School Psychology Training Program Practicum Handbook

School Psychology

Training Program

Practicum

Handbook

2012-2013

Donald L. Stovall, Psy.D. & Todd A. Savage, Ph.D., NCSP

University-Based Practicum Supervisors

2012-2013 UWRF School Psychology Practicum Handbook Page 1

Summer 2012

Greetings and welcome to your practicum year! As you are aware, SPSY 771 & 772:

Comprehensive School Psychology Practice (Practica I & II) serve as the vehicles for

you to begin to synthesize and integrate the knowledge related to the field you have

constructed through your coursework, as well as opportunities for you to apply your

knowledge in real-world settings under the supervision of seasoned, practicing school

psychologists. You may be experiencing a number of feelings as you enter the practica

experiences: excitement, anxiety, eagerness, urgency, fear, etc. These feelings are

normative and it is important for you to pay attention to them and to manage and channel

them to your benefit as you prepare to take on the role of the school psychologist during

your internship. Be aware, too, you will be receiving much support and guidance from

several experienced sources, including your field-based and university-based supervisors,

throughout your practicum. We invite you to rely on your supervisors and to take

advantage of their expertise as you develop your skills and abilities this year.

In conjunction with your practicum syllabus, this handbook provides much information

and many tools you will need to navigate your practicum experience. Please, keep it

handy and consult it as necessary throughout the practicum year. Your ability to meet the

requirements contained herein will be critical not only in terms of your own academic

and professional development, but in your matriculation to the internship experience in

the very near future, as well. The requirements are designed in accordance with NASP

and other federal and state training standards and successful completion of them will

stand you in good stead in the coming years.

We extend many good wishes to you as you embark on your practica. Do not hesitate to

contact us as indicated below should you have questions or needs for clarification.

Sincerely,

Donald L. Stovall, Psy.D.

University-based Faculty Practicum Supervisor

Office: (715) 425-3291

Fax: (715) 425-3242

E-mail: [email protected]

Todd A. Savage, Ph.D., NCSP

University-based Faculty Practicum Supervisor

Office: (715) 425-3243

Fax: (715) 425-3242

E-mail: [email protected]


TABLE OF CONTENTS

The Practicum Experience 3

Practicum Requirements 5

Practicum Calendar 10

Liability Insurance Requirement 11

Grading 12

Appendices

Appendix A: Practicum Case Documentation Forms 13

Appendix B: Practicum Activities Hours Log 19

Appendix C: Practicum Field-based Supervision Log 22

Appendix D: Performance-based Rubric (Teaming & Collaboration) 24

Appendix E: Performance-based Rubric (Group Counseling) 27

Appendix F: Performance-based Rubric (In-service) 30

Appendix G: In-service Participant Evaluation Form 33

Appendix H: Practicum Field-based Supervisor Evaluation Form 35

Appendix I: Guidelines for Summary and Reflection Activities 40

Appendix J: Field-Based Supervisor Interview 42

Appendix K: In-Class Case Presentation Format 44

Appendix L: Assignment Criteria for Grading: Book Review & Critique 47

Appendix M: Diversity Values and Dispositions Evaluation 49

Appendix N: Professional Work Characteristics Form 54

Appendix O: Intervention Case Study Example: Kara 57

Appendix P: Intervention Integrity Rating Form 66

Appendix Q: Intervention Case Study Appraisal Rubric 71

Appendix R: Readiness for Internship Form 73


UWRF SCHOOL PSYCHOLOGY TRAINING PROGRAM

THE PRACTICUM EXPERIENCE (2012-2013)

The Comprehensive School Psychology Practice Practicum I (SPSY 771) and Practicum

II (SPSY 772) courses are designed to provide candidates with their first opportunities for

intensive supervised, field-based experiences. The overarching philosophy undergirding

this practicum experience is candidates will have access to varied experiences through the

delivery of a comprehensive range of services with diverse student, family, and

professional populations. Through the practica experiences, school psychology

candidates will complete and document a minimum of 600 clock hours spent in

practicum activities, which translates to approximately 20 hours per week over the course

of an entire academic year. That is, practicum candidates are expected to engage in

practicum experiences until at least the end of the UWRF spring semester, as cooperating

districts are operating under this understanding. So, regardless of when candidates accrue

600 practicum hours, be it February or April of the practicum year, they are expected to

continue accruing practicum hours at their assigned practicum sites, again, until at least

the end of the UWRF spring semester of the practicum year. Given the intensive time

demands and commitment that practicum requires during the 3rd

year of training,

candidates must reduce any other full-time work responsibilities during this time (e.g.,

sabbatical, job share, time reduction). Practicum-related expectations and other

coursework during the 3rd

year often involve a time commitment similar to a full-time

work experience.

Third-year practicum experiences are supervised by both a university-based school

psychology faculty member and a field-based, licensed school psychologist. Numerous

public school practicum sites are located throughout western Wisconsin, eastern

Minnesota, south-central Minnesota, and the Minneapolis-St. Paul metroplex, all within

commuting distance to the university. Given the guiding philosophy for the practicum

experience outlined in the paragraph above, each candidate will be assigned to at least

two different practicum settings during the practicum year. It is the belief of the school

psychology faculty that being exposed to at least two different sites allows the practicum

candidate the opportunity to experience how different districts, schools, and supervisors

function and approach the education process. Through the assignment of at least two

practicum settings, program candidates should be exposed to a comprehensive range of

service delivery opportunities. Although practicum candidates may express a preference

for practicum placements, the school psychology faculty is ultimately responsible for

making practicum placements. A critical concern for a practicum placement is that a

comprehensive range of school psychology service delivery opportunities is made

available to the candidate and that she or he is able to gain experience in serving a diverse

population (defined broadly). Additionally, faculty members also consider the strengths

and areas of growth practicum candidates demonstrate in terms of their emerging

professional identities and skills; such consideration assists faculty members in ensuring

a fit between practicum candidates, districts, and field-based supervisors. In the event it is

determined a particular placement is not meeting the specific needs of the candidate, it is

possible the faculty, in tandem with the appropriate cooperating professionals, will re-

assign the candidate to another supervisor or practicum setting.


It is critical for candidates to understand that an application must be made for admittance

to practicum. It is by no means a guaranteed experience to all who are admitted to the

UW-RF school psychology program. Candidate professional work characteristics are

evaluated by university faculty to determine readiness for the practicum (see Appendix G

in this handbook). In the event that the majority of faculty members rate a candidate as

not a good nominee for the practicum experience, the candidate will be denied a

practicum placement. A professional growth plan can be developed (see Appendix Y of

the UWRF school psychology program student handbook) that identifies steps to correct

concerns to be addressed prior to practicum placement or the candidate may be advised to

discontinue the school psychology program altogether. Practicum assignments are made

by the university-based practicum supervisor(s). Candidate preferences for a location are

considered, but the ultimate placement is made by the university-based practicum

supervisor(s). The following details outline additional practicum placement procedures:

(1) The school psychology candidate must demonstrate evidence of academic

competence to be admitted to practicum. This evidence shall consist of

submission of a current university transcript at the time of practicum

application, documenting a cumulative grade point average of no less than 3.0,

and achievement of the Master of Science in Education (M.S.E.) degree.

(2) The school psychology candidate must demonstrate evidence of having

acceptable professional characteristics and interpersonal skills to be admitted

to practicum. This evidence shall consist of submission of Professional Work

Characteristics Appraisal Forms from appropriate faculty members (including

all school psychology faculty members) at the time of practicum application

(see Appendix K in the UWRF school psychology program student

handbook). Advisor review of portfolio progress, using the portfolio rating

rubric (see Appendix U in this handbook) will also be considered when

assessing candidate readiness for practicum.

Practicum-application procedures will be reviewed and materials distributed in the spring

semester of each year. Applications for practicum will be processed by the end of the

semester and placements for the following year will be announced near the end of spring

semester, or in some cases, the beginning of summer session. Candidates who do not

have the necessary prerequisites for practicum will not be permitted to engage in the

supervised field experience. Additionally, all candidates must purchase and maintain

enrollment as a NASP student member and in the Forrest T. Jones professional liability

insurance plan as required by the UWRF school psychology program throughout their

entire tenure in the program. Failure to purchase and maintain NASP student

membership and/or the Forrest T. Jones professional liability insurance will result in

the candidate being either prevented from entering the practicum experience or

dropped from the practicum experience.

Once the candidate has been approved to engage in the practicum sequence, she or he

must fulfill the specific practicum requirements outlined in the section that follows.


PLEASE, NOTE: Many school districts require an additional criminal background check

prior to the practicum placement. The school psychology faculty may approve and place

candidates at practicum sites, but the site always has the option not to approve a

candidate for placement based on the outcome of the background check.

Once the candidate has been approved to engage in the practicum sequence, she or he

must fulfill the specific practicum requirements outlined in the section that follows.

SUMMARY OF UWRF SCHOOL PSYCHOLOGY PROGRAM

PRACTICUM REQUIREMENTS

I. Hours. Each practicum candidate will engage in the practicum portion of the

program for a minimum of 600 hours distributed evenly across one academic

year; of these 600 hours, at least 300 must be spent in direct service with

clients. Observation of general and special education classrooms at both the

elementary and secondary levels should be conducted as part of these hours

and portions of the practicum experience must be devoted to working with

students in each of the following age-level groupings: pre-kindergarten,

elementary, and secondary. Please, note practicum requirements may not be

completed during summer break months. The practicum must be completed

within one year, except under extraordinary circumstances and at the

discretion of the university-based practicum supervisor. Practicum hours also

include the DIBELS screenings required of the practicum candidate three

times during the year in the River Falls School District. More information in

regard to the DIBELS expectations will be provided at the outset of the fall

semester. Regardless, the hours must be documented in the logs provided in

the practicum handbook, which is available online, and signed by the field-

based supervisors before submission to the university supervisor.

II. Cases. The practicum candidate must complete a minimum of 20 individual

student cases during the practicum experience. These cases may include the

following: (1) development of interventions that involve academic needs,

social needs, behavioral needs, or cognitive needs, (2) design, implementation,

and evaluation of interventions for students in general and special education

placements; (3) collaborative design, implementation, and evaluation of

consultations with families, teachers, or other professionals (4) direct service

through individual counseling or through the facilitation of student support

groups; (5) indirect service through some type of consultation delivery model;

(6) involvement in program planning and development; (7) participation in

research and data collection; (8) participation in the data-based decision-

making process, with emphasis on strategies for positive growth and change.

Of these 20 cases, a minimum of five (5) cases must be completed within each

of the following age designations: (a) infancy through age 5 years, 11 months;

(b) students aged 6-12 years; and (c) students aged 13 years and above;

additionally, at least five (5) cases must be based on a consultation process


employed to address issues raised by teachers or families related to a child.

All cases should be based on students demonstrating a variety of exceptional

needs (including giftedness) or issues to be addressed in both general and

special education settings. Documentation, through case study or other means,

of work with students from diverse cultural or linguistic backgrounds (i.e.,

English-language learners) is also required. Documentation of the completion

of these cases will occur through the signing of the Case Documentation

forms available in the practicum handbook by the field-based supervisor.

