Information provided in your record of supervision should include the topics covered, brief descriptions of cases or issues discussed, specific guidance or instruction provided by your field instructor and follow up items specific to the area described. Provide detailed, specific and meaningful information to show what you are learning. Write your record of supervision as if you are taking detailed minutes of the meeting so that the reader can easily and fully understand what you discussed and learned from the meeting.
Use this template to create an agenda and bring it with you to your required formal supervision meetings at your practicum site.
Summarize the discussion or feedback received at the meeting for each item discussed.
Not all areas need to be discussed each time but you should cover at least one area from each section (head, hand, heart) each time.
The notes you provide should provide specific information showing areas discussed in the meeting and demonstrate your learning and the variety of issues being addressed.
Write your notes as if they are minutes to this meeting.
YOU MUST INCORPORATE THE INFORMATION FROM MY LEARNING CONTRACT INTO THIS ASSIGNMENT:
Core Competency 2: Engage Diversity and Difference in Advanced Social Work Practice
Able to describe the role
diversity and difference
play in shaping life
experiences in a
particular clinical
context
Student will critically analyze the benefits of collaboration with clients
from different ethnic and cultural backgrounds. Student will complete
a journal reflection.
November
20th
Head (knowledge / ideas)
Case Reviews
Provide summary of diagnostics, analysis, recommendations, successful interventions,
next steps
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Theories
Identify theories and models related to practice and how applied
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Policy
Identify agency, community, state, federal policies reviewed or discussed
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Feedback from Supervisor (must complete)
Areas of growth or improvement identified (document at least 1)
Agenda/Discussion/Feedback [required]
Answer:
FollowUp/NextSteps1 [required]
Answer:
Strengths identified (document at least 1)
Agenda/Discussion/Feedback [required]
Answer:
FollowUp/NextSteps1 [required]
Answer:
Student Signature [required]
MSW Program Practicum
Student Record of Supervision
Name ___________________________________ Date _______________________
Field Instructor ____________________________________________
Meeting # _______________
Use this template to create an agenda for and bring with you to your required formal supervision meetings at your practicum site.
Summarize the discussion or feedback received at the meeting for each item discussed. Not all areas need to be discussed each time
but you should cover at least one area from each section (head, hand, heart) each time. These notes should provide specific
information showing areas discussed and demonstrate your learning and the variety of issues being addressed. Please also note
follow up, action items or next steps you have been asked to take or that you would like to take for each area.
Complete feedback from Supervisor section for each meeting.
Topic
Learning Contract:
Identify assignments to review,
mid-term or final evaluation
Agenda / Discussion / Feedback
Reviewed progress on learning contract with
supervisor. Discussed activity in competency 5
regarding agency policy for no shows. I will add goal to
learning contract regarding review of no show policy,
and assess current impact on clients and therapists. I
will complete research on other agency no show
policies and suggest ideas for change.
Follow up / Next Steps
By December 1st
Head (knowledge / ideas)
Case Reviews
Provide summary of diagnostics,
analysis, successful
interventions, next steps
Theories
Identify theories and models
related to practice and how
applied
Review direct service case for client LP. Ideas for
engagement, next steps. Discussed L.P. a 32 year old
white man struggling with depression and alcohol
abuse. Reviewed motivational interviewing techniques
and discussed choosing strategies for engagement
based on stages of change model.
Observe another clinician
using stage of change
model in treatment
planning.
Motivational interviewing applies to this case due to
the clients resistance to treatment. Supervisor
suggests that he may also benefit from CBT to explore
negative thinking patterns impacting his depression.
Review negative thinking
patterns worksheet with
client in session.
Propose a treatment plan
for review for LP based on
current stage of change.
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Policy
Identify agency, community,
state, federal policies reviewed
or discussed
Hand (skills / practice)
Process Recording
Reviews
Review process recording on client SR
describe case and key insights
learned
11.2017
AS2.2.1, AS2.2.7, MS2.2.2, MS2.2.3, AS2.2.7
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MSW Program Practicum
Student Record of Supervision
Health, Safety and Risk
Identify Issues and Planning
related to these issues
Clinical Observation
Reviews
Describe insights gained and
growth areas discussed
Training or Skills Needed
or Practiced
Identify trainings completed,
needed or skill improvements
reviewed.
Discussed client risk issues related to suicidal ideation
and self-harm. Reviewed strategies and appropriate
responses. Supervisor explained agency policy on
reporting and safety planning tool required for high
risk events.
Reviewed feedback from clinical observation.
Discussed my strengths being empathy and
engagement with client. Also discussed growth areas
of increased sensitivity to cultural issues and not giving
advice to clients.
Request to attend training on domestic violence issues
coming up next month.
Discuss assistance needed with writing measurable
goals.
Complete a sample risk and
safety plan on my client
and bring to supervisor for
review and discussion.
Continue to request
feedback from other
clinicians on their
approach.
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Research describe
connections of research /
evidence to practice and
practice to research.
Heart (values, cognitive and affective processes)
Diversity / Cultural Issues
What areas were identified and
discussed related to practice?
Ethical / Boundaries Issues
What areas were identified and
discussed related to practice?
Self-care
Review cultural issues related to community group
involvement issues related to race and poverty
impacting community planning effort. Supervisor
explained history of relationships between black and
white communities and attempts to work together
with faith based organizations to improve outcomes.
Discussed areas of sensitivity and approaches for
better engagement.
Discuss boundary concerns regarding client
complimenting me a lot during meetings. Supervisor
recommended that I state clear to the client that
although I appreciate his strength of being a
complimentary person. It is not appropriate for him to
compliment me on my appearance in session as the
focus should be on him
.
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Rapport, Relationships,
Team Building issues
What areas were identified and
discussed related to practice?
Human Rights and Social
Justice Issues discussed
11.2017
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AS2.2.1, AS2.2.7, MS2.2.2, MS2.2.3, AS2.2.7
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MSW Program Practicum
Student Record of Supervision
What areas were identified and
discussed related to practice?
Feedback from Supervisor
Areas of growth or
improvement identified
(document at least 1)
Strengths identified
(document at least 1)
What can I do better? What is a good next step for me? Supervisor reports that I am doing well in learning the processes and procedures of the agency. She states I should continue to work on understanding motivational interviewing and will provide additional videos to help me learn this approach.
What am I doing well? What positives can I build on?
Supervisor states my strengths are working well with others and engaging clients quickly. I am also a fast learner.
______________________________________________________
Student Signature
_____________________________________________________
Field Instructor Signature
11.2017
AS2.2.1, AS2.2.7, MS2.2.2, MS2.2.3, AS2.2.7
Watch training videos on
MI
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