Harding University Speech Clinic
Revised January, 2006
Clinical Supervisors
Robert Hale, Au.D., CCC-A
Rebecca A. McLain, M.S.,
CCC-SLP
Daniel C. Tullos, Ph.D.,
CCC-SLP
Rebecca O. Weaver, Ph.D.,
CCC-SLP
PREFACE
This manual is designed to
make the
transition from a student of speech-language pathology to a student
clinician
in the Harding University Speech Clinic a little easier, and a little
less
frightening. This handbook of
guidelines should introduce you to the procedures utilized in our
clinic, and
answer many of the questions that may develop during your practicum as
a
student speech clinician. There is
no way to make this manual thorough enough to answer all questions, but
as a
supplement to the Clinical Practicum class sessions, it should prove a
useful
guide.
As
all of your course instructors have told you, each institution of
learning, as
well as each employment setting uses different methods, procedures,
etc. and
that any guide should be used as an example in that setting and not as
Òthe
correct way.Ó The information in
this manual will prove useful in completing future job
responsibilities, but
there is seldom one correct way of completing a task.
The
format is designed so that you can print and place this manual along
with all
of your Communication Sciences and Disorders (CSD) course syllabi in
your COMD
235 portfolio. It is strongly
suggested that you also include all handouts from each course. Several students in the past have been
able to avoid repeating a course at the graduate level by producing the
course
syllabus and handouts.
It
is the intention of the faculty and clinical supervisors that you have
a
clinical experience that is both pleasant and productive; however, the
well-being of each client is our ultimate responsibility.
As we all work together, may we serve
the clients needs and continue in service to the glory of our Lord.
TABLE OF CONTENTS
Assessment and
Evaluation Assignments
Getting Underway with
Assessments
Semester Goals & Progress
Reports
Tests and Assessment Materials
APPENDICES
Assessment
Report Outline
Semester
Goals Report Outline
Enrollment
Agreement
Release
of Information to an Outside Agency
Release of
Information to Harding University
Oral
Peripheral Examination Form
Fee
Schedule and Billing Form
Therapy
Plan Form
Observation
Report Form
Student
Speech and Hearing Association Constitution
Authorization
for Photography/Videotaping
Contact
Information Form
Speech
& Hearing Clinic Bill for Services
Standard
Acceptable Abbreviations
The
Communication Department operates the Speech Clinic at Harding
University as
part of its Communication Sciences and Disorders training program,. There are presently two divisions of
the clinic: 1) the on campus
clinic, and 2) the off-campus practicum program. This
latter division may include joint projects with the
Harding Academy, Searcy Head Start Center, the Sunshine School, area
hospitals
and specified schools accepting Harding speech clinicians completing
their
off-campus placement for future certification.
The
primary purpose of the Harding University Speech Clinic is to provide a
basic
undergraduate training for future speech-language pathologists and
audiologists. In so doing, the
clinic encourages and permits student clinicians to observe and work
with
communicatively handicapped individuals under the supervision of ASHA
certified
speech-language pathologists and audiologists.
A
second purpose of the clinic is to provide out-patient speech and
hearing
services. Working cooperatively
with Harding University and other health and educational programs, the
clinic
seeks to fulfill a need for services in the east central Arkansas area. Clients enrolled in the clinic include
all age ranges needing clinical services in the areas of articulation
and
language. These individuals are
referred to the clinic by Harding faculty, public school teachers,
physicians,
nurses, psychologists, rehabilitation counselors, other speech
pathologists,
and parents themselves. No formal
referral is required for a client to be eligible for therapy, but such
a
referral is preferred.
Therapy
and diagnosis are carried out by qualified faculty members and students
in
training. As outlined in more
specific detail later, the supervisors receive regular written reports
of
therapy plans and progress. A
weekly meeting between the supervisor and the student clinician is
often
necessary during the course of the semester to insure that the
appropriate
therapeutic objectives and procedures are being carried out. Other reports and requirements are
discussed under the following sections.
The
staff of the Speech and Hearing Clinic is composed of several members
of the
Communication Department faculty plus student clinicians.
The CSD Program Director is responsible
for the curriculum and academic credit and placement, procedures and
grades for
off-campus practicum (COMD 421).
