School of Social Welfare
University at Albany, State University of New York
Liaison: ___________________________
Agency: ________________________________________________________
Field Instructor: __________________________________________________
From: ____________ To: _____________
Semester:
1st
2nd
Student: ________________________________________________________
INSTRUCTIONS
BSSW Evaluation Instrument #2 & 3
This BSW field evaluation instrument is comprised of six sections: Student as
Learner; Development of Professional Attitudes, Values and Ethics; Knowledge
and Skills for Agency-Based Work; Communication Skills; Assessment Skills; and
Intervention Skills. The skills are applicable to individuals, families, groups, and
community assignments.
For each evaluation period, please rate a student on every item by entering the
number that corresponds to your assessment of the student’s demonstrated
performance in the box or boxes to the right of each item. Reevaluate a student’s
performance from a previous evaluation when the student’s performance has
changed.
Ratings
0
1
2
3
4
5
9
No significant opportunity yet
Unacceptable (never or rarely meets criteria)
Needs improvement (meets criteria inconsistently)
Satisfactory (meets criteria most of the time)
Very good (consistently meets criteria)
Outstanding (consistently exceeds criteria)
Not applicable in setting
Summarize the student’s overall performance for each section by placing an X at
the point on the bar graph that represents his or her overall performance for that
section. Include comments in the space provided after each section.
The last page includes an overall student rating, space for comments, goals for the
next evaluation period, and the signature page. The student and field instructor are
required to sign each evaluation. When a student disagrees with the contents of the
evaluation, he or she can submit an addendum stating the reasons for disagreement
which is attached to the evaluation in the student’s file. The faculty field liaison
reads all evaluations and is available for discussion at the student’s or field
instructor’s request.
Any time a student receives a summary rating, in any section, of “needs
improvement” or “unacceptable,” please provide supporting documentation
in the comments section.
Your careful attention to completing the evaluation form is greatly appreciated.
Evaluation is a crucial part of a student’s professional training and provides an
opportunity for feedback and educational planning.
School of Social Welfare, University at Albany, State University of New York
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
Describe the student’s assignment for this evaluation period:
Describe the student’s caseload:
How many individual clients assigned?
How many families or groups assigned?
The Student as Learner
The student is able to
Dec
May
participate in developing/updating learning agreement.
utilize the field instructor as an educator of social work values, attitudes, knowledge and
skills.
prepare for supervision, including development of an agenda.
seek direction for an assignment, as needed.
seek and respond nondefensively to feedback about professional performance and apply to
practice.
identify and discuss strengths and challenges in knowledge, skills, accomplishments and
learning needs with the field instructor.
complete process recording(s) in a timely manner.
demonstrate initiative in participating in learning opportunities such as on-site trainings.
May
demonstrate an ability to generalize learning from one case or situation to another.
carry learning from supervisory conference to work with clients, agency
and community.
identify experiences in the field agency that address learning needs and relate to
coursework.
use process recordings or other learning to critique practice
BSW Evaluation #2 & 3 11/2011
2
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
Summary for Student as Learner (See Instructions)
☐
☐
☐
unacceptable
needs improvement
satisfactory
9 Not applicable
☐
☐
very good
outstanding
Please comment on specific behaviors utilizing examples of student’s strengths and challenges:
Development of Professional Attitudes, Values and Ethics
The student is able to
Dec
May
identify personal values about race, creed, sexual orientation, color, gender, age, national
origin, socio-emotional factors, disabilities or life-styles and their impact on social work
practice.
demonstrate acceptance of self and others.
protect client’s right to confidentiality including information retrieved and obtained
through technology.
preserve human dignity and client individuality.
identify (and incorporate – May) social work values and ethics in work with colleagues
and clients and in other professional relations.
support (and protect – May) clients right to self-determination.
form and sustain professional relationships and recognize the impact of student’s
personality on them.
respect the rights of others to maintain perspectives and positions different from one’s
own.
act professionally and responsibly in matters of punctuality, appearance and presentation
of self.
set priorities for the use of time.
BSW Evaluation #2 & 3 11/2011
3
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
May
struggle with and resolve value dilemmas.
prevent personal values and biases from interfering with practice decisions in the best
interest of the client.
demonstrate a commitment to a multi-cultural perspective.
demonstrate a commitment to the promotion of social and economic justice.
Summary for Development of Professional Attitudes, Values and Ethics (See Instructions)
☐
☐
☐
☐
☐
unacceptable
needs improvement
satisfactory
very good
outstanding
Please comment on specific behaviors utilizing examples of student strengths and challenges:
Knowledge and Skills for Agency-Based Work
The student is able to
Dec
May
identify the field agency’s structure, goals, sanction and target population and
implications for service delivery.
seek out relevant agency policies and procedures.
understand the relation of the field agency to other agencies or organizations in the
community.
identify the range of relevant services (formal and informal) available in the community
and the ways in which these services are used for referrals by the field agency.
identify the formal and informal channels of communication in the field agency.
identify the primary duties and responsibilities of various staff positions with whom the
student has contact.
share the collegial work responsibilities, including meeting deadlines and accepting
assignments.
BSW Evaluation #2 & 3 11/2011
4
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
Dec
May
understand the types and purpose of groups within the agency setting.
identify the purpose and use of agency records and forms.
complete agency records, statistics and forms on a timely basis.
May
seek out relevant, evidence-based practices appropriate to the setting.
identify social policy relevant to the agency.
take an active role in collective work such as team meetings, staff meetings, committees.
Summary for Knowledge and Skills for Agency-Based Work (See Instructions)
☐
☐
☐
☐
unacceptable
needs improvement
satisfactory
very good
☐
outstanding
Please comment on specific behaviors utilizing examples of student strengths and challenges:
Communication Skills
*Please note: client system, in all cases, may refer to a group, community, family, or organization.
The student is able to
Dec
May
listen attentively to client/client system*.
reflect client’s concerns empathetically.
demonstrate the following skills:
appropriate use of open and closed ended questions
paraphrasing
focusing
clarifying
summarizing
BSW Evaluation #2 & 3 11/2011
5
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
Dec
May
recognize the importance of student nonverbal communication with the client/client
system*.
recognize nonverbal client/client system* communication.
recognize that moralizing, threatening, criticizing and being judgmental are not
appropriate in a social work interview.
communicate clearly and strategically with field instructor, agency personnel and referral
sources verbally, electronically and in writing.
May
use e-mail, faxes, and other technology to communicate appropriately with clients and
colleagues.
limit persuading and premature reassurance in a social work interview.
focus an interview, group or community meeting.
Summary for Communication Skills (See Instructions)
☐
☐
☐
unacceptable
needs improvement
satisfactory
☐
☐
very good
outstanding
Please comment on specific behaviors utilizing examples of student’s strengths and challenges:
Assessment Skills
The student is able to
Dec
May
gather information collaboratively with the client to define the problem.
recognize the importance of separating facts from her or his own attitudes and biases.
use different sources of information, including nonverbal data, client’s support system,
and collateral contacts in the assessment process.
recognize and elicit information that will contribute to the understanding of the client and
the client’s situation.
BSW Evaluation #2 & 3 11/2011
6
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
Dec
May
articulate some of the emotional, social (including effects of racism, sexism and ageism),
economic, and cultural facets of a presenting problem.
organize, interpret, and summarize collected information.
identify group dynamics.
identify sources of strengths and stress in the client and in the client’s support system.
individualize clients.
May
present this information in a well-written formal assessment incorporating client
perspective, strengths and priorities, using agency format.
use her or his knowledge of group dynamics to help clients build a positive group
culture.
develop a plan of intervention on multiple levels based on the problem definition and
appropriate, relevant, evidence-based practices.
revise the plan based on new information.
Summary for Assessment Skills (See Instructions)
☐
☐
☐
unacceptable
needs improvement
satisfactory
☐
☐
very good
outstanding
Please comment on specific behaviors utilizing examples of student’s strengths and challenges:
Intervention Skills
The student is able to
Dec
May
demonstrate problem-solving skills.
understand the concept of contracting as a key element of problem-solving with clients.
negotiate the terms of the work with the client/group, including time, place and
frequency of contact.
involve the client/group in establishing desired goals.
BSW Evaluation #2 & 3 11/2011
7
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
9 Not applicable
Dec
May
develop goals with the client based assessment
identify immediate, short-term and long-range goals with client
keep goal planning within the constraints of the agency’s function
set priorities, with the client, in plans for intervention.
reduce larger problems into manageable parts.
identify appropriate tasks for the student, the client system, and collateral contacts.
recognize client/group barriers to seeking help.
gain cooperation from relevant agencies to meet client needs.
monitor the implementation plan and, assess new problems.
respond to crisis situations.
articulate and utilize themes and/or patterns from session to session .
identify issues related to interdisciplinary teamwork in supervision
anticipate and deal with a range of client/group and student reactions to termination
May
actively participate in case conferences and interdisciplinary teams.
identify and carry out interventions in a group setting.
demonstrate advocacy skills and mobilize services for clients/client groups.
determine with client when to terminate intervention.
engage the client/group in a review of accomplishments and areas of continuing concern.
Summary for Intervention Skills (See Instructions)
☐
☐
☐
unacceptable
needs improvement
satisfactory
☐
very good
☐
outstanding
Please comment on specific behaviors utilizing examples of student strengths and challenges:
BSW Evaluation #2 & 3 11/2011
8
0 No significant opportunity yet
2 Needs improvement
4 Very good
1 Unacceptable
3 Satisfactory
5 Outstanding
Overall Student Rating
☐
unacceptable
☐
☐
needs improvement
satisfactory
☐
very good
9 Not applicable
☐
outstanding
Comments:
Goals for Next Evaluation Period:
Would you like to talk to the faculty liaison regarding this student’s field experience?
☐
Yes
☐
No, unnecessary at this time
Instructor’s signature
Date
I have read the contents of this evaluation.
Student’s signature
BSW Evaluation #2 & 3 11/2011
Date
9