Orchard Supervision Agreement

This Agreement is intended to operate together with the applicable university-Orchard affiliation agreement or MOU, the student’s Orchard internship or practicum agreement and policies, university field-placement documents, and any separate agreement governing the supervisor’s relationship with Orchard or the university. It does not replace those documents. If documents impose compatible requirements, all applicable requirements will be followed. If provisions materially conflict, the parties will consult promptly, with mandatory Georgia clinical-practice and client-safety requirements controlling services delivered through Orchard in Georgia.

This Agreement is effective for the placement term identified above unless ended earlier by Orchard, the university, the supervisor, or the student in accordance with applicable agreements and policies. Material changes to the designated supervisor, supervision structure, or clinical role should be documented in writing. Electronic signatures and counterparts may be accepted to the extent permitted by the participating organizations.

Client information may be discussed with the university only to the extent permitted by law, informed consent, applicable educational requirements, and Orchard policy. Case material used for academic purposes must be de-identified unless a lawful and authorized basis permits otherwise. The student will use only Orchard-approved systems, devices, communication methods, telehealth platforms, and documentation procedures for clinical work unless written authorization provides otherwise. Audio or video recording of sessions is prohibited unless specifically authorized by Orchard and the supervisor and completed with all legally and ethically required client consent and safeguards. Client information will not be stored on personal devices, in personal email, or in personal cloud storage at any time, including temporarily.

The student must follow Orchard’s current emergency, crisis, mandated-reporting, and escalation procedures. In an emergency, the student will prioritize immediate client safety and use available emergency resources while contacting the designated clinical supervisor or Orchard’s identified backup clinician as soon as practicable. The student may not delay emergency action solely because the primary supervisor is unavailable. Crisis resources. 911 in the client’s jurisdiction · 988 Suicide & Crisis Lifeline · Georgia Crisis & Access Line 1-800-715-4225. The student will confirm the client’s physical location at the start of every session so emergency services can be directed accurately.

Georgia Composite Board: Ga. Comp. R. & Regs. Ch. 135-5 (Requirements for Licensure), including Rule 135-5-.02 for Professional Counselors and applicable social work provisions; Ch. 135-7 (Code of Ethics); Ch. 135-9 (Continuing Education); Rule 135-11-.01 (TeleMental Health), as amended. CACREP, when applicable: 2024 CACREP Standards, Section 4, including written supervision agreement requirements for practicum and internship. CSWE, when applicable: current Educational Policy and Accreditation Standards for field education. Template note. This document is an administrative and clinical training template, not legal advice. Orchard should have counsel review the final form for organizational use and update it when applicable law, Board rules, accreditation standards, university requirements, or Orchard policies change.

Governing clinical standards

Services under this placement are delivered through The Orchard Human Services, Inc. to clients located primarily in Georgia. The student and supervisor will comply with applicable Georgia law and the rules and ethics requirements of the Georgia Composite Board of Professional Counselors, Social Workers and Marriage and Family Therapists, as applicable to the discipline and services provided, and with the requirements of any other jurisdiction in which services are authorised and delivered. Client location governs. Authority to practise follows the client’s physical location at the time of each session, not the client’s residence or mailing address. The student will confirm and document the client’s location at the start of every session. Where a client is located outside Georgia, the student will not proceed until the supervisor has determined in advance what, if anything, may lawfully be provided in that jurisdiction. Student location. The student will inform Orchard of the state from which they will deliver services and will notify the supervisor before delivering services from any other state. Some jurisdictions regulate practice originating within their borders; where the student’s location raises a question, clinical work will not proceed until it is resolved with the supervisor. University and accreditation requirements. The student will also comply with applicable university requirements and, when applicable, programmatic accreditation standards such as CACREP or CSWE requirements. University or accreditation requirements may impose additional educational or supervisory expectations when those requirements are consistent with Georgia law, Board rules, client welfare, and Orchard policy. Conflict. If a university requirement conflicts with a mandatory Georgia clinical-practice requirement or Orchard client-safety policy, the parties will promptly consult. Clinical services at Orchard will not be performed in a manner that violates applicable Georgia law or Board rules. Out-of-state contact is a supervisor decision, never the student’s. Definitions of practice vary considerably between jurisdictions. The student will raise any out-of-state situation with the supervisor in advance wherever possible, and will not make the determination independently or change the nature of a session mid-session. No automatic licensure credit. This Agreement documents graduate practicum or internship supervision. It does not promise, certify, or guarantee that any particular hour will qualify toward future licensure in Georgia or another jurisdiction. The student is responsible for confirming licensure-credit requirements with the relevant licensing authority.

