New Agency Onboarding Book 2022-2023

WELCOME!

New Agency Onboarding UNC Charlotte School of Social Work Field Office

New Agency Onboarding Packet Overview Field Office Information and the Placement Process: School of Social Work Overview Field Education Program Overview Field Office Infographic Agency Onboarding Checklist Field Placement Checklist Sample Forms: Sample Affiliation Agreement Sample MSW Foundation Field Confirmation Sample Employment-Based Field Confirmation Sample MSW Preceptor Letter Sample Learning Agreement Note: BSW Field Confirmation, MSW Advanced Year Field Confirmation, and BSW Preceptor letter are not included in this packet but are similar to the samples included and can be provided as needed.

School of Social Work

Program Mission: The program mission of the School of Social Work is to prepare future social work professionals for leadership in areas of culturally-informed, community-engaged practice, policy, and research, with a particular emphasis on persistent and emerging social problems in rapidly diversifying urban areas locally, nationally and globally.

Vision Statement: The vision of the School of Social Work is to foster optimal health and well-being, equal human rights and a just society.

Code of Ethics: Value: Service Ethical Principle: Social workers’ primary goal is to help people in need and to address social problems Value: Social Justice Ethical Principle: Social workers challenge social injustice Value: Dignity and Worth of the Person Ethical Principle: Social workers respect the inherent dignity and worth of the person.

Value: Importance of Human Relationships Ethical Principle: Social workers recognize the central importance of human relationships.

Value: Integrity Ethical Principle: Social workers behave in a trustworthy manner.

Value: Competence Ethical Principle: Social workers practice within their areas of competence and develop and enhance their professional expertise.

School of Social Work Field Education Program Overview The Field Office supports 270+ BSW/MSW students in concurrent field education internships.

Field Instructors/Task Supervisors Responsibility: ● Provide critical feedback designed to support their growth ● Serve as a mentor and foster professional growth ● Assist the student in developing a Learning Agreement ● Complete a Student Evaluation each semester with your student ● Make your intern feel a part of the team and help them to contribute ● Must meet the school’s requirements for field instruction and/or task supervision Possible Social Work Intern Tasks: ● Facilitate groups ● Advocate for clients and policy change ● Conduct intakes and psychosocial assessments ● Provide mental health and substance use counseling

● ● ● ● ● ●

Work on grant proposals Community outreach Develop needs assessment for agencies Analyze how policy impacts services Focus on special projects Improve service delivery

Support: ● We offer a New Field Instructor Training to provide an overview of expectations ● Student’s Field Liaison’s (Student’s professor) will come out to visit and make regular contact ● We offer a number of trainings and continuing education events Logistics: ● Students are required to complete 16 hours per week ● Student typically begin field in late August until the end of April ● Days in Field: The Field Office allows flexibility on days if it works with the student’s and agency’s schedule ● Students typically interview for the upcoming year school between January and May ● A formal Affiliation Agreement between the agency and the university must be in place

Contact the Field Office at ssw-field@uncc.edu

School of Social Work Field Office Agency Onboarding Checklist Getting Started: Meeting between agency and UNC Charlotte School of Social Work Field Office.

Agency should complete the Affiliation Agreement and Compliance Form. ●

Once completed, the UNC Charlotte Health and Human Services’ Dean’s Office will reach out via email and all affiliation agreement documents are completed electronically.

Agency completes the Agency and Social Work Internship Description Form.

If the agency already knows who the Field Instructor/Task Supervisor will be, the Field Instructor(s)/Task Supervisor(s) should complete the Field Instructor Information Form.

Getting an Intern: The School of Social Work Field Office will reach out to determine your availability for hosting students in the upcoming year.

If you are available to take interns, expect to be contacted about a specific student between January and August regarding a student.

Agency interviews the student and determines whether or not they will accept the student for a placement.

If accepting the student, the student will ask you to assist with completing the Field Confirmation and then the student will return this document to the Field Office.

Field Instructor(s) and/or Task Supervisor(s) will attend New Field Instructor Orientation.

The Field Office will work with students to complete all compliance requirements.

The Field Office will send a formal preceptor letter via email notifying that the student is cleared to begin placement.

If not already completed, the Field Instructor/Task Supervisor should complete the Field Instructor Information Form.

Questions? Contact the Field Office at ssw-field@uncc.edu

Field Placement Timeline *The Field Placement Process begins in January and concludes in August* Phase

What happens during this step?

Inquiry

The Field Office will reach out to inquire if you have the capacity to host social work interns.

Connection Email

Once an appropriate student is matched, the Field Office will follow-up with a connection email with the student’s field application and resume.

Interview Acceptance

The agency will interview the student either virtually or in-person.

If the student is accepted, the Field Instructor/Task Supervisor at the agency will work with the student to sign the Field Confirmation.

The agency will work with the student to provide any onboarding material and/or summer requirements.

Preparation

The Field Office will support students in acquiring any clinical compliance (background check, drug screen, etc.) required by the agency.

The Field Instructor will participate in Field Instructor Orientation.

Preceptor Letter

Once all student requirements have been met, the Field Office will send a final preceptor letter to the field instructor stating that the student is cleared to start field and will include any other field education updates.

