Summary form for certification in speech-language pathology



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KNOWLEDGE AND SKILLS ACQUISITION (KASA)

SUMMARY FORM FOR

CERTIFICATION IN SPEECH-LANGUAGE PATHOLOGY

Student Name
Graduate Advisor

San Francisco State University

Communicative Disorders Program
Knowledge and Skills Acquisition (KASA) Summary Form

For Certification in Speech-Language Pathology

Last updated June, 2014



KNOWLEDGE AND SKILLS ACQUISITION (KASA)

SUMMARY FORM FOR

SPEECH-LANGUAGE PATHOLOGY

Instructions for Use

The Knowledge and Skills Acquisition (KASA) form summarizes a student's acquisition of the knowledge and skills delineated in the Standards for the Certificate of Clinical Competence (SCCC). Entries are made only upon acquisition of the knowledge or skill; thus the KASA is not an evaluation, but only a record that a particular knowledge or skill has been acquired.


Required Documentation
1. Students from CAA-accredited programs (Refer to "Automatic Approval" language in Standard I. Degree) must submit the "Verification by Program Director" page of the KASA when applying for certification.
2. All other applicants must submit the entire, completed document, including the "Verification by Program Director" page when applying for certification.

Use of the KASA Form

1. The CFCC encourages programs to use the KASA to demonstrate compliance with accreditation standards related to preparing students to meet ASHA certification requirements. However, programs may develop other documents to verify student's acquisition of knowledge and skills.


2. For students who must submit the entire KASA, and for academic programs wishing to use the KASA as a tracking document, indicate with a check mark in Column B whether each knowledge and skill was achieved. If a particular knowledge or skill was acquired through work completed in a specific course or courses, the title and number of the course(s) should be entered in Column C. If the knowledge or skills were acquired in clinical practicum, enter the title of the clinic, and the semester and year of the clinic, in Column E, to the right of the number of the practicum course listed in Column D. If the knowledge or skill was acquired through course work and/or clinical practicum, and/or lab or research activities, there should be entries in all of the applicable columns: C, D, and/or E.
3. Students and programs using the KASA are advised to keep a copy in a safe place, should they need to provide information to the Council For Clinical Certification at a later date (e.g., upon application for reinstatement). Students and their advisors should review the KASA form on an ongoing basis throughout the program.
4. CFCC encourages programs and students to periodically review the KASA (or other tracking documents developed by the program) to assist students in determining knowledge and skills already acquired and those yet to be attained.
Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
The KASA form is intended for use by the applicant during the graduate program to track the processes by which the knowledge and skills specified in the 2014 Standards for the CCC are being acquired. Each applicant should review the KASA form at the beginning of graduate study, and update it at intervals throughout the graduate program, and at the conclusion of the program. http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards/
The student, with input and monitoring of program faculty, must enter the semester and year that the course was taken in column B, as each of the knowledge and skills is acquired in academic coursework, and the semester and year of the clinic that was taken in column E, as each of the knowledge and skills is acquired in clinical training. It is expected that many entries will appear in the course work and the clinical practicum columns, with some entries, as appropriate, in the “Other” (lab, research, etc.) columns. Please enter the course or practicum number and title and description of other applicable activity. Optional courses (e.g., SPED791, SPED825, SPED794, SPED 743, SPED 746) should be filled out only if the student has taken the course.
Standard IV. Knowledge Outcomes


A

B

C

D

E

Standards

Requirement Met (Date)

Course #

Practicum Experiences

Other (e.g., labs, research) (Include description of activity)

Standard IV-A. The applicant must demonstrate knowledge of the principles of the biological sciences, physical sciences, statistics, and the social/behavioral sciences.

