Download 1 - Case Western Reserve University

REQUIREMENTS AND PROCEDURES
FOR CLINICAL EDUCATION
IN SPEECH-LANGUAGE PATHOLOGY
DEPARTMENT OF COMMUNICATION SCIENCES
CASE WESTERN RESERVE UNIVERSITY
2004-06
SIGN-OFF SHEET
I have read all of the information in the Clinical Education Manual. I understand that I am responsible for
completing the requirements outlined therein. Please sign and return to Department Assistant.
________________________________
Signature
_________________
Date
PHILOSOPHY AND OBJECTIVES
The graduate program in speech-language pathology is accredited by the Council on Academic Accreditation in
Audiology and Speech-Language Pathology of the American Speech-Language and Hearing Association (ASHA).
The Department is affiliated with and located in the Cleveland Hearing and Speech Center (CHSC), one of the
largest centers serving children and adults with communication disorders. The Cleveland Hearing & Speech
Center is an ASHA accredited professional service program.
The program's philosophy and objective is to educate highly competent clinical practitioners and researchers in
speech and language disorders. The intent is to educate all students to embody the best of the clinician's and
researcher's rigorous approach to problem solving and intuitive, artful skills.
Clinical education is viewed as a dynamic process which prepares practitioners who manifest the following
characteristics:
•
•
•
•
•
A broadly-based foundation of knowledge in communication sciences and disorders, with emphasis on a
processing framework that helps the student analyze and synthesize information.
A problem-solving attitude of inquiry and decision making as represented in the scientific method.
A high level of applied skill competency in clinical diagnosis and treatment.
An ability to participate in the interprofessional rehabilitation management of clients.
The ability to communicate effectively and professionally with clients, their families and with other
professionals.
Clinical education offers preparation necessary to meet requirements for the following:
1. ASHA Certificate of Clinical Competence in Speech-Language Pathology
2. Ohio Licensure in Speech-Language Pathology
3. Ohio Department of Education Teacher Licensure as a Speech and Language Therapist for schools
Appropriate application forms and specific requirements for each of these certificates and licenses are available in
the office of the Department of Communication Sciences.
CLINICAL REQUIREMENTS AND PROCEDURES
STUDENT CLINICIANS
Student interns work in cooperation with certified speech-language pathologists and/or audiologists in the delivery
of services to communicatively impaired persons. The practicum experience is designed to facilitate application of
principles and procedures gained through academic course-work and clinical observations to the actual delivery of
services. Practicum assignments are chosen to allow for the gradual development of those skills required for
independent functioning as clinical speech-language pathologists. Student responsibilities during each practicum
assignment are determined based on 1) guidelines set by Council on Academic Accreditation in Audiology and
Speech-Language Pathology (CAA) of the American Speech-Language and Hearing Association (ASHA), 2) the
student's level of competence, and 3) the policies and procedures of the facility where the student is placed.
During each semester of enrollment in the Master's degree program students are required to participate in clinical
practicum and enroll in COSI 452: Graduate Clinical Practicum for 1 credit (3 semesters minimum). All Master's
students must have completed an undergraduate course in Clinical Procedures before enrolling in COSI 452. If a
student did not complete a Clinical Procedures course as an undergraduate, he/she must complete COSI 352:
Practicum in Communication Disorders before enrolling in COSI 452.
Undergraduate students who have declared Communication Disorders as a major and who have achieved senior
status have the option of participating in clinical practicum. During the Fall Semester of the senior year, students
must enroll in COSI 352 INTRODUCTION TO CLINICAL PRACTICE. Practicum assignments are made through
this course by the Coordinator of Clinical Education after graduate student assignments have been made.
PROCEDURES FOR OBTAINING CLINICAL ASSIGNMENTS
Clinical Assignments are made by the Coordinator of Clinical Education with CHSC Clinicians and externship
Supervisors. Procedures for clinical assignments are as follows:
1. Students turn in practicum requests, class schedules, a listing of their previous clinical experience, and a
listing of all courses they have completed and are currently enrolled in during the first week of classes each
semester. Students also note the approximate number of hours per week they would like for their clinical
assignment. This information should be completed on the Graduate Practicum Clinical Summary form located
in Appendix B.
2. Students must have a 3.0 GPA to be enrolled in Clinic.
3. The Coordinator of Clinical Education contacts CHSC Clinicians and Externship Supervisors to determine
potential placements.
4. Assignments are given to students by the beginning of the second week of classes. Students should contact
their Clinical Supervisors immediately and make arrangements to begin clinical assignments.
5. Any revisions in schedule are completed by the end of the third week of classes.
6. Students begin clinical work by the third week of classes. Students should contact the Coordinator of Clinical
Education immediately if there are any difficulties/concerns related to their clinical assignment (e.g., decrease
in hours projected; change in supervisor’s schedule; concerns about skills in clinic).
7. Students terminate clinical work at the END of regularly scheduled courses. (No clinic final exam week.)
Students may continue their placements for a longer period of time if approved by their supervisor and the
Coordinator of Clinical Education.
8. In some cases a student’s clinical assignment may continue across a two semester period. Extension of an
assignment for more than one semester should benefit the student’s training needs. Such decisions are made
at the discretion of the Coordinator of Clinical Education with input from the clinical supervisor/instructor and
the student.
ASSISTANT CLINICIANS
Undergraduate and graduate students enrolled in COSI 352 may be assigned as assistant clinicians. The purpose
of this experience is to provide the novice student clinicians with a structured introduction to therapy. Before
students are assigned as assistant clinicians, they must have completed their 25 hours of supervised clinical
observation.
The assistant clinician will be considered part of the treatment team along with the primary student clinician and
the supervisor. As a result, the assistant clinician is expected to attend every therapy session and every
scheduled conference the primary student clinician has with the supervisor. If there is a disagreement between
the two student clinicians concerning treatment, they should first attempt to resolve it themselves and then seek
the advice of their supervisor. Assistant clinicians are expected to independently seek out information related to
their clinical experience. In addition, the assistant clinician will be required to do the following:
1. Contact primary clinician. Read the case folder as soon as the client is assigned. The student clinicians should
discuss the case together, before the initial conference with the supervisor.
2. The assistant clinician should be aware of the information on the case summary form the primary clinician
completes prior to the initial supervisory conference.
3. The assistant clinician should have the primary clinician explain the lesson plan for each session so that he or
she is fully aware of the goals, their rationale, and the procedures to be used during the session.
4. The assistant clinician will generally be in the room for every session.
5. After the assistant clinician has become familiar with the client and his/her goals, he or she will choose one
area to work on with the Client. For that area, this clinician will write the goal, plan the therapy, and execute the
therapy plan.
6. By the last two weeks of therapy, the assistant clinician should be able to plan the sessions with the help of the
primary clinician and completely run the sessions. The last two sessions or the last two out of three sessions
should be completely planned by and executed by the assistant clinician.
7. The assistant clinician will be responsible for section(s) of the progress report as assigned by the supervisor.
The following are some suggested duties for the assistant clinician:
1. Help in attaining or analyzing a speech/language sample.
2. Taking data during therapy sessions.
3. Serve as a speech/language model for the Client.
4. Assist with the manipulation of therapy materials.
5. Provide reinforcements to Client.
6. Explain therapy goals and tasks to family members/elicit their input concerning therapy.
7. Contact other sources of the Client’s natural environment for information about their communication outside of
the clinic setting.
8. Set up the room for therapy session.
9. Design therapy materials.
10. Monitor a specified behavior of the primary clinician.
Assistant clinicians are given letter grades of A, B, or C. Any students receiving a C as an assistant clinician will
have to be an assistant clinician again before he or she can be assigned a client as the primary clinician.
GRADUATE PRACTICUM COURSE REQUIREMENTS
1. All students participating in Graduate Practicum assignments must be enrolled in COSI 452.
2. All full-time graduate students will initially be assigned to clinical duties at CHSC for approximately 4-8 hours
per week. Part-time students will be assigned to 2-4 hours per week. Once a student has successfully
completed approximately 100 contact hours, he/she can be considered for an externship site placement.
Externship placements are typically made for 10 hours per week during the school year.
During the summer semester, students are encouraged to schedule 2-4 full days per week of clinical
assignments (8 weeks minimum). This allows students to simulate the professional expectations and hours of
a speech-language pathologist in a typical job setting. It also allows students to complete a large number of
clinical hours during a period of time when coursework is minimal.
Externship sites vary in the time commitments required. Some sites require that students work three days per
week; other site vary their expectations in relation to the goals and needs of the student. Some sites interview
potential student externs from CWRU and other area programs prior to selecting the candidate for the position.
Interviewing schedules will be announced during Graduate Practicum class.
3. Students enrolled in Graduate Clinical Practicum are required to attend all sessions of the practicum course.
Unexcused absences from this course will result in the lowering of the student's semester grade by one letter
grade.
4. First and second year students are required to do a formal case presentation to the Department through the
COSI 452 course.
5. All students must submit two (2) completed Evaluation of videotaped/audiotaped sessions.
6. Students assigned to a public school site, who are working towards school certification, may be excused from
the weekly course meetings on an individual basis as determined by the Coordinator of Clinical Education.
Students are typically assigned to the school setting for 4 days per week for 16 weeks. Semester grades for
these students will be determined solely by their Master Teacher through the public school evaluation.
School assignments are made by Coordinator of Teacher Licensure. Please inform the Director of your
intention to complete a public school practicum at least one semester before the placement is needed.
Students should review their course of study on an individual basis with the Coordinator to ensure they are
meeting all the requirements for Ohio Teacher Licensure.
7. Students are required to submit signed certification of practicum hours within 30 days of the completion of their
clinical assignment. The clinical practicum record forms may be obtained from the Coordinator of Clinical
Education or the Department office. (See Appendix A)
8. Students are required to provide the Coordinator of Clinical Education with all original, signed practicum
records, keep personal copies of their practicum records, and inform the Coordinator of Clinical Education as
to their completion of ASHA requirements. A record of clinical hours will be kept on file by the Coordinator of
Clinical Education.
9. A student’s grade for the Graduate Practicum course (COSI 452) will be determined from their clinical
performance (as evaluated by their clinical supervisor(s)), their attendance at COSI 452 class, and their
performance on class assignments. When students are placed with more than one supervisor, their clinic
grade will be weighted in relation to the number of hours earned with each supervisor.
10. Students must meet with the Coordinator of Clinical Education 30 days prior to graduation to initiate a final
clinical hours certification check.
Expectations
Students should view themselves as professionals while participating in their clinic assignments. It is assumed
that graduate clinicians are responsible and will take initiative in meeting all clinical and professional expectations
in their clinical assignments. Students are expected to conform to procedures used at each of their educational
sites. Specific guidelines will be provided at CHSC and each externship.
Clinical Contracts
When students approach one of the Clinical Supervisors to arrange clinical assignments, THEY ARE, IN EFFECT,
ENTERING INTO A VERBAL CONTRACTUAL AGREEMENT WITH THE INSTRUCTOR. Students may not alter
the contract unless the changes are approved by the Clinical Supervisors and the Coordinator of Clinical
Education. In addition to the verbal agreement, Clinical Supervisors will complete a written clinical contract with
the student. A copy of that contract is provided in Appendix B. Despite requirements of coursework, obligations to
clients and supervisors may not be offset.
Absences from Assignments
Clinical absences require notification of the Instructor (and client when appropriate) within a timely fashion. Rules
regarding absence from clinical duties are as follows: with exception of illness, family emergencies, and University
holidays, your contractual agreement with your Clinical Instructor must be honored. Students should inform their
clinical instructors of upcoming University holidays and deadlines (i.e., date of end of the semester). Other causes
for absences, such as religious holidays, will be considered on an individual basis by the Coordinator of Clinical
Education and the Clinical Supervisors upon submission of absence request.
Dress Code
The first impression a person often makes about another is his/her manner of dress. This is especially true when
one seeks professional services. As a clinician, it is important that your appearance underscore and not distract
from your professional image. Professional dress is conservative. This professional dress must be followed when
seeing clients and when observing therapy. Failure to follow dress code will result in a less favorable evaluation.
The specific rules for professional dress are as follows:
• Men - Must wear conservative shirt and tie
Dress slacks
Appropriate shoes
• Women - Conservative blouses
Dress slacks
Skirts and dresses must be knee length
Appropriate shoes
The following are considered unprofessional dress:
Blouses with low necklines
Backless tops or dresses
Shorts
Short skirts
Party dresses
Jeans
T-shirts
Sweatshirts
Tennis or gym shoes
Work boots
Distracting makeup, necklaces, or jewelry
Dress should not distract or inhibit a graduate clinician’s ability to conduct clinical duties effectively. Dress codes
will vary from site to site. Please talk with supervisors at each site to clarify dress expectations.
Professional Language
Any type of profanity or swearing is not allowed. This restriction includes swearing that may be allowed on
television or PG rated movies. In addition, when dealing with clients or their families, one should be careful in
using other examples of unprofessional language such as slang or inappropriate humor. Your communications
with clients, their families, the clinical staff, and the secretarial staff should always be polite. All supervisors should
be addressed formally; thus they should be addressed as Dr., Mrs., Ms., or Mr. at all times. Adult clients and
parents of child clients should always initially be addressed formally.
Professionalism
Professionalism encompasses the above areas of professional dress and professional language. It also includes
other behaviors which are expected of a professional. As you are in training to become a professional, it is
essential that you develop appropriate professional behaviors. Among these professional behaviors are: 1)
punctuality for meetings, deadlines, and therapy sessions, 2) dependability, 3) ability to take and act upon
constructive criticism, 4) ability to voice appropriately your opinions to your supervisors, 5) being aware of what
you do and do not know, 6) appropriate non-verbal behaviors, 7) self-evaluating your performance, 8)
demonstrating confidence, 9) intellectual curiosity, 10) ethical behavior, 11) non-discrimination, 12) emotional
control, 13) demeanor, 14) attitude. As you will throughout your career, you need to independently seek out
information to improve your clinical knowledge and skills. Most importantly, professionalism entails a dedication to
helping your clients improve in their ability to communicate.
External Placements
With the exception of public school practicum, external placement decisions in speech-language pathology are
made by the Coordinator of Clinical Education with advice from the supervisory staff. Students must have at least
100 clinic hours before they can be considered for most external sites. Many sites require other specific
requirements such as previous hospital experience. The student must have an overall GPA of at least 3.0 to be
considered for an external placement. Many sites require each student to complete a clinically oriented project as
part of the practicum experience. Some externships also require that the student be interviewed before being
accepted as an extern. Several factors will be taken into consideration for being given an external placement.
Among them are the following:
1. Previous clinical experiences-types of clients seen
2. Number of clinical hours earned
3. Opinion of previous supervisors that you can make clinical decisions with a certain degree of
independence
4. Previous coursework
5. Date of graduation-those near graduation will be given priority
6. Success in previous external practicum
7. Level of professionalism in interaction with others
8. Transportation available to site
9. Willingness and/or ability to follow requirements of the site
10. Number of hours available per week to give to site
11. Schedule flexibility
12. Interest in populations seen at a given available site
It should be stressed that being assigned any external placement is something that must be earned and is not a
right. If a student has more than 50 hours from an undergraduate program other than CWRU, he or she will still be
required to complete at least 25 hours in the CHSC before being considered for an external placement.
It is of paramount importance that you take full advantage of your external placements. External placements are
invaluable training for future employment. Employers are highly impressed with a positive evaluation from an
external supervisor. You should also remember that external supervisors are not paid for taking students and do it
because they are dedicated to helping train future speech-language pathologists. They are, as a group, patient
and willing to help students who demonstrate a sincere desire to improve their skills. Be sure to take advantage of
attending team meetings and other experiences such as observing at other sites affiliated with your site.
From conversations with various external supervisors, the following will result in a more favorable evaluation:
• Enthusiasm toward working with the populations seen at the facility
• Completing independent reading on the types of disorders the clients at the site have
• Asking pertinent questions
• Requesting reading materials to increase fund of knowledge
• Independently searching for information for improving your therapy techniques
• Familiarizing yourself with assessment techniques used at the site
• Flexibility to changing schedules and demands
• Willingness to change approach if client is having difficulty
• Willingness and ability to counsel the families of clients seen
• Ability to empathize with client needs
• Willingness to try new procedures
• Punctuality in all areas
• Using time effectively
• Adapting to the note and report writing style used at the site
• Presenting in a positive constructive way at interdisciplinary meetings
• Ability to interpret diagnostic information
•
•
•
Demonstrating the ability to use supervisor feedback successfully
Willingness and ability to become more independent in clinical skills as the practicum experience proceeds
Overall professionalism while at the site
EVALUATION PROCEDURES
The following outline presents the steps for evaluating students' progress during a semester of Clinical Practicum.
1. Evaluation of clinical skills is an ongoing process throughout the student's clinical education. At any point
during the course of the semester a Clinical Supervisor may request a conference to discuss a student's
progress. The Clinical Supervisor needs to apprise the Coordinator of Clinical Education of any issues or
concerns that arise relating to Clinical Education. (Sample forms for session feed-back and midterm/end-ofsemester evaluation are included in Appendix B of this document.) Students are also encouraged to make an
appointment to meet with the Coordinator of Clinical Education at any time during the semester to discuss their
progress and performance in their practicum assignments.
2. At the beginning of each clinic, practicum students will meet with their supervisors and complete the
supervisory needs form to help identify how the supervisor can best help the student (Appendix B)
3. A midterm evaluation will be held by each student and supervisor to review performance and identify strengths
and areas to be improved. A written copy of the midterm evaluation will be sent to the Coordinator of Clinical
Education. (See Appendix B)
4. At the conclusion of the semester the following should be completed:
a) A written evaluation of the student's progress will be completed by the Clinical Supervisor, reviewed
orally with the student and sent to the Coordinator of Clinical Education.
b) The student clinician will complete the Supervisor Evaluation Form (See Appendix B). Students can
provide their clinical supervisor with a copy of the evaluation after the student's semester grade has been
completed. A copy of the Supervisor Evaluation information must be given to the Coordinator of Clinical
Education at the end of the semester.
c) The student will make an appointment to meet with the Coordinator of Clinical Education to review clinical
strengths and areas to improve. This meeting will also provide an opportunity to discuss upcoming clinic
placements and to update the Coordinator of Clinical Education on progress toward ASHA requirements
(clinical hours).
5. Within the final two weeks of the semester the Coordinator of Clinical Education and the Clinical Supervisors
and Externship Clinical Supervisors will share the following information:
a. The student's clinical strengths and weaknesses
b. Recommendations for clinical status (as appropriate)
c. Point value earned by the student in assignment with each supervisor
6. Clinical Probation. Clinical practicum assignments are a privilege and students are expected to act in a
professional manner. Students judged as acting in an unprofessional manner or making inadequate progress
will be placed on Clinical Probation. Clinical Probation status will be considered on an individual basis. When
a student is placed on Clinical Probation, the Coordinator of Clinical Education will meet with the faculty and
the Clinical Supervisors to define expectations for the student. These expectations will be defined in writing to
the student and placed in their Student File. The student's response to the requirements will determine
whether he/she is returned to regular clinical status or dismissed from the clinical education program.
Students who have not met the stipulations of the Clinical Probation may not be permitted to complete their
clinical requirements.
7. Grades will not be issued until all reports and clinical duties are completed to the supervisor's satisfaction.
The student's grade may be lowered one letter grade each week that reports are overdue.
CLINICAL GRADES: A STATEMENT OF PURPOSE
The purpose of clinical grades is two-fold. First, these grades provide a system of measure for the level of clinical
expertise presently maintained by the student-intern. Second, they serve to provide a continuous record of clinical
performance through the student's course of study.
The goal of both students and supervisors is to have graduating clinicians performing at the A grade level at the
completion of their 375 supervised clinical hours. However, some students may reach the A grade level criteria
early in their clinical training. Through systematic use of the Clinical Contract and the Semester Evaluations,
students can identify areas for improvement. These areas can be focused on in subsequent clinical work so that
the student can achieve success.
Mid-term grade status will be communicated to the student by the Clinical Supervisor during the 8th week of the
semester. Midterm grades provide a formal mechanism for identifying student strengths and areas to improve.
Final Grades will be communicated at a final conference with the Clinical Instructor and Student Intern during Final
Exam Week. Grades will be sent to the Coordinator of Clinical Education for placement in the clinical file. The
Coordinator of Clinical Education may request a conference with Student Clinicians to discuss clinical progress at
any point in the semester. Students are also encouraged to meet with the Coordinator of Clinical Education
whenever the/a need
Clinical grades are included in academic averages. The grading criteria are defined on forms in Appendix B and
help a student build skills towards a professional level of competence. An overall clinical grade is derived from 1)a
student’s participation in COSI 452 course and 2)weighted grading from clinical supervisors across assignments.
The clinical grading systems includes a three-tier system of grades. Students will be graded in relation to
expectations for their level of clinical experience as follows:
Level I: 0-100 hours of clinic experience in SLP
Level II: 101-200 hours of clinic experience in SLP; first externship site placement
Level III: 201 or more hours of clinic experience in SLP; has had at least one previous externship site
experience
Letter grades are computed by the Coordinator of Clinical Education through weighted scorings on the points
earned with each clinical assignment/supervisor. Clinical grades are also influenced by student participation and
mandatory attendance in the COSI 452 class. A student’s grade can be lowered by one letter grade if they miss
more than one class meeting of COSI 452 per semester.
4.5+
3.7 - 4.4
3.6 - 3.0
2.3 - 2.9
Below 2.3
=
=
=
=
=
A
B
C
D
F
CLINICAL REQUIREMENTS
NAME BADGE: All graduate clinicians will be provided with a CWRU Name Badge at the beginning of Fall
Semester. Badges must be worn whenever services are provided at CHSC. Some externship sites also
require identification badges. If lost, a replacement badge may be purchased for $2.00 through the
department office.
EQUIPMENT: All practicum students are required to have a tape recorder, microphone and audio cassettes for
use in their practicum experience. Equipment should allow for quality recordings to enable students to do
accurate transcription of speech/language samples.
STUDENT LIABILITY INSURANCE: All students participating in clinical practicum are required to purchase
student liability insurance annually. Proof of insurance must be given to the Coordinator of Clinical Education
and filed in the student's clinic file. Insurance may be purchased through NSSHLA or through OSHA.
STUDENT EXTERNSHIP MEDICAL STATEMENT: May be completed by family physician or may be completed
by Case Student Health Services (http://www.cwru.edu/stuaff/UHS/uhs.html; 216-368-2450) at no cost. See
attached form.
CLINICAL FEES: Students will pay a $25 clinical fee annually (due in the Fall). This fee will be used to purchase
clinical materials and forms which will be housed in the department.
DEPARTMENT OF COMMUNICATION SCIENCES STUDENT EXTERNSHIP MEDICAL STATEMENT
Student Name
Date of Exam
Date of Birth
SSN
This is to certify that I have examined the above-named person and have found him/her to be:
1. Free from apparent communicable disease.
2. Free from tuberculosis verified by two step Mantoux skin test (except for those with documentation of previously
significant reaction).
3. Physically fit for work in a health care facility.
4. Immunizations:
a. Immunized against measles and mumps; or born before December 31, 1956; or has a disease history of
measles and mumps; or exempt from this requirement for medical or religious reasons.
b. Immunized against rubella; or has a laboratory test demonstrating detectable rubella antibodies; or exempt
from this requirement for medical or religious reasons.
c. Immunized against tetanus and diptheria; or exempt from this requirement for medical or religious reasons.
5. List known allergies
Signature of Physician
Street Address
City, State, and Zip Code
Telephone No. ( )
Note: This does not take the place of a complete physical examination. The physician may exempt the student
from the above immunization requirements for medical reasons. This form was adapted from the ODHS Child
Care Center/Type A and Certified Type B Family Day Care Homes. (9/97)
CLEVELAND HEARING & SPEECH (CHSC) WORKFORCE CONFIDENTIALITY AGREEMENT
I understand that CHSC has a legal and ethical responsibility to maintain patient privacy, including obligations to
protect and safeguard the confidentiality of patient information. In addition, I understand that I may see or hear
other confidential information such as financial data and operational information.
As a condition of my employment/affiliation with CHSC, I understand that I must sign and comply with this
agreement. By signing this document, I understand and agree that:
I understand that any patient or confidential information that I access at CHSC does not belong to me.
I will disclose patient/confidential information only if such disclosure complies with CHSC policies and is required
for the performance of my job.
I will not discuss any information pertaining to CHSC in an area where unauthorized individuals may hear (e.g.,
hallways, elevators, social events). I understand that it is not acceptable to discuss patient or confidential
information in public areas even if specifics such as patient name are not used.
I will not make inquiries about patient or confidential information for any individual or party who does not have
proper authorization to access such information.
I will not access or view any information other than what is required to do my job. If I have any question about
whether access to certain information is required, I will ask my supervisor.
I will not make any unauthorized transmissions, copies, disclosures, inquiries, modifications, or purgings of patient
or confidential information. Such unauthorized transmissions include, but are not limited to removing and/or
transferring patient or confidential information from CHSC’s computer system to unauthorized locations (e.g., my
home).
Upon termination from CHSC, I will immediately return all property (e.g., keys, documents).
I agree that my obligations under this agreement regarding patient information will continue after the termination of
my employment/affiliation with CHSC.
I understand that violation of this Agreement may result in disciplinary action, up to and including termination
and/or suspension, restriction or loss or privileges, in accordance with CHSC’s policies, as well as potential
personal civil and/or criminal legal penalties.
My access code(s), user ID(s), password(s), etc. are kept confidential at all times.
I have read the above agreement and agree to comply with all its terms as a condition of continuing employment.
___________________________
Signature
Date
_____________________
___________________________
Name
effective 4/14/03
My personal access code(s), user ID(s), access key(s) and password(s) used to access computer systems or
other equipment are kept confidential at all times.
HEALTH & SAFETY
Students should be knowledgeable about procedures that can help protect themselves and their clients from the
transmission of communicable diseases. These policies have been taken from the Policies & Procedures Manual
of the Cleveland Hearing & Speech Center.
Many common diseases are transmitted through contact with the body fluids of an infected person. To minimize
the risk of transmission of these diseases, these guidelines describe universal precautions which are to be used
with all clients at all times. They assume that blood and other body fluids from all clients are potentially
infective and that exposure to these body fluids may occur during routine performance of job duties.
Universal Precautions
All students who work directly with clients in the course of Graduate Practicum must recognize that certain health
risks are inherent in the practice of speech/language pathology. In order to protect themselves in this work
environment, students should strictly adhere to the universal precautions which are described below. Universal
precautions are recognized by infection control specialists as the best defense against the spread of infectious
diseases. They are listed in the box below and described in more detail in the following sections.
UNIVERSAL PRECAUTIONS
Practicum students should treat all blood and OPIM (other potentially infectious materials) as though they
are infectious and use universal precautions at all appropriate times. (Saliva and gingival fluids are
considered to be potentially infectious material since they often may be contaminated with blood.
1. ROUTINE HAND WASHING
2. DISPOSABLE GLOVES
3. DISINFECT
1.
Routine Hand Washing
Wash hands carefully and thoroughly:
*BEFORE AND AFTER EACH CLINICAL SESSION
*when hands become contaminated with saliva, blood, or other body fluids (e.g., after sneezing,
coughing, or wiping a nose)
*after you use the toilet or help a client with toileting
*after diapering
*after handling soiled items, such as used tissues or dirty toys
*before preparing or eating food
2.
Disposable Gloves
Wear disposable gloves when in contact with urine, stool, blood, or saliva, such as during oral examinations,
cleaning wounds, or testing blood glucose.
*wash hands immediately after removing gloves
*dispose of gloves in plastic-lined container
3. Disinfect
Sanitize potentially contaminated surfaces and objects:
*Toys & other objects--if soiled with blood, feces, vomit, or urine must be disinfected or
discarded immediately. Mouthed toys must be washed with soap and water or disinfected.
*Dishes--wash with dishwashing liquid and hot water (120 degrees F), air dry.
*Ear probe tips--if contaminated with blood or other visible substance, wash with soap and water.
Disinfect in 70% alcohol solution for a minimum of 30 minutes. This solution should be
changed
daily.
*Diapering->Wear disposable gloves when changing child. Dispose gloves after each child has
been changed.
>Changing surfaces should be non-porous. Disinfect surface after each diaper change.
>Place soiled clothes in plastic bag to be sent home with child.
>Clean child with dampened paper towels. Dispose of these materials in plastic-lined
container.
>Diaper & dress child.
>Wash child’s hands in sink.
>Clean changing mat with disinfectant.
>Wash your hands thoroughly with soap and water.
*Environmental spills of blood (e.g., nosebleeds), vomit, or other body fluids:
>Wear disposable gloves
>Wipe up spill with paper towels. Immediately dispose of this material in plastic-lined
container
>Wash area with soap and water
>Douse with disinfectant or bleach (1:10 ratio of bleach to water)
>Dispose of gloves in plastic-lined container
>Wash hands thoroughly with soap and water
EXPOSURE CONTROL
The following job classifications at the Cleveland Hearing and Speech Center are at moderate risk for occupational
exposure to blood or other potentially infectious materials (OPIM): Speech/Language Pathologists; Audiologists;
Interpreters; and Graduate Students working with CHSC clients under CHSC staff supervision.
Clinical tasks and procedures associated with occupational exposure which may occur during
speech/language pathology practicum assignments:
1. Oral Mechanism Screenings
2. Intervention that has potential for splattering (i.e., patients with tracheostomy or tracheostoma).
3. Servicing or routine cleansing of specialized medical equipment.
4. Performing dysphagia assessment and therapy.
5. Cleaning a blood of OPIM spill.
6. Coming into contact with blood or OPIM.
7. Assisting with toileting.
8. Disposing of medical waste including but not limited to blood or OPIM either in liquid, semi-liquid, or solid
form.
Clinical tasks and procedures associated with occupational exposure which may occur during practicum
assignments under the supervision of audiologists include the following:
1. Cleaning a blood or OPIM spill.
2. Coming into contact with blood or OPIM.
3. Disposing of medical waste including but not limited to blood or OPIM either in liquid, semi-liquid, or solid
form.
HEPATITIS B VACCINE INFORMATION
Hepatitis B Infection
Hepatitis B is a major health problem in the United States. It is caused by a virus, the hepatitis B virus, and
primarily affects the liver.
Acute symptomatic infection can incapacitate a person for weeks or months and can, sometimes, lead to
complications or chronic disease conditions. Fortunately, most people recover fully. Fifty to sixty percent of all
hepatitis B infections, however, produce no symptoms in the infected person. These cases are more likely than
the symptomatic ones to progress to complications.
Some of the major chronic problems of hepatitis B infection are a chronic carrier state which develops in
approximately 10% of the cases, and chronic persistent and chronic active hepatitis. Sometimes cirrhosis of the
liver develops in a carrier. Also, the incidence of primary liver cancer is higher among chronic carriers than in
noncarriers.
Many cases of hepatitis B can now be prevented by vaccine.
Hepatitis Risks to Students
When a person has hepatitis B, the virus is found in their blood and many other body fluids. Because of the nature
of client contact and the types of clients served, some students are at a higher risk for contracting hepatitis B than
others. Many studies have been done to accurately attempt to identify just which people are at highest risk.
These areas include departments where there is frequent contact with the blood of clients. Frequent blood contact
has been shown to be the most important factor related to risk, especially contact with the blood of clients who are
at high risk for developing hepatitis B.
Hepatitis B Vaccine
A vaccine for the prevention of hepatitis B first became available in 1982. A newer vaccine became available in
1987. This new vaccine is produced in yeast cells and does not involve the blood of hepatitis carriers. The
vaccine is very effective, producing protective antibodies in 91% to 98% of healthy adults vaccinated. The
duration of immunity is unknown at this time. The vaccine is administered intramuscularly in the deltoid muscle of
the arm. The three does necessary for complete immunization are given over a six-month period of time.
Soreness at the injection site is the most common adverse reaction. Less common are fatigue/weakness and
headache. Fever and infection are also uncommon reactions. No serious adverse reactions have occurred in
recipients of the new vaccine. As with any vaccine, there is the possibility that broad use of the vaccine could
reveal adverse reactions not observed in clinical trials.
Contraindications for use of the vaccine are any serious active infection or a hypersensitivity (allergy) to yeast.
Hepatitis B vaccine will not prevent hepatitis caused by other agents, including the hepatitis A virus, the agent(s)
which cause non-A, non-B hepatitis, or other viruses known to infect the liver.
Students may want to consider having a hepatitis B vaccine series. Individuals should discuss this with their family
physician. Some externship sites may require the Hepatitis B series. Please check with your hospital or skilled
nursing facility extern supervisor for specific requirements.
CLINICAL STAFF
1. COORDINATOR OF CLINICAL EDUCATION
The Coordinator of Clinical Education oversees all aspects of clinical education and is responsible for clinical
assignments and records of all Speech-Language Pathology Students.
2. DEPARTMENT OF COMMUNICATION SCIENCES FACULTY:
Faculty, through coursework, assist students in developing a theoretical basis in communication sciences and
disorders. They act as resources for both students and clinical instructors. As evidence of the close professional
relationship between the Department of Communication Sciences and the Cleveland Hearing and Speech Center,
all faculty hold appointments as consultants to the Cleveland Hearing and Speech Center staff and clinicians. The
appointments enable faculty to take an active role in each student's clinical education.
3. CLEVELAND HEARING AND SPEECH CENTER DEPARTMENT DIRECTORS:
Directors of Audiology and Speech/Language Pathology help develop the schedule of all Cleveland Hearing and
Speech Center clinical assignments, and serve as coordinators of education within their respective departments.
They hold clinical appointments in the Department of Communication Sciences.
4. CLINICAL SUPERVISORS:
Clinical Instructors have broad academic and clinical bases in the area of communication disorders, as well as
special areas of expertise and interest, which qualify them to educate students. Clinical education, like all
teaching/learning paradigms, requires the involvement of both the instructor and the student. The clinical
instruction process is characterized by exchanges between the instructor and student and is highly interactive in
nature.
The skills listed here could be extended almost indefinitely since the role of Clinical Supervisor is a complex one.
However, the general skill requirements for Clinical Supervisors include the ability to:
a.
Assist the student in development of appropriate assessment, management, and treatment
programs.
b.
Serve as a resource person for the student requiring specialized knowledge related to a
communication disorder.
c.
Utilize a variety of instructional/supervision methods (audio- and/or video recordings, group and/or
individual conference staffings, self evaluation, peer evaluation) to assist the student in developing
and refining clinical skills through a supportive learning environment.
d.
Observe, record, analyze and evaluate the student's clinical skills and share this information in a
direct manner with the student, CHSC Department Directors, the Coordinator of Clinical Education,
and the Faculty.
There are two categories of Clinical Instructor appointments within the Department of Communication Sciences:
a.
Clinical Instructors: Cleveland Hearing & Speech Center (CHSC). The major affiliation for clinical
education is with Cleveland Hearing & Speech Center. Members of the professional staff of CHSC
hold appointments as Clinical Instructors in the Department of Communication Sciences at Case
Western Reserve University. They are responsible for direct instruction in the student's clinical
education experience. The professional staff of the CHSC may hold appointments as Adjunct
Clinical Instructors at Case Western Reserve University.
b.
Adjunct Clinical Instructors: ASHA requires that students receive education at two or more
externship sites in addition to their primary clinical education facility. Instructors at externship
locations may hold appointments as Adjunct Clinical Instructors. Their responsibilities are also to
provide direct
instruction in the student's clinical education experience.
CLINICAL FACILITIES
Cleveland Hearing & Speech Center
The Cleveland Hearing & Speech Center is the primary clinical educational site for Audiology and SpeechLanguage Pathology. The Department of Communication Sciences is committed to assisting CHSC in providing
quality clinical services that involve student intern participation. The personnel and facilities of the CHSC provide
exceptional clinical experiences for students. The professional staff are vitally involved in the clinical education of
students seeking clinical certification in Speech-Language Pathology.
Clinical services at the Cleveland Hearing & Speech Center include:
A. Speech-Language Pathology
1. In-house Diagnosis and Treatment of:
Speech Production Disorders-- Articulation Disorders, Phonological Disorders, Voice Disorders
Foreign Accent Reduction, and Fluency Disorders
Developmental Language Disorders
Language-Learning Disabilities
Aural Rehabilitation Services
Augmentative/Alternative Communication (AAC)
Neurogenic Language Disorders----Aphasia, Dysarthria, Apraxia
Structural/Neurologic Disorders: Craniofacial Anomalies, Laryngectomy, Brain Injury, and
Neurologic Disease
2. Contracted Services throughout the greater Cleveland area-Provide diagnostic and treatment services in community settings. Sites include HeadStart
programs, Day Care Centers, Private Elementary, and Secondary Schools.
3. Audiology
Comprehensive Audiologic Evaluation
Otoacoustic Emissions Testing
Hearing Aid Services including consultation
Hearing Aid Fitting and Repairing
Aural Rehabilitation
Hearing Conservation Programs
Hearing Screening
Case Reviews
CHSC Clinical Forms
Students participating in practicum assignments with CHSC staff will utilize forms and procedures described in the
Policies and Procedures Manual of the Cleveland Hearing & Speech Center. Clinic supervisors will review
procedures which are relevant to the caseload being covered by the student’s assignment. Appendix E includes
copies of CHSC forms (treatment plan/progress report, diagnostic reports, SOAP note procedures).
Diagnostic and Therapy Materials
The COSI Department has a collection of diagnostic and intervention materials (assessment tools stored in Room
401 and toys stored in Room 415B (See Appendix G for a list). Materials must be returned within a three-hour
period.
Students may also use the diagnostic and therapy materials of the CHSC when working with CHSC clients.
Materials must be checked out through a CHSC staff member (who has a key). Check out materials by signing
your name and the name of your supervisor as follows:
CHSC PEDIATRIC MATERIALS ROOM PROCEDURES
GRADUATE STUDENTS
Check out:
1. Sign out all materials on the white bulletin board/sign out sheet.
and date/time checked out.
2. List your name, the name of the clinician who is supervising you, the name of the material, and date/time
checked out.
For Check-in:
1. Note date returned on the right side of your name.
2. Cross out your name.
3. Return item(s) to their correct location on shelves.
The therapy materials room is located on the second floor in Room 204. Pediatric and adult diagnostic materials
are housed in Room 205. A listing of CHSC Diagnostic materials appears in AppendixG.
It is imperative that you sign out materials as described above. The adult materials sign-out sheet is located on
the door of the room. MATERIALS MUST BE RETURNED TO THEIR APPROPRIATE LOCATION BY THE END
OF THE DAY. Remember that the use of these materials is a privilege.
Materials cannot be checked out overnight unless approved by a CHSC clinician. Overnight materials can
be taken after 4:30 and MUST be returned by 8:30 the next morning.
MATERIALS IN PEDIATRIC MATERIALS ROOM (ROOM 204) and Room 205
Organization of materials:
Room 204:
1. All toys/objects are located on the shelves (including script kits, dolls, etc. on the back wall and the right-hand
side of the room). Shelves are labeled and items should be returned to their appropriate
location.
2. Intervention materials are on the shelves. They are organized by topics (i.e., infant;
reading; writing). Please return items to their correct location.
phonology/arctic; voice;
Room 205:
1. The file cabinet with diagnostic forms has been reinstituted. Forms are filed in alphabetical order. DO NOT
TAKE THE LAST FORM!. Each test has 1 form (for Xeroxing only) in the file. Please do not use the forms in
the test box/kit.
2. Diagnostic materials are filed alphabetically on the shelves. Please return to the appropriate location when
you have finished with the materials.
Externship Sites
After students have completed approximately 100 clinical hours of service under the supervision of Cleveland
Hearing & Speech Center Clinical Instructors they may begin their externship assignments. ASHA requires that
during a student’s clinical training they participate in at least three different types of settings (each for a minimum
of 50 hours each) The COSI Department draws upon clinical resources in University Circle and the Greater
Cleveland Area offering students a diversity of settings to select from.
The following facilities are among those that serve as externship sites for clinical education:
Clinical Education
Facility (Type of Setting)
Achievement Center for Children
(Center-based early intervention)
Diagnosis and remediation of speech and language
problems of 0-5 population in a multidisciplinary team setting.
Akron City Hospital
Diagnosis and treatment for pediatric, inpatient,
rehabilitation, outpatient, and craniofacial team.
Berea, Cleveland, Cleveland Heights,
East Cleveland, Euclid, Lakewood,
Mayfield, Positive Education Program (PEP),
Shaker Heights, and University Heights Boards
of Education (Public School)
Diagnosis and remediation of speech, language, and
language and learning problems in public school
setting; and aural rehabilitation opportunities.
Cleveland Clinic Center for Autism
Outpatient treatment for children with autism
Cleveland Veteran's Medical Center
(Acute care; outpatient center)
Diagnosis and remediation of communication
disorders with special attention to effects of drugs on
communication and knowledge of medical terminology.
Cuyahoga County Board of Mental
Retardation (Center-based and
home-based early intervention;
vocational setting for adults)
Diagnosis and remediation of children and adults with
with mental retardation at schools and sheltered workshop
settings and in home-based services for 0-3 years.
Deepwood Center/CLEO
Lake Count Board of Mental Retardation &
Developmental Disability
Assessment and treatment therapy of adults with MR in
homes and sheltered workshops.
Grace Hospital (rehab setting)
Specialty in patient with vents and/or tracheostomies.
Harborside Healthcare (Skilled Nursing Facility)
Diagnosis and treatment of adult neurogenic patients in a
skilled nursing setting
Health Hill (rehab setting)
Inpatient and outpatient rehabilitation of medically-fragile
children with communication disorders in a team setting.
Heather Hill (rehab setting)
Rehabilitation of adults with Aphasia and closed-head
injuries in a team-based setting.
Lakewood Hospital
Inpatient and outpatient services for adults and children with
varying communication disorders.
Manor Care
Diagnosis and treatment of adult neurogenic patients in a
skilled nursing facility.
Menorah Park (skilled nursing facility)
Meridia Euclid Hospital
Range of supported living options, speech-language
screenings, evaluations and therapy services.
Diagnosis and treatment therapy of adults with varying
communication disorders in acute, sub-acute, and skilled
nursing settings.
MetroHealth Medical Center
(outpatient clinic)
Diagnosis and remediation of speech, language, and hearing
disorders and a comprehensive program for extended
rehabilitation of brain injured clients.
Parma Community Hospital
(Outpatient & inpatient comm. Hosp)
Inpatient and outpatient services for adults and children with
varying communication disorders.
Rainbow Babies & Children's Hospital
(outpatient rehab)
Assessment and treatment of infants, toddlers, and
preschoolers with varying communication disorders.
RoseMary Center (school setting)
Rehabilitation of children and young adults with severe to
profound mental retardation and multiple handicaps.
Southwest General Hospital
Diagnosis and remediation of speech, language, and hearing
(inpatient & outpatient community hospital) disorders in
children and adults in in-patient & out-patient settings.
University Hospitals of Cleveland
(acute care)
Diagnosis and treatment of hearing and communication
problems in adult neurogenic and ENT patients.
University Mednet
Diagnosis and treatment therapy of children and adults with
varying communication disorders in an outpatient setting.
APPENDIX A: CLINICAL DOCUMENTATION FORMS
These forms are to be used for your documentation of clinical hours for COSI 452 and
observation hours for COSI 352.
INSTRUCTIONS:
•
•
•
•
•
Complete the practicum log after each session to track your hours.
Complete the Ohio Board of Speech-Language Pathology and Audiology hours sheet each
semester and have your supervisor sign the hours that you attained over the course of the
semester. ONLY ONE SHEET SHOULD BE USED OVER THE COURSE OF YOUR
ACADEMIC/CLINICAL PROGRAM.
Each semester/supervisor should fill one line only. See example.
Hours should be calculated to the nearest quarter hour (e.g. 10.25, 10.5, 10.75)
Ohio Board of Speech-Language Pathology hours sheet should be returned to the Department
Assistant after review by the Coordinator of Clinical Education. Students may copy their hours
sheet every semester for their records, however the original hours sheet should be kept in the
student’s permanent file in the Department Office.
PRACTICUM LOG
SEMESTER
STUDENT
NOTE DURATION OF TIME SPENT: .25, .50, .75, 1.0 etc. (hrs)
DATE
SURPV
AD/CH
SPEECH
Diag Tx
LANG
Diag Tx
AUD/AR
DESCRIPTION/CLIENT
SUMMARY OF CLINICAL OBSERVATIONS
UNDERGRADUATE PRACTICUM
STUDENT:
DATE
TIME SPENT
(.25, .50, .75, 1.0 hours)
TOTAL NUMBER OF HOURS BSERVED THIS PAGE:
TOTAL NUMBER OF HOURS OBSERVED:
CLINICIAN SIGNATURE
AND LICENSE NUMBER
CLIENT AGE LEVEL
HOURS
(COMPLETE ON LAST PAGE ONLY)
DISORDER TYPE
APPENDIX B: COSI 452 CLINICAL PRACTICUM ASSIGNMENTS
INSTRUCTIONS FOR INITIAL CASE MANAGEMENT: CHSC ASSIGNMENTS
This form is designed to help students plan for their first supervisory conference, and the first session of therapy
and should be completed by the student prior to the first supervisory conference.
Instructions
1. Check out your client’s case file from the front desk in the lobby. Fill out a Records Retrieval form with you
name and your supervisor’s name. The case file will be placed in your supervisor’s mailbox. Read this file
thoroughly and return it to the Records Room mailbox within 24 hours. You may complete case summaries in
the graduate carrel room. Under no circumstance is a case file to leave the Cleveland Hearing & Speech
Center. Violation of this rule will result in an automatic grade reduction of one letter grade for the semester.
2. Complete the Summary of Case Management side of the form from information that may be obtained through
thorough review of past therapy reports, diagnostic reports, reports from other professionals, and case history
information. Summarize the data that you collect. Think about the factors (e.g. cognitive, audiological,
environmental etc.) that are contributing to the client’s current communication status. Record these factors on
your form in the appropriate spaces. Record the client’s current communication skills on the form in the
appropriate categories. This information should include, but is not limited to, testing information (i.e. standard
scores and percentiles) from the previous semester report. Statements regarding the severity of the client’s
disorder should also be noted (i.e. mild, moderate, severe, profound).
3. Prior to completing the reverse side of the form entitled “Assessment Plan”, think about what you now know
and what you do not yet know about this client. What additional questions/measures are needed in order to
have a more complete knowledge about the client? How do you plan to get this information? (e.g.
standardized testing, stimulability testing, etc.) List these items/ideas/instruments on your Assessment Plan
side of the form, in the appropriate categories. What are possible goals for intervention?
4. Be prepared to discuss this information in an organized manner during your first conference with your
supervisor.
5. Following formulation of client goals, a treatment hierarchy should be written for each goal. This hierarchy
should be used to help guide your lesson planning. Examples of hierarchies may be found in theGoldberg text
(on reserve in room 414) in addition to the example in this section.
6. Clinicians/supervisors should familiarize themselves with evidence based practices and apply them to clinical
practice consistent with ASHA guidelines (see following section on Evidence Based Practices). Also see
ASHA Preferred Practice Guidelines and Knowledge and Skills documents available on ASHA website
(www.asha.org) for more information.
6. Learning Outcomes for all CHSC assignments are located in Appendix D.
7. Clinical forms are located in Appendix E.
Evidence-Based Practice
Evidence-based practice entails the use of current best research results to make clinical decisions about
patient care. Based on the evidence from a comprehensive literature search and review of published
research studies, practice guidelines are developed to assist clinicians and patients in choosing the
appropriate care for specific conditions. Guidelines are designed to address a specific issue in areas such
as screening, diagnosis, or treatment. Ideally, they should be:
•
Systematic
•
Logical
•
Defensible
•
Practical
•
Feasible
•
Understandable
•
Include both clinician and patient in the decision-making
Evidence-Based Practice: Practice Guidelines
The current emphasis on developing practice guidelines in all healthcare fields, including speech-language
pathology and audiology, has evolved naturally from a historical emphasis on treatment efficacy . To be
efficacious, a procedure must provide a benefit to the intended population under ideal circumstances. In
contrast, a procedure may be deemed effective if the intended population benefits from the procedure
under average or typical conditions. Practice guidelines are developed from the systematic review of
efficacy research in a particular area.
The development of practice guidelines came into full-swing in the early 1990s when the first practice
guideline was funded by the Agency for Health Care Policy and Research (AHCPR), now the Agency for
Healthcare Research and Quality (AHRQ, www.ahrq.gov ). Previously completed guidelines can be
accessed on the National Guidelines Clearinghouse web site at www.guideline.gov/index.asp . In addition
to practice guidelines, AHRQ also funds the development of Evidence Reports, which are a summary of
research evidence within a particular field or area of study, and Technology Assessments, which review
the risks, benefits, and clinical effectiveness of current technological interventions.
It is important to note that AHRQ reports and guidelines have not been uniformly accepted in the clinical
and medical fields. ASHA has expressed concerns, for example, about the limitations of focusing on only
one population in the dysphagia evidence report and studying only the value of dysphagia services in the
prevention of aspiration, to the exclusion of other equally serious outcomes of swallowing problems. Read
the complete summary of ASHA’s response to the AHCPR Dysphagia report.
Increased interest in the development and use of practice guidelines has been the result of increased
accessibility to published research, particularly via the Internet, a need for improved services and
outcomes, and reimbursement policy changes. Practice guidelines provide many benefits to clinicians,
patients, and lawmakers in that they can help to increase the quality of services provided, diminish
variations in practice, help identify cost-effective strategies, prevent unfounded practices, and highlight
research needs. Policymakers, payers, and patients can then justify the cost of and improve access to
quality care.
Levels of Evidence
Typically, research evidence is rated or classified according to levels based on the type of research
completed and the research design quality. The following is an example of a research classification
system:
•
Class I evidence comes from at least one well-designed, randomized controlled clinical trial
•
Class II evidence is from at least one well-designed observational, clinical study with concurrent
controls
•
Class III evidence is provided by expert opinion, case studies, and studies with historical controls
Practice Guidelines are developed using a classification system such as the one described above. It is
important to note that guidelines differ from Practice Standards and Practice Options. These differences
include:
•
Standards are accepted principles of patient care based on a high degree of certainty and Class I
or strong Class II evidence.
•
Guidelines reflect a moderate degree of certainty, are not fixed protocols or rigid treatment rules,
and are typically based on Class II evidence.
•
Options are possible treatment strategies, but are based on limited certainty or conflicting
evidence or opinion.
In some arenas, the strict adherence to levels of evidence is problematic. For example, in the area of
neurologic communication disorders, it may be difficult to find a large enough group of subjects with a
particular disorder to complete a randomized controlled trial (often the preferred type of study). Some
advocate for an approach to the available literature that allows for review of the relationship of intervention
and outcome when direct evidence is not available. The American Psychological Association developed a
series of questions to ask when considering the merits of research. These questions include:
•
How well are the subjects described?
•
How well is the treatment described?
•
What measures of control are imposed in the study?
•
Are the consequences of the intervention well described?
Literature Review Sites and EBP Tools
Agency for Healthcare Research and Quality (AHRQ)
www.ahrq.gov
American Speech-Language-Hearing Association (ASHA)
•
ASHA Journal Online
•
Treatment Efficacy Bibliography
ASHA’s National Center for Treatment Effectiveness in Communication Disorders
•
"Evidence-Based Practice: The Marriage of Research and Clinical Services."
ASHA Leader article by Kenn Apel and Trisha Self, September 9, 2003.
ERIC
www.eric.ed.gov
PubMed
www.ncbi.nlm.nih.gov/PubMed
The Cochrane Collaboration
www.cochrane.org
American College of Physicians Journal Club
www.acpjc.org
Combined Health Information Database (CHID) online
www.chid.nih.gov
REHABDATA
www.naric.com/search/rhab
elibrary
www.ask.elibrary.com
Ingenta
www.ingenta.com
Free Medical Journals Site
www.freemedicaljournals.com
ProQuest Digital Dissertations
www.lib.umf.com/dissertations/
National Institute on Deafness and Other Communication Disorders (NIDCD)
www.nidcd.nih.gov
VA Audiology and Speech Pathology Service Field Advisory Council
Evidence-Based Treatment Outcomes in Aphasia
www.washington.med.va.gov/audio-speech/aphasia.doc
Bandolier
www.jr2.ox.ac.uk/bandolier/
Clinical Evidence, BMJ Publishing Group
www.clinicalevidence.org
Evidence-Based Practice Newsletter
www.ebponline.net
Health Sciences Library at the University of North Carolina
www.hsl.unc.edu/visitors.cfm
Research Navigator
www.ablongman.com/researchnavigator
The Communication Disorders Dome
www.comdisdome.com
Evidence-Based Practice Myths and Realities
cite as:
Dollaghan, C. (2004, April 13). Evidence-based practice myths and realities. The ASHA Leader, pp.
12.
by Christine Dollaghan
How do you feel when you hear the words "evidence-based practice" or "EBP"? In talking about EBP with
clinicians, colleagues, and students during the past few years, I've seen reactions ranging from euphoria
(admittedly rare) to outrage (thankfully also rare).
The most common feeling, however, seems to be a mixture of curiosity and anxiety: curiosity about the
reasons for the "buzz" about EBP, and anxiety over the possibility that EBP will turn out to be just one
more unrealistic demand placed on already over-burdened professionals. By a brief description of some of
the myths and realities of EBP, I hope to encourage the "EBP-curious" to feel considerably more confident
about what this perspective on clinical decision-making can offer to those willing to keep both euphoria
and outrage at bay.
Myths and Definitions
By now, most people are familiar with the definition of EBP as ". . .the conscientious, explicit, and
judicious use of current best evidence in making decisions about the care of individual patients . . . [by]
integrating individual clinical expertise with the best available external clinical evidence from systematic
research" (Sackett et al., 1996). However, some parts of this definition ("best available external clinical
evidence from systematic research") seem to get a lot more attention than others ("individual clinical
experience"). So the first myth about EBP that needs to be dispelled is the idea that evidence from
systematic research is the only acceptable basis for clinical decision-making. As Guyatt and colleagues
(2000) note, "evidence is never enough;" the EBP framework acknowledges that the experiences, values,
and preferences of ourselves and our patients can and should contribute to our clinical decisions.
EBP does require us, however, to identify and make use of the highest quality scientific evidence as one
component of our efforts to provide optimal patient care. Unfortunately, this worthy goal is linked to
another myth about EBP: namely, that it requires clinicians to spend hours each week scouring the
hundreds of newly published articles and textbooks for nuggets of evidence "gold." No practitioner has the
time and few have either the inclination or the expertise for such a task.
Instead, proponents of EBP (e.g., Sackett et al., 2000) suggest several strategies by which clinicians can
find the relatively rare evidence that is of sufficient quality to influence clinical practice, while at the same
time ignoring, or better yet avoiding altogether, the deluge of weaker evidence. These authors suggest
that practitioners are likely to have no more than 30 minutes per week to devote to locating and evaluating
evidence; thus, their suggestions are oriented around this minimal time investment.
One of their suggestions is that practitioners focus their limited time on evidence from "high-yield" sources.
Such sources contain evidence that is current, of high quality (according to the criteria described below),
and directly applicable to clinical practice. Sackett et al. (2000; 1999) urge us to examine journals and
evidence compilers such as those described below to identify the one(s) most likely to contain quality
evidence, and to limit ourselves to these rather than devoting time to low-yield and/or dated sources such
as traditional textbooks and journals oriented to "basic science." The de-emphasis in EBP on evidence
sources that are difficult to update rapidly, such as traditional textbooks, derives from the explicit
acknowledgment that what we "know" at any point is virtually guaranteed to change as science
progresses, so our efforts to identify current best evidence should focus on the most contemporary
sources.
Similarly, the EBP orientation disavows the longstanding belief that all basic science findings are relevant
to clinical practice. The goals, designs, and methods of studies aimed at providing strong answers to
questions about clinical practice are in some respects quite different from those of studies aimed at
understanding basic mechanisms of disease. In the EBP framework, evidence from studies of basic
mechanisms plays a similar role to evidence derived from personal experience or the opinions of
authorities; all of these sources can provide fruitful "leads," but these must be followed up in subsequent
studies explicitly designed to address questions about clinical practice.
Internet access to high-yield sources and sites exponentially decreases the time needed to locate current
best evidence. For example, www.guideline.gov, a free resource sponsored by the Agency for Healthcare
Research and Quality, provides a compilation of evidence reviews and practice guidelines published by a
variety of groups on a wide range of topics. Clinicians can search the Web site for information on specific
topics or browse for guidelines in category headings. Although the bulk of information concerns medical
conditions, the site contains a number of guidelines on such topics as hearing screening, autism, attention
deficit hyperactivity disorder, learning disorders, and others, providing busy practitioners with rapid access
to a synthesis of information on screening, diagnosis, treatment, and prognosis.
Individuals can also register to receive free weekly e-mail updates listing new or revised guidelines, and
those of interest can be accessed in a matter of seconds. Similarly, PubMed (www.ncbi.nlm.nih.gov) is a
free site sponsored by the National Library of Medicine, in which users can search for specific information
from among literally millions of biomedical and other life science citations, and in many cases, the
complete article can be accessed online. The PubMed site has a number of extraordinarily helpful
features, such as a "cubby" in which an individual user can store results from previous searches and ask
"what's new" on that topic at a later date, again in a matter of seconds. PubMed also has a "clinical query"
search, specifically designed to allow searches concerning diagnosis, therapy, etiology, and prognosis for
a given condition using research methodology filters that increase the likelihood that results will be directly
relevant to clinical practice. Finally, sites such as the Cochrane Library (www.updatesoftware.com/cochrane) develop and report systematic evidence reviews on a wide range of topics. These
abstracts are available at no charge.
The availability of millions of articles and tens of sites containing evidence makes it easy to debunk a third
myth about EBP: namely, that clinicians can or should be able to "stay current" on every aspect of clinical
practice at all times. Instead, Sackett et al. (2000) assert that we seek evidence mainly when we have
specific questions about specific patients, disorders, or procedures. Formulating a specific question (e.g.,
"Compared to direct, clinician-administered therapy, are parent-administered programs effective
treatments for 3-year-olds with specific language deficits?") makes it much easier to zero in on what will
usually be a relatively small set of articles. These can then be scanned rapidly to determine whether their
quality appears sufficiently high to warrant a full reading. Day-to-day clinical activity will often proceed on
the basis of our existing knowledge and experience; EBP implies not that we upend everything that we
think we know, but rather that we upgrade our knowledge base in response to particular clinical questions
in the explicit, judicious, and conscientious manner described in the definition of EBP.
Critical Appraisal
Evaluating evidence quality depends on a process of critical appraisal, which has been described by a
number of authors working in EBP but has been applied only rarely in the literature on communication
disorders (e.g., Yorkston et al., 2001). A myth about critical appraisal is that only people who have
completed years of specialized study can do it. In fact, Sackett et al. (2000) describe critical appraisal in
some detail, and worksheets for evaluating systematic reviews and articles concerning studies of
diagnosis, treatment, prognosis, and harm can be found in the section titled "Teaching Materials" at
www.cebm.utoronto.ca.
Some of the criteria will be familiar to clinicians (e.g., Were there statistically significant differences
between treated and untreated groups? Were the outcome measures valid and reliable?) but others are
less familiar, being more specifically tied to studies addressing clinical questions (e.g., Were patients
assigned randomly to groups? Were evaluators blinded to group assignment? Were the group differences
large or practically significant?). The many excellent sources of accessible information on critical
appraisal, including clear and concise self-tutorials (e.g., at www.poems.msu.edu/InfoMastery) make it
possible for interested individuals to learn to evaluate evidence quality at whatever level of intensity or
commitment they choose.
Familiarity with the process of critical appraisal allows us to reject the myth that studies with certain
designs, in particular randomized controlled trials (RCTs) of treatment, always provide high quality
evidence. Like any other type of study, RCTs can be designed and conducted well or poorly; only those
studies that meet the critical appraisal criteria can yield strong evidence concerning treatment. By applying
the critical appraisal criteria, we identify the strengths and weaknesses in all kinds of studies, providing a
principled basis for resolving disagreements about the optimal approaches to client care. Because few
studies meet all of the critical appraisal criteria, reasonable people can disagree about the quality of
evidence from a particular study, making it important for individuals to think independently about the
validity, importance, and precision of results from empirical studies as a prelude to applying them to
clinical care.
In reality, EBP is neither the panacea nor the bugaboo that its mythology has suggested. Rather, EBP
offers us a framework and a set of tools by which we can systematically improve in our efforts to be better
clinicians, colleagues, advocates, and investigators-not by ignoring clinical experience and patient
preferences but rather by considering these against a background of the highest quality scientific evidence
that can be found.
SEMESTER OUTLINE OF REQUIREMENTS FOR CHSC SPEECH-LANGUAGE PATHOLOGY
PRACTICUM PLACEMENTS
Please place a check before each item when completed:
_____ 1. Summary of Case Management (Initial Meeting).
_____ Clinical contracts should be signed at this time.
_____ 2. Baseline Data Collection (By 2nd therapy session).
_____ 3. Treatment Plan (signed following 4th therapy session).
_____ 4. Treatment Hierarchy (by 5th therapy session).
_____ 5. Midterm Grade (on or about 8th week of semester; on or about 4th-5th week of summer session).
_____ 6. Progress component of treatment plan according to client schedule.
_____ 7. Research article summary.
_____ 8. Final grade (last week of semester or finals week).
_____ Supervisor evaluations completed at this time.
Copies of the following forms should be turned into the Coordinator of Clinical Education:
•
•
•
•
Clinical Contract
Mid-term Grading Form
Final Grading Form
Supervisor Evaluation Form
Guidelines • Admission/Discharge Criteria in Speech-Language
Guidelines
Pathology
2004 - 65
Admission/Discharge Criteria in SpeechLanguage Pathology
Ad Hoc Committee on Admission/Discharge Criteria in
Speech-Language Pathology
This guideline document is an official statement of the
American Speech-Language-Hearing Association (ASHA).
The ASHA Scope of Practice states that the practice of speechlanguage pathology includes making admission and discharge decisions. The ASHA Preferred Practice Patterns are
statements that define universally applicable characteristics
of speech-language pathology practice. The guidelines
within this document fulfill the need for more specific procedures and protocols for serving individuals with speech,
language, communication, or feeding and swallowing disorders across all settings. It is required that individuals who
practice independently in this area hold the Certificate of
Clinical Competence in Speech-Language Pathology and
abide by the ASHA Code of Ethics, including Principle of
Ethics II Rule B, which states: “Individuals shall engage in
only those aspects of the professions that are within the scope
of their competence, considering their level of education,
training, and experience.”
updated to reflect current research and preferred practice.
These guidelines were approved by ASHA’s Legislative
Council in March 2003.
Executive Summary
Admission and discharge criteria originally were prepared by the Ad Hoc Committee on Admission/Discharge
Criteria in Speech-Language Pathology: Evie Hagerman,
chair; Sandra Bennett; Douglas Duguay; Sara JonesMcNamara; Noma LeMoine; Rita Marshall; and Michelle
Ferketic, ex officio. Crystal Cooper, 1994–1996 vice president for professional practices in speech-language pathology, and Diane Eger, 1991–1993 vice president for
professional practices, served as monitoring vice presidents.
The criteria were approved as a technical report by the Executive Board in October 1994. In 2002, with input from
the National Joint Committee for the Communication Needs
of Persons With Severe Disabilities (NJC)1, the criteria were
The ASHA Admission/Discharge Criteria in Speech
Language Pathology document was developed to provide general factors for speech-language pathologists
to consider when making admission and discharge
decisions across practice settings and clinical populations. The criteria were designed as a basis for developing program-specific admission and discharge
criteria for children and adults with various speech,
language, communication, and feeding and swallowing disorders. ASHA originally published admission/discharge criteria in 1994. These criteria were
revised to reflect current research and clinical practice
in order to ensure that communication services and
supports are provided to all individuals in need. One
concern prompting the update of the criteria is that
cognitive referencing (i.e., referencing scores on language measures to scores on cognitive measures) was
being used to deny speech and language services. Contemporary research and practice question the use of a
language/cognitive discrepancy as a criterion for admission or discharge because individuals with similar language and cognitive levels or without certain
cognitive skills may still make progress with appropriate communication intervention. Therefore, cognitive referencing is not one of the criteria for admission
or discharge in the revised document.
Reference this material as: American Speech-LanguageHearing Association. (2004). Admission/discharge criteria in speech-language pathology. ASHA Supplement
24, 65–70.
Index terms: admission criteria, SLP; discharge criteria, SLP;
eligibility for admission, discharge; referral; entrance
criteria; exit criteria.
Document type: guidelines
The admission criteria are factors that indicate
eligibility or the need for further assessment to determine the need for treatment. Discharge criteria present
situations when a speech, language, communication,
or feeding and swallowing disorder is remedied; when
compensatory strategies are successfully established;
when the individual or family chooses not to participate in treatment, relocates, or seeks another provider.
It is the clinician’s ethical responsibility to review and
analyze all aspects of past services in order to identify
66 - 2004
American Speech-Language-Hearing Association
specific modification(s) that have the greatest probability of yielding improved outcomes and then implement
those improvements with ongoing monitoring. A flow
chart depicts the sequence to follow when treatment
no longer results in measurable benefits and discharge
is being considered (see Figure 1).
ASHA developed general admission/discharge
criteria to help speech-language pathologists identify
patients/clients for treatment; to provide accrediting
agency reviewers with information to evaluate service
delivery and patient/client management; to assist government agencies, third-party payers, or school districts in the development of regulations and health care
reform plans; to provide educators with information
about appropriate candidates for speech-language
pathology services; and to provide information for
consumer education.
Background
Speech-language pathologists are frequently
asked to provide admission and discharge criteria2 for
persons with speech, language, communication, and
feeding and swallowing disorders to school and health
care administrators, third-party payers, and accrediting and regulatory agencies. Determining these criteria is a complex process that is influenced by many
clinical and administrative factors, including the etiology, severity, and prognosis of the disorder, and any
regulations imposed by federal, state, and local government, accrediting organizations, and education
agencies. In all cases, admission and discharge decisions should be consistent with the ethical practices
described in the current ASHA Code of Ethics (ASHA,
2003).
ASHA previously addressed the development of
admission and discharge criteria. The document, Issues
in Determining Eligibility for Language Intervention, prepared by the former Committee on Language Learning
Disorders, focused on economic, administrative, and
political issues related to the eligibility requirements
of children for language services (ASHA, 1989). Many
of these same issues influence the admission of children and adults for speech, language, communication,
feeding and swallowing services. Further, the former
ASHA Professional Services Board (PSB) required accredited programs to follow established policies and
procedures for patient/client admission, discharge,
and follow-up (ASHA, 1992).
In August 1992, ASHA established the Ad Hoc
Committee on Admission/Discharge Criteria to develop a report that would guide speech-language pathologists in developing program-specific admission
and discharge criteria for various ages and communi-
cation disabilities seen across the spectrum of service
delivery settings. Recognizing the range of professional services and practice settings and the diversity
of clinical populations addressed by speech-language
pathologists, the Committee identified factors that
could be used as a basis for developing admission and
discharge criteria. The Committee determined that it
was neither feasible—given the established time
frame—nor advisable to develop prescriptive criteria
to replace existing individual program criteria. The
identified factors are general so they are applicable to
all practice settings and clinical populations.
The original Committee obtained and reviewed
existing admission and discharge criteria from various speech-language pathology service delivery programs. The Committee also reviewed the areas of
practice for speech-language pathologists, the expected outcomes, and the clinical indicators identified
in ASHA’s original version of the Preferred Practice
Patterns for the Professions of Speech-Language Pathology
and Audiology (ASHA, 1993) to develop the criteria. In
2002, the criteria were updated to reflect the new and
revised speech-language pathology practice policies
approved since 1994, including the Scope of Practice in
Speech-Language Pathology (ASHA, 2001), the Preferred
Practice Patterns for the Profession of Speech-Language
Pathology (ASHA, 1997), and the new position statement and supporting documentation entitled Access to
Communication Services and Supports: Concerns Regarding the Application of Restrictive “Eligibility” Policies
(NJC, 2002; approved by ASHA in June, 2002). A related resource is ASHA’s Guidelines for Referral to
Speech-Language Pathologists (ASHA, 1998). The referral guidelines were developed to help educate potential referral sources (e.g., case managers, consumers,
physicians) about the scope of practice of speech-language pathologists. Referral is often the initiating event
leading to admission to speech-language pathology
services across settings. Awareness of these referral
guidelines may help to increase timely and appropriate use of these services.
A major reason prompting the revision of the 1994
admissions and discharge criteria was a concern that
statements in the report could lead to inappropriate
denial of communication services and support to those
individuals in need. Specifically, the report included
as a criterion for admission that “The individual’s
communication abilities are not commensurate with
his or her developmental abilities,” and a criterion for
discharge that, “The individual’s communication
abilities are commensurate with developmental abilities.” However, the use of “cognitive referencing” or a
language/cognitive discrepancy as a means of diagnosing language impairment has been seriously ques-
Guidelines • Admission/Discharge Criteria in Speech-Language Pathology
tioned (see summary in ASHA, 1996). Nelson (1996)
indicates that cognitive referencing means that “scores
on measures of language development are referenced
to scores on measures of cognitive development for the
purpose of determining who is eligible for language
intervention services” (pp. 3-4). Problems cited in the
literature with using cognitive referencing for eligibility decisions include measurement concerns (e.g., measurement error, test reliability, individual variability,
and cultural and linguistic assessment bias), theoretical concerns about the relationship between cognition
and language (e.g., language may exceed cognitive
level), and lack of empirical support for the use of cognitive referencing (see Casby, 1996; Cole, 1996; Lahey,
1996; Terrell, 1996). In fact, individuals with similar
language and cognitive levels or without certain cognitive skills may still make progress with appropriate
communication intervention (NJC, 2002). The NJC
position statement was written in response to concerns
that communication supports and services were being
denied to those in need based on restrictive and inappropriate eligibility criteria. The statement and accompanying documentation (NJC, 2002) emphasize that
eligibility criteria should be based on individual and
functional needs rather than on a priori criteria such
as discrepancies between cognitive and communication functioning and absence of cognitive skills purported to be prerequisites. Based on recent research
findings and contemporary policy statements, the revised criteria do not use cognitive referencing as a basis
for admission or discharge.
Admission to Speech-Language
Pathology Services
In general, individuals of all ages are eligible for
speech-language pathology services when their ability to communicate and/or swallow effectively is reduced or impaired or when there is reason to believe
(e.g., risk factors) that treatment will prevent the development of a speech, language, communication, or feeding and swallowing disorder; reduce the degree of
impairment; lead to improved functional communication skills and/or functional feeding and swallowing
abilities; or prevent the decline of communication,
and/or swallowing abilities. The decision to admit an
individual to speech-language pathology services in
a school, health care, or other setting must be made in
conjunction with the individual and family3 or designated guardian, as appropriate. Listed below are factors that indicate eligibility or the need for further
assessment of a person’s communication or feeding
and swallowing abilities to determine the need for treatment. Eligibility for services or for evaluation is indicated if one or more of these factors is present:
2004 - 67
1.
Referral from the individual, family member,
audiologist, physician, teacher, other speechlanguage pathologist, or team (e.g., interdisciplinary, educational management) because
of a suspected speech, language, communication, or feeding and swallowing disorder.
2. Failure to pass a screening assessment for
communication and/or swallowing function.
3. The individual is unable to communicate functionally or optimally across environments and
communication partners.
4. The individual is unable to swallow to maintain adequate nutrition, hydration, and pulmonary status and/or the swallow is
inadequate for management of oral and pharyngeal saliva accumulations.
5. The presence of a communication and/or
swallowing disorder has been verified
through an evaluation by an ASHA-certified
speech-language pathologist.
6. The individual’s communication abilities are
not comparable to those of others of the same
chronological age, gender, ethnicity, or cultural and linguistic background.
7. The individual’s communication skills negatively affect educational, social, emotional, or
vocational performance, or health or safety
status.
8. The individual’s swallowing skills negatively
affect his or her nutritional health or safety
status.
9. The individual, family, and/or guardian
seeks services to achieve and/or maintain
optimal communication (including alternative and augmentative means of communication), and/or swallowing skills.
10. The individual, family, and/or guardian
seeks services to enhance communication
skills.
Discharge From Speech-Language
Pathology Services
Patient/client discharge from treatment ideally
occurs when the individual, family, or designated
guardian, and speech-language pathologist as a team
conclude that the communication or feeding and swallowing disorder is remediated or when compensatory
strategies are successfully established, as in the following situations:
1. The speech, language, communication, or
feeding and swallowing disorder is now de-
68 - 2004
2.
3.
4.
5.
6.
7.
American Speech-Language-Hearing Association
fined within normal limits or is now consistent with the individual’s premorbid status.
The goals and objectives of treatment have
been met.
The individual’s communication abilities
have become comparable to those of others of
the same chronological age, gender, ethnicity,
or cultural and linguistic background.
The individual’s speech, language, communication, and/or feeding and swallowing skills
no longer adversely affect the individual’s
educational, social, emotional, vocational performance, or health status.
The individual who uses an augmentative or
alternative communication system has
achieved optimal communication across environments and communication partners.
The individual’s nutritional and hydration
needs are optimally met by alternative means
(e.g., percutaneous endoscopic gastrostomy),
and swallow is adequate for management of
oral and pharyngeal saliva accumulations.
The individual has attained the desired level
of enhanced communication skills.
In some situations, the individual, family, or designated guardian may choose not to participate in
treatment, may relocate, or may seek another provider
if the therapeutic relationship is not satisfactory. Therefore, discharge is also appropriate in the following situations, provided that the patient/client, family, and/
or guardian have been advised of the likely outcomes
of discontinuation.
8. The individual is unwilling to participate in
treatment; treatment attendance has been inconsistent or poor, and efforts to address these
factors have not been successful.
9. The individual, family, and/or guardian requests to be discharged or requests continuation of services with another provider.
10. The individual is transferred or discharged to
another location where ongoing service from
the current provider is not reasonably available. Efforts should be made to ensure continuation of services in the new locale.
When considering discharge in situations other
than those described above, it is the clinician’s ethical
responsibility to review and analyze all aspects of past
services in order to identify specific modification(s)
that have the greatest probability of yielding improved
outcomes and then implement those improvements
with ongoing monitoring.4 The flow chart depicts the
sequence to follow when treatment no longer results
in measurable benefits and discharge is being considered (see Figure 1). Specifically, the clinician should
insure that the following factors have been addressed:
(a) appropriate intervention goals and objectives were
specified; (b) sufficient instructional time was provided; (c) current and suitable intervention methods
or materials were used; (d) meaningful and functional
performance data were collected and analyzed on an
ongoing basis to monitor and evaluate progress; (e)
appropriate assistive technology or other technology
supports were provided, when necessary; (f) a plan to
address the needs and concerns of culturally/linguistically diverse families (e.g., use of interpreter or translator) as they affect participation in communication
services was designed and implemented (ASHA, 1983);
(g) relevant and accurate criteria were used to evaluate intervention; and (h) health, educational, environmental, or other supports relevant to communication
interventions were provided. In addition, when provision of treatment that includes all of these factors is
beyond the expertise of an individual clinician or the
clinician’s recommendations are not acceptable to the
individual, referral to professionals with specific expertise in the area of concern should be made prior to
discharge. Situations relevant to the criteria include the
following:
11. Treatment no longer results in measurable
benefits. There does not appear to be any reasonable prognosis for improvement with continued treatment. Reevaluation should be
considered at a later date to determine whether
the patient/client’s status has changed or
whether new treatment options have become
available.
12. The individual is unable to tolerate treatment
because of a serious medical, psychological,
or other condition.
13. The individual demonstrates behavior that
interferes with improvement or participation
in treatment (e.g., noncompliance, malingering), providing that efforts to address the interfering behavior have been unsuccessful.
Each program should have established policies
and procedures for following the patient/client after
discharge. Follow-up is necessary for a variety of reasons, including the fact that circumstances may
change in the individual’s environment, new treatment options may become available, or the individual
may respond differently due to maturational or motivational changes or new life transitions.
Guidelines • Admission/Discharge Criteria in Speech-Language Pathology
2004 - 69
Conclusion
References
These criteria were developed as a guide for
speech-language pathologists in all settings when
considering initiating or discontinuing services for
persons with speech, language, communication, feeding and swallowing, and related disorders. They may
be used as a basis for developing more specific admission/discharge criteria to meet the particular needs of
a school, health care, or other program. By identifying
general admission/discharge factors for speech-language pathologists, the criteria also help speech-language pathologists identify patients/clients to include
on their caseload; provides accrediting agency reviewers with information to evaluate service delivery and
patient/client management; provides guidelines to
government agencies, third-party payers, or school
districts in the development of regulations, health care
reform plans, and so forth; provides educators with
consistent information to share with students in determining appropriate candidates for speech-language pathology services; and provides information
that can be used for consumer education.
American Speech-Language-Hearing Association. (1983,
September). Social dialects. Committee on the Status of
Racial Minorities. Asha, 25, 23–27.
American Speech-Language-Hearing Association. Committee on Language Learning Disorders. (1989, March).
Issues in determining eligibility for language intervention. Asha, 31, 113-118.
American Speech-Language-Hearing Association. (1992,
September). Standards for professional service programs in audiology and speech-language pathology.
Asha, 34, 63-70.
American Speech-Language-Hearing Association. Task
Force on Clinical Standards. (1993, March). Preferred
practice patterns for the professions of speech-language
pathology and audiology. Asha, 35 (Suppl. 11).
American Speech-Language-Hearing Association. (1996,
April). In P.A. Prelock (Ed.), Special interest divisions,
Division 1: Language learning and education, 3(1), 1–27.
American Speech-Language-Hearing Association. (1997).
Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1998).
Guidelines for referral to speech-language pathologists.
Rockville, MD: Author.
American Speech-Language-Hearing Association. (2001).
Scope of practice in speech-language pathology. Rockville,
MD: Author.
American Speech-Language-Hearing Association. (2003).
Code of ethics. Rockville, MD: Author.
Casby, M. W. (1996, April). Cognition and language: Basis,
policy, practice, and recommendations. In P. A. Prelock
(Ed.), Special interest divisions, language learning and education, 3(1), 5.
Cole, K. (1996, April). What is the evidence from research
with young children with language disorders? In P. A.
Prelock (Ed.), Special interest divisions, language learning
and education, 3(1), 6–7.
Joint Commission on Accreditation of Healthcare Organizations. (2002). 2002 Hospital accreditation standards.
Oakbrook Terrace, IL: Author.
Lahey, M. (1996, April). Who shall be called language disordered? An update. In P. A. Prelock (Ed.), Special interest divisions, language learning and education, 3(1), 5–6.
National Joint Committee for the Communication Needs
of Persons With Severe Disabilities. (2002). Access to communication services and supports: Concerns regarding the
application of restrictive “eligibility” policies. Rockville, MD:
American Speech-Language-Hearing Association.
Nelson, N. W. (1996, April). Discrepancy models and the
discrepancy between policy and evidence. Opening remarks: Are we asking the wrong questions? In P. A.
Prelock (Ed.), Special interest divisions, language learning
and education, 3(1), 3–5.
Terrell, S. L. (1996, April). Discrepancy model: Questions
of concern regarding use for culturally different children.
In P. A. Prelock (Ed.), Special interest divisions, language
learning and education, 3(1), 8–9.
Notes
1
NJC member organizations include the American
Association on Mental Retardation; the American
Occupational Therapy Association; the American
Physical Therapy Association; the American SpeechLanguage-Hearing Association; the Council for
Exceptional Children, Division for Communicative
Disabilities and Deafness; RESNA; TASH; and the
United States Society for Augmentative and Alternative Communication.
2
For the purpose of these guidelines, the terms
admission and discharge are synonymous with the
terms entrance and exit, respectively.
3
The term “family” refers to “the person(s) who
plays a significant role in the individual’s life. This
may include a person(s) not legally related to the
individual” (Joint Commission on Accreditation of
Healthcare Organizations, 2002, p. 339).
4
The ASHA Code of Ethics, Principle 1, Rule B states
that: “Individuals shall use every resource, including
referral when appropriate, to insure that high-quality
service is provided” (ASHA, 2003).
70 - 2004
American Speech-Language-Hearing Association
Figure 1. Discharge considerations when treatment no longer results in measurable benefits.
Treatment no longer results
in measurable benefit
^
^
Review and analyze
aspects of past service and
seek consultation
^
Modify treatment or
made referral
^
No
Measurable benefit?
^
No
Discharge
^
Continue
treatment
^
^
Yes
Follow up
Knowledge
Skills
Knowledge and Skills Needed by SLPs and Audiologists to Provide Culturally and Linguistically
Appropriate and
Services
2004 - 1
Knowledge and Skills Needed by
Speech-Language Pathologists
and Audiologists to Provide
Culturally and Linguistically
Appropriate Services
ASHA’s Multicultural Issues Board
This knowledge and skills document is an official statement
of the American Speech-Language-Hearing Association (ASHA).
It describes the particular knowledge and skills needed to provide culturally and linguistically appropriate services in our
professions. This document acknowledges the need to consider
the impact of culture and linguistic exposure/acquisition on all
our clients/patients, not simply for minority or diverse clients/
patients. In doing so, this document augments and expands the
ASHA Scope of Practice in Speech-Language Pathology (ASHA,
2001), the ASHA Scope of Practice in Audiology (ASHA, 1996
in references), and the ASHA Preferred Practice Patterns (ASHA,
1997a, 1997b).
This document was prepared by the members of ASHA’s
Multicultural Issues Board: Bopanna Ballachanda, Julie K.
Bisbee, Catherine J. Crowley, Diana Diaz, Nancy Eng, Debra
Garrett, Nikki Giorgis, Edgarita Long, Nidhi Mahendra, Joe A.
Melcher, Wesley Nicholson, Constance Dean Qualls, Luis F.
Riquelme, Marlene Salas-Provance, Toni Salisbury, Linda
McCabe Smith, Carmen Vega-Barachowitz, Kenneth E. Wolf,
and Vicki Deal-Williams (ex officio), and monitoring vice presidents for administration and planning Michael Kimbarow and
Lyn Goldberg provided guidance. In addition, previous members of the Multicultural Issues Board—Ellen Fye, Charles
Haynes, Celeste Roseberry-McKibbin, Emma Muñoz, Ravi
Nigam, Jennifer Rayburn, Gari Smith, Kenneth Tom, and Janice
Wright are gratefully acknowledged for their contributions to
previous drafts and related policy that served as a basis for this
document.
Reference this material as: American Speech-LanguageHearing Association. (2004). Knowledge and skills needed
by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services.
ASHA Supplement 24, in press.
Index terms: assessment, bilingual/multilingual, CLD populations, cultural competence, diversity, English Language
Learner (ELL), multicultural, treatment/management
Document type: knowledge and skills
Introduction
The ethnic, cultural, and linguistic makeup of this
country has been changing steadily over the past few decades. Cultural diversity can result from many factors and
influences including ethnicity, religious beliefs, sexual
orientation, socioeconomic levels, regionalisms, age-based
peer groups, educational background, and mental/physical disability. With cultural diversity comes linguistic diversity, including an increase in the number of people who
are English Language Learners, as well as those who speak
non-mainstream dialects of English. In the United States,
racial and ethnic projections for the years 2000-2015 indicate that the percentage of racial/ethnic minorities will
increase to over 30% of the total population. The makeup
of our school children will continue to diversify so that by
2010, children of immigrants will represent 22% of the
school-age population (U.S. Bureau of the Census, 2000).
As professionals, we must be prepared to provide services that are responsive to this diversity to ensure our effectiveness. Every clinician has a culture, just as every
client/patient has a culture. Similarly, every clinician
speaks at least one dialect of English and perhaps dialects
from other languages, as does every client/patient. Given
the myriad factors that shape one’s culture and linguistic
background, it is not possible to match a clinician to clients/patients based upon their cultural and linguistic influences. Indeed, recent ASHA demographics indicate that
only about 7% of the total membership are from a racial/
ethnic minority background and less than 6% of ASHA
members identify themselves as bilingual or multilingual
(ASHA, 2002).
Only by providing culturally and linguistically appropriate services can we provide the quality of services our
clients/patients deserve. Regardless of our personal culture, practice setting, or caseload demographics, we must
strive for culturally and linguistically appropriate service
delivery. For example, we must consider how communication disorders or differences might be manifested, identi-
2004 - 2
American Speech-Language-Hearing Association
fied, or described in our client’s/patient’s cultural and linguistic community. This will inform all aspects of our practice including our assessment procedures, diagnostic
criteria, treatment plan, and treatment discharge decisions.
This document sets forth the knowledge and skills that
we as professionals must strive to develop so that we can
provide culturally and linguistically appropriate services
to our clients/patients. The task may seem daunting at first.
Given the knowledge and skills needed, we may shy away
from working with clients/patients from certain cultural
or linguistic groups. We may question whether it is ethical
for us to work with these clients/patients. These guidelines provide a way to answer that question for each clinician.
It is true that “Individuals shall engage in only those
aspects of the profession that are within the scope of their
competence, considering their level of education, training,
and experience” (ASHA Principles of Ethics II, Rule B). So,
without the appropriate knowledge and skills, we ethically
cannot provide services. Yet, this does not discharge our
responsibilities in this area. The ASHA Principles of Ethics further state, “Individuals shall not discriminate in the
delivery of professional services” (ASHA Principles of Ethics I, Rule C). Thus, this ethical principle essentially mandates that clinicians continue in lifelong learning to
develop those knowledge and skills required to provide
culturally and linguistically appropriate services, rather
than interpret Principles of Ethics II, Rule B as a reason not
to provide the services. This document sets forth those
knowledge and skills needed to provide culturally and linguistically appropriate services. It can be used to identify
one’s strengths and weaknesses, and to develop a plan to
fill in any gaps in one’s knowledge and skills in this area
(ASHA, December 2001).
Cultural Competence
1.0 Role: Sensitivity to cultural and linguistic differences
that affect the identification, assessment, treatment and
management of communication disorders/differences
in persons. This includes knowledge and skills related
to:
1.1 Influence of one’s own beliefs and biases in providing
effective services.
1.2 Respect for an individual’s race, ethnic background,
lifestyle, physical/mental ability, religious beliefs/practices, and heritage.
1.3 Influence of the client’s/patient’s traditions, customs,
values, and beliefs related to providing effective services.
1.4 Impact of assimilation and/or acculturation processes
on the identification, assessment, treatment, and management of communication disorders/differences.
1.5 Recognition of the clinician’s own limitations in education/training in providing services to a client/patient
from a particular cultural and/or linguistic community.
1.6 Appropriate intervention and assessment strategies
and materials, such as food, objects, and/or activities
that do not violate the patient’s/client’s values and/or
that may form a constructive bridge between the client’s/
patient’s home culture and community or communication environment.
1.7 Appropriate communications with clients/patients,
caregivers, and significant others, so that the values
imparted in the counseling are consistent with those of
the client/patient.
1.8 The need to refer to/consult with other service providers
with appropriate cultural and linguistic proficiency,
including a cultural informant/broker, as it pertains to
a specific client/patient.
1.9 Ethical responsibilities of the clinician concerning the
provision of culturally and linguistically appropriate
services.
2.0 Role: Advocate for and empower consumers, families,
and communities at risk for or with communication/
swallowing/balance disorders. This includes knowledge and skills related to:
2.1 Community resources available for the dissemination of
educational, health, and medical information pertinent
to particular communities.
2.2 High risk factors for communication/swallowing/balance disorders in particular communities.
2.3 Prevention strategies for communication/cognition/
swallowing/balance disorders in particular communities.
2.4 The impact of regulatory processes on service delivery to
communities.
2.5 Incidence and prevalence of culturally-based risk factors (e.g., hypertension, heart disease, diabetes, fetal alcohol syndrome) resulting in greater likelihood for communication/cognition/swallowing/balance disorders.
2.6 Appropriate consumer information and marketing
materials/tools for outreach, service provision, and education.
Language Competencies of the Clinician
3.0 Role: Ability to identify the appropriate service provider
for clients/patients.
3.1 Bilingual/Multilingual clinician. Native or near-native
proficiency in the language(s) spoken or signed by the
client/patient. Knowledge and skills related to the impact of the differences between the dialect spoken by the
clinician and by the client/patient on the quality of
services provided.
Knowledge and Skills Needed by SLPs and Audiologists to Provide Culturally and Linguistically Appropriate Services
3.2 Clinician without native or near-native proficiency in the
language(s)/dialect(s) spoken or signed by the client/patient.
Knowledge and skills related to:
A. Obtaining information on the features and developmental characteristics of the language(s)/dialect(s)
spoken or signed by the client/patient (see Language section).
B. Obtaining information on the sociolinguistic features of the client’s/patient’s significant cultural
and linguistic influences.
C. Developing appropriate collaborative relationships
with translators/interpreters (professional or from
the community):
1) Maintain appropriate relationships among
the clinician, the client/patient, and interpreter/translator.
2) Ensure that the interpreter/translator has
knowledge and skills in the following areas:
a) Native proficiency in client’s/patient’s
language(s)/dialect(s) and the ability to provide accurate interpretation/translations.
b) Familiarity with and positive regard for
the client’s/patient’s particular culture, and
speech community or communicative environment.
c) Interview techniques, including ethnographic interviewing.
d) Professional ethics and client/patient
confidentiality.
e) Professional terminology.
f) Basic principles of assessment and/or
intervention principles to provide context to
understand objectives..
Language
4.0 Role: Obtain knowledge base needed to distinguish
typical and disordered language of clients/patients.
This includes knowledge and skills related to:
4.1 Sociolinguistic and cultural influences including:
A. Client’s/patient’s speech community or communication environment, including its discourse norms,
and the impact of topic, participant, setting, and
function on language use.
B. Effective interviewing techniques so caregiver/parent and/or client/patient feels comfortable providing accurate and complete information.
C. Impact of social and political power and prestige
on language choice and use.
D. Impact of sociolinguistics on code-switching and
code-mixing.
2004 - 3
E. Language socialization patterns that affect language use in the clients/patient’s speech community. Types of language socialization patterns
include narrative structure; importance of labeling;
attitudes toward appropriateness of child-adult
and child-child communications, ways of gathering information, and ways of giving commands
such as known questions and veiled commands/
indirect speech acts.
F. Cultural differences and similarities held by both
client/patient and clinician, with resultant impact
on language use in all communicative environments.
G. Impact of client’s/patient’s attitudes, values, and
beliefs toward non-oral approaches to communication such as augmentative/alternative communication, sign language, and assistive listening devices.
4.2 Language and linguistics including:
A. Typical language development in simultaneous
and sequential bilinguals.
B. Normal processes of second-language acquisition,
including language transfer, language attrition,
interlanguage, and affective variables.
C. Difference between an accent and a dialect, and a
language and a dialect.
D. Patterns of language recovery following neurological insult.
E. Grammatical constraints on code-switching and
code mixing.
F. Typical development in the client’s/patient’s
language(s)/dialect(s) in all areas (see 4.3).
4.3 Identifying, obtaining and integrating available resources to determine what is typical speech/language
development in the client’s/patient’s speech community and communication environment, including:
A. Research on the client’s/patient’s culture(s), speech
community, or communication environment.
B. Interview with a parent or other caregiver on how
the client’s/patient’s speech/language development compares to peers in his/her speech community or communication environment.
C. Interview with a family member, or other person
who knew the client/patient previously, to describe
and compare the client’s/patient’s language skills
before the insult or injury that may have led to an
acquired language disorder.
D. Family history of speech/language problems or
academic difficulties.
E. Cultural informant/broker to gain insight into the
impact of culture on the client’s/patient’s communication skills.
2004 - 4
American Speech-Language-Hearing Association
F. Linguistic/sociolinguistic informant/broker from
the client’s/patient’s speech community or communication environment, such as for grammaticality
judgments and for judgments based upon
sociolinguistic considerations related to the
client’s/patient’s speech community or communication environment.
G. Use of speech/language data provided by translator/interpreter.
H. Clinician’s personal knowledge base.
I. Application of the clinician’s clinical judgment to
synthesize, evaluate, analyze, and make determinations based upon all the data/information gathered.
5.0 Role: Identification/Assessment of typical and disordered language. This includes knowledge and skills
related to:
5.1 Foundational content:
A. Current research and preferred practice patterns in
the identification/assessment of language disorders/delays.
B. Legal, regulatory, ethical, and professional guidelines relating to language assessment.
C. Appropriate criteria for distinguishing a disorder
from a difference by using the norms of the client’s/
patient’s speech community as the standard.
D. Appropriate ethnographic interviewing techniques,
such as knowing effective ways to ask for crucial
but sensitive information so the caregiver/parent
and/or client/patient, is comfortable enough to
provide that information.
E. Impact on language use by the client/patient with
regard to topic, participants, setting, and function
on the linguistic interaction, based upon knowledge
of the standards of communicative competence in
the client’s/patient’s speech community or communication environment (see 4.3).
5.2 Assessment materials/tests/tools:
A. Appropriate use of published test materials in language assessment including standardized normreferenced tests and criterion-referenced tests,
including analyzing normative sampling limitations, general psychometric issues especially related
to validity and reliability, and inherent cultural and
linguistic biases in these test materials.
B. Application of appropriate criteria so that assessment materials/tests/tools that fail to meet standards be used as informal probes, with no
accompanying scores.
C. Inherent problems in using translated tests so that
translated tests are used only as informal probes,
with no accompanying scores.
D. Appropriate use of alternative approaches to assessment including dynamic assessment, portfolio assessment, structured observation, narrative
assessment, academic and social language sampling, interview assessment tools, and curriculumbased procedures, including analysis of validity,
reliability, and inherent cultural and linguistic biases.
E. How cultural and linguistic biases in assessment
tools impact on an appropriate differential diagnosis between a language disorder and a language
difference.
1. Cultural biases include question types, content, specific response tasks, and test formats
that are not commonly used in the client’s/
patient’s speech community or communication
environment.
2. Linguistic biases include differences in when
certain features of language are acquired and/
or in certain linguistic forms that may not be
common, or present at all, in the language(s)
and/or dialect(s) spoken or used by the client/
patient.
5.3 Differential diagnosis:
A. How linguistic features and learning characteristics of language differences and second-language
acquisition are different from those associated with
a true learning disability, emotional disturbance,
central auditory processing deficit, elective mutism,
or attention deficit disorder. (Diagnoses that might
be confused with a linguistic or cultural difference
or second language learning.)
B. Preparation of written reports that incorporate information about the client’s/patient’s cultural and
linguistic influences.
C. Determination of whether a language disorder is
present based upon one’s clinical judgment after
reviewing and analyzing all the critical information
(See 4.3).
D. Determination of the severity level of any identified
language disorder.
E. Ethical issues raised if scores are provided for tests
that are psychometrically flawed, translated and not
adapted, culturally biased, and/or linguistically
biased.
6.0 Role: Treatment/Management of disordered language.
This includes knowledge and skills related to:
A. Current research and best practices in the treatment/management of language disorders/delays,
including various delivery models and options for
intervention.
Knowledge and Skills Needed by SLPs and Audiologists to Provide Culturally and Linguistically Appropriate Services
B. Appropriate language(s)/dialect(s) to use in treatment and management.
C. Impact of the client’s/patient’s current and historical language/dialect exposure and experience.
D. Standards of the client’s/patient’s speech community or communication environment in determining
discharge/dismissal criteria, rather than base that
decision on the client/patient mastering the
clinician’s or interpreter’s/translator’s language(s)/dialect(s) and language socialization practices.
E. Integration of the client’s/patient’s attitudes, values, and beliefs toward non-oral approaches to
communication such as augmentative/alternative
communication, sign language, and assistive listening devices when those approaches are incorporated into treatment.
F. Consideration of client’s/patient’s and/or
parent’s/caregiver’s desire and need for fluency in
the native language and/or English when considering the language for intervention.
G. Legislative and regulatory mandates and limitations to resources that may impact the language
used for intervention.
Articulation and Phonology
7.0 Role: Identification/Assessment of individuals at risk
for articulation/phonological disorders. This includes
knowledge and skills related to:
A. Current research and best practices in the identification/assessment of articulation/phonological
disorders in the languages(s) and/or dialect(s) spoken by the client/patient.
B. Phonemic and allophonic variations of the
language(s) and/or dialect(s) spoken in the
client’s/patient’s speech community and how
those variations affect a determination of disorder
or difference.
C. Difference between an articulation disorder, phonological disorder, an accent, a dialect, transfer patterns and typical developmental patterns.
D. Standards of the client’s/patient’s speech community or communication environment to determine
whether he or she has an articulation or phonological disorder/delay. Identifying and using available
resources to determine what is typical speech development in the client’s/patient’s speech community or communication environment (See 4.3).
8.0 Role: Treatment/Management of individuals with articulation or phonological disorders. This includes knowledge and skills related to:
2004 - 5
A. Current research and best practices in the treatment/management of articulation and phonological disorders/delays in the languages(s) and/or
dialect(s) spoken by the client/patient.
B. Community standards of typical articulation and
phonology patterns, so that in treatment/management dialect, and accent features are not treated as
articulation or phonological disorders.
C. Standards of the client’s/patient’s speech community in determining discharge/dismissal criteria so
that discharge/dismissal is based upon whether the
client/patient is speaking his/her dialect appropriately.
Resonance/Voice/Fluency
9.0 Role: Identification/Assessment and Treatment/Management of individuals at risk for resonance, voice, and/
or fluency disorders. This includes knowledge and skills
related to:
A. Current research on preferred practice patterns in
the identification/assessment and treatment/management of resonance, voice and/or fluency disorders.
B. Community standards of typical resonance, voice,
and/or fluency patterns.
C. Application of the standards of the client’s/
patient’s speech/communication community for
dismissal/discharge criteria.
Swallowing
10.0 Role: Identification/Assessment and Treatment/Management of individuals at risk for swallowing/feeding
disorders. This includes knowledge and skills related to:
A. Current research and preferred practice patterns in
the identification/assessment of swallowing/feeding disorders.
B. Community standards of typical swallowing/feeding patterns and preferences.
C. Incorporation of the client’s/patient’s dietary preferences, related to the identification/assessment of
swallowing/feeding disorders.
D. Application of the standards of the client’s/
patient’s community for dismissal/discharge criteria.
Hearing/Balance
11.0 Role: Identification/Assessment of clients/patients
with or at risk for hearing/balance disorders. This includes knowledge and skills related to:
2004 - 6
American Speech-Language-Hearing Association
A. Current research and preferred practice patterns in
the identification/assessment of hearing/balance
disorders.
B. Application of the community standards and beliefs
regarding hearing/balance impairment.
C. Culturally and linguistically appropriate assessment materials, tools, and methods.
D. Inherent problems in using speech testing materials (e.g., word lists, speech discrimination lists) that
have been translated, not adapted, and/or not fully
researched and not reflective of the phonological
patterns of the client’s/patient’s language/dialect.
E. Influences of language and speech differences including issues related to bilingualism and dialectal differences between the client/patient and the
clinician on hearing evaluation decisions, such as
in speech recognition tests in quiet and noise. (See
sections 7.0 and 8.0).
F. How other factors, (e.g., the color and consistency
of cerumen), may influence findings on otoscopic
examination and external canal management.
12.0 Role: Treatment/Management of individuals at risk for
hearing/balance disorders. This includes knowledge
and skills related to:
A. Current research and preferred practice patterns in
the treatment/management of those hearing/balance disorders that are more prevalent in certain
racial/ethnic communities and which are more
prevalent due to cultural variables.
B. Application of the community standards and beliefs
regarding hearing/balance disorders.
C. Attitudes and beliefs related to the treatment/management of hearing/balance disorders, such as attitudes towards using a manually coded system of
communication; and assistive listening devices
such as hearing aids, FM units, and cochlear implants.
D. Application of the standards of the client/patient
speech community for dismissal/discharge criteria.
E. Components of a culturally appropriate audiological rehabilitation program.
F. Availability of personal assistive devices such as
earmolds and hearing aids with greater cosmetic
appeal for varying skin tones.
Terminology
Accent: (1) A set of shared variables, related to pronunciation, common to a particular speech community. It is standard practice to distinguish accent from dialect. Accent refers
only to distinctive features of pronunciation, whereas dia-
lect refers to distinctive lexical, morphological, and syntactical features. (2) A set of phonetic traits of one language
that is carried over into the use of another language a person is learning (foreign accent).
Bidialectalism: The use of two different dialects of a given
language. In terms of linguistic structure, one dialect of any
language is not “superior” to another; however, from a
social point of view, several dialects are considered to be
prestigious and others are considered to be non-prestigious.
Bilingualism: The use of at least two languages by an individual. The degree of proficiency in the languages can
range from a person in the initial stages of acquisition of
two languages to a person who speaks, understands,
reads, and writes two languages at native or near-native
proficiency.
Code mixing: (1) Code-switching. (2) Term used to describe
the mixed-language utterances used by a bilingual individual. It involves the utilization of features of both languages (usually at the lexical level) within a sentence
(intra-sentential level).
Code switching: The juxtaposition within the same speech
exchange of passages belonging to two different grammatical systems. The switch can be intrasentential, (within a
sentence) (Spanish-English switch: Dame a glass of water.
“Give me a glass of water”). It can be intersentential, across
sentence boundaries (Spanish-English switch: Give me a
glass of water. Tengo sed. “Give me a glass of water. I’m
thirsty”). The switches are not random; they are governed
by constraints such as the Free Morpheme Constraint and
the Equivalency Constraint. Many who are bilingual and/
or bidialectal are self-conscious about their code switching and try to avoid it with certain interlocutors and in
particular situations. However, in informal speech it is a
natural and powerful feature of a bilingual’s/bidialectal’s
interactions.
Communication environment: The communicative environment of users of assistive or augmentative communication systems, and some forms of manual communication.
Communicative competence: The ability to use
language(s) and/or dialect(s) and to know when and
where to use which and with whom. This ability requires
grammatical, sociolinguistic, discourse, and strategic competence. It is evidenced in a speaker’s unconscious knowledge (awareness) of the rules/factors which govern
acceptable speech in social situations.
Cultural informant/broker: A person who is knowledgeable about the client’s/patient’s culture and/or speech
community and who provides this information to the clinician for optimizing services.
Culturally diverse: When an individual or group is exposed to, and/or immersed in more than one set of cultural
Knowledge and Skills Needed by SLPs and Audiologists to Provide Culturally and Linguistically Appropriate Services
beliefs, values, and attitudes. These beliefs, values, and
attitudes may be influenced by race/ethnicity, sexual orientation, religious or political beliefs, or gender identification.
Dialect: A neutral term used to describe a language variation. Dialects are seen as applicable to all languages and
all speakers. All languages are analyzed into a range of
dialects, which reflect the regional and social background
of their speakers.
Linguistic/sociolinguistic informant/broker: A trained
and knowledgeable person from the client’s/patient’s
speech community or communication environment who
under the clinician’s guidance can provide valuable information about language and sociolinguistic norms in the
client’s/patient’s speech community and communication
environment. A properly trained informant/broker can
provide information such as grammaticality judgments as
to whether the client’s/patient’s language and phonetic
production is consistent with the norms of that speech
community or communication environment; information
on the language socialization patterns of that speech community or communication environment; and information
on other areas of language including semantics and pragmatics.
Interlanguage: An intermediate-state language system
created by someone in the process of learning a foreign
language. The interlanguage contains properties of L1
transfer, overgeneralization of L2 rules and semantic features, as well as strategies of second language learning.
Interpreter: A person specially trained to translate oral
communications or manual communication systems from
one language to another.
Language loss (also known as language attrition): A potential consequence of second-language acquisition
whereby a person may lose his/her ability to speak, write,
read, and/or understand a particular language or dialect
due to lack of use or exposure.
Linguistically diverse: Where an individual or group has
had significant exposure to more than one language or
dialect.
Sequential bilingualism (also known as successive bilingualism): Occurs when an individual has had significant
exposure to a second language after the first language is
well established.
Simultaneous bilingualism: Occurs when a young child
has had significant exposure to two languages simultaneously, before one language is well established.
2004 - 7
Speech community: A group of people who share at least
one speech variety in common. Members of bilingual/
bidialectal communities often have access to more than one
speech variety. The selection of the specific variety depends
on such variables as the participants, the topic, the function, and the location of the speech event.
Translator: A person specially trained to translate written
text from one language to another.
References
American Speech-Language-Hearing Association. (1996,
spring). Scope of practice in audiology. Asha 38 (Suppl. 16),
12–15.
American Speech-Language-Hearing Association. (2001). Scope
of practice in speech-language pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1997a). Preferred practice patterns for the profession of audiology. Rockville,
MD: Author.
American Speech-Language-Hearing Association. (1997b). Preferred practice patterns for the profession of speech-language pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1997a,
1997b). Preferred practice patterns. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2001, December 26). Code of ethics (revised). The ASHA Leader, 6(23),
p. 2.
American Speech-Language-Hearing Association. (2002). Communication development and disorders in multicultural populations: Readings and related materials. Available online at http:/
/www.asha.org/about/leadership-projects/multicultural/
readings/OMA_fact_sheets.htm
National Standards for Culturally and Linguistically Appropriate Services in Health Care. (2001, March). Washington, DC:
U.S. Department of Health and Human Services, OPHS Office of Minority Health.
U.S. Bureau of the Census. (2000). Statistical abstract of the United
States 119th ed. Washington, DC: U.S. Department of Commerce.
SUMMARY OF CASE MANAGEMENT
CLIENT
CLINICIAN
SEMESTER
SUPERVISOR
Audiological/ENT/
Neurological/Other
Evaluations
Include latest date of testing;
any medical follow-up;
Diagnoses: results;
recommendations
Cognitive/Academic
Considerations
Cognitive status C Indicate
any presence of learning
disability; emotional disturbance;
developmental delay; grade in
school; school classroom
placement; therapy received at
school
Family/Parent Support
System
Indicate client’s family situation
(e.g. foster care, group home,
intact);
family stressors; involvement of
social services; incidence of
communication disorder in
family
Voice/Fluency
Typical quality of voice; any
vocal fold pathology; presence
of dysfluencies C type of
frequency and severity
Oral Mechanism
Include assessment of
structures and functions. Any
oral/motor problems, apraxia or
surgeries.
Articulation
Include testing from last report;
indicate sounds in error and
severity. Include past treatment
methods found to be effective in
therapy.
Semantics
Include test results from past
report; knowledge and use of
words and word relationships
(vocabulary)
Syntax
Include test results. Language
sample analyses; MLU; use of
simple or complex sentences;
use of standard vs non-standard
forms, etc.
Phonology
Include tests and analyses from
past report; list developmental
and non-developmental
processes displayed; statement
of awareness
Pragmatics
Include analyses of
conversational Skills; verbal and
non-verbal interactions
Comments/Special Needs
May include clinical
impressions; progress; parentchild interaction; physical
limitations; recommendations
from previous semester; goals
not attained previous semester.
ASSESSMENT
Audiological Evaluation
Other Referral
Include reason for referral
Cognitive/Academic
Referral/Consultation
Does this client need to be seen
for psych./educational
assessment? If so, note here.
Also indicate need for
consultation with school SLP.
Social Service Referral
Does this client need to be seen
by social worker or other social
service agency? Do you need
to consult with SW?
Voice/Fluency Measures
Diagnostic measures of
voice/fluency. Visipitch,
commercially available
instruments, speech sample,
etc.
Oral Mechanism
Describe procedures for oral
mech. exam if needed. Need
for Dental/Orthodontic/
Otolaryngolic consult.
Articulation
Tests to be given; other
measures of articulation and
intelligibility.
Stimulability
List phonemes to be tested and
reason.
Semantics
Receptive
List tests to be given; contexts
to investigate.
Syntax
Receptive
List tests to be given and probes
to be utilized.
Expressive
List tests to be given; contexts
to investigate.
Expressive
Lists tests to be given;
procedures for obtaining and
scoring language sample.
Pragmatics
Conversational analysis; tests;
procedures, surveys to be used.
Interview
What questions will you ask
client/family?
Phonology
List tests/analyses to be given.
Stimulability
Phonemes to assess; phonetic
contexts.
Tentative Goals
List possible goals for
intervention.
SUMMARY OF CASE MANAGEMENT
SEMESTER
SUPERVISOR
CLIENT
CLINICIAN
Audiological/ENT/
Neurological/Other
Evaluations
Cognitive/Academic
Considerations
Family/Parent Support
System
Voice/Fluency
Oral Mechanism
Articulation
Semantics
Syntax
Phonology
Pragmatics
Comments/Special Needs
ASSESSMENT
Audiological Evaluation
Other Referral
Cognitive/Academic
Referral/Consultation
Social Service Referral
Voice/Fluency Measures
Oral Mechanism
Articulation
Stimulability
Semantics
Receptive
Syntax
Receptive
Phonology
Expressive
Expressive
Stimulability
Pragmatics
Interview
Tentative Goals
GRADUATE CLINICAL PRACTICUM SUMMARY
** Complete and turn into Coordinator of Clinical Education to request your clinical placement
Name: _______________________________
Year:
Junior
Senior
Phone: _______________________
Graduate: 1st year 2nd year
3rd year
Expected Date of Graduation: _______________
COURSE WORK COMPLETED (Note whether UG (undergraduate) or G (graduate level)
_____ Phonetics & Phonology
_____Neuroscience of Communication and
_____ Language Development
Communication Disorders
_____Speech & Hearing Science
_____ Medical Aspects I (Voice Disorders)
_____Anatomy & Physiology
_____ Fluency
_____Practicum in Communication Disorders
_____ Child Language Disorders
(Clinical Procedures)
_____ Diagnosis of Speech/Lang Disorders
_____Communication & Aging
_____ Methods of Research
_____Introduction to Audiology
_____ Medical Aspects II (Neuromotor and
_____Speech Language Therapy in Schools
Craniofacial Anomalies)
_____Articulation and Phonology
_____ Acquired Adult Language & Cognitive Disorders
_____ Other: (Please List)
CLINICAL EXPERIENCE (Approximate hours experience)
Required Minimum
_____ Observation hours
25
_____ Audiological Testing*
_____ Aural Rehabilitation*
*Must have total of 20 hours in audiology or aural rehab combined
_____
_____
_____
_____
_____
_____
_____
_____
Child Language Disorders Therapy
Adult Language Disorders Therapy
Child Speech Disorders Therapy
Adult Speech Disorders Therapy
Evaluation in Child Language Disorders
Evaluation in Adult Language Disorders
Evaluation in Child Speech Disorders
Evaluation in Adult Speech Disorders
20
20
20
20
20
20
20
20
Must have total of 350 clock hours in speech/language pathology (250 hours at Graduate level) with minimum
levels in each disorder area as follows
CURRENT & PAST SUPERVISORS/SITES (CHSC, Externship)/TYPE THERAPY (Group, etc.)
PLACEMENT PREFERENCES
A.
I would like __________ hours of clinic this semester.
B.
Preferred placement -- note client types and/or settings. (Level II and III students only)
C.
Priority needs (3rd and 4th semester students only)
SCHEDULE:
Please note courses/work schedule, etc. for when you are already booked.
Monday
8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
Tuesday
Wednesday
Thursday
Friday
To be completed by each student twice during each semester of COSI 452: Graduate Practicum. Details are
located on the course syllabus. Attached is an example.
Case Western Reserve University
Graduate Student Practicum
EVALUATION OF VIDEOTAPED/AUDIOTAPED SESSION
Date
Student Clinician
Client
Diagnosis
Age of Client
Length of Session
Supervisor
1st
2nd
year student (circle one)
Directions: Summarize the events taking place in your session in the space below. Next, briefly comment on each
skill/behavior listed. Finally, list at least three suggestions that you believe will help you to make your next session
more effective.
1. Timing of session
2. Non-verbal behavior of clinician
3. Amount of social speech
4. Introduced session goals
5. Clarity of instructions
6. Discrimination/feedback
7. Appropriate reinforcement
8. Concluded/reviewed session performance
9. Appropriate & professional interpersonal skills
10. Were session goals accomplished?
Think about three areas to improve upon for your next session. How will you affect the changes that need to be
made? Write your suggestion here.
EXAMPLE EVALUATION OF VIDEOTAPED/AUDIOTAPED SESSION #1
EXAMPLE EVALUATION OF VIDEOTAPED/AUDIOTAPED SESSION #2
1. Timing of Session:
Mr. K was seen for a 45 minute session in the patient lounge of the Subacute Rehabilitation Unit.
2.
Non-verbal behavior of clinician:
Mr. K has been a client of the department of communicative disorders for several weeks. In this time period, I had
an excellent chance to build a strong rapport with Mr. K. The session was conducted in a relaxed environment with both
myself and the client sitting next to a table. Mr. K responded very well to head nods and facial expressions which were
used as a means of cueing the client about the appropriateness of his answers.
3.
Amount of social speech:
Mr. K liked to talk about stimulus items (when appropriate), often adding bits and pieces of information about
their relation to his own life at home when he could. I encouraged this spontaneous verbal expression as well as the
social speech Mr. K made great strides in during his hospitalization. He went from his most frequent response of, “oh
okay okay” to asking how I was doing in this session. He mentions several times how he will bet better little by little.
On this date he told me that if he could just get back to 85-90% functioning he’d be happy. I used Mr. K’s social speech
this date to expand of his expressive capabilities.
4.
Introduced session goals:
At the beginning of this session, as with all others, I provided a brief review of what we had been working on in
the previous session and what other areas I might like to begin probing today. Goals for the session this date included
naming common objects, naming functions of common objects, sentence completion, and matching words to their
corresponding picture from a choice of two. Mr. K was also introduced to the task of selecting the correct word from a
choice of three on this date. Further probing was done by having Mr. K identify which word did not “fit” into a list of
category related words. Mr. K did very well with this task and “homework” assignments regarding his reading ability
were assigned. Mr. K is very motivated to complete these assignments and brings them to the next day’s session to
review his work and assist in monitoring his progress.
5.
Clarity of instructions:
I presented Mr. K with instructions for the exact task I wanted him to complete at the beginning of each one. So
when we begin naming objects, I talked about taking out “the box” again (Lark box), and explained I would be pulling
out items one by one. As I showed him each one, I wanted him to tell me what it was. I ask Mr. K is he understands,
and he responds yes and we begin. While the task isn’t always easy, he knows what he needs to do.
6.
Discrimination/feedback:
Mr. K is at a level this date where he does a lot of self-correction of his errors. Often, if he does mislabel an
object, he recognizes quickly that he has done this and says “no no wait”. I give him feedback letting him know that he
has indeed mislabeled but I also encourage him to realize that sometimes the error was semantically related (i.e. calling a
glass a cup or a spoon a fork). If Mr. K is having difficulty, I ask him to recall the cueing strategies we work on. This
date, Mr. K is making progress with using them. If the task is to identify a spoon, I prompt him to use the technique or re
calling what you do with it and then rehearsing the phrase in his head to facilitate recall (i.e. you stir coffee with a …).
7.
Appropriate reinforcement:
I reinforce any part of a response that approximates the correct answer. If Mr. K is on track, I reinforce it. I
remind him of the strategies that will hopefully cue the desired response. Mr. K and I talk about the difficulty of verbal
expression since the stroke, but we also talk about the progress he has made since he was first admitted. This provided
him with encouragement and sessions become more of challenge. One thing that we have begun doing recently and
continue to do in this session is s a comparison to previous sessions’ performance . Mr. K likes the reinforcing feedback
of knowing that last week, for example he was at 65% accuracy in naming and this week it’s more like 70-75%.
8.
Concluded/reviewed session performance:
Again, the comparisons to previous sessions provide Mr. K with valuable information on his performance. I let
him know how he did today and point out very notable areas of improvement. For example, today Mr. k was able to
spontaneously name two objects he had previously needed moderate assistance in naming. The fact that he was able to
identify them independently today was a great sign of progress, so I point it out and encourage it. I also gave Mr. K
some idea of what we’d work on in the next session and where I’m trying to get him to on his goals. We reviewed how
important these abilities will be, especially when Mr. K goes home.
9.
Appropriate and professional interpersonal skills:
Working with Mr. K, in today’s session, as well as on a day to day basis has given me a wonderful opportunity to
strengthen my ability to relate and convey information to my client. Mr. K’s wife is present almost every session, and
together we talk about challenges Mr. K will face as he returns to the home environment. While I work with Mr. K, I
provide as much modeling as possible for Mrs. K so that she learns how to be an effective facilitator of communication
and will be able to keep frustration for Mr. K at home to a minimum. I often encourage Mr.s K to participate in the
session. On this date, Mrs K has done a terrific job of using personally relevant information about how Mr. K uses an
item at home to facility him being able to name it.
10. Were session goals accomplished?
Mr. K made progress on all goals today. He was able to spontaneously name some items that had previously
required moderate cueing. Mr. K demonstrated greater use of self-cuing and self-correction this date. Continued
progress in all of these areas will facilitate improved communication in the home environment and work on more
challenging functional goals in terms of reading etc.
Think about three areas to improve upon for your next session. How will you affect the changes that need to be
made?
1. Although I provided appropriate cueing today, there are some areas in which I would like to improve. I provide Mr.
K with a lot of time to respond, which is good, however, often I let him go too long without introducing some kind
of cuing for assistance. Timing is an issue I would like to improve. I need to realize that while I want him to
succeed independently, at this time, I need to keep expectations to a level at which Mr. K can perform. If he will be
more successful with some level of cuing, I need to provide it and reinforce it until I can more gradually begin to
fade the cues.
2. Another related area is in terms of the general timing of my session. At times, I tend to really get into working with
my client and thus do not end the session onetime. This leads to decreased time to write session notes and has at
times interfered with beginning my next session on time. I ran a little over today, but nothing too significant.
3. Another thing I’d like to improve upon is in type of discrimination/feedback. I’d like to brainstorm new ways in
which I can provide Mr. K with cueing etc. I tend to use the same strategies again and again. While some degree of
consistency may be good, I might be able to find curing techniques that work better for Mr. K and assist in learning
their use.
GUIDELINES FOR CASE PRESENTATION
COSI 452
Requirements
All graduate students are required to complete a formal case presentation through the Graduate Practicum course
one time during their graduate program. The Case Presentation should be 20-30 minutes in length. It will include
a written outline for the audience and a clearly presented oral summary of the case supported by a video- or audiotaped sample of the client (when possible). Students should be able to answer questions from the audience
(including faculty members, CHSC staff, and other class members enrolled in COSI 452) and provide well-thought
out rationale for their clinical decision-making.
Objectives
1.
To provide students a formalized opportunity to demonstrate their ability to integrate academic knowledge
with clinical problem solving
2.
To provide students with an opportunity to demonstrate their clinical problem solving skills and to develop
skills to verbally describe and support clinical decision-making
3.
To provide students a forum for increasing their verbal interaction skills (both as a presenter and as
member of the audience)
4.
To provide students with an opportunity to refine their case presentation skills
Suggested Organization/Components of Presentation
I.
Intervention Case
A.
Summary of relevant history
B.
Description of communication skills (prior to intervention)
C.
Diagnosis and prognosis for improvement
D.
Description of intervention program (techniques, strategies, protocols) -- with rationale, description
of theoretical approach, schedule of therapy, and format of therapy
E.
Presentation of results (baseline data, intervention data, end of program measures)
F.
Summary and conclusions
II.
Diagnostic Case Presentation
A.
Summary of relevant history and background information
B.
Presentation of hypotheses concerning the client
C.
Diagnostic plan that was prepared
D.
Summary of procedures used and results
E.
Interpretation of results--description of areas of strength, weaknesses, areas not measured
completely, diagnosis, and prognosis
F.
Recommendation with detailed plan of how intervention should be approached including
identification of specific goals, therapy schedule, strategies and techniques to be used
G.
Case Disposition--description of status of client after the diagnostic (i.e., enrolled in therapy, case
closed, transferred to another agency)
For each presentation, the student should complete a relevant article summary. See following pages.k
Schedule of Presentation
Students should plan to complete their case presentation during the 3rd or 4th semester of their graduate program.
Before the first day of class in the semester they wish to present, they should inform the instructor of Graduate
Clinical Practicum of their intent to present. The instructor will determine the specific date of the presentation and
will incorporate it into the syllabus plans for that semester. Students are responsible for informing the faculty and
CHSC staff of the day/time of their presentation at least 2 weeks before the scheduled date so that interested staff
can make plans to attend the presentation.
RESOURCES/FORM FOR ARTICLE SUMMARY
ARTICLE SUMMARY FORM
INSERT HERE THE CITATION SO THAT YOU CAN LATER FIND THE ARTICLE AND YOU CAN IDENTIFY WHAT ARTICLE YOU ARE SUMMARIZING
Research Questions/Purpose
Results
Discussion/Implications
AUTHORS GENERALLY STATE THESE QUITE
CLEARLY AND YOU CAN COPY THESE
VERBATIN FROM THE ARTICLE. KNOWING THE
QUESTIONS AND PURPOSE WILL HELP YOU
ORGANIZE AND EVALUATE THE RESULTS
Subjects
SUMMARIZE THE RESULTS. IT IS IMPORTANT
TO INCLUDE DATA AS WELL AS WHETHER THE
RESULTS WERE STATISTICALLY SIGNIFICATNT.
DAT-GROUP MEANS, STANDARD
DEVEIATIONS, ETC.
FROM THE ARTICLE, WHAT DO THE AUTHORS
REVEAL AS TO THE SUMMARY OF THEIR
MAJOR FINDINGS AND THE IMPLICATION SOF
THESE FINDINGS. HOW DO THESE FINDINGS
RELATE TO OTHER LITERATURE? YOU MIGHT
WANT TO MAKE BULLETED POINTS THAT ARE
EASY TO REFER BACK TO.
LIST THE IMPORTANT INFORMATION ABOUT
PARTICIPANTS-GROUP, NUMBER OF
PARTICIPANTS, CRITERIA FOR PARTICIPANT
SELECTION, AGES, GENDER, AND SO ON.
HERE AND THROUGHOUT YOU WILL WANT TO
USE BULLETED POINTS. YOU WANT TO MAKE
THIS DOCUMENT EASY TO READ AND REFER
TO LATER ON, HENCE PROSE ARE NOT MOST
BENEFICIAL.
Procedures
Questions/Critique
DESCRIBE THE PROCEDURES FOR THE
STUDY…HOW WAS THE DATE COLLECTED?
HOW WERE THE VARIABLES DERIVED
WHAT QUESTOINS DO YOU HAVE AFTER
REVIEWING THIS STUDY? THIS IS FOR YOUR
CRITIQUE OF THE STUDY AND PRESENTATION
OF THE STUDY, NOT FOR THE LIMITATIONS
RAISED BY THE AUTHORS.
YOU DO NOT NEED TO SUMMARIZE
RELIABILITY.
ARTICLE SUMMARY FORM
INSERT HERE THE CITATION SO THAT YOU CAN LATER FIND THE ARTICLE AND YOU CAN IDENTIFY WHAT ARTICLE YOU ARE SUMMARIZING
Research Questions/Purpose
Results
Discussion/Implications
.
Subjects
Procedures
Questions/Critique
Case Western Reserve University
COSI 452 CASE PRESENTATION FEEDBACK FORM
Case Western Reserve University
COSI 452 CASE PRESENTATION FEEDBACK FORM
Student: ________________________________ Date: ________________
Student: ________________________________ Date: ________________
Case Description: Adult Child Therapy
Diagnostic
Diagnosis: _________________________________________________
Case Description: Adult Child Therapy
Diagnostic
Diagnosis: _________________________________________________
Key: + = Excellent
Key: + = Excellent
OK=Adequate
NI = Needs to be Improved
OK=Adequate
NI = Needs to be Improved
NOTE: Provide Feedback in areas relevant to the student’s presentation. All slots do
not need to be filled-in.
NOTE: Provide Feedback in areas relevant to the student’s presentation. All slots do
not need to be filled-in.
____ 1. Presents information in an organized manner
____ 2. Appropriate nonverbal behaviors utilized (loudness, rate, eye contact)
____ 3. Case presentation is complete and thorough:
___ Case History ___ Diagnostic measures ___Description of tx strategies
___ Prognosis
___ Severity Level(s)
___ Summary of progress
___ Contributing factors
___ Plan of Treatment
___Other_____________________________________________________
__
____ 4. Includes analysis of variables affecting client behavior
____ 5. Clearly summarizes info from at least one article
____ 6. Cites research appropriately
____ 7. Describes how the research article relates to the case
____ 8. Demonstrates ability to critically evaluate research related to case
____ 9. Able to respond to question-answer sequences
____ 10. Able to reflect on current clinical strengths/areas to improve
____ 1. Presents information in an organized manner
____ 2. Appropriate nonverbal behaviors utilized (loudness, rate, eye contact)
____ 3. Case presentation is complete and thorough:
___ Case History ___ Diagnostic measures ___Description of tx strategies
___ Prognosis
___ Severity Level(s)
___ Summary of progress
___ Contributing factors
___ Plan of Treatment
___Other_____________________________________________________
__
____ 4. Includes analysis of variables affecting client behavior
____ 5. Clearly summarizes info from at least one article
____ 6. Cites research appropriately
____ 7. Describes how the research article relates to the case
____ 8. Demonstrates ability to critically evaluate research related to case
____ 9. Able to respond to question-answer sequences
____ 10. Able to reflect on current clinical strengths/areas to improve
COMMENTS:
COMMENTS:
Adapted from CPR-#2 Feedback Form
CSD Clinic Committee
University of Pittsburgh
Adapted from CPR-#2 Feedback Form
CSD Clinic Committee
University of Pittsburgh
SUPERVISION
INTRODUCTION:
At the beginning of each placement, it is your responsibility to give your supervisor a Supervisor Packet. This
includes:
• Thank You letter from the Coordinator of Clinical Education
• Academic Calendar
• Clinical Evaluation Forms
• Clinical Evaluation Scoring Systems
• Supervisory Needs Rating Scale
• Supervisory Expectations Rating Scale
• Session feedback form
• Clinical Contract
The following is an EXAMPLE of such a packet. The packets will be available outside the office of the
Coordinator of Clinical Education during the first week of each semester.
Semester: Fall
Spring
Summer
Year: 20_______
Midterm/Final (Circle)
SAMPLE “THANK YOU” LETTER
DATE
Dear
,
Thank you for agreeing to supervise a graduate student clinician from our Department. Below is
information concerning the student assigned to you:
Student:
Phone:
Email:
Approximate number of clinical hours already completed:
Prior externship site experiences:
The assignment should extend from the week of
through
.
Students are expected to complete at least two days per week with a schedule that meets your needs.
Please contact me if there are any difficulties with this.
Attached, please find paperwork requirements for the semester. There is also a calendar that defines
deadlines and holidays. After the student has completed two weeks of their assignment with you,
please complete the clinical contract form and return a copy to me. This form allows you to define your
expectations during the training period. A clinical evaluation form for the mid-semester review is also
enclosed. Your student will bring another copy of the form for the end of semester grading. Please
complete this form using the numeric clinical evaluation scoring system attached—you are not required
to provide a letter grade. You may find it helpful to use the Supervisor Expectations/Needs form
included in this packet at the beginning and middle of the semester.
Thank you for participating in our student training program. The success of our graduate program is
highly dependent on the excellent clinical training that students receive at externship sites by the site
supervisors. If you have any questions or concerns, please call me at (216)368-2385. In addition, if
our faculty can be of assistance to you or your department, please let us know.
Sincerely,
Kay McNeal, M.S., CCC-SLP
Coordinator of Clinical Education
Semester: Fall
Spring
Summer
Year: 20_______
Midterm/Final (Circle)
CLINICAL EVALUATION FORM -- Level I (0-100 hours)
Student Clinician
Date _____________
Clinical Site
Clinical Supervisor
# Clinical Hours Evaluated
1 = Poor 2 = Needs to Improve 3 = Adequate 4 = Good 5 = Very Good
I.
INTERPERSONAL SKILLS
A. With Client
1. Relates comfortably to client
2. Attends to client’s total behavior with emphasis
on interaction with client
3. Keeps personal concerns and problems from interfering
with therapy
_____ 4. Maintains a confident image while working with client
_____ 5. Demonstrates sensitivity to cultural/linguistic differences
B. With Others (professionals and family members)
1. Clearly explains therapy goals and progress
2. Responds appropriately to feedback
_____ 3. Uses language appropriate to the listener (i.e. professional vs family members)
______ 4. Demonstrates sensitivity to cultural/linguistic differences
II. TECHNICAL SKILLS
A. Therapy Planning
1. Short term
_____ a. Formulates behavioral objectives on a session-tosession basis
_____ b. Uses materials that are motivating and appropriate
for the client
_____ c. Has rationale for selected procedures consistent
with evidence based practices
_____ d. Structures plan to obtain maximum number of
responses
_____ e. Modifies program when change is indicated
_____ f. Organizes therapy setting (room & materials) to
enhance therapy effectiveness
2. Long Term:
_____ Formulates reasonable long term objectives
B. Therapy Execution
_____ 1. Uses appropriate language for client’s abilities
_____ 2. Obtains appropriate number of client responses per
session
_____ 3. Gives client sufficient time to respond
_____ 4. Discriminates errors from target behavior
_____ 5. Uses appropriate correction techniques
_____ 6. Gives meaningful and motivating feedback
_____ 7. Accurately records responses
_____ 8. Appropriate ratio of clinician-client talk time
_____ 9. Demonstrates flexibility when following lesson plan
_____ 10. Able to make smooth transitions between activities
_____ 11. Modifies activities when appropriate and provides a
rationale for modifications
NA = Does Not Apply
COMMENTS
Semester: Fall
1 = Poor
Spring
Summer
Year: 20_______
2 = Needs to Improve 3 = Adequate 4 = Good
Midterm/Final (Circle)
5 = Very Good
C. Behavior Management
_____ 1. Manipulates the environment in order to facilitate optimal
performance
_____ 2. Deals appropriately with unacceptable behavior
NA = Does Not Apply
COMMENTS
D. Daily Clinical Documentation
_____ 1. Develops data collection procedures to measure client
progress
_____ 2. Accurately records responses
_____ 3. Writes accurate and complete SOAP notes
E. Professional Responsibilities
1. Observes rules:
_____ a. Dresses appropriately
_____ b. Respects guidelines of facility (e.g. returning
materials, files, etc.)
_____ c. On time for therapy and meetings
_____ d. Paperwork submitted in a timely fashion
_____ e. Respects client confidentiality
_____ 2. Prepares for supervisor conference
_____ 3. Identifies alternative procedures during discussion of
clients
_____ 4. Demonstrates ability to problem solve after session,
making appropriate changes in therapy plan
_____ 5. Identifies strengths and weaknesses of session
III. CLINICAL REPORTING
_____ A. Uses appropriate clinical language in reports
_____ B. Documents pertinent, accurate, and complete information
_____ C. Logical organization is used (i.e. examples of behaviors,
avoids excessive use of professional jargon)
_____ D. Makes appropriate and specific recommendations for
client
_____ E. Incorporates supervisor’s suggestions in drafts of report
_____ F. Proofreads report for errors before turning it in
Score: Total points/# Items Scored ______/ 47 = ______
Strengths:
Areas to improve:
Suggestions for improving these areas:
__________________________________/______
Student Clinician
Date
____________________________/_______
Supervisor
Date
Semester: Fall
Spring
Summer
Year: 20_______
Midterm/Final (Circle)
CLINICAL EVALUATION FORM -- Level II (101 - 225 hours)
Clinical Supervisor
Student Clinician
Date _____________
Clinical Site
# Clinical Hours Evaluated_________
1 = Poor 2 = Needs to Improve 3 = Adequate 4 = Good 5 = Very Good
I.
INTERPERSONAL SKILLS
A. With Client
1. Relates comfortably to client
_____ 2. Keeps personal concerns and problems from interfering
with therapy
_____ 3. Demonstrates appropriate initiative
_____ 4. Demonstrates ability and willingness to function
independently
_____ 5. Deals with attitudes and behaviors displayed by clients
_____ 6. Projects confident, professional image in clinical setting
_____ 7. Demonstrates sensitivity to cultural/linguistic differences
B. With Others (professionals and family members)
_____ 1. Interacts appropriately with other professionals
_____ 2. Conveys therapy goals and progress
_____ 3. Responds appropriately to feedback
_____ 4. Uses language appropriate to the listener (i.e. professional vs family member)
_____ 5. Demonstrates sensitivity to cultural/linguistic differences
II. TECHNICAL SKILLS
A. Daily Planning
1. Short term
_____ a. Objectives and materials are appropriate
_____ b. Has rational for selected procedures consistent
with evidence based practices
_____ c. Structures plan to obtain maximum number of client
responses
_____ d. Initiates proposals for changes in program when
appropriate
2. Long term planning (e.g. semester)
_____ a. Formulates reasonable long term objectives
_____ b. Able to plan sequential steps to lead to long term
objectives
B. Therapy Execution
_____ 1. Activities are appropriate for client’s objectives and
abilities
_____ 2. Uses appropriate language for client’s developmental
and language abilities
_____ 3. Elicits and cues client appropriately when needed
_____ 4. Identifies target behavior
_____ 5. Gives client sufficient time to respond
_____ 6. Discriminates error from target behavior
_____ 7. Uses appropriate correction techniques and feedback
_____ 8. Demonstrates flexibility responding to client needs
and improvises procedures when necessary
_____ 9. Makes smooth transitions between activities
_____ 10. Initiates contacts with other professionals involved
with the client
NA = Does Not Apply
COMMENTS
Semester: Fall
1 = Poor
Spring
Summer
Year: 20_______
2 = Needs to Improve 3 = Adequate 4 = Good
Midterm/Final (Circle)
5 = Very Good
C. Behavior Management
_____ 1. Structures environment in order to facilitate optimal
performance
_____ 2. Deals appropriately with unacceptable behavior
_____ 3. Develops strategies to deal with behavior issues
NA = Does Not Apply
COMMENTS
D. Clinical Documentation
_____ 1. Develops data collection procedures to measure client
progress
_____ 2. Collects accurate baseline measures
_____ 3. Accurately records responses on-line during session
_____ 4. SOAP notes completed independently
5. Demonstrates ability to interpret data for use in
evaluating therapy progress and changes therapy
plan accordingly
_____ 6. Demonstrates ability to interpret data accurately
E. Additional Practicum Responsibilities
_____ 1. Prepares for supervisory conference
_____ 2. Identifies alternative procedures during discussion of
client
_____ 3. Demonstrates ability to problem solve during and after
session
_____ 4. Recognizes own strengths, weaknesses and professional limitations
III. ORAL AND WRITTEN REPORTING
_____ A. Writes report with clarity and organizes information
appropriately
_____ B. Report contains pertinent, accurate, and complete
information
_____ C. Includes all necessary information with accuracy and
completeness
_____ D. Demonstrates ability to interpret information and make
appropriate recommendations for the client’s needs
_____ E. Appearance of report is professional (e.g. spelling,
punctuation, grammar, neatness, proofreading, etc.)
Score: Total points/# Items Scored ______/ 46
= ______
Strengths:
Areas to improve:
Suggestions for improving these areas:
__________________________________/______
Student Clinician
Date
____________________________/_______
Supervisor
Date
Semester: Fall
Spring
Summer
Year: 20_______
Midterm/Final (Circle)
CLINICAL EVALUATION FORM -- Level III (226+ hours)
Clinical Supervisor
Student Clinician
Date _____________
Clinical Site
# Clinical Hours Evaluated_______
1 = Poor 2 = Needs to Improve 3 = Adequate 4 = Good 5 = Clinical Competence NA = Does Not Apply
I. PROFESSIONAL SKILLS
COMMENTS
A. With Client
_____ 1. Demonstrates initiative and independence
_____ 2. Recognizes strengths, weaknesses and professional
limitations
_____ 3. Deals with attitudes displayed by clients
_____ 4. Maintains confident, professional image in clinical setting
_____ 5. Demonstrates sensitivity to cultural/linguistic differences
B. With Others (professionals and family members)
_____ 1. Interacts appropriately with other professionals
_____ 2. Able to handle confrontations
_____ 3. Responds appropriately to feedback
_____ 4. Presents appropriate information clearly
_____ 5. Demonstrates sensitivity to cultural/linguistic differences
II. TECHNICAL SKILLS
A. Therapy Planning
1. Daily Planning
_____ a. Objectives and materials are appropriate
_____ b. Establishes priorities
_____ c. Evaluates and modifies program as needed
2. Long Term Planning (e.g. semester)
_____ a. Applies theoretical knowledge of disorders to therapeutic
practice
_____ b. Incorporates prognostic indicators in long term planning
B. Therapy Execution
_____ 1. Uses language appropriate for client(s)
_____ 2. Discriminates errors
_____ 3. Creates maximal opportunities for client to communicate
_____ 4. Gives consistent, concrete and concise feedback
_____ 5. Encourages client to self-evaluate (as appropriate)
_____ 6. Alters pace of session in relation to client needs
_____ 7. Resolves unexpected problems
_____ 8. Demonstrates flexibility in responding to client needs
_____ 9. Initiates and pursues contacts with other professionals
involved with client
C. Behavior Management
_____ 1. Initiates and carries through a behavior management
program
_____ 2. Systematically alters behavior program when needed
Semester: Fall
Spring
Summer
Year: 20_______
1 = Poor 2 = Needs to Improve 3 = Adequate 4 = Good
Midterm/Final (Circle)
5 = Clinical Competence NA = Does Not Apply
D. Clinical Documentation
_____ 1. Obtains and records accurate baseline measures
_____ 2. Accurately records responses on-line during session
_____ 3. Develops data collection procedures which measure
client progress
_____ 4. Demonstrates ability to interpret data for use in
evaluating therapy/progress and changes therapy plan
accordingly
COMMENTS
E. Supervisory Conference
_____ 1. Prepares for conference
_____ 2. Identifies alternative procedures
_____ 3. Evaluates own clinical performance
_____ 4. Identifies and implements strategies for improvement
_____ 5. Requests help as needed
III. ORAL AND WRITTEN REPORTING
_____ A. Writes reports with clarity and organizes information
appropriately
_____ B. Report contains pertinent, accurate, and complete
information
_____ C. Makes appropriate, specific recommendations for the client’s
needs
_____ D. Overall appearance of the report is professional (i.e. spelling
neatness, grammar, proofreading, etc.)
