SOCIAL WORK PROGRAM
SENIOR FIELD PLACEMENT EVALUATION FORM
Name of Student: ____________________________________________________________
Agency: ____________________________________________________________________
Field Instructor: ______________________________________________________________
Total Hours Student Completed in Field: ____________(216 Hours Required for Each Semester) This evaluation provides an opportunity for field instructors to assess the student’s knowledge, skills, and acquisition of competencies in field. The learning contract completed in the beginning of the semester should be the guide for assessing student performance. The evaluation should be a mutual process, with the student actively involved and signing this form once completed. Field instructors should write a brief narrative addressing Items I through V below and complete Performance Outcomes in accordance with the Council on Social Work Education 2015 competencies on the following pages.
I. Briefly list or describe the activities the student has been involved in during the semester.
II. Identify the student’s strengths as you observed his/her field activities.
III. What areas do you think the student needs to improve?
IV. What is the student’s potential for working in the profession of social work?
V. Other comments
Rating Scale for Evaluation of Field Placement Performance
Instructions: The standard by which an intern is to be compared is that of a new, BSW, entry-level social worker. The 9 competencies specified in this evaluation form are those established by our national accrediting organization (the Council on Social Work Education). Under each competency statement are several practice behaviors that we ask you to rate according to the following criteria:
5 = The intern excelled in consistently demonstrating the knowledge, values, skills, and cognitive- affective processes related to this practice behavior.
4 =The intern performed above expectations most of the time in demonstrating the knowledge, values, skills, and cognitive-affective processes related to this practice behavior.
3 =The intern met the expectations for demonstrating the knowledge, values, skills, and cognitive- affective processes related to this practice behavior at a basic level.
2 =The intern has not as yet met the expectations for demonstrating the knowledge, values, skills, and cognitive-affective processes related to this practice behavior, but gives indication of the potential for doing so in the future”?
1 =The intern has not met the expectations in this area, and does not give Indication s/he will do so in the near future. *Please provide specific explanation in comment section
The Field Coordinator has responsibility for assigning the grade for the Field Seminar. The grade that is assigned will be based on: overall evaluation of the student’s performance in field per the field
instructor’s evaluation and other factors such as seminar participation and assignments that integrate field with seminar instruction.
To the Field Instructor: Please check the number corresponding to the response that best represents your assessment of the student’s performance in the competency area specified. You are encouraged to write comments to expand upon any competency rating, if they so desire. All items need at minimum a number rating. Please rate the student accurately according to their demonstrated performance as this highlights areas for student growth and provides a fair comparison to other students preparing to graduate as generalist social work professionals
Competency 1: Demonstrate Ethical and Professional Behavior
Practice Behavior 1: Make ethical decisions by applying the standards of the NASW Code of Ethics, relevant laws and regulations, models for ethical decision-making, ethical conduct of research, and additional codes of ethics as
appropriate to context.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Identifies ethical dilemmas in the practice setting
• Utilizes the NASW code of ethics to analyze ethical dilemmas that arise
• Learned the laws, regulations and ethical standards specific to the agency Practice Behavior 2: Use reflection and self-regulation to manage personal values and maintain professionalism in practice situations.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Reflects, in both supervision and practice, on how personal reactions and experiences impacts their work
• Reflects, in both supervision and practice, on how professional reactions and experiences impacts their work
• Demonstrates, in both supervision and practice, self-awareness of their own reactions and willingness to explore them
• Engages in self-care activities and monitors stress levels
Practice Behavior 3: Demonstrate professional demeanor in behavior; appearance; and oral, written, and electronic communication.
☐ ☐ ☐ ☐ ☐
5 4 3 2 1 • Communicates in written agency documentation in an ethical and professional tone
• Communicates verbally with staff in an ethical and professional tone
• Communicate verbally with clients in an ethical and professional tone
• Dresses appropriately for the agency setting
Practice Behavior 4: Use technology ethically and appropriately to facilitate practice outcomes.
