1 FCHD 4970 STUDENT VERSION GERONTOLOGY CERTIFICATION PRACTICUM HANDBOOK Department of Family, Consumer, and Human Development Emma Eccles Jones College of Education and Human Services Utah State University Logan, Utah February, 2011 Not to be reprinted or copied except by permission
2 TABLE OF CONTENTS Page INTRODUCTION... 4 GERONTOLOGY PRACTICUM... 4 Definition of Titles... 4 Philosophy... 4 Practicum Objectives... 5 PRACTICUM POLICIES AND PROCEDURES... 6 University Responsibilities... 6 Gerontology Certificate Coordinator... 6 Practicum Coordinator... 6 Practicum Site Responsibilities... 7 Practicum Site Supervisor... 7 Appropriate Activities for Practicum Students... 8 Practicum Requirements & Student Responsibilities... 9 Application Process.9 Background Check.10 PRACTICUM REQUIREMENTS Grading Statement of Confidentiality Practicum Agreement Practicum Objectives Evaluations & Site Visits 12 Work Hours Practicum Written Assignments Second Practicum Experience Professional Conduct Written Assignments..14 Assignment # Assignment #
3 Ethics PRACTICUM FORMS Practicum Application Letters of Recommendation Confidentiality Statement Practicum Agreement Practicum Objectives Mid-Practicum Evaluation Form Final Practicum Evaluation Form Gerontology Practicum Evaluation Form
4 INTRODUCTION This handbook has been developed to facilitate and coordinate the Gerontology Practicum through the Department of Family, Consumer, and Human Development (FCHD 4970). The handbook should be utilized as a reference for understanding the perspective and scope of the certification process. The FCHD website is located at where you can find the practicum syllabus by going to course & student resources then under courses and selecting FCHD 4970 syllabus. If you are doing a future practicum then wait until the updated version is available. GERONTOLOGY PRACTICUM Definition of Titles The Practicum Student is undergraduate student enrolled in the Gerontology Certificate Program who temporarily assumes a professional role within an agency or a placement setting. The Practicum Site is an agency that provides gerontology services to families and/or individuals. The Site Supervisor is the professional agency representative who supervises and evaluates the Practicum Student during the duration of the Practicum experience. The Practicum Coordinator coordinates the Practicum experience between the student, the participating agency, and the University. The Gerontology Certificate Coordinator is the Utah State University faculty member who directs the gerontology certification program. Philosophy The purpose of the Gerontology Practicum is to assist students in the integration of their major field of study with the field of gerontology. Within a supervised professional setting, the practicum experience offers gerontology students a chance to demonstrate and apply knowledge, skills, and personal qualities. This valuable experience can be a practical method for determining a student's readiness for a career in Gerontology.
5 Practicum Objectives At the completion of the Gerontology Practicum, the student is expected to have developed the following: 1. A beginning identification with basic values and attitudes consistent with professions within the field of Gerontology. 2. An understanding of the scope of the Gerontology profession, including the physical effects of aging on the individual and the impact of social systems, (agency, hospital, institution, and community etc.), on aging citizens. 3. An awareness of the impact of social problems such as poverty, mental illness, crime, family breakdown, etc., upon aging individuals and their families. 4. An understanding of the various programs and services available to help aging clients find the agency best suited to help with their needs. 5. An ability to assess the effectiveness of social systems in the delivery of services to aging clients. 6. An understanding of the "team" approach, including a familiarity with professionals and other individuals important to the client or family who would be part of the team. 7. An ability to function professionally within their area of expertise. 8. Interpersonal skills that are engaging, helpful, collaborative, and/or directive (in rare instances)--depending upon the situation. Effective interpersonal skills require the ability to observe, listen, and communicate both verbally and in writing with individuals, and groups.
