learning agreement instructions: the shaded area under...

California State University, Long BeachSchool of Social Work

SW 495 A/BUNDERGRADUATE LEARNING AGREEMENT

ANDSENIOR

COMPREHENSIVE SKILLS EVALUATION

Academic Year 2019-2020

Student Name (print): ____________________________________________

Seminar Instructor/Liaison Name (print):_______________________________

http://www.csulb.edu/colleges/chhs/departments/social-work/continuing-education/


Field Education

Undergraduate Learning Agreement & Mid-Year Evaluation

Student Identification Information

Student First Name

Student Middle Name

Student Last Name

Student ID

Student Field Liaison/Professor Information

Liaison Name

Agency Identification InformationAgency and Program NameAgency Address

Agency Contact Person

Agency Phone Number

Field Instructor Identification Information

Field Instructor Name

Field Instructor Phone

Field Instructor Email

Preceptor Identification Information

Preceptor Name

Preceptor Phone

Preceptor Email

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The Agency and the Community

A. Agency Mission

B. Briefly describe your agency’s organizational structures:

C. Describe the agency services available to the community:

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The Agency and the Community - Continued

D. Briefly describe the community served by your agency and include:1. Geographic location and location of the agency within the

community:

2. Ethnicity of the population served:

3. Socio-economic status of population:

4. Community’s need for resources:

5. Community’s perception of the agency:

6. Agencies to whom referrals are made:

7. What were the sources of your information in answering the above?

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General Time Management

1. Days and hours in field placement:

2. Day, time, and length of individual field instruction:

3. Names(s) of preceptor(s) and/or contact person in field instructor’s absence:

4. Day and time of field seminar:

5. If the plan is for you to rotate or change programs in the agency, specify the time frame for the rotation:

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Student Expectations for Supervision in the Field/Instruction

1. Describe your expectations of the supervision process.

2. Describe your expectations of yourself in supervision.

3. Describe your expectations of your Field Instructor.

4. Describe your expectations of your Preceptor (if applicable).

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Field Instructor Teaching Plan

1. Detail your expectations of your student in supervision.

2. How do you structure your weekly field instruction? Briefly describe your teaching plan. Please include how you plan to maximize diversity in your case assignments for each student.

3. Describe your plan for use of a preceptor with your student (If applicable).

a. Role of Preceptor

b. Detail your plan for monitoring and evaluating this experience:

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Orientation ChecklistAgency Overview

Review agency vision and mission/purpose statementTour of agencyIntroductions to colleagues, support staff, and administrationReview organizational structureReview the role of the agency in relation to the community and its resourcesReview security and/or safety procedures and protocol

Agency Policies and ProtocolsReview office procedures, supplies, and provisionsReview telephone and communication/computer utilizationReview intake/admissions/eligibility policy and proceduresReview internal communicationReview parking detailsReview mileage policyReview agency, department, and/or unit meeting scheduleReview client record/charting, policies and proceduresReview forms for documentation/accountabilityReview regulations regarding confidentiality, release of information, etc.Review client fees/payment scheduleReview client emergency protocolReview child or elder abuse reporting protocolReview work schedule, including lunch and breaksReview information/referral policyReview agency policy regarding harassmentReview agency policy regarding discriminationReview agency policy regarding the Americans with Disabilities ActReview agency policy regarding OSHAReview agency policy regarding HIPAA

Field Instructor and Student ResponsibilitiesReview expectations for supervision and scheduleReview educationally based recording scheduleReview use of preceptor (if applicable)Review plan for diversity/multi-cultural experiencesReview plan for monitoring of student hours (by both field instructor and student)Review agency training or staff development opportunitiesReview student’s personal safety issues and concerns and strategies to deal with them

Signature DateField Instructor

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Student

Senior Field Evaluation – To Be Completed At the End of Fall Semester

INSTRUCTIONS FOR RATING INTERNS:Comments required at the end of each semester, the student’s level of skill development should be a minimum of 2-3 for all practice behaviors at the end of the Fall semester. Please contact the Field Liaison with any 1 rating.

