midterm Flashcards
1
Q
principle of ethics 1
A
client comes first
2
Q
implied consent
A
person implicitly approves access to their records by staff or support personnel (internet record access)
3
Q
written consent
A
necessary for release of info to individuals or agencies outside the facility (external record access)
4
Q
inherent consent
A
when release of info is in the best interest of the client (sharing suicidal thoughts or abuse)
5
Q
principle of ethics 2
A
be a life long learner
seek and maintain continuing education
6
Q
principle of ethics 3
A
principle of acting without conflict of interest or misrepresentation
7
Q
principle of ethics 4
A
principle of professional relationships
-collaboration with other professionals
8
Q
functional communication
A
person’s ability to communicate despite the presence of impairments
9
Q
functional assessment
A
should ID client’s ability to convey, receive messages, in various modalities, including words, phrases, sentences, gestures, written, spoken, drawing, AAC
10
Q
outcomes
A
changes in performance, as a result of treatment
11
Q
benchmarkers for outcomes
A
- number of treatment sessions
- degree of improvements with functional communication
- degree of improvement in test scores
- degree of improvement in life-satisfaction or life participation
- functional changes on the play ground, classrooms
- increase in intelligibility
12
Q
why measure outcomes?
A
- demonstrate value of our services
- planning ahead for provision of services on a caseload (time, resources, needs)
- anticipate potential for degree of change in functional independence
13
Q
goals of functional assessment
A
- determine how bad the problem is
- determine how much the problem disrupts daily life
- determine what degree of assistance is needed
- determine level at which the skill “maxes” out
- determine expected level of performance within various environments
- establish baseline for which to compare outcomes
14
Q
types of functional assessment
A
- rating scales
- functional tests, multi-modality communication
15
Q
specific purpose for functional rating scales
A
- identify level of severity
- measure outcomes via movement on that scale
- therefore allowing you to determine efficiency of Tx (change over time)
- benchmark progress nationally
- research variables
- necessary for accreditation
- relate impairment to life skills
16
Q
ASHA NOMS
A
- national outcomes measurement system
- developed to illustrate the value of speech-language pathology, audiology services
- rating scale specific to communication disorders
17
Q
maximal cueing
A
- multiple cues
- may be a combination of modalities
18
Q
moderate cueing
A
- still need combination of cueing modalities
- some of these may be “intrusive”
19
Q
minimal cueing
A
-subtle cues; only one modality/ type of cue
20
Q
support
A
the structure, environmental modifications or accommodations, that are required to assist a person in becoming functional and independent in variety of situations
21
Q
support examples
A
- allowing additional processing time
- re-reading info
- providing receptions
- probing questions
22
Q
demand
A
- the type of communication demand placed on the child
- the educational, social, work or activity in which the person is engaged
- varies according to age or level of education/training/vocation
23
Q
low degree of demand
A
- requires skills masters at a younger age
- minimal environmental “noise” or “distraction”
- pragmatic context in inherently supportive, predicatable
- support is provided by the SLP
24
Q
high degree of demand
A
- requires skills more recently acquired
- may require communicating over competing noise
- pragmatic context is vague, unfamiliar
- the child is on the playground without the SLP
25
target behavior
- the skill, action, behavior, response, ability, insight, capacity that you want to teach
- the "do" statement
26
treatment plans vs therapy plans
treatment plans= for the whole semester
| therapy plan= day to day or week to week
27
normative approach
- compare the client to developmental norms
- often used with artic, lang diagnoses
- what is expected to occur next?
- what should have already occurred?
28
client-specfic approach
- when developmental norm approach is irrelevant
- adult, acquired, brain damage, cancer, disease process
- select targets based on prognosis, course of the disease
- select targets that are culturally and linguistically appropriate
- consider their occupation
29
why prioritize target behaviors?
- to achieve an end-goal that might be comprised of multiple, individual target behaviors
- to sequence, shape, develop, or transition performance over time
- to meet the current needs of the client, based on his/her goals or complications
- avoid overwhelming the client
- isolate individual variables for the purpose of taking and analyzing data
30
criteria to meet when selecting target behaviors
- can make an immediate and socially significant difference in communication
- may build up to a larger goal or outcome
- may be produced and reinforced at home/natural setting
- is culturally and linguistically appropriate to the client or family
- is supported by evidence and theory
- is within your realm of comfort and proficiency as a clinician
31
after you select a target behavior..
- write the target behavior as measurable goals and objectives
- write as a measurable action, to track response to Tx over time
- 2 versions to write: goal and behavioral objective
32
goal
an overall behavior that you plan to achieve in the long term
-long term goal
33
behavioral objective
a more narrow "sub" behavior that you plan to achieve in the short term
- short term goal
- should match up to achieve your goals
- wanting to accomplish this in one therapy session
34
DO statment
action
- verbs that denote observable activity (produce, verbalize, generate, retrieve, write, identify)
- critical so that you know exactly what is or isn't being targeted in Tx
35
CONDITION statment
situation
- must indicate the circumstances in which the behavior will be executed
- critical bc clients may demonstrate mastery of a behavior in one situation and not in another
36
CRITERION statement
how well
- specifies how well the target behavior must be performed for the objective to be achieved
- critical bc you must know when, or if, your target behavior has been achieved
37
pre-treatment baselines
-asking the client to do something but not giving them help or specific feedback
38
generalization
- how well the client can apply behaviors in the natural environment
- requires the client to monitor and apply behaviors independently
39
therapeutic process
collect baseline --> write LTG and STG (take data, analyze data, advance goals) --> transition and generalize to natural settings
40
EBP
-a term that our discipline has borrowed from medicine where it is referred to as EBP
41
EBP involves
- clinical experience
- best available evidence
- client/family input
42
what is meant by EBP?
