AO TR 222i AX Association, inc. Fieldwork Performance Evaluation For The Occupational Therapy Student sss Ss SIGNATURES: NAME: (LAS (FIRST) (MIDDLE) | HAVE READ THIS REPORT. Univers: of Viah COLLEGE ORUNWERSTY _ SeMATURE OFS FIELDWORK SETTING: Life skills Cliaie ! ‘IE OF ORGANTZATONFACIITY UNGER OF PERSONS CONTRUTING TO THS REPORT Bite peapecn Yr. Ste_200 ‘ADDF (STREET OR PO BOX) as Ste or 4/08 aTR/ey MoT” or SHE Fo SGNAOREOFRAER A otpotiot Pediatric. - Krishne Barrios Mor, ore /e TYPE OF FIELDWORK PRINT NAMEICREDENTIALS/POSITION ORDEROF PLACEMENT.().2 8 4 OUTOF 1@s 4 ram May |6,2011 we Avg Zor DATES OF SEMENT ‘SIGNATURE OF RATER #2 (IF APPLICABLE) NUMBER OF HOURS COMPLETED PRINT NAME/GREDENTIALSIPOSITION i4 FINAL SCORE vass:_X No Pass: SUMMARY COMMENTS: (ADDRESSES STUDENTS CLINICAL COMPETENCE) Rely cap tinal Sele HCY Prpess ard Ansisteinty orsfardiry performance jn all areas!Fieldwork Performance Evaluation For The Occupational Therapy Student This evaluations arevision ofthe 1967 American Occupational Therapy Assocation, Ine. Feldwork Evaluation Form for the Occupational Tharapst and was produced by a committee of the Commission on dation PURPOSE “Tho primary purpose ofthe Fieldwork Perfomance Evaluation for the ‘Occupational Therapy Student is to measure entry-level competence of the occupational therapy student. The evaluation is designed to diferen- tiate the competent student from the incompetent student and is not designed to ferentat levels above entry level competence. For further Clefication on entry-evel competency rte othe Standards of Pracioe {or Occupational Therapy (1). The evaluation is designed to measure the performance ofthe occupa: tional therapy process and was not designed to measure the spectic ‘occupational therapy tasks in isolation. This evaluation reflects the 1998 ‘Accreditation Council fr Occupational Therapy Education Standards (2) and the National Boar for Certfication in Occupational Therapy, no. Practice Analysis results (3). In adtion, this evaluation allows students to evaluate ther own strengths and challenges in relation to thelr per foxmance as an occupational therapist. USE OF THE FIELDWORK PERFORMANCE EVALUATION FOR THE OCCUPATIONAL THERAPY STUDENT ‘The Fiekiwork Performance Evaluation i intended to provide the student with an accurate assessment of hisher competence for entry-level prac- tice. Both the student and fieldwork educator should recognize that ‘growth occurs over time. The midterm and final evaluation scores will reflect development of student competency and growth In order to cffectvely use this evaluation to assess student competence, site- -spottc objectives: need to be developed. Utilize this evaluation as a framework to assist in ensuring that all key performance areas are reflected in the site-spectic objectives. Using this evaluation at midterm and fina, iis suggested thatthe stue ent complete a sel-evaluaton of hisher oun performance. During the midterm review process, the student and fiecwork educator should col laboratively develop a plan, which would enable the student to achieve entry-level competence by the end ofthe fslwork experience. Ths plan should include specific objectives and enabling activites 10 be used by the student and felwork educator in order to achieve the desired competence, ‘The Fieldwork Educator must conlact the Academic Fieldwork Coordinator when: 1) a student exhibits unsatisfactory behavior in a substantial number of tasks oF 2) a students potent fr achieving entry-level competence by the endo the efit is in question. DIRECTIONS FOR RATING STUDENT PERFORMANCE * There ae 42 performance items. + Every item must be score, using the one to four point rating scale (see below). * The rating scales should be carefully studied prior to using this, ‘evaluation. Defntions ofthe scales ae given atthe top of each page ‘Cirle the number that contesponds to the description that best Cescrbes the students performance. * The ratings forthe Ethics and Safety items must be scored at 3 or ‘above onthe final evaluation for the student to pass the fieldwork ‘experience. Ifthe ratings are below 3, continue to complete the Fieldwork Performance Evaluation to provide feedback tothe student con hers performance. + Record micterm and fnalratings onthe Performance Rating Summary Sheet + Compare overall midterm and final score to the scale below, OVERALL MIDTERM SCORE Satisfactory Peformance. 