socw 6371: mssw foundation field … j...rvsd 05/18/2015 university of texas-rio grande valley...

RVSD 05/18/2015

UNIVERSITY OF TEXAS-RIO GRANDE VALLEY Department of Social Work

Office of Field Education

SOCW 6371: MSSW FOUNDATION FIELD

Educational Agreement and Evaluation Forms

Intern’s Name:

Name of Student:

Name of Agency:

Description of agency services:

Field Instructor’s name, employment title, and credentials

Term/year:

Field Instructor signature: _____________________________

Student signature: ___________________________________

Faculty Liaison signature: _____________________________

Date:

Date:

Date:

Signatures indicate agreement with all terms stipulated in the Educational Agreement. Copies: One for each person who signs

Work schedule (include days & hours, coverage in student's absence, make-up arrangements for absences)

Supervision: (day, time, where, with whom)

Other staff with whom the student is expected to work to complete assignments: (include names & titles)

Space and facilities for intern

RVSD 05/18/2015

Student Learning Goals (to be completed by student in consultation with the Field Instructor). What do you want to learn this semester? Consider this in terms of personal and professional growth. Some examples of learning goals are: “I want to examine my own personal biases surrounding this agency’s population” (personal goal); “I want to learn to work more effectively with administration” (professional goal). List minimum of three goals.

1.

(Above goal supports Field Competency # _____)

2.


3.


4.


5.


6.


Students and field instructors may add competencies to the field objectives which are deemed to be appropriate for

their respective agency and which assist the student to achieve the learning goals listed above. An electronic version of the educational agreement may be used to develop an individualized learning plan.

However, required competencies cannot be deleted.

Intern’s Name:

RVSD 05/18/2015

EVALUATION SCALE

Rating Scale Corresponding Course Grade

Exceeds Expectations

5 points Pass

Meets Expectations

4 points 3 points

Pass

Unsatisfactory Performance

2 points 1 point

Fail

Evaluation Criteria Legend MSSW FOUNDATION FIELD PRACTICUM Unsatisfactory performance: 1 to 2 points: below average Fails to meet expectations of performance of basic practice behaviors for social work generalist practice in field setting Meets Expectations: 3 to 4 points: good performance Meets expectations of acceptable levels of performance of basic practice behaviors for social work generalist practice in field setting Exceeds Expectations: 5 points: excellent performance Significantly exceeds expectations of acceptable levels of performance of basic practice behaviors for social work generalist practice in field setting

** Please note that an overall unsatisfactory (below average) performance evaluation denote a Failing

grade

Intern’s Name:

Educational Agreement/Evaluation

RVSD 05/18/2015

To be completed by Field Instructor and Student

Field Competency 2.1.1: Identify as a professional social worker and conduct oneself accordingly.

Overall Rating 1 to 5


__________

__________

Mid-term Final

EDUCATIONAL AGREEMENT EVALUATION RATING SCALE

In all their professional interactions, students are expected to demonstrate the following practice behaviors for sound social work practice:

Essential Practice Behaviors Students must have assignments/tasks under each competency (ALL MUST BE CHECKED):

[1] Advocate for client access to the services of social work Mid-term: _____ Final: _____

[2] Practice personal reflection and self-correction to assure continual professional development Mid-term: _____ Final: _____

[3] Attend to professional roles and boundaries Mid-term: _____ Final: _____

[4] Demonstrate profession demeanor in behavior, appearance, and communication Mid-term: _____ Final: _____

[5] Engage in career long learning Mid-term: _____ Final: _____

[6] Use supervision and consultation Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional)

[ ] Plan and implement appropriate termination processes with the client or client systems Mid-term: _____ Final: _____

[ ] Plan, prioritize, and manage work assignments effectively Mid-term: _____ Final: _____

[ ] Complete assigned tasks in a timely manner Mid-term: _____ Final: _____

[ ] Other _________________________________________________ Mid-term: _____ Final: _____

Please describe specifically what the intern will do to attain these practice behaviors:

Narrative (by both field instructor and the intern) to support the above grade can be included here:

Intern’s Name:


RVSD 05/18/2015

Field Competency 2.1.2: Apply social work ethical principles to guide professional practice.


Overall Rating

1 to 5

__________ __________ Mid-term Final




[7] Recognize and manage personal values in a way that allows professional values to guide practice Mid-term: _____ Final: _____

[8] Make ethical decision by applying standards of the National Association of Social Workers Code of Ethics and, as applicable of the International Federation of Social Workers/International Association of Social Work Ethics in Social Work, Statement of Principles Mid-term: _____ Final: _____

[9] Tolerate ambiguity in resolving ethical conflicts Mid-term: _____ Final: _____

[10] Apply strategies of ethical reasoning to arrive at principled

decisions Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional) [ ] Maintain confidentiality of client information Mid-term: _____ Final: _____

[ ] Identify ethical dilemmas and discuss these with field instructor Mid-term: _____ Final: _____

[ ] Maintain accurate and up-to-date client records, notes, or other documentation in accordance with agency policies. Mid-term: _____ Final: _____

[ ] Other__________________________________________________ Mid-term: _____ Final: _____

Please describe specifically what the intern will do to attain these practice behaviors :

Narrative (by both field instructor and the intern) to support the above grade can be included here: Intern’s Name:

RVSD 05/18/2015


Field Competency 2.1.3: Apply critical thinking to inform and communicate professional judgments.



__________ __________

Mid-term Final



Essential Practice Behaviors Students must have assignments/tasks under each competency (ALL MUST BE CHECKED): [11] Distinguish, appraise, and integrate multiple sources of knowledge, including research based knowledge and practice wisdom Mid-term: _____ Final: _____

[12] Analyze models of assessment, prevention, intervention, and evaluation Mid-term: _____ Final: _____

[13] Demonstrate effective oral and written communication in working with individuals, families, groups, organizations, communities, and colleagues Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional) [ ] Use language that is respectful of gender, sexual orientation, racial and

ethnic identity, age, and persons with disabilities Mid-term: _____ Final: _____

[ ] Maintain accurate and up-to-date client records, notes, or other

documentation in accordance with agency policies Mid-term: _____ Final: _____

[ ] Other ________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.4: Engage diversity and difference in practice.


Overall Rating

1 to 5 ___________ ___________

Mid-term Final




[14] Recognize the extent to which a culture’s structures and values may oppress, marginalize, alienate, or create or enhance privilege and power Mid-term: _____ Final: _____ [15] Gain sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups Mid-term: _____ Final: _____ [16] Recognize and communicate their understanding of the importance of difference in shaping life experiences Mid-term: _____ Final: _____ [17] View themselves as learners and engage those with whom they work as informants Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional) [ ] Critically examine the effects and relevance of practice methods with diverse populations Mid-term: _____ Final: _____ [ ] Understand the community’s demographics and how the agency accommodates or does not accommodate diversity within the community Mid-term: _____ Final: _____ [ ] Other____________________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.5: Advance human rights and social and economic justice.


Overall Rating

1 to 5 ___________ ___________

Mid-term Final




[18] Understand the forms and mechanism of oppression and discrimination Mid-term: _____ Final: _____ [19] Advocate for human rights and social and economic justice Mid-term: _____ Final: _____ [20] Engage in practices that advance social and economic justice Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional) [ ] Identify the social problems relevant to the community and critically

analyze the impact of social policies and services in addressing these problems Mid-term: _____ Final: _____

[ ] Other ________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015

Educational Agreement/Evaluation Field Competency 2.1.6: Engage in research-informed practice and practice-informed-research.


Overall Rating

1 to 5 __________ __________

Mid-term Final




[21] Use practice experience to inform scientific inquiry Mid-term: _____ Final: _____

[22] Use research evidence to inform practice Mid-term: _____ Final: _____

Desirable Practice Behaviors (Optional) [ ] Apply concepts and knowledge of social work practice theories in direct

practice activities Mid-term: _____ Final: _____

[ ] Set measureable goals with client and continuously monitors progress

toward meeting these goals Mid-term: _____ Final: _____ [ ] Other ________________________________________

_______________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.7: Apply knowledge of human behavior and the social environment.


