for students to become a part of the counseling world, to make
personal and professional contacts, and to develop a sense of
involvement in the larger counseling issues. It is our hope that you will
invite the practicum and internship students to accompany you to local or
state workshops, to encourage them to become involved in the political
issues that affect counseling today, and to direct them to reading
materials that will help them continue with their education.

III. PROVIDING FEEDBACK AND DIRECTION TO THE STUDENT
THROUGH HIS/HER WORK; AUDIO/VIDEO TAPING

The site supervisor provides the student with appropriate training, and
ensures that the student is able to tape (audio or video) sessions with
clients, provided consent forms (see Appendix E) have been filled
with clients and appropriate steps have been taken to ensure the
client’s confidentiality (e.g., removing any identifying information in the
written case, using pseudonyms, etc.).

The heart of supervision is direction and feedback regarding the
counseling process itself. Individual supervision can best be
accomplished through direct observation or through observation via
audio and video tapes. As we know, students learn best through
immediate and direct feedback, as well as presentation of alternative
interventions. We encourage you to insist that our practicum and
internship students follow a particular model (of their choosing) with
their clients. During the term, students may choose to switch models, or
to combine them, but it is vital that they have a plan to follow with their
clients and which they can communicate to their supervisor. The
supervisor, in turn, must be knowledgeable of the various models and
skilled enough to provide needed direction to the student.

IV. EVALUATION

Midterm and Final Evaluations. The site supervisor is responsible
for evaluating the student’s performance in writing, for both the mid-
term and final evaluations. This is submitted to the UNF
14

practicum/internship supervisor at the mid term and at the end of the
semester. A sample of the mental health evaluation form is provided
in Appendix G.

We encourage you to comment on the competencies of the student and
in reference to each learning objective identified. If you note that a
student is weak in a particular area, or perhaps had no experience in
that activity, it will be important to increase the focus in that area during
the second half of the semester. At the end of the semester, the site
supervisor will complete the same instrument as a final evaluation; on
this form, the site supervisor will also recommend a grade.

Contact the UNF Supervisor (the P/I faculty) when problems arise.
Please feel free to telephone the UNF supervisor at any time when
problems arise with students. If an individual student appears unskilled
enough to complete the practicum or internship, we certainly need to
have this feedback immediately. In some cases, students have had
language or writing difficulties that have hampered their performance.
Sometimes, students have not been successful in cooperating with other
counselors in the school or agency; in some cases, students have not
followed through on a particular project they selected. The UNF
supervisor involves the Director of Clinical Field Experiences when
necessary, and they both have the responsibility to take corrective action
when a student has problems at the site; however, we do have to be
kept abreast of the situation in order to take necessary steps. Likewise,
we hope you will let us know when a particular student has gone above
and beyond the call of duty with their practicum or internship; we all
enjoy hearing about student successes!

Evaluation of supervisors and sites. At the end of each semester,
the student will have an opportunity to evaluate their supervisors, as
well. The Student Evaluation of UNF Practicum or Internship Supervisor
is shown in Appendix I; The Student Evaluation of Practicum/Internship
Site appears in Appendix J.

V. SITE SUPERVISOR TUITION WAIVER

As a means of thanking you for your time and service and your
willingness to supervise our students, UNF offers site supervisors
opportunities to take courses tuition-free. For every 300 clock hours
of student practicum or internship which you have supervised, you
will be able to register for up to six semester hours of courses in a
given semester. The number of practicum or internship hours is
recorded on the Report of Time Distribution (see Appendix H). As a
supervisor, you can request a fee waiver for the semester desired by
submitting a Certificate of Participation Application (see Appendix K)
to UNF’s Director of Clinical Field Experiences. The Director of
Clinical Field Experiences will forward this Certificate of Participation
15

Application for necessary signatures and then submit this to the
College of Education and Human Services (see Appendix L).

