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\nName:    \nFirst Middle Last  \nAddress:    \nNumber Street City State Zip  \nDaytime Phone: (  )   -    \nDates of Internship: From  / /  To  / /   \nTotal Hours at Site:  Total Direct:   Total Diagnostic & Assessment   Internship Site:  \nSite Name:    \nAddress:  \n________________________________________  \n****************************************************************************** Part B: (to be completed by the internship supervisor)  \nName:    \nLast, First License  \nList your areas of professional competence.  \n______________________________________________________________________________  \n______________________________________________________________________________  \nPlease describe the counseling responsibilities that were supervised.  \n\n|  |\n| --- |\n|  |\n|  |\n\nPart B (continued)  \nPlease rate the trainee with the following rating scale:  \n1 - not acceptable  \n2 - marginally acceptable  \n3 - acceptable  \n4 - not observed  \nI. Professional Ethics and Counselor Law  \n1. Demonstrates knowledge of Ohio Counselor Law and counseling ethics 1 2 3 4  \n2. Understands, respects, and accommodates gender, racial, and cultural differences.  \n1 2 3 4  \n3. Understands and maintains professional boundaries with clients 1 2 3 4  \n4. Understands the legal obligations involved in reporting abuse, neglect, and Duty To Warn 1 2 3 4  \n5. Demonstrates skill in completing case records, reports, correspondence, and pertinent  \ncase information in an accurate and timely manner 1 2 3 4  \nII. Assessment and Diagnosis  \n6. Uses appropriate assessment techniques and procedures 1 2 3 4  \n7. Demonstrates skill in using diagnostic and assessment principles 1 2 3 4  \n8. Understands culturally bound syndromes when formulating a diagnosis 1 2 3 4  \n9. Demonstrates a basic understanding of the application and use of personality and  \nstandardized assessment instruments 1 2 3 4  \n10. Demonstrates skill in appropriately communicating assessment and test results to the client 1 2 3 4  \n11. Demonstrates skill in assessing client readiness for change 1 2 3 4  \n12. Demonstrates skill in assessing client appropriateness for group counseling  \n1 2 3 4  \n13. Demonstrates skill in assessing risk factors in suicidal, homicidal, and violent behaviors 1 2 3 4  \nIII. Counseling Skill and Interventions  \n14. Demonstrate ability to develop rapport with clients 1 2 3 4  \n15. Demonstrates skill in developing conceptual framework for understanding the client’s issues 1 2 3 4  \n16. Demonstrates skill in using assessment information to develop appropriate strategies and interventions 1 2 3 4  \n17. Except in crisis, focuses on the therapeutic process and not just content 1 2 3 4  \n18. Recognizes and accurately interprets covert messages and nonverbal cues 1 2 3 4  \n19. Demonstrates skill in the following areas:  \nOpening sessions 1 2 3 4  \nClosing sessions 1 2 3 4  \nTermination of treatment 1 2 3 4  \nManaging emergencies 1 2 3 4  \nConveying interest in and acceptanceof the client 1 2 3 4  \n20. Applies appropriate clinical judgment in managing the client 1 2 3 4  \n21. Demonstrates skill in facilitating group counseling 1 2 3 4  \n22. Demonstrates awareness of medication as a possible treatment option 1 2 3 4  \n23. Understands the procedures involved in consultation and referral 1 2 3 4  \nIV. Professional Growth and Self-Awareness  \n24. Demonstrates the ability to assess and describe the impact of his/her personality on the client 1 2 3 4  \n25. Incorporates supervisory guidance into clinical performance 1 2 3 4  \n26. Seeks consultation from the supervisor in unfamiliar clinical situations 1 2 3 4  \n27. Demonstrates awareness of his/her limitations in skill and competence  \n28. Recognizes his/her deficiencies and actively works to overcome them  \nV. Training Modalities and Specialties  \n29. Demonstrates basic understanding of the following:  \nIndividual therapeutic modalities 1 2  \nGroup t","cbCaiazFo5WSlS5A","https://ap.wps.com/l/cbCaiazFo5WSlS5A","pdf",529268,"English","# Part A: Internship Student\n## Student information\n## Dates and hours\n# Part B: Internship Supervisor\n## Professional competence areas\n## Counseling responsibilities supervised\n## Rating scale and competency areas\n## Overall rating and trainee capability\n## Discussion confirmation and supervisor certification","[{\"question\":\"Part A需要由实习学生填写哪些信息？\",\"answer\":\"需填写姓名、地址、白天联系电话、实习日期范围、实习总时数与实习机构名称及地址等基本资料。\"},{\"question\":\"督导在Part B中如何对受训者进行评分？\",\"answer\":\"使用1到4的评分量表：1不合格，2勉强合格，3合格，4未观察。评分覆盖多个能力领域。\"},{\"question\":\"评价中包含哪些主要能力维度？\",\"answer\":\"包括职业伦理与辅导员法律、评估与诊断、咨询技能与干预、专业成长与自我觉察、培训方式与专长等，并最终给出总体评级与相关说明。\"}]","Clinical Internship Final Evaluation Form - Rating Scale and Competency Areas | PDF",1790651137]