Advanced Practicum Learning Contract
Community–Centered Integrative Practice Concentration
(Expandable Word versions from the Practicum website can be Saved As a template to your computer to work on electronically)
Student Name:
Student email:
Agency Name:
PI Phone #:
Practicum Instructor:
Co-Practicum Instructor (if Applicable)
Task supervisor (if applicable):
SSW Faculty Practicum Liaison:
email:
email:
email:
email:
Instructions: The purpose of the practicum contract is to articulate a learning plan to be followed by both the Practicum Instructors(s) and
student. This learning plan consists of: 1) program objectives, which integrate MSW curriculum goals, coursework, and field work;
2) competencies to be achieved under each objective; 3) recommended activities, which support School objectives and help standardize
competency development; and, 4) site-specific individualized activities, developed from the student’s learning plan to meet practicum goals.
Insure that the contract is accompanied by the signed Acknowledgement of Risk form, (p. 6 of 6).
The contract is negotiated between the student, PI, and any other agency personnel involved in student teaching, and provides the basis for
evaluating the student's professional development. Progress towards competencies is evaluated quarterly. The contract should be submitted no
later than the end of the fourth week in the first quarter of the placement. The student must also provide the Practicum Instructor a copy of each
course syllabus by the third week of each quarter to facilitate integration of theory and practice.
Placement Schedule and Practicum Credit Plan
1.
Please list the days and times the student will be in placement. Students in MSW Advanced Practicum are
required to complete a total of 720 hours (18 credits).For Advanced Generalist students in the Extended Degree
Program the number of credits and hours may vary each quarter according to student and agency needs. The
formula for developing practicum plans is one credit = 40 hours in practicum.
Days:
2.
Time:
Weekly Individual Instruction/Supervision Schedule:
Day:
Start Date:
Time: From:
to:
NOTE: Students proposing to be in practicum over quarterly breaks should add those hours to the following
quarter. Summer quarter is 9 weeks; other quarters are 10 weeks long. (There are five weeks between the end
of Summer Quarter and the beginning of Fall Quarter).
3.
Quarter/Credit Plan: 720 hours /18 total credits required. 1 credit =
complete:
Extended Program Model Plan
Summer Quarter:
Autumn Quarter:
Winter Quarter:
Spring Quarter:
40 hours at Agency. Please check or
16 hrs/wk/x9wks = 160 hrs 4 Cr.
16 hrs/wk/x15 wks = 200 hrs 6 Cr.
16 hrs/wk/x10 wks = 160 hrs 4 Cr.
16 hrs/wk/x10 wks = 160 hrs 4 Cr.
720 hrs 18 Cr.
(OR, Develop Individual Plan, depending on student schedule and agency agreement)
Other: please specify:
1st
Qtr
2nd
Qtr:
3rd
Qtr:
4th
Qtr.
5th
Qtr:
hrs/wk =
hrs/wk =
hrs/wk =
hrs/wk =
hrs/wk =
Credits.
Credits:
Credits:
Credits:
Credits:
Student’s Educational Self- Assessment
(COMPLETION OF THIS SECTION IS REQUIRED)
1. Identify the strengths you bring to practicum:
2. Identify areas for future growth and professional development goals:
3. Identify the methods by which you learn best (e.g., observation, extensive reading, discussion,
immediate involvement in work tasks, keep a journal, etc.) and share with Practicum Instructor.
Confidentiality Statement: Each of the parties to this educational contract recognizes the sensitivity of the
client information acquired during client-provider interactions and therefore agree to maintain and protect
the confidentiality of client information and records. Although the educational nature of the experience may
necessitate discussion of client-provider interactions, under no circumstance will the identity of any
individual client be disclosed beyond the student, practicum liaison, and practicum instructor relationship,
and then only when necessary.
