Name of Speech/Language Pathologist (Optional)
_________________________________________________________
Evaluator _________________________________________________
Evaluator's Position/Title ____________________________________
Date _____________________
1. Level Distribution: Please estimate the distribution of the clinician's caseload in percentages:
% of caseload
_____ 0-3 population
_____ Preschool
_____ Primary Grades (K-6th)
_____ Secondary Grades (7-12th) _____ Special (students with special needs such as mental retardation, hearing loss)
_____ Adults
_____ Other (please specify) ____________________________________________________
2. Composition of Caseload: Please estimate the percentage of the total caseload in each category.
_____ Articulation/Phonology (non-organic)
_____ Language (nonorganic)
_____ Fluency (stuttering)
_____ Hearing Loss
_____ Cerebral Palsy
_____ Cleft Palate/Orofacial Anomalies
_____ Voice
_____ Aphasia
_____ Right-Hemisphere Disorder
_____ Traumatic-Brain Injury
_____ Swallowing
_____ Dementia
_____ Fetal Alcohol Syndrome
_____ Other (please specify) ____________________________________________________
3. Distribution of Responsibilities: Please estimate the percentage of time the clinician spends in each task over a one-year period.
_____ Assessment of communication problems
_____ Direct treatment of communication problems (Individual or small group sessions)
_____ Dysphagia (swallowing assessment and treatment)
_____ Conferences or consultations with parents, spouse, teachers, rehabilitation teams, IEP and MDT meetings, etc.
_____ Classroom service delivery
_____ Administration (paperwork, supervision, budgeting, etc.)
_____ Other (please specify) ____________________________________________________
4. Program Description: Please indicate what type of program you supervise and/or administer.
_____ Public School Program
_____ Private School Program
_____ Acute Care Hospital
_____ Other Type of Hospital (Please specify) _____________________________________
_____ Rehabilitation Hospital or Program
_____ Private Practice
_____ Institution for Persons with Mental Handicaps
_____ College or University Clinic
_____ Other (Please specify) ___________________________________________________
Other details, if appropriate.
5. a. Can the clinician complete speech, language, or hearing screening procedures appropriately?
b. Are there procedures that the clinician cannot perform? If so, please specify.
6. a. Does the clinician demonstrate adequate knowledge of diagnostic techniques?
b. Does the clinician demonstrate adequate knowledge of instrumentation?
c. Which techniques and/or instruments does the clinician handle with proficiency?
d. With which techniques and/or instruments should the clinician be more proficient?
7. a. Is the clinician able to establish an appropriate caseload?
b. What, if any, problems does the clinician have in establishing a caseload?
8. Does the clinician apply current research findings to therapy regimens?
9. a. Does the clinician work better in a one-to-one therapy situation or in a group situation?
b. What accounts for this difference, if any?
10. a. Does the clinician establish appropriate long-and-short range goals for each client in the caseload?
b. What problems, if any does the graduate have in establishing these?
c. What do you believe the UNK program could do to improve our graduates' ability to establish clinical objectives?
11. a. Are there certain types of handicapping conditions the clinician handles extremely well?
b. What do you believe accounts for this skill?
12. a. Does the clinician write complete reports?
b. What are their strengths/weaknesses?
13. How does the clinician respond to supervision?
14. a. Does the clinician maintain positive relationships with clients and professional staff?
b. If not, what appears to be the primary source of difficulty?
c. How could this be resolved?
15. a. How would you suggest the UNK program be modified to correct any problems that occur in
establishing a caseload?
b. What do you believe the UNK program could do to ensure that our graduates work equally well in a one-to-one and a group situation?
c. What do you believe the UNK program could do to improve our graduates' ability to establish clinical objectives?
d. What do you believe the UNK program could do to improve report writing?
Additional Comments: