Clinical Speech & Language Studies, Trinity College, Dublin
Sample clinical session forms 2012
Forms must not contain any information that would allow a client or service to be identified. Students should agree the form they may use to identify clients with the practice educator. Students must complete a session plan and submit this to their practice educator before undertaking assessment or therapy with any client. Session outcomes should be evaluated in writing on the plan after each session. Completed session planning and evaluation forms must be kept in the student client file for the duration of each placement. This file contains a sample number of sample forms to structure session planning.
Students will be advised on the appropriate session planning form for each clinic by the practise educator.
Forms should be printed out in Landscape.
Clinical Speech & Language Studies, Trinity College, Dublin
Student Diagnostic Session 1 Pre assessment worksheet
Client identifier / Student nameSession date / Time / SLT
Date of birth / Age
Presenting Problem
Tentative clinical hypothesis:
What do you think is the nature of the problem?
What might be possible causes/contributory factors?
Hypothesis testing
How will you confirm / reject your hypothesis?
What do you need to find out about this client pre assessment? / List information needed and sample interview questions
What measures will you use?
• Formal
• Informal
Diagnostic session goals
Client / SO goals
SLT goals
How will you meet these goals during testing?
How will you meet all the goals of all participants in reporting?
Alternate hypotheses
What else might it be?
How will you rule this out?
What else do you need to know about this client?
3
Sample session forms CSLS TCD 2012-13
Clinical Speech & Language Studies, Trinity College, Dublin
Student Diagnostic Session 1 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
Objective / How it will be achieved / Activities /Materials / reinforcers
Resources needed
Knowledge / skills / Materials / equipment
Session evaluation
Objective
Analysis
Plan
Date and time of next session
Student Self evaluation
How well did I / Not well / Just about / Very wellCapture client interest
Link session to past sessions/ client learning goals
Introduce the sessionlearning goals
Make the aims of activities clear to client
Monitor progress during activities
Provide feedback / reinforcement
Summarise and evaluate learning for client after each learning set
Transit smoothly from between learning sets
Maintain motivation and attention levels
Monitor own communication and change to suit client / session objectives
Summarise session learning for client and ensure that they are aware of necessary transfer activities
Clinical Speech & Language Studies, Trinity College, Dublin
Student Therapy Session 1 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
What will the client learn? / How will you know that he/she has learned this? / Why is this important for the client to learn? / What activities / materials will you use to help him/her to learn? / What reinforcers will you use to inform him/her of successes /failures in learning? / Session evaluation
1
2
3
4
Evaluation of session outcomes (What did the client gain? What best facilitated learning?)
Implications for next session
Date and time of next session
Self evaluation
How well did I / Not well / Just about / Very wellCapture client interest
Link session to past sessions/ client learning goals
Introduce the sessionlearning goals
Make the aims of activities clear to client
Monitor progress during activities
Provide feedback / reinforcement
Summarise and evaluate learning for client after each learning set
Transit smoothly from between learning sets
Maintain motivation and attention levels
Monitor own communication and change to suit client / session objectives
Summarise session learning for client and ensure that they are aware of necessary transfer activities
Three positive comments on professional relationships, knowledge and skills observed during the session and how these enabled therapy objectives to be met
1
2
3
Three things you would change and why
1
2
3
Clinical skills and competencies that require further development
Clinical Speech & Language Studies, Trinity College, Dublin
Student Therapy Session 2 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
Measurable session objectives / outcomes / State each as a SMART objective and number
1
2
3
4
5
Approach and rationale for selection / List assessment or intervention approach and outline theoretical reason for selection. Number to match objectives
1
2
3
4
5
Activities / Outline activities /tasks- time frame /materials/ instructions/ feedback / possible modifications
1
2
3
4
5
Evidence of achievement objectives / Relate to smart objectives and specify degree to which each was achieved
1
2
3
4
5
Evaluation of session outcomes / Evaluate objectives selected, activities and materials used/ modifications required, etc.1
1
2
3
4
5
Implications for future sessions / Client long term goals
Students learning goals
Clinical Speech & Language Studies, Trinity College, Dublin
Student Therapy Session 3 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
Outcomes / Strategies
Activities / Rationale / Duration / Indicators
Assessment / Resources / Evaluation
1 / · Activity A
· Strategies / X mins / Indicator / Items XYZ
2 / · Activity B
· Strategies / X mins / Indicator / Item XYZ
3 / · Activity c
· Strategies / X mins / Indicator / Item XYZ
Transfer activities
Activity A
Activity B
Activity C / XX mins
XX mins
XX mins / Indicator
Indicator / Item XYZ
Session evaluation
Objective
Analysis
Plan
Clinical Speech & Language Studies, Trinity College, Dublin
Clinical Therapy session 4 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
What are the objectives for this client in this session? / Why have these been selected? / How will we achieve these objectives (approaches & strategies such as modelling, reinforcement , etc) / Why did I select this approach and these strategies? / How will you know that he/she has achieved the objectives e.g. outcome measures, evidence of change / Session evaluation
Benefit to the client
What did the client/ carer gain? What were the outcomes? / Self evaluation
What did I do/not do that impacted on the session?
What do I need to focus on to modify my work?
1
2
3
4
Self evaluation
Capture client interest
Link session to past sessions/ client learning goals
Introduce the sessionlearning goals
Make the aims of activities clear to client
Monitor progress during activities
Provide feedback / reinforcement
Summarise and evaluate learning for client after each learning set
Transit smoothly from between learning sets
Maintain motivation and attention levels
Monitor own communication and change to suit client / session objectives
Summarise session learning for client and ensure that they are aware of necessary transfer activities
Three positive comments on professional relationships, knowledge and skills observed during the session
1
2
3
How did these enable therapy objectives to be met?
Three things you would change and why
1
2
3
Three clinical skills and competencies that require further development
1.
2.
3.
Clinical Speech & Language Studies, Trinity College, Dublin
Student Therapy Session 5 Plan and evaluation
Client identifier / Student nameSession date / Time / SLT
SMART Objective / Rationale / Activity / Step-up Activity / Step-down Activity / Homework Activity / Evaluation of Client’s Performance
Evaluation of self (What you did well; what you need to work on):
Implications of client and self evaluation for next session
Notes
14
Sample session forms CSLS TCD 2012-13