C. Responsibilities of UNF Supervisors

I. PRACTICUM MEETINGS
During practicum, students meet individually and in small groups of
up to six students with their UNF practicum supervisor, on a regular
basis. Additionally, the UNF supervisor will either a) meet with the
student and/or with the on- site supervisor at the practicum site or b)
provide 1 hour of individual supervision. The purpose of these
meetings is as follows:

1. to share information among students regarding best practices
and solutions to problems and issues;
2. to learn innovative ideas to deal with specific issues from
the presentation of case studies;
3. to review legal and ethical issues that may arise at the site;
4. to review relevant literature and /or current topics that would
impact all members of the group;
5. to learn to conduct an assessment, formulate a diagnosis and
appropriate treatment plans, and provide professional
counseling to facilitate treatment goals.
6. to discuss information regarding licensure, certification,
continuing education, professional organizations, and other
practical considerations.

II. INTERNSHIP MEETINGS
During internship, students will meet individually and in groups of no
more than twelve with the UNF internship supervisor. During these
sessions, the focus will be on individual and group supervision of their
counseling skills, discussion of current topics in counseling, and in
developing their skills in counseling-related areas. Students are required
to bring their recorded client sessions (audio-tape or video-tape) for their
case presentations in group supervision.

III. EVALUATION
The UNF supervisor will evaluate student performance in terms of
their participation in group supervision and the seminar. Additionally,
with recommendations from the site supervisor, the UNF supervisor
assigns a final grade in practicum and internship. Students receive a
letter grade in practicum, and a grade of Pass/Fail in internship.

The University of North Florida is accredited by the Commission on Colleges
of the Southern Association of Colleges and Schools (1866 Southern Lane,
Decatur, Georgia 30033-4097; Telephone number 404-679-4501) to
award baccalaureate, masters, and doctoral degrees and by the
Council for Accreditation of Counseling and other Related
Counseling Programs, 1001 North Fairfax Street, Suite 510,
Alexandria
16

UNIVERSITY OF NORTH FLORIDA 1 UNF Drive, Bldg. 39, Rm. 4033, Jacksonville, Florida 32224-2676 (904) 620-2840
Mental Health Counseling Program, Department of Public Health, Brooks College of Health, University of North Florida

Appendix A

COUNSELING PRACTICUM OR INTERNSHIP AGREEMENT FORM
Semester

Student Name (typed or printed) Social Security Number

Home Address City State Zip code Phone

Practicum Setting Phone

Location (mailing address)

Dates of Practicum (beginning & ending dates) Signature of Student

Site Supervisor (typed or printed) Degree/Licensure/Certification#

Site Supervisor (signature) Social Security Number

Director of Agency (if applicable) (signature) Date

NOTE TO STUDENT: AT THIS POINT, PLEASE RETURN AGREEMENT FORM TO
FACULTY SUPERVISOR.

FOR UNIVERSITY USE ONLY - DO NOT WRITE BELOW THIS LINE

University Supervisor (signature) Date

Program Director, Mental Health Counseling (signature) Date
17

Appendix B

Practicum or Internship Statement of Understanding

I acknowledge that my primary obligation, as a practicum or internship student, is to do
no harm to my clients or students. I therefore agree to maintain ethical behavior at all
times during this field experience. I further acknowledge that my UNF and site
supervisors are legally and ethically obligated to protect my clients from potential harm
as much as possible through their supervision and review of my performance. In the
event that any of my supervisors have reason to believe that I may harm my client
through unethical or incompetent behavior, they have the right and responsibility to take
immediate action. Such action may include removing me, temporarily or permanently,
from the practicum or internship.

Student/Date

Site Supervisor/Date

UNF Supervisor/Date
18

Appendix C

PRACTICUM/INTERNSHIP INFORMATION SHEET

--------------------------------------------------------------------------------------------------------------------

Name:

Date:

Address:

Home Phone: Work Phone:

Practicum/Internship Information:

Name of Agency:

Address:

Phone:

Supervisor:

Anticipated days and times at Practicum/Internship site:

Monday

Tuesday

Wednesday

Thursday

Friday

Weekend
19

Appendix D

Practicum or Internship
Learning Contract
Directions: Students, in consultation with site and/or UNF supervisors, will choose projects or
activities to complete during practicum or internship. Describe the projects or activities in terms of
measurable objectives below. The UNF supervisor will review and approve the objectives at the
beginning of the semester. The site supervisor will describe the degree of accomplishment of the
objective, will sign below, and return this form to the UNF supervisor at the conclusion of
practicum or internship with the student’s final evaluation.

