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					KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu




                                                  AGENCY DATA FORM
                                                 Date submitted: January 27, 2011

Agency Name:                                 Argentine Middle School
Address:                                     2123 Ruby Ave
City/State/Zip:                              Kansas City, KS 66106
Phone:                                       913-627-6756 (Aug – May)
                                             913-706-5525 (June – July – Cell)
FAX:                                         913-627-6783 (Aug – May)
E-mail:                                      Donnad@ku.edu
Agency Website:

Agency Representative to KU:                 Donna Devine
Agency Rep. contact info:                    donnad@ku.edu
Agency Executive:                            Stephanie Bryson, Phd - Director


Attention Agencies: The information contained in this form will be posted on the KUSSW website unless otherwise noted. Check
here is you DO NOT want your agency’s information on our website.

Please indicate the number of students you are able to accommodate in your agency for the academic
year(August-April):

Level of Student(s)           No. of        If Employment Based ONLY           Proposed Field Instructor’s          Check if NEW to KU
                              Student(s)            (check here)               Name & Credentials                   Field Instruction (if yes,
                                                                                                                    please enclose resume)
BSW         (BSW only         1                                                Donna Devine, MSW
available in NE part of KS:
KC, Lawrence, Topeka etc)
Foundation: MSW               2                                                Donna Devine, MSW
(1st yr)
Advanced MSW:
Clinical
Advanced MSW:                 1                                                Donna Devine, MSW
Social Admin.*
Will Take Total No.           4
Students

          *Agencies requesting Administration students must be able to provide access to agency budgets, personnel policies/ procedures,
          and client outcome data.

Description of Agency Setting and Population Served:

Mission: To connect hard to reach, uninsured and under-insured Argentine Middle School youth to appropriate mental health
services.

Structure: The Youth Success program falls under the umbrella of the KCK-KU Partnership Center, a program of the
University of Kansas, School of Social Welfare. The Youth Success office is located in Argentine Middle School which is in
the urban core of Kansas City, Kansas.
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

The Youth Success staff includes the Program Manager/Field Instructor, a bilingual Family Advocate, and 5 KU School of
Social Welfare practicum students (1 BSW, 2 MSW Foundation and 1 Administration). Practicum students may attend classes
at any of the three campuses which include Lawrence, Edwards or Kansas City Kansas Community College.

Populations Served:
The student population at Argentine Middle School (AMS) is ethnically diverse. In 2008-2009, 59% of students were
Hispanic, 20% Caucasian, 18% African American, and 3% other. 93% of the students are eligible to receive free or reduced
cost meals. 34% of students are classified as English Language Learners (ELL).

Learning Opportunities for Students: (educational requirements for practicum for each level of student is
outlined in the attached document entitled “Practicum Planning”).

ALL STUDENTS:
   The student team will tour six to ten social service agencies in Wyandotte County during the two semesters of
      practicum to better understand the community in which the student population lives in and develop an awareness of the
      available resources..

        A guest speaker is invited each month to speak to the student team, to share insights and experiences regarding his or
         her role as a social worker and/or social service provider.

        Students may attend neighborhood and local governmental meetings, school functions and a variety of community
         activities to increase their understanding of community organizations, their structures and service delivery systems.

        Students may choose to complete a police ride-along with a Kansas City, Kansas police officer to better understand
         conditions in the community and the role of the police.


ADMINISTRATIVE STUDENTS:

Professional Development
 Administrative students develop professional relationships with middle school administration and staff, families and
   students, community professionals and community members by: participating in professional meetings and workgroups as
   well as social activities; meeting school staff, parents and youth and making mental health referrals with follow-up; and
   may make home visits.

   Administrative students develop professional written communication skills through preparation of e-mails, program
    brochures and flyers, meeting agendas and minutes, program summaries, draft sections of grant applications, draft sections
    of grant report narratives; and cover, thank you and request letters.

   Administrative students develop public speaking skills through team meeting facilitation and program presentations to
    groups of various sizes and backgrounds.

   Administrative students increase their understanding and sensitivity to diversity (cultural, ethnicity, race, economic status,
    age, sexual orientation, religious) through one on one interaction, immersion and observation at the Argentine Middle
    School and in the community.

   Administrative students increase their understanding of various social service professions including but not limited to
    police, medical, teaching, neighborhood advocates, mental health, special education, counseling, school administration,
    and religion through one and one and group interaction with persons from these professions.

   Administration students apply the NASW Code of Ethics through daily practices, observation of ethical dilemmas within
    the target setting.

Policy and Programs
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

   Administration students in close conjunction with assignments in SW720 and with support of the Program Manager, select
    and analyze federal, state and local policies of interest to the student that impacts the target population of the KCK-KU
    Partnership Center.

