| |
| What is your current age? | | |
|
|
|
|
|
|
|
|
| |
| Please indicate the type of academic training program your supervisees are trained in: |
| |
|
|
|
|
| |
| At what point in their academic program are students able to start at your facility? |
| |
|
|
|
|
| |
| Are you primarily a practicum, internship, or fellowship site? |
| |
|
|
|
|
| |
| What type of facility do students work in? |
| |
|
|
|
|
| |
| How many on-site supervisors are involved in training your facility? | | |
|
|
|
|
| |
| How many adjunct supervisors are affiliated with your facility (e.g., off-site University supervisor): | | |
|
|
|
|
| |
| Total Number of supervisees per semester: | | |
|
|
|
|
| |
| Number of hours/week in the clinic for supervisors: | | |
|
|
|
|
| |
| Number of hours/week in the clinic for supervisees: | | |
|
|
|
|
| |
| Frequency of scheduled group supervision: |
| |
|
|
|
|
| |
| Duration of scheduled group supervision: |
| |
|
|
|
|
| |
| Frequency of scheduled individual supervision: |
| |
|
|
|
|
| |
| Duration of scheduled individual supervision: |
| |
|
|
|
|
| |
| Communication methods with supervisor outside of scheduled supervision: |
| |
|
|
|
|
| |
| Who attends your scheduled supervision sessions? Please check all that apply. |
| |
|
|
|
|
|
| |
| Frequency of supervisor consultations with PCP: |
| |
|
|
|
|
| |
| Purpose of consultation with PCP: |
| |
|
|
|
|
| |
If your training site incorporates a peer supervisor, please indicate all of their primary responsibilities below:
|
| |
|
|
|
|
|
| |
| Frequency of didactic trainings for students |
| |
|
|
|
|
| |
If you provide educational trainings at your practicum site, please indicate the topics these trainings have included:
|
| |
|
|
|
|
|
|
|
|
|
| |
| Do Supervisees shadow supervisors? |
| |
|
|
|
|
| Percentage of supervision time spent on:
|
|
|
|
|
|
| |
| How do you provide feedback (check all that apply)? |
| |
|
|
|
|
|
| |
| Who contributes to trainees’ formal evaluative feedback? |
| |
|
|
|
|
|
| |
Which of the following are competencies to be achieved by practicum students at your site?
|
| |
|
Clinical Practice Knowledge and Skills (e.g., role definition, problem identification, assessment, problem focus, population-based care, biopsychosocial approach, use of empirically-supported interventions, intervention design, multi-patient intervention skills, pharmacotherapy)
| |
Practice Management Skills (e.g., visit efficiency, time management, follow-up planning, intervention efficiency, visit flexibility, triage, case management, community resource referrals)
| |
Consultation Skills (e.g., referral clarity, curbside consultations, assertive follow-up, PCP education, recommendation usefulness, value-added orientation
| |
Documentation Skills (e.g., concise and clear charting, prompt PCP feedback, appropriate format)
| |
Administrative Knowledge and Skills (e.g., BHC policies and procedures, risk-management protocols, coding documentation)
| |
Team Performance Skills (e.g., fit with primary care culture, knows team members, responsiveness, availability)
|
|
|
|
|
|
| |
| Who is responsible for developing supervisee competencies to be achieved? |
| |
|
|
|
|
| |
| How much training have you received about supervision? |
| |
|
|
|
|
| |
| How useful was the supervision training? |
| |
|
|
|
|
|
|
|
|
| |
| What theoretical models did the training include? |
| |
|
|
|
|
|
| |
| If you believe there are some barriers to providing adequate supervision, please indicate below: |
| |
|
|
|
|
| |
| How much supervisory experience do you have in your current setting? |
| |
|
|
|
|
| |
| How long have you been a clinical supervisor in total? |
| |
|
|
|
|
| |
If you have worked as a supervisor in other clinical positions (i.e., traditional psychotheapy), please indicate your satisfaction level with your responsibilities in behavioral health as compared to those experiences.
|
| |
|
|
|
|
| |
| How often do diversity issues arise in supervision? |
| |
|
|
|
|
| |
| What types of diversity issues have you encountered? |
| |
|
|
|
|
| |
| Did you receive training on how to deal with diversity issues? |
| |
|
|
|
|
| |
| If yes, what type of training did you receive? |
| |
|
|
|
|
| |
| Is diversity issue a patient issue, trainee issue, or staff/team issue? |
| |
|
|
|
|
| |
During the course of a semester, how frequently does your supervision team discuss issues related to diversity?
|
| |
|
|
|
|
Loading...
