LOYOLA UNIVERSITY CHICAGO
SCHOOL OF SOCIAL WORK
FIELD WORK OFFICE
SECOND LEVEL (MSW) ADVANCED EVALUATION
HEALTH SPECIALIZATION
Please check one:
• Mid-term evaluation (630)
• Final evaluation (631)
Date: ____________________
Student: ________________________________ Student ID: ___________________
Start Date: ________________________ End Date: _________________________
Placement Site: _____________________________________________________
Field Instructor: _____________________ Field Liaison: _____________________
Cumulative Hours: _______
(Student needs to complete 720 hours total)
Total Clients: _______
Recommended Grade: _________
(P=PASS, NP=NO PASS)
Please refer to the Learning Agreement and use the following criteria to rate the student.
You will find bulleted qualifiers under each of the ten competencies. Please note that the bullets listed are
suggestions to highlight the behavior of your student. Keep in mind that the rating should reflect the student’s
progress at this point in the overall internship. If the student’s internship experience does not include tasks or
activities related to the competency, circle “0”. Please complete the questions at the end of the evaluation. No
further write-up is necessary. After you and the student have reviewed the evaluation, sign it and submit it to the
field office:
Rating Scale Criteria
1 Demonstrates no competency in this area Demonstrates no competency in this area
Demonstrates minimal competency, little knowledge or skill, limited evidence of growth or change, rarely
2 demonstrates progress on tasks and behaviors, and takes little initiative for learning.
Developing competence with assistance, with some coaching or prompting demonstrates some skill, marginal
competency working towards improvement, beginning level of skill development, needs continued practice and
3 assistance, progress on tasks and behaviors is inconsistent, inconsistently takes initiative for learning.
Emerging competency, demonstrates the ability to independently apply skills in simple situations, moderate
competency, demonstrating ongoing progress, adequate performance just needs more practice, takes initiative for
4 learning.
Demonstrates the competency to begin independent social work practice, demonstrates the ability to apply skills in
complex situations, consistent growth and change, demonstrates the ability to complete assigned tasks and activities,
5 takes full responsibility for learning.
0 Does not relate to the student’s internship experience or not sufficient experience to evaluate skill level- “NA”.
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COMPETENCY #1: PROFESSIONALISM
Identify with the social work profession, its mission and core values, and conduct oneself accordingly
Student demonstrates the ability to:
No
Minimal Developing Emerging Competency N/A
Competency Competency Competency Competency
1
2
3
4
5
0
Practice self-reflection and self-correction.
Students will independently analyze and reflect on their practice in
the organization and/or institute in which they are practicing
Advocate for client access to services.
Students will examine client access to services, develop methods for
operationalization, empower client for self-advocacy, and evaluate
outcome as part of their professional advocate role.
Attend to professional roles and boundaries.
Students will be cognizant of and compliant and contribute to the
development of social work roles.
Use supervision and consultation.
Students will actively prepare for supervision and constructively
analyze their own practice, taking an active role in consultation and
supervision.
Students will anticipate and respond to crises and ethical dilemmas.
Engage in life-long learning & professional growth.
Students will evaluate their learning needs and regularly select
venues that increase their expertise, e.g., workshops, training and
reading professional publications.
Students at the Advanced level will demonstrate advanced
professional use of self with client(s).
Demonstrate professional demeanor in behavior, appearance,
and communication.
COMPETENCY #2: VALUES AND ETHICS
Define and apply social work ethical principles to guide professional practice in this setting
Students will demonstrate the ability to:
No
Minimal Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Make ethical decisions by applying standards of the NASW Code
of Ethics
Students will anticipate areas of potential conflict relevant to their
area of specialty and formulate a plan of action should such conflict
arise.
Students will assess the intersection of relevant codes of ethics and
state/federal laws and justify a reasoned approach when ethics and
laws are in conflict.
Tolerate ambiguity and cultural differences in resolving ethical
conflicts
Students will evaluate alternative courses of action and justify their
choice of action in resolving an ethical issue.
Apply ethical reasoning to arrive at principled decisions
Students will formulate, apply, and evaluate the outcome of a
reasoned, critical approach to resolving an ethical issue.
Articulate the process of ethical decision making in work with
client systems.
