performance assessment forcenterforchildwelfare.fmhi.usf.edu/kb/trainerscorner/fsp5348-lc.pdf · 2...

PERFORMANCE ASSESSMENT

for CHILD PROTECTION

LICENSING COUNSELOR CANDIDATES

Planning

Interpersonal

Documentation

Assessment

Safety Permanency Well-Being

Effective August 2010

CF-FSP 5348, PDF 08/2010 [65C-33.006, F.A.C.]

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Instructions For full instructions on the implementation of the Performance Assessment process, please refer to 65C-33.006, F.A.C. Introduction After successful completion of all of the required classroom and field training provided as part of the State of Florida Child Welfare Pre-Service Training Program (or completion of the individual’s waiver plan, if applicable), and upon approval of the candidate’s supervisor, the candidate is considered eligible to take the Performance Assessment. The Performance Assessment is a standardized, on-the-job, competency-based performance evaluation of child protection professionals to assess their knowledge, skills, abilities and priorities in performing their jobs. This Assessment is designed for Child Protection Licensing Counselor candidates; it was developed to evaluate the candidate’s ability to demonstrate core competency elements through skilled performance of minimum applicable key case activities. Although every agency must utilize this standard core Performance Assessment approved by the Department for Child Protection Licensing Counselor candidates, each agency may incorporate into the Assessment additional components which reflect the agency’s own System of Care, Peer Review, or Quality Assurance measures. These additions must not change the core elements of the Assessment, and although they may be more prescriptive than statute, rule and Department policy, they may not be less so. (The agency-specific additions to the core Performance Assessment are not required to be forwarded to the Office of Family Safety for approval prior to use.) Although there is no set time frame during which the candidate must begin the Performance Assessment, it is important to consider the following for planning and scheduling purposes:

• All evaluations of each component of the Performance Assessment (including any re-takes, if

necessary) must be completed no later than one (1) year from the date of hire, or the date of the candidate’s successful completion of the post-test or waiver test, whichever is earlier.

There are two (2) components of this Performance Assessment, which are designed to enable Child Protection Licensing candidates to demonstrate their competency in the following areas:

Casework Component:

o Assessment (Competency A) o Planning (Competency B)

o Documentation (Competency C)

Interpersonal Skills Component: o Interpersonal Skills Observation (Competency D)

There is no requirement as to which component of the Performance Assessment is evaluated first, the casework or the interpersonal skills portion; successful completion of both portions of the Performance Assessment is required in order to achieve the certification designation of “Certified Child Protection Licensing Counselor”. All candidates for certification are provided with two opportunities to pass the Performance Assessment; both attempts (including all evaluations) must be completed no later than one (1) year from the date of hire into the position, or the date of the candidate’s successful completion of the post-test or waiver test, whichever is earlier.

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Casework Component: Case Selection Procedures For each Child Protection Licensing Counselor candidate, the casework portion of the Performance Assessment will be conducted on one of the licensing (or relicensing) files from the candidate’s case load which meets the parameters for selection as described below.

Each employing agency will establish Performance Assessment case selection procedures which may include identifying one “test” case per candidate, or a combination of several such cases per candidate, in order to determine an average rating of all standards. Case selection procedures may include random or planned identification of the one or more “test” cases, which meet the established criteria for the casework component of the Assessment. Inasmuch as the Performance Assessment enables child protection professionals to demonstrate their skills consistent with the specific tasks their job requires, each individual must complete the Performance Assessment that is most representative of or most closely matches his or her job responsibilities. The evaluators will be looking at the actual case materials completed while working with the foster family to assess the candidate’s ability to demonstrate effective casework skills, therefore, candidates may not create “dummy” documents for the purpose of the evaluation. The file must be an initial licensing file (or relicensing file if the candidate’s work involves only relicensing files), and must be one in which the candidate completed all of the case documents being evaluated. The parameters for case selection for this Performance Assessment are:

• Child Protection Licensing Counselor Candidate:

o Initial Licensing File: The file must be one which has been completed in full, so that it includes

all of the documents evaluated by the assessment (including, but not limited to the home study, all supporting licensing documentation, and a recommendation to license), and all such documents being evaluated must have been personally completed by the candidate. The file can be one which has been submitted (or one which has not yet been submitted) for licensure.

o Relicensing File: If the candidate’s work involves only relicensing files, the file selected for the

Performance Assessment may be a relicensing file, provided that the file is an active (not closed) relicensing file of a foster home which has had at least one placement (not respite) for a minimum of 90 days during the past licensing year.

Casework Component: Work Products Demonstration of skills through written work products will be evaluated during the casework component of the Performance Assessment. All documents evaluated must be the sole work of the candidate. The casework evaluation must include a review of all documentation in both the paper case file (if any) and the electronic SACWIS (FSFN) record of the case (or other approved system if the provider is unable to input, retrieve or otherwise access information in the FSFN system). In those situations where it is anticipated or known that an evaluator may be unable to access or view documentation within the FSFN record, all documents, completed forms and information in the electronic FSFN or other record of the case must be printed out and placed into the case file to be evaluated (or otherwise made accessible to all evaluators), prior to the scheduled starting date of the Performance Assessment. No documents may be added to, removed from, or changed within either the electronic or printed case file once the Performance Assessment process has begun. Casework Component: Scoring Procedures Each competency area must be passed by the Child Protection Licensing Counselor candidate in order to successfully complete the Performance Assessment.

