School Psychology Internship Evaluation. Psychology 686: Internship in School Psychology Millersville University Department of Psychology

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1 School Psychology Internship Evaluation 1 Psychology 686: Internship in School Psychology Millersville University Department of Psychology Intern: Field Supervisor: Date of Evaluation: / / School District: Instructions: This form is designed to help supervisors provide feedback about the performance of students during their field experience. It will become a part of the student s record and may be considered in assigning grades for the practicum course. In your evaluation please consider the Intern's work and involvement in university assignments, professional development, agency involvement, and school psychology opportunities provided by the school district. Please answer each item using the scale provided. If you feel it would be helpful to provide a context in which to consider your ratings, please feel free to do so below. Answer Code for Evaluation Items: N/O = not observed 1 = does not meet proficiency 2 = partially proficient 3 = proficient 4 = exemplary I. Professional Dispositions and Related NASP Domains (Behavior) A. Communicates Professionally 1. Follows appropriate channels of communication (Domain 2.10) 2. Abides by FERPA (Federal Educational Rights and Privacy Act) (Domain 2.10) 3. Writes and speaks to easily understood by multiple audiences (Domain 2.10) 4. Conveys professional tone (Domain 2.10) 5. Listen carefully and actively (Domain 2.10) B. Demonstrates Professional Growth 1. Exhibits enthusiasm about the profession (Domain 2.10) 2. Self-regulates and modifies professional behavior based upon feedback (Domain 2.10) 3. Is aware and involved with professional organizations, publications, and activities (Domain 2.10) 4. Participates consistently and appropriately (Domain 2.10)

2 2 C. Demonstrates Professional Relationships 1. Understands and respects diversity (Domain 2.5) 2. Is respectful during interactions with school students, educational personnel, and families (Domain 2.6) 3. Works collaboratively with other colleagues, university, and field supervisors (Domains 2.2, 2.6) 4. Completes high quality products in a timely manner (Domains 2.6, 2.10) D. Exhibits Attributes Suitable to the Profession 1. Adapts and is flexible to change (Domain 2.6) 2. Displays excellent interpersonal skills (Domain 2.6) 3. Maintains professional appearance (Domain 2.6) 4. Displays initiative and reflective judgment (Domain 2.6) 5. Provides leadership and problem solving (Domain 2.6) E. Displays Responsible and Ethical Behavior 1. Adheres Professional Codes of Ethics of MU, NASP, and APA (Domain 2.6) 2. Presents data honestly (Domain 2.10) 3. Follows organizational protocol (Domains 2.6, 2.10) II. School Psychology A. Student Competencies (Blueprint II) and Related NASP Domains 1. Develops assessment batteries appropriate to answering specific referral questions to assist in educational decision-making (Domain 2.1) 2. Administers, scores, and interprets appropriately chosen psychological test instruments for diverse populations of children (Domain 2.1) 3. Administers, scores, and interprets curriculum-based and standardized measures of educational functioning (Domains 2.1, 2.11) 4. Conducts systematic observations in a classroom and organizes the obtained data into useful information for teachers (Domains 2.3, 2.11) 5. Interviews parents for the purpose of gathering information needed to adequately conduct an individual assessment of their child (Domains 2.2, 2.4) 6. Writes psychological reports appropriate to the referral question in language appropriate to persons using the report (Domain 2.1) 7. Interprets assessment results orally to school personnel and parents (Domains 2.1, 2.2) 8. Engages in ongoing consultation with teachers and other school personnel in planning strategies to facilitate the learning of individual students and/or classes of students (Domain 2.2) 9. Applies knowledge of principles of child and adolescent development when making educational decisions (Domain 2.3)

3 10. Uses systematic data collection to monitor the effectiveness of interventions and make educational decisions (Domains 2.1, 2.3, 2.4, 2.9) 11. Establishes rapport with, and relates comfortably to, children and youth of diverse cultural backgrounds (Domain 2.5) 12. Develops and employs therapeutic interventions with children and youth of diverse cultural backgrounds (Domain 2.5) 13. Establishes rapport with, and relates effectively to, teachers, administrators, and other school personnel (Domains 2.2, 2.6) 14. Establishes rapport with, and relates effectively to, parents of diverse cultural backgrounds (Domains 2.2, 2.8) 15. Consults effectively with parents concerning the needs of their child (Domains 2.2, 2.8) 16. Demonstrates knowledge of programs, services, and related resources within the greater school setting (Domain 2.6) 17. Participates effectively in interdisciplinary team conferences (Domain 2.6) 18. Demonstrates knowledge of community resources providing services to children and youth of diverse cultural backgrounds (Domain 2.7) 19. Consults effectively with community agencies and programs on behalf of children and youth and their families (Domain 2.7) 20. Utilizes skills within the framework of existing ethical codes and legal mandates governing professional practice and educational services (Domain 2.10) 21. Shows evidence of interest for, and participation in, professional growth activities (Domain 2.10) 3 B. Themes (Blueprint II) 1. School psychologists must knowledgeably use data to solve problems and make professional decisions. 2. School psychologists must identify referral questions with accuracy and address them effectively and efficiently. 3. School psychologists must consider how multiculturalism and diversity manifests itself in our society and determine the ramifications of these various contexts (assessment, determining eligibility, placement decisions, interventions, etc.). 4. School psychologists must continually monitor the ecological contexts of children (especially the learning situation) and of those who are concerned about them (parents, teachers, school personnel, the community, etc.). 5. School psychologists must link all forms of assessment (comprehensive, CBA, informal, summative, formative, etc.) to meaningful and practical academic and behavioral interventions. 6. School psychologists must engage in ongoing consultation and relate effectively with other professionals and those who have a vested interest in a child to promote his/her learning.

