SMITH COLLEGE SCHOOL FOR SOCIAL WORK
Faculty Field Advisors Placement Recommendations for Returning Students
Name of Student: ____________________ Faculty Field Advisor: ____________________
Please summarize your recommendations for next year's field placement for the student named
above. Include types of learning, supervisory styles, opportunities student most needs, type of
setting and any particular needs (personal or educational) you wish to stress for the student.
____________________________________
Signature
_________________________
Date
Please send to the Field Placement Committee by the date noted on calendar
sswfield@smith.edu
SCSSW, Lilly Hall, Northampton, MA 01063
MAJOR CASE STUDY SHEET
(to be completed by FFA for all case studies and returned to the School)
Date: _______________
Faculty Field Advisor: __________________________ Focus: _________________________
Identifying Client Information
Age: _____
Race/Ethnicity: ________________
Citizenship: ____________
Gender: _______
Religion: _____________________
Social Class: ___________
Sexual Orientation: _________________________
Facility: _________________________
Modality: __________________________
Duration of Intervention: ____________________
Mode of Intervention: __________
Presenting Problems: ___________________________________________________________
Diagnostic: ___________________________________________________________________
Major Themes/Issues: ___________________________________________________________
How Services were Funded: ______________________________________________________
Education & Usage: ___________________
Summary of Case: (please limit to one paragraph)
Grade (circle one): P
MP
F
Evaluation of Case Study’s Potential use for Teaching :
Excellent ____
Very Good ____ Fair _____ Poor _____
Identifying Student Information:
Author’s Name: __________________
Author’s Race/Ethnicity: ___________
Placement Year:
1st
2nd
FOR OFFICE USE ONLY
Student’s approval obtained: _________
Date: _________
When Used: _______________________
When Used: _______________________
When Used: _______________________
Course: _________________________
Course: _________________________
Course: _________________________
FACULTY FIELD ADVISOR’S EVALUATIVE FEEDBACK & GRADING RUBRIC
Major Case Study
Faculty Field Advisor:
Student’s name:
Title of case:
Date:
Please comment on the following objectives and return this form along with the case directly to
the student.
1
Objective
The case study is well
written
2
Case material and
clinical ideas are well
organized and clearly
presented
3
The client’s concerns
are clearly stated
4
The case study
includes an appropriate
and comprehensive
biopsychosocial
assessment
The case study
includes a clear
statement of mutually
agreed upon goals
5
6
The treatment plan is
clearly articulated and
tied to the assessment
and goal
7
Relevant theory is
selected and
appropriately applied
to the assessment,
treatment plan and
practice interventions
Needs Improvement
Meets expectations
Exceeds expectations
8
9
10
11
Objective
There is a clear
description, and
illustration through
process recordings, of
the practice
interventions and the
rationale for them
There is a
demonstrated
awareness and
understanding of
student’s own
reactions to the client,
including attention to
counter-transference
issues
The case reflects the
capacity to evaluate
one’s own practice and
an understanding of
the factors which
contributed to the
outcomes in the case.
Relevant questions are
raised for consultation
Needs Improvement
Meets expectations
Exceeds expectations
Final grade (circle one):
P:
Pass (8-11) objectives of the assignment meet or exceed expectations)
MP: Marginal Pass (6-7 objectives meet or exceed expectations)
F:
Fail (fewer than 6 objectives are met)
Note: Students receiving a grade of MP or F will be given the opportunity to re-write the case
study if they wish to do so. Students receiving a final grade of F will be asked to participate in a
consultation designed to help address the areas of concern.
SMITH COLLEGE SCHOOL FOR SOCIAL WORK
MSW PROGRAM MONTHLY REPORT
(to be sent to your FFA by the 1st of each month)
Name
Agency
Month
FFA
CASELOAD Please indicate all family, group and individual case assignments.




