AOTA B88" FZ Association, inc Fieldwork Performance Evaluation For The Occupational Therapy Student ven olin \ein Palecco, _____ SIGNATURES: nA (LAST) . (FIRST) (MIDDLE) | HAVE READ THIS REPORT. LEGE OA UNVERST TURE OF STUOENT FIELDWORK SETTING: NAME OF ORGANIZATIONFAGILTY ‘NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT Se S. Book FaDRESS. (STREETORPOSDD “Sony UAH Ay ‘TYPE OF FIELDWORK PRINT NAME/CREDENTIALSIPOSITION ORDEROF PLACEMENT) 2 94 oUTOF 1Q 9-4 oo DST = S/ALI7 DATES OF PLACEMENT yo ‘OF RATER #2 (F APPLICABLE) ABO Wes (Rultione= wks NUMBER OF HOURS COMPLETED PRINT NAMEICREDENTIALSIPOSITION \ FINAL SCORE a SUMMARY COMMENTS: (ADDRESSES STUDENT'S CLINICAL COMPETENCE) You are well on your Wy to becoming, an entry- ke wi, You nave done wry wel with petiawks, and You are Nery personable - Nigu hawe Successfully demonstra d ate goisty A WA, padre Foc loreye> dgdls, and discha’ aes iy AW \ngotient Wel Sektiney. Yyy have done e ancedarr sso GF bed Chie -cevtered with +e al ce expreses OPS * OWTOMES loaSed ON FIM CrimOrec cyce lett Wark Sy‘This evaluation isa revision ofthe 1987 American Occupational Therapy ‘Association, Ine. Fieldwork Evaluation Form for the Occupational Therapist and was produced by a committee of the Commission on Education, PURPOSE ‘The primary purpose ofthe Fieldwork Performance Evaluation forthe Occupational Therapy Students to measure entry-level competence of ‘the occupational therapy student. The evaluation is designed to dferen- tite the competent student from the incompetent student and is not ‘designed to diferente levels above entry level competence. For futher Clacton on entry 4vel competency refer to he Standards of Practice {or Occupational Therapy (1). ‘The evaluation is designed to measure the performance ofthe occupa tional therapy process and was not designed to measure the specic ‘ccupational therapy tasks in isolation. This evaluation reflects the 1998 ‘Accreditation Council for Occupational Therapy Education Standards {2) andthe National Board for Certification in Occupational Therapy, Inc. Practice Analysis resus (3). In addition his evaluation allows students to evaluate their own strengths and challenges in relation to their per- formance as an occupational therapist USE OF THE FIELDWORK PERFORMANCE EVALUATION FOR THE OCCUPATIONAL THERAPY STUDENT ‘The Fieldwork Perrmance Evaluation isintendedto provide the student with an accurate assessment of hisher competence for ent lve prac- tie, Both the student and fieldwork educator should recognize that ‘growth occurs overtime. The midterm and final evaluation scores will reflect development of student competency and growth, In oder to cfecvely use this evaluation to assess student competence, ste specie objectives need to be developed. Usize this evaluation as a framework to assist in ensuring that all key perrmance areas are reflectod in the ste pectic objectives. Using this evaluation at midterm and fina, it is suggested that the stu- dent complete a sel evaluation o hither own performance. During the midterm review process, the student and fieldwork educator should col laboratively develop a plan, which would enable the student to achieve entry-level competence bythe end of the fleldwork experience. This plan should include specie objectives and enabing activites to be used by the student and fieldwork educator in order to achieve the desired ‘competence, Fieldwork Performance Evaluation For The Occupational Therapy Student The Fieldwork Educator must contact the Academic Fieldwork Coordinator when: 1) a student exhibits unsatisfactory behavior in a ‘substantial number of tasks or 2) a students potential for achieving ‘entry-level competence by the end of the affiliation isin question. DIRECTIONS FOR RATING STUDENT PERFORMANCE + There are 42 performance ites + Every item must be scored, using the one to four point rating soale (See below). ‘+The rating scales should be carefully studied prior to using this evaluation. Deftons of the scales are given atthe top of each page. ile the number that corresponds to the description that best cescrbes the students performance. * The ratings forthe Ethics and Safety items must be scored at 3 or ‘above on the final evaluation forthe student to pass the fieldwork experience, Ifthe ratings are below 3, confine to complete the Fieldwork Performance Evaluation to provide feedback to the student on herhis perormance. ‘+ Record micterm and fnal ratings onthe Performance Rating Summary Sheet + Compare overall midterm and final score to the scale below. OVERALL MIDTERM SCORE Satisfactory Performance. 