Student Objectives Site Supervisor
Evaluation

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

Student Signature Date

Site Supervisor Signature Date
20

Appendix E

Permission to Record and Consult

I, the client (or parent or guardian), consent to the recording of my
counseling sessions for purposes of professional consultation with the goal of
helping improve the counselor’s effectiveness. This recording may be done by
video and/or audio taping.

This consent is being given in regard to the professional services provided
by the counselor named below. I understand that I will be given counseling even
if I choose not to sign this authorization. I understand that even if I sign this
authorization, I may ask for the recording to be turned off or erased at any time
during my sessions. All audio and videotapes will be kept in a safe location and
will be destroyed at the end of the semester.

I further understand that to improve counseling techniques, my counselor
may be consulting with the supervisor of this agency as well as my UNF faculty
supervisor. She/he may also select a portion of the tape to be viewed by other
counselor graduate trainees during group supervision. I therefore authorize any
of the supervisors and graduate trainees to observe or have access to
information relating to my treatment. It is understood that these professionals
and their students are bound by state laws and by professional rules about
client’s privacy.

Signature
(Client or parent/guardian)
Date

Printed name

I, the counselor, have discussed the issues above with the client (and/or his or
her parent or guardian). My observations of this person’s behavior and
responses give me reason to believe that this person is fully competent to give
informed and willing consent.

Signature Date
(Counselor)
copy accepted by client copy accepted by counselor
21

Appendix F

MHS 6800 / MHS 6830
PRACTICUM OR INTERNSHIP IN MENTAL HEALTH COUNSELING

DOCUMENTED SUPERVISION

Student Name Date / /

Beginning Time Ending Time

Functions Reviewed:

client screening client intake client assessment
treatment planning client orientation ___evaluation
individual counseling group counseling family counseling
crisis intervention referral consultation
outreach client follow-up client education
reports/record keeping case management case review
written communication community education other

Specific Issues Discussed and/or Reviewed

Specific Suggestions for Student

Date / / Student Signature

Date / / Supervisor Signature
22

Appendix G

Site Supervisor’s Evaluation of

Mental Health Practicum/Internship Student

Name of Student: Practicum/Internship Site:

Name of Supervisor Title

Period of Evaluation Mid - Term or Final Evaluation

Directions: This evaluation will be used by the faculty of the Mental Health Counseling Program to provide an
indication of the student=s performance during her/his practicum/internship experience. Please circle the number to
the right of each item which best describes your assessment of your supervisee. Please note:
0 = Not observed; 1 = Unsatisfactory; 2= Adequate; 3 = Does well, 4 = Outstanding

I. INTERPERSONAL SKILLS:

Χ Displays sensitivity toward others 0 1 2 3 4
Χ Accepts differences (i.e. racial, 0 1 2 3 4
ethnic, sexual orientation, etc.)
Χ Self-aware (strengths, personal issues, 0 1 2 3 4
limitations, etc.)
Χ Open to personal and professional 0 1 2 3 4
growth
Χ Recognizes her/his personal and 0 1 2 3 4
profession impact upon others
Χ Professional demeanor 0 1 2 3 4

Comments:

II. COUNSELING SKILLS:

Χ Behaves ethically and responsibly 0 1 2 3 4
Χ Is appropriately respectful and sincere 0 1 2 3 4
in relation to clients
Χ Displays effective attending and active 0 1 2 3 4
listening skills
Χ Able to respond appropriately at the 0 1 2 3 4
client’s level
Χ Able to formulate accurate diagnostic 0 1 2 3 4
impressions
Χ Able to formulate appropriate
treatment goals/plans 0 1 2 3 4
Χ Demonstrates awareness of physical, 0 1 2 3 4
psychological, spiritual, and social
factors impinging on the client
Χ Able to implement proposed treatment 0 1 2 3 4
plans
Χ Applies general knowledge appropriately 0 1 2 3 4
to specific client needs
Χ Recognizes his/her own competencies and 0 1 2 3 4
the limitations of techniques
Χ Displays effective group leadership skills 0 1 2 3 4
Χ Displays confidence in his/her skills 0 1 2 3 4
Χ Able to appropriately terminate a 0 1 2 3 4
23

counseling relationship

Comments:

III. CONSULTATION SKILLS:

Χ Able to elicit and utilize feedback from 0 1 2 3 4
others
Χ Able to consult with others while 0 1 2 3 4
maintaining confidentiality
Χ Able to follow through with assigned 0 1 2 3 4
tasks/responsibilities
Χ Able to interact effectively with agency 0 1 2 3 4
personnel/staff
Χ Displays effective oral communication skills 0 1 2 3 4
Χ Able to make appropriate referrals 0 1 2 3 4

Comments:

IV. GLOBAL ASSESSMENT:

Χ Overall assessment of his/her effectiveness as a 0 1 2 3 4
Mental Health Counselor

Χ Potential for becoming an effective Counselor 0 1 2 3 4

V. SUMMARY NOTES:

Student’s strong points:

Student’s needs for improvement:

Have you discussed this evaluation with the student?

Yes No

(If no, please note the this evaluation may be seen by the student upon request as required by the Buckley
Amendment).

Based upon the preceding information, I would recommend a grade of for the student.

Supervisor’s Signature Date

If this is the Final Evaluation, please attach the student’s
Learning Contract to this form.
24

Revised 5.2009

Appendix H

UNIVERSITY OF NORTH FLORIDA 1 UNF Drive, Bldg. 39, Rm. 4033 Jacksonville, Florida 32224-2676 (904) 620-2840
Mental Health Counseling, Department of Public Health, Brooks College of Health, University of North Florida

REPORT OF TIME DISTRIBUTION
Practicum Internship
An exact report of the number of hours the student spent in his or her Counseling Practicum or Internship
experience is required for the student’s record as well as for the site supervisor’s record. Site supervisors
receive free tuition for every 300 hours of student practicum or internship.

Students are to return the original of this report at the close of the Practicum or Internship to the UNF
Supervisor.

Name of Student

Site

Number of hours spent by the student in:

Observation: Intake Interviews:

Individual Counseling: *Group Counseling:

Family Counseling: Case Staffings:

Research: Professional Development:

Supervision:
Individual (Site): Group (Site):

Individual (Campus): Group (Campus):

Documentation/Record Keeping: Outreach/Advocacy:

Other (specify):

Total Hours: From To

Typed or Printed Name of Site Supervisor Signature of Site Supervisor

Degree, License, or Certification Social Security Number

Date Signed

*1 hour credit is assigned for group sessions consisting of 6 or fewer members; an additional 15
minutes credit is assigned for each additional client group member.
25

Appendix I

Student Evaluation of UNF Practicum or Internship Supervisor
0=not helpful 1=somewhat helpful 2=helpful 3=very helpful 4=not applicable

1. Assisted me in evaluating my readiness for practicum 0 1 2 3 4
or internship.
Comments:

2. Assisted me in selecting a practicum or internship site. 0 1 2 3 4
Comments:

3. Provided me with information regarding expectations 0 1 2 3 4
and requirements of practicum or internship.
Comments:

4. Provided me with opportunities to consult, on an individual 0 1 2 3 4
basis, regarding problems or issues concerning practicum
or internship.
Comments:

5. Allowed students to contribute input regarding the emphasis 0 1 2 3 4
and direction of class discussion.
Comments:

6. Led small group discussions of issues relevant to all 0 1 2 3 4
practicum or internship students.
Comments:

7. Provided structure for student - led case presentations. 0 1 2 3 4
Comments:

8. Provided relevant literature and/or other resources 0 1 2 3 4
relative to current topics of interest to all practicum
or internship students.
Comments:

9. Provided information related to licensure, certification, exams, 0 1 2 3 4
continuing education, graduation, and professional organizations.
Comments:

10. Provided information about opportunities to participate in 0 1 2 3 4
community, agency, or school professional development activities.
Comments:
26

Appendix J

Student Evaluation of Practicum or Internship Site
Note to Student: The information you provide may be shared in general terms with the site supervisor.
Site/Agency/School Name: Date:

Address: Phone:

Student completing this evaluation: Practicum Internship

Directions: On the rating scale to the right of each item please circle the number which best describes your practicum/internship
experience. Please note: 1 = poor; 2 = adequate; 3 = good; 4 = very good, and 5 = superior.

