1500 HS MOD 5 ASSN
Interview Checklist Sheet
Name of Practitioner: __________________________________
Initials of Volunteer: __________________________________
Date: __________________________________
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Skill Set: |
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Building Relationships |
Check if observed |
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Attending (Did you do/have the following?) |
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Open and accessible body posture |
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Congruent facial expression (matches body language and words) |
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Slightly inclined toward client (not leaning back) |
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Regular, appropriate eye contact |
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No distracting behaviors (fidgeting, tapping pencil, swinging legs, etc) |
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Minimal encouragement (nod head occasionally, mhmm, etc) |
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Notes:
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Observing (Did you pay attention to the following in your client?) **For this activity, if you complete a phone interview, some if these obviously can’t be observed visually. However, many can be observed through listening carefully.) |
Check if observed |
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Client’s facial expressions |
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Eye contact |
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Body position and movement |
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Breathing Patterns |
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Muscle tone (relaxed, tense, shaky?) |
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Gestures |
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Skin tone changes (did they flush, grow pale, become sweaty?) |
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Notes:
Questioning: (Did you do the following?) |
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Used closed-ended questions when appropriate |
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Used open-ended questions when appropriate |
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Asked one question at a time |
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Avoided using leading questions or interrogating |
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Seeking Clarification: (Did you do the following?) |
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Exploring the meaning of client words and client body language |
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Elicited further details and clarification from client |
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Allowed Silence |
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Avoided client requests for advice |
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Avoided asking leading or loaded questions |
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Notes:
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Assessing Readiness and Motivation: (Did you observe the following?) |
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Stage of readiness of client |
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Assessed motivation to change |
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Identified discrepancies (mismatch between words, words and actions, actions) |
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Establishing Goals: (Did you help client to do the following?) |
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Reached agreement on a general goal |
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Ensured that goal(s) developed was MAPS |
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Notes:
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Taking Action: (Did you do or help the client to do the following? |
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Identify the skills needed to take the required steps |
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Teach |
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Direct |
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Give Feedback |
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Use appropriate self-disclosure |
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Notes:
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******************************************************************** |
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Refer to Appendix A in text, page 223-224 & assess performance in the following: |
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Level 1,3,or 5 |
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Listening: Content and Process Evaluation Scale |
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Empathy Evaluation Scale |
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Warmth Evaluation Scale |
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Respect Evaluation Scale |
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Genuineness Evaluation Scale |
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Notes:
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