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1 Department of Communication Sciences and Disorders School of Health and Rehabilitation Sciences 2018-2020 Revised: August 2018 Note: This is an active document that is updated and redistributed to incorporate changes in national, state, and institutional process and procedures

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Page 1: Department of Communication Sciences and Disorders School ...€¦ · American Speech Language and Hearing Association Praxis Examination The national examination in speech-language

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DepartmentofCommunicationSciencesandDisorders

SchoolofHealthandRehabilitationSciences

2018-2020

Revised:August2018Note:Thisisanactivedocumentthatisupdatedandredistributedtoincorporatechangesinnational,

state,andinstitutionalprocessandprocedures

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INTRODUCTION..................................................................................................................................5

Overview:EntryLevelPracticumExperiences....................................................................................5

Overview:Intermediate/AdvancedPracticumExperiences................................................................5

ConcentrationPractica........................................................................................................................6

MAStateDESEReadingLicensurePracticum......................................................................................6

MAStateEarlyInterventionLicensurePracticum...............................................................................6

IMPACTPracticeCenter’sSpeechLanguageandLiteracyCenter......................................................6

CERTIFICATIONANDLICENSUREINFORMATION................................................................................7

CouncilonAcademicAccreditation(CAA)inAudiologyandSpeech-LanguagePathology.................7

StandardsandImplementationProceduresfortheCertificateofClinicalCompetence(CCC)inSpeech-LanguagePathology............................................................................................................................7

AmericanSpeechLanguageandHearingAssociationPraxisExamination..........................................8

MassachusettsDepartmentofEducationTeachingLicensure............................................................8

MassachusettsDepartmentofPublicHealth(DPH)EarlyIntervention(EI)Specialist........................9

GENERALCLINICALPOLICIESANDPROCEDURES.................................................................................9

TotalHoursRequiredbyASHA...........................................................................................................9

EvaluationofClinicalCompetency....................................................................................................10

EvaluationofSupervisionandPracticum..........................................................................................11

ProfessionalConduct........................................................................................................................11

Supervision.......................................................................................................................................12

Referrals...........................................................................................................................................13

ClientSchedules................................................................................................................................13

ContactwithFamilyandProfessionals.............................................................................................13

ClientPlanofCare............................................................................................................................14

CancellationsbyClientandAbsenceofStudentsduetoIllness.......................................................14

ProfessionalPractice.........................................................................................................................14

ProfessionalDuty..............................................................................................................................14

Communication................................................................................................................................14

CulturalCompetence........................................................................................................................14

CollaborativePractice.......................................................................................................................15

ProfessionalPracticeGrading...........................................................................................................15

OUTPLACEMENTPRACTICUM:ADDITIONALPOLICIESANDPROCEDURES........................................15

ClinicalPlacementsinExternalSites.................................................................................................15

PracticumCommittee.......................................................................................................................15

FactorsConsideredforPlacement....................................................................................................15

TimingandScheduleofClinicalExperiences.....................................................................................16

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ExpensesandTravel..........................................................................................................................16

DifferentSites...................................................................................................................................17

Grades..............................................................................................................................................17

Non-PassingGrades..........................................................................................................................17

RefusalofPracticum.........................................................................................................................17

TerminationofPracticum.................................................................................................................18

Mediation.........................................................................................................................................18

PolicyforDocumentationofSupervisedClinicalHoursandClinicalPracticumEvaluations.............19

LocationofForms.............................................................................................................................19

SPEECHLANGUAGEANDLITERACYCENTERPOLICIESANDPROCEDURES........................................19

PatientFiles.......................................................................................................................................19

GettingStarted.................................................................................................................................20

ContentsofNewClientFilesShouldContain:...................................................................................20

ContentsofEstablishedFiles(ReturningClients)..............................................................................20

OngoingResponsibilitiesforMaintenanceofClientFiles.................................................................20

ConfidentialityandCommunication.................................................................................................20

DocumentationofClinicalPracticeFormat......................................................................................20

LessonPlans......................................................................................................................................20

EvaluationofDocumentation...........................................................................................................21

Supervision.......................................................................................................................................21

HourDocumentation........................................................................................................................21

Materials...........................................................................................................................................21

Toys...................................................................................................................................................21

TherapyRoomsandSessions............................................................................................................21

Scheduling.........................................................................................................................................22

Holidays............................................................................................................................................22

SnowCancellations...........................................................................................................................22

EdiblesinTherapy.............................................................................................................................22

ClinicalTeamCaseDiscussions(CT)Groups.....................................................................................22

Mission/Outcomes...........................................................................................................................22

Structure...........................................................................................................................................22

StudentExpectations........................................................................................................................22

ElectronicClientDocumentationandInformation...........................................................................23

APHASIACENTERMANUAL...............................................................................................................24

2018-2020.........................................................................................................................................24

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APHASIACENTERPOLICIESANDPROCEDURES.................................................................................25

PreparingforAphasiaCenterPlacement..........................................................................................25

StudentClinicianOrientation............................................................................................................26

Client/ClinicianSchedules.................................................................................................................26

SchedulingChanges..........................................................................................................................26

PreparingfortheFirstSession..........................................................................................................26

Supervisor/ClientSessions................................................................................................................27

PreparingforSubsequentSessions...................................................................................................27

ClientDiagnosticEvaluationsandDiagnosticReports......................................................................27

PatientFiles.......................................................................................................................................28

AphasiaGroupsandGroupBinder/Box............................................................................................28

Co-Treatments..................................................................................................................................29

ObservationatSpauldingRehabilitationHospital............................................................................29

AphasiaCenterOutingsandParties..................................................................................................29

DocumentationofClinicalPractice...................................................................................................29

Studentsshouldmakeeveryefforttocompletedocumentationasifeverydraftwereafinaldraft.30

ClientReassessments........................................................................................................................30

StandardAphasiaTherapyPrograms................................................................................................30

FamilyMeetings................................................................................................................................31

AACDevices......................................................................................................................................31

ResearchOpportunities....................................................................................................................31

InterprofessionalActivities...............................................................................................................31

RequiredReflectiveWriting(Journaling)Exercise............................................................................31

StudentPracticumContract..............................................................................................................32

SharedResourceBinder....................................................................................................................32

RoomSchedule.................................................................................................................................32

EndofSemesterTreatmentPlansforIncomingClinicians................................................................32

Materials...........................................................................................................................................32

AphasiaCaseDiscussion(CD)Groups...............................................................................................33

Structure...........................................................................................................................................33

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INTRODUCTIONTheclinicalmanualisdesignedtoassistCSDstudentsthroughouttheclinicalpracticumcomponentsoftheirgraduateprogram.Themanualincludesclinicalpoliciesandproceduresforinternalandexternalpracticumexperiences,AmericanSpeech-Language-HearingAssociation(ASHA)certificationstandards,andMAStateandDepartmentofElementaryandSecondaryEducation(DESE)licensingstandards,andoperatingguidelines,andproceduresfortheMGHInstitute’sIMPACTPracticeCenter.ClinicalpracticaarepartofthepreparationformasteryinthesixdomainsoftheIHP’sCoreCompetencies(https://www.mghihp.edu/impact-practice-core-competencies).Inaddition,studentswillbeorientedinclassandclinicalmeetingstoclinicalpolicies,forms,andproceduresthatareaccessiblethroughtheInstitute’sD2LCourseware.

Overview:EntryLevelPracticumExperiencesAllbeginningCSDstudentscompletetheirfirsttwotermsofclinicalpracticumintheMGHInstitute’sSpeechLanguageandLiteracyCenter(SLLC)supervisedbyCSDfaculty.TheSLLCishousedwithintheInstitute’sinter-professionalIMPACTPracticeCenter. Studentsspendonetermworkingwithchildrenwithoraldisordersofcommunicationandonetermworkingwithchildrenandadultsutilizingexplicit,structuredandsystematicapproachestointerventionforwrittenlanguagedisorders.Thepurposeoftheinitialclinicalexperiencesistheestablishmentoffoundationalcompetenciesrelatedtoexcellenceinclinicalpractice,professionalpracticecompetencies,andtheintegrationofacademiccourseworkknowledgeintoclinicalskillapplicationthroughfacultymentorship.Eachbeginningstudentisassignedasleadcliniciantooneclientandtoagraduatedyadpartnerandclient.Dyadpartnersshareequallyintheprovisionofservicesineachsession.Clientscometwiceweeklyforsessions.Experienceswithclientsareaccompaniedbythreehoursaweekofpracticumseminars,taughtbyfaculty,thatfocusondiagnosisandremediationofcommunicationdisorders.Inaddition,studentsattendfacultyguidedclinicalteammeetings(CTGroups)weeklywheretheypresenttheirclients,analyzecases,andlearntoapplytheoreticalinformationtopractice.Experiencesarecloselylinkedtocourseworkinacademiccourses.Overview:Intermediate/AdvancedPracticumExperiencesThreeTermsofIntermediate/AdvancedPracticumExperiencesAllstudentsparticipateinthreetermsofintermediatetoadvancedclinicalpractice.Studentsworkwithclientsacrossthelifespanwithdiversedisordersofvariedseverity.Allstudentsworkwithculturallyandlinguisticallydiversepopulationsandparticipateinintervention,diagnosis,andpreventionactivities.Allstudentswillcompleteaschool-basedplacement,whichwillmakethemeligibleforlicensurebytheMADepartmentofElementaryandSecondaryEducationasaSpecialistinSpeech,Language,andHearing

