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Speech-Language Pathology Graduate Student Clinic Handbook

The Appalachian State University SLP Clinic Handbook is intended for information purposes only and does not constitute a contract between the University and the student. While this handbook presents policies and programs as accurately as possible at the time of publication, the program reserves the right to revise any section or part without notice or obligation. Changes in degree requirements do not affect students already enrolled in a degree program, although adaptations may be needed. Degree requirements can be found in the Graduate Bulletin and Program of Study for the student's year of admission to the university. Changes in program and academic policies become effective for all students on the date approved for implementation; therefore all SLP students are subject to those policies as posted herein.

TABLE OF CONTENTS

GENERAL INFORMATION & OPERATION……………………………………………………………………………

GENERAL CLINIC PROCEDURES………………………………………………………………………………………...

INFECTION CONTROL POLICY AND PROCEDURES

COUNCIL ON ACADEMIC ACCREDITATION (CAA).........................................................................................

ASHA CODE OF ETHICS 

CLINICAL HOURS……………………………………………………………………………………....................................

SUPERVISION AND GRADUATE STUDENT EXPECTATIONS

TREATMENT/INTERVENTION AND EVALUATION PROCEDURES…………………………………………………………………………………………………………………..

PRIVACY AND CONFIDENTIALITY POLICIES……………………………………………………………………....

STUDENT AND SUPERVISOR EVALUATIONS…………………………………………………………………….

ESSENTIAL FUNCTIONS FOR THE SLP GRADUATE CLINICIAN………………………………...................

THE NEXT STEPS…………………………………………………………………………………………………………….

APPENDICES

GENERAL INFORMATION & OPERATION

History of the SLP Clinic

The Department of Rehabilitation Sciences operates two Communication Disorders Clinics within the Beaver College of Health Sciences. We serve people of all ages from the Boone and greater High Country region.

The Charles E. and Geneva S. Scott Scottish Rite Communication Disorders Clinic, located in University Hall, was established in September 1968 as a training facility for students. It serves children who have speech and language disorders that are primarily behavioral or developmental in nature. The Interprofessional Communication Disorders Clinic, located in the Leon Levine Hall of Health Sciences, was established in 2018 and provides speech-language pathology services for adults and children with medically-based communication and swallowing disorders, as well as audiology services.

The primary purpose of the Clinics is the provision of "hands-on" clinical learning experiences for students pursuing a Master's degree in Speech-Language Pathology. The Clinics provides quality services to children, adolescents and adults with communication disorders in the region. The Clinics do not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

The Clinics serves as a community-based training facility for graduate students and provides outreach programs and additional clinical opportunities at various facilities in the area.

The Speech-Language Pathology Program is accredited by the Council on Academic Accreditation (CAA) of the American Speech-Language-Hearing Association (ASHA). The professional staff includes Audiologists and Speech-Language Pathologists who are licensed by the state of North Carolina and certified by ASHA.

Speech-Language Pathology Program Vision, Mission and Strategic Plan

Vision

The Speech-Language Pathology Program aspires to be a community of scholars and practitioners educating students in models of best practice through the integration of diverse academic and clinical learning experiences, research, and service.

Mission 

The mission of the Speech-Language Pathology Program is to provide rigorous pre-professional and professional training of students seeking careers working with and advocating for individuals who have diverse communication needs or swallowing difficulties and their families. We are guided by the Core Values of the Beaver College of Health Sciences as we prepare graduates who are ethically and culturally competent and uphold the principles of evidenced-based and interprofessional practice.  prepare students for successful careers in speech‐ language pathology. Students attain knowledge and skills in basic human communication processes, and in the prevention, assessment, and treatment of communication and swallowing disorders through outcome‐based educational practices.

Strategic Plan 

The Speech-Language Pathology Program’ Vision, Mission and Strategic aligns with the Beaver College of Health Sciences Strategic Plan. It guides us in achieving our vision and fulfilling our mission.

Philosophy of Clinical Education

The  program’s objective is to help students acquire the knowledge and skills through in-depth academic content, sequentially structured clinical education experiences, and learning assignments. The clinical education component is viewed as a dynamic process where students participate actively in learning to apply academic information to clinical practice while working with clients who have various communicative disorders.

Our goal is to prepare student clinicians to demonstrate strengths in the following areas before they complete their clinical practicum experience:

Student Role in Clinical Education

The goal is to acquire the knowledge and skills to enable the student to be independent and successful in an entry-level position to implement screening, prevention, assessment, and treatment services with patients who have varied types of communication disorders across the lifespan.

Clinics, Clinic Rooms, and Student Areas

The Communication Disorders Clinics are a part of the Blue Cross and Blue Shield of North Carolina Institute for Health and Human Services (IHHS). The Clinics provide interprofessional clinical services on site at Leon Levine Hall (LLH) (1179 State Farm Road) and University Hall  (400 University Hall Drive above Staples off of Hwy 321). Clinical placements for graduate students may be at University Hall, Leon Levine Hall, or an off-campus clinical site.

The university has affiliation agreements with various other sites (i.e., schools, private practices, hospitals, and skilled nursing facilities) around the region. Due to the geographic location of the university, students should expect to drive more than one hour to and from their off-campus clinical sites for at least 2 semesters.

On-Campus Information

For students placed on-campus, the Professional Preparation Room (University Hall room 122) is provided for students’ benefit. It is a place where students can work on confidential information. Student clinicians are responsible for maintaining the room. The designated space for students to work at LLH is room 132 F. Laptops can be checked out from the LLH Interprofessional (IP) Clinic’s front desk for students’ use while working in the LLH IP clinic.

The Kitchen (University Hall room 108) is an area that may be used by staff and students. A microwave and refrigerator are provided and staff and students are expected to keep them clean. Students are expected to clean up after themselves. On the second floor of University Hall, there is a drink machine. In LLH, there is a graduate student lounge located on the second floor. A refrigerator, microwave, and sink are available for use, as well as work areas. The Rise Market and Bakery is located in the LLH Atrium. There is also a microwave and vending machines on the first floor of the LLH for all students’ use.

The Student Lounge (University Hall room 107) is provided for the students’ benefit. It is a place where students can store their materials and work on confidential information. Student clinicians are responsible for maintaining the room. Food is permitted as long as students clean up after themselves. Each student will have their own locker and mailbox in this room. A printer (only for clinic materials), laminator, and binding machine are also available for student use.

Off-Campus Information

Students placed off-campus for their clinical practicum should receive site specific information from their clinical supervisor or during the onboarding process.

Location and Instructions for Checkout of Clinical Materials

There are assessments and treatment materials available to students who are assigned to one of the on-campus clinics. Students assigned to placements off-campus sites should discuss the assessments and treatment materials available to them at their specific site.

Assessment/Test Materials

Tests and materials are located in University Hall room 123A and at Leon Levine. They may be checked-out during the posted hours.. If tests or treatment materials are checked out during the day, they must remain in the clinic area or may be taken to a clinical educator’s office. If the test is not being examined by a clinician, discussed with a clinical educator, or used in a diagnostic session, then it must be returned to the materials room. To search the Material Database go to http://cdc.appstate.edu/materials.php.

Tests and therapy materials may be checked out for overnight usage at 3:00 p.m. They are to be returned to the material room the following morning by 8:00 a.m. Tests checked out on Friday afternoon at 3:00 p.m. must be returned by 8:00 a.m. Monday morning. 

Therapy Materials

Therapy materials and a limited number of supplies are stored in the observation and treatment rooms at University Hall. Check-out of materials is only required for room 134. Therapy materials are also available in University Hall room 123A. Items used during a session should be returned to their proper location, in the appropriate container, immediately following the therapy session. Materials may not be taken from the Preschool Language Classroom (PLC).

Audiological Equipment

All audiometric equipment is calibrated according to ANSI specifications and time guidelines. Annual calibration is obtained through an equipment distributor. Student clinicians should conduct listening checks on the portable audiometers as they are used.

Other Equipment

Clinical equipment of various kinds is stored in appropriate areas of the Clinic and is maintained according to manufacturer specifications by the SLP program staff.  Certain items may be checked out overnight through the office staff. The equipment should be returned to its appropriate place when the session in which it is used is completed.

Access to Forms and Test Protocols

Some forms and protocols used by student clinicians are stored in the Student Lounge at University Hall. Notify the office staff when the forms need to be replenished. Other clinic forms are available as needed from the office assistant. Blank test record forms/protocols are located in the Clinic Office. The office staff will dispense these forms.

Recording Materials  

The case clinical educator will dispense appropriate audio and video recording materials to each student on an as-needed basis. All materials containing recordings should be retained by the case clinical educator, as these recordings are confidential. After an evaluation report is completed, materials from the recorded session should be retained by the clinical educator. Since records of intervention sessions or evaluations are confidential and only to be recorded on clinic devices, they may be viewed ONLY in the clinic.

All recorded materials, both audio and video, should be destroyed at the conclusion of an evaluation, at the end of an academic semester, or when no longer needed for clinical education purposes.

Instructions for Checking Out Assessment/Test, Therapy Materials, and Audiometers

For checking out test/assessments and therapy materials, the following rules must be followed:

  1. Find therapy material or assessments in the material room (123A) OR look through the material list binder.
  2. Fill out a green card in material room, room 107, or room 128 as follows:

Date/material number, title/clinician initials/supervisor initials

You may put multiple materials on one card, BUT if you check out more than one and return any, make sure to cross off the returned material.

  1. Place the green card in the OUT hanging bin in room 128.
  2. After you return the material to the proper place in 123A, move the green card to IN so that faculty, staff and other students know the item has been returned.

If there are items in the clinic office, please take your green card to check out with the office staff.

Do not check out materials for off campus use. Special permissions would need to be approved by the Director of Clinical Education. See Heather Woodruff if you have questions.

Any material checked out must be returned by 5pm. If you have permission to keep overnight, material must be returned by 8am the following day. If you will be using the item for therapy or for an evaluation after 8:00 am, put a note on the card letting others know (example: will return on 4/26 after 9:00 am Dx) when the item is expected to be returned. This includes audiometers.

Each test material contains a sample original protocol/test form. These samples are included so you can see what the actual test forms look like. Do NOT write on these sample forms for practice or use them for your evaluation. Ask the office staff for any protocols you will use for an evaluation. Use a copy to practice.

             

 Building Security

The exterior doors to UH and LLHS clinics are open from 8 AM to approximately 5 PM on business days only. The facilities are closed after 5 PM, on weekends and holidays, and at times when the University is closed. Plan accordingly when meeting deadlines.

General Clinic Procedures

Safety Policy/ Emergency Response Plan

In the event of concern of immediate danger, witnessing a crime, or observing suspicious activity, do not hesitate to call 911 (9-911 from a campus phone) and contact Campus Police at 828-262-8000. Non-urgent concerns can be reported to 828-262-2150. For more information go to: Report A Crime.

Please notify your clinical educator, program director, or department chair immediately if there are any incidents or concerns regarding your safety or the safety of others. Each student clinician should review the university’s Emergency Response Plan prior to the beginning of his/her clinical experience.

Client Safety

Safety of the clients served in the Clinics is paramount. All students providing services to children under the age of 16 must complete the Protection of Minors on Campus training prior to beginning their clinical assignment.

For clients served at University Hall, parents are required to escort their child into the building, unless the child drives himself or herself to the session or unless prior written arrangements are made with the clinical educator in charge of the case. The child should sit in the waiting room with the permission of the clinic staff or the parent should deliver the child to the clinician for treatment. Parents must pick the child up immediately upon the completion of the therapy session. Children will not be allowed to wait for parents outside the building or to remain in the building unattended. Failure to comply with these rules may result in dismissal from treatment. Student clinicians should report any issues to their clinical educator.         

Given the possibility of injury, no child should be left unattended, either in a therapy room, the hall, or in the waiting areas. The student clinician should verify that an adult has assumed the responsibility for a child upon the completion of a therapy session.         

If a client has a known problem requiring specific medical intervention methodology or treatment, the parent or caregiver must be present during all interactions with the client. Although clinic personnel are trained in the provision of basic life support within the definition of North Carolina’s Good Samaritan Act, medical intervention procedures which are not within the scope of practice of a speech-language pathologist or audiologist cannot be performed by Clinic personnel.

In the event of a medical emergency or personal injury: 

Please see the following link for additional information:

https://emergency.appstate.edu/basic-emergency-responses

Safety in the Field

Students are responsible for becoming familiar with the safety policies and procedures of their off-campus clinical sites. In addition, each student should have a conversation with their off-campus clinical educator related to these policies and the method to reach your supervisor, including a plan for coverage if the supervisor is immediately not available. The Director of Clinical Education or the Graduate Program Director should be contacted if a safety issue occurs with a student.

Cancellation policy/Inclement Weather Policy

Appalachian State University reserves the right to cancel or delay classes during severe weather conditions. “The university is closed” means that all classes and other activities, including clinical practicum, are canceled and that only essential personnel who can reach campus safely are expected to report. Information regarding weather cancellations, closings, and delays can be found at https://www.appstate.edu/ and will be the primary source for information should the university's operating schedule change. In addition, a recorded message announcing a change in normal operation will be available at (828) 262-SNOW.

Weather and road conditions often vary significantly within this area, therefore, the decision whether to travel must rest with the individual as students are not to endanger their lives traveling to clinical placements. Clinical educators will notify the Department Chair and any graduate clinicians by preferred communication in the event that clients are being canceled.

The student clinician and clinical educator will discuss and implement the procedures to follow in case of inclement weather. The student is responsible for making these arrangements, which may include, but are not limited to:

Each Clinical Educator will determine individual course attendance and participation requirements and how these will be impacted by adverse weather. Students will be responsible for making up any clinical hours, missed activities, or assignments. In the event of extended inclement weather or in situations in which activities cannot be made up, the Clinical Educator, off-campus Clinical Educator, Director of Clinical Educator or the Graduate Program Director will work with students to develop alternative assignments to meet clinical requirements.

See Attendance Policy on page 15 for further details

Infection Control Policy and Procedures

The Appalachian State University Communication Disorders Clinics are committed to the delivery of quality healthcare to all clients.The program will provide training, resources, engineering controls, and personal protective equipment to promote safe work practices and to reduce hazards in the workplace.

Consistent with our dedication to provide the highest level of care to our patients, we are in compliance with OSHA Bloodborne Pathogen requirements.

All clinics will practice standard precautions to prevent contact with blood or other potentially infectious materials, to reduce the risk of occupational exposure, and to protect the client and others from exposure. In standard precautions any human extraction is treated as a potential danger. Students must adhere to the policies and procedures set forth regarding precautionary measures to be taken to minimize the risk of infectious transmissions.

Infection Control Training

All graduate student clinicians are required to complete the Infection Control Module and Online Quiz (posted on AsULearn under SLP Clinical Practicum) before starting clinic. Students must score 80% or better on the quiz to receive a passing score.

COUNCIL ON ACADEMIC ACCREDITATION (CAA)

Council of Academic Accreditation Standards (CAA) and Requirements

The Speech-Language Pathology Program follows the Council of Academic Accreditation Standards (CAA). The following standards are related specifically to clinical practice:

Standard 3.5B

An effective speech-language pathology program is organized and delivered in such a manner that the diversity, equity, and inclusion are reflected in the program and throughout academic and clinical education.

Standard 3.6B

The clinical education component of an effective entry-level speech-language pathology program is planned for each student so that there is access to a base of individuals who may be served that is sufficient to achieve the program’s stated mission and goals and includes a variety of clinical settings, populations, and age groups. The comprehensive clinical experiences must include direct contact with individuals seeking service, consultation, recordkeeping, and administrative duties relevant to professional service delivery in speech-language pathology.

Standard 3.7B

An effective speech-language pathology program ensures that clinical education is provided in a manner that supports student development so that each student is prepared to enter professional practice. The type and structure of the clinical education is commensurate with the development of knowledge and skills of each student.

Standard 3.8B

Clinical education is provided in a manner that ensures that the welfare of each person served by a student and clinical educator team is protected and in accordance with recognized standards of ethical practice and relevant federal and state regulations.

Standard 3.9B

Clinical education obtained in external placements is governed by agreements between the program and the external facility and is monitored by program faculty.

Standard 3.10B

An effective entry-level speech-language pathology program ensures that its students know the expectations regarding their exercise of the highest level of academic and clinical integrity during all aspects of their education.

Standard 4.3

The program has policies and procedures for identifying the need to provide intervention for each student who does not meet program expectations for the acquisition of knowledge and skills in the academic and clinical components of the program.

Standard 4.4

Students are informed about the program's policies and procedures, expectations regarding academic integrity and honesty, ethical practice, degree requirements, and requirements for professional credentialing.

American Speech-Language-Hearing Association (ASHA) Code of Ethics

Student clinicians are expected to adhere to the ASHA Code of Ethics and ensure the welfare of clients at all times. The principles of the ASHA Code of Ethics will be addressed throughout the graduate program in academic coursework and clinical rotations. Students are expected to become well-acquainted with the Code of Ethics.  Any questions or concerns regarding ASHA’s Code of Ethics can be discussed with the Director of Clinical Education or other faculty members.

ASHA STANDARDS AND IMPLEMENTATION FOR CERTIFICATE OF CLINICAL COMPETENCE IN SPEECH-LANGUAGE PATHOLOGY

ASHA Hours Requirements

According to the 2020 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology, students must complete a minimum of 400 clock hours of supervised clinical experience in the practice of speech-language pathology. Twenty-five hours must be spent in clinical observation, and 375 hours must be spent in direct client/patient contact (At least 325 of the 400 clock hours must be completed while the student 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).  Direct client contact is defined as face-to-face diagnostics or treatment with individuals or groups. Activities such as telephone contact, planning, record keeping, travel, and administrative activities are not considered direct client contact. If in doubt, the student may ask the clinical educator in charge of the case or the Director of Clinical Education.

ASHA specifies that supervised practicum must include experience with client populations across the lifespan and from culturally/linguistically diverse backgrounds. Practicum must include experience with client populations with various types and severities of communication and/or related disorders, differences, and disabilities. The Internship Coordinator and the Director of Clinical Educator will work diligently to ensure that students get the required experiences.

In addition, students must demonstrate, as outlined in the Knowledge and Skills Acquisition (KASA) Standards, including knowledge of basic human communication and swallowing processes, including their biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases, and 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.

Council for Clinical Certification in Audiology and Speech-Language Pathology Requirements

“The Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) is a semi-autonomous credentialing body of the American  Speech-Language-Hearing Association (ASHA). The charges to the CFCC are to define the standards for clinical certification; to apply those standards in granting certification to individuals; to have final authority to withdraw certification in cases where certification has been granted on the basis of inaccurate information; and to administer the certification maintenance program.” The SLP Clinic and program adhere to the  CFCC Standards and Requirements.

Reference: 2020 Certification standards in speech-language pathology. (n.d.). Retrieved May 30, 2019, from https://www.asha.org/Certification/2020-SLP-Certification-Standards/#4

CLINICAL HOURS

Observation Hours

All students accepted into the SLP Graduate Program must complete 25 guided observation hours as required by ASHA prior to beginning clinicals. If you have not completed your 25 guided observation hours further direction will be provided prior to beginning clinicals. Verification of these hours is completed by the end of July. These hours should be signed by the supervisor and include the supervisor’s ASHA number.

In accordance with the 2020 standards, CCC-SLPs who are clinical educators/supervisors involved in the clinical preparation of student clinicians must meet the following requirements: a) current CCC-SLP, b) 9 months of full time, post-certification clinical experience, and c) completed 2 hours of professional development in supervision.

OBSERVATION OF CLINICAL ACTIVITY

Only authorized persons may observe clinical activity. Such persons include Communication Disorders clinic staff, students in training (enrolled or not enrolled in Clinical Practicum), family of the client, and others approved by the client or responsible party. Students in training must have the clinical educator's approval prior to observing. The number of observers will be strictly limited because of restricted observation space. Efforts are made to provide for videotaping of sessions to increase observation capability for students in training. Student clinicians cannot have family or friends observe their therapy setting without the permission of their Clinical Educator.

CALIPSO - Documenting hours

Clinical Assessment of Learning Inventory of Performance Streamlined Office Operations (CALIPSO) is a web-based application that manages key aspects of academic and clinical education. Following admission into the graduate program, each student must register in CALIPSO prior to starting his/her clinical practicum experience. Practicum registration requirements, observation hours, direct contact hours, and academic competencies are all tracked in CALIPSO. Students are expected to follow the CALIPSO Student Instructions provided during Clinical Orientation, which provide detailed instructions about how to register in CALIPSO, enter daily clock hours, and view performance and cumulative evaluations. Students are required to input their clinic hours at least weekly unless otherwise stated by their clinical educator. Please keep in mind that some clinical educators require that you enter your hours into CALIPSO daily. You should plan accordingly. If your hours are not entered into CALIPSO as prescribed by your clinical educator, the clinical educator may not approve them.

Keep in mind that confirmation of clinical clock hours is required when applying for ASHA certification; therefore, it is important to maintain accurate daily logs. Student clinicians may earn clock hours only for the portion of time they are actively participating in providing services to a client. Only direct contact spent with the client or client’s family in assessment, management, and/or counseling can be counted toward clock hour requirements. Critical aspects of clinical management, planning, preparation, report writing, language sample analysis, etc., are not accepted activities toward required clinical clock hours by ASHA standards, but students should take every opportunity to gain knowledge in these areas as they are considered part of the comprehensive clinical experiences. According to ASHA: “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.” As required for North Carolina licensure, 50% of each diagnostic must be supervised. The clinical educator for the off-campus site will approve clinical hours as appropriate via Calipso, the web based program the program uses to track student clinical hours. In accordance with North Carolina law, the clinical educator must be on-site and accessible.

Students should expect to accrue at least 50 hours each semester as part of their practicum and 150 - 200 clinical hours during their internship. Students’ experience may vary depending on their placement and supervisor. Students should take every opportunity to gain as much experience as possible in as many different areas as possible throughout the semester. 

When recording clinical hours, students should consult their supervisor. Pay close attention to opportunities to serve clients/patients in low incidence populations, such as fluency, voice, hearing, AAC, and resonance.

Login: https://www.calipsoclient.com/appstate/account/login

NORTH CAROLINA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGIST AND AUDIOLOGIST (NCBOESLPA) Clinical Hour Requirements

If a student is planning on becoming licensed in NC, he/she should become familiar with the North Carolina Board of Examiners for Speech-Language Pathologists and Audiologists General Statutes. If a student is planning on applying for licensure in another state, he/she should review that state’s licensure requirements. If a student has a question regarding licensure, he/she should contact the Director of Clinical Education.

Students who drop or make an unsatisfactory grade in a clinical practicum course may not count clinical clock hours obtained in any area during that semester.

PROCESS FOR DETERMINING CLINICAL PLACEMENTS

The program has developed a comprehensive plan for making clinical assignments. Clinical practicum and internship allow students the opportunity to integrate information learned academically into clinical practice. Students will receive experience in a variety of clinical settings, such as, at University Hall, private practice, skilled nursing facility, hospital, home health and a school. Students cannot earn hours at a clinical site unless they have already completed or are in the process of completing academic coursework in a specific area.

