Clinical Manual 2016-17

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© Division of Speech and Hearing Sciences, Faculty of Education, HKU Date of Revision: Summer, 2016

Division of Speech & Hearing Sciences

Faculty of Education

The University of Hong Kong

BSc (Speech and Hearing Sciences)

CLINICAL MANUAL

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Preface This clinical manual is designed to provide students with the policies and procedures that are relevant to their clinical learning experience during the Bachelor Programme of Speech and Hearing Sciences at The University of Hong Kong. It is vital that students read the information in this manual and are familiar with it before commencing the clinical placements. This manual is a compilation of ideas from the Clinical Education Team of the Division of Speech and Hearing Sciences, the University of Hong Kong, and the community clinical supervisors of various settings. We welcome any feedback about the content and structure. Please forward any comments to the clinical coordinator of the year. Clinical Education Team Division of Speech and Hearing Sciences Faculty of Education The University of Hong Kong

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Content

Contact Information 5 SECTION ONE: OVERVIEW OF CLINICAL PROGRAMME 6 1.1 Goals of Clinical Programme 6 1.2 Details of Clinical Education Programme 6 1.2.1 Year Three 7 1.2.2 Year Four 8 1.2.3 Year Five 9 1.3 Audiology Clinic 10 1.4 Overview Summary of Clinical Practicum 10 SECTION TWO: A MODEL OF CLINICAL EDUCATION 11 SECTION THREE: CLINICAL LEARNING OBJECTIVES 13 3.1 General Clinical Learning Objectives (Macro-skills) 13 3.2 Occupational Competence (Micro-skills) 13 SECTION FOUR: ASSESSMENT OF CLINICAL SKILLS 16 4.1 4.1.1 Year 3 and Year 4 16 4.2 4.1.2 Year 5

16

SECTION FIVE: CLINICAL HOURS 18 5.1 Minimum Supervised Contact Hours

18

SECTION SIX: CLINIC POLICIES AND STUDENT RESPONSIBILITIES 20

6.1 Sick Leave 20 6.1.1 External Clinics 20 6.1.2 Internal Clinic 20 6.2 Leave Policy for Clinical Placement 20 6.3 Clinic Time 21 6.4 Access to Client Files in Internal Clinic 21 6.5 Organization of Client Files in Internal Clinic 22 6.6 Confidentiality and Clients’ Consent 22 6.6.1 Confidentiality 22 6.6.2 Client’s Consent 23 6.7 Ethical Use of Standardized Test 23 6.7.1 Qualified Test Administrators 23 6.7.2 Protection of Test Content from Clients 23 6.7.3 Protection of Test Content from General Public 24 6.8 Evidence-based Practice 24 6.9 Technical Support Services 26 6.10 Use of Toys in Internal Clinic 26 6.11 Clinic Room Use and Reservations 26

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6.12 Catalogue System for Clinic Materials 27 6.13 Use of Clinic Resources 27 6.14 Clinic Observation 28 6.15 Evaluation of Clinical Skills 29 6.16 Use of telephone 29 6.17 Procedures for the resolution of grievances of

students 29

SECTION SEVEN: PROCEDURES FOR RECORDING CLINICAL HOURS

31

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Contact Information Ms. Feeling Chan

39170789 [email protected] Receptionist

Ms. Winnie Cheung 39170728 [email protected] Year 5 Clinical coordinator & Clinic Manager

Ms. Ada Chu 39170729 [email protected] Year 4 Clinical coordinator

Ms. Carmela Tin 39170799 [email protected] Year 3 Clinical coordinator

Dr. Anita Wong 39171593 [email protected] Clinical Education Director Clinic email: [email protected] Postal Address: 1/F Kennedy Town Centre (KTC), 23 Belcher's St., Kennedy Town,

Hong Kong.

mailto:[email protected]

mailto:[email protected]

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SECTION ONE: OVERVIEW OF THE CLINICAL EDUCATION PROGRAMME

The Division provides an undergraduate course leading to a clinical qualification in Speech and Language Therapy since its establishment. In addition to the achievement of the curriculum course works and examinations, compliance to professional ethics and standards are essential criteria to become a speech therapist. Failure to abide to the rules set at different clinical settings may breach the professional conducts and result in failing the clinical practicum module (for Year 3 and Year 4 students), while Year 5 students may not be considered to sit the final viva exams. All these would lead to discontinuation of the program.

1.1 Goals By the end of their fifth year in the program 1. Students will develop entry level clinical competencies to be qualified speech

therapists. 2. Students will adhere to evidence-based practice in their clinical placements. 3. Students will work independently as qualified speech therapists in Hong Kong. 1.2 Details of clinical education programme Students’ clinical education begins with observation of individuals with speech, language or communication disorders in the internal clinics. . Year 1 students will observe the child clinic and Year II students will observe the adult clinic in semester 2. Students’ direct work with individual(s) with speech, language or communication disorders begin in Year III, with a focus on the child population. In year IV, students will work with adults with speech, language, communication or swallowing disorders. In Year V, students will engage an intensive practicum involving in three clinical placements with the paediatric population and one placement with the adult population. Students’ clinical practicum is either supervised by our Division’s clinical supervisors who are themselves experienced speech therapists or qualified speech therapists in the community. Through a diverse range of placements with different supervisors, students will develop generic competences (including reasoning skills, lifelong learning, professionalism, communication) and occupational competencies (including assessment skills, case analysis and interpretation, intervention strategies and services delivery skills; professional and community education; and professional development). Students will begin their practicum with individuals with less complex speech, language or communication disorders under close supervision. As students advance in years, they will work with individuals with more complex problems and handle a larger case load with minimal support from their supervisors. In the following sections, details of the students’ practicum in Year III, IV and V are described.

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1.2.1 Year Three The Clinical Practice is parts of two courses: Paediatric Clinical Practicum (I) & (II), in which the placements target on primarily paediatric populations, to be arranged across both semesters 1 & 2 This course introduces students with clinical knowledge to work with children with speech sound disorders and language disorders across the pre-primary to the secondary school years. Students will learn to provide assessment, interpret and analyse data and plan intervention under supervision. Students will learn to manage client behaviours and work with parents, Students will develop novice-level professional and clinical competence in the management of paediatric cases as specified by CBOS. Students will translate theory to practice and make evidence-based decisions in all aspects of client management, and as demonstrated in reflective-practice discussion. Clinical Placement Semester 1 Each student will have 7-weeks clinical placement working in the model of apprenticeship with respective clinical supervisor, who can be our internal assistant lecturers or well-experienced external speech therapists. The clinical supervisors will demonstrate generic clinical skills to the student with hands-on on site teaching. Students will proceed from observing the supervisors to direct working with children with communication disorders across the 7 weeks placement. Each week, the students will attend one half-day clinic with1 direct client contact, at HKU Speech, Language and Hearing Clinic or at external clinical sites. The clinical weeks will run from October to December.

During the course of practicum, students will keep reflective journals, critically appraise their clinical skills, and set personal learning goals for subsequent sessions, culminating in a personal learning plan for Paediatric Clinical Practicum II. This submission will be marked by the responsible clinical supervisor. By the end of the practicum students will achieve novice-level status on the Evaluation of Clinical Competence (ECC). The ECC will be completed with the clinical supervisor responsible. Semester 2 Each student will have 10-weeks clinical placement working with children with communication disorders in the internal clinic and external placement settings, under on-site supervision by clinical supervisors. Each week, the students will attend two half-day clinics with 2 direct client contacts on their own and post clinical evaluation with clinical supervisor on the spot. The clinical weeks will run from Mar to May.

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During the course of practicum, students will keep reflective journals, critically appraise the clinical skills they demonstrated, and set personal learning goals for subsequent sessions, culminating in a personal learning plan for Adult Clinical Practicum I. This submission will be marked by the responsible clinical supervisor. By the end of the practicum students will achieve intermediate-level status for clinical practice with children as specified by the ECC. The ECC will be completed with the clinical supervisor responsible. 1.2.3 Year Four The Clinical Practice are parts of two courses: Adult Clinical Practice (I) & (II), which the placements target primarily on adult populations, to be arranged across both semesters 1 & 2 This course introduces students to clinical practice with adults with communication disorders. Students will learn to provide assessment, interpret and analyse data, and plan intervention under supervision. Students will apply the WHO-ICF framework to the assessment and management of adult communication and swallowing disorders in a range of settings with consideration of the cultural and ethical contexts of practice. Students will develop novice-level professional and clinical competence in the management of adult cases as specified by CBOS. Students will translate theory to practice and make evidence-based decisions in all aspects of client management, and as demonstrated in reflective-practice discussions. Clinical Visits Before semester two begins, students will visit medical settings twice to familiarize with the speech therapy service of adult population in hospitals. Clinical Orientation and Clinical Education Programme This course aims at equipping students to develop intermediate-level professional/clinical competence to work with adult with communication and swallowing problems. It also targets at helping students to translate theory into practice and make evidence-based decisions on client management. Clinical Placement Semester 1 Each student will have 9-weeks clinical placement working in the model of apprenticeship with respective clinical supervisor. The clinical supervisor will demonstrate generic clinical skills to the student with hands-on on site teaching. Students will proceed from observing the supervisor to direct working with adults with communication and swallowing disorders across the 9 weeks placement. Each week, the students will attend one half-day clinic with1 direct client contact, at different external clinical sites. The clinical weeks will run from September to December.

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By the end of the practicum students will achieve novice-level status for assessment and management of adult clients with communication and/or swallowing disorders on the Evaluation of Clinical Competence (ECC). The ECC will be completed with the clinical supervisor responsible. Semester 2 Each student will have 10-week clinical placement working with adults with communication and/or swallowing disorders from hospitals and rehabilitation centres. Each week, the students will attend two half-day clinics (one in a hospital and one in a rehabilitation centre) with direct client contact. During the clinic block, students are required to manage their clients, primarily with medical and/or neurogenic in nature, under the supervision of clinical supervisors, either hospital speech therapists or internal assistant lecturers. Each student is responsible to assess clients, plan therapy, and implement treatment procedures. The clinics are also organized to welcome active participation of care-takers of clients, so students are also responsible to develop home assignments, follow-up therapies and may involve in counselling of the clients’ families. Each student will be assessed through supervisor evaluation in the middle and at the end of clinical block. The supervisors’ report will be counted as final grade for Clinical Practicum in the year. By the end of the practicum students will achieve intermediate-level status for assessment and management of adult clients with communication and/or swallowing disorders on the Evaluation of Clinical Competence (ECC). The ECC will be completed with the clinical supervisor responsible. 1.2.4 Year Five The Clinical Practice is part of the course of ‘Advance Clinical Practicum’ which aims at equipping students with entry-level professional and clinical competence in the management of paediatric and adult cases as specified by CBOS. This capstone course further facilitates students’ development of ethical, professional and clinical competence in a range of paediatric and adult communication and swallowing disorders. It extends students’ professional focus to the development of entry-level skills in prevention, counselling and consultation in interdisciplinary and multicultural contexts. Components of the course include intensive clinical placements, professional issues seminars and clinical education program. Clinical placement for students is year-round and more intensive. In the first and second semester, the students have to attend clinical placement for at least 80 hours in 10 consecutive weeks. Some students may attend optional clinic in summer. In January, there will be a short clinical education program focusing on assessment and clients’ management.

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During the year, the students consolidate their previously acquired clinical skills and develop these skills further in holistic management of clients with communication, feeding and swallowing problems across different ages, pathologies, backgrounds and clinical settings. In addition to acquiring real-world clinic experience, students may be exposed to special areas such as multiple-handicap or clients of minor ethnic groups. Students are expected to be more independent in clinical management. They will not only deliver direct clinical services to clients, but will be encouraged to engage in consultation model of management, group training, and may be in peer supervision of junior student clinicians if opportunities arise. Students may also have chances to participate in related professional activities such as case conferences, in-service training, parent groups, public education seminars and establishment of patient self-help groups. Final year students will be assessed in the middle and end of first semester through formative supervisor’s evaluation in both semesters. They also need to sit in examinations for case studies at the end of both semesters one and two. In mid to late May, students will be evaluated on their clinical competence through an assessment of a real case in a clinical viva. 1.3 Audiology Clinic Students will attend audiology clinics during their first year. They will learn basic techniques in history taking, pure tone audiometry, tympanometry, and some counselling under close supervision of audiologists. The students will also engage in hearing screening activities under supervision where they may learn how to conduct hearing screening.

