6.4. Contract conditions will include the
name and degrees of the supervisee, supervisor and adjunctive supervisor, the
population to be served, where the supervisee will perform services, where
supervision will occur, the supervisee's intended scope of practice with the
supervisor and/or adjunctive supervisor, strategies of supervision, information
on fees of supervisor(s), effective date, signatures of all parties, dates
signed. The current Board Supervision Contracts for Doctoral, Masters, and
School Psychologist candidates are as follows:
Supervision Contract Doctoral Degree
Purpose: As required under Title 17, Series 3 of the West
Virginia Board of Examiners of Psychologists Legislative Rules, Psychologists
and School Psychologists must complete a period of supervision prior to
licensure. If that supervision will take place in West Virginia, this contract
serves as a written record verifying the agreement between the Supervisor and
the Supervisee as approved by the Board of Examiners of Psychologists,
hereafter referred to as The Board. It is also intended to clarify roles of the
supervisor and supervisee.
Imperative to the purpose of supervision and this contract
are the following:
1) Ensuring the
public welfare
2) Promoting
learning and readiness for licensure
3) Monitoring and reporting the Supervisee's
progress at regular intervals
4)
Fulfilling all requirements of the applicable state codes and regulations in
preparation for licensure as a Psychologist or School Psychologist in the State
of West Virginia.
5) Discontinuing,
or sanctioning, Supervisors who do not adhere to the rules imposed for the
above purposes.
Supervision Requirements:
1) Supervisors will provide a minimum of 1
hour of individual supervision per 20 hours of the Supervisee's clinical
practice, with a minimum of 1 hour per week regardless of hours
spent in practice. Individual supervision sessions must occur no less
frequently than every 2 weeks.
2)
In addition to a minimum of 6 hours per month of individual face-to-face
supervision for Full Time Supervisees, group supervision and other
venues of supervision such as grand rounds, and/or multidisciplinary
supervision as delineated in the individual's supervision contract may
constitute 2 hours per month of the total supervision experience.
3) Individual supervision is in person,
face-to-face, unless express permission to do otherwise for a minimal portion
of the supervision hours is granted by Board majority and is documented in this
contract. Video conferencing may be a Board approved alternative for
face-to-face supervision. At least once per quarter, one of the required
individual face-to-face sessions shall occur at the location(s) where the
Supervisee is providing services. Furthermore, supervision sessions do not
occur in a public setting.
4) The
Supervisee will be a W-2 employee of the Supervisor or the agency for which the
Supervisee works. Only psychologists licensed for independent practice may
provide independent services on a contract basis.
5) The Supervisee practices under the
Supervisor. The Supervisor maintains legal and ethical responsibility for the
Supervisee's actions and practice. Appropriate professional liability insurance
coverage must be in place.
6) The
Supervisee must sign all work with the designation "Supervised
Psychologist".
7) The Supervisor is
available to the Supervisee via phone or in person during the hours of
supervisee practice.
8)
Arrangements will be specified between the Supervisor and Supervisee for
supervisory coverage during times when the supervisor is unavailable. These
arrangements will also meet the legal and ethical requirements already agreed
to in the contract.
9) The
Supervisee must practice only within certain herein specified areas in which
the Supervisor is deemed competent to supervise.
10) When the Supervisee plans to practice
outside the Supervisor's approved scope of practice, competent adjunctive
supervision must be arranged in advance, Board approved, and included in this
contract or an approved addendum to this contract.
11) The Supervisor will maintain familiarity
with the Supervisee's clients' presenting concerns, treatment plans, treatment
progress, and treatment termination plan.
12) The Supervisor will intervene
appropriately when client welfare is at risk. Meeting as co-therapists, meeting
face to face, and other interventions may be appropriate at times.
13) In addition to thorough review and
co-signing of written work (e.g. notes, reports, or other written statements or
documents), there must be sufficient observation of the Supervisee's work,
whether in vivo or via recorded material, to enable the Supervisor to provide
accurate assessment of the Supervisee's performance.
14) The Supervisor will provide timely and
constructive feedback to the Supervisee. The Supervisor subsequently reassesses
the work of the Supervisee in a reasonable time frame to make certain that the
Supervisee is incorporating the feedback into practice.
15) Formal written evaluations of Supervisee
performance will be completed by the Supervisor and reviewed and signed by both
parties at least quarterly during the period of supervision and submitted to
the Board on the quarterly report. However, ongoing verbal feedback to the
supervisee is also expected.
16)
The Supervisor will maintain and submit to the Board, if requested a
supervision log including, but not necessarily limited to, content of
supervision sessions, training activities, and evaluation procedures and
results. The supervision log, in written format approved by the Board, is to be
co-signed by both Supervisor and Supervisee.