_____ E. Completes reports independently and efficiently with
minimal revisions
_____ F. Oral case presentations are well organized, accurate,
and professionally presented
Score: Total points/# Items Scored ______/ 41
= ______
Strengths:
Areas to improve:
Suggestions for improving these areas:
__________________________________/______
Student Clinician
Date
____________________________/_______
Supervisor
Date
CLINICAL EVALUATION SCORING SYSTEMS
Level I* (0 - 100 clinical hours)
5 = Very good. Displays minor technical problems which do not hinder the therapeutic process. Demonstrates
the behavior consistently and frequently.
4 = Good. Frequently demonstrates the clinical behavior. Exhibits awareness of the need to monitor and adjust
and make changes. Modifications are generally effective.
3 = Adequate. The clinical skill/behavior is emerging. Efforts to modify may result in varying degrees of success.
2 = Needs to improve. With supervisor input, implements the behavior/skill with difficulty. Efforts to modify are
generally unsuccessful.
1 = Poor. The clinical behavior is not evident. Unable to modify behavior when directed by supervisor repeatedly.
Little awareness of need to change behavior.
Level II* (101 - 225 hours)
5 = Very good. Appropriately implements the clinical skills/behavior. Beginning to initiate some independent and
creative problem solving.
4 = Good. Displays minor technical problems which do not hinder the therapeutic process. Beginning to show
some independence and initiative in clinical duties.
3 = Adequate. Inconsistently demonstrates the clinical behavior. Exhibits awareness of the need to monitor and
adjust and make changes. Modifications are generally effective. Demonstrates basic understanding of clinical
problems and/or procedures.
2 = Needs to Improve. The clinical skill/behavior is beginning to emerge. Efforts to modify may result in varying
degree of success. Incomplete understanding of clinical problems and/or procedures.
1 = Poor. Implements the skill with difficulty. Efforts to modify are generally unsuccessful.
Level III** (226 + hours)
5 = Clinical Competence. Demonstrates professional/CFY level of competence in the area. Demonstrates
independence by taking initiative and completing both assigned and unassigned duties. Demonstrates good
understanding of clinical problems and meets the individual needs of clients. Displays superior competencies in
ability to evaluate self/client accurately. Makes changes as needed.
4 = Good. Demonstrates independence but needs general direction from supervisor to improve clinical skills and
to evaluate self/client accurately. Beginning to show initiative in planning and knows how to assign priorities.
Thoughtful application of therapy techniques but needs further refinement in understanding of clinical
problems or application of clinical procedures.
3 = Adequate. Needs general and some specific direction from supervisor to perform clinical skills and evaluate
self/client accurately. Student demonstrates basic understanding of treatment principles and the needs of the
client.
2 = Needs to Improve. Needs repeated specific direction and/or demonstration from supervisor to perform clinical
tasks and to evaluate self/client accurately. Incomplete understanding of clinical problems, the needs of
client(s) or treatment procedures. Difficulty in defining goals and/or assigning priorities for treatment.
1 = Poor. Specific direction from supervisor does not alter unsatisfactory performance skills. Despite repeated
input from supervisor, is unable to alter own performance adequately. Unable to relate effectively with the
client(s) and is inadequately prepared for sessions. Does not seek guidance or does not implement
suggestions appropriately.
*Adapted from Leith, McNiece & Fusilier (1989)
**Adapted from K. Chapman (Dx format) and Chris McDonald/Mt. Sinai grading protocol
SUPERVISORY EXPECTATIONS RATING SCALE
SUPERVISORY NEEDS RATING SCALE
DEPARTMENT OF COMMUNICATION SCIENCES
CLINICAL CONTRACT
Student _________________________
Semester/Year ____________________
Supervisor ________________________
Facility ________________________________
The following document is to be completed by the clinical instructor in consultation with the student clinician. The original
is to be retained by the clinical instructor and returned to the Coordinator of Clinical Education, as quickly as possible. The
student may wish to make a copy to serve as a guide. In addition to the general performance criteria outlined in the
Semester Evaluation Form, this contract is designed to provide specific requirements for each practicum assignment.
Revisions may be agreed upon during the course of the semester. Questions should be directed to the Coordinator of
Clinical Education.
Contract Points:
STUDENT SCHEDULE (days/times):
STUDENT RESPONSIBILITIES & TIME LINE (lesson plans, report due dates, lesson materials, outside readings, self
evaluation, etc.):
EVALUATION DATES/PROCEDURES (i.e., midterm eval):
STUDENT CLINICAL GOALS:
OTHER COMMENTS:
We, the undersigned, agree to meet the above stated contract:
Initial conference date ______________________
Student _________________________________
Instructor ______________________________
Case Western Reserve University
Department of Communication Sciences
EVALUATION OF CLINICAL SUPERVISOR
(Adapted from Emerson College School of Communication Sciences and Disorders)
Supervisor’s Name ______________________________ Term ___________
Student’s name (optional) __________________________________________
Number of clients for which supervisor is responsible _____________________
Please mark your degree of satisfaction with your supervisor in each of the following categories.
Provide comments about supervisory behavior in the spaces provided. If you choose #1 or #2
as a rating, we strongly urge you to elaborate below the category or at the end of the form.
Please return THE FORM TO THE COORDINATOR OF CLINICAL EDUCATION’S MAILBOX
as soon as possible. Please make a copy to give to your supervisor during your final
meeting of the semester.
RATING SCALE-Select from categories 0-5 and insert number on blank line.
0-not applicable
1-not at all
2-less than adequate
3-adequate
4-better than adequate
5-very satisfied
A. Discussion at the beginning of the term.
1. Did discussion of case help you prepare to begin therapy? ___________
2. If you requested, were you directed to additional resources? __________
B. Case Management
1. Were case management conferences held regularly and on time? ________
2. Did she/he help you formulate appropriate rationale for procedures? _______
3. Did she/he provide adequate information regarding the therapy process? _____
4. Did she/he provide adequate information regarding the diagnostic process (e.g.
hypothesis formulation testing, standardized/non-standardized testing/analysis,
family counseling, written report, etc.) __________
5. Was supervisor’s involvement helpful in therapy sessions? _________________
6. Was feedback regarding reports and lesson plans adequate and constructive? _______
7. Did she/he appear knowledgeable about subject matter or willing to guide students to
other sources? __________
8. Do you feel your time in case management conferences was worthwhile? ___________
Comments:
1. Describe one or more aspects of your student-supervisor interaction that you found valuable.
2. Please provide one or more suggestions for improving your student-supervisor interaction.
APPENDIX C: COSI 464 DIAGNOSTIC CLINICAL PRACTICUM
REQUIREMENTS
1. Each student must participate in/complete 5 evaluations to receive a grade in COSI 464.
2. As students are primarily working in teams, student responsibilities will be divided as follows:
a. Interviewer: Responsible for information getting and information giving interviews;
Responsible for history, summary, prognosis and recommendations/plan of care section
of report.
b. Tester: Responsible for all standardized and non-standardized testing including hearing screening and
oral mechanism evaluation.
Responsible for scoring, interpretation of standardized and non-standardized assessments and
those parts of the report.
Roles will alternate weekly For those students not partnered, the supervisor may act as the partner for the
first two-three weeks, or for the entire experience. This should be worked out according to the student's skill
level and should be left to the supervisor's discretion.
3. Students are required to complete the long form of the evaluation report (see attached). The first draft should
be turned in 48 hours after the evaluation. Requests for re-writes from the supervisor should be made in as
timely a manner as possible. The goal is to have one week's diagnostic report out prior to the next diagnostic
session.
4. Students should meet with their supervisors prior to the diagnostic, if possible, to review the diagnostic plan.
Students should complete the case history review form to aid in this process.
5. Students should complete self supervision forms weekly.
6. Students should review test manuals and practice tests during the month of September. It is expected that
students know that they are required to demonstrate proficiency with the tests in order to remain as part of the
diagnostic team in each evaluation. Students should practice tests no less than 3 times prior to administering
them to patients/clients.
7. Grades will be determined by the COSI course instructor. Please turn a copy of each diagnostic grade sheet
in to her.
CASE SUMMARY SHEET
DOB/AGE:
CLIENT NAME:
FAMILY MEMBER:
/
CASE #:
STUDENT CLINICIAN REVIEWING FILE:
PHONE CONTACT MADE? YES NO (circle)
REFERRED BY:
STATEMENT OF PROBLEM(s):
CASE HISTORY REVIEW
Child currently communicates using (circle all relevant)
Sentences
Phrases
Single words
Vocalizations/gestures
Medical History:
Developmental History:
Family/Social History:
Other:
AREAS TO BE EXPLORED FURTHER
ISSUE OF CLIENT CONFIDENTIALITY
Remember that all information obtained during the diagnostic process is confidential. That is, the information
should not be discussed in public unless you have the written permission of the client/family. You may discuss
issues related to the client with others (i.e., fellow students, faculty members), without mentioning personal
information about the client (including name, address, phone, etc.)
You can only discuss results and recommendations of the diagnostic with other professionals, when you have
family permission.
With each diagnostic, you should check to be sure that you have a signed release of information form (see
attached). Ask the family if there are any other people who should receive a copy of the report. You might
specifically ask if there is a doctor who should receive a copy, or whether the school should (as appropriate).
SELF-CRITIQUE FORM
Diagnostic Practicum
Name:
Date of Evaluation:
Age of Client:
Disorder:
CLINICAL AREAS OF STRENGTH:
CLINICAL AREAS TO IMPROVE:
PLAN OF ACTION FOR IMPROVING AREAS OF WEAKNESS:
DIAGNOSTIC SESSION SELF-SUPERVISION FORM
(Leith, McNiece & Fusilier, 1989)
CLINICAL LEVEL*
DATE
NAME
SUPERVISOR
AGENCY
CLIENT
*Clinical Level: B/beginning (0-100 hours); I/intermediate (100-200 hours); A/advanced (200-300 hours)
P/professional: CFY or beyond
NOTE: 1. Rate only pertinent behaviors. Use "Key to Clinical Competencies" to rate amount of supervision (S),
first column, and quality of performance (P), second column. 5 = Very Good, 4 = Good, 3 =
Satisfactory, 2 = Less Than Satisfactory, 1 = Poor
2. Numbers in () refer to the description of the particular behavior in the "Behavioral Descriptors."
3. SO = Significant Others
4. For rating conference, use Clinical Session Self-Supervision form, "C" items.
PLANNING
S
P
Did you read the case history and select an appropriate test battery? (5)
Did you meet with the diagnostic supervisor before the diagnostic and present a rationale for a
selected test battery? (5)
INTERACTIONS
Did you relate information to client/SO in an organized and professional manner? (10)
Did you maintain a confident image with clients/SO/other professionals/fellow students during the
diagnostic? (14)
Did you interact appropriately with other professionals involved? (17)
MANAGEMENT
Did you manipulate the clinical environment so that it was conducive to testing? Did you present the
test instructions/materials appropriately? (19)
Did you effectively deal with any behavior problems? Did you use a consistent reward/penalty
system? (20)
Did you maintain the client's attention and motivation? Did your client exhibit approach motivation?
(21)
PROCEDURES
Did you present instructions so that the client clearly understood the goals of the session? (22)
Did you use rewards and penalties that were appropriate, consistent, verified? (30)
Did you determine and implement an effective and accurate behavioral data collection system? (33)
Did you administer all formal tests accurately and efficiently? (35)
Did you demonstrate accurate clinical observation skills with sensitivity to and awareness of all
relevant client behaviors? (36)
Did you elicit and evaluate all appropriate speech/language/hearing behaviors? Did you accurately
interpret test results and make all appropriate recommendations? (37)
REPORT WRITING (38)
Did you report formal and informal test results accurately?
Did you describe all aspects of communicative behaviors using terminology that would be clearly
understood by those reading it?
Did you organize your report according to established guidelines?
Did you use correct syntax, spelling, punctuation?
Did you make recommendations and referrals that were appropriate, specific, and complete?
Did you make necessary revisions and resubmit the report on time?
OTHER DIAGNOSTIC RESPONSIBILITIES
Were you prompt and professional in sending information to outside agencies/individuals? (42)
Did you evaluate your own diagnostic performance and set goals for your professional development?
(43)
GOALS FOR DEVELOPMENT:
INVENTORY OF DIAGNOSTIC SKILLS
(Syracuse University: format adapted from the W-PACC/University of Wisconsin-Madison)
Clinician
Date
Supervisor(s)
Age(s) of Client(s)
Preparation (score 1-5)
Reads folder thoroughly
Suggests appropriate evaluation procedures based on client information and knowledge of communication
problem
Is able to explain rationale for tests and procedures suggested
Contributes equally to diagnostic team effort during pre-staffing
Prepares diagnostic setting to meet client and observer needs
Diagnostic (score 1-5)
Establishes professional test atmosphere with client
Explains rationale for assessment to client/family
Explains rationale for assessment to client/family in language appropriate to their level of understanding
Administers tests according to standardized procedures
Administers tests in critically important order for client and problem
Adaptability -- makes modifications in assessment based on client performance or parent information
Administers appropriate feedback or reinforcement consistent with test procedures
Increases/decreases rate of time for test administration
Removes distracting items during testing
Scores tests/records unobtrusively, accurately, quickly
Handles and manipulates test equipment efficiently
Uses language and intonation appropriate to the age and functioning level of the client
Is able to informally assess (nonstandard measures) skills comparably assessed on formal measures
Demonstrates trial teaching techniques within the diagnostic setting
Interviewing (score 1-5)
Begins and ends the interview gracefully
Uses interpersonal skills/professional demeanor appropriate for informant
Prepares the clinical setting for the interview
Questions are formed clearly and are productive in terms of the quality/quantity of informant's response
Sequences and switches topics smoothly
Extracts pertinent/accurate information from the interviewer
_____ Demonstrates sensitivity to cultural/linguistic differences
Postdiagnostic (score 1-5)
Is able to interpret test findings
Offers information or comments to team members based on own observations of client performance
Qualifies assumptions with observed behaviors in report
Is able to integrate information observations from team members
Makes appropriate recommendations and suggestions based on diagnostic team findings
Is able to relate interpreted test findings to family/client
Reports information in written form that is accurate and inclusive
Reports information in written form that is pertinent
Incorporates recommended treatment/management suggestions in report
Clinician self-evaluates strengths and weaknesses
Personal Qualities (score S [Satisfactory], U [Unsatisfactory], I [Inconsistent], LI [Lack of Information], DNA
[Does Not Apply])
Punctual for prestaffing
Punctual for diagnostic evaluation
Appears to recognize professional limitations
Prepares for diagnostic by setting up materials and equipment
Returns test equipment and materials after diagnostic evaluation
Dress, voice and manner is appropriate for evaluation
Meets deadlines for reports
Rating Code:
NA
Not Applicable
1
Specific direction from supervisor does not alter unsatisfactory performance/evaluation skills; inability
to make change.
2
Needs repeated specific direction and/or demonstration from supervisor to perform competently and
evaluate self/client accurately.
3
Needs general and some specific direction from supervisor to perform competently and evaluate
self/client accurately.
4
Demonstrates independence but needs general direction from supervisor to perform competently and
evaluate self/client accurately.
5
Demonstrates independence by taking initiative; displays superior competencies and evaluates
self/client accurately.
*PREPARATION (P)
*DIAGNOSTIC (D)
___
*INTERVIEWING (I)
___
*POSTDIAGNOSTIC (PD)
___
AVERAGE P + D + I +PD
___
PERSONAL QUALITIES SUMMARY
Number of "SATISFACTORY" items
___
Number of "INCONSISTENT" items
___
Number of "UNSATISFACTORY" items
___
Number of "LACK OF INFORMATION" items
___
Number of "DOES NOT APPLY" items
___
*SCORE = SUM OF SCORED ITEMS / NUMBER OF ITEMS SCORED
/
=
DIAGNOSTIC SKILLS
DESCRIPTORS
PREPARATION
1. Reads client folder thoroughly.
• The clinician can extract and summarize pertinent and accurate information from available
background information for supervisor/team members.
2. Suggests appropriate evaluation procedures based on client information and knowledge of communication
problem.
• The clinician is able to list and enumerate possible evaluation procedures specific to the problem.
3. Is able to explain rationale for tests and procedures suggested.
• The clinician is able to explain why one assessment procedure is preferable over another, taking into
account the following factors:
o evaluation procedure(s) specific to problem(s)
o validity/reliability of standardized tests
o developmental age appropriateness
o formal vs informal procedures
o test is suitable in view of other handicapping conditions
o knows when alternate form of test should be given
4. Contributes equally to diagnostic team effort during pre-staffing.
• The clinician's verbal input is comparable to other team members' input.
• The clinician evaluates and questions other team members' input.
• Prepares a flexible outline for order of test administration.
5. Prepares diagnostic setting to meet client and observer needs.
•
•
•
•
•
The environment is pleasant to the eye (clutter free), distractable objects removed.
The informant is made physically comfortable.
Prepares diagnostic setting to meet observer needs.
Materials/tests are readily available and organized.
Audio/video taping equipment is set up.
DIAGNOSTIC
6. Establishes professional test atmosphere with client.
• The clinician introduces himself/herself.
• The clinician engages in social conversation to reduce test anxiety if applicable.
• The clinician briefly outlines the diagnostic format when appropriate.
• The clinician demonstrates warmth, appropriate eye contact, ease and sensitivity to the client's feelings.
7. Explains rationale for assessment to client/family.
• The clinician initiates an explanation of why a particular test is being given.
• The clinician is able to answer client/family questions as to why a test is being given.
8. Explains rationale for assessment to client/family in language appropriate to their level of understanding.
• Clinician defines terms, provides examples to facilitate parent/family understanding of diagnostic
procedure(s).
9. Administers tests according to standardized procedures.
• Clinician gives appropriate directions.
• Clinician uses basal and ceiling levels.
• Clinician adheres to time limitations.
10. Administers test in critically important order for client and problem.
• Clinician administers tests most critical to assessing presenting problems when client is fatigued,
disinterested, distractable, or physically limited (e.g., clinician adminsters auditory perception or
discrimination tests after the client's auditory acuity has been assessed).
•
When appropriate, clinician adjusts or changes pre-staffing diagnostic outline.
11. Adaptability. Makes modifications in assessment based on client performance or parent information.
• Clinician introduces or modifies type or schedule of reinforcement to increase client on-task behavior.
• Clinician changes from using formal to using less formal assessment when client's off-task behavior
increases.
• Clinician discusses client's hobbies, skills, social interests to informally assess articulation syntactic
structure, language comprehension, etc.
• Clinician spontaneously introduces new procedures.
12. Administers appropriate feedback or reinforcement consistent with test procedures.
• Clinician gives social approval ("good, that's a good answer:"), smiles, nods, encourages, ("try, just do
your best," "you're dong well").
• Clinician reinforces on a variable schedule without patterning or cueing the client (e.g., nodding for only
correct responses, allowing delay after incorrect client response for client to change answer).
• Clinician may tally and show correct responses to client to reinforce on-task test performance.
• Clinician knows when to use and change and/or eliminate token/food reinforcers when inappropriate to
client's interest or developmental level.
• Clinician is familiar with instructions for reinforcement when these are specified in the test manual.
13. Increases/decreases rate of time for test administration. Speeds up or slows down the "pace of the session.
• When no time limit is specified for test/subtest administration, clinician modifies rate of test time
presentation when appropriate.
• Clinician allows reasonable time for client to respond after stimulus is presented.
14. Removes distracting items during testing.
• No descriptors.
15. Scores tests/records responses unobtrusively, accurately, quickly.
• Clinician fills in pertinent identification information on test form.
• Clinician accurately scores tests according to test manual instructions.
• Clinician scores both correct and incorrect responses to avoid cueing client.
• Clinician relates information/data obtained to some standardized/developmental age reference norm.
16. Handles and manipulates test equipment efficiently.
• Materials are organized sequentially for facile test administration.
• Clinician knows how to operate test equipment (tape recorder, videotape, pitch meter, spectrogram,
accelerometer, etc.)
• Clinician co-ordinates test material presentation and scoring.
17. Uses language and intonation appropriate to age and functioning level of the client.
• No descriptors.
18. Is able to informally access (non-standardized measures) skills comparably assessed on formal measures.
• Clinician is familiar with source for developmental norms (e.g., phonological or language development
norms).
• Clinician records observations of client behaviors which are not being directly assessed.
19. Demonstrates trial teaching techniques within the diagnostic setting.
• Clinician attempts to recommend management strategies/techniques based on observed test
performance.
• Clinician uses several methods/approaches to stimulate sound production.
• Clinician models language structures to determine client's ability to acquire and retain skills on a short
term basis.
• Clinician presents same concept(s) through various modalities (auditory, visual combined) for suggestions
for possible therapeutic approaches.
20. Begins and ends the interview gracefully.
a. Beginning the interview
• The interviewer establishes a professional/supportive atmosphere during the initial greeting
(introduction).
b. Ending the interview
• The interviewer expresses appreciation for informant's cooperation.
• The interviewer asks for further information/questions in relation to the problem.
21. Uses interpersonal skills/professional demeanor appropriate for informant.
• Interviewer uses adequate eye contact.
• Listens carefully and talks with the client, not at or down to the client.
• Reacts appropriately during client expressions of emotion (responds to the emotion expressed rather than
to the answer to the question).
22. Prepares the clinical setting for the interviewer.
• The environment is pleasant to the eye (clutter free).
• The informant(s) is/are made physically comfortable.
• Audio-recording equipment is properly assembled.
• Question guideline is prepared.
23. Questions are formed clearly and are productive in terms of the quality/quantity of informant's response.
• Double or multiple questions are avoided.
• Appropriate vocabulary is used; terms are defined when necessary.
• Questions are not "leading" or "loading" (i.e., wording that would suggest what would be an acceptable
answer).
• An appropriate variety of questions are used, preferable open-ended ones.
• The rationale for questions asked is understood by the clinician.
24. Sequences and switches topics smoothly.
• Obtains neutral, factual information before emotionally laden information.
• Follows a reasonable chronology of questioning.
• Uses transitional statements when changing the topic or area of questioning.
25. Extracts pertinent/accurate information from the interview.
• Probing questions are appropriately used to obtain information about a relevant topic.
• Appropriate amount of time is spent for questions in important and less important areas.
• The informant's interpretation of events is obtained.
• Details are "pinned down" by relating events to significant family milestones.
• Causal relationships are defined in terms of time and space.
• Unobstrusive checking of inconsistent responses.
• Gets the informant "back on track" without discouraging free expression.
POST DIAGNOSTIC
26. Is able to interpret test findings.
• Clinician scores test(s) before post diagnostic meeting.
• Clinician correctly scores individual tests and procedures according to test standards.
• Clinician takes into consideration additional factors (i.e., client's fatigue, attention to task, understanding of
instructions).
27. Offers information or comments to team members based on own observations of client performance.
• Clinician suggests management approaches, recommendations, or referral services based on client
behavior which was observed or reported.
• Clinician is able to make general summary statements about the client/family based on specific examples
of client/family behavior.
• Clinician can suggest if therapy or subsequent services are recommended based on client-demonstrated
performance.
28. Qualifies assumptions with observed behaviors in report.
• See 27
29. Is able to integrate informational observations from team members.
•
Clinician displays skills in integrating the information (informal/formal tests, case history, observations,
previous evaluations) gathered to determine nature and severity of the client's problem.
30. Makes appropriate recommendations and suggestions based on diagnostic team findings.
• Clinician displays skills in generating appropriate recommendations and possible referrals based on
information gathered and on the needs of the client.
• Clinician knows when to initiate these contacts with appropriate referrals.
31. Is able to relate interpreted test findings to family/client.
• Clinician relates information using appropriate vocabulary, clear concise language.
• Clinician displays skills in relating relevant and organized facts while counseling parents and/or clients.
• Clinician displays skills in sequencing positive aspects of client behavior before negative.
•
Clinician is able to appropriately respond to questions asked by the parent/client in relation to his/her
problem/prognosis.
32. Reports information in written form that is accurate and inclusive.
• Clinician's first draft includes information that is well organized, chronologically appropriate and
grammatically correct, concise, and clear.
• Clinician summarizes all aspects of the diagnostic and integrates information given by additional team
members.
• Clinician researches the problem and reads sample reports before writing and handing in the report to the
supervisor.
33. Reports information in written form that is pertinent.
34. Incorporates recommended treatment/management suggestions in report.
• Clinician includes information concerning the types of tests (informal vs formal) administered, purpose of
test, results, possible therapy plans and recommendations.
• Clinician exhibits adequate theoretical background in the particular disorder.
• Clinician suggests and specifies objective criteria for achievement of goals.
• Clinician suggests appropriate type and variety of materials/programs.
35. Clinician self evaluates strengths and weaknesses.
• Clinician is able to indicate assets of his/her diagnostic performance.
• Clinician perceives areas for modification and suggests alternate ways of improving future performance.
DESCRIPTION OF PROGNOSTIC LEVELS
SPEECH-LANGUAGE PATHOLOGY and AUDIOLOGY
In keeping with standards for increased accountability, it is necessary to provide for each client a prognosis for
improvement. The words traditionally used to describe prognosis, along with a brief description, are as follows:
Excellent - This prognosis statement indicates that the client has a high likelihood of improving significantly. All
indicators are positive for significant improvement. This classification can be used for clients who may require only
a short period of therapy.
Good - Choosing this option indicates that the client can be expected to make reasonable progress toward
improving functional communication. This statement may be qualified to state that the prognosis for achieving a
limited set of goals is good. The person may have positive and negative influences on their likelihood to improve
but a majority of the indicators are positive.
Fair - This term may be used for the client that has a similar number of both positive and negative prognostic
indicators. The person may still be considered a candidate for therapy if the clinician determines that improvement
is possible.
Poor - This term is used for the client who is not likely to demonstrate functional improvement from therapeutic
intervention. This client has more negative than positive indices for improvement. This designation is used for the
person who is not going to be enrolled in therapy or should be discontinued from therapy because he/she is not
expected to continue to demonstrate progress. The clinician should provide the reason(s) for the poor prognosis.
The following are a list of common influences on a person's prognosis for improvement:
Age
Severity of impairment
Cognitive abilities including memory
Oral/motor control
Hearing status
Visual impairment
Motivation
Level of family involvement
Family attitudes
Client's emotional reaction to disorder
Auditory comprehension
Auditory discrimination
Pre-requisite language skills
Health factors
Intensity, duration of previous therapy
Appropriateness of previous therapy
Integrity of neurological system
Integrity of oral/facial structures
Psychological difficulties
Ability to self-monitor
Ability to self-correct
Previous response to therapy
Willingness to work on communication outside clinical setting
Professional/personal reasons for wanting to change behavior
Ability to attend sessions regularly
Transportation readily available to attend sessions
Time since onset of disorder
Stimulability
Non-verbal interaction with others
Play behavior
Response to clinician's cues
Ability to focus attention
Ability to sustain attention
Ability to sustain attention with possible distractions
Client willing to change aspects of lifestyle
Pre-morbid personality characteristics
Level of daily communicative interaction with others
Interest in attending therapy
Client's belief that therapy will result in improvement
Environmental factors
Interest in interacting with others
Additional Audiology Prognostic Indicators -- In addition to the prognostic indicators given for speech and
language clients, manual dexterity must also be considered for audiology clients, especially for the purposes of
hearing aid and battery manipulation, sign language and Cued Speech use.
In stating the audiology prognosis, indicate clearly which aspect of communication to which you are referring (e.g.:
development of oral communication, use of a hearing aid or assistive listening device, progression of hearing
loss, etc.).
Use the terms "Excellent, Good, Fair or Poor" as described in the description of Prognostic Levels. The progress
may also be described. "Guarded" if it presently appears "poor," but may improve significantly after either medical
intervention or fitting of appropriate amplification.
In the case of a client who requires medical evaluation or intervention, you may state that "the prognosis is being
withheld, pending medical consultation."
SEVERITY RATING INFORMATION
This information serves to provide general guidelines for severity ratings assigned to clients with
communication disorders. This information may be applied to categories of impairment, handicap and
disability that you may encounter through various managed health care organizations.
Within Normal Limits
• No noticeable impairment in this area
• This classification can be used for the following types of clients:
1. Proficiency in this area is technically within normal limits but is near the lower
boundaries of what is considered normal. For a child, a recommendation may be to
monitor and/or to follow-up with a consultation at some specified time in the future.
2. Someone who subjectively reports some effort in performing the skill but this difficulty
is not evident to the listener.
3. Foreign dialect client whose dialect never or rarely interferes with intelligibility.
Mild
In general, a classification of either of the mild ratings indicates a disorder which may be evident but does
not significantly reduce the ability to be an effective communicator. In other words, there is a disorder but
it does not interfere with everyday, functional communication. For a child, this classification would include
those who are six to eight months below age expectancy in functional communication ability.
• Examples of the use of this classification include the following:
1. Disorder is noticeable to a trained listener, may not be apparent to casual observer in a
limited context.
2. Persons who have difficulty only in a few specific demanding situations.
3. Persons who have no or little difficulty with everyday, functional communication but may
experience minor difficulty in several demanding situations such as a high level
contextual conversation or in the presence of competing stimuli.
4. Persons who require some increased effort to communicate resulting in rarely noticed
reduced facility of speech/language without significant decrease in ability to comprehend
and/or express wants and thoughts.
Moderate
In general, this category represents the level in which a disorder of comprehension or expression
becomes a definite impairment in communication. However, the skill level still enables the
communicatively-impaired person to effectively communicate in many structured and/or limited contexts.
For a child, this level would be used to describe one who is eight to twelve months below age expectancy
in functional communicative ability.
• Examples of the use of this classification include the following:
1. A person whose disorder is readily apparent to even the casual conversational partner.
The impairment makes it somewhat more effortful to communicate with the
communicatively-impaired person.
2. A person who shares the burden of communication with the listener but the listener is still
sometimes required to fill in the blanks.
3. A person whose disorder is readily apparent. This person’s conversation partner finds
that it is effortful to communicate with the person, especially when not dealing with
everyday topics or with unknown referent.
4. A child who is clearly below normal limits on a given communicative skill but retains
enough functional ability in this area to get across basic wants and needs.
5. A communicatively-impaired person who shares the burden of communication with others
at least half of the time. The conversational partner is often required to fill in gaps.
Severe
In general, this classification should be used to describe the client who often does not equally share the
burden of communication with his/her partner. The person has limited ability to express basic wants and
needs and is not usually able to participate in an actual conversation. The client’s prognosis for
developing any of these skills may range from poor to good. For the child, this level would be used to
describe the child who 12 months or more below age expectancy level for functional communication.
•
Examples of this classification could include the following:
1. A person whose communication impairment interferes with all but the most elementary and
routine conversational exchanges such as responding appropriately to How are you?
2. A person who can only be understood in limited contexts with referent known.
3. A child or adult with limited ability to express basic wants and needs. May be able to
communicate some desires via sample verbal or non-verbal means.
4. A person whose communication impairment makes it difficult to communicate even with
routine exchanges.
5. A person who has difficulty being understood even in limited contexts with referent known.
6. A child or adult with limited ability to express even the most basic of needs by any means.
Profound
This category denotes no observable ability in functional communication.
TERMINOLOGIES USED IN REPORT WRITING
The following lists represent a compilation of commonly used terms noted in clinical reports. The lists are
by no means complete, and are presented purely as an outline for use by beginning clinicians. It is to be
used as a foundation from which to build a clinical report writing style. For logistic purposes, the terms
have been placed under major headings; however, many may be used interchangeably depending upon
the nature of the report being written.
The Person
You Work With
the client
the patient
the child
the youngster
Johnny (child's name)
Mr.
Mrs.
Ms.
You
the (this) clinician)
the (this) therapist
the (this) examiner
What's Wrong?
speech
communication
articulation
language
voice
rhythm
fluency
hearing
impairment
distractible
deviancy
deviation
problem
disorder
difficulty
abnormality
dysfunction
anomaly
defect
What You Did
the therapy
the remediation
the intervention
the speech rehabilitation
the assessment
the testing
the appraisal
"Professional Tone Words"
unremarkable
baseline
causal
reinforcement
determine
projected
informant
feedback
utterance
performed
production
performance
tasks
data
progressive
nature
outlook
onset
status
congenital
goals
etiology
characteristics
objectives
criterion
generalized
symptomatology
administered
skill
ability
verbalization
carryover
observations
exhibits
manifests
demonstrates
revealed
occurred
increased
target behavior
evidenced
similar
indicated
improved
contingent
terminated
behavior
response
impression
judgment
stated
indicated
parameter
appeared
reported
Haynes, Hartman: "The Agony of Report Writing: A New Look at an Old Problem," JNSSHA, December,
1975.
SPELLING
(Misspelling is not one of the most serious errors to commit, but it is one of the easiest to avoid. Follow
the first entries of different acceptable spellings in a recent edition of a dictionary. Inconsistency (for
example, alternating between modeled and modeling or between cuing and cuing is distracting. Choose
the preferred style and stick to it. Keep a record of accurate spellings of difficult words.)
Style Sheet Suggestions
absence
deterrence
abscess
embarrass
Caesarean
exceed
commitment
grammar
concomitant
hemorrhage
concurrence
independent
conscious
likable
consistent
misspell
counseled
notable
debilitating
occurrence
dependent
parallel
persistent
personnel
precede
preference
proceed
recommendation
recurrence
repetition
resistant
separate
unnecessary
STYLE
A. CLINIC TRADITIONS
(Sometimes we need to write in a manner that is familiar and acceptable to all clinicians.)
Draft: Mr. Ripley relies on information from his listeners to adjust his intensity.
***
Draft: Lester has received speech therapy twice weekly since the second grade. His parents do
not feel there has been any progress.
Don't be redundant. Don't use more words than necessary. Don't be repetitious. It's highly
superfluous. --- Anonymous
1. WORD REPETITIONS
Sometimes a word or a form of a word is repeated unnecessarily; the reader's interest is dulled.
Draft: Langley was hospitalized at age five for corrective heart surgery which because of
complications necessitated the need of three operations.
***
Draft: The Test for Oral Apraxia was administered. Jenny was capable of producing all the
volitional movements adequately. Adequate velopharyngeal elevation on /a/ was observed.
***
2. IDEA REPETITIONS
Sometimes several words are used to express essentially the same thought.
Draft: There was no family history of prior speech problems.
Draft: Jesse sometimes gets frustrated on occasion when he's misunderstood.
***
Draft: Nina's father describes her as being very emotional and as displaying her feelings
frequently.
B. WORDINESS
In progress reports the problem is how to make it look like you've been doing much more than you
really have been all these months. The secret is long sentences, the longer and more complicated the
better. This gives the reader the impression that at least you have been thinking about these things
pretty hard, while at the same time you are tiring him out so rapidly that he doesn't have the energy to
go back over it carefully and see exactly what you did. -- James Jerger
1. SUPERFLUOUS WORDS AND PHRASES
In composing, as a general rule, run your pen through every other word you have written; you have no
idea what vigor it will give your style. -- Sydney Smith
Draft: Mrs. Fargut's oral structures were examined and found to be within normal
***
Draft: Prognosis for this client is considered excellent.
Draft: Her general health was reported as being excellent.
***
Draft: Oral structures were within normal limits for the production of speech.
***
Draft: Speech was found to be characterized by fillers and initial phoneme repetitions.
Draft: I recommend contact with the teacher on a regular basis.
ORGANIZATION/SEQUENCING
The neck bone's connected to the collar bone, the collar bone's connected to the shoulder bone, them
bones, them bones, them dry bones... -- Anonymous
(Connect relevant statements and order the information so that the reader easily follows the report's
progression.)
A. SENTENCE LEVEL
Draft: Therapy should focus on speech-rate reduction to improve intelligibility, eye-contact
maintenance to improve listener involvement and over-articulation.
B. PARAGRAPH LEVEL
Draft: Therapy began when he was three; he was seen at home twice weekly by a private-practice
clinician. Over the next fifteen years, remediation focused on developing lip-reading skills, correcting
misarticulations, and improving intelligibility through exaggerated enunciation. Mr. Kellog's primary
means of communication now is lip reading; he is also proficient in American Sign Language (ASL).
He then received one semester of speech therapy in our clinic during his first year here at Boston
University.
1. ACTIVE VOICE PREFERENCE
The active voice normally is shorter, livelier and more direct.
***
Draft: Edna was evaluated by the team in the fall of 1982.
***
Draft: Her syntactic skills deficit was revealed through an occasional omission of articles.
***
PASSIVE-VOICE JUSTIFICATION
The passive voice is justified if the actor is less important than what is acted upon.
Draft: I manipulated the variables to see if the direction of causation could be determined.
NEUTRAL-COPULATIVE OVERUSE
...the sentence's verbal force has been shunted into a noun and for a verb we make do with "is," the
neutral copulative, the weakest verb in the language. Such sentences project no life, no vigor. They
just "are." -- Richard Lanham
Draft: Another notable feature of the language sample was the use of attributes and possessives.
COLLOQUIALISMS
It is possible, of course, to be too casual in a report. Some words are better than others because they
are correct, because they are right for the audience, or because they are preferred by most good
writers.
Draft: There was a large space between her teeth.
OVERWEIGHT WORDS AND PHRASES
at this point in time
with reference to
with respect to
on the order of
it is often the case that
in the event that
be of the opinion that
due to
owing to the fact that
in spite of the fact that
is indicative of
had occasion to be
take into consideration
be in agreement
be in possession
give authorization
give a description
give instruction
have a belief
be cognizant
be in accord
have the capability
present a picture similar to
serve the function of being
OFFICIAL ABBREVIATIONS
A
a
aa
AAxL
ac
accom
ACTH
ad
ad lib
AE
AFB
A/G Ratio
AICA
AIDS
AKA
AK
ALL
ALS
AM
AMA
before
of each
anterior axillary line
before meals
accommodation
adrenocorticotrophic hormone
right ear
as desired
above elbow
acid fast bacilli
albumin, globulin ratio
anterior inferior cerebellar artery
acquired immunodeficiency syndrome
also known as
above knee
acute lymphocytic leukemia
amyotrophic, lateral sclerosis
before noon
against medical advice
ambul
amt
ant
AODM
A&P repair
aq
aq dist
ARD(S)
AROM
A/R pulse
as
ASA
ASD
ASCVD
au
AV
AWOL
Ax
A2
ambulatory
amount
anterior
adult onset diabetes mellitus
anterior and posterior repair
water
distilled water
adult respiratory distress (syndrome)
artificial rupture of membranes
apical/radial pulse
left ear
acetylsalicylic acid (Aspirin)
atrial septal defect
arteriosclerotic cardiovascular disease
each ear; both ears
arterioventricular defect
absent without leave
axis (in cylindrical lenses)
aortic second sound
B
BAER
Ba
BCP
BaE
BE
bid
BIH
BBB
BK
Bm
MB (BMT)
BP or bp
BPH
BRP
BSO
BUN
Bx
brainstem auditory evoked response
barium
birth control pill
barium enema
below elbow
twice daily
bilateral inguinal hernia
bundle branch block
below knee
bowel movement
bone marrow (bone marrow transplant)
blood pressure
benign prostatic hypertrophy
bathroom privileges
bilateral salpingo-oophorectomy
blood urea nitrogen
biopsy
C
c
with
CA
cancer
Ca
calcium
CABG
coronary artery bypass graft
CAD
coronary artery disease
cal
calories
CAT
catheterize
CBC
complete blood count
CBF
cerebral blood flow
cc
cubic centimeter
CC
chief complaint
CD
constant drainage
CHD
congenital heart disease
CHF
congestive heart failure
chr
chronic
Cl
chloride
CML
chronic myeloid leukemia
CMU
cardia monitoring unit
CMV
cytomegalovirus
CNS
central nervous system
c/o
complained of
CO2
carbon dioxide
CO2 Comb Power carbon dioxide combining power
conjunct
conjunctiva
cont
continued
COPD
chronic obstructive pulmonary disease
CP
cerebral palsy
CPK
creatine phosphokinase
CPR
cardiopulmonary resuscitation
CRF
chronic renal failure
CS
Cesarean section
C&S
culture and sensitivities
CSF
cerebral spinal fluid
CSR
corrected sedimentation rate
CVA
cerebral vascular accident
CVP
central venous pressure
CVS
cardiovascular system
CVU
clean void urine
Cx
C xr
Cysto
D
D/C
D&C
Dept
DIC
cervix
chest x-ray
cystoscopy
Diff
dil
DIP
div
DL
DOA
DOE
DPT
Dr
DTR
dx
discontinue
dilatation and curettage
department
disseminated intravascular
coagulation
differential white blood cell count
dilute
Distal Interphalangeal Joint
division
danger list
dead on arrival
dyspnea on exertion
diphtheria, pertussis, tetanus toxoid
doctor
deep tendon reflex
diagnosis
E
ea
EDC
EENT
EEG
EGA
EKG or ECG
EMG
ENG
EOG
ENT
EOM
Epis
E/S
ESR
ETOH
Exam
ext
each
expected date of confinement
Eye, Ear, Nose & Throat
electroencephalogram
estimated gestational age
electrocardiogram
electromyography
electronystagmography
electro-oculography
Eye, Nose & Throat
extra-ocular muscles
episiotomy
essentially the same
erythrocyte sedimentation rate
ethanol
examination
external
F
FT4I
FB
FBS
Fe
FH
FHR
fl
FSH
FUO
origin
FWB
Fx
G
GH
GI
free thyroxine index
foreign body
fasting blood sugar
Iron
family history
fetal heart rate
fluid
follicle stimulating hormone
fever of undetermined or unknown
full weight bearing
fracture
growth hormone
gastrointestinal
Gm
GSW
gtt
GTT
GU
GVH
Gyn
gram
gunshot wound
drops
glucose tolerance test
genitourinary
graft versus host
gynecology
H
(h) or (H)
h
HA
H&E
HBP
Hct
HCVD
Hbg
H2O
H2F
hs
hwb
Hx
hypodermic
hour
headache
hematoxylin & eosin stain
high blood pressure
hematocrit
hypertensive cardiovascular disease
hemoglobin
water
high power field
at bedtime
hot water bottle
history
I
ICA
ICP
IM
inf
inj
int
INO
I&O
IPPA
IPPB
IR
irrig
ITP
ITT
IUD
IUP
IV
IVC
IVP
internal carotid artery
intracranial pressure
intramuscular
inferior
injection
internal
internuclear ophthalmoplegia
intake and output
inspection, palpation, percussion and
auscultation
intermittent positive pressure breathing
infra-red
irrigate
idiopathic, thrombocytopenia purpura
Insulin Tolerance Test
intrauterine device
intrauterine pregnancy
intravenous
intravenous cholangiogram
intravenous pyelogram
K
K
kg
KUB
potassium
kilogram
kidney, urinary and bladder
L
(L)
lab
LAD
lat
LBCD
LBP
LDH
left
laboratory
left anterior descending (artery)
lateral
left border of cardiac dullness
low back pain
lactic dehydrogenase
LE
LED
LF
LFT
lg
LH
LHRH
liq
LL
LLL
LLQ
LMP
LOA
LP
lph
LUQ
LVH
LUL
M
MAxL
MCA
MCL
DMCP
MG
Mg
mg
MGSO4
MGW enema
lower extremity
lupus erythematosus prep
low forceps
liver function test
large
luteinizing hormone
luteinizing hormone releasing hormone
liquid
lower lobe
left lower lobe
left lower quadrant
last menstrual period
leave of absence
lumbar puncture
low power field
left upper quadrant
left ventricular hypertrophy
left upper lobe
MHB
MI
min
ml
mm
mm HG
mod
MOM
MRI
MS
MTP
MWB
mid-axillary line
middle cerebral artery
mid-clavicular line
metacarpophalangeal joint
myasthenia gravis
magnesium
milligram
magnesium sulfate
magnesium sulfate, glycerine and water
enema
maximum hospital benefit
myocardial infarction
minute
milliliter
millimeter
millimeter of Mercury (for tonometry)
moderate
milk of magnesia
magnetic resonance imaging
multiple sclerosis
metatarsophalangeal joint
minimal weight bearing
N
Na
NCV
neg
NG
no
non rep
NPD
NPH
NTG
NWB
sodium
nerve conduction velocity
negative
nasogastric tube
number
do not repeat
no pathologic diagnosis
neutral protamine Hagedorn (insulin)
nitroglycerin
non-weight bearing
O
O2
OA
Obl
OD
OD
Oint
OOB
OP
OR
ortho
OS
OT
OU
P
P
P
P
PO4
P2
PA
PAP (smear)
PAxL
pc
pc - 2 hr pc
PDA
PE
PERLA
PFT
PH
PI
PICA
PID
PIP
plt
PM
PMI
PMP
po
POC
POD
pos
Post
Post-op
PP
PPD
Pre-op
prep
prn
PROM
pro time
PSP
Oxygen
occiput anterior (ROA & LOA = right or
left OA)
oblique (muscle)
overdose
right eye
ointment
out of bed
occiput posterior (ROP & LOP = right or
left OP)
operating room
orthopedic
left eye
occupational therapy
each eye, both eyes
pulse
para
after
phosphorous
pulmonic second sound
posterior-anterior
Papanicolaou smear
posterior axillary line
after meals
specimen of blood drawn two hours after
a meal
patient ductus arteriosus
physical examination
"pupils equal + reactive to light and
accommodation"
pulmonary function test
past history
present illness
posterior inferior cerebellar artery
pelvic inflammatory disease
proximal interphalangeal joint
platelet
afternoon
point of maximal impulse
previous menstrual period
by mouth
products of conception
post operative day
positive
posterior
following operation
postpartum
postpartum day or purified protein
derivative
prior to operation
surgical preparation
according to necessity
premature rupture of membranes
prothrombin time
Pt
PT
PTT
PWB
PZI
phenosulphonphthalein or progressive
supranuclear palsy
patient
physical therapy
partial thromboplastin time
partial weight bearing
protamine zinc insulin
Q
q 1 (2, 3) h
q 15 m
qd
qhs
qid
QNS
qod
QOH or qoh
qpr
qs
qw
every 1 (2, 3) hours
every 15 minutes
daily
every bedtime
four times a day
quantity not sufficient
every other day
every other hour
at earliest convenience
as much as necessary
weekly
R
(R)
R
RBC
RCA
RCM
RDS
rec'd
Reg
RES
retic count
RHD
RLQ
RLL
RML Epis
ROM
ROS
R/T
RTC
RUL
RUQ
RVH
Rx
right
respirations
red blood count
right coronary artery
right costal margin
respiratory distress syndrome
received
regular insulin
reticuloendothelial system
reticulocyte count
rheumatic heart disease
right lower quadrant
right lower lobe
right mediolateral episiotomy
range of motion
review of systems
related to
return to clinic
right upper lobe
right upper quadrant
right ventricular hypertrophy
treatment
S
s
without
SAH
subarachnoid hemorrhage
SC
subcutaneous
SDH
subdural hematoma
Sec
second
sed rate or ESR s edimentation rate
SGA
small for gestational age
SGOT
serum glutamic oxidase transaminase
SGPT
serum glutamic pyruvate transaminase
SIDS
sudden infant death syndrome (crib
death)
SLR
straight leg raising
sm
SOB or sob
Sol
sos
Sp Gr
ss
SS enema
stat
STS
sup
surg
SVD
syr
small
shortness of breath
solution
administer once if necessary
specific gravity
(and) one half
soapsuds enema
at once
serological test for syphilis
superior
surgery or surgical
spontaneous vaginal delivery
syrup
T
T
T4
T&A
tab
TAB
TAH
TBC
TD
temp
TGV
tid
TP
TPR
PSH
TUG
TUR
temperature
thyroxine
tonsils and adenoids
tablet
therapeutic abortion
total abdominal hysterectomy
tuberculosis
tardive dyskinesia
temperature
transposition of great vessels
three times a day
total protein
temperature, pulse and respirations
thyroid stimulating hormone (test)
Total Urinary Gonadotropins
Transurethral Resection
U
UA
UE
UL
ung
URI
US
UT
UTI
UV
urinalysis
upper extremity
upper lobe
ointment
upper respiratory infection
ultrasound
uterus
urinary tract infection
ultra violet
V
VC
VD
VER
vert
Vag Hyst
VF
VMA
VNA
VS
VSD
vital capacity
venereal disease
visual evoked response
vertical
vaginal hysterectomy
visual fields
Vanilyl Mandelic Acid
Visiting Nurse Association
vital signs
ventricular septal defect
W
WA
WBC
while awake
white blood count
wgt
wh
WNL
weight
white
within normal limits
X
x
times - as prn x 6, or q 15 m x 8
FREQUENTLY USED SYMBOLS
↑
↓
>
<
+
=
♀
~
♂
%
#
o
1o
2o
3o
∆
‘
“
c
s
increase; also
∧
decrease; also
∨
greater than; also ≥
less than; also
≤
positive
negative
equals
female
approximately
male
percent
pound/number
degree
primary; first degree
secondary, second degree
tertiary; third degree
change
foot
inches
with
without
THE LANGUAGE USED TO DESCRIBE INDIVIDUALS WITH DISABILITIES
John Folkins, ASHA Publications Board
December 1992
This statement of principles is intended as a resource for editors and authors. It is advisory only; that is,
none of the principles given should be considered to be binding rules for material published by ASHA.
Principle One: Person First Language
Use person-first language. Disabilities are not persons and they do not define persons, so do not replace
person-nouns with disability-nouns.1,2
Avoid:
“the aphasic”
“the schizophrenic”
“stutterers”
“cleft palates”
“the hearing impaired”
Further, emphasize the person, not the disability, by putting the person-noun first.
Use:
“people with cleft palate”
“the lawyer who has dyslexia”
“persons who stutter”
“the speech of children with language impairment”
“the speech of individuals who stutter”
Avoid:
“cleft palate children”
“the hearing impaired client”
“the dyslexic lawyer”
“the retarded adult”
Is there a difference between “to be” and “to have”? Between saying a person “with a hearing loss” and
saying a person “is hearing impaired”? Some have suggested that “to have” may imply possession and
“to be” may imply identity.3 Thus they argue that it is less stigmatizing to use “have” than “be”.
“The deaf” and “the speech of the deaf” also violate the person first rule. However, the community of
persons who are deaf prefer to use deaf with a capital D to denote the Deaf culture and the Deaf
community, not the hearing loss. As a general rule, we may wish to follow the preferences of a disability
group, even if it violates other principles. The problems with following the desires of different groups occur
when one doesn’t know what the members of a group want or when the preferences of individuals in a
group differ.
In my opinion, “stuttered speech” is okay. “Stuttered” describes the speech. “Cleft palate speech” is not
ok, because the person (not the speech) has the cleft. However, “deaf speech” violates this rule, yet,
many people believe that “deaf speech” is acceptable.
Person-first language makes sentences more complicated. The consensus of the Publications Board on
November 19, 1992, was that deviations from person-first language should be allowed in cases when the
only alternative is awkward sentence structure. When publishing research reports in ASHA journals, it is
important to describe individuals with sensitivity. There are no absolute rules in regard to what language
is sensitive and what language is not sensitive. Clearly, the most appropriate approaches may differ
across different circumstances and different types of publications.
The clarity of research papers may be affected if one is required to use person-first language every time a
group of subjects from a specific population is mentioned. One approach may be to describe populations
with person-nouns first in the initial description of the subjects. Then one can refer to these descriptions
throughout the rest of the paper. It is more important to use person-first language when describing
individuals making up a group than when referring to the group. That is, although it may be preferable to
say “the group of individuals who are dysarthric” than to say “the group of dysarthrics” when stylistically
necessary, it may be appropriate to use “the dysarthric group”. The general rule is that person-first
language is more important than group-first language.
There are many examples in which we do categorize people and omit the person-noun and the personfirst position; for example, the audiologist (as opposed to “the person who performs audiological
services”), the speech-language pathologist, the professor, the professional, the teacher, the grandparent,
the leader, the pacifist, the hypocrite, et cetera. One could make the case that we should not categorize
the person by these attributes. Yet, “the person who grandmothers” is difficult to support as an alternative
to “grandmother”.
When the categorizing is negative, person-first language might be preferable. “The person with a criminal
record” may be better than “The criminal”. However, we may need to do the same thing for both positive
and negative attributes. If we use person-first language only for negative attributes, then person-first
language could take on a negative connotation. The way out of this is to assert that it is proper for society
to categorize people without person-first language in many instances, but that disabilities are not one of
them. Disabilities need not be defining characteristics in the way that a profession or role in society is.
There are many circumstances in which it may be appropriate to use the terms, “disability”, “disorder”, or
“impairment”. One needs to be sensitive to when it is, and when it is not, appropriate to use terms with a
negative connotation.
Principle Two: Disability versus Handicap
Disabilities, disorders, or impairments can be caused by birth defects, illnesses, or injuries; but disability is
a possible result, not a synonym, for the birth defect, illness, or injury.4,5 The public may have negative
connotations for sickness and disease (e.g., diseases are sometimes contagious, disabilities are not).
Inability differs from disability in that inability implies a total loss. The World Health Organization has
explicit definitions that distinguish among disabilities, disorders, and impairments; however, for most
purposes these terms are synonymous. Further, people have disabilities, not handicaps. Handicaps are
social or environmental obstacles imposed by society on those with disabilities.
To summarize:
Disability, disorder, and impairment can be synonyms.
Disability does not equal inability.
Disability does not equal birth defect, illness, disease, or injury.
Disability does not equal handicap.
People do not have handicaps; society imposes them.
Handicap is a useful term in golf and horse racing.
Some writers don’t like “birth defect” and “congenital anomaly”. Congenital disability can be substituted if
appropriate. A disabled computer, light switch, or bomb are objects that do not work at all. Here disability
really does not imply inability.
Principle Three: We all like to think of ourselves as normal
Individuals with disabilities are “normal” in many ways. Referring to persons without disabilities as normal
makes the inference that persons who have disabilities are abnormal.3 The term abnormal has a pejorative
flavor. At the least, normal should be used only in regard to explicitly defined limits for specific attributes.
Avoid:
normals
normal speakers
the speech of individuals who are normal
Use:
the speech of individuals with no history of speech, language, or hearing impairment
individuals who were judged to show no speech, language, or hearing impairment
children with normally developing speech and language
normal-hearing
hearing sensitivity within normal limits
normal speech (can be used when speech sounds normal and it can be produced in
some instances by individuals with speech impairments)
normal-language group (“group first” language is not always necessary)
Principle Four: Avoid terms that project an unnecessary negative connotation
It is desirable to avoid language that projects struggle, pain, or suffering when it is not necessarily part of
the circumstances being described. When suffering is a part of the message to be conveyed, it is
appropriate to use the term; for example, “tinnitus sufferer”. However, this may not always be clear-cut.
For example, some groups suggest avoiding the term “hard of hearing” because it implies struggle. Other
groups (e.g., the Commission of Persons with Disabilities”6 version 2 and presumably Self-Help for Hard of
Hearing People, Inc.) prefer “hard-of-hearing” to either “hearing impaired” or “hearing loss”.
Some authors have suggested avoiding the terms “dysfluency”.7 They prefer to use “disfluency”. They
claim that “dys” has more of a pathological flavor. The prefix “dis” means apart from. The prefix “dys”
means “difficult, painful, bad, or disordered”. This is clearly a judgment call and there is presently little
consistency among authors.7,8
In general, avoid the following: 1,2,4,6,9
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
patient (use client for most recipients of clinical services because patient may denote sickness
or medical intervention, patient is appropriate for individuals who are patients in a hospital
confined to a wheelchair, restricted to a wheelchair, wheelchair bound (people receive mobility
from
wheelchairs, not confinement)
victim (this implies a desire for sympathy)
cripple, crippled, the crippled, lame, the lame
deformed (may imply ugly)
deaf and dumb, deaf mute (needs no justification)
afflicted with, stricken with, suffering from (say the person has)
invalid (not valid)
courageous, brave, inspirational (not all people with disabilities have these traits)
unfortunate, pitiful, poor (condescending when used in reference to a disability)
incapacitated (there are still capacities)
retardate, mongoloid, idiot, moron, mentally deficient, mentally defective, imbecile, feeble
minded (use “persons with mental retardation” or “children with developmental delay”)
mentally deranged, mentally ill, mentally deviant, maniac, crazy, lunatic, mad (use “persons
with a mental disorder”)
deafening silence, blind rage, blind faith, turned a deaf ear, lame excuse (avoid metaphors with
pejorative connotations)
fit (use “seizure” when applicable, “Fit” may be an appropriate synonym for tantrum)
spastic (use only to describe muscular spasticity, not all types of cerebral palsy involve
spasticity, muscles are spastic--not people)
hare lip (does not compliment people or rabbits. Use cleft lip)
Principle Five: Don’t overdo it
Be careful with the term “special”. In some respects, we are all special. From another perspective, people
with disabilities are not necessarily special even if they are enrolled in “special education”.
“Language challenged” or “hearing challenged” may imply that one needs to try harder than they are trying
at present.
Blatant euphemisms (differently hearing, physically different, differently-abled, speech inconvenienced,
vertically challenged, horizontally challenged, chronologically gifted) don’t hide disability, but they can
produce confusion. It is not more sensitive to refer to individuals who are physically within normal limits as
temporarily able-bodied (TaBs) or momentarily able-bodied (MaBs).3
References
1. National Easter Seal Society, “Portraying people with disabilities in the media”. undated pamphlet.
2. National Rehabilitation Association Newsletter, “Language Awareness,” March, 1985, unauthored
statement.
3. Journal of the Disability Advisory Council of Australia (formerly the Australian Rehabilitation Review),
“The language of disability: Problems of politics and practice,” volume 1, issue 3, pages 13-21, 1988,
no author listed.
4. Monjar, Stephen, “What do you say after you see they’re disabled?” The Rehabilitation Institute of
Chicago, undated pamphlet.
5. National Easter Seal Society, “Awareness is the first step toward change: tips for disability
awareness,” undated pamphlet.
6. Commission of Persons with Disabilities, Iowa Department of Human Rights, “Use words with dignity,”
undated, unauthored one-page handout. There are two different versions of this handout.
7. Quesal, Robert, “Inexact use of ‘disfluency’ and ‘dysfluency’ in stuttering research.” Journal of Speech
and Hearing Disorders, 53: 349-350, 1988.
8. Bernstein Rattner, Nan. “Response to Quesal: Terminology in stuttering research.” Journal of
Speech and Hearing Disorders, 53: 350-351, 1988.
9.
National Easter Seal Society, “Awareness is the first step toward change: tips for portraying people
with disabilities in the media,” undated pamphlet.
SAMPLE REPORTS
CLEVELAND HEARING and SPEECH CENTER
SPEECH/LANGUAGE EVALUATION
NAME:
ADDRESS:
PHONE:
PARENTS:
REFERRED BY:
CASE NO: 96DATE OF BIRTH/(AGE):
DATE OF EVALUATION:
CLASSIFICATION:
CLINICIAN: student/supervisor
REPORTS TO:
SUMMARY OF FINDINGS
Write a 1-2 paragraph summary which notes the primary areas of concern with severity ratings. Should address
receptive language, expressive language (note how child communicates, i.e., single words, phrases, simple
sentences), speech sound skills, oral mech, hearing. Be sure to address all relevant components of language.
May also note areas of strength or areas of particular concern. This section should provide the reader (i.e., the
referring physician) with a focused summary of the most relevant information. The information should lead the
reader to accepting the recommendations that are written in the Plan of Care section.
PROGNOSIS
as indicated by
. (Support your prognosis with
The prognosis for improvement is
factors which may affect improvement--i.e., consistent attendance in therapy, follow-through on goals in the home,
family support, motivation, etc.)
RECOMMENDATIONS/PLAN OF CARE
1. Receive therapy if appropriate and note possible broad areas of goals for intervention. If measures still need
to be completed, include them here (i.e., hearing screening, oral mechanism exam, further analysis of
spontaneous language, etc.).
2. May recommend follow-up by other professionals.
3.
4.
FIRST PAGE SHOULD END HERE. EVERYTHING THAT A PHYSICIAN WOULD NEED TO KNOW SHOULD
APPEAR ON THIS TOP PAGE OF THE DIAGNOSTIC REPORT.
Page 2/Last name, first
Case No: YRSpeech/Language Evaluation
INCLUDE THIS HEADING ON EACH PAGE
CASE HISTORY
First sentence should be a "statement of the problem" that led the family to seeking the diagnostic (Example:
John was referred for a speech/language evaluation due to concern about delayed communication
skills/unintelligible speech, etc.). Then move into a brief summary highlighting relevant information. Case history
section is typically 2-3 short paragraphs, unless you have a client with a significant history that requires a longer
narrative.
Organize your case history information into sections--one paragraph on medical history, one paragraph on
developmental milestones, one possibly on family history. When you write these sections, introduce the topic of
the paragraph to the reader (Example: In regards to medical history... A review of developmental milestones
indicated... John currently lives with his ...).
STANDARDIZED MEASURES
Provide listing of standardized measures (also MLU, Play level) completed during diagnostic.
TESTS/SUBTESTS
STANDARD SCORE
PERCENTILE INTERPRETATION
RESULTS AND INTERPRETATION
Start off this section with information on how long the diagnostic was and whether parent was in room or
observing. Make comments on whether results are considered valid measures or preliminary measures of ability.
This section includes your interpretation of the results. Organize the info into sections with subtitles if appropriate
(For young children with limited Skills, this may not be needed.). Once again, introduce each paragraph with the
topic to be discussed. Include interpretation based standardized measures, non-standardized measures, and
information from parent interview. Your interpretation may include statements noting where the child should be for
their age.
Cognitive Skills -- Discuss your observations on cognitive skills based on the limited screening measures
that you use. This section should give the reader an orientation as to whether the child appeared to be
functioning at a level appropriate for their chronological age or not. If delays were noted across domains of
learning, note this here. This section should help provide a baseline level for our expectations for
communication skills.
Receptive Language
Expressive Language
Speech Sound Skills
Oral Mechanism and Hearing
CASE DISPOSITION
Note where case is in terms of agency status. Is case open and child on waiting list, is case being closed and
client referred to another agency -- if so, note this. It is the responsibility of the clinician to follow a case until it is
on the waiting list or closed.
Your name, degree
Graduate Student Clinician
Supervisor's Name, degree, CCC-SLP
Supervisor's title (ask them what it is)
Ohio License SP-XXXX (ask them their #)
SAMPLE REPORT -- SCHOOL AGE
CLEVELAND HEARING and SPEECH CENTER
Speech/Language Evaluation
NAME:
ADDRESS:
Mike
N. Olmsted, OH 44070
PHONE:
PARENTS:
Cindy
REFERRED BY: Jane Doe
CASE NO: 96DATE OF BIRTH/(AGE): 7-13-87 / (8;6 yrs.
DATE OF EVALUATION: 1-26-96
CLASSIFICATION: Expressive & Receptive Language
Deficit
CLINICIAN: Suzie Q.
REPORTS TO: Parents
SUMMARY OF FINDINGS
The results of the speech/language evaluation indicated that Mike has a moderate deficit in receptive and
expressive language skills and a mild-to-moderate deficit in articulation abilities. Difficulties in attending to
structured tasks were also noted. Mike showed age appropriate skills in both understanding and producing
vocabulary at a single-word level. Deficits were noted in language comprehension when word relationships were
explored beyond the single word level. Mike also performed below normal across expressive language tasks
including sentence repetition skills, and on sentence formulation tasks. It is felt that weaknesses in oral language
abilities have influenced Mike's ability to acquire written language skills. It will be important to focus on improving
oral language skills while working on acquisition of reading and writing skills. Additionally, intervention strategies
may need to be developed to increase Mike's ability to participate independently in structured tasks.
In regards to speech sound skills, Mike's speech was mildly-to-moderately unintelligible due to decreased
loudness and errors in production of the /r/ sound and r-blends (consonant and vowel combinations). An oral
mechanism examination indicated that structures and functioning were generally adequate for speech production.
Hearing was screened and found to be within normal limits.
PROGNOSIS
Prognosis for improvement is good if language intervention services are implemented in conjunction with a
reading/writing tutoring program. Prognosis for improvement is dependent upon coordination of services and
intervention strategies between the school, the home, and tutoring programs to maximize Mike's skill acquisition.
RECOMMENDATIONS/PLAN OF CARE
1. Mike should be enrolled in speech/language intervention services focusing on improving both receptive and
expressive language skills for a period of not less than six months. Prior to identifying specific intervention
objectives, measures of Mike's spontaneous communication skills should be completed including evaluation of
complexity of syntax, vocabulary, and narrative skills. Information on classroom communication patterns would
also be useful. Services could be received through private sources or through the public school program.
2. This information should be shared with Mike's school program and with professionals involved in evaluating
Mike's abilities. When a plan of action is developed for Mike, this information should be incorporated into the plan.
Page 2/
, Mike
Case No: YRSpeech/Language Evaluation
CASE HISTORY
Mike was referred for a speech/language evaluation due to concern about his performance at school. Recently,
the North Olmsted school district requested a multi factored evaluation of Mike (including an evaluation of
speech/language skills), which the parents have elected to have completed outside of the school system. Specific
concerns include significant difficulties with reading skills. Cindy, Mike's mother, reported that he has shown a
consistent pattern of being slow to acquire skills, but then reaches the level of his peers over time. A
speech/language evaluation was sought in order to rule out speech and hearing difficulties as influencing factors
on Mike's reading skills and academic performance.
Mike's initial school experiences were in a Montessori-based program for two years of preschool and kindergarten.
During the last year of Montessori programming, concerns were expressed about Mike's skills in pre-reading
areas. In the Montessori program, Mike was exposed to pre-reading skills using a phonics approach. When Mike
was enrolled in the public school program in first grade, concerns about reading difficulties were noted
immediately. Cindy initiated reading tutoring privately in December of that year and the tutor used a sight word
approach, which Mrs.
now feels may not have been the best option for Mike with his Montessori background.
The reading tutoring continued through summer of 1995, but stopped in the fall. A new reading tutor has recently
been hired who is trained in a method called "Reading Recovery." She is currently working with Mike three times
per week. According to Cindy, the tutor is optimistic that Mike will have grade appropriate reading skills (beginning
third grade level) by next fall, if Mike continues to progress at his current rate in the tutoring program.
Case history review indicated that Mike has had no serious medical conditions, except for a few bouts of otitis
media as a young child. Language milestones have been consistently slow with phrases and sentences not
produced until he was three years old. Motor skills have developed within normal limits.
Mike is the youngest of four children. He lives with his brothers, mother and stepfather in North Olmsted.
