Alabama A&M University
Speech-Language-Hearing Clinic
Weekly Diagnostic Worksheet/ Plan Grade
Student Clinician:Areas to be Assessed
***Note: If maximum number of points is not obtained, see information in the left column and make the necessary revisions within 3 days. Then resubmit the revised document to the attending clinical supervisor for final approval. Highlight all revisions when
resubmitting document. Maximum Points Achievable Week of: Client:
Document is submitted by 12:00 noon on Friday for the following week (note: exceptions for tardy work will need to be accompanied by a University approved excuse- See Sonoya Williams in CCN Rm 106 or submit a doctor’s excuse or funeral announcement to the attending supervisor).
**Note: Technical and personal computer issues are
the responsibility of the clinician. In case of technical failure of a personal computer, computers are available in the LRC and in the computer lab for student use. Students should plan ahead (complete paperwork early- i.e. 24 hours prior to submission deadline) in order to allow time to use library, computer lab, or family/friend computers in the event of technical failure. Tardy submission of paperwork due to technical or personal issues will be reflected in the weekly grade.
10 Points- Document is submitted before 12:00 noon on Friday for the following week 0 Points- Document is submitted after 12:00 noon on Friday for the following week
10
The entire document uses font size11 and Times New
Roman style text and only one area of assessment is used per row. Extra unused rows are deleted (place
curser in far left column of row, drag cursor across row to highlight the entire row, and click “delete”).
**Note: If extra rows are needed to accommodate numerous goals/tests: Place cursor in the bottom of the far right column of the last row, right click, and choose “Insert Row Below”
10 Points- See column to the left
5 Points- Varying font size or style is used throughout the document and/or formatting for STG’s is not appropriate (see column to the left)
0 Points- Varying font size and style are used throughout the document and formatting for STG’s is not appropriate (see column to the left)
10
Document is free of typing, spelling, and grammatical errors
***Note: Use grammar check and spell check at all times and proofread document before submission
15 Points- Document contains no more than 2 typing, spelling, and/or grammatical errors. See column to the left
10 Points- Document contains 3 typing , spelling, and/or grammatical errors 5 Points- Document contains 4 typing , spelling, and/or grammatical errors
0 Points- Document contains more than 4 typing , spelling, and/or grammatical errors
Footer information (refer to Sample Diagnostic Worksheets on-line on the CSD 516 website) on page 2 and thereafter is accurate. Date is reported as Month/Days/Year:
For Example:
Week of: September 1-5, 2012
5 Points- Footer information is accurate
0- Inaccurate information is present in footer ( page numbers, client initials, and/or “week of” dates are incorrect)
5
All fields pertaining to identifying information (Client initials, Date, Age of Client, Clinician, and Supervisor) are filled in accurately. Information is reported in the same format as seen on the Diagnostic Worksheet Sample on the CSD 516 website.
5 Points- Identifying information is accurate.
0 Points- One or more errors are present. See column to the left. Client initials, Date, Client Age, student clinician, and/or clinical supervisor information is missing or is inaccurate.
5
Introduction information is present. All materials and forms that will need to be provided to clients are documented (e.g. the AAMU CSD Client Handbook 2012-2013 as well as appropriate authorization forms). Refer to the Diagnostic Worksheet Samples on-line on the CSD 516 website.
**Note: The title of the CSD clinic handbook should be
underlined or italicized
5 Points- Introduction information is present and complete.
2.5 Points- One or more components of the introduction are not present (see column to the left) 0 Points- Introduction is missing
5
Area Assessed Column –Typically 6 components
(oral-peripheral exam, hearing screening, articulation, language, voice, and fluency) must be addressed for all
clients undergoing diagnostic testing in the CSD clinic (the clinical supervisor will advise students when an exception is indicated for a particular client). Each of these areas should remain on the Diagnostic Worksheet until that component has been thoroughly assessed. When a component has been thoroughly assessed and data has been reported on in a Diagnostic SOAP note and approved by the clinical supervisor, that component can be deleted for the following week. For example, once hearing has been assessed and the hearing screening has been passed, the entire row containing Hearing Assessment can be deleted from the Diagnostic Worksheet for the following week (place the cursor in the far left column at the beginning of the text and drag the cursor across the row from left to right to highlight the row, right click on “Delete Cells” and then click “OK”.