The Speech Clinic Director is responsible for on-campus clinical
scheduling, clinical procedures, awarding grades for COMD 380/381, and
documentation of clinical hours obtained during all practicum courses. The clinical supervisors serve as
academic advisors, oversee the completion of the certification
requirements,
carry out other pertinent clinical tasks, and participate in the Speech
and
Hearing Clinic operation.
Speech
and language evaluations as well as any hearing screenings are carried
out by
or under the supervision of certified and licensed speech-language
pathologists
or audiologists. Speech or hearing
therapy sessions are carried out by or supervised by a clinical
supervisor. All reports must have
the name, degree, and title of the appropriate supervisor written in
the
following manner:
Robert
Hale, Au.D., CCC-A
Audiologist
and Clinical Supervisor
Rebecca
A. McLain, M.S., CCC-SLP
Speech
Pathologist and Clinical
Supervisor
Daniel
C. Tullos, Ph.D., CCC-SLP
Speech
Pathologist and Clinical
Supervisor
Rebecca
Weaver, Ph.D., CCC-SLP
Speech
Pathologist and Clinical
Supervisor
ASHA
Standard IV-C: The applicant for
certification in speech-language pathology must complete a minimum of
400 clock
hours of supervised clinical experience in the practice of
speech-language
pathology. Twenty-five hours must be spent in clinical observation, and
375
hours must be spent in direct client/patient contact (2005).
ASHA
Standard IV-D: At least 325 of the
400 clock hours must be completed while the applicant is engaged in
graduate
study in a program accredited in speech-language pathology by the
Council on
Academic Accreditation in Audiology and Speech-Language Pathology
(2005).
The
2005 Standards of the American Speech-Language-Hearing Association
(ASHA)
require a total of 400 clinical clock hours for certification (upon
completion
of the graduate degree). Of that
number, 375 hours must be direct client contact, with the remaining 25
hours
spent in clinical observation. The
current Standards require observation before direct client contact,
however the
number of observation hours before a student clinician encounters their
first
client are no longer specified.
Previously, Harding (and all graduate programs) required all 25
hours of
observation before client contact.
Although this is no longer the case, many graduate schools are
continuing to require all observation before the initiation of therapy
as they
transition to the new Standards.
With this in mind, the Harding CSD program is still recommending
that
each student obtains all 25 observation hours before beginning COMD
380,
Clinical Methods and Procedures: Diagnostics. At
least 18 observation hours are required as a part of your
academic curriculum (COMD 215, 250, 325, 326, etc.).
You will need to complete additional hours
independently. If you have not
completed the 25 hours currently required by some graduate programs,
you will
be expected to sign a release indicating that you were informed about
the
current Standards and graduate school expectations.
This form will be distributed as you begin your clinical
experiences
in COMD 380.
Currently,
the Harding University CSD degree requires the completion of
approximately 100
clock hours of direct client contact.
Although graduate programs can only accept up to 50 of these
hours (see
ASHA Standard IV-D), it is the consensus of the Harding CSD faculty
that the
entire Harding clinical experience will be of benefit in clinical
preparation. Therefore, you will
be expected to complete approximately 40 hours of direct client contact
while
enrolled in COMD 380 and 381, and the remaining 60 hours while enrolled
in your
off-campus practicum placement (COMD 421). The
Harding University Speech Clinic daily clock hours
report form is included in Appendix A.
This form must be completed and submitted at the end
of each semester. A semester
summary clock hour form must also be submitted each semester (Appendix
B). This form, when completed, will be
added to the hours previously completed and will become a permanent
record of
clinical experiences at Harding.
Additional
information is available
from:
American-Speech-Language-Hearing
Association
10801
Rockville Pike
Rockville,
Maryland 20852
(301)
897-5700
http://www.asha.org
Students
must be enrolled in COMD 380, 381, or 421 in order to provide clinical
(therapy) services. The
Communication Sciences and Disorders Program provides an off-campus
supervised
clinic experience semester for CSD majors. To
participate in this experience, students must enroll in
COMD 421, Supervised Speech Pathology Practicum. Placement
will be determined based on need, extenuating
circumstances, specific requests, etc. Many students will need to
commute up to
an hour. Each student must complete the placement and the number of
available
sites is limited. Therefore, it is
the student's responsibility to notify the COMD 421 instructor of any
needs in
writing well before assignments are made.