☐ ☐ ☐ ☐ ☐
5 4 3 2 1 • Uses technology appropriately and professionally, including social media and email/text/voicemail communications
• Learned agency protocols and policies regarding use of technology Practice Behavior 5: Use supervision and consultation to guide professional judgment and behavior.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Student uses supervision to address ethical issues/questions and to guide ethical, professional decision-making and behavior
• Student demonstrates willingness and ability to share their self-reflections in supervision
• Student demonstrates openness to constructive feedback and ability to incorporate that feedback into ongoing growth
COMMENTS:
Competency 2: Engage Diversity and Difference in Practice
Practice Behavior 6: Apply and communicate understanding of the importance of diversity and difference in shaping life experiences in practice at the micro, mezzo, and macro levels.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Attended trainings to enhance their understanding of diversity
• Increased knowledge of culturally sensitive engagement, assessment and intervention tools with the diverse client population the agency serves
• Increased ability to identify policies and issues on a societal level that impact the diverse client population the agency serves
• Incorporates their understanding of diversity in their work with clients and/or within the organization
Practice Behavior 7: Present themselves as learners and engage clients and constituencies as experts of their own experiences.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Openly engages with issues of difference and diversity with the clients, rather than avoids them
• Open to learning about clients’ unique experiences
Practice Behavior 8: Apply self-awareness and self-regulation to manage the influence of personal biases and values in working with diverse clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Utilizes supervision to practice self-reflection to manage bias
• Articulates/applies an awareness of how their life experiences (values, needs and biases) influences their responses to experiences with clients
COMMENTS:
Competency 3: Advance Human Rights and Social, Economic and Environmental Justice
Practice Behavior 9: Apply their understanding of social, economic, and environmental justice to advocate for human rights at the individual and system levels
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Gained awareness of the injustices impacting the diverse client population the agency serves
• Advocates for clients within the agency, community and/or larger systems
• Advocates for the agency within the community
Practice Behavior 10: Engage in practices that advance social, economic, and environmental justice.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Provided outreach and/or education in the community
• Advanced clients’ finances, environment, or economic resources
• Identify community resources that address clients’ social, economic or environmental needs
• Refers clients to community resources that address clients’ social, economic or environmental needs
COMMENTS:
Competency 4: Engage in Practice-informed research and Research-informed Practice
Practice Behavior 11: Use practice experience and theory to inform scientific inquiry and research.☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Developed interest in research questions based on practice experience
• Researched topics in response to their experiences with clients, the agency or the community
Practice Behavior 12: Apply critical thinking to engage in analysis of quantitative and qualitative research methods and research findings.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Read and understood research related to practice experience (published articles, books, agency research projects, etc.)
• Utilizes supervision to consider current research as it informs intervention and assessment tools used in the agency
Practice Behavior 13: Use and translate research evidence to inform and improve practice, policy, and service delivery.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Identifies and reviews research that may improve agency services
• Recognizes the use of evidence-based practices within the agency and their usefulness
• Explores/participates in program evaluation
• Engages in the agency’s research activities
COMMENTS:
Competency 5: Engage in Policy Practice
Practice Behavior 14: Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Identified local, state, and federal social policies that impact client experience within the agency and in the community
• Identified local, state, and federal social policies that impact the agency and staff’s experience
Practice Behavior 15: Assess how social welfare and economic policies impact the delivery of and access to social services.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Learned ways in which social and economic polices impact client’s ability to access services (eligibility, transportation, etc.)
• Learned ways in which social and economic policies impact the
agency’s/community’s ability to provide services (funding, staffing, etc.)
Practice Behavior 16: Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Utilizes supervision to critically think about policies and their application to their work
• Explores/participates in program development within the agency to help address clients’ needs
COMMENTS:
Competency 6: Engage with Individuals, Families, Groups, Organizations, and Communities
Practice Behavior 17: Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks to engage with clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Understands multiple theoretical frameworks and their connection to service delivery with individuals, families, groups and communities
• Actively practices the application of theory in their engagement with clients and constituencies
• Actively considers the importance of “person-in-environment” in engagement Practice Behavior 18: Use empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Uses empathy, warmth, and genuineness to engage with clients, groups, staff and the community?
• Uses interpersonal skills effectively to build rapport with clients, groups, staff and the community?
COMMENTS:
Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities
Practice Behavior 19: Collect and organize data, and apply critical thinking to interpret information from clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Conducted, observed, or participated in training on any level of assessment, intake, or application procedures
• Participated in the decision-making process regarding eligibility or service delivery in response to data collected in assessments, intakes or applications.
• Applied critical thinking to interpret results and make decisions based on information obtained from assessment, intake, or other data collection procedures
Practice Behavior 20: Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in the analysis of assessment data from clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Utilized their understanding of theory when conducting assessments
• Utilizes their understanding of theory when making decisions regarding assessment, intakes or applications
• Discusses the integration of the theory and assessment in supervision Practice Behavior 21: Develop mutually agreed-on intervention goals and objectives based on the critical assessment of strengths, needs, and challenges within clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Conducted, observed, or participated in training on any level of goal setting
• Incorporates a strengths perspective in goal setting
• Translates client “problems” into “needs” in understanding goals
• Demonstrates the ability to collaborate with clients in creating treatment goals Practice Behavior 22: Select appropriate intervention strategies based on the assessment, research knowledge, and values and preferences of clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Conducted, observed, or been trained in the process of intervention/treatment selection for clients and families
• Demonstrates knowledge about the interventions available within the agency
• Demonstrates knowledge about the interventions available within the community
• Demonstrates the ability to collaborate with clients in selecting interventions
COMMENTS:
Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities
Practice Behavior 23: Critically choose and implement interventions to achieve practice goals and enhance capacities of clients and constituencies.☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Conducted, observed, or been trained in interventions/treatment for individuals, families, groups and/or a community.