Students receive information early in their program about the types of sites they will be assigned to accrue a variety of experiences with clients across the lifespan and from linguistically and culturally diverse populations. Prior to assigning off-campus placements, students are queried regarding their interest areas. When appropriate and if possible, student preferences for particular sites or types of sites are considered. Each semester the Director of Clinical Education monitors the students' clinical experiences to ensure they have an opportunity to experience the breadth and depth of clinical practice. This includes monitoring experiences with different populations, work settings, administrative duties, recordkeeping, consultation and exposure to a variety of resources and equipment.

The Director of Clinical Education and the Internship Coordinator meet with students each semester to discuss possible clinic placements for the upcoming semester and for their internship (last semester of the program). Students have the opportunity to modify their previously stated preferences.

Prior to making a placement, the Director of Clinical Education verifies (1) that the supervisor meets ASHA requirements for supervision and holds a current state license, and (2) that a current affiliation agreement is in place for the site. The Internship Coordinator or Director of Clinical Education then contacts the site representative or supervisor to determine if a placement is possible. When a site has taken our graduate students in the recent past, we review the site and supervisor evaluations completed by students, together with information provided by the site and our CALIPSO database concerning caseload, clinical population, and depth and breadth of experiences offered to students at the facility. If all documentation is in place and there are positive outcomes from previous experiences, then the placement is finalized. When the site is a new facility for the program, we collect information regarding clinical populations and personnel. This is typically completed via email and by phone to determine the suitability of this site for the needs of the student and the program. Once every aspect of the placement has been verified, the student is matched with the site.

Students are assigned to clinical practicum and internship sites based on their previous academic and clinical experience. Supervisors are informed prior to the beginning of the clinical experience of the student's clinical training status (i.e., first, second, third, or fourth clinical practicum), the classes that have been completed, current coursework, experience with the population assigned, and previous clinical experience. At a minimum, students are supervised 25% of all treatment sessions and 50% of each assessment, per NC state requirements. Supervisors use their clinical and professional judgment based on the population served, setting requirements, and student performance to ensure that specific needs are met for each individual client.

Selection of External Clinical Sites

In order to place students in external facilities, initially the Director of Clinical Education examines previous CALIPSO records to determine the types of hours students receive at each site on a semester-by-semester basis. If a site has not been previously used, the Director of Clinical Education meets with the supervising SLP to determine what types of clinical experiences and the amount of supervision students can expect to receive. Each semester it is confirmed that the supervising SLP at each external clinical site has up-to-date professional credentials (ASHA card and state SLP license) and has met other ASHA requirements for supervision. Additionally, students complete evaluation forms at the end of each semester in which they rate the quality of the clinical supervisor/supervision at the site. Students' evaluation responses are monitored to ensure that supervision is adequate. If student evaluations or other reports from students indicate subpar supervision or inadequate clinical experiences, the Director of Clinical Education communicates with the supervising SLP to determine whether modifications can be implemented to address the concerns. If the Director of Clinical Education determines that deficiencies cannot be adequately addressed, then the site is no longer used for student placements.

Practicum Placements

Students are assigned to their clinical practicum by the Internship Coordinator and the Director of Clinical Education who will review each student’s clinical log on CALIPSO and meet with students one-on-one to determine the student’s next clinical placement. Students are informed of their clinical placement at least one week prior to the start of that semester.  

Internship Placement

Students will attend an internship meeting during their first semester and each subsequent semester at which time the process for internship will be discussed. We recognize that some students would like to stay in the area and work after graduation. Thus,they often request that their internship is “local”. However, clinical sites that are used for practicum sites may not be used for internships unless the site is not needed for a practicum site during that semester. For example, students should not request an internship at Catawba Valley Medical Center in Hickory because the site is used each semester for practicum. In addition, students cannot request an internship placement with any conflict of interest, such as family, friends, or former colleagues working in the same facility. If a student has a specific request, he/she should discuss it with the Internship Coordinator and/or the Director of Clinical Education.

GENERAL CLINIC SYLLABUS

Attendance policy

Students are required to attend all scheduled sessions or days. Failure to comply with the attendance rule may result in an unsatisfactory grade in clinic. Student clinicians should obtain permission from their clinical educator(s) and the Director of Clinical Education or the Internship Coordinator if a necessary absence requires canceling a therapy or diagnostic session. Students may be asked for documentation concerning any missed clinical time. Any such missed sessions may require a make-up session at a time convenient to all parties during the term in which the absence occurs. Substitution by another student clinician is permitted if approved in advance by the clinical educator in charge of the case.

If a student's clinical supervisor is absent, the student is expected to make every effort to arrange a make-up day for the missed clinical experience. The student should coordinate with both the clinical site and the program to find a suitable time to complete the missed hours. It is the student's responsibility to ensure that all required clinical hours are fulfilled to meet program requirements.

In the event of any unforeseen issues with clinical sites, including but not limited to site closures, unavailability of a clinical supervisor, or other unexpected circumstances, the situation will be addressed on a case-by-case basis. The program will work closely with affected students to identify alternative arrangements and ensure that they are able to fulfill their clinical requirements. Every effort will be made to minimize disruptions to the student's clinical education while maintaining the integrity and quality of their training.

Students are allowed at least 2 days per academic year for religious observances. Up to two absences for such observances will be excused, without penalty to the student, provided that the student has informed the Director of Clinical Education  at the beginning of the semester so that arrangements can be made with the clinical educator(s) supervising the student. Students are encouraged to make up any days missed due to religious observances.  

Name Badge

All students are required to wear a professional name badge at all times in clinic. The SLP program provides a name badge to students providing identification as a student clinician. There is a charge for badge replacement.

Professionalism and appropriate dress

Student clinicians and student observers are expected to dress appropriately for a work environment. Appropriate dress should be modest and professional and care should be taken so that clothing is not potentially embarrassing for the client or clinician. Shoes or sandals must be worn. Clothes that are in nice condition (e.g., not frayed or torn) should be worn. Specifics about dress code depend on the clinical educator and site. The clinical educators in charge of the cases reserve the right to make final decisions concerning appropriate dress. Tattoos that contain potentially offensive messages should be covered. Distracting piercings and jewelry should be removed. Hair should be a natural color and makeup/nails should be reasonable. There should be no visible undergarments, cleavage or low cut tops, and no midriff or back showing. Additionally, student clinicians should not chew gum when providing clinical services.

Olfactory Sensitivities

Due to chemical sensitivity of some clients/patients/students, scented hand lotions, perfumes, and aftershaves are not recommended.  

Food/Beverages

Water is the only acceptable beverage in any clinical session unless food/another beverage has immediate relevance to the activity being conducted. Clinicians should not share food with clients including candy unless approved by their Clinical Educator.

Cell Phones/Computers/Electronics

Cell phones must be set to vibrate during clinical placement. Students may only use computers at the placement site for data entry, professional notes or other tasks assigned specifically by the Clinical Educator. It is recommended that students wear a watch in clinic. Smart watches are permitted as long as they are kept on silent and aren’t distracting. Specific electronic policies may vary per clinical educator and specific clinical placement.

The clinic telephone is for business use only. The phone in the Professional Preparation room at UH is to be used for calls to clients. This phone can be used to call clients long distance. To remain compliant with Health Insurance Portability and Accountability Act (HIPAA) standards, do not use a client’s full number in emails, initials, address or any other personal information. Discuss with your supervisor how he/she would like for you to refer to clients if emailing.

More information about HIPAA standards can be found here: HIPAA.GOV

Email/Mail Policy

Email should be checked daily. You may receive information regarding client cancellation via email. You should only use your App State email address for clinical emails. Mailboxes for student clinicians are located in the Student Lounge (University Hall room 107). They are to be used for communication between students and the professional staff of the clinic. Other information regarding clinical practicum will be made through email communication.

Social Media/Best Ethical Practice Guidelines

Networking is an important part of working in the field of speech-language pathology; however, during your clinical experience it is important that you begin appropriate, professional, and ethical habits that you follow throughout your career. It is recommended that as a graduate student you comply with the following guidelines:

AI USAGE POLICY

This policy outlines the appropriate use of Artificial Intelligence (AI) in clinical settings within the Speech-Language Pathology (SLP) program at Appalachian State University. AI tools may be utilized to enhance clinical education and patient care, provided their use aligns with the following guidelines.

VACCINATIONS/CPR TRAINING

Hepatitis B Vaccine

Student clinicians will be offered the Hepatitis B series of vaccination through the Appalachian State University Health Services at a nominal charge.

PPD  Skin Test

To participate in the clinic, you will need to have a test for TB completed (or have had one recently/within the last year) and send a copy of the negative results. A copy must also be uploaded into Calipso. If a student has a positive test on the PPD, they must supply the clinic with proof of a clear chest x-ray or other appropriate treatment in order to participate in clinical activities. Note that some clinical sites require a 2-step TB test. Your PPD must remain current throughout your graduate program, including internship.

CPR Training

All graduate student clinicians must have cardiopulmonary resuscitation (CPR) training. The training is set up by the SLP program and is good for two years. Your certification must remain current throughout your graduate program, including internship.

First aid kits are available in the following locations: Clinic Office at UH and LLS, Audiology Suite, and Preschool Language Classroom. Each kit contains emergency phone numbers, including Appalachian State University Police, Poison Control, Boone Fire Department, and emergency response agencies; adhesive bandages; gauze pads for covering wounds; cloth tape; antiseptic wipes for cleaning wounds; antiseptic cream; ammonia capsules; and disposable mouth pieces for rescue breathing. In the event that items are used from one of the kits, please notify the clinic office so they can be replaced.

An Automated External Defibrillator (AED) is located for easy access in the Communication Disorders Clinic, as well as, on each floor by the elevators in LLHS. Only trained personnel should use it.

Initial Criminal Background Check

In accordance with the  BCBS Criminal Background Check Policy, the Speech-Language Pathology graduate program requires all students to complete a criminal background check (CBC) prior to their first semester of classes.  In order to maintain privacy of student information, the CBC process is coordinated by a designated staff person in the BCHS Dean’s office (the CBC Coordinator). 

Following admission to the program, the SLP Director of Clinical Education and/or the SLP Program Director will provide students with the website link to the BSCH criminal background check portal. Students will then sign up to complete the background check and complete all requirements. For this first CBC, students should list CSD 5561 as the associated course. Students are responsible for this cost.  If a student’s CBC indicates a serious past offense, then the CBC Coordinator will notify the SLP Director of Clinical Education and she/he will review the CBC findings with the Department Chair and Graduate Program Director. 

The following offenses may be deemed to render a student unsuited for direct client care and may result in dismissal from the program: violent crime, criminal sexual conduct, criminal domestic violence, assault and battery, unlawful neglect of a child or helpless person, abuse of children or incapacitated persons, abuse or physical violence to a client or patient, administering or attempting to administer poison, and unlawful and malicious tampering with a human drug product or food.  Other serious offenses will be evaluated on an individual basis, and may result in dismissal from the program.  

Any student who intentionally provides false or incomplete information for the CBC will be dismissed from the program.

If a student is convicted of an offense after the CBC is completed, then the student must notify the Director of Clinical Education immediately.  

The complete SLP Policy for Student Criminal Background Checks can be found here.  

Other site-specific requirements

Some facilities may require students to update their criminal background check prior to placement. In addition, many clinical sites require students to complete a drug screening, flu shot, or other vaccinations. Most drug screenings must be obtained shortly before the placement begins. Students are responsible for the cost of required screenings, vaccinations, and background checks if the clinical site does not cover the expense.

