Greater Rochester Collaborative MSW Program
Interdisciplinary Health Concentration Field Evaluation
Student Name: _______________________________Semester: __________ Year: __________
Agency Name: _______________________________Number of Completed Hours: __________
It is expected that satisfactory progress in developing competence is required by the end of the first semester. By the end of the second
semester, the student is expected to meet expectations as an MSW level practitioner ready to begin professional practice.
Rating Scale
5
Advanced Competence: (AC) Able to skillfully demonstrate awareness, knowledge, and skills. Practice behaviors are performed in
a highly competent manner, and the student demonstrates high levels of understanding and proficiency
4
Competent©: Consistently demonstrates awareness, knowledge, and skills. Practice behaviors are performed in a competent
manner, and the student demonstrates understanding and proficiency
3
Emerging Competence at the expected level of growth and development (EM): Consistently demonstrates professional
growth and application of knowledge, values and skills required for generalist level practice. Practice behaviors are appropriate
and the student demonstrates beginning level understanding and proficiency
2
Insufficient Progress (IP) Inconsistently demonstrates awareness, knowledge, and skills. Practice behaviors are handled with many
difficulties and the student is unable to demonstrate an adequate level of understanding or proficiency. Corrective action and
additional training are required.
1
Unacceptable Progress (UP): Unable to demonstrate awareness, knowledge, and skills. Most practice behaviors are handled with
a high degree of difficulty and the student is unable to demonstrate a fundamental level of understanding and proficiency.
n/a No opportunity this semester to complete this practice behavior. (This rating is only allowed in fall semester and a plan
needs to be developed to assess the practice behavior in spring semester).
Competence 1: Identify as a professional social worker and conduct oneself
accordingly(EPAS 2.1.1)
IH2.1.1a Demonstrate professional use of self.
IH2.1.1b
Utilize and identify professional strengths, limitations, and challenges.
IH2.1.1c
Work effectively within Interprofessional team practice
AC
5
Summary (add sum and divide by 3)
Comments:
Competence #2 :Apply social work ethical principles to guide professional
practice. (EPAS 2.1.2)
IH2.1.2a Employ strategies of ethical reasoning to address dilemmas in
Interdisciplinary Health Care practice.
IH2.1.2b Effectively manage professional boundaries
Summary (Add sum & divide by 2)
Comments:
C
4
EC
3
IP
2
UP
1
NA
Competence 1 =
AC
5
C
4
Competence 2 =
EC
3
IP
2
UP
1
NA
Competence # 3: Apply critical thinking to inform and communicate
professional judgments. (EPAS 2.1.3)
IH2.1.3a Utilize theoretical perspectives, research, and practice knowledge and
apply them to client situations
AC
5
C
4
EC
3
IP
2
UP
1
NA
UP
1
NA
IH2.1.3b
Integrate and communicate professional judgments to other social
workers and to professionals from other disciplines in both verbal
and written formats.
Summary (Add sum & divide by 2)
Comments:
Competence 3 =
Competence #4: Engage diversity and difference in practice. (EPAS 2.1.4)
IH2.1.4a
AC
5
C
4
EC
3
IP
3
Address the cultural, spiritual and ethnic values and beliefs of client
systems in understanding their perspective on health practices
IH2.1.4b
Translate cultural competence into practice skills of assessment,
treatment planning & intervention to enhance client physical and mental
health & well-being.
Summary (Add sum & divide by 2)
Comments:
Competence #5: Advance human rights and social and economic justice. (EPAS
2.1.5)
IH2.1.5a Identify and use knowledge of relationship dynamics, including power
differentials to advocate at multiple levels for economic, employment,
health, education and housing equality.
IH2.1.5b Understand the potentially challenging effects of economic, social,
environmental and cultural factors in the lives of clients and client systems
in health and mental health treatment.
Summary (Add sum & divide by 2)
Comments:
.
Competence 4 =
AC
5
C
4
EC
3
Competence 5 =
IP
2
UP
1
NA
Competence #6: Engage in research-informed practice and practice-informed
research. (EPAS 2.1.6)
IH2.1.6a Reviewing evidence based literature related to health and mental health
care topics.
IH2.1.6b Demonstrate the knowledge of program evaluation and in achieving
intended health outcomes.
IH2.1.6c Use of research including evidence-based practice to evaluate and
enhance the effectiveness of social work and health care practice.
Summary (Add sum & divide by 3)
Comments:
Competence #7: Apply knowledge of human behavior and the social
environment. (EPAS 2.1.7)
IH2.1.7a Demonstrate knowledge of theoretical perspectives that inform health
care practice inventions.
IH2.1.7b Apply theories of human behavior and the social environment to guide
social work and health care practice.
Summary (Add sum and divide by 2)
Comments:
AC
5
C
4
EC
3
IP
2
UP
1
NA
EC
3
IP
2
UP
1
NA
EC
3
IP
2
UP
1
NA
Competence 6=
AC
5
C
4
Competence 7 =
.
Competence #8: Engage in policy practice to advance social and economic
well-being and to deliver effective social work services. (EPAS 2.1.8)
IH2.1.8a Identify the connection between clients, practice, and both public and
organizational policy.
IH2.1.8b
AC
5
C
4
Advocate to influence health and mental health policies that affect
clients and health care services.
Summary (Add sum and divide by 2)
Comments:
Competence #9: Respond to contexts that shape practice. (EPAS 2.1.9)
IH2.1.9a
Demonstrate knowledge of current social contexts and trends that affects
client health and mental health systems.
IH2.1.9b
Work collaboratively with key stakeholders to effect systemic change that
is sustainable.
Competence 8 =
AC
5
C
4
EC
3
IP
2
UP
1
NA
Summary (Add sum & divide by 2)
Comments:
Competence 9 =
Competence #10: Engage, assess, intervene and evaluate with individuals, families, groups, organizations, and communities.
(EPAS 2.1.10)
Engagement (EPAS 2.1.10a)
AC
C
EC
IP
UP
5
4
IH2.1.10a
Develop culturally responsive therapeutic and collaborative
relationships.
IH2.1.10b Manage the dynamics and contextual factors that both strengthen and
potentially threaten the therapeutic and working relationship.
IH2.1.10.c Maintain a rapport that encourages client (s) to be equal participants in
the working relationship.
Assessment (EPAS 2.1.10 b)
IH2.1.10d
Conduct comprehensive assessments.
IH2.1.10e
IH2.1.10f
Select and modify appropriate intervention strategies based on
continuous assessment.
Administer and interpret standardized assessment and diagnostic tools.
IH2.1.10g
Contribute to interdisciplinary team assessments of client and
community systems
Intervention (EPAS 2.1.10c)
IH2.1.10h
Apply best practices and evidence-based interventions to health and
mental health related service delivery.
IH2.1.10i
Collaborate with other professionals to coordinate interventions.
IH2.1.10j
Effectively mobilize resources and assets to enhance client system
capacity
Evaluation (EPAS 2.1.10d)
IH2.1.10.k Develop clear, timely, and appropriate intervention plans with
measureable objectives and outcomes.
IH2.1.10l
Demonstrate the knowledge of practice evaluation in achieving intended
health outcomes.
IH2.1.10m Based upon the results of evaluation, adjust interventions plans on a
continuing basis and appropriately disseminate findings.
Summary (Add sum & divide by 12)
Comments:
Competence 10 =
3
2
1
NA
Summary of Quality Points by Competency (worksheet)
Summary of Scores (worksheet)
Competence 1
Competence 2
Competence 3
Competence 4
Competence 5
Competence 6
Competence 7
Competence 8
Competence 9
Competence 10
Unsatisfactory
2.9 and lower
Sum of scores
divided by 10
Please describe the student’s strengths and areas of accomplishment:
(Please attach additional sheets as needed)
Please indicate areas requiring further development and improvement:
(Please attach additional sheets as needed)
Satisfactory
3.0 and higher
Student Section:
I am in agreement with this evaluation:
Yes
No
Student Comments:
Signatures
Field Instructor Name:
Signature:
Date:
Student Name:
Signature:
Date:
Faculty Liaison Name:
Signature:
Date:
Field Education Office Review:
Signature:
Date: