Gallaudet University

Department of Hearing, Speech and Language Sciences

HSL 895: Practicum in Higher Education Clinical Supervision (3)
Fall 2015

Instructors Name: Karen Garrido-Nag, PhD, MS, CCC-SLP

Office: SLCC 2223
Contact Information: 202-448-6964 (Office), Karen.garrido-nag@gallaudet.edu
Office Hours: By appointment

CATALOG DESCRIPTION
In this practicum, under the supervision of HSLS faculty and clinical educators, the Ph.D.
student supervises clinical SLP students who are developing their knowledge, skills, and
dispositions related to providing clinical SLP services to culturally and linguistically
diverse clients, including clients who are deaf or hard of hearing. Clients served include
Gallaudet community as well as to individuals in the Washington D.C. metropolitan area.
ASHA Certification of Clinical Competence in Speech-Language Pathology (CCC-SLP);
satisfactory completion of HSL 896: Seminar in Higher Education Instruction and
Supervision and HSLS 846-847: Clinical Applications of Sign Language I and II.

LEARNING OUTCOMES BASED ON THE PH.D. PROGRAM COMPETENCIES

1.0 Establish and Maintain an Effective Working Relationship with the Supervisee
1.1 Ability to facilitate an understanding of the clinical and supervisory processes
1.2 Ability to organize and provide information regarding the logical sequences of
supervisory interaction - that is, joint setting of goals and objectives, data collection
and analysis, evaluation
1.3 Ability to interact from a contemporary perspective with the supervisee in both the
clinic and supervisory process
1.4 Ability to apply learning principles in the supervisory process
1.5 Ability to apply skills of interpersonal communication in the supervisory process
1.6. Ability to facilitate independent thinking and problem solving by the supervisee
1.7 Ability to maintain a professional and supportive relationship that allows
supervisor and supervisee growth
1.8 Ability to interact with the supervisee objectively
1.9 Ability to establish joint communication regarding expectations and
responsibilities in the clinic and supervisory processes
1.10 Ability to evaluate, with the supervisee, the effectiveness of the ongoing
supervisory relationship
2.0 Assisting the Supervisee in Developing Clinical goals and objectives
2.1 Ability to assist the supervisee in planning effective client goals and objectives
2.2 Ability to plan, with the supervisee, effective goals and objectives for clinical and
professional growth
2.3 Ability to assist the supervisee in using observation and assessment in preparation
of client
goals and objectives
2.4 Ability to assist the supervisee in using self-analysis and previous evaluation in
preparation of goals and objectives for professional growth
2.5 Ability to assist the supervisee in assigning priorities to clinical goals and objectives
2.6 Ability to assist the supervisee in assigning priorities to goals and objectives for
professional growth
3.0 Assisting the Supervisee in Developing and Refining Assessment Skills
3.1 Ability to share current research findings and evaluation procedures in
communication disorders
3.2 Ability to facility an integration of research findings in client assessment
3.3 Ability to assist the supervisee in providing rationale for assessment procedures
3.4 Ability to Assist supervisee in communicating assessment procedures and
rationales
3.5 Ability to assist the supervisee in integrating findings and observations to make
appropriate recommendations
3.6 Ability to facilitate the supervisees independent planning of assessment
4.0 Assisting the Supervisee in Developing and Refining Management Skills
4.1 Ability to share current research findings and management procedures in
communication disorders
4.2 Ability to facilitate an integration of research findings in client management
4.3 Ability to assist the supervisee in providing rationale for treatment procedures
4.4 Ability to assist the supervisee in identifying appropriate sequences for client
change
4.5 Ability to assist the supervisee in adjusting steps in the progression toward a goal
4.6 Ability to assist the supervisee in the description and measurement of client and
clinician change
4.7 Ability to assist the supervisee in documenting client and clinician change
5.0 Demonstrating For and Participating With the Supervisee in the Clinical
Process
5.1 Ability to determine jointly when demonstration is appropriate
5.2 Ability to demonstrate or participate in an effective client-clinician relationship
5.3 Ability to demonstrate a variety of clinical techniques and participate with
supervisees in clinical management
5.4 Ability to demonstrate or use jointly the specific materials and equipment of the
profession
5..5 Ability to demonstrate or participate jointly in counseling of clients or
family/guardians of clients
6.0 Assisting the Supervisee in Observing and Analyzing Assessment and
Treatment Sessions
6.1 Ability to assist the supervisee in learning a variety of data collection process
6.2 Ability to assist the supervisee in selecting and executing data collection
procedures
6.3 Ability to assist the supervisee in accurately recording data
6.4 Ability to assist the supervisee in analyzing and interpreting data objectively
6.5 Ability to assist the supervisee in revising plans for client management based on
data obtained
7.0 Assisting the Supervisee in Development and Maintenance of Clinical and
Supervisory Records
7.1 Ability to assist the supervisee in applying record-keeping systems to supervisory
and clinical processes
7.2 Ability to assist the supervisee in effectively documenting supervisory and clinically
related interactions
7.3 Ability to assist the supervisee in organizing records to facilitate easy retrieval of
information concerning clinical and supervisory interactions
7.4 Ability to assist the supervisee in establishing and following policies and procedures
to protect the confidentiality of clinical and supervisory records
7.5 Ability to share information regarding documentation requirements of various
accrediting and
regulatory agencies and third-party funding sources
8.0 Interacting with the Supervisee in Planning, Executing, and Analyzing
Supervisory Conferences
8.1 Ability to determine with the supervisee when a conference should be scheduled
8.2 Ability to assist the supervisee in planning a supervisory conference agenda
8.3 Ability to involve the supervisee in jointly establishing a conference agenda
8.4 Ability to involve the supervisee in joint discussion of previously identified clinical
or supervisory data or issues
8.5 Ability to interact with the supervisee in a manner that facilitates the supervisees
self-exploration and problem solving
8.6 Ability to adjust conference content based on the supervisees level of training and
experience
8.7 Ability to encourage and maintain supervisee motivation for continuing self-growth
8.8 Ability to assist the supervisee in making commitments for changes in clinical
behavior
8.9 Ability to involve the supervisee in ongoing analysis of supervisory interactions
9.0 Assisting the Supervisee in Evaluation of clinical Performance
9.1 Ability to assist the supervisee in the use of clinical evaluation tools
9.2 Ability to assist the supervisee in the description and measurement of his/her
progress and achievement
9.3 Ability to assist the supervisee in developing skills of self-evaluation
9.4 Ability to evaluate clinical skills with the supervisee for purposes of grade
assignment, completion of
Clinical Fellowship Year, professional advancement, etc.
10.0 Assisting the Supervisee in Developing Skills of Verbal Reporting, Writing,
and Editing
10.1 Ability to assist the supervisee in identifying appropriate information to be
included in a verbal or written report
10.2 Ability to assist the supervisee in presenting information in a logical, concise, and
sequential manner
10.3 Ability to assist the supervisee in using appropriate professional terminology and
style in verbal and written reporting
10.4 Ability to assist the supervisee in adapting verbal and written reports to the work
environment and communication situation
10.5 Ability to alter and edit a report as appropriate while preserving the supervisees
writing style
Sharing Information Regarding Ethical, Legal, Regulatory, and Reimbursement
Aspects of the Profession
11.1 Ability to communicate to the supervisee a knowledge of professional codes of
ethics (e.g., ASHA, state licensing boards, etc.
11.2 Ability to communicate to the supervisee an understanding of legal and regulatory
documents and their impact on the practice of the profession (licensure, PL 94-142,
Medicare, Medicaid, etc.)
11.3 Ability to communicate to the r supervisee an understanding of reimbursement
policies and procedures of the work setting
11.4 Ability to communicate a knowledge of supervisee rights and appeal procedures
specific to the work setting.
12. 0 Modeling and Facilitating Professional Conduct
12.1 Ability to assume responsibility
12.2 Ability to analyze, evaluate, and modify own behavior
12.3 Ability to demonstrate ethical and legal conduct
12.4 Ability to meet and respect deadlines
12.5 Ability to maintain professional protocols (respect for confidentiality, etc.)
12.6 Ability to provide current information regarding professional standards (PSB,
ESB, Licensure, teacher certification, etc.
12,7 Ability to communicate information regarding fees, billing procedures, and third
party reimbursement
12.8 Ability to demonstrate familiarity with professional issues
12.9 Ability to demonstrate continued professional growth
13.0 Demonstrating Research Skills in the Clinical or Supervisory Processes
13.1 Ability to read, interpret, and apply clinical and supervisory research
13.2 Ability to formulate clinical or supervisory research questions
13.3 Ability to investigate clinical or supervisory research question
13.4 Ability to support and refute clinical or supervisory research and disseminate as
appropriate (e.g., in-service, conferences, publications)
14.0 Communicating with Deaf/HH Individuals
14.1 Ability to communicate with deaf and hard of hearing individuals with a variety of
communication abilities
14.2 Abilities to communicate with deaf and hard of hearing individuals who use ASL
as their primary language
 Seminar Format and Procedures

1. The Ph.D. student completes Practicum Form 1 (attached) that includes the goals
for the practicum, a copy of the syllabus and plans for observations and feedback
from the supervisor to the practicum student
2. The Ph.D. student meets with the Faculty supervisor and who will be overseeing
the practicum and completes Form 2, rating current competencies in clinical
supervision and prioritizing competencies to be developed. The Ph.D. student and
will coordinate with the Faculty Supervisor to regarding observations and
evaluations schedule.
3. The Ph.D. student will create a syllabus that will cover the practicum experience
for the student intern.
4. The Ph.D. student will discuss with the Faculty supervisor using the evidence-
based practice format different aspects of clinical education/supervison.
5. At the conclusion of the practicum, the Clinical Educator evaluates the practicum
student, the student evaluates the overall quality of the practicum, and the Faculty
Supervisor does a summary evaluation and gives a grade for the practicum.

Date Topic Date Topic

8/31 Review syllabus for 896; discuss 9/7 Creation of syllabus by the
requirements of university for the supervisor for the student
student intern; intern

9/14 First day of observation 9/21 EBP: self assessment

observation schedule for the rest
of the semester; self assessment
of the student intern

10/12 Observation: ID student intern 10/19 EBP: Blooms

level taxonomy/learner skills

10/26 Observation: clinical educator 11/2 EBP: clinical educator

style/level style/level

11/9 Observation: Formative feedback 11/16 EBP: formative feedback

Date Topic Date Topic

11/30 Observation: Summative 12/7 EBP: summative

Feedback assessment
Concept Map: Supervision

Syllabus/Clinical Contract Format: Create a syllabus/contract that will reflect what

you plans are for this student internship.

CONTACT INFORMATION:
Practicum DESCRIPTION:
Evaluation and treatment of speech and language disorders
Treatment plan development
Evaluation and progress reports writing
Clients and families counseling
Specifics?
Practicum OBJECTIVES (specialty internship)
Evaluation
Treatment
Paperwork
Professionalism and Development as a Clinician
CLINIC MATERIALS/THERAPY:
SUGGESTED BOOKS/RESOURCES:
THERAPY NOTEBOOK: record keeping
HOUSEKEEPING/CLINIC POLICIES:
HIPAA
Consent and Waiver
Communication in the setting
DRESS/PROFESSIONAL ATTIRE
ATTENDANCE
Accommodations
Weekly/Daily/Bi-weekly supervisor meeting content and format
Expectations for the meeting
Schedule of paperwork/requirement
Content topics to be covered during the semester
EVALUATION/SELF-EVALUATION & GRADING
Grading rubric: consider creating a multi-level grading rubric to reflect what
experience level the student intern is in. Also incorporate the following factors
o Learner characteristics novice intermediate entry level
 Teacher Characteristics:
o novice advanced beginner competent practitioner professional artist
o Telling selling participating delegating
Teaching strategies:
o evaluation-feedback (direct active) transitional to collaborative self
supervision (Consultative)

Evidence-based practice (EBP)

We will review several topics that covers different aspects of supervision. We will find
article(s) that we can discuss during our bi-weekly meetings. These include:
1. Self-Assessment
2. Learner characteristics
3. Teacher characteristics
4. Teaching Strategies

Step 1: Framing the Clinical Question

The first step in applying evidence to a clinical decision is framing the specific
question about which evidence will be sought. One widely-used approach to framing
these questions is known as PICO, for Population, Intervention, Comparison, Outcome.
Ensuring that the clinical question addresses all four of these areas will help to ensure
that the evidence will be relevant to the particular circumstance faced by the clinician.