The Director of Clinical Education or the Internship Coordinator will notify students if there are additional requirements for a specific clinical site. Students may not begin any clinical experience until all site requirements are met. Failure to meet these requirements will result in the student being unable to participate in clinic for that semester.

Professional liability insurance

The state of North Carolina maintains a professional liability policy covering the professional staff employed by the Clinic. The Communication Disorders Clinic maintains a student liability policy, renewed each year, to cover practicum and internship experiences. The charge for coverage is included in the miscellaneous service fee.

Student Professional and Fundamental Requirements

Graduate clinicians are expected to develop and demonstrate the following professional and fundamental requirements during ALL courses of the clinical sequence:

CLINICAL EDUCATION STUDENT LEARNING OUTCOMES

  1. Screening/prevention – demonstrate ability to screen persons of all ages for communication disorders; engage in activities focused on prevention of communication disorders The student clinician must be able to differentiate and demonstrate the functions of screening and preventative activities.
  2. Diagnostics/Evaluation
  1. Demonstrate ability to identify important, relevant aspects of the case history/background information/relevant professional input
  2. Interpret test results and screening results accurately
  3. Conduct client/client family interview
  4. Administer formal & informal tests accurately
  5. Record responses of tests accurately
  6. Score tests accurately

The student clinician must be able to accurately administer a variety of norm-referenced and nonstandard assessments. The student clinician must be able to administer post-intervention measures for baseline comparison.

  1. Therapy/Intervention
  1. Demonstrate ability to determine content of a therapy session.– Write goals [within SOAP, SMART, goals/objectives/benchmarks/milestones]
  2. Implement activities/interactions
  3. Record client responses accurately
  4. Use appropriate cues/prompts
  5. Interpret performance data within and between experiences

The student clinician must be able to develop and implement an intervention/treatment plan including long term goal(s), short term objectives, and intervention strategies. The student clinician must be able to obtain baseline data, document patient/client performance, and provide accurate analysis of findings.

  1. Therapeutic Setting
  1. Demonstrates appropriate use of time, space and materials
  2. Able to engage client and maintain engagement
  3. Able to manage transitions
  4. Identifies and communicates clear expectations to the client
  5. Applies principles of counseling

The student clinician must be able to appropriately engage patients/clients in the therapeutic process.

  1. Demonstrate Professional Affect and Communication
  1. Follow procedures and meet deadlines as required
  2. Effective professional oral and written communication – effective speaking and listening; uses appropriate tone of voice and nonverbal expressions
  3. Use of professional grammar and appropriate terminology and language
  4. Ability to effectively write professional reports, SOAP, lesson plans, and progress reports
  5. Demonstrate good judgment and critical thinking – analyzes, synthesizes, interprets and discusses ideas and concepts appropriately in clinical settings
  6. Comply with administrative, legal, and regulatory policies of all agencies
  7. Interact in a generally friendly, polite manner
  8. Listen attentively to others in a variety of contexts
  9. Initiate communication to address professional issues

The student clinician must be able to demonstrate the ability to obtain an accurate case history and report diagnostic/therapy findings to family members and patients/clients. The student clinician must be able to demonstrate effective professional writing of diagnostic reports, intervention plans, progress reports, documentation [i.e. SOAP, IEP] .

  1. Demonstrates Collaboration – the ability to work with others
  1. Cooperates with others, contributes to group work, and supports the work of others
  2. Demonstrates understanding and application of inter-professional practices
  3. Willingly supports decisions of group, even if different from own
  4. Considers opinions of others with an open mind
  5. Demonstrates concern, consideration and respect for others
  6. Takes care of property of others
  7. Displays equitable treatment of others
  1. Approach to Learning
  1. Values knowledge, content, and experiences presented in preservice experiences
  2. Demonstrates positive attitude toward learning
  3. Takes initiative to expand knowledge base and learn new skills
  4. Uses credible and data-based sources
  5. Demonstrates accountability and follow-through
  6. Prepares appropriately to meet clinical responsibilities
  1. Flexibility and Maturity
  1. Identifies personal responsibility in conflict/problem situations
  2. Adapts communication style to needs of client (vocabulary, language level, nonverbal)
  3. Demonstrates accurate self-analysis regarding one’s own strengths and weaknesses and accepts consequences for personal actions or decisions
  4. Adapts to changes and unexpected or new situations
  5. Generalizes knowledge and skills in a variety of situations
  6. Accepts less than ideal situations when necessary

Expectations for SLP Graduate Program Clinic Seminar Meetings

In order to meet our responsibilities to provide quality professional education and to ensure that our graduates are able to function in a broad variety of professional situations, the Speech-Language Pathology Program has set forth additional clinical activities: the SLP Graduate Program Clinic Seminar Meetings.  Students will be given a schedule of events at the beginning of each semester. Students are expected to attend all clinic seminar meetings unless he/she has a clinical assignment at the same time. If this occurs, students should inform the Director of Clinical Education via email prior to the scheduled event.

TREATMENT/INTERVENTION AND EVALUATION PROCEDURES

For On-Campus Sites

Client Records

Appalachian State University is a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the individual identifiable health information relevant to a client is considered protected health information. In accordance with HIPAA, client records are confidential. They are not to be divulged to anyone other than personnel associated with the Clinics unless there is a signed written release. Such written releases are effective for one year from the date of signature, and may be revoked at any time by written directive from the client or responsible party. Graduate clinicians MUST complete the HIPAA training module and quiz on AsULearn prior to beginning their clinical practicum experience. Graduate students must score 80% or better on the quiz to obtain a passing score.

Client records can be accessed through uStor (see directions below). Student clinicians will also use uStor to write SOAP notes, treatment plans, progress reports, and any other official documents. Each on campus clinical supervisor will discuss with you how he/she would like for you to label and submit information via uStor.

Directions for Accessing uStor and uDesk

In order to access the uStor network from your personal computer, you will need to “map” the network to your computer using uDesk. By doing this mapping, you are essentially establishing digital pathways. Here are the directions for doing so:

Note: at some point in these steps, you will need to choose between 'client download' and 'html'. Choose 'html'.

1.    Helpful hint: Closing all applications, like email, Word, etc., except for a web browser, makes it easier to keep the uDesk virtual desktop separate from the desktop on your local hard drive. This helps you to avoid unintentional violations of the EPHI policies.

2.    From a web browser go to https://uDesk.appstate.edu

3.    Login using your Appstate credentials.

 4.   Once logged in, you will then click uDesk Student.

 5.   You will be presented with a virtual windows desktop.

 6.   Next, you will need to map to the uStor drives by right clicking on the This PC desktop icon and selecting Map Network Drive.

7.    In the "Map Network Drive" window, type \\uStor.appstate.edu\SLP and then click Finish.

8.  You will then have access to the clinical data as a mapped network drive.

9.  You will need to remap your drive each semester that you are on campus as you will have access to different drives each semester.

If you need technical assistance with mapping the uStor drives or accessing uDesk, you can call the Appstate Help Desk at (828) 262-6266.

Other information, such as correspondence with referral agencies, is maintained as it occurs. Each client contact, by whatever means, and entry or distribution of pertinent documents is to be recorded on the Progress Note form or Staff Note form and signed by the recording person. Clients generally have the right to review and obtain copies of their charts and to request in writing amendments to the information in the chart.

Records are maintained for screening services. These records include relevant data forms for the individuals served and an indication of recommendations (on individual forms or a group summary sheet).

Client records and test information are CONFIDENTIAL, legally binding documents. All client information, including test records, is to be kept in the client’s electronic chart at all times.

Evaluation

Audiologic evaluations should include at least the gathering of pertinent background information, an observation of speech and language skills, an attempt to obtain individual ear pure tone air conduction thresholds, bone conduction testing as indicated by air conduction results, speech recognition testing, visual inspection of the ears, and immittance testing. Sound field testing may be used in conjunction with immittance testing when the preferred test data cannot be obtained. Otoacoustic emissions or auditory brainstem response testing also may be attempted.

Speech and language evaluations should include at least the gathering of pertinent background data, attempts at audiometric and orofacial screenings, and testing or systematic observation in the areas of concern. A variety of assessment tools and strategies are used to gather relevant functional and developmental information. To the extent possible, standardized tests used should be reliable and valid according to the technical standards of test development. When appropriate to meet the needs of the client, the tests should be validated for the specific purpose for which they are used and should be administered in accordance with any instructions provided by the producer of the test. Formal or systematic informal audiologic screening for children three years of age or younger should be accomplished in the audiology suite under the supervision of a clinical audiologist. Audiometric screening for persons four years of age and older may be attempted in the speech-language evaluation with a portable audiometer.

Reports should contain a statement concerning the information given to the client and to the caregiver and family concerning the disorder. It should also contain a prognostic statement. If the client must wait for longer than one or two months for intervention, then alternative accommodations should be indicated on the report.  

Suggested formats for audiologic and speech-language evaluation reports are contained in Appendix A. Variations in the report may be made as the clinical educator deems necessary. For speech and language evaluations, a summary letter may be sent to the client, parents, or legal guardian. Consult with your clinical educator for deadlines and specifics regarding each report as each clinical educator may have different requirements.

Preschool screening process

Note: If not absolutely needed, the client’s full date of birth should not be used on the preschool screening forms (ASU University Attorney 2/19/2018)

 

Treatment/Intervention Plans

Intervention plans are to be prepared for any client who is receiving therapy services in the Communication Disorders Clinic. These reports should be completed four to six weeks following the client's second visit.  Client attendance may necessitate an extension of the date in individual cases. Discuss with your clinical educator the format of the plan and the dates he/she would like for you to complete the plan. The suggested formats for these plans and guidelines for writing clinical objectives are included in Appendix A. The Clinical Educator in charge of the case will determine if the report should be mailed to the parents or to any referring agencies, as indicated by the parent. There is some variability between clinical sites and educators regarding intervention plans. Check with your Clinical Educator to determine the expectations he/she has for you.

SOAP/Daily Notes

The SOAP/Daily note is the legal record of the client’s visit or other actions taken. It is used to document the diagnostic evaluation information and the client’s progress in therapy. Notes are used to document billable sessions, either diagnostic or treatment, or missed sessions, which would have been billable. The SOAP/Daily notes should contain a reason for a missed or canceled session. SOAP/Daily notes also include information regarding management of a client, including hearing aids, meetings with professionals from a child’s school, or other relevant meetings. Ideally, the note should be completed following the session and sent to your clinical educator for review.  

The student clinician should NOT sign the SOAP/Daily note. The case clinical educator will review the progress note and sign it with his/her full name and credentials.

If a mistake is made in writing the note or any other note in the client chart, the case clinical educator should make a single line through the note and initial and date the error. The note, including the mistake, should still be readable.

More information about SOAP/Daily notes can be found in Appendix A.

Lesson Plans

Lesson plans should be detailed and cover the therapy scheduled for the following week. The lesson plan should be given to the clinical educator according to the schedule determined by the clinical educator and the student clinician. If the lesson plan requires revision, this should be done in a timely manner. Sample lesson plan forms are in Appendix B. 

Progress reports/discharge summaries

Progress Reports and Discharge Summaries detail progress in therapy and recommendations for continuation of treatment, dismissal from services, or referral to another professional or agency. This progress report is done each semester for a client receiving services in the Communication Disorders Clinic. Recommendations other than continuation or dismissal because goals are met must have reasons documented in either the Progress Toward Goals or Clinical Impression section of the report. Discussion of progress should clearly indicate a need for continued therapy, and discussion of prognosis should clearly indicate potential to profit from continued therapy, if such is recommended. Progress Reports and Discharge Summaries are to be completed (with signatures) and ready for mailing by the end of the work day on the last day of classes each semester. These data, and the date for submitting drafts to clinical educators, are given to student clinicians at the beginning of each semester. Suggested format for these reports is included in Appendix A.

