FSW/FA: ____________________________________________________
Supervisor: _________________________________________________
This page is used only for FSWs/FAs
Date of supervision: ___________________
Healthy Families New York
Home Visitor Supervision Form
Focus on Family Support Workers/Father Advocates
Start time ______________ End time_________________
Blue = instructions
Each supervision session should have a corresponding supervision log
You will complete this page for each supervision for an FSW or FA. This form is designed to capture an overall
picture of what supervision focused on (listing of each family discussed in-depth and in a brief status check) and a
description of how this supervision focused directly on the strengths and needs of the FSW/FA.
Notes from review of MIS reports and other materials related to FSW/FA performance: Complete prior to
supervision This space is designed for you to capture your thoughts prior to supervision, so that you are prepared to
integrate MIS information related to this home visitor. What supporting information would enhance your focus this
week? It may not be possible to review all materials before every supervision, so you’ll have to decide what is
pertinent this week. This can include but is not limited to:

home visit achievement rate

outstanding service referrals

outstanding documentation

caseload management
Names of participant families to be discussed in depth (see Focus on Participant Family for notes):
You will just list the names of family’s discussed.
Between 4-6 families reviewed in-depth is a reasonable number. It is important to look at the particular home
visitor’s number of families and use a formula that will assure that every family is reviewed in-depth at least once a
month. For example, if you’re working with a relatively new FSW and they have 10 families all at level one, you may
only be discussing three families in-depth for that that particular supervision, whereas you might review 5 to 7 for a
more seasoned home visitor with 25 families. Ideally the families discussed in-depth will be determined with the
home visitor before supervision; this way, each of you can come to the discussion well prepared.
This section also includes families on both Level X and pre-intake.
Names of Families for Status Check (See each family’s Status Check page for notes):
Just list the names of all families who were briefly discussed.
FSW/FA successes:
This section is to focus on the home visitor’s overall successes since last supervision. This could include but is not
limited to:
 success with a particular family
 success with group work
 a particular skill or activity
 using something learned from training
 something related to inter-office dynamics
 success meeting performance targets
Supervisor initials and date when form was completed ___________________
Notes are ideally completed on the same day as when supervision took place. If not, they should be completed a short time after
that date. This is the place to document when the note was finalized.
Form 1a
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FSW/FA: ____________________________________________________
Supervisor: __________________________________________________
This page is used only for FSWs/FAs
Date of supervision ___________________
FSW/FA challenges:
This section is to focus on the home visitor’s overall challenges since last supervision. This could include but is not
limited to:
 meeting home visiting achievement rate due to illness, weather challenges, professional development,
vacation, etc.
 timeliness of documentation due to illness, professional development, vacation, etc.
 personal concerns, such as: unreliable transportation, illness, family illness, etc.
Administrative Topics: (includes role boundaries, intra-office /team dynamics, cultural sensitivity, self-care and
safety, documentation, performance targets and other topics.)
One required aspect of supervision is that of administration, which includes oversight of the program’s policies,
rules, procedures and adherence to the HFA Best Practice Standards. This also includes overseeing paperwork and
monitoring productivity.
This section is designed for you to have a running commentary on these topics. It can include first time
conversations as well as on-going follow up. This section might also include discussions/evidence of:

A positive work environment
 Creating a nurturing environment that provides opportunities for respite
 Assuring use of an open-door policy for supervision and on-call availability
 Effective staff meetings
 Offering a career ladder for home visitors
Professional Development (includes training preparation and follow up, incorporating knowledge and skill into
practice, skill building and coaching, and integrating follow up from QA activities)
This can include identifying areas for growth, using TOL workbooks, learning from co-workers through shadowing
and conversations (formal and informal), discussion of performance targets, monitoring documentation,
productivity, time management and flexibility.
Follow up on areas of concern (focus on FSW/FA) from previous supervision. See Supervision Form
____________ (date).
This is the place to track conversations and also the place to make notes of what Administrative Topics you want to
discuss as you are preparing for supervision. This can also include what the supervisor might do differently for next
supervision, developing a plan with the home visitor for work going forward and offering employee assistance, when
available.
The space for a date is for you to reference a previous note without having to re-write it. This could include but is
not limited to:






QA documentation (internal and external-PCANY)
Feedback from OCFS visits
Performance reviews
Participant Satisfaction Surveys
Outstanding documentation
Other areas of concern
Supervisor initials and date when form was completed ___________________
Notes are ideally completed on the same day as when supervision took place. If not, they should be completed a short time after
that date. This is the place to document when the note was finalized.
Form 1a
121214
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