ࡱ>  6bjbj 4.0  MMMMMaaa8ta'#f))???..."""""""$/'p"M....."MM??"b!b!b!.TM?M?"b!."b!b!:"",b"?\'a pN" ""0'#X" ' p'b"'Mb"T..b!.....""b!...'#....'.........  : MIDTERM Evaluation of Field Placement Performance ϳԹ Social Work Program Name of Intern __________________________________ Date ___________________ Instructions for Rating Interns on the 10 Competencies in the First Part of the Evaluation: The standard by which an intern is to be compared is that of a new beginning-level social worker. The 10 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 items that we ask that you rate according to the following criteria. 5The intern has excelled in this area4The intern is functioning above expectations for interns in this area3The intern has met the expectations for interns in this area2The intern has not as yet met the expectations in this area, but the gives indication s/he will do so in the near future1The intern has not met the expectations in this area, and does not give indications s/he will do so in the near futuren/aNot applicable, as the intern has not had the opportunity to demonstrate competence in this area Comments may be made under any competency statement, if desired. Please be sure to indicate those areas in which you think the intern is particularly strong and those areas in which the student need improvement. This evaluation is intended to give the intern feedback about her or his performance. Competence #1: Intern identifies as a professional social worker and conducts himself/herself accordingly. 1.1Knows the professions history54321na1.2Has a commitment to enhancing the profession54321na1.3Has a commitment to conducting himself/herself as a professional social worker54321na1.4Has a commitment to career-long learning and growth54321na1.5Advocates well for client access to the services of social work54321na1.6Practices personal reflection and self-correction to assure continual professional development54321na1.7Attends well to professional roles and boundaries54321na1.8Demonstrates professional demeanor in appearance54321na1.9Demonstrates professional demeanor in communication54321na1.10Uses supervision and consultation effectively54321na Comments: Competence #2: Intern applies social work ethical principles to guide his or her professional practice. 2.1Is knowledgeable about the value base of the profession54321na2.2Is knowledgeable of, and abides by, the ethical standards of the profession54321na2.3Is knowledgeable of, and abides by, laws relevant to social work54321na2.4Recognizes and manages personal values in a way that allows professional values to guide practice (e.g., on such issues as abortion and gay rights)54321na2.5Tolerates ambiguity well in resolving ethical conflicts54321na2.6Is able to apply strategies of ethical reasoning to arrive at principled decisions54321na Comments: Competence #3: Intern applies critical thinking to inform and communicate professional judgments. 3.1Is knowledgeable about the principles of logic and scientific inquiry54321na3.2Is able to effectively cope with ambiguity when making professional judgments54321na3.3Is skilled in using critical thinking augmented by creativity 54321na3.4Has good assessment skills54321na3.5Has good problem-solving skills54321na3.6Has good data gathering skills54321na3.7Analyzes complex material well54321na3.8Is skilled at appraising and integrating multiple sources of knowledge including research-based knowledge and practice wisdom54321na3.9Is skilled at analyzing models of assessment, prevention, intervention, and evaluation54321na3.10Demonstrates effective oral communication in working with individuals, families, groups, organizations, communities, and colleagues54321na3.11Demonstrates effective written communication in working with individuals, families, groups, organizations, communities, and colleagues54321na Comments: Competence #4: Intern engages diversity and difference in practice. 4.1Treats diverse clients with dignity and respect54321na4.2Is knowledgeable and respectful of clients who differ by such factors as age, class, color, culture, disability, ethnicity, gender identity and expression, immigration status, political ideology, race, religion, sex, and sexual orientation54321na4.3Recognizes the extent to which a cultures structures and values may oppress, marginalize, alienate, or create or enhance privilege and power54321na4.4Has sufficient self-awareness to eliminate the influence of personal biases and values in working with diverse groups54321na4.5Recognizes and communicates her or his understanding of the importance of difference in shaping life experiences54321na4.6Views herself or himself as a learner and engages those he or she works with as informants54321na Comments: Competence #5: Intern advances human rights and social and economic justice. 5.1Recognizes that each person, regardless of position in society, has basic human rights54321na5.2Recognizes the global interconnections of oppression and is knowledgeable about theories of justice and strategies to promote human and civil rights54321na5.3Understands the forms and mechanisms of oppression and discrimination54321na5.4Is skilled at advocating for human rights and social and economic justice54321na5.5Is skilled at engaging in practices that advance social and economic justice54321na Comments: Competence #6: Intern engages in research-informed practice and practice-informed research. 