PROCESSING OF REPORTS

Intervention Plans, Evaluation Reports, Progress Reports and Discharge Summaries must be typed. Computers are available in the Professional Preparation room (University Hall room 122). The Professional Preparation room is open anytime the Clinic is open. If a student experiences difficulty with the availability of computers in the Professional Preparation room, the Director of Clinical Education should be notified.

The first page of the final copy of all reports must be formatted to appear on Clinic letterhead stationery (8 lines from the top of the page, if using a font size of 12). Additional pages should be formatted for plain stationery (3 lines from the top of the page) with the correct header in the top left corner of the page. Paper clip (do not staple) the pages of a completed report.

When a report draft is ready for the clinical educator to review, it should be submitted to the case clinical educator. Inclusion of the client chart and other information is at the clinical educator's discretion. All audiologic reports are placed in the client chart and placed in the designated area of the Clinic Office. The clinical educator will return the reviewed draft to the student clinician. This process continues as needed until the final copy of the report is signed. Final copies should be carefully proofed by the clinical educator and student. Copies of the report that are to be sent to other agencies should have a current signed release form. Release forms should be updated every twelve months. Signed final copies of the report should be submitted to the Office Staff.

PRIVACY AND CONFIDENTIALITY POLICIES

Confidentiality

In accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the ASHA Code of Ethics, all information concerning past and present clients is strictly confidential. The following information is not to be divulged to anyone without permission: name of client, nature of the problem, family information, recordings of the client’s speech, lesson plans, test results, observation reports, any draft of clinical reports. Students should be careful to avoid the following circumstances which may lead to violations of confidentiality: conversations with other professionals not involved with the client; taking materials pertinent to a client out of the clinic; reports, lesson plans, or other materials left in a notebook or on a table where others may read them; and conversations in the Clinic which may be overhead by other people.

Student clinicians may work on reports at home using uStor. Students should not remove any records, including test protocols, from the client charts in the Clinic. No client information should be stored on a hard drive.

Students who violate the privacy or security of protected health information will receive a reprimand and reduced scores for appropriate sections of the clinical outcomes. For severe breaches of confidentiality the student will be removed from the practicum course with a failing grade.

Electronic Medical Records (EMR)

The Clinic uses CureMD to store all client files and bill for services.   Each Clinical Educator bills for their clients. Student clinicians may be given an overview of the system at the discretion of the clinical educator.

STUDENT AND SUPERVISOR EVALUATIONS

Evaluation of Clinical Faculty

Clinical faculty members are evaluated by student clinicians near the end of each semester during the time when course evaluations are being conducted. These evaluations are anonymous, and the summaries of results are provided to the clinical educators after practicum grades are turned in (usually the early part of the following term). These evaluation summaries are provided each term to the Department Chair, for purposes of annual evaluation of clinical staff who are primarily teaching faculty.  

Evaluation of clinical faculty members includes both a formative and summative component. It is important to assist students in learning to develop appropriate professional relationships, including the provision of feedback to the clinical educator concerning their performance and ways to assist students in the clinical process.

A component of the reappointment process, as well as contract renewal, is the assessment of performance and accomplishments related to “clinical teaching.” Measures of clinical teaching effectiveness consist of a variety of strategies that are dependent upon qualitative and quantitative data that compose a personal portfolio of accomplishments and growth in this area.

Evaluation of Student Clinicians

Clinical supervision is a collaborative process between supervisor and supervisee with the eventual goal of student independence and professional knowledge that will effectively serve clients with communication disorders. Supervision exists on a continuum beginning with significant levels of direct feedback provided by the supervisor and transitioning through a collaborative stage to the eventual goal of self-supervision. Students meet regularly with their clinical supervisors.

Student clinicians may be provided with feedback each time they are observed. They also are evaluated at midterm and at the end of each semester via Calipso. The midterm evaluation is for the purpose of determining skill level and developing clinical performance goals for the semester.

The Clinic Director or designee will be responsible for conferencing with all clinical educators to determine student progress in their clinical practicum assignments. Student clinician progress will be reviewed throughout the semester during Clinical faculty meetings as a means of monitoring student progress.

Discussion with a student who is having difficulty should take place with the clinical educator to clarify concerns. The clinical educator and student clinician may develop a list of objectives to remediate the concern.  After multiple attempts to provide guidance in shaping the competency, the clinical educator may present the concern at the Clinical Faculty meeting. The clinical educator may present concrete examples of issues that interfere with clinical performance. Other clinical educators may comment on observations regarding the competencies of concern. Further strategies may be suggested to further address the student’s difficulty toward successful development during the semester.

It is the responsibility of clinical educators to identify student clinicians who are not meeting the practicum outcomes. The above plan for students who are experiencing difficulty in practicum should have been followed and documented. However, if concerns continue to be evident, the clinical educator should notify the Director of Clinical Education to describe the difficulties. A meeting with all clinical educators assigned to the student clinician during the semester, as well as the student clinician, should be held to outline the specific concerns and to list possible objectives to remediate the problems.

A remediation plan is devised to assist the student in attaining the objectives, including a timeline toward completion. Completion of the plan must be met in the semester following the development of the plan as a part of practicum assignments. Failure to complete the plan by the end of the following semester would result in a failing grade for clinical practicum and possible removal from the program.

If the student clinician does not agree with the proposed plan, the student should schedule a meeting with the Director of Clinical Education to discuss the problem. If after meeting with the Director of Clinical Education, the student’s dissatisfaction continues, the student will meet with the Graduate Program Director and/or the Department Chair, following the Conflict Resolution Policy.

In response to our ethical obligations to avoid exploiting students, any decision regarding the fitness of any students to continue training as a speech-language pathologist must be made in consultation with the Director of Clinical Education, Clinic Director, and/or Graduate Program Director.  

INCOMPLETE GRADE POLICY

Grades of “I” are to be determined on an individual basis and following Graduate Program policy. Therefore student clinicians cannot receive an incomplete if forms are not turned in on time. The student will receive a grade of “U” if all paperwork is not completed. The period of time before a grade of “I” defaults to a grade of “U” is one semester. Students do not re-register for a class in which a grade of “I” was earned.

A student receiving a grade of “I” may count the clinical clock hours earned during the semester. A student receiving a grade of “U” or dropping a clinical practicum course may not count the clock hours.

If a student’s Clinical Educator requests that a student be removed from a site due to academic, clinical, or professional reasons, the student will either receive a grade of “I” or “U”. Situations will be reviewed on an individual basis.

STUDENT CLINICIAN MEETINGS

Prior to beginning clinical practicum, all graduate students are required to attend the clinic orientation meeting. The time and location are determined when semester course schedules are being prepared. Other student clinician meetings may be called during the semester.

Many practicum sites require meetings prior to beginning the rotation. If a student misses a required meeting, then it is at the discretion of the Clinical Educator to allow the student into the practicum. Student clinicians should work cooperatively with their Clinical Educator for determining meeting locations and times prior to the beginning of each semester.

ESSENTIAL FUNCTIONS FOR THE SLP GRADUATE CLINICIAN 

Statement of Policy

The Department of Rehabilitation Sciences offers undergraduate and graduate programs to prepare individuals for clinical practice as speech-language pathologists. Speech-language pathologists provide diagnostic and therapy services to infants, children, and adults with speech, language, hearing, swallowing and cognitive communication disorders. Undergraduate and graduate students in SLP must have the intellectual and academic capabilities sufficient to meet the curricular demands of the programs, be proficient in oral and written English, and possess certain dispositions, behaviors and essential functions that are expected of professionals engaged in clinical practice. See the SLP Program English Proficiency Policy for more information.

Required Professional Dispositions, Behaviors, and Essential Functions

The Council of Academic Accreditation of the American Speech-Language-Hearing Association (ASHA) accredits professional training programs and requires that program graduates be qualified to deliver entry-level clinical services. Accredited programs must provide evidence that their graduates have acquired the knowledge and skills necessary for the Certificate of Clinical Competence and possess the professional dispositions, behaviors and essential functions for clinical practice. SLP students are expected to progress from awareness and understanding to demonstrating, mastering and integrating the following Professional Dispositions, Behaviors and Essential Functions. These are required for successful progression through the undergraduate and graduate programs in Speech-Language Pathology Program and Speech Language Pathology.

  1. Professionalism: The ability to maintain appropriate hygiene, dress, and demeanor and to follow program policies and procedures.
  2. Collaboration: The willingness and ability to work together with students, faculty and clients.
  3. Honesty/Integrity: The ability to demonstrate moral excellence and trustworthiness. Also see the University's Student Conduct page for University standards.
  4. Respect: The ability to demonstrate consideration and regard for self and others regardless of ethnicity, age, sexual orientation, gender, or religious affiliation. The University’s EEO statement specifies non-discrimination on the basis of “race, color, national origin, religion, sex, gender identity and expression, political affiliation, age, disability, veteran status, genetic information or sexual orientation.” Also see University Policy 602.1 at http://policy.appstate.edu/Equal_Opportunity
  5. Reverence for Learning: Be able to demonstrate reverence for knowledge, experience, and being prepared for academic and clinical responsibilities.
  6. Emotional Maturity: The ability to control emotions by exhibiting appropriate social behavior in the classroom and clinic and during other program activities and interactions.
  7. Flexibility: The willingness to accept and adapt to change. The student is expected to have the flexibility to function effectively under stress; that is, the individual is expected to be able to learn to adapt to changing environments, to display flexibility and to learn to function in the face of uncertainties inherent in the clinical problems of many clients.
  8. Sensory/observational/modeling skills: The ability to recognize typical and disordered fluency, articulation, voice, resonance, respiration, oral and written language, hearing and balance, swallowing, cognition and social interactions related to communication. Also, the ability to model target behaviors related to voice, articulation, fluency, and resonance.
  9. Communication skills: The ability to demonstrate social awareness and the communication skills (including written, verbal and nonverbal) necessary for establishing rapport with clients, conducting clinical sessions, counseling clients and interacting with colleagues, faculty, and other professionals.
  10. Motor-coordination skills: The ability to perform the physical activities and examinations necessary to make diagnoses, manipulate and use necessary equipment without violating testing protocol and with best therapeutic practice. Sustain necessary physical activity required for classroom and clinical activities. Be responsible for transportation to clinical and academic placements.

Accessibility of Programs to Qualified Individuals with Disabilities

Statement of Policy

Consistent with Section 504 of the Rehabilitation Act of 1973 (Section 504) and the Americans with Disabilities Act of 1990 (ADA), it is the policy of Appalachian State University that no qualified individual with a disability shall be excluded from, denied the benefits of, or be subjected to discrimination in any university program, service or activity. In accordance with Section 504 and the ADA, all applicants for the SLP program must be qualified individuals who are able to meet the essential competency requirements of the program, with or without reasonable accommodations.

The SLP program is committed to providing access to its programs to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. However, the program is unable to make accommodations that impose an undue burden, present a threat to the health or safety of the individual or others, or fundamentally alter the nature of the academic or clinical curriculum. Individuals who believe they qualify for accommodations should contact the Office of Disability Resources.

SLP Students Remain Subject to Other Policies, Regulations, and Laws 

In addition to satisfying the Professional Dispositions, Behaviors, and Essential Functions set forth in this policy, all SLP students remain subject to all other academic standards established by the SLP program; as well as to all policies, regulations, and laws applicable to all Appalachian State University students, including but not limited to the University’s Code of Student Conduct and Code of Academic Integrity.

Student grievance policy

Students who are dissatisfied with decisions regarding course concerns, final course grades, Academic Performance Reviews, or termination from the SLP Program are expected to follow University-wide and SLP program grievance procedures.

Students may have concerns in a clinical course that are not related to a final grade.  When these concerns arise, students are encouraged to address their concerns directly with their clinical supervisor or the Director of Clinical Education. If the concerns are not addressed to the student’s satisfaction, then the student may address these concerns with the Department Chair. Students should refer to the SLP Graduate Student Handbook for additional information and specific steps that should be taken.

Please note: The Appalachian State University Speech-Language Pathology Program website, student graduate program handbooks, and clinical handbook  are intended for information purposes only and do not constitute a contract between the University and the student. While the program website presents policies and programs as accurately as possible, the program reserves the right to revise any section or part without notice or obligation.

THE NEXT STEPS

NC Board of Examiners for Speech-Language Pathologists and Audiologists Licensing (NCBOESLPA) Requirements

At the end of your clinical and academic experience, you will be eligible to apply for your Supervised Experience Year (SEY) temporary license with the NCBOESLPA. The program is set up to ensure that all students meet the clinical hours experience. If a student is not planning on staying in NC for his/her SEY/CFY, he/she should read the requirements from the state to which they want to reside and work. If a graduate student is planning on completing his/her SEY in NC, he/she should reference the NCBOESLPA Licensure Statute.

Here are the qualifications for applicants for temporary licensure in NC.

  1. To be eligible for temporary licensure an applicant must:
  1. Meet the academic and clinical practicum requirements of G.S. 90-295(1), (2), and (3); and
  2. Submit a plan of supervised experience complying with the provisions of G.S. 90-295(4); and
  3. Pay the temporary license fee required by G.S. 90-305(5).
  4. A temporary license is required when an applicant has not completed the required supervised experience and passed the required examination.
  5. A temporary license issued under this section shall be valid only during the period of supervised experience required by G.S. 90-295(4), and shall not be renewed. (1975, c. 773, s. 1; 1987, c. 665, s. 6.)

For more information see the NCBOESLPA Temporary License Page which includes Instructions for Temporary License.

Reference: http://ncboeslpa.org 

APPENDICES

APPENDIX A

SOAP Note Format

S (SUBJECTIVE): Describe your impressions (give examples of what you observe) of the client’s behavior, attitudes, or emotional states that affected the session in the subjective section. Write comments (use direct quotes) from the client or other pertinent individuals (e.g., teacher, parent, spouse, etc.) regarding information received.

        

O (OBJECTIVE): Write measurable information in the objective section.  This information is based on the goals you are targeting. Include prompts, cues and level of support needed. You should give the number of trials and percentages when applicable.

A (ASSESSMENT): Describe your analysis of the session and whether criteria was met. You may also compare the client’s performance across sessions.

P (PLAN): Outline the course of treatment based on prior information in the plan section. The plan should be specific.

SOAP Note Examples

Example 1 (articulation goal)

Client’s Target Goal: In response to an adult model, Brock will produce the /r/ phoneme in the medial position of a word in 36 out of 40 trials (90% accuracy) during one session, over three consecutive sessions in one week.

S:  The client was cooperative and attentive during the therapy session and willingly attempted different therapeutic strategies given.

O: The clinician provided moderate phonemic cues (50% of the time) and modeling while targeting the /r/ phoneme in the medial position of a word. The client completed with 25 out of 40 trials (63%) accuracy.        

A: The client has not met criteria for producing the /r/ phoneme in the medial position of single words in the second of three sessions. The client increased correct production when moderate phonemic cues were given in addition to modeling.

P:  Continue current treatment activities. Continue training production of /r/ in the medial position of words at the imitative level.

Example 2

S: The patient needed to be coaxed into entering the therapy room initially. She participated with enthusiasm throughout the remainder of the therapy session.

O: GOALS: The client will correctly use syntax in her conversational speech. The client used incorrect syntax once in the session (don’t instead of doesn’t). The client will reduce the phonological process of cluster simplification by spontaneously producing the /s/ sound in blend words in conversational speech. The client correctly produced the /s/ sound in blend words in conversational speech spontaneously 39 out of 42 times (93% accuracy). After verbal cues from the clinician, the client increased her correct productions to 40 out of 42 times (95% accuracy).

A: The client independently produced the /s/ sound in many blend words in conversational speech successfully throughout the session. If the client deleted the /s/ sound, the clinician repeated the production with a quizzical look and rising intonation (“pider?”) to elicit a self-correction. This method appeared effective in eliciting a self-correction from the client (“spider”). If the client used incorrect syntax, the clinician provided her with a verbal model to imitate (“Tell me, ‘he doesn’t eat strawberries’”). The clinician provided the client with specific positive feedback in order to increase her motivation and self-confidence as she participated in planned therapy activities.

P: Continue therapy on January 28th, 2020 with a target on decreasing the phonological process of velar fronting by correctly producing the /k/ sound in all positions of words and increasing the correct use of syntax in conversational speech.

APPENDIX B

Lesson Plan Example

Objectives

Methods

Tuesday Activities

Tuesday Materials

1) The client will reduce the phonological process of palatal fronting by correctly producing the /sh/ sound after a prompt from the clinician in all positions of words.

2) The client will correctly use syntax in her conversational speech.

 

 

The clinician will begin and

end each session with amplified auditory stimulation using the /sh/ sound in all positions of words.

The clinician will incorporate recasting to address the client’s incorrect use of  pronouns. For example, if the client said, “Me want the puzzle”, the clinician would say, “I want the puzzle. Tell me I want the puzzle”, emphasizing the correct pronoun.

The clinician will use /sh/ sound pictures to elicit correct productions of the sound in words. If the client does not correctly produce the /sh/ sound in words, the clinician will provide  verbal-visual cues and, if needed, model correct productions and request imitation.

The clinician might provide a verbal prompt by imitating the client’s incorrect production with rising intonation and a quizzical look to elicit a correct production (“?”)

If the client does not self-correct after this verbal cue, the clinician will model the target word and request imitation from the client.

The clinician will consistently provide specific positive

verbal feedback to motivate and encourage the client’s

participation in correct production of the target sound in conversation.

The clinician will take every opportunity to produce correct syntax during all therapy activities. The clinician might also repeat the client’s incorrect use using rising intonation and a quizzical look to elicit a self-correction (“her go?”). If the client is unable to self-correct, the clinician will model the correct production and request the client to imitate.

Amplified auditory stimulation: The clinician will read a target word list for 1.5-2 minutes while the client engages in a quiet activity.

Craft: The client will make a fish craft. Each time she glues a decoration on her fish, she will produce 3 /sh/ words.

Go Fish: The client and the clinician will play Go Fish using /sh/ cards.

Fish and Say /sh/: The client will go fishing for words with the /sh/ sound in all positions. When the client catches a fish, she will produce the target word.

Chutes and Ladders: The client and the clinician will play Chutes and Ladders. To earn a turn, they will say an /sh/ word. 

Book: The clinician will read a book aloud to the client. During this time, the clinician will attempt to elicit spontaneous utterances from the client that include the use of syntax and words with the /sh/ sound

Bean Bag Game: The client and the clinician will take turns tossing a bean bag onto /sh/ cards. They will read the card the bean bag lands on.

Play-Doh: Time permitting, the client  will engage in imaginary play with the clinician while playing with Play-Doh. The client will be encouraged to make animals or items with the /sh/ sound.

Headphones

/sh/ word list

Elsa coloring page

Sequins

Pom-poms

Paper plate

Construction paper

/sh/ cards

Fish and Say /sh/

Chutes and Ladders

/sh/ cards

The Rainbow Fish

Bean Bag

/sh/ cards

Play-Doh

APPENDIX C

Therapy Plan Example

Therapy Plan

Name: E                                                                                     Responsible Party: Parents

Address:                                                                                      Type of Service: Phonology and Language        

                                                                                                           Treatment Schedule: 4x/week

Phone:                                                                                            Sessions Scheduled:  35 sessions                                                                

Date of Birth:                                                                             Report Date:  2018

Functional Categories:

Phonological Processing

Expressive Language

Functional Outcomes:

E will increase the intelligibility of her conversational speech.

E will use correct pronouns in her conversational speech.

Treatment Methodology and Rationale

The clinician will incorporate the Cycles approach (Hodson and Paden, 1991) to assist the child in acquiring developmentally appropriate phonological patterns in her speech. Each session will begin and end with amplified auditory stimulation. A different phonological process is targeted every two weeks, or four consecutive sessions.  The Cycles approach incorporates three elements: cyclical planning, amplified auditory stimulation, and production practice.

The cyclical planning component originates from the idea that phonological acquisition is a slow process. Intervention is divided into cycles that target individual phonological patterns and sounds within that pattern. For example, if targeting the phonological process of cluster reduction, therapy will focus on producing the /s/ sound in blend words such as, “slow”, “sticky”, and “sparkly.”  The child will be exposed to a variety of sounds. Therapy will focus on one phonological pattern for a two-week cycle.  

Amplified auditory stimulation involves the child listening to multiple target phonemes using low-level amplification. This provides multiple opportunities for the child to listen to the correct productions of the target phoneme. The slight amplification will allow the child to hear the correct productions more clearly. Amplified auditory stimulation operates under the fact that a child must hear the sounds of a language in order to understand, learn, and produce them correctly.

Production practice involves engaging the child in drill and loaded play activities that provide visual, verbal, and tactile cues to assist in the production of a target phoneme in words. During drill play, the child will produce words that contain the target phoneme multiple times. These frequent productions practice opportunities facilitate appropriate phoneme acquisition. The clinician will frequently model correct productions during loaded play and provide multiple opportunities for the child to imitate a target phoneme in words. For example, if targeting velar fronting by correcting producing the /k/ phoneme in words, the clinician plans activities that allow multiple opportunities to produce and elicit target words in context. In grocery shopping pretend-play, the clinician might model words such as cap, cup, basket and cow, allowing opportunity for the child to imitate the /k/ sound with correct production.

Language is a vital link that enables the individual to express and receive information, thoughts, and ideas. Language incorporated into play-based intervention is effective in preschool age children with speech and language delays, since it brings the concept of language into the child’s natural environment.

 Modeling is a strategy used in play-based therapy. This method allows the clinician to model verbal language at a level that will facilitate emergence of communication in the child. Self-talk and parallel-talk are forms of modeling. Self-talk can be described as talking aloud to ourselves, verbalizing what we are seeing, hearing, doing, or feeling. For example, the clinician might say, “I rolled the dice,” modeling correct use of pronouns in the context of conversational speech. In parallel-talk, the adult shifts from their own thoughts and actions to proclamations about the child’s actions. Comments such as, “You are dressing the princess” and “She is beautiful” might be used by the clinician to model correct pronouns in connected speech. The clinician continues to comment on the actions and objects of interest to the child. However, no demands are placed on the child to respond.

Based on progress from the previous semester, informal observations, and parental input, the following goals were selected for the Fall 2018 semester:

 

 

Treatment Goals and Criteria

1. E will reduce the phonological process of cluster simplification by producing the /s/ sound in blend words after a model from the clinician with 80% accuracy.

 2. E will use correct syntax in her conversational speech each session.

 3. E will reduce the phonological process of velar fronting by correctly producing the /k/ sound in all positions of words with 55% accuracy and the /g/ sound in all positions of words after a model from the clinician with 80% accuracy.

 

Initial Status: September 4, 2018

1.     E produced the /s/ sound in blend words with 55% accuracy.

 2.  E used incorrect syntax 13 times in her conversational speech during one session.

 3.     E was able to correctly produce the /k/ sound in all positions of words with 30% accuracy after a model from the clinician. E produced the /g/ sound correctly in all positions of words with 52% accuracy after a model from the clinician.

