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Exit Survey
 
 
Rice County Supervision Observation Rating Form


For each of the following skills, circle the number that best characterizes the extent to which the officer uses the skill, based on the following scale:
 
 
 
S3 Coach's Name
   
 
 
 
Officer's Name:
   
 
 
 
Offender's Name:
   
 
 
 
Date of Observation:
 
 
Working Relationship Skills:
Unacceptable Use of Skill (0) Unsatisfactory Use of Skill (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
1. Officer consistently provides affirmations for probationer, and affirmations clearly identify prosocial behavior.
2. Officer uses a non-confrontational tone and invites the probationer to speak about ambivalence and verbalize their perceptions of the change process.
3. Officer consistently uses open-ended questions to elicit probationer’s perspective and appropriately reflects/summarizes the probationer’s perspective. Questioning and reflections include a deep understanding of probationer’s perspective to include not just what has been said explicitly but also what the probationer means and has not said.
4. Officer demonstrates flexibility and openness with probationer to identify goals and respond to circumstances that may involve conditions, court requirements, and compliance. Officer responds swiftly to condition violations and actively solicits probationer’s ideas when addressing conditions, court requirements, and holding the probationer accountable for behavior in a respectful manner.
5. Officer encourages probationer’s perspective through open-ended questioning and is accepting of probationer’s perspective without educating.
6. Officer uses open-ended questions and reflections specifically to evoke probationer’s motivation to change with reflections and understanding based not only on what the probationer has explicitly said but also what the probationer has not said.
7. Officer actively fosters and encourages an equal balance of power during contacts with probationer, presents as open to allow the probationer to provide substantial influence in the direction of the contact, and demonstrates an exceptional understanding of the probationer’s issues and target behavior.
 
 
 
Working Relationship Notes:
   
 
 
Case Plan-Driven Supervision
Unacceptable Use of Skill (0) Unsatisfactory Use of Skill (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
8. Officer schedules appropriate contacts, sets urinalysis schedule, and refers probationer for appropriate evaluations and treatment programs based on identified needs according to the LS/CMI assessment and case plan.
9. Officer discusses probationer-identified problem(s), makes referral(s) to time-specific and measurable goals from the case plan during contact, and discusses process/next steps with probationer.
10. Officer reviews case plan goals and tasks during contact, and prompts probationer to identify expectations (tasks) to be completed for next visit.
11. Officer uses open-ended questions and reflections to gauge readiness and motivation to change as related to identified goals and tasks during case planning process.
12. Officer uses OARS to engage the probationer in a discussion of his/her strengths, protective factors, resources, and previous successes. Officer seizes most/all opportunities to affirm the probationer and to link identified strengths with tasks/goals.
13. Officer updates the case plan during the contact, with probationer input, and goals/tasks are reflected in keeping with the probationer’s words; no drop-down items are used.
14. Officer identifies both incentives and sanctions to reinforce goals and tasks.
 
 
 
Case Plan-Driven Supervision Notes:
   
 
 
Effective Use of Reinforcement (Officers with EPICS Training Only):
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
15. Officer acknowledges something specific that the probationer has done that they approve of and uses OARS to explain why they like the behavior.
16. Officer uses OARS to engage the probationer in a discussion of the short term benefits of performing the behavior.
17. Officer uses OARS to engage the probationer in a discussion of the long term benefits of continuing to perform the behavior in the future.
18. Officer obtains commitment from the probationer to continue to perform the behavior in the future.
 
 
 
Effective Use of Reinforcement Notes:
   
 
 
Effective Use of Disapproval (Officers with EPICS Training Only):
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
19. Officer acknowledges something specific that the probationer has done that they disapprove of and uses OARS to explain their disapproval.
20. Officer uses OARS to engage the probationer in a discussion of the short term consequences of engaging in the problem behavior.
21. Officer uses OARS to engage the probationer in a discussion of the long term consequences of engaging in the problem behavior.
22. Officer uses OARS to engage the probationer in a discussion of alternatives to the problem behavior.
23. Officer obtains commitment from the probationer to use identified alternative, prosocial behavior(s) in the future.
 
 
 
Effective Use of Disapproval Notes:
   
 
 
Role Clarification (Officers with EPICS Training Only):
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
1. Officer describes probation’s goals for supervision and uses OARS to engage the probationer and gauge understanding. Officer does not discuss court conditions at this time.
2. Officer uses OARS to identify probationer’s hopes/goals while on supervision, to accurately reflect/summarize these goals, and to identify/affirm prosocial hopes/goals.
3. Officer explains their “dual role” (supportive, treatment/rehabilitative focus and officer of the court) and what they hope to accomplish during the supervision process. Officer asks for probationer’s feedback to ensure understanding.
4. Officer clearly defines the rules of supervision, their expectations, the probationer’s schedule for meeting the requirements of probation, and reviews any conditions assigned by the court; officer engages probationer in a discussion to gauge their understanding of the conditions. Officer describes which conditions are negotiable and which are non-negotiable.
5. Officer clearly identifies the limits of confidentiality, his/her duty to report information to the court, and his/her responsibility to protect information from the general public. Officer engages probationer in a discussion to gauge their understanding of the limits of confidentiality.
6. Officer completes all role clarification steps in correct order. Officer uses OARS to engage probationer in discussion at each step in order to gauge probationer understanding.
7. Officer uses eye contact consistently and in tandem with nonverbal cues of listening (e.g., nodding head).
 
