practicum/internship clinical experience handbookinternship coordinator will send a notice via...
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PRACTICUM/INTERNSHIP
CLINICAL EXPERIENCE
HANDBOOK
School & Clinical Mental Health counseling
Candidates
Counselor Education program
Department of Counselor education, leadership, and
research
TABLE OF CONTENTS
Topic Page
PURPOSE OF HANDBOOK….…………………………………………. 4
PRACTICM/INTERNSHIP REQUIREMENTS AND
PROCEDURE………………………………………………………….. 5
Prerequisites..……………………………………………………… 5
PRACTICUM………………………………………………. 5
INTERNSHIP……………………………………………… 7
Liability Insurance………………………………………………… 9
Expectations……………………………………………………….. 9
PRACTICUM ……………………………………………… 9
1. Course Requirements………………………….. 9
2. Supervision Requirements…………………….. 10
3. Professional Requirements ……………………. 11
INTERNSHIP……………………………………………… 12
1. Course Requirements………………………….. 12
2. Supervision Requirements…………………….. 13
3. Professional Requirements ……………………. 14
4. Inability to Complete Requirements………….. 15
APPENDIX (FORMS) ……………………………………………………. 16
1. Background Check……………………………………………... 17
2. Checklist of Field Experience………………………………….. 18
3. Application for Field Experience ……………………………… 19
CEP Clinical Experience Handbook 4 Revised Spring 2016
4. On-site Supervision Attendance Log ………………………….. 20
5. Log Summary Sheet …………………………………………… 21
6. School Counseling Candidate Evaluation
By On-Site Supervisor………………………………………… 22
7. Community Counseling Candidate Evaluation
By On-Site Supervisor………………………………………… 34
8. Counseling Candidate Evaluation of
Site-Supervisor and Field Experience………………………... 38
9. Parent Consent Form …………………………………………. 41
10. Client Consent Form………………………………………….. 42
11. Counseling Skills Scale (CSS)………………………………….. 43
12. Case Presentation of Recordings ……………………………. 48
13. Case Presentation of Recording Evaluation…………………. 50
CEP Clinical Experience Handbook 5 Revised Spring 2016
PURPOSE OF HANDBOOK
In accordance with the Council for Accreditation of Counseling and Related
Educational Programs (CACREP) standards, the Counselor Education Program at
Augusta University (Augusta) offers experiential Practicum/Internship opportunities
whereby candidates can apply, practice, and develop their awareness, knowledge, and
skills in a clinical and/or school setting. For the purposes of this handbook, this
experiential opportunity is designated as the clinical experience for both school and
mental health counseling candidates. This handbook is designed as a resource for
Augusta Counselor Education candidates seeking to enroll in the Practicum/Internship
clinical experience. Therefore, the handbook is intended for both School Counseling and
Clinical Mental Health Counseling (CMHC) track candidates alike and respective sample
paperwork is provided in the appendix of this handbook. Aspects related to expectations,
requirements, and successful completion of COUN 6880 Counseling Practicum, COUN
6900/COUN 6920 Counseling Internship I & II for School Counseling candidates, and
COUN 6890 CMHC Practicum, COUN 6910 CMHC Internship I, and COUN 6930
CMHC Internship II for Clinical Mental Health Counseling candidates will be
introduced.
As a prospective candidate, you may experience anxiety and excitement about
your upcoming clinical experience. This handbook cannot alleviate every concern as no
handbook can completely prepare students for this upcoming experience. The purpose of
this handbook, however, is to provide information related to required paperwork,
professional expectations, and details related to your field experience which may assist
you in preparing for this endeavor. Ultimately, your experience in the selected site(s)
should offer an opportunity to learn, grow, and flourish as a future professional
counselor. This practical experience should represent an opportunity to refine your
awareness, knowledge, and skills as an effective and culturally responsive counselor in a
mental health and/or school setting.
Important Note: It will be your responsibility to maintain, duplicate and keep any
paperwork regarding your clinical experience at your site and university setting. In the
future, you may need to refer to this paperwork when you to apply for licensure and/or
certification. Furthermore, all of the paperwork related to your clinical experience,
including this handbook, can be accessed via the Augusta Counselor Education website.
CEP Clinical Experience Handbook 6 Revised Spring 2016
PRACTICUM AND INTERNSHIP:
REQUIREMENTS AND PROCEDURES
Prerequisites
PRACTICUM:
In addition to the academic program objectives established, the Counselor
Education Program adheres to the professional counseling accreditation standards for
clinical instruction outlined by the Council for Accreditation of Counseling and Related
Educational Programs (CACREP). As such, certain requirements and procedures must
be met in order to enroll in COUN 6880 (School Counseling Practicum). There are four
steps in this process:
1. Meeting Eligibility Requirements
Candidates may apply for the upcoming Practicum experience provided that the
necessary courses are successfully completed. These required courses are outlined as
follows:
School Counseling: In order to be eligible for enrollment in COUN 6880 (School
Counseling Practicum), School Counseling candidates must complete the
following courses:
COUN 6620: Human Development in Counseling,
COUN 6630: Professional Orientation and Ethics,
COUN 6660: Communication Skills in Counseling,
COUN 6680: Theories & Techniques of Counseling.
Additionally, these two courses must be completed prior to or concurrent
with COUN 6880 School Counseling Practicum:
PSYC 6147 Seminar in Group Process,
COUN 6780 School Counseling.
Clinical Mental Health Counseling: In order to be eligible for enrollment in
COUN 6890 CMHC Practicum, CMHC candidates must complete the following
courses:
COUN 6620: Human Development in Counseling,
COUN 6630: Professional Orientation and Ethics,
COUN 6660: Communication Skills in Counseling,
COUN 6680: Theories & Techniques of Counseling.
CEP Clinical Experience Handbook 7 Revised Spring 2016
Additionally, these two courses must be completed prior to or concurrent
with COUN 6890 Counseling Practicum:
PSYC 6147 Seminar in Group Process,
COUN 6800 Assessment, Diagnosis, and Intervention in Counseling.
At the beginning of the semester BEFORE candidates plan to take a Practicum or
Internship course, they should review the Approved Site List found on the program
website.
2. Submit Applications
Before the eighth week of the semester, the Counselor Education Practicum and
Internship Coordinator will send a notice via JAGMail email indicating the deadline for
candidates seeking to apply for the Practicum or Internship experience during the
following calendar semester (see Application for Counseling Field Experience in
Appendix). The submission of this Application for Counseling Field Experience is the
first step for candidates planning to enroll in the Practicum and/or Internship clinical
experience for the following semester. It is important to note that all candidates are
required to submit an Application for Counseling Field Experience each semester that
they intend to register for any clinical experience regardless of site selection.
On the application, the candidate must identify courses successfully completed as
well as upcoming coursework in which the candidate intends to enroll. Additionally, the
candidate must select three or more potential and specific sites in sequential order of
preference on this application. Candidates can view and select potential community
schools and sites from the Approved Site List found on the program website. A complete
application must be submitted in order for the application to be accepted. IF
CANDIDATES FAIL TO SUBMIT A COMPLETED APPLICATION BY THE
DEADLINE, THEY WILL NOT BE ABLE TO ENROLL IN THE CLINICAL
EXPERIENCE FOR THE UPCOMING SEMESTER.
3. Attend Mandatory Pre-Practicum Orientation
For Practicum candidates, there will be a mandatory Pre-Practicum Orientation
scheduled within three weeks after the application deadline whereby issues related to the
upcoming Practicum will be further outlined. All students who intend to enroll in COUN
6880 (Counseling Practicum) are required to attend a mandatory Pre-Practicum
Orientation in the semester prior to their clinical experience course whereby this contract
will be discussed. IF THE STUDENT DOES NOT ATTEND THE PRE-PRACTICUM
ORIENTATION, HE OR SHE WILL NOT BE ABLE TO ENROLL IN THE
PRACTICUM COURSE IN THE UPCOMING SEMESTER.
4. Secure your Site
Finding an appropriate site is the responsibility of the student and there is a list of
acceptable sites found on the Counselor Education website. After the applications are
CEP Clinical Experience Handbook 8 Revised Spring 2016
accepted by the posted deadline, the Practicum and Internship Coordinator will send
written confirmation (via email or paper memo) to each candidate. This written
confirmation allows the candidate to begin contacting clinical sites for Practicum or
Internship. DO NOT CONTACT ANY SITES UNTIL YOU HAVE RECEIVED
WRITTEN CONFIRMATION TO DO SO FROM THE PRACTICUM AND
INTERNSHIP COORDINATOR.
At your meeting give a copy of your current resume to the site supervisor so that
he or she can get to know some of your previous experiences. Also, provide a copy of
your liability insurance (see Insurance section). Discuss a potential schedule for days and
times that you could work. This is particularly important if you have another full or part-
time job.
Lastly, complete the Practicum/Internship Contract (found on the CE website).
Candidates will submit a COPY of this contract to their respective course instructor and
to the site supervisor at the beginning of the semester. The candidate will keep the
original Contract form.
Since the practicum and internship clinical courses represent the capstone
experiences in a candidate’s professional training it is imperative that each candidate
carefully attend to the specific course requirements and the procedures for finding and
securing an approved internship site. Each student will need to work closely with his/her
advisor and the Clinical Coordinator as he/she proceeds through the process.
INTERNSHIP:
In addition to the academic program objectives established, the Counselor
Education Program adheres to the professional counseling accreditation standards for
clinical instruction outlined by the Council for Accreditation of Counseling and Related
Educational Programs (CACREP). As such, certain requirements and procedures must
be met in order to enroll in COUN 6900/6920/ (Counseling Internship). First, COUN
6880/6890 (Counseling Practicum) must be successfully completed before a candidate
can register for Internship I. Therefore, practicum and internship cannot be taken in the
same semester. Additionally, there are three steps in this process:
1. Meeting Eligibility Requirements
Candidates may apply for the upcoming Internship experience provided that
necessary courses are successfully completed. In addition, the candidate must have
completed certain specialized coursework in order to be eligible for Internship.
