CUYAHOGA COMMUNITY COLLEGE

HUMAN SERVICES PROGRAM

PRACTICUM EVALUATION

STUDENT: Nicole Correa SEMESTER: Fall Year: 2021

COURSE: HS # 2850 INSTRUCTOR: Irene Diritsky

PRACTICUM SITE: Ohio Guidestone

ADDRESS: 3500 Carnegie Ave.

CITY/ZIP CODE: Cleveland, OH, 44115

PHONE NUMBER: (216) 870-6408

SUPERVISOR NAME: Ashley Katsaros

NUMBER OF TERMS THE STUDENT HAS BEEN IN, AT YOUR PRACTICUM

SITE: Two semesters

PRACTICUM DATES: FROM: June 2021 TO: May 2022

STUDENT SPECIALIZATION: X GENERALIST _____CHEMICAL DEP.

DESCRIBE THE TYPE OF AGENCY: (e.g. group home, treatment center, mental
health center, etc.)_______________________________________________________

_______________________________________________________________________

FUNDING SOURCE: X Private non-profit, ___ Public non-profit, ___For profit

If the student is assigned to a specific program within the Agency, please identify the
name and address._______________________________________________________

________________________________________________________________________
 CLIENT CHARACTERISTICS

Indicate the age, gender and socio-cultural background of the clients served by the
student:

AGE: ___Pre-school ___ Pre-teen ___ Adolescent ___ Adult ___ Seniors

GENDER: ____ Male ____Female

PROBLEM AREAS OF THE CLIENT POPULATION SERVED BY THE

STUDENT: (check all that apply)

____ Abuse ____ Income Maintenance

____ Aging ____ Learning Problems
____ AIDS ____ Legal Systems
____ Alcoholism ____ Marital Problems/divorce
____ Anti-social Behavior __x__ Mental Health
____ Chemical Dependency __x__ Parent/Child Problems
____ Child Protection ____ Physical Disability
____ Crisis Intervention __x__ Poverty
____ Domestic Violence ____ Other (Specify)
____ Developmental Challenges
____ Employment
__x__ Family Problems
____ Homelessness

SOCIO-CULTURAL BACKGROUND

Please identify the racial, ethnic and socio-economic background of the clients served by
the student: ____race, ethnicity and socioeconomic status
varies__________________________________________________________

________________________________________________________________________

I. QUALITY OF PROFESSIONAL DEVELOPMENT

EVALUATION CRITERIA: Using the following criteria, please rate the student on
Professional Development. Using the same form, students will be evaluated at mid-
semester and the end of each semester. During the mid –semester evaluation, students
may score a 1 or 0 in an area. By the end of the semester, students must perform at a
rating of 2 or better to successfully complete the course.
_________________________________________________________________
Performance meets or exceeds the agency standards =3
Performance is satisfactory/average =2

2
Performance needs improvement =1
Performance is unsatisfactory (CCC Instructor has been notified) =0
________________________________________________________________
RATINGS

MID-SEMESTER END SEMESTER

A.) Organization and Planning: Organizes and manages time

efficiently; completes tasks within a specified time frame; provides
accurate information about work and services completed. ______2_______ ________3_____

B.) Decision Making: Recognizes problems/potential problems;

makes sound decisions under pressure; exercises good judgment,
demonstrates progress toward independence. ______2_______ _______3______

C.) Dependability: Follows through with assignments; arranges

personal schedule to avoid interfering with professional obligations;
prompt, meets professional commitment /obligations as agreed with others_____2____ ______3______

D.) Initiative: Acts promptly; willing to take independent action;

Consistently attains goals; volunteers enthusiastically; self motivated _______2_____ _____3_______
E.) Resourcefulness: Readily determines an alternative course of plan/
action in event of change; seeks additional learning experiences to improve
areas of knowledge; thinks outside the box. ______2______ ____3_______

F.) Adaptability: Flexible; demonstrates a positive “attitude” to new

assignments, change, and adversity ______3_____ ___3_________

G.) Enthusiasm: Maintains a positive outlook; demonstrates

confidence; displays interest and curiosity _____2___ ____3____

H.) Interpersonal Skills: Conducts self in a tactful, professional

and positive manner, accepts criticism; is cooperative and respectful
of clients and staff; is able to work as a team member _______2____ ______3_____

I.) Professional Values and Ethical Conduct: Adheres to

policies and procedures of the institution and practicum program; conducts
self with honesty, integrity, and fairness; accepts and respects supervision
and guidance; respects and maintains the confidentiality of clients and personnel __2____ ______3____

J.) Verbal and Nonverbal Communication: Listens and follows

directions as given; actively participates in discussions and meetings;
demonstrates a positive attitude towards workload, preceptors, peers and clients__2_____ ______3_____

K.) Written Communication: Written work is well organized, clear,

concise, professional and consistent with the documentation policies and
procedures of the agency __2_____ _____3_____

L.) Professional Development: Knows and uses educational resources and

references appropriately; is aware of personal/professional strengths and
weaknesses; integrates classroom learning at practicum; utilizes supervision at
the practicum; completes self assessment and develops appropriate plans for
professional development __2_____ _____3____

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 II. QUALITY OF PRACTICE/COMPETENCY SKILLS

Students are expected to develop skills in each of the competency areas, throughout
their 3 semesters of practicum. Please complete the following:

1.) Identify the competency skills the student has on their goal sheet for this
semester, by checking the space next to the skills.
2.) Provide a rating of performance (using the scale identified above) for each
competency skill, at mid-semester and the end of semester.
3.) Document comments on student performance for each competency skill,
addressing the extent that each goal was met, were there modifications
required, student’s strengths and areas of weakness.

Students may also continue to demonstrate additional competencies not identified on

their goal sheet, in the performance of their duties at the agency. Please evaluate students
on these competencies as well, by providing comments in the space provided.

Check here if chosen as # RATING:

a semester competency MIDSEMESTER END SEMESTER

1.) INTAKE: ________ ___________ _____________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

2.)ASSESSMENT: _______ ___________ _____________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

3.) SCREENING: ___x____ ______2____ ______3______

COMMENTS:__Nicole Is learning the screening process and will review as new clients
are assigned.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_________________________________________________________

4.) REFERRAL:_____x___ ___2______ _____3_______

COMMENTS:__Nicole researches referrals for her clients so that she is prepared in

case need
occur___________________________________________________________________

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________________________________________________________________________
________________________________________________________________________
______________________________________________________________
5. CRISIS INTERVENTION:________ ____________ ____________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

6. CASE MANAGEMENT:________ _____________ _____________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

7. RECORD KEEPING:________ ____________ ____________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

8. COMMUNITY SUPPORT:________ ______2_____ ___3_______

COMMENTS:__Nicole has been learing how to find supports in the community that
would benefit her
clients.__________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________

9. OUTREACH:__________ ____________ ___________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

10. CO-THERAPY_____x____ _____2_____ ______3______

COMMENTS:_Nicole has been collaborating with others regarding her
cases.___________________________________________________________________
_Making great progress and good
communicator.___________________________________________________________
________________________________________________________________________
___
11. GROUP FACILITATION:________ ___________ _________

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 ( CO-FACILITATION)
COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

12. FACILITATION OF FAMILIES:_______ __________ ________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________

13. ADVOCACY:_______ __________ ________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

14. ORIENTATION, EDUCATION:________ __________ ________

PREVENTION
COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

15. BEHAVIOR CHANGER:________ __________ ________

COMMENTS:___________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

For the areas of practice that have a numeric rating, compute a mean score.( add
scores together and divide by the number of scores for mean rating) RATING=____

_Ashley Katsaros LISW-S 10/11/2021_ ____________________________

Supervisor Signature at Midterm Evaluation Student Signature at Midterm
/Date Evaluation /Date

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 END OF THE SEMESTER SUMMARY STATEMENT

STUDENT’S PROFESSIONAL ABILITIES:__Nicole thinks critically and thinks

situations through. She is reflective and insightful.

AREAS OF STRENGTH:
____She easily engages with her clients and has a very great ability to connect with
young people.
AREAS NEEDING IMPROVEMENT:
_I think Nicole is doing really well but I hope to see her confidence in her abilities
increase next semester.

ADDITIONAL AREAS NEEDED FOR STUDENT DEVELOPMENT:

_Nicole will comply with any mandatory trainings as well as seeking out her own
interests to build on her skills.

IF STUDENT IS GRADUATING, PLEASE COMMENT ON STUDENT’S

PREPAREDNESS FOR EMPLOYMENT AND SPECIFIC AREAS OF
EXPERTISE:___not graduating yet.

I HAVE READ AND PARTICIPATED

IN THIS EVALUATION:

Ashley Katsaros LISW-S 11/10/2021 ________________________________

SIGNATURE OF SUPERVISOR/DATE SIGNATURE OF STUDENT/DATE

________________________________________
SIGNATURE OF CCC INSTRUCTOR/DATE

Rev. ID 2001