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The criteria which must be met in order for the candidate to pass each of the competency areas are found in the following pages of the Performance Assessment, along with examples and illustrations of each standard, and factors that should be considered by candidates as well as evaluators in determining to what degree each standard was met in each case:

Competency A: Assessment Competency B: Planning Competency C: Documentation Competency D: Interpersonal Skills

The ratings to be used by evaluators when scoring the Assessment competency in the casework component of the Performance Assessment are the following:

Yes = Meets basic performance standards (Pass) No = Needs improvement to meet basic performance standards (Fail) Each standard of the Assessment competency must achieve a rating of “Yes” in order to pass. A score of “No” on any standard indicates an insufficiency in demonstrated skills and the entire Assessment competency must be retaken and successfully completed in order to be eligible for certification. When a second Performance Assessment attempt is required, the candidate need only demonstrate skills for the competency (ies) not passed on the first attempt. For example, there are five standards that comprise the Assessment competency (Competency A); a Child Protection Licensing Counselor candidate who achieves a rating of “YES” on standards 1, 2, 3, and 5, but receives a rating of “NO” on standard number 4 has not passed the Assessment competency. Thus, assuming that this candidate received a passing rating on all of the standards in the remaining casework competencies (in this example, Planning and Documentation), the candidate, on his/her second attempt of the Performance Assessment, would only need to be evaluated on all of the standards in the Assessment competency (which is the competency in which s/he failed one of the standards); s/he would not need to be evaluated again on the Planning or Documentation competencies, since s/he passed all of those standards on his/her first Performance Assessment attempt. The ratings to be used by evaluators when scoring the Planning and Documentation competencies in the casework component of the Performance Assessment are the following:

1 = Needs improvement to meet basic performance standards (Fail) 2 = Meets basic performance standards (Pass) 3 = Exceeds basic performance standards (Pass)

Each standard of the Planning and Documentation competencies must achieve a rating of “2” or “3” in order to pass. A score of “1” on any standard indicates an insufficiency in demonstrated skills and that entire competency must be retaken and successfully completed in order to be eligible for certification. As indicated previously, when a second Performance Assessment attempt is required, the candidate need only demonstrate skills for the competency (ies) not passed on the first attempt. Any casework component standard which has as a choice “N/A,” means that any evaluator may select “N/A” only if the standard was not applicable to the file under review; an “N/A” rating for a standard in which “N/A” is a choice does not count against the candidate.

Interpersonal Skills Component

Each Child Protection Licensing Counselor candidate will be evaluated on his or her interpersonal skills while interacting with a family during a home visit. The family selected does not have to be the same family as that which was selected for the casework component, however it may be.

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It is the responsibility of the candidate to select the interaction(s) for the interpersonal skills evaluation(s) and to schedule the observation(s). For Child Protection Licensing Counselor candidates, the interpersonal skills evaluation(s) must be scheduled in the home of a family that is seeking licensure or relicensure. The interpersonal skills evaluation(s) may be scheduled at any time after the Performance Assessment process has begun, as long as there is sufficient time for both the Casework and Interpersonal components of the Assessment (including any retakes, if necessary) to be completed no later than one (1) year from the date of the candidate’s hire into the position, or successful completion of the waiver or post-test, whichever is earlier. For all candidates for certification, the professional interaction shall be evaluated per the criteria set forth in the Department-approved basic, core Performance Assessment. The ratings to be used by evaluators when scoring the Interpersonal Skills Assessment are as follows:

Yes = Meets basic performance standards (Pass) No = Needs improvement to meet basic performance standards (Fail)

Each standard must achieve a rating of “Yes” to be considered passing. A score of “No” on any standard indicates an insufficiency in demonstrated skills and the entire Interpersonal Skills Assessment must be retaken and successfully completed in order to be eligible for certification. Any interpersonal skills standard which has as a choice “N/A,” means that the evaluator may select “N/A” only if the standard was not applicable to the interaction being observed; an “N/A” rating for a standard in which “N/A” is a choice does not count against the candidate.

Casework and Interpersonal Components: Evaluators Both the Casework and Interpersonal components of the Performance Assessment must undergo a two-tiered evaluation, whereby each component is assessed by two (2) evaluators, either internal or external to the employing agency, both of whom must be certified, and at least one of whom shall be an “independent evaluator” of the candidate’s Performance Assessment (i.e., “independent” in that s/he is not in the candidate’s chain of command).

• First Tier: If certified as a supervisor, the candidate’s supervisor may serve as the first-tier evaluator, but is not required to do so.

o If the candidate’s immediate supervisor is not certified as a supervisor, he or she must not serve as the first-tier evaluator for either the Casework or Interpersonal components of the Performance Assessment; another supervisor or other evaluator at the supervisory or higher level (supervisor; specialist; trainer) must conduct the evaluation. When possible, the certified individual serving as an evaluator should be certified in the same program area of child protection expertise as that in which the candidate is seeking certification (i.e., Licensing).

• Second Tier (Independent Evaluator): For Child Protection Licensing Counselor candidates, an

independent evaluator may be any individual certified as a Supervisor, Trainer or Specialist.

o Independent evaluators may be from within the same employing agency as that of the candidate, or from another agency which performs the same or substantially similar child welfare/child protection work, provided that the individuals meet the independent evaluator criteria. Agency policy may include the assignment of more than one independent evaluator or the use of independent evaluation “teams”.

o An independent evaluator must not conduct an assessment of any candidate within his or her

chain of command, or of any candidate with whom there may exist a personal relationship or other possible conflict of interest.

o The second-tier (independent) evaluation of the Casework component of the Performance

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Assessment may be conducted only after the initial evaluation has been completed by the first-tier evaluator.

o If more than one independent evaluator is assigned, the same independent evaluator(s) is not

required to evaluate both components of a candidate’s Performance Assessment (including any agency-specific additions); one independent evaluator may evaluate the Casework component, and another evaluate the Interpersonal component of the Assessment.

There is no requirement that the first-tier evaluator and the independent evaluator observe separate interpersonal interactions, although they may do so, based upon such factors as scheduling availability and sensitivity to the needs of clients and families. If the first-tier evaluator and independent evaluator observe separate interactions, either evaluator’s observation may be completed first.

Evaluation Process The two (or more, if applicable) evaluators will assess the same case materials; as indicated previously, they may observe the same interpersonal skills interactions or separate interactions, depending upon scheduling availability. Each evaluator will complete his or her Evaluator Criteria worksheets independently of any other reviewers; both the first and second tier Casework component evaluation includes review of the entire licensing (or relicensing) file (both written and FSFN work products), where each evaluator rates the candidate’s ability to meet or exceed basic performance standards, as evidenced by the casework competency the candidate demonstrated in the selected licensing or relicensing file. Absent special circumstances accommodated by the employing agency, the first-tier evaluator must conclude his or her evaluation within 10 business days of having all licensing file information provided to him or her by the candidate’s supervisor. Upon completion of his or her evaluation (but no later than 10 business days of receiving all case materials), the first-tier evaluator must provide same case materials to the independent evaluator for his or her evaluation, regardless of the results of the first-tier evaluation. Each independent evaluator has 10 business days from the date he or she has been provided with the case materials to conclude his or her evaluation of the candidate’s casework. The results of the first-tier evaluator’s rating of the Casework component of the Performance Assessment must not be shared with the candidate, the independent evaluator, or any other party prior to the independent evaluator having completed his or her evaluation. Completion of the Performance Assessment All four competency areas (Assessment; Planning; Documentation; Interpersonal) of the Performance Assessment, including any agency-designed and agency-required additional components, must be successfully completed in order for the individual to fulfill the minimum performance standards required for initial certification as a Child Protection Licensing Counselor. Successful completion of the Performance Assessment requires that both the first-tier evaluator and the assigned independent evaluator concur that the candidate effectively demonstrated the knowledge, skills, abilities and priorities in both the Casework and Interpersonal components of the Performance Assessment which are necessary for the competent performance of the duties required by his or her position. At such time as the independent evaluator has completed both the Casework and Interpersonal evaluations, he or she (or they), along with the first-tier evaluator and the candidate’s supervisor (if different) will meet to review and discuss the findings, prior to meeting with the candidate to present the results. Agree/Pass: If both the independent evaluator and the first-tier evaluator agree that the individual successfully completed all components of the Performance Assessment, the candidate has met the standard

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for initial certification as a Child Protection Licensing Counselor and the necessary paperwork must be completed per the process set forth in Rule 65C-33.009, F.A.C., to request that the candidate be issued his or her certificate. Agree/Fail: If both the independent evaluator and the first-tier evaluator agree that the individual did not successfully complete all components of the Performance Assessment (including any agency-designed additional components), the candidate’s supervisor will provide the candidate with a copy of the signed Assessment Results Form documenting the performance deficiencies in those skill areas that need improvement in order for the candidate to pass a second attempt of the Performance Assessment. Disagree: The employing agency shall have established a protocol for the resolution of differences which arise in the event that, after a review of the findings, the first-tier evaluator and the independent evaluator(s) differ in their perspective on whether or not the candidate successfully completed all components of the Performance Assessment. Such agency protocol should include convening a Review Panel (or some similar resolution process) consisting of at least three executive staff (supervisory or higher level, at least one of whom must be certified) from the employing or other agency (who did not participate in initially evaluating the candidate’s Performance Assessment), to evaluate the same work products and skills assessed during the initial evaluation. Within three (3) business days of the request for a Review Panel, all Performance Assessment work product materials (including all completed first and second-tier evaluation forms) shall be forwarded to the senior member of the panel by the candidate’s supervisor. Within five (5) business days of receipt of the Performance Assessment materials by the senior panel member, the Panel shall meet, review the materials and make a determination as to whether or not the candidate successfully completed the Performance Assessment. The Panel must conclude its evaluation of all work products no later than 15 business days after having been notified that the Tier 1 and Tier 2 evaluators disagree on their findings. As part of the panel’s decision-making process, the panel may request that both the first and second-tier evaluators appear and discuss their findings. In the case of a difference of opinion between the panel members as to whether or not the candidate successfully completed the Performance Assessment, the senior panel member shall make the final decision. Within two (2) business days of the panel having reached a decision, the senior member of the Panel shall return all Performance Assessment materials to the candidate’s supervisor. Within two (2) business days of having the materials returned to him/her, the candidate’s supervisor shall meet with the candidate to officially present the determination of the Review Panel. The Panel decision shall be final and binding. Second Attempted Performance Assessment Case selection for a second attempted Performance Assessment (Casework component), will follow the same agency protocol as established for selection of a case for a candidate’s initial Performance Assessment attempt. A candidate may not use the same file/case for the second attempt as was used for the first attempt. Selection and scheduling of a professional interaction for a second attempted interpersonal skills evaluation remains the responsibility of the candidate. For both the Casework and Interpersonal components, the first-tier evaluator and independent evaluator(s) for the individual’s second Assessment attempt must not be the same individual(s) as those who participated in rating the candidate’s first attempt of the Performance Assessment. All initial and subsequently attempted Performance Assessment activities and evaluations must be concluded no later than one (1) year from the date the individual was hired into the position, or passed the waiver or post-test (whichever is earlier), by which time the individual must have either achieved Child Protection Professional certification or must be removed from any position requiring such certification.

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Child Protection Licensing Counselor Certification Candidate Assessment Results Form Candidate’s Name:____________________________________________________________________ Date of Hire/Post-Test/Waiver Test (Latest):______________ Agency Name:__________________________________________ Case Identification Name or Number:__________________________________________________________________________ Performance Assessment Attempt Number (circle one): 1 2

Each standard in each competency HAS achieved a rating of 3 or higher (or “Yes”) from all Review Panel members.

Therefore, we confirm that the Candidate HAS demonstrated competency as required by the Performance Assessment.

Each standard in each competency HAS NOT achieved a rating of 3 or higher (or “Yes”) from all Review Panel members. Therefore, we confirm that the Candidate HAS NOT demonstrated competency as required by the Performance

Assessment. The competency(ies) not passed are (please check and explain all that apply):

Assessment (A)_______________________________________________________________________________

Planning (B)__________________________________________________________________________________

Documentation (C)_____________________________________________________________________________

Interpersonal Skills (D)_________________________________________________________________________ Please explain above (and on additional sheets, if necessary) all deficiencies noted and what the Candidate must do in order to demonstrate competency in those areas. Supervisor’s Name (please print):____________________________________________ Date:________________________ Supervisor’s Signature:_________________________________________________________________________________ 1st Tier Evaluator’s Name (please print):_______________________________________ Date:________________________ 1st Tier Evaluator’s Signature:____________________________________________________________________________ 2nd Tier Evaluator’s Name (please print):______________________________________ Date:________________________ 2nd Tier Evaluator’s Signature:____________________________________________________________________________ I, the undersigned Candidate for Certification, have received the results of the Performance Assessment on this date. Candidate’s Name (please print):___________________________________________ Date:________________________ Candidate’s Signature:_________________________________________________________________________________

The Candidate refused to sign. The Candidate received a copy of this Assessment Results Form. ______________ (Supervisor must initial above)

Planning

Interpersonal

Assessment

Documentation


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Child Protection Licensing Counselor Certification Candidate Assessment Results Form REVIEW PANEL ONLY (if required) Candidate’s Name:_____________________________________________________________________________________ Date of Hire/Post-Test/Waiver Test (Latest):______________ Agency Name: ______________________________________ Case Identification Name or Number: ______________________________________________________________________ Performance Assessment Attempt Number (circle one): 1 2

Each standard in each competency HAS achieved a rating of 3 or higher (or “Yes”) from all Review Panel members.

