School Psychology PhD Practicum Competencies, Outcomes ... · Web viewThe Pre-practicum, Practicum,...

University of Massachusetts BostonSchool Psychology PhD Program

School Psychology Fieldwork Handbook

ContentsCounseling and School Psychology PhD Program Fieldwork Requirements..............................................2

Practica....................................................................................................................................................................................... 3

School Psychology Advanced Practicum Database.................................................................................................9

Past Placements................................................................................................................................................................... 14

Cover Letter Template......................................................................................................................................................15

Sample CVs............................................................................................................................................................................. 16

Practicum Readiness Requirements...........................................................................................................................17

Advanced Practicum Student Evaluation Form.....................................................................................................18

Assessment Observation.............................................................................................................................................28

General Observation.....................................................................................................................................................29

Team Meeting Presentation.......................................................................................................................................30

New Advanced Practicum Form...................................................................................................................................32

Supervision Communication Flow Chart..................................................................................................................34

Appendix A. Pre-Practicum Experience Log (Post-Baccalaureate Students)...........................................35

Appendix B: Internship Placement Contract...........................................................................................................36

Appendix C: Case Study Rubric.....................................................................................................................................40

Appendix D: Psychoeducational Rubric....................................................................................................................47

Appendix E: Functional Behavioral Assessment / Behavior Intervention Plan Rubric.......................51

Appendix F: Intervention Treatment Integrity Checklist..................................................................................59

Appendix G: Data Analysis Table..................................................................................................................................60

Appendix H. Advanced Practicum Contract............................................................................................................61

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Counseling and School Psychology PhD Program Fieldwork Requirements

The University of Massachusetts Boston Counseling and School Psychology Ph.D. Program offers a balance of theory and practical experience. Pre-practicum, practicum, and internship fieldwork provide opportunities to apply professional skills and knowledge in fieldwork settings. The following are fieldwork requirements: pre-practica; four one-semester practica; and an internship (five days per week for an entire year). During field placements, students actively participate in the activities of a psychologist. Faculty and field supervisors measure students’ professional competencies via the “Practicum Student Evaluation Form.” The following information pertains to all students in fieldwork:

Ethical Guidelines. All students in fieldwork must be familiar with, and are held accountable to, all existing rules, requirements, and regulations of the site (school system, department, or institution) to which they are assigned. Students are also required to comply with professional ethical guidelines as outlined by NASP and APA.

Attendance. Punctual attendance is required for all days of assignment and placement. Students must notify the appropriate supervisor on any given day when illnesses or other emergencies interfere with attendance at their assigned placement. Students are expected to attend all orientation sessions, staff meetings, evaluation sessions, day or evening schedules or meetings required by the school system or institution, with the exception of events conflicting with the required seminar or their other classes. Students should also introduce themselves to site personnel and obtain information about the system’s organization and operation. Practicum and internship hours and vacations correspond to those of the site rather than to those of the university. The Internship is the equivalent of full time work for an entire year, which begins before, and ends after, the university academic year.

Liability Insurance. All practicum and internship students are required to acquire professional liability insurance prior to their field placement and to keep it current. Failure to obtain such insurance will result in a student not being permitted to enroll or participate in the placement. Practicum and Seminar Instructors must have a copy of the insurance verification. Student liability insurance can be obtained through APA or NASP with a student membership.

CORI and TB tests. When required by the site, pre-practicum students, practicum students, and interns must attain a Criminal Offender Record Inquiry (CORI) and/or a TB test. Sites may also require registry of fingerprints as part of the background check, and a fee may accompany this registration.

Logs. Logs are required in order to satisfy pre-practicum, practicum, and internship requirements. Logs list daily activities including conferences with the Field Supervisor as well as all forms of service delivery including meetings, counseling sessions, team evaluations, consultations with parents, teachers, children, and adolescents, and assessments of children and adolescents. The practicum and internship logs should be reviewed with the University Supervisor during each seminar meeting. Logs for pre-practicum experiences at the pre-practicum level are kept on the pre-practicum experience log (See Appendix A). Students enrolled in advanced practicum use either Time2Track (http://www.mypsychtrack.com/) or MyPsychTrack (http://www.mypsychtrack.com/). Students at the end of each semester print summary sheet(s), and have them signed by the Field Supervisor. These forms are then submitted to the Program Director for inclusion in the student’s permanent file. The Pre-practicum, Practicum, and Internship Logs are included in their entirety in the Portfolio that School Psychology students complete.

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http://www.mypsychtrack.com/


Practica

Students are required to complete a minimum of two practica in appropriate sites. As the minimum graduation requirement, students are to take four semesters of three-credit practicum (SPY785/786 and CSP785/786). Please know that these are the minimum practica requirements for graduation, but that once you have completed the minimum requirements you may continue to register for CSP 787, 1 to 3 credits per semester, for as many semesters as desired if you have an approved practica site.

Initial practicum activities are focused at the beginner level. Practicum supervision is closely provided by a University Supervisor (Practicum Instructor) and by appropriately credentialed personnel at the school or counseling sites. Students are provided with weekly conferences in which they obtain constructive feedback about their performance and progress. In addition, Practicum Instructors conduct weekly seminars and are responsible for assigning the grade. The fieldwork policies regarding ethical practice, attendance, CORI checks, liability insurance, and logs described previously apply to all practicum students.

Students who have already completed a Masters or Education Specialist Degree program must submit their materials for evaluation of practicum readiness, and be granted permission to enroll in the Advanced Practicum (CSP785/786). Readiness will be assessed through evaluating products by way of both the Case Study Rubric and Psycho-education Evaluation Rubric. Submissions for the readiness assessment evaluation are rolling but required to be submitted the semester prior to enrolling in practicum. Permission to enroll will be sent to students via email four to six weeks after the application. Students are requested to attend carefully to all prerequisites for practicum. The student’s advisor will sign the practicum application and file it on time.

Programs maintain lists of possible practicum sites. Practicum sites are identified by students in collaboration with program faculty and must be approved by the Practicum Coordinator and the Director of Training. Approved sites must meet specified criteria, including supervision by a licensed psychologist at least 1 hour per week for part time or 2 hours per week for full time placements. Students are responsible for successful interviewing and acceptance for each practicum site.

For your first two semesters of advanced practicum, School Psychology students register for CSP 785 & CSP 786. These two consecutive semesters are taken with one site. The minimum requirement for direct client contact hours is 25% of total hours for each semester. Students then enroll in CSP 787/788 for the necessary university supervision for at least two semesters.

For all practica, individual supervision needs to be provided on-site by an appropriately credentialed school psychologist or licensed psychologist field supervisor. UMB has structured practicum placements so that all students meet State licensure regulations in Massachusetts which indicate that all supervision oversight is conducted by a licensed mental health professional, with at least 50% of supervision be by a licensed psychologist. Exception to this requirement must be granted by the faculty after the student (1) meets with his or her advisor, (2) submits a letter of appeal to the faculty, and (3) is granted the waiver in writing.

For all practica, students are required to keep a detailed hour log (direct client contact hours, indirect service hours, supervision hours, etc.), which you are required to turn in as a final assignment. Many students recommend using the APPIC form on <time2track.com> or <MyPsychTrack>.University of Massachusetts Boston Field Placement Policy

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http://time2track.com/

The College of Education and Human Development (CEHD) at the University of Massachusetts Boston (UMass Boston) is committed to serving schools and community agencies and to providing authentic learning experiences for students enrolled in our professional preparation programs. Training professionals involves field placements (e.g., practicum, internship, student teaching). The following policies are offered to ensure productive learning experiences for pre-service students as well as mutually beneficial partnerships with schools and community agencies. Each academic program in CEHD will also provide information concerning field placement procedures and a description of student responsibilities.

Student Code of Conduct

Students in CEHD programs are obligated to meet all of the following conduct and training obligations throughout their enrollment in classroom and fieldwork experiences:

1. policies of the University of Massachusetts Boston, including the Code of Conduct https://www.umb.edu/life_on_campus/policies/community/code;

2. the standards or competencies required in their professional program of study or license/certification process;

3. rules/policies of the cooperating school or agency placement that do not conflict with UMass Boston policy

Students are expected to demonstrate appropriate conduct and professional dispositions essential for safe and competent practice at all times; examples include: honesty, trustworthiness, integrity, accountability, reliability, distinguishing right from wrong, avoidance of aggression to self and others, and taking personal responsibility for one’s own actions. Absence of these dispositions includes: hostile or destructive conduct toward self or others, disregard for the safety or rights of others; disregard for honesty, integrity, or trustworthiness; inability and/or unwillingness to maintain professional standards of behavior; inability to control personal stress, mental or emotional dysfunctions, and/or interpersonal difficulties that interfere with professional competence; substance abuse; and violations of federal, state, or local laws. Individual programs of study may include additional expectations regarding professional conduct.

Placement Assignments

Each program in the College of Education and Human Development that requires field placements has established procedures for making those placements. Procedures vary across programs. Students are responsible to learn and follow the policies and procedures.

1. In order for students to be placed, the field placement policy of each program must be followed, including, but not limited to: application deadlines, site selection, completion of prerequisite coursework, completing placement forms, applications, and/or contracts before the established due dates.

2. Students expecting to participate in a field placement must meet their respective program requirements and register for the appropriate course.

3. Students who want to participate in a field placement must exhibit professional conduct/behavior throughout all courses in the program. Failure to exhibit professional conduct/behavior may result in denial of field placement.

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a. A student’s unprofessional conduct may be reported to the Program Director by faculty members, university staff, other students, or staff in partnering schools/community agencies.

b. Upon review of the allegations and using the standards listed in the first section of this guide, the Program Director may decide to deny a field placement and implement a remediation or termination plan consistent with their program guidelines.

c. A student who believes his or her conduct is not in violation of the standards or a decision has been made on the basis of factual error can appeal this decision to the Department Chair.

d. If the field placement is required for completion of the degree/license/certificate, inability to complete the fieldwork requirements after remediation attempts have been unsuccessful at a placement, would lead to termination from the program.

Problems during Field Experience

If a student encounters problems related to a field experience,1. the student has a responsibility to contact the University supervisor (i.e., primary

supervisor/teacher of record for field placement, practicum, or internship) overseeing the placement to resolve the problem. The supervisor and student may work on a plan to resolve the concern or problem occurring within the placement. The student and university supervisor will follow the plan for resolution or remediation of the problem.

2. If the concern is not resolved to a satisfactory conclusion, the student should contact the UMass Boston Program Director.

3. If the concern is not resolved to a satisfactory conclusion after meeting the Program Director, the student and Program Director should refer the matter to the Department Chair.

Background Check and Violations of Law

Students applying for field placement may be required to undergo a Criminal Offender Record Information (CORI) check through their placement site and may be required to undergo a National Background Check (NBC), including fingerprinting. Students may also be asked by their program to complete a self-report background check. The purpose of these checks is to ensure public safety and avoid unacceptable risk to vulnerable populations. Students who refuse to consent to a CORI/NBC will be administratively withdrawn from their program.

Background checks are typically conducted by the placement site. If a violation is discovered or self-reported, authorized personnel at the school or agency determine the suitability of a candidate for placement at the facility. The UMass Boston Program Director may also determine the suitability of a candidate for field placement eligibility based on discovered or self-reported information. Unless otherwise provided by law, factors considered in determining suitability may include, but are not limited to the following:

relevance of the crime to the practical experience nature of the work to be performed time since conviction

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age of the candidate at the time of the offense seriousness and specific circumstances of the offense number of offenses existence of pending charges any relevant evidence of rehabilitation

Students may challenge a CORI finding by appealing to the Commonwealth of Massachusetts Criminal History Systems Board.

If a student is charged with a crime during field placement, he/she must report it to the University supervisor or Program Director. Depending on the nature of the violation, the Program Director and Department Chair may suspend the student from the field experience or terminate the student from the program.

Please refer to the UMass Boston student Code of Conduct for policy regarding a student being charged with a crime at any time during their enrollment in an academic program.

Performance Evaluation

Each program outlines the learning goals and professional conduct expectations during field experiences, including those listed in the above section Student Code of Conduct.

1. Students are evaluated by their University instructor in consultation with the cooperating professional at the placement site according to the criteria set by the program of study and the instructor.

2. Grades can be appealed through a process established by the University and found on the UMass Boston website: https://www.umb.edu/life_on_campus/policies/academics.

3. University supervisors will report problems or concerns with performance or conduct in field placements to the Program Director or Department Chair.

4. A concern related to the safety or well-being of an individual or to the violation of professional standards may result in immediate removal from a placement while the issue is considered by the Program Director or Department Chair. A student would only be allowed to resume the placement with the permission of the Program Director or Department Chair. If the violation is confirmed and removal from a placement is upheld, this may be considered failing the course.

5. If a student is asked to leave a field placement by the cooperating professional or is removed from a placement by the department for unsatisfactory performance or conduct, the student may receive a failing grade for the course. A failing grade resulting from a request by the cooperating school or community agency to remove a student is not subject to appeal through the College.

6. Each program publishes its requirements for academic and professional performance and the consequences of failing a field placement experience. Program faculty may allow a student to continue in the program with an additional field placement, subject to conditions outlined in a probationary performance or remedial plan for completing that field placement. A student who fails two field experiences will not be allowed to complete the program.

7. If a student is allowed to continue in the program, failing a field placement requires repeating the entire experience.

8. Occasionally, a student may not meet the requirements to pass a field placement but the University instructor believes that extending the placement may allow the student to satisfy the requirement. An extension can be granted in these circumstances with the approval of the cooperating school or agency.

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Telesupervision Policy and Procedures

Supervision by telephone and/or video call is allowed, provided the program criteria and circumstances are met. The overarching principle is that telesupervision is the exception, not the rule, and therefore use of telesupervision must always be justified and approved by the DTC.

While supervision has historically been delivered in face-to-face sessions, either in dyads or small groups, advances in technology and changes in practice standards have opened up opportunities for the use of telesupervision to augment primary supervision in clinical training. Supervisor expertise, and the working alliance between supervisor and supervisee are important factors in considering the use of telesupervision. In situations in which utilizing a remote supervisor would enhance either of these factors, it should be considered and may have priority over supervisory dyads that would lead to suboptimal expertise and/or working alliance. In some circumstances a student may have the opportunity to receive training in a remote location, making in-person telesupervision with UMB faculty prohibitive. Such situations will have numerous ramifications on training and must be approved by the DCT – thus the use of telesupervision in these cases will be considered within the overall benefit of the remote training opportunity. These policies are created in accordance with the APA guidelines - http://www.apa.org/ed/accreditation/about/policies/implementing-regs.pdf (page 81).

The following criteria outline our policy requirements for the use of telesupervision.

1. Telesupervision can only be utilized in dyadic supervision, it is not permissible for group supervision.

2. Telesupervision may not exceed one hour, or 50% of weekly supervision received during pre-practicum, practicum, or internship.

3. Telesupervision cannot be utilized during a student’s first year of practicum (SPY685/686).4. Telesupervision may be conducted on a voice-only communication line, but video is preferred.

a. While it is possible to discuss clients in “anonymous” language for much of supervision, there may be times in which personal identifiers must be used. Hence, the video mechanism must be HIPAA compliant. At the time of this writing, neither Skype, or Google Hangouts are HIPAA compliant.

5. Telesupervision cannot be the “primary” form of supervision. Students must receive regular supervision from a licensed psychologist who works on the premises of the training site and who assumes primary responsibility for the student’s clients.

a. Consequently, non-scheduled and crisis situations must be addressed first with the primary supervisor.

b. Primary supervisors are not always available; thus if secondary supervision is telesupervision then there must be a written procedure indicating what days/times the supervisor is available (and thus unavailable) and specific procedures for the trainee to follow in crises situations should the primary supervisor not be available; and, situations for when the secondary supervisor is not available. This written procedure should be presented at the time that telesupervision is being requested and thus a part of the DCT approval process.

6. Any student in good standing who has completed SPY 685 and SPY 686 may petition to receive telesupervision.

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http://www.apa.org/ed/accreditation/about/policies/implementing-regs.pdf

Professional knowledge and skills. Upon completing the final practicum, the practicum student must demonstrate adequate skills in each domain of practice. Adequate professional skills are demonstrated by:

(1) Scores of at least 4.0 average for all scores on the final “Practicum Evaluation” completed by the Field Supervisor, and no less than 4.0 in any of the following domains: 1. Relationship/Interpersonal Skills; 2. Ethics; 8. Professional Development—Skills to maintain effective clinical practice; and, 9. Professional Development—Competencies.

(2) Grades of at least 3.0 on required practicum assignments including if applicable independently completed psychological assessments and reports; intervention design, implementation, and monitoring, as evidenced by successful case studies; and other assignments such as the design and implementation of in-service training programs as well as program evaluations.

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School Psychology Advanced Practicum Database

Site Name and Training Director Application Due Date Required Materials Submission Directions Site Information

K-12 PUBLIC SCHOOL DISTRICTSBoston Public School District: Dr. Catherine Ellison-Rosa Parks Early Education School & Reverend Michael C. Haynes Early Education Center

Paula St. James, Ph.D.Ellison/Parks: 617-635-7680Haynes: 617-635-6446Email: [email protected]

None required (partnership with program)

NA NA http://www.bostonpublicschools.org/Page/811

http://www.bostonpublicschools.org/Page/828

Boston Public School District: Boston Latin School

Allen Cohen, Ph.D.(617) 635-8895Email: [email protected] g


NA NA http://www.bls.org/

Boston Public School District: Samuel W. Mason Elementary School

Mary Cohen, Ph.D.617-635-8405Email: [email protected]


NA NA https://sites.google.com/site/masonpilot/

Boston Public School District: Mattahunt Elementary School

Jennifer Corish-White, M.Ed., [email protected]


NA NA http://www.bostonpublicschools.org/school/mattahunt-elementary-school

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http://www.bostonpublicschools.org/school/mattahunt-elementary-school



https://sites.google.com/site/masonpilot/

https://sites.google.com/site/masonpilot/

http://www.bls.org/

mailto:[email protected]








gBurlington Public School District

John Shoudt,[email protected]


NANA http://www.burlington.org/

residents/schools/burlington_public_schools/index.php

EastCONN

Ravit Stein,Ph.D.(860) 228-3240 [email protected]


NA NA http://www.eastconn.org/index.php/psychological-behavioral-consultation-services

The May Institute

Marcie Handler,Ph.D., [email protected]


NA NA http://www.mayinstitute.org/consultation-to-schools/index.html

Wediko Children’s Services

Edward J. Zadravec, [email protected]


NA NA http://www.wediko.org/school-based-services.html

HOSPITAL/STATE AGENCYLearning Support Services Office Massachusetts Department of Elementary & Secondary Education

Jennifer Curtain, M.PHRachelle Engler Bennett, [email protected]

Rolling *Letter of interest*Resume

http://www.doe.mass.edu/jobs/intern.html

http://www.doe.mass.edu/ssce/ss.html

Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program at Boston Children’s Hospital

David Helm, Ph.D.

Rolling *Letter of Interest*Resume*References

Submit to:David Helm, Ph.D.Institute for Community Inclusion/LEND ProjectChildren’s Hospital300 Longwood AvenueBoston, MA 02115

http://www.lendboston.org

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http://www.lendboston.org/

http://www.doe.mass.edu/ssce/ss.html




http://www.burlington.org/residents/schools/burlington_public_schools/index.php




School Psychology PhD Practicum Competencies, Outcomes, & Artifacts 2016

Course Requirement CDSPP Practicum Competency Standards

Outcome Measure Portfolio Artifacts

Skills in forming & Maintaining productive

relationshipsEthical skills

Supervisory skillsPro development

1 – skills in forming & Maintaining productive relationships

7-ethical skills 9-supervisory skills 10-pro development

Student Evaluation Form (completed by Field Supervisor)

Critical Personal Qualities Rubric (completed by Field Supervisor)

Site Impressions Rubric

Site Impressions Form

Policy-development/school-hospital partnership

collaboration

5 – consultation/inter-professional collaboration

7-ethical skills 9-supervisory skills

Consultation Rating Form – completed by consultee

Think about attending meetings & grant stuff for DESE

Where to evaluate the following activity: Modify CBHM handbook to address family-school collaboration

Meeting Reflection

Training or in-service experiences

8-leadership skills 2-research skills

Presentation evaluation Presentation Evaluation

Participant Ratings

Presentation powerpoint & other presentation materials

Program Evaluation 5 – consultation/inter-professional collaboration

6-skills in cultural and linguistic diversity

Program Evaluation Form & Rubric

Needs Assessment Logic Model Report that includes

Evaluation of Summative

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7-ethical skills 8-leadership skills

& Formative Data

Course Requirement CDSPP Practicum Competency Standards

Outcome Measure Portfolio Artifacts

Applied Research –single-case design

2 – Research Skills 4- intervention skills 5 – consultation/inter-

professional collaboration 7-ethical skills

Case Study Rubric Case Study Report

Direct & Indirect Service Delivery with Complex Cases

4- Intervention Skills 5-consultation/inter-

professional collaboration 6-skills in cultural and linguistic

diversity 7-ethical skills

Consultation Rating form – completed by consultee

Parent satisfaction survey Counseling plan rubric Case study plan & rubric Presentation evaluation

Consultation Case Notes Case study plan Counseling Plan & Notes Presentation ppt and

other materials

Community-based/Tertiary-care & School collaboration

5-consultation/inter-professional collaboration


7-ethical skills 8-leadership skills

Consultation Rating form – completed by consultee

Consultation Case Notes

Psychoeducational /FBA/Advanced screening

Assessments

3 – Psychological Assessment Skills


7-ethical skills 8-leadership

FBA & BIP plan rubric Parent satisfaction survey Psychoeducational assessment

rubric Presentation evaluation Universal Screening Report

Rubric

Psychoeducation assessment report

FBA/BIP report & Plan Presentation ppt and

other materials

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Past Placements

2013-14Boston Public School District: Dr. Catherine Ellison-Rosa Parks Early Education School & Reverend Michael C. Haynes Early Education Center

Boston Public School District: Boston Latin School

Boston Public School District: Samuel W. Mason Elementary School

Learning Support Services Office of the Massachusetts Department of Elementary and Secondary Education

2014-15

Boston Public School District: Dr. Catherine Ellison-Rosa Parks Early Education School & Reverend Michael C. Haynes Early Education Center

Boston Public School District: Mattahunt Elementary School

Burlington Public School District

Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program at Boston Children’s Hospital

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Cover Letter Template(Applying to Pre-Doctoral Internships)

Your AddressTypedHere Date The Site addressTypedHere Dear Dr. ***, I am writing to apply for a position as a pre-doctoral intern at ***site beginning in ***. I am a doctoral student at the University of Massachusetts Boston’s School Psychology Program and will be beginning my [fourth] year of doctoral work following a terminal Masters degree in which I completed over [1000] supervised clinical hours (if true!).

