AOTA © The American Occupational Therapy ‘Association, Inc. Fieldwork Performance Evaluation For The Occupational Therapy Student wan Syhrowshy, Alex wae“) fs ODE Gets nee io FIELOWORK SETTING: Y 2) 1 Child ce WANE OF ORGANZATONFACLITY (275 £. Lairh EA ADDRESS: (STREET OR PO BO%) Git lake Ghy , b y/o ary ‘STATE SIGNATURES: | HAVE READ THIS REPORT, ors ‘SIGNATUREOF NOMBER OF PERSONS CONTRIBUTING TO THIS REPORT Goonn Boupeaaed SIGNATURE OF RATER #1_) Pediatric Oudpack, Bhob Kexenn Reauccaard Mor orpl, [YPE OF FIELOWORK Fr Nnscrepe aL O5 a, diedree Out o Pept ORDER OF PLACEMENT(G)2 34 OUTOF 1()3 4 ron 4/20} ro F/6/IO/E DATES OF PLACEMENT SIGNATURE OF BATER #2 (F APPLICABLE) £2 bibecks Cito hrs fureek) ‘NUNBER OF HOURS COMPLETED PRINT NAME]GREDENTIALSPOSTTION mato FINAL SCORE mss YES SEP vonass SUMMARY COMMEN (ADDRESSES STUDENTS CLNIGAL COMPETENCE}Fieldwork Performance Evaluation For The Occupational Therapy Student ‘This evaluation is a revision of the 1987 American Occupational Therapy ‘Association, Inc. Fieldwork Evaluation Form for the Occupational ‘Therapist and was produced by a commitlee of the Commission on Education. PURPOSE ‘The primary purpose ofthe Fieldwork Performance Evaluation for the ‘Occupational Therapy Student is to measure entry-level competence of the occupational therapy student. The evaluation is designed to diferen- tile the competent student from the incompetent student and Is not designed to diteretiat levels above entry level competence. For further clarification on entry 4vel competency refer to the Standards of Practice {or Occupational Therapy (1). ‘The evaluation is designed to measure the performance of the oocupa- tional therapy process and was not designed to measure the specific ‘occupational therapy tasks in isolation. This evaluation reflects the 1998 Accreditation Council for Occupational Therapy Education Standards (2) and the National Board or Cectiicaton in Occupational Therap, nc. Practice Analysis results (3) In addition, this evaluation allows students to evaluate thei own strengihs and challenges in relation to ther per- formance as an occupational therapist USE OF THE FIELDWORK PERFORMANCE EVALUATION FOR THE OCCUPATIONAL THERAPY STUDENT “The Fieldwork Performance Evaluation i intended to provide the student with an aocurate assessment of hisher competence for entry evel prac: tice, Bath the student and fieldwork educator should recognize that growth occurs over ime, The midterm and final evaluation scores will reflect development of student competency and growth, inorder to effectively use this evaluation to assess student competence, site speci objectives need to be developed. Utilize this eraluaton as a framework to assist in ensuring that all Key performance areas are reflected in the site-specitc objectives, Using this evaluation at midterm and final, it is suggested thatthe stu- dent compete a selevaluaton of hisher own performance. During the ‘midterm review process, the student and fiekwork educator should col- laboratively develop a plan, which would enable the student to achieve entry-level competence bythe end ofthe fekiwork experience. This pian should include spectic objectives and enabling activites to be used by the student and feldwork educator in order to achieve the desired competence. ‘The Fieldwork Educator must contact the Academic Fieldwork Coordinator when: 1) a student exhibits unsatisactory behavior in a ‘substantial number of tasks or 2) a students potential for achieving ‘ontrylovel competence by the end ofthe affiliation is in question DIRECTIONS FOR RATING STUDENT PERFORMANCE «There are 42 porformance items. + Every item must be scored, using the one o four point ating scale (see below) ‘The rating scales should be carefully studied prior to using this, evaluation. Detton of te scales are given atthe top of each page ‘Cite the number that coespands to the description that best describes the students performance. +The ratings forthe Ethics and Safety items must be scored at 3 or above on te final evaluation forthe student to pass the fieldwork experienc. Ifthe ratings are below 3, continue to complete the Fieldwork Performance Evaluation to provide feedback tothe student on herhis perormance + Record midterm anda ratings onthe Perormance Rating Summary Sheet ‘Compare overal midterm and final score tothe scale below. OVERALL MIDTERM SCORE Satisfactory Periormance. 90 and above Unsatisfactory Performance, 89 and below OVERALL FINAL SCORE Pasa... ar sxcnove 122 points and above No Pass ... 121 points and below RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Pecormance i igh sled and slated. “This rating is rarely glen and would represent the top 5% of al the students you have supervised 3.— Meets Standards: Perormanceiscorsistont with entry evel practice, This ating is infrequently given at midterm ands @ strong rating at final — Needs improvement: Prtormance Is progressing but stil needs Improvement for entryeve practice This is a realistic rating of Petiormance at midterm, and some ings of 2 maybe reasonable at the fn 1 —Unsatistactry: Performance is below standards and requires development fren eel practice. This rating i gvon when there is ‘a concem about performance.RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Peormance i highly sled and slinitated This ating i arly given and would represent the top 5% of all the students you have supervised 3 — Meets Standards: Peormarce is consistent with entry evel practice. This ating is infrequently given at midterm andi a strong rating at fina 2— Needs improvement: Pertormance Is progressing but si neds imorovement or enty-evel practice, This is a realistic rating of performance at midterm, and some ratings of 2 maybe easonable at the fn 1—Unsatistactory: Perormance is bolow standards and requires evelopment for eniryevel practice. Tis rating is given when there is ‘a concer about performance. 'UNDAMENTALS OF PRACTICE: Allitems in this area must be scored at a #3 or above onthe final ‘evaluation inorder to as fieldwork 1. Adheres to ethics: Adheres consistently tothe American (Occupational Therapy Association Code of Ethics (4) and site's policies and procedures inclucing when relevant, thse related to human subject researc, Mdem 1 2 8 @ Fl 128 2. Adheres to safety regulations: Adheres consistent to safety regulations. Ancpates potentially hazardous situations and takes steps to prevent accidents. Midem 1 2 GD 4 Final 1 2 3 @® 3. Uses judgment in safety: Uses sound judgment in regard to sale- ty of se and others during all feldwork-related activites, Midom 1 2 @) 4 fas kk |] ‘Comments on strengths and areas for improvement: + Miter i 2+ Needs mor expenencs Kanalag . oe vanehy of : a fia fe juts ban din 7 2 Si tly hese a te BASIC TENETS: 4, Clearly and confidently articulates the values and beliefs o the ‘occupational therapy profession to cents, families, significant ot 15, colleagues, service providers, andthe publ Midorm 4 2 Final 1 2 3 @ 5. Cleary. confident, and accurately articulates the value of occu- pation as a method and desired outcome of occupational therapy to cients, famies, significant others, colleagues, service providers, ‘and the publi Midterm 4 2 @ 4 Final 1 2 3 @® 6. Clearly, confidently, and accurately communicates the roles of the occupational therapist and occupational therapy assistant, to clans, familes,sigticant others, colleagues, service providers, andthe pubic Mdem 1 2 @) 4 fol = 128 @!) 7. Collaborates with cont, family, and significant others throughout the occupational therapy process. Mitem 1 G3 4 Final 1 2 3 @D Comments on strengths and areas for improvement: “Midterm danihe: te Needs more we lanthe’s a “ “ o “re clearly whe, fo oe. fie ne eine s- o 3 Has hadily mproved cate ane Cammunccdten! arth parentsRATING SCALE FOR STUDENT PERFORMANCE 4 Exconds Standards: Performance is highly sted and seltintted This ating rarely given are would represent the top 5% of ll the students you have supervised 3 — Moots Standards: Perormance Is consistent with entry-level practice, This ating is infrequently given at midterm and sa strong rating at final 2 —Needs improvement: Perormance Is progressing but stl needs Improvement or enty-eve practice This is a realistic rating of performance at midterm, and some rains of 2 may be reasonable at the fina, 1 Unsatisfactory: Performance is below standards and rogues evelopment for eit evel practice, This rating is given when there is ‘ concem about performance. Ill EVALUATION AND SCREENING: 8. Articulates a clear and logical rationale for the evaluation process. Mitem 1 2 @) 4 Final 1 2 G4 9. Selects relevant screening and assessment methods while considering such factors as cient’ prorties, contexts), theovies, ‘and evidence-based practioe. Wien 12 @® 4 Final 1 2 Gps 10, Determines client's occupational profile and performance through appropriate assessment methods, awn 2 OF m1 2 8 A) 11, Assesses factors and context(s) that support or hinder cesiatorl perma. mem 1 2 GH 4 fa 128 12, Obtains sutfcient and necessary information from relevant resources such as client, families, significant others, service providers, and records prior to and during the evaluation process. Migterm 1 2 3 @ Fool = 128 MD 13, Administers assessments in a uniform manner to ensure findings are valid and reliable. Widen 1 2 39 @® Fel 128 ED 14, Adjusts/modifes the assessment procedures based on lens needs, behavior, and cute, Mdem 1 2 @ 4 fd 128 |} 45, Interprets evaluation results to determine clients occupational performance strengths and chalenges. Mitem 1 GD 38 4 Final 1 2 @s 16. Establishes an accurate and appropriate plan based on the ‘evaluation results, through integrating multiple factors such as cents prortes, contexts), theories, and evidence-based practice, Mitem 1 @ 9 4 Final 1 2 @ta 17, Documents the results of the evaluation process that demon- strates objective measurement of client's occupational perorm- ance, Maem 1 2 9 @ Fl = 128 CAD ‘Comments on strengths and atees for improvement: * Midterm: F “Needs more are: tes fo make Gecisrins Af evel ewrthaat guidance au 7 10> rap roving isiap ene gs 12> Tnihahs #rading inh 17 ~ PDMS = AMAZTNG £ (EK admen 4 - Riesds nore apurince ibi=" Har ast bene -ongortouihs oy Cagle + Final bs leversf 1423 ta rrackeal © Mab etal ty Reel Feeds mere divers gp La of dehimin chill o- Hable ihn = ip, ba Shinesl “obeanred wen “ Ja sce Sx ghore (2 Many Se 33 as lines hay, adn s teh eed acces te irderactes nor Sus i eB chil tg ~ Aagde won, 5 Melo! fes INTERVENTION: mult pee 18. Articulate a clear and logical rationale forthe intervention process. Midterm 1 2 @ta Final 1 2 3 Ct 19, Utilizes evidence from published research and relevant resources ‘to:make informed intervention decisions. wae 1 @) 38 or Final 1 220. Chooses occupations that motivate and challenge cents, Maem 1 2 3 @ Fr 1k GF 21, Selects relevant occupations to feclitate cients meeting estab- lished goals. Midterm 1 2 @t 4 Fl 123 DH 22, Implements intervention plans that are client-centered. Maem 1 2 3 G@ Fed 1k 23, Implements intervention plans that are occupation-based, Midterm 1 2 3 ® Final 1 2 38 @® 24, Modifies task approach, occupations, and the environment to maximize cient performance, Midterm 4 2 4 Final 1 2 8 @r 25, Updates, modifies, or terminates the intervention plan based upon careful monitoring ofthe cients status. @® s 4 @ *% 26, Documents client's response to servis in a manner that demonstrates tho effcacy oilerventions. Midem 1 2 G4 or Comments on strengths and areas for improvement: Midterm Final 1 2 Final 1 2 3 «ery . yen Steves fo clegely [logy cally Therk Se en 19 ~ Wd supervrian ; Be donnie hos nal bayided a1 ~ Needs here oppurtan:hes 22 ~ Very aweve ot childeene develepmantat feet at of coud - rf peds Be Able ded Ie ths moment £ as Needs more cpppertanches 26 Decumpnh relebtind mks A reppork som nee Brag . r Be Zoo extant 20 9 Pads in a Trans 3 praia BY. By wee 2 cunt of theme Bid rmchuathng Nhe eccupahun S Able raosityin the racmant ¥ Pron sestian fe Se5/60 2s Needs mon porhancher a@ OurstandsiNole? \V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: 27. 2. 30, 31 Demonstrates through practice discussioh the ability to a aponite eapeaens beer tey assistant and occupatonal therapy ide Midiom 1 2 CH 4 Final 1 2 @ 4 Demonstrates through practice occas ability to actively collaborate with he occupational therapy asssian Mem 1 2 G@ 4 @ +s Demonstrates understanding ofthe costs and funding related to occupational therapy services at this site. Midtrm 1 2 G3) fa 12 OT ‘Accomplishes organizational goals by estabishing proitios, developing strategies, and meeting deadlines. Final 1 2 Midem 1238 @ eae Produces the volume of work required inthe expected time fame Widem 91 209 @) Fri 123 GAYE ‘Comments on strengths and areas for improvement: idterm 22 ~ No gpertencdy Bei dass bebo ) F Neds mene ink . 10 - Aloiays corp lates decumendrher W planning lon theme ar ovell befor Fr Handling volama would aapeed by uneh bor 9 + Final 22 PF Needs BY Enaarging tnowledge 399 Net a wicthen He sas Ragre Oe Pee dthle & doc amand ofr a Sesser epyorbon hes of a complex useRATING SCALE FOR STUDENT PERFORMANCE ‘4 — Exooeds Standards: Performance i highly skied and sollnitiated. ‘This ating Is rarely given and would represent the top 5% of all the ‘students you have supervised 3—Meets Standards: Peformance is consistent with entry-level practice ‘This aig is inftequently given at midterm and sa strong rating at fina 2.—Needs improvement: Prormance Is progressing but sl needs improvement fr onzyovl practice. This isa realistic rating of performance at midterm, and some raings of 2 may be reasonable at the fn 1 — Unsatistactory: Perfomance is below standards and requros development fore evel practice. This rating s given when there Is ‘a concem about performance. VL COMMUNICATION: 2, Clearly and ettectvely communicates verbally and nonverbal- Iynith cen amis, signcant thers, coleagues, service providers, and the publ @ wide 128 ® Final 1 2 3 38, Produces clear and accurate documentation according to site requirements. Midterm 1 2 3 @ fod = 1k HE 34, All wtten communication is legible, using proper spaling, punctuation, and grammar Maem 1 23 Final 1 2 3 G+ 36. Uses language appropriate to the recipient ofthe information, including but not ited to funding agencies and regulatory agen- cis. Mitem 1 2 @ 4 Fina 1 23 @ ‘Comments on strengths and areas for ren + Midterm MALE A blehar trast * bey Bo dazine pet BS Lean decal securdips 35 - Leaning fetter of medi ¥ Fi ahah wth undestoad washed communes 73 = Hes, access hilly, learned 9 really yet conessely Jocumar sy Could fe a dats on gtomenar * punctuahon as. ‘EKCEUENT ¢ Vil. PROFESSIONAL BEHAVIORS: 36, Collaborates with supervisor(s) to maximize the learning experience Midem 1 2 8) @ Final 1 2 3 Hy 87, Takes responsibly for attaining professional competence by seeking ou learing opportunites and intractons wit super sor(s) and oer Mite = 1 2 3 @ Fol = t28 E 4B. Responds constructively to feedback. Mdem 1 2 3 @ Final 1 2 3 @ 39. Demonstrates consistent work behaviors including initiative, preparedness, dependabilly, and worksite maintenance, Midterm 1 2 3° oO Fel = 12 40, Demonstrates effective time management. Maem 1 2 8) @) fol = 128 @ 4. Demonstrates postive Interpersonal kiln bt ot i ited cooperation, ecb et and orpat, Wien 128) Final 1 2 