Interview Checklist Sheet
Name of Practitioner: __________________________________
Initials of Volunteer: __________________________________
Date: __________________________________
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Skill Set:
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Building Relationships
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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.)
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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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Notes:
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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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*************
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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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