  • Biological sciences (emphasizing a content area related to human or animal sciences)













  • Physical sciences (courses with a component of physics or chemistry)













  • Statistics













  • Social/Behavioral sciences (psychology, sociology, anthropology or public health)













Standard IV-B: The applicant must have demonstrated knowledge of basic human communication and swallowing processes, including the appropriate biological, neurological, acoustic, psychological, developmental, and linguistic and cultural bases. The applicant must have demonstrated the ability to integrate information pertaining to normal and abnormal human development across the life span

Basic Human Communication Processes



    • Biological




    CD660

    CD651








    • Neurological




    CD660

    CD668


    CD661







    • Acoustic




    CD652







    • Psychological




    CD668

    CD661








    • Developmental/Lifespan




    CD660

    CD661








    • Linguistic




    CD668







    • Cultural




    CD660

    CD668










Swallowing Processes

  • Biological




CD651

CD661








  • Neurological




CD651

CD661








  • Acoustic




NA







  • Psychological




CD651







  • Developmental/Lifespan




CD651







  • Linguistic




NA







  • Cultural




NA







Standard IV-C: The applicant must have demonstrated knowledge of communication and swallowing disorders and differences, including the appropriate etiologies, characteristics, anatomical/physiological, acoustic, psychological, developmental, and linguistic and cultural correlates in the following areas:

Articulation

  • Etiologies

  • Characteristics




CD660

CD651


CD659

CD709


CD 768







Fluency

  • Etiologies

  • Characteristics




CD660

CD653


CD 768







Voice and resonance (respiration and phonation)

  • Etiologies

  • Characteristics




CD660

CD651


CD653

CD 768








Receptive/expressive language (phonology, morphology, syntax, semantics, pragmatics, prelinguistic communication, and paralinguistic communication) in speaking, listening, reading, writing, manual modalities

  • Etiologies

  • Characteristics




CD660

CD668


CD658

CD701


CD707

CD 768








Hearing, including the impact on speech and language

  • Etiologies

  • Characteristics




CD652

CD705


CD654

CD 768








Swallowing (oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myology)

  • Etiologies

  • Characteristics




CD651

CD659


CD710

CD 768








Cognitive aspects of communication (attention, memory, sequencing, problem-solving, executive functioning)

  • Etiologies

  • Characteristics




CD661

CD668


CD658

CD701


CD708

CD 768


SPED791







Social aspects of communication (challenging behavior, ineffective social skills, lack of communication opportunities)

  • Etiologies

  • Characteristics




CD701

CD706


CD707

CD768


SPED791

SPED794


SPED825







Augmentative and alternative communication modalities

  • Etiologies

  • Characteristics




CD663/ SPED 743

SPED 746








Standard IV-D: For each of the areas specified in Standard VI-C, the applicant must have demonstrated current knowledge of the principles and methods of prevention, assessment, and intervention for people with communication and swallowing disorders, including consideration of anatomical/physiological, psychological, developmental, and linguistic and cultural correlates.

Articulation

  • Prevention

  • Assessment

  • Intervention




CD656

CD659


CD709

CD 768


CD711/713

CD715

CD880


CD882

CD884





Fluency

  • Prevention

  • Assessment

  • Intervention




CD653

CD 768


CD711

CD715

CD880


CD882

CD884





Voice and resonance

  • Prevention

  • Assessment

  • Intervention




CD653

CD 768


CD711/713

CD715

CD880


CD882

CD884


Self-guided Visi-Pitch Lab

Self-guided Video Lab



Receptive and expressive language

  • Prevention

  • Assessment

  • Intervention




CD656

CD658


CD701

CD707


CD708

CD711/713

CD756

CD 768


CD715

CD880


CD882

CD884





Hearing, including the impact on speech and language

  • Prevention

  • Assessment

  • Intervention




CD652

CD654


CD705

CD 768


CD715

CD880





Swallowing

  • Prevention

  • Assessment

  • Intervention




CD710

CD 768


CD882

Self-guided Video Lab

Cognitive aspects of communication

  • Prevention

  • Assessment

  • Intervention




CD656

CD701


CD707

CD708


CD756

\CD 768


SPED791

CD715

CD880


CD882

CD884





Social aspects of communication

  • Prevention

  • Assessment

  • Intervention




CD656

CD701


CD706

CD707


CD708

CD710


CD756

CD768


SPED791

SPED794


SPED825

CD715

CD880


CD882

CD884





Augmentative and alternative communication modalities

  • Prevention not applicable

  • Assessment

  • Intervention




CD663/ SPED 743

CD715

CD880


CD882

CD884





Standard IV-E: The applicant must have demonstrated knowledge of standards of ethical conduct.







