SOP_NUMBER: 508.07-att-1
TITLE: Record of Clinical Supervision
REFERENCE_CODE: VG15-0001
DIVISION: Mental Health Services
TOPIC_AREA: 508 Policy-MH Administration/Staff/Certification
EFFECTIVE_DATE: 2022-08-15
WORD_COUNT: 77
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/267410
URL: https://gps.press/sop-data/508.07-att-1/

SUMMARY:
This form documents clinical supervision sessions conducted with mental health staff members in the Georgia Department of Corrections. Supervisors use this record to document the offender cases discussed, clinical issues and concerns identified, and the supervisee's strengths and limitations during individual or group supervision sessions. The completed form is retained in the staff member's supervision file.

KEY_TOPICS: clinical supervision, mental health staff supervision, supervision documentation, supervisory record, offender case review, clinical issues, staff performance evaluation, mental health services, supervision session

ATTACHMENTS:
  1. Record of Clinical Supervision
     URL: https://gps.press/sop-data/508.07-att-1/
  2. Semi-Annual Report of Clinical Supervision
     URL: https://gps.press/sop-data/508.07-att-2/
  3. Record of Individual Clinical Case Consultation
     URL: https://gps.press/sop-data/508.07-att-3/
  4. Clinical Group Case Conference Record (Attachment 4)
     URL: https://gps.press/sop-data/508.07-att-4/

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FULL TEXT:
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SOP 508.07
Attachment 1

8/15/22


**GEORGIA DEPARTMENT OF CORRECTIONS – MENTAL HEALTH SERVICES**
**RECORD OF CLINICAL SUPERVISION**

Institution: _______________________________ Date of Session: _______________________

Supervisee: ______________________________ Supervisor: ___________________________

Start time of Session: ______  End time of Session: _____ Modality: Group [  ] Individual [  ]

Offender/Cases Discussed:

|Name|ID#|Name|ID#|
|---|---|---|---|
|<br>||||
|<br>||||
|<br>||||



Clinical Issues/Concerns: ________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Supervisee’s Strengths and Limitations: ____________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________ ____________________________
Signature/Title of Supervisor Date


Form no. M15-01-01                                                                                        Page 1 of 1

Retention Schedule: Upon completion, this form will be placed in the staff member’s supervision file.