Student Information:
Spring Semester/2
ND
Year Graduate Field Placement
MHSA Stipend Field Placement Addendum
FIRST NAME LAST NAME
STREET ADDRESS CITY ZIP CODE
HOME PHONE CELL PHONE WORK PHONE
CAMPUS E MAIL ADDRESS
ACADEMIC ADVISOR PHONE E MAIL ADDRESS
Agency Information:
AGENCY NAME
STREET ADDRESS CITY ZIP CODE
FIELD INSTRUCTOR (M.S.W.) PHONE E MAIL ADDRESS
AGENCY SUPERVISOR (non-M.S.W.) PHONE E MAIL ADDRESS
Identify as a professional social worker and conduct oneself accordingly
1. Student is knowledgeable about principles of wellness and recovery and the
Mental Health Services Act, and integrates this knowledge into his/her
professional practice both ethically and without bias, and advocates for access to
integrated service -delivery systems.
Date
Completed
a.
Effectively applies decision-making strategies that are grounded in social work
values and ethics and person-centered principles.
Apply critical thinking to inform and communicate professional judgments
2
. Student consistently demonstrates ability to critically distinguish, appraise and
integrate evidence- based findings and practice wisdom to inform practice.
Date
Completed
a. Applies
thoughtful judgment in evaluating, selecting and integrating treatment options
identified collaboratively with consumers and the consumer’s self-identified support system.
b. Evaluates behavioral health assessment and treatment options based on evidence
-based
findings, best practices and practice wisdom and has a strong grasp of each consumer’s
unique needs and strengths.
Engage diversity and difference in practice
3
. Student demonstrates skill in effectively engaging persons of diverse backgrounds,
performing assessments and utilizing strengths in practice situations.
Date
Completed
a.
In supervision student can identify multisystem alternatives and or demonstrate efforts to
eliminate disparities for client populations in accessing and receiving services.
b
. Demonstrates strengths- based approaches to working with diverse clients in a culturally
sensitive behavioral health practice and applies knowledge of social determinants of health
(physical and behavioral) into social work practice.
d. Engages
collateral informants to appreciate the uniqueness of individuals and families (e.g.
strengths, cultural background, lifestyle, challenges, etc.) and their consequences.
Advance human rights and social and economic justice
4
. Student advocates for social justice and demonstrates ability to proactively identify
and implement interventions addressing the causes as well as impacts of
discrimination, stigma and injustice.
Date
Completed
a. Articulates the effects of stigma, discrimination and oppress
ion on individuals, families,
groups and communities in supervision
b. Identifies and confronts stigma and disparities that exist between diverse cultural and
disability groups, such as persons living with mental illness and addictions, through
advocacy and outreach and/or can identify possible interventions (micro, mezzo, macro) in
supervision.
Engage in research informed practice and practice informed research
. Student contributes professional knowledge that supports MHSA principles,
behavioral health wellness and recovery.
Date
Completed
evidence-based treatment models, as they inform behavioral health practice with the
uniqueness of consumers and family members from a perspective of wellness and
resiliency.
. Student engages in critical evaluation to inform one’s own and agency practice.
Date
Completed
practice wisdom and communicate this information effectively across a variety of
professional interactions (e.g. in supervision, clinical staffing, administrative meetings).
-based practice as it informs
working with the uniqueness of consumers/family members.
and understanding of role of supervision and ongoing professional
development as vital to providing research-informed/effective services.
Engage in policy practice to advance social and economic well-being
and to deliver effective social services
7
. Student systematically formulates and advocates for policies that effectively advance
recovery principles and practices.
Date
Completed
a.
Applies research and practice experience to assess public policies and agency practice in
relation to recovery-oriented service delivery.
8
.
Student demonstrates capacity to
take a leadership role in policy action activities.
Date
Completed
a. A
pplies strengths-based theories to practice to identify and engage stakeholders in wellness
and recovery-oriented policy development and implementation.
Respond to contexts that shape practice.
9
. Student demonstrates ability to evaluate and proactively adapt to changing social
conditions and systemic changes in behavioral health policy and practice.
Date
Completed
a. Demonstrates good judgment in assessing and adapting to changing social conditions,
scientific (theories and EBP) knowledge and practice models, e.g. the recovery movement,
use of evidence-based practices and integrated health care.
Assessment
1
0. Student utilizes knowledge of major theories, models and treatment interventions
relating to behavioral health conditions in developing strategic and client driven
assessments and plans.
Date
Completed
a.
Demonstrates an understanding of issues related to the use of medication and medication
information, non-pharmacological interventions and psychiatric consultation within the
scope of social work practice.
b. Utilizes knowledge of efficacy of treatment models, including evidence
-based treatment
approaches to develop a multidimensional treatment plan.
Evaluation
11.
Student consistently uses critical
thinking and practice evaluation to determine
efficacy and appropriateness of services
provided, and to improve one’s
own and
agency practice.
Date
Completed
a. Demonstrates critical thinking in evaluating efficacy of own practice through analysis of
service outcomes; utilizes outcomes to
ensure, effectiveness in relation to evidenced based
practice model that is utilized.
b. Understands the value of best pr
actices and practice wisdom based on program and own
practice outcome evaluation in improving services and policies
; contributes practice-based
knowledge to inform evaluation process.
Signatures:
______________________________________________________________________________________________
__
STUDENT SIGNATURE DATE
______________________________________________________________________________________________
__
M.S.W. FIELD INSTRUCTOR SIGNATURE DATE
______________________________________________________________________________________________
__
FACULTY LIAISON SIGNATURE DATE
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