• Conducted, observed, or been trained in interventions for an organization
Practice Behavior 24: Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in interventions with clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Utilized their understanding of theory when conducting interventions
• Utilizes their understanding of theory when making decisions regarding the implementation of interventions
• Discusses the integration of the theory and treatment in supervision
Practice Behavior 25: Use inter-professional collaboration as appropriate to achieve beneficial practice outcomes.
☐ ☐ ☐ ☐ ☐
5 4 3 2 1 • Conducts or observes collaboration with other agencies
• Reaches out to staff within the agency for resources and supports
Practice Behavior 26: Negotiate, mediate, and advocate with and on behalf of diverse clients and constituencies.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Represents interests of diverse clients, groups, and constituencies within the agency and the community
• Supports clients’ efforts to meet their needs and accomplish their goals
• Engages in community action/organizing or task force on behalf of clients and constituencies
Practice Behavior 27: Facilitate effective transitions and endings that advance mutually agreed-on goals.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Discusses questions and challenges around termination in supervision
• Conducts or observes effective terminations or referrals to new services for clients
COMMENTS:
Competency 9: Evaluate Practice with individuals, Families, Groups, organizations, and Communities
Practice Behavior 28: Select and use appropriate methods for evaluation of outcomes.☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Conducted, observed, or participated in training on the evaluation of work with clients, families or groups?
• Conducted, observed, or been trained in any level of program evaluation for the agency
Practice Behavior 29: Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in the evaluation of outcomes.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Utilized their understanding of theory when evaluating interventions and/or programs
• Utilizes their understanding of theory when making decisions regarding the evaluations of interventions and/or programs
• Discusses the integration of the theory and evaluation in supervision
Practice Behavior 30: Critically analyze, monitor, and evaluate intervention and program processes and outcome.
☐ ☐ ☐ ☐ ☐
5 4 3 2 1 • Helped to identify challenges or problems with existing evaluation tools used in the agency
• Monitored interventions for the agency
Practice Behavior 31: Apply evaluation findings to improve practice effectiveness at the micro, mezzo, and macro levels.
☐ ☐ ☐ ☐ ☐ 5 4 3 2 1
• Considered how evaluation findings can be used to better client, community or agency service delivery
• Used evaluation findings to improve their understanding of clients, communities or the agency
COMMENTS:
Please check one of the following:
☐
This intern has excelled in field placement by performing above expectations for interns.☐
This intern has met the expectations of the field placement.☐
This intern is not yet ready for beginning level social work practice.☐
This intern is not yet ready for beginning level social work practice, and has demonstrated serious problems in performance, and perhaps should be encouraged to pursue another field of interest.Recommended Grade: ______
The field internship grade will be determined jointly between the student, field instructor and Coordinator of Field based on the student’s performance in completing all tasks agreed upon as specified in their learning contract. Absenteeism, no calls and no shows will result in deductions from your field internship grade. In order to successfully pass the Field Seminar (SOW 411, SOW 488) class you must receive a passing grade from both the class and the internship experience. Likewise, you must pass both the Field Seminar (SOW 488) and Senior Seminar (SOW 412) classes in order to finish the sequence or graduate. If you fail either, you will need to repeat both concurrently.
Signature of Field Instructor: ______________________________ Date: ___________________
THE FOLLOWING SECTION SHOULD BE COMPLETED BY THE INTERN:
My field instructor and Coordinator of Field have discussed this evaluation with me, and I have received a copy. My agreement or disagreement follows: (Please Check the Appropriate Response)
☐
I agree with the evaluation☐
I do not agree with the evaluation.Intern’s Signature: ______________________________________ Date: _____________________
***Note: If the intern disagrees with the evaluation she/he should state that disagreement in writing and submit a copy to the field instructor and Coordinator of Field Education, Cabrini University Social Work Department, within 3 days of receiving the evaluation. A meeting between the student, Coordinator of Field, and faculty members as appropriate will then be held to discuss the disagreement.