These necessary courses are outlined as follows:
School Counseling: In addition to the courses required for practicum, candidates
must also have successfully completed the following courses to be eligible for
enrollment in COUN 6900/6920 Counseling Internship I and II:
COUN 6780: School Counseling,
COUN 6860: Counseling Children and Adolescents,
CEP Clinical Experience Handbook 9 Revised Spring 2016
PSYC 6147: Seminar in Group Process.
Clinical Mental Health Counseling: In addition to the courses required for
practicum, candidates must also have successfully completed the following
courses to be eligible for enrollment in COUN 6900/6920 Counseling Internship I
and II:
COUN 6700: Marriage and Family Counseling,
COUN 6800: Assessment, Diagnosis, and Intervention in Counseling,
PSYC 6147: Seminar in Group Process.
At the beginning of the semester BEFORE candidates plan to take a Practicum or
Internship course, they should review the Approved Site List found on the program
website.
2. Submit Applications
Before the eighth week of the semester, the Counselor Education Practicum and
Internship Coordinator will send a notice via JAGMail email indicating the deadline for
candidates seeking to apply for the Practicum or Internship experience during the
following calendar semester (see Application for Counseling Field Experience in
Appendix). The submission of this Application for Counseling Field Experience is the
first step for candidates planning to enroll in the Practicum and/or Internship clinical
experience for the following semester. It is important to note that all candidates are
required to submit an Application for Counseling Field Experience each semester that
they intend to register for any clinical experience regardless of site selection.
On the application, the candidate must identify courses successfully completed as
well as upcoming coursework in which the candidate intends to enroll. Additionally, the
candidate must select three or more potential and specific sites in sequential order of
preference on this application. Candidates can view and select potential community
schools and sites from the Approved Site List found on the program website. A complete
application must be submitted in order for the application to be accepted. IF
CANDIDATES FAIL TO SUBMIT A COMPLETED APPLICATION BY THE
DEADLINE, THEY WILL NOT BE ABLE TO ENROLL IN THE CLINICAL
EXPERIENCE FOR THE UPCOMING SEMESTER.
3. Secure Your Site
Finding an appropriate site is the responsibility of the student and there is a list of
acceptable sites found on the Counselor Education website. After the applications are
accepted by the posted deadline, the Practicum and Internship Coordinator will send
written confirmation (via email or paper memo) to each candidate. This written
confirmation allows the candidate to begin contacting clinical sites for Practicum or
Internship. DO NOT CONTACT ANY SITES UNTIL YOU HAVE RECEIVED
CEP Clinical Experience Handbook 10 Revised Spring 2016
WRITTEN CONFIRMATION TO DO SO FROM THE PRACTICUM AND
INTERNSHIP COORDINATOR.
At your meeting give a copy of your current resume to the site supervisor so that
he or she can get to know some of your previous experiences. Also, provide a copy of
your liability insurance (see Insurance section). Discuss a potential schedule for days and
times that you could work. This is particularly important if you have another full or part-
time job.
Lastly, complete the Practicum/Internship Contract (found on the CE website).
Candidates will submit a COPY of this contract to their respective course instructor and
to the site supervisor at the beginning of the semester. The candidate will keep the
original Contract form. Since the internship clinical courses represent the capstone
experiences in a candidate’s professional training it is imperative that each candidate
carefully attend to the specific course requirements and the procedures for finding and
securing an approved internship site. Each student will need to work closely with his/her
advisor and the Clinical Coordinator as he/she proceeds through the process.
Liability Insurance
All candidates are required to obtain liability insurance and provide proof of their
liability coverage to their Practicum or Internship course instructor on the first night of
class. The form must include three elements: 1) dates of coverage, 2) amount of coverage
(at least one million) and, 3) that coverage will be provided for your counseling duties as
a practicum or internship student. Without evidence of appropriate liability insurance, the
candidate will not be placed in any Practicum or Internship site. While lawsuits
involving school or community counselors are relatively uncommon, any service
provided the public by a professional (or a professional in training) is vulnerable to the
threat of lawsuit. Liability insurance is available to American Counseling Association
(ACA) student members at special student rate through Healthcare Providers Service
Organization (HPSO) or through the American School Counselor Association (ASCA).
Expectations
PRACTICUM
1. Course Requirements. There are three Practicum requirements that are necessary to
complete the course at a community agency or school site. These requirements include:
a) The candidate must complete 100 clock hours (150 clock hours for CMHC program)
of counseling and counseling-related activities community agency or a school site to
meet the requirements of Practicum. Candidates should plan to spend 8-10 hours per
week during the 16 week semester at a community agency or school site.
b) Of these 100 hours, at least 40 (60 for CMHC) must be direct service hours. Direct
service hours are defined as face-to-face interaction with clients which includes
individual counseling, group counseling, classroom guidance, or consultation with
family or team members.
CEP Clinical Experience Handbook 11 Revised Spring 2016
c) The candidate must be allowed to either audio/videotape the direct service hours for
the purpose of supervision. Candidates are required to provide their own tapes for
these purposes. An accepted alternative method is for the site or university supervisor
to provide live supervision of the candidate’s interactions with clients. Supervision
will be provided on a weekly basis by the Site-Supervisor. Meanwhile, the candidate
will attend bi-weekly individual or triadic supervision with an Educational Specialist
(Ed.S.) Supervisor. If the Ed.S. Supervisor is not available, the faculty instructor will
assume this role of providing bi-weekly individual or triadic supervision. These
supervision meetings will be assigned at the beginning of each semester.
Additionally, the candidate will attend and participate in group supervision with the
Counselor Education faculty supervisor on a bi-weekly basis (scheduled class time).
2. Supervision Requirements. Because Practicum represents the first opportunity for the
candidate to engage in direct service with "real" clients, the faculty assumes primary
responsibility for the candidate's supervision. This provides an opportunity whereby
faculty can include pertinent didactic instruction and skills preparation for and during the
counseling process itself. The candidate will participate in a group supervision seminar
on campus with his/her Practicum instructor for a minimum of 1-1/2 hours per week (or 3
hours bi-weekly) during which the seminar group will focus on didactic and experiential
activities and include some form of review of counseling practices.
The site (school, agency, practice group, or university) must provide weekly
supervision by a clinician acceptable to the Counselor Education Program. The identified
site supervisor must hold a minimum of a Master's Degree in the program emphasis area
and possess appropriate certifications or licenses. In addition, the site supervisor must
have a minimum of two years experience as a counselor or clinician in their professional
specialty (i.e., counselor education, psychology, social work). Candidates will be asked to
obtain a copy of the site supervisor’s resume to be submitted with the Practicum
Contract.
In addition to the site-supervisor and faculty supervisor, the candidate will
participate in individual or triadic supervision for a minimum of 1.5 hours on a bi-weekly
basis with a student in the Education Specialist (Ed.S.) Counselor Education program (or
faculty instructor if an Ed.S. student is not available). In each of these bi-weekly triadic
supervision meetings, candidates will be required to submit and review audio/video taped
sessions. Additionally, the students will be required to submit paperwork (ie. CSS form
provided in the Appendix) according to the course syllabus in order to facilitate this
supervision.
In order to review student performance throughout the semester, the faculty
instructor will maintain bi-weekly contact with the site-supervisor. The faculty instructor
will be responsible for maintaining contact and documenting this regular contact. This
documentation will be submitted into the candidate file at the end of the semester.
A contract will be discussed and established among the members of interest in
order for the candidate to participate at a particular site. This contract is agreed upon by
members such as the candidate, faculty, site supervisor, Ed.S supervisor, and any other
individuals that will assist in the field placement. Elements of the contract include such
factors as:
CEP Clinical Experience Handbook 12 Revised Spring 2016
a. assign a Practicum Site Supervisor who has appropriate credentials, time, and
interest for training the candidate, who can generally monitor the practicum to ensure
that both the candidate’s needs and the clients’ needs are being met;
b. provide opportunities for the candidate to engage in a variety of counseling activities
consistent with the CACREP standards for supervision and for evaluating the
candidate's performance (suggested counseling experiences are included in Practicum
contract);
c. ensure that the candidate has the opportunity to accumulate the required number of
client contact hours;
d. provide the candidate with an orientation to the site and adequate work space,
telephone, office supplies, and staff to conduct professional counseling activities
(consistent with those provided for the Site Supervisor).
e. meet for individual supervision with the candidate a minimum of one hour each week
that the student accrues hours at the site; and be available for on-site emergency
situations;
f. ensure that the candidate can audio or video tape at least six counseling sessions
during the semester for university supervision or provide live supervision of the
candidate’s interactions with clients;
g. provide written evaluation of the candidate, based on criteria established by the
Augusta University Program.
3. Professional Requirements. During Practicum, the role of candidates shifts towards
that of a professional counselor. Professional qualities include factors such as:
a. Candidates are expected to follow the rules and regulations governing the school or
agency to which they are assigned. This requirement includes standard employee
guidelines, such as arriving on time and calling in if you are ill, and following
standard operating procedures and protocol. Candidates are expected to have and
demonstrate the prerequisite skills of a professional counselor. Candidates are
expected to recognize and acknowledge skill deficits and work toward refinement of
counseling skills. Candidates are expected to continue to develop their own personal
orientation/style of counseling.
b. Candidates are expected to monitor their personal and professional growth and to be
able to identify those attitudes, beliefs, feelings, and personal characteristics that
facilitate or hinder their growth as professional counselors and discuss them during
individual and/or group supervision sessions. Additionally, during group supervision
sessions, candidates are expected to provide constructive feedback to their fellow
students, further developing their observation and facilitative skills.
CEP Clinical Experience Handbook 13 Revised Spring 2016
c. Candidates are also expected to arrive promptly, be prepared for, and attend all
classes. For any absence over 1/2, a deduction of 5 points per half/class absence will
be made from the final course grade. “If the student has been absent for more than the
equivalent of 10% of class time, regardless of cause, then the professor may withdraw
the student from the class for excessive absences.” (p. 20, 2007-2008 Augusta
University Catalog). If you must miss class for any reason, please contact the
instructor in advance. See the Course Requirements Contract for other management
and procedural issues. Note: Typically more than one section of Practicum is
offered each semester. If you must miss a class, you may be allowed to make up
that class by attending a class in another practicum section. Check with your
instructor and the instructor of other Practicum sections to gain permission to
substitute a class.
d. All Practicum and Internship forms are available in download format on the Augusta
Counselor Education website. Candidates are responsible for providing their own
forms to use from website throughout the practicum experience.
e. Candidates must successfully complete all requirements of the course in order to
receive a final course grade.
INTERNSHIP
Following successful completion of the counseling Practicum, candidates must successfully
complete one 600-hour semester or two 300-hour semesters of counseling Internship in either
school counseling or in community counseling facilities, according to the candidate’s area of
focus.
1. Course Requirements. There are three requirements for Internship that need careful
consideration. These requirements include:
a. The candidate must complete 600 clock hours total to the school or community site(s)
respective to their area of concentration to meet the requirement of Internship. The
typical method of doing this is two semesters of 300 clock hours each. IMPORTANT
NOTE: Candidates working twenty or more hours per week outside of school will not
be allowed to attempt more than one Internship per semester.
b. Of these 300 hours in each Internship course, at least 120 hours must be direct service
hours. Direct service hours are defined as face-to-face interaction with clients which
includes individual counseling, group counseling, classroom guidance, or
consultation with family or team members. Of these direct hours at least 10 hours
must be leading or co-leading groups. The remaining hours are to involve indirect
service work such as office administrative duties, consultation, in-service staff
development activities, clinical staffing of counseling cases, clinical supervision, and
staff meetings. Like all internship sites, this site must be approved by the faculty
Practicum/Internship Coordinator.
c. The candidate must be allowed to either audio/videotape the direct service hours for
the purpose of supervision. Candidates are required to provide their own tapes for
CEP Clinical Experience Handbook 14 Revised Spring 2016
these purposes. An accepted alternative method is for the site or university supervisor
to provide live supervision of the candidate’s interactions with clients. The candidate
will attend and participate in group supervision with the Counselor Education faculty
supervisor on a bi-weekly basis (scheduled class time).
2. Supervision Requirements. Because Internship represents an opportunity for the
candidate to engage in direct service with "real" clients, the faculty assumes primary
responsibility for the candidate's supervision. This provides an opportunity whereby
faculty can include pertinent didactic instruction and skills preparation for and during the
counseling process itself. The candidate will participate in a group supervision seminar
on campus with his/her Internship instructor for a minimum of 1-1/2 hours per week
during which the seminar group will focus on didactic and experiential activities and
include some form of review of counseling practices.
The site (school, agency, practice group, or university) must provide weekly
supervision by a clinician acceptable to the Counselor Education Program. The identified
site supervisor must hold a minimum of a Master's Degree in the program emphasis area
and possess appropriate certifications or licenses. In addition, the site supervisor must
have a minimum of two years experience as a counselor or clinician in their professional
specialty (i.e., counselor education, psychology, social work). Candidates will be asked to
obtain a copy of the site supervisor’s resume to be submitted with the Internship
Contract.
In addition to weekly supervision with the site-supervisor for at least one-hour per
week, the candidates will attend weekly group supervision for at least 1.5 hours (or 3
hours on a bi-weekly basis) with the faculty instructor. Additionally, the students will be
required to submit paperwork (ie. CSS form provided in the Appendix) according to the
course syllabus in order to facilitate this supervision.
The site must permit the candidate to participate in a variety of professional
activities in addition to direct service work. These activities should be those that a
regularly employed staff member in the setting would be expected to perform. In
addition, the program requests that the site operate in the following capacity:
a. assign an Internship Site Supervisor who has appropriate credentials, time, and
interest for training the candidate, who can generally monitor the internship to ensure
that both the candidate’s needs and the clients’ needs are being met;
b. provide opportunities for the candidate to engage in a variety of counseling activities
consistent with the CACREP standards for supervision and for evaluating the
candidate's performance (suggested counseling experiences are included in Practicum
contract);
c. ensure that the candidate has the opportunity to accumulate the required number of
client contact hours;
d. provide the candidate with an orientation to the site and adequate work space,
telephone, office supplies, and staff to conduct professional counseling activities
(consistent with those provided for the Site Supervisor).
CEP Clinical Experience Handbook 15 Revised Spring 2016
e. meet for individual supervision with the candidate a minimum of one hour each week
that the student accrues hours at the site; and be available for on-site emergency
situations;
f. ensure that the candidate can audio or video tape at least six counseling sessions
during the semester for university supervision or provide live supervision of the
candidate’s interactions with clients;
g. provide written evaluation of the candidate, based on criteria established by the
Augusta University Program.
3. Professional Requirements. During Internship, the role of candidates emphasizes
conduct expected of professional counselors. Professional qualities include factors such
as:
a. Candidates are expected to follow the rules and regulations governing the school or
agency to which they are assigned. This requirement includes standard employee
guidelines, such as arriving on time and calling in if you are ill, and following
standard operating procedures and protocol. Candidates are expected to have and
demonstrate the prerequisite skills of a professional counselor. Candidates are
expected to recognize and acknowledge skill deficits and work toward refinement of
counseling skills. Candidates are expected to continue to develop their own personal
orientation/style of counseling.
b. Candidates are expected to monitor their personal and professional growth and to be
able to identify those attitudes, beliefs, feelings, and personal characteristics that
facilitate or hinder their growth as professional counselors and discuss them during
individual and/or group supervision sessions. Additionally, during group supervision
sessions, candidates are expected to provide constructive feedback to their fellow
students, further developing their observation and facilitative skills.
c. Candidates are also expected to arrive promptly, be prepared for, and attend all
classes. For any absence over 1/2, a deduction of 5 points per half/class absence will
be made from the final course grade. “If the student has been absent for more than the
equivalent of 10% of class time, regardless of cause, then the professor may withdraw
the student from the class for excessive absences.” (p. 20, 2007-2008 Augusta
University Catalog). If you must miss class for any reason, please contact the
instructor in advance. See the Course Requirements Contract for other management
and procedural issues. Note: Typically more than one section of Internship is
offered each semester. If you must miss a class, you may be allowed to make up
that class by attending a class in another Internship section. Check with your
instructor and the instructor of other Internship sections to gain permission to
substitute a class.
d. All Practicum and Internship forms are available in download format on the Augusta
Counselor Education website. Candidates are responsible for providing their own
forms to use from website throughout the practicum experience.
CEP Clinical Experience Handbook 16 Revised Spring 2016
d. Candidates must successfully complete all requirements of the course in order to
receive a final course grade.
4. Inability to Complete Requirements. Candidates who have enrolled in two 300-hour
Internships and have not completed hourly or assignment requirements will be required to
enroll in COUN 6950 Special Topics for the following semester. It is the candidate’s
responsibility to inform the program coordinator the semester before if this course will be
needed so that we can ensure that it will be posted on the schedule and the approate
credits will be offered. The number of credits (1-3) in which to enroll is determined by
the following rate:
Candidates needing to complete less than 100 Internship hours must enroll in one
credit of COUN 6950 Special Topics in Counseling
Candidates needing to complete 101 to 200 Internship hours must enroll in two
credits of COUN 6950 Special Topics in Counseling
Candidates needing to complete more than 200 hours must enroll in three credits of
COUN 6950 Special Topics in Counseling
CEP Clinical Experience Handbook 17 Revised Spring 2016
APPENDIX (FORMS)
CEP Clinical Experience Handbook 18 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
Background Investigation Questionnaire and Release Form
Field Experience in Counselor Education
Confidential
I understand that this form will be kept separately from my student file and that the information regarding my date of birth, place
of birth, and listed physical characteristics will not be kept in my student file. I further understand that the admission decision to
the College of Education will be made based on my police record and other College of Education admission requirements as
related to the guidelines set forth by the Georgia Professional Standards Commission.
PLEASE PRINT OR TYPE
Name (last, first middle)
Please indicate other names used (maiden name, name by former marriages, former names changed legally or otherwise
such as aliases, nicknames, etc. Please specify and show dates used:
Drivers License (number and State)
Social Security Number
Address (street, city, state, zip code)
Phone Home Cell
Date of Birth Place of Birth
Sex Race Height
Weight Eye Color Hair Color
Do not include anything that happened before your seventeenth birthday. Do not include minor traffic violations for which a fine of $100
or less was imposed. All other citations must be included even if they were pardoned (pleas of nolo should be included).
Have you ever been convicted of a misdemeanor? Yes No
List all convictions including date, location, and agency involved:
Have you ever been convicted of a felony? Yes No
List all convictions including date, location, and agency involved:
I hereby authorize Augusta University to receive any criminal history record information pertaining to me which may be
in the files of any local, state, or federal agency to this date. I attest that the information furnished by me in the
foregoing form is true and correct.
Printed Name:
Signature:
Date:
CEP Clinical Experience Handbook 19 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
CHECKLIST OF FIELD EXPERIENCE
Counseling
Candidate:
Semester:
School /
Agency:
Site
Supervisor:
Focus: Community School Course: Practicum
Internship1 Internship 2
The following items will be placed in the student permanent:
Initialed by:
Professor Candidate
1. Checklist for Field Experience Paperwork
2. Field Experience Application (practicum or internship)
3. Site Contract
4. Insurance Verification (copy of insurance policy page denoting
coverage)
5. On-Site Supervision Attendance Log (record of weekly
supervision sessions with on-site supervisor)
6. Internship Log Summary Sheet (contains signatures of site
supervisor, professor, and candidate in order to verify total number of
hours; this sheet is stapled to the top of the collection of weekly logs
at the end of internship)
7. Weekly Logs (most recent on top)
8. On-Site Supervisor’s Evaluation
9. Candidate Evaluation of Site Supervisor
NOTE: These documents will verify your field experience hours. This is necessary when you seek school counselor certification and also when
you apply for licensure. The total hours from both practicum and internship constitutes one year toward four years of practical counseling
experience required for licensure. Thus, after your one year of practicum/internship is verified by your college professor and supervisor, you will need three more years of supervised counseling experience before you can obtain the LPC endorsement. IT IS RECOMMENDED THAT YOU
KEEP COPIES OF ALL OF THESE DOCUNMENTS AND SUBMIT YOUR ORIGINAL WORK WITH THIS CHECKLIST AT THE END OF THE
SEMESTER.