17) Supervision sessions will include
discussion of areas of concern, conflict, and/or failure of either party to
abide by agreements and directives delineated in this supervision contract. If
concerns cannot be resolved within the supervision process, either or both
parties will contact the Board for assistance.
18) Any Supervisor of record during the 12
months prior to the Supervisee's oral examination will be available for
telephone consultation with the Board at the time of the Supervisee's initial
oral examination. If continuation of Supervision is required, the Supervisor
agrees to attend the Supervisee's subsequent Oral Exam by the Board. In
addition, the Board may require the supervisor to meet the Board based upon any
concerns that the Board may have at any time.
19) Clinical supervision shall not include
any potentially problematic multiple relationships between the Supervisor and
Supervisee. Any type of business relationship outside the parameters stated in
this Supervision Contract is strictly prohibited between the Supervisor and
Supervisee. Other potentially problematic relationships include, but are not
limited to, therapeutic, familial, and financial.
20) Supervisor and Supervisee understand and
agree that sexual and/or romantic relationships between the two parties are
always unethical and should never occur.
21) Supervision will not be limited to case
discussion. Supervisors will employ a variety of strategies such as
observation, reading assignments, or co-therapy.
22) Both parties will maintain current
knowledge of HIPAA and other pertinent legal, ethical, and regulatory
guidelines and responsibilities.
23) In case of emergency, Supervisee will
contact Supervisor at locations specified herein.
24) If applicable, fees for supervision shall
be paid as designated in this contract.
25) Either party can terminate this contract
at any time, and both Supervisor and Supervisee will notify the Board in
writing within ten (10) days of any such termination. In such case, both
parties are responsible for making certain the supervisee's patients receive
appropriate referrals so that any potential negative impact to treatment is
held to a minimum.
Supervision Contract Master's Degree
Purpose: As required under Title 17, Series 3 of the West
Virginia Board of Examiners of Psychologists Legislative Rules, Psychologists
and School Psychologists must complete a period of supervision prior to
licensure. This contract serves as a written record verifying the agreement
between the Supervisor and the Supervisee as approved by the Board of Examiners
of Psychologists, hereafter referred to as The Board. It is also intended to
clarify roles of the supervisor and supervisee.
Imperative to the purpose of supervision and this contract
are the following:
1) Ensuring the
public welfare
2) Promoting
learning and readiness for licensure
3) Monitoring and reporting the Supervisee's
progress at regular intervals
4)
Fulfilling all requirements of the applicable state codes and regulations in
preparation for licensure as a Psychologist in the State of West
Virginia.
5) Discontinuing, or
sanctioning, Supervisors who do not adhere to the rules imposed for the above
purposes.
Supervision Requirements:
1) During the five-year supervision period, a
Supervisee must have at least two Supervisors. One Supervisor is designated as
primary and the other as adjunct. They may supervise jointly or at different
periods during the supervision period. The Board accepts supervision via a
secure videoconference site. The Supervisee must inform the Board of the
mechanism of supervision and if joint supervision occurs during a supervisory
period, both Supervisors must sign the supervision log.
2) Supervisors will provide a minimum of 1
hour of individual supervision per 20 hours of the Supervisee's clinical
practice, with a minimum of 1 hour per week regardless of hours
spent in practice. Individual supervision sessions must occur no less
frequently than every 2 weeks.
3)
In addition to a minimum of 6 hours per month of individual face-to-face
supervision for full time supervisees, group supervision, and/or
multidisciplinary supervision as delineated in the individual's supervision
contract may constitute 2 hours per month of the total supervision
experience.
4) Individual
supervision is in person, face-to-face, unless express permission to do
otherwise for a minimal portion of the supervision hours is granted by the
Board and is documented in this contract. Video conferencing may be a Board
approved alternative for face-to-face supervision. At least once per quarter,
one of the required individual face-to-face sessions shall occur at the
location(s) where the Supervisee is providing services. Furthermore,
supervision sessions do not occur in a public setting.
5) The Supervisee may be a W-2 employee of
the Supervisor or agency for which the Supervisee works. Only psychologists
licensed for independent practice may provide services on a contract basis.
Weekly individual meetings between the Supervisor and Supervisee are required
even when they work at different sites. The Supervisor shall be available to
the Supervisee by phone or in person during the work day.
6) The Supervisee practices under the
Supervisor. The Supervisor maintains legal and ethical responsibility for the
Supervisee's actions and practice. Appropriate professional liability insurance
coverage must be in place.
7) The
Supervisee must sign all work with the designation "Supervised
Psychologist".
8) The Supervisor is
available to the supervisee via phone or in person during the hours of
supervisee practice.
9)
Arrangements will be specified between the Supervisor and Supervisee for
supervisory coverage during times when the Supervisor is unavailable.
10) The Supervisee must practice only within
certain herein specified areas in which the Supervisor is deemed competent to
supervise.
