__________________________________________________________________________
College of Health and Human Services
Department of Social Work
Field Education
749 Chestnut Street
Terre Haute, Indiana 47809
Telephone: 812-237-2322
Fax: 812-237-8114
MSW CLINICAL Field Placement: Learning Plan and Performance Evaluation
Name of Intern __________________________________ 991____________________
Student’s Concentration: Health
Clinical Level Placement
Mental Health and Addictions
SOWK 610
SOWK 615
Midterm
Final
Name of Agency: _________________________________________________________
Name of Supervisor: ______________________________________________________
Name of Field Instructor: __________________________________________________
Date Evaluation was Completed __________________________
This evaluation is intended to give the intern feedback about her or his performance. The
Faculty Field Liaison (course instructor) has responsibility of assigning the grade for field
instruction. The grade that is assigned will be based on: the Faculty Field Liaison or Field
Director’s overall evaluation of the student’s performance in field placement in conjunction
with the field instructor and task supervisor evaluation and other submitted materials such as:
intern journals; seminar participation; papers that integrate field with classroom instruction.
The paper document of the evaluation form in the Field Manual Appendix serves as an aid in
discussion and understanding field documentation. For implementation of the document,
students are required to use the form electronically in Wiki in the course Blackboard site and
do concurrent documentation on the Wiki. Students should print from the Wiki and provide
the document to each supervisor for midterm and final evaluations, then once complete, the
comments and ratings should be typed into the Wiki document for future reference and
usage. It is not an acceptable practice for the student to utilize a word document on his/her
own computer only; it must be documented in the Wiki in Blackboard.
Rating the Student:
10 The student is fully prepared to be clinical level social worker and demonstrates mastery of skill. The
student qualifies as ‘a shining star’. The student initiates action and has the ability to deal with difficult
situations and uses best practices appropriately. The student no longer needs the supervisor to prompt action
and demonstrates a ‘can do’ attitude. Supervisor would like to have the student as a clinical colleague based on
the student’s demonstration of skills and abilities.
9 The student demonstrates near mastery of skill. The student is mostly proficient though sometimes does not
show ‘best practice of all the necessary parts”. The student has an appropriate level of skills and acts
appropriately as situations arise most of the time. The student demonstrates best practice ‘more than 80% of the
time”.
8 The student has an above average ability to perform as a clinical social worker. The student demonstrates a
good grasp of skills and abilities and is capable and confident. The student has basic skills but still needs
experience and practice to establish best practice.
7 The student is meeting the expectations of clinical social work practice, but more at a level of basic
competence, and performs to the level of the average social worker. The student is lacking ability to perform
best practices most of the time.
6 The student is developing clinical social work skills. The student is able to engage with clients and has an
understanding of the goals. The student is developing the ability to make decisions as situations occur but still
clearly is not ready to make decisions independently and needs to consult with supervisor before taking actions
with clients.
5 The student is emerging. The student is able to address basic clinical issues with a client, but is likely more
focused on learning necessary clinical theories, skills, and knowledge and observation of professionals in skill
usage.
4 The student is at the introductory, or beginning, clinical level. The student has little clinical knowledge or
experience yet is inquisitive and curious, and demonstrates an awareness of surroundings.
3 The student demonstrates less than motivated behavior and there is concern for the student’s development.
The student is demonstrating resistance to working in some aspect of the agency or with some types of clients,
is not inquisitive or demonstrating inquiry and has difficulty ‘fitting in’. Staff may be reporting not feeling that
the student is ‘getting it’ or is demonstrating a lack of empathy or compassion with clients.
2 The student is resistant to development and is not demonstrating a grasp of content. The student’s manner
and presentation are having a negative effect on the work environment and/or with clients. Supervisors feels
that the student is not ready to work with clients and needs to have some corrective plans before being ready to
move on in placement.
1 Student demonstrates unacceptable behavior that has been addressed without successful change. Further
attempt to resolve presenting problems is not likely to make a difference. Student should be removed from the
field practicum.
0 Insufficient evidence to evaluate the student
Instructions for completing the document:
The student and Field Instructor/Task Supervisor will discuss learning plan goals and who will supervise each
activity. Together they will define at least 1 activity per practice behavior and note it in the ‘assignment’
column. These items should be selected and marked within the first 2 weeks of placement. Any items
designated for completion with a Field Instructor outside the agency must also be marked as such, discussed
with the Field Instructor, and approved by all. In the case of a Field Instructor that is not an agency employee,
the student must maintain an open and transparent communication process with both supervisors throughout the
placement regarding all activities, hours, concerns, changes, etc.
Once an activity is completed the student should review the assignment with the designated supervisor and note
comments and completion date in the ‘evidence of completion/date’ column of the document. The date should
match with journal entries and timesheets. Remember, concurrent documentation is an agency as well as field
practice.
The student should begin immediately to complete learning plan items, and should make progress weekly. It is
not acceptable to wait until end of placement to complete items. N/A, ongoing, discussed, per supervisor, or
blank are not acceptable replies to any learning plan item.
Every student should complete at least 1assignment per practice behavior competency per placement. All
students should complete the core (PB series) and clinical practice behaviors (APB-C series); only those in the
mental health and addictions concentration should complete the substance use competencies (APB-SU series).
The student should be evaluated at the midterm and final by all parties involved in supervising the student. In
other words, if the student has one supervisor then only one evaluation is needed, but if the student has more
than one supervisor, they should each complete an evaluation of the student or jointly complete one evaluation
and both parties should sign.
Competency 1: Identify as a professional social worker and conduct oneself accordingly.
Social workers serve as representatives of the profession, its mission, and its core values. They
know the profession’s history. Social workers commit themselves to the profession’s
enhancement and to their own professional conduct and growth. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 1. Advocate for client
access to services of social
work.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB2. Practice personal
reflection and self
correction to assure
continual professional
development.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 3. Attend to
professional roles and
boundaries.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 4. Demonstrate
professional demeanor in
behavior, appearance, and
communication.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 5. Engage in career
long learning.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 6. Use supervision and
consultation.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 1: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work recognize the importance of the
therapeutic relationships, the person-in-environment and strengths perspectives, the
professional use of self with clients, and adherence to the ethical guidelines of professional
behavior. Advanced practitioners in clinical social work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C1. Readily Identify
as social work professions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C2. Demonstrate
professional use of self
with client(s).
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C3. Understand and
identify professional
strengths, limitations, and
challenges.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C4. Develop,
manage, and maintain
therapeutic relationships
with clients within the
person-in-environment and
strengths perspectives.
Fall Semester:
Comments:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 1: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in prevention of substance
use disorders )PUDS) recognize the potentially unique role of social work in prevention.
Advanced practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU1. Identify
opportunities for social
work involvement in
prevention of substance
use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 2: Apply social work ethical principles to guide professional practice. Social
workers have an obligation to conduct themselves ethically and to engage in ethical decision
making. Social workers are knowledgeable about the value base of the profession, its ethical
standards, and relevant law. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 7. Recognize and
manage personal values in
a way that allows
professional values to
guide practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 8. Make ethical
decisions by applying the
standards of the National
Association of Social
Workers Code of Ethics.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 9. Tolerate ambiguity
in resolving ethical
conflicts.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 10. Apply strategies of
ethical reasoning to arrive
at principled decisions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 2: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work are knowledgeable about ethical
issues, legal parameters, and shifting societal mores that affect the therapeutic relationship.
Advanced practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C5. Apply ethical
decision making skills to
issues specific to clinical
social work.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C6. Employ
strategies of ethical
reasoning to address the
use of technology in
clinical practice and its
impact on client rights.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C7. Identify and use
knowledge of relationship
dynamics, including power
differentials.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C8. Recognize and
manage personal biases as
they affect the therapeutic
relationship in the service
of the clients' well-being.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 2: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD are
knowledgeable about ethical issues specific to substance use disorders and prevention.
Advanced practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU2. Apply ethical
decision making skills to
the prevention of
substance use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 3: Apply critical thinking to inform and communicate professional judgments.
Social workers are knowledgeable about the principles of logic, scientific inquiry, and
reasoned discernment. They use critical thinking augmented by creativity and curiosity.
Critical thinking also requires the synthesis and communication of relevant information. Social
workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 11. Distinguish,
appraise, and integrate
multiple sources of
knowledge, including
research-based knowledge
and practice wisdom.
Fall Semester:
Comments:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 12. Analyze models of
assessment, prevention,
intervention, and
evaluation.
Fall Semester:
Comments:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 13. Demonstrate
effective oral and written
communication in working
with individuals, families,
organizations,
communities, and
colleagues.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 3: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners understand and differentiate the strengths and limitations of
multiple practice theories and methods, clinical processes, and technical tools, including
differential diagnosis. They deconstruct theories and methods to evaluate how they relate to
clients and client systems within their environmental context. They regularly question and
reflect on their own assumptions and consider how these might affect practice. Advanced
practitioners in clinical social work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C9. Engage in
reflective practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C10. Identify and
articulate clients' strengths
and vulnerabilities.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C11. Evaluate,
select, and implement
appropriate
multidimensional
assessment, diagnostic,
intervention, and practice
evaluation tools.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C12. Evaluate the
strengths &weaknesses of
multiple theoretical
perspectives and
differentially apply to
client situations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C13. Communicate
professional judgments to
other social workers and to
professionals from other
disciplines, in both verbal
and written formats.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 3: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). Because of the multidisciplinary nature of the problems in PSUD, at the
concentration level advanced practitioners understand cross-discipline terminology and
communication techniques. Advanced practitioners in PSUD understand how substance abuse
interfaces with problems that social workers face (e.g., health, mental health, crime, poverty,
child welfare, and violence). Advanced practitioners in PSUD
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-SU3. Evaluate,
select, and implement
appropriate assessment,
intervention, and
evaluation tools for use
with target populations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU4. Communicate
effectively with diverse
populations and with
multi- or inter disciplinary
colleagues.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 4: Engage diversity and difference in practice. Social workers understand how
diversity characterizes and shapes the human experience and is critical to the formation of
identity. The dimensions of diversity are understood as the intersectionality of multiple factors
including age, class, color, culture, disability, ethnicity, gender, gender identity and
expression, immigration status, political ideology, race, religion, sex, and sexual orientation.
Social workers appreciate that, as a consequence of difference, a person’s life experiences may
include oppression, poverty, marginalization, and alienation as well as privilege, power, and
acclaim.
Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 14. Recognize the
extent to which a culture's
structures and values may
oppress, marginalize,
alienate, or create or
enhance privilege and
power.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 15. Gain sufficient
self-awareness to
eliminiate the influence of
personal biases and values
in working with diverse
groups.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 16. Recognize and
communicate their
understanding of the
importance of difference in
shaping life experiences.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 17. View themselves as
learners and engage those
with whom they work as
informants.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 4: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners are knowledgeable about many forms of diversity and
difference and how these influence the therapeutic relationship with clients' presenting issues.
Advanced practitioners are knowledgeable about the ways in which various dimensions of
diversity affect (a) explanations of illness, (b) help-seeking behavior, and (c) healing practices.
Advanced practitioners are cultural beings and understand how clinical practice choices can be
culture-bound. Advanced practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C14. Research and
apply knowledge of
diverse populations to
enhance client well-being.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C15. Work
effectively with diverse
populations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C16. Identify and
use practitioner/client
differences from a
strengths perspective.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 4: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners are knowledgeable about
various perspectives on social constructions of substance use, misuse, abuse, and dependence.
They understand substances in cultural context. Advanced practitioners are familiar with
variations in the nature and courses of substance use disorders across the life span and in
diverse communities (e.g., between men and women, across cultures and social classes, sexual
orientation and gender identity). Advanced practitioners are familiar with bio/physiological
processes impacting different populations. Advanced practitioners in PSUD
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-SU5. Identify
appropriate substance use
disorders and prevention
target groups.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU6. Assess
predictive factors
competently within and
across groups (e.g. gender,
ethnicity/race, age, SES,
sexual orientation) and
across system levels.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU7. Analyze and
compare different social
constructions of substance
use, misuse, abuse, and
dependence and their
implications.
Fall Semester:
Comments:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 5: Advance human rights and social and economic justice. 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. Social workers recognize the global
interconnections of oppression and are knowledgeable about theories of justice and strategies
to promote human and civil rights. Social work incorporates social justice practices in
organizations, institutions, and society to ensure that these basic human rights are distributed
equitably and without prejudice. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 18. Understand the
forms and mechanisms of
oppression and
discrimination.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 19. Advocate for
human rights and social
and economic justice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 20. Engage in practices
that advance social and
economic justice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 5: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work understand the potentially challenging
effects of economic, social, and cultural factors in the lives of clients and client systems.