Therefore, we confirm that the Candidate HAS demonstrated competency as required by the Performance Assessment.

Each standard in each competency HAS NOT achieved a rating of 3 or higher (or “Yes”) from all Review Panel members.

Therefore, we confirm that the Candidate HAS NOT demonstrated competency as required by the Performance

Assessment. The competency(ies) not passed are (please check and explain all that apply):

Assessment (A)_______________________________________________________________________________

Planning (B)__________________________________________________________________________________

Documentation (C)_____________________________________________________________________________

Interpersonal Skills (D)_________________________________________________________________________ Please explain above (and on additional sheets, if necessary) all deficiencies noted and what the Candidate must do in order to demonstrate competency in those areas. Panel Member’s Name (please print):____________________________________________ Date:____________________ Panel Member’s Signature:_____________________________________________________________________________ Panel Member’s Name (please print):____________________________________________ Date:____________________ Panel Member’s Signature:_____________________________________________________________________________ Panel Member’s Name (please print):___________________________________________ Date:___________________ Panel Member’s Signature:_____________________________________________________________________________ I, the undersigned Candidate for Certification, have received the results of the Performance Assessment on this date. Candidate’s Name (please print):___________________________________________ Date:________________________ Candidate’s Signature:_________________________________________________________________________________

The Candidate refused to sign. The Candidate received a copy of this Assessment Results Form. ______________ (Supervisor must initial above)

Planning

Interpersonal

Documentation

Assessment


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Child Protection Licensing Performance Assessment

Licensing Counselor Candidate Name:____________________________________________________ Evaluator Name:_____________________________________ Date:_____________ Foster Home File Identifier (Name or Number):_____________________________________________ Attempt # (Circle one): 1 2

Evaluator Rating for Competency A: ASSESSMENT

Evaluate the candidate’s work as provided on the Licensing Standards Checklist and other supporting documentation. In order to meet basic performance standards, the candidate’s documentation should address all the criteria and elements on this form whether applicable to the inspection or not. For example, “This home has no swimming pool or body of water.”

Each standard in the Assessment competency must be evaluated as follows: Yes = Meets basic performance standards (Pass) No = Needs improvement to meet basic performance standards (Fail) Each of the applicable standards in this competency must receive a rating of “Yes” in order for the Candidate to have passed this competency. In order to meet the minimum standard, the candidate must have addressed each of the elements listed in each standard; if not addressed, or not addressed adequately or appropriately, the reviewer must rate the standard as “No”. A score of “No” on any of the following five (5) standards indicates an insufficiency in demonstrated skills, and the entire Assessment competency must be retaken and successfully completed (on a different file) in order to be eligible for certification. Assessment Competency: This section evaluates the extent to which the information provided by the candidate’s assessment of the prospective (or licensed) foster family and home addresses issues with sufficient thoroughness to support sound decision-making in terms of child safety. Assessment information may be found on the Licensing Standards Checklist, or in other supporting documentation in the selected file.

Yes

No

I. Home Safety: Standard: The candidate adequately and appropriately addressed if the following home safety requirements are in compliance, or if there are violations. In order to meet the minimum standard, the candidate must have addressed each of the following:

a. The acknowledgement provided to the foster parents (“Acknowledgement of Firearms Safety Requirements”, CF-FSP 5343, March 2010, incorporated by reference and available at www.dcf.state.fl.us/admin/publications/), regarding the fact that anyone who owns or stores a loaded firearm must keep it in a locked place, secure from any minor who could gain access to it without lawful permission.

b. All medications, poisonous chemicals, and cleaning materials must be kept in a locked place, inaccessible to children.

c. Alcoholic beverages shall be stored in a location out of reach to children. d. Children’s access to large pets or potentially dangerous animals must be restricted. e. Transportation and access to telephone must be available for immediate use in

Planning

Interpersonal

Documentation

Assessment


http://www.dcf.state.fl.us/admin/publications/

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emergencies. Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Yes

No

II. Transportation Safety: STANDARD: The candidate adequately and appropriately addressed if the following transportation safety requirements are in compliance, or if there are violations. In order to meet the minimum standard, the candidate must have addressed each of the following:

a. All vehicles used to transport children must comply with the applicable motor vehicle laws of the state and be equipped with seat belts and/or approved car seats for children under 4 years of age.

b. All vehicles owned by substitute parents used for transporting children must have proof of liability insurance.

c. Substitute parents who drive must have a valid driver’s license (obtain the license number, or a copy of the driver’s license).

d. A copy of the driving record of each applicant must be included. Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Yes

No

III. Care and Supervision: STANDARD: The candidate adequately and appropriately addressed if the following care and supervision requirements are in compliance, or if there are violations noted. In order to meet the minimum standard, the candidate must have addressed each of the following:

a. There are no more than two infants under 2 years of age in the home. (If this capacity is exceeded, an approved, current [not expired] waiver must be in the file.)

b. There are no more than five children in the home, including the substitute parent’s own children. (If this capacity is exceeded, an approved, current [not expired] waiver must be in the file.)

c. Substitute parents have been advised of and have agreed to abide by the discipline policy set forth in 65C-13.029(1)(g)11.e.(I)-(X), F.A.C.

Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Even though the home study may indicate that a waiver was included, that in itself is not

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sufficient; a copy of the approved, current (not expired) waiver must be included in the file. • The discipline policy may be included in the Bi-Lateral Agreement, or may be a separate

form. • For relicensing files, in order to determine if there has been a period at any time during the

year if the home exceeded capacity, the evaluator must review the history of placements, to ensure that there was an approved waiver in effect for any time during the relicensing year that any capacity was exceeded.

Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Yes

No

IV. Physical Environment: STANDARD: The candidate adequately and appropriately addressed if the following physical environment requirements are in compliance, or if violations are noted. In order to meet the minimum standard, the candidate must have addressed each of the following:

a. The home premises must be free from objects, materials, and conditions that constitute a danger to children.

b. The home must have a safe outdoor play area as part of the property or within reasonable walking distance.

c. Each child must be provided with adequate storage space for personal belongings and a designated space for hanging clothes in or near the bedroom occupied by the child.

d. Any children over 3 years of age must not share a bedroom with a child of the opposite sex.


_____________________________________________________________________________

_____________________________________________________________________________ ______________________________________________________________________________

Yes

No

V. Swimming Pool/Body of Water:

STANDARD: The candidate adequately and appropriately addressed whether or not the following swimming pool and body of water requirements are in compliance, or if violations are noted. In order to meet the minimum standard, the candidate must have addressed each of the following:

a. Swimming pools must have a barrier on all sides at least four feet high. b. All access through the barrier must have one of the following safety features (indicate

which one): a) alarm, b) key lock, c) self-locking doors, or d) bolt lock that is not accessible to children.

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c. When swimming pool is not in use, all entry points must be locked. d. Steps or ladders leading to above-ground pools must be secured, locked, or removed

when the pool is not in use. e. Hot tubs and spas shall be required to have a safety cover that is locked when not in use. f. Swimming pools must be equipped with one of the following lifesaving devices (indicate

which one): a) ring buoy, b) rescue tube, or c) other appropriate device with a rope attached which is sufficient in length to cover the area.

g. Substitute care parents who have swimming pools (or whose property is adjacent to a body of water unprotected by a barrier of at least four feet high) must have completed a basic water safety course.

h. Substitute care providers have been informed that direct adult supervision is required when children are using the swimming pool, spa or hot tub, or are in the pool area.


• The evaluator may rate as “Yes” if the candidate documented once that there is no swimming pool or body of water and then chose “N/A” for subsequent pool/body of water questions.

• If the candidate did not document that there is no swimming pool or body of water, rate as “No”.


_____________________________________________________________________________

_____________________________________________________________________________

Additional Reviewer/Evaluator Comments on Competency A – Assessment:

______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Licensing Counselor Candidate Name:___________________________________________________ Evaluator Name:___________________________________ Date:______________ Foster Home File Identifier (Name or Number):____________________________________________ Attempt # (Circle one): 1 2

Evaluator Rating for Competency B: PLANNING Evaluate the candidate’s work as provided in the case file and in the electronic SACWIS (FSFN) record of the case (and/or other approved system if the provider is unable to input, retrieve or otherwise access information in the FSFN system). The casework will reflect the candidate’s analysis of the information gathered through the licensing (or relicensing) process. Evaluate the candidate’s work as provided in the Home Study to successfully address safety, permanence and well being; the Home Study and other supporting documentation should address all the criteria and elements on this form whether applicable to the assessment or not. For example, “The family has no history of domestic violence.”

Each standard in the Planning competency must be evaluated as follows: 1 = Needs improvement to meet basic performance standards (Fail) 2 = Meets basic performance standards (Pass) 3 = Exceeds basic performance standards (Pass) Each of the applicable standards in this competency must receive a rating of “2” or “3” in order for the Candidate to have passed this competency. In order to meet the minimum standard, the candidate must have addressed each of the elements listed in each standard; if not addressed, or not addressed adequately or appropriately, the reviewer must rate the standard as “1”.

A score of “1” on any of the following four (4) standards indicates an insufficiency in demonstrated skills, and the entire Planning competency must be retaken and successfully completed in order to be eligible for certification.

Planning Competency: This competency evaluates the extent to which the candidate’s Home Study (or updated Home Study, in the case of relicensing files) provides accurate and relevant information for licensing/placement purposes, as well as for immediate and long-term safety planning, case planning, and permanency considerations. This competency also evaluates if the candidate’s assessment of the family and home appropriately addresses relevant strengths and needs of the family in terms of any present or emerging dangers, placement considerations, and caregiver protective capacities. In addition, this competency assesses the thoroughness with which all family and home information is updated in order to support sound decision-making in terms of child safety, permanence and well-being.

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2

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I. STANDARD: The candidate explored and described completely the composition of the household and the interaction of the members of the foster family. Reviewers/evaluators must consider the following factors in determining to what degree this standard was met:

a. For BOTH initial and relicensing files, the rule requires interviews with all household members.

b. For BOTH initial and relicensing files, the candidate must address who lives in the home and how they are related (parents, children, paramours, relatives, etc.).

c. For initial licensing files, the candidate must address family life by documenting observations

Planning

Interpersonal

Documentation

Assessment


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of family members, personalities, and their interpersonal relationships. The candidate must describe family activities, hobbies and interests and civic involvement, and for each child living in the home, the candidate must describe interests, as well as his or her feelings about having a foster child in the home. The candidate should explore how the family anticipates that the foster child will be incorporated into the family’s life. For relicensing files, the candidate must address and explore how any foster children were incorporated into the family’s life.

d. For initial licensing, did the candidate explore what will be the relationship of relatives and close family friends with the foster child (i.e., how will relatives and close family members interact with the foster child)?

For relicensing files, did the candidate interview all household members and address the family’s feelings of how fostering has affected their relationships or lifestyle?


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

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2

3

II. STANDARD: The candidate explored and described completely any issues of possible concern relating to the foster family. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

a. For BOTH initial and relicensing files, the candidate must address and explore any past or present involvement in any criminal activity, domestic violence, physical abuse, sexual abuse or substance abuse. If so, the candidate must address what caused the situation and how it has been resolved or changed. In all cases, all findings of protective orders must be addressed, and the candidate must address any results of civil records checks or supporting documentation revealing any concerns.

b. For initial licensing files, the candidate must address and explore if any family member presently has (or had in the past) any health problems. If so, the candidate must address how the health situation has been resolved or changed. For relicensing files, the candidate must address and explore any changes in health since the last licensure.

c. For initial licensing files, the candidate must provide a description of the discipline methods used by the applicant’s own family while growing up, and must address and explore the discipline methods used by the applicant on his or her own children, as well as the plan for disciplining foster care children in the home. The candidate must document that the family understands the discipline/no corporal punishment policy.

