ae AOTRK 220" PNG Fieldwork Performance Evaluation For The Occupational Therapy Student si ne il ceca OC ian a FIELDWORK SETTING: Bente a CONTRIBUTING TO THISREPORT IRDGRESS. (STREET OR PO-BON) Muay ut Le. Baresi 7 pau ae " uay,.0Aee bea M- Pur gan, StL ™ FIELDWORK PRINT NAME/CREDENTIALS/POSITION onoenorevcauenn (Je 84 ouror(D2 a « P2204» oR/Z0K4 hua Holl oes ‘OF PLACEMENT aor “RATER #2 (IF APPLICABLE) po Holl Ope{L aaah rre onion ngihstiell Delt acne mass No Pass: ‘SUMMARY COMMENTS: Tr (06 DOT alg gh le fe etn Kynred, and hes the inhanwe 10 inne lee fet As ws A thanp st Up Abedys pgpnds wie te Peed lav, AnA (here fp Sid 0 Ri atthe. ne ot Th IS Vind pnd very Vonttned Alnret her pothirts, Sc Wes bac Dror al Pye Insts BP proade the Bt Qe poze to Pl erpaily. Tae 15 A tate pllipre, avd Lillaboratic wall Wille Mice Avarnpy Sif Aad hnestlag, Tr» tell he A peaat-fr He UT phen.Fieldwork Performance Evaluation For The Occupational Therapy Student ‘This evaluations a revision ofthe 1987 American Occupational Therapy Association, Inc. Fieldwork Evaluation Form for the Occupational ‘Therapist and was produced by a commitiee o! the Commission on Education. PURPOSE ‘The primary purpose ofthe Fieldwork Perlormance Evaluation forthe ‘Occupational Therapy Students to measure entry-level competence of ‘the occupational therapy student. The evaluation is designed to ciren- tiate the competent student from the incompetent student and i not Cesigned to diferente levels above entry level competence. Fr further Clanfcation on entryeve competency reer othe Standards of Practice for Occupational Therapy (1). ‘The evaluation is designed to measure the performance ofthe occupa tional therapy process and was nat designed to measure the spectic, ‘occupational therapy tasks insolation. This evalvation relics the 1998 ‘Aereditaton Councl for Occupational Therapy Educaton Standards (2) and the National Board for Certicaton in Occupational Therapy In. Practice Analysis resis (3) In adlton, this evaluation allons students to evaluate thor 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 Performance Evaluation is intended to provide the student with an aeouate assessment ofhishher competence for entry-eve prac: tie Both the student and fieldwork educator should recognize that «growth ocous overtime The midterm and final evaluation scores will reflect development of student competency and growth. In order io cfectiely use this evaluation to assess student competence, site- specie objectives need to be developed. Uiize tis evaluation as @ framework to assist in ensuring that all Key performance areas are reflected in the ste-spectfc objectives. Using this evaluation at midterm and fina iis suggested thatthe shir dent complete a sel-evaluation of hishher own pertormance, During the ricterm review process, the student and felwork educator shoud col- laorately develop a plan, which woud enable the student to achieve entry love competence by the end ofthe eldwork experience. This plan should include spectic objectives and enabling activites to be used by the student and filowork educator in order to achieve the desired competence ‘The Fieldwork Educator must contact the Academic Fieldwork Coordinator when: 1) a student exhibits unsatsactoy behavior in a substantial number of tasks or 2) a students potent far achieving, entry-level competence by the end of he aflaon isn question, DIRECTIONS FOR RATING STUDENT PERFORMANCE. + There are 42 performance items. «Every tem mustbe scored, using the on to four point rang scale 82 below). + The rating scales should be carefully studied prior to using this evaluation. Defions of the scales are gven atthe op of each page. * Circle the number that conesponds to the deserpton that best deserbes the students performance. +The ratings for the Ethics and Safety items must be scored ator, ‘above on the final evaluation fr the student to pass thefeldwork experience, If the ratings are below 3, continue to complete the Fieldwork Performance Evaluation to provide feedback tothe student ‘on hedtis performance. ‘+ Record miter and final ratings onthe Perormance Rating Summary Sheet ‘+ Compare overall midterm and final score tothe scale below. ‘OVERALL MIDTERM SCORE Satislactory Perormance. 