Finally, each candidate is required to complete two systematic intervention

case studies (single subject design; one student each semester) during the

practicum year (one during the fall semester and one during the spring

semester) based on the Intervention Case Study rubric (see the practicum

handbook for these forms) that includes four sections: 1) problem

identification, 2) problem analysis, 3) intervention, 4) evaluation. These cases

studies will be culled from the pool of 20 cases outlined above and they must

be based on students from diverse backgrounds. The candidate must also

complete an Intervention Integrity Rating form (See the practicum handbook

handbook) for each of these cases, as well. An example of a well-written

intervention case-study write-up can be found in both the School Psychology

Student Handbook and the practicum handbook, both of which can be found

on line. *NOTE: These case intervention studies may serve as an artifact

in the programmatic portfolio to meet the following NASP domains: 1, 2,

3, 4, 5, 6, 7, and 8.

III. Case parameters: The assignment of cases is made by the field-based

supervisor, who should ensure the proper permission to assess/observe/work

with a student has been procured from the appropriate family member or legal

guardian. Throughout the process, it is the ethical responsibility of each

practicum candidate to present she or he as being a school psychologist in-

training, ensuring she or he informs families, legal guardians, school

personnel, the students with whom she or he is working, and other affiliated

persons of such a designation. All formal reports the candidate creates must be

reviewed, approved, and co-signed by the field-based supervisor.

Each student evaluated by the practicum candidate should be observed in

various settings as part of the data-based decision-making process. School

psychology practicum candidates should confirm proper permission has been

obtained to assess a student. Furthermore, the practicum candidate should

interview the appropriate persons attached to the case, including teachers,

families, and other educational or community-based professionals as a part of

the data-based decision-making process. Also, as a part of the data-based

decision-making process, the candidate student should participate actively in

multidisciplinary staffings, to share results and recommendations with

teachers, families, and other specialists. In cases where individual follow-up

conferences (e.g., with families) are needed, the practicum candidate, in


conjunction with her or his field-based supervisor, should insure that such

conferences are scheduled and executed in a timely fashion.

IV. In-service presentation: The practicum candidate must prepare and participate

in at least one in-service presentation most likely during the spring semester

portion of the practicum experience, though it could be accomplished in the

fall semester, should the opportunity present itself. Both the field-based and

university-based supervisors should approve the topic of the in-service. This

presentation may be either an individual effort by the practicum candidate or a

portion of a larger presentation made in conjunction with other professionals.

The presentation must include a formal assessment or evaluation piece

completed by the session participants. The candidate must then write a 3-5

page reflection piece that summarizes the session, overall, the candidate’s

perceived strengths and areas of growth related to the presentation, in

particular, and the evaluations completed by the session participants. The

candidate should also outline how she or he intends to address their areas of

growth in this domain.

V. Group experience. The practicum candidate must organize and conduct a

minimum of one student or family group during the practicum year that meets

regularly for a specified period of time. Co-facilitation of a group with an

experienced staff member is preferred for candidates with no previous

experience in conducting group counseling or family education sessions.

Outcomes data must be collected and reported as a part of this process.

VI. Legal/ethical issue case summary: Each semester, the practicum candidate

must write and submit one case summary and reflection piece that addresses a

legal or ethical issue encountered during the practicum experience. Parameters

for this case study are provided the practicum handbook, which is available

online.

VII. Crisis prevention/intervention activities summary. Each semester, the

practicum candidate must write and submit documentation of participation in

some type of crisis prevention/intervention activity that occurred during the

practicum experience. Such activities could include reviewing the

school’s/district’s crisis prevention/intervention manual, participating on a

crisis prevention/intervention team, assisting in the implementation of a bully-

proofing program, etc. Parameters for this activities summary are provided in

the practicum handbook, which is available online.

VIII. RtI activities summary. Each semester, the practicum candidate must write and

submit documentation of participation in some type of RtI process or related

activity that occurred during the practicum experience. Such activities could

include participating in the school- or district-wide RtI process, attending

workshops or other professional development offerings related to RtI, etc.


Parameters for this activities summary are provided in the practicum

handbook, which is available online.

IX. Field-based face-to-face supervision. Each practicum candidate will meet

individually on a weekly basis with his or her field-based supervisor for a

minimum of one (1) hour of face-to-face supervision related to all practicum

activities. These hours must be documented in the appropriate log contained in

the practicum handbook and which need to be signed by the field-based

supervisor.

X. University-based face-to-face supervision. During the fall semester, each

practicum candidate will meet individually with his or her university-based

supervisor on a once per month basis for ½ hour of face-to-face supervision of

all practicum activities.

XI. Group seminars. Throughout the practicum year, each candidate will

participate in two regularly-scheduled university-based group seminars per

month for group supervision and content delivery.

XII. Two field-based supervisor assessments. It is the responsibility of each

practicum candidate to make all necessary arrangements for the field-based

supervisor to assess two (2) total (1 per semester) multidisciplinary meetings,

in-service presentations, or group sessions conducted by the practicum

candidate. The field-based supervisor will rate the candidate’s performance

according to the appropriate performance-based rubric available in the both

the UWRF School Psychology Student Handbook and the practicum

handbook, both of which are available online. These formal assessments are

above and beyond the expected, ongoing supervision activities between the

candidate and her or his field-based supervisor. *NOTE: A field-based

supervisor assessment pertaining to an activity in which parents are

involved may be used as an artifact in the programmatic portfolio under

NASP domain #7.

XIII. Four university-based supervisor assessments. It is the responsibility of each

practicum candidate to make all necessary arrangements for the university-

based supervisor to assess four (4) total (2 per semester), including two (2)

multidisciplinary meetings, one (1) in-service presentations, and one (1) group

session conducted by the practicum candidate. The university-based

supervisor will rate the candidate’s performance during the observation

according to the appropriate performance-based rubric contained in the

UWRF School Psychology Student Handbook and the practicum handbook,

both of which are available online. *NOTE: A university-based supervisor

assessment pertaining to an activity in which parents are involved may be

used as an artifact in the programmatic portfolio under NASP domain #7.


XIV. Field-based supervisor evaluations. The field-based supervisor will complete

an evaluation of the practicum candidate’s performance at mid-term and at the

end of the semester; the evaluation form is contained in both the UWRF

School Psychology Student Handbook and the practicum handbook. Thus, by

the end of the practicum experience, candidates will have a total of four (4)

evaluations completed by field-based supervisors (2 mid-term evaluations, 2

end-of-the-semester evaluations). These evaluations will be reviewed and

discussed with each candidate by both the field and university-based

supervisors through an informing conference, which could take place over the

phone. *NOTE: The summative (i.e., final) field-based supervisor

evaluation from SPSY 772 (i.e., spring 2013) is a necessary artifact to be

included in the programmatic portfolio to meet the following NASP

domains: 1, 2, 3, 4, 5, 6, and 10.

XV. Documentation logs. The practicum candidate will maintain monthly logs of

hours (see Appendix B in the practicum handbook) that document the range of

activities and services in which the candidate engages, in addition to the

specific number of hours engaged in individual activities and the total number

of hours engaged in all practicum-related activities. This log will be submitted

to the university-based supervisor once per week for review. Candidates are

expected to achieve a minimum level of 20 hours per week devoted to

practicum that includes an average of 1 hour per week of face-to-face

supervision with the field-based supervisor.

XVI. Book reviews: Each semester, the candidate must write and submit a book

review and critique based on texts selected by the university-based faculty

supervisors. Parameters for these book reviews are outlined in the practicum

syllabus as well as in Appendix L of the practicum handbook, which is

available online.

XVII. Annual programmatic self-assessments. At the end of the spring semester, the

candidate must complete and submit the annual programmatic self-assessment

measures, including the Diversity Values and Dispositions self-rating form

(see the UWRF School Psychology Student Handbook and the practicum

handbook for these forms). Candidates must also have their field-based

supervisors complete the Professional Work Characteristics Form (see the

UWRF School Psychology Student Handbook and the practicum handbook

for this form) and include the completed forms in the Programmatic Portfolio

each semester. *NOTE: The Professional Work Characteristics forms

completed by the field-based supervisor at the end of SPSY 772 (i.e.,

spring 2013) can be included as an artifact in the programmatic portfolio

under NASP domains #7 and #10.

XVIII. Programmatic portfolio. At the end of each semester of practicum, the

candidate must submit an updated programmatic portfolio that includes

reflections and artifacts in each of two sections: NASP domains and the WI


DPI Pupil Services area. Guidelines for this portfolio are contained in the

UWRF School Psychology Student Handbook, which is available online.

XIX. Ethical obligations. Each practicum candidate is expected to engage in all

practicum activities in strict accordance with the ethical principles established

by the National Association of School Psychologists and the American

Psychological Association. The 2010 NASP ethical standards can be found at

<http://nasponline.org/standards/2010standards/1_%20Ethical%20Principles.

pdf >.

XX. Miscellaneous. If needed, the university-based supervisor will meet with the

field-based supervisor and practicum candidate at times other than those

regularly-scheduled meetings to discuss the practicum placement or other

issues of concern.

XXI. Field-Based Supervisor Interview. During the fall semester, the candidate will

conduct an interview with one of her or his field-based supervisors regarding

the cooperating school district based on the interview protocol provided in the

practicum handbook. The candidate will be expected to present the results of

the interview in the practicum seminar as assigned. The parameters for this

interview can be found in the practicum handbook.

XXII. Case Presentations. Several times throughout the year, the candidate will

conduct case presentations during seminar based on actual cases from the field

and according to the case presentation guidelines found in the practicum

handbook.

XXIII. Readiness for Internship. By the time the candidate reaches the final eight

weeks of the SPSY 772 practicum experience, she or he must submit

completed Readiness for Internship forms (see either the UWRF School

Psychology Student Handbook or the practicum handbook for this form) from

two field-based practicum supervisors and her or his university-based

practicum supervisor. These forms will be reviewed by the school psychology

program faculty in tandem with the other myriad practicum data to determine

whether the candidate may matriculate to the required internship experience.

PRACTICUM CALENDAR

Due to the nature of the calendars established by the various cooperating public school

districts, the practicum candidate should expect to begin their practicum experience prior

to the beginning of the UWRF fall semester. The candidate may also be expected to

return to their practicum sites in January prior to the beginning of the spring semester.

Finally, cooperating districts and field-based supervisors expect the practicum candidate

to finish out the experience on a date that coincides with the end of their academic year,

which, in most cases, will extend 1-3 weeks beyond the end of the UWRF spring

semester. As such, practicum candidates with receive an “I” grade for SPSY 772 that will


be converted to the appropriate letter grade once candidates have completed their hours

and submitted documentation of such to their university-based supervisor.

LIABILITY INSURANCE REQUIREMENT

As part of the candidate’s entire tenure in the UWRF school psychology program, she or

he must obtain professional liability insurance for school psychologists in-training.

Having such insurance is necessary before the student can participate in the required

practica experiences. Liability insurance through the Forrest T. Jones company is the

required coverage by the UWRF school psychology program and it is available at a

discounted rate through the National Association of School Psychologists, which requires

one to be a member of the professional organization in order to take advantage of the

insurance benefit. Information about NASP membership is available at the NASP

Website (www.nasponline.org) while information about the liability insurance program is

available at the Forrest T. Jones Website (www.ftj.com). Failure to purchase and

maintain NASP student membership and the Forrest T. Jones professional liability

insurance will result in the candidate being either prevented from entering the

practicum experience or dropped from the practicum experience.