Questions? Contact the Field Office at ssw-field@uncc.edu

AFFILIATION AGREEMENT THIS AGREEMENT, made the ___ day of ________, 20xx, between The University of North Carolina at Charlotte for its College of Health and Human Services (hereinafter UNIVERSITY) and ________________(hereinafter FACILITY), sets forth the terms and conditions under which students from UNIVERSITY’s health career related programs may receive selected teaching-learning experiences at FACILITY (hereinafter Programs).

WHEREAS, UNIVERSITY is engaged in the education of students enrolled in courses through its College of Health and Human Services, and WHEREAS, selected teaching-learning experiences are essential to accomplish the educational objectives for those students enrolled in UNIVERSITY’s Health and Human Services programs, and WHEREAS, FACILITY routinely provides social services to the general public, and WHEREAS, UNIVERSITY desires that certain of its students gain teaching-learning experience in the facilities of FACILITY, and FACILITY has agreed to provide facilities wherein said students can gain such teaching-learning experiences; NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, the parties agree as follows: I. UNIVERSITY shall: 1.

Meet and maintain pertinent state and national standards recommended by the respective discipline state board (i.e., North Carolina Social Work Certification and Licensure Board) and applicable national accrediting agencies relative to the organization and administration of the College of Health and Human Services.

2.

Be responsible for the educational experience and all planned learning experiences of participating students related to program objectives and provide appropriate faculty for this purpose. Faculty will have at least a master’s degree, appropriate credentials, and practice experience in the area of teaching assignments. The selection of teaching-learning experiences by faculty will be made in cooperation with designated FACILITY personnel.

3.

Keep FACILITY informed of the objectives of UNIVERSITY in the relevant programs of the College of Health and Human Services.

4.

Provide notice to participating students and faculty of FACILITY policies, procedures, and practices prior to the start of Programs; provided, however, that FACILITY shall identify and make available to UNIVERSITY such policies, procedures, and practices in a timely manner.

5.

Provide disciplinary procedures for participating students for their failure to comply with established policies, rules, and procedures of FACILITY.

6.

Notify participating students and faculty that they are required to abide by any policies of FACILITY related to basic life support certification.

7.

Agree to provide, upon written request from FACILITY, proof of professional and general liability insurance through an entity acceptable to FACILITY for all participating faculty and students for acts or

omissions occurring at FACILITY. 8.

Provide FACILITY with the names of students participating in the Program prior to their placement.

9.

Notify participating students and faculty that they are required to abide by any policies of FACILITY that require criminal background checks.

II. FACILITY shall: 1.

Ensure that FACILITY is an equal opportunity employment agency that provides client care services regardless of race, color, creed, sex, age, national origin, religion, disability, or political belief.

2.

Meet and maintain all applicable state and federal standards relative to the organization and administration of FACILITY.

3.

Make facilities of FACILITY available to participating students and faculty of the College of Health and Human Services for the purpose of carrying out the objectives of the Programs.

4.

Maintain all responsibility for client services and care while cooperating with UNIVERSITY faculty in selecting teaching-learning experiences available to students. Full responsibility for client services and care is at all times controlled by FACILITY.

5.

Designate an appropriate official of FACILITY as liaison between FACILITY and the Dean of the College of Health and Human Services, or designee.

6.

Comply with the Family Educational Rights and Privacy Act (FERPA) and its regulations with regard to disclosure or redisclosure of any student education records.

III. UNIVERSITY and FACILITY further agree that: 1.

The resources of FACILITY may be utilized for selected teaching-learning experiences in the Social Work program of UNIVERSITY as specifically approved by the FACILITY representative and by the Dean of the College of Health and Human Services, or designee.

2.

Appropriate FACILITY personnel may share in the evaluation of student achievement regarding behavioral objectives of the Program, as indicated by UNIVERSITY. Full responsibility for the academic content of the Program and the credit granted to participating students upon satisfactory completion of the Program is at all times controlled by UNIVERSITY.

3.

Any student of the College of Health and Human Services assigned to the Program shall be under the direct supervision of a member of the faculty or a designated teaching-learning preceptor approved by UNIVERSITY and FACILITY. In case of such a preceptorship, UNIVERSITY shall identify the student, preceptor, and course name, and shall specify the terms of the preceptorship in a separate letter, attached hereto and incorporated herein as Attachment 1.

4.

The students and faculty shall respect the confidential nature of all information that they have access to at FACILITY, including but not limited to clients' personal information provided to them orally, contained in client records, or maintained on FACILITY’s electronic information system.

UNIVERSITY shall advise all students and faculty of the importance of complying with all relevant state and federal confidentiality laws, including the Health Insurance Portability and Accountability Act

of 1996 (HIPAA), to the extent applicable. In addition, UNIVERSITY agrees to provide students and faculty with training in the requirements of the privacy and security provisions of HIPAA and to advise them of the importance of complying with FACILITY’s policies and procedures relative to HIPAA. FACILITY agrees to provide students and faculty with training regarding FACILITY’s policies and procedures relative to HIPAA. UNIVERSITY and FACILITY acknowledge that students and faculty may use clients' personal information for educational purposes at FACILITY and at UNIVERSITY. To the extent practicable, all information used for such purposes shall be appropriately de-identified so as to remove all data that may be used to connect such information back to the client to whom it relates.

5.

Students or faculty assigned to FACILITY facilities pursuant to this Agreement shall not be deemed employees or agents of FACILITY. FACILITY shall not be responsible for payment to any student or faculty member of any salary, wage, or employment-related benefit, including, but not limited to, worker’s compensation benefits.

