Missouri State University
SPEECH-LANGUAGE
and HEARING CLINIC
Scope
of Services (ASHA Standard 1.1, CAA 4.1)
The American Speech-Language and Hearing Association (ASHA, 1990) and the Council on Education of the Deaf (CED-CEC, 1995) scope of services are the broad definition of services and support offered within the profession. The Clinic and its associated practicum sites afford experience within this scope of practice, as well as that specified by the licensure and certification laws within the state of Missouri.
Full diagnostic, habilitative, rehabilitative, preventive, related counseling services and hearing screenings are available through the Speech-Language Pathology program to individuals of any age in the following areas:
LANGUAGE: receptive (comprehension) and expressive language (production);
SPEECH: articulation, fluency, and voice;
ORAL-PHARYNGEAL: tongue thrusting, swallowing, and related functions;
COGNITION/COMMUNICATION;
AUGMENTATIVE/ALTERNATIVE COMMUNICATION;
AURAL REHABILITATION;
ENGLISH-LANGUAGE PROFICIENCY AND COMMUNICATION EFFECTIVENESS: accent reduction and English as a second language.
Full diagnostic, habilitative, rehabilitative, preventive and related counseling services are available through the Audiology program to those of any age in the following areas:
AUDITORY AND VESTIBULAR FUNCTION;
HEARING CONSERVATION AND PRESERVATION;
AMPLIFICATION AND ASSISTIVE LISTENING.
Early intervention services (diagnostic, habilitative, collaborative for programming and transitioning services) for children who are deaf or hard of hearing and their families are available through the Education of the Deaf/Hard of Hearing program in the following areas:
PARENT-INFANT EDUCATION (Birth to 36 months);
PRESCHOOL EDUCATION (3-5 years);
FAMILY EDUCATION AND SUPPORT.
Intervention services provide a focus on the child’s development in the areas of language, cognition, speech, auditory-perceptual and social skills, as well as the family.
Client
Management Procedures
Entry into
Services (ASHA Standards 2.1, 2.5)
Referrals for service are accepted from schools, speech-language pathologists, audiologists, physicians, health-related or other community agency, family members or individuals. Children under 18 years in age are accepted when services are requested by a custodial parent or legal guardian. Specific requirements for services may be dictated and/or negotiated by the contracting agency. Physician referral is required for the following areas: voice therapy following evaluation (ENT); hearing aid fitting for children (ENT).
Referral for evaluation, treatment or educational services is documented on the Request for Service Form (see Appendix A). Specific questions about the nature of services offered are referred to professional staff members. Initial information gathered pertaining to a request for treatment or education of the deaf/hard of hearing may suggest a diagnostic evaluation be scheduled if none has been done or a significant period of time has lapsed since one has been completed. A diagnostic evaluation must be secured before treatment services begin. Diagnostic-treatment may be recommended for a 30-day placement. In the education of the deaf/hard of hearing, an evaluation of the child receiving educational services will be completed within 30 school days of the child’s admittance in the program.
All client services are conducted by appointment only. Such appointments are scheduled by office staff:
the Clinic assistant schedules audiological evaluations; the Clinic
director assigns speech-language evaluations and treatment; supervisors
associated with education of the deaf/hard of hearing schedule referred
children. Scheduling of all
services is based upon completed paperwork, as well as time and personnel
availability, warranting placement on a waiting list if necessary.
Appointment day, time, room and supervisor/practicum student assignment
for each client is determined. When
schedule/room changes occur, the supervisor and practicum student are notified
via the Notice of Schedule/Room Change Form (see Appendix B). If under 18 years in age, children must be accompanied to the
appointment by the custodial parent or legal guardian.
If unable to attend, the parent or legal guardian must sign a Release
(see Appendix C) expressing permission for the services to be rendered.
Client Attendance and Billing (ASHA Standard 2.6)
Clients entering the Clinic for speech-language services will announce their arrival to the receptionist. The receptionist will inform personnel of the client’s presence and note attendance in the Client Attendance Log (see Appendix D). At the end of the Clinic session, practicum students will complete the Client Contact/Billing Log, (see Appendix E) in the client’s working file. The log will document the date the service was rendered, the contact time, category of service. A copy of these forms is to be turned in to the Clinic receptionist at the end of the month for billing purposes. The receptionist will cross check the Client Attendance Log with the Client Contact/Billing Log prior to billing. The Clinic Assistant inserts client information on a database used in processing monthly forms submitted to Missouri State Financial Services. Clients receive a Summary of Fees from the Clinic to be used for possible filing of medical insurance. Missouri State Financial Services will also send monthly statements regarding balance due on account and procedures for forwarding payment. All client contact records must contain complete, accurate information.
Clients attending the Clinic for audiological/hearing aid services must notify the receptionist of their arrival, followed by the receptionist notifying designated personnel.
Supervisors in the area of education of the deaf/hard of hearing will keep accurate attendance records and complete monthly billing sheets on each child’s days of attendance. Supplemental information required for billing purposes will also be completed and submitted to the bookkeeper according to specific billing guidelines.
Client Records
(ASHA Standard 2.6)
Permanent client files are housed in the Clinic office and are released on a written check-out basis for use within the confines of the Clinic by designated Clinic personnel. No section of a permanent file should be removed from the file upon its return for housing. The office staff is responsible for tracking files removed from the main filing system. At the end of each semester, clinical supervisors will be responsible for assuring completeness of each client file. Should a file not be found for an assigned client, the Clinic director should be immediately notified. Requests for release of confidential information (reports, test results, etc.) to another site should be managed by the Clinic office based on completion of designated Clinic form, Authorization for Release of Information (see Appendix F). Notification of such action should be in writing, submitted to the Clinic office, and be documented in the client file.
Client files are maintained in a standard format, initially set up by the
office staff at the time of the client’s first visit.
It is the ultimate responsibility of the assigned supervisor for each
client to maintain client file folders, including designated sections with
current and complete paperwork. Each
client file should contain identifying information including client name and
identifying information including the designated disorder.
Information should be organized in sections from front-to-back in
chronological order such that the most recent paperwork is directly underneath
the colored dividers. The following
contents for files of clients receiving speech-pathology services should be
organized in the following sections:
a.
Speech-language Diagnostic Evaluation (red):
diagnostic report from Missouri State or outside diagnostic source, test results,
and raw test data;
b.
Audiological Evaluation (blue): report
and associated raw test data.
c.
Speech-language Treatment Summary Report and Parent Conferences (yellow):
a report should be on file for each semester services are rendered at the
Clinic; also, information on all conferences held in person or by telephone in
regard to client; and/or
d.
Authorization for Release of Information, records and correspondence
(green): all correspondence
received, Authorization for Release of Information, form for correspondence sent
to agencies and/or individuals.
The file also should have a Patient Data Sheet (see Appendix G) (inside front file cover), Client Contact Log (see Appendix H) (inside back file cover) and Correspondence Record (see Appendix I) (inside back file cover). It should be noted that contents of file folders are not limited to this list nor is this list designed to be comprehensive.
Each child receiving early intervention services for children who are deaf or hard of hearing will have a permanent file. Supervisors in the area of deaf or hard of hearing are the primary responsible party for maintaining the educational section of each child on their caseload.
Confidentiality of client information must be maintained at all times. Written and verbal information pertaining to clients, active and inactive, is to be treated in a confidential manner. Professional discretion should always be employed in relation to client information. Confidentiality of client information is discussed in the ASHA Code of Ethics, CEC Code of Ethics and in the Missouri State Speech-language & Hearing Clinic Practicum Handbook. Office staff, professional staff and practicum students are expected to adhere to these standards.
The purpose of an evaluation is to determine the presence of a hearing
and/or communication disorder/difference and the need for intervention;
regarding learners who are deaf or hard of hearing, evaluation is conducted to
determine status of all developmental areas for appropriate programming.
The following speech-language pathology and audiology guidelines will be
used dependent upon the individual presenting concern and needs:
1.
select
and administer evaluation procedures which are consistent with current
information on the disorder associated with the primary area of concern (include
standardized tests as part of evaluation battery or describe why they were not
included); the ASHA Preferred Practice Patterns for the Professions of
Speech-Language Pathology and Audiology for additional guidelines relative to
assessment procedures;
2.
assess
related communication skills to eliminate or describe concomitant strengths and
weaknesses;
3.
gather
case history information through completed client/family questionnaire and
interview;
4.
complete
oral mechanism examination (for speech-language evaluations);
5.
complete
a pure tone audiometric screening with immittance screening (for speech-language
evaluations);
6.
speech-language
observation/screening (for audiological evaluations);
7.
meet with
client/family to offer initial findings and recommendations;
8.
a copy of
the written evaluation report will be sent to client/family, with the original
report to be housed in the Clinic permanent client file within 15 working days
of the evaluation date (copies of report may also be distributed based on
completion of required authorization).
Diagnostic
reports will be generated for each evaluation.
The initial draft of the diagnostic report is due to the supervising
professional within 48 hours following the evaluation unless determined
differently by the case supervisor. Reports
should be proofread by the author and a colleague before each submission.
After final approval of the report, signatures of parties conducting the
evaluation should be affixed and the report distributed.
Audiology diagnostic reports must be submitted according to any further
timelines established by audiology supervisors.
Punctuality in submitting reports to the supervisor is considered an
important aspect of the practicum student’s demonstration of professionalism.
Evaluation
reports should contain the following information:
·
identifying
information with date of evaluation;
·
referral
source, presenting concern, and history of client (including birth,
developmental, medical and relevant family history);
·
findings
of evaluation procedures which include description of test instruments and
standardized results, formal/informal observations, impressions and
interpretations;
·
behavioral
observations during evaluation to describe client’s general response to the
testing environment and tasks;
·
summary
of evaluations findings with a diagnostic statements;
·
recommendations
that articulate intervention considerations, further assessment or referral, if
warranted;
·
prognostic
statement.
Following client/family discussion of the evaluation
findings, a Client Disposition Form (see Appendix J) should be completed
with information regarding client identification, evaluation findings,
recommendations for intervention procedures and frequency if warranted, as well
as client availability for services at the Missouri State Clinic should they be requested.
This form should be submitted to the Clinic Director not later than when
the final evaluation reports are distributed.
If a re-evaluation is recommended after the evaluation, a Request for
Service form should be completed for scheduling purposes in the future.
Clinical supervisors in the area of learners who are deaf or hard of
hearing are the primary responsible party for initial diagnostic evaluations of
children who are deaf or hard of hearing from birth-to-five years.
Diagnostic reports will be generated for initial evaluations with
additional input/evaluation from parents, professionals, and/or school
districts/agencies as specified by the needs of the child and primary service
provider.
Client Contact
(ASHA Standard 2.6)
Any contact that is made with clients other than when associated with an evaluation or treatment session, should be documented on the Client Contact Log in the client’s permanent file folder. This form is attached inside the back of the file cover. A Correspondence Record (see Appendix I) (inside the back file cover) should document when written reports are distributed, as well as any other written correspondence other than routine scheduling contacts. The office staff is responsible for documenting when information or reports are mailed to the client, family, or others authorized to receive information. The professional staff are responsible for documenting phone, personal, home/site visits, or mail contacts especially when additional case information is presented. This documentation should include consultation with other professionals, the client or client’s family, staffing, etc.
Clinic intervention services are scheduled prior to each academic semester, with intervention commencing as announced. Each practicum student is responsible for assigned client cases, and must follow the guidance of the assigned professional supervisor regarding all client management decisions. Treatment protocols are necessarily highly varied across clinical service settings and are based on a wide range of needs displayed by clients. Intervention programs accommodate various treatment frequencies, group versus individual sessions, clinic-based or off-site locations, and direct versus consultative models.
A Treatment Plan will be developed each academic semester for clients receiving speech-language intervention at the Missouri State Clinic. An exception to this policy involves the intervention for learners who are deaf or hard of hearing; all intervention plans must follow the stated and approved goals and objectives of the IEP or the IFSP as mandated by Federal Law. At the beginning of the semester, the SLP Treatment Plan will document identifying client information, pertinent information regarding the client’s disorder characteristics, significant history including that of recent therapeutic interest, intervention long-term goals and short-term objectives, as well as treatment strategies. At the end of the semester, a Treatment Summary will be completed to include the initial Treatment Plan, the client response to therapy, progress achieved and recommendations for future management and planning. The date each short-term objective is achieved, or the current status of each objective should be documented including disposition. These reports continue to be useful guides for clinicians when outlining future therapy goals, ensuring continuity of service. The format for these reports should be followed carefully according to the Clinic Template (see Appendix K). The final Treatment Summary will be housed in the permanent client file.
Daily progress notes regarding intervention are recorded using SOAP note format (see description of SOAP note format in the Clinic Practicum Handbook). All variations of this format are approved by the Clinic Director and CSD Department Chair in order to maintain adherence to accreditation requirements. It is also understood that certain off-site services may require other documentation which is consistent with the needs of that setting and in strict accordance with outside accrediting agencies. The certified speech-language pathologist or audiologist managing the case is responsible for signing or initialing treatment notes. These notes will be housed in the client’s file.
Clients in treatment programs are re-evaluated annually or as determined appropriate by the supervising professional. Standardized testing procedures and/or clinical observations should be used with results documented in a Re-evaluation Report (format follows that of Evaluation Report). Re-evaluation results should be shared with the client/parent upon completion, with a copy of the report distributed to them and the original housed in the client’s permanent file.
Early intervention services for children who are deaf/hard of hearing will be guided by programming decisions based upon formal and informal assessment, IEP/IFSP team, observational data and parent/family input. Clinical services, including speech, will be driven by current IEP/IFSP documents.
Discharge and Follow-up (ASHA Standards 2.1, 2.6, 2.5)
The
supervising professional is responsible for determining the need for discharge.
The following criteria should be considered when determining discharge:
1.
Terminal objectives for remediation have been met;
2.
Skill areas are determined to be within normal limits or functional for
needs;
3.
Treatment has not resulted in any measurable gains for the client;
4.
Treatment has reached maximum benefit;
5.
Client attendance has been poor resulting in decreased benefit (possible
decrease in priority when scheduling);
6.
Four unexcused absences without notification
7.
Client/parent requests discharge;
8. Scheduling conflicts do not permit continued intervention.
Discharge from services should be documented in the permanent file by a
Discharge Report (completed
within 15 working days), or documented in the client’s Treatment Summary.
The Discharge Report Format is to be followed and will include:
· identifying information, cumulative number of treatment hours and discharge date;
· reason for discharge;
· summary of progress;
· recommendations.