TeleMental Health requirements

Orchard delivers services almost exclusively by secure telehealth. The following applies to every placement. Before delivering any clinical TeleMental Health, the student will complete the training required by Ga. Comp. R. & Regs. r. 135-11-.01 and by Orchard policy, and Orchard will retain evidence of completion. Where supervision is itself delivered by telehealth, the supervisor will meet the additional training requirement applicable to supervisors under that rule. The student will obtain and document verbal and written informed consent specific to TeleMental Health before the first session, using Orchard’s approved consent documents. The student will use only Orchard-approved platforms for which a business associate agreement is in place, and will follow Orchard’s session-start procedures for identity, location, privacy, and safety at every session. The student will follow Orchard’s connection-failure and crisis protocols, including confirming a working callback number and the client’s physical address at the start of each session. This is a placement requirement, not a formality. Delivering clinical TeleMental Health before completing the required training is a Board-rule violation for the licensee and a supervision failure for the supervisor. No client contact by telehealth occurs before the requirement is met and documented.

Student / Intern

Practice only within the scope authorized by the university, Orchard, the designated supervisor, and applicable law and Board rules.
Identify themselves accurately as a graduate student or intern and make required disclosures to clients regarding trainee status, the supervisor’s name and credentials, and that the supervisor has access to the record.
Attend supervision as scheduled; prepare cases honestly and completely; disclose clinical risk, errors, boundary concerns, complaints, and incidents promptly.
Complete documentation, time records, university evaluations, and Orchard records accurately and on time; protect confidentiality and follow HIPAA and Orchard privacy and security policies.
Not independently change treatment plans, disposition, level of care, or crisis response when supervisor consultation is required by policy, competence, or client risk.
Maintain professional liability insurance in the amount required by the university or Orchard, whichever is greater, and provide proof of coverage before client contact begins.
Complete all Orchard onboarding requirements before client contact, including required training modules, background screening where applicable, and platform and documentation orientation.

Orchard Clinical Supervisor

Provide clinical supervision consistent with the supervisor’s license, competence, Georgia requirements, and the student’s discipline and assigned activities, and retain clinical responsibility for services delivered by the student at Orchard.
Monitor the student’s clinical development, documentation, ethical conduct, client safety, and scope of competence, and provide corrective feedback, remediation, or restriction of duties when needed.
Maintain required supervision records and participate in evaluation and consultation with the university.
Be reasonably available, or ensure a qualified clinical coverage process is available, for consultation concerning urgent clinical matters arising within the student’s assigned Orchard duties.

University Faculty / Program Supervisor

Communicate academic and field-placement expectations, evaluation requirements, required supervision frequency, and any program-specific limitations relevant to the placement.
Consult with Orchard and the site supervisor at the frequency required by the program and when student performance, remediation, client safety, or placement continuation requires coordination.
Provide timely notice of material changes in the student’s academic standing or placement authorization that affect clinical participation, subject to applicable privacy requirements.

Authority and escalation

Orchard and the designated supervisor retain authority to determine whether the student is sufficiently trained, competent, and ready to perform a particular clinical activity at Orchard. University approval of a placement or assignment does not independently authorize a student to perform an activity that Orchard or the supervisor determines is outside the student’s competence, scope, training level, or authorized role. The supervisor may increase supervision, require additional training, limit or suspend clinical activities, reassign cases, require remediation, or remove the student from client contact when reasonably necessary for client welfare, ethical compliance, or safe practice. The student must immediately seek supervision for situations involving imminent risk of harm, suspected abuse or neglect, serious deterioration, threats, medical emergency, mandated-reporting concerns, boundary violations, subpoenas or legal demands, or other circumstances identified by Orchard policy as requiring escalation. Self-harm, suicidality, and homicidality are never the student’s independent determination. The student will not decide alone whether risk is manageable, whether a safety plan is adequate, or whether anyone needs to be notified.

By signing, the parties acknowledge their respective roles in this graduate practicum or internship placement and agree to communicate promptly about material concerns affecting student learning, supervision, ethical practice, or client safety.