Northern Arizona University – Communication Sciences and Disorders
Clinical Competency Evaluation (CCE)
Date: ____________________________
Semester/Year: ___________________________
Clinician: __________________________ _______________
Mid-term
Student ID #: _____________________
OR
Final
Site: (Name/City/State) __________________________________________________
Supervisor: _______________________________________________________________ Supervisor’s email address: ____________________________________________________________
Full-Time _____
Full-time Leveler _____ Part-time _____
Practicum I _____
Practicum II _____
Practicum III _____
Externship ____
EVALUATION COMPETENCY
Evaluation skills outcomes
(place an “x” in the
D or F
C or lower
B
A
Skills are not
Skills are below expected
Skills are at expected
Skills are above
demonstrated for
level for student’s
level for student’s
expected level for
student’s experience and
experience and
experience and
student’s experience and
knowledge.
knowledge. (1 pt.)
knowledge. (2 pts.)
knowledge. (3 pts.)
N/A
Comments
appropriate box)
1. Conduct screening and prevention
procedures (including prevention activities).
2. Collect case history information and
integrate information from clients/patients,
family, caregivers, teachers, and relevant others,
including other professionals.
3. Select and administer appropriate evaluation
procedures (behavioral observations, nonstandardized/standardized tests, and
instrumental procedures).
4. Adapt evaluation procedures to meet
client/patient needs.
5. Interpret, integrate, and synthesize all
information to develop diagnoses and make
appropriate recommendations for intervention.
6. Complete administrative and reporting
functions necessary to support evaluation.
7. Refer clients/patients for appropriate
services.
OVERALL EVALUATION SKILLS SCORE/LETTER GRADE:
Page | 1
Total score _____
Grade _____ Supervisor makes final grade determination.
Form revised: 1/27/2015
Northern Arizona University – Communication Sciences and Disorders
Clinical Competency Evaluation (CCE)
INTERVENTION COMPETENCY
Intervention skills outcomes
(place an “x” in the
D or F
C or lower
B
A
Skills are not
Skills are below expected
Skills are at expected level
Skills are above
demonstrated for
level for student’s
for student’s experience
expected level for
student’s experience and
experience and
and knowledge. (2 pts.)
student’s experience
knowledge.
knowledge. (1 pt.)
N/A
Comments
and knowledge. (3 pts.)
appropriate box)
8. Develop setting-appropriate intervention
plans with measurable and achievable goals that
meet client’/patient’ needs. Collaborate with
clients/patients and relevant others in the
planning process.
9. Implement intervention plans (involve
clients/patients and relevant others in the
intervention process).
10. Select or develop and use appropriate
materials and instrumentation for prevention
and intervention.
11. Measure and evaluate clients’/patients’
performance and progress.
12. Modify intervention plans, strategies,
materials, or instrumentation as appropriate to
meet the needs of clients/patients.
13. Complete administrative and reporting
functions necessary to support intervention.
14. Identify and refer clients/patients for
services as appropriate.
OVERALL INTERVENTION SKILLS SCORE/LETTER GRADE:
Page | 2
Total score _____
Grade _____
Supervisor makes final grade determination.
Form revised: 1/27/2015
Northern Arizona University – Communication Sciences and Disorders
Clinical Competency Evaluation (CCE)
INTERACTION AND PERSONAL QUALITIES COMPETENCY
Interaction and personal qualities skills
D or F
C or lower
B
A
outcomes
Skills are not
Skills are below
Skills are at expected level
Skills are above
demonstrated for
expected level for
for student’s experience and
expected level for
student’s experience and
student’s experience
knowledge. (2 pts.)
student’s experience
knowledge.
and knowledge. (1 pt.)
(place an “x” in the
N/A
Comments
and knowledge. (3 pts.)
appropriate box)
15. Communicate effectively, recognizing the
needs, values, preferred mode of
communication, and cultural/linguistic
background of the client/patient, family,
caregivers, and relevant others.
16. Collaborate with other professionals in case
management.
17. Provide counseling regarding
communication and swallowing disorders to
clients/patients, family, caregivers, and relevant
others.
18. Adhere to the ASHA Code of Ethics and
behave professionally.
OVERALL INTERACTION & PERSONAL QUALITIES SKILLS SCORE/LETTER GRADE:
Total score _____
Grade _____
Supervisor makes final grade determination.
__________________________________________________________________________________________________________________________________________________________________
Regardless of score, supervisor makes final grade determination. MID-SESSION: Earned Total score _____ Letter grade _____ FINAL: Earned Total score _____ Letter grade _____
Total scores: 49-54 = A
43-48=B
38-42=C
__________________________________________________________________________________________________________________________________________________________________
Signature of Supervisor
State License #:
ASHA #:
Other Comments:
_______________________________________________________________________
__________________________________________________
Signature of Student
Date
Page | 3
Form revised: 1/27/2015