Discharge from early intervention services for
children who are deaf or hard of hearing will be guided by an IEP/IFSP team,
which includes parent(s)/family.
Follow-up with clients formerly in treatment is planned at the discretion of the supervising professional or Clinic Director. For some services, follow-up is considered an integral aspect of treatment. Communication associated with such follow-up is documented on the Contact Sheet. Follow-up for evaluation will be managed by the Clinic office/Director as described previously. Ultimately, it is the responsibility of the client or parent to notify the Clinic if concerns continue to exist.
Referral
for Additional Services or Transfer of Services
(ASHA
Standards 2.4, 2.5)
Outside referral to related professionals may be warranted for clients being served at the Clinic. Clients may benefit from counseling or require testing by physical and occupational therapists, educational and psychological evaluations, developmental and genetic assessments, medical appraisal of structures, etc. The client should be advised of the referral, and if the client agrees with the recommendation, the supervising professional should assist the client in identifying possible resources. Generally, clients who are seen in either the audiology, speech pathology, or education for the deaf or hard of hearing branches of the Clinic are provided information about services within the Clinic as well as outside agencies. Likewise, should individuals not be scheduled for services at the Clinic due to constraints of the agency or those of the clients, they will be referred to other qualified professionals in the region. The case manager or supervising professional may also refer clients to other qualified professionals when it is determined that Clinic personnel are not capable of assisting the client in a particular disorder area.
The client may request services be transferred to another agency, service provider or the public school system. Parents of children over the age of 3 years should be informed about the availability of services for children meeting eligibility criteria through Early Childhood Special Education in the public schools. Parents may choose to continue services at the Missouri State Clinic regardless of their participation with a school-based program; however, payment for services will remain with the parents unless services are requested and arranged by the responsible public school agency
It is the responsibility of the case manager to assist the office staff in distributing appropriate information as requested and authorized by the client/parent. Such referral recommendations or request for transfer of services should be documented in associated Clinic reports, or separate notation, to be housed in the permanent file. Attendance at pertinent staffings or meetings by Clinic personnel is encouraged.
Permission to Photograph/Videotape (ASHA Standard 2.6)
At the beginning of services each academic semester, authorization is established with clients receiving services on a signed Treatment Consent Form (see Appendix l) regarding the right to videotape for educational purposes and publicity for the Department of Communication Sciences and Disorders. All Treatment Consent forms are placed in the client’s permanent file.
As members of the clinical staff of the Department of Communication Sciences and Disorders, we share the University goals of service, training, and research. Research involving human subjects is regulated by federal statute and is authorized under a set of review procedures established within Missouri State. Routine clinical information obtained for the primary purpose of clinical intervention is not covered under the definition of research. If that same clinical information is obtained for the purpose of research, it is considered research information and requires review. The research investigator is responsible for following the guidelines of the Office of Sponsored Research and/or Graduate College procedures to attain approval for research with human subjects. Such research shall not commence until the approval process has been completed and a letter stating approval is filed with the CSD department.
All client contacts and review of client records within the Clinic can only be utilized for research with the prior approval of the Clinic Director. This policy is designed to maintain the security, confidentiality and integrity of the clinical program.
Clients who agree to participate in research activities must sign Release of Information if any of the case record is to be released to the investigator. Client fees for services will be waived for the duration of the research investigation, with fees instated at the beginning of the academic semester following the semester when scope of the study terminated. No client will be denied services based on their decision to participate or not participate in research projects. Clinical equipment and materials used for research purposes must also be approved by the Clinic Director.
Appendix of Forms for Client Management Procedures Follows
Practicum Responsibilities for Supervisors
Supervisor
Schedules (ASHA Standards 6.2.2, 6.4)
Each academic semester, supervisor schedules are drafted and/or approved by the Clinic Director. Specifically in the area of speech-language pathology services, caseload size is based on a formula regarding semester hours and proposed number of clients to manage. Full-time supervisors are assigned 12 semester hours of clinical supervision, with hours subtracted depending on academic responsibilities. Per course supervisors will be assigned caseloads based on the same formula. ASHA and CED supervision guidelines, expertise of the supervisor, familiarity of case, needs of the client and Clinic, and continuity of service to clients are factors influencing supervisor assignments. In the clinical areas of audiological services and education for learners who are deaf or hard of hearing, supervisory schedules are drafted by personnel in the discipline. This schedule information is given to the Clinic Director each semester.
A Clinic calendar indicating noteworthy dates will be provided to supervisors each academic semester. The calendar will list the opening/termination of services, Clinic closings and special events. Each Clinic branch may distribute a supplemental calendar with information specific to that discipline.
