SWRK 4120 BSW Field Evaluation Form

B.S.W. Field Placement

SWRK4120

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 must possess a social work degree and is appointed by the University to supervise the student. An Agency Mentor is the onsite person who does not hold a social work degree but is directly supervising the student and works in collaboration with the Field Instructor.

☐ Distance Delivery BSW Field Program
Field Coordinator
Distance Delivery BSW Field Program
Faculty of Social Work
University of Manitoba
Phone: 204.474.6812
Toll Free: 1.800.432.1960 Ext: 6812
Fax: 204.474.7594 / ☐ Fort Garry & Inner City Field Programs
Field Coordinator
Fort Garry & Inner City Social Work Field Programs
Faculty of Social Work
University of Manitoba
Phone: 204.474.8300
Fax: 204.474.7594 / ☐ Northern Social Work Program
Field Coordinator
Northern Social Work Program
Faculty of Social Work
University of Manitoba
Phone: 1.204.677.1456
Fax: 1.204.677.4110

Please indicate below which Field Coordinator (Program) you are submitting this Evaluation form to:

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 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
Student practices as a professional and conducts self in a professional manner. The student is able to articulate social work ethical principles that will guide professional practice.
LEARNING CONTRACT
More than one learning objective is appropriate
Objectives / Activities / Timeline
  1. Practice personal reflection and self-evaluation for professional development
  1. Identify major values that support and challenge my professional practice and identify, analyze and apply strategies to resolve ethical dilemmas
/ -Discussions with supervisor
-Work on strategies that foster continual
growth (participate in PDopportunities)
-Journaling on the strengths and challenges
I have had with clients
-Review the CASW Code of Ethics
-Discuss with co-workers how they face
ethical dilemmas
-Discuss with supervisor possible solutions
toethical problems / March 20XX
Dec., 20XX

SKILLS EVALUATION

One purpose of the 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 made in other instances as well.

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 4120 for a defined period, to be 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 this skill set, or if the Field Instructor has not been able to evaluate a particular attribute of a skill set.

Assessing an attribute as 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 can 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
Student demonstrates social work principles and values in practice, and is actively engaged in one’s learning.
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
1.1Demonstrates the use of knowledge and skills of a professional social worker. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.2Demonstrates competence in carrying out the agency’s mandate. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.3Documentation and practice reflect a respectful and unbiased position toward the client. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.4Able 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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1.5Discusses ethical issues in practice with Field Instructor in the context of the student’s own values and the CASW Code of Ethics, with a resolution to the issue. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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1.6Respects 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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1.7Other(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 interventions skills.
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
2.1Competence with 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 with 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 conducts meetings/interviews with clients and collaterals. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.4Able to articulate and intervene on relevant concerns and goalswith clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.5Able to integrate theoretical knowledge into practice and provides rationale for assessments and interventions. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.6Identifies and actively collaborates with clients to build social networksand social supports. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.7Reviews and evaluates client’s progress on established goals and modifies goals when necessary and with client’s input. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.8Able to work collaboratively with a variety of systems anddisciplines. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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2.9Other(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 engages in constructive discussions and reflections of 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 thinking and examination ofone’s own beliefs, values, actions, and reactions to others. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.2Demonstrates an ability to apply critical and constructive feedback fromthe Field Instructor. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.3Practice consistently reflects a theoretical base and there is an absence of personal judgment in communications about clients. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.4Demonstrates and ability to cope effectively with stress and engage in selfcare, as needed. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.5Consistently critically evaluates one’s own practice and responds appropriately to feedback. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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3.6Other(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.Promotion of Human Rights and Social Justice
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, human diversity, 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 clients to advocate for their own basic human rights
(e.g., freedom, safety, privacy, an adequate standard of living, health care, and education.) / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.3Respects and advocates for the rights of others, and brings to the attention of the field instructor any human rights concerns. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.4Practices with cultural sensitivity. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.5Actively promotes a safe environment for clients andco-workers. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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4.6Other(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)
5.Integration of Policy and Practice
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
5.1Identifies 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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5.2Demonstrates analytical skills through examination of social issues impacting clients, including the relevance and impact of social policies. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.3Actively involved in research and clinical evaluation. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.4Able to identify the limitations of various Canadian social welfare programs and can assist clients to navigate and access required programs. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.5Conducts needs assessments/community asset mapping, and can articulate relevant social issues. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.6Demonstrates capacity to assist with the mobilization of communities, groups and organizations on significant issues. / Choose an item. / Choose an item. / Instructor
Choose an item. / Choose an item. / Student
Examples:
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5.7Other(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.

Learning Contract Signatures Date