1.4 Overview Summary of Clinical Practicum

Sem Year

Semester One Semester Two

Months Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Year 3 Coursework, 7 weeks clinical practicum in internal / external child clinic (each student serves 1 client)

10-weeks clinic in Internal and child clinics (each student serves 2 clients)

Summer break

Year 4 Coursework, clinical visits, 9 weeks clinical practicum in internal / external adult clinic (each student serves 1 client)

10-week clinic in hospitals and rehabilitation centres

Summer break

( Year 5) Optional summer clinic

Year 5 10-week clinic preschools, educational settings, or rehabilitation settings Professional issues seminar Assessment practice

Clinical education sessions 10-week clinic preschools, educational settings, rehabilitation settings or peer supervision (if opportunities arise)

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SECTION TWO: A MODEL OF CLINICAL EDUCATION In the model of ‘Continuum of Supervision’ by Anderson (1988), supervisors take a more directive role at the initial stage of supervision but progress to a more consultative role at the end stage. The goal is to assist students to become independent clinicians capable of self-supervision, progressing from an evaluation-feedback stage at the beginning to a self-supervision stage at the end. The transition stage in between is characterised by a gradual decrease in the amount of supervision. In our clinical education, we have carefully considered progressive increase in amount of caseload, decrease in amount of supervision, work from group to individual, when the number of clients increases. Clinical supervisors are well equipped to support students to develop strong clinical and interpersonal skills. According to ASHA (1985), tasks that clinical supervisors engage in include:

1. Establishing and maintaining an effective working relationship with the supervisee;

2. Assisting the supervisee in developing clinical goals and objectives;

3. Assisting the supervisee in developing and refining assessment skills;

4. Assisting the supervisee in developing and refining clinical management skills;

5. Demonstrating for and participating with the supervisee in the clinical process;

6. Assisting the supervisee in observing and analysing assessment and treatment sessions;

7. Assisting the supervisee in the development and maintenance of clinical and supervisory records;

8. Interacting with the supervisee in planning, executing, and analysing supervisory conferences;

9. Assisting the supervisee in evaluation of clinical performance;

10. Assisting the supervisee in developing skills of verbal reporting, writing, and editing;

11. Sharing information regarding ethical, legal, regulatory, and reimbursement aspects of professional practice;

12. Modelling and facilitating professional conduct; and

13. Demonstrating research skills in the clinical or supervisory processes.

The type of supervision provided to students is provided according to the needs of the student and the type of placement. This should be discussed in the initial meeting between the supervisor and supervisee. Students are encouraged to discover their own learning styles, whether they:

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- Prefer to be actively involved from the start of the placement and learn from doing the tasks

- Prefer to think, plan and reflect on what they need to do by reading and watching before doing

- Prefer to receive verbal advice with some observations before doing

Students are also encouraged to learn what type of feedback they respond to best- immediate verbal, delayed verbal, written feedback. This information, in addition to their learning style should be communicated to the clinical supervisor so they can tailor their supervision style to the needs of the student.

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SECTION THREE: CLINICAL LEARNING OBJECTIVES 3.1 General Clinical Competency (Macro-skills) Students are expected to achieve the following aspects of competences upon graduation Clinical Reasoning

● Ensure evidence-based speech pathology practice. ● Integrates collaborative and holistic viewpoints into professional reasoning. ● Use sound professional reasoning strategies to assist planning for all aspects of service

management. Professional Communication

● Use adequate interpersonal communication skills to facilitate their practice ● Use adequate oral and written reporting and presentation skills for communications

with clients, their family members, and other professionals ● Communicate effectively with other members in the team.

Self-Evaluation Skills &Lifelong learning ● Be able to reflect on performance. ● Construct and plan for own learning/professional development. ● Demonstrate basic administrative responsibilities

Professionalism ● Be punctual ● Display organisational skills. ● Demonstrate self in a professional manner. ● Discharge administrative responsibilities effectively. ● Possess a professional attitude/orientation.

3.2 Occupational Competency (Micro-skills) Assessment

● Identify and document presenting condition/issues; identifies significant others; collates information on client.

● Identify areas for investigation; and most suitable manner for investigation. ● Administer relevant assessment. ● Undertake assessment within ethical guidelines, and medico-legal responsibilities.

Analysis and Interpretation

● Analyse and interpret assessment data. ● Identify gaps in information required to understand issues, and seek information to fill

those gaps. ● Determine basis for diagnosis of communication/swallowing issues or condition, and

prognosis ● Report on analysis and interpretation. ● Provide feedback on results of interpreted assessments to client/significant others and

referral sources and discuss management.

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Planning of Intervention ● Seek additional information for intervention planning. ● Discuss long-term outcomes and decide, in consultation with client, whether or not

intervention strategies are appropriate and/or required. ● Select speech pathology programme or intervention in conjunction with client and

significant other. ● Establish goals for intervention. ● Define roles and responsibilities for client management. ● Document intervention plans, goals, outcomes, decisions for discharge.

Delivering Intervention

● Establish rapport in therapy. ● Implement management programme based on assessment, interpretation and

planning. ● Undertake continuing evaluation of intervention and modification of program as

necessary. ● Document progress and changes in intervention. ● Work within the ethical guidelines of the profession, and legal constraints and

responsibilities. Maintaining Services

● Pay attention to service providers’ policies. ● Use and maintain an efficient information management or filing system. ● Start to be aware of caseload management. ● Update, acquire and/or develop resources. ● Consult and co-ordinate with professional groups and services. ● Demonstrate adherence to scientific principles in work practices. ● Collaborate in research initiated and/or supported by others. ● Participate in evaluation of speech pathology services.

Continuing Professional development

● Uphold the Code of Ethics by Hong Kong Association of Speech Therapists ● Be aware of the importance of continuing professional development. ● Demonstrate awareness of networks for professional support ● Develop personal growth and professional identity.

Students need to observe code of ethics of Hong Kong Association of Speech Therapists (www.speechtherapy.org.hk). If a student fails to observe code of ethics and breach professional ethical codes may lead to discontinuation from the course. Examples of un-ethical behaviours:

● Disclose client’s confidentiality to other people without client’s prior consent; ● Make copy of client’s information in any form without prior consent from client; and ● Discusses client’s information with people who are not managing the client;

http://www.speechtherapy.org.hk/

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A student who demonstrates the following behaviours will receive warning:

● misses an appointment without early notice ● is late for an appointment; ● fails to hand in written work on time; ● tidies up clinic room after use; and

Students who have received warnings twice will need to present themselves to the Clinical Education Director and may result in discontinuation from the programme.

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SECTION FOUR: ASSESSMENT OF CLINICAL SKILLS 4.1 Supervisor Evaluation and Clinical Viva 4.1.1 Year 3 and 4 Semester 1 (Clinic Block)

Year 3 End-block: End of last four weeks Year 4 End-block: End of last five weeks

Supervisor Evaluation (Summative)

Semester 2 (Clinic Block)

Mid-block: End of first five weeks Supervisor Evaluation (Formative)

End-block: End of last five weeks Supervisor Evaluation (Summative)

The assessment of clinical skills will be a combination of formative and summative evaluation by Clinical supervisors. Educators evaluate students’ clinical skills using the evaluation form provided by the Division. They are expected to give students formative evaluations in the middle of the whole period of placement and summative evaluations at the end of the placement. In formative evaluation, clinical supervisors are asked to discuss and evaluate their ratings of the student’s performance with respective students such that better students can move into more advances areas, and weaker students are supported to develop as the clinical supervisor sees fit. For summative evaluation, the rating will be on a Pass or Fail basis. From the academic year 2015-2016, a new evaluation form for student performance across all cohorts, Evaluation of Core Competency (ECC), has been adopted. The aims of ECC may better assist clinical supervisors and students to more easily identify the requirements of the clinical placement and collaboratively set meaningful and achievable goals during Mid- and End- Block placement. The ECC may also enable Clinical supervisors to identify areas that are not being performed by students at the required level at both mid and end block placement. 4.1.2 Year Five

Summer Clinic (July to August)

End-summer Supervisor Evaluation (Formative)

First Semester (September to first week of December)


End-block: End of last five weeks Supervisor Evaluation (Formative)

Second Semester (January to first week of May)


End-block: End of last five weeks Supervisor Evaluation (Formative)

Second Semester (May to June)

End-year Clinical Viva Examination (Summative)

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The assessment of clinical skills in the year will be a combination of formative evaluation by clinical supervisors and clinical viva evaluation. Clinical viva is the only summative evaluation of clinical skills in Year 4. However, students have all their formative evaluation completed before they can sit in their clinical viva examination.

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SECTION FIVE: CLINICAL HOURS 5.1 Minimum Supervised Contact hours (Based on CASLPA guidelines) Amount of clinical experience Currently the clinical education follows the clinical hours requirements of Canadian Association of Speech-Language Pathologist and Audiologist (CASLPA). The total time allocated for clinical placement over the whole curriculum is a minimum of 300 clinical hours in Specific Client Services and Related Client Service. Additionally, there are also 50 hours of clinical/ professional activities. Below defines specific client services, client related service and clinical/professional activities. Client Specific Service “Client Specific Service” refers to clinical activities where the client or family member is present and the focus of the clinical activity. Client Specific Service includes direct clinical activities such as screening, assessment, treatment, counselling or consultation with clients and their caregivers. In client specific service, students are assumed to work under supervision. Related Client Service “Client Related Service” refers to clinical activities related to a specific client but the client or family is not necessarily present. Client Related Service includes intra and inter-professional communication on a specific client’s rehabilitation. Case conference, team meetings, Supervisor-case discussion and inter-professional communications are examples of related client service. Clinical/ Professional activities “Clinical/Professional Activities” refers to activities that are clinically relevant and meaningful learning experiences, but not necessarily related to a specific client. They can be simulated clinical activities, workshops aiming at increasing the public awareness towards a specific kind of speech therapy related disorder or inter-professional meeting targeting at increasing awareness of the scope of practice of different professions and enhance understanding of collegial relationships. The website for recording clinical hours starting from 2009/10: http://www.speech.hku.hk/shseval/clinicaleval/ The codes for the supervisors and institution may be found at the website: http://www.speech.hku.hk/teaching_clinical_students.html Details about how to record the clinical hours can be found in Appendix 1.

http://www.speech.hku.hk/teaching_clinical_students.html

http://www.speech.hku.hk/teaching_clinical_students.html

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Summary of Excepted Supervised Contact Hours by Year Year Course or clinics Estimated Number of Hours,

clinic-based and (non-clinic based)

Year 1

Clinical observations at paediatric clinics (4)

Year 2 1 half-day Clinical observations at adult clinics (4) Audiology Clinic 15

Year 3 5 weeks Peadiatric Clinical Practicum I (SHSC3038) (15) 7weeks Sem 1 Clinical practicum (pediatric) 28 10 weeks Sem 2 Clinical practicum (pediatric) 80

Year 4 5 weeks Adult Clinical Practicum I (SHSC4038) (12) 2 half days Clinical Visit (7) 9 weeks Sem 1 Clinical practicum (adult) 36 10 weeks Sem 2 Clincial practicum (adult) 80

Year 5 1st Semester Sp. & Lang. Clinics at Education Setting or

Medical Setting 80

2nd Semester Sp. & Lang. Clinics at Education Setting or Medical Setting

80

13 sessions Professional Issues Seminars (20) 5 half-days Clinical Education Program (non-clinic

based) (16)

Clinical Education Program (clinic based) 4 Total contact hours Clinic-based hours: ~403 hours

Non-clinic based hours: 78 hours

* Non-clinic based hours (in parenthesis) are: Focused clinical teachings, Related Experience, Student-directed learning (e.g. lectures, skills labs, visits) Minimum clinical hours are used as a reference guideline for students in terms of their length of placement. However, due to the necessary of different learning exposures and experiences, students are encourages to abide to the number of days set by their clinical supervisors.

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SECTION SIX: CLINIC POLICIES AND STUDENT RESPONSIBILITIES 6.1 SICK LEAVE When a student is sick and request for approved absence, the Division’s policy is as follows: 6.1.1 External Clinics Notify the supervisor as soon as possible (the day before if you know your illness will last before 9:00 a.m. on your clinic day). Inform your supervisor as well as the Year Clinical Coordinator of the Division that you are ill and will not be able to attend clinic on that day. It is your responsibility to negotiate with you supervisor to arrange “make-up” days because failure to attend all 10 sessions may jeopardize your clinical evaluation at the end of each semester. However, supervisors do not have any obligation to make up the session for you. You have to present the original copy of a doctor’s certificate with sick leave form (downloadable from http://www.speech.hku.hk/teaching_clinical_students.html) to the Year Clinical Coordinator afterwards within one week of your sick leave. A copy of the doctor’s certificate together with sick leave form have to be sent to your clinical supervisor too. 6.1.2 Internal Clinic Notify the supervisor as well as the Year Clinical Coordinator who is responsible for the particular clinic/year of study the day before if you know your illness will last before 9:00 a.m. on your clinic day. In case if you cannot reach any of them, you are required to notify our clinic reception, Ms. Feeling Chan at 39170789. It is your responsibility to discuss with your supervisor afterwards to arrange “make-up” days because failure to attend all sessions may jeopardize your clinical evaluation at the end of each semester. However, supervisors do not have any obligation to make up the session for you. You have to present the original copy of a doctor’s certificate with sick leave form (downloadable from http://www.speech.hku.hk/teaching_clinical_students.html) to the Clinical Supervisor afterwards within one week of you sick leave. A copy of the doctor’s certificate together with sick leave form has to be sent to your clinical supervisor too. 6.2 LEAVE POLICY FOR CLINICAL PLACEMENT A student must attend all sessions of each placement. Application for sick leave must enclose a medical certificate signed by a registered medical practitioner on which should be started the specific period of sick leave recommended. Applications for other special leave should be applied through Year Clinical Coordinator to the Head of Division with written statement of reasons of application (application form also downloadable from http://www.speech.hku.hk/teaching_clinical_students.html).

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6.3 CLINIC TIME All clinic sessions are expected to begin and finish on time, as scheduled. In the first clinic session, clients must be advised of the clinic policy regarding punctuality. We are not obligated to make up the time loss due to lateness or any other reasons. Clients, arriving after the scheduled time, will still be charged the full regular fee. 6.4 ACCESS TO CLIENT FILES IN INTERNAL CLINIC All client files before January 2006 must be checked out through the Clinic receptionist. You have to leave your name, year of study, client’s names and clients’ numbers on the check-out record. A student may request the clinic files for any client in the internal clinic, kept at the reception, of the Division of Speech and Hearing Sciences. Client files must be returned on the same day they were checked out. For evening clinics, you may keep the files for your discussion afterwards. When you have finished, all files should be returned to you supervisor who will return to the Clinic receptionist the next day. Students may not retain files overnight. You can only read the clients files at designated clinic areas. Client files, portion, or whole, may not be taken away from the Division. No information of the clients’ file can be photocopied UNDER ANY CIRCUMSTANCES. Failure to abide by this policy will be considered as a breach in professional ethics. Clinic receptionist will report to the supervisors any files not returned by the end of the day. Starting from January 2006, students are required to upload the plans and reports of their clients on the website, 147.8.222.187/cfs1/userlogin.htm, after finishing the whole block of clinic. Students can only upload and read the clients’ files through designated clinic computers. You are required to login with your own login name and password, which are given to each student individually. Client files, portion, or whole, must not be downloaded. No information of the clients’ file can be downloaded UNDER ANY CIRCUMSTANCES. Failure to abide by this policy will be considered as a breach in professional ethics. Students are required to upload all internal clinic and CRN patients’ session notes to the University electronic record system by the end of each clinic block. Failure to comply will be considered as a breach to the professional ethics.

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6.5 ORGANIZATION OF CLIENT FILES IN INTERNAL CLINICS All internal clinic files before January 2006, with the exception of Audiology Clinic files, were organized consistently in the following fashion: Each section is divided by a standard color-coded sheet. BLUE- Therapy reports (e.g. session plans, session summaries, therapy reports) GREEN- Assessment (e.g. evaluation reports, completed test forms) YELLOW- Case History (e.g. background information) ORANGE- Correspondence (e.g. referral letter, transfer letter, etc.) All new materials go on top of existing ones in their corresponding sections. So the most recent therapy report is at the front immediately under the blue divider. None of the individual contents, for example, therapy reports, can be checked out or taken out of the files. All files must be signed out and returned complete. Failure to abide to this regulation will be considered as a breach in professional ethics. Starting from January 2006, all written documents of the clients should be uploaded to the internet within one week after the clinic is over. The website is 147.8.222.187/cfs1/suerlogin.htm. You should follow the instructions there upload all the documents of the clients and read the documents of the clients through designated computers. No documents can be downloaded. Failure to abide to this regulation will be considered as a breach in professional ethics. 6.6 CONFIDENTALITY AND CLIENTS’ CONSENT 6.6.1 Confidentiality Confidentiality of client information must be respected in all internal and external clinic. Client’s full names and their identifying information cannot be mentioned outside the clinic. One exception is in case discussion with peers and/or supervisors in our lecture rooms, therapy rooms or observation rooms. Client names or information on white boards must be erased immediately after discussion or class. Draft reports or evaluation summaries are to be shredded before disposal. Any emailing of the clinical record must be done by the University email account instead of the personal account to warrant server safety.