6 PRACTICUM POLICIES AND PROCEDURES The following guidelines have been prepared to outline general and specific expectations and responsibilities of the University, the participating agency or placement setting, and the student. University Responsibilities Gerontology Certificate Coordinator 1. Examine student transcripts and gerontology practicum application in order to determine whether or not the student has completed the necessary requirements for placement. 2. Meet with the student to determine readiness for practicum placement and sign the student s practicum application prior to its submission to the Practicum Coordinator. 3. Notify the Academic Advisor in the FCHD department that the student is eligible to enroll into the Gerontology Practicum class. Practicum Coordinator 1. Work with the Gerontology Certificate Coordinator to determine whether or not the student has completed the necessary requirements for placement. 2. Insure that the student has the necessary knowledge, skills, and professionalism needed for a successful practicum experience. Where deficits exist, the student will be advised accordingly. 3. Develop policies and guidelines for practicum experiences in cooperation with the Certificate Coordinator, faculty, practicum sites, and students. 4. Assist the student in formalizing the Practicum Agreement between the student and the practicum site. 5. Provide access to an on-line syllabus with due dates and grading information for the semester in which the student is completing their practicum experience. 7. Grade student assignments, assign points for required paperwork, and assign a final grade at the end of the practicum.
7 Practicum Site Responsibilities Practicum Site Supervisor 1. Interview the student to determine whether the student's needs and career objectives correspond with those of the practicum site. 2. Orient the student to the practicum site by explaining its historical development, purposes, goals, services rendered, eligibility requirements, area served, administrative structure, methods of recording, etc. A special attempt should be made to help the student become aware of how the practicum site fits into the network of community services. 3. Identify the parameters of the student's role and responsibility within the placement setting, introduce them to staff members, and arrange for them to attend staff or committee meetings whenever possible. 4. Provide the student with adequate work space and other practical necessities that may be involved in completing work assignments. 5. Assist the student in defining and establishing behavioral learning objectives congruent with the function of the practicum site and the role of the student in the agency. 6. Facilitate meaningful experiences that will provide breadth of exposure and indepth experience. 7. Make the student aware of referral sources within the community and introduce them to professionals outside the immediate practicum site when referral or a team approach is indicated. 8. Schedule regular supervision time with the student where an ongoing evaluation of the student's performance is shared. 9. Inform the student and the Practicum Coordinator immediately if the student's level of performance is not satisfactory. 10. Prepare jointly with the student two written evaluations of their progress and share with the Practicum Coordinator. One evaluation is due at mid-practicum and the other at the end of the practicum experience. 11. Participate in a mid-practicum site visit interview with the Practicum Coordinator and the student (set up by them) that takes place at the practicum site.
8 12. Assist the student in documenting the completion of required practicum hours and sign off the hours on the final evaluation form when they are completed. 13. Assign a suggested grade on the final evaluation form at the end of the practicum. Appropriate Activities For Gerontology Practicum Students Since Gerontology Certificate students come from a variety of majors, appropriate activities should fall within the scope of the student s education and professional training. In most cases, Gerontology Certificate students may participate in the following types of supervised practicum experiences: 1. Intake interviews. 2. Attend and assist with therapeutic and support groups. 3. Developing and teaching community education classes focused on aging-related topics. 4. Observing and interacting with older individuals and their families. 5. Learning the day-to-day practicum site management routines. 6. Supervised case management. 7. Assisting with family problem-solving in a community setting. 8. Participation in the assessment, planning, and implementation of programs to assist the older adults. 9. Observing and participating in practicum site staff meetings, community planning meetings, and interagency meetings. 10. Participating in special training sessions. 11. Completing relevant readings suggested by the Practicum Site Supervisor. 12. Working on special projects such as making brochures, posters, or bulletin boards to facilitate the services provided by the practicum site. 13. Research related to the field of gerontology. 14. Other activities related to the field of gerontology within the student s major field of study.
