Learning Agreement (Sample) The Learning Agreement (LA) should be completed by the student in collaboration with the field instructor within the first month of the field placement. This agreement is used to:     ASSESS the student’s baseline level of experience at the beginning of the placement, so that the field instructor can select appropriate learning activities; CLARIFY expectations of the Division of Social Work, the student, and the field instructor; STRUCTURE the field placement by identifying the specific activities the student will engage to progress towards the desired outcomes; and MONITOR the success of the placement and the student’s performance. When developing this agreement, the student and field instructor should also review the end-of-semester Field Evaluation for an idea of performance criteria for each desired outcome. Learning Agreement Format The LA is a list of nine (9) competencies (10 for MSW II) and associated behavioral indicators that the student is expected to achieve during the year. In the column next to each competency the Field Instructor (FI) and student should list all activities the student will undertake in the placement to grow in each competency. Activities should be listed to cover all competencies and their behavioral indicators. A sample LA containing examples of placement activities is available on the field ‘FORMS’ page of the website. The student, Field Instructor (FI), and Task Supervisor (TS) should sign the LA. The student is responsible for obtaining and delivering hard copies to the following and the original to the Division:     The Field Instructor The Task Supervisor (if applicable) The Faculty Field Liaison The Division of Social Work – place the original in the drop box outside the Social Work office in Mariposa Hall # 4010 (faxed or scanned copies are not accepted) The student should keep a copy for their records. Although this agreement should include activities that span the entire year, it can be modified at any time by the field instructor and/or student, signed by both. At minimum, this agreement should be reviewed and/or revised at the beginning of the Spring semester. All questions regarding this agreement should be directed to the student’s faculty liaison. The completed Field Placement Safety Protocol, Confidentiality & Mandated Reporting Verification form, page 6 of this document, must accompany the LA. Instructions for Learning Agreement Sample Rev Aug 2014 Page 1 of 1 Learning Agreement (Sample) Student Name:__________________________________________________________________________________________ (please print legibility) COMPETENCIES 1. Student identifies as a professional social worker and conducts self accordingly. 1.1. Student can verbally describe own internal process of developing self-awareness of emotions and judgments in relation to all aspects of field experience. 1.2. Student demonstrates behavior change and growth in self-awareness as a result of receiving feedback. ACTIVITIES STUDENT WILL: 1.1-1.3. Shadow and observe social workers, debrief experience during supervision. SEMESTER Fall Be assigned cases when FI assess readiness. Cases will be assigned until maximum of ___ is attained. Both Address self-awareness in all supervision sessions. Both 1.3. Student verbally describes appropriate professional roles and boundaries of field setting. Student demonstrates ability to self-monitor when there are questions about boundaries and uses supervision to clarify. Complete one process recording per month. 1.4. In all interactions at the field setting, student engages in productive problem-solving and appropriate conflict resolution. Student follows agency chain of command. Student directs concerns to the appropriate person. Student uses open communication. 1.4. Read agency policy and procedure manual, organization chart. FI will review these with student. Fall 1.5.-1.6. Complete a weekly time sheet and submit to FI. Both 1.7. See 1.5. Obtain in-house training schedule. Submit evidence of attendance. Go through agency orientation process. Make brief presentation about agency during a community meeting. Both 1.8. Student proactively seeks out additional trainings, written materials, conversations with knowledgeable persons, and other opportunities to deepen knowledge about the placement and population(s) served. 1.7 Consult with FI and other staff regarding learning opportunities. Both 1.9. Student is able to express self verbally in a manner that is clear and in line with agency standards. Student communicates in manner consistent with professional setting. 1.9. Discuss with FI appropriate verbal communication and receive and use feedback if needed. Fall 1.10. Student writes reports, case notes, emails, and other products according to agency format and professional expectations. Student’s writing is legible and correct grammar is used. 1.10. Receive training in formatting of case notes & other documents & be responsible for producing these documents according to agency standards. Fall/Spring 1.5. Student is on-time to the placement and is not excessively absent or tardy. Student completes tasks within allotted timeframe and proactively seeks help when difficulties arise. 1.6. Student meets agency expectations regarding attire, demeanor, and conduct. 1.7. Student attends required trainings, reads policy and procedure manuals, and takes responsibility for knowing relevant agency protocol. Student is able to explain basic agency mission, services, structure and population. Learning Agreement (Sample) Rev Aug 2014 Page 1 of 6 Learning Agreement (Sample) Student Name:__________________________________________________________________________________________(please print legibility) COMPETENCIES 2. Student applies social work ethical principles to guide professional practice. 2.1. Can verbally articulate familiarity with the NASW Code of Ethics and agency policies that relate to it. 2.2. Follows agency procedures that safeguard client confidentiality. 2.3. Communicates non-judgmental stance through words and behavior in work with clients. 2.4. Interacts with clients only within the confines of the social worker role, as that role is enacted in the agency setting. Does not engage in excessive self-disclosure. 2.5. Verbally describes steps in the principles and process of ethical decision making. Student seeks field instructor guidance when ethical dilemmas arise, and follows that guidance in resolving them. 2.6. Articulates when personal values clash with professional values. Student uses supervision to develop ways to manage the conflict. ACTIVITIES STUDENT WILL: 2.1. Receive orientation on agency protocol regarding confidentiality, HIPPA, mandated reporting law, use of computer records, how to deal with clients outside of agency setting, role conflicts, etc. Discuss with FI own understanding of Code of Ethics. Student is responsible for letting FI about any confusion or uncertainty. Ethical issues will be a topic in every supervision meeting. SEMESTER Fall Fall/Spring 2.2. Share knowledge of ethical decision- making steps gleaned from classes or previous experience, and refine with FI’s input. Explain how these steps are followed in actual cases. Fall & Spring 2.3-2.4. Openly share with FI when personal values clash with the professional, and when student experiences discomfort with process. Be open to feedback and selfreflection. Fall & Spring 2.7. Recognizes and acknowledges internal experience of dealing with ambiguity – often discomfort, fear, or frustration, and is willing to use supervision to resolve the situation. 3. Student applies critical thinking to inform and communicate professional judgments. 3.1 -3.3 Discuss cases in supervision, utilizing critical thinking principles described. 3.1. Able to analyze complex material. Fall/Spring 3.2. Applies abstract concepts to practice experience. 3.3. Examines own assumptions and is able to test them against evidence and other perspectives. Learning Agreement (Sample) Rev Aug 2014 Page 2 of 6 Learning Agreement (Sample) Student Name:__________________________________________________________________________________________(please print legibility) COMPETENCIES ACTIVITIES SEMESTER STUDENT WILL: 4. Student engages diversity and difference in practice. In all levels and areas of practice, with regard to diversity factors such as age, class, color, culture, disability, ethnicity, gender, gender identity and expression, immigration status, political ideology, race, religion, sex and sexual orientation, student: 4.1. From the beginning of the placement, articulates self-awareness regarding own identity, biases, and fears related to various groups and/or when discussing/planning client work. 4.2. Consistently considers the role of diversity, oppression, privilege and culture in understanding client situations. 4.1.-4.2. Discuss with FI own self-knowledge regarding identity and diversity “sensitive spots”. Bring diversity issues to discuss of all cases. Fall/Spring 4.3. Consult with FI & other designated staff regarding diversity-sensitive practice in agency. Attend trainings, read articles, etc. as needed. Fall 4.3. Employs diversity-sensitive practice skills. 5. Student advances human rights to include social and economic justice. 5. Attend meeting of constituent Advisory Board. Spring 5.1. Identifies opportunities in the placement setting to advocate for human rights, social & economic justice, and becomes involved in such an effort. 6. Student engages in research-informed practice and practice-informed research. Participate in community awareness event.. Spring 6.1. Identifies strategy for evaluating own practice within agency. 6.1 Query supervisor & other staff regarding their method for evaluating own practice. Implement agency-sanctioned methods for evaluating practice. 6.2. Demonstrates familiarity with evidence-based for agency practice. 6.2 Read assigned articles on CBT & DBT evidence based. 6.3. Applies research findings to practice. 6.3 Articulated how evidence base is applied to work with clients. 7. Student applies knowledge of human behavior and the social environment. 7. In all case discussions, incorporates knowledge from HBSE courses and other applicable resources. Fall & Spring 7.1. Articulates knowledge of human behavior specifically relevant to the field setting. 7.2. Plans and implements services incorporating this knowledge. 8. Student engages in policy practice to advance social and economic well-being delivering effective social work services. 8. Reads and articulates understanding of key policies that govern field setting, e.g., enabling legislation, grant requirements, governmental regulations. Fall 8.1. Articulates understanding of key organizational, regulatory, and governing policies relevant to agency clients and communities. Collaborates with clients and colleagues in some aspect of policy process relevant to them. Learning Agreement (Sample) Rev Aug 2014 Page 3 of 6 Learning Agreement (Sample) Student Name:__________________________________________________________________________________________(please print legibility) COMPETENCIES ACTIVITIES SEMESTER STUDENT WILL: 9. Student engages, assesses, intervenes and evaluates with individuals, families, groups, organizations and communities. Please indicate if the skills were demonstrated with one or more of the following client groups: Individuals_______ Families_________ Groups__________ Organizations_____ Communities______ Engagement 9.1. Establishes effective working relationships with clients/client systems. Fall 9.1-9.12. Observe other staff & identify how they demonstrate key elements of engagement, assessment, and intervention. Fall Fall/Spring 9.2. Able to develop and maintain trust, communicate empathy, and respect. Practice engagement skills with clients in informal settings such as waiting rooms, playgrounds, activity groups, etc. Fall/Spring 9.3. Effectively prepares for work with clients. Answer telephone calls and provide information. 9.4. Develops mutually agreed upon focus of work and desired outcomes with clients. Assessment – Using the strengths and ecological perspectives: 9.5. Collects, organizes, and interprets client data. Visit agencies that work with our clients. Spring Fall/Spring Conduct intakes and assessments. Spring Make home visits. Spring Develop written case plans according to agency standards. Spring 9.6. Assesses client strengths and limitations. 9.7. Develops mutually agreed on intervention goals and objectives. Plan a 6-week group with co-facilitator. Fall 9.8. Selects appropriate intervention strategies. Co-facilitate group. Intervention 9.9. Implements intervention strategies. Fall/Spring Communicate with other agencies and resources on behalf of client. Fall/Spring 9.10. Helps clients resolve problems. Be able to articulate rational for interventions. 9.11. Negotiates, mediates, and advocates for clients. Attend case staffings. 9.12. Facilitates transitions and endings for clients. 10. Student takes a leadership role during the course of the placement in an effort to further social work values and improve or enhance services to clients. Develops and delivers presentation for high school students on services provided by agency. Spring 10.1. Proactively identifies and/or responds to opportunities for leadership role. 10.2. Organizes an activity or project involving clients, colleagues, and/or community. Learning Agreement (Sample) Rev Aug 2014 Page 4 of 6 Learning Agreement (Sample) Student Signature: ____________________________________________ Date Student Printed Name: ________________________________________ FI Signature: _______________________________________ Date Student Email: ____________________________________________________________ FI Printed Name:____________________________________ Student Phone Number: _______________________________________ CSUS ID: ___________________________________________________ FI Email: __________________________________________________ FI Phone Number:___________________________________ Field Instructor, please check one: ( ) BASW ( ) MSW ( ) LCSW Faculty Liaison Printed Name:___________________________________ (If Applicable) TS Signature: ______________________________________ (If Applicable) Date TS Printed Name ____________________________________ The completed Field Placement Safety Protocol, Confidentiality & Mandated Reporting Verification form, page 6 of this document, must accompany the LA Signature Page Learning Agreement (Sample) Rev Aug 2014 Page 5 of 6 FIELD PLACEMENT SAFETY PROTOCOL, CONFIDENTIALITY & MANDATED REPORTING VERIFICATION Sacramento State University Risk Management policies require that the Division of Social Work obtain documentation confirming that field students receive safety protocol orientation in their field placement. This orientation must occur before the student has direct contact with clients, or within the first 4 weeks of placement, whichever comes first. Orientation should cover the topics below. Both Field Instructor and Student must sign this form. Topics to be covered: Safety 1. Working with potentially violent clients. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 2. Safety precautions in the neighborhood or surrounding areas. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 3. Precautions when making home visits and transporting clients. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 4. Emergency procedures in case of a client crisis. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 5. Emergency procedures in case of other dangers (e.g., severe weather, fire, other misc. threat). How covered: ____ formal training ____ consultation with FI or other staff _____written policy 6. Protocol for driving in the course of placement duties, to include car accidents. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 7. Health and wellness precautions (e.g., contagious disease). How covered: ____ formal training ____ consultation with FI or other staff _____written policy Ethics 8. Agency procedures safeguarding client confidentiality. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 9. Policy and procedures for mandated reporting of abuse/neglect and client danger to self or others. How covered: ____ formal training ____ consultation with FI or other staff _____written policy 10. Expectations regarding boundaries, student self-disclosure, appropriate contact and professional role with clients. How covered: ____ formal training ____ consultation with FI or other staff _____written policy I, _____________________________________________________, have received orientation on the topics above. STUDENT PRINTED NAME ____________________________________________ Student Signature __________________ Date Student CSUS ID (REQUIRED)__________________________________________________________________________________________ ______________________________ Field Instructor Printed Name _____________________________________________ Field Instructor Signature Safety Protocol, Confidentiality & Mandat4ed Reporting Verification form Rev Aug 2014 _________________ Date 6 of 6