The College at Brockport, State University of New York

Undergraduate Social Work Program Field Placement Learning Contract

Preliminary □ Amended/Final □
Name of Intern: Elizabeth Champlin Date: 4/3/20

Agency/Program: HCR Homecare

Name of Field Instructor: Stephanie Little
Name of Task Supervisor (if applicable): Jenna Cohen
Name of Faculty Liaison (Professor teaching seminar): ____Kristina Washington
Field Practicum Days of the Week Schedule: Mondays and Fridays
Hourly Field Practicum Schedule: 8:30-5
Day and Time of Weekly Supervision: Fridays 1-2

Instructions for completing the Field Placement Learning Contract:

This contract is intended to be developed collaboratively between the Field Instructor, Faculty Liaison,
and student. The 9 competencies that are specified in this form are those established by our national
accrediting organization, the Council on Social Work Education (CSWE). Under each competency
statement are several demonstration examples and are included in the overall definition of the
competency itself. The entire definition will be used to evaluate the student’s performance at the
mid-point and completion of this placement using the field evaluation of student form. Each
competency describes the knowledge, values, skills, and cognitive and affective processes that comprise
the competency at the generalist level of practice, followed by a set of behaviors that integrate these
components. These behaviors represent observable components of the competencies, while the preceding
statements represent the underlying content and processes that inform the behaviors. These behaviors
represent possible observable components of each of the competencies that will be evaluated in the field
placement setting. Please consider the unique practice experiences available at your agency and identify
specific tasks to assign your student for each competency. These activity descriptions will enable the
Field Instructor to accurately assess the student’s achievement using the evaluation form. Field Instructors
are also asked to provide an approximate time frame that each assignment/task should be completed by.
This must minimally include initial dates of completion, even if the activity will be “ongoing” or “weeks
2-3” for specific assignments that might be time limited. Field Instructors will have an opportunity to
amend this learning agreement at mid-point or at any time deemed necessary in consultation with the
student’s faculty liaison.
More information on the competencies themselves as well as competency-based social work education
can be found here: 2015 CSWE Educational Policy and Accreditation Standards
Competency 1–Demonstrate Ethical and Professional Behavior
Social workers understand the value base of the profession and its ethical standards, as well as relevant
laws and regulations that may impact practice at the micro, mezzo, and macro levels. Social workers
understand frameworks of ethical decision-making and how to apply principles of critical thinking to
those frameworks in practice, research, and policy arenas. Social workers recognize personal values and
the distinction between personal and professional values. They also understand how their personal
experiences and affective reactions influence their professional judgment and behavior. Social workers
understand the profession’s history, its mission, and the roles and responsibilities of the profession.

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Social Workers also understand the role of other professions when engaged in interprofessional teams.
Social workers recognize the importance of life-long learning and are committed to continually updating
their skills to ensure they are relevant and effective. Social workers also understand emerging forms of
technology and the ethical use of technology in social work practice. Social workers:
● make ethical decisions by applying the standards of the NASW Code of Ethics, relevant laws and
regulations, models for ethical decision-making, ethical conduct of research, and additional codes of
ethics as appropriate to context;
● use reflection and self-regulation to manage personal values and maintain professionalism in
practice situations;
● demonstrate professional demeanor in behavior; appearance; and oral, written, and electronic
communication;
● use technology ethically and appropriately to facilitate practice outcomes; and
● use supervision and consultation to guide professional judgment and behavior.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Maintain confidentiality throughout internship using HIPAA guidelines

- Attend weekly supervision for one hour
- Respond to communication within one business day
- Adhere to professional and ethical standards while working remotely

Competency 2- Engage Diversity and Difference in Practice

Social workers understand how diversity and difference characterize and shape the human experience and
are critical to the formation of identity. The dimensions of diversity are understood as the Intersectionality
of multiple factors including but not limited to age, class, color, culture, disability and ability, ethnicity,
gender, gender identity and expression, immigration status, marital status, political ideology, race,
religion/spirituality, sex, sexual orientation, and tribal sovereign status. Social workers understand that, as
a consequence of difference, a person’s life experiences may include oppression, poverty,
marginalization, and alienation as well as privilege, power, and acclaim. Social workers also understand
the forms and mechanisms of oppression and discrimination and recognize the extent to which a culture’s
structures and values, including social, economic, political, and cultural exclusions, may oppress,
marginalize, alienate, or create privilege and power. Social workers:
● apply and communicate understanding of the importance of diversity and difference in shaping
life experiences in practice at the micro, mezzo, and macro levels;
● present themselves as learners and engage clients and constituencies as experts of their own
experiences; and
● apply self-awareness and self-regulation to manage the influence of personal biases and values in
working with diverse clients and constituencies.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Reflect on personal biases and discuss with supervisor by end of semester

- Find at least two research articles about refugee populations and apply learning in interactions with clients and
coworkers by mid semester
- Apply knowledge of the importance of diversity when working in the field by assessing client’s individual needs
and preferences during visits at least three times in the semester
- Use interview skills to learn about diversity on a micro, mezzo, and macro level to develop two plans of care
- Explore how certain situations in the community can impact various populations and discuss with supervisor

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Competency 3 –Advance Human Rights and Social, Economic, and Environmental Justice
Social workers understand that every person regardless of position in society has fundamental human
rights such as freedom, safety, privacy, an adequate standard of living, health care, and education. Social
workers understand the global interconnections of oppression and human rights violations, and are
knowledgeable about theories of human need and social justice and strategies to promote social and
economic justice and human rights. Social workers understand strategies designed to eliminate oppressive
structural barriers to ensure that social goods, rights, and responsibilities are distributed equitably and that
civil, political, environmental, economic, social, and cultural human rights are protected. Social workers:
● apply their understanding of social, economic, and environmental justice to advocate for human
rights at the individual and system levels; and
● engage in practices that advance social, economic, and environmental justice.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Assess clients’ social and economic needs and any barriers to meeting those needs. Then provide resources for
clients to meet those needs at least three times in the semester
- Attend at least one webinar training for a diverse population during the semester
- Explore gap in care regarding medical transportation and discuss with agency administration
- Explore how the Covid-19 state of emergency and other situations can impact advocating for clients and discuss
with supervisor

Competency 4- Engage in Practice-informed Research and Research–informed Practice

Social workers understand quantitative and qualitative research methods and their respective roles in
advancing a science of social work and in evaluating their practice. Social workers know the principles of
logic, scientific inquiry, and culturally informed and ethical approaches to building knowledge. Social
workers understand that evidence that informs practice derives from multidisciplinary sources and
multiple ways of knowing. They also understand the processes of translating research findings into
effective practice. Social workers:
● use practice experience and theory to inform scientific inquiry and research;
● apply critical thinking to engage in analysis of quantitative and qualitative research
methods and research findings; and
● use and translate research evidence to inform and improve practice, policy, and
service delivery.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Use agency policy of compliance learned in first semester to provide care to clients during visits
- Apply Department of Health policy to create plan of care at least once this semester and to complete
documentation at least once per month
- Effectively use technology to complete work tasks and documentation monthly
- Learn about improvements in workflow during a staff meeting this semester and apply to practice

Competency 5- Engage in Policy Practice

Social workers understand that human rights and social justice, as well as social welfare and services, are
mediated by policy and its implementation at the federal, state, and local levels. Social workers
understand the history and current structures of social policies and services, the role of policy in service
delivery, and the role of practice in policy development. Social workers understand their role in policy

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development and implementation within their practice settings at the micro, mezzo, and macro levels and
they actively engage in policy practice to effect change within those settings. Social workers recognize
and understand the historical, social, cultural, economic, organizational, environmental, and global
influences that affect social policy. They are also knowledgeable about policy formulation, analysis,
implementation, and evaluation. Social workers:
• Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and
access to social services;
• assess how social welfare and economic policies impact the delivery of and access to social services;
• apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and
social, economic, and environmental justice.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Apply knowledge of client confidentiality and privacy by respecting client privacy and only sharing personal
information to authorized parties when needed.
- Understand eligibility criteria for emergency assistance such as Temporary Assistance for Needy Families and
Supplemental Nutrition Assistance Program and provide information for client to receive this support
- Gain understanding of healthcare companies policies regarding providers and relay information to clients when
needed
- Use knowledge learned from previous policies to inform clients of the process and barriers they may encounter

Competency 6- Engage with Individuals, Families, Groups, Organizations and

Communities
Social workers understand that engagement is an ongoing component of the dynamic and interactive
process of social work practice with, and on behalf of, diverse individuals, families, groups,
organizations, and communities. Social workers value the importance of human relationships. Social
workers understand theories of human behavior and the social environment, and critically evaluate and
apply this knowledge to facilitate engagement with clients and constituencies, including individuals,
families, groups, organizations, and communities. Social workers understand strategies to engage diverse
clients and constituencies to advance practice effectiveness. Social workers understand how their personal
experiences and affective reactions may impact their ability to effectively engage with diverse clients and
constituencies. Social workers value principles of relationship-building and interprofessional
collaboration to facilitate engagement with clients, constituencies, and other professionals as appropriate.
Social workers:
• apply knowledge of human behavior and the social environment, person-in-environment, and other
multidisciplinary theoretical frameworks to engage with clients and constituencies; and
• use empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Will successfully complete required monthly visits with clients for the month of March
- Will complete at least 2 enrollment visits face to face by the end of the semester
- Use engagement skills learned last semester when interacting with clients, families, and providers at least once
per month
- Will communicate with providers to help connect clients to resources at least three times by the end of the
semester
- Will maintain a caseload of 2-3 people throughout the semester or until unable to do so

Competency 7- Assess Individuals, Families, Groups, Organizations and Communities

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Social workers understand that assessment is an ongoing component of the dynamic and interactive
process of social work practice with, and on behalf of, diverse individuals, families, groups,
organizations, and communities. Social workers understand theories of human behavior and the social
environment, and critically evaluate and apply this knowledge in the assessment of diverse clients and
constituencies, including individuals, families, groups, organizations, and communities. Social workers
understand methods of assessment with diverse clients and constituencies to advance practice
effectiveness. Social workers recognize the implications of the larger practice context in the assessment
process and value the importance of interprofessional collaboration in this process. Social workers
understand how their personal experiences and affective reactions may affect their assessment and
decision-making. Social workers:
• collect and organize data, and apply critical thinking to interpret information from clients and
constituencies;
• apply knowledge of human behavior and the social environment, person-in-environment, and other
multidisciplinary theoretical frameworks in the analysis of assessment data from clients and
constituencies;
• develop mutually agreed-on intervention goals and objectives based on the critical assessment of
strengths, needs, and challenges within clients and constituencies; and
• select appropriate intervention strategies based on the assessment, research knowledge, and values and
preferences of clients and constituencies.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Will complete at least three comprehensive assessment by the end of semester

- Complete at least one enrollments independently by end of semester
- Develop at least one plan of care by the end of the semester
- Identify strengths or barriers to inform plan of care during engagement process by the end of the semester

Competency 8: Intervene with Individuals, Families, Groups, Organizations, and

Communities Social workers understand that intervention is an ongoing component of the dynamic and
interactive process of social work practice with, and on behalf of, diverse individuals, families, groups,
organizations, and communities. Social workers are knowledgeable about evidence-informed
interventions to achieve the goals of clients and constituencies, including individuals, families, groups,
organizations, and communities. Social workers understand theories of human behavior and the social
environment, and critically evaluate and apply this knowledge to effectively intervene with clients and
constituencies. Social workers understand methods of identifying, analyzing and implementing evidence-
informed interventions to achieve client and constituency goals. Social workers value the importance of
interprofessional teamwork and communication in interventions, recognizing that beneficial outcomes
may require interdisciplinary, interprofessional, and inter-organizational collaboration. Social workers:
• critically choose and implement interventions to achieve practice goals and enhance capacities of
clients and constituencies;
• apply knowledge of human behavior and the social environment, person-in-environment, and other
multidisciplinary theoretical frameworks in interventions with clients and constituencies;
• use inter-professional collaboration as appropriate to achieve beneficial practice outcomes;
• negotiate, mediate, and advocate with and on behalf of diverse clients and constituencies; and
• facilitate effective transitions and endings that advance mutually agreed-on goals.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Identify resources for available food pantries for clients in need and provide referrals when needed at least once
this semester

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 - Use crisis management skills and individualized Crisis Plan to respond appropriately during times of crisis
- Advocate for client’s needs with service providers through communication with providers at least three times by
the end of the semester
- Communicate with providers to be informed of recommendations for clients and discuss these recommendations
with clients at least once per month of working with a case load
-Attend Motivational Interviewing training and apply knowledge to work with clients

Competency 9: Evaluate Practice with Individuals, Families, Groups, Organizations, and

Communities
Social workers understand that evaluation is an ongoing component of the dynamic and interactive
process of social work practice with, and on behalf of, diverse individuals, families, groups, organizations
and communities. Social workers recognize the importance of evaluating processes and outcomes to
advance practice, policy, and service delivery effectiveness. Social workers understand theories of human
behavior and the social environment, and critically evaluate and apply this knowledge in evaluating
outcomes. Social workers understand qualitative and quantitative methods for evaluating outcomes and
practice effectiveness. Social workers:
• select and use appropriate methods for evaluation of outcomes;
• apply knowledge of human behavior and the social environment, person-in-environment, and other
multidisciplinary theoretical frameworks in the evaluation of outcomes;
• critically analyze, monitor, and evaluate intervention and program processes and outcomes; and
• apply evaluation findings to improve practice effectiveness at the micro, mezzo, and macro levels.
Tasks, Practice Activities and Time Frames: (Please be specific – what, how, with who, by when, etc. –
Think SMART – Specific, Measurable, Attainable, Relevant and Timely)

- Discuss with supervisor what success of an intervention may look like and the next steps would be by the end of
the semester.
- Evaluate how changes in agency protocol and policies due to the Covid-19 state of emergency were effective
and discuss with supervisor
- Communicate with insurance companies to evaluate services provided to client at least once this semester
- Use the experience and knowledge gained to improve practice in working with clients and providers by end of
the semester

Signature of Agency Field Instructor: ______________________ Date ____________

Signature of Task Supervisor: _________________________ Date ____________

(If applicable, not required)

Signature of Student Intern:___________________________ Date ____________

Signature of Faculty Liaison: ________________________ Date ______________

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