 
 
Role Clarification Notes:
   
 
 
LS/CMI Assessment
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
8. Officer gathers current criminal history information from appropriate sources prior to first office visit and completes LS/CMI during first visit (unless LS/CMI was completed during PSI).
9. Officer discusses the purpose of the interview and/or information gathering, explains what the LS/CMI is, and how it relates to the supervision process.
10. Officer allows the probationer to complete the self-report section of the LS/CMI assessment on paper and reviews self-reported responses with the probationer.
11. Officer determines if there are literacy or language issues and completes self-report section of LS/CMI with the probationer during office contact asking questions as written and without leading or influencing responses.
12. Officer uses OARS while completing the LS/CMI assessment interview.
13. Officer identifies areas of discrepancy between probationer’s self-report and official record and effectively discusses (using OARS) inconsistencies with probationer to resolve discrepancies.
14. Officer explains what recidivism is and engages the probationer in a discussion of how their risk impacts/influences their probation.
15. Officer defines criminogenic needs and uses OARS to engage probationer in a discussion of their needs and how they relate to their current lifestyle and probation.
 
 
 
LS/CMI Assessment Notes:
   
 
 
Intervention Skills
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
16. Officer uses OARS to engage probationer in a discussion that clearly connects the probationer’s current high risk situations to his/her high criminogenic needs on LS/CMI. Officer utilizes Behavioral Analysis as a tool to identify patterns of behavior/thinking in high risk situations.
17. Officer effectively uses cost benefit analysis or behavioral analysis tools during office contact to assist with identifying goals and related tasks.
18. Officer utilizes behavioral analysis to assist with the development/revision of the probationer’s case plan.
19. Officer explains a) what the cognitive model is and benefits of it, b) explains the three main components of the cognitive model (external, internal, and behavior), c) and goes through a neutral practice example. Officer fully engages probationer in demonstration of the example. Officer checks for understanding by probationer throughout the above steps.
20. Officer clearly transitions probationer from explanation of cognitive model to the application of model to their own situation. Officer coaches probationer and allows them to complete the model for their own situation.
21. Officer clearly solicits the probationer to commit to using the cognitive model in the future.
 
 
 
Intervention Skills Notes:
   
 
 
Case Planning
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
22. Officer reviews/summarizes LS/CMI needs accurately and clearly, and elicits feedback from probationer about high/low needs. Officer uses OARS to engage the probationer & gauge understanding.
23. Officer prioritizes stabilization needs and top three criminogenic needs (attitude, peers & personality) as identified by research and LS/CMI scores.
24. Officer uses open-ended questions and reflections to gauge readiness and motivation to change as related to top three criminogenic needs (attitude, peers & personality) during case planning process.
25. Officer uses OARS to elicit and affirm probationer’s ideas for possible options to address goal/target behavior.
26. Officer engages the probationer in a discussion of the generated list of possible solutions, using OARS to gauge probationer’s desire and perceived ability to succeed. Officer engages the probationer in a discussion of past efforts to cope with and/or avoid high risk situations, using OARS to link past successes with current options.
27. Officer completes the case plan during the contact, with probationer input, and goals/tasks are reflected in keeping with the probationer’s words.
28. Officer identifies both incentives and sanctions to reinforce goals and tasks.
29. All goals/tasks in the case plan are written using the probationer’s language; no drop-down items are used.
 
 
 
Case Planning Notes:
   
 
 
LS/CMI Reassessment
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
30. Officer gathers current criminal history information from appropriate sources prior to the office visit.
31. Officer allows the probationer to complete the self-report section of the LS/CMI assessment on paper and reviews self-reported responses with the probationer.
32. Officer determines if there are literacy or language issues and completes self-report section of LS/CMI with the probationer during office contact, asking questions as written and without leading or influencing responses.
33. Officer uses OARS while completing the LS/CMI assessment interview.
34. Officer identifies areas of discrepancy between probationer’s self-report and official record and effectively discusses (using OARS) inconsistencies with probationer to resolve discrepancies.
35. Officer uses eye contact consistently and in tandem with nonverbal cues of listening (e.g., nodding head).
36. Officer explains what recidivism is and engages the probationer in a discussion of how their risk impacts/influences their probation.
 
 
 
LS/CMI Reassessment Notes:
   
 
 
Responding to Violations/Problems
Unacceptable Use of Skills (0) Unsatisfactory Use of Skills (1) Satisfactory Use of Skill (2) Ideal Use of Skill (3) N/A
37. Officer gives an objective description of the probationer’s behavior without judgment and discusses the problem behavior as it relates to their criminogenic needs and/or pattern of offending.
38. Officer effectively uses open ended questions, affirmations, reflections, and summarizations to elicit information during the contact with the probationer. Officer seeks to obtain the thinking/underlying attitude or beliefs of the probationer.
39. Officer uses OARS while exploring potential future behavior and guides probationer to identify/examine existing thinking associated with problem behavior.
40. Officer elicits new thinking from the probationer.
41. Officer summarizes and reflects new thinking and obtains verbal commitment from the probationer to use new thinking in the future.
42. Officer applies graduated sanctions (e.g., the severity of the sanction matches the risk and degree of the violation) and elicits the probationer’s input with regard to an appropriate sanction.
 
 
 
Responding to Violations/Problems Notes:
   
 
 
 
Working Relationship Skills Score
   
Case Plan-Driven Supervision Score
   
Effective Use of Reinforcement Score
   
Effective Use of Disapproval Score
   
Role Clarification Score
   
LS/CMI Assessment Score
   
Intervention Skills Score
   
Case Planning Score
   
LS/CMI Reassessment Score
   
Responding to Violations/Problems Score
   
 
 
 
Additional Comments: