SECTION B PRACTICUM INFORMATION

SECTION B PRACTICUM INFORMATION Clinical Practicum Faculty Clinical Mentors Clinical Practicum Supervision Instructions Case - Summary Reports Case Summary Report (form) Request for Diagnostic Evaluation (release form) Course Syllabus: CSD 602 Practicum Practicum Information Sheet (form) Record Keeping Daily Clock Hours (form) Summary of Clock Hours (form) CSD Clinical Clock Hour Accumulations (form) Graduate Student Trainee Rating Scale (form) Clinical Education Site Identification (form) Rev. May 2002 B 1

CLINICAL PRACTICUM 1. Students have two files in the department: an academic file and a practicum file. The practicum file must be complete before a student may complete the program of study. 2. Students may begin clinical practicum after they have successfully completed CSD 510, Clinical Methods, with a grade of B or better. 3. You must arrange your clinical practicum experiences at either your employment setting or an identified alternate setting. Please submit the Student Practicum Information Sheet (see page B 10) to the Program Coordinator when you make your clinical practicum arrangements. Students must identify alternate practicum settings, in writing, before beginning the practicum. 4. Clinical practicum requires enrollment in 2 courses of CSD 602 Clinical Practicum for two summers, for a total of 6 semester credit hours. Course requirements are defined in the CSD 602 Clinical Practicum Course Syllabus included in this handbook (page B 8 and B 9). 5. ASHA Certification Standard III B stipulates completion of at least 350 clock hours of supervised clinical experiences that concern the evaluation and treatment of children and adults with disorders of speech, language and hearing (see ASHA Handbook or go to website at www.asha.org). These hours must be completed after you have completed 25 clock hours of supervised observation. It is expected that you will complete at least 150 practicum clock hours during your CSD 602 enrollments with the remainder (200 hours) obtained during your externship. 6. In your clinical practicum at least 50 supervised clock hours must be completed in each of at least two different settings. These two settings may be defined within your current work setting as pre-school, high school or self-contained vs normal classroom settings. If your current employment setting does not permit identification of clinical activities as at least two distinct settings, you will have to establish a clinical practicum in an alternate setting. 7. Twenty (20) of your clinical practicum hours must be in audiology and must be completed according to ASHA standards. See ASHA Certification Standard III-B for details. If you completed audiology screening hours as an undergraduate, these may be applied toward fulfilling this requirement. Please send documentation to the Program Coordinator. 8. Up to 100 clinical clock hours completed during an undergraduate program may be applied toward clinical practicum requirements. These hours also fulfill one setting requirement, if they total at least 50 (and no more than 100) hours. To apply these hours toward your clinical clock hour requirements, please send the Program Coordinator a log copy of all undergraduate practicum hours, signed by a certified supervisor. Rev. May 2002 B 2

FACULTY CLINICAL MENTORS Faculty Clinical Mentors are the link between your clinical education site and the university program. Please feel free to contact your mentor for any matters related to your clinical education. Faculty Clinical Mentors are assigned according to the first letter of your last name. If you change your name you will stay assigned to your original mentor. They will review and evaluate your case summaries and be available for any clinical therapy questions. Clinical Mentor Activities Include: 1. Supervisory Interactions with Practicum Students and Supervisors as Needed 2. Review of 5 Case Summaries for the first 25 Clock Hours 3. Practicum/Externship Supervisor Interactions 4. Clinical Therapy Advice Dr. Judith King Phone: (928) 523-7436 Dr. William Culbertson Phone: (928) 523-7440 Dr. Elise Lindstedt Phone: (928) 523-9591 Dr. Dennis Tanner Phone: (928) 523-7439 Dr. Mary Oelschlaeger Phone: (928) 523-4952 A,B,C Email: Judith.King@nau.edu D,E,F,G,H Email: Bill.Culbertson@nau.edu I,J,K,L,M Email: Elise.Lindstedt@nau.edu N,O,P,Q,R Email: Dennis.Tanner@nau.edu S,T,U,V,W,X,Y,Z Email: Mary.Oelschlaeger@nau.edu Please direct all clinical therapy and diagnostic questions to the above Faculty Clinical Mentors. CLINICAL PRACTICUM SUPERVISION The first 25 hours of your clinical practicum (following the ASHA mandated 25 observation hours) require review by a Faculty Clinical Mentor. To obtain this review, you must prepare case summary reports representing the first 5 hours of treatment for 5 clients seen during this period. Rev. May 2002 B 3