GRADING

The following rubric will be used in determining candidates’ practicum grade at the end of each semester:

Category 4 3 2 1 Level

Professional Work

Characteristics

Routinely

demonstrated

professionalism, including, but not

limited to:

organization, dress, punctuality,

dedication, ability to

accept feedback and other interpersonal

skills (e.g., patience,

respect).

Often demonstrated

professionalism

including, but not limited to:

organization, dress,

punctuality, dedication, ability to

accept feedback and

other interpersonal skills (e.g., patience,

respect).

Sometimes

demonstrated

professionalism including, but not

limited to:

organization, dress, punctuality,

dedication, ability to

accept feedback and other interpersonal

skills (e.g., patience,

respect).

Rarely demonstrated

professionalism

including, but not limited to:

organization, dress,

punctuality, dedication, ability to

accept feedback and

other interpersonal skills (e.g., patience,

respect).

Timely and proper

completion of NASP

and UWRF program

requirements

ALL requirements

were submitted by

the due dates in the syllabus. This

includes timely

submission of course packets and

materials to the

instructors

Some, but not all,

requirements were

submitted by the due dates in the syllabus.

Candidate struggled

to complete

requirements by the due dates in the

syllabus.

Field Supervisor

Evaluations

Routinely evaluated as excellent or a well-

above average

practicum candidate in terms of knowledge

and performance

competency.

Typically evaluated as a solid or

developing practicum

candidate in terms of knowledge and

performance

competency.

Typically evaluated as a practicum

candidate of average

or adequate knowledge and

performance

competency.

Typically evaluated as a below-average or

struggling practicum

candidate in terms of knowledge and

performance

competency.

Book review &

critique

>90 points earned on

the book review and

critique according to the book review

scoring rubric

80-89 points earned

on the book review

and critique according to the book

review scoring rubric

70-79 points earned

on the book review

and critique according to the

book review scoring

rubric

< 69 points earned on

the book review and

critique according to the book review

scoring rubric

Course portfolio

>90 points earned on

the course portfolio

according to the portfolio scoring

rubric.

80-89 points earned

on the course

portfolio according to the portfolio scoring

rubric.

70-79 points earned

on the course

portfolio according to the portfolio

scoring rubric.

< 69 points earned on

the course portfolio

according to the portfolio scoring

rubric.

TOTAL

Grading Rubric Total Guide:

>17 = A; 15-16 = B; 13-14 = C; 11-12 = D; < 10 = F


Appendix A


UWRF School Psychology Training Program Practicum Case Documentation Forms

UWRF Practicum Case Requirements

Case # Case

Type*

Early

Childhood

(n = 5)

Elementary

(n = 5)

Secondary

(n = 5)

Consultation

(n = 5)

Field-based

Supervisor’s

Initials &

Date

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

*Key: A = assessment (e.g., cognitive, academic, personality)

ACI = academic intervention

BI = behavior intervention (e.g., development of behavior intervention plan)

IC = individual counseling

GC = group counseling

CC = consultation/collaboration

RP = research or program evaluation

Documentation of In-service Presentation

Date of

In-service

Presentation

Title of In-Service Presentation Field-based

Supervisor’s

Signature &

Date

University-based

Supervisor’s

Signature &

Date


ASSESSMENT AND INTERVENTION EXPERIENCE

How much experience with different types of assessment and intervention activities

are you accruing as a result of engaging in the practica experiences? Please, report

actual clock hours in direct service to clients. Hours should not be counted in more than

one category. Experiences involving information gathering about the client but not in the

actual presence of the client should be recorded in the “Support Activities” table found

elsewhere in this document.

Type of Activity Total # of Hours Spent

Face-to-Face with Clients

In This Activity

Total # of Different

Individuals Served

Through This Activity

Cognitive Assessment

-Early childhood (0-5.11)

-Elementary (6-12.11)

-Secondary (13+)

Academic Assessment



-Secondary (13+)

Social/Emotional/Behavioral



-Secondary (13+)

Academic Intervention



-Secondary (13+)

Behavior Intervention



-Secondary (13+)

Consultation/Collaboration



-Secondary (13+)

Individual Counseling



-Secondary (13+)

Group Counseling Total # of Different

Groups Run



-Secondary (13+)

Program Evaluation


SUPPORT ACTIVITIES

This section involves describing the practicum activities in which you engaged that

supported your assessment and intervention experiences. This section includes

activities in which you engaged outside of the actual test administration and individual

and/or group counseling sessions conducted with clients. In addition, it includes the

activity of participating in didactic training held at your field-based site and on the UW-

RF campus related to your practica experiences.

Activity Total # Total # of Hours Spent in

the Activity

Case conferences

Case management, case

consultation

Didactic training/seminars

Progress notes/Records

Review

Assessment scoring,

interpretation, and report

writing

Video-audio-digital

recording review

Total


CLIENT PROFILES

Race/Ethnicity Number of Different Clients Seen

Assessment Intervention

African American/Black/African origin

Asian American/Asian origin/Pacific

Islander/Hawaii native

Latino-a/Hispanic

American Indian-Native American/Alaska

native/First Nation Canadian

European origin/Caucasian

Bi-racial/Multi-racial

Other (Specify: )

Sexual Orientation (This information may

not be known for all clients; please, indicate

only when known)

Number of Different Clients Seen


Heterosexual

Lesbian

Gay

Bisexual

Exceptionalities Number of Different Clients Seen


Physical/orthopedic disability

Blind/visually impaired

Deaf/hard of hearing/hearing impaired

Developmental disability (including cognitive

disabilities and autism spectrum disorders)

Serious mental illness (e.g., primary psychotic

disorders, major mood disorders that interfere

significantly with adaptive functioning)

Learning disability

Gifted

Other (Specify: )

Gender Number of Different Clients Seen


Female

Male

Transgender

Other (Specify: )

Language Number of Different Clients Seen


English-language learners


TEST ADMINISTRATION

What is your experience with the following instruments? Please, indicate all

instruments used by you in your assessment experiences completed during your practica

experiences. You may include any experience you have had with these instruments other

than practice administrations. Indicate the number of tests you administered and scored

in the first column. In the second column, indicate how of those tests you administered

and scored in Column I that were subsequently interpreted in a report you wrote.

Test # Administered

& Scored

# of Reports

Written

Achenbach Child Behavior Checklist

Adaptive Behavior Assessment System-Second Ed.

Barkely-Murphy Checklist for AD/HD

AIMS-Web

Bayley-III

BASC-2

Bender-Gestalt

BVAT

Conner’s Scales

DIBELS

Differential Abilities Scale-Second Edition

KABC-II

Projective measures

Stanford-Binet Intelligence Scales-Fifth Edition

Systematic observation/time sampling

UNIT

Vineland-II

VMI

WAIS-IV

Wechsler Memory Scale-Third Edition

WIAT-II

WISC-IV

WJ-III: Cognitive

WJ-III: Achievement

Woodcock-Muñoz Batería-Third Edition (NU)

Woodcock-Muñoz Language Survey-Revised

WPPSI-III

Other (Specify: )

Other (Specify: )

INTEGRATED REPORT WRITING

Client Population # of Integrated Reports Written

Child/Adolescent

Adult


Appendix B


UWRF School Psychology Training Program Practicum Activities Hour Log

PRACTICUM LOG - 2012-2013

AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY Total Hours

ACTIVITIES

Interventions

Dyadic collaboration 0.0

Intervention Teaming 0.0

Intervention Implementation 0.0

Intervention Measurement 0.0

Misc. Intervention practices 0.0

Diverse Ethnicity/Culture

Consultation - Other 0.0

Counseling

Group 0.0

Individual 0.0


Norm-Referenced Assessment

Preschool (3.0-5.11) 0.0

Elementary (6.0-12.6) 0.0

Middle (12.7-14.6) 0.0

High (14.7 and above) 0.0


Alternative Assessments

Curriculum-Based Measurement 0.0

Criterion-Referenced 0.0


Observation

Preschool (3.0-5.11) 0.0

Elementary (6.0-12.6) 0.0

Middle (12.7-14.6) 0.0

High (14.7 and above) 0.0


Interviewing

Teacher 0.0

Parent/Care Giver 0.0

Student 0.0


Report Writing 0.0

Child Study/M-Team 0.0

Case Staffing 0.0

Case Management 0.0

Miscellaneous

Crisis Intervention 0.0

In-Service (Giving) 0.0

In-Service (Attending) 0.0


Professional Development 0.0

Orientation 0.0

Organizational Time 0.0

Parent Conference 0.0

Program Evaluation 0.0

Program Planning 0.0

Research 0.0

Screening 0.0

Supervision (field) 0.0

Supervision (university) 0.0

Travel 0.0

Other:____________________ 0.0

Other:____________________ 0.0

Other:____________________ 0.0

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0

_________________________________________________ _______________

Field-based Supervisor’s Signature Date

_________________________________________________ _______________

University-based Supervisor’s Signature Date


Appendix C


UWRF School Psychology Training Program Practicum Field-based Supervision Log

UW-RF School Psychology Practicum

Weekly Field-based Supervision Hours 2012-2013

Candidate Name:_________________________ _________________

Field-based Supervisor Name:__________________________

Week 1

Week 2 Week 3 Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10

Week 11


Week 15

Week 16

Week 17

Week 18

Week 19

Week 20

Week 21


Week 25

Week 26

Week 27

Week 28

Week 29

Week 30

Week 31


Week 35

Week 36

Week 37

Week 38

Week 39

Week 40

Total Field Supervision Hours: 0

Mean Field Superv. Hours Per Week:

_________________________________________________ _______________

Field-based Supervisor’s Signature Date

_________________________________________________ _______________

University-based Supervisor’s Signature Date


Appendix D


UWRF School Psychology Training Program Practicum Assessment: Performance-Based Rubric (TEAMING & COLLABORATION)

Candidate name & observation site: _________________________________________________

Description of activity observed: ___________________________________________________

Observer name and date: _________________________________________________________

Category 4 3 2 1 Level Interpersonal

skills and

communication

Routinely demonstrated effective interpersonal skills

(e.g., strong listening, patience,

and respect). Communicated information very clearly and

enthusiastically. Showed

dedicated interest in audience

understanding.

Usually demonstrated effective interpersonal skills

(e.g., strong listening,

patience, and respect). Information usually

explained and followed up

upon effectively.

Sometimes demonstrated effective interpersonal

skills (e.g., listening,

patience, and respect). Was able to communicate

information adequately,

but at a basic level.

Rarely demonstrated effective interpersonal

skills (e.g., strong

listening, patience, and respect). Struggled to

communicate information

effectively.

General problem-

solving

collaboration

Routinely solicited and helped

synthesize information from others. Interjected own ideas

assertively without being

domineering. Demonstrated clear preference for win-win

strategies and positive

approaches to problem solving.

Usually demonstrated ability

to interject own ideas and synthesize information from

others. Not yet viewed as a

clear problem-solving leader, but shows strong

foundational skills.

Sometimes used

information provided by others in team. Was

sometimes able to

collaborate effectively, but sometimes too

passive or aggressive

with own ideas.

