Harbor Hospice Skill Observation: Music Therapy Music Therapy Competency Assessment By Observation – For New Hires & Every 3 Years Employee name(Required) First Last Date completed(Required) MM slash DD slash YYYY Evaluator name(Required) First Last MRNDemonstrates competency in the performance of job related skills appropriate to his/her patient populations1. Observes professional boundaries with patients and families (home visit)(Required) Yes No N/A Comments:2. Demonstrates cultural competence and sensitivity (home visit)(Required) Yes No N/A Comments:3. Demonstrates flexibility regarding the wishes of the patients and families (home visit)(Required) Yes No N/A Comments:4. Demonstrates open communication style with patients, families, other IDT members and service providers as appropriate (home visit)(Required) Yes No N/A Comments:5. Supports patient’s personal and relational treatment goals (home visit)(Required) Yes No N/A Comments:6. Demonstrates understanding of comprehensive diagnosis, needs, and utilization of music therapy interventions (home visit)(Required) Yes No N/A Comments:7. Demonstrates coordination of music therapy with symptom management, life validation, and daily enrichment (home visit)(Required) Yes No N/A Comments:8. Demonstrates utilization of appropriate interventions for therapeutic, clinical, and evidence-based services (home visit)(Required) Yes No N/A Comments:Additional comments:Employee signature(Required)Date(Required) MM slash DD slash YYYY Evaluator signature(Required)Date(Required) MM slash DD slash YYYY Δ