Overall Rating

1 to 5

___________ ___________ Mid-term Final




[23] Utilize conceptual frameworks to guide the processes of assessment,

intervention, and evaluation Mid-term: _____ Final: _____

[24] Critique and apply knowledge to understand person and environment Mid-term: _____ Final: _____


[ ] Demonstrate skill in completing psychosocial assessments of the client or

client system Mid-term: _____ Final: _____

[ ] Apply knowledge of human growth and development and family dynamics

in client assessments Mid-term: _____ Final: _____

[ ] Other _________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.8: Engage in policy practice to advance social and economic well-being and to deliver effective social work service.



__________

__________

Mid-term Final




[25] Analyze, formulate, and advocate for policies that advance social well- being Mid-term: _____ Final: _____

[26] Collaborate with colleagues and clients for effective policy action Mid-term: _____ Final: _____


[ ] Describe the process used in the agency to create or change formal and

informal policies and procedures Mid-term: _____ Final: _____

[ ] Other _________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.9: Respond to contexts that shape practice.



________ _________ Mid-term Final




[27] Continuously discover, appraise, and attend to changing locales, populations, scientific, and technological developments, and emerging societal trends to provide relevant services Mid-term: _____ Final: _____ [28] Provide leadership in promoting sustainable changes in service delivery and practice to improve the quality of social services Mid-term: _____ Final: _____


[ ] Identify social problems that have an impact in the community Mid-term: _____ Final: _____ [ ] Other ________________________________________ Mid-term: _____ Final: _____ Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015


Field Competency 2.1.10: Engage, assess, intervene, and evaluate with individuals, families, groups, organizations, and communities.



__________ __________ Mid-term Final



Essential Practice Behaviors Students must have assignments/tasks under each competency (ALL MUST BE CHECKED): [29] Substantively and affectively prepare for action with individuals,

families, groups, organizations, and communities Mid-term: _____ Final: _____

[30] Use empathy and other interpersonal skills Mid-term: _____ Final: _____

[31] Develop a mutually agreed on intervention goals and desired

outcomes Mid-term: _____ Final: _____

[32] Collect, organize, and interpret, client data Mid-term: _____ Final: _____

[33] Assess clients strengths and limitations Mid-term: _____ Final: _____ [34] Develop a mutually agreed-on intervention goals and objectives Mid-term: _____ Final: _____

[35] Select appropriate intervention strategies Mid-term: _____ Final: _____

[36] Initiate actions to achieve organizational goals Mid-term: _____ Final: _____

[37] Implement prevention interventions that enhance client

capabilities Mid-term: _____ Final: _____

[38] Help clients resolve problems Mid-term: _____ Final: _____

[39] Negotiate, mediate, and advocate for clients Mid-term: _____ Final: _____

[40] Facilitate transitions and endings Mid-term: _____ Final: _____

[41] Critically analyze, monitor, and evaluate interventions Mid-term: _____ Final: _____


[ ] Other _______________________________________ Mid-term: _____ Final: _____

Please describe specifically what the intern will do to attain these practice behaviors:


RVSD 05/18/2015

MID-TERM EVALUATION SOCW 6371

Faculty Field Liaison Name: Term: Total hours completed: hours.

PLEASE SIGN AND DATE ANY ADDITIONAL ATTACHMENTS. This page must be signed and dated

upon completion of the Mid-term: Evaluation

Signatures:

Field Instructor: Date:

Student: Date:

________________________________________________________________

Optional Liaison/ Field Liaison Comments:

Mid-term: Grade _____ Pass _____ Fail Signature: Liaison: ______________________________________ Date: _______________

RVSD 05/18/2015

FINAL EVALUATION SOCW 6371

Faculty Field Liaison Name: Term: Total hours completed: hours.

PLEASE SIGN AND DATE ANY ADDITIONAL ATTACHMENTS. This page must be signed and dated

upon completion of the Mid-term: Evaluation

Signatures:

Field Instructor: Date:

Student: Date:

________________________________________________________________

Optional Liaison/Field Liaison Comments:

Final-term: Grade _____ Pass _____ Fail Signature: Liaison: ______________________________________ Date: _______________

socw 6371: mssw foundation field … j...rvsd 05/18/2015 university of texas-rio grande valley...

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