9 PRACTICUM REQUIREMENTS AND STUDENT RESPONSIBILITIES Application Process 1. Students must obtain the FCHD 4970 Practicum Handbook and associated materials from the practicum coordinator (FL 217) or the advising office (FL 205). The practicum application (see Forms section) must be reviewed and approved (by signature) first by the Gerontology Certificate Coordinator, and then by the Practicum Coordinator before registering for practicum credit. 2. As part of the application process all students must complete a background check. The paperwork for the background check is included with the handbook and associated materials indicated above. 3. Practicum application deadlines are listed on the FCHD department website. This includes obtaining a signature on the Gerontology Practicum application form by the Gerontology Certificate Coordinator and submitting this application, an unofficial copy of transcripts, and two form letters-of-recommendation to the Gerontology Practicum Coordinator, as well as, following the outlined process for the background check. 4. After receiving a letter of approval in the mail from the Gerontology Practicum Coordinator, the student can make an appointment to coordinate practicum site placement with the coordinator. The student is ultimately responsible for locating a site which meets his or her needs and negotiating the specifics of the practicum experience. In most cases, arrangements for placement must be completed at least six weeks prior to the beginning of the practicum experience. 5. It is important for students to notify the Gerontology Practicum Coordinator of address, phone, or changes so the student may be contacted if needed. The University does not automatically forward changes to the department. 6. After locating an appropriate site, the student initiates an interview with the Site Supervisor to arrange a practicum experience. It is recommended that students take their Practicum Agreement to this meeting and have it signed by the Site Supervisor at the time their practicum is arranged. (A few sites may require a referral from the coordinator or additional paperwork. It may be helpful for students to schedule an interview with the practicum coordinator prior to initiating
10 the interview with the selected site supervisor.) Background Check As part of the application process, all students must complete a background check. APPLICATIONS WILL NOT BE PROCESSED UNTIL THE BACKGROUND CHECK IS RECEIVED BY THE PRACTICUM COORDINATOR. 1. The background check packet is part of the application packet. 2. The student must first complete the top part of the application. All previous names used must be listed, including married and maiden names. Put the following address (unless already there) on the Third Party Waiver where it states I hereby ask that the criminal history information requested be released and sent to: Attn: Practicum Coordinator Family, Consumer, and Human Development Utah State University 2905 Old Main Hill Logan, UT Next, the student needs to be fingerprinted. This can be done at any local law enforcement agency. You are only being fingerprinted here, not having them run the background check. MAKE SURE THE LAW ENFORCEMENT AGENT DOING THE FINGERPRINTS ALSO SIGNS THE APPLICATION. 4. Mail the completed application with fingerprints, signed Third Party Release, and $15 processing fee directly to the BCI who will run the actual background check: Utah Bureau of Criminal Identification, 3888 West 5400 South, Taylorsville, UT In most cases, the Gerontology Practicum Coordinator will receive the completed background check in about 2 weeks.
11 Practicum Requirements The student is expected to take the initiative in arranging the practicum site, the mid-practicum interview, turning in all assignments and evaluations on time, and notifying the practicum coordinator about any problems which may affect any aspect of the practicum experience. 1. Grading: An on-line syllabus with specific due dates is available on the FCHD Department website and Blackboard each semester. Grading is based on points assigned for completing and turning in the Confidentiality Statement, Agreement, Objectives, Written Assignments 1 & 2, Practicum Site Visit, and the Mid and Final Evaluations. A letter grade is assigned based on the percentage of possible points earned by the student for the paperwork that is due each semester as outlined in the syllabus. Late or missing paperwork, failure to communicate with the Gerontology Practicum Coordinator about emergencies, and failure to display responsible behavior at the practicum site will impact grades in a negative way. The practicum site experience is the most important part of practicum, so the majority of the points earned will come from that experience. Points awarded for the site will be based on the evaluations (mid and final) and will reflect the evaluation scores and grade given. 2. Statement of Confidentiality: A Statement of Confidentiality (see Forms Section) must be signed by the student and must be turned in to the Practicum Coordinator (who will then sign the form) prior to beginning practicum hours. This form is in addition to, and not in place of, any which the student may be required to sign at the practicum site. Failure to submit this form could result in an incomplete grade. 3. Agreement: The Agreement (see Forms section) must be signed by the student and the Site Supervisor then turned in to the Practicum Coordinator who will then sign it. This is due the first week of the semester in which the student s practicum begins. 4. Objectives: The student should write four practicum objectives (see Forms section). Once the objectives are written, they should be signed by the student
