Guide to the Clinical Fellowship Skills Inventory (CFSI)

Future certified speech-language pathologists are required to complete a clinical fellowship through the American Speech-Language-Hearing Association (ASHA). During the clinical experience, the fellowship supervisor rates each student, known as a “fellow,” in 21 skills. These essential skills make up the Clinical Fellowship Skills Inventory (CFSI), and demonstrate whether a fellow is ready to transition from an SLP student to an independent practitioner. 

What Is the ASHA Clinical Fellowship Skills Inventory?

A speech pathology graduate student preparing for their clinical fellowship should get to know ASHA’s requirements and how scoring works in the most recent Clinical Fellowship Skills Inventory. The 2020 CFSI is composed of 21 skills in four areas: assessment, treatment, professional practices and interpersonal. Fellows have to show proficiency in all these skills to receive their certification and become independent speech-language pathologists. 

Before January 2020, the Clinical Fellowship Skills Inventory had 18 skills, but in 2018, the Council for the Clinical Certification in Audiology and Speech-Language Pathology (CFCC) completed a comprehensive revalidation of the skills inventory, which hadn’t changed much since 1993. 

Scoring also changed in 2020; the CFSI used to require a rating between one and five. Now, a supervisor will rate the fellow between one and three on each skill. Fellows should prepare to work closely with their supervisor, who will need plenty of observation hours to rate them accurately and provide feedback during the clinical experience. 

The 4 Areas of the ASHA CFSI

Fellows have to develop skills in four separate practice areas. These four areas used to be known as evaluation, treatment, management and interaction. The 2020 Clinical Fellowship Skills Inventory includes updated language, but despite new terminology, the four areas remain largely the same as before. These areas are assessment, treatment, professional practices and interpersonal.


These skills focus on whether a fellow can consistently and accurately screen clients to determine their skills and needs. 


These skills focus on whether a fellow can consistently and appropriately develop and implement treatment plans and interventions for clients. 

Professional Practices

These skills focus on whether a fellow consistently handles the practical aspects of their profession, including documentation, recordkeeping, clinical reporting, and working within local, state, and federal regulations.


These skills focus on how well a fellow interacts with clients from all types of backgrounds and with varying communication abilities, as well as how a fellow interacts with clients’ loved ones and caregivers. 

The 21 Clinical Skills Inventory

According to ASHA, the 2020 Clinical Fellowship Skills Inventory includes 21 skills covering the assessment, treatment, professional practices and interpersonal areas.

1. Implements screening procedures 

  • Implements screening procedures fitting for various populations
  • Chooses screening criteria, scores it and educates others about it 
  • Skill area: assessment

2. Interprets results of screening procedures

  • Interprets results
  • Makes recommendations and referrals
  • Skill area: assessment

3. Collects and integrates comprehensive case history information

  • Collects case history
  • Collects and obtains additional information from various sources and records
  • Integrates information from all sources to identify etiologic or contributing factors
  • Skill area: assessment

4. Selects and implements assessment procedures

  • Selects assessments
  • Adapts assessment procedures to various populations
  • Administers and scores assessments accurately
  • Skill area: assessment

5. Interprets and integrates assessment results

  • Interprets and integrates all assessment results
  • Makes diagnostic impressions
  • Integrates assessment results into treatment plans
  • Skill area: assessment

6. Develops recommendations based on a comprehensive assessment

  • Chooses required criteria for treatment
  • Determines requirements for treatment discharge
  • Effectively communicates assessment results to pertinent individuals
  • Provides referrals
  • Skill area: assessment

7. Designs and documents evidence-based client-centered treatment plans

  • Establishes treatment plans
  • Sets specific, measurable, attainable, realistic and timely goals
  • Uses best practices to prescribe the proper cadence and intensity of treatment
  • Skill area: treatment

8. Selects and implements evidence-based treatment

  • Selects or develops intervention strategies
  • Independently implements intervention strategies
  • Provides treatment that addresses goals
  • Skill area: treatment

9. Selects and utilizes materials

  • Selects or develops materials that are relevant to client needs
  • Utilizes materials or instrumentation effectively
  • Skill area: treatment

10. Adapts treatment components to meet individual client needs

  • Understands the importance of adapting strategies and is able to do so
  • Adapts treatment to serve the needs of diverse clients, culturally and linguistically
  • Skill area: treatment

11. Collects data routinely to determine treatment efficacy and effectiveness

  • Independently and accurately collects data
  • Utilizes treatment data to guide decisions and determine the effectiveness of services
  • Skill area: treatment

12. Determines criteria to initiate, alter and end treatment

  • Determines criteria for treatment initiation, changes and discharge
  • Clearly communicates treatment outcomes to relevant individuals
  • Skill area: treatment

