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ABC _Clinical Supervision - 2023

The Clinical Supervision survey is a targeted assessment tool utilized by supervisors to observe and evaluate the performance of their staff members. It involves structured observations of employees' work habits, interactions, and adherence to policies and procedures. This survey provides valuable insights into individual performance, identifies strengths and areas for development, and enables supervisors to provide constructive feedback and support to enhance overall productivity and effectiveness within the team.
1.Employee Name
2.Supervision Date
Supervision Date
3.Supervisor Name
4.Supervision Type
5.Ongoing Supervisory Issues: Items 1 and 2 must be addressed once every 6 months.
Exceptional
Adequate
Needs Improvement (Comment Required)
N/A
Accuracy of assessment and referral skills.
Appropriateness of the treatment/service intervention selected relative to client's specific needs.
Treatment/service effectiveness as reflected by the client meeting their individual goals.
Risk factors for suicide and other dangerous behaviors.
Provision of feedback from Supervisee to Supervisor.
Issues of ethics, legal aspects of clinical practice, boundaries, and professional standards.
Clinical documentation issues identified through ongoing compliance review.
Cultural competency issues.
Model fidelity re:evidence-based practices.
6.Comments (spefic to "Needs Improvement" response
7.Other Areas
Exceptional
Adequate
Needs Improvement (Comment Required)
N/A
Emergency Response
Appropriate use of supervision
Insight into client problems
Concern for welfare of client
Attendance and punctuality
Objectivity
Boundaries
Personal Integrity
Interactions with co-workers
Recognition of own limits
Continuing education (trainings)
8.Comments (Specific to "Needs Improvement" response