Write a paragraph or so describing why you are a good fit for this site. Think about what you think would make the supervisors at the site interested in interviewing you. What you write should be tailored to each site. You could write about past clinical experiences you have had, training experiences, your background, any language skills you have, the types of clients you have seen, the classes you have taken, or papers/projects you have conducted. Selectively highlight certain accomplishments (e.g., coursework, clinical experiences, readings, research) in connection with the site’s goals and your learning goals to show how you are a good fit there. Show them your interests by telling them about your research, readings, coursework in a given area and then tell them about your future plans to augment this information. Try to avoid simply listing your experiences, as these are on your CV. This is the place where you show who you are, not just what you have done, by describing your intentions, passions, interests, and connection to this particular site. You might describe what you are especially looking forward to learning at their site. You might highlight here the type and amount of supervision you have had. It is good for the site to hear that you are interested in learning from them and interested in what they have to offer. Provide your contact information in a closing paragraph, indicate that you would welcome the opportunity to visit the site, and thank the readers for their consideration. Sincerely, Student, M.S.

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Sample CVs

Please visit the CSP PhD program website to view sample CVs.

URL: https://w.taskstream.com/ts/beard35/CounselingSchoolPsychologyPhDProgram.html Password: (contact me)

Please note that if you are visiting the site on a shared/public computer, you should close the browser when you’re done in order to sign out of the website (and make sure no one outside our program can see it).

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https://w.taskstream.com/ts/beard35/CounselingSchoolPsychologyPhDProgram.html

Practicum Readiness Requirements

The following three areas are evaluated before approval is provided for students to proceed to advanced practicum. Post-bachelors students will supply this information following the masters’ coursework and practica experiences, in the second or third year of the program. Post-masters students should supply this information within the first year of the program, by April of the spring semester.

1. Coursework completeda. COU 617 (or equivalent)b. COU 614 (or equivalent)c. SPY 601 (or equivalent)d. SPY 602 (or equivalent)e. SPY 603 (or equivalent)f. SPY 604 (or equivalent)g. SPY 607 or 608 (or equivalent)h. COU 632 (or equivalent)i. SPY 635 (or equivalent)j. SPY 685 (or equivalent)k. SPY 686 (or equivalent)

2. Psycho-educational Assessment Report: Students wishing to participate in advanced practicum must submit a completed comprehensive psychoeducational assessment report to be evaluated.

3. Case Study Report: Students wishing to participate in advanced practicum must submit a case study addressing an academic, social skill, or behavioral problem that includes progress monitoring data and provision of an intervention (direct or indirect).

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University of Massachusetts BostonPh.D. Program in School Psychology

Advanced Practicum Student Evaluation Form(to be completed by student’s practicum supervisor)

Adapted from Evaluation Form developed by Joan H. Liem, Ph.D. and reflect The Council of Directors of School Psychology Programs (CDSPP) Practicum Taskforce adaption (2009-2010) of the Practicum Competencies Outline

(Hatcher & Lassiter, 2007).

Student Name:

Practicum Site:

Practicum Supervisor(s):

Date of Training Period:

Please evaluate students in the competencies listed below, noting that ethical issues, consideration of individual and cultural differences, and integration of evidence-based practice are integral to the achievement of each competency. For the numerical ratings, please use the following scale:

For a doctoral student at the current level of training, the student:4 – Exceeds expected competence3 – Meets expected competence2 – Does not meet expected competence but is projected to attain required competence within the

required training period by minor remediation1 – Does not meet expected competence but is projected to attain required competence within the

required training period by major remediation0 – Does not meet expected competence and is not projected to attain required competence within

the required training periodN/A –If an item is not applicable to the student/site

We also would appreciate your comments concerning how you see the student’s growth in competencies, their special strengths, and areas in need of further development.

1. Relationship/Interpersonal Skills Midyear End of year

a) Establishing and maintaining productive, professional relationships with clients/families, including children and adolescents, from diverse backgrounds.

b) Establishing and maintaining productive, professional relationships with colleagues individually.

c) Establishing and maintaining productive, professional relationships with supervisors.

d) Establishing and maintaining productive, professional relationships with support staff (e.g., the ability to be respectful of support staff roles and persons).

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e) Establishing and maintaining productive, professional relationships as a team member at the practicum site (e.g. the ability to participate fully in team’s work and to understand and observe team’s operating procedures).

f) Establishing and maintaining productive, professional relationships with community professionals (e.g., communicate professionally and work collaboratively with community professional).

Please note any additional comments you would like to make about the student's relationship/ interpersonal competence here:

Mid-Year

End-of-Year

2. Ethics: Midyear End of year

a) Has knowledge of ethical/professional codes, standards and guidelines, including school specific issues.

b) Demonstrates understanding of client/systems issues.

c) Recognizes and analyzes ethical and legal issues across the range of professional activities in the practicum setting.

d) Recognizes and understands the ethical dimensions/features of his/her own attitudes and practice in the school/clinical setting.

e) Practices appropriate professional assertiveness related to ethical issues (e.g., by raising issues when they become apparent).

f) Seeks appropriate information and supervision/consultation when faced with ethical issues.

g) Evidences commitment to ethical practice.

Please note any additional comments you would like to make about the student's competence in ethics here:

Mid-Year

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End-of-Year

3. Knowledge of and Application of Research Skills Midyear End of year

a) Development of skills and habits in seeking and applying theoretical and research knowledge relevant to the practice of psychology in the school/clinical setting, including accessing and applying scientific knowledge bases.

b) Understanding and application of theoretical and research knowledge related to diagnosis/assessment.

c) Understanding and application of theoretical and research knowledge related to prevention/intervention.

d) Understanding and application of theoretical and research knowledge related to consultation.

e) Understanding and application of theoretical and research knowledge related to diversity issues.

f) Understanding and application of theoretical and research knowledge related to supervision.

g) Understanding and application of theoretical and research knowledge related to ethical practice.

h) Demonstrates ability to share research-based information both in oral and written formats with colleagues, patients/clients, ad families in order to promote best practices.

Please note any additional comments you would like to make about the student's competence in application of research here:

Mid-Year

End-of-Year

4. Psychological Assessment Skills Midyear End of year

a) Ability to select and implement multiple methods and means of evaluation in ways that are responsive to and respectful of diverse individuals, couples, families or groups.

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b) Ability to utilize systematic approaches to gathering data to inform clinical/professional decision making.

c) The student demonstrates knowledge of psychometric issues and bases of assessment methods including recognition of the importance of using valid assessment tools with different populations and to make decisions.

d) The student demonstrates skill in administering evaluation instruments to various populations, including specialized groups such as young children, English Language Learners, etc.

e) The student demonstrates the ability to score and interpret results from individual assessment instruments.

f) The student demonstrates the ability to integrate assessment data from different sources for diagnostic purposes.

g) The student demonstrates the ability to select, implement, score and interpret group screening instruments (e.g., Response to Intervention).

h) The student demonstrates the ability to integrate assessment results to develop appropriate academic, behavioral, and socio-emotional intervention recommendations.

i) The student demonstrates an understanding of the strengths and limitations of current assessments and diagnostic approaches.

j) The student demonstrates an understanding of the strengths and limitations of current assessments and diagnostic approaches.

k) The student demonstrates the ability to verbally communicate assessment results to diverse audiences including other professionals, parents, children, etc.

l) The student demonstrates the ability to communicate assessment results to diverse audiences in written form.

m) The student demonstrates the ability to collect and use assessment results to monitor the impact of interventions on academic, social, behavioral and emotional functioning.

Please note any additional comments you would like to make about the student's competence in assessment here:

Mid-Year

End-of-Year

5. Intervention Skills Midyear End of year

a) Ability to formulate and conceptualize cases in a developmentally and

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culturally appropriate manner.b) The student demonstrates knowledge of psychological intervention theory,

research and practice.c) The student demonstrates knowledge of the influence of context and

systems on client behavior and intervention effectiveness.d) Ability to implement intervention skills, covering a wide range of

developmental, preventive and “remedial” interventions, including psychotherapy (e.g., CBT, behavioral, etc.), psychoeducational interventions, crisis management and psychological/psychiatric emergency situations, depending on the focus and scope of the practicum site and the developmental and cultural background of the client(s).

e) The student demonstrates the ability to support intervention integrity through the use of appropriate organizational and change strategies.

f) The student demonstrates the ability to assess and monitor intervention progress and outcomes.

g) The student demonstrates the ability to link concepts of therapeutic process and change to intervention strategies and tactics.

Please note any additional comments you would like to make about the student's competence in intervention skills here:

Mid-Year

End-of-Year

6. Consultation/Interprofessional Collaboration Skills: Midyear End of year

a) The student demonstrates knowledge of consultation models (e.g., expert, consultee-centered, collaborative, process, etc.)

b) The student demonstrates knowledge of the unique role of other professionals and family members.

c) The student demonstrates the interpersonal and communication skills necessary for effective consultation, including the ability to communicate with other professionals and family members involved in the individual's care (e.g., physicians, teachers, etc.) and avoid the use of psychological jargon.

d) The student demonstrates the ability to implement a systematic approach to data collection in a consultative role.

e) The student demonstrates the ability to initiate and maintain effective

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consultation with other professionals and family members.f) The student will be able to articulate, align and coordinate the home,

school and community contexts as a means to facilitate positive outcomes for students, both behaviorally and academically.

g) The student demonstrates the ability to write well-organized and succinct consultative reports which provide useful and relevant recommendations to other professionals.

h) The student demonstrates an understanding of the multicultural aspects of consultation and demonstrate the ability to consult cross-culturally.

Please note any additional comments you would like to make about the student's competence in consultation/collaboration here:

Mid-Year

End-of-Year

7. Skills in Cultural and Linguistic Diversity: Midyear End of year

a) The student demonstrates knowledge of self in the context of diversity as one operates across environments with diverse others (i.e., knowledge of self-values, attitudes, beliefs and personal strengths and limitations).

b) The student demonstrates knowledge of the role culture plays across the lifespan.

c) The student demonstrates knowledge of the nature and impact of diversity across home, school and community settings.

d) The student demonstrates knowledge of the role of cultural and language difference in academic, behavioral, and social-emotional assessment and interventions.

e) The student demonstrates the ability to work effectively with diverse individuals in assessment, treatment and consultation.

f) The student demonstrates the ability to communicate effectively with culturally and linguistically diverse individuals, including children, parents, and other family, school, or community members.

Please note any additional comments you would like to make about the student's competence in consultation/collaboration here:

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Mid-Year

End-of-Year

8. Leadership Skills: Midyear End of year

a) The student will recognize his or her role in creating policy, participating in system change, and management.

b) The student demonstrates an understanding of the major staff and administrative roles of the organization and the relationship between roles of supervisor, manager and executive.

c) The student will be able to identify the decision making processes, norms, values and culture of the practicum setting.

d) The student demonstrates an understanding of the role of leadership in

promoting organizational effectiveness.e) The student demonstrates an awareness of the role of social relationships

and interactions in the development of social change.f) The student demonstrates an understanding of the purpose and process of

collaborative strategic planning.g) The student demonstrates an understanding of the financial structure of the

practicum setting as it pertains to psychological service delivery.h) The student recognizes the importance of structuring, planning and

facilitating effective meetings.i) The student demonstrates an understanding of the organizational change

process and how organizational structures such as staffing, stakeholder support, committees, and evaluation and feedback systems can influence the success of change efforts.

j) The student demonstrates the ability to assess the fit of potential new practices and programs within an organization.

k) The student demonstrates the ability to provide appropriate training and technical assistance options to organizational staff in order to facilitate the provision of new practices and programs.

Please note any additional comments you would like to make about the student's supervisory competence here:

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Mid-Year

End-of-Year

9. Supervisory Knowledge and Skills: Midyear End of year

a) The student demonstrates knowledge of how psychology students develop into skilled professionals.

b) The student demonstrates knowledge of the methods and issues related to the evaluation of professional work, including the delivery of formative and summative feedback.

c) The student demonstrates knowledge of the ethical and legal aspects of the supervisory relationship.

d) The student demonstrates knowledge of individual and cultural differences in the supervision process.

e) The student demonstrates knowledge of supervisory models, theories and research.

f) The student demonstrates knowledge of the limits of his or her supervisory skills.


Mid-Year

End-of-Year

10. Professional Development: Midyear End of year

a) The student demonstrates adherence to the agency/school's procedures and guidelines while adhering to professional ethics.

b) The student will develop an organized and disciplined approach to time management and professional practice (systematic organization of daily activities, timely writing, maintenance of notes and records, attendance, promptness, etc.)

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c) The student will be organized and prepared for professional service delivery.

d) The student will responsibly carry out assigned duties.e) The student demonstrates flexibility and adaptability to novel and

unexpected situations.f) The student will utilize resources to promote effective practice and continued

professional development.


Mid-Year

End-of-Year

11. Metaknowledge/Metacompetencies – Skilled Learning: Midyear End of yeara) The student demonstrates sensitivity to the boundaries of his or her

professional expertise.b) The student demonstrates an awareness of his or her personal well-

being and will be able to seek resources to promote self-care and healthy functioning.

c) The student demonstrates knowledge of the epistemologies underlying various aspects of psychological practice (e.g. assessment, diagnosis, treatment, consultation, prevention, etc.).

d) The student demonstrates a commitment to life-long learning and quality improvement.

e) The student demonstrates the ability to use supervision, consultation, and other resources to improve and extend his or her skills.

Please note any additional comments you would like to make about the student's professional development here:

Mid-Year

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End-of-Year

Summative

Please indicate the student’s overall areas of strength and competency:

Mid-Year

End-of-Year

Please indicate areas in which further growth is needed. (Please discuss any areas in which you gave the student a 0, 1, or 2 and note appropriate remediation plans where indicated.)

Mid-Year

End-of-Year

Do you recommend that the student receive credit for this practicum? Yes No

Signature(s) of Supervisor(s): Date:

Signature(s) of Supervisor(s): Date:

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Signature of Student: Date: Assessment ObservationSchool Psychology Program

University of Massachusetts Boston

Intern: Observer:School: Date:Grade:Instrument(s) Observed:

Level: Elementary (P-5) Middle (6-8) Secondary (9-12)Type: Academic Behavioral Emotional ELL

Relevant Domains:1. Relationship/Interpersonal Skills 7. Skills in Cultural & Linguistic Diversity2. Ethics 8. Leadership Skills3. Knowledge & Application of Research Skills 9. Supervisory Knowledge & Skills4. Psychological Assessment Skills 10. Professional Development5. Intervention Skills 11. Metaknowledge/Metacompetencies6. Consultation/Interprofessional Collaboration Skills

Remediation Required

Meets Expectations

Exceeds Expectations

Not Applicable

Rapport with examineeOrganization of testing materialsComfort level of test administrationAdherence to test directions according to test manualsAdherence to appropriate scoring proceduresUse of stopwatchResponse to needs for breaks or redirectionEfficiency of timeAn X indicates the rating for each criterion.

Specific Notes:

Date of Feedback Conference:

_____________________________ ___________________________________Intern Signature Field or University Supervisor

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Observation Forms General Observation

School Psychology ProgramUniversity of Massachusetts Boston

Intern: Observer:School: Date:Activity:

Level: Elementary (P-5) Middle (6-8) Secondary (9-12)Type: Academic Behavioral Emotional ELLUse an X to indicate the appropriateness of the report.


CriterionRemediation

RequiredMeets

ExpectationsExceeds

ExpectationsN/A

Arrived on timeWas professional in appearanceDemonstrated good rapport othersWas well organizedUsed appropriate forms and proceduresSpoke audiblyUsed language & terminology that communicated effectivelySolicited inputAnswered questions knowledgeablySummarized/paraphrased important points

Observation narrative:

Suggestions and Comments:


_______________________________ ________________________________Signature of Intern Signature of University or Field Supervisor

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Observation FormsTeam Meeting PresentationSchool Psychology Program

University of Massachusetts Boston

Intern: Observer:School: Date:

Level: Elementary (P-5) Middle (6-8) Secondary (9-12)Type: Academic Behavioral Emotional ELL

Observation Forms, General Observation

Intern: Observer:School: Date:Activity:

Level: Elementary (P-5) Middle (6-8) Secondary (9-12)Type: Academic Behavioral Emotional ELLUse an X to indicate the appropriateness of the report.


CriterionRemediation Required

Meets Expectations

Exceeds Expectations

N/A

Arrived on timeWas professional in appearanceDemonstrated good rapport othersWas well organizedUsed appropriate forms and proceduresSpoke audiblyUsed language & terminology that communicated effectivelySolicited inputAnswered questions knowledgeablySummarized/paraphrased important pointsObservation narrative:

Suggestions and Comments:

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Date of Feedback Conference: _______________________________ ________________________________Signature of Intern Signature of University or Field Supervisor

GeneralRemediation

RequiredMeets

ExpectationsExceeds

ExpectationsN/A

Arrived on timeDemonstrated good rapport with othersWas well organizedUsed appropriate forms and proceduresSpoke audiblyCommunicated effectivelySolicited inputAnswered questions knowledgeablySummarized/paraphrased important pointsMade suggestions for action or arranged for further contactInitial MeetingReview of recordsCompletion of psychology referral formExplanation of proposed testing/checklistsAssessment ReviewExplanation of tests administeredExplanation of report conclusionsAbility to talk about recommendations

Specific Notes:


_______________________________ ________________________________Signature of Intern Signature of University or Field Supervisor

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New Advanced Practicum Form

Faculty Member/Doctoral Student submitting form: Site Name:

Practicum Title(s) (e.g., School Psychology Practicum, School consultation, etc...):

Supervisor Contact info (phone, email, mailing address):

Supervisor Degree: Degree: ___Ph.D. ___Psy.D. ____NCSP ____MSW ___MA (LEP) ___Other(please describe below

Supervisor Massachusetts Licensure Status (please indicate if licensed in another state):

Website for practicum site:

Practicum site address:

Setting description (e.g., Public School District, Private School, community mental health setting, or hospital):

Application due date:

Application requirements and process (e.g., Cover letter (in which you describe your interests and qualifications), and your CV.):

Application prerequisites (e.g., testing experience, foreign language fluency):

Practicum paid: ___No ___Yes (If yes, rate per hour $___ OR salary $_______ for ______ months)

This practicum provides students the following training experiences (X to left of descriptor indicates the experience is available at the site):

______ Academic Assessment______ Socio-Emotional Assessment______ Cognitive Assessment______ Curriculum-based Assessment and/or intervention______ Behavioral Consultation______ Systems Assessment and Intervention

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______ Individual Counseling / Therapy with children______ Family Counseling / Therapy______ Group Counseling / Therapy______ Group Supervision______ Professional Development / Didactic Training______ Multidisciplinary Treatment Meetings / Grand rounds

Notes (e.g., specific forms of treatment, didactics or trainings offered, descriptions of psychotherapy orientations students will learn about, descriptions of learning activities):

Start date:

End date:

Average direct client contact hours/week:

Required total hours/week (e.g., amount of hours per week and time off):

Supervision hours/week (at minimum 1 hour of supervision for every 4 direct client contact hours):

Types of Supervision/Psychotherapy Orientations/Interventions:

Days and specific times required to be on-site (Note: Graduate classes are usually held on Mondays and Tuesdays): Number of practicum students/year:

Diversity of population (e.g., Give us a sense of the type of clients that you typically see by giving rough estimates of proportions of clients of different diagnoses, cultural or diversity factors such as cultural background, age, socio-economic status, sexual orientation, gender, as relevant to your setting. This information can help students who are interested in working with a particular population take note of your site):

Notes for Faculty/Students gathering information: Our Requirements

1. 1:4 ratio of supervision to direct client hours,2. "Enough" variability in clients 3. Availability to take essential classes for that year4. Licensed psychologist in MA on site5. Appropriate activities (including about 8 hours of direct client hours per week)6. Time – must be minimum of 16 and no more than 25 unless advanced prac in final on-

campus year.

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Supervision Communication Flow ChartDoctoral & EdS Fieldwork in School Psychology

Student speaks directly to site supervisor

Student speaks directly to university supervisor with plans to follow up with

site supervisor

Student speaks directly to site supervisor

If the issue can't be resolved between the student and sitesupervisor, the

supervisor will contact the university supervisor

If the issue can't be resolved between the siteand university supervisors, the

site Supervison Coordinator is to be contacted by the univeristy supervision

contact person

A resolution will be determined between the siteSupervision Coordinator and the

university supervision contact personThe resolution will be communicated by the site Supervision Coordinator and the university supervision contact person to

their respective parties

A problem-solving meeting, supported by the Site Supervision Coordinator, is

always an available option and open to students, university parterns and site

supervisors

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Appendix A. Pre-Practicum Experience Log (Post-Baccalaureate Students).

Log for Pre-PracticumUniversity of Massachusetts Boston

School Psychology Program

Student: _________________________ Student ID: _______________

Instructor: _______________________ Course: _________ Term and Year: ___________

Directions: Indicate the date, the location, the activities pursued, domains of training and practice addressed, and the number of hours in each activity. Obtain the signature of an appropriate school employee or parent for each activity.

Key to Domains:1: Data-Based Decision Making & Accountability2: Consultation & Collaboration3: Interventions & Instructional Support for Academic Skills4: Interventions & Mental Health Services for Social & Life Skills5: School-Wide Practices to Promote Learning

6: Preventive and Responsive Services 7: Family–School Collaboration Services 8: Diversity in Development and Learning 9: Research & Program Evaluation10: Legal, Ethical, and Professional Practice

Date Location Activity Domains Hours Signature

Total hours ___________

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Appendix B: Internship Placement Contract

University of Massachusetts at BostonCounseling and School Psychology Doctoral Program

Internship Placement Contract for: Fall 20_______ and Spring 20_________

Please complete this form and return it to the Director of Counseling Psychology or School Psychology.

The following Doctoral student:

Name__________________________________ Year Level: _________________________

Phone ____________________________e-mail____________________________________

Street ______________________ City ________________State ______Zip Code_______

Is placed as a psychology intern at: _______________________ Site’s Phone #___________

Street ________________________City _____________________State____ Zip Code______

The internship will consist of ___ hours per week for the academic year of ___ & ___

The placement will begin on ______ and end on _____.

The placement is: Full-time Part-time

Vacation dates will be:_____________________________________________________________

This is a paid internship: YES NO

If paid, please indicate amount of stipend or salary $_______________Per_____________

The student will have experience in the following areas: (Please specify client population(s) served and clinical services rendered.)

The student must be on site for the following times for supervision/case presentations, etc:

____________________________________________________________________________

The primary internship supervisor agrees to:

1. Provide ___ hours of direct supervision per week to come from the student’s regular hours.

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2. Oversee___ hours of additional supervision per week to come from the student’s regular hours.

3. Oversee that weekly in-service training is provided to the student.

4. Provide supervision that takes into consideration the student’s academic experience at UMass Boston (the student will provide the supervisor with relevant course outlines, the overall goals of the program) and the student’s individual learning goals. See the training plan requirements below.

5. Be available to discuss student’s progress with the internship coordinator person and/or Directory of Training either by telephone contact or on-site visits.

6. Provide opportunities for site visits to the UMass/Boston internship coordinator and faculty.

7. Complete written evaluations of the student’s progress twice during the year (see guidelines below).

8. Please include any other contractual agreement you have made with your supervisee regarding training and/or any exception to the standards in items 1 through 7.

Other Internship Programmatic Requirements:

1. Supervisor(s) must hold a license in the state in which the internship is hosted. Note that half of supervision must be provided by a licensed psychologist (item 7 below):

Supervisor(s) (Name & Degree) License Type License State

License #

2. The applicant’s title while working on internship must be one of “intern”, “resident”, or “fellow”:

Trainee’s Title:

3. Twenty-five percent (25%) of trainee time must be in direct service delivery for a total of 400 hours (full time) or 200 hours (part time):

Anticipated Avg. Hours/Wk for Direct Service Delivery: # of Work Weeks

4. A qualifying supervisor (licensed psychologist, board-certified psychiatrist, or licensed independent clinical social worker) must be on the premises at all times in which the trainee delivers health services. Telephone availability from off-premises does not qualify.

A Qualified Supervisor Will Be On Site At All Times: Yes No

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5. At least fifty percent (50%) of total hours of supervised experience must be in service related activities, defined as: treatment/intervention, assessment, interviews, report writing, case presentations, and consultations

50% of trainee experience will be service related: Yes No

6. The Trainee will receive a minimum of two hours of individual face-to-face supervision with a qualifying supervisor per week

Number of hours of individual, face-to-face supervision with qualifying supervisor:

7. At least half of all supervision must be provided by a licensed psychologist.

50% of supervision will be provided by a licensed psychologist: Yes No

8. There must be at least 1 hour of group supervision per 16 hours of work. The group must contain 2 trainees and not more than 3.

Hours of group supervision per 16 hours of work: Number of trainees:

9. There must be at least two trainees at the level of “intern”.

Number of interns at the site:

TRAINING PLAN

The training plan must address:1. How the trainee’s time will be allotted2. How the plan assures the quality, breadth, and depth of the training experience with:

a. Specified goals and objectivesb. Methods of evaluation

3. How the plan fits with the trainee’s preparation and training program goals and objectives.

Provide training plan here, or as an attachment:

Fill in the XX & YY details below, or delete and provide training plan in this space:

See attachment titled: “Internship Training Plan for XXXX at YYYY”

3.5 individual—meeting two groups, half-hour group, live supervision for Trainee over 12 months

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Internship Requirements(Enter Site Requirements Not Addressed Above)

Primary Supervisor_____________________________________________Date__________

Student_____________________________________________________ Date___________

Internship Coordinator/Director of Training______________________________________________________Date___________

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University of Massachusetts at BostonCounseling Psychology Specialization: Ph.D. in Counseling and School Psychology

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Appendix C: Case Study Rubric

Case Study RubricUniversity of Massachusetts School Psychology Program

Intern:

Case Study #: Name

Level: Pre-K/Primary (P-5) Middle (6-8) Secondary (9-12)Type: Academic Behavioral Emotional ELLUse an X to indicate the appropriateness of the report.

Relevant NASP Domains:1. Data-Based Decision Making & Accountability 6. Preventive & Responsive Services2. Consultation & Collaboration 7. Family–School Collaboration Services3. Interventions & Instructional Support for Academics 8. Diversity in Development & Learning4. Interventions & MH Services for Social & Life Skills 9. Research & Program Evaluation5. School-Wide Practices to Promote Learning 10. Legal, Ethical, & Professional Practice

Use an X to indicate the domains that are relevant to the case study.

1: Problem IdentificationVery Effective (4) Effective (3) Needs Development (2)

1.1 The student's behavior is1.11 Defined operationally in1.12 Measureable,1.13 Observable terms, AND1.14 Described in the context of

appropriate grade and/or peer expectations, e.g., local norms

The student's behavior is1.11 Defined operationally in1.12 Measureable, and1.13 Observable terms.

The student's behavior is identified but not operationally defined

1.2 The problem is1.21 Collaboratively defined (for

example, within a child study team) AND

1.22 Takes into consideration at least 3 reasons for referral or areas of concern.

The problem is1.21 Collaboratively defined (for

example, within a child study team) AND

1.22 Takes into consideration 1 reason for referral or area of concern.

The problem is not collaboratively defined

Note: Reasons are not hypotheses. Reasons are based on facts; hypotheses are sophisticated guesses about why things happen. List reasons here and hypotheses in 2.1.

1.3 The behavior is operationally defined or quantified in terms of

1.31 Current AND1.32 Desired levels of

performance (i.e., goal statements), AND

1.33 The discrepancy between current and desired level of performance is explained

The behavior is operationally defined or quantified in terms of

1.31 Current AND1.32 Desired levels of

performance (i.e., goal statements).

The behavior is not operationally defined or quantified.

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Note: Make the goal statements in 1.32 agree with those in Rubric 3.13.

1.4 Baseline includes1.41 The student behavior using

sufficient data* AND1.42 Peer/grade norms and

expectations with computed trend lines if relevant.

Baseline includes1.41 The student behavior using

sufficient data*

A baseline for the student behavior is not established or has insufficient data

*Note: Sufficient data means at least 3 data points for academic concerns, 6 data points for behavioral.

1.5 The student behavior is1.51 Identified as a skill, fluency,

and/or performance deficit.1.52 Defined within a context that

includes at least 8 of the following:

1.521 File review 1.522 Student observation 1.523 Interviews with: 1.5231 Teacher 1.5232 Parent 1.5233 Student interview 1.524 Review of work samples 1.525 Consideration of

1.5251 Native language1.5252 Previous evaluations1.5253 Previous interventions

1.526 History1.5261 Educational, including

grade and attendance patterns

1.5262 Medical, including vision & hearing

1.5263 Social, including friends, hobbies, sports

1.527 CBM data 1.528 Daily behavior report card

The student behavior is1.51 Identified as a skill,

fluency, and/or performance deficit.

1.52 Defined within a context that includes at least 5 of the following:

1.521 File review 1.522 Student observation 1.523 Interviews with: 1.5231 Teacher 1.5232 Parent 1.5233 Student interview 1.524 Review of work samples 1.525 Consideration of

1.5251 Native language1.5252 Previous evaluations1.5253 Previous interventions

1.526 History1.5261 Educational, including

grade and attendance patterns

1.5262 Medical, including vision & hearing

1.5263 Social, including friends, hobbies, sports

1.527 CBM data1.528 Daily behavior report

card

The student behavior is not identified as a skill, fluency, and/or performance deficit and context is insufficiently considered in problem identification.

A check with the school nurse is essential for all cases.

1.6 Parents/guardians, student(s), and teachers are involved in the problem-identification process.

Parents/guardians, student(s), and/or teachers are involved in the problem-identification process.

Parents/guardians and teachers are not involved in the problem-identification process

2: Problem AnalysisVery Effective (4) Effective (3) Needs Development (2)

2.1 2.11 Multiple, comprehensive, and measureable hypotheses are generated

2.12 Through collaboration with

2.11 One or more measureable hypotheses are developed to identify

2.12 [No collaboration]

Hypotheses are not developed, hypotheses are developed in only one area and/or

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teacher, student, and/or parent

2.13 To identify the functions that the behavior serves and/or the conditions under which the behavior is occurring or has developed

2.14 In two or more of the following areas:2.141 Student factors,2.142 Curriculum,2.143 Peers,2.144 Teacher,2.145 Classroom,2.146 Home, and2.147 Neighborhood.

2.15 The hypotheses are narrowed and

2.16 The chosen hypotheses are explored using evidence-based research.

2.13 the functions that the behavior serves and/or the conditions under which the behavior is occurring or has developed

2.14 in two or more of the following areas:

2.141 Student factors,2.142 Curriculum,2.143 Peers,2.144 Teacher,2.145 Classroom,2.146 Home

hypotheses are not measurable

Note: 2.11-2.14 describes coming up with hypotheses in a brainstorming way where many ideas are generated. In 2.15, the hypotheses are examined more critically and some are eliminated.

2.2 2.21 There are multiple sources of systematic, multi-method, and appropriate data that

2.22 Converge on each proposed hypothesis AND

2.23 Appropriate data include one or more of the following:2.231 Record review,2.232 Interview,2.233 Observation,2.234 Testing, and2.235 Self-report

2.24 The information isappropriately integrated and interpreted.

There is evidence that2.21 appropriate data are

collected that2.22 confirm or reject the

proposed hypotheses.2.23 Appropriate data include

one or more of the following:2.231 Record review,2.232 Interview,2.233 Observation,2.234 Testing, and2.235 Self-report

Appropriate data are not collected to confirm or reject the hypotheses

2.3 Hypotheses reflect an awareness of issues of diversity (e.g., physical, social, linguistic, racial/ethnic, disability, cultural)

Hypotheses do not reflect an awareness of issues related to diversity (e.g., physical, social, linguistic, racial/ethnic, disability, cultural)

Note: For native speakers write something like, His/her {classroom/English teacher} {guidance counselor}

verified that FN’s English proficiency is adequate for academic learning and assessment.

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If you suspect no issues of cultural diversity, use the same authoritative information source to address that concern.

3: InterventionVery Effective (4) Effective (3) Needs Development (2)

3.1 Intervention3.11 is linked to observable,

measurable goal statement(s) [see Rubric 1.32]

3.12 addresses all aspects or concerns

3.13 includes a numeric goal for student performance

3.14 addresses the baseline data and desired improvement

3.15 includes a timeframe (usually 6-8 weeks).

Intervention3.11 is linked to observable,

measurable goal statement(s) (see Rubric 1.32)

3.12 addresses some aspects3.13 includes a numeric goal for

student performance3.14 addresses the baseline data

and desired improvement.

Intervention is not linked to observable, measurable goal statement(s).

Note: Make the goal statements in 3.13 agree with those in Rubric 1.32

Note 2: Discuss the intervention in Sections 3.11-3.15 as if it were a plan and not an event in the past (e.g., The team developed an intervention plan in which the student would meet with the intern to work on . . .).

3.2 Intervention(s) selection is based on data from problem analysis and hypothesis testing

Intervention(s) selection is not based on data from problem analysis and hypothesis testing

3.3 3.31 Intervention(s) is evidence-based (e.g., research literature, functional analysis, single case design analysis).

3.32 Research sources supporting the intervention are correctly cited.

Intervention(s) is evidence-based (e.g., research literature, functional analysis, single case design analysis).

Intervention(s) is not evidence-based (e.g., research literature, functional analysis, single case design analysis)

3.4 3.41 Intervention(s) is developed collaboratively.

3.42 The collaboration is described in detail, including frequency and participants (parents, teachers, paraprofessionals, community agencies.

3.43 Follow-up procedures are described

3.44 Parent-teacher-paraprofessional training is described.

Intervention(s) is developed collaboratively.

Intervention(s) is not developed collaboratively

3.5 3.51 Intervention(s) reflects sensitivity to individual differences, resources, classroom practices, and

3.51 Intervention(s) reflects sensitivity to individual differences, resources, classroom practices, and

3.51 Intervention(s) does not reflect sensitivity to individual differences, resources,

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other system issues.3.52 Acceptability of intervention

is verified*, assessed and accommodations are made as appropriate.

other system issues.3.52 Acceptability of

intervention is verified*

classroom practices, and other system issues.

3.52 Acceptability of intervention not verified

*Note: Verify acceptability with the target student as well as the parent(s)/ guardian(s), teacher(s) most affected, and other staff affected.

