UNIVERSITY OF CENTRAL MISSOURI - Communication Disorders Program Mid/Final Semester Student Clinician Grading Form

Student: UG / G (circle one) Supervisor: Date:

700#: Grade: Mid-Semester: Letter grade Points Avg ______// Final Grade: Letter grade____ Points Avg ______

Client’s 3-Letter Identification: Clinical Setting: ☐ UCM (W-SCCD) Clinic ☐ ECCSEP ☐Other:

Type of Population Served (check one): ☐Early Intervention (0-3) ☐Preschool (3-5) ☐School Age (6-12) ☐Adolescent (13-18) ☐Adult (19-61) ☐Senior Adult (62+) Gender: ☐Male ☐Female

Ethnic Group (check one): ☐Asian ☐ African-American ☐ Hispanic ☐ Native American ☐ Caucasian (non-Hispanic) ☐ Other:

Etiology/Medical Diagnosis: S/L Diagnosis: Associated Conditions:

KASA – Standard IV-G: The applicant for certification must complete a program of study that includes supervised clinical experiences sufficient in breadth and depth to achieve the following skills outcomes. In addition to clinical experiences, skills may be demonstrated through successful performance on academic course work and examinations, independent projects, or other appropriate alternative methods.

Types of disorders and/or differences.
☐ disorder ☐ difference (check one)
(circle the appropriate severity rating) /

Articulation

mild
moderate
severe /

Fluency

mild moderate
severe /

Voice and

Resonance

mild
moderate
severe /

Language

mild
moderate
severe /

Hearing

mild
moderate
severe /

Swallowing

mild
moderate
severe /

Cognition

mild
moderate
severe /

Social

Aspects
mild
moderate
severe /

Alternative

Modalities
mild
moderate
severe
1. Evaluation / / Student utilizes evidence-based practice procedures in evaluation (please check if true)
a. Conduct screening and prevention procedures.
(including prevention activities)
b. Collect case history information and integrate information from clients/patients, family, caregivers, teachers, relevant others, and other professionals.
c. Select and administer appropriate evaluation procedures, such as behavioral observations, non-standardized and standardized tests, and instrumental procedures.
d. Adapt evaluation procedures to meet client/patient needs.
e. Interpret, integrate, and synthesize all information to develop diagnosis and make appropriate recommendations for intervention.
f. Complete administrative and reporting functions necessary to support evaluation.
g. Refer clients/patients for appropriate services.
2. Intervention / / Student utilizes evidence-based practice procedures in intervention (please check if true)
a. Develop setting-appropriate intervention plans with measurable and achievable goals that meet the client’s/patient’s needs. Collaborate with clients/patients and relevant others in the planning process.
b. Implement intervention plans (involve clients/patients and relevant others in the intervention process).
c. Select or develop and use appropriate materials and instrumentation for prevention and intervention.
d. Measure and evaluate client’s/patient’s performance and progress.
e. Modify intervention plans, strategies, materials, or instrumentation, as appropriate, to meet the needs of the clients/patients.
f. Complete administrative and reporting functions necessary to support intervention.
g. Refer clients/patients for appropriate services.
Types of disorders and/or differences.
☐ disorder ☐ difference (check one)
(circle the appropriate severity rating) /

Articulation

mild
moderate
severe /

Fluency

mild moderate
severe /

Voice and

Resonance

mild
moderate
severe /

Language

mild
moderate
severe /

Hearing

mild
moderate
severe /

Swallowing

mild
moderate
severe /

Cognition

mild
moderate
severe /

Social

Aspects
mild
moderate
severe /

Alternative

Modalities
mild
moderate
severe
3. Interaction and Personal Qualities
a. Communicate effectively, recognizing the needs, values, preferred mode of communication and cultural/linguistic background of the client/patient, family, caregivers, and relevant others.
b. Collaborate with other professionals in case management.
c. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others.
d. Adhere to ASHA Code of Ethics and behave professionally.
Final Clinical Skill Outcome Needs:

Supervisor’s Signature: Student’s Signature:

☐ A minimum of 25% of this practicum experience has received direct supervision. *Student is on a remediation plan ☐ YES ☐ NO

☐ Student presented Formative Self Evaluation form to Clinical Instructor at Mid-case conference Dates: Initiated - ___/___/_____ Completed - ___/___/_____

Summary of Skills Grading Rubric:

N/O / No opportunity
1 / Not evident / Student does not demonstrate skill; does not recognize clinical strengths and weaknesses; and, requires maximum level of supervision.
2 / Emerging / Student is beginning to demonstrate skill and recognize clinical strengths and weaknesses. Student can recognize both if pointed out by the supervisor after the session. Student requires moderate to maximum level of supervision, as determined by the supervisor.
3 / Developing / Student demonstrates skill most of the time. In addition, student recognizes clinical strengths and weaknesses after the session and independently or with supervisor’s help can generate some ideas for change. Student requires moderate level of supervision, as determined by the supervisor.
4 / Refining / The student is creative and effective but continues to grow towards independence. Student recognizes clinical strengths and weaknesses during the session but cannot always make on-line changes. Student requires minimum level of supervision as defined within the Certification Standards and required by ASHA for entry into the Clinical Fellowship (CF). (Skills demonstrated at this level of competence are to be marked on the student’s KASA.)
5 / Independent / Student functions essentially as the responsible, professional; clearly recognizes clinical strengths and weaknesses; and, requires minimum level of supervision as defined within the Certification Standards and required by ASHA for entry into the Clinical Fellowship (CF). (Skills demonstrated at this level of competence are to be marked on the student’s KASA.)

Nine (9) Major Areas:

Articulation (disorder of the sound system including motor speech disorders, phonological processing, and functional articulation) / Graduate:
Fluency / A / 4.3 – 5.0
Voice and resonance, including respiration and phonation. / B / 3.0 – 4.2
Receptive and expressive language (phonology, morphology, syntax, semantics, and pragmatics) in speaking, listening, reading, writing, and manual modalities. / C / 2.0 – 2.9
Hearing, including the impact on speech and language. / D / 1.9 and below
Swallowing (oral, pharyngeal, esophageal, and related functions, including oral functions for feeding; orofacial myofunction). / Undergraduate/1st-Time Clinician:
Cognitive aspects of communication (attention, memory, sequencing, problem-solving, executive functioning). / A / 3.6 – 5.0
Social aspects of communication (including challenging behavior, ineffective social skills, lack of communication opportunities). / B / 2.6 – 3.5
Communication modalities (including oral, manual, augmentative, and alternative communication techniques and Assistive technologies). / C / 1.5 – 2.5

Last Revised: 11/12/2013