Individual Supervision Agreement Terms and Conditions.

 

R.E.A.L. Supervision and Counseling Services LLC.

 111 Townsquare Place Ste1238 PMB 893369

 Jersey City, New Jersey 07310 ph.: 732-943-2854

         

​Virtual Individual Supervision Services Agreement.

This document serves as a contract to services by REAL Supervision and Counseling services LLC and client person receiving supervision (name first and last) as the client individual seeking to fill the supervision requirement services in the states of New Jersey or New York for the specified time of up to 2 -5 years.

As the owner and qualified professional of the business name above Sherin Ahmed NJLCSW-CCS and NY-LCSWR is authorized to provide clinical supervision based on the New Jersey Board of Social Work Examiners office and or the New York Office of the Professions.

Definition of Clinical Supervisor: An individual who meets the qualifications of a Licensed Clinical Social Worker (LCSW) according to state guidelines, authorized or certified by the appropriate licensing authority in the state(s) where they practice as licensed mental health professionals.

Definition of the Supervisee- the supervisee is a licensed mental health professional seeking higher licensing credentials as required by the relevant state boards.

 

Responsibilities of the Supervisor- All supervision services will be provided virtually in accordance with each state’s requirements. A face-to-face virtual hr. (52 minute minimum per week during a mutual agreed time is required. It is the responsibility of R.E.A.L. Supervision and Counseling services to ensure that all supervision requirements by licensing entities are met in accordance with the NJ BSWE and the NY State Office of the Professions.

Cancellation of Scheduled Supervision by the supervisor. It is the clinical supervisor’s responsibility to schedule an alternate make-up supervision time that is equivalent to the missed supervision hour should it be cancelled by the clinical supervisor for any reason, no later than the following two weeks.

 

It is the responsibility of the clinical supervisor to ensure that:

1)Supervision notes are taken by the supervisee summarizing the process and agenda gathered collected and stored for future reference.

2)To provide the supervisee with an agenda at least 24 hrs. prior to supervision.

3)Provide the necessary qualifying documentation for the supervisee’s attestation application within one week of each supervision contract's end.

4) To provide a professional ethical clinical developmental learning space to address clinical psychotherapy practice issues using multiple means of communication and teaching tools.

5) REAL Supervision and Counseling LLC will not be held responsible for any missed minutes in the scheduled supervision time by the supervisee prior to the 72-hour rule and will not be required to make up those minutes missed by the supervisee.

6) REAL Supervision and Counseling LLC can terminate supervision services without a refund or completion of required hours if the supervisee behaves unethically, unprofessionally, fails to follow up on steps or recommendations, or acts irresponsibly. Recommendations will not be made to the licensure board for those who breach behavioral or practice standards or the NASW ethical code.

7) REAL Supervision and Counseling takes the best practice standards very seriously and will provide clinical guidance and support, as directed by the NASW code of ethics, BSWE and Office of the profession’s standard of clinical practice supervision.  

8) The clinical Supervisor Reserves the right to hold or dis-approve paperwork of any supervisee, under the following circumstances:  a) client/supervisee has not met basic competency requirements and or professional and ethical requirements of clinical psychotherapy practices as defined by the NASW code of ethics and governing board standards  b) has not demonstrated consistency in managing professional expectations of supervision, c) has breached any terms of this agreement, d) is not following directives post supervisory prompts, fails to meet documentation best practice/ compliance deadlines, participates regularly in supervision space,  keep consistent attendance or fails to meet payments expectations or any monies owed to R.E.A.L. Supervision and Counseling Services LLC.

9) The clinical supervisor will deliver the state required forms, evidence of supervisory certification, attestation, and all other required forms and signatures by the clinical supervisor at any time the services are ended provided that the supervisee meets the standards by regs and as stated in this agreement.

 

Responsibilities of the Supervisee:

1. To follow best practice guidance in theory to practice applications as per directives and execute recommendations by the supervisor.

2. Maintain and document the supervision process attended by note taking.

3. To commit to sound and ethical practice principles as provided by the supervisor and previous educational institutions.

4. To track all individual supervision hours on supervisee’s behalf on a weekly basis based on hours and supervision log.

5. To track all session types held in CPT codes, the date psychotherapy session/s is held and duration on a weekly basis. (i.e. 90832 30min 90834.45min or 90837 60 minutes 90791 intake) and other social work activities (clinical psychotherapy notes are excluded if notes are not part of this service agreement) as deemed necessary or appropriate to count towards clinical case practice hours under supervised hours of a qualified clinical supervisor the appropriate practice state.

6. To commit to being timely and accountable for communicating any foreseeable issue that can get in the way of regular attendance.

7.  To communicate timely high-risk needs of a particular case client and abide by mandated requirements-based state specific guidelines if necessary, and directives provided by the clinical supervisor.

8. YOU MUST be already licensed in your state and carrying a case load and or practicing with a client of mental health to be clinically supervised prior to initiating this service agreement.

9. The supervisee is responsible for obtaining tracking and attending their necessary CEU in their licensure state.

10. The supervisee must be practicing clinically with an active NPI, must provide proof of identification by driver’s license and LSW or LMSW license number before the supervision process begins. Verification of employment may also be required.

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Payment Terms and Conditions

1. All hourly sessions are $95 per hour via on-line credit card payment method and are due 7 calendar days before the scheduled first session, and 7 calendars days of each supervision session thereafter. Failure to make payment in a timely manner will result in the cancellation of supervision hours of the following week or termination of this contract/ agreement.

2. Payment is collected via credit card or Zelle 7 days before a scheduled supervision                    session. For example, if supervision starts on January 1st, payment is due on December 24th via the website. If payment is not made, the session will be canceled with no guarantee of rescheduling.

3. No refunds will be given if the supervisee needs to reschedule with less than 72-hour notice AND the Supervisor cannot accommodate.

4. Lateness: scheduled supervision hours are paid for in full regardless of lateness             minutes on behalf of the supervisee. The clinical supervisor is not obligated to wait past a 15-minute lateness will disconnect form the virtual platform and a partial refund or full refund will not be issued.

Termination- This contract can be terminated by either party at any time with written notice by both parties effective 15 days in advance via email, or when supervision required hours and case practice of at least 3000hrs no less than 2 years and no more than 5 years are met.

All Supervision conversations, guidance written, stated verbally, materials, clinical tools, trainings sites and processes are subject to transcription and or virtual recording by the clinical supervisor hired needed for reference material and follow up. You may be asked to record your virtual or in-person sessions for case review and supervisory feedback. All conversations related to, and supervisory sessions are confidential.

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ARBITRATION. In the event of any dispute arising in and out of this Agreement between the Parties, it shall be resolved by arbitration. There shall be [03] arbitrator(s), who shall be appointed by The American Arbitration Association. The venue of arbitration shall be New Jersey, and the seat shall be New Jersey. The arbitrators' decision shall be final and binding on both Parties.

 

Limitation of Liability

Notwithstanding anything to the contrary herein, under no circumstances will REAL’s total liability to the Individual for any breach of this agreement exceed an amount equal to $95 equivalent to one individual session hour.

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​COPY RIGHTS

Intellectual properties, material/s presented or used by REAL Supervision and Counseling LLC. are confidential and subject to copyright rules, laws, and regulations. No duplication or sharing of the information identified as such by the clinical supervisor are to be copied and passed along to others outside of the supervision time/space without written permissions by REAL Supervision and Counseling LLC.