12 and the Site Supervisor. The student should keep a copy and turn in the original to the Practicum Coordinator. Objectives may be revised as necessary during the practicum experience. The objectives are due during the first month of the practicum. Objectives should be specific, measurable, and include a time frame and how the student plans to accomplish them. They should indicate what the student intends to do, not what the student wants to do. 5. Evaluations and Site Visits: It is the student s responsibility to notify their Site Supervisor about due dates for evaluations, give the evaluation forms to their supervisor at least one week in advance, set a time to meet with the supervisor to complete the evaluation process, and then turn the forms in to the Practicum Coordinator by the due dates listed in the syllabus. A mid-practicum evaluation should take place between the Site Supervisor and the student mid way through the practicum. A site visit must be scheduled during the course of the practicum with the Site Supervisor, the Practicum Coordinator, and the student. A time should be arranged by the student when all can meet together at the practicum site. If an on-site visit is not possible, a phone site visit may be arranged. A final evaluation meeting must be held by the Site Supervisor and the student to discuss the practicum experience. The final evaluation form must be turned in to the Practicum Coordinator by the student by the last day of finals unless other arrangements have been made with the Practicum Coordinator. The Gerontology Practicum Evaluation form (See Forms Section) should be filled out by the student at the conclusion of their practicum and turned in to the Practicum Coordinator by the last day of finals. 6. Work Hours: The student earns FCHD 4970 credit by working fifty hours of clock time for each semester hour of credit, or a total of 150 hours of clock time for three FCHD 4970 credits. The completion of practicum hours is monitored by the Practicum Site Supervisor and verified on the final evaluation form. 7. Practicum Written Assignments: Written assignments 1 & 2 are to assist the practicum student in focusing on certain important aspects of the practicum experience. These assignments are not required for second practicum experiences.
13 8. Second Practicum Experience (for the same degree or certification): Once the requirements for a first practicum experience have been completed, students may participate in a second practicum experience at a new site without going through the entire application process again. The Information Sheet for a Second Practicum (see Forms section) must be turned in to the Practicum Coordinator prior to starting a second practicum. Requirements for a second practicum include the Practicum Agreement, Objectives, and Mid and Final Evaluations. No written assignments or site visits are required for a second practicum. If a student is doing a second practicum to fill a requirement for a second major or an additional certification all of the requirements for a first practicum will apply. Professional Conduct Within the agency setting, students are expected to conduct themselves professionally in the following ways: 1. Understand the philosophy and method of operation and comply with the rules of practice within the practicum setting. 2. Maintain a professional appearance and exhibit dependability and promptness in all dealings at the practicum site. 3. Give advance notice to the Practicum Site Supervisor and make up the time on another day if it is necessary to miss time at the agency. 4. Take the initiative to interact with co-workers and to draw from their experience, being aware that much learning is acquired from informal contacts. 5. Be aware of the ethical codes adhered to by the agency and implement the Ethical Decision Making Process when necessary. 6. Prepare for regularly scheduled supervision sessions with their Site Supervisor. 7. Make yourself available for and attend staff and other meetings when possible. Information about the operation of the agency can be obtained from attending agency meetings. 8. Notify the Gerontology Practicum Coordinator immediately should any problem arise which may affect the successful completion of the practicum experience.
