Field Instrument 12 Seale for Evaluation of ‘Midterm a Final “< \dStudent_Kevstyma Kaminski Date >| ZZ2\ ODO Instructions for Rating Field students on the 10 Competencies of CSWE in the First Part of the Evaluation: Name of “The standard by which a field student isto be compared is that ofa new beginning-level sosil worker. The 10 competen specified in ths evaluation form are those established by our national accrediting organization (the Couneil on Social Work Education). Under teh competency statement are several items that we ask that you rete according tothe following criteria “The field student has excelled in this area “The field student is functioning above expectations for field students in this area z “The field student has met the expectations for field students inthis area “The field student has not as yet met the expectations in this area, but gives indication s/he will do so in the near future The field student has not met the expectations in this area, and does not give indications s/he will do 30 in the near future ja_| Not applicable, as the field student has not had the opportunity to demonstrate competence in this area B-)9)-)414 ‘Comments may be made under any competency statement, if desired. Please be sute to indicate those area in which you think the field student is particulary strong and those areas in which the student need improvement, “This evaluation is intended to give the field stadent feedback about her or his performance. The field instructor's rating ofthese items will not directly be used to calculate the grade given tothe field student, ‘The faculty Ditector has responsibility of assigning the grade for field instruction, ‘The grade that is assigned willbe based on: the faculty Director's overall evaluation ofthe student’s performance in field placement in conjunetion withthe field instructor’s evaluation and other submitted ich ast field student logs; seminar participation; papers that integrate field with classroom instruction. you prefer to use another evalyation system in addition to this form to evaluate a student's performs Faculty Director. totals please discuss this with the A: Field student identifi ‘CSWE Compet ‘a professional social worker and conducts himself/herself accordingly. TEs i TR HOE 1.2 _| Has a commitment to enhancing the profession Wis [2 [1 [ma 13 [Has a commitment to conducting himselfferseifas a profesional socal worker Gls (3 [2 [1 [nm 1.4 _ | Has a commitment to career-long learning and growth 5 @)3 [2 [1 [no 1s ‘Advocates well for client access to the services of social work E 4 [3 [2 [1 [na 1.5 Pratioes personal flection and self-correction to assure continual profesional development | § (4) [3_|2 [1 | na 17] Attends wel to profesional roles and boundaries es 2 [te 1.8 _ | Demonstrates professional demeanor in appearance @l4 [3 [2 [1 | na 1.9 | Demonstrates professional demeanor in communication 5s (23 [2 [it [ma 1L10~_[ Uses supervision and consultation effectively 5 Op 2 [1 | m att | Student will wear namctag every day Diets [2 fm [[Acr2 | Student wil dress appropriately reps fe me Comment Lerekynnlnrs gone Anos ard Beyord wns Aree SWE Competence #2: Feld student applies solal work etal prineples to gulde his or her professional practice. Zi [Is knowledgeable about te value base of the profeion SOB 2 [1 [ae 22 | Is nowledgeable of and abides by the ethical standards oF 5 {a3 12 |b pm the profession [23 [Is knowledgeable, and abides by, awe relevant 0 socal work ss [21 [aa Z| Recognizes and manages personal values na way that allows ses [2 [2 [neProfessional values to guide practic (eg, on such Issues as Abortion and gay rights) 25 _[ Tolerates well ambiguity a vesolving ethical conficts EME 2 [1 [oa 3.6 ~[ Te able to apply strategies of ethical reasoning .o arrive at principled decisions ma 2 [1 [am “Ket? | Student will show respect to students as observed by Field Instructor yi4 21 [aa Comments: ‘CSWE Competence #3: Field student applies critical thinking fo inform and communicate professional judgments. Til [Is Fnowledgeable about the principles of logic and scientific inquiry 7OpPL =| 32__| Isable to grasp and comprehend what is obscure 3/4 2 [1 [na 33 | Is skilled in using eritical thinking augmented by ereativity and curiosity 3/4 2 [1 [na 3.4 | Has good assessment skills sft 2 [1 [na 3.5. | Has good problem-solving sills SID fs [2 1 [oa 3.6 | Has good data gathering skills 3/4 2 [1 [mm 3.7 | Analyzes complex material well steps [2 [1 [na 3.8 | Is killed at appraising & integrating multiple sources of knowledge including sO ]s [2 [1 faa research-based knowledge and practice wisdom 35 Ts skied at analyzing models of assessment, prevention, intervention, and evaluation [3 [4 [3 [2 [1 Con} S10} Demonstrates effective oral communication in working with individuals families, [5 |@)[3 [2 [1 | ma groups, organizations, communities, and colleagues TIT T Denpestates effective writen communication in working with individuals, families, [5 (@)[3 [2 [1 [ma groups, organizations, communities, and colleagues et T | Student will communicate with 10% grade Suocess House teachers weekly 4 2 [1 [ma ‘Tet? | Student will attend Life Coach mesting weekly D+ [3 [2 [1 [oe Comments: [ CSWE Competence #4; Feld student engages diversity and difference in practice EL_[ Treats diverse clients wih dignity and respect 1 [na 42 Ts knowledgeable and respectful oF clients who differ by such factors as age, class, color, (5) 1 | ne culture, disability, ethnicity, gender identity and expression, immigration status, politcal ‘ideology, race, religion, sex, and sexual orientation I~] Recognizes the extent co which a culture's structures and values may oppress, marginalize, 1 [na alienate, or create or enfiance privilege and power Fa] Tas sufficient selE-awareness to eliminate the influence of personal biases and values in T [na working with diverse groups TS] Recognizes and communicates her or his widestanding of the importance of difference in T [aa shaping life experiences 46 ‘Views herself or himself as a learner and engages those he or she works with as informants T [na | ‘Act | | Student will write a reflection on cultural humility T | na | ‘Act2 | Student will work withthe GSA at DSHS once a month 1 [1a Comments:(CSWE Competence #5: Field student advances human rights & social & economic justice, 5.1 | Recognizes that each person, regardless of position in society, has basic human rights, (S/]4 [3 [2 ]1 |na sac a coe, aati, peey, xo gina ot Be elk aoa 3] Recognizes tho global inlewonnecioas oF oppression ands owindgeable about] 3] @)|3 [2] fam theories ofjustce and stags to promote man and cil righ Ti | Cadena te tne & mostuclon i opel dria SOs fm 3 | Tesi! wedeoaning Te larenrigiis roi en. enone jin Spe D2 [tf 535 [Ts sled at engaging in actos that advance socal & economic ustoe Se | etT Student wil advocate for House students with elvan eachers as obser byFiekd [5 (4)]3 [2 }1 [am Insbrustor ta at | Stent wil contact sadets daring COVID-I9 to assare tay have aceamry resouros ([ 5) c eo sgaled Ps Alec hCEe Last & Vogue oS onaler Beery al geintens Leeds Kec@ae load OF SodartS Cogaqedeod Cane deck CSWE Competence #6: Field student engages in research-informed practice and practice-informed research. G:1__| Tatalled at using practi experience to inform research SP BP we 6.2 _ | Iskilled at employing evidence-based interventions 32 [2 [1 [ma 6.3 _| Is skilled at evaluating her or his practice 5 (Os [2 [1 [mm 6:4 | Is skilled atusing research ndings to improve practice, polly, and social service delivery | 5 3 [2 [1 [ma 63 _ | Comprehends quantitative research s_[4 [3 [2 [1 dw 6.6 | Comprehends qualitative research 3 4 [3 2 [1 fap | 6.7 | Understands seientific and ethical approaches to building knowlede x [4 [3 [2 [1 Cow ‘Act | Student wil wit literature review on hour to work with students with anxiog ss [2 [1 [ma ‘Act 2 | Student will send high-school students self-care ideas to help cope with COVID-19 (le Be fa Comments ‘CSWE Competence #7: Field student applies knowledge of human behavior and the social environment. T1_| Te knowledgeable about human behavior acrows the Ife course a fay3 [2 [7 [wa 7.2 [Ts knowledgeable about the range of social systems in which people Ti 3 [4 2 [1 [a 7.3 _| Is nowledgeable about the ways social systems promote or deter people immainamning | 5 {3 f2 [1 [na or achieving health and well-being 74 | Te skilled at applying theories and knowledge about biological variables, social variables, [5 {4} [2 [7 | ma ciara variables, psychological variables, and spiritual development 7 | Issilled at wiizing conceptual frameworks to guide the processes of assessment, 5] qDl2 ft fm intervention, and evaluation “et | Student wil take a seminar course on Traumna-lnformed Services and Treatments for (S| 4] ]2 J [ra Crossover Youth ‘at | Student will complete a taining on Adverse Childhood Experiences (ACES) Ole EET fa Comments:‘CSWE Competence #8: Field student engages in policy effective social work services. practice (o advance social and economic well-being and to deliver 1 Tindestnds at policy affects servi delivery ee [52 [ Actively engages in policy practice 3 [2 [1 food 3.3] is knowledgeable about te history oF Wek policies &servioes xt 3. [Tv knowledgeable about corent social policies and services [2 fa [8.5 | Is fowiedgeable about the role of practice in policy development 2 [1 [ms 54 | Teakillod-at analyzing, formulating, and advoeating for policies that advance social well ola being 37 ~ [Tesi at celaborating wit colleagues and cons Fr effestive policy action SAD 13 [2 [1 [oe +7 | Stadent will write polly review onthe attendance and behavior policiesin the DSHS [5)]# [3 |2 [¥ [as hhandbook Kat | Stadent wil tend a One Towa webinar on how wo advocate Tor LGBT® related Tas TPs z I]t am from home ~ Comments: CSWE Competence 89: Feld student responds to contexts that shape practice. oN Ts informed, resourceful, and proactive in responding to evolving organizational, 514 ]3 [2]! f=) community, and