SWRK 6050 Pre-MSW Evaluation Form

Pre-MSW Field Placement

SWRK6050

LEARNING CONTRACT AND SKILLS EVALUATION

STUDENT NAME:

IDENTIFYING INFORMATION
Field Placement Days: Mon. ☐ Tues. ☐ Wed. ☐ Thurs. ☐ Fri. ☐ Sat. ☐ Sun. ☐
Time(example: 8 a.m. – 4 p.m.; 10 a.m. – 2 p.m.): Click here to enter text.
Reflective journal frequency (e.g., daily, weekly, bi-weekly, monthly): Choose an item.
Day(s) and time(s) of weekly field supervision: Choose an item.
Student / Click here to enter text. / Field Instructor* / Click here to enter text. /
U of M Email / Click here to enter text. / Email / Click here to enter text. /
Primary Phone / Click here to enter text. / Primary Phone / Click here to enter text. /
Faculty/Field Liaison / Click here to enter text. / Agency Mentor*
(if applicable) / Click here to enter text. /
Email / Click here to enter text. / Email / Click here to enter text. /
Primary Phone / Click here to enter text. / Primary Phone / Click here to enter text. /
Agency / Click here to enter text. / Contact Name
(if applicable) / Click here to enter text. /
Address / Click here to enter text. / Email / Click here to enter text. /
Fax # / Click here to enter text. / Primary Phone / Click here to enter text. /

*Note:A Field Instructor possesses a social work degree and is appointed by the University to supervise a student. An Agency Mentor is the onsite person who does not hold a social work degree but is directlysupervising the student and works in collaboration with the Field Instructor.

Pre-MSWField Coordinator
Faculty of Social Work
University of Manitoba
Phone: 204.474.8300
Fax: 204.474.7594

The Learning Contract and Skills Evaluation is forwarded (at end of final term) to the following:

LEARNING CONTRACT

The Learning Contract is an important tool in the field instruction process. Its purpose is to assist in making learning goals and expectations explicit. The student develops it, collaboratively with the Field Instructor, and in consultation with the Field Liaison. It is a working document, meant to be flexible and dynamic. It can be assessed on an ongoing basis throughout the field placement and modified if required to acknowledge changing needs and goals.The Learning Contract can be found at the beginning of each of the five (5) skills sets identified in the Skills Evaluation. In other words, the Learning Contract flows throughout the Evaluation Form. There can be several learning objectives for each section. An example of the Learning Contract is found below.

  1. Professionalism/Ethical Standards
The student conducts self in a professional manner and applies social work principles and values in
practice.
LEARNING CONTRACT
Several learning objectives are appropriate
Objectives / Activities / Timeline
1-Practice personal reflection and self-evaluation to promote ongoing professional development
2-Identify the major values that support and challenge my professional practice; and identify and apply strategies to resolve ethical concerns / -Discussions with supervisor
-Work on strategies that fosters growth and
professional development
-Journaling on the strengths and challenges experienced with clients
-Review the CASW Code of Ethics
-Discuss with co-workers how they address ethical dilemmas
-Discuss with supervisor possible solutions to ethical dilemmas / Month/Year
e.g., Jan., 20XX
Month/Year
e.g., Dec., 20XX

SKILLS EVALUATION

One purpose of an Evaluation Form is to provide a standardized instrument that can provide a consistent guide for Field Instructors and students to measure student performance. A Pass/Fail grade is intended to encourage students to risk themselves in their professional development without risking a lower numerical grade. The assessment of the student’s performance is meant to be progressive.

Each section contains a number of attributes that are to be evaluated. An explanation for assessing knowledge/ability/skills at a 1, 2, 3, or a 4 can be found on the next page. Boxes titled “Example” follow each attribute. Examples are mandatory whenever a student is assessed as not meeting expectations or when a student requires further development in a particular skill set. Examples can also be provided in other instances, such as when a student exceeds expectations.

There are three (3) grade recommendations to be considered. A Pass indicates that the student has met expectations and has demonstrated skills at a 3 & 4 level. A Fail indicates that the student has failed to meet expectations and has demonstrated the majority of skills at a 1 or 2level.A Fail Incomplete indicates that the student is required to continue in SWRK 6050 for a defined period, as contracted with the student, Field Instructor, and Faculty Field Liaison. Examples for the four (4) assessments levels follow on the next page. It is also acceptable to use not applicable (N/A)ornot observed (N/O) if a student has not had the opportunity to demonstrate or practice a skill set, or if the Field Instructor has not been able to evaluate a particular attribute of a skill set.

Assessing an attribute 1 means the student does not meet expectations; assessed as 2, the student needs development; assessed as 3, the student meets expectations; and assessed as 4, the student demonstrates exceptional skill well-grounded in theory. Examples for the four (4) assessment rankings follow on the next page.

