School Psychology Handbook

APPENDIX A
Printer Friendly Appendix A

University of Delaware
School Psychology Field Experience Checklist
And Evaluation Form for Practica and Internship

Student:                                                           Semester and year:
School:                                                            School District:
Site Supervisor:                University supervisor:

Field experience: (circle one)

First Practicum      Second Practicum       Third Practicum          Internship

This instrument serves two purposes: (1) as a checklist for you and your site supervisor to plan your field experiences for the semester and (2) as an evaluation form to be completed by your site supervisor. The form applies to both practicum and internship experiences. Please note, however, that whereas the evaluation component is to be completed twice each semester during practicum (mid-term and end of the semester), it is to be completed only once during each semester of the internship (at the end of the semester).

In the left hand column please either check if the activity is planned for the semester or record the approximate time when you expect the activity will occur. This is to be completed at the very beginning of the semester jointly by the student and his or her site supervisor. In the far right hand columns, your site supervisor is to complete the evaluation component.

Use the same form for planning and evaluation components. When each component is completed, make 3 copies. Keep one, give one to your site supervisor, and give one to your university supervisor. NOTE THAT THE FINAL FORM TURNED IN AT THE END OF EACH SEMESTER TO YOUR UNIVERSITY SUPERVISOR IS TO HAVE ALL COMPONENTS COMPLETED ON IT [i.e., the planning column and the evaluation column(s)].

Please see Practicum and Internship Guidelines and the course syllabus for additional evaluative components and for the dates on which each component is due.

For activities in the following section, please rate each activity using the following scale: NA = Not appropriate, or available, for this placement. 1 = Activity was appropriate, but was not completed adequately. 2 = Activity was completed adequately.
Knowledge of School Organization, Policies, and Procedure
Planned	Activity	Mid-term Evaluation	Final Evaluation
	Reviews with supervisor the organization and administration of general education and special education services in the assigned school(s) and district.	NA 1 2	NA 1 2
	Reviews with supervisor the various school-based and community programs and services for children with diverse needs.	NA 1 2	NA 1 2
	Learns roles and responsibilities of school personnel, including the school psychologist, school counselor, speech clinician, reading specialist, special education teacher, general education teacher, and administrators	NA 1 2	NA 1 2
	Reviews the philosophy and goals of the school and district.	NA 1 2	NA 1 2
	Reviews the disciplinary policies, prevention programs, and crisis response plans of the school and district.	NA 1 2	NA 1 2
	Reviews the school's curricula, including the scope and sequence of the reading curriculum in the elementary school.	NA 1 2	NA 1 2
	Demonstrates understanding of, and adherence to, the district's special education regulations, guidelines, and procedures.	NA 1 2	NA 1 2
	Reviews IEP requirements and forms and observes an IEP meeting that includes the child's parent.	NA 1 2	NA 1 2
	Observes child study team (i.e., intervention assistance team, START team, etc.) and reviews its responsibilities, policies, and procedures.	NA 1 2	NA 1 2
	Observes school psychologist performing various services, including assessment linked to direct and indirect intervention.	NA 1 2	NA 1 2
	Observes and interviews staff of various school-based programs that serve students with diverse needs (check those that apply; 3 or more should be checked for each semester): ___ resource or TAM classrooms ___ classes, or schools, for children with low incidence disabilities (e.g., programs for children with autism, deafness, blindness, severe MR, etc.). Programs observed: ___________________________ ___ gifted education ___ alternative education ___ discipline (prevention and intervention) ___ school counseling ___ nursing ___ remedial reading ___ crisis response ___ other (__________________)	NA 1 2	NA 1 2
	Drawing from the above sources, and other sources, demonstrates an understanding and appreciation of a systems perspective toward schooling.	NA 1 2	NA 1 2
	Drawing from the above sources, and other sources, demonstrates an understanding and appreciation of human diversity, including knowledge of the importance of differences in families, cultures, and the individual backgrounds and learning characteristics of children.	NA 1 2	NA 1 2
For each objective in the following sections, please rate the student’s skill level using the following scale: 0 = Not appropriate for this placement. 1 = Unsatisfactory. (The student needs much more practice and supervision than the majority of other students at the same level of training). 2 = Satisfactory. (The student demonstrates skills consistent with current level of training. It is understood continued practice and supervision are recommended). 3 = Competent. (The student demonstrates mastery of this skill, requiring little, or no, additional supervision).
	Use of Multiple Methods to Gather Data	Mid-term	Final
	Reviews student records and obtains background information on the student’s developmental and educational history. Accurately summarizes the information, including results of previous evaluations, where appropriate.	0 1 2 3	0 1 2 3
	Interviews teachers and support staff and gathers information that addresses the referral question.	0 1 2 3	0 1 2 3
	Interviews parents (personally, or by phone if necessary) and gathers information that addresses the referral question.	0 1 2 3	0 1 2 3
	Interviews the student and gathers information that addresses the referral question.	0 1 2 3	0 1 2 3
	Observes the student and the classroom environment and gathers information that addresses the referral question. Employs methods of recording that are appropriate for the targeted behavior (e.g., narrative, interval, frequency, duration, momentary time sampling).	0 1 2 3	0 1 2 3
	Where appropriate, conducts functional behavioral assessments, as required in IDEA.	0 1 2 3	0 1 2 3
	Selects and uses a variety of assessment methods that address the referral question, are psychometrically sound, and provide an accurate and useful profile of the student’s strengths and weaknesses.	0 1 2 3	0 1 2 3
	Adheres to standardized directions and procedures when administering standardized tests of intellectual ability. List measures administered this semester:	0 1 2 3	0 1 2 3
	Adheres to standardized directions and procedures when administering standardized tests of academic achievement. List measures of general achievement and specific areas of achievement that were administered this semester:	0 1 2 3	0 1 2 3
	Adheres to standardized directions and procedures when administering standardized measures of social and emotional functioning and adaptive behavior. List measures administered this semester:	0 1 2 3	0 1 2 3
	Conducts curriculum-based assessments in specific areas of achievement to obtain practical, authentic information that addresses the referral question.	0 1 2 3	0 1 2 3
	Scores all tests with accuracy	0 1 2 3	0 1 2 3