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Disorders.TheCSDDepartmentisaffiliatedwithover200hospitals,schools,earlyinterventioncenters,andspecialsettingsintheNewEnglandarea.TheSpeechLanguageandLiteracyCenterwithintheIMPACTPracticeCenteralsohasanAdvancedAcquiredDisordersCenter,whichprovidesservicestoadultswithacquiredcommunicationdisorders,suchasaphasia,andconductsresearchintheareaofacquireddisorders.Studentsmayparticipateinthisadvancedclinicduringtheirtermsofadvancedclinicalpractice.Advancedstudentsseemultipleclientsweekly.Generally,8graduatestudentseachtermareassignedtothispracticum,andaresupervisedbyfacultyexperts.ConcentrationPracticaAllstudentswhochoosetoenrollinaconcentrationarea(autism,adultneurogenicdisorders,medical,literacywithlicensure,literacywithoutlicensure,earlyintervention,orvoice)willparticipateinoneclinicalrotationwithintheirconcentrationpopulation.MAStateDESEReadingLicensurePracticumAllstudentswhoconcentrateinliteracyandwhowanttobecomelicensedbytheMADepartmentofElementary&SecondaryEducation(DESE)asReadingSpecialistswillspend150hoursinareadingpracticum.ThispracticumwillbebasedintheschoolsandsupervisedbyaMA-licensedReadingSpecialist,inadditiontothethreeabove-mentionedSLPsettings(a4thplacement).This3-credit4thplacement,underthesupervisionofaDESElicensedReadingSpecialist,doesnotcounttowardASHAhoursortheminimumacademic/clinicalcreditsneededtograduate.StudentsconcentratinginLiteracywhodonotwishtobecomeeligibleforMAlicensurearenotrequiredtocompletea4thplacement.MAStateEarlyInterventionLicensurePracticumStudentswhowanttobelicensedbytheMADepartmentofPublicHealthasEarlyInterventionSpecialistsmustdooneoftheir3requiredadvancedclinicaloutplacementsinaMassachusettsEarlyInterventionsettingandcompletetheEarlyInterventionelective.

IMPACTPracticeCenter’sSpeechLanguageandLiteracyCenterTheSpeech,LanguageandLiteracyCenter(SLLC)isoperatedbytheDepartmentofCommunicationSciencesandDisordersattheMGHInstituteofHealthProfessions.TheCenterisanintegralpartofthedepartment’sclinicaleducationcurriculum.TheclinicaleducationexperienceswithintheSLLChavebeendesignedtointegratescience,theory,andpracticeunderthementorshipanddirectionoflicensedCSDfacultysupervisors.Theseclinicalexperiencesarecoordinatedcloselywithclassroom-basedcourseworkandpracticumseminarstopromoteknowledgeandskillsintegrationandtomeetknowledgeandskillstandardsestablishedbyASHA.TheSLLCprovidesprevention,assessment,andinterventionservicesintheareasofspeech,language,andliteracytochildrenandadults.Itdoesnotdiscriminateinthe

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deliveryofprofessionalservicesonthebasisofrace,ethnicity,gender,age,religion,nationalorigin,sexualorientation,ortheabilitytopay.Thegraduatestudentclinicians,workingunderthesupervisionofnationally-certifiedandstate-licensedfaculty,performtheservicesprovidedattheSLLC.Thefacultyofrecordoneachcaseistheindividualresponsibleforallaspectsofthatclient’scareandco-signsalldocuments.Supervisionisprovidedthroughdirectobservation,collaborativehands-onworkwithclients,reviewandrevisionofdocumentation,andweeklycasediscussion/clinicalteammeetingswhichincludevideoreviewofsessions.Studentsaregenerallyobserveddirectlybytheirfacultysupervisor100%ofthetimeinitially,withagoalofincreasedindependenceoverthecourseoftwoterms.ASHAstandardsfor25%directobservationofinterventionandassessmentaremet.Supervisionisbasedonclientandstudentneedsandmodifiedaccordingly.ThereisalwaysalicensedfacultymemberonsiteandinchargeoftheSLLCwhenclientsarebeingseen.

CERTIFICATIONANDLICENSUREINFORMATIONTheAmericanSpeech-Language-HearingAssociation(ASHA)ASHAisthenationalscientific,professional,andcredentialingassociationforspeech-languagepathology/hearingscientists.ASHApromotesappropriateacademicandclinicalpreparationandprovidesopportunitiesforcontinuingprofessionaldevelopmenttokeeppractitionerscurrentwiththelatestknowledge.ASHAcanbereachedatwww.asha.orgor800-498-2071.CouncilonAcademicAccreditation(CAA)inAudiologyandSpeech-LanguagePathologyTheCAAaccreditsclinicaldoctoralprogramsinaudiologyandmaster’sdegreeprogramsinspeech-languagepathology.TheCAAestablishesaccreditationstandardsandfacilitatescontinuousqualityimprovementofaccreditedprograms. TheMGHInstitutemaster’seducationprograminCommunicationSciencesandDisordersisaccreditedbytheCAA.TheCAAcanbereachedat800-498-2071,2200ResearchBoulevard,#310,Rockville,MD.https://caa.asha.org/

StandardsandImplementationProceduresfortheCertificateofClinicalCompetence(CCC)inSpeech-LanguagePathologyStudentsareorientedtotheStandardsandImplementationProceduresfortheCertificateofClinicalCompetence(CCC)inSpeech-LanguagePathologyinthecontextoftheirclinicalpracticumseminar,whichtakesplaceduringtheirfirsttermintheprogram.Standardsandapplicationproceduresformembershipandcertificationarereviewedduringclinicalseminarspriortograduation.Thecurrentstandardscanbeviewedatthefollowinglink:http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-

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Standards/.AmericanSpeechLanguageandHearingAssociationPraxisExaminationThenationalexaminationinspeech-languagepathologyisdesignedtoassess,inacomprehensivefashion,theapplicant’smasteryofknowledgeofprofessionalconceptsandissuestowhichtheapplicanthasbeenexposedthroughoutprofessionaleducationandclinicalpractica.TobeeligibleforcertificationbyASHA,graduatesmustobtainapassingscoreonthePraxisSeriesexaminationinspeech-languagepathology.Theprogramrecommendsthatstudentstaketheexaminationnoearlierthanthesummeroftheirfinaltermintheprogram,whenthemajorityofcourseworkhasbeencompletedandstudyingfortheprogram’ssummativecomprehensiveexaminationhaspreparedthemforthisexam.ASHAprovidesinformationaboutthePraxisexaminationat:http://www.asha.org/certification/praxis/praxis_registration/

Registrationfortheexaminationcanbecompletedonlineat:http://www.ets.org/praxis/asha/

StudentsshouldsendtheirscoresdirectlytoASHA(code:R5031),tothestatelicensureboardwherethestudentplanstowork(MA:R7421),andtotheMassachusettsStateDepartmentofElementary&SecondaryEducation(copiesareaccepted).MassachusettsDepartmentofEducationTeachingLicensureTheprogramisaccreditedbytheMassachusettsDepartmentofElementary&SecondaryEducation(DESE)topreparestudentsforanInitialLicenseintheareasofTeacherofStudentswithSpeechLanguageandHearingImpairments,andtheInitialLicenseforReadingSpecialist.AllgraduatingstudentsmustmeettheacademicandclinicalstandardsforanInitialLicenseintheareasofTeacherofStudentswithSpeech,Language,andHearingImpairments.Inadditiontocompletingtheprogram’sacademicandclinicalrequirements,allapplicantsforDESElicensureinMassachusettsmustpasstheASHAPraxisexaminationandtheMassachusettsTestsforEducatorLicensureintheareasofCommunicationandLiteracySkills.GraduatesoftheCSDmaster’sprogramwhowanttoapplyforlicensureasReadingSpecialistmustpasstheReadingSubjectMatterTestoftheMassachusettsTestsforEducatorLicensure(MTEL),andholdanInitialLicenseinanotherarea.GraduateswhodonotalreadyholdanInitialTeachingLicensecanmakeanapplicationforReadingSpecialistfollowingoneyearofemploymentinMAintheroleofSLPunderanInitialLicense.StudentswillbeadvisedontheprocessofobtainingDESElicensurethroughadvisingseminars.TheMADESEcanbereachedat:http://www.doe.mass.edu/licensure/

AllstudentsmustcompleteanEducatorLicensureandRecruitment(ELAR)profilewith

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DESEbyfollowingthelinkabove.ThisresultsintheassignmentofaMassachusettsEducationPersonnelID(MEPID)number,whichallowstheprogramtoendorsestudentsforlicensureupongraduation.QuestionsshouldbeaddressedtoDr.CharlesHaynes,DESEliaison,[email protected].

MassachusettsDepartmentofPublicHealth(DPH)EarlyIntervention(EI)Specialist

StudentswhowanttobecomecertifiedbytheMassachusettsDepartmentofPublicHealthinEarlyIntervention(ages0-3)mustcompleteaplacementinEIataDPH-approvedsiteandsuccessfullycompletetheclass,“EarlyIntervention:Birthto3”.GraduatesareeligibleforProvisionalCertificationwithAdvanceStandingasEarlyInterventionSpecialists.StudentswillbeorientedtotheEIspecializationprocessintheclinicalseminars.FormoreinformationonthisEIcertification,contacttheDPHatwww.eitrainingcenter.org.