6.

Periodic communication between UNIVERSITY and FACILITY may occur to discuss any problems encountered in the Program. Such communication may be initiated by either party. All amendments to this Agreement shall be in writing and signed by authorized representatives of both parties.

7.

Information specific to the Program will be communicated between representatives of UNIVERSITY and FACILITY. UNIVERSITY shall provide evaluation mechanisms and course objectives/goals. In addition, UNIVERSITY will furnish the following to FACILITY prior to the beginning of each Program: (a) The applicable course descriptions, their purpose and objectives, and assignments; and (b) A schedule including the names of participating students and faculty members and designating the hours to be assigned to participating students and faculty members each week.

8.

There shall be no monetary exchange between the parties for services rendered by FACILITY or services rendered by participating students and/or faculty pursuant to this Agreement unless FACILITY requires payment to participating students. It is expected that as a result of the Program FACILITY and UNIVERSITY will be mutually enriched through the stimulus of participating in the Program.

9.

For the purposes of this Agreement, both UNIVERSITY and FACILITY are independent contractors.

Neither UNIVERSITY nor FACILITY is authorized nor permitted to act as an agent or employee of the other.

10.

FACILITY agrees to permit participating students and faculty to carry out mutually approved research projects, publications, speaking engagements, and other activities concerning data results and summaries.

11.

FACILITY shall retain the right to dismiss any student if deemed necessary by FACILITY; provided, however, that in the event FACILITY dismisses or excludes a student, it shall immediately notify the student and the University and shall provide an explanation of the reasons for such exclusion, along with all evidence supporting such explanation. FACILITY shall also provide an opportunity for the excluded student to respond to any allegations resulting in exclusion from the Program.

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The term of this Agreement shall be for five years, beginning on the date indicated above, and may be renewed by written agreement every five years, after a review by both parties. This Agreement may be

terminated in the following manner: (1) By either party for breach if there has been a failure to cure after thirty (30) days written notice; (2) at any time by mutual agreement, or (3) upon written notice of either party given at least 150 days prior to the effective date of such cancellation; provided, however, that no termination shall become effective during an academic semester in progress. Summer sessions I and II shall be construed together as one academic semester.

13.

Each party shall be responsible for its own acts and omissions and shall not be responsible for the acts and omissions of the other party.

14.

Any notice to be given hereunder shall be given in writing and delivered personally or by registered or certified mail, postage prepaid as follows: To FACILITY:

[NAME] [ADDRESS] [ADDRESS] [ADDRESS] Phone: [PHONE] Fax: [FAX] Email: [EMAIL]

To UNIVERSITY:

Jane B. Neese, Ph.D., R.N. Senior Associate Dean for Academic Affairs College of Health and Human Services UNC Charlotte 9201 University City Blvd.

Charlotte, NC 28223-0001 Phone: 704-687-8374 Fax: 704-687-1639

15.

This Agreement shall be for the benefit of UNIVERSITY for its College of Health and Human Services and shall not be assigned or transferred by either party.

16.

This Agreement shall be binding upon and inure to the benefit of the parties hereto, their successors and permitted assigns. Nothing in this Agreement is intended, nor shall be deemed, to confer any benefits on any third party, including without limitation, any patients of FACILITY, nor shall such person or entity have any right to seek, enforce or recover any right or remedy with respect hereto.

IN WITNESS WHEREOF, the parties have caused this Agreement to be executed as of the date first written above.

UNC CHARLOTTE

FACILITY

By:

By: ____________________________

------

Signed: Title:

Signed: ------

Title:

FOUNDATION MSW Field Placement Confirmation 20xx-20xx In consideration of being permitted to participate in the Social Work Field Placement Program at UNC Charlotte, I, __________________________________ , hereby agree: (Student’s Name) 1. To spend a minimum of 16 hours per week during the 20xx-20xx academic year in a Field Placement at _____________________________________ (Agency) 2. To be in the agency between the hours of and on (days of the week) and . Field Placement will begin on Month/Day, 20xx and end at the conclusion of the spring 20xx semester.

3. To make arrangements with my Field Instructor for any absences from the agency during the times specified above. I understand that I am expected to be in the agency except for illness or urgent personal business. When possible, I will arrange for absences in advance and make alternative plans for clients and/or any other duties that are pending.

4. To accept the supervision and instruction of the agency representative designated as my Field Instructor. I understand that I am responsible to my Field Instructor while in the agency and that we will have regular and frequent conferences to assess my learning needs and progress.

5. To meet with my Field Instructor and Social Work Faculty Liaison at times that may be designated to evaluate my learning needs and progress. I understand that I am expected to evaluate myself and contribute to the evaluation conferences.

6. To follow the policies, practices, and procedures of my agency as I fulfill my responsibilities as a social work student. I will consult with my Field Instructor about policies and procedures I do not understand or find difficult to accept.

7. To arrange with my Field Instructor for use of any materials from agency records to be used in social work course assignments. I understand that I am not to tape record any client interviews without special permission from the client, my Field Instructor, and my Social Work Faculty Liaison.

8. To regard all information I receive concerning clients as confidential. I will not use names of clients or other identifying information about them outside the agency.

9. To be responsible for providing my own transportation to and from the agency.

10. The student is to assume personal and professional liability by carrying the level of liability insurance deemed appropriate by the agency. I understand that if I (the student) use my personal car for agency business, I will be reimbursed for travel at the rate of per mile.

11. To discuss the use of student’s personal car to transport clients with the Field Instructor and the Director of Field Education. The University advises against the use of students to transport clients.

The student will not be asked to transport clients in their own car as part of this practicum.

12. The student is responsible for completing all compliance requirements as indicated by the Field Office and placement. Formal clearance to begin field placement will come from the Field Office 13. Any exceptions or additions to the provisions of this agreement which have been agreed to by the social work student, the Field Instructor and the Social Work Faculty Advisor are to be entered below.

14. Field Agency and Field Instructor/Task Supervisor contact information: Field Instructor Information Field instructors must hold a Master of Social Work degree from a social work program accredited by the Council on Social Work Education. The field instructor must have at least two (2) years post MSW practice experience.

Field Instructor Name: __________________________________________________________________ Field Instructor Credentials: BSW MSW LCSW/LCSWA Other:_______________________ Year(s) of Experience: ___________________________________________________________________ Agency Address:________________________________________________________________________ Phone Number: _______________________________________________________________________ Fax Number: __________________________________________________________________________ Email: _______________________________________________________________________________ Attended UNC Charlotte Social Work Field Instructor Training?

NO- Will need to attend a UNC Charlotte Field Instructor Training YES -If yes, when (year) ________________________________ Task Supervisor Information (If Applicable) Please complete this section only if a Field Instructor (see above) is not available at your placement.

If no MSW is available to serve as the primary Field Instructor at the agency, a Task Instructor/Task Supervisor may be assigned as the primary instructor. Please complete contact information below for the person who will be serving as the task instructor/task supervisor. Task Supervisor must have an undergraduate and/or advanced degree in a closely related field or may have been grandfathered in as an LCSW by the North Carolina Certification and Licensure Board, but not have an MSW. Experience: The task supervisor must have at least two (2) years post degree practice experience.

NOTE: In some cases MSW’s with 2 years experience will serve as a co-field instructor or secondary task supervisor to the student. The contact information can be added in this section.

Task Supervisor Name: __________________________________________________________________ Task Supervisor Credentials: BSW MSW LCSW/LCSWA Other:_______________________ Year(s) of Experience: ___________________________________________________________________ Agency Address:________________________________________________________________________ Phone Number: ________________________________________________________________________ Fax Number: __________________________________________________________________________ Email: _______________________________________________________________________________ Attended UNC Charlotte Social Work Field Instructor Training?

NO- Will need to attend a UNC Charlotte Field Instructor Training YES -If yes, when (year) ________________________________

______________________________________________________

MSW Student’s Signature ______________________________________________________

Field Instructor’s Signature ______________________________________________________

Task Supervisor’s Signature (If applicable)

School of Social Work EMPLOYMENT-BASED FIELD PLACEMENT CONFIRMATION This Agreement is between the University of North Carolina at Charlotte, School of Social Work(“University”) and the employing agency named below (“Employing Agency”) regarding an employment-based Field Placement for a UNC Charlotte Social Work student who is also an employee of the Employing Agency.

Employing Agency: _________________________________________________ Agency Address: ___________________________________________________ An employment-based Field Placement is an option that is not routinely available for UNC Charlotte Social Work students but can be an option if a student is employed in an agency that qualifies as a field site for the UNC Charlotte Social Work program. To be qualified as a field site for the UNC Charlotte Social Work program, such an agency must meet all field instruction and other UNC Charlotte Social Work program standards and expectations. The relevant current CSWE guidelines provide as follows: “The program describes how its field education program develops policies regarding field placements in an organization in which the student is also employed. To ensure the role of student as learner, student assignments and field education supervision are not the same as those of the student’s employment.” (CSWE, 2015, pg.13).

The student named below is currently an employee at the Employing Agency and will remain on employee status there during his/her Field Placement unless the employment status is terminated by the agency which will mean that the Field Placement will not remain employment based and may be terminated.

Name of Student: ________________________________ BSW Field Placement MSW Foundation Year Field Placement MSW Advanced Year Field Placement

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The Employing Agency and the University agree to the following conditions as the means necessary to protect the educational integrity of the Field Placement: 1. The designated Field Instructor named below, an employee of the Employing Agency, must be approved by the UNC Charlotte School of Social Work. He/she/they must be an MSW degree with at least two years post-degree experience (for MSW students) or a BSW degree with at least two years post degree experience (for BSW students) or serve as a task supervisor. The Field Instructor may not be the direct supervisor of the student in the student’s capacity as an employee of Employing Agency.

Name current supervisor: _________________ Phone Number: _____________ Email: _____________________ Name of proposed Field Instructor and/or Task Supervisor: ___________________ Phone Number: ________________ Email: ________________________ BSW Degree and 2 years post BSW experience MSW Degree and 2 years post MSW experience Name of proposed Task Supervisor: ___________________ Phone Number: ________________ Email: ________________________ Please list highest degree:______________________________ 2. Field Placement learning experiences must be in an entirely different program or division of the Employing Agency from the unit in which the Student is regularly employed. The learning experiences assigned for the Student must be as varied as possible and must differ substantially from their employee role. The level of assignments will be determined by the Student’s role as a student, not his or her role as an employee.

3. The Employing Agency shall release the Student from paid employment duties and expectations during the business hours and days that the Student participates in the Field Placement. The Student shall not be expected to perform any employment duties while participating in Field Placement activities, and will not be penalized for failure to perform employment duties while participating in Field Placement activities.

4. After approval of the Field Placement Plan, the Field Instructor will prepare a learning agreement to be signed by the Employing Agency and the Student that details the activities and responsibilities of

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the Student during the Field Placement. Such agreement must be reviewed and approved by the University’s faculty liaison and the Director of Field Education before being signed.

5. During the months that the Student is participating in the Field Placement, the Field Instructor will meet with the Field Liaison and the Student on a regular basis for the purpose of coordinating learning plans and to review the progress of the Student.

6. The Employing Agency and the Student must develop an Employment-Based Field Placement Plan for the proposed Field Placement that details specifically how the Employing Agency will meet the conditions of this Employment Based Field Agreement. Insert below. The Written Field Placement Plan must follow the general field education guidelines outlined in the UNC Charlotte Field Placement Manual.

Employment-Based Field Placement Plan should include the following: a. Current employment responsibilities: i. Enter <HERE> b. Proposed practicum roles and tasks: Specific information about the educational learning opportunities for the proposed placement which includes the population served, service methods available for student learning, field of service, and practicum experience i. Enter <HERE> c. Schedule Information: Work Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Field Placement Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Field Placement Start Date: Field Placement End Date: Total number of field placement hours per week: 16

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____________________________________ Authorized Signature for Employing Agency

____________________ Date

____________________________________ Title ____________________________________ Task Supervisor Signature

____________________ Date

____________________________________ MSW/BSW Field Instructor

____________________ Date

___________________________________ Social Work Student

____________________ Date

____________________________________ Ticola C. Ross, PhD, MSW, LCSW Clinical Assistant Professor-Director of Field Education School of Social Work

_____________________ Date

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9201 University City Boulevard Charlotte, NC 28223-0001 School of Social Work Phone (704) 687-7938 Fax (704) 687-2343

DATE Re: Student Name Agency Name: XXXX Dear Field Instructor NAME, Thank you for the opportunity to arrange for a field experience at your agency for the 20xx-20xx academic year. The student is enrolled in Social Work MSW Field Education Series in the School of Social Work, College of Health and Human Services (CHHS). While at your agency, the student will work with you as the student’s designated field instructor. The student will require a minimum of 16 hours per week during the fall semester and 16 hours per week during the spring semester of the 20xx-20xx academic year. The student and field office will reach out regarding the formal start date in August 20xx.

You as the preceptor shall directly supervise the student and ensure that the student does not work independently as a professional. If applicable, you shall countersign any medical records/notes that the student writes and indicate that s/he/they has seen the patient/client referred to and that you agree with the student’s documentation. Professional practice skills will be stressed in the classroom and should be reinforced in the field setting. The student should be on time, prepared with paper work, and exhibit appropriate behavior towards colleagues, clients, and supervisors. Please refer to the UNC Charlotte Social Work Field Handbook that is available to instructors and students at our website: https://socialwork.uncc.edu/field-education/students

If needed, please feel free to contact The Field Office at ssw-field@uncc.edu .

UNC Charlotte, College of Health and Human Services, currently has an existing education Affiliation Agreement with your facility. The terms of that Agreement, including liability insurance, blood borne pathogen training, tb screening and all other requirements set forth in that Agreement are applicable to this field experience.

There shall be no compensation provided to either party for engaging in the field experience unless the Agency requires payment to the student.

CHHS shall advise the student of the importance of complying with all relevant state and federal confidentiality laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to the extent applicable, including the need to respect the confidential nature of all information that the student has access to at Agency, including but not limited to patients’/clients’ personal health information provided to them orally, contained in patient/client medical records, or maintained on Agency’s electronic information system. Agency may require the student to sign a confidentiality agreement. Agency agrees to provide the student with training regarding Agency’s policies and procedures relative to HIPAA. CHHS and Agency acknowledge that the student may use patients’/clients’ personal information for educational purposes at Agency and at CHHS. To the extent practicable, all information used for such purposes shall be appropriately de-identified so as to remove all data that may be used to connect such information back to the patient/client to whom it relates.

Thank you again for the opportunity to participate in what should prove to be a mutually beneficial arrangement.

Sincerely, [signature] The Field Office School of Social Work UNC Charlotte ssw-field@uncc.edu

FIELD LEARNING AGREEMENT & EVALUATION SAMPLE BASED ON DIFFERENT SETTINGS Student Name: Nancy Niner Agency Name: School of Social Work OVERVIEW This document encompasses the Field Learning Agreement and Evaluation. Each section of this document has designated areas for students and field instructors to complete. Students and Field Instructors/Task Supervisors are advised to make a copy of this document for their records each time it is updated throughout the semester. Students are responsible for the submission of this document as per the deadlines outlined in their syllabus.

COMPETENCY BASED FIELD INSTRUCTION The UNC Charlotte Learning Agreement and Evaluation document outlines the competencies and practice behaviors (actions) expected of all students completing their practicum, as outlined by the Council on Social Work Education (2015): 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.

A total of nine Social Work competencies are outlined on this document, followed by specific practice behaviors for each competency. The practice behaviors outline four dimensions: Knowledge: Student is able to incorporate their academic learning and prior field experience (if applicable) into their practice.

