Washington Association for Infant Mental Health · Intro to RS for Supervisors_Online

Introduction to Reflective Supervision for Supervisors

October 5, 6, 12, & 13 | Tuesdays & Wednesdays | 9:00am - 12:30pm PST

Online

Training & monthly consultation: $905 (no CEUs) | $950 (with CEUs)

This is a professional development opportunity for supervisors to receive training on how to use reflective supervision (RS) with your supervisees, as well as to receive ongoing monthly reflective supervision/consultation (RS/C) from WA-AIMH to support you as you begin to implement RS with your supervisees. This opportunity will require a 12 month commitment. Services from WA-AIMH include:

2-day Introduction to Reflective Supervision for Supervisors training
12 months of web-based group RS/C

WA-AIMH will schedule monthly RS/C meetings in coordination with group members.

Are you completing this registration form for yourself or someone else (e.g., a staff member)?

Myself

Someone else

Have you received a registration code from WA-AIMH?

Yes

Please enter your registration code exactly as you received it from WA-AIMH.

Contact Information

Name

First Name

Last Name

Verify Email

Type of email?

Personal

Work

Organization/Employer

Program model, if applicable (e.g., home visiting model)

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Are there accommodations that you will need in order to participate in this training?

Yes

If yes, please describe below or email us at training@wa-aimh.org.

Training Materials

We will be sending you a print copy of the Region X Reflective Supervision Guidelines and Self-Assessment Tools. If you would like these mailed to a different address than the one above, please enter it here.

Would you also like a copy of the Self-Assessment Tools in Spanish? (The RS Guidelines are only available in English at this time.)

Yes

Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Requirements

Are you able to participate in all 4 days of the 12-hr training?

Yes

Do you have some flexibility and capacity in your schedule to attend a monthly (1.5 hour) online RS/C session with WA-AIMH for 12 months following the initial training (days/times to be determined by the group)?

Yes

Are you able to participate in the workshop and group RS/C through web-based technology? (You will not need to pay or sign up for a service, but please ensure that you have reliable internet and webcam capability)

Yes

Do you have a graduate degree?

Yes

Your RS/C Experience

Please help us understand your background in receiving and/or providing RS/C.

Have you received RS/C currently or in the past? If yes, please describe (how long, group or individual, etc.):

Have you provided RS/C currently or in the past? If yes, please describe (how long, group or individual, etc.):

Do you have prior training on RS/C? If yes, please describe.

Will you be providing RS over the next year, over the course of the monthly RS/C calls? If yes, please describe below (to how many supervisees will you be providing RS, will it be group or individual, etc.):

Are you Endorsed or seeking Infant Mental Health Endorsement?

Yes

Training Demographics Survey

Optional: The data collected below allows us to better understand our training participants and can help us communicate our impact to scholarship funders. Data is only reported for groups as a whole--your individual information will be kept confidential. By filling out the survey below, you are acknowledging that the information you provide can be included in WA-AIMH summaries and reports. Please provide any information that you are comfortable sharing. WHEN YOU ARE FINISHED, PLEASE CLICK 'SUBMIT' AT THE BOTTOM TO COMPLETE YOUR REGISTRATION.

Highest degree earned

High School/GED

CDA

Associates

Bachelors

Masters

Doctorate

Medical or Law

Field Employed (other)

Years worked with infants, young children, and families

Less than 2 years

2 - 5 years

5 - 10 years

10+ years

Individual annual income

<$10,000

$10,000-$30,000

$30,000-$50,000

$50,000-$70,000

$70,000-$90,000

$90,000+

Do you directly support families on a weekly basis?

Yes

Do you supervise staff who directly support families?

Yes

Ethnic background (self-describe)

Please describe.

Please describe your gender (if desired).

Do you live in the community you serve?

Yes

CEUs

Would you like to receive CEUs?

CEUs will be available for mental health professionals. The CEU fee is $45 for 12 hours.

Yes

Payment

You must click "submit" at the bottom of the page to complete your registration and proceed to payment.

Registration Amount

$0 - Registration fees waived

Registration Amount

$905 - Training & monthly RS/C (no CEUs)

$950 - Training & monthly RS/C (with CEUs)

Please click "submit" to complete your registration below.

We will contact you to confirm your registration.

Add 3% to my total amount to help cover the payment processing fees