Step 2: Finding the Evidence

Ideally, evidence-based clinical practice guidelines relevant to your clinical question will
already exist (see Making the Decision). When that is not the case, however, the clinician
needs to seek out scientific evidence to help inform the treatment decision. Two major
types of evidence may be useful:
Systematic Reviews
Individual Studies
Step 3: Assessing the Evidence
There are at least two important factors to keep in mind when assessing a systematic
 review.
The first is relevance of the review to your specific clinical question (see framing
the clinical question). If the brain-injured patient whose care prompted your question is a
member of a cultural or linguistic minority, for example, how useful is a brain-injury
review that excludes or makes no specific mention of culturally or linguistically diverse
populations? If you are treating an autistic teenager, of what relevance are reviews based
primarily on studies of younger children? Once again, the expertise and experience of the
individual clinician is an absolutely essential part of evidence-based practice.
The second factor to consider is who wrote and published the review. While many
reviews are produced by academic institutions and interdisciplinary collaborations, others
are produced by advocacy groups or payors. It is important to consider who produced the
reviews and to what extent they would likely be affected by positive or negative findings.
However, reviews emanating from a "trusted" source are no more guaranteed to be of
high quality than are reviews coming from a less objective source guaranteed to be
flawed.

Level Description
Ia Well-designed meta-analysis of >1 randomized controlled trial
Ib Well-designed randomized controlled study
IIa Well-designed controlled study without randomization
IIb Well-designed quasi-experimental study
III Well-designed non-experimental studies, i.e., correlational and case studies
IV Expert committee report, consensus conference, clinical experience of respected authorities

Step 4: Making the Clinical Decision

Finally, the time will come to combine clinical expertise, the patient's perspective,
and the available scientific evidence in making a specific clinical decision with a specific
patient. In some instances, evidence-based clinical guidelines will already have been
developed on topics related to your particular question. There are at least three important
factors to keep in mind when considering whether and to what extent to follow the
guidance contained in such documents.
The first is relevance of the guideline to your specific clinical question (see
framing the clinical question and EBP Compendium). If the brain-injured patient whose
care prompted your question is a member of a cultural or linguistic minority, for example,
how useful are brain-injury guidelines that exclude or make no specific mention of
culturally or linguistically diverse populations? If you are treating an autistic teenager, of
what relevance are guidelines developed primarily on the basis of evidence from younger
children? Once again, the expertise and experience of the individual clinician is an
absolutely essential part of evidence-based practice.
The second consideration is the extent to which clinical practice guidelines are truly
evidenced-based. Many guidelines are produced via an expert consensus process or other
non-systematic approaches. While expert consensus can certainly be a valuable source of
information, the conclusions are particularly vulnerable to the biases held by the
"experts", and history is full of examples of such conclusions being simply wrong.
If a guideline is truly evidence-based, the methodology by which evidence was
identified and evaluated should be transparent. Unfortunately, transparency in itself is not
a guarantee of quality. It can be a challenge for clinicians to determine what is and is not
a high quality evidence-based practice guideline. Systems for evaluating practice
guidelines have been developed and can be useful tools to help determine whether a
guideline should be applied. The most prominent of these tools is the Appraisal of
Guidelines Research and Evaluation II (AGREE II) framework. AGREE II was
developed by the European Union and has subsequently been endorsed by the US
Agency for Health Research and Quality (AHRQ).
The third factor to consider is who wrote and published the guideline. While
many guidelines are produced by academic institutions and interdisciplinary
collaborations, others are produced by advocacy groups or payors. It is important to
consider who produced the guidelines and to what extent they would likely be affected by
positive or negative recommendations. However, guidelines emanating from a "trusted"
source are no more guaranteed to be of high quality than are guidelines coming from a
less objective source guaranteed to be flawed. Application of the AGREE II or other
objective criteria should be the final determinant of the guideline's quality.

Where to Find Evidence-Based Practice Guidelines

1. N-CEP's Compendium of Guidelines and Systematic Reviews (ASHA)
2. Scottish Intercollegiate Guidelines Network (SIGN)
3. The National Guideline Clearinghouse
4. American Academy of Pediatrics
5. U.S. Department of Veterans Affairs
6. Academy of Neurologic Communication Disorders and Sciences (ANCDS)
7. National Electronic Library for Health (National Health Service of the UK)
8. Royal College of Speech-Language Therapists

When guidelines are either inapplicable or non-existent, then the clinician must rely
on the evidence identified and assessed in the previous steps (Finding the Evidence and
Assessing the Evidence). There typically is no magic formula for determining how much
evidence is "enough." Factors such as patient preference, cost effectiveness, potential for
harm and availability of alternative treatments all come into play in ultimately making the
treatment decision.

Graduate School and University policies:

Please take a moment to familiarize yourselves with important Graduate School and
University policies regarding OSWD accommodation, academic integrity, course
registration and withdrawal, grading and the academic appeals procedure. You can access
the current text for all these policies by clicking on the Policies link:
https://securedgspp.gallaudet.edu/gradpolicies/detail.aspx?id=116 and
http://aaweb.gallaudet.edu/Documents/Academic/GSPP/catalog/11-
12/gradcatalog_11_12.pdf
 HSL 895: Ph.D. Clinical Supervision Practicum: Form 1
Proposal for Practicum in University Clinical Supervision in Audiology
(Advisor files this form in students file)

Directions to the Ph.D. Student: Students are strongly recommended to submit this
proposal with the students Preliminary Degree Plan. If it is not submitted with the
Preliminary Program, it must be submitted to the Speech-Language Pathology Program
Director by December 15th. The Advisor is responsible for filing the approved plan in the
student's file

Student: __________________________
Semester:__________________________

Supervisor: __________________________ No. of Credits for Practicum: ________

Course: ________________________________________________________________
Dept/number Name # of Credits

Sign Communication Level ___________ Date Achieved: __________________

List of Practicum Student's Responsibilities (Faculty develops with Ph.D. student)

Faculty Observation Arrangements (mutually agreed upon by student and supervisor).

