DEPARTMENT OF PROFESSIONAL COUNSELING UNIVERSITY OF WISCONSIN OSHKOSH OSHKOSH, WI Clinical Mental Health Counseling Intern Evaluation

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1 DEPARTMENT OF PROFESSIONAL COUNSELING UNIVERSITY OF WISCONSIN OSHKOSH OSHKOSH, WI Clinical Mental Health Counseling Intern Evaluation Intern Date Site Supervisor School Directions For each item, assess the Intern s skill development on a scale of 1 through 4. If you have comments or recommendations, please type them into the grey boxes. These boxes will expand as you type. You may use either a e-signature, image or your signature, type your name, or print the signature page and scan it back into the computer to be ed. Exceeds Expectations (EE)/ Demonstrates Competencies (4) = the counseling student demonstrates strong (i.e., exceeding the expectations of a beginning professional counselor) knowledge, skills, and dispositions in the specified counseling skill(s), professional disposition(s), and professional behavior(s). Meets Expectations (ME) / Demonstrates Competencies (3) = the counseling student demonstrates consistent and proficient knowledge, skills, and dispositions in the specified counseling skill(s), professional disposition(s), and professional behavior(s). A beginning professional counselor should be at this level at the conclusion of his or her practicum and/or internship. Near Expectations (NE) / Developing towards Competencies (2) = the counseling student demonstrates inconsistent and limited knowledge, skills, and dispositions in the specified counseling skill(s), professional disposition(s), and professional behavior(s). Below Expectations (BE)/ Insufficient / Unacceptable (1) = the counseling student demonstrates limited or no evidence of the knowledge, skills, and dispositions in the specified counseling skill(s), professional disposition(s), and professional behavior(s). Not Observed (N/0) = not observed at this time.

2 CACREP CLINICAL MENTAL HEALTH COMPETENCY STANDARDS Foundations BE NE ME EE N/O 1. Demonstrates the ability to apply and adhere to ethical and legal standards in clinical mental health counseling. 2. Applies an understanding of the roles and functions of clinical mental health counselors in various practice settings and the importance of relationships between counselors and other professionals, including interdisciplinary treatment teams. Counseling, Prevention, and Intervention BE NE ME EE N/O 1. Uses the principles and practices and practices of diagnosis, treatment, referral, and prevention of mental and emotional disorders to initiate, maintain, and terminate counseling. 2. Applies multicultural competencies to clinical mental health counseling involving case conceptualization, diagnosis, treatment, referral, and prevention of mental and emotional disorders. 3. Promotes optimal human development, wellness, and mental health through prevention. 4. Applies effective strategies to promote client understanding of and access to a variety of community resources. 5. Demonstrates appropriate use of culturally responsive individual, couple, family, group and systems modalities for initiating, maintaining, and terminating counseling. 6. Demonstrates the ability to use procedures for assessing and managing suicide risk. 7. Applies current record-keeping standards related to clinical mental health counseling. 8. Provides appropriate counseling strategies when working with clients with addiction and co-occuring disorders. 9. Demonstrates the ability to recognize his or her limitations as a clinical mental health counselor and to seek supervision or refer clients when appropriate. Diversity and Advocacy BE NE ME EE N/O 1. Maintains information regarding clinical mental health resources to make appropriate referrals. 2. Advocates for policies, programs, and services that are

3 equitable and responsive to the unique needs of clients. 3. Demonstrates the ability to modify counseling systems, theories, techniques, and interventions to make them culturally appropriate for diverse individuals. Assessment BE NE ME EE N/O 1. Selects appropriate assessment interventions to assist in diagnosis and treatment planning, with an awareness of cultural bias in the implementation and interpretation of assessment protocols. 2. Demonstrates skill in conducting an intake interview, a mental status evaluation, a biopsychosocial history, a mental health history, and a psychological assessment for treatment planning and caseload management. 3. Screens for addiction, aggression, and danger to self and/or others, as well as co-occurring mental disorders. 4. Applies the assessment of a client s stage of dependence, change, or recovery to determine the appropriate treatment modality and placement criteria within the continuum of care. Research and Evaluation BE NE ME EE N/O 1. Applies relevant research findings to inform the practice of clinical mental health counseling. 2. Develops measurable outcomes for clinical mental health counseling programs, interventions, and treatments. 3. Analyzes and uses data to increase the effectiveness of clinical mental health counseling interventions and programs. Diagnosis BE NE ME EE N/O 1. Demonstrates appropriate use of diagnostic tools, including the current edition of the DSM, to describe the symptoms and clinical presentation of clients with mental and emotional impairments. 2. Is able to conceptualize an accurate multi-axial diagnosis of disorders presented by a client and discuss the differential diagnosis with collaborating professionals.

4 3. Differentiates between diagnosis and developmentally appropriate reactions during crisis, disasters, and other trauma-causing events. PROFESSIONAL COUNSELING DISPOSITIONS Respect for others BE NE ME EE N/O 1. Presents opinions and comments in a non-threatening and non-antagonistic manner. Is open-minded and receptive to new ideas or alternative perspectives. Demonstrates tactfulness in conversations and interactions with others. Personal Responsibility BE NE ME EE N/O 2. Applies an understanding of the roles and functions of clinical mental health counselors in various practice settings and the importance of relationships between counselors and other professionals, including interdisciplinary treatment teams. Perceives and Honors Diversity BE NE ME EE N/O 3. Shows an appreciation and respect for the culture, values, lifestyles and opinions of others. Seeks feedback about multicultural knowledge, skills, and competencies. Attends to issues of social, economic and political equity for individuals and groups that differ by gender, race, ethnicity, social class, ability, and sexual orientation. Commitment to Learning BE NE ME EE N/O 4. Actively participates in all learning experiences designed to foster mastery of the content, competencies, and professional counseling practice. Accepts leadership responsibilities, demonstrates initiative, and engages in professional behavior toward faculty, peers, colleagues, supervisors, and clients. Demonstrates a proactive approach to professional development beyond course expectations. Course work and assignments reflect quality effort. Self-Reflection BE NE ME EE N/O 5. Identifies personal strengths and areas needing development or change. Demonstrates a desire to grow and develop as an emerging professional counselor. Demonstrates the ability to think about and change restrictive personal behaviors. Personal Integrity BE NE ME EE N/O 6. Is honest. Is authentic, sincere and compassionate. Understands own personal values and beliefs and the ways in which these affect interpersonal relationships.

5 Interpersonal Competence BE NE ME EE N/O 7. Participates as an effective team member. Interacts with others in a positive, professional manner. Actively engages in teamwork. Personal and Professional Maturity BE NE ME EE N/O 8. Displays a positive work attitude and enthusiasm for the task at-hand. Internalizes importance of professional work behaviors. Demonstrates diplomacy and poise. Demonstrates social perceptiveness; being aware of others' reactions and exerting an effort to understand such reactions. Self-Care BE NE ME EE N/O 9. Addresses personal issues that may affect professional life. Demonstrates desire for wellness and balance. Concluding comments about the Intern s overall strengths, areas needing improvement, and recommendations for further professional development? On-Site Supervisor Signature Date