Department of Counseling & Student Affairs
Clinical Mental Health / Marriage, Couple, & Family
Internship Evaluation of Student Performance
Student’s Name
Term & Year
Site Supervisor
Dates of Evaluation
Faculty Supervisor
Directions: At mid-term and the conclusion of each semester, please rate the student on the following skills
and abilities according to the following scale:
(1) Unsatisfactory, did not meet expectations
(2) Below expectations for training level
(3) Satisfactory; meets expectations for training level
(4) Above expectations for training level
(5) Outstanding for training level
(NA) Insufficient contact to judge
2009 CAREP Standards
Foundations
CMHC B.1 Demonstrates the ability to apply and adhere to ethical and legal
MCFC B.1 standards in counseling.
CMHC B.2 Applies knowledge of public mental health policy, financing, and
regulatory processes to improve service delivery opportunities in
clinical mental health counseling.
MCFC B.2 Demonstrates the ability to select models or techniques
appropriate to couples’ or families’ presenting problems.
Counseling, Prevention, and Intervention
CMHC D.1 Uses the principles and practices of diagnosis, treatment,
referral, and prevention of mental and emotional disorders to
initiate, maintain, and terminate counseling.
CMHC D.2 Applies multicultural competencies to clinical mental health
counseling involving case conceptualization, diagnosis,
treatment, referral, and prevention of mental and emotional
disorders.
CMHC D.3 Promotes optimal human development, wellness, and mental
health through prevention, education, and advocacy activities.
CMHC D.4 Applies effective strategies to promote client understanding of
and access to a variety of community resources.
CMHC D.5 Demonstrates appropriate use of culturally responsive individual,
couple, family, group, and systems modalities for initiating,
maintaining, and terminating counseling.
CMHC D.7 On time for work and appointments. Completes necessary
MCFC paperwork punctually, accurately, and thoroughly. Adheres to
B.1, D.5
ethical and legal standards, confidentiality responsibilities, record
keeping, reimbursement, and business aspects of practice.
CMHC D.8 Provides appropriate counseling strategies when working with
clients with addiction and co-occurring disorders.
MCFC D.1 Uses preventive, developmental, and wellness approaches in
working with individuals, couples, families, and other systems
such as premarital counseling, parenting skills training, and
relationship enhancement.
1
2
3
4
5
NA
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2009 CAREP Standards
Counseling, Prevention, and Intervention
MCFC D.2 Uses systems theory to conceptualize issues in marriage,
couple, and family counseling.
MCFC D.3 Uses systems theories to implement treatment, planning, and
intervention strategies.
MCFC D.6 Demonstrates the ability to recognize his or her own limitations
as counselor and to seek supervision or refer clients when
appropriate.
Openly receives and uses supervisory and peer feedback. Is
aware of when personal concerns and emotional responses
influence counseling.
Identifies and directs exploration of client themes; remains
focused on important issues and sets effective counseling goals.
Facilitates clients’ expression of concerns and feelings
effectively.
Uses therapeutic confrontation effectively; recognizes and resists
manipulation by the client.
Diversity and Advocacy
CMHC F.1 Maintains information regarding community resources to make
MCFC F.2 appropriate referrals.
CMHC F.2 Advocates for policies, programs, and services that are equitable
and responsive to the unique needs of clients.
CMHC F.3 Demonstrates the ability to modify counseling systems, theories,
techniques, and interventions to make them culturally appropriate
for diverse populations.
MCFC F.1 Demonstrates the ability to provide effective services to clients in
a multicultural society.
MCFC F.4 Demonstrates the ability to modify counseling systems, theories,
techniques, and interventions to make them culturally appropriate
for diverse couples and families.
Assessment
CMHC Conducts appropriate intakes, evaluations, history, and a
H.1, H.2 psychological assessment for treatment planning; consistent with
MCFC H.1
a system’s perspective when counseling families and couples.
MCFC Uses systems assessment models to evaluate family functioning
H.2, H.3 and determine members of a family system who should be
involved in treatment.
CMHC Able to screen for addiction, aggression, and danger to self
H.3, H.4 and/or others, co-occurring mental disorders, and stages of
dependence, change, or recovery.
1
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5
NA
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Diagnosis
CMHC
L.1, L.2
Appropriately use diagnostic tools, including the DSM, to
describe clients’ symptoms and clinical presentation,
conceptualize an accurate multi-axial diagnosis
Internship Evaluation of Student Performance
Revised 1/2015
Comments and suggestions about the student’s progress (i.e., strengths, areas for growth)
Recommended Grade
A
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B
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F
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Site Supervisor Signature
Date
Faculty Supervisor Signature
Date
Incomplete
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My signature indicates that I have read the above report and have discussed the content with my site
supervisor. It does not necessarily indicate that I agree with the report in part or in whole.
Student Counselor Signature
Internship Evaluation of Student Performance
Date
Revised 1/2015