0 = Not appropriate for this placement 1 = Unsatisfactory 2 = Satisfactory 3 = Competent
	Interpreting and reporting data	Midterm	Final
	Written report presents data clearly and accurately.	0 1 2 3	0 1 2 3
	Written report presents a clear, accurate, and useful interpretation of results of the assessment of intellectual ability.	0 1 2 3	0 1 2 3
	Written report presents a clear, accurate, and useful interpretation of results of the assessment of academic achievement.	0 1 2 3	0 1 2 3
	Written report presents a clear, accurate, and useful interpretation of results of the assessment of social, emotional, and adaptive functioning.	0 1 2 3	0 1 2 3
	Written report integrates data across multiple methods and sources.	0 1 2 3	0 1 2 3
	Written report addresses the referral question.	0 1 2 3	0 1 2 3
	Written report offers a variety of practical interventions that address the referral question and assessment results.	0 1 2 3	0 1 2 3
	Completes reports in a timely manner.	0 1 2 3	0 1 2 3
	In oral reports to teachers, parents, and others, data are presented clearly and accurately.	0 1 2 3	0 1 2 3
	In oral reports to teachers, parents, and others, a variety of practical interventions are discussed in a collaborative, problem solving manner.	0 1 2 3	0 1 2 3
	In oral reports to teachers, parents, and others the referral question is well addressed.	0 1 2 3	0 1 2 3

0 = Not appropriate for this placement 1 = Unsatisfactory 2 = Satisfactory 3 = Competent
	Linking Assessment to Interventions	Midterm	Final
	Selects and implements interventions that are linked to results of formal and informal methods of problem solving assessment.	0 1 2 3	0 1 2 3
	Implements interventions that address the referral question.	0 1 2 3	0 1 2 3
	Selects or develops interventions that are supported by theory and/or research.	0 1 2 3	0 1 2 3
	Selects or develops interventions based on the individual characteristics, strengths, and needs of students.	0 1 2 3	0 1 2 3
	Collaborates effectively with others throughout the assessment to intervention process.	0 1 2 3	0 1 2 3
	Collects and analyzes data to evaluate the effectiveness of interventions.	0 1 2 3	0 1 2 3
	Makes every effort to involve families in interventions.	0 1 2 3	0 1 2 3
	Below are a variety of direct and indirect interventions. Please check those for which the above skills have been applied and rate the student's competency for each intervention implemented.
	Direct Interventions:
	Individual counseling	0 1 2 3	0 1 2 3
	Group counseling	0 1 2 3	0 1 2 3
	Applied behavior analysis and intervention	0 1 2 3	0 1 2 3
	Social skills and social problem solving training	0 1 2 3	0 1 2 3
	Indirect Interventions:
	Collaborative consultation with individual teacher/support staff.	0 1 2 3	0 1 2 3
	Collaborative consultation with parents.	0 1 2 3	0 1 2 3
	Collaborative consultation with pre-referral or intervention assistance teams.	0 1 2 3	0 1 2 3
	Collaborative consultation with others (other than those listed above). Please list:	0 1 2 3	0 1 2 3
	In-service presentations to teachers, parents, and/or others.	0 1 2 3	0 1 2 3

