Form #7: Intern Supervised Clinical Experience Plan Page 3
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44. SUPERVISION TRAINING.
Completed 30 clock hours of post-masters training in supervision theory and practice through
workshops, or academic coursework, or completed the necessary requirements to be an AAMFT
approved supervisor, NBCC approved clinical supervisor, or an APCA diplomate. List coursework,
workshops, seminars, or national accreditation:
Title of class / workshop / seminars
Sponsor of program
Date taken
No. of
National Accreditation
clock hrs
SUPERVISOR AGREES TO:
Supervision:
Ensure compliance with Board’s current Oregon Administrative Rules.
Provide ongoing, clinical supervision in a professional setting.
Ensure that supervision of the supervisee is face-to-face; up to 75% of the supervision hours may
be conducted through electronic means.
Discuss and review case notes, charts, records, and available audio or video for all clients with
the registered intern.
Review and closely supervise the registered intern and all problem cases, providing special
attention to assessments, diagnosis, treatment planning, ongoing case management, emergency
intervention, record keeping, and termination.
Focus on the appropriateness of the treatment plans and monitor the appropriateness of clients
served based on the applicant/intern’s therapeutic skill. Direct the applicant/intern to refer clients
who fall beyond their level of competence.
Maintain confidentiality of all client and supervisory materials.
Review the Oregon licensing laws (ORS 675.705 – 675.835), administrative rules (OAR 833), and
Code of Ethics (OAR 833, Division 100) with registered intern.
Seek timely clarification/consultation from the Board if there are any problems or conflicts
between commitments to agency, administrative supervisor, and client or other conflicts relating
to the authority, or shared responsibility for fulfilling the responsibilities under this Plan.
Reporting:
Establish and maintain a record-keeping system to track the direct client contact and supervision
hours. Supervisor will be prepared to provide supporting documentation verifying the accuracy of
information reported, if requested by Board.
Ensure that the Six-month Registered Intern Supervisor Evaluation and Reported Hours are
submitted to the Board within one-month of the end of the reporting period.
Notify the Board of any changes to supervisor’s business address and phone number or change
in credential status.
Notify the Board of any interruption or proposed termination of the plan.
Intern Clinical Experience Plan
Page 3 of 4
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