3 4 42, Demonstrates respect for diversity factors of others including but not Emited to socio-cutural, socioeconomic, spiritual, and llestyle choles. Midem 4 2 8 G) m1 2k 8 Comments on strengths and areas for improvement: Boey4 TP enthusteh cally 2A geet ale te ah Laken 7¢- Recapires Redback nae (elena srowdk = ~ Age ers ‘af mp cud acre punky uns document a neg an ae wis EE spy Tern perend qe 42 - No iabephep a predjudsce , as oe “Fina ee Sr Near dew inbadee ay edad nee seck oho on Ps ie #5- Parorinel ! uw 393 very POEESIONAL hy aoe ee dil sill erable Hag fespersene ropstor Tg i efPERFORMANCE RATING SUMMARY SHEET Performance ems — Wialerm Ratings — Final Ratings |. FUNDAMENTALS OF PRACTICE 4.Adneres to ethics 2. Acheres to safety regulations 3. Uses judgment in salety Il, BASIC TENETS OF OCCUPATIONAL THERAPY 4. Atcuates values and belels 5. Arfculates value of occupation 6. Communicates role of occupational therapist 7. Collaborates with clients IN EVALUATION AND SCREENING £8. Ariculates clear rationale for evaluation 28, Selects relevant methods I 10. Determines occupational profile | & WU BhY why 11. Assesses cent and contextual facors 42. Obtains sufcient and necessary information 13, Administer assessments, 14, Adjustsmodties assossment procedures Interprets evaluation resus Ry olapt|Alo ho “¥6.Estabishes accurate plan 417. Documents rests of evaluation IWAINTERVENTION 18. Articulates clear rationale for intervention $ Rfola eee hey * th 419. Utizes evidence to make informed decisions 20. Chooses ooupations that motivate and challengo 21, Selects relevant occupations 22. implemen cient centered interventions 22, implemen occupation based interventions 24, Modifies approach, occupation, and environment 25, Updates, modifies, or trminates intervention plan 26, Documents lent response \V. MANAGEMENT OF OT SERVICES 27. Demonstrates ably to assign through practice or discussion 28, Demonstrates abity to colaborate through practice or discussion 29, Understands costs and funding - 30. Accompishes organizational goals — 31, Produces workin expected time fame Vi COMMUNICATION 32. Communicates verbaly and nonverbaly ‘33, Produces clear documentation ten communication i legible 36. Uses language anpropriate to recipient ‘Vil. PROFESSIONAL BEHAVIORS 36, Collaborates with supervisor 37 Takes responsibly for professional conpotence — '38, Responds constructively to feedback " fe +4 ‘39, Demonstrates consistent work benavions 40, Demonstrates time management 41, Demonstrates postive interpersonal skis Lele wahele SAB H shi clela baht ole, 4 e 42, Demonstrates respect for diversity je) SS is S| Sess TOTAL SCORE MIDTERM: FINAL: Satstactory ertormance Pass . 122 points and above Unsatisfactory Performance. No Pass . 121 points and belowREFERENCES 4. American Occupational Therapy Associaton (1988). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 52, 866-269, 2, Accreditation Counc for Occupational Therapy Education, (1999). Standards for an accredited educational program forthe occupa- tional therapist, American Joural of Oocupatonal Therapy, 53, 575-582. 3. National Board for Certification in Occupational Therapy. (1897) ‘National Study of Occupational Therapy Practice, Executive Summary 4. American Occupational Therapy Associaton. (2000), Occupational ‘therapy code of ethics (2000). American Journal of Occupational Therapy, 54, 614-616, 5. American Occupational Therapy Associaton (2002), Oocupational ‘therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 606-639. GLOSSARY Client Factors: Those factors that reside within the cient and that may affect performance in areas of occupation, Ciient factors inctude ‘body functions and body structures + body functions (a client factor, including physical, cognitive, psy- ‘chosocial aspects)—"the physiological function of body systems {Including