GENERALCLINICALPOLICIESANDPROCEDURESObservationHoursTheobservationofpatientsinthediagnosisandtreatmentofspeechandlanguagedisordershasatwo-foldpurpose:

1. Tointroducestudentstoavarietyofdisordersandtheirmanifestations.2. Toobservetheapplicationoftheoryandtheclinicalmanagementofthepatientby

theclinician.ASHArequiresthecompletionof25hoursofobservationwithinthescopeofpracticeofspeech-languagepathology.Theprogrammaintainsdocumentationofthesehoursintheprogramoffice(seeD2LforacopyoftheSupervisedObservationHoursform).StudentsareinitiallyorientedtothisprocessthroughD2L“Orientation101”followingadmission.Studentswhohavecompletedtheir25hoursofobservationinothersettingspriortoenteringthisprogrammustsubmitwrittendocumentationoftheobtainedhoursalongwiththesupervisors’signaturesandASHAcertificationnumbers.ThesehoursmustbeprovidedtotheDepartmentOfficepriortobeginningtheprogram.(SeeAppendixA)

TotalHoursRequiredbyASHAASHArequiresthatapplicantscompleteatleast375hoursofsupervisedclinicalpracticathatincludetheevaluationandtreatmentofclient/patientpopulationsacrossthelifespan

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andfromculturally/linguisticallydiversebackgrounds.Practicummustincludeexperiencewithclient/patientpopulationswithvarioustypesandseveritiesofcommunicationand/orrelateddisorders,differences,anddisabilities.Applicantsforcertificationmusthavehadexperiencewithmulti-linguisticandmulti-culturalpopulations.Atleast325hoursmustbecompletedatthegraduatelevel.StudentswithundergraduatepracticumexperiencemustsubmitcopiesofofficialdocumentationfromtheirundergraduateprogramstotheCSDDepartmentOffice.Studentswillbeorientedtoclinicalpracticumstandardsinthecontextofclinicalseminars.Clinicalhoursarerecordedbystudentsandapprovedbysupervisorsinouronlinedatasystem,E*Value.StudentstracktheirhourtotalsandtheirprogresstowardscompletionusingE*Valueathttps://www.e-value.net/login.cfmandsubmitthosetotalstotheCSDDepartmenteachterminthecontextofaTotalHoursTrackingForm.(SeeAppendixB)EvaluationofClinicalCompetencyTheclinicalevaluationsystemisusedtoevaluateclinicalcompetencyandskillsacrosssettings.AllgradingforclinicalpracticeisPass/Fail.Thesystemusesdefinitionsforperformanceineachareaofcompetencybasedonamountofsupervisorysupportwithstandardsforindependencethatchangeasstudentsmovefromanentryleveltoanadvancedlevelofpractice.TheevaluationmeasureiscorrelatedwithASHAstandardsforclinicalknowledgeandskills,CAAProfessionalPracticeCompetencies,andtheMGHInstitute’sCoreInterprofessionalCompetencies.Studentsareevaluatedbyclinicalsupervisorseachtermatmidtermandduringthefinalweeksofpracticum.Self-evaluationisacentralpartoftheclinicalevaluationprocessacrossterms.Developmentalgoals,alistofstrengths,andaplanwithstrategiesformeetingthesegoalsareco-createdbythestudentandsupervisoraspartofeachclinicalevaluationandaredocumentedintheevaluation.Clinicalevaluationsareconductedinwrittenandverbalform.EvaluationsarerecordedelectronicallybysupervisorsintheE*Valueelectronicrecordkeepingsysteminindividualstudentportfolios.StudentswillbeorientedtoE*Valueinseminarsduringtheirfirsttermintheprogram.Thesameprocessisfollowedinexternalsites.Afacultypracticumcoordinatormeetswiththestudentandtheclinicalsupervisoronsiteatmidtermandfacilitatesthestudent’sreflectionontheirgrowthandtheirlearninggoalsaspartoftheevaluationprocess.Aformativeassessmentoforalcommunicationskillsisconductedinthecontextofaformalself-evaluationprocess,whichoccursprogressivelyoverthefirsttwotermsofpracticumintheSLLC.Inaddition,thereareitemsrelatedtooralcommunicationontheclinicalevaluationmeasure.Studentskeepcopiesoftheseassessments,andcopiesarekeptonfileintheDepartmentOffice.FormsrelatingtotheseassessmentsareavailableontheonlineD2Lcourseware.WrittencommunicationofclinicalinformationisevaluatedusingawritingrubricdevelopedbyCSDfacultytoassesscriticalthinking,content,organization,styleandform.Therubricisusedasawritingguide,asaself-reflectiontool,andasanevaluative

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toolduringTermIandTermIIofEntryLevelpractice.Systematicimplementationinadvancedsettingsisbeingpilotedin2018-19.Theclinicalevaluationsystemisreviewedwitheachstudentduringtheirfirsttermofenrollmentinthein-houseClinicalPracticum.Allchecklists,pointsystems,anddefinitionsareaccessibletoallontheonlineD2LCourseware.AcopyoftheClinicalEvaluationwillbereviewedwithstudentsinclinicalteammeetingsduringthefirstterm.Itisthestudent’sresponsibilitytoreviewthecompetenciesanddefinitionsofperformancerelatingtohisorherlevelofpracticeeachterm.CopiesoftheformscanbefoundinE*ValueandonlineintheCSDStudentResourceModuleonD2L.(SeeAppendixesC,D,E)EvaluationofSupervisionandPracticumStudentscompleteasupervisorevaluationeachterm.Thesupervisorevaluationisdesignedtogivefeedbacktothesupervisorinhoweffectivetheywereinsupportingthestudentstowardsdevelopingclinicalskillsandfoundationalcompetenciessuchascriticalthinking,effectivecommunication,collaboration,accountability,andself-knowledgeandreflection. StudentsareorientedtotheprocessofsupervisionduringclinicalteammeetingactivitiesduringTermI.AnonymoussupervisorevaluationsaresubmittedattheendoftheterminE*Valueforin-houseplacements.Supervisorevaluationsareusedaspartoftheannualreviewprocessforfaculty,andaspartofthepracticumplacementprocessbyclinicalpracticumcoordinators.Inexternalplacementswherethereisoftenonlyonestudentassigned,supervisorevaluationsarenotanonymous.Studentslearntogivefeedbackanddiscusssupervisorystrategiesthattheyfindfacilitativetolearninginaprofessionalmannerusingthesupervisorevaluationprocess.Studentsalsoevaluatetheirpracticumsiteseachterm.Thepracticumself-reflectionandevaluationprocessrequiresstudentstoreflectonhowtheirexperiencehasexpandedtheirclinicalknowledgeandskills,theircollaborativeability,criticalthinking,innovationandcreativity,communicationandperspectivetaking,growthmindsetinresponsetochallenges,andself-knowledgeandreflectionineachterm.AlloftheseformscanbefoundinE*Value.(PleaseseeAppendixesF,G)ProfessionalConductAllstudentsmustadheretotheprinciplesofethicsdescribedintheASHACodeofEthicswhichispostedonlineintheCSDStudentResourcemoduleandreviewedinSeminars.Inaddition,studentsintheCSDProgramareexpectedtoadheretotheguidelinesforprofessionalconductasstatedintheMGHInstitute’sIMPACTPracticeCenterPoliciesandProceduresManual,andtotheDepartmentofCommunicationSciencesandDisordersPoliciesandProceduresManual,aswellasfollowingallguidelinesspecifictotheprofessionalroleofspeech-languagepathologists.Theseguidelineshavebeenestablishedtoprotecttherightsofstudents,faculty,and

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clients,andcanbefoundhere:http://www.asha.org/Code-of-Ethics/

https://www.mghihp.edu/faculty-staff/handbooks-manuals-and-guidesImpactPracticeCenterManual(SeeIMPACTPracticemoduleinD2L)SupervisionThemannerandamountofsupervisionprovidedtostudentsisdeterminedandadjustedtoreflectthecompetenceofeachstudentandtoalloweachstudenttoprogresstowardstheindependencerequiredtoenterprofessionalpractice.Supervisionisadjustedtoensurethatspecificneedsaremetforeachindividualreceivingservice.Theclinicalcompetencyevaluationutilizedtoevaluatestudentseachtermatmidtermandfinalisbasedona1-5scale.Theamountofdirectinstructionneedediscorrelatedwiththestageofdevelopmentofthestudent.5=demonstratesbehaviorindependently4=demonstratesbehaviorwithminimalguidancefromsupervisor3=demonstratesbehaviorwithgeneralguidancefromsupervisor2=demonstratesbehaviorwithspecificinstructionfromsupervisor1=failstodemonstratebehaviorconsistentlyregardlessofamountofsupervisionorneedsexcessiveandrepetitiveinstructions

CompetencyScaleBasedUponLevelofExperience HighPass Pass PasswithConcerns FailCD761andCD762 3.0-5.0 2.0-2.99 1.5-1.99 1.0-1.49CD771,CD871,CD872 4.0-5.0 3.0-3.99 2.5-2.99 1.0-2.49CD873 4.5-5.0 3.5-4.49 3.0-3.49 1.0-2.99

UsingAnderson’scontinuumofsupervision(1988)studentswhoenterintoallclinicalplacements,bothinternalandexternalpracticumsitesareunderstoodtobeginintheevaluation/feedbackstageofthecontinuumforeachnewexperience,andadvancetothetransitionalandself-supervisionstageswithsupport.

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Supervisorsareresponsibleformakingfinaldecisionsregardingallclientcareconductedbystudentclinicians.Supervisorsmustdirectlysuperviseaminimumof25%ofthestudent’stotalcontacttimewitheachclientduringinterventionandassessmentinaccordancewithASHAstandards.Practicumsitescanandwillestablishtheirownguidelinesregardingthespecificissuesaddressedbelow.Studentsmustalwayscollaboratewithsupervisorsintheplanningandprovisionofservices.(AppendixH)

ReferralsStudentsshouldnotmakereferralstooutsidesourceswithoutspecificpermissionfromtheirsupervisor.Allservicedeliverymustbeprovidedincollaborationwiththesupervisor.ClientSchedulesStudentsshouldnotalteraclient’sschedulewithoutconsultingtheirsupervisor.Allservicedeliverymustbeprovidedincollaborationwiththesupervisor.ContactwithFamilyandProfessionalsStudentsprovidecareandinteractwithclientsandfamiliesinaccordancewithrecognizedstandardsofethicalpractice.Allinteractionswithpersonsassociatedwiththeclientshouldbemadeonlywithspecificapprovalofthesupervisor.Supervisorsareresponsibleforoverseeingtheformandcontentofallinteractionsassociatedwithclientcare.Studentsshouldnotinteractwithclientsinnon-professionalcontexts.Studentsarenotallowedtoprovidepersonalservices(babysitting,petsitting,housesitting)whiletheyaredirectlyinvolvedwithaclientand/orclient’sfamily.

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ClientPlanofCareSupervisorsareresponsibleforallfinaldecisionsregardingclientcare.Discussionsofalternativecareplansshouldbeconductedwithinthecontextofsupervisorymeetings.

CancellationsbyClientandAbsenceofStudentsduetoIllnessStudentsareresponsibleforknowingtheprocedurespertainingtoclientandcliniciancancellationasoutlinedbyeachclinicalsetting.Studentsmustnotifytheirsupervisorandestablishaplanofactionforclientcoverageintheeventthattheyareabsentduetoillness.Mostabsencesotherthanillnessarenotallowedduringclinicalterms.Vacationsmustbeplannedduringthebreaksbetweenacademicterms.Exceptforexceptionalsituations,illnessistheonlyapprovedreasonforcancellationbystudents.Exceptionalsituationsmustbeapprovedbythesupervisorandthepracticumcoordinator.

ProfessionalPracticeAccountabilityandIntegrityStudentsareresponsibleforpracticinginamannerthatisconsistentwiththeASHAcodeofethicsandthescopeofpracticedocumentsforspeech-languagepathology.Studentsmustadheretoallstateandinstitutionalregulationsandpoliciesandusethehighestlevelofintegritywitheachindividualserved.ProfessionalDutyStudentsmustunderstandandfollowallsiterulesrelatedtomaintainingthesafetyofallindividualsserved.Confidentialityrulesmustbestrictlyfollowedtoprotecttheprivacyandrightsofthosethatareserved.Studentsmustmeetallclinicalresponsibilitiesinatimelyandpunctualmanner.Studentsshouldplantoarriveearlyandbeconsistentlywellpreparedforclinicalpractice.Standardsfortimelysubmissionofdocumentationmaybeestablishedbyeachclinicalsetting.Studentsareresponsibleforunderstandingandadheringtoallstandardsforeachsetting.CommunicationStudentsshouldutilizeprofessionalcommunicationacrossmodestoensurethatthehighestqualityofcareisdelivered.Alldraftsofclinicaldocumentationshouldbeeditedandproofedforaccuracy,grammar,spelling,andpunctuationpriortosubmission.Studentsshouldmakeeveryefforttocompletedocumentationasifeverydraftwereafinaldraft.CulturalCompetenceStudentsshouldunderstandtheimpactofhisorherownsetofculturalandlinguisticvariablesandthoseofindividualsservedonthedeliveryofeffectivecare.Theseinclude,butarenotlimitedto,variablessuchasage,ethnicity,linguisticbackground,nationalorigin,race,religion,genderandsexualorientation.Studentsshouldunderstandthe

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characteristicsofindividualsserved(e.g.,age,demographics,culturalandlinguisticdiversity,educationalhistoryandstatus,medicalandcognitivehistoryandstatus,socioeconomicstatus,andphysicalandsensoryabilities)andhowthesecharacteristicsrelatetoprovidingcaretoindividualsserved.CollaborativePracticeStudentsshouldunderstandanddemonstrateinterprofessionalteamcompetenciesandutilizethosecompetenciestoperformeffectivelyonIPteamstodeliverclientcenteredcare.ProfessionalPracticeGradingStudentswhodonotmeetsitestandardsforprofessionalismconsistentlywillreceiveafailinggradeundertheprofessionalismcompetencyonthePracticumCompetencyEvaluationChecklistforthattermandwillberequiredtoimprovethatcompetencypriortograduationtoaminimumvalueof3.Studentswithfailingorlowprofessionalismgradeswillnotbeconsideredforadvancedpractica.

OUTPLACEMENTPRACTICUM:ADDITIONALPOLICIESANDPROCEDURES

(Pleasereviewthepriorsectionsforgeneralguidelines)ClinicalPlacementsinExternalSitesPrerequisitesforenrollinginCD771,871,872,873:Outplacementpracticumincludethefollowing:

• acumulativegradepointaverageof3.0;• meetcompetenciesandreceiveapassinggradeintwotermsofCD760-01and02

(in-houseclinical);• statusasamatriculatedstudent;• sufficientcourseworkrelatedtothepopulationtobeserved.

PracticumCommitteeThemembersofthePracticumCommitteeincludetheDirectorofClinicalEducation,theAssociateDirectorofClinicalEducationandtheAssistantPracticumCoordinator.ThePracticumCommitteeisresponsibleforoverseeingclinicaleducationinIntermediateandAdvancedplacements,monitoringandmentoringeachstudent’sclinicalcompetencygrowthduringCD771,871,872and873,assigningplacements,anddevelopingplansofactionforissuesrelatedtoplacements.Studentsshouldtakeconcernsrelatedtoplacementsdirectlytotheplacementcoordinatorassignedforthatplacement.ConcernsthatthecoordinatorisunabletomediatewillbereferredbythecoordinatortothePracticumCommittee.FactorsConsideredforPlacementIntroductionEachstudentisexpectedtoparticipateactivelyintheirclinicalcompetencydevelopmentby

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settingpersonalgoalsfordevelopmentutilizingon-goingassessmentandfeedbackfromsupervisorsandself-reflection.Facilitatedbythisself-assessmentandinconsultationwiththeClinicalPracticumCommittee,AcademicAdvisor,otheracademicfaculty,and/orclinicalinstructors,studentsareexpectedtoplayanactiveroleinidentifyingandrequestingclinicaleducationexperiencesthatwillfostergrowthinidentifieddevelopmentalareas.Ultimately,theClinicalPracticumCommitteemakesallclinicaleducationassignments.Factorswillincludeaccuracyofstudentself-assessment,prioracademicandclinicalperformance,andcharacteristicsofthelearningenvironmentattheclinicalsite.Studentsmaynotdeclineaclinicalplacement;suchactionwillbeconsideredrefusaltotakearequiredcourse.Thereisnoguaranteethatassignmentswillbeinthefacilitiesorgeographiclocationsrequestedbystudentsorthatstudentswillcompleteafull-timeclinicalexperienceorinternshipinthemetropolitanBostonarea.Studentsareadvisedthatnotallfacilitiesareavailableforallclinicaleducationexperiences.AvailabilityisbasedonresourceconstraintsoftheclinicalfacilitiesandontheClinicalPracticumCommittee’sdecisionsregardingappropriatenessofthefacilitytospecificclinicalexperiencesinthecurriculumand/ortoaspecificstudent’slearningneeds.PlacementplanningmeetingdocumentscanbefoundinAppendixI.TimingandScheduleofClinicalExperiencesThespecifictiming(includingstartandenddates,day(s)ofweek,andhours)ofanygivenclinicaleducationexperiencemayvaryfromfacilitytofacilityandyeartoyearbasedonresourceavailability.Studentsareexpectedtocomplywiththefacility’stimingofclinicaleducationexperiencesandmustflextheirpersonalschedulestoaccommodatespecifictimeconstraintsofthefacility.TheClinicalPracticumCommitteewillincludeanticipatedtimingofclinicalplacementsininformationprovidedtostudentsaspartoftheclinicaleducationmatchprocess.Ifthetimingofaclinicaleducationexperienceischangedbyaclinicalfacility,theClinicalPracticumCommitteewillcommunicatethechangetothestudent(s)immediatelyuponnotificationbythefacility.ExpensesandTravelStudentsareresponsibleforallexpensesassociatedwithclinicaleducation.Clinicaleducation,especiallyafull-timeclinicalexperience,typicallyinvolvessomeexpensetothestudent.Thecostassociatedwithagivenclinicaleducationexperiencewilldependonmanyvariablesincluding,butnotlimitedto,thecostoftransportation,andmeals.Studentsareadvisedtoplanforsuchexpenses,asstudentswillbeassignedtoclinicalfacilitiesrequiringtraveloutsideoftheBostonareaoroutsidethepublictransportationsystem.Studentsareresponsibleforalltraveltoandfromclinicaleducationexperiences.Thisincludeslocaltravel(e.g.dailyorweeklytravelforafull-timeexperienceorpracticum).

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Manyclinicaleducationfacilitiesarenotaccessiblebypublictransportation.Everystudentshouldanticipateneedingaccesstoacarforsomeportionoftheclinicaleducationcomponentofthecurriculum.DifferentSitesTomeetASHAcertificationrequirements,studentsarerequiredtocomplete375hoursofclinicalpracticum.InordertomeettheMassachusettsDESErequirementsforinitiallicensure,oneofthesesitesmustconsistof100hoursinaM.G.L.c71-approvedprivateschool,aneducationalcollaborative,apublicschool,oranycombination.AfourthtermofoutplacementclinicalpracticuminreadingisrequiredforstudentsseekinglicensureasaReadingSpecialistfromtheMassachusettsDESE.ThecreditsfromthispracticumdonotcounttowardtheCSDProgramminimumcreditrequirementstograduate,nordothehourscounttowardASHA’s375-hourrequirement,unlessthesupervisorisASHA-certifiedandtheworkiswithinthescopeofpracticeforwrittenlanguageasoutlinedbyASHA.GradesPracticumisgradedonaPass/Failbasis.SupervisorsdeterminearecommendedgradeusingtheClinicalPracticumEvaluationofClinicalCompetencyChecklists.TheDirectorofClinicalEducation,inconsultationwiththepracticumcoordinators,isthefacultyofrecordforallclinicalpracticumcoursesandisresponsibleforassigningthefinalgradesforthosecourses.Non-PassingGradesStudentsreceivingaFailanytwotermsofclinicalpracticumwillbedismissedfromtheProgram.Studentsreceivinganon-passinggradeinpracticummustparticipateinaClinicalandAcademicReviewwhereaninterventionplanisdeveloped,baseduponASHAandprogramclinicalcompetencyrequirements,withstrategiestosupportacquisitionofclinicalcompetencies.Studentsmustpasseachclinicalcompetencywithanaveragegradeacrosstermsof3orhighertomeetASHA’sstandardsforclinicalskillcompetency.StudentsfallingbelowthisstandardinpracticummustparticipateinaClinicalandAcademicReviewwhereaninterventionplanisdeveloped,baseduponASHAandprogramclinicalcompetencyrequirements,withstrategiestosupportacquisitionofclinicalcompetencies.RefusalofPracticumPracticumcoursesarerequired,justasacademiccoursesare.Studentsenrolledinclinicalpracticumareexpectedtoattendtheirassignedplacement.Studentswhorefuseaclinicalplacementwillnotbeassignedtoanotherplacementforthattermandmaynotgraduateontime.

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TerminationofPracticumTherearefourcategoriesofissuesthatareconsideredgroundsforremovalofastudentfromaclinicalpracticumexperiencebytheClinicalDirectorincollaborationwiththePracticumCoordinators.Categoriesofissuesconsideredgroundsforterminationofapracticumarelistedbelow:

1. Unethicalbehavior,accordingtotheASHACodeofEthics,onthepartofstudentorsupervisor.

2. Unprofessionalbehavioronthepartofthestudentorsupervisorthatisunabletobemediated.

3. Significantsafetyorhealthissues.4. SignificantandpersistentdeviationsfromacceptedASHApracticepatternsacross

clinicalcontextsatthepracticesite.StudentsremovedfromplacementforunethicalbehaviorontheirpartwillreceiveagradeofFail,aswillstudentswhoarenotabletomeetclinicalcompetenciesrelatedtoprofessionalism.Studentswhohaveaplacementterminatedduetosite-relatedissuesorillnesswillreceiveagradeofIncomplete.Everyeffortwillbemadetofindanewsiteinthesecases.MediationIssuescanbereferredbythePracticumCoordinatortothePracticumCommitteeformediation,whereuponamediationprocessledbythePracticumCoordinatorswillfollow.Thefollowingareasofconcernareconsideredgroundsfortheinitiationofamediationprocess:

• Concernsregardingthesupervisoryprocess.• Communicationbreakdownsbetweensupervisorandstudent.• Personalstyleconflictsbetweenthesupervisorandstudent.• Healthissuespertainingtotheplacement.• Unprofessionalbehavioronthepartofthestudentorsupervisor.• Contractissuesrelatedtotime,studentorsupervisorresponsibilities,and

opportunitiesforlearning.MediationProcess

1. ContacttheIHPpracticumcoordinatorassignedtoyoursite.2. Provideasummaryofissue(s)relatedtoitemsabove.3. PracticumCoordinatormayscheduleameetingwithstudentandsupervisorto

developaplanofaction. Planofactionmayinclude:a. Formalinterventionplan,ClinicalAcademicReview(CAR)b. Continuedcurrentcommunicationwithsite,supervisor,andstudentc. Additionalvisits

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PolicyforDocumentationofSupervisedClinicalHoursandClinicalPracticumEvaluationsSubmissionofCompletedFormsDocumentationforclinicalpracticumissubmittedutilizingtwosystems,E*ValueandD2L.Documentationmustbecompletedbythefinaldayofclasseseachsemester.StudentswillbeorientedtotheclinicaldocumentationsystemduringthefirsttermintheSpeechLanguageandLiteracyCenterandinanexternalclinicalplacementmeetingduringTermII.Alldocumentationmustbecheckedbythestudentforaccuracypriortosubmission.DocumentationsubmittedfollowingthatdatewillresultinagradeofIncompletefortheterm.Studentssubmittingincomplete,inaccurate,and/orlatedocumentationwillreceiveanotationintheareaofProfessionalCompetencyontheirClinicalEvaluationfortheterm.Studentsarerequiredtokeepcopiesofallcompletedforms.LocationofFormsCopiesofformsforclinicaldocumentationcanbefoundonlineintheCSDStudentResourceModuleunderExternalPlacementinD2LandintheelectronicE*Valuesystem.

SPEECHLANGUAGEANDLITERACYCENTERPOLICIESANDPROCEDURES

(PleasereviewtheIMPACTPracticeCenter(IPC)Manualforpoliciesandproceduresrelatedtoall

practiceintheIPC.ThefollowingpoliciesandproceduresarespecifictotheCSDDepartment’sprograms):

PatientFilesREDCapStartingwiththe2018-2019year,allclientdemographicandbackgroundinformationwillbeelectronicallystoredinREDCap.REDCapisasecure,web-basedapplicationsystemthatsupportsdatastorage.AllclientsattendingtheSLLCwillbeprovidedwithalinktotheprogramandcompleteallnecessarypermissionforms,demographicinformationandcasehistoryformsforstudentreview.FurtherproceduresregardingstudentaccesstotheREDCapprogramwillbeprovidedinSeptember,2018.PaperFilesManyoftheSLLCclientinformation,specificallyclinicalassignments,attendancerecords,outsideinformationandreportsandothermaterialswillcontinuetobestoredinpaperfilefolders.FilesdonotleavetheIMPACTPracticeCenterandstudentsmaynotcopyorcarryanythingwithclientidentifiersincludingtestingprotocolsoutsideofthecenter.HoursofaccesstoclientfilesisbasedontheoperatinghoursoftheIPCandwillbepostedinthestudentworkroomintheIPC.

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GettingStartedChecktomakesurethatyourclienthasahangingfilewithamanilafileinthestudentworkroomintheIPC. Reporttoyoursupervisoranymissingmaterials.ContentsofNewClientFilesShouldContain:

• Attendancesheets• Contactsheets• Tabsectiondividers

ContentsofEstablishedFiles(ReturningClients)

• Allinformationlistedfornewfiles(seeabove)• Acompletedcasehistoryform• Writteninformationprovidedbyfamily/clientsuchasIEPs(IndividualEducational

Planswrittenbyschoolsystems)andpreviousreports• Diagnosticassessmentassignments,onewithidentifyinginformationandone

without• Family/clienthandoutsummarizingdiagnosticinformation• TreatmentPlan• 2SampleLessonPlans(mostrecent)• FinalProgressNotesummarizingtheprogressfortheyear,onewithidentifying

informationandonewithout• Finalfamily/clienthandoutsummarizingprogressfortheyear

OngoingResponsibilitiesforMaintenanceofClientFiles

1. Allclientrelatedcontactmustbeapprovedbythefacultysupervisor.2. Fileinformationshouldbemaintainedinthetabbedsections.3. Fileallclientinformationsuchasreports,testprotocolsassoonasitisreceived.4. Documentattendanceforeachsessionthedayofthesession.5. DiagnosticInformationshouldbefiledassoonasitiscompleted.6. TwoSampleLessonPlansattheendofeachterm.7. FinalProgressNotenolaterthanthelastdayoftheterm.