 

Ending Status as of December 5, 2018

Procedures for Goals

The Cycles approach (Hodson and Paden, 1991) will be implemented to assist E in acquiring developmentally appropriate phonological patterns. Each session will begin and end with amplified auditory stimulation. E will participate in a quiet activity, such as working a puzzle, coloring, or sculpting playdough while the clinician reads a list of words containing the target phoneme using low-level amplification for one to two minutes.

The clinician will use a variety of strategies to elicit productions of target words from E as she participates in drill-play activities.  Based on her interests, E should be motivated by activities such as arts and crafts, basketball, board games, and scavenger hunts. Picture cards and target-sound objects will be utilized to prompt for correct production of target words such as “spoon,” “dog,” and “cow.” If needed, the clinician will provide verbal, visual, and tactile prompts, as well as, specific placement and phonemic cues, to elicit correct productions of target words throughout each therapy session. Verbal cues such as, “I need to hear the /s/ sound at the beginning of ‘sweet’” or “Is it ‘tar’ or ‘car?’” will be implemented by the clinician to elicit correct productions of target words during practice drills and conversational exchanges. If needed, the clinician will model correct productions of target words and request imitation from E.  This should be an effective strategy for the elicitation of correct productions of target sounds in words. The break down/build up method will also be incorporated to elicit correct productions of target sounds from E. This method will involve breaking down a target word and then building it back up to its original form (“/s/ + /pot/ = “spot”). This strategy will allow E to hear and produce the target sound in isolation and place the target sound in the correct position before attempting to correctly produce the whole word. The implementation of this method will be effective in eliciting correct productions of target sounds in all positions of words. If E has more success producing the target in final positions of words, the co-articulation method will be incorporated into drill play activities. E will be asked to produce a final /k/ or /g/ word immediately following an initial /k/ or /g/ word such as “bike can” or “dog gown”. This strategy should be successful in assisting E to produce a correct initial /k/ or /g/ sound in words.

The clinician will engage E in a book activity each therapy session. This will allow her to be exposed to correct productions of the target phoneme in connected speech and for the clinician to prompt for additional production practice opportunities from E. On occasion, E will be asked questions related to the story that could elicit target sound production opportunities.

The clinician will take advantage of play-based therapy opportunities to model the correct use of pronouns in a natural setting. The clinician will model correct pronoun usage such as, “She is nice” or “that is my piece”.

When needed, the clinician will elicit self-correction of incorrect grammar use by using rising terminal contour and expressing a quizzical look while asking, “Her looks pretty?” If further prompting is required, the clinician might prompt for correct use of grammar verbally by asking, “Him going home? or He is going home?” Direct prompts will also be used: “She looks pretty. E, tell me “She looks pretty.” Correct productions will be followed by positive feedback such as, “That’s right!, ‘He is going home.’” The clinician will take every opportunity to offer verbal praise to E on her spontaneous correct use of grammar: “Awesome, I like that you said, ‘They are going to get hurt.’”

Specific positive verbal and tactile feedback will be provided by the clinician throughout each therapy session. Reinforcements will include high-fives, or statements such as, “Awesome, You opened your mouth to say the /k/ sound!” This will allow the clinician to encourage and build E’s self-confidence while participating in production practice drills throughout therapy sessions. The clinician will take every opportunity to notice and respond accordingly when E produces a target word correctly or uses correct pronouns in conversational speech.

 ____________________________________                                        

                                       M.A. CCC-SLP                                                  

Speech Language Pathologist

cc:  parents

APPENDIX D

Therapy Plan / Progress Report Example 

Therapy Plan / Progress Report 

Child:

Z

Responsible Party:

Parents

Address:

                  

Type of Service:

Articulation

 

Treatment Schedule:

2x/ week

Phone:

 

Sessions Scheduled /Attended:

 sessions

Date of Birth:

 

Report Date:

/2019

 

 

 

Functional Categories

Articulation

Voice

Functional Outcomes

Z will increase the intelligibility of his conversational speech.

Z will increase the use of vocal inflections and intonation during conversational speech.

Treatment Methodology and Rationale

The ability to communicate effectively is a vital part of development. The American Speech-Language and Hearing Association (ASHA) states that expressive receptive language delays should be addressed early to promote success during future school years. If a child has difficulties communicating, it is imperative to address those deficits at an early age. This assists the child in developing successful intelligible communication skills.

During a child’s early years, well developed communication skills become essential for success in effective interactions. Language and communication skills are important for preschool children to apply and practice. Production practice is important in mastering correct productions of sounds in words. Intelligibility of speech is crucial for a child when in social situations at school, play, and extracurricular activities.

Amplified Auditory Stimulation involves reading a list of words to the child that contains the target phoneme using low-level amplification. Reading the list of words allows the child to hear multiple exposures to correct productions of the target phoneme, and slight amplification allows the child to hear these correct productions more clearly. This process utilizes the fact that a child must hear correct productions of sounds in words in order to learn and produce them.

Production practice involves engaging the child in functional play that provides visual, tactile, and auditory elements to associate with the target phoneme and assist in phoneme acquisition. The child repeatedly produces words that contain the target phoneme during drill play, which allows the child to frequently produce the target phoneme practice that will facilitate appropriate phoneme acquisition. The clinician frequently models correct production during loaded play and provides multiple opportunities for the child to produce the target phoneme in words. For example, if /ch/ is the target phoneme, the clinician would plan activities to elicit the sound in words. A loaded play activity could be planned by the clinician to allow the child to produce target sounds in words, such as “chair” “teacher,” and “beach”.

Based on evaluation results, informal observations, and parent input, the following goals have been selected for the Spring 2019 semester:

 

Treatment Goals and Criteria

 

1. Z will correctly produce the /sh/ sound in all positions of a word with 30% accuracy after a model from the clinician. 

2. Z will correctly produce the /ch/ sound in all positions of a word with 30% accuracy after a model from the clinician.

 

Initial Status as of February 27, 2019

 

1. After a model from the clinician, Z correctly produced the /sh/ sound in words with 16% accuracy.

 2. After a model from the clinician, Z correctly produced the /ch/ sound in words with 20% accuracy.

Ending Status as of April 24, 2019

 

1. After a model from the clinician, Z correctly produced the /sh/ sound in words with 27% accuracy.

 2. After a model from the clinician, Z correctly produced the /ch/ sound in words with 27% accuracy.

 

Procedures for Goals

Amplified auditory stimulation was used at the beginning and end of each therapy session to expose Z to the correct production of the target sound in all positions of words. Z listened for 1-2 minutes while engaged in a quiet activity, such as a puzzle. This strategy assisted in preparing Z for the session as well as conclude the production practice drills.

Drill and loaded play based activities were utilized for each planned therapy session. During drill play, Z produced the target sound in words before continuing with an activity. Loaded play consisted of the clinician modeling the target sound in words associated with the activity Z is engaged in. For instance, when participating in a drill play activity, the clinician modeled words such as, “shark” and “fish” to provide an auditory model of the correct production of words with the target phoneme.  If needed, Z was asked to imitate the clinician’s model.

Visual models of the correct production of the target sound were used frequently throughout sessions. These included a mirror or mouth puppet. These prompts increased Z’s ability to incorporate correct placement of the lips and tongue. The clinician frequently talked about and modeled correct placement of articulators that are used to correctly produce the /sh/ and /ch/ sounds. This allowed Z to become aware of his phonetic placement during incorrect productions and to provide a visual of the correct placement of his articulators. Verbal prompts such as “Let’s make the quiet sound” were used by the clinician as a cue for Z to repeat the target sound with the correct placement of the tongue and lips.

Additional opportunities for Z to produce target words were embedded into the natural course of the activities such as talking about school and games, prompting Z to produce target words in a conversational context. The clinician produced all words that contain target phonemes using added volume and stress to make the phonemes significant to Z.

Specific positive verbal feedback was provided by the clinician consistently throughout each therapy session. The clinician made comments such as “I like how you pushed your lips out!” or “I heard that train sound”. This provided the reinforcement needed to motivate and encourage Z during production practice drills.

 

 

 

Comments/Summary:

 Z was a delight to work with this semester. He was motivated in therapy and willing to participate in production practice drills. Some drill play activities that Z enjoyed included, Pop the Pig, Ned’s head, Chipper Chat, and Fish & Say. Loaded play activities that Z liked were, Thomas the Train set and the Magnetalk Adventure board.

Z enjoyed a variety of activities.  He liked to be up and moving.   Activities that promoted movement seemed to keep him engaged and interested in participating.  Z showed progress in correctly producing target sounds in words.  The clinician noted that he appears more aware of his speech productions and placement of articulators.  Z was able to demonstrate meaning in his voice when imitating a model from the clinician. When imitating, he is able to vary vocal pitch and intonations to match the words, therefore relaying his message with more intent. These goals should continue to be targeted next semester.

The clinician provided Z’s mother with weekly progress notes. It is recommended that therapy continue during the Summer 2019 semester.

 

 

 

Recommendations:

 

X

1. Continue Current Goals

2. New Goal

 

3. Functional Outcome Goal Met

 

4. Discontinue Treatment Services

 

5. Refer to:

 

Goals for the 2019 Summer Semester should target:

1.     Correctly producing the /sh/ sound in all positions of words after a model from the clinician.

2.     Correctly producing the /ch/ sound in all positions of words after a model from the clinician.

   

 

 

_____________________________                                              

M.A. CCC-SLP                                                                                

Speech Language Pathologist              

                                            

Cc

APPENDIX E

Speech & Language Re-Evaluation Example

SPEECH AND LANGUAGE RE-EVALUATION

 REPORT 

Client

:

G

Resp. Party/Informant

:

 

Address

:

 

Evaluation Date

:

 

Phone

:

 

Report Date

:

 2019

Birthdate

:

 

 

 

 

G, a four-year three-month old female, was seen in 2019 at XXXXX Preschool to re-evaluate her speech and language skills. Gwas previously evaluated in May 2017 and began receiving early intervention speech-language services once a week to increase her expressive communication skills. After moving to Boone in 2017, G began receiving twice-weekly services through the ASU Communication Disorders Clinic in September 2017. An evaluation administered on November 10, 2017 determined that G’s expressive language was moderately delayed and her auditory comprehension was within age expectations. Today’s re-evaluation will provide updated information about G’s communication skills and assist in determining the direction of speech and language therapy. 

Birth and Medical History

G’s mother reported no complications during or following her pregnancy, labor, or delivery. Mom reports that G met her motor developmental milestones, began babbling, and said her first word as expected, but was delayed in combining words. Mom did not indicate that G had any other complications or illnesses since birth. G lives with her mother, father, and younger brother. G’s younger brother is currently receiving services for phonological and expressive language delay. She attends Boone United Methodist Preschool five mornings a week. G’s parents continue to be concerned about the intelligibility of her conversational speech.

Evaluation

 The Clinical Evaluation of Language Fundamentals – Preschool, 2nd edition (CELF-P 2) was administered to assess G’s expressive and receptive language abilities.

The Receptive Language Subtests include the following sections:

1. Sentence Structure: Using visual cues to correctly identify the sentence that was read.

2. Concepts & Following Directions: Following one-, two- and three- step directions with aid of visual cues.

3. Basic Concepts:  Differentiating between two different attributes.        

4. Word Classes: Identifying two items out of three or four presented that are alike.

 Sentence Structure: G correctly identified 18 of the 22 items in this subtest with the aid of visual cues (e.g. “Point to the boy that is sleepy”). She had difficulty identifying more complex sentence structures such as those with subordinate clauses (e.g., She drank the milk before she ate the sandwich).

