Self-Assessment Tool (SAT)
Section 1: Practice Considerations
Name:
Date completed:
Registration #:
For three-year period:
Profession:
Date(s) updated:
Practice Description: Indicate the percentage of time you spend in:
Clinical
%
Administrative
%
Research
%
Education of students in the profession
%
Other (specify)
%
Client Demographics: Describe your clients, considering that “clients” may be agencies, educators,
other health professionals, students of the profession, etc. as well as individuals with communication and
hearing disorders and their families.
Special Contributions and Achievements:
Recent Changes to Scope of Practice: Has your scope of practice changed or developed within
the past year - has it become more or less specialized, have you returned to practice after an absence,
or have you had a change in your professional role?
ACSLPA CCP Self-Assessment Tool (June 2007)
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Anticipated Changes to Scope of Practice: How might your practice change over the next three
years?
Other: Describe any other aspects of your practice that will impact your self-assessment, as applicable.
Consider constraints to service delivery, such as recruitment, funding, accessibility, remote location,
waitlists, etc.
Instructions for Section 2: Competence Self-Assessment
(starts on page 3)
This is your tool to assist you in developing your continuing competence goal(s). Please be
as honest and objective as possible, as it will assist you in creating goals and ultimately
benefit clients. Please note the definition of “client” - “clients” may be agencies,
educators, other health professionals, students of the profession, etc. as well as
individuals with communication and hearing disorders and their families.
Tick the box (N/A, Partial, Yes) that best describes your compliance with the competence
indicator. The indicators should be interpreted as broadly as possible to fit your definition of
client as well as the role and setting in which you currently practice and plan to practice.
After indicating your compliance with the competence indicator, rate your competence level
(Entry Level / Emerging, Proficient, Advanced) for the aspect of the essential competency
and indicate whether or not this is an aspect of competence you wish to set goals for during
the next three years. See the Guidelines for Completing CCP Forms for the description
of the rating scales.
The information from the SAT will then be used to develop goal(s) on the Continuing
Competence Goal Tool (CCGT).
ACSLPA CCP Self-Assessment Tool (June 2007)
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Section 2: Competence Self-Assessment
Competency 1: Practice Knowledge
For audiologists (from the practice statement in Schedule 28 of the Health Professions Act
(HPA)):
Demonstrates knowledge, skills, and abilities to:
 assess auditory and vestibular function and diagnose, rehabilitate, prevent and
provide appropriate devices and treatment for auditory and vestibular dysfunction, in
applicable practice setting;
 teach, manage and conduct research in the science and practice of audiology, in
applicable practice setting; and
 provide restricted activities authorized by the regulations
in applicable practice setting.
For speech-language pathologists (from the practice statement in Schedule 28 of the
Health Professions Act (HPA)):
Demonstrates knowledge, skills, and abilities to:
 assess, diagnose, rehabilitate and prevent communication and oral motor and
pharyngeal dysfunctions and disorders;
 teach, manage, and conduct research in the science and practice of speechlanguage pathology; and
 provide restricted activities authorized by the regulations
in applicable practice setting.
Practice Knowledge 1.1
N/A
Partial
Yes
Within area(s) of practice (clinical, administrative, research or education of students in
the profession) demonstrates an integration of speech-language pathology/audiology
skills with current theory and relevant supporting scientific knowledge. Specifically,
demonstrates knowledge in the applicable clinical area(s) of practice as outlined in the
adopted standards of practice reference:
Assessing and Certifying Clinical
Competence: Foundations of Clinical Practice for Audiology and Speech-Language
Pathology (2004) (http://www.caslpa.ca/english/resources/foundations.asp).
A. For Audiologists:
a.
b.
Basic Requirements (anatomy, physiology, genetics,
counseling, medical interventions, research methods, etc.)
Prevention, Evaluation, and Diagnosis
c.
d.
Client Management
Neonatal and Infant Population
e.
f.
Preschool and School Populations
Profoundly Hearing Impaired Populations
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.1
N/A
Partial
Yes
A. For Audiologists (continued):
g.
h.
