Chapter 5: Practicum

Chapter Overview

This chapter aims to outline recommended core components of a practicum inspired by (a) statewide educational partners who are implementing practicums and internships for their existing programs, and (b) potential BHSS practicum site placements.

Use the links below to jump to a particular section:

Practicum Definitions
Pre-Practicum Preparation
Practicum Hours
Site Supervisor Qualifications
Site Supervision
Clinical Sites
Practicum Educator/Academic Supervisor
Sample Practicum Templates
Things to Consider/Next Steps

How to Use This Chapter

SSB 5189 Section 8 (opens in a new tab) states BHSS students will complete a “supervised clinical practicum with demonstrated clinical skills in core competencies” as part of their baccalaureate training. This chapter in V1 is an advisory note for educational programs on the organization and implementation of a practicum. The DOH will lead rulemaking for the BHSS credential in 2023-2024. V2 of the Implementation Guide will include any revisions made during rule making that impact practicum.

Practicum Definitions

Academic Supervisor is a person responsible for overseeing the practicum course for academic credit.

Behavioral Health: There are varied definitions of behavioral health in policy and literature. RCW 71 and the subsequent WAC defines behavioral health as “the prevention, treatment of, and recovery from any or all of the following disorders: substance use disorders, mental health disorders, co-occurring disorders, or problem gambling and gambling disorders.” The Agency for Health Research and Quality or AHRQ employs the following definition for integrated care: “Behavioral health is an umbrella term that includes mental health and substance abuse conditions, life stressors and crises, stress-related physical symptoms, and health behavior” (2023). An expanded understanding of behavioral health is important to preparing the BHSS for a variety of work settings where behavioral health service delivery occurs.

Field Study: for the purpose of this chapter will be used interchangeably with practicum.

Internship: for the purpose of this chapter will be used interchangeably with practicum.

Mental Health: UMASS Global (n.d.) expands on the subtle difference between mental and behavioral health, stating:

“Behavioral health has more to do with the specific actions people take. It’s about how they respond in various scenarios. Two people who are experiencing similar emotions may react in very different ways. Mental health, on the other hand, has more to do with thoughts and feelings. It is specific to biological factors that influence our mental state.”

Practicum means a clinical experience under routine supervision that prepares the student for work in the behavioral health profession with opportunities for direct and indirect service to patients. A practicum is associated with a college or university course and involves assessment and evaluation of student progress developing proficiency as a BHSS. Practicum is frequently used interchangeably with internship in graduate programs, although there may be distinct differences at the graduate level (Hodges, 2021).

Shared Supervision is an arrangement between the degree granting institution and practicum site to collaboratively provide supervision to a student during the practicum experience. The site and academic supervisor routinely communicate about student progress and share information regarding student learning and application of learning to work with patients or clients. Generally, with patient consent, the educational institution provides supervision of skill development related to patient cases often through verbatim reports, audio recording, or video observations. The site supervisor manages acute concerns related to patient welfare. This is an optional arrangement to support the supervised practicum experience and not a requirement.

Site Supervisor is a person responsible for overseeing the practicum at an approved site for a BHSS practicum student.

Supervision of Supervision is an activity associated with the preparation of a clinical supervisor in the behavioral health professions. It means a novice supervisor is receiving supervision from an experienced supervisor as part of their professional development. Supervision of supervision is a recommended activity for persons seeking to become an approved supervisor in select behavioral health professions. Supervision of supervision is often accompanied by supervisor education.

Standards for Practicum

Pre-Practicum Preparation

Academic Preparation

Prior to starting a practicum, students have completed all courses identified by the higher educational institution as essential to starting a practicum. Due to the variability in course schedules at participating higher education institutions, the host college or university program will set standards for pre-practicum course requirements. We recommend that programs introduce students to the BHSS competencies with an emphasis on legal, ethical, and professional issues prior to starting a practicum.

Educational Institution

The practicum is part of a course, and the educational institution has an assigned faculty member overseeing the practicum, who acts as a point of contact for questions and emergencies from the student or practicum site.

Practicum Site Selection

The college or university provides support to students to identify an appropriate practicum placement. The practicum site understands their obligations to the student and relationship with the educational institution.

Practicum Site and Educational Institution Agreement

The educational institution provides a formal agreement to the practicum site that includes learning objectives, evaluation criteria, and procedures for managing urgent concerns.

Practicum Scope of Work

Students have an opportunity to engage in clinical practice appropriate to the bachelor-level BHSS. This will be discussed further in the Educator’s Guide, which was discussed in the Introduction of this Implementation Guide.

Liability Insurance

The educational institution verifies student holds liability insurance during practicum.

Practicum Hours

Total Practicum Hours

In V1 of this document, we are recommending a minimum of 240 total hours for practicum. These hours are usually distributed over 2-3 academic quarters. We determined the minimum hour requirement in consultation with current education partners.