societal contexts at all levels of practice | 5 Ressgniet tat the context oF pratice is dynamic, nd has the Knowledge and skis to [3 [4-32 [1 (aB)] respond proactively 93 fis skilled at continuously discovering, appraising, and attending to changing locales, [5 [4 [3 [2 [1 (a) populations, sienifie nd technological developments, and emerging societal trends in order to provide relevant services Ta] Trak at providing leadership in promoting sustainable changes in sevice d sya fs [2 |) em and practice to improve the quality of social services oe ACT [Student wil lp ereate an open closet wih lodhing and other essentials 3 [af fo at] Student wil lp analyze how COVID-19 wil disproportionately affect dhe Mar a ]2 [1 fea population in Dubuque commen: TEWE Competence #10; Fld student engages, assesses, intervenes and evaluates with individuals, families, groups, ‘organizations, and communities. GE iikiod a eng, aang, md plement venee tased merenons [> ]* (]2 ]t | me designed to achieve cient goals 03 Tesiled atusing research and ehnological advances ZO | be 10.3” Is skilled at evaluaing rogram outcomes Ss [ap [tne TD. | Ts sled at evaluating the effectiveness of her or his practice seep [2 [1 [na Og} Tesklld at dovelopig, analyzing, advocating, and providing Ieadenp forpoticiesand | 5 [4 (3/2 [1 [ma services TOA Is siled at promoting social and esononic justice sf 2 | [ae 10:7 [Is sled at engaging (developing a positive relationship) with individuals Se [3 [2 [1 [ae109 _| Ts skilled at engaging groups 10.10 | Is skilled at engaging organizations 10.11 _| Is skilled at engaging communities 10.12 | Is skilled at assessing individuals, 10.13 | Is skilled at assessing families 10.14 | Is skilled at assessing groups 10.15 | Tsskilled at assessing organizations 10.16 | Is skilled at assessing communities 10.17 | Isskilled at providing effective services to individuals 10.18 | Is skilled at providing effective services to families 10.19 | Is skilled at providing effective services to groups 10.20 | Is skilled at providing effective services to organizations 10.21_| Is skilled at providing effective services to communities ‘Act I_| Student will meet with a student outside of Success Houses weekly ‘Act2_| Student will meet with 10th grade House students weekly Act3_| Student will complete Sereening, Brief Intervention, and Referral to Treatment training ‘Act4_| Student will debrief with FI. weekly ‘Act 5_| Student will meet weekly with 10 students independently ‘Act 6__| Student will complete training for suicide prevention and postvention ‘Act7_| Student will complete a self-evaluation at Midterm ‘Aet& | Student will ereate an evaluation journal fora high school student with weekly goals and checking eelofo[oye/ole/ofaktalolofololok CREES- REP FEPREPEEE PES ‘Comments: Arup wes reek Wika Whoidsal Stuclen'§, Cc Lomed Wn Cai ba Qolinvorned w| Ker Waase temas as Ga nwelurs Ades soap eltekoe GOICES BHA Grech. Ueretpe Weg ee ABI Lo parwle ome pn Geter eelebergags WOT AA SS BwodkenkS Ghat ore poltente ant unicalse Qe Wgek < ee Loerle Wwe do here and wee elitr bo RAag tochrnoe eres Wwe[ FINAL OVERALL EVALUATION: tee Please check one of the following at the final evaluation, At the midterm evaluation do NOT complete this section, "This field student has excelled in field placement by performing above expectations for field students. If an appropriate position were open at this agency, for a beginning level social worker, ths field student would be considered among the top candidates for this position. ‘This field student has met the expectations of the field placement. This field student is ready for beginning level social work practice, ‘This field student is not yet ready for beginning level social work practice. ‘This field student is not yet ready for beginning level social work practice, and has demonstrated serious problems in performance, and pethaps should be encouraged to pursue another major. lease issue a grade you believe corresponds with the student's readiness for beginning social work practice: A (A>) BY Bs B CH CC Dt D DF Commensllaboraton: ne : Ro ee sacs Ee bere WE ARC CRED LO AT ephe led RE ase Gee HE Gases Signature of Agency Field Instructor. Agemy SE SEN ‘The following section should be completed by the field students DN ve Se2lZo Student comments/elaboration: My agency supervisor and faculty Director have discussed this evaluation with me, and I avs received a copy. My agreement or disagreement follows: agree with the evaluation Ido not agree with evaluation ‘Comments: Field Student’s Signature __ Date Ifthe field student disagrees with the evaluation sheshe should state that disagreement in writing and subsnit a copy to both the agency supervisor andthe faculty supervisor. A meeting between the student, agency supervisor, and faculty supervisor should then be held to discuss the disagreement. “rat, Yeaesi (hn Propes), Ar erretetion the Cm on Sock Wark Edo, 200 Bical Pac and Accretion Standards Soi Work ‘eccarete wt Hs