evidenced based practice: assessment and treatment Flashcards
what is a multidisciplinary team
team members represent different disciplines, each member conducts their own eval and write separate reports. There is little interaction
what is a transdisciplinary team
multiple specialists work together in the initial assessment but only one or two provide services
what is an interdisciplinary team
tem members from multiple disciplines collaborate write an evaluation and intervention plan
what percentage of a sample will have scores within 1 standard deviation
68%
what are percentile ranks
show the percentage of subjects who scores at or below a specific raw score.
what does a score at the 25th percentile mean
75% scored better
why are SLPs turning to functional assessment
reimbursers are requiring documentation of functional outcomes of treatment
how does a clinician target functional communication during as assessment
- observe client with amily and peers
- arrange a child-caretaker interaction
- arrange for peer interactions
- talk with 2 or 3 peers about how the child interacts
- observe in classroom, cafeteria, playground with
peers - observe patient interaction with health care providers and family while assessing in medical settings
- emphasize conversational interaction. Do no make clinical judgments based solely on imitative or picture naming
- observe and record conversation in naturalistic situation
- create meaningful tasks
- use sentences that include names of family members, activities the client enjoys
- document variations in the disorder in natural settings
- examine the effect the client produces when he or she attempts to communicate
what are client specific assessments
alternative to standardized test
- generate data that are helpful in developing client specific treatment
- evoke speech-language samples over time by use of culturally appropriate client specific materials instead of standard stimuli
how do you establish a baseline for client specific assessment
establish baselines of targeted behaviors just before they are taught
what is criterion referenced assessment
performance is evaluated against a standard of performance called a criterion
- may be helpful when the norms of standardized tests do not apply to a particular client.
- they allow for more in depth evaluation of the patient
what is authentic assessment
speech and language samples in everyday settings
what is minimal competency core
a variation of authentic assessment
it takes age and specific context into account
the least amount of skill a typical speaker is expected to display
what is contrastive analysis
used to establish whether a speech pattern is part of a speaker’s cultural background or is a disorder
2. requiresknowledge of dialect
what is dynamic assessment
evaluates a child/s ability to earn when provided with istruction
- test-teach-retest
- demonstrates the modifiability of deficient skills
describe a comprehensive and integrated assessment
- clinician retains necessary elements of the traditional approach (cases history, interview, language sample, orofacial exam, and hearing screening)
- standardized tests may be used
- clinician uses a client-specific stimulus material, sample communication in natural settings, and evaluate each skill in depth
- targets are functional and meaningful
- clinician may expand data to include reading and writing samples, copies of academic records, reports from teacher or other professionals, video of conversation with others
what is the directmethod of response reduction
reducing behaviors by immediately providing a corrective feedback
what are discrete trials
each opportunity to produce a response is counted separately. They are more efficient in establishing target behaviors but are less efficient than naturalistic methods
what is escape
a behavior that reduces or terminates an aversive event after having come in contact with that event
what is an evoked trial
no modeling is given. Pictures, questions and other stimuli are used to provoke a response. Evoked trials follow modeled trails
what is an exemplay
specific target response that illustrates a broader target behavior. Individual items trained in therapy sessions: /s/ is an exemplar of the word soup
what is extinction
withholding reinforcers to reduce a response: appropriate in reducing behaviors as crying
what is fading
when the controlling power of a stimulus is gradually reduced while the response is maintained (making modeling less and less audible to client until withdrawn)
what are functional outcomes
effects of treatment that are generalized and personally meaningful to clients. They are qualitative. Related to quality of life
what are indirect methods of response reduction
reducing undesirable behaviors by positively reinforcing and thus increasing desirable behaviors
what are probes
procedures to assess generalized production of responses without reinforcing them. Involve a criterion to be met before shifting training to a more complex level
what are prompts
additional verbal or nonverbal that increase the probability of a target response (the word start with a t…)
what is punishment
reducing undesirable behaviors by withdrawal of stimuli. Includes corrective feedback, time-out and response cost
what is response cost
reducing responses by withdrawing reinforcers contingent on each response (take token away for every incorrect production)
what is shaping
a method of teaching nonexistent responses that are not even imitated. The target response is broken down into initial, intermediate, and terminal components and those are taught in an ascending sequence
what is time out
a brief period of silence, inactivity, averted eye contact, and lack of reinforcement imposed on a response to be reduced (cancellation)
what is continuous reinforcement
all correct responses are reinforced
what is intermittent reinforcement
reinforcing some responses and not others
what is differential reinforcement
teaching the client to give different responses to different stimuli (plural response to plural stimuli)
what is differential reinforcement of alternative behaviors
reinforcing a desirable behavior as an alternative to an undesirable one. (teaching a child to verbally request instead of whining)
what is differential reinforcement of low rates of responding
decreasing undesirable behavior gradually by reinforcing progressively lower frequencies of that behavior (reinforcing a child for asking fewer interfering questions during treatment)
what is differential reinforcement of incompatable behaviors
reinforcing a desirable behavior that cannot coexist with an undesirable behavior
what is differential reinforcement of other behaviors
specifying one behavior that will not be reinforced while reinforcing many unspecified desirable behaviors
what is an automatic reinforcer
sensory consequence of a behavior that reinforce that behavior (sensation for autistic kid who bangs their head against the wall)
what is backup reinforcer
given at end of treatment in exchange for tokens earned in session
what is a conditioned generalized reinforcer
reinforcer whose effect does not depend on motivational state of the client
what are secondary reinforcers
praise, smiles, and approval that strengthen response because of past experience
what are negative reinforcers
events that are aversive and reinforce a response that terminates, avoids, or postpones them
what are positive reinforcers
events that follow a response and strengthen them
what are primary reinforcers
effects that do not depend on past learning or conditioning.
Biologically determined because of survival value
useful in teaching infants, and toddlers with severe ID
response to verbal mands
what is the normative strategy for treatment
age-based norms that dictate the selection of speech and language targets.
what is the client specific strategy for treatment
behaviors that improve communication and meet the social, academic, and other demands made on the clinet will be targeted
what is the functional communication strategy
target behaviors are selected that are the most useful to enhance demands of daily living
what is the integrated approach to target behavior selection
targets are appropriate or the client’s age, ethnocultural background, individual uniqueness, and communication requirements
places more emphasis on the client and less on age-appropriateness
that is the treatment sequence
1 response complexity: starts at simple level and grows more complex
- degree of structure: treatment is more structured in initial stages
- response modes: starts with imitation of modeled: modeling then withdrawn; progresses to spontaneous production in less structured environment
- multiple targets: multiple phonemes may be taught in a certain sequence; gentle onset and airflow management and slow speech for fluency
- training and maintenance:
- shifts in treatment contingencies: initially client reinforced for every correct response. Schedule changes to intermittent
how do you increase maintenance
- select targets that are more likely to be produced in natural settings
- use a variety of stimuli
- give sufficient treatment with varied exemplars
- before dismissal, reinforce the skills in naturalistic conversation
- teach self-monitoring
- fade initial continuous reinforcement to intermittent and last use only social reinforcers
- teach family members to stimulate, prompt, and reinforce correct responses
- teach the client to prime others for reinforcement
- follow up with booster treatment if needed
what is the procedure for follow up treatment
- record extended conversation to analyze continued production of treated behaviors
- determine a follow up schedule
what is a follow up schedule timeline
first follow up at 3 months
second at 6 months
third at 1 year
subsequent assessments as necessary
what is a booster treatment
treatment offered any time after initial dismissal
may be identical to the original treatment
may be a modified version
may be a different form know to be more effective
may be much less extended
what are the 7 steps of all treatment programs
- select functional targets. Select short and long term goals. Make these objective, measurable, functional, and ethnoculturally relevant
- establish baselines
- plan a comprehensive treatment that specifies what the client will be required to do, what the clinician will do
- imprelemtn program wile managing behavioral contingencies that decrease undesirable responses
- implement a maintenance program. Teach client to self monitor and train key people. Arrange for booster
- follow up with client to assess maintenance over time
- conduct booster treatment if necessary
