Instructions to Supervisor ATER COMPLETING THIS FORM, SEAL ITIN A BUSINESS SIZE ENVELOPE, SIGN ACROSS THE SEAL, AND RETURN THE ENVELOPE TO THE COUNSELOR TRAINEE, PART B: TO BE COMPLETED BY THE SUPERVISOR 1.) List your area(s) of professional competencies. Please refer to Ohio Counselor Rule 4757-5-12(B\3}a): 2) Please describe the counsel Greve + Famaset fp ‘Please rate the Counselor Ttaince with the following rating scale: 1 not acceptable 2- ‘marginally acceptable x ceptable 4- not observed Wy 2 3) 4 ” a. 6) 8) 9), 10) m1) Professional Ethies and Counselor Law ‘Demonstrates knowledge of Ohio Counsclor Law and counseling ethics 1204 ‘Understands, respects, and accommodates for gender, racial, and cultural differences, 1264 ‘Understands and maintains professional boundaries with elients 1264 ‘Understands the legal obligations involved in reporting abuse, neglect and Duty to Warn 1204 Demonstrates skill in completing case records, reports, correspondence, and pertinent case information jn an accurate and timely manner 1284 Assessment and Dingnosis Uses appropriate assessment techniques and procedures 1284 ‘Demonstrates skill in using diagnostic and assessment principles 1264 ‘Understands culturally-bound syndromes when formulating a diagnosis 1284 Demonstrates abasic understnding ofthe ppistion and we of eronliy and sandgedized essen inmate 1264 Demonstrates skill in appropriately communicating assessment and test results to the er 1264 12a Demonstrates skill in being able to assess the client's readiness for change. 14) 15) 16) 1) 18) 19) WV. 24) 23) 26) 27) 28) 29) Demonstrates skill in assessing a client’e appropriateness for group counseling 1204 Demonstrates skill in assessing risk factors in suicidal, homicidal, and violent behavioy 4 ‘Counseling Skill and Interventions Demonstrates ability to develop rapport with clients ‘Demonstrates developing, conceptual framework for understanding the client's Demons lin bring able to take ses inormaton and develo appropri sates and "4 interventions. 12 Except in crisis, focuses on the therapeutic process and not just content 124 Recognizes and accurately interprets the client's covert messages including non-verbal cues. 1204 Demonstrates skills in the following areas: ‘Opening sessions 12 : Closing sessions 1284 ‘Termination of treatment 1294 Managing emergencies 126% Conveying interest in acceptance of the client 12 § 4 Applies appropriate clinical judgment to the management of the client 1264 Demonstrates skill n facilitating group counseling 1204 Demonstrates awareness of medication as a possible treatment option 1264 Professional Growth and Self-Awareness Demonstrates his/her ability to assess and describe the impact of his/her personality on the client, 12 Incorporates supervisory guidance into clinical performance 1204 Seeks consultation fram hilher supervisor in unFunilia clinical situations 1 24 Demonstrates hivher awareness of own limitations of clinical skills and competence 1204 Recognizes hivfher deficiencies nl clively works fo overcame them 1204 Tri ing Modalities and Speci Demonstrates hasic understanding of the fallowing: Individual therapeutic modalities Group therapentic modalities Family therapeutic modalities Child/Adolescent therapeutic modalities Career Assessment and Intervention modalities School Counseling Assessment and Intervention modalities Suhstance Abuse Assessment and Intervention modalities, : BV2BSOBPlease circle the OVERALL rating of the Counselor ‘Trainee 1- not acceptable 2- marginally acceptable acceptable DOES TIIE COUNSEI.OR TRAINEE POSSESS THE KNOWLEDGE, SKILLS AND ABILITIES TO PRACTICE. COMPETENTLY AS A PROFESSIONAL COUNSELOR? J ves 1 vo L vs, with esrvations Please explain your response of Noor “with ewervaine’ \Lpxy Ceara Oe Lewrhor ‘The Board recommends that the Counselor Trainee have knowledge of TS v.11 information. Tave you discussed Lert hat is etohip was completed on 1 do \ \, we ~ Dy Yeu ater in _Mecbedd SON =i/pas aint Ree ined Gray) Na ay ae - ide, Laos Je aL Ali Besse aia ings Name & PCS ese 8 Pine Choy) Tah Yee By pes DA doy Super sors Signature Year sec nh CPC etoni8sh Law ‘Supervisor’ sti i pec. Les”