psychological functions)" (WHO, 2001, p.10) * body stuctures—‘anatomical parts ofthe body such as organs, limbs and their components {that support body function} (WHO, 2001, p10) (Occupational therapy practice framework: Domain and process. ‘American Journal of Occupational Therapy, 56, 608-639.) (5) Code of Ethics: refer io mmv.acta org/generalcoe.asp Collaborate: To work together with a mutual sharing of thoughts and ideas, (ACOTE Glossary) ‘Competency: adequate skis and ables to practice as an entry level ‘occupational therapist or occupational therapy assistant Context: refers o a variely of interelated conditions within and sur rounding the cent that inluence performance. Contexts include cultural, physical, social, personal, situa, temporal and viral. (Occupational therapy practice framework: Domain and process. ‘American Journal of Occupational Therapy, 56, 06-639.) (5) Efficacy: having the desired intuence or outcome (tom Nelstadt and Crepeau, Ets Wile & Spackman's Occupational Therapy, th edition, 1998) (© 2002by te Ameizan Cerupatorl They Assia, Ire. Al igs ered No partis veton maybe repeduos in whoo party ey are went pomison Prt ne Und Sas of Ama, Entry-level practice: reler to www acta orgimemberstareazidocs! sectionb pat Evidence-based Practice: ‘conscientious, expt and judicious use of current best evidence in making decisions about the cae of nd duel patients The practice of evidence-based [heath care] ‘means integrating individual cinical expertise with the best ava able external cinical evidence from systematic research’. (Sackett and colleagues, Evidence-based medicine: How to praca and teach EBM, 1997, p.2) (hom the Mary Law article “Evidence: ‘Based Practice: What Can it Mean for ME?—found ontine at wir aota.og) ‘Occupation: Groups of atvtes and tasks of everyday if, named, organized and given value and meaning by individuals anda cu- ture; occupation s everything peope do to occupy themseves, including looking after themselves (cel-cre), enjoying lie (leisure), and contributing to the social and economic fabric of their communities (productivity); the domain of concem and the therapeutic medium of occupational therapy. (Townsend, ectr, 1997, Enabling Occupation: An Cecupational Therapy Perspective, pie!) Occupational Performance: The result of @ dynamic, interwoven rele tionship between persons, environment and occupation over @ persons lifespan; the ably to choose, organize, and saisactoily perform meaningful occupations that are culturally defined and ‘age appropriate for locking after oneself, enjoying life, and con- tributing to the social and economic fabric of @ community. (Townsend, editor, 1997, Enabling Occupation: An Occupational Therapy Perspective, p18) Occupational Profil: a pote that describes the cents occupational histor, patterns of dally ving, interests, values and needs. (Cccupational therapy practice framework: Domain and process, ‘American Journal of Occupational Therapy, 56, 606-638) (5) Spiritual: a contet)—the fundamental orientation ofa person's it; that which inspires and motivates that individual (Occupational therapy practice framework: Domain and process. American Journal of Qocupational Therapy, 56, 608-690) (5) ‘Theory: “an organized way of thinking about given phenomena, In ‘occupational therapy the phenomenon of concern is occupational ‘endeavor. Theory attemps to (1) define and explain the rlation- ships between concepts or ideas related to the phenomenon of interest, (2) explain how these relationships can predict behavior ‘or evenis, and (3) suggest ways thatthe phenomenon can be ‘changed or controled. Occupational therapy theory is concerned with four major concepts related to occupational endeavor: per ‘son, environment, heath, and cocupation’ (Neistadt and Crepeau, Eds, Wilard & Spackman’s Occupational Therapy, Sth edition, 1998, p.52t)