3.6 Logistics of setting, time, resources and personnel are included in the intervention plan

Logistics of setting, time, resources and personnel are not included in the intervention plan

Note: Switch to past tense for this section, discussing how the intervention plan was implemented (e.g., The student met with the intern each week to . . .).

3.7 Intervention selection considers unintended outcomes or limitations

Intervention selection does not consider unintended outcomes or limitations

3.8 3.81 Intervention is monitored and data collected at least weekly.

3.82 Data that ensure that the intervention is implemented as designed are gathered and presented.

3.83 The monitoring processes and tools are fully described.

3.84 The tools are attached as an appendix.

3.81 Intervention is monitored and data collected at least weekly.

3.82 Data that ensure that the intervention is implemented as designed are gathered and presented.

Treatment integrity is not monitored

Note: Criterion 3.82 is about monitoring for intervention integrity. You get credit for 3.82 only by presenting data.

4: EvaluationVery Effective (4) Effective (3) Needs Development (2)

4.1 4.11 Progress monitoring data are demonstrated on a chart

4.12 The chart includes student performance trend lines, and/or goal lines*.

4.13 The chart includes baseline data compared to outcome data.

Progress monitoring data are demonstrated on a chart

Progress monitoring data are not demonstrated on a chart

*Note: A goal line (“aim line”) is a straight line drawn from the median baseline value to the numeric goal. It has a slope; it is not horizontal. See Hosp, Hosp, & Howell (2007) p. 125 for instructions for drawing trend lines.

4.2 Progress monitoring data are demonstrated to be effective

4.21 when compared to data generated from multiple

Progress monitoring data are demonstrated to be effective

4.21 when compared to baseline data.

Intervention is not demonstrated to be effective through data comparison

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sources/settings, &4.22 using percent non-

overlapping data (PND; value must be greater than 51%).

4.22 Report includes percent non-overlapping data (PND)

PND = (# data points higher/lower than the highest/ lowest baseline data point) ÷ (# data points for the intervention) x 100. Ex: 4 ÷ 6 x 100 = 67%

4.3 4.31 Response to intervention data are used to inform problem solving and decision making.

4.32 The type of single case design was specified (e.g., changing criterion, parametric, component analysis, multiple baseline, alternating treatment).

4.33 A detailed plan for appropriately adjusting the intervention is described.

Data are used to inform further problem solving and decision making (i.e., continuation of intervention, modification of intervention, maintenance of intervention).

Data are not used to inform further problem solving and decision making

4.4 4.41 Strategies for transfer/generalizing outcomes to other settings are addressed AND

4.42 documented as effective

Strategies for transfer/generalizing outcomes to other settings are addressed

Strategies for transfer/generalizing outcomes to other settings are not addressed

Note: Do not leave target in charge of generalizing. Make a plan for adults (e.g., parents, teachers) to use for generalizing to another setting (e.g., from school to home; from spelling to math, etc.)

4.5 4.51 Effectiveness of intervention is shared through collaboration with parents, teachers, and other personnel.

4.52 Modifications for future interventions are considered based upon collaborative examination of effectiveness data.

Effectiveness of intervention is shared through collaboration with parents, teachers, and other personnel.

Effectiveness of intervention is not shared or communicated

Shared: Mention how results were disseminated to parents, teachers, or others.

Modifications: Review the intervention collaboratively regarding how the team could do it differently in the future.

4.6 4.61 Strategies for follow-up are developed and

4.62 Implemented

Suggestions for follow-up are developed (continued progress monitoring, transition planning)

Suggestions for follow-up are not developed

5. Case Study Report Evaluation5.1 Required appendixes:

Monitoring toolReferences

5.2 Optional appendixes:

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Support planBehavior plan/contractParent handoutsEducator handouts

5.3 Professional appearance (spelling, grammar, coherence, APA format for citations)

5.4 Clear writing: sensitively and clearly written for non-psychologists

Summary of Strengths and Areas for Improvement: Comments:

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Appendix D: Psychoeducational Rubric

Psychoeducational Report RubricUniversity of Massachusetts Boston School Psychology Program

Student Name:Assignment and number: Level: Primary___ Intermediate____ Middle____ High School____Type of Case: Academic____ Soc/Emot/Beh ______ Ethnically Diverse ______

Relevant Domains:Domain 1: Data-Based Decision Making and AccountabilityDomain 2: Consultation and CollaborationDomain 3: Interventions and Instructional Support to

Develop Academic SkillsDomain 4: Interventions and Mental Health Services to

Develop Social and Life Skills

Domain 5: School-Wide Practices to Promote Learning Domain 6: Preventive and Responsive ServicesDomain 7: Family–School Collaboration ServicesDomain 8: Diversity in Development and LearningDomain 9: Research & Program EvaluationDomain 10: Legal, Ethical, and Professional Practice

Category Criteria Rating2= Present1= Partially Present0= Absent

1) Title a. Psychoeducational Reportb. CONFIDENTIAL

2) Identifying Information

a. Nameb. Date of Birth and Chronological Aged. Gradee. Schoolf. Examinerg. Date of Exam and Date of Report

3) Reason for Referral a. Referral type (initial, 3-yr, etc.)b. Concerns raisedc. Referral questions posed

4) Information Sources

a. Review of school recordsb. Interview(s) with parents, teachers, studentc. Classroom observationd. Tools used listed

5) Background Information(Information from file review, interviews with teacher, and interviews with parents.)

a. Schools attended, length at present school, attendance patternsb. Past and present academic performance including

patterns of strengths and weaknessesc. Previous assessment resultsd. Health, vision, hearing—past and currente. Family situationf. Social situation (friends, etc.)g. Interests and hobbiesh. English language proficiency including language

assessment resultsi. Description of educationally related cultural and

linguistic factors6) Classroom Observations

a. Information from observation using time sampling tool (BOSS)

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b. Evaluation of the learning ecology/opportunities to learn

7) AssessmentObservations

a. Quality of rapport establishedb. Reliability & validity of assessmentc. Test-taking behaviord. Methods used to minimize bias (nonverbal, cross-

battery, short form)8) Cognitive Assessment(note: a through c may be included as an appendix rather than in the body of the report)

a. Description of instrument(s) including brief description of additional instruments referenced (e.g. WJ Cognitive administered by LD specialist) b. Coverage of obtained scores c. Identification of most representative score i) Restated as percentile ii) Confidence interval for the Score iii) Score Descriptor d. Strengths/Weaknesses i) Described as abilities ii) Made meaningfule. Comment on agreement of different sources of

information9) Achievement Assessment(note: a through c may be included as an appendix rather than in the body of the report)

a. Description of instruments or approach (if reading is referral problem, should have a narrow-band reading scale (e.g., WRMT) in addition to a broad-band achievement test (WJ Achievement ), and a survey level CBA reading assessment b. Coverage of obtained scores c. Identification of most representative score if

available i) Restated as percentile ii) Confidence interval for the Score iii) Score Descriptor d. Strengths/Weaknesses i) Described as abilities ii) Made meaningful iii) integrated across instrumentse. Comment on agreement of measures and classroom

academic functioning10) Social-Emotional-BehavioralAssessment(note: a through c may be included as an appendix rather than in the body of the report)

a. Description of instruments b. Coverage of obtained scores c. Identification of most representative score i) Restated as percentile ii) Confidence interval for the Score iii) Score Descriptor d. Strengths/Weaknesses i) Described as abilities ii) Made meaningful iii) integrated across instrumentse. Comment on agreement of various scales and

functioning11) Functional Behavioral Assessment

a. Results of interviews with teachers, parents, students, & other using (i) Functional Assessment Interview (FAI) and/or (ii) Functional Assessment Checklist for Teachers & Staff (FACTS-A & B)b. Clear description of problem behavior(s) in

measurable, observable terms

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d. Multiple direct observations of student in a variety of settings to identify frequency, duration, intensity of behavior using frequency counts, momentary time sampling, latency and/or the Functional Assessment Observation Form (General rule: at least 3 observations of problem behavior).e. Classroom and teacher observation data, including

comparison children.f. Using triangulation of data, identification of

antecedents (times, situations) that predict when the problem behaviors will and will not occurg. Using triangulation of data, identification of the

maintaining consequences that support the repetition of problem behaviorsh. Hypotheses regarding the function of the behavior

12) Summary andConclusions

a. Restate referral questionsb. List information sourcesc. Summarize results brieflyd. Give the “Big Picture” and pull together the referral

questions, the assessment tools, the student’s functioning, and the conclusionse. Answer the referral questionsf. State opinion about eligibility for identification with

a disability, including language that would be understandable in terms of DOE and/or DSM criteria

13) Recommendations: a. Recommended interventions, all evidence-based, and each tied to both the referral question and assessment results (i.e., to facilitate reading fluency. .)b. Specific recommended plans of action that are

realistic and relevant(for [functional] behavior assessment, the plan should

include suggestions to reduce frequency/duration of problem behavior(s) by addressing antecedents and/or consequences)c. Monitoring plan suggested for at least one

recommendation (goals, data to collect, responsible persons, frequency of intervention, and anticipated duration of intervention)

14) Signatures a. Blanks for signatures of intern and supervisorb. Typed name of report writer and supervisorc. Titles and student identified as intern or student

15) Appendix: References

For recommendations given in (14)

16) Appendix: Data charts(note: these may include tool descriptors and scores)

a. Titleb. Abbreviations definedc. Columns & rows identifiedd. Headings underlinede. Subtests & composites aligned leftf. Values defined (standard scores, percentile)g. Confidence interval for most representative score

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17) Overall Comments a. Clarity for non-psychologistsb. Appearancec. Grammar and mechanicsd. Professional writing

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Appendix E: Functional Behavioral Assessment / Behavior Intervention Plan Rubric

Functional Behavioral Assessment/Behavior Intervention Plan RubricUniversity of Massachusetts Boston School Psychology Program

Student Name:Level: Primary___ Intermediate____ Middle____ High School____

Relevant Domains:Domain 1: Data-Based Decision Making and AccountabilityDomain 2: Consultation and CollaborationDomain 3: Interventions and Instructional Support to Develop Academic SkillsDomain 4: Interventions and Mental Health Services to Develop Social and Life Skills

Domain 5: School-Wide Practices to Promote Learning Domain 6: Preventive and Responsive ServicesDomain 7: Family–School Collaboration ServicesDomain 8: Diversity in Development and LearningDomain 9: Research & Program EvaluationDomain 10: Legal, Ethical, and Professional Practice

Functional Behavior Assessment

Category Required Content Basis for Evaluation Unsatisfactory Satisfactory Exemplary

Title & Identifiers

Title - Functional Behavioral Assessment List identifiers, including student name, date

of birth, chronicle age, school, grade, teacher name, examiner, and date of report

Applicable for all categories: Inclusion of required content Professional appearance,

formatting, and writing

0 0.5 1

Reason for Referral

Brief description of the reason for referral that indicates FBA was chosen to better understand the target behaviors and related variables

Include target behavior(s), definitions, and examples/non-examples.

Appropriateness of summary and delineation of target behaviors.

Measurable and observable nature of behavior definitions

Completeness of examples/non-examples

1 3 5

Assessment Methods Used

List interview(s): Note who participate in interview -

teacher(s), parents/guardians(s) and/or student, as appropriate

Note interview format used (e.g.,

The completeness and appropriateness of the assessment methods used based on the reason for referral, target behavior(s),

1 3 5

Functional Assessment Interview, Functional Assessment Checklist for Teachers and Staff, Problem Identification Interview, or combination)

List direct observations, including: The dates of at least 3 observations

conducted to identify the relevant dimension(s) of behavior and type of recording used (e.g., time sampling or event recording)

The dates of at least three observations to identify antecedents and consequences using the Functional Assessment Observation Form or other similar form

List checklists (if appropriate): Identify the checklists used (e.g.,

Functional Analysis Screening Tool [FAST], Motivation Assessment Scale [MAS]), who completed them

List any observation or permanent product data collected by school personnel (if appropriate)

Classroom Ecology (if appropriate)

and setting

Functional Interview(s)

In different sections, organize teacher, parent, and student interviews to describe their impressions of the target behavior(s), related variables, and previous efforts to address the behavior. For each interviewee include the following: List relation to student Indicate interviewee’s description of

students strengths, including times when the student is successful

Inclusion of only relevant, useful information that is clearly described as the impressions of the interviewees.

1 5 10

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For each target behavior, describe the (a) reported frequency and other relevant dimensions of behavior, (b) reported desired behavior and any appropriate alternative or replacement behaviors, (c) reported setting events, antecedents and consequences, and (c) past attempts to address the behavior.

Direct Observation of Behavior

If all target behaviors were observed across observation, open section with a description of when, where, and how often student was observed. If separate observations were conducted for distinct behaviors, provide this context information separately.

For each target behavior, graph data across observations and summarize in narrative format. Describe frequency, duration, latency, etc. of target student behavior and peer’s behavior (e.g., time sampling or event recording).

Complete description of observation context

Clear graphs that are organized appropriately for the ABC data and facilitate reader understanding

Summaries that clearly describe the target behavior data

1 5 10

Direct Observation of ABC sequence

For each target behavior, make graphs or a table for the antecedent and consequence data for each target behavior across observations and summarize in narrative format. Describe antecedents that preceded and consequences that followed the target behavior.

Clear graphs or table that are organized appropriately for the ABC data and facilitate reader understanding

Summaries that clearly describe the target behavior data

1 5 10

Checklists (if appropriate)*

Describe purpose of checklist Reliability & validity of assessment (if

available) Describe who completed the checklist, when,

Clear graphs or table that are organized appropriately for the ABC data and facilitate reader understanding

1 5 10

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for what target behaviors Include a graph or table that indicates

checklist data and summarize findings across respondents (e.g., teachers/parents/other)

Appropriate description of the checklist and the respondent

Summary of the checklist data that is accurate and places data in context of the assessment method

Data Collected by School Personnel (if appropriate)*

Based on the data (e.g., observation, permanent products) collected by the school personnel, summarize in a graph or table to illustrate the findings. Provide context for the data, including the date(s) when and setting(s) where data were collected.

Clear graphs or table that are organized appropriately for the data and facilitate reader understanding

Summary of the data that is accurate and places data in context of the assessment method

Classroom Ecology (if appropriate)*

* Note – only one of these assessments must be included.

Based on the classroom ecology data, summarize in a graph or table to illustrate the findings. Provide context for the data, including the date(s) when and setting(s) where data were collected.

Data may include information from formal observation using time sampling tool (round robin format where a new student is observed during each 15/30 s interval), evaluation of the learning ecology/opportunities to learn, or other methods/approaches.

Clear graphs or table that are organized appropriately for the data and facilitate reader understanding

Summary of the data that is accurate and places data in context of the assessment method

Summary Statements

For each behavior class, write a summary statement in the following form:

When/During <insert immediate antecedents> STUDENT <insert name of problem behavior(s)>, s/he <insert operational definition/description of behavior> in order to <insert possible reasons for behavior – escape/avoid/gain access to preferred task/activity/item/gain attention from

Summary statements for each behavior class accurately based on the synthesis of the interviews and observation data

1 5 10

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peers/teachers. These behaviors are more likely to occur <insert setting events-distant>.

Competing Pathway

Complete a Competing Pathway diagram for each behavior class that indicates the (a) current setting event, antecedent, behavior, and consequence sequence, (b) desired behavior and the related natural consequence, and (c) replacement behavior.

Competing pathway for each behavior class accurately based on the synthesis of the interviews and observation data

1 5 10

Summary Summarize the reason for referral and assessment methods used in the report. Describe the target behavior(s) and the analysis of behavior, including the summary statements identified. Reference the development of a BSP.

Complete, but brief summary that accurately characterizes the FBA and appropriate reference to the BSP

1 3 5

Behavior Support Plan

Category Required Content Basis for Evaluation Unsatisfactory

Satisfactory

Exemplary

Title & Identifiers

Title - Functional Behavioral Assessment List identifiers, including student name, date

of birth, chronicle age, school, grade, teacher name, examiner, date of FBA, and date of BSP

Applicable for all categories: Inclusion of required content Professional appearance,

formatting, and writing

0 0.5 1

Summarize FBA Indicate that this BSP is based on a FBA developed to address the reason for referral.

For each target behavior, list the definitions, and examples/non-examples. Describe the relevant topography of the problem behavior based on the observations. List the summary statement.

Include (or attach as an appendix) a Competing Pathway diagram for each behavior class that indicates the (a) current

Complete summary of the FBA that accurately characterizes findings and includes all required content

1 3 5

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setting event, antecedent, behavior, and consequence sequence, (b) desired behavior and the related natural consequence, and (c) replacement behavior.

Describe BSP Describe the purpose and format of the BSP Provide an advanced organizer for the introduction of the BSP strategies

1 3 5

Setting Event Strategies

List name of strategy that addresses the function/reason of/for the problem behavior.

Describe how the strategy should be implemented in enough detail that anyone using the plan could perform the procedure

Data-drive identification of contextually appropriate strategies

Clear, observable description of how to implement the strategy

1 5 10

Antecedent Strategies





1 5 10

Teaching Strategies

List name of strategy that addresses building the skills for the adaptive alternative behavior (the opposite or replacement for the problem behavior) that will permit appropriate escape (e.g., ask for break or help)/attention (e.g., praise for following directions).




1 5 10

Consequence Strategies




Clear, observable description of how to implement the

1 5 10

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strategy Goal

Statements Include short-term and long-term goals to

reduce frequency/duration of problem behavior(s) by addressing antecedents and/or consequences and increase alternative appropriate behaviors.

Goals should be SMART (specific, measurable, assignable, realistic, time-limited) and formatted like an IEP goal (i.e., setting behavior should be observed in, learner name, operational description of behavior, and goal). That is, During/When <insert antecedent or setting>, STUDENT will <describe desired behavior> for <insert goal>.

Short-term and long-term goals are SMART and driven by the FBA findings and BSP

1 5 10

Implementation and Monitoring Plan

Indicate the date when components of the BSP will be implemented and by whom.

List who will deliver implementation support or training and gather materials, if needed, prior to implementation.

Describe the progress monitoring and treatment integrity data to be collected, who is responsible for the collecting and graphing the data, how often it will be collected, and when it will be reviewed.

Identify the date for reviewing the progress monitoring and implementation data.

Implementation plan is realistic and appropriate for the personnel and context

Appropriate methods for progress monitoring and treatment integrity data are specified and plan for evaluating these data are appropriate

1 5 10

Signatures Blanks for signatures of intern and supervisor Typed name of report writer and supervisor Titles and student identified as intern or

student

0 0.5 1

References List references that support the recommended strategies.

Key references that are appropriate for the student and context are used to

1 3 5

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support the strategies described in the BSP

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Appendix F: Intervention Treatment Integrity Checklist

Intervention Treatment Integrity Checklist (e. g., BIP, Counseling, Behavioral & Academic Cases)

Researchers and practitioners are encouraged to note the limitation of the analyses (and designs) they may use and couple them with visual analysis (Riley-Tillman & Burns, 2009, p. 122).

Please review your intervention cases to make sure that the following are included:

YES NO

Referral data is included

Background information is included

Intervention is evidenced based

- References are included in text and in the reference section

Intervention steps are clearly defined

Goal (s) for the intervention is/are identified based on norms, rate of improvement (ROI) or Goal Attainment Scaling….

Outcome data is evaluated using visual analysis:- Level (Average)- Trend (Rate of Improvement)- Variability- Immediacy/Latency

Outcome data is evaluated using empirical analysis:- Effect size- Percentage of non-overlapping data

Context is provided for interpreting the empirical data

Outcome data is graphed using appropriate single case design (SCD)…

Limitations of the SCD are taken into consideration in the analysis of the outcome data.

Recommendations are included

Treatment integrity checklist is attached

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Appendix G: Data Analysis Table

DATA ANALYSIS TABLE: USE THIS TABLE WHEN ANALYZING YOUR FBA, ACADEMIC AND BEHAVIORAL

INTERVENTIONS CASES.

Behavior

Visual AnalysesEmpirical Analyses

Treatment Integrity Effective?

Level Trend/ROI VariabilityImmediacy/

Latency ESa PNDb Percentage c (Yes/No)Baseline

InterventionGoal 1Goal 2Criterion Not

availableNot available

Not available

Not available

≥ 2.87 ≥ 80% ≥ 60%

a Burns & Wager (2008)b Scruggs & Mastropieri (1998)c Schulte, Easton, & Parker (2009)

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UNIVERSITY OF MASSACHUSETTS BOSTON

SCHOOL PSYCHOLOGYAppendix H. Advanced Practicum Contract

Student name: _________________________________________ Email: _________________________

Home phone: ________________ Address: __________________________________________

Cell phone: __________________ Student ID # UMS__________________________________

Field Supervisor Name: _________________________________ Title: ___________________________

Best mailing address:_____________________________________________________________

Email_______________________ Office phone: ________________ Cell phone: ____________

School / Program assignments:

______________________________________________________________________________

Department of Education School Psychology licensure number: ______Initial or professional?

Psychologist/Educational Psychologist license number: ________ NCSP number:____________

Number of years work experience as a licensed psychologist / school psychologist: ______

Years in this district / program: _____

Race/ethnicity: ____________________

Program / District Administrator Name and position

______________________________________________________________________________


Email_____________________ Office phone: _________________ Cell phone: ____________

University Supervisor Name ____________________________________________________________

Best mailing address:____________________________________________________________

Email_______________________ Office phone: _________________ Cell phone: ___________

Seminar Instructor Name _______________________________________________________________


Email_______________________Office phone: ________________ Cell phone: ____________

Program Director Name ________________________________________________________________


Email_______________________Office phone: _______________ Cell phone: ____________

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Practicum characteristics

Program / District:_________________________________________________________

Assignments: High school _______________________________________________________Junior high/middle school ____________________________________________Elementary school __________________________________________________Alternative school __________________________________________________Mental/Behavioral health facility ______________________________________

Practicum duration: Hours per week: ________ Dates: _______, 20 ____ through _______, 20 ___.

Anticipated nature of Practicum assignments (please describe briefly)Assessment _______________________________________________________________________________________________________________________________________________________________________

Consultation ______________________________________________________________________________________________________________________________________________________________________

Counseling ________________________________________________________________________________________________________________________________________________________________________

Prevention/Early intervention_________________________________________________________________________________________________________________________________________________________

Inservice/staff development___________________________________________________________________________________________________________________________________________________________

The undersigned have read the attached contract and agree to abide by its stipulations:

___________________________ ________Student date

___________________________ ________District administrator date

___________________________ ________Seminar instructor date

___________________________ ________Field supervisor date

___________________________ ________University supervisor date

___________________________ ________Program director date

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STUDENT RESPONSIBILITIESBy signing this Practicum contract, the student ____________________________ indicates that he or she understands that this agreement is subject to final approval by the university supervisor and program director. The student also officially verifies that all prerequisite requirements have been satisfactorily completed, that a favorable interview has been completed, and that he or she has been accepted for assignment for the Practicum in school psychology. The student further agrees:

1. To fulfill all requirements as specified for satisfactory completion of an Practicum field experience in School Psychology as stipulated by the University of Massachusetts Boston School Psychology Program: to complete opportunities that demonstrate the full range of competencies required by the Massachusetts State Department of Education, American Psychological Association (Section B3), and the National Association of School Psychologists certification standards; and to obtain the full range of experiences (k-12) across the domains of professional practice.

