Results:

Student:

Examiner

Date:

COMPETENCY QUESTION

STANDARDS

YES

NO

1.   Greeted and welcomed the client?

- say hello or welcome

- address the client by name (clarify how to address the client)

-welcome anyone accompanying the client

Established a comfortable and private physical space to hold the interview?

-maximizes privacy

-sat facing client directly or sat besides client

positioned self at the same level as client

Introduced self to the client?

-say first name

-say last name

-say title

-say how to address by name

Established rapport with the client?

-communicated warmth and concern, e.g., "How are you today?"

Stated the purpose of the interview?

-say why the interview is taking place

Explained what to expect during the interview?

-how long the interview will take

Explained confidentiality policy?

-stated the agency?s confidentiality policy

-say who has access to the file.

Explained the agency?s immigration rights policy?

-say the agency?s policy regarding the INS with realistic reassurances.

COMPETENCY QUESTION

STANDARDS

YES

NO

9. Explained how the agency uses the client?s social security number and identification number?

-said how their ID number will be used.

Communicated in an easy to understand manner?

-did not use jargon

-did not use acronyms

-spoke distinctly at a comfortable pace.

Monitored the client?s understanding of the interview?

-observed body language for signs of understanding, e.g., frowns, nods, etc.

-asked, "Do you have any questions?"

-maintained eye contact

Took notes in a nonintrusive manner?

-maintained eye contact while notetaking

-maintained attention during interview

Explained to the client what to expect after the interview?

-said when the next contact will take place

-told the client when and how services will begin

COMPETENCY CRITERIA

STANDARDS

YES

NO

1. Explained the purpose of the program/agency?

-explain mission statement of the agency.

Explained agency services?

-provided a list of agency services

-told what they will need to access services: identification, money, transportation.

Provided agency phone numbers and discussed with the client how to contact agency?

-discuss the contact information with the client

-told phone hours

-told who to contact.

Explained who will be involved in providing services?

-describe their roles clearly

-no jargon or acronyms

Explained to the client what to do in case of an emergency?

-who to call

-where to go

-what to bring.

Monitored the client?s understanding of the interview.

-observed body language for signs of understanding, e.g., frowns, nods, etc.

-asked, "Do you have any questions??

-maintained eye contact

COMPETENCY QUESTION

STANDARD

YES

NO

Identified client health concern/ problem?

-reflected back to the client the stated health concern

-actively listened for deeper issues, e.g., embarrassment

*  Discussed health concern with the client?

-discuss accurate health information

Provided informational pamphlets/brochures?

-give client appropriate brochures/pamphlets

-discussed information with client

*  Identified myths expressed by the client?

-accurately identified myths

Discussed myths and facts about health concern?

-provided accurate information

Answered client questions?

-responded in a nonjudgmental manner

-gave accurate information

Used plain language when communicating with client?

-did not use jargon

-did not use acronyms

Used active listening techniques?

-reflected back to the client what was expressed

-made eye contact

-used appropriate body language

Used "I messages" to communicate vs. blame and judgment?

COMPETENCY QUESTION

STANDARDS

YES

NO

1. Explained the purpose of the referral given?

-described the referral.

Explained how the referral will benefit the client?

-explained how the referral will improve the current situation

Provided detailed information about the referral?

-said who to contact

-said what to bring

-said agency hours

-told tips about how to best access services

Identified possible barriers to accessing the referral?

-informed client of cost

-transportation

-immigration status, drug rehabilitation status, criminal record

Used referral resource guide to look up detailed information about the referral?

-used the index and table of contents to look up referral agencies

Scheduled a follow up appointment with the client?

-arranged an appointment with the client

-wrote the date and time of the appointment on a card for the client