Clinical Social Work Supervision Training Plan

(Note: This sample may not completely  match the current BSRB format or requirements

but it will give you a general idea of what the Board typically expects)


I.    Information regarding supervisee: [Completed by supervisee]

II.      Information regarding supervision setting: [Completed by supervisee]

III. Information regarding Supervision Training Plan: [Completed by supervisee and supervisor(s) together]

1.     Describe the clinical practicum completed while in your masters of social work program.

My first year graduate social work practicum was at Bert Nash CMHC in Lawerence, Kansas.  I provided individual and group counseling, case  management, and interdisciplinary collaboration for children ages 6-18. 

My second year practicum was at Counseling and Psychological Services (CAPS) at the University of Kansas.  I provided intake assessments (including diagnosis), crisis intervention, individual  and group therapy.

2.     Will you be using the DSM V in diagnosing clients?

 Yes, all clients I serve will receive a DSM diagnosis.

3.     Please list some specific diagnosis you expect to treat.

 PTSD, Major Depressive Disorder, Generalized Anxiety Disorder, Acute Stress Disorder, Dysthymia, AD/HD, Oppositional Defiant  Disorder, Conduct Disorder, RAD

4.     What are the anticipated types of clients to whom you will be providing services?

I will provide clinical services to male and female adolescents and their families served at the SuperHelpers Center.  The adolescent clients will be primarily mandated into services, however a few are voluntary.  Their presenting concerns include substance use, truancy, childhood physical and sexual abuse, running away, opposition and defiance, school failure, criminal activity, sexual acting out, and self harm behavior.  The family-clients will be the adolescent client’s family of origin, extended family, adoptive family, or the families they will go to after leaving our facility.


5.     What services will you be providing to clients?

I will be providing individual and group therapy for the youth, and family therapy for the youth and their care-givers.  I will also provide coordination with other service providers involved in their care.


6.     What are some theories of psychotherapy you plan to use in treating clients?

Solution-Focused Brief Therapy, Strategic and Structural Family Therapy, CBT, Narrative Approach,

Motivational Interviewing.


7.     What dates are to be covered with the Supervision Training Plan?

Upon approval of the training plan by the board, supervison will begin on June 1, 2013 and continue until June 15, 2015, or until 150 hours of clinical supervision have been accumulated.


8.     List your clinical supervision goals and briefly describe how you will attain those goals. Be sure to review the definition of clinical social work and incorporate into your goals. [See K.A.R. 102-2-1a (e)] Also, include goals that relate to diagnosis and treatment of mental disorders. Include a description that specifies how you will meet the requirement to provide 1500 hours of psychotherapy and assessment.

  • [K.A.R. 102-2-1a (e) “Clinical social work practice” means the professional application of social work theory and methods to the treatment and prevention of psychosocial problems, disability, or impairment, including emotional and mental disorders.]



Assessment: Develop skills in assessing psychopathology and risk while also assessing for client and client-system strengths with each client. Increase knowledge and skills in additional forms of assessment including CBT, Solution Focused Brief Therapy, Motivational Interviewing, and Family Systems Theory.

Diagnosis: Develop diagnostic skills using the DSM-V with all clients on my caseload. Review diagnostic related information for 1 or 2 clients at each weekly supervision session to practice differential diagnosis. Additionally, when the supervisee or agency team has difficulty or disagreement about diagnosis of a particular client, this will be discussed in supervision to identify probably diagnosis.

Treatment: Increase skills with a variety of treatment modalities, methods and techniques, especially those with an evidence base.  All clients on supervisee’s caseload will be reviewed on a rotating basis to review treatment options and assure treatment effectiveness.

Consultation: Develop consultation and collaboration skills for use with family members, school personnel, mental health and medical professionals, colleagues, and other service providers.  Methods and models for consulting will also be discussed, reviewed, and practiced.

Evaluation: Develop skills at both initial evaluation and outcome evaluation utilizing a variety of currently accepted methods including Liekert scales, SFBT scaling questions, normed symptom scales and check lists, client self report, outcome rating scales, and client satisfaction surveys.  Initial evaluations and client progress will be reviewed with supervisor on a rotating basis to develop practical skills at both initial and outcome evaluation.  Supervisee accepts responsibility to monitor any signs of risk (suicide, homicide, self-harm, treatment failure, etc) and discuss these immediately with the supervisor.

Client Centered Advocacy and Cultural Competence: Utilize understanding of human diversity and apply this knowledge when seeking resources specific to client needs and strengths. Become more aware of the experience and impact of being from a marginalized group and issues related to social injustice issues and oppression.


9.     Outline your supervisor’s responsibilities in relation to these goals and objectives.

Clinical Supervisor will provide direction, guidance and oversight related to meeting the requirements of the Kansas BSRB for clinical licensure. Specifically, supervisor will provide clear, direct, timely feedback on an ongoing basis related to diagnosis and treatment for all cases presented.  Feedback will also be given on supervisee’s professional development. This will include all areas discussed above related to clinical social work, as well as self awareness, use of self, boundaries, and ethical dilemma resolution. Clinical supervisor will maintain documentation of the number, content, format, and length of all supervisory sessions to document supervisee’s progress toward meeting requirements of clinical licensure. If desired, supervisor will provide supervisee a written evaluation regarding progress toward requirements for clinical license and offer recommendations for future progress.  Supervisor will arrange with for alternate supervision should he be unavailable.


10.  Outline your responsibilities in relation to these goals and objectives.

  • Take responsibility for my professional development by maintaining focus on and monitoring progress toward the training plan goals.
  • Prepare in advance for each supervisory session to review clinical issues for all clients on a rotating basis, at the rate of 2 or 3 in depth at each meeting. 
  • Inform supervisor of additions or changes to case load.
  • Immediately discuss any risks (to self, other clients, social worker, agency, community, or any other) so that ethical and legal responsibilities, as well as treatment options can be discussed.
  • Notify Clinical Supervisor as soon as possible if unable to keep an appointment.
  • Maintain ongoing learning as well as address risks with alternate supervisor when Clinical Supervisor is unavailable.
  • Keep a record/log of all supervision sessions that includes; date, duration, format and location.
  • Obtain additional professional liability insurance beyond what employer carries and provide Mr. Kreider with proof of that coverage.


11.  Describe your plan and the supervisor’s plan for documentation of the date, length, method, content, and format of each supervisory meeting and your progress toward the learning goals.

  • The supervisee will keep a log that records the date, length, method and content of each session, as well as whether it was individual or group supervision.

  • The supervisor will keep a log for each supervisory meeting that documents date, length, method and content as well as how what was discussed is relevant to progress toward the goals and objectives.


12.  Answer the following questions regarding your supervision:

a.  Describe the schedule for supervision.

I will meet with  my clinical supervisor for 90 minutes (typically 8:00-9:30 am) on each Friday beginning September 1, 2013.  We will not meet when vacations, holidays, illness, training events, or other circumstances take precedence.


b.  What is the ratio of supervision to direct client contact that you will receive?

I will receive a minimum of 1 hour of supervision for every 20 hours of direct face to face client contact and 40 hours of clinical work.  1.5 hours of supervision per week will be the norm.


c.  How many supervision hours will be individual?

My current plan is to receive all 150 hours of supervision individually.


d.  Will you receive group supervision? If so, how many supervision hours will be done in group? Also, how many supervisees will be in the group?

No, I do not plan to participate in group supervision at this time.


e.  What is the total number of supervision hours you will complete?

150 hours.


f.  What is the total number of supervisory meetings you will complete?

A minimum of 100 supervisory meetings in not less than two years.


13.  Describe the plan for documenting your progress toward meeting the required 4000 hours of supervised clinical experience, and the 2000 hours of direct client contact.

I will maintain a log that records my total hours worked and how how many hours were spent in direct client contact providing clinical assessment and psychotherapy.


14.  Describe the plan for documenting your progress toward meeting the required 1500 hours or direct face to face client contact providing psychotherapy and assessment services.

I will maintain a log that records the date and length of time spent in direct face-to-face contact with clients for each day I meet directly with clients.


15.  Describe the plan for evaluating your progress in supervision.

Supervisor will provide ongoing verbal feedback regarding progress (related to the above goals and responsibilities) at each supervisory session.  We will discuss a summary of progress at least every quarter.  If requested, supervisor will also provide a written summary that identifies progress toward goals and suggestions for improvement/ continued progress.


16.  Describe the plan for notifying the clients that you are practicing under supervision, the limits of the confidentiality under supervision, and the name and contact information for your supervisor.

All clients will receive, review and sign a release of information informing them that I am under supervision, working toward clinical licensure, and that their case related information will be discussed with my supervisor. The release will detail what information will be shared with the supervisor and that he will not record identifying information or share confidential information with anyone else, unless required by law to do so.  Contact information for the clinical supervisor will be provided in the event a client wants to discuss something with him.  A release of information form will be signed and dated by each of the supervisee’s clients all of the above items.   The release form will be kept in a supervision file by the supervisee.


17.  Describe the process for renegotiating this plan if warranted, including the need to submit all changes to the board office within 45 days of the change.

If for any reason the above plan needs to be modified, Ms. Socialworker and Mr. Kreider will discuss options until an agreement is reached.  Ms. Socialworker will submit any changes to the BSRB for approval within 45 days of the change.


18.  Describe the process for mediating conflicts between yourself and the supervisor.

Conflicts will be identified as early as possible, then discussed openly.  All possible methods to resolve conflicts will be considered and explored.  If  resolution is not achieved by the supervisee and supervisor talking openly and directly with each other, assistance from a mutually agreed upon third party will be engaged to facilitate the negotiation of an agreement.


19.  Describe the contingency plans for emergency supervision, missed supervision sessions, and supervision while the supervisor is unavailable.  Be sure to include a backup supervisor.

In the event that a supervision session, must be missed Ms. Socialworker and Mr. Kreider will arrange a make up date if possible. If not possible, the supervisee has the option of meeting with the alternate supervisor, Max Brilliant, LSCSW. In order to assure adequate guidance and oversight, supervisee will meet with the alternate supervisor if more than one Clinical Supervision session must be missed.


IV.  Information regarding supervisor:[Completed by supervisor]

V.    Information regarding the supervisory relationship:[Completed by supervisor]

VI.  Supervisor’s and Supervisee’s Attestation

We, the undersigned supervisee and supervisor, acknowledge that we have both read and agree to all of this plan, and have read and understand the post graduate supervised work experience requirements set forth in regulations.  We attest, the the best of our knowledge, that this plan meets the training requirements as outlined in statutes and regulation, including the requirements for the provision of psychotherapy and assessment as well as the required supervision.  We also attest that the forgoing information constitutes an accurate and honest description of the duties to be performs b the supervisee.  Additionally, the supervisee hereby gives consent to the supervisor to discuss supervision or performance issues with the supervisee’s clients, other professionals in the practice setting, the Board, or any other individual to whom either is professionally accountable.



   Susy Socialworker, LMSW (Supervisee)                                                     Date



     Jim Kreider, LSCSW (Supervisor)                                                              Date



 Max Brilliant, LSCSW ( Alternate Supervisor)                                               Date


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