Section 2

Question 1

What are the three levels of prevention of communication disorders?

Answer 1

Primary
Secondary
Tertiary

Question 2

Describe primary prevention and provide at least two examples.

Answer 2

The elimination or inhibition of the onset and development of a disorder by altering susceptibility or reducing exposure for susceptible individuals

Reduces the incident of the disorder

Ex. Inoculation to prevent Rubella
Proper health and medical care
Prenatal care
Education on impacts of drugs/alcohol/smoking on fetal development

Question 3

Describe secondary prevention and provide at least two examples.

Answer 3

Early detection and treatment are used to eliminate the disorder or retard its progress, thereby preventing further complications

Ex. Newborn hearing screening to detect hearing loss and provide early amplification or cochlear implantation
Kindergarten/Preschool speech/language screening

Question 4

Describe tertiary prevention and provide at least two examples.

Answer 4

Intervention is used to reduce a disability by attempting to restore effective functioning

ex. Providing rehabilitation and special education services to a child with down syndrome
Ongoing support as disability persists

Question 5

What are some risk factors for language disorders in infancy?

Answer 5

Low birth weight
SES
Alcohol/drugs
Premature birth
Genetic and congenital conditions
Prenatal factors

Question 6

What variables impact children’s language development in low SES families?

Answer 6

Parents lower education levels
Parents decreased financial resources
Parent’s decreased emotional resources due to stress

Question 7

What are some potential psychological and physical effects of poverty and homelessness?

Answer 7

Malnutrition (-> difficulty learning, hard to concentrate)
Illness (-> lost days of school and potential hearing loss with middle ear infections)
Hearing and vision problems
Housing problems (e.g., frequent moving, no safe place to play outdoors)
Neighborhood problems
Family stress (increased cortisol-> negative impact on working memory, behavior, attention)
Fewer learning resources
Lack of cognitive and linguistic stimulation

Question 8

What are some possible or required therapy goals for at-risk children in poverty?

Answer 8

Parent attachment and emotional responsiveness
Increased exposure to language to build expressive and receptive vocabulary
Increased exposure to abstract language, verbal elaboration, problem solving
Pre-literacy and phonological awareness (*mother’s education level is the highest predictor of SES)
Exposure to academic talk and the hidden curriculum

Question 9

What are some genetically associated language disorders?

Answer 9

Fragile X
(some) Parkinson’s
(some) Alzhiemer’s
(some) Frontotemporal Dementia
(some) Childhood Apraxia of Speech 
(some) Stuttering that doesn’t respond to intensive therapy 
Usher Syndrome 
Huntington’s

Question 10

What are some language disorders that have family history links but no identified gene?

Answer 10

Stuttering
Late-Talker
Hearing Loss
Cleft Lip and Palate
Developmental Disabilities 
Autism
ADHD
Dyslexia

Question 11

What is the two/too rule for genetic testing referral?

Answer 11

When describing a patient or family history with words like “two” or too
Too tall/short, too many, too young/old
Two congenital anomalies
Two (or more) family members/generations affected

Question 12

What are the different developmental domains?

Answer 12

Physical - fine and gross motor
Emotional- emotional identification and self-regulation
Social- separation anxiety, play styles, trust, learning social norms and acting according to them, attachment
Communication- reciprocal communication, speech goals, etc -communicating out, and also understanding those around you
Cognitive -theory of mind, executive functioning, memory, problem solving

Question 13

How is communication impacted by the developmental domains?

Answer 13

Physical - developing motor skills for speech/sign including breathing
Emotional- emotions overriding communication skills
Socially - communication requires turn-taking, learning what not to communicate, correct communication level or topic for conversation partner
Cognitive -comprehension difficulties impact communication

Question 14

How does development in the different domains effect each other?

Answer 14

They’re developing all domains at the same time not one at a time
Skill deficits in one area can lead to difficulties in skills in another area i.e. poor gross motor postural control can lead to poor breath support for speech
Activity limitations due to other developmental domains may impact access to experiences, and related vocabulary development

Question 15

What can influence childhood development?

Answer 15

Environment- input - activities they get to participate in, experiences they are given, what is praised and encouraged or discouraged by important adults
Cultural norms around children’s speech
Genetics
Development of “prerequisite” skills in that area

Question 16

What are the principles of assessment?

Answer 16

Assessment with a purpose
Assessments can only tell you what the child can do in that environment, in that moment, on that day.
Assessments don’t give a whole picture, or take into account personal goals and choices

Question 17

What are the different procedural elements of an assessment in children?

Answer 17

Assessment of the identified areas of concern using appropriate standardize and/or non-standardized procedures
Observation of areas of communication function - may be formal or informal and indicate the need for formal at a later date
Methodology based on sound professional judgement
Obtain case history that provides sufficient background information– will vary depending on the age of child, environment and type of assessment
Review medical, educational, auditory, visual, fine/gross motor and/or cognitive status as assessed by other professionals as available
Child and family-centred approach addressing all appropriate communication contexts
Caregiver counselling to address nature of communication or related delay/disorder and its impact, recommended follow-up plan and possible outcomes of the procedure

Question 18

What are the different procedural elements of assessment in adults?

Answer 18

Assessment must be sufficient to make recommendations for follow-up or indicate that no follow-up is required
include chosen communication mode and linguistic system
Use current and appropriate materials and approaches
Report results to the adult and/or SD
Based on: case history information, standardized assessment protocols, and informed professional judgement
Include identified areas of concerns
Patient/family centred
Include counselling
Outcomes of assessment must include a description of strengths and needs and/or recommendations for follow-up and rationale

Question 19

What case history information should you make sure to include for a late talker and ASD?

Answer 19

Family history
Access to peers
Family and cultural communication styles and values
Other developmental milestones

Question 20

What case history information should you make sure to include for a child with literacy delays/disorder?

Answer 20

Family history
Literacy exposure history
Other language development history
Other developmental milestones

Question 21

What case history information should you make sure to include for a child with a speech sound disorder?

Answer 21

Family history
Speech//Language models
Other language development history
Hearing
Other developmental milestones

Question 22

What case history information should you make sure to include for a child with fluency issues?

Answer 22

Family history
Other language development history
Other developmental milestones

Question 23

What case history information should you make sure to include for a child with voice issues?

Answer 23

Family history
Other language/behaviour development history
Other developmental milestones
Environmental factors 
Medical factors

Question 24

What case history information should you make sure to include for an adult with dysphagia?

Answer 24

Medical history
Medications
Environment
Time since onset
Acute/Chronic

Question 25

What case history information should you make sure to include for an adult with voice issues?

Answer 25

Family history
Medical history
Medications
Environment
Time since onset
Acute/Chronic

Question 26

What case history information should you make sure to include for an adult with aphasia?

Answer 26

Pre-morbid speech/language/swallowing
Other complications of trauma
Medical history, medications

Question 27

What case history information should you make sure to include for an adult with dysarthria?

Answer 27

Pre-morbid speech/language/swallowing
Other complications of trauma
Medical history, medications

Question 28

What case history information should you make sure to include for an adult with ABI?

Answer 28

Pre-morbid speech/language/swallowing

Question 29

List the advantages, disadvantages, and limitations of standardized assessments.

Answer 29

Advantage: Can provide clear evidence of disorder
Scores can be used to justify services
Disadvantages: Requires assessor to administer same items in the same way
Limitations: Most are not culturally sensitive
Require translation from test scores to real world implications

Question 30

List the advantages, disadvantages, and limitations of non-standardized assessments.

Answer 30

Advantage: Often more “real life” and “functional”
Can be specifically tailored to your clients expressed needs, interests, and environments
Can provide more information about more communication/swallowing environments
Disadvantage:In settings where a score is needed to justify services, these may not cut it.
Limitations: May not cue to presence of less expected difficulties the way standardized tests can, more difficult to analyze for patterns
Ex. CAPE-V, Rosetti, OASES

Question 31

Compare norm and criterion referenced assessments.

Answer 31

Norm: translate a raw score on a test into standard scores, percentiles and age or grade equivalents - where in the “normal” population does this client fall? i.e., PLS-5, CELF-5, REEL-4
Criterion: Determine what items on a list a client can do, that they are expected to do by a certain age or within a certain ability. I.e. Rosetti, Cognitive Linguistic Quick Test (CLQT)

Question 32

Define Basal, ceiling, raw score, standard score, and percentile in reference to assessment.

Answer 32

Basal: The number of questions in a row correct you need to be able to assume everything question that precedes it that you didn’t ask was correct
Ceiling: The number of questions in a row the client must get wrong to end testing
Raw Score: Number of items correct or incorrect
Standard Score: raw score converted so that 50th percentile, or mean is a score of 100
Percentile: how the score compares to same-age peers - 50th is mean.

Question 33

What is the circle of care?

Answer 33

The circle of care (not a defined term under PHIPA), that allows for assumed implied consent when collecting, using, or disclosing personal health information for the purpose of providing, or assisting in providing health care.
With respect to physicians office examples include: physician, nurse, specialists or other healthcare practitioner referred by the physician and any other health care practitioner selected by the patient such as pharmacist or physiotherapist
In hospital context: attending physician, health care team, residents, nurses, clinical clerks, employees assigned to patients who have responsibility of providing care to the individual or assisting in that care.
Doe not include: healthcare providers who are not part of the direct or follow-up treatment of an individual, and insurance companies

Question 34

What are CASLPOs guidelines for SLPs working in schools?

Answer 34

Informed consent must be obtained from a parent prior to disclosure of information regarding students between team members and must be informed of the purpose of sharing information i.e. assessment results with teacher, language goals with multidisciplinary school team, and give consent to the information sharing at a team meeting or conference.
The SLP:
Cannot “just listen quickly” to a child who is not on your caseload, anything that may constitute screening
Cannot discuss a student not yet referred to you at a school team meeting without prior consent
Require consent to refer to other SLPs outside the board, information sharing after referral between SLPs is considered circle of care, however it is prudent to include consent for this in initial referral consent conversation
If parent gives teacher private SLP report, teacher can share report with school SLP without consent -reasonably assume the parent wanted all at the board to have it

Question 35

Provide the general scope of an OT and what some indicators for referrals might be.