ConfidentialityandCommunicationConfidentialityiscentraltoprotectionofclientprivacyandrights.TheprocedureswillbereviewedinorientationtoclinicandseminartermI.PleaseReviewGeneralPoliciesandProceduresstatedintheIPC’sPoliciesandProceduresManualDocumentationofClinicalPracticeFormatAllpaperworkshouldbecomputergeneratedandeditedforgrammar,spelling,andpunctuationpriortosubmissiontoyoursupervisor.Finaldraftsofdocumentationmustcontainnoerrors.LessonPlansLessonplansmustbesubmittedweeklytothesupervisoratleast24hourspriortoeach

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sessionviathedistancelearningcoursewareoremail.Supervisorsmayrequestspecifictimelinesrelatedtotheirschedulesthatrequiresubmissionofplansmorethan24hoursinadvanceofsessions.Emailmaybeutilizedwithpermissionofthesupervisorandadherencetoconfidentialitypolicies.EvaluationofDocumentationTheuseofreportmodelsandsupervisorwrittenfeedbackwillbeprovidedtostudentsforallclinicalwritingassignments.TheuseoftheClinicalWritingRubricwillbeusedontheDiagnosticReport/AssignmentandtheFinalProgressNote.(seeforminAppendixandinD2LSeminar).SupervisionStudentswillbeprovidedwithguidelinesformovingtowardsindependenceoverthecourseoftheTermIandTermIIwiththegoalofdecreasedspecificfeedbackandincreasedself-supervision.Nostudentwillbesupervisedlessthan25%ofthetimeforinterventionor25%ofthetimeforassessment.HourDocumentationASHAhoursandonsitehoursmustbesubmittedweeklyviatheE*Valueelectronicsystem.StudentscancreateacomputergeneratedTotalHourReportwiththeirhourtotalssotheycantracktheirprogresstowardsgraduation.TheCSDDepartmentwillgenerateatotalhoursheetattheendofeachtermtotrackstudentprogress.MaterialsTestsTestsandmaterialsdonotleavethebuildingandmustbeusedwithintheIPCorotherdesignatedareasin2CC.SignoutteststhatyouarereviewingorusingintheCenteronthesignoutformthatcanbefoundintheStudentWorkRoom.ReplacealltestsintheappropriatefilewhenfinishedToysCleanandreplacealltoysandmaterialsontheappropriateshelforcontainerimmediatelyfollowingatherapysession(pleaserefertocleaningproceduresoutlinedintheIMPACTPracticeCenter’sPoliciesandProceduresManual).TherapyRoomsandSessionsNoeatingordrinkingispermittedinthetherapyroomsorwaitingareaintheIPC.Nowaterorgumchewingisallowedduringsessions.Cleanandreplaceallmaterialsfollowingeachsession.Removeallgarbageandwipedowntableswithdisinfectantfollowingeachsession.Cleanwritingboardsandreplacepensintheirappropriateslots.

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SchedulingThe clinical faculty conducts all scheduling and schedule changes.Cliniciansmust notchangetheirclient’ssessiontimewithoutfirstclearingchangeswiththeirsupervisor.HolidaysTheIPCisaneutralentitythathonorsallculturalandreligiousbeliefsandseekstocreateaninclusiveenvironment.Insupportofthispolicy,noreligiousholidaysarecelebratedorrepresentedbythefacultyandgraduatestudentsprovidingservicesinthecenter.Thismeansnodecorationsforholidaysorgiftsorholidayspecificactivitiesareutilized.Clientsarewelcometobringitemsrelatedtotheircelebrationsandbeliefsintothecenteriftheychoosetodoso.SnowCancellationsThecenteroperatesonthesnowcancellationscheduleoftheInstitute. Clinicianswillbenotifiedbyemail,phone,ortextdependingonpreferencethroughtheautomatedIonlinesystemortheycancalltheIHPSnowHotlineat617-724-8484iftheInstituteclosesduetoweather.Studentcliniciansmustnotifytheirclientsifthecenterisclosedduetoweather.EdiblesinTherapyBoththeparents/guardiansandthesupervisormustapproveanyediblesusedinsessionsbeforethetherapysessionbegins.Disinfectallsurfacesthatcomeincontactwithfoodproducts.Ediblesfortheclientshouldbeprovidedbytheclientand/orparent/caregiver.GiftsStudentsshouldnotgivegiftstotheirclients.Prizeswillbeavailableforallclientsandsuppliedbythecenter.Clientsmaygivesmallgiftstostudentsiftheychoosetodoso.Studentsarenotallowedtoacceptgiftsofcash.ClinicalTeamCaseDiscussions(CT)GroupsPleaserefertoproceduresintheCSDClinicalSeminarsD2L.YouwillbeorientedtotheseproceduresbyfacultyinthecontextofCTgroupsduringSeptemberandinweeklyClinicalTeamMeetingagendasprovidedbyyoursupervisor.Mission/OutcomesStudentswilldeveloptheirabilitytoapplytheorytoclinicalpracticewhilelearningtothinkcritically,analyzeandsynthesizeinformation,collaborateandcommunicateprofessionally.StructureStudentsparticipateinfacultymentoredclinicalteammeetingsfor2hoursweeklyingroupsof4-8. Studentspresenttheirclinicalcasesweeklyfordiscussionbythegroup.StudentExpectations

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• CometoCT-Groupmeetingsontime.• Communicatewiththesupervisorpriortothegroupmeetingtimeifthediscussion

grouphastobemissedduetoillnessorfamilyemergency.• Preparea15-minutediscussionoftheclienteachweek.Presentationsshould

include:o digitalsystemcuedtokeyaspectsofthesessiono asummarizationofthesessionortask’sobjectiveso asummarizationofthetheoreticalrationalessupportingtheobjectivesand

theprocedureso adiscussionofthesession’sstrengthsandweaknesseso questionsforthesupervisorandfortheteamo considerations/planforfuturesessionsbaseduponthedatafromthesession

underdiscussion• Participateactivelyingroupdiscussionsofallclientsby:

o askingquestionso makingsuggestionso addinginformationo listeningactively

• Useprofessionalcommunicationstyle,specifically:o professionspecificvocabularyo MAEgrammaro appropriatespeechrateo cleararticulationo professionalvoicequality

ElectronicClientDocumentationandInformation

• Noidentifyinginformationregardingclientsshouldbetransmittedviaemailinanysetting.

• Alldraftsofclientdocumentationshouldincludetheclient’scode(firstinitialandlastinitialoftheclient)inlieuofanyidentifyingpersonalinformation.

• Allclientinformationthatisidentifying,suchascasehistories,mustbefiledintheclient’sofficialfileinthebadge-accessibleIPCdesignatedarea.CLIENTCHARTSMUSTNEVERLEAVETHECENTERorothersettings.

• Allfinaldraftsofdocumentationcontainingidentifyinginformationonstudent’sH:drivesshouldbedeletedfollowingfinalapprovalofthedocumentbysupervisors.

• Client-specificidentifyinginformationwillbeincludedonlyinthefinalcopyofdiagnosticreports,andotherdocumentation,andwillbefiledintheIPC’slockedfilearea.

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APHASIACENTERMANUAL

2018-2020

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APHASIACENTERPOLICIESANDPROCEDURES(PleaseseeIMPACTPracticeCenterManualforpoliciesandproceduresrelatedtoallpracticeinthe

IPC.ThefollowingpoliciesandproceduresarespecifictotheCSDDepartment’sprograms)TheAphasiaCenterprovidesassessment,andinterventionservicesintheareasofspeech,language,andliteracytoadultswithacquiredcommunicationdisorders;specifically,aphasia,dysarthria,apraxiaofspeechandcognitivedisorders.ResearchintheareaofacquireddisordersisalsocompletedwithinthisCenter.TheAphasiaCenterisconsideredtobeanIntermediateorAdvancedplacement.TheAphasiaCenterdoesnotdiscriminateinthedeliveryofprofessionalservicesonthebasisofrace,ethnicity,gender,age,religion,nationalorigin,sexualorientation,ortheabilitytopay.AphasiaCenterservicesareprovidedfreeofcharge,thoughanominalclinicsupportfeemayberequestedeachsemester.ThegraduatestudentcliniciansareassignedtotheAphasiaCenterfora13-weeksemesterandworkunderthesupervisionofASHAcertifiedandstatelicensedfaculty.StudentcliniciansperformtheservicesprovidedattheAphasiaCenter.Thestudentcliniciansprovideindividualtreatmentsessionstoapproximately6-9clientsperweek.Mostclientsparticipateintherapysessionstwiceweeklyforone-hourindividualsessionsandatleastonehourofgrouptherapy. Manyclientswillrequirecompletionofaninitialdiagnosticassessmentorperiodicre-assessment.Generally,sevengraduatestudentseachtermareassignedtothispracticum,andsupervisedbyonefull-timeandtwopart-timefacultysupervisors.Thefacultyoneachcaseistheindividualresponsibleforallaspectsofthatclient’scareandwillco-signalldocuments.Supervisionisprovidedthroughdirectobservation,collaborativehandsonworkwithclients,reviewandrevisionofalldocumentation,andbi-weeklycasediscussiongroupswhichmayincludevideoreviewofsessions.Studentsaregenerallyobserveddirectlybytheirfacultysupervisor50%ofthetimeinitiallywithagoalofincreasedindependenceoverthecourseofthesemester.ASHAstandardsrequire25%directobservation.ThereisalwaysalicensedfacultymemberonsiteandinchargeattheAphasiaCenterwhenclientsarebeingseen.TheAphasia Center program is coordinated byCSDdepartment facultymembersRachelPittmann,MSCCC-SLPandMarjorieNicholas,PhDCCC-SLP. RachelPittmannistheprimarycoordinatorandsupervisorandMarjorieNicholas,SuzannePennington,andotherfacultymembersserveassupervisors.PreparingforAphasiaCenterPlacementPrior to starting a placementwithin theAphasia Center, it is recommended that studentcliniciansreviewnotesfromAphasiaClass,CD839.TextbooksthatwillbehelpfulincludetheManualofAphasiaandAphasiaTherapyandAphasiaandRelatedNeurogenicLanguageDisorders.It is helpful to review the administration and scoring of the Boston Diagnostic AphasiaExamination-3 (BDAE-3), Standard Form, Boston Naming Test (BNT), and the Cognitive

