Ashford University Record of Supervision Worksheet

Description

Complete the record of supervision documenting your conversation in at least one area of the Head, the Heart, and the Hand categories. Make sure that each Student Record of Supervision form also includes at least one area of growth or improvement and at least one area of strength documented by the field instructor. Include the topics covered, brief descriptions of cases or issues discussed, specific guidance or instruction provided by your field instructor and follow up items specific to each area you describe.

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Core Competency 1: Demonstrate Ethical and Professional Behavior in Advanced Social Work Practice
Collaborates with
The student will provide supervisor a written summary of one interdisciplinary team
interdisciplinary teams to create collaboration.
ethically sound interventions
Head (knowledge / ideas)
Case Reviews
Provide summary of diagnostics, analysis, recommendations, successful interventions, next steps
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Theories
Identify theories and models related to practice and how applied
January
31st
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Policy
Identify agency, community, state, federal policies reviewed or discussed
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Hand (skills / practice)
Process Recording Reviews
Describe case and key feedback from supervisor upon review.
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Heart (values, cognitive and affective processes)
Diversity / Cultural Issues
Describe any areas or issues identified and discussed related to practice.
Agenda/Discussion/Feedback
Answer:
FollowUp/NextSteps1
Answer:
Feedback from Supervisor (must complete)
Areas of growth or improvement identified (document at least 1)
Agenda/Discussion/Feedback [required]
Answer:
FollowUp/NextSteps1 [required]
Answer:
Strengths identified (document at least 1)
Agenda/Discussion/Feedback [required]
Answer:
FollowUp/NextSteps1 [required]
Answer:
Student Signature [required]
References

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