Social Services Worker Program

Field 2 Final Placement Evaluation Form

This evaluation form is to be completed at the end of the semester. The form is designed to help on-site field supervisors provide feedback about the performance of students on practicum. The areas assessed directly correspond with the general goal areas of the students’ learning contract. This form will become a part of the student’s record for this course and is a vital evaluation component considered by faculty.

The following rating scale will be used in assessing the student’s performance in the areas contained in the evaluation form.

Rating

/ Evaluation / Evaluation
4 = / Outstanding performance / Performance is consistently above expected level
3 = / Very good performance / Performance is usually above expected level
2 = / Acceptable performance / Performance is at expected level
1 = / Unacceptable/Incompetent Performance / Performance is below expected level
N/O = / Not observed / Not able to evaluate at this time
N/A = / Not applicable / Not applicable to setting/at this time

Evaluation rating: Reflects the range of learning as an ongoing process. A rating of 2 represents expectations of SSW students, ratings of 3-4 indicate entry-level SSW work skills. A rating of 1 represents significant concerns that require faculty, supervisor and student attention. Please provide specific behavioural examples of student performance that support rating given in each area.

Student’s Full Name:

Please print clearly.

Name of Community Agency Name of Field Supervisor

Name of Faculty Advisor

Date

1. Understanding of Placement Setting: / 4 / 3 / 2 / 1 / N/O / N/A
Recognizes & understands placement setting mandate, values, goals, services
Knowledgeable of placement setting structure, organizational chart & decision-making process
Understands and adheres to setting policies and procedures
Identifies the presenting needs of populations served
Identifies key community partnerships and community resources
Knowledge of ethical guidelines applicable to setting and populations served

Comments:

2. Effective Work Related Interpersonal Skills: / 4 / 3 / 2 / 1 / N/O /

N/A

Arrives on time consistently & maintains attendance
Plans ahead, sets priorities and organizes workload effectively
Demonstrates initiative and reliably completes assigned tasks
Is responsive to placement setting norms about clothing, appearance, language etc.
Develops effective working relationships with staff
Actively seeks feedback on performance and is receptive to feedback from supervisor and/or staff
Demonstrates ability to collaborate, consult and problem-solve as an effective member of a team

Comments:

3. Ability to develop helping relationship with service users: / 4 / 3 / 2 / 1 / N/O / N/A
Establishes working relationships that reflect professional code of ethics, standards of practice and setting guidelines
Maintains clear and appropriate boundaries between professional and personal relationships
Able to develop rapport with service users
Demonstrates ability to be respectful, non-judgmental and empathetic
Use of active and reflective listening skills
4 / 3 / 2 / 1 / N/O / N/A
Use of clarifying, paraphrasing and summarizing skills
Appears comfortable interacting with service users
Initiates interactions with service users
Displays sensitivity and responsiveness to issues of diversity
Respects service user right to self-determination

Comments:

4. Knowledge and application of effective assessment approach and skills: / 4 / 3 / 2 / 1 / N/O / N/A
Identifies and understands presenting concerns of service users
Able to collect and summarize best practice knowledge about service users (reviews videos, articles, books to enhance understanding)
Able to assess needs and strengths of service user or situation utilizing the placement setting guidelines and/or social service approach
Identifies and assesses the available placement setting & community resources
Demonstrates ability to apply a person-centred or strengths-based assessment approach
Effectively sets up a mutual, working agreement with service user or persons served
Able to set mutually agreed upon goals with service user
Understands and applies eligibility and intake criteria
In collaboration with service user advocates, links and refers appropriately

Comments:

5. Knowledge and application of effective intervention model(s) and skills: / 4 / 3 / 2 / 1 / N/O / N/A
Understands the concepts, theories, and information about intervention models/methods pertinent to the placement setting
Creates and applies helpful intervention strategies
4 / 3 / 2 / 1 / N/O / N/A
Prepares, plans and implements effective plans of action to address service user need within the guidelines of the placement setting
Actively seeks consultation, supervision and debriefing regarding work with service users
Demonstrates ability to intervene in a manner that promotes service user dignity, right to self-determination, empowerment and capacity building
Adheres to the SSW scope of practice
Effectively utilizes various informal and formal supports in intervention plans

Comments:

6. Able to identify across difference using an anti oppressive/ anti racist approach to practice with diverse groups: / 4 / 3 / 2 / 1 / N/O / N/A
Demonstrates acceptance and respect of diversity and differences
Identifies personal, interpersonal and societal barriers that “oppress” or “discriminate” against diverse groups and actively engages in integrating this awareness into practice
Demonstrates working knowledge of own social location; the social location of others; the privilege and power that exists as a result of differing social locations and the impact on working relationships with service users; colleagues and community
Respects and adheres to Human Rights Legislation and the relevant policies and procedures
Demonstrates self awareness of values and/or biases that may impact anti oppressive/anti-racist practices and works to address these
Able to implement assessment and intervention plans that respect diversity and incorporate relevant anti oppressive/ anti-racist competent practice
Develops effective helping and collegial relationships regardless of ethnicity, race, gender, social & economic level, age, or sexual orientation etc.

Comments:

7. Ability to Identify and understand the social
policies, laws, and legislations relevant to the setting/placement: / 4 / 3 / 2 / 1 / N/O / N/A
Identifies and describes the relevant legislation, mandated policies and regulations which may affect service and service users
Identifies and describes the presenting problems of individuals, families and communities in the context of the larger structural issues (structural analysis)
Describes relevant social problems with a micro, mezzo and macro level of understanding
Appropriately contributes to and/or advocates for social change and/or service user rights in collaboration with the service user with a focus on capacity building

Comments:

8. Conveys professional values, ethics and attitudes: / 4 / 3 / 2 / 1 / N/O / N/A
Personal and professional behaviour is consistent with SSW ethical guidelines & expectations
Demonstrates self awareness & commitment to professional development
Consistently applies and respects the SSW Code of Ethics & Standards of Practice
Regards the welfare of the “service user” as a primary obligation
Respects and maintains the confidentiality of service user

Comments:

9. Ability to communicate clearly, concisely and professionally using a variety of methods: / 4 / 3 / 2 / 1 / N/O / N/A
Written reports are accurate and presented in a professional manner
Keeps written work/documentation up to date or completes work to meet timelines
4 / 3 / 2 / 1 / N/O / N/A
Clearly writes and logically organizes records, reports and correspondence as required
Verbal communication skills are clear, respectful and accurate
Able to communicate effectively for various audiences and purposes

Comments:

10. Identify any specialized Knowledge, Skills, Attitudes, and Values relevant to this placement setting not mentioned above: (OPTIONAL) / 4 / 3 / 2 / 1 / N/O / N/A

Comments:

Field Supervisor’s Comments:

1.  The students strengths are:

2.  Areas needing further work are:

3.  Additional Comments:

Student Comments:

1.  Progress During this field placement (semester):

2.  My Strengths:

Please provide specific behavioural examples

3.  The areas I need to work on and how I plan to integrate this into my practice:

Please provide specific behavioural examples

4.  Other Comments:

Faculty Comments:

Student’s Signature Field Supervisor Signature

Faculty Advisor Signature

Date

Student’s Full Name:

Please print clearly.