1)Does Not Meet Expectations: The student fails to demonstrate the necessary skills and abilities. Examples include, but are not limited to, the following:
  • Demonstrates significant difficulty with integration of theory with practice
  • Demonstrates unprofessional behaviour such as tardiness and unreliability (e.g., inconsistent attendance, lack of adequate notification if late or absent due to illness, and lack of follow through with assigned tasks)
  • Demonstrates a lack of initiative in fulfilling expectations and assigned tasks
  • Does not access, accept or use supervision including constructive and critical feedback, as provided
  • Demonstrates lack of awareness of own values, biases and needs
  • Demonstrates a lack of awareness and/or understanding of agency policies and procedures
  • Demonstrates lack of appropriate communication skills, verbal and/or non-verbal
Action: Student, Field Instructor and Field Liaison may either discuss an extension of placement and complete an Addendum to the Learning Contract or discuss termination. / 2)Needs Development: The student demonstrates potential for
growth in her or his professional role, but in an inconsistent
manner. Examples include, but are not limited to, the following:
  • Demonstrates some difficulty with integration of theory with practice skills
  • Demonstrates some attainment of learning goals but requires additional support and enhanced clarification
  • Does not consistently access or use guidance and supervision when appropriate
  • Identifies her/his own values and biases but experiences some difficulty with understanding the implications on practice
  • Identifies and understands agency policies and practicesbut refers to and/or follows on an inconsistent basis
  • Documentation requires some improvement (e.g., not always clearly or objectively written)
  • Demonstrating a minimum level of attainment of learning goals
Action: Field Instructor and Field Liaison will review with the student, on a regular basis, the skills that have been identified for further development.
3)Meets Expectations: The student regularly demonstrates abilities and skills. Examples include, but are not limited to, the following:
  • Demonstrates ability to integrate theory with practice
  • Demonstrates ability to describe and assess the client/system and to suggest possible interventions
  • Demonstrates an awareness of personal strengths in addition to areas for personal and professional growth
  • Demonstrates skills in self-evaluation including an ability to transfer new learning from one situation to another
  • Effectively uses a range of interpersonal communication skills
  • Documentation is clear, purposeful and objective
  • Effectively prepares for supervision and actively seeks and uses guidance and direction, as provided
  • Demonstrates gradual but consistent professional growth and achievement of learning goals
/ 4)Exceeds Expectations:The student would receive a “4”
when s/he demonstrates competence or exceptionalskills and outstanding awareness on a consistent basis. Examples include, but are not limited to, the following:
  • Consistently demonstrates integration of theory with practice
  • Demonstrates an ability to build rapport and strong working relationships with clients/systems
  • Demonstrates an ability to apply a wide range of assessment and intervention skills in practice
  • Demonstrates an ability to critically analyse use of self in working with clients and others; and identifies areas and methods towards strengthening practice
  • Consistently reflects upon personal and professional values and potential impact upon practice
  • Consistently meets and exceeds expectations relative to documentation requirements
  • Consistently accesses supervision if required, and uses feedback to improve upon effectiveness in working with others
  • Demonstrates and exceeds expectations related to achievement of learning goals and overall professional development

Note: In this evaluation client may refer to individuals, families, community groups, and/or organizations