***Note: When assessing reading or phonology,
document as Language/Reading or Language/Phonology
10 Points-All necessary components are present and are appropriate for the client for the week 5 Points- One or more of the necessary assessment areas is missing (see column to the left) for the client for the week
0 Points – Information is not accurate and/or appropriate for the client for the week
***Note: Pre-school age children and children in the AAMU CDC will need speech intelligibility assessed along with calculation of MLU (refer to the Shipley and McAfee text). For examples, see last page of this file (font style/size will need to be changed).
Procedure/Test- Includes the formal and/or informal assessments to be performed during diagnostic speech-language testing. Each assessment should be documented on a separate row. For example, if two different language tests will be administered, each assessment will be documented separately (see Diagnostic Worksheet Samples on-line on the CSD website). To add rows to the worksheet, place cursor in the bottom far right of the last column of the last row, right click, choose “Insert”, then choose “Row Below”. To delete excess rows, place cursor in the far left column, drag cursor across the row to highlight the row, right click, choose delete “Delete Cells” and then choose “OK”. **Note: Names of ALL FORMAL TESTS must be
underlined or italicized.
If the test includes subtests, list each subtest also
10 Points- Procedure/Test information is accurate and appropriate for the client and disorder for the week. Names of all formal tests are underlined or italicized and subtests are documented. 5 Points- Procedure/Test information is not complete and/or is not accurate for the client for the week or names of formal tests are not underlined or italicized.
0 Points- Procedure/Test information is not complete, does not match Area Assessed and/or is not appropriate for the client for the week.
10
Activity/Materials-Is very specific and includes all necessary materials/activities for EACH area to be assessed and for EACH test/procedure (e.g. tape recorder, protocols, test booklets, mirror, pen light, blocks, etc). Refer to Sample Diagnostic Worksheets on-line on the CSD 516 website.
**Note: Names of ALL FORMAL TEST
books/protocols must be underlined or italicized.
10 Points- Activities/Materials are thoroughly documented and are appropriate for the assessments to be administered for the week. Names of all formal tests are underlined or italicized. Subtests (when applicable) are noted.
5 Points- One or more areas to be assessed is lacking appropriate materials/activities or subtests are not documented for a formal test(s). Names of one or more formal tests are not underlined or italicized.
0 Points- Activities/Materials are not properly documented for multiple areas to be assessed. Names of formal tests are not consistently underlined or italicized. See column to the left.
10
Person Responsible- Either the first initial plus last name of the Student Clinician OR the person responsible for the assessment is present in EACH row for each area to be assessed (e.g. S. Jones OR Dr. B. Bush). Refer to Sample Diagnostic Worksheets on-line on the CSD 516 website.
10 Points- Person Responsible is documented in each row for each area to be assessed 5 Points- Person Responsible is not documented in each row for each area to be assessed 0 Points- Person Responsible is not documented or is not consistently documented in each row for each area to be assessed
10
Estimated Time- An approximation of the time needed for each area to be assessed or for each test/subtest. Time is documented in minutes (e.g. 20-25 minutes or 90 minutes, etc.).
5 Points- Estimated Time is documented appropriately for each area to be assessed or for each test/subtest
0 Points- Estimated Time is not documented appropriately for each area to be assessed or for each test/subtest
5
Priority-A priority number is assigned to each area to be assessed and areas to be assessed are listed in consecutive order by row (e.g. The area to be assessed with the highest priority, 1, will go in the first row of the worksheet followed by the item with the second priority in the second row etc.).
5 Points- Priority is documented for each area to be assessed 0 Points- Priority is not documented for each area to be assessed
5
Points: Grade:
Area Assessed Procedure/Test Activity/Materials Person Responsible Estimated Time Priority
Language MLU/Informal Language Sample
The clinician will informally assess the client’s language via use of the MLU calculation sheet. The clinician will engage the child in play activity such as building blocks or coloring to assist in eliciting informal conversation with the client. The clinician will ask the client probing questions during the play activity as needed, to collect a representative sample of the child’s language. Materials: Tape Recorder Blocks Crayons Coloring Book AAMU CSD Clinic
Worksheet for Recording a Language Sample
Reinforcement: Verbal praise for completion of the task.
Intelligibility Informal Language Sample The client’s intelligibility will be informally assessed via means of diagnostic play. The clinician will present the client with various play activities, while instructing the client to pick a play activity of choice (choices listed below in the materials section). The clinician will engage the client in informal conversation, via the use of probing questions during diagnostic play. Materials: Recorder Blocks Mr. Potato Head Bubbles Coloring Book Crayons (Shipley/MacAfee) Intelligibility Calculation Worksheet
Reinforcement: Verbal praise for completion of the task.
