ON CAMPUS SPEECH-LANGUAGE CLINICIAN’S MANUAL 2013-2014

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ON CAMPUS

SPEECH-LANGUAGE CLINICIAN’S MANUAL 2013-2014

Karen Pottash, M.A., CCC-SLP SLP Clinic Administrator

Custom course packets are non-returnable

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TABLE OF CONTENTS

MISSION STATEMENTS College of Health Professions Mission Statement ………………………………………………………. 7 Department Mission Statement……………………………………………………………………………8 Profile of the Department of Audiology, Speech-Language Pathology and Deaf Studies…………….9-10 Conceptual Framework for Professional Education……………………………………………………...11 Essential Disposition for Educators………………………………………………………………………12 SYLLABI Clinical Practicum………………………………………………………………………………………...14 SPPA 487……………………………………………………………………………………………...15-19 SPPA 690……………………………………………………………………………………………...20-26 SPPA 745………………………………………………………………………………………….…..27-32 SPPA 798……………………………………………………………………………………………...33-38 Clinical Requirements for all Syllabi………………………………………………………………….….39 ASHA INFORMATION Standards for Certificate of Clinical Competence…………………………………………………......41-42 SPEECH LANGUAGE CLINIC PRACTICE PROCEDURES Clinic Information……………………………………………………………………………...…….44-45 Clinic Scheduling Form…………………………………………………………………………...….46-47 Clinic Practice Procedures……………………………………………………………………………48-53 Computer Use…………………………………………………………………………………………... 54 Sign Out for Diagnostic Materials………………………………………………………………… 54-55 Folder Sign Out Procedures……………………………………………………………………………...55 Labels for Client Folders………………………………………………………………………………...55 Checklist for Getting Started………………………………………………………………………… 56 End of Semester Checklist……………………………………………………………………………….57 Preparing for Final Conference with Supervisor………………………………………………………...58 Things to Bring to Checkout……………………………………………………………………………..59 Organization of Inactive Client Files…………………………………………………………………….60 Organization of Active Client Folders Checklist………………………………………………………...61 CLINICAL PRACTICUM GRADING POLICY Clinical Practicum Grading Policy………………………………………………………………….. 63-65 Practicum Evaluation Form……………………………………………………………………………...66 Practicum Evaluation Scale…………………………………………………………………………..67-76 Report Writing Evaluation Form………………………………………………………………………...77 Diagnostic Evaluation Form……………………………………………………………………………..78 Supervisor Observation Report 1………………………………………………………………………. 79 Supervisor Observation Report 2………………………………………………………………………..80 Self Evaluation of Session……………………………………………………………………………….81

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DEPARTMENT AND CLINIC ATTENDANCE POLICIES Department Attendance Policy…………………………………………………………………………..83 Clinic Attendance Policy………………………………………………………………………………...84 Patient Lateness Policy…………………………………………………………………………………..85 Speech, Language & Hearing Center Opening/Closing Policy………………………………………….86 CLINICAL PRACTICUM BEHAVIOR CODES Confidentiality Agreement………………………………………………………………………………89 Dress Code………………………………………………………………………………………………90 Student-Client Communication Policy…………………………………………………………………..91 Students with Disabilities Policy………………………………………………………………………...92 Clinical Practicum Behavior Code…………………………………………………………………....93-94 Professional Behavior Policy…………………………………………………………………………95-100 Policy Regarding Continuance or Removal from Field Placements………………………………..101-103 Student Criminal Background Check Policy…………………………………………………………...104 THE SUPERVISORY PROCESS Suggestions for Supervisees on Preparing for Supervision…………………………………………….106 Guidelines for Receiving Feedback……………………………………………………………………107 Evaluation of Supervision Form………………………………………………………………………..108 HIPAA The Basics of HIPAA…………………………………………………………………………………..110 HIPAA Training Acknowledgement…………………………………………………………………...111 Notice of Privacy Practices………………………………………………………………………..112-117 HIPPA TRAINING Towson University HIPAA Training Powerpoint…………………………………………………118-131 Towson University HIPAA Policy………………………………………………………………...132-133 Towson University HIPAA Complaint Procedure………………………………………………...134-136 SAFE WORK PRACTICES IN THE CLINIC Hepatitis B Shots……………………………………………………………………………………….138 Aseptic Caution Procedures……………………………………………………………………….139-140 HBV versus HIV……………………………………………………………………………………….141 HBV Information….………………………………………………………………………………142-143 Hand Washing Techniques……………………………………………………………………………..144 FIRE EMERGENCY POLICY Fire Emergency Policy: Dept of Environmental Health & Safety………..……………………….145-152 CLINICIAN FORMS Permission to be Taped…………………………………………………………………………………154 Client Enrollment Letter………………………………………………………………………………..155

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Enrollment Letter for DD Clients………………………………………………………………………155 Client Summary Form……………………………………………………………………………..156-157 Disposition Sheet……………………………………………………………………………………….158 Clock Hour Report……………………………………………………………………………………...159 Time Sheet…………………………………………………………………………………………160-162 Student Directions for Typhon…………………………………………………………………………163 Typhon Blank Case Log Worksheet……………………………………………………………………164 Typhon Case Log Details Sheet………………………………………………………………………..165 POLICY OF NON-DISCRIMINATION Speech Language & Hearing Center Policy of Non-Discrimination……………………………………167 CLIENT FORMS Request for Services………………………………………………………………………….…………169 Authorization Form……………………………………………………………………………….…….170 Client Attendance Policy………………………………………………………………………….…….171 Cover Sheet Information………………………………………………………………………….…….172 Client Impressions………………………………………………………………………………….…...173 Client Schedule for Treatment…………………………………………………………………….…….174 CASE HISTORY FORMS Child……………………………………………………………………………………………….176-179 Adult……………………………………………………………………………………………….180-181 MR/Developmentally Delayed…...………………………………………………………………..182-189 Aural Rehabilitation (AR)……………………..…………………………………………………..190-191 AR Communication Assessment…………..………………………………………………………192-194 ON-CAMPUS SCREENING INFORMATION Education, Nursing, and OT Screening Instructions…...………………………………………….196-197 Screening Form…………………………………………………………………………………………198 Rainbow Passage……………………………………………………………………………………….199 Hearing Screening Form for Clients………………………..…………………………………………..200 Hearing Screening Pass Criteria………………………………………………………………………..201 Hearing Screening Report……………………………………………………………………………...202 Immittance Screening………………………...……………………………………………………203-204 Immittance Screening Form…………………………………………………………………………….205 Immittance Screening Report…………………………………………………………………………..206 Otoacoustic Emission Screening………………………………………………………………………..207 Audiometry – A Quick Review……...…………………………………………………………….208-214 OFF-CAMPUS PRESCHOOL SCREENING PROGRAM Off Campus Preschool Screening Information…………………………………………………………216 Speech Language/Hearing Screening Results Form……………………………………………………217 Instructions for Administering the Fluharty…………………………………………………………….218 Hearing Screening Form………………………………………………………………………………...219 Hearing Screening Procedures for Preschool Children………………………………………………...220 Pass/Refer Criteria……………………………………………………………………………………...221 Tips for Successful and Valid Screenings……………………………………………………………...222

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ASHA Recommended Guidelines for Screening for Hearing Impairment…………………………….223 Middle Ear Screening Procedures for Preschool Children (pass/refer criteria)………………………...224 DIAGNOSTIC EVALUATION Procedures for Diagnostic Evaluations…………………………………………………………………226 Instructions for Diagnostic Teams……………...………………………………………………….227-228 Diagnostic Evaluation Checklist……......………………………………………………………………229 Appointment Letter………………………………………………………………………………….….230 Billing Procedure Instructions……………………………………………………………………….….231 Client Diagnostic Evaluation……………………………………………………………………………232 Superbill...………………………………………………………………………………………………233 Diagnostic Codes……………………………………………………………………………………….234 Informal Diagnostic Summary………………………………………………………………………….235 Report Form………………………..………………………………………………………………236-238 Sample Letter to Accompany a DX Report…………………………………………………………….239 SESSION PLANS AND TREATMENT PLANS Directions for Filling out Session Plan……………...……………………………………………..241-242 Individualized Treatment Program and Session Plan Information………………………………….….243 Data Sheets………………………………………………………………………………………….….244 Individualized Speech-language Treatment Program………………..……………………………245-246 Session Plan Form……………………………………………………………………………………...247 Abbreviations for Common Terms……………………………………………………………………..248 PROGRESS REPORT WRITING Progress Report Form………..…………………………………………………………………….250-252 Guidelines for Typing…………………………………………………………………………………..253 Procedures and Progress……………………….…………………………………………………...254-256 Client/Parent/Significant Other Letter………………………………………………………………….257 Parent Letter Example…………………………………………………………………………………..258 Adult Letter Example…………………………………………………………………………………...259 ASSESSMENT AND TREATMENT MATERIALS Clinic Materials………………………………………………………………………...………......261-272 REFERRAL INFORMATION Referral Agencies………………………………………………………………….…………..…..273-275

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Mission Statements for the College of Health Professions and the

Department of Audiology, Speech-Language Pathology, and Deaf

Studies

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TOWSON UNIVERSITY COLLEGE OF HEALTH PROFESSIONS

VISION

To be a preeminent leader in the education of health and sport-related professionals for clinical practice, education, management,

and research and in the provision of initiatives that support the integration of health, wellness, and education.

MOTTO

Optimizing Wellness for Life

MISSION

To provide the highest quality of undergraduate and graduate education in a wide range of health care and sport-related professions

that promote and enhance health and human performance. Graduates will exhibit the highest ethical principles and professional

behaviors in the application of knowledge and critical thinking, the proficient use of skills, the effective use of communication, and

the meaningful use of technology within disciplinary and interdisciplinary settings. They will display a commitment to the

development of knowledge, leadership, competence, diversity, and social justice. The College contributes to the wellness of all

students through a wide variety of academic and non-academic activities. Through collaborative research, outreach, and educational

partnerships, the College provides support for the health and human performance needs of on- and off-campus communities.

VALUES

The key values of the College of Health Professions are:

*worth and dignity of all people

*ethical and moral conduct

*excellence

*collaboration

*life-long learning

*promotion of wellness across the lifespan

PUBLIC RELATIONS STATEMENT

Towson University enrolls more bachelors and masters health care and sport related professional students than any other institution

in the State of Maryland and has one of the largest enrollments in the mid-Atlantic region.

PROFILE OF THE COLLEGE

The College of Health Professions’ mission is accomplished by disciplinary and interdisciplinary efforts of the:

• Department of Audiology, Speech-Language Pathology and Deaf Studies

• Department of Health Science

• Department of Kinesiology

• Department of Nursing

• Department of Occupational Therapy and Occupational Science

• Program in Physician Assistant Sciences

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Audiology, Speech-Language Pathology & Deaf Studies Towson University

Mission Statement (Revised 8/2010)

The Department of Audiology, Speech-Language Pathology & Deaf Studies educates and inspires students to value human communication in all of its diversity. The faculty is committed to developing students who use critical thinking, high ethical standards, and state-of-the-art skills to guide them throughout their professional careers. The faculty is also committed to demonstrating these qualities through student involvement in applied research that focuses on understanding or improving all forms of communication, and through community outreach that improves and enhances the lives of individuals with diverse communication abilities.

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PROFILE OF THE DEPARTMENT OF AUDIOLOGY, SPEEECH-LANGUAGE PATHOLOGY AND DEAF STUDIES POST BACCALAREATE PROGRAMS

The Department of Audiology, Speech-Language Pathology and Deaf Studies Department educates students for clinical positions in Speech and Language Pathology and Audiology in a variety of settings including educations systems, acute care, sub-acute, and rehabilitation hospitals, skilled nursing facilities, and private practice. The graduate curriculum is consistent with standards set by the Council on Academic Accreditation of the American Speech, Language, and Hearing Association. Each ASLD graduate is expected to perform successfully in the following eight areas:

1. COMMUNICATION

• Demonstrate effective listening skills and communicative effectively with the patient/client, family members, health professionals, and educators.

• Write articulate, accurate clinical reports and scientific papers using appropriate format (e.g. APA), writing style, and content.

• Present training seminars using current information technology. • Write proposals for research studies.

2. THINKING-CRITICAL, CREATIVE, REFLECTIVE

• Use problem-solving techniques. • Use critical, creative, and flexible thinking to derive integrated and documented conclusions. • Analyze and synthesize information.

3. PROFESSIONAL DEVELOPMENT

• Apply theory and content in one’s major. • Value the relevance of all disciplines in the education, psychological/social, and clinical settings. • Formulate, investigate, and report results of clinical questions. • Read, integrate, and apply research. • Participate in professional organizations and their meetings. • Develop career goals and plan for continuing education. • Develop a professional resume. • Advocate for the profession • Promote literacy skills across the age span.

4. CLINICAL SKILLS

• Plan, implement, and interpret assessment protocols for specific communication disorder sand differences based on scientific rationale.

• Plan, implement, and interpret treatment goals, objectives, and plans. • Maintain clinical records in an organized and confidential manner. • Analyze and modify client’s communication and related behaviors. • Develop behavioral observation skills.

5. INTERPERSONAL SKILLS

• Accept responsibility for one’s own actions. • Display a positive, non-judgmental attitude. • Demonstrate effective team skills. • Display professional behavior and appearance.

• Use self-evaluation for individual development of clinical skills and for professional growth. • Use good organization and time-management skills. • Show flexibility in interaction styles depending on communication partner and/or working setting.

6. TECHNOLOGY

• Use current technology for clinical assessment, treatment, and writing.

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• Use current assistive technology methods in clinical practice. • Use information retrieval systems to seek answers to clinical questions. • Use internet communication systems.

7. DIVERSITY-INTERNATIONAL and DEMOGRAPHIC

• Demonstrate knowledge of concepts in multiculturalism related to SLP and AuD in academic and clinical settings.

• Understand phonological, morphological, syntactic, pragmatic and narrative rules among different cultures. • Interact in a professional manner in clinical and educational settings with all people regardless of race, color,

religion, age, national origin, sex and handicap. 8. ETHICS-PROFESSIONAL PRACTICE

• Use ethical behavior in dealing with clients, their families, and other professionals. • Deliver clinical services within the professional scope of practice.

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Mission: Inspire, educate and prepare facilitators of active learning for diverse and inclusive communities of learners in environments that are technologically advanced

Facilitators of Active Learning:

Media Specialist Speech Pathologist

Instructional Leader

Audiologist

School Psychologist

Teacher

Reading Specialist

Professional, State and Institutional Standards:

Initial Preparation Standards Advanced Preparation Standards

Providing leadership through scholarly endeavors

Developing Collaborative partnerships

Developing professional conscience

Utilizing appropriate technology

Preparing educators for diverse and inclusive classrooms

Reflecting upon and refining best practices

Ensuring academic mastery

Mission: Inspire, educate and prepare facilitators of active learning for diverse and inclusive communities of learners in environments that are technologically advanced

Conceptual Framework for Professional Education Towson University

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AESSENTIAL DISPOSITIONS FOR EDUCATORS

Overview

At Towson University, we recognize the importance of preparing candidates who are worthy to join the education profession. All students enrolled in the Professional Education Unit programs are expected to develop a professional conscience by demonstrating important human characteristics and dispositions necessary to work with diverse and inclusive communities of learners. Following is a list of dispositions, including important diversity proficiencies, which have been identified as core behaviors expected of all graduates of all Unit programs. As candidates progress through coursework and field experiences, they are expected to demonstrate increased understanding and eventual mastery of these dispositions.

• Commitment to Professional Practice The successful candidate: - Respects and models high academic standards and demonstrates proficiency in academic writing

and professional oral presentation. - Demonstrates a repertoire of pedagogical skills that develop all students’ critical and independent

thinking and performance capabilities. - Uses ongoing assessment as an integral part of the instructional process. - Reflects on practice regularly in order to improve student learning. - Makes decisions based on ethical and legal practices, including respect for confidentiality. • Caring for the Success and Well-being of All Students The successful candidate: - Believes that all students can learn and persists in facilitating their success. - Accepts and demonstrates responsibility for improving learning for all students. - Values co-operation with colleagues, students, and families by respecting their views on improving

student achievement. - Models the virtues of an educated person, including the drive to work hard and become flexible. - Demonstrates culturally responsive teaching and celebrates cultural differences. • Collaboration with Colleagues and Stakeholders The successful candidate: - Establishes and contributes to a positive learning climate for all students. - Engages in continual learning and discussion with other professionals. - Recognizes families, colleagues, and supervisors as partners in teaching and learning by creating

opportunities to involve them in instructional decisions. - Seeks expert knowledge in order to improve teaching and learning. - Accepts suggestions and implements changes to improve professional practice.

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SYLLABI FOR

ON-CAMPUS

CLINICAL

PRACTICUM

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GRADUATE CLINICAL PRACTICUM Revised Spring, 2012

SPPA 487 Clinical Practicum-On Campus (3) credits; Supervised undergraduate clinical experience in the university clinic. Prerequisites: Successful completion of Clinical Observation and Techniques Class (SPPA 416), completed communication screening, G.P.A > 3.5 and 25 hours of observation. SPPA 690 Clinical Practicum On Campus (3) credits; Supervised graduate clinical experience in the university clinical facility with children and adults who have communication impairments. Prerequisites: Completed communication screening, SPPA 416 (or equivalent documentation of a minimum of 25 hours observation), Graduate standing and consent of the Department. SPPA 745 Advanced Clinical Practicum On Campus (3) credits; Supervised practicum experience includes the evaluation and treatment of various types of speech, language and/or hearing disorders. Prerequisites: SPPA 690 and consent of the Department. SPPA 746 Advanced Clinical Practicum Off Campus (3) credits; Advanced clinical practice in programs that service adults. Experience includes identification, assessment, and/or treatment of various types of speech, language, and/or hearing disorders in adult facilities affiliated with TU Department of Audiology, Speech-Language Pathology, and Deaf-Studies. Prerequisites: SPPA 745, 75 clock hours in major track SLP/AUD in a University Speech, Language & Hearing Center, 18 credits of graduate coursework exclusive of clinical practicum, SPPA 690, SPPA 745, G.P.A. > 3.0. and consent of the Department. SPPA 747 Advanced Clinical Practicum in Schools (3) credits; Advanced clinical practicum in school programs affiliated with TU for graduate students in speech-language pathology and/or audiology track(s). The experience includes the evaluation and treatment of various types of speech, language and/or hearing disorders. Prerequisites: SPPA 690 and 745, 75 graduate clock hours in major track (SLP/AUD) in a University Speech, Language & Hearing Center, G.P.A. > 3.0, and consent of the Department. SPPA 748 Advanced Pediatric Practicum Off Campus (3) credits; Advanced clinical practicum in pediatric programs affiliated with TU for graduate students in speech-language pathology and/or audiology track(s). The experience includes the evaluation and treatment of various types of speech, language and/or hearing disorders. Prerequisites: SPPA 690 and 745, 75 graduate clock hours in major track (SLP/AUD) in a University Speech, Language & Hearing Center, G.P.A. >3.0 and consent of the Department. SPPA 798 Advanced Clinical Practicum Continuum On Campus (3) credits; Advanced clinical practicum for students in the Speech-Language Pathology and/or Audiology track(s) continuing in on-campus practicum experiences previously taken for credit. Supervised practicum experience includes the evaluation and treatment of various types of speech, language and/or hearing disorders. Prerequisites: SPPA 745 and consent of the Department. SPPA 799 Advanced Clinical Practicum Continuum Off Campus (3) credits; Advanced clinical practicum for students in the Speech-Language Pathology and/or Audiology track(s) continuing in off-campus experiences previously taken for credit. Supervised practicum experience includes the evaluation and treatment of various types of speech, language and/or hearing disorders. Prerequisites: Prior off-campus practicum placement and consent of the Department.

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Towson University Department of Audiology, Speech-Language Pathology, and Deaf Studies

CLINICAL INTERNSHIP SPPA 487 (3 CREDITS)

SPEECH, LANGUAGE & HEARING CENTER INSTITUTE FOR WELL BEING

SUMMER/FALL, 2013 AND SPRING, 2014 INSTRUCTOR: CLINICAL SUPERVISORS OFFICE LOCATION: SPEECH, LANGUAGE & HEARING CENTER OFFICE HOURS: BY APPOINTMENT PHONE NUMBER: 410-704-3095 FAX NUMBER: 410-704-6303 EMAIL: [email protected] CATALOG DESCRIPTION: Clinical practice in therapeutic procedures with various types of speech, language and/or hearing disorders in the Towson University Speech, Language & Hearing Center. PREREQUISITE COURSES: Minimum 3.50 GPA in prerequisite major courses, 25 documented hours of observation, SPPA 416, completed communication screening, or consent of the department. May be taken concurrently with SPPA 417.

COURSE OUTCOMES: The learning outcomes for this course are as follows:

In collaboration with the supervisor, student will be able

1. Collect case history information from confidential folders, client and/or family members. 2. Baseline speech and/or language behaviors using behavioral observation and standardized or non-

standardized testing. 3. Develop intervention plans to target client needs/disorder. 4. Use appropriate materials for intervention. 5. Measure client’s performance. 6. Modify plans as needed. 7. Complete documentation necessary to report on intervention. 8. Communicate effectively with client, family or relevant others. 9. Maintain professional code of behavior and adhere to clinic policies/procedures. 10. Interact appropriately with clients of varying ages and cultural/linguistic backgrounds.

REQUIRED TEXTBOOK(S): Towson University Clinician’s Manual RECOMMENDED TEXTBOOK(S): See Bibliography

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COURSE POLICIES AND PROCEDURES: This section should include, but not be limited to, the following areas:

COURSE REQUIREMENTS: All students enrolled in clinical practicum must have completed a Criminal Background Check and adhere to the Towson University Education Program Professional Behavior Policy and HIPAA guidelines for confidentiality. Students must also abide by the clinical practice procedures as outlined in the Clinician’s Manual.

CLASS ATTENDANCE AND LATENESS: All students must adhere to the Department and Clinic Attendance Policies, Lateness policy and Opening/Closing Policy as outlined in the Clinician’s Manual. Students must attend all clinic classes, treatment/diagnostic sessions and supervisor meetings. For each absence, students must supply verifiable documentation to the instructor. Unexcused absences from class will result in lowering of the clinic grade by one letter grade per 3 unexcused absences. Unexcused absences from clinical assignments will result in a lowered grade (one letter grade for each session missed.) Students should also reference “Program Availability Requirements” of the Department of Audiology, Speech-Language Pathology and Deaf Studies as specified in the Clinician’s Manual.

PARTICIPATION Professional characteristics of student clinicians will be graded. Please see the Practicum Evaluation Scale in the Clinician Manual for descriptions of responsibilities related to professionalism, participation and documentation. INCOMPLETES Incomplete grades are given when verifiable circumstances prevent the student from completing a course within the term. The Towson University Academic Regulations regarding the grade of incomplete can be reviewed in the Towson University Undergraduate Catalog. COURSE REPETITION Students may not repeat a course more than once without prior permission of the Academic Standards Committee. Students who wish to take a class for the third time must complete a “Third Attempt for a Course Petition Form” and submit it to the department chair before registering for, or taking the class. If approved, the department chair will send the form to the Academic Standards Committee for final approval.

TOWSON UNIVERSITY CHEATING AND ACADEMIC DISHONESTY POLICY The Department of Audiology, Speech Language Pathology and Deaf Studies adheres to the Student Academic Integrity Policy approved by the Towson University Senate available on the university web page http://www.towson.edu/studentaffairs/policies/ . Please take time to familiarize yourself with this policy. All students must adhere to the Clinical Practicum Behavior Code as written in the Clinician’s Manual and the ASHA Code of Ethics. OFFICE OF DISABILITY SUPPORT SERVICES (DSS) Students with Disabilities: The department is in compliance with Towson University policies for students with disabilities. Students with disabilities are encouraged to register with Disability Support Services (DSS) Administration Bldg, Rm. 232, (410) 704-2638 (Voice or TTY). Students who suspect that they have a disability but do not have documentation are encouraged to contact DSS for advice on how to obtain an appropriate evaluation. A memo from DSS authorizing your accommodation is needed before any accommodation can be made and any such accommodation will not be retroactive.

http://www.towson.edu/studentaffairs/policies/

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CONCERNS ABOUT THE COURSE AND/OR GRADE APPEALS The Department of Audiology, Speech Language Pathology & Deaf Studies has a policy to address student concerns about the teaching, grading, or other aspects of a class. Students are first expected to bring those concerns to the faculty member teaching the class either via email, or a face to face meeting. After the concerns are brought to the attention of the faculty member, if the situation is not resolved, students can bring their concerns to the Clinic Director. Before this meeting occurs, the faculty member teaching the class will be contacted to make sure that the student has communicated with the class instructor about the issue. If a meeting with the Clinic Director does not resolve the situation, contact the Department Chair for information on what to do next. There are two exceptions to this policy. (1) Students who want to report faculty discrimination on the basis or gender, race, or disability, or (2) students who want to report faculty violations of the code of conduct for faculty student relationships. Students with those two concerns should report directly to the Department Chair.

COURSE GRADING SCALE: UNDERGRADUATE: Please see Clinical Practicum Grading Policy included in the Clinician’s Manual.

Students will be evaluated based on the following scale in accordance with Towson University policy: A: 93.00-100% A-: 90.00-92.99% B+: 87.00-89.99% B: 83.00-86.99% B-: 80.00-82.99% C+: 77.00-79.99% C: 70.00-76.99% D+: 67.00-69.99% D: 60.00-66.99% F: 59.99% and below

GENERAL EXPLANATION OF EVALUATION TECHNIQUES: Practical Examinations A midterm and final grade will be given to assess understanding of and ability to accurately perform clinical skills. Students will be required to self evaluate a session during the semester and complete a written self evaluation at midterm. Weekly conferences with supervisor will include verbal/written feedback on student performance and to facilitate the student’s assessment of their clinical effectiveness. (See grading section of Clinician Manual).

COURSECONTENT:

WEEK 1 LECTURE: CLINIC ORIENTATION/ SPEECH-LANGUAGE-HEARING SCREENING PROCEDURES

WEEK 2 NO CLASS- STUDENTS WILL PARTICIPATE IN SCREENINGS WEEK 3 LECTURE: EVALUATING CURRENT COMMUNICATION SKILLS ACHIEVING A BASELINE OF PERFORMANCE WEEK 4 LECTURE: PLANNING AND WRITING TREATMENT GOALS WEEK 5 LECTURE: USING A MULTISENSORY APPROACH IN TREATMENT WEEK 6 LECTURE: PROGRESS REPORT WRITING

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WEEK 7 LECTURE: ORAL MOTOR ASSESSMENT AND TREATMENT TECHNIQUES WEEK 8 LECTURE: BUILDING SUCCESS INTO YOUR TREATMENT WEEK 9 LECTURE: GETTING THE MOST OUT OF THE SUPERVISORY RELATIONSHIP WEEK 10 LECTURE: THERAPY IDEAS THAT WORK (STUDENT PRESENTATIONS) WEEK 11 LECTURE: THERAPY IDEAS THAT WORK (STUDENT PRESENTATIONS) WEEK 12 LECTURE: BEHAVIOR MANAGEMENT WEEK 13 LECTURE: ADMINISTRATIVE FUNCTIONS OF SPEECH-LANGUAGE PATHOLOGY WEEK 14 LECTURE: CONFERENCING WITH CLIENTS AND FAMILIES WEEK 1 5 LECTURE: END OF SEMESTER PROCEDURES COURSE BIBLIOGRAPHY Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Needham Heights, MA: Allyn &

Bacon.

Blockcolsky, V. D., Frazer, J. M., & Frazer, D. H. (1987). 40,000 selected words: Organized by letter, sound, and

syllable. Tucson, AZ: Communication Skill Builders, Inc.

Green, J. L. (2007). Technology for communication and cognitive treatment: The clinician’s guide. Potomac, MD:

Innovative Speech Therapy.

Guilford, A. M., Graham, S. V., & Scheuerle, J. (2007). The speech-language pathologist: From novice to expert.

Upper saddle river, NJ: Pearson.

Haddon, M. (2003). The curious incident of the dog in the night-time. New York: Random House, Inc.

Hegde, M.N. & Davis, D. (2009). Clinical methods and practicum in speech-language pathology (5th ed.). San

Diego: Singular Publishing Group, Inc.

Luterman, D. M. (2008). Counseling persons with communication disorders and their families (5th ed.). Austin,

TX: Pro-ed.

Moon Meyer, S. (2004). Survival guide for the beginning speech-language clinician (2nd ed.). Gaithersburg, MD:

Aspen Publishers.

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Roth, F. P. & Worthington, C. K. (2010). Treatment resource manual for speech- language pathology (4th ed.).

Albany, NY: Delmar Thomson Learning.

Shipley, K. G. & McAfee, J. G. (2008). Assessment in speech-language pathology: A resource manual (4th ed.).

Clifton Park, NY: Thomson Delmar Learning

Tomblin, J. B., Morris, H. L., & Spriestersbach, D. C. (2002). Diagnosis in speech-language pathology second

edition. San Diego, CA: Singular Thomson Learning.

Paul, R. (2006). Introduction to clinical methods in communication disorders (2nd ed.). Baltimore, MD: Paul H.

Brookes Publishing Co.

Paul, R. (2006). Language disorders from infancy through adolescence: Assessment & intervention (3rd ed.). St.

Louis, Missouri: Mosby, Inc.

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CLINICAL PRACTICUM ON-CAMPUS SPPA 690 (3 CREDITS)


FALL, 2013 INSTRUCTOR: CLINICAL SUPERVISORS OFFICE LOCATION: SPEECH, LANGUAGE & HEARING CENTER OFFICE HOURS: BY APPOINTMENT PHONE NUMBER: 410-704-3095 FAX NUMBER: 410-704-6303 EMAIL: [email protected] CATALOG DESCRIPTION: Supervised clinical experience in the university clinical facility with children and adults who have communication impairments. PREREQUISITE COURSES: Completed communication screening, SPPA 416 (or equivalent documentation of a minimum of 25 hours of observation); graduate standing and/or consent of department.


In collaboration with the supervisor, student will be able to perform all diagnostic and intervention tasks as outlined in the following KASA standards.

ASHA KASA STANDARDS

Standard KASA Requirements/Objectives

Sub-category Learning Activities

Portfolio Evidence

Evaluation Criteria

IV-G The applicant for certification must complete a program of study that includes supervised clinical experiences sufficient in breadth and depth to achieve the following skills:

1. Evaluation a. Conduct screening and

prevention procedures b. Collect case history

information c. Select and administer

appropriate evaluation procedures

*Articulation *Fluency *Voice and Resonance *Receptive and Expressive Language *Hearing *Swallowing *Cognitive aspects of

On-Campus Clinical Practicum *Adult Screenings *Preschool Screenings *Diagnostics Meetings with supervisors

Written Evaluation Reports

Clinical Supervisor Grading at midterm and final

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d. Adapt evaluation procedures to meet client/patient needs

e. Interpret, integrate, and synthesize all information to develop diagnoses and make appropriate recommendations for intervention

f. Complete administrative and reporting functions

g. Refer clients/patients for appropriate services

communication *Social Aspects of Communication *Communication Modalities

IV-G 2. Intervention a. Develop appropriate

intervention plans with measurable and achievable goals. Collaborate with clients/patients in planning process

b. Implement intervention plans

c. Select or develop and use appropriate materials and instrumentation for prevention and intervention

d. Measure and evaluate clients’/patients’ performance and progress

e. Modify intervention plans, strategies, materials, or instrumentation as appropriate to meet the needs of clients/patiens

f. Complete administrative and reporting functions necessary to support intervention’

g. Identify and refer clients/patients for services as appropriate

3. Interaction and

*Articulation *Fluency *Voice and Resonance *Receptive and Expressive Language *Hearing *Swallowing *Cognitive aspects of communication *Social Aspects of Communication *Communication Modalities

On-Campus Clinical Practicum Experience which includes individual and group therapy sessions, clinic class and individual meetings with supervisors

*Written Lesson Plans (SOAP notes) *Treatment plans *Progress Reports

Daily Observation Reports for written feedback of sessions Clinical Supervisor Grading at midterm and final

22

Personal Qualities a. Communicate

effectively, recognizing the needs, values, preferred mode of communication and cultural/linguistic background of the client/patient, family, caregivers and relevant others

b. Collaborate with other professionals in case management

c. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others

d. Adhere to the ASHA Code of Ethics and behave professionally

REQUIRED TEXTBOOK(S): Towson University Clinician’s Manual RECOMMENDED TEXTBOOK(S): See Bibliography COURSE POLICIES AND PROCEDURES:



PARTICIPATION

23

Professional characteristics of student clinicians will be graded. Please see the Practicum Evaluation Scale in the Clinician Manual for descriptions of responsibilities related to professionalism, participation and documentation. INCOMPLETES Incomplete grades are given when verifiable circumstances prevent the student from completing a course within the term. The Towson University Academic Regulations regarding the grade of incomplete can be reviewed in the Towson University Graduate Catalog. COURSE REPETITION Students may not repeat a course more than once without prior permission of the Academic Standards Committee. Students who wish to take a class for the third time must complete a “Third Attempt for a Course Petition Form” and submit it to the department chair before registering for, or taking the class. If approved, the department chair will send the form to the Academic Standards Committee for final approval.


CONCERNS ABOUT THE COURSE AND/OR GRADE APPEALS

The Department of Audiology, Speech Language Pathology & Deaf Studies has a policy to address student concerns about the teaching, grading, or other aspects of a class. Students are first expected to bring those concerns to the faculty member teaching the class either via email, or a face to face meeting. After the concerns are brought to the attention of the faculty member, if the situation is not resolved, students can bring their concerns to the Clinic Director. Before this meeting occurs, the faculty member teaching the class will be contacted to make sure that the student has communicated with the class instructor about the issue. If a meeting with the Clinic Director does not resolve the situation, contact the Department Chair for information on what to do next. There are two exceptions to this policy. (1) Students who want to report faculty discrimination on the basis or gender, race, or disability, or (2) students who want to report faculty violations of the code of conduct for faculty student relationships. Students with those two concerns should report directly to the Department Chair.


24

COURSE GRADING SCALE: GRADUATE: Please see Clinical Practicum Grading Policy included in the Clinician’s Manual. Students will be evaluated based on the following scale in accordance with Towson University policy:

A: 93.00-100% A-: 90.00-92.99% B+: 87.00-89.99% B: 80.00-86.99% C: 70.00-79.99% F: 0-69.99%

GENERAL EXPLANATION OF EVALUATION TECHNIQUES: Practical Examinations A midterm and final grade will be given to assess understanding of and ability to accurately perform clinical skills. Students will be required to self evaluate a session during the semester and complete a written self evaluation at midterm. Weekly conferences with supervisor will include verbal/written feedback on student performance and to facilitate the student’s assessment of their clinical effectiveness. COURSE CONTENT: WEEK 1 LECTURE: CLINIC ORIENTATION/ SPEECH-LANGUAGE-HEARING SCREENING PROCEDURES

WEEK 2 NO CLASS- STUDENTS WILL PARTICIPATE IN SCREENINGS WEEK 3 LECTURE: EVALUATING CURRENT COMMUNICATION SKILLS ACHIEVING A BASELINE OF PERFORMANCE WEEK 4 LECTURE: PLANNING AND WRITING TREATMENT GOALS WEEK 5 LECTURE: USING A MULTISENSORY APPROACH IN TREATMENT WEEK 6 LECTURE: PROGRESS REPORT WRITING WEEK 7 LECTURE: ORAL MOTOR ASSESSMENT AND TREATMENT TECHNIQUES WEEK 8 LECTURE: BUILDING SUCCESS INTO YOUR TREATMENT WEEK 9 LECTURE: GETTING THE MOST OUT OF THE SUPERVISORY RELATIONSHIP WEEK 10 LECTURE: THERAPY IDEAS THAT WORK (STUDENT PRESENTATIONS) WEEK 11 LECTURE: THERAPY IDEAS THAT WORK (STUDENT PRESENTATIONS) WEEK 12 LECTURE: BEHAVIOR MANAGEMENT WEEK 13 LECTURE: ADMINISTRATIVE FUNCTIONS OF SPEECH-LANGUAGE PATHOLOGY WEEK 14 LECTURE: CONFERENCING WITH CLIENTS AND FAMILIES

25

WEEK 15 LECTURE: END OF SEMESTER PROCEDURES COURSE BIBLIOGRAPHY Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Needham Heights, MA: Allyn &

Bacon.











TX: Pro-ed.


Aspen Publishers.









26



27

Towson University

Department of Audiology, Speech-Language Pathology, and Deaf Studies

ADVANCED CLINICAL PRACTICUM ON-CAMPUS

SPPA 745 (3 CREDITS) SPEECH, LANGUAGE & HEARING CENTER

INSTITUTE FOR WELL BEING SPRING, 2014

INSTRUCTOR: CLINICAL SUPERVISORS OFFICE LOCATION: SPEECH, LANGUAGE & HEARING CENTER OFFICE HOURS: BY APPOINTMENT PHONE NUMBER: 410-704-3095 FAX NUMBER: 410-704-6303 EMAIL: [email protected] CATALOG DESCRIPTION: Supervised practicum experience includes the evaluation and treatment of various types of speech and language disorders. PREREQUISITE COURSES: SPPA 690 and/or consent of department.


In collaboration with the supervisor, student will be able to perform all diagnostic and intervention tasks as outlined in the following KASA standards.

ASHA KASA STANDARDS

Standard KASA Requirements/Objectives

Sub-category Learning Activities

Portfolio Evidence

Evaluation Criteria


4. Evaluation h. Conduct screening and

prevention procedures i. Collect case history

information j. Select and administer

*Articulation *Fluency *Voice and Resonance *Receptive and Expressive Language *Hearing *Swallowing *Cognitive

On-Campus Clinical Practicum *Adult Screenings *Preschool Screenings *Diagnostics Meetings with

Written Evaluation Reports

Clinical Supervisor Grading at midterm and final

28


k. Adapt evaluation procedures to meet client/patient needs

l. Interpret, integrate, and synthesize all information to develop diagnoses and make appropriate recommendations for intervention

m. Complete administrative and reporting functions

n. Refer clients/patients for appropriate services

aspects of communication *Social Aspects of Communication *Communication Modalities

supervisors

IV-G 5. Intervention h. Develop appropriate


i. Implement intervention plans

j. Select or develop and use appropriate materials and instrumentation for prevention and intervention

k. Measure and evaluate clients’/patients’ performance and progress

l. Modify intervention plans, strategies, materials, or instrumentation as appropriate to meet the needs of clients/patiens

m. Complete administrative and reporting functions necessary to support intervention’

n. Identify and refer clients/patients for

*Articulation *Fluency *Voice and Resonance *Receptive and Expressive Language *Hearing *Swallowing *Cognitive aspects of communication *Social Aspects of Communication *Communication Modalities

On-Campus Clinical Practicum Experience which includes individual and group therapy sessions, clinic class and individual meetings with supervisors

*Written Lesson Plans (SOAP notes) *Treatment plans *Progress Reports

Daily Observation Reports for written feedback of sessions Clinical Supervisor Grading at midterm and final

29

services as appropriate 6. Interaction and

Personal Qualities e. Communicate

effectively, recognizing the needs, values, preferred mode of communication and cultural/linguistic background of the client/patient, family, caregivers and relevant others

f. Collaborate with other professionals in case management

g. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others

h. Adhere to the ASHA Code of Ethics and behave professionally

REQUIRED TEXTBOOK(S): Towson University Clinician’s Manual RECOMMENDED TEXTBOOK(S): See Bibliography COURSE POLICIES AND PROCEDURES:



30

PARTICIPATION Professional characteristics of student clinicians will be graded. Please see the Practicum Evaluation Scale in the Clinician Manual for descriptions of responsibilities related to professionalism, participation and documentation. INCOMPLETES Incomplete grades are given when verifiable circumstances prevent the student from completing a course within the term. The Towson University Academic Regulations regarding the grade of incomplete can be reviewed in the Towson University Graduate Catalog. COURSE REPETITION Students may not repeat a course more than once without prior permission of the Academic Standards Committee. Students who wish to take a class for the third time must complete a “Third Attempt for a Course Petition Form” and submit it to the department chair before registering for, or taking the class. If approved, the department chair will send the form to the Academic Standards Committee for final approval.






31

A: 93.00-100% A-: 90.00-92.99% B+: 87.00-89.99% B: 80.00-86.99% C: 70.00-79.99% F: 0-69.99%

GENERAL EXPLANATION OF EVALUATION TECHNIQUES: Practical Examinations A midterm and final grade will be given to assess understanding of and ability to accurately perform clinical skills. Students will be required to self evaluate a session during the semester and complete a written self evaluation at midterm. Weekly conferences with supervisor will include verbal/written feedback on student performance and to facilitate the student’s assessment of their clinical effectiveness.

COURSE CONTENT:

WEEK 1 LECTURE: INTRODUCTION TO OFF-CAMPUS CLINICAL PRACTICUM WEEK 2 NO CLASS- STUDENTS WILL PARTICIPATE IN SCREENINGS WEEK 3 LECTURE: SALT PRESENTATION WEEK 4 LECTURE: PROFESSIONAL RESUME WRITING/INTERVIEWING SKILLS WEEK 5 LECTURE: CENTER FOR PROFESSIONAL PRACTICE WEEK 6 LECTURE: SCHOOL BASED SPEECH-LANGUAGE PATHOLOGY WEEK 7 LECTURE: MARYLAND SPEECH-LANGUAGE-HEARING ASSOCIATION WEEK 8 SPRING BREAK WEEK 9 LECTURE: SPEECH-LANGUAGE PATHOLOGY IN A NON-PUBLIC SCHOOL SETTING WEEK 10 LECTURE: SPEECH-LANGUAGE PATHOLOGY IN AN ACUTE CARE/ HOSPITAL SETTING WEEK 11 LECTURE: SPEECH-LANGUAGE PATHOLOGY IN AN OUTPATIENT SETTING WEEK 12 LECTURE: SPEECH-LANGUAGE PATHOLOGY WITH TRAUMATIC BRAIN INJURED

PATIENTS WEEK 13 LECTURE: SPEECH-LANGUAGE PATHOLOGY IN PRIVATE PRACTICE WEEK 14 LECTURE: SPEECH-LANGUAGE PATHOLOGY IN A SUB-ACUTE, REHAB AND LONG TERM SETTING WEEK 15 LECTURE: REVIEW COURSE BIBLIOGRAPHY

32

Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Needham Heights, MA: Allyn &

Bacon.











TX: Pro-ed.


Aspen Publishers.











33


CLINICAL INTERNSHIP SPPA 798 (3 CREDITS)


SUMMER, 2014 INSTRUCTOR: CLINICAL SUPERVISORS OFFICE LOCATION: SPEECH, LANGUAGE & HEARING CENTER OFFICE HOURS: BY APPOINTMENT PHONE NUMBER: 410-704-3095 FAX NUMBER: 410-704-6303 EMAIL: [email protected] CATALOG DESCRIPTION: Clinical practice in therapeutic procedures with various types of speech, language and/or hearing disorders in the Towson University Speech, Language & Hearing Center. PREREQUISITE COURSES: Minimum 3.50 GPA in prerequisite major courses, 25 documented hours of observation, SPPA 416, completed communication screening, or consent of the department. May be taken concurrently with SPPA 417.


In collaboration with the supervisor, student will be able

1. Collect case history information from confidential folders, client and/or family members. 2. Baseline speech and/or language behaviors using behavioral observation and standardized or non-

standardized testing. 3. Develop intervention plans to target client needs/disorder. 4. Use appropriate materials for intervention. 5. Measure client’s performance. 6. Modify plans as needed. 7. Complete documentation necessary to report on intervention. 8. Communicate effectively with client, family or relevant others. 9. Maintain professional code of behavior and adhere to clinic policies/procedures. 10. Interact appropriately with clients of varying ages and cultural/linguistic backgrounds.

34

ASHA KASA STANDARDS

Standard KASA

Requirements/Objectives

Sub-category Learning

Activities

Portfolio

Evidence

Evaluation

Criteria


1. Evaluation a. Conduct screening and

prevention procedures b. Collect case history

information c. Select and administer


d. Adapt evaluation procedures to meet client/patient needs

e. Interpret, integrate, and synthesize all information to develop diagnoses and make appropriate recommendations for intervention

f. Complete administrative and reporting functions

g. Refer clients/patients for appropriate services

*Articulation

*Fluency

*Voice and

Resonance

*Receptive and

Expressive

Language

*Hearing

*Swallowing

*Cognitive

aspects of

communication

*Social Aspects

of

Communication

*Communicatio

n Modalities

On-Campus

Clinical

Practicum

*Adult

Screenings

*Preschool

Screenings

*Diagnostics

Meetings

with

supervisors

Written

Evaluation

Reports

Clinical

Supervisor

Grading at

midterm

and final

IV-G 2. Intervention a. Develop appropriate


b. Implement intervention plans

c. Select or develop and use appropriate materials and instrumentation for prevention and intervention

d. Measure and evaluate

*Articulation

*Fluency

*Voice and

Resonance

*Receptive and

Expressive

Language

*Hearing

*Swallowing

*Cognitive

aspects of

communication

*Social Aspects

On-Campus

Clinical

Practicum

Experience

which

includes

individual

and group

therapy

sessions,

clinic class

and

individual

*Written

Lesson

Plans

(SOAP

notes)

*Treatmen

t plans

*Progress

Reports

Daily

Observation

Reports for

written

feedback of

sessions

Clinical

Supervisor

Grading at

midterm

and final

35

clients’/patients’ performance and progress

e. Modify intervention plans, strategies, materials, or instrumentation as appropriate to meet the needs of clients/patiens

f. Complete administrative and reporting functions necessary to support intervention’

g. Identify and refer clients/patients for services as appropriate

3. Interaction and Personal Qualities

a. Communicate effectively, recognizing the needs, values, preferred mode of communication and cultural/linguistic background of the client/patient, family, caregivers and relevant others

b. Collaborate with other professionals in case management

c. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others

d. Adhere to the ASHA Code of Ethics and behave professionally

of

Communication

*Communicatio

n Modalities

meetings with

supervisors

REQUIRED TEXTBOOK(S): Towson University Clinician’s Manual

36

RECOMMENDED TEXTBOOK(S): See Bibliography COURSE POLICIES AND PROCEDURES:



PARTICIPATION Professional characteristics of student clinicians will be graded. Please see the Practicum Evaluation Scale in the Clinician Manual for descriptions of responsibilities related to professionalism, participation and documentation. INCOMPLETES Incomplete grades are given when verifiable circumstances prevent the student from completing a course within the term. The Towson University Academic Regulations regarding the grade of incomplete can be reviewed in the Towson University Graduate Catalog. COURSE REPETITION Students may not repeat a course more than once without prior permission of the Academic Standards Committee. Students who wish to take a class for the third time must complete a “Third Attempt for a Course Petition Form” and submit it to the department chair before registering for, or taking the class. If approved, the department chair will send the form to the Academic Standards Committee for final approval.

TOWSON UNIVERSITY CHEATING AND ACADEMIC DISHONESTY POLICY The Department of Audiology, Speech Language Pathology and Deaf Studies adheres to the Student Academic Integrity Policy approved by the Towson University Senate available on the university web page http://www.towson.edu/studentaffairs/policies/ . Please take time to familiarize yourself with this policy. All students must adhere to the Clinical Practicum Behavior Code as written in the Clinician’s Manual and the ASHA Code of Ethics. OFFICE OF DISABILITY SUPPORT SERVICES (DSS) Students with Disabilities: The department is in compliance with Towson University policies for students with disabilities. Students with disabilities are encouraged to register with Disability Support Services


37

(DSS) Administration Bldg, Rm. 232, (410) 704-2638 (Voice or TTY). Students who suspect that they have a disability but do not have documentation are encouraged to contact DSS for advice on how to obtain an appropriate evaluation. A memo from DSS authorizing your accommodation is needed before any accommodation can be made and any such accommodation will not be retroactive.




A: 93.00-100% A-: 90.00-92.99% B+: 87.00-89.99% B: 80.00-86.99% C: 70.00-79.99% F: 0-69.99%

GENERAL EXPLANATION OF EVALUATION TECHNIQUES: Practical Examinations A midterm and final grade will be given to assess understanding of and ability to accurately perform clinical skills. Students will be required to self evaluate a session during the semester and complete a written self evaluation at midterm. Weekly conferences with supervisor will include verbal/written feedback on student performance and to facilitate the student’s assessment of their clinical effectiveness.

COURSE BIBLIOGRAPHY Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Needham Heights, MA: Allyn &

Bacon.

38











TX: Pro-ed.


Aspen Publishers.











39

CLINICAL REQUIREMENTS

FOR ALL ON- CAMPUS CLINICAL PRACTICUM SYLLABI (SPPA 487, 690, 745, AND 798)

1. It is the policy of the Speech, Language & Hearing Center that students will: A. Be assigned to clinic based upon the:

1) needs of the student, client, and clinic 2) experience of student 3) student, client, and supervisor schedules 4) availability of facilities, and 5) practicum clock hour requirements

B. Meet client(s) and/or supervisor(s) as scheduled C. Attend scheduled clinic meetings and weekly clinic class. D. Follow procedures and policies as specified in the Clinician's Manual (See Clinical Practice Procedures) E. Abide by the Code of Ethics of the American Speech-Language-Hearing Association (See Code of Ethics) F. Comply with the Confidentiality Policy of the Department of Audiology, Speech-Language Pathology and Deaf Studies. (See Confidentiality Agreement) G. Comply with the attendance policy (See Department and Clinic Attendance Policies) H. Be observed and evaluated by supervisors for a minimum of 25% of all treatment sessions and 50% of each evaluation session (See Clinical Practicum Grading Policy) I. Comply with deadlines and policies as established by the supervisor(s) and/or Clinic Director J. Dress and act in a professional manner (See Dress Code) K. Maintain academic integrity (See Clinical Practicum Behavior Code)

2. All student clinicians are responsible for all information and deadlines in the Clinicians' Manual and on the

Clinic Schedule. E ach semester, all students should receive a cl inic packet with important clinic information and with forms to be filled out and returned by stated date.

3. Failure to comply with clinic policies stated in the manual, on the clinic schedule, or by clinic supervisors

and clinic director will result in disciplinary actions and/or a lowering of the clinical practicum grade. 4. To attract and maintain a varied clinical population to meet student training needs, students must be

available to staff the on-campus clinic when these clients are in need of service. 5. Graduate students are required to do two semesters of on-campus clinical practicum prior to going off-

campus. 6. Undergraduates are offered one elective semester of on-campus clinical practice if they meet the criteria.

40

ASHA

INFORMATION

41

Standards for Certificate of Clinical Competence Revised March 2009

(adapted from www.asha.org/certification/slp_standards/)

Standards for entry-level practice include the following requirements: Standard I - Degree Effective January 1, 2005, the applicant for certification must have a master's or doctoral or other recognized post-baccalaureate degree. A minimum of 75 semester credit hours must be completed in a course of study addressing the knowledge and skills pertinent to the field of speech-language pathology.

Standard II: Institution of Higher Education The graduate degree must be granted by a regionally accredited institution of higher education.

Standard III: Program of Study - Knowledge Outcomes The applicant for certification must complete a program of study (a minimum of 75 semester credit hours overall, including at least 36 at the graduate level) that includes academic course work sufficient in depth and breadth to achieve the specified knowledge outcomes.

Standard III-A: The applicant must have prerequisite knowledge of the biological sciences, physical sciences, mathematics, and the social/behavioral sciences.

Standard III-B: The applicant must demonstrate knowledge of basic human communication and swallowing processes, including their biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases.

Standard III-C: The applicant must demonstrate knowledge of the nature of speech, language, hearing, and communication disorders and differences and swallowing disorders, including the etiologies, characteristics, anatomical/physiological, acoustic, psychological, developmental, and linguistic and cultural correlates. Specific knowledge must be demonstrated in the following areas:

Articulation Fluency voice and resonance, including respiration and phonation receptive and expressive language hearing, including the impact on speech and language swallowing cognitive aspects of communication social aspects of communication communication modalities

Standard III-D: The applicant must possess knowledge of the principles and methods of prevention, assessment, and intervention for people with communication and swallowing disorders, including consideration of anatomical/physiological, psychological, developmental, and linguistic and cultural correlates of the disorders.

Standard III-E: The applicant must demonstrate knowledge of standards of ethical conduct.

Standard III-F: The applicant must demonstrate knowledge of processes used in research and the integration of research principles into evidence-based clinical practice.

Standard III-G: The applicant must demonstrate knowledge of contemporary professional issues.

42

Standard III-H: The applicant must demonstrate knowledge about certification, specialty recognition, licensure, and other relevant professional credentials.

Standard IV: Program of Study-Skills Outcomes Standard IV-A: The applicant must complete a curriculum of academic and clinical education that follows an appropriate sequence of learning sufficient to achieve the skills outcomes in Standard IV-G.

Standard IV-B: The applicant must possess skill in oral and written or other forms of communication sufficient for entry into professional practice.

Standard IV-C: The applicant for certification in speech-language pathology must complete a minimum for 400 clock hours of supervised clinical experience in the practice of speech-language pathology. Twenty-five hours must be spent in clinical observation, and 375 hours must be spent in direct client/patient contact.

Standard IV-D: At least 325 of the 400 clock hours must be completed while the applicant is engaged in graduate study in a program accredited in speech-language pathology by the Council on Academic Accreditation in Audiology and Speech-Language Pathology.

Standard IV-E: Supervision must be provided by individuals who hold the Certificate of Clinical Competence in the appropriate area of practice. The amount of supervision must be appropriate to the student's level of knowledge, experience, and competence. Supervision must be sufficient to ensure the welfare of the client/patient.

Standard IV-F: Supervised practicum must include experience with client/patient populations across the life span and from culturally/linguistically diverse backgrounds. Practicum must include experience with client/patient populations with various types and severities of communication and/or related disorders, differences, and disabilities.

Standard V: Assessment The applicant for certification must demonstrate successful achievement of the knowledge and skills delineated in Standard III and Standard IV by means of both formative and summative assessment.

Standard VI: Speech-Language Pathology Clinical Fellowship

After completion of academic course work and practicum (Standard IV), the applicant then must successfully complete a Speech-Language Pathology Clinical Fellowship (SLPCF).

Standard VII: Maintenance of Certification Demonstration of continued professional development is mandated for maintenance of the Certificate of Clinical Competence in Speech-Language Pathology. The renewal period will be three years. This standard will apply to all certificate holders, regardless of the date of initial certification.

For complete standards and implementation, go to www.asha.org/certification/slp_standards/.

43

SPEECH-LANGUAGE

CLINIC PRACTICE

PROCEDURES

44

CLINIC INFORMATION

Prior to Fall and Spring Semesters, graduate students and those undergraduate students with special permits for Clinical Practicum will receive a Clinic Packet containing information and forms to be filled out and returned to the clinic by the stated date. Students desiring placement in the Speech-Language On-Campus Clinic must attend the organizational meeting, which takes place prior to the beginning of classes. (See clinic schedule) Schedules will be distributed at that time according to the submitted information. All students in Clinical Practicum should have completed 25 hour s of observation prior to beginning their practicum. All students new to TU must have submitted the documentation of these observation hours to the Graduate Program Director. Undergraduate students need a minimum of 3.5 GPA and graduate students need a minimum of 3.0 GPA to participate in clinical practicum. All students in Clinical Practicum must have completed a Criminal Background Check (CBC). P rior to clinical practicum, students will be sent instructions for completing a CBC. All students new to the TU clinic must complete a Communication Screening. New graduate students must take the screening during their first semester in the graduate program. The screenings are usually completed during the second week of the semester. T he screening dates are posted and the sign-up sheet will be in the Speech, Language & Hearing Center. All on-campus student clinicians should participate, as screeners, in the speech and hearing screening of the Education, Occupational Therapy, and Nursing students. Every student must sign up for speech and/or hearing screening as well as hall monitoring. The screening will be held during the second week of each semester. Clinic materials are shared by all students and supervisors. If you cannot find what you need, ask the graduate assistant. It is imperative that we keep the materials in good order. Assessment materials, laptops, and software will need to be reserved and checked out properly, and returned promptly. Use the binder to sign out assessment materials and laptops. Please come to the clinic prepared with pens, paper, glue etc. Paper clips, tape and stapler are available in the materials room. Tape recorders, stop watches, laptops, I-Pads and portable video cameras can be checked out of the clinic office. Each semester we ask the on-campus Speech-Language student clinicians for their preference of types of disorders and we use this information in our scheduling of clients, clinicians, and supervisors. However, we are not always able to give you e xactly what you want. T here are many variables that must be considered in scheduling diagnostics and treatment. I n some cases, a s tudent may need more experience with a specific communicative disorder. Also, clinic needs must be met to insure the continued availability of varied clinic populations to satisfy student training needs. In speech-language clinical practicum at TU, the number of clients scheduled per student clinician depends on the student's experience level and the needs of the clinic to maintain a varied caseload. Student clinicians must use word processing for their reports and session plans. The Computer Lab, in the Institute for Well Being, is available for you to complete paperwork. You will need to supply your own paper for printing.

45

Each student is required to volunteer in the clinic for 3 hours per semester. The Graduate Assistant will have a sign-up sheet posted soon after the semester starts. Volunteers are also needed just prior to the opening of clinic and just after the closing of clinic each semester as well as during the course of the semester.

46

TOWSON UNIVERSITY SPEECH-LANGUAGE-HEARING CLINIC CLINIC SCHEDULING FORM

SEMESTER________________

ALL STUDENTS WANTING TO ENROLL FOR ON-CAMPUS SPEECH-LANGUAGE CLINIC MUST RETURN THIS COMPLETED FORM TO THE CLINIC.

Level ______ For Office Use Only

Name: ___________Undergraduate Graduate ______

ADDRESS: _______

PHONE: (h) (w) E-MAIL: _______

EXPECTED DATE OF GRADUATION: SIGN LANGUAGE LEVEL:

1. Total number of Undergraduate Clock Hours (not including observation hours):

Speech-Language Hours: Audiology Hours:__________ Documentation Submitted: yes_____no_____

2. Total number of Graduate Clock Hours (not including observation hours):

Speech-Language Hours:________ Audiology Hours:________ Documentation Submitted: yes_____no_____

3. Have you completed your 25 hours of observation? yes_____no_____

Documentation Submitted: yes_____no______

4. Please list below any relevant volunteer or work experience outside of courses or clock hour experiences. Indicate place and time of experience. You may continue on the back if necessary.

47

Name:________________________________

1. Indicate the times of your academic courses on the schedule form below if you already know when your classes are scheduled. F or graduate students who do not have a class schedule yet, Dr. Fallon will give it to the clinic for you.

2. Indicate other weekly commitments beneath the schedule form*. Note: you are expected to schedule all other commitments around your clinic assignments.

3. If changes are made in your schedule after you turn in this form, you M UST notify the clinic as soon as possible.

Monday

Tuesday

Wednesday

Thursday

Friday

8:30-9:30

9:30-10:30

10:30-11:30

11:30-12:30

1- 2

2- 3

3- 4

4--5

5-6

*Other Weekly Commitments (Days/Times) –

CLOCK HOURS INFORMATION

TREATMENT HOURS COMPLETED DIAGN0STIC HOURS COMPLETED

I. CHILD SPEECH

II. CHILD LANGUAGE III. ADULT SPEECH IV. ADULT LANG V. AURAL REHABILITATION Please check your preferences for type of assignment(s) on campus.

LANGUAGE

ARTICULATION

FLUENCY

VOICE

AURAL REHAB.

DEVELOPMENTALLY DISABLED

DIAGNOSTIC

CHILD

ADULT

48

CLINICAL PRACTICE PROCEDURES Case Assignments:

1. Clients are assigned by the Clinic Director. The bulk of the clients will be assigned in the beginning of the semester. However, new clients may be assigned throughout the semester.

2. The number of cases an d types of clinical disorders assigned to a st udent are

determined by the student's level of training, past treatment experiences, and needs for additional or new clinical experiences, plus the availability of clients and needs of the clinic. (See Clinic Policy)

3. In filling out your clinic schedule for speech-language client, leave the schedule

form blank as this is for office use only. Work and personal obligations should be scheduled around class and clinic assignments. This will make it possible for us to give all students the opportunity to earn clock hours in the specific required areas for certification and to satisfy client requests.

4. Most of the treatment sessions have been prescheduled by the staff. T his was

designed to fit in with supervisor's, student's, and client's schedules as well as with room and client parking availability.

5. Student clinicians will be given their clinic assignment at the organizational

meeting or the first clinic class-meeting of the semester. S tudents are to check their mailboxes and emails on a daily basis for possible changes.

6. The student clinician is to contact each client or parent immediately to inform

them of the times for treatment. If there are any changes or conflicts in scheduling, the student must check with his/her supervisor and the Clinic Director before making changes of day or time.

a. If the client does not wish to return for treatment, find out if he/she desires

to be placed on the waiting list for future semesters.

b. If the client desires treatment, inform him/her of days, times, the first day to report, the days the clinic will be closed, and the last day of clinic. Mail an Enrollment Letter immediately after the client has confirmed the schedule.

Room Assignment:

1. You will be assigned a room in the Institute for Well Being for your clients. If there are any problems, see the Clinic Director immediately.

2. Changing Schedule:

49

Once a client has been scheduled, changes in this schedule can only be made with your supervisor's and Clinic Director’s consent. Clinicians are not to arbitrarily make client, room, day, or time changes. Students will be notified when changes in clients or schedules are made.

Client Folders:

1. Prior to meeting with your supervisor, read the client’s confidential file which is in the Speech, Language & Hearing Center Office. The clinic secretary or graduate assistant will help you locate your file.

a. Fill out a Client Summary Form for each client based on the information in their

file and take it with you when discussing that client with your supervisor. This form will be sent to you electronically at the beginning of the semester. A copy is also located in the clinic manual.

b. Client folders (treatment and diagnostic folders) must be signed out according to

folder sign-out procedures. (See Sign-out Procedures)

c. Folders are never to be removed from the clinic areas of the IWB. Files may be taken to the supervisor's office or to student work areas within the IWB. Removal of folders is a violation of clinic policy (See Confidentiality Agreement). Folders will be checked periodically throughout the day and at the close of clinic to determine if folders are being correctly filed and students are adhering to the clinic policies.

d. Folders should be returned immediately when finished. Be sure to remove the

“out card” and scratch off name.

e. No information should be removed from the folders. A ll raw and typed data must be kept in the folder at all times.

f. Remember, all client information is confidential. Y ou must read and sign the

Confidentiality Agreement Form.

g. Do not discuss clients in the waiting room, hall, etc, or outside of the clinic.

h. Replace client folders in the appropriate place on the shelf. Make sure folder is filed according to last name.

Cancellations:

1. If your client cannot attend a particular session, he/she is to call the clinic office at (410) 704-3095 and notify the clinic secretary.

a. All cancellations by clients will sent to you by e-mail or by phone if it is a

last minute cancellation. C heck your e-mail/voicemail before each session.

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b. Each client (or parent) should be given a card with the following information:

Your Name Clinic Phone Days and Times of Treatment Your Home Phone (if you desire) Supervisor's Name

2. The student clinician is a professional in training whose responsibility it is to attend scheduled

treatment sessions. If you must cancel a session, it must be for a valid reason. (See attendance policy). Please follow these procedures if you have to cancel a session:

a. Notify your supervisor of the cancellation. Call your supervisor or leave a written note if

you know of the cancellation in advance. b. Call your client and cancel the session. The secretary will not be able to call for you. Be

sure to give your clients ample notice and call them before they leave home. Keep your client's phone number with you in case of emergency.

c. Plan a make-up time with supervisor's approval. Make sure a room is available.

d. You must give your supervisor written, verifiable documentation for absences.

3. Student clinicians must record client attendance information and the time the student is observed

on the designated Time Sheet. This should be done after each session. Attendance information will be used to verify clinician’s clock hours. This form will be checked and signed by your supervisor at the end of the semester.

4. Client attendance must also be documented on Superbills. These will be supplied to you at the

beginning of the semester and will be used for billing purposes. S tudents should complete Superbills after each treatment or diagnostic session and should be submitted to the clinic secretaries in the appropriate bin.

Supervision:

1. You will be assigned a supervisor for each client or group. T he same supervisor sometimes supervises more than one of your clients. However, you often have more than one supervisor.

2. You and your supervisor should meet on a weekly basis to discuss your treatment. Additional meetings can be requested by the clinician or the supervisor as needed.

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3. Each client receiving diagnostic or treatment services will be observed by the supervisor. The clinic supervisors will meet the ASHA Education and Council on Academic Accreditation (CAA) standards of at least 25% direct observation of treatment sessions conducted by a student clinician and at least 50% direct observation of each diagnostic session. T he Department of Audiology, Speech-Language Pathology and Deaf Studies requires supervisors to achieve 50% observation for overall treatment and 100% observation for each diagnostic. a. The supervisor will write up an observation report for all visits.

b. One copy of the report will go to each of the following:

(1) The Clinician (2) The Supervisor (3) The Clinician's academic file at the end of the semester.

c. Feel free to question your supervisors about their comments.

4. Student clinicians must obtain approval from their supervisors before they implement or

communicate to their clients major decisions regarding evaluation and treatment. M ajor decisions include such activities as feedback regarding diagnostic conclusions, referrals for additional information, recommendations for the use and purchase of a prosthetic device (e.g. hearing aid), termination of treatment, etc.

Mailboxes:

A mailbox is provided in the materials room for each on-campus student clinician and each supervisor.

1. Supervisors will use these mailboxes for many types of communication.

2. It is your responsibility to check your mailbox many times a day during the first couple of weeks and daily thereafter.

3. Supervisors have mailboxes in the clinic office and/or in the department office. Check with your

supervisors to find out how they want different correspondence handled (e.g. client cancellations, session plans, etc.

Session Plans:

1. Session plan templates should be sent to you in an e-mail from the GA.

2. You must write a plan for each clinic session unless otherwise informed by your supervisor.

3. Prior to treatment, a copy of the session plan should be given to the supervisor.

4. After the session, put a copy in the supervisor's mailbox with the S.O.A.P. evaluation section filled out.

5. Save all session plans. You will need a complete set for your client's file at the end of the

semester. Clock Hours:

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1. Clock hours are obtained only for direct client contact. If two students are working in a

therapeutic team, hours will only be obtained if they have direct client contact and if they are performing separate and distinct therapeutic functions.

2. It is your responsibility to keep track of the amount of time spent in treatment with each client.

You may get clock hours in several different categories (language, articulation, etc.) for one client, if you are doing these types of treatment.

3. At the end of the semester you will submit a summary of your clock hours on the clinic form to

your supervisor(s) for approval and signature.

4. At the end of each semester, all on-campus clock hours (treatment, diagnostic, and screening) must be turned in to the graduate assistant. At the beginning of each semester, graduate students are given a printout of their accumulated clock hours. Students must check all of the figures and return the printout (with corrections) to the graduate assistant within two weeks. It is extremely important that students make sure that figures are correct. G raduation and/or ASHA Certification could be delayed if there are errors on this form.

Materials and Equipment:

Most materials are available in the clinic workroom or office and MUST BE CHECKED OUT ACCORDING TO CLINIC RULES. Please return all materials to appropriate places immediately after they are used. Make sure all parts of the test or materials are together. If anything is missing, notify the Clinic Director or Graduate Assistant immediately. P lease keep materials straight and in good condition. This material is purchased for your use. It is your responsibility to see that it is available for the use of all clinicians. When using decks of cards, take the entire deck instead of just the pictures you need. Put all cards back in the right place. Please come to the clinic prepared with pens, paper, etc. Paper clips, stapler, and tape are available in the materials room.

End of the Semester:

At the end of the semester, you are to hand in all items listed on the End-of-Semester Checklist. The graduate assistant will inform you of the times he/she will be available to collect this material. All end-of-semester materials must be handed in on specified dates unless written permission has been obtained from supervisor(s) and reported to clinic director.

Check the Clinic Schedule for dates of meetings, deadlines, etc. You are responsible for all deadlines. The Clinic Schedule is sent to all graduate students and those undergraduates with special permits for clinical practicum. T he forms included with the schedule are to be filled out by student clinicians desiring Speech-Language clients. If you do not receive this information one month prior to the first day of classes, call the Clinic Office at 410-704-3095.

Written Materials:

It is the responsibility of the student to ensure that the supervisor receives all written documents as scheduled.

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Liability Insurance Blanket Policy:

In the performance of your services as student clinicians, there is always the possibility that you may be held responsible for some alleged malpractice, error or mistake in the rendering or failure to render professional services. Whether valid or not, a claim for a professional act or omission could mean, at the least, an expensive court action. Further, if an award is rendered against you, you could be faced with paying an expensive, even staggering, judgment.

Since 1982, Towson University Speech, Language & Hearing Center has required all student clinicians to carry malpractice insurance. As a result, the University takes out a blanket student liability policy each year. This policy has a one million/three million dollar limit, paying up to one million for each claim and up to a total of three million in any one year. Under this program, students are covered for malpractice related to their normal curriculum, studies and assignments.

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COMPUTER USE Students must use word processing for their reports. Students may use the computers in the computer lab. Laptop computers and software are available in the Speech, Language & Hearing Center for therapeutic use only. These may be signed out from the main office and can only be used in the clinic.

IMPORTANT DOCUMENT E-MAIL Each SLP student clinician in the on-campus clinic will receive an e-mail which contains the following forms: End of Semester Checklist Evaluation of Supervisor Individual Treatment Plan Time Sheet Treatment Evaluation Enrollment Letter Session Plan Client Summary Instructions for Disk Letterhead Stationery Client Schedule Student Information Form Procedures and Progress Student will fill out the above forms on the computer and hand them in to appropriate recipient or place in appropriate folder according to clinic protocol and schedule.

SIGN OUT FOR DIAGNOSTIC MATERIALS

Daily Sign Out of Tests

Follow the procedures listed below for reserving and removing tests.

1. Check the binder on the door of the clinic office. There is a tab for each month, and a sign-up sheet for each day in the month.

2. Sign your name, materials needed, and time desired on the sheet. All materials will be available on a first come, first served basis, so sign up as soon you know you need a test or an audiometer.

3. On the day desired, you may take the test at the time you have signed up for. 4. Return the materials to their appropriate location in the materials room.

IF YOU PLAN ON TAKING A TEST OUT OVERNIGHT FOLLOW THE INSTRUCTIONS BELOW. Overnight Sign Out of Tests/Books To remove a test or book from the clinic overnight, follow the same instructions for signing out tests during clinic hours. Tests can only be taken out after 4:30 p.m. for one night and must be returned by 8:30 a.m. the following morning. Missing materials Please let the graduate assistant know when a test is running low on forms. This way, new materials can be ordered in time for the next diagnostic. Thank you!

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Please make sure you return all tests, materials, and books to the proper place and that all parts of tests and materials are included and in the correct order.

FOLDER SIGNOUT PROCEDURES

1. Get an “OUT” Card from the top of the file cabinet. You must sign out the folder by including ALL of the following information on the “OUT” Card:

A. Client’s name B. Your name C. Date

2. Put the “OUT” Card in the exact place from which you removed the folder so that others looking for the

folder will know where to find it. 3. Folders removed must be returned to the appropriate place (i.e., be sure folder is in correct alphabetical

order according to last name). ** “OUT” Card must be removed and placed on top of filing cabinet.

4. Please follow the procedures described above exactly so that folders can be easily located when needed and so that no folders will be misplaced.

5. Clinic files/folders (treatment or diagnostic) cannot be taken home or removed from the clinic for any reason. Clinic files may only be taken to clinical and office areas within the IWB. Folders checks will be done routinely to assure that policies are being followed by the student clinicians. Disciplinary action will be taken if students do not follow the procedures and policies of the clinic (see Confidentiality Agreement).

LABELS FOR CLIENT FILES

The law requires retention of client records for a period of 6 years. The typed label on a client file will contain the name, date of birth, disability or difference and child or adult status if applicable. Put Ad for Adult or Ch for Child typed on the label. Use blue labels for inactive and diagnostic folders and white labels for active folders. SAMPLE LABELS Speech DX(Blue label) Speech TX(White label) SMITH, JOSEPH 01-01-02 ART Ch SMITH, JOSEPH 01-01-02 ART Ch SMITH, JOSEPH 01-01-30 ART Ad SMITH, JOSEPH 01-01-30 ART Ch

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STUDENT CLINICIANS CHECKLIST FOR GETTING STARTED IN CLINIC

1. Contact your client to introduce yourself, verify the schedule (day and time). 2. Schedule a one-hour conference with your supervisor to discuss the client. 3. Review client’s folder and fill out a Client Summary form. 4. Plan your first session. Collect all materials and forms necessary to complete client’ confidential folder (Request for Service form, Release of Information and Attendance Agreement form) completed and signed by you and your supervisor. 5. Obtain a two pocket folder with clasps to keep all client session plans, treatment plans, and observation forms. 6. Put session plan in supervisor’s mailbox before each treatment session. After each session, please write SOAP note on the plan and return to the supervisor before your client’s next session. 7. Collect diagnostic/baseline information on your client to be handed in and discussed with the supervisor in the second week of treatment. 8. Formulate the client’s semester goals with the aid of the supervisor. Goals must be completed by the end of the third week of clinic on the Treatment Plan form. 9. Screen hearing (puretone and immittance). Record results and file in client’s confidential folder. 10. Keep record of all time spent with the client on the specified form (Time Sheet is kept in client’s folder). 11. Attend weekly conferences. Be prepared with questions, comments and concerns. 12. Turn in all reports on schedule. 13. Be open and honest with your supervisor throughout the semester. 14. Be professional in dealings with your supervisor, peers and client. 15. Videotape treatment sessions upon request. 16. Keep all information about your clients confidential. 17. Keep asking questions and KEEP SMILING!

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END OF SEMESTER CHECKLIST 2 WEEKS PRIOR TO FINAL SESSION OF SEMESTER:

� Give client impressions and client scheduling form to your clients. Collect by final session.

� Sign up for a checkout appointment with the GA.

� Make sure volunteer hours are completed

� Schedule a final meeting with your supervisor.

FINAL SUPERVISOR MEETING: • Supervisor should sign the following:

� Organization of Folder checklist

� Time Sheet

� Cover Letters (all copies)

� Progress Reports (all copies)

� Clock Hours Form FINAL CHECKOUT MEETING WITH GA:

• The following items in your client folder should be completed:

� Disposition Sheet: All correspondence, cancellations, etc. listed and initialed; include future Tx recommendations and when progress reports mailed (also who is on CC:)

� Organization of Active Folders Checklist: Signed and dated

� Time Sheet: Completed and signed

� SOAP Notes: For each session listed on time sheet

� Individualized Tx Plan: Completed for each LTO

� Request for Services: Signed by client and a supervisor (current or former)

� Authorization Form: Signed by client and covering entire semester. This form MUST be updated yearly!

� Attendance Policy: Signed by client

� Hearing Screening: Pure tone and immittance screenings completed. If client was unable to be conditioned, include a form that states this.

� Progress Reports & Cover Letters: 1 Copy of report AND primary cover letter for file, and copies of progress report and cover letter for each person listed on authorization form.

� Envelopes: 1 for each progress report. 1 envelope addressed to yourself for clinic grades.

• Other Paperwork:

� IF CLIENT IS GOING INACTIVE: BLUE FILE LABEL (Completed with same info on regular folder)

� Client Impressions Form: Filled out by client

� Client Scheduling Form: For semester client is returning

� Student clinic scheduling form for next semester (if applicable)

� Supervisor Evaluation Form: One per supervisor, including IAD and diagnostics

� Clock Hours Form

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PREPARING FOR FINAL CONFERENCE WITH SUPERVISOR

Please bring the following to the final conference:

1. Client’s folder – make sure the release form is signed by the client with the signature being within one year.

2. Electronic copy of reports

3. Completed progress reports – single-spaced on letterhead (don’t forget to put cc: at bottom with the appropriate people the report will be sent to).

4. Completed treatment plans.

5. Completed lesson plans/SOAP notes in chronological order

6. Completed parent/client letter.

7. Completed time sheets calculated.

8. All test forms, etc.

9. Clock hour form (Remember to round up to one decimal place)

We are getting close to the end. Thanks for all your hard work this semester!!!

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Things to Bring to Checkout: 1. Client folders: (If your client is going inactive make sure you bring a manila folder with a blue label

already typed). 2. SIGNED progress reports and COPIES of all your progress reports (1 copy for each person you are

sending the report to) 3. SIGNED letters and COPIES of all your letters (1 copy for each person you are sending the letters to) 4. Typed envelope (1 for each person you are sending the letters/reports to) – make sure you use ALL

CAPITALS AND NO PUNCTUATION 5. All SOAP Notes- (with the most recent on top) 6. COMPLETED TREATMENT PLANS with all of your long-term objectives 7. CLIENT SCHEDULE (even if you client is returning in the fall and not the summer, please fill out the

client’s name and phone number and write “returning in the fall”. If the client is unsure of their schedule still fill one out with the client’s name and phone number and state “Do not know their summer schedule”.)

8. Clinician Evaluation form (this form can be found in the e-mail from the beginning of the semester) Give it to your client early so they can return it!

9. SIGNED TIMESHEET by you and your supervisor! Make sure the percentage of observation is also calculated. This form is found in the e-mail from the beginning of the semester.

10. SUPERVISOR EVALS (1 for each supervisor) 11. SIGNED CLOCK HOUR FORM! Make sure your supervisor initials the totals and any cross outs. 12. TYPHON SUMMARY 13. An envelope with your address over the break so your grades can be mailed to you.

For your folder 1. SIGNED Organization of folder checklist 2. Disposition sheet) make sure you record any cancellations and any times you contacted the client. Initial all entries and write in black pen.) The last 2 entries should state:

o Recommended to continue or discontinue TX in the summer/fall/spring o Progress reports mailed and cc:__________

3. SIGNED Request for Services form (include the stall supervisor signature) 4. SIGNED and UPDATED Authorization Form (If your auth form expires this semester it needs to be updated or the reports cannot be sent out!!) 5. ATTENTANCE Policy (AS long as there is one in there it does not have to be updated) 6. HEARING SCREENING and IMMITANCE RESULTS: If you client is followed by an audiologist, you do not have to complete a screening. If your client could not be conditioned, write on a sheet stating “could not be conditioned” 7. COVER SHEET and CASE HISTORY FORM (Make sure the social security number is on the cover sheet).

E-MAIL the GA with any questions!

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ORGANIZATION OF SPEECH-LANGUAGE INACTIVE CLIENT FILES

Each file should be arranged according to the order below. EACH SECTION SHOULD BE IN CHRONOLOGICAL ORDER WITH MOST RECENT INFORMATION ON TOP. Left Side of Folder- material is stapled to folder BOTTOM TO TOP 1. Attendance Policy 2. Permission Forms - on bottom 3. Request for Services 4. Disposition Sheets 5. TU Cover Sheet - on top Right Side of Folder- material is not stapled to folder BOTTOM TO TOP 1. Organization of Client Folder Checklist (from Tx) - on bottom 2. Miscellaneous 3. Raw Data: formal and informal test results (stapled by semester or by evaluation) 4. Other Agency’s Reports, Letters, IEP’s, and other information 5. TU SLP Progress Reports 6. TU SLP and Audiology Evaluation/Screening Reports and Letters 7. Case Histories - on top Label on file The label must contain the name, date of birth, the disability if applicable, and whether the client is a child (Ch) or adult (Ad). If another language is spoken, indicate that on the label with an >E=. For further detail, follow instructions for Labels For Client Files, in the 1999 Clinic Supplement of the Clinic Manual (p 7b). Example: SMITH, Joseph 01-01-90 ART Ch OTHER INSTRUCTIONS:

- waiting list form goes on bottom of Evaluation Raw Data - be sure to place this top sheet in each completed folder - put any blank forms found in folders in the appropriate cabinet or drawers

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Organization of Active Client Folders Checklist This checklist should be used to organize your active client’s file. A sample file is located at the student workstation. Take the organized file and the checklist to your supervisor/clinician meeting at the end of the semester for review. Your supervisor will sign the checklist when the file is complete. You will need to show proof of a completed file to the graduate assistant at the end of the semester. White label - The last name should be typed first in all capital letters followed by the first name in lower case letters, date of

birth, disability if applicable, and whether the client is a child (Ch) or adult (Ad). If another language is spoken, indicate that on the label with an ‘E’. For further detail, follow the instructions for Labels for Client Files (p. 25).

(example -SMITH, Joseph 01-01-90 ART Ch) All material must be in chronological order, with the most recent information on top

Arrange each section in the order indicated below from top to bottom (Example - (1a) Folder checklist on top, Disposition Sheet on bottom)

First section of folder

(1a) left side - Checklist Disposition Sheet

(1b) right side - Cover Sheet

Time Sheet

Second section of folder (2a) left side - Request for Services

Permission Forms Attendance Policy

(2b) right side - Case History Form Related Outside Reports

Third section of folder

(3a) left side - T.U. Evaluation Report All Audiologic Reports (evaluations & screenings)

(3b) right side - T.U. Progress Reports

Letters to Parents All raw data should be placed in the file pockets in chronological order

Pocket A - Current semester raw data (unstapled) Pocket B - Past raw data - stapled by semester and labeled (i.e., Spring 2000)

__________________________________________________________________________________________________________________

CLIENT NAME: ________________________________

DATE

STUDENT CLINICIAN

SUPERVISOR

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CLINICAL

PRACTICUM

GRADING

POLICY

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CLINICAL PRACTICUM GRADING POLICY

Students will receive a graded evaluation for each observed client evaluation/treatment session no later than the fourth session. Clock hours will be earned for any client session receiving a passing grade. Supervisors evaluate the performance of students assigned to them and submit midterm/final grades to the Clinic Director. If a student has more than one supervisor, each supervisor's grade is weighted according to the number of clinical clock hours involved in that grade. Weighted grades are then averaged for your final clinical practicum grade.

Supervisors base their grades on student performance of professional, interpersonal and technical skills in the following:

1. Direct observation by the supervisor

2. Indirect observation by the supervisor (meetings, conferences, etc.)

3. Written materials submitted:

a. Session plans/SOAP notes b. Individualized Speech-Language Treatment Plan c. Progress reports and/or Diagnostic Reports d. Parent/client letters e. other written materials as requested by the supervisor such as self-evaluations,

home programs, etc.

Course grade may be lowered as the result of: continued unexcused absences from clinical assignments, supervisor conferences, and weekly class meetings without valid, verifiable, written documentation; late submission of written materials, and failure to adhere to clinic rules, policies, procedures, and deadlines. Students are expected to perform in a professional, ethical manner.

Final grade determination is contingent upon both supervisor evaluation and compliance with the requirements identified above. Final grades will be assigned following completion of all clinical responsibilities including reports and paperwork.

GRADING EXPLANATION

(Revised 7/2012)

At the beginning of the semester each student should read the Practicum Evaluation Scale descriptors in the clinic manual for an explanation of criteria for midterm and final grading. The Practicum Evaluation Form will be filled out by Clinical Supervisors at mid-term and at the end of the semester. Points for marked categories will be added and divided by the number of categories used to obtain the Mean Skill Level. The mean skill level placed in blank I will be for midterm evaluation. The mean skill level placed in blank II will reflect the final grade which will be inclusive of the entire semester. Students enrolled in on campus practicum are graded as Level I. Students participating in off campus practicum experiences are graded as Level II. Performance expectations will differ for each student Level and these differences will be reflected in the letter grade assignments. Letter grades will be assigned as follows:

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Level

I= On Campus II= Off Campus

A

B

C

F

II. Mean Skill Level

Range Cut Off Score

A 4.4-5.0 A- 4.2-4.39

*<2

B+ 3.8-4.19 B 3.6-3.79 B- 3.2-3.59

*<1

C+ 2.8-3.19 C 2.6-2.79 C- 2.2-2.59

*<0

< 2.2

I. Mean Skill Level

Range Cut Off Score

A 4.2-5.0 A- 4.0-4.19

*≤1

B+ 3.6-3.99 B 3.4-3.59 B- 3.0-3.39

*≤0

C+ 2.6- 2.99 C 2.4 -2.59 C- 2.1 -2.39

*≤0

< 2.1

*If a student achieves a Mean Skill Level for a particular letter grade but has some scores which fall at or below the Cut Off Score for that letter grade, the supervisor may assign a lower letter grade. If a discrepancy occurs between the Mean Skill Level and assigned letter grade, specific reason(s) will be listed by the supervisor under Comments. **According to University Grading Policy a C- in an undergraduate course would not meet requirements for passing any major required course. **A “C” in a graduate course may effect graduate requirements for maintaining a “B” average and lead to academic warning. Any grade below a “C” would not meet requirements for passing. If a student has questions about individual item(s), grade, or comments, that student should schedule an appointment with the supervisor to discuss. The yellow copy of the Practicum Evaluation Form will be given to the student, the pink copy will be retained by the supervisor, and the white copy will be placed in the student academic’s file. Per semester, all on-campus and off-campus final grades are used in determining your one clinic grade for the semester. Each individual grade is weighted according to the number of clinical clock hours involved in that grade. Weighted grades are then averaged for your final clinical practicum grade. In order to fulfill semester requirements, the student is expected to complete all client sessions (both treatment and diagnostic) for the entire semester. As some diagnostic sessions extend over the allotted time, students are expected to remain with the client unless prior supervisory permission has been obtained. A written or narrative evaluation will be given for each session observed by the supervisor. Grading of individual treatment sessions will begin no later than the third session the client is seen by the student clinician. For a written midterm grade, the student clinician should have been observed by the supervisor a minimum of four times. No clock hours will be earned for any session receiving a grade below passing. Supervisors evaluate the performance of students assigned to them and submit midterm/final grades to the Clinic Director. Final grade determination is contingent upon supervisor evaluation and compliance with the requirements of the clinic.

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Any individual supervisor’s final grade below passing will result in no semester clock hours being earned for that evaluation and/or treatment segment.

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Towson University *Speech, Language & Hearing Center* Practicum Evaluation Form (Revised 7/2012) Student________________________Supervisor_______________________Semester______ Client_________________________ Age______ Disorder(s): Artic/ Fluency/ Voice/ Lang /Hearing Swallowing/ Cog. Comm./ Social Comm./ AAC Student Level _____Skill Level _________/________=_________MT/F Grade __________ Total Score divided by # of items scored = # Grade Letter Equivalent

I. Interpersonal & Professional Characteristics NA 0 1 2 3 4 5

1 Seeking 2 Interactive/Communicative 3 Self-aware/Perceptive 4 Responsible: Professionalism 5 Responsible: Participation 6 Responsible: Documentation

II. Technical Skills - Competencies NA 0 1 2 3 4 5 7 Determine baseline abilities 8 Record data to measure performance/progress 9 Provide education/counseling 10 Formulate outcomes & long term objectives 11 Formulate/sequence short term objectives 12 Use procedures congruent with written objectives 13 Implement procedures based on evidence based

practice

14 Modify procedure and/or treatment when indicated 15 Adapt treatment for age/cultural/linguistic diversity 16 Obtain maximum number & type of responses 17 Use appropriate materials & activities 18 Use time effectively 19 Manage client/patient behaviors 20 Identify target & discriminate from error 21 Provide appropriate/consistent correction 22 Provide appropriate/consistent

feedback/reinforcement

23 Encourage client/patient to self-evaluate III. Report Writing: For All Drafts NA 0 1 2 3 4 5

24 Content & Organization 25 Writing Style 26 Writing Use & Mechanics 27 Revision of Report Client is a native speaker of English? yes/no If no, what native language? _________ Ethnic Origin of client: American Indian/ Asian/ Black/ Hispanic/ White/ Other Comments:

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TOWSON UNIVERSITY PRACTICUM EVALUATION SCALE I. INTERPERSONAL AND PROFESSIONAL CHARACTERISTICS OF STUDENT CLINICIANS IN

PRACTICA (Revised 7/2012)

O 1 2 3 4 5 Rarely Emerging Generally Often Mostly Consistently % of 50% 70% 80% 90% 98-100% the time 1 Seeking Initiative in obtaining from supervisor an appropriate

degree of guidance and support and uses other resources (e.g., journals, internet, text) for enhancement of own clinical skills.

2 Interactive/Communicative Uses appropriate language, speech (rate), and voice intensity/quality for client’s cognitive level, language ability and clinical profile. Refrains from unnecessary verbal output during client’s response time and gives client sufficient time to

respond. Listening skills which facilitate communication and resolution of problems in supervisory and clinical processes.

3 Self-aware/Perceptive Constructive evaluation of own intentions,

performance and interaction style. Recognizes when changes need to be made. Awareness of client/family culture, attitudes and expectations, behaviors and needs.

4 Responsible: Professionalism Follows policies and procedures of clinic; dresses

and acts professionally; takes responsibility for materials borrowed; signs out materials, tests, and folders; maintains client confidentiality.

5 Responsible: Participation Attends all client sessions, supervisory conferences,

and class sessions consistently and on time. Cancels early and only for valid, verifiable reasons.

6 Responsible: Documentation Submits all forms, reports, and any other paperwork

related to client care and to the clinic-setting thoroughly, accurately, and on time; makes changes based on feedback.

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II. TECHNICAL SKILLS: COMPETENCIES REQUIRED ARE THE ABILITY TO:

7 Determine baseline abilities 0. Unable to select and use appropriate diagnostic/baseline procedures even with

supervisor’s help. 1. With detailed specific help from supervisor is able to select diagnostic/baseline

procedures and is beginning to be able to use procedures effectively; even with supervisor’s help has difficulty interpreting diagnostic/baseline information.

2. With guidance from supervisor is able to select and use diagnostic/baseline

procedures and is beginning to be able to use procedures effectively; with guidance is able to interpret diagnostic/baseline information.

3. With guidance from supervisor is able to select and use diagnostic/baseline

procedures effectively; and interprets diagnostic/baseline information accurately.

4. With minimal guidance from supervisor selects diagnostic/baseline procedures and uses procedures effectively; and interprets diagnostic/baseline information accurately.

5. Independently selects and uses diagnostic/baseline procedures effectively, and

interprets diagnostic/baseline information accurately. Requires only consultative collaboration.

8 Record data to measure performance/progress

0. Unable to set up recording system even with specific guidance from supervisor.

1. Has difficulty with qualitative and/or quantitative description of behavior; needs supervisor assistance and rarely charts behaviors.

2. With supervisor’s specific help attempts to implement recording system and as

evidenced by progress notes has good qualitative and quantitative description of behaviors.

3. With supervisor’s general help sets up recording system and implements with

minimal difficulty.

4. Independently sets up efficient recording system and implements most of the time.

5. Independently sets up efficient recording system and implements all of the time. Requires only consultative collaboration.

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9 Provide education/counseling for clients and families

0. With specific help from supervisor, clinician attempts to present information to and involve client, family member(s) and/or appropriate others; however, their participation is undirected and, therefore, minimally beneficial.

1. With specific help from supervisor, clinician integrates client, family and/or

appropriate other participation and gives information successfully approximately 50% of the appropriate time.

2. With specific guidance from supervisor, clinician integrates client, family and/or

appropriate other participation and gives information successfully approximately 75% of the appropriate time.

3. With general guidance from supervisor, clinician integrates client, family and/or

appropriate other participation in the clinical process and gives information successfully most of the appropriate time.

4. Independently gives information and integrates client, family and/or appropriate

other participation in the clinical process appropriately with at least 75% consistency and success.

5. Independently gives information and integrates client, family and/or appropriate

other participation in the clinical process appropriately with greater than 75% consistency and success. Requires only consultative collaboration.

10 Formulate outcomes and long term objectives

0. Outcomes and objectives are inappropriate, but after discussion with supervisor realizes the necessity for change.

1. Specific discussion with supervisor and major revisions necessary to formulate

outcomes and long term objectives.

2. Specific discussion with supervisor and minor revisions necessary to formulate long term objectives.

3. General discussion with supervisor about client and gathering of data necessary to

formulate long term objectives which require only minor revisions.

4. Formulates appropriate long term objectives after general discussion with supervisor and data collection.

5. Independently formulates appropriate long term objectives after gathering relevant

data; gives rationale for objectives during supervisory conference. Requires only consultative collaboration.

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11 Formulate/sequence short term objectives 0. Major revisions needed in written short term behavioral objectives.

1. Revisions needed in written short term behavioral objectives; difficulty separating procedures from objectives and in using behavioral wording.

2. With specific assistance is able to write short term objectives with appropriate

behavioral wording; needs assistance in separating procedures from objectives and in sequencing objectives in hierarchy of clinical skills.

3. With general assistance from the supervisor, objectives are sometimes appropriate;

some difficulty separating procedures from objectives and in sequencing and prioritizing objectives in hierarchy of clinical skills.

4. Writes, sequences and prioritizes acceptable short term behavioral objectives most

of the time. No difficulty separating procedures from objectives.

5. Writes, sequences and prioritizes acceptable short term behavioral objectives all of the time. No difficulty separating procedures from objectives. Requires only consultative collaboration.

12 Use procedures which are congruent with written objectives

0. Inconsistent discrepancies between written objectives and procedures; has difficulty modifying even with supervisor’s help.

1. Discrepancies between written objectives and procedures but can modify with the

supervisor’s help.

2. Minor discrepancies apparent but do not hinder treatment progress; can modify with the supervisor’s help.

3. With consistent guidance from the supervisor, infrequent discrepancies between

written objectives and procedures occur.

4. Uses procedures which are congruent with written objectives most of the time; independently modifies any discrepancies which occur.

5. Consistently uses procedures which are congruent with written objectives. Requires

only consultative collaboration. 13 Implement procedures based on evidence based practice

0. Appears to understand rationale for strategies and procedures but does not attempt to follow supervisor’s suggestions.

1. Appears to understand rationale for strategies and procedures and attempts to follow

supervisor’s suggestions but has difficulty incorporating suggestions.

2. Appears to understand rationale for strategies and procedures and successfully incorporates supervisor’s specific suggestions.

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3. With general guidance is able to generate and incorporate strategies and procedures which are based upon sound rationale.

4. Independently generates and incorporates strategies and procedures which are based

upon sound rationale most of the time. 5. Independently generates and incorporates strategies and procedures which are based

upon sound rationale consistently. Requires only consultative collaboration.

14 Modify procedure and/or treatment program when indicated 0. Does not recognize need for change and is inconsistent in implementing suggested

changes.

1. With supervisor’s assistance is able to recognize need for change but is inconsistent in implementing suggested changes.

2. Inconsistently recognizes need for change; but with guidance modifies program and

implements change.

3. Consistently recognized need for change and with guidance modifies program and implements change.

4. Independently recognizes need for change and modifies program appropriately most

of the time. 5. Independently recognizes need for change and modifies program appropriately and

consistently. Requires only consultative collaboration. 15 Adapt treatment for age/cultural/linguistic diversity

0. Does not recognize need to adapt treatment and is inconsistent in implementing suggested changes.

1. With supervisor’s assistance is able to recognize treatment adaptations but is

inconsistent in implementing suggested changes.

2. Inconsistently recognizes need for treatment adaptations; but with guidance adapts program and implements change.

3. Consistently recognized need for adaptations and with guidance adapts program and

implements change.

4. Independently recognizes need for adaptations and adapts program appropriately most of the time.

5. Independently recognizes need for treatment adaptations and adapts program

appropriately and consistently. Requires only consultative collaboration.

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16 Obtain maximum number and type of responses 0. Incorporates supervisor’s specific suggestions inconsistently to obtain maximum

number and type of responses. 1. Incorporates supervisor’s specific suggestions consistently to obtain maximum

number and type of responses.

2. Inconsistently plans session to obtain maximum number and type of responses with general guidance from supervisor.

3. Consistently plans session to obtain maximum number and type of responses with minimal guidance from supervisor.

4. Independently plans session to obtain maximum number and type of responses

without guidance from supervisor most of the time.

5. Independently plans session to obtain maximum number and type of responses without guidance from supervisor consistently. Requires only consultative collaboration.

17 Use appropriate materials and activities

0. Even with supervisor modeling, uses materials, equipment, and activites, in an ineffective manner, makes minimal effort to obtain necessary materials and equipment.

1. Requires constant prompting from supervisor to obtain, develop, use and/or adapt

necessary materials and activities.

2. With specific guidance from supervisor is able to obtain, develop, use and/or adapt techniques, materials/equipment, and activities.

3. With general guidance from supervisor is able to obtain, develop, use and/or adapt

techniques, materials/equipment, and activities.

4. Independently obtains, develops, and/or adapts techniques, materials/equipment, and activities most of the time and uses them correctly.

5. Independently obtains, develops, and/or adapts techniques, materials/equipment,

and activities all of the time and uses them consistently. Requires only consultative collaboration.

18 Use time effectively

0. Has difficulty planning sufficient appropriate activities; transition between activities is not smooth; does not recognize attentional limits of client.

1. Even with supervisor’s help, transition between activities is awkward;

inconsistently recognizes attentional limits of client; inconsistently spends appropriate time on priorities; brings sufficient activities but sometimes not appropriate.

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2. With supervisor’s help, transition between activities may be awkward; beginning to

carry through well constructed activities; inconsistently recognizes attentional limits of client; inconsistently spends appropriate time on priorities, brings sufficient activities, but sometimes not appropriate.

3. With supervisor’s help throughout semester, plans sufficient appropriate activity for

treatment time; each activity is well constructed (with appropriate introduction and conclusion); has smooth transition from activity to activity; recognizes attentional limits of client and spends appropriate time for priorities.

4. With supervisor’s initial help, plans sufficient appropriate activity for treatment

time; each activity is well constructed (has beginning, middle and end); smooth transition from activity to activity; recognized attentional limits of client and spends appropriate time for priorities.

5. Independently plans sufficient appropriate activity for treatment time; each activity

is well constructed (has beginning, middle and end); smooth transition from activity to activity; recognizes attentional limits of client and spends appropriate time for priorities. Requires only consultative collaboration.

19 Manage client/patient behaviors

0. Needs repeated assistance to manipulate environment or treatment and/or handle behavior or unexpected problems.

1. Manipulates some variables in environment or treatment appropriately in an attempt

to manage behavior or unexpected problems.

2. With frequent assistance creates maximal environment and/or appropriate behavior management plan for therapeutic change.

3. With minimal assistance creates maximal environment and/or appropriate behavior

management plan for therapeutic change.

4. Independently creates optimal environment and manages behavior most of the time (i.e., positions materials and client appropriately; uses appropriate actions and stimuli); resolves unexpected problems successfully; and/or implements appropriate behavior management plan.

5. Independently creates optimal environment and manages behavior consistently (i.e.,

positions materials and client appropriately; uses appropriate actions and stimuli); resolves unexpected problems successfully; and/or implements appropriate behavior management plan. Requires only consultative collaboration.

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20 Identify target behavior and discriminate from error 0. Rarely identifies target behavior or discriminate error from target even with

supervisor’s help.

1. Inconsistently identifies target behavior and discriminates error from target.

2. With supervisor’s specific help identifies target responses and discriminates error from target.

3. With supervisor’s general help identifies target behavior and discriminates

error from target consistently.

4. Independently identifies target behavior and discriminates error from target consistently most of the time.

5. Independently identifies target behavior and discriminates error from target

consistently. Only requires consultative collaboration.

21 Use appropriate, consistent correction techniques (e.g., modeling, cueing, prompting, etc.) 0. Has consistent difficulty implementing correction techniques determined by

supervisor.

1. After supervisor determines specific and appropriate correction techniques, clinician inconsistently implements techniques suggested by supervisor.

2. After supervisor determines specific and appropriate correction techniques,

clinician consistently implements techniques suggested by supervisor.

3. With supervisor’s ongoing general help, clinician consistently uses appropriate correction techniques.

4. With supervisor’s initial help clinician consistently uses appropriate

correction techniques.

5. Independently and consistently uses appropriate correction techniques. Requires only consultative collaboration.

22 Give consistent, concrete, and specific feedback and reinforcement

0. With supervisor’s help still has difficulty using appropriate feedback.

1. With supervisor’s specific help clinician implements feedback system inconsistently.

2. With general help of supervisor can implement appropriate and meaningful

feedback system and/or reinforcement procedures.

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3. With minimal help of supervisor can implement appropriate and meaningful feedback system and/or reinforcement procedures.

4. Independently implements appropriate and meaningful feedback system

and/or reinforcement procedures most of the time.

5. Independently implements appropriate and meaningful feedback system and/or reinforcement procedures consistently. Requires only consultative collaboration.

23 Encourage client/patient to self-evaluate

0. Understands need for client to self-evaluate but does not carry through.

1. With supervisors help is beginning to encourage client to self-evaluate. 2. With supervisor’s help has client self-evaluation performance on some

appropriate tasks.

3. With supervisor’s help throughout the semester has client self-evaluate performance for all appropriate tasks.

4. With initial help from the supervisor has client self-evaluate for all

appropriate tasks.

5. Independently has client self-evaluate performance. III. REPORT WRITING: FOR ALL DRAFTS (Grade is Average of Each Individual Draft Grade) 24 Content and Organization 0. Report needs to be completely rewritten. 1. 50% or more information was missing and/or incorrect, AND organization

was ineffective or lacked chronology. 2. 40% of the information was missing and/or incorrect, OR organizations was

ineffective or lacked chronology. 3. 30% of the information was missing, and/or organization was effective and

chronological. 4. 20% of the information was missing, and organization was effective and

chronological. 5. Information was complete, integrated, organized chronologically, and

organized effectively by topic.

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25 Writing Style 0. Report needs to be completely rewritten. 1. Writing style makes it difficult to read and understand the report in at least one

section. 2. Words are used incorrectly or are missing, redundant wording and phrasing is used,

syntax is awkward or filled with jargon throughout the report. 3. Syntax or vocabulary is overly complex, awkward, or filled with jargon in more than

one section of the report. 4. Syntax or vocabulary is overly complex, awkward, or filled with jargon in one

section of the report. 5. Tone is professional; vocabulary and syntax are mature, and terms are easy to

understand throughout the paper. 26 Writing Use and Mechanics 0. Frequent errors in writing mechanics throughout report make it difficult to follow. 1. Frequent errors in writing mechanics and use make it difficult to follow the report in

at least one section. 2. Frequent errors in spelling, punctuation, and formatting, or frequent grammatical or

syntax errors. 3. Occasional errors in spelling, punctuation, formatting, grammar and syntax. More

time is needed in proofing. 4. Minimal errors in spelling, punctuation, formatting, grammar or syntax. 5. The report is free of errors in spelling, punctuation, formatting, grammar, or syntax.

Headers are used appropriately. 27 Revision of Report 0. Does not make suggested revisions. 1. Makes approximately half of the suggested revisions in the next draft. 2. Makes approximately three-quarters of the suggested revisions in the next draft, but

does not edit report. 3. Makes most of the suggested revisions in the next draft or edits most of each draft to

ensure clarity. 4. Makes most of the suggested revisions in the next draft and edits each draft. 5. Makes all of the revisions and edits all of the drafts to ensure clarity.

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Towson University *Speech, Language & Hearing Center* Report Writing Evaluation Form (revised 7/2012) Student___________________________ Supervisor ____________________ Semester _____ Client____________________________ Draft Number _______________________________ Student Level__________ Average Number Grade ______________ Letter Grade ________ 24 Content and Organization 0. Report needs to be completely rewritten. 1. Major information was missing and/or incorrect, AND organization was ineffective

or lacked chronology. 2. Major information was missing and/or incorrect, OR organization was ineffective or

lacked chronology. 3. Minor information was missing, and/or organization was effective and chronological. 4. Minor information was missing, and organization was effective and chronological. 5. Information was complete, integrated, organized chronologically, and organized

effectively by topic. 25 Writing Style 0. Report needs to be completely rewritten. 1. Writing style makes it difficult to read and understand the report in at least one

section. 2. Words are used incorrectly or are missing, redundant wording and phrasing is used,

syntax is awkward or filled with jargon throughout the report. 3. Syntax or vocabulary is overly complex, awkward, or filled with jrgon in more than

one section of the report. 4. Syntax or vocabulary is overly complex, awkward, or filled with jargon in one

section of the report. 5. Tone is professional; vocabulary and syntax are mature, and terms are easy to

understand throughout the paper. 26 Writing Use and Mechanics 0. Frequent errors in writing mechanics throughout report make it difficult to follow. 1. Frequent errors in writing mechanics and use make it difficult to follow the report in

at least one section. 2. Frequent errors in spelling, punctuation, and formatting, or frequent grammatical or

syntax errors. 3. Occasional errors in spelling, punctuation, formatting, grammar and syntax. More

time is needed in proofing. 4. Minimal errors in spelling, punctuation, formatting, grammar or syntax. 5. The report is free of errors in spelling, punctuation, formatting, grammar, or syntax.

Headers are used appropriately. 27 Revision of Report 0. Does not make suggested revisions. 1. Makes approximately half of the suggested revisions in the next draft. 2. Makes approximately three-quarters of the suggested revisions in the next draft, but

does not edit report. 3. Makes most of the suggested revisions in the next draft or edits most of each draft to

ensure clarity. 4. Makes most of the suggested revisions in the next draft and edits each draft. 5. Makes all of the revisions and edits all of the drafts to ensure clarity.

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Towson University Speech, Language & Hearing Center Diagnostic Evaluation Form (Revised 7/2012)

Student______________________Supervisor___________________Semester________ Towson University Speech, Language & Hearing Center Diagnostic Evaluation Form Student______________________Supervisor___________________Semester________ Student Level_______Skill Level______/______=I_______II______SESSION/MT/F Total Score/# of Cat. Date______ Grade______

Diagnostic Skills Rating: 0-could not perform even with specific guidance by supervisor 1-performed inconsistently with specific guidance by supervisor 2-performed with specific guidance by supervisor 3-performed with general guidance by supervisor 4-performed independently most of the time 5-performed independently all of the time N/A 0 1 2 3 4 5 1 Collected case history/completed chart review 2 Planned diagnostic sessions to meet pt needs 3 Interviewed client/relevant others 4 Interacted appropriately with client/parent 5 Administered standardized assessments 6 Administered nonstandardized assessments 7 Collected behavioral data 8 Managed client’s behavior during the session 9 Scored and analyzed all data 10 Interpreted data to determine diagnosis/prognosis 11 Developed recommendations and treatment plan 12 Provided education/counseling regarding results 13 Referred client for appropriate services 14 Completed all required documentation 15 Collaborated w/other team members/professionals Report Writing Skills –Content 0-Report was late or not completed 1- Needed major revisions, major information was incorrect and missing and organization was ineffective 2- Needed major revisions, major information was incorrect and/or missing or organization was ineffective 3-Minor information was missing and minor changes were needed in organization 4- Minor information was missing or minor changes were needed in organization 5-Information was correct, compete and organized N/A 0 1 2 3 4 5 1 Case History Information 2 Tests and Observations 3 Summary Statement 4 Recommendations Report Style Rating: 0-Report was not typed in the standard format

1-Difficult to understand and frequent errors in spelling, punctuation, and syntax 2-Difficult to understand or frequent errors in spelling, punctuation and syntax 3-Words used incorrectly; syntax was awkward; frequent errors in spelling or punctuation 4-Syntax or vocabulary was complex/awkward; occasional spelling, punctuation, syntax errors 5-Tone was professional; paper was free of spelling, punctuation or syntax errors N/A 0 1 2 3 4 5

5 Writing Style and Mechanics Comments:

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Speech, Language & Hearing Center Towson University

SUPERVISOR'S OBSERVATION REPORT

Student Clinician Date Client Student Level Classification Time Begin Time End Supervisor Rating I. Clinician Client Relationship: II. Management of Therapy Session: III. Equipment and/or Materials Used: IV. Procedures: V. General Impression:

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SUPERVISOR OBSERVATION REPORT Student Clinician________________________________________________Date_____________ Client Time Supervisor Grade

CLINICIAN-CLIENT RELATIONSHIP

yes

some-times

no

Clinician demonstrates warmth, empathy, and personal regard

Clinician appears interested in the client and the treatment Clinician sets and enforces reasonable limits appropriate to the clients= levels of maturity

Clinician appropriately and effectively responds to the client’s questions and comments

Clinician appropriately and effectively asks questions and makes comments TREATMENT PLANNING AND MANAGEMENT

Lesson plan is written behaviorally and descriptively

Session objectives are appropriate for client’s type of disability and level of functioning

Clinician utilizes time efficiently and purposefully

Clinician demonstrates flexibility by responding to client’s immediate needs

EQUIPMENT AND MATERIALS

Clinician provides clear and understandable directions

Clinician selects materials which are appropriate for clients

Clinician uses materials which are effective in teaching the task and helping the client achieve the desired behavior

TREATMENT EXECUTION

Clinician selects procedures that maximize responding & the number of target responses

Clinician effectively uses correction or control techniques

Clinician successfully discriminates error from target behavior Clinician provides consistent and meaningful reinforcement and feedback

Clinician uses appropriate language, articulation, and voice quality

COMMENTS:_____________________________________________________________________________________________________________________________________________________________

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TOWSON UNIVERSITY

SPEECH, LANGUAGE & HEARING CENTER Self-Evaluation of the Session

Date Memory Videotape Please complete this evaluation and give to your supervisor after the session. You will not get the supervisor’sobservation report until after you have handed in this self-evaluation. Student Clinician Level Client Supervisor 1. How did this client session go? 1 2 3 4 5 6 7 8

Miserably Superbly Circle One 2. What factors made the session successful? 3. If the session did not go smoothly, what contributed to this? 4. What do you see as your strong points in this client session? 5. Where do you need to make improvement? What would you change about the way you conducted

this session? 6. Based on your answer to number 5, make a contract with yourself-

In order to improve the session management next time I shall: a.

b.

c.

7. Did you keep your contract (i.e., Did you make the changes you said you would on the last self-

evaluation form)? Yes No Why not? Explain. Supervisor comments:

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DEPARTMENT

AND

CLINIC

ATTENDANCE

POLICIES

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DEPARTMENT OF AUDIOLOGY, SPEECH-LANGUAGE PATHOLOGY, AND DEAF-STUDIES

CLASS ATTENDANCE/ABSENCE POLICY The following policy was written in accordance with the Towson University policy on attendance and absence.

1. Students are expected to attend all classes and clinical sessions. Frequent absences (excused and unexcused) may affect the final grade.

2. It is the policy of the university to excuse student absences for the following reasons.

Illness or injury when the student is unable to attend class Religious observance where the nature of the observance prevents the student from

attending class Participation in university activities at the request of university authorities Compelling verifiable circumstances beyond the control of the student

3. Students requesting an excused absence must provide verifiable documentation to the instructor. When know in advance, documentation should be provided to the instructor at the beginning of the semester. Students enrolled in clinic should also indicate planned absences on the clinic scheduling form submitted prior to the beginning of the semester. When not known in advance, the student must provide documentation within one week of returning to class.

4. Absences that do not fall into any of the categories outlined in item number two are unexcused.

Unexcused absences may result in reduction of the course grade as outlined in the course syllabus. 5. Students who have an excused absence from class are responsible for any missed work,

assignments, or assessments. When absences are known in advance, students should submit assignments prior to the deadline. In cases where absences are not know in advance, students should discuss with faculty members within one week of returning to class the timeline for submitting assignments.

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CLINIC ATTENDANCE POLICY FOR SPPA 487, 690, 745, & 798

All student clinicians are expected to attend all assigned clinical sessions, clinic class meetings, and supervisor conferences. Students missing these obligations without written, valid, verifiable documentation will be subject to disciplinary measures, which could include lowering of the clinical practicum grade. Students also are expected to be on time for sessions, classes, and conferences. CLINIC CLASS All students enrolled in Speech-Language on-campus clinical practicum (487, 690, 745, or 798) are required to attend the SLP student clinician classes. In Fall semesters, all undergraduate students and those graduate students who have not previously attended a Fall or Spring student clinician class at Towson University are expected to attend all classes. In Spring semesters, there is one class for undergraduates and graduates enrolled in 690 and another class for graduate students in 745 and 798. For each absence, students must supply written verifiable documentation to the instructor. Unexcused absences from class will result in a lowering of the clinic grade by one letter grade per 3 unexcused absences. CLINIC TREATMENT AND DIAGNOSTIC SESSIONS There are no authorized absences. In the case of serious illness, death in the family, religious observances where the nature of the observance prevents the student from attending class, professional conferences, and valid emergencies, students are expected to make up client sessions. For any absence, students must provide valid, written, verifiable documentation. Students must complete at least 75% of the scheduled sessions (excluding those cancelled by the client) in order to obtain a clinic grade for the semester. Incompletes are granted based on university policy. Course completion plan will be determined on a case-by-case basis by the faculty. The clinic grade for a specific client, group, or diagnostic will be lowered by one letter grade for each session the student misses without the required valid, written, verifiable documentation. If a letter grade less that “C” is awarded, no clock hours will be received and the lowered grade, in this instance, will be weighted according to the number of scheduled hours (excluding those cancelled by the client) and not the number of hours completed. If a client discontinues treatment, all efforts will be made to assign a new client to the student clinician. If client cancels or does not show for a session, the student should attempt to make up the session. The student must inform the supervisor of all client absences and “no shows.” All make-up sessions must be scheduled with permission of supervisor and during scheduled clinic times.

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SPEECH, LANGUAGE & HEARING CENTER @ TOWSON UNIVERSITY PATIENT LATENESS POLICY

(March 2008)

1. Treatment patients- if a client/patient is not on time for a treatment session, the student should check with the front office to find out if the client/patient has called to cancel or tell us they are coming late. If they have not called, the student should attempt to reach them by phone. If unable to do so, the student should wait 30 minutes at which time if the patient does not arrive the student may leave. If they have called to say they are coming late, the student should remain until the end of the session. Sessions should not be extended to accommodate lateness and session plans should be modified as needed.

2. Speech/Language Diagnostic and Audiology sessions- if a client/patient is not on time for a

diagnostic or audiological appointment, the student should check with the front office to find out if the client/patient has called to cancel or tell us they are coming late. If they have not called, the student should attempt to reach them by phone. If unable to reach the client/patient, the student(s) will meet with their supervisor to discuss how best to utilize the reminder of the session. Activities may include editing reports, reviewing past sessions, planning for future sessions, analyzing data, reviewing administration of new diagnostic tools, etc. If the patient is a no-show, a determination will be made as to whether or not they will be rescheduled. If a client/patient has called or been contacted and has indicated that they are coming late, the student(s) and supervisor will wait until they arrive. They may engage in other learning or volunteer activities until the patient arrives or the session times expire. Once the client/patient arrives, the diagnostic session may be performed with modifications due to time constraints and all other data not collected will be identified in the recommendation section of the report. The supervisor should inform the client/patient on arrival that all the testing may not be completed due to time constraints and scheduling a follow-up appointment may be necessary. The client/patient will be responsible for full payment.

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SPEECH, LANGUAGE & HEARING CENTER AT TOWSON UNIVERSITY OPENING/CLOSING POLICY

During the Fall and Spring semesters, when the clinic is in session, the opening and closing times

are 8:00am to 6:00 p.m. from Mondays through Thursdays and 8:00am to 4:30pm on Fridays. During the Summer semester, the clinic times are 8:00am to 5:00pm Mondays through Thursdays and 8:00 to 4:30 on Fridays. Between semesters, when the University is open, the clinic is open from 8:00 a.m. – 4:30 p.m. The Speech-Language & Hearing Center clinic office coordinator and administrative assistant will be responsible for unlocking and locking all doors in the Center, and for opening or closing front and back doors to the Center at designated opening and closing times.

Patients should be escorted out by their student clinicians at the end of the session time. If a supervisors schedules a meeting with a student, patient, or parent beyond closing time, that supervisor will be responsible for ensuring that the patient and/or parent has/have left the Center before he/she (the supervisor) leaves.

If a supervisor schedules meetings with students beyond closing time, the supervisor may leave at the end of the conference, regardless of whether or not the student chooses to stay on the premises.

When any student stays beyond closing time, whether it be to continue report writing, completing research, etc. it is the full responsibility of the student to ensure that the entire Center is secure when he/she leaves.

Should an incident arise in which the supervisor/student is locked out or needs assistance after hours, he/she should contact the campus police at 410-704-2133. Please be aware that any time that the University is officially closed (e.g., between Christmas and New Year’s Day) NO ONE is allowed on campus without prior permission from the Dean. There are a few other times that the University is officially closed. Check the “Significant Date Calendar” on the Towson University website at http://wwwnew.towson.edu/main/calendar/morecalendars.asp.

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CLINICAL

PRACTICUM

BEHAVIOR

CODES

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SPEECH, LANGUAGE & HEARING CENTER CONFIDENTIALITY AGREEMENT

I _____________________________________________ understand that as a condition of my employment in the Department of Audiology, Speech-Language Pathology, and Deaf-Studies or as part of my clinical practicum in the Speech, Language & Hearing Center of Towson University, I must safeguard the privacy, security, and integrity of client records at all times. I agree to abide by all state and federal laws and regulations governing the security and confidentiality of individually identifiable health information and records. I agree that I will not engage in behavior that may cause a breach of confidentiality or the appearance of a breach, whether intentional or not. This includes but is not limited to:

Discussing information contained in files or distributing confidential files to others.

Discussing a client’s confidential information with another student or faculty member where it can be overheard by other clients and individuals not involved in the care of that client (e.g. discussing a client in a hallway or near the client waiting area.)

Discussing a client with friends, other clients, other professionals, or anyone, inside or outside the Clinic, not directly involved in the care of that client or in a consultative role regarding the client’s care.

Releasing client records without the client’s consent unless required by law. (Consent may be given by written release, or by faxed and signed memo, and must specify which parts of the record may be released.)

Leaving records unsecured in an open area where they can be viewed by other individuals not directly involved in the care of clients.

Removing client folders from the clinic area except to be taken to the supervisor’s office or to the VB computer lab. All folders must be signed out according to clinic sign-out procedures.

Leaving computer workstation screens with identifiable client information unattended or unlocked so that anyone may view or access other client’s confidential health information.

Leaving reports, treatment plans or session plans in printers or garbage without being shredded.

Leaving identifiable client information on computer disk or hard drive at the end of the clinical assignment

Transmitting reports with identifiable confidential information via email (see university email policy).

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Making copies of client information or reports.

Removing any reports or raw data from the client folder. As an employee, I understand that I may be disciplined, including termination, for violating state or federal statutes or university policy regarding confidentiality and privacy of protected information. Discipline for employees shall be imposed in accordance with USM and University policies. As a student, I understand discipline shall be imposed pursuant to the Student Code of Conduct. Course grade may be dropped one letter for each offense, no clinical clock hours given for the particular assignment and/or an incident report put in student’s academic folder. I understand that I may be subject to legal action if I violate state or federal statutes regarding protected health information. By my signature, I agree to abide by all the premises and principles contained in this agreement. Signature:______________________________________________ Date:___________________________

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Dress Code for Speech, Language & Hearing Center

• When you are in the clinic, you are not just a student, you are a professional-in-training; dress the part (if you look like a student, your clients will think of you as a student – if you look like a professional, your clients will think of you as a professional)

• Guidelines for Appropriate Dress

A. Acceptable for Female Clinicians

• Skirt and blouse or suit (blazer, jacket or sweater optional) • Dress

• Slacks and blouse (blazer, jacket or sweater optional) • Comfortable dress shoes (open toe shoes may be worn during summer clinic only –

no bare legs or bare toes please.)

B. Acceptable for Male Clinicians

• Slacks and collared shirt, suit or sports jacket (tie optional) • Comfortable dress shoes or loafers

C. Unacceptable for Any Clinician

• Jeans • Shorts • Sweats • T-shirts with any writing on front or back • Athletic Shoes or beach shoes (flip-flops) • Bare midriff, low cut shirt/blouse/dress or tight fitting clothing • Jewelry or body adornment that could be a distraction, is a danger to the client or

yourself, interferes with provision services, or detracts from a professional appearance.

NOTE: You may need to bend, sit and reach as part of your clinical duties. Please wear clothing that allows you to move comfortably without exposing yourself. If you have a question about the appropriateness of an outfit, ask your supervisor. If you wear something that a supervisor tells you is inappropriate, accept it as constructive criticism (meant to contribute to your professional development), not as an attack on your personal taste in clothing.

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Speech, Language & Hearing Center Student-Client Communication Policy (updated 4/2/2012)

With the upsurge in the usage of electronic communication, it has become increasingly important to establish professional and ethical boundaries for these practices. The ASHA Code of Ethics addresses this issue within the Principles and Rules of Ethics document. These guidelines specify that:

“Individuals who hold the Certificate of Competence may delegate tasks related to the provision of clinical service… only if those

services are appropriately supervised” and that said individuals shall “prohibit anyone under their supervision from engaging in any practice

that violates the Code of Ethics.”

Therefore, it has been determined that the Speech, Language & Hearing Center policy will be as follows: • All electronic communication between student clinicians and clients will be strictly

limited to notification regarding scheduling or client well- being (i.e., administration of food within the therapeutic sessions or food allergies).

• Any and all electronic correspondence must be copied to the student’s immediate supervisor and logged into the client’s clinic folder.

• Establishing and maintaining on-line communications to discuss course and outcomes of treatment, school or workplace concerns or to offer counseling or diagnosis is prohibited.

• Students may not attend meetings with other professionals unless supervised.

• Students may not maintain social contact or working relationships with clients or their families during the course of the treating semester.

• Students may not establish social media connections (i.e. Facebook or Twitter) with clients or client families.

• Students may decide if they want to share personal cell phone information with the client.

Consequences for violation of these standards shall be determined by an ethics committee comprising clinical faculty and the clinic director. Consequences may include a reduction in the clinic grade or expulsion from the program.

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Students with Disabilities Policy

Students with disabilities are encouraged to register with Disability Support Services (DSS) at 7800 York Road, Suite 135, 410-704-2638. (Voice or TDD.) Students who suspect they have a disability but do not have documentation are encouraged to contact DSS for advice on how to obtain appropriate evaluation. Documentation from DSS authorizing your accommodation is needed before any accommodation can be made.

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CLINICAL PRACTICUM BEHAVIOR CODE

I. Student Academic Integrity Policy As responsible members of the academic community, students are obligated not to violate the basic standards of integrity. Should a student have a reason to believe that a violation of academic integrity has occurred, he/she is encouraged to make the suspicion known to a member o the faculty or university administration. The provisions of Towson University’s Student Academic Integrity Policy follow. This policy applies to all enrolled students, undergraduate and graduate, regardless of teaching site (off campus) or teaching mode (distance learning.) II. Procedures for Handling Cases A faculty member responsible for assigning final grades in a course may acquire evidence, either directly or through information supplied by others, that a student violation of academic integrity may have occurred. After collecting the evidence, the faculty member meets with the student to present the evidence and to request an explanation. Once a faculty member has charged a student with academic dishonesty, the student may not withdraw from the course. If the faculty member accepts the student’s explanation, no further action is taken. If the faculty member determines that a violation has occurred, the faculty member informs the student, in writing, of the academic penalty and of the student’s rights of appeal. The faculty member sends a copy of the letter to the department chairperson and to the Office of Judicial Affairs. The letter will include:

• Nature of the charge/evidence against the student; • Brief summary of the meeting with the student • Faculty member’s decision • Right of appeal to the department chair

If the student is not found responsible, the student may either:

• Remain in the course without penalty, or • Withdraw from the course regardless of any published deadlines

If the student is found responsible, the student will receive the sanction imposed by the instructor of other academic authority. III. Penalties Penalties for an academic violation may include the following:

• A revision of the work of question and/or completion of alternative work, with or without grade reduction;

• A reduced grade (including “F” or zero) for the assignment • A reduced grade (including “F”) for the entire course.

Second violations can/will include the following:

• Suspension from the university for a designated period of time

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• Expulsion from the university; • Any sanctions listed in the Code of Student Conduct.

IV. Definitions of Violations A. Plagiarism 1. One quotes another person’s actual words or replicates all or part of another’s product. This includes all information gleaned from any source, including the Internet. 2. One uses another person’s ideas, opinions, work, data, or theories, even if they are completely paraphrased in one’s own words. 3. One borrows facts, statistics, or other illustrative materials. B. Fabrication and Falsification 1. Intentionally and knowingly making unauthorized alterations to information, or inventing any information or citation in an academic exercise. 2. Typical Examples-Fabrication a. Inventing or counterfeiting data, research results, information or procecdures b. Fabricating research procedures to make it appear that the results of one process are actually the results of several processes 3. Typical Examples-Falsification a. Altering the record of data or experimental procedures or results b. False citation of the source of information c. Reporting false information about practicum or clinical experiences d. Submitting a false excuse for absence or tardiness C. Cheating 1. Intentionally using or attempting to use unauthorized materials, information, notes, study aids, or other devices in any academic exercise. D. Complicity in Academic Dishonesty 1. Intentionally knowingly helping, or attempting to help, another commit an act of academic dishonesty. E. Multiple Submissions 1. Intentionally or knowingly submitting substantial portions of the same academic work (including oral reports) for credit more than once without authorization of the instructor. For more information about Academic Dishonesty Procedures, please see the Towson University Student Academic Integrity Policy.

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TOWSON UNIVERSITY EDUCATION PROGRAM

PROFESSIONAL BEHAVIOR POLICY¹

Introduction and Rationale The Teacher Education Executive Board (TEEB) has a responsibility to the education community to ensure that individuals whom Towson University recommends to the State of Maryland for certification are highly qualified to join the education profession. The teaching profession requires strong academic preparation, mastery of pedagogy, and other professional competencies. The profession also requires non-academic professional behaviors, such as interpersonal skills, which are as critical to success as those in the academic domain. The goal of this Professional Behavior Policy is to help candidates demonstrate professional behaviors in a school environment. This document sets forth those essential professional behaviors for the entire education unit. A professional behavior policy serves several important functions, including, but not limited to: (a) providing information to those considering teaching careers that will help such students in their career decision-making; (b) serving as the basis for feedback provided to students throughout their teaching program regarding their progress toward mastery of all program objectives; and (c) serving as the basis for the final assessment of attainment of graduation requirements and recommendation for certification. All candidates in education programs are expected to demonstrate they are prepared to work with students and adults in educational settings. This preparation results from the combination of successful completion of Towson University coursework, field/internship experiences, and the demonstration of professional behavior that all educators should possess. These professional behaviors are outlined below. EDUCATION PROFESSIONAL BEHAVIOR STATEMENT

The Teacher Education Executive Board (TEEB) reserves the right for each department/program to refuse, deny, or revoke the application for admission to professional education programs or continuation in professional education programs of any student whose observed behavior is deemed incongruent with established guidelines of professional behavior. As a professional discipline, education is “vested by the public with a trust and responsibility requiring the highest ideals of professional service.” All teacher education students agree to accept “the responsibility to adhere to the highest ethical standards of professional behavior.” Placing the importance of professional behavior and duties above one’s own convenience is the cornerstone of professionalism. All teacher education students are responsible for understanding department- and program-specific professional expectations. In addition to fulfilling all academic requirements, successful completion of all field experiences requires demonstrated professional behavior including, but not limited to, punctuality, attendance, professional attire, discretion, respect for confidentiality, effective and appropriate communication with University and school-based students and personnel, and acceptance of diversity.

All teacher education students must exhibit behaviors consistent with the University's Code of Behavior and established professional practice in educational and clinical settings. Successful completion of all field experiences is a requirement for continuation in the education program.

_________________________ ¹Adapted from the University of Maryland, College Park (2005) College of Education Technical Standards Policy. Used with permission

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Program Expectations of Behavior The Education Program’s Expectations of Professional Behavior are grouped into three categories: Communication/Interpersonal Skills, Emotional and Physical Abilities, and Personal and Professional Behavior. Candidates enrolled in an education program must: Communication/Interpersonal Skills

• express themselves effectively in standard written and oral English in order to communicate concepts, assignments, evaluations, and expectations with members of the learning community such as University faculty, students, parents, administrators, and other staff

o Candidates write clearly and use correct grammar and spelling. They demonstrate sufficient skills in written Standard English to understand content presented in the program and to adequately complete all written assignments, as specified by faculty. o Candidates communicate effectively with other students, faculty, staff, and professionals. They express ideas and feelings clearly and demonstrate a willingness and an ability to listen to others. o Candidates demonstrate sufficient skills in spoken Standard English to understand content presented in the program, to adequately complete all oral assignments, and to meet the objectives of field placement experiences, as specified by faculty.

• have communication skills that are responsive to a variety of perspectives represented in diverse

classrooms and/or other professional environments

o Candidates appreciate the value of diversity and look beyond self in interactions with others. They must not impose personal, religious, sexual, and/or cultural values on others. o Candidates demonstrate their awareness of appropriate social boundaries between students and educators and their readiness to observe those boundaries.

• have the necessary interpersonal competencies to function effectively with students and

parents/guardians, and to function collaboratively as part of a professional team

o Candidates demonstrate positive social skills in professional and social interactions with faculty, colleagues, parents/guardians, and students. o Candidates demonstrate the ability to express their viewpoints and negotiate difficulties appropriately, without behaving unprofessionally with instructors, peers, or students.

Emotional and Physical Abilities

• be able to work appropriately with time constraints and deadlines, to concentrate in distracting situations, to make subjective judgments to best serve the needs of students, and to ensure safety in the classroom and in emergency situations

o Candidates demonstrate the ability to work with frequent interruptions, to respond appropriately to unexpected situations, and to cope with variations in workload and stress levels.

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o Candidates demonstrate the ability to multi-task and to adapt to and display flexibility in changing situations. o Candidates possess the ability to make and execute quick, appropriate, and accurate decisions in a complex, stressful environment. o Candidates maintain composure and continue to function well in a myriad of situations.

• have the physical stamina to work a contractual day and perform extended and additional duties of a

school professional such as parent conferences, after-school events, and other assigned duties

o Candidates exhibit motor and sensory abilities to attend and participate in class and practicum placements. o Candidates tolerate physically demanding workloads and to function effectively under stress.

Personal and Professional Behavior

• arrive on time for professional commitments, including classes and field experiences

o Candidates meet deadlines for course assignments and program requirements. A pattern of repeated absences, lateness, and failure to meet deadlines in courses or fieldwork is not acceptable.

• seek assistance and follow supervision in a timely manner, and accept and respond appropriately to

constructive reviews of their work from supervisors

o Candidates reflect on their practice and accept constructive feedback in a professional manner. They demonstrate the ability to act upon appropriate suggestions and reasonable criticism. o Candidates are flexible, open to new ideas and willing to modify their beliefs and practices to best serve the needs of their students.

• demonstrate attitudes of integrity, responsibility, and tolerance

o Candidates demonstrate honesty and integrity by being truthful about background, experiences, and qualifications; doing their own work; giving credit for the ideas of others; and providing proper citation of source materials. o Candidates interact courteously, fairly, and professionally with people from diverse racial, cultural, and social backgrounds and of different genders or sexual preferences. o Candidates must not make verbal or physical threats; engage in sexual harassment; become involved in sexual relationships with their students, supervisors, or faculty; or abuse others in physical, emotional, verbal, or sexual ways. o Candidates demonstrate the ability to understand the perspectives of others and the ability to separate personal and professional issues. o Candidates exhibit acceptance of and are able to make appropriate adjustments for exceptional learners. o Candidates protect the confidentiality of student and colleague information unless disclosure serves professional purposes or is required by law.

• show respect for self and others

o Candidates exhibit respect for all Towson University and school personnel, peers/colleagues, students, their parents/guardians, and community members.

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o Candidates know cell phone use is prohibited during class hours (inc.texting). o Candidates are free of the influence of illegal drugs and alcoholic beverages on university premises and field placements. They are expected to abide by the Towson University Code of Student Behavior. o Candidates demonstrate the ability to deal with personal and professional stressors through the use of appropriate coping mechanisms. They handle stress effectively by using appropriate self-care and by developing supportive relationships with colleagues, peers, and others. o Candidates use sound judgment. They seek and effectively use help for medical and emotional problems that may interfere with scholastic and/or professional performance. o Candidates realize their representations on the internet will be considered within the scope of their professional demeanor.

• project an image of professionalism

o Candidates demonstrate appropriate personal hygiene. o Candidates dress appropriately for their professional contexts. o Candidates possess maturity, self-discipline, and appropriate professional judgment. o Candidates attend and assist as needed in lessons being observed. o Candidates demonstrate good attendance, integrity, honesty, conscientiousness in work, and teamwork.

• social media policy

o The same principles and guidelines that apply to students’ activities in general also apply to their activities online. This includes all forms of online publishing and discussion, including blogs, user-generated video and audio, social networks and other social media applications. The Internet is neither anonymous nor forgetful, and there is no clear line between one’s professional life and personal life on a social media site. Teacher candidates need to weigh every posting for how it affects their effectiveness as teachers.

Implementation and Review Procedures Each program of education will introduce this policy, and candidates will receive a copy of the Program’s Professional Behavior Policy and sign a Professional Behavior Policy Acknowledgement Form prior to the entry of the clinical experiences. Candidates in the programs will be required to submit an updated Professional Behavior Policy Acknowledgment Form prior to entry into the Professional Year. At various points (e.g., field experiences) candidates will be notified of Professional Behavior inadequacies that may prevent them from progressing through their program. Documentation and consensus regarding the student's functioning will be sought before any action is taken. Candidates who experience deficiencies in any areas will be encouraged to seek appropriate professional help from Towson University or other sources. If the problem seems to be beyond remediation, the candidate’s continuation in professional programs, graduation, or recommendation for certification may be denied.

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Assistance for Individuals with Disabilities Professional behavior may be met with or without accommodations. The University complies with the requirements of Section 504 of the Rehabilitation Act and the Americans with Disabilities Act of 1990. Therefore, Towson University will endeavor to make reasonable accommodations with respect to its behavior standards for an applicant with a disability who is otherwise qualified. "Disability" shall mean, with respect to an individual, (1) a physical or mental impairment that substantially limits one or more of the major life functions of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment. The University reserves the right to reject any requests for accommodations that are unreasonable, including those that would involve the use of an intermediary that would require a student to rely on someone else's power of selection and observation, fundamentally alter the nature of the University's educational program, lower academic standards, cause an undue hardship on the University, or endanger the safety of students or others. For all requests for accommodations, students should contact Towson University's Disability Support Services (410-704-2638) and follow established university policy and procedures. Unless a student has expressly waived his or her privilege to confidentiality of medical records provided to substantiate either a disability or a recommendation for an accommodation, program administrators to which such information has been communicated shall maintain such information in a manner that preserves its confidentiality. Under no circumstances shall such information become part of a student's academic records.

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TOWSON UNIVERSITY PROFESSIONAL BEHAVIOR POLICY

EDUCATION STUDENT ACKNOWLEDGEMENT FORM

Within the professional context to which each candidate aspires, all candidates must: Communication/Interpersonal Skills

• be able to express themselves effectively in standard written and oral English in order to communicate concepts, assignments, evaluations, and expectations with members of the learning community such as University faculty, students, parents, administrators, and other staff

• have communication skills that are responsive to different perspectives represented in diverse

classrooms and/or other professional environments

• have the necessary interpersonal competencies to function effectively with students and parents, and to function collaboratively as part of a professional team

Emotional and Physical Abilities

• be able to work under time constraints, concentrate in distracting situations, make subjective judgments, and ensure safety in emergencies

• have the physical stamina to work a contractual day and perform extended and additional duties of a school professional such as parent conferences, after-school events, and other assigned duties

Personal and Professional Requirements

• arrive (and be on time) for professional commitments, including classes and field experiences

• seek assistance and follow supervision in a timely manner, and accept and respond appropriately to constructive review of their work from supervisors

• demonstrate attitudes of integrity, responsibility, and tolerance

• show respect for self and others

• project an image of professionalism I have read and acknowledge receipt of the Professional Behavior Policy. I understand that if the criteria listed above are not met satisfactorily, I may be recommended for dismissal from the Teaching Program and/or denied the opportunity to complete the internship and student teaching component of the curriculum. Candidate Signature PRINTED Name Date This document should be given to the Department Chair.

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NOTE: The University has a legal obligation to provide appropriate accommodations for students with documented disabilities. Documented disability students seeking accommodations, should register with the University's Office of Disability Support Services and notify your course instructor, and/or academic advisor prior to the start of classes and/or field experience.

POLICY REGARDING CONTINUANCE OR REMOVAL FROM FIELD PLACEMENTS

As well as academic preparation and teaching skills, the teaching profession also requires non-academic professional behaviors, such as interpersonal skills, which are as critical to success as those in the academic domain. The “Education Professional Behavior Policy” (part 2 of this document) describes the professional behavior expected of teacher candidates in all placements. C andidates who fail to demonstrate appropriate professional behavior pedagogical skills, or mastery of content may be removed from the field placement after other options may be explored. Should a school leader request the removal of an intern from a school placement, the placement at that school shall be ended immediately. T he intern will proceed to step five of this policy if the school requests that the intern be removed from the setting. If a candidate’s actions are considered illegal activities, there is an automatic referral to step five of this policy. If a candidate fails to demonstrate competence in one or more expectations in the school placement, the following policy shall be implemented. Procedure for Removing Candidates from Field Experiences and Concurrent Courses: 1. The university supervisor ensures that the mentor teacher has modeled appropriate planning and instruction and has involved the intern in a gradual progression of appropriate professional experiences such as co-teaching, small group instruction, whole class instruction, and independent teaching if that is warranted. The University supervisor is responsible for observing the intern and providing both oral and written feedback for each lesson observed. T he mentor teacher should give written feedback to any candidate that is having difficulty after formative discussions with the candidate have occurred.

2. When an intern encounters difficulty in the school/classroom, it is the university supervisor’s responsibility to inform the intern, in writing, that he/she is not meeting expectations and to specify the behaviors, dispositions, knowledge, and/or skills that need remediation. O nce informed of the area(s) requiring remediation, the candidate is responsible for developing/proposing an Assistance Plan (in response to the area(s) requiring remediation) with the university supervisor. After review, discussion, and revision (as needed) of the proposed plan, the university supervisor, along with the mentor teacher and the intern, will finalize and sign an Assistance Plan that includes the areas of weakness and the steps the intern must follow to remediate those weaknesses. The plan will include a timeline that specifies how and when the candidate will be expected to address the identified weaknesses, benchmarks, criteria, and the steps that will follow if the weaknesses are not remediated within the time frame. E ach time the university supervisor and the mentor teacher observe the candidate, references will be written as to the progress being made on the Assistance Plan. The university supervisor will give a copy of the Assistance Plan to the TU department chair or the program director as a way to alert them that the candidate is experiencing difficulty. Should the candidate refuse to sign or fail to implement the Assistance Plan, the candidate will be removed from the placement and will proceed to step five of this policy.

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3. At the end of the time frame set forth in the Assistance Plan, the intern is either allowed to proceed in the field experience as long as h e/she is able to maintain all of the responsibilities expected of the experience, or he/she is removed from the field experience due to lack of progress on the Assistance Plan. This decision will be made by the university supervisor in collaboration with the department chair; the director of the Center of Professional Practice (CPP) will be notified in writing of the decision that is made. 4. If an intern is removed from a field placement, he/she will receive a grade of F or U for the internship course. If the withdrawal occurs before the deadline for officially withdrawing from courses, the candidate may be allowed to withdraw from the internship and receive a g rade of W for the course. Candidates taking concurrent courses will be allowed to finish those courses if the courses do not require continuing work with children/students in the field placement. C andidates may not work with other children/students outside of the given placement to fulfill the field placement components of the internship and concurrent courses. 5. Candidates may appeal the removal from field placement to the Dean of the College of Education or appropriate College within 48 hours of being removed from the placement. T he Dean will make a decision on the appeal based on university policy as stated in the appropriate catalog. If the Dean rules in favor of the candidate, the candidate will be placed back in an appropriate classroom setting. T he candidate will not return to the original classroom or school, but may be reinstated in an internship in a different setting or in a future semester. 6. T o be reinstated in a field placement and/or the concurrent courses in a subsequent semester, the candidate must make a written request to the department chair or the program director at least 30 days before the beginning of the semester in which the placement is sought. Individual departments will set requirements for reinstatement. ADDENDUM The above policy applies to all settings that a Speech-Language Pathology student may be assigned to complete a clinical practicum experience.

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Towson University Professional Year Assistance Plan

Student: Soc. Sec. No: Program: ___________________________

Issues

Solutions

Action & Date

Failure to complete this plan satisfactorily may result in

removal from the internship.

Follow-Up:

_______________________ _______________________ Copy to: dept. chair, and ___________ TU Intern University Liaison Center for Professional Practice Date

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Instructions for Completing a Criminal Background Check for Clinical Practicum Towson University Speech, Language, & Hearing Center

May 2011

1. All students who participate in the Towson University Speech, Language, Hearing Center must successfully complete a fingerprinting and Criminal Background Check (CBC).

a. Dr Fallon will provide the needed forms. You either received them in the mail or you picked them up at her office.

b. You must complete the fingerprinting and submission of forms at the MD Criminal Justice Information Services (CJIS) office. It is located at 6776 Reisterstown Rd, Suite 102, Balt, MD 21215. (phone 410 764-4501). Tell them you need to complete a Criminal Background Check (CBC) for Child Care. Phone office for directions, cost, and hours of operation.

2. On the Form, here is some important information already filled out for out for you: a. The reason for being finger printed is Child Care b. You will need to bring a check made payable to CJIS Central Repository. I am told the

fee currently is $57.50. Your results will be forwarded to The Towson University Center for Professional Practice. Authorization number for Towson University is 9800091840 (as stated on the Form) Attention Director, Center for Professional Practice College of Education, Towson University 8000 York Road Towson, Md. 21252-0001

3. If you have any questions contact The Towson University Center for Professional

Practice at 410 704-2567. 4. DO NOT CONTACT Dr. Fallon regarding further questions or have your results sent to the

Department of Audiology, Speech Language Pathology and Deaf Studies. We are not allowed to have direct access to Criminal Background Check information.

5. Complete your CBC & Fingerprinting at least 30 days before the start of Clinical Practicum! If you’re not cleared by the Center for Professional Practice, you will not be able to start your Clinical Practicum.

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THE

SUPERVISORY

PROCESS

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Suggestions for Supervisees on Preparing for Supervision

A. Pre-Supervision 1. Choose one client. Videotape or audiotape a clinical or supervisory session. 2. Watching and listening to the tape, choose three segments, each about 5 minutes long:

If you observed the session a. One segment in which the session was effective b. One segment in which the session was ineffective c. One segment that surprised you

If you conducted the session a. One segment in which you were satisfied with your performance b. One segment in which you were dissatisfied with your performance c. One segment that surprised you

3. For each segment, write down your impressions concerning: If you observed the session

a. What you learned from this segment b. Your feelings/reactions during this segment, that is, the impact of the patient/client on you c. The effect or impact of the therapist's intervention on the patient/client

If you conducted the session a. Your skill as a clinician in this segment b. Your feelings/reactions during this segment, that is, the impact of the patient/client on you c. The effect or impact of your intervention on the patient/client

4. Choose one of the three segments to present during supervision. Write down why you have chosen this segment.

B. In-Supervision 1. Present the case, the clinical or supervisory segment, and why you chose it. 2. Identify the "problem" you want to deal with. 3. Define your objectives vis-à-vis this segment and this supervision session (i.e., want to determine

clear plan of what to do next time). 4. Identify your expectations for your supervisor (i.e., want confirming feedback that you handled the

situation well). 5. Choose the method by which you feel you can best be helped in this supervision session (i.e., tape

review, discussion, role-play) 6. Using the method chosen, go over the interview segment with the supervisor and self-evaluate a,

b, and c. 7. Check your self-evaluation with your supervisor's feedback on a, b, and c. 8. Work out incongruent evaluations 9. Explore with your supervisor alternatives for strategies whereby you can change certain behaviors

or ways of interacting with patient/client. 10. Try out alternative chosen in role-play situations. 11. Self-evaluate "new behavior" and check out with supervisor's feedback. 12. Evaluate the supervision session (i.e. What did you learn? What plan of action resulted from it?

Did this session respond to your needs?).

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Date ________ TOWSON UNIVERSITY

EVALUATION OF SUPERVISION FORM

SUPERVISOR ___________SEMESTER/YEAR ________ STUDENT’S NAME (OPTIONAL) ____________ Please rate the quality of supervision you received on the following tasks of supervision. Base your rating on the following scale: 5 = Strongly agree; 4 = Agree; 3 = Neither Agree or Disagree/Neutral; 2 = Disagree; 1 = Strongly disagree; N/A Not applicable or necessary.

1. My supervisor maintained a professional and supportive relationship that allowed for my clinical growth.

2. My supervisor communicated at a level that I understood.

3. My supervisor demonstrated and maintained ethical, legal and professional conduct.

4. My supervisor discussed diagnostic evaluation procedures with me.

5. I was assisted in determining a rationale for assessment and/or treatment procedures.

6. My supervisor assisted me in planning for my client.

7. My supervisor assisted me in developing observational skills for assessment and treatment sessions.

8. My supervisor assisted me in planning and modifying client treatment plans or case management based on data obtained and diagnostic findings.

9. I was provided with suggestions and guidance for intervention when appropriate.

10. My supervisor demonstrated clinical and/or counseling techniques to me when appropriate.

11. My supervisor was knowledgeable about the communication disorder(s) of my patient(s).

12. I feel I was observed an appropriate amount of time.

13. My supervisor was available for weekly supervisory conferences as scheduled.

14. My supervisor provided sufficient feedback of my clinical performance in written and verbal feedback.

15. My supervisor identified specific clinical strengths and communicated them to me.

16. My supervisor identified specific behaviors to be modified and communicated them to me in a way that helped me

improve.

17. I was encouraged to assess my professional and clinical strengths and weaknesses.

18. My supervisor facilitated my independent thinking and problem solving.

19. My supervisor assisted me in identifying appropriate information to include in clinical reports or notes.

20. My supervisor assisted me in using appropriate professional terminology and style in clinical writing.

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HIPAA

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THE BASICS OF HIPAA

I. What is HIPAA? HIPAA stands for the Health Insurance Portability and Accountability Act, which was implemented in 1996. This act created national rules regarding the privacy of health care information. Patient access to records, patient education regarding privacy, and receiving patient consent before the release of information are included under this act. HIPPA also established formats for the electronic transmission of clinical data. II. What is the Privacy Rule? The privacy rule of HIPPA enables the protection of individually identifiable health information contained in a patient’s medical record. This information includes a patient’s name, address, Social Security number, financial data, etc. Both hard and soft files are covered. The compliance date for this Rule was in effect on April 14, 2003. III. How does this affect me? As a student clinician you must abide by these federal laws to secure client confidentiality. Please refer to the Confidentiality Agreement. IV. How will I know what I can and cannot do? You will receive specific training on HIPAA guidelines, which will be documented on a HIPAA Training Acknowledgement Form. V. How will I inform the clients of our clinic practices? Clients will be given a Notice of Privacy Practices to read. The will then sign a Request for Services form to document that they have been informed. For more information about HIPAA, visit: www1.towson.edu/hipaa/ www.hhs.gov/ocr/hipaa. www.hcfa.gov/medicaid/hipaa/default.asp. www.hippacomply.com/legal.htm.

http://www.hhs.gov/ocr/hipaa

http://www.hcfa.gov/medicaid/hipaa/default.asp

http://www.hippacomply.com/legal.htm

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Speech, Language &Hearing Center Towson University-8000 York Road-Towson, MD 21252-0001 Voice or TDD: 410-704-3095 - Fax: 410-704-6303

HIPAA TRAINING ACKNOWLEDGEMENT

Employee/Student:____________________________________ Department:_________________________________________ HIPAA training completed on :_____________(date) Employee/Student Signature:____________________________ Trainer’s Signature:____________________________________

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Speech, Language & Hearing Center Towson University-8000 York Road-Towson, MD 21252-0001 Voice or TDD: 410-704-3095 - Fax: 410-704-6303 Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Examples of Disclosures for Treatment, Payment and Health Operations

1. We will use your health information for treatment. For example a speech-language pathologist or audiologist and a clinician in training under professional supervision will record information in your record to diagnose your condition and determine the best course of treatment. Some aspects of your evaluation and treatment may be used for instructional or demonstration purposes because we are a university training program. There may be observations by students from Towson University and affiliated training programs; confidential use of audio and video tape recording and clinic records; and/ore use of clinic records for research purposes.

2. We will use your health information for payment. For example, we may send a bill to you or a

third-party payer, such as a health insurer. The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received, and supplies used.

3. We will use your health information for health operations. For example, members of the

University’s staff, the University’s risk or quality improvement manager, or members of the University’s quality assurance team who have signed acknowledgements of their duty not to re-disclose any patient identifying information as defined by Maryland law may use information in your health record to assess the care and outcomes in your case and the competence of the caregivers. We will use this information to attempt to continually improve the quality and effectiveness of the healthcare and services we provide. As we are a university training program, we also may use audio or video taped recordings for teaching purposes in our academic course work.

Other Permitted Uses and Disclosures

Business associates: We provide some services through contracts with business associates. An example would be a hearing aid company we use to order hearing aids. When we use these services, we may disclose your health information to the business associates so they can perform the function(s) we have hired them to do, and bill you or your third-party payer for services rendered. However, we require the business associate to appropriately safeguard your information. Notification: We may use or disclose information to (help) notify a family member, personal representative, or another person responsible for your care, of your location and general condition.

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Communication with persons involved in your care: Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your payment for your care. Research: We may disclose information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. Continuity of care: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Fund-raising: We may contact you as part of a fund-raising effort. You have the right to request not to receive subsequent fund-raising materials. Please do so in writing addressed to the Speech-Language & Hearing Center at Towson University 8000 York Rd. Baltimore, MD 21252. Food and Drug Administration (FDA): We may disclose health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement. Workers Compensation: We may disclose health information as authorized by and as necessary to comply with workers compensation laws or similar programs established by law. Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, child abuse or neglect; or to a person at risk of contracting or spreading a disease or condition, if authorized by law. Correctional Institution: If you are an inmate of a correctional institution, we may disclose to the institution, or its agents, health information necessary for your health and the health and safety of other individuals, for law enforcement on the premises of the correctional institution, or the administration and maintenance of the safety, security and good order of the correctional institution. Law Enforcement: We may disclose health information purposes as required by law, to a law enforcement official for law enforcement purposes, or in response to a valid subpoena. Whistleblowing: If a member of our work force or a business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public, they may disclose your health information to health oversight agencies and/or public health authorities, such as the department of health, or to an attorney providing legal advice with respect to such a situation. Employer: We may disclose to your employer information relating to medical surveillance of the workplace or to work-related illness(es) or injury(ies). Disaster Relief: We may use or disclose your health information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordination with those entities the uses or disclosures permitted by the “Notification” section above.

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Authorization: We may use of disclose information incidental to a use or disclosure that is permitted or required by the privacy regulations. Incidental: We may use or disclose information incidental to a use or disclosure that is permitted or required by the privacy regulations. To you: We must disclose your health information to you on your request, as required by regulations on access to your health information and accounting of health information. Victims of abuse, neglect, or domestic violence: If we reasonably believe you are a victim of abuse, neglect, or domestic violence, we may disclose information about you to a government authority authorized by law to receive reports of such abuse, neglect, or domestic violence, including a social service or protective services agency. De-Identified information: We may use and disclose health information that does not identify you and which we have no reasonable basis to believe can be used to identify you. Health oversight activities: We may disclose information to a health oversight agency for authorized activities including audits; civil, criminal, or administrative investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight of the healthcare system; government benefit programs for which health information is relevant to beneficiary eligibility; entities subject to government regulatory programs for which health information is necessary for determining compliance with program standards; or entities subject to civil rights laws for which health information is necessary for determining compliance. Disclosure for judicial and administrative proceedings: We may disclose information in any judicial or administrative proceeding in response to an order of a court or administrative body, a subpoena, discovery request, or other lawful process. Threat to health or safety: We may use or disclose information if we believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, or is necessary for law enforcement officials to identify and apprehend a person admitting participation in a violent crime. Specialized government functions: We may use and disclose U.S. or foreign military personnel’s health information as deemed necessary by military command authorities. We may use and disclose information to authorized federal officials to conduct lawful intelligence, counter-intelligence and other national security activities. We may use and disclose information to authorized federal officials who provide protective services. The federal department of Health and Human Services (DHHS): Under the privacy standards, we must disclose your health information to DHHS as necessary for them to determine our compliance with those standards.

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Your Rights Under the Federal Privacy Regulations

Although your health records are property of the health care provider who completed them, you have certain rights in the confirmation contained in the records. You have the right to: 1. Request restriction on uses and disclosures of your health information for treatment, payment, and

healthcare operations; uses and disclosures for involvement in your care and for notification purposes. Health care operations are activities that are necessary to carry out our operations, such as quality assurance and peer review. Involvement in your care and notification purposes includes disclosure to a person directly related to that person’s involvement with your care, or payment for your care; notification to a person responsible for your care of your location, general condition, or death; and uses and disclosures for disaster relief purposes. We do not have to agree to any restriction you request. However, if we do agree, we will comply with the restriction, unless disclosure is necessary to provide you with emergency treatment, or unless you request otherwise or we give you advance notice.

You may also request, in writing that we communicate with you by alternate means or at alternate locations. If the request is reasonable, we must grant it. 2. Obtain a copy of this notice of information practices. Although we have posted a copy of this notice

in prominent locations throughout the facility and on our website, you have a right to request and receive a paper copy.

3. Inspect and copy your health information upon your written request. This right is not absolute. In

certain situations we can deny access. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable cost-based fee for making copies.

4. Request in writing, amendment/correction of your health information, providing reasons to support

the requested amendment. We do not have to grant the request if: a. We did not create the record. For example, if we have a consultation report from another

provider, we did not create the record, and we cannot know whether it is accurate or not. In such cases, you must seek amendment/correction from the party creating the record. If they amend or correct the record, we will put the corrected record in our records.

b. The records are not available to you for inspection as discussed in section 3 immediately above c. The record is accurate and complete

If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), how you can request that we include your request and our denial with any future disclosures, and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those you indicate should receive the corrected information. 5. Obtain an accounting of “non-routine” uses and disclosures (those other than for treatment, payment,

and health care operations). We do not need to provide an accounting for disclosures: a. to you of protected health information about you b. which you have authorized c. for the facility directory or to persons involved in your care or for other notification purposes

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under section 164.510 d. for national security or intelligence purposes under section 164.512(k)(2) e. to correctional institutions or law enforcement officials under section 164.512(k)(5) f. that occurred before April 14, 2003

We must provide the accounting within 60 days. The accounting must include the date of each disclosure; the name and address of the organization or person who received the protected health information; a brief description of the information disclosed; a brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure, or a copy of the written request for disclosure. The first accounting in any 12 month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee. 6. Revoke, in writing, your authorization to use or disclose health information except to the extent that

we have already taken action in reliance on the authorization 7.

Complaints If you believe your privacy rights have been violated, you may complain to Towson University and/or to the Secretary of the U.S. Department of health and Human Services. To complain to Towson University, you should contact the University’s privacy officer, Daniel Leonard, at 410-704-2361 or [email protected]. You will not be retaliated against for filing such a complaint.

Our Obligations Under the Federal Privacy Standard In addition to providing you the rights detailed above, the federal privacy regulations require us to:

1. Maintain the privacy of your personally identifiable health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information

2. Provide you with notice of our legal duties and privacy practices with respect to individually identifiable information we collect and maintain about you

3. Abide by the terms of this notice 4. Train our personnel concerning privacy and confidentiality 5. Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies

with regard thereto 6. Mitigate (lessen the harm of) any breach of privacy/confidentiality

WE RESERVE THE RIGHT TO CHANGE OUR PRIVACY PRACTICES AS SET FORTH IN THIS NOTICE AND TO MAKE NEW PROVISIONS EFFECTIVE FOR ALL INDIVIDUALLY INDENTIFIABLE HEALTH INFORMATION WE MAINTAIN. SHOULD WE CHANGE OUR INFORMATION PRACTICES, WE WILL MAIL A REVISED NOTICE TO THE ADDRESS YOU HAVE SUPPLIED US. We will not use or disclose your health information without your authorization, except as described in this notice or otherwise required by law.

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How to Get More Information or to Report a Problem If you have questions and/or would like additional information, you may contact the privacy officer, Daniel Leonard at 410-704-2361.

Effective Date

This notice is effective as of O:\student\SLH Center Forms

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HIPAA Training

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Slide 1

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Towson University HIPAA Training

Revised 6-02-2003

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HIPAA Overview

•General explanation of HIPAA

•Departmental policies & procedures

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Agenda• History• Purpose• Failure to comply• Covered entities• Electronic transactions• Security• Privacy• Complaint Procedure

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History• HIPAA stands for “Health

Insurance Portability & Accountability Act of 1996”

• HIPAA was passed in 1996 as part of a broad congressional attempt at healthcare reform

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Purpose

• Health care portability• Accountability

– Fight abuse– Reduce expenses– Provide EDI standards– Provide security &

privacy of health care information.

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Title II Fraud and Abuse

Medical Liability Reform

Administrative Simplification

Electronic Transaction Standards (EDI)

Security Standards

PrivacyStandards

Includes clinical code sets Includes key identifiers

For protecting electronic health information

To spell out permissible uses of patient identifiable healthcare information

Title II: Administrative Simplification

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Title II: Administrative Simplification

• To protect and enhance privacy rights• To restore consumer trust in health care systems• To increase the efficiency and effectiveness of

the entire health care system through: The electronic exchange of information The standardization of that information

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Enforcement/Liabilities

• Civil DHHS/OCR $100 per violation per person up to a maximum of

$25,000 per person per year per standard violated• Criminal DOJ/U.S. Attorney Up to $50,000, 1 year in prison, or both, for

inappropriate use of PHI Up to $100,000, 5 years in prison, or both for using PHI

under false pretenses Up to $250,000, 10 years in prison or both, for the intent

to sell or use PHI for commercial advantage, personal gain, or malicious harm

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Am I Covered Under HIPAA Regulations?

• Yes- that’s why you’re here!

•Voluntary entity•Covered entity

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HIPAA Applies To:Covered entities:

• Health plans (licensed insurers, ERISA plans, HMOS, Medicare, etc.)

• Providers (physicians, hospitals, home health, pharmacy, chiropractic, dental, etc.) Who conduct 1 or more of the HIPAA-defined transactions electronically

• Clearinghouses

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Electronic Transactions

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Electronic Transactions

Health Center Speech-Language-Hearing Clinic

Providers

Testing labs

Insurance Companies

Bursar’s Office

Hearing Aid Company

Patient

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Electronic Transactions• Must use HIPAA standards for

designated transactions• Must use appropriate code sets in

transactionsMedical data code sets Non-medical data code sets

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Security

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Security

•Security management•Security official•Appropriate access to PHI•Security awareness & training•Security incident policies & procedures

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Security

•Limit physical access to information systems•Workstation use & security•Device & media controls•Technical controls

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Privacy

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Privacy: Key Features

• PHI• Uses & disclosures• Minimum necessary• Business associates• Privacy notice• Authorization

• Patient rights• State law Interaction• Administrative

Requirements• Enforcement• Complaint Procedure

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Privacy Rule: What Does It Do?

HIPAA regulates the use or disclosure of protected health information (PHI).

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What Is PHI?Health and demographic information about an

individual, transmitted or maintained in any medium that:

• Is created or received by a health care provider, health plan, employer, or health care clearinghouse; And

• Relates to the past, present, or future: Physical or mental health condition of an individual, or Provision of health care to an individual, or Payment for the provision of health care to an individual.

• Identifies, or can be used to identify, the individual

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Permitted Uses & Disclosures

Covered entities are permitted to use and disclose PHI for:

• Treatment• Payment• Health care operations

“TPO”

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Permitted Uses & Disclosures• HIPAA also permits the disclosure of PHI for

certain purposes such as: Health oversight activities Judicial and administrative proceedings Required by other law Law enforcement purposes Research purposes Health or safety emergency

• All other uses or disclosures outside of TPO require an authorization.

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Mandated Uses & Disclosures

HIPAA mandates the disclosure of PHI to:• Department of Health & Human Services• The Patient

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Minimum Necessary

The privacy rule requires covered entities to use or disclose only the “minimum necessary” PHI to accomplish the intended purpose of the use, disclosure, or request.

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Minimum Necessary

• Internal requirements: Identify workforce who need to access PHIFor each class, category or person identified,

limit access based on need-to-know • External requirements:Limit access to what is needed to accomplish

the purpose for which the request was madeMay “reasonably rely” that the requesting

entity is asking for the “minimum necessary”.

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Business Associate

A person or entity who either provides services on behalf of a Covered Entity, or to a Covered Entity which involves the use or disclosure of PHI

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Business Associate

• InternalCANSBursar’s officePrinting servicesInternal auditingLegal

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Business Associate• ExternalMedical laboratoriesStudent insurance planMedical software vendorDocument Shredding Companies

• Need special HIPAA provisions in contract• Recourse if BA violates HIPAA

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Privacy NoticePrivacy notices must:

• Be in plain language• Contain a description and example of TPO• Contain a description and example of other

uses and disclosures not requiring authorizationWhat you can do is limited by what’s in your

notice

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Privacy NoticePrivacy notices must:

• Include statements about an individual’s rights• Include statements about the covered entity’s duties• Describe the complaint process

Provide other specific requirements•Must retain a written acknowledgement•Must be available to patient no later than first treatment

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Authorization• Authorization must be obtained for ALL uses and

disclosures other than TPO or those mandated or permitted by HIPAA.

• Authorizations must include: A description of the information to be disclosed The name of the person or entities to whom the

information will be disclosed An expiration date (generally limited to a year) Information regarding right to revoke Date and signature Purpose of disclosure Effect of refusal to sign authorization

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Patient RightsPatients have the right to:• Receive written notice of privacy practices • Request restrictions on uses & disclosures• Request alternate methods &/or locations for

communication• Access, inspect & copy their PHI• Request amendment or correction of their PHI• Receive an accounting of disclosures of their PHI

(except those related to treatment, payment, & operations)

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Interaction With State Law

HIPAA is subject to state law provisions that are “more stringent”

In general, “more stringent” means provisions that provide more access by patient to their own PHI, and less access to patient’s PHI by anyone else.

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Administrative Requirements

• Designate a privacy officer to ensure HIPAA compliance

• Establish workforce training programs• Implement policies & procedures to prevent

disclosures of PHI• Establish safe-guards to protect PHI• Establish a HIPAA complaint procedure• Implement sanctions for HIPAA violations

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Towson University Complaint Procedure

• Privacy OfficerDan Leonard, 410-704-2361

• 120 days• Confidentiality• Good faith• Discipline• EXTERNAL FILING

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Resources

Web Pages

• Towson University WWW.Towson.edu/HIPAA

• U.S. Department of Health and Human Services http://aspe.hhs.gov/

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Resources

Other

• Department liaison

• HIPAA guide

Who you can call:

• Privacy officer 410-704-2361

• CANS help desk 410-704-5151

• Legal counsel 410-704-6062

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Towson University Policy on Compliance with the Health Insurance Portability and Accountability Act

I. General The policy of Towson University is to comply with the Health Insurance Portability and Accountability Act (HIPAA), and its implementing regulations, to the extent that HIPAA and the HIPAA regulations are applicable to the University. II. Status as Hybrid Entity Towson University has determined that it is a hybrid entity, and has designated its health care components (including those which would be business associates if they were separate legal entities). The University’s HIPAA privacy officer keeps the current designations. Such designations may be amended from time to time by the privacy officer. III. Required Designations The University’s HIPAA privacy officer, who is also designated to receive complaints and provide further information about matters covered by the University’s Notice of Information Practices, is. IV. Procedures Each health care component designated as described in section II above is responsible for developing procedures to comply with HIPAA, including safeguards to protect the privacy of protected health information as required by HIPAA. Each component is also responsible for providing the University’s privacy officer with a current copy of the procedures, and the name, title and phone number of the component’s contact person for HIPAA issues. The privacy officer can require a health care component to change its procedures. V. Meetings The privacy officer has authority to call a meeting of all designated health care components as necessary in his or her discretion. VI. No retaliation. Neither the University, nor any of its employees, will intimidate, threaten, coerce, discriminate against, or take other retaliatory action against:

1. Any individual for his or her exercise of any rights under, or participation in any process established by, the HIPAA privacy regulations, including filing a complaint ; or

2. Any person for: a. filing a complaint with the U.S. Secretary of Health and Human Services (or any other officer or employee of HHS to whom the authority has been designated) under the HIPAA regulations; b. testifying, assisting, or participating in an investigation, compliance review, proceeding, or hearing under Part C of Title IX; or

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c. opposing any act or practice made unlawful by the HIPAA privacy regulations, provided the person has a good faith belief that the practice opposed is unlawful, and the manner of the opposition is reasonable and does not involve a disclosure of protected health information in violation of the HIPAA privacy regulations. VII. Training The University will develop a general training program to be used in each health care component as designated in section II. The University’s privacy officer will have current copies of all training materials. In addition, each component is responsible for developing a training specific to that component, and for providing the University’s privacy officer with copies of its specific training materials. Both the general and the specific training will be provided to employees as required by HIPAA, under the oversight of the University’s privacy officer. The privacy officer can require a health care component to revise its training materials. VIII. Waiver of Rights The University may not require individuals to waive their rights under section 160.306 of the HIPAA regulations, or under the HIPAA privacy regulations, as a condition of the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits. IX. Mitigation The University must mitigate, to the extent practicable, any harmful effect that is know to it of a use or disclosure, by the University or its business associates, of protected health information in violation of its policies and procedures or the HIPAA privacy regulations. X. Sanctions Violation of this policy by a University employee is subject to appropriate personnel action. XI. Documentation The University’s privacy officer will determine whether documentation required by HIPAA should be kept centrally by the privacy officer, or whether any health care component will be responsible for keeping its own documentation as required by HIPAA. The privacy officer has the authority to require any health care component to send all documentation to him/her. XII. Amendment The University may change this policy and the procedures described herein as necessary and appropriate, in accordance with standard University procedures.

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TOWSON UNIVERSITY HIPAA COMPLAINT PROCEDURE

I. GENERAL A. Purpose: The policy of Towson University is to comply with the Health Insurance Portability and Accountability Act (HIPAA), and its implementing regulations, to the extent that HIPAA and the HIPAA regulations are applicable to the University. Pursuant to the HIPAA Policy the Privacy Officer has established the complaint procedure to investigate allegations of policy violation, and to provide for appropriate discipline for persons who violate the policy. The complaint procedure also applies to the university units that voluntarily choose to apply HIPAA standards, even though HIPAA is not applicable to them. To complain to Towson University, you should contact the University Privacy Officer, Dan Leonard at 410-704-2361, or email at [email protected]. B. Notification of Policy Requirement: This procedure is available at www.towson.edu/HIPAA. It is also included among the University's personnel policies. All complainants shall be informed of their right to file a complaint with the Privacy Officer. The Privacy Officer shall then notify the complaining individual (the “Complainant”) of the HIPAA policy and of the procedures for filing a complaint, or verify that the Complainant already has this information. C. Prohibition Against Retaliation: Retaliation against a Complainant or a person who provides information in support of a Complainant is prohibited. Any person who retaliates against a Complainant or a person who provides information in support of a Complainant shall be subject to disciplinary action as provided in the HIPAA policy. II. COMPLAINT PROCEDURES A. Generally: Individuals subjected to a violation of HIPAA should direct any complaints to the attention of Towson University Privacy Officer. Complaints reported to the Privacy Officer shall be retained in a confidential file, separate from any other personnel or student files. The confidential file will include the name of the Complainant, the name of the person alleged to have violated the HIPAA policy (the “Respondent”), the nature of the complaint,

http://www.somewhereontowsonuniversity'swebpage/

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incident date(s), disposition, witnesses and any other information relevant to the incident. All complaint files will be retained for six years. The University is committed to taking appropriate action against persons who violate the HIPAA policy, but ultimately, it may not be able to satisfactorily investigate or resolve a particular complaint without the initiative and continuous cooperation of the person who feels injured. B. Filing a Complaint: Complaints alleging violation of HIPAA or retaliation in violation of the HIPAA policy must be made within one hundred twenty (120) days following an alleged incident of violation or retaliation. The Privacy Officer may waive the 120-day period upon a showing of good cause. Upon receipt of the complaint, the Privacy Officer will arrange to speak with the Complainant to discuss how to proceed with formal complaint procedures. The Complainant should set forth in writing the facts or omissions giving rise to the alleged violation of HIPAA or retaliation including the date(s) the alleged conduct occurred, the name(s) of the person(s) alleged to have violated the HIPAA policy, the name(s) of person(s) having knowledge of the alleged violation(s), and any supporting documentation. The Privacy Officer shall investigate the complaint; however, if the Privacy Officer is the subject of the complaint, then the University’s Counsel shall investigate the complaint. The investigation may include discussions with the Respondent. During the investigation, the Privacy Officer shall be given access to any information that relates or pertains to the complaint. The Respondent shall cooperate during the investigation by being available during reasonable business hours to discuss the complaint and to make available the information requested by the Privacy Officer. No information shall be denied the Privacy Officer absent good cause. In the event the Privacy Officer is denied information or the Respondent refuses to cooperate during the investigation, the Privacy Officer shall seek the advice of Counsel regarding the denial or the refusal to cooperate. Counsel shall then review the matter and advise whether the information should be disclosed or whether the Respondent must cooperate. Refusal to provide the Privacy Officer the requested information or to cooperate following Counsel’s opinion that the information should be disclosed or that Respondent’s cooperation is necessary may constitute a violation of the HIPAA policy. The Privacy Officer shall, within 90 days following the date the Complainant elects to proceed formally, make a determination addressing whether the HIPAA policy has been violated. The Privacy Officer may submit the results of the investigation to Counsel for legal review. The Complainant and the Respondent will be sent a formal letter of finding informing them of the findings and conclusions of the investigation. C. Confidentiality: The Complainant, the Respondent, witness or any other person involved in the investigation or resolution of a complaint may disclose information only to those persons necessary to the filing, investigation and disposition of the complaint under the HIPAA policy. Failure to exercise care in the disclosure of information is a violation of this policy and may result in disciplinary action as more particularly provided in the HIPAA policy.

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D. Good Faith Requirement: Allegations of violation of HIPAA are serious, with potential for great harm if made without justification. Accordingly, it is a violation of the HIPAA policy for an individual to file a complaint without justification or in bad faith. An individual found to have filed a complaint without justification or in bad faith has violated the HIPAA policy and will be subject to disciplinary action. E. Other Violations of the Policy: The Privacy Officer may, on his or her own motion, identify policies, practices or patterns of behavior which may reflect violation of HIPAA prohibited by the HIPAA policy, and call these to the attention of the appropriate officials of the unit involved and recommend appropriate action. The Privacy Officer shall endeavor by negotiation to eliminate the alleged violation of HIPAA . Where such efforts fail, the Privacy Officer may on his or her own motion report the matter to the President. III. DISCIPLINE Discipline, including termination, may be imposed for violating the HIPAA policy. If the employee found to be in violation of the HIPAA policy (“Violator”) is a classified employee, whether exempt or non-exempt, any discipline shall be imposed in accordance with USM policies relating to the discipline of classified employees. If the Violator is an exempt regular employee any discipline shall be imposed in accordance with USM and University policies relating to regular exempt employees. If the Violator is a tenured or tenure-track faculty member, or a person with seven or more years of continuous service as a full time instructor or lecturer, any discipline shall be imposed pursuant to USM and University policies on Appointment, Rank and Tenure. If Violator is a student any discipline may, at the discretion of the Privacy Officer, be imposed pursuant to the Student Code of Conduct. Unless another relevant policy (as described above) specifies a different procedure, the university Privacy Officer shall impose the discipline, if any, by informing the Violator in writing of the discipline and the reasons supporting it. IV. EXTERNAL FILING PROCEDURES The Privacy Officer shall ensure that each complainant is informed of his/her right to file the complaint with the appropriate state and federal agencies. A person wishing to file a formal complaint with an external agency may do so. External complaint procedures DO NOT apply to the university units that voluntarily choose to apply HIPAA standards.

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SAFE WORK

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THE CLINIC

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HEPATITIS B SHOTS/BLOODBORNE PATHOGENS The nature of the clinical work that Speech-Language Pathologists and Audiologists do will bring them into contact with clients who have identified or unidentified Hepatitis B Virus. You should discuss with your physician the advisability of obtaining the three-shot Hepatitis B Vaccination series, which is offered to you at reduced cost ($45.00 per shot) at the University Health Clinic. Shots are available throughout the year. Contact Health Clinic (830-2466) for specific times and to make an appointment. You can pay for each shot either through your Retail Spending Account, by check at the Health Clinic, or can be billed. If using the Retail Spending Account go to Room 118 of University Union to pay for shot and bring I.D. card to Health Clinic when you go for shot. You only pay for one shot at a time. All on-and off-campus student clinicians in SLP and Aud must either take the series of shots or sign a declination form if they choose not to receive the vaccine at the present time. Forms will be given out at all Organizational Meetings. It is strongly recommended that all student clinicians obtain the shots. We have clients in the Clinic with identified Hepatitis B. However, it is the unidentified population that is the real problem in your clinical and personal interactions. Prior to working in the clinic, all SLP and Aud Student Clinicians off and on campus must attend a meeting on Safe Work Practices in the Clinical Setting to learn about Occupational Exposure to Bloodborne Pathogens. If you have not attended the TU meeting previously, you must do so prior to starting clinical practicum. (See clinic schedule) This information is for your protection as well as that of your clients. Those students who had the lecture, either in Observations and Clinical Techniques class or in past Clinical Practicum at TU, do not have to attend the meeting.

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Speech, Language & Hearing Center Towson University-8000 York Road-Towson, MD 21252-0001 Voice or TDD: 410-704-3095 - Fax: 410-704-6303

ASEPTIC CAUTIONS AND PROCEDURES

The following information was provided during Bloodborne Pathogen Training presented by TU’s Department of Environmental Health & Safety. Bloodborne Pathogen training is provided to employees both initially and on an annual basis. BBP training is provided to students upon request. The purpose of the policy is to reduce the risk of occupational exposure to those involved with bloodborne pathogens including Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). In this clinic, the main potential hazard for contracting a bloodborne pathogen is via saliva transfer during evaluations and/or human bites. Definition of Terms:

1. Occupational Exposure – reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s (student clinician’s) duties.

2. Other Potentially Infectious Materials – (1) The following human body fluids: semen, vaginal

secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

3. Exposure Incident – a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral

contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

4. Bloodborne Pathogens – pathogenic microorganisms that are present in human blood and can

cause disease in humans. These pathogens include, but are not limited to, HBV and HIV.

5. HBV – a disease of the liver caused by the Hepatitis B Virus.

6. HCV – a disease of the liver with symptoms similar to HBV.

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7. HIV – a disease causing the destruction of the immune system and which ultimately leads to a group of symptoms and diseases known as Acquired Immunodeficiency Syndrome (AIDS).

8. Engineering Controls – specific devices used to isolate or remove the bloodborne pathogens

hazard from the workplace. (E.g., sharps disposal containers, self-sheathing needles, sharps with engineered sharps injury protections, etc.)

9. Work Practice Controls – specific procedures that reduce the likelihood of exposure by altering the

manner in which a task is performed. (E.g., wearing personal protective equipment, cleaning work surfaces regularly, proper disposal of medical waste, etc.)

10. Universal Precautions – an approach to infection control whereby all human blood and certain

human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

11. Needlestick Prevention Act – requires employers to use needleless systems and to use sharps with

engineered protection features. A Sharps Injury Log, containing detailed information about any sharps injuries that may occur, must be maintained.

12. Exposure Control Plan – a written program designed to minimize or eliminate employee

occupational exposure. The Plan is available for review at the Dept. of Environmental Health & Safety.

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HBV versus HIV HBV HIV Mode of Transmission Blood yes yes Semen yes yes Vaginal Secretions yes yes Saliva (from a bite) yes no Target in Body liver immune system Risk of infection after needlestick or infected blood 6-30 % 0.3 % Number of cases in HCW’s 12,000/yr 40 (total) (Health Care Workers)

High number of viruses yes no in blood Estimated amount of 0.00004 ml 0.1 ml blood needed for transmission* Vaccine available yes no *Typical needlestick inoculates 0.001 ml of blood

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IMPORTANT INFORMATION REGARDING HBV

1. 25% of infected individuals develop acute hepatitis

2. 6-10% become HBV carriers that can develop liver disease and are infectious to others.

3. HBV is fairly widespread and 12,000 Health Care workers become infected through occupational exposure every year. The main mode of infection is needlesticks.

4. Antibodies for HBV in an infected person’s blood can be detected through testing.

5. At present there are preventive and post exposure vaccines available for HBV.

6. Vaccines provide >90% protection for 7 or more years.

7. Post exposure vaccines are 70-80% effective when given within one week of exposure.

PRECAUTIONS AND SAFE WORK PRACTICES To reduce the risk of exposure to infectious materials, the following precautions should be taken:

1. Blood and other body fluids from ALL clients should be considered infective

2. Eating, drinking, smoking, applying cosmetics, handling contact lenses are prohibited in work areas where there is reasonable chance of occupational exposure.

3. Be careful of human bites for they increase the risk of being infected with HBV because y

ou may incur saliva to blood contact (if skin is broken). 4. Latex gloves should be worn at certain times. (See Aseptic Technique in manual). If gloves

are used, hands should be washed immediately after gloves are removed. Disinfect all work surfaces before and after seeing a client. Gloves should be worn when cleaning surface areas if there is visible contamination.

5. Students should follow the Aseptic Technique procedures outlined in the manual.

6. Tongue depressors as well as gloves must be disposed of in the Med Express Pac (for

hazardous waste).

7. If clothes are contaminated, the spot should be washed off as soon as possible with spot remover or soap and water. This will eliminate further contamination. The longer you are in contact with the infected material the higher the risk of being infected.

8. If there is some reason to believe you have been exposed to infectious material, contact the

personnel in the Speech, Language & Hearing Center immediately. If you and/or personnel in the Speech, Language & Hearing Center feel there is a need for further evaluation, contact the TU Health Center.

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9. Hands and other skin surfaces should be washed immediately if contaminated with blood or other body fluids.

10. Reusable materials that are contaminated with blood or bodily fluids should be cleaned with

disinfectant.

11. Wash hands before and after treating a client.

12. If a glove is torn for some reason, the glove should be removed and replaced with a new glove immediately. Gloves should fit properly and may even be doubled up. Make sure gloves are changed between clients.

13. Soiled, reusable linen should be placed in a leak proof bag and laundered.

14. Dispose of gloves and tongue blades in a Medical waste can – not in the trash can.

15. If an active ear infection is suspected, do not have clients or significant others use ear

phones. This includes screening, testing, and observation.

HANDWASHING 1. This should be performed in a utility or restroom sink and never in a food preparation area. 2. Wash with soap and water.

3. See handwashing technique in Manual and in Restrooms.

**This information is provided for your benefit and safety. All safe work practices and procedures are to be followed (especially when working with high risk populations such as the mentally handicapped and IV drug users.)

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HANDWASHING TECHNIQUE

This technique is to be utilized by EVERY clinician before and after EVERY client contact. 1) Using liquid soap, lather hands, wrists, and forearms. 2) Rub hands vigorously with soapy water for 60 seconds,

interlacing fingers. 3) Rinse thoroughly, allowing water to drain from fingertips to

forearms 4) Use paper towels to dry hands. 5) Turn off faucets and handle doorknobs with dry paper

towels AFTER drying hands.

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FIRE

EMERGENCY

POLICY

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Department of Environmental Health & Safety Phone: (410) 704-2949 Fax: (410) 704-2993 Emergency: (410) 704-2133 Email: [email protected] Website: http://wwwnew.towson.edu/adminfinance/facilities/ehs/ REVISED MARCH 2004

FIRE EMERGENCY

POLICY

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FIRE EMERGENCY POLICY This is a statement of offi cial University policy for the reporting of fi re emergencies and for the evacuation of all campus buildings during fire emergencies, in compliance with local, state, and federal regulations. The Department of Environmental Health & Safety (EHS) is the University’s primary point of contact for all fire safety issues and all Federal, State and Local fire protection agencies and organizations including, but not limited to, the Maryland State Fire Marshal’s (SFM) Office and the Baltimore County Fire Department (BCFD). The Baltimore County Fire Department (BCFD) is the primary point of contact for all fire emergencies. A. POLICY:

1. A “Fire Emergency” exists whenever:

a) A building fire alarm is sounding;

b) An uncontrolled fire or imminent fire hazard occurs in any building or area of the campus;

c) There is the presence of smoke, or the odor of burning within any campus building;

d) There is spontaneous or abnormal heating of any material.

e) There is an uncontrolled release of a hazardous material.

f) There is the odor of natural gas in any building on campus.

2. If condition a. listed above exists: It will be reported immediately to the TUPD. They have 2 minutes in which to confirm an automatic fire alarm by either having an Officer verify on scene or receiving independent telephonic confirmation. If the alarm is not confirmed within 2 m inutes, the BCFD will be notified immediately. IN NO INSTANCE WILL THE DELAY IN NOTIFYING THE BCFD BE GREATER THAN 2 MINUTES.

3. If any condition listed in b. through d. above exists: It will be reported immediately to Baltimore County’s 911 Center.

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4. If any condition listed in e. and f. above exists:

It will be reported immediately to the TUPD. Upon confirmation, and as necessary, the TUPD will notify the appropriate internal departments (EHS, Facilities Management) and the BCFD. EHS will notify the appropriate external departments/agencies (MDE, OSHA, SFM, etc.). B. INTERRUPTION OF FIRE ALARM:

1. No person may shut off any fire protection or alarm system during a fire emergency incident without the permission of the BCFD.

2. No person may shut off any fire protection or alarm system during a bomb threat emergency without the permission of the TUPD Incident Commander.

3. It shall be the responsibility of Facilities Management to reset any fire protection or a larm system after an emergency incident when notified by the BCFD or TUPD Incident Commander. EHS in cooperation with Facilities Management shall inspect each such system as soon as possible after every emergency incident and place the system in serviceable condition. If repairs are required, the responsible contractor shall be notified immediately. If repairs cannot be completed within 24 hours, and the system is considered non-functional by EHS, the impairment policy will be placed into effect until such time as the repairs can be completed.

4. Facilities Management may reset an alarm system only if there is no damage to the system and when it is within their technical capabilities to do so.

5. Any person desiring to interrupt service to any fire protection or a larm system must obtain permission from EHS through Facilities Management’s Work Control Center.

6. The TUPD should request Facilities Management to reset a fire protection system or EHS to repair a fire protection system, via the Work Control Center (x4-2481)

C. PROCEDURES: Campus Buildings shall be immediately and totally evacuated whenever the building fire alarm is sounding. All personnel will evacuate the building. NO PERSONNEL WILL ATTEMPT TO FIGHT THE FIRE. Upon discovery of evidence that a fire emergency exists, an individual shall accomplish, or cause to be accomplished, the following actions:

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IF THERE IS A FIRE:

1. PULL THE BUILDING FIRE ALARM. If you discover or suspect a fire, sound the building alarm.

• From a safe location outside of the building, dial 911. At the emergency blue-light & yellow phones located around campus, press the emergency button to be connected to the TUPD who can contact the 911 Center, or dial 911 on the key pad to be connected directly to the 911 Center.

• Remain calm; give your name and the location of the fire (building and room number and what is burning, if known).

• Meet the Fire Department outside and direct them to the emergency.

2. DO NOT ATTEMP TO FIGHT THE FIRE – EVACUATE!!!! Towson University’s official policy is that no employees will fight fires in University buildings. All employees will immediately evacuate the building and notify the 911 Center there is a fire.

3. FEEL THE DOOR. If the door is closed in the room where you are located, do not open the door before feeling the knob and upper door for heat.

• If the knob and door are cool to the touch, brace yourself against the door and open it slightly.

Check the conditions of the hall. If the hall does not contain excessive heat and smoke, proceed to the nearest exit.

• If the knob and/or door is hot, or even warm to the touch, do not open the door – there is a good

chance that the fire is in the hallway near your room and your probability of reaching an exit is very slim. Remain in your room and follow the instructions for being trapped.

4. GO TO THE NEAREST EXIT OR STAIRWAY. Evacuate the building using corridors and stairwells. Close as many doors as possible between you and the fire. This helps to confine the fire. Shut off all machinery and equipment in your area on your way out.

5. NEVER USE AN ELEVATOR! The power can fail leaving you stranded between floors in a burning

building. Elevator shafts and open stairwells produce a chimney effect, drawing smoke and heat up the shaft.

6. CRAWL IF THERE IS SMOKE. If you encounter excessive smoke while evacuating the building, get as low as possible and crawl to the nearest exit. Heat and smoke rise, so the coolest, cleanest air will be near the floor. If possible, cover your mouth and nose with a wet cloth, etc. to cool and partially filter the air you breathe.

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7. If your primary exit becomes blocked, use a secondary exit. Once outside the building, move to a safe

location at least 300 feet away from the building. DO NOT RE-ENTER THE BUILDING FOR ANYTHING UNTIL A FIRE OR POLICE OFFICIAL SAYS IT IS SAFE TO DO SO.

8. All fires, even if extinguished or found to be extinguished, must be reported to TUPD at x4-2133.

9. All fire alarms, even if suspected of being false or accidental, must be reported to the Baltimore County 911 Center.

10. The Department of Environmental Health and Safety (EHS) asks that you render reasonable assistance to disabled persons to evacuate and ensure that they are aware of the alarm if these actions do not place you in personal danger.

IF YOU ARE DISABLED:

1. If you are disabled, either temporarily or permanently, to an extent that impairs your mobility, it is your responsibility to inform your Supervisor and Environmental Health and Safety (x4-2949). You are the best judge of your physical limitations. Your name, building, room number and the nature of your disability will be placed on a list that will be given to the Baltimore County Fire Department (BCFD) in an emergency. If you are unable to evacuate and your office is in a fire area, your rescue will be the first priority for rescue units.

2. Co-workers will assist you to evacuate only if this places them in no personal danger. (See Item #10 above).

3. NEVER use elevators for evacuations.

4. Mobility impaired persons in wheelchairs on non-ground level floors should proceed to the nearest enclosed stairwell and wait for the BCFD to arrive. Have someone stay with you (if it places them in no personal danger) and someone meet the responding BCFD Unit to report your location. (Follow the instructions below for being trapped if you cannot get to an enclosed stairwell.)

5. Visually impaired persons should have a sighted assistant to guide them to safety.

6. Individually inform hearing impaired persons of the emergency. Do not assume they know what is happening by watching others.

IF YOU GET TRAPPED:

1. Stuff the cracks around the door with towels, lab coats, throw rugs, etc. to keep out as much heat and smoke as possible.

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2. Go to the window and if it is clear outside (no smoke or flames), open the window at the top (to let any heat and smoke out of the room) and at the bottom (for a source of fresh air). Signal for help by hanging a “flag” (sheet, jacket, etc.) out of the window.

3. If there is a telephone in the room, call 911 and advise them of your exact location, even if the BCFD is are already on the scene. They will send rescue personnel to your location.

4. Do not attempt to jump from a multi-story building. Jumps from heights of three floors (36 feet) or higher are almost always fatal.

BEFORE A FIRE OCCURS:

1. Learn the location of fire exits and fire alarm pull stations where you work, live, and when traveling – it may well save your life! (Fire alarm pull stations are usually located near building exits.)

2. Maintain corridors clear of ALL OBSTRUCTIONS.

3. Report damaged fire equipment.

• Fire Doors - Keep stairwell doors and smoke doors in corridors CLOSED unless equipped with automatic self-closing devices connected to a smoke detector or the building fire alarm system.

• Exit Signs – Two exits should be visible from all public areas. • Fire Alarms – Keep audio/visual devices and pull stations accessible. • Smoke Detectors – Keep them clear so they can detect smoke easily.

4. Use only U.L. listed appliances and do not overload outlets. Replace damaged wires.

5. Participate in fire drills…they are for your life safety.

D. EVACUATION POLICY: The evacuation policy shall be as follows:

1. It shall be the responsibility of every person to immediately leave a University building whenever the fire alarm is activated or a fire emergency exists. All students, faculty, and staff are required to leave the building and remain outside until the emergency is over. No one shall restrict or impede the evacuation. NO ONE WILL ATTEMPT TO FIGHT A FIRE IN A CAMPUS BUILDING. The BCFD has the responsibility to extinguish all fires on campus.

E. REVIEW: Department heads are expected to review fire prevention and fire survival policies at the beginning of each semester with faculty and staff, or to schedule

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such a presentation with EHS. Such information is available from EHS for use and distribution. F. IMPAIRMENT: Whenever a building fire alarm or sprinkler system is inoperable or has been placed out of service, the University’s “Fire Protection System Impairment Policy” is in effect. This policy is available from EHS. G. INFORMATION RELEASE TO MEDIA AND THE PUBLIC: All information regarding University “Fire Emergencies” will be released through the Office of University Relations. No other University agency or employee may release official statements regarding the cause, origin, or nature or campus fires unless specifically authorized to do so by the Office of University Relations.

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CLINICIAN

FORMS

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As a student taking Clinical Practicum (SPPA 487, 690, 745, or 798) at the Towson University Speech, Language & Hearing Center, I understand that I may be audio tape recorded, video tape recorded, and/or photographed while providing diagnostic or treatment services to clients in the Towson University Speech, Language & Hearing Center. I also give permission to be photographed, video taped and /or audio taped during the supervisory conference. This will be done only for demonstration and instruction purposes for the sole use of the Department of Audiology, Speech-Language Pathology, and Deaf-Studies. __________________________________ Student Signature Date

_________________________________ Witness Signature Date TO BE SENT TO CLIENT

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Dear__________________________________, This letter is to confirm enrollment in the Towson University Speech, Language& Hearing Center for the semester, 20 . Treatment is scheduled for from to . Sessions will begin on and end on . The student clinician is and will be supervising the treatment program. The Speech, Language & Hearing Center provides clinical services to the Towson University community and the general public. It offers clinical instruction to undergraduate and graduate students enrolled in speech-language pathology and audiology. Students receive considerable academic instruction as preparation for the clinical practicum experience, and they work under the guidance of clinical supervisors who hold the Certificate of Clinical Competence from the American Speech-Language-Hearing Association and who are licensed by the Maryland Boards of Examiners for Speech Pathology and Audiology. The student clinicians receive academic credit for the clinical practicum and clock-hour credit for professional certification. In order for clients to receive maximum benefit from the treatment program and in order for student clinicians to obtain clinical experience, persons accepted for treatment are expected to attend sessions promptly and regularly. If a session must be canceled, please call the clinic office as early as possible before the session and leave a message for your clinician. Frequent absences or tardiness will be considered when scheduling further treatment. The fee for treatment sessions is _________ per semester. F ees are to be paid to the clinic secretary on the first day of treatment. Since we cannot accept cash, payment must be in the form of check, credit card or money order made payable to: Towson University. Client's insurance company may be billed. However, clients are responsible for supplying the office with any required documents (i.e., referral, pre-authorization, or special forms) necessary for insurance reimbursement. I f client's insurance is billed for service and denies payment, client is responsible for payment. Flexible arrangements can be made for those in financial need. If you have any questions or concerns, please feel free to call us. We look forward to serving you.

Sincerely,

Karen Pottash Clinic Director

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Enrollment letter to be sent to confirm treatment for adult developmentally disabled clients. Speech, Language & Hearing Center Towson University-8000 York Road-Towson, MD 21252-0001 Voice or TDD: 410-704-3095 - Fax: 410-704-6303 Dear_ : This letter is to confirm _ enrollment in the Towson University Speech, Language & Hearing Center for the _ semester. will be seen for speech-language treatment on at the time of in room/s and end on . The Center will be closed on the following special occasions: . The student clinician who will be working with is and the supervisor is . The Towson University Speech, Language & Hearing Center provides clinical services and clinical instruction to undergraduate and graduate students enrolled in speech-language pathology and audiology. Students receive considerable academic instruction as preparation for the clinical practicum experience, and they work under the guidance of clinical supervisors who hold the Certificate of Clinical Competence from the American Speech-Language-Hearing Association (ASHA) and who are licensed by the Maryland Boards of Examiners for Speech Pathology and Audiology. The students who serve as clinicians receive academic credit for the clinical practicum course and clock hour credit for professional certification. In order for clients to receive maximum benefit from the treatment program and in order for student clinicians to obtain clinical experience, persons accepted for treatment are expected to attend sessions promptly and regularly. If a session must be canceled, please call the clinic office as early as possible before the session and leave a message for your clinician and supervisor. Two unexcused absences will constitute dismissal from the clinic program. -------------------------------------------------------------------------------------------------------------------------- If there is a recent history of any communicable diseases, or abusive or unhealthy behaviors (biting, licking, hitting, kicking, wetting, depression, mood swings, etc.) PLEASE note them here: COMMENTS: If the client is allergic or has a restriction to any food or environmental factors, PLEASE note them here: COMMENTS: Is the client prone to escapism? Is the client on medication? (If yes,...what? ) The transporter of the client MUST REMAIN IN THE CENTER TO OBSERVE AND/OR PARTICIPATE in the treatment session and ALWAYS be AVAILABLE for consult as the needs arise. Fees for treatment are per semester and due the first of the month of treatment. You will be provided with a parking permit for our lot and all legal ungated lots. Space is limited. If you have any questions, call supervisor or clinician. See you on . Please bring the bottom portion of this form with you. Client Name: Date: Person Filling Out Form: Title: Phone No.: Agency:

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TOWSON UNIVERSITY SPEECH, LANGUAGE & HEARING CENTER Client Summary Form - For Clients in Treatment

Name: Date: Birthdate: C.A. Clinician: _____ ------------------------------------------------------------------------------------------------------------------------- List Formal (Tests and Test Scores) and Informal Data ------------------------------------------------------------------------------------------------------------------------- History: Auditory and Attending Behavior: (Including Audiometric Results) Language Comprehension: Language Expression: Articulation and Oral Mechanism (Structure and Function): Non-language Development (Motor, Social, Emotional Behaviors): Voice Quality, Fluency and Prosody (List medical results, if available):

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Summary of Past Treatment and Current Recomendations: On the back, list the tests you need to give initially plus tentative (informal) goals for the semester.

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TOWSON UNIVERSITY

SPEECH, LANGUAGE & HEARING CENTER Date Disposition

O:\SLP Graduate Assistant\FORMS06/2008

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CLIENT CLINICIAN SUPERVISOR SEMESTER CODE: +( ) = present (mins.) x = client cancelled o = clinician cancelled NS = no show Numbers under Obs. refer to length of supervisor observation in minutes.

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Student Directions for Using Typhon 1. Go to the typhon website and log in at:

https://www.typhongroup.net/ahst/data/login.asp?facility=9088 2. Click “Add new case log” 3. Click the calendar to choose the date of the encounter and click “Save Data” 4. Enter the semester, course number, clinical supervisor, and clinic site. If completing observation

hours, your clinical supervisor is Karen Pottash and the clinical site is “undergraduate university.” If completing treatment or diagnostic hours, put your clinical supervisor and the clinical site is “Speech, Language & Hearing Center.”

5. Next, check the “group encounter” box if you were working with more than one client. 6. If the encounter was with only one client, enter the age, gender, and race. 7. Enter the time spent with the patient (in minutes) 8. Leave the “consult with clinical supervisor” box blank. 9. Enter the type of skills used. If you are entering your observation hours, enter “observation

only.” For on-campus clinic during your first year enter “ basic skills.” For off-campus clinic during your second year of graduate school enter “complex skills.”

10. Enter the diagnosis code. If unknown, click the small search box and type in the keywords of the disorder.

11. Enter the age group, setting type, severity of communication disorder, patient’s primary language, and the primary diagnosis/disorder from the drop down menu.

12. Enter the amount of minutes spent treating or diagnosing, depending on the nature of the session. The total should equal the minutes of “Time with Patient.”

a. For example, if it was a 50 minute session that consisted of articulation and language therapy, you would enter “25” into “Tx receptive/expressive” and “25” into “Tx articulation/phonology.”

13. For each type of treatment or diagnostic that you performed and indicated with the number of minutes, enter the competencies demonstrated on the right side of the screen

a. For example, if you entered time next to “Tx social communication,” go through the competencies checklist under “Tx social communication” and check off each item that you completed in your session. List the competency as “observed” or “performed” as appropriate.

14. Add any significant clinical notes in the “Clinical Notes” box that would be helpful to you or your supervisor. This may be helpful if you have the same supervisor for two different clients. Put the time of treatment or the client’s initials in this space.

15. Scroll to the bottom and click “Save Data” 16. To enter another encounter during the same semester with the same client and supervisor, go to

the typhon home page and click “View/edit case logs.” Then, click a previously entered case log from the same client. Scroll to the bottom and click “Copy this case as a new encounter.” Then, enter the date and repeat directions 4-15.

https://www.typhongroup.net/ahst/data/login.asp?facility=9088

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POLICY OF NON-

DISCRIMINATION

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Policy of Non-Discrimination

The Speech, Language & Hearing Center at Towson University does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race,

color, national origin or disability (including but not limited to HIV disease), in admission to, participation in, or receipt of services or benefits under any of its

programs or activities. This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1954, the Age Discrimination Act of 1975, Section 504 of the Rehabilitation Act of 1973, and Regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at Title 45 Code of Federal Regulations Parts 80, 91 and 84. If you believe you have been discriminated against on the basis of race, color, national origin, age or disability (including but not limited to HIV disease), you may file a grievance against the Speech, Language & Hearing Center at Towson University and/or a member of its staff with:

Dan Leonard Fair Practices Officers

410-704-2361

Filing a grievance with Dan Leonard will not prevent you from filing a discrimination complaint with the: Office for Civil Rights, Region III U.S. Department of Health and Human Services 150 S. Independence Mall West Suite 372, Public Ledger Building Philadelphia PA 19106-9111 Main Line (215) 861-4441 Hotline (800) 368-1019 FAX (215) 861-4431

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CLIENT FORMS

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REQUEST FOR SERVICES Dear Client: The Speech, Language & Hearing Center welcomes the opportunity to provide our services to you. Our full range of clinical services is provided at reduced cost by s taff or graduate and senior undergraduate student clinicians under the direct supervision of our clinic staff. Every clinic staff member is nationally certified by the American Speech-Language-Hearing Association and licensed by the State of Maryland which ensures that you will receive quality service. This Center is a very important part of the Speech-Language Pathology and Audiology program of Towson University. S ome aspects of your clinic evaluation or treatment may be used for instructional and demonstration purposes because we are a university training program. There may be observations by students from Towson University and affiliated training programs; confidential use of audio and video tape recording and clinic records; and/or review of clinical records for research purposes. If clinical records are used for research purposes, client names and identifying information will be omitted. If any specific research project involving your direct participation is contemplated you will be given information about the project and asked to participate. Our student clinicians are trained to abide by all state and federal laws and regulations governing the security and confidentiality of client records. Each client is responsible for Center service fees. In regard to insurance billing, obtaining referrals, pre-authorization, or special forms necessary for reimbursement is the responsibility of the client. Insurance membership cards must be presented at time of appointment or on first day of treatment. If your insurance is billed for service and insurance company denies payment, you are responsible for payment. Any balance due for speech-language treatment or training must be paid by client prior to continuation of services in the following semester. I hereby acknowledge that as of this date, I have read the above information and I have received the Towson University Speech, Language & Hearing Center Notice of Privacy Practices. This notice is available on our clinic website and is posted in our clinic. If desired, we will provide you with a paper copy. Client, Parent\Guardian Signature Date (I wish to use the services of the Towson University Center and I understand and agree to the above information) Staff Supervisor Signature Date

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AUTHORIZATION FORM

I, _____________________________, hereby authorize Towson University Speech, Language &Hearing Center Name of individual authorizing use/disclosure Clinic to use/disclose the following information from the speech/language or audiology record(s) of : Name: _________________________________SSN: _________________________ Birthdate: ________________ Address: _________________________________ Home phone: ___________________Work phone:______________ __________________________________ Cell phone: ____________________ Information to be used/disclosed: � Diagnostic Report performed on Date: _____________ � Progress Report covering the period from: Date: ________________to Date: _______________ � Other: _______________________________________________________________________ Purpose of disclosure of information: � At patient’s request � Assist health care providers in care of patient � Verification of services provided for insurance payment purposes � Research purposes � Other: ___________________________________________________________________________________ Person/institution to whom information is to be disclosed: � Name/Address: � Name/Address: � Name/Address: ____________________________ __________________________ ___________________________ ____________________________ __________________________ ___________________________ _______________________ ______________________ _______________________ A message may be left: � at home � at work � do not leave a message Expiration date (may not exceed one year)_________________ The University may not condition its provision of treatment, payment, enrollment or eligibility for benefits on your signing this authorization. However, there are two exceptions: 1. If you refuse to sign this authorization to use or disclose protected health information for research, it may refuse to provide treatment related to that research and: 2. If you refuse to sign this authorization to disclose information to a third party, it may refuse to provide health care that is solely for the purpose of disclosure to that third party. You may revoke this authorization at any time, by writing to the Clinic Administrator of the Speech, Language & Hearing Center. The revocation will become effective on the day the University receives it, except to the extent that: (a) the University has made a disclosure before the effective date of the revocation; or (b) if the authorization was obtained as a condition of obtaining health insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself. You should be aware that information disclosed pursuant to this authorization could possibly be disclosed by the recipient and thus no longer be protected by the Health Insurance Portability and Accountability Act and its implementing regulations. Signature of Client, Parent/Guardian: __________________________________________Date: ______________ Signature of Personal Representative if applicable*: ___________________________________________________ * Describe authority to act for the client: ____________________________________________________________ Signature of Witness________________________________________________________Date:_______________

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ATTENDANCE POLICY

The Towson University Speech, Language & Hearing Center keeps a weekly appointment schedule for all clients in treatment per semester. It is important to the client’s progress that sessions are attended on a regular basis as consistent attendance is directly related to progress in treatment. Any missed sessions must be cancelled in a timely manner. If you know in advance that you will be unable to attend a specific session or sessions, please inform your clinician as soon as possible. If you must cancel your appointment on the scheduled day, please call the Center by 8:00 a.m. at (410) 704-3095. If your clinician has requested that he or she also be notified, please do so in addition to calling the Center. We encourage clinicians to reschedule cancelled sessions. Unfortunately, this is not always possible due to client, clinician, and supervisor schedules. Excessive cancellations may result in termination of treatment for that semester. Missed appointments that you have not cancelled (i.e., no-shows) cannot be made up. Three or more no-shows during the semester will result in termination of treatment services for the current semester. However, special circumstances will be reviewed by the clinic director. We look forward to working with your this semester. If you have any questions, please feel free to call me at the above number or email me at [email protected]. Karen Pottash, M.A., CCC SLP SLP Center Director I agree to and understand the terms of this Attendance Policy. Signature of client, parent, guardian, or caregiver Date

mailto:[email protected]

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SPEECH EVALUATION COVER SHEET

NAME: BIRTHDATE:_______ AGE: ________ ADDRESS: HOME PHONE: WORK PHONE: EDUCATIONAL STATUS: SCHOOL: OCCUPATION: S.S.# _______________________________ SINGLE MARRIED SPOUSE:

OCCUPATION:

MOTHER: AGE: OCCUPATION: _____________________

S.S.#____________ PHONE: FATHER: AGE: _______OCCUPATION: ______________________ S.S.#______________ PHONE: ______________________

SIBLINGS: AGE: OCCUPATION: AGE: OCCUPATION: AGE: OCCUPATION: AGE: OCCUPATION: REFERRED BY: INFORMANT: DIAGNOSTIC CLASSIFICATION: DATE OF EXAMINATION:

T O W S O N U N I V E R S I T Y Speech, Language & Hearing Center

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Summer Therapeutic Program We invite clients or their representative to evaluate the effectiveness of our services. Please read the following statements and circle the appropriate number. 1 2 3 Agree Undecided Disagree 1. My child felt comfortable talking with their clinician. 1 2 3 2. The clinician listened to my child. 1 2 3 3. The clinician interacted well with my child. 1 2 3 4. The clinician discussed the communication problem and

treatment/clinic camp program adequately. 1 2 3 5. The clinician dealt with my fears and concerns about

the communication problem. 1 2 3 6. The clinician helped me understand my child’s goals. 1 2 3 7. I was pleased with how the clinician addressed my child’s goals in the clinic camp environment. 1 2 3 8. Progress was made this summer in clinic camp. 1 2 3 9. I was satisfied with the input from the faculty supervisor. 1 2 3 10. I was satisfied with the clinic camp facility. 1 2 3 11. I was pleased with how much I learned about my child’s

communication difficulty and the clinic camp program. 1 2 3 12. I would recommend the TU Clinic camp for preschoolers

who have a communication difficulty. 1 2 3

____________________________ Name Relationship to Client

Clinician Date

1. What do you think are the strengths of the clinic? 2. Do you have any suggestions that would improve our services?

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Speech, Language & Hearing Center Towson University-8000 York Road-Towson, MD 21252-0001 Voice or TDD: 410-704-3095 - Fax: 410-704-6303 Date __________________________________ Client Name ___________________________

(Last, First) Phone Number__________________________ Thank you for your interest in receiving treatment at the Towson University Speech, Language & Hearing Center. In order to be placed on the waiting list, please complete the form below. *If you are currently enrolled in treatment and would like to keep the same days and times, please indicate the times in the schedule below by writing "CLINIC" in those designated slots. Al so, FOLLOW THE DIRECTIONS BELOW IN CASE WE ARE UNABLE TO ACCOMMODATE THE CURRENT SCHEDULE. Place an "X" in ALL time slots that can be scheduled for treatment sessions. Place a "C" in time slots that would be most convenient. Designate as much time as possible. We will try to fit into the specified time frame. Be sure to arrange times that permit early arrival so that there is time to locate a parking spot.