CEP Clinical Experience Handbook 20 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
Application for Counseling Field Experience
Counseling
Candidate:
Semester for
Field Experience:
Candidate
ID:
Course: Practicum Internship
Location: School Community Date: __________________
Address: (street, city, state, zip code)
Phone: Home: Work:
Cell:
Email: Home: Work:
IMPORTANT NOTE: Courses that are required prior to enrolling in Practicum are indicated by one asterisk
(*). Also, courses that are required prior to or concurrent with Practicum are indicated by two asterisks (**).
Additional courses that are required prior to enrolling in Internship are indicated by three asterisks (***).
Please indicate which semester you have completed the following courses.
Title Course Semester/Year COUN 6620* Human Development
COUN 6630* Professional Orientation and Ethics
COUN 6660* Communication Skills
COUN 6680* Theories and Techniques in Counseling
COUN 6720 Career Development Theories and Practice
COUN 6760 Diversity Sensitivity
COUN 6770 Crisis Intervention Counseling
COUN 6147** Seminar in Group Counseling
EDUC 6021 Introduction to Research Methods
School Counseling Focus:
EDUC 6040 Test and Measurements in Education
COUN 6780** School Counseling
COUN 6820 Administration and Consultation
COUN 6860*** Counseling Children and Adolescents
Community Counseling Focus:
PSYC 6125 Tests and Measurements
COUN 6700*** Marriage and Family
COUN 6790 Community Counseling
COUN 6800** Assessment, Diagnosis, and Intervention
Preferred Sites and Location Contact Name and Number
CEP Clinical Experience Handbook 21 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
On-Site Supervision Attendance Log Counseling
Candidate:
Semester:
Supervisor: Site:
Course: Practicum Internship 1 Internship 2
Date of Supervision
Supervisor’s Signature (or explanation/approval of missed session)
Total Supervision Hours:
Supervisor’s Signature:
Date:
CEP Clinical Experience Handbook 22 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
LOG SUMMARY SHEET
Counseling Candidate:
Course: Practicum Internship 1 Internship 2
Semester:
On-Site Supervisor(s):
Location(s):
Beginning and Ending
Dates of Field
Experience:
Total Number of
Direct Hours:
Total Number of
Hours for Field
Experience:
Candidate Signature:
On-Site Supervisor
Signature:
University Supervisor
Signature:
CEP Clinical Experience Handbook 23 Revised Spring 2016
Augusta University
Department of Educational Leadership, Counseling, and Special Education
Counselor Education Program
FIELD SUPERVISOR EVALUATION OF SCHOOL COUNSELING CANDIDATE
Candidate: Supervisor:
School: Semester:
Course: School Counseling Practicum
School Counseling Internship
The following form should be used to evaluate the school counseling candidate at a level of
competence expected of a proficient beginning counselor. If this is submitted as a hard copy,
please simply circle your selected answers.
Rating Scale
4 = exemplary level - level of excellence/mastery 2 = in progress level -
approaching competence
3 = proficient level - level of competence 1 = unsatisfactory level - not
competent at this time
NA = Not observed/applicable
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
I. Professional Practice, Advocacy, and Collaboration
I.A. Advocates for
school policies,
programs and
services that are
equitable and
responsive to cultural
differences among
students [BoR II.A.1;
CACREP I.F.3, III.F.3,
III.H.5; CF P4, R3;
NCATE I.G.2]
Candidate displays a
lack of initiative in
implementing the
advocacy
competencies in the
counseling profession
or awareness of
social issues affecting
clients or groups.
Candidate displays
basic initiative in
implementing
advocacy
competencies and
growing awareness
of issues affecting
individuals, groups,
or the counseling
profession.
Candidate
demonstrates strong
advocacy skills and
processes needed to
address institutional
and social barriers
that impede access,
equity, and success
for clients, groups,
and/or the counseling
profession.
Candidate
demonstrates
exemplary
advocacy skills
and passionate
commitment to
advocate for
processes needed
to address
institutional and
social barriers that
impede access,
equity, and
success for clients,
groups, and/or the
counseling
profession.
I.B. Advocates for
rigorous academic
preparation of all
students to close the
achievement gap
Candidate
demonstrates a lack
of advocacy skills in
closing the academic
achievement gap for
Candidate
demonstrates basic
advocacy skills in
closing the
academic
Candidate
demonstrates strong
advocacy skills in
closing the academic
achievement gap for
Candidate
demonstrates
exemplary
advocacy skills in
closing the
CEP Clinical Experience Handbook 24 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
among demographic
groups [BoR II.A.2;
CACREP III.H.5; CF P4,
R3; NCATE I.E.5, I.F.3,
I.G.2]
all students. achievement gap
for all students.
all students. academic
achievement gap
for all students.
I.C. Demonstrates
the ability to
articulate, model, and
advocate for an
appropriate school
counselor identity
and program [CACREP
III.B.2; CF P1, P4, P6, R2,
R6]
Candidate lacks an
awareness of or
ability to articulate
appropriately the role
and identity of school
counselors within the
school and
importance of a
comprehensive
school counseling
program.
Candidate
demonstrates a
basic awareness or
an ability to
articulate
appropriately the
role and identity of
school counselors
within the school
and importance of
a comprehensive
school counseling
program.
Candidate
demonstrates strong
awareness of or an
ability to articulate
appropriately the role
and identity of school
counselors within the
school and
importance of a
comprehensive
school counseling
program.
Candidate
demonstrates a
keen awareness of
and exemplary
ability to articulate
appropriately the
role and identity
of school
counselors within
the school and
importance of a
comprehensive
school counseling
program.
I.D. Locates
resources in the
community that can
be used in the school
to improve student
achievement and
success [CACREP
III.H.4, III.N.3; CF P6,
R5; NCATE I.E.2, I.E.5]
Candidate displays a
lack of understanding
of community,
environmental, and
institutional factors
that positively affect
client development.
Candidate displays
basic
understanding of
community,
environmental, and
institutional factors
that positively
affect client
development.
Candidate displays
in-depth
understanding of
community,
environmental, and
institutional factors
that positively affect
client development.
Candidate displays
a refined
understanding of
community,
environmental,
and institutional
factors that
positively affect
client
development.
I.E. Plans and
presents school
counseling-related
educational programs
for use with parents,
teachers and
community agencies [CACREP III.P.2; CF P6,
R5; NCATE I.E.2, I.E.5,
I.F.1]
Candidate lacks the
ability to recognize
the need for or ability
to implement
appropriate and
necessary counseling-
related educational
programs for
educational
stakeholders
including parents,
teachers, and
community agencies.
Candidate displays
a basic ability to
recognize the need
for and ability to
implement
appropriate and
necessary
counseling-related
educational
programs for
educational
stakeholders
including parents,
teachers, and
community
agencies.
Candidate displays a
strong ability to
recognize the need
for and ability to
implement
appropriate and
necessary
counseling-related
educational programs
for educational
stakeholders
including parents,
teachers, and
community agencies.
Candidate displays
exceptional ability
to recognize the
need for and
refined ability to
implement
appropriate and
necessary
counseling-related
educational
programs for
educational
stakeholders
including parents,
teachers, and
community
agencies.
I.F. Provides
leadership in the
development,
implementation,
evaluation, and
Candidate
demonstrates a lack
of basic leadership
abilities in
developing,
Candidate
demonstrates basic
leadership abilities
in developing,
implementing,
Candidate
demonstrates strong
leadership abilities in
developing,
implementing,
Candidate
demonstrates
exemplary
leadership abilities
in developing,
CEP Clinical Experience Handbook 25 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
revision of a
comprehensive
school counseling
plan that contributes
to school renewal by
promoting increased
academic success,
career preparedness,
and social/emotional
development for all
students [BoR II.A.4;
CACREP III.P.1; CF P4,
P5, P6, A1, R4; NCATE ,
I.E.5]
implementing,
evaluating, and
revising a
comprehensive
school counseling
program that supports
or displays limited
awareness of how
such a program
would enhance
school reform
activities while
promoting academic
success, career
preparedness, and
social/emotion
development for all
students.
evaluating, and
revising a
comprehensive
school counseling
program that
supports and
enhances school
reform activities
while promoting
academic success,
career
preparedness, and
social/emotion
development for all
students.
evaluating, and
revising a
comprehensive
school counseling
program that
supports and
enhances school
reform activities
while promoting
academic success,
career preparedness,
and social/emotion
development for all
students.
implementing,
evaluating, and
revising a
comprehensive
school counseling
program that
supports and
enhances school
reform activities
while promoting
academic success,
career
preparedness, and
social/emotion
development for
all students.
I.F.1. Assesses
and promotes
student
improvement
utilizing state and
national
standards. [CF P2,
A4, R4; NCATE
I.E.1, I.E.5]
Candidate lacks an
awareness of or
ability to implement
state and national
standards when
assessing student
improvement.
Candidate
demonstrates a
basic awareness of
and ability to
implement state
and national
standards when
assessing and
promoting student
improvement.
Candidate
demonstrates strong
awareness of and
ability to implement
state and national
standards when
assessing and
promoting student
improvement.
Candidate
demonstrates an
exceptional
awareness and
understanding of
and keen ability to
implement state
and national
standards when
assessing and
promoting student
improvement.
I.G Demonstrates
professional
dispositions in
counseling practice [NCATE I.G.1, I.G.3]
Candidate rarely
displays professional
dispositions expected
in the school
counseling practice.
Candidate
intermittently
displays
professional
dispositions
expected in the
school counseling
practice.
Candidate
consistently and
effectively displays
professional
dispositions expected
in the school
counseling practice.
Candidate
consistently and in
an exemplarily
manner displays
professional
dispositions
expected in the
school counseling
practice.