STANDARDIZED MEASURES
Clinical Evaluation of Language Fundamentals-Revised (CELF-R)
Standard Score
Subtests
Oral Directions
8
Word Classes
6
Semantic Relationships
6
Percentile
25th
9th
9th
Formulated Sentences
Recalling Sentences
Sentence Assembly
7
5
6
16th
5th
5th
3
2
2
Composite Scores
Receptive Language
Expressive Language
78
73
7th
4th
2
1
Age Equivalent Score:
6;2 years
Peabody Picture Vocabulary Test-Revised (PPVT-R)
Standard Score: 104
Percentile: 61st
Age Equivalent: 9;1 years
Stanine: 6
Expressive One-Word Picture Vocabulary Test (EOWPVT-R)
Standard Score: 100
Percentile: 50th
Age Equivalent: 8;6 years
Stanine: 5
Page 3/
Stanine
4
2
2
, Mike
Case No: 96Speech/Language Evaluation
RESULTS AND INTERPRETATION
Mike was seen for a two-hour speech/language evaluation. He was accompanied to the evaluation by his mother
and step-father, who observed the evaluation through the two-way mirror. During the evaluation, it was frequently
necessary to re-direct Mike's attention to the structured tasks. He often requested to go see his mother, and
visited the restroom for long periods of time on three occasions during the two-hour period. (Mrs.
noted that
Mike may have had a stomach bug that morning, but that extensive bathroom visits are common for him in the
home and at school). Compared to other children his age, Mike showed difficulties being able to attend to the
structured tasks. Fewer activities were completed in the two hour period than are typically accomplished with a
second grader. Mike's difficulties attending to the structured tasks seemed to be related motivation rather than to
actual attention difficulties. Children with language deficits often experience motivational difficulties with language
tasks, because the tasks are difficult for them to participate in; therefore, avoidance techniques (i.e., leaving the
room) may be used. Despite motivational influences, the results of the measures are considered valid measures
of Mike's current skills.
As a whole, the results of the speech/language evaluation indicated that Mike has moderate deficits in both
receptive and expressive language domains. Additionally, he showed a mild-to-moderate deficit in articulation
Skills. In order to interpret the language measures accurately, it is necessary to have an I.Q. measure to use as
the baseline expectation level. For purposes here, it will be assumed that Mike's I.Q. is at an average level (100).
When the psychological test results are available, it may be appropriate to alter this interpretation of the language
scores in relation to actual I.Q. measures.
Language Comprehension Skills
Language comprehension measures indicated that Mike's understanding of single-word vocabulary, as measured
by the Peabody Picture Vocabulary Test (Revised), was an area of strength. Mike performed within normal limits
with a score just above expectations for his age level. Mike's mother and step-father confirmed that vocabulary
skills are an area of strength for him. Receptive single-word vocabulary skills were stronger than expressive
single-word vocabulary abilities. Mike also performed within normal limits on the Oral Directions subtest. He was
able to follow commands that included identification of at least two shapes described with one to three descriptors
each (e.g., "Point to the small white square and the last little triangle). On this task, oral directions are evaluated
in a context requiring knowledge of only a few linguistic concepts (e.g., shapes, colors, sizes, location (first, last),
and the subtest measured Mike's ability to follow commands of increasing length. Mike was able to follow these
types of commands without difficulty.
Moderate deficits in language comprehension were experienced when vocabulary skills were evaluated further.
Difficulties were noted when semantic skills were evaluated beyond a single-word level. Mike performed below
normal limits on one task that required him to identify tow related words from a set of four words (e.g., find the two
that go together: down old thin up). On this task, Mike was orally given the four words. Identification of the
two correct items require that Mike retain the four target words and identify which two had some type of
relationship to one another (synonyms, antonyms, or similar concepts). When Mike experienced difficulty, he
often repeated to last two items (on 9/14 incorrect responses). On another receptive semantic task (Semantic
Relationships), Mike showed significant difficulties across all four types of semantic concepts assessed
(comparatives, spatial, passive, and temporal). Weaknesses in completing the tasks could have been related to
difficulties with the task and/or difficulties with the concepts being measured. However, since Mike was able to
follow long commands on the Oral Directions subtest where vocabulary was controlled, it was felt that difficulties
here were related to weaknesses in utilizing more abstract semantic concepts in problem solving situations.
In summary, Mike showed age appropriate skills in comprehension of single-word vocabulary and comprehension
of commands of increasing length with controlled vocabulary. Significant weaknesses were noted in word
knowledge beyond the single word level. Difficulties were most apparent when Mike had to retain items and
indicate concepts related to word relationships. On the receptive language composite score of the CELF-F, Mike
performed more than one standard deviation below normal. Deficits in comprehension of oral language could
impact on Mike's ability to comprehend information in written language as well.
Expressive Language Skills
Similar to language comprehension results, single-word vocabulary knowledge was an area of strength in
expressive language. Mike performed at an average level for his age level in identifying pictures with a single
word label.
Significant deficits were noted on expressive language measures on the CELF-R where language expression
skills were measured at a sentence level. Mike performed more than one standard deviation below normal
(Standard Score 74; 4th percentile) indicating significant deficits in this area. Mike showed difficulties repeating
sentences verbatim, often altering vocabulary items and grammatical markers while retaining meaning. He also
showed difficulty making sentences from scrambled phrases, when required to provide at least two versions. On
the Formulated Sentences subtest, Mike was asked to make a complete sentence that went with a picture using
one or two target words in the sentence. He typically responded with an incomplete phrase, rather than providing
a complete sentence.
There was limited opportunity to measure Mike's spontaneous communication skills. Observations indicated that
his sentences were complete grammatically and that ideas were sequenced adequately. It was not possible to
determine whether vocabulary skills were adequate and whether Mike was utilizing complex syntax constructions
in his sentences. Parent report indicated that in conversation Mike is able to express his ideas clearly, that he
provides details and that he is able to retell past events without difficulty. It should be noted that students with
semantic deficits are typically able to express their ideas in a correct sequence, but they tend to provide reduced
information (details, specifics) even when prodded to provide more information. Before specific language
objectives are defined for Mike, it is recommended that measures of his spontaneous communication skills be
completed.
In summary, expressive language skills were moderately delayed compared to age level expectations on
standardized measures. Such expressive language deficits have likely contributed to Mike's difficulties in
acquiring written language skills.
An additional concern from this evaluation is Mike's ability to attend to and participate in structured tasks.
Difficulties on the day of the evaluation in a one-on-one context, suggested that such attention and participation in
structured tasks may be of even more concern in a classroom where there are more children and less adult
attention. As noted, motivation may have played a role during this evaluation. It is also possible that Mike's
difficulties in attending to and participating in structured tasks are influenced by weaknesses in language
comprehension and production. Participation in language activities may elicit decreased willingness to participate,
because these activities are difficult for Mike. Such factors could influence classroom performance, where so
many academic tasks require adequate language skills. Another factor that may contribute to difficulties is social
maturity, which may influence ability to participate in tasks more independently. It was felt that Mike appeared less
mature socially than other boys his age.
While it may not be possible to determine how all these factors inter-relate to one another, it will be important to
identify multiple factors which may contribute to or diminish Mike's ability to perform successfully in class.
Discussions about intervention strategies should attempt to identify influencing factors and help to shape Mike's
skills and coping strategies to maximize his performance.
Speech Sound Skills, Ora; Mechanism and Hearing
Spontaneous measures of Mike's speech sound abilities were completed during the evaluation. Mike's speech
was often unintelligible due to decreased loudness. Mike incorrectly articulated the /r/ sound and produced
consonant blends with the /r/ incorrectly, reducing the sound to a single vowel. Stimulability testing produced
vowel + r combinations incorrectly, reducing the sound to a single vowel. Stimulability testing indicated that he
was able to produce the /r/ at a sound level correctly with a model and could inconsistently produce single
syllables with an initial /r/. He could not imitate words with an initial /r/ correctly. It is felt that Mike has a good
prognosis for improving his speech patterns if speech therapy services are initiated. It is also felt, however, that
Mike's language deficits are of more concern, at this time, than his inaccurate production of /r/ sounds.
An examination of Mike's oral mechanism indicated that structures were adequate for speech production. Mike
showed some difficulties in rapid movements of the tongue and lips. Slowness was noted in lateral movements of
the tongue outside of the mouth and movement of the articulators during attempts to elicit rapid syllable patterns.
Mike's speech, however, was intelligible the majority of the time; thus, it is not felt that there are any significant
deficits in speech production skills.
Mike's hearing was screened and found to be within normal limits. There are not concerns with hearing abilities at
this time.
CASE DISPOSITION
The results of the evaluation will be discussed with Cindy
. Attempts have been made to reach her by
phone. This case will remain open; if no further services are needed within a month, this case will be closed.
Mike's parents should feel free to contact this clinician at any time in the future for assistance as needed.
M.S., CCC-SLP
Pediatric Program Specialist
Ohio License SPXXXXX
SAMPLE HOSPITAL REPORT
, John
CLIENT:
D.O.B.: 9-29-88
DATE OF EVALUATION: 9-27-90
SUMMARY OF SPEECH/LANGUAGE EVALUATION
John was seen for a speech/language evaluation due to concern about delayed vocabulary development. John
has a history of middle-ear infections and extensive hospitalizations due to nutritionally related medical factors.
The speech/language evaluation was conducted using standardized testing, spontaneous communication
measures and parent report.
On the expressive subtest of the Battelle Developmental Inventory (BDI), John obtained an age equivalent score
of 14 months, which was at the first percentile compared to other children his age. John communicated primarily
using complex gestures and sounds. Sound productions consisted of CV and reduplicated CVCV syllables as well
as the use of isolated consonant sounds. Sounds noted during the evaluation were used occasionally but not
consistently. Mrs. W reported that words are often used for a period of time and then disappear from use.
Language comprehension skills were estimated using the BDI and found to be at a 21-22 month level, which was
at the 27th percentile compared to other children John's age. John was able to follow simple commands and to
locate a variety of familiar objects, He also demonstrated comprehension of the possession relation (e.g., mama's
nose vs John's nose). Mrs.W noted that at home John's comprehension of familiar routines is excellent.
John demonstrated the use of multiple play sequences and extended play sequences to other agents (i.e.,
combed mom's hair). Thus, his play skills appeared to be age appropriate, suggesting no concerns about his
cognitive skills.
John presented as a child with specific language impairment. That is, his development across skills appears to be
age appropriate except in the domain of communication Skills. It is felt that his extensive medical difficulties,
including frequent hospitalizations as well as the ear infections, may have contributed to his language delays.
However, they most likely did not cause the deficit.
RECOMMENDATIONS
on 10-2-90. The following recommendations
The results and recommendations were discussed with Mrs.
were made:
1. John should be enrolled in speech/language intervention services one to two times per week for a
minimum of six months. The focus should be on developing an expressive vocabulary through direct services
and parent training.
should try to use one and two words when communicating with their son. That is,
2. Mr. and Mrs.
they should focus on modeling single word productions. Additionally, play activities should focus on
imaginative play and sequences of play within a related scheme (i.e., having Fisher Price man buy gas, then
drive to mall, then buy ice-cream cone in the mall).
CASE DISPOSITION
elected to receive speech/language services through Cleveland Hearing and Speech Center even
Mrs.
though that would require a long drive for the family. Mrs.
will initiate services by contacting this clinician
directly when John is recovered from his most recent surgery.
M.S., CCC-SLP
Pediatric Program Specialist
Ohio License SP
CLEVELAND HEARING and SPEECH CENTER
SAMPLE SPEECH LANGUAGE CONSULTATION #1
NAME:
ADDRESS:
C
Willoughby OH 44094
PHONE:
440
REPORTS TO: Mother
CASE NC.: 96BIRTHDATE/(AGE): 04/19/85 (11;2)
DATE OF EVALUATION: 06/19/96
CLASSIFICATION: Fluency
CLINICIAN: Suzie Q.
EVALUATION SUMMARY
This consultation revealed a severe fluency disorder. Core behaviors consisted of sound and syllable repetitions.
Secondary behaviors consisted of had nodding, eye blinking, and finger rubbing. C was very polite but somewhat
reticent when discussing his stuttering. Receptive and expressive language skills were not evaluated. Articulation
skills were recently assessed by the Speech-Language Pathologist with the
Schools; however, no formal
report was available. During this consultation, C was observed utilizing /w/r/ substitutions and an occasional
distortion of /s/. An oral mechanism examination revealed structures and functions adequate for speech sound
production. A hearing screening revealed hearing acuity within normal limits
PROGNOSIS
Prognosis for increased fluency is good with consistent therapy.
RECOMMENDATIONS/PLAN OF CARE
1. Enrollment in one hour individual therapy per week for a minimum of six months to target fluency shaping
techniques (diaphragmatic breathing, pre-voice exhalation, and easy vocal onset), and elimination of secondary
behaviors.
2. Enrollment in one hour group therapy per week targeting feelings and attitudes toward stuttering. This group
therapy will also facilitate transfer.
3. To coordinate the services received at Cleveland Hearing and Speech Center with the services C will be
receiving through his IEP for the 1996-97 school year.
,C
Speech-Language Evaluation
June 19, 1996
Page - 2 STATEMENT OF PROBLEM/HISTORY
C, age 11 years 2 months, was seen at the Cleveland Hearing and Speech Center on June 19, 1996 as part of the
summer fluency program. C was enrolled in the summer fluency program in order to continue speech remediation
during the summer months. He was accompanied by his mother and father.
C has been receiving speech therapy for stuttering and articulation. He stated that during therapy, he worked on
elongating and pull-out and to breathe before every sentence. C stated that he felt these techniques did help him
to be more fluent.
CLIENT / PARENTAL INTERVIEW
C, as well as his mother and father, stated that his stuttering was worse when he talks in front of the class, reads
out loud, or talks to strangers. C feels that he stutters everyday and ranks his stuttering at this time as a A5" on a
ten-point scale (10 = severe, 1 = fluent). His parents added that there are days as well as periods when he is
much more fluent and when he is extremely disfluent. He expressed having the most difficulty when speaking to
strangers and when saying “w” words. C stated that if he kept his answers to a yes or no response in class, that
he did not stutter. C’s mother and father have noticed that he is more disfluent when he is tired or nervous and
he avoids placing his own orders with the server at restaurants.
C employs a constructive strategy when he is teased at school; he informs the teachers so they can speak with
the offending children. He expressed feeling sad and mad when he is teased. C stated that when he stutters in
front of his friends, they just try to listen. When someone tries to help him finish a word or sentence, C lets them
do it but he doesn’t like it. He stated that it upsets him.
C stated that his mother, father and brothers are very supportive. He commented that it is easier for him to speak
at home with his family than with others outside the home. The family does discuss C’ s stuttering openly in the
home when the subject arises.
During the moment of stuttering, C stated he feels tight and “like you just want to get the word out.” When asked if
he really wanted to be here, he replied no because it’s summer and he just wants to have fun.
STANDARDIZED TEST MEASURES
A baseline was obtained using the CAFET diagnostic program in order to measure C’s breathing and voicing
pattern.
Characteristics
breath groups/min.
% voiced cycles
% v.c. with held breath
% v.c. with speech onset delay
Ave. % of phonation breaks
% speech time
% v.c. with low air
Spontaneous Speech
22.1
91.8
16.1
12.0
18.1/min.
46.0
41.1
Oral Reading
24.3
100.0
2.7
0.0
5.6/min.
88.8
30.1
During six (6), one-minute spontaneous speech samples, C was found to hold his breath during speech, exhibit
delayed voicing, and speak on low air. He demonstrated several phonation breaks within a breath and had a low
percentage of talk time. Based upon normal criteria, C’s test results for percentage of breath holding, low air, and
delayed onset of voicing were all significantly above normal. His percentage of talk time was below normal. His
oral reading results were much better, possibly reflecting previous therapy which utilized reading for a therapy
medium. His number of breath groups were within normal limits; however, he still exhibited a significant
percentage of speaking on low air. This would indicate that C tends to breath very shallow, perhaps using
clavicular or thoracic breathing rather than diaphragmatic.
The Stuttering Severity Instrument (Riley, 1972)
Job task:
percentage
Reading task:
percentage
37%
35%
score 9
score 9
,C
Speech-Language Evaluation
June 19, 1996
Page - 3 Duration:
Physical concomitants:
10 to 30 seconds
eye blinking
head nodding
finger movement
Total overall score:
Severity:
30
Severe
score 5
The spontaneous speech sample and reading samples were characterized by mainly sound repetitions and
occasionally syllable repetitions. The repetitions would often last 10 to 30 seconds in duration. Secondary
characteristics during the spontaneous sample consisted of eye blinking, head nodding, and finger rubbing. C’s
stuttering decreased slightly during the reading task. C appeared to have a significant amount of difficulty with
words that began with /w/. This also includes any words beginning with /r/, since C substitutes /w/ for /r/. Words
beginning with “wh” also appear to cause a great amount of difficulty.
Additional Testing
An informal assessment of C’s receptive and expressive language abilities was conducted and they appeared to
be within normal limits. Articulations skills were not re-evaluated during this consult. However, words beginning
with /r, s, w/ and “wh” were targeted in isolation and in sentences. In the pre-diagnostic questionnaire completed
C and Mrs. B, they had indicated an increased amount of difficulty in articulation as well as disfluency of words
beginning with those sounds. The informal assessment revealed a /w/r/ substitution and an occasional slight
distortion (lateralization) of /s/. C demonstrated 90 - 100% disfluency in words and sentences in which he
articulated “w” (w, r, wh) as the initial phoneme. An oral mechanism examination was conducted and all
structures and functions appear to be within normal limits. A hearing screening revealed hearing to be within
normal limits.
CASE DISPOSITION
Results of this evaluation were shared with C and his parents. Mr. and Mrs. B have expressed an interest in
enrolling C in the Summer Fluency Program at the Cleveland Hearing and Speech Center. C has been enrolled in
one hour individual and one hour group therapy for the summer session. This case is open.
Suzie Q., MA, CCC-SLP
Speech-Language Pathologist
Ohio License SP #
Graduate Student
Case Western Reserve University
CLEVELAND HEARING and SPEECH CENTER
SAMPLE SPEECH LANGUAGE CONSULTATION #2
NAME:
ADDRESS:
X
Cleveland OH 44106
PHONE:
216
REPORTS TO: Mother
CASE NC.: 96BIRTHDATE/(AGE): 02/13/82 (14;4)
DATE OF EVALUATION: 06/18/96
CLASSIFICATION: Fluency
CLINICIAN: Suzie Q.
EVALUATION SUMMARY
This consultation revealed a moderate fluency disorder. Core behaviors consisted of blocks characterized by
increased upper body, neck and facial tension. Secondary behaviors consisted of leg movements, hand slapping,
finger movements, and jerking back into the chair. X was fairly sociable and very willing to talk about his
stuttering. Receptive and expressive language skills were not evaluated. Articulation skills recently assessed by
the Speech-Language Pathologist with the
Schools were reported to be within normal limits. An oral
mechanism examination revealed structures and functions adequate for speech sound production. A hearing
screening was not conducted due to time constraints.
PROGNOSIS
Prognosis for increased fluency is good with consistent therapy.
RECOMMENDATIONS/PLAN OF CARE
1. Enrollment in one hour individual therapy per week targeting fluency, shaping techniques (diaphragmatic
breathing, pre-voice exhalation, and easy vocal onset), and elimination of secondary behaviors.
2. Enrollment in one hour group therapy per week targeting feelings and attitudes toward stuttering. This
group therapy will also facilitate transfer.
3. To conduct a hearing screening within a therapy session in order to confirm normal hearing.
4. To assist Mrs. B in obtaining additional speech services in his new school for the 1996-97 school year.
, X
Speech-Language Evaluation
June 18, 1996
Page - 2 STATEMENT OF PROBLEM / HISTORY
X, age 14 years 4 months, was seen at the Cleveland Hearing and Speech Center on June 18, 1996. The
appointment was made by his mother due to an increase in his disfluencies over the past few months. He was
accompanied by his mother and his best friend, R.
X received speech therapy for stuttering during third and fourth grade through his school. According to his mother,
the speech therapist referred to X’s disfluencies as “blocks.” He stated that during therapy, he was asked to
read and talk out loud while using the fluency strategies he had been taught. The strategies were to stop and start
again when he stuttered. X stated that he felt these techniques did not help him with his disfluencies.
CLIENT / PARENTAL INTERVIEW
X and his mother both stated that his stuttering has increased in the past few months, especially when he reads
out loud, talks on the phone, or gives a speech in class. X feels that he stutters a little everyday but ranks his
stuttering at this time as a A7" on a ten-point scale (10 - severe, 1 = fluent). He expressed having the most
difficulty when speaking to strangers and during classes. X did state that if he kept his answers short in class, he
was more fluent. Neither his mother nor X have noticed any differences in X’s stuttering when he is tired, angry,
happy.
X maintains a healthy attitude about his stuttering even though he has occasionally been teased by school mates
and received a poor grade on an oral report given for speech class this year. X expressed feeling nervous before
he gave his report. After receiving his grade from his teacher, he attempted to explain to her that he stutters.
However, X states that the teacher did not accept his explanation and the grade the same.
During the moment of stuttering, X stated that he feels like he can’t breathe. He also agrees that he has tension
in his chest and head. He said that sometimes after he stutters that his head hurts. X has expressed a desire to
enroll in speech therapy at this time.
STANDARDIZED TEST MEASURES
A baseline was obtained using the CAFET diagnostic program in order to measure X’s breathing and voicing
patterns.
Characteristics
breath groups/min.
% voiced cycles
% v.c. with held breath
% v.c. with speech onset delay
Ave. % of phonation breaks
% speech time
% v.c. with low air
Spontaneous Speech
7.6
64.5
60.0
5.0
22.3/min.
48.4
20.0
Oral Reading
10.3
100.0
32.2
51.6
7.3/min.
36.5
25.8
During three (3), one-minute spontaneous speech samples, X was found to often exhale rapidly during a block,
speak rapidly on low air, or hold his breath during his speech sample. He demonstrated several phonation breaks
within a breath and had several delayed voice onsets. Based upon normed criteria, X’s test results for
percentage of breath holding, low air, fast air flow, and delayed onset of voicing were all significantly above
normal. His percentage of talk time was below normal.
The Stuttering Severity Instrument (Riley, 1972)
Job task:
percentage 20%
Reading task:
percentage 23%
Duration:
2 to 9 seconds
Physical concomitants:
jaw muscles tense
poor eye contact
leg, finger, and body movements
Total overall score:
23
score 8
score 8
score 4
_______, X
Speech-Language Evaluation
June 18, 1996
Page -3Severity:
Moderate
The spontaneous speech sample and reading sample were characterized by inaudible blocks of approximately 2-9
seconds duration. Secondary characteristics during the spontaneous sample consisted of eye movements
directed up and away from the listener, repetitive “together then apart” leg movements, and flicking-like motion
with his fingers. X’s stuttering increased slightly during the reading task as well as the duration of the blocks.
The “up and away” eye movements increased during reading. There appeared to be a noticeable increase in jaw
tension. His leg and finger movements decreased.
Additional Testing
An informal assessment of X’s receptive and expressive language abilities were conducted and they appeared to
be within normal limits. Articulation skills were not re-evaluated during this consult. An oral mechanism
examination was conducted and all structures and functions appear to be within normal limits. A hearing
screening was not evaluated at this time due to time constraints.
CASE DISPOSITION
Results of this evaluation were shared with X and his mother. Mrs. B has expressed an interest in enrolling X in
the Summer Fluency Program at the Cleveland Hearing and Speech Center. X has been enrolled in one hour
individual and one hour group therapy for the summer session. This case is open.
Suzie Q., MA, CCC-SLP
Speech-Language Pathologist
Ohio License SP #
Graduate Student
Case Western Reserve University
DIAGNOSTIC CASE FILE FORMS
•
•
•
•
•
•
Pediatric Case History Form
Audiologic Screening Test
Release of Information Forms
Client Intake Form
Cover Letter
Attendance Agreement
PEDIATRIC CASE HISTORY FORM
AUDIOLOGIC SCREENING TEST
C
COVER LETTER
May 25, 2004
<First Name> <Last Name>
<Address>
<City, State, Zip>
RE: Child
DOB: XX/XX/XXXX
Dear <Title> <Last Name>:
Thank you for contacting the Cleveland Hearing & Speech Center. We sincerely care about
the communication needs of you and your family.
Your child’s evaluation is scheduled for <Appointment Day>, <Appointment Date> at
<Appointment Time> with <SLP>, SLP at our University Circle office.
Please:
• Complete the enclosed forms before your arrival and bring with you to your
appointment.
• Arrive 15 minutes prior to your appointment time to complete patient registration.
• Remember to bring your insurance card(s).
• Be sure to contact your child’s primary care physician PRIOR to the appointment if your
insurance company requires a referral.
We look forward to seeing you. If you are unable to keep this appointment, please give us at
least 48 hours notice at (216) 231-8787 ex. 299.
Sincerely,
Client Relations
LANGUAGE SAMPLE COLLECTION: SOME TECHNIQUES, AND CONSIDERATIONS FOR INTERVENTION
The clinician who needs to collect a representative spontaneous language sample from a child faces no small test.
Beginning student clinicians may have the notion that language sampling procedures involve little advance
thought and planning, just some sharpened pencils for transcription, a working recording device and some toys or
books to “make the child want to talk”. Experience has shown that collecting a spontaneous language sample
from children is a challenge. The language measures derived when the sample is analyzed will be as valid as the
sample is both accurate and representative. Therefore, it is important that we consider the following:
1. When interacting with a child, do I share information as well as the opportunity to generate the topic of
conversation?
2. Am I able to converse at an interest level appropriate for the child?
3. Do I constrain the child’s productions by using too many interrogative forms? Are there ways of increasing
the open-endedness of questions?
4. How often do I tell children what to do, think or feel rather than give opportunities for them to tell me?
5. Do I really listen when children speak to me? Am I sure that my “listening behavior” is evident to the client?
6. How often do I use incomplete sentences, sentence fragments and automatic (stereotypical) speech? Do I
sound redundant?
7. Do I set up activities conducive to speech and thus, exchange of information?
8. How many different speaking environments do I provide for the child with different settings, expectations and
listeners?
9. Are the situations I choose reality-based? Do they lead to positive feeling between client and clinician?
Several types of intervention strategies follow. Many are fancy labels for sensical, natural dialogues which occur
daily at home or in the classrooms. Two categories of strategies, adult initiated and child initiated, are delineated.
Adult Initiated
1. Parallel Talk: As the adult and child are interacting together in an activity such as water play or making juice,
the adult describes the activities, names the objects, etc., which correspond with the immediate situation:
“Sherry is stirring the juice”, “You are pushing the boat”, and so on. The adult could also narrate what
she/he is doing as they interact together: “I’m using the big white spoon”, or could narrate the actions of a
doll, puppet, etc., “The girl jumped in the water”. The child could be nonverbally cued (a nod, glance) to join
in the verbalizing. A more direct procedure would be warmly instructing the child to: “Tell about what you are
doing”.
2. Question-Answer-Question: To insure a more positive situation for question answering, this technique
provides the child a question, the answer, the question again and his/her opportunity to spontaneously
respond correctly: “What is on the table? A cup is on the table. What is on the table?” Child response: “
“.
3. Answer-Question: A variation on the preceding is offering the answer, asking the question and giving the child
“.
the opportunity to spontaneously answer: “this is a toy dog. What is this?” Child response: “
4. Close Technique or Open Ended: When beginning a project such as making playdough, the adult could begin
with an open-ended comment such as:
Adult: “Let’s make playdough...we’ll need uh...”
Child: “spoo”, etc., or
When the adult and child are prepared for an activity and have materials spread out, the adult might say:
Adult: “We have a lot of stuff; I wonder what we could do with it...”
Child: “Cut,” etc.
5. Backward Chaining: The adult provides a picture or object stimulus. The child should be familiar with the
label/action represented. The sentence presented by the adult has the target deleted at the end. The followup offering by the adult omits the final two words, and so on. The sequence builds to the entire sentence
being given by the child:
Child: “car”, etc.
Adult: “This is a
“
Child: “a car”, etc.
Adult: “This is
“
“
Child: “is a car”, etc.
Adult: “This
Adult: No verbal output but
Child: “This is a car”, etc.
holds the item.
Child Initiated
Note: Each of these procedures requires at least a single-word utterance generated by the child.
1. Expansion: This form of parent-child verbal interaction has been found to be very natural and frequent.
Brown and Bellugi (1964) noted the manner in which parents spontaneously complete the child’s original
utterance by adding the deleted syntactical elements. This is an immediate measure to acknowledge and
expand the child’s reduced comment at the time when it was uttered to insure relevance. An example could
be:
“Car go” (child)
“Yes, the car is going” (adult)
There seems to be some controversy over the usefulness of this technique. Some pitfalls of this intervention
strategy have been suggested. First, because this technique focuses heavily upon structure, it may restrict
the idea/intent of the child rather than extend it. Secondly, as the adult builds upon the child’s utterance
through the addition of grammatical elements, the final product may not represent the child’s intent. An
utterance such as “car go” could mean a variety of things and the adult’s expansion may not focus upon the
accurate intention of the child. Thirdly, the child’s attention span may not accommodate an overabundance
of expansions since he would be hearing basically an instant replay of his original utterance in a grammatically
correct form. No new information of interest would have been added. Thus, this method has been shown
more successful in the building of syntax than in enhancing the child’s semantic variety.
2. Expatiation or Semantic Extension: Cazden (1965) used the term “Modeling” then later shifted to extension
to cover the same technique. Muma offers expatiation as a parallel term. This procedure frequently occurs
with expansion in parent-child verbal interactions. When the two procedures, extension and expansion, were
artificially separated in Cazden’s study with preschoolers in 1965, extension was found to be more successful
than syntactical expansion. This seems to be a higher level of intervention strategy.
Example: Child “ball roll”
Adult “The ball is red and round. It rolls on the floor or you could throw it. I like to play
with the ball.”
Once again, it is important to bear in mind that the two procedures, expansion and expatiation, occur naturally
together. Expatiation or semantic extension addresses itself to areas of syntax and semantics and supplies
experience in the instrumental employment of language, rather than being restricted to syntax only as in
expansion.
3. Interrogative Stimulus/Divergent Thinking Model: The adult encourages the child’s ability to think abstractly.
Alternative means of expressing a though are the target. No attempt is made to correct syntax.
Example: Child: “car go”
Adult: “Is it a fast car or a slow one? Why do cars go?”
Combination of Techniques
Scene: Child and adult are using the water table together.
Adult:
Child:
Adult:
Adult:
Child:
Adult:
Child:
Adult:
Adult:
Child:
Adult:
“I’m pushing my boat.” (Parallel Talk)
“Me boat.”
(holds boat close to self to indicate possession)
“Yes, that’s your boat.” (Expansion)
“Here’s my boat.”
(adult draws boat close to self to indicate possession)
“What are you doing? Pushing. What are you doing?” (Question-Answer-Question)
“Push”
“You are pushing the boat in the water.” (Expansion, Expatiation, Parallel Talk)
“Me push.”
(child says as she/he pushes boat again)
“Look at the waves you make when you push your boat.”
(Expatiation)
“Ah, here’s a duck. I wonder what I could do with it...I could...” (Close Technique)
“Put in water.”
“The duck and the boat are both in the water now.” (Expansion, Expatiation, Parallel Talk)
SOME ADDITIONAL HELPFUL HINTS FOR LANGUAGE SAMPLE COLLECTION
1. Ask the parent or teacher about areas of interest the child has. Perhaps the child has a favorite toy, a pet, a
favorite television show, a special occasion may be coming.
2. Use age-appropriate materials.
3. Present only a few items at a time to the child, and avoid overloading the child with either materials or
questions. Let the child make a selection from the several items presented.
4. Demonstrate what you would like the child to do if s/he fails to initiate with some language and/or activity.
5. Vary situations, materials, listeners. Avoid very specific questions, asking the child to tell you very familiar
stories, using stimulus materials that limit both vocabulary and syntax as well as “boy-like” or “girl-like” toys or
pictures.
6. Be aware of the different language constructions you want to target and before the collection session, think
through methods which might elicit such constructions.
**This handout pulled together information from several others. Acknowledgments are due to Nancy E. Green and
Joan G. Erickson among others, for materials compiled while affiliated with the University of Illinois.
BEHAVIOR MANAGEMENT PRINCIPLES
1.
Observe behaviors that are conducive to therapy and learning. Catch the child being “good” and
reinforce. Praise the behavior not the whole child. As much as possible, ignore inappropriate
behavior.
2.
Observe behaviors which are disruptive to therapy and learning. Look for reasons why these
behaviors may be occurring: task too difficult, materials distracting, drill too slow, etc.
Restructure the therapy environment to eliminate these.
3.
Do not allow blank spaces between activities. Children dink around and “get in trouble” when they
have nothing to do.
4.
Don’t ask for cooperation if you aren’t willing to accept “no” for an answer. That is, don’t say “Will
you sit down” if you really mean “Sit down!” A good way to handle this firmly but fairly is to give
the child a choice: “Do you want to sit in this chair or that chair?”
5.
Establish the “rules” behavioral limits, early with children. Also, establish the “punishment” for
breaking the rules- we’ll use Time-Out from group activities. The idea is to be fair.
6.
Establish the contingencies for getting a reward. “If you want to play with the car, then do this.”
“After we do this, then we’ll blow bubbles.”
IF YOU USE TIME-OUT
7.
When a child is acting as a disruptor of group activities or a therapy activity, give him a warning or
choice. Examples: “You have a choice. You can sit at the table and play with us, or you can sit in
the corner by yourself.” “If you don’t stop whistling, you’ll have to sit in the corner.”
8.
Act immediately and be consistent with behavior management.
9.
Check periodically on the child in Time-Out, saying “When you’re ready to follow the rules, you
may come back and join us.”
10.
Follow through!
11.
Use activities, tokens, etc., that the child considers reinforcing. Group activities must be FUN, or
else Time-Out won’t work, for example.
12.
Apply Time-Out matter-of-factly. Always separate “bad behavior” from “bad child.” If the limits are
clearly established and you apply the consequences immediately, then you’ll be less likely to get
angry and violate this principle.
13.
Above all, respect children as people who have rights to fair treatment.
Steps to Follow in Dealing with Inappropriate Behavior
1.
Give clear directions to the child. State the rule simply.
2.
Reinforce those who have followed directions, ignore inappropriate behavior at this time,
excepting situations of danger.
3.
Restate the rule.
4.
Model desired behavior.
5.
Remove materials. (“When you’re ready to sit in your chair, you can have this back.”)
6.
Move chair slightly away from table or push chair slightly away from group. (We’d really like you
to be here with us. When you’re ready to sit in your chair, you can push it back and join us at the
table.)
7.
Provide an alternative for him. (“Either you sit in your chair with us, or you’ll have to sit there by
yourself.”)
8.
Remove child from the group or reinforcing situation. (Time-Out)
9.
Remove child from the classroom.
10.
Reinforce appropriate behavior whenever possible.
Prevention Techniques
1.
Provide many, clear directions.
2.
Make sure each child knows where he is supposed to be and what he is supposed to be doing at
all times. Gestures or physical guidance may be necessary with some of them. Don’t assume he
understands until you get sufficient feedback.
3.
Designate a specific place for each child to sit. (“Here’s your place on the floor,” while pointing to
his spot or “This is your chair.”)
4.
Call on children individually to direct, instead of directing them as a group.
5.
Call on children at the beginning who may have difficulty waiting for their turn. Giving them an
extra turn during games or songs often helps.
6.
During games, remind children that everyone will get a turn.
7.
Utilize teacher aides. Call on them first to stand by the door or to go to a certain place before
directing the children. Use them as models to go through the process as visual reinforcement for
your “clear” directions.
8.
When directing an activity, center yourself with the bulk of the children. Direct your aides to help a
child having difficulty.
9.
Have your children seated were you want them before you bring out materials. Bring out only the
materials you need at one given time; replace them before bringing out others.
10.
Seat yourself at a place at the table where you can easily reach all children. This will help you
assist all the children, promotes more interactions, and puts you in a spot for easy intervention.
11.
Keep all materials out of children’s reach unless you want them to be touched.
12.
Careful planning is a great preventive measure. Have everything you need on your tray so you
won’t have to leave the group.
13.
Remind children when it is almost time to finish an activity so they have time to finish up and
prepare for the next activity. Give them time to do this for themselves. Be aware of their timing as
well as your schedule.
14.
Keep the children occupied and interested. Make use of emergency equipment (books, play doh,
puppets, etc.)
15.
If a child finishes an activity sooner than the others and is having a hard time waiting, give him a
special job (wiping the table, collecting papers, gathering equipment, helping others).
16.
Keep things moving. There’s no excuse for nothing to do. Everything is intriguing to preschoolers
if you work through the tips they give you.
17.
Use much eye contact, especially while reinforcing.
18.
If you need to refocus a child’s attention, calling his name and directing a question to him usually
helps. A gentle pat on the back or pat on the leg adds a personal touch.
19.
If necessary, casually separate children who set each other off. Seat such children apart and you
in the middle if needed.
20.
Your voice and mood will be a key factor in the children’s reactions to an activity. (If an activity is
boring to you, it will probably be boring to them, too.) Putting a little pizzazz in your voice helps
get the kids more excited. Don’t be afraid to smile and laugh with them when appropriate and
don’t be afraid to use firmness. Talking quietly and slowly sets another mood.
21.
Be absolutely sure all behavior expectations are feasible for each child. Avoid setting demands
for the children; give them choices. Make sure you always follow through with any demands you
have made. (Threats without follow-through can do more harm than good.)
22.
Don’t be over stifled by structure! If a lesson plan calls for 3 turns and you can see it’s bombing
after 1, go on to something else; make the session interesting, but try to stick to the main
objective. Flow with the kids.
23.
Try to out guess certain behaviors to avoid a conflict situation. If someone always goes to his
favorite toy, stand by the toy shelf and assume he is on his way to the appropriate place.
24.
POSITIVE REINFORCEMENT cannot be overemphasized. Children are innocent until proven
innocent! It’s a circular phenomenon, using it will probably alleviate most of your problems before
they even occur.
Compiled by Cathy Healy, University of Illinois, Colonel Wolfe Preschool. 403 E Healy, Champaign IL
61820.
APPENDIX D: LEARNING OUTCOMES/SESSION FEEDBACK
FORMS/SUPERVISORY CONFERENCE OUTLINES
Dear Students/Supervisors:
The following outlines are the learning outcomes for clinical placements at CHSC,
suggested topics for supervisory meetings, and the new session evaluation forms.
Please take a moment to review those learning outcomes that correspond with your
clinical placements. Students, as a reminder, required reading (noted on the
supervisory outlines in your packet) to help you achieve the learning outcomes is
located in the big white binder in the graduate carrel room.
Session evaluation forms are designed to help the student/supervisor partners focus, in
written form, on the attainment of specific learning outcomes. Please copy those forms
that you will need for the semester.
LEARNING OUTCOMES FOR INDIVIDUAL SESSIONS
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Read relevant literature, review chart.
2. Collect and analyze data.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Formulate goals, initiate treatment plan.
5. Modeling and cueing target behavior
6. Increase client response rate.
7. Corrective feedback.
8. Explaining goals, rationale, and techniques to client/parent(s).
9. Writing daily progress notes (complete treatment plan).
10. Develop home program/homework assignments.
SESSION FEEDBACK FORM: INDIVIDUAL SESSIONS
5. Modeling and cueing target
behavior.
6. Increase client response rate.
7. Corrective feedback.
8. Explaining goals, rationale, and
techniques to client/parent(s).
9. Writing daily progress notes
(complete treatment plan).
10. Develop home program/homework
assignments.
11. Utilize behavior management
techniques effectively.
Supervisor:
Circle appropriate learning outcome (2-3 per
session)
1. Read relevant literature, review
chart.
2. Collect and analyze data.
3. Demonstrate sensitivity to
cultural/linguistic differences.
4. Formulate goals, initiate treatment
plan.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR PARENT TODDLER GROUP
In accordance with Evidence Based Practices, by the end of the semester, you will attain proficiency in the
following:
1. Collecting and analyzing data.
2. Formulating treatment goals consistent with evidence based practices.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Modeling language facilitation techniques.
5. Managing challenging behavior.
6. Delivering corrective feedback.
7. Leading group therapy.
8. Leading parent discussion.
9. Explaining therapy goals and techniques to parents.
SESSION FEEDBACK FORM: PARENT TODDLER GROUP
5.
6.
7.
8.
9.
Managing challenging behavior.
Delivering corrective feedback.
Leading group therapy.
Leading parent discussion.
Explaining therapy goals and
techniques to parents.
10. Demonstrate effective behavior
management strategies.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Collecting and analyzing data.
2. Formulating treatment goals consistent
with evidence based practices.
3. Demonstrate sensitivity to
cultural/linguistic differences.
4. Modeling language facilitation
techniques.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR LANGUAGE LEARNING DISABLED GROUP
In accordance with Evidence Based Practices, by the end of the semester you will have gained
proficiency in the following:
1. Completing a review of pertinent LLD literature.
2. Collecting and analyzing data in a group setting.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Leading group therapy.
5. Using a commercially available Written Language Program.
6. Delivering corrective feedback.
7. Using appropriate behavior management techniques.
8. Modeling a variety of conversational skills.
9. Formulating long and short-term goals.
10. Discussing LLD issues with parents.
11. Explaining goals and progress to parents and school personnel.
SESSION FEEDBACK FORM: LANGUAGE LEARNING DISABLED GROUP
6. Delivering corrective feedback...
7. Using appropriate behavior
management techniques.
8. Modeling a variety of conversational
skills.
9. Formulating long and short term goals
10. Discussing LLD issues with parents.
11. Explaining goals and progress to
parents and school personnel.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Completing a review of pertinent LLD
literature...
2. Collecting and analyzing data in group
setting.
3. Demonstrate sensitivity to
cultural/linguistic differences.
4. Leading group therapy.
5. Using a commercially available Written
Language Program
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR SCHOOL AGED FLUENCY GROUP
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Collecting and analyzing speech samples.
2. Formulating semester goals.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Implementing a commercially available fluency treatment program.
5. Implementing appropriate behavior management strategies.
6. Modeling a variety of fluency shaping strategies.
7. Delivering corrective feedback.
8. Collecting data in a group setting.
9. Leading group therapy.
10. Leading parent group discussion/education sessions.
11. Explaining therapy goals and techniques to parents.
SESSION FEEDBACK FORM: SCHOOL AGED FLUENCY GROUP
6. Modeling a variety of fluency shaping
strategies.
7. Delivering corrective feedback.
8. Collecting data in a group setting.
9. Leading group therapy.
10. Leading parent group
discussion/education sessions.
11.Explaining therapy goals and
techniques to parents.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Collecting and analyzing speech
samples.
2. Formulating semester goals.
3. Demonstrate sensitivity to
cultural/linguistic differences.
4. Implementing a commercially available
fluency treatment program.
5. Implementing appropriate behavior
management strategies.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR ADOLESCENT FLUENCY GROUP
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Collecting and analyzing speech samples.
2. Formulating semester goals.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Modeling a variety of fluency shaping strategies.
5. Delivering corrective feedback.
6. Leading relaxation exercises.
7. Leading group therapy.
8. Leading parent group discussion.
9. Explaining therapy goals and techniques to parents.
SESSION FEEDBACK FORM: ADOLESCENT FLUENCY GROUP
5. Implementing appropriate behavior
management strategies.
6. Delivering corrective feedback.
7. Leading relaxation exercises.
8. Leading group therapy.
9. Leading parent group discussion.
10. Explaining therapy goals and
techniques to parents.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Collecting and analyzing speech
samples.
2. Formulating semester goals.
3. Demonstrate sensitivity to
cultural/linguistic differences.
4. Modeling a variety of fluency shaping
strategies.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR PRESCHOOL SPEECH GROUP
In accordance with Evidence Based Practices, by the end of the semester, you will have attained
proficiency in the following:
1. Demonstrating knowledge of basic characteristics of developmental apraxia, phonological
processes, and pre-reading skills.
2. Collecting and analyzing data.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Formulating treatment goals.
5. Applying cueing hierarchy to elicit accurate responses.
6. Managing challenging behavior.
7. Delivering corrective feedback.
8. Leading group therapy activities.
9. Explaining therapy goals/progress and techniques to parents.
10. Developing a home practice program.
11. Implementing a commercially available phonological awareness program
SESSION FEEDBACK FORM: PRESCHOOL SPEECH GROUP
6.
7.
Managing challenging behavior.
Using appropriate behavior management
techniques.
8. Delivering corrective feedback.
9. Leading group therapy activities.
10. Explaining therapy goals/progress and
techniques to parents.
11. Developing a home practice program.
12. Implementing a commercially available
phonological awareness program.
Supervisor: Circle appropriate learning outcome (2-3 per
session)
1. Demonstrating knowledge of basic
characteristics of developmental apraxia,
phonological processes, and pre-reading
skills.
2. Collecting and analyzing data.
3. Demonstrate sensitivity to cultural/linguistic
differences
4. Formulating treatment goals.
5. Applying cueing hierarchy to elicit accurate
responses.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR HEAD START SERVICES LANGUAGE CLASSROOM
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Demonstrate knowledge of theoretical underpinnings of the Prevention Model.
2.
Demonstrate knowledge of Head Start services and placement in language classroom.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Deliver corrective/reinforcing feedback.
5. Collaborate with teachers/parents and administrators.
6. Structure the environment toward effective service delivery.
7. Create/implement age appropriate lesson plans which target skills in the small group setting.
8. Demonstrate effective behavior management strategies.
9. Promote communication development in the classroom and home (creating parent/teacher handout).
10. Data keeping in a small group format.
SESSION FEEDBACK FORM: HEAD START SERVICES LANGUAGE CLASSROOM
6. Structure the environment toward effective
service delivery.
7. Create/implement age appropriate lesson plans
which target skills in the small group setting.
8. Demonstrate effective behavior management
strategies.
9. Promote communication development in the
classroom and home (creating parent/teacher
handout).
10. Data keeping in a small group format.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Demonstrate knowledge of theoretical
underpinnings of the Prevention Model.
2. Demonstrate knowledge of Head Start services
and placement in language classroom.
3. Demonstrate sensitivity to cultural/linguistic
differences.
4. Deliver corrective/reinforcing feedback.
5. Collaborate with teachers/parents and
administrators.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR HEAD START SERVICES FOR THERAPY
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Read and summarize relevant research/literature.
2. Collaborate with parents/teachers and administrators.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Structure the environment toward effective service delivery.
5. Demonstrate the ability to take the child’s perspective.
6. Establish age appropriate therapy goals.
7. Formulate relevant lesson plans for therapy.
8. Increase response rate.
9. Deliver corrective and reinforcing feedback.
10. Collaborate with parents, teacher, and administrators.
11. Demonstrate effective behavior management strategies.
SESSION FEEDBACK FORM: HEAD START SERVICES FOR THERAPY
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Read and summarize relevant
research/literature.
2. Collaborate with parents/teachers and
administrators.
3. Demonstrate sensitivity to cultural/linguistic
differences.
4. Structure the environment toward effective
service delivery.
5. Demonstrate the ability to take the child’s
perspective.
Strengths
1.
6.
7.
8.
9.
10.
Establish age appropriate therapy goals.
Formulate relevant lesson plans for therapy.
Increase response rate.
Deliver corrective and reinforcing feedback.
Collaborate with parents, teacher, and
administrators.
11. Demonstrate effective behavior management
strategies.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR HEAD START SERVICES SCREENING/EVALUATION
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Collect and analyze speech samples.
2. Administer and score screening and evaluation instruments.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Structure the environment toward effective service delivery.
5. Demonstrate the ability to take the child’s perspective.
6. Interpret test results.
7. Write cohesive/concise evaluation reports.
8. Demonstrate effective behavior management strategies.
9. Collaborate with parents, teachers, and administrators.
SESSION FEEDBACK FORM: HEAD START SERVICES SCREENING/EVALUATION
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Collect and analyze speech samples.
2. Administer and score screening and evaluation
instruments.
3. Demonstrate sensitivity to cultural/linguistic
differences.
4. Structure the environment toward effective
service delivery.
5. Demonstrate the ability to take the child’s
perspective.
6. Interpret test results.
7. Write cohesive/concise evaluation reports.
8. Demonstrate effective behavior management
strategies.
9. Collaborate with parents, teachers, and
administrators.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
LEARNING OUTCOMES FOR DEAF/HARD OF HEARING LANGUAGE GROUP
In accordance with Evidence Based Practices, by the end of this semester, you will attain proficiency in
the following:
1. Demonstrate knowledge of various deaf/HH information (methodology, language facilitation in sign vs.
oral modes, speech, listening/auditory mode).
2. Demonstrate use of sign in language facilitation techniques.
3. Demonstrate sensitivity to cultural/linguistic differences.
4. Collect and analyze data.
5. Formulate therapy goals of deaf/HH clients.
6. Model language facilitation techniques.
7. Demonstrate effective behavior management strategies.
8. Deliver corrective feedback.
9. Lead group therapy.
10. Explain therapy goals and techniques to parents.
SESSION FEEDBACK FORM: DEAF/HARD OF HEARING LANGUAGE GROUP
4. Formulate therapy goals of deaf/HH
clients.
5. Model language facilitation techniques.
6. Demonstrate effective behavior
management strategies.
7. Deliver corrective feedback
8. Lead group therapy.
9. Explain therapy goals and techniques
to parents.
Supervisor: Circle appropriate learning outcome (2-3
per session)
1. Demonstrate knowledge of various
deaf/HH information (methodology,
language facilitation in sign vs. oral
modes, speech, listening/auditory
mode).
2. Demonstrate use of sign in language
facilitation techniques.
3. Collect and analyze data.
Strengths
1.
2.
3.
Areas for Improvement
1.
Suggestions for next session
1.
2.
2.
3.
3.
Supervisor Signature
Student Clinician Signature
SUPERVISORY CONFERENCE OUTLINE: COLLECTING AND ANALYZING DATA
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Collecting and analyzing data.
PREPARATION
1. Read Miller Ch. 1, 2, and PLS-3
supplemental measure; language
sample checklist.
2. Student will analyze their data
collection system used in Tx and
develop ideas for revision.
3. Review info on SOAPS.
Response rate. Clinician client
talk time-calculate on KISS (the
supervisory process p. 377-378)
as assigned. Ch. 5 Goldberg
(silver book).
4. Continue to revise systems
needed and increase client
response rate.
DISCUSSION
1. First Meeting:
a. Any questions from readings.
b. Determining method of data
collection, e.g. on-line vs.
taping.
c. Discuss system of data
collection to be used in the next
session, e.g. chart with targets
listed.
2. Second Meeting: Discuss
specific requirements with
supervisor.
3. Meeting to discuss results and
develop strategies for increasing
client response rate.
SUPERVISORY CONFERENCE OUTLINE: FORMULATING TX GOALS
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Formulating Tx goals
PREPARATION
Research
Review info of client- specific dev.
milestones (normative data)
DISCUSSION
Meeting: bring and summarize
material found on normative
development.
Review chart/eval/SOAP notes
Complete case management sheet.
Meeting: present on highlights of case
management sheet—current levels,
strengths/weaknesses
Refer to and review info on Tx
hierarchy (Planning Curriculum Goals)
(PA)
Goldberg Ch. 6 p. 199 (Silver book)
Choose a goal and develop Tx
hierarchy.
Review info on goal writing and
planning—Hedge Ch. 7 p. 167
Curriculum goals (P.A.) Fey ch.5
Student writes Tx plan (because goals
are measurable)
Explain rationale for steps of hierarchy
for part. goal. Revise as needed
following discussion with supervisor.
Student will discuss with supervisor,
target areas to develop goals for.
Review with supervisor and revise.
SUPERVISORY CONFERENCE OUTLINE: IMPLEMENT LANGUAGE FACILITATION TECHNIQUES
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Implement language facilitation
techniques.
PREPARATION
Birth-3 packet HC/ES.
Hedge Ch. 8
COSI 352 methods material.
Pick 1-2 specific tech. to focus on in Tx
sessions.
DISCUSSION
Role play with peer or supervisor
various techniques.
Repeat as needed for subsequent
techniques.
Repeat as needed for subsequent
techniques.
Develop carryover activity, e.g.
handout to be used with
parents/caregivers of self or
commercial.
Review with supervisor.
Get parent/caregiver feedback.
With supervisor or prior to meeting as
needed.
Watch videotape or ongoing Tx and
identify specific techniques used by
SLP or student clinician or alternative
strategies not implemented.
Report in self-evaluation on 1-2
specific techniques used in Tx session.
SUPERVISORY CONFERENCE OUTLINE: DELIVER CORRECTIVE/REINFORCING FEEDBACK
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Deliver corrective/reinforcing feedback.
•
•
•
•
•
PREPARATION
Review literature pertinent to
disorder/client (corrective/positive
feedback).
Review info on reinforcing
feedback. Goldberg p. 123-132, p.
298-301.
Observe Tx/watch video and ID
techniques used.
Tape self and complete KISS
corrective feedback, p. 325.
Tape self and complete KISS on
positive reinforcement.
DISCUSSION
Discussion to review
comments/questions
Present findings and suggestions
Present findings.
SUPERVISORY CONFERENCE OUTLINE: MANAGE CHALLENGING BEHAVIOR
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Manage challenging behavior
PREPARATION
Review Gianni: Classroom
management guidelines
H.O. ES/HC
DISCUSSION
Discussion of reasons for
negative/off task behavior and
strategies to improve/manage.
Generate list of client problem
behaviors specific with strategies to
implement in Tx.
Present on rationale of strategies
listed.
Self-evaluation of session.
Implement plan.
Revise strategies as needed.
SUPERVISORY CONFERENCE OUTLINE: COMPLETE A REVIEW OF PERTINENT LLD LITERATURE
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Complete a review of pertinent LLD
literature
PREPARATION
Read:
Wallach & Butler, Chs. 1,9,10
Merritt & Culatta, Ch. 7
DISCUSSION
Discuss:
Any questions concerning reading
material.
SUPERVISORY CONFERENCE OUTLINE: DISCUSS LLD ISSUES WITH PARENTS
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Discuss LLD issues with parents.
PREPARATION
1. Locate resources for parent
education (internet, LDA
CCSERC, IDA)
2. Read material.
3. Choose material to share with
parents
4. Highlight pertinent information.
DISCUSSION
Review #3 & 4 from preparation; role
play information dissemination.
SUPERVISORY CONFERENCE OUTLINE: USE COMMERCIALLY AVAILABLE THERAPY/TREATMENT PROGRAM
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Use commercially available
therapy/treatment program.
Applications:
• written language
• fluency
• phonology
PREPARATION
Read:
Manuals specified by your supervisor.
DISCUSSION
Discuss:
Any questions.
SUPERVISORY CONFERENCE OUTLINE: LEAD GROUP THERAPY (LLD GROUP)
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Lead group therapy.
Applications:
LLD group
PREPARATION
Read:
Wiig & Semel, Ch. 2
DISCUSSION
Discuss:
Discuss with supervisor differences in
learning styles and implications for
leading a group.
SUPERVISORY CONFERENCE OUTLINE: ADMINISTERING AND SCORING SCREENING AND EVALUATION INSTRUMENTS
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Administering and scoring screening and
evaluation instruments.
PREPARATION
Familiarize self with test protocols
appropriate for client.
DISCUSSION
Rec evaluation tools to be used and
discuss with supervisors.
Observe SLP or video tapes
conducting evaluation.
Comments/ Questions following
evaluation with supervisor.
Administer Dx tool as determined by
SLP.
Supervisor will provide feedback on
adm. skills (test specific strategies)
Implement strategies discussed on
next administration of test.
Become familiar with scoring
procedures.
Identify strengths/weaknesses.
Determine severity level (formal with
informal info)
SUPERVISORY CONFERENCE OUTLINE: INTERPRETING TEST RESULTS
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Interpreting test results.
•
•
•
•
PREPARATION
Read Test manuals to be familiar
with scoring and test interpretation
Review GFTA scoring sheet re:
dialectal differences
Review sample reports and scored
tests
Complete first draft of report to be
turned into supervisor.
•
•
DISCUSSION
Meet with supervisor to discuss
test interpretation.
Review comments/changes to first
draft and revise.
SUPERVISORY CONFERENCE OUTLINE: COLLABORATING WITH TEACHERS AND ADMINISTRATORS
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Collaborating with teachers &
administrators.
•
•
Overall Reading Assignment:
p. 249-252 LOWE
•
•
PREPARATION
Elicit information relative to child’s
disorder from teacher
Formulate questions and
hypothetical situations to be asked
of teacher. Revise Teacher
questionnaire p. 129
Naidecker/Blosser
•
Schedule meeting time with
teacher
-during teacher meeting, gather
and document information relative
to child.
-interpret information gathered and
compile additional information to
be shared with teacher.
•
Schedule follow up meeting with
teacher and disseminate info.
•
•
DISCUSSION
Share with supervisor.
Interpret information gathered and
compile additional information to
be shared with teacher.
Role play teacher/clinician
information sharing re: child’s
performance in
assessment/therapy.
Repeat as necessary and update
goals/objective if necessary.
SUPERVISORY CONFERENCE OUTLINE: EXPLAIN GOALS AND PROGRESS TO PARENTS AND SCHOOL PERSONNEL
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Explain goals and progress to parents
and school personnel.
PREPARATION
Prepare script.
DISCUSSION
Role play script with supervisor/peer.
SUPERVISORY CONFERENCE OUTLINE: STRUCTURING THE ENVIRONMENT TOWARD EFFECTIVE SERVICE DELIVERY
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Structuring the environment toward
effective service delivery.
•
•
•
•
•
PREPARATION
Visit room and document physical
structure of room as well as
auditory and visual distractions.
Separate into positive and
negative aspects of environment.
Develop strategies to further
enhance/modify environment to
best meet student needs.
Request changes to environment
on-site and give to appropriate
personnel.
Modify as necessary
•
DISCUSSION
Share with supervisor.
•
Share with supervisor
•
See Preparation
•
See Preparation.
SUPERVISORY CONFERENCE OUTLINE: COLLECT AND ANALYZE SPEECH SAMPLES
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Collect and analyze speech samples.
Applications:
• School aged fluency group
• Adolescent fluency group
PREPARATION
Prepare stimulus materials for at
least 2 audio/videotaped
spontaneous speech samples and
2 reading samples (if appropriate).
(samples should be at least 200
syllables each)
•
•
Review frameworks for speech
sample analysis (rate and type)
e.g.:
1) Shipley & McAfee pp. 227-232
2) Gregory & Hill
•
•
DISCUSSION
Play samples of tape to verify
accuracy of analysis with
supervisor.
Utilize results to prepare baseline
data collection plans.
SUPERVISORY CONFERENCE OUTLINE: MODELING A VARIETY OF FLUENCY SHAPING TECHNIQUES
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Modeling a variety of fluency shaping
techniques.
•
•
•
•
PREPARATION
Review fluency training packet
material on fluency shaping (e.g.
continuous phonation, easy onset,
etc.)
Choose most appropriate
techniques for client (based on
speech sample analysis, past
therapy outcomes, results of
baseline data)
Practice techniques (with
supervisor approval) in front of
mirror and while taping yourself,
review and check for accuracy.
Write script to explain techniques
to client.
DISCUSSION
Practice technique prior to therapy
session with supervisor.
SUPERVISORY CONFERENCE OUTLINE: LEADING RELAXATION EXERCISES
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Leading relaxation exercises.
•
•
•
•
•
PREPARATION
Collect information on relaxation
strategies (e.g. “Progressive
Relaxation” in Daly & Burnett,
relaxation response, etc.).
Practice relaxation technique at
home (including visual imagery)
Prepare therapy room.
Implement strategies with client.
Solicit client’s feedback
(subjective) about benefit of
relaxation.
•
•
DISCUSSION
Analyze time spent on relaxation
and benefit for client.
Adjust as necessary to maximize
benefit for client.
SUPERVISORY CONFERENCE OUTLINE: LEADING GROUP THERAPY (ADOLESCENT FLUENCY GROUP)
Practicum Placement _______________________________
DATE
LEARNING OUTCOME
Leading group therapy.
Applications:
• Adolescent fluency group.
•
•
•
•
•
PREPARATION
Read Ramig et al. article in fluency
training packet.
Establish purpose/goals of group
therapy.
Incorporate individual fluency
goal(s) into group setting as
appropriate.
Formulate group therapy
hierarchy.
Establish schedule of clinicians to
lead activities/group.
DISCUSSION
Discuss each preparation step with
clinician group prior to meeting with
supervision.
APPENDIX E: CHSC CLINIC FORMS
•
•
•
•
•
CHSC Treatment Plan/Progress/Discharge Form
Lesson Plan
CHSC Progress Notes Speech Language Pathology
Sample Lesson Plans
Head Start Forms
You will find the treatment plan/progress report in each client’s working file. The clinician lists goals for the
given semester on this form and records attained progress on these goals.
CHSC TREATMENT PLAN/PROGRESS/DISCHARGE FORM
LESSON PLANS
Lesson plans must be completed and turned into your supervisor prior to your clients’ sessions according to the schedule
outlined in your clinical contract. Failure to turn in lesson plans for any session will result in loss of clinical hours for that
session. You are to complete your analysis of the session including session strengths, areas to improve and suggestions,
and turn it into your supervisor following the session.
Progress notes are to be completed after each session following the SOAP format and should be attached to the client’s
working file.
DETAILED LESSON PLAN FORM
SAMPLE DETAILED LESSON PLAN #1
SAMPLE DETAILED LESSON PLAN #2
Client Jeremy
Clinician
Graduate Student
Date
3/31/98
Time 5:00 p.m.
Supervisor Kay McNeal, CCC-SLP
Short Term Objectives:
1. Diaphragmatic breathing: Jeremy will learn/use diaphragmatic breathing at the short phrase level (2-3 words) with 80% accuracy.
2. Jeremy will identify when he is releasing air rapidly prior to speaking and talking on low air volume in a 3 minute monologue with 80%
consistency.
3. Slow, smooth speech: Jeremy will learn/use slow, smooth speech with 80% consistency at the short phrase level (2-4 words or up to 8
syllables)
4. Jeremy will incorporate his use of diaphragmatic breathing and slow, smooth speech at the short phrase level with 80% consistency.
ANTECEDENT EVENTS
Treatment Procedures/Materials
Cues
Cafet for Kids: Jeremy will do 4
syllable phrase stretches using a
stimulus list and consecutive
vocalizations.
Visual (Stimulus
List)
2.
Cafet for Kids: 5 syllable phrase
stretches using a stimulus list and
consecutive vocalizations.
CALMER sign
as reminder to
use
conversational
tone
3.
Cafet for Kids: (if time
allows) move to 6 syllable
phrases using a stimulus list and
consecutive vocalizations.
1.
TRANSFER Activity: Since Jeremy
liked it so much last session and
worked well: Outburst Junior for Kids
ages 7-14. Clinician will have Jeremy
answer stimulus questions.
Ruler—as
reminder to
stretch out
Verbal
RESPONSE DEFINITION
Session Behavioral
Feedback and
Objective Response
Reinforcement
Level and Conditions
Jeremy will produce 4
syllable phrase stretches
using slow, smooth
speech with 80%
accuracy.
Jeremy will produce 5
syllable phrase stretches
using slow, smooth
speech with 60%
accuracy.
Jeremy will produce 6
syllable phrase stretches
using slow, smooth
speech with 80%
accuracy
Jeremy will produce 4-5
syllable phrase answers
using slow, smooth
speech with 80%
accuracy.
Verbal praise
and connective
feedback (esp.
regarding
instances of fast
air and/or
insufficient length
of syllable)
Reinforce
ment
Schedule
Continuous
SUBSEQUENT EVENTS
Clinician Response if Target Behavior is Not
Produced
Clinician will model appropriate syllable stretch and
provide explanation of when fast air is noted—clinician
will practice with Jeremy releasing air slowly as he
begins to vocalize.
STRENGTHS:
AREAS TO IMPROVE:
SUGGESTIONS TO IMPROVE THOSE AREAS:
CHSC PROGRESS NOTES
PROBLEM ORIENTED PROGRESS NOTES FOR SOAPS
Problem oriented progress notes include four components:
S = subjective information
O = objective information
A = assessment of the objective information
P = a plan
The initial goal is to identify a problem list which provides for initial format for long range planning. This list
will define every problem the child has which may potentially interfere with or relate to the communication
process. Thus, although you may not treat all of the problems, you will list all of them. A sample problem
list appears elsewhere in this handout.
Once you have devised the problem list, you then write a SOAP for each problem. Even though you may
not immediately or ever treat each problem, you should write a SOAP on it. For example, one problem
may be "Velopharyngeal incompetency due to an unrepaired cleft," where the child is also under the care
of a physician who will soon be performing the necessary surgical repair work. You would write an initial
SOAP describing this problem. Since you are not directly treating the problem, follow-up SOAP would not
be required.
For problems/objectives that you are treating, a SOAP will take the place of daily logs. SOAPs are written
and provide subjective, objective, assessment, and planning information for each objective targeted in a
session.
Subjective (S) data: List subjective impressions of the particular objective. This may include your
feelings and impressions (or mother, father, or child's feelings) with respect to the problem. Generally,
this will consist of information which may account for unexpected changes, either negative or positive,
in your O data. Examples can be found on in following pages.
Objective (O) data: The information is to be written in operational, objective terms. This means that
anyone could examine the measures and come up with the same information. This may include
percentages, numbers, amount of time engaged in particular behavior, etc. Complete sentences are
not necessary. No interpretation of the data is necessary - rather, just report the results.
Assessment (A): This is where you interpret your O as well as your S data. You make judgments as
to whether the child is regressing, improving or maintaining. This is also the place where you will
indicate changes in treatment goals. For example, if you had been working on establishing an SVO
syntactic structure on which the child had achieved productivity as indicated in the O data, you might
have the following statement: As productivity has been achieved on SVO, this structure will no longer
be the main focus of treatment." Note that you will not specify what the new treatment goal will be;
that information belongs in the plan.
Plan (P): A concise, complete statement of a) the behavior to be established, and b) the means to be
used to establish the behavior. SOAPs will be short if they are stated concisely. Remember not to be
redundant. You will probably not have totally new S, O, A and P information each week. In fact, your
plan will probably frequently stay the same. In this case, all you need is, "same as SOAP dated...."
Since you will be obtaining weekly language samples, your O and A data will probably always change.
Remember, every time you have O data you will need to have A data. Your subjective information
will probably not change significantly unless you have weeks where your child does not seem to feel
well and you think it is important to mention this. Your plan will only change as criteria for targets is
reached and you need to establish new targets or if there is no change in behavior and you need to
modify your means for establishing a behavior.
S and P may or may not change.
O and A usually change.
SAMPLE PROBLEM LIST
P1 Semantic/ syntactic abilities not ageappropriate
P2 Inappropriate social-interactive skills with
peers
EXAMPLES OF SOAPS
P1
S -O --
A -P --
P2
P3
P3 Disruptive crying behavior
P4 Fluctuating conductive hearing loss
P5 Vocabulary size not age-appropriate
Child seemed very shy and rarely talked directly to clinician.
Generally talked to a doll.
MLU = 1.43. One-word declarative statements comprised 75% of the 100 utterance sample.
In the remaining 25 utterances, the following semantic relations were present. Nomination 15%; Recurrence - 50%; Notice - 10%; Action & Object - 15%; Agent & Action - 10%. Of the
relations expressed, only nomination was productive. There was no evidence of the heuristic
or informative social language functions. No grammatical morphemes or transformations
evidenced in sample.
Child exhibits severe delay in semantic/syntactic skills. MLU should be 3.5 for age level.
Further, all grammatical morphemes as well as the question, negative, and imperative
transformations should be present.
Target: Establish productive use of the following two-term semantic relations: recurrence,
action, object, and agent. Procedure: Following child's lead in imitative play and modeling
appropriate target structures. Treatment on grammatical morphemes and more complex
structures will be delayed until prerequisite syntactic (i.e., two-term relations) have been
established. Target behaviors to be established by (date).
S -- Mother very defensive about child's social behavior: claims "she's shy and will outgrow it."
O -- 30 minutes of 30-minute group session spent alone in corner. Trantrumed every time effort (6
times) was made to require group participation.
A -- Child attended to activity while in the corner. However, a child of this age should be actively
participating with peers.
P -Target: Establish 10 minutes of group participation by (date). Procedure: Engage in
imitative play with child and model introduction of other children into activity. If child resists,
physical manipulation will be used to keep her in proximity to other children.
S -- Child did not seem scared, rather was angry, at having to stay in individual treatment
instead of going to large play room.
O -- Cried 20 of 30 minute individual session.
A -Child does not cry in group treatment. Seems to use crying as a manipulation
behavior to obtain own way.
P -- Target: Eliminate crying by (date). Procedure: Clinician will ignore child when crying
and immediately attend when crying ceases.
P4
S -- Mother reports "frequent" ear infections
O -Audiometric evaluation reported a mild (30 db) bilateral conductive hearing loss
due to fluid in ears.