The Aging Adult Population
Occupational Hearing Loss
i.
Professional Practices and Issues
j.
Other (specify):
Example or aspect specific to my practice (optional):
B. For Speech-Language Pathologists:
a.
b.
c.
d.
e.
f.
g.
h.
Basic Requirements (anatomy, physiology, genetics,
counseling, medical interventions, research methods, etc.)
Principles of Clinical Practice and Professional Practice
Issues
Developmental Articulation / Phonological Disorders
Neurologically Based Speech Disorders
Developmental Language Disorders
Acquired Language Disorders
Voice Disorders
Resonance Disorders
i.
j.
k.
Fluency Disorders
Augmentative and Alternative Communication
Hearing Disorders and Related Speech-Language
Disorders
l.
Dysphagia
m. Other (specify):
Example or aspect specific to my practice (optional):
Disregarding all N/As, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.2
N/A
Partial
Yes
Performs restricted activities, as authorized in the Speech-Language Pathologists and
Audiologists Profession Regulation
(http://www.qp.gov.ab.ca/documents/Regs/2002_124.cfm?frm_isbn=077971203X)
in a competent manner if the restricted activity is appropriate to area of practice.
A. For Audiologists:
a.
Insert or remove instruments or devices beyond the
cartilaginous portion of the ear canal
b.
Insert into the ear canal: i) liquid, air or gas under
pressure, or ii) a substance that subsequently solidifies
Example or aspect specific to my practice (optional):
B. For Speech-Language Pathologists:
a.
Insert into the ear canal air under pressure
b.
Insert or remove instruments or devices beyond the point
in the nasal passages where they normally narrow
c.
Insert or remove instruments, devices or fingers beyond
the pharynx
d.
Insert or remove instruments or devices into an artificial
opening into the body
e.
Administer oral diagnostic imaging contrast agents
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
N/A
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.3
N/A
Partial
Yes
Assessment skills
a.
Integrates knowledge of research findings into client
assessment
b.
Knows and applies rationale for use of assessment
procedures
c.
Communicates assessment procedures and rationale
d.
Integrates findings and observations to make appropriate
recommendations
e.
Demonstrates independent assessment planning
f.
Uses assessment tools effectively
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.4
N/A
Partial
Yes
Clinical management skills (includes consultation and intervention/therapy/treatment)
a.
Integrates research findings with client management
b.
Plans effective goals and objectives for client intervention
– uses information from observation and assessment,
assigns priorities
c.
Knows and applies rationale for treatment procedures
d.
Sequences and adjusts steps in progress toward a goal
e.
Describes, measures and documents client change
f.
Evaluates progress and develops recommendations
based on client change
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.5
N/A
Partial
Yes
Analyzes Data and Service Delivery
a. Gathers, analyzes, critically applies and interprets
information to generate options for service delivery
b. Identifies and determines the nature of a problem using
relevant knowledge base
c. Demonstrates knowledge of a variety of data collection
procedures
d. Selects and applies appropriate data collection procedures
e. Accurately records data
f.
Analyzes and interprets data objectively
g. Supports decision with evidence based practice rationale
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.6
N/A
Partial
Yes
Clinical Records
a.
Maintains confidentiality and security in all oral and
written communication
b.
Applies record-keeping systems to clinical records
c.
Documents
appropriate
d.
Organizes records to facilitate information retrieval
e.
Establishes and follows policies and procedures to
protect clinical record confidentiality
f.
Includes appropriate information in verbal and written
reports
g.
Presents information in logical, concise and sequential
manner
h.
Uses appropriate professional terminology and style
i.
Adapts verbal and written reports to work environment
and communication situation
j.
Edits reports as appropriate
relevant
to
clinical
interactions,
as
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Practice Knowledge 1.7
N/A
Partial
Yes
Research Skills in the Clinical Process
a.
Reads, interprets and applies clinical research
b.
Demonstrates ability to formulate clinical research
questions
c.