Super visory
Conferences (ASHA Standards 6.2.2, 6.4;
CAA 2.4, 2.6, 3.1-3.3, 4.10)
At the beginning of each academic semester, Clinic supervisors will schedule conferences with graduate practicum students assigned to clients on the supervisor’s caseload. The supervisor and supervisee are responsible for developing effective use of the conference time. Discussion of case management may include client diagnostic evaluation and assessment procedures, therapy planning, therapy evaluation, treatment rationale, role-playing skills used in assessment/therapy, critique and guidance regarding student clinical competencies, relevant academic and research literature, accessing associated assessment/therapy materials and resources, etc.
Children receiving interdisciplinary services within the Clinic will be staffed by appropriate associated personnel at the onset of services and on a regular basis. Development of Individual Education Programs for learners who are deaf or hard of hearing and review of learner progress will follow best practice guidelines as mandated by Federal Law.
Supervisor
Meetings (ASHA Standards 2.3, 3.2, 4.1, 4.2, 4.5, 6.2.2;
CAA 2.8, 5.3)
A meeting for all Clinic supervisors shall be convened by the Clinic Director each academic semester to address relevant Clinic and practicum issues. SLP Clinic supervisors will meet with the Clinic Director each month, with one meeting designated a mid-term review and one designated a semester summary to discuss student progress. Full-time SLP supervisors may also meet to assist in development of the Clinic schedule for clients each semester.
Evaluation
of Student Clinicians (ASHA Standard 6.2.2;
CAA 3.3, 3.4, 3.6)
Supervisors evaluate graduate practicum students during the mid-term and final portions of each semester. Practicum requirements and evaluation procedures differ between the various clinical branches. The competencies which have been developed for students in speech pathology, audiology and education of the deaf and hard of hearing are rated on a numerical scale so that a semester grade may be determined. Syllabi for each branch of practicum is distributed to students at the beginning of the academic semester; practicum objectives and the grading system are described in the Syllabus (see Appendix A).
For the definition of success in practicum, a grade of A or B is considered satisfactory demonstration of competency development. A grade of C indicates less than satisfactory performance and no clock hours may be counted in association with client cases having that mark. The D and F grades are no credit and no clock hours may be counted. Final SLP practicum grades are determined by averaging the numerical grades from supervisors assigned to each student. SLP supervisors are responsible for turning in all final grades for students to the Clinic Director for averaging and determining the final practicum grade. For additional information regarding academic success related to practicum and probation, see both the Clinical Practicum Handbook and the Missouri State Graduate Student Handbook.
Supervisor Evaluation (ASHA Standards 3.1, 6.3)
At
the conclusion of each academic semester, graduate practicum students are asked
to evaluate each of their assigned clinical supervisors.
Supervisor evaluation forms vary across the various branches of clinical
services. The evaluation forms for
SLP supervisors are collected according to confidentiality practices. The results are compiled by the Clinic Director, then
distributed to each supervisor for review.
Ratings and comments from these evaluations may serve as professional
development goals, as selected by the supervisor during the annual evaluation
process. Results of evaluations for
supervisors in audiology will be forwarded to the Clinic Director. Evaluations in the education of learners who are deaf or hard
of hearing program are routinely collected.
Evaluation results may serve to enhance professional development goals
and/or refine practicum experiences.
Clinical Clock Hours (ASHA Standard 6.2.2; CAA 1.8, 1.9, 2.3,
4.1-4.10)
Each clinical supervisor is expected to be familiar with ASHA or CED guidelines for practicum clock hours, which are fully described as part of the Clinical Practicum Handbook. Although each practicum student is responsible for maintaining accurate accounting of clock hours, supervisors must be prepared to verify and sign those hours on clock hour summary forms. It is expected that the number of hours earned by students is in agreement with at least one of the following records: (1) the record of clinical clock hours maintained by the supervisor; (2) the client attendance record kept in the client’s working file; (3) the number of Client Contact Hours recorded by the clinic. Students involved in externships also are responsible for keeping an accurate record of clock hours and securing required supervisor signatures. In the area of education for learners who are deaf or hard of hearing, students present clock hour totals each week for signature verification, as well as summative hours at the end of the semester.
Students must submit accumulated clock hours from each semester to the Clinic office for summative record keeping. The Clock Hour Summary will be housed in each student’s practicum file in the Clinic office. Graduate clinicians who have attained clock hours of practicum from other academic institutions must provide the Clinic Director with verified copies of clock hours immediately upon entering the graduate program or within the first week of practicum enrollment.
Students
Experiencing Difficulty in Practicum
(ASHA
Standard 6.5)
Meetings held monthly by SLP supervisors and Clinic Director will provide opportunity to review progress of all practicum students. In this way, student progress will continually be monitored. Discussion with any given student should have occurred with the supervisor to clarify concerns; the supervisor and supervisee may develop a list of objectives to remediate the problem. However, when a supervisor determines that a student is having difficulty in practicum after multiple attempts to provide guidance in shaping the competency, the supervisor will present the concern at the monthly supervisory meeting. The supervisor may present concrete examples as to why these issues interfere with clinical performance. Other supervisors assigned to the student may comment on observations regarding the competencies of concern. The SLP supervisors may assist by proposing strategies to further address the student’s difficulty toward successful development during the semester. At the same time, all supervisors assigned to the student may serve in assisting development of the competency in the varied contexts they witness.
Graduate students experiencing difficulty in competency areas within the practicum setting or student teaching setting will receive constructive feedback/suggestions from both an M.A.-level supervisor/model teacher and faculty member in the area of education of learners who are deaf or hard of hearing. Direct supervision hours and/or student hours within the practicum assignment may be increased to give the student additional opportunities for success within the deficit competency(ies). Although supervisory guidance in the process is critical, it is the student’s responsibility to accomplish the identified goals for change.
Identification of Below Average or Failing Students
(ASHA Standard 6.2.2, CAA 4.7)
It is the responsibility of supervisors to identify students who are not meeting the practicum competencies such that it could result in an unsatisfactory grade. The above plan for student’s experiencing difficulty in practicum should have been followed and documented. However, if concerns continue to be evident at the conclusion of the academic semester, the supervisor should notify the Clinic Director to describe difficulties. A meeting with all supervisors assigned to the student during that semester should be held to:
1. Outline the specific concerns;
2. Provide concrete examples as to why these issues continue to interfere
with clinical performance;
3. List possible objectives to remediate the problems.
Following this meeting, the Clinic Director will meet with the student. The
student is asked to discuss and/or describe perceptions of the problem and possible solutions. It may be determined that a student qualifies for additional assistance through development of an Individualized Enrichment Plan (see Appendix B). This plan is developed by the student and the Clinic Director based upon the identified concerns described by clinical supervisors. The plan will contain objectives that include a timeline toward completion, responsibility each party assumes in meeting the objective, and an assessment of the student performance related to the objective. Completion of the plan must be accomplished within the semester in which it is developed as part of practicum requirements; however, no grade will be integrated into the overall practicum grade. Should a student not complete their responsibilities associated with the plan, an Incomplete will be given for practicum until such time as all responsibilities are met. If not all of the objectives in the plan are assessed as met satisfactorily, a plan will be developed for the following practicum semester to further support development of plan objectives.
Students in audiology may be determined to be at-risk in competency development. A meeting shall occur with the student, Clinic Director or academic faculty member in audiology, and a 3rd party for review of student performance. A plan shall be developed and followed to support student improvement in the identified areas.
When students training to be educators of learners who are deaf or hard of
hearing are identified as not meeting expectations in skill development, an associated academic faculty member is asked to consult on the student status. The model teacher working with the student and the academic faculty member will then meet with the students to discuss strengths, needs and establish goals.
Appeal Process: If the student does not agree with the proposed plan, the student
should schedule an appointment with the Clinic Director to discuss the problem. If after the meeting with the Director the student’s dissatisfaction continues, the student will meet with the Chair of the CSD department, the Director and the student’s academic advisor, or advocate of choice, in order to determine a course of action with the Chair having the final determination.
Graduate Clinicians with Disabilities (ASHA Standard 4.4;
CAA 1.2, 1.3)
Missouri State University is a community of people with respect for diversity. The University emphasizes the dignity and equality common to all persons and adheres to a strict nondiscrimination policy regarding the treatment of individual faculty, staff and students. In addition, in accord with federal law and applicable Missouri statues, the University does not discriminate on the basis of race, color, religion, sex, national origin, ancestry, age, disability or veteran status in employment or in any program or activity offered or sponsored by the University. The University maintains a grievance procedure incorporating due process available to any person who believes he or she has been discriminated against.
In cooperation with the American Disabilities Act (ADA) and the IDEA, Missouri State furnishes persons with disabilities a reasonable amount of help which will allow equal participation. Disability with respect to an individual is defined as a physical or mental impairment that substantially limits one or more of the major life activities of such individuals. Students seeking assistance must be registered officially with Missouri State Disability Support Services as possessing an impairment. Based on the findings of Disability Support Services, accommodations will be supplied to faculty of courses the student requests. Faculty and staff members notified of accommodations may ask about implementation of accommodations and further recommendations; however, they may not ask about the nature of the disability or subject the student to tests which tend to screen out those with disabilities. Accommodations cannot be urged upon the individual when they have not been requested.
Students who have a documented disabling condition which might require adaptive instruction or accommodation are responsible for notifying Disability Support Services, and subsequently the Clinic Director, before clinic practicum commences. The Clinic Director will work with the appropriate personnel in Disability Support Services and the Office of Affirmative Action. The student should be aware of the Essential Functions identified for professional delivery of services as documented by Missouri State Department of Communication Sciences and Disorders.
When
a supervisor becomes concerned that the student’s disabling condition is
interfering with the student’s completion of practicum requirements, the
supervisor meets with the Clinic Director.
Following this meeting, the procedure for a student whose performance is
unsatisfactory can be followed; however, no accommodations may be made relevant
to the disability until the student initiates action through Disability Support
Services.
Academic Instruction by Supervisory Staff
(ASHA
Standards 6.1, 6.3)
GOAL:
Integration of coursework and practicum.
STRATEGY
I: Develop discipline-specific
teams to design diagnostic and intervention protocols.
STRATEGY
II: Professional development activities will be organized to foster
conversations on a regular basis between clinical and academic faculty.
POLICY
EVALUATION: The policy shall be
monitored through a standing committee to determine effectiveness and possible
recommendations regarding the policy and/or the stated strategies.
Upon review, the policy will be evident in pertinent clinic/department
manuals.
Faculty members are encouraged to have Clinical Supervisors participate in academic courses by giving lectures, demonstrations, or sharing videotapes; however, lecturing to classes is not an acceptable reason for canceling client evaluation and treatment sessions. Supervisory staff are encouraged to seek other methods, such as arranging for coverage or rescheduling in order to fulfill clinical responsibilities.
Appendix for Practicum Responsibilities for
Supervisors Follows
Quality
Improvement
Quality Improvement Plan Overview (ASHA Standards 3.1-3.3;
CAA 1.3, 1.7, 2.7, 2.8, 3.3, 5.2, 5.4)
Quality improvement is addressed due to the desire of the Speech-Language and Hearing Clinic in the Department of Communication Sciences and Disorders to pursue increased measurable benefit for our consumers. The consumers we serve include departmental students, clients of clinical services, and the varied professionals and agencies that rely on our program within the community, across the state and country. The activities of the Quality Improvement Plan (see Appendix A) outline the purposes, scope, administration, and general procedures for monitors each semester.
Customer
Satisfaction (ASHA Standards 3.1, 3.3;
CAA
1.2, 1.3, 4.5-4.8, 4.11)
Customer satisfaction is a vital part of the Quality Improvement Plan and is monitored through the regular use of customer satisfaction forms. The office staff is responsible for disseminating these forms. Random clients entering the Clinic for an audiology evaluation are asked to complete a Customer Satisfaction Form for Audiology (see Appendix B). Clients who are in on-going intervention programs in Speech-Language services are given Customer Satisfaction Form for Speech-Language Services (see Appendix C) at the conclusion of each academic semester. Consumers of service for learners who are deaf or hard of hearing are provided a questionnaire annually to investigate satisfaction of services; the Evaluation of Services questionnaires are shared with the appropriate education of the deaf or hard of hearing supervisor and Clinic Director. From the collected response forms, the results are summarized and distributed to professional clinical staff, practicum students, and Chair of the CSD Department. This summary is also a part of the permanent Clinic record. Results may provide evidence of action needed if an indicator is consistently less than satisfactory.
Continuous Quality Improvement Appendix A
Missouri State University
Department of Communication Sciences and Disorders
Clinical Services
CONTINUOUS QUALITY IMPROVEMENT PROGRAM
PURPOSE: The goal of the Quality Improvement Program is to create an on-going mechanism for improvement of services provided by Missouri State University Speech-Language and Hearing Clinic. This program will be a constant and systematic attempt to resolve identified concerns and improve overall client care. Standards of care are pre-established and will be utilized for monitoring all aspects of performance. Resolutions will be generated, implemented, and documented in a timely manner. The results of the program will be communicated to the Head of the Communication Sciences and Disorders program and all clinical providers within the Missouri State Speech-Language and Hearing Clinic.
OBJECTIVES:
1. To create constancy of purpose toward improvement of services in speech/language, audiology and education for learners who are deaf or hard of hearing.
2. To identify and resolve areas of suboptimal service through the use of retrospective, concurrent, or prospective evaluation mechanisms.
3. To regularly implement monitors to assure that improvements in quality of care are maintained.
4. To comply with the requirements of regulatory agencies.
5. To minimize the departmental and institutional exposure to the risk of legal action for malpractice or negligence.
6. To improve all services being provided such that quality and productivity result in cost-effectiveness for both the client and Speech-Language and Hearing Clinic.
THE FOLLOWING TEN STEPS DESCRIBE THE MONITORING AND EVALUATION PROCESS FOR THE Missouri State SPEECH-LANGUAGE AND HEARING CLINIC:
1. AUTHORITY/RESPONSIBILITY
The Clinic Director is responsible for overseeing the implementation of this plan at all levels. He/She has the authority to implement resolutions which are determined through these monitors. The Clinical Supervisors assist in the identification of areas to be monitored, designation of personnel to develop and complete the evaluations, review of the results of the evaluations, and creation of resolutions for areas of suboptimal service.
2. SCOPE OF CARE
Full diagnostic services in all areas of speech, language, and hearing are available for any age patient with suspected communications needs. Outpatient treatment is provided based upon the needs identified through an evaluation. Diagnostic and educational services are also available to children who are deaf or hard of hearing that are birth-to-five years in age.