Rarely utilized

information from other group members during

decision making. Was

excessively passive or aggressive with own

ideas.

Intervention

enhancement

A clear leader in helping develop appropriate goals and

interventions. Demonstrated

excellent awareness of varied interventions or instructional

methodologies.

Demonstrated helpful awareness and effort in

assisting development of

goals and interventions.

Provided some help in developing goals and

interventions. Ideas were

somewhat helpful, but viewed as basic.

Rarely or did not help develop goals or

interventions. Did not

recognize the need to link data to interventions or

modifications.

Diversity values

and dispositions

Routinely was respectful (valuing other perspectives,

listening actively, exhibiting

empathy, pacing the meeting), inclusive (thinking of others),

open, collaborative, and

cooperative. Adapted practice effectively and appropriately as

necessary to meet the needs of

others.

Often was respectful (valuing other perspectives,

listening actively, exhibiting

empathy, pacing the meeting), inclusive (thinking

of others), open,

collaborative, and cooperative. Adapted

practice adequately as

necessary to meet the needs of others.

Sometimes was respectful (valuing other

perspectives, listening

actively, exhibiting empathy, pacing the

meeting), inclusive

(thinking of others), open, collaborative, and

cooperative. Showed

some effort to adapt practice to meet the needs

of others.

Did not present as being respectful (valuing other



meeting), inclusive


cooperative. Did not

adapt practice to meet the needs of others.

Data-based

decision-making

Collected valuable data for understanding problems.

Utilized multiple tools and

techniques (as needed) in gathering the data.

Recognized as a clear leader in

data collection, interpretation, and data-based decision

making.

Collected acceptable data for understanding problems.

Chosen tools and techniques

were sufficient, and data provided to team was

valuable in decision making.

Collected adequate data for understanding

problems, with room for

improved variability. Showed some effort to

connect data to

interventions.

Collected data were incomplete or

inappropriate for the

presenting problem. Did not effectively connect

data to interventions or

goals.

Professional, legal,

and ethical

responsibility

Clear and effective adherence

to due process guidelines in all decisions affecting students.

Maintained high ethical

standards.

Adhered to due process

guidelines in most decisions affecting students.

Maintained acceptable

ethical standards.

Adhered to due process

guidelines in most decisions affecting

students. Ethical

standards were adequate.

Neglected or failed to

recognize some due process guidelines.

And/or did not address

ethical issues appropriately.

TOTAL


Additional observation notes:

The completed rubric was reviewed and discussed with me and I had an opportunity to have my

questions answered about the evaluation of my performance through this observation.

________________________________________________________ ___________________

Practicum candidate signature Date

___________________________________________________ __________________

Supervisor signature Date

Rubric total guide:

22 – 24 Outstanding skill, knowledge, and effort observed. The candidate is emerging as an independent,

well-respected, and highly-motivated school psychologist.

18 – 21 Adequate skill, knowledge, and effort observed. Strong foundational skills in place. The

candidate is moving in the direction of becoming an effective and independent practicum-level

school psychologist.

15 – 17 Average skill, knowledge, and/or effort observed. Some strengths noted. Some areas will require

significant development to ensure the candidate develops as an effective school psychologist.

Strengths:

Areas for growth:


Appendix E


UWRF School Psychology Training Program Practicum Assessment: Performance-Based Rubric (GROUP COUNSELING)

Candidate name and observation site: _______________________________________________



Category 4 3 2 1 Level Intervention &

counseling skills

A clear leader in assisting client(s)

develop appropriate

goals. Demonstrated

excellent awareness of

varied counseling

approaches.

Demonstrated helpful awareness and effort in

assisting client(s)

develop goals.

Provided some assisting client(s) in

developing goals.

Ideas were somewhat

helpful, but viewed

as basic.

Rarely or did not assist client(s)

develop appropriate

goals.

Interpersonal skills

and communication

Routinely demonstrated

effective interpersonal

skills (e.g., strong listening, patience).

Communicated very

clearly and enthusiastically.

Showed dedicated

interest in understanding.

Usually demonstrated


skills (e.g., strong listening, patience). Was

able to communicate

appropriately.

Sometimes

demonstrated

effective interpersonal skills

(e.g., listening,

patience). Was able to communicate

information

adequately, but at a basic level.

Rarely demonstrated

effective

interpersonal skills (e.g., strong listening,

patience). Struggled

to communicate information

effectively.

General problem-

solving

collaboration

Routinely solicited and

helped synthesize information from

client(s). Interjected

own ideas assertively without being

domineering.


ability to interject own ideas and synthesize

information from

client(s).

Sometimes was able

to effectively solicit and synthesize

information from

client(s).

Rarely utilized

information from client(s) in problem

solving. Was

excessively passive or aggressive with

own ideas.

Diversity values and

dispositions

Routinely was

respectful (valuing other perspectives, listening

actively, exhibiting

empathy, pacing the meeting), inclusive

(thinking of others),

open, collaborative, and cooperative. Adapted

practice effectively and

appropriately as necessary to meet the

needs of others.

Often was respectful

(valuing other perspectives, listening

actively, exhibiting

empathy, pacing the meeting), inclusive

(thinking of others),

open, collaborative, and cooperative. Adapted

practice adequately as

necessary to meet the needs of others.

Sometimes was

respectful (valuing other perspectives,

listening actively,

exhibiting empathy, pacing the meeting),

inclusive (thinking of

others), open, collaborative, and

cooperative. Showed

some effort to adapt practice to meet the

needs of others.

Did not present as

being respectful (valuing other

perspectives,

listening actively, exhibiting empathy,

pacing the meeting),

inclusive (thinking of others), open,

collaborative, and

cooperative. Did not adapt practice to

meet the needs of others.


and ethical

responsibility


standards and

professional approach.


ethical standards and

professional approach.

Ethical standards and

professionalism were

adequate.


recognize ethical and

professional responsibilities issues

appropriately.

TOTAL





________________________________________________________ ___________________


___________________________________________________ __________________


Rubric total guide:

18– 20 Outstanding skill, knowledge, and effort observed. The candidate is emerging as an independent,





11 – 13 Average skill, knowledge, and/or effort observed. Some strengths noted. Some areas will require


Strengths:

Areas for growth:


Appendix F


UWRF School Psychology Training Program Practicum Assessment: Performance-Based Rubric (IN-SERVICE)

Candidate name and observation site: _______________________________________________



Category 4 3 2 1 Level In-service

development

Developed an in-service presentation that

definitely addressed an

area of need for the

audience and that was

clearly empirically-

based in terms of its content.

Developed an in-service presentation that

addressed an established

area of need for the

audience and that

included content derived

from empirically-based literature specific to the

topic.

Some attempt was made to tailor the

presentation based on

the established needs

of the audience and

some effort went into

basing the content on information provided

in the empirical

literature.

The in-service presentation was

disconnected from

the established needs

of the audience

and/or its content was

not derived from empirically-based

literature.

Interpersonal skills

and communication

Routinely demonstrated


skills (e.g., strong listening, patience).

Communicated very

clearly and enthusiastically.

Showed dedicated

interest in meeting the needs of the audience

and adjusted approach

accordingly.



skills (e.g., strong listening, patience). Was

able to communicate

appropriately. Showed interest in meeting the

needs of the audience

and attempted to adjust the approach

accordingly.

Sometimes

demonstrated

effective interpersonal skills

(e.g., listening,

patience). Was able to communicate

information

adequately, but at a basic level. Some

attempts made to

meet the needs of the audience and to

adjust the approach.

Rarely demonstrated

effective

interpersonal skills (e.g., strong listening,

patience). Struggled

to communicate information

effectively. No

interest in or attempts made to meet the

needs of the audience

and to adjust the approach as

necessary.

Diversity values and

dispositions

Routinely was respectful (valuing other



meeting), inclusive


cooperative. Adapted

practice effectively and appropriately as

necessary to meet the

needs of others.

Often was respectful (valuing other



meeting), inclusive


cooperative. Adapted

practice adequately as necessary to meet the

needs of others.

Sometimes was respectful (valuing

other perspectives,

listening actively, exhibiting empathy,

pacing the meeting),

inclusive (thinking of others), open,

collaborative, and

cooperative. Showed some effort to adapt

practice to meet the

needs of others.

Did not present as being respectful

(valuing other

perspectives, listening actively,

exhibiting empathy,

pacing the meeting), inclusive (thinking of

others), open,

collaborative, and cooperative. Did not

adapt practice to

meet the needs of others.


and ethical

responsibility


standards and professional approach.


ethical standards and professional approach.

Ethical standards and

professionalism were adequate.


recognize ethical and professional

responsibilities issues

appropriately.

TOTAL





________________________________________________________ ___________________


___________________________________________________ __________________


Rubric total guide:

14 – 16 Outstanding skill, knowledge, and effort observed. The candidate is emerging as an independent,





8-9 Average skill, knowledge, and/or effort observed. Some strengths noted. Some areas will require


Strengths:

Areas for growth:


Appendix G


UWRF School Psychology Training Program In-Service Participant Evaluation Form

Session Title:

Presenter:

Date:

Place:

Please, respond to the statements below according to the following scale:

1 = Disagree 2 = Neutral 3 = Agree

1. Session objectives were met. 1 2 3

2. I gained useful and helpful

knowledge from this session. 1 2 3

3. Knowledge I gained from this

session applies to me directly

in my work in the school setting. 1 2 3

4. The materials/handouts provided 1 2 3

were helpful and informative.

5. The presenter was knowledgeable

and professional. 1 2 3

6. Strengths of the session include:

7. Suggested improvements for the session include:

Thank you for your participation and for your feedback!


Appendix H


UWRF School Psychology Program Practicum Candidate Evaluation of Knowledge & Emerging Skills

Practicum candidate: _____________________________________________________________

Field-based supervisor completing this evaluation: _____________________________________

Evaluation cycle: _____ Mid-term _____ End-of-Semester

Semester: _____ Fall _____ Spring

Date: _________________________________________________________________________

RATING INSTRUCTIONS: Please, evaluate the practicum candidate’s knowledge and skill development by circling the

appropriate rating next to each question on the following pages. Item content is based on the 2010

NASP standards for graduate education of school psychologists (see:

http://www.nasponline.org/standards/2010standards/1_Graduate_Preparation.pdf for additional

details).

Use the scale provided while considering the practicum candidate’s progress relative to

expectations for all practicum level school psychologists-in-training. Please, note: The practicum

candidate should be rated on ALL items (i.e., do not indicate “NA”). If you are unsure about the

practicum candidate’s progress on an item, please discuss the item content with others who may

know.

PROVIDING FEEDBACK:

Feedback to the candidate should be provided about her or his development relative to

graduating intern expectations. Written comments on any particular strength or challenging

characteristic may be included in the box at the end of this form. Please, communicate with

other supervisors about the practicum candidate’s progress, as needed.

