ASSESSMENT TOOL FOR CMD 560 561 ‑ SPEECH AND LANGUAGE
PRACTICUM A AND B
Southern Connecticut State University
Center for Communication Disorders
CMD 560/561: Speech‑Language Pathology Practicum
Competency Assessment Sheet
Student: Supervisor: Semester: Year:
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Related ASHA SLP Standards |
Midterm |
Final |
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Competency Indicators |
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Rating |
Rating |
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Session Management |
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1. Interacts and communicates appropriately with clients and family members |
Standards III B; III D IV F; IV G-3a |
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across the lifespan and from culturally/linguistically diverse |
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backgrounds. |
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2. Accurately interprets baseline and/or ongoing assessment data and |
Standards III D; IV G-2a |
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uses it appropriately to establish and modify treatment goals and |
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objectives. |
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3. Develops and implements effective and appropriate long-term goals |
Standards III A, B, C„D; IV G-2b |
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and session objectives. |
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4. Integrates academic information/research into clinical practice; |
Standards III A, B C, D, F; IV G-2a |
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provides rationale for selection of specific therapy methods. |
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5. Uses level of language and instruction to optimize client's responses.
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Standards; III C, D; IV B, G-2b, 3a |
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6. Selects and employs appropriate stimuli to elicit type and level of |
Standards III D; IV G-2c |
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response required. |
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7. Develops a variety of meaningful, creative, and interesting tasks to |
Standards III D; IV G-2b |
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support objectives. |
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8. Demonstrates flexibility within session, modifying the plan as |
Standards III D; IV G-2b |
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necessary. |
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9. Sequences and paces activities within the treatment session to |
Standard III D; N G-2b |
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facilitate client success. |
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10. Uses appropriate reinforcement and feedback strategies. |
Standard III D; IV G-2b |
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11. Collects and records quantitative and qualitative data in an accurate, |
Standard III D; N G-2d |
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efficient and unobtrusive manner. |
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12. Uses qualitative and quantitative data to adjust client's program as |
Standard III D; N G-2d, 2e |
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necessary. |
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13. Provides appropriate information regarding skill generalization, |
Standards III D; IV G-3a, 3b |
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family /caregiver training, and home-based activities. |
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Professionalism/Self-Evaluation |
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14. Initiates and uses self-evaluation process to refine clinical skills.
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Standard IV B |
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15. Actively and cooperatively engages in supervisory process; uses , |
Standard IV B |
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supervisory feedback to refine subsequent sessions. |
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16. Completes all case assignments by specified due dates.
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Standard III E |
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17. Interacts and communicates effectively with other specialists/ professionals. as necessary. |
Standards III E; IV B, G-3b, 3d |
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Clinical Writing |
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18. Uses correct documentation format including appropriate use of professional language and
terminology, correct grammar, spelling |
Standards IV B, G‑2f
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19. Accurately reports assessment and treatment information in a cohesive manner. |
Standards IV B, G‑2f
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20. Provides a succinct, accurate comparative data analysis. |
Standards IV B, G‑2f
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21. Provides an accurate summative statement based on a comparative data analysis. |
Standards IV B, G‑2f
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22. Provides an accurate interpretive statement regarding the client's current communicative status. |
Standards IV B, G‑2f
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23. States appropriate recommendations for subsequent treatment, additional testing, and/or referrals, as necessary. |
Standards IV l3, G‑2f, 2g
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Average Score: Divide the sum of scores by the number of competencies rated to calculate average score.
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Competency Rating Code: Rate each competency indicator from 1.0 to 5.0 Decimal fractions may be used (e.g. 3.5 4.7, etc)
5.0 = Demonstrates behavior independently or with minimal guidance.
4.0 = Demonstrates behavior with general guidance from supervisor.
3.0 = Demonstrates behavior with specific guidance from supervisor.
2.0 = Demonstrates behavior with excessive and repeated instruction from supervisor.
1.0 = Fails to demonstrate behavior regardless of amount of supervision.
Grade Scale: 4.8 – 5.0 A+; 4.7 – 4.4 A; 4.3 – 4.0 A-; 3.9 – 3.7 B+; 3.6 – 3.4 B; 3.3 – 3.0 B-; 2.9 – 2.5 C; <2.5 F
Recommended Midterm Letter Grade: _____________
Supervisor’s Signature: _______________________ Date: _________ Student Clinician’s Signature: __________________ Date: ________
Recommended Final Letter Grade: __________
Final grade may be adjusted by supervisor based on additional factors discussed with student.
Supervisor’s Signature: _______________________ Date: _________ Student Clinician’s Signature ___________________ Date: ________
Rev. 1/03
Southern Connecticut State University, Department of Communication Disorders
Summary of Clinical Performance
Midterm Review
Student: Supervisor: Practicurn: Term & Year:
Areas of Strength / Emerging Competencies:
Mid‑term Formative Assessment: Goal Setting (use any of the following areas that apply)
Personal and Professional Competencies: Goal(s):
Foundation Knowledge: Goal(s):
Evaluation Skills: Goal(s):
Intervention Skills: Goal(s):
Oral Communication: Goal(s):
Written Communication: Goal(s):
________________________ ________ ___________________________ _________
Supervisor Signature Date Student Clinician Signature Date
Southern Connecticut State University, Department of Communication Disorders
Summary of Clinical Performance
Semester End Review
Student: Supervisor: Practicum: Term & Year:
Review of Midterm Goals and Emerging Competencies:
Suggestions for Continued Competency Refinement:
____________________________ _______ ___________________________ __________
Supervisor Signature Date Student Clinician Signature Date