Clinical Supervision Session Form Page 2
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2Clinical Supervision Session Form
AZBBHE Clinical Supervision – referenced to A.A.C ‐ R4‐6‐212
⃝
Review of legal and ethical requirements applicable to the scope of practice, including
professional conduct
– F1
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Monitoring of activities to ensure that services are provided safely and competently –
F2
⃝
Verification that the supervisee provides clients with appropriate written notice of clinical
supervision, including the name and telephone number of the supervisee's clinical supervisor
– F3
⃝
On‐going compliance review to ensure that the supervisee maintains adequate written
documentation
– F7
ADHS/DBHS Practice Protocol – Clinical Supervision
The following minimum elements must be addressed when providing clinical supervision.
Additional items can be discussed as determined by clinical necessity.
⃝
Legal and ethical requirements applicable to the scope of practice
⃝
Adherence to agency, licensing and accrediting requirements
⃝
ADHS/DBHS Provider Manual and Clinical Practice Protocols
⃝
Arizona Vision and 12 Principles and Arizona Statutes
⃝
Meet Me Where I Am practice fidelity/collaboration with services
⃝
Special needs of Children
⃝
Special needs of the Developmentally Disabled
⃝
Assessment and evaluation of competence and effectiveness
⃝
Self‐monitoring of compassion fatigue, burnout and impairment
⃝
Client’s and/or family’s behavioral health
⃝
Client progress towards the agreed upon ISP goals
⃝
Degree of client symptomatic and functional limitations
⃝
Client adherence to treatment and interventions to improve adherence
⃝
Promotion of culturally sensitive treatment interventions
⃝
Promotion of recovery
⃝
Multidisciplinary collaboration around patient’s needs
⃝
Development of strengths‐based/recovery oriented treatment goals
⃝
Enhancement of personal/professional development
⃝
Client and family spirituality needs
*Clinical supervisors have an obligation to fulfill the legal requirements and ethical responsibilities
associated with state, national, and professional standards for supervision. This would include revising
this document as necessary, to reflect any relevant future regulatory amendments. This document
should not be construed as legal advice for any particular facts or circumstances.
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