Include a description of (a) the number of observations, (b) the nature (written, oral) of
feedback, and (c) the location and timing of feedback to be given student after each
observation. Typically the student receives formal feedback 3-4 times during the
practicum

______________________________________
Ph.D. Student Date

_______________________________________
Faculty Supervisor Date
 HSL 895: Ph.D. Practicum in Clinical Supervision Form 2
Ph.D. Students Pre-Practicum Self-Evaluation of Supervision Competencies
And Priorities for HSLS 895: Practicum in Clinical Supervision

Student: _______________________________________ Semester: ______________

Explanations of Ratings:
PRIORITY
H HIGH
M MEDIUM
L - LOW

SELF-EVALUATION
1. STRENGTH Consistently Demonstrated by Supervisor-in-Training
2. EMERGING: Frequently Demonstrated by Supervisor-in-Training
3. WEAKNESS: Infrequently Demonstrated by Supervisor-in-Training

Priority Competencies Trainees Self

Evaluation
1.0 Establish and Maintain an Effective Working
Relationship with the Supervisee
1.1 Ability to facilitate an understanding of the clinical and
supervisory processes
1.2 Ability to organize and provide information regarding
the logical sequences of supervisory interaction - that is,
joint setting of goals and objectives, data collection and
analysis, evaluation
1.3 Ability to interact from a contemporary perspective
with the supervisee in both the clinic and supervisory
process
1.4 Ability to apply learning principles in the supervisory
process
1.5 Ability to apply skills of interpersonal communication
in the supervisory process
1.6. Ability to facilitate independent thinking and problem
solving by the supervisee
1.7 Ability to maintain a professional and supportive
relationship that allows supervisor and supervisee growth
1.8 Ability to interact with the supervisee objectively
1.9 Ability to establish joint communication regarding
expectations and responsibilities in the clinic and
supervisory processes
1.10 Ability to evaluate, with the supervisee, the
effectiveness of the ongoing supervisory relationship
2.0 Assisting the Supervisee in Developing Clinical goals
and objectives
2.1 Ability to assist the supervisee in planning effective
client goals and objectives
2.2 Ability to plan, with the supervisee, effective goals and
objectives for clinical and professional
growth
2.3 Ability to assist the supervisee in using observation and
assessment in preparation of client
goals and objectives
2.4 Ability to assist the supervisee in using self-analysis and
previous evaluation in preparation of goals and
objectives for professional growth
2.5 Ability to assist the supervisee in assigning priorities to
clinical goals and objectives

2.6 Ability to assist the supervisee in assigning priorities to

goals and objectives for professional
growth
3.0 Assisting the Supervisee in Developing and Refining
Assessment Skills
3.1 Ability to share current research findings and evaluation
procedures in communication disorders
3.2 Ability to facility an integration of research findings in
client assessment
3.3 Ability to assist the supervisee in providing rationale for
assessment procedures
3.4 Ability to Assist supervisee in communicating
assessment procedures and rationales
3.5 Ability to assist the supervisee in integrating findings
and observations to make appropriate
recommendations
3.6 Ability to facilitate the supervisees independent
planning of assessment
4.0 Assisting the Supervisee in Developing and Refining
Management Skills
4.1 Ability to share current research findings and
management procedures in communication disorders
4.2 Ability to facilitate an integration of research findings in
client management
4.3 Ability to assist the supervisee in providing rationale for
treatment procedures
4.4 Ability to assist the supervisee in identifying appropriate
sequences for client change
4.5 Ability to assist the supervisee in adjusting steps in the
progression toward a goal
4.6 Ability to assist the supervisee in the description and
measurement of client and clinician change
4.7 Ability to assist the supervisee in documenting client and
clinician change
5.0 Demonstrating For and Participating With the
Supervisee in the Clinical Process
5.1 Ability to determine jointly when demonstration is
appropriate
5.2 Ability to demonstrate or participate in an effective
client-clinician relationship
5.3 Ability to demonstrate a variety of clinical techniques
and participate with the supervisee in clinical
management
5.4 Ability to demonstrate or use jointly the specific
materials and equipment of the profession
5..5 Ability to demonstrate or participate jointly in
counseling of clients or family/guardians of clients
6.0 Assisting the Supervisee in Observing and Analyzing
Assessment and Treatment Sessions
6.1 Ability to assist the supervisee in learning a variety of
data collection process
6.2 Ability to assist the supervisee in selecting and
executing data collection procedures
6.3 Ability to assist the supervisee in accurately recording
data
6.4 Ability to assist the supervisee in analyzing and
interpreting data objectively
6.5 Ability to assist the supervisee in revising plans for client
management based on data obtained
7.0 Assisting the Supervisee in Development and
Maintenance of Clinical and Supervisory Records
7.1 Ability to assist the supervisee in applying record-
keeping systems to supervisory and clinical processes
7.2 Ability to assist the supervisee in effectively
documenting supervisory and clinically related
interactions
7.3 Ability to assist the supervisee in organizing records to
facilitate easy retrieval of information concerning
clinical and supervisory interactions
7.4 Ability to assist the supervisee in establishing and
following policies and procedures to protect the
confidentiality of clinical and supervisory records
7.5 Ability to share information regarding documentation
requirements of various accrediting and
regulatory agencies and third-party funding sources
8.0 Interacting with the Supervisee in Planning,
Executing, and Analyzing Supervisory Conferences
8.1 Ability to determine with the supervisee when a
 conference should be scheduled
8.2 Ability to assist the supervisee in planning a supervisory
conference agenda
8.3 Ability to involve the supervisee in jointly establishing a
conference agenda
8.4 Ability to involve the supervisee in joint discussion of
previously identified clinical or supervisory
data or issues
8.5 Ability to interact with the supervisee in a manner that
facilitates the supervisees self-exploration and problem
solving
8.6 Ability to adjust conference content based on the
supervisees level of training and experience
8.7 Ability to encourage and maintain supervisee motivation
for continuing self- growth
8.8 Ability to assist the supervisee in making commitments
for changes in clinical behavior
8.9 Ability to involve the supervisee in ongoing analysis of
supervisory interactions
9.0 Assisting the Supervisee in Evaluation of clinical
Performance
9.1 Ability to assist the supervisee in the use of clinical
evaluation tools
9.2 Ability to assist the supervisee in the description and
measurement of his/her progress and achievement
9.3 Ability to assist the supervisee in developing skills of
self-evaluation
9.4 Ability to evaluate clinical skills with the supervisee for
purposes of grade assignment, completion of Clinical
Fellowship Year, professional advancement, etc.
10.0 Assisting the Supervisee in Developing Skills of
Verbal Reporting, Writing, and Editing
10.1 Ability to assist the supervisee in identifying
appropriate information to be included in a verbal or
written report
10.2 Ability to assist the supervisee in presenting
information in a logical, concise, and sequential manner
10.3 Ability to assist the supervisee in using appropriate
professional terminology and style in verbal and
written reporting
10.4 Ability to assist the supervisee in adapting verbal and
written reports to the work environment and
communication situation
10.5 Ability to alter and edit a report as appropriate while
preserving the supervisees writing style
11.0 Sharing Information Regarding Ethical, Legal,
 Regulatory, and Reimbursement Aspects of the
Profession
11.1 Ability to communicate to the supervisee a knowledge
of professional codes of ethics (e.g., ASHA, state
licensing boards, etc.
11.2 Ability to communicate to the supervisee an
understanding of legal and regulatory documents and their
impact on the practice of the profession (licensure, PL 94-
142, Medicare, Medicaid, etc.)
11.3 Ability to communicate to the r supervisee an
understanding of reimbursement policies and procedures
of the work setting
11.4 Ability to communicate a knowledge of supervisee
rights and appeal procedures specific to the work setting.
12. 0 Modeling and Facilitating Professional Conduct
12.1 Ability to assume responsibility
12.2 Ability to analyze, evaluate, and modify own behavior
12.3 Ability to demonstrate ethical and legal conduct
12.4 Ability to meet and respect deadlines
12.5 Ability to maintain professional protocols (respect for
confidentiality, etc.)
12.6 Ability to provide current information regarding
professional standards (PSB, ESB, Licensure, teacher
certification, etc.
12,7 Ability to communicate information regarding fees,
billing procedures, and third party reimbursement
12.8 Ability to demonstrate familiarity with professional
issues
12.9 Ability to demonstrate continued professional growth
13.0 Demonstrating Research Skills in the Clinical or
Supervisory Processes

13.1 Ability to read, interpret, and apply clinical and

supervisory research
13.2 Ability to formulate clinical or supervisory research
questions
13.3 Ability to investigate clinical or supervisory research
question
13.4 Ability to support and refute clinical or supervisory
research and disseminate as appropriate (e.g., in-service,
conferences, publications)
14.0 Communicating with Deaf/HH Individuals
14.1 Ability to communicate with deaf and hard of hearing
individuals with a variety of communication abilities
14.2 Abilities to communicate with deaf and hard of hearing
individuals who use ASL as their primary language
 HSL 895: Ph.D. Practicum in Clinical Supervision Form 3
MID-TERM EVALUATION OF Ph.D. Practicum in Clinical Supervision

Student: ____________________________________ Semester: _______________

Explanations of Ratings:
CLINICAL EDUCATORS PRIORITY FOR PRACTICUM STUDENT
H HIGH
M MEDIUM
L - LOW
CLIICAL EDUCATORS EVALUATION
1 STRENGTH Consistently Demonstrated by Supervisor-in-Training
2 EMERGING: Frequently Demonstrated by Supervisor-in-Training
3 WEAKNESS: Infrequently Demonstrated by Supervisor-in-Training

