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    This document is a midterm evaluation form for an MSW intern from the University of North Carolina at Pembroke. It provides instructions for rating interns on 10 core social work competencies using a 5-point scale. The competencies cover areas like professionalism, ethics, critical thinking, diversity, social justice, research, human behavior theory, policy practice, and engagement/assessment. The evaluation rates the intern across each competency, provides comments, and gives an overall rating of meeting or exceeding expectations at the midterm point.

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    This document is a midterm evaluation form for an MSW intern from the University of North Carolina at Pembroke. It provides instructions for rating interns on 10 core social work competencies using a 5-point scale. The competencies cover areas like professionalism, ethics, critical thinking, diversity, social justice, research, human behavior theory, policy practice, and engagement/assessment. The evaluation rates the intern across each competency, provides comments, and gives an overall rating of meeting or exceeding expectations at the midterm point.

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    This document is a midterm evaluation form for an MSW intern from the University of North Carolina at Pembroke. It provides instructions for rating interns on 10 core social work competencies using a 5-point scale. The competencies cover areas like professionalism, ethics, critical thinking, diversity, social justice, research, human behavior theory, policy practice, and engagement/assessment. The evaluation rates the intern across each competency, provides comments, and gives an overall rating of meeting or exceeding expectations at the midterm point.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    83 views5 pages

    Img 20151011 0002

    Uploaded by

    api-293721825
    This document is a midterm evaluation form for an MSW intern from the University of North Carolina at Pembroke. It provides instructions for rating interns on 10 core social work competencies using a 5-point scale. The competencies cover areas like professionalism, ethics, critical thinking, diversity, social justice, research, human behavior theory, policy practice, and engagement/assessment. The evaluation rates the intern across each competency, provides comments, and gives an overall rating of meeting or exceeding expectations at the midterm point.

    Copyright:

    © All Rights Reserved
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    of 5

    The University of North Carolina at Pembroke

    Department of Social Work

    Midterm Evaluation

    Bsw X

    Name

    orrntern

    MSw Foundation

    lftqna
    rJ

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    tr

    MSW Foundation

    II

    Date

    fnstructionsfor Rating Interns on the 10 Competencies in the First Part of the Evaluation:
    The standard by which an intern is to be compared is that of a foundation level social worker. The 10
    competencies that are specified in this evaluation form are those established by our national accrediting
    organization (the Council on Social Work Education). Under each competency statement are several
    items that we ask you to rate according to the following criteria.
    5

    4
    3

    2
    1

    The intern has excelled in this area


    The ir(ern is functioning above expectations for intems in this area
    The intern has met the expectations for interns in this area
    The intern has not as yet met the expectations in this area, but there is hope that the intern will meet
    the expectations in the near future
    The intern has not met the expectations in this area, and there is not much hope that the intern will
    meet the expectations in this area in the near future

    Comments may be made under any competency statement, if desired. Please be sure to indicate those
    areas in which you think the intern is particularly strong and those areas that need improvement.
    Comments may be made under any competency statement. Please be sure to indicate those areas in which
    you think the intern is particularly strong and those areas that need improvement. Please give examples
    for any area in which the student received a rating of 1 or 2.
    Evaluation should be a shared process with an opporhrnity for the student and agency field instructor to
    discuss similarities and differences in perception. Although the agency field instructor is responsible for
    completing the evaluation, it is the responsibility of the faculty field director to assign a grade. The
    student's overall grade for the course will be determined by the faculty field director and based on the
    overall evaluation of the student's performance in placement in conjunction with the agency field
    instructor's evaluation, classroom participation, and course assignments.
    This evaluation is intended to give the intern feedback about her or his performance.
    NOTE: lf you prefer to use another evaluation system in addition to this form to evaluate a student's
    performance, please discuss this with the faculty field director.
    Competence

    #1:

    Intern identifies as a professional social worker and conducts himself/herself


    accordrnqly.

    1.1

    1.2
    1.3

    1.4
    1.5

    t.6

    Advocates well for client access to the services of social work


    Practices personal reflection and self-correction to assure continual
    orofessional development
    Attends wellto professional roles and boundaries
    Demonstrates professional demeanor in apDearance
    Demonstrates professional demeanor in communication
    Uses supervision and consultation effectively
    Comments:

    2
    2

    2
    2
    2

    I
    1

    4
    4

    s)
    E(
    JI

    4
    4
    4
    4

    Competence

    #2:

    Intern applies social work ethical principles to guide his or her professional

    2.1

    Recognizes and manages personal values in a way that allows


    Professional values to guide practice (e.g., on such issues as
    Abortion and gay rishts)

    2.2

    Is knowledgeable of, and abides by, the ethical standards

    2.4

    of

    the profession
    Tolerates well ambizuiW in resolvine ethical conflicts
    Is able to apply strategies of ethical reasoning to arrive at principled
    decisions

    5')

    2
    2

    4
    4

    sl
    )f

    Comments:

    Competence

    3.1

    3.2

    5.J

    #3: Intern applies critical thinking to inform and communicate

    Is skilled at appraising and integrating multiple sources of


    knowledge; including research-based knowledge and practice
    wisdom
    Is skilled atanalyzingmodels of assessment, prevention,
    intervention, and evaluation
    Demonstrates effective oral and written communication in working
    with individuals, families, groups, organizations, communities, and

    professional

    'f\

    '
    U

    a
    J

    a
    J

    \t-j

    colleagues
    Comments:

    Com

    #42

    Intern

    diversitv and difference in

    4.t

    Recognizes the extent to which a culture's structures and values


    may oppress, marginalize, alienate, or create or enhance privilege

    4.2

    Has sufficient self-awareness to eliminate the influence of personal


    biases and values in working with diverse groups
    Recognizes and communicates her or his understanding of the
    importance of difference in shaping life experiences
    Views herself or himself as a learner and engages those he or she

    .sJ

    and power

    4.3

    4.4

    works (clients) with as informants

    !")
    '41

    J{)

    Comments:

    Comnetence

    #5:

    Intern advances human riehts and social and economic iustice.

    9\

    5.1

    Understands the forms and mechanisms of oppression and

    a
    J

    5.2

    discrimination
    Is skilled at advocating for human rights and social and economic

    5.3

    iustice
    Is skilled at engaging in practices that advance social and economic
    iustice

    Comments:

    Competence
    research.
    6.1

    6.2

    #6:

    Intern engagm in research-informed practice and

    Is skilled at using practice experience to inform research


    Is skilled at using research findings to improve practice, policy, and
    social service delivery

    I
    I

    2
    2

    practice-informed

    J
    J

    '4)

    3?

    Comments:

    Comnetence

    #7:

    Intern

    of human behavior and the social environment.

    7.1

    Is skilled at utilizing conceptual frameworks (Theories) to guide the

    !)

    7.2

    processes of a.ssessment, intervention, and evaluation


    Is knowledgeable about the range of social systems in which people
    live and can apply it to understand client behaviors and

    a_)

    environments.
    Comments:

    Competence

    8.1

    8.2

    #8:

    Intern engages in policy practice to advance social and economic well-being and
    to deliver effective social work services.

    Is skilled at analyzing, formulating, and advocating for policies that


    advance social well-being
    Is skilled at collaborating with colleagues and clients for effective
    policy action
    Comments:

    a
    J

    4l

    #92

    Co

    9.t

    Intern

    to contexts that

    Is skilled at continuously discovering, appraising, and affending to


    changing locales, populations, scientific and technological
    developments, and emerging societal trends in order to provide
    relevant services
    Is skilled at providing leadership in promoting sustainable changes
    in service delivery and practice to improve the quality of social

    9.2

    4\

    services
    Comments:

    Competence

    10.1

    10.2
    10.3

    r0.4
    I0.5
    10.6

    ta.7
    10.8
    10.9
    10.10

    l0.l

    10.t2
    10.13

    #10: Intern

    engages, assesses, interenes and evaluates


    groups, organizations, and communities.

    Is skilled at preparing for action with individuals, families, groups,


    organizations, and communities.
    Is ski led at using empathy and other interpersonal skills.
    Is ski led at developins a mutuallv agreed-on focus of work
    Is sk led at collecting, organizins. and intemreting client data.
    Is ski led at assessing client strengths and limitations
    Is skilled at developing mutually agreed-on intervention goals and
    obiectives.
    Is skilled at selecting appropriate intervention strategies.
    Is skilled at initiatine actions to achieve orsanizational goals.
    Is skilled at irnplementing prevention interventions that enhance
    client capacities.
    Is skilled at helpins clients resolve problems.

    Is skilled at neeotiatine. mediatins. and advocatine for clients.


    Is skilled at facilitating transitions and endings.
    Is skilled at analyzing, monitoring, and evaluating interventions

    critically.

    with individuals, families,


    2

    14')

    :4)

    :4)

    2
    2
    2
    2
    2

    1
    1

    4l
    (A

    (4)

    (4\

    2
    2
    2
    2

    {4

    J
    J

    1
    1

    I
    1

    5
    5

    (j

    5
    5

    Comments:

    Overall Evaluation at
    Please check one of the follow
    The intern has excelled

    at the midterm evaluation.

    The intern is functionins above expectations


    The intern has met expectations
    The intern has not as yet met expectations, but there is hope that the intern will meet expectations in
    the near future
    The intem has not met the expectations and there is not much hope that the intern will meet
    expectations in the near future

    Number of Clock Hours Completed.


    Comments/elaboration:

    Signature

    e,

    Asencv Field lnstruct

    Agency

    or&,1.^-*" .'ff]?'&r,rrlC
    Jc.
    s -Sou*[ Wr* Date t ct/Al t S
    (-

    Thefollowing section should be completed by the intern:

    My agency supervisor and faculty supervisor have discussed this evaluation with me, and I have received
    a copy. My agreement or disagreement follows:
    I agree with the evaluation
    I do not aeree with evaluation

    Intern's Signature

    tr

    D",.

    Id-6-[5

    If the intern disagrees with the evaluation shelhe should state that disagreement in writing and
    submit a copy to both the agency field instructor and the faculty field director. A meeting
    between the student, agency instructor, and faculty field director should then be held to discuss
    the disagreement.

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