2. To abide by all rules, policies, regulations, and approved codes of conduct and behavior. These include local, state, federal legal regulations; ethical standards of the National Association of School Psychologists and the American Psychological Association; and all University, College, and Department policies, regulations, and standards.

3. To maintain strict confidentiality of information obtained during the field experience.

4. To become familiar with and be held accountable for all existing rules, requirements, and regulations of the assigned site and to abide to the commitment made to the school district to complete the experience even if the hours are accrued before the district closes for the year.

5. To attend all days of assignment and placement. Only valid reasons for absences will be accepted. The Field Supervisor will be notified on days when illness or other emergencies prevent attendance.

6. To attend all orientation sessions, staff meetings, and evaluation sessions (day or evening) as the school system or site requires.

7. To maintain a daily log that lists activities and the numerals of the domains addressed, and submit it each semester.

8. To maintain a supervision log that indicates time spent in supervision and submit each semester.

9. To develop a Practicum portfolio that contains (1) evidence of competency in each of the eleven professional domains and (2) evidence that the Practicum student’s professional practice improves child and adolescent learning or the learning environment.

10. To attend and participate in all scheduled and assigned weekly seminars and to complete associated assignments in a timely manner.

11. To obtain appropriate professional liability insurance through a professional organization.

12. To complete and submit all required paperwork to the university supervisor and seminar instructor in a timely fashion. This includes: the Portfolio, Practicum Log, Supervision Log, Practicum Evaluation Form, Field Supervisor Tuition Voucher Application Form, and the Field Experience Evaluation.

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http://www.apa.org/ed/accreditation/about/policies/interns.aspx

13. To complete satisfactory work such that Practicum grades of B or above are earned for two consecutive semesters (or four semesters of part-time work) to complete Practicum requirements (note: a grade of F is assigned if the student is dismissed from the Practicum site for an ethical violation).

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FIELD SUPERVISOR RESPONSIBILITIES

By signing this Practicum contract, the field supervisor ___________________________indicates that s/he understands that this agreement is subject to final approval by the university supervisor and program director. The field supervisor(s) also officially verifies that s/he has at least three years’ experience as a licensed school psychologist and holds a current and valid license to practice school psychology. The field supervisor(s) further indicates that a favorable interview has been completed, and that the student ____________________________ has been accepted for assignment for a Practicum in school psychology at ________________________________ . The field supervisor(s) agrees:

1. To provide adequate supervision. This includes: at least two hours of face-to-face supervision each week for full-time Practicum throughout the

year, or one hour of face-to-face supervision for part-time Practicum; more than two hours of weekly supervision during the initial Practicum period; provision of opportunities for the Practicum student to observe your professional practice; provision of opportunities for the Practicum student to collaborate with you in providing

professional services; use of appropriate supervisory strategies such as process notes, session feedback, supervision

plans, review of recordings, review of assessment protocols and reports, review of child/adolescent progress monitoring data, etc.;

explicit directions on how to respond to crisis situations and telephone access maintained at all times;

provision of additional supervision in areas in which the field supervisor is not qualified (i.e. assignment to an adjustment counselor for supervision of counseling adolescents with substance abuse when that is not an area in which the field supervisor is qualified);

sufficient supervisory conferences so that feedback and constructive critiques of the Practicum students’ performances and progress are provided on an ongoing basis;

co-sign all written reports completed by the Practicum student; and take ultimate responsible for the services provided by the Practicum student.

2. To provide the professional assistance, guidance, and training associated with enrollment in a Practicum course and the earning of graduate degree credit. Also, to provide the patience, encouragement, genuine interest, professional example, and personal expertise that best serves the learning needs and helps to facilitate the professional training and development of an Practicum student in his or her first opportunity to apply professional skills and competencies in a "real life" setting.

Facilitate selection of students and problems for case studies that include baseline and intervention outcome monitoring data.

Assist Practicum students in obtaining parental permission for case studies.

3. To actively facilitate the Practicum student’s fulfillment of all requirements as specified for satisfactory completion of a Practicum field experience in School Psychology as stipulated by the University of Massachusetts Boston School Psychology Program:

at minimum of 450 clock hours of supervised placement; opportunities to demonstrate the full range of competencies required by the American

Psychological Association (APA; B4 & B5), Massachusetts State Department of Education, and National Association of School Psychologists;

sufficient experience across grade levels to merit K-12 licensure

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sufficient opportunities to develop competency across the domains of school psychology practice as defined by the American Psychological Association and National Association of School Psychologists: at least 20% assessment, 20% direct interventions such as counseling, and 20% indirect interventions such as consultation. Additionally, there should be experience in the provision of in-service training, in providing or participating in prevention/early intervention programs, and in observing/participating in preschool programs;

sufficient opportunities to complete Case Studies during which the Practicum student (a) collects background information and baseline data to facilitate problem identification and problem analysis; (b) designs and implements evidence-based interventions, and (c) collects data to determine whether or not the intervention(s) worked.

4. To eventually delegate work experience and responsibilities comparable to those expected of a professional school psychologist who might normally be assigned to that position or engaged in the same responsibilities to which the Practicum student has been assigned.

5. To include the Practicum student in orientation sessions, staff meetings, parent conferences, critique and evaluation sessions required by the school system or institution as appropriate.

6. To excuse the Practicum student from any assignments during scheduled university seminar meetings so that s/he can attend the seminar that is a required part of the experience and receive associated graduate credit.

7. To provide appropriate desk space, assessment equipment, and other suitable working facilities as applicable to the assignment.

8. To provide background information and insights of those being served, including children, adolescents, and school personnel.

9. To prepare others (school personnel, clients, administrators, etc.) for the arrival of the Practicum student as appropriate.

10. To discuss evaluation criteria, as designated by the Practicum student Evaluation Form, with the Practicum student and university supervisor at the onset of each semester of the Practicum in order to develop an Practicum and supervision plan that covers required competencies.

11. To regularly communicate with the university supervisor and seminar instructor (should that be a different individual), particularly if there are any areas of concern, so that corrective action can be taken in a timely fashion.

12. To collaborate with the university supervisor and Practicum student in evaluating the Practicum student at the end of each semester and to discuss the evaluation, as designated by the Practicum student Evaluation Form, with the Practicum student.

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UNIVERSITY SUPERVISOR RESPONSIBILITIES

By signing the Practicum contract, the university supervisor ____________________________ indicates that s/he understands that this agreement is subject to final approval by the program director. The university supervisor also officially verifies that s/he has at least three years’ experience as a licensed school psychologist and holds a current and valid license to practice school psychology and agrees:

1. To provide at least two on-site visits across the course of the Practicum hours. a.The first visit will occur during the first six weeks of the Practicum and will include a three-way

meeting with the Practicum student, field supervisor, and university supervisor to clarify expectations and evaluation procedures.

b.The second visit will occur during the month before the end of the first 300 hours and will include a three-way meeting with the Practicum student, field supervisor, and university supervisor to complete the Practicum student evaluation form.

c. The third visit will occur during the month before the end of the 600 hours and will include a three-way meeting with the Practicum student, field supervisor, and university supervisor to complete the Practicum student evaluation form.

d.Observations of the Practicum student-at-work should occur during these visits. These observations should be of the Practicum student engaging in professional activities, such as: (1) conducting an assessment, (2) providing an intervention to a group of students (e.g., class-wide bullying prevention program, group counseling), (3) problem-solving in collaboration with educator(s), and (4) meeting with a parent.

e.Take notes of the observation, add comments, and share a hard copy with the Practicum student.

2. To periodically review the Practicum student Log, Supervision Log, reports, and other work samples to ensure that appropriate practice is being observed.

3. To monitor the appropriateness of the Practicum across grade levels, domains of practice, and work load and to collaborate with the field supervisor to make corrections as appropriate.

4. To ensure that the Practicum student is obtaining adequate field supervision.

5. To be accessible to the Practicum student and to assist in problem solving.

6. To collaborate with the field supervisor(s) and Practicum student in completing the Practicum student evaluation form at the end of each semester.

7. To assign and record a grade for the Practicum.

8. To assist the Practicum student as he or she completes licensure applications. To submit verification of visits to the Licensure Officer using the Commonwealth of Massachusetts Department of Education Preservice Performance Assessment Cover Sheet.

9. To submit all required paperwork to the program director as soon as possible at the end of the semester. This includes: the Portfolio, Practicum Log, Supervision Log, Portfolio Scoring Rubrics and Portfolio Checklist, Practicum student Evaluation Form, Field Supervisor Tuition Voucher Application Form, and the Field Experience Evaluation

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10. To notify the program director, in a timely manner, if and when problems occur.

11. To assign Practicum grades (A through F). The final grade should indicate whether the Practicum student has attained sufficient proficiency to merit licensure as a school psychologist. A grade of C indicates unsatisfactory progress and the Practicum must be repeated.

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SEMINAR INSTRUCTOR RESPONSIBILITIES

By signing the Practicum contract, the seminar instructor ____________________________ indicates that s/he understands that this agreement is subject to final approval by the program director. The seminar instructor also officially verifies that he or she has at least three years’ experience as a licensed school psychologist and holds a current and valid license to practice school psychology. The seminar instructor further agrees:

1. To provide weekly seminar classes during which Practicum students are: Provided the emotional support necessary for beginning practitioners Provided opportunities to present cases for consultation with the instructor as well as peers Encouraged to develop a “community of learners” with peers Are exposed to additional information, resources, assessment tools, and other professional

information

2. To collect and provide feedback on rough draft and completed portfolio assignments throughout the year, including the Description of the Practicum Site, the Conclusion Essay, the In-service Presentation, the Case Study Presentation, and the required Case Studies.

3. To complete the case study rubric for each case study.

4. To periodically review the Practicum student Log, Supervision Log, reports, and other work samples to ensure that appropriate practice is being observed.

5. To monitor the appropriateness of the Practicum across grade levels, domains of practice, and work load and to collaborate with the field supervisor and university supervisor to make corrections as appropriate.

6. To be accessible to the Practicum student and to assist in problem solving.

7. To evaluate the Practicum students’ portfolio at the end of the year and complete the portfolio scoring rubric.

8. To assist the Practicum student as s/he completes licensure applications.

9. To notify the program director, in a timely manner that enables problem-solving, if and when problems occur.

10. To submit the student portfolio, case study rubrics, and portfolio scoring rubrics to the Program Director.

11. To assign seminar grades in a timely fashion. The final grade should indicate whether the Practicum student has attained sufficient proficiency to merit licensure as a school psychologist.

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PROGRAM DIRECTOR RESPONSIBILITIES

1. Facilitate appropriate Practicum placements.

2. Collaborate with the university supervisor and seminar instructor as appropriate.

3.To facilitate sending to the field supervisor(s) a UMass Boston tuition certificates/vouchers at the completion of the 450 hour Practicum (good for 3 graduate credits of study at UMass Boston with certain restrictions; it may be transferred to any other professional assigned but may not be used by the Practicum student).

4. Maintain the Practicum portfolio, evaluation forms, and other information.

5. Maintain and aggregate accurate records regarding Practicums sufficiently to maintain APA, NASP, NCATE, and DOE program approval.

6. Facilitate the Practicum experience as much as possible.

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School Psychology PhD Practicum Competencies, Outcomes ... · Web viewThe Pre-practicum, Practicum,...

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