13. Adheres to ASHA and state codes of ethics and federal, state, and local laws related to client information

  • Reviews and interprets the codes of ethics before taking actions
  • Adheres to the codes of ethics
  • Maintains client records following HIPAA and FERPA policies, including the appropriate, confidential and ethical use of social media
  • Skill area: professional practice

14. Schedules and prioritizes direct and indirect service activities

  • Prioritizes and coordinates various activities, including scheduling client contacts and meetings
  • Skill area: professional practice

15. Manages and documents client records

  • Maintains accurate, detailed client records and completes documentation, including professional contacts
  • Completes documentation promptly
  • Skill area: professional practice

16. Complies with local, state, federal and payer’s regulations to determine eligibility and complete billing requirements for reimbursement

  • Reviews and interprets regulations from the above entities before taking actions
  • Acts under the local, state, federal and payer’s regulations
  • Completes billing requirements accurately and on time
  • Skill area: professional practice

17. Demonstrates competencies and adapts to individualized needs of culturally and linguistically diverse populations

  • Gains knowledge of and applies best practices for culturally and linguistically diverse groups 
  • Provides education and resources to promote best practices for these groups
  • Skill area: professional practice

18. Provides education and resources

  • Provides clear and meaningful education and resources to promote the knowledge, prevention, and treatment of communication and related disorders
  • Skill area: professional practice

19. Adapts communication style to meet the needs of all individuals

  • Acknowledges and adapts personal nonverbal communications
  • Interprets and responds to nonverbal communications of others
  • Uses terminology and phrasing in oral and written communications that correspond to the semantic competency of the audience
  • Actively listens to clients and others and responds accordingly
  • Includes information that is accurate and complete
  • Skill area: interpersonal

20. Collaborates interprofessionally

  • Maintain professional boundaries, utilizing the scope of practice of allied health or education professionals
  • Engages interprofessionally with allied health or education professionals to enhance client outcomes
  • Skill area: interpersonal

21. Counsels and educates clients and other relevant individuals

  • Actively listens to clients and others and responds accordingly
  • Engages clients and relevant others in problem-solving
  • Educates and encourages client self-advocacy
  • Provides information and resources that are specific to the needs of the client
  • Skill area: interpersonal

The Speech Pathology Clinical Fellowship Rating System

A clinical fellowship supervisor will rate a fellow on each skill at least once during each of the fellowship’s three segments. The supervisor rates each skill independently, which means a fellow’s rating for one skill may not be the same as the rating on another skill. To provide the most accurate rating possible, supervisors need to interact with fellows frequently and have plenty of time to observe their skills on the job. 

The supervisor must rate a fellow from one to three for each skill. Below is the CFSI score breakdown:

  • One point: “Does Not Meet Improvement.” The fellow is inaccurate and inconsistent, cannot work independently in routine situations, or doesn’t seek guidance when appropriate.
  • Two points: “Meets Expectations.” The fellow is accurate, consistent, seeks minimal guidance in routine situations and has skills consistent with entry-level practitioners.
  • Three points: “Exceeds Expectations.” The fellow is consistently accurate and independent in routine and complex situations, has an intuitive grasp of varied situations and their skills exceed those of entry-level practitioners. 

To complete the fellowship satisfactorily and receive certification, a fellow must receive at least a two on each skill. When rating a fellow in the Clinical Fellowship Skills Inventory, the supervisor must consider their effectiveness when they work with various client populations in terms of clients’ age, communication disorders, physical limitations, cultural backgrounds, English language proficiency, literacy and alternative communication systems. 

Supervisors base their rating off of four main factors: accuracy, consistency, independence and supervisory guidance.


The degree to which the fellow performs a skill without making mistakes. 


The degree to which the fellow performs a skill at the same level of mastery across multiple instances. 


The degree to which the fellow performs a skill without assistance or direction.

Supervisory Guidance

The degree to which the fellow seeks appropriate consultation and guidance when needed. 

Why Is the Clinical Fellowship Skills Inventory Important to Master?

The Clinical Fellowship Skills Inventory is important because it is a concise breakdown of the skills a speech pathologist needs to provide excellent care and excel in their profession. In addition to completing a graduate degree, such as a speech pathology master’s program, completing a clinical fellowship is an essential factor in obtaining certification for the Certificate of Clinical Competence for Speech-Language Pathologists (CCC-SLP), which is offered through ASHA. Students who are unable to master CFSI skills will not be granted their certification. 

After a student completes their clinical fellowship experience, they have 90 days to log in to their ASHA accounts and enter their fellowship experience details to their online application. Then, supervisors have 90 days to verify the information and complete their portion of the documentation, which replaces the paper Clinical Fellowship Report and Rating Form.

Information last updated September 2020

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