Fitness and Developmental Practice Workbook

Educational and supervisory decision aid

Fitness to Enter Practice

Educational and Supervisory Decision Aid. This instrument is not a validated psychometric measure. Use reflection, interview, observation, and professional judgment. It does not replace applicable employment law, disability law, professional regulation, clinical evaluation, or organizational policy. No total score is calculated.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Part A: Learner Reflection

What is bringing you into psychedelic practice at this point in your life?

What do you hope participation in this work gives you personally, professionally, relationally, spiritually, or financially?

Which parts of your own history most strongly shape the way you respond to people who are suffering?

Are there particular experiences or populations with whom you expect to identify strongly? What makes those situations personally significant?

What happens internally when somebody refuses your help?

What happens when another person is more qualified than you to provide what somebody needs?

How do you usually respond when someone gives you difficult feedback?

Describe a recent situation in which you realized that your original interpretation of another person was wrong.

What are the signs that you are becoming emotionally overloaded?

What are the signs that you are becoming overly invested in another person’s choices or outcomes?

How do you recognize when you need consultation?

What sources of support exist in your life outside psychedelic practice?

What parts of your identity remain meaningful if you never become a facilitator?

How do you currently care for unresolved personal material that may become activated by this work?

What would make you decide that you should delay entering practice?

What would make you voluntarily step out of a participant facing role after entering practice?

What does being “helpful” mean to you when the most appropriate action is to remain quiet, wait, or find somebody else?

Describe your understanding of confidentiality and the limits of what may be discussed outside the practice environment.

Describe how you would respond if a senior practitioner instructed you to do something that you believed placed a participant at risk or crossed an ethical boundary.

What would you want a supervisor to notice about you before you noticed it yourself?

Part C: Scenario Review

A participant tells you privately that they trust you more than the lead facilitator and asks you not to tell the rest of the team about something that may affect their safety. Describe what you would do and why.

A participant’s history closely resembles your own. You feel an immediate connection and become convinced that you understand what they are going through. During the session, they reject a suggestion that was personally important in your own recovery. Describe what you notice in yourself and what you do next.

A participant tells you that you are the first person who has ever truly understood them. They begin contacting you frequently outside the established communication structure. Describe how you would respond.

You believe that a participant is becoming medically or psychologically unstable. The person supervising you appears unconcerned. Describe your next steps.

A participant has an experience that conflicts strongly with your spiritual beliefs. They ask you what you think it means. Describe how you would respond.

You have been helping in the program for several months and believe you are ready for more responsibility. Your supervisor disagrees. Describe how you would handle the disagreement.

You notice yourself strongly disliking a participant. You remain outwardly polite, though you notice impatience and a desire to avoid them. Describe what you would do with that information.

You are exhausted after a difficult personal week. You have already committed to helping with a session and know the team is short staffed. Describe how you decide whether to attend.

A participant asks you for advice that falls outside your training. You believe you know the answer from personal experience. Describe what you would do.

A participant’s improvement makes you feel unusually proud and personally responsible for their progress. Describe how you would examine that reaction.

Part D: Entry Decision

Select the current decision

Ready To Enter Practice

Ready To Enter Practice With A Development Plan

Entry Deferred

Insufficient Information

○ Ready To Enter Practice ○ Ready To Enter Practice With A Development Plan ○ Entry Deferred ○ Insufficient Information

Ready To Enter Practice: The learner currently demonstrates sufficient stability, reliability, reflective capacity, boundary awareness, supervision readiness, and role understanding to begin participating within the responsibilities assigned to an entry level learner.
Ready To Enter Practice With A Development Plan: The learner can enter the practice environment with clearly identified supports, limits, supervision needs, or developmental goals. The plan must define responsibilities, supervision frequency, concerns being monitored, and the conditions under which the plan will be reviewed.
Entry Deferred: Current concerns would make participant facing involvement inappropriate at this time. The decision should identify functional concerns and, whenever possible, the conditions under which entry may be reconsidered.
Insufficient Information: The program does not yet have enough information to make a responsible determination.