90 and above Unsatsactory Performance. 89 and below OVERALL FINAL SCORE Pass 122 points and above No Pass 121 points and below RATING SCALE FOR STUDENT PERFORMANCE 44— Exceeds Standards: Patormanceis ih skilled and seFnated. “This rag is arly gven an woul rpeesent the top 5% of al the ‘students you have supervised '3-—Meets Standards: Performance is contort wth entry level pace, Tag ineqenty gen tice aris ong ang at 2 —Needs improvement: Prana» Is progressing but sill neds improvement x erirylve pracice. Tiss a realise rating of Berman at mit, and sme ees of mabe eins a ial. 1 —Unsatstatory: Prormancs ie below standards and eques ‘evetapont erie pce. Thang gen when hares concer abou performance,RATING SCALE FOR STUDENT PERFORMANCE 4 scone Suartad: Puttnsncn hep ei mo eas Fine ating rly gw er woul repro hp fo th ‘dents ys tare vig 2 Mma Stand: Borers eset 10 at ul en Th ney rt i a og ag 2 Heads improve Purine toques bt rs ingronsan erry er gracien Ths 9 ric rating feronmance wir, ware age 2 ryt ocr Sates 1 Unetitactory Portree bow standard acd oqaeee deere x etry Wows yacien Tes aes wae har a ‘concern ston perlormance, FUNDAMENTALS OF PRACTICE: ‘A foe i hi area rust bo scored at a #3 or aber on te fat ‘valuation in odor to pass lkbnork. 1 Adhores to ethic: Aches ein s O Final 1 2 3 © 0 Natal tty plete: hors cx te elephant wd es tatoo aod ie a), Fira atin © ty of salt and others during all feldwork-related activibes. eet Purell 30h @ Pes 5 cm i a on eres ed BO Wither bi aos inte a 4 eb with "oe, a ae Shane 4 ie ta if Weave + fompdtendy Ore Uses judgment in safety: Uses sound judgrant in rgard to wale |W, BASIC TENETS:, Cnnty 08 ue heuey weet the ales 206 talits f % won 1 f) a 4 mi 1 fF @ 4 oary velar waco ate tv ec (ao sss ar te st asta ay Psa, Sle tn, esti Os wavaptie mo 1 2 Os 6 cum erty sr scsi commutes est the occupational therapist and occupational therapy assistant ries, ogpcant thers, coleaguas, sarin rarer wou 1 (3 4 ee er ee 7 Colaorates wih cert, ay ad scat cers caps a ccagatona here eres an tel ee Final 1 2 wy 4 Cee nan eeipe nearer Fen cows pe with yduating the wn fede & OL ArA eee yee A) Vitek ty Ac. ingen alate yu tate (he Roe of Me UP regents abs (ira wie bree Nepted Jere 6 ey igcupahor. based She ie hal 2B Gad segs is an Nhs ti Ste Ale thie fn ee AMlints Taels ie Lllowede Wty Hie adh Anite ie d lings: 7 Uollatavatior ud Lot % Moe cintt memelees AC AeA. (vita).RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Pertrmarce is highly sllled and sel-itated ‘This ratings rarely given and would represent he top 5% fal the ‘students you have supers, ‘3 Meets Standards: Peromance eons wth practice. Tag sinteqntysen tern an tong reg at na 2—Noeds improvement: Peformance Is progressing bt sil needs improvement or entyevl practice. Ts i realistic ating of performance at midterm, and some raings ol 2 may be reascnate at the al 1 — Unsatisfactory: Prtormanceis below standards and reques Cveopment ren ee practice. Ts ring i gen when there fs ‘a concern about performance. lM EVALUATION AND SCREENING: 8. Articulates a clear and logical rationale forthe evalvaton proves. Miterm 1 34 Final 1 2 @ 4 4. ‘Selcts relevant serening and assesment methods wie conaiorng sc ace a ens proves, cote), Hens, snlenecetase pace wa 1 (2) 3 4 mi 1 2 @ 4 10, Determines cents occupations pti and seromarce trough appoprate sees moss Migem 1 2 @ ¢ Final 1 2 pr 4 11, Assesses cent actor and oo)! porto iner cczpatna pefomarco wien 1 @ 38 4 rm 1 2 @ « 42. Obtains sufficient and necessary information from relevant resouroes such as client, famile, significant others, service ‘providers, and records prior to and during the evaluation proces. Mier 12 4 Final 1 2 4 19, Administers