14 WRITTEN ASSIGNMENTS Assignments should focus on the student's experiences, thoughts, and feelings as they apply their knowledge in a professional setting. Assignments are expected to be neatly typed, double spaced, and proofread. Grading will take into consideration content, grammar, and spelling as well as assignment due dates. There are no length requirements; however, brevity and conciseness are encouraged. Students should focus on evaluating their personal growth experiences within their practicum setting. For more information on due dates, turning in assignments, etc., see the syllabus. Assignment #1 1. Describe the services provided by the agency where you are completing your practicum. Include a description of what your role will be during your practicum. 2. Using the GSA Ethics Statement (see p. 15) and professional ethical code followed by your practicum site, describe the three most important ethical issues that you will need to be aware of during your practicum experience. 3. Identify some of the special needs of your older adult clients and how you are helping to meet their needs. Identify some of the barriers you perceive may affect provision of services to older adult clients. 4. Describe some of the problems and frustrations faced by family care givers of older adult family members and describe at least one resource that might be available for helping family care givers. Assignment #2 1. Identify some of the factors that could contribute to professional burnout. Interview your supervisor or another employee of your agency about how they prevent burnout and have them suggest some ideas that might help you to prevent burnout. 2. a. Describe your best practicum experience. b. Describe your most frustrating practicum experience and how it was handled. Was it effectively handled? If not, how could it have been handled more effectively? 3. Discuss how your practicum experience has influenced your feelings about yourself as an aging person. 4. Describe and evaluate your objectives. Did you accomplish what you desired? If not, why? What would you do differently? How has your practicum experience affected your future career and personal goals as they relate to a profession in the field of Gerontology?
15 Gerontological Society of America (GSA) Ethics Statement This ethics statement applies but is not limited to our relations with research subjects, colleagues, students, employees and society at large as we carry out our aging related work. Adopted by Society's Council July 13, To those we study we owe disclosure of our research goals, methods, and sponsorship. The participation of people in our research activities shall only be on a voluntary basis and only on research projects approved by an appropriate institutional review board. We shall provide a means through our research activities and in subsequent publications and reports to maintain the confidentiality of those we study. The people we study and their proxies must be made aware of the likely limits of confidentiality and must not be promised a greater degree of confidentiality than can be realistically expected under current legal circumstances in our respective nations. We shall, within the limits of our knowledge, disclose any significant risks or limits of possible benefits to those we study. 2. To the individuals, families and communities ultimately affected by our activities we owe our respect for their dignity, integrity, and worth. We will avoid taking or recommending action on behalf of a sponsor which is harmful to individuals and groups we study and/or serve. 3. To our colleagues we have the responsibility to avoid engaging in actions that impede their reasonable professional activities. Among other things, this means that while respecting the needs, responsibilities, and legitimate proprietary interests of our sponsors we should not impede the flow of information about research outcomes and professional practice techniques. We shall accurately attribute the contributions of colleagues in our work. We shall not condone falsification or distortion by others. We shall not prejudice communities or agencies against a colleague for reasons of personal gain. 4. To our students, interns, and trainees, we owe nondiscriminatory access to education and training. We shall provide education and training that is informed, accurate, and relevant to the needs of our students and relevant
16 to the needs of the larger society. We recognize the need to responsibly advise and mentor our students and to conscientiously supervise their academic and professional development. We have an obligation to inform students of their ethical responsibilities. We recognize the need for continuing education in order to improve and expand our skills and knowledge in substantive and pedagogical areas. Student contributions to our professional activities, including research and publication will be appropriately recognized. 5. To our employers and other sponsors we owe accurate reporting of our qualifications and competent, efficient, and timely performance of the work we undertake for them. We shall establish a clear understanding with each employer or other sponsor regarding the scope of our expertise and the nature of our professional responsibilities. We shall report our research, teaching and service activities accurately. We will prevent distortion or suppression of research results or policy recommendations by concerned agencies. 6. To society as a whole we owe the benefit of our knowledge and understanding of Biological, Cultural, Social, and Psychological Aspects of Aging. We should communicate our understanding of human aging to the society at large. Gerontological research, teaching and practice pose choices for which we individually and collectively bear ethical responsibility. Since gerontologists are members of a variety of professional groups and subject to a variety of ethical codes, choices must sometimes be made not only among the varied obligations outlined in this statement but also between those of this statement and those incurred in other statuses or roles. This statement does not dictate choice or propose sanctions. Rather, it is designed to promote discussion and provide general guidelines for ethically responsible decisions. (Gerontology Society of America (2002). Gerontology Society of America Ethics Statement, Accessed at October 23, 2007.)
