This package contains very important forms needed to provide supervision for other mental health therapists.
Forms Included in this Package:
- Supervisory Informed Consent (w/TeleMental Health Supervision Addressed)
- Supervisee Info. Form (w/documents required before starting supervision)
- Supervision Note-Taking Form (w/Ethical Check-list)
- Superbill with Supervisor Co-Signature
- Assessment for Fit for Telemental Health Clients (For Supervisees to use with each client)
- Assessment for Fit for Telemental Health Supervision (For Supervisor to do with Supervisees)
- Supervisee Emergency Procedures
- Consent to Audio/Video Record
- Excel Hours logs with calculations built-in (Intern, Associate Licensed, & Post-Doc)
The Supervision Package contains several very important forms if you do any supervision with other mental health practitioners. These forms include two Supervisory Informed Consents, which address all of the important areas that need to be discussed when entering a supervisory relationship. There is one consent for masters-level supervisees and a second for post-doctoral level supervisees, since the requirements are usually different for these practitioners. These two documents specify Georgia state law, but provide the prompt to enter the law pertinent to your state if different. Third, there is a detailed Supervision Information Form, which asks background information regarding education and theoretical orientation, questions about the supervisee's goals, details about the site where they will be seeing clients, what has/has not been helpful in past supervisory relationships, a prompt to bring in a copy of the supervisee's malpractice insurance, among other relevant and thorough questions. Fourth, you'll find an excellent Supervisory Record Form, which incorporates actions taken as needed for risk management situations such as reporting abuse, clients with suicidal ideation, etc. Fifth, you'll receive a Superbill that has a place for the supervisee's information as the provider and yours as the supervisor. The delineation is very distinct regarding who is providing the services to prevent insurance fraud while also being able to provide a superbill for clients where reimbursement may be possible. Sixth, you'll receive two forms related to TeleMental Health Assessment for Fit. One is for the supervisee to use with clients to make sure that they are evaluating the most critical concerns. The second is for the supervisor to make sure that their supervisee is appropriate for Supervision via TeleMental Health. Seventh, a five-page Emergency Procedures Policy is included. This is a requirement for CPCS supervisors in Georgia but a must for anyone who practices supervision for risk management purposes. Lastly, there is a form for supervisees to receive permission from the client to audio and/or video record sessions.
Each form is designed in Microsoft Word format (.doc) so that you may edit them as you see appropriate. Every place in a document where you need to enter information particular to your practice (e.g., your name, location, fees, etc.) will be in a bright blue font to prompt you for this information.
By purchasing and downloading these forms, you understand and accept that the forms are intended to be used as examples or samples of ways in which the forms and information can be used. You understand and accept that you are ultimately responsible for your own version of the forms and for adapting the forms for your own use.
Neither Dr. Becky Beaton nor Dr. Becky Beaton, LLC (DBA The Knowledge Tree) assume any liability or responsibility for the use or misuse of the forms you download. All of Dr. Beaton's forms are copyrighted. You understand and accept that unauthorized duplication or sharing of the forms you download or any information contained therein is strictly prohibited and illegal. Thank you very much for your cooperation.
Supervision Information About the Author: Dr. Beaton-York has provided supervision for hundreds of new clinicians since 1997. She was part of creating the very first Counseling Professional Certified Supervisor designation requirements in Georgia, and she has taught continuing education courses as well as university courses on supervision since 2000.
Dr. Becky Beaton-York is the author of Practice Smart Forms, and they have all been vetted by more than one attorney. She is passionate about psychological ethics and helping therapists grow their practices grounded in ethics and integrity while also creating a personally and professionally fulfilling career. Dr. Beaton-York began creating these forms when she founded The Anxiety & Stress Management Institute, a very large outpatient facility in Atlanta, Georgia, which she clinically directed for 15 years. She realized quickly that managing therapists required creating documentation that was ethically and legally sound while also being as efficient as possible to ensure compliance. Her staff grew to love these forms, as well as thousands of other clinicians who rave about them in Georgia and around the country. Several hospitals and university counseling centers have also adopted them.
Dr. Beaton-York is a Licensed Psychologist and a Licensed Professional Counselor. She has been on the Georgia Psychological Association's (GPA) Ethics Committee since 2010 and Ethics Chair for eight of those years. Additionally, she was the Ethics Chair for the Licensed Professional Counselor's Association of Georgia (LPCA-GA) for two years and has taught numerous ethics workshops since 1999.
Related to her interest in ethics and documentation, Dr. Beaton-York has served as an ethics expert in malpractice lawsuits. Part of her role in these cases is to examine the clinician's documentation to determine if the therapist was practicing below the standard of care and/or committing any ethical violations. This experience has made Dr. Beaton-York extremely aware and diligent about designing these forms to help the therapist write them in such a way that they will hold up in court. Of course, there are no guarantees in court; however, this is a great place to start! We hope you find them to be helpful.