assessments n a unior manner to ensure findings ae vaid and relable Miterm 12 4 Final fe 4 “4, Adjustsimodifies the assessment procedures based on cients ‘nee0s, behaviors, and cute, wen 1 @ 3 4 ml ee ee 15, Interprets evaluation resuls to determine clients cocupatonal performance strengths and challenges. tii 12) Final 1 2 Doe Establishes an accurate and appropriate plan basod onthe ‘evaluation resus, through integrating mute factors such as cents piorites, contexts), theories, and evidence-based prac. Mdem 1 2 (3) 4 Final 1 2 @ 4 Documents the results ofthe evaluation process thet demon- strates cbyctve measurement of cients ccevpatonal perorm- ance, Stara ee ; Final 1g Comments on strengths and areas for improvement: Jen due a a Hie se huey te al prc, feyatt info Palade Anon inp ere twmfoetalae Wi) (rar learn bv ee Hes Waltons ie ut With a aia “dl recone Pe and puns A Gear parsee! tft Perbirinoe NwAs, Inte bina Wits At ‘oh ptt, daw Mra APN: w Ive Lett ty Vegan fp Ws IN. INTERVENTION: 18, Articulates a clear and logical rationale for he intervention process. Midterm 1 g a 4 Final 1 Oo + 19. Uilizes evidence from pubished research and relevant resources {o make informed intervention decisions.20, Chooses occupations that motvate and challenge cients. V. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICES: wan 1G) 9 4 27. ounonase tough prac or dacotion te abo a aie assign aprorat reconebties oe oust heteoy assistant and occupatnal therapy ade 2 Selects relevant occupations tacit cens meeting estb- emdpoe Mite 4 304 a ae rm 1 2 (> 4 in) 12 ©4 28. Demonstrates through practice or discussion the abiity to actively colaorate wth he occupational eapyaestant. 22, implements intervention plan that are clen-centered. * Mann 1) D8) a ‘ Final 1 2 ® 4 Fr ‘ 6 28 amore neg lt at ad nd eed 23, Implements intervention plans that are occupation-based, ‘to occupational therapy services at this ste ser Maem 1 2 @ 4 Midterm 1 34 Fal 1 2 ® 4 Final 1 2 @ 4 ‘24, Modifies task approach, occupations, andthe environment fo 39, Accomplishes organizational goals by estabishng proses, smaxinize cient performance developing strategies, and mesting deadlines. me waem 1 &) 3 4 Moon 1 G3 4 Frat 12 @ 4 Final 1 2 f) 4 25. Updates, modifies, or terminates the intervention plan based 31. Produces the volume of work required in the expected time upon carl monoang ofthe cess tome mem 1 6) 3 4 wom 1 @ 3 4 aes Fa sit 2k Dt 26. Documents client's response io betfces in a manne tat ‘Comments on strengths and areas for improvement: demonstrates the eficacy of interventions. Mtom 1 (2) 3 4 er Ie at Jc Fra ae a) 4 ovake Wu omen o LT ya yontie nr i sen Aue A Ate | pace ie ic Gites. IM ear rae ie fe iia Panik wl 2 ki nye fobs att Shin inpatient it iepr Fee set Slater el are ee Act Wee orale Sere Ine Wnptived On. Adapt ree frets a iy tt ad ae fi ye ae eieas Pie id peed Wor Ind gee ag Uipthow oe 5 plead tine Intrag titer t KF Ainentahr Aten ny adnate (act gedRATING SCALE FOR STUDENT PERFORMANCE 4 — Exceeds Standards: Pertormance shih lle and satiated ‘This ang rarely given and would represent the top 5% ofall the students you rave supervised. 9.—Meets Standards: Pertrmarce is consent wih entryvel prac Th ag inreauenty given at mem ris ron rating at 2— Needs improvement: Perormance is progressing but sil neess improvement or enity-evl pace. This realistic rating ot Performance at materm, and some rings of 2 may be reasonable at the fal 1 —Unsatstactoy: Fertormarce is below standards and requres ‘evtogment err eel race. This rang guen when there is. ‘aconcem about pecormance ‘VI. COMMUNICATION: £2, Clearly and ettectively communicates verbally and nonvetbal- ty winches femtes sgntcant oes, coleaques. sence provers andthe puthe wen 1 @ 3 4 ft 1 2 @ 4 Bil ple ead sre ocr eco we eae wee 2 Ge Final 1 2 0 4 Sse oa hill ce Fee Peon le ‘ Fa) PE Oe en ¢ Uses anguage sppoprat tothe recipient othe intormaton ineuing Bt nt ltd to furdng agence and regulatory agen