FOUNDATION STUDENT LEARNING AGREEMENT &
COMPETENCY EVALUATION
Student
Email
Phone Number
Agency
Unit
Unit Address
Field Instructor
Email
Phone Number
Task supervisor
Email
Phone Number
Period covered by this Learning Agreement: from__
Field Faculty
to
Email
Phone Number
As part of the Learning Agreement, please specify the following:
Student’s Work Schedule (include days and hours, coverage in field instructor’s absence, make up
arrangements for student absences:
MSW Supervision (include days, times, and with whom):
Briefly list the primary activities the student will be engaged in:
•
•
•
•
•
1
Instructions for completing this combined learning agreement and competency evaluation document:
The UNC-CH, School of Social Work recommends that the student’s learning agreement and competency
evaluation be completed in discussion between the field instructor and the student in consultation with
the field faculty member. The learning agreement is a dynamic teaching and learning tool that specifies
the areas of learning each field experience should provide. It brings together the contributions of the
classroom instructor, student, field instructor and field faculty member. The learning agreement has a
direct relationship to the student’s course work and the learning opportunities available at his/her field
site. The learning agreement should be developed by the student, in consultation with the field
instructor/task supervisor, after identifying the learning opportunities the agency offers. Concurrent
students should complete the learning agreement by the sixth week of placement and block placement
students by the end of the second week of placement. The learning agreement is in place for the
duration of the student’s placement. The form must be entered on-line. The field instructor, task
supervisor (if applicable), student, and field faculty member should complete appropriate sections. All
must sign the learning agreement and evaluation electronically. The learning agreement and
competency evaluations become part of the student’s permanent academic record. Both student and
field instructor should keep a printed copy of this document.
Organization: There are nine Core Competencies. Within each competency are 2 to 6 Indicators. For
each indicator are several suggested Learning Activities. Competency evaluations for both SOWO 520
and SOWO 521 are included on this combined document.
Learning Agreement Development
Begin the document by completing the front page, which includes identifying information, supervision
arrangements, and a work schedule for the student. Review the competencies and indicators on the
subsequent pages; these represent the school’s expectations regarding achievable outcomes during
placement. Foundation placements should include approximately 50% direct practice (DP) activities and
50% Community Management and Policy Practice (CMPP) activities, and the Learning Agreement should
reflect this. Consider the suggested learning activities for each indicator and check those that are
available in the agency (DP, CMPP, or both), which will help the student accomplish the prescribed
competencies. Each indicator has two “other” boxes. This is an optional area to add appropriate
activities that may not be in the list of suggested learning activities.
The learning agreement is documentation of the planned learning experience during the student’s
practicum. It should be viewed as a dynamic document that can be changed as the practicum proceeds.
Major changes should be reviewed by the field faculty member prior to the student making changes in
the document.
The learning agreement should be reviewed at least monthly by the student, field instructor and task
supervisor. Monthly reports should report the student’s progress in applying the indicators of the
competencies.
2
Field Competency Evaluation Grading Criteria
A Competency Evaluation is required at the end of each semester/summer session in which the student
has registered for field education. In the Evaluation the field instructor/task supervisor and student will
provide ratings of the student’s Competency for each indicator of each competency. The rating should
reflect the student’s Competency relative to where they are in the program (e.g. first semester vs.
second semester). The rating scale for this form ranges from the need for significant improvement to
exceptional mastery, as described below:
1. Unsatisfactory – student does not have command of essential knowledge and/or does not
understand the application of knowledge to practice.
2. Limited Competence – Student demonstrates limited understanding of essential knowledge
and/or the application of knowledge to practice.
3. Emerging Competence - Student understands the skill and demonstrates a growing ability to
apply knowledge to practice.
4. Competence - Student understands and can assess the applicability of the skill and
demonstrates the skill regularly in practice.
5. Excellence - Student readily adapts the skill to the setting and demonstrates mastery of the skill
in novel, diverse and difficult contexts.