Priority Establish and maintain an effective working relationship Clinical

with the supervisee Educators
Evaluation
1.0 Establish and Maintain an Effective Working
Relationship with the Supervisee
1.1 Ability to facilitate an understanding of the clinical and
supervisory processes
1.2 Ability to organize and provide information regarding the
logical sequences of supervisory interaction - that is, joint
setting of goals and objectives, data collection and analysis,
evaluation
1.3 Ability to interact from a contemporary perspective with
the supervisee in both the clinic and supervisory process
1.4 Ability to apply learning principles in the supervisory
process
1.5 Ability to apply skills of interpersonal communication in
the supervisory process
1.6. Ability to facilitate independent thinking and problem
solving by the supervisee
1.7 Ability to maintain a professional and supportive
relationship that allows supervisor and supervisee growth
1.8 Ability to interact with the supervisee objectively
1.9 Ability to establish joint communication regarding
expectations and responsibilities in the clinic and
supervisory processes
1.10 Ability to evaluate, with the supervisee, the effectiveness
of the ongoing supervisory relationship
2.0 Assisting the Supervisee in Developing Clinical goals
and objectives
2.1 Ability to assist the supervisee in planning effective client
goals and objectives
2.2 Ability to plan, with the supervisee, effective goals and
objectives for clinical and professional growth
2.3 Ability to assist the supervisee in using observation and
assessment in preparation of client goals and objectives
2.4 Ability to assist the supervisee in using self-analysis and
previous evaluation in preparation of goals and objectives
for professional growth
2.5 Ability to assist the supervisee in assigning priorities to
clinical goals and objectives
2.6 Ability to assist the supervisee in assigning priorities to
goals and objectives for professional growth
3.0 Assisting the Supervisee in Developing and Refining
Assessment Skills
3.1 Ability to share current research findings and evaluation
procedures in communication disorders
3.2 Ability to facility an integration of research findings in
client assessment
3.3 Ability to assist the supervisee in providing rationale for
assessment procedures
3.4 Ability to Assist supervisee in communicating assessment
procedures and rationales
3.5 Ability to assist the supervisee in integrating findings and
observations to make appropriate recommendations
3.6 Ability to facilitate the supervisees independent planning
of assessment
4.0 Assisting the Supervisee in Developing and Refining
Management Skills
4.1 Ability to share current research findings and management
procedures in communication disorders
4.2 Ability to facilitate an integration of research findings in
client management
4.3 Ability to assist the supervisee in providing rationale for
treatment procedures
4.4 Ability to assist the supervisee in identifying appropriate
sequences for client change
4.5 Ability to assist the supervisee in adjusting steps in the
progression toward a goal
4.6 Ability to assist the supervisee in the description and
measurement of client and clinician change
4.7 Ability to assist the supervisee in documenting client and
clinician change
5.0 Demonstrating For and Participating With the
Supervisee in the Clinical Process
5.1 Ability to determine jointly when demonstration is
appropriate
5.2 Ability to demonstrate or participate in an effective client-
 clinician relationship
5.3 Ability to demonstrate a variety of clinical techniques and
participate with the supervisee in clinical management
5.4 Ability to demonstrate or use jointly the specific materials
and equipment of the profession
5..5 Ability to demonstrate or participate jointly in counseling
of clients or family/guardians of clients
6.0 Assisting the Supervisee in Observing and Analyzing
Assessment and Treatment Sessions
6.1 Ability to assist the supervisee in learning a variety of data
collection process
6.2 Ability to assist the supervisee in selecting and executing
data collection procedures
6.3 Ability to assist the supervisee in accurately recording data
6.4 Ability to assist the supervisee in analyzing and interpreting
data objectively
6.5 Ability to assist the supervisee in revising plans for client
management based on data obtained
7.0 Assisting the Supervisee in Development and
Maintenance of Clinical and Supervisory Records
7.1 Ability to assist the supervisee in applying record-keeping
systems to supervisory and clinical processes
7.2 Ability to assist the supervisee in effectively documenting
supervisory and clinically related interactions
7.3 Ability to assist the supervisee in organizing records to
facilitate easy retrieval of information concerning clinical and
supervisory interactions
7.4 Ability to assist the supervisee in establishing and following
policies and procedures to protect the confidentiality of
clinical and supervisory records
7.5 Ability to share information regarding documentation
requirements of various accrediting and regulatory agencies
and third-party funding sources
8.0 Interacting with the Supervisee in Planning, Executing,
and Analyzing Supervisory Conferences
8.1 Ability to determine with the supervisee when a conference
should be scheduled
8.2 Ability to assist the supervisee in planning a supervisory
conference agenda
8.3 Ability to involve the supervisee in jointly establishing a
conference agenda
8.4 Ability to involve the supervisee in joint discussion of
previously identified clinical or supervisory data or issues
8.5 Ability to interact with the supervisee in a manner that
facilitates the supervisees self-exploration and problem
solving
8.6 Ability to adjust conference content based on the
supervisees level of training and experience
8.7 Ability to encourage and maintain supervisee motivation
for continuing self-growth
8.8 Ability to assist the supervisee in making commitments for
changes in clinical behavior
8.9 Ability to involve the supervisee in ongoing analysis of
supervisory interactions
9.0 Assisting the Supervisee in Evaluation of clinical
Performance
9.1 Ability to assist the supervisee in the use of clinical
evaluation tools
9.2 Ability to assist the supervisee in the description and
measurement of his/her progress and achievement
9.3 Ability to assist the supervisee in developing skills of self-
evaluation
9.4 Ability to evaluate clinical skills with the supervisee for
purposes of grade assignment, completion of Clinical
Fellowship Year, professional advancement
10.0 Assisting the Supervisee in Developing Skills of Verbal
Reporting, Writing, and Editing
10.1 Ability to assist the supervisee in identifying appropriate
information to be included in a verbal or written report
10.2 Ability to assist the supervisee in presenting information in
a logical, concise, and sequential manner
10.3 Ability to assist the supervisee in using appropriate
professional terminology and style in verbal and written
reporting
10.4 Ability to assist the supervisee in adapting verbal and
written reports to the work environment and communication
situation
10.5 Ability to alter and edit a report as appropriate while
preserving the supervisees writing style
Sharing Information Regarding Ethical, Legal, Regulatory,
and Reimbursement Aspects of the Profession
11.1 Ability to communicate to the supervisee a knowledge of
professional codes of ethics (e.g., ASHA, state licensing
boards, etc.
11.2 Ability to communicate to the supervisee an understanding
of legal and regulatory documents and their impact on the
practice of the profession (licensure, PL 94-142, Medicare,
Medicaid, etc.)
11.3 Ability to communicate to the r supervisee an
understanding of reimbursement policies and procedures of
the work setting
11.4 Ability to communicate a knowledge of supervisee rights
 and appeal procedures specific to the work setting.
12. 0 Modeling and Facilitating Professional Conduct
12.1 Ability to assume responsibility
12.2 Ability to analyze, evaluate, and modify own behavior
12.3 Ability to demonstrate ethical and legal conduct
12.4 Ability to meet and respect deadlines
12.5 Ability to maintain professional protocols (respect for
confidentiality, etc.)
12.6 Ability to provide current information regarding
professional standards (PSB, ESB, Licensure, teacher
certification, etc.
12,7 Ability to communicate information regarding fees, billing
procedures, and third party reimbursement
12.8 Ability to demonstrate familiarity with professional issues
12.9 Ability to demonstrate continued professional growth
13.0 Demonstrating Research Skills in the Clinical or
Supervisory Processes
13.1 Ability to read, interpret, and apply clinical and
supervisory research
13.2 Ability to formulate clinical or supervisory research
questions
13.3 Ability to investigate clinical or supervisory research
question
13.4 Ability to support and refute clinical or supervisory
research and disseminate as appropriate (e.g., in-service,
conferences, publications)
14.0 Communicating with Deaf/HH Individuals
14.1 Ability to communicate with deaf and hard of hearing
individuals with a variety of communication abilities
14.2 Abilities to communicate with deaf and hard of hearing
individuals who use ASL as their primary language
 HSL 895: Ph.D. Practicum in Clinical Supervision Form 4
FINAL EVALUATION OF Ph.D. Practicum in Clinical Supervision