d. For relicensing files, the candidate must address and provide a description of how the licensed out-of-home caregiver has handled any behavioral problems with every child placed in the home. The candidate must explore all discipline practices and behavior management

16

techniques used by the applicant with all children in the home.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

III. STANDARD: The candidate explored and fully described the foster family’s employment, social, and community context. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

a. For BOTH initial and relicensing files, the candidate must address and explore whether or not the family has sufficient income to assure the stability and the security of their own family without having to rely on board payments. For relicensing files, any changes in employment and/or income must be fully explored.

b. For initial licensing files, the candidate must address and explore whether or not the family’s home provides access to schools, houses of worship, medical care, recreation, and community facilities. The candidate must also address and explore how the family will provide “normalcy” opportunities for any children being placed with them to participate in recreational activities and community events in order to help promote their social development. For relicensing files, the candidate must address and explore any changes in access to schools; houses of worship; medical care; recreation; and community facilities. The candidate must also address and explore how the family provided “normalcy” opportunities for any children in placement with them to participate in recreational activities and community events in order to help promote their social development.

Reviewer/Evaluator Comments: _________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

17

1

2

3

IV. STANDARD: The candidate explored and fully described the foster family’s perceptions of meeting the needs of the child. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

a. For BOTH initial and relicensing files, the candidate must address and explore the family’s reactions to the child’s needs by assessing the family’s ability to provide for the physical and emotional needs of a child. In initial licensing files, the candidate must address this in terms of “How would you…?” whereas in relicensing files, the candidate must address this in terms of “How did you…?” with regard to each child that was placed in the home.

b. For BOTH initial and relicensing files, the candidate must address and explore the family’s

feelings about foster care, and the family’s motivation to be (or to continue as) a foster family, as well as their commitment to the foster care experience.

c. For BOTH initial and relicensing files, the candidate must address and explore the

strengths, needs, and personal adjustment of each member of the household with regard to the ability to meet the needs of children in care, taking into consideration all factors affecting the health, safety, and welfare of children who might be (or were) placed in this home (including but not limited to the medical, educational, emotional, behavioral, social and normalcy needs of each child).

In initial licensing files, the candidate must address each of these areas (strengths, needs, personal adjustment) in terms of the perceptions of the candidate, the family, and others known by the family with regard to how their strengths, needs, and personal adjustment could impact a child placed in the home.

In relicensing files, the candidate must address each of these areas (strengths, needs, personal adjustment) in terms of how the family members were able to meet the unique medical, educational, emotional, behavioral, social and normalcy needs of each of the children placed with them (e.g., to what degree and how well did the family work with the birth parent[s] of the children placed with them; how involved was the family in each child’s education and medical care; etc.).

d. For BOTH initial and relicensing files, the candidate must address and explore the

willingness of the family to accept services.

In initial licensing files, the candidate must address, explore, and document the applicant’s demonstrated willingness to work with the supervising agency and all applicable parties to work towards permanence.

In relicensing files, the candidate must address, explore, and document the caregiver’s experiences with staff and providers, and his/her/their statements regarding services received by each of the children placed in their home.

e. For BOTH initial and relicensing files, the candidate must address and explore the family’s

understanding of and respect for the importance of preserving a child’s family connections and relationships.

Reviewer/Evaluator Comments: _________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

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Additional Reviewer/Evaluator Comments on Competency B – Planning: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Licensing Counselor Candidate Name:_____________________________________________________ Evaluator Name:____________________________________ Date:_______________ Foster Home Identifier (Name or Number):_______________________________________________ Attempt # (Circle one): 1 2

Evaluator Rating for Competency C: DOCUMENTATION

Evaluate the candidate’s work as provided in the licensing file and in the electronic SACWIS (FSFN) record of the case (and/or other approved system if the provider is unable to input, retrieve or otherwise access information in the FSFN system). The casework will reflect the candidate’s documentation of the information gathered through the licensing or relicensing process.

Each standard in the Documentation competency must be evaluated as follows: 1 = Needs improvement to meet basic performance standards (Fail) 2 = Meets basic performance standards (Pass) 3 = Exceeds basic performance standards (Pass) Each of the applicable standards in this competency must receive a rating of “2” or “3” in order for the Candidate to have passed this competency. In order to meet the minimum standard, the candidate must have addressed each of the elements listed in each standard; if not addressed, or not addressed adequately or appropriately, the reviewer must rate the standard as “1”. A score of “1” on any of the following 13 standards indicates an insufficiency in demonstrated skills, and the entire Documentation competency must be retaken and successfully completed in order to be eligible for certification. Documentation Competency: This section assesses the extent to which the licensing (or relicensing) file under review is maintained in a consistent and organized manner, and whether each file under review includes all required documentation. This competency also assesses the candidate’s documentation of planning activities and time frame compliance, as well as documented coordination/provision of referrals and services to the licensed foster home. In addition, this competency assesses the candidate’s level of collaboration and participation with other individuals and/or entities in order to help enhance timely service provision, address concerns, or as mechanisms for ensuring that relevant information is reviewed and shared between affected parties for optimal decision-making.

1

2

3

I. STANDARD: The candidate’s licensing/relicensing file is organized in sections as directed by region/agency policy. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Examples include supporting licensing documentation, inspections and complaints; and • All documents are placed in chronological order by region/agency policy; and • Documents are neat, secured and filed correctly.

Planning

Interpersonal

Documentation

Assessment


20

Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

1

2

3

II. STANDARD: The licensing/relicensing file communicates all information in a clear and understandable manner. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Documentation in the home study must match the supporting documentation found in the file, and must reflect that the home study was customized to the family, rather than a “cut-and-paste” or “boiler-plate” study.

• The home study should answer more questions than it raises; any issues addressed should be fully explored and explained in the study.


