Practicum Readiness Certification Form Name:
Date:
Advisor:
Specialization:
Requirements I-V below must be fulfilled prior to your advisor interview. I.
Prerequisite Courses
A. Must be taken before enrolling in Practicum: COUN 504 (Prepracticum,)
Semester
Grade
____
___
Centerpiece Assessment Turned in to Advisor
___ Clinical Assessment forms
B. One of the following courses must be taken before enrolling in Practicum: and the other can be taken concurrently wit Practicum: COUN 503(Prof. Orient.) ____ ___ ___ Self Assessment Paper COUN 520(Theory & Practice)
___ Philosophy of Counseling Diverse Clients Submit copies of the centerpiece assessments for the courses taken prior to your interview with your advisor or to Sergio E. Rodriguez, SOLES 215 srodriguez@sandiego.edu II.
____
___
Verification of Personal Counseling Hours (15 of 25 hours done prior to Practicum, remaining prior to internship/fieldwork)
(Please attach completed form)
III. IV.
Evidence of Liability Insurance
(Please attach a copy of evidence indicating that coverage will begin on the first day of practicum)
Fingerprint Clearance - School Counseling Specialization ONLY!
(Please attach copy)
Credential Analyst Signature Required: The above-named student has submitted the necessary Fingerprinting Clearance documentation Date:
(Tedi Kostka)
V.
Self-Reflection Essay (Instructions Attached)
VI.
Advisor Interview
(Attach Essay)
Date Scheduled:
------------------------------------------------------------------The above-named student has completed all the readiness requirements and is certified to register for the Counseling Practicum COUN588P or COUN 589P (circle one) Faculty Advisor Signature:
Date:_____________
I certify that I have provided accurate information regarding all practicum readiness requirements. Student Signature: Additional Required Signature:
Date:_____________
Director of Clinical Instruction:
Date:_____________ Ronn Johnson, Ph.D.
Once completed, please return the CIBA packet to the Counseling Program Executive Assistant. Last Updated 11/2007:ser
CIBA – Self-Assessment Essay Instructions The USD Counseling Program is designed to prepare you to function in a variety of settings that include, as a part of your professional role and function, clinical work. Therefore, an important part of your preparation as a professional is the clinical instruction you receive. In general this instruction includes pre-practicum experiences, a counseling practicum, and fieldwork/internships appropriate to your program specializations. Readiness for the practicum is seen by the Counseling Program faculty as a particularly significant benchmark in your training. To assess your readiness for practicum, the Counseling Program requires that you complete the Clinical Instruction Benchmark Assessment (CIBA) process. Counseling Program faculty utilize the CIBA to assess your readiness for the more advanced clinical instruction involved in practicum and fieldwork/internship. Assessment inputs include centerpiece assignments from practicum prerequisite course as well as a self-assessment essay and an interview with your program advisor. The Self-Assessment Essay provides candidates with an opportunity to reflect on their readiness for the counseling practicum experience. Students have completed a Self-Assessment paper as part of the COUN 503 (Introduction to Counseling: Practice) course requirements. Submit a copy of this Self-Assessment paper with the Practicum Readiness Certification Form. This paper should reviewed by the student and the advisor before the CIBA interview is held. The COUN 503 Self-Assessment paper was designed to answer the following questions: 1) Introduction • What is your program specialization? • What are the client populations you want to work with in your counseling practice? • What do you think you want to do when you finish your graduate degree? 2) Why do you want to be a counselor? 3) What are your experiences in being mentored for the profession? 4) What are your experiences with different client populations and what specific competencies have you demonstrated up to this time in your interactions with client populations you might serve? Any client populations you haven’t worked with or don’t want to work with? 5) What are the characteristics of effective counselors that you believe you already possess? 6) What are some additional skills you hope to learn and/or areas of knowledge or disposition that need further development? How have you worked on these areas to date? In the CIBA – Self-Assessment Essay the Counseling Program faculty looks for evidence of further reflection, this time on your readiness to start your practicum experience. In a 3-4 page, double-spaced essay, candidates should answer the following questions: • • •
What areas of growth will you need to focus attention on during the practicum? How do you see yourself utilizing feedback in practicum and fieldwork/internship supervision? Any specific areas of expertise you want to develop and demonstrate during your clinical instruction courses (practicum and internship/fieldwork)? How might your personal style as a helper enhance and/or inhibit your ability to work with clients, supervisors, staff at your practicum site and other counseling students? How do you see your current effectiveness in establishing a facilitative counseling relationship? How do you see your current effectiveness in relation to identifying clients with whom you cannot work effectively and making appropriate referrals?
Last Updated 11/2007:ser
Self-Assessment Essay pg. 1 • From your work in the theories course (COUN 520) what do you see as a possible theoretical orientation that would be effective with your preferred client populations? What is your current knowledge and skill level when working with diverse clients? What are your specific plans for increasing your skills during clinical instruction courses? • What proactive steps are you planning to take outside of the counseling program to facilitate the development of your professional identity and your knowledge and skills as a professional counselor, including your awareness of the profession’s ethical codes and demonstrating that awareness through ethical behavior? This additional reflection paper should be submitted with your other paperwork before you meet with your advisor. Self-Assessment Essay pg. 2 Centerpiece Assessment Coursework Requirements and Paperwork Needed for CIBA interview with your advisor A. Must be taken before enrolling in Practicum COUN 504 Prepracticum Students who completed this course Fall 05 or later will submit copies of the Clinical Assessment form filled out by the student and, if possible, the form filled out by the prepracticum instructor at the end of 504. Students who took 502 or the Summer 05 COUN 504 course will submit copies of instructor, peer and self assessment forms completed based on demonstrations of counseling skills. B. One of the following courses must be taken before enrolling in Practicum: and the other can be taken concurrently wit Practicum You should submit the assignment from the course(s) you completed before enrolling in Practicum. COUN 503 - Orientation to Professional Counseling and Ethics Submit your Self Assessment paper that addressed your reasons for wanting to be a counselor, the characteristics and experiences you have had so fat that prepared you to be an effective counselor, and a discussion of the skills area you wanted to develop during the program. COUN 520 - Theory and Practice of Counseling Submit your Philosophy of Counseling and Working Effectively with Diverse Clients assignment that you completed in Dr. Johnson’s class.
Last Updated 11/2007:ser
Verification of Required Counseling Hours To promote a deeper understanding of the counseling process and the roles of counselor and client, students are required to have completed a minimum of 25 hours of interpersonal, career, family, or pastoral counseling in individual or group settings. At least 15 counseling hours must be completed before the student enrolls in Practicum (COUN 588P or 589P). Any uncompleted hours of the required 25 hours must be completed by the time the student enrolls in Fieldwork (COUN 590F or Internship 592F, COUN 593F). Counseling services experienced up to two years prior to entering graduate study may be used to meet this requirement. A variety of counseling services are offered on campus and in the San Diego community. Your advisor and course instructors will often have information about specific opportunities during a particular semester. Information is also posted on the Counseling Program bulletin board outside Serra Hall 316. Please contact the following campus departments for more information or to schedule an appointment: USD Counseling Center, Serra Hall 300 USD Career Services, Hughes Center, 110 USD Graduate Campus Ministry
(619) 260-4655 (619) 260-4645 (619) 260 2265
Community Resources Catholic Charities Jewish Family Services Family Services Association of San Diego County United Way INFO Line
(619) 231-2828 (619) 291-0473 (858) 279-0400 (619) 230-0997
Please turn in the following Certification of Completed Counseling Service to either the Counseling Program Executive Assistant, Sergio E. Rodriguez as part of your CIBA packet or to your advisor during your CIBA interview. CERTIFICATION OF COMPLETED COUNSELING SERVICES Name:
_________________________________________________________________________
Counseling Program Specialization: _________________________________________________ Date of Program Entry:
_____________________________________________________________
Counseling Services: Agency/Department
Type of Service
Date of Service
Hours Completed
________________________
______________
_____________
_______________
________________________
______________
_____________
_______________
________________________
______________
_____________
_______________
Total Hours Completed:
____________________
I certify that the above information is correct and I have completed the program requirement for participation in counseling services. Print Name:
___________________________________________
Signature:
___________________________________________ Date:____________________ Last Updated 11/2007:ser