II. Assessment, Research, and Evaluation II.A. Assesses and
interprets students’
strengths, needs,
recognizing
uniqueness in
cultures, languages,
values, backgrounds,
and abilities; and
makes appropriate
referrals to school
CEP Clinical Experience Handbook 26 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
and/or community
resources
II.A.1. Uses data
to assess and
facilitate student
academic success [BoR II.A.5, II.A.8;
CACREP III.H.1; CF
P2, P3, P4, P6, A1,
A3, A4, R1, R2, R3,
R4, R5; NCATE
I.E.2, I.E.3, I.F.2]
Based on students
needs, candidate
demonstrates limited
ability to implement
programs to improve
academic
achievement of
individual students,
small groups and
school population as
a whole.
Based on students
needs, candidate
sporadically
implements
programs to
improve academic
achievement of
individual students,
small groups and
school population
as a whole.
Based on students
needs, candidate
regularly implements
programs to improve
academic
achievement of
individual students,
small groups and
school population as
a whole.
With creativity
and minimal
supervision,
candidate initiates
and implements
programs to
improve academic
achievement of
individual
students, small
groups and school
population as a
whole.
II.A.2. Assesses
student
social/emotional
needs [BoR II.A.5,
II.A.8; CACREP
III.H.1; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
Candidate
demonstrates limited
ability to assess and
implement programs
to improve the
social/emotional
development of
individual students,
small groups and
school population as
a whole.
Candidate
sporadically
assesses and
implements
programs to
improve the
social/emotional
development of
individual students,
small groups and
school population
as a whole.
Candidate regularly
assesses and
implements programs
to improve the
social/emotional
development of
individual students,
small groups and
school population as
a whole.
With creativity
and minimal
supervision,
candidate initiates
and implements
programs to
improve the
social/emotional
development of
individual
students, small
groups and school
population as a
whole.
II.A.3.
Assessments
student career
needs [BoR II.A.5,
II.A.8; CACREP
III.H.1; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
Candidate
demonstrates limited
ability to assess and
implement programs
to enhance the career
development of
individual students,
small groups and
school population as
a whole.
Candidate
sporadically
assesses and
implements
programs to
enhance the career
development of
individual students,
small groups and
school population
as a whole.
Candidate regularly
assesses and
implements programs
to enhance the career
development of
individual students,
small groups and
school population as
a whole.
With creativity
and minimal
supervision,
candidate initiates
assessment and
implementation of
programs to
enhance the career
development of
individual
students, small
groups and school
population as a
whole.
II.A.4. Refers
students to
appropriate
resources as
needed [BoR
II.A.5, II.A.8;
CACREP III.H.1,
Candidate displays a
lack of knowledge of
or does not display
initiative to utilize
appropriate
community resources
to further assist with
Candidate displays
basic knowledge of
and initiative to
utilize appropriate
community
resources to further
assist with student
Candidate displays
in-depth knowledge
of and initiative to
utilize appropriate
community resources
to further assist with
student development.
Candidate displays
a refined
knowledge of and
initiative to utilize
appropriate
community
resources to
CEP Clinical Experience Handbook 27 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4 III.H.4; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
student development. development. further assist with
student
development.
II.A.5. Assists
students with
special needs,
including
gifted/talented
and ESL. [BoR
II.A.5, II.A.8;
CACREP III.H.1,
III.H.4; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
Candidate fails to
demonstrate
understanding of,
appreciation for, or
ability to facilitate
positive interaction
with students with
varying special
needs.
Candidate
demonstrates a
basic
understanding of,
appreciation for,
and ability to
facilitate positive
interaction with
students with
varying special
needs.
Candidate
demonstrates an in-
depth understanding
of, appreciation for,
and ability to
facilitate positive
interaction with
students with varying
special needs.
Candidate
demonstrates a
refined
understanding of,
appreciation for,
and ability to
facilitate positive
interaction with
students with
varying special
needs.
II.A.6. Analyses
assessment
information in a
manner that
produces valid
inferences when
evaluating the
needs of
individual
students. [BoR
II.A.5, II.A.8;
CACREP III.H.1,
III.H.3; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
Candidate
demonstrates limited
ability to correctly
aggregate and
disaggregate student
achievement and
achievement-related
data to make
informed educational
decisions for positive
student development.
Candidate
sporadically
demonstrates
ability to correctly
aggregate and
disaggregate
student
achievement and
achievement-
related data to
make informed
educational
decisions for
positive student
development.
Candidate
consistently
demonstrates ability
to correctly aggregate
and disaggregate
student achievement
and achievement-
related data to make
informed educational
decisions for positive
student development.
Candidate
consistently
demonstrates
ability to correctly
aggregate and
disaggregate
student
achievement and
achievement-
related data to
make informed
educational
decisions for
positive student
development and
systemic change.
II.A.7. Assesses
barriers that
impede students’
academic, career,
and
personal/social
development. [BoR II.A.5, II.A.8;
CACREP III.H.1,
III.H.5; CF P2, P3,
P4, P6, A1, A3, A4,
R1, R2, R3, R4, R5;
NCATE I.E.2, I.E.3,
I.F.2]
Candidate fails to
scrutinize programs,
services, and policies
as to
fairness/appropriaten
ess of content, or to
monitor courses for
equal access, or to
design programs to
close the
achievement gap.
Candidate
sometimes
scrutinizes all
programs, services,
and policies as to
fairness/appropriat
eness of content,
monitor courses for
equal access, and
designs programs
to close the
achievement gap.
Candidate regularly
scrutinizes all
programs, services,
and policies as to
fairness/appropriaten
ess of content,
monitor courses for
equal access, and
designs programs to
close the
achievement gap.
Candidate
regularly and
inventively
scrutinizes all
programs,
services, and
policies as to
fairness/appropriat
eness of content,
monitor courses
for equal access,
and designs
programs to close
the achievement
gap.
CEP Clinical Experience Handbook 28 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
II.B. Analyzes and
uses data to enhance
school counseling
programs [BoR II.A.5;
CACREP III.I.4; III.J.3;
CF P2, P3, P4, P6, A1,
A3, A4, R1, R2, R3, R4,
R5; NCATE I.E.2, I.E.3]
Candidate fails to
demonstrate ability to
regularly collect,
analyze, or utilize
assessment data from
students, parents,
school personnel, and
community
stakeholders to
continuously improve
and create a viable
and influential
comprehensive
school counseling
program for all
students.
Candidate
sporadically
demonstrates
ability to regularly
collect, analyze,
and utilize
assessment data
from students,
parents, school
personnel, and
community
stakeholders to
continuously
improve and create
a viable and
influential
comprehensive
school counseling
program for all
students.
Candidate
consistently
demonstrates ability
to regularly collect,
analyze, and utilize
assessment data from
students, parents,
school personnel, and
community
stakeholders to
continuously
improve and create a
viable and influential
comprehensive
school counseling
program for all
students.
Candidate
demonstrates
strong leadership
to regularly
collect, analyze,
and utilize
assessment data
from students,
parents, school
personnel, and
community
stakeholders to
continuously
improve and
create a viable and
influential
comprehensive
school counseling
program for all
students.
III. Counseling, Prevention, Intervention
III.A. Provides
individual and group
counseling, and
classroom guidance
that promotes
academic success,
social/emotional
development, and
career preparedness
for all students
III.A.1. Individual
counseling
III.A.l.a.
Academic
success [BoR
II.A.6; CACREP
III.F.2, III.L.1; CF
P1, P4, A1, A2, A3,
A4, A5, R1, R2, R3,
R4; NCATE I.E.1,
I.E.5, I.F.2]
Candidate is unable
to demonstrate
reliable ability to
provide effective
individual counseling
services that promote
academic success.
Candidate is able to
demonstrate basic
ability to
occasionally
provide effective
individual
counseling services
that promote
academic success.
Candidate is able to
reliably demonstrate
purposeful ability to
provide effective
individual counseling
services that promote
academic success.
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
effective
individual
counseling
services that pro-
actively promote
academic success.
III.A.l.b.
Social/emotional
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
Candidate is unable
to demonstrate ability
to provide effective
individual counseling
services that promote
Candidate is able to
demonstrate basic
ability to
occasionally
provide effective
Candidate is able to
reliably demonstrate
purposeful ability to
provide effective
individual counseling
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
CEP Clinical Experience Handbook 29 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4 A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.2]
social/emotional
development.
individual
counseling services
that promote
social/emotional
development.
services that promote
social/emotional
development.
effective
individual
counseling
services that pro-
actively promote
social/emotional
development.
III.A.l.c. Career
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.2]
Candidate is unable
to demonstrate ability
to provide effective
individual counseling
services that promote
career development.
Candidate is able to
demonstrate basic
ability to
occasionally
provide effective
individual
counseling services
that promote career
development.
Candidate is able to
reliably demonstrate
purposeful ability to
provide effective
individual counseling
services that promote
career development.
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
effective
individual
counseling
services that pro-
actively promote
career
development.
III.A.2. Group
counseling
III.A.2.a.
Academic
success [BoR
II.A.6; CACREP
III.F.2, III.L.1; CF
P1, P4, A1, A2, A3,
A4, A5, R1, R2, R3,
R4; NCATE I.E.1,
I.E.5, I.F.1, I.F.2]
Candidate is unable
to demonstrate
reliable ability to
provide ability to
provide effective
group counseling
services that promote
academic success.
Candidate is able to
demonstrate basic
ability to
occasionally ability
to provide effective
group counseling
services that
promote academic
success.
Candidate is able to
reliably demonstrate
purposeful ability to
provide ability to
provide effective
group counseling
services that promote
academic success.
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
effective group
counseling
services that
proactively
promote academic
success.
III.A.2.b.
Social/emotional
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.1, I.F.2]
Candidate is unable
to demonstrate
reliable ability to
provide ability to
provide effective
group counseling
services that promote
social/emotional
development.
Candidate is able to
demonstrate basic
ability to
occasionally
provide ability to
provide effective
group counseling
services that
promote
social/emotional
development.
Candidate is able to
reliably demonstrate
purposeful ability to
provide ability to
provide effective
group counseling
services that promote
social/emotional
development.
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
ability to provide
effective group
counseling
services that
proactively
promote
social/emotional
development.
