Group Supervision Services Agreement with Business Entity/Agency.

This document functions as a contract for services between REAL Supervision and Counseling Services LLC and (the business entity/agency) seeking to hire a qualified clinical supervisor to meet the licensed staff therapist/counselor supervision requirements in the states of New Jersey or New York for a period of 4 weeks- 5 years. As the owner and clinically 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 credentials, authorized by the relevant state boards by a qualified clinical supervisor.

Responsibilities of the Supervisor (Sherin Ahmed)

1)All supervision services will be provided virtually and in person in accordance with each state’s requirements. A minimum of 1 face-to-face virtual group scheduled hr. per week during a mutually agreed time is required. It is the responsibility of R.E.A.L Supervision and Counseling services to ensure that all requirements by licensing entities are met in accordance with the NJ BSWE and the NY State Office of the Professions.

 

2)Cancellation/s of Scheduled Supervision by the Supervisor. In the event of cancellation by REAL Supervision and Counseling. It is the Clinical Supervisors responsibility to schedule an alternate make-up group 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. All members are required to make efforts to attend this extended session for this to count towards their supervised hours.

Responsibilities of the Supervisor Continued:

3) supervision notes taken by the supervisee/s summarizing the process and agenda gathered collected and stored for future reference.

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

5) To provide the qualifications documentation required by each state entity for the supervisee’s attestation application within one week of the end of this contract requirement met whichever comes first.

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

 

Responsibility of the Business Entity:

1)A Business Associates Agreement on behalf of the business entity or agency will be required to hire REAL Supervision and Counseling Services as a Consulting Clinical Supervisor for this time.

2)The business entity agrees to allow access to systems and EHR limited to the staff receiving supervision services and the cases associated with their case load.  The business entity agrees to support clinical supervisors' guidance and recommendations regarding business entity or agency identified client.

3)The business entity will arrange for correction and dismissal of a given supervisee who is not adhering to the standards of clinical documentation and professional practice based on the clinical supervisor's request or recommendation of their removal from the group.

 

4)The business entity or agency will designate an administrative liaison or contact person to discuss terms, agreements, and feedback as needed. This will help create an environment of partnership and continuity for supervisees, staff, and the identified mental health patient.

5)The business entity or agency is responsible for ensuring their staff members hold current licensure standing and qualifications and are actively practicing psychotherapy services on individuals deemed as clients/patients of the business and entity or agency.

6) Please be advised the a clinical supervisor is entrusted with the vicarious care of clients and must be provided with a degree of control and freedoms to hold supervisees accountable for actions that directly affect client mental health care. Administrative and Human Resources support must be provided to the clinical supervisor.

 

Payment terms.

1) The business entity / agency will provide prompt payment for services as per contract terms for services provided by R.E.A.L Supervision and Counseling Services LLC. The Supervisor will collect payment for a maximum of 4 members per business entity /agency in advance for 12 scheduled group supervision hours (once per week x by 12 weeks) of Group Supervision to be paid in full one week prior to the first group SCHEDULED hour in the amount of $280per grp hr.x12hrs= $3,360.  If the business entity prefers for the hired clinical supervisor to review and sign off on 4 staff therapist’s /counselors’ caseload psychotherapy notes, an additional $65 per hour for note reviews will be added. This includes commentary, next steps or follow-up recommendations.

If the first 12 hours of scheduled group supervision is accepted by all members, we will continue the contract. A non-refundable payment of $3,369 will be due every 12 weeks (12 hours completed) for a year, totaling $13,,476 USD annually.

Refund Terms.

2) A one-time Refund opportunity is available only during the first 12 sessions. A $280 group hourly supervision fee will be deducted from the $3,360 paid upfront for any group supervision sessions conducted. This refund option is NOT available for any subsequent agreed on 12-week renewal contracts moving forward. 

2a) Once a contract is renewed for 12 group supervision sessions, there will be NO refunds should changes occur within the business entity/agency staff cohort of 4 per group to keep staff from completing the 12 session/s series. Should the business entity or agency request to discontinue, we would simply not renew for another 12 sessions. 

3) Refund for Time/Lateness: scheduled group supervision hours are paid for in full regardless of lateness, minutes lost on behalf of the supervisees/ staff. The clinical supervisor is not obligated to wait for past a 15-minute lateness (should no one show up during this time) and a refund for lost time will not be issued.

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Attendance: REAL Supervision and Counseling LLC will not be held responsible for any missed minutes, or for any missing staff for any scheduled group supervision time and will not be required to make up those minutes when the session is revised by the staff.