Decision rationale

Required supports

Role limitations

Supervisor responsible

Date of review

Conditions for progression

Learner comments

Supervisor comments

All fitness instruments

Educational and supervisory decision aid

Orientation Completion Record

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Completion review

Learner

Educator

Date

Assigned role

Named supervisor and contact procedure

Outstanding learning needs

Learner acknowledgment of role limits

All fitness instruments

Educational and supervisory decision aid

Observation Guide

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Observation

What did the practitioner do to establish safety and trust?

What information appeared to influence the practitioner’s decisions?

When did the practitioner speak?

When did the practitioner remain quiet?

What signs of participant distress did you notice?

What signs did the practitioner notice that you initially missed?

Where did participant autonomy become visible?

Where did power become visible?

Were there moments when the practitioner consulted another team member?

What prompted consultation?

Did the practitioner appear emotionally affected at any point?

How did they manage it?

Were boundaries tested?

How were they maintained?

What assumptions did you make about the participant that later changed?

What did you want the practitioner to do that they chose not to do?

What did you learn from that restraint?

What would have changed the safety picture?

What questions do you want to bring to supervision?

Debrief

Post observation supervisor debrief

All fitness instruments

Educational and supervisory decision aid

Supervised Helping Observation Record

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

All fitness instruments

Educational and supervisory decision aid

Supervised Participant Support Observation Record

Some questions describe useful behavior and others describe concerns. Interpret the narrative evidence in context; these responses are not a score.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

All fitness instruments

Educational and supervisory decision aid

Developmental Supervision Record

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Supervised encounter

Learner

Supervisor

Date

Setting

Learner stage

Participant contact type

Responsibilities assigned

Responsibilities actually performed

Unexpected events

Consultations requested

Escalations performed

Areas of strong performance

Areas requiring coaching

Boundary observations

Countertransference or strong relational reactions discussed in supervision

Scope issues

Documentation quality

Response to feedback

Readiness for increased responsibility

Progression decision

Select the current decision

Remain at current stage

Increase selected responsibilities

Advance to next developmental stage

Add targeted supervision

Pause participant contact pending review

Return to an earlier level of responsibility temporarily

○ Remain at current stage ○ Increase selected responsibilities ○ Advance to next developmental stage ○ Add targeted supervision ○ Pause participant contact pending review ○ Return to an earlier level of responsibility temporarily

What does this learner need to demonstrate next?

Review date

All fitness instruments

Educational and supervisory decision aid

Competence to Assume Responsibility Review

Entrustment applies only to the role, setting, population, and responsibilities described here. It does not override licensure, law, organizational policy, credentialing, medical scope, or future changes in the practitioner’s fitness.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Review context

Practitioner

Reviewer

Review date

Proposed scope of responsibility

Settings covered by decision

Population limitations, if any

Jurisdictional or credential limitations, if any

Evidence reviewed

Final decision

Select the current decision

Entrusted for defined responsibility

Entrusted with conditions

Additional supervised practice required

Entrustment deferred pending remediation

Insufficient evidence

○ Entrusted for defined responsibility ○ Entrusted with conditions ○ Additional supervised practice required ○ Entrustment deferred pending remediation ○ Insufficient evidence

Defined scope of entrustment

Excluded responsibilities

Required consultation

Required continuing supervision

Date for review

Conditions that would require reassessment

Supervisor rationale

Practitioner acknowledgment

All fitness instruments

Educational and supervisory decision aid

Fitness to Facilitate Now

Pre Session and Pre Shift Readiness Check. This is a structured professional decision aid, not a validated diagnostic or psychometric instrument.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Physical Capacity

How much sleep have I had during the period relevant to this assignment?

Is that amount adequate for the expected length and demands of the responsibility I am about to assume?

Am I ill?

Am I experiencing pain that is interfering with attention, movement, judgment, or patience?

Am I experiencing medication effects that could impair attention, reaction time, coordination, judgment, or emotional regulation?

Am I experiencing intoxication, withdrawal, or residual effects from alcohol, cannabis, psychedelics, sedatives, stimulants, or another psychoactive substance?

Can I physically perform the duties assigned to me?

Cognitive Capacity

Is my attention clear?

Am I tracking information normally?

Can I sustain concentration for the expected period of responsibility?

Am I unusually forgetful, distracted, confused, cognitively slowed, or preoccupied?

Can I follow procedures accurately?

Can I communicate clearly?

Can I document accurately?

Emotional Capacity

Am I carrying acute grief, anger, fear, panic, conflict, or another emotional state that is repeatedly capturing my attention?

Can I remain present with participant distress without needing the participant to regulate me?

Do I have enough capacity to tolerate crying, anger, confusion, fear, rejection, silence, and uncertainty today?

Have I noticed unusual irritability, urgency, emotional flooding, numbness, or withdrawal in myself?

Relational Capacity

Do I have a prior relationship with this participant that could influence my judgment?

Am I experiencing strong attraction, aversion, protectiveness, fear, resentment, admiration, rescuing impulses, competitiveness, parental feelings, or overidentification toward this participant?

Is there unresolved conflict between us?

Do I need a particular response, decision, or outcome from this participant?

Would another practitioner be able to approach this participant with greater neutrality?

Ethical Capacity

Are my boundaries clear?

Is there a conflict of interest?

Are there dual relationships that require review?

Can I respect this participant’s decisions even when I disagree?

Am I prepared to protect confidentiality?

Can I recognize the difference between my beliefs and the participant’s beliefs?

Professional Capacity

Is this assignment within my actual training and scope?

Do I understand exactly what I am responsible for?

Do I understand what I am not responsible for?

Do I know who assumes responsibility when something exceeds my role?

Are there participant needs today that exceed my competence?

Operational Capacity

Is staffing adequate?

Is qualified backup actually available?

Do I know how to reach that person?

Is the handoff process clear?

Are emergency procedures available and functional?

Can I take an appropriate break or transfer responsibility without leaving the participant unsupported?

Has anything changed since the plan was created?

Decision

Select the current decision

Fit To Facilitate

Fit With Modification Or Additional Support

Not Fit For This Assignment

○ Fit To Facilitate ○ Fit With Modification Or Additional Support ○ Not Fit For This Assignment

Fit To Facilitate: No identified issue is currently interfering with safe performance of the assigned role.
Fit With Modification Or Additional Support: A concern exists that can be responsibly managed through a change in duties, additional supervision, shorter responsibility period, additional staffing, participant reassignment, consultation, or another defined modification.
Not Fit For This Assignment: The practitioner’s current condition or the available system of support does not permit safe performance of the assigned responsibility.

Concern identified

Modification required

Person responsible for approving modification

Additional supervision

Responsibilities removed

Relief coverage

Participant reassignment if applicable

Time for reassessment

When not fit for this assignment

Transfer responsibility before participant care continues. Document the operational handoff according to organizational policy. Share functional information needed for a safe assignment and protect unnecessary private medical or psychological details.

Private note

All fitness instruments

Educational and supervisory decision aid

In Session Fitness Change and Handoff Record

Use functional information relevant to safety and handoff. Keep unnecessary personal psychological details out of operational records.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

All fitness instruments

Educational and supervisory decision aid

Post Session Practitioner Debrief

Private reflection and team debrief can be printed separately. Personal reflections belong only in the setting where you choose to share them. Serious ethical violations still require appropriate accountability.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

Private reflection

What am I still carrying from this session?

Which moments affected me most strongly?

Did I feel unusually protective, irritated, fearful, attracted, helpless, proud, rejected, or responsible?

Did I want the participant to make a particular decision?

Did I disclose anything about myself? What function did that disclosure serve?

Were there moments when my own history became especially present?

Did I remain within scope?

Did I ask for help when I needed it?

Was there a moment when I should have asked earlier?

Did I notice fatigue affecting my performance?

Is there anything from this session that needs supervision?

Is there anything from this session that belongs in my own therapy, recovery support, mentoring, or personal life rather than in supervision?

Am I ready to assume another participant facing responsibility?

Team debrief

What occurred?

What went well?

What changed unexpectedly?

Were there communication failures?

Were there staffing problems?

Were roles clear?

Was escalation timely?

Did any team member appear overloaded?

Was relief coverage adequate?

