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SPEECH & LANGUAGE PATHOLOGIST

SKILLS/PROFICIENCY INVENTORY

 

By completing this checklist to the best of your ability, you will help us match your skills and the areas of interest with our available assignments. Please choose the answer that most accurately describes your level of experience with each skill.

Use the following format to indicate your level of experience for each answer.

 

3

 Very experienced  
 

2

 Experienced  
 

1

 Some experience  
 

0

 No experience  
 

Ped

 Pediatric experience  
 

Adult

 Adult experience  
 

 

    
 
  Note: you can combine answers. For example:  "1, adult"  
 
 
 
 
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Your name (first, last)

  

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Type of qualifications

  

 

    

Today's date

 

I. a) Overall experience in clinical settings

 

I. b) Specific experience in clinical settings:

  Home Health  
  Hospital  
  Outpatient Clinic  
  Private  
  Private School  
  Skilled Nursing Facility  

II. Experience with communication disorders

ADD/ADHD

ALS

Alzheimer's (dementia)

Aphasia

Apraxia

Articulation

Autism Spectrum Disorders

Cerebral Palsy

Cleft Palate

CVA

Dysarthria

Feeding Disorders

Fluency

Head Trauma

Hearing_Impaired

Language Disorders

Laryngetomy

Learning Disability

Low Level Functioning Patients

Mental Retardation

Multi-Handicapped

Non-Oral

Parkinson’s

PDD

Phonological Disorders

Trachs

Traumatic Brain Inquiry

Ventilator Dependent Patients

Videofluroscopy

Voice

III. Diagnostic skills

ALPS (Aphasia Language Perf. Scale) Boston
CADL (Comm. Ability Daily) CELF-3
Detroit Minnesota (Schuell)
OWLS (Oral & Written Language Skills) PICA (Porch Index of Com. Ability)
Token Western Aphasia Battery (WAB)
       

IV. Medicare guidelines

Daily Treatment Notes    
Measurable Goals    
Medicare Documentation    
Narrative Format    
SOAP Notes    

V. Program development

Community Awareness of your Services Establishing a Caseload
In-Services Interaction with OT
Interaction with Physician Interaction with PT
Multidisciplinary Approach Referral Development
Screenings Staff Education
    Writing Grants
       
       
       

VI. Therapy skills/experience

Accent Reduction    
Augmentative/Alternative Communication    
Aural Rehabilitation    
Communication Boards    
Discrete Trial Training    
Early Intervention    
Foreign Language    
Sign Language    

VII. Age groups treated

0-3 years Early Intervention    
3-5 years Pre-School    

5-11 years Elementary School

 

    
14-18 years High School    
19-22 years    
23-39 years    
39-64 years    
65 plus years    

VIII. Supervisory roles

Chief/Director    
Supervisor    
Intern supervisor    
CFY supervisor    
Consultant    

IX. Languages    Please list foreign language training and level of competency, such as conversational, reading, writing and ability to easily provide therapy to others.

X. Additional skills  Please list any other skills and talents you might have. Be generous!