The DEP Supervisor Self-reflection and Supervisor Feedback Form
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Name:
Do you have prior experience as a supervisor?
Clear selection
Instructions
The DEP-SSFS examines implementation integrity of the behavioral markers for each of the DEP components and for the characteristics of effective supervisory relationship.

It can be used as both a supervisor self-reflection instrument and as a means of receiving formal feedback from a supervisee.
It serves both as an advance organizer of the concepts focused on in Credential Training and as a baseline perspective on your supervisory practices. We will also use the DEP-SSFS information in assessing the benefits of this training program.

If you have experience as a supervisor, please complete the DEP-SSFS Survey online before the first day of the course.  Use it as a self-reflection tool on your current supervisory practices.  We only ask for your name in case we do a later follow up survey to assess the Credential Program's effectiveness.

If you do not have experience as a supervisor, please complete the survey as if you were providing feedback for someone who has supervised you.  It will serve as an Advance Organizer for concepts presented in this workshop.  


(DEP-SSFS) The Supervisory Relationship: Interpersonal Process


The professional literature has identified the main characteristics of an effective supervisor and  supervisory relationship and the supervisory process that fosters a positive relationship.


For each statement below, choose the number (4 to 1) that best describes how you feel about your experience in this professional development. *
   Rating Scale:  4 – Strongly Agree      3 – Agree      2 – Disagree      1 – Strongly Disagree
4
3
2
1
1. Spends time in rapport building to establish a personal foundation for our relationship
2. Is empathetic
3. Is genuine/non-judgmental
4. Is respectful towards me
5. Creates a safe learning environment
6. Is flexible
7. Is accessible
8. Sets high goals
9. Notes and integrates my strengths into supervision
10. Is open to feedback
11. Maintains professional boundaries
12. Demonstrates awareness of what else is occurring in my life and supports self-care
13. Only addresses personal issues that are relevant to clinical and professional development and does so in a respectful and emotionally supportive manner
14. Appropriately utilizes self-disclosure during supervision
15. Is attuned to diversity issues in the supervisory relationship, open, supportive, and respectful in acknowledging the potential impact of differences
16. Models respect and professionalism toward me and others
17. Advocates for my needs
18. Maintains regular “protected” time for supervision
19. Specifies how to handle requests for additional supervision
20. If I had more than one supervisor, my primary supervisor communicates with other supervisors for purposes of evaluation, monitoring my progress, and managing workload
Developmental Domain
Supervision requires attention to the Developmental stages of intern growth, providing as much  structure as necessary, assessing training goals and needs, providing effective formative feedback and  summative evaluation, deploying multiple methods of supervision, and guiding the supervisee toward  independent practice.

21. Employs a Socratic approach consistent with my developmental level (does not just tell me  the answers)
Clear selection
22. Clearly defined roles, responsibilities, and expectations at the outset of supervision  through utilization of a written contract and/or focused discussion of the nature or our  supervisory relationship.
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22a. Indicate if a written contract was utilized as part of your supervisory relationship:  
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23. Requires and models appropriate planning for supervision including advance agenda  planning
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23a. Indicate if the “ Intern’s Supervision Planner” was utilized:
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24. Requires and models appropriate planning for psychological consultation, problem-  solving, and intervention activities including review and recommendations prior to  engaging in these activities.
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24a. Indicate if “Intern’s Client/Activity Planner” was utilized:
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25. Models and requires appropriate documentation of professional activities
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25a.  Indicate if a planning form is used to prepare for activities, i.e., “Intern’s Client/Activity  Session Planner”
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25b.  Indicate if a form is used for documenting activities, i.e., “Intern’s Client  Summary/Progress Notes
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26. Engages me in a developmental assessment of my entry skill levels across Internship Plan  domains, delineating areas where I have some mastery and where I need additional   experience and closer supervision
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27. Engages me in goal setting and identification of my perspective of needs for training and  supervision
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28. Provides fair, understandable, and timely formative feedback throughout the internship  recognizing my competencies and suggesting areas of growth and improvement
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29. Provides formal comprehensive summative feedback as required by the internship  consortium, university, or site
Clear selection
30. Provides summative feedback that is unsurprising (all issues of concern were previously  noted in ongoing formative feedback)
Clear selection
31. Notes both strengths and areas requiring further development during feedback and   evaluation
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32. Provides a balance of dependence and independence appropriate to the various stages of  the internship
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33. Uses multiple supervision methods during supervision (indicate methods utilized below)
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33a. Modeling and Demonstration:
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33b. Intern self-report
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33c. Co-therapy and case consultation
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33d. Live observation
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33e. Video recording
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33f. Audio recording
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33g.  Coaching
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Ecological Domain
Supervision requires attention to ecological, systemic, multi-cultural, and diversity elements of  professional practice. It is impossible to understand individual students, classrooms, or school  communities without understanding their interaction with larger environments.  