Distinguish between personal and professional ethics and behaviors.
Students will manage personal values and interpret the values of the
profession and relevant codes of ethics in their application to practice
situations.
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COMPETENCY #3: CRITICAL THINKING
Apply critical thinking to inform and communicate professional judgments
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Critically appraise and integrate multiple sources of knowledge,
including research-based knowledge and evidence informed
practice wisdom
Students will critically evaluate different knowledge bases,
including research informed practice and practice wisdom, and
constructively contribute to the advancement of those sources.
Analyze models of assessment, prevention, intervention and
evaluation
Students will analyze the outcome of their use of differing
knowledge sources and further delineate sources are most effective
with which practice populations and setting.
Students will evaluate and make modifications as needed of models
of treatment for diverse client systems correcting for any models
that oppress vulnerable populations.
Use various methods of technology to search for information,
critically interpret evidence, and communicate with others
Demonstrate critical thinking by communicating professional
judgment using oral and written communication as appropriate
to the practice setting.
COMPETENCY #4: DIVERSITY
Engage diversity and difference in practice.
Student demonstrates the ability to:
0
Exhibit an appreciation for both differences and similarities
within social contexts
Inventory and measure one’s own assumptive worldviews of self
and others.
Engage client systems in diverse settings to challenge
oppression, discrimination, and privilege at the societal,
institutional and personal level.
Appraise the impact of institutional structures that perpetuate
inequality, oppression, discrimination and privilege
Gain sufficient self-awareness to minimize the influence of
personal biases and values in working with diverse groups
Evaluate the elements of a culturally competent practice with
diverse client systems.
Examine self-awareness of stereotypes, biases and prejudices
towards culturally diverse communities in all forms.
Recognize and communicate their understanding of the
importance of differences and similarities in shaping life
experiences
Develop and apply culturally sensitive and appropriate interventions
that acknowledge differences in values.
View themselves as learners and engage those with whom they
work as informants
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COMPETENCY #5: SOCIAL AND ECONOMIC JUSTICE
Advance local and international human rights and social and economic justice
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Understand the forms and mechanisms of oppression and
discrimination
Evaluate the appropriateness and feasibility of social justice and
human rights considerations and models in social work practice.
Advocate for human rights and social and economic justice
Assess social work client circumstances and then choose ethically
sound practice skills in furthering social justice and human rights.
Engage in practices that advance social and economic justice
Propose and implement collective action and political advocacy to
promote social change.
Manage and revise organizational and community change in
response to local level service gaps.
Use knowledge of the effects of oppression and discrimination
on clients and client systems to guide treatment planning and
intervention.
COMPETENCY #6: RESEARCH INFORMED PRACTICE
Engage in research-informed practice and practice-informed research.
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Use research evidence and other disciplines to inform practice
Conduct analysis of social work practice through the lens of practice
based research.
Conduct comprehensive review of research related to a practice
focused research question to include critical evaluation of research
studies as they apply to disenfranchised populations.
Use practice experience with clients to inform the formulation of
researchable questions.
Become more evidence-informed in selecting interventions,
particularly with diverse and marginalized clients.
Propose practice-based research questions based on practice
experience.
Understand the process of evidence-informed practice
Critically analyze ethics of research designs, particularly related to
the potential of differential impact on vulnerable populations
Demonstrate basic understanding of research design, methods,
and statistics
Formulate and propose a research design based on practice based
research questions, the current state of professional research, and
resources available.
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COMPETENCY #7: HUMAN BEHAVIOR AND SOCIAL ENVIRONMENT (HBSE)
Apply knowledge of human behavior and the social environment
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Select diverse theories of human behavior and the social
environment to guide clinical practice.
Examine and inspect information from human behavior and the
social environment with consideration for social justice.
Distinguish among practice situations where HBSE knowledge may
apply.
Distinguish among elect conceptual frameworks that best fit the
practice situations of diverse client systems.
Evaluate and revise the utility of conceptual frameworks as they are
applied to practice.
Judge the utility and limitations frameworks and facts.
Critique and apply knowledge to understand the reciprocal
interactions between people and their environments
Differentially evaluate the applicability of HBSE knowledge to
practice situations and diverse client systems.
Assess how relevant HBSE knowledge applies to practice situations
and diverse client systems.
Measure and rate how relevant HBSE knowledge applies to
practice.
COMPETENCY #8: POLICY
Engage in policy practice to address social and economic well-being and to deliver effective social work services
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Analyze, formulate and advocate for policies that advance social
well-being
Conduct analysis of policy system for an issue to include defining
the problem or issue, formulate the vision if the problem or issues
was resolved, identifying a range of policy options, compare and
contrast policy options, and propose a potential policy option that
maximizes social work values.
Distinguish theories and models that inform the identification of
steps in implementing policy change that leads to the advancement
of the social and economic well-being of a target population. For a
specific target population, formulate a policy change process
securely rooted in these theories and models.
Collaborate with colleagues, clients, administrators, policy
makers and legislators for effective policy implementation and
action
For a specific targeted population and problem or issue, formulate a
collaborative change plan to include identification of specific
stakeholders, the role of the stakeholder in the policy changes, and
strategies to engage stakeholders.
Communicate to stakeholders and policymakers the
implications of policies and policy change in the lives of clients
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COMPETENCY #9: SHAPING PRACTICE
Respond to contexts that shape practice.
Student demonstrates the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Continuously discover, appraise, and learn about populations,
scientific and technological developments, and emerging social
trends to provide relevant social services
Maintain and improve professional skills by engaging with the
analysis, evaluation and reformulation of changing demographics,
theoretical and scientific developments and emerging social trends
as they arise within the profession.
Assess and evaluate one’s own professional efficacy and ethics
regularly, within the context of social work practice principles.
Continuously evaluate the current technology that most efficiently
communicates social work skills and efficacy.
Analyze ongoing needs for service and construct and,/or reformulate
leadership skills.
Provide leadership in promoting sustainable changes in service
delivery and practice to improve the quality of social services
Analyze on-going social work situations and identify areas in need
of stronger leadership skills.
Construct strategies for relevant social services with corresponding
methods of evaluation.
Identify ways that to maximize the strengths of the client
context to design and promote effective interventions with
clients.
COMPETENCY #10: ENGAGE, ASSESS, INTERVENE AND EVALUATE
A. Engagement
Students will demonstrate the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Substantively and affectively prepare for action with
individuals, families, groups, organizations, and communities
Establish and maintain social work professional identity and adhere
to professional values, ethics, role and function in interdisciplinary
contexts.
Demonstrate familiarity with medical terminology.
Build on the biological foundation introduced in HBSE during the
foundation year to understand genetics, disease processes and
corresponding treatments, including pharmacology.
Understand micro, mezzo, and macro level interventions in
healthcare settings.
Describe the trajectory of social work intervention in various
healthcare settings.
Use empathy and other interpersonal skills
Prepare for action: collect information from clients and collaterals.
Engagement-extending/widening empathic skills, including cultural
competence, to quickly engage and serve client systems in
healthcare settings.
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2
Develop a mutually agreed-on focus of work and desired outcomes
Construct and describe strategies to engage clients in focus of work
and outcomes.
Collaborate with professionals from other disciplines; integrate into
client identified focus of work and outcomes.
Recognize and exercise available sources of power in order to serve
client systems.
Demonstrate sensitivity to the interpersonal dynamics and
cultural/contextual factors that can both strengthen and
potentially threaten a therapeutic alliance.
B. Assessment
Students will demonstrate the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Collect, organize, and interpret client data
Collect and integrate information from medicine, nursing, other
allied health professionals and consumers to integrate into
biopsychosocial-spiritual/multidimensional assessment.
Apply (theories of) policy analysis techniques in healthcare settings
with diverse client systems with an emphasis on social justice and
health disparities.
Apply theories of human development to understand the impact of
illness upon individuals, families and communities.
Understand problem solving processes related to the complexities of
the healthcare policy, funding and delivery systems; articulate
strategies to advocate for clients within these systems.
Differential assessment skills (pediatric, geriatric, etc.)
Ability to attend to client spirituality in assessment and intervention
in diverse, multi-cultural contexts.
Assist families to adapt to new roles, structures and functions.
Assess client strengths and limitations
Describe and demonstrate frameworks that guide the identification,
assessment, and implications of strengths and limitations of multiple
client systems on the client’s trajectory of care.
Consider client strengths and limitations within the current
healthcare facilities as well as potential future healthcare facilities.
Engage client identified systems in assessment.
evelop mutually agreed-on intervention goals and objectives
Describe the process of maintaining client preferences in the
development of mutually agreed goals and objectives in light of
potentially contradictory information from other healthcare
disciplines and other client systems.
Engage client and client system in interventions that facilitate
processes necessary for the client to reconcile hoped for outcomes
and predicted outcomes (e.g., mourning interventions).
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3
Select and modify social work interventions based on ongoing
assessment with clients
Analyze and design intervention strategies appropriate to diverse
healthcare systems, situations, and organizational contexts as
informed by current professional scholarship and research.
Devise and construct interventions informed by evidence based
practice.
Collaborate with multidisciplinary systems to formulate a
comprehensive intervention and service delivery system.
Precisely formulate interventions for the specific system to address
target areas of change
Understand various legal healthcare issues; describe strategies to
approach clients regarding these (e.g., Understand advanced
directives and surrogate decision making as these apply to health
care and how to approach clients regarding these issues).
C. Intervention
Students will demonstrate the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Demonstrate the use of specific and appropriate techniques for a range
of presenting problems identified in the psychosocial assessment of the
client.
Document activities with client systems including assessment,
treatment plans and after care.
Analyze and evaluate organizational goals through collaboration
with relevant disciplines in a medical setting, and their effectiveness
to meet the needs of the client(s) system.
Implement prevention interventions that enhance client capabilities
Describe strategies and the social work role in primary, secondary,
and tertiary prevention in healthcare.
Describe strategies and the social work role in community level
health crises such as bioterrorism and contagious disease.
Providing services within a framework of understanding the
reciprocal relationship between policy and service delivery.
Help clients resolve problems
Explain advanced directives and surrogate decision making to client
systems.
Appropriately reviewing healthcare data/utilize reliable empiricallybased data to inform interventions with client systems in diverse
healthcare settings.
In medical setting, initiate and deliver interventions as deemed
appropriate such as family-centered care, groupwork, and
interventions related to spirituality.
Empowering clients to be informed consumers of healthcare.
Attend to client spiritually in assessment and intervention in diverse,
multi-cultural context.
Utilize small group theory in interdisciplinary practice and the
fundamentals of social group work to intervene on the health care
team.
Negotiate, mediate, and advocate for clients
Understand how economic and social attitudes shape healthcare
funding and delivery systems, particularly affecting marginalized
client systems.
Use policy analysis techniques to advocate on behalf of client
systems in healthcare settings.
Determine circumstantial use of mandated reporting laws and use of
protective service agencies.
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2
Facilitate transitions and endings
Demonstrate competence in case management & discharge
planning; differentiate the social work role in these processes from
other healthcare professions.
D. Evaluation
Students will demonstrate the ability to:
No
Minimal
Developing Emerging Competency
Competency Competency Competency Competency
1
2
3
4
5
N/A
0
Critically analyze, monitor and evaluate social work interventions
Collect data for individual patients that indicates implemented
interventions are leading to intended outcomes.
Collect and utilize outcome data to evaluate and inform future
interventions in healthcare practice.
Evaluate the outcomes of interventions and use this information
to calibrate and modify further work with clients.
ADDITIONAL COMMENTS
Identify the methods used to evaluate the student’s performance (example: process recording, observation, etc.).
Identify the student’s strengths.
Identify the area(s) where the student needs improvement.
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3
What is the plan to address the area(s) needed for improvement?
Summarize the student’s performance, overall, as it relates to these competencies.
___________________________
SUPERVISOR’S SIGNATURE
___________________________
STUDENT’S SIGNATURE
______________
DATE
______________
DATE
Please make sure that the:
· Supervisor keeps a copy
· Student keeps a copy
· Student submits copy to the Loyola field office.
· Evaluation can be submitted to Lewis Tower, Room 850 in person, by fax to 312-915-7090 or by e-mail to internship coordinator.
· Student submits time logs with evaluation signed by supervisor
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