In this assignment, you will create your own supervisor professional disclosure statement.
Note that you can include lessons learned from this assignment in your Personal Supervision Philosophy Paper, which is due in Unit 9.
Most states require professional disclosure statements, and you may have already created one for your clinical licensure. This document will be a fluid, ongoing work-in-progress throughout your lifetime as a professional, and may change with each new job site or expectation. You will be completing internship soon, and this document may be used to notify your master’s level supervisees of your position as a doctoral intern.
As a part of your internship, you will co-supervise master’s learners who are working with real clients in their internships. Use this setting as a backdrop for your Supervisor Professional Disclosure Statement paper. Include information about yourself as you expect to be during your internship. In other words, if you are licensed, list a license or other credential that you expect to have obtained. Do not list any credentials that you don’t expect to have obtained by then. Note that you will have completed your coursework by that time, and you will have passed comps, but you will not yet have your PhD.
You may use the information found on pages 154 and 302–307 in the Bernard and Goodyear Fundamentals of Clinical Supervision text to guide you in developing your disclosure statement. If your state has specific requirements for disclosure statements, use these requirements and include a copy of the state regulation with your statement.
For the purposes of this assignment, your statement should be 4–6 pages of text, double-spaced, incorporating all APA elements.
Include the following in your statement:
- Your professional qualifications, experience, education, training, license, and contact information.
- Your model of supervision, supervisor’s role in supervision process, and goals of supervision.
- An explanation of the evaluation process, limits and scope of confidentiality, and privileged communication in the supervisory relationship.
- An explanation of the role of disclosure of supervisee’s actions and the supervisor’s supervisor in supervisory process.
- Any fee schedules (if applicable) and emergency contact information should also be included in this statement of supervision.
- A statement of ethics, referencing an appropriate credentialing body’s code of ethics.