Number of hours completed:

If the student has not completed the required number of hours, please describe in detail the plan for these hours to be completed:___________________________________________________________________________________ ___________________________________________________________________________________ Student Strengths: Areas Needing Improvement:

Field Instructor Signature Date

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Student Signature Date

Student’s signature acknowledges that the student has participated in and has reviewed the evaluation.

Senior Field Evaluation – To Be Completed At the End of Spring Semester

INSTRUCTIONS FOR RATING INTERNS:Comments required at the end of each semester, the student’s level of skill development should be a minimum of 3-4 for all practice behaviors at the end of the Spring semester. Please contact the Field Liaison with any ratings below 3.

Number of hours completed:

If the student has not completed the required number of hours, please describe in detail the plan for these hours to be completed:___________________________________________________________________________________ ___________________________________________________________________________________

Areas of strength and suggestions for further development:

Field Instructor Signature Date

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Student Signature Date

Student’s signature acknowledges that the student has participated in and has reviewed the evaluation.

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INSTRUCTIONS FOR RATING INTERNS

Level 1 = does not meet expectation Level 2 = beginning level of skill Level 3 = competentLevel 4 = advancedLevel 5 = mastered

Comments required at the end of each semester, the student’s level of skill development should be a minimum of 2-3 for all practice behaviors at the end of the Fall semester. Please contact the Field Liaison with any ratings of 1.Comments required at the end of each semester, the student’s level of skill development should be a minimum of 3-4 for all practice behaviors at the end of the Spring semester. Please contact the Field Liaison with any ratings below 3.

LEARNING AGREEMENT INSTRUCTIONS

The shaded area under each competency is the Learning Agreement Plan. The Student and Field Instructor will identify planned learning activities specific to the agency. The activities will provide opportunities to achieve each competency. A minimum of three activities must be listed for each competency. You may add more rows if needed.

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Competency #1: Ethical and Professional Behavior - Intern identifies as a professional social worker and conduct oneself accordingly. Apply social work ethical principles to guide professional practice.

LEARNING OPPORTUNITIES AND STUDENT ACTIVITIES TO ACHIEVE COMPETENCY #11.

2.

3.

Evaluation of Practice BehaviorsDoes Not Meet

ExpectationBeginning Level

of Skill Competent Advanced Mastered

1 2 3 4 5

Fall Spring

a. Articulates the various roles, functions, and purposes of social workers b. Demonstrates professional behavior in (demeanor, appearance and

communication)c. Establishes and maintains professional boundaries (with clients, staff, field

instructor & other professionals)d. Engages in appropriate use of supervision and consultatione. Demonstrates ability to be self-evaluative and accountable for his/her own

learning and professional development.f. Makes ethical decisions by applying ethical standards of the NASW Code of

Ethics.g. Recognizes and understands how professional values can guide social work

practice.h. Applies ethical problem solving strategies in situations of uncertainty. i. Applies relevant legal standards to practice (such as mandated reporting,

parental consent, legal consent, etc.).j. Demonstrates insight into personal dynamics, feelings, and values.k. Writes professionally with clarity, organization, and conciseness.l. Articulates orally with clarity, organization, and conciseness.m. Uses technology to enhance the communication of ideas.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: ____

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_________________________

______

Competency #2 Diversity and Difference - Intern engages diversity and difference in practice.


2.

3.


ExpectationBeginning Level of

SkillCompete

nt Advanced Mastered

1 2 3 4 5

Fall Spring

a. Recognizes how a culture’s structures and values may oppress, discriminate, and marginalize, as well as enhance privilege or power. b. Recognizes own biases and values, recognizing one’s role as a learner, in work with diverse and different groups.c. Views oneself as a learner and seeks guidance from experienced professionals and others.d. Understands and applies the multiple aspects of diversity including but not limited to age, class, color, disability, ethnicity, gender, gender identity and expression, immigration status, race religion, political ideology, and sexual orientation in shaping life experiences.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: ___________________________________________________________________________________________

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____________________________________________________________________________________________ ___________________________________________________________________________________________

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Competency #3: Social Justice and Human Rights - Intern advances human rights, social, economic, and environmental justice.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Understands theories, forms and mechanisms of oppression and discrimination to promote human and civil rights. b. Is knowledgeable of local, regional and global programs and services available for advocacy of human rights.c. Engages in practices that advance human rights and social and economic justice.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: ______________________________________________________________________________ ___________________________________________________________________________________________

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Competency #4: Research and Practice – Intern engages in research-informed practice and practice informed research.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Is familiar with a variety of research methods.

b. Critically evaluates and applies research evidence to inform practice.

c. Uses practice experience to inform scientific inquiry

d. Understands and responds to ongoing emerging societal trends, and scientific and technological developments.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: ______________________________________________________________________________ ___________________________________________________________________________________________

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Competency #5: Policy Practice - Intern engages in policy informed practice to advance social and economic well-being and to deliver effective social work services.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Identifies the role of policy in service delivery and its impact on social welfare delivery system.

b. Identifies the role of practice in policy development.

c. Engages and advocates in policy practice for effective policy actions that advances social well-being.d. Recognizes the importance of collaboration with colleagues and clients for effective policy action.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: _____________________________________________________________________________________ ___________________________________________________________________________________________

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Competency #6: Engagement – Intern engages with individuals, families, groups, organizations, and communities.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Develops a collaborative working relationship with client systems of all sizes.

b. Demonstrates use of empathy and active listening skills

c. Is aware of how they are perceived by clients, and able to modify behavior as indicated by client responsed. Demonstrates ability to develop trusting working relationships with clients.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: ____________________________________________________________________________________ ___________________________________________________________________________________________

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Competency #7: Assessment - Intern assesses individuals, families, groups, organizations, and communities.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Assesses client’s systems, conducts assessment, including strengths, risk factors, and cultural considerationsb. Able to organize key content areas including basic summary and interpretation of client data.

c. Develops mutually agreed upon goals/outcomes

d. Selects appropriate intervention strategies based on assessment.e. Integrates, analyzes, and synthesizes information from a variety of perspectives and multiple sources of knowledge in the development of professional judgment and assessment. f. Utilizes conceptual frameworks to guide process of assessment.g. Critiques and applies knowledge of theoretical frameworks to understand person and environment, and their reciprocal interactions (which is how they impact each other).


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Competency #8: Intervention - Intern intervenes with individuals, families, groups, organizations, and communities.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Demonstrates ability to define client needs in behavioral and measurable terms that are realistic and attainable.b. Selects intervention strategy appropriate to client goals, including prevention as indicated

c. Implements intervention strategy to attain client goals and initiatives

d. Advocates for clients and works collaboratively with available resources

e. Facilitates transitions and endings

f. Utilizes conceptual frameworks to guide process of intervention.


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Competency #9: Evaluation – Intern evaluates practice with individuals, families, groups, organizations, and communities.


2.

3.



SkillCompete


1 2 3 4 5

Fall Spring

a. Critically analyzes monitors and evaluates interventions.

b. Utilizes evaluation data to revise interventions.

c. Able to appropriately end client relationship, evaluate need for further resources when needed.

d. Utilizes conceptual frameworks to guide process of evaluation.

e. Analyzes and evaluates agency’s response to changes and needs of the community.f. Demonstrates an ability to identify and appraise existing services and resources.g. Provides suggestions for change in service delivery and practice, based on contextual analysis.

Comments required for all ratings at the end of each semester. Please contact the Liaison about any ratings of 1 in fall semester and any ratings below 3 in spring semester: _____________________________________________________________________________________ __________________________________________________________________________________________________

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_____________________________________________________________________________________________________________________________________________________________________________________________

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