University at Albany, State University of New York s2

School of Social Welfare

University at Albany, State University of New York

INSTRUCTIONS

Second-Year Clinical Practice Evaluation Instrument – Summer/Fall Modified

The second-year clinical practice field evaluation instrument is comprised of nine sections: Demonstrate Ethical and Professional Behavior; Engage Diversity and Difference in Practice; Advance Human Rights and Social, Economic and Environmental Justice; Engage In Practice-informed Research and Research-informed Practice; Engage in Policy Practice; Engage with Individuals, Families and/or Groups; Assess Individuals, Families and/or Groups; Intervene with Individuals, Families and/or Groups; and Evaluate Practice with Individuals, Families and/or Groups. Students are evaluated on a continuum of skills at three intervals throughout the two-semester placement. The skills are applicable to individuals, families, groups, and community assignments.

For each evaluation period, please rate a student on every item by entering the number that corresponds to your assessment of the student’s demonstrated performance in the box or boxes to the right of each item. Reevaluate a student’s performance from a previous evaluation when the student’s performance has changed.

Ratings

1 Unacceptable (never or rarely meets criteria)

2 Needs improvement (meets criteria inconsistently)

3 Satisfactory (meets criteria most of the time)

4 Very good (consistently meets criteria)

5 Outstanding (consistently exceeds criteria)

9 Not applicable in practice setting

Summarize the student’s overall performance for each section by placing an X at the point on the bar graph that represents his or her overall performance for that section. Space for comments is included after each section.

The last page includes an overall student rating, space for comments, goals for the next evaluation period, and the signature page. The student and field instructor are required to sign each evaluation. When a student disagrees with the contents of the evaluation, he or she can submit an addendum stating the reasons for disagreement which is attached to the evaluation in the student’s file. Each faculty field liaison reads all evaluations for assigned agencies and will be available for discussion at the student’s or field instructor’s request.

Any time a student receives a summary rating, in any section, of “needs improvement” or “unacceptable,” please provide supporting documentation

in the comments section.

Your careful attention to completing the evaluation form is greatly appreciated. Evaluation is a crucial part of a student’s professional training and provides an opportunity for feedback and educational planning.

School of Social Welfare, University at Albany, State University of New York

School of Social Welfare

University at Albany, State University of New York

______

Field Education

Second-Year Clinical Practice Evaluation Instrument – Summer/Fall Modified

Student’s Name:

Agency Name:

Field Instructor’s Name:

Field Liaison’s Name:

Evaluation: 1st ☐ 2nd ☐ Final ☐

Evaluation Period (Month)

Program Year

clinical CONCENTRATION – summer/fall modified / 2

Describe the student’s assignment for this evaluation period:

Describe the student’s caseload:

How many individual clients assigned?
How many families or groups assigned?
How often do you meet for supervision? / Weekly / In group / In staff meeting

Demonstrates Ethical and Professional Behavior – Evaluates the student’s ability to demonstrate ethical and professional behavior.

The student is able to / Aug / Oct / Dec
utilize the field instructor as an educator of social work values, attitudes, knowledge and skills.
participate in developing/updating learning agreement.
prepare for supervision, including development of an agenda.
analyze and verbally articulate one’s own knowledge, skills, accomplishments and learning needs.
seek and respond nondefensively to feedback about professional performance.
use constructive criticism to try new skills to improve practice.
seek direction for an assignment, as needed.
complete process recordings in a timely manner.
use process recording or other learning tools to critique practice.
communicate clearly and purposefully.
identify social work values and ethics in work with colleagues and clients and in other professional relations.
respect the rights of others to maintain perspectives and positions different from one’s own.
struggle with value dilemmas.
differentiate between presenting a personal, professional or organizational position.
protect client’s right to confidentiality.
protect client’s right to self-determination.
preserve human dignity and client individuality.
elicit and demonstrate commitment to client’s participation in decision making.
Aug / Oct / Dec
recognize the impact that the student’s personality has on professional relationships.
prevent personal values and biases from interfering with practice decisions in the best interest of the client.
recognize one’s own verbal and nonverbal communication biases and feelings in an interview, group or meeting.
avoid tendencies toward moralizing, persuading, prematurely reassuring, threatening, judging and/or criticizing during a social work interview or meeting.
act professionally and responsibly in matters of punctuality, appearance and presentation of self.
engage in collegial work responsibilities, including meetings, staff meetings and committees.
form and sustain professional relationships.
complete agency records and forms in a timely manner.
identify the primary duties and responsibilities of various staff positions with whom the student has contact with.
integrate the elements of the therapeutic relationship as demonstrated by consistent use of genuineness.
selectively use the instructor and other agency resources in supervision.
integrate the elements of the therapeutic relationship as demonstrated by consistent use of concern for others, empathy and purposeful communication.
accept assignments.
respond to crisis situations.
make appropriate use of other available learning opportunities.
actively participate in case conferences.
demonstrate skills in case management.
demonstrate skills in interdisciplinary teamwork.
The student is able to / Oct / Dec
recognize during supervision personal obstacles to working with a client.
identify the formal and informal channels of communication in the field agency.
explore emotionally charged issues.
deal with anger and conflict with client/group in the therapeutic relationship.
deal with client/group resistance about seeking help.
be innovative and imaginative in applying knowledge and skill in practice.
Dec
identify areas of learning for continuing education and supervision.

Summary for Demonstrates Ethical and Professional Behavior (See Instructions)

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