The format of these case summary reports is presented on the Case Summary Reports Instructions form (page B 5). Students must follow the form format. The required information should fit on a single page or, at most, two. Prior to writing these summaries, you must obtain permission for the release of this information to NAU. You may use NAU's Request for Diagnostic Evaluation and/or Therapy Services form (page B 7) or your site s form to document permission. Release permission forms are required, and practicum grades will not be posted unless they are included in the student s practicum file. Use only client's first and last initials on the form (not the full name). To complete case summaries: Identify 5 cases from your current caseload and prepare case summaries on each based on the first 5 hours of treatment. Include only the information required in the Case Summary Reports form (page B 6). Mail your case summaries, client release forms and corresponding clock hour form(s) to the Program Coordinator by October 15. Remaining hours and grade/evaluation sheet (page B 15 and B 16) should be submitted by the end of fall semester. If not, your grade will be recorded as IP (in progress). Please note that you will not receive a grade for Clinical Practicum I or be registered for your Clinical Practicum II until this process is completed. Upon receipt of your case summaries, your faculty clinical mentor will review them and document the results of this review on the Case Summary Review Form. Your Faculty Clinical Mentor will contact you regarding these reports and your clinical practicum in general. When communication is completed, your performance will be noted as satisfactory and the Case Summary Review form will be filed accordingly. Please feel free to contact your Faculty Clinical Mentor if you have any questions concerning your case studies and clinical practicum. Other clock hours beyond the initial 25 are to be supervised by your CCC licensed on-site clinical supervisor. Requirements of supervision of these hours are defined by ASHA as: 50% supervision of diagnostic sessions, including screenings. 25% supervision of treatment sessions. Upon completion of each CSD 602 enrollment, the Graduate Student Trainee Rating Scale (B15 and B 16) must be completed by your supervisor. Please share the grading criteria with your supervisor and ask him/her to complete the grade computation form. Your supervisor must verify that you were supervised according to ASHA standards with their signature and ASHA membership number. This form should then be mailed by your supervisor to the Program Coordinator. Rev. May 2002 B 4

INSTRUCTIONS CASE SUMMARY REPORTS CLIENT INITIALS LOCATION DOB C.A. DISORDER SUPERVISOR/SLP ASHA # BACKGROUND INFORMATION: Include an introductory statement about your client. Do not use the client's full name, only use initials. Briefly state reason for therapy, how often the client is being seen, how long sessions last and the type of service delivery modality. Include brief information regarding case history, including date and findings of the initial evaluation, educational placement, pertinent medical findings, and developmental history. PRESENT COMUNICATIVE STATUS (level of function): Include the evaluation and assessment information that you have used to make inferences about your client's abilities, therapy and classroom communicative functioning. Include statements of intelligibility, language comprehension and language use. Where possible, report quantitative findings. GOALS: Why is the client being treated? What is the planned treatment outcome? OBJECTIVES: Exactly what behaviors will signify that the client has met or approximated the treatment goals? These should be stated as quantities. IMPRESSIONS: Describe the client's response to treatment in terms of the planned objectives. Report plans for further treatment, including discharge or modifications. SLP s Signature Date Student Signature Sem/Year * "Goal" and Objective" information may be copied directly from the client s IEP or HCFA (700, 485) forms. On HCFA forms "Goals" are "Treatment Outcomes" and"objectives" are "Goals (Short Term)." Rev. May 2002 B 5

CASE SUMMARY REPORT CLIENT INITIALS LOCATION DOB C.A. DISORDER SUPERVISOR/SLP ASHA # BACKGROUND INFORMATION: PRESENT COMUNICATIVE STATUS (level of function): GOALS: OBJECTIVES: IMPRESSIONS: SLP Signature Date Student Signature Sem/Year * "Goal" and Objective" information may be copied directly from the client s IEP or HCFA (700, 485) forms. On HCFA forms "Goals" are "Treatment Outcomes" and"objectives" are "Goals (Short Term)." Rev. May 2002 B 6

NORTHERN ARIZONA UNIVERSITY SPEECH AND HEARING CLINIC REQUEST FOR DIAGNOSTIC EVALUATION AND/OR THERAPY SERVICES NAME BIRTHDATE SEX PARENT EVALUATION(S) REQUESTED: SPEECH HEARING PHONE ADDRESS REFERRED BY MY SIGNATURE UPON THIS FORM INDICATES THAT I UNDERSTAND AND AGREE TO THE FOLLOWING CONDITIONS: 1. I grant permission to the Northern Arizona University, Department of Communication Sciences and Disorders to provide appropriate services to the above named client. I understand that I have the right to ask questions regarding services at any time. 2. I understand that services provided are performed by students with appropriate training under supervision of faculty with American Speech-Language-Hearing Association Certification. Observation by authorized persons for instructional purposes may also occur. 3. I grant permission to audiotape, videotape or take pictures of the above named client for use in research and/or training in speech-language/hearing. Confidentiality will be maintained. I can refuse permission without loss of services. Permission granted? Yes No 4. I understand that supervisory faculty of Northern Arizona University, Department of Communications Sciences and Disorders, may review any written reports concerning therapeutic services in order to ensure compliance with professional standards. Signed Date Rev. May 2002 B 7

COURSE SYLLABUS COURSE TITLE INSTRUCTOR/SUPERVISOR CSD 602 PRACTICUM I and II Your on-site ASHA certified supervisor CREDIT HOURS 3 COURSE DESCRIPTION In-depth preparation and professional level clinical application of speech language pathology and audiology concepts. COURSE PREREQUISTES 1. Undergraduate degree in Speech Pathology, admission to Graduate Program in Clinical Speech Pathology. 2. Completion and documentation of 25 hours of supervised observation of speech therapy in the student's permanent department file. 3. Completion of CSD 510, Clinical and Educational Methods in Speech-Language Pathology with a grade of B or better. REQUIRED TEXT SUGGESTED TEXT NAU Summers-Only Handbook ASHA Certification and Membership Handbook, current edition Culbertson, W., and Tanner, D. (2002) Clinical Reference Manual for Communication Sciences and Disorders. Tempe, AZ: Scholargy COURSE OBJECTIVES 1. Students will apply the theories learned about speech, language and hearing disorders in diagnostic and remedial contexts. 2. Students will partially complete clinical clock hour requirements for attaining the American Speech-Language-Hearing Association Certificate of Clinical Competence, by working directly with clients, under supervision, at a variety of approved off-campus sites. Rev. May 2002 B 8

COURSE REQUIREMENTS In order to complete this practicum course the student must complete a minimum of 50 clinical clock hours. If a student does not complete the minimum hours required for the course, she/he will receive a grade of "incomplete" for the course. Practicum I Successful completion of 5 case studies for the first 25 hours. Students are expected to acquire and read the Certification and Membership Handbook, current edition, of the American Speech Language-Hearing Association and stay abreast of any changes in standards that apply to them. Summers-Only students must keep abreast of posted program announcements and updates on the Summers-Only web site (see link at http://www.nau.edu/hp/dept/speech/index.html). Required documentation for completion of each Practicum: Practicum I only Case Studies and Client Release Forms Clinical Faculty Mentor s Evaluation indicating complete Practicum I and II Practicum Information Form (B 10) Daily Clock Hours Form (B 12) Summary of Clock Hours Form (B 13) CSD Clinical Clock Hour Accumulations Form (B 14) Graduate Student Trainee Rating Scale (B15 and B 16) ASHA Clinical Education Site Identifcation Fomr (B 17-19) All forms must be complete, and appropriately signed and dated. APPROACH The practicum student will complete supervised clinical practicum clock hours in accordance with standard III-B of ASHA s certification guidelines. The practicum student will deliver diagnostic and treatment services under supervision of ASHA certified facility listed in the student s permanent file in accordance with ASHA standards. Rev. May 2002 B 9

PRACTICUM INFORMATION SHEET STUDENT NAME Date STUDENT ID E-MAIL ADDRESS EMPLOYER NAME EMPLOYER ADDRESS SUPERVISOR S NAME SUPERVISOR ASHA# (Attach copy of current membership card) SUPERVISOR S TELEPHONE Please answer the following questions: Can you complete the audiology (screening) hours in this clinical setting? In what clinical settings will hours be completed? When are you scheduled for your first clinical practicum enrollment? When do you anticipate starting your externship? PLEASE ATTACH COPY OF SUPERVISOR S ASHA MEMBERSHIP CARD Rev. May 2002 B 10

RECORD KEEPING 1. The following system of record keeping of clinical clock hours conforms to the requirements set forth by ASHA. You are expected to maintain records according to this system. You are responsible for keeping records of your clinical clock hours and for ensuring their inclusion in your CSD practicum file. 2. Use the following guidelines for reporting clock hours and fractions of hours: 60 minutes = 1 hour 30 minutes =.5 hour 55 minutes =.9 hour 25 minutes =.4 hour 50 minutes.8 hour 20 minutes =.3 hour 45 minutes =.75 hour 15 minutes =.25 hour 40 minutes =.7 hour 10 minutes =.2 hour 35 minutes =.6 hour 5 minutes =.1 hour 3. Use the NAU CSD daily clinical clock hour log throughout the semester (see page B 12). Complete one form for each site, rather than each client. Your name, semester, site, and setting should be noted at the top. The semester notation must include the year. 4. Categories for disorders are noted in columns. If the client fits into more than one category (i.e., has both language and speech disorder), identify the disorder and allocate time spent for diagnosis and treatment of each disorder. 5. At completion of each clinical practicum, total the columns by minutes and then by hours. Send a copy, signed by your supervisor, to the Program Coordinator. Also complete and submit summary of clock hours (page B 13) and clock hour accumulations (page B 14). 6. At the end of each Clinical Practicum enrollment obtain supervisors' signatures on all forms and mail copies to the Program Coordinator. 7. Use separate sheets for each site and include all clients you treated at that site on the forms. Complete a separate form for each site. If you treated both adults and children at the same site, use a separate sheet for each age group and duly note the difference. Be Sure to Keep Your Original Copy of All Clinical Clock Hours! Rev. May 2002 B 11

Northern Arizona University Department of Communication Sciences and Disorders Daily Clock Minutes Form Clinician Site Setting Child Adult Clock Minutes Week Ending Date E=Eval T=Treat Language Disorders Artic Disorders Semester/Year Pct I Pct II Ext Voice Disorders Fluency Disorders Dysphagia Audiology Hours Total Minutes Total Hours (Min/60) Supervisor Signature Please Print Name ASHA# Date Rev. May 2002 B 12

Northern Arizona University Department of Communication Sciences and Disorders Summary of Clock Hours Use this form to keep track of your total hours Clinician Semester/Year Site Pct I Pct II Ext Child Adult Child Eval Adult Eval Child Trmt Adult Trmt Total Artic. Voice Fluency Total Speech Language Audiology Hours Site Total Site (if more than one site is used) Child Eval. Adult Eval. Child Trmt. Adult Trmt. Total Artic. Voice Fluency Total Speech Language Audiology Hours Site Total Supervisor s Signature Date Supervisor s ASHA Number Student s Signature Date Rev. May 2002 B 13

CSD CLINICAL CLOCK HOUR ACCUMULATIONS Please Indicate: Practicum I Practicum II Externship STUDENT SS# 25 Observation hours 1 st Practicum Completed (date) 2 nd Practicum Completed (date) 5 Case Summaries Total Undergraduate hours Evaluation: Children Language Disorders Clock Hour Totals: (see ASHA Standard III-B) Record hours under areas in which they were completed: Speech Disorders Audiology Related Staffing Total Hours Totals: Totals: Totals: Totals: Totals: Totals: 20 hours min 20 hours min 20 hours max 25 hours max Evaluation: Adults Language Disorders Record hours under areas in which they were completed: Speech Disorders Audiology Related Staffing Total Hours Totals: Totals: Totals: Totals: Totals: Totals: 20 hours min 20 hours min 20 hours max 25 hours max Treatment: Children Language Disorders Record hours under areas in which they were completed: Speech Disorders Audiology Related Staffing Total Hours Totals: Totals: Totals: Totals: Totals: Totals: 20 hours min 20 hours min 20 hours max 25 hours max Treatment: Adults Language Disorders Record hours under areas in which they were completed: Speech Disorders Audiology Related Staffing Total Hours Totals: Totals: Totals: Totals: Totals: Totals: 20 hours min 20 hours min 20 hours min total 20 hours max 25 hours max Date Student Signature Rev. May 2002 B 14

Northern Arizona University Communication Sciences and Disorders Box 15045 Flagstaff AZ, 86011 GRADUATE STUDENT TRAINEE RATING SCALE Practicum I Practicum II Externship Dear Supervisor: Kindly complete this clinical rating scale of your NAU Trainee and return it to the above address. Please rate the trainee on the qualities listed below as follows: A=Excellent, B=Good, C=Fair, D=Poor A passing grade is A or B Trainee Name: Number of clinical hours in placement Supervisor: Site: Date: AHSA# I. Professional Fitness Rating Desire And Initiative For Professional Growth Emotional Maturity And Common Sense Ability To Interact With Members Of Other Disciplines Responsiveness To Supervision Competence In Fulfilling Responsibilities Oral Skills Writing Skills Personal Appearance II. Clinical Abilities Rating A. Interpersonal skills: Ability to relate to client as function of the client s: Age Gender Symptoms Ability To Inform And/Or Counsel Clients Or Their Families Development and Implementation of Clear Goals/Objectives Rev. May 2002 B 15

B. Program Planning Rating Adequacy Of Theoretical Knowledge Ability To Administer Diagnostic Evaluation Ability To Interpret Diagnostic Data Ability To Develop Clinical Program Ability To Adapt Program To Individual Needs Ability to Develop And Implement Clear Goals And Objectives C. Program Application Rating Control And Direction Of Therapy Session Maintenance Of Client Interest And Motivation Clarity And Sufficiency Of Direction And Feedback To Client Accuracy Of Observation And Recording Management Of Reinforcement Ability To Modify Sessions According To Client s Needs Overall Grade: I certify that I have supervised the above-named trainee/student according to current ASHA standards: Supervisor Signature and ASHA # Date Please include additional comments, if any, on the reverse side of this form. Thank you! Rev. May 2002 B 16

Northern Arizona University Department of Communication Sciences and Disorders P O Box 15045 Flagstaff, AZ 86011 Dear Clinical Supervisor: Many thanks for your contribution to the clinical education of our summers-only track student. The connection between the university program and clinical education sites is very important to us. We look forward to discussions about our students and our program, and are happy to explain any details about ASHA clinical education requirements. Be assured that we are happy to address any concerns you may have about the training process. The American Speech-Language and Hearing Association requires us to maintain certifying information about each one of our clinical education sites. We must have this information on file in order to count the student s clinical clock-hours. Please take a few minutes to help our student complete the enclosed form about your site. It is our goal to maintain communicative lines with all of our clinical education sites, and you are very important to us. Our offices can be reached by telephone, paper mail or e- mail, and we look forward to communicating with you in the future. Sincerely, William R. Culbertson, Ph. D. Chair Attachments Rev. May 2002 B 17

CLINICAL EDUCATION SITE IDENTIFICATION FORM Student s Name Pct I Pct II Externship (circle one) Semester Year 1. Name Of Facility 2. Type Of Facility (School, Rehabilitation Hospital, Etc.) 3. Location And Distance From The Flagstaff Campus 4. On-Site Supervisor(s): a. Full Name b. ASHA Account Number c. Area(s) Of Certification: SLP AUD 5. Typical Number Of Students Per Supervisor Per Academic Term From NAU/CSD and Other Programs 6. Number Of Terms (Quarter Or Semester) NAU/CSD Has Used This Facility In The Past 2 Years 7. Average Number Of Clinical Education Hours Per Academic Term A Student Obtains At The Site 8. Types Of Activities In Which Students Engage At The Facility 9. Please fill out the attached Appendix VIII describing your clinical population. *Course prerequisites for CSD 602, Clinical Practicum are: Undergraduate degree in Speech Pathology, admission to Graduate Program in, Clinical Speech-Language Pathology. And Completion and documentation of 25 hours of supervised observation of speech therapy in the student's permanent department file. **Course prerequisites for CSD 608, Fieldwork Experience (Externship) are: Completion of 45 credit hours of your academic program with a GPA of at least 3.0, Completion of 6 credit hours of CSD 602 Clinical Practicum, a grade of B or better in the final semester of CSD 602 Clinical Practicum, and a minimum of 150 supervised clinical clock hours completed obtained in two clinical settings, with at least 50 hours completed in each setting. Supervisor s Signature: Date: Rev. May 2002 B 18

APPENDIX VIII: CLINICAL POPULATION CATEGORY AVERAGE NUMBER OF CLIENTS PER ACADEMIC TERM SPEECH-LANGUAGE Total Children * Adults * Evaluation: Speech Evaluation: Language Speech and Language Screening Treatment: Speech Disorders: Articulation Voice Fluency Treatment: Language Disorders Augmentative Communication Dysphagia Related Disorders Other (specify) AUDIOLOGY Evaluation: Hearing Aural Habilitation/Rehabilitation Selection and Use: Amplification Assistive Devices Hearing Screening Other (specify) Name of Facility * Age range for adults: children: Rev. May 2002 B 19