Ch. 11: Assessment & Treatment: Principles of Evidence-Based Practice Flashcards
Evidence Based Practice
Form of practice that ensures that clients receive services that are known to be based on reliable and valid research and sound clinical judgment.
Screening
A brief procedure that helps determine whether a client should undergo further, more detailed assessment.
Case History
Yields detailed information that helps the clinician understand the client and his or her communication disorder and associated variables. Involves gathering information about the client’s family, health, education, occupation, and other variables such as cultural and linguistic factors. Emphasis depends on the age of the client and the nature of the disorder.
Prognosis
A professional judgment made about the future course of a disorder or disease. It is a predictive statement about what might happen under various future circumstances.
Factors Influencing Prognosis
- Severity of the disorder
- Client’s general health
- The physiological course of an underlying disease
- Time of intervention
- Quantity, quality, and intensity of treatment offered
- Consistency with which treatment is received
- Family support for the client and participation in the treatment process
- Client’s motivation to work hard in treatment and outside the treatment setting
- Social reinforcement for maintaining gains made in treatment
- Client and family’s religious and cultural beliefs about the necessity for and efficacy of treatment
Hearing Screening
A quick procedure to determine whether a client can be assumed to have normal hearing or needs to be more thoroughly evaluated by an audiologist.
Orofacial Examination
An evaluation of the oral and facial structures to identify or rule out obvious structural abnormalities that affect speech production, and therefore, may require medical attention or affect communication treatment.
Interview
Involves a face-to-face exchange with the client, family members, or both to obtain additional information given on the printed case history form. Can be used to obtain data or information, to inform the clients and their families, and to provide support. Should include:
- Orienting the interviewees to the nature of the interview
- Explaining why certain information is requested
- Not making the client feel rushed
- Listening
- Using appropriate verbal and nonverbal communication
- Assuring the client of (and maintaining) confidentiality
Rapport
Respect, trust, and a harmonious relationship between the clinician and the family. Also involves recognizing and accounting for cultural and linguistic variables that might influence the interview.
Speech and Language Sample
The primary means of assessing a client’s speech and language production. Many clinicians record the sample for further listening, and some clinicians videotape the sample. More naturalistic than standardized tests. Goal is to obtain a representative sample of the client’s speech-language production in naturalistic contexts that reflect the client’s everyday communication.
Multidisciplinary Teams
Team members represent multiple disciplines, but each member conducts his or her individual evaluation, writes a separate report, and has little interaction with other team members.
Transdisciplinary Teams
Multiple specialists work together in the initial assessment, but only one or two team members provide services.
Interdisciplinary Team
Team members from multiple disciplines interact and use each other’s suggestions and information in interpreting data. The team collaboratively writes the evaluation report and intervention plan.
Standardized Test
A test that is systematic. Has explicit directions and strict controls about what the examiner must say and do. Specific stimuli are used, and there are explicit rules for scoring the test. The goal is to ensure that the behaviors being measured are not influenced by the examiner’s biases. Administration should be uniform across all examiners. Results yield quantitative information, allowing the client’s performance to be compared to peer performance that was sampled in the standardization process. A test can be standardized without being norm-referenced. Limitations include inadequate and non-diverse sampling.
Norm-Referenced Test
Purpose of this kind of test is to compare the individual client’s score to the average score of the normative group. This allows the clinician to determine if the client has a problem, if the problem is clinically significant, and whether the problem warrants intervention. The authors select tasks that they believe are valid in measuring certain behaviors and administer those tasks to groups of subjects who are thought to be representative of the population. The performance of the large sample is analyzed, resulting in normative data for specific age groups.
Norms
Represent the average performance of a typical group of people (typically children), sampled at different age levels during the standardization of a test.
Raw Scores
The actual scores earned on a test. Typically converted into a standard score.
Distributions
Yield measures of the client’s performance compared to the performance of the normative sample. Used to compare the client’s performance to that of a normative group.
Standard Deviation
The extent to which scores deviate from the mean or average score. Reflects the variability of all of the scores of the normative sample.
Percentile Ranks
Concerted scores that show the percentage of subjects who scored at or below a specific raw score. Use percentile points to express a client’s score relative to the normal sample. 50th percentile is equivalent to the mean and the median.
Age Equivalency
Scores that show the chronological age for which a raw score is the mean score in the standardization sample.
Functional Assessment
Purpose is to evaluate a client’s day-to-day communication skills in naturalistic, socially meaningful contexts. Does not depend on standardized test scores. Requires the clinician to make targets, procedures, and settings of assessment as naturalistic as possible.
Individualized/Client-Specific Procedures
Procedures that are a preferred alternative to standardized tests. Form a valid basis for developing client-specific treatments. These procedures use the evocation of speech-language samples over time, by means of culturally appropriate client-specific materials instead of standard stimuli. Baselines before starting treatment are another valid pretreatment measure of communication skills.
Criterion-Referenced Testing
A form of assessment that minimizes the role of standardized test scores in assessing skills. The performance assessed trough any means—including even standardized tests—is evaluated not against the statistical norms, but against a standard of performance selected by the clinician. This approach gives greater flexibility to the clinician to set the criterion that may be educationally and clinically meaningful, this avoiding a more rigid comparative evaluation against the test norms. Allows for more in-depth evaluation of the client.
Criterion
Standard of performance.