We attest that we have jointly negotiated and agreed to this practicum learning contract:
_____________________________________________
Practicum Instructor Signature:
Year MSW Received: ______________
Date: _____________
___________________________________________________________ Date: _____________
Co - Practicum Instructor Signature (if applicable):
Year MSW Received: _______________
___________________________________________________________ Date: ______________
Task Supervisor Signature (if applicable):
____________________________________________
Student Signature:
Date: ______________
____________________________________________
Social Work Faculty Practicum Liaison Approval:
Date: ___ __________
ADVANCED LEARNING OBJECTIVES
1. SOCIAL JUSTICE: To demonstrate a commitment to the promotion of social justice, through one’s own work
and that of the larger social work profession, and apply advanced knowledge and principals of multiculturalism and
empowerment to social change efforts in one’s practice.
Competencies:
a. Demonstrate ability to apply effective, empowering and culturally appropriate change strategies in one’s
everyday practice, toward the goal of promoting social justice and behavioral and social change.
b. Demonstrate cultural competency through the ability to collaborate effectively across differences of race,
ethnicity, socioeconomic status, gender, age, sexual orientation or ability.
c. Demonstrate ability to work closely with constituents to create and support change efforts that effectively
increase the social, cultural, political and economic empowerment of vulnerable and marginalized
populations.
Recommended activities:
a. Articulate with PI your growth in cultural competence and ability to relate your background and biases to
advanced social work practice.
b. Using principles of social justice, identify and analyze with the PI the effects of race, ethnicity,
socioeconomic status, gender, age, sexual orientation or ability on clients, organization and community, and
ways that systems of discrimination and oppression may be reflected in the agency context.
Required: At least one specific, individualized activity relevant to advanced practice, agency context, and
coursework:
(e.g., Assess with PI agency efforts to apply theories and frameworks of cultural competence in foster care
and child welfare; plan and/or participate in at least one agency initiative or community coalition addressing
issues of cultural competency or social change for immigrant and refugees):
2. POLICY SERVICES: To demonstrate advanced knowledge and skills in critical analysis of the sociopolitical
factors that shape policy and services formation in one’s area of practice or setting, in analyzing and influencing
existing policies and services, and in advocating for change in policies, services and practices locally, nationally and
globally.
Competencies:
a. Demonstrate ability to apply advanced social work principles to evaluate the efficacy of social policies,
programs and interventions in promoting justice and preventing/alleviating economic and social inequalities.
b. Demonstrate ability to analyze the structural/societal sources and uses of power and authority.
c. Demonstrate ability to promote social justice through ethical use of power and authority in advocating for and
with vulnerable and marginalized constituents.
Recommended activities:
a. Assess and analyze with PI how relevant laws standards, regulations and internal and external policies affect
service delivery.
b. Analyze with PI how the agency’s policies and practices address social justice principles, and make
recommendations to strengthen effectiveness.
c. Assess the impact of a specific social policy or program on the distribution of resources, and analyze with PI
the resulting material and social outcomes.
Required: At least one specific, individualized activity relevant to advanced practice, setting and coursework
(e.g., evaluate the effect of the No Child Left Behind Act on school services; analyze the Three Strikes law
and its impact on justice system constituents; investigate the effects of proposed Medicaid cuts on hospital
services):
3. COMMUNITY -CENTERED INTEGRATIVE PRACTICE: To articulate the theories, knowledge of human
behavior, and research evidence that informs one’s practice, apply these mindfully in one’s work with diverse
constituents, and demonstrate advanced skills through a variety of professional roles across multi-levels of practice.
Mix appropriate to student setting
A. Community Centered Integrative Practice competencies
a.
Demonstrate mastery in the use of effective interpersonal relationships in practice, characterized by
warmth, genuineness, empathy, and cultural awareness.
b. Demonstrate advanced skills in ethical decision-making processes and ability to resolve value conflicts in
one’s professional practice, consistent with NASW Code of Ethics.
c. Demonstrate ability to apply advanced knowledge and skills related to human behavior in the social
environment when conducting theory-based assessments and interventions with diverse populations.
d. Demonstrate the capacity for on-going leadership in multiethnic and mulitcultural community groups
(refugee or immigrant, tribes, other) applying knowledge of planning and evaluation processes for service
delivery; and employing empowerment strategies to build constituent autonomy.
e. Demonstrate effective relational and communications skills, with and between groups, including ability to
identify and analyze power differentials to ensure that all positions are taken into account.