mgm 1 2 (3) 4 Final ‘le 1G Comments on strengths and areas for improvement: ene ai fn ka iis a in We tr 5 Se wi). ber Avan Dre Whe, Shorre [npn enn We ie Nek: & Qonpoet lewal] wndceapindy Oe Uh Y) trace ne [hep 6 Able tice 4 preonll mire eas 4 Uplans tae] Reh inty We Vil. PROFESSIONAL BEHAVIORS: 36 Collaborates with supervisor(s) to maximize the learning rece vam 1 2 38 @ mi 12 437. Takes responsibilty fo attaining professional competence by ‘seeking out learning opportunities and interactions wih super ‘sander wan 1 2 @ 4 Final 1 2 3 es 68, Responds constctalyt fesdbck | wien 1 289 @ Final i ie 38, Demonstrates consistent work behaviors incucng ntatve, proparednes, dependabiy, and work site maintenance. wen 1 2 3 @ Final, 1 2 &@ @ 40, Demonstrates eect ine managenent. wan 1 2 @ 4 fd tk 8 41, Demonstrates postive interpersonal sls including but oti ted to cooperation, fei, tact, and erty Midterm 1 2 @ 4 Final 1 2 3 @ 42, Demonstrates respect for diversity facorso thers inclcing ‘ut not imited o socio-cultural, socoeconomi, spittual, and este choices. Maem 128. Fro 4 Re sr Comments on strengths and areas for improvement: J 6 a sary! she is abe fo YL Uy ify Y ics Ria he Ake A Wireddefueh job Wl Fedlaue tine pnts reject ld dieop. a iS Veh Aided - Ate b et as Aa, LeOhs | A- ft a ine in ‘ange 4 ee oho is oyPERFORMANCE RATING SUMMARY SHEET Pertormance Noms | FUNDAMENTALS OF PRACTICE | 1. Adhere to eics 2. Acer to satel regulations ‘3. Uses judgment in salety IL BASIC TENETS OF OCCUPATIONAL THERAPY | ‘Ariens va rd bbls —, 5. Atelts valve of cosipaton | % 6. Conmunicatos role of eupatoral herent % “L Hicterm Ratings 7. Collaborates wit clients IL EVALUATION AND SCREENING 8. Aiculates cea rationale for evaluation x 9. Selects relevant methods 410. Determines occupatonal profile | eae, 11. Assesses lent and contra aos 12. Obans sulin and necessary normaton 3 1 Admnters assessments 14. Adustsmdes assessment peceoues 16. teres evaluation esuts 16 Establishes accurate pan Z 117. Documents results of evaluation we IM INTERVENTION 16 Arteultes clear atonal for rveton 19 Unizes evcence o make inrmed decisions 20 Chooses oocupaons hat mavate and calenge 2, Selects relevant ooopatons implements cien-certered eremios 2 Iplemerscccyaton based iervenions 24 Neries approach, cecinaton and enonment 2 Updates, modes, or emiates nenenton pan 26, Documents cients response V. MANAGEMENT OF OT SERVICES 277 Demonstals aby o assign trough practice or dscusscn 28 Demonte abi to colabort trough pereo:dscusion z 28. Understands cosis and nding 0, Aacomplshes ogarzatonal goals 21, Prades workin expected tne ane ‘VI COMMUNICATION: | 34. Weiten communication is legible 36, Uses language appropriate to recent Vil, PROFESSIONAL BEHAVIORS 36, Colaborates with supervisor St Tae eps x resin opr, 38, Responds const 39, Demonstrates con 40, Demonstrates tine management 41, Demonstrates positive interpersonal stil DIE OAT omy QQngnnnny 42. Demonstrates respect fr diversity _ I ‘TOTAL SCORE I MIDTERM: Satisfactory Performance, .............90 and above +122 points and above Unsatisfactory Perormance. ........... 89 and below «121 points and belowREFERENCES 1 American Occupational Therapy Associaton. (1998). Standards of ractce for ccupatonal therapy American Jour of Occupational Thora, 62, 266-263, 2. hoctedtation Counc lor Occupational Therapy Education (1909) Standards for an accredted ecucatoral program forthe cocupa: tional therapst. American Joural of Occupational Therapy. 58, 575-582 3. National Boar for Certication in Occupational Therapy (1997), ‘atonal Study of Oceupational Therapy Practoe, Exocutve Summary 4. American Occupational Therapy Associaton. (2000). Occupational therapy code of ethics (2000), Amencan Journal of Occupational Therapy 54, 614-616. 