   Administration students develop and implement a minimum of one intervention to advocate for a policy change related to
    the work of the KCK-KU Partnership Center (examples: visit a legislator, organize a group of parents to address an issue
    and present it to school administration, write a letter to a newspaper editor, write and distribute flyers in the neighborhood)

Social Program Design and Management
 Administration students, in close conjunction with assigned requirements of SW840 and with the support of the Program
   Manager, design a social program for potential implementation addressing unmet needs of a target population of the KCK-
   KU Partnership Center

   Administration students participate in critical analysis with KCK-KU Partnership Center staff and student team members
    of current program design and management, develop and implement recommended enhancements

Financial Management
 Administration students track program expenditures: order supplies within budgeted allocations; prepare invoices; monitor
   payments; maintain internal data base.

   Administration students research financial capabilities of potential funders using online resources such as Guidestar.

   Administrative students assist in preparation of financial requests to program funders including the identification of
    expenses and allocation of costs



Personnel Management
 Administrative students interview practicum students for next academic year.

   Adminsitrative students provide leadership to KU team members.

   Adminsitrative students assist the Program Manager in supervision and support of KU team members.

Assessing and Managing Outcomes
 Adminsitrative students assist in identification and attainment of program outcomes as required by program funder and to
   enhance service delivery and effectiveness of program.

   Administrative students contribute ideas, implement, and track changes in services delivery/program structure and measure
    actual change in outcomes through collection of qualitative and quantitative data.

   Administrative students research federal, state and local policies as they pertain to existing or new programs that affect
    target populations to understand impact on program outcomes.

MSW FOUNDATION AND BSW STUDENTS:

Professional
 Develop professional relationships with middle school administration and staff, families and students, community
   professionals and community members by: participating in professional meetings, workgroups and social activities;
   interviewing school staff, parents and youth and making mental health referrals with follow-up; making home visits.

   Develop Professional written communication skills through preparation of e-mails, program brochures and flyers, meeting
    agendas and minutes, program summaries, and case note documentation.
   Opportunities to volunteer to develop public speaking skills through meeting facilitation and program presentations to
    groups of various sizes and backgrounds.
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu



   Increase their understanding and sensitivity to diversity (cultural, ethnicity, race, economic, age, sexual orientation,
    religious) through one on one interaction, immersion in and observation at the Argentine Middle School and in the
    community.

   Increase their understanding of various social service professions including but not limited to police, medical, teaching,
    neighborhood advocates, mental health, special education, counseling, school administration, and religion.

   Apply the NASW Code of Ethics through daily practices, observation of ethical dilemmas within the target setting and that
    occur within the practicum program setting.

Direct Practice
 Meet with teaching staff, middle school students and family members in order to make referral for mental health services.
   Make referral. Follow up to assure proper service delivery.

   Provide case management by tracking student’s progress and advocating on behalf of student and family when additional
    resources are needed.

   Assist and take the lead as comfortable with after school social skills groups such as Young Women on the Move, Girl
    Power/Health Power, Art Expressions, etc. They participate in group activities (increase knowledge of group processes
    and dynamics).

   Support students during and after school, one on one, who do not receive mental health services, yet need individual
    attention.

   Connect students, families and teaching staff to community resources.

   Complete a bio-psyho-social assessment as required in SW510


Community and Organizational Practice
 Increase their knowledge of community resources by visiting community agencies and listening to invited community
  representative at team meetings.

   Advocate for change in organizational practices at middle school, within the team, and in the community through
    collection of data, interviews, review of current literature on chosen topics and then write letters to identified persons with
    power, picket, make presentations at meetings, educate stakeholders, etc.

   Support and participate in community activities such as Habitat for Humanity build, KU Medical Center Street Fair,
    Christmas in October, Feed a Family, etc.

Research and Policy Practice
 Work with a KU Research and Evaluation team by collecting evaluation data through the implementation of surveys and
   qualitative data. Students complete training on the use of human subjects in research.

   Read and apply research regarding evidence based practice in the areas of mental health engagement, community practice
    and advocacy.

   May participate in additional research projects with KU staff and faculty as projects arise throughout the year.