PASSING CRITERIA:

The Practicum Candidate’s Evaluation of Knowledge & Emerging Skills appraisal rubric

has 165 total points. Passing levels are as follows:

Semester Item Passing Level TOTAL rubric passing level Fall - Formative Minimum rating of 2 60% (100+)

Spring -Summative Minimum rating of 3 80% (132+)

Ratings of 2 (minimal) and 3 (average) are normative in the fall semester of practicum,

with growth expected thereafter. At the time of the fall formative evaluation and beyond,

a non-passing level TOTAL score may necessitate the development of a “Professional

Growth Plan” (see Appendix Y of the Program Handbook) or other new goals for the

candidate. Individual items that are not passed should be discussed and should guide new

goal setting.

http://www.nasponline.org/standards/2010standards/1_Graduate_Preparation.pdf


RATING SCALE:

1: The practicum candidate has been significantly challenged by lack of knowledge or

skill in this area

2: Some knowledge or skill development

3: Average knowledge or skill development

4: Emerging knowledge or skill; nearing proficiency

5: Proficient; the intern has demonstrated highly developed knowledge or skill; similar to

other school psychology internship completers.

The practicum candidate…

1) DATA-BASED DECISION MAKING AND ACCOUNTABILITY

1) Is knowledgeable of various models and methods of assessment

for identifying strengths and needs 1 2 3 4 5

2) Is knowledgeable of various models and methods of assessment

for measuring progress and outcomes of services 1 2 3 4 5

3) Effectively applies data results to design, implementation and evaluation

of response to services 1 2 3 4 5

DOMAIN TOTAL =

2) CONSULTATION AND COLLABORATION

4) Is knowledgeable of varied methods of consultation, collaboration, and

communication 1 2 3 4 5

5) Communicates opinions and data to all appropriate parties in a supportive,

problem-solving fashion. 1 2 3 4 5

6) Demonstrates effective consultation and collaboration skills during design,

implementation, and evaluation of services and programs 1 2 3 4 5

DOMAIN TOTAL =

3) INTERVENTIONS AND INSTRUCTIONAL SUPPORT TO DEVELOP ACADEMIC SKILLS

7) Is knowledgeable about biological influences on academic skills and

instructional strategies 1 2 3 4 5

8) Is knowledgeable about cultural and social influences on academic skills and

instructional strategies 1 2 3 4 5

9) Demonstrates skills to implement and evaluate services that support

cognitive and academic skills 1 2 3 4 5

DOMAIN TOTAL =

4) INTERVENTIONS AND MENTAL HEALTH SERVICES TO DEVELOP SOCIAL AND LIFE

SKILLS 10) Is knowledgeable about biological, cultural, developmental, and social

influences on behavior and mental health 1 2 3 4 5

11) Is knowledgeable about behavioral and emotional impacts on learning

and life skills 1 2 3 4 5

12) Demonstrates skills to implement and evaluate evidence-based strategies to

promote social–emotional functioning and mental health 1 2 3 4 5

DOMAIN TOTAL =


5) SCHOOL-WIDE PRACTICES TO PROMOTE LEARNING

13) Is knowledgeable about school and systems structure, organization, and theory 1 2 3 4 5

14) Is knowledgeable about general and special education, technology resources,

and evidence-based school practices 1 2 3 4 5

15) Demonstrates skills to develop and implement practices that create and

maintain effective and supportive learning environments for children and others 1 2 3 4 5

DOMAIN TOTAL =

6) PREVENTIVE AND RESPONSIVE SERVICES

16) Is knowledgeable of principles and research related to resilience and risk factors

in learning and mental health 1 2 3 4 5

17) Is knowledgeable of multi-tiered prevention and evidence-based strategies 1 2 3 4 5

18) Demonstrates skills to promote services that enhance mental health, safety,

physical well-being, and effective crisis preparation, response, and recovery 1 2 3 4 5

DOMAIN TOTAL =

7) FAMILY-SCHOOL COLLABORATION SERVICES

19) Is knowledgeable of principles and research related to family systems, strengths,

needs and culture 1 2 3 4 5

20) Is knowledgeable of evidence-based strategies to support family influences on

children’s learning, socialization, and mental health 1 2 3 4 5

21) Demonstrates skills to design, implement, and evaluate services that facilitate

family and school partnerships 1 2 3 4 5

DOMAIN TOTAL =

8) DIVERSITY IN DEVELOPMENT AND LEARNING

22) Is knowledgeable of individual differences, abilities, disabilities, and other

diverse characteristics 1 2 3 4 5

23) Is knowledgeable of research related to diversity factors for children, families,

and schools, including factors related to culture and individual and role

differences 1 2 3 4 5

24) Demonstrates skills that promote effective functioning for individuals, families,

and schools with diverse characteristics, cultures, and backgrounds 1 2 3 4 5

DOMAIN TOTAL =

9) RESEARCH AND PROGRAM EVALUATION

25) Is knowledgeable of research design, statistics, measurement, varied

data collection and analysis techniques, and program evaluation methods 1 2 3 4 5

26) Uses various technology resources for data collection,

measurement, and analysis of problems to support effective practices 1 2 3 4 5

27) Demonstrates skills to evaluate and apply research as a foundation

for service delivery 1 2 3 4 5

DOMAIN TOTAL =

10) LEGAL, ETHICAL, AND PROFESSIONAL PRACTICE

28) Is knowledgeable of the history and foundations of school psychology and

multiple service models and methods 1 2 3 4 5

29) Is knowledgeable of the ethical, legal, and professional standards, and other

factors related to professional identity and effective practice 1 2 3 4 5

30) Demonstrates skills related to providing services consistent with ethical, legal,

and professional standards 1 2 3 4 5

DOMAIN TOTAL =


OVERALL POSITIVE IMPACT ON YOUTH, SCHOOLS, AND OTHER CONSUMERS

31) Has contributed to improving student academic learning or social, emotional, or

behavioral well-being 1 2 3 4 5

32) Has contributed to the success of other educators through consultation &

collaboration 1 2 3 4 5

33) Has contributed to parent knowledge, skill, and/or satisfaction with

their child’s education 1 2 3 4 5

SECTION TOTAL =

We have reviewed this evaluation together and have discussed steps to continue progress

toward goals. Items that are not rated at a passing level are being used to help develop

additional internship goals as needed.

________________________________________________________________________

Supervisor Signature/Date

________________________________________________________________________

Practicum Candidate Signature/Date

Additional Comments:

Evaluation Rating TOTAL Score: _________

Item content that needs development:


Appendix I


UW-RF School Psychology Training Program Guidelines for Summary and Reflection Activities

As outlined in the practicum syllabus, the candidate must produce and submit summaries

and reflections related to the following activities:

-Legal/ethical issue that arises during the practicum experience (one per semester, two

summaries total)

-Crisis prevention/intervention activities summary (one per semester, two summaries

total)

-RtI activities summary (one per semester, two summaries total)

-Reflection piece related to an in-service presentation conducted by the candidate (one in-

service presentation required, meaning one reflection piece in this domain)

Pertaining to the first three items listed above, the candidate should provide a 1-2 page

summary of the issue or activity, followed by 2-3 pages of reflection related to the issue

or activity. As for the write-up related to the in-service presentation conducted by the

candidate at her or his practicum site, the candidate should summarize briefly what kind

of presentation was conducted, what transpired during the presentation itself, the results

of the evaluations collected from the in-service participants through the presentation

process, and reflections by the candidate as to her or his strengths, areas for growth, and

methods to address her or his identified areas of growth. This piece should be 3-5 pages

total in length.


Appendix J


FIELD-BASED SUPERVISOR INTERVIEW

Your assignment is to prepare a written summary of your practicum setting, and the role

of the school psychologist within your setting. You should interview your supervising

school psychologist so that you can discuss how the role of the school psychologist is

practiced within your setting. If possible, interview at least one other school psychologist

in the district to get his or her perception of the duties they believe are important for

school psychologists.

As part of your profile, you should discuss the several components. What is the profile of

the district? Here you can provide information about the number of students in the

district, number of students in special education programs, diversity statistics for the

district, including percentage of students of color, number of school psychologists.

Is the district changing, growing, or remaining stable? What are the primary duties the

school psychologist is expected to complete? Here talk about how does the school

psychologist view his or her role?

How many schools does the school psychologist serve? What does the school

psychologist mainly do? What does the school psychologist like about his or her job/role?

What does the school psychologist dislike about his or her job/role?

What recommendations would the school psychologist give to a new student, as far as

training emphasis or particular skills? Does your school psychologist have any thoughts

about the future of school psychology, and where the profession needs to go? How is the

district preparing for response to intervention?

Do school psychologists in the district serve in any specialty roles, such as Autism

Specialist, Due Process Coordinator?

Does the school psychologist participate on any committees, and if so, what do the

committees focus on?

How much contact does the school psychologist have with families? Do they believe they

have enough contact with families?


Appendix K


IN-CLASS CASE PRESENTATION FORMAT

The case can be a circumstance where you participated in an assessment for eligibility,

provided supportive counseling to a student, conducted an observation of a student,

facilitated the development of an intervention through a collaborative consultation

process, or participated in a group as a leader or co-facilitator. Other examples of a case

involve circumstances where you have provided support to a student through crisis

intervention, or worked with a teacher or parent as a consultant.

Information you should include in your presentation. Reason for services, description of

the student, review of information you collected, interpretation of the information or the

student's status, recommendations for the student, and how the information collected or

services provided were intended to help the student. In situations where you have

collected data, providing a summary of the data could be helpful to your peers. Please,

describe any positive changes for the student involved, and note cases where

diversity considerations played a prominent role.

Format for Case Discussion

Identifying Information/Demographics: Age, gender, cultural/ethnic background, or

other social factors that may be relevant (e.g., new to school).

Concerns: One or two sentence summary, a statement from the student about their needs,

or a parent or teacher description is recommended.

History of Concerns: Chronology and context of symptom development (how long, new

or long-lasting concern). Any relevant contributing or complicating environmental factors

(family stress etc.), previous treatment already tried for the presenting problem. List all

significant illnesses, injuries, surgeries, and birth complications/defects that would have a

direct bearing on student performance.

Current Health and Physical Status: Descriptions of health, identification of any

medicals for treatment of attention or other needs (e.g., depression, anxiety).

Treatment History: Discuss past interventions or current strategies used. Previous

assessment results and diagnoses, type of treatment, where treated, compliance with

treatment, and results.

Family History: To your knowledge, report on the history of any family members for a

DSM-IV disorder, or any family members (e.g., siblings, parents) that have a history of

special educational concerns. Other family dynamics include family constellation, recent

changes such as divorce or separation

Social History: A wide variety of information about the student falls into this category.

Peer relationships, enjoyed activities, participation in clubs or sports. Rating of peer

affiliation from strong connections to problematic connections.


Assessment: Summarize assessment results and provide relevant assessment data.

Intervention History: Types of services, impact of services.

Discussion and Plan: Discuss the synthesis of the information about the student and how

the information was connected to recommendations or strategies to benefit the student.

Discuss intervention recommendations and the rationale for these over other alternatives.

When possible, please describe any positive changes for the student involved.

Format for Group Presentation

Targeted Audience for the Group: social skills needs, study habits, behavior

management, self-esteem.

Identifying Information/Demographics: Ages, gender, cultural/ethnic background of

the participants, or other social factors that may be relevant.

Goals of the group: What do you hope to accomplish with the group? Build friendships

skills? Lessen anxiety of participants while in a school setting?

Number and length of sessions: Include discussion about follow-up with students after

session ends.

