Psychology Intern Evaluation

Trainee’s Name:__________________________________________ Training Period (1-4):___________

Supervisor:_________________________ # Assessments Supervised: __________

# Individual Cases Supervised: _____________
Rotation:__________________________ # Groups Supervised: ________________

Supervision Hours This Period:

Supervision Methods:  Observation  Tape

 Individual
 Group

Supervisor’s experience and knowledge of intern’s clinical performance:

Very Limited 1 2
3
4
5

Extensive

*See evaluation guide for description of 0-5 ratings.

Assessment Activities

1. Ability to Build Rapport 0 1

2 3 4 5

2. Interview Skills 0 1
2 3 4 5

3. Initial Assessment Accuracy 0 1

2 3 4 5

4. Test Use/Interpretation 0
1 2 3 4 5

5. Behavioral Assessment 0
1 2 3 4 5

6. Recognition of Cultural and

Individual Factors

0
1
2
3
4
5

7. Use of Diagnostic System

0
1
2
3

1
 4
5

Comments:

2
 Intervention Activities

1. Case Conceptualization 0 1
2 3 4 5

2. Treatment Planning

0
1
2
3
4
5

3. Mgt. of Treatment Relationship 0

1 2 3 4 5

4. Response to Client-Specific Factors 0

1 2 3 4 5

5. Adapts Interventions to Process 0

1 2 3 4 5

6. Case Management 0 1 2
3 4 5

7. Crisis Intervention 0 1 2
3 4 5

8. Knowledge of Group Treatment 0 1 2 3 4

5

Comments:

Communication and Consultation

1. Written Reports (Info. and Conclusions) 0 1 2 3 4 5

2. Writing Style 0 1
2 3 4 5

3. Consultation With Other Disciplines 0 1 2 3 4 5

4. Participation in Conferences/Meetings 0
1

3
 2
3
4
5

Comments:

4
 Scholarship and Research Activities

1. Relates Science to Practice 0 1 2 3 4 5

2. Research Activities

0
1
2
3
4
5

3. Engages in Specialized Readings or Study 0 1 2 3 4 5

4. Provides Expertise

0
1
2
3
4
5

Comments:

Use of Supervision

1. Preparation for Supervision

0
1
2
3
4
5

2. Accuracy of Self-Perception
0
1
2
3
4
5

3. Autonomy v. Need for Supervision 0

1
2

5
 3
4
5

4. Acceptance of Feedback
0
1
2
3
4
5

Comments:_____________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________\

______________________________________________________________________________________________________

Supervision of Practicum Student/s

1. Ability to
recognize
strengths

0
1
2
3
4
5
and weaknesses of supervisee

2. Facilitates a
collaborative
relationship
0
1
2
3
4
5

6
3. Provides
appropriate
feedback in

0
1
2
3
4
5
technical and theoretical knowledge

4. Encourages a
sense of
professional

0
1
2
3
4
5
integrity and responsibility

Comments:____________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

Professional Development

1. Observance of Ethical Guidelines 0

1
2
3
4
5

2. Organization

0
1
2
3
4
5

3. Conscientiousness/Responsibility 0
1

7
 2
3
4
5

Comments:

Overall Appraisal

 Overall performance is satisfactory (may include comments below).

OR

 Significant performance weaknesses are noted, and the following remedial actions should be completed:

Student’s comments on own performance:

8
Rotation Supervisor or Director of Training Signature/Date

Intern/Trainee Signature/Date