SOP_NUMBER: 508.07-att-2
TITLE: Semi-Annual Report 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: 161
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/267411
URL: https://gps.press/sop-data/508.07-att-2/

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

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/

========================================================================
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