Advanced practitioners understand the stigma and shame associated with disorders, diagnoses,
and help-seeking behaviors across diverse populations. They also understand strategies for
advancing human rights and economic justice in the domestic and global contexts. Advanced
practitioners in clinical social work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C17. Use knowledge
of the effects of
oppression, discrimination,
and historical trauma on
client and client systems to
guide treatment planning
and intervention.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C18. Advocate at
multiple levels for mental
health parity and reduction
of health disparities for
diverse populations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 5: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD recognize health
disparities in the distribution of substance use, problems with substance use, and predictors
across groups. Advanced practitioners recognize stigma and shame associated with substance
use, misuse, abuse, and dependence (e.g., discrimination and denial of the problems,
stereotyping of populations). Advanced practitioners are familiar with international
perspectives on preventing substance use, misuse, abuse, and dependence. Advanced
practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU8. Advocate at
multiple levels for health
promotion, for reduction of
health disparities and
stigma for diverse
populations affected by
substances and substance
use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 6: Engage in research-informed practice and practice-informed research. Social
workers use practice experience to inform research, employ evidence-based interventions,
evaluate their own practice, and use research findings to improve practice, policy, and social
service delivery. Social workers comprehend quantitative and qualitative research and
understand scientific and ethical approaches to building knowledge. Social workers
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
PB 21. Use practice to
inform scientific inquiry.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 22. Use research
evidence to inform
practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C19. Use the
evidence-based practice
process in clinical
assessment and
intervention with clients.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C20. Participate in
the generation of new
clinical knowledge,
through research and
practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C21. Use research
methodology to evaluate
clinical practice
effectiveness and/or
outcomes.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 6: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). Advanced practitioners are familiar with valid and reliable assessment tools
for identifying the problem, risk, and protective factors; vulnerability and resilience factors;
and consequences for different groups, practice levels, and ages. Advanced practitioners in
PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU9. Relate
substance use disorder
theories, models, and
research to appropriate
client systems and
circumstances.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU10. Identify,
evaluate, and select
effective substance use
disorder prevention
strategies.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU11. Apply
foundation research skills
to the evaluation of
prevention of substance
use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU12. Work
collaboratively with
evaluators/researchers to
assess intervention
efficacy and effectiveness.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 7: Apply knowledge of human behavior and the social environment. Social
workers are knowledgeable about human behavior across the life course; the range of social
systems in which people live; and the ways social systems promote or deter people in
maintaining or achieving health and well-being. Social workers apply theories and knowledge
from the liberal arts to understand biological, social, cultural, psychological, and spiritual
development. Social workers
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
PB 23. Utilize conceptual
frameworks to guide the
processes of assessment,
intervention, and
evaluation.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 24. Critique and apply
knowledge to understand
person and environment.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 7: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners understand how to synthesize and differentially apply the
theories of human behavior and the social environment (biological, developmental,
psychological, social, cultural, and spiritual). They are familiar with diagnostic classification
systems used in the formation of a comprehensive assessment. Advanced practitioners
understand how sociocultural contexts influence definitions of psychopathology. They have a
working knowledge of psychotropic medications that are typically used in the treatment of
mental health disorders, including expected results and side effects. Advanced practitioners in
clinical social work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C22. Synthesize and
differentially apply
theories of human
behavior and the social
environment to guide
clinical practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C23. Use biopsycho-social spiritual
theories and multiaxial
diagnostic classification
systems in formulation of
comprehensive
assessments.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C24. Consult with
medical professionals, as
needed, to confirm
diagnosis and/or monitor
medication and treatment
progress.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 7: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in prevention of substance
use disorders are knowledgeable about substances of abuse and their actions, etiology, and
course including patterns fo use, misuse, abuse, and dependence and their interactions with
environmental factors. They understand systems of service delivery in relation to substance
use problems. Advanced practitioners are familiar with multilevel frameworks of prevention
and health promotion. They understand social work specific frameworks and theories for
prevention practice, including the bio-psycho-social perspective. Advanced practitioners in
PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU13. Relate
substance use disorders
