TX HHS Form 3260. Licensed Chemical Dependency Counselor Intern Supervision Assessment

The TX HHS Form 3260, "Licensed Chemical Dependency Counselor Intern Supervision Assessment," is a crucial tool for clinical training institutions (CTIs) and certified clinical supervisors (CCSs) to evaluate the supervision of licensed chemical dependency counselor interns (LCDC-Is). This form helps ensure that LCDC-I candidates receive quality training and guidance during their internship period.

The assessment consists of five sections, including information about the CTI site, CCS, internship details, supervisor evaluation, and GovDelivery updates. Key features include required information such as CTI site name, CCS name and license type, internship start and end dates, and supervisor observation frequency. The form also asks LCDC-I candidates to rate their supervision experience, providing valuable feedback for the CTI and CCS.

This form should be used by clinical training institutions (CTIs) and certified clinical supervisors (CCSs) to assess the supervision of licensed chemical dependency counselor interns (LCDC-Is) under their care. The completed form must be mailed directly to the Texas Health and Human Services Commission or emailed to [email protected] for processing. By using this form, CTIs and CCSs can ensure compliance with Texas Administrative Code Title 26 Section 562.21(m) and provide a comprehensive evaluation of LCDC-I supervision.