MIDTERM EVALUATION

This form is to be completed by the Field Instructor and discussed with student. It will
automatically be sent to the Faculty Field Liaison once it is completed online.
Student:

Kelly Burg

Agency:

Spaulding for Children

Agency Field Instructor(s):

Kristina Vaseau, LMSW

Faculty Field Liaison:

Dennis Muzzi

Please Check One:

X

BSW
BSW WOW
MSW Foundation Year
MSW Advance Year

Q3 Please check and complete all that apply.

X Student has received agency orientation and work space has been assigned.
X Student has completed 96 hours to date.
X Student is actively engaged in weekly supervision.
X Learning Plan has been completed and submitted to the Field Instructor and Faculty Field
Liaison.
X Process Recordings or PRACSIS have been reviewed by Field Instructor and submitted to the
Faculty Field Liaison (students should check with assigned Faculty Field Liaison to find out
the number of Process Recordings or PRACSIS required).

Please describe any areas of strength or concern in regard to the students performance
and/or the availability of required learning assignments.
Kelly has continued to do well during the last few weeks. The assigned worker left the agency
and Kelly has adjusted well to receiving a new worker. she has new cases that she will be
working with. There are no concerns with the work that Kelly has completed. She is beginning to
work more with a specific birth family who has mental illness. She is being challenged to
prepare herself for difficult conversations. Kelly is receptive to guidance and continues to seek
clarification.

Instructions for completing the mid-term evaluation: Please evaluate students performance
halfway through the semester by indicating Progress, No Progress, or No Opportunity. Please
reference the students Learning Plan specific practice outcomes to determine the rating.
Performance rating scale based on the (11) competencies:
PROGRESS Student met performance expectation and/or is exhibiting progression to
meet expectations
NO PROGRESS Student did not meet performance expectations
NO OPPORTUNITY There was not an opportunity to meet expectations

COMPETENCY AREAS 1 11

Identify as a professional social worker and conduct oneself accordingly.

PROGRESS

Apply social work ethical principles to guide professional practice.

PROGRESS

Apply critical thinking to inform and communicate professional judgments.

PROGRESS

Engage diversity and difference in practice.

PROGRESS

Advance human rights and social and economic justice.

PROGRESS

Engage in research-informed practice and practice-informed research.

PROGRESS

Apply knowledge of human behavior and the social environment.

PROGRESS

Engage in policy practice to advance social and economic well-being and to

deliver effective social work services.

PROGRESS

Respond to contexts that shape practice.

PROGRESS

Engage, assess, intervene, and evaluate with individuals, families, groups,

organizations, and communities.

PROGRESS

Analyze the impact of the urban context on a range of client systems, including
practice implications.

PROGRESS

If there is a Competency Area in which the student has not met minimum performance
expectations to date, a plan of action must be noted below. If there will not be an
opportunity to address a competency area, please state that.
N/A
In the section below, please provide an Overall Rating of Progress or No Progress for the
students performance, as indicated by the rating that is most frequent of the eleven (11)
competencies. All parties are required to sign the midterm evaluation to indicate that they have
discussed the evaluation, even if the student does not agree with the evaluation.

FIELD INSTRUCTOR SECTION

Recommend:

PROGRESS

Comments:
N/A
**Please note: By typing my name below, I certify that I have reviewed the document,
completed my portion and agree with the content.
(Vaseau, Kristina): Kristina Vaseau, LMSW Feb 26, 2016 9:31 AM
Field Instructor (agency-based supervisor)

STUDENT SECTION

I...

Agree with the evaluation.

Comments:
**Please note: By typing my name below, I certify that I have reviewed the document,
completed my portion and agree with the content.
By signing you will submit Midterm FIASC information to the assigned faculty advisor from the
Wayne State University School of Social Work. Once the form is completed you will not be able
to modify your responses.
(Burg, Kelly): Kelly Burg Feb 26, 2016 10:44 AM
Student

(Dennis Muzzi): Dennis Muzzi, LMSW Mar 1, 2016 8:00 PM

Faculty Field Liaison