Authentic Assessment
Naturalistic observation of skills. Seeks to sample speech and language skills in everyday settings and thus avoids contrived or formal test situations. Skills are assessed in the context of realistic learning situations and demands. Speech samples collected in classrooms, homes, and other naturalistic settings constitute the primary assessment data.
Minimal Competency Core
The least amount of linguistic skill or knowledge that a typical speaker is expected to display, taking age and specific context into account.
Contrastive Analysis
Appropriate for establishing whether a speech pattern is part of a speaker’s cultural background or is a disorder. Requires a knowledge of the speaker’s dialect and a naturalistic language sample to determine whether the differences found in the sample are disorders or culturally appropriate communication patterns.
Dynamic Assessment
Alternative to standardized test-based assessment. Seeks to evaluate a child’s ability to learn when provided with instruction. Uses a test-teach-retest format. Clients are tested and their skills are measured. Then the children are taught the skills that they did not manifest during testing. Finally, the child is retested to assess how quickly and well he or she learned the material presented. A unique feature is the incorporation of intervention into the assessment process.
Portfolio Assessment
Alternative to standardized test-based approaches. Involves collecting samples of a child’s work or performance over a period of time and observing the growth that occurs when instruction is provided. A client’s portfolio may include samples of drawings, writings, other forms of academic work, videos of conversations with family members or peers, notes from teachers, reports from other specialists, progress notes (relevant to academic performance as well as speech-language treatment), and so forth.
Comprehensive and Integrative Assessment
In this form of assessment, the clinician will retain the necessary elements of the traditional approach (case history, interview, language sample, orofacial examination, and hearing screening). Standardized tests may not be used, but if necessary, the clinician will prudently select ethnoculturally appropriate tests and interpret all test results cautiously. Includes the elements of functional, client-specific, criterion-referenced, authentic, dynamic, and portfolio assessments along with the essential elements of the dynamic approach.
Treatment/
Remediation/
Intervention/
Therapy
Ways of modifying impaired or deficient communication to achieve patterns or normal, functional, or socially more acceptable forms of communication. Follows a comprehensive assessment, which results in a diagnosis of a communication disorder. Teaching, training, any type of remedial or rehabilitative work, and all attempts at helping people by changing their behaviors or teaching new skills. A procedure in which contingent relations between antecedents, responses, and consequences are managed by a clinician to effect desirable changes in communication and swallowing behaviors.
Communication Disorders
Communication behaviors that attract negative attention, create difficulty in interactions, and cause speakers to sound different from other people in their speech communities. Often also create academic, social, and occupational limitations for an individual.
Antecedents/
Treatment Stimuli
Various objects, pictures, instructions, modeling, prompts, and other stimuli the clinician uses to evoke target responses from clients.
Aversive Stimuli
Events people tend to avoid. Events people describe as unpleasant and hence work hard to avoid.
Avoidance
An action that results in not coming in contact with an aversive event and hence is repeated in the future when such contact seems imminent. A behavior exhibited by many clients and needs to be reduced in some cases.
Baselines
Measures response rates in the absence of treatment. The natural rate of a response when nothing special is done to affect its frequency. Baselines help prove that treatment was necessary by establishing that the client did not produce the target behaviors. Also help compare the initial and final response rates under treatment. Part of reliable EBP.
Booster Treatment
Treatment given any time after the client was dismissed from the initial treatment. It is an important maintenance strategy and may involve the original or a new form of treatment.
Constituent Definitions
Definitions of target behaviors in dictionary terms. Defining concepts with the help of other conceptual (not procedural) terms (e.g., language is the mental capacity to communicate). Not helpful in measuring what is being defined in contrast with operational definitions.
Corrective Feedback
Information given to the client on incorrect or unacceptable responses in an effort to decrease those responses (e.g., saying “no” or “wrong” when an incorrect response is given).
Criteria
Guidelines for making such clinical decisions as when to judge whether a response is trained, when to move on to another target, and when to dismiss the client from treatment.
Direct Methods of Response Reduction
Reducing behaviors by immediately providing a corrective feedback (e.g., saying “no” or “that’s not correct” when a client gives a wrong response). Contrasted with indirect methods of response reduction.
Discrete Trials
Treatment methods in which each opportunity to produce a response (e.g., individual words in learning correct articulation; specific sentences) is counted separately. Each opportunity is clearly separated in time (e.g., by pausing for a few seconds after each attempt and scoring each response as correct or incorrect). More efficient in establishing target behaviors but are less efficient that naturalistic methods in promoting generalization.
Escape
A behavior that reduces or terminates an aversive event after having come in contact with that event. A behavior that increases in frequency because it helped to reduce or terminate an aversive event (e.g., a person who stutters may respond to a hostile listener by terminating a conversation). A behavior to be reduced in some clients.
Evoked Trial
Clinical procedure in which no modeling is given. Pictures, questions, and other stimuli are used to provoke a response (e.g., asking the client to name a picture or asking such questions as “Johnny, what is this?” while showing a picture or an object). Follow modeled trials.
Exemplar
A specific target response that illustrates a broader target behavior. Individual items trained in therapy sessions (e.g., the word soup in teaching the /s/ or the phrase two cups in teaching the regular plural inflection is an exemplar).
Extinction
Simply withholding such reinforcers as attention to reduce a response. Appropriate in reducing such behaviors as crying and interfering questioning in treatment.