Number of new cases assigned this month __________
Number of cases closed this month__________
Total number of current cases ___________
Please describe the sociocultural variables reflected in your current caseload
(race/ethnicity, religion, age, primary language, socioeconomic status, gender
identity, sexual orientation, ability/disability etc.)
DIRECT SERVICE ACTIVITIES
Please note the number of sessions conducted and the time involved this month in each category.
Number of Sessions
Time Spent in Session
Group sessions
Family or couple sessions
Individual Child
Individual Adolescent
Individual Adult
Individual Elder
Number of hours spent in milieu work (in community with clients)_____
Number of cancelled appointments_____; number of “no-shows” ______
SUPERVISION AND TRAINING
 Number of hours of primary supervision this month _____
 Number of hours of secondary supervision this month _____
 Number of process recordings completed this month _____
 Please note any conferences, team meetings, student seminars, trainings, etc. attended
this month
ADDITIONAL ACTIVITIES Please note any activities not covered in above material, i.e.
phone contacts, collateral work on behalf of clients, consultations, anti-racism work.
READINGS Please indicate major readings done this month (approx. 4 hours/week expected)
NARRATIVE
Please use this space to share with your FFA your reflections on your experience in internship
this month (for example, emerging themes in your learning and professional development,
dilemmas you may be encountering, issues of race and racism as they are experienced in the field
and in the clinical practice with which you are engaged, and any other questions or issues around
which you might like your FFA’s input or assistance) This section serves as a communication
with your FFA about your ongoing experience and should provide a basis for discussion during
FFA visits. Please attach additional pages as necessary.
Intern - Agency Learning Plan
Student Name: _____________________
Date: ______________
Agency Name: _______________________________________________________
Supervisor Name: _____________________________________________________
FFA: _____________________________
This learning plan is to be developed in consultation with your agency supervisor and in keeping
with the School’s stated learning objectives for field. Please assess what your major learning
goals and objectives are for this training year and describe the ways in which you feel you might
best meet them.
Individual Learning Goals:
Activities & Assignments designed to help meet these goals:
_____________________________
Agency Supervisor
______________________________
Intern
Please summit to the field work department:
SCSSW, Lilly Hall, Northampton, MA 01063
sswfield@smith.edu
STUDENT DESCRIPTION OF INTERNSHIP
(to be completed by the group of students at placement site)
(Please TYPE OR WRITE CLEARLY so that information may be duplicated for distribution.)
Name of Agency
Location
Number of Smith Students in the Agency
---------------------------------------------------------------------------1.
Outline the agency philosophy, focus, and commitment towards professional education:
2.
Describe caseload and check treatment modalities available:
a. Casework with Adults
c. Group Treatment
b. Casework with Children
d. Family Treatment
3.
Using the group opinion, what kinds of things should another student know about your
agency? Be both brief and specific.
4.
Describe the interaction of the agency with the community.
5.
Describe the learning opportunities available in this setting in addition to supervision.
6.
Please note anything you would like to share about your experience with the anti-racism project
(2nd years):
Signed:
(All students participating
in the formulation of the
description.)
Smith College School for Social Work Field Evaluation
Note: Thisevaluation format has been developedin close collaboration with the elected field
representatives from student org. and the field department. It is meant to give students one
comprehensive evaluation tool in which they can assess the totality of the field experience.
Students should complete this entire evaluation, discuss and share the supervisory portion
with their primary supervisor who should sign it to indicate that it has been read and
discussed, and then submit the entire evaulation to the field department according to the
instructions on the Master Calendar. Any questions or concerns should be directed to the
field department. Thank you!
Name:_______________________
Agency:_____________________
Supervisor:___________________
FFA_________________________
Quantitative Question Key: 1 (lowest) to 4 (highest), choose N/A where “not applicable”
Field Work Department and Placement Process
1) The field assignment process was presented in an organized and clear manner and was
followed in accordance with those guidelines. _____
2) The field work department made an effort to address special circumstances I identified
(family obligations, medical considerations, etc), within the parameters of the program.
_____
3) Please share any additional feedback on the field placement process:
Internship setting
Please comment on the nature and quality of the social work training at this agency

The agency has a clearly articulated conceptual and/or theoretical framework that guides
the work. _____

I was welcomed and oriented to the agency when I first arrived. _____

My agency provided orientation to and support of clear safety protocols in the work
setting. _____

My educational needs, the School’s learning objectives, and my role as a learner were
supported in my agency. _____

The work assignments I was given were linked to my stage of learning and to my role as
a social work intern. _____

Please share any additional feedback on your experience in the field agency. _____
Field Assignments (monthly reports, weekly readings, process recordings, issue-oriented report,
agency assessment, anti-racism assignment and the major case study)

The field assignments were consistent with Smith SSW’s published learning objectives in
the Field Guidelines. _____

Field assignments were relevant to material presented in summer coursework. _____

The field placement assignments were presented in an organized and understandable
manner. _____

I was able to use the assignments as a forum to reflect on my work in the agency. _____

Which assignments were most useful for your learning and why?

Which assignments were least useful for your learning and why?

Please share any additional feedback on the field assignments:
Faculty Field Advisor
Please describe your experience with your FFA and the nature of the advising process
Consultation

The FFA helped to clarify roles and responsibilities of the FFA, Supervisor and interns.
_____

The FFA provided perspective on the process of my learning and identified learning
opportunities available in the agency. _____

The FFA advised me about educational goals for second year placement (for first year
students) or future professional goals (for second year students). _____

The FFA was helpful in addressing issues of difference, racism and anti-racism work.
_____
Educational Support


The FFA clarified and supported resolution of field challenges (ex. working within
hierarchical settings, addressing conflict, collaborating with the supervisor, etc.) _____
The FFA followed up with me around any issues or concerns raised in my monthly
narrative. _____


The FFA provided adequate and timely feedback on written field assignments. _____
The FFA was available for questions and concerns regarding assignments and the
internship _____

The FFA was actively engaged in my educational experience. _____
Administration

The timing and structure of the FFA field visit was on keeping with what is described in
the Guidelines for the Field Internship. _____

The quality of the student-FFA dialogue during the FFA visit enhanced my learning.
_____

The quality of the student-supervisor-FFA conversation during the FFA field visit served
to promote my learning. _____
Additional feedback

Please share any additional feedback about your experience with the field advising
relationship:
Field Supervisor
The School has long endorsed the principal that an open dialogue creates the best atmosphere for
learning and has encouraged students and supervisors to mutually evaluate the student’s learning
experience. In keeping with this belief, students are asked to share their evaluation with the
supervisor, to discuss it openly and for both supervisor and student to sign the evaluation,
indicating that it has been shared and discussed. Any questions or concerns about this should be
directed to the field department.
Development of Professional Identity

My supervisor acted as a professional role model, demonstrating a commitment to
continued social work learning. _____

My supervisor demonstrated an alliance with and willingness to serve client(s) from
differing backgrounds. _____

My supervisor demonstrated clear and professional boundaries. _____

My supervisor modeled professional social work ethics and values and helped me address
ethical dilemmas in the work. _____
Development of an Understanding of the Agency’s Role and Functions

My supervisor was able to convey the agency’s philosophy, orientation, strengths, and
limitations. _____

My supervisor was open to discussing my questions about the agency. _____

My supervisor helped me understand the agency context and any disagreements that
arose in the agency. _____

My supervisor helped me understand how issues of oppression impact the client
population and the community in which the agency is based. _____

My supervisor taught effective collaboration with, and utilization of, additional
community resources. _____
Development of a Knowledge Base for Practice

The supervisor helped me learn to integrate clinical theory and practice techniques
relevant to biopsychosocial assessment of and intervention with clients. _____

The supervisor was able to engage me in the learning process by attending to my learning
goals and current objectives. _____

The supervisor consistently provided written and verbal feedback on the required two
process recordings each week. _____

The agency supports learning via conferences, seminars, team meetings and readings,
providing an atmosphere that promotes inquiry. _____
Development of the Supervisory Relationship

The supervisor offered both support and constructive criticism designed to help me
develop my clinical social work skills. _____

The supervisor encouraged me to think in depth about the therapeutic relationship,
attending, for example, to issues related to the working alliance, the differential use of
self, as well as transference and countertransference themes. _____

The supervisor and I were to establish a positive and respectful learning alliance. _____

The supervisor provided the required two hours/week of supervisory time. _____
Additional feedback

Please share any additional feedback you might like to share on the supervisory
relationship
Student’s name _____________________
Supervisor’s name ____________________
Signature _________________________
Signature ____________________________
Date ____________
Date ___________
Student Self-Evaluation – (Signed by student)

I invested myself in my field internship. _____

I increased my capacity for self-reflection and to both give and receive feedback. _____

I developed my understanding of how to integrate clinical theory & practice. _____

I engaged as an active learner in reading relevant articles and texts. _____

I communicated with my supervisor about questions, learning concerns or clinical issues
I experienced. _____

I communicated with my FFA about questions, learning concerns or clinical issues I
experienced. _____

I submitted field assignments by the deadline. _____

I came to my supervision time with specific questions for discussion. _____

I consistently submitted and made use of the required two process recordings a week.
_____

I was able to share ideas and learn from my peers, staff and other professionals. _____

I was an active participant in identifying and pursuing my learning objectives. _____

I took advantage of the learning opportunities available to me in the agency. _____
Student Name: ________________________________
Signature: _____________________________
Date: ______________
SMITH COLLEGE SCHOOL FOR SOCIAL WORK
Northampton, MA 01063
EVALUATION OF THE COMMUNITY PROJECT ADVISOR
Student Name:
Advisor’s Name:
Date:
These questions are designed to elicit your assessment of the community project advisor’s
role in working with you on your project. It also serves as a self-assessment of your
participation. While you may submit your comments anonymously, it is suggested that you
share your thoughts directly with your advisor as well.
Part I
Possible
Responses:
Not at all
1
2
3
4
Extremely
5
1. Was the advisor available by the mail and/or telephone at mutually convenient
times?
2. Was the advisor helpful in identifying and articulating the focus of your
project, as needed?
3. Was the advisor helpful in identifying potential obstacles in completing the
project?
4. Was the advisor helpful to you in furthering your understanding of macro
practice skills?
5. Was the advisor helpful in clarifying your role with your community project
supervisor?
6. Was the advisor helpful to you in your writing of the final report?
7. Were you and your advisor successfully able to negotiate expectations about
the level or amount of effort required to complete the project?
8. How helpful was the advisor in suggesting ways to meet those standards?
9. How appropriate was the advisor’s interpretation of Smith standards of
performance?
10. Overall, was a good working alliance formed with your advisor?
11. How invested/supportive has your advisor been in this process?
12. How satisfied were you with the help you received from your advisor?
13. How satisfied were you with the turn-around time for comments from your
advisor?
NA
9