Once assignments are made, it will not be possible to change
placement
locations.
All
student clinicians are required to enroll in COMD 380, Clinical
Methods and
Procedures: Diagnostic
or COMD 381, Clinical Methods and Procedures: Treatment for the semesters they are
providing
therapy in the Clinic. In
addition, each student must also enroll in a lab. These
courses and labs allow each student to receive
academic credit for therapy, as well as provide an opportunity for
presentation
of clinical assessment and intervention procedures.
In addition, COMD 421, Supervised Speech Pathology
Practicum
and a lab,
are required during the off-campus supervised practicum semester. No student will be allowed to provide
therapy services unless enrolled in COMD 380, 381, or 421.
Before
the initial class meeting of COMD 380 or 381, each student clinician is
expected to provide a complete class/work schedule that will be used as
a guide
in assigning clients. It should be
noted that clients would be scheduled according to the information
provided by
the student clinicians. Each
student clinician is expected to arrange their work and class schedule
in such
a way that they are available for therapy on at least one of the
following:
Monday/Wednesday afternoons, Tuesday/Thursday afternoons, or
Tuesday/Thursday
mornings.
Every
student providing clinical services will be required to attend all COMD 380, 381 and 421 class
meetings. This is required.
Special permission must be obtained before missing these classes. There are no exceptions.
The
clinical director will notify student clinicians of cases assigned to
them. A therapy assignment form
provides the clinician with the information necessary to begin to plan
therapy.
The
student clinician must then become familiar with the background
information
available in the clinic file.
After familiarizing himself with his new clientÕs
history, the student
clinician should arrange a meeting with the clinical supervisor. The student clinician should be
prepared to discuss the clientÕs disorder and possible courses
of action.
The
assigned supervisor will provide additional ideas and answer any
questions
prior to the initial therapy session.
The student clinician will then complete and submit weekly
Lesson Plans
to the supervisor for approval.
(Specifics and an example are presented in COMD 380 or 381 class
presentations, and are discussed in the Lesson Plan section of this
document).
Due
to the increasing number of student clinicians involved with the Speech
Clinic,
it may be difficult to provide each with the number of therapy
assignments she
would like. If such problems
arise, those with fewest clock hours will be given Òfirst
optionÓ in order to
meet requirements for graduation.
As
therapy is initiated, the clinician must then gather together materials
to meet
the goals specified in the Lesson Plan.
Therapy materials must always be goal oriented (a
concept
discussed in your academic courses) and never be used as a time filler. Enough materials should be readily
available to keep the client interested and goal directed throughout
the session.
A
nice amount of therapy material is available in the supply room in the
clinic. If the clinician is
interested in using this he should check it out prior to his/her
therapy
session and back in immediately afterwards. ALWAYS
RETURN THE CARDS, TESTS, GAMES, AND ETC, TO
THEIR PROPER PLACE IMMEDIATELY AFTER THERAPY.
Many of the materials needed for good (or acceptable) therapy
sessions
will have to be created by the clinician.
This is an aspect of training that will prove valuable in future
employment
settings.
When
the client arrives in the waiting room, the following procedure should
be
considered as a guide for conduct.
1.
At the
exact time of the scheduled appointment, the clinician should go to the
waiting
room, approach the parents, and introduce himself/herself as _(clientÕs
name) Ôs speech
clinician.
2.
The
clinician should then introduce himself to the client, mention
something
exciting planned for the session, and as swiftly as possible guide the
child to
the clinic.
3.
Begin the
session by building rapport through simple activities and free
conversation.
4.
Get into
goal-oriented activities. Keep the
session moving by having plenty of materials readily at hand.
5.
Use the
last several minutes for reinforcement activities.
6.
Summarize
the session for the parent, and inform her of any homework assignments,
in
writing.
7.
Remind
the parent of the next appointment and say goodbye to the child.
If the client is an adult,
adapt the
above procedures appropriately.
Every
clinician is required to prepare therapy plans for clients assigned to
him. The Therapy Plan Form is
included in Appendix J.
Copies of this form are available online and thoroughly
discussed in
COMD 380 and 381. Planning is an
extremely important part of a therapy program, and therapy plans should
be used
as a guide in every therapy session.