For each statement below, choose the number (4 to 1) that best describes how you feel about your experience in this professional development. *
   Rating Scale:  4 – Strongly Agree      3 – Agree      2 – Disagree      1 – Strongly Disagree  (DNA) Does not Apply
4
3
2
1
(DNA) Does not Apply
34. Oriented me to the school culture and, as appropriate, to the representative ethnic cultures present in the school community
35. Provides sufficient opportunities for training and involvement in “universal” interventions such as PBIS, Social Emotional Learning Curriculum, and/or psychoeducational activities to promote healthy psychological development across the school community (Tier 1)
36. Provides sufficient opportunities for training and involvement in parent conferencing and consultation and/or parent training programs
37. Provides sufficient training and opportunities for teacher consultation centered around classroom management
38. Engages me in case conceptualization, problem-solving, and intervention planning that addresses both individual and contextual factors (i.e., family, peer, classroom, school, cultural, community…)
39. Fosters my acquisition of evidence-based academic and mental health intervention strategies that are “multi-tiered” (Tiers 2 & 3) and “multi-systemic”
40. Provides sufficient training and involvement appropriate for an intern in program development and leadership skills.
41. Specifically addresses and provides sufficient training in multicultural and diversity competency
42. Addresses multi-cultural and diversity contextual factors as part of problem-solving
43. Teaches me how to manage dysfunctional elements of the system and protects my intern status (focus on training not less expensive employee)
Problem-solving Domain
Problem-solving is the core activity of school psychology. It is rooted in data-based decision making that  links assessment to intervention, addresses both individual and contextual factors, applies empirically  supported intervention strategies, monitors outcomes to revise strategies as necessary, and fosters  reasonable innovation to treat complex problems while continuing to monitor intervention effectiveness.  Supervision activity centers on these activities and strives to teach the intern effective case  conceptualization and intervention strategies to apply to the full range of psychological issues.  

For each statement below, choose the number (4 to 1) that best describes how you feel about your experience in this professional development. *
   Rating Scale:  4 – Strongly Agree      3 – Agree      2 – Disagree      1 – Strongly Disagree  (DNA) Does not Apply
4
3
2
1
(DNA) Does not Apply
44. Engages effectively in collaborative problem solving
45. Uses a systematic approach to problem solving (problem identification, problem analysis, etc.)
46. Thinks out loud (shares his/her internal process while engaged in problem-solving)
47. Encourages emotional awareness: encourages me to think more about how I’m feeling and how that impacts my client
48. Specifically addresses multicultural and diversity contextual factors as part of problem- solving
49. Teaches me a framework for systematic case conceptualization that addresses both individual and contextual factors
50. Provides opportunities for me to be involved across multiple tiers of service delivery (preventive/universal, targeted, and intensive)
51. Develops my skills in data-based decision making across intervention domains
52. Develops my skills in linking assessment to intervention
53. Perceives complexity but is still able to suggest or direct concrete paths of action
54. Supports consistent use of evidence-based practices
55. Develops my skills in facilitating and measuring intervention integrity
56. Assists me in integrating theory and research into practice
57. Directs me to appropriate resources
Have you previously participate in a DEP workshop?
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Have you read the DEP Text from Routledge Press?
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Additional comments:
From: Simon, D.J., & Swerdlik, M.E. (2017). Supervision in school psychology: The Developmental,  Ecological Problem-solving model. New York, NY: Routledge Press.
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