School of Social Welfare

University at Albany, State University of New York

INSTRUCTIONS
Second-Year Clinical Practice Evaluation Instrument

The second-year clinical practice field evaluation instrument is comprised of nine sections: Demonstrate
Ethical and Professional Behavior; Engage Diversity and Difference in Practice; Advance Human Rights and
Social, Economic and Environmental Justice; Engage In Practice-informed Research and Research-informed
Practice; Engage in Policy Practice; Engage with Individuals, Families and/or Groups; Assess Individuals,
Families and/or Groups; Intervene with Individuals, Families and/or Groups; and Evaluate Practice with
Individuals, Families and/or Groups. Students are evaluated on a continuum of skills at three intervals
throughout the year-long placement. The skills are applicable to work with individuals, families, groups, and
communities.

For each evaluation period, please rate a student on every item by entering the number that corresponds to your
assessment of the student’s demonstrated performance in the box or boxes to the right of each item.

Ratings

1 Unacceptable (never or rarely meets criteria)

2 Needs improvement (meets criteria inconsistently)
3 Satisfactory (meets criteria most of the time)
4 Very good (consistently meets criteria)
5 Outstanding (consistently exceeds criteria)
9 Not applicable in practice setting

Summarize the student’s overall performance for each section by placing an X at the point on the bar graph
that represents their overall performance for that section. Space for comments is included after each section.

The last page includes an overall student rating, space for comments, goals for the next evaluation period, and
the signature page. The student and field instructor are required to sign each evaluation. When a student
disagrees with the contents of the evaluation, they can submit an addendum stating the reasons for
disagreement which is attached to the evaluation in the student’s file. Each faculty field liaison reads all
evaluations for assigned agencies and will be available for discussion at the student’s or field instructor’s
request.

Any time a student receives a summary rating, in any section, of “needs improvement” or “unacceptable,”
please provide supporting documentation
in the comments section.

Your careful attention to completing the evaluation form is greatly appreciated. Evaluation is a crucial part of
a student’s professional training and provides an opportunity for feedback and educational planning.

School of Social Welfare, University at Albany, State University of New York

ADVANCED CONCENTRATION – CLINICAL 1

School of Social Welfare
University at Albany, State University of New York
_____________________________________________________________________________________________

Field Education
Second-Year Clinical Practice Evaluation Instrument

Student’s Name:
Agency Name:
Field Instructor’s Name:
Field Liaison’s Name:

Evaluation: 1st 2nd Final

Evaluation Period (Month)

Program Year

ADVANCED CONCENTRATION – CLINICAL 2

Describe the student’s assignment for this evaluation period:

Describe the student’s caseload:

How many individual clients assigned?

How many families or groups assigned?

How often do you meet for supervision? Weekly In group In staff meeting

Demonstrates Ethical and Professional Behavior – Evaluates the student’s ability to demonstrate
ethical and professional behavior.

The student is able to 1st 2nd Final

utilize the field instructor as an educator of social work values, attitudes, knowledge and
skills.

participate in developing/updating learning agreement.

prepare for supervision, including development of an agenda.

analyze and verbally articulate one’s own knowledge, skills, accomplishments and
learning needs.

seek and respond nondefensively to feedback about professional performance.

use constructive criticism to try new skills to improve practice.

seek direction for an assignment, as needed.

complete process recordings in a timely manner.

use process recording or other learning tools to critique practice.

communicate clearly and purposefully.

identify social work values and ethics in work with colleagues and clients and in other
professional relations.

respect the rights of others to maintain perspectives and positions different from one’s
own.

struggle with value dilemmas.

differentiate between presenting a personal, professional or organizational position.

protect client’s right to confidentiality.

protect client’s right to self-determination.

1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

1st 2nd Final

preserve human dignity and client individuality.

elicit and demonstrate commitment to client’s participation in decision making.

recognize the impact that the student’s personality has on professional relationships.

prevent personal values and biases from interfering with practice decisions in the best
interest of the client.

recognize one’s own verbal and nonverbal communication biases and feelings in an
interview, group or meeting.

avoid tendencies toward moralizing, persuading, prematurely reassuring, threatening,

judging and/or criticizing during a social work interview or meeting.

act professionally and responsibly in matters of punctuality, appearance and presentation

of self.

engage in collegial work responsibilities, including meetings, staff meetings and

committees.

form and sustain professional relationships.

complete agency records and forms in a timely manner.

identify the primary duties and responsibilities of various staff positions with whom the
student has contact with.

integrate the elements of the therapeutic relationship as demonstrated by consistent use

of genuineness.

selectively use the instructor and other agency resources in supervision.

integrate the elements of the therapeutic relationship as demonstrated by consistent use

of concern for others, empathy and purposeful communication.

accept assignments.

make appropriate use of other available learning opportunities.

actively participate in case conferences.

demonstrate skills in case management.

demonstrate skills in interdisciplinary teamwork.