-integration of best research evidence with a clinical expertise and patient values
43
underlying concept of EBP
clinicians should rely on well-designed empirical research when selecting treatment procedures
-formal approach
44
step one of EBP
pose an answerable question
45
popular format used to frame an EBP question
PICO - population, intervention, comparison, outcome
46
step 2 EBP
search for the best evidence
47
step 3 of EBP
critically evaluate the evidence for its validity and relevance
48
level 1 of EBP
best evidence you can be looking for
49
level 2 of EBP
we aren't controlling variable; the research isn't really controlling the independent variable
50
level 3 of EBP
case studies (small groups)
51
level 4 of EBP
textbook info, comes with clinical experience, have to have data to support your clinical experience
52
step 4 of EBP
- integrate the best evidence with clinical experience and the clients values
- making adjustments to therapeutic techniques so that benefits are optimized for a given individual's circumstances
- the client and the family have to buy in to what you are doing
53
step 5 of EBP
implement clinical decision
- gather the data to document the outcomes
- am i making progress?
54
step 6 of EBP
evaluate performance after acting on the evidence
- "choose measures to monitor outcomes and then adjust decisions if the intended effects are not observed"
- do i keep using it or do i change
55
EBP challenges
- discount the opinions of expert authorities when those opinions are contradicted by scientific evidence
- focus on a small portion of research that is directly relevant to decisions about practice
- judge the quality by analyzing: validity, importance and precision
56
treatment is
- an agent of change
| - rearranging communicative relations between speakers and listeners
57
method section includes..
techniques, renforcement, and stimuli
58
basic methods of treatment
- evoke communicative behaviors
- create nonexistent communicative behaviors
- increase existing behaviors
- strengthen and sustain behaviors (carryover)
- control undesirable behaviors
59
physical stimuli
- pictures, objects, toys
| - discontinue use of pictures ASAP
60
instructions
- select target behavior
- analyze target behavior
- determine how to elicit the target behavior
- write out instructions
- instruct at client's level
- deliver in natural manner
- repeat as necessary
- provide new instructions when target behavior is changed
61
modeling
- clinician's production of the clients target response (direct model)
- imitation is the response of the client
- indirect model= providing specific behavior frequently to expose a client to numerous well-formed examples of target behavior
- reducing stimulus as client becomes more successful = fading
62
effective modeling
- ROT 5 consecutive correct responses until you start to fade away
- reinstate modeling when 2-4 wrong responses are given
- model new targets
- model some targets when moving to higher level
- reinforce
63
prompts
- often a partial stimulus
- can be nonverbal - silent, gestural
- perfer subtle and short over loud and lengthy
- prompt more frequently in the beginning
- fade prompts as client becomes successful
- teach prompts to family
64
shaping
- may be necessary if client is unable to imitate
- successive approximations to reach the target response
- manual guidance = physical assistance in shaping response
65
effective shaping
select final target behavior
- analyze the behavior
- determine what client can imitate
- teach more complex responses
- use instruction, modeling and manual guidance as needed
- reinforce
- fade
66
reinforcment
used to strengthen the frequency of newly established responses
67
postive reinforcers
increase the frequency of responses
68
primary reinforcers
increase the response rate bc of their biological value (food)
69
social or conditional reinforcers
natural reinforcers (smile)
70
feedback
the information given back to the client
71
data collection
-the primary mechanism for accountability
72
what are we accountable for?
- efficiency of therapy
- effectiveness of therapy
- use of resources (time, money, effort)
73
2 important functions of data collection
- monitor client's progress from one session to the next
| - document efficacy of a given treatment strategy
74
ways to measure data
- appropriate data recording sheets
| - notation system (yes/no, continuum, time demonstrated)
75
treatment sequence
- assessment
- select target behaviors; write objectives
- establish baseline performance of those behaviors
- initiate treatment
- collect data; analyze; re-evaluate
- move treatment forward
- repeat
- analyze and dismiss when appropriate
76
probes
repeated baseline tests in the middle of therapy
-a given oppurtunity to let the client demonstrate how well they independently use the target response in other situations
77
what do we take baseline data on
- each communicative behavior
| - in each situation you intend to treat
78
target response
the production given at each proffered stimulus
| -an individual response
79
target behavior
the correct production of the target in varied contexts or situations
- outside of specific training or stimulus presentations
- collection of responses
80
when is a target response trained?
when the client gives 10 consecutively correct, non-imitated responses to a selected exemplar
81
when is a target BEHAVIOR trained?
when 90% of productions are correct during probe trails
82
topographical shift
- move from one level of behavior to the next
- there is a sequence of levels leading up ti the ultimate level
- ultimate goal is the most complex form of the target behavior
- shift when behavior meets "probe criterion"
83
periodic basis reports
- final semester report
- yearly eval
- discharge report
84
1:1 basis reports
- SOAP notes
- computer-entry notations
- progress notes
85
purpose of daily progress notes
- allow you to monitor Tx plan, in order to make any necessary changes ASAP
- provides daily snapshot to other professionals working with client
- when you don't write it down, it didn't happen- HAVE TO DOCUMENT
86
S
- subjective
- complaints as phrased by patient
- your personal opinion relevant to client behavior or status
87
O
- objective
- events which occurred in session
- data taken in session for each targeted behavior
- types of assistance/instruction/[rompting
88
A
professional interpretations, conclusions
| diagnosis/severity/ functional implications
89
P
treatment plan
| recommendations