CEP Clinical Experience Handbook 30 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
III.A.2.c. Career
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.1, I.F.2]
Candidate is unable
to demonstrate
reliable ability to
provide ability to
provide effective
group counseling
services that promote
career development.
Candidate is able to
demonstrate basic
ability to
occasionally
provide ability to
provide effective
group counseling
services that
promote career
development.
Candidate is able to
reliably demonstrate
purposeful ability to
provide ability to
provide effective
group counseling
services that promote
career development.
Candidate is able
to repeatedly
demonstrate
extraordinary
ability to provide
ability to provide
effective group
counseling
services that
proactively
promote career
development.
III.A.3. Classroom
guidance. Implements
differentiated
instructional
strategies that draw
on subject matter and
pedagogical content
knowledge and skills
to promote student
achievement
III.A.3.a.
Academic
success [BoR
II.A.6; CACREP
III.F.2, III.L.1; CF
P1, P4, A1, A2, A3,
A4, A5, R1, R2, R3,
R4; NCATE I.E.1,
I.E.5, I.F.1, I.F.2]
Candidate fails to
effectively
incorporate visual,
auditory, tactile or
experiential
instructional methods
to teach lessons based
on state guidance
curriculum standards
that promote
academic success and
meet the varying
needs of learners.
To meet the
varying needs of
learners, candidate
sometimes
incorporates visual,
auditory, tactile
and/or experiential
instructional
methods to teach
lessons based on
state guidance
curriculum
standards that
promote academic
success.
To meet the varying
needs of learners,
candidate regularly
and effectively
incorporates visual,
auditory, tactile
and/or experiential
instructional methods
to teach lessons
based on state
guidance curriculum
standards that
promote academic
success.
To meet the
varying needs of
learners, candidate
creatively and
effectively
incorporates
visual, auditory,
tactile and/or
experiential
instructional
methods to teach
lessons based on
state guidance
curriculum
standards that
promote academic
success.
III.A.3.b.
Social/emotional
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.1, I.F.2
Candidate fails to
effectively
incorporate visual,
auditory, tactile or
experiential
instructional methods
to teach lessons based
on state guidance
curriculum standards
that promote
To meet the
varying needs of
learners, candidate
sometimes
incorporates visual,
auditory, tactile
and/or experiential
instructional
methods to teach
lessons based on
To meet the varying
needs of learners,
candidate regularly
and effectively
incorporates visual,
auditory, tactile
and/or experiential
instructional methods
to teach lessons
based on state
To meet the
varying needs of
learners, candidate
creatively and
effectively
incorporates
visual, auditory,
tactile and/or
experiential
instructional
CEP Clinical Experience Handbook 31 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
social/emotional
development and
meet the varying
needs of learners.
state guidance
curriculum
standards that
promote
social/emotional
development.
guidance curriculum
standards that
promote
social/emotional
development.
methods to teach
lessons based on
state guidance
curriculum
standards that
promote
social/emotional
development.
III.A.3.c. Career
development [BoR
II.A.6; CACREP
III.F.2; CF P1, P4,
A1, A2, A3, A4, A5,
R1, R2, R3, R4;
NCATE I.E.1, I.E.5,
I.F.1, I.F.2]
Candidate fails to
effectively
incorporate visual,
auditory, tactile or
experiential
instructional methods
to teach lessons based
on state guidance
curriculum standards
that promote career
development and
meet the varying
needs of learners.
To meet the
varying needs of
learners, candidate
sometimes
incorporates visual,
auditory, tactile
and/or experiential
instructional
methods to teach
lessons based on
state guidance
curriculum
standards that
promote career
development.
To meet the varying
needs of learners,
candidate regularly
and effectively
incorporates visual,
auditory, tactile
and/or experiential
instructional methods
to teach lessons
based on state
guidance curriculum
standards that
promote career
development.
To meet the
varying needs of
learners, candidate
creatively and
effectively
incorporates
visual, auditory,
tactile and/or
experiential
instructional
methods to teach
lessons based on
state guidance
curriculum
standards that
promote career
development.
III.B. Designs and
implements
prevention and
intervention plans
related to the effects
of (a) atypical
growth and
development, (b)
health and wellness,
(c) language, (d)
ability level, (e)
multicultural issues,
and (f) factors of
resiliency on student
learning and
development. [BoR
II.A.6; CACREP III.D. 3,
III.F.2; CF P1, P3, P4, P5,
P6, A1, A2, A3, A4, A5,
R1, R2, R3; NCATE
I.E.1, I.E.5, I.F.2]
Candidate is unable
or often times
struggles to
reasonably design or
implement
appropriate
prevention and
intervention plans
while considering
factors such as (a)
atypical growth and
development, (b)
health and wellness,
(c) language, (d)
ability level, (3)
multicultural issues,
and (f) factors of
resiliency on student
learning and
development.
At times, candidate
is able to design
and/or implement
appropriate
prevention and
intervention plans
while considering
factors such as (a)
atypical growth
and development,
(b) health and
wellness, (c)
language, (d)
ability level, (e)
multicultural
issues, and (f)
factors of
resiliency on
student learning
and development.
Candidate
consistently displays
ability to design and
purposefully
implement
appropriate
prevention and
intervention plans
while considering
factors such as (a)
atypical growth and
development, (b)
health and wellness,
(c) language, (e)
ability level, (3)
multicultural issues,
and (f) factors of
resiliency on student
learning and
development.
Candidate
consistently
displays
extraordinary
ability to design
and strategically
implement
appropriate
prevention and
intervention plans
while considering
factors such as (a)
atypical growth
and development,
(b) health and
wellness, (c)
language, (d)
ability level, (e)
multicultural
issues, and (f)
factors of
resiliency on
student learning
and development.
CEP Clinical Experience Handbook 32 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
III.C. Demonstrates
the ability to
recognize his or her
limitations as a
school counselor and
to seek supervision or
refer students when
appropriate. [CACREP
III.D.5; CF P2, P3, P4, P5,
P6, A1, A4, R1, R2, R3,
R4, R5]
Candidate lacks basic
awareness regarding
own limitations as a
school counselor and
avoids supervision
and referring students
when appropriate.
Candidate displays
basic awareness
regarding own
limitations as a
school counselor
and seeks
supervision at
times and/or may
delay in referring
students at times.
Candidate displays
consistent awareness
and introspective
ability to monitor
own limitations as a
school counselor and
is reliably
responsible in terms
of seeking
supervision and
referral sources when
appropriate.
Candidate displays
heightened
awareness and
introspective
ability to monitor
own limitations as
a school counselor
and is reliably
proactive in terms
of seeking
supervision and
referral sources
when appropriate.
IV. Diversity and Advocacy
IV.A. Multicultural
IV.A.1.
Demonstrates a
commitment to
developing
multicultural
competencies;
acknowledges
personal biases
and works to
reduce them. [CACREP III.F.1; CF
P1, P2, P3, P4, P5,
P6, Al, A2, A3, A4,
A5, R1, R2, R3, R4;
NCATE ; NCATE
I.E.1, I.F.3, I.G.2]
Candidate displays
little to no
commitment to
developing
multicultural
competencies or
lacks willingness to
acknowledge and
reduce personal
biases.
Candidate is
developing a
commitment to
developing
multicultural
competencies while
intermittently
acknowledging and
reducing personal
biases.
Candidate
consistently
demonstrates a
commitment to
developing
multicultural
competencies while
reliably
acknowledging and
reducing personal
biases.
Candidate displays
exceptional
commitment to
developing
multicultural
competencies
while actively
acknowledging
and reducing
personal biases.
IV.A.2.
Demonstrates
awareness,
valuing, and
knowledge of
diverse
worldviews [CACREP III.F.1; CF
P1, P2, P3, P4, P5,
P6, Al, A2, A3, A4,
A5, R1, R2, R3, R4,
R5;NCATE I.E.2,
I.F.3, I.G.2 ]
Candidate
consistently
demonstrates closed-
mindedness or is
unable or unwilling
to value or attain
knowledge of diverse
worldviews.
Candidate
occasionally
demonstrates open-
mindedness,
intermittently or
selectively values
differences, or
possesses
rudimentary
knowledge of
diverse
worldviews.
Candidate
consistently
demonstrates open-
mindedness, a
willingness to respect
different points of
view and reliably
values differences.
Candidate displays
extraordinary
open-mindedness
by routinely
honoring and
valuing
differences while
actively seeking to
attain substantial
knowledge of
diverse
worldviews.
IV.A.3.
Effectively
applies skills in a
multicultural
Candidate has
difficulty applying
skills in a
multicultural context.
Candidate
sporadically
applies effective
skills in a
multicultural
Candidate
intentionally applies
effective skills in a
multicultural context.
Candidate
proactively applies
effective skills in a
multicultural
context.
CEP Clinical Experience Handbook 33 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4
context to
promote student
learning and
development [CACREP III.F.1; CF
P1, P2, P3, P4, P5,
P6, Al, A2, A3, A4,
A5, R1, R2, R3, R4,
R5; NCATE I.E.1,
I.F.3, I.G.2]
context.
IV.B. Recognizing
the uniqueness of
each student, engages
and consults with
school personnel,
parents, guardians,
family, and
stakeholders to
promote and advocate
for the academic,
career, and
personal/social
development of all
students [CACREP
III.F.4, III.N.1, III.N.3,
III.N.5; CF P1, P2, P3, P4,
P5, P6,Al, A2, A3, A4,
A5, R1, R2, R3, R4, R5;
NCATE I.E.2, I.F.3,
I.G.2]
Candidate fails to
recognize student’s
uniqueness, or rarely
engages and consults
with related
professionals and
family members for
student’s academic,
career, and
personal/social
development.
Candidate
occasionally
recognize student’s
uniqueness, or
intermittently
engages and
consults with
related
professionals and
family members
for student’s
academic, career,
and personal/social
development.
Candidate
consistently
recognizes student’s
uniqueness and
regularly engages
and consults with
related professionals
and family members
for student’s
academic, career, and
personal/social
development.
Candidate
proactively
recognizes
student’s
uniqueness,
regularly engages
and consults with
related
professionals and
family members
for student’s
academic, career,
and
social/personal
development.
