COORDINATOR EVALUATION OF HOME VISITOR PRACTICE
HOME VISITOR: ______
COORDINATOR: ______DATE: ______

Instructions: Rate Home Visitors on the following scale for the item’s presence:

(1) None (2) Slight (3) Moderate (4) Marked (0) Not applicable or no information

Add all ratings within each category for total and enter below:

Category I Total – Knowledge and Attitude: ______

Category II Total – Dependability: ______

Category III Total – Use of the Group Supervision:______

Category IV Total – Work Skills: ______

Add Category Scores for TOTAL HOME VISITOR BEHAVIOR SCORE: ______

CATEGORIES

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RATING

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COORDINATOR’S COMMENTS
I.KNOWLEDGE AND ATTITUDE
Understands PCHP goals and own role
Respects privacy of families
Observes confidentiality
Is culturally aware and sensitive
Positive attitude toward parent
Positive attitude toward child
Respects parent
Respects child
Sensitive to parents’ feelings and problems
Sensitive to children’s feelings, problems, and development
Recognizes child is parent’s responsibility
Flexible interaction with families
Adequate self-esteem for job
Commitment to PCHP goals
Uses good judgment
COORDINATOR EVALUATION OF HOME VISITOR PRACTICE (continued)

CATEGORIES

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RATING

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COORDINATOR’S COMMENTS
II. DEPENDABILITY
Appropriate dress, demeanor
Staff Meeting: Attendance
Staff meeting: punctuality
Notifies Coordinator if will be absent
Home Visits: attendance
Home Visits: notifies parent of cancellation
Keeps HV reports up-to-date
Keeps signature form up-to-date
HV reports complete
HV reports provide sufficient info to assess family progress
  1. USE OF GROUP SUPERVISION

Learns undefensively
Asks appropriate questions
Contributes to discussion
Capable of being self reflective
Interacts well with others
Helps others in group
Accepts help from the Coordinator
Modifies behavior in accordance with supervision
Adapts to organizational or staff changes
IV. WORK SKILLS
Uses appropriate techniques in home visits
Is creative in home visits
Gives parents early responsibility
Cares adequately for materials
Relates to children
Relates to parents
Fosters team work with parents
Adequate VISM manipulation
Adapts flexibly to home visit emergencies

COORDINATOR’S GENERAL COMMENTS:

The Parent-Child Home Program, Inc. 2013Section VIII - 1