Field Practice Learning Agreement and Evaluation Form

Transcription

1 SOCIAL WORK PROGRAM Field Practice Learning Agreement and Evaluation Form Brief Instructions: Please see field manual, available at for complete instructions and for additional downloadable copies of this form. Learning Agreement (September & January) The Learning Agreement (planned activities) portion of this form is to be completed by the student with guidance and approval from the field instructor within the first four weeks of the field placement. The Field instructor will retain the original and submit a copy to the faculty liaison. A new Learning Agreement will be completed for the spring semester carrying forward relevant objectives. We recommend completing and maintaining electronic versions of this document. Evaluation (December & May) At the end of the semester, the field instructor will complete and submit the evaluation to the social work office after reviewing the evaluation with the student and obtaining the student s signature. Student Name: Semester: Fall Spring Year: Junior Senior Agency: Field Instructor: Address: Telephone: Cell Phone: Additional Agency Supervisor: Internship Schedule: days/hours: Supervision Schedule: Day: Time: SJC Faculty Liaison:

2 S U M M A R Y P A G E D e s c r i p t i o n o f g e n e r a l i s t s o c i a l w o r k a s s i g n m e n t s : Individuals, Groups & Families assignments: (For example, list specific number and type of individual, group, family cases and whether the student is assigned to be primary worker, co-facilitator, observer etc.) Community/Policy Practice assignments: (For example, students might be assigned to research a policy and its impact on clients; track a legislative initiative; interview clients to learn their perspective as service recipients; participate in a committee writing new policies for the agency; or participate in a coalition) Participation at regular staff meetings, agency trainings, and other general agency activity: Planned attendance at professional conferences, workshops (minimum of one professional development activity required each semester) Signatures to be signed at the beginning of the semester indicating agreement with the plan: F i e l d I n s t r u c t o r D a t e S t u d e n t D a t e F a c u l t y L i a i s o n D a t e 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

3 S T U D E N T O RIENTATI O N : Objective: To develop knowledge of the placement agency and the role of the agency in meeting human needs in the community. To understand agency policies and procedures governing practice experiences. Checklist of orientation activities designed to build student knowledge: Field Instructor/Supervisor orientation activities: Schedule supervision sessions to orient the student to agency, Review practice standards, policies, and customs such as dress code, lunch patterns, etc. Send out memo/ to staff introducing the student; Provide tour of agency; Introduce student to clerical staff and provide orientation to making copies, printing, telephone, /internet systems. Student orientation activities: Student review of agency policy manuals; brochures, program materials Student meeting(s) with administrative and program staff; Please specify: Student visit(s) to community programs and resources, tour of neighborhood, specify: Field instructor/supervisor review of agency protocols; instructions for how students should respond to: transportation of clients; mandatory reporting, child abuse, elder abuse suicide/homicide threats drugs/alcohol, weapons, safety issues Other: 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

4 In September: At the beginning of the semester use the space below to identify student learning activities that will facilitate the assessment of the competencies listed. See suggested assignments for each competency in the Learning Contract Tool Kit document attached In December: At the conclusion of the semester use the scale below each competency to assess the student's achievement of each of the competencies and practice behaviors identified in this Learning Agreement and Evaluation Form. Competence #1: Intern identifies as a professional social worker and conducts himself/herself accordingly. Assignments should involve: client advocacy, understanding of professional development and deportment, professional roles and boundaries, and the use of supervision. COMPETENCY One expectations in this area EVALUATION OF COMPETENCY 1 1 advocates for client access to the services of social work 2 practices personal reflection and self-correction to assure continual professional development 3 attends to professional roles and boundaries 4 demonstrates professional demeanor in behavior, appearance, and communication 5 engages in career-long learning 6 uses supervision and consultation 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

5 Competence #2: Intern applies social work ethical principles to guide his or her professional practice. Assignments should include: discussing personal values and practice in using the NASW Code of Ethics to make ethical decisions. COMPETENCY Two expectations in this area C o mplete at t h e end of th e semester: EVALUATION OF COMPETENCY 2 1 recognizes and manage personal values in a way that allows professional values to guide practice 2 makes ethical decisions 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 Schools of Social Work Ethics in Social Work Statement of Principles 3 tolerates ambiguity in resolving ethical conflicts 4 applies strategies of ethical reasoning to arrive at principled decisions Asylum Avenue ~ West Hartford, CT ~ ~ (860)

6 Competence #3: Intern applies critical thinking to inform and communicate professional judgments. Assignments should include: use of multiple sources of knowledge, analysis of models of assessment, prevention, intervention, and evaluation and opportunity to practice written and oral communication. COMPETENCY Three expectations in this area EVALUATION OF COMPETENCY 3 1 distinguishes, appraises, and integrates multiple sources of knowledge, including research-based knowledge, and practice wisdom 2 analyzes models of assessment, prevention, intervention, and evaluation 3 demonstrates effective oral and written communication in working with individuals, families, groups, organizations, and communities Asylum Avenue ~ West Hartford, CT ~ ~ (860)

7 Competence #4: Intern engages diversity and difference in practice. Assignments should include: opportunities to discover how a culture s structures may positively or negatively affect the creation or enhancement of privilege and power; to gain self-awareness, to understand the importance of difference, and to accept that the process of learning is life-long. COMPETENCY Four expectations in this area EVALUATION OF COMPETENCY 4 1 recognizes the extent to which a culture s structures and values may opposes, marginalize, alienate, or create or enhance privilege and power 2 gains sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups 3 recognizes and communicate their understanding of the importance of difference in shaping life experiences 4 views his/herself as a learner and engage those with whom she works as informants Asylum Avenue ~ West Hartford, CT ~ ~ (860)

8 Competence #5: Intern advances human rights and social and economic justice. Assignments should include: experience with oppression and discrimination and opportunities for advocacy and practice with advancing human rights and economic justice. COMPETENCY Five expectations in this area EVALUATION OF COMPETENCY 5 1 understands the forms and mechanisms of oppression and discrimination 2 advocates for human rights and social and economic justice 3 engages in practices that advance social and economic justice 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

9 Competence #6: Intern engages in research-informed practice and practiceinformed research. Assignments should include: opportunities to understand the role of research in the agency and its application to practice, and how practice informs research. COMPETENCY Six expectations in this area EVALUATION OF COMPETENCY uses practice experiences to inform scientific inquiry 6.2 uses research evidence to inform practice 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

10 Competence #7: Intern applies knowledge of human behavior and the social environment. Assignments should include: discussion and opportunities to apply and critique human behavior concepts in assessment, intervention and evaluation. COMPETENCY Seven expectations in this area EVALUATION OF COMPETENCY utilizes conceptual frameworks to guide the processes of assessment, intervention, and evaluation 7.2 critiques and applies knowledge to understand person and environment Asylum Avenue ~ West Hartford, CT ~ ~ (860)

11 Competence #8: Intern engages in policy practice to advance social and economic well-being and to deliver effective social work services. Assignments should include: discussion of policy and its effect on service delivery, analysis of the policy change process in the agency and the opportunity to explore policy change. COMPETENCY Eight expectations in this area EVALUATION OF COMPETENCY analyzes, formulates, and advocates for policies that advance social well-being; 8.2 collaborates with colleagues and clients for effective policy action 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)

12 Competence #9: Intern responds to contexts that shape practice. Assignments should include: exploration of the community served by the agency and observation or involvement in developing services to respond to changing needs in the community. COMPETENCY Nine expectations in this area EVALUATION OF COMPETENCY continuously discovers, appraises, and attends to changing locales, populations, scientific and technological developments, and emerging societal trends to provide relevant services 9.2 provides leadership in promoting sustainable changes in service delivery and practice to improve the quality of social services Asylum Avenue ~ West Hartford, CT ~ ~ (860)

13 Competence #10: Intern engages, assesses, intervenes and evaluates with individuals, families, groups, organizations, and communities. Assignments should include: working with an individual, group or community to apply skills in engagement, assessment, intervention, and evaluation. COMPETENCY Ten expectations in this area EVALUATION OF COMPETENCY EP10(a) Engagement substantively & affectively prepares for action with individuals, families, groups, organizations, and communities; uses empathy and other interpersonal skills; and develops mutually agreed-upon focus of work & desired outcomes 10.2 EP10(b) Assessment collects, organizes, and interprets client data; assesses client strengths and limitations; develops mutually agreed-upon intervention goals & objectives; and selects appropriate intervention strategies EP10(c) Intervention initiates actions to achieve organizational goals; 10.3 implements prevention interventions that enhance client capacities; helps clients resolve problems; negotiates, mediates, and advocates for clients; and facilitates transitions and endings. EP10(d) Evaluation Critically analyzes, monitors, and evaluates interventions Asylum Avenue ~ West Hartford, CT ~ ~ (860)

14 S u m m a t i v e C o m m e n t s : Please provide additional narrative summary of the student s performance in the practicum for the period covered by this evaluation. Identify areas of student growth, specific strengths, and suggest directions for future development. S tuden t C o mments and S elf Evaluation: Please attach additional sheets as needed. E n d o f S e m e s t e r E v a l u a t i o n o f S t u d e n t : x This intern is excelling in field placement by performing above expectations for interns. This intern is meeting the expectations of a field placement intern. This intern is functioning somewhat below the expectations of a field placement intern. There is a question whether this intern will be ready for beginning level social work practice by the end of placement. This intern is functioning below the expectations of a field placement intern. There is considerable concern that this intern will not be ready for beginning level social work practice by the end of placement. Final grading decision for the field practice class is determined by the faculty liaison and includes student performance in the field practice seminar and written assignments. E v a l u a t i o n S i g n a t u r e s : F i e l d I n s t r u c t o r D a t e S t u d e n t D a t e F a c u l t y L i a i s o n D a t e 1678 Asylum Avenue ~ West Hartford, CT ~ ~ (860)