Supervision Documentation for LCSW
Supervision Documentation for LCSW
(Supervisee’s Name) (Supervisor’s Name)
(Supervisee’s License Number) (Supervisor’s License Number)
Date: _________________ Time: _________________ Duration: _________________
Learning Theme(s):
❑ Assessment
❑ Case Management
❑ Case Reviews
❑ Consultation
❑ Crisis Counseling
❑ Cultural Competence
❑ Documentation
❑ Interventions / Methods
❑ Outcomes Measures
❑ Professional Values & Ethics
❑ Safety & Self-care
❑ Systems Issues
❑ Treatment Planning
❑ Other _______________________________________
❑ Other _______________________________________
Notes:
Assignments:
Signatures: Supervisor ________________________ Supervisee ________________________
Cumulative Practice Hours (to date) _______ Face-to-Face Practice Hours (to date) _______
Documented Supervision Hours (to date) _______ (Individual Sup. _______ ; Group Sup. _______ )
Case Study Format
Case Summary:
Identification of Relevant Issues for Discussion
– Assessment
– Case Management
– Case History
– Clinical Interventions (past and present)
– Crises
– Cultural Competence
– Professional Values & Ethics
– Safety & Self-care
– Systems Issues
– Treatment Approaches / Methods
– Other _______________________________________
Selecting Courses of Action and Setting Priorities
– Case Management
– Clinical Interventions
– Crisis Management
– Documentation
– Outcome Measures
– Professional Values & Ethics
– Safety & Self-care
– Systems Issues
– Treatment / Treatment Planning
– Other _______________________________________
Are We Covered…? (Is there more we can / should do?)
– Administratively…
– Educationally…
– Supportively…
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