N/A (Not Applicable) may be appropriate in the first semester, before a student has an opportunity to
engage in an activity, but this rating would rarely be appropriate at the end of the second semester of
field. Likewise, a student may receive a rating of 1 or 2 on some indicators during the first semester
when beginning to practice new skills, but a rating of 2 on the final evaluation would indicate the
student’s lack of ability to acquire the skill level expected by the end of the placement. When a student
receives a rating of 2, 1, or N/A in an indicator during the first semester, the field instructor or task
supervisor and student must provide comments about the action plan developed to improve these areas
of competence in the final semester. If a student receives a rating of 2 or below in the final semester,
the field instructor or task supervisor and the student must provide specific comments to provide
context for the rating.
At the end of each competency (not each indicator), students will provide an example from the field
related tasks that demonstrates developing proficiency.
Following the Competency Evaluation, a grade of P (pass), L (Limited Competence), F (fail), or IN
(incomplete) is assigned by field faculty. The grade of P indicates satisfactory Competency; the grade of
F indicates unsatisfactory Competency; a grade of L indicates the student is performing at a minimal or
inconsistent level. Students receiving an L in field education are required to work with the field
education office to develop a plan for future field experiences designed to improve the student’s
Competency. IN means that the student withdrew during the semester or in some other way did not
complete all the requirements during the semester. If a mark of IN is given the student will develop a
contract with the field faculty member, defining when and how the work will be completed. A grade will
be assigned when the work is complete. A grade of F will be assigned if the work is not complete by the
conclusion of the contracted time period.
Responsibility for assigning the grade belongs to the field faculty member.
3
Core Competency 1 – Demonstrate Ethical and Professional Behavior
This student
demonstrates the
ability to:
1a. Make ethical
decisions by
applying the
standards of the
NASW Code of
Ethics, relevant
laws and
regulations,
models for ethical
decision-making,
ethical conduct of
research, and
additional codes
of ethics as
appropriate to
context.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1b. Use reflection
and selfregulation to
manage personal
values and
maintain
professionalism
in practice
situations.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review agency policies and NASW code of ethics and analyze similarities
and differences in weekly supervision.
Identify ethical concerns and explain how the NASW Code of Ethics guides
your response to clients and client systems.
Identify how your personal values may conflict with social work
professional values and develop plan for guiding your practice.
Review and discuss with FI/TS agency policies related to confidentiality,
client rights, and social work disclosure requirements.
Respond to ethical concerns at the time of occurrence and resolve
appropriately with the guidance of the FI/TS.
Discuss cross-cultural issues with FI and other agency professionals.
Other:
Other:
Check all that
apply
DP
CMPP
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☐
☐
☐
☐
Competency Evaluation for Item 1a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Utilize weekly journal to record personal reactions to work with clients
and client systems.
Use appropriate boundaries and use of self-disclosure with client systems
and agency staff.
Identify how your personal values may conflict with social work
professional values and develop an appropriate plan for guiding your
practice with clients and client systems.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☒
☒
☒
☒
☐
☐
☐
☐
Competency Evaluation for Item 1b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
4
1c. Use
technology
ethically and
appropriately to
facilitate practice
outcomes.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1d. Use
supervision and
consultation to
guide
professional
judgment and
behavior.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
1e. Demonstrate
professional
demeanor in
behavior;
appearance; and
oral, written, and
electronic
communication.
5 – Excellence
4 – Competence
Utilize social media in adherence with agency guidelines, while
maintaining clients’ rights to privacy and confidentiality.
Follow agency policy regarding internet use.
Other:
Other:
☒
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Competency Evaluation for Item 1c
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Demonstrate efficient use of supervision through developed agendas,
prioritized needs, and articulated concerns.
Discuss ambiguity and process challenges in supervision.
Record feedback and implement suggestions in practice.
Show appropriate emotional intensity and respond non-defensively to
FI/TS feedback.
Other:
Other:
Check all that
apply
DP
CMPP
☒
☒
☒
☒
☒
☒
☒
☒
☐
☐
☐
☐
Competency Evaluation for Item 1d
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Dress appropriately for agency setting, exhibit timely attendance, and use
professional work habits.
Establish and maintain appropriate relationships with administrators,
staff, and colleagues.
Understand, articulate, and adhere to agency policies and guidelines.
Manage workload and complete tasks within expected agency timelines.
Other:
Other:
Check all that
apply
DP
CMPP
☒
☒
☒
☒
☒
☒
☒
☒
☐
☐
☐
☐
Competency Evaluation for Item 1e
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
5
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
1 – Demonstrate Ethical and Professional Behavior:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
1 – Demonstrate Ethical and Professional Behavior:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
6
Core Competency 2 – Engage Diversity and Difference in Practice
This student
demonstrates the
ability to:
2a. Apply and
communicate
understanding of
the importance of
diversity and
difference in
shaping life
experiences in
practice at the
micro, mezzo, and
macro levels.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
2b. Present
themselves as
learners and
engage clients
and
constituencies as
experts of their
own
experiences.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with FI the impact of race, class, color, culture, disability,
ethnicity, family structure, marital status, national origin, religion, age,
sexual orientation and socioeconomic status on client system.
Review literature on best practices with diverse client systems.
Observe social work interactions and interventions with client systems.
Seek consultation from other social workers and team members.
Identify mechanisms of possible discrimination and oppression in the field
agency and community.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Other:
Competency Evaluation for Item 2a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Learn and use ethnographic interviewing techniques In work with clients,
client systems, and colleagues.
Discuss with FI/TS the challenges of respecting right of clients and client
systems to maintain different perspectives and positions than your own.
Participate in trainings related to cultural competency/humility and
discuss with FI in weekly supervision.
Utilize weekly supervision to discuss oppressive and discriminatory
practices and seek solutions to these.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 2b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
7
Complete journal entries on ways in which personal biases and values
2c. Apply selfinfluence work with diverse client systems.
☐
☐
awareness and
self-regulation to
Explore and process personal biases, projection and counter-transference
manage the
☐
☐
in weekly supervision.
influence of
Recognize and support clients’ rights to self-determination.
personal biases
☐
☐
and
values in working Other:
☐
☐
with diverse
clients and
Other:
☐
☐
constituencies.
5 – Excellence
Competency Evaluation for Item 2c
4 – Competence
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
2 –Engage Diversity and Difference in Practice:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
2 – Engage Diversity and Difference in Practice:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
8
Core Competency 3 - Advance Human Rights and Social, Economic, and
Environmental Justice
This student
demonstrates the
ability to:
3a. Apply their
understanding of
social, economic,
and
environmental
justice to
advocate for
human rights at
the individual and
system levels.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
3b. Engage in
practices that
advance social,
economic, and
environmental
justice.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Read agency policies on discrimination.
Identify current political, social, economic & environmental events and
discuss the effects on client systems with your FI/TS.
Recognize incidents of institutional discrimination and discuss with FI/TS.
Draft a letter to the media or policy maker advocating for social justice.
Participate in agency and NASW advocacy days.
Advocate for client system access to services.
Other:
Other:
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 3a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Observe an intake or waiting room and assess the environment on client
systems and service providers. Discuss with FI/TS.
Make referrals that are culturally appropriate.
Identify community coalitions/groups that advocate for client systems.
Attend committee/community meeting convened to promote social
justice.
Inform client systems of their rights.
Assist client systems in identifying eligibility for social programs.
Help client systems navigate social service delivery structures.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
Check all that
apply
DP
CMPP
☐
☐
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 3b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
9
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
3 – Advance Human Rights and Social, Economic, and Environmental Justice:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
3 – Advance Human Rights and Social, Economic, and Environmental Justice:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
10
Core Competency 4 – Engage in Practice-informed Research and ResearchInformed Practice
This student
demonstrates the
ability to:
4a. Use practice
experience and
theory to inform
scientific inquiry
and research.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4b. Apply critical
thinking to
engage in analysis
of quantitative
and qualitative
research methods
and research
findings.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
4c. Use and
translate research
evidence to
inform and
improve practice,
policy, and
service delivery.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Develop research questions that emerge from interactions with client
systems.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 4a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Participate in an agency research project.
Assist agency in gathering research data.
Identify the strengths, weaknesses and appropriate use of varying
theories and treatment models.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 4b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify agency practice models.
Describe how agency practice models are chosen.
Research evidence based practice interventions for client systems and
discuss with FI/TS.
Investigate available information relevant to practice from a variety of
sources and discuss findings in supervision.
Discuss with FI/TS how practice experience informs agency policy and
practice.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
11
Other:
☐
☐
5 – Excellence
Competency Evaluation for Item 4c
4 – Competence
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
4 – Engage in Practice-informed Research and Research-Informed Practice
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
4 – Engage in Practice-informed Research and Research-Informed Practice
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
12
This student
demonstrates the
ability to:
5a. Identify social
policy at the
local, state, and
federal level that
impacts wellbring, service
delivery, and
access to social
services.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
5b. Assess how
social welfare and
economic policies
impact the
delivery of and
access to
social services.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
5c. Apply critical
thinking to
analyze,
formulate, and
advocate for
policies that
Core Competency 5 – Engage in Policy Practice
Select appropriate learning activities and/or add additional activities in
the “other” box.
Research and describe laws and policies impacting clients systems served
by the agency.
Interview administrators, staff and/or clients in order to understand the
impact of public policy on clients.
Attend and participate in staff, task force and board meetings.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 5a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify agency processes involved in policy development.
Develop or update policies and procedures for agency.
Tour local community agency(s) and learn about policies that effect
service delivery.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
Other:
☐
☐
Other:
☐
☐
Competency Evaluation for Item 5b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with FI/TS agency culture and its impact on service delivery.
Discuss with FI/TS political, social and economic factors that affect agency
policy.
Discuss with FI/TS strategies to effect policy change within the agency.
Attend social work advocacy day.
Help client systems navigate barriers created by agency and community.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
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☐
13
advance human
Other:
☐
☐
rights and social,
economic, and
Other:
environmental
☐
☐
justice.
5 – Excellence
Competency Evaluation for Item 5c
4 – Competence
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
5 – Engage in Policy Practice
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
5 – Engage in Policy Practice
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
14
Core Competency 6 – Engage with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
6a. Apply
knowledge of
human behavior
and the social
environment,
person-inenvironment, and
other
multidisciplinary
theoretical
frameworks to
engage with
client and
constituencies.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify human behavior and social environment theories from
coursework that are relevant to the agency client population.
Discuss with FI/TS the application of HBSE theories with specific client
systems in supervision.
Provide to & discuss with FI/TS at least two journal articles that describe
the impact of human behavior in the social environment with client
systems served by the agency.
Complete initial interviews and assessments using theories and
approaches of human development and the ecological perspective.
Identify client’s strengths, resilience and informal supports.
Use person-in-environment and strengths perspective in assessments,
goal setting, and interventions.
Identify and review characteristics unique to the client system. Discuss
impact on client engagement and interaction with FI/TS.
Utilize genograms and ecomaps to engage clients and assess relationships
and connections.
Demonstrate social work approaches to empower client systems to
partner in the helping process.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
6b. Use empathy,
reflection, s and
interpersonal
skills to
effectively engage
diverse clients
and
constituencies.
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
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☐
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Competency Evaluation for Item 6a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Observe field instructor and other community professionals’ relationship
building and interactions with client systems.
Explore clients’ personal values, cultural preferences and sensitivities to
increase student’s awareness of community and larger culture.
Express care, concern, authenticity and genuineness with client systems.
Demonstrate effective communication skills such as paraphrasing,
reflective listening and reframing with client systems.
Maintain appropriate professional boundaries with clients and agency
staff.
Complete process recording and/or video/audio recording and review
with FI/TS in supervision.
Record a log or journal of personal reactions to client systems.
Check all that
apply
DP
CMPP
☐
☐
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15
Identify personal strengths, limitations and challenges with FI and
appropriately manage such in supervision and professional activities.
Recognize and appropriately address counter-transference and
transference in client interactions with FI/TS in supervision.
Other:
Other:
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5 – Excellence
Competency Evaluation for Item 6b
4 – Competence
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
6 –Engage with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
6 – Engage with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
16
Core Competency 7 – Assess Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
7a. Collect,
organize, and
apply critical
thinking to
interpret
information from
clients and
constituencies.
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review current empirical literature related to the client populations and
services offered by the agency.
Review and utilize assessment tools and approaches used in the agency.
Observe other professionals completing assessments with individuals,
families and/or groups and review observations with Field Instructor
and/or other agency personnel.
Collect relevant data from individuals, families, other organizations, and
other significant elements of the client system’s environment.
Create a genogram or ecomap for an individual or client system.
Conduct a community needs assessment, review findings with Field
Instructor, and use the assessment to inform social work practice with
clients.
Document and articulate a sound assessment of client systems at both
the Direct and Community, Management and Policy Practice levels in
accordance with agency procedures.
Present assessment findings in team meetings or case review
conferences.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7b. Apply
knowledge of
human behavior
and the social
environment,
person-inenvironment,
and other
multidisciplinary
theoretical
frameworks in
the assessment of
Check all that
apply
DP
CMPP
☐
☐
☐
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☐
☐
☐
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☐
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☐
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Competency Evaluation for Item 7a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify biological, psychological, social, spiritual and environmental
factors that influence development and behavior of client system.
Identify and discuss theoretical frameworks and evidence based practice
models appropriate for the client system.
Critique the strengths and limitations of theoretical frameworks for
guiding assessments.
Employ a strength based perspective in identifying strengths, healthy
coping behaviors, and resources with clients.
Explore areas of needs, challenges and clients’ desired service outcomes.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
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☐
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17
data from clients
and
constituencies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7c. Develop
mutually agreedon intervention
goals and
objectives based
on the critical
assessment of
strengths, needs,
and challenges
within clients and
constituencies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
7d. Select
appropriate
intervention
strategies based
on the
assessment,
research
knowledge, and
values and
preferences of
clients and
constituencies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Other:
☐
☐
Competency Evaluation for Item 7b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Collaborate with client systems to identify and select goals and objectives
for interventions.
Review selected goals with field instructor and treatment team.
Continually assess client system progress toward achieving goals and
modify as needed.
Using the agency format, develop an appropriate case plan.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
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Competency Evaluation for Item 7c
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review literature on evidence-based interventions used with client
systems in the placement setting.
Consult with field instructor to identify potential intervention strategies
that are consistent with assessment.
Develop a treatment plan in collaboration with client systems consistent
with client system values and preferences.
Plan a program or intervention to address a community problem using
logic models and theories of change.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
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☐
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Competency Evaluation for Item 7d
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
18
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
7 – Assess Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
7 – Assess Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
19
Core Competency 8 – Intervene with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
8a. Critically
choose and
implement
interventions to
achieve practice
goals and
enhance
capacities of
clients and
constituencies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
8b. Apply
knowledge of
human behavior
and the social
environment,
person-inenvironment,
and other
multidisciplinary
theoretical
frameworks in
interventions
with clients and
constituencies.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
Select appropriate learning activities and/or add additional activities in
the “other” box.
Provide selected interventions to clients consistent with identified goals.
Lead a case presentation (either in class or at the agency), solicit feedback
from FI/TS, agency staff, professors, classmates, and then incorporate
feedback into case plan.
Integrate the client’s family, community, and larger cultures into
interventions.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
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Competency Evaluation for Item 8a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Discuss with field instructor and/or task supervisor how an assessment
translates to an intervention.
Implement interventions directed at multiple system levels consistent
with the assessment tool (case plan).
Review with field instructor and/or task supervisor how the client’s
values, preferences, and expectations impact the context of the
intervention provided.
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
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☐
☐
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Other:
Competency Evaluation for Item 8b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Check all that
apply
DP
CMPP
20
8c. Use interprofessional
collaboration as
appropriate to
achieve beneficial
practice
outcomes.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
8d. Negotiate,
mediate, and
advocate with
and on behalf of
clients and
constituencies.
Participate in staff meetings and interdisciplinary meetings within the
agency.
Establish partnerships between the agency and local faith communities,
civic groups and neighborhood associations.
Other:
Other:
8e. Facilitate
effective
transitions and
endings that
advance mutually
agreed-on goals.
5 – Excellence
4 – Competence
☐
☐
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☐
☐
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☐
Competency Evaluation for Item 8c
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Identify and collaborate with key people in client systems critical to
effecting change.
Research resources within the agency and community and make
appropriate referrals.
Coordinate referrals and assist clients with accessing needed services.
Discuss in agency team meetings or supervision unmet client or client
system needs, resource gaps, or service barriers, and develop advocacy
plans.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
☐
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
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☐
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Competency Evaluation for Item 8d
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Plan and facilitate the termination process, including review of client
systemsaccomplishments, and identification of a process of obtaining
services if future needs arise.
Coordinate transitions of clients/projects to other agency staff through
planned sharing of goals and service needs.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
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Competency Evaluation for Item 8e
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
21
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
8 – Intervene with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
8 – Intervene with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
22
Core Competency 9 – Evaluate Practice with Individuals, Families, Groups,
Organizations, and Communities
This student
demonstrates the
ability to:
9a. Select and use
appropriate
methods for
evaluation of
outcomes.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
9b. Apply
knowledge of
human behavior
and the social
environment,
person-inenvironment, and
other
multidisciplinary
theoretical
frameworks in
the evaluation of
outcomes.
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
9c. Critically
analyze, monitor,
and evaluate
intervention
processes and
Select appropriate learning activities and/or add additional activities in
the “other” box.
Review agency evaluation tools and processes.
Research and use reliable and valid evaluation strategies relevant to
intervention.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 9a
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Provide FI/TS with a copy of the SOWO 510 syllabus. Discuss with FI/TS
how you may integrate field learning experiences with classroom
assignments.
Discuss with FI/TS how practice evaluation tools are selected.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
Competency Evaluation for Item 9b
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Utilize instruments, assessment tools, and record keeping to monitor
client change.
Plan and implement methods to seek feedback from clients and
stakeholders.
Interview stakeholders and clients to evaluate program effectiveness.
Check all that
apply
DP
CMPP
☐
☐
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23
outcomes.
Conduct a focus group of participants in a program to assess program
experiences and outcomes.
Create and conduct a client satisfaction survey (survey individuals,
groups, organizations, and/or communities).
Develop and implement evaluation tools to assess client knowledge and
behavior change post interventions.
Other:
Other:
5 – Excellence
4 – Competence
3 – Emerging
2 – Limited
Competence
1 – Unsatisfactory
N/A – at this time
This student
demonstrates the
ability to:
9d. Apply
evaluation
findings to
improve practice
effectiveness at
the micro, mezzo,
and macro levels.
☐
☐
☐
☐
☐
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☐
☐
☐
☐
Competency Evaluation for Item 9c
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
Student SelfField Instructor
Student SelfField Instructor
Assessment
Assessment
Assessment
Assessment
Select appropriate learning activities and/or add additional activities in
the “other” box.
Integrate evaluation results into ongoing and future planning and
selection of interventions.
Draft a report to a public or private funder concerning program or project
activities and outcomes.
Utilize evaluation and field placement experience to develop best
practices.
Other:
Other:
Check all that
apply
DP
CMPP
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
5 – Excellence
Competency Evaluation for Item 9d
4 – Competence
First Evaluation: SOWO 520
Final Evaluation: SOWO 521
3 – Emerging
Student SelfField Instructor
Student SelfField Instructor
2 – Limited
Assessment
Assessment
Assessment
Assessment
Competence
1 – Unsatisfactory
N/A – at this time
SOWO 520 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
9 – Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities:
Field Instructor/TS Comments:
SOWO 520 Comments
(required if there is a
score of 2 or less OR if
score is NA, then an
Student comments:
activity plan should be
addressed)
SOWO 521 - Student provides a specific, descriptive example of demonstrated competence of Core Competency
9 – Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities:
24
Field Instructor/TS Comments:
SOWO 521 Comments
(required if there is a
score of 2 or less)
Student Comments:
LEARNING AGREEMENT SIGNATURES
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
25
SUMMARY FOR SOWO 520
Overall Rating of Student’s Competency:
Enter rating here
(5 = Excellence, 4 = Competence, 3 = Emerging, 2 = Limited Competence, 1 =
Unsatisfactory)
Student’s Major Strengths and Limitations:
Directions and Goals for Student’s Future Learning:
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
SUMMARY FOR SOWO 521
Overall Rating of Student’s Competency:
Enter rating here
(5 = Excellence, 4 = Competence, 3 = Emerging, 2 = Limited Competence, 1 =
Unsatisfactory)
Student’s Major Strengths and Limitations:
Directions and Goals for Student’s Future Learning:
Field Instructor Signature
Task Supervisor Signature
Student Signature
Field Faculty Signature
Date
Date
Date
Date
26