Therapy
plans for the upcoming week must be submitted to the clinical
supervisor by
12:00pm Friday and a copy will serve as your guide for conducting each
session.
These plans should include the semester objective along with the goals
and
procedures to be used during all therapy sessions to be conducted the
next
week. It is imperative that each
clinician records the objective documentation for each session on their
copy
after each session. These therapy
progress notes will be submitted to the supervisor along with the
therapy plans
for the next week. The student
clinician copy is to be placed in the clientÕs working folder
and made
available to the supervisor during each meeting. This
documentation is used to determine if the client is
progressing in a timely manner.
The
clinician should refer to these plans often, and at the end of the
semester a
weekly record of goals, procedures, and progress will exist. This will be invaluable in completing
progress or final reports.
THESE
PLANS ARE STRICTLY CONFIDENTIAL.
Client numbers must be used on all plans. They should never be left lying on desks,
bookshelves,
or tables. Information pertaining
to clients should never be discussed outside of the clinic setting.
ASSESSMENT AND
EVALUATION
ASSIGNMENTS
The
clinical director schedules all evaluations in the Speech Clinic. A case history form is usually obtained
before an assessment is scheduled.
A draft of the assessment or evaluation report must be submitted
to the
clinical supervisor within 5 days
of the completed assessment procedure.
This draft must be typed and saved on one of the computers in
the
workroom. Corrections will be
indicated by your supervisor and returned to you for entry in the
computer. When approved, the final
draft will be submitted on Harding University letterhead to the
clinical
supervisor for a signature. An
outline of the subdivisions of such a report is included in Appendix
C.
The
tests chosen and the order of administration should be determined by
information provided on the case history form. After
the clinician is familiar with this form, a meeting
with the clinical supervisor should be arranged. At
this meeting, specific tasks will be assigned and planning
suggestions will be offered as necessary.
GETTING UNDERWAY WITH
ASSESSMENTS
1.
Arrange
to conduct the parent interview in the clinic conference room or the
therapy
room with chairs. Never conduct
the interview in the lobby or waiting room.
2.
Put the
parent Òat easeÓ by making general remarks and chatting,
then state the purpose
of the interview.
3.
Explain
that all information is strictly confidential and will be released only
with
the parentÕs specific written consent.
4.
Review
the case history and ask any questions that will provide valuable
information
(including preferred name of the child, informant, school problems, and
etc.)
5.
Answer
any questions concerning services offered. Have
the parents review and sign the therapy enrollment form
(Appendix E).
6.
Be
relaxed during the interview--a tense and anxious interviewer makes
parents
uncomfortable.
7.
Do not
display emotional reactions to any of the information given, such as
shock,
horror, embarrassment, anger, etc.
8.
Make sure
that the Release of Information Forms have been signed, and ask if our
report
should be sent to someone. If so,
a Release of Information to an Outside Agency (Appendix F) must
be
completed. If another agency such
as an assessment team at a childrenÕs hospital has evaluated the
client, the
parents should complete the Release of Information to Harding Form
included in Appendix
G.
9.
Explain
to the parent what will take place during the assessment.
Since
each assessment must be designed with the individual child in mind it
would be
impossible to present an accurate assessment procedure guide. However, the following information may
prove valuable to the new student clinicians.
Articulation
If
the parent or referral source expresses concern about sound production
the
following aspects should be covered.
1.
Hearing
Screening
2.
Oral
Peripheral (Appendix H)
3.
Articulation
measure-- possibly one of the following:
a)
Arizona Articulation Proficiency Scale: Revised
b)
Goldman-Fristoe Articulation Test
c)
Photo Articulation Test
d)Templin-Darley
Articulation Test
4.
A sample
of conversational speech (tape recorded)
5.
Basic
Language Analysis-- after studying the specific case, one of the
following
measures may be selected:
a)
Preschool Language Scale, Revised
b)
Peabody Picture Vocabulary Test, Revised
c)
Test for Auditory Comprehension of Language
d)
Utah Test of Language Development
e)
spontaneous language sample
f)
or one of the other language measures available in the clinic.
Language
If
the referral is based on language concerns, the above format would be
followed
with the addition of comprehensive language measures.
Note: An
assessment measure should never be used until you are very familiar
with
administering it. If you are not
familiar with the specific instructions, the test is invalid and a
waste of
time.
After
testing is completed, the clinician and the supervisor should inform
the
parents or client of the results and basic recommendations. Every effort should be made to assure
that the results and suggestions are fully understood.
Once again, ask if copies of the final
report should be supplied to any specific individuals or agencies.
An
evaluation or assessment report is required for each new client
beginning
therapy in the clinic. The reports
MUST be typed and saved on the computers in the clinic workroom then
turned in
to the clinical supervisor within five days of the assessment.
The
format of the evaluation report varies slightly for speech and hearing
primarily because of the nature of the content of the reports. An outline of a Speech and/or Language
Assessment Report is located in Appendix C.
This outline should be used as a guide but each childÕs
assessment report should indicate his individual needs.
All
reports must be submitted to the clinical supervisor in accordance with
the
guidelines previously presented (see Assessment and Evaluation
Assignments).
SEMESTER GOALS &
PROGRESS
REPORTS
Within
one week of beginning therapy with a new client, each clinician is
required to
submit semester therapy goals to the supervisor. Each
clinician should consult with the supervisor when
planning the goals and objectives for the semester.
There are several books available in the clinic to help you
in this process including Planning Individualized Speech and
Language
Intervention Programs by Nelson.
If you are using the suggested goals from the book, you can ask
the
clinic secretary to photocopy the appropriate pages.
The goals are to be placed in the client's working
folder. It is the responsibility
of the clinician to consult with the supervisor during this process.
Throughout
the semester, goals that are achieved should be noted in the
appropriate space
on the goal sheet. At the
conclusion of the semester, or if a client is dismissed from therapy
during the
semester, all attained goals should be documented and general
subjective
comments regarding the progression of therapy and recommendations for
the
following semester should be noted on the goal sheet.
It is the responsibility of the clinician to turn in the
goal sheet at the end of the semester to the supervisor.
The
recommendations section is a very important part of the progress report. The clinician should have a conference
with the supervisor to discuss this aspect of the report before the
report is
finalized. While the clinician is
encouraged to suggest recommendations, it should be noted that the
supervisor
is the final authority.
Clinicians, because of their constant contact with the client,
should be
able to document the basis for their recommendations.
The supervisor will generally concur with the clinicianÕs
view.
Procedures
for client records are extremely important and must always be followed
carefully. The clinician is
responsible for reporting any missing or incomplete records to the
supervisor.
The
following procedure is followed for case records:
Client file:
When a client contacts or is referred to the clinic, a permanent
file is
begun and a client number is assigned.
All correspondence, case history forms, etc. are placed in this
file. The clinician assigned to
conduct the evaluation or assessment will need to study the file. If the client is to be actively
followed by the clinic, the file will be placed in the active files
drawers in
the file cabinet in the waiting room.
If the client does not respond to appointments or is dismissed
from
therapy, the file is placed in Òinactive.Ó
Lesson plan records:
Lesson plans are to remain in the client's working file along
with
specific notes. These records are
also kept confidential and may not be removed from the clinic.
Goals sheet:
Goal sheets are to be placed in the folder within one week of
beginning
therapy. Attained goals should be
documented as soon as they are achieved.
TESTS AND ASSESSMENT
MATERIALS
Several
assessment measures and tests are kept in the supply room.
These are to be checked out by the
clinician, if they are taken out of the clinic. Placing
the name of the item, the person removing it, and
the time and date removed on the checkout form in the workroom. The
test must
be returned immediately after use and no later than 8:30 AM the
following
morning.
Occasionally,
a clinician may check out a test for study purposes, but this should be
done
only with the permission of the supervisor and only on the following
conditions:
1.
A test
may be checked out only after the clinic responsibilities including all
assessments and therapy have been completed for the day, usually after
4:30 PM.
2.
Any test
must be returned before clinic responsibilities begin on the following
morning. Materials may be checked
out following therapy on the Friday before Thanksgiving and after exams
before
Christmas break, but must be returned on the Monday morning following
the
break.
Permission from the
supervisor is
necessary in each case. This
checkout procedure applies to test manuals also.
