CHARTR (CHArting Rational TReatment) is an explicit model for clinical decision-making developed at the University of Oregon Speech-Language-Hearing Center. It provides a method to improve systematic training for student clinicians by making the clinical process more concrete and increasing the consistency of supervisor training and feedback. CHARTR concepts are taught in Clinical Practicum courses, academic coursework, and through individual supervision.

The main purpose of CHARTR is to encourage students to think about WHY they are making certain clinical decisions when planning assessments or treatment programs. It is important that clinicians provide clear, rational explanations for their decisions based on the best available research evidence and current theory. Evidence-based practice (EBP) encourages clinicians to integrate research evidence and current theory with a client’s values and preferences using their clinical expertise and experience. It is no longer acceptable to plan assessments or treatments based only on your experience, intuition, or because “it works.” EBP allows for increased accountability to our clients and profession, and promises better outcomes from our services. CHARTR attempts to shift the focus of our clinical training program toward an evidence-based, rational perspective.

CHARTR has two main components: Flowcharts and Worksheets. The Flowcharts are the main teaching tools; these help put the “big picture” of clinical problem solving in perspective. There is a flowchart to represent the assessment, treatment, and evidence-based practice processes. These flowcharts are color coded. Grey boxes indicate where students should focus their time and effort. Blue indicates that client/caregiver input is required. Yellow indicates a trigger for Evidence-Based Practice. The Worksheets walk students through the decision making process, following the sequence of the flowcharts. There are five worksheets posted here: Assessment, Treatment, and three worksheets related to EBP: Asking Searchable Clinical Questions Worksheet; Searching for Evidence Worksheet; and Critical Appraisal Worksheet.

We hope you find these materials and information useful. If you have specific questions about CHARTR, please feel free to contact Rik Lemoncello, MS, CCC/SLP at rlemonce@uoregon.edu.