_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

III. STANDARD: The file contains all documentation as required by region/agency policy. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met (each of the following must be included):

• License application; signed copy of license; supporting documents; and • Licensing checklist or similar documentation of compliance with administrative rule; and • Background screening results; and • References; and • Bi-Lateral Agreement; and • “Acknowledgement of Firearms Safety Requirements”, CF-FSP 5343,

incorporated by reference and available in DCF Forms; and • Discipline Policy Acknowledgement (is included in Bi-Lateral, or separate document); and • Financial Statement; and • Licensing Summary A and B (for relicensing files). • Other (please specify):____________________________________________________


_____________________________________________________________________________

_____________________________________________________________________________

21

1

2

3

N/A

IV. STANDARD: There is documented evidence of planning and steps to be taken to resolve identified problems or issues. Examples include: chronological notes; staffing summaries; the agency’s corrective action plan; safety plan; and the absence of any new reports. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• The candidate documented a plan to achieve compliance for any licensing standard that is identified as not in compliance, or requested a waiver in writing.

• The candidate’s documentation includes clear, time-limited statements of actions necessary for compliance.

• There is documentation of appropriate efforts to assist the foster home in meeting licensing (or relicensing) standards in a timely manner.

• Rate as “1” if problems or issues were identified, but the candidate took no action to resolve them.

• Rate as “N/A” if there were no identified problems or issues. Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________ _____________________________________________________________________________

1

2

3

N/A

V. STANDARD: There is evidence in the licensing/relicensing file to reflect that complaints or issues requiring follow-up were investigated and documented in a timely manner.

Examples of follow-up include such mechanisms as a safety plan; additional training; corrective action plan.


• For initial licensing files, this includes negative responses on personal or employment references; on adult/child references; and/or on school/daycare references.

• For both initial and relicensing files, this includes unsatisfactory ratings on health

inspections or negative comments or concerns raised by an inspector, even if a satisfactory rating was provided by the inspector.

• For relicensing files, this includes staff inquiries, exit interviews, and/or counselor reviews

of foster parent performance if any concerns were noted; also, foster parent comments on Relicensing Summary B.

• For relicensing files, this also includes foster care referrals (calls from the Hotline): Were all concerns followed up upon?

22

. • Rate as “N/A” if there were no complaints or issues requiring investigation or follow up.


_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

N/A

VI. STANDARD: There is evidence in the relicensing file to reflect that all license renewals were completed on or before the expiration date. (For relicensing files only)


• All renewal materials must be submitted to the licensing authority no less than 30 days prior to expiration, but cannot be initiated more than 90 days prior to expiration.

• Rate as “N/A” if the selected file is a relicensure on a home that closed and is relicensed

within 90 days of that closure. (Note that a case of this type is only to be used if no other cases fit the Performance Assessment criteria.)

• Rate as “N/A” if the selected file is an initial licensing file.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

VII. STANDARD: There is documentation reflecting that all inspections were performed as required (both by 65C-13, F.A.C., as well as those required by local protocol).

Note that this standard assesses all inspections required by each county government, health department or other local agency, including but not limited to inspections for: Radon Gas; Lead; or any specific water tests/inspections required. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Environmental health inspection reports and/or other region/agency-approved documentation is included, if required;

• Fire inspection reports and/or other region/agency-approved documentation is included, if

required;

• Other inspections are included, if required.

23

• If any inspections were required but not conducted, rate as a “1”.

Reviewer/Evaluator Comments: _________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

1

2

3

VIII. STANDARD: There is documentation to indicate that the candidate planned, coordinated, facilitated or referred the foster parents to appropriate (pre-service or in-service) training opportunities.

Examples may be found in In-Service Training Logs; documented in the licensing/relicensing file; and in the Home Study or updated Home Study. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Documentation should reflect 12 hours of training during the first two (2) years of licensure, and then eight (8) hours every year thereafter.

• For initial licensing files, examples include MAPP certification.

• For relicensing files, each foster parent is required to participate in a minimum of eight (8)

hours of in-service training per licensing year: • Did the candidate recommend training based on any noted deficiencies? • Did the candidate recommend training based on any foster parent request(s)? • Did the candidate refer to or arrange any specialized or medical/therapeutic trainings?

• For BOTH initial and relicensing files, did the candidate ensure and document that the foster parents completed:

• Psychotherapeutic Medication Training? • Water Safety Training (if applicable)? • Any other training required by local protocol? (Please specify)


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

24

1

2

3

N/A

IX. STANDARD: There is documentation to indicate that the candidate referred the foster parents for needed services or technical assistance when necessary or when requested. (For relicensing files)

Examples of documented referrals or requests for technical assistance include:

• Correspondence with the Case Manager (including emails to and from); • Information obtained from sources such as exit interviews; the “Services Worker’s Review

of Licensed Out-of-Home Caregiver’s Performance” form; this also includes staff inquiries, exit interviews, and/or case manager reviews of foster parent performance, if any concerns were noted; also, foster parent comments on Relicensing Summary B.

• Other supporting documentation to request services or support for the foster parents (or foster children) if the family (or the candidate’s supervisor or other professional) identified a need for the family to receive services or technical assistance.


• Rate as “N/A” if there were no referral or technical assistance needs; • If referrals or services were needed but not provided, rate as a “1”. • If referrals or services were requested by the foster parents (or the candidate’s supervisor, or other professional) and were not provided, rate as a “1”. • Rate as “N/A” for initial licensing files.


_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

X. STANDARD: There is documentation to reflect that the candidate interacted with the foster parents as required by policy and local protocol.


• Initial Licensing File – The Home Study must include chronological dates of all home visits and interviews of all household members (the dates, names of persons interviewed and a summary of these interviews must be documented in the home study). • Relicensing File – The updated Home Study must include chronological dates of home visits and names of all persons interviewed. • All files – Phone calls, emails, and/or other types of correspondence from the foster parents were responded to by the candidate in a timely manner.


_____________________________________________________________________________

_____________________________________________________________________________

25

1

2

3

N/A

XI. STANDARD: Documentation reflects evidence of candidate follow-up on supervisory direction and guidance when provided.

