@ The American AOT DOcevpational Therapy MD EAN ioscciton. ne Fieldwork Performance Evaluation For The Occupational Therapy ‘Student q SAR, AG SIGNATURES: Nawe (ST) ASN (HODLEY | WAVE READ THIS REPORT. Touro ¢)nivecsit COLLEGE OR UNWERSTY ‘SIGNATURE OF STUDENT FIELDWORK SETTING: est _O-T ele TAME OF ORGANIZATIONFACIITY ‘NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT } lina st lo ‘ADDRESS (STREET OF PO BOK) < CAA 2- Lhesdheerge 5 oa # Gr anteR IN EDS Digg Bc deer CIC Ouro” EOF FRLONORR PRINT NaN REDENTALSROSTION OROEROF PLACEMENT: 2.3.4 OUTOF 1@3 4 ox _4)24)1Y —_» \afoa)iy DATES OF PLACEMENT 424.S [NOMBER OF HOURS COMPLETED PRINT NANEIGREDENTIALSPOSITION a FINAL SCORE mse VO NO PASS: ‘SUMMARY COMMENTS: (ADDRESSES STUDENTS CLINICAL COMPETENCE) ‘SIGNATURE OF RATER 82 (F APPLICABLE) page oro iy einRATING SCALE FOR STUDENT PERFORMANCE ‘4— Exceeds standards: Perlrmanceis highly sled and set nitated. “Tis rating is rarely given and would represent the top 5% of al the students you have supervised. '3—Meets standards: Performance ls consistent wth entry evel practice. ans iemenysven at item a song rang at inal ‘2 ~ Needs improvement: Perormance is progressing but sil neds improvement for entry eel pace. This is a realise rating ot performance at midterm, and some ratings of 2 may be reasonable at the fina 1 —Unsatistactory: Performance is below standards and requires development or entry ve prac. This rating is qven when there is ‘8 concer about performance. | FUNDAMENTALS OF PRACTICE: Allitems inthis area must be scored ata #3 or above onthe fina evaluation in order to pass fieldwork. 1, Adheres to ethics: Adheres consistently tothe American ‘Occupational Therapy Association's Code of Ethics (4) and site's policies and provedures including when relevant, those related to ‘human subject research vim 1 @ a 4 fil? iy S88 Ca) 2. Adheres to safety regulations: Acheres consistently to safety regulations. Anticipates potently hazardous situations and takes ‘steps to prevent accidents. 4 4 Midterm 12 Final tee te: 3. Uses judgment in safety: Uses sound judgment in regard to safe- ty of self and others during all eldworktelated activites. was. 1 G)o a= 4 Final 1 2 @ @® Comments on strengths and areas fr improvement: + Midterm Elise demapsrares en Leth Sater win Cherkd &@ Ohes Wm cimic. oF Elise Shows tad Chine @ cuir Fenw Cnum. Heo Gnarn for $ fare har Aen oo Re iP erdny wl « prema ener ay a, in re hn oa U, BASIC TENETS: 4. Clearly and confdertly articulates the values and beliefs of the ‘cocupational theragy profession fo clients, famies, significant ot- es, colleagues, service providers, andthe pubic. ham Ge a rm 1 2 @ 4 5. Clearly, confidently, and accurately articulates the value of occu- pation as @ method and desired outcome of occupational therapy to cients, families, significant others, coleagues, service providers, andthe publ wien 1 @ 38 4 Final 1 2 © 4 6, Clearly, confidently, and accurately communicates the roles of the occupational therapist and occupational therapy assistant to clients, families, significant others, coleagues, service providers, andthe publ Midem 1 (@ 3 4 ae ay Se Qs 7. Collaborates wih cient, fai, and significant others throughout the occupational therapy process. Migem 1 @ 3 4 Fal fe Gye ‘Comments on strengths and areas for improvement: + Midterm: Elise works elk Wan a\ ONES ptreemsy E pelwant OCCOPaNEANS 40 exer CAenr . Ses developing, Wer cnn A Se 4 hes begun Communications f pacts of Ginyy . reed UP Cortng @ weeks Git haveTrA OE 4D prefergicnadl Sree REA PY gree ‘S, “Final AN Bad chorale eee ners. Elsa immcnars prefessicnalt ity paresis ¢ ONL membud of Tk team, PI Ee A a aRATING SCALE FOR STUDENT PERFORMANCE 4— Excoeds standards: Pertxmanceis highly sled and stated. This ratings rarely given and would represent the top 5% of al the ‘students you have superise. Meets standards: Peformance is content wth entry 4velractoe. tn requ ge tara en rag t 2 —Needs improvement: Performance is progressing but stil needs Improvement for entytevel practice This is realistic rating of Performance at midterm, and some ratings of2 may be reasonable at the final, ‘Unsatistactory: Peroxmance is blow standards and requires {evelopment fr entry-velpractie. This ratings given when there is ‘@ concem about performance. I EVALUATION AND SCREENING: 8. Articulate a clear and logical rationale forthe evaluation process. Midterm 1 a4 Final 1 @ @ + 9. Selects relevant screening and assessment methods while ‘considering such factors as clint’ pots, context), theories, ‘and evidence-based practice. Midem 1 @) 3 4 Final 1 a 4 Determines client's occupational