90 and above Unsatistactory Performance. .... £89 and below OVERALL FINAL SCORE Pass eeeeeeee «122 points and above No Pass .. «121 points and below RATING SCALE FOR STUDENT PERFORMANCE. 4— Exceeds Standards: Performance i highly sled and colt-niated, ‘Tis rang s rarely glen and would represent the top 5% ofall the students you have supervised. 3 —Meots Standards: Periormanceis consistent wih entryfevel pac, “Tis ang is infrequently given at micterm andis.a strong rating at fina .2-— Needs improvement: Performance is progressing bu sill neds Improvement for enty4evelpacca, This is a realistic rating of performance at midterm, and some rings ot 2 may be reasonable at the final 11 —Unsatistactory: Perormance is below standards and requires development or enty4evel practice Ths angi given when there is ‘a concern about performance. en nnn nnn en SaaS USINEN SUSU ASPEN UDNNSUgLEDOSIUSIUEE ToeRATING SCALE FOR STUDENT PERFORMANCE 4—Exoeeds Standards: Pertrmance is highly séled and sotiniiated. “This rangi rarely given and woul represent the top 5% of al the students you have supervised ‘8— Meets Standards: Performance i consistent wih entry evel practice ‘Ths rating is infrequent given at midterm ards a strong rating at final. 2— Needs improvement: Peformance is progressing but il needs ‘improvement fren evel practice. This a realistic rating of perfomance at midterm, and some rings of 2 maybe reasonable at the fina ‘1— Unsatisfactory: Perormance is below standards and requires «evelopment for ei tve practi. This rating is given when there Is 2 concer about performance. | FUNDAMENTALS OF PRACTICE: All ters inthis area must be scored at a #3 or above onthe final evaluation in order to pass fieldwork. 1. Adheres to ethics: Adheres consistently tothe American ‘Occupational Therapy Assocation Code of Ethics (4) and site's policies and procedures including when relevant, those related to human subject research. Midterm 4 2 @ 4 Final 1 2 8 ® 2. Adheres to safety regulations: Acheres consistently to safety regulations. Anticipates potently hazerdous situations and takes stops to prevent accidents Mdem 1 2 @ 4 rm 1 2 3 Q 3. Uses judgment in safety: Uses sound judgment in regard to safe- ty of self and others during all fiekiworkrelated activites. Midterm 4 2 @ 4 Final 1 2 3 © Comments on strengths and areas for improvement: + Midterm . . = Yo are, doinoy reat in AMIS AFA. No sogehs \ Rync Wrens - ° Y fetneal + Final ~ Boing, Great! Y You Are Cautious /sate, priotto + during, ot care. I BASIC TENETS: 4. Clearly and confident articulates the values and beliefs ofthe ‘occupational therapy profession to cents, amis, significant oh 8, colleagues, service providers, and the pubic Midterm 4 2 ® 4 fa = 1 2 @ Clearly, confident, and accurately articulates the value of occu- pation as a method and desired outcome of occupational therapy to cients families, significant others, coleagues, service providers, and the pubic. a 4 Final 1 2 9 4 6. Clearly, confidently, and accurately communicates the roles of ‘the occupational therapist and occupational therapy assistant to clients, families, significant others, colleagues, service providers, ‘and the publ. Midterm 4 @ 3 4 Final 1 2 © 4 7. Collaborates with cient, family, and significant others throughout the occupational therapy process. Midterm 1 © 3 4 Final 1 2 3 Comments on strengths and areas for improvement: rachee with IMAC ONS / delineation F COTA/ OTK YaeS recommended ~ Tnoressed Communication with famiy TMLYS (Caregivers > EXPAN, the volefalue of OT 4 FR 1 & a Smily Suppor [recemmonds ~ yo have ot better ean oF at OT vs Cor AN WOW Cesponsibi (rte delinested PRSWEES ake ~ Sou have dove an excellent Vo with collaboration o¢ bt’s/Samittes and involv in the bee. INVOWING temRATING SCALE FOR STUDENT PERFORMANCE ‘4— Exceeds Standards: Prinmance i highly lied ae slated. ‘This ang sae given and woud represent he top 5% of al the ‘students you nave suprised. 3—Mets Standards: Petarmance i conitent wih etrylevel tice ‘This aingis neque given at midterm ands strong rating at fia 2—Needs improvement: Perernance Is progressing bts reads ingrovement fo erryevel practice Tiss a realtc rating of performance at midterm, and soma ratings of 2 maybe reasonable at the ina. 1 —Unsatisactory: Performances below standards and requtes ‘development reir evel ration Tis ating is gen whan there is ‘concer about performance. Ml EVALUATION AND SCREENING: 8. Articulates a clear and logical rationale for the evaluation process. Mien 1 @ 9 4 fd 1 2 8, Selects relevant screening and assessment methods wile considering such factors as oles pote, conten), theories, and evidence-based prac. wiem 1 O84 1 2 @ 4 10, Determines client's occupational profile and performance through appropiate assessment methods. Mitem 1 2 @ 4 Final 1 2 8 @ 11, Assesses client factors and contexts) that supporto hinder ‘occupational perormance Mim 1 2 @ 6 fm = 1 28 12, Obtains sufficient and necessary information frm relevant resoures such as cent, fails, significant others, service roviders, and records prior o and during the evaluation process, Midterm 1 a 4 Final 1 2 6 4 13, Administers assessments ina unorm manner to ensure findings ‘are valid and reliable. wien 1 © 8 4 fd 12 4 14, Adjusts/modifies the assessment procedures based on cients ‘needs, behavior, and culture. Nem 4 Final 1 4 3 2 ® 6 é 15, Itprets eration ests to determine cents ozcupaonal perorane stents ard chalenges nt? 4 fa 1 ke 16, Establishes an accurate and appropriate pan based onthe evaluation results, trough integrating mutipl factors such a8 Clent’s pros, context), theories, and evidence-based practice. Witem 12 GO Final 1 2 3 @ 17, Documents he est ofthe evaluation pes tha deren sites objective measurement of cents occupational perform ance, wien + 2 @ 4 en) Comments on strengths and areas for improve Midterm — You dO well with te OT eval WAeMS SF adyninistation + Cecuieabiow . Tusk wore experen -T'd Paes Es more, iaviatWe wi! on zt ee eee, a > MNT uy Berg ‘oalance, WWE demonstrated qteat PrOGFESS with odin teri winter predd yg, OT asses: Wen ANG, results © RWI Ahure inte treatmertt SSIS 45 ; SAN * increase, IMINTERVENTION: 18. Aticulates a clear and logical rationale forthe intervention process. Midterm 4 2 @® 4 Fal 1 2 3 @ 19. Uilizes evidence rom published research and relevant resources to maka informed intervention decisions, Miter 1 ® 34 mm 1 620. Chyeses occupations that motivate and challenge cents. wacm 12 4 fl 1k 21, Selects relevant occupation false ces meting estab lshed gat wom 1 2 © 4 fo 128 22, Implements inerventon plans that ae cent centered. Mdem 102) 4 fed 12 22, Implements intervention plans that ar occpation-based Maem 1 82 @ 4 Final 1 23 6 24, Motes ak approach occupations, andthe envtonment i mame cle pestomance waem 1 2 @ 4 fed 128 25. Updates, modes, or teint the Itrvetion plan based pon cared nensong ole r's ah waem 1 © 3 4 fd kG 26. Documents client’ response to services in a manne that demonstrates the efeacy of interventions. waem 1 2 @ 4 “wt «¢ £ es @ Comments on stengts and areas or improvenent Mi “up do well witty madigying /updating Apals . — yo will yeogtit Frat Ol MMS | Hein 2 occurdhe Wik ability ty Kuratey and i ci 1 eT YaMelgte Q Se i Cocrenr AOL e\MS- “Tyouve densnsteted He slr = You do welt wih progressing Dele deaninpyde whet ot aA V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: 27. Dundas rough racic or cussion habit to tap pops mops ocupenal bony sense ané onupabond heey ade, wien 1 Q@ 8 4 fo 1 2M Demonstrates through practice or discussion the ability to actively collaborate wit the occupational therapy assistant wom 1 Q 3 4 Fal 1 2 6 4 29, Demonstrates understanding of the costs and funding rested to cccupatioal therapy serwces at this st nem 1 @Q 3 4 Final 1 2 6 4 £0. Accomplishes organizational goals by esaising panes. devonng taages and meeting deadlines nem 1 2 @ 4 ft 1 2 31, Produces the volume of work required in the expected tine frame neem 1 2 @ 4 Foot 28 Comments on stegths and areas forimproverent + Mater = Facer peacrice meded cos ae wrt COTA + under Bundi Vales cules, CequaonS ete. Mou Ware able +o gain Weight Who Ot vs COTA FespONSiblitHieS [Roles Further experience — recommend Saino! in oteRATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Performance i highly sled and soifted This rains rarely given and would represent he top 5% o ll the ‘students you hae supenised 3—Meets Standards: Perormanceis consistent wih entryeve practi. This rag is intequently aven at midterm andi a strong rating at final 2—Needs improvement: Periormance Is progressing but sl needs improvement or eiryteve practice. Ths i realistic rating of performance at midterm, and some rags of 2 may be reasonable at the final 1 — Unsatisfactory: Pertrmance is below standards and requires velopment for entry eve practice. This rating is given when there fs @ concern about performance. VI. COMMUNICATION: 2, Clearly and effectively communicates verbally and nonverbal- ly with cients fais, leagues, sevice providers, and the public Mien 1 @ 3 4 Final 1 2 sg 4 38, Produces clear and accurate documentation according fo ste requicements.. widem 1 2 @ 4 Fri to 28 34, All written communication is legible, using proper speling, punctuation, and grammar. Mitem 1 0-20 @] 8 Final 1 2 3 © 35. Uses language appropriate to the recipient ofthe information, {ncuding but not imited to funding agencies and regulatory agen- es. wim 1 2 @ 4 m1 2 9 © ‘Comments on strengths and areas for improvement: MENp are ding, area oan Acumantation + Worcr tell ConmUMCahon , Mkt Lrom, yt will bev aRae \ case cammunicat on ig es ur Colleagues, \ac cameatots Fina ne aon Xe RAS Pot & Vschage . ~ YOU Wer® able 45 Commun cote enrol Ne pis / familie! MATE LFCHVE) Calleaguers | & are Yael Vil. PROFESSIONAL BEHAVIORS: 4 6. Collaborates with supervisors) to maximize the learning experience ee eee Takes responsibilty for attaining professional competence by seeking out earring opportunites and interactions with super sors) and others. witem 1 @ a 4 fo 81 2 Q 4 08, Responds contctay to feedback Maem 1 2 @ 4 m1 2 8 ® 39, Demonstrates consistent work behaviors including inate, 255, dependably, and work ste maintenance, 1 2 @ 4 fw 1 2 3 © 40. Demonstrates effective time management. wien 1 2 @ 4 fa 12 41, Demonstrates positive interpersonal sills including but not le- ited 10 cooperaton, flexi, tac, and empathy. uem 1 2 @ 4 m™ 1 2 3 @ 42. Demonstrates respect for diversity factors of others including but not lites to socio-cultural, socioeconomsc,spntual, and liestyle choces. mim 1 2 @ 4 fot 2 8G ‘Comments on strengths and areas for improvement; - a Gou respond well to feedback + Conshruchve critic isin. - T would like to Re wore DE ASSEMHWENASS with more WANDA, Hrs Families, of CARVE calations lassesoue nts SH More Confidence at y “very professiond! & ans Work ekwic - Sood =Nale Ao manage, Schudu le cages AWA gor NOTICR "OMA Cons well.+ PERFORMANCE RATING SUMMARY SHEET Performance tems |. FUNDAMENTALS OF PRACTICE 1. Adheres to etios _ 2, Adheres to safety regulations 3. Uses judgment in safety |. BASIC TENETS OF OCCUPATIONAL THERAPY 4. Articulates values and bells —_ 5 Arcus value of occupation ‘6. Communicates role of eccupatoal therapist 7. Colabocates with cents II EVALUATION AND SCREENING ‘8. Artiulates Gear rationale for evaluation ‘8. Selects elvant methods “11 Assesses cient and contextual 10% “2 Obtains sufcient and necessary information 13.Administers assessments 14. Adustsmodies assessment procedures 5 Interprets evaluation “16. Estabshes accurate plan PPPOW EE pps 17. Documents resis of evaluation |W. INTERVENTION “18, Arculats clear rationale for intervention 19. Uitiizes evidence to make informed decisions 20. Chooses occupation at mavae ard caloge 21, Selects relevant occupations 22. Implements cien-centeredinferventons 23. Implements occupation based interventions 24, Modes approach, occupation, ad environment 25. Undates, modifies, or terminates intervention plan 26. Documents clients response \V. MANAGEMENT OF OT SERVICES 27. Demonstates abilly to assign through practice or discussion Dea) wiurobs p bo aud ity to colaborate through practice o discussion Is “31, Produces workin expected tne frame VL. COMMUNICATION 32. Communicates verbaly and nonverblly ‘3G. Produces clear documentation 34. Witten communication slegile ‘35, Uses language appropriate to recipient Vil. PROFESSIONAL BEHAVIORS £36. Colaborates wih supervisor 537. Takosresponsbilly for professional competence us wo|P “8. oegonds consti eek "33, Demonstrates consistent work behaviors 40, Demonstrates time management 41, Demonstates postive interpersonal Sils 42. Demonstrates respect for versity ‘TOTAL SCORE Pebeiclec bs woclly eopew curesiecwe +65 MIDTERM: Satstactory Perbrmance. Unsaistactory Performance... +90 and above 89 and below FINAL: No Pass «2 points and above 121 points and below