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6.6.2 Client’s Consent Clients arrive on their first appointment at the clinic will be required to sign a consent form for the clinics. Their information is reserved strictly within the Division for clinical, teaching or research purpose. Without client’s prior authorization, no information of the client can be released to outside related professionals such as schools, hospitals, social workers or others. 6.7 Ethical Use of Standardized Tests The confidentiality of standardized test questions and answers is paramount to maintaining the integrity of the tests and the validity of test results. Disclosure of the test content or materials will lead to permanent harm to the validity of such tests. When test items are disclosed to the general public, there is an increased chance that clients will be able to access specific items or answers. The sensitivity of test items in identifying clients with language problems would then be reduced and hence true cases may be under-diagnosed. Such a practice may partly explain why one specific local preschool language test is reported to be no longer sensitive enough in identifying children with language problems. Enormous fiscal and human resources have been spent on the research and ‘norming’ of standardized speech and language tests. Any leakage of test items severely compromises the value of the tests. Given the above issues, we recommend the following measures to protect the privacy of all standardized tests to reduce further damage to current tests. 6.7.1 Qualified Test Administrators Access to speech and language standardized test materials (e.g., record sheets, test user’s manuals, scoring keys, test booklets, protocols) should be granted only to qualified test administrators, speech-language therapists, or other professionals who use the materials in their clinical practice, teaching, or research. All such personnel should be thoroughly trained in the appropriate administration of the specific test being used. Students who use the materials in their research or clinical practicum should have completed appropriate coursework in tests and measurements, psychometrics and statistics. They should also be supervised appropriately by a qualified test administrator during administration. Results or interpretations should be reported by students only under the direct supervision of a qualified supervisor. 6.7.2 Protection of Test Content from Clients In school and preschool settings, release of copies of test questions or protocols in any form is not required. Speech-language pathologists (SLPs) and students are encouraged to review test results with parents. If the SLP deems appropriate, s/he may want to review children’s responses to individual items. This process may involve showing an answer or test items in the record booklets to parents. However, we strongly oppose the release of copies of scoring

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forms or testing protocols to the parents - for the reasons noted above. We recognize that, in some cases, parents may wish to consult a second professional regarding a child’s standardized test results. In such situations, we have no objection to a copy of the completed test form being sent to another professional for review purposes; however, all the materials should pass directly from professional to professional and not through the parents or their attorney. 6.7.3 Protection of Test Content from General Public All test questions and answers, user’s manuals and other materials revealing test questions or answers constitute highly confidential and proprietary information which test users should take every precaution to protect from disclosure beyond what is necessary for the purpose of test administration. Any copying of test materials (e.g., picture booklets) or audio- or video recording during test administration constitutes copyright infringement. This may lead to legal actions from the test developers and their copyright holders. All SLPs and student clinicians have an ethical duty to protect the integrity of standardized tests by maintaining the confidentiality of the questions and answers to the test items and by releasing such tests only to qualified professionals. The minimum measures necessary to protect the security and integrity of standardized tests, as well as the copyright and other proprietary rights in the test. 6.8 EVIDENCE-BASED PRACTICE Students are required to use evidence-based practice in their clinical decisions and practices during all client-related activities to ensure high quality care. Evidence–based practice is defined as “… the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients … [by] integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996, p. 71).

According to the American Speech-Language-Hearing Association (ASHA), in making clinical practice evidence-based, audiologists and speech-language pathologists—

● recognize the needs, abilities, values, preferences, and interests of individuals and families to whom they provide clinical services, and integrate those factors along with best current research evidence and their clinical expertise in making clinical decisions;

● acquire and maintain the knowledge and skills that are necessary to provide high quality professional services, including knowledge and skills related to evidence-based practice;

● evaluate prevention, screening, and diagnostic procedures, protocols, and measures to identify maximally informative and cost-effective diagnostic and screening tools, using recognized appraisal criteria described in the evidence-based practice literature;

http://www.asha.org/policy/TR2004-00001.htm#r14

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● evaluate the efficacy, effectiveness, and efficiency of clinical protocols for prevention, treatment, and enhancement using criteria recognized in the evidence-based practice literature;

● evaluate the quality of evidence appearing in any source or format, including journal articles, textbooks, continuing education offerings, newsletters, advertising, and Web-based products, prior to incorporating such evidence into clinical decision making; and

● monitor and incorporate new and high quality research evidence having implications for clinical practice.(2005)

Evidence used by students when making decisions on client diagnoses and treatment should be evaluated to ensure its validity and reliability. The following table shows the levels of evidence with 1a being the most credible, and IV being the least credible.

Level

Description

Ia Well-designed meta-analysis of >1 randomized controlled trial

Ib Well-designed randomized controlled study

IIa Well-designed controlled study without randomization

IIb Well-designed quasi-experimental study

III Well-designed nonexperimental studies, i.e., correlational and case studies

IV Expert committee report, consensus conference, clinical experience of respected authorities

(adapted from the Scottish Intercollegiate Guideline Network, www.sign.ac.uk).

To implement evidence-based practice, students should follow the following steps:

1. Devise a clinical question that needs answering (eg. What approach should I use for a 6

year old with stuttering?)

2. Conduct a literature review to collect information that may help to answer the clinical

question

3. Review the evidence for its validity and reliability (see table above)

4. Use the most credible evidence to answer the clinical question and create an action

plan.

Evidence of students using evidence-based practice should be reflected in their session plans

http://www.sign.ac.uk/

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(with explicit reference to literature), self-evaluations, assessment plans, intervention plans, referral letters, assessment reports, progress reports and in discussions with colleagues and supervisors.

6.9 TECHNICAL SUPPORT SERVICES Immediately after the last client leaves, clinic receptionist will lock up all the therapy rooms EXCEPT the room is being used for discussion with responsible supervisor. The supervisor is responsible to lock this room before leaving the Division. Students must prepare their own audio-recording equipment. Students must PLAN AHEAD and submit request of video-recording BEFORE the clinic in order to eliminate interruptions to clinic staff during clinic time. Please submit a request form for videotaping at least half an hour before your session starts. If students wish to observe videos recordings, they may do so later in the day (for morning clinics) or the next day (for afternoon or evening clinics). Students must NOT owe a duplicate of DVD of any therapy sessions. Parents/families and clients may request through the clinical supervisor for copies of videos of therapy sessions. 6.10 USE OF TOYS IN INTERNAL CLINIC All toys are categorized and stored separately between the cupboards in the four therapy rooms and two observation rooms. Each cupboard will have its own inventory. For use within the Division students are not required to “checkout” a toy. While it is appreciated that there is normal “wear and tear”, students are reminded that to use toys in a reasonable and sensible way. You are required to RETURN the toys to the ORIGINAL PLACE (room and cupboard) immediately following your session. Students are not allowed to borrow toys for use in external clinics. Each Friday, the Clinic receptionist will check toys and inventories. Abuse of the system will be noted and privileges will be withdrawn. 6.11 CLINIC ROOM USE AND RESERVATIONS Clinic rooms are scheduled primarily for internal clinic use, including precedent preparation and follow up discussions. Students are required to keep these rooms undisturbed while the above mentioned activities are being carried out.

