UMSL School of Social Work, MSW Program
Advanced Social Work Practice with Individuals, Families and Groups
Agency Supervisor's Final Evaluation (Revised 05/2014)
Course 6800
Course 6850
Return forms: Hand-signed forms may be submitted in person or by fax to: (314) 516-6416. Forms sent as an email
attachment to socialwork@umsl.edu may be signed electronically provided the document is sent from the professional email
address of the practicum supervisor, and the student signer is copied. This fill form is best for a PC and Internet Explorer.
Student's Name:
Student ID#:
Semester:
Year:
Agency Name:
Supervisor's Name:
Phone:
Please complete the evaluation below by placing a check mark in the rating box that is appropriate for
the student for each practice behavior identified. Please use the comment area to discuss ways in
which the competency was met and to identify any areas in which you believe the student is
particularly strong or those areas that need improvement.
*Practice behaviors in italics are specific to advanced practice with individuals, families and groups.
 Professional Identification: Identifies as a professional social worker and conducts oneself
accordingly (EPAS 2.1.1)
Unacceptable Deficient
Developing Accomplished Exemplary
1
2
3
4
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Advocates for client access to
the services of social work
Attends to professional roles
and boundaries
Understands and follows
agency policies and
procedures
Demonstrates professional
demeanor in behavior,
appearance, and
communication
Uses supervision and
consultation
Establishes and maintains
effective professional relations
with clients, co-workers,
representatives from other
disciplines and other agencies
1
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Organizes time and plans
work accordingly
Demonstrates initiative and
resourcefulness in practicum
Understands agency's
mission, goals, function and
role
Understands how own
behavior and values affect
relationships with clients
Able to use social work
knowledge and skills in
work with clients
Uses person-in-environment
and/or strengths
perspectives to guide
therapeutic relationships
Understands challenges
when using social work
values and knowledge in
multi-disciplinary setting
Uses social work
professional knowledge and
skills to engage clients in
problem solving that will
help restore functioning
Comments:

. Applies social work ethical principles to guide professional practice (EPAS 2.1.2)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates knowledge of,
and abides by, the NASW
Code of Ethics in practice
Tolerates ambiguity in
resolving ethical conflicts
Applies ethical decision
making skills and
frameworks to issues
specific to work with
individuals, families and
groups
2
Identifies personal biases
and understands how to
manage these biases
Understands ethical issues
in the use of technology in
clinical practice and use this
knowledge to manage
technology to protect clients
Comments:

. Applies critical thinking to inform and communicate professional judgments (EPAS 2.1.3)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates effective oral
and written communication in
working with individuals,
families, groups,
organizations, communities,
and colleagues
Differentiates between
several theoretical
perspectives and
determines which are most
appropriate in working with
client/s
Keeps professional records
Presents professional
understanding of clients at
team meetings and in other
situations in which social
work knowledge is needed
Comments:
3
IV. Engages diversity and difference in practice (EPAS 2.1.4)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Demonstrates awareness and
sensitivity to racial, ethnic,
cultural, religious, gender,
disability, and sexual
orientation factors in
understanding clients
Has sufficient self-awareness
to eliminate the influence of
personal biases and values in
working with diverse groups
Recognizes and
communicates understanding
of the importance of difference
in shaping life experiences
Views self as a learner, and
engages those with whom
he/she works as informants
Shares with colleagues
current information about
best clinical practices for
intervention with diverse
clients
Uses practitioner/client
differences to identify client
strengths
Identifies the diverse
population residing in the
metropolitan region and
shares information about
how to respond
appropriately to those who
are experiencing poverty,
marginalization or alienation
Comments:
4
V. Advances human rights and social and economic justice (EPAS 2.1.5)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Engages in practice that
advances social and economic
justice
Recognizes that each person,
regardless of position in
society, has basic human
rights, such as freedom,
safety, privacy, an adequate
standard of living, health care
and education
Develops approaches to
treatment that take into
account client's difficulties
created by social injustice,
particularly in terms of
inability to access services
Comments:
VI. Engages in research-informed practice and practice-informed research (EPAS 2.1.6)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies the research base
for the work done at the
agency
5
Identifies and uses
evidence-based practices in
work with clients
Evaluates own practice or
that of agency
Comments:
VII. Applies knowledge of human behavior and the social environment (EPAS 2.1.7)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Utilizes conceptual
frameworks to guide the
processes of assessment,
intervention, and evaluation
Demonstrates an
understanding of how
biological, psychological, and
cultural factors influence
human behavior
Demonstrates an
understanding about the ways
in which social systems
promote or deter people in
maintaining or achieving
health and well-being
Differentiates among
theories and determines
which are most appropriate
for use with targeted client
group
6
Uses bio-psycho-socialspiritual theories and/or
multi-axial diagnostic
classification systems in
formulation of assessments
Understands when to
consult with others to
confirm diagnoses and/or
monitor interventions
Comments:
VIII. Engages in policy practice to advance social and economic well-being and to deliver
effective social work services (EPAS 2.1.8)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies the role of policy in
service delivery
Collaborates with colleagues
and clients for effective policy
action
Communicates with
stakeholders or others the
implications of policy and/or
policy changes for clients
Comments:
7
IX. Responds to the contexts that shape practice (EPAS 2.1.9)
Unacceptable
1
Deficient
2
Developing
3
Accomplished
4
Exemplary
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Identifies and analyzes factors
that impact the agency's
mission and service delivery
system (i.e., organizational
structure, operation, policies,
funding, scientific
developments, economy, etc.)
Recognizes that the context of
practice is dynamic and has
the knowledge and skills to
respond proactively
Assesses clients'
interactions with social
contexts to understand how
changes in the clients'
environments may affect
their ability to engage in
and/or use intervention
Works collaboratively with
clients or others to plan/and
or bring about systemic
change
Recognizes knowledge,
skills and values needed to
provide leadership in
agency
Comments:
8
X. Engages, assesses, intervenes, and evaluates with individuals, families, groups,
organizations and communities (EPAS 2.1.10)
Unacceptable Deficient
Developing Accomplished Exemplary
1
2
3
4
5
Performance is
generally
unacceptable;
never meets
competency
Rarely
meets
competency
Engagement
Substantively and affectively
prepares for action with
individuals, families or groups
Embodies the concept of
starting where the client is
Conveys respect for the client
Uses empathy and other
interpersonal skills
Develops a culturally
responsive therapeutic
relationship with a client
Encourages clients to be
equal partners in the
establishment of treatment
goals and/or expected
outcomes
Assessment
Collects, organizes, and
interprets client data
Assesses client strengths and
limitations
Uses multi-dimensional
assessment tools or
approaches to plan
interventions that take into
account clients' coping
strategies and willingness
to change
Selects and, when
appropriate, modifies
interventions based on
continuous assessment of
client progress
Intervention
Utilizes agency services and
community resources on
behalf of client
Helps clients resolve problems
9
Inconsistently
meets
competency
Consistently
meets
competency
Consistently
exhibits
mastery of
competency
Facilitates transitions and
endings
Critically evaluates, selects
and applies best practices
and/or evidence-based
practice
Collaborates with other
professionals to coordinate
interventions
Evaluation
Applies research skills to
evaluate practice
Uses practice evaluation to
determine best
interventions for a range of
conditions
Comments:
Please describe the student’s primary strengths and areas for growth.
Strengths:
Growth Areas:
In what ways could the social work faculty have been more helpful to the agency or the student during the
course of the practicum?
Is your organization planning any changes (such as in staffing, programming, etc.) of which the University
should be aware? Please describe.
Please place a check mark next to the number that reflects your response to the following questions.
How would you rank this student’s effort in completing practicum tasks?
1.
Consistent and outstanding
2.
Consistent and above average
3.
Consistent and average
4.
Inconsistent and average
5.
Inconsistent and below average
10
How would you rank this student’s level of knowledge and skill compared to a typical advanced-practice level
MSW student?
1.
Outstanding
2.
Above average
3.
Average
4.
Below average
5.
Poor
If this is the student’s final semester in field placement, please provide your assessment of this student’s
readiness for entry level social work practice.
1.
2.
3.
Surpasses expectations for entry level social work practice
Meets expectations for entry level social work practice
Meets expectations for entry level social work practice with the following exceptions:
4.
Does not meet expectations for entry level social work practice. Please explain:
5.
Does not apply. This student is not in his/her final semester of field placement
Please check to verify that the student has completed 300 practicum hours
Supervisor Signature
Date
Student Signature
Date
Return forms: Hand-signed forms may be submitted in person or by fax to: (314) 516-6416. Forms submitted as an email
attachment to socialwork@umsl.edu may use an electronic signature (any format) provided the document is sent from the
professional email address of the practicum supervisor, and the student signer is copied.
11