17 Practicum Forms
18 FCHD 4970 GERONTOLOGY PRACTICUM APPLICATION UTAH STATE UNIVERSITY DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT NAME A # LOCAL ADDRESS PHONE PERMANENT ADDRESS PHONE MAJOR MINOR EDUCATION: (List most recent first) COLLEGES ATTENDED DATES DEGREES MAJOR GPA WORK EXPERIENCE: (List most recent first) AGENCY LOCATION DATES TITLE or DESCRIPTION Specialized Skills Volunteer Experience List any limitations that may restrict your working environment: CURRENT STATUS: 1. What are your career objectives?
19 2. If you are interested in a specific site, please specify. 3. List gerontology certificate courses that you have completed, are currently enrolled in this semester, or that you will enroll in and complete prior to your practicum experience. Only list those classes required for the gerontology certificate. NOTE: At least 12 gerontology credits must be completed prior to beginning practicum. Gerontology Certificate Courses Completed: Current Semester Current Gerontology Certificate courses: Planned Gerontology Certificate courses for Semester: 4. If you are currently working, what impact will this have on your availability to complete your practicum experience? SEMESTER AND YEAR OF DESIRED PRACTICUM EXPERIENCE: Semester Year Student s Signature Date Gerontology Certificate Coordinator s Signature Date Attach (1) a recent unofficial transcript and (2) two letters of recommendation in envelopes with the seal signed by the writer. Return to: Practicum Coordinator Department of Family, Consumer, and Human Development 2905 Old Main Hill Utah State University Logan, UT
20 LETTER OF RECOMMENDATION FCHD 4970 GERONTOLOGY PRACTICUM DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT UTAH STATE UNIVERSITY Please return this letter to the applicant listed below in a sealed envelope with your signature across the seal. Name of applicant: Last First Middle When did you first become acquainted with this applicant? How did you become acquainted with this applicant? Advisor Employer Special Project Class/es (list) Research Project Volunteer Other (explain) Are you aware for any reason this applicant should not be allowed to participate in a professional practicum experience? No Yes (explain) Comments: Signature and Title Date Organization
21 LETTER OF RECOMMENDATION FCHD 4970 GERONTOLOGY PRACTICUM DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT UTAH STATE UNIVERSITY Please return this letter to the applicant listed below in a sealed envelope with your signature across the seal. Name of applicant: Last First Middle When did you first become acquainted with this applicant? How did you become acquainted with this applicant? Advisor Employer Special Project Class/es (list) Research Project Volunteer Other (explain) Are you aware for any reason this applicant should not be allowed to participate in a professional practicum experience? No Yes (explain) Comments: Signature and Title Date Organization
22 STUDENT STATEMENT OF CONFIDENTIALITY As a student participating in the Gerontology Practicum administered by the Department of Family, Consumer, and Human Development at Utah State University in Logan, Utah, I,, understand that I am representing the Family, Consumer, and Human Development Department while placed in a practicum setting to fulfill the requirements for the FCHD 4970 Practicum experience as part of my education. As a condition of this placement, I agree to the following: 1. I will treat any and all clients with whom I may come in contact in a professional, respectful, and confidential manner. 2. In the practicum site where I will be completing my practicum hours, I understand that I may be exposed to information of a personal and confidential nature. I agree to treat any such information in a respectful manner, including not disclosing confidential information in any way to those outside the practicum site unless the agency's requirements for such disclosure have been met. 3. I understand that this agreement does not replace, but is in addition to any which I may be required to sign at the practicum site where I will be completing my practicum experience. 4. Should I violate this agreement, I understand that disciplinary action may be initiated against me by the FCHD Department in addition to any at the practicum site where I am placed. Student Date Practicum Coordinator Date