f. Demonstrate ability to build coalitions and collaborative relationships that impact services, involving
constituents in identifying the strengths and barriers inherent in community or policy change
g. Demonstrated ability to apply social change efforts in one’s practice to structural dynamics and inequalities
of society, both locally and globally.
h. Demonstrate ability to apply social change efforts in one’s practice to structural dynamics and inequalities of
society, both locally and globally.
i. Demonstrate skill in representing the profession and the agency in community change efforts, utilizing
effective teaching and training methodologies.
j. Demonstrate ability to apply financial, organizational, administrative processes to the delivery of services
Possible activities as appropriate to setting:
a. Identify with the PI the assumptions, elements, and interventions included in practice theories relevant to the
setting, and use in work with constituents.
b. Conduct and document assessments, theory-based interventions, advocacy, service brokerage, referrals, and
evaluations from a strengths and empowerment perspective (e.g., bio-psychosocial assessments, community
or organizational assessments) depending on agency mission and practicum role.
c. Examine structures, processes, and policies related to ethical practice and conflict resolution;
participate in and document ethical decision-making
d. Review the organization’s mission statement, articles of incorporation, bylaws, policies and
e.
f.
g.
h.
i.
procedures, and analyze with PI ways in which the social work role contributes to organizational
leadership
Investigate the organizational culture, its impact on workers and clients, and analyze with PI
effective and ineffective means of organizational change
Participate in staff meetings, case consultations, project meetings, and/or community planning
meetings; analyze group dynamics with PI
Identify with PI the funding and resources available to clients and organization; analyze resource
limitations and ways to develop new resources or linkage
Participate in a community coalition or alliance that supports social change
Research a specific policy or legislation and develop an advocacy approach for instituting change to
benefit constituents.
Required: Identify at least six specific ,individualized community-centered practice activities relevant to students
practicum setting.
1.
2.
3.
4.
5.
6.
7.
8.
4.
RESEARCH AND EVALUATION: To demonstrate the advanced knowledge and skills required to assess
the differential needs of diverse constituents, plan and implement evidence-based interventions in collaboration with
constituent, and critically evaluate, monitor, and continuously refine one’s practice using appropriate research and
evaluation methods.
Competencies:
a. Demonstrate ability to use empirically-based knowledge and culturally sensitive methodologies in planning
interventions and monitoring practice effectiveness;
b. Demonstrate ability to develop and test hypotheses regarding service delivery variables which may have
positive or negative impact on desired outcomes;
c. Demonstrate ability to identify and apply outcome indicators which can reliably measure the effects of service
delivery variables on desired outcomes;
Recommended activities:
a. Identify research articles related to advanced practice and utilize evidence-based methodologies in assigned
cases or projects;
b. Conduct a systematic review of literature, constituent information, and organizational mission, policies and
procedures that inform agency program evaluation; analyze with PI the strengths and limitations of existing
evaluation methods; strategize ways that evaluation might be improved.
Required: At least one specific, individualized activity relevant to advanced practice, agency context, and
coursework
(e.g., , involve constituents in developing and measuring outcomes of one’s practice; create and conduct a
constituent satisfaction survey and give recommendations to appropriate staff.):
5. PROFESSIONAL GROWTH, DEVELOPMENT, AND RESPONSIBILITY: To demonstrate professional
values, skills and behavior through a self-reflective understanding of and adherence to the NASW Code of Ethics and
other relevant professional standards.
Competencies:
a. Demonstrate ethical practice based on the NASW Code of Ethics, and resolution of ethical dilemmas across
levels of practice and involving relevant constituents.
b. Demonstrate self awareness, including the ability to differentiate between presenting personal, professional,
or organizational positions, and prevent personal values and biases from interfering with professional
decisions.
c. Demonstrate respect for the rights of others to maintain perspectives and positions different from one’s own
and support the right of self-determination.
d. Demonstrate professional behavior and professional growth, including communication skills and an
investment in learning.
e. Demonstrate professional responsibility by being courteous to clients and colleagues; by being punctual and
dependable; and by organizing and prioritizing work responsibilities effectively.