Answer 35

Supporting individuals in activities of daily living including personally meaningful activities such as work and leisure. Often very functionally based.

Pediatrics: fine motor, sensory, self-feeding, self-regulation

Adults: fine motor, daily living skills, return to work, return to driving, pacing, fatigue management/energy conservation, environmental modifications

Question 36

Provide the general scope of a PT and what some indicators for referrals might be.

Answer 36

Rehabilitation of gross motor function

Pediatrics: balance, gait, difficulties with gross motor activities

Adults: balance, gait, difficulties with gross motor activities

Question 37

Provide the general scope of an audiologist and what some indicators for referrals might be.

Answer 37

Hearing testing, hearing aids, cochlear implants, aural rehabilitation

Pediatrics: language and/or attention concerns with no known underlying cause

Adults: family or self report of difficulties with attention and/or responsiveness

Question 38

Provide the general scope of a psychologist and what some indicators for referrals might be.

Answer 38

Mental health professional- does not prescribe medication can perform:
Psychoeducational assessment
Neuropsychological assessment
Assessments for mental health conditions

Psychoeducational assessment: indicators of developmental disability, learning disability and need for confirmation to access supports in school

Neuropsych: understand cognitive implications of ABI, often for funding purposes

Question 39

Provide the general scope of a developmental paediatrician and what some indicators for referrals might be.

Answer 39

Assess for, and diagnose, autism, adhd
Provide developmental disorder specific care and support

Indicators for autism, adhd, learning disability, genetic condition

Question 40

Provide the general scope of a genetic counsellor and what some indicators for referrals might be.

Answer 40

Support families with genetic diagnoses, support families with decisions regarding more children, if others should be tested as carriers etc

Indicators for genetic conditions including: huntingtons, hearing loss, fragile x, down syndrome

Question 41

Provide the general scope of a social worker and what some indicators for referrals might be.

Answer 41

Social support professionals -often involved in connecting clients to other professionals and acting in a case manager and facilitator role. Can also be involved in mental health care.

Family and/or individual reports emotional distress or fatigue, and/or need to access other services outside scope of SLP

Question 42

Describe the pheonix theory of family attendance.

Answer 42

6 aspects
A - Family composition (the family vehicle): number of adults who contribute to care, the parents’ age, and the number of children in the family.
B - Health complexity (working condition): accumulated child, sibling, and parent physical and mental health.
C - Service complexity (the road): number of organizations and professionals.
D - Process of attendance, participation, and engagement (parent gears): skills, feelings, knowledge, values and beliefs, logistics, parent-professional relationship.
E - Factors that affect the process (grease and grit): child, parent, professional, or organizational factors that affect gears.
F - destination (child health and happiness)

Question 43

Define and compare direct vs. indirect intervention. Provide examples for each.

Answer 43

Direct intervention: The SLP is eliciting specific targets from a child/client/patient. Aims/targets are written for the child
Examples: Articulation therapy, apraxia therapy with PROMPT, VNEST (aphasia) Semantic Feature mapping (aphasia)

Indirect intervention: The SLP works with communication partners and trains them to change their strategies to elicit more from the child/client/patient including typically by changing their communication to facilitate child’s communication. Aims/targets are written for the parent
Examples: Hanen, Communication Partner Training, Supported Conversation Training, Lidcombe, Palin, Play Project

Question 44

What are the key elements of goals?

Answer 44

Specific, observable, achievable, motivating behaviour
Context defined (setting, partner, novel/familiar stimuli, language level, etc.)
Measurement specified and with what level of cuing

Question 45

What are the different types of goals?

Answer 45

Process focused -a habit or means to an end, i.e. Joey will refer to the grocery list on his phone 3 times on a grocery shopping trip
OR
Product focused -the end i.e. Joey will independently purchase 90% of his grocery list.

Question 46

Describe GAS goals.

Answer 46

Goal attainment scaling. 
Jointly discussed and agreed upon with clinician and client 5 point rating scale of objective, concrete definitive behaviours associated with each level. 
-2: worst possible/much less than now
 -1: now
0: achieved
1: better than expected 
2: much better than expected

Question 47

Describe the process to writing a GAS goal.

Answer 47

Identify the focus of treatment (AIMS)
Translate the focus into 2–4 goals (TARGETS)
Label each goal using a strong action verb (i.e., “increase # of acquaintances in social network”)
Select an indicator for each goal (i.e., the specific behavior that will be used to measure progress)
Set the expected outcome using indicator (i.e., must be a realistic outcome given the client, context, and duration of treatment)
Set somewhat more and somewhat less outcome levels, based on the expected outcome
Set the much more and much less outcome levels, based on the expected outcome.

Question 48

Describe SMART goals.

Answer 48

Specific
Measurable
Attainable 
Relevant
Time-Based 

Examples:
Johnny will accurately complete two-step directions with no more than one verbal or visual prompt/cue with 80% accuracy or better