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HANDBOOK FOR CG 699 – INTERNSHIP AND SEMINAR IN MENTAL HEALTH COUNSELING

Counseling Program

Lincoln Memorial University - Harrogate, TN

Revised: 10/21/12

Primary LMU Faculty Contact:

Mark Tichon, Ph.D., LPC/MHSP

mark.tichon@lmunet.edu

865-406-5646

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TABLE OF CONTENTS

INTRODUCTION TO THE INTERNSHIP

1. What is an Internship? 3

2. Terms & Definitions 4

3. Mental health Counseling Internship 5

4. Individual Responsibilities 5

STEP BY STEP GUIDE TO THE INTERNSHIP

1. Getting Started 6

2. The LMU Internship Contract 7

3. Record Keeping 7

4. Site Supervisors 7

APPENDICES: PAGES 9 - 30 Appendix A – Internship Supervision Agreement 9

Appendix B – Site Selection Criteria 12

Appendix C – Counseling Internship Plan 13

Appendix D – Site Supervisor Evaluation Form 14

Appendix E – Student Evaluation of Internship Placement 19

Appendix F – Summary of Internship Hours 20

Appendix G – Professional Disclosure Statement 21

Appendix H – Weekly Time Log 22

Appendix I – Release to Record Counseling Sessions 23

Appendix J – Weekly Supervision Form 24

Appendix K – Audio/Video tape Write-up 25

Appendix L – ACA Compliance Statement 27

Appendix M – Tape Critique Form 28

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Introduction and Welcome Congratulations on getting to this point in your preparation for a career in professional

counseling! Your academic coursework and practicum experience have provided you with the

beginnings of a foundation in your professional preparation. The internship experience

represents your opportunity to develop your skills and identity as a professional counselor in an

intensive and practical setting under the supervision of an experienced mentor. This Handbook

for the Internship will serve as your guide through the experience, with explanations of role

responsibilities of the various participants and the process for evaluating counselors in training.

As a student in this course, you are asked to make a copy of this document for your site

supervisor and go over the contents prior to developing your plan for the semester and

executing the contract between LMU and your host site.

What is an Internship? The Internship is designed to be a capstone experience in the LMU Counseling Program,

offering the student opportunities to use knowledge and skills learned in prior coursework in a

field placement that is closely mentored by an experienced site supervisor. The counseling

intern will be exposed to a wide variety of professional roles and responsibilities to prepare her

or him for entrance into the field as a professional counselor upon graduation. This Internship

and Seminar Handbook has been specifically designed for use in the Mental Health Counseling

Program. As this program represents an academic path toward licensure, it is critical that the

student fully understand the expectations and seriousness of the internship course

requirements and expectations. It should be emphasized that the preparation for licensure is a

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skills based process, where you will be expected to demonstrate both knowledge and skill in the

delivery of counseling services. This internship is a 6 credit hour, 600 hour experience in mental

health counseling, which takes place over 2 academic semesters. Your internship experience

should include the following:

1. 600 clock hours of direct and/or indirect services under the supervision of your site supervisor. (40% in Direct Services)

2. Weekly interaction with program faculty member in a small group supervision setting.

3. Weekly 1:1 supervision with site supervisor, duration of supervision to amount to 1 hour per week.

4. Participating with regular attendance in the scheduled group supervision/seminar component of the class for at least 1 ½ hours per week with the assigned faculty member.

5. Site Supervisor Evaluation of student. (Appendix D).

Definition of Terms A. Department Supervisor: LMU Instructor

B. Site Supervisor: On-Site Supervisor

C. Program Director: Director of Counseling Department at LMU.

D. Direct Services: (See Appendices C and F)

E. Indirect Services: (See Appendices C and F)

F. Treatment Plan: A written document that outlines the objectives, goals, and methods used in counseling treatment.

G. Professional Disclosure Statement: Statement of education, training and scope of practice developed by mental health counselors.

Mental Health Counseling Majors A. Mental health counseling majors will download and become familiar with all

requirements for licensure as an LPC, LPC/MHSP or LMHC in their respective states,

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including any required post-masters supervision hours, currently 3000 hours in the state of Tennessee.

B. Mental health counseling majors will begin to prepare for the NCE, Jurisprudence exam, and National Mental Health Clinical Exam for licensure.

C. Mental health counseling majors will demonstrate knowledge and skill with HIPPA regulations regarding the provision of mental health services including issues such as informed consent, confidentiality and the limits of confidentiality.