Recommended activities:
a. Review cases and projects to identify ethical issues and practice that reflects an advanced understanding of
social justice, social change, and multiculturalism.
b. Review with PI progress towards ability to respond to constituents at an advanced practitioner level, using
effective oral, non-verbal, and written communication.
j. Work with PI to develop a schedule and learn workload priorities; and then manage workload effectively so that
obligations are met.
Required:: At least one specific, individualized activity relevant to advanced practice, setting and coursework
(e.g.: Review individual learning plan (ILP) with PI and evaluate progress towards goals):
6. AUTONOMOUS PRACTICE: To achieve a level of competency such that, with self-monitoring and use of
informed consultation, one can practice autonomously in one’s area of concentration.
Competencies:
a. Demonstrate ability to integrate and apply advanced knowledge, values, and skills enabling independent
judgment in professional practice.
b. Demonstrate ability to use supervisory suggestions and guidance from the practicum instructor, consultants,
advisory groups, boards and community policy groups in preparation for and to monitor autonomous practice.
c. Demonstrate ability to incorporate critical and reflective thinking in autonomous practice, continuous self
evaluation and learning.
Recommended activities:
a. Utilize weekly instruction for consultation, planning, prioritizing, and integrating theory and practice, critical
thinking, and self-evaluation in preparation for and to evaluate autonomous practice.
b. Identify knowledge and skills necessary for autonomous practice in this setting, and discuss with PI progress
towards this goal.
Required: Any agency-specific, individualized activity identified by the PI as necessary for autonomous practice in
this setting (e.g., submit at least two audio or video recordings of client interactions for critique in supervision; plan
and rehearse project plans with PI prior to independent community presentation):
S:newadss\merdedocuments\practicum\contracts&evaluations\2008 Community-Centered Integrative Practice Contract(6-08)
University of Washington School of Social Work
Acknowledgment of Risk and Consent for Treatment for Practicum Participants
Section 1 (To be completed by practicum participant)
I acknowledge that there are certain risks inherent in my participation in this practicum, including, but not
limited to risks arising from:
 Driving to and from the practicum site, or while in the course of practicum activities;
 Unpredictable or violent behavior of certain client populations served by the practicum site;
 Exposure to infectious diseases, including tuberculosis or other airborne pathogens, and hepatitis, HIV
or other bloodborne pathogens.
I acknowledge that all risks cannot be prevented and could result in my bodily injury, up to and including
death, and agree to assume those risks beyond the control of University faculty and staff. I agree that it is
my responsibility to understand and follow the Practicum Site's policies and procedures designed to identify
and control risks, including safety and security procedures and bloodborne pathogen policies, and to obtain
any immunizations which the Practicum Site may recommend or the University require. I represent that I
am otherwise capable, with or without accommodation, to participate in this practicum.
Should I require emergency medical treatment as a result of accident or illness arising during the practicum,
I consent to such treatment. I acknowledge that the University of Washington does not provide health and
accident insurance for practicum participants and I agree to be financially responsible for any medical bills
incurred as a result of emergency or other medical treatments. I acknowledge that I have been given the
option to purchase field trip and students' health insurance through the University. I will notify my
Practicum Instructor if I have medical conditions about which emergency personnel should be informed.
Name of Practicum Site: ___________________________________________________
Printed Name of Student:___________________________________________________
__________________________________________
_______________________
Signature of Student
Date
_______________________________________________________________________
Section 2 (General Information)
 To request disability accommodations for this practicum, please contact Disabled Resources for
Students at least 10 days in advance of the practicum start date by calling (206)543-8924 (voice); (206)
543-8925 (TTY); or (206) 616-8379 (FAX); or email uwdss@u.washington.edu
 To purchase optional field trip insurance, please call (206) 543-3419. To purchase student health
insurance, call (206) 543-6202.
 All School of Social Work students must meet all of the annual immunization requirements set by the
University of Washington Health Sciences Administration in order to begin and continue in their
practicum. As part of this process students are required to have their immunization history reviewed by
the Hall Health Immunization Clinic. The School of Social Work must receive confirmation of
compliance with immunization requirements from Hall Health before students may begin a practicum
placement.
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