PROFESSIONAL DISCLOSURE STATEMENT and INFORMATION REGARDING CLINICAL SUPERVISION SERVICES REV /29/2014. Contact Information

Transcription

1 PROFESSIONAL DISCLOSURE STATEMENT and INFORMATION REGARDING CLINICAL SUPERVISION SERVICES REV /29/2014 Contact Information Perri Corvino, LCSW, MA, LAC South Parker Road, Suite 300 Parker, CO Degrees, Licenses, Credentials, Experience Degrees Loyola University Chicago 2010 Master of Social Work Chicago, IL Loyola University Chicago 2010 Master of Art, Women s Studies Chicago, IL State University of New York at Potsdam 2007 Bachelor of Arts, Psychology Potsdam, NY Licenses and Credentials Licensed Clinical Social Worker (State of Colorado, # ) Licensed Addiction Counselor (State of Colorado, #437) Acupuncture Detoxification Specialist Trainee Experience Owner: Radiant Psychotherapy, LLC, 2012 current Pro-bono Therapist: Harm Reduction Action Center, 2012 current Behavioral Health Director (Substance Use Disorders): The Empowerment Program, Inc., Primary Therapist: Arapahoe House, Clinical Intern: Deborah s Place, General Areas of Competence in Behavioral Health Practice: I have had specialized training and have also supervised developing counselors in the following areas of practice: Developmental and complex trauma Substance use disorders Trauma informed care Motivational interviewing Transtheoretical Model Harm reduction model Gender responsive treatment Best practices for trauma, substance use, and mental health treatment Marginalized populations (homelessness, incarceration, injection drug users, trans* community) Privilege and oppression Dual diagnosis in adults Traumatic impact on women Mindfulness practices Mediation Dialectical Behavioral Therapy (DBT)

2 Training and Experience in Clinical Supervision My experience involves clinical supervision of students who were pursuing their Master of Social Work or Master of Counseling degree and of candidates for LPC. I have accessed and read the NASW best practices for clinical supervision. As per the standards set forth for addiction counseling credentialing, I completed 35 hours of Clinical Supervision training which prepared me to supervise motivational interviewing skills. Model or Approach to Clinical Work, Role of the Supervisor, Objectives and Goals of Supervision, and Modalities I draw from a number of theories and therefore, my approach is an integrative one. The theory I utilize the most is object relations, a branch of psychodynamic theory popularized by D. W. Winnicott. I also utilize DBT, motivational interviewing, feminist theory, harm reduction, and the recovery model. Please consider the following from Coleman, 2003: There are references to social work supervision dating back to the early 1900s. Recognizing the importance of individual supervision within a program, the Charity Organization Department of the Russell Sage Foundation offered the first course in social work supervision in 1911 (Kaduskin, 1992). Early on, three major components of supervision were identified and continue to be recognized today: administrative, educational, and supportive. Administrative supervision is oriented towards an agency or organization s policy and public accountability (Barker, 1990). It is here that objectives are translated into tasks to be performed by social workers. The major responsibility of the administrative supervisor is to ensure that the work is performed. Educational supervision is also called clinical supervision. This type of supervision establishes a learning alliance between the supervisor and supervisee in which the supervisee learns therapeutic skills while developing self-awareness at the same time. It is also concerned with teaching the knowledge, skills, and attitudes important to clinical tasks by analyzing the social worker s interaction with the patient. The supervisor teaches the social worker what he or she needs to know to provide specific services to specific patients. Supportive supervision is concerned with increasing job performance by decreasing job related stress that interferes with work performance. The supervisor increases the social worker s motivation and develops a work environment that enhances work performance. My goals in supervision are to empower the supervisee to reach her stated objectives and to challenge her to an appropriate degree so that she increases her abilities to be more self aware and flexible as a clinician. I also have the objective of helping clinicians learn how to work with their own blind spots and how to effectively use transference and countertransference in positive ways that assists the client in the therapeutic relationship and which assists the clinician in further developing within the supervisory relationship. The modalities employed are individual, group, case reviews, chart reviews, direct observation, and discussion of theory and cultural factors. Evaluation Procedures Evaluation is an important and integral part of the supervision process. Evaluation involves making judgments and providing feedback about the quality of work, need for improvement, and the observation of ethical boundaries. We will spend much of our time together focused on your work as a learning clinician and my feedback will be ongoing, emphasizing process and progress rather than outcome. All supervisees will receive a copy of the Clinical Supervision Session Note for every session. I recommend that you also maintain your own records. As a supervisee you are in control of the relationship and may end the supervision at any time. I will be supportive of your decision. If you are completing your internship with me, we will evaluate your progress as required by your university. I will provide signatures on any supporting documents and we will collaborate on evaluations as needed.

3 If you are completing licensure or certification hours with me, there will a formal, planned evaluation biannually. This evaluation will be based on your goals and other mutually agreed upon criteria. You are responsible to keep track of the number of clinical hours individual or group supervision hours, the qualifications of your supervisors, etc. Be certain that I can document every hour of supervision that you submit. Limits and Scope of Confidentiality and Privileged Communication All information you share with me about the participants you work with or yourself, including any records I may keep, will be kept confidential and will not be shared with others. There are several important exceptions that pertain to the release of confidential information. We are both required to break confidentiality under the following circumstances: Any threats to harm self, others, or national security Reasonable suspicion of the abuse of a child, elder, or an incapacitated person When ordered by the court or national security agency When you sign a request that I provide information to others If the supervisee exhibits signs of impairment. If the supervisee exhibits behaviors that are unethical and/or dangerous to the participant. If the supervisee exhibits signs of impairment, unethical or dangerous behavior, every effort will be made to construct corrective and therapeutic strategies to resolve the issues. However, as a clinical supervisor, I am bound by the Code of Ethics to report such matters to the appropriate boards and licensing commissions in order to protect the safety and well-being of participants. If I as a supervisor am court ordered to testify about the nature of a supervision relationship or of a client of the supervisee. If subpoenaed an attempt to forgo the request for a court appearance will be conducted. Supervisees must inform their participants that they are obtaining clinical supervision from me and they must inform their participants of my name and how to get in touch with me should any difficulties or concerns arise. When you report to me any forms of unprofessional conduct". If at any time you are dissatisfied with my services, please let me know. It is important that we discuss your concerns in detail and attempt to resolve them. If I am unable to resolve your concerns, you may report your complaints to: The State of Colorado Department of Regulatory Agencies State Board of Social Work Examiners State Board of Addiction Counselor Examiners 1560 Broadway, Suite 1550 Denver, CO Lifelong Consultation I believe in lifelong consultation. I meet monthly for consultation in regard to my actions in therapy with the participants I receive consultation with the following professionals: Cori Woodland, MA, LPC, LAC for somatic and movement based trauma therapies. Cori is currently in private practice where she employs yoga and other movement therapies. Emergency Contact I am accessible via cell phone and (see above). Emergency coverage by another qualified professional is always established when I am out of town on training or personal trips and all supervisees are informed about this prior to my departure.

4 Code of Ethics As a clinical social worker and addiction counselor, I follow a number of ethical codes. My primary code of ethics is that of the National Association of Social Workers (NASW) of which I am a member. I also follow the Codes of Ethics endorsed by the following entities: International Society for Traumatic Stress Studies (ISTSS) National Association for Alcoholism and Drug Abuse Counselors (NAADAC) National Acupuncture Detoxification Association (NADA) I follow the code of ethical behavior espoused by NASW s Best Practice Standards in Social Work Supervision. References Coleman, M. (2003). Supervision and the clinical social worker. Clinical Social Work Practice Update, 3 (2).

5 INFORMED CONSENT I confirm the following: I have read over in its entirety the Professional Disclosure Statement and Information Regarding Clinical Supervision/Consultation Services. I understand completely all of the requirements of the clinical supervision/consultation services I confirm that I have had ample opportunity to ask questions and clarify specific issues related to the supervision/consultation relationship I am forging with Perri Corvino, LCSW, MA, LAC. I aspire and am fully aware about my professions Code of Ethical behaviors. The code I follow is. I acknowledge that I can terminate this clinical supervision relationship at any time that I desire simply by informing Perri Corvino that I would like to end. Supervisee s Signature and Date: Supervisor s Signature and Date: The Supervisee accepted a copy of the Informed Consent Form. rejected a copy of the Informed Consent Form.