90 and above Unsatistactory Performance. {89 and below OVERALL FINAL SCORE Pass orc 122 points and above No Pass . 421 points and below RATING SCALE FOR STUDENT PERFORMANCE 4—Exceeds Standards: Peano highly skid and sola “This rang is rrely given and would represent the top 5% of lth students you have suprised. ‘3 Moos Standards: Prtormancos consistent wth entry eve rate. “Thera nequenty given at midterm ands strong rating at final 2—Noods improvement: Feomanceis progressing but il needs improvement for nye rect. This realist rtng of performance at midtrm, and somo raings of 2 may be reasonable at the fra Unctsacor:Peormanceis below standards and requires cevelopment ren vel prac. This ring i en wen there is «concer about performanee.RATING SCALE FOR STUDENT PERFORMANCE 4— Exceeds Standards: Performance is highly sléled and sel-nitatod. This rang is rarely given and would represent the top 5% of al the students you have supervised ‘3— Meets Standards: Pertrmance is consistent wh entylevel practice. “Tis rangi infrequenty given at micterm and sa strong rating at fina 2— Needs improvement: Peioance is progressing but sll nods improvement fo enty-4ve practice This i @ realistic rating of performance at midterm, and some rings of may be reasonable at the fn 1 Unsatisfactory: Porrmance is below standards and requires development for enryev! practice, Tis ratings gven when there is 1 concem about performance. L FUNDAMENTALS OF PRACTICE: Altos inthis area must be scored at a #8 or above on tho fal ‘evaluation in order fo pass felwork 1. Adheres to ethics: Adheres consistently to the American ‘Occupational Therapy Associaton Code of Ethics (4) and site's polices and procedures including when relevant, those related to human subject research, Midterm 4 2 4 Final 1 2 @) 4 2 Adheres to safety regulations: Achores consistently to safety regulations. Anticipates potentially hazardous situations and takes ‘steps to prevent accidents. Witem 1 2 @ 4 Final 1 2 ® 4 3, Uses judgment in safety: Uses sound judgment in regard to sale- ty of set and others during al feldwork-related activites. Nidom 1 2 @ 4 Final 1 2 @ 4 Comments on strengths and areas for improvement: Midterm Cansistetly ethical andl fe in Ul Sessions and gore Final ILBASICTENETS: 4. Clearly and confidently articulates the values and beliefs of the ‘ocupatonal therapy profession to lens, fale, significant oth- es, colleagues, service providers, and the public a Ff Final 1 2 @ 4 5. Cleary, confidently, and accurately articulates the value of occu- pation as a method and desired outcome of occupational therapy to cients, famiies, significant others, coleagues, service providers, and the pubic. wien 1 @ 8 4 Final il 2 © 4 6. Cleat, confidently, and accurately communicates the roles of the occupational therapist and occupational therapy assistant to lent, fais, sinicant others, colleagues, sevice provides, andthe public. Wim 1 Qa Final 1 2 @ 4 7. Collaborates with cent, amily, and significant others throughout the oocupatonal therapy process. witem 1 @ 9 4 Final il 2 ® 4 ‘Comments on strengths and areas for Improvement: “+ Midterm Malang good projres. in updaking Pavers in therapy and advecedi By he profession with pare and othersRATING SCALE FOR STUDENT PERFORMANCE 4 — Exceeds Standards: Perrmance i highly sled and seltnitatd. This angi rarely given and would represent the top 5% of all tho students you have supervised ‘3— Meets Standards: Periamanceis consistent wth entry evel prac, This ating is nfroquently given at midterm and is a strong rating at final 2—Needs improvement: Perfomance Is progressing but stil needs improvement or enylvel practice. This is a reals rating of Performance at midterm, an some ratings of may be reasonable at the fn 1 — Unsatisfactory: Performance is below standards and requires development fr enryev! practice. Tis rang is given when there Is ‘a concem about performance. Ill EVALUATION AND SCREENING: 8. Articulates a clear and logical rationale forthe evaluation process. wan 1 Ga 4 Final 1 2 ® 4 9. Selects relevant screening and assessment methods while considering such factors as clon’ priorities, content(s), theories, and evidence-based practice Midterm 1 © 3 4 fo 1 2 @ 4 10. Determines client's occupational profile end perormance ‘through appropriate assessment methods Magee (od rm 1 2 @ 4 ‘1. Assesses client factors and context(s) hat support or hinder cecupational performance, Midem 1 @) 3 4 Final 1 2 © 4 12, Obtains sufficient and necessary information trom relevant resources such as clint, families, significant others, service providers, and records prior o and during the evaluation process. wun 1 @ 3 4 Final 1 2 © 4 13, Administers assessments in a uniform manner to ensure findings are valid and reliable witem 1 @) 9 4 Final 1 2 @® + 14, Adjusts/modifes the assessment procedures based on cents needs, behaviors, and culture. Final 1 2 @® + 15, Interprets evaluation results to determine cents occupational performance strengths and challenges. Miterm = 1 @) 3 4 Final i 2 @ 4 16. Establishes an accurate and appropriate plan based onthe evaluation resus, through integrating multiple facors such as, client’ prories, contents), theories, and evidence-based practice. ie ee) 4 Final 1 2 @Q 4 17, Documents the results ofthe evaluation process that dernon- strates objective measurement of cients occupational perform ance wien 1 G) 8 4 Final 1 2 4 ‘Comments on strengths and areas for improvement: + Midterm Wasnt jad a lot of assesmant/ evaluettns So far - byt Promesig Well with thse she has done. Always asks relevant questions eharding assessmeddS ‘Final IV. INTERVENTION: 18, Articulates a clear and logical rationale for the intervention process. i mm 1 2 @ 4 19, Utilizes evidence from published research and relevant resources, to make informed intervention decisions. Mitem 1 @) 3 4 Final 1 2 © 420, Chooses occupations that motivate and challenge cents Midterm 1 2 (3) 4 Final 1 2 4 21, Selects relevant occupations to facilitate cients maeting estab lished goals, Midterm 1 2 © 4 Final 1 2 3 @ 22, Implements intervention plans that ae clien-centered Witem 1 2 @Q 4 Final 1 2 3 @ 23. Implements intervention plans that are occupation-based., Midterm 4 2 @ 4 Final nr) 24, Modifies task approach, occupations, and the environment to ‘maximize client performance. wien 1 Goa 4 ml 1 2 @ 4 25. Updates, modifies, or terminates the intervention plan based upon careful monitoring ofthe client's status. warn 2 oe 26, Documents client's response to sence ina manner that demonstrates the efficacy of inlervention. ium 2G) Final 1 2 3 @ ‘Comments on strengths and areas for improvement: «+ Midterm Dang yell ~increieg owervatio + locumadation With expenen@ and as Final \. MANAGEMENT OF OCCUPATIONAL THERAPY SERVICI 27. Demonstrates through practice or discussion the ably to assign appropriate responsibil tothe oocupational therepy assistant and occupational therapy ae. Vide 4 24 aoe 28. Demonstrates through practice or discussion the ability to actively collaborate with the occupational therapy assistant tam 1 @ 3 4 29. Demonstrates understanding of the costs and funding related to occupational therapy servis at tis site 9 (8) 2B 4 Final { 2 @ ¢ 30. Accomplishes organizational goals by establishing priorities, veloping strategies, and meeting deadlines. an 1 2G) fm 1 2 8 @ 31. Produces the volume of work required in the expected time frame, Mtem 1 892 (@) 4 Final 1 2 38 @ ‘Comments on strengths and areas for improvement: “Midterm cepted ak completing cloomed-. adin and responsibilities: Garni expenene- with Sperisien of offers: + FinalRATING SCALE FOR STUDENT PERFORMANCE 4 — Exceeds Standards: Performance I hich sled and sella. This ating is rarely given and would represent the top 5% of all the students you have supervised. ‘3 Meets Standards: Perfomance ie consistent wth entryfevel practice, This ang is infrequently given at midterm ands a strong rating at fina. ‘2 —Needs improvement: Performance Is progressing but stl needs improvement or entryievelpracce This is a