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Unnamed: 0 | Speech and Language Clinic at SUNY Geneseo | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Unnamed: 26 | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37 | Unnamed: 38 | Unnamed: 39 | Unnamed: 40 | Unnamed: 41 | Unnamed: 42 | Unnamed: 43 | Unnamed: 44 | Unnamed: 45
 | Clinical Evaluation Form for CDSc 585: Advanced Clinical Practicum in Speech Pathology and CDSc 587:  Graduate Internship
 | Student's Name:
 | Supervisor's Name:
 | Initial Grade: |  |  |  |  | Date:
 | Final Grade: |  |  |  |  | Date:
 | Rate each clinical skill using the following scale: Exemplary=12; Proficient=11, 10; Sufficient=9, 8; Adequate=7, 6; Developing=5, 4, 3; and Insufficient=2, 1.  Skills rated as Not Observed should be marked with an X.   Comments should be included.
 | I. | Development and Preparation for Therapy |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | reports | client | Grades | [NAME].
 |  | A. | Ability to develop lesson plans that reflect an understanding of client speech-language development, present level of performance and task analysis. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] | Adult | A | S
 |  | B. | Ability to establish appropriate, measurable goals and objectives driven by client need and present level of performance. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Progress Report | Child | A- | U
 |  | C. | Ability to select and construct appropriate informal assessments including baseline measurements. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]
 |  | D. | Ability to prepare, select and vary appropriate materials. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | B
 |  | E. | Ability to research multiple methods and teaching strategies to address client need. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | B-
 |  | F. | Ability to provide carryover techniques that support continued progress outside of the therapy setting. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes or No | C+
 |  | G. | Ability to accurately summarize data/observations from therapy sessions and evaluate client performance based on that information. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | YES | C
 |  | H. | Ability to be ingenious and creative in the construction and adaptation of materials and instrumentation. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NO | C-
 |  | I. | Ability to knowledgeably discuss client and his/her communicative disorder. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D
 | Points Earned: |  |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 | 0 | 0 | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | E
 | COMMENTS:
 | II. | Execution of Therapy |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to introduce and explain new materials, instructional methods and activities.
 |  | B. | Ability to use materials and instructional methods in an effective and sequential manner.
 |  | C. | Ability to deliver appropriate prompts.
 |  | D. | Ability to provide appropriate evaluative feedback to help shape inaccurate responses.
 |  | E. | Ability to appropriately reinforce accurate responses and effort.
 |  | F. | Ability to pace therapy, obtaining a realistic number of responses.
 |  | G. | Ability to balance structure and spontaneity.
 | II. | Execution of Therapy (Continued) |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed
 |  | H. | Ability to collect quantitative and qualitative data by hearing/seeing/discriminating accurate versus inaccurate responses and using appropriate data collection sheets.
 |  | I. | Ability to modify planned activities based on client responses.
 |  | J. | Ability to expand client responses.
 |  | K. | Ability to actively address the transfer of skills through a gradual fading of clinician support and an increase in client self-evaluation.
 |  | L. | Ability to address more than one target skill within an activity.
 |  | M. | Ability to incorporate incidental learning into sessions.
 |  | N. | Ability to effectively and independently open and close a session.
 |  | O. | Ability to independently execute group lessons.
 | Points Earned: |  |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 | 0 | 0 | 0
 | COMMENTS:
 | III. | Behavioral Management |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to clearly set appropriate limits and behavioral expectations.
 |  | B. | Ability to promptly follow through with stated consequences.
 |  | C. | Ability to easily minimize distractions (e.g., arrangement of room, materials).
 |  | D. | Ability to motivate the client who is not working up to potential.
 |  | E. | Ability to effectively balance the use of natural and tangible reinforcement, with an increased shift toward intrinsic rewards.
 |  | F. | Ability to adjust methods and pacing to keep client engaged and to decrease off-task behavior.
 |  | G. | Ability to effectively manage groups of clients.
 | Points Earned: |  |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 | 0 | 0 | 0
 | COMMENTS:
 | IV. | Personal and Professional |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to build rapport with client, relevant others and supervisor.
 |  | B. | Ability to provide a good speech and language model.
 |  | C. | Ability to communicate commensurate with intended audience.
 |  | D. | Ability to demonstrate good organizational skills.
 |  | E. | Ability to respond to supervisory feedback in an open, non-defensive manner.
 |  | F. | Assumes full responsibility for the use of self-evaluation and supervisory feedback to improve clinical skills.
 |  | G. | Ability to critically think and problem solve appropriate for a graduate clinician with at least two clinical experiences at the graduate level.
 |  | H. | Dependable, thorough and timely completion of clinical responsibilities including lesson plans, daily/monthly progress notes, clinical reports, etc.
 |  | I. | Ability to follow expected format for lesson plans, clinical reports, etc.
 |  | J. | Ability to effectively use professional language in lesson plans, clinical reports, etc.
 |  | K. | Ability to write lesson plans, clinical reports, etc., that are cohesive and which show accurate, in-depth and insightful interpretation of the information.
 |  | L. | Ability to write lesson plans, clinical reports, etc., using appropriate technical writing skills including capitalization, punctuation, grammar, sentence structure, etc.
 |  | M. | Ability to accurately and expeditiously make requested revisions/edits in lesson plans, clinical reports, etc.
 |  | N. | Ability to demonstrate independence and self-confidence in clinical skills.
 |  | O. | Ability to accurately and independently self-evaluate.
 |  | P. | Ability to collaborate with others in case management.
 |  | Q. | Ability to provide counseling regarding communicative and swallowing disorders.
 | Points Earned: |  |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 | 0 | 0 | 0
 | COMMENTS:
 | V. | Evaluation |  |  |  |  |  |  |  |  | [NAME] | Proficient | Sufficient | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to select appropriate evaluation procedures.
 |  | B. | Ability to administer evaluation procedures effectively and efficiently.
 |  | C. | Ability conduct a speech-language screening.
 |  | D. | Ability to collect and use pertinent case history information and integrate it in a meaningful way.
 |  | E | Ability to adapt evaluation procedures to meet client needs.
 |  | F. | Ability to accurately score evaluation procedures.
 |  | G. | Ability to interpret, intergrate and synthesize all information to develop diagnoses and make appropriate recommendations.
 |  | H. | Ability to identify and refer clients for appropriate services.
 |  | I. | Ability to thoroughly complete administrative functions necessary to support the evaluation.
 | Points Earned: |  |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 | 0 | 0 | 0
 | COMMENTS:
 | Clinician adheres to the ASHA Code of Ethics:
 | Calculations From Above: |  |  |  |  |  |  |  | Figures Needed To Calculate Percent:
 | Total Number of Not Observed Ratings: |  |  |  |  | 0 |  |  | Not Observed Ratings x 12: |  |  |  |  |  | 0
 | Total Number of Points Earned: |  |  |  |  | 0 |  |  | Total Number of Points Possible: |  |  |  |  |  | 684
 | Percentage earned: |  |  | 0 | = | 0 |  |  | = | Total Number of Points Earned divided by
 |  |  |  |  |  | 684 | - | 0 |  | (Points Possible) minus (Not Observed Ratings x 12)
 | Letter Grade Equivalent:
 | We have discussed the information contained within this document on:
 | ______________________________________________        __________________________________________________
 | Student Signature                                                                       Clinical Supervisor Signature
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Rev: 5/10