Individual Responsibilities 1. Faculty Supervisor Responsibilities:

A. Work with student on site selection and approval.

B. Meet in seminar weekly and review student progress/development.

C. Be available for consultation with Site-Supervisors.

D. Promote effective communication between LMU and the Site.

E. Maintain Records on the student.

F. Lead group supervision and seminar on a weekly basis.

2. Site-Supervisor Responsibilities:

A. Collaborate with student to develop plan and approve internship contract. (Appendix ???).

B. Share expectations with student.

C. Monitor student development and provide appropriate feedback, including one hour of direct weekly supervision throughout the internship experience.

D. Engage with student regularly regarding professional development.

E. Provide opportunities for the student to become familiar with a variety of professional activities and resources in addition to direct service (e.g., record keeping, assessment instruments, supervision, information and referral, in-service and staff meetings).

F. Complete Evaluation of student. (Appendix ???).

3. Student Responsibilities:

A. Complete Application/Contract for the Internship.

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B. Obtain and maintain liability insurance during internship experience.

C. Obtain necessary Client or Parental Consent prior to recording any counseling session.

D. Prepare recordings of counseling sessions as described in the syllabus.

E. Log a minimum of 150 hours in any semester in order to receive a continuing grade of IP. LMU understands that students working and going to school may sometimes have to extend the practicum experience into two semesters due to work schedule conflicts; however the 150 hour per semester requirement is the minimal number possible in order to progress in the program.

F. Maintain accurate and legible logs of internship hours.

G. Complete the Placement Evaluation (Appendix ???).

H. Complete and turn in the Internship Contract. (Appendix ???).

I. Conduct all duties in accordance with the ACA Code of Ethics.

J. Follow Dress Code and all Human Resource Policies of the hosting site.

K. Report any absences to both the site supervisor and faculty member for seminar.

L. Complete other assignments assigned by the instructor or in the syllabus.

Step by Step Guide for the Internship Getting Started

A. The student should begin planning their internship experience at least two semesters prior to registering for the course. The student should also begin to make a list of preferred sites.

B. The student should contact the faculty supervisor as soon as possible and inform him/her of their intent to register as well as a list of their preferred sites.

C. The student should initiate a telephone conference with the faculty supervisor for the purpose of discussing options, expectations, special accommodations and goals regarding the internship experience. During this conference the student should collaborate with the faculty member on a plan to contact the requested site.

D. The student OR faculty member will contact the site for the purpose of making the request. (This depends on institutional policies and past practice as to whether the student or faculty member makes the initial contact.)

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E. The student will present the proposed contract to the site supervisor and give the proposed supervisor contact information for the faculty supervisor. This document must be completed by both parties before logging internship hours.

The LMU Application/Contract should be downloaded and printed. (Appendix A).

Record Keeping

A. Record keeping is an integral component of professional counseling and good habits should be developed in the internship experience.

B. The student should copy Appendices D??? and E??? for use in record keeping during the internship. In addition, the student should assist the site supervisor in the development of appropriate and accurate records that are the design of the district or agency.

C. All client records must always treated with the highest standard regarding legal and ethical concerns. This includes the generation, maintenance, sharing, transfer and destruction of counseling records.

Site Supervisors

A. LMU is appreciative of the efforts of partnering site supervisors as they serve the profession of professional counseling as mentors to those in training.

B. Site-Supervisors are encouraged to contact the faculty supervisor for collaboration and support in the supervision of counselors in training.

C. Site-Supervisors make the distinction between administrative and clinical supervision and convey that distinction to students as issues and opportunities arise.

D. LMU Counseling faculty will provide training in supervision to counselors not having such training provided they are willing to serve as site supervisors for counselor trainees. This training is available at the Harrogate or Cedar Bluff location. Please contact the LMU faculty supervisor for the internship if you are interested.

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APPENDICES

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Appendix A (3 Pages)

LMU School Counseling Internship Application/Contract APPLICATION/CONTRACT FOR C&G 699 Internship

Date received by faculty supervisor: ______ __________

Name: ________________________________________________________________________

Address: _________________________________________________________________________

_________________________________________________________________________

E-mail: _________________________________________________________________________

(Send an email to Dr. Mark Tichon, faculty supervisor, from your LMU email address. The email address is: mark.tichon@lmunet.edu)

Day/Evening Telephone Numbers: ___________________________________________________

Where would you like to complete your Internship? ___________________________________

A site supervisor must be identified who has:

Masters Degree in Counseling or the equivalent

Three years of experience and appropriate credentials in the setting in which you will be serving

Willingness to provide face-to-face, individual supervision one hour per week (or 30 hrs. logged).