profile and performance through appropriate assessment methods. feast ei aes ways fae 1g to, Ge Assesses client factors and context(s) that support or hinder occupational performance. wm 1 @ 3 4 Final 1 2 4 12. Obtains sufficient and necessary Tnformation from relevant resources such as clent, families, signifcant others, service ‘providers, and records prior to and during the evaluation process. Midterm 1 3 4 a pias ® + ‘Administers assessments in a uniform manner to ensure findings, are valid and reliable, Midterm 1 3a 4 Final tr (a= @ a 14, Adjuste/modifies the assessment procedures based on client's needs, behaviors, and culture. Midterm = 1 a8 Ces amigos. i gt Ty can eo na ace no i wih andi 10, 11 13, 15, Interprets evaluation results to determine cents occupational pertormance strengths and challenges. itor (heeitar 64 fr 1 2 @ 4 Establishes an accurate and appropriate plan based on the evaluation results, through integrating mutiple factors such a client's prorties, contexts), theories, and evidence-based practice. mtem 1 @) 3 4 wm 1 2 G4 Documents the results of the evaluation process that demon- strates objective measurement of clent’s occupational perform ee fon} OE 4 mom Final 1 Comments on strengths and areas for improvement: sMidtem Qysc Was begur tO Adm | Scere , durto? WF 16. 17. Pras gq goats 1 BY EIS Wawarien will be Lyrecrvince mere Po cancers © erenecrcc level. Find Elisa OSA a venehy of arsessterts ( Sensory. brandwerh Gress Nowe deme rluer) - SVR Badr arsdered, Scored & wvore— Boats hat usmaa veltvart « IMLINTERVENTION: 18, Articulate a clear and logleal rational othe intention proces. Maem 1 @ 3 4 fm 1 2G) 4 19, Use evidence from published research and relevant resources to ‘make informed intervention decisions, Midte 1 2 3 4 ere @ +Midterm 4 3 4 Final 1 Zz os, *CAy 21. Selects relevant occupations to facitate clients meeting estab- 20. Chooses occupations | or ‘and challenge cients. a 2 lished goals. Midterm 4 © 3 4 Final 1 ire 4 22. Implements intervention plans Tat are client centered. Widen 1 2 (G) 4 Fal 1 2 38 23, implements intervention pias that are oSGupation based. Mem 1 2 G@) 4 Final 1 2 3 Q@ 24. Modifies task approach, occupations, and the environment to ‘maximize cient performance. ween t (@) «a Final 1 2 3 Q 25. Updates, modifies, or terminates the intervention plan based ‘upon careful monitoring ofthe clients status. widem 1 @Y 3 4 Final 1 2 & 4 28. Documents client's response to services in a manner that demonstrates the efficacy of interventions. Witem 1 (2) 9 4 Fal 1 2 @ 4 ‘Comments on strengths and areas for improvement: smite Etisa as a wide Veni of cies Ger dc - NyJo & has made Ogre RAGES THAIN ACRES B wmreactiey T A wike range Of QS Bde'S, BS Aiscossed, Se wt Sac IF Ara rce er , AL oe Birmetrente EZ sueenasien only fren Sve additleraltey Gs Smereutrny sFinal (Memes, IQ iuiry Wo TO. Ae Imeurert HEP. Elisa (S Competed im choaring gel © rere tasks for meant Aue fo ner goats, She arated Grabow ha ess She hee os \. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: 27. Demonstrates through practice or discussion the ability 10 ‘assign appropiate responsiblies tothe occupational therapy assistant and occupational therapy aide. Moen 1 OY 3 4 Fal 1 2 3 @ 28. Demonstrates through practice or discussion the ability to actively collaborate with the occupational therapy assistant. Midterm = 1 g 3 4 Final 1 2 @) 4 29, Demonstrates understanding ofthe costs and funding related to occupational therapy services at this site. Mim 1 2 @ 4 rm 1 2 8 © 30, Accomplishes organizational goals by establishing priories, veloping strategies, and meeting deadines. Mien 1 @ 3 4 Fatt ae fat. 31. Produces the volume of work required within the expected time frame. tom 1 2 @ 4 Final 4, “Er 8. Comments on strengths and areas for improvement: Midterm Cisne GemerS~raeS Creolreay- OABmVarNerat Sells enme Manages: She ig KG « ind FON oe Me cos to prarvu, Pres We Clinic is ReaD SPM Coca her anistem Wn ig, sFinal Love (> Orgereac) rwgue) 4d tates ro Accor ttt Cosy associated GB tc'tea a la. castload. She Contivew denaswaieel @ Good Work “ere « Corer all dotwurertehod tests (reves | A Ary eases Aprror- aS needed by Ceart Warne Lacars - Re ee in ptmenmdpmaana ae RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds standards: Perfrmance is highly sided and set.ntated ‘This ratings rarely given and would represent the top 5% of all the students you have supervised, 3 — Meets standards: Perormance is consent with entr-4evel practice. TR arg Ireuanty gen at mtr ad song rating at 2— Needs improvement: Penance is progressing buts needs improvement for ent