Community Outreach Therapist Skills Checklist
Use this assessment to review a therapist’s experience, outreach readiness, and core skills for community outreach work.
Respondent Information
Full Name
*
First Name
Middle Name
Last Name
Organization / Agency Name
*
Job Title / Role
*
Preferred Contact Email or Phone
*
Outreach Experience and Availability
Years of Community Outreach Experience
*
Primary Community Settings Served
*
Schools
Shelters
Clinics
Home Visits
Community Centers
Faith-Based Organizations
Other
Current Availability for Outreach Assignments
*
Full-time
Part-time
Per diem
Limited availability
Therapist Skills Checklist
Therapist Skills Checklist
*
Rows
Not yet developed
Developing
Proficient
Advanced
Rapport building with diverse populations
1
2
3
4
Trauma-informed communication
5
6
7
8
De-escalation
9
10
11
12
Cultural responsiveness
13
14
15
16
Crisis recognition and referral
17
18
19
20
Boundary setting
21
22
23
24
Documentation accuracy
25
26
27
28
Collaboration with community partners
29
30
31
32
Overall readiness for community outreach work
*
1
2
3
4
5
Areas for growth or additional training needs
Relevant certifications or specialized training completed
Trauma-informed care
Crisis intervention
Cultural competency
Community outreach
Other
Submit assessment
Should be Empty: