Download - Brigham Young University - BYU McKay School of Education · Web viewBrigham Young University School Psychology Program Practicum and Internship Site Evaluation To be completed by

Brigham Young University School Psychology Program

Practicum Handbook 2006-2007

Title / Form Form?Yes No

Who completes the form?

Page

CPSE 679-R FALL 2006 CLASS SCHEDULE

No NA 6

Fall 2006Evaluation Of Student Competency

Yes Site supervisor & student

8

Summary of Fall Prac hours

Yes Site Supervisor, faculty, & student

10

Winter 2007Evaluation of Student Competency


11

Summary of Winter Prac hours


13

Spring 2007Evaluation Of Student Competency


14

Summary of Spring Prac hours


16

Field Demographics Worksheet

Yes Student 17

Portfolio Feedback Fall

Yes Faculty 18

Portfolio Feedback Winter

Yes Faculty 20

Portfolio Feedback Spring

Yes Faculty 22

Evaluating Professional Disposition

Yes Site Supervisor 25

Student’s Evaluation of Supervisor

Yes Student 26

Practicum and Internship Site Evaluation

Yes Student 28

Site Supervisor’s Evaluation of Practicum Student

Yes Site Supervisor 29

Student’s Documented Use of Technology

Yes Student 30

Steps in resolving an Ethical Dilemma

Yes Student 31

Suggested Elements of a Behavior Intervention Plan

No NA 32

Report Writing No NA 34

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Format Assessment Report: Evaluation Form

Yes Site Supervisor and Faculty

36

Practicum Goal Setting Chart

Yes Student 38

NASP Case Study Rubric

Yes Faculty 39

Assignment List and Portfolio

Yes Student 45

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Brigham Young UniversitySchool Psychology Program ADVANCED PRACTICUM

CPSE 679-R

Fall 2006Monday 1:00 – 2:20 & 1:30-2:50Room: 343 & 341 MCKBInstructor: Melissa Allen Heath, Ph.D. Office: 340-K MCKBe-mail: <[email protected]>422-1235 (W) 491-8386 (H)Office Hours: Monday 10:30-12:00 noon & 3:30-5:00 p.m.Tuesday & Thursday 2:00-5:00 p.m.Please call or e-mail to make appointments as needed.

Winter 2007Monday 4:00-5:30 & 4:30-6:00Room: 1179 Harmon BldgInstructor: Dr. J. Lane Valume-mail: [email protected] [email protected] (W) 801-467-5190 (H)Office Hours: Available prior to or following class. Please call or e-mail to make appointments as needed.

Spring 2007To be assigned

Major Focus of Practicum Behavioral Assessment

and Intervention Consultation and

Collaboration: Family Project

DOMAIN I: Data-Based Decision-Making & Accountability DOMAIN II: Consultation & Collaboration DOMAIN VIII: Home/School/Community Collaboration

Multicultural Project

Social Emotional Assessment and Intervention

Academic Assessment and Intervention

DOMAIN III: Effective Instruction & Development of Cognitive/Academic SkillsDOMAIN IV: Socialization and Development of Life SkillsDOMAIN V: Student Diversity in Development and Learning

Crisis Intervention- counseling interventions

Program Evaluation: evaluating school-based crisis intervention plan and facilitating effectiveness of plan.

DOMAIN VI: School & Systems Organization, Policy Development, & ClimateDOMAIN VII: Prevention, Crisis Intervention, and Mental HealthDOMAIN IX: Research and Program Evaluation

All Practicum experiences build on the competencies of DOMAIN X: School Psychology Practice and Development and DOMAIN XI: Information Technology. Students are evaluated each semester in the area of professional competencies. Each semester, students are required to document their use of technology and maintain a running log of internet resources and links, key to functioning in a profession that greatly benefits from the latest information and support of technology. Additionally, students are required to keep a time log (excel file), collect data, and analyze data using computer programs. Work samples in the student’s portfolio document competencies.

Special Lab Fee: $60.00 (provides site supervisor’s stipend) Pay this lab fee during fall and winter semester. Required Texts:NOTE: During Practicum we utilize the text books for courses during that particular semester.

FALL PRACTICUM: Text books required for CPSE 610 (Consultation with School and Family) & CPSE 614 (Behavioral Assessment and Intervention)Umbreit, Ferro, Liaupsin, & Lane (2007). Functional Behavioral Assessment and Function-

Based Intervention: An Effective, Practical Approach. Upper Saddle River, NJ: Prentice Hall.

Lane & Beebe-Frankenberger (2004). School-Based Interventions: The Tools You Need To Succeed. Boston, MA: Allyn & Bacon.

Murphy, J. (1997). Brief Solution Focused Counseling in the Middle and High School.

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mailto:[email protected]



Alexandria, VA: American Counseling Association.Thomas, A., & Grimes, J. (Eds.). (2002). Best practices in school psychology. Bethesda, MD:

National Association of School Psychologists.Handouts from Your School Psychologist. (NASP-2004).

WINTER PRACTICUM: Text books required for CPSE 602 (Child Social/Emotional Assessment and Intervention), CPSE 609 (Academic Assessment and Intervention), & CPSE 751 (Multicultural)

SPRING PRACTICUM: Text books required for CPSE 655 (Crisis Intervention) COURSE DESCRIPTION:Advanced Practicum is designed to provide skill-building experiences for school psychology students in their second year. Students are assigned to either an elementary, secondary, or alternative school setting (or a combination of settings) for 10 hours per week over a 13 week period, totaling a minimum of 130 hours of practicum experience per semester and a minimum of 300 hours of practicum prior to internship. This experience requires students to take a more active role in consulting and collaboration; collecting data and conducting assessment for intervention; designing, implementing, monitoring, and refining interventions based on data-based decision making (individual, classroom, and school wide); providing counseling intervention (group and individual); and participating in other school psychology roles and functions.

The Practicum is a closely supervised experience, providing opportunities to fulfill assignments associated with university courses. Practicum also provides students with the opportunity to develop and demonstrate competencies. During fall semester, students primarily focus on developing and demonstrating competencies in behavioral assessment (CPSE 614) and consultation (CPSE 610). During winter semester practicum focuses on social/emotional assessment and intervention (CPSE 602); a multicultural project to demonstrate competency in serving students and families from diverse backgrounds (CPSE 751); and academic assessment and intervention, using data to inform practice (CPSE 609). During spring semester, students participate in crisis intervention (CPSE 655) and program evaluation, evaluating school-based crisis prevention and intervention programs and facilitating the effectiveness of that program. NOTE: Additionally, prior to internship, students are required to conduct a minimum of one group and one individual counseling case, each over a period of 6 weeks.

During practicum, students are required to integrate their knowledge with practice. Additionally, assigned readings, summaries of current research, reviews of intervention strategies, and class presentations on pertinent topics are reviewed during practicum class. This provides students with an arsenal of cutting edge research-based interventions. Students put their knowledge into practice as they problem solve in their school setting, developing prevention/intervention plans, collecting data, and monitoring effectiveness of interventions. Students are required to collect work samples, qualitative and quantitative data demonstrating their competency. Their developing professional competency must be linked to data demonstrating results: evidence of a positive impact in the lives of children, families, and schools.

In summary, practicum provides “hands on” opportunities to blend academic learning and research with practice. Students are required to document their work, keeping a time log of activities and compiling a portfolio with work samples and data to demonstrate the effectiveness of their work during their practicum year. In particular, students are required to document data-based decision making and to monitor the effectiveness of interventions across time.

Supervision: Each practicum student is assigned to a site-based supervisor who holds a valid state license as a school psychologist or, in a non-school setting, a licensed psychologist. The site supervisor provides one hour of planned, face-to-face, individualized supervision each week. Site supervisors model professional activities and also directly observe the practicum student in the school setting, providing feedback and suggestions for

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improvement. Practicum students also attend and participate in weekly group supervision conducted by university faculty. The university professor visits students on-site each semester to observe, monitor, document, and evaluate student practicum activities and developing competencies.

Time Log: Students maintain a time log documenting their activities (formulas for excel spreadsheet provided). The site supervisors review and sign weekly time logs, monthly summary logs, and a one-sheet summary of semester activities. The university professor signs monthly and semester time log summaries.

Portfolio : Practicum students collect and organize evidence of their developing competencies. For example, work samples may include case consultation notes, CPSE 610 consultation family project, assessments and reports identifying research-based interventions and demonstrating data-based decision making, and formative and summative evaluations of site-based and university supervisors. Additionally, the portfolio should also include class projects aligned with course objectives.A list is attached that describes the required elements to be included in the portfolio.

FALL PRACTICUM OBJECTIVES:

(1) In determining the need for and type of supportive intervention, practicum students will demonstrate the ability to collect and integrate a variety of formal and informal assessments. Information is collected from a variety of settings and sources (classroom, recess, lunch room, home; student, teacher, and parent).

(2) Based on assignments from CPSE 614 (Behavioral Assessment and Intervention), practicum students will conduct behavioral observations for students representing various ages, disabilities, and backgrounds, integrating behavioral observations into a report/summary to provide key information designed to assist in developing interventions. Additionally, practicum students will monitor the effectiveness of interventions by collecting data across time.

(3) Based on the CPSE 610 family project, practicum students will document developing competencies related to facilitating supportive consultation with parents and teachers and monitoring the effectiveness of collaborative efforts to facilitate positive changes.

(4) Practicum students will demonstrate appropriate professional attitude and behavior including establishing and maintaining effective working relationships with staff, supervisors and colleagues to be assessed during faculty site visit and by site-supervisor. (See attached form: Evaluation of Professional Competencies).

(5) Practicum students will demonstrate personal traits conducive to effective learning and professional development, including sensitivity to and productive growth from constructive feedback. These competencies are evaluated by the faculty and site-supervisor. (See attached form: Evaluation of Professional Competencies).

(6) Practicum students will demonstrate the ability to exercise sound professional judgment and ethical behavior in real-life situations. Students will demonstrate their ability to cope with, face, and resolve an ethical dilemma by using the 9-step ethical problem solving model (provided in CPSE 710 and included in the Student Handbook).

(7) NOTE: Optional, but must be addressed prior to internship: Practicum students will demonstrate competency in positively influencing the behavior change process through determining the need for, developing a plan for, and implementing and monitoring the effectiveness of individual and group counseling intervention.

Grading Criteria:Points Assignment 100 REPORTS: (100 points per report---2 reports are due.)

Reports must be completed prior to December 15. For info on behavioral

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observations, see information from CPSE 614. Reports must follow the attached outline.

100 Family project – documentation/data collection/written report (see CPSE 610 Consultation syllabus)300 Faculty site visit (150 pts per visit---2 scheduled visits)—(See attached form: Site Visit)200 PARTICIPATION: Active participation goes beyond attendance.

Citizenship implies respectfulness of others and engagement in discussion. Discussions that invite learning are encouraged.

100 Classroom presentation on “hot topic” related to schools. Students provide a handout to accompany their presentation. Student base their presentation on a specific case in their practicum site, providing a context for the “hot topic.”

100 LOGS: (Weekly & monthly documentation of activities)— monthly logs are due prior to the 30th of each month.

100 Portfolio – minimally includes (a) time log (with signatures), (b) 2 goals and updates of progress toward goals, (c) evaluations (site-supervisor’s midterm and semester; university supervisor’s site visit evaluations; student evaluations of site and supervisor), (d) projects (CPSE 614, CSPE 610), and 9 step ethical dilemma from CPSE 710. Domain summary sheets must be included in the portfolio to explain how projects and work samples document competency in the 11 NASP training domains. Projects may document competency in several domains. (See attached list describing portfolio.)

1000 = TOTAL

A = 940 - 1000A- = 900 - 939B+ = 860 - 899B = 820 - 859B- = 795 - 819 NOTE: Students earning a score below 795 will be required to re-take the course. Additionally if a student scores below 180 on class participation and/or below 270 on faculty site visit evaluation will receive “needs improvement” or “unsatisfactory” on their faculty semester evaluation. Additionally, if the site supervisor notes critical weakness or problems with a particular practicum student, that student will receive “needs improvement” or “unsatisfactory” on their faculty semester evaluation. A remediation plan will be developed for students receiving less than satisfactory ratings.

Requirements:Practicum Student Responsibilities:

(1) TIME LOGS: Maintain and review weekly time logs and monthly summaries on the 30th of each month, documenting 10 hours of practicum each week and activities related to competencies. Site supervisor signs weekly, monthly and semester time log summary. University supervisor signs monthly and semester time log summary.

(2) GOAL SETTING: Set 2 goals for the semester: one goal in the area of consultation and collaboration and one goal in the area of behavioral assessment tied to data-based decision making and accountability. Review your personal goals each month, documenting progress and concerns. Realistic and meaningful goal setting provides you the opportunity to monitor personal and professional growth.

(3) ATTENDANCE: Attend class, practicum field placement, and scheduled weekly site-based supervision. Students are expected to be prompt and to participate as active learners.

(4) Prior to entering internship: COUNSELING INTERVENTIONS: Maintain 1 individual case and 1 group counseling assignment over a minimum of 6-sessions (including weekly meetings with the student, documenting counseling sessions on the forms provided

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in the handbook: session summary and case conference notes). Identify target problem, document research-based intervention, collect data documenting the effectiveness of counseling intervention.

(5) DATA BASED DECISION MAKING: Complete two full evaluations (the family project report for 610 and the behavioral assessment report for 614), demonstrating the ability to integrate assessment data and provide useful recommendations (written reports required). If protocols are used, provide professor with a copy of the protocols with names removed to ensure confidentiality. Note: Have a classmate review and comment on the reports prior to turning the report in to the professor).

(6) ASSESSMENT: Demonstrate familiarity with a variety of assessment instruments. Maintain a list of assessment instruments reviewed and utilized during practicum. Include standardized and non-standardized types of assessment.

(7) EVALUATION OF COMPETENCY: Maintain average to above ratings on midterm (formative) and end-of-semester (summative) evaluations from site supervisor and faculty supervisor. Evaluation forms are attached.

(8) EVALUATIONS: Complete evaluation of site and evaluation of supervisor (included in handbook).

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CPSE 679-R FALL 2006 CLASS SCHEDULE

CLASS PRESENTATIONS: “HOT TOPICS”In conjunction with the 610 family consultation project and the 614 behavioral assessment and intervention assignments, identify a target problem behavior or special issue. Research possible interventions, prepare a short handout and share your findings with the practicum class. This should compliment existing assignments in other courses and assist you in formulating strategies for research-based interventions.Possible topics: Eating Disorders, Autism, Multicultural Sensitivity, Oppositional behavior, Noncompliance, Play Therapy, School phobia, Divorce, Positive peer mentoring, Relationship issues, Bullying, Social Skills, Aggressive behavior, ADHD, Developmental delays, etc.

SUPPORT AND GROUP SUPERVISION OF PRACTICUM STUDENTS: Practicum class will primarily focus on providing support to students, problem solving, and assisting students in developing competencies in key areas. During fall semester these competencies primarily include (1) behavioral assessment and intervention and (2) consultation and collaboration: Family Project.

Class #1: September 11, 2006 Review syllabus and outline practicum requirements Discuss fall semester course syllabi: CPSE 610 and CPSE 614 assignments Review evaluations: site-supervisor evaluation, practicum student’s evaluation of site and supervisor, faculty site visit evaluation, portfolio evaluation Review paperwork and handbook Complete excel grid with practicum contact information and practicum site info

Class #2: September 18, 2006 Review forms for self-assessment and goal setting Make calendar for school site, listing work hours, supervision time with site-supervisor Create practicum time logs Set 2 goals related to consultation (CPSE 610) and behavioral assessment (CPSE-614), set a method to measure goals and criteria for attainment. Additionally, set a time frame for completing goals. Sign up to meet individually with professor prior to 10/9/06: Review goals

Class #3: September 25, 2006 Guest Lecture: Reporting suspected abuse- Amanda Raider -DFS What is the protocol for reporting abuse in your practicum site? Review responsibility for reporting suspected abuse. Class discussion: Where to start with a counseling case.... Case notes and case conceptualizationPRESENTATION: __________________________________________________________

Class #4: October 2, 2006 Turn in September monthly time log summary Review: Problem Solving model (2 chapters in Best Practice) Review Murphy readings p. 1-85 PRESENTATION: ___________________________________________________________

Class #5: October 9, 2006 Review theoretical basis and underlying assumptions for interventions and therapy Lecture: Prochaska’s Model of Change Reading: pgs. 87- 118 (Murphy) PRESENTATION: ___________________________________________________________

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Class #6: October 16, 2006 Reading Review: 119-145 (Murphy) Changing behaviors, changing perceptions Review progress on CPSE 610 family consultation projectPRESENTATION: ___________________________________________________________

Class #7: October 23, 2006 Class Discussion: Writing integrative reports that inform interventions Review report writing expectations and review a model report Peer review reports (drafts of projects due in CPSE 610 and CPSE 614) PRESENTATION: ___________________________________________________________ Class #8: October 30, 2006 1:00 - 3:30 Assist with Suicide Prevention Conference (putting packets together) at Provo School District Office Suicide Prevention Conference is Friday November 3 in the Harmon Building. Turn in October monthly time log summary Review report writing: Overview of report writing samples Report on project progress (CPSE 614 & 610 projects)PRESENTATION: ___________________________________________________________

Class #9: November 6, 2006Interventions for students with severe disabilities and handicapping conditionsPRESENTATION: ___________________________________________________________

Class #10: November 13, 2006PRESENTATION: ___________________________________________________________

Class #11: November 20, 2006PRESENTATION: ___________________________________________________________

Class #12: November 27, 2006 Reading Review: pgs 147-149, 153-163 (Murphy)PRESENTATION: ___________________________________________________________

Class #13: December 4, 2006 Turn in November monthly time log summary Class Discussion: Semester Termination/Ending counseling, closure, troubleshooting,

referral to community agencies- Community-based support: United Way Book, emergency numbers for parents and teens,

shelters, etc.PRESENTATION: ___________________________________________________________

Class #14: December 11, 2006Guest Lecture: PANEL DISCUSSION, Special Education Issues and LawPRESENTATION: ___________________________________________________________

NOTE: PORTFOLIO is due prior to Monday, December 18As part of the portfolio, students are responsible for turning in the end of semester evaluations (student’s site evaluation, student’s site evaluation of supervisor, supervisor’s evaluation of student).

SPECIAL CONSIDERATIONS FOR STUDENTS

Sexual HarassmentTitle IX of the Education Amendments of 1972 prohibits sex discrimination against any participant in an educational program or activity that receives federal funds. The act is intended to eliminate sex discrimination in education. Title IX covers discrimination in programs, admissions, activities, and student-to-student sexual harassment. BYU’s policy against sexual harassment extends not only to employees of the university but to students

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as well. If you encounter unlawful sexual harassment or gender based discrimination, please talk to your professor; contact the Equal Employment Office at 422-5895 or 367-5689 (24-hours); or contact the Honor Code Office at 422-2847.

Students with DisabilitiesBrigham Young University is committed to providing a working and learning atmosphere which reasonably accommodates qualified persons with disabilities. If you have any disability which may impair your ability to complete this course successfully, please contact the Services for Students with Disabilities Office (422-2767). Reasonable academic accommodations are reviewed for all students who have qualified documented disabilities. Services are coordinated with the student and instructor by the SSD Office. If you need assistance or if you feel you have been unlawfully discriminated against on the basis of disability, you may seek resolution through established grievance policy and procedures. You should contact the Equal Employment Office at 422-5895, D-282 ASB.

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PRACTICUM FALL 2006EVALUATION OF STUDENT COMPETENCY

To be completed by the site-supervisor and practicum studentSite-Supervisor, please complete this evaluation in mid October (October 15) and then again in mid December (December 15).Complete the evaluation with the student present, discussing feedback with the student. If you have questions, please contact the faculty supervisor: Melissa Allen Heath 422-1235 (w) 491-8386 (H) [email protected] Date: ______________________Student: _________________________________________________________Site-Supervisor: ____________________________________________________Faculty Supervisor: _________________________________________________Because we recognize that professional competencies are developed over time and are part of a learning process, you and your supervisors will provide two types of ratings for each competency area. This assessment is meant to help you and your supervisor know which areas are your strengths and which areas are emerging skills requiring focused effort and additional supervision.Note: This evaluation form was based on San Diego State’s School Psychology Internship evaluation forms and NASP standards.

Develop: Degree of Competency DevelopmentRating Descriptor Definition

0 Not seen No opportunity or not yet demonstrated/observed in this setting1 Emerging Beginning to demonstrate this knowledge/skill2 Established Basic knowledge/skills attained and demonstrated routinely3 Integrated Uses knowledge/skills flexibly as part of an overall repertoire

Evaluation: Evaluation of Competency Development for Stage in the ProgramRating Descriptor Definition

1 Concern Stronger development expected; Focus for further development2 Satisfactory Development consistent with expectations at this stage3 Commendable Above and beyond expectations at this stage

DOMAIN I: Data-Based Decision-Making and AccountabilityDevelopment Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 - IntegratedEvaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableData-Based Decision-Making and Accountability Student’s

Self-EvaluationSite-Supervisor’s Evaluation

COMPETENCIES Develop

Evaluation

Develop

Evaluation

Demonstrates knowledge and use of varied models and methods of assessment Demonstrates ability to translate assessment results into empirically-based servicesDemonstrates ability to evaluate the outcomes of servicesDemonstrates knowledge and use of effective data-based problem solving processes

DOMAIN II: Consultation and Collaboration Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 - IntegratedEvaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableConsultation and Collaboration Student’s


COMPETENCIES Develo Evaluati Develo Evaluati

11


p on p onDemonstrates knowledge and application of various consultation modelsCollaborates with others in planning and decision-making processes at the individual, group, and system levelsDemonstrates use of effective collaboration skills with individuals of diverse backgrounds and characteristicsEmploys positive interpersonal skills and effective listeningDemonstrates flexibility, tolerance of opposing viewpoints, and patience in difficult situations

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DOMAIN VIII: Home/School/Community CollaborationDevelopment Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 - IntegratedEvaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableHome/School/Community Collaboration Student’s



Evaluation

Develop

Evaluation

Demonstrates knowledge of family systems, including family strengths and influences on student development, learning, and behaviorDemonstrates knowledge and application of methods to involve families in education and service deliveryDemonstrates knowledge of cultural issues that impact home-school collaborationDemonstrates knowledge of other family, home, and community factors that work to support learning and achievement in schoolDemonstrates ability to apply this knowledge to design, implement, and evaluate programs that promote school, family, and/or community partnerships and enhance academic and behavioral goals for studentsProvides support and assistance for parents when participating in school functions or activities to help them become comfortable, active, effective participantsDemonstrates knowledge about school and community resources; helps create links between schools, families, and community agencies; and helps coordinate services when programming for children, including multiple agencies

DOMAIN X: School Psychology Practice and Development Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool Psychology Practice and Development Student’s

Self-EvaluationSupervisor’s Evaluation


Evaluation

Develop

Evaluation

Demonstrates knowledge of the history and foundations of School Psychology professionDemonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional developmentDOMAIN XI: Information Technology Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Student’s



Evaluation

Develop

Evaluation

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Demonstrates knowledge of information sources and technology relevant to school psychology practiceDemonstrates ability to access, evaluate, and utilize information sources and technology in ways that safeguard or enhance the quality of servicesDemonstrates knowledge and skills in using word processing, spread sheets, test scoring software, and other computer resources to function more effectively and efficientlyDemonstrates knowledge about technology resources for children (e.g., instructional software, adaptive technology for individuals with disabilities)Demonstrates use of information technology when designing, implementing, and evaluating instructional programs or interventions for children

SUMMARY OF FALL SEMESTER PRACTICUM HOURS

To be completed by the site-supervisor, practicum student, and faculty supervisor

PRACTICUM HOURS:__________Total Practicum Hours for Fall

SITE-SUPERVISION: __________Total semester hours of SUPERVISION provided by Site-Supervisor (Fall )Note: For each 10 hours in the school setting, practicum students should receive 1 hour of individualized supervision. Site-based supervision for fall semester should equal 15 hours of individualized supervision.

GROUP SUPERVISION:__________Total semester hours of GROUP SUPERVISION provided by BYU Faculty Supervisor (Fall)Note: Practicum students attend 1 ½ hours of group supervision each week of practicum during fall semester of their second year. Group supervision during fall semester should equal 21 hours.

Practicum Student: ________________________________________________ Date: (signature)

Site-Supervisor________________________ _________________ Date: (signature)

BYU Faculty Supervisor: ___________________________ _____ Date: (signature)

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PRACTICUM WINTER 2007To be completed by the site-supervisor and practicum student

Evaluation of Student CompetencySite-Supervisor, please complete this evaluation in mid February (February 15) and then again in mid April (April 15).Complete the evaluation with the student present, discussing feedback with the student. If you have questions, please contact the faculty supervisor: Lane Valum (W ) 801-256-5229 (H) [email protected] or [email protected]

Date: ______________________Student: _________________________________________________________Site-Supervisor: ____________________________________________________Faculty Supervisor: _________________________________________________

Because we recognize that professional competencies are developed over time and are part of a learning process, you and your supervisors will provide two types of ratings for each competency area. This assessment is meant to help you and your supervisor know which areas are your strengths and which areas are emerging skills requiring focused effort and additional supervision.Note: This evaluation form was based on San Diego State’s School Psychology Internship evaluation forms and NASP standards.


0 Not seen No opportunity or not yet demonstrated/observed in this setting

1 Emerging Beginning to demonstrate this knowledge/skill2 Established Basic knowledge/skills attained and demonstrated

routinely3 Integrated Uses knowledge/skills flexibly as part of an overall

repertoire

Evaluation: Evaluation of Competency Development for Stage in the Program

Rating Descriptor Definition1 Concern Stronger development expected; Focus for further

development2 Satisfactory Development consistent with expectations at this

stage3 Commenda

bleAbove and beyond expectations at this stage

DOMAIN III: Effective Instruction & Development of Cognitive/Academic Skills Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableEffective Instruction and Development of Cognitive/Academic Skills

Self-Evaluation Supervisor’s Evaluation

COMPETENCIES Develop Evaluation

Develop

Evaluation

Demonstrates knowledge of human learning processes

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Demonstrates knowledge of techniques to improve human learning processesDemonstrates knowledge of direct and indirect services applicable to the development of cognitive and academic skillsDevelops appropriate cognitive and academic goals for students with different abilities, disabilities, strengths, and needsImplements interventions to achieve cognitive and academic goals; and evaluates the effectiveness of interventionsApplies effective instructional strategies to promote student learningApplies use of assessment and instructional strategies Demonstrates effectiveness with students with diverse backgrounds and experiencesDemonstrates application of principles to help students develop their abilities to be self-regulated learners

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DOMAIN IV: Socialization and Development of Life SkillsDevelop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableSocialization and Development of Life Skills Self-Evaluation Supervisor’s

EvaluationCOMPETENCIES Devel

opEvaluation

Develop

Evaluation

Demonstrates knowledge of human developmental processes in behavioral, social, affective, and adaptive domainsImplements sound techniques to assess human developmental processes Implements direct and indirect services applicable to the development of behavioral, affective, adaptive, and social skillsDevelops appropriate behavioral, affective, adaptive, and social goals for students of varying abilities, disabilities and backgrounds Implements interventions to achieve those goalsEvaluates the effectiveness of those interventions to assist in revising intervention strategies as necessaryDevelops interventions that can be implemented across settings (e.g., school, home, community)Demonstrates knowledge of research on classroom climate and of ecological and behavioral approaches to classroom management

DOMAIN V: Student Diversity in Development and Learning Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableStudent Diversity in Development and Learning Self-Evaluation Supervisor’s

EvaluationCOMPETENCIES Develo

pEvaluation

Develop

Evaluation

Demonstrates knowledge of individual differences, abilities, disabilities and of linguistic factors in development and learning Demonstrates knowledge of biological, social, cultural, ethnic, socioeconomic and gender-related factors in development and learningDemonstrates sensitivity and skills needed to work with individuals of diverse characteristicsDemonstrates ability to implement strategies selected and/or adapted based on individual characteristics, strengths, and needsRecognizes the subtle racial, class, gender, cultural, and other biases in self and others and the way these biases influence decision-making, instruction, behavior, and long-term outcomes for students



COMPETENCIES Develo Evaluati Develo Evaluati

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p on p onDemonstrates knowledge of the history and foundations of School Psychology professionDemonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional development

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DOMAIN XI: Information Technology Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Student’s



Evaluation

Develop

Evaluation


SUMMARY OF WINTER SEMESTER PRACTICUM HOURS

To be completed by the site-supervisor, practicum student, and faculty supervisor

PRACTICUM HOURS:__________Total Practicum Hours for winter semester

SITE-SUPERVISION: __________Total semester hours of SUPERVISION provided by Site-Supervisor (winter)Note: For each 10 hours in the school setting, practicum students should receive 1 hour of individualized supervision. Site-based supervision for winter semester should equal 15 hours of individualized supervision.

GROUP SUPERVISION:__________Total semester hours of GROUP SUPERVISION provided by BYU Faculty Supervisor (winter)Note: Practicum students attend 1 ½ hours of group supervision each week of practicum during fall semester of their second year. Group supervision during winter semester should equal 21 hours.




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PRACTICUM SPRING 2007Evaluation of Student Competency

To be completed by the site-supervisor and practicum student

Site-Supervisor, please complete this evaluation in mid May (May 15) and then again in mid June (June 15).Complete the evaluation with the student present, discussing feedback with the student. If you have questions, please contact the faculty supervisor: Melissa Allen Heath 422-1235 (w) 491-8386 (H) [email protected] Date: ______________________Student: _________________________________________________________Site-Supervisor: ____________________________________________________Faculty Supervisor: _________________________________________________

Because we recognize that professional competencies are developed over time and are part of a learning process, you and your supervisors will provide two types of ratings for each competency area. This assessment is meant to help you and your supervisor know which areas are your strengths and which areas are emerging skills requiring focused effort and additional supervision.Note: This evaluation form was based on San Diego State’s School Psychology Internship evaluation forms and NASP standards.


0 Not seen No opportunity or not yet demonstrated/observed in this setting

1 Emerging Beginning to demonstrate this knowledge/skill2 Established Basic knowledge/skills attained and demonstrated

routinely3 Integrated Uses knowledge/skills flexibly as part of an overall

repertoire

Evaluation: Evaluation of Competency Development for Stage in the Program

Rating Descriptor Definition1 Concern Stronger development expected; Focus for further

development2 Satisfactory Development consistent with expectations at this

stage3 Commenda

bleAbove and beyond expectations at this stage

DOMAIN VI: School & Systems Organization, Policy Development, & Climate Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool and Systems Organization, Policy Development, and Climate

Student’s Self-Evaluation

Supervisor’s Evaluation


Evaluation

Develop

Evaluation

Demonstrates knowledge of general education, special education, and other educational and related services

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Demonstrates understanding of schools and other settings as systemsDemonstrates ability to work with individuals and groups to facilitate policies and practices that create and maintain safe, supportive, and effective learning environments for children and othersDOMAIN VII: Prevention, Crisis Intervention, and Mental Health Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendablePrevention, Crisis Intervention, and Mental Health Student’s



Evaluation

Develop

Evaluation

Demonstrates knowledge of human development and psychopathology and of associated biological, cultural, and social influences on human behaviorDemonstrates ability to apply knowledge of these factors to the identification and recognition of behaviors that are precursors to academic, behavioral, and serious personal difficulties (e.g., conduct disorders, internalizing disorders, drug and alcohol abuse, etc.)Demonstrates knowledge of effective prevention strategies and ability to develop, implement, and evaluate programs based on recognition of the precursors that lead to children’s severe learning and behavior problemsDemonstrates knowledge of crisis intervention and ability to collaborate with school personnel, parents, and the community in the aftermath of crises (e.g., suicide, death, natural disasters, murder, bombs or bomb threats, extraordinary violence, sexual harassment, etc.)Demonstrates knowledge of and ability to respond appropriately to diverse health issues such as diet, eating disorders, teenage pregnancy, AIDS prevention, and stress management

DOMAIN IX: Research and Program Evaluation Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableResearch and Program Evaluation Student’s



Evaluation

Develop

Evaluation

Demonstrates knowledge of research, statistics, and evaluation methodsDemonstrates ability to evaluate research, translate research into practice, and understand research design and statistics

Plans and conducts investigations and program evaluations for improvement of servicesDemonstrates knowledge of research and statistics in sufficient depth to evaluate published research and to plan and conduct their own investigationsDemonstrates knowledge of measurement principles and psychometric standards and ability to apply the knowledge when selecting and using assessment

21

techniques and published testsDemonstrates ability to translate new research findings into service delivery improvements




Evaluation

Develop

Evaluation

Demonstrates knowledge of the history and foundations of School Psychology professionDemonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional development

DOMAIN XI: Information Technology Develop: Development Rating: 0 - Not Seen; 1 - Emerging; 2 - Established; 3 – IntegratedEvaluation: Evaluation Rating: 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Student’s



Evaluation

Develop

Evaluation


SUMMARY OF SPRING SEMESTER PRACTICUM HOURS

To be completed by the site-supervisor, practicum student, and

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faculty supervisor

PRACTICUM HOURS:__________Total Practicum Hours for spring semester

SITE-SUPERVISION: __________Total semester hours of SUPERVISION provided by Site-Supervisor (spring)Note: For each 10 hours in the school setting, practicum students should receive 1 hour of individualized supervision. Site-based supervision for winter semester should equal 7.5 hours of individualized supervision during spring semester.

GROUP SUPERVISION:__________Total semester hours of GROUP SUPERVISION provided by BYU Faculty Supervisor (spring)Note: Practicum students attend 1 ½ hours of group supervision each week of practicum during spring semester of their second year. Group supervision during spring semester should equal 10.5 hours.




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FIELD EXPERIENCE DEMOGRAPHICS WORKSHEET (8/4/06)

To be completed by the practicum studentThis form details information about schools served by university students. Each semester during practicum and internship, university students record their interaction with students of diversity. If a university student is placed in FEWER than three schools, extra spaces on this worksheet are left blank. School Name: 1.___________________________________

2.___________________________________3.___________________________________

On the USOE web site—WWW.USOE.org, click on “School Report Cards” (right side of page), then “reports” (top menu), then “Current UPASS School Performance Reports” (appears as option under reports menu), then select the “district and school” to find the demographic information for each school. For elementary schools: SCH1 SCH2 SCH3

Language Arts Status / Progress

Math Status / Progress

Science Status / Progress

On the school report site, look under “additional information.” Document actual numbers for schools, not estimates or approximations. SCH1 SCH2 SCH3

Average Daily Attendance (%)

School Mobility Rate (%)

Total Number of Students Enrolled:

# African American/Black

# American Indian

# Asian

# Hispanic

# Not Declared

# Pacific Islander

# White

# English Language Learners

# Socioeconomic Status (Free/Reduced Lunch)

# Students with Disabilities

Elementary Title 1 program(s) yes / no

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http://WWW.USOE.org/

FALL SEMESTER 2006PORTFOLIO: SUMMARY OF EVALUATION FEEDBACK

Practicum Student: Faculty Reviewer: Date: . Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 – Commendable

To be completed by the faculty supervisorDomain Requirements

(refer to syllabus for specific details)

Reviewer’s Comments OVERALL RATING0, 1, 2, 3

DOMAIN I: Data-Based Decision-Making and Accountability

Domain summary sheet & documentation of work samples

DOMAIN II: Consultation and Collaboration

Domain summary sheet& documentation of work samples

DOMAIN VIII: Home/School/Community Collaboration


DOMAIN IX: Research and Program Evaluation


DOMAIN X: School Psychology Practice and Development


DOMAIN XI: Information Technology


DOMAIN I: Data-Based Decision-Making and AccountabilityEvaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableData-Based Decision-Making and Accountability

Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge and use of varied models and methods of assessment Demonstrates ability to translate assessment results into empirically-based servicesDemonstrates ability to evaluate the outcomes of servicesDemonstrates knowledge and use of effective data-based problem solving processesDOMAIN II: Consultation and Collaboration Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableConsultation and Collaboration Evaluation Rating

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COMPETENCIES 0 1 2 3Demonstrates knowledge and application of various consultation modelsCollaborates with others in planning and decision-making processes at the individual, group, and system levelsDemonstrates use of effective collaboration skills with individuals of diverse backgrounds and characteristicsEmploys positive interpersonal skills and effective listeningDemonstrates flexibility, tolerance of opposing viewpoints, and patience in difficult situationsDOMAIN VIII: Home/School/Community CollaborationEvaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableHome/School/Community Collaboration Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of family systems, including family strengths and influences on student development, learning, and behaviorDemonstrates knowledge and application of methods to involve families in education and service deliveryDemonstrates knowledge of cultural issues that impact home-school collaborationDemonstrates knowledge of other family, home, and community factors that work to support learning and achievement in schoolDemonstrates ability to apply this knowledge to design, implement, and evaluate programs that promote school, family, and/or community partnerships and enhance academic and behavioral goals for studentsProvides support and assistance for parents when participating in school functions or activities to help them become comfortable, active, effective participantsDemonstrates knowledge about school and community resources; helps create links between schools, families, and community agencies; and helps coordinate services when programming for children, including multiple agencies

DOMAIN X: School Psychology Practice and Development Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool Psychology Practice and Development Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of the history and foundations of School Psychology professionDemonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional development

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DOMAIN XI: Information Technology Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of information sources and technology relevant to school psychology practiceDemonstrates ability to access, evaluate, and utilize information sources and technology in ways that safeguard or enhance the quality of servicesDemonstrates knowledge and skills in using word processing, spread sheets, test scoring software, and other computer resources to function more effectively and efficientlyDemonstrates knowledge about technology resources for children (e.g., instructional software, adaptive technology for individuals with disabilities)Demonstrates use of information technology when designing, implementing, and evaluating instructional programs or interventions for children

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WINTER SEMESTER 2007PORTFOLIO: SUMMARY OF EVALUATION FEEDBACK




Reviewer’s Comments OVERALL RATING0, 1, 2, 3

DOMAIN III: Effective Instruction & Development of Cognitive/Academic Skills


DOMAIN IV: Socialization and Development of Life Skills


DOMAIN V: Student Diversity in Development and Learning






DOMAIN III: Effective Instruction & Development of Cognitive/Academic Skills Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableEffective Instruction and Development of Cognitive/Academic Skills

Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of human learning processesDemonstrates knowledge of techniques to improve human learning processesDemonstrates knowledge of direct and indirect services applicable to the development of cognitive and academic skillsDevelops appropriate cognitive and academic goals for students with different abilities, disabilities, strengths, and needsImplements interventions to achieve cognitive and academic goals; and evaluates the effectiveness of interventionsApplies effective instructional strategies to promote student learningApplies use of assessment and instructional strategies

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Demonstrates effectiveness with students with diverse backgrounds and experiencesDemonstrates application of principles to help students develop their abilities to be self-regulated learnersDOMAIN IV: Socialization and Development of Life Skills Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableSocialization and Development of Life Skills Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of human developmental processes in behavioral, social, affective, and adaptive domainsImplements sound techniques to assess human developmental processes Implements direct and indirect services applicable to the development of behavioral, affective, adaptive, and social skillsDevelops appropriate behavioral, affective, adaptive, and social goals for students of varying abilities, disabilities and backgrounds Implements interventions to achieve those goalsEvaluates the effectiveness of those interventions to assist in revising intervention strategies as necessaryDevelops interventions that can be implemented across settings (e.g., school, home, community)Demonstrates knowledge of research on classroom climate and of ecological and behavioral approaches to classroom managementDOMAIN V: Student Diversity in Development and Learning Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableStudent Diversity in Development and Learning Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of individual differences, abilities, disabilities and of linguistic factors in development and learning Demonstrates knowledge of biological, social, cultural, ethnic, socioeconomic and gender-related factors in development and learningDemonstrates sensitivity and skills needed to work with individuals of diverse characteristicsDemonstrates ability to implement strategies selected and/or adapted based on individual characteristics, strengths, and needsRecognizes the subtle racial, class, gender, cultural, and other biases in self and others and the way these biases influence decision-making, instruction, behavior, and long-term outcomes for studentsDOMAIN X: School Psychology Practice and Development Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool Psychology Practice and Development Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of the history and foundations of School Psychology profession

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Demonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional developmentDOMAIN XI: Information Technology Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of information sources and technology relevant to school psychology practiceDemonstrates ability to access, evaluate, and utilize information sources and technology in ways that safeguard or enhance the quality of servicesDemonstrates knowledge and skills in using word processing, spread sheets, test scoring software, and other computer resources to function more effectively and efficientlyDemonstrates knowledge about technology resources for children (e.g., instructional software, adaptive technology for individuals with disabilities)Demonstrates use of information technology when designing, implementing, and evaluating instructional programs or interventions for children

SPRING SEMESTER 2007PORTFOLIO: SUMMARY OF EVALUATION FEEDBACK




Reviewer’s Comments RATING0, 1, 2, 3

DOMAIN VI: School & Systems Organization, Policy Development, & Climate


DOMAIN VII: Prevention, Crisis Intervention, and Mental Health



Domain summary sheet & documentation

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of work samplesDOMAIN X: School Psychology Practice and Development




DOMAIN VI: School & Systems Organization, Policy Development, & Climate Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool and Systems Organization, Policy Development, and Climate

Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of general education, special education, and other educational and related servicesDemonstrates understanding of schools and other settings as systemsDemonstrates ability to work with individuals and groups to facilitate policies and practices that create and maintain safe, supportive, and effective learning environments for children and othersDOMAIN VII: Prevention, Crisis Intervention, and Mental Health Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendablePrevention, Crisis Intervention, and Mental Health Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of human development and psychopathology and of associated biological, cultural, and social influences on human behaviorDemonstrates ability to apply knowledge of these factors to the identification and recognition of behaviors that are precursors to academic, behavioral, and serious personal difficulties (e.g., conduct disorders, internalizing disorders, drug and alcohol abuse, etc.)Demonstrates knowledge of effective prevention strategies and ability to develop, implement, and evaluate programs based on recognition of the precursors that lead to children’s severe learning and behavior problemsDemonstrates knowledge of crisis intervention and ability to collaborate with school personnel, parents, and the community in the aftermath of crises (e.g., suicide, death, natural disasters, murder, bombs or bomb threats, extraordinary violence, sexual harassment, etc.)Demonstrates knowledge of and ability to respond appropriately to diverse health issues such as diet, eating disorders, teenage pregnancy, AIDS prevention, and stress managementDOMAIN IX: Research and Program Evaluation Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableResearch and Program Evaluation Evaluation Rating

COMPETENCIES 0 1 2 3

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Demonstrates knowledge of research, statistics, and evaluation methodsDemonstrates ability to evaluate research, translate research into practice, and understand research design and statistics

Plans and conducts investigations and program evaluations for improvement of servicesDemonstrates knowledge of research and statistics in sufficient depth to evaluate published research and to plan and conduct their own investigationsDemonstrates knowledge of measurement principles and psychometric standards and ability to apply the knowledge when selecting and using assessment techniques and published testsDemonstrates ability to translate new research findings into service delivery improvements

DOMAIN X: School Psychology Practice and Development Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableSchool Psychology Practice and Development Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of the history and foundations of School Psychology professionDemonstrates knowledge of various service models and methodsDemonstrates knowledge of public policy development applicable to services to children and familiesDemonstrates knowledge of ethical, professional, and legal standardsPractices in ways that are consistent with applicable standardsDemonstrates Involvement in the profession of School PsychologyDemonstrates knowledge and skills needed to acquire career-long professional developmentDOMAIN XI: Information Technology Evaluation Rating: 0 – no evidence 1 - Concern; 2 - Satisfactory; 3 - CommendableInformation Technology Evaluation Rating

COMPETENCIES 0 1 2 3Demonstrates knowledge of information sources and technology relevant to school psychology practiceDemonstrates ability to access, evaluate, and utilize information sources and technology in ways that safeguard or enhance the quality of servicesDemonstrates knowledge and skills in using word processing, spread sheets, test scoring software, and other computer resources to function more effectively and efficientlyDemonstrates knowledge about technology resources for children (e.g., instructional software, adaptive technology for individuals with disabilities)Demonstrates use of information technology when designing, implementing, and evaluating instructional

32

programs or interventions for children33

EVALUATING PROFESSIONAL DISPOSTIONBrigham Young University School Psychology Program

Practicum- Supervisor’s FeedbackTo be completed by the site-supervisor

SP Practicum Student: ___________________________________Field/Site Supervisor: ___________________________________ Semester/Date:

____________________Please provide feedback regarding your observations of this Practicum student. Your comments will assist us in designing future practicum and internship experiences to fit the student’s needs.Please indicate the level this student demonstrates the following personal and professional attributes.

Unsatisfactory

Satisfactory

Exemplary Concerns or Comments

1. Student adheres to professional

and ethical standards of behavior.

2. Student demonstrates a commitment to the understanding of & responsiveness to human diversity.

3. Student demonstrates knowledge &

expertise in communicating effectivelywith teacher, students, support staffand administrators.

4. Student demonstrates effective interpersonal relations.

5. Student demonstrates flexibility

6. Student demonstrates initiative and dependability.

7. Student respects individual and family’s rights of confidentiality.

8. Student demonstrates a strong professional work ethic.

In regard to their practicum assignment, list unique talents or abilities you observed in this student. (write on other side if needed)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

List areas of improvement and additional experiences you would recommend to assist in this student’s professional development.

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_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Total # of hours Practicum student spent at practicum site: ________ Total # of site supervision hours attended by student: ________Total # of hours in group university supervision: ________

_____________________________________ ________ ___________________________________________Site Supervisor Signature Date School Assignment

_____________________________________ ________University Faculty Supervisor Signature Date

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Student’s Evaluation of SupervisorTo be completed by the practicum student

SUGGESTED USE: The university practicum or internship faculty supervisor obtains feedback on the student’s supervision by asking practicum students and interns to complete this form. The evaluation is completed at the end of Fall (prior to December 20) and Winter semesters (prior to April 20). The purposes are twofold: (1) to provide the university with feedback for improving supervision and (2) to encourage students to evaluate their own experience regarding supervision.Practicum/Intern Student: ____________________________________________________________________Practicum or Internship On-site Supervisor: ______________________________________________________Supervision time period covered:_______________ to ________________

DIRECTIONS: School Psychology practicum students/interns evaluate their on-site supervision. Circle the number that best represents how you, the student, feel about the supervision you received. After the form is completed, BYU faculty review the student’s comments and ratings. Faculty may suggest a meeting to discuss the student’s supervision.

Poor Adequate Good

1. Gives time and energy in directly observing my activities.

1 2

3 4

5 6

2. Accepts and respects me as a person. 1 2 3 4 5 6

3. Recognizes and encourages further development of my strengths and capabilities.

1 2

3 4

5 6

4. Gives me useful feedback when I do something well. 1 2 3 4

5 6

5. Provides me the freedom to develop flexible and effective counseling styles.

1 2

3 4

5 6

6. Encourages and listens to my ideas and suggestions for developing my counseling and assessment skills.

1 2 3 4

5 6

7. Provides suggestions for developing my counseling and assessment skills.

1 2

3 4

5 6

8. Helps me understand the implications and dynamics of the counseling approaches I use.

1 2 3 4

5 6

9. Encourages me to use new and different techniques when appropriate.

1 2

3 4

5 6

10. Is spontaneous and flexible in the supervisory sessions.

1 2 3 4

5 6

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11. Helps me define and achieve specific concrete goals for myself during the practicum/intern experience.

1 2

3 4

5 6

12. Gives me useful feedback when I do something wrong.

1 2 3 4

5 6

13. Allows me to discuss problems I encounter in my practicum/intern setting.

1 2

3 4

5 6

14. Pays attention to both me and my clients. 1 2 3 4

5 6

15. Focuses on both my verbal and nonverbal behavior.

1 2

3 4

5 6

16. Helps me define and maintain ethical behavior in counseling, assessment & case management.

1 2 3 4

5 6

17. Encourages me to engage in professional behavior.

1 2

3 4

5 6

18. Maintains confidentiality to material discussed in supervisory sessions.

1 2 3 4

5 6

19. Deals with both content and affect when supervising.

1 2

3 4

5 6

20. Focuses on the implications, consequences, and contingencies of specific behaviors in counseling and supervision.

1 2 3 4

5 6

21. Helps me organize relevant case data in planning goals and strategies with my clients.

1 2

3 4

5 6

22. Helps me formulate a theoretically sound rationale of human behavior.

1 2 3 4

5 6

23. Offers resource information when I request or need it.

1 2

3 4

5 6

24. Helps me develop increased skill in critiquing and gaining insight from my counseling and assessment via direct observation or reviewing logs and case notes.

1 2

3 4

5 6

25. Allows and encourages me to evaluate myself. 1 2 3 4

5 6

26. Explains his/her criteria for evaluation clearly in behavioral terms.

1 2

3 4

5 6

27. Applies his/her criteria fairly in evaluating my performance.

1 2 3 4

5 6

Printed by permission from Dr. Harold Hackney, Assistant Professor, Purdue University. This form was designed by two graduate students based upon material drawn from Counseling Strategies and Objectives by H. Hackney and S. Nye, Prentice-

37

hall, 1973. This form originally was printed in Chapter 10 in the Practicum Manual for Counseling and Psychotherapy by K. Dimick and F. Krause, Muncie, IN: Accelerated Development, 1980.

ADDITIONAL COMMENTS AND/OR SUGGESTIONS:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________________ ___________Signature: Practicum Student/Intern Date

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Practicum and Internship Site EvaluationTo be completed by the practicum student

DIRECTIONS: Student completes this form at the end of each semester during practicum and/or internship (Fall and Winter). Student makes a copy for their own records/portfolio. Student turns this form in to the university supervisor or internship coordinator.

Name: ______________________________ Site: _______________________________

Dates of Placement: ___________________ Site Supervisor: ______________________

Faculty Liaison: ______________________

Rate the following questions about your site and experience by the following:A = Very satisfactoryB = Moderately satisfactoryC = Moderately unsatisfactoryD = Very unsatisfactory

. _____ Amount of on-site supervision.

. _____ Quality of usefulness of on-site supervision.

. _____ Usefulness and helpfulness of faculty liaison.

. _____ Relevance of experience to career goals.

. _____ Exposure to and communication of school/agency goals.

. _____ Exposure to and communication of school/agency procedures.

. _____ Exposure to professional roles and functions within the school/agency.

. _____ Exposure to information about community resources.

. Rate all applicable experiences that you had at your site: _____ Report writing _____ Intake interviewing _____ Administration and interpretation of tests _____ Staff presentations/case conferences _____ Individual counseling _____ Group counseling _____ Family counseling _____ Psycho-educational activities _____ Consultation _____ Career Counseling _____ Crisis Intervention _____ Working with students from diverse backgrounds _____ Other _____________________________

. _____ Overall evaluation of the site.

COMMENTS: Include any suggestions for improvements in the experiences you have rated moderately (C) or very unsatisfactory (D).

39

SITE-SUPERVISOR’S EVALUATION OF PRACTICUM STUDENT

To be completed by the site-supervisor

Practicum Student_______________________________________________ Date: __________

(1) At the end of Fall and Winter semesters, BYU needs a summary of practicum students’ time logs, documenting student experiences. These logs must be signed by both the on-site supervisor and the practicum student. Please make sure the supervision hours are documented.(2) We need a brief summary of the practicum student’s experiences in the following areas (listed below). We realize that the student may not have some of these opportunities during their practicum. We need to know which experiences are lacking so we can address these areas in future practicum and internship settings. The student and their on-site supervisor should sit down and discuss each of the domains listed below, commenting on where they gained experiences to strengthen their competencies and where they may need additional work.(3) Based on course projects and activities completed this semester, please complete the rubrics evaluating student competencies. These rubrics are provided to you by the BYU faculty practicum supervisor._____________________________________________________________________________________________________________________________DOMAIN I: Data-Based Decision-Making and Accountability

DOMAIN II: Consultation and Collaboration

DOMAIN III: Effective Instruction and Development of Cognitive/Academic Skills

DOMAIN IV: Socialization and Development of Life Skills

DOMAIN V: Student Diversity in Development and Learning

DOMAIN VI: School and Systems Organization, Policy Development, and Climate

DOMAIN VII: Prevention, Crisis Intervention, and Mental Health

DOMAIN VIII: Home/School/Community Collaboration



40

DOMAIN XI: Information Technology41

STUDENT’S DOCUMENTED USE OF TECHNOLOGY

To be completed by the practicum studentDATE TECHNOLOGY USED ACTIVITY/TIME SPENT

COMMENTS

42

Steps in Resolving an Ethical DilemmaTo be completed by the practicum student

Date:____________________

(1) Identify the problem or dilemma.

(2) Identify the potential issues involved.

(3) Review the relevant ethics codes.

(4) Know the applicable laws and regulations.

(5) Obtain consultation.

(6) Consider possible and probable courses of action.

(7) Enumerate the consequences of various decisions.

(8) Decide on what appears to be the best course of action.

(9) Document your actions.

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SUGGESTED ELEMENTS OF A BEHAVIOR INTERVENTION PLAN

Name: __________________________ School:____________________________Date of BIP: __________

REVIEW OF EXISTING EVALUATION DATE:_____ Information provided by parents/guardians_____ Evaluation(s) performed by the district _______________________________ _____ Evaluation(s) performed by outside agency _________________________________ Current classroom based assessments and observations_____ Teacher and/or related service providers observations_____ Previous Behavior Intervention Plan (Date of plan __________)_____ Other (specify) __________________________________________________

Functional Behavioral Assessment:Information obtained from: ___Teacher ___Parent/guardian information ___Other

ProfessionalThe functional behavior assessment addresses the relationship between a behavior and the relevant factors that may affect the student’s performance.

Behaviors reported by School Staff that interfere with learning or disrupt the classroom environment (including estimated frequency): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Behaviors reported by Parent/Guardian (including estimated frequency): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Summarize Behavior Observation (if applicable): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

44

Events preceding student’s behavioral difficulties:_____ Request/directive from teachers/staff

______________________________________________ Redirected from inappropriate activity

______________________________________________ Provocation by peers

___________________________________________________________ Engaged in academic activity

_____________________________________________________ Off task

_____________________________________________________________________ Student is in unstructured setting (halls, cafeteria, etc.)

__________________________________ Other

_______________________________________________________________________ Other

__________________________________________________________________

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BEHAVIOR INTERVENTION PLAN

Events typically following the problem behaviors in the school setting:_____ Positive social reinforcement from others

____________________________________________ Withhold privileges

_____________________________________________________________ Redirection

___________________________________________________________________ Verbal Correction/reminders

_____________________________________________________ Removal from the classroom

______________________________________________________ Sent to principal’s office

_________________________________________________________ After school detention or lunch detention

____________________________________________ Time out (length of time____________)

____________________________________________ In School Suspension

___________________________________________________________ Alternative Education Placement (AEP)

_____________________________________________ Other

__________________________________________________________________

Reinforcers (activities, people, tangible items, privileges, token economies, free time, recess, etc.) that have been attempted during the past year and their effectiveness: _________________ ________ . ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The following list of behaviors are targeted for improvement:

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

Note: Changes in the regular discipline plan need to be approved by the IEP committee and the school principal.

46

BYU School Psychology Program

Report Writing FormatA recommended practice for conducting the psycho-educational assessment is the Referral Question Consultation Model. The report must also reflect the “problem solving model.” In this model, assessment personnel:

Review all existing data,Meet with the referral source to behaviorally define initial concerns and need for

additional data,Test for some initial hypothesis, and determine the goal of the assessment,Develop a hypothesis and determine which tests will specifically answer the referral

questions and facilitate the link between assessment and intervention (Select a multi-trait, multi-method assessment procedure),

Develop data-based referral questions that will guide the assessment process and confirm or reject the generated hypothesis, (these are generally listed in the reason for referral section of report)

Apply the assessment and background data to answer the referral questions, Identify and select intervention strategies and recommendations, and

Develop a written report that documents this process (Batsche, 1984).

Pscho-Educational Report Writing Format:

Identifying InformationStudent’s NameBirth-date- Age GradeSchoolAssessment DateExaminer (including title and degree)

Reason for ReferralThis should include precipitating events that led up to the referral. Who initiated the referral? Include information from school personnel and family. If there is a relevant documented history, it too can be briefly included here. This section succinctly states the referral question which will follow through the entire report. In other words: What is the purpose of this assessment?

Background InformationData does not exist in a vacuum. Issues such as current living arrangements and significant family information, prenatal and neonatal development, developmental milestones, temperament, reported strengths and weaknesses, previous school achievement (behavioral and academic), family issues, previous diagnoses, use of medication, attendance, etc. should be included in this section. Use this section to identify information gained through the interview and documented on the social history form. This section should only include information that is relevant to the assessment. Irrelevant past history and student descriptors such as, average build, blonde hair, etc. are usually irrelevant to understanding the student’s school problems.

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Behavioral ObservationsThis is a snapshot of the student’s behavior that you have observed. Indicate rapport, resistance, anxiety, and approach to the task, test motivation and a statement of test validity.

Assessments and Data CollectionIQ / Cognitive Test(s) Adaptive Behavior Testing (if concerned about developmental delays or possible mental deficiency)Achievement Tests

Norm Referenced (WJ-III, WIAT, etc)Criterion ReferencedCurriculum Based Assessment

Perceptual MotorVMIBender

Social/Emotional and Behavioral TestsBehavior Rating Scales (BASC, CBCL)*List informantSubjective/social emotional assessment (PIC, RCMAS, CDI, Self-Esteem

Inventories)Projective Tests (interpret with caution: sentence completion, drawings, TAT,

etc.)Interviews

Review of Previous RecordsConsultations with Medical Personnel or Outside Agencies

Validity of Assessment Results (Test Caveat): Are the results of this assessment considered to be a valid representation of the student’s functioning? Concerns about the validity of test results must be noted. List factors affecting the assessment’s validity. Also list cautions to consider when drawing conclusions based on assessment data. When assessing students from culturally or linguistically diverse backgrounds, always explain testing limitations and cautions for interpreting test results, particularly for those assessments that have not included individuals of similar background in the standardization sample.

Assessment ResultsResults should be listed numerically in a table, followed by a brief, objective narrative. Use standard scores, not raw scores. Avoid grade equivalent scores. Include one sentence describing the purpose and format of the test. Results should be listed in the same order as stated above. Results should indicate strengths and difficulties. List the most salient strengths and difficulties that are related to the referral question.

SummaryThis section addresses the referral question. This section contains a brief summary of pertinent test findings and a statement of whether you consider the assessment results to be valid (if not, briefly explain what factors contributed to questionable testing results). You also briefly state you clinical impressions that either support or refute identification of a handicapping condition and potential eligibility for special education services. HOWEVER, your report is information for the team to assist

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them in identifying appropriate interventions and to also assist them in making a decision to identify or not to identify a student for special education services. Identification of handicapping conditions and eligibility for special education services is a TEAM decision.

RecommendationsThe first recommendation should be related to an eligibility statement, unless further testing is warranted, then that should be the first recommendation. Suggest that the results of this assessment should be reviewed by the IEP team in order to discuss the possible need for special education services. REMEMBER: Eligibility is determined by the IEP team, not solely by the results of your assessment. Your assessment will assist the team in determining eligibility. Academic/programming recommendations are listed next. Social/emotional/behavioral recommendations should follow. Recommendations should always be driven by the referral questions. Subheadings are helpful to organize your recommendations. Avoid using terms such as “should” or “required.” Tentative terms such as “may be beneficial” are preferable. All recommendations should be anchored in “best practices” and should be supported by current research.

Signature LineYour title is School Psychology Practicum Student. Use this title on all written documents. Supervisors must co-sign your reports and list their title: Practicum Supervisor.

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BYU School Psychology ProgramAssessment Report: Evaluation Form

To be completed by the site supervisor & faculty supervisorIntern/Practicum Student: _____________________________________ Date ___________ Supervisor rating report: _____________________________________General Evaluation: Rating Scale

1 or 2 Below Competency (Student revises report & resubmits) 3 Proficient -Minimum Level of Expected Competency4 Exceeds Expectations -Excellent Synthesis & Integration

1. Referral Question 1 2 3 4 States referral source: Who initiated the referral? States purpose of referral (ie: major concerns/ possible eligibility for special education services/ need for recommendations) BRIEFLY Documents attempts & success/failure of previous intervention BRIEFLY presents relevant background information (including previous involvement

in special education)Comments_________________________________________________________________________________________

2. Background Information 1 2 3 4 Integration of pertinent information Includes accurate information (do not include hear-say). Always state who provided

the background information. Provide accurate developmental & social history Provide information regarding student’s strengths & assets Respect confidential information (ie: history of sexual abuse, parental depression,

or drug abuse) Stick to facts: Unless diagnosed by a doctor/psychiatrist and report is in hand, avoid

labels & diagnoses- State information in objective, observable terms Comments_________________________________________________________________________________________

3. Observations 1 2 3 4 Include only objective, behavioral defined information Include information relevant to the referral question Address testing attention, on-task behavior, rapport,

openness, temperament, persistence, distractibility,overall testing behavior

Report classroom observations relevant to the referral question Based on your observations, comment on reliability and validity of the test resultsComments_________________________________________________________________________________________

4. Test Results 1 2 3 4 Choose tests that provide information to answer the referral question

Chose tests that are appropriate for student (consider background- particularly language and cultural differences)

Include 1-2 sentences describing the test (avoid jargon) Present information numerically in tables followed by a narrative When possible, highlight themes or commonalities across assessment results Report and explain confidence interval for FSIQ Must test all areas of suspected disability (all 7 areas- refer to UTAH Golden Rules) Be objective- report only factsComments___________________________________________________________________________

5. Interpretation 1 2 3 4 Interpret results in light of the referral question Discuss what subtests measure and implications for school

(particularly academic performance) Tell how information translates into school performance-implications for

student’s academic success

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Identify themes representing strengths and weaknessesComments_________________________________________________________________________________________

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6. Summary / Answer to the Referral Question 1 2 3 4 Integrate test data & observations – be succinct- Note significant strengths

and weaknesses. Relate summary back to the referral question No new information should be in the summary section! Evaluate your hypothesis Express your clinical judgment- What is your impression based on the data.

If assessment was conducted to assist in determining eligibility, state how yourdata supports or refutes the diagnosis/eligibility.

Comments_________________________________________________________________________________________

7. Eligibility Statement (with supporting documentation) 1 2 3 4 State that the IEP team will review assessment findings in order to formally

determine eligibility for special education services. Briefly refer to Federal & State definitions/criteria and how the assessment

supports or refutes eligibility. Based on the assessment, state how the student’s deficits effect functioning

(functional implications)Comments__________________________________________________________________________________________

8. Recommendations 1 2 3 4 Recommendations should be organized according to the referral question

(ie: if an academic concern, list academic recommendations first; if a behavioralconcern, list behavioral recommendations first)

Clearly state realistic and achievable recommendations, based on “best practice”and current research.

Don’t recommend specific programs or mandate interventions. Be tentative in wording.

Recommendations should be related to assessment data, behavioral observations, and interpretations

Identify modifications or techniques to assist student in coping with weaknesses Identify how strengths can be used to compensate for weaknessesComments_________________________________________________________________________________________

9. Style and Presentation 1 2 3 4 Sentences are well constructed Avoid jargon and clichés Avoid inconsistencies Tables of data are explained in text of report. Report is organized and neatly arranged.Comments_________________________________________________________________________________________

10. Organization 1 2 3 4 Logical and meaningful Appropriate length, succinct Follows report format and is easy to locate information.Comments_________________________________________________________________________________________

11. Spelling & Grammar 1 2 3 4 Void of spelling and grammatical errorsComments_________________________________________________________________________________________

12. Overall Rating 1 2 3 4 Comments: Please write comments on the other side of this form.

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PRACTICUM GOAL SETTING CHARTTo be completed by the practicum student

Practicum Student: __________________________________________________ Date: __________

NASP DOMAI

NObjective Activities Indications of

Success

Projected date

of complet

ion

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NASP CASE STUDY RUBRIC

Copied from the following NASP website: http://www.nasponline.org/certification/nonapprovedapp705.pdf

NCSP application for non-approved programs: pages 26-30

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http://www.nasponline.org/certification/nonapprovedapp705.pdf

Fall Practicum 2006 ASSIGNMENT LIST AND PORTFOLIO

To be completed by the practicum student

Student:_________________________ Date: _____________

(1) ______Review topics and content of Handouts from Your School Psychologist. (2) ______ Complete a minimum of 130 hours of practicum in school setting.(3) ______ PORTFOLIO- due December 18, 2006

_____time logs (signed by supervisor, student, and faculty) and semester summary of practicum hours

_____Field Experience Demographics Worksheet (attached) _____List of assessment instruments (formal and informal) _____List technology – key internet sites and resources,

computer programs, etc. _____9-step ethical dilemma _____2 goals, account of progress toward meeting goals _____Domain sheets summarizing work samples and explaining

how data documents competencies (quantitative and qualitative data)

Evaluations: o _____Student evaluation of practicum site o _____Student evaluation of site supervisoro _____Site-Supervisor’s evaluation of student and student’s

self-evaluation (formative and summative)o _____Faculty site visit: observation of and evaluation of

student competencieso _____Faculty evaluation of portfolioo _____Projects/reports from CPSE 610 and CPSE 614

(minimally documenting DOMAIN I: Data-Based Decision-Making and Accountability; DOMAIN II: Consultation and Collaboration; and DOMAIN VIII: Home/School/Community Collaboration)

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