A -None
P -Child currently under care of physician. No direct treatment in this clinic.
P5
S -- None
O -- TTR of .10
A -- This is a low ratio of new words to total number of utterances.
P -- Target: To increase number of lexical terms. Procedure: While engaging in imitative
play and modeling, two-term semantic relations, clinician will also model a variety of
lexical terms.
HEAD START
SAFETY REMINDER LIST
HEAD START LOCATIONS
HEAD START PROCEDURES
CHSC SPEECH-LANGUAGE SCREENING FORM
CHSC SCREENING REPORT
LANGUAGE CLASSROOM TARGET AREAS
CHSC HEAD START TREATMENT PLAN/PROGRESS PEPORT/DISCHARGE
SPEECH-LANGUAGE PATHOLOGY CONTRACT SERVICES DAILY PROGRESS NOTES
CHSC LANGUAGE CLASSROOM MONTHLY PROGRESS REPORT
CHSC CLIENT TRACKING SHEET
HEAD START SERVICES BILLING FORM
CHSC AUDITORY COMPREHENSION AND VERBAL ABILITY SCREENING
COLLECTING AND RECORDING SPEECH SAMPLES
HOW TO CONDUCT AN OTOSCOPIC EXAMINATION
CHSC SPEECH-LANGUAGE PATHOLOGY SCREENING FORM
APPENDIX F: CHSC INFORMATION FOR STUDENTS IN AUDIOLOGY PRACTICUM
AUDIOLOGY PRACTICUM GRADING
for
SPEECH-LANGUAGE PATHOLOGY STUDENTS
LEVEL 1: Audiology practicum with an SLP graduate intern who is a beginner -- first 10 hours. This level
will also be used for the student who is only assigned to an audiology slot for a short or sporadic time
period.
5: Very good.
Displays technical problems which do not hinder the evaluation/treatment
process. Demonstrates appropriate clinical behaviors consistently.
4: Good.
Frequently demonstrates the clinical behavior. Exhibits awareness of the
need to modify behaviors. Modifications are generally effective.
3: Adequate.
The clinical skill is emerging. Efforts to modify may result in varying
degrees of success.
2: Needs Improvement.
With supervisor input, implements the behavior/skill with difficulty. Efforts
to modify are generally unsuccessful.
1: Poor.
The clinical behavior is not evident. Unable to modify behavior when
directed by supervisor repeatedly. Little awareness of need to change
behavior.
LEVEL 2: Audiology practicum with an SLP graduate student who is completing their audiology hours.
5: Clinical Competence.
Independent work accomplished with accuracy and superior skill level.
4: Good.
Demonstrates independence but may need specific or general directions.
3: Adequate.
Generally needs direction from supervisor.
2: Needs Improvement.
Needs repeated and specific direction to perform clinical tasks
accurately. Incomplete understanding of clinical problems, the needs of
the patients or procedures.
1: Poor.
Specific direction from supervisor does not alter unsatisfactory skills.
Unable to relate effectively with patients and is inadequately prepared.
Does not seek guidance or implement suggestions appropriately.
AUDIOLOGY PRACTICUM GRADING
for
SPEECH-LANGUAGE PATHOLOGY STUDENTS
Supervisor:
Student Clinician:
Site:
Level*: 1 / 2
Semester:
Year:
Number of Hours Evaluation Based on:
Midterm / Final
*Please see attached grading guide for description of numerical values for student level 1 or 2.
PROFESSIONAL RESPONSIBILITY
Punctuality and Attendance
Professional Presentation
Demonstrates Initiative
Interest in Improving Performance
Comments:
PROFESSIONAL INTERACTION
Effectiveness and poise in dealing with patients and families
Understands and utilizes effective communication with people with hearing impairments
Has knowledge of and ability to obtain case history from patient and/or family
Comments:
CONVENTIONAL AUDIOMETRY
Gives instructions
Pure tone air and bone conduction
Speech audiometry
Immittance
Interpretation and recommendations are verbalized to supervisor and/or patient/family
Documentation including history, impressions and recommendations on audiogram and HAP chart
notes
Comments:
AURAL REHABILITATION
Troubleshoots hearing aid malfunctions
Instructs patient/family on use of hearing aid
Performs repairs as able
Is able to subjectively/objectively quantify benefit
Participates in Dispensing Visit including:
Battery
Insertion and removal
Handling of controls
Counseling re: realistic expectations
Care and maintenance
Comments:
SCORE:
Total points / # items scored
/
=
CHSC AUDIOLOGY CASE HISTORY
CHSC HEARING TEST FORM
CHSC HEARING TEST RESULTS FORM
CHSC AUDIOLOGY PROGRESS NOTES
CHSC HEARING AID BENEFIT SURVEY
HEARING AID DISPENSING/ORIENTATION/SATISFACTION SHEET
APPENDIX G: AVAILABLE CLINICAL MATERIALS
DEPARTMENT OF COMMUNICATION
SCIENCES
•
•
ASHA FACS- Functional Assessment of
Communication Skills for Adults
ASSET- Assessing Semantic Skills
Through Everyday Themes
•
•
Bankson-Berenthal Test of Phonology
Boston Naming Test
•
CDI- MacArthur Communicative
Development Inventories
CSBS- Communication and Symbolic
Behavior Scales
•
•
•
•
DIAL-3 Developmental Indicators for the
Assessment of Learning
EOWPVT-R Expressive One Word
Picture Vocabulary Test-Revised
EVT- Expressive Vocabulary Test
•
FLCI- Functional Linguistic
Communication Inventory
•
GFTA- Goldman Fristoe Test of
Articulation (version 1)
•
IDA- Infant-Toddler Developmental
Assessment
•
K-ABC Kaufman Assessment Battery for
Children
•
•
Mullen Scales of Early Language
MVPT- Motor-free Visual Perception
Test
OWLS- Oral and Written Language
Scales
•
•
•
•
•
•
•
PPVT-III Peabody Picture Vocabulary
Test III
SEEC- Vineland Social-Emotional Early
Childhood Scales
SPELT-II Structured Photgraphic
Expressive Language Test II
SPELT-P Structured Photographic
Expressive Language Test-Preschool
TLC- Test of Language Competence
TOPA- Test of Phonological Awareness
CHSC ADULT DIAGNOSTIC TESTS
•
•
•
•
•
•
•
•
Aphasia Dx Profiles
Aphasia Screening Test
Apraxia Battery for Adults
Appraisal of Language Disturbance
Arizona Battery for Communication
Disorders of Dementia
Assessment of Fluency
Auditory Comprehension Test Probes
AACT
•
•
•
Boston Assessment of Severe Aphasia
BDAE/Pictures/Forms
Boston Naming Test
•
Communicative Abilities in Daily Living
(Revised edition is not available)
CHI-behavioral checklist
Cognitive-Language Assessment
CASL (7-21)
•
•
•
•
•
•
•
•
Dementia Evaluation
Dworkin Oro-Facial Evaluation
Dysarthria Profile
Dysphagia Bedside Evaluation
Assessment of Intelligibility of Dysarthric
Speech
•
Fluency in Aphasia
•
Halstead-Wepman Aphasia Screening
•
•
Mini Inventories of Right Brain Injury
Minnesota Test of Differential Diagnosis
of Aphasia
•
Orofacial Exam
•
Peabody Picture Vocabulary TestRevised (3)
Pre Language Checklist
Prosody-Voice Screening Profile
•
•
•
•
•
•
•
•
•
Rainbow Passage
Reading Passage
Reading Comprehension Battery for
Adults
Reading Test Probes
Right CVA Battery
Receptive/Expressive Checklist
Rice
•
•
•
•
Scholastic Abilities Test for Adults
(SATA)
S/P Stuttering: Parent Dx Questionnaire
Stuttering: Behavior Profile Sheet
Stuttering Severity Instrument for
Children and Adults (3)
•
Birth to Three Screening Test of
Learning & Language Development
•
•
•
•
•
CASL (3-6)
Carrow Elicited Language Inventory
CELF-3
CELF-R Screening
Checklist of Communicative Functions &
Means
Clinical Language Intervention Program
CADET-Communication Ability Dx Test
Comprehensive Test of Adaptive
Behavior (CTAB)
Communication & Symbolic Behavior
Scales
Criterion Referenced Inventory of
Language
•
•
•
•
TLC-E Technical Manual
TOWL
TLC
Profile-Token
•
•
Voice Protocol
Voice Evaluation
•
•
Written Expression Test Probe
•
SOFTWARE
•
•
•
•
•
•
•
•
Kid’s World- The Great Reading
Adventure (CD Rom)
Edmark Millie and Bailey; Start School
with Skills and Confidence-3 kits
Discovery Toys Plastic Bags (3)
Reading Mansion-Great Wave Software
Busy Town-Richard Scarry’s Best Ever
1st Grade Starter Pack; 3 kits
On Track Software; Same or Different
CD Rom; 3 kits
On Track Software; Beginning Sounds
CD Rom; 3 kits
On Track Software-Beginning Reading
CD Rom
•
•
•
•
•
•
•
•
•
•
•
•
•
•
ELM-2
ECO Scales
ELI-Environmental Language Inventory
Environmental Prelanguage Battery
Expressive One Word Picture
Vocabulary Test - Revised (EOWPVT-R)
•
•
Goldman-Fristoe Test of Articulation
(GFTA)
Gray Oral Reading Test
•
The Help Test
•
Infant Scale of Communicative Intent
•
Kaufman Scale of Education
Achievement
•
•
Language Processing Test
Let’s Talk Inventory for Adolescents
•
MacArthur Communicative Development
Inventories
CHSC PEDIATRIC DIAGNOSTIC TESTS
•
•
•
•
•
•
•
•
•
•
•
•
Adolescent WORD Test
Arizona Articulation Proficiency Test Revised
Apraxia Exam
ACLC
ALPHA
Assessment of Phonological Processes
- Revised
Assessing Semantic Skills through
Everyday Themes (ASSET)
Auditory Analysis Test
Autistic Behavior Composite (Checklist
& Profile)
BBTOP
Bankson-Bernthal Test of Phonology
Bayley Scales of Infant Development
Decoding Skills Test
Denver Developmental Screening Test
Detroit Tests of Learning Aptitude - 2nd
edition
Detroit Tests of Learning Aptitude- 3rd
Edition
Diagnostic Achievement Battery - 2nd
edition
Diagnostic Achievement Test for
Adolescents
•
•
•
Miller-Yoder Language Comprehension Test
Mother/Infant Communication Screening
Multilevel Informal Language Inventory
•
Normative Adaptive Behavior Checklist
•
•
•
Observation of Communication Interaction
Oral-Motor Feeding Rating Scale
OWLS: Oral Written Language Scales
•
Peabody Individual Achievement Tests (Vol I &
II)
Peabody Picture Vocabulary Test - Forms III
A&B
Phonological Awareness Profile
Photo Articulation Test
PAT: Phonological Awareness Test
Preverbal Assessment - Intervention Profile
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Receptive One Word Picture Vocabulary Test
(ROWPVT)
REEL-R (2)
Record Form for Semantics and Morph.
Rescorla: Language Development Survey
Rosetti Infant/Toddler Language Scale
Sawyer’s Test of Awareness of Language
Segments
SALT-P
Screening Test for Developmental Apraxia of
Speech
Sequenced Inventory of Communication
Development - Revised edition (SICD-R)
SICD Instruction Manual
Social Skills (Questioinnaires/Assessments)
Spell Master
Speech and Hearing Checklist
SSI-3 Stuttering Severity Instrument-3
Stuttering Prevention Instrument (SPI)
Test for Examining Expressive Morphology
(TEEM)
Templin-Darley Screening and Dx Test of
Articulation
Test of Adolescent/Adult Word Finding
Test of Early Reading Ability (1 & 2)
Test of Early Written Language
TEWL-2 Manual/Test Forms
Test of Language Competence-Expanded
Edition (1 &2)
Test of Language Development - 3 Primary
(TOLD-3 Primary)
Test of Legible Handwriting (TOLH)
Test of Minimal Articulation Competence
Test of pragmatic Language
•
•
•
•
•
•
•
•
•
•
•
Test of Pragmatic Skills
Test of Problem Solving-Revised (TOPS-R)
Test of Problem Solving-Adolescents (TOPS)
Test of Word Finding
Test of Written Language
Test of Reading Comprehension
Test of Written Spelling-2
Token Test for Children
Westby Pay Assessment
Woodcock Reading Master Test-R
Word Test-R (elementary)
APPENDIX H: ASHA MEMBERSHIP & CERTIFICATION/OHIO BOARD OF
SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY LICENSING
The following section provides information on the academic and clinical requirements in order to
become eligible for applying for the ASHA Certificate of Clinical Competence and licensure by the
Ohio Board of Speech Language Pathology. Information on how to apply for certification and
licensure at the end of your master’s program will be included in Appendix J: Guidelines
for Graduate Students.
AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION (ASHA)
CERTIFICATION IN SPEECH-LANGUAGE PATHOLOGY
The following sections are excerpted from the 2004 Membership and Certification Handbook of
the American-Speech-Language-Hearing Association: Speech-Language Pathology. These
sections address the following questions:
• What is ASHA?
• What is the Certificate of Clinical Competence (CCC)?
• What is membership in ASHA?
• What must I do to obtain membership and certification?
• What is a clinical fellow?
• What is the National Examination in Speech-Language Pathology and how do I take it?
As a student, you will be most concerned with section III. Standards and Implementation
Procedures for the Certificate of Clinical Competence which outlines all academic and
clinical requirements to become certified in Speech-Language Pathology. READ THIS
INFORMATION CAREFULLY.
At the end of your program, you will need to complete the “Application for
Membership/Certification”. A curren copy of the Membership and Certification Handbook and the
“Application for Membership/Certification” can be found on ASHA’s website www.ASHA.org.
. . . . . . . . . . . . . . . . . . . .
WHAT IS ASHA?
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
The American Speech-Language-Hearing Association (ASHA) is the national scientific and
professional association for speech-language pathologists; audiologists; and speech, language,
and hearing scientists concerned with communication behavior and disorders. The Association, a
nonprofit organization, was founded in 1925. It now has over 114,000 members, certificate
holders, and affiliates, and recognizes 52 state speech and hearing association affiliates, including
the District of Columbia and the Overseas Association of Communication Sciences. In
addition, the Organización Puertorriqueña de Patologia del Habla Lenguaje y Audiologia, Inc. is
also affiliated with ASHA.
The purposes of ASHA are to:
•
encourage basic scientific study of the processes of individual human communication,
with special reference to speech, language, and hearing;
•
promote appropriate academic and clinical preparation of individuals entering the
discipline of human communication sciences and disorders and to promote the
maintenance of current knowledge and skills of those within the discipline;
•
promote investigation and prevention of disorders of human communication;
•
foster improvement of clinical services and procedures addressing such disorders;
•
stimulate exchange of information among persons and organizations thus engaged and to
disseminate such information;
•
advocate for the rights and interests of persons with communication disorders; and
•
promote the individual and collective professional interests of the members of the
Association.
ASHA ACTIVITIES
ASHA maintains its permanent National Office in the Washington, DC, metropolitan area, where
the executive, professional, and administrative staffs assist in coordinating the following
Association activities:
•
sponsoring national conferences, institutes, and workshops each year as part of its
continuing professional education program
•
maintaining programs related to research, education, and delivery of clinical services
•
conducting an Annual Convention at which scientific sessions, exhibits, short courses,
and other educational and professional programs and a placement center are offered
•
maintaining a national career information program, a governmental affairs program, and a
public information program
•
carrying out a continuing program of data collection related to professional training,
human resource needs, and membership characteristics and activities
•
sponsoring a voluntary continuing education program that approves providers of
continuing education activities and offers an Award for Continuing Education to certified
individuals and members
•
publishing several professional journals and other professional materials
•
providing technical support to practitioner members on issues affecting the delivery of
services
•
maintaining a computerized database that provides information about federal and private
funding sources in the United States and Canada (includes abstract; amount; funding
source; and contact person's address, telephone number, and email address)
•
protecting the public interest by maintaining high standards for members, certificate
holders, accredited clinics, and accredited graduate educational programs.
ASHA also recognizes the National Student Speech-Language-Hearing Association (NSSLHA),
founded in 1972. NSSLHA is represented on certain key ASHA boards and committees. In
addition, members of NSSLHA receive many benefits from ASHA at substantial savings.
GOVERNANCE
ASHA is governed by an Executive Board (EB) consisting of 11 elected officers and the executive
director of the Association and a Legislative Council (LC) elected by members in each of the 50
states, the District of Columbia, members residing outside the United States, and other
representatives as specified in the ASHA Bylaws. Two elected members of the National Student
Speech-Language-Hearing Association (NSSLHA) also serve on the Legislative Council. The
president of the Association serves as the chair of the Legislative Council, and the other members
of the Executive Board serve as ex officio members. The Legislative Council and Executive Board
establish the policies of the Association.
The Executive Board supervises, controls, and directs the affairs of the Association, and in
collaboration with the Legislative Council identifies priority issues and outcomes for the
Association. The EB and the LC operate in accordance with the policies established by the
Association's Bylaws.
COUNCIL FOR CLINICAL CERTIFICATION
The Council For Clinical Certification (CFCC) consists of speech-language pathologists and
audiologists and a public member who are appointed by ASHA's Executive Board, and a student
representative appointed by NSSLHA. The ASHA executive director's designee serves as an ex
officio, nonvoting member of the CFCC. All professional members of the CFCC hold the
Certificate of Clinical Competence in speech-language pathology (CCC-SLP) or audiology (CCCA) or both. This CFCC, a semi-autonomous body, is charged with developing, interpreting and
applying the certification standards; formulating procedures for applications, examination, and
review; awarding certification to qualified individuals; and, through appointment of a Special
Appeals Panel, hearing and adjudicating appeals of certification decisions.
COUNCIL ON ACADEMIC ACCREDITATION IN AUDIOLOGY AND SPEECH-LANGUAGE
PATHOLOGY
The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA), a
semi-autonomous body, defines the standards for the accreditation of graduate educational
programs and applies those standards in the accreditation of such programs. The CAA has final
authority to establish the standards and processes for academic accreditation; and, subject to the
application of established appeal procedures, the decisions of the CAA in awarding or denying
academic accreditation are final.
WHAT IS THE CERTIFICATE OF CLINICAL COMPETENCE?
CERTIFICATES OF CLINICAL COMPETENCE
ASHA's Certificates of Clinical Competence (CCC), which are granted in speech-language
pathology and in audiology, allow the holder to provide independent clinical services and to
supervise the clinical practice of student trainees, clinicians who do not hold certification, and
support personnel. The certificate can be obtained by an individual who meets specific
requirements in terms of degree, course work, practicum, and supervised professional experience,
and who passes the national examination in speech-language pathology or audiology. The
certificates are presently held by over 86,000 professionals, who provide services in schools,
colleges, speech-language and hearing centers, clinics, hospitals, private practices, and other
programs throughout the United States, Canada, and many other countries.
To hold the CCC an individual must have a graduate degree, must have an active interest in the
field of communication, must meet academic course work and clinical practicum requirements in
the professional area, and must have completed a supervised Clinical Fellowship experience and
achieved a passing score on the appropriate Praxis examination. Holders of the CCC must abide
by ASHA's Code of Ethics, which incorporates the highest standards of integrity and ethical
principles. An ASHA member who supervises the provision of clinical services must hold a current
CCC in the appropriate area. An ASHA member may provide clinical services in speech-language
pathology and audiology only when the individual holds the appropriate Certificate of Clinical
Competence or is in the process of obtaining certification and is supervised by an individual who
holds the appropriate CCC. Otherwise that individual is in violation of ASHA's "Code of Ethics."
Maintaining the CCC is contingent upon the timely payment of annual dues and fees. ASHA
resolution LC 5-81 states: "...individuals whose Annual Certification Fees are in arrears on April 1
will have allowed their certificates to expire on that date." Additionally, effective January 1, 2005,
all certificate holders in speech-language pathology, regardless of their date of certification, will be
required to participate in continuing professional development activities to maintain their
certification. Specific information on this requirement is available on our Web site.
BENEFITS OF CERTIFICATION
Many associations use professional certification to recognize individuals for their dedication to
their chosen career and their ability to perform to established standards. The certification process
is one of the single most important steps you can make in career development. Here are several
reasons you should consider ASHA certification.
•
Certification demonstrates your commitment to your profession. Certification shows
your peers and supervisors and, in turn, the general public your commitment to your
chosen career.
•
Certification enhances the profession's image. Association certification programs seek
to enlist, develop, and promote certified professionals who can stand 'out in front' as
examples of excellence in their field.
•
Certification establishes professional credentials that are national in scope.
Certification lends weight to your résumé, in that it serves as an impartial, objective
evaluation of your knowledge and experience. And when the public looks for individuals
qualified to perform clinical services, they seek individuals 'like you' who have achieved
certification.
•
Certification builds self-esteem. Certification programs create a standard for the
profession. You'll begin to define yourself beyond a job description or academic degree.
You'll see yourself as a certified professional who can control his or her own professional
destiny and find a deep sense of personal satisfaction.
•
Certification prepares you for greater on-the-job responsibilities. Because
certification is a voluntary professional commitment to a field of knowledge, it is a clear
indicator of your willingness to invest in your own professional development. Certified
professionals are aware of the constant change in their professional environment and
possess the tools to anticipate and respond to change.
ASHA certification has value beyond the ability to provide or supervise individuals in the provision
of clinical services. ASHA certificate holders can:
•
receive reimbursement for services rendered from certain third-party payers, including
private insurance agencies and some publicly funded programs;
•
be eligible for employment as speech-language pathologists in hospitals, health care
settings, educational programs, and private practices;
•
be eligible for promotion in some employment settings, including the U.S. military;
•
be assured of an easier and more manageable state licensure process;
•
have maximum employment flexibility and portability between states; and
•
be recognized by state and federal policy makers as holding nationally validated
professional credentials.
Check into certification soon. It will give your career and professional life a real boost!
WHAT IS MEMBERSHIP IN ASHA?
The American Speech-Language-Hearing Association (ASHA) represents more than 114,000
members and affiliates who are speech-language pathologists; audiologists; and speech,
language, and hearing scientists. ASHA is recognized nationally as an organization that maintains
high standards of ethical conduct and professionalism, produces quality journals and continuing
education programs, monitors and participates in the development and implementation of health
care reform proposals and programs at the federal and state levels, and offers its members
benefits and services that cannot be obtained elsewhere. Members of the Association must abide
by ASHA's Code of Ethics.
There are several categories of membership in ASHA. The applicant should review the description
of membership categories given below before completing the membership application form and
submitting the appropriate dues and fees (see Form A and Form B in this Handbook).
MEMBERSHIP AND CERTIFICATION CATEGORIES
Membership with certification. An individual who wishes to provide or supervise clinical services
and resides in the United States or its territories must apply for this category of membership. To
be eligible for this membership category the individual must have successfully completed all
requirements for the Certificates of Clinical Competence in speech-language pathology (CCCSLP). The requirements include holding a graduate degree. Applicants for this category of
membership typically are granted membership in ASHA while they are in the certification process.
Until the CCC-SLP is awarded, the applicant may not provide clinical services except under the
supervision of an individual who holds the CCC-SLP. While in the certification process a
candidate for certification must pay the annual dues and the annual certification-in-process fee. As
a member who has been awarded the CCC-SLP, an individual may provide independent clinical
services and supervise students involved in clinical practicum, clinical fellows, and support
personnel. Maintaining certification status and enjoying the benefits of membership are
contingent upon the timely payment of annual dues and fees and, beginning January 1,
2005, mandatory participation in continuing professional development activities.
Membership without certification. This category of membership is open to an individual who (a)
holds a graduate degree with major emphasis in speech-language pathology; audiology; or
speech, language, or hearing science, (b) is not involved in providing clinical services or in
supervising students and/or clinical fellows, and resides in the United States. Complete
application materials for Membership without certification (PDF Format) to become a member.
Membership without certification (Research or allied professional). An individual who holds a
graduate degree and presents evidence of active research, interest, and performance in the field
of human communication is eligible for membership without certification as a research or allied
professional (PDF Format). Only individuals who do not provide or supervise clinical services may
apply for this category of membership. (Note: Clinical services are defined as evaluation and
treatment of persons with speech-language and/or hearing impairments, whether such services
are provided in elemenatary or secondary schools, in private practice, or in free-standing
community clinics, rehabiliation centers, hospitals, nursing homes, or other facilities.)
International Affiliate. An individual who holds a graduate degree and who resides abroad may
apply for international affiliate status. An individual with foreign or dual U.S. and foreign citizenship
who meets these criteria may apply for International Affiliation (PDF Format). Please review
the dues schedule and submit the completed charge payment form with your application.
International Affiliates are entitled to all the privileges of Association membership except for voting
and holding office. International Affiliates are not eligible for certification and must abide by an
ethical code of professional practice statement that prohibits use of affiliation with ASHA in the
promotion of commercial products.
Certificate Holder. An individual may also choose to maintain certificate-holder status--that is,
hold the Certificate of Clinical Competence--but not become a member of the Association. Nonmember certificate holders are not eligible for member benefits.
Life Member. Individuals who are 65 years old and have been an ASHA member for 25
consecutive years are eligible to apply for life membership. Please contact the Action Center at
the ASHA National Office for details.
WHAT MUST I DO TO OBTAIN MEMBERSHIP AND CERTIFICATION?
STANDARDS AND IMPLEMENTATION PROCEDURES FOR THE CERTIFICATE OF
CLINICAL COMPETENCE
OVERVIEW OF STANDARDS
Although previous certification standards emphasized process measures of academic and clinical
knowledge, the 2005 standards combine process and outcome measures of academic and clinical
knowledge and skills. Process standards specify the experiences, such as course work or
practicum hours; outcome standards require demonstration of specific knowledge and skills. The
2005 standards utilize a combination of formative and summative assessments for the purpose of
improving and measuring student learning.
Salient features of the standards for entry- level practice include the following requirements:
A. A minimum of 75 semester credit hours culminating in a master’s, doctoral, or other recognized
post-baccalaureate degree. The graduate education in speech-language pathology must be
initiated and completed in a program accredited by the Council on Academic Accreditation in
Audiology and Speech-Language Pathology (CAA) of the American Speech-Language-Hearing
Association.
B. Skills in oral and written communication and demonstrated knowledge of ethical standards,
research principles, and current professional and regulatory issues.
C. Practicum experiences that encompass the breadth of the current scope of practice with both
adults and children (with no specific clock-hour requirements for given disorders or settings)
resulting in a minimum of 400 clock hours of supervised practicum, of which at least 375 hours
must be in direct client/patient contact and 25 in clinical observation.
D. A 36-week speech- language pathology clinical fellowship that establishes a collaboration
between the clinical fellow and a mentor.
E. A maintenance of certification requirement (Standard VII) that goes into effect on January 1,
2005.
Standards and Implementation for the Certificate of Clinical Competence in SpeechLanguage Pathology. Effective January 1, 2005
Applicants for Initial Certification
Individuals applying for initial certification before January 1, 2005, may be able to apply under
either the 1993 or the 2005 Standards, depending on when they began their graduate program of
study. Please refer to the chart below that describes the scenarios under which individuals may
apply for certification.
Applicant Began
Graduate Program
Under Which Standards
(1993 or 2005)?
And Completed
And Applies for
Program Under Which
Certification
Standards (1993 or
When?
2005)?
Applicant Applies for
Certification Under
Which Standards (1993
or 2005)?
1. 1993
1993
Before 1/1/05
1993 Standards
2. 1993
1993
After 1/1/05
1993 Standards (through
12/31/05); then 2005
Standards beginning
1/1/06
3. 1993
After program
evaluated by CAA
under 2005 Standards
Before 1/1/05
Either 1993 or 2005
Standards (through
12/31/05)
4. 1993
After program
evaluated by CAA
under 2005 Standards
a. But completed
before 1/1/05
b. But completed after
1/1/05
After 1/1/05
Either 1993 or 2005
Standards (through
12/31/05)
5. 2005
Before 1/1/05
Before 1/1/05
2005 Standards
6. 2005
Before 1/1/05
After 1/1/05
2005 Standards
Applicants for Reinstatement
Individuals who were previously certified and who let their certification lapse must meet the 2005
standards if they wish to reinstate certification on or after January 1, 2005.
The Standards for the Certificate of Clinical Competence in Speech-Language Pathology are
shown in bold. The related implementation procedures are shown in normal text following each
standard.
STANDARD I: DEGREE
Effective January 1, 2005, the applicant for certification must have a master’s or doctoral or
other recognized post-baccalaureate degree. A minimum of 75 semester credit hours must
be completed in a course of study addressing the knowledge and skills pertinent to the
field of speech-language pathology.
Implementation:
Verification of the graduate degree is required of the applicant before the certificate is awarded.
Degree verification is accomplished by submitting (a) an application signed by the director of the
graduate program indicating the degree date, and (b) an official transcript showing that the degree
has been awarded. Individuals educated in foreign countries must submit official transcripts and
evaluations of their degrees and courses to verify equivalency.
All graduate course work and graduate clinical practicum required in the professional area
for which the Certificate is sought must have been initiated and completed at an institution
whose program was accredited by the Council on Academic Accreditation in Audiology
and Speech-Language Pathology (CAA) of the American Speech-Language-Hearing
Association in the area for which the Certificate is sought.
Automatic Approval. If the graduate program of study is completed in a CAA-accredited program
and if the program director verifies that all knowledge and skills requirements have been met,
approval of the application is automatic, provided that the application for the Certificate of Clinical
Competence is received by the National Office in accordance with the time lines stipulated in the
chart above.
Evaluation Required. The following categories of applicants must submit a completed application
for certification, which includes the Knowledge and Skills Acquisition (KASA) summary form for
evaluation by the Council For Clinical Certification (CFCC):
(a) those who apply after the dates stipulated in the chart above
(b) those who were graduate students and were continuously enrolled in a CAA-program that had
its accreditation withdrawn during the applicant’s enrollment
(c) those who satisfactorily completed graduate course work, clinical practicum, and knowledge
and skills requirements in the area for which certification is sought in a program that held
candidacy status for accreditation
(d) those who satisfactorily completed graduate course work, clinical practicum, and knowledge
and skills requirements in the area for which certification is sought at a CAA-accredited program
but (1) received a graduate degree from a program not accredited by CAA; (2) received a
graduate degree in a related area; or (3) received a graduate degree from a non-U.S. institution of
higher education
The graduate program director must verify satisfactory completion of both undergraduate and
graduate academic course work, clinical practicum, and knowledge and skills requirements.
STANDARD II: INSTITUTION OF HIGHER EDUCATION
The graduate degree must be granted by a regionally accredited institution of higher
education.
Implementation:
The institution of higher education must be accredited by one of the following: Commission on
Higher Education, Middle States Association of Colleges and Schools; Commission on Institutions
of Higher Education, New England Association of Schools and Colleges; Commission on
Institutions of Higher Education, North Central Association of Colleges and Schools; Commission
on Colleges, Northwest Association Schools and Colleges; Commission on Colleges, Southern
Association of Colleges and Schools; and Accrediting Commission for Senior Colleges and
Universities, Western Association of Schools and Colleges.
Individuals educated in foreign countries must submit documentation that course work was
completed in an institution of higher education that is regionally accredited or recognized by the
appropriate regulatory authority for that country. In addition, applicants educated in foreign
countries must meet each of the Standards that follow.
STANDARD III: PROGRAM OF STUDY—KNOWLEDGE OUTCOMES
The applicant for certification must complete a program of study (a minimum of 75
semester credit hours overall, including at least 36 at the graduate level) that includes
academic course work sufficient in depth and breadth to achieve the specified knowledge
outcomes.
Implementation:
The program of study must address the knowledge and skills pertinent to the field of speechlanguage pathology. The applicant must maintain documentation of course work at both
undergraduate and graduate levels demonstrating that the requirements in this standard have
been met. The minimum 75 semester credit hours may include credit earned for course work,
clinical practicum, research, and/or thesis/dissertation. Verification is accomplished by submitting
an official transcript showing that the minimum credit hours have been competed.
Standard III-A: The applicant must demonstrate knowledge of the principles of biological
sciences, physical sciences, mathematics, and the social/behavioral sciences.
Implementation:
The applicant must have transcript credit (which could include course work, advanced placement,
CLEP, or examination of equivalency) for each of the following areas: biological sciences, physical
sciences, social/behavioral sciences, and mathematics. Appropriate course work may include
human anatomy and physiology, neuroanatomy and neurophysiology, genetics, physics, inorganic
and organic chemistry, psychology, sociology, anthropology, and non-remedial mathematics. The
intent of this standard is to require students to have a broad liberal arts and science background.
Courses in biological and physical sciences specifically related to communication sciences and
disorders (CSD) may not be applied for certification purposes in this category. In addition to
transcript credit, applicants may be required by their graduate program to provide further evidence
of meeting this requirement.
Standard III-B: The applicant must demonstrate knowledge of basic human communication
and swallowing processes, including their biological, neurological, acoustic,
psychological, developmental, and linguistic and cultural bases.
Implementation:
This standard emphasizes the basic human communication processes. The applicant must
demonstrate the ability to integrate information pertaining to normal and abnormal human
development across the life span, including basic communication processes and the impact of
cultural and linguistic diversity on communication. Similar knowledge must also be obtained in
swallowing processes and new emerging areas of practice. Program documentation may include
transcript credit and information obtained by the applicant through clinical experiences,
independent studies, and research projects.
Standard III-C: The applicant must demonstrate knowledge of the nature of speech,
language, hearing, and communication disorders and differences and swallowing
disorders, including the etiologies, characteristics, anatomical/ physiological, acoustic,
psychological, developmental, and linguistic and cultural correlates. Specific knowledge
must be demonstrated in the following areas:
· articulation
· fluency
· voice and resonance, including respiration and phonation
· receptive and expressive language (phonology, morphology, syntax, semantics, and
pragmatics) in speaking, listening, reading, writing, and manual modalities
· hearing, including the impact on speech and language
· swallowing (oral, pharyngeal, esophageal, and related functions, including oral function
for feeding; orofacial myofunction)
· cognitive aspects of communication (attention, memory, sequencing, problem-solving,
executive functioning)
· social aspects of communication (including challenging behavior, ineffective social skills,
lack of communication opportunities)
· communication modalities (including oral, manual, augmentative, and alternative
communication techniques and assistive technologies)
Implementation:
The applicant must demonstrate the ability to integrate information delineated in this standard.
Program documentation may include transcript credit and information obtained by the applicant
through clinical experiences, independent studies, and research projects. It is expected that
course work addressing the professional knowledge specified in Standard III-C will occur primarily
at the graduate level. The knowledge gained from the graduate program should include an
effective balance between traditional parameters of communication (articulation/phonology, voice,
fluency, language, and hearing) and additional recognized and emerging areas of practice (e.g.,
swallowing, upper aerodigestive functions).
Standard III-D: The applicant must possess knowledge of the principles and methods of
prevention, assessment, and intervention for people with communication and swallowing
disorders, including consideration of anatomical/physiological, psychological,
developmental, and linguistic and cultural correlates of the disorders.
Implementation:
The applicant must demonstrate the ability to integrate information about prevention, assessment,
and intervention over the range of differences and disorders specified in Standard III C above.
Program documentation may include transcript credit and information obtained by the applicant
through clinical experiences, independent studies, and research projects.
Standard III-E: The applicant must demonstrate knowledge of standards of ethical conduct.
Implementation:
The applicant must demonstrate knowledge of, appreciation for, and ability to interpret the ASHA
Code of Ethics. Program documentation may reflect coursework, workshop participation,
instructional module, clinical experiences, and independent projects.
Standard III-F: The applicant must demonstrate knowledge of processes used in research
and the integration of research principles into evidence-based clinical practice.
Implementation:
The applicant must demonstrate comprehension of the principles of basic and applied research
and research design. In addition the applicant should know how to access sources of research
information and have experience relating research to clinical practice. Program documentation
could include information obtained through class projects, clinical experiences, independent
studies, and research projects.
Standard III-G: The applicant must demonstrate knowledge of contemporary professional
issues.
Implementation:
The applicant must demonstrate knowledge of professional issues that affect speech-language
pathology as a profession. Issues typically include professional practice, academic program
accreditation standards, ASHA practice policies and guidelines, and reimbursement procedures.
Documentation could include information obtained through clinical experiences, workshops, and
independent studies.
Standard III-H: The applicant must demonstrate knowledge about certification, specialty
recognition, licensure, and other relevant professional credentials.
Implementation:
The applicant must demonstrate knowledge of state and federal regulations and policies related to
the practice of speech-language pathology and credentials for professional practice.
Documentation could include course modules and instructional workshops.
STANDARD IV: PROGRAM OF STUDY—SKILLS OUTCOMES
Standard IV-A: The applicant must complete a curriculum of academic and clinical
education that follows an appropriate sequence of learning sufficient to achieve the skills
outcomes in Standard IV-G.
Implementation:
The applicant’s program of study should follow a systematic knowledge- and skill-building
sequence in which basic course work and practicum precede, insofar as possible, more advanced
course work and practicum.
Standard IV-B: The applicant must possess skill in oral and written or other forms of
communication sufficient for entry into professional practice.
Implementation:
The applicant must demonstrate communication skills sufficient to achieve effective clinical and
professional interaction with clients/patients and relevant others. For oral communication, the
applicant must demonstrate speech and language skills in English, which, at a minimum, are
consistent with ASHA’s most current position statement on students and professionals who speak
English with accents and nonstandard dialects. For written communication, the applicant must be
able to write and comprehend technical reports, diagnostic and treatment reports, treatment plans,
and professional correspondence.
Individuals educated in foreign countries must meet the criteria required by the International
Commission of Healthcare Professions (ICHP) in order to meet this standard.
Standard IV-C: The applicant for certification in speech-language pathology must complete
a minimum of 400 clock hours of supervised clinical experience in the practice of speechlanguage pathology. Twenty-five hours must be spent in clinical observation, and 375
hours must be spent in direct client/patient contact.
Implementation:
Observation hours generally precede direct contact with clients/patients. However, completion of
all 25 observation hours is not a prerequisite to begin direct client/patient contact. The observation
and direct client/patient contact hours must be within the scope of practice of speech-language
pathology.
For certification purposes, observation experiences must be under the direction of a qualified
clinical supervisor who holds current ASHA certification in the appropriate practice area. Such
direction may occur simultaneously with the student’s observation or may be through review and
approval of written reports or summaries submitted by the student. Students may use videotapes
of the provision of client services for observation purposes. The applicant must maintain
documentation of time spent in supervised observation, verified by the program in accordance
with Standards III and IV.
Applicants should be assigned practicum only after they have acquired a sufficient knowledge
base to qualify for such experience. Only direct contact with the client or the client’s family in
assessment, management, and/or counseling can be counted toward practicum. Although several
students may observe a clinical session at one time, clinical practicum hours should be assigned
only to the student who provides direct services to the client or client’s family. Typically, only one
student should be working with a given client. In rare circumstances, it is possible for several
students working as a team to receive credit for the same session depending on the specific
responsibilities each student is assigned. For example, in a diagnostic session, if one student
evaluates the client and another interviews the parents, both students may receive credit for the
time each spent in providing the service. However, if one student works with the client for 30
minutes and another student works with the client for the next 45 minutes, each student receives
credit for the time he/she actually provided services— that is, 30 and 45 minutes, not 75 minutes.
The applicant must maintain documentation of time spent in supervised practicum, verified by the
program in accordance with Standards III and IV.
Standard IV-D: At least 325 of the 400 clock hours must be completed while the applicant is
engaged in graduate study in a program accredited in speech-language pathology by the
Council on Academic Accreditation in Audiology and Speech-Language Pathology.
Implementation:
A minimum of 325 hours of clinical practicum must be completed at the graduate level. The
remaining required hours may have been completed at the undergraduate level, at the discretion
of the graduate program.
Standard IV-E: Supervision must be provided by individuals who hold the Certificate of
Clinical Competence in the appropriate area of practice. The amount of supervision must
be appropriate to the student’s level of knowledge, experience, and competence.
Supervision must be sufficient to ensure the welfare of the client/patient.
Implementation:
Direct supervision must be in real time and must never be less than 25% of the student’s total
contact with each client/patient and must take place periodically throughout the practicum. These
are minimum requirements that should be adjusted upward if the student’s level of knowledge,
experience, and competence warrants. A supervisor must be available to consult as appropriate
for the client’s/patient’s disorder with a student providing clinical services as part of the student’s
clinical education. Supervision of clinical practicum must include direct observation, guidance, and
feedback to permit the student to monitor, evaluate, and improve performance and to develop
clinical competence.
All observation and clinical practicum hours used to meet Standard IV-C must be supervised by
individuals who hold a current CCC in the professional area in which the observation and
practicum hours are being obtained Only the supervisor who actually observes the student in a
clinical session is permitted to verify the credit given to the student for the clinical practicum hours.
Standard IV-F: Supervised practicum must include experience with client/patient
populations across the life span and from culturally/linguistically diverse backgrounds.
Practicum must include experience with client/patient populations with various types and
severities of communication and/or related disorders, differences, and disabilities.
Implementation:
The applicant must demonstrate direct client/patient clinical experiences in both diagnosis and
treatment with both children and adults from the range of disorders and differences named in
Standard III-C.
Standard IV-G: The applicant for certification must complete a program of study that
includes supervised clinical experiences sufficient in breadth and depth to achieve the
following skills outcomes:
1. Evaluation:
a. conduct screening and prevention procedures (including prevention activities)
b. collect case history information and integrate information from clients/patients, family,
caregivers, teachers, relevant others, and other professionals
c. select and administer appropriate evaluation procedures, such as behavioral
observations, nonstandardized and standardized tests, and instrumental procedures
d. adapt evaluation procedures to meet client/patient needs
e. interpret, integrate, and synthesize all information to develop diagnoses and make
appropriate recommendations for intervention
f. complete administrative and reporting functions necessary to support evaluation
g. refer clients/patients for appropriate services
2. Intervention:
a. develop setting -appropriate intervention plans with measurable and achie vable goals
that meet clients’/patients’ needs. Collaborate with clients/patients and relevant others in
the planning process
b. implement intervention plans (Involve clients/patients and relevant others in the
intervention process
c. select or develop and use appropriate materials and instrumentation for prevention and
intervention
d. measure and evaluate clients’/patients’ performance and progress
e. modify intervention plans, strategies, materials, or instrumentation as appropriate to
meet the needs of clients/patients
f. complete administrative and reporting functions necessary to support intervention
g. identify and refer clients/patients for services as appropriate
3. Interaction and Personal Qualities:
a. communicate effectively, recognizing the needs, values, preferred mode of
communication, and cultural/linguistic background of the client/patient, family, caregivers,
and relevant others
b. collaborate with other professionals in case management
c. provide counseling regarding communication and swallowing disorders to clients
/patients, family, caregivers, and relevant others
d. adhere to the ASHA Code of Ethics and behave professionally
Implementation:
The applicant must document the acquisition of the skills referred to in this Standard applicable
across the nine major areas listed in Standard III-C. Clinical skills may be developed and
demonstrated by means other than direct client/patient contact in clinical practicum experiences,
such as academic course work, labs, simulations, examinations, and completion of independent
projects. This documentation must be maintained and verified by the program director or official
designee.
For certification purposes, only direct client/patient contact may be applied toward the required
minimum of 375 clock hours of supervised clinical experience.
STANDARD V: ASSESSMENT
The applicant for certification must demonstrate successful achievement of the knowledge
and skills delineated in Standard III and Standard IV by means of both formative and
summative assessment.
Standard V-A: Formative Assessment
The applicant must meet the education program’s requirements for demonstrating
satisfactory performance through ongoing formative assessment of knowledge and skills.
Implementation:
Formative assessment yields critical information for monitoring an individual’s acquisition of
knowledge and skills. Therefore, to ensure that the applicant pursues the outcomes stipulated in
Standard III and Standard IV in a systematic manner, academic and clinical educators must have
assessed developing knowledge and skills throughout the applicant’s program of graduate study.
Applicants may also be part of the process through self-assessment. Applicants and program
faculties should use the ongoing assessment to help the applicant achieve requisite knowledge
and skills. Thus, assessments should be followed by implementation of strategies for acquisition
of knowledge and skills.
The applicant must adhere to the academic program’s formative assessment process and must
maintain records verifying ongoing formative assessment. The applicant shall make these records
available to the Council For Clinical Certification upon its request. Documentation of formative
assessment may take a variety of forms, such as checklists of skills, records of progress in clinical
skill development, portfolios, and statements of achievement of academic and practicum course
objectives, among others.
Standard V-B: Summative Assessment
The applicant must pass the national examination adopted by ASHA for purposes of
certification in speech-language pathology.
Implementation:
Summative assessment is a comprehensive examination of learning outcomes at the culmination
of professional preparation. Evidence of a passing score on the ASHA-approved national
examination in speech-language pathology must be submitted to the National Office by the testing
agency administering the examination.
STANDARD VI: SPEECH-LANGUAGE PATHOLOGY CLINICAL FELLOWSHIP
After completion of academic course work and practicum (Standard VI), the applicant then
must successfully complete a Speech-Language Pathology Clinical Fellowship (SLPCF).
Implementation:
The Clinical Fellow may be engaged in clinical service delivery or clinical research that fosters the
continued growth and integration of the knowledge, skills, and tasks of clinical practice in speechlanguage pathology consistent with ASHA’s current Scope of Practice. The Clinical Fellow’s major
responsibilities must be in direct client/patient contact, consultations, record keeping, and
administrative duties.
The SLPCF may not be initiated until completion of the graduate course work and graduate
clinical practicum required for ASHA certification.
It is the Clinical Fellow’s responsibility to identify a mentoring speech-language pathologist (SLP)
who holds a current Certificate of Clinical Competence in Speech-Language Pathology. Before
beginning the SLPCF and periodically throughout the SLPCF experience, the Clinical Fellow must
contact the ASHA National Office to verify the mentoring SLP’s current certification status.
Standard VI-A: The mentoring speech-language pathologist and Speech-Language
Pathology Clinical Fellow will establish outcomes and performance levels to be achieved
during the Speech-Language Pathology Fellowship (SLPCF), based on the Clinical Fellow’s
academic experiences, setting -specific requirements, and professional interests/goals.
Implementation:
The Clinical Fellow and mentoring SLP will determine outcomes and performance levels in a goalsetting conference within 4 weeks of initiating the SLPCF. It is the Clinical Fellow’s responsibility
to retain documentation of the agreed-upon outcomes and performance levels. The mentoring
SLP’s guidance should be adequate throughout the SLPCF to achieve the stated outcomes, such
that the Clinical Fellow can function independently by the completion of the SLPCF. The Clinical
Fellow will submit the SLPCF Report and Rating Form to the Council For Clinical Certification at
the conclusion of the SLPCF.
Standard VI-B: The Clinical Fellow and mentoring SLP must engage in periodic assessment
of the Clinical Fellow’s performance, evaluating the Clinical Fellow’s progress toward
meeting the established goals and achievement of the clinical skills necessary for
independent practice.
Implementation:
Assessment of performance may be by both formal and informal means. The Clinical Fellow and
mentoring SLP should keep a written record of assessment processes and recommendations.
One means of assessment must be the SLPCF Report and Rating Form.
Standard VI-C: The Speech-Language Pathology Clinical Fellowship (SLPCF) will consist of
the equivalent of 36 weeks of full-time clinical practice.
Implementation:
Full-time clinical practice is defined as a minimum of 35 hours per week in direct patient/client
contact, consultations, record keeping, and administrative duties relevant to a bona fide program
of clinical work. The length of the SLPCF may be modified for less than full-time employment
(FTE) as follows:
15-20 hours/week over 72 weeks
21-26 hours/week over 60 weeks
27-34 hours/week over 48 weeks
Professional experience of less than 15 hours per week does not meet the requirement and may
not be counted toward the SLPCF. Similarly, experience of more than 35 hours per week cannot
be used to shorten the SLPCF to less than 36 weeks.
Standard VI-D: The Clinical Fellow must submit evidence of successful completion of the
Speech-Language Pathology Clinical Fellowship (SLPCF) to the Council For Clinical
Certification.
Implementation:
The Clinical Fellow must submit the SLPCF Report and Rating Form, which includes the CFSI
and documentation of successful achievement of the goals established at the beginning of the
SLPCF. This report must be completed by both the Clinical Fellow and the mentoring SLP. The
Clinical Fellow must also submit the Employer(s) Verification Form, signed by the employer, which
attests to the completion of the 36-week full-time SLPCF or its part-time equivalent.
STANDARD VII: MAINTENANCE OF CERTIFICATION
Demonstration of continued professional development is mandated for maintenance of the
Certificate of Clinical Competence in Speech-Language Pathology. This standard will take
effect on January 1, 2005. The renewal period will be 3 years. This standard will apply to all
certificate holders, regardless of the date of initial certification.
Implementation:
Individuals who hold the Certificate of Clinical Competence (CCC) in Speech-Language Pathology
must accumulate 30 contact hours of professional development over the 3-year period in order to
meet this standard. At the time of payment of the annual certification fee, individuals holding the
CCC in Speech-Language Pathology must acknowledge that they agree to meet this standard. At
the conclusion of the renewal period, certified individuals will verify that they have met the
requirements of the standard. Individuals will be subject to random review of their professional
development activities. If renewal of certification is not accomplished by the end of the 3-year
period, certification will lapse. Re-application for certification will be required, and certification
standards in effect at the time of re-application must be met.
Continued professional development may be demonstrated through one or more of the following
options:
•
Accumulation of 3 continuing education units (CEUs) (30 contact hours) from continuing
education providers approved by the American Speech-Language-Hearing Association
(ASHA). ASHA CEUs may be earned through group activities (e.g., workshops,
conferences), independent study (e.g., course development, research projects,
internships, attendance at educational programs offered by non-ASHA CE providers), and
self-study (e.g., videotapes, audiotapes, journals).
•
Accumulation of 3 CEUs (30 contact hours) from a provider authorized by the
International Association for Continuing Education and Training (IACET).
•
Accumulation of 2 semester hours (3 quarter hours) from a college or university that holds
regional accreditation or accreditation from an equivalent nationally recognized or
governmental accreditation authority.
•
Accumulation of 30 contact hours from employer-sponsored in-service or other continuing
education activities that contribute to professional development.
Professional development is defined as any activity that relates to the science and contemporary
practice of audiology, speech-language pathology, and speech/language/hearing sciences, and
results in the acquisition of new knowledge and skills or the enhancement of current knowledge
and skills. Professional development activities should be planned in advance and be based on an
assessment of knowledge, skills and competencies of the individual and/or an assessment of
knowledge, skills, and competencies required for the independent practice of any area of the
professions.
For the first renewal cycle, beginning January 1, 2005, applications for renewal will be processed
on a staggered basis, determined by their initial certification dates. For individuals initially certified
before January 1, 1980, professional development activities must be completed between January
1, 2005, and December 31, 2007; for individuals initially certified between January 1, 1980, and
December 31, 1989, professional development activities must be completed between January 1,
2006, and December 31, 2008; and for individuals initially certified after January 1, 1990,
professional development activities must be completed between January 1, 2007, and December
31, 2009. All individuals will have a 3-year period to complete the process for renewal of
certification.
WHAT IS A CLINICAL FELLOWSHIP?
CLINICAL FELLOWSHIP: REQUIREMENTS AND PROCEDURES
The American Speech-Language-Hearing Association (ASHA) maintains that academic and
practicum experiences alone are not sufficient preparation for an individual to function as an
independent, competent professional providing high quality care in speech-language pathology.
Therefore, all applicants for the Certificates of Clinical Competence (CCC) are required to
successfully complete a clinical fellowship (CF) in addition to the required academic and practicum
experiences and the national examination in speech-language pathology. The clinical fellowship is
an important transitional phase between supervised graduate-level practicum and the independent
delivery of services. Inherent in this transition are:
•
development of a total commitment to quality speech, language, and hearing services;
•
integration and application of theoretical knowledge gained in academic training;
•
evaluation of individual strengths and limitations;
•
refinement of clinical skills;
•
and development of clinical skills consistent with the current scope of practice in the
profession.
CLINICAL FELLOWS
The clinical fellow is an individual who is obtaining the supervised professional clinical experience
required to obtain the CCC. Professional experience includes direct patient contact, consultations,
record keeping, or any other duties relevant to a bona fide program of clinical work. Time spent in
supervision of students, academic teaching, and research, as well as administrative activity that
does not deal directly with patient management, may not be counted as professional experience
in this context. The clinical fellow may not supervise students in clinical practicum.
Academic and clinical practicum requirements must be completed before the clinical
fellowship is initiated. The clinical fellow must request supervision from a person holding a
current CCC-SLP. It is the responsibility of the clinical fellow to verify the certification status of the
clinical fellowship supervisor before initiating the experience and to verify the supervisor's
continuing certification throughout the duration of the clinical fellowship experience. Individuals
may verify the certification status of their supervisor in the following ways: (a) call ASHA's Action
Center at its toll-free number (1-800-498-2071); (b) call the Certification office at the National
Office (301-897-5700); or (c) ask to see your supervisor's ASHA membership card with the
expiration date.
Information to note:
•
A family member or individual related in any way to the clinical fellow may not serve as a
clinical fellowship supervisor.
•
If dual certification is sought, full clinical fellowship requirements must be met in each
area.
•
ASHA's Board of Ethics has determined that clinical fellows may specify "CF/SLP" after
their names. However, if you wish to provide clinical services in the United States, you
must first contact the appropriate state regulatory agency for specific regulations
regarding use of the designation of audiologist (A) or speech-language pathologist (SLP).
STATE LICENSURE/REGULATORY REQUIREMENTS
Before beginning a clinical fellowship, the clinical fellow should determine what the state licensing
agency requires of persons fulfilling a clinical fellowship. Some states use a different designation
for the fellowship (e.g., Required Professional Employment). Many states require clinical fellows to
register with the licensing agency, obtain a provisional or temporary license, and/or file a clinical
fellowship plan. The addresses and phone numbers of the state regulatory agencies are on
ASHA's Web site. Completing the clinical fellowship without also meeting the state requirements
may jeopardize one's ability to practice.
CLINICAL FELLOWSHIP SETTING
It is recognized that services for persons with speech, language, and hearing disabilities can be
provided in any one of a number of diverse employment settings. The determination of whether a
given setting is appropriate for the clinical fellowship is made by first applying the criterion of
whether the particular program or program component is designed to evaluate, habilitate, or
rehabilitate individuals with speech, language, and hearing disabilities. Second, the program must
afford the possibility that clinical fellowship supervisory requirements can be met. It is the clinical
fellow's responsibility to obtain employment in a setting that meets these criteria. It is also the
clinical fellow's responsibility to abide by ASHA's "Code of Ethics" during the clinical fellowship.
It is further recognized that many highly specialized programs are appropriate for the clinical
fellowship, even though they deal intensively with only a small number of individuals. Evaluation
and treatment programs in schools, clinics, hospitals, community agencies, nursing homes, and
home health agencies are appropriate clinical fellowship settings. However, programs that
primarily provide screening services are not suitable for the clinical fellowship experience.
Because the clinical fellowship is not intended to be an extension of the clinical practicum
experience undertaken as part of academic study, the clinical service program of an educational
program may not be an appropriate work setting for the clinical fellowship. If such a site is
selected for the clinical fellowship, it is important that the clinical fellow perform clinical services as
a bona fide staff member and that all of the requirements for the clinical fellowship are met.
If the clinical fellow changes the clinical fellowship site, the clinical fellowship supervisor, or the
category of number of hours worked per week, the clinical fellow must document any changes in
the final Clinical Fellowship Report and Rating Form (see Form D) as noted below. For example, if
a clinical fellow began the clinical fellowship indicating the intent to work 18 hours/week and after
2 months of work he/she changes to 26 hours/week or after 3 months of work selects another
supervisor and moves to another facility, then those changes must be documented in the final
report, with a separate report submitted for each component of the experience.
Professional Services Accreditation. ASHA administers a voluntary accreditation program for
speech-language pathology and audiology programs in a variety of clinical facilities in which the
clinical fellowship experience may occur. The program documents and verifies use of standards
established by the Council on Professional Standards. The ASHA "Guidelines for Professional
Service Programs in Audiology and Speech-Language Pathology" address the following areas:
program mission, goals, and objectives; nature and quality of services; quality improvement and
program evaluation; administration; financial resources and management; human resources;
physical facilities and program environment; and equipment and materials.
Professional services accreditation demonstrates to regulatory agencies, insurance carriers,
HMOs, and other funding agencies that a clinical program meets ASHA's nationally recognized
standards of quality service delivery. This accreditation is currently used by many state funding
agencies as the criterion for selection of speech-language pathology and audiology service
providers. Although it is not required that the facility in which an individual completes the clinical
fellowship be accredited by ASHA's Professional Services Accreditation (PSA) program, it is
recognized that the current PSA guidelines do ensure the provision of both high quality services to
the public and a commitment to adequate supervision of non-certified staff members. Individuals
completing their clinical fellowship in an accredited facility will not be required to complete the
entire Clinical Fellowship Report and Rating Form (Form D), as described later.
For a complete list of accredited clinical service delivery programs, you can consult ASHA's Web
site.
LENGTH OF CLINICAL FELLOWSHIP
The clinical fellowship is defined as no less than 36 weeks of full-time professional employment. A
minimum of 30 hours of work per week constitutes full-time employment. At least 80% of the
clinical fellowship work week must be in direct client contact (assessment, diagnosis, evaluation,
screening, habilitation, or rehabilitation) related to the management process. Thus, in a 30-hour
work week, at least 24 hours must be devoted to direct clinical activities. The clinical fellowship
requirement can also be met by less than full-time employment. For example, if the clinical fellow
works:
•
25-29 hours per week, the length of the clinical fellowship must be at least 48 weeks.
•
20-24 hours per week, the length of the clinical fellowship must be at least 60 weeks.
•
15-19 hours per week, the length of the clinical fellowship must be at least 72 weeks.
Professional employment of less than 15 hours per week may not be used to fulfill any part of
the clinical fellowship requirement . If the clinical fellowship is not completed within 4 years of
the date the academic and practicum education is completed, the clinical fellow must reapply and
meet the academic and practicum requirements in effect at the time of reapplication.
ALTERNATE MECHANISM FOR SUPERVISION
The CFCC recognizes that under certain circumstances alternative mechanisms may be
necessary to meet the clinical fellowship supervision requirements. A request to use an alternative
method to meet clinical fellowship supervision requirements must be submitted in writing to the
CFCC. The request must include a detailed outline explaining the type, length, and frequency of
each alternative supervisory activity and the reason for the alternative. For example, if the request
is for the use of videotapes instead of direct observations, the fellow must specify the length of
each videotaped session, how often the videotapes will be made, and the total number of such
videotapes. The request and the detailed outline of the proposed alternate supervisory program
must be approved by the CFCC before initiation of the clinical fellowship .
CLINICAL FELLOWSHIP SUPERVISOR
A clinical fellow can be supervised only by an individual holding a valid CCC in the professional
area in which the clinical fellow is seeking certification. A family member or individual related in
any way to the clinical fellow may not serve as the clinical fellowship supervisor.
It is the responsibility of the clinical fellowship supervisor to maintain his/her certification during the
entire clinical fellowship period through timely payment of annual dues and fees.
If the clinical fellowship supervisor's certification lapses, the clinical fellow may be required to
extend his/her clinical fellowship. Currently, individuals are not required to work a minimum
amount of time after becoming certified before supervising other individuals. However, clinical
fellows are encouraged to seek supervisors with some prior supervisory experience.
If a clinical fellow is supervised by multiple individuals, it is the responsibility of one clinical
fellowship supervisor to collate the evaluations of all supervisors and to verify that the policies
governing supervision and evaluation have been met. All clinical fellowship supervisors must hold
a current CCC in the area in which certification is sought and must maintain this certification
throughout the period of supervision.
Learn and Earn for Supervisors. Did you know that CF supervisors may earn ASHA CEUs for
the new supervisory knowledge and skills acquired as a result of their supervisory experience?
For more information, see Learning Related to Clinical Fellow Supervision.
Mandatory Supervision Requirements. Clinical fellowship supervision must include the personal
and direct involvement of the supervisor. The clinical fellowship supervisor must directly observe
diagnostic and therapeutic procedures in order to monitor and evaluate the clinical fellow's
performance in professional employment. The clinical fellowship is divided into three equal
segments, each segment representing one third of the total experience. For example, a 36-week
clinical fellowship is divided into three 12-week segments; a 72-week clinical fellowship is divided
into three 24-week segments.
The clinical fellowship supervisor must complete no less than 36 supervisory activities spaced
uniformly throughout the clinical fellowship. The supervisor must complete at least 18 on-site
observations (one hour = 1 on-site observation). At least 6 on-site observations must be
accrued during each third of the experience (up to 6 hours may be accrued in one day). In
addition to direct observation, the clinical fellowship supervisor must complete 18 other
monitoring activities, at least 6 per segment . Such activities may include:
•
conferring with the clinical fellow concerning clinical treatment strategies
•
monitoring changes in clients' communication behaviors ' evaluating the clinical fellow's
clinical records, including (a) diagnostic records, (b) treatment records, (c)
correspondence, (d) plans of treatment, and (e) summaries of clinical conferences (These
activities may be conducted in correspondence.)
•
monitoring the clinical fellow's participation in case conferences
•
evaluating the clinical fellow on the basis of consultation with professional colleagues and
employers
•
evaluating the clinical fellow's work on the basis of consultation with clients and their
families
•
monitoring the clinical fellow's contributions to professional meetings and publications, as
well as participation in other professional growth opportunities.
Clinical Fellowship Supervisor's Responsibilities. From time to time, the Board of Ethics
determines that members and certificate holders can benefit from additional analysis and
instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended
to heighten sensitivity and increase awareness. They are illustrative of the "Code of Ethics" and
intended to promote thoughtful consideration of ethical issues. They may assist members and
certificate holders in engaging in self-guided ethical decision-making. These statements do not
absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter
of concern will determine whether the activity is ethical. The current Issues in Ethics statement,
"Clinical Fellowship Supervisor's Responsibilities," is available on ASHA's Web site.
Guidelines for Direct Expense Reimbursement for Clinical Fellowship Supervisors. It is the
interpretation of the CFCC that clinical fellowship supervisors should not accept compensation for
supervision or sponsorship from the clinical fellow being supervised or sponsored, beyond
reasonable reimbursement for direct expenses. The guidelines below apply specifically to those
instances in which direct expenses are personally assumed by the clinical fellow.
1. The clinical fellow and the clinical fellowship supervisor should execute a written agreement,
and each should retain a signed copy. The agreement should include:
•
the duration of the supervision
•
the number of on-site supervisory activities and the duration of each on-site supervisory
activity
•
the occasion, nature, and number of other monitoring activities
•
the mechanism whereby the clinical fellow receives feedback
•
the clinical fellowship supervisor's commitment to complete and sign the Clinical
Fellowship Report and Rating Form (Form D) within 30 days of completion of the CF
experience
•
a mechanism for terminating the clinical fellowship if it becomes necessary before the
expected completion date
•
an account of the direct expenses for which the clinical fellowship supervisor will be
reimbursed (e.g., transportation, meals, lodging, telephone, etc.)
•
the payment schedule for reimbursement of direct expenses incurred by the clinical
fellowship supervisor (Payment must not be conditional upon the clinical fellowship
supervisor's recommendation for approval of the clinical fellowship.)
•
a statement that both the supervisor and the clinical fellow have verified that the clinical
fellowship supervisor's certification is current throughout the clinical fellowship.
2. Expenses should be reimbursed at a reasonable level. Reasonable refers to the exact
expenses incurred for transportation, meals, lodging, telephone, and postage.
3. If the clinical fellow and the clinical fellowship supervisor work for the same employer or
institution, there shall be no remuneration.
EVALUATION OF CLINICAL FELLOWS
The Standards for the Certificates of Clinical Competence require the clinical fellowship supervisor
to conduct periodic formal evaluations of the clinical fellow. The section on " Clinical Fellowship
Skills Inventory (CFSI-SLP) " contains instructions for use during the formal evaluations. It is the
responsibility of the clinical fellow and the clinical fellowship supervisor to make certain that they
follow the instructions in these sections and that the clinical fellowship supervisor uses the CFSISLP (see Form E) to complete the mandatory evaluations and that these ratings are entered on
the Clinical Fellowship Report and Rating Form (Form D). As stated in the CFCC Implementation
Procedures, the clinical fellowship supervisor must use the current evaluation instrument at least
once during each of the three segments of the clinical fellowship. That is, the supervisor must
conduct at least three formal evaluations using the Clinical Fellowship Skills Inventory,
spaced uniformly throughout the clinical fellowship. No later than 4 weeks after the clinical
fellowship is completed, the clinical fellow and the clinical fellowship supervisor must
sign, date, and submit to the National Office for review by the CFCC a Clinical Fellowship
Report and Rating Form (Form D) reflecting the three formal evaluations .
If a clinical fellow is supervised by multiple individuals, it is the responsibility of one clinical
fellowship supervisor to collate the evaluations of all supervisors and to verify that the policies
governing supervision and evaluation have been met. All clinical fellowship supervisors must hold
a current CCC in the area in which certification is sought, and they must maintain this certification
throughout the period of supervision.
Ongoing Feedback. Because one purpose of the clinical fellowship is to improve the clinical
effectiveness of the clinical fellow, supervisors must provide performance feedback to the clinical
fellow throughout the clinical fellowship . Feedback and goal-setting require two-way
communication whereby both the clinical fellowship supervisor and the clinical fellow share
important information about the clinical fellow's performance of clinical activities. A specific time
should be set aside for each performance feedback session at the end of each of the three
segments of the clinical fellowship. This session should be used to identify performance strengths
and weaknesses and, through discussion and goal-setting, to assist the clinical fellow in
developing the required skills.
If the clinical fellowship supervisor anticipates at any time during the clinical fellowship that the
clinical fellow under supervision will fail to meet requirements, the clinical fellowship supervisor
must counsel the clinical fellow both orally and in writing and maintain written records of all
contacts and conferences over the ensuing months. If the clinical fellowship experience is
terminated at any time before completion of the clinical fellowship, or if the clinical fellowship
supervisor does not recommend approval of the clinical fellowship experience at the end of the
clinical fellowship, he/she must so indicate in Section 8 of the Clinical Fellowship Report and
Rating Form. Within 30 days of making the negative recommendation, the clinical fellowship
supervisor must submit to the CFCC (a) a letter of explanation and supporting documentation, and
(b) a signed Clinical Fellowship Report and Rating Form completed for the portion of the clinical
fellowship he/she supervised. This information must be shared with the clinical fellow. Following a
negative recommendation, the clinical fellow may complete an entirely new clinical fellowship, a
portion of the clinical fellowship, and/or request an Initial Determination Review by the CFCC.
Initial Determination. To request an Initial Determination Review, the clinical fellow must submit
to the CFCC within 30 days of the negative recommendation (a) the completed and signed Clinical
Fellowship Report and Rating Form (Form D and (b) a letter of explanation and supporting
documentation to indicate why the clinical fellowship should be accepted. The CFCC may share
this information with the clinical fellowship supervisor and may solicit any additional information
the supervisor wishes to provide. The decision to approve the clinical fellowship rests solely with
the CFCC. The CFCC will review all information submitted to determine if the clinical fellowship
experience will be approved, in part or in full. (For more information see Section VII. Procedures
for Appeal).
Clinical Fellowship Skills Inventory (CFSI-SLP). The CFSI-SLP provides the means for
determining whether the clinical fellow can satisfactorily perform the skills necessary for
independent practice and addresses the need to assess the clinical fellow in developing these
skills. The CFSI-SLP stresses the need for both the clinical fellowship supervisor and the clinical
fellow to identify performance areas in which improvement is needed and then to develop and
implement performance improvement plans. This approach to the performance appraisal process
includes the following features: (a) a standardized system for reviewing the clinical work of all
clinical fellows at regularly scheduled intervals, (b) a procedure to ensure that the clinical fellow
has the skills for independent practice, (c) a means by which the clinical fellowship supervisor can
meaningfully supervise the clinical fellow's progress in attaining and improving skills, (d) a process
by which the clinical fellow gains experience in the self-evaluation of his or her skills, and (e) a
collaborative effort in which the clinical fellowship supervisor and the clinical fellow are
encouraged to work together to make the clinical fellowship a valuable learning experience.
Performance appraisal protects the public interest and serves as a clinical teaching and learning
tool.
