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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
 | Clinical Evaluation Form for CDSc 330: Clinical Intervention I
 | Student's Name: |  |  |  |  |  |  |  | Case Type:
 | Supervisor's Name: |  |  |  |  |  |  |  | Client:
 | Report: |  |  | Report Grade: |  |  |  | No. of Clinical Hours:
 | Mid-Semester Conference Date: |  |  |  |  |  | Final Grade: |  | Date:
 | Rate each clinical skill using the following scale: Adequate=7, 6; Developing=5, 4, 3; and Insufficient=2, 1.  Skills rated as Not Observed should be marked with an X.  Please include comments.
 | I. | Development and Preparation for Therapy |  |  |  |  |  |  |  | Adequate | Developing | Insufficient | Not Observed |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | reports | client | GRADE
 |  | A. | Ability to develop lesson plans that reflect an understanding of client speech-language development, present level of performance and task analysis. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME] | Adult | S
 |  | B. | Ability to establish appropriate, measurable goals and objectives driven by client need and present level of performance. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Progress Report | Child | S-
 |  | C. | Ability to select and construct appropriate informal assessments including baseline measurements. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | U
 |  | D. | Ability to prepare and select appropriate materials.
 |  | E. | Ability to research instructional methods to address client needs.
 |  | F. | Ability to provide carryover techniques that support continued progress outside of the therapy setting. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes or No
 |  | G. | Ability to accurately summarize data/observations from therapy sessions and evaluate client performance based on that information. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | YES
 | Points Earned: |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | NO
 |  |  |  |  |  |  |  |  | Skill Area Rating:
 | COMMENTS:
 | II. | Execution of Therapy |  |  |  |  |  |  |  | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to introduce and explain 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.
 |  | F. | Ability to pace therapy, obtaining a realistic number of responses.
 |  | G. | Ability to balance structure and spontaneity.
 |  | H. | Ability to collect data by hearing/seeing/discriminating accurate versus inaccurate responses and using appropriate data collection sheets.
 |  | I. | Ability to appropriately modify planned activities based on client responses.
 |  | J. | Abillity to expand client responses.
 | Points Earned: |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0
 |  |  |  |  |  |  |  |  | Skill Area Rating:
 | COMMENTS:
 | III. | Behavioral Management |  |  |  |  |  |  |  | Adequate | Developing | Insufficient | Not Observed
 |  | A. | Ability to clearly set appropriate limits and behavioral expectations.
 |  | B. | Ability to follow through with stated consequences.
 |  | C. | Ability to minimize distractions (e.g., arrangement of room, materials).
 |  | D. | Ability to motivate the client who is not working up to potential.
 | Points Earned: |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0
 |  |  |  |  |  |  |  |  | Skill Area Rating:
 | COMMENTS:
 | IV. | Personal and Professional |  |  |  |  |  |  |  | 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 effectively 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. | Ability to use supervisory feedback to improve clinical skills.
 |  | G. | Ability to critically think and problem solve appropriate for an undergraduate clinician completing his/her first clinical experience.
 |  | H. | Dependable, thorough and timely completion of clinical responsibilities including lesson plans, 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., with content that is cohesive, accurate and which shows 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 revisions/edits in clinical reports, lesson plans, etc.
 | Points Earned: |  |  |  |  |  |  |  |  | 0 | 0 | 0 | 0
 |  |  |  |  |  |  |  |  | Skill Area Rating:
 | 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 7: |  |  |  | 0
 | Total Number of Points Earned: |  |  |  |  | 0 |  | Total Number of Points Possible: |  |  |  | 238
 | Percentage earned: |  |  | 0 | = | 0
 |  |  |  |  |  | 238 | - | 0
 |  |  |  |  |  |  | = | Total Number of Points Earned divided by
 |  |  |  |  |  |  |  | (Points possible) minus (Not Observed Ratings x 7)
 | Number of class points earned:
 | We have discussed the information contained within this document on:
 | ______________________________________________        __________________________________________________
 | Student Signature                                                                        Clinical Supervisor Signature
 |  |  |  |  |  |  |  |  |  |  | Rev. 5/10