Report - The Association of Counseling Center Training Agencies by gegeshandong

VIEWS: 2 PAGES: 13

									                   INTERN EVALUATION FORM: PRIMARY SUPERVISION
                           University of San Diego Counseling Center

Name of Intern:                                          Semester:                        Year:

Name of Supervisor:

Methods of Evaluation:
               Client File Review                            Tape Review

               Case Presentation                             Client Satisfaction Survey

               Co-Counseling                                 Direct Observation

               Case Discussion




  RATINGS:
    5 Significantly above current expected level of competency.
       This rating signifies performance that is well above what would be expected for an intern who
       was successfully completing internship. This may be a significant area of expertise for this
       intern, or a skill that is far above what would ordinarily be seen.
     4 Above current expected level of competency

       This rating indicates that the intern is performing quite well and is surpassing expectations.
     3 At current expected level of competency
       This rating indicates that the intern is performing at the level of an intern who is meeting
       expectations. This means that the intern is doing well and is on track in this area to
       successfully complete internship. Most interns would be expected to receive a large number of
       3 ratings.
     2 Below current expected level of competency
       Many interns may receive a couple of 2 ratings, signifying an area in which the intern requires
       some additional work. This should indicate an area for further experience or more focused
       work in supervision.
     1 Significantly below current expected level of competency.

       Interns receiving this score should know that in this area, they are performing significantly
       below expectations for interns, and are likely to require formal remediation in this area.


Passing grades constitute an average of "3" in each area, with no more than two scores of two or less.




                                              Page 1 of 13
          Goal I. To train interns in the development of the professional skills, behaviors
                                         and identity necessary to…

Objective A. …cultivate appropriate ethical strategies and decision making skills.

* Competency 1. Interns will develop and demonstrate appropriate ethical thinking and decision
making.
        a. Knowledge of APA ethical principles.
        b. Knowledge of California laws and regulations relating to the practice of psychology.
        c Actively seeks out and recognizes relevant ethical and legal issues emerging in
       diff different professional activities.
        d. Awareness of power differentials that influence different professional roles.
         e Seeks consultation regarding ethical quandaries.
         f Uses an ethical decision making model.
         g Integrates ethical and legal understanding in performance of all competency areas.
        h Applies ethical and legal principles to decision making.
         i Keeps appropriate boundaries in professional relationships (e.g., clients, supervisees.)
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Comments:




                                              Page 2 of 13
Objective B. …manifest appropriate understanding of and sensitivity to diversity issues, and to
integrate such understanding into all forms of service delivery.

* Competency 2. Interns will demonstrate knowledge of sensitivity to, and skill in addressing diversity
issues in their professional work.
         a. Demonstrates broad knowledge about diversity variables.
         b. Has shown awareness of stages of ethnic identity development, acculturation and other
             aspects of diversity.
         c. Uses awareness of salient client diversity issues to inform assessment and treatment planning.
         d. Modifies treatment plans incorporating awareness of cultural issues.
          e. Provides culturally sensitive treatment.
          f. Utilizes respectful, culturally inclusive language in professional communication.
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Comments:




Objective C. …cultivate an attitude of scientific mindedness that informs their professional
work.

* Competency 3. Interns will show knowledge of outcome research and scholarly writing
that informs their treatment choices, and will investigate further information when necessary to aid in
the psychological services they provide.
         a. Demonstrates knowledge of relevant outcome research and theoretical writing pertinent
            to the treatment of client concerns.
         b. Utilizes outcome research and theoretical writing pertinent to the treatment of client
            concerns in clinical decision making.
         c. Is proactive in seeking out relevant materials that may supplement the intern’s knowledge
             about clinical issues.
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Comments:




                                              Page 3 of 13
Objective D. …establish and maintain appropriate and effective professional relationships with
individuals, groups, and communities.

*Competency 4. Interns will relate effectively with clients, colleagues, and members
of the community.
         a. Establishes and maintains effective and respectful relationships with clients.
         b. Establishes and maintains effective and respectful relationships with peers.
         c. Establishes and maintains effective and respectful relationships with supervisors.
         d. Establishes and maintains effective and respectful relationships with members
            of the university community.
         e. Successfully engages in interdisciplinary collaboration as evidenced by
            collaborative referrals to other departments or professionals.
         f. Communicates clearly in written and verbal formats.
         g. Maintains appropriate professional image in the community.
         h. Demonstrates flexibility in responses to changes in agency, clients, etc.
         i. Demonstrates understanding of and respect for different perspectives.
         j. Demonstrates the ability to provide effective feedback to others.
         k. Demonstrates the ability to receive feedback non defensively.
         l. Is a team player and pitches in when needed.
         m. Ability to negotiate differences with others and handle conflict.
         n. Possesses affect tolerance as shown by the ability to maintain professionalism in
            difficult circumstances.
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Comments:




                                              Page 4 of 13
Objective E. …demonstrate the self awareness necessary to function effectively and competently
as psychologists.

