Learning Contract and Skills Evaluation

B.S.W. Field Placement

SWRK 4120 LEARNING CONTRACT AND SKILLS EVALUATION Student Name: SWRK 4120 BSW Field Evaluation Form

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.

Agency Mentor* Faculty/Field Liaison Click here to enter text. Click here to enter text. (if applicable) 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.

Contact Name Agency Click here to enter text. Click here to enter text. (if applicable) 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 ☐ Fort Garry & Inner City Field Programs ☐ Northern Social Work Program Program Field Coordinator Field Coordinator Northern Social Work Program Fort Garry & Inner City Social Work Field Field Coordinator Programs Faculty of Social Work Distance Delivery BSW Field Program Faculty of Social Work Faculty of Social Work University of Manitoba University of Manitoba Phone: 204.474.6812 University of Manitoba Phone: 1.204.677.1456

Toll Free: 1.800.432.1960 Ext: 6812 Phone: 204.474.8300 Fax: 1.204.677.4110

Fax: 204.474.7594 Fax: 204.474.7594

Please indicate below which Field Coordinator (Program) you are submitting this Evaluation form to: SWRK 4120 BSW Field Evaluation Form 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 - Discussions with supervisor March 20XX and self-evaluation for - Work on strategies that foster professional development continual growth (participate in PD opportunities) - Journaling on the strengths and 2. Identify major values that challenges Dec., 20XX support and challenge my I have had with clients professional practice and identify, analyze and apply - Review the CASW Code of Ethics strategies to resolve ethical - Discuss with co-workers how they dilemmas face ethical dilemmas -Discuss with supervisor possible solutions to ethical problems

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 2 level. 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) or not observed (N/O) if a student has not had the opportunity to SWRK 4120 BSW Field Evaluation Form 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. SWRK 4120 BSW Field Evaluation Form

1) Does Not Meet Expectations: The student fails to 2) Needs Development: The student demonstrates potential for demonstrate the necessary skills and abilities. Examples growth in her or his professional role, but in an inconsistent include, but are not limited to, the following: manner. Examples include, but are not limited to, the following:

 Demonstrates significant difficulty with integration of  Demonstrates some difficulty with integration of theory theory with practice with practice skills

 Demonstrates unprofessional behaviour such as  Demonstrates some attainment of learning goals but tardiness and unreliability (e.g., inconsistent requires additional support and enhanced clarification attendance, lack of adequate notification if late or absent due to illness, and lack of follow through with  Does not consistently access or use guidance and assigned tasks) supervision when appropriate

 Demonstrates a lack of initiative in fulfilling expectations and assigned tasks  Identifies her/his own values and biases but experiences some difficulty with understanding the implications on practice  Does not access, accept or use supervision including constructive and critical feedback, as provided  Identifies and understands agency policies and practices but  Demonstrates lack of awareness of own values, biases refers to and/or follows on an inconsistent basis and needs  Documentation requires some improvement (e.g., not  Demonstrates a lack of awareness and/or always clearly or objectively written) understanding of agency policies and procedures

3) Meets Expectations: The student regularly demonstrates 4)Exceeds Demonstrating Expectations: a minimum The student level would of attainment receive aof “4” learning abilities and skills. Examples include, but are not limited to, when s/he demonstrates competence or exceptional skills and the following: outstanding awareness on a consistent basis. Examples include, but are not limited to, the following:  Demonstrates ability to integrate theory with practice  Consistently demonstrates integration of theory with practice

 Demonstrates ability to describe and assess the  Demonstrates an ability to build rapport and strong client/system and to suggest possible interventions working relationships with clients/systems

 Demonstrates an ability to apply a wide range of  Demonstrates an awareness of personal strengths in assessment and intervention skills in practice addition to areas for personal and professional  Demonstrates an ability to critically analyse use of self in growth working with clients and others; and identifies areas and methods towards strengthening practice

 Demonstrates skills in self-evaluation including an  Consistently reflects upon personal and professional values ability to transfer new learning from one situation to and potential impact upon practice another  Consistently meets and exceeds expectations relative to documentation requirements

 Effectively uses a range of interpersonal  Consistently accesses supervision if required, and uses communication skills feedback to improve upon effectiveness in working with others

Note: In this evaluation Client can refer to individuals, families, community groups, and/or organizations SWRK 4120 BSW Field Evaluation Form

1 2 3 4 Does Not Meet Needs Meets Exceeds N/A N/O Expectations Development Expectations Expectations (Not Applicable) (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 Click here to enter Click here to enter text. text. text.

Mid Term Final 1.1 Choose an item. Choose an item. Instructor

Demonstrates the use of knowledge and skills of a Choose an item. Choose an item. Student professional social worker. Examples: Click here to enter text. 1.2 Choose an item. Choose an item. Instructor

Demonstrates competence in carrying out the Choose an item. Choose an item. Student agency’s mandate. Examples: Click here to enter text. 1.3 Choose an item. Choose an item. Instructor

Documentation and practice reflect a respectful and Choose an item. Choose an item. Student unbiased position toward the client. SWRK 4120 BSW Field Evaluation Form

Examples: Click here to enter text.

1.4 Able to Choose an item. Choose an item. Instructor clarify, develop, maintain, and reinforce professional Choose an item. Choose an item. Student boundaries. Examples: Click here to enter text. SWRK 4120 BSW Field Evaluation Form

1.5 Discusses ethical issues in practice with Field Instructor in the context of Choose Choose Instructor the student’s own values and the CASW Code of Ethics, with a resolution an item. an item. to the issue. Choose Choose Student an item. an item. Examples: Click here to enter text. 1.6 Respects clients’ privacy and promotes the rights of clients to self- Choose Choose Instructor determination. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text. 1.7 Other (Please describe) Choose Choose Instructor Click here to enter text. an item. an item. Choose Choose Student an item. an item. 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. SWRK 4120 BSW Field Evaluation Form

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 Click here to enter Click here to enter text. text. text.

Mid Term Final 2.1 Choose an item. Choose an item. Instructor

Competence with a range of interpersonal communication skills Choose an item. Choose an item. Student (e.g. reflection, clarification, paraphrasing and questioning). Examples: Click here to enter text.

2.2 Choose an item. Choose an item. Instructor Demonstrates ability to work with complex situations and Choose an item. Choose an item. Student with involuntary and challenging clients. Examples: Click here to enter text. 2.3 Effectively Choose an item. Choose an item. Instructor SWRK 4120 BSW Field Evaluation Form conducts meetings/intervie Choose an item. Choose an item. Student ws with clients and collaterals. Examples: Click here to enter text.

2.4 Able to Choose an item. Choose an item. Instructor articulate and intervene on relevant concerns Choose an item. Choose an item. Student and goals with clients. Examples: Click here to enter text. SWRK 4120 BSW Field Evaluation Form

2.5 Able to integrate theoretical knowledge into practice and provides rationale Choose Choose Instructor for assessments and interventions. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text.

2.6 Identifies and actively collaborates with clients to build social networks and Choose Choose Instructor social supports. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text.

2.7 Reviews and evaluates client’s progress on established goals and Choose Choose Instructor modifies goals when necessary and with client’s input. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text. 2.8 Able to work collaboratively with a variety of systems and disciplines. Choose Choose Instructor an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text. 2.9 Other (Please describe) Choose Choose Instructor Click here to enter text. an item. an item. Choose Choose Student an item. an item. 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.

3. Reflective Capacity and Critical Analysis The student engages in constructive discussions and reflections of self, clients and service delivery.

Mid Term Final

3.1 Engages in Choose an item. Choose an item. Instructor the process of critical thinking and examination of one’s own beliefs, Choose an item. Choose an item. Student values, actions, and reactions to others. Examples: Click here to enter text.

3.2 Choose an item. Choose an item. Instructor

Demonstrates an ability to apply critical and constructive Choose an item. Choose an item. Student feedback from the Field Instructor. Examples: Click here to enter text.

3.3 Practice Choose an item. Choose an item. Instructor consistently Choose an item. Choose an item. Student reflects a theoretical base SWRK 4120 BSW Field Evaluation Form and there is an absence of personal judgment in communications about clients. Examples: Click here to enter text. 3.4 Choose an item. Choose an item. Instructor

Demonstrates and ability to cope effectively Choose an item. Choose an item. Student with stress and engage in selfcare, as needed. Examples: Click here to enter text.

