Supervisory Plan Template Free Download

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You must also have a current social work license in ND and have a MSW degree to submit the supervision plan form. If you have not yet been licensed in ND, you will need to wait until you have been issued a license number to complete a supervision plan form.

"Clinical social work practice" means the professional application of social work theory, knowledge, methods, ethics, and the professional use of self to restore or enhance social, psychosocial, or biopsychosocial functioning of individuals, couples, families, and groups. The practice of clinical social work requires specialized clinical knowledge and advanced clinical skills in the area of assessment, diagnosis, and treatment of mental, emotional, and behavioral disorder, conditions, and addictions. Treatment methods include the provision of individual, marital, couple, family, and group psychotherapy.

The supervision plan must include these elements as once licensed as an LCSW, you will be licensed to practice independently.

Additional definitions regarding the supervision plan can be found in ND Administrative Code 75.5-02-01-03.

Once you have graduated with your Master's Degree in Social Work, you are eligible to begin working toward a Licensed Clinical Social Work (LCSW) licensure. Prior to earning clinical supervision hours for achieving LCSW status, you must submit a Supervision Plan to the Board for approval. Components of a supervision plan include:

Supervision: The applicant must participate in a minimum of 150 total hours of face-to-face supervision. Not more than 50 of the required face-to-face supervision hours may be group supervision. Group supervision is defined in the Administrative Code as one supervisor and more than one supervisee, including health professionals in related professions. Group supervision is facilitated by the supervisor and involves an exchange among all group members. The size of the group shall be limited to seven, including the supervisor. The plan must show how the applicant will complete and document a minimum of 3000 hours of supervised clinical social work experience during the 4-year period.

Extensions: Under current law and rules, the Board cannot extend the plan due to the pandemic, illness, or another reason delaying the completion of the supervision plan within 4 years. The Board does not have any provisions in its law and rules to extend a plan. The Board can only operate within the parameters of the law and rules. If you are unable to complete the plan within four years, you may still continue with the plan, but you will lose hours you earned in the beginning of the plan.

All completed plans are reviewed by a Board member. Plans can be approved without a Board meeting. If the Board member has any concerns about the plan, it may be held until the Board can discuss it at a quarterly Board meeting. Incomplete plans will not be reviewed, and the Board Office will send an email requesting the missing information. You must have already graduated with your MSW degree before you can begin earning clinical social work hours.

Past supervision hours will now be accepted if the requirements for clinical supervision are equal or more stringent than what the Board requires. The Board will now accept supervision hours even if the hours were completed prior to a plan being submitted in North Dakota. This does include hours earned in other states. You should submit verification showing how many hours you already completed along with a copy of your supervision plan in the other state, if applicable. Verification may be a copy of a completion form from the other state board. If the Board does not have a completion form, your supervisor may complete the ND completion forms, Verification of MSW Supervision and Verification of MSW Employment. If you previously completed hours in Minnesota, you may submit a copy of the Supervised Practice Report. To have your past hours reviewed, you must submit a supervision plan. The Board cannot review anything without a completed plan.

To make changes to your supervision plan, you will need to complete a Online Supervision Plan form to revise your plan. You will need to use the number assigned to your supervision plan. Plans approved after November 24, 2020, will have a plan number at the bottom of the approval letter sent to you by email. If you do not have the plan # or were approved for a plan before that date, please email the Board office.

New or additional supervisor: If your supervisor changes or a supervisor is added during the course of your plan, please complete a new supervision plan form with a copy of the license for the new supervisor and a new diagnosing letter. You will also need to have your former supervisor and/or employer complete the Verification of MSW Supervision and Verification of MSW Employment. You do not need to send another job description if it has not changed. An email will be sent to you after reviewing the change.

Upon completion of the supervision plan, you will need to have your clinical supervisor(s) and employer(s) complete the Verification of MSW Supervision and Verification of MSW Employment forms. These forms will be required as part of the LCSW license application process.

The CF mentor and the Clinical Fellow must coordinate the observation schedule to ensure that all skills are observed and evaluated during each segment of the CF experience. It is expected that the observations are spread throughout the duration of the CF experience, with no more than 6 total observation hours completed in 1 day. You may use this template for tracking supervisory activities [PDF].

For the purposes of ASHA certification, Clinical Fellows may work in more than one location, and they may have more than one CF mentor. If the Clinical Fellow has more than one CF mentor, each CF mentor must complete the required supervisory activities for the weeks and hours to be counted toward the completed CF unless the CF mentors collaborate to provide a robust CF experience. In these instances,

CF experiences with negative recommendations will not be applied toward the total number of hours/weeks required to complete the CF. Within 30 days of making the negative recommendation, the CF mentor must submit to the CFCC a letter of explanation with supporting documentation. This information must be shared with the Clinical Fellow. Following a negative recommendation, the Clinical Fellow may complete an entirely new CF, a portion of the CF, and/or request an appeal by the CFCC. ff782bc1db