I. Orientation:
Time provided for orientation 1 2 3 4 5
Comprehensiveness of orientation 1 2 3 4 5
Overall quality of orientation 1 2 3 4 5

Comments:

II. Supervision:
Supervision was regularly scheduled 1 2 3 4 5
Supervision was appropriate for my needs 1 2 3 4 5
Feedback from my supervisor was helpful 1 2 3 4 5
Supervisor was accessible (beyond regularly 1 2 3 4 5
scheduled times)
Supportiveness of supervisor 1 2 3 4 5
Overall quality of supervision 1 2 3 4 5

Comments:

III. Learning Experiences:
Availability of clients 1 2 3 4 5
Appropriateness of clients 1 2 3 4 5
Suitability of tasks/duties 1 2 3 4 5
Number of tasks/duties 1 2 3 4 5
Overall quality of learning experiences 1 2 3 4 5

Comments:

IV. Professionalism
Treatment as a professional 1 2 3 4 5
Opportunities for input 1 2 3 4 5
Inclusion/reception by staff persons 1 2 3 4 5
Overall sense of professionalism 1 2 3 4 5

Comments:

V. Global Assessment of Practicum/Internship 1 2 3 4 5

VI. Would you recommend this site to others? yes no
Why? Why not? Please explain on back.
27

Appendix K

Certificate of Participation Application
Mental Health Counseling Program
Department of Public Health, Brooks College of Health
University of North Florida

• This certificate allows the Site Preceptor to exempt the tuition fee for up to six hours during one term of
instruction at any State University in Florida. The holder will be required to pay all current fees applicable at the
time of registration except tuition fees. Admission to the University is not guaranteed by the certificate.
• The certificate application must be typed. The Certificate of Participation will not be issued without the site
preceptor’s social security number and home address.
• Only an original certificate application will be accepted. A scanned or faxed copy is NOT acceptable.
• Given the confidential information that is included on this application, it can be put in a sealed envelope and
mailed directly to the Faculty Internship Coordinator at the address below.
Tes Tuason
Department of Public Health
University of North Florida
1 UNF Drive
Jacksonville, FL 32224
• The certificate application will be routed for signatures and reported to the Office of Educational Field Experiences
at the end of the semester of supervision. Allow a minimum of 4-6 weeks for processing. The official Certificate of
Participation will be mailed to the home address reported on the certificate application.
• Do not contact the Office of Educational Field Experiences with questions. All correspondence should be directed
to the Director of Clinical Field Experiences, Tes Tuason, ttuason@unf.edu or (904) 620-1611.
I certify that I served as a field site preceptor and supervised an intern as follows:

Date:
Name of Student:
Course Number/Program:
Term/Dates of Supervision:
Total Number of Internship Hours:

Agency:
Agency Address:
City: State: Zip Code:
Business Phone: Fax: E-mail:

Site Preceptor’s Name:
Site Preceptor’s Social Security Number:
Site Preceptor’s Home Address:
City: State: Zip Code:
Site Supervisor’s Home Phone: Fax: E-mail:
__________________________________________ ______________________
Field Site Preceptor Date
__________________________________________ ______________________
Faculty Internship Coordinator Date
__________________________________________ ______________________
Department Chairperson Date
1 UNF Drive, J Brooks Brown Hall, Bldg. 39, Jacksonville Florida 32224
28

Appendix L

Internship Remuneration
Guidelines for obtaining a certificate entitling the bearer to register for 2 courses (6 credit
hours) at UNF, tuition free. The certificate is awarded on a one time basis, for completion of
300 hours of supervision of student-interns in the Brooks College of Health:

1. Documentation of the 300 hours must accompany the request. If more than one student
and/or more than one term are involved, documentation must include student’s name,
term and year during which the supervision took place, and the number of hours for
each student.

2. Documentation must be verified by Program Leader or his/her designee (the
documentation should carry a signature from both the supervisor requesting the
certificate and the Program Leader.

3. The certificate request and the accompanying documentation should be forwarded to
Dr. Cathy O’Farrell in the College of Education and Human Services, who will issue the
certificate.

4. A certificate to be used in exchange for tuition for two college credit courses may only
be awarded to an individual supervisor one time.
29

Appendix M
UNIVERSITY OF NORTH FLORIDA 1 UNF Drive, Bldg. 39, Rm. 4016 Jacksonville, Florida 32224-2676 (904) 620-1055
Department of Mental Health Counseling, Brooks College of Health, University of North Florida

Background Check Information

A background check will be required of all students who will be participating in field experiences as part of their
educational program. The background check will be required prior to the practicum and internship experience. These
field experiences include, but are not necessarily limited to: practicum, internships, clinical experiences, or other
types of experiential learning either directly involving or in agencies serving children, the elderly, patients, or other
vulnerable populations.
The background check shall be completed:
1. annually for students enrolled in the Mental Health Counseling Program the semester prior to their practicum
and every year thereafter while enrolled in an Internship course.

2. in the semester immediately preceding the experience for students in those programs including these
experiences as a final or capstone experience.

3. must be done through the vendor sanctioned by the College.

NOTE: To meet Brooks College’s contractual obligation to the agencies in which students are placed, the background
check must be done through the vendor sanctioned by the Brooks College of Health which is Certified Background
Checks at CertifiedBackgound.com which is the only vendor accepted by the Brooks College of Health.

In order to complete your background check,

1. Go to www.CertifiedBackground.com.
2. You will be asked to give your full name, social security number, current address, phone number, and e-mail
address
3. Click on “students” and enter the Package Code.
4. Our package code is “UA 39” --- Full background check package + Fingerprint
5. The cost is $91.00 plus possible additional charges for each county where you have lived.

NOTE. You can order your Background Check securely on the site for a fee. However, please be informed that you
will be charged for every additional county you have lived in within the past 7 years. Since this Background Check is
at your personal expense, this fee may then be between $91+, depending on the number of counties you have lived.
Since this check needs to be current while you are involved in field experiences, you would need to order this before
Practicum, and then order another one before the previous background check expires, which is before your last
Internship class (assuming you are doing your Internship courses consecutively per semester). Please prepare then
to order this Background Check twice.

The detailed mechanism for obtaining the background check is explained in the pdf document located in
the P/I tab in the Blackboard site, entitled, UA39-Mental Health Counseling.pdf. Students with
questions regarding what may appear on their background check, should contact the Director of Clinical
Field Experiences of the Mental Health Counseling Program.

Information revealed by a background check may:

1. prohibit participation in required practicum and/or internship. Inability to participate in required field
experience will jeopardize successful completion of the program.

2. prohibit sitting for required post-graduate national examinations for licensure and/or certification
and/or post-graduate internships.
30

Appendix N

SPECIALIZED LEARNING CONTRACT: Completion of Practicum/Internship at Employment
Setting

Requirements:

(a) receive approval from the Director of Clinical Field Experiences prior to commencing field
hours

(b) establish a “specialized learning contract” with the Director of Clinical Field Experiences
which describes employment activities relevant to practicum/internship and specifies
additional requirements if necessary

(c) seek weekly one-hour supervision from a qualified site supervisor other than the person
responsible for the evaluation of your job performance

Instructions for completion of specialized learning contract:

(a) Meet and obtain written approval from the Director of Clinical Field Experiences prior to
commencing practicum or internship
(b) Attach job description from your job site
(d) Obtain consent of on-site supervisor who will provide weekly one-hour supervision (other than
the person responsible for the evaluation of your job performance)
(c) Retain a copy of written approval for your own records

Concise description of job activities which are applicable to Practicum/Internship:

Hours per week:

List nonemployment-related (e.g. special learning project) activities:

Hours per week:

_______________________________________________
Student/Date

_______________________________________________
Director of Clinical Field Experiences /Date

________________________________________________
Site Supervisor/Date