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

Example 9:30-10:30

XC

X

XC

X

8:30-9:30

9:30-10:30

10:30-11:30

11:30-12:30

12:30-1:30

1:30-2:30

2:30-3:30

3:30-4:30

4:30-5:30

Please return the above information and any requested records by _______________. Clients should call the Center to assure that records have been received. If there are any questions, please call the Center at 410-704-3095. Fax information at 410-704-6303.

FOR OFFICE USE ONLY Supervisor's Initials ______

Check the appropriate box: Υ Continuing treatment* Υ On waiting list following TU DX Υ On waiting list Sessions per week: Length in Minutes_____ Group OR Individual_____ Semester____________

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CASE

HISTORY

FORMS

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CHILD CASE HISTORY FORM Please fill in the information requested below. If your appointment is with audiology, bring completed form the day of your appointment; If your appointment is with speech, Fax or return completed form immediately in self-addressed envelope enclosed to the Towson University Speech, Language & Hearing Center. Name of child to be evaluated Date of birth: Age: _________S.S. No: Home Address: Home phone: _________________________ Work phone: _________________________ Parent’s name: Child’s doctor: School: Grade: Name of person filling out this form and relationship to client: How were you referred to us? Please describe any family history of speech, language, or hearing difficulties: Please describe previous or recent evaluation (speech/language, hearing, educational and/or psychological, etc.): Date: Location: Specialist: Evaluation: Date: Location: Specialist: Evaluation: Briefly describe type of previous treatment (speech/language, hearing, educational and/or psychological, etc.): Date: Location: Specialist: Treatment: Date: Location: Specialist: Treatment: Please request each of the persons listed to forward to us copies of their records.

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Page 2

I. BIRTH HISTORY A. Pregnancy:

1. At time of delivery: age of mother ________ age of father ________ 2. Order of pregnancy (1st born, etc.) _______ 3. Was pregnancy full term? Yes ____ No ____ 4. Were there any complications? Yes ____ No ____ If yes, please explain:

_______________________________________________________________________________

_______________________________________________________________________________

5. List medications taken during pregnancy:

_______________________________________________________________________________

_______________________________________________________________________________

B. Delivery (check):

1. Normal: Yes ____ No ____ 4. By Instruments: Yes ____ No ____ 2. Difficult: Yes: ____ No ____ 5. Breech: Yes ____ No ____

3. By Caesarian Yes ____ No ____ 6. Length of Labor: Yes ____ No ____ C. Neonatal Period (check):

1. Normal: Yes ____ No ____ 3. Jaundiced: Yes ____ No ____ 2. Cyanotic (blue): Yes: ____ No ____ 4. Other (list) _______________________ 5. What was the birth weight? _______ 6. Were there any feeding problems? Yes ____ No ____ 7. Are there any feeding problems at this time? Yes ____ No ____ 8. Was the baby’s activity level: Average ____ Overactive ____ Underactive ____

II. DEVELOPMENTAL HISTORY A. Motor Development (give ages):

1. Sat unsupported: ________ 4. Fed Self: _______ 2. Crawled: ________ 5. Toilet trained: bladder ____ bowel ____ 3. Walked: ________ 6. Motor Development: Normal _______ Delayed _______ 7. Are there any difficulties in chewing or swallowing? Yes ____ No ____ If yes, please explain:

_______________________________________________________________________________

III. MEDICAL HISTORY A. Childhood Illnesses:

Age Severity High Fever 1. Mumps ____ _______ _________ 2. Measles ____ _______ _________ 3. Chicken Pox ____ _______ _________ 4. Convulsion ____ _______ _________ 5. Allergies ____ _______ _________

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Page 3

1. Is the child on a special diet or taking any medications regularly? Yes ____ No ____ If yes, please list names and dosages.

_______________________________________________________________________________

_______________________________________________________________________________

2. Does the child currently have any communicable disease? Yes _____ No ____ If yes, list disease(s) and precautions that must be taken by person working with this child.

_______________________________________________________________________________

_______________________________________________________________________________

3. List significant medical problems, operations, and injuries including age of occurrence.

_______________________________________________________________________________

_______________________________________________________________________________

IV. OTOLOGICAL HISTORY Yes No How many? Which ear(s)? Age(s)

Ear infections: ____ ____ __________ ___________ ___________ Ears draining ____ ____ __________ ___________ ___________ Chronic colds ____ ____ __________ ___________

Has the child had the following:

Yes No Age(s) a) Pressure Equalization (P.E.) Tubes? ____ ____ ______

If yes, which ear(s): ______________ b) Tonsillectomy? _____ _____ ______ c) Adenoidectomy? _____ _____ ______

V. SPEECH AND LANGUAGE HISTORY: (Give Ages)

1. Babbling ________ 3.Use of first word ________ 2. Imitation of words ________ 4. Put words together ________ 3. Did speech and language development seem to progress normally and then stop or regress? Yes _____ No _____ If yes, at what age? __________ 4. Does the child communicate in (check all that apply) Gestures _____ Single words _____ Jargon _____ Phrases _____

Complete, but grammatically incorrect sentences _____ Complete, grammatically correct sentences _____ Sign Language _____ A second language _____ (bilingual)

5. Does the child: (check all that apply) Mispronounce words _____ Hesitate or repeat sounds and words _____ Sound nasal _____ Sound hoarse _____ Other _____

6. Does the child speak (check all that apply); Too Slow _____ Too Fast _____ Too Loud _____ Too Soft _____ Monotonously _____

7. What language other than English is spoken in the home? _________________ 8. Does the child understand what is said to him/her? Yes _____ No _____ 9. Is there any reason to suspect a hearing problem? Yes _____ No _____

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Page 4 10. Does the child currently wear a hearing aid? Yes _____ No _____

If yes, please list type, model and serial number(s)

_______________________________________________________________________________

_______________________________________________________________________________

11. If not has the child worn a hearing aid in the past? Yes _____ No _____ If yes, please list type, model and serial number(s)

_______________________________________________________________________________

_______________________________________________________________________________

12. Does the child respond to: soft sounds Yes _____ No _____ environmental sounds Yes _____ No _____

13. Is the child distracted by background noises? Yes _____ No _____ 14. Is the child disturbed by loud noise? Yes _____ No _____

VI. EDUCATIONAL AND EMOTIONAL HISTORY

1. Have there been any problems in school? Yes _____ No _____ If yes, explain briefly.

_________________________________________________________________________________________

_____________________________________________________________________

2. Has the child ever received special help or been in a special class in school? Yes ____ No ____ If yes, explain briefly.

_________________________________________________________________________________________

_____________________________________________________________________

3. Has the child exhibited any social and/or emotional problems? Yes _____ No _____ If yes, explain briefly.

_________________________________________________________________________________________

_____________________________________________________________________

VII. COMMENTS

Please provide any additional information that will aid us in evaluating this client.

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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ADULT CASE HISTORY FORM Please fill in the information requested below. If your appointment is with audiology, bring completed form the day of your appointment; If your appointment is with speech, Fax or return completed form immediately in self-addressed envelope enclosed to the Towson University Speech, Language & Hearing Center. Appointment Name of Person to be Evaluated: Date: Date of Birth: Age: Soc. Sec.#: Occupation: Place of Employment: If college student, School: Academic Status 1 2 3 4

(please circle) Graduate Marital Status: Permanent Home Address: Work or School Address: Home Phone: Work Phone: Name of Person filling out this form: Relationship to Client: How were you referred to us? Please describe the current speech/language problem and/or difference or hearing problem. Do you currently wear a hearing aid? yes( ) no( ) Type, make & model If not, have you worn a hearing aid in the past? yes( ) no( ) What is your primary mode of communication? speech( ) sign language( ) lip reading( ) other( ) please list: Primary Language: List below any previous evaluation and/or treatment for speech/language or hearing problems you have had. P lease request each of the persons listed below to forward to us copies of their records. Date Specialist Location Findings

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Briefly describe type of treatment. Describe any significant medical background that we should know (accidents, illnesses, injuries, birth history, etc.). Describe any significant speech, language, and/or hearing background that would help us in our evaluation of your communication functioning. Please list name and dosage of all medication currently being taken. Do you have any history of a) learning difficulties yes( ) no( ) or b) emotional problems? yes( ) no( ) If yes, please describe. Does the client currently have any communicable diseases? yes( ) no( ) If so, list disease(s) and precautions that must be taken by person working with the individual. Please indicate any other information you believe we should know prior to the evaluation.

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COMMUNICATION QUESTIONNAIRE FOR DEVELOPMENTALLY DELAYED CLIENTS

NAME: DATE: DOB: AGE: SEX: M F NAME OF RESIDENCE: TYPE OF RESIDENCE: (check all that apply)

School/Academic setting Activity Clinic Sheltered Workshop Day Care Clinic

Vocational Clinic Prevocational Employment Site Clinic

DIAGNOSIS: (check all that apply) Mental Retardation Seizures Motor Sensory Mild type/degree CP-mild visually impaired\ Moderate unknown CP-moderate degree unknown Severe major motor CP-severe partially blind Profound seizures CP-athetoid totally blind minor motor CP-spastic hearing impairment\ CP-diplegic degree unknown

CP-hemiplegic partial hearing

CP-quadriplegic loss totally deaf

Other: Downs Syndrome Spinal Bifida Emotional disorder Other, specify MEDICATIONS: (check all that apply) None Depekene Mellaril Other, specify Dilantin Diamox Compazine Phenobarbital Mysoline Valium

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Tegretol Aldomet Vitamins Inderol Laxatives NAME OF PERSON COMPLETING FORM: Supervisor Direct Care Staff Other

Explain PHONE NUMBER: FACILITY:

INSTRUCTIONS The purpose of this questionnaire is to obtain information to assist the Speech-Language Pathologist and/or Audiologist in their evaluation and/or treatment of the client or perspective client. The questionnaire is not designed to be a comprehensive evaluation. Complete the questionnaire by answering each of the questions. Answer "YES" if:

1. the statement if true.

2. the person consistently completes the skill without additional physical or verbal assistance from others and the person consistently completes the skill within a reasonable amount of time.

Answer "NO" if:

1. the statement is false.

2. the person is unable to complete the skill.

3. the person cannot complete the skill without additional physical or verbal assistance from others. (Please state the type of assistance needed under the comment section).

4. the person is unable to complete the skill in a reasonable amount of time. (Please state the

amount of time required to complete the skill under the comment section). Answer "NOT OBSERVED" if:

1. the specific ability or skill has not been observed in your setting, and you are unable to obtain this information from other staff/programs/records.

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BACKGROUND INFORMATION

YES

NO

NOT OBSERVED

1. Has the person ever had a hearing test?

2. Has the person ever been evaluated by a speech-language

pathologist?

Comments re: Background and Results of Above Testing

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

HEARING AND UNDERSTANDING

YES

NO

NOT OBSERVED

3. Does the person have difficulty hearing?

4. Can the person understand simple commands like "show me your

work"?

5. Can the person understand longer and more complex instructions

like "stop your work, go get your hat and let's go out in the car"?

6. Do you need to use gestures to help the person understand?

Comments re: Hearing and Understanding

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SPOKEN COMMUNICATION

YES

NO

NOT OBSERVED

7. Does the person try to communicate with you using speech?

8. Can you understand the person's speech most of the time?

9. Can you understand the person's speech some of the time?

10. Can the person be understood by strangers?

11. Can the person be understood over the telephone?

12. Does the person communicate in single words most of the time?

13. Does the person communicate in two or three word phrases?

14. Does the person communicate in sentences?

15. Is the person's speech slurred?

16. Does the person seem to talk nonsense?

17. Does the person stutter?

Comments re: Spoken Communication

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NON-VERBAL COMMUNICATION

YES

NO

NOT OBSERVED

18. Does the person rely on non-verbal means of communicating in

your setting.

19. Does the person use gestures?

20. Does the person use sign language?

21. Does the person use a picture or word board?

22. Does the person use an electronic device or computer?

Comments re: Non-Verbal Communication

GENERAL COMMUNICATION

YES NO

NOT OBSERVED

23. Does the person's way of communicating work well for you and for

the person?

24. Does the person's difficulty with communication prevent the person

from doing well or from learning new things and getting along with people at your clinic?

25. Is the person frustrated in attempting to communicate with others?

26. Does the person greet people and indicate goodbye?

27. Does the person express basic wants and needs adequately?

28. Does the person have an effective way to refuse something?

29. Does the person ask for help?

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GENERAL COMMUNICATION (Cont'd.)

YES

NO

NOT OBSERVED

30. Does the person thank people?

31. Does the person ask for the name of someone or something?

32. Does the person ask about the location of someone or something?

33. Does the person ask what someone is doing?

34. Does the person ask when something will occur?

35. Does the person ask how to do something?

36. Does the person tell you about something that occurred in the

past?

37. Does the person make jokes?

38. Does the person explain things to peers and to staff?

Comments re: Communication

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RESIDENTIAL COMMUNICATION INTERVIEW Direction: Please read the statements below. For each statement mark a SD for Strongly Disagree, D for Disagree, N for Neutral, about each statement. If you have any comments to add please use the section labeled "additional comments" at the end of the interview form. 1. My client communicates primarily using words in phrases and sentences. 2. My client communicates primarily through gestures. 3. My client looks directly at me when attempting to communicate. 4. My client attempts to ask questions and seek information. 5. My client indicates emotions (pain, happiness, like/dislike) by using words in phrases and sentences.

using gestures. 6. My client will attempt to begin a conversation when we are together. 7. My client will respond to questions or my attempts at starting a conversation. 8. My client demonstrates turn-taking behavior with other clients and staff persons. 9. I have very little difficulty understanding what my client is attempting to communicate.

10. My client seems to have very little difficulty understanding what I am saying. 11. I think my clients communication skills are adequate for their needs. 12. My client can respond accurately to questions requiring a yes/no response. 13. My client would benefit from improved communication skills. 14. I feel comfortable conversing with my client. 15. I would like to learn more about communicating with my client. 16. I have seen changes in my client's ability to communicate within the past two months.

ADDITIONAL COMMENTS:

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TOWSON UNIVERSITY SPEECH, LANGUAGE & HEARING CENTER

One of our goals in providing services to our clients is to allow our instruction during therapy to carry over into daily living situations. T o assist with this learning, we feel that knowledge of the below mentioned questions may better help us plan future sessions. Please feel free to make any additional comments you f eel would help us in enhancing our clients' daily living skills.

DURING SPEECH TREATMENT

AT HOME

How does he/she interact or talk with other people?

Does he/she ask questions?

Does he/she answer questions?

Does he/she use the vocabulary discussed during speech class?

Does he/she tells others about what is seen happening around them?

What do you feel he/she needs to work on the most concerning speech therapy?

What are his/her favorite activities? What does he/she enjoy doing with others or by themselves?

Name of Client Date Person Filling Out This Form

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AURAL REHABILITATION CASE HISTORY* TOWSON UNIVERSITY SPEECH, LANGUAGE & HEARING CENTER

NAME: AGE: SEX: DATE: _____ PRESENT OCCUPATION: PREVIOUS OCCUPATION:______________ REASON FOR SEEKING AURAL REHABILITATION: ________________________________ ___________________________________________________________________________ PLEASE INDICATE THE SITUATIONS IN WHICH YOU HAVE DIFFICULTY COMMUNICATING. INDICATE WITH A CHECK MARK.

NO PROBLEM PROBLEM DESCRIBE PROBLEM

SOCIALLY

DINNER TABLE

TELEPHONE

IN THE HOME

WITH MALES

WITH FEMALES

WITH CHILDREN

WITH GROUPS

WITH INDIVIDUALS

AT WORK

OTHERS (PLEASE INDICATE)

HOW DO YOU COMPENSATE IN DIFFICULT CONVERSATIONAL SITUATIONS?__________________________________________________________________________________________________________ HAVE YOU EVER WORN A HEARING AID? YE S ( ) NO ( ) IF SO, WHAT TYPE? _________________ HOW LONG HAVE YOU WORN A HEARING AID? ______________________________________________ DOES THE HEARING AID HELP YOU HEAR IN ALL LISTENING SITUATIONS? YES ( ) NO ( ) IF NOT, IN WHICH SITUATIONS DOES IT HELP AND IN WHICH DOES IT NOT HELP?_______________________ ____________________________________________________________________________ ____________________________________________________________________________

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*To Be Used In Conjunction With TU Case History Form. Check client's Speech and/or Audiology folder to see if TU Case History Form has already been filled out. HAVE YOU EVER ATTENDED A HEARING AID ORIENTATION PROGRAM? YES ( ) NO ( ) IF SO, WHEN AND WHERE?___________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ HAVE YOU EVER HAD ANY INSTRUCTIONS IN THE FOLLOWING?________________________________ SPEECH READING (LIP READING) YES ( ) NO ( ) COMMUNICATION STRATEGIES YES ( ) NO ( ) IF YES, WHERE?_____________________IF YES, WHERE?__________________________ WHEN?__________ HOW LONG?__________ WHEN?_________ HOW LONG?__________ DO YOU HAVE ANY VISUAL PROBLEMS? YES ( ) NO ( ) DO YOU WEAR GLASSES? YES ( ) NO ( ) DOES THE UTILIZATION OF VISUAL CLUES HELP YOU UNDERSTAND WHAT PEOPLE ARE SAYING? ________________________________________________________________ DO YOU UTILIZE ANY ASSISTIVE LISTENING DEVICES? YES ( ) NO ( ) IF SO, WHICH KIND?_______________________________________________________________________________ DO YOU FEEL THAT THE ABOVE IS/ARE HELPFUL &, IF SO, IN WHAT SITUATIONS? _________________________________________________________________________ ____________________________________________________________________________ HOW DOES YOUR HEARING IMPAIRMENT IMPACT ON YOUR RELATIONSHIPS WITH FAMILY, FRIENDS, AND/OR FELLOW WORKERS?__________________________________ ____________________________________________________________________________ ____________________________________________________________________________ WHAT WOULD YOU LIKE TO LEARN IN OUR GROUP MEETINGS? _______________________________ __________________________________________________________________________

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COMMUNICATION ASSESSMENT – ADULT

Please answer the questions below to assist in planning for your communication assessment. If regular audiological services are received elsewhere, please include a copy of your most recent audiogram with this profile.

Background Name: _________________________________ Date: ______________________________

Home Address: __________________________ Birthdate:___________________________

__________________________

Home Phone Number: _____________________ Work Phone Number: _________________

Amplification History (Answer question or check appropriate space) 1) Which type of hearing aid do you use? Behind-the-ear ______ In-the-ear ______ In-the-canal ______ No aid ______ 2) Type of hearing loss? conductive _____ sensorineural _____ 3) Degree of hearing loss? mild _____ moderate ______ severe _____ profound _____ 4) The aid(s) is worn on which ear(s): Right _____ Left _____ Both _____ 5) Please list the hearing aid brand, model, and age of instrument: 6) When/where do you use your hearing aid(s)? 7) Do either of your hearing aids have a telephone switch? 8) When were the hearing aids last checked? 9) When was your last hearing evaluation? 10) If you are experiencing any problems with your hearing aid(s), please describe below.

(Modified from Fairfax County Schools: Dept.of Student Services and Special Education, 1994) Assistive Device Use History, Courtesy of Assistive Device Center, University of Pittsburgh

194

The following is a list of some sample assistive listening and alerting devices. Please place an X under the appropriate categories. If you currently have any of the following devices, please indicate type and brand.

Devise

Currently

Have

Satisfied

With

Interested in

Having Alarm Clock

Doorbell alerting device

Alerting device (i.e., baby cry, appliances)

Smoke alarm alerting device

Telephone alerting device

Telephone amplifier (handset or portable)

TDD/TTY

Television amplification device

Television decoding device (Closed Captioning)

Personal communication device

Group communication device

Classroom communication device

Other

Have you used an assistive device in the past? If so, please specify and indicate why the device is no longer used. Are you aware of any assistive devices that are available at public facilities in your community? (For example, theaters/movie theaters, churches/synagogues, libraries, meeting rooms, etc.) If so, please list the facility and devices(s) available. I would like to improve my ability to understand communication in the following situations: (check all that apply)

One-to-one conversations Family/group gatherings In school

195

At the breakfast/dinner table In the car Outside with friends On vacation At the movies While watching television While listening to stereo/walkman Other (please specify)

I would like to be aware of the following environmental sounds: (check all that apply)

Doorbell/knock at the door Telephone ring Alarm clock Smoke alarm Baby crying in the house Someone calling from another room Other (specify)

How many people live in your home? Approximately how many hours a day are you alone? Are you involved in any sports, religious, or group activities (Please describe)? Do you have any difficulty hearing in these environments? Do you participate in a lot of outdoor activities? Please indicate what particular activities: Please give a brief description of your average week.

O:/ Student/ AuD Graduate Assistant/ On Campus/ Clinic Forms/ Aural Rehabilitation

196

ON-CAMPUS

SCREENING

INFORMATION

197

INSTRUCTIONS FOR SPEECH AND HEARING SCREENING OF EDUCATION, NURSING, OCCUPATIONAL THERAPY STUDENTS

MONITORS:

1. One monitor will be in charge of the forms. He/she will sit in the waiting room. Each student to be screened will be given the screening form. He/she is to fill it out before entering the screening rooms.

2. People to be screened will sign in when they arrive.

3. The monitor is to MAKE SURE EACH STUDENT FILLS OUT THE FIRST 4 LINES

AS COMPLETELY AS POSSIBLE!

4. One monitor will direct students into the screening rooms. It is his/her responsibility to keep things quiet near the screening rooms and to keep the flow of students moving quickly. The monitor continuously checks the rooms for vacancies.

5. When there is an opening, students, one-at-a-time, will go into the speech or hearing

screening room. Then they will wait quietly for the other part of the screening.

6. All finished forms must be returned to a monitor who ensures the student received the pink copy and puts the white and yellow copies in alphabetical order based on field of study in the box provided. The last monitor each day should put these completed forms in the Center Office. The first monitors each day should take the forms and the box from the Center Office and set up the screening if this has not already been done. T he Screening Coordinator will be there to help. The first monitors should come ten minutes early for setting up.

7. If a S peech, Language, Voice, and/or Hearing evaluation has been recommended, the

waiting room monitor should remind the students to go to the Center Office to sign up for this evaluation, if they wish to have it done at TU.

SPEECH SCREENERS:

1. Listen to the speech for any possible deviations: fluency, articulation, voice, rate, etc. The sample should be elicited through quick conversation and reading the "Rainbow Passage."

2. Circle your decision for each area on the form. Write comments on left (for student

screeners)

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3. If you suspect a problem, take the student to the faculty member assigned to supervise at that time. This information should be posted in the clinic. Be sure to sign your name as examiner on the screening form.

4. The faculty member will indicate on the form if the speech needs further evaluation.

5. If you do n ot suspect a problem, fill out the form and sign your name where it indicates

speech examiner (on the bottom left of the form). HEARING SCREENERS:

1. Screen at 20dBHL at 1000, 2000, 4000 and 6000 Hz. Use "+" for no response obtained or "-" for response obtained. Left side of frequency box is for "screen" and right, for "rescreen."

2. If the student passes, check "within normal limits" on the form.

3. If the student does not pass, check "re-screen" and direct him/her to the Audiology Suite.

4. The first hearing screeners each day should set up the screening rooms and check the

audiometers. They should arrive 10 minutes early for this purpose.

5. The hearing screeners testing until the end of the day are responsible for unplugging the equipment.

6. Be sure to sign your name as examiner in the Hearing Screening Section.

7. If the student has a known hearing loss, do no t screen. Take the student to the Audiology

Supervisor on duty in the Audiology Suite. S tudent screener or supervisor should indicate this on the form.

ALL SCREENERS:

Students should fill out ONE Clock Hour Form and keep it to be signed by t he Screening Coordinator at the end of the semester. Students should turn in this Clock Hour Form to the Graduate Assistant with their end-of-semester materials.

You are not to discuss the ramifications of this evaluation with the clients. That is done by the respective departments (who get a copy of the completed form for each client).

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TOWSON UNIVERSITY SPEECH, LANGUAGE, & HEARING CENTER 410-704-3095

SPEECH & HEARING SCREENING FORM

Name:___________________________________________________ Date:______________________________ Last First Mailing Address:__________________________________________ Academic Status:____________________ ________________________________________ Phone:____________________________ Academic Advisor:___________________________ Major:__________________ Dept.:_________________

Hearing Screening (Calibrated ANSI-1989) - = Negative test results; Response obtained + = Positive test result; No response obtained Frequency 500 Hz __dB 1000Hz __dB 2000Hz __dB 4000Hz __dB 6000Hz __dB

Right Ear

Left Ear

_____Rescreen _____ Refer for Complete Audiologic Evaluation _____ Within Normal Limits (This service available at TU Hearing Center) Comments:_______________________________________________________________________________________________________________________________________________________________________________________________________ Examiner:________________________________________________________________________________________________ Rescreener:_____________________________________________Supervisor:________________________________________

Speech Screening Circle Below: (Within Normal Limits) = WNL; (Rescreen by Supervisor) = RBS

Comments – Student Screener Comments – Supervisor Voice: Pitch, WNL/RBS ___________________________________________________________________ Quality, intensity Prosody: Phrasing WNL/RBS ___________________________________________________________________ syllable stress, intonation Articulation WNL/RBS ___________________________________________________________________ Fluency/Rate WNL/RBS ___________________________________________________________________ Good Overall Speech Fair Poor ___________________________________________________________________ Intelligibility Recommendations for Follow-Up (Supervisor checks appropriate ones) No Follow-Up Necessary _____Rescreen within 3 weeks _______Return for a rescreening __________________________ Date Time Faculty Rescreener______________________________________________ Complete Speech, Language and/or Voice Evaluation _________ Speech, Language and/or Voice Treatment _________

(These services are available at TU Speech-Language Center) Comments: _________________________________________________________________________________________________ Examiner: _________________________________ Date:____________________ Supervisor: ____________________

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THE RAINBOW PASSAGE

When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a division of white light into many beautiful colors. These take the shape of a long round arch with its path high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of gold at one end. People look, but no one ever finds it. When a man looks for something beyond his reach, his friends say he is looking for the pot of gold at the end of the rainbow.

Throughout the centuries men have explained the rainbow in various ways. Some have accepted it as a m iracle without physical explanation. To the Hebrews it was a token that there would be no more universal floods. T he Greeks used to imagine that it was a sign from the gods to foretell war or heavy rain. The Norsemen considered the rainbow as a br idge over which the gods passed from earth to their home in the sky. Other men have tried to explain the phenomenon physically. Aristotle thought that the rainbow was caused by reflection of the sun’s rays by the rain. Since then physicists have found that is not reflection, but refraction by the raindrops which causes the rainbow. Many complicated ideas about the rainbow have been formed. The difference in the rainbow depends considerably upon the size of the water drops, and the width of the colored band increases as the size of the drops increases. The actual primary rainbow observed is said to be the effect of superposition of a number of bows. If the red of the second bow falls upon the green of the first, the result is to give a bow with an abnormally wide yellow band, since red and green lights when mixed form yellow. This is a very common type of bow, one showing mainly red and yellow, with little or no green or blue.

Documents

ON CAMPUS SPEECH-LANGUAGE CLINICIAN’S MANUAL 2013-2014