Please provide the following information about the proposed site- supervisor:

Supervisor’s Name: __________________________________________________________

School and School District: ___________________________________________________

Address: __________________________________________________________

Telephone Number: __________________________________________________________

E-mail: __________________________________________________________

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Appendix A (Page 2)

INTERNSHIP SUPERVISION AGREEMENT

I. UNIVERSITY/PLACEMENTSCHOOL/AGENCY AGREEMENT We, the undersigned, hereby agree to the following arrangements between Lincoln Memorial University and ____________________________________________ (School/Agency) to provide an appropriately supervised Counseling Practicum for _________________ during the __________ semester or _________academic year. 1. The Placement School/Agency agrees to:

A. Consider for acceptance a student of the University who is eligible for the Counseling Practicum and has expressed interest in this School/Agency. The Internship consists of 600 clock hour placement in the School/Agency with a required on-campus seminar.

B. Appoint a professional staff member to serve as Site Supervisor and provide adequate

time for him/her to perform the responsibilities of the Site Supervisor.

C. Provide coverage for the Student under the School/Agency’s liability as appropriate for volunteers within the School/Agency. The Student will be covered under the University’s student insurance policy, but some Schools/Agencies may choose to include the Student under the School/Agency volunteer liability policy also.

D. Provide the University with a brief credential profile of the appointed Site Supervisor. A master’s degree in counseling and three years experience is preferred for Site Supervisors.

2. The Placement Site Supervisor agrees to:

A. Coordinate the activities of the Student and create opportunities for a variety of learning experiences for the student to become familiar with a variety of professional activities and resources in addition to direct service (e.g., record keeping, assessment instruments, supervision, information and referral, in-service and staff meetings).

B. Familiarize the Student with the Placement School’s/Agency’s regulations, policies, and procedures, including the confidentiality of records of the school or agency.

C. Provide the University Field Supervisor with a written evaluation of the Student’s strengths, weaknesses, and overall performance at the end of the Practicum.

3. Lincoln Memorial University agrees to:

A. Appoint a University Faculty Supervisor to be the primary liaison between the University and the Placement Site.

Provide coverage for the Student under the University’s student liability insurance

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policy for the duration of the Internship.

4. The University Faculty Supervisor agrees to:

A. Plan with the Student and the Site Supervisor ways and means of meeting competencies as stated in the Counseling Practicum Plan.

B. Submit the final letter grade assigned for the Practicum to the Student, and the University Registrar.

5. The Counselor Trainee/LMU Student agrees to:

A. Become familiar with and abide by all rules and policies of the Practicum placement site.

B. Meet weekly in both Group Supervision and Individual/Triadic Supervision with Faculty Supervisor

C. Follow all Professional and Ethical Guidelines of the American Counseling Association

D. Keep open lines of communication and discuss any issues of concern with site supervisor and faculty supervisor.

_____________________________________________________________________________________

Counseling Degree Candidate Date

Placement School/Agency Site Supervisor Date

Lincoln Memorial Faculty Supervisor Date

_____________________________________________________________________________________

Program Director, Counseling & Guidance Department Date

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Appendix B

SITE SELECTION CRITERIA

It is agreed that the student and on-site supervisor will receive no remuneration for services provided during the Counseling Internship from Lincoln Memorial University. If a particular site and its administrative personnel contract with the graduate student to provide services, under appropriate supervision, then that contract will be a part of this agreement (attach a copy of contract).

A. It is agreed and understood that Lincoln Memorial University and the School/Agency Site assume no liability for injury or death to the student incurred when providing services during this field placement. Exceptions may result from gross negligence as determined in a court of law.

B. It is agreed and understood that Lincoln Memorial University and/or the School/Agency Site may suspend/terminate student’s placement for failure to comply with regulations, policies, and procedures, including the confidentiality of records of the agency.

C. It is agreed and understood that the student’s internship will be professional in nature and include requisite experiences as outlined in the Counseling Internship Plan.

D. The student will serve a total of ______ clock hours of internship of which 40% will be in direct services to students/clients.

E. Students will be expected to attend internship seminar sessions as scheduled.

F. Students will be expected to develop and maintain a portfolio of materials, lessons, tapes, tests, etc. used during the internship.

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Appendix C

SERVICE HOURS REQUIREMENTS:

Direct service hours are defined as those activities generally conducted under the service areas. Indirect services are generally defined as planning/preparation for direct services.

TOTAL HOURS OF DIRECT SERVICE PLANNED: __________ (must be at least 40% of total)

TOTAL HOURS OF INDIRECT SERVICE PLANNED: __________

TOTAL HOURS PLANNED: __________

Approval Signatures:

________________________________________ ___________________________________

Site Supervisor Date LMU Faculty Supervisor Date

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Appendix D (5 pages)

CG Site Supervisor Evaluation Form – CG 699 Mental Health Counseling .

Site Supervisor Name____________________________________Lic. Expiration Date__________Telephone Number____________________Email_________________

Name of Site_____________________________________________________________

Student Intern_____________________________________Campus________________

Student Intern completed all logs, forms and hourly requirements in accordance with the syllabus Y___N___

LMU COUNSELING PROGRAM OBJECTIVES: For each of the following ten (10) LMU Counseling Program Objectives, consider how well you feel the LMU Counseling Intern performs based on your observations and knowledge of their work. Please use the following scale to answer these questions:

5 = Mastery. You feel that the LMU Counseling Graduate has achieved marked proficiency and competency in this domain, and are able to perform independently and can mentor and teach this skill to others. 4 = Accomplished. You feel that LMU Counseling Graduate has achieved marked proficiency and competency in this domain most of the time, and are able to perform independently, with occasional need for supervision or consultation.

3 = Capable. You feel that for the most part, the LMU Counseling Graduate demonstrates significant ability in this domain, but still requires collaboration and/or consultation in this area.

2 = Acceptable. You feel that LMU Counseling Graduate has achieved basic expected competencies to perform job related duties in this area.

1 = Improvement Needed. This area or learning domain is a significant area for growth for the LMU Counseling Graduate, and you feel that he or she would benefit from ongoing training, development, and supervision in this area. If you feel that an area does not apply, feel free to leave that question blank

LMU PROGRAM AREA OBJECTIVES

1. Professional Orientation and Ethical Practice – Demonstrates an understanding of the counseling profession, a professional identity as a counselor and a willingness to provide counseling services within the ethical guidelines of the counseling profession.

5 4 3 2 1

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2. Social and Cultural Diversity – Demonstrates an awareness of, and an appreciation for, social and cultural influences on human behavior and recognizes the impact of individual differences on the counseling process.

5 4 3 2 1

3. Human Growth and Development – Demonstrates an understanding of developmental aspects of human growth and appreciation for the nature of human developmental behavior.

5 4 3 2 1

4. Career Development – Demonstrates an understanding of career development and related life factors and the effects on an individual’s mental health and lifestyle.

5 4 3 2 1

5. Helping Relationships – Demonstrates effective individual and group counseling skills which facilitate client growth and the ability to evaluate client progress toward treatment goals.

5 4 3 2 1

6. Group Work – Demonstrates both theoretical and experiential understandings of group purpose, development, dynamics, counseling theories, group counseling methods and skills, and other group approaches.

5 4 3 2 1

7. Assessment – Demonstrates knowledge and skills in assessment techniques and the ability to apply concepts to individual and group appraisal.

5 4 3 2 1

8. Research and Program Evaluation – Demonstrates the ability to read, critique, evaluate, and contribute to professional research literature.

5 4 3 2 1

9. Service Learning – Engages in service to the community, develops advocacy competencies, collaborative relationships with community agencies, and personal awareness of the needs of historically underserved populations.

5 4 3 2 1

10. Reflective Practice – Demonstrates interpersonal and intrapersonal awareness, and the ability to engage in continuous, life-long learning.

5 4 3 2 1

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SKILL AND PRACTICE DOMAINS: Based on your observations and supervision, please fill out the following evaluation of the Counseling Intern. For each Skill and Practice Domain, consider how student has performed in the various areas of engagement, and use the following scale to assess the Counseling Intern performance.

4 = Superior. Counseling Intern shows marked proficiency and competency in this domain most all of the time, and is able to perform independently and model this skill for others.

3 = Competent. Counseling Intern consistently demonstrates significant competencies in this domain, requires minimal supervision and consultation in this area

2 = Adequate. Intern meets basic expected competencies in this area.

1 = Improvement Needed. This area or learning domain is significant area for growth, and requires ongoing training and developmental needs in this area.

COUNSELING FOUNDATIONS

Demonstrates the ability to apply and adhere to ethical and legal standards in clinical mental health counseling.