23 FCHD 4970 GERONTOLOGY PRACTICUM AGREEMENT DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT UTAH STATE UNIVERSITY This Practicum Agreement is to define the conditions whereby (Student's Name) is to receive instruction and training under the supervision of (Practicum Site Supervisor). The student will be placed with (Practicum Site) as a. (Position) The Practicum hours will be completed during Semester. The points of agreement as outlined in the Practicum Handbook specify the roles and expectations of the student, the Practicum Site Supervisor, and the Practicum Coordinator. The specified roles and expectations serve as the tenets of this document. I hereby indicate that I have read and understand the roles and expectations as outlined in the Practicum Handbook. Furthermore, I agree to abide by the expectations which correspond specifically with my role for the duration of this agreement. Student Practicum Site Supervisor Practicum Coordinator Date Date Date
24 FCHD 4970 GERONTOLOGY PRACTICUM OBJECTIVES Objectives are a necessary part of the practicum experience to help you focus and evaluate your progress. Objectives should be discussed with your Practicum Site Supervisor to make sure they are achievable in your practicum setting. Also, by working with the Practicum Site Supervisor in choosing objectives, you will be more likely to have a meaningful practicum experience. When writing your objectives, make sure they are clear and specific. Ask yourself, "How will I know I have achieved this goal?" Rather than writing "I want to learn about Alzheimer's Disease," you may write "By the end of my practicum, I will to learn about three ways that Alzheimer's Disease affects individuals and their families." This type of objective leaves no doubt about whether or not it was achieved. Objectives should describe (1) your expected performance or behavior, (2) the conditions and timeframe under which it will be accomplished, and (3) how well it will be performed. Three objectives must be written and a copy turned in to the Practicum Coordinator by the end of your fourth week. NAME: SITE: 1. 2.
25 3. Student Date Practicum Site Supervisor Date
27 FCHD 4970 GERONTOLOGY MID-PRACTICUM EVALUATION DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT UTAH STATE UNIVERSITY Student Agency Evaluator Semester/s Student s Position Competency Scale: NA = Not Applicable NO = Not Observable 1 = limited accomplishment 2 = average accomplishment 3 = better than average accomplishment 4 = outstanding accomplishment Practicum Site Related Performance 1. Is prompt and regular in attendance. Rating 2. Shows interest in and commitment to the agency. 3. Shows understanding of agency purpose and function. 4. Willing to accept and implement suggestions. 5. Willing to request help when needed. 6. Attends staff and other meetings when possible. Comments: Professional Integrity 7. Respects confidential information and maintains confidentiality. 8. Assumes responsibility in a leadership role. 9. Meets conflict with self-control and confidence. 10. Seeks to expand knowledge and experience. 11. Demonstrates interest in self-improvement.
28 Comments: Ability to Form Relationships 12. Seeks to establish rapport with supervisor. 13. Seeks to establish rapport with agency staff. 14. Seeks to establish rapport with clientele. Comments: Interpersonal Skills 15. Uses effective verbal techniques. 16. Uses effective non-verbal techniques. 17. Assumes a non-judgmental attitude and demonstrates unconditional positive regard. 18. Shows awareness of clients' need for understanding. 19. Shows awareness of clients' need to make their own choices concerning their own lives. 20. Avoids becoming over-involved with clients. Comments: Service to Clients 21. Ability to work with clients to identify needs. 22. Ability to work with clients to plan interventions based on client needs. 23. Follows through and assists client in implementing plans. 24. Uses evaluative feedback appropriately. 25. Opportunities to relate to: Comments: Clients individually yes no Clients in groups yes no
29 Collaboration and Supervision 26. Uses practicum site staff as resources. 27. Identifies and utilizes community resources. 28. Communicates openly with supervisor/s. Comments: Personal Growth and Development 29. Acknowledges and uses feedback about self. 30. Displays flexibility and adaptability to change. 31. Seeks out and assumes responsibility. 32. Displays self-motivation. 33. Willing to seek additional information when needed. 34. Uses self-evaluation as basis for personal growth. 35. Demonstrates a knowledge of the aging process its effects on the individual. 36. Understands the impact of various processes (i.e. health, family interactions, social systems, etc.) on the aging individual. Comments: 37. Site Supervisor Comments: Specify student's strengths and areas which maybe improved: 38. Student Response: Specify aspects of practicum that have been most helpful and aspects that might be modified to be more helpful.