V. Career and Life Transitions
V.A. Implements
strategies and
activities to prepare
students for a full
range of post-
secondary options
and opportunities
V. A.1. Utilizes
best practices for
career awareness
and planning to
school personnel,
students,
parents/guardians [CACREP II.G.4; CF
P1, P2, P3, P4, P5,
Candidate provides
insufficient
information or lacks
understanding of
career awareness and
planning to school
personnel, students,
and
parents/guardians.
Candidate provides
satisfactory
information for
career awareness
and planning to
school personnel,
students, and
parents/guardians.
Candidate
consistently provides
valuable current
information for
career awareness and
planning to school
personnel, students,
and
parents/guardians.
Candidate
demonstrates
exemplary career
awareness and
exceptional ability
to provide
valuable current
information for
career awareness
CEP Clinical Experience Handbook 34 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4 P6, Al, A2, A3, A4,
A5, R1, R2, R3, R4,
R5; NCATE I.E.l,
I.E.2, I.E.3]
and planning to
school personnel,
students, and
parents/guardians.
V. A.2. Meets
with
student/parents/g
uardians to plan
career path (with
recognition that
the path leads to
plausible career
choices) [CACREP
II.G.4, III.L.2; CF P1,
P2, P3, P4, P5, P6,
Al, A2, A3, A4, A5,
R1, R2, R3, R4, R5;
NCATE I.E.l, I.E.2,
I.F.2]
Candidate rarely
meets with students,
parents, and
guardians to develop
possible career plans
that reflect student’s
interest, abilities, and
skills.
Candidate
intermittently meet
with students,
parents, and
guardians to
develop possible
career plans that
reflect student’s
interest, abilities,
and skills.
Candidate routinely
meets with students,
parents, and
guardians to develop
possible career plans
that reflect student’s
interest, abilities, and
skills.
With exceptional
awareness of
career options,
candidate
routinely meets
with students,
parents, and
guardians to
develop possible
career plans that
reflect student’s
interest, abilities,
and skills.
V. A.3.
Coordinates a
school-to-career
transition plan for
each student [CACREP II.G.4,
III.C.4, III.L.2; BoR
II.A.3; CF P1, P2, P3,
P4, P5, P6, Al, A2,
A3, A4, A5, R1, R2,
R3, R4, R5; NCATE
I.E.l, I.F.2]
Candidate has
difficulty
coordinating school-
to-career transition
plan for each student
as appropriate to
educational and
developmental level.
Candidate
intermittently
coordinates a
school-to-career
transition plan for
each student as
appropriate to each
education and
developmental
level.
Candidate
purposefully
coordinates an
effective school-to-
career transition plan
for each student as
appropriate to each
education and
developmental level.
Candidate displays
exceptional
awareness of
various post-
secondary
opportunities and
coordinates an
effective
comprehensive
school-to-career
transition plan for
each student as
appropriate to
each education
and developmental
level.
V.B. Attends to
other transition
processes such as
:
V.B.1. school
entrance/exit
(beginning,
middle school,
high school) [CACREP III.C.4;
CF P1, P2, P3, P4,
P5, P6, Al, A2, A3,
A4, A5, R1, R2,
Candidate rarely or
fail to attend to issues
related to school
entrance/exit
transitions.
Candidate
moderatelyattends
to issues related to
school
entrance/exit
transitions based
on students’
developmental
levels.
Candidate fully
attends to issues
related to school
entrance/exit
transitions based on
students’
developmental levels.
Candidate
proactively attends
to issues related to
school
entrance/exit
transitions based
on students’
developmental
levels.
CEP Clinical Experience Handbook 35 Revised Spring 2016
Component NA
Unsatisfactory
1
In Progress
2
Proficient
3
Exemplary
4 R3, R4, R5;
NCATE I.E.l,
I.F.2]
V.B.2.develop
ment across the
life span (birth,
death, divorce,
etc.) [CACREP
III.C.3; CF P1, P2,
P3, P4, P5, P6, Al,
A2, A3, A4, A5,
R1, R2, R3, R4,
R5; NCATE I.E.l,
I.F.2]
Candidate
demonstrates
insufficient
knowledge of or
ability to incorporate
appropriate life span
transition strategies
to enhance student
development
Candidate
demonstrates a
basic knowledge of
or ability to
incorporate
appropriate life
span transition
strategies to
enhance student
development.
Candidate
demonstrates a wide
knowledge of and
ability to incorporate
appropriate life span
transition strategies
to enhance student
development.
Candidate
demonstrates
exceptional
knowledge of and
ability to
incorporate
appropriate life
span transition
strategies to
enhance student
development.
VI. Technology
Uses technology in
their practices [NCATE I.e.4; CF P5,
A5 ]
Candidate fails to
understand or utilize
appropriate and
effective technology
to enhance student
achievement and
improve counseling
practice and program.
Candidate
intermittently
utilizes a variety of
appropriate and
effective
technology to
enhance student
achievement and
improve counseling
practice and
program.
Candidate regularly
utilizes a variety of
appropriate and
effective technology
to enhance student
achievement and
improve counseling
practice and
program.
Candidate
regularly
demonstrates
refined skills in
utilizing an
advanced variety
of appropriate and
effective
technology to
enhance student
achievement and
improve
counseling
practice and
program.
CEP Clinical Experience Handbook 36 Revised Spring 2016
COLLEGE OF EDUCATION Department of Educational Leadership,
Counseling, and Special Education
Counselor Education Program
2500 Walton Way
Augusta, GA 30904-2200
COMMUNITY COUNSELING CANDIDATE EVALUATION BY ON-SITE
SUPERVISOR
Counseling
Candidate:
Level: Practicum Internship Semester/Year:
School:
Address:
On-Site Supervisor:
Phone: Email:
Directions: Please evaluate the above named community counseling candidate on the counseling
competencies indicated on this form. Your judgment as to the extent to which the counseling candidate
possesses each competency is a vital part of his or her final grade. Please indicate your response by
placing the number in the box next to each criteria that best describes, in your judgment, the competency
level of the counseling candidate based on the following scale: 0 = not observed, 1 = poor, 2 = fair, 3 =
good, 4 = very good, 5 = excellent. Please feel free to include additional comments or documentation you
feel is relevant to your evaluation.
Thank you for hosting a community counseling candidate and completing this important evaluation.
Student Counselor's Relationship with Supervisor Rating
1. Involvement:
a. Demonstrates receptivity to the supervision process
b. Demonstrates involvement and seriousness of being a counselor
2. Growth:
a. Shows development in communication skills
b. Shows personal growth during this internship experience
3. Rapport: Establishes positive relationships with supervisors
CEP Clinical Experience Handbook 37 Revised Spring 2016
4. Awareness of Limitations:
a. Demonstrates ability to share competencies and skills with peers and supervisors
b. Demonstrates humility to share deficiencies with peers and supervisors
Comments:
A. Counseling/Consultant Relationship Rating
1. Ease of beginning an interview/session with a client
2. Demonstrates sensitivity to the client's feelings
3. Establishes rapport with client
4. Permits and facilitates client expression
5. Is able to focus on content or problem
6. Is able to focus on the client
7. Initiates a working relationship with client
8. Communicates acceptance
9. Communicate understanding
10. Communicates genuineness
Comments:
B. Organization and Preparation Rating
1. Effectively organizes case material in file
2. Recognizes implications of case material
3. Recognizes discrepancies and meaning of inconsistent information
4. Considers various approaches with client
5. Aware of client readiness
6. Defines goals tentatively/mutually with client
7. Utilizes appropriate structure during session
8. Distinguishes between immediate and long term goals
Comments:
CEP Clinical Experience Handbook 38 Revised Spring 2016
Implementation Rating
1. Accurate use of tests and conveying test information to client
2. Dealing with affect
a. Recognizes and handles positive affect
b. Recognizes and handles negative affect
3. Presents unpleasant information
4. Recognizes impact of student counselor behavior and activities on clients
5. Recognizes the importance of timing on imparting information
6. Focuses on specific client behaviors
7. Monitors and evaluates progress towards goals
8. Terminates session/case appropriately
Comments:
Additional comments:
Site Supervisor’s Signature Date
Student’s Signature Date
CEP Clinical Experience Handbook 39 Revised Spring 2016
AUGUSTA UNIVERSITY
College Of Education
Department of Educational Leadership, Counseling, and Special Education
Counselor Education Program
Counseling Candidate Evaluation of Site Supervisor and Field Experience
Candidate Name: Semester / Year:
Supervisor Name:
Practicum Internship 1
Internship 2
Site Location: School Community
This is your opportunity to evaluate your practicum / internship experience. Please indicate your
numerical response (on a scale of 1-5) to the questions below. Space is provided for you to add additional
comments. This evaluation is critical for it will assist us assessing field experiences and in providing
positive placements for students in the future. Please base your evaluation on the following scale: 1=
strongly disagree, 2= somewhat disagree, 3=neutral, 4= somewhat agree, 5=strongly agree.
Rating
1. Your supervisor provided you with an orientation to the site and other staff and
ensured adequate resources were available for you to conduct professional
activities.
Comments:
2. Your supervisor provided opportunities for you to engage in a variety of counseling
activities consistent with the CACREP standards for supervision?
Comments:
3. The supervisor ensured and provided opportunities that you could audiotape at least
one counseling session each week for review with the University Supervisor.
Comments:
4. You met individually with your supervisor for at least one hour per week to discuss
your counseling experiences.
CEP Clinical Experience Handbook 40 Revised Spring 2016
Comments:
5. You were satisfied with the amount of supervision that you received.
Comments:
6. You were satisfied with the quality of supervision that you received.
Comments:
7. The supervisor enabled you to express opinions, questions, and concerns about
your counseling.
Comments:
8. The supervisor provided useful feedback regarding counseling skills and
interventions.
Comments:
9. The supervisor provided evaluation of your performance on a regular basis.
Comments:
10. The evaluation process was fair and helpful.
Comments:
11. Your supervisor was knowledgeable about the school/agency setting in which you
worked, and he/she shared that knowledge and expertise freely.