The care is provided by graduate students or model teacher/supervisors in the area of learners who are deaf or hard of hearing in the Communication Sciences and Disorders program and supervised by licensed, certified personnel. The primary setting as applicable to the Quality Improvement Plan is the Missouri State Speech-Language and Hearing Clinic. Services are provided between regular office hours of 9:00 a.m. to 7 p.m. on Monday and Wednesday, 9 a.m. to 5 p.m. Tuesday, Thursday and Friday.
3. IMPORTANT ASPECTS OF CARE
All aspects of speech-language and hearing care and education for learners who are deaf or hard of hearing are considered important for quality improvement. Aspects associated with outcome of care, the delivery process, staff factors, and interdepartmental university relationships may warrant monitoring at a given time. Specifically, high volume procedures or services which effect the majority of the clients are studied. All services which are considered high risk are evaluated. Additionally, areas of care which appear to be problem prone in nature are considered important for monitoring.
4. IDENTIFICATION OF INDICATORS
Indicators are developed by the Clinic Director with assistance from the Clinical Supervisors. Indicators are developed on a yearly basis in order to assist with continuous quality improvement and on an as needed basis to monitor suspected areas of suboptimal care. The clinical indicators are designed to evaluate structure, process, and outcome. Each indicator is designed to be objective, measurable, and based upon current knowledge and clinical experience.
5. INDICATOR THRESHOLDS
Thresholds are set prior to monitoring for each indicator as possible. When specific thresholds cannot be predetermined, analysis of data consists of describing a significant trend over time or attempting to compare rates in peer institutions. Thresholds do not represent the optimal standard of care. Rather, they serve to determine if further study is needed.
6. COLLECTION AND ORGANIZATION OF DATA
The specific data elements and sources are described for each indicator as part of the study. Data sources may include but are not limited to client surveys, clinical observations, or staff/client report. Data may be collected retrospectively, concurrently, or through client-interview statistics. Sampling strategies vary with the specific indicators. The Clinic Director is responsible for organizing the data and presenting the data in written form.
7. EVALUATION
The organized data is then evaluated by the Clinic Director with or without assistance from the Clinical Supervisors. Areas of performance which are suboptimal are identified. A review of the client, practitioner, and facility factors related to that indicator provides a basis for problem-solving. Resolutions for the area targeted for improvement are generated.
8. QUALITY IMPROVEMENT ACTIONS
The Clinic Director selects the appropriate actions to be taken as identified during the evaluation. Additionally, the Director is responsible for supervising implementation of the chosen action. Implementation includes designating the individuals who carry-out the action and the time during which change is expected. Each Clinical Supervisor is responsible for following the designated recommendations.
9. ACTION EFFECTIVENESS
The Clinic Director continues to maintain adequate documentation of the clinical actions designated so that the effectiveness of the actions can be assessed. Follow-up studies are completed to evaluate improvement in the targeted area of care. If improvement cannot be demonstrated, then additional actions are determined and effectiveness of the new actions continues to be monitored.
10. COMMUNICATION OF QUALITY IMPROVEMENT RESULTS
The Clinic Director communicates the results to the Clinical Supervisors on a regular basis either through meetings or memorandum. Written results are also communicated to the Head of the Department of Communication Sciences and Disorders as necessary.
Infection
Control (ASHA Standard 7.3)
Infection control and risk management are considered aspects of the Quality Improvement Plan. Procedures are defined for employee and student action in the infection control program. These policies and procedures are outlined in the Clinic Practicum Handbook. Annual review of procedures is conducted to insure familiarity with acceptable methods of infection control within the Clinic setting.
Clinical
Program Evaluation (ASHA Standard 1.3, 1.4, 3.1
3.2, 3.3; CAA 5.1-5.4)
Program evaluation is an integral part of the Quality Improvement Plan. It is the responsibility of the Clinic Director with the assistance of the Clinic Committee to review the annual program goals each year and establish new program goals for the forthcoming year. This information is shared with the department, the clinical staff, and remains part of the permanent Clinic record.
Clinical
Program Administration
(schematic)
Clinical Staff (ASHA Standard 4.5)
-- to be included
Job
Descriptions
Director of Speech-Language & Hearing Clinic (ASHA Standards 4.2,
6.1, 6.2, 6.2.1, 6.3; CAA 2.3, 4.5, 4.6, 4.8-4.11)
Job Qualifications: Master’s degree in Speech-Language Pathology,
Audiology or Education of the Deaf or Hard of Hearing
ASHA Certificate of Clinical Competence (SLP, A), or Council on Education of the Deaf (CED) Certification
Missouri State License and/or certification
Job Responsibilities: include if documented or refer to UT
Immediate Supervisor: Chair of Communication Sciences & Disorders Dept.
Clinical
Supervisor (ASHA Standards 4.2, 6.1, 6.2, 6.2.1, 6.3;
CAA 2.3, 4.5, 4.6, 4.8-4.11)
Job Qualifications: Master’s degree in Speech-Language Pathology, Audiology,
or Education of the Deaf or Hard of Hearing;
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