Clinical Report Form

CLINICAL REPORT FORM (CRF)

The student is responsible for completing this page

Student's Name: / Under/Postgraduate / Level / Semester
Placement Number (1-6)

PLACEMENT SESSIONS

Target / 20 / Total Sessions Achieved:
of which: Paed Sessions: / Adult Sessions / including: Adult Acquired Neurology
Number of clinicians involved: / Board(s) / Peer placement / Y / N
Practice Educator 1: / Location:
Practice Educator 2: / Location:
Practice Educator 3: / Location:
ASSESSMENT REQUIREMENTS: / Clinician’s grading in the final week / Y / N / Support selection of CPE case/s / Y / N
Formative Mark Awarded / %

PLACEMENT ACTIVITY: 1 portfolio activity – provide number from handbook or give brief description:

Date completed: / PE initial to confirm has seen: / Was this 'an Initial Interview?' / Y / N

Record of Student Attendance /Experience

Placement
Week / Dates / Attendance
Y / N / P'folio / Practice EducatorNo. / Adult/Paed
A/P / Case Type
1 / am
pm
2 / am
pm
3 / am
pm
4 / am
pm
5 / am
pm
6 / am
pm
7 / am
pm
8 / am
pm
9 / am
pm
10 / am
pm
11 / am / Spare
pm / Spare

Clinician please sign and date to confirm that this is a fair record

Signature: / Date:

Checking student identity and attendance monitoring

Identity Check

To enable an identity check we have asked all students to show the relevant practice educator their QMU Matriculation card. This card shows the photograph and name of the student. All practice educators are asked to sign the declaration below, to indicate that the photograph matches the student who has arrived on placement.

Please contact us immediately if there is a discrepancy.

Attendance

We require that all students inform both their practice educator and the University should they be unable to attend their placement on any given day. Where the student has an agreed absence from placement, we ask that the practice educator informs the University of this arrangement within a 48 hour period.

In the event that a student has an unauthorised/unexpected absence from placement, we ask that the practice educator informs the University of this absence immediately.

Contact

Gill Glover on 0131 474 0000 / the first instance. If she is not available, please redial and ask to speak to the School Office. If more convenient, please stating the student’s name, the date and the nature of the absence.

Practice educator declaration: I have seen 's QMU matriculation card and can confirm that the photograph on the card matches the student on placement. I also understand the action I should take in the event of any student absence from placement.

Signature: / Date:

Case Type

What follows are abbreviations of the types of case you might work with. It is impossible to provide a comprehensive list. Please complete the case type column as best you can. If you have seen a mixture of case types during the session please state the majority.

If none of the abbreviations suit the cases you have seen please write in a description.

Underlying communication impairment
in client group / Abbrev-iation
Acquired Neurological Disorders
Dysphasia, Dysarthria, Dyspraxia, Dysphagia / AN
Autism Spectrum Disorders / ASD
Cerebral Palsy / CP
Craniofacial Conditions including
Cleft lip/Palate and Velopharyngeal disorders / CC
Deafness / DF
Developmental Speech and/or Language Delay / DSLD
Dysfluency / DYS
Ear, nose and throat / ENT
Learning Disability: Mild/moderate/severe / LD
Dyslexia / DLEX
Mental Health including dementia. / MH
Oncology / ONC
Parent program (Including Hanen) / PP
Progressive Neurological Disorder
Including multiple sclerosis, motor neurone disease, Parkinson’s disease. / PND
Specific Language Impairment / SLI
Traumatic Brain Injury / TBI
Eating, Drinking and Swallowing [paed] / EDS
Specific Speech Impairment / SSI
Visual Impairment / VI
Voice / V

The progression from the first placement to the final placement charts student development from dependency on the placement educator (PE) to provide ideas and guidance to becoming increasingly proactive in planning, justifying, carrying outand evaluating clinical case and case-load management. This includes:

client assessment – selection, delivery, data analysis, interpretation
using information from all relevant sources to form an evidence based holistic profile of the client’s communicative strengths and weaknesses
formulating justified aims for intervention, planning, carrying out and evaluating the effectiveness of direct or indirect intervention activities
sourcing useful literature to support thinking about the case

Students also develop their communication skills (oral and written) – from initially formulating pertinent questions to being able to discuss with the PE and other members of the professional team issues surrounding thecaseload(including individual clients), setting and service delivery, professional responsibilities and constraints, case prioritisation and administration requirements. Communication with service users develops from general social interaction to providing clear explanations of management plans and effectiveand motivating feedback on performance.

In any clinical placement the student can:

Observe what the PE is doing
Follow the PE lead and assist in a joint activity
Prepare, lead and evaluate a joint activity
Prepare, carry out and evaluate the effectiveness of a session/client contact themselves – either supervised, observed or independently, following discussion with the PE. In level 4 this will include incorporating findings from any session into future management plans.

Student’s progress is always at the discretion of the PE who hasthe duty of care for any clients seen.As students progress from their first to final placement it is expected that the amount of time spent in observation before progressing to case planning responsibility will becomeshorter,although it is recognised that even advanced students willfind observation important as it is likely that they will be working with a client group that is new to them.

Conversion Table from Previous Levels to new Placement Numbers

Placement Number / Previous Level
1 / Level 2
2 / Summer Block
3 / Level 3.1
4 / Level 3.2
5 / Level 4.1
6 / Level 4.2

Professional Requirements for all placements

Meeting these standards is a basic requirement for all students on all clinical placements. Should a difficulty in any of these areas persist beyond an initial discussion, please contact the placement team. If any of these attributes are problematic in the final review the student will automatically fail the placement

Present / Problematic
1 / Demonstrates interest in all aspects of clinical work
2 / Is responsible about time keeping
3 / Takes responsibility for contacting clinic when necessary
4 / Demonstrates appreciation of clinic-specific requirements, including dress code, hygiene (e.g. handwashing) and health and safety procedures as outlined by the PE
5 / Demonstrates appreciation of and practices confidentiality as outlined in NHS Code of Practice
6 / Adopts a non-judgmental attitude to clients and carers
7 / Interacts appropriately with clients and carers and other staff outwith sessions (e.g. in the waiting room)
8 / Interacts appropriately with professionals
9 / Discusses previous experience and learning goals with the placement educator
10 / Comes to clinic sessions well prepared and organised
11 / Prepares a session plan for each activity requested by the placement host for the following placement day (unless specifically requested not to)

Additional comments:

Columns below to be completed . . . . . / At the mid-way point / At the end of the placement
Please use black ink as these forms are scanned and filed electronically
Professional Abilities which can show progression /

Placement

Number / At the time of review these abilities are:
Absent / Emerging / Present / Enhanced / N/A
1 / Is co-operative and responsive to requests and suggestions from clinician. / 1
2 / Asks clinician about how to be useful in the clinical setting. / 1
3 / Asks appropriate questions about clinic organisation and client management. / 1
4 / Responds constructively towards changing circumstances and demands in the practice setting / 3
5 / Is pro-active and anticipates appropriate role without prompting. / 3 and 4
6 / Discusses clinical issues and participates in client management in equal/near equal partnership with clinician. / 5 and 6
7 / Is able to discuss client management issues with other professionals. / 5 and 6

Additional comments:

Evaluation of clients’ abilities and needs /

Placement

Number / At the time of review these abilities are:
Absent / Emerging / Present / Enhanced / N/A
1 / Makes relevant, objective observations and reports them systematically. / 1
2 / Demonstrates appreciation of the importance of consultation with clients/carers, other involved professionals and gaining information from others who know the client well. / 1
3 / Synthesises information in case files when evaluating client. / 1
4 / Carries out formal and/or informalassessment procedures chosen by the clinician. / 1
5 / Demonstrates ability to collect speech / language/ communicative data for analysis using procedures suggested by the clinician. / 1
6 / Interviews client / carer appropriately and reports findings systematically. / 3
7 / Selects appropriate assessment procedures (formal and/or informal). / 3
8 / Selects appropriate procedures to gather speech / language / communicative data for analysis. / 3
9 / Demonstrates awareness of the need to collect data in a variety of communication setting and the importance of taking a holistic view of the client rather than from the results of one avenue of assessment. / 3
10 / Scores and processes formal assessment data fully and accurately. / 3
11 / Analyses speech / language / communicative data appropriately. / 3
12 / Interprets results of assessment procedures and data analysis appropriately. / 4
13 / Reports interpretations of data effectively to the clinician (verbally or in writing). / 4
14 / Integrates information from all sources to make an holistic evaluation of the client. / 4
15 / Demonstrates ability to make accurate evaluations of individual clients in group settings. / 4
16 / Summarises the evaluation of data and discusses client prognosis in terms appropriate for different audiences (e.g. client, carer, other professional). / 5 and 6
17 / On the basis of available information, formulates hypotheses about the client to be tested as part of the continuing management process i.e. what does the student think the problem is and how will the assumption be tested? / 5 and 6

