Student Intern Evaluation (LADC)

Instructions

Please evaluate the student intern’s performance as a beginning LADC practitioner in each core function using the following scale. In addition, use the last section of each core function area to make summary comments about the intern’s performance.  Please provide specific steps for improvement for each area rated as a 1 or a 2.  Also, please remember to comment on the student’s strengths in each area.  You will need the student’s total hours interned in each core function to date in order to complete this evaluation.  Thank you for taking the time to provide a thoughtful evaluation of your student intern.  This invaluable tool provides your student with an increased capacity for growth and skill development.

4 = performs consistently in an excellent manner

3 = usually performs in a superior manner

2 = usually performs in an adequate manner but still needs some work

1 = performs consistently in an inferior manner, needs extensive work

N/A = data not available to evaluate

Save & Continue or Save & Share

There is an option at the bottom of the page to save the evaluation to complete it at a later date.  The evaluation can also be shared with other practitioners to contribute to by using the save function at the end of the page and emailing a link to another professional.

Student Intern Evaluation (Chemical Dependency)

  • Date Format: MM slash DD slash YYYY
  • A copy of the completed evaluation will be sent to the email address provided above. If you wish for additional people to receive a copy of this confidential student intern evaluation (additional site supervisor, student intern, etc.) please enter the additional email addresses separated by a comma. This form will automatically be sent to the BSU Field Director.
  • Screening - The process by which the client is determined appropriate and eligible for admission to a particular program.
  • Screening - The process by which the client is determined appropriate and eligible for admission to a particular program.
  • Screening - The process by which the client is determined appropriate and eligible for admission to a particular program.
  • Screening - The process by which the client is determined appropriate and eligible for admission to a particular program.
  • Screening - The process by which the client is determined appropriate and eligible for admission to a particular program.
  • Orientation - Describing to the client the following; general nature and goals of the program, rules governing client conduct and infractions that can lead to a disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
  • Orientation - Describing to the client the following; general nature and goals of the program, rules governing client conduct and infractions that can lead to a disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
  • Orientation - Describing to the client the following; general nature and goals of the program, rules governing client conduct and infractions that can lead to a disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
  • Assessment – Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan. (Minnesota Rule 31 Dimensions: Acute intoxication and withdrawal potential; Biomedical conditions and complications; Emotional and behavioral conditions and complications; Treatment acceptance, resistance; Relapse and continued use potential; and Recovery environment)
  • Assessment – Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan. (Minnesota Rule 31 Dimensions: Acute intoxication and withdrawal potential; Biomedical conditions and complications; Emotional and behavioral conditions and complications; Treatment acceptance, resistance; Relapse and continued use potential; and Recovery environment)
  • Assessment – Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan. (Minnesota Rule 31 Dimensions: Acute intoxication and withdrawal potential; Biomedical conditions and complications; Emotional and behavioral conditions and complications; Treatment acceptance, resistance; Relapse and continued use potential; and Recovery environment)
  • Assessment – Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan. (Minnesota Rule 31 Dimensions: Acute intoxication and withdrawal potential; Biomedical conditions and complications; Emotional and behavioral conditions and complications; Treatment acceptance, resistance; Relapse and continued use potential; and Recovery environment)
  • Assessment – Those procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of the treatment plan. (Minnesota Rule 31 Dimensions: Acute intoxication and withdrawal potential; Biomedical conditions and complications; Emotional and behavioral conditions and complications; Treatment acceptance, resistance; Relapse and continued use potential; and Recovery environment)
  • Treatment Planning – Process by which one counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long term goals; and decide on a treatment process and the resources to be utilized.
  • Treatment Planning – Process by which one counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long term goals; and decide on a treatment process and the resources to be utilized.
  • Treatment Planning – Process by which one counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long term goals; and decide on a treatment process and the resources to be utilized.
  • Treatment Planning – Process by which one counselor and the client identify and rank problems needing resolution; establish agreed upon immediate and long term goals; and decide on a treatment process and the resources to be utilized.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Counseling – (Individual, Group, and Significant Others) The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.
  • Case Management – Activities which bring services, agencies, resources, or people together within a planned framework of action towards the achievement of established goals. It may involve liaison activities and collateral contacts.
  • Case Management – Activities which bring services, agencies, resources, or people together within a planned framework of action towards the achievement of established goals. It may involve liaison activities and collateral contacts.
  • Crisis Intervention - Those services which correspond to an alcohol and/or other drug abuser’s needs during acute emotional and/or physical distress.
  • Crisis Intervention - Those services which correspond to an alcohol and/or other drug abuser’s needs during acute emotional and/or physical distress.
  • Crisis Intervention - Those services which correspond to an alcohol and/or other drug abuser’s needs during acute emotional and/or physical distress.
  • Client Education - Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.
  • Client Education - Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.
  • Referral - Identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
  • Referral - Identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
  • Referral - Identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
  • Referral - Identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
  • Referral - Identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
  • Reports and record keeping - Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries, and other client-related data.
  • Reports and record keeping - Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries, and other client-related data.
  • Reports and record keeping - Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries, and other client-related data.
  • Consultation with other professionals in regard to client treatment/services - Relating with our own and other professionals to assure comprehensive, quality care for the client.
  • Consultation with other professionals in regard to client treatment/services - Relating with our own and other professionals to assure comprehensive, quality care for the client.
  • Consultation with other professionals in regard to client treatment/services - Relating with our own and other professionals to assure comprehensive, quality care for the client.
  • Consultation with other professionals in regard to client treatment/services - Relating with our own and other professionals to assure comprehensive, quality care for the client.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
  • Please indicate the number of hours the student intern has spent working in each core function to date.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's professionalism as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.
    Please rate the student's performance in the counseling relationship as a beginning LADC practitioner.

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