Social Work Department

MSW Advanced Learning Agreement and Final ASSESSMENT

Student Name Student ID

Student Address Zip

Student Email Home Phone Cell

Field Site

Site Address Zip Phone

Field Supervisor Phone Ext.

Field Supervisor E-mail Cell

Task Instructor (if needed) Phone

Task Instructor E-mail Cell

ASU Faculty Liaison

The student will complete the Learning Agreement with the assistance of the Field Supervisor. Learning activities will provide the opportunity for students to demonstrate the competencies. The student should write a rough draft and present the draft for discussion to the FS. The contents of the final document must be agreed to by all involved parties with everyone receiving a copy.

The Learning Agreement serves as a guide to assess academic and professional performance throughout the semester. It is a tool for an informal mid-semester assessment during the site visit with the Faculty Liaison to assess the student’s progress. If needed, amendments can be added on the original with date of change. .

At the end of the semester, this form will be used to assess overall student performance. The FS will evaluate each objective with the rating scale and complete the evaluation of professional work skills. The fall assessment should serve as a planning tool for the spring semester, but a new agreement will be developed.

The student is responsible for managing the original document that must be present at the midterm evaluation to allow all parties to sign the midterm summary. The original will then be given to the FS prior to the final site visit to allow the FS to evaluate the student’s performance with the rating scale. The original will be turned into the SW Dept. by the faculty liaison, and placed in the student’s file.

It is not required that all competencies be assessed the fall learning agreement, but all competencies must be assessed and documented in the spring learning agreement.

In this section of the Learning Agreement, students should identify the tasks and/or activities that will enable them to demonstrate the objective of the specific competencies.

Rating Scale

1 – Consistently fails to meet expectations	2 – Occasionally meets expectations	3 – Meets Expectations

4 – Occasionally exceeds expectations	5 – Consistently exceeds expectations	6 – N/A

1. Demonstrate Ethical and Professional Behavior

Recognize and resolve ethical issues common to clinical social work practice in the rural environment. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Analyze and respond to relationship dynamics including power differentials. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

2. Engage Diversity and Difference in Practice

Identify and understand diversity, populations at risk and oppression. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Differently adapt and apply clinical practice skills to respond to the characteristics of diversity, populations at risk, and oppression within the rural context of practice. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

3. Advance Human Rights and Social, Economic, and Environmental Justice.

Use knowledge of the historical effects of oppression, discrimination, and historical trauma on clients systems, particularly those from rural communities to guide assessment, treatment planning and interventions. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Recognize strengths, limitations and barriers of rural communities and develop strategies for enhancing social justice and equality of services. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

4. Engage in Practice-informed Research and Research-informed Practice.

Critically evaluate research to determine generalizability and relevance for clinical practice with diverse populations and client systems in rural environments Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Integrate evidence based practice and best practice model research into clinical practice. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

5. Engage in Policy Practice

Analyze intended and unintended effects of policies on client systems in rural environments. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Design intervention strategies that engage constituents from rural environments to advocate for policies that promote social justice, reduce disparities and promote quality of life. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

Engage with Individuals, Families, Groups, Organizations, and Communities

Collaborate with formal and informal resources in rural communities to enhance service and to effect positive change. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Demonstrate capacity to engage & build clinical relationships with clients, including those who have experienced trauma Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

7. Assess Individuals, Families, Groups, Organizations, and Communities

Synthesize bio-psycho-social-spiritual theories and diagnostic systems in the formulation of comprehensive assessments. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Assess the impact of loss and trauma on clients and client systems physical, social and emotional well-being. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

Intervene with Individuals, Families, Groups, Organizations, and Communities

Use appropriate clinical techniques including cognitive behavioral therapy and crisis intervention to respond to concerns identified through on-going assessment Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Develop prevention strategies focused on at risk individuals, groups and communities in order to prevent trauma and ameliorate its potential impact. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities

Contribute to the theoretical knowledge base of social work through practice based research that explores trauma and loss, and enhances the professions understanding and appreciation of rural communities. Learning Activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating
Implement practice evaluation strategies to assess the effectiveness of clinical practice. Learning activity	Final Outcomes/Evaluation -to be completed at conclusion of semester
Rating

Learning Agreement Signatures:

My signature below indicates that I agree that the above-mentioned tasks/activities are achievable this semester. I have participated in the formation of this document and will fulfill my role to complete the activities planned.

_____________________________________________________	_____________________________

Signature of Field Supervisor	Date

__________________________________________________________	_____________________________

Signature of Task Instructor (If Applicable)	Date

__________________________________________________________	____________________________

Signature of Student	Date

___________________________________________________________ ______________________________

Signature of Faculty Liaison	Date

Midterm Site Visit Date: ___________________________

Summary & Comments

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Strengths Noted

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Recommendations and/or addendums made to Learning Agreement

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

________________________________	______________________________

Faculty Liaison	Date	Field Supervisor	Date

________________________________	_____________________________

Student**	Date	Task Supervisor	Date

**My signature reflects that I was present for this site visit and aware of the current assessment and recommendations**

Evaluation of Student Basic Work Skills and Attributes

To the Field Supervisor – After completing the rating scale above relative to each Learning Activity, please use the following scale to rate your student’s basic work skills and attributes

Rating Scale

1 – Consistently fails to meet expectations	2 – Occasionally meets expectations	3 – Meets Expectations

4 – Occasionally exceeds expectations	5 – Consistently exceeds expectations	6 – N/A

Demonstrates positive time management skills.

Works independently and is reliable.

Open to suggestions in supervision.

Implements supervision suggestions and instructions.

Copes appropriately with job demands and stresses.

Expresses opinions and ideas in useful manner.

Recognizes need for continued professional growth.

Relates appropriately to staff in agency.

Relates appropriately to clients in agency.

Conducts self in professional manner and attire.

Responds to communications with respect and empathy.

Demonstrates professional writing skills.

Maintains accurate, complete, up-to-date records.

Field Instructor recommendation of final letter grade _____

Final Evaluation Signatures:

My signature below indicates that I have either completed the evaluation or have reviewed the evaluation.

FIELD SUPERVISOR RESPONSE TO EVALUATION

Field Supervisor’s Comments (Optional)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

______________________________________	_______________________________

Signature of Field Supervisor	Date

____________________________________________	______________________

Signature of Task Instructor (If applicable)	Date

STUDENT RESPONSE TO EVALUATION

_____ I agree	_____ I agree with reservation	_____ I disagree

Students Comments (Optional)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

______________________________________	_______________________________

Signature of Student	Date

____________________________________________	________________________________

Signature of Faculty Liaison	Date