SPCH2011 ASSESSMENT 1:

0-37592000

SPCH2011 ASSESSMENT 1:

Speech Pathology Case History Short Report

Clinical Rationale for completing a case history:

Communication development:

Other developmental domains:

Cognitive:

Socio-emotional:

Motor:

____________________________________________________________________________________

Summary and Recommendations:

References: (start a new page)

0-37592000

SPCH2011 ASSESSMENT 1: SCAFFOLD

Speech Pathology Case History Short Report

Clinical Rationale for completing at case history x 2:

Communication development:

What features of communication does the parent report? Is this in line with (or above) typical development? When does the literature say should happen?

Receptive language (understanding)

Expressive Language (form, content & Use )Speech (articulation - intelligibility, phonetic inventory- speech sounds used):

Other developmental domains:

Brief description of developmental domain/ what developmental features does the parent report? Is this in line with typical development? What/When does the literature say should happen?

Cognitive Development

Physical development

Social/Emotional development

Summary: Give two recommendations to continue to expand Johns Communication skills.

References:

031000

Speech Pathology Child Case History Form

Client Details

Date: Clients Name: Clinical Educator:

Clients Date of Birth: Clients Age Clients Sex:

Address:

Is the client of Aboriginal or Torres Strait Islander origin?

No Yes Aboriginal Yes - Torres Strait Islander Parent/Carer Details

Relationship to Child: Relationship to Child:

Full Name Address: Phone (home): Phone (mobile): Email: Occupation: Country of Birth: Year Arrived in Australia: Primary Contact Person:

(indicate with tick) Family Details (other people living in the home)

Name Age Relationship to Child

What language/s spoken at home?

Explained Confidentiality and Client Rights (Consent Form, Student clinic)

Referral Information

Referral Source: Mother Reason for Referral:

Current concerns:

When did you first notice this?

What has happened since this was noticed?

Is your child aware of his/her difficulties?

Is there any evidence of frustration?

Is there any family history of speech, language or literacy difficulties?

What other professionals or agencies have been involved?

Please give brief details and year/s seen:

Speech Pathologist Details

Occupational therapist Details

Physiotherapist Details

School Counsellor Details

Psychologist Details

Audiologist Detail

Support teacher Details

GP Details

Paediatrician Details

ENT Details

Disability Services Details

Child and Youth Mental Health Service Details

Other _______________________________________________

Do we have your consent to contact? If so, who?*

* Obtain written consent using consent for release of information form

Child Care/Playgroup/Preschool/School:

Has your childs teacher mentioned any concerns about your childs development? Please describe their concerns.

Child related factors

Pregnancy and Birth

Mothers health during pregnancy:

Length of pregnancy:

Birth:

weight:

Corrected age (if preterm):

Did your baby require intensive or special care?

If yes, details:

Health

Current health:

Does your child have any chronic illness or condition?

Does your child have any allergies or sensitivities? Has hearing been assessed? Yes / No Hearing device? Yes / No

If yes, when? What was the result?

Has vision been assessed? Yes / No Glasses? Yes / No

If yes, when? What was the result?

Do you have any current concerns about your childs hearing or vision?

History of cough/colds:

Ear infections:

If yes, details:

Grommets inserted? Yes/ no If yes, details:

Medications:

Has your child ever been hospitalised?

If yes, details:

Development

Motor development

At what age did your child

Roll Sit up

Crawl Walk

Toilet train by day Toilet train by night

Briefly describe your childs physical capabilities (e.g. coordination, level of activity, fine motor [e.g. drawing, writing]):

Communication

At what age did your child

Babble Use first words

Make 2-3 word combinations Produce sentences

Speak clearly so strangers could understand

Describe how your child communicates now (sounds, words, number of words together, pointing*, gestures*) *If not using words yet or just a few words

Sentences:

How many words does your child put together in a sentence on average?

How many words would be the longest sentence your child uses?

Does your child ask wh questions? (What, Who, Where, Why)

Intelligibility Rating: 5- Always 4- Usually 3- Sometimes 2- Rarely 1- Never

Do you understand your child? _______

Do immediate members of your family understand your child? _______

Do extended members of your family understand your child? _______

Do your childs friends understand your child? _______

Do other acquaintances understand your child? _______

Do your childs teachers understand your child? _______

Do strangers understand your child? _______

Adapted from: (McLeod, Harrison, & McCormack, 2012)

How well does your child talk to you about his/her experiences (for example what happened at preschool)?

Are these stories easy to follow?

Describe your childs conversations and interactions with others

Have you or any other person thought that your child may be stuttering? Yes / No

If so, details:

Comprehension:

How does your child go following instructions if it is not something that you ask routinely?

(Do you need to use additional prompts do you need to repeat instructions lots of times, does it seem easier when you point?)

Literacy:

How interested is your child in books (depending on age - picture books, being read to, story-telling with books)? Frequency?

How is your child going with reading at school?

Does your child know the common sounds to match letters?

Can your child write their name?

Eating and drinking:

Early feeding: Breast feeding / bottle feeding Until how old?

Introduction to solids

Previous and current food preferences and dislikes (tastes, textures)

Any excessive dribbling/drooling?

Social Emotional:

What are your childs interests?

What are your childs strengths and weaknesses?

Describe your childs temperament/personality now

Reaction to being left with others?

Reaction when you return?

Describe childs behaviour (if any issues mentioned above)

Does your child play well with other children?

What sort of play does your child prefer? (e.g. plays on own, plays alongside another but not with, enjoys groups)

Does your child engage in any form of pretend play? E.g. tea parties

Community Factors:

Community support / networks?

Goals and Expectations

What are your expectations for Speech Pathology input?

What are your goals?