Values: Students are expected to demonstrate practice that is in accordance with the values outlined by the social work profession.

Skills: Student is able to demonstrate social work skills and professional behaviors.

Cognitive and Affective Processes: As per CSWE (2015), cognitive and affective processes include critical thinking, affective reactions, and exercise of judgement.

LEARNING AGREEMENT INSTRUCTIONS The Field Student is responsible for completing the Learning Agreement. The Learning Agreement should be developed in collaboration with the on-site supervisor (field instructor or task supervisor), and the Department of Social Work Field Liaison. The Learning Agreement should have clear timelines noted to

expose the student to each practice area and should be updated and reviewed as part of the supervisory process with objectives clearly outlined for this semester. It is essential that the student and field instructor view the document as a work in process which may be revised to meet the learning needs of the student over the course of the academic year.

The Learning Agreement must reflect the student’s knowledge of the placement agency, ability to write effectively, and note professional objectives that are a component of your graduate education. It should reflect each student’s learning needs, priorities, and identify activities/tasks that will allow the student to demonstrate and show evidence of competency as a social worker student. Tasks should be focused on the further development of the student’s knowledge, values, skills, and cognitive and affective processes as a professional social worker that were demonstrated during their placement.

Steps to Completing the Field Learning Agreement 1. Review each competency and practice behavior.

2. Meet with your on-site supervisor (Field Instructor or Task Supervisor) to discuss how the competency and practice behaviors will be addressed.

Students should schedule a time to discuss this document with their on-site supervisor well in advance of the due date.

3. After discussion with your on-site supervisor, the student should identify a minimum of at least one activity that will demonstrate your level of performance for each behavior. Each activity must be completed by the target date within the semester. In accordance with the dimensions mentioned earlier in this document, please identify how the practice behavior will be assessed through demonstration of one or more of the following: Knowledge, Values, Skills, Cognitive and Affective Processes.

4. The Learning Agreement page must be signed by the student and on-site supervisor (Field Instructor or Task Supervisor). Students in External Supervision should obtain both the Task Supervisor and Field Instructor signature.

5. Submit the Learning Agreement to your Field Faculty Liaison on the due date outlined in your syllabus. Update your Learning Agreement as needed.

FIELD EVALUATION INSTRUCTIONS FOR FIELD INSTRUCTOR OR TASK SUPERVISOR The Field Evaluation reviews the level of progress and performance achieved during the field semester. Field students are evaluated based on the competencies and practice behaviors outlined by the Council on Social Work Education. The student’s on-site supervisor is required to complete this form (Field Instructor or Task Supervisor). Field Instructors/Task Supervisors must be able to observe and assess their student(s) for competency in all practice areas noted by the end of each semester. Each competency area includes several practice behaviors, for which the student identifies practice behaviors that they will demonstrate.

Students will be evaluated on this form for the final semester evaluation. Students will update their Learning Agreement each semester.

The on-site supervisor (Field Instructors or Task Supervisor) is to circle the appropriate rating for the student’s level of demonstrated competency for each activity and average the score for each competency for the final evaluation. At the end of the document, the on-site supervisor will circle the student’s overall score for the evaluation based on the rating scale. Please fill in the average number score and corresponding letter grade in the last grading box. Field Instructors/Task Supervisors are encouraged to add comments regarding the student’s performance in the Comment section.

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Submission: All evaluations must be signed and dated by the student and the field instructor or task supervisor to be considered valid. Field instructors/Task Supervisors and students may hand write their signature and date or use a virtual signature (no typed in signatures will be accepted). The student must upload the signed evaluation to Canvas. All evaluations must be submitted by the deadline outlined in the course syllabus. A delay in the submission of this evaluation will impact the student’s grade.

Grading Rubric 5 = (A) Exceptional Competence This reflects that the student has exhibited performance skills of the highest quality and has practiced well above the expected skill level for the social work student. Student has excelled and uses these skills consistently and effectively.

4 = (B) Competence This reflects that the student has exhibited performance skills at an expected level and has practiced at the expected skill level for a beginning level social work student. Demonstrates effective use of the practice skills most of the time.

3 = (C) Emerging Competence This reflects that the student is performing at a marginal level. There are some deficiencies in the student’s performance nor have they performed at the expected level. The student understands the skill and offers some evidence of appropriate use for a beginning level social work student. More practice is required.

2 = (D) Limited Competence This reflects that the student is performing with limited insight and/or inconsistent in demonstrating an understanding of the skill for a beginning level social work student.

1 = (F) Not Competent This reflects that the student is not performing at an acceptable level for a beginning level social work student. The student does not demonstrate an understanding of the skill.

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

3

Competency 1: Demonstrate Ethical and Professional Behavior Macro County Placement

Practice Behaviors Intern makes 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 Intern uses reflection and self-regulation to manage personal values and maintain professionalism in practice situations Demonstrate professional behavior; appearance; and oral, written, and electronic communication Use technology ethically and appropriately to facilitate practice outcomes Use supervision and consultation to guide professional judgment and behavior

Learning Activities/Products:

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

● Compare and Contrast NASW Ethics Code to County Ethical Standards

K&V

Supervision Discussion

9/18

● Keep a journal

CAP

Supervision Discussion

Ongoing

● Dress professionally ● Use formal communication when using email ● Only use county email to communicate

S

Observation

Ongoing

S

Observation

Ongoing

● Inquire about organizational culture

K

Supervision Discussion

8/31

Total Average Field Instructor/Task Supervisor Comments: Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

4

Competency 2: Engage Diversity and Difference in Practice Macro County Placement

Practice Behaviors

Learning Activities/Products:

Intern applies and communicates understanding of the importance of diversity and difference in shaping life experiences in practice at the micro, mezzo, and macro levels.

Intern presents themselves as learners to clients and constituencies.

● Meet with Diversity, Inclusion and Equity Office

Intern engages clients and constituencies as experts of their own experiences.

Intern applies self-awareness and self-regulation to manage the influence of personal biases and values in working with diverse clients and constituencies.

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

K

Supervision Discussion

10/15

● Wear County ID at all times S ● Introduce myself as a social work intern ● Actively listen during community S meetings

Observation

Ongoing

Observation

11/15

● Take online implicit bias test ● Read How to be an Anti-Racist

by Kendi

Supervision Discussion

10/31

V & CAP

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice Department of Social Services Placement

Practice Behaviors Intern applies and communicates understanding of the importance of diversity and difference in shaping life experiences in practice at the micro, mezzo, and macro levels.

Intern engages in practices that advance social, economic, and environmental justice.

Learning Activities/Products:

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

● Intern provides statistics on K number of DSS case by race and gender

Supervision Discussion

11/15

● Attend DSS budget meeting K ● Meet with DSS leadership to advocate for Child Welfare Education Collaborative funding

Supervision Discussion

9/15 12/5

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Competency 4: Engage in Practice-informed Research and Research-informed Practice Department of Social Services Placement

Practice Behaviors Intern uses theory to inform scientific inquiry and research.

Intern uses practice experience to inform scientific inquiry and research.

Intern applies critical thinking to engage in analysis of quantitative and qualitative research methods and research findings.

Intern uses and translates research evidence to inform and improve practice, policy, and service delivery.

Learning Activities/Products:

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

● Examine attachment theory and K its impact on DSS involved parents ● Investigate characteristic of K&S parents with multiple DSS cases and connect with an evidence-based approach to reduce re-entry ● Assess a recent DSS report S

Supervision Discussion

11/1

Supervision Discussion

10/1

Supervision Discussion

9/15

● Intern researches best practices K trans-racial adoptions and compare with current adoption policies

Supervision Discussion

10/15

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

7

Competency 5: Engage in Policy Practice Medical Social Work Placement

Practice Behaviors Intern identifies social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services Intern assesses how social welfare and economic policies impact the delivery of and access to social services Intern applies critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.

Learning Activities/Products:

Dimension(s)

● Review Affordable Healthcare K Act ● Research NC Medicaid Transformation ● Investigate the discharge V&S process and its impact on homeless populations ● Develop social media posts S related to eliminating barriers to accessing healthcare

Method(s) of Evaluation

Supervision Discussion

Target Date Final Score

9/15

Staff Observation 10/15

Documentation 10/1 Review

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

8

Competency 6: Engage with Individuals, Families, Groups, Organizations, and Communities Medical Social Work Placement

Practice Behaviors Intern applies knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks to engage with clients and constituencies.

Intern uses empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.

Learning Activities/Products:

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

● Shadow different social workers S and observe their engagement approach with patients.

Supervision Discussion

12/1

● Initiate discharge planning K&S process with patients using a person-centered approach ● Watch Brene Brown’s RSA Short Empathy video

Observation

10/15

Supervision Discussion

9/15

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

9

Competency 7: Assess Individuals, Families, Groups, Organizations, and Communities School Social Work Placement

Practice Behaviors Intern collects and organizes data, and applies critical thinking to interpret information from clients and constituencies.

Intern applies 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.

Intern develops mutually agreed-on intervention goals and objectives based on the critical assessment of strengths needs, and challenges within clients and constituencies.

Intern selects appropriate intervention strategies based on the assessment, research knowledge, and values and preferences of clients and constituencies.

Learning Activities/Products:

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

● Participate in a McKinney Vento S Assessment

Supervision Discussion

● Apply a strengths-based approach with a child having behavioral issues using a DAP note

S

Document Review 10/15

● Participate/co-lead parent meeting

S & CAP

Observation

11/30

Supervision Discussion

11/1

● Make recommendations for S parents experiencing housing issues ● Use mindfulness for support students with behavioral issues

12/1

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

10

Competency 8: Intervene with Individuals, Families, Groups Organizations and Communities School Social Work Placement

Practice Behaviors Intern critically chooses and implements interventions to achieve practice goals and enhance capacities of clients and constituencies.

Intern applies knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in interventions with clients and constituencies.

Intern uses inter-professional collaboration as appropriate to achieve beneficial practice outcomes.

Intern negotiates, mediates, and advocates with and on behalf of diverse clients and constituencies.

Intern facilitates effective transitions and endings that advance mutually agreed on goals.

Learning Activities/Products:

● Teach a Growth Mindset lesson

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

S

Observation

12/1

● Review developmental stages for K elementary age students

Supervision Discussion

9/30

● Consult with school psychologist V & S and Communities in Schools staff ● Present to administrative team S regarding the need for more one-on-one time with students ● Winter termination meetings V & CAP with students on my caseload

Team Meetings

12/1

Staff Observation 12/1

Supervision Discussion

12/5

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Competency 9: Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities Nonprofit with a youth focus

Practice Behaviors Intern selects and uses appropriate methods for evaluation of outcomes.