CEP Clinical Experience Handbook 41 Revised Spring 2016
Comments:
12. The variety and quantity of counseling activities in which you participated met
your expectations of a quality practicum / internship experience.
Comments:
13. You believe the experiences you have had during this practicum / internship has
prepared you to assume duties as a professional counselor.
Comments:
14. The overall quality of the supervision that you received was good.
Comments:
15. You would recommend this supervisor to a friend.
Comments:
Additional comments:
Candidate Signature: Date:
CEP Clinical Experience Handbook 42 Revised Spring 2016
Department of Educational Leadership,
Counseling, and Special Education
Counselor Education Program
2500 Walton Way
Augusta, GA 30904-2200
Parent Consent Form The field experience component of the Master’s Degree Program in Counselor Education
at Augusta University includes a practicum and internship experience. Internship is a period of
supervised practice when counseling candidates observe and practice individual or group
counseling and other counseling-related activities. Counseling services are conducted by
counseling candidates from the Counselor Education Program who are under supervision from
the professors in Counselor Education Program, as well as from certified or licensed counselors
or other mental health practitioners at the school or community agency.
The counseling process is an involving experience. Professional counselors commonly
utilize audio and/or videotapes as an effective means of summary and reflection for client and
counselor. The tapes are reviewed by the faculty supervisor in order to provide supervision for
the counseling candidate. All tapes are kept in strict confidence and are used only for training
purposes. Tapes are promptly erased after supervision has been provided.
I give permission for the following counseling candidate to tape sessions for training
purposes:
Counselor
Candidate
Printed
Name
Counselor
Candidate
Signature:
Date:
Parent or
Guardian
Signature:
Date:
CEP Clinical Experience Handbook 43 Revised Spring 2016
Department of Educational Leadership,
Counseling, and Special Education
Counselor Education Program
2500 Walton Way
Augusta, GA 30904-2200
Client Consent Form
The field experience component of the Master’s Degree Program in Counselor Education
at Augusta University includes a practicum and internship experience. Internship is a period of
supervised practice when candidates observe and practice individual or group counseling and
other counseling-related activities. Counseling services are conducted by counseling candidates
from the Counselor Education Program who are under supervision from the professors in
Counselor Education Program, as well as from certified or licensed counselors or other mental
health practitioners at the school or community agency.
The counseling process is an involving experience. Professional counselors commonly
utilize audio and/or videotapes as an effective means of summary and reflection for client and
counselor. The tapes are reviewed by the faculty supervisor in order to provide supervision for
the counseling candidate. All tapes are kept in strict confidence and are used only for training
purposes. Tapes are promptly erased after supervision has been provided.
I give permission for the following counseling candidate to tape sessions for training
purposes:
Counselor
Candidate
Printed
Name
Counselor
Candidate
Signature:
Date:
Client
Signature:
Date:
CEP Clinical Experience Handbook 44 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
Candidate Name Date
Client First Name Tape #
Faculty Name
Reviewed by Audio Video Transcript
Reviewed for Practicum Internship I Internship II
PART ONE: COUNSELING SKILLS SCALE (CSS) – Candidate Counselor
Version
Directions: As you review the tape, please identify specific examples of skills and write these along with any
comments in the corresponding areas.
SHOWS INTEREST AND APPRECIATION
1. Body Language and Appearance – Maintains open, relaxed, confident posture with appropriate eye contact.
Leans forward when talking, leans back when client talks on target. Uses head nods and body gestures to
encourage client talk. Maintains professional dress.
2. Minimal Encouragers -- Repeats key words and phrases. Uses prompts (uh huh, okay, right, yes) to let
client know s/he is heard. Uses silence helpfully.
3. Vocal Tone – Uses vocal tone that matches the sense of the session and session goals. Vocal tone
communicates caring and connection with the client.
4. Evoking and Punctuating Client Strengths -- Includes questions and reflections related to assets and
competencies; positively reframes client experiences.
CEP Clinical Experience Handbook 45 Revised Spring 2016
ENCOURAGES EXPLORATION
5. Questioning -- Asks open-ended questions that encourage the client to continue talking and to provide
information. Uses when needed and when theoretically consistent. Uses closed questions judiciously. Does
not overuse questions.
6. Requesting Concrete and Specific Examples -- Asks for concrete and specific instances when clients
provide vague generalities. ("Give me an example of how you might feel or behave when facing
__________.")
7. Paraphrasing (reflection of content) -- Engages in brief, accurate, and clear rephrasing of what the client
has expressed.
8. Summarizing -- Makes statements at key moments in the session that capture the overall sense of what the
client has been expressing.
DEEPENS THE SESSION
9. Reflecting Feeling -- States succinctly the feeling and the content of the problem faced by the client ("You
feel ______ when ______.")
10. Using Immediacy -- Recognizes here-and-now feelings, expressed verbally or nonverbally, of the client or
the counselor. Can be related to the counselor-client relationship. ("As we talk about _____ problem, I sense
you are feeling _____ about me. In turn, I'm feeling _____ about how you are viewing the problem right
now.")
CEP Clinical Experience Handbook 46 Revised Spring 2016
1. Planning Action and Anticipating Possible Obstacles --Reaches agreement about actions to take between
sessions, who is responsible for them, and when they will be done. Helps client to list what obstacles might
interfere and decide how to handle them. (“So, you will do __________by ______date. What could prevent
you from accomplishing your plan?”)
11. Observing Themes and Patterns -- Identifies more overarching patterns of acting, thinking, or behaving in
problem situations (“In ______ situations, you regularly do _____ [or think______ or feel _____."])
12. Challenging/Pointing out Discrepancies -- Expresses observations of discrepancies. ("You expect yourself
to do_____ when facing the problem of _____, but you do ______ instead. When this happens you feel _____
about yourself.")
13. Reflecting Meaning and Values – Reflects the unexpressed meaning or belief/value system that is behind
the words the client is saying. (“You feel strongly about making choices based on _______ belief.”)
ENCOURAGES CHANGE
14. Determining Goals and Desired Outcomes – Collaboratively determines outcomes toward which the
counseling process will aim. Helps client set goals.
15. Using Strategies for Creating Change – Uses theoretically-consistent and intentional intervention strategies
to help client move forward toward treatment goals [such as setting up reinforcement systems, using guided
imagery, asking the miracle question, directives, self-disclosure, interpretation, advice, opinion, information
instruction].
16. Considering Alternatives and their Consequences – Helps the client review possible solutions and the
value of each over the long term. (“One option would be ________, and that would mean________. Another
option would be….”)
CEP Clinical Experience Handbook 47 Revised Spring 2016
DEVELOPS THERAPEUTIC RELATIONSHIP
2. Consistently engages in caring manner with client, particularly by demonstrating such core conditions as
genuineness and authenticity, warmth and acceptance, respect and positive regard, and empathy.
ENCOURAGES CHANGE
3. Opens session smoothly and warmly greets client. Begins work on counseling issues in a timely way.
Structures session, directing client naturally through opening, exploration, deeper understanding, creating
change, and closing; focuses client on essence of issues at a level deep enough to promote positive
movement. Smoothly and warmly ends the session, in a timely way, planning for future sessions or for
termination.
Additional Comments:
Permission to copy for training purposes given to Augusta by Karen Eriksen
CEP Clinical Experience Handbook 48 Revised Spring 2016
PART TWO: PROCESS QUESTIONS (Counselor Candidate)
1. What were the goals for this session?
2. Did anything happen during the session to cause the goals to be reconsidered? How did you
resolve this?
3. What were the major themes of the session? Was there any important content?
4. How did you feel during the session? About the client? About yourself?
5. Did you struggle with any goals? Or, were all of the session goals accomplished?
6. What plans/goals were set for the next session?
7. What did you learn about the counseling process by observing this session?
8. What question(s) do you have for the class?
CEP Clinical Experience Handbook 49 Revised Spring 2016
AUGUSTA UNIVERSITY
College of Education
Department of Educational Leadership Counseling and Special Education
Counselor Education Program
CASE PRESENTATION OF RECORDINGS
Counseling
Candidate:
Date:
Case: Location:
Focus: Community School Course: Practicum Internship
Instructions: Watch/listen to video or audio tape. Select a portion of the tape to share with class
(suggested amount of time - 5 minutes). Tape should be prepared to start at the point the student wishes to
share information with the class. It is the student’s responsibility to lead the case discussion using all of
the following steps.
Steps Points
1. Information about Counseling Case: presenting problem, history of presenting problem,
previous attempts at problem solution, and pertinent information regarding the counselee.
Include information about how counselor’s and client’s culture lens may influence their
perspectives of presenting issues.
/10
2. Counseling Plan: goals, action step(s), and desired outcomes.
/10
3. Counselor’s Action: name techniques, skills, strategies, and interventions.
/10
4. Counselor’s Self Awareness: thoughts, feelings about client, about self, and about the
counseling process.
/10
CEP Clinical Experience Handbook 50 Revised Spring 2016
Additional Comments:
Points Earned: /50 Updated Spring 2010
5. Counselor’s Request: I need help with:
6. Case Goals: After all feedback from supervisor and group, determine future direction
for the case: goals, action steps, evidence.
/10
7. Counselor Goals: Future goals for the counselor: goals, action steps, evidence.
CEP Clinical Experience Handbook 51 Revised Spring 2016
AUGUSTA UNIVERSITY College of Education
Department of Educational Leadership, Counseling, and Special Education Counselor Education Program
Case Presentation of Recordings Evaluation
Presenter:
Presentation Topic:
Date Presented:
Please respond on a scale of 1-5 with 5 being the highest, your agreement to the following: Score
(1-5) 1. The presentation was well organized, easily understood, and based on recent documentation.
2. The presenter appeared to be comfortable and in command of the topic.
3. The presenter has a relaxed and engaging delivery style which kept my interest throughout the
presentation.
4. The handouts were helpful and well designed.
5. The PowerPoint used in this presentation was visually appealing, well organized, and helped my
understanding of the presentation content.
Overall rating for this presentation on a scale of 1-5
Strengths of this presentation:
Recommendations for improving future presentations.