Mental Health Evaluation Form for Supervisors
Supervisor's Name
First Name
Last Name
Evaluation Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Supervisee's Name
First Name
Last Name
Mental Health Evaluation
Rows
Poor
Below Average
Average
Above Average
Excellent
Not Applicable
Supervisee exhibits an understanding of the ACA ethical rules as well as the ability to recognize and resolve ethical dilemmas.
1
2
3
4
5
6
Supervisee attempts to comprehend agency policy and legal concerns, as well as deal with agency personnel courteously and appropriately.
7
8
9
10
11
12
Case management abilities are demonstrated by the supervisee, including adherence to agency recordkeeping policies.
13
14
15
16
17
18
Supervisee works well with agency employees to provide services that meet all clients' academic, personal, social, and career development needs.
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20
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24
Supervisee forms and maintains successful individual counseling relationships with clients, exhibits cultural sensitivity, and attempts to understand and respond to client issues.
25
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28
29
30
The supervisee exhibits the ability to design and facilitate small-group counseling interventions. The practicum supervisee is learning about group counseling theory and procedures as part of his or her practicum.
31
32
33
34
35
36
The practicum supervisee exhibits the capacity to successfully consult with coworkers, staff, and the community.
37
38
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40
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42
The practicum supervisoree exhibits coordination abilities. He/she is resourceful when it comes to offering information to clients about services and programs. When necessary, the practicum supervisee facilitates referrals to outside agencies.
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48
The supervisee makes good use of supervision. When supervision is required, s/he actively seeks it, is open to feedback and suggestions from supervisors, and is willing to address personal and professional strengths as well as developmental concerns.
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54
Supervisor's Signature
Submit
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