MSW Healthcare Concentration -Student Learning Agreement Walden University -- Barbara Solomon School of Social Work Used with SOCW 6520 and SOCW 6530 Agency Name: Georgia Regional Hospital-Savannah Agency Address: 1915 Eisenhower Drive, Savannah, Georgia 31406 Student Information Instructor/Supervisor Information Name: Talibra Saures Walden Email: Name: Barbara Brisbon-Rivers talibra.saures@waldenu.edu Email: Barbara.BrisbonPhone: 912-596-2710 Rivers@dbhdd.ga.gov Phone: 912-353-3216 Academic Term Fall 2020. Course Number SOCW 6520-12 Faculty Liaison Information Name: Angela Bullock Email: angela.bullock@mail.waldenu.edu Phone: 240-764-6152 Agency Info Description: Georgia Regional Hospital at Savannah (GRHS) is a statefunded multi-service facility operated by the Department of Behavioral Health and Developmental Disabilities. The hospital provides quality care to mentally ill adults and individuals living with intellectual and developmental disabilities from its 34-county catchment area in Southeast Georgia. They offer clinical services, support services, adult mental health acute care, recovery care, and forensics services. Population Served: Adults Proposed Schedule: Tuesday’s and Wednesday’s 8:30 am – 2:30 pm Describe what your regular tasks will be at the agency: Meeting/interviewing clients. Engaging clients to build rapport. Completing Assessments. Making collateral contact with family and social supports. Completing documentation. Completing social work notes. Reviewing policies. Attending treatment plan meetings. Working with psycho educational groups. Assist with discharge planning. Making Referrals. Crisis intervention. Developing interventions. Importance of the Learning Agreement Purpose of the Learning Agreement: The learning agreement is designed to ensure students are mindful about the learning expectations in their field placement. It was developed to help students and supervisors/instructors plan a well-rounded experience that will help students meet the learning objectives. Learning Objectives: The Council on Social Work Education (CSWE) requires students gain competency in nine areas of social work practice. These areas of practice are defined as core competencies of the profession. Each core competency requires particular behaviors students should be able to engage and gain competency in. Students should provide examples of activities in the agency they can participate in to help them meet the learning objectives. Some examples of activities are provided. This is not an exhaustive list, so others can be added. Students must have an opportunity to complete tasks in all nine areas of competency. Connection to the Student Evaluation: Not only is the learning agreement a helpful tool to plan the learning goals for the term, but it connects directly to the evaluation points in the student evaluation. Field Instructors/supervisors will be asked to complete student evaluations. Each student is evaluated on the nine core competencies of social work. Having a solid learning agreement aligns the learning goals with the student’s evaluation, so no areas are missed. Instructions Negotiating the Agreement: The learning agreement should be completed by week 3 at the agency. This is a collaborative process, where the field instructor/supervisor and student meet to establish goals for the term. The student will then submit the agreement to the faculty liaison for feedback and comments. Once everyone is happy with the agreement, all parties sign the agreement. During the evaluation session, toward the end of the quarter, the student and instructor/supervisor should meet to discuss progress and challenges with the plan and develop ways to adjust the learning for the remainder of the placement and the next quarter. Form Layout: Each page/grid is devoted to one of the nine Social Work Core Competencies. Students must have experience in all nine competencies. Section Descriptions: Expected Behaviors – the expected behaviors are those that are identified for the concentration area. These behaviors should be demonstrated by students during the term of the field placement/internship. Agency Activities-These are examples of particular activities that students can do at the agency to demonstrate the expected behaviors. Most of these are general to all settings. However, if they don’t quite match, feel free to add/change these to fit with the context of your agency. Check all activities that apply. Field Course Assignments-These are a few examples of field course assignments that help reinforce the Social Work Core Competencies. Students will be required to complete all field course assignments. How to Complete the Form: a- By week 2, students should complete all student designated sections on the learning agreement and discuss it with their supervisor/instructor. b- By week 3, students should upload the learning agreement to Blackboard for the faculty liaison to review. (Only upload agreements that have been approved by your supervisor/instructor). c- After the faculty liaison reviews and signs the agreement, the student and instructor should sign it. d- After the agreement has been signed, the student will upload it to Meditrek. Learning Agreement Social Work Core Competency 1 – Demonstrate Ethical and Professional Behavior Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Makes ethical decisions based on the NASW Code of Ethics within healthcare contexts which follow state and federal statutes and regulations, and HIPPA compliance. Adhere to ethical standards outlined by the NASW and maintain HIPPA compliance. SOCW 6520 (Field III) Assignments: Identifies and manages professional values in to address patients’ healthcare needs, rights, and choices. Incorporates professional behavior when engaging with patients, families, colleagues, and other professionals. Evaluates the ethical and appropriate use of technology to facilitate delivery of social work services. Integrates principles of supervision and consultation to guide professional judgement and behavior. Demonstrates professional development by identifying the specialized skills and knowledge need to practice social work in a healthcare setting. Self-Assessment Assignment (Week1) Discuss personal values in supervision when they conflict with the values of the profession and adjust practice as needed. Blog post on confidentiality (Week 2) Blog Post safety in field (Week 3) Recognize personal triggers that could impede effectiveness with clients. Discuss those triggers with your supervisor. Discuss case scenarios with my supervisor and faculty liaison that require ethical reasoning. Seek guidance when you experience and ethical dilemma. Blog Post on Supervision (Week 4) Blog on Ethics (Week 5) Use of Self Blog (Week 8) Sexual Harassment Training Maintain professional boundaries with clients and others and discuss and potential boundary challenges in supervision. Use professional communication and interaction with SMVF and caregivers and professionals. Use professional behavior in the healthcare context. Adhere to agency polices about technology and record keeping. Discuss with your supervisor any Incident Management Training potential ethical challenges that may arise because of the use of technology. Add other activities here: For Student: After reviewing the Agency Activities and Field Course Assignments, describe how these expectations and activities will help you increase competence in ethical and professional behavior. For example, how will you use your strengths, improve knowledge, develop skills, and address any areas you need to improve as a professional (be specific)? Personal check to ensure personal bias do not interfere with serving this population. Review NASW Code of Ethics routinely to remain current and well informed of professional expectations. Staff potential conflicts with supervisor to ensure all clients are served with respect and receive the best service possible. For Student: Write two goals that you want to achieve to help you develop as a professional social worker (these goals should address areas of growth and professional development). 1. Show transition from student intern to professional 2. Have a sense of integration into the staff and others in the practicum agency. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during evaluation). Social Work Core Competency 2 – Engage Diversity and Difference in Practice Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Demonstrates cultural awareness by recognizing and integrating diverse populations’ values related to healthcare interventions and medical systems. Engage culturally responsive practice with patients. SOCW 6520 (Field III) Assignments: Demonstrates cultural humility by managing personal biases when partnering with patients. Discuss in supervision and in class the strengths of engaging diversity and the challenges you have when engaging difference. Agency Assignment – describe the population (Week 4) Diversity Blog (Week 7) Communicates in a culturally responsive way recognizing various cultural norms and values about healthcare. Engage in self-refection about personal biases related to cultural differences, discuss with supervisor, and be able to demonstrate that you can have a personal view and a professional view in practice. Engaged with hearing impaired client, client of different race/cultural background. Training on Trauma informed care Develop a diversity/cultural competency plan that allows you to learn about the various cultural norms and values that may affect healthcare decisions patients make and consider ways to be culturally responsive when communicating with clients. Add other activities here: For Student: After reviewing the Agency Activities and Field Course Assignments, describe how these will help you engage diversity and difference in practice. For example, how will you use your strengths, improve knowledge, develop skills, and address any areas you need to improve as a professional (be specific)? By engaging the client to learn more about their background as well as doing research on diverse populations served will help me develop more knowledge and skills to better serve the clients. For Student: Write two goals that you want to achieve to engage diversity and difference in practice (these goals should address areas of growth and professional development). 1. Gain a broad sense of diversity as it applies to client populations 2. Engage clients from the needs presented by the client based on their diverse needs. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during the evaluation). Social Work Core Competency 3- Advance Human Rights and Social, Economic, and Environmental Justice Expected Behaviors – You will be evaluated on these at the end of the quarter Examines and take steps toward eliminating barriers to healthcare access caused by the effects of oppression, discrimination, structural social inequality. Chooses social work practices that promote human rights and social, economic, and environmental justice within a complex healthcare system that presents competing demands. Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Identify barriers patients face when accessing services. Completing Advanced Directive with clients. Develop a plan to learn about the effects of oppression, discrimination, inequality, and trauma on patients’ health and recovery. Use evidence-based practices that consider the unique challenges patients have when faced with oppression, discrimination, social inequality, and historical trauma. Completing and informing informed consent with clients. Informing clients on their rights to self determination. Discuss with supervisor about how social, economic, and environmental factors affect patient outcomes and overall well-being. Work with instructor/supervisor to engage advocacy for needs and needs of patients. Collaborate with a local or national organization that advocate for the needs of patients. Add other activities here: For Student: After reviewing the Agency Activities and Field Course Assignments, describe how these will help you advance human rights and social, economic, and environmental justice. For example how will you use your strengths, improve knowledge, develop skills, and address any areas you need to improve as a professional (be specific)? This will help me improve my knowledge on patients rights. For Student: Write two goals that you want to achieve to help you advance human rights and justice (these goals should address areas of growth and professional development). 1. My goal is to advocate for the patient needs on the treatment team. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during the evaluation) Social Work Core Competency 4 – Engage in Practice-Informed Research and Research-Informed Practice Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Critically evaluates research related to social work practice in healthcare settings. Research the evidence-based treatment interventions to meet the needs of patients. SOCW 6520 (Field III) Assignment: Develops care plans and interventions based on the best available research and “best practices”. Use critical thinking to evaluate the benefits and challenges of the evidence-based interventions. Discuss your ideas with your supervisor. Intervention Treatment Plan Assignment Develop treatment plans to address the needs of patients, families, and caregivers. SOCW6530 (Field IV) Assignment: Intervention Treatment Plan Assignment part II Add other activities here: For Student: After reviewing the Agency Activities and Field Course Assignments, describe how these will help you engage in practice-informed research and research-informed practice. For example, how will you use your strengths, improve knowledge, develop skills, and address any areas you need to improve as a professional (be specific)? The agency I am working with uses an Assertive Community Treatment approach (ACT) bringing resources together to ensure the client needs are met for various needs. Improving my skills on using the right approach when working with different clients. For Student: Write two goals that you want to achieve to help you improve use research in your practice justice (these goals should address areas of growth and professional development). 1. To advance my skills, additional models and approaches used to serve clients struggling with addiction and mental illness. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during evaluation). Social Work Core Competency- 5- Engage in Policy Practice Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Critically evaluates and creates awareness about policies and regulations in medical systems and/or government institutions that impact the well-being of patients. Consider policies that affect patients and caregivers then discuss those challenges with your supervisor. SOCW 6520 (Field III) Assignment: Applies critical thinking to analyze, formulate, and advocate for policies that support access to healthcare and culturally responsive care. Use critical thinking to examine the negative impact of policies on health and well-being. Consider ways to engage in advocacy to improve healthcare access and other policies related to health. Explore how social problems are connected to policies that impact patients, families, and caregivers and advocate where needed. Week 10 focuses on Organizational Policy Social Problem/Policy Assignment SOCW6530 (Field IV) Assignment: Agency Funding and Policy Implication Assignment Utilizing policies at the agency that govern the population. For example American Disability Act Explore how agency funding is connected to policy. Add other activities here: For Student: After reviewing the Agency Activities and Field Course Assignments, describe how these will help you engage in policy practice. For example, how will you use your strengths, improve knowledge, develop skills, and address any areas you need to improve as a professional (be specific)? Ensuring that I obtain and learn information from the agency policies to better serve the client. For Student: Write two goals that you want to achieve to engage in policy practice (these goals should address areas of growth and professional development). 1. The ability to analyze and stay up to date with policy changes that affect the clients. 2. The ability to review client grievances with the patient advocate. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during evaluation) Social Work Core Competency 6- Engage with Individuals, Families, Groups, Organizations, and Communities Expected Behaviors – You will beevaluated on these at the end of the quarter Individuals Uses empathy, reflection, and interpersonal skills to engage patients, recognizing the unique protocols and regulations in medical setting. Families Uses empathy, reflection, and interpersonal skills to engage with families, recognizing the various roles families play in supportive care, and their needs during emergency, loss, and grief situations. Agency Activities to help you achieve the expected behaviors – Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. SOCW 6520 (Field III) –First 11 weeks Show care, empathy, and genuineness with patients, families, and caregivers to initiate professional relationships. Use a strengths-based approach when engaging patients, families, and caregivers. Use active listening, reflection, and other engagement skills. Process Recording (Week 5) Process Recording (Week 7) Week 9 focuses on Individual, Family, and Group contexts SOCW6530 (Field IV)- Second 11 weeks Groups Uses empathy, reflection, and interpersonal skills to facilitate conversations in patient and/or family groups. Uses interpersonal skills to engage with interprofessional teams in hospital/medical settings. Organizations Engages with medical providers and other stakeholders who provide advocacy, resources, and services to ensure the continuity of care. Communities Identifies and actively participates in opportunities to communicate with community leaders and Consult with organizations to assist with the needs and support of patients, families, and caregivers. Connect with community organizations to advocate for or participate in initiatives for health and well-being. Add other engagement activities: Week 1 & Week 2 Focus on Engagement Blog on Engagement (Week 2) Process Recording (Week 3) members to support healthy communities and resources. For Student: After reviewing the Agency Activities and Field Course Assignments, describe how you will engage with the following target systems in the context of your agency: Individuals: I will prepare to take action by reviewing the client’s prior records, staffing the case with supervisor to build rapport with client. Families: I will assist with communication with client representatives (on phone or in person) with family and patient prior to discharge. Groups: Engaging clients in group by facilitating the group to reflect on their needs and address their situation by helping them build skills to help them cope. Communities: I will demonstrate at least three ways that they are aware of the client’s culture and have attempted to be competent in engaging the client. Organizations: Networking with organizations that address the needs of the clients. For Student: Write two goals that you want to achieve to help you develop your engagement skills (these goals should address areas of growth and professional development). 1. Gain an expansive sense of diversity as it applies to patient populaces 2. Engage patients from the necessities introduced by the patient dependent on diverse needs. 3. I will learn in any event 2 new techniques for client engagement to improve proficient engagement aptitudes. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during the evaluation) Social Work Core Competency 7-Assess Individuals, Families, Groups, Organizations, and Communities Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Individuals Conducts assessments that provide information about the biopsychosocial-spiritual needs of patients. Utilize agency appropriate forms, tools, and processes to complete safety, risk, and biopsychosocial assessments for patients. SOCW6520 (Field III) – First 11 weeks Utilize developmentally, and strengths-based approaches to assessment. Week 9 Focus on Individuals, Families, and Groups SOCW 6510 (Field II)- Second 11 weeks Uses critical thinking to apply the strengths perspective, theories of human behavior and the social environment, and theories human development when analyzing and interpreting assessment information within a healthcare context. Develops mutually agreed-on goals and interventions that consider the patients’ rights and safety. Families Conducts family assessments to understand family roles/structure (legal appointees and next of kin), family cohesion, resources, and support needs. Uses critical thinking to apply theories of family systems when analyzing and interpreting family functioning, support, and dynamics. Groups Identifies the professional role of the social worker in an inter-professional group context and assesses how that role contributes to the group’s purpose. Assesses the functioning and needs of professional and/or patient focused groups, and considers the best intervention strategies, based on professional knowledge and ethics. Organizations Assesses how the agency’s mission, structure, vision, connect to client outcomes. Assist patients and families in developing mutually agreed upon goals and interventions to ensure minimize risk, promote independence, and choice. Assess family functioning, relationships and support utilizing family systems theory. Contribute to interprofessional team meetings providing the social work perspective to ensure the patients’ rights, preferences, receipt of resources, and support services. Discuss with the supervisor interprofessional team dynamics, strengths, challenges to develop ways to engage effectively. Assess how other organizations assist with patient needs and where there may be gaps in services. Assess the role the community plays in providing services patients, their families, and caregivers. (financial, legislative, representative, etc.) Discuss your findings with your supervisor and plan advocacy where needed. Add other assessment activities: Process Recording (Week 5) SOCW 6530 (Field IV)- Second 11 weeks Week 3 and 4 devoted to the assessment process, with assignments of blogs and process recordings. Completing BioPsychoSocial Assessments Participating in treatment team meetings 30. Uses critical thinking to consider the strengths and limitations of health providers’ services, considering their ability to provide healthcare access to diverse groups, including underserved populations. Communities Develops knowledge about community resources, governance, political climate, and overall support for healthcare access. Uses critical thinking to consider the strengths and limitations of the community resources and how those impact healthcare services for those in the community For Student: After reviewing the Agency Activities and Field Course Assignments, describe how you will assess the following target systems in the context of your agency: Individuals: By completing BioPsychoSocial assessment. I will l conduct initial assessments on at least five clients and staff the case with supervisor to show the decisions planned for the client’s case plan . Families: By taking part in family treatment meetings preceding the patients release. Groups: Evaluate individuals needs and figure out what interventions to implement . Organizations: By working with outside associations within the community to help with meeting the patients needs post release. Communities: By utilizing community personal and resources and engaging with these constituents to guarantee that the patient can effectively progress once more into the community with the proper administrations post release. For Student: Write two goals that you want to achieve to help you develop your assessment skills (these goals should address areas of growth and professional development). 1. Distinguish and give proper resources and referrals to patients to enable them to progress after release. 2. Take an interest in networking in the community 3. Being more confident, skilled, and thorough in my assessment skills. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during supervision) Social Work Core Competency 8-Intervene with Individuals, Families, Groups, Communities, and Organizations Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Individuals Implements interventions consistent with a strengths perspective and with the biopsychosocial needs of patients in in-patient and out-patient settings. Utilizes appropriate resources and services for patients. Collaborates with inter-professional teams to ensure coordination and continuity of care. Families Implements interventions that support family functioning, considering the medical context where families often face loss, role changes, and life disruptions. Utilizes appropriate resources and benefits for family interventions. Groups Provides social work perspective that assists with the purpose and function of inter-professional healthcare teams. Field Course Assignments – Complete these in the course when assigned. SOCW 6520 (Field III) First 11 weeks Use agency-appropriate and developmentallyappropriate intervention strategies for patients. Use relevant prevention strategies to minimize risk and support patients’ choices and rights. Week 9 focuses on Individuals, Families, and Groups Utilize various evidence-based interventions appropriate for the patients’ situation. Discuss with supervisor evidence-based practices used in agency setting Intervene with families by providing support, resources, and education. SOCW 6530 (Field IV) Second 11 weeks Explore and utilizes resources to provide holistic care and support the need of patients, families, and caregivers. Talk with supervisor about planning for termination or transitions with patients. Consult with supervisor about ways to be involved in service delivery improvement. ☐Consults with supervisor about opportunities to be involved in advocacy at the organizational and community level. Add other activities here: Weeks 5 and 6 focus on intervention with assignments of blogs and process recordings. Week 9 focuses on Termination with clients Completing Discharge Planning. Participating in treatment team meetings Uses professional ethics and knowledge to evaluate intervention strategies in professional and/or patient group settings. Organizations Participates in opportunities to assist with improving agency systems, collaborating with advocacy groups, and/or any other organizational activities that may improve healthcare services. Communities Explores and actively participates in opportunities to advocate for community services that support health and well-being. For Student: After reviewing the Agency Activities and Field Course Assignments, describe how you will intervene with all of the following target systems in the context of your agency: Individuals: Practice engagement skills with patients Families: Observing Patient and their family behavior to distinguish the degree of help needed to accommodate the patient. Groups: recognize and discuss group process during supervision meetings. Organizations: conduct an assessment of services and treatment strategies. Communities: Participate in community organizing strategies. For Student: Write two goals that you want to achieve to help you apply appropriate intervention strategies (these goals should address areas of growth and professional development). 1. Create more grounded group facilitation abilities. 2. Create certainty around being an expert social worker. 3. See how state and government approaches influence administrations to clients. For Student: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during evaluation) Social Work Core Competency 9- Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities Expected Behaviors – You will be evaluated on these at the end of the quarter Agency Activities to help you achieve the expected behaviors- Check ALL that apply AND add other activities specific to your agency. Field Course Assignments – Complete these in the course when assigned. Individuals Evaluates the effectiveness of intervention strategies and medical social services provided. Considers the effectiveness of therapeutic interventions and makes changes to treatment plans as needed. SOCW 6520 (Field III) First 11 weeks Utilizes evaluation data to inform individual treatment strategies. Consults with supervisor treatment plan outcomes to consider potential alternatives. Families Evaluates the effectiveness of intervention strategies used to improve family functioning and support. Evaluate the effectiveness of social services provided organizations and communities. Utilizes evaluation data to inform family treatment strategies and resources. Groups Evaluates the effectiveness of group related processes such as communication, brieftherapeutic interventions, task accomplishment, support goals, etc. Meet with patients to assess the progress of their goals and make changes in treatment plans as necessary. Participate in data collection, needs assessments, and other research efforts to plan advocacy activities. Add other activities here: Utilizes evaluation data to inform future group processes. Organizations Evaluates the effectiveness of social services and intervention strategies provided by agencies and healthcare providers. Utilizes evaluation data to inform advocacy initiatives to improve healthcare delivery. Communities Evaluates the effectiveness of community services and healthcare access. Week 9 focuses on Individuals, Families, and Groups SOCW 6530 (Field IV) Second 11 weeks Weeks 7 and 8 focuses on evaluation of client success with assignments of blog posts and process recordings. Utilizes evaluation data to inform advocacy initiatives For Student: After reviewing the Agency Activities and Field Course Assignments, describe how you will evaluate the following target systems in the context of your agency: Individuals: Clearly communicating agency and role requirements and processes to individuals. Families: Engaging with patient families as a help to the patients treatment plan and discharge planning. Groups: Viably facilitate groups. Organizations: Discuss with the supervisor, organizational change and the processes influencing organizational change in the agency and community. Evaluate with the supervisor, authoritative change and the cycles impacting hierarchical change in the agency and community Communities: Take an interest in agency endeavors to connect with the community. For Students: Write two goals that you want to achieve to help you understand how to evaluate clients and other systems 1. Effectively acting in the role of an advocate. 2. Applying social work theories in my practice. For Students: Write down any questions you have for your instructor/supervisor or faculty liaison: Instructor/Supervisor’s Feedback for Evaluation: (To be completed during evaluation) Signature Page X X X Student's Signature Printed Name Date X X X Faculty Liaison's Signature Printed Name Date Barbara Brisbon-Rivers, MSW Barbara Brisbon-Rivers, MSW September 16, 2020 The Field Office accepts e-signatures, so feel free to type in your full name and email as your official signature.