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  2. 2015
  3. December
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  5. Intern Evaluation Form
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Welcome to the Intern Evaluation form.

Thank you for participating in this survey, your feedback is important.
 
 
 
 
Intern
   
 
 
 
Primary Supervisor
   
 
 
 
Year
   
 
 
 
Please use the following Rating Scale for all items on the Doctoral Intern Evaluation Form:

1- Not applicable/No opportunity to assess

2 - Perform significantly below expected competency level for doctoral intern. Requires constant and close supervision for basic skills. Needs remediation.

3 - Performs below expected competency level for doctoral intern. Requires ongoing supervision for basic skills.

4 - Performs as expected competency level for doctoral intern. Require standard supervision for basic skills and requires ongoing supervision for developing advanced skills.

5 - Performs above expected competency level for doctoral intern. Requires minimal supervision for basic skills and ongoing supervision for advanced skills.

6 - Performs significantly above expected competency level for doctoral intern. Displays mastery basic skills. Requires periodic supervision for refinement of advanced skills.

7 - Performs activity at advanced level-minimum level expected of senior staff in most areas. Performs activity independently requiring minimal supervision.
 
 
 
I. Clinical Services
 
 
A. Individual Brief Therapy
1- Not applicable/No opportunity to assess 2 - Perform significantly below expected competency level for doctoral intern. Requires constant and close supervision for basic skills. Needs remediation. 3 - Performs below expected competency level for doctoral intern. Requires ongoing supervision for basic skills. 4 - Performs as expected competency level for doctoral intern. Require standard supervision for basic skills and requires ongoing supervision for developing advanced skills. 5 - Performs above expected competency level for doctoral intern. Requires minimal supervision for basic skills and ongoing supervision for advanced skills. 6 - Performs significantly above expected competency level for doctoral intern. Displays mastery basic skills. Requires periodic supervision for refinement of advanced skills. 7 - Performs activity at advanced level-minimum level expected of senior staff in most areas. Performs activity independently requiring minimal supervision.
Develop and establish therapeutic relationships with clients.
Articulate and apply one or more theoretical frameworks to client problems and treatment planning with flexibility and integration
Ability to develop a working assessment and treatment plan for each client
Ability to identify and utilize treatment approaches that fit standard of care and are empirically supported for specific psychological presentations, diagnoses, and populations