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Every student is responsible to keep clinic rooms and observation rooms clean and tidy. NO EATING OR DRINKING would be allowed in any of those rooms unless such activities are carried out for therapeutic purpose. All furniture and equipment should be returned to their original places when you have finished your sessions. Abuse of the regulation will be noted and privileges will be withdrawn. 6.12 CATALOGUE SYSTEM FOR CLINIC MATERIALS All our clinical materials are categorized. You can assess our clinical materials in the catalogue in SHS clinic. 6.13 USE OF CLINIC RESOURCES 1. Students can browse, borrow and return materials in resource room ONLY during the

opening hours of 9:00a.m.to 12:00noon and 2:30p.m. to 4:30p.m.from Monday to Friday. 2. Students can obtain a barcode from the technicians. You need to show your barcode

when you borrow resources from the resource room. 3. Students should report any missing items to our clinic staff when you receive the

resources, or you will be responsible for the loss. 4. For those who wish to borrow items outside the normal opening hours, you are required

to obtain an approval from your clinical supervisors. 5. Students are allowed to borrow an item for a loan period of 24 hours. 6. Students may return the borrowed materials to our clinic staff before 5:15 p.m. after the

clinic sessions if you want to return the items within the same day. 7. Leaving materials on the counter of the Clinic Reception area (particularly when the gate

is closed) does NOT constitute a return of the materials. Students may have borrowing rights withdrawn.

8. An e-mail will be sent to a borrower who keeps an item for more than 24 hours. 9. Any student who returns an item late (more than 24 hours) will donate 3 hours to assist

with clinical resources (e.g. inventory taking by the end of the semester). 10. If the clinic receptionist who is keeping the resource room has to leave the room

temporarily, you will be requested to vacate the room until he/she returns. At NO time should there be students in the resource room without a clinic receptionist.

11. Any student who does not abide by the regulations regarding the borrowing of clinic materials may have this privilege revoked by the Clinic Manager or Clinical coordinators.

12. Clinical Tests and materials: Clinic tests and materials are valuable both financially and in terms of their value to clinical and research work, so please be reminded of the followings:

● Portions of a test MUST not be removed from the entire test for use in some other way in a therapy session. (For example, if you want a toy pig for your session, you MAY NOT take a pig from the Reynell Developmental Language Scales).

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● If a test or any part is missing, the person who borrowed it MAY be responsible for the cost of replacing the ENTIRE test. Some test can cost as much as HKD 10,000. (This regulation also applies to non-test materials)

● Photocopying of test is a breach of copyright law. In addition the photocopying of the test materials of a standardized test means that the test materials used in the clinical assessment are not standardized and therefore the results of the test cannot be compared to the normative data of the test. In addition a number of tests have restrictions upon who is permitted to administer them. Often a training programme has to be completed before a clinician may use a test. Widespread photocopying of clinical tests may result in tests becoming used by individual who are not qualified to use them.

● It is ILLEGAL to photocopy more than one chapter of a book or more than one item of a test. The Division of Speech and Hearing Sciences is not prepared to condone illegal photocopying and students are advised to follow the Divisional policy. Any student possessing an illegal copy of a clinic test, or clinic materials will be asked to account for his or her actions in an interview with the Head of Division. Any student observed using a photocopy of a test during clinical assessments will be viewed as having committed a breach of ethics. The student will not be allowed to continue with the assessment or therapy and will be called to account for his or her actions in an interview with the Head of Division.

● Student/ Staff borrowing a test or materials are responsible for checking that all items are present BEFORE leaving the resource room.

● Test record forms, especially those of tests published overseas are costly. The clinic will supply one copy of each record form for each client. The forms are filled when completed as part of the client record. Forms are not to be taken as study materials for your own. The form is to be requested and completed by the principal clinician for the session/client. Students who take a supporting role in the session or those observing the client can record the data in note pad. Students must be aware that photocopy of these forms INFRINGE publishers’ copyright.

6.14 CLINIC OBSERVATION Students may observe other clinics only with PRIOR permission from the supervisor. There should never be any walk-ins. You should behave professionally even when observing, as a courtesy to yourselves, the client, the supervisor, and your peers. There should be only approved observers in the observation room at one time and no recording is allowed.

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6.15 EVALUATION OF CLINICAL SKILLS At the end of each semester (or placement), either your internal or external; supervisor will evaluate your clinical skills using our standard evaluation form. As the evaluation will be counted as part of the formative and summative evaluation of your Clinical Practicum as in other course work, you must return the evaluation form from your direct supervisor to the Clinical Instructors within one week after the evaluation.

