Chapter 2 HH Flashcards
Overall objective of SLP services
optimize individuals’ ability to communicate and/or swallow (ASHA 2001)
ASHA’s Mission
”to promote the interest of and provide the highest quality services for professionals in audiology, speech-language pathology, and speech and hearing science, and to advocate for people with communicative disabilities”
Professional Ethics
- The profession is firmly grounded on principles of professional ethics.
- Those entering the profession are encouraged to embrace concepts of professional ethics and to emulate those ethics during training and in all aspects of professional endeavors, thereafter
- If you don’t do this you lose your certification
The Therapeutic Process Defined
For purposes of speech-language pathology, the therapeutic process is defined as:
- broad-based professional procedures
- activities, and
- interactions with clients designed for the intervention of communication disorders
Helping to correct communicative disorders
Therapeutic process includes
- 4 components
- assessing
- planning
- implementing, and
- evaluating procedures for speech-language therapy services
Basic Confidence and Trust in the Therapeutic Process
Trust – a “firm reliance in the honesty, dependability, strength, or character of something or someone.”
Confidence in the Therapeutic Process
- The SLP must first develop confidence in his/her ability to appropriately serve clients
- The SLP must build/earn the client’s trust in his/her abilities to appropriately serve the client
Increasing the SLP’s Confidence in the Therapeutic Process
- The knowledge and skills required are vast
- The credentialing process is grueling
- Thus a healthy respect for training and practice standards is appropriate for the beginning SLP – it is important to understand that self-confidence in the therapeutic process is essential
SLP Confidence
Professionals need to develop confidence in these areas:
- the information given, the techniques used, and overall directions in which to lead clients – This information MUST be the BEST available
- the outcomes toward which clients are working are valid for the client
Perfection is not a valid outcome for all outcomes, bring them to the highest level of communication
- as professionals, we possess the skills and knowledge to effect those outcomes.
REMEMBER: Time and experience are required to impact levels of confidence in clinical skills across broad- based services.
SLP Confidence- beginning clinicians are encouraged to:
- gather information (make sure it is good information)
- interpret findings by bridging findings with known information, and
- develop conclusions with appropriate rationales early in training and to continue those practices even as seasoned and experienced professionals
Through systematic questioning, hypothesizing, testing, and reaching conclusions, student SLPs begin to –
- understand concepts related to the profession and
- to build confidence in their own skills in determining appropriate directions and arriving at appropriate conclusions for client management
The following activities help foster confidence:
- read client files from the beginning of therapy to dismissal – develop a sense of the “flow” of therapy
- talk to former clients – hear their views on how therapy helped them
- develop a relationship with professionals for observations in the same setting periodically so progress can be seen over time
Building Client Trust 1
- The SLP must also build/earn the client’s trust in his/her abilities to appropriately serve the client
- There are several things the SLP can do to build/earn the client’s confidence in the clinicians’ ability to appropriately serve the client
- Need to show the clients that you are competent
Building Client Trust 2
- Think about and practice a communicative style to introduce yourself
- Practice your handshake
- Practice appropriate business eye contact (“triangle of eye contact”)
- Be sure you are comfortable in appropriate professional clothing for therapy
- Become familiar with the intake data and other information available for each client
- Become familiar with the data and forms you will need to fill out during the session with your client
- Plan well for all aspects of your contact with the client (being prepared puts the client at ease)
- Actually practice the session, and mentally walk through each aspect of the contact with the client
- Determine if contact with caregivers will be possible, and if so, practice interactions and communications with them as well
- Know the payment arrangements for services and be prepared to direct the client or caregiver to the appropriate person(s)
- Practice the therapeutic process as if someone will be taking notes on every aspect of your performance because, essentially, someone is: your client and your supervisor
Increasing the Client’s Trust in the Therapeutic Process
- The practicing SLP should remain cognizant of ASHA’s Code of Ethics and the approved standards of the profession-
- Share these standards with the client as a way of helping the client establish trust in the SLP and in the communication disorder profession as a whole
- SLPs may also choose to highlight various federal and state laws that impact services to clients
- In the school setting, IEP meetings
The Therapeutic Relationship
- Stone (1992) found that well-functioning relationships are characterized by “open communication and a respect for different beliefs and feelings.
- Roles and rules are clear, flexible, and appropriate to the participants’ abilities and needs.”
Stone identified six concepts regarding therapeutic relationships:
- Participants in a relationship are interdependent
- Interaction patterns are shaped and sustained by all participants in a relationship
- Relationships have rules based on patterns of behavior and expected roles
- Rule violation and change are stressful in an established relationship
- People in a relationship communicate about the nature of the relationship as well as about actions and events
You let children take over, therapy stops. Clients will test you
- Relationships interact with larger systems and are affected by these systems
- SLPs must acknowledge that the therapeutic relationship is dependent on the quality of interpersonal and intrapersonal communications exhibited by group members
When communications among and between group members become problematic
- it is the SLP’s responsibility to assess and redirect the dynamics of the communication
- in order to provide effective therapeutic interaction for the benefit of all clients
- Behavior intervention or management is occasionally required to establish effective therapeutic interactions
- The SLP must remember that the primary reason for addressing the dynamics of the therapeutic relationship is to maximize progress in therapy (Communication!)
Referrals to Other Professionals
- medical
- educational
- psychological
- Speech-language therapy may not be progressing as expected, and the SLP must explore causes for lack of appropriate progress
- The client’s progress may be proceeding as expected,
- but it is simply time to add or explore the possibilities of addressing related issues that were previously identified,
- but were not addressed due to the more pressing communication needs
Referrals:Shipley & McAfee (2005) developed a referral form consisting of the following elements –
- Title of the form
- Demographic information for the client
- Salutation to the receiving professional
- Indication of when and why the SLP evaluated the client
- Status of the client’s skills during assessment
- Findings of the SLP assessment
- Indication of prior intervention efforts
- Request for professional evaluation of the client by the receiving professional
- Enclosure of the form the SLP would like the receiving professional to complete
- Instructions for returning the enclosed form to the referring SLP
- Closing not of appreciation to the receiving professional
- Signature, address, and telephone lines for the referring SLP