* Competency 5. Interns will develop an attitude of self reflectiveness that allows for accurate
assessment of their own strengths, challenges, and needs.
       a. Monitors internal states and the potential influence these may have on performance.
       b. Actively seeks to address self-care needs identified in through introspective reflection.
       c. Is aware of strengths and weaknesses and seeks to effectively address these.
       d. Is aware of own biases, needs, personal beliefs and values, and the potential influence
           these may have on others, as well as on professional decision making.
       e. Is aware of own multiple identities and roles, and the potential impact these may
           have on others.
       f. Routinely self evaluates clinical performance by reviewing session recordings.
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Comments:




Objective F. …engage in supervision and consultation experiences in an
effective and meaningful way.

Competency 6. As preparation for seeking out consultation in an ongoing way throughout
their professional careers, interns will seek out and utilize supervision in an open and reflective
manner.
        a. Is open to feedback.
        b. Seeks additional consultation when needed.
        c. Participates actively in consultation groups.
        d. Takes initiative and actively participates in supervision process.
        e. Provides session recordings regularly, on at least a weekly basis.
        f. Demonstrates willingness to take risks and expose areas of growth.
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Comments:




                                               Page 5 of 13
Objective G. …maintain accountability for professional activities.

Competency 7. As emerging professionals, interns will demonstrate their ability to take on and fulfill
professional responsibilities in a proactive and responsible manner.
        a. Participates actively in seminars and other training activities.
        b. Is reliable and competent in completion of documentation, report writing
            and other commitments.
        c. Is on time for professional activities.
        d. Maintains appropriate deportment (professional dress, demeanor, responsiveness.)
        e. Maintains accurate electronic schedule.
        f. Maintains log of clinical hours and professional activities, and provides this for
             supervisory review weekly.
        g. Is responsive to electronic and voice communications and requests.
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Comments:




                                              Page 6 of 13
  Goal II. To train emerging professionals with applied psychological skills and knowledge in
           preparation for their entry into practice, as evidenced by their ability to…

Objective H. …develop effective assessment, diagnostic and conceptual abilities.

* Competency 8. Interns will develop solid intake, diagnostic and conceptualization skills.
      a. Accurately assesses presenting issues taking into account the client’s larger life
          context, including diversity factors
      b. Skill in writing intake summaries
      c. Differential diagnosis skills
      d. Ability to conceptualize client concerns
      e. Ongoing integration of new information into conceptual understanding of client
      f. Remains open to new information
      g. Incorporation of testing results into treatment (when applicable)
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Comments:




                                             Page 7 of 13
Objective I. …develop effective individual intervention skills.

*Competency 9. Interns will develop effective treatment planning, therapeutic relationship-building,
crisis management and intervention skills, and will document these activities effectively.
         a. Treatment plans are appropriate for diagnosis
         b. Treatment plans incorporate awareness of relevant outcome research and
             evidence based practice.
         c. Treatment planning is contextual, maintaining sensitivity to client’s diversity
             factors and needs
         d. Develops and delivers intervention(s) appropriate to presenting issues and
             contextual factors
         e. Effectively collaborates with client in development of therapeutic goals and
             treatment plan
         f. Ability to independently assess treatment effectiveness
         g. Accurate evaluation of own performance in the treatment role
         h. Attentiveness to client nonverbals
          i. Ability to track content of sessions
          j. Establishes rapport with a wide variety of clients
         k. Ability to provide empathic therapy relationships
          l. Ability to facilitate affective expression
         m. Ability to provide emotional containment and structure when needed in session
         n. Ability to process in the moment interactions with client
         o. Awareness and management of reactions to clients
         p. Awareness and management of clients’ reactions to therapist
         q. Use of a theoretical framework to guide interventions
         r. Ability to integrate approaches that come from a different theoretical orientation
             when appropriate for client's needs
         s. Effective use of a time limited therapy framework
          t. Demonstrates good judgment in responding to unexpected issues that arise in therapy
         u. Effectively implements interventions with attention to evidence based models and
             flexibility to adapt when needed
         v. Ability to use confrontation skills when needed
         w. Sensitively plans for and addresses termination
         x. Ability to assess lethality/suicidality
         y. Responsiveness and flexibility in crisis situations
         z. Ability to take on a more directive role when necessary in crisis situations
        aa. Ability to respond appropriately to crisis situations
        bb. Consults in crisis situations
        cc. Integrates knowledge of contextual and diversity factors in assessing and
             intervening in crisis situations
        dd. Ability to use the SOAP note format to document clinical sessions
        ee. Writes accurate and well written intake summaries
         ff. Produces documentation in a timely manner


                                             Page 8 of 13
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*Competency 10. Interns will demonstrate the ability to demonstrate consultation skills in the clinical
realm.
       a. Awareness of situations in which consultation is appropriate
       b. Capacity to shift functions and behavior to meet different referral needs.
       c. Ability to gather necessary information to formulate recommendations
       d. Ability to provide consultation to different constituent groups
          (e.g., parents, Residential Life staff, professors)
       e. Provides useful, effective recommendations to consultee
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Comments:




Intern                                                  Date


Supervisor                                              Date




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ment planning.




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