Did the system create avoidable strain?

Does any protocol need revision?

Does any practitioner require additional support, supervision, or time away from participant responsibility?

All fitness instruments

Educational and supervisory decision aid

Organizational Fitness Review

Use observed behavior, reflection, and supervisory judgment. This tool has no numerical score and has not been validated as a psychometric measure.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

Record context

Name or local identifier

Date

Setting and assigned role

All fitness instruments

Educational and supervisory decision aid

Ibogaine Fitness to Assume Responsibility Now

Complete the general Fitness to Facilitate Now assessment first. Modification or handoff must occur before responsibility continues when a concern compromises safe performance.

Your responses stay in this browser session and are not submitted or stored. Reloading or leaving the page clears them. Printing or saving a PDF creates your own copy under your control. Use these tools according to the privacy requirements of your setting. Responses entered on this website are not intended to create a clinical record or personnel record.

I am assigned monitoring responsibilities

Record context

Name or local identifier

Date

Setting and assigned role

Role Clarity

What is my assigned role for this participant?

What responsibilities do I hold?

What responsibilities are explicitly outside my role?

Who holds medical responsibility?

Who is responsible for cardiac monitoring?

Who is responsible for medication decisions?

Who can authorize emergency intervention?

Who assumes my responsibilities if I need relief?

Fatigue and Vigilance

How long is my expected period of responsibility?

How much sleep have I obtained during the relevant period?

Is my alertness adequate for sustained observation?

When is my planned relief?

Who is providing relief?

Am I already carrying fatigue from another participant or shift?

Has the program scheduled overlapping responsibilities that could interfere with monitoring?

Participant Specific Awareness

Have I received the information necessary for my role regarding this participant’s current condition?

Do I know the participant’s relevant medical and medication concerns to the extent required by my role?

Do I know the current safety plan?

Do I know what changes require immediate escalation?

Do I know the participant’s mobility status?

Do I know what assistance is required for movement?

Do I know whether vomiting or aspiration risk requires specific precautions within the established protocol?

Emergency Readiness

Are required emergency resources present and functioning according to protocol?

Does each person know their emergency role?

Is the route for higher level care established?

Is communication equipment functional?

Can emergency services be activated immediately when required?

Is there enough staff to manage the participant while another person obtains additional help?

Mobility and Physical Support

Is adequate staff support available for participant movement?

Does the assigned person understand the participant’s current fall risk?

Is the environment arranged to reduce avoidable mobility hazards?

Is assistance available for toileting or other necessary movement?

Handoff

Participant condition

Current monitoring status

Recent changes

Symptoms

Mobility status

Vomiting or hydration concerns relevant to assigned role

Outstanding medical concerns

Outstanding psychological concerns

Medications or interventions already provided by authorized personnel

Pending reassessment

Current safety concerns

Receiving practitioner confirmation

Time responsibility accepted

Ibogaine Fitness Decision

Select the current decision

Fit for assigned ibogaine responsibility

Fit with modification

Not fit for assigned ibogaine responsibility

○ Fit for assigned ibogaine responsibility ○ Fit with modification ○ Not fit for assigned ibogaine responsibility

Modification or handoff required

Person accepting responsibility

Time of reassessment

All fitness instruments

Fitness and Developmental Practice Workbook

Record context

Part A: Learner Reflection

Part B: Structured Interview Domains

Part C: Scenario Review

Part D: Entry Decision

Record context

Orientation topics

Completion review

Record context

Observation

Debrief

Record context

Observed behavior

Record context

Participant interaction

Record context

Supervised encounter

Progression decision

Record context

Review context

Evidence of competence

Final decision

Record context

Physical Capacity

Cognitive Capacity

Emotional Capacity

Relational Capacity

Ethical Capacity

Professional Capacity

Operational Capacity

Decision

When not fit for this assignment

Record context

Change identified

Decision

Record context

Private reflection

Team debrief

Record context

Organizational conditions

Record context

Role Clarity

Fatigue and Vigilance

Participant Specific Awareness

Emergency Readiness

Mobility and Physical Support

Handoff

Ibogaine Fitness Decision