Co-facilitator and your relationship with: How will you and your co-facilitator, if any,

relate and work with each other?

Treatment History: Have member of the group participated in services before? What is

the make up of students who have and IEP compared to those who do not have an IEP?

Describe the Curriculum you plan to use: A standardized curriculum? One that has

been adapted, and if so, what changes were made? Is their homework? What

mechanisms are in place to check for transfer of skills learned in group to skills in other

settings such as the classroom or home?

Assessment: How will you assess or judge whether or not the students have benefited

from the group? Describe any pre or post treatment measures.

Discussion and Plan: Discuss your perceptions about the group and the participant’s

response to group activities. It is not necessary that the group has been completed. When

possible, please, describe any positive changes for the student involved.

.


Appendix L


ASSIGNMENT CRITERIA FOR GRADING

Book Review and Critique (100 points each)

In order to provide the candidate an opportunity to demonstrate her or his ability to become a more

reflective school psychologist, to apply skills of culturally-responsive professional process, to examine

alternative viewpoints or multiple perspectives, and to construct meaning from messages communicated in

the writings of a researcher and author, candidates will complete a book review and critique for the texts

listed below. Additionally, the candidate must come to class the afternoon book discussions are listed on

the syllabus prepared with questions pertaining to each book that will be asked much like a book club.

Fall 2012: Gay, G. (2010). Culturally-responsive teaching: Theory, research, & practice (2

nd ed.). New York: Teachers

College Press.

Spring 2013: Delpit, L., & Dowdy, J. D. (Eds.). (2008). The skin that we speak: Thoughts on language and culture in the

classroom. New York: The New Press.

Yang, K. K. (2008). The latehomecomer: A Hmong family memoir. Minneapolis, MN: Coffee House Press.

Each book review and critique should be cited and referenced according to American Psychological

Association (6th

edition) criteria, typed, and double-spaced. The text of each review and critique should

be limited to no more than 10 pages in length. The format of each manuscript should include a cover

page, abstract, introduction, summary, discussion, implications, and reference page. In the development of

each critique, the candidate should incorporate the following:

-An examination of the common themes, topics, and ideas

-Reactions and reflections from you, the book reviewer

-Implications and conclusions of text related to you and your professional development

-A discussion of how the ideas posited by the authors relate to other materials presented in class

-Relevance to school psychology preparation programs

Grading: 90-100 points Meets and/or exceeds all stated criteria in an effective manner

1. Summary discussion of text themes, topics, ideas

2. Examines links to shaping of professional development

3. Discusses relevance to the field of school psychology

4. Presents reactions and reflections

5. Reference page

6. APA format, typed, double-spaced

7. Uses correct grammar, spelling, and mechanics of writing

80-89 points Meets most stated criteria in an effective manner

70-79 points Meets some stated criteria in an effective manner

0-69 points Meets few stated criteria in an effective manner


Appendix M


UW-RF School Psychology Training Program Diversity Values and Dispositions Evaluation

Candidate name: ________________________________________________________________

Date: _________________________________________________________________________

Using the scale below, please, rate the extent to which you believe the practicum

candidate has demonstrated the following diversity values and dispositions throughout

the field-based component of her or his practicum experience. Choose the corresponding

number for each category.

1.....2…..3…..4…..5

not at all a great deal

Being Respectful

Valuing other’s experiences, contributions, and expertise 1.....2…..3…..4…..5

Valuing diversity and cultural differences, in general 1.....2…..3…..4…..5

Listening 1.....2…..3…..4…..5

Empathizing 1.....2…..3…..4…..5

Engaged in active learning 1.....2…..3…..4…..5

Thinking of others and our impact on others 1.....2…..3…..4…..5

Pacing the learning process 1.....2…..3…..4…..5

Being Inclusive

Demonstrating a willingness and desire to relate to

and to work with all people (e.g., clients) 1.....2…..3…..4…..5

Considering others (e.g., when making decisions) 1.....2…..3…..4…..5

Including people in the process of learning,

research, service, etc. 1.....2…..3…..4…..5

Willing to challenge one’s own beliefs that classify

a group of persons as pejorative in some way 1.....2…..3…..4…..5


Being Collaborative and Cooperative

Working cooperatively and effectively with others 1.....2…..3…..4…..5

Being responsive to others 1.....2…..3…..4…..5

Demonstrating an interest and ability to learn from others

about their experiences of culture and diversity 1.....2…..3…..4…..5

Engaging in dialogues, rather than debates, regarding

multiculturalism and diversity issues 1.....2…..3…..4…..5

Working together, to understand one another 1.....2…..3…..4…..5

Being Open

Being open to new ideas and learning in general 1.....2…..3…..4…..5

Engaging in perspective-taking 1.....2…..3…..4…..5

Demonstrating flexibility 1.....2…..3…..4…..5

Being receptive and responsive to feedback 1.....2…..3…..4…..5

Seeking help when needed 1.....2…..3…..4…..5

Taking risks to promote professional growth/development 1.....2…..3…..4…..5

Engaging in self-disclosure that is relevant to professional

effectiveness 1.....2…..3…..4…..5

Being Inquisitive

Showing interest and a curiosity about people and

their diverse cultural life experiences 1.....2…..3…..4…..5

Seeking additional knowledge and experiences related

to diversity and multicultural issues 1.....2…..3…..4…..5

Demonstrating a desire to learn about others 1.....2…..3…..4…..5

Scientifically-minded (applying ethical/professional

standards and scientific findings) to diversity/multicultural

issues 1.....2…..3…..4…..5


Self-aware and Introspective

Awareness of personal and professional strengths 1.....2…..3…..4…..5

Awareness of personal and professional areas of growth 1.....2…..3…..4…..5

Demonstrating an awareness of one’s biases/prejudices

and ignorance 1.....2…..3…..4…..5

Reflecting on one’s impact on others and the tasks at

hand 1.....2…..3…..4…..5

Reflecting on how one is affected by others 1.....2…..3…..4…..5

Engaging in critical thinking (e.g., different perspectives) 1.....2…..3…..4…..5

Evaluating one’s feelings, decisions, actions, and how

one relates to others 1.....2…..3…..4…..5

Culturally-Aware

Learning about, understanding, and accepting people

from a variety of diverse and cultural backgrounds 1.....2…..3…..4…..5

Providing culturally-relevant services to people based

on theoretical and research knowledge 1.....2…..3…..4…..5

Being aware of how one’s own cultural background may

impact her or his assessment practices, consultation

interactions, or interventions with persons from diverse

backgrounds 1.....2…..3…..4…..5

Being aware of how different cultures view what is

normal, acceptable, and okay 1.....2…..3…..4…..5

Understanding the process and interpersonal dynamics

necessary to be effective with persons from diverse

backgrounds 1.....2…..3…..4…..5

Demonstrating an interest in and a commitment to

conducting research on multicultural and diversity issues 1.....2…..3…..4…..5

Using appropriate research methods with diverse

populations 1.....2…..3…..4…..5


Socially-Just

Engaging in active support and advocacy to promote

equality and justice for underserved, oppressed, and/or

marginalized groups of people 1.....2…..3…..4…..5

Involved in the development of research programs

related to social justice issues 1.....2…..3…..4…..5

Committed to service and community efforts for diverse

populations 1.....2…..3…..4…..5

Aware of power and privilege dynamics on various levels 1.....2…..3…..4…..5

Actively addressing institutional barriers 1.....2…..3…..4…..5

Professional Growth and Improvement Demonstrating a desire to learn and improve one’s

knowledge base, research, and service skills 1.....2…..3…..4…..5

Seeking actively feedback regarding one’s performance 1.....2…..3…..4…..5

Willingness to abandon nonproductive strategies in an

attempt to self-correct 1.....2…..3…..4…..5

Applying the ethical and professional standards of the

profession to one’ work 1.....2…..3…..4…..5

Applying scientific findings to professional work 1.....2…..3…..4…..5

*Permission to use and to adapt this measure was granted by the primary author, Dr. Kathleen Bieschke.

March 2008


Appendix N


UW-RF School Psychology Training Program Professional Work Characteristics Appraisal

Candidate: _______________________________________________________________ Rater: ___________________________________________________________________ Year in Program: 1st 2nd 3rd (Practicum) or 4th (Intern) Date: ______________ Please, rate the candidate on each item using the scale below. Comments on any particular strength or weakness and recommendations, if any, may be written at the end of the form.

Characteristic Rating (circle one)

Initiative – initiates activities when appropriate; does not wait to be asked or told when to begin an anticipated task.

NA 1 2 3 4 5

Dependability – can be counted on to follow through on a task once a commitment to it has been made; reliably completes assignments in a timely manner.

NA 1 2 3 4 5

Time Management/Work Organization – organizes work and manages time effectively.

NA 1 2 3 4 5

Problem-Solving/Critical Thinking – thinks critically; effectively analyzes problem situations and conceptualizes alternative approaches and solutions.

NA 1 2 3 4 5

Respect for Human Diversity – respects racial, cultural, socioeconomic, religious, gender-related, sexual orientation, and other human differences; demonstrates the sensitivity and skills needed to work with diverse populations.

NA 1 2 3 4 5

Oral Communication – expresses self orally in an organized and clear manner.

NA 1 2 3 4 5

Written Communication – writes in an organized, clear manner. NA 1 2 3 4 5

Attending/Listening Skills – attends to important communications; listens attentively.

NA 1 2 3 4 5

Effective Interpersonal Relations – relates effectively to colleagues, faculty, supervisors, and clients.

NA 1 2 3 4 5

Teamwork – works well with others; collaborates effectively with others on assignments/projects.

NA 1 2 3 4 5

Adaptability/Flexibility – adapts effectively to the demands of a situation; is sufficiently flexible to deal with change.

NA 1 2 3 4 5

Rating Scale NA No opportunity to observe/don’t know 1 Needs substantial improvement to be at level appropriate for year in program 2 Needs some improvement to be at level appropriate year in program 3 Exhibits average level for year in program 4 Exhibits level that is above average for year in program 5 Exhibits level that is exceptionally strong for year in program


Comments/Recommendations

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Characteristic Rating (circle one)

Responsiveness to Supervision/Feedback – is open to supervision/feedback and responds to such appropriately.

NA

1 2 3 4 5

Self-Awareness – shows realistic awareness of personal strengths and weaknesses and impact this has on professional functioning and relationships with others.

NA

1 2 3 4 5

Professional Identity/Development – appears to identify with the profession of school psychology; conducts oneself as a professional; concerned with own professional growth.

NA

1 2 3 4 5

Independent Functioning – functions with minimal supervision or independently, when appropriate.

NA

1 2 3 4 5

Data-Based Case Conceptualization – able to use data/information to conceptualize cases and generate hypotheses and possible solutions; uses evidence to evaluate outcomes.

NA

1 2 3 4 5

Systems Orientation – understands that schools, families, and organizations are systems; recognizes and effectively utilizes rules, policies, and other characteristics of systems.