Demonstrates ability to conduct clinical research
d.
Demonstrates ability to support or refute clinical research
findings
e.
Reports results of clinical research and disseminates, as
appropriate to practice
f.
Shares knowledge of current research findings,
evaluation and management procedures
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Competency 2: Professional Practice Management
Manages role and implements speech-language pathology or audiology services within the
diverse contexts of practice.
Professional Practice Management 2.1
N/A
Partial
Yes
Uses available and appropriate resources to support safe, effective and efficient client
services.
a.
Promotes client safety
b.
Delivers professional services in a safe physical
environment
c.
Demonstrates due precautions in relation to hazards in
environment
d.
Verifies that equipment is in safe working order and
contributes to maintaining safety of equipment
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Practice Management 2.2
N/A
Partial
Yes
Supervises support personnel involved in the delivery of audiology and/or speechlanguage pathology services, including audiometric technicians, speech-language
pathologist assistants, volunteers and others.

Audiologists’ reference: Audiologists’ Guidelines for Working with Support Personnel from
http://www.acslpa.ab.ca/public/data/documents/AUD_Guidelines_for_Use_of_Support_Pe
rsonnel_Final_(ECopy).pdf.
 SLPs’ reference: Speech-Language Pathologists’ Guidelines for Working with Support
Personnel from
http://www.acslpa.ab.ca/public/data/documents/SLP_Guidelines_for_Use_of_Support_Per
sonnel_Final_(ECopy).pdf
a. Assesses performance of support personnel involved in the
delivery of services
b.
Assigns and monitors tasks appropriately
c.
Accepts responsibility for delegated decision-making
situations
d.
Documents supervisory interactions with support personnel
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
N/A
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Practice Management 2.3
N/A
Partial
Yes
Supervises students involved in the delivery of audiology – hearing related and/or
speech-language pathology services.
a.
Assesses performance of students involved in the delivery
of services
b.
Assigns tasks appropriate to the student acting within the
profession appropriate guidelines
c.
Accepts responsibility for delegated decision-making
situations
d.
Documents supervisory interactions with students
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
N/A
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Competency 3: Professional Accountability and Responsibility
Assumes professional responsibility and demonstrates safe, ethical, culturally sensitive and
autonomous professional practice.
Note: N/A is not a rating option for Competency 3:
Responsibility
Professional Accountability and
Professional Accountability and Responsibility 3.1
Partial
Yes
Conducts self within legal and ethical requirements relevant to the profession and
practice setting.
a.
Demonstrates knowledge of and complies with the Health Professions
Act – general web link: http://www.qp.gov.ab.ca. Specific web link:
http://www.qp.gov.ab.ca/documents/Acts/H07.cfm?frm_isbn=077974182X
b.
i) Mandatory registration
ii) Registration requirements
iii) Protected titles
iv) Restricted activities
v) Competence program
vi) Professional practice
vii) Discipline
Demonstrates knowledge of and complies with the Speech-Language
Pathologists and Audiologists Profession Regulation - general web link:
http://www.qp.gov.ab.ca. Specific web link:
http://www.qp.gov.ab.ca/documents/Regs/2002_124.cfm?frm_isbn=077971203X
c.
i) Uses regulated titles appropriately
ii) Practices only with a valid practice permit
iii) Performs and supervises restricted activities as specified
iv) Participates in Continuing Competence Program
Demonstrates knowledge of and complies with any other applicable
legislation that may impact on practice (e.g. privacy legislation)
d.
Demonstrates knowledge of rights and appeal procedures specific to
the work setting
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Accountability and Responsibility 3.2
Partial
Yes
Provides ethical professional services.
a.
Demonstrates knowledge of and complies with the Code of Ethics (see
http://www.acslpa.ab.ca/public/data/documents/ACSLPA_Code_of_Ethi
cs_-_April_2009.pdf) and professional obligations
b.
Questions policies and procedures that are inconsistent with client
outcomes, best practice and safety standards
c.