If
the clinician plans to use the material for assessment, etc., at a
specific
time, a note taped to the item (stating the date and time he plans to
use it
and his name) will alert other clinicians to the fact that the test is
needed
in the clinic at that particular time.
We
have several tape recorders (located in the supervisors offices),
picture
cards, games, puzzles, blocks, toys, stickers, flashlights, tongue
depressors,
gloves, hand cleaner, and other supplies that can help make therapy
motivation
and productive. You are free to
use these supplies as you need them.
Please do not abuse this privilege. You
may never keep any of these materials in your mailbox
and prevent other clinicians from having access to them.
You may never ÒhideÓ these materials
for your own use, thereby preventing others from using them.
It
is important that each clinician become proficient in the operation of
equipment commonly employed in speech and hearing work.
Each clinician should also treat each
item with care to avoid damage and should report any damage to a
clinical
supervisor immediately. You must
return all equipment to its proper location immediately after use.
In
addition to the equipment and assessment materials, the clinic also
attempts to
maintain a basic supply of therapy materials. Items
available include: Peabody Language
Development Kits, Peabody
Articulation Cards, Developmental Learning Materials, Game
Oriented Activities for Language Kits I and II (GOAL), and
miscellaneous
toys and stimulus materials. These
kits are very expensive and should be carefully maintained.
Every
item must
be placed
back in the kit after use.
Sometimes a single item lost from a kit can make the rest
worthless. Cooperation by all
clinicians will insure longer life of therapy materials and equipment. This will also permit maximum
circulation and application of these items.
Factors
considered in arriving at a letter grade in practicum courses have been
established to provide uniformity in assigning grades to clinicians. Specific grading forms will be provided
and explained in COMD 380, 381 and 421.
These forms will be added to the online manual in the near
future.
To
elaborate on the points used in evaluating clinicians, the following
outline is
presented as evaluation criteria.
Personal and Interactive
Effectiveness: To what degree
does the clinician have desirable:
1.
Appearance
2.
Emotional
Maturity
3.
Social
sensitivity and responsibility
4.
Ability
to project
5.
Friendliness
6.
Tact
7.
Poise
8.
Acceptance
of clients
9.
Acceptance
of peers
10.
Oral
expression
11.
Written
communication skills
Academic and Professional
Effectiveness: To what degree does the clinician:
1.
Relate
subject matter and activities to the age and maturity level of the
client
2.
Plan for
full use of therapy time
3.
Make use
of available materials
4.
Help
clients use a variety of materials
5.
Plan and
organize for clientÕs teaching
6.
Fulfill
lesson plans
7.
Take
initiative in assuming responsibility
8.
Accomplish
thoroughness in teaching
9.
Show
resourcefulness
10.
Know and
understand client
11.
Establish
client-therapist respect and rapport
12.
Evidence
academic thoroughness and preparedness
13.
Arouse
client enthusiasm in learning process
14.
Enrich
the learning situation
15.
Vary his
approach to problems
16.
Evaluate
client growth and progress
17.
Evaluate
himself
18.
Evidence
leadership potential
19.
Modify
behavior after professional criticism
20.
Show
interest in the professional aspect of speech pathology
Additional
points of evaluation-- actually an extension of some of the more
important
items from the preceding lists-- are presented to further clarify to
the
clinician what entails quality clinical work.
1.
Do
children enter and leave the clinic rooms in an orderly manner?
2.
Are
children interested in their work?
3.
Do
children slouch on chairs and the table?
4.
Does the
clinician deal in a kind, firm, and impartial manner with the children?
5.
Does the
clinician talk to the children as though they were his equal?
6.
Does the
clinician provide constructive activity for the child who wants to
dominate,
especially in group therapy?
7.
Does the
clinician encourage the retiring child?
8.
Does the
clinician introduce visitors (observers or supervisors present in the
observation
room) to the client?
9.
Does the
clinician avoid discussing the clientÕs speech difficulties in
the clientÕs
presence?
10.
Does work
provide variety in group therapy according to the needs of individual
members?
11.
Are
devices adapted to the age and speech development of the client?
12.
Are
speech activities correlated with activities in the classroom,
playground, and
home?
13.
Does the
clinician talk too much?
14.
Is the
work planned so that each client gets sufficient opportunity to
practice his
ÒgoodÓ sound in group situations?
15.