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1) REAL Supervision and Counseling LLC holds the right to end these services at any time should the supervisee/s conduct themselves in ways that are less than ethical, professional, and responsible behaviors as deemed by the standards of governing and regulating licensure boards. Staff are expected to adhere to the REAL Supervision and Counseling supervisor’s schedule and regular attendance. Chronic absences may lead to dismal from the group without refund. Flexibility and fluidity make things more possible and manageable.

 

2) 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. Any directives by the clinical supervisor on a given clinical problem or situation are expected to be executed by the attending staff members in a timely and effective manner with odd hours support of the clinical supervisor of up to 15 minutes per occurrence available at no extra fee. Should REAL’s case practice recommendations come into any conflict with business entity or agency policies, the staff will make it known to the clinical supervisor and their admin direct supervisor, their given agencies of the required actions on a case by the clinical supervisor.

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Limitation of Liability

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Notwithstanding anything to the contrary herein, under no circumstances will REAL’s total liability to the business entity or agency for any breach of this agreement exceed an amount equal to $228 equivalent to one group session hour.

 

1) REAL Supervision and Counseling Services will not be held liable for any treatment case recommendations that are not carried out by the supervisee of their business entity or agency supervisor/s admins etc. in a timely and effective manner as per states regs on best clinical practice of licensed mental health professional attending supervision.

2) The clinical supervisor reserves the right to hold or disapprove any supervisee's necessary paperwork if they do not meet basic competency, professional, or ethical and professional standards in clinical psychotherapy, with no contest or refund as per supervisors' appraisal /evaluation of the said supervisees progress.

3) The clinical supervisor will deliver the state required forms and 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 above AND payment is made by the agency or business entity. Accounts that are not paid in full will result in the hold on each staff members necessary attestation documents required for fulfillment of the state's requirement.

 

Responsibilities of each Supervisee:

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1. To follow best practice guidance in theory to practice applications as per directives by the clinical supervisor including but not limited to data collection, treatment planning, assessment, crisis response, discharge planning level of care and scope of practice.

2. Maintain and document by rotation the group supervision process attended in form of a Group Supervision Notes provided by REAL Supervision and Counseling Services Template.

3. To commit to sound and ethical practice principles as provided by the supervisor and previous educational institutions. This may include all scenarios of after-hours follow-up needed, including but not limited to collaboration or care coordination with other service providers to alleviate a client in crisis or in harm’s way.

4. To track all group supervision hours on supervisee’s behalf in the form of tracking log, attend training recommendations and or continuing educational credits.

5. To track all session types held in CPT codes, the date session is held and duration on a weekly basis. (i.e. 90834, 30min.45min or 60 minutes, intake 90791) 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 consistent and punctual attendance.

7. To establish clear and compliance standard held by the clinical supervisor psychotherapy notes if note review and signature at the hourly rate above is part of this agreement.

8.  To communicate timely high-risk needs of a particular case client and abide by mandated requirements or “next steps” based on the parameters of their licensure scope state specific guidelines if necessary, and directives provided by the clinical supervisor.

9. Any staff members attending of a business entity or agency 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.

10. To participate in role plays, presentations. Supervisor may attend session silently for observation.

 

 Lateness: Scheduled supervision hours are paid for in full regardless of lateness /minutes on behalf of the supervisee. As stated above, the clinical supervisor is not obligated to wait past a 15-minute lateness and a refund will not be issued.

Consistency, camaraderie, and a safe psychological space make for healthy group learning dynamics. If a staff member drops out indefinitely, replacements are allowed only within the first 12 weeks (about 3 months) of group supervision, without exceptions. R.E.A.L Supervision and Counseling LLC reserves the right to dismiss any member due to unprofessional conduct or failure to follow supervisory directives at any moment during the process without refund or reimbursement.

All Supervision conversations and guidance written, expressed, verbally, materials provided, clinical tools applied, trainings sites and processes are subject to transcription and or virtual recording by the clinical supervisor hired needed for reference material, training and follow up.

All related conversations and supervisory sessions are confidential and conducted via a HIPAA-secure Zoom link provided by the clinical supervisor.

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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.

 

Copy Rights.

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

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Cancellation/ Termination terms.

Either party can terminate this agreement before the 12-week restart time frame. The contract renews every 12 sessions/ weeks (about 3 months) after each payment. To cancel, either party reserves the right to simply not renew for the next quarter. Once all payments are reconciled and requirements met, the supervisor will provide the necessary documentation and attestation of supervision time to the supervisee of successful time attended and practiced. REAL Supervision and Counseling has the right to hold any necessary documentation necessary for non-payment or any outstanding balances for any given staff/employee by a business entity/private practice or agency and other reasons as stated above.

I have read, understand, and agree to the terms above of this agreement.

__________________________________________    Date ___________________

Business Entity or Agency Representatives        

Frist and Last name and title of staff anticipated to attend    

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