The CFSI-SLP consists of 18 skill segments covering four areas. The skills selected for inclusion
in the CFSI-SLP are derived from a role delineation and validation study conducted for ASHA by
the Professional Examination Service. Following is a general description of each of the four
performance areas:
•
Evaluation (5 skills): selection, adaptation, administration of an assessment battery and
interpretation of results
•
Treatment (5 skills): selection, development, adaptation, and implementation of treatment
plans and intervention strategies
•
Management (3 skills): service activities and compliance with administrative and policy
requirements
•
Interaction (5 skills): communication skills and collaboration with other professionals
The rating scale for each skill has been designed along a 5-point continuum, ranging from '5'
(representing the most effective performance) to '1' (representing the least effective performance).
The clinical fellowship supervisor will match the clinical fellow's performance to the descriptors for
each skill. The ratings for one skill may not be the same as the ratings for other skills. For each
skill included on the CFSI-SLP the clinical fellowship supervisor will have to decide which point on
the scale best reflects the performance of the clinical fellow during the segment being rated. The
category "Not Applicable (NA)" appears on two items of the rating scale and may be used only for
these items. NA should be used only if the facility does not provide an opportunity for the
clinical fellow to perform the skill during the segment. However, the clinical fellowship
supervisor is encouraged to coordinate the observation schedule to ensure that all applicable
skills are observed and evaluated.
The clinical fellowship supervisor must use the rating scale at least once during each of the three
segments of the clinical fellowship. This evaluation must be shared and discussed with the clinical
fellow. Supervisors must follow the instructions below to complete the rating process at the end of
each segment.
Instructions for the Rating Process
The clinical fellowship supervisor completes the Clinical Fellowship Report and Rating Form
(Form D) to rate the performance of the clinical fellow on each of 18 skills.
Both the clinical fellowship supervisor and the clinical fellow must sign the Clinical Fellowship
Report and Rating Form and note the dates when the performance feedback sessions were held.
At the end of the clinical fellowship, the clinical fellowship supervisor mails the
completed Clinical Fellowship Report and Rating Form to the Certification office at ASHA.
The clinical fellowship supervisor retains a photocopy of the completed Clinical Fellowship Report
and Rating Form.
At the beginning of the first segment of the clinical fellowship, the clinical fellowship supervisor
and the clinical fellow should meet to discuss assigned work responsibilities, performance
expectations, and the requirement that regularly scheduled performance appraisals be conducted
during the clinical fellowship. They should review the CFSI-SLP to ensure that both the skills to be
evaluated and the rating scale are understood and to determine if there is a particular skill or skill
area requiring a special focus. Setting goals at this time to prepare for the second and third
segments will give the clinical fellowship supervisor and the clinical fellow an opportunity to
discuss concerns that have arisen and to plan new performance goals before the beginning of
another segment. Goal setting also encourages the supervisor and fellow to consider realistically
how much improvement can be achieved from one performance assessment to another. It is an
important component in the performance appraisal process--one that requires collaboration
between the clinical fellowship supervisor and the clinical fellow.
The clinical fellow should prepare for each performance feedback session by reviewing the CFSISLP (i.e., the performance skills and rating scale). It is also recommended that the clinical fellow
conduct a self-evaluation using the CFSI-SLP. Self-evaluation can provide the clinical fellow with
important insights to use in improving performance. The clinical fellow can then compare his or
her own ratings with those given by the clinical fellowship supervisor.
Minimum Rating for Core Skills. Core skills must be assessed during at least one segment of
the clinical fellowship, and each skill must receive a rating of at least a "3" on a 5-point scale
during the last segment in which the core skill is rated. The core skills are 2-5, 8-11, and 14-17
and are so noted on the list of skills found in Appendix 5.
For clinical fellowships initiated as of September 1, 1997, a minimum rating of "3" on core skills
during the last segment in which the core skill was rated will be required for approval of the
fellowship.
Supervisors may rate the clinical fellow only on the clinical skills identified in the CFSI. If a rating
of "3" is achieved for each of the core skills during the last segment in which the core skill was
rated, the supervisor must include in the final Clinical Fellowship Report and Rating Form a
positive recommendation for certification or provide a specific rationale and documentation for why
the fellow is not being recommended for certification.
CLINICAL FELLOWSHIP REPORT AND RATING FORM
Upon completion of the clinical fellowship, a conference must be held to provide the clinical fellow
the opportunity to discuss the evaluation with the supervisor. The supervisor and the clinical fellow
must complete, sign, and submit the Clinical Fellowship Report and Rating Form (Form D) to the
CFCC as soon as possible after completion of the clinical fellowship. If the application for
certification has not been submitted to the National Office, it must be filed at this time.
If a change is made in the clinical fellowship site, clinical fellowship supervisor, or category of
hours worked per week, the clinical fellowship supervisor must submit to the CFCC, within 4
weeks of the change, the completed and signed Clinical Fellowship Report and Rating Form for
the portion of the clinical fellowship that was completed.
Remember --a separate Clinical Fellowship Report and Rating Form must be submitted for each
component of the clinical fellowship that involved a change of site, supervisor, or work schedule.
WHAT IS THE NATIONAL EXAMINATION IN SPEECH-LANGUAGE PATHOLOGY?
GENERAL INFORMATION
The national examination in speech-language pathology is administered at least five times a year
as the Specialty Area Test of the Praxis Series by the Educational Testing Service (ETS). The
examination is administered at over 400 test centers throughout the nation. All sites administer
exams that follow the same content outline. The exam "Registration Bulletin" and "Tests At A
Glance" (TAAG), which contains the content outline and sample questions for the examination,
may be obtained directly from ETS.
The Praxis Series Educational Testing Service
P.O. Box 6051
Princeton, NJ 08541-6051
800-772-9476
(TTY: 800-272-1391)
The examination is designed to measure the examinees' academic preparation in and knowledge
of the profession. The examination focuses on three major areas: (a) evaluation, (b) management,
and (c) administration. The examination has approximately 150 objective multiple-choice
questions that must be answered in approximately 2 hours. To answer the test questions,
applicants must recall basic knowledge, interpret data, and use data to solve problems. Some
questions may require the examinee to interpret and analyze data similar to that seen in a clinical
setting.
Applicants for the Certificates of Clinical Competence (CCC) must pass the examination in
speech-language pathology within 2 years from the date the course work and practicum
submitted by the applicant are approved by the Council For Clinical Certification (CFCC). Within
this 2-year period, the applicant may retake the examination as often as it is administered until a
passing score is achieved. If the applicant does not pass the examination during this period,
the certification file will be closed, and the applicant will be required to reapply for
certification, after passing the exam, and meet the standards in effect at the time of
reapplication.
PASSING SCORE
Applicants for certification must pass the national examination in the area for which certification is
desired. The current passing score is 600.
REPORTING SCORES
Exam results must be sent directly from the Educational Testing Service (ETS) in order to
be applicable toward certification. When you register to take the exam, request that your score
be reported directly to ASHA. ETS charges an additional fee to report scores after the examination
has been taken.
To have ETS report your score to ASHA use the code R-5031 for Certification on the exam
Registration Form as indicated in the ETS "Registration Bulletin."
Your score will be sent to the ASHA National Office within 8 weeks of the examination date. The
National Office is able to automatically match scores with individuals only if your application for
certification is on file with the Certification office at the time the score is received and if a computer
record has been established for you.
To assist the National Office in processing your examination information, it will be helpful if you
submit a copy of the report sent to you by the testing service when you submit your application for
certification. However, please note that this copy will not be used as official verification of
completion of the examination requirement.
PREPARATION FOR THE NATIONAL EXAMINATION
The CFCC encourages you to register and take the examination no earlier than the completion
of your graduate education. To help you prepare for the test, the ETS has made available study
guides for the examination, which can be ordered directly from ETS. The study guide contains the
content outline for the examination, sample questions, helpful suggestions for test-taking, and a
practice test. For information on ordering the study guide, refer to the Test Code 0330 and order
online at http://www.ets.org or mail the order to:
The Praxis Series
Educational Testing Service
N00
P.O. Box 6058
Princeton, NJ 08541-6058
ASHA does not currently offer review courses or sell study guides. However, some review courses
are offered by certain universities, state speech-language-hearing associations, or continuing
education sponsors. To obtain information regarding these courses, please call the agencies
directly or call ASHA's Continuing Education unit at 301-897-5700 for any offerings in your area.
Additionally, consult ASHA's Web site for information on the examination.
Individuals With Disabilities
If the applicant for ASHA certification has a disability that impairs his or her ability to take the
examination under standard conditions, the individual should contact ETS directly to arrange for
appropriate accommodations. The examinee should write to The Praxis Series, Nonstandard
Testing Accommodations, Educational Testing Service, P.O. Box 6054, Princeton, NJ 085416054.
Applicants requesting nonstandard testing arrangements must complete and submit to ETS the
following items:
Exam Registration Form
Eligibility Questionnaire
Certification of Documentation Form
Appropriate forms and additional information regarding the requirements for nonstandard testing
accommodations can be found in the examination "Registration Bulletin."
SAVE YOUR EXAM SCORE. The ETS retains an examination score for 5 years only. Therefore,
you must keep your exam score in a secure place with other important documents. If in the future
you apply for certification or state licensure and are unable to provide a copy of your examination
score, you may be required to take the exam again and obtain a passing score in effect at that
time. The ASHA National Office is not responsible for maintaining examination scores after
certification is awarded.
Technical
Report
2001 / I - 25
25
Scope
of Practice
Practice • Scope of Practice in Speech-Language Pathology
Scope of Practice in
Speech-Language Pathology
Ad Hoc Committee on Scope of Practice
in Speech-Language Pathology
This document was approved by the ASHA Legislative Council in April 2001 (LC 7-01). Members of the
000 Ad Hoc Committee on Scope of Practice in SpeechLanguage Pathology who developed this document are
Nicholas Bankson (chair), Allan Diefendorf, Roberta Elman,
Susan Forsythe, Elizabeth Gavett, Alex Johnson (vice president for professional practices in speech-language pathology who serves as Executive Board liaison), Lori Lombard,
Ninevah Murray, Arlene Pietranton (ex officio), and Carmen
Vega-Barachowitz.
Statement of Purpose
The purpose of this document is to define the scope
of practice in speech-language pathology in order to:
l. Delineate areas of speech-language pathology
professional practice provided by members
of the American Speech-Language-Hearing
Association (ASHA) and clinical certification
holders in accordance with the ASHA Code
of Ethics;
2. Educate health care, education, and other professionals, consumers, payers, regulators, and
members of the general public about professional services offered by speech-language
pathologists as qualified providers;
3.
Assist ASHA members and certificate holders
in the provision of high quality and evidencebased services to individuals across the life
Reference this material as: American Speech-LanguageHearing Association. (2001). Scope of practice in speechlanguage pathology. Rockville, MD: Author.
Index terms: ASHA reference products, practice scope and
patterns, SLP education and qualifications, SLP practice
settings, SLP roles and activities, speech-language pathology, World Health Organization (WHO) framework
Document type: Practice guidelines and policies
4.
span who present with communication,
swallowing, or other upper aerodigestive
concerns1;
Provide guidance for education programs in
speech-language pathology curriculum.
The scope of practice defined here and the areas
specifically set forth describe the breadth of professional practice offered within the profession. Levels of
education, experience, skill, and proficiency with respect to the activities identified within this scope of
practice vary among individual providers; a speechlanguage pathologist does not typically practice in all
areas of the field. As the ASHA Code of Ethics specifies, individuals may only practice in areas in which
they are competent based on their education, training,
and experience. However, speech-language pathologists may expand their current level of expertise. Certain situations may necessitate that speech-language
pathologists pursue additional education or training
to expand their personal scope of practice.
This scope of practice statement does not supersede existing state licensure laws or affect the interpretation or implementation of such laws. It may serve,
however, as a model for the development or modification of licensure laws.
The schema in Figure 1 (see next page) depicts the
relationship of the scope of practice to practice policy
documents, certification standards, and the ASHA
Code of Ethics. As indicated, individuals must fulfill
the speech-language pathology certification standards in order to enter the practice of the profession.
Practice policy documents (i.e., preferred practice patterns, position statements, guidelines, and knowledge
and skills statements), address current and emerging
speech-language pathology practice areas. These docu1
aeromechanical events related to communication, respiration, and swallowing (e.g., speaking valve selection,
respiratory retraining for paradoxical vocal fold motion,
stomal stenosis management and insufflation testing
after total laryngectomy).
I - 26 / 2001
ASHA Desk Reference 2002 • Cardinal Documents of the Association
ments build on the knowledge, skills, and experiences
required by the certification standards. The ASHA
Code of Ethics sets forth the fundamental principles
and rules considered essential to the preservation of
the highest standards of integrity and ethical conduct
to which members of the profession of speech-language
pathology are bound.
Speech-language pathology is a dynamic and
continuously developing profession; listing specific
areas within this scope of practice does not exclude
emerging areas of practice. Although not specifically
identified in this document, in certain instances
speech-language pathologists may be called on to
perform services (e.g., “multiskilling” in a health care
setting, collaborative service delivery in schools) for the
well-being of the individual(s) they are serving. In such
instances it is both ethically and legally incumbent
upon professionals to determine that they have the
knowledge and skills necessary to conduct such
tasks. Finally, it should be indicated that factors such
as changes in service delivery systems, increasing
numbers of people needing services, projected United
States population growth of cultural and linguistic
minority groups, and technological and scientific advances mandate that a scope of practice statement
for the profession of speech-language pathology be
dynamic in nature. For these reasons this document
will undergo periodic review and possible revision.
Framework for Practice
The domain of speech-language pathology includes human communication behaviors and disorders as well as swallowing or other upper
aerodigestive functions and disorders. The overall
objective of speech-language pathology services is to
optimize individuals’ ability to communicate and/or
swallow in natural environments, and thus improve
their quality of life. This objective is best achieved
through the provision of integrated services in meaningful life contexts. The World Health Organization
Practice • Scope of Practice in Speech-Language Pathology
(WHO) is in the process of finalizing a multipurpose
health classification system identified as the International Classification of Functioning, Disability and
Health (ICIDH-2)* that offers clinical service providers an internationally recognized conceptual framework and common language for discussing and
describing human functioning and disability (WHO,
2000). This framework can be used to describe the
role of speech-language pathologists in enhancing
quality of life by optimizing human communication
behavior, swallowing, or other upper aerodigestive
functions regardless of setting. The ICIDH-2 [ICF]
framework has two parts. The first is termed Functioning and Disability; the second refers to Contextual
Factors. Functioning and Disability includes the following two components:
• Body Functions and Structures: Body Functions refers to the physiological or psychological functions of body systems; Body Structures
*Editor’s note: In 2001 the original acronym, ICIDH-2, was
changed to ICF.
•
2001 / I - 27
refers to the anatomic parts of the body and
their components.
Activity and Participation: Activity refers to
the performance of a task or action of a given
individual; Participation refers to an
individual’s involvement in a life situation.
Both Activity and Participation components
are modified with Capacity and Performance
qualifiers. The Capacity qualifier describes an
individual’s ability to execute a task or an action in a standardized or uniform environment. The Performance qualifier describes
what an individual does in the current environment or actual context in which s/he lives.
Figure 2 illustrates the components of the framework as applied to the practice of speech-language
pathology. Each component can be expressed as a
continuum of function. One end of the continuum
indicates intact or neutral functioning; the other
I - 28 / 2001
ASHA Desk Reference 2002 • Cardinal Documents of the Association
indicates completely compromised function or
disability (e.g., impairment, activity limitation [formerly referred to as disability (WHO, 1980)], or participation restriction [formerly referred to as handicap
(WHO, 1980)]). For example, the component of Body
Functions and Structures has a continuum that
ranges from normal variation to complete impairment;
Activity ranges from no activity limitation to complete
activity limitation; and Participation ranges from no
participation restriction to complete participation restriction.
The second part of the ICIDH-2 [ICF] framework
refers to Contextual Factors. Contextual Factors may
interact with Body Functions and Structures, Activity,
or Participation as facilitators or barriers to functioning. Contextual Factors include the following two components:
• Environmental Factors: defined as the physical, social, and attitudinal environment in
which people live.
• Personal Factors: include such features of an
individual as age, race, gender, educational
background, and lifestyle. Although not formally classified in the ICIDH-2 [ICF], Personal
Factors are acknowledged to be contributors
to intervention outcomes.
The scope of practice in speech-language pathology encompasses all components and factors identified in the WHO framework. That is, speech-language
pathologists work to improve quality of life by reducing impairments of body functions and structures,
activity limitations, participation restrictions, and environmental barriers of the individuals they serve.
They serve individuals with known disease processes
(e.g., aphasia, cleft palate) as well as those with activity limitations or participation restrictions (e.g., individuals needing classroom support services or special
educational placement), including when such limitations or restrictions occur in the absence of known disease processes or impairments (e.g., individuals with
differences in dialect). The role of speech-language
pathologists includes prevention of communication,
swallowing, or other upper aerodigestive disorders as
well as diagnosis, habilitation, rehabilitation, and enhancement of these functions.
Education and Qualifications
Speech-language pathologists must hold a
graduate degree, the Certificate of Clinical Competence
(CCC-SLP) of the American Speech-LanguageHearing Association (ASHA), and where applicable,
other required credentials (e.g., state licensure, teaching certification).
As primary care providers for communication,
swallowing, or other upper aerodigestive disorders,
speech-language pathologists are autonomous
professionals; that is, their services need not be prescribed or supervised by individuals in other professions. However, in many cases individuals are best
served when speech-language pathologists work
collaboratively with other professionals.
Scope of Practice
The practice of speech-language pathology includes prevention, diagnosis, habilitation, and rehabilitation of communication, swallowing, or other
upper aerodigestive disorders; elective modification of
communication behaviors; and enhancement of communication. This includes services that address the
dimensions of body structure and function, activity,
and/or participation as proposed by the World Health
Organization model (WHO, 2000). The practice of
speech-language pathology involves:
1. Providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and
follow-up services for disorders of:
• speech (i.e., articulation, fluency, resonance,
and voice including aeromechanical components of respiration);
• language (i.e., phonology, morphology, syntax, semantics, and pragmatic/social aspects
of communication) including comprehension and expression in oral, written, graphic,
and manual modalities; language processing; preliteracy and language-based literacy
skills, including phonological awareness;
• swallowing or other upper aerodigestive
functions such as infant feeding and
aeromechanical events (evaluation of esophageal function is for the purpose of referral
to medical professionals);
• cognitive aspects of communication (e.g., attention, memory, problem solving, executive
functions).
• sensory awareness related to communication, swallowing, or other upper
aerodigestive functions.
2. Establishing augmentative and alternative
communication techniques and strategies including developing, selecting, and prescribing
of such systems and devices (e.g., speech generating devices).
3. Providing services to individuals with hearing loss and their families/caregivers (e.g.,
Practice • Scope of Practice in Speech-Language Pathology
auditory training; speechreading; speech and
language intervention secondary to hearing
loss; visual inspection and listening checks of
amplification devices for the purpose of
troubleshooting, including verification of appropriate battery voltage).
4. Screening hearing of individuals who can
participate in conventional pure-tone air conduction methods, as well as screening for
middle ear pathology through screening
tympanometry for the purpose of referral of individuals for further evaluation and management.
5. Using instrumentation (e.g., videofluoroscopy, EMG, nasendoscopy, stroboscopy,
computer technology) to observe, collect data,
and measure parameters of communication
and swallowing, or other upper aerodigestive
functions in accordance with the principles of
evidence-based practice.
6. Selecting, fitting, and establishing effective
use of prosthetic/adaptive devices for communication, swallowing, or other upper
aerodigestive functions (e.g., tracheoesophageal prostheses, speaking valves,
electrolarynges). This does not include sensory devices used by individuals with hearing loss or other auditory perceptual deficits.
7. Collaborating in the assessment of central
auditory processing disorders and providing
intervention where there is evidence of
speech, language, and/or other cognitivecommunication disorders.
8. Educating and counseling individuals,
families, co-workers, educators, and other
persons in the community regarding acceptance, adaptation, and decision making about
communication, swallowing, or other upper
aerodigestive concerns.
9. Advocating for individuals through community awareness, education, and training programs to promote and facilitate access to full
participation in communication, including
the elimination of societal barriers.
10. Collaborating with and providing referrals
and information to audiologists, educators,
and health professionals as individual needs
dictate.
11. Addressing behaviors (e.g., perseverative or
disruptive actions) and environments (e.g.,
seating, positioning for swallowing safety or
2001 / I - 29
attention, communication opportunities) that
affect communication, swallowing, or other
upper aerodigestive functions.
12. Providing services to modify or enhance communication performance (e.g., accent modification, transgendered voice, care and
improvement of the professional voice, personal/professional communication effectiveness).
13. Recognizing the need to provide and appropriately accommodate diagnostic and treatment services to individuals from diverse
cultural backgrounds and adjust treatment
and assessment services accordingly.
Professional Roles and Activities
Speech-language pathologists serve individuals,
families, groups, and the general public through a
broad range of professional activities. They:
• Identify, define, and diagnose disorders of human communication and swallowing and
assist in localization and diagnosis of diseases and conditions.
• Provide direct services using a variety of service delivery models to treat and/or address
communication, swallowing, or other upper
aerodigestive concerns.
• Conduct research related to communication
sciences and disorders, swallowing, or other
upper aerodigestive functions.
• Educate, supervise, and mentor future
speech-language pathologists.
• Serve as case managers and service delivery
coordinators.
• Administer and manage clinical and academic
programs.
• Educate and provide in-service training to
families, caregivers, and other professionals.
• Participate in outcomes measurement activities and use data to guide clinical decision
making and determine the effectiveness of services provided in accordance with the principles of evidence-based practice.
• Train, supervise, and manage speechlanguage pathology assistants and other
support personnel.
• Promote healthy lifestyle practices for the
prevention of communication, hearing,
swallowing, or other upper aerodigestive
disorders.
I - 30 / 2001
•
•
•
•
•
•
ASHA Desk Reference 2002 • Cardinal Documents of the Association
Foster public awareness of speech, language,
hearing, and swallowing, and other upper
aerodigestive disorders and their treatment.
Advocate at the local, state, and national levels for access to and funding for services to
address communication, hearing, swallowing, or other upper aerodigestive disorders.
Serve as expert witnesses.
Collaborate with audiologists in identifying
neonates and infants at risk for hearing loss.
Recognize the special needs of culturally diverse populations by providing services that
are free of potential biases, including selection
and/or adaptation of materials to ensure ethnic and linguistic sensitivity.
Provide services using tele-electronic diagnostic measures and treatment methodologies
(including remote applications).
Practice Settings
Speech-language pathologists provide services in
a wide variety of settings, which may include but are
not exclusive to:
• Public and private schools
• Health care settings (e.g., hospitals, medical
rehabilitation facilities, long-term care facilities, home health agencies, community clinics,
behavioral/mental health facilities)
• Private practice settings
• Universities and university clinics
• Individuals’ homes
• Group homes and sheltered workshops
• Neonatal intensive care units, early intervention settings, preschools, and day care centers
• Community and state agencies and institutions
• Correctional institutions
• Research facilities
• Corporate and industrial settings
Reference and Resource List
General
American Speech-Language-Hearing Association. (1986,
May). The autonomy of speech-language pathology
and audiology. Asha, 28, 53–57.
American Speech-Language-Hearing Association. (1992).
Sedation and topical anesthetics in audiology and
speech-language pathology. Asha, 34 (Suppl. 7), 41–42.
American Speech-Language-Hearing Association. (1993).
Definition of communication disorders and variations.
Asha, 35 (Suppl. 10), 40–41.
American Speech-Language-Hearing Association. (1993).
Guidelines for caseload size and speech-language pathology service delivery in the school. Asha, 35 (Suppl.
10), 33–39.
American Speech-Language-Hearing Association. (1994).
Admission/discharge criteria in speech-language pathology.
Unpublished report. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1994).
Code of ethics. Asha, 36 (Suppl. 13), 1–2. under revision
American Speech-Language-Hearing Association. (1996).
Inclusive practices for children and youths with communication disorders. Asha, 38 (Suppl. 16), 35–44.
American Speech-Language-Hearing Association. (1996).
Scope of practice in audiology. Asha, 38 (Suppl. 16),
12–15.
American Speech-Language-Hearing Association. (1997).
Position statement and technical report: Multiskilled
personnel. Asha, 39 (Suppl. 17), 13.
American Speech-Language-Hearing Association. (1997).
Preferred practice patterns for the profession of speechlanguage pathology. Rockville, MD: Author.
American Speech-Language-Hearing Association. (1999).
Guidelines for the roles and responsibilities of the school-based
speech-language pathologist. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2000).
IDEA and your caseload: A template for eligibility and dismissal criteria for students ages 3 to 21. Rockville, MD:
Author.
Council on Professional Standards in Speech-Language Pathology and Audiology. (2000). Speech-language pathology certification standards. Rockville, MD: Author.
World Health Organization. (2000). International classification of functioning, disability and health: Prefinal draft.
Geneva, Switzerland: Author.
Augmentative and Alternative Communication
American Speech-Language-Hearing Association. (1989).
Competencies for speech-language pathologists providing services in augmentative communication. Asha, 31
(3), 107–110.
American Speech-Language-Hearing Association. (1991).
Augmentative and alternative communication. Asha, 33
(Suppl. 5), 8.
American Speech-Language-Hearing Association. (1991).
Report: Augmentative and alternative communication.
Asha, 33 (Suppl. 5), 9–12.
American Speech-Language-Hearing Association. (1998).
Maximizing the provision of appropriate technology
services and devices for students in schools. Asha, 40
(Suppl. 18), 33–42.
National Joint Committee for the Communicative Needs
of Persons with Severe Disabilities. (1992). Guidelines
for meeting the communication needs of persons with
severe disabilities. Asha, 34 (Suppl. 7), 1–8.
Practice • Scope of Practice in Speech-Language Pathology
Cognitive Aspects of Communication
American Speech-Language-Hearing Association. (1982).
Serving the communicatively handicapped mentally
retarded individual. Asha, 24 (8), 547–553.
American Speech-Language-Hearing Association. (1987).
The role of speech-language pathologists in the habilitation and rehabilitation of cognitively impaired individuals. Asha, 29 (6), 53–55.
American Speech-Language-Hearing Association. (1988).
Mental retardation and developmental disabilities
curriculum guide for speech-language pathologists and
audiologists. ASHA Desk Reference, vol. 4, 185–189.
American Speech-Language-Hearing Association. (1988).
The role of speech-language pathologists in the identification, diagnosis, and treatment of individuals with
cognitive-communicative impairments. Asha, 30 (3), 79.
American Speech-Language-Hearing Association. (1990).
Interdisciplinary approaches to brain damage. Asha, 32
(Suppl. 2), 3.
American Speech-Language-Hearing Association. (1990).
The role of speech-language pathologists and audiologists in service delivery for persons with mental retardation and developmental disabilities in community
settings. Asha, 32 (Suppl. 2), 5–6.
American Speech-Language-Hearing Association. (1991).
Guidelines for speech-language pathologists serving
persons with language, socio-communicative and/or
cognitive-communicative impairments. Asha, 33 (Suppl.
5), 21–28.
American Speech-Language-Hearing Association. (1995).
Guidelines for the structure and function of an interdisciplinary team for persons with brain injury. Asha, 37
(Suppl. 14), 23.
Deaf and Hard of Hearing
American Speech-Language-Hearing Association. (1984).
Competencies for aural rehabilitation. Asha, 26 (5),
37–41.
American Speech-Language-Hearing Association. (1990).
Aural rehabilitation: an annotated bibliography. Asha,
32 (Suppl. 1), 1–12.
American Speech-Language-Hearing Association. (1994,
August). Service provision under the Individuals with
Disabilities Education Act–Part H, as Amended (IDEA–
Part H) to children who are deaf and hard of hearing
ages birth to 36 months. Asha, 36, 117–121.
Hearing Screening
American National Standards Institute. (1996). Specifications
for audiometers (ANSI S3.6.-1996). New York: Acoustical
Society of America.
American National Standards Institute. (1991). Maximum
permissible ambient noise levels for audiometric test rooms
(ANSI S3.1-1991). New York: Acoustical Society of
America.
American Speech-Language-Hearing Association. (1994).
Clinical practice by certificate holders in the profession
in which they are not certified. Asha, 36 (13), 11–12.
2001 / I - 31
American Speech-Language-Hearing Association. (1997).
Guidelines for audiologic screening. Rockville, MD: Author.
Joint Committee on Infant Hearing. (2000). Year 2000
position statement: Principles and guidelines for early
hearing detection and intervention programs. American
Journal of Audiology, 9, 9–29.
Language and Literacy
American Speech-Language-Hearing Association. (1982).
Definition of language. Asha, 24 (6), 44.
American Speech-Language-Hearing Association. (1982).
Position statement on language learning disorders. Asha,
24 (11), 937–944.
American Speech-Language-Hearing Association. (1989).
Issues in determining eligibility for language intervention. Asha, 31 (3), 113–118.
American Speech-Language-Hearing Association. (1991).
A model for collaborative service delivery for students
with language-learning disorders in the public schools.
Asha, 33 (Suppl. 5), 44–50.
American Speech-Language-Hearing Association. (1991).
Guidelines for speech-language pathologists serving
persons with language, socio-communicative and/or
cognitive-communicative impairments. Asha, 33 (Suppl.
5), 21–28.
American Speech-Language-Hearing Association Task
Force on Central Auditory Processing Consensus Development. (1995). Central auditory processing: Current
status of research and implications for clinical practice.
Rockville, MD: ASHA.
American Speech-Language-Hearing Association. (2000).
Guidelines on the roles and responsibilities of speechlanguage pathologists with respect to reading and writing in
children and adolescents. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2000).
Position statement on the roles and responsibilities of speechlanguage pathologists with respect to reading and writing in
children and adolescents. Rockville, MD: Author.
American Speech-Language-Hearing Association. (2000).
Technical report on the roles and responsibilities of speechlanguage pathologists with respect to reading and writing in
children and adolescents. Rockville, MD: Author.
National Joint Committee on Learning Disabilities. (1989).
Communication-based services for infants, toddlers,
and their families. ASHA Desk Reference, vol. 3, 159–163.
Multicultural Issues
American Speech-Language-Hearing Association. (1983).
Social dialects (and implications). Asha, 25 (9), 23–27.
American Speech-Language-Hearing Association. (1985).
Clinical management of communicatively handicapped
minority language populations. Asha, 27 (6), 29–32.
American Speech-Language-Hearing Association. (1989).
Bilingual speech-language pathologists and audiologists. Asha, 31, 93.
I - 32 / 2001
ASHA Desk Reference 2002 • Cardinal Documents of the Association
American Speech-Language-Hearing Association. (1998).
Provision of English-as-a-second-language instruction
by speech-language pathologists in school settings:
Position statement and technical report. Asha, 40 (Suppl.
18), 24–27.
Prevention
American Speech-Language-Hearing Association. (1982).
Prevention of speech, language, hearing problems. Asha,
24, 425, 431.
American Speech-Language-Hearing Association. (1988,
March). Prevention of communication disorders. Asha,
30, 90.
American Speech-Language-Hearing Association. (1991).
The prevention of communication disorders tutorial.
Asha, 33 (Suppl. 6), 15–41.
Research
American Speech-Language-Hearing Association. (1992).
Ethics in research and professional practice. Asha, 34
(Suppl. 9), 11–12.
Speech: Articulation, Fluency, Voice, Resonance
American Speech-Language-Hearing Association. (1992).
Position statement and guidelines for evaluation and
treatment for tracheoesophageal fistulization/puncture. Asha, 34 (Suppl. 7), 17–21.
American Speech-Language-Hearing Association. (1992).
Position statement and guidelines for vocal tract visualization and imaging. Asha, 34 (Suppl. 7), 31–40.
American Speech-Language-Hearing Association. (1993).
Position statement and guidelines for oral and oropharyngeal prostheses. Asha, 35 (Suppl. 10), 14–16.
American Speech-Language-Hearing Association. (1993).
Position statement and guidelines on the use of voice
prostheses in tracheotomized persons with or without
ventilatory dependence. Asha, 35 (Suppl. 10), 17–20.
American Speech-Language-Hearing Association. (1993).
The role of the speech-language pathologist and teacher
of voice in the remediation of singers with voice disorders. Asha, 35 (1), 63.
American Speech-Language-Hearing Association. (1995,
March). Guidelines for practice in stuttering treatment.
Asha, 37 (Suppl. 14), 26–35.
American Speech-Language-Hearing Association. (1998).
Roles of otolaryngologists and speech-language pathologists in the performance and interpretation of
strobovideolaryngoscopy. Asha, 40 (Suppl. 18), 32.
ASHA Special Interest Division 3: Voice and Voice Disorders. (1997). Training guidelines for laryngeal
videoendoscopy/stroboscopy. Unpublished report.
Rockville: MD. Author.
Supervision
American Speech-Language-Hearing Association. (1985).
Clinical supervision in speech-language pathology and
audiology. Asha, 28 (6), 57–60.
American Speech-Language-Hearing Association. (1989).
Preparation models for the supervisory process in
speech-language pathology and audiology. Asha, 32 (3),
97–106.
American Speech-Language-Hearing Association. (1992).
Supervision of student clinicians. Asha, 34 (Suppl. 9), 8.
American Speech-Language-Hearing Association. (1992).
Clinical fellowship supervisor’s responsibilities. Asha, 34
(Suppl. 9), 16–17.
American Speech-Language-Hearing Association. (1996,
Spring). Guidelines for the training, credentialing, use,
and supervision of speech-language pathology assistants. Asha, 38 (Suppl. 16), 21–34.
American Speech-Language-Hearing Association. (in
preparation). Knowledge and skills for supervision of
speech-language pathology assistants.
Swallowing/Upper Aerodigestive Function
American Speech-Language-Hearing Association. (1987).
Ad hoc committee on dysphagia report. Asha, 29 (4),
57–58.
American Speech-Language-Hearing Association. (1989).
Report: Ad hoc committee on labial-lingual posturing
function. Asha, 31 (11), 92–94.
American Speech-Language-Hearing Association. (1990).
Knowledge and skills needed by speech-language
pathologists providing services to dysphagic patients/
clients. Asha, 32 (Suppl. 2), 7–12.
American Speech-Language-Hearing Association. (1991).
The role of the speech-language pathologist in assessment and management of oral myofunctional disorders.
Asha, 33 (Suppl. 5), 7.
American Speech-Language-Hearing Association. (1992).
Position statement and guidelines for instrumental
diagnostic procedures for swallowing, Asha, 34 (Suppl.
7), 25–33.
American Speech-Language-Hearing Association. (1993).
Orofacial myofunctional disorders: knowledge and
skills. Asha, 35 (Suppl. 10), 21–23.
American Speech-Language-Hearing Association. (2000).
Clinical indicators for instrumental assessment of
dysphagia (guidelines): Executive summary. ASHA
Suppl. 20, 18–9.
American Speech-Language-Hearing Association. (2000).
Roles of the speech-language pathologist and otolaryngologist in the performance and interpretation of endoscopic examination of swallowing (position
statement). ASHA Suppl. 20, 17.
ASHA Special Interest Division 13: Swallowing and
Swallowing Disorders (Dysphagia). (1997). Graduate
curriculum on swallowing and swallowing disorders
(adult and pediatric dysphagia). ASHA Desk Reference,
vol. 3, 248a–248n.
Ethics • Code of Ethics
Ethics
2001 / I - 185
Code of Ethics
Last Revised January 1, 2003
Preamble
The preservation of the highest standards of
integrity and ethical principles is vital to the responsible discharge of obligations by speech-language pathologists, audiologists, and speech, language, and
hearing scientists. This Code of Ethics sets forth the
fundamental principles and rules considered essential to this purpose.
Every individual who is (a) a member of the
American Speech-Language-Hearing Association,
whether certified or not, (b) a nonmember holding
the Certificate of Clinical Competence from the
Association, (c) an applicant for membership or
certification, or (d) a Clinical Fellow seeking to fulfill
standards for certification shall abide by this Code
of Ethics.
Any violation of the spirit and purpose
of this Code shall be considered unethical. Failure
to specify any particular responsibility or practice
in this Code of Ethics shall not be construed as denial
of the existence of such responsibilities or practices.
The fundamentals of ethical conduct are described by Principles of Ethics and by Rules of Ethics
as they relate to the conduct of research and scholarly
activities and responsibility to persons served, the
public, and speech-language pathologists, audiologists, and speech, language, and hearing scientists.
Principles of Ethics, aspirational and inspirational in nature, form the underlying moral basis for
the Code of Ethics. Individuals shall observe these
principles as affirmative obligations under all conditions of professional activity.
Reference this material as: American Speech-LanguageHearing Association. Code of ethics (revised).
ASHA Supplement, 23, pp. 13–15.
Index terms: ASHA reference products, ethics (professional
practice issues), ethics and related papers
Document type: Ethics and related documents
Rules of Ethics are specific statements of
minimally acceptable professional conduct or of
prohibitions and are applicable to all individuals.
Principle of Ethics I
Individuals shall honor their responsibility
to hold paramount the welfare of persons they serve
professionally or participants in research and scholarly activities and shall treat animals involved in research in a humane manner.
Rules of Ethics
A. Individuals shall provide all services competently.
B. Individuals shall use every resource, including
referral when appropriate, to ensure that highquality service is provided.
C. Individuals shall not discriminate in the delivery
of professional services or the conduct of research
and scholarly activities on the basis of race or
ethnicity, gender, age, religion, national origin,
sexual orientation, or disability.
D. Individuals shall not misrepresent the credentials of assistants, technicians, or support
personnel and shall inform those they serve
professionally of the name and professional
credentials of persons providing services.
E. Individuals who hold the Certificates of Clinical
Competence shall not delegate tasks that require
the unique skills, knowledge, and judgment that
are within the scope of their profession to assistants, technicians, support personnel, students, or
any nonprofessionals over whom they have supervisory responsibility. An individual may delegate
support services to assistants, technicians,
support personnel, students, or any other persons
only if those services are adequately supervised by
an individual who holds the appropriate Certificate of Clinical Competence.
I -186 / 2001
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
ASHA Desk Reference 2002 Volume 1 • Cardinal Documents of the Association
Individuals shall fully inform the persons
they serve of the nature and possible effects of
services rendered and products dispensed, and
they shall inform participants in research about
the possible effects of their participation in research conducted.
Individuals shall evaluate the effectiveness of
services rendered and of products dispensed
and shall provide services or dispense products
only when benefit can reasonably be expected.
Individuals shall not guarantee the results of
any treatment or procedure, directly or by
implication; however, they may make a reasonable statement of prognosis.
Individuals shall not provide clinical services
solely by correspondence.
Individuals may practice by telecommunication
(for example, telehealth/e-health), where not
prohibited by law.
Individuals shall adequately maintain and
appropriately
secure
records
of
professional services rendered, research and scholarly activities conducted, and products
dispensed and shall allow access to these records
only when authorized or when required by law.
Individuals shall not reveal, without authorization, any professional or personal information
about identified persons served professionally or
identified participants involved in research and
scholarly activities unless required by law to do so,
or unless doing so is necessary to protect the
welfare of the person or of the community or
otherwise required by law.
Individuals shall not charge for services not
rendered, nor shall they misrepresent services rendered, products dispensed, or research and scholarly activities conducted.
Individuals shall use persons in research or as
subjects of teaching demonstrations only with
their informed consent.
Individuals whose professional services are
adversely affected by substance abuse or other
health-related conditions shall seek professional
assistance and, where appropriate, withdraw
from the affected areas of practice.
Principle of Ethics II
Individuals shall honor their responsibility to
achieve and maintain the highest level of professional
competence.
Rules of Ethics
A. Individuals shall engage in the provision of
clinical services only when they hold the appropriate Certificate of Clinical Competence or
when they are in the certification process and
are supervised by an individual who holds the
appropriate Certificate of Clinical Competence.
B. Individuals shall engage in only those aspects
of the professions that are within the scope of
their competence, considering their level of education, training, and experience.
C. Individuals shall continue their professional
development throughout their careers.
D. Individuals shall delegate the provision of
clinical services only to: (1) persons who hold the
appropriate Certificate of Clinical Competence;
(2) persons in the education or certification
process who are appropriately supervised by
an individual who holds the appropriate Certificate of Clinical Competence; or (3) assistants,
technicians, or support personnel who are adequately supervised by an individual who
holds the appropriate Certificate of Clinical
Competence.
E. Individuals shall not require or permit their professional staff to provide services or conduct research
activities that exceed the staff member’s
competence, level of education, training, and experience.
F. Individuals shall ensure that all equipment used
in the provision of services or to conduct research
and scholarly activities is in proper working order
and is properly calibrated.
Principle of Ethics III
Individuals shall honor their responsibility to
the public by promoting public understanding of
the professions, by supporting the development of
services designed to fulfill the unmet needs of the
public, and by providing accurate information in
all communications involving any aspect of the
professions, including dissemination of research findings and scholarly activities.
Rules of Ethics
A. Individuals shall not misrepresent their credentials, competence, education, training, experience,
or scholarly or research contributions.
B. Individuals shall not participate in professional
activities that constitute a conflict of interest.
C. Individuals shall refer those served professionally solely on the basis of the interest of those
Ethics • Code of Ethics
being referred and not on any personal financial
interest.
D. Individuals shall not misrepresent diagnostic
information, research, services rendered, or
products dispensed; neither shall they engage
in any scheme to defraud in connection with obtaining payment or reimbursement for such
services or products.
E. Individuals’ statements to the public shall provide accurate information about the nature
and management of communication disorders,
about the professions, about professional
services, and about research and scholarly activities.
F. Individuals’ statements to the public—advertising, announcing, and marketing their professional services, reporting research results, and
promoting products—shall adhere to prevailing
professional standards and shall not contain
misrepresentations.
Principle of Ethics IV
Individuals shall honor their responsibilities to
the professions and their relationships with colleagues, students, and members of allied professions.
Individuals shall uphold the dignity and autonomy
of the professions, maintain harmonious interprofessional and intraprofessional relationships,
and accept the professions’ self-imposed standards.
Rules of Ethics
A. Individuals shall prohibit anyone under their
supervision from engaging in any practice that
violates the Code of Ethics.
B. Individuals shall not engage in dishonesty,
fraud, deceit, misrepresentation, sexual
harrassment, or any other form of conduct that
adversely reflects on the professions or on the
individual’s fitness to serve persons professionally.
2001 / I - 187
C. Individuals shall not engage in sexual activities
with clients or students over whom they
exercise professional authority.
D. Individuals shall assign credit only to those
who have contributed to a publication, presentation, or product. Credit shall be assigned
in proportion to the contribution and only with
the contributor’s consent.
E. Individuals shall reference the source when
using other persons’ ideas, research, presentations, or products in written, oral, or any other
media presentation or summary.
F. Individuals’ statements to colleagues about
professional services, research results, and
products shall adhere to prevailing professional standards and shall contain no misrepresentations.
G. Individuals shall not provide professional
services without exercising independent professional judgment, regardless of referral source
or prescription.
H. Individuals shall not discriminate in their relationships with colleagues, students, and
members of allied professions on the basis of
race or ethnicity, gender, age, religion, national
origin, sexual orientation, or disability.
I. Individuals who have reason to believe that
the Code of Ethics has been violated shall inform
the Board of Ethics.
J. Individuals shall comply fully with the policies
of the Board of Ethics in its consideration and
adjudication of complaints of violations of the
Code of Ethics.
Issues in Ethics • Confidentiality
Issues in Ethics
2004/ 43
Confidentiality
Board of Ethics
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics determines
that members and certificate holders can benefit from
additional analysis and instruction concerning a specific
issue of ethical conduct. Issues in Ethics statements are
intended to heighten sensitivity and increase awareness.
They are illustrative of the Code of Ethics and intended
to promote thoughtful consideration of ethical issues.
They may assist members and certificate holders in
engaging in self-guided ethical decision-making. These
statements do not absolutely prohibit or require specified
activity. The facts and circumstances surrounding a matter
of concern will determine whether the activity is ethical. This
Issues in Ethics statement was revised to update references
to the Code of Ethics as revised in 2003.
Introduction
This Issues in Ethics statement is presented for
the guidance of ASHA members and certificate
holders in matters relating to confidentiality.
ASHA members and certificate holders are employed in a variety of work settings and are faced
daily with issues of confidentiality of client/student/
patient information. Some examples include records
management, information exchanged in the course
of the client-clinician relationship, disclosure,
release of information, access to records, exchange
of records between professionals. The following
information is provided in an attempt to heighten
sensitivity, increase awareness, and enhance judg-
Reference this material as: American Speech-LanguageHearing Association. (2004). Confidentiality. ASHA
Supplement 24, 43–45.
Index terms: Ethics (professional practice issues), practice
scope and patterns, professional practice activities and
issues
Document type: Ethics and related documents
ments in situations dealing with confidentiality of
information.
ASHA members and certificate holders are
also faced with issues of confidentiality in their
relationships with colleagues and information they
obtain as they serve in roles such as site visitors,
consultants, supervisors, or reviewers.
Background
Confidentiality of client/student/patient information is specifically addressed by the ASHA
Code of Ethics through Principle of Ethics I, Rules
K and L.
K. Individuals shall adequately maintain and appropriately secure records of professional services rendered,
research and scholarly activities conducted, and products
dispensed and shall allow access to these records only when
authorized or when required by law.
L. Individuals shall not reveal, without authorization,
any professional or personal information about identified
persons served professionally or identified participants involved in research and scholarly activities unless required
by law to do so, or unless doing so is necessary to protect the
welfare of the person or of the community or otherwise required by law.
The ASHA Code of Ethics, through Principle
of Ethics IV, Rules B, F, I, and J, addresses confidentiality in relationships with colleagues.
B. Individuals shall not engage in dishonesty, fraud,
deceit, misrepresentation, sexual harassment, or any
other form of conduct that adversely reflects on the
professions or on the individual’s fitness to serve persons professionally.
F. Individuals’ statements to colleagues about professional services, research results, and products shall
adhere to prevailing professional standards and shall
contain no misrepresentations.
44 / 2004
American Speech-Language-Hearing Association
I. Individuals who have reason to believe that the
Code of Ethics has been violated shall inform the Board of
Ethics.
the course of employment in a particular setting is
not “owned” by the speech-language pathologist or
audiologist.
J. Individuals shall comply fully with policies of
the Board of Ethics in its consideration and adjudication
of complaints of violation of the Code of Ethics.
2. Persons other than the client/student may
request information about the client’s communication problem. Requests might come from an off-site
clinic supervisor, Clinical Fellowship supervisor, a
professional who supervises student teachers,
reporters, insurance companies, and government
agencies. Again, information cannot be disclosed
without signed releases.
Confidentiality of Client/Student/Patient
Information
Discussion
Confidentiality of privileged information stems
from codes of ethics, federal law, and state law. If
one works in an educational setting (such as a
college or school) there are relevant laws that specify
the management of school records including access
to information and release of information. If one
works in a health care setting (such as a hospital,
nursing facility, or rehabilitation setting) there are
relevant laws for the management of medical records.
If one works in a private practice setting confidentiality of client/student/patient information must be
protected. Speech-language pathologists and audiologists, regardless of setting, are responsible for
obtaining and adhering to laws and guidance policies
for records management in that setting.
Records management guidance will typically
cover
• record storage;
• ownership of records;
• access of clients and their legal guardians to
records;
• record retention and statutes of limitation;
• transfer of information;
• requests for information by someone other
than the client/student or the client’s/
student’s legal guardian; and
• use of client/student records for research.
Guidance
1. Speech-language pathologists and audiologists
must be aware of who owns the records. In a medical
setting, the hospital owns the record. In a private
practice the individual who is legally responsible for
the practice owns the records. In a school setting,
the school district owns the record. For example, a
school district maintains one “official” record on
each student. Speech-language pathology or audiology reports are the property of the school district
and may not be released to anyone without appropriate, signed releases of information. A report prepared
by a speech-language pathologist or audiologist in
3. It is important to be aware of what information
is required and what information is appropriate to be
included in the client’s legal record and to
exercise professional judgment in making notations
in the client’s/student’s record.
4. Data and the personal identities of individual participants in clinical activities and research
must be kept confidential. Some reasonable precautions to protect and respect the confidentiality of
participants include
• dissemination of clinical service and research
findings without disclosure of personal
identifying information, if possible;
• secure storage and limited access to clinical
and research records by authorized personnel
only;
• removal, disguise, or coding of personal identifying information; and
• written, informed consent from participants,
parent, or guardian to disseminate findings
observable from photographic/video images
or audio voice recordings in which personal
identifying information may be disclosed to
others.
Summary
It is incumbent on the speech-language pathologist or audiologist to be knowledgeable about federal
and state laws, professional codes of ethics to which
they must adhere (in addition to the ASHA Code of
Ethics), and work-site specific procedures regarding
the handling of patient information.
Confidentiality in Relationships With
Colleagues
Discussion
Speech-language pathologists and audiologists
function in a variety of roles and activities that allow
access to information of a personal and confidential
Issues in Ethics • Confidentiality
2004/ 45
nature. For example, speech-language pathologists
may be reviewers of manuscripts/publications
authored by others or of grant, fellowship, or scholarship applications; site visitors; consultants; supervisors; administrators; or participants in groups
dealing with confidential and personal information.
2. With regard to reporting/responding to
alleged violations of codes of conduct, respect for
the confidentiality of the matter is the responsibility
of all individuals involved. It would be prudent to
consider all aspects of a matter confidential until a
final decision is rendered.
Individuals reporting or responding to alleged
violations of codes of ethics or professional codes of
conduct are also dealing with a confidential matter
and acting in a confidential relationship with the
adjudicating body.
3. With respect to disclosure of decisions by
adjudicating bodies, individuals need to inform
themselves of pertinent laws and organizational
policies regarding disclosure of information.
Adjudicating bodies typically follow rules
of confidentiality (some dictated by law and regulation, some dictated by the organization’s internal
governance policies and procedures) regarding
disclosure of decisions.
Summary
It is incumbent on speech-language pathologists
or audiologists to honor their responsibilities to the
profession and their relationships with colleagues
in matters of confidentiality of proprietary and
personal information.
Guidance
1. In the multiple roles and activities in which
speech-language pathologists and audiologists are
engaged, confidentiality of proprietary and personal
information obtained in conjunction with the activity/
role is paramount.
2001; revised 2003
Ethics
Ethics: Fees for Clinical Service Provided by Students and Clinical Fellows
2004 / 1
Fees for Clinical Service
Provided by Students and Clinical
Fellows
Board of Ethics
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics determines that
members and certificate holders can benefit from additional
analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to
heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics and intended to promote
thoughtful consideration of ethical issues. They may assist
members and certificate holders in engaging in self-guided
ethical decision-making. These statements do not absolutely
prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine
whether the activity is ethical. This statement replaces an
earlier version (1978) titled, “Fees for Clinical Service Provided by Students.”
Introduction
The Board of Ethics has been asked to address ethical questions that may arise when fees are charged for
clinical services provided by students and clinical fellows. These ethical issues involve the following: (1) the
legitimacy of charging for work done by individuals
who are not yet fully trained or certified; (2) the nature
of supervision provided these individuals; and (3) the
public’s right to be informed regarding the qualifications of those providing the services.
The Board of Ethics refers readers to Principles of
Ethics II and III and Principle of Ethics II, Rule A, and
Principle of Ethics III, Rule A, for discussion of these
issues:
Reference this material as: American Speech-LanguageHearing Association. (2004). Fees for clinical service provided by students. ASHA Supplement 24, in press.
Index terms: Clinical service providers, students, supervision
Document type: Ethics and related documents
Principle of Ethics II: Individuals shall honor their
responsibility to achieve and maintain the highest level
of professional competence.
Principle of Ethics II, Rule A: Individuals shall
engage in the provision of clinical services only when
they hold the appropriate Certificate of Clinical Competence or when they are in the certification process
and are supervised by an individual who holds the
appropriate Certificate of Clinical Competence.
Principle fo Ethics III: Individuals shall honor their
responsibility to the public by promoting public understanding of the professions, by supporting the development of services designed to fulfill the unmet
needs of the public, and by providing accurate information in all communications involving any aspect of
the professions, including dissemination of research
findings and scholarly activities.
Principle of Ethics III, Rule A: Individuals shall not
misrepresent their credentials, competence, education,
training, experience, or scholarly or research contributions.
Discussion and Guidance
Principle of Ethics II, Rule A of the Code of Ethics
recognizes the professional acceptability of appropriately supervised clinical practice by students and clinical fellows in training. Hence, the Board of Ethics has
concluded that it has no basis for suggesting or requiring that such fees be fixed at any specific level or differ
in any manner or proportion from the fees normally
charged for services provided by certified audiologists
or speech-language pathologists. Although students
and clinical fellows may be involved in the provision
of clinical services, client welfare is the responsibility
of the certified supervisor. Clinical fellows are covered
under the Code of Ethics and must adhere to its principles and rules.
Of importance here is the nature, type, and quality of the supervision, rather than the fee schedule. The
services provided must meet or exceed professional
2004 / 2
American Speech-Language-Hearing Association
standards of supervision, as well as any legal and regulatory standards that may apply. The nature and intensity of supervision should be based on the stage of
clinical development of each student or clinical fellow.
If appropriate supervision is provided, the fees
charged are justified; if not, there is something fundamentally wrong with the service offered, and the fee
level is immaterial in view of Principle of Ethics I of
the Code, which obligates members and/or certificate
holders to “honor their responsibility to hold paramount the welfare of persons they serve professionally.”
Third-party payors may be very specific as regards
payment for services provided by students and clinical fellows. Therefore, it is imperative that supervisors
be knowledgeable regarding these specific requirements.
A final issue concerns the client’s right to be fully
informed of the professional qualifications of the service provider. Principle of Ethics III, Rule A of the Code
instructs that members and/or certificate holders
“shall not misrepresent their credentials, competence,
education, training, or experience.” Students, clinical
fellows, and supervisors must identify themselves as
such to those they service, for example, by use of an
appropriate name tag.
1978; revised 2003
OHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
LICENSURE
In addition to ASHA certification, most states require a license to practice speech-language
pathology. Ohio is one of these states. At the end of your master’s program, you will
apply for a conditional license in Ohio or the state in which you will practice. Below are the
requirements you will meet throughout your master’s program that will allow you to apply
for licensure in Ohio. If you intend on practicing in another state, you must check with
their governing board for the appropriate requirements.
EDUCATIONAL REQUIREMENTS FOR LICENSURE
(A) To be eligible for licensure, an applicant must demonstrate that the following course work
requirements are met:
(1) He/she obtained a broad general education, which may include study from among the
areas of human psychology, sociology, psychological and physical development, the
physical sciences, especially those that pertain to acoustic and biological phenomena,
and human anatomy and physiology, including neuroanatomy and neurophysiology.
(2) He/she obtained at least a master's degree in the area in which licensure is sought or
the equivalent as determined by the board from a college or university accredited by
one of the following regional or national accrediting organizations or their successor
organizations:
(a) "Middle States Association of Colleges and Schools- Commission on Higher
Education"
(b) "New England Association of Schools and Colleges"
(c) "North Central Association of Colleges and Schools"
(d) "Northwest Association of Schools and Colleges"
(e) "Southern Association of Colleges and Schools"
(f) "Western Association of Schools and Colleges - Accrediting Commission for
Senior Colleges"
The best source for determining whether the college or university is accredited by one of the
above organizations or successors is the college or university itself.
(3) The academic credit upon which the master's degree or higher was awarded must
include course work accumulated in the completion of a well-integrated course of
study, as follows:
(a) A total of seventy-five semester hours or one hundred twelve and one-half
quarter hours were accumulated.
(b) The course work consisted of at least the minimum number of hours in all
areas listed below:
(i) Twenty-seven semester hours in basic science course work. Of the
twenty-seven semester hours, six semester hours must be in
biological/physical sciences and mathematics and six semester hours
must be in behavioral or social sciences;
(ii) Fifteen semester hours in basic human communication processes,
including all of the following: the anatomic and physiologic bases, the
physical and psychophysical bases, and the linguistic and
psycholinguistic aspects;
(iii) Thirty-six semester hours in professional course work. Of the thirty-six
semester hours, thirty of the semester hours must be in courses for which
graduate credit was received and comply with the requirements below
that are applicable to the area in which licensure is sought:
(a) For speech-language pathology: thirty semester hours shall be in
speech-language pathology, with at least six semester hours in
language disorders; six semester hours shall be in audiology,
with three semester hours in hearing disorders and hearing
evaluation and three semester hours in habilitative/rehabilitative
procedures.
(b) For audiology: thirty semester hours shall be in audiology, with at
least six semester hours in hearing disorders and hearing
evaluation and at least six semester hours in
habilitative/rehabilitative procedures; six semester hours shall
be in speech-language pathology, not associated with hearing
impairment, with three semester hours in speech disorders and
three semester hours in language disorders.
(c) For both speech-language pathology and audiology, course of
study shall include content on ethical practice standards.
(B) Verification of education shall be the official transcript submitted to the board by the university
or college.
(1) No credit may be allowed for courses listed on the application unless satisfactory
completion of the course is verified by an official transcript.
(2) Satisfactory completion is defined as the applicant's having received academic credit
in semester hours, quarter hours, or other unit or credit with a passing grade as
defined by the college or university.
(3) Where the course work is reported in quarter hours, the following formula will be used:
one semester hour equals one and one half quarter hours.
(4) The applicant is solely responsible for authorizing the college or university to
send an official transcript to the board.
(5) The board may require additional verification of course work content.
(C) Course work listed on a college or university transcript shall be evaluated under the following
standards:
(1) A specific course may be split and credited to no more than two categories. If a course
is split, a description of the course taken from the university catalog must be submitted.
At least one semester hour of the course must address the area in which partial credit
is requested.
(2) Up to six semester hours for a thesis or dissertation may be accepted in the basic
human communications processes or the professional course work categories.
(a) An abstract of the thesis/dissertation content must be submitted with the
application.
(b) Academic credit that is associated with thesis or dissertation and for which
graduate credit was received may apply in the professional area, but may not
be counted as meeting any of the minimum requirements.
(c) "Minimum requirements" means six semester credit hours in speech disorders,
six semester credit hours in language disorders, three semester credit hours in
hearing disorders and hearing evaluations, three semester credit hours in
habilitative/rehabilitative procedures, and twenty-one graduate semester credit
hours in the area of licensure.
(d) Credit earned for research methodology courses, such as research methods,
introduction to graduate study, etc., may be counted toward the thirty semester
credit hours of course work at the graduate level but may not be used toward
any of the minimum requirements.
(D) Course work requirements for licensure shall be deemed to be met when the applicant was
awarded a master's degree or higher in the area in which licensure is sought from a college or
university program accredited by a regional or national specialized accrediting organization in
speech-language pathology and/or audiology recognized by the "United States Department of
Education" and the "Council for Higher Education Accreditation," One Dupont Circle Northwest,
Suite 50, Washington, D.C. 20036-1135, or its predecessors or successors, at the time the
master's degree was awarded.
(E) Course work requirements for licensure shall be deemed to be met when the applicant holds a
current certificate in audiology in good standing received from the "American Board of Audiology"
when both of the following criteria are met:
(1) Verification of certification is received from the "American Board of Audiology."
(2) The student clinical and professional experience completed for certification, if
performed in Ohio, were done in conformance with Ohio law and rules.
(F) Pursuant to section 4753.08(C) of the Revised Code, educational requirements for licensure
shall be waived for an applicant who presents proof of a current certificate of clinical competence
in the area in which licensure is sought that is in good standing and received from the "American
Speech-Language-Hearing Association" when both of the following criteria are met:
(1) Verification of certification is received from the "American Speech-Language-Hearing
Association."
(2) The student clinical and professional experience completed for certification, if
performed in Ohio, were done in conformance with Ohio law and rules.
(G) In order to expedite the licensure of graduates prior to the preparation of final transcripts, the
board shall consider on an individual basis any application for which the university provides a
letter from the registrar, graduate officer or speech-language pathology and/or audiology
department chairperson containing all of the following:
(1) A statement that the final transcript is not available;
(2) A statement that the applicant has met all requirements for a master's degree or
higher;
(3) A statement of the area in which the master's degree or higher was earned;
(4) The university or college seal or notarized signature of the university or college official
providing such letter.
The applicant is solely responsible for authorizing the college or university to send an official
transcript to the board within ninety days of licensure or when it is available.
STUDENT CLINICAL EXPERIENCE REQUIREMENTS
(A) Definitions
(1) For purposes of division (C) of section 4753.06 of the Revised Code, supervised
clinical experience of a student or intern means those clock hours of clinical
experience obtained in direct contact with persons served through a college or
university accredited by a regional or national accrediting organization recognized by
the board, in a cooperating program of said college or university, or in anther program
approved by the board.
(2) "Clock hour" means a time increment of sixty minutes.
(3) "Evaluation" means screening, assessment and diagnosis of hearing disorders and
language and speech disorders (articulation, fluency, voice and dysphagia) occurring
before initiation of a treatment program.
(a) Clock hours devoted to counseling associated with the evaluation/diagnostic
process may be counted.
(b) Clock hours spent in formal reevaluation may be applied to this category.
(c) Periodic assessments during treatment may not be considered as evaluation
but may be applied to the treatment category.
(d) The majority of the evaluation hours in each category must be in areas other
than screening activities.
(4) "Treatment for language and speech disorders" (articulation, fluency, voice, and
dysphagia) means clinical management, including direct and indirect services,
progress in monitoring activities, and counseling. Clock hours devoted to counseling
associated with the treatment process may be counted in this category.
(5) "Treatment for hearing disorders" means clinical management and counseling,
including auditory training, speech-reading, and speech and language services for
those with hearing impairment.
(6) "Direct supervision" means that the supervisor provides guidance and direction to the
student based upon on site observation of the student while in the same room or
through an observation window or observation by video simulcast or closed-circuit
television.
(7) "Indirect supervision" means that the supervisor providing guidance and direction to
the student is on site during the majority of the student clinical experience.
(B) To meet requirements for licensure, the student clinical experience must meet all of the
following criteria:
(1) The documentation establishes that the applicant obtained three hundred seventy-five
hours of supervised clinical practicum, of which twenty-five clock hours shall be
clinical observation prior to beginning initial clinical practicum and three hundred fifty
clock hours shall be clinical practicum. Two hundred fifty of the three hundred
seventy-five clock hours shall be at the graduate level in the area in which licensure is
sought.
(2) The documentation establishes that the following minimum requirements are met in
the applicable area:
(a) In the area of speech-language pathology:
(i) Twenty clock hours shall be in each of the following eight categories:
evaluation of speech disorders in children; evaluation of speech disorders
in adults; evaluation of language disorders in children; evaluation of
language disorders in adults; treatment of speech disorders in children;
treatment of speech disorders in adults; treatment of language disorders
in children; and treatment of language disorders in adults;
(ii) Twenty clock hours shall be in audiology and may include
evaluation/screening and/or habilitation/rehabilitation;
(iii) Fifty clock hours shall be in each of three types of clinical settings.
(b) In the area of audiology:
(i) At least fifty clock hours shall be in each of three types of clinical settings.
The student must have experience in the evaluation and treatment of
children and adults and with a variety of types and severity of disorders of
hearing, speech, and language, and with the selection and use of
amplification and assistive devices;
(ii) At least eighty clock hours shall be in each of the following categories,
with a minimum of ten hours in each category: selection and use of
amplification and assistive devices for children, and selection and use of
amplification and assistive devices for adults;
(iii) At least twenty clock hours shall be in the treatment of hearing disorders
in children and adults;
(iv) Twenty clock hours shall be in speech-language pathology unrelated to
hearing impairment and may include evaluation/screening and/or
treatment.
(3) The documentation establishes that the supervision of the experience was in
compliance with all of the supervision criteria set forth in paragraph (C) of this rule.
(C) Student clinical experience supervision
(1) The documentation establishes that the student clinical experience supervision was a
combination of direct and indirect supervision, as follows:
(a) At least ninety-five clock hours shall be directly supervised.
(b) Two hundred eighty clock hours shall be at least indirectly supervised.
(2) Supervisor observation of student clinical experience clock hours took place on site or
by closed-circuit television. It is recommended that evaluation of student performance
include activities such as conferences, audio and video recordings, written evaluations,
rating instruments, and inspection of lesson plans and written reports.
(a) The supervisor must directly observe at least twenty-five percent of the
student's contact time with each person served.
(b) The supervisor must directly observe at least fifty percent of the student's time
in each diagnostic evaluation, including screening and identification.
(D) Verification of student clinical experience shall be submitted directly from the college or
university on forms prescribed by the board.
(1) The verification must bear the notarized signature of the department head or
applicant's clinical supervisor. The board may at its discretion require additional
verification of student clinical experience.
(2) It is the applicant's responsibility to ensure that the college or university is authorized
to send student clinical experience records.
(E) The student clinical experience requirements set forth in paragraphs (B) and (C) of this rule
shall be deemed to be met when the applicant presents proof that he/she was awarded a master's
degree or higher in the area in which licensure is sought from a college or university program in
speech-language pathology and/or audiology accredited by a regional or national specialized
accrediting organization in speech-language pathology or audiology recognized by the "United
States Department of Education" and "Council for Higher Education Accreditation," One Dupont
Circle Northwest, Suite 50, Washington, D.C. 20036-1135, or its predecessors or successors, at
the time the master's degree was awarded.
(F) The student clinical experience requirements set forth in paragraphs (B) and (C) of this rule
shall be deemed to be met when the applicant holds current certification in audiology that is in
good standing and received from the "American Board of Audiology" and both of the following
criteria are met:
(1) Verification of certification is received from the "American Board of Audiology."
(2) The student clinical experience and professional experience upon which certification
was granted, if completed in Ohio, were done in conformance with Ohio law and rules.
(G) The student clinical experience requirements sets forth in paragraphs (B) and (C) of this rule
shall be deemed to be met when the applicant holds a current certificate of clinical competence in
the area in which licensure is sought that is in good standing and received from the "American
Speech-Language-Hearing Association" and both of the following criteria are met:
(1) Verification of certification is received from the "American Speech-Language-Hearing
Association."
(2) The student clinical experience and professional experience upon which certification
was granted, if completed in Ohio, were done in conformance with Ohio law and rules.
(H) Academic credit for student clinical experience may not be used to satisfy specific course work
minimum requirements. A maximum of six semester clock hours for student clinical experience
may be applied to the thirty-six semester clock hours of professional course work.
(I) Students shall not receive reimbursement or compensation for services provided during the
student clinical experience, unless the board finds that extraordinary circumstances render
reimbursement or compensation appropriate.
(J) Student clinical experience must have been under the supervision of a person who meets one
of the following criteria:
(1) Student clinical experience obtained in the state of Ohio shall have been under the
supervision of a person who during the entire student clinical experience was licensed
under Chapter 4753. of the Revised Code in the area in which the applicant seeks
licensure.
(2) Student clinical experience obtained outside of Ohio shall have been under the
supervision of a person who during the entire student clinical experience was licensed
in the area in which the applicant seeks licensure in the state in which the student
clinical experience was performed.
(3) Student clinical experience obtained in a state that does not have licensure shall have
been under the supervision of a person who during the entire student clinical
experience was certified by the "American Speech-Language-Hearing Association" or
the "American Board of Audiology," in the area in which the applicant seeks licensure.
EXAMINATION REQUIREMENTS
An applicant shall have satisfied the examination requirements of the board if he/she has
achieved a score of six hundred or above on the "National Examination in Speech Pathology" or
the "National Examination in Audiology" or “The Praxis Series II Test in Speech-Language
Pathology” or “The Praxis Series II Test in Audiology” administered by the "educational testing
service" of Princeton, New Jersey, in the area in which licensure is sought or any other such
practical and oral or written examinations as the board shall determine as necessary. Verification
of the test score shall be submitted to the board by the "Educational Testing Service." Scores
which cannot be reported by the "Educational Testing Service" may be submitted by another
source with the approval of the board. It is the applicant's responsibility to ensure that the
“Educational Testing Service” is authorized to report the test score.