6.1Is skilled at using practice experience to inform research54321na6.2Is skilled at employing evidence-based interventions54321na6.3Is skilled at evaluating her or his practice54321na6.4Is skilled at using research findings to improve practice, policy, and social service delivery54321na6.5Comprehends quantitative research54321na6.6Comprehends qualitative research54321na6.7Understands scientific and ethical approaches to building knowledge54321na Comments: Competence #7: Intern applies knowledge of human behavior and the social environment. 7.1Is knowledgeable about human behavior across the life course54321na7.2Is knowledgeable about the range of social systems in which people live54321na7.3Is knowledgeable about the ways social systems promote or deter people in maintaining or achieving health and well-being54321na7.4Is knowledgeable about and skilled at applying basic bio-psycho-social-spiritual theories 54321na7.5Is skilled at utilizing conceptual frameworks to guide the processes of assessment, intervention, and evaluation54321na Comments: Competence #8: Intern engages in policy practice to advance social and economic well-being and to deliver effective social work services. 8.1Understands that policy affects service delivery54321na8.2Actively engages in policy practice54321na8.3Is knowledgeable about the history of social policies and services54321na8.4Is knowledgeable about current social policies and services54321na8.5Is knowledgeable about the role of practice in policy development54321na8.6Is skilled at analyzing, formulating, and advocating for policies that advance social well-being54321na8.7Is skilled at collaborating with colleagues and clients for effective policy action54321na Comments: Competence #9: Intern responds to contexts that shape practice. 9.1Is informed, resourceful, and proactive in responding to evolving organizational, community, and societal contexts at all levels of practice54321na9.2Recognizes that the context of practice is dynamic, and has the knowledge and skills to respond proactively54321na9.3Is skilled at continuously discovering, appraising, and attending to changing locales, populations, scientific and technological developments, and emerging societal trends in order to provide relevant services54321na9.4Is skilled at providing leadership in promoting sustainable changes in service delivery and practice to improve the quality of social services54321na Comments: Competence #10: Intern engages, assesses, intervenes and evaluates with individuals, families, groups, organizations, and communities. 10.1Is skilled at identifying, analyzing, and implementing evidence-based interventions designed to achieve client goals54321na10.2Is skilled at using research and technological advances54321na10.3Is skilled at evaluating program outcomes54321na10.4Is skilled at evaluating the effectiveness of her or his practice54321na10.5Is skilled at developing, analyzing, advocating, and providing leadership for policies and services54321na10.6Is skilled at promoting social and economic justice54321na10.7Is skilled at engaging (developing a positive relationship) with individuals54321na10.8Is skilled at engaging families54321na10.9Is skilled at engaging groups54321na10.10Is skilled at engaging organizations54321na10.11Is skilled at engaging communities54321na10.12Is skilled at assessing individuals54321na10.13Is skilled at assessing families54321na10.14Is skilled at assessing groups54321na10.15Is skilled at assessing organizations54321na10.16Is skilled at assessing communities54321na10.17Is skilled at providing effective services to individuals54321na10.18Is skilled at providing effective services to families54321na10.19Is skilled at providing effective services to groups54321na10.20Is skilled at providing effective services to organizations54321na10.21Is skilled at providing effective services to communities54321na Comments: Overall Evaluation at MIDTERM: Please check one of the following for the students midterm evaluation. 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. This intern should perhaps be encouraged to pursue another major. Comments/elaboration: Signature of Agency Field Instructor ________________________________________________ Phone number__________________________________________________________________ Agency ____________________________________________ Date ___________________ The following section should be completed by the intern: My agency supervisor and faculty supervisor have discussed this evaluation with me, and I have received a copy. My agreement or disagreement follows: I agree with the evaluation ( I do not agree with evaluation ( Interns Signature _________________________________ Date _____________________ If the intern disagrees with the evaluation she/he should state that disagreement in writing and submit a copy to both the agency supervisor and the Field Coordinator. A meeting between the student, agency supervisor, and Field Coordinator should then be held to discuss the disagreement. This Field Evaluation form was adapted from Zastrow (2009).     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