NA

1 2 3 4 5

Rating Scale NA No opportunity to observe/don’t know 1 Needs substantial improvement to be at level appropriate for year in program 2 Needs some improvement to be at level appropriate year in program 3 Exhibits average level for year in program 4 Exhibits level that is above average for year in program 5 Exhibits level that is exceptionally strong for year in program


Appendix O


Intervention Case Study Example: Kara

Problem Identification

Kara turned in an average of 50% of her assignments per week. Her teacher indicated in order for

Kara to achieve a higher level of academic competency, it was important for her to complete at

least 95% of her assignments. The teacher noted Kara seemed to be alone quite a bit and asked to

leave the classroom frequently to use the bathroom. On occasion, the teacher observed Kara

"staring into space." When encouraged to participate in group activities, she would comply. The

teacher wondered if Kara was either depressed or had some sort of medical problem to account

for her behavior.

The classroom teacher indicated a set of six school-wide behavioral goals have been established

through the Positive Behavioral Supports methodology. In addition, her class has established its

own interpretation of these goals. One of the goals is to have students complete and turn in all

assignments. A review of the teacher's grade book for this fifth-grade class indicated students

turned in a mean of 80% of their assignments.

Skill analysis. An analysis of completed assignments verified the papers turned in had very few

errors. Furthermore, the fact that sometimes Kara did turn in her assignments to the designated

box on the teacher's desk indicated she knew the procedure for turning in her assignments. A

review of Kara's test results in the teacher's grade book indicated she typically understood the

academic content because the grades that she received were generally a "C" or above. On class-

wide curriculum-based measures for reading fluency, math, writing, and spelling, Kara performed

at or above the 50th percentile in comparison to her peers in the class.

Performance analysis. Kara is a fifth-grade student who has recently moved into the district. Her

mother stated she had remarried last year and Kara and her mother moved into the home of the

new husband and his three children. Kara is now the second-youngest sibling of the four children.

The youngest child attends the same school and she has been struggling academically for several

years.

A review of the records from Kara's previous school indicate Kara's performance was average or

above in all academic areas. Kara passed both the hearing and vision screenings. A review of the

teacher's grade book showed Kara turned in most assignments on Wednesdays and Thursdays.

An interview the Kara's mother indicated she helps all four of her children with their homework.

Each child was required to spend at least 1/2 hour sitting at the kitchen table each night

completing homework or, if there was no homework, reading a book. She was concerned about

Kara due to her change in behavior since the recent divorce and marriage. Kara seemed to be

more sullen and she did not participate in family activities much. She was previously a very

organized youngster, who took pride in having a clean and orderly room. Recently, however, she

seems to have lost interest in many things. In addition, she often returned from her weekend visits

with her father looking tired and unhappy. However, when her mother questioned her about her


visits with her father, Kara always indicated they were "fine." Kara's weekend visits typically

occurred three out of four weekends a month. When asked about the teacher's concern regarding

Kara's health, her mother indicated she had noticed Kara’s eating patterns had changed recently

and she seemed to want to sleep more than she had previously. However, the issue of a medical

problem was one that had not been considered.

Kara stated she was not happy with her new school and her new family. She said the work was

"too hard" and she especially did not like her younger sister because she was "dumb." Her affect

during the interview seemed relatively depressed and it was difficult to engage Kara

in conversation.

A class-wide intervention/prevention strategy had been established by the teacher to increase the

number of assignments that students turn in. The teacher stated the entire class reviews the six

school-wide behavioral goals daily, including the goal to turn in all assignments. She then tracks

on a chart, the number of daily assignments turned in compared to the number of assignments

given. The teacher reviews this chart with each student weekly. Students who fall behind in their

assignments are encouraged to complete the work at home.

Three in-class observations were conducted and recorded in narrative form in order to obtain a

full picture of Kara's performance. In summary, it appeared Kara tended to enter the classroom at

the beginning of each day demonstrating behavior patterns that predicted whether she would turn

in her assignments. For example, when she entered the classroom quietly and appeared tired she

would typically fail to turn in her assignments. On the other hand, when she entered the

classroom, engaged in conversation with her peers and did not appear tired, she would turn in her

assignments. More often than not, Kara sat alone and failed to engage in social activities and

conversations with her peers. The classroom teacher confirmed that these patterns were typical

for Kara.

Problem Analysis

A meeting was convened to review the results of the data-gathering efforts thus far with the

classroom teacher and the student's parent. Four hypotheses were generated and a plan for testing

each hypothesis was developed. The first hypothesis was Kara was not turning in her assignments

on Mondays, Tuesdays, and Fridays because she forgot to do so as a result of her concern about

spending the weekend with her father. The second hypothesis was Kara was not turning in her

assignments because she was seeking attention from her mother who has, since her new marriage,

split her attention between four siblings. This has changed since Kara and her mother lived

together and all of her mother's attention was focused on Kara. In addition, as a result of this life

change, Kara may have felt left out because she believed she is different than her siblings and

peers because she is the only one with a Mexican heritage. The third hypothesis was Kara was not

turning in her assignments because she forgot to do so as a result of being tired and, perhaps,

physically ill. She seemed to be going to the bathroom frequently, often looked tired and

sometimes seemed confused. The final hypothesis was Kara was not turning in her assignments

because she was not motivated to do so. Although the teacher keeps a chart on assignment

completion, Kara may not have been checking this chart on a regular basis. Furthermore, the chart


itself may not have been motivating enough for her, and that there was a need to ensure Kara

participated in the monitoring to determine if this had an impact on her assignment completion.

The first hypothesis was tested to determine the relationship between Kara's rate of turning in

assignments and whether she spends the weekend with her father. Kara was observed on

Mondays, Tuesdays, and Fridays during weeks when she spent time with her father and when she

did not spend time with her father. The number of assignments turned in was monitored and so

was her affect and social interaction. The actual difference in the rate of assignments she turned

in was not significantly different for Fridays. However, the assignments continued to remain low

on the Mondays and Tuesdays after she visited with her father compared to those same days when

she did not visit with her father. Kara continued to appear fatigued and have poor affect on those

Mondays and Tuesdays, as well. Therefore, this hypothesis was not rejected. However, the

hypothesis was modified to eliminate Fridays.

The second hypothesis was tested to determine if there was a relationship between the amount of

time her mother spends with Kara and the rate of turning in assignments. Kara's mother agreed to

keep track of the amount of time that she spent individually with her daughter for two weeks. In

addition, an attempt was made to vary the times. She contacted the classroom teacher daily with

her report of time spent the night before. The classroom teacher noted the number of assignments

turned in on the assignment completion chart. These data over the course of the two weeks were

analyzed and it was determined there was no correlation between the two variables. Therefore,

this hypothesis was rejected.

The third hypothesis was tested by determining if Kara had a medical problem that affected her

rate of turning in assignments. Kara was diagnosed with diabetes by her pediatrician and began

monitoring her blood sugar and controlling her diet. Her rate of turning in assignments increased

somewhat. However, her affect and rate of interacting with her peers seemed to continue to vary.

Mondays and Tuesdays continued to be days Kara's affect and socialization were somewhat low.

Therefore, a follow-up hypothesis was tested after confirming with Kara's father he had not been

careful about the food she was eating during her weekend visits with him. This hypothesis was

Kara's mood and thus the rate of turning in her assignments on Monday and Tuesday were

affected by unmodified food consumption, based on requirements for treating diabetes, when she

visited with her father on the weekend. Kara's father did monitor and limit her food consumption

on the weekend and there was a dramatic change in Kara's affect and social interaction on the first

Monday and Tuesday after he began. Therefore, this hypothesis was accepted.

The fourth hypothesis was tested to determine whether self-monitoring of her assignments would

motivate Kara to turn in her assignments. Kara kept track of each assignment she turned in for 2

weeks. The classroom teacher met with Kara each day to review her assignment completion chart

and to determine the amount of agreement between Kara's recording and the teacher's recording

of assignment completion. During the first three days (i.e., Monday, Tuesday, and Wednesday)

that the plan was implemented, the number of completed assignments increased. However, after

day three the rate reverted to approximately the original rate. It could not be determined if this

hypothesis should be rejected or not due to the lack of long-term data. Therefore, although the

hypothesis was not accepted, the teacher agreed to continue to work on this with Kara. The data


would be monitored weekly to determine the impact of this self-monitoring

assessment/intervention.

Although her academic skills were within the average range or higher than those of her peers,

her behavior had been characterized by variable moods, a lower rate of engagement with peers

and a lower rate of turning in assignments. She also had a noticeably different appearance from

her siblings in the family and from her peers in the class. Her new siblings had fair skin and hair,

while Kara had dark hair and dark skin. Most of her peers in the class were Caucasian or

African American, while Kara was of Mexican heritage. Kara's primary language was English,

but she was fluent in Spanish, as well. The results from hypothesis testing suggested her rate of

turning in assignments was impacted primarily by her health conditions, interviews and

observations did not indicate her perception of her social status had an impact on her behavior.

Intervention

Data obtained from hypothesis testing indicated Kara's rate of turning in assignments increased

when her food consumption and sugar level were monitored and controlled at home and at her

father's house. Therefore, the intervention included three monitoring charts for (1) sugar level, (2)

food consumption, and (3) turning in assignments. The goals for this complex intervention were

to assist Kara to monitor her sugar levels; to reduce the amount of "junk food" she eats, especially

when she spends the weekend with her father, and to increase her rate of turning in assignments.

The school psychologist, teacher, student's parent, and student discussed and formulated the

intervention plan. Kara's goal was to turn in 95% of her assignments per week. This was

anticipated initially to occur rapidly due to the fact the hypothesis was medically based. Since the

problem is medically based, it will be important to ensure Kara continues to track her food and

sugar level throughout her life. Although the hypothesis regarding motivation was not accepted

previously, it was anticipated that motivation to monitor blood sugar levels and food consumption

on a continuous basis will vary over time. So the intervention is expected to remain in place with

the addition of an incentive system, until fading is used to reduce Kara's need for the intervention

and she demonstrates she is self-sufficient in controlling her food intake and sugar level.

The school psychologist provided training for the classroom teacher and Kara's parents for

implementing the self-monitoring methods (Shapiro, Durnan, Post (2002) and Skibiskey

Levinson, 2002). Self-monitoring has been demonstrated to promote independence (Connell et

al., 1993; Trammel, Schloss, & Alper, 1994), which is the long term goal of the intervention. The

methods were tailored to the situation and to the needs of the family and the classroom teacher. A

check for treatment integrity was built into the checklists. Failure to complete the checklist

indicated lack of integrity to the intervention.

The charts for maintaining sugar level and food consumption were completed by Kara and

checked by her parents on a daily basis. The work completion chart was completed by Kara at the

end of each day, and it was verified by the classroom teacher. See the charts below. Each Friday,

the results of the week were shared between home and school via email. The teacher and Kara

reviewed her charts for each day of the week on Friday, and the teacher sent an email message


back to both parents regarding the similarities across the three charts. The incentive was then

selected by Kara and the team from the established list and implemented as appropriate.

This intervention was considered by the teacher and Kara's mother to require a higher level of

intensity, since the completion and review of the charts, as well as the development and

implementation of incentives required daily attention by Kara, her parents, and the classroom

teacher. However, the team agreed this level of intervention delivery and the response to the

intervention did not require special education services.

Although Kara was not pleased about needing to monitor her sugar level and food consumption,

she agreed that it was necessary. Kara's family and classroom teacher also agreed the intervention

was likely to be the least intrusive, most effective plan to deal with her health and rate of turning

in assignments.