APPENDIX I: WORLD HEALTH ORGANIZATION (WHO)
ICF
Introduction
ICF
Introduction
1
2
ICF
Introduction
1. Background
This volume contains the International Classification of Functioning, Disability
1
and Health, known as ICF. The overall aim of the ICF classification is to provide
a unified and standard language and framework for the description of health and
health-related states. It defines components of health and some health-related
components of well-being (such as education and labour). The domains
contained in ICF can, therefore, be seen as health domains and health-related
domains. These domains are described from the perspective of the body, the
individual and society in two basic lists: (1) Body Functions and Structures; and
2
(2) Activities and Participation. As a classification, ICF systematically groups
3
different domains for a person in a given health condition (e.g. what a person
with a disease or disorder does do or can do). Functioning is an umbrella term
encompassing all body functions, activities and participation; similarly, disability
serves as an umbrella term for impairments, activity limitations or participation
restrictions. ICF also lists environmental factors that interact with all these
constructs. In this way, it enables the user to record useful profiles of individuals’
functioning, disability and health in various domains.
ICF belongs to the “family” of international classifications developed by the
World Health Organization (WHO) for application to various aspects of health.
The WHO family of international classifications provides a framework to code a
wide range of information about health (e.g. diagnosis, functioning and
disability, reasons for contact with health services) and uses a standardized
common language permitting communication about health and health care
across the world in various disciplines and sciences.
In WHO’s international classifications, health conditions (diseases, disorders,
injuries, etc.) are classified primarily in ICD-10 (shorthand for the International
1
The text represents a revision of the International Classification of Impairments, Disabilities, and
Handicaps (ICIDH), which was first published by the World Health Organization for trial purposes in
1980. Developed after systematic field trials and international consultation over the past five years, it
was endorsed by the Fifty-fourth World Health Assembly for international use on 22 May 2001
(resolution WHA54.21).
2
These terms, which replace the formerly used terms “impairment”, “disability” and “handicap” ,
extend the scope of the classification to allow positive experiences to be described. The new terms are
further defined in this Introduction and are detailed within the classification. It should be noted that
these terms are used with specific meanings that may differ from their everyday usage.
3
A domain is a practical and meaningful set of related physiological functions, anatomical structures,
actions, tasks, or areas of life.
3
Introduction
ICF
4
Classification of Diseases, Tenth Revision), which provides an etiological
framework. Functioning and disability associated with health conditions are
5
classified in ICF. ICD-10 and ICF are therefore complementary, and users are
encouraged to utilize these two members of the WHO family of international
classifications together. ICD-10 provides a “diagnosis” of diseases, disorders or
other health conditions, and this information is enriched by the additional
6
information given by ICF on functioning. Together, information on diagnosis
plus functioning provides a broader and more meaningful picture of the health of
people or populations, which can then be used for decision-making purposes.
The WHO family of international classifications provides a valuable tool to
describe and compare the health of populations in an international context. The
information on mortality (provided by ICD-10) and on health outcomes
(provided by ICF) may be combined in summary measures of population health
for monitoring the health of populations and its distribution, and also for
assessing the contributions of different causes of mortality and morbidity.
ICF has moved away from being a “consequences of disease” classification (1980
version) to become a “components of health” classification. “Components of
health” identifies the constituents of health, whereas “consequences” focuses on
the impacts of diseases or other health conditions that may follow as a result.
Thus, ICF takes a neutral stand with regard to etiology so that researchers can
draw causal inferences using appropriate scientific methods. Similarly, this
approach is also different from a “determinants of health” or "risk factors"
approach. To facilitate the study of determinants or risk factors, ICF includes a
list of environmental factors that describe the context in which individuals live.
4
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision,
Vols. 1-3. Geneva, World Health Organization, 1992-1994.
5
It is also important to recognize the overlap between ICD-10 and ICF. Both classifications begin with
the body systems. Impairments refer to body structures and functions, which are usually parts of the
“disease process” and are therefore also used in the ICD-10. Nevertheless, ICD-10 uses impairments
(as signs and symptoms) as parts of a constellation that forms a “disease”, or sometimes as reasons for
contact with health services, whereas the ICF system uses impairments as problems of body functions
and structures associated with health conditions.
6
Two persons with the same disease can have different levels of functioning, and two persons with
the same level of functioning do not necessarily have the same health condition. Hence, joint use
enhances data quality for medical purposes. Use of ICF should not bypass regular diagnostic
procedures. In other uses, ICF may be used alone.
4
ICF
Introduction
2. Aims of ICF
ICF is a multipurpose classification designed to serve various disciplines and
different sectors. Its specific aims can be summarized as follows:
•
to provide a scientific basis for understanding and studying health and
health-related states, outcomes and determinants;
•
to establish a common language for describing health and health-related
states in order to improve communication between different users, such as
health care workers, researchers, policy-makers and the public, including
people with disabilities;
•
to permit comparison of data across countries, health care disciplines,
services and time;
•
to provide a systematic coding scheme for health information systems.
These aims are interrelated, since the need for and uses of ICF require the
construction of a meaningful and practical system that can be used by various
consumers for health policy, quality assurance and outcome evaluation in
different cultures.
2.1
Applications of ICF
Since its publication as a trial version in 1980, ICIDH has been used for various
purposes, for example:
•
as a statistical tool – in the collection and recording of data (e.g. in
population studies and surveys or in management information systems);
•
as a research tool – to measure outcomes, quality of life or environmental
factors;
•
as a clinical tool – in needs assessment, matching treatments with specific
conditions, vocational assessment, rehabilitation and outcome evaluation;
•
as a social policy tool – in social security planning, compensation systems
and policy design and implementation;
•
as an educational tool – in curriculum design and to raise awareness and
undertake social action.
Since ICF is inherently a health and health-related classification it is also used by
sectors such as insurance, social security, labour, education, economics, social
policy and general legislation development, and environmental modification. It
has been accepted as one of the United Nations social classifications and is
referred to in and incorporates The Standard Rules on the Equalization of
5
Introduction
ICF
Opportunities for Persons with Disabilities. Thus ICF provides an appropriate
instrument for the implementation of stated international human rights
mandates as well as national legislation.
7
ICF is useful for a broad spectrum of different applications, for example social
security, evaluation in managed health care, and population surveys at local,
national and international levels. It offers a conceptual framework for
information that is applicable to personal health care, including prevention,
health promotion, and the improvement of participation by removing or
mitigating societal hindrances and encouraging the provision of social supports
and facilitators. It is also useful for the study of health care systems, in terms of
both evaluation and policy formulation.
7
The Standard Rules on the Equalization of Opportunities for Persons with Disabilities. Adopted by the
United Nations General Assembly at its 48th session on 20 December 1993 (resolution 48/96). New
York, NY, United Nations Department of Public Information, 1994.
6
ICF
3.
Introduction
Properties of ICF
A classification should be clear about what it classifies: its universe, its scope, its
units of classification, its organization, and how these elements are structured in
terms of their relation to each other. The following sections explain these basic
properties of ICF.
3.1 Universe of ICF
ICF encompasses all aspects of human health and some health-relevant
components of well-being and describes them in terms of health domains and
health-related domains. The classification remains in the broad context of health
and does not cover circumstances that are not health-related, such as those
brought about by socioeconomic factors. For example, because of their race,
gender, religion or other socioeconomic characteristics people may be restricted
in their execution of a task in their current environment, but these are not healthrelated restrictions of participation as classified in ICF.
8
There is a widely held misunderstanding that ICF is only about people with
disabilities; in fact, it is about all people. The health and health-related states
associated with all health conditions can be described using ICF. In other words,
ICF has universal application.
9
3.2 Scope of ICF
ICF provides a description of situations with regard to human functioning and its
restrictions and serves as a framework to organize this information. It structures
the information in a meaningful, interrelated and easily accessible way.
ICF organizes information in two parts. Part 1 deals with Functioning and
Disability, while Part 2 covers Contextual Factors. Each part has two
components:
1. Components of Functioning and Disability
The Body component comprises two classifications, one for functions of body
systems, and one for body structures. The chapters in both classifications are
organized according to the body systems.
8
Examples of health domains include seeing, hearing, walking, learning and remembering, while
examples of health-related domains include transportation, education and social interactions.
9
Bickenbach JE, Chatterji S, Badley EM, Üstün TB. Models of disablement, universalism and the
ICIDH, Social Science and Medicine, 1999, 48:1173-1187.
7
Introduction
ICF
The Activities and Participation component covers the complete range of
domains denoting aspects of functioning from both an individual and a societal
perspective.
2. Components of Contextual Factors
A list of Environmental Factors is the first component of Contextual Factors.
Environmental factors have an impact on all components of functioning and
disability and are organized in sequence from the individual’s most immediate
environment to the general environment.
Personal Factors is also a component of Contextual Factors but they are not
classified in ICF because of the large social and cultural variance associated with
them.
The components of Functioning and Disability in Part 1 of ICF can be expressed
in two ways. On the one hand, they can be used to indicate problems (e.g.
impairment, activity limitation or participation restriction summarized under the
umbrella term disability); on the other hand they can indicate nonproblematic
(i.e. neutral) aspects of health and health-related states summarized under the
umbrella term functioning).
These components of functioning and disability are interpreted by means of four
separate but related constructs. These constructs are operationalized by using
qualifiers. Body functions and structures can be interpreted by means of changes
in physiological systems or in anatomical structures. For the Activities and
Participation component, two constructs are available: capacity and performance
(see section 4.2).
A person's functioning and disability is conceived as a dynamic interaction
between health conditions (diseases, disorders, injuries, traumas, etc.) and
contextual factors. As indicate above, Contextual Factors include both personal
and environmental factors. ICF includes a comprehensive list of environmental
factors as an essential component of the classification. Environmental factors
interact with all the components of functioning and disability. The basic
construct of the Environmental Factors component is the facilitating or
hindering impact of features of the physical, social and attitudinal world.
10
3.3 Unit of classification
ICF classifies health and health-related states. The unit of classification is,
therefore, categories within health and health-related domains. It is important to
note, therefore, that in ICF persons are not the units of classification; that is, ICF
does not classify people, but describes the situation of each person within an
array of health or health-related domains. Moreover, the description is always
made within the context of environmental and personal factors.
10
This interaction can be viewed as a process or a result depending on the user.
8
ICF
Introduction
3.4 Presentation of ICF
ICF is presented in two versions in order to meet the needs of different users for
varying levels of detail.
The full version of ICF, as contained in this volume, provides classification at four
levels of detail. These four levels can be aggregated into a higher-level
classification system that includes all the domains at the second level. The twolevel system is also available as a short version of ICF.
9
Introduction
ICF
4. Overview of ICF components
DEFINITIONS
11
In the context of health:
Body functions are the physiological functions of body systems (including
psychological functions).
Body structures are anatomical parts of the body such as organs, limbs and
their components.
Impairments are problems in body function or structure such as a significant
deviation or loss.
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in executing
activities.
Participation restrictions are problems an individual may experience in
involvement in life situations.
Environmental factors make up the physical, social and attitudinal
environment in which people live and conduct their lives.
An overview of these concepts is given in Table 1; they are explained further in
operational terms in section 5.1. As the table indicates:
•
ICF has two parts, each with two components:
Part 1. Functioning and Disability
(a) Body Functions and Structures
(b) Activities and Participation
Part 2. Contextual Factors
(c) Environmental Factors
(d) Personal Factors
•
Each component can be expressed in both positive and negative terms.
•
Each component consists of various domains and, within each domain,
categories, which are the units of classification. Health and health-related
states of an individual may be recorded by selecting the appropriate category
11
See also Annex 1, Taxonomic and Terminological Issues.
10
ICF
Introduction
code or codes and then adding qualifiers, which are numeric codes that
specify the extent or the magnitude of the functioning or disability in that
category, or the extent to which an environmental factor is a facilitator or
barrier.
Table 1. An overview of ICF
Part 1: Functioning and Disability
Components
Domains
Body Functions
and Structures
Body functions
Body structures
Change in body
functions
(physiological)
Constructs
Change in body
structures
(anatomical)
Positive aspect
Functional and
structural integrity
Part 2: Contextual Factors
Activities and
Participation
Environmental
Factors
Personal Factors
Life areas
(tasks, actions)
External influences
on functioning and
disability
Internal influences on
functioning and
disability
Facilitating or
Capacity
Executing tasks in a hindering impact of
Impact of attributes of
standard environment
features of the
physical, social, and
the person
Performance
attitudinal world
Executing tasks in the
current environment
Activities
Participation
Facilitators
not applicable
Barriers / hindrances
not applicable
Functioning
Impairment
Negative aspect
Activity limitation
Participation
restriction
Disability
11
Introduction
ICF
4.1 Body Functions and Structures and impairments
Definitions:
Body functions are the physiological functions of body systems
(including psychological functions).
Body structures are anatomical parts of the body such as organs,
limbs and their components.
Impairments are problems in body function or structure as a
significant deviation or loss.
(1) Body functions and body structures are classified in two different sections.
These two classifications are designed for use in parallel. For example, body
functions include basic human senses such as “seeing functions” and their
structural correlates exist in the form of “eye and related structures”.
(2) “Body” refers to the human organism as a whole; hence it includes the brain
and its functions, i.e. the mind. Mental (or psychological) functions are
therefore subsumed under body functions.
(3) Body functions and structures are classified according to body systems;
consequently, body structures are not considered as organs.
12
(4) Impairments of structure can involve an anomaly, defect, loss or other
significant deviation in body structures. Impairments have been
conceptualized in congruence with biological knowledge at the level of
tissues or cells and at the subcellular or molecular level. For practical reasons,
however, these levels are not listed. The biological foundations of
impairments have guided the classification and there may be room for
expanding the classification at the cellular or molecular levels. For medical
users, it should be noted that impairments are not the same as the underlying
pathology, but are the manifestations of that pathology.
13
(5) Impairments represent a deviation from certain generally accepted
population standards in the biomedical status of the body and its functions,
and definition of their constituents is undertaken primarily by those
qualified to judge physical and mental functioning according to these
standards.
(6) Impairments can be temporary or permanent; progressive, regressive or
static; intermittent or continuous. The deviation from the population norm
may be slight or severe and may fluctuate over time. These characteristics are
captured in further descriptions, mainly in the codes, by means of qualifiers
after the point.
12
Although organ level was mentioned in the 1980 version of ICIDH, the definition of an “organ” is
not clear. The eye and ear are traditionally considered as organs; however, it is difficult to identify and
define their boundaries, and the same is true of extremities and internal organs. Instead of an
approach by “organ”, which implies the existence of an entity or unit within the body, ICF replaces
this term with “body structure”.
13
Thus impairments coded using the full version of ICF should be detectable or noticeable by others
or the person concerned by direct observation or by inference from observation.
12
ICF
Introduction
(7) Impairments are not contingent on etiology or how they are developed; for
example, loss of vision or a limb may arise from a genetic abnormality or an
injury. The presence of an impairment necessarily implies a cause; however,
the cause may not be sufficient to explain the resulting impairment. Also,
when there is an impairment, there is a dysfunction in body functions or
structures, but this may be related to any of the various diseases, disorders or
physiological states.
(8) Impairments may be part or an expression of a health condition, but do not
necessarily indicate that a disease is present or that the individual should be
regarded as sick.
(9) Impairments are broader and more inclusive in scope than disorders or
diseases; for example, the loss of a leg is an impairment of body structure,
but not a disorder or a disease.
(10) Impairments may result in other impairments; for example, a lack of muscle
power may impair movement functions, heart functions may relate to deficit
in respiratory functions, and impaired perception may relate to thought
functions.
(11) Some categories of the Body Functions and Structures component and the
ICD-10 categories seem to overlap, particularly with regard to symptoms
and signs. However, the purposes of the two classifications are different.
ICD-10 classifies symptoms in special chapters to document morbidity or
service utilization, whereas ICF shows them as part of the body functions,
which may be used for prevention or identifying patients’ needs. Most
importantly, in ICF the Body Functions and Structures classification is
intended to be used along with the Activities and Participation categories.
(12) Impairments are classified in the appropriate categories using defined
identification criteria (e.g. as present or absent according to a threshold
level). These criteria are the same for body functions and structures. They
are: (a) loss or lack; (b) reduction; (c) addition or excess; and (d) deviation.
Once an impairment is present, it may be scaled in terms of its severity using
the generic qualifier in the ICF.
(13) Environmental factors interact with body functions, as in the interactions
between air quality and breathing, light and seeing, sounds and hearing,
distracting stimuli and attention, ground texture and balance, and ambient
temperature and body temperature regulation.
13
Introduction
ICF
4.2 Activities and Participation /activity limitations and
participation restrictions
Definitions:
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in
executing activities.
Participation restrictions are problems an individual may
experience in involvement in life situations.
(1) The domains for the Activities and Participation component are given in a
single list that covers the full range of life areas (from basic learning or
watching to composite areas such as interpersonal interactions or
employment). The component can be used to denote activities (a) or
participation (p) or both. The domains of this component are qualified by
the two qualifiers of performance and capacity. Hence the information
gathered from the list provides a data matrix that has no overlap or
redundancy (see Table 2).
Table 2. Activities and Participation: information matrix
Qualifiers
Domains
d1
Learning and applying knowledge
d2
General tasks and demands
d3
Communication
d4
Mobility
d5
Self-care
d6
Domestic life
d7
d8
Interpersonal interactions and
relationships
Major life areas
d9
Community, social and civic life
Performance
14
Capacity
ICF
Introduction
(2) The performance qualifier describes what an individual does in his or her
current environment. Because the current environment includes a societal
context, performance can also be understood as "involvement in a life
situation" or "the lived experience" of people in the actual context in which
14
they live. This context includes the environmental factors – all aspects of
the physical, social and attitudinal world which can be coded using the
Environmental Factors component.
(3) The capacity qualifier describes an individual’s ability to execute a task or an
action. This construct aims to indicate the highest probable level of
functioning that a person may reach in a given domain at a given moment.
To assess the full ability of the individual, one would need to have a
“standardized” environment to neutralize the varying impact of different
environments on the ability of the individual. This standardized
environment may be: (a) an actual environment commonly used for capacity
assessment in test settings; or (b) in cases where this is not possible, an
assumed environment which can be thought to have a uniform impact. This
environment can be called a “uniform” or “standard” environment. Thus,
capacity reflects the environmentally adjusted ability of the individual. This
adjustment has to be the same for all persons in all countries to allow for
international comparisons. The features of the uniform or standard
environment can be coded using the Environmental Factors classification.
The gap between capacity and performance reflects the difference between
the impacts of current and uniform environments, and thus provides a
useful guide as to what can be done to the environment of the individual to
improve performance.
(4) Both capacity and performance qualifiers can further be used with and
without assistive devices or personal assistance. While neither devices nor
personal assistance eliminate the impairments, they may remove limitations
on functioning in specific domains. This type of coding is particularly useful
to identify how much the functioning of the individual would be limited
without the assistive devices (see coding guidelines in Annex 2)
(5) Difficulties or problems in these domains can arise when there is a qualitative
or quantitative alteration in the way in which an individual carries out these
domain functions. Limitations or restrictions are assessed against a generally
accepted population standard. The standard or norm against which an
individual’s capacity and performance is compared is that of an individual
without a similar health condition (disease, disorder or injury, etc.). The
limitation or restriction records the discordance between the observed and
the expected performance. The expected performance is the population
norm, which represents the experience of people without the specific health
14
The definition of “participation” brings in the concept of involvement. Some proposed definitions
of “involvement” incorporate taking part, being included or engaged in an area of life, being
accepted, or having access to needed resources. Within the information matrix in Table 2 the only
possible indicator of participation is coding through performance. This does not mean that
participation is automatically equated with performance. The concept of involvement should also be
distinguished from the subjective experience of involvement (the sense of “belonging”). Users who
wish to code involvement separately should refer to the coding guidelines in Annex 2.
15
Introduction
ICF
condition. The same norm is used in the capacity qualifier so that one can
infer what can be done to the environment of the individual to enhance
performance.
(6) A problem with performance can result directly from the social
environment, even when the individual has no impairment. For example, an
individual who is HIV-positive without any symptoms or disease, or
someone with a genetic predisposition to a certain disease, may exhibit no
impairments or may have sufficient capacity to work, yet may not do so
because of the denial of access to services, discrimination or stigma.
(7) It is difficult to distinguish between "Activities" and "Participation" on the
basis of the domains in the Activities and Participation component.
Similarly, differentiating between “individual” and “societal” perspectives on
the basis of domains has not been possible given international variation and
differences in the approaches of professionals and theoretical frameworks.
Therefore, ICF provides a single list that can be used, if users so wish, to
differentiate activities and participation in their own operational ways. This
is further explained in Annex 3. There are four possible ways of doing so:
(a) to designate some domains as activities and others as participation,
not allowing any overlap;
(b) same as (a) above, but allowing partial overlap;
(c) to designate all detailed domains as activities and the broad
category headings as participation;
(d) to use all domains as both activities and participation.
4.3 Contextual Factors
Contextual Factors represent the complete background of an individual’s life and
living. They include two components: Environmental Factors and Personal
Factors – which may have an impact on the individual with a health condition
and that individual’s health and health-related states.
Environmental factors make up the physical, social and attitudinal environment
in which people live and conduct their lives. These factors are external to
individuals and can have a positive or negative influence on the individual’s
performance as a member of society, on the individual’s capacity to execute
actions or tasks, or on the individual’s body function or structure.
(1) Environmental factors are organized in the classification to focus on two
different levels:
(a) Individual – in the immediate environment of the individual,
including settings such as home, workplace and school. Included at
this level are the physical and material features of the environment
that an individual comes face to face with, as well as direct contact
with others such as family, acquaintances, peers and strangers.
16
ICF
Introduction
(b) Societal – formal and informal social structures, services and
overarching approaches or systems in the community or society
that have an impact on individuals. This level includes
organizations and services related to the work environment,
community activities, government agencies, communication and
transportation services, and informal social networks as well as
laws, regulations, formal and informal rules, attitudes and
ideologies.
(2) Environmental factors interact with the components of Body Functions and
Structures and Activities and Participation. For each component, the nature
and extent of that interaction may be elaborated by future scientific work.
Disability is characterized as the outcome or result of a complex relationship
between an individual’s health condition and personal factors, and of the
external factors that represent the circumstances in which the individual
lives. Because of this relationship, different environments may have a very
different impact on the same individual with a given health condition. An
environment with barriers, or without facilitators, will restrict the
individual’s performance; other environments that are more facilitating may
increase that performance. Society may hinder an individual's performance
because either it creates barriers (e.g. inaccessible buildings) or it does not
provide facilitators (e.g. unavailability of assistive devices).
Personal factors are the particular background of an individual’s life and living,
and comprise features of the individual that are not part of a health condition or
health states. These factors may include gender, race, age, other health
conditions, fitness, lifestyle, habits, upbringing, coping styles, social background,
education, profession, past and current experience (past life events and
concurrent events), overall behaviour pattern and character style, individual
psychological assets and other characteristics, all or any of which may play a role
in disability at any level. Personal factors are not classified in ICF. However, they
are included in Fig. 1 to show their contribution, which may have an impact on
the outcome of various interventions.
17
Introduction
ICF
5. Model of Functioning and Disability
5.1 Process of functioning and disability
As a classification, ICF does not model the “process” of functioning and
disability. It can be used, however, to describe the process by providing the
means to map the different constructs and domains. It provides a multiperspective approach to the classification of functioning and disability as an
interactive and evolutionary process. It provides the building blocks for users
who wish to create models and study different aspects of this process. In this
sense, ICF can be seen as a language: the texts that can be created with it depend
on the users, their creativity and their scientific orientation. In order to visualize
the current understanding of interaction of various components, the diagram
presented in Fig. 1 may be helpful.
15
Fig. 1. Interactions between the components of ICF
Health condition
(disorder or disease)
Body Functions and
Structures
Activities
Environmental
Factors
Participation
Personal
Factors
15
ICF differs substantially from the 1980 version of ICIDH in the depiction of the interrelations
between functioning and disability. It should be noted that any diagram is likely to be incomplete and
prone to misrepresentation because of the complexity of interactions in a multidimensional model.
The model is drawn to illustrate multiple interactions. Other depictions indicating other important
foci in the process are certainly possible. Interpretations of interactions between different
components and constructs may also vary (for example, the impact of environmental factors on body
functions certainly differs from their impact on participation).
18
ICF
Introduction
In this diagram, an individual's functioning in a specific domain is an interaction
or complex relationship between the health condition and contextual factors (i.e.
environmental and personal factors). There is a dynamic interaction among these
entities: interventions in one entity have the potential to modify one or more of
the other entities. These interactions are specific and not always in a predictable
one-to-one relationship. The interaction works in two directions; the presence of
disability may even modify the health condition itself. To infer a limitation in
capacity from one or more impairments, or a restriction of performance from
one or more limitations, may often seem reasonable. It is important, however, to
collect data on these constructs independently and thereafter explore associations
and causal links between them. If the full health experience is to be described, all
components are useful. For example, one may:
•
have impairments without having capacity limitations (e.g. a disfigurement
in leprosy may have no effect on a person's capacity);
•
have performance problems and capacity limitations without evident
impairments (e.g. reduced performance in daily activities associated with
many diseases);
•
have performance problems without impairments or capacity limitations
(e.g. an HIV-positive individual, or an ex-patient recovered from mental
illness, facing stigmatization or discrimination in interpersonal relations or
work);
•
have capacity limitations without assistance, and no performance problems
in the current environment (e.g. an individual with mobility limitations may
be provided by society with assistive technology to move around);
•
experience a degree of influence in a reverse direction (e.g. lack of use of
limbs can cause muscle atrophy; institutionalization may result in loss of
social skills).
Case examples in Annex 4 further illustrate possibilities of interactions between
the constructs.
The scheme shown in Fig. 1 demonstrates the role that contextual factors (i.e.
environmental and personal factors) play in the process. These factors interact
with the individual with a health condition and determine the level and extent of
the individual’s functioning. Environmental factors are extrinsic to the
individual (e.g. the attitudes of the society, architectural characteristics, the legal
system) and are classified in the Environmental Factors classification. Personal
Factors, on the other hand, are not classified in the current version of ICF. They
include gender, race, age, fitness, lifestyle, habits, coping styles and other such
factors. Their assessment is left to the user, if needed.
19
Introduction
ICF
5.2 Medical and social models
A variety of conceptual models has been proposed to understand and explain
disability and functioning. These may be expressed in a dialectic of “medical
model” versus “social model”. The medical model views disability as a problem of
the person, directly caused by disease, trauma or other health condition, which
requires medical care provided in the form of individual treatment by
professionals. Management of the disability is aimed at cure or the individual’s
adjustment and behaviour change. Medical care is viewed as the main issue, and
at the political level the principal response is that of modifying or reforming
health care policy. The social model of disability, on the other hand, sees the issue
mainly as a socially created problem, and basically as a matter of the full
integration of individuals into society. Disability is not an attribute of an
individual, but rather a complex collection of conditions, many of which are
created by the social environment. Hence the management of the problem
requires social action, and it is the collective responsibility of society at large to
make the environmental modifications necessary for the full participation of
people with disabilities in all areas of social life. The issue is therefore an
attitudinal or ideological one requiring social change, which at the political level
becomes a question of human rights. For this model disability is a political issue.
16
ICF is based on an integration of these two opposing models. In order to capture
the integration of the various perspectives of functioning, a “biopsychosocial”
approach is used. Thus, ICF attempts to achieve a synthesis, in order to provide a
coherent view of different perspectives of health from a biological, individual and
social perspective.
17
16
The term "model" here means construct or paradigm, which differs from the use of the term in the
previous section.
17
See also Annex 5 - “ICF and people with disabilities”.
20
ICF
Introduction
6. Use of ICF
ICF is a classification of human functioning and disability. It systematically
groups health and health-related domains. Within each component, domains are
further grouped according to their common characteristics (such as their origin,
type, or similarity) and ordered in a meaningful way. The classification is
organized according to a set of principles (see Annex 1). These principles refer to
the interrelatedness of the levels and the hierarchy of the classification (sets of
levels). However, some categories in ICF are arranged in a non-hierarchical
manner, with no ordering but as equal members of a branch.
The following are structural features of the classification that have a bearing on its
use.
(1) ICF gives standard operational definitions of the health and health-related
domains as opposed to “vernacular” definitions of health. These definitions
describe the essential attributes of each domain (e.g. qualities, properties,
and relationships) and contain information as to what is included and
excluded in each domain. The definitions contain commonly used anchor
points for assessment so that they can be translated into questionnaires.
Conversely, results from existing assessment instruments can be coded in
ICF terms. For example, “seeing functions” are defined in terms of functions
of sensing form and contour, from varying distances, using one or both eyes,
so that the severity of difficulties of vision can be coded at mild, moderate,
severe or total levels in relation to these parameters.
(2) ICF uses an alphanumeric system in which the letters b, s, d and e are used to
denote Body Functions, Body Structures, Activities and Participation, and
Environmental Factors. These letters are followed by a numeric code that
starts with the chapter number (one digit), followed by the second level (two
digits), and the third and fourth levels (one digit each).
(3) ICF categories are “nested” so that broader categories are defined to include
more detailed subcategories of the parent category. (For example, Chapter 4
in the Activities and Participation component, on Mobility, includes
separate categories on standing, sitting, walking, carrying items, and so on).
The short (concise) version covers two levels, whereas the full (detailed)
version extends to four levels. The short version and full version codes are in
correspondence, and the short version can be aggregated from the full
version.
(4) Any individual may have a range of codes at each level. These may be
independent or interrelated.
(5) The ICF codes are only complete with the presence of a qualifier, which
denotes a magnitude of the level of health (e.g. severity of the problem).
Qualifiers are coded as one, two or more numbers after a point (or
separator). Use of any code should be accompanied by at least one qualifier.
Without qualifiers, codes have no inherent meaning.
21
Introduction
ICF
(6) The first qualifier for Body Functions and Structures, the performance and
capacity qualifiers for Activities and Participation, and the first qualifier for
Environmental Factors all describe the extent of problems in the respective
component.
(7) All three components classified in ICF (Body Functions and Structures,
Activities and Participation, and Environmental Factors) are quantified
using the same generic scale. Having a problem may mean an impairment,
limitation, restriction or barrier depending on the construct. Appropriate
qualifying words as shown in brackets below should be chosen according to
the relevant classification domain (where xxx stands for the second-level
domain number). For this quantification to be used in a universal manner,
assessment procedures need to be developed through research. Broad ranges
of percentages are provided for those cases in which calibrated assessment
instruments or other standards are available to quantify the impairment,
capacity limitation, performance problem or barrier. For example, when
“no problem” or “complete problem” is specified the coding has a margin of
error of up to 5%. “Moderate problem” is defined as up to half of the time or
half the scale of total difficulty. The percentages are to be calibrated in
different domains with reference to relevant population standards as
percentiles.
xxx.0 NO problem
xxx.1 MILD problem
xxx.2 MODERATE problem
xxx.3 SEVERE problem
xxx.4 COMPLETE problem
xxx.8 not specified
xxx.9 not applicable
(none, absent, negligible,… )
(slight, low,…)
(medium, fair,...)
(high, extreme, …)
(total,…)
0-4 %
5-24 %
25-49 %
50-95 %
96-100 %
(8) In the case of environmental factors, this first qualifier can be used to denote
either the extent of positive effects of the environment, i.e. facilitators, or the
extent of negative effects, i.e. barriers. Both use the same 0-4 scale, but to
denote facilitators the point is replaced by a plus sign: for example e110+2.
Environmental Factors can be coded (a) in relation to each construct
individually, or (b) overall, without reference to any individual construct.
The first option is preferable, since it identifies the impact and attribution
more clearly.
(9) For different users, it might be appropriate and helpful to add other kinds of
information to the coding of each item. There are a variety of additional
qualifiers that could be useful. Table 3 sets out the details of the qualifiers for
each component as well as suggested additional qualifiers to be developed.
(10) The descriptions of health and health-related domains refer to their use at a
given moment (i.e. as a snapshot). However, use at multiple time points is
possible to describe a trajectory over time and process.
(11) In ICF, a person's health and health-related states are given an array of codes
that encompass the two parts of the classification. Thus the maximum
22
ICF
Introduction
number of codes per person can be 34 at the one-digit level (8 body
functions, 8 body structures, 9 performance and 9 capacity codes). Similarly,
for the two-level items the total number of codes is 362. At more detailed
levels, these codes number up to 1424 items. In real-life applications of ICF,
a set of 3 to 18 codes may be adequate to describe a case with two-level
(three-digit) precision. Generally the more detailed four-level version is used
for specialist services (e.g. rehabilitation outcomes, geriatrics), whereas the
two-level classification can be used for surveys and clinical outcome
evaluation.
Further coding guidelines are presented in Annex 2. Users are strongly
recommended to obtain training in the use of the classification through WHO
and its network of collaborating centres.
23
Introduction
ICF
Table 3. Qualifiers
Components
Body Functions (b)
First qualifier
Second qualifier
Generic qualifier with the negative
scale used to indicate the extent or
magnitude of an impairment
None
Example: b167.3 to indicate a severe
impairment in specific mental
functions of language
Body Structures (s)
Activities and
Participation (d)
Generic qualifier with the negative
scale used to indicate the extent or
magnitude of an impairment
Example: s730.3 to indicate a severe
impairment of the upper extremity
Used to indicate the nature of the
change in the respective body
structure:
0 no change in structure
1 total absence
2 partial absence
3 additional part
4 aberrant dimensions
5 discontinuity
6 deviating position
7 qualitative changes in
structure, including
accumulation of fluid
8 not specified
9 not applicable
Example: s730.32 to indicate the partial
absence of the upper extremity
Performance
Capacity
Generic qualifier
Generic qualifier
Problem in the person's current
environment
Limitation without assistance
Example: d5101.1_ to indicate mild
difficulty with bathing the whole body
with the use of assistive devices that
are available to the person in his or
her current environment
Environmental
Factors (e)
Generic qualifier, with negative and
positive scale, to denote extent of
barriers and facilitators respectively
Example: e130.2 to indicate that
products for education are a moderate
barrier. Conversely, e130+2 would
indicate that products for education
are a moderate facilitator
24
Example: d5101._2 to indicate
moderate difficulty with bathing the
whole body; implies that there is
moderate difficulty without the use of
assistive devices or personal help
None
ICF
Introduction
54th World Health Assembly endorsement of ICF for
international use
The resolution WHA54.21 reads as follows:
The Fifty-fourth World Health Assembly,
1.
ENDORSES the second edition of the International Classification of
Impairments, Disabilities and Handicaps (ICIDH), with the title International
Classification of Functioning, Disability and Health, henceforth referred to in
short as ICF;
2.
URGES Member States to use ICF in their research, surveillance and
reporting as appropriate, taking into account specific situations in Member States
and, in particular, in view of possible future revisions;
3.
REQUESTS the Director-General to provide support to Member States,
at their request, in making use of ICF.
25
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
1
Subcommittee on Populations
National Committee on Vital and Health Statistics (NCVHS)
CLASSIFYING AND REPORTING FUNCTIONAL STATUS
Information on functional status is becoming increasingly essential for fostering
healthy people and a healthy population. Achieving optimal health and well-being for
Americans requires an understanding across the life span of the effects of people’s
health conditions on their ability to do basic activities and participate in life situationsin other words, their functional status.
Some clinical professionals routinely use functional status information to care
for their patients, but the information is often missing from physicians’ notes for acute
hospital care and routine outpatient medical visits. And even when the information is
present in medical records, it only rarely becomes part of administrative records. This
prevents a host of possible beneficial uses of the information for management, research, public health, and policy purposes.
This report is the result of an 18-month-long review by the Subcommittee on
Populations of the National Committee on Vital and Health Statistics (NCVHS), concerning the feasibility of including functional status data in administrative records.
NCVHS advises the Department of Health and Human Services on national health information policy.1 The Populations Subcommittee consulted with 27 clinicians, researchers, and other data users from the U.S., Canada, and the World Health Organization at three NCVHS hearings in 2000. The presenters were unanimous in stressing
that health care and health policy must go beyond a narrow disease-based focus to a
broader approach that emphasizes people’s health and well-being, with a goal of
minimizing future loss of function.
This report has two major purposes: to put functional status solidly on the radar screens of those responsible for health information policy, and to begin laying the
groundwork for greater use of functional status information in and beyond clinical
care. It stems from the belief that while the International Classification of Diseases
(ICD) has served us well for more than a century in characterizing diagnoses, it is now
time to complement it with a parallel system for characterizing functional status.
The report begins by surveying the current and potential uses of functional
status information, and then discusses the importance of including this information in
clinical and administrative records to support optimal decision-making for health. The
World Health Organization’s newly-revised International Classification of Functioning,
Disability and Health (ICF) is described as a promising approach to coding functional
status information. The Committee believes that a coding system that specifies the
Further information about NCVHS and its work in areas related to this report is contained in
Appendix 5.
1
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
2
elements of functioning is an appropriate place to start dealing with the issues of
measurement and interpretation of functional status. Further, the Committee believes
that the ICF deserves careful study, under the direction of the Department of Health
and Human Services, as a potential codeset for reporting this information. The report
concludes with a series of recommendations on the ICF and related topics.2
FUNCTIONAL STATUS INFORMATION
Definitions
Functional status is variously defined in the health field, by clinicians with different emphases as well as in different policy contexts. This NCVHS project uses a
broad view of functional status that covers both the individual carrying out activities
of daily living and the individual participating in life situations and society. These two
broad areas include 1) basic physical and cognitive activities such as walking or
reaching, focusing attention, and communicating, as well as the routine activities of
daily living, including eating, bathing, dressing, transferring, and toileting; and 2) life
situations such as school or play for children and, for adults, work outside the home
or maintaining a household.
Functional limitations occur when a person’s capacity to carry out such activities or performance of such activities is compromised due to a health condition or injury and is not compensated by environmental factors (including physical, social, and
attitudinal factors). Functional status is affected by physical, developmental, behavioral, emotional, social, and environmental conditions. This conception encompasses
the whole person, as engaged in his or her physical and social environment. It applies
across the lifespan, although interpretation of functional status differs for different age
groups.
Current and Potential Uses of Functional Status Measurement
We must have a way to study our interventions in order to treat the right conditions at the right time and in the right manner.3
—
We waste a lot of time and an enormous amount of effort in the transition between
services [for children] because we don’t have a common language.4
—
Functional status is among the most predictive elements in terms of utilization as
well as outcomes.5
2Quotes used throughout this report were part of testimony given in the January, April, and
July 2000 Subcommittee hearings. All presenters are listed in Appendix 2.
3 Judy Hawley, P.T. (July)
4 Rune Simeonsson, M.D. (April)
5 Robert Kane, M.D. (January)
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
3
Functional status assessment is carried out through professional observation,
testing, and/or self-report by the patient or a proxy. Some functional status instruments are generic, such as the SF-36, while others are disease-specific, such as the
Activities of Daily Vision Scale. Instruments addressing the activities of daily living
(ADLs) include the Functional Independence Measure (FIM), the Minimum Data Set
(MDS), the MDS for Post-Acute Care (MDS-PAC), and the Outcome and Assessment
Information Set (OASIS). Hundreds of specialized instruments have been developed to
assist practice in such areas as geriatrics, psychiatry, and nursing practice.
The information generated by these assessments can be used not only in clinical care but also for health care management, quality assurance, public health planning and practice, policy development, and research. At present, the most developed
uses of the information are in clinical care; the others remain largely potentialities, to
be realized once a standardized way has been found to include the data in administrative records and related data sets.
The concept of functional status is integral to all health care and applies to
every person, regardless of age, physical or mental condition, or other characteristic.
Two individuals with the same diagnosisfor example, cerebral palsy, bipolar disorder, or arthritiscan have very different levels of functioning, and their actual health
status could be either better or worse than assumed. Even those who at certain times
in their lives have no functional limitations should have this information included in
their medical records at appropriate intervals along with other routinely-recorded
clinical findings, to complement the information on diagnosis and health condition.
Research is needed on such questions as frequency, coding, self-report and provider
assessment.
Functional status information is commonly used in rehabilitative medicine,
physical and occupational therapy, and nursing home and home care. The information
is used to guide therapy in areas such as hearing, speech, vision, cognition, and mobility. It also is used to design and coordinate services for children with special needs
and to monitor the well-being of people with various chronic conditions. Depending on
the person and condition, health care providers can use functional status information
to determine people’s needs, develop interventions to restore or maintain function or
prevent or minimize its decline, and prevent secondary disabilities. They also can
track changes and follow people across settings and monitor quality and outcomes.
Using functional status information, health care providers can help their patients
maximize their abilitiesarguably the purpose of all health care.
The Committee does not recommend imposing a single measurement instrument or methodology on clinical practice; rather, it recommends the use of a uniform
code set so that health care providers can consistently report on their findings across
the continuum of care, for clinical and administrative purposes. 6
A code set is any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes. The International Classification of Diseases and the National Drug Codes are examples of code sets.
6
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
4
Functional status information could serve the management needs of health
care providers and payers in such areas as financial management, utilization review
and quality assurance. The information is used, or could be used, to evaluate outcomes, compare treatment modalities, and predict costs. Knowing and tracking people’s functional status could help health care organizations predict service utilization
and resource use. The information is useful for risk adjustment and for documenting
medical necessity, both of which are needed for payment and other purposes. Payers
could use functional status information to adjust payment levels and capitation rates.
Eligibility determination for some public programs requires information on function.
Information in administrative records on people’s functional status and changes
in it over time could strengthen efforts to evaluate health care performance, compare
treatment modalities, and tie inputs to outcomes for quality assurance purposes.
Quality assurance activities often start with administrative data, which are more readily available than clinical data. Such assessments are of interest not only to public and
private payers, but also to policy makers, bodies such as the National Committee on
Quality Assurance, and health care providers themselves. The President’s Advisory
Commission on Consumer Protection and Quality explicitly discussed the importance
of functional status information in its 1998 report. HCFA, the largest public-sector
payer, is supporting several quality improvement initiatives in managed care and feefor-service environments. A major thrust is the development of standardized data collection and reporting tools to enhance the utility of regularly collected information, potentially including functional status information. Of course, functional status information could be used not only to assess quality of care but also to improve it, for the
reasons noted in the preceding section.
Functional status information could help public health practitioners monitor
and evaluate the health of the entire population and its component groups. Some of
the most compelling needs for the information relate to Healthy People 2010. The two
overarching goals for Healthy People 2010increasing quality and years of healthy life
and eliminating population health disparitiesdepend on functional status assessment. Also, the specific 2010 objectives for disabilities and secondary conditions (section 6) cannot be measured, much less met, without functional status information.
Many other objectives also require it. Currently, some state and federal surveys collect
this information on samples of the population, which can complement missing administrative data. The samples used in surveys do not have broad enough coverage, however, to give confidence that functional status within the population is accurately represented. A major contribution of surveys is to provide valid and reliable depth about
specific areas of functional status; administrative data are needed for breadth.
Several potential policy applications of functional status information have already been mentioned. These include helping decision-makers set research and policy
priorities, predict costs, prioritize federal, state and local health care and public health
initiatives, and develop programs for priority populations. Ongoing surveillance data
may be used to monitor changes and evaluate the effect of interventions.
Finally, researchers need functional status information not only to investigate
clinical subjects but also for research in the areas of health care management, public
health practice, and policy.
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
5
If we are going to assess characteristics of people, we want to know something
more about what is going to contribute to their health and well being. Knowledge
of limitations and personal activities will provide the most useful additional information for understanding the individual, as well as aggregated information describing health needs and possible resources required.7
—
We have to have a way to reduce the potential for future loss of function, particularly in the 10 or 15 percent of the population that use most of our health care dollars and are most vulnerable to loss of function.8
The Challenges of Measuring and Reporting Functional Status
Little attention is being paid to the cumulative impact of childhood impairment over
the lifetime…. So although it seems like these are very complicated issues, it is
very important that we deal with them, and that we include functioning.9
Although there is growing recognition of the importance of functional status information, assessment, measurement and interpretation still involve many challenges.
These include the existence of different conceptual bases as well as technical and
methodological problems with the tools themselves, lack of proper validation studies in
some cases, issues with how they are administered, complications stemming from the
multiplicity of tools, and a host of external issues related to institutional barriers, cost,
time constraints, training needs, and conceptual barriers.
Measuring functional status is particularly difficult with persons with cognitive
limitations, either because cognitive capacity has not yet developed (as in very young
children) or because it is impaired. The need to use proxies in these cases raises questions about the validity of the findings. In addition, it often is not possible to assess
children’s inherent capacity to do something because their physical and cognitive
skills are undeveloped. Children must be assessed in terms of both their current and
potential functioning in order to develop appropriate interventions. Pediatrician Ruth
Stein noted “four Ds of childhood” that distinguish children from adults and pose
challenges for interpreting functional differences: “developmental change, dependency
on parents and other adults, differential epidemiology, and difference in demographic
patterns.”10
As with all health information, privacy issues must be taken into consideration
in the disclosure and use of functional status information for people of all ages (although some experts view the privacy concerns in this area as no more serious than in
others). Another issue is that because functional status affects such things as disabilDonald Lollar, Ed.D. (January)
Gretchen Swanson, Ph.D. (January)
9 Ruth Stein, M.D. (January)
10 (January)
7
8
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
6
ity benefits and payment based on medical necessity, patients or proxies and providers
have a perverse incentive to modulate reporting, making measurement subject to conscious as well as unconscious bias.
In all, discussions during the NCVHS hearings made it abundantly clear that
the science of functional status measurement is still under development and that no
consensus yet exists on how to define and measure this complex phenomenon. At the
same time, it was also clear that dozens of workable generic and disease-specific instruments are available and in use, with many still undergoing further testing and yet
others being newly developed.
The Subcommittee concluded that reviewing functional status measurement
was beyond its scope and purview, except to note that much more work is needed in
developing suitable instruments for infants and children. The decision to focus on the
feasibility of incorporating functional status information into standardized clinical and
administrative records stemmed in part from the expectation that a uniform coding
instrument could mitigate some of the challenges related to functional status measurement, especially those related to the multiplicity of tools and definitions. Furthermore, by essentially defining concepts in operational terms, a code set makes it possible to deal with both measurement and interpretation issues more intelligently and
efficiently.
FUNCTIONAL STATUS IN ADMINISTRATIVE RECORDS
If the purpose of the health care claim is to submit information in order to be paid
appropriately for service rendered, [then] the more accurate the information, the
more appropriately the claim is paid. . . . If a physical therapist could code what
they are treatingfor instance, gait dysfunctionthe picture created for the insurance company would be more accurate and complete.11
The point has already been made that administrative data generally do not include information on functional status.12 The significance of this fact is that information on this dimension of healthincreasingly the sine qua non for understanding
healthis not available to the health care system (e.g., insurers and health plans), nor
to the researchers, public health workers, and policy makers who depend on administrative data. What is needed, therefore, is a standardized code set that will enable providers, with minimal burden, to include functional status information in administrative data. For this reason, the NCVHS Subcommittee on Populations focused its study
on the feasibility of including functional status information in administrative data, including a beginning look at how the information could be coded and transmitted.
11Judy
Hawley, P.T. (July)
The best-known exceptions to this rule are the Minimum Data Set (MDS), collected quarterly
in nursing homes; the Outcome and Assessment Information Set (OASIS), collected during
home health visits; and collection by rehabilitation hospitals using various approaches. Medicare requires the use of MDS and OASIS with Medicare beneficiaries, and includes this information in its administrative data. However, these “enriched” administrative data represent only
small, non-random populations, mostly seniors.
12
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
7
Administrative data are compiled from the enrollment process and health care
encounters. Resulting claims or encounter records are submitted by providers to payers and health plans so they can be reimbursed for their services (in non-capitated
programs) and service utilization and aspects of quality can be monitored. Thus, payment and financial management are the first order of business for administrative data.
They serve other equally important purposes, however. Administrative data complement surveys as an essential source of health statistics used to identify people with
potentially disabling conditions, monitor the population’s health, target interventions,
evaluate health care quality, predict costs, design and track the results of health policy, and conduct health services research.
Although they have many limitations, administrative data offer a number of important advantages. First, they already exist, are relatively inexpensive to acquire, and
are computer-readable. Second, they can include large groups of people, thus enhancing the utility of information for management purposes. Third, for some population
subgroups (primarily Medicare beneficiaries at present), longitudinal, person-level administrative databases can track study subjects over time and across settings of care.
And finally, the large number of cases in aggregated data bases helps hide individual
identities.
It must be acknowledged that a major problem with administrative data is that
with some exceptions, they exclude the uninsured. For those with administrative records, however, the chief limitations of current data stem from their reliance on diagnostic codes, which are regarded as having questionable accuracy, completeness,
clinical scope, and meaningfulness. Most diagnoses alone convey little about their effects on people’s daily activities or the impact of people’s social or physical environments. Diagnosis does not reveal or predict functionand function has an enormous
effect on utilization rates and is a good indicator of quality of care, among other
things.
Without functional status information, the researchers, policy makers, and others who are already using administrative data have at best a rough idea of how people,
individually and collectively, are doingand at worst they are making erroneous assumptions and decisions. The addition of this information would make administrative
records far more useful for the purposes for which they are already used, as well as for
the many other potential applications discussed above. For example, the information
is critically needed to support DHHS initiatives to design and modify prospective payment systems under Medicaid and Medicare. And Dr. Gregg Meyer, Director of the
Center for Quality Measurement and Improvement for the Agency for Healthcare Research and Quality, told the Committee in June 1999 that functional status information was one of his top “wishes” for administrative data for use in assessing quality of
care.
In short, the institutions responsible for payment, public health, and policy
need this information, along with information about diagnoses and health conditions,
to make the best possible decisions in their domains.
The passage of the Health Insurance Portability and Accountability Act (HIPAA)
in 1996 introduced another powerful vector into the dynamics of this issue. When the
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
8
first standards become mandatory in October 2002, providers will no longer contend
with dozens of different claim forms, definitions, and sets of instructions. National
standards are developed in consultation with Standards Development Organizations
(SDOs). By agreement with the federal government, recommended changes in claims
and transaction standards are the purview of Designated SDOs and Data Content
Committees, known collectively as Designated Standards Maintenance Organizations,
or DSMOs. The law’s administrative simplification provisions impose stringent requirements for changing or enhancing the standards, necessitating the support of the
healthcare industry based on a strong business case. However, they also represent active federal support for standardizing administrative data, code sets, and transactions.
There are other signs of growing interest in standardization. Of particular note
is a recent congressional requirement, enacted as part of the Medicare, Medicaid, and
SCHIP Benefits Improvement Act of 2000, calling for the HHS Secretary to submit to
several congressional committees by January 1, 2005 a report on the development of
standard instruments for the assessment of the health and functional status of beneficiaries for whom a wide array of Medicare services are provided. This legislative requirement was foreshadowed in January, 2000, when Sally Kaplan, Ph.D., of the
Medicare Payment Advisory Commission (MedPac) told the Subcommittee on Populations,
We strongly believe that it would be extremely useful, to say the least, to have
standardization of functional status measures at least in post-acute care so that
if similar patients are treated in different post-acute settings, or if patients are
treated in successive post-acute care settings, that we would have a means of
measuring them.... It would expand the utility of regularly collected information.13
Subsequently, in a March 2001 report to Congress, MedPac advised that HCFA have a
single tool for functional status measurement and reporting.
In sum, there seems to be considerable momentum toward standardizing definitions and terminology related to functional status so that it is possible to track people
across settings and to communicate across disciplines.
ICF: CANDIDATE FOR THE CODE SET
The ICIDH-2 provides a solid conceptual framework for clinical assessment and
provides strong support for all that we do as rehabilitation service providers, clinicians, researchers and teachers.14
Based on its extensive hearings and deliberations over a period of 18 months,
the Subcommittee on Populations concluded that a promising candidate as a code
setand the only viable one at presentis the International Classification of Func-
The National Committee had made similar observations in a July 3, 1997 letter to the HHS
Data Council (see NCVHS web site).
14 Gloriajean Wallace, Ph.D. (July)
13
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
9
tioning, Disability and Health (ICF15). This newly revised classification was created in
1980 (and then called the International Classification of Impairments, Disabilities, and
Handicaps, or ICIDH) by the World Health Organization (WHO) to provide a unifying
framework for classifying the consequences of disease. The classification complements
WHO’s International Classification of Diseases (ICD), which contains information on
diagnosis and health condition but not on functional status.
A Brief Description
The ICF provides a framework and classification scheme for describing a wide
range of information about health. It is structured around two broad components 
1) body functions and structure and 2) activities (related to tasks and actions by an
individual) and participation (involvement in a life situation)  with additional information on severity and environmental factors. Functioning and disability are viewed
as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by
this combination of factors and dimensions is of “the person in his or her world.” The
classification treats these dimensions as interactive and dynamic rather than linear or
static. It allows for an assessment of the degree of disability, although it is not a
measurement instrument. It is applicable to all people, whatever their health condition. The language of the ICF is neutral as to etiology, placing the emphasis on function rather than condition or disease. It also is carefully designed to be relevant across
cultures as well as age groups and genders, making it highly appropriate for the heterogeneous population of the United States. An example of the use of the ICF to classify a case study is contained in Appendix 4; a WHO description of the classification is
in Appendix 3.16
Many who spoke at the Subcommittee’s hearings described the conceptual
framework of the ICF as solid and useful. Some recommended that the classification
be piloted and further tested to determine its appropriateness as a standardized set for
coding functional status data. Others who testified said their organizations have already started to use it for this and other purposes (see examples below). On the
strength of these recommendations, the National Committee has concluded that the
ICF is worthy of consideration as a possible standardized format for coding functional
status information, following testing, piloting, and perhaps further modification.
Development of ICIDH/ICF
The exhaustive revision process that resulted in the ICF took nearly a decade
and involved comments from more than 80 countries and field tests in 42 countries,
as well as input from scientists, non-governmental organizations, and others. The process, which was explicitly guided by the needs of users, resulted in a version that was
approved by the WHO Executive Board in January 2001 and given final approval by
the World Health Assembly in May 2001.
Also sometimes called ICIDH-2.
This example captures all components of ICF, while routine collection of functional status in
administrative records might be more limited and focused on functional limitations.
15
16
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
10
The United States played a major role in the revision, which involved not only
federal agencies but also consumer advocacy groups, professional organizations, private sector disability insurance companies, and mental health and disability researchers. Early in the revision process, NCVHS hosted a hearing on the ICIDH in 1993,
hearing from consumer advocates, scientists, data users, clinicians, and administrators about their hopes for the revision process. All of these groups had further opportunities to provide input into the process. The WHO Collaborating Center for the Classification of Diseases for North America, housed at the National Center for Health
Statistics (and informally called the North American Collaborating Center), coordinated
the participation of the U.S. and Canada. Americans had leadership roles in the International Mental Health Task Force, which achieved one of the major changes in the
second edition, giving mental functioning parity with physical functioning. North
Americans also had leadership roles in the International Children’s Task Force and the
International Environmental Task Force.
The revised version, the ICF, is widely regarded as a significant conceptual and
practical advance over the first one, making it more flexible and useful. The revision
process also instituted a process for updating the classification. Dr. Raymond Seltser
has noted that the issues with ICIDH that were outlined by Dr. Saad Nagi in a 1991
Institute of Medicine Committee report do not apply to the ICF.17 Efforts were made to
make the ICF relevant to children, and the new version can be used to classify their
functioning. The International Children’s Task Force is working on a children’s version, which is expected in about two years.
Steps to advance the ICF and its use in the U.S. and abroad are being spearheaded by WHO and various stakeholders including the North American Collaborating
Center, HHS, and the following professional organizations: the American Speech, Language and Hearing Association; the American Occupational Therapy Association; and
the American Psychological Association (APA). A wide range of educational, training,
and pilot-testing efforts are also planned or underway. In addition to building awareness of the classification among clinicians, APA is working collaboratively with WHO,
other professional organizations, and business and government stakeholders to develop a standard functional assessment procedure manual based on the ICF. In another arena, the ICF was used as a conceptual base for the development of WHO’s
Disability Assessment Schedule II, in collaboration with three Institutes from the National Institutes of Health. It is now being used in national surveys in the U.S. as well
as in international studies.18
Saad Nagi, "Disability Concepts Revisited: Implications for Prevention," Appendix A of IOM’s
Disability in America (1991). Dr. Seltser’s comments were made at the July hearing.
18 More information on ICF is available on the WHO website, http://www.who.int/icidh
17
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
11
Comments on the Classification’s Merits and Drawbacks
[The ICF model] addresses the outcome measure of individual performance across
disciplines. This hasn't been done before in our medical system. It is also a model
which explicitly recognizes the contribution of the environment on the performance
of people who have disabilities, and we hope it will eliminate language barriers
between professions. As the pressure for accountability increases and the evidence of clinical effectiveness becomes a requirement for reimbursement, this
model may become a clear measure to determine if the appropriate clinical outcomes have been achieved. This model would help payers recognize the performance gains in therapy.19
The panelists in the April and July hearings offered opinions on the ICF that
ranged from qualified support tempered by caveats, on the one hand, to enthusiastic
endorsement and reports of arenas in which clinicians, educators, and researchers are
already using the classification, on the other. A few representative comments from the
July 2000 meeting, which was devoted to the ICF, are summarized below. (It is worth
noting that the classification has undergone significant additional development since
then.)
In the policy area, John Crews of the Centers for Disease Control and Prevention observed that the ICF creates a method for linking broad public policy (e.g., on
transportation and employment) with disability policy. Dr. Raymond Seltser of the
University of Pittsburgh stressed the unprecedented ability of the classification to
unify disparate fields, make encounter forms more meaningful, and enable the healthcare delivery system to help people maximize their abilities.
The American Psychological Association, which values the etiological neutrality
of the classification, believes the ICF would be an appropriate way to capture functional status information on health care claims and that this can be done in a relatively simple, methodologically sound manner. So reported Christopher McLaughlin of
APA.
Dr. Travis Threats of St. Louis University and the American Speech, Language,
and Hearing Association said the Schwab Rehabilitation Center, affiliated with the
University of Chicago Hospital, has adopted the ICF as a rehabilitation model.
Dr. Susan Stark of Washington University School of Medicine reported that the
American Occupational Therapy’s practice guide for occupational therapists uses the
ICF as a model for understanding the relationships between person, environment, and
outcome factors. AOTA views the classification as a “language neutralizer” that facilitates communication between disciplines. Dr. Stark cited institutions that are using
the ICF for education and training of OTs, and she stated that the classification can
guide assessment, help show clinical effectiveness, and track performance.
19
Susan Stark, Ph.D., OTR/L (July)
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
12
Judy Hawley, P.T., of the Minnesota chapter of the American Physical Therapy
Association (APTA) reported that this state chapter intends to incorporate the ICF into
the Minnesota Outcome Study and use it to capture activity and activity limitation.
The Minnesota chapter is not representative of the parent body, however. Dr.
Andrew Guccione of APTA expressed concerns about the validity of the ICF, particularly in the area of participation and the way it addresses the environment. Nevertheless, he noted the potential value of the classification for crosswalking to different assessments and for developing computerized documentation systems. Perhaps the
greatest concern of APTA is that the ICF is not compatible with the current requirements of insurance companies and payers.
Two other presenters, Michael Wolfson and Alexander Ruggieri, raised questions about the conceptual design as well as operational issues. Dr. Wolfson, who is
Assistant Chief Statistician at Statistics Canada and an active partner in the WHO
Collaborating Center for the Classification of Diseases for North America, discussed
many of the potential contributions of the ICF but also raised concerns about aspects
of its conceptual framework. He advised caution, pointing out that even unanimity on
the importance of functional status on the encounter form would not necessarily mean
that the ICF is the appropriate mechanism for it.
Dr. Ruggieri, of the Mayo Foundation, called the ICF “a promising conceptual
tool” but also noted the need for a rigorous modeling effort. In addition, he commented
on the problems in establishing any new data field on administrative forms. He called
for studies to evaluate how well the ICF serves informational needs in various clinical
settings before considering its appropriateness as a functional status data field on
health care claims.
During the July hearing, the Subcommittee also elicited comments on a possible process for achieving the inclusion of functional status information in clinical and
administrative records. Dr. Seltser commented on the change in thinking and practice
this calls for: “Something has to be done to reverse this situation where the physicians
don’t think functional assessment is important because the ICD is the driving force.
The disease model is being perpetuated by the encounter form.” He added, “The journey of 1,000 miles begins with a single step. And what you are asking us to consider
in terms of the incorporation of a functional assessment element into the encounter
forms, administrative records, is to me the first step in a journey of 1,000 miles.” On
testing the ICF as a tool for that purpose, Dr. Jayne Lux, a former WHO staff member,
took a similarly long-term view, saying that a pilot of coding functional status on administrative records using the ICF could roll out in “a couple of years.”
Several speakers at the hearings offered specific suggestions on strategy. Dr.
Seltser advocated raising awareness among those on the business side of health care
about the potential economic benefits of functional status information. Robert Griss
suggested the initiation of demonstration projects in managed care, and Dr. Wallace
stressed the importance of minimizing the burden of collecting and coding the information. Dr. Iezzoni advised that alliances be formed with the physician groups most
likely to be sympathetic, such as physical medicine, geriatrics, rheumatology, and pediatrics. Mr. McLaughlin described the collaborative process to which the American
Psychological Association has already committed considerable time and resources.
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
13
The net effect of this array of expert, experience-based observation, then, is not
only to affirm the critical uses of functional status information but also to portray the
ICF as a possible code set for including the information in standardized clinical and
administrative records. The National Committee believes the ICF is a worthwhile subject of rigorous examination and testing in this regard.
NCVHS RECOMMENDATIONS
The following NCVHS recommendations are intended to help bring about three
basic and necessary steps, which are likely to take several years: first, broad agreement on the importance of collecting functional status information; second, selection
of a code set for functional status data in standardized records, including electronic
patient records and claims and encounter records; and third, selection and testing of a
code set for these purposes. The Committee believes that the ICF should be evaluated
for use in coding functional status information in both electronic patient records and
administrative data. This research should begin as soon as possible, under the leadership of HHS, with the intention of readying a code set for use when broader agreement
has been reached that it is needed. More specifically, the Committee recommends the
following:
1. Functional status information is integral to understanding health and should be
included in patient records (computerized and otherwise) in the range of settings
where care is provided. (The Committee is not recommending any particular functional status measures or instruments.)
2. Because of its importance for both health practice and such policy-related functions as quality assurance and monitoring progress toward Healthy People 2010
objectives, functional status information should be reported at appropriate intervals in standardized data sets, as well as in computerized patient records.
3. The concepts and conceptual framework of the ICF have promise as a code set for
reporting functional status information in administrative records and computerized
medical records. In the Committee’s view, the ICF is the only existing classification
system that could be used to code functional status across the age span.
4. Before any recommendations are made about widespread implementation of the
ICF in administrative records and computerized medical records, thorough work is
needed by means of research, analysis, testing, and demonstration projects to examine issues such as the following:
•
the classification’s adequacy across the lifespan
•
where the gaps are in the testing of the ICF done to date
•
the feasibility of extracting functional status information from patient records in
different settings
•
the training required for personnel
•
the time required to ascertain and code functional status information
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
•
the cost of extracting functional status information
•
the appropriate interval at which to collect the information in medical records
•
the value of the resulting information
•
the reliability and validity of the information
14
5. Gaps in the availability of instruments for assessing functional status, appropriate
to the population as well as the clinical context, should be identified and addressed. The lack of accepted tools for measuring the functional status of children
is of particular concern.
6. Any special privacy issues surrounding collection and reporting of functional
status information need continuing review.
7. Efforts should be made to increase awareness of functional status assessment and
the ICF among policy makers, professional organizations, government organizations, researchers, and other relevant parties.
8. The Department of Health and Human Services is encouraged to take the lead in
the activities recommended above. In addition, HHS should provide resources
within the Department and to WHO to support work, nationally and internationally, on the classificationin particular, demonstration, testing, maintenance, and
updating.
9. The designated standards maintenance organizations (DSMOs) should be alerted
that NCVHS and the Department have a strong interest in the coding of functional
status information in administrative records and computerized medical records.
CONCLUSION
There are many signs that agreement is emerging on the importance of functional status information for the optimal carrying out of clinical care, public health
practice, policy, and administration. The next task is to find an effective way to get this
information into standardized records, and to evaluate the ICF as a possible mechanism for that purpose. The National Committee urges the Department of Health and
Human Services to exercise leadership in this effort and to give it the priority it deserves, in continued collaboration with the World Health Organization. The Committee
would welcome annual status reports from the Department on this project, beginning
in 2002. The standards community is encouraged to begin looking at this issue and
possible solutions. Finally, the Committee offers its advice and enthusiastic support
for all efforts aimed at enriching clinical and administrative data with functional
status information.
This report was written for NCVHS by Susan Baird Kanaan.
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
15
APPENDIX 1
References
Anderson, E. M., D. L. Patrick, W. B. Carter, and J. A. Malmgren. “Comparing the Performance
of Health Status Measures for Healthy Older Adults.” Journal of the American Geriatrics Society 43, no. 9 (1995): 1030-4.
Bindman, A. B., D. Keane, and N. Lurie. “Measuring Health Changes Among Severely Ill Patients. The Floor Phenomenon.” Medical Care 28, no. 12 (1990): 1142-52.
Calkins, D. R., L. V. Rubenstein, P. D. Cleary, A. R. Davies, A. M. Jette, A. Fink, J. Kosecoff, R.
T. Young, R. H. Brook, and T. L. Delbanco. “Failure of Physicians to Recognize Functional Disability in Ambulatory Patients.” Annals of Internal Medicine 114, no. 6 (1991): 451-54.
Heerkens, Y. F., C. D. Van Ravensberg and J. W. Brandsma. The Need for Revision of the
ICIDH: an example – problems in gait. Disability and Rehabilitation, 1995 (17: 184-94).
Iezzoni, L.I, Using Administrative Data to Study People with Disabilities, April 2001. Commissioned paper for the U.S. Agency for Healthcare Research and Quality.
International Classification of Functioning, Disability and Health, ICF. Geneva: World Health
Organization, 2001.
International Classification of Functioning and Disability, ICIDH-2. Beta-2 draft, Full Version.
Geneva: World Health Organization, 1999
MacFarlane, Alexander C. The International Classification of Impairments, Disabilities, and
Handicaps: its usefulness in classifying and understanding biopsychosocial phenomena. Australian and New Zealand Journal of Psychiatry, 1988 (22:31-42).
Mangione, C. M., R. S. Phillips, J. M. Seddon, M. G. Lawrence, E. F. Cook, R. Dailey, and L.
Goldman. “Development of the `Activities of Daily Vision Scale’: A Measure of Visual Functional Status.” Medical Care 30, no. 12 (1992): 1111-26.
McDowell, I., and C. Newell. Measuring Health: A Guide to Rating Scales and Questionnaires.
New York: Oxford University Press, 1987.
McHorney, C. A., J. E. Ware, Jr., J. F. Rachel Lu, and C. D. Sherbourne. “The MOS 36-Item
Short-Form Health Survey (SF-36): III. Tests of Data Quality, Scaling Assumptions, and Reliability Across Diverse Patient Groups.” Medical Care 32, no. 1 (1994): 40-66.
Pope, Andrew M. and Alvin R. Tarlov (eds.). Disability in America: Toward a National Agenda
for Prevention. Institute of Medicine, National Academy Press, Washington, D.C., 1991.
Rubenstein, L. V., D. R. Calkins, S. Greenfield, A. M. Jette, R. F. Meenan, M. A. Nevins, L. Z.
Rubenstein, J. H. Wasson, and M. E. Williams. “Health Status Assessment for Elderly Patients: Report of the Society of General Internal Medicine Task Force on Health Assessment.”
Journal of the American Geriatric Society 37, no. 6 (1988): 562-69.
Simeonsson, Rune J., Lollar, Donald, Hollowell, Joseph, and Mike Adams. Revision of the International Classification of Impairments, Disabilities, and Handicaps: Developmental Issues.
Journal of Clinical Epidemiology 53 (2000) 113-124.
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
16
Stein, Ruth E.K., Westbrook, Lauren E., and Laurie J. Bauman. The Questionnaire for Identifying Children with Chronic Conditions: A Measure Based on a Noncategorical Approach. Pediatrics, 1997, Vol. 99, No. 4. 513-521
Stewart, A. L., J. E. Ware, Jr., and R. H. Brook. “Advances in the Measurement of Functional
Status: Construction of Aggregate Indexes.” Medical Care 19, no. 5 (1981): 473-488.
Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD, McGlynn EA, and Ware JE
Jr. Functional status and well-being of patients with chronic conditions. Results from the
Medical Outcomes Study. JAMA 1989;262:907-13.
Stewart, A. L., and J. E. Ware, Jr., eds. Measuring Functioning and Well-Being: The Medical
Outcomes Approach. Durham, NC: Duke University Press, 1992.