3.5 Choose an item. Choose an item. Instructor

Consistently critically evaluates one’s own practice and Choose an item. Choose an item. Student responds appropriately to feedback. Examples: Click here to enter text. 3.6 Other Choose an item. Choose an item. Instructor (Please describe) Click here Choose an item. Choose an item. Student to enter text. Examples: Click here to enter text.

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 Click here to enter Click here to enter text. text. text.

Mid Term Final

4.1 Articulates Choose an item. Choose an item. Instructor and demonstrates how issues of inequality in society (e.g. diversity, oppression, Choose an item. Choose an item. Student discrimination, power, ethno- culture, human diversity, and privilege) impact the client. Examples: Click here to enter text. 4.2 Empowers Choose an item. Choose an item. Instructor clients to Choose an item. Choose an item. Student advocate for their own basic human rights (e.g., freedom, safety, privacy, an adequate standard of living, SWRK 4120 BSW Field Evaluation Form health care, and education.) Examples: Click here to enter text. 4.3 Respects Choose an item. Choose an item. Instructor and advocates for the rights of others, and brings to the attention of Choose an item. Choose an item. Student the field instructor any human rights concerns. Examples: Click here to enter text. 4.4 Practices Choose an item. Choose an item. Instructor with cultural sensitivity. Choose an item. Choose an item. Student Examples: Click here to enter text. 4.5 Actively Choose an item. Choose an item. Instructor promotes a safe environment for clients and co- Choose an item. Choose an item. Student workers. Examples: Click here to enter text. 4.6 Other Choose an item. Choose an item. Instructor (Please describe) Click here to enter Choose an item. Choose an item. Student text. Examples: Click here to enter text.

Comments SWRK 4120 BSW Field Evaluation Form

Summary comments at Mid-Term are requested. Please include additions and changes to the learning activities or objectives.

5. Integration of Policy and Practice

Student demonstrates the knowledge and skills required to integrate policy into social work practice.

Mid Term Final 5.1 Identifies Choose an item. Choose an item. Instructor how policies at all levels impact practice within Choose an item. Choose an item. Student the agency and upon clients. Examples: Click here to enter text. 5.2 Choose an item. Choose an item. Instructor

Demonstrates analytical skills through examination of social issues impacting Choose an item. Choose an item. Student clients, including the relevance and impact of social policies. Examples: Click here to enter text. 5.3 Actively Choose an item. Choose an item. Instructor involved in Choose an item. Choose an item. Student research and clinical SWRK 4120 BSW Field Evaluation Form evaluation. Examples: Click here to enter text. 5.4 Able to Choose an item. Choose an item. Instructor identify the limitations of various Canadian social welfare programs and can Choose an item. Choose an item. Student assist clients to navigate and access required programs. Examples: Click here to enter text. SWRK 4120 BSW Field Evaluation Form

5.5 Conducts needs assessments/community asset mapping, and can Choose Choose Instructor articulate relevant social issues. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text.

5.6 Demonstrates capacity to assist with the mobilization of communities, groups Choose Choose Instructor and organizations on significant issues. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text.

5.7 Other (Please describe) Choose Choose Instructor Click here to enter text. an item. an item. Choose Choose Student an item. an item. Examples: Click here to enter text.

Learning Contract Signatures Date Click here to enter a date. Field Instructor (BSW, MSW, PhD): Click here to enter a date. Student: Click here to enter a date. Agency Mentor: Click here to enter a date. Faculty Field Liaison:

Midterm Evaluation Signatures Date Click here to enter a date. Field Instructor: Click here to enter a date. Student: Click here to enter a date. Agency Mentor: Click here to enter a date. Faculty Field Liaison:

☐ Time Sheets submitted Number of Hours Completed: ☐ Journals submitted

COMMENTS: Click here to enter text.

Final Evaluation Signatures Date Click here to enter a date. Field Instructor: Click here to enter a date. Student: Click here to enter a date. Agency Mentor (if applicable): Click here to enter a date. Faculty Field Liaison:

☐ Time Sheets submitted Number of Hours Completed: ☐ Journals submitted

COMMENTS: Click here to enter text.

Signatures acknowledge that all parties have participated in a discussion and have an understanding of this evaluation. Once signed, this page MUST BE SENT IN to the Faculty Field Liaison (faxed, scanned/email).

Grade Recommendation ☐ Pass ☐ Fail ☐ Fail Incomplete SWRK 4120 BSW Field Evaluation Form