ee OTA 22S FX Association, Ine Fieldwork Performance Evaluation For The Occupational Therapy Student ws t el olut Ale __gcnarures: NAME: “TST RST) DOLE) ave READTHS REPORT. VWunwersety_=y (eh LEGE OA URIVERGTY FIELDWORK SETTING: Luuiverssh) of Utah Heprial NAME OF ORGANIZATION/FACILITY NUMBER OF PERSONS CONTRIBUTING TO THIS REPORT iol Drive, Sal aby wey UT BHIB2— A Melinda Jarre ory oy SiaTE 2 ‘SIGNATURE QF RATER Level De Melinda ~ lannetotrR/Le Tree FFT HE EDS CSPOT ORDER OF PLACEMENT: 12.8 4 OUTOF 1 29 4 roe Nga 15 291 Why ort DATES 57 PLACENENT ‘SIGNATURE OF RATER #2 (F APPLICABLE) NUMBER OF HOURS COMPLETED a PRINT NANEICREDENTIALS POSITION lo FINAL SCORE, PASS: _ NO PASS: ‘SUMMARY COMMENTS: (ADDRESSES STUDENTS CLINICAL COMPETENCE)Fieldwork Performance Evaluation For The Occupational Therapy Student This evaluation is 2 revision of the 1987 American Occupational Therapy Association, Ine, Fieldwork Evaluation Form for the Occupational ‘Therapist and was produced by @ commitee of the Commission on Etvcation, PURPOSE The primary purpose of the Fiekdwork Perormance Evaluation fr the ‘Occupational Therapy Students to measure entyevel competence of the occupational therapy student. The evaluation is designed to stren- fate the competent stufent from te incompetent student and & rat designed to diferent eels above erty lve competence. For further Giarfcation on enryevel competency refer tothe Standards ol Pracice for Occupational Therapy (1) ‘The evaluation is designed to measure the performance ofthe ocoupa tonal therepy process and was rot designed to measure the specific ‘ecupatonal therapy tasks in cation. This evaluation refit the 1098 ‘Accreditation Counc tor Occupational Therapy Education Standards (2) nd the Natoral oad lor Certification in Occupational Therapy, Ie Practice Analysis results (9) In edition, his evaluaton allows students to evaluate ther own stengts and chalengos in relation to th per formance as an eccupational herepist. USE OF THE FIELDWORK PERFORMANCE EVALUATION FORTHE OCCUPATIONAL THERAPY STUDENT The Fielcrk Pertrmance Evalvation is intended to provide the student wih an accurate assessment of hither competence for entylevel prac toe, Both the studen! and felcwork educator should recognize that ont occurs overtime. The micterm and final eveluation scores will rellect development of student competency and growth ncrder to cfectvely use this evauaon 10 assess student competence, si speci objctives need to be developed. Use this evluaton as @ framework to assist in ensuring that all key perormance areas are relected in the ste spect objectives, Using this evaluation at midterm and final, iis suggested that the stu- det complete a sethevaluation of hither own performance, During the ricterm review process, the student and fekdwork educator should ool- laborativly develop a plan, which would enable the student fo achieve entry-level competence by the end of the fieldwork experience This plan should include speci objectives and enabing activites to be used by the student and fieldwork educator in order to achieve the desired competence, The Fielcwork Educator must contact the Academic Fieldwork ‘Coordinator when: 1) a student exhibits unsatisfactory behavior in a substantial number of tasks or 2) a stucents potential for achieving cenirysevel competence by the end ofthe alton is in question. DIRECTIONS FOR RATING STUDENT PERFORMANCE + There are 42 perormance tems. + Every item must be scored using the one to four pent rating scale (See below) * The rating scales should be carefully studied prior to using this valuation. Defitons othe scles are gen atthe op of each page. ‘Cite the number that corresponds to the descripfon that best describes the student's pertrmance. « The ratings forthe Ethies and Satety items must be scored at 3 or above onthe tinal evaluation forthe student to pass the feldwork experience, Ifthe ratings are below 3, continze fo complete the Feldwork Pecormance Evaluation to provde eedback to he student con hers pecormance + Record mite and fil ratings on the Peformance Rating Surmery Sheet. + Compere overall midterm and final score tothe scale below. OVERALL MIDTERM SCORE Setislatory Pertormance, 90 and above Unsatistactory Performance, 89 and below OVERALL FINAL SCORE Pass 122 points and above No Pass 124 points and below RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Perfomance is hight sled and salted. ‘Ts range rarely gen and would represent he top 5% of al the students you have supervised, 9— Meets Standards: Perrmarce is consistont wih entyevel race, ‘This tings nfrequenty given at mictarm and is 2 rong rating at final 2—Needs improvement: Peormance Is progressing but sil reeds Improveent for etyove practice This a reali rating cf performance at miter, and some rings of 2 may be reasonable st the fia 1 —Unsatistactory: Peformance is below standards and reqs development rent level prac. This rang is gven when there Io 1 concern about performance,RATING SCALE FOR STUDENT PERFORMANCE 4 Exceeds Standards: Perormance is highly skied and slated “Tis rag is aely given and would represent the top % of ll the students you heve supervised. 3 Meets Standards: Perforrance i content wth entry evel pact, ‘This angi infrequently given at midterm ands @ strong rating at final 2— Needs improvement: Peformance Is progressing but sill needs imerovement or enry-leve rate, Tiss a reali ating of performance at miter, ac caro raings of 2 may be ressonable at the fal 1 —Unsatistactory: Prtormence is below standards and requires development ox entry level practice. Tis rating is Qven wren there Is «concern about performance, |, FUNDAMENTALS OF PRACTICE: Al items inthis area must be scored at a #3 or above onthe final evaluation in order to pass felwark 1, Adheres to ethics: Adheres consistenly tothe American Occupational Therapy Associaton Code of Ethics (4) and site's polices and provedures including when relevant, those related to human sbjc research Maem 1 2 CP 4 fl = 12 AY 4 2, Adhores to safety regulations: Adheres consistently to setety ‘equations Anticipates potently hazardous stuations and takes steps to prevent accidents 7 oy + 2) Midterm 1 fl ty ofsef and others during all leldvork-related activites. Maem 1 C2) 3 4 Final 1 2 Oo 4 Comments on strengths and areas for improvement: + Midterm = Coed given for medical savehy (ee dana orertel Have Improved with ee wwe? gi sa Yous Cp youd a Seca Alte a sity py sey awareness nos 1 prwed go $0 sr ye ldots ow ss we eal st Swe vos 9 a barr toda ee a Gare fan § Uses sound judgment in regard to sate- Il, BASIC TENETS: 4, Clery and confidently articulates the values and belies of he cocupatoral therapy potession to cents, eis, sincznt oh er, coleagues, service providers, and the puble, Mem 1 2 G@) 4 Feral 1 2 @ 4 5, Clearly, confident, and accurately articulates the value of occu- pation as a method and desired outcome of occupational therapy to liens, families, signcant others, coleaques, service provider, and the pubic wien 1 ‘ Fal 1 2 @Mas 6, Clearly, confident, and accurately communicates the roles of the occupational therapist and occupational therapy assistant to clients, faifes, significant thers, coleagues, sence providers, adhe put Maem 1 2D 3 4 fat 2D 4 7. Collaborates with client, family, and sgnicant others thoughout the cocupational therapy process: 1@s 4 Mien fa = 12D Comments on strengths and ares forimproverent +N ~ Cond trplanations of whet OT Ls - (ould explain jrock during interveithon. fhe reasoning behind doing occpafars Collaborating “with famtiig dell corn f wapreve + Final ool. hwnd 4 “Sple or ills alt aoe — Vere se mach wet tony] abet oe collaborates UA Fareily :RATING SCALE FOR STUDENT PERFORMANCE |4— Exceeds Standards: Peformance i igh stiles end st-niite, This ring is rarely given and would reprasant the top 8% of al the ‘students you have supervised. 3 —Meets Standards: Peomance i consistent wih entrydevel practi ‘This ring i nrequenty glven at midterm endis a strong ating at final. 2.— Needs Improvement: Peformance fs progressing but il needs improvement ren evel praice. This is arealtic rating of performance al midterm, end some ratings of 2 may be reasoratle at the fra. 1 —Unsatistectory: Porormance is below standerds and requres evelopment or entry pracice. This rating is given when there is ‘concern about performance. lll. EVALUATION AND SCREENING: 2 ites cerned aon bre ein Fal 12 @) 4 8, Selects relevant screening and assessment methods while considering such factors as clan's priorities, context), theories, and evidence-based practice, Midterm 1 Final 1 2 10, Determines client's occupational profile and perormance ‘hrough agpropiate assessment methods. Maem 1 @) a 4 Final 1 2 3 4 11, Assesses client factors and contexts) that support or hinder ‘occupational performance, Midterm 1 a 4 mm 1 FG) 4 12, Obtains suffent and necessary information tom evant resources such as client, families, significant others, service: provides, ard records pico and dng the eveuton process. Wisem 4 2 4 Fal 1% ©) 4 13, Administers assessments ina unilorm manne to ensure finsings are valid and rele, 15, Interprets evaluation results to determine cients occupational performance strengths and chalenges. Mien 12 G4 fe tk 18, Establishes an eccurete and appropriate plan based onthe ‘evaluation resus, trough Integrating matipe factors such as cients priorities, cortet{s), theories, end evidence-based practice Widem 1 @) 3 4 fa tk |) 17, Documents the results ofthe evaluation process that demon- states cbjective measurement of cfent's occupational perfom- ance Midterm 4 © 3 ‘ fa = 1 oe (3) 6 ‘Comments on strengths and areas for improvement: + Midterm ~ Nowe a tie asics! Imaproving the fiow 2 refining Hu neeescunents eae runt Ste — owe strong with Suimthesi2nug the i to “determine pts Hers and weakiesses ‘Ther endlvatiory ak unproved fo wucly dures thus second eo a u ur Feld bei § oes YO i nt ee fs knewrg- fre ells \nlor preting the ve ae ay mine SWE NAPS € chal allanges. IV. INTERVENTION: 18. Articulates a clear and logical rationale forthe intervention process. ow Mice 34 14, Adjusts/motifes the assessment procedures based on cients needs, behaviors, and cure Migterm 1 2 4 Final 1 2 4 Midterm = 1 QD 4 Final 1 2 3 @& 19. Utilzes evidence from publshed research and relevant resources to make informed intervention decisions. Midterm: 1 ‘@ 3 4 ma 1 2 (3) 420. Chooses occupations that motivate end challenge clients Miderm 1 3 4 Final 1 2 3 &D 21, Selects relevant occupations to fcitate cents mating estab- shed goals meen ele ieeatvaeett artes) Inlet ren lars tha centered fr St OG Implements intervention plans that are occupation-based. wien 12D Modifies task approach, occupations, and the environment io ‘maximize cient performance. Midterm 2 @ 4 fret «12 D4 Updates, modifies, or terminates the intervention plan based ‘upon caret monitoring ofthe cients status. wom 1 2 (@) 4 Fed ot eo i CD 28, Documents cont’ response to services in ¢ manner that demonstates the efficacy of interventions. 1 2 4 Final 1 2 4 ‘Comments on strengths and areas for improvement: * Midterm te ad ot explaining the \V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: 27. Demonstrates through practice or discussion the ablty to ‘assign approorate responsible to the occupational therapy assistant and occupational therapy aide. wien 1 (D3 4 Bae ea 28, Demonstrates through practice or discussion the ability to actively collaborate withthe occupational theray assistant an ey Final Tineesis2cles (Oxparw 4 Demonstrates understanding ofthe costs and funding rezted ne aa mre rot ot @ 4 30, Accomplishes organizational goal by establishing priottes, developing strategies, anc mesting deadlines. wie 4 24 Frat 1 F@s 31, Produces the volume of work rquited in the expected tine frame. vam + Goa 4 mi 1 2 @ 4 Comments on strengths and areas for improvement + Midterm css - [els have you prachee Collabovating with the nn Fe move tone? bad Ol assistal ~ [e's discuss more a OF costs heré a of work Paste ee of pens me, - Produciaa “the wlume bat ae lain othe, weil be probably bt your ote ee Prrpose cial nak a Hines the fest & i - (ont ld and “ieeatirerce aan OO their Final we =I Sy Veeeats TG "4p fing more e Peni cain ua pe etal ing spe View won + Final —U awa yea apa Ate ni Fa Ne te = Uswr Aeahmorts [rave ‘ied be woe ee bse y \ A Wihliagng, @étarche 4 gm ws (hegey e ® an o beap avewingRATING SCALE FOR STUDENT PERFORMANCE ‘Vil PROFESSIONAL BEHAVIORS: 4.— Exceeds Standard: Peformance i highly ed and settee 238. Collaborates with supervisr(s) to maxinize the laring Thera ie raraly ven and woud represent the op 5% fl the experience, sents yeu have sipersee. titan Sy ate 2h Gi ete ‘3—-Meetastncards:Peromance consort wih enteel pce ‘Ths ag lnrequnty given at migiarm ands a strong cating et Fal 1 2 3G cl 37, Takes responsibilty for attaining professional competence by 2 Neos Improvement Porormance ia pogressag but si nods seekng ot learning opportunites and interecons wih superd- imrcvement renee pace. Ts a realist rating of Ex otone performance at metem, and seme aings of 2 maybe resonate at. tbe final Mien = 1 (QD 8 4 LUnstistctory: Pecomance fs below standards and requires re 12 @s deveteprent x arty eval racic. Ts agi gen when ther Is ‘concer about performance 438. Responds constructively to feedback Mdem 1 2 CD 4 VL. COMMUNICATION: Final i 2:48 ©) 39, Demonstrates consistent work behaviors includng inate, 42. Clearly and ettectively communicates verbally end nonverbal- preparedness, dependbity, and worksite maintenance. ty with cients, familes, significant others, coleagues, service ie oe pte am 12 tiem 1 G2 3 4 ae ce mi 1 2 3 @&© 40. Devotees eve manage 3 Prete cor deci soometsivaeenght agent D8 renter ee eae Vow 1 : : 41. Danonsets ot ner sling et mak Oy) 4 reiccnprt toy a nema 24 ad wt conmuentn ei ng rp: sy, eerie Calg punctuation, and grammar Final 1 C wom 12 re eee) @ 42, Demonstrates respect for diversity factors of thers including Fal 1 2 03 tut rot ned to sococulur,sociceconami, sual, and 95. Uses language appropriate to the recipient of the information, lifestyle choices, dig butt ited ng eens and easy oe wan 1 2 @ 4 mt GS caer see ‘Comments on strengths and arees for improvement: pe “Midterm ios ynanagement is, pratt Pe + + ales {ues ~ Content of docamantation is a “han visas oh shrigq) F \ — ore geting belur + bate ae Sorat wait, me fer Communicating” vt colle . lalcty 4 jnctiahve, \toy taking VesponsiDte Communicating uth fam iy wt ener Copier te pane biting wallg pty pow Tings inal Als aye & aveat a “Tie scleboatn, ye oe in erper’ ‘four gocumerdebor hag. bie aoe a iat) wel ee ips relate f queuveee Wu doe > wilt staf hats WyPERFORMANCE RATING SUMMARY SHEET Frriomance ers Wika Pains | FUNDAMENTALS OF PRACTICE 1. Adhere to thics 2 Achores to safety regulations T 43. Uses judgment in salty ‘Il, BASIC TENETS OF OCCUPATIONAL THERAPY 4, Areults values and belts 5, Arius value of occupation 5. Commurizses rol of cceupatonl heapit 7. Colaboris with clens Ill EVALUATION AND SCREENING 8. Articulate dear atonal for evaluation 9. Selects relevant methods 10. Detemires coupatonal pot I 11 Assesses clint and contextual fons T i 42. Oblains sufficient and necessary information t 13. Administers assessments a eae 14, Adjusts/modifies assessment procedures = 2 15. Interprets evaluation results ~ g| nist § 8909p fulus Final Ratings g 16. Estabistes accurate pian 2 37. Documents results of eveliavon IMINTERVENTION 18. Ariculates clear rationale for nterention 18, Uizes evidence to make informed decisions 20, Chooses cecupalon that motivate and chalenge 21, Selects relevant occupations 22. mpiements Gent-certered nlerventons 7 23, Implerents occupation based inteventons 24, Modifies approach, cceupation, and environment | 25. Updates, modes, or terminates intervention plan I 26, Documents client’ response \V. MANAGEMENT OF OT SERVICES ! 27. Dernonstrates ailty to assign through race or escussion i 26, Dermonstrates ability to colaborete through practice or discussion | 72, Understands costs and funding 30, Accomglshes organizational goals | 231. Produces work in expected time frame VL.COMMUNICATION 32, Communicates verbally and nonverbal 335 Produoes clear documentation 34, Writen communication is legible | 235, Uses language appropriate to recipient j 2 ral | VIL PROFESSIONAL BEHAVIORS eal 36. Collaborates with supervisor 37. Tekes responsbiity for profesional competence '36, Responds constructively to feedback » e p i als om WRsfelelelo|.e y poltlafela/vwla wufalss ohsfo Sw ® S @| Sy 3 Z az 29, Demonstrates consstont work behaviors 3 z Z 40. Damonsizates ine management “41, Demonstrates postive interpersonal sis _ 42, Demonstrates respect for versity Za TOTAL SCORE I | TD) eal MIDTERM: FINAL: Salistactory Performance. ........+.+.-90 and above Pass... Unsatisfactory Performance. 89 and below No Pass .. sees 122 pons end above 121 points and belowREFERENCES +. American Occupational Therapy Assocation, (1988), Standards of pracce for occupational therapy. American Joural of ‘Occupational Trerepy, 52, 865-869, 2. Accteaion Counc for Occupatora Therapy Education. (198). ‘Standards fran accredited educational program fr the oocupar tional therapist. American Journal of Oocopationa Theracy, 53, 575-682. 43. National Board for Certification in Occupational Thevpy. 1997). ‘National Study of Occupational Therapy Practice, Executive Summary 4. American Occupatonal Therapy Association. (2000) Occupational therapy code of ethics (2000). American Journal of Qocupational Therapy, $4, 614-616. 5. American Occupational Therepy Association (2002) Occupational therapy practice framework Domain and process. American Journal ot Occupational Therapy. 66, 06-633. GLOSSARY Client Factors: Those factors that reside within the cent and that may affect performance in areas of occupation. Client factor incude body functions and body structures * body functions (a cient facto, including physical, cognaive, psy- chesociel aspects) "the physiological function of body systems (including psychological functions)" (WHO, 2001, p.10} * body structues—"enatorrica! pars of the body suchas organs, limbs and thelr components [that support body function (WHO, 2001, p.10) (Cccupational therapy practi fremeworke Domain and process, American Joumal of Occupational Therapy, 56, 06-£23) (6) Code of Ethics: reer to wirnaota.orlgeneraltce asp Collaborate: Te werk together with a mutual sharing of thoughts and ideas, (COTE Glossary) Competency. adequate skils and abilies to preci as an entry lave! ‘ecupational therapist or occupational therapy assistant Context: refers to a variety of ntersated conditions within and sur rounding the cient that infuence performance, Contexts include cultural, physical, socal, personal, spiritual, temporal and vitul (Occupational therapy practic framework: Domain and process. ‘American Joumal of Occupational Therapy, 56, 606-€35) (5) Effleacy: having te desired infuence or outcome (Irom Neistact and CCrepeau, Eds. Wilrd & Spackman's Occupational Therapy, Sh ection, 1988) (©2002 by he Anercan Dospan Therapy Assan nl gl reseed. "pate nis econ maybe opreces elo ga yy mse wiht paren, Pind nt Ue Sts of Ane. Entry-level practice: refer to www aota.crgimembersaree2Idocs! section’ pat Evidence-based Practice: conscientous, expand jucious use ot curtent best evidence in making decisions about the care of inc- ‘vidal patients. The practice of evidence-based feat cae] means itegratng individual clinical expertise wih the best ava- able exeralcirical evidence frm systematic esearch’. Sacket and colleagues, Evidence-based medicine: How to practice and teach EBM, 1967, p2) (Hom the Mary Law artle “Evidence ‘Based Practice: What Can it Mean for ME?—bund onfne at wwr.20ta.crg) ‘Occupation: Groups of activites and tasks of everyday Ife, named, ‘organized and given value and meaning by individuals end a cu- ture; occupation is everything people do to occupy themselves, inlucing locking aftr themselves (col-cae), enjoying ite (isu), and contibuting to the social and econo fabric ot their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy. (Townsend, editor, 1987, Enabling Occupation: An Occupational Therapy Perspecive, p11) ‘Occupational Performance: The ecu of @ Amari, interwoven rel tionship between persons, environment and occupation ver a person lifespan; the abit to choose, oxgarize, and satactorly perform meaningful occupations that ere cull defined and age aperoptat for looking air onese, enon if, and con- tutng tothe social and economic ei ofa county (Townsend, editor, 1987, Enabing Occupation: An Occupational Therapy Perspective, .181) Occupational Profile a proe hat describes the cients occupational history patterns of daly living interests, values and needs. (Occupational therapy pracie framework: Domein end process. ‘American Joural of Occupational Therapy, 86, C6-€99) (6) ‘Spiritual (a cortext}—the fundamental orientation of a persa's Ie; that which Inspires and motivates tha! Indvigul. (Occupational therapy practice framework: Domain and process, American Journal of Occupational Therany, 66, 606-638) (5) ‘Theory: “an organized wey of tinkng about given phenomena, in ‘occupational therapy the phenomencn of concer is occupational endeavor Theory atts fo (1) dene and explain the rlatin- ships between concepts or ideas related to the phenomenon of interest, 2) expain hw these relationships can prediet behavior ‘or evens, and (3) suogest ways thatthe phenomenon can be changed or controled. Cocyptional therapy ther is concemed wi four major concep related fo occupational endeavor per- on, emironment, heath, and occupation” (Neistadt and Crepeau, Eos. Witerd & Spackman's Occupational Therapy, Sh edtion, 1888°BS21}