Competency-Based Framework

The total number of recommended practicum hours is a minimum standard by which a student may demonstrate developing proficiency of the BHSS competencies. Through formative assessment procedures, programs and practicum sites should determine if the student has satisfactorily demonstrated proficiency with the BHSS competencies or if the practicum hours need to be extended to make this judgment. Programs should inform students that a practicum may be extended to assess a competency or competencies in which they are deficient or need more time to practice.

Direct Service Hours

Direct service examples include in-person face-to-face meetings, telehealth sessions, group sessions, and phone interactions where clinical skills are applied.

Indirect Service Hours

Indirect service examples are scheduling appointments, leaving messages, documenting time with patient or client, consultation, supervision, team meetings, and continuing education. Shadowing experienced providers is usually considered a form of indirect service. Educational institutions and practicum site supervisors may determine independently if a select number of hours shadowing meets criteria for direct service to accommodate individual circumstances.

Site Supervisor Qualifications

• Per SSB 5189, BHSS supervisors must be licensed “to assess, diagnose and treat identifiable mental and behavioral health conditions as part of their scope of practice” (2023).
• In Washington state, the following mental and behavioral health licensure types are the most common supervisors for BHSS practicum: LCSW, LMFT, LMHC, Psychologist, Psychiatrist, and Psychiatric Nurse. In rural and under-resourced areas of the State, an alternate form of shared supervision between a licensure type listed above and a licensed medical provider (MD, DO, ARNP, PA) is a strategy to increase behavioral health workforce within integrated care settings.
• The BHSS Project Team recommends licensed associates, interns, and residents from the above professions with supervisor education and who receive supervision-of-supervision be considered as potential practicum supervisors.

Site Supervision

We recommend the following options for practicum supervision:

• 1:1 Supervision between student and site supervisor.
• Triadic Supervision between two students and a site supervisor.
• Group Supervision between a site supervisor and approximately 5-6 students.
• Shared Supervision between educational program and the site.

The time dedicated to supervision should be proportional to the number of practicum students being supervised and the number of direct service hours delivered by the practicum student.

Supervision may be provided in person or virtually. Educational institutions may select standards for supervision appropriate to the mission of the program, such as requiring all supervision to occur in-person.

Clinical Sites

Practicum sites will usually be integrated care practices, healthcare clinics, hospitals, long-term care facilities, crisis services, social services, behavioral health agencies, or a setting where behavioral health care delivery occurs in a team-based setting on a regular basis.

Practicum Educator/Academic Supervisor

A practicum is part of a registered course. The educational institution will appoint a faculty member to facilitate the practicum experience with the responsibilities of verifying student practicum placement, maintaining regular contact with the practicum site, and verifying that evaluation forms are completed. The practicum educator usually holds a license to practice mental and behavioral health, however this is not a mandatory requirement when the site supervisor holds a valid credential.

Sample Practicum Templates

Available

• Supervisor Assessment of BHSS Student During Practicum – Evaluation Template (opens in a new tab)

Under Development

• Student Evaluation of Supervisor and Practicum Site
• Supervisor Evaluation of BHSS Academic Program

Things to Consider/Next Steps

• One of the most critical components to establishing a BHSS clinical training program will be the identification of practicum sites and practicum supervisors. The BHSS Clinical Training Program is interested in supporting collaborative spaces for identification of practicum sites. These efforts will likely be regionally based.
• There is often debate on the minimum hour requirement for a clinical practicum. For V1 of this Implementation Guide, the range of hours under consideration was 160-400. This range represents current practice among educational partners. There appears to be no clear evidence base for the number of hours needed to assess proficiency in practicum (Kaslow et al., 2005; Ko & Rodolfa, 2005). At the same time, research in counselor education has indicated that student self-efficacy is correlated with more internship hours and supervised work experience (Tang et al., 2004). Educational partners will likely want to strike a balance between sufficient time for a student to practice skills, with the resource costs to practicum sites when hosting and supervising a student. Several educational partners have a minimum standard that exceeds the 240-hour requirement, ranging from 266-400 hours. We recommend BHSS educational partners identify the standard that matches the overall mission and objectives for their respective baccalaureate program, with 240 hours as a minimum.
• A practicum is a capstone, in-vivo learning experience for a BHSS student. Successful practicums are well planned, organized, and supervised. Mutual understanding of evaluation criteria by all parties prior to the start of the practicum and the delivery of formative evaluation and summative evaluation help to anchor the practicum in a reliable structure to celebrate successes and address performance problems directly.

Summary

• The recommended minimum hours for a BHSS practicum are 240.
• Site supervisors will need to meet qualifications to qualify and will have to follow direct service hour and evaluation guidelines to supervise a BHSS student.
• The BHSS Project Team will provide more practicum resources as they are created or become available.

Up Next

By now, you should have a solid understanding of the rationale behind and scope of the BHSS curriculum. In the next chapter – Chapter 6. BHSS Curriculum Map – we will introduce you to the BHSS Clinical Training Program’s curriculum map to describe the development process, outcomes, and suggested sequencing of the BHSS curriculum.