vel pracie. Tis i realistic rating of performance at miderm, and some ratings of 2 ay be reasonable at then 1 Unsatisfactory: Peformance is below standards and requires ‘evelopment fr eine practice. This rangi ven when ther is «concer about performance. VL COMMUNICATION: 32, Clearly and effectively communicates verbally and nonverbal ly wih cients, families, significant others, colleagues, service providers, and the publi Miter 1@®a ‘4 Final POE Ge 4 3, Produces clear and accurate documentation aocarding to ste Perot vem 1 Goa 4 me i? 34, All written communication is legible and uses proper sping, punctuation, and grammar. wn 1 @ a 4 wa A Gc ‘35. Uses language appropriate to the recipient ofthe information, including but not limited to funding agencies and regulatory agen- so wins 4 Oe he 4 fae ch a GY Comments on strengths and areas for improvement: sMidtem FEeSinacke Crem Prusiad Nemeisr, Educamona\ erator FESS in Fate 5 thar Kae “s. Merapome , Praferioa\ Pusant Alera" Siga_ wil har Td DOCrmmVN~a LA next 6 wei TO CA loose TF Otur Prefers~ralS sFinal OT erg, TON Shared chants,” Vil. PROFESSIONAL BEHAVIORS: 36. Collaborates with supervisor(s) to maximize the learning exetnce Mitem 102 G4 fa eae eh 57. Take responsibility for attaining professional competence by seeking out ering opportunities ana interactions wih supe sors) ard obers. Maem 1 2 @ 4 Fra! 1 22, 84.6) 38, Responds constructively to feedback. witom 1 2 @) 4 Fal 1 2 8 © 39, Demonstrates consistent work behaviors including intiatve, preparedness, dependability, and worksite maintenance. Micterm 1 2 @® 4 m1 2 8 @ 40, Demonstrates effective time management. Maem 12 @ 4 2 © 41, Demonstrates positive interpersonal skills including but not im- ited to cooperation, ext, tact, and empathy. wom 1 (@) 3 4 dt ajl seoe at OG) 42. Demonstrates respect for diversity factors of others including but not limited to socio cultural, socioeconomic, spiral, and lifesty'e choices. >. a Maem @ Final i Final ji eee 8 Comments on strengths and areas for improvement: sMidtem ELisa aes Pakerss Comferta tne by ad L\osrrsy wee awopreacn Ae Fo #any Child -She is proper, © astine fer . Gees Oy ome & Ass. Genc Find Lis Asad qersnons yestarched & Alwaus wart EUSR ComMuniGles erofesioraily 40 Leary more. HEC prafesrrral EZ ofes on te tear. ther docereeene> 'S Clear & Vanenal, (Steet sana ne ana sion oh ted pr (nivnch eas & PeSeect for a, (nddndeats is excebtends-PERFORMANCE RATING SUMMARY SHEET Performance items a | FUNDAMENTALS OF PRACTICE 1. Adheres to ethics 2, Adheres to safely regulations '3. Uses judgment in safety I BASIC TENETS OF OCCUPATIONAL THERAPY 4. Ariculates values and betes 5. Artioulates value of occupation Midterm Ratings Final Ratings 6. Communicates role of occupational therapist 7. Collaborates with cents Il EVALUATION AND SCREENING 8. Amticulates clear rationale for evaluation 9. Selects relevant methods 10. Determines occupational profile 111. Assesses clent and contextual faciors| 42. Obtains sufficient and necessary information 1, Administers assessments 15. Interprets evaluation resus 16. Establishes acourate plan 17. Documents results of evaluation IV. INTERVENTION iculates clear rationale for intervention 419. Uses evdence to rake informed decisions 20. Chooses occupations that motivate and challenge 22. Selects relevant occupations 22. implements clent-centered interventions 23. Implements occupation based interventions 224, Modiies approach, occupation, and environment 25. Updates, moses, of terminates iterventon plan 26. Documents cen’ response \V. MANAGEMENT OF OT SERVICES 27. Demonstrates ability to assign through pratie or discussion £28, Demonstrates abit to oolaborate through practice or discussion 29, Understands costs and funding 30. Aocomplishes organizational goals 31. Produces work in expected te frame ‘VLCOMMUNICATION 32. Communicates verbally and nonverbally rrpenppis SSITP RNS ap ebb qth £33, Produces clear documentation ‘34, Written communication is legible 36. Uses language appropriate to recipient Vil, PROFESSIONAL BEHAVIORS 36. Collaborates with supervisor 37. Takes responsibilty for professional competence 38, Responds constructively to feedback 39, Demonstrates consistent work behaviors +40. Demonstrates time management “41, Demonstrates positive interpersonal skils “22. Demonstrates respect for diversity Rielle plese & femal p TOTAL SCORE = ES oe elf lw Seo wile Colle Gd in Lt] o Lh Le ol bw gay lo thes MIDTERM: Satisfactory Performance css 90nd above Unsatisfactory Performance .........-.-89 and below Trtecea ane tts bon bn aio aided ria «122 points and above 121 points and below