Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
| WORKING WITH OTHERS | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Engages in active and reflective listening |
 |
||||||
| Speaks clearly and slowly enough to be understood |
|
||||||
| Uses non-judgmental words and behaviors |
|
||||||
| Communicates directly with the client’s family & significant others (with client consent) |
|
||||||
| Uses “person centered/person first” language |
|
||||||
| Uses technical language correctly, including clinical terminology |
|
||||||
| Demonstrates warmth, empathy, and genuineness |
|
||||||
| Shows respect and concern for others through words and actions |
|
||||||
| Focuses on and respects the concerns and preferences of the client and family |
|
||||||
| Provides support and encouragement to clients |
|
||||||
| Collaborates with providers and clients to complete tasks and solve problems |
|
||||||
| Maintains appropriate boundaries in all relationships |
|
||||||
| SCREENING & ASSESSMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Obtains information from providers knowledgeable of the client and family |
|
||||||
| Collects demographic, psychological, social, and medical information through interviews of the client and family |
|
||||||
| Summarizes all information verbally or in writing |
|
||||||
| Demonstrates sound judgment in evaluating and using the information collected |
|
||||||
| Assists clients in completing screening tools on substance use and mental health conditions |
|
||||||
| Scores and interprets the results of screening tools correctly |
|
||||||
| Assesses clients’ preferred method of communication and language barriers |
|
||||||
| Identifies client and family strengths and resources |
|
||||||
| Identifies client and family goals |
|
||||||
| Assesses clients’ motivation and readiness to participate in services |
|
||||||
| Identifies client problems, mental health and substance use conditions, and stressors |
|
||||||
| Identifies signs of abuse and neglect |
|
||||||
| Assesses level of risk for harm to self or others |
|
||||||
| Determines whether additional assessment is required and arranges if necessary |
|
||||||
| Assesses physical and psychological risk associated with acute intoxication, overdose, withdrawal, detoxification, and co-occurring mental health and substance use disorders |
|
||||||
| Applies the criteria in the current version of the Diagnostic and Statistical Manual for Mental Disorders (DSM) in assessing clients’ behavioral health conditions |
|
||||||
| Applies the ASAM criteria to guide treatment planning and recommend a level of care |
|
||||||
| PLANNING SERVICES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Identifies recommended short-term and longerterm service goals |
|
||||||
| Identifies service options based on experience & research |
|
||||||
| Evaluates eligibility and insurance coverage or ability to pay for recommended services |
|
||||||
| Communicates outcome of the screening & assessment to the client & family |
|
||||||
| Assists the client & family in understanding the client’s conditions and effects |
|
||||||
| Discusses recommended goals and services with client & family & alternate options |
|
||||||
| Assists client in communicating his or her needs to others |
|
||||||
| Negotiates and finalizes a plan of care with the client & family based on their preferences |
|
||||||
| Assists the client in developing a crisis plan for future episodes of illness |
|
||||||
| Supports the client in developing wellness & recovery plans |
|
||||||
| PROVIDING SERVICES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Arranges for assistance, if needed, with language translation or literacy |
|
||||||
| Implements the plan of care (e.g., begins services, makes referrals) |
|
||||||
| Monitors client’s condition, behavior, and progress on a continuous basis |
|
||||||
| Recognizes when progress has slowed, addresses barriers, and works to motivate the client |
|
||||||
| Evaluates progress and reviews and revises the plan of care on a regular basis |
|
||||||
| Encourages client participation in services and reaches out when the client is not engaged |
|
||||||
| Participates in developing, coordinating, and monitoring a discharge plan |
|
||||||
| Establishes working relationships & coordinates care with other providers and teams in the agency |
|
||||||
| Establishes working relationships & coordinates care with other providers in other agencies |
|
||||||
| Assists in establishing routine and formal working relationships with other agencies. |
|
||||||
| Reviews the list of the client’s medications and their effects and side effects |
|
||||||
| Supports client and family education about medication effects and side effects |
|
||||||
| Coaches the client on strategies for taking medications as prescribed |
|
||||||
| Coaches the family on strategies for supporting the client in taking medications |
|
||||||
| Supports the client’s participation in medical appointments, medical monitoring, and lab testing. |
|
||||||
| Assists the client in monitoring and reporting medication effects and side effects to the medical prescriber |
|
||||||
| Provides emotional support, encouragement, and reassurance |
|
||||||
| Helps the client define the problem by telling their story, discussing their situation, and challenging his or her current perspective, when warranted. |
|
||||||
| Helps the client set goals by discussing the possibilities and assisting the client to select and commit to new goals |
|
||||||
| Helps the client take action through problemsolving, education and training, reflecting on past experiences and patterns, creating an action plan, contracting, and providing feedback |
|
||||||
| Recognizes behavioral health crises and early warning signs of crises |
|
||||||
| Assists in deescalating problems in their early phase |
|
||||||
| Reports crises and seeks assistance from a supervisor or licensed behavioral health professional |
|
||||||
| Seeks assistance, as needed, from Village Public Safety Officers, other first responders, or community members |
|
||||||
| Assists in implementing the response to a individual, family, and community crises |
|
||||||
| Communicates with the family and others about the crisis and the response |
|
||||||
| Assists with notifications and investigations of reportable events (e.g., abuse, domestic violence, assaults, neglect, deaths) |
|
||||||
| Provides support to those effected by the crisis and assist them in accessing supportive services |
|
||||||
| Assists the client and family in obtaining services related to the crisis (e.g., domestic violence shelter; emergency foster care). |
|
||||||
| Participates in debriefing meetings to discuss the crisis and the response |
|
||||||
| Assesses family norms and roles (in nuclear and extended families, clans, biological and nonbiological families |
|
||||||
| Uses genograms and sociograms to assess and work with families |
|
||||||
| Identifies family dynamics, functional and dysfunctional units, and barriers to communication |
|
||||||
| Identifies the impact within the family of an individual with a mental health or substance use condition and accommodations made by the family for the individual |
|
||||||
| Identifies the impact on family functioning of stressors (e.g., medical illness, separation, divorce, abuse, financial concerns, housing issues, legal trouble) |
|
||||||
| Engages members of the family in constructive problem-solving |
|
||||||
| Assists the family in improving its functioning |
|
||||||
| Identifies the functions, limitations, and risks of different types of groups (educational, psychoeducational, self-help, support, activity, skill development, therapeutic) |
|
||||||
| Identifies appropriate members for the different types of groups |
|
||||||
| Orients new members to groups addressing the purpose, rules, boundaries, levels of selfdisclosure |
|
||||||
| Runs groups effectively, providing adequate structure, encouraging member interaction, and maintaining safety |
|
||||||
| Assists clients in ending participation in a group or transitioning to another group |
|
||||||
| Manages the ending of groups |
|
||||||
| LINKING TO COMMUNITY RESOURCES | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Maintains information on a range of community resources (e.g., service, medical, financial, housing, spiritual, volunteer) |
|
||||||
| Maintains information on traditional support & intervention resources (Elders, traditional healers) |
|
||||||
| Identifies recommended resources and traditional supports for the client and family based on need and eligibility |
|
||||||
| Identifies resources outside of the community that may need to be brought into the community |
|
||||||
| Discusses resource recommendations & options with the client & family |
|
||||||
| Motivates the client & family to access and use resources |
|
||||||
| Negotiates a plan with the client & family about accessing resources based on their preferences |
|
||||||
| Makes a referral and actively connects the client or family to selected resources |
|
||||||
| Ensures that the referral was accepted and client or family is receiving services |
|
||||||
| Makes an alternate referral if the initial referral was unsuccessful |
|
||||||
| Draws on individuals in the community to offer support to the client & family |
|
||||||
| Educates clients, families, and the community about behavioral health conditions and their prevention and treatment |
|
||||||
| Provides information to destigmatize people with mental health and substance use conditions |
|
||||||
| Uses community gatherings to encourage healthy behaviors |
|
||||||
| Serves in community workgroups focused on prevention and early intervention with behavioral health conditions |
|
||||||
| Works with community leaders to develop supports for individuals and families at risk |
|
||||||
| Engages and provides support to individuals and families at risk |
|
||||||
| Educates clients and families about strategies for improving physical and mental health |
|
||||||
| Assists in assessing community needs and readiness for prevention and early interventions activities |
|
||||||
| Provides information to clients and families about their rights and responsibilities |
|
||||||
| Supports individual and family goals and wishes within the agency and with other organizations |
|
||||||
| Helps clients and families to participate in service planning meetings |
|
||||||
| Refers clients and families to peer and family support activities and advocacy organizations |
|
||||||
| CULTURAL COMPETENCY & INDIVIDUALIZING CARE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Recognizes and adapts to different cultures, including the varied Alaska Native tribes and communities |
|
||||||
| Recognizes and respects diversity, differences, and cultural traditions, including among different Alaska Native tribes and communities |
|
||||||
| Assesses and manages one’s own personal biases |
|
||||||
| Is aware of the traditions of the community. |
|
||||||
| Demonstrates awareness of and sensitivity to the client degree of involvement in their traditions, values, and community |
|
||||||
| Adapts services to the unique characteristics and preferences of the client and family |
|
||||||
| Applies knowledge of gender, sexual orientation, life span development, financial status, religion, disability, and intergenerational differences in delivering services |
|
||||||
| Promotes empowerment as a goal and desirable treatment outcome for Alaska Native/American Indian people by fostering client and family decision-making, problemsolving, and self-determination. |
|
||||||
| Effectively discusses cultural issues and differences with clients |
|
||||||
| Uses cultural views of health and family when assisting in providing services |
|
||||||
| Utilizes cultural resources and traditional practices when providing services (e.g., storytelling, talking circles, and deferring to elders) |
|
||||||
| Identifies and addresses issues of difference to reduce conflict between individuals and groups |
|
||||||
| Routinely considers and discusses cultural issues in supervision and team meetings |
|
||||||
| Consults with elders or traditional healers in the community |
|
||||||
| DOCUMENTING | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Completes all required documentation (e.g., screening & assessment, intake, service plans, progress notes, discharge summaries) |
|
||||||
| Produces documentation that is objective, accurate, and legible with correct language, grammar, and spelling |
|
||||||
| Completes documentation in a timely manner |
|
||||||
| Reviews client documentation with clients when they request to do so and when approved by the agency |
|
||||||
| Demonstrates sensitivity when assisting clients in understanding their documentation during a records review |
|
||||||
| PROFESSIONAL & ETHICAL PRACTICE | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Minimizes absences, arrives on time, and completes a full work day |
|
||||||
| Completes assigned duties in a timely way and follows through on instructions received, reasonable requests, and promises made |
|
||||||
| Acts professional in interactions with the client, family, community and other professionals |
|
||||||
| Works within the limits of assigned duties and role |
|
||||||
| Recognizes personal limits of knowledge and skills |
|
||||||
| Seeks additional supervision or consultation when uncertain about what to do or concerned about the performance of others |
|
||||||
| Complies with the Code of Ethics |
|
||||||
| Complies with laws, regulations, and agency policies |
|
||||||
| Manages effectively personal and professional boundaries with clients, families, and the community |
|
||||||
| Models appropriate personal and professional behavior |
|
||||||
| Respects client and family rights |
|
||||||
| Provides information and obtains informed consent |
|
||||||
| Complies with special rules and procedures related to consent for: involuntary commitment; mandated reporting; minors; or individuals unable to consent, under guardianship, or subject to a court order |
|
||||||
| Complies with laws, regulations, and agency policies regarding confidentiality and privacy (e.g., HIPAA, Federal Privacy Act, 42 C.F.R, Part 2) |
|
||||||
| Complies with the procedures regarding disclosure of confidential information (e.g., mandated reporting, duty to warm, client authorized releases of information) |
|
||||||
| Maintains the physical security of confidential information (electronic and hard copy) |
|
||||||
| Educates clients and families about confidentiality, privacy, and their limits |
|
||||||
| Assists clients with decisions and process to release confidential information |
|
||||||
| Maintains the confidences and privacy of clients and families, even when not required by law, regulation or policy |
|
||||||
| Protects client and family anonymity when providing information for statistical information and research |
|
||||||
| Assists in ensuring that other individuals providing services comply with the laws, regulations, and policy on confidentiality and privacy |
|
||||||
| Recognizes signs of personal stress |
|
||||||
| Uses self-care strategies to manage stress, maintain health, and prevent burnout |
|
||||||
| PROFESSIONAL DEVELOPMENT | Rating Stars (Click) | 1 | 2 | 3 | 4 | ||
| Sets personal goals for professional development |
|
||||||
| Participates in employer sponsored training and other continuing education activities |
|
||||||
| Adopts best practices learned through continuing education |
|
||||||
| Participates routinely and constructively in supervision |
|
||||||
| Uses supervision, peer consultation, and selfevaluation to enhance self-awareness and improve professional performance |
|
||||||
| Uses formal evaluations to improve professional performance and the quality of services provided |
|
||||||
| Provides guidance and mentoring to others |
|
||||||