The student is able to 2nd Final

recognize during supervision personal obstacles to working with a client.

identify the formal and informal channels of communication in the field agency.

explore emotionally charged issues.

deal with anger and conflict with client/group in the therapeutic relationship.

deal with client/group resistance about seeking help.

be innovative and imaginative in applying knowledge and skill in practice.

Final
identify areas of learning for continuing education and supervision. 4
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Summary for Demonstrates Ethical and Professional Behavior (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

Comments:

Engages Diversity and Difference in Practice – Evaluates the student’s ability to engage diversity
and difference in practice.
The student is able to 1st 2nd Final
recognize personal feelings about racism, sexism, homophobia, ageism, client difference
and the impact it may have in work with clients.

integrate the elements of the therapeutic relationship as demonstrated by consistent

appropriate use of authority and power.

recognize and initiate steps to work collaboratively with or resolve problems that arise
with co-workers.

2nd Final
prevent personal biases from interfering with practice decisions in the best interests of
the client.

conceptualize and synthesize knowledge of emotional, biological, social, organizational

(including effects of racism, sexism, social class, homophobia, and ageism), economic
and cultural components in a critical manner.

5
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Fina
l
accurately respond to client’s or group’s full range of intensity of feelings most of the
time.

Summary for Engages Diversity and Difference in Practice (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

Comments:

Advances Human Rights and Social, Economic and Environmental Justice – Evaluates student’s
ability to advance human rights and social, economic and environmental justice.
The student is able to 1st 2nd Final
work with a range of clients and client problems.

use strategies that recognize client strengths and empower individuals, families and
groups.

Fina
l
critically examine agency programs and planning and make appropriate suggestions for
constructive change.

Summary for Advances Human Rights and Social, Economic and Environmental Justice (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

6
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Comments:

Engages in Practice-informed research and Research-informed practice – Evaluates student’s

ability to engage in practice-informed research and research-informed practice.
The student is able to 1st 2nd Final

analyze interventions.

base goals on assessment conclusions.

2nd Final
present and defend one’s own point of view verbally or in writing.

Final

use more than one method of data collection for research and evaluation results to
modify practice.

evaluate, with the client or group, the extent to which the objectives of the intervention
plan were achieved.

utilize evaluation results to modify practice.

Summary for Engages in Practice-informed research and Research-informed practice (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

7
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Comments:

Engages in Policy Practice – Evaluates the student’s ability to apply policy perspectives to
professional practice.
The student is able to 1st 2nd Final
assess the effect of regulations, policies and procedures on service delivery.
identify the range of relevant services (formal and informal) available in the community
and the ways in which these services are used for referrals by the field agency.

keep goal planning within constraints of agency function.

demonstrate skills in advocacy, brokerage and linkage.

seek cooperation from relevant agencies to meet client needs.

utilize services from relevant agencies to meet client needs.

integrate knowledge of emotional, biological, social, organizational (including racism,

sexism, homophobia and ageism), economic and cultural competencies into assessment.

apply assessment skills to organizational settings.

interpret one’s own agency’s role and function with client.

identify when individual client needs and organizational structures or practices are in
conflict.

take an active role in collective work such as team meetings, staff meetings, and
committees.

actively participate in case conferences.

describe the procedures followed by agency staff in developing and maintaining

cooperative relationships with other agencies in the community.

analyze and verbally articulate one’s own knowledge, skills, accomplishments and
learning needs.

control one’s own verbal and nonverbal communication of biases and feelings in an
interview.

8
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

2nd Final
differentiate between representing a personal, professional or organizational position.

Engage client as a partner in the therapeutic process.

Revise the plan based on new information.

identify the formal and informal means by which agency policy is formulated or
influenced by internal or external factors.

Final
identify ways in which changes in the agency’s relationships with other agencies could
affect service delivery.

Summary for Engages in Policy Practice (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

Comments:

Engages with Individuals, Families and/or Groups – Evaluates the student’s ability to engage with
individuals, families and/or groups.
The student is able to 1st 2nd Final
recognize the importance of student’s nonverbal communication with the client/client
system(s).

communicate clearly and purposefully in a client group or family setting.

help clients elaborate on problems.

elicit underlying feelings.

individualize clients.

9
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

1st 2nd Final

identify emotionally charged issues.

integrate the elements of the therapeutic relationship as demonstrated by consistent use

of acceptance and identification/communication of expectations.

identify client group dynamics.

maintain focus on client concerns.

demonstrate active and accurate listening.

2nd Final
articulate client’s implicit concerns and expectations.

identify and address both one’s own and client’s interpersonal obstacles to
communication (e.g. resistance, student bias, student style).

Summary for Engages with Individuals, Families and/or Groups (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

Comments:

Assesses Individuals, Families and/or Groups – Evaluates the student’s ability to assess individuals,
families and/or groups.
The student is able to 1st 2nd Final
gather data related to the presenting problem.

use different sources of information, including nonverbal data, client’s support system,
and collateral contacts in the assessment process.

identify family system dynamics.

identify group dynamics.

identify sources of strengths and stress in the client and in the client’s support system.

10
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

1st 2nd Final

connect a problem with its emotional, biological, social (including effects of racism,
sexism, social class and ageism), economic, and cultural components with some
consistency.

recognize the difference between the needs of an individual and the needs of a client
group.

recognize and elicit information that will contribute to the understanding of the client and
the client’s situation.

set priorities in plans for intervention.

present this information in a well-written, formal assessment, using agency format and
separating facts and inferences.

develop a plan of intervention based on the problem definition.

revise the plan based on new information.

recognize nonverbal client/client system communication.

summarize session content with client/client system.

involve the client/group in establishing desired goals.

reduce larger problems into manageable parts.

consider appropriate tasks for the client system and collateral contacts.

identify immediate, short-term and long-range goals.

elicit client responses to the contract/treatment plan.

base goals on assessment conclusions.

look beyond the symptom(s) to the underlying problem.

assess and understand the individual within the context of the family system.

integrate theoretical knowledge about normative and pathological human development,

individual, family, community, and group structures and processes into assessment.

2nd Final
assess emerging patterns of behavior in a group and identify interventions that facilitate
functional group behaviors.

Summary for Assesses Individuals, Families and/or Groups (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

11
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Comments:

Intervenes with Individuals, Families and/or Groups – Evaluates the student’s ability to intervene
with individuals, families and/or groups.
The student is able to 1st 2nd Final

negotiate the terms of the work with the client/group, including time, place and
frequency of contact.

recognize client/group hesitancy to seeking help.

deal with client/group hesitancy about seeking help.

monitor the implementation plan (analyze consequences of change, modify objectives

and tasks as indicated, assess new problems that require action).

gain cooperation from relevant agencies to meet client needs.

respond to crisis situations.

understand the types and purposes of groups within the agency setting.

adapt and focus interviewing techniques to the needs of a variety of clients.

develop focused, realistic interventions within the client system.

identify and attempt interventions in a group setting.

focus an interview, group or community meeting.

carry learning from supervisory conference to work with clients, agency and community.

identify obstacles, as they arise, in implementing the contract with clients and groups.

use goals to develop interventions.

incorporate use of self in intervention skills.

identify and implement appropriate tasks for the student, client system, and collateral
contacts.

model, rehearse and impart coping and interactional skills to clients.

12
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

1st 2nd Final

summarize session content with client.

articulate and utilize recurring themes from session to session.

use one’s own knowledge of group dynamics to help clients build a positive group
culture.

revise the contract/treatment plan based on feedback.

propose alternative strategies.

understand and incorporate a range of interventions in a family setting.

understand and incorporate a range of interventions in a group setting.

2nd Final
engage in differential treatment planning and distinguish between treatment models.

demonstrate a specialized knowledge base relevant to specific problems and clients.

demonstrate development of crisis intervention skills.

Final
determine when to terminate intervention.

anticipate and deal with a range of client/group and student reactions to termination.

engage client or group in a review of accomplishments and areas of continuing concern.

develop a capacity for self-directed practice.

Summary for Intervenes with Individuals, Families and/or Groups (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

13
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Comments:

Evaluates Practice with Individuals, Families and/or Groups – Evaluates the student’s ability to
evaluate practice with individuals, families and/or groups.
The student is able to 1st 2nd Final
analyze client’s and student’s respective roles in the intervention.

use theoretical and practice knowledge in determining goals.

identify critical points in an interview.

2nd Final
develop a plan to increase the likelihood of maintenance of change.

monitor the implementation plan (analyze consequence of change, modify objectives and
tasks as indicated, assess new problems that require actions).

negotiate and agree on individual tasks and responsibilities for projects or assignments
requiring cooperation with co-workers.

Final
differentiate one’s own effectiveness across areas of practice.

Summary for Evaluates Practice with Individuals, Families and/or Groups (See Instructions)

unacceptable needs improvement satisfactory very good outstanding

14
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Comments:

Overall Student Rating

unacceptable needs improvement satisfactory very good outstanding

Comments:

Goals for Next Evaluation Period:

15
1 Unacceptable 3 Satisfactory 5 Outstanding

2 Needs improvement 4 Very good 9 Not applicable in practice setting

Field Instructor Attestation

At this time, would you like to talk to your field liaison regarding field concerns?
Yes No, unnecessary at this time

Please verify that your assigned field liaison made an attempt to contact you this year via email, voice mail, phone conversation or in-person.
Yes No

Field Instructor’s signature Date

Student Attestation

At this time, would you like to talk to your field liaison regarding your field experience?
Yes No, unnecessary at this time

Please verify that your assigned field liaison made an attempt to contact you this year via email, voice mail, phone conversation or in-person.
Yes No

I have read and understand the contents of this evaluation.

Student’s signature Date

PROCESS RECORDING Required: Reminder- Attach a current process recording on which your field instructor has made
feedback comments, while being sure to protect client confidentiality.

16