5. American Occupational Therapy Associaton (2002) Occupational therapy pracoe framework: Domain and process. Amentcan Joumal of Occupational Therapy, $5, 606-639, GLOSSARY Client Factors: Those factors hat reside tin he cient and hat may alloc poromance in areas of oceupaton. Chen factors nude body functons an boy stucures * body ures a cient facto, iecuing physical cogntve, psy chosocialaspects|—the physilogcalfurction of body systems (cling psychologcal tunctons)" (WHO, 2001, p19) * boty sructures—‘anatorical parts of he body such as gas, limbs and that component [rat support body uncon] (WHO, 2001, p10) (Occipational merapy pace revert Domain and proces. “Amoncan soural of Cccypatnal Therap. 55, 606-628.) (5) Code of Ethics refer to wwwacta rgigoneralcoe.asp Collaborate: To work together wih a mutual sharing of thoughts and ‘ideas. (ACOTE Glossary) ‘Competency: adequate skils and abilities to practice as an entry eve ‘occupatonal therapist or occupational therapy assistant Context: rfers toa variety of interrelated conditons wihin and su- ‘rounding the client tat influence performance. Conte's include cut, physica, socal, persona, sprtval temporal and vitua. (Cceupatonal therapy practice framework: Domain and process. “American Jounal of Occupational Therapy, 56, 606-629) (5) Efficacy: having the desired intluence or outcome (rom Neistat and ‘Crepeau, Eds. Wilard & Spackman's Occupational Therapy Sth edition, 1998) ‘0 22y te ArercanOcspator Teay Assn, el ages io partis walt may be repre wr crn pat by any means wou pes, Pons Unto Sas of Aree. Entry-level practice: orto mir acta orgmerbersiaretitoes! sect pat Evidence-based Practice: ‘oxnscentious, expt and usicious use of current best endance in making decisins about the care of i wal patents. The practice of eidacca-based eat care) moans integrating incividualcrical expertise with the best aval able eternal dinical exdence tom systematc research. (Sackett and coleaques, Evtdece-based medicine: How 0 oractice and teach EBM, 1997, 62) (tom the Mary Law arfile "Evdence- Based Practice: What Can It Mean for ME?—ourd online at won acta. org) ‘Occupation: Grougs of actives and tasks of everyday ito, named, organized and given value and meaning by individuals anda cu- ‘re; cccupaton is everything peope dota cceuny themsehes, including lacking ater themseives (sel-care), enjyg ile (leisure), and contriuting tothe social and economic fabric of ‘heir communities (productivity); the domain of concern and the ‘therapeutic medium of occupational therapy. (Townsend, edtor, 1997, Enabing Occupation: An Occupational Therapy Perspecive, 181) Occupational Performance: The resut of @ dynamic, interoven rle- tionship between persons, envrenment and occupation over a perso ifespan the ably to choose, organize. and satisfactory perlorm meaning occupations tht are curly defined and ‘ge appropiate for locking afer ones enjoying life, anc con- tnbuting to the social and economic feb of a conmunty (Townsend, ectr, 1997, Enabling Occupation: An Occupational Therapy Perspective 9.181) Occupational Profil: a profie inst deserbes the cients occupational history, patterns of cally ining, interests, values and needs. (Occupational therapy precce framework Domain and process. ‘American Journal of Occupational Therapy, 56, 606-638) (5) Spiritual: a context)—ne fundamental orentation ofa persone: that which inspires and motivates that individual. (Occupational therapy practice framework: Domain and process, American Joural of Occupational Therapy 56, 606-833) (5) ‘Theory: “an organized way of thinking about given phenomena. In ‘ceupational therapy the phenomenon of concern is occupational endeavor. Theory attempis to (1) deine and explain the relaion- ship between concepts or ideas relatd to the phenomenon of interest, (2) explain how these relationships can predict behavior ‘revents, and (3} suggest ways tha the phenomenon can be changed or controled. Occupational therapy theory is concerned ‘wth four major concepts related to occupational endeavor: pe- 300, environment, heath, and occupation” (Neistadt and Crepeau, Ets, Wilard & Spackman's Occupational Therapy, Sh edtion, 1998, p521)