Type of student most successful in this setting:
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

PLEASE COMPLETE THIS PORTION – SPECIFIC REQUIREMENTS FOR STUDENT PLACEMENT
AT YOUR AGENCY
Please type (Y=Yes; N=No) to the following requirements that pertain to your agency:
YES      Student needs to mail a copy of his/her resume PRIOR to the interview.
YES Advanced Level Student needs to bring a copy of his/her foundation-level practicum evaluation (or BSW evaluation if
Advanced Standing student).
YES Professional liability insurance must be obtained by the student, and proof provided to the agency before practicum
begins. (Field Education Office provides information to students on how to obtain insurance)
         Drug screen required and proof to agency before practicum begins. Does agency pay for this?
         The student must have a TB check and provide proof to the agency before practicum begins. Does agency pay for
this?         (Note: Field Education Office does not keep student health information)
         The student must have a physical exam and provide proof to the agency before practicum begins. Does agency pay
for this?         (Field Education Office does not keep student health information)
         The student must show proof of health insurance coverage.
YES      The student must undergo criminal background checks (completed by agency).
YES The student MUST have their own vehicle to conduct daily agency business: If this is a requirement, are students
reimbursed for mileage? NO
         If students are required to transport clients, must they have a specified level of automobile liability insurance? NO
         If YES specify the amount: $
YES Students are expected to share and discuss any current life-issues, (e.g., substance abuse, surviving sexual abuse, chronic
mental illness, etc.) that may affect their ability to work with a specific client population. If this is a requirement, specify
client populations(s): Young Adults
YES Students MUST attend certain agency meetings. This is critical information to attempt to avoid potential conflicts with
classroom courses. If this is a requirement please specify the exact day(s) M T W R F and hours: Team Meeting is held
every Tuesday morning.
Additionally, some community meetings, events, activities may take place on evenings and weekends. Students are
     not required to attend these events, but will find attendance strongly enhances their learning experiences.

         Students are ENCOURAGED to attend certain agency meetings. Please specify the days
M T W R F and hours:                . We cannot guarantee but will make all possible effort to avoid conflicts between meetings
and course schedules.
       A formal, written memorandum of agreement is required by the agency in order to enter into an affiliation with the KU
School of Social Welfare. If required, attach memorandum. NOTE: Please submit no later than the end of May.
Please note any other factors that are important in referring students to your agency for an interview (Anything unusual
      or unique such as agency specific exams, dress code, an early start date or later ending date, required orientation,
      specific student skills such as second language required etc.).

Agency Idiosyncrasies (if any): List anything pertinent the student needs to know about your agency and working with
clients, etc. here:

The primary work of the Youth Success program is to overcome the barriers in connecting hard to reach, under and uninsured
Argentine Middle School students to mental health services. The Youth Success team members work closely with: middle
school administrators and staff; PACES (a program of the local community mental health center); Mattie Rhodes Art and
Counseling Center; private mental health providers; students and family members; community members; and other community
agencies.
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

The underlying premise of the Youth Success program is that team members must become an integral part of the school and
the community. Then, when issues of mental health services arise, Youth Success team members are seen as knowledgeable,
trusted and as an effective resource to facilitate connections to services.

Youth Success team members arrange mental health awareness trainings for middle school staff, parents and students;
implements strategies to increase parental involvement at the school; support pro-social in and out of school activities for
families and students; meet with referred students to identify mental health need: identify appropriate mental health and non-
mental health resources; make referrals and follow up to assure satisfactory and effective service delivery. Additionally, the
team collects relevant data that is used by and in consultation with KCK-KU Partnership Center staff to develop and
implement strategies to increase the effectiveness of the Youth Success program.

The focus of the Youth Success program is systems change. Work activity is directed towards needs identification, leveraging
existing resources, advocating for new and more efficient service delivery systems and implementation of strategies to create a
stronger community. Practicum students learn skills and techniques to positively interact with individuals and groups while
coming to understand the strength of community partnerships and collaborations. Some opportunities are available for
students interested in developing ongoing, one on one, relationships to address individual, personal, client needs. However,
this is primarily a macro practicum experience.

The Kansas City Kansas Public Schools begin classes in mid August. To best serve the clients of the - Youth Success
program, practicum students need to be available for training and to start practicum (on a limited basis) in early/mid August.
Later in August the full practicum schedule is initiated. Practicum students are given credit for the time they spend at
practicum prior to the official practicum start date.

Dress is business casual. However, work attire can range from nice jeans to formal professional, depending on the activities
of the day.

Practicum students need to be available to work on days and hours that the Argentine Middle School is open. The Argentine
Middle School schedule is as follows:
        Monday Tuesday, Wednesday*, Thursday, Friday:
        7:30 am students and teachers begin arriving at school
        7:55 am school begins
        2:55 pm school dismissed
        3 - 5:00 pm after school activities
        *On Wednesdays, school dismisses early at 12:55 pm. After school activities end at 3 pm.

Practicum students must be available for Youth Success team meetings which are held every Wednesday morning.

Students need to have transportation to attend meetings at other community agencies and training that occurs perhaps once a
month. Typically, Youth Success practicum team members will arrange amongst themselves to carpool when feasible.

Students may, if they choose, to participate in a limited number of service learning activities available through
community partners during the summer, prior to the official practicum start date.

Dress is business casual, with some casual dress depending on the activities of the day.

Students who speak Spanish are strongly encouraged to apply for this practicum setting.
Students sign a confidentiality statement regarding communications with, and knowledge of, circumstances of
individuals within the target population.
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

SPECIAL OPPORTUNITIES: Please check any that apply to your agency:

YES     We offer student financial assistance. If yes, specify amount and criteria: We have connections to community
agencies who sometimes hire KU practicum students on a very part time basis – which, with the approval of the
Field Instructor and Practicum Office, can be counted toward practicum hours. These agencies contact the Youth
Success Project Manager/Filed Instructor and students are informed of the opportunities.
         Agency covers student in case of accidental injury
         Agency provides students with professional liability insurance for work completed during practicum
         We are able to offer a Flexible Time Practicum. If yes, please describe: depending upon supervisor and students’
interests.
KU School of Social Welfare▪ Field Education ▪ 1545 Lilac Lane ▪ Lawrence KS 66044 ▪ 785/864-2268 ▪ practicum@ku.edu▪ www.socwel.ku.edu

                                                         Field Instructor Responsibilities
                                                               Agreement Form
      (Only to be completed and returned by each agency indentified Field Instructor. If the person completing this ADF is NOT a
                                        Field Instructor, please forward to Field Instructor(s) accordingly)
    The Field Instructor is the student's primary educational resource within the agency, and as such agrees to support the educational goals
    of the School of Social Welfare's field education program. The field instructor must be willing to assume the overall responsibility for
    the student's educational experiences in the agency. The time commitment required of a field instructor is approximately 4
    hours/week. To qualify, the field instructor must have a MSW degree from an accredited school of social work and at least two years
    of successful post-MSW experience. If supervising a BSW student, the Field Instructor can have a BSW from an accredited school of
    social work and at least two years of post BSW experience. Specific responsibilities include:
    1.   Prepare for and conduct regularly scheduled weekly conferences with the student. Conferences are 1-1 ½ hours weekly for 30
         weeks. A minimum of 30 hours of field education conferences is expected.
    2.   Collaborate with, and support the student in identifying safety concerns that need to be considered in the agency and practice, and
         develop a safety plan with the student.
    3.   Abide by the NASW Code of Ethics in your relationships with clients, colleagues and students and include discussions about the
         Code of Ethics in the weekly field education conferences with the student.
    4.   Actively collaborate with the student and Field Liaison in the development, implementation and ongoing use of a Learning
         Contract.
    5.   Coordinate any student learning experiences delegated to other staff members.
    6.   Provide the student with ongoing feedback on the student's performance, including evaluation of both process and content oriented
         records that are required by the School.
    7.   Support the student in gaining access to other learning opportunities and resources in the agency and professional community.
    8.   Maintain an ongoing evaluation of the student's progress, and complete written evaluations of the student as required by the School
         of Social Welfare.
    9.   Collaborate with the Field Liaison in planning, review and evaluation of the student's performance and recommend a mid-year and
         final grade to the Field Liaison.
    10. Inform the field liaison promptly of any problem in the field placement and, when necessary, develop a detailed written plan of
        remedial action with the student and field liaison.
    11. Participate in school-sponsored field education meetings, and when new to field instruction in the KU School of Social Welfare,
        attend the seminar for new field instructors in August.
    12. Provide feedback to the field liaison and the Field Education office on the KU Liaison’s performance of their responsibilities.
    13. If not already on file in the Field Education office, complete a resume and submit to the Field Education Office
    For EBP(Employment Based Practicum’s):
    14. Actively collaborate with the student's agency work supervisor to ensure reduction of employment responsibilities, identified
        practicum hours, and appropriate learning experiences very different from the student’s employment responsibilities.
    15. Thoroughly review the students EBP application, showing your agreement and support of KU’s expectations for EBP’s.
    The submission of these materials indicates you have reviewed and agree to provide a practicum setting which meets KU’s learning
    objectives for the level of student you requested, as well as your agreement to abide by the requirements for field instruction. (If the
    field instructor is not the person filling out this form, it is the agencies responsibility to be sure the field instructor receives a copy).
           ____________________________                                 ______________________________________
    Type or Print Name/Credentials                               Mailing Address


           _____________________________________                         _______________________________________________
    Type or Print Title                                          Mailing Address (cont.)

                                                                         ________________________________________________
    _____________________________________                        City, State, Zip Code

    Signature (not required for electronic submission)                  ________________________________________________
                                                                 Telephone Number

                                                                        ___________________________________
                                                                 E-Mail Address

				
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