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Supervisee Evaluation
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Supervisee/CSW:
Supervisor:
From
Enter date here
To
Enter date here
The present level of each skill should be rated as follows:
s Strength
/ Ability commensurate with level of training
? Insufficient data
n Needs improvement (must specify) na Not applicable Any rating of “needs improvement” must be accompanied by specific recommendations in the comments section. Supervisors are encouraged to provide narrative commentary as much as possible.
I. CONTRIBUTES TO CLINICAL TEAM
Conscientious; fulfills responsibilities without reminders, is productive
s
/
?
n
na
Accepting and cooperative toward staff at all levels; forms positive relationships
s
/
?
n
na
Establishes effective supervisory alliance
s
/
?
n
na
exercises good judgment in seeking help
s
/
?
n
na
exercises good judgment when acting independently
s
/
?
n
na
contributes to task completion and cohesion in meetings
s
/
?
n
na
exhibits increased autonomy over course of year
s
/
?
n
na
outside communications reflect positively on agency
s
/
?
n
na
II. CAPACITY FOR PROFESSIONAL DEVELOPMENT
approaches supervision in open and collaborative manner.
s
/
?
n
na
acknowledges impact of own feelings and cultural values on practice
s
/
?
n
na
appropriately self-critical; accurate assessing self
s
/
?
n
na
incorporates new ideas and critical feedback
s
/
?
n
na
motivated to learn (information and help-seeking)
s
/
?
n
na
actively participates in diagnostic teams and seminars
s
/
?
n
na
appropriately questions and challenges colleagues and supervisors
s
/
?
n
na
demonstrates improvement in skills over course of year
s
/
?
n
na
conduct consistently reflects knowledge of and conformance to NASW ethical principles and state laws.
s
/
?
n
na
III. GENERAL PSYCHOTHERAPY SKILLS
A. CASE MANAGEMENT SKILLS
documents services fully but concisely
s
/
?
n
na
assesses nonpsychological needs
s
/
?
n
na
initiates referrals as needed
s
/
?
n
na
completes documentation adequately and in according the agency policy
s
/
?
n
na
able to network and coordinate services with external agencies and other service providers
s
/
?
n
na
B. ASSESSMENT SKILLS
1. Therapeutic Alliance:
conveys warmth, genuineness, empathy
s
/
?
n
na
conveys credibility
s
/
?
n
na
facilitates depth of self-disclosure
s
/
?
n
na
establishes alliance with all family members
s
/
?
n
na
respects client as whole person with strengths and needs
s
/
?
n
na
maintains objectivity
s
/
?
n
na
able to include cultural variables in alliance building
s
/
?
n
na
2. Data Gathering Skills:
aware of impact of own behavior and culture on client behavior
s
/
?
n
na
understands cultural background in client’s presentation
s
/
?
n
na
assesses dangerousness to self and others
s
/
?
n
na
handles child maltreatment issues appropriately
s
/
?
n
na
recognizes and understands nonverbal communication
s
/
?
n
na
recognizes and understands metaphorical communication
s
/
?
n
na
understands clinical process issues
s
/
?
n
na
assesses risk appropriately and with evidence-based practices
s
/
?
n
na
3. Diagnostic-Analytic Skills:
conceptualizes and organizes data from definite theoretical view
s
/
?
n
na
recognizes impact of multicultural variables on psychological differences and response to treatment
s
/
?
n
na
incorporates empirical findings in literature in diagnostic formulation
s
/
?
n
na
generates accurate differential diagnosis
s
/
?
n
na
develops assessment plan to rule out differential diagnosis
s
/
?
n
na
generates accurate case formulation integrating development, self-report, interview- process, projective, and other data
s
/
?
n
na
communicates findings orally in case presentations
s
/
?
n
na
generates accurate and timely written reports
s
/
?
n
na
C. INTERVENTION SKILLS
1. Maintains Working Alliance:
tracks or reflects (particularly affect) client statements in session
s
/
?
n
na
maintains client’s motivation to work (without overwhelming or client becoming dependent)
s
/
?
n
na
balances tracking functions with guiding functions consistent with theoretical perspective
s
/
?
n
na
demonstrates multicultural competence
s
/
?
n
na
maintains appropriate case load
s
/
?
n
na
2. Focuses Therapy:
formulates realistic short and long-term behavioral goals
s
/
?
n
na
formulates methods for achieving outcome
s
/
?
n
na
establishes shared sense of outcome and process goals with client
s
/
?
n
na
fosters positive expectations of hope
s
/
?
n
na
recognizes therapeutic impasses
s
/
?
n
na
realistic in assessing and re-assessing progress and revising formulation and diagnosis as indicated
s
/
?
n
na
interventions are consistent with theoretical formulation
s
/
?
n
na
interventions are culturally and ethically appropriate
s
/
?
n
na
interventions potentiate change
s
/
?
n
na
able to focus on process issues in session
s
/
?
n
na
interventions are prescriptive vs. generic
s
/
?
n
na
interventions reflect basic knowledge of cognitive-behavioral, dynamic, time limited, crisis intervention, and systemic interventions
s
/
?
n
na
3. Understands Interpersonal Process Issues:
uses personal response to client to aid assessment
s
/
?
n
na
selectively responds to accurate self-report, distortions, and client-therapist demands
s
/
?
n
na
responds appropriately to metaphoric and nonverbal content
s
/
?
n
na
recognizes and highlights underlying affect, cognition, or themes from content
s
/
?
n
na
accurately intuits culturally meaningful behavior
s
/
?
n
na
able to accept direct observation and constructive feedback
s
/
?
n
na
4. Biopsychosocial Assessment:
able to accurately reflect client’s strengths and needs
s
/
?
n
na
able to accurately integrate findings in a comprehensive report
s
/
?
n
na
able to formulate a dynamic conceptualization of client functioning
s
/
?
n
na
is sensitive to cultural issues in terms of appropriateness of the instruments selected with the interpretation of data
s
/
?
n
na
able to generate appropriate diagnosis(es) and treatment recommendations based on the results of the assessment
s
/
?
n
na
EVALUATOR COMMENTS:
Based on Hall-Marley (2000), an evaluation form used to give feedback to supervisees. Sections include contributions to clinical team, capacity for professional development, general psychotherapy skills (case management, assessment, intervention), and evaluator comments. Reprinted in Falender, C.A., & Shafranske, E.P. (2004). Clinical Supervision: A Competency-based Approach. Washington, D.C.: APA.
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