Student: _____________________________________ Semester: _______________

Explanations of Ratings:
CLINICAL EDUCATORS PRIORITY FOR PRACTICUM STUDENT
H HIGH
M MEDIUM
L - LOW
CLIICAL EDUCATORS EVALUATION
1 STRENGTH Consistently Demonstrated by Supervisor-in-Training
2 EMERGING: Frequently Demonstrated by Supervisor-in-Training
3 WEAKNESS: Infrequently Demonstrated by Supervisor-in-Training

Competencies Clinical
Educators
Final
Evaluation
1.0 Establish and Maintain an Effective Working Relationship
with the Supervisee
1.1 Ability to facilitate an understanding of the clinical and
supervisory processes
1.2 Ability to organize and provide information regarding the logical
sequences of supervisory interaction - that is, joint setting of
goals and objectives, data collection and analysis, evaluation
1.3 Ability to interact from a contemporary perspective with the
supervisee in both the clinic and supervisory process
1.4 Ability to apply learning principles in the supervisory process
1.5 Ability to apply skills of interpersonal communication in the
supervisory process
1.6. Ability to facilitate independent thinking and problem solving by
the supervisee
1.7 Ability to maintain a professional and supportive relationship
that allows supervisor and supervisee growth
1.8 Ability to interact with the supervisee objectively
1.9 Ability to establish joint communication regarding expectations
and responsibilities in the clinic and supervisory processes
1.10 Ability to evaluate, with the supervisee, the effectiveness of the
ongoing supervisory relationship
2.0 Assisting the Supervisee in Developing Clinical goals and
objectives
2.1 Ability to assist the supervisee in planning effective client goals
and objectives
2.2 Ability to plan, with the supervisee, effective goals and
objectives for clinical and professional growth
2.3 Ability to assist the supervisee in using observation and
assessment in preparation of client goals and objectives
2.4 Ability to assist the supervisee in using self-analysis and previous
evaluation in preparation of goals and objectives for professional
growth
2.5 Ability to assist the supervisee in assigning priorities to clinical
goals and objectives
2.6 Ability to assist the supervisee in assigning priorities to goals and
objectives for professional growth
3.0 Assisting the Supervisee in Developing and Refining
Assessment Skills
3.1 Ability to share current research findings and evaluation
procedures in communication disorders
3.2 Ability to facility an integration of research findings in client
assessment
3.3 Ability to assist the supervisee in providing rationale for
assessment procedures
3.4 Ability to Assist supervisee in communicating assessment
procedures and rationales
3.5 Ability to assist the supervisee in integrating findings and
observations to make appropriate recommendations
3.6 Ability to facilitate the supervisees independent planning of
assessment
4.0 Assisting the Supervisee in Developing and Refining
Management Skills
4.1 Ability to share current research findings and management
procedures in communication disorders
4.2 Ability to facilitate an integration of research findings in client
management
4.3 Ability to assist the supervisee in providing rationale for
treatment procedures
4.4 Ability to assist the supervisee in identifying appropriate
sequences for client change
4.5 Ability to assist the supervisee in adjusting steps in the
progression toward a goal
4.6 Ability to assist the supervisee in the description and
measurement of client and clinician change
4.7 Ability to assist the supervisee in documenting client and
clinician change
5.0 Demonstrating For and Participating With the Supervisee in
the Clinical Process
5.1 Ability to determine jointly when demonstration is appropriate
5.2 Ability to demonstrate or participate in an effective client-
clinician relationship
5.3 Ability to demonstrate a variety of clinical techniques and
participate with the supervisee in clinical management
5.4 Ability to demonstrate or use jointly the specific materials and
equipment of the profession
5..5 Ability to demonstrate or participate jointly in counseling of
clients or family/guardians of clients
6.0 Assisting the Supervisee in Observing and Analyzing
Assessment and Treatment Sessions
6.1 Ability to assist the supervisee in learning a variety of data
collection process
6.2 Ability to assist the supervisee in selecting and executing data
collection procedures
6.3 Ability to assist the supervisee in accurately recording data
6.4 Ability to assist the supervisee in analyzing and interpreting data
objectively
6.5 Ability to assist the supervisee in revising plans for client
management based on data obtained
7.0 Assisting the Supervisee in Development and Maintenance of
Clinical and Supervisory Records
7.1 Ability to assist the supervisee in applying record-keeping
systems to supervisory and clinical processes
7.2 Ability to assist the supervisee in effectively documenting
supervisory and clinically related interactions
7.3 Ability to assist the supervisee in organizing records to facilitate
easy retrieval of information concerning clinical and supervisory
interactions
7.4 Ability to assist the supervisee in establishing and following
policies and procedures to protect the confidentiality of clinical
and supervisory records
7.5 Ability to share information regarding documentation
requirements of various accrediting and regulatory agencies and
third-party funding sources
8.0 Interacting with the Supervisee in Planning, Executing, and
Analyzing Supervisory Conferences
8.1 Ability to determine with the supervisee when a conference
should be scheduled
8.2 Ability to assist the supervisee in planning a supervisory
conference agenda
8.3 Ability to involve the supervisee in jointly establishing a
conference agenda
8.4 Ability to involve the supervisee in joint discussion of previously
identified clinical or supervisory data or issues
8.5 Ability to interact with the supervisee in a manner that facilitates
the supervisees self-exploration and problem solving
8.6 Ability to adjust conference content based on the supervisees
level of training and experience
8.7 Ability to encourage and maintain supervisee motivation for
continuing self-growth
8.8 Ability to assist the supervisee in making commitments for
changes in clinical behavior
8.9 Ability to involve the supervisee in ongoing analysis of
supervisory interactions
9.0 Assisting the Supervisee in Evaluation of clinical Performance
9.1 Ability to assist the supervisee in the use of clinical evaluation
tools
9.2 Ability to assist the supervisee in the description and
measurement of his/her progress and achievement
9.3 Ability to assist the supervisee in developing skills of self-
evaluation
9.4 Ability to evaluate clinical skills with the supervisee for purposes
of grade assignment, completion of Clinical Fellowship Year,
professional advancement, etc.
10.0 Assisting the Supervisee in Developing Skills of Verbal
Reporting, Writing, and Editing
10.1 Ability to assist the supervisee in identifying appropriate
information to be included in a verbal or written report
10.2 Ability to assist the supervisee in presenting information in a
logical, concise, and sequential manner
10.3 Ability to assist the supervisee in using appropriate professional
terminology and style in verbal and written reporting
10.4 Ability to assist the supervisee in adapting verbal and written
reports to the work environment and communication situation
10.5 Ability to alter and edit a report as appropriate while preserving
the supervisees writing style
11.0 Sharing Information Regarding Ethical, Legal, Regulatory,
and Reimbursement Aspects of the Profession
11.1 Ability to communicate to the supervisee a knowledge of
professional codes of ethics (e.g., ASHA, state licensing boards,
etc.
11.2 Ability to communicate to the supervisee an understanding of
legal and regulatory documents and their impact on the practice of
the profession (licensure, PL 94-142, Medicare, Medicaid, etc.)
11.3 Ability to communicate to the supervisee an understanding of
reimbursement policies and procedures of the work setting
11.4 Ability to communicate a knowledge of supervisee rights and
appeal procedures specific to the work setting.
12. 0 Modeling and Facilitating Professional Conduct
12.1 Ability to assume responsibility
12.2 Ability to analyze, evaluate, and modify own behavior
12.3 Ability to demonstrate ethical and legal conduct
12.4 Ability to meet and respect deadlines
12.5 Ability to maintain professional protocols (respect for
confidentiality, etc.)
12.6 Ability to provide current information regarding professional
standards (PSB, ESB, Licensure, teacher certification, etc.
12,7 Ability to communicate information regarding fees, billing
procedures, and third party
reimbursement
12.8 Ability to demonstrate familiarity with professional issues
12.9 Ability to demonstrate continued professional growth
13.0 Demonstrating Research Skills in the Clinical or Supervisory
Processes
13.1 Ability to read, interpret, and apply clinical and supervisory
research
13.2 Ability to formulate clinical or supervisory research questions
13.3 Ability to investigate clinical or supervisory research question
13.4 Ability to support and refute clinical or supervisory research and
disseminate as appropriate (e.g., in- service, conferences,
publications)
14.0 Communicating with Deaf/HH Individuals
14.1 Ability to communicate with deaf and hard of hearing individuals
with a variety of communication abilities
14.2 Abilities to communicate with deaf and hard of hearing
individuals who use ASL as their primary language
 HSL 895: Clinical Supervision Practicum Form 5
Faculty Supervisors Evaluation of the Practicum Student

Dates of Supervision Practicum ______________________________________________

Faculty Supervisor: _______________________________________________________

Nature of Evaluation (number of times the Faculty Supervisor met with the Ph.D. student
and Clinical Educator/ length of meetings

Clinical Educators Evaluation Re the Extent to which Ph.D. Competencies were met
(circle one)
1. All competencies were fully met
2. Almost all competencies were met
3. Most competencies were met
4. Fewer than half of the competencies were met.

Summary of Supervisees Evaluations (attach course evaluation summary tally sheet)

Faculty Supervisors Justification for the Grade, including the evaluation of clients,
clinical educator, and practicum students self evaluation. The narrative should include
uggested areas to evaluate include planning; appropriateness of strategies and procedures;
rapport with students; availability; mastery of audiology knowledge and skills; ability to
communicate ideas; poise as instructor of graduate students; sign communication
abilities) - attach a separate sheet if necessary.

_________________________________ ________________________________
Signature of HSLS University Supervisor Date

Attachment: Student Evaluations of the course

cc: Advisor
 HSL 895: Clinical Supervision Practicum Form 6:
Practicum Students Evaluation of Clinical Supervisor

Directions to the Student: Complete this form within one week after the conclusion of
the Practicum. A copy of this evaluation will be given to the Practicum Supervisor after
grades have been submitted.

Practicum Supervisor: _____________________________________________________

Dates (Semester/Year) of Practicum:_____________ Number of Clients Served_______

Number of Contact Hours with Clients: ____ Average length of Session with Client ____

Please evaluate the quality of supervision you received. As a minimum, include

statements regarding each of the following:
a. Clarity of the Clinical Educators expectations for the practicum (reviewed, in
advance, the competencies planned to be developed in the practicum; indicated
number and nature of observations; described type of feedback that would be
provided; described the role the supervisor would be assuming).

b. Quality of input provided for the strategies, procedures, and materials used.

c. The number of times you were observed by the Clinical Educator and effort made to
observe different supervision strategies.

d. Quality (timeliness and helpfulness) of feedback from the Clinical Educators

observations.

(1)
e. Availability of the Clinical Educator to discuss problems as they arose.

f. Quality of midterm evaluation to discuss student evaluations

g. Quality of comprehensive final evaluation of your performance where strengths and

weaknesses were noted

h. Other:

Strengths of Supervisor (example: knowledge of field being covered by course;

competence as university instructor; rapport and availability to practicum student; ability
to communicate expectations to practicum student; quality of feedback to student (type
and amount); fairness of final evaluation and course grade.)

Suggestions for improving supervision of future practicum students

__________________________________ _____________________________
Signature of Evaluator (Practicum Student) Date

cc: Advisor
(2)
Supervision philosophy
Learning track or continuum
Blooms taxonomy

Scan throught supervison book