Documented examples may be found in staffing notes; information in FSFN; and email correspondence. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Rate as “N/A” if no supervisory guidance or direction was warranted. • If supervisory guidance was warranted but not sought, rate as a “1”. • If supervisory guidance was warranted and sought, but guidance was not implemented,

rate as a “1”. Reviewer/Evaluator Comments: _________________________________________________ _____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

1

2

3

N/A

XII. STANDARD: Documentation reflects evidence of participation with legal counsel when warranted.

Documented examples may be found in legal staffing notes; administrative hearing notes; information in FSFN; email correspondence. Note that if the foster home was recommended for license denial, suspension or revocation, the candidate must have sought advice from legal counsel. Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Rate as “N/A” if no legal guidance or direction was warranted. • If legal guidance was warranted but not sought, rate as a “1”. • If legal guidance was warranted and sought, but guidance was not implemented, rate as a “1”.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

26

1

2

3

N/A

XIII. STANDARD: Documentation reflects evidence of contact with Department of Children and Families (DCF) staff, or other Community-Based Care (CBC) or agency staff when warranted, necessary, or appropriate. Documented examples include: contact to discuss corrective actions (case file issues); technical assistance (issues with foster parents or abuse reports); staffing notes; emails or other correspondence; FSFN notes; participation in staffings (such as Institutional Child Abuse and Neglect Staffings [ICANS]; foster care review committee staffings; etc.). Reviewers/evaluators should consider the following factors in determining to what degree this standard was met:

• Rate as N/A if no such contact was warranted, necessary or appropriate. • If such contact was warranted, necessary, or appropriate but not sought, rate as a “1”.


_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Additional Reviewer/Evaluator Comments on Competency C – Documentation: ______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

27

Additional Reviewer/Evaluator Comments on Candidate’s Casework Component (Overall): _____________________________________________________________________________________ _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

28


Licensing Counselor Candidate Name:____________________________________________________ Evaluator Name:______________________________________ Date:_____________ Interviewee(s) Names:_____________________________________________________________ Attempt # (Circle one): 1 2

Evaluator Rating for Competency D: INTERPERSONAL SKILLS Evaluate the candidate’s demonstration of interpersonal skills while interacting with a family. Examples are provided of actions that may illustrate that a particular skill has been demonstrated; note that evaluator “tips” are prompts to assist in identifying the types of activities that may be indicative of a candidate having met the standard. Please provide examples of skills observed under each standard in order to document in what ways the individual met or failed to meet each specific standard.

Each standard in the Assessment competency must be evaluated as follows: Yes = Meets basic performance standards (Pass) No = Needs improvement to meet basic performance standards (Fail) Each of the applicable standards in this competency must receive a rating of “Yes” in order for the Candidate to have passed this competency. A score of “No” on any of the following 12 standards indicates an insufficiency in demonstrated skills, and the entire Interpersonal Skills competency must be retaken and successfully completed in order to be eligible for certification. Any interpersonal skills standard which has as a choice “N/A,” means that the evaluator may select “N/A” only if the standard was not applicable to the interaction being observed; an “N/A” rating for a standard in which “N/A” is a choice does not count against the candidate.

Yes

No

I. STANDARD: The candidate demonstrated advanced preparation for the interview. For example, s/he was knowledgeable about and was able to provide a brief oral chronology/history of the family and the home (e.g., capacity; number of own children; children placed and their specific needs); had previously reviewed the file and/or was aware of any possible licensing issues; knew the purpose of the visit; was dressed appropriately; identified any issues that needed to be addressed with the foster parents. Reviewer comments/examples of skills noted or absent:____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Planning

Interpersonal

Documentation

Assessment


29

Yes

No

II. STANDARD: The candidate performed an appropriate introduction and explained the purpose of the visit. For example, s/he greeted the family appropriately; stated name, position, and showed ID card when appropriate to do so; explained the purpose of the visit to the family; introduced the evaluator. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

III. STANDARD: The candidate conducted a walkthrough visual safety inspection of the home. For example, s/he noted compliance with licensing standards and requirements; identified any existing or potential safety hazards; noted sleeping arrangements of all household members; addressed any changes in household composition or safety measures since the last licensure or since the last home visit; noted availability of safe play areas; responded appropriately to any concerns the foster parent had regarding the walkthrough. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

IV. STANDARD: The candidate maintained an objective approach with the family. For example, s/he used professional, non-judgmental language; appropriate body language; objective statements and questions. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

30

Yes

No

V. STANDARD: The candidate communicated professionally with the foster parents. For example, s/he re-stated what the family said to help ensure understanding; asked for family members’ opinions, points of view, and/or questions; asked family relevant questions; accessed resources for foreign language or other special needs. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

N/A

VI. STANDARD: The candidate communicated appropriately with the child(ren) in the home (if verbal). For example, s/he spoke directly with the child(ren) when appropriate to do so; used non-intimidating words, appropriate body language and displayed a friendly demeanor. If no child was present, or if the child present was non-verbal and the candidate was unable to demonstrate this skill, rate as “N/A”. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

VII. STANDARD: The candidate demonstrated active listening skills. For example, s/he responded to questions appropriately; allowed the family to complete statements or thoughts without interrupting; and asked primarily open-ended questions during the interview. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

VIII. STANDARD: The candidate maintained the focus of the interaction. For example, s/he redirected the conversation when necessary; was flexible and focused on any concern the family expressed. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________

31

Yes

No

N/A

IX. STANDARD: The candidate appropriately responded to unexpected events. For example, s/he confronted unpleasant issues effectively; de-escalated situations when necessary; allowed family members to vent; discussed conditions in the home that might need to be addressed (e.g., parenting or discipline issues; any new family stressors, such as death in the family; loss of job; new child in the home). If no unexpected events occurred during the observed interaction, rate as “N/A”. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

X. STANDARD: The candidate verbalized the family’s strengths and needs. For example, s/he provided positive feedback; made clear statements, and verified and/or validated the family’s concerns. If issues were identified in Standard I, did the candidate appropriately address those issues with the family? Did the candidate provide a status update or an update on any resolved issues? Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

Yes

No

XI. STANDARD: The candidate offered service and/or provider alternatives to the family (for the adults or the children). For example, s/he was able to demonstrate the ability to negotiate with the family; explained benefits and possible consequences of certain actions; as liaison with the agency, candidate identified any needs of the family or children and provided appropriate referral(s) and/or follow-up. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

32

Yes

No

XII. STANDARD: The candidate conducted appropriate closing activities. For example, s/he was able to summarize results of the interaction; asked for questions/clarifications and explained the next step(s); provided referral information as needed; thanked the family for their time. Reviewer comments/examples of skills noted or absent: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Additional Reviewer/Evaluator Comments on Competency D: Interpersonal Skills:

______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________