Concepts & Following Directions:  G was able to follow 9 of 22 directions provided. She correctly identified one-step directions such as, “Point to the tallest animal.” G was challenged to follow most multi-step directions with increasing complexity such as, “Point to either one of the cats and all of the bears.” Understand temporal and spatial concepts such as, “Point to the big dog and then the little monkey”, also appeared challenging.

Basic Concepts:  G correctly identified 15 of the 18 items in this section. She was able to correctly identify concepts when given verbal directions such as, “Point to the one that is slow”.

Word Classes - Receptive: G correctly identified 14 out of 20 items in the receptive subtest. It was challenging for her to determine if there was a relationship between two objects when there were four to choose from as opposed to when there were only three.  

The Expressive Language Subtests included the following sections:

1. Word Structure: Completing a sentence by relating it to the visual stimulus.

2. Expressive Vocabulary: Verbally naming a single picture or group of pictures.

3. Recalling Sentences: Listening to a sentence and repeating it verbatim.

4. Word Classes: Explaining how two items are related.

 Word Structure:  G correctly identified 12 of the 24 items presented. It was challenging for her to understand progressive –ing (walking), future tense (will slide), subjective (he is) and reflexive (herself) pronouns, copulas (it is big), and irregular past tense (blew) concepts. She demonstrated an understanding of regular plurals (horses), possessive nouns (hers), third person singular (sleeps), and objective pronouns (her).

Expressive Vocabulary:  G scored 21 out of 40 possible points on this section.  She was able to correctly identify common items such as food (carrot), occupations (fireman), and music (piano).  She had some difficulty labeling pictures relating to science (telescope) and math (calculator, calendar, scale).

Recalling Sentences: G was asked to listen and repeat sentences verbatim.  During this portion of the test, the number of errors increased as complexity and length of sentence increased. G was able to complete a simple sentence (i.e., “he is nice”). She had more difficulty as the sentence length increased. For example, G was unable to fully reproduce the sentence, “The rabbit was not put in the cage by the girl.” G responded to 1 of the 13 items administered with no errors, 2 of the 13 items with 1 error, 4 of the 13 items with 2-3 errors, and 6 of the 13 items with 4+ errors.

Word Classes - Expressive: G correctly identified 9 out of 20 items in the expressive subtest. She demonstrated difficulty with specific groups of items and verbs. For example, when explaining why shoes and socks are grouped together, G responded with “them tennis shoes.” She correctly identified blankets and pillows as items that should go together, stating, “you sleep with them.”

Clinical Evaluation of Language Fundamentals-Preschool (CELF-Preschool 2)

Subtest

Percentiles

Age Equivalent

Sentence Structure

50%

 4:5

Word Structure

37%

 3:9

Expressive Vocabulary

63%

 4:6

Concepts and Following Directions

37%

    3:11

Recalling Sentences

Basic Concepts

25%

37%

 3:8

 4:0

Word Classes-Receptive

37%

                            <4:0

Word Classes-Expressive

37%

 4:8

Word Classes –Total

63%

 4:4

 

G’s Core Language standard score of 100 indicates that she is performing in the 50th percentile. She achieved a Receptive Language standard score of 96, indicating that she is performing in the 39th percentile. The Expressive Language standard score of 96 indicates that Grace is performing in the 39th percentile. Her Language Content standard score was 98, indicating that she is performing in the 45th percentile. The Language Structure standard score of 94 indicates that Grace is performing in the 34th percentile. Grace’s scores are no more than one standard deviation below the mean, indicating that she is within the normal range for her age.

 The Goldman Fristoe-Test of Articulation-3 (GFTA-3) was administered to determine the presence of errors in the production of the individual sounds that G produced. She was presented 47 pictures to name with 60 target words to elicit speech productions.  Her responses were transcribed phonetically.  G received a standard score of 59, which indicated that she is performing in the 0.3rd percentile, with a test-age equivalent of less than 2 years at the one-word level.

The GFTA-3 was analyzed using the Khan-Lewis Phonological Analysis ­– 3 (KLPA-3) to determine G’s overall usage of phonological processes. The phonological processes revealed by the KLPA-3 are summarized in the table below. This test assesses the production of each of the twenty-three consonants in the initial, medial, and final positions of words, as well as twelve consonant blends.  G scored in the 1st percentile with a standard score of 63 and an age equivalent of <2 years old. The intelligibility of G’s conversational speech is greatly affected by the many sound errors. Errors were noted in the following sounds in single words that were produced by G.

Error Pattern

Initial Position

Medial Position

Final Position

Substitution

/d/ for /g/ (go)

/t/ for /k/ (monkey)

/d/ for /g/ (pig)

 

/t/ for /k/ (quack)

/d/ for /g/ (tiger)

/t/ for /k/ (duck)

 

/th/ for /f/ (fish)

/s/ for /z/ (puzzle)

/t/ for /k/ (quack)

 

/w/ for /r/ (drum)

/d/ for /g/ (finger)

/o/ for /er/ (hammer)

 

/w/ for /l/ (plate)

/s/ for /f/ (elephant)

/th/ for /sh/ (fish)

 

/s/ for /sh/ (shoe)

/t/ for /k/ (vacuum)

/ts/ for /ch/ (watch)

 

/w/ for /w/ (slide)

/b/ for /v/ (shovel)

/uh/ for /er/ (spider

 

/w/ for /l/ (lion)

/ts/ for /ch/ (teacher)

/p/ for /f/ (knife)

 

/t/ for /ch/ (chair)

/w/ for /r/ (zebra)

/n/ for /ng/ (swing)

 

/dw/ for /gl/ (glasses)

/th/ for /t/ (vegetable)

/uh/ for /er/ (tiger)

 

/th/ /f/ (finger)

/w/ for /l/ (yellow)

/p/ for /f/ (giraffe)

 

/w/ for /r/ (ring)

/d/ for /th/ (brother)

/n/ for /ng/ (brushing)

 

/s/ for /th/ (thumb)

/d/ for /t/ (cookie)

/uh/ for /er/ (brother

 

/b/ for /v/ (vacuum)

/d/ for /j/ (pajamas)

/d/ for /g/ (frog)

 

/s/ for /sh/ (shovel)

/b/ for /v/ (seven)

/p/ for /f/ (leaf)

 

/d/ for /j/ (giraffe)

 

/t/ for /th/ (teeth)

 

/b/ for /v/ (vegetable)

 

/t/ for /k/ (truck)

 

/w/ for /l/ (blue)

 

/b/ for /v/ (five)

 

/w/ for /r/ (brother)

 

 

 

/w/ for /r/ (frog)

 

 

 

/dw/ for /gr/ (green)

 

 

 

/d/ for /th/ (that)

 

 

 

/w/ for /l/ (leaf)

 

 

 

/t/ for /k/ (cookie)

 

 

 

/t/ for /ch/ (cheese)

 

 

 

/w/ for /r/ (princess)

 

 

 

/w/ for /r/ (crown)

 

 

 

/w/ for /r/ (truck)

 

 

 

/w/ for /r/ (red)

 

 

 

/d/ for /j/ (juice)

 

 

 

/s/ for /f/ (five)

 

 

Omissions

 

 

 

 

“pider” for spider

“tar” for guitar

“ajamas” for pajamas

“tar” for star

“betho” for vegetable

 

“da” for door

“betho” for vegetable

 

 

 

 

 

Phonological Process

 

Example

 

Number of Occurrences

 

Percentage of Occurrences

Gliding of liquids

/dwum/ for drum

18 out of 20

90%

Stopping of fricatives & affricates

/ter/ for /chair/

12 out of 48

25%

Deaffrication

/ter/ for chair

7 out of 8

87%

Stridency deletion

/tar/ for star

1 out of 42

2%

Palatal fronting

/brusin/ for brushing

4 out of 12

33%

Cluster simplification

/paiduh/ for spider

2 out of 23

9%

Syllable reduction

/tar/ for guitar

3 out of 25

12%

Final devoicing

 N/A

0 out of 35

0%

Initial voicing

 N/A

0 out of 35

0%

Vocalization

/taiduh/ for tiger

4 out of 15

27%

Velar fronting

/swin/ for swing

15 out of 23

65%

Deletion of final consonant

/da/ for door

2 out of 36

6%

 

Additional phonological processes used (not included in the standard score of the KLPA-3):

Phonological Process

Example

Number of Occurrences

Percentage of Occurrence

Frication

/betho/ for vegetable

1

1%

Deletion of initial consonant

/tar/ for star

3

5%

Stopping

/frod/ for frog

3

5%

Deletion of medial consonant

/betho/ for vegetable

2

7%

 

The Peabody Picture Vocabulary Test (PPVT-4)

The PPVT-4 was administered to assess G’s receptive language ability at the one word level. This test required G to point to one of four pictures that corresponded to a word given by the clinician. For example, the clinician said, “Show me gate” and G responded by pointing to the picture depicting the “gate.” When the clinician said, “Show me chain,” she responded incorrectly by pointing to the picture of bells. G achieved a standard score of 106 on the PPVT-4, with a percentile rank of 66, and an age equivalent of 4 years, 6 months.

Raw Score:         73                Standard Score:      106                         Percentile: 66% 

                                                                                                                                       

The Expressive Vocabulary Test (EVT-2)

The EVT-2 was administered to assess G’s expressive language ability at the one word level. This test required G to look at single pictures and verbally identify them. For example, when shown a picture of a drum, the clinician asked, “What is she doing?” G responded appropriately, “digging.” When shown a picture of an oval and asked, “What shape is this?” G responded inappropriately with “triangle.” G received a standard score of 111 on the EVT-2. Her percentile rank was 77, with an age equivalent of 4 years, 10 months.

Raw Score:  61                   Standard Score:       111                          Percentile: 77%                                                                                                                      

Hearing

A hearing screening was administered in June  2019. G passed a pure-tone hearing screening at 25dB at 1000, 2000, and 4000 Hz in both ears.

Fluency/Voice

No disfluencies or voice abnormalities were noted in G’s conversational speech during the evaluation.

Oral Mechanism Examination

No physical abnormalities or oral motor dysfunctions were noted during this evaluation.

Diagnosis

G presents age-appropriate receptive and expressive language skills. During this assessment, the clinicians noted that G was more successful when responding to items that were concrete (“What is this?”).  Abstract questions, such as, “Tell me another word for angry”, appeared more challenging for her. G understood regular plurals, such as “cats” and possessive nouns, such as “King’s.” The intelligibility of G’s conversational speech can be challenging for the unfamiliar listener. She presents with a consistent interdentalized lisp when producing all fricatives (e.g., /s/, /z/). She also demonstrates multiple phonological processes.  Some of these consist of gliding of liquids, cluster reduction, deaffrication, and velar fronting. In addition, it was noted that G consistently uses incorrect pronouns (“them/they, her/she, him/he”) in her conversational speech.

 Prognosis

The prognosis for improvement of G’s articulation skills is positive due to her age-appropriate receptive and expressive language skills, consistent speech therapy, and strong family support. She would benefit from continued speech-language therapy to increase intelligibility.  Speech-language therapy services should continue to be provided two times a week at XXXX Preschool.

                                         Recommendations

1.     Speech-language therapy two times a week.

2.     Therapy should focus on phonology in the following areas:

A)        Reduce the phonological process of deaffrication by correctly producing the /ch/ sound in all positions of words.

B)        Reduce the phonological process of velar fronting by correctly producing the /k/ and /g/ sounds in all positions of words.

C)        Reduce the phonological process of cluster deduction by producing the /s/ sound in blend words.

3.         Use of correct pronouns in her conversational speech.

 

Submitted by

________________________              

Speech-Language Pathologist