CD660

CD706


CD711

CD712


CD713

CD725


CD768

CD715

CD880


CD882

CD884





Standard IV-F: The applicant must have demonstrated knowledge of processes used in research and of the integration of research principles into evidence-based clinical practice.







ISED 797

CD656


CD701

CD706


CD707

CD708


CD709

CD710


CD756

CD768


CD715

CD880


CD882

CD884





Standard IV-G: The applicant must have demonstrated knowledge of contemporary professional issues.







SPED 788

CD712


CD725

CD706


CD 768







Standard IV-H: The applicant must have demonstrated knowledge of entry level and advanced certifications, licensure, and other relevant professional credentials, as well as local, state, and national regulations and policies relevant to professional practice.







CD712

CD725








Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology
Standard V. Skills Outcomes


Standard V-A: The applicant must have demonstrated skills in oral and written or other forms of communication sufficient for entry into professional practice.

Written English Proficiency Requirement met with (list date next to the way in which this requirement was met):




GRE Analytical Writing Skills Test

CSET Writing Skills

Other:____________


Oral communication skills sufficient to achieve effective clinical and professional interaction with clients/patients and relevant others




CD706

CD712


CD725

CD768


CD715

CD880


CD882

CD884





Written communication skills sufficient to achieve effective clinical and professional interaction with clients/patients and relevant others.




CD768

CD706



CD715

CD880


CD882

CD884





Standard V-B: The applicant for certification must complete a program of study that includes supervised clinical experiences sufficient in breadth and depth to achieve the following skills outcomes (in addition to clinical experiences, skills may be demonstrated through successful performance on academic course work and examinations, independent projects, or other appropriate alternative methods):

1. Evaluation (must include all skill outcomes listed in a-g below for each of the 9 major areas)

a. Conduct screening and prevention procedures (including prevention activities)

b. Collect case history information and integrate information from clients/patients, family, caregivers, teachers, relevant others, and other professionals

c. Select and administer appropriate evaluation procedures, such as behavioral observations, nonstandardized and standardized tests, and instrumental procedures

d. Adapt evaluation procedures to meet client/patient needs.

e. Interpret, integrate, and synthesize all information to develop diagnoses and make appropriate recommendations for intervention

f. Complete administrative and reporting functions necessary to support evaluation

g. Refer clients/patients for appropriate services.

  • Articulation




CD656

CD659


CD709

CD711/713

CD768


CD715

CD880


CD882

CD884





  • Fluency




CD656

CD653


CD711/713

CD768


CD715

CD880


CD882

CD884








CD656

CD653


CD711/713

CD768


CD715

CD880


CD882

CD884





  • Receptive and expressive language (phonology, morphology, syntax, semantics, and pragmatics) in speaking, listening, reading, writing, and manual modalities




CD656

CD658


CD701

CD707


CD708

CD711/713

CD756

CD768


CD715

CD880


CD882

CD884





  • Hearing, including the impact on speech and language




CD652

CD654


CD705

CD768


CD715

CD880


CD882

CD884





  • Swallowing (oral pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction)




CD710

CD768



CD715

CD880


CD882

CD884





  • Cognitive aspects of communication (attention, memory, sequencing, problem-solving, executive functioning)




CD656

CD701


CD707

CD708


CD711/713

CD756


CD768

SPED791


CD715

CD880


CD882

CD884





  • Social aspects of communication (including challenging behavior, ineffective social skills, lack of communication opportunities)




CD656

CD701


CD706

CD707


CD708

CD711/713

CD756

CD768


SPED825

SPED794


CD715

CD880


CD882

CD884





  • Communication modalities (including oral, manual, augmentative, and alternative communication techniques and assistive technologies)