30 Site Supervisor Signature Date Student Signature Date
31 FCHD 4970 GERONTOLOGY FINAL PRACTICUM EVALUATION DEPARTMENT OF FAMILY, CONSUMER, AND HUMAN DEVELOPMENT UTAH STATE UNIVERSITY Student Evaluator Agency Student s Position Competency Scale: Practicum Site Related Performance 1. Is prompt and regular in attendance. Semester/s NA = Not Applicable NO = Not Observable 1 = limited accomplishment 2 = average accomplishment 3 = better than average accomplishment 4 = outstanding accomplishment Rating 2. Shows interest in and commitment to the agency. 3. Shows understanding of agency purpose and function. 4. Willing to accept and implement suggestions. 5. Willing to request help when needed. 6. Attends staff and other meetings when possible. Comments: Professional Integrity 7. Respects confidential information and maintains confidentiality. 8. Assumes responsibility in a leadership role. 9. Meets conflict with self-control and confidence. 10. Seeks to expand knowledge and experience. 11. Demonstrates interest in self-improvement. Comments:
32 Ability to Form Relationships 12. Seeks to establish rapport with supervisor. 13. Seeks to establish rapport with agency staff. 14. Seeks to establish rapport with clientele. Comments: Interpersonal Skills 15. Uses effective verbal techniques. 16. Uses effective non-verbal techniques. 17. Assumes a non-judgmental attitude and demonstrates unconditional positive regard. 18. Shows awareness of clients' need for understanding. 19. Shows awareness of clients' need to make own choices concerning own lives. 20. Avoids becoming over-involved with clients. Comments: Service to Clients 21. Ability to work with clients and identify needs. 22. Ability to work with clients to plan interventions based on client needs. 23. Follows through and assists clients in implementing plans. 24. Uses evaluative feedback appropriately. 25. Opportunities to relate to: Comments: Clients individually yes no Clients in groups yes no
33 Collaboration and Supervision 26. Uses practicum site staff as resources. 27. Identifies and utilizes community resources. 28. Communicates openly with supervisor/s. Comments: Personal Growth and Development 29. Acknowledges and uses feedback about self. 30. Displays flexibility and adaptability to change. 31. Seeks out and assumes responsibility. 32. Displays self-motivation. 33. Willing to seek additional information when needed. 34. Uses self-evaluation as basis for personal growth. 35. Demonstrates a knowledge of the aging process its effects on the individual. 36. Understands the impact of various processes (i.e. Health, family interactions, social systems, etc.) on the aging individual. Comments: 37. Site Supervisor Comments: Specify student's strengths and areas which may be improved: 38. Student Response: Please specify the aspects of your practicum that were the most helpful and aspects that might be modified for future practicum students.
34 To be completed at the end of the practicum experience by the Site Supervisor: Recommended Final Grade: A B C D F Number of clock hours completed by practicum student: hours Site Supervisor Signature Date Student Signature Date
35 Utah State University FCHD 4970 Gerontology Practicum Evaluation To be filled out by the student at the end of their practicum and returned to FL 205. PRACTICUM SITE: SEMESTER: Student evaluations are an important part of the assessment of practicum effectiveness. Please respond as honestly and candidly as possible. The completed forms and the computer data will not be available to the practicum coordinator until after class grades are awarded. Turn in the completed form to FL 205 by the last day of finals. I. INFORMATION ABOUT THE PRACTICUM Excellent Very Good Good Fair Poo r The overall quality of my practicum: E VG G F P VP The overall effectiveness of the USU Gerontology Practicum Coordinator: The extent to which practicum requirements were clear: The relevance of assignments to practicum experiences: The appropriateness of workload to practicum goal(s): Very Poor E VG G F P VP E VG G F P VP E VG G F P VP E VG G F P VP The fairness of practicum grading procedures: E VG G F P VP The extent to which responsibilities of students were clarified: E VG G F P VP The helpfulness of the practicum handbook: E VG G F P VP The effort I put into ensuring the success of my practicum experience was: E VG G F P VP
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