realistic rating of petformance at midterm, and some raings of may be essonable at the al, ‘1 — Unsatisfactory: ecormance is below standards and requies velopment for ent eve practic. This rain is given when thre Is ‘ concern about performance. VL COMMUNICATION: 32, Clearly and effectively communicates verbally and nonverbal- ly wit cients, families, significant others, colleagues, service providers, and the public wom 12 G4 md 1 2S 3, Produces clear and accurate documentation according o ste requirements. Midterm 4 2 © 4 Final 1 2 3 6 34, All writen communication is legible, using proper speling, Punctuation, and grammar. pe) m1 8 35, Uses language appropriate to the recipient o the information, including but not limite to funding agencies and regulatory agen- cies. wien 1 2 @ 4 fa tk Commons on sng an ar fr pnt + Midterm: Exeellent docrmnenkadivo very receptive (oclback Final Vil. PROFESSIONAL BEHAVIORS: 36. Collaborates with supervisor(s) to maximize the learning experience, wien 1 2 @ 4 om 44 6 6 87. Takes responsibility for attaining professional competence by seeking out learning opportunities and interactions with superv- sor(s) and others. item 12 @ 4 m1 2 39 @ 38. Responds constructively to feedback, vem 12 @ 4 Final 1 2 3 4 38, Demonstrates consistent work behaviors including inate, Preparedness, dependabilly, and work site maintenance, en 12) Final 7 40. Demonstrates effective time management. Moen + 2 @ 4 - ma 1 28k @ 41. Demonstrates positive interpersonal skills including but not im- ited to cooperation, flexibility, tact, and empathy. Midterm 4 2 4 m= 1 1 2 @ 42. Demonstrates respect for diversity factors of others incuding but not limited to sociocutural, socioeconomic, spiritual, and ltestye choices. Mien 1 2 @) 4 Fal + 2 3 &) ‘Comments on strengths and areas for Improvement: + Midterm Renlly Strong in all 410% areas! * FinalPERFORMANCE RATING SUMMARY SHEET Performance Items — ~—— Midterm Ratings: |. FUNDAMENTALS OF PRACTICE 4. Adheres to ethics Z| Final Ratings 3 2. Adhers to safety regulations 3 8. Uses judgment in safety 3 IL BASIC TENETS OF OCCUPATIONAL THERAPY 4, Ariculates values and beliefs yn 5. Artcultes value of occupation | 8. Communicates role of occupational therapist | 7. Collaborates with cents Ill EVALUATION AND SCREENING 8. Articulate clea rationale fr evaluation 3 a 5 3 5 3 89. Selects relevant methods 10. Determines occupational profile 11, Assesses clent and contextual factors 412. Obiains sufficient and necessary information priyirfpps yp) 18, Administers assessments - “14. Adjusts modifies assessment procedures 15. Inerprets evaluation results 16, Establishes accurate plan 17. Documents resuts of evaluation IV.INTERVENTION 418, Articulate clear rationale for intervention - I 19. Utiizs evidence to make informed decisions [ 20. Chooses occupations that motivate and challenge © ppp | AE 221, Selects relevant occupations 22. Implements cler-centered interventions | 23, Implements occupation based interventions | 24, Modifies approach, occupation, and envionment | 25. Updates, modifies, otrminates intervention pan | 26, Documents clients response | \V. MANAGEMENT OF OT SERVICES | | T Llahwlaiw Lats balan Opa papd)d AIS? us) ohaho 27. Demonstrates ability to assign though practice or discussion 28, Demonstates abit o collaborate tough pracive or discussion 28, Understands cost and funding 90. Accomplshes organizational goals | 31. Produces work in expected time fame 1 ‘Vi. COMMUNICATION | 32. Communicates verbaly and nonverbally 38, Produces clear documentation 34, Witton communication is legible 36. Uses language appropriate o recipient ‘Vl PROFESSIONAL BEHAVIORS 36. Collaborates with supervisor 37 Tees responsi for professional competence 38, Responds constructively 1o feedback “38, Demonstrates consistent work behaviors 40. Demonstrates me management 41. Demonstrates postive interpersonal skis 42, Demonstrates respect for dvrsty 3 Kshs Le cectte chelate ch) shell ola og acts TOTAL SCORE [ole MIDTERM: FINAL: Satstatory Performance, +90 and above Pass... Unsatisiactory Performance. ........., 88 and below No Pass cy 4122 points and above - 121 points and below