4 3 2 1

COUNSELING PREVETION AND INTERVENTION

Uses the principles and practices of diagnosis, treatment, referral, and prevention of mental and emotional disorders to initiate, maintain, and terminate counseling.

4 3 2 1

Demonstrates the ability to use procedures for assessing and managing suicide risk.

4 3 2 1

Applies current record-keeping standards related to clinical mental health counseling.

4 3 2 1

Provides appropriate counseling strategies when working with clients with addiction and co-occurring disorders.

4 3 2 1

Demonstrates the ability to recognize his or her own limitations as a clinical mental health counselor and to seek supervision or refer clients when appropriate.

4 3 2 1

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DIVERSITY AND ADVOCACY

Demonstrates the ability to modify counseling systems, theories, techniques, and interventions to make them culturally appropriate for diverse populations.

4 3 2 1

ASSESSMENT

Demonstrates skill in conducting an intake interview, a mental status evaluation, a biopsychosocial history, a mental health history, and a psychological assessment for treatment planning and caseload management.

4 3 2 1

Screens for addiction, aggression, and danger to self and/or others, as well as co-occurring mental disorders.

4 3 2 1

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I see the Biggest Strengths of The Counselor in Training as:

Areas for continued growth that I observed in the Counselor in Training are:

Other Comments on the student’s overall performance on Internship:

I, as site supervisor, recommend that _______________________(name) pass______(Check) Not-Pass_____(Check) the internship based on satisfying the above standards and syllabus requirements.

Site Supervisor Signature_______________________________________Date______________________

I have had the opportunity to discuss this evaluation with my site supervisor.

Signature_______________________________________Date______________________

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Appendix E

Evaluation of Internship Site by Student

Student________________________________________________________________

Site Supervisor__________________________________________________________

Site Location___________________________________________________________

Course________Semester/YR_____________________________________________

Date____________

1. Discuss the positives of this placement___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. How could this placement be more helpful in your development?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Recommendations for improvement_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student Signature Date

_____________________________________________ _____________________

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Appendix F Summary of Internship Hours

Name of Internship Student ________________________________________ Semester (s________________

Phone______________________________________________Email_________________________________

Internship Site(s):

___________________________________________________________________________________________

Internship: Number of direct client contact hours: __________________ Date Internship began: ____________

Direct Indirect Total

Individual

Group & Family Systems

Supervision N/A

Treatment Team and Staffing

N/A

Professional Development

N/A

Total

Percent of Total

Student’s Signature ________________________________________ Site Supervisor’s Signature__________________________________ LMU Faculty Supervisor’s Signature___________________________

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Appendix G Guidelines for Writing a Professional Disclosure Statement

A Professional Disclosure Statement is a document that clarifies the role of the counselor and provides for accurate informed consent at the beginning of the counseling process. The counselor trainee is a guest in the field placement setting. In some cases administrators, parents, clients, and staff are uncertain as to the counselor trainee’s role, responsibilities, and educational level. Therefore, each counselor trainee will complete a Professional Disclosure Statement that is to be available to anyone who may be concerned about the credentials of the trainee, and which is to be handed out to the client, or legal guardian. Document should be brief, one page, or two pages at most.

The following should serve as a guide to The Professional Disclosure Statement:

• Name • Status as a Counselor trainee at LMU • Highest degree received, Academic Program enrolled in at the present • Philosophy of Counseling and Theoretical Orientation • Names of all relevant credentials (teacher license, certificate, social work license, etc.) • Names of Supervisor(s) – both site and LMU • Description of practicum activities commonly preformed • Fee structure (if applicable) • Policy for Cancellation and No Show • An explanation of confidentiality • Signature lines for both Client and Counselor in Training

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Appendix H Weekly Time Log – Week of: __________-___________ Individual Group &

Family Systems

Supervision Treatment Team and Staffing

Indirect Time & Preparation

Professional Development

# of Hours and Description

# of Hours and Description

# of Hours and Description

# of Hours and Description

# of Hours and Description

# of Hours and Description

Monday

Tuesday

Wednesday

Thursday

Friday

Sat/Sun

Total Hours:

Week Total: hours

Student’s Signature ____________________________________ Site Supervisor’s Signature _______________________________

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Appendix I

Release to Record Counseling Sessions for Practicum/Internship Students

Dear Client/ Parent/Legal Guardian:

My name is ____________________________and I am a graduate student at LMU majoring in Professional

Counseling. A requirement for the practicum and internship experience is that I submit two counseling sessions

with students in either a DVD or VHS format for the purpose of obtaining instructor review and suggestions as I

develop my counseling skills and prepare for state licensure. The recordings will not have any student name or

personally identifiable information and they will be destroyed at the end of the semester. Other than myself, the

only other persons that will see the recording will be my instructor and other counselors in training in this Seminar.

I would like to work with your child on this project and your signature below will give me the consent I need to

complete this important requirement for the Counseling Program at Lincoln Memorial University. If you have any

questions regarding this project my instructor can be reached at michael.hayes@lmunet.edu. Thank you for your

support in this project.

Sincerely,

__________________, Graduate Student, LMU My telephone_____________________

Yes, I give consent for my child to be recorded in this assignment and I understand that my child’s name will not be

revealed and the tape destroyed at the end of the semester.

Parent/Guardian/Client_____________________Date__________Child Name______________

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Appendix J

Weekly Supervision Form

Complete this form for every week of your internship experience. Submit this form to Dr. Tichon at the beginning of each class. Be brief in you responses. Estimated time to complete this form is no more than 15 minutes. Total number of hours logged this week: _____ Goal for the week: Rate your progress toward that goal: 0 1 2 3 4 5 6 7 8 9 10 Activity/situation that was most positive:

Activity/situation that was most negative: What I would do differently in the negative situation, if I had the chance. Specific concerns regarding clients/situations: Questions for Dr. Tichon: Signature of Internship student:

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Appendix K

CG 699 Signature Assignment #2 Completion Guide –

Audio/Video Tape Transcription and Write-up

Student: ___________________ Age: _____________________Date of Session: _______

Counselor (graduate student): ____________________________Session # _______

Presenting concern:

Please use the following format as a guide for the Audio/Video Tape Write-up. Counselor-in-Training is to provide a transcript of a complete counseling session along with the session write up guidelines below.

1. Mood of the client at start of session (Record observable behaviors rather than impressions or

assumptions):

2. Major issues addressed in this session:

3. Theoretical Orientation and Counseling Techniques utilized:

4. Modifications made, if any, to counseling systems, theories, techniques, and interventions to make them culturally appropriate for clients social and cultural background (CACREP CMHC F. 3. Demonstrates the ability to modify counseling systems, theories, techniques, and interventions to make them culturally appropriate for diverse populations.)

5. Was of substance use screened for and addressed if present? (CACREP CMHC D. 8. Provides appropriate counseling strategies when working with clients with addiction and co-occurring disorders.)

6. Was suicide risk assessed and managed? (CACREP CMHC D. 6. Demonstrates the ability to use procedures for assessing and managing suicide risk.)

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7. Outcome of session. This might include new perspective, ideas for change, plans for change, things to investigate/do before next session, change in effect, etc.:

8. Mood of client at conclusion of session. Record observable behaviors rather than impressions or assumptions:

9. Issues to come back to/unfinished business:

10. Strengths of session:

11. Areas for growth of session (CACREP CMHC D. 9. Demonstrates the ability to recognize his or her own limitations as a clinical mental health counselor and to seek supervision or refer clients when appropriate.):

12. Other Remarks or thoughts about session:

13. I learned that:

14. Counseling Note for this session. Please write out a concise summary of a clinical note based on this session that would be entered into clinical mental health chart. (CACREP CMHC D. 7. Applies current record-keeping standards related to clinical mental health counseling.)

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Appendix L

PREPARING PROFESSIONAL EDUCATORS OF DISTINCTION TO MAKE A POSITIVE IMPACT

ON THIS GENERATION AND THE NEXT

Student Name______________________________________________________

Date_____________________Semester__________________________________

Course Name & Number______________________________________________

Counseling Major (school, mental health, or student affairs)__________________

I, _(Name)____________________________________have read the current Code of Ethics in

their entirety from the American Counseling Association and agree to follow the Code in all of

my practicum/internship experiences, as well as in any learning activity in my preparation as a

professional counselor at Lincoln Memorial University.

_________________________________

_______________________________________

Faculty Signature Student Signature

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Appendix M Tape Review Form

Student Name Major Date of Tape

LMU Faculty Supervisor Date of Review

Summary of Session

Intended Goals__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Strengths____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Targets for Growth_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dynamics of Session_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Future Plans for Client_____________________________________________________________________________________________________________________________________________________________________

Conference Documentation:

Supervisor Signature Student Signature Date

(Signatures only indicate a follow up conference occurred. It does not indicate agreement.)