11) When the Supervisee
plans to practice outside the Supervisor's approved scope of practice,
competent adjunctive supervision must be arranged in advance, Board approved,
and included in this contract or an approved addendum to this
contract.
12) The Supervisor will
maintain familiarity with the Supervisee's clients' presenting concerns,
treatment plans, treatment progress, and treatment termination plan.
13) The Supervisor will intervene
appropriately when client welfare is at risk.
14) In addition to thorough review and
co-signing of written work (e.g. notes, reports, or other written statements or
documents), there must be sufficient observation of the Supervisee's work,
whether in vivo or via recorded material, to enable the Supervisor to provide
accurate assessment of the Supervisee's performance.
15) The Supervisor will provide timely and
constructive feedback to the Supervisee. The Supervisor subsequently reassesses
the work of the Supervisee in a reasonable time frame to make certain that the
Supervisee is incorporating the feedback into practice.
16) Written evaluations of Supervisee
performance will be completed by the Supervisor and reviewed and signed by both
parties at least quarterly during the period of supervision and submitted to
the Board on the quarterly report. However, ongoing verbal feedback to the
supervisee is also expected.
17)
The Supervisor will maintain and submit to the board, if requested, a
supervision log including but not necessarily limited to, content of
supervision sessions, training activities, and evaluation procedures and
results. The Supervision log, in written format approved by the Board, is to be
co-signed by both Supervisor(s) and supervisee.
18) Supervision sessions will include
discussion of areas of concern, conflict, and/or failure of either party to
abide by agreements and directives delineated in this supervision contract. If
concerns cannot be resolved within the supervision process, either or both
parties will contact the Board for assistance.
19) Any Supervisor of record during the 12
months prior to the Supervisee's oral examination will be available for
telephone consultation with the Board at the time of the Supervisee's initial
oral examination. If continuation of supervision is required, the Supervisor
agrees to attend the Supervisee's subsequent oral examination by the
Board.
20) Clinical supervision
shall not include any potentially problematic multiple relationships between
the Supervisor and Supervisees. Any type of business relationship outside the
parameters stated in this Supervision Contract is strictly prohibited between
the Supervisor(s) and the Supervisee. Other potentially problematic
relationships include, but are not limited to, therapeutic, familial, and
financial.
21) Supervisor and
Supervisee understand and agree that sexual and/or romantic relationships
between the two parties are always unethical and should never occur.
22) Supervision will not be limited to case
discussion. Supervisors will employ a variety of strategies such as
observation, reading assignments, or co-therapy.
23) Both parties will maintain current
knowledge of HIPAA and other pertinent legal, ethical and regulatory guidelines
and responsibilities.
24) In case
of emergency, Supervisees will contact Supervisor at locations specified
herein.
25) If applicable, fees for
supervision shall be paid as designated in this contract.
26) Either party can terminate this contract
at any time, and both Supervisor(s) and Supervisees will notify the Board in
writing within ten (10) days of any such termination. In such case, both
parties are responsible for making certain the Supervisee's patients receive
appropriate referrals so that any potential negative impact to treatment is
held to a minimum.
Supervision Contract School Psychologist
Degree
Purpose: As required under Title 17, Series 3 of the West
Virginia Board of Examiners of Psychologists Legislative Rules, Psychologists
and School Psychologists must complete a period of supervision prior to
licensure. This contract serves as a written record verifying the agreement
between the Supervisor and the Supervisee as approved by the Board of Examiners
of Psychologists, hereafter referred to as The Board. It is also intended to
clarify roles of the supervisor and supervisee.
Imperative to the purpose of supervision and this contract
are the following:
1) Ensuring the
public welfare
2) Promoting
learning and readiness for licensure
3) Monitoring and reporting the Supervisee's
progress at regular intervals
4)
Fulfilling all requirements of the applicable state codes and regulations in
preparation for licensure as a School Psychologist in the State of West
Virginia.
5) Discontinuing, or
sanctioning, Supervisors who do not adhere to the rules imposed for the above
purposes.
Supervision Requirements:
1) Supervisees requiring multiple years of
supervision will have at a minimum two different supervisors to provide
guidance and monitor their work. The supervision may occur concurrently or
sequentially.
2) Supervisors will
provide a minimum of 1 hour of individual supervision per 20 hours of the
Supervisee's clinical practice, with a minimum of 1 hour per week regardless of
hours spent in practice. Individual supervision sessions must occur no less
frequently than every 2 weeks.
3)
In addition to a minimum of 6 hours per month of individual face-to-face
supervision for full time supervisees, group supervision, and/or
multidisciplinary supervision as delineated in the individual's supervision
contract may constitute 2 hours per month of the total supervision
experience.
4) Individual
supervision is in person, face-to-face, unless express permission to do
otherwise for a minimal portion of the supervision hours is granted by the
Board and is documented in this contract. Video conferencing may be a Board
approved alternative for face-to-face supervision. At least once per quarter,
one of the required individual face-to-face sessions shall occur at the
location(s) where the Supervisee is providing services. Furthermore,
supervision sessions do not occur in a public setting.
5) The Supervisee may be a W-2 employee of
the Supervisor or agency for which the Supervisee works. Only psychologists
licensed for independent practice may provide services on a contract
basis.
6) The Supervisee practices
under the Supervisor. The Supervisor maintains legal and ethical responsibility
for the Supervisee's actions and practice. Appropriate professional liability
insurance coverage must be in place.
7) The Supervisor will co-sign all reports if
the Supervisee is a contractor with the school board. Supervisors do not need
to sign Supervisees' reports if Supervisees are full-time employees of a local
school board, yet the reports shall be logged in the Supervisor's log. If the
Supervisee works in a private practice setting, all psychological work must be
co-signed by the Supervisor. Regardless of employment status, all work by
Supervisees shall be signed as "Supervised School Psychologist" and be reviewed
by the Supervisor.
8) Arrangements
will be specified between the Supervisor and Supervisee for supervisory
coverage during times when the Supervisor is unavailable.
9) The Supervisee must practice only within
certain herein specified areas in which the Supervisor is deemed competent to
supervise. Supervision of Level 1 School Psychologists shall include all
aspects of school psychology professional practice. These aspects include but
are not limited to evaluations, consultations, ethics, crisis intervention,
counseling, record keeping and professional development. Level II supervision
should include this and other topics deemed appropriate by the
Supervisor.
10) When the Supervisee
plans to practice outside the Supervisor's approved scope of practice,
competent adjunctive supervision must be arranged in advance, Board approved,
and included in this contract or an approved addendum to this
contract.
11) The Supervisor will
maintain familiarity with the Supervisee's clients' presenting concerns,
treatment plans, treatment progress, and treatment termination plan.
12) The Supervisor will intervene
appropriately when client welfare is at risk.
13) In addition to thorough review and
co-signing of written work (e.g. notes, reports, or other written statements or
documents), there must be sufficient observation of the Supervisee's work,
whether in vivo or via recorded material, to enable the Supervisor to provide
accurate assessment of the Supervisee's performance.
14) The Supervisor will provide timely and
constructive feedback to the Supervisee. The Supervisor subsequently reassesses
the work of the Supervisee in a reasonable time frame to make certain that the
Supervisee is incorporating the feedback into practice.
15) Written evaluations of Supervisee
performance will be completed by the Supervisor and reviewed and signed by both
parties at least quarterly during the period of supervision and submitted to
the Board on the quarterly report. However, ongoing verbal feedback to the
supervisee is also expected.
16)
The Supervisor will maintain and submit to the board, if requested, a
supervision log including but not necessarily limited to, content of
supervision sessions, training activities, and evaluation procedures and
results. The Supervision log, in written format approved by the Board, is to be
co-signed by both Supervisor(s) and supervisee.
17) Supervision sessions will include
discussion of areas of concern, conflict, and/or failure of either party to
abide by agreements and directives delineated in this supervision contract. If
concerns cannot be resolved within the supervision process, either or both
parties will contact the Board for assistance.
18) Any Supervisor of record during the 12
months prior to the Supervisee's oral examination will be available for
telephone consultation with the Board at the time of the Supervisee's initial
oral examination. If continuation of supervision is required, the Supervisor
agrees to attend the Supervisee's subsequent oral examination by the
Board.
19) Clinical supervision
shall not include any potentially problematic multiple relationships between
the Supervisor and Supervisees. Any type of business relationship outside the
parameters stated in this Supervision Contract is strictly prohibited between
the Supervisor(s) and the Supervisee. Other potentially problematic
relationships include, but are not limited to, therapeutic, familial, and
financial.
20) Supervisor and
Supervisee understand and agree that sexual and/or romantic relationships
between the two parties are always unethical and should never occur.
21) Supervision will not be limited to case
discussion. Supervisors will employ a variety of strategies such as
observation, reading assignments, or co-therapy.
22) Both parties will maintain current
knowledge of HIPAA and other pertinent legal, ethical and regulatory guidelines
and responsibilities.
23) In case
of emergency, Supervisees will contact Supervisor at locations specified
herein.
24) If applicable, fees for
supervision shall be paid as designated in this contract.
25) Either party can terminate this contract
at any time, and both Supervisor(s) and Supervisees will notify the Board in
writing within ten (10) days of any such termination. In such case, both
parties are responsible for making certain the Supervisee's patients receive
appropriate referrals so that any potential negative impact to treatment is
held to a minimum.