Assignments Checklist

Monday Tuesday Wednesday Thursday Friday

How many assignments did I turn in today?

How many assignments did my teacher

have listed on the board today?

Did I reach my goal (95%)? Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

My teacher agreed with my ratings today.

Sugar Level Checklist

Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Each time I check my sugar level

and it was okay I make a mark

here.

Each time I check my sugar level

and it was not okay I make a

mark here.

My sugar level was good all day

todav (Ratinq 3).

My sugar level was good most of

the day today (Ratinq 2).

My sugar level was not good

most of the dav todav (Rating 1).

My parent agreed with my ratings

today.


Food Checklist

Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Each time I eat something that is

on my "Okay List" I make a mark

here.

Each time I eat something that is

not on my "Okay List" I make a

mark here.

I ate only foods that were on my

"Okav List" today (Ratinq 3).

I ate a little food that was not on

mv "Okav List" today (Rating 2).

I ate a lot of food that was not on

mv "Okav List" today (Ratinq 1).

My parent agreed with my ratings

today.

Rating Comparison Checklist

Week Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Did I reach my goal for turning in

assiqnments?

Suqar Ratinq (1, 2, 3)

Food Ratinq (1,2,3)

Evaluation

The success of the intervention was evaluated based on an A-B design, with A representing the

baseline and B representing the implementation of the described intervention. Although it would

not be a good idea to eliminate the components of the intervention in which her diet and sugar

were monitored and controlled, it was possible to keep track of the levels of implementation for

these factors. Thus, it was confirmed that the rate of turning in assignments was related to diet

and sugar levels, with better control of health components being related to higher rates of

turning in assignments.


Percent of Turning in Assignments Comparing Baseline to Goal

Comparison Chart


Kara's rate of turning in assignments during baseline was 50%. After four weeks of the intervention, her

rate increased to an average of 95%. The classroom teacher reported Kara's general affect and

socialization seemed to improve after the intervention was implemented. Kara reported she felt much

better when her sugar was under control, as a result of the change in her diet. However, she also indicated

it would probably be difficult to continue to do this for the rest of her life. Treatment integrity for the

intervention ranged from 70% to 100% during the entire intervention phase.

The parents, teacher and school psychologist team met at the conclusion of the four-week intervention

period and agreed the intervention was a success. However, all expressed concern Kara would need to

learn to self-manage her diabetes with the ongoing support of her family and her teachers. A strong

cautionary note was expressed by the team. The members felt the monitoring intervention should not be

considered an option, but instead is necessary for Kara to keep her good health. Generalization to all

times and settings continued to be a concern.

It is recommended periodic meetings between Kara's family and the classroom teacher be conducted each

year to ensure Kara's health and academic progress are well managed.


Appendix P


Intervention Integrity Rating Form

Use the following scale to help determine the integrity of the implementation of your

intervention. Consider the questions with the entire timeframe of the intervention in mind. This is

only a guide. You may develop your own integrity rating scale to better suit the specific

intervention being implemented.

1 = Never or rarely

2 = Sometimes or inconsistently

3 = Often or most of the time

4 = Always or almost always

Intervention Integrity Evaluation Guide:

The following is intended to be a guide only for the total score. Please, review scores for each

item carefully and use professional judgment at all times.

13-16 = Strong Intervention Integrity; Intervention Often or Always implemented properly

11-12 = Average or adequate Intervention Integrity; Intervention may have been implemented

properly at times but not ideal; Intervention results may be questionable

< 11 = Poor Intervention Integrity; Intervention results cannot be evaluated properly

The intervention was used as designed/developed

1 2 3 4

The agreed upon intervention materials were used

1 2 3 4

The agreed upon consequences/reactions were contingently delivered

(e.g., reinforcers, feedback, rewards, etc.) 1 2 3 4

The agreed upon charting of intervention progress was completed

(e.g., tally marks, self-monitoring, etc.) 1 2 3 4

TOTAL


Appendix Q


UWRF School Psychology Program Intervention Case Study Appraisal Rubric

Candidate: ___________________________________________________________________

Rater: _____________________________________________________________________________

Year in Program: 3rd

(Practicum) or 4th

(Intern) Date: __________________________

RATING INSTRUCTIONS:

While passing levels will vary by year in the program (see table below), all ratings should be

assigned with the expectations of a graduating intern in mind. Feedback to the candidate should

be provided about her or his intervention skills and awareness relative to graduating-intern

expectations. A non-passing level TOTAL score may necessitate the development of a

Professional Growth Plan (see Appendix Y of the UWRF school psychology program handbook)

or other new goals for the candidate.

The Intervention Case Study rubric has 57 total points. Passing levels vary by year in program,

as follows:

Year in Program TOTAL rubric passing level Practicum, Year 3 70% (40+)

Intern, Year 4 80% (47+)

Please, rate the candidate on each item using the scale below. Comments on any particular strength or

challenging characteristic may be written in the box at the end of the rubric.

RATING SCALE:

1: This intervention component is not clearly included or minimally described

2 or 3: This intervention component is adequately described or comprehensively described

(assignment of 2 or 3 will depend on maximum item score – varies by item).


Section 1:

Problem

Identification

3 2 1 LEVEL

1.1 Student’s behavior is defined

in the context of appropriate

grade and/or peer expectations

The student’s behavior is

operationally defined.

The student’s behavior is

identified by not operationally

defined.

1.2 The problem is

collaboratively defined.

The problem is not

collaboratively defined.

1.3 The discrepancy between

current and desired level of performance is explained.

The behavior is operationally

defined or quantified in terms of both current and desired

level of performance

The behavior is not operationally

defined in terms of both current and desired levels of

performance.

1.4 Baseline includes the student behavior and peer/grade

norms and expectations with

computed trend lines.

A baseline for the student is established using sufficient

data.

A baseline for the student behavior is not established or

has insufficient data.

1.5 The student behavior is identified as a skill deficit or

a performance deficit.

The student behavior is not identified as a skill or

performance deficit.

1.6 Parents/guardians and teachers are involved in the

problem-identification

process.

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

identification process.

TOTAL

Section 2:

Problem

Analysis

3 2 1 LEVEL

2.1 Hypotheses are generated through collaboration with

teacher and/or parents.

One or more hypotheses are developed to identify the

functions that the behavior

serves and/or the conditions under which the behavior is

occurring (two or more of the

following factors: child factors, curriculum, peers,

teacher, classroom, home.)

Hypotheses are not developed or are developed in only one area

and/or hypotheses are not

measurable.

2.2 There are multiple sources of data that converge on each

proposed hypothesis.

There is evidence that appropriate data are collected

to confirm or reject the

proposed hypotheses. Appropriate data include one

or more of the following:

record review, interview, observation, testing, 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, cultural).

Hypotheses do not reflect an awareness of issues related to

diversity.

TOTAL


Section 3:

Intervention

3 2 1 LEVEL

3.1 Intervention is linked to observable,

measurable goal statement(s).

Intervention is not linked to

observable, measurable goal

statement(s).

3.2 Intervention selection is based on data from problem analysis and

hypothesis testing.

Intervention selection is not based on data from problem

analysis and hypothesis testing.

3.3 Intervention is evidence-based (e.g., research literature, functional

analysis, single case design

analysis).

Intervention is not evidence-based.

3.4 Intervention is developed collaboratively.

Intervention is not developed collaboratively.

3.5 Intervention reflects sensitivity to

individual differences, resources, classroom practices, and other

system issues. Acceptability of

intervention is verified.

Intervention does not reflect

sensitivity to individual differences, resources, classroom

practices, and other system

issues. Acceptability of intervention is not verified.

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.

3.7 Intervention selection considers

unintended outcomes or limitations.

Intervention selection does not

consider unintended outcomes or

limitations.

3.8 Intervention is monitored and data

are provided to ensure that it is

implemented as designed (Intervention Integrity)

Intervention Integrity is not

monitored.

TOTAL

Section 4:

Evaluation 3 2 1 LEVEL

4.1 Charting includes student

performance trend lines

and/or goal lines.

Progress monitoring data are

demonstrated on a chart.

Progress monitoring data are not

demonstrated on a chart.

4.2 Progress monitoring data are

demonstrated to be effective

when compared to data generated from multiple

sources/settings.

Progress monitoring data are

demonstrated to be effective

when compared to baseline data.

Intervention is not demonstrated

to be effective through data

comparison.

4.3 Responses to Intervention

data are used to inform problem-solving and decision

making. Single-case design

was specified.

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 Strategies for

transfer/generalizing outcomes to other settings are

documented as effective.

Strategies for

transfer/generalizing outcomes to other settings are

addressed.

Strategies for

transfer/generalizing outcomes to other settings are not

addressed.

4.5 Modifications for future interventions are considered

based upon collaborative

examination of effective data.

Effectiveness of intervention is shared through

collaboration with parents,

teachers, and other personnel.

Effectiveness of intervention is not shared or communicated.

4.6 Strategies for follow-up are developed and implemented.

Suggestions for follow-up are developed (e.g., continued

progress monitoring,

transition planning).

Suggestions for follow-up are not developed.

TOTAL


Summary Data for the Intervention

Comments/Recommendations:

______________________________________________________________________________

Supervisor/Date

CASE STUDY OVERALL RATING

Section 1 TOTAL ___/15




RUBRIC TOTAL ___/57 P or F

Intervention Integrity Rating (separate form)

(80 to 100% is considered acceptable)

___%

Effect Size or % of Non-overlapping data points

<.20 = little or no effect

.20 = small effect

.50 = medium effect

.80+ = large effect

___


Appendix R


READINESS FOR INTERNSHIP: SUPERVISOR RATINGS

To help assess candidate readiness for internship, the following ratings must be requested from

two practicum field-based supervisors and the practicum university-based supervisor by April 1st

of the spring semester. The data collected will be used by candidates as they develop internship

goals. In some cases, the faculty may require the candidate to complete a more thorough

Professional Growth Plan or, in cases where significant improvement is required, a candidate

may be denied access to the internship altogether. Supervisors are asked to provide a candid

assessment of the practicum candidate below. Thank You.

Unacceptable Needs Some

Improvement

Adequate Above

Average

Exceptional Cannot

Rate

Initiative

Dependability

Verbal Communication

Written Communication

Flexibility/Adaptability

Cooperation/Collaboration

Independence

Emotional Stability

Leadership

Organization

Professional Ethics

Willingness to work

outside personal zone of

comfort (i.e., desire to

broaden experiences)

Respect for Diversity

Responsiveness to

Feedback


In your judgment, is this individual a good candidate for the internship experience? YES NO

Please, offer suggestions to help this candidate prepare for internship:

Candidate Name:

Supervisor Printed Name:

Supervisor Signature: Please, return this form to: Scott Woitaszewski, Wyman Education Building, UWRF, River Falls, WI 54022

FOR PROGRAM DIRECTOR USE ONLY:

By the end of the spring semester of practicum:

- PRAXIS exam has been taken at least once. Date:_______; Passing Date:_______

- Directed Research project completed. Date:_______

- Programmatic Portfolio Approved. Date:________

- NO incomplete grades from any program courses. Confirmation Date:_______

School Psychology Training Program Practicum Handbook

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