Form 4 (F)

Therapeutic Recreation Final Evaluation of Student

This final evaluation is designed as a working tool for the Agency Supervisor
to provide clinical evaluation of the student at the final point of the
internship experience. This evaluation does reflect the students actual
grade, and should be a representation of their progress so throughout the
entire internship.
Name: ___Kristin Welker______________
Internship Agency: ____Recovery Ways_____
Agency TR Supervisor: _Courtney Barnum___
Rating Scale
1
Consistently does not meet expectations
2
Needs improvement in meeting expectations
3
Meets expectations
4
Consistently exceeds expectations
5
Frequently exceeds expectations
na
Job task has not be introduced

Part One: Performance Criteria

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Professional Relationships and Responsibilities

Establish/maintain effective working relationships
Create/maintain a safe and therapeutic environment
Maintain CTRS/required state credential(s)
Participate in in-service training/staff development
Maintain knowledge of current TR/RT trends
Enhance professional competence/additional
credentials
Enhance professional competence
Support the development of evidence-based
practices
Adhere to professional standards of practice and
code of ethics
Participate in quality improvement process
Participate in agency/professional committees
Assessment
Request/secure referrals/orders
Obtain/review pertinent information
Select/develop assessment methods/setting
Establish therapeutic relationship
Conduct assessments
Analyze/interpret results
Integrate/record/disseminate results

2 3 4 5 na
X
X
X
X
X
X
X
X
X
X

X
2 3 4 5 na
X
X
X
X
X
X
X

19
20
21
22
23
24
25
26
27
28
29
30

Plan Interventions and/or Programs

Discuss results of assessment
Develop/document intervention plan
Develop/select interventions/approaches
Develop/select protocols
Utilize activity/task analysis
Select adaptations/modifications/assistive technology
Implement Interventions and/or Programs
Explain the purpose/outcomes of the
intervention/program
Implement individual/group sessions(s)
Use leadership/facilitation/adaption techniques
Monitor/address safety
Observe for response to intervention/program
Monitor effectiveness of intervention/program

Evaluate Outcomes of the

Interventions/Programs
31 Evaluate changes in functioning
32 Determine effectiveness of individual intervention
plan
33 Revise individualized intervention plan
34 Evaluate for additional/alternative/discharge of
services
35 Determine effectiveness of protocols/programs
Document Intervention Services
36 Document participation/adherence to intervention
37 Document behavioral observations
38 Document occurrences related to risk management
39 Document protocols/modalities
40 Document program effectiveness
Treatment Teams and/or Service Providers
41 Identify the treatment team/community partners
42 Provide information to team/community partners
43 Communicate information
44 Coordinate/integrate intervention plan
45 Develop/provide collaborative services
Develo 1
2
3
4
p and
Mainta
in
Progra
ms
46 Maintain equipment/supply inventory
47 Plan/coordinate support services

2 3 4 5 na
X
X
X
X
X
X
2 3 4 5 na
X
X
X
X
X
X

2 3 4 5 n
a
X
X
X
X

X
1 2 3 4 5 na
X
X
X
X
X
1 2 3 4 5 na
X
X
X
X
X
5
na

X
X

48
49
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51
52
53

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69

Maintain program budget/expense records

Develop/distribute schedules
Identify funding sources
Conduct needs assessment
Conduct ongoing program evaluation
Follow risk management practices
Managing TR/RT Services
Comply with standards/regulations
Prepare/update written plan of operation
Confirm programs are consistent with agency
mission
Recruit/train/educate/supervise/evaluate staff
Provide staff development/mentorship
Develop/implement/maintain internship program
Prepare/implement/evaluate/monitor annual budget
Support research programs/projects
Develop/conduct quality improvement plan
Write summary reports of TR/RT services
Identify/obtain/manage supplemental funding
Awareness and Advocacy
Establish/maintain network with
organizations/advocates
Advocate for rights of person(s) served
Provide education to the internal/external
stakeholders
Promote marketing/public relations
Monitor legislative/regulatory changes

X
X
X
X
X
X
1

2 3 4 5 na
X
X
X
X
X
X
X
X
X
X

X
2 3 4 5 na
X
X
X
X
X

Part Two: Personal and Professional Development Criteria

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2
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10
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The Therapeutic Recreation Intern Demonstrates:

Positive Attitude
Enthusiasm
Self-confidence
Empathy
Flexibility
Willingness to learn
Judgment
Initiative
Respect and courtesy
Cooperation
Ability to evaluate personal strengths and weakness
Ability to accept constructive criticism
Professional dress according to setting

2 3 4 5 na
X
X
X
X
X
X
X
X
X
X
X
X
X

14
15
16
17
18
19
20
21
22
23

Work habits (timeliness, completeness, consistent

quality of work
Planning and organizational skills (time
management, management of space and materials)
Interpersonal relationships (with supervisor, staff,
customers)
Effective verbal communication skills (assertiveness,
clarity, organization)
Effective written communication (skills grammar,
spelling, legibility)
Uses available computer
Use of medical terminology and abbreviations
Maintenance of professional boundaries (personal
space, relationships, language)
Ability to seek direct and indirect supervision
Ability to accept direct and indirect supervision

X
X
X
X
X
X
X
X
X
X

Outcome Scoring
Part One: Performance Criteria
Professional Roles and Responsibilities
Assessment
Planning Interventions and/or Programs
Implementing Interventions and/or Programs
Evaluate Outcomes of the Interventions and/or Programs
Documenting Intervention Services
Working with Treatment and/or Service Teams
Organizing Programs
Managing TR/RT Services
Public Awareness and Advocacy
Final Score (Add all average scores and divide by 10)
Part Two: Personal and Professional Development
Final Average Score (Average the two scores in part one
and part two)
Final Grade (see scale below)

Average
Score
4.9
5
5
5
5
4.6
5
5
4.9
5
4.94
Average
Score: 5
4.97

Grading Scale:
The following grading scale is intended as a reference for the Agency
Supervisor to assign a letter grade for the student. The supervisor may
choose to score the student differently than the suggested point distribution
but still feel the student completed the internship at a higher letter grade.

Please indicate the letter grade you feel the student has earned if different
than the point value. Letter Grade:____A_____
Score of:
5.0-4.3
4.2-3.5
3.4-2.7
2.6-1.9
1.8-1.0

Grade
Grade
Grade
Grade
Grade

A
B
C
D
F

Part Three: Comments

1. In what areas does the intern excel?
Kristin has become a very competent and confident recreation therapist. She
has been challenged in many ways and handles every hurdle like a
professional. Kristin has improved drastically in processing, facilitating
groups and completing all necessary documentation that is required. She has
been the acting recreation therapist for a house at Recovery Ways and I have
felt it has been in good hands. Kristin excels at relating to and interacting
with the clients but also setting appropriate boundaries. She conducted
herself as Beyonc would.
2. In what areas does the intern need further development?
Kristin is competent and I would trust her in hiring her as a recreation
therapist. As with any skill, she will become more skilled and confident over
time. Processing seems to be the skill that takes the longest but she is on a
great path and has practiced this skill a lot while at Recovery Ways. It is
tempting to say she need further development in general so I can keep her
on my team. She was necessary to the improvement and functioning of the
recreation therapy team at Recovery Ways during her time with us.

Date of Evaluation: 11/9/2016 Agency Supervisor Signature:

Courtney Barnum
Student
Signature:___________________________________________________________________
_______________
Courtney Barnum