CD656

CD663/ SPED743

SPED746

CD711/713



CD768

CD715

CD880


CD882

CD884





2. Intervention (must include all skill outcomes listed in a-g below for each of the 9 major areas)

a. Develop setting-appropriate intervention plans with measurable and achievable goals that meet clients’/ patients’ needs. Collaborate with clients/patients and relevant others in the planning process

b. Implement intervention plans. (Involve clients/patients and relevant others in the intervention process)

c. Select or develop and use appropriate materials and instrumentation for prevention and intervention

d. Measure and evaluate clients’/ patients’ performance and progress

e. Modify intervention plans, strategies, materials, or instrumentation as appropriate to meet the needs of clients/patients

f. Complete administrative and reporting functions necessary to support intervention

g. Identify and refer clients/patients for services as appropriate.

  • Articulation




CD656

CD659


CD709

CD711/713

CD768


CD715

CD880


CD882





  • Fluency




CD656

CD653


CD711/713

CD768


CD715

CD880


CD882





  • Voice and resonance, including respiration and phonation




CD656

CD653


CD711/713

CD768


CD715

CD880


CD882





  • Receptive and expressive language (phonology, morphology, syntax, semantics, and pragmatics) in speaking, listening, reading, writing, and manual modalities




CD656

CD658


CD701

CD707


CD708

CD711/713

CD756

CD768


CD715

CD880


CD882





  • Hearing, including the impact on speech and language




CD652

CD654


CD705

CD768


CD715

CD880


CD882





  • Swallowing (oral pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction)




CD710

CD768



CD715

CD880


CD882





  • Cognitive aspects of communication (attention, memory, sequencing, problem-solving, executive functioning)




CD656

CD701


CD707

CD708


CD711/713

CD756


CD768

SPED791


CD715

CD880


CD882





  • Social aspects of communication (including challenging behavior, ineffective social skills, lack of communication opportunities)




CD656

CD701


CD706

CD707


CD708

CD711/713

CD756

CD768


SPED825

SPED794


CD715

CD880


CD882





  • Communication modalities (including oral, manual, augmentative, and alternative communication techniques and assistive technologies)




CD656

CD663/ SPED743

SPED746

CD711/713



CD768

CD715

CD880


CD882





3. Interaction and Personal Qualities

  • a. Communicate effectively, recognizing the needs values, preferred mode of communication, and cultural/linguistic background of the client/ patient, family, caregivers, and relevant others




CD706

CD711


CD712

CD713


CD725

CD768


CD715

CD880


CD882

CD884





  • b. Collaborate with other professionals in case management




CD706

CD711/713

CD712

CD725


CD768

CD715

CD880


CD882

CD884





  • c. Provide counseling regarding communication and swallowing disorders to clients/patients, family, caregivers, and relevant others




CD706

CD710


CD711

CD712


CD713

CD715

CD880


CD882

CD884





  • d. Adhere to the ASHA Code of Ethics and behave professionally.




CD660

CD706


CD711

CD712


CD713

CD725


CD768

CD715

CD880


CD882

CD884





Standard V-C: The applicant for certification in speech-language pathology must complete a minimum of 400 clock hours of supervised clinical experience in the practice of speech-language pathology. Twenty-five hours must be spent in clinical observation, and 375 hours must be spent in direct client/patient contact.

25 observation hours

Requirement met (semester and year):

375 clinical clock hours

Requirement met (semester and year):

Standard V-D: At least 325 of the 400 clock hours must be completed while the applicant is engaged in graduate study in a program accredited in speech-language pathology by the Council on Academic Accreditation in Audiology and Speech-Language Pathology.

Total number of clinical clock hours completed while in graduate program:



Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology



CA Licensure Requirements: http://www.speechandhearing.ca.gov/applicants/app_pack_slp.shtml


  • 60 semester units (su) in normal development, function, and use of speech, hearing, and language and information about, and training in, management of speech, voice, hearing, and language disorders.

  • At least 24 of the required 60 semester units shall be related to disorders of speech, voice, or language.

