SOP 508.07-att-2: Semi-Annual Report of Clinical Supervision

Division:
Mental Health Services
Effective Date:
August 15, 2022
Reference Code:
VG15-0001
Topic Area:
508 Policy-MH Administration/Staff/Certification
PowerDMS:
View on PowerDMS
Length:
161 words

Summary

This form is used to document semi-annual clinical supervision evaluations for mental health staff in GDC facilities. Supervisors complete this report to assess supervisees' attendance, attitude, compliance, professional boundaries, clinical practices, and ethical conduct. The completed form is retained in the staff member's supervision file as part of their personnel record.

Key Topics

  • clinical supervision
  • mental health staff evaluation
  • supervisory assessment
  • professional boundaries
  • clinical practices
  • confidentiality compliance
  • ethical conduct
  • supervisor report
  • staff performance evaluation
  • mental health services

Full Text

SOP 508.07
Attachment 2

8/15/22

GEORGIA DEPARTMENT OF CORRECTIONS – MENTAL HEALTH SERVICES
SEMI-ANNUAL REPORT OF CLINICAL SUPERVISION

Institution: ______________________________________ Date: _______________________________

Supervisee’s Name/Title: ________________________________________________________________

Comment on the following areas:

a. The supervisee’s attendance of weekly supervision sessions.

b. The supervisee’s attitude toward supervision.

c. The supervisee’s compliance with the supervisor’s instructions.

d. The supervisee’s observation of professional boundaries with offenders and other staff.

e. The supervisee’s attitude toward offenders.

f. The supervisee’s adherence to the limits of confidentiality.

Form no. M15-01-02 Page 1 of 2

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

SOP 508.07
Attachment 2

8/15/22

g. The supervisee’s clinical practices.

h. Any ethical or clinical concerns about the supervisee’s clinical practice.

i. The supervisor’s overall impression of the supervisee.

_______________________________________________ _________________________
Supervisor’s Signature/Title Date

Form no. M15-01-02 Page 2 of 2

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

Attachments (4)

  1. Record of Clinical Supervision (77 words)
  2. Semi-Annual Report of Clinical Supervision (161 words)
  3. Record of Individual Clinical Case Consultation (77 words)
  4. Clinical Group Case Conference Record (Attachment 4) (84 words)
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