ASSESSMENT TOOL FOR CMD 562 ‑ SCHOOLS PRACTICUM AND CMD 569
NUROPATHOLOGIES PRACTICUM
Southern Connecticut State University
Department of Communication Disorders
Competency-Based Evaluation for Off-Site Clinical Practica
Student: __________________________________ Dates of Placement: / / 20_____ to / / 20_____
Supervisor: _______________________________ Placement Location: _____________________________________
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Competency Indicators |
Related ASHA SLP Standard(s) |
Midterm Rating |
Final Rating |
Interaction and Personal Qualities |
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Adheres to all aspects of the ASHA Code of Ethics.
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Standards III E; IV G3-d |
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Exhibits interest and enthusiasm in all aspects of clinical assignment.
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Standards IV G 3-d |
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Respects cultural beliefs and linguistic diversity of clients, families and significant others,, caregivers, co-workers and relevant others. |
Standards IV F; IV G 3a |
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Demonstrates appropriate professional dress, appearance, and demeanor.
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Standards IV G3-d |
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Demonstrates prompt and regular attendance.
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Standards III E; IV G 3-d |
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Completes all assignments within the required time frame.
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Standards III E; IV G 3-d |
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Demonstrates effective organizational and time management skills.
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Standards IV G 3-d |
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Engages in effective oral and written communication, recognizing the needs, values, preferred mode of communication, and cultural/linguistic background of the client, family, caregivers, and relevant others. |
Standards IV B; IV G 3-a |
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Demonstrates flexibility and problem solving when presented with changes in assignment or routine. |
Standards IV G 3-d |
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Evaluation: |
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Reviews available background information and identifies key diagnostic issues.
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Standards III B, C, D, F; IV G 1-c |
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Chooses tests and assessment procedures related to identified diagnostic issues.
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Standards III B, C, D, F, G; IV E 1a,c |
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Administers evaluation procedures, such as behavioral observations, non-standardized and standardized tests, instrumental procedures. |
Standards IV D, III D; IV G 1-c |
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Competency Indicators |
Related ASHA SLP Standard(s) |
Midterm Rating |
Final Rating |
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Adapts evaluation procedures to meet client’s needs.
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Standards III D; IV G 1-d, 3-a |
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Interprets standardized and non-standardized results accurately; draws logical diagnostic conclusions. |
Standards IV B III A, B, C, F; IV G 1-e |
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Documents all assessment findings in a cohesive manner in the required format(s).
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Standards IV B; III G; IV G 1-f |
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Makes appropriate recommendations and referrals, based on evaluation outcomes.
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Standards IV B; III A, B, C, G; IV G 1-f,g |
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Intervention |
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Accurately interprets baseline and/or ongoing assessment data and uses it appropriately to establish and modify treatment goals and objectives. |
Standards III D; IV G-2a |
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Develops and implements effective and appropriate goals and objectives.
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Standards IV B III A, B, C; IV G-2b |
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Integrates academic information/research into clinical practice; provides rationale for selection of specific therapy methods. |
Standards III A, B, C, D, F; IV G-2a |
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Uses level of language and instruction to optimize client’s responses.
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Standards IV B; III C, D; IV G-2b, 3a |
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Selects and employs appropriate stimuli to elicit type and level of response required.
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Standards III D; IV G-2c |
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Develops a variety of functional and appropriate tasks to support objectives.
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Standards III D; IV G-2b |
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Demonstrates flexibility within session, modifying intervention plan as necessary.
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Standards III D; IV G-2b |
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Sequences and paces activities within the treatment session to facilitate intervention outcome. |
Standard III D; IV G-2b |
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Uses appropriate reinforcement and feedback strategies.
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Standard III D; IV G-2b |
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Collects and records quantitative and qualitative data in an accurate, efficient and unobtrusive manner. |
Standard III D; IV G-2d |
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Uses qualitative and quantitative data to adjust client’s program as necessary.
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Standard III D; IV G-2d, 2e |
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Provides appropriate information regarding skill generalization, family/caregiver training, and home-based activities. |
Standards III D; IV G-3a, 3b |
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Competency Indicators |
Related ASHA SLP Standard(s) |
Midterm Rating |
Final Rating |
Counseling, Conferencing and Team Participation |
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Provides counseling regarding communication and swallowing disorders as needed to clients, family, caregivers, and relevant others. |
Standards III A, B, C, D, E, F, G, ; IV B; IV G 3-a,b,c |
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Collaborates effectively and appropriately with other professionals to facilitate case management. |
Standards III E, G; IV B; IV G 3-a,b |
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Participates in and contributes to client centered team meetings in an appropriate manner.
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Standards III E, G; IV B; IV G 3-a,b |
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Reacts appropriately and professionally when conflicting viewpoints are expressed.
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Standards III E; IV G 3-a,b |
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Supervisory Process |
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Interacts cooperatively and collaboratively with supervising clinician.
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Standards IV B; IV G 3-d |
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Initiates and uses self-evaluation process to refine clinical skills.
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Standards IV B; IV G 3-d |
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Actively and cooperatively engages in and contributes to the supervisory process.
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Standards IV B; IV G 3-d |
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Uses supervisory feedback to refine clinical performance.
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Standards IV B; IV G 3-d |
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Competency Rating Code: Rate the student’s progress in mastering each competency indicator using the following “Level of Support” codes:
I = Demonstrates behavior independently
M = Demonstrates behavior with minimal guidance from supervisor.
S = Demonstrates behavior with specific guidance from supervisor.
R = Demonstrates behavior with excessive and repeated instruction from supervisor.
F = Fails to demonstrate behavior regardless of amount of supervision.
~~~~~PLEASE DO NOT ASSIGN A LETTER GRADE ~~~~~
Midterm Review:
Supervisor’s Signature: _____________________ Date: _______ Student Clinician’s Signature: _____________________ Date: ________
Final Review:
Supervisor’s Signature: _____________________ Date: _______ Student Clinician’s Signature: _____________________ Date: ________
Southern Connecticut State University, Department of Communication Disorders
Summary of Clinical Performance
Midterm Review
Student: Supervisor: Practicum: 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