Tilquin, C., P. Michelon, W. D’Hoore, C. Sicotte, E. Carillo and G. Leonard. Using the Handicap
Code of the ICIDH for Classifying Patients by Intensity of Nursing Care Requirements. Disability and Rehabilitation, 1995. (17:176-83).
Tinetti, M. E., T. F. Williams, and R. Mayewski. “Fall Risk Index for Elderly Patients Based on
Number of Chronic Disabilities.” American Journal of Medicine 80, no. 3 (1986): 429-34.
Ware, J. E., Jr. “Conceptualizing and Measuring Generic Health Outcomes.” Cancer 67, no. 3
(Suppl) (1991): 774-779.
Weinberger, M., E. Z. Oddone, G. P. Samsa, and P. B. Landsman. “Are Health-Related Qualityof-Life Measures Affected by the Mode of Administration?” Journal of Clinical Epidemiology 49,
no. 2 (1996): 135-140.
Young, N. L., J. I. Williams, K. K. Yoshida, C. Bombardier, and J. G. Wright. “The Context of
Measuring Disability: Does It Matter Whether Capability or Performance Is Measured?” Journal of Clinical Epidemiology 49, no. 10 (1996): 1097-101.
http://www.who.int/icidh
http://aspe.os.dhhs.gov/admnsimp
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
APPENDIX 2
Hearing Participants and Agendas
JANUARY 24, 2000 (Chair: Lisa Iezzoni, M.D., M.S.)
Overview of Functional Assessment and Health Status: Issue Identification
Robert L. Kane, M.D., University of Minnesota
William Braithwaite, M.D., ASPE
Functional Assessment and Health Status: Lessons Learned
Donald Lollar, Ed.D., CDC
Nancy Whitelaw, Ph.D., National Council on the Aging
Functional Assessment: Risk Adjustment and Rehabilitation Focus
Gretchen Swanson, Ph.D., Western University of Health Sciences
Dr. Jinnet Fowles, HealthSystem, Minnesota
Dr. Margaret Stineman, University of Pennsylvania
Functional Assessment: Selected Focus Areas
Ruth Stein, M.D., Albert Einstein College of Medicine
Dr. Alice Kroliczak, HRSA
Dr. Sally Kaplan, Medicare Payment Advisory Commission
APRIL 13, 2000 (Chair: Lisa Iezzoni, M.D., M.S.)
Proxy, Disability, and ICIDH:
Donald Lollar, Ed.D., CDC
Michele Adler, SSA
Overview of ICIDH
Gerry Hendershot, Ph.D., NCHS
Functional Assessment and ICIDH
Margo Holm, University of Pittsburgh
Rune Simeonsson, M.D., University of North Carolina
Allan Meyers, Boston University
NHIS: Functional Assessment
Jennifer Madans, Ph.D., NCHS
Else Pamuk, NCHS
Recap of the Day and Discussion
17
National Committee on Vital and Health Statistics: Classifying and Reporting Functional Status
JULY 17, 2000 (Chair: Lisa Iezzoni, M.D., M.S.)
International Standards and Applications
Michael Wolfson, Ph.D., Statistics Canada
Jayne Lux, M.S., CCC/SLP, former World Health Organization
Yerker Andersson, Ph.D., National Council on Disability
ICIDH-2 Training and Testing Activities
Gerry Hendershot, Ph.D., NCHS
Paul Placek, Ph.D., NCHS
Judy Hawley, P.T., Minnesota APTA
Gloriajean Wallace, Ph.D., University of Cincinnati
Considerations in Possible Uses of ICIDH-2
Nora Wells, MSED, Family Voices
Robert Griss, Center on Disability and Health
John Crews, DPA, CDC
Raymond Seltser, M.D., M.P.H. University of Pittsburgh
ICIDH-2 Revision and Applications
T. Bedirhan Ustun, M.D., World Health Organization
Logistical Considerations in Applications of ICIDH-2
Christopher McLaughlin, American Psychological Association
Travis Threats, Ph.D., Saint Louis University
Andrew Guccione, P.T., Ph.D., FAPTA American Physical Therapy Association
Susy Stark, Ph.D., ORT/L Washington University School of Medicine (AOTA)
Conceptual Clarity and Comparable Measures
Alexander P. Ruggieri, M.D., Mayo Foundation
Elena Andresen, Ph.D., Saint Louis University School of Public Health
18
APPENDIX J: GUIDELINES FOR GRADUATE STUDENTS
REQUIREMENTS AND PROCEDURES FOR GRADUATE STUDY (M.A.) in SPEECH-LANGUAGE
PATHOLOGY
General Requirements
1. Admission to the School of Graduate Studies requires an application for admission, three letters of
reference, and transcripts from all university or colleges previously attended. See the CWRU
General Bulletin and the departmental website for procedures and further details.
2. Students are responsible for observing the University’s “Academic Regulations” for graduate study
as printed in the CWRU General Bulletin, as well as the Department requirements and procedures
as outlined in this document. Students have the right to petition in writing for exceptions to these
regulations and requirements. In such cases students should consult their advisors.
3. Any deviations from Departmental graduate requirements (e.g., waiving COSI 497) need written
approval from the advisor and the Department Chair. The student will petition in writing the
requested change and secure the signatures of the advisor and the chair as documentation of
approval.
Master of Arts in Speech-Language Pathology
1. Program Objectives:
The degree of Master of Arts in the Department of Communication Sciences requires that the student
demonstrate: 1) knowledge of the basic anatomic/physiologic, physical/psychophysical, and
linguistic/psycholinguistic processes involved in speech, language, and hearing, 2) comprehensive
knowledge of disordered communication, 3) the ability to appropriately evaluate and establish treatment
goals for persons with communication impairments, 4) appropriate intervention skills with children and
adults with communication impairments, and 5) knowledge of research methodology employed in
communication sciences and disorders
2. Advisors and Registration:
a. Each student is assigned to an advisor upon entry into the program. After the orientation in the
first semester and at the time of registration for each subsequent semester, the student must meet
with the advisor.
b. A student may request a change of advisor during the course of study. This change must be
approved by the Department Chair. A “Change of Advisor” form is available in the Department
Office.
3. Program of Study:
a. Two plans of study are possible: Plan A-M.A. with a thesis based on individual research and a
final oral examination. Plan B-M.A. without a thesis but requiring a comprehensive examination.
b. Plan A: The M.A. Thesis
The decision to undertake a thesis must be carefully weighed. Any student who intends to pursue
a doctoral degree should consider Plan A. The student and the advisor must consider such
factors as background, clinical needs, general resources, ability, and time constraints.
Students selecting Plan A must take a minimum of six hours of thesis research (COSI 651). For
further details concerning thesis requirements and procedures, consult the CWRU General
Bulletin and the Department's Master’s Thesis Regulations, included at the end of this document.
Plan A requires 30 hours of coursework plus 6 hours of thesis credit or 27 hours and 9 hours of
thesis credit). This represents an additional nine semester hours of coursework beyond the
minimum of twenty-seven semester hours set forth by the School of Graduate Studies. No more
than 9 hours of thesis credit may count towards graduate credit for graduation. Once registered for
thesis credit, the student must register for thesis credit in each succeeding regular semester until
the thesis examination occurs. At least 30 semester hours of coursework, including thesis, must
be at the 400 level or higher. The written thesis must conform to regulations concerning format,
quality, and time of submission as established by the Dean of Graduate Studies. Detailed
instructions can be obtained from the Office of Graduate Studies. For completion of the master’s
degree under Plan A, an oral examination (defense) of the master’s thesis is required. This
examination is conducted by a committee of at least three members of the University faculty. The
candidate’s thesis adviser customarily serves as the chair of the examining committee. The other
members of the committee are appointed by the Department Chair or curricular program faculty
supervising the candidate’s course of study.
c.
Plan B: Requires 36 semester hours beyond the undergraduate degree. This represents an
additional nine semester hours beyond the minimum of twenty-seven semester hours set forth by
the School of Graduate Studies. At least 30 semester hours must be at the 400 level or higher.
Each candidate for the master’s degree under Plan B must pass satisfactorily a comprehensive
examination. The examination may be written or oral or both. A student must be registered
during the semester in which any part of the comprehensive examination is taken. If not
registered for other courses, the student will be required to register for one semester hour of
EXAM 600, Comprehensive Examination, before taking the examination.
d. The program of study the student pursues will be determined in part by the student's
undergraduate background and his academic and career goals. The program of study must,
however, include a minimum of four semesters (four credits) of COSI 452 (A, B, C, E, or D)
GRADUATE PRACTICUM and COSI 497 METHODS OF RESEARCH. The latter requirement
may be modified for students who enter the program with two or more research/statistics courses.
The student should submit a petition in writing to the chair, with the approval of the advisor.
e. As a program accredited by the Council on Academic Accreditation of the American SpeechLanguage-Hearing Association, Case's M.A. degree in speech-language pathology fulfills the
academic requirements for the Certificate of Clinical Competence. ASHA requirements are
detailed in the Requirements for the Certificate of Clinical Competence which is available on the
ASHA website (www.asha.org). In addition, completion of the M.A. degree requirements meets
some of the requirements for state licensure in Ohio. For the student desiring Ohio Teacher
Licensure, the program of study must also meet the requirements for Ohio Teacher Licensure.
f.
Whereas deficiencies in background subject matter or skills will not prevent acceptance into the
graduate program, students accepted under these circumstances will be required to make up
deficiencies in a manner approved by the advisor and the Department Chair. Students entering
without an undergraduate major in communication disorders will be required to take the essential
undergraduate coursework in communication sciences and disorders (up to 18 hours of
coursework). Students entering with an undergraduate major in communication disorders, but
with deficiencies in their undergraduate program, will be required to make up the appropriate
coursework. When a student is required to take courses at the undergraduate level, credits
earned at the 300 level or below may not apply toward the 36 hours required under either Plan A
or Plan B as described in this document.
g. During the first semester of study, each student will, in consultation with his/her advisor, prepare a
plan of study that will be used as the guideline for subsequent registration. Students will not be
permitted to register for subsequent semesters until the proposed program has been approved by
the advisor and Department Chair. Any changes made to the plan of study will require a
resubmission of the corrected document to the advisor, department chair and student file. The
final plan of study is submitted to the graduate school in the semester of graduation.
4. Academic Progression
a. University Standards for the Maintenance of Good Standing (General Bulletin 1998-2000)
A student will be subject to separation from the university for any of the following reasons.
1) Failure to achieve a quality-point average of 2.5 or higher at the completion of 12
semester hours or 2 semesters of graduate study.
2) Failure to achieve a quality-average of 2.75 or higher at the completion of 21
semester hours or 4 semesters of graduate study.
3) Failure to receive a grade of S in thesis research 651 or dissertation research. A
student who receives a grade of U in thesis or dissertation research will be placed
on probation and be subject to separation. The probationary status will be
recorded on the student's transcript. The student must be removed from probation
by the end of the semester immediately following receipt of the grade of U by
repeating the course for the same number of credit hours, and achieving a grade
of S. Although removal from probation restores the student's good standing, the
grade of U received will not be canceled or substituted by the grade of S
subsequently received. Separation will occur if the student placed on probation
receives another grade of U in the following semester; or, if the Dean of Graduate
Studies, in consultation with the academic unit, determines that the student is
unlikely to be successful in working independently and productively toward the
completion of the thesis or dissertation research.
4) Failure of a provisionally admitted student to satisfy the provisions stated in the
letter of acceptance by the end of the first academic year (2 semesters) or after
18 credits of coursework.
5) Failure to make progress towards degree completion. If the student is not making
progress towards degree completion, and it has been judged that the student is
unlikely to be successful in working independently and productively toward the
completion of the thesis, the department and/or the Dean of Graduate Studies (in
consultation with the department) can recommend academic separation.
6) In addition to disciplinary actions based on academic standards, on
recommendation of the student's department or school, the Dean of Graduate
Studies can suspend or separate a student from the university for failure to
maintain appropriate standards of conduct and integrity. Such a suspension or
separation will be implemented only for serious breaches of conduct that threaten
to compromise the standards of a department or create concern for the safety and
welfare of others. In the event of such suspension or separation, the student will
be entitled to an appeal through the grievance procedure of the Graduate School.
b.University Standards for the Maintenance of Quality Point Average (General Bulletin 19982000):
In calculating the quality-point average, courses taken as a student in the School of
Graduate Studies at the 400 level and above, as well as any courses accepted toward
fulfillment of degree requirements for which quality points are given, will be counted,
including courses which may need to be repeated. Unless otherwise stated by the
department a minimum cumulative quality-point average of 2.75 is required for the
award of the Master's degree. Any department, school, or curricular program
committee may choose to establish quality standards higher than those stated above if
such additional requirements are made known in writing to the students upon
matriculation, and are recorded with the Dean of Graduate Studies. In that case, the
departmental standards supersede the minimum standards.
c. Departmental Standards for Good Standing and Quality-Point Average to Supercede
Above:
For item 4.a.1 and 4.a.2 above, departmental standards read:
(1) Failure to achieve a quality-point average of 3.0 or higher at the completion of 12
semester hours or 2 semesters of graduate study will result in separation from the
university. Students must maintain a 3.0 quality-point average during succeeding
semesters of enrollment. If a student’s quality-point average falls below a 3.0 in any
succeeding semester, the student will be separated from the university.
For item 4.b. above, departmental standards read:
Only 400 level courses and above or lower level courses approved to meet the M.A. semester hours
requirement will be used to calculate the quality-point average.
5. Clinical Requirements in Speech-Language Pathology and Audiology:
a. The M.A. degree program is designed to provide the student with clinical experience to meet the
practicum requirements for American Speech-Language-Hearing Association Certificate of Clinical
Competence, state licensure, and teacher licensure. The Coordinator of Clinical Education works
with each student in designing an appropriate semester-by-semester clinical program. It is the
student’s responsibility to maintain contact with the Coordinator of Clinical Education to implement
this program. Students must maintain a grade point average of 3.0 or greater to participate in
clinical practicum.
b. The M.A. in speech-language pathology reflects clinical as well as academic competence. The
Department reserves the right to place a student on clinical probation or discontinue the student’s
clinical practicum if clinical performance is judged as unacceptable. Students whose clinical
performance is not acceptable will not be permitted to continue in clinical practicum. Appropriate
notation of this will be entered on the student’s records and cited on any recommendation required
from the Department.
c. Further information concerning clinical requirements and procedures is detailed in the
Department’s Clinical Handbook.
6. Comprehensive Examinations:
a. Students who choose Plan B (non-thesis option) are required to take a comprehensive
examination.
b. Written comprehensive examinations are administered to assess the student’s mastery of the field
of speech-language pathology and audiology. The written examination may be followed by a
one-hour oral examination in the weeks after the written examination.
c. Written comprehensive examination dates are scheduled and posted by the Department during
the fall and spring semesters. At least two weeks prior to the scheduled date, the student must
petition to take the examination. The form for this petition is available in the Department Office.
The petition must be approved by the advisor and Department Chair.
d. The written comprehensive exam is a departmental exam and the content encompasses all
aspects of the field of study. Written comprehensive exams are not individualized or limited to a
student’s plan of study.
e. Written answers will be graded by the faculty. Written feedback is generated and distributed to all
students participating in comprehensive exams that semester. Grades are given for each
question based on the following criteria:
A (4.0)= Addresses critical aspects of the question. Shows clear understanding of the
question and topic.
B (3.0)= Demonstrates understanding of key concepts. Not all supporting information is
included.
C (2.0)= Demonstrates understanding of some key concepts. Lacks information or
includes incorrect information.
F (0.0)= Unacceptable. Failure to address the question. Seriously deficient in content.
(1) To pass the written comprehensive exam a student must have a 3.0 average across all
questions, with no F grades from any reviewer.
(2) If a student does not meet the requirement in (1), he or she must develop a written remediation
plan, which must be approved by the Department Chair. The student and advisor will meet to
develop the plan.
(3) If the student fails two (2) written questions (receives an average grade of F for those
questions), the remediation plan will include a re-write of the entire comprehensive examination
within the same semester or the following semester. If the student does not fail two (2) written
questions, but fails to achieve a 3.0 average, the remediation plan will include a re-writing effort
that may include multiple questions.
(4) Re-written questions will be re-graded. The student's final examination grade will be calculated
from the re-written questions and the initial attempt on all questions that were not re-written.
(5) If a student fails to achieve a 3.0 average on the written comprehensive examination after rewriting, he or she will be required to complete an oral examination in addition to other elements of
the remediation plan developed by his or her advisor and the Department Chair.
(6) The oral examination will take place the same semester as the written comprehensive
examination or the following semester. The oral examining committee will be composed of the
student's advisor and two other faculty members.
(7) If the student fails to meet the requirements of the remediation plan, including passing the oral
examination, he or she will be separated from the University.
7. Application for the Degree:
An application for the degree must be filed with the Dean of Graduate Studies no less than two
months before the desired commencement date. Application forms are available in the Office of the Dean
of Graduate Studies.
MASTER’S DEGREE IN SPEECH-LANGUAGE PATHOLOGY: SEQUENCE OF COURSES
Minimum number of credits required for the degree is 36 credit hours. All students are required to take COSI 497: Methods of Research and 4
credit hours of COSI 452: Graduate Clinical Practicum. Students typically take three 3-credit hour courses per semester and 1 credit hour of COSI
452: Graduate Clinical Practicum (10 hours total). Coursework is chosen in consultation with the student’s academic advisor.
Second Year
First Year
Fall Semester*
COSI 405
Neuroscience of Communication and
Communication Disorders (3)
COSI 452
Graduate Clinical Practicum (1)
COSI 453
Articulation & Phonology Disorders (3)
COSI 497
Research Methods (3)
**Based on the student’s undergraduate record, the following courses
may be suggested:
COSI 211
Phonetics and Phonology (3)
COSI 325
Anatomy & Physiology of Speech and Hearing (3)
COSI 352
Introduction to Clinical Practice (3)
COSI 413
Language Development (3)
COSI 470
Introduction to Audiology (3)
Spring Semester**
COSI 452
Graduate Clinical Practicum (1)
COSI 456
Child Language Disorders (3)
COSI 557
Acquired Adult Language & Cognitive Disorders (3)
COSI 561
Medical Aspects II: Neuromotor & Craniofacial
Anomolies (3)
COSI 562
Medical Aspects III: Dysphagia (2)|
*Based on the student’s undergraduate record, the following course
may be suggested:
COSI 321
Speech and Hearing Sciences (3)
Summer Semester
COSI 452
Graduate Clinical Practicum (1)
COSI 455
Fluency Disorders (3)
COSI 600
Special Topics: Augmentative & Alternative
Communication (3)
OR
COSI 600
Special Topics: Intervention & Assessment: Birth-3
(3)
Fall Semester
COSI 452
COSI 463
(3)
COSI 464
COSI 560
Graduate Clinical Practicum (1)
Speech & Language Therapy in Educational Settings
Diagnosis of Speech & Language Disorders (3)
Medical Aspects I: Voice Disorders (3)
Spring Semester
COSI 452 Graduate Clinical Practicum (1)
COSI 580 Aural Rehabilitation (3)
MASTER’S THESIS REGULATIONS
Plan A
For Master's Plan A, the student must complete either 6 credit hours of thesis research (COSI 651), and 30 semester
hours of additional coursework at the 400 level or higher, or, alternatively, 9 credit hours of thesis research and 27
semester hours of coursework at the 400-level or higher.
The student’s advisor, in consultation with the student and with the approval of the graduate committee of the
department will form a thesis committee. The thesis committee will consist of at least three faculty members from the
department, at least one of whom must be a member of the regular faculty as defined by the College of Arts and
Sciences.
The student must submit a written plan for the thesis to this committee, for its approval prior to initiating the research.
This plan should include a brief literature review and rationale for the study, a proposed research method, a proposed
timeline for steps involved in the research, and a brief discussion of expected results and their potential significance.
The student will present the thesis information in two forums: 1) an informal discussion with peers and members of
his/her committee prior to initiating the thesis research, to obtain feedback and direction; and 2) a formal presentation
of the thesis research to faculty and students. The precise format of the formal presentation will depend on the nature
of the research (e.g., oral presentations, computer demonstrations of software, etc.). The presentation may be a
work-in-progress colloquium to report preliminary findings and generate discussion, or may be a presentation of final
results. If the formal presentation is a presentation of final results, it may serve as the public oral presentation of the
thesis defense (see below).
The student must prepare a thesis describing the research and its significance and submit to an oral defense of the
thesis. This will include a brief (approximately 20 minute) public oral presentation, followed by examination by the
committee. The examination will be open to all members of the faculty but will be otherwise closed. Only members of
the thesis committee will vote on whether the thesis and its defense satisfy the requirements of the Department and
the School o f Graduate Studies for the M.A. degree. If the student presents a colloquium at the conclusion of his/her
research, this may serve as the oral presentation component of the defense.
The student must submit an Application to Graduate to the School of Graduate Studies in the semester in which he or
she plans to graduate, and file two copies of the thesis according to the dates and guidelines of the School of
Graduate Studies.
GUIDE FOR GRADUATE STUDENT ADVISING
Student: _________
_______________
Advisor: _______
____
FIRST SEMESTER
Initial advising meeting with student
Date: __________
_____ a. Review transcript with student. Identify ASHA requirements which have been met and ASHA
requirements which will need to be met during grad program (complete Part I of Academic Advising
Worksheet)
_____ b. Talk to the student about the thesis/nonthesis option
_____ c. Identify courses student should be enrolled in for first semester and complete course registration
form with student
Second advising meeting with student (after midterm)
Date: ___________
_____ a. Meet with student to check on how they are doing in current coursework
_____ b. Map out sequence of coursework for graduate program with student (Part II of the Academic
Advising Worksheet)
_____ c. Advisor files copy of Academic Advising Worksheet in student’s permanent file
_____ d. Advise student on courses for 2nd semester and complete/sign registration form
_____ e. Discuss the purpose of the Plan of Study and refer student to the plan of study examples in
graduate student manual. Tell student to complete the plan of study by the first week of second
semester.
NOTES:
SECOND SEMESTER
Creating the Plan of Study
_____ a. Review rough draft of Plan of Study completed by student. Check to be sure that courses are
placed under the appropriate category, that course numbers and titles are listed as they appear on
transcripts, and that student meets all minimal requirements set by ASHA and CWRU
_____ b. Do a final check on plan of study, sign it, and turn in to department chair for final review.
_____ c. Department Chair reviews plan and either approves it or sends it back to the advisor for
modification
Filing the Plan of Study
_____ a. When department Chair approves Plan, it is given to the Department Assistant
_____ b. Department Assistant will make copies of the Plan of Study and will distribute them to the following:
student; advisor; student file; and the graduate school
_____ c. Advisor checks to ensure that Plan of Study has been filed. Date: ________
Academic advising
_____ a. Ensure that student knows options for summer courses
_____ b. Check on status of completing ASHA requirements (i.e., math, UG leveling)
_____ c. Check on student’s performance after midterms
_____ d. At end of semester review courses recommended for third semester & sign registration form.
Preparation for comprehensive exams (does not apply to student’s doing thesis)
_____ a. Talk to student about organizing class notes/references into subject areas in preparation for
comprehensive exam process
_____ b. Discuss timeline of comprehensive examination and begin addressing strategies that need to be
acquired by the student to maximize their effectiveness in comps.
Preparation for thesis (does not apply to students doing comps)
_____ a. Faculty member agrees to be chair of student’s thesis.
_____ b. Student identifies a potential topic area and begins to review literature and develop possible
question, and procedures under guidance of faculty member.
_____ c. Timeline for completion of project reviewed between thesis advisor and student.
_____ d. Faculty expectations defined (e.g., publication; student independence)
NOTES:
THIRD SEMESTER
Academic Advising
_____ a. Sign registration for third semester enrollment or distribute PIN #.
_____ b. Check on status of student performance after midterms
_____ c. At end of semester, review courses recommended for fourth semester and sign registration form.
_____ d. Final check by advisor to insure that all COSI and ASHA academic requirements will be met within
expected time frame.
Comprehensive examination preparation
Date: ______________
_____ a. Describe comprehensive examination process including the following:
______ 1. Purpose of the comprehensive examination process
______ 2. Written comprehensive exam format
______ 3. Discuss performance expectations on comps
______ 5. Recommended strategies for studying for comprehensive exams
______ 6. Discuss timeline for doing comps (consider student’s courseload, time
for preparing for comps; strengths/weaknesses in completing comp format questions)
______ 7. Complete practice questions and obtain feedback from faculty member on practice questions
Thesis
_____ a. Thesis committee identified and agreed upon (by members)
_____ b. Thesis prospectus prepared and given to committee members
_____ c. Prospectus meeting held and input provided
_____ d. Prospectus procedures approved by the committee
_____ e. Human Subjects Approval form submitted (may be done before prospectus meeting if approved by
advisor)
_____ f. Data collection
NOTES:
FOURTH SEMESTER
File Check
_____ a. Department Assistant reviews student’s folder to ensure that all paperwork for academic
requirements is documented in permanent file and organized correctly (see check sheet
in front of student’s file).
_____ b. Student is notified in writing of any deficiencies in the file with a copy of the notification
placed in student’s file.
Pre-requisite to comprehensive examination
_____ a. Student completes “Request for Examination” form and brings to advisor to sign.
_____ b. Student files paperwork with graduate office.
_____ c. Student reminded to meet with the Coordinator of Clinical Education to ensure that all
clinical requirements will be met.
Comprehensive examination
_____ a. Student completes written examination.
_____ b. Department Assistant distributes copies to exam graders.
_____ c. Within one week, exams are graded and general feedback is distributed.
_____ d. Advisor meets with student to convey written exam results and recommendations.
Thesis
_____ a. Data analysis completed and checked by thesis chair
_____ b. Student submits written drafts to thesis chair for approval
_____ c. When thesis is approved by advisor, submits copies to committee members.
_____ d. Date set for oral defense of thesis
_____ e. Oral defense held
_____ 1. Student brings yellow cards to meeting
_____ 2. Department Assistant gives advisor the Request for Exam form
_____ 3 . When final form of thesis is approved by committee members, paperwork is
signed and returned to the office manager by the thesis advisor.
_____ 4. Department Assistant files paperwork in student file and with graduate office
_____ f. Student provides department with copy of approved thesis
_____ g. Student submits appropriate paperwork/thesis to graduate school
NOTES:
FINAL CHECK-OUT PROCEDURES
Students should make an appointment to complete checks with Coordinator of Clinical
Education. Students should allow 10 working days for completion of all paperwork items
within the COSI department.
______ 1. Completes final check on clinic hours with Coordinator of Clinical Education
______ 2. Makes at least two copies of clinic hours to be retained by the student after Department
chair re-checks and signs hours
______ 3. Department Assistant notarizes final copies of hour sheets (originals retained in COSI file;
student takes 2 copies)
______ 4. Coordinator of Clinical Education completes clinical sections of ASHA checklist
______ 5. Office Manager does final check on student’s permanent file to ensure that it is
complete. Date: ________________
______ 6. Chair of Department completes ASHA paperwork documenting student’s completion of
ASHA requirements for CFY application (and licensure, if appropriate).
MASTER OF ARTS IN SPEECH-LANGUAGE PATHOLOGY: ASHA CERTIFICATION WORKSHEET
Name
Advisor
Dated
75 semester credit hours in Academic Coursework-MINIMUM*
27 semester credits-BASIC SCIENCE COURSEWORK-MIN*
36 semester credits-PROFESSIONAL COURSEWORK-MIN*
30 semester cr-Graduate
21 semester cr-Professional Area
6 credits
Biological/
Physical
Sciences: 1
course
Math: 1
course
6 credits
Behavioral and/or
Social Sciences
COSI 109 Introduction
to Communication
Disorders (3) F/S
COSI 220 Introduction
to American Sign
Language I (3) F/S
COSI 260 Multicultural
Aspects of Human
Communication (3) F
15 credits
Basic Communication Processes
Linguistic &
Physical
Anatomic
Psycholinguistic
PsychoPhysiologic
Physical
1 course in each area-minimum
COSI 211
COSI 321
COSI 405
Phonetics &
Speech &
Neuroscience of
Phonology (3) F
Hearing
Communication
Science (3) S
Disorders (3) F
COSI 313
Language
Development (3) F
6 credits
Audiology
3 credits
3 credits Hearing
Habilitation &
Disorders &
Rehabilitation
Evaluation
Procedures
COSI 3/470
Introduction to
Audiology (3) F
COSI 580 Aural
Rehabilitation (3)
S
6 credits Language
Disorders
6 credits Speech
Disorders
COSI 445
Communication & Aging
(3) S
COSI 453
Articulation &
Phonology (3) F
COSI 456 Child
Language Disorders (3) S
COSI 455 Fluency
Disorders (3) Su
COSI 464 Case Studies:
Diagnosis & Treatment
(3) F
COSI 560
Neuromotor &
Craniofacial
Anomolies (3) S
COSI 557 Acquired Adult
Language Disorders (3) S
COSI 600 Intervention &
Assessment Birth-3 (1-3)
Su
COSI 561 Voice
Disorders (3) F
COSI 562 Dysphagia
(2) S
COSI 600 Augmentative
& Alternative Comm (1-3)
Su
* A MINIMUM of 6 semester credits of practicum may be applied to the 36 semester credits MINIMUM Professional Coursework, but PRACTICUM MAY NOT BE USED TO
SATISFY minimum requirements in AUDIOLOGY or LANGUAGE or SPEECH
OTHER:
COSI 352 Introduction to Clinical Practice (3) F
COSI 463 SLP in Educational Settings (3) F
COSI 600 Counseling (1) Su
COSI 452 Graduate Clinical Practicum A-E (1) F/S/Su
COSI 497 Methods of Research (3) F
KNOWLEDGE AND SKILLS ACQUISITION (KASA)
SUMMARY FORM FOR
CERTIFICATION IN SPEECH-LANGUAGE PATHOLOGY
Knowledge and Skills Acquisition (KASA) Summary Form
For Certification in Speech-Language Pathology
March, 2003
KNOWLEDGE AND SKILLS ACQUISITION (KASA)
SUMMARY FORM FOR
SPEECH-LANGUAGE PATHOLOGY
Instructions for Use
The Knowledge and Skills Acquisition (KASA) form summarizes a student's acquisition of the knowledge and skills delineated in the Standards for
the Certificate of Clinical Competence (SCCC). Entries are made only upon acquisition of the knowledge or skill; thus the KASA is not an evaluation,
but only a record that a particular knowledge or skill has been acquired.
Required Documentation
1. Students from CAA-accredited programs (Refer to "Automatic Approval" language in Standard I. Degree) must submit the "Verification by Program
Director" page of the KASA when applying for certification.
2. All other applicants must submit the entire, completed document, including the "Verification by Program Director" page when applying for
certification.
Use of the KASA Form
1. The CFCC encourages programs to use the KASA to demonstrate compliance with accreditation standards related to preparing students to meet
ASHA certification requirements. However, programs may develop other documents to verify student's acquisition of knowledge and skills.
2. For students who must submit the entire KASA, and for academic programs wishing to use the KASA as a tracking document, indicate with a
check mark in Column B whether each knowledge and skill was achieved. If a particular knowledge or skill was acquired through work completed in
a specific course or courses, the title and number of the course(s) should be entered in Column C. If the knowledge or skills were acquired in clinical
practicum, enter the title and number of the practicum in Column D. If the knowledge or skill was acquired through course work and/or clinical
practicum, and/or lab or research activities, there should be entries in all of the applicable columns: C, D, and/or E.
3. Students and programs using the KASA are advised to keep a copy in a safe place, should they need to provide information to the Council For
Clinical Certification at a later date (e.g., upon application for reinstatement).
4. CFCC encourages programs and students to periodically review the KASA (or other tracking documents developed by the program) to assist
students in determining knowledge and skills already acquired and those yet to be attained.
Knowledge And Skills Acquisition (KASA) Summary Form
For Certification in Speech-Language Pathology
The KASA form is intended for use by the certification applicant during the graduate program to track the processes by which the knowledge and skills specified in the
2005 Standards for the CCC are being acquired. Each student should review the KASA form at the beginning of graduate study, and update it at intervals throughout
the graduate program and at the conclusion of the program.
The student, with input and monitoring of program faculty, must enter a check mark in column B as each of the knowledge and skills is acquired. It is expected that
many entries will appear in the course work and the clinical practicum columns, with some entries, as appropriate, in the "Other" (lab, research, etc.) columns. Please
enter the course or practicum number and title and description of other applicable activity.
I. KNOWLEDGE AREAS
A
Standards
Standard III-A. The applicant must
demonstrate knowledge of the
principles of:
● Biological sciences
● Physical sciences
● Mathematics
● Social/Behavioral sciences
Standard III-B. The applicant must
demonstrate knowledge of basic
human communication and
swallowing processes, including
their biological, neurological,
acoustic, psychological,
developmental, and linguistic and
cultural bases
● Basic Human Communication
Processes
● Biological
● Neurological
B
C
How Achieved?
D
Knowledge/
Skill Met?
(check )
Course # and Title
Practicum Experiences # and
Title
3
January, 2003
E
Other (e.g. labs, research) (Include
description of activity)
A
Standards
● Acoustic
● Psychological
● Developmental/Lifespan
● Linguistic
● Cultural
● Swallowing Processes
● Biological
● Neurological
● Acoustic
● Psychological
● Developmental/Lifespan
● Linguistic
● Cultural
B
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
Standard III-C. The applicant must
demonstrate knowledge of the nature
of speech, language, hearing, and
communication disorders and
differences and swallowing
disorders, including their etiologies,
characteristics,
anatomical/physiological, acoustic,
psychological, developmental, and
linguistic and cultural correlates.
Specific knowledge must be
demonstrated in the following areas:
Articulation
● Etiologies
● Characteristics
Fluency
● Etiologies
● Characteristics
4
January, 2003
A
Standards
Voice and resonance, including
respiration and phonation
● Etiologies
● Characteristics
B
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
Receptive and expressive language
(phonology, morphology, syntax,
semantics, and pragmatics) in
speaking, listening, reading, writing,
and manual modalities
● Etiologies
● Characteristics
Hearing, including the impact on
speech and language
● Etiologies
● Characteristics
Swallowing (oral, pharyngeal,
esophageal, and related functions,
including oral function for feeding;
orofacial myofunction)
● Etiologies
● Characteristics
Cognitive aspects of communication
(attention, memory, sequencing,
problem-solving, executive
functioning
● Etiologies
● Characteristics
5
January, 2003
A
B
Standards
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
Social aspects of communication
(challenging behavior, ineffective
social skills, lack of communication
opportunities)
● Etiologies
● Characteristics
Communication modalities (including
oral, manual, augmentative and
alternative communication
techniques, and assistive
technologies)
● Characteristics
Standard III-D: The applicant must
possess knowledge of the principles
and methods of prevention,
assessment, and intervention for
people with communication and
swallowing disorders, including
consideration of
anatomical/physiological,
psychological, developmental, and
linguistic and cultural correlates of
the disorders.
Articulation
● Prevention
● Assessment
● Intervention
Fluency
● Prevention
● Assessment
6
January, 2003
A
B
Standards
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
● Intervention
Voice and Resonance
● Prevention
● Assessment
● Intervention
Receptive and Expressive Language
● Prevention
● Assessment
● Intervention
Hearing, including the impact on
speech and language
● Prevention
● Assessment
● Intervention
Swallowing
● Prevention
● Assessment
● Intervention
Cognitive aspects of communication
● Prevention
● Assessment
● Intervention
Social aspects of communication
● Prevention
● Assessment
7
January, 2003
A
B
Standards
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
● Intervention
Communication Modalities
● (Prevention not applicable)
● Assessment
● Intervention
Standard IV-G: The applicant for
certification must complete a
program of study that includes
supervised clinical experiences
sufficient in breadth and depth to
achieve the following skills
outcomes (in addition to clinical
experiences, skills may be
demonstrated through successful
performance on academic course
work and examinations, independent
projects, or other appropriate
alternative methods):
1. Evaluation (must include all skill
outcomes listed in a-g below for
each of the 9 major areas)
a. Conduct screening and prevention
procedures (including prevention
activities)
b. Collect case history information
and integrate information from
clients/patients, family, caregivers,
teachers, relevant others, and other
professionals
8
January, 2003
A
B
Standards
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
c. Select and administer appropriate
evaluation procedures, such as
behavioral observations
nonstandardized and standardized
tests, and instrumental procedures
d. Adapt evaluation procedures to
meet client/patient needs
e. Interpret, integrate, and synthesize
all information to develop diagnoses
and make appropriate
recommendations for intervention
f. Complete administrative and
reporting functions necessary to
support evaluation
g. Refer clients/patients for
appropriate services
● Articulation
● Fluency
● Voice and resonance, including
respiration and phonation
● Receptive and expressive language
(phonology, morphology, syntax,
semantics, and pragmatics) in
speaking, listening, reading, writing, and
manual modalities
● Hearing, including the impact on
speech and language
● Swallowing (oral, pharyngeal,
esophageal, and related functions,
including oral function for feeding;
orofacial myofunction)
9
January, 2003
A
B
Standards
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
● Cognitive aspects of communication
(attention, memory, sequencing,
problem-solving, executive functioning)
● Social aspects of communication
(including challenging behavior,
ineffective social skills, lack of
communication opportunities)
● Communication modalities (including
oral, manual, augmentative, and
alternative communication techniques
and assistive technologies)
2. Intervention (must include all skill
outcomes listed in a-g below for
each of the 9 major areas)
a. Develop setting-appropriate
intervention plans with measurable
and achievable goals that meet
clients'/patients' needs. Collaborate
with clients/patients and relevant
others in the planning process
b. Implement intervention plans
(involve clients/patients and relevant
others in the intervention process)
c. Select or develop and use
appropriate materials and
instrumentation for prevention and
intervention
d. Measure and evaluate
clients'/patients' performance and
progress
10
January, 2003
A
Standards
e. Modify intervention plans,
strategies, materials, or
instrumentation as appropriate to
meet the needs of clients/patients
f. Complete administrative and
reporting functions necessary to
support intervention
B
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
g. Identify and refer clients/patients
for services as appropriate
● Articulation
● Fluency
● Voice and resonance
● Receptive and expressive language
● Hearing, including the impact on
speech and language
● Swallowing
● Cognitive aspects of communication
● Social aspects of communication
● Communication modalities
3. Interaction and Personal Qualities
a. Communicate effectively,
recognizing the needs, values,
preferred mode of communication, and
cultural/linguistic background of the
client/patient, family, caregivers, and
relevant others.
b. Collaborate with other professionals
in case management.
11
January, 2003
A
Standards
c. Provide counseling regarding
communication and swallowing
disorders to clients/patients, family,
caregivers, and relevant others.
d. Adhere to the ASHA Code of Ethics
and behave professionally.
B
Knowledge/
Skill Met?
(check )
C
How Achieved?
D
E
Course # and Title
Practicum Experiences # and
Title
Other (e.g. labs, research) (Include
description of activity)
12
January, 2003
Knowledge and Skills Acquisition (KASA) Summary Form
For Certification in Speech-Language Pathology
Verification by Program Director
The applicant for certification:
Has a master's or doctoral degree. A minimum of 75 semester credit hours were completed in a course of study addressing the
□ Yes
□ No
knowledge and skills pertinent to the field of speech-language pathology (Std. I)
Initiated and completed all graduate course work and graduate clinical practicum in an institution whose program was accredited by the CAA (Std. I)
□ Yes
□ No
□ Yes
□ No
□ Yes
□ No
□
□
□
□
□
□
□
□
□
□
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
□ Yes
□ Yes
□ No
□ No
□ Yes
□ Yes
□ No
□ No
□ Yes
□ No
□ Yes
□ No
Has completed a program of study (a minimum of 75 semester credit hours overall, including at least 36 at the graduate level) that
includes academic course work sufficient in depth and breadth to achieve the specified knowledge outcomes (Std. III-A,B,C)
Possesses knoweldge of the principles and methods of prevention, assessment and intervention for people with communication
and swallowing disorders (Std. III-D)
Has demonstrated knowledge of standards of ethical conduct (Std. III-E)
Has knowledge of processes used in research and the integration of research principles into evidence-based clinical practice (Std.
Has demonstrated knowledge of contemporary professional issues (Std. III-G)
Has demonstrated knowledge about certification, specialty recognition, licensure, and other relevant professional credentials
Has completed a curriculum of academic and clinical education that follows an appropriate sequence of learning sufficient to
achieve the skills outcomes in Standard IV-G (Std. IV-A)
Possesses skill in oral and written and other forms of communication sufficient for entry into professional practice (Std. IV-B)
Has completed a minimum of 400 clock hours of supervised clinical experience in the practice of speech-language pathology,
including 25 hours in clinical observation and 375 hours in direct client/patient contact (Std. IV-C)
Has completed at least 325 clock hours while engaged in graduate study (Std. IV-D)
Has been supervised by individuals holding a current ASHA Certificate of Clinical Competence in the appropriate area of practice.
The amount of supervision was appropriate to the student's level of knowledge, experience, and competence and the supervision
was sufficient to ensure the welfare of the client/patient populations (Std. IV-E)
Has gained knowledge of and experience with individuals from culturally/linguistically diverse backgrounds and with client/patient
populations across the life span (Std. IV-F)
The applicant has met the education program's requirements for demonstrating satisfactory performance through ongoing
formative assessment of knowledge and skills. (Std. V-A)
The program director verifies that the student met each standard and has successfully met the education program's requirements for demonstrating
satisfactory performance through ongoing assessment of knowledge and skills.
_____________________________________________________
Name
_____________________________________________________
Title
_____________________________________________________
Signature
_____________________________________________________
Program
___________________________________
Date
11
January, 2003
STEPS TOWARD CERTIFICATION, AND LICENSURE
I. ASHA CERTIFICATION: Obtain Certification and Membership application forms from the ASHA
website: http://www.asha.org/about/membership-certification/handbooks/slp/default.htm.
II.
OHIO License: Obtain Ohio Board of Speech-Language Pathology and Audiology application for
licensure from website: http://slpaud.ohio.gov/
Upon Completion of Comprehensive Exams and coursework:
1. Complete final course and practicum requirements. Make sure you have signatures from ALL of your
supervisors and their license numbers. Once you have completed your coursework, final practicum,
and have all of the required signatures, neatly hand-write or type a new copy of your Ohio Board hours
sheet. Do Not Total the Columns. Make 3 photocopies of this new sheet.
2.
Make an appointment to meet with Coordinator of Clinical Education for a final check on practicum
requirements. This meeting should be held 1-2 weeks prior to the deadline for submitting application
materials to the Ohio Board. The Ohio Board reviews applications on the 1st and 15th of every month.
All application materials must be received 5 business days prior to the review date.
3. After meeting with the Coordinator of Clinical Education, your clinical hours sheets will be forwarded to
the Department Assistant for signature and notarization. She will notify you when they are available
for pick-up.
THE DEPARTMENT UNDERSTANDS THAT YOU ARE EAGER TO BEGIN YOUR PROFESSIONAL
CAREER, HOWEVER, IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT YOU HAVE ALL
APPLICATION MATERIALS TOGETHER AND SUBMITTED TO THE APPROPRIATE PEOPLE IN A
TIMELY MANNER. NO EXCEPTIONS!
INSTRUCTION FOR OBTAINING AND MAINTAINING ASHA CERTIFICATION
The Certificates of Clinical Competence in Speech-Language Pathology (CCC-SLP) and Audiology (CCCA) are awarded by ASHA's Council For Clinical Certification (CFCC) to applicants who hold a graduate
degree and who have successfully completed (a) all academic course work and clinical practicum, (b) a
clinical fellowship, and (c) the national examination in the area in which certification is sought, as specified
in the Standards and Implementation Procedures for the Certificates of Clinical Competence (SCCC) in
Speech-Language Pathology and Audiology (see Section III of this Handbook). The applicant must submit
an application completed as specified, the appropriate dues and fees, and the supporting documents
required for processing the application. Maintaining the CCC-SLP is contingent upon the timely payment
of annual dues and fees, and beginning in January 1, 2005, completion of 30 contact hours of continuing
professional development. Individuals who are in the certification process, hold the CCC, and/or are
members of the Association must abide by ASHA's Code of Ethics. All applicants for certification must
meet the currently published standards, policies, and procedures.
STEPS FOR OBTAINING AND MAINTAINING THE CERTIFICATES OF CLINICAL COMPETENCE
1. Application Materials. Submit to the ASHA Certification office one complete packet including the
following:
a properly completed and signed application
verification of receipt of graduate degree (Individuals should not submit the application until the graduate
degree has been awarded. Those individuals who graduate from a program that has only one graduation
per year may apply before receipt of the degree if all graduate course work and graduate level practicum
have been completed.)
course descriptions or transcripts, if required
appropriate payment, by either check or charge (VISA or MasterCard only). [See the "Schedule of
Required Dues and Fees,"]
No individual documents should be submitted to the ASHA Certification office before submission of the
application for certification. Items received before receipt of the application will be returned to the sender.
Please note that individuals who wish to be certified in both audiology and speech-language pathology
must meet the standards and requirements in both professional areas.
2. Clinical Fellowship (CF) Experience. After verifying that you meet the requirements for state licensure
(see "State Licensure/Regulatory Requirements" in Section IV. Clinical Fellowship: Requirements and
Procedures), begin the clinical fellowship experience. Both the fellow and the supervisor are responsible
for verifying that the supervisor's certification remains valid throughout the entire clinical fellowship period.
(For more information about verifying supervisors' certification, see "Clinical Fellows".)
3. Clinical Fellowship Evaluations and Observations. During the CF experience, the clinical fellowship
supervisor must complete (a) at least three formal evaluations of the clinical performance using the CFSISLP, and (b) at least 18 on-site observations, 6 per segment, and 18 other monitoring activities, 6 per
segment (see Section IV. Clinical Fellowship: Requirements and Procedures for specific information.)
4. Clinical Fellowship Report and Rating Form. At the completion of the CF experience, the clinical
fellowship supervisor must complete and submit the Clinical Fellowship Report and Rating Form (Form
D) to the CFCC within 4 weeks of the date the clinical fellowship is completed. Both the supervisor and
fellow must sign the report and rating form.
5. Examination. Obtain a passing score on the national examination. Exam results must be sent directly
from the Educational Testing Service (ETS) in order to be applicable toward certification. When you
register to take the exam, request that your score be reported directly to ASHA. ETS charges an additional
fee to report scores after the examination has been taken. To assist the National Office in processing your
examination information, it will be helpful if you submit a copy of the report sent to you by the testing
service when you submit your application for certification. However, please note that this copy will not be
used as official verification of completion of the examination requirement.
6. Certificate. Once certification has been awarded, ordering the certificate is optional. If one is desired,
complete and return the certificate order form sent to you with your notification. The certificate will be sent
approximately 8 weeks after the certificate order is received in the ASHA National Office.
7. Renew Certification and Membership. Pay annual dues and fees when the annual invoice is
received. Maintenance of certification and/or membership is contingent upon the timely payment of annual
dues and fees and, beginning January 1, 2005, completion of 30 contact hours of continuing professional
development activities. (See ASHA's Certification section for specific information.)
Application Instructions "Pass-Through" Applicants
You will be considered a "pass-through" applicant if you initiated and completed your graduate education
at a program accredited by the Council on Academic Accreditation (CAA). Such applicants are not
required to complete the entire application if the program director verifies that all course work and
practicum requirements have been met and if the application is submitted no more than 3 years from the
date the degree was awarded (see Section III. Standards and Implementation Procedures for the
Certificates of Clinical Competence, for specific information). However, if you do not meet these
requirements or received your education in a foreign country, you will not be considered a 'pass-through'
applicant and will be required to complete the entire application as noted in the section below regarding
'Non-Pass-Through' applicants.
"Pass-through" applicants should adhere to the following procedures: Program Director Signature. Have
the director of your graduate program review and sign section 21 of the application (Form A). Your
program director must verify that all requirements for graduate course work and practicum have been met.
Of vital importance are the date on which the course work requirements were completed and the date on
which the practicum requirements were completed. Also complete sections 1 through 6 and 19 through 21
of the application.
Degree Verification. If the graduate degree has been officially conferred, completion of Section 20.C and
the signature of the program director will serve as verification that the applicant has a graduate degree. No
additional verification of degree is required; transcripts do not have to be submitted if the degree has been
conferred at the time the application is signed by the program director.
Degree Conferred in Future. If the graduate degree will be conferred after the application is signed by
the program director, verification of actual receipt of the graduate degree is required. Verification can be
submitted in any one of the following ways: (a) an official transcript with the degree date imprinted, (b) an
unofficial transcript or a photocopy of a transcript with the degree date imprinted, (c) a letter signed by the
graduate program director verifying the date on which the graduate degree was awarded, or (d) a letter
from the registrar verifying the degree and the date it was awarded. Certification will not be awarded until
verification of receipt of the graduate degree has been received by the Certification unit of the National
Office.
Examination. Exam results must be sent directly from the Educational Testing Service (ETS) in order to
be applicable toward certification. When you register to take the exam, request that your score be reported
directly to ASHA. ETS charges an additional fee to report scores after the examination has been taken. To
assist the National Office in processing your examination information, it will be helpful if you submit a copy
of the report sent to you by the testing service when you submit your application for certification. However,
please note that this copy will not be used as official verification of completion of the examination
requirement.
Application Checklist. Finally, before you submit your application materials to the National Office, review
the Application Checklist (Form F) to confirm that you have completed all the requirements for certification.
Incomplete applications will be returned to the applicant.
"Non-Pass-Through" Applicants
You will be considered a 'non-pass-through' applicant if you (a) apply more than 3 years after the date
your degree is awarded by an institution in which a CAA-accredited program is housed, (b) were enrolled
in a CAA-accredited program that had its accreditation withdrawn before you graduated, (c) completed
your graduate course work and practicum in the area in which you seek certification in a program that held
candidacy status for accreditation, (d) completed your graduate course work and practicum in the area in
which you seek certification in a CAA-accredited program but did not receive your graduate degree from
the accredited program or received your graduate degree in a related area or received your graduate
degree from an institution outside the United States and are not currently certified by an agency that has a
reciprocal certification agreement with ASHA. Such applicants must complete the
Membership/Certification Application (Form A) in its entirety and must follow the instructions below. Official
graduate and undergraduate transcripts must be submitted before the CFCC will evaluate the application.
Official transcripts can be submitted either from the applicant or directly from colleges/universities. (Also
see Section III. Standards and Implementation Procedures for the Certificate of Clinical Competence,
Standard I, for additional information regarding who must complete the entire application.) Complete
sections 1 through 18 of the application. Have the director of your graduate program verify your graduate
practicum hours at the end of section 18 and complete sections 19 through 21 of the application.
List all course work in semester hours. If you earned credit on the quarter-hour system, use the conversion
chart to convert quarter hours to semester hours. If you received some other type of credit, you must
submit information from your university which equates the credit you earned to the semester-hour system.
Applicants must have at least 75 semester credit hours combined over all course work. Only 6 semester
credit hours of clinical practicum hours will be accepted within this overall total.
Provide the course number and title as listed on your transcripts. If a course title is general or vague,
submit a copy of the course description from the college/university catalog to clarify course content.
If you wish to receive credit for a thesis/dissertation, you must submit an abstract. Do not send a copy of
the entire thesis; materials are not returned to applicants.
Be sure to check the appropriate columns for graduate credit, practicum credit, courses with culturally
diverse populations, and courses in development and behavior across the life span.
In completing the practicum section of the application, cite only those clock hours that were supervised by
the indicated supervisor.
Double check your math on the hours listed in the practicum sections.
Have the application reviewed and signed by the authorized signer at the program where the graduate
course work and practicum were completed. Sections 19-21 must be completed. Incomplete applications
or those that bear invalid signatures will be returned to the applicant.
Exam results must be sent directly from the Educational Testing Service (ETS) in order to be applicable
toward certification. When you register to take the exam, request that your score be reported directly to
ASHA. ETS charges an additional fee to report scores after the examination has been taken. To assist the
National Office in processing your examination information, it will be helpful if you submit a copy of the
report sent to you by the testing service when you submit your application for certification. However,
please note that this copy will not be used as official verification of completion of the examination
requirement.
Finally, before you submit your application materials to the National Office, review the Application
Checklist (Form F) to confirm that you have completed all the requirements for certification. Incomplete
applications will be returned to the applicant.
CFCC Interpretations on Course Work. Credit for a course is allowed only if an official transcript shows
a passing grade for the course. Course credits should not be split unless it is absolutely necessary. If
necessary, a course may be credited to no more than two categories, with no less than 1 semester hour
credit assigned to each category. For courses with vague titles, such as "Directed Study," "Independent
Study," "Speech Pathology I," "Audiology II," etc., the applicant must submit a copy of the catalog
description. Copies of abstracts of projects, theses, or dissertations also must be submitted to the CFCC
in order to be counted for credit. The CFCC may request further information on course content or projects
if needed for the evaluation.
Instructions for Dues and Fees. Refer to section 2 of the application form (Form A) and the current
'Schedule of Required Dues and Fees' (Form B) to determine the amount you must submit with your
application. The entire payment must be submitted with the application. Applications received without
payment will be returned. All fees must be paid in U.S. currency.
Payment may be made by check, money order, or credit card (VISA or MasterCard). Do not send cash.
Applications and payments received between January 1 and August 31 are processed for the year in
which they are received; individuals will receive an invoice in October for dues and fees for the following
year. Applications and payments received between September 1 and December 31 are processed for the
following year, and applicants will receive complimentary membership from the time of application through
the remainder of that year. Date of receipt is determined by the received date stamped in ASHA's Postal
Operations center. Certification staff will not hold applications that arrive before August 31, but will process
them as they are received. Dues and fees are based on a calendar year. The required renewal dues and
fees must be paid annually upon receipt of the invoice in order to maintain membership, certification, or
certification-in-process status.
If you are unclear about the fees that you should submit with your application, please contact ASHA's
Action Center (1-800-498-2071) for assistance.
ABOUT THE PRAXIS EXAM
The Praxis Examinations in Speech-Language Pathology and Audiology are a major component for ASHA
certification and most state licensing requirements for audiologists and speech-language pathologists. The
active participation of faculty and students in ensuring the success of the Praxis experience is essential to
the future of each profession. To ensure success, it is essential that students prepare for the examinations
and that faculty assist them with their preparation activities.
The Praxis Series Specialty Area Tests in Speech-Language Pathology and Audiology are developed and
owned by the Educational Testing Service (ETS). The exam is designed to provide a system of thorough,
fair, and carefully validated tests and assessments.
HOW IS THE TEST SCORED?
Only questions answered correctly count toward the reported score. Therefore, it is better to
guess than to leave an answer blank .
There are several versions for each Praxis examination in speech-language pathology or audiology. The
questions on one edition may be slightly more difficult (or easier) than those on another edition. ETS uses
statistical methods to ensure that the various scores earned on editions of the active tests are comparable
to each other.
The passing score for ASHA certification is 600 out of a possible 800 for both Speech Language
Pathology and Audiology.
Each state determines its passing score for professional licensure and teacher certification. Most states
use the same score of 600 as required for ASHA certification. However, in some states the Praxis
examination score for licensure or teacher certification may be higher or lower than the ASHA minimum
passing score.
Typically, 80% of students in both speech-language pathology and audiology pass the Praxis examination
on their first attempt.
For the academic year 1998-1999, the mean score in audiology was 628, and the mean score in speechlanguage pathology was 651.
Speech-language pathology and audiology test takers who have not earned a passing score have no
limitation for a two-year period on the number of times that the Praxis examination can be taken. If the
examination is not passed successfully within a 2-year period, the applicant's certification file will be
closed. If the examination is passed at a later date, the individual will have to reapply for certification under
the standards in effect at the time of reapplication.
It is recommended that students register and take the examination no earlier than the completion of their
graduate coursework and graduate clinical practicum or during the CF experience.
WHO WRITES THE PRAXIS QUESTIONS?
Several groups of individuals are involved in developing the questions to be included in each Praxis
examination. ETS has a test development committee comprised of faculty and clinicians in speechlanguage pathology and a separate ETS test development committee for audiology. These individuals are
well versed in developing test questions in specific content areas. In addition, ETS staff have specific
responsibilities in developing and evaluating the Praxis questions. The ETS staff work very closely with
staff members at ASHA's National Office who are involved in the areas of academic affairs, academic
program accreditation and clinical certification. The following is a general overview of the role of the ETS
Test Development Committees, ETS staff and ASHA staff.
The Role of ASHA National Office Staff
•
Make recommendations to ETS about potential test development committee members
•
Contract with ETS every 5 to 7 years to conduct a job analysis and skills validation study for each
profession
•
Identify the knowledge and skills necessary for entry-level practitioners to practice either speechlanguage pathology or audiology, based on the job analysis and skills validation study.
The Role of ETS Staff
•
Develop contracts with each test development committee member
•
Review individual test questions from both content and statistical perspectives
•
Develop and/or modify a pool of questions
•
Review any questions identified as potentially flawed during a particular test administration
•
Assemble tests to conform to rigorous test standards and analyses of test questions
•
Provide differential statistical analyses to remove any cultural bias and to ensure a representative
reflection of the multicultural nature of our society
•
Respond to questions raised by test takers, faculty and/or administrators
•
ETS will conduct cut-score studies for professional certification and licensure
The Role of the ETS Test Development Committee
•
Provide feedback on the current scope of practice in the profession and changing demands of
clinical practitioners
For more information about the Praxis exam, see www.ets.org/praxis.
FREQUENTLY ASKED QUESTIONS ABOUT THE PRAXIS EXAM
Is it possible to study for the Praxis exam in Speech-Language Pathology or Audiology?
Yes. Reviewing your course materials, becoming familiar with the test, and taking practice exams are all
effective ways to prepare for the Praxis exams. This will help you to pace yourself, improve your score,
and understand the questions that are asked.
What is the format of the Praxis exam?
The Praxis exams are 2-hour, multiple-choice tests. Multiple-choice questions based on case studies are
included in the exams. There are no essay questions on the examinations.
Is there a penalty for guessing on the Praxis exam?
No. Only correct answers count toward your score. Leave NO question blank. It is to your advantage to
guess!
Is it true that as long as you get good grades in your courses and clinical practica you will pass the
Praxis exam?
No. You must be able to integrate this information and draw from your coursework and clinical
experiences to pass the Praxis examination.
Are there accommodations available for students with disabilities?
Yes. See www.ets.org/praxis/prxdsabl.html for details.
Can you cancel your score once you sit for the exam?
Yes. If ETS receives a written request to cancel your score within one week of your test date, your
score can be canceled. For special circumstances see www.ets.org/praxis/praxcrs.html for more
information about score reporting.
Do you have to pass the Praxis exam in order to be eligible for ASHA's Certificate of Clinical
Competence (CCC) in Speech Language Pathology or Audiology?
Yes. ASHA has set a passing score of 600 as one requirement for the CCC-SLP and CCC-A.
If your primary language is not English, can you request special testing conditions?
Yes. If your primary language is not English, you may be eligible for an alternate test site and/or extended
time. Monday testing is available for those individuals unable to take a Saturday exam for religious
reasons or because they are in the U.S. Armed Forces. Find out more details from www.ets.org/praxis.
Is the Praxis exam culturally and linguistically fair?
Yes. Each question undergoes a rigorous review for sensitivity and differential item analysis to ensure that
no question favors or disfavors any group of test-takers by race, gender, or ethnicity. Also, each test is
reviewed by a team of linguists with specific training in sociolinguistics to ensure accessibility.
Does a Praxis score belong to ASHA once you take the test?
No. You have the right to control the information that ETS has regarding your test score. No one will see
your scores unless you designate them as a score recipient.
SPEECH-LANGUAGE PATHOLOGY EXAM CONTENT
Topics Covered
The following list represents the topics covered the Speech Language Pathology Exam that is currently
being administered. These topics are consistent with standards for clinical certification set by the American
Speech-Language-Hearing Association.
Basic Human Communication Processes
•
•
•
Language acquisition and learning theory
o
normal development of speech and language
o
developmental norms in phonology, syntax, semantics, and pragmatics
o
theoretical models of learning related to language and cognition
o
behavior management and modification
o
cognitive development
o
developmental, motor, and linguistic processes
Language science
o
the structure of language
o
the phonetic and phonological representations of speech sounds
o
phonological theory as it relates to normal development
o
grammatical categories
o
morphology, syntax, semantics, and pragmatics, as these fields relate to normal language
processing and production
Learning theory
o
theoretical models of learning related to language and the effective treatment of disorders
o
models of behavior management and modification
o
•
•
theories of cognitive development
Multicultural awareness
o
applications of theoretical models of language in society to a variety of linguistic and
cultural groups
o
cultural and socioeconomic factors that influence speech and language
o
communicative differences between speakers of the same language, including idiolectal
and dialectal distinctions
o
differentiation between first language/dialect interference and speech/language disorders
o
cultural differences in the use of nonverbal communication
Speech science
o
speech perception
o
physiological phonetics
o
acoustic phonetics
o
anatomy and physiology, as related to the production, reception, and processing of
speech, language, and hearing
o
neural bases of speech and hearing
Phonological and Language Disorders Assessment and Treatment
•
•
Phonological disorders
o
articulation disorders as influenced by anomalous, oral-motor, dental, learning, or
behavioral factors
o
phonological process disorders
Language disorders
o
developmental, motor, and linguistic processes
o
differentiation of normal, delayed, and disordered language development
o
the nature of expressive and receptive language disorders
o
treatment of language delays and language disorders
Speech Disorders: Identification, Assessment, Treatment, and Prevention
•
Fluency disorders
o
theories of fluency
o
neurological and psychological factors
o
assessment, treatment, and prevention of fluency disorders
•
•
Resonance disorders
o
resonance, as influenced by congenital anomalies, neuralgic disorders, disease, trauma,
and behavioral factors
o
assessment, treatment, and prevention of resonance disorders
Voice disorders
o
phonation, as influenced by respiratory, laryngeal, and airway problems resulting from
malformations, neuralgia, disease, trauma, and behavioral factors
o
alaryngeal speech
o
assessment, treatment, and prevention of voice disorders
Neurogenic Disorders
•
•
Neurological disorders
o
aphasia
o
progressive disorders
o
motor speech disorders
o
traumatic brain injury
o
cognitive communication disorders
Dysphagia
o
the process of swallowing
o
causes and effects of swallowing disorders
o
assessment and treatment of swallowing disorders
Audiology/Hearing
•
•
Hearing science
o
principles of hearing
o
anatomy and physiology of the hearing mechanism
o
congenital and acquired hearing loss in children and adults
Audiological assessment
o
hearing screening for clients of all ages
o
interpretation of audiograms and tympanograms
o
referrals to appropriate professionals
•
Auditory habilitation and rehabilitation
o
management of clients with hearing loss
o
issues of intervention relevant to the practice of speech-language pathology
Clinical Management
•
•
•
•
•
•
Alternative/augmentative communication
o
assessment and use of alternative/augmentative communication devices
o
determining candidacy for alternative/augmentative devices
Counseling
o
communicating assessment and treatment plans, progress, and results to clients and
appropriate professionals
o
interpersonal communication and counseling techniques
Documentation and monitoring client progress
o
collecting and using information from other agencies
o
communicating to other professionals concerning the client's history
o
data gathering and interpretation
o
determining termination criteria based on prognosis, progress, and motivation
o
procedures for referral and follow-up
o
writing professional reports
Efficacy
o
demonstration of results of clinical services in relation to speech, language, and hearing
o
determining and communicating information about the outcomes of assessment and
treatment
Instrumentation
o
instrumentation used in speech and language analysis
o
the purpose, use, and applications of technological developments with respect to
assessment and treatment of speech and language disorders
Speech-language assessment
o
establishing clients' past and present status
•
•
o
formulating recommendations, including impact of life conditions, type of treatment, and
service-delivery models
o
identifying individuals at risk for communication disorders
o
interviewing techniques and interpersonal skills
o
procedures for screening clients of all ages
o
selection and administration of standardized evaluation procedures, such as formal tests
o
selection and administration of non-standardized procedures, such as language samples
and behavioral observations
Speech-language intervention
o
diagnostic intervention
o
selecting activities appropriate to the client's age, sociocultural membership, and disorder
o
implementing remediation methods and strategies for disorders
Syndromes and genetics
o
basic principles of genetics
o
syndromic and nonsyndromic inherited and developmental conditions
o
influence of syndromic and nonsyndromic conditions on hearing, speech and language
development, production, and processing
Professional Issues/Psychometrics/Research
•
•
•
Ethical practices
o
understanding standards for professional conduct
o
making referrals, obtaining permissions, keeping and using client records
o
ensuring client privacy
o
handling staffing issues in a professional and legally prudent manner
Research methodology/psychometrics
o
criteria for selection of test materials
o
determining the reliability of assessment procedures
o
models of research design
o
test construction principles
Standards and laws
o
designing appropriate assessment and treatment through knowledge of governmental
regulations and professional standards
o
federal laws and regulations impacting delivery of services
o
reporting requirements of governmental agencies
SOURCES FOR THE NATIONAL EXAMINATION IN SPEECH LANGUAGE PATHOLOGY AND
AUDIOLOGY
Although there are no specific study guides for the examinations, some individuals have reported the
following sources to be helpful. (If you know of additional helpful review materials or courses, please
notify the Certification Section in the National Office.)
ASHA does not have these publications available. To receive additional information on how to obtain
these books, please contact your local bookstore or library, or the publisher directly.
Lass, N., et al. (1988). Handbook of Speech-Language Pathology and Audiology. B.C. Decker, Inc. A
comprehensive volume covering the latest information on processes/pathologies of speech, language and
hearing.
Shames & Anderson (2003). Human Communication Disorders: An Introduction. Pearson Allyn & Bacon.
Perkins, W. & Bell, J. (1977). Study Guide for Speech Pathology and Review for the National
Examination. Mosby Co. Out of Print. May be available at local libraries.
Nicolosi, L., Harryman, E. & Kresheck, J. (2003). Terminology of Communication Disorders - Speech,
Language, Hearing. Lippincott Williams & Wilkins Company, Baltimore, MD. Provides a comprehensive
dictionary/source book which includes definitions of the terminology used in the field and in allied areas.
Educational Testing Service. (2003) Speech-Language Pathology Study Guide (Praxis Study Guides).
WHEN
First Semester
TIMELINE FOR TRANSITION FROM GRADUATE STUDENT TO SLP PROFESSIONAL
CASE
ASHA CERTIFICATION
OHIO LICENSURE
DESCRIPTION/ACTIVITY
X
Complete initial Plan of Study with advisor.
If you are interested in School Certification, please see
Coordinator of Teacher Licensure.
X
Throughout Program
X
X
X
X
X
X
Completion of required academic coursework and
clinical hours.
Begin preparing for comprehensive exam process.
Organize notes, articles, etc. for each area. By the
middle of the semester, you should meet with your
advisor to discuss strategies for studying and to discuss
comprehensive exam process. Begin studying.
Complete practice questions and get feedback from
faculty members.
Successfully complete comprehensive exams.
3rd Semester or Semester
Before Comprehensive Exams
X
4th Semester or Semester of
Comprehensive Exams
X
X
X
Apply for Graduation.
X
X
X
Take the PRAXIS Exam. Have scores sent to Case,
Ohio Board of Speech Language Pathology and
Audiology, ASHA, and Ohio Department of Education if
filing for Teacher Licensure.
X
Request ASHA Membership and Certification Handbook
(www.asha.org).
X
Request “Conditional License” application materials from
the Ohio Board of Speech Language Pathology and
Audiology (www.state.oh/us/slp)
X
X
X
Complete final academic and clinical requirements.
X
X
X
Prepare resume for job search process.
X
X
Obtain a CFY position and a CFY supervisor.
X
Complete application materials for Ohio Board of Speech
Language Pathology and Audiology.
APPENDIX K: PORTFOLIO
ASSESSMENT AND INTERVENTION FORMS
Use the following forms to document your clinical experiences each semester. Keep a copy for your
portfolio. In addition, provide a copy for the Coordinator of Clinical Education at the end of each
semester. You may choose to share these with your supervisor as you formulate your goals for clinical
growth.
A completed example has bee provided.
ASSESSMENT
Semester _______
Year _________
Standardized Tools
Placement: ___________________________________________
Non-standardized Tools
Analysis
INTERVENTION
Semester ______________
Diagnosis
Year _______________
Age/Demographic Variables
Placement _________________________________
Treatment Approaches
Describe contact with others
relevant to client’s
communication (e.g. parents,
teachers, aides, etc.)