Use of technology and information sources
Uses technology and information sources in a variety of assessment and intervention tasks in a manner that improves the quality of services. Rate each of the following used this semester:
Word processing	0 1 2 3	0 1 2 3
E-mail	0 1 2 3	0 1 2 3
Test scoring and interpretation	0 1 2 3	0 1 2 3
Information retrieval via various websites	0 1 2 3	0 1 2 3
PowerPoint and visual presentations of data	0 1 2 3	0 1 2 3
Other (please describe):	0 1 2 3	0 1 2 3

For each of the following professional behaviors, please rate the student’s skill level using the following scale: 0 = No opportunity to observe. 1 = Unsatisfactory. (The student fails to exhibit this professional behavior and needs to improve substantially in this area in order to function successfully as a school psychologist.) 2 = Satisfactory. (The student demonstrates this professional behavior, with only minor exceptions. Minor improvement in this may be needed.) 3 = Outstanding. (The student consistently demonstrates this professional behavior.)
Professional Behaviors:
	Reliable, responsible, and dependable	0 1 2 3	0 1 2 3
	Performs functions with confidence and appropriate assertiveness.	0 1 2 3	0 1 2 3
	Assumes initiative (e.g., doesn't wait to be told what needs to done).	0 1 2 3	0 1 2 3
	Is prepared for supervision.	0 1 2 3	0 1 2 3
	Accepts and makes effective use of feedback from supervisor.	0 1 2 3	0 1 2 3
	Establishes and maintains positive and appropriate relations with children.	0 1 2 3	0 1 2 3
	Establishes and maintains positive and collaborative relations with teachers and school staff.	0 1 2 3	0 1 2 3
	Establishes and maintains positive and collaborative relations with parents, families, and members of the community.	0 1 2 3	0 1 2 3
	Demonstrates awareness and responsiveness to human and cultural diversity.	0 1 2 3	0 1 2 3
	Consistently demonstrates sensitivity and interpersonal skills necessary to work with student, parents, teachers, and others of diverse characteristics.	0 1 2 3	0 1 2 3
	Understands and adheres to professional, ethical, and legal standards in school psychology and education.	0 1 2 3	0 1 2 3

ADDITIONAL ACTIVITIES THAT ARE MORE SPECIFIC TO THE INTERNSHIP. (However, please complete this section for practicum if any of these activities apply). 0 = Not appropriate for this placement 1 = Unsatisfactory 2 = Satisfactory 3 = Competent
	Works collaboratively with others at the systems-level in developing and implementing prevention and intervention programs that promote learning environments that are positive, safe, and facilitate the emotional, social, and academic development of all children. Please describe activities:	0 1 2 3	0 1 2 3
	Engages in research and program evaluation. Please describe activities:	0 1 2 3	0 1 2 3
	Stays abreast of current research and translates it into practice.	0 1 2 3	0 1 2 3
	Evaluates the effectiveness of interventions and consultation.	0 1 2 3	0 1 2 3
	Demonstrates commitment to continuous learning and professional development activities (e.g., is a member of state and/or national organization of school psychologists; attends meetings of professional organizations; attends local, state, or national workshops and in-services presentations; engages in self-study in areas of interest and need; subscribes to list-serves in school psychology). List activities below (and record them in your log).	0 1 2 3	0 1 2 3

Please sign and date when each component is completed:

Planning Component.                     Date:

    Signature of student:                Signature of site supervisor:


Supervisor's Comments:

    Student's Comments:

Mid-term Evaluation (practicum only).       Date:

    Signature of student:                Signature of site supervisor:


Supervisor's Comments:


    Student's Comments:

Final Evaluation.                    Date:

    Signature of student:                   Signature of site supervisor:


Supervisor's Comments:

    Student's Comments:

M.A. in School Psychology

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