  • These 60 units do not include credit for thesis, dissertation, or clinical practice.



Requirement met (semester and year):

Undergrad (36 su):

CD660 CD653 CD656 CD661

CD651 CD654 CD658 CD663/ SPED 743

CD652 CD668 CD659 CD664



Requirement met (semester and year):

Graduate (35 non-clinical su):

CD701 CD708 CD768

CD705 CD709 ISED797

CD706 CD710 SPED788

CD707 CD756 CD712

CD725


  • 300 clock hours of clinical experience with individuals representative of a wide spectrum of ages and communication disorders in 3 different clinical settings (2532.2-b)

Requirement met (semester and year):

Graduate (24 clinical practica su)

CD711 x2

CD713

CD715


CD880-C1

CD880-C2

CD880-A

CD882


CD884


Clinical settings from the following kinds of settings: SFSU CD Clinic; public and/or public schools; hospital / rehabilitation / community:

Clinical Setting 1: SFSU CD Clinic (CD 880-711-C1, CD 880-711-C2, CD-713-A)


Clinical Clock Hours Earned:

Clinical Setting 2:



Clinical Clock Hours Earned:

Clinical Setting 3:



Clinical Clock Hours Earned:

Clinical Clock Hours Total:




Student Name
Knowledge And Skills Acquisition (KASA) Summary Form For Certification in Speech-Language Pathology



Speech-Language Pathology Services Credential Requirements: http://www.ctc.ca.gov/credentials/leaflets/cl879.pdf


Completion of CD 715 and CD 725

(which requires SFSU commission-approved specialized preparation program resulting in the formal recommendation for the credential by the college or university where the program was completed

[http://cig.ctc.ca.gov/cig/CTC_apm/apm_one.php?-recid=70&-prior=all.php])


Requirement met (semester and year):

Completion of Basic Skills Requirement (CBEST)


Requirement met (semester and year):


KEY TO COURSES

CD 300 Human Communicative Development and Disorders 3

CD 651 Anatomy and Physiology of the Speech Mechanism 3

CD 652 Audiology 3

CD 653 Voice & Fluency 3

CD 654 Audiometry 3

CD 655 Dynamics of Communication Development 3

CD 656 Diagnosis of Communicative Disorders 3

CD 658 Communication Development and Disorders 3

CD 659 Articulatory and Phonological Disorders 3

CD 660 Communicative Disorders 3

CD 661 Neurolinguistics 3

CD 663/ SPED 743 Augmentative and Alternative Communication 3

CD 668 Language Acquisition and Development 3

CD 701 Seminar in Language Differences and Disorders in Children 3

CD 705 Aural Rehabilitation 3

CD 706 Seminar in Counseling in Communicative Disorders 3

CD 707 Advanced Seminar in Language Disorders in Children 3

CD 708 Seminar in Neurogenic Disorders of Language 3

CD 709 Seminar in Motor Speech Disorders 3

CD 710 Seminar in Dysphagia 3

CD 711 Seminar in Therapy for Functional Communicative Disorders 1

CD 712 Medical Internship Workshop 1

CD 713 Seminar in Therapy for Organic Communicative Disorders 1

CD 715 Clinical/Rehabilitative Experience in the School 8

CD 725 School Internship Workshop: Communication Handicapped 1

CD 756 Adv. Dx. of Communicatively Handicapped Adults & Children 3

CD 768 Seminar in Advanced Clinical Skills 3

CD 880 Advanced Communication Therapy 2

CD 882 Internship in Communicative Disorders 6

CD 884 Advanced Diagnosis in Communicative Disorders 3

CD 664 American Phonetics 3

ISED 797 Seminar in Educational Research 3


SPED 746 Teaching Individuals with Physical and Other Health Impairments 3


SPED 788 Professional, Legal, and Ethical Practices 3

SPED 791 Nature of Autism Spectrum Disorders 3

SPED 825 Communication, Behavior and Instruction: Autism* 3

SPED 794 Socialization and Imagination: Autism 3





Updated 8/5/14



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