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LinguisticQuickTest(CLQT).StudentClinicianOrientationAll Aphasia Center student clinicians are required to complete an orientation with theprimary supervisor. This meeting will take place approximately one week before thebeginning of direct client contact. During this meeting, caseloads will be assigned andclient/clinicianscheduleswillbeprovided.Also,thesupervisorandstudentclinicianswillprovideeachotherwiththeircontactinformation(phonenumber).Manyofthefollowingtopicswillbediscussedandexplainedduringtheorientation.Client/ClinicianSchedulesAphasiaCentersupervisorswillprovideeachstudentclinicianwithatherapyscheduleapproximatelyoneweekpriortothebeginningofthesemester. Thisschedulewillbeprovidedelectronicallyandwillincludeindividualsessiontimes,therequiredgrouptimesaswellastherequiredclinicalcasediscussiongroupmeetings(CDGroups).SchedulingChangesTheclinicalfacultyconductsallschedulingandschedulechanges.Cliniciansmustnotchangetheirclient’ssessiontimewithoutfirstclearingchangeswiththeirsupervisor.PreparingfortheFirstSessionUponcaseloadassignment,clientfilesshouldbecarefullyreviewed.Eachfilewillcontaintheinformationoutlinedbelow.Thepastsemester’sstudentclinicianwillhaveplacedaClientTreatmentPlanandthemostcurrentSOAPnoteinthefrontofeachfile.Pleaseusethesedocumentsinplanningyoursessions.Thesewillincludedetailsaboutclientgoalsandperformanceaswellasinformalinformationaboutclient’spersonalitiesandneeds.Thetreatmentplanshouldalsohavenotedthedate,time,androomnumberofapreviouslyrecordedtreatmentsessionthatcanbereviewedontheviewingsystem.Pleasereviewatleastonepreviousdigitallyrecordedsessionperclientpriortomeetingtheclients.Contactinformationforthelaststudentclinicianshouldalsobeprovided.Itisrecommendedthatincomingstudentclinicianscontactthelaststudentcliniciantoexchangeclientinformation.(PleaseseeConfidentialityGuidelinesoutlinedintheIMPACTPracticeCenter’sPoliciesandProceduresmoduleinD2L.)Ifneeded,studentcliniciansmayscheduletomeetindividuallywiththesupervisortodiscusstheclientsonthecaseload.Pleasecontacteachclientpriortotheirfirsttherapysessiontoremindthemofthetimeanddateoftheirfirstsessionthatsemester.(Clientsreceivetheirschedulesbyemailand/ormail).Clients/caregiversmaybecontactedviaphoneand/oremail.Clientcontactlistswillbeprovidedelectronicallypriortothestartofthesemester.Theinitialsessionisprimarilyspentinrapport-building,or“gettingtoknoweachother”.

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Studentsshouldusethistimetobecomefamiliarwiththecommunicationskillsofeachclientandtoaskquestionsabouteachclient(studentsshouldhavesomepreviousknowledgeabouteachclientfromthefilereview).Itishelpfulforthestudentcliniciantoprepareandpresentpersonalinformationtosharewiththeclient.Appropriateexamplesincludeshortphotoalbums,scrapbooks,orslidepresentations.Pleaseprepareandgiveeachclient/caregiveryourcontactinformation,printedonpaper,includingphonenumber,emailaddress,andphotographforcommunicationofcancellations,illness,etc.

Supervisor/ClientSessionsThesupervisorwillconductaclienttherapysessionwithmanyoftheclientswithinthefirstthreeweeksofthesemester.Theschedulewillbedeterminedbythesupervisorandwillallowthestudentcliniciantoobserveamasterclinicianprovidingtreatmenttoaclient.Studentcliniciansareinvitedtoparticipateinthesesessionstotakedata.PreparingforSubsequentSessionsTreatmenttasksshouldbeadministeredinthesecondsessionofthesemester.Todetermineappropriatetasks,pleaseusetheinformationfromtheprevioussemester’streatmentplansandSOAPnotes,includingthegoals,andfromtheclientsessionstobecompletedbythesupervisor. Generally,theclientcompletesapproximatelythreetreatmentactivitiesforeachsession.Itisrecommendedthatadditionaltherapyactivitiesbepreparedandavailable.ClientDiagnosticEvaluationsandDiagnosticReportsEachclinicianwillberequiredtocompleteaminimumofonediagnosticevaluationanddiagnosticreport.ThiscaneitherbecompletedonaclientthatisnewtotheAphasiaCenterorwithaclientwhohasbeenattendingthecenterforatleasttwosemesters.Thesupervisorwillassignaminimumofoneclientpercaseloadforassessment.Diagnostictestingshouldbeginduringthefirstsession.Thisincludesthecompletionofaclient/caregiverinterviewwhereadetailedcasehistory/backgroundinformationwillbecompleted.AssessmentmeasuresthatshouldbecompletedincludetheBDAE-3(StandardForm),theBostonNamingTest,andtheCognitiveLinguisticQuickTest.Othertestingmeasuresmayalsoberequiredaspersupervisorrecommendation. Audiorecordingoftheassessmentisrecommended.Diagnosticreportsshouldincludeconcisewrittenbackgroundinformation,testingscoresandinterpretation,impressions,planofcare,and,long-andshort-termgoals.Multiplerevisionsofdiagnosticreportsmayberequired.Reportduedateswillbeassignedbythesupervisor.

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PatientFilesEach client has ahanging filewith amanila folder in the designated filing cabinet in theStudentWorkroomintheIMPACTPracticeCenter.ForFall2017anewfilesystemwillbeusedsoeveryclientthatisseeninFall2017shouldhaveanewfilemadeforthemandthatfile will be used going forward until it is full. Report to your supervisor any missingmaterials.Newandongoingclientfilesshouldcontain:

• Afileorganizationchecklist• Acompletedcasehistoryform• Asigneddigitalrecordingreleaseform• Anattendancesheet• Medicalrecordsorotherinformationfromoutsidefacilities• Dateddiagnosticprotocols(BDAE,BNT,CLQTetc)• DiagnosticreportsandmonthlySOAPnotes• Audiotapes(whenapplicable)

AphasiaGroupsandGroupBinder/BoxStudentsarerequiredtoplanandimplementAphasiaCenterGroups.Thesemayinclude,butarenotlimitedto,aDiscussionGroup,aMovieGroup,andWiigroup.Conversationgroupwillmeetasawholetwoweekspermonthandwillbealternatedwithtwosmallergroups(groupsplitintwo)theothertwoweeksofthemonth.Theresponsibilitiesofthestudentcliniciansduringtheconversationgroupincludeassistingclientsinunderstandingtheconversationwithinthegroupbywritingnotesforthemandbyclarifyinginformation.Theyarealsoresponsibleformakingsuretheconversationremainsongoingandthatallmemberswhowishtocontributetotheconversationhaveanopportunitytodoso. Inaddition,studentsshouldusetheirbestjudgmenttoguidetheconversationawayfromoffensiveorpoliticallyincorrecttopicsshouldthesearise.Thegroupboxandbinder(foundintheAphasiaworkroomonthetallmetalbookcase)shouldbetakentoeachgroup.Clientnametags,foundinthegroupbox,shouldbedistributedduringeachgroupandcollectedattheendofthegroup.MinutesforeachgroupwillberecordedintheGroupbinder.Theclient’sspouses/caregivershavechosentohavetheirownsupportgroupsimultaneoustotheAphasiaConversationgroup.ThisgroupisheldindependentlyfromtheAphasiaCenterstudentcliniciansorsupervisors.Therearenostudentresponsibilitiesforthisgroup.MovieGroup(FallandSpringSemesteronly)takesplaceonThursdaymorningsfrom10-11:00am.Thestudentclinicianswillbedividedinpairswhichwilleachbeassignedtoimplementmoviegroupfor3-4consecutiveweeks.Eachpairofstudentswillberotatedthroughthisgroup.PleaserefertotheMovieGroupProtocolfordetailsonplanningandleadingthisgroup.Studentsareresponsibleforpreparingtheclassroomsassignedtothegroupsaheadoftimetoaccommodatetheneedsofthegroupandforreturningtheclassroomchairsandtablestotheformerconfigurationafterthegroup.

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Co-TreatmentsVariousclientsareseenonceweeklyinaco-treatmentwithanotherclientwheresocialskillscanbepracticedandtherapeutictaskscanbeshared.TheseareparticularlyprominentduringtheSummersemester.Eachclientwhoparticipatesinaco-treatmentwillalsobeseenindividuallyonceweeklywithhis/herprimaryclinician.Occasionally,theprimaryclinicianwillnotbepresentintheco-treatmentsession,anditwillbetheresponsibilityoftheclinicianassignedtotheco-treatmenttoimplementtheco-treatmentsession.Itistheprimaryclinician’sresponsibilitytocompletetheclient’smonthlySOAPnote,includinganyimportantdataorfindingsfromtheco-treatments.ObservationatSpauldingRehabilitationHospitalDuringtheFallandSpringsemesters,eachstudent,inasmallgroupof2-3studentclinicians,willbeprovidedanopportunitytoobserveadultSpeechandLanguageassessmentsand/ortreatmentsatSpauldingRehabHospitalforapproximately2-3hourstotalwithSuzannePennington.Studentclinicianswillnotprovidedirectclientcare,butwilltakedataonsessionsandparticipateinadiscussionandthewrittenreportforeachsession.ThepurposeofthisobservationistobeexposedtothecontinuumofcarethatourclientsinTheAphasiaCenterhaveexperiencedandtoreflectuponsimilaritiesanddifferencesinthetwosettings.AphasiaCenterOutingsandPartiesStudentsarerequiredtocollaborateintheplanningandimplementationofagroupoutingthatwillgenerallytakeplaceduringthelastweekofthetreatmentsemester.Allclients,spouses/caregivers,supervisors,andstudentswillbeinvitedtotheoutings.Pleasecontactthesupervisorregardingthegivenbudgetforeachouting/party.Generalguidelinesincludedecidingonalocation6weekspriortotheevent,creatinginvitations5weekspriortotheevent,distributingtheinvitationsandadvertisingtheevent(inpersonandbymail)3&4weekspriortotheevent,collectingRSVPs(andmoneywhenapplicable)1&2weekspriortotheevent.DocumentationofClinicalPracticeAlldraftsofclinicaldocumentationshouldbecomputergenerated,edited,andproofedforgrammar,spelling,andpunctuationpriortosubmission.Studentsshouldmakeeveryefforttocompletedocumentationasifeverydraftwereafinaldraft.MonthlyS.O.A.P.notesarerequiredwheretheclient’sattendance,participation,data,andprogresstowardgoalswillbereported. Revisionofgoalsandestablishmentofnewgoalsshouldbeincludedasappropriate.Duringthesemester,atotalofthreeprogressnoteswillbewritten.SOAPnoteswillbesenttothesupervisorviaemail,usingtheclient’sinitialsonly. Duedatesforthenoteswillbespecifiedinthestudentpracticumcontract. SupervisorsmayrequirerevisionsoftheseSOAPnotesandsupervisorsmayrequestaduedateforrevisedreports.

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Finaldraftsofdocumentationmustcontainnoerrorsandshouldbeprintedout,signedbythestudentclinicianandsupervisor,andplacedineachclient’sfile.Besuretousethefollowingnamingconventionwhensavingandsendingfilestoyoursupervisors:clientfirst/lastinitial,year,semester,typeofdocumentandnumber,clinicianlastnameMD2017FallSOAP1PittmannMD2017FallSOAP2PittmannMD2017FallSOAP3PittmannStudentsshouldmakeeveryefforttocompletedocumentationasifeverydraftwereafinaldraft.OngoingResponsibilities

1. Attendanceshouldbedocumentedforeverysession2. DiagnosticreportsandSOAPnotesshouldbefiledassoonastheyarecompletedand

signedbythesupervisor3. File information shouldbemaintained in theorder listedon the file organization

checklistcontainedinthefile.ClientReassessmentsClientsshouldbereassessedapproximatelyeverysixmonths.ResultsofthereassessmentwillbeincludedinthemonthlySOAPnoteunlessotherwiseindicated.StandardAphasiaTherapyProgramsStudentcliniciansmaylearntoadministerthefollowingaphasiatherapyprogramsthattheylearnedaboutintheiraphasiacourse,dependingonthetreatmentplanoftheirparticularclients: (Thisisnotanexhaustivelist)

• MelodicIntonationTherapy(MIT)• VoluntaryControlofInvoluntaryUtterances(VCIU)• Boardmaker(forCommunicationNotebooks)• TreatmentofAphasiaPerseveration(TAP)• SentenceProductionProgramforAphasia(SPPA)• VerbNetworkStrengtheningTreatment(VNeST)• OralReadingforLanguageinAphasia(ORLA)• TreatmentofWernicke’sAphasia(TWA)• Varioustreatmentsforanomia• ResponseElaborationTreatment(RET)• AnagramCopyandRecallTreatment(ACRT)• MultipleOralRereading• Variousdrawingtherapyprograms• Amerindgesturetraining

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FamilyMeetingsStudentclinicianswillconductclient/family/caregivermeetingswithaminimumofoneclientduringthesemester(i.e.uponcompletingdiagnostictesting,atmidterm,oratendofsemester).Clientsmaychoosetoparticipateinthismeeting.Clientperformanceandprogresswillbediscussed,andfamily/caregiverwillbeeducatedregardingappropriatetasksortechniquesthatcanbeimplementedoutsideofthetherapeuticenvironment.AACDevicesAACdevicesusedbyAphasiaCenterclienteleincludesDynavox,Lingraphica,andvariousapplicationsontheiPadsuchasProloquo2Go,PictelloandSmallTalkAphasia.In-serviceswillbeprovidedasneeded.ThesupervisorisresponsiblefordownloadingnewapplicationsontotheiPad.ResearchOpportunitiesParticipationinvariousresearchprojectsmaybeavailableincoordinationwithIRBapprovedfacultyresearchprojectsand/orIRBapprovedresearchforastudentthesis.InterprofessionalActivitiesTheIMPACTPracticeCenteriscurrentlydevelopingofferingseachsemester.BelowareafewexamplesofinterdisciplinaryactivitiesthatoccurintheImpactPracticeCenter:Fall:

1. S-IHP’sCAPInterdisciplinaryprogram2. WellnessGroup3. CaregiverGroup4. ScreeningGroup

Spring:

1.PhysicalTherapyHealthPromotionsled-Group(asthetherapyscheduleallows).SLPstudentswillalsoberesponsibleforcreatinganin-serviceaboutaphasiaandpresentingittothePTstudentswithintheHealthPromotionsGroup.

RequiredReflectiveWriting(Journaling)ExerciseEachstudentwillberequiredtowritereflectivelyaboutoneclientonaweeklybasis.Thistoolistobeusedasameansforstudentclinicianstorespondtoandworkthroughevokedemotionsthatmaycomeaspartofthisclinicalexperience.Writingentrieswillbesubmittedforsupervisoryreviewaweekbeforemidtermandfinalevaluations. Furtherdetailswillbeprovidedinthesemester’sfirstCDgroup.

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a.Tests

StudentPracticumContractThestudentclinicianswillprovidetheirstudentpracticumcontracttothesupervisorduringthefirstweekofthesemester.Theclinicianisrequiredtocompleteasmuchoftheformashe/sheisable,includingtheContractClinicalGrowthGoals,andwillsigntheform.Thesupervisorwillcompletetheremainderoftheform,signit,andreturnacopytothestudent.Thecontractmaybesubmittedviathee*ValueSystem.SharedResourceBinderStudentcliniciansareencouragedtosharetherapyresourcesthattheyhavecreatedorfound.TheymaybeplacedintheSharedResourceBinderwhichisfoundonthetallmetalbookcaseintheaphasiaworkroom.RoomSchedulePleaserefertotheSLLCMasterScheduleforroomsthathavebeenassignedtotheAphasiaCenterduringthatday/time.EndofSemesterTreatmentPlansforIncomingCliniciansPriortothelastdayofthesemester,studentcliniciansarerequiredtocreateaTreatmentPlanforeachclientandplaceitintheclient’sfolders.Thisshouldincludeanyinformationthatyouwouldhavelikedtoknowabouteachclientpriortomeetinghim/her.Detailsaboutclientgoalsandperformanceaswellasinformalinformationaboutclient’spersonalitiesandneedsshouldbeoutlined.Thetreatmentplanshouldalsohavenotedthedate,time,androomnumberofapreviouslyrecordedtreatmentsessionthatthefuturestudentcliniciancanreviewontheMilestoneviewingsystem. Pleaseprovidecontactinformationsuchasemailorphonenumbersothatthefutureclinicianmaycontactyou,ifneeded.(PleaseseeConfidentialityGuidelinesbelow).Ahardcopyofeachtreatmentplanshouldbeplacedineachclient’sfolderbythelastdayoffinalsweek.Treatmentplansdonotneedtobesubmittedtothesupervisor.Materials

Tests and materials do not leave the building and must be used within the IPC and other designated areas.

TestsarekeptinalphabeticalorderinthedesignatedstoragecabinetintheStudentWorkroom.Testmanualsandformsarekepttogetherinthefiles. Pleasekeepalltestsinalphabeticalorder.

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Eachtestfilecontainsoriginalformswhicharetobeuseforadministeringformalteststoyourclients. Pleasedonotusethefinalforminafile. Notifyasupervisorifwearelowonforms.

• TreatmentMaterials:TreatmentmaterialsandkeptindesignatedfilingsystemsalsofoundintheStudentWorkroom.Materialsincludetherapymanuals,picturecards,lettertilesetc.Signoutofthesematerialsisnotnecessarythoughitisrequiredthatmaterialsbereturnedtotheirplaceeachday.

• Boardmaker:TwocopiesofBoardmakerarekeptintheFacultyObservationRoom.Eachcopyneedstobechecked-outfromasupervisoranddocumentedonthesign-outsheetprovided.Theyalsoneedtobechecked-inandreturnedtothislocation.

• LaptopsandiPads:LaptopsandiPadsarealsostoredintheFacultyObservationRoom.Theycanbechecked-outfromasupervisoranddocumentedonthesign-outsheetprovided.Theyalsoneedtobechecked-inandreturnedtothislocation.

AphasiaCaseDiscussion(CD)GroupsMission/Outcomes:Studentswilldeveloptheirabilitytoapplytheorytoclinicalpracticewhilelearningtothinkcritically,analyzeandsynthesizeinformation,andcollaborateandcommunicateprofessionally.StructureAllAphasiaCenterstudentsparticipatetogetherinfacultymentoredAphasiaCentercasediscussiongroupsapproximatelytwicemonthlyforonehour.(Pleaserefertothissemester’sCDGroupschedule).Whenrequired,studentspresenttheirclinicalcasesfordiscussion.Supervisorswillprovideinstructionontestadministrationandscoring,datacollectionandreporting,clinicaldocumentation,clientcounseling,clinicalexcellenceetc.Timelyarrivalandactiveparticipationarerequiredastheyserveasaformativeassessmentmeasureattheendofeachterm.Communicatewiththesupervisorpriortothegroupmeetingtimeifthediscussiongrouphastobemissedduetoillnessorfamilyemergency.PleaseseeIMPACTPracticeCenterManualandCSDPoliciesandProceduresManualsforadditionalimportantpoliciesandprocedures.