Demonstrates a realistic sense of own professional limitations
d.
Demonstrates professional integrity and a commitment to the well-being
of all clients
e.
Understands the obligation of protection of the public and acts
accordingly
f.
Maintains appropriate boundaries in therapeutic and working
relationships
g.
Charges applicable fees which are documented for the client,
appropriate and justifiable for the services performed and product
provided (as applicable to practice)
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Accountability and Responsibility 3.3
Partial
Yes
Respects the individuality and autonomy of the client.
a.
Demonstrates sensitivity to and respect for each client
b.
Ensures each client is treated respectfully
c.
Uses a client-centred approach
d.
Demonstrates sensitivity to other cultures and religions; values diversity
e.
Demonstrates awareness of own cultural values and biases and their
impact on practice
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Accountability and Responsibility 3.4
Partial
Yes
Delivers professional services incorporating education, research and ACSLPA preferred
practice guidelines.
a.
Provides services that reflect effective use of resources
b.
Plans and delivers services using an approach based on experience,
best available evidence and resources
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
Professional Accountability and Responsibility 3.5
Partial
Yes
Provides services within the scope of professional practice for speech-language
pathology or audiology and within the parameters of personal competence
a.
Demonstrates knowledge of and complies with the standards of practice
- http://www.caslpa.ca/english/resources/foundations.asp - see 1.1 for
detailed breakdown
b.
Maintains autonomy in practice that supports professional decision
making
c.
Accepts responsibility at all times for actions and decisions
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Professional Accountability and Responsibility 3.6
Partial
Yes
Engages in professional development and lifelong learning activities.
a.
Engages in professional activities that enhance and support evidence
based knowledge in the profession
b.
Plans effective goals and objectives for clinical and professional growth
– uses self-evaluation, assigns priorities
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Competency 4: Communication and Collaboration
Communicates with clients and professionals in other disciplines to collaborate and
coordinate services.
Note: N/A is not a rating option for Competency 3:
Responsibility
Professional Accountability and
Communication and Collaboration 4.1
Partial
Yes
Establishes and maintains effective communication with clients and caregivers.
a.
Establishes rapport and trust in client relationships
b.
Facilitates decision making by clients
c.
Informs clients of benefits, limits and potential risks of intervention
d.
Uses appropriate verbal, nonverbal and written communication
e.
Matches communication style and content to the needs of the client
f.
Communicates with clients and relevant others about services, including
completion and follow-up
g.
Manages conflict in a professional manner
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Communication and Collaboration 4.2
Partial
Yes
Establishes and maintains effective communication with professional colleagues.
a.
Establishes rapport and trust in interprofessional relationships
b.
Collaborates to provide interprofessional client service, as needed, to
achieve client goals and outcomes
c.
Communicates with professional colleagues regarding planning,
implementing and evaluating care
d.
Uses appropriate verbal, nonverbal and written communication
e.
Manages conflict in a professional manner
f.
Consults with and shares information with other professionals in a
timely manner to ensure comprehensive service delivery
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
ACSLPA CCP Self-Assessment Tool (June 2007)
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Competency 5: Professional Judgment and Reasoning
Applies principles of critical thinking while solving problems and making decisions.
Professional Judgment and Reasoning 5.1
Partial
Yes
Engages in reflective and evaluative approach to practice.
a.
Uses a comprehensive problem solving approach to decision making
b.
Recognizes own background, education, experience, perceptions,
values and beliefs and their effect on decision making
c.
Recognizes patterns of occurrence based on previous learning,
experience and professional knowledge and uses this information in
action
d.
Demonstrates self awareness and self-evaluation skills to reflect on
actions and decisions
e.
Analyzes, evaluates and modifies own behaviour
f.
Meets and respects deadlines
g.
Sets priorities
Example or aspect specific to my practice (optional):
Overall, I rate myself on this aspect of competency as:
Entry Level / Emerging
Proficient
Advanced
I consider this an aspect of competency that I want to set goal(s) for during the next
three years:
Yes
No
Comments:
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