SELF ASSESSMENT OF PERSONAL AND PROFESSIONAL BOUNDARIES

CESA 2 Therapeutic Learning Center (Rock County's Early Intervention Program) SELF ASSESSMENT OF PERSONAL AND PROFESSIONAL BOUNDARIES
(Please answer each of these with "Always", "Sometimes", or "Never")

  1. I find it difficult to follow agency guidelines with families.
  2. I need clarification regarding my job description, policies, or guidelines
  3. I determine or influence desired family priorities or outcomes.
  4. I work harder than families to meet desired outcomes.
  5. I find it difficult to engage families so I "do it" for them.
  6. I have expectations beyond what the family identifies in the “Parent Partnership Agreement”.
  7. I find it difficult to accomplish my objectives during home visits.
  8. I accept gifts from families.
  9. I attend private functions when invited by families (i.e., weddings, birthday parties, etc.).
  10. I provide childcare services for families.
  11. I provide transportation for families.
  12. I take families grocery shopping, or supply them with food or clothing.
  13. I give gifts to the children and/or families.
  14. I give my home phone number to families.
  15. I offer advice to families.
  16. I loan money or personal property to families.
  17. I stay for dinner or lunch when invited by families.
  18. I invite families to my personal functions outside of work (parties, shopping, coffee, etc).
  19. I call families outside of my work hours.
  20. I struggle to find interests, hobbies, or people to spend time with outside of work.

Assessment Key: "Always" indicates immediate need for Self Improvement Plan with Supervisory Guidance
"Sometimes" indicates caution and suggests need for Self Improvement Plan with Supervisory Guidance

CESA 2

Therapeutic Learning Center (Rock County's Early Intervention Program)

PERSONAL AND PROFESSIONAL BOUNDARIES SELF IMPROVEMENT PLAN Employee:
Date Hired:
Supervisor:
Plan Date:

Plan Development Process:

A "Self Improvement Plan" may be developed at any time based on the request of the employee or the recommendation of the immediate supervisor. Prior to developing a plan, the employee will complete a "Self Assessment of Personal and Professional Boundaries ".

The plan will be developed based on the results of the self assessment and input from the immediate Supervisor. The final task will be to develop measurable performance goals for continued professional development. Upon completion of developing a plan, the employee and the immediate supervisor will set a date to review the progress on the identified goals.

A copy of the "Self Improvement Plan" will be provided to the employee. The original will be kept in the employee's personnel file.

PLAN SUMMARY
(To be completed by the Supervisor at the end of the Self Improvement Plan Meeting)

In order to meet personal and professional boundary expectations for job responsibilities, this employee needs...

Identified supports needed...

SIGNATURES

The following signatures indicate active participation in the "Self Improvement Plan" meeting:
Employee:
Date:
Supervisor:
Date:
Review Date:

Employee’s Strengths related to Personal and Professional Boundaries:

Employee’s Areas for Further Development:

Self Improvement Goal:

Supports Needed:

How will the success of the goal be measured?

Self Improvement Goal:

Supports Needed:

How will the success of the goal be measured?

Self Improvement Goal:

Supports Needed:

How will the success of the goal be measured?