INDIANA
Family-School Specialization Intern
Evaluation
NAME OF STUDENT: ____________________________________________________ DATE: ________________
EVALUATOR: __________________________________________________________
(Title) (Name)
PLACEMENT: __________________________________________________________
DIRECTIONS: This rating form is intended to provide the student with formative feedback. To that end, it should provide a meaningful learning opportunity for the student. Please complete this form after each 100 hours of supervision. Given that 300 hours of supervised internship are required, this form should be completed three times. Thank you for taking the time to complete this form. Please use the following rating scale in evaluating the student on the characteristics listed below:
N/A - Not Applicable: Goal was not addressed during this 100 hour period.
0 - Not observed
1 - Unsatisfactory: Student’s skills reflect insufficient mastery in this area; Student needs additional course-based instruction in this skill.
2 - Needs improvement: Plans should be made to insure student gains extra practice in this skill prior to leaving the program.
3 - Satisfactory: Student’s skills in this area are adequate. Student should continue to practice this skill under professional supervision.
4 - Competent: Student is comfortably independent in this skill.
5 - Outstanding: Student’s skills in this area are exceptionally strong; Student could be a model practitioner in this skill area.
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Personal
Characteristics |
Not
Applicable N/A |
Not Observed 0 |
Unsatisfactory 1 |
Needs Improvement 2 |
Satisfactory 3 |
Competent 4 |
Outstanding 5 |
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Presents a good personal
appearance |
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Demonstrates
dependability |
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Meets difficult situations with
self-control |
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Demonstrates good judgment and common
sense |
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Communicates and listens
effectively |
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Shows concern, respect, and
sensitivity for the needs of staff, and
clients/students |
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Works well with other
staff |
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Is able to relate well to
children/adults |
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Utilizes constructive
criticism |
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Displays initiative and
resourcefulness |
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Demonstrates tolerance for other’s
values and viewpoints |
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Shows evidence of continued
self-evaluation |
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Assessment and
Therapeutic Interventions with Families and Schools |
Not
Applicable N/A |
Not Observed 0 |
Unsatisfactory 1 |
Needs Improvement 2 |
Satisfactory 3 |
Competent 4 |
Outstanding 5 |
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Identifies
family problems within a systems framework |
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Is able to set clear therapeutic
goals |
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Is able to
establish rapport and join with all family members |
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Is able to make
each member of the family feel understood and
accepted |
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Is able to
identify the emotional needs of the family |
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Asks questions in a non-blaming
way |
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Is able to reframe problems
effectively |
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Is able to
manage family conflict within the session |
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Is able to
generate appropriate homework activities for the
family |
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Is able to
provide skill training in communication and problem-solving when
necessary |
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Is able to
provide parent training when necessary |
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Is able to
identify family resistance to treatment when it
occurs |
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Is able to
structure homework assignments for the family to facilitate
completion |
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Is comfortable
responding to sensitive, emotional issues within the
session |
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Is able to
develop a collaborative set between family and
school |
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Is able to identify family
strengths |
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Is able to
utilize family strengths as part of the therapeutic
process |
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Professional
Responsibilities |
Not Applicable N/A |
Not Observed 0 |
Unsatisfactory 1 |
Needs Improvement 2 |
Satisfactory |