Intern applies knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in the evaluation of outcomes.

Intern critically analyzes, monitors, and evaluates intervention and program process and outcomes.

Intern applies evaluation findings to improved practice at the micro, mezzo, and macro level.

Learning Activities/Products:

●

Review pre and post data and conduct a t-test to assess for difference. ● Review best practices for collecting evaluation data with youth ● Review Kirkpatrick Model for Evaluation ● Assess current and previous evaluations ● Make recommendations based on evaluation data

Dimension(s)

Method(s) of Evaluation

Target Date Final Score

S

Supervision Discussion

11/15

K

Supervision Discussion

9/30

K

Supervision Discussion

9/30

S & CAP

Team Meeting

10/15

Total Average Field Instructor/Task Supervisor Comments:

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Work Ethics: NOTE: Grading Rubric DIFFERENT 5 = Exceptional 4 = Exceeds Expectations 3 = Met Expectations 2 = Needs Improvement 1 = Unacceptable

Practice Behaviors

Comments:

Final Score

Attendance: Attends field; arrives/leaves on time; notifies in advance of planned absences Productivity: Follows safety practices; keeps work area neat and clean; follows directions and procedures; submits assignments punctually; participates Teamwork: respects the rights of others; respects confidentiality; is a team worker, is cooperative; is assertive; displays a customer service attitude; seeks opportunities for continuous learning; demonstrates mannerly behavior Character: Displays loyalty, honesty, trustworthiness, dependability, reliability, initiative, self-discipline, and self-responsibility Leadership: Displays leadership skills; appropriately handles criticism, conflicts, and complaints; demonstrates problem-solving capability, maintains appropriate relationships with supervisors and peers; follows chain of command.

Organization: Manifests skills in prioritizing and management of time and stress; demonstrates flexibility in handling change Communication: Displays appropriate nonverbal (eye contact, body language) or oral (listening, telephone etiquette, grammar) skills Self-Esteem: Demonstrates a positive attitude; appears self-confident; has realistic expectations of self

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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Learning Agreement Signature Page (Digital Signatures or Wet Signatures Acceptable -No typed in signatures will be accepted) STUDENT NAME:

(Signature/Date)

FIELD INSTRUCTOR:

(Signature/Date)

TASK SUPERVISOR (if applicable):

(Signature/Date)

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

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FINAL FALL EVALUATION - Semester Scoring Summary Worksheet Field Instructors or Task Supervisors should use this summary table to find the average score total.

Competency

Final Score Total

1: Demonstrate Ethical and Professional Behavior 2: Engage Diversity and Difference in Practice 3: Advance Human Rights and Social, Economic, and Environmental Justice 4: Engage in Practice-informed Research and Research-informed Practice 5: Engage in Policy Practice 6: Engage with Individuals, Families, Groups, Organizations, and Communities

7: Assess Individuals, Families, Groups, Organizations, and Communities 8: Intervene with Individuals, Families, Groups Organizations and Communities 9: Evaluate Practice with Individuals, Families, Groups, Organizations, and Communities Work Ethics

Average Total

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

15

Field Instructors/Task Supervisors - Please check ONE overall score below. Your score should be based on the average score from the semester scoring summary worksheet. _________ 5 = (A) Exceptional Competence: This grade reflects that the student has exhibited performance skills of the highest quality and has practiced well above the expected skill level for the social work student. Student has excelled and uses these skills consistently and effectively. _________ 4 = (B) Competence: This reflects that the student has exhibited performance skills at an expected level and has practiced at the expected skill level for a beginning level social work student. Demonstrates effective use of the practice skills most of the time. _________ 3 = (C) Fair Competence: This reflects that the student is performing at a marginal level. There are some deficiencies in the student’s performance, nor have they performed at the expected level. The student understands the skill and offers some evidence of appropriate use for a beginning level social work student. More practice is required. _________ 2 = (D) Limited Competence: This reflects that the student is performing with limited insight and/or inconsistent in demonstrating an understanding of the skills for a beginning level social work student. _________ 1 = (F) Not Competent This reflects that the student is not performing at an acceptable level for a beginning level social work student. The student does not demonstrate an understanding of the skill.

Comments:

Field Instructor Signature/Date: __________________________________________________________________________ Student Signature/Date: ____________________________________________________________________________________ Task Supervisor Signature/Date: _________________________________________________________________________

(Digital Signatures or Wet Signatures Acceptable -No typed in signatures will be accepted)

Methods of Evaluation: Observation, Supervision Discussion, Staff Observation, Team Meetings, Documentation Review, Other Grading Rubric: 5 = Exceptional Competence 4 = Competence 3 = Emerging Competence 2 = Limited Competence 1 = Not Competent Dimensions: K = Knowledge

V = Values

S = Skills

CAP = Cognitive and Affective Processes

16

Thank you!

Ready to partner with us?

Complete the Affiliation Agreement and Compliance Form Once we have your responses, we will pass them along to our Dean's Office to get the Affiliation Agreement started Complete the Agency and Social Work Internship Information Form Note: If you have trouble accessing any of the forms or documents, please let us know and we can share them in an alternate format!

Questions? Concerns?

Contact the Field Office at ssw-field@uncc.edu