Counselor Intern Evaluation Form Central Methodist University

Transcription

1 MSCC 6 Counselor Intern Evaluation Form Central Methodist University M.S. Clinical Counseling Program Practicum/Internship Experience (circle one) Counselor Intern Name Today s Date Course #/ Title Site Name of Field Instructor/Supervisor completing this form Clinical Site Name: Site Phone #: Site Instructor or Supervisor, complete the following evaluation on each Counselor Intern using the scale to the right where: 1 equals Low, the Counselor Intern lacks competence in this area; 2 equals Low Average, the Counselor Intern evidences some competence but needs improvement; 3 equals Average, the Counselor Intern evidences adequate competence; 4 equals High Average, Counselor Intern s performance is more than adequate in this area; 5 equals High, the Counselor Intern performs extremely well in this area; and NA, Counselor Intern evidence of the skill was not required for this course. This evaluation is to be completed at the midterm and end term. Counselor Interns showing deficient skills necessary for the above named course (score of 1-2) require a personal meeting with the instructor at midterm and or end term to discuss results and recommended next steps. Fifty percent of the scores ranked needs to be 3 or above to be considered satisfactory in addition to submitting all assignments. (Copies of this form to be placed in student file in administrative office of site. Original to be provided to student) CL=client; CN=counselor; hx=history; dx=diagnosis; tx=treatment Basic Counseling Skills 1. Demonstrates unconditional positive regard in Client relationship 2. Demonstrates development of therapeutic alliance with Client 3. Demonstrates appropriate body language with Client including eye contact, facial expressions, congruent language, body position, and distance from Client, taking into consideration social and cultural norms of the Client 4. Avoids double questions 5. Maintains focus on Client issue as appropriate 1

2 Student Name SEM/YR 2 MSCC 6 6. Asks open ended questions 7. Summarizes periodically 8. Avoids answering the question for the Client 9. Demonstrates ability to assess for suicidal ideation, homicidal ideation, addiction, and understands differences between sexual, physical, verbal, emotional, and elderly abuse (H3) 10. Applies effective strategies to promote client understanding of and access to a variety of community resources (D4). 11. Understands the concept of informed consent and uses regularly with clients 12. Understands the concept of referral and termination and applies effective strategies to promote client understanding of and access to a variety of community resources. (D4) 13. Uses silence appropriately (knows when to break) 14. Paraphrases accurately 15. Reflects client content with affect Advanced Counseling Skills 1. Confronts clients with incongruities in a professional and appropriate manner 2. Encourages transition of session content to outside functioning 3. Interrupts appropriately 4. Understands level of professional competence and training and practices accordingly 5. Understands appropriate application of treatment related to chemical addiction 6. Evidences knowledge of the relationship between medications and treatment and understands basic classifications indications & contraindications of commonly prescribed psychopharmacological medications so that appropriate referrals can be made for medication evaluations & so that side effects of such medications can be identified (G3) Adapted from Bernard & Goodyear, 2004 and CACREP,

3 Student Name SEM/YR 3 MSCC 6 7. Demonstrates understanding of difference between crisis, disaster, and trauma counseling and Can make an accurate DSM diagnosis when appropriate (which implies one knows when it is not appropriate) (L3) 8. Demonstrates ability to integrate selected theory within evidencedbased practices and applies relevant research findings to inform the practice of clinical mental health counseling (J1) 9. Self-discloses appropriately Ethics and Professionalism 1. Advocates for policies, programs, and services that are equitable and responsive to unique needs of clients (F2) 2. Demonstrates professional promptness in both school and client settings 3. Demonstrates professionalism in discussions of conflict or concern 4. Participates in professional organizations in seminars, workshops, and or other activities that contribute to personal and professional growth. 5. Exemplifies clear counselor identity 6. Applies and adheres to the ethical codes of ACA and the state and federal standards (B1) 7. Promotes optimal human development, wellness, and mental health through prevention, education, and advocacy activities (D3) Awareness of Social and Cultural Issues 1. Demonstrates awareness of own personal biases and values (D2; D9) 2. Demonstrates awareness of own racial identity level (D2) 3. Demonstrates awareness of the ways others cultural differences impact therapeutic approach and session content (D2;D5) 4. Demonstrates appropriate use of culturally responsive individual, couple, family, group, and systems modalities for initiating, maintaining, and terminating counseling (F3) Adapted from Bernard & Goodyear, 2004 and CACREP,

4 Student Name SEM/YR 4 MSCC 6 Self Awareness and Openness to Supervision 1. Understands the concept of and evidences regular practice of self care 2. Is aware of effect on others 3. Understands the differences between personal and professional boundaries and demonstrates appropriate use of boundaries in interpersonal interactions 4. Takes feedback non defensively 5. Provides feedback to peers in a manner consistent with that of a counselor 6. Demonstrates ability to recognize own limitations (D9) 7. Comprehends supervisory feedback and integrates it into next client session Planning and In-session time 1. Demonstrates appropriate use of theory in relation to case conceptualization skills 2. Demonstrates ethical and timely documentation of assessment, treatment plan, case progress notes, referral and termination, ensuring all documentation is co-signed by the clinical supervisor 3. Ability to develop and implement measurable treatment goals (D1; J2) 4. Can make an accurate DSM diagnosis when appropriate and demonstrates knowledge of the relationship between diagnosis and treatment (D1; L1; L3) 5. Can implement a professional intake interview including psychosocial history and mental status examination, and 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 (H2) 6. Analyzes and uses data to increase the effectiveness of clinical mental health counseling interventions and programs (J3) Overall Skill Developed at Supervision Site Adapted from Bernard & Goodyear, 2004 and CACREP,

5 Student Name SEM/YR 5 MSCC 6 1. Ability to conduct individual counseling 2. Ability to conduct co therapy 3. Ability to conduct group therapy (as facilitator) 4. Ability to conduct family counseling 5. Ability to conduct couples and marriage counseling 6. Ability to conduct counseling with minors Counselor Intern Strengths: Areas that need more attention for this Counselor Intern and recommendations of Supervisor/Instructor completing this form: Evaluator Signature Counselor Intern Signature Date Date Adapted from Bernard & Goodyear, 2004 and CACREP,