Students’ performance should be continuously monitored throughout each placement block and feedback should be given on an on-going manner. Formally, feedback is discussed and provided at both the mid and end block through the completion of the Evaluation of Clinical Competency (ECC) form. At the mid-block evaluation, students will be told whether their progress is satisfactory or unsatisfactory (i.e. at risk of not demonstrating the required skill level by the end of the placement). If this is the case, the block clinical supervisor will contact the HKU Clinical Supervisor who will discuss with the student what measures can be taken to assist the student to improve their performance to an appropriate level. For semester 1, students are expected to pass at least 70% of total items in the ECC form. For semester 2, students are expected to obtain at least 70% of total items in the ECC form graded as satisfactory or above during the end-block evaluation. If this criteria is not reached, the supervisor will tick that the student has not demonstrated adequate level (or above) of clinical competence, and will suggest areas for improvement in the comments box on the final page. If a student fails any one of his/her clinical practicum, he/she has to initiate a meeting with the responsible internal clinical supervisor. They have to review the ECC form and discuss with the placement supervisor to determine what the next step will be. This may be a written self-reflection, counselling and/ or clinical skills review session from the clinical supervisor and/or repeating the placement. 6.16 USE OF TELEPHONE When there is clinical sessions going on, students are requested to TURN-OFF their personal mobile phones within the area of clinics (including waiting area, reception, observation rooms, therapy rooms and hallway outside the clinic). Students should observe the professional conducts and pay courtesy to the clients, the supervisors and your peers. 6.17 PROCEDURES FOR THE RESOLUTION OF GRIEVANCE The procedures set out in this manual apply to all BSc SHS students for dealing with complaints. These procedures, however, do not apply to examination and clinic results determined by the Board of Examinations. There is no provision of appeals against examination results in the University; the decisions of the Board of Examiners on examination results are final. The procedures described in the remaining paragraphs mainly relate to complains which the students may have against clinical supervisors (which for this purpose

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includes all persons involved in teaching activities) and all other persons employed by The University of Hong Kong 1. A student who wishes to make a complaint on an administrative or clinical matter should

do so to the respective clinical year coordinators 2. In making his complaint, a student shall identify himself properly. An anonymous

complaint shall not normally be dealt with, although complains by an identified student for himself and on behalf of others will be accepted.

3. On the receipt of a complaint, the clinical year coordinator or the clinical director shall investigate the matter. It is important that all possible attempts should be made to seek remedial action at this stage, with a view to having the complaint resolved fairly and informally in a manner acceptable to all parties concerned

4. If it is not possible for the complaint to be resolved fairly and informally under paragraph 3 above, the Head of Department shall be referred. The student shall be so informed, and shall be required to submit his grievance formally in writing if he has not yet done so. The written submission shall explain the grounds on which the complaint is made and the matters that constitute the grievance. The Dean of Student Affairs will be able to give advice on the preparation of the written submission.

5. The complainant must submit his grievance formally in writing to the Head of Department. In addition to details of the grievance and the grounds on which the complaint is made, the written submission must also explain: a. why he is not satisfied with the outcome of the investigation described in paragraph 3

above; or b. why he believes that his complaint will not be properly dealt with in accordance with

the normal procedure 6. The Head of Department shall, on receipt of a complaint, take appropriate action which

may include the following: a. considering the complaint informally and resolving in himself; or b. referring the complaint to the Dean/Officer concerned or relevant committee or office

of the University for investigation or action or c. referring the complaint to an outside body, e.g. the police or ICAC, if appropriate; or

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SECTION SEVEN: PROCEDURES FOR RECORDING CLINICAL HOURS YEAR indicates the current year of study of each student. Y: (1) Year 2 (2) Year 3, (3) Year 4, (4) Year 5 All clients contact must be entered in 1 of the 6 PATHOLOGY categories. P: (1) Speech (2) Language (3) Fluency (4) Voice (5) Hearing (6) Feeding Client contact is not categorized by etiology, e.g. cleft palate would be entered under articulation, language or voice, whichever is appropriate to the hours and to client management. AGE of client is classified into: A: (1) Adult (18 yr or above)

(2) School-age – mainstream or special schools (3) Pre-school

TYPE has only two categories: Clinic based and non- clinic based T: Clinical based activities in clinic blocks –

(1) Diagnosis (2) Treatment (3) Patient-specific observation (a) Diagnosis or (b) Treatment (4) Patient-specific discussion (a) Diagnosis or (b) Treatment (5) Consultation - case conference, consultation with other professionals; organization of

workshops Non-clinical based activities beyond clinic blocks –

(6) Bridge week sessions (7) General clinical observation.

For MODE of therapy, there are two categories. G: (1) group (2) individual. Clinic hours must be submitted within one week after the final day of each semester. Failure to do this will mean that you will be unable to start your next clinic attachment.

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References American Speech-Language-Hearing Association. (1985). Clinical supervision in speech-language pathology and audiology [Position Statement]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (2004). Evidence-based practice in communication disorders: an introduction [Technical Report]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (2005). Evidence-based practice in communication disorders [Position Statement]. Available from www.asha.org/policy. Anderson, J. L. (1988). The Supervisory Process in Speech-Language Pathology and Audiology. Boston: College-Hill Press/Little Brown and Company. Canadian Association of Speech-Language Pathologist and Audiologist (CASLPA). Description of Clinical Hours Requirements. Accessed at http://www.sac-oac.ca/sites/default/files/resources/SLP%20-%20Description%20of%20Clinical%20Hours% 20Requirements%20-%20English.pdf Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. Evidence-based medicine: What it is and what it isn't. Article based on an editorial in the British Medical Journal, 1996. 312, 71 72. Accessed at http://www.cebm.jr2.ox.ac.uk/ebmisisnt. Scottish Intercollegiate Guidelines Network. Glossary of key terms. 2002. Accessed at http://www.sign.ac.uk.

Competency Based Occupational Standards (CBOS). Accessed at https://www.speechpathologyaustralia.org.au/spaweb/Document_Management/Public/CBOS.aspx McAllister, S. (2005). Competency Based Assessment of Speech Pathology Students' Performance in the Workplace. Unpublished PhD, The University of Sydney, Sydney. Full text available from Online Digital Thesis Repository: http://hdl.handle.net/2123/1130. McAllister, S., M. Lincoln, et al. (2006). COMPASS® : Competency assessment in speech pathology. Melbourne, Speech Pathology Association of Australia Ltd.

http://www.asha.org/policy

http://www.sac-oac.ca/sites/default/files/resources/SLP%20-%20Description%20of%20Clinical%20Hours%25%2020Requirements%20-%20English.pdf



http://www.cebm.jr2.ox.ac.uk/ebmisisnt

http://www.sign.ac.uk/

https://www.speechpathologyaustralia.org.au/spaweb/Document_Management/Public/CBOS.aspx

https://www.speechpathologyaustralia.org.au/spaweb/Document_Management/Public/CBOS.aspx

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Clinical Manual 2016-17