Additional comments:

Ability to integrate theoretical knowledge with clinical practice /

Placement

Number

/ At the time of review these abilities are:
Absent / Emerging / Present / Enhanced / N/A
1 / Demonstrates an understanding that clinical work is driven by knowledge base and theories, underpinning SLT.
For example:
Theoretical- how learning theory may relate to SLT intervention.Knowledge- anatomical, knowledge of typical sequence of child development. / 1
2 / Responds to suggestions to undertake relevant reading. / 1
3 / Independently initiates relevant literature searching and discusses findings with clinician. / 3
4 / Draws on relevant scientific principles and theoretical frameworks in all aspects of clinical work. For example: develops hypotheses about clients and considers ways to test these. Can relate theory to clinical cases. / 4
5 / Critically evaluates assessment and intervention procedures in the light of evidence from the literature For example, independently researches and reports on efficacy studies and how this might be applied with this client group. / 4
6 / Integrates findings from efficacy studies(where available) in formulating management plans for the current client group. / 5 and 6
7 / Demonstrates ability to devise outcome measures (short term or long term) to evaluate the efficacy of therapy for individual clients. / 5 and 6

Additional comments:

Ability to identify aims of therapeutic intervention /

Placement number

/ At the time of review these abilities are:
Absent / Emerging / Present / Enhanced / N/A
1 / Is able to ask questions about the aims of therapy and how they are devised. / 1
2 / Demonstrates awareness that aims of intervention may be directed at the client’s level of activity/participation as well as impairment. For example, intervention may be aimed at adapting the client’s social or physical environment in order to maximise their social participation as well as/instead of focusing on the client’s skill level. / 1
3 / Demonstrates appreciation of the value of a team approach when deciding on aims of management. For example synthesises information from other professionals, people who know the client well. / 1
4 / Demonstrates awareness of the need to consult the client/carers when deciding on the aims of management e.g. about their priorities / 1
5 / After observing an assessment or therapy session, demonstrates ability to contribute to discussion about aims for the next session. / 1
6 / After a session/contact /intervention demonstrates ability to identify appropriate aims for the next session on the basis of own evaluation. / 3
7 / Identifies appropriate long term aims of management on the basis of own evaluation of client.
e.g. discharge planning, referral onto another service / 4
8 / Demonstrates awareness of the need to take service protocols and patterns of service delivery into account when devising session plans e.g. individual v group v consultancy model; direct v indirect intervention. / 5 and 6

Additional comments:

Ability to devise and document session plans. (This can include evaluation/direct intervention/social or environmental adaptation) /

Placement number

/ At the time of review these abilities are:
Absent / Emerging / Present / Enhanced / N/A
1 / Demonstrates interest in the process of session planning and its relationship to aims. / 1
2 / Suggests appropriate tasks and materials appropriate to the aims of the session, taking the client’s abilities and motivations into account . / 1
3 / Writes appropriate and systematic session plans showing understanding of the principles of aims setting (see guidance in general handbook).. / 1
4 / Can explain how intervention techniques incorporated into therapy tasks are expected to facilitate client learning and positive change in a target behaviour. For example, modelling, prompting etc. / 3
5 / Can explain how a particular targeted change(s) to the client’s physical or social environment is expected to facilitate their social participation. . For example, how a symbol timetable /day plan may impact on a client’s understanding of what will be happening. / 3
6 / Analyses the motor, cognitive, linguistic and communicative demands which a particular session will make on a client. / 4
7 / Analyses the demands (e.g. organisational, time) which a particular environmental or social adaptation might make on the communicative partner (e.g. teacher/care worker/parent) / 4
8 / Writes session plans which include means of monitoring change in targeted behaviours( see session plan guidelines) / 4
7 / Successfully incorporates investigative/hypothesis testing elements into therapy plans. / 5 and 6

Additional comments:

Ability to implement therapeutic intervention /

Placement number

At the time of review these abilities are:

Absent / Emerging / Present / Enhanced / N/A
1 / Carries out intervention, devised by the clinician, appropriately and in an organised manner. / 1
2 / Encourages client’s motivation, participation and co-operation. / 1
3 / Explains/demonstrates a new task to a client clearly and appropriately. / 1
4 / Demonstrates awareness of possibility of client distress/anxiety. / 1
5 / Responds appropriately to client’s emotional state and physical needs. / 1
6 / Demonstrates ability to be encouraging to the client while reinforcing only appropriate/target behaviours. / 3
7 / Paces the delivery of intervention appropriately. / 3
8 / Achieves smooth transitions from one component of a session to another. / 3
9 / Demonstrates ability to introduce and close an intervention taking account of the needs of all participants. / 3
10 / Demonstrates ability to adopt a variety of roles in group sessions (e.g. leader, facilitator, and observer). / 4
11 / Demonstrates ability to respond to the needs of individual clients in group sessions. / 4
12 / Demonstrates ability to facilitate client learning through graded feedback and discussion. / 4
13 / Is able to adapt prepared plans during a session in the light of client response and mood. / 4
14 / Demonstrates ability to manage a range of clients, including members of client groups not previously encountered. / 5 and 6
15 / Independently accesses appropriate resources in order to manage a new client group. / 5 and 6
16 / Demonstrates ability to work effectively in interdisciplinary settings. / 5 and 6
17 / Demonstrates increasing independence of the placement educator in settings where this is felt by the PE to be appropriate. / 5 and 6

Additional comments:

Ability to make evaluations of client response to therapy

Placement number

At the time of review these abilities are:

Absent / Emerging / Present / Enhanced / N/A
1 / Employs techniques to make a record of client response in sessions: e.g. note-taking, audio/video recording. / 1
2 / Gives accurate and systematic verbal reports on client’s response. / 3
3 / Evaluates client response in the light of previous knowledge of the client / 3
4 / Reports accurately, systematically and clearly on client’s response, in writing. / 3
5 / Develops further hypotheses about the client’s profile of communicative strengths and weaknesses from evaluation of client’s responses. / 4
6 / Demonstrates ability to make judgements about the priority of a case on the basis of an informed understanding of the client’s profile of communicative strengths and weaknesses. / 5 and 6
7 / Able to devise an appropriate method for evaluation of effectiveness / 5 and 6

Additional comments:

Ability to evaluate own performance and development needs /

Placement number

At the time of review these abilities are:

Absent / Emerging / Present / Enhanced / N/A
1 / Is responsive to constructive feedback on performance (this may include using an audio or visual recording to assist in this). / 1
2 / Demonstrates awareness of the effects of own behaviour on clients’ responses. / 1
3 / Can reflect and make a realistic evaluation of own performance and identifies own development needs. / 1
4 / Reflects and identifies how own development needs can be met and takes responsibility for own learning. / 3

Additional comments:

Ability to carry out administrative tasks /

Placement Number

At the time of review these abilities are:

Absent / Emerging / Present / Enhanced / N/A
1 / Writes accurate notes in client files. / 1
2 / Where appropriate, carries out clinic administrative procedures such as statistics recording. / 1
3 / Drafts administrative letters to clients and carers. / 3
4 / Drafts letters and reports to other professionals. / 3
5 / Maintains client files in good order. / 3
6 / Makes telephone contacts in an appropriate manner with clients, carers and other professionals. / 4
7 / Demonstrates awareness of issues in caseload management such as prioritisation. / 5 and 6
8 / Demonstrates ability to take full responsibility for writing letters and reports. / 5 and 6

Additional comments:

Record of discussion to monitor progress (approximately halfway through placement)
Agreed developmental objectives for the remainder of the placement

Clinician's Signature:

Date:

Student's Signature:

Date:

Summary comments at end of placement
Developmental objectives suggested for the next placement / first clinical post

Clinician's Signature:

Date:

Student's Signature:

Date:

CLINICAL REPORT FORMMark sheet and criteria for allocating grades (Placement number 1-6)

Information for Practice Educators: Select the appropriate grading (based on the criteria provided below – see also Appendix 6 of the Clinical Placement Handbook for a definition of terms and further information on completing the form) and then put a bar at the point that best reflects the student’s performance. NB in making these judgements it is important to bear in mind the extent to which the placement has given a student the opportunity to demonstrate the attribute being considered and on what can be expected from the student at that level.