theories, models, and
research appropriate to
client systems and
circumstances.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 8: Engage in policy practice to advance social and economic well-being and to
deliver effective social work services. Social work practitioners understand that policy affects
service delivery, and they actively engage in policy practice. Social workers know the history
and current structures of social policies and services; the role of policy in service delivery; and
the role of practice in policy development. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 25. Analyze, formulate,
and advocate for policies
that advance social wellbeing.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 26. Collaborate with
colleagues and clients for
effective policy action.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 8: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work recognize the connection between
clients, practice, and both public and organizational policy. Advanced practitioners have
knowledge about factors that influence the development of legislation, policies, program
services, and funding at all system levels. They have knowledge of advocacy methods that
contribute to effective policies that promote social and economic well-being. Advanced
practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C25. Communicate
to stakeholders the
implications of policies
and policy change in the
lives of clients.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C26. Use evidencebased practice and
practice-based evidence in
advocacy for policies that
advance social and
economic wellbeing.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C27. Advocate with
and inform administrators
and legislators to influence
policies that affect clients
and service.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 8: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in prevention of substance
use disorders understand how policies and service delivery system factors are part of the
prevention. Advanced practitioners are familiar with the history and current trends in policies
and service delivery systems as related to substance use, misuse, abuse, and dependence
problems and interventions. Advanced practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU14. Apply policy
practice skills for
substance use disorders
prevention.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 9: Respond to contexts that shape practice. Social workers are informed,
resourceful, and proactive in responding to evolving organizational, community, and societal
contexts at all levels of practice. Social workers recognize that the context of practice is
dynamic, and use knowledge and skill to respond proactively. Social workers
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
PB 27. Continuously
discover, appraise, and
attend to changing locales,
populations, scientific and
technological
developments, and
emerging societal trends to
provide relevant services.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 28. Provide leadership
in promoting sustainable
changes in service delivery
and practice to improve the
quality of social services.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 9: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work are knowledgeable about how
relational, organizational, and community systems may impact clients. They anticipate and
react to evolving cultural, technological, geographical, political, legal, economic, and
environmental contexts. They encourage clients to effect change within these contexts.
Advanced practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C28. Assess the
quality of clients'
interactions within their
social contexts.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C29. Develop
intervention plans to
accomplish systematic
change.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C30. Work
collaboratively with others
to effect systematic change
that is sustainable.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 9: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD understand the
interaction of different modes and roles of intervention including prevention, intervention,
treatment and recovery. They understand the venues for prevention including individual,
family, community, service settings, local, state, and federal involvement, the contribution of
legislation, and resource distribution. Advanced practitioners are familiar with the history and
legacy of various paradigms related to substance use, misuse, abuse, and dependence.
Advanced practitioners in PSUD
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-SU15. Act as change
agent to promote
prevention of substance
use, misuse, abuse, and
dependence.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU16. Advocate at
multiple levels for health
promotion, for promotion
of known resiliency
factors, for reduction of
risk and vulnerability
factors, for promotion of
prevention, and for diverse
populations affected by
substances and substance
use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10: Engage, assess, intervene, and evaluate with individuals, families, groups,
organizations, and communities. Professional practice involves the dynamic and interactive
processes of engagement, assessment, intervention, and evaluation at multiple levels. Social
workers have the knowledge and skills to practice with individuals, families, groups,
organizations, and communities. Practice knowledge includes 7 identifying, analyzing, and
implementing evidence-based interventions designed to achieve client goals; using research
and technological advances; evaluating program outcomes and practice effectiveness;
developing, analyzing, advocating, and providing leadership for policies and services; and
promoting social and economic justice.
Clinical Social Work practice involves the dynamic, interactive, and reciprocal processes of
therapeutic engagement, multidimensional assessment, clinical intervention, and practice
evaluation at multiple levels. Advanced practitioners have a theoretically informed knowledge
base so as to effectively practice with individuals, families, and groups. Clinical practice
knowledge includes understanding and implementing practice theories (models,
metaperspectives, strategies, techniques, and approaches); evaluating treatment outcomes and
practice effectiveness.
A: Engagement. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 29. Substantively and
affectively prepare for
action with individuals,
families, groups,
organizations, and
communities.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 30. Use empathy and
other interpersonal skills.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 31. Develop a mutually
agreed-on focus of work
and desired outcomes.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10a: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in social work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C31. Develop a
culturally responsive
therapeutic relationship.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C32. Attend to the
interpersonal dynamics
and contextual factors that
both strengthen and
potentially threaten the
therapeutic alliance.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C33. Establish a
relationally based process
that encourages clients to
be equal participants in the
establishment of treatment
goals and expected
outcomes.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10a: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD recognize and
understand the diverse groups affected by prevention of substance use disorders. Advanced
practitioners in PSUD
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-SU17. Engage
diverse groups (e.g.,
gender, race/ethnicity,
sexual orientation and
gender expression, age) in
prevention practice.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
B: Assessment. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 32. Collect, organize,
and interpret client data.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 33. Assess client
strengths and limitations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 34. Develop mutually
agreed upon intervention
goals and objectives.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 35. Select appropriate
intervention strategies.
Fall Semester:
Comments:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10b: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C34. Use
multidimensional biopsycho-social spiritual
assessment tools.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C35. Assess clients'
readiness for change.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C36. Assess client
coping strategies to
reinforce and improve
adaptation to life
situations, circumstances,
and events.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C37. Select and
modify appropriate
intervention strategies
based on continuous
clinical assessment.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C38. Use differential
and multiaxial diagnoses.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10b: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners PSUD understand the
epidemiology of substance use and problems with substance use, as well as the predictors of
substance use and abuse in populations, across place and development. Advanced
practitioners are familiar with multidisciplinary and multidimensional assessment methods.
They understand etiology, nature and course, substance use, misuse, abuse, and dependence.
Advanced practitioners are familiar with theories and models of prevention. Advanced
practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU18. Adapt,
modify, and use
assessment tools and
approaches, including in
situations in which specific
abilities and functions may
be affected by substance
use, misuse, abuse, and
dependence - such as short
and long term cognitive,
affective, & physiological
effects.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU19. Evaluate,
select, and implement
appropriate assessment
instruments for use with
target populations.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU20. Conduct
needs assessment for
prevention of substance
use disorders, including
identifying and using
existing epidemiological
data.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU21. Relate
substance use disorders
theories, models, and
research appropriate to
client systems and
circumstances.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
C: Intervention. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 36. Initiate actions to
achieve organizational
goals.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 37. Implement
prevention interventions
that enhance client
capacities.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 38. Help clients resolve
problems.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 39. Negotiate, mediate,
and advocate for clients.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 40. Facilitate
transitions and endings.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10c: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical work
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C39. Critically
evaluate, select, and apply
best practices and
evidence-based
interventions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C40. Demonstrate
the use of appropriate
clinical techniques for a
range of presenting
concerns identified in the
assessment, including
crisis intervention
strategies as needed.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C41. Collaborate
with other professionals to
coordinate treatment
interventions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10c: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD understand the
relationships among prevention, early intervention, and treatment, as well as different types of
prevention (e.g., abstinence based, harm reduction, relapse prevention). They understand
types of prevention strategies (e.g., primary, secondary, tertiary; universal, selective,
dedicated). Advanced practitioners are familiar with resources for identifying effective
substance use disorders prevention approaches. They understand how to adapt substance use
disorders models and prevention strategies to make them relevant to the target population.
Advanced practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU22. Apply types
of prevention strategies
across levels of
intervention, including the
individual, family, school,
agency, community, or
larger context.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU23. Develop and
implement collaborative
multidisciplinary
prevention strategies.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU24. Implement
effective substance use
disorder prevention
strategies with fidelity.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU25. Identify,
evaluate, and select
effective substance use
disorders prevention
strategies.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
D: Evaluation. Social workers
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
PB 41. Critically analyze,
monitor, and evaluate
interventions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10d: Advanced Practice Behavior - Clinical Social Work (For Health and Mental
Health). Advanced practitioners in clinical social work
Evidence of Completion: 1.
Practice Behavior
Assignment
Item 2. Verified by 3. Date
Complete
APB-C42. Contribute to
the theoretical knowledge
base of the social work
profession through
practice-based research.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-C43. Use clinical
evaluation of the process
and/or outcomes to
develop best practice
interventions for a range of
bio-psycho-social spiritual
conditions.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Competency 10d: Advanced Practice Behavior - Prevention of Substance Use (For
MH/Addictions). At the concentration level, advanced practitioners in PSUD are familiar with
the unique challenges in prevention evaluation (e.g., need for multiple years of follow up to
see the impact on substance use outcomes). Advanced practitioners are familiar with
prevention and substance use evaluation methodologies and with evaluation tools for
substance use disorders and prevention. They understand the potential effects of intervention
on multiple levels. Advanced practitioners in PSUD
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU26. Apply
research skills to the
evaluation of prevention of
substance use disorders.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU27. Identify and
use evaluation tools for
substance use disorders
and prevention.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU28. Communicate
and disseminate evaluation
results appropriate to the
intended audience.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Practice Behavior
Assignment
Evidence of Completion: 1.
Item 2. Verified by 3. Date
Complete
APB-SU29. Work
collaboratively with
evaluators/researchers to
assess intervention
efficacy and effectiveness.
Fall Semester:
Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
Spring Semester: Midterm 10 9 8 7 6 5 4 3 2 1 0 Final 10 9 8 7 6 5 4 3 2 1 0
Comments:
MSW Clinical - First Semester
Mean score =
A=mean 8 >, no score of 5 or below
B=mean 7-8, no score of 5 or below
C=mean 6-7, no score of 5 or below
MSW Clinical - Second Semester
Mean score =
A=mean 9 >, no score of 5 or below
B=mean 8-9, no score of 5 or below
C=mean 7-8, no score of 5 or below
I have completed all of the assignments, as described, and have demonstrated professional
and ethical behavior in doing so. I have completed all assignments under the supervision of
my task/agency supervisor and/or my field instructor.
Student, Date
The student has completed the above activities either under my supervision, or my designee,
within the agency.
Task/Agency Supervisor, Date
I serve as Field Instructor for the student, as a consulting social worker. The student and I
met for an hour per week, or the equivalent, for the duration of this placement and I
consulted with the student in relevant activities and processes from the social work
perspective.
Field Instructor, Date
***All parties should review the full document prior to signing the document, and if there are
discrepancies with notation, it should be documented.
Overall Evaluation at MIDTERM:
Please check one of the following at the midterm evaluation. At the final evaluation do NOT
complete this section.

This intern is excelling in field placement by performing above expectations for interns.

This intern is meeting the expectations of a field placement intern.

This intern is functioning somewhat below the expectations of a field placement intern.
There is a question whether this intern will be ready for beginning level social work
practice by the end of placement.

This intern is functioning below the expectations of a field placement intern. There is
considerable concern that this intern will not be ready for beginning level social work
practice by the end of placement. This intern should perhaps be encouraged to pursue
another major.
Comments/elaboration:
Strengths:
Limitations:
FINAL OVERALL EVALUATION:
The student successfully completed her/his learning plan
□ Yes □ No (explain)
Please check one of the following at the final evaluation. At the midterm evaluation do NOT
complete this section.

This intern excelled in field placement by performing above expectations for interns.
If an appropriate position were open at this agency, for a beginning level social worker,
this intern would be considered among the top candidates for this position.

This intern has met the expectations of the field placement. This intern is ready for
beginning level social work practice.

This intern is not yet ready for beginning level social work practice.

This intern is not yet ready for beginning level social work practice, and has
demonstrated serious problems in performance, and perhaps should be encouraged to
pursue another major.
Comments/elaboration:
Strengths:
Limitations:
______________________________________________
Signature of Task/Agency Supervisor
______________
Date
______________________________________________
Signature of Field Instructor (if different than above)
______________
Date
The following section should be completed by the intern:
My agency supervisor and Field Director, or designee, have discussed this evaluation with
me, and I have received a copy. My agreement or disagreement follows:
I agree with the evaluation
I do not agree with evaluation

or

If the intern disagrees with the evaluation she/he should state that disagreement in writing
(below) and submit a copy to both the agency supervisor and the Field Director.
Intern’s Signature _________________________________ Date _____________________
03/2001; Revised 11/14/2002; 07/2005; 08/2007; 08/2008; 08/2009; 08/2013