1 / 2 / 3 / 4
Does Not Meet Expectations / Needs Development / Meets Expectations / Exceeds Expectations / N/A
(Not Applicable) / N/O
(Not Observed)
  1. Professionalism/Ethical Standards
The student conducts self in a professional manner and applies social work principles and values in practice.
LEARNING CONTRACT
Please identify as many learning objectivesas appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
1.1Understands and articulates the role of social work within the context of the field placement setting. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.2Demonstrates knowledge of social work values and principles and adherence to the CASW Code of Ethics within practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.3Documentation and practice reflects a respectful and unbiased position towards the client. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.4Demonstrates ability to clarify, develop, maintain, and reinforce professional boundaries. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.5Takes initiative and responsibility for one’s own learning including a commitment to ongoing professional development. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.6Demonstrates a strengths-based perspective in working with clients and others. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.7Respects clients’ privacy and promotes the rights of clients to self-determination. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.8Other(Please describe)
Click here to enter text. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.
Click here to enter text.
Summary comments at Final are requested. Please include recommendations for future growth and development in practice.
Click here to enter text.
1 / 2 / 3 / 4
Does Not Meet Expectations / Needs Development / Meets Expectations / Exceeds Expectations / N/A
(Not Applicable) / N/O
(Not Observed)
2.Assessment and Intervention Skills in Practice
The student uses self effectively, and competently demonstrates communication, engagement, assessment, and interventionskills.
LEARNING CONTRACT
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
2.1Demonstrates competence in using a range of interpersonal communication skills(e.g. reflection, clarification, paraphrasing and questioning). / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.2Demonstrates ability to work effectively in complex situations, and with involuntary and challenging clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.3Effectively prepares for and conducts placement meetings and interviews with clients and collaterals in a professional manner. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.4Assesses client readiness for change based on a number of factors (e.g., access to formal and informal resources, potential barriers, motivation level and past history.) / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.5Demonstrates ability to integrate theoretical knowledge into practice by providing rationale for assessments and interventions. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.6Works effectively with clients who display a range of beliefs, emotions andbehaviours. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.7Demonstrates awareness of how factors, such as race, age, class, sexual orientation and gender can impact upon case planning. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.8Understands a range of social work interventions at the individual, family, group, organizational, community and societal levels. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.9Works collaboratively with clients and intervenes, as appropriate, to review and address identified concerns and goals. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.10Establishes rapport and effective working relationships with agency personnel in addition to others from a range of systems and disciplines. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.11Understands the importance of the termination process and takes the steps necessary to effectively prepare client and self for closure. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.12Other (Please describe)
Click here to enter text. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.
Click here to enter text.
Summary comments at Final are requested. Please include recommendations for future growth and development in practice.
Click here to enter text.
1 / 2 / 3 / 4
Does Not Meet Expectations / Needs Development / Meets Expectations / Exceeds Expectations / N/A
(Not Applicable) / N/O
(Not Observed)
3.Reflective Capacity and Critical Analysis
The student applies critical thinking to social work practice including self, clients and service delivery.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
3.1Engages in the process of critical thinkingincluding an examination of one’s own beliefs, values, actions and potential impact upon practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.2Discusses ethical dilemmas with the Field Instructor and identifies possible resolutions. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.3Actively seeks and applies critical and constructive feedback from the Field Instructor and relevant others to improve professional practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.4Demonstrates an awareness of how one’s own social location (e.g., race, economic and social status, gender) influences practice with clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.5Demonstrates an awareness of the client’s relationship with her/his environment (e.g., social, physical, spiritual) / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.6Demonstrates the ability to take risks by integrating acquired learning in the field placement. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.7Demonstrates an ability to cope effectively with stress and engage in self-
care, as needed. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.8Other (Please describe)
Click here to enter text. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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Comments
Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.
Click here to enter text.
Summary comments at Final are requested. Please include recommendations for future growth and development in practice.
Click here to enter text.
1 / 2 / 3 / 4
Does Not Meet Expectations / Needs Development / Meets Expectations / Exceeds Expectations / N/A
(Not Applicable) / N/O
(Not Observed)
4.Fostering and Promotion of Human Rights and Social Justice
The student demonstrates an awareness and application of global and anti-oppressive practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
4.1Articulates and demonstrates how issues of inequality in society
(e.g. diversity, oppression, discrimination, power, ethno-culture, and privilege) impact the client. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.2Empowers the client to advocate for her/his own basic human rights
(e.g., freedom, safety, privacy, adequate standard of living, health care and education.) / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
Click here to enter text.
4.3Respects and advocates for the rights of others, and discusses with the Field Instructor any human rights questions or concerns. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.4Acknowledges and understands the implications of discrimination and oppression experienced by clients/groups/communities, both historically and currently. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.5Practices from a culturally sensitive perspective and seeks consultation, as required, to effectively address the needs of the client. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.6Identifies the power structure and lines of authority within the field agency, including impact upon roles, responsibilities, resources and constraints. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.7Other (Please describe)
Click here to enter text. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
Click here to enter text.
Comments
Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.
Click here to enter text.
Summary comments at Final are requested. Please include recommendations for future growth and development in practice.
Click here to enter text.
1 / 2 / 3 / 4
Does Not Meet Expectations / Needs Development / Meets Expectations / Exceeds Expectations / N/A
(Not Applicable) / N/O
(Not Observed)
5.Integration of Policy and Practice
The student demonstrates the knowledge and skills required to integrate policy into social work practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Mid Term / Final
5.1Understands and complies with agency policies and procedures. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.2Identifies how policies at all levels impact practice within the agency and upon clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.3Awareness of the various Canadian social welfare programs, including an understanding of program limitations, and ability to assist clients in accessing required resources. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.4Understands and integrates research and clinical evaluation in social work practice. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.5Demonstrates ability to prepare preliminary outlines, drafts, reports, presentations and workshop materials, when required. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.6Assists, with direction from Instructor, in identifying project goals, activities, time frames, consent requirements and means of evaluation. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.7Understands and uses appropriate methods of technology and communication, including social media, to gather information and/or distribute research findings. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.8Demonstrates competencein assisting communities, groups and organizations in mobilizing, in an attemptto address issues of shared concern. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.9Other (Please describe)
Click here to enter text. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
Click here to enter text.
Comments
Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.
Click here to enter text.
Summary comments at Final are requested. Please include recommendations for future growth and development in practice.
Click here to enter text.

Learning Contract Signatures Date