Tool 8

Supervision Contract Template

This document serves as a description of the supervision provided by (supervisor name, credentials, title) to (supervisee, credentials, title).
Primary Purpose, Goals, and Objectives
  • Monitor and ensure client welfare
  • Facilitate professional development
  • Evaluate job performance
Provision
  • (Frequency) of individual supervision at (day and time)
  • (Supervision model and case review format) will be used
  • Clients of the counselor will give informed consent for supervision of their case
  • Counselor will have a minimum of (amount) of supervision for every (number) of client contact hours
  • All client cases will be reviewed on a rotating basis based on need
Documentation
  • (Form name) will be used to document the content and progress of the supervision
  • Informal feedback will be provided at the end of each session
  • Written formal evaluation will be provided (frequency)
  • Supervision notes will be shared (at the supervisor’s discretion or at request of counselor)
Duties and Responsibilities
The supervisor at a minimum will:
  • Review all psychosocial histories, progress notes, treatment plans, and discharge plans.
  • Question the counselor to justify approach and techniques used.
  • Present and model appropriate clinical interventions.
  • Intervene directly if client welfare is at risk.
  • Ensure that ethical guidelines and legal statutes are upheld.
  • Monitor proficiencies in working with community resources and networking with community agencies.
The counselor at a minimum will:
  • Uphold all ethical guidelines and legal statutes.
  • Be prepared to discuss all client cases.
  • Discuss approaches and techniques used and any boundary issues or violations that occur.
  • Consult supervisor or designee in emergencies.
  • Implement supervisor directives.
  • Adhere to all agency policies and procedures.
Procedural Consideration
  • The Individual Development Plan’s goals and objectives will be discussed and amended if necessary.
  • The quality of the supervisory relationship will be discussed and conflicts resolved.
  • If conflicts cannot be resolved, (name) will be consulted.
  • In the event of an emergency, the counselor is to contact the supervisor. If unavailable, contact (alternate’s name, title, and other relevant back-up information).
  • Crises or emergency consultations will be documented.
  • Due process procedures (as explained in the agency’s policy and procedure handbook) have been reviewed and will be discussed as needed.
Supervisor’s Scope of Competence
  • Title/date of credentials/licensure.
  • Formal supervisory training and credentials.
  • Years providing supervision.
  • Current supervisory responsibilities.
This agreement is subject to revision at any time on request of either person. Revision will be made only with consent of the counselor and approval of the supervisor. We agree to uphold the directives outlined in this agreement to the best of our ability and to conduct our professional behavior according to the ethical principles and codes of conduct of our professional associations.
Supervisor_______________ Title_______________ Date_______________
Supervisee_______________ Title_______________ Date_______________
This agreement is in effect from (current date) to (annual date of review or termination)

Source: Mattel, 2007

From: Part 2, Chapter 2, Clinical Supervision and Professional Development of the Substance Abuse Counselor: A Guide for Administrators

Cover of Clinical Supervision and Professional Development of the Substance Abuse Counselor
Clinical Supervision and Professional Development of the Substance Abuse Counselor.
Treatment Improvement Protocol (TIP) Series, No. 52.
Center for Substance Abuse Treatment.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.