4 C. Student Competencies (Blueprint III) and Related NASP Domains 1. Helps design and implement prevention and intervention programs to promote wellness and resiliency. (Domains 2.4, 2.7) 2. Works with school personnel, students, parents and the general community in the prevention of crises. (Domains 2.4, 2.7) 3. Helps schools in developing achievable behavioral, affective, and adaptive goals for all students. (Domains 2.4, 2.7) 4. Is knowledgeable about development in social, affective, and adaptive domains and to apply sound principles of behavior change within these domains. (Domains 2.4, 2.7) 5. Provides leadership in creating instructional environments that promote student welfare and treats members of the school community with respect and dignity. (Domains 2.4, 2.7) 6. Recognizes and applies empirically supported components of effective instruction and alternative instructional methodologies with integrity. (Domain 2.3) 7. Assist teachers and others to improve instruction and enhance achievement. (Domain 2.3) 8. Assists teachers and others in translating emerging critical research to instructional practice. (Domain 2.3) 9. Understands how the systems work in which students live and learn. (Domain 2.6) 10. Uses their knowledge of systems to help organize schools and classrooms in ways that promote learning and prevent problems and a sense of community. (Domain 2.6) 11. Understands public policy initiatives. (Domain 2.6) 12. Is a good problem-solver who collects information that is relevant for understanding problems in order to make decisions about appropriate interventions, assess educational outcomes, and help others assess accountability for the decisions they make. (Domains 2.1, 2.9) 13. Gathers and integrates data about school systems, programs, and classroom environments through the use of: observations, interviews, standardized norm-referenced tests, functional behavioral assessment, curriculum-based assessment, ecological/environmental assessment, technology-enhanced assessment, and progress monitoring. (Domains 2.1, 2.9) 14. Practices in ways that meet all the appropriate ethical, professional and legal standards in order to enhance the quality of services and protect the rights of all parties. (Domain 2.10) 15. Develops a continuing education plan for professional development beyond the training program. (Domain 2.10) 16. Uses technology to gather, evaluate, and enhance communication of information. (Domain 2.11) 17. Knows where and how to access technology, and how to evaluate its safety and value, and how to use it to enhance classroom learning. (Domain 2.11) 18. Recognizes the impact of diversity on school settings and on student learning outcomes. (Domain 2.5) 19. Assists schools to embrace and respect diversity. (Domain 2.5) 20. Modifies or adapts in response to diverse populations. (Domain 2.5) 4

5 21. Understands the importance of collaboration and be able to facilitate it effectively in multiple contexts. (Domains 2.2, 2.8) 22. Listens to, and communicates effectively with, diverse audiences in both oral and written forms. (Domains 2.2, 2.8) 5 D. Objectives (Blueprint III) and Related NASP Domains 1. Enhances the development of wellness, resiliency, social skills, and life competencies (Domains 2.4, 2.7) 2. Enhances the development of cognitive and academic skills (Domain 2.3) 3. Provides leadership in promoting effective and caring systems that support learning (Domain 2.6) 4. Makes informed decisions based on data (Domains 2.1, 2.9) 5. Practices in ways that meet all appropriate ethical, professional, and legal standards and with mindfulness of their social responsibility in serving others (Domain 2.10) 6. Applies technology to improve outcomes and supports their efforts in serving others (Domain 2.11) 7. Is aware of issues of diversity and provides sensitive quality service to diverse populations (Domain 2.5) 8. Assists with and monitors the development of those interpersonal and collaborative skills that will enable candidates to work effectively and cooperatively with others. (Domains 2.2, 2.8) III. School Psychology Practice and Development A. Basic Work Requirements 1. Arrives on time consistently 2. Uses time efficiently 3. Informs supervisor and makes arrangements for absences 4. Completes requested or assigned tasks reliably and on time 5. Completes required total number of hours or days on site 6. Is responsive to norms about clothing, language, etc. on site B. Response to Supervision 1. Actively seeks supervision when necessary 2. Is receptive to feedback and suggestions from supervisor 3. Understands information communicated in supervision 4. Successfully implements suggestions from supervision 5. Is aware of ideas that need improvement 6. Is willing to explore personal strengths and weaknesses

6 Services 6 Assessments Number Completed Number On-going Total ADHD/ADD Autism/Aspergers/PDD Emotional Disturbance Learning Disabilities FBA (alone or part of an assessment) Other Health Impaired Other Direct Services Counseling Groups Counseling Individual Consultation Cases School Initiatives Building Level Committees School-Based Teams Evaluation Questions: What would you identify as areas in which this intern should improve? Would you recommend this student for doctoral studies? Signature of Field Supervisor/Date Signature of Intern/Date Thank you for your time in supervising this intern and for completing this evaluation.

7 NASP Domains For Millersville Faculty Only 7 Domains Items 2.1. Data-Based Decision Making and Accountability II: A1-3,A6,A7,A10, C11-12, D Consultation and Collaboration I: C3 II: A5,A7,A7,A13,A14,A15, C21-22, D Effective Instruction and Development of Cognitive/Academic Skills A4,A9,A10, C6-8, D Socialization and Development of Life Skills A5,A10, C1-5, D Student Diversity in Development and Learning I: C1 II: A11,A12,C18-20,D School and Systems Organization, Policy, Development, and Climate I: C2-4, D1-5, E1, E3 II: A13,A16,A17,C9-11,D Prevention, Crisis, Intervention, and Mental Health II: A18,A19,C1-5,D1,D Home/School/Community Collaboration II: A14,A15,C21-22,D Research and Program Evaluation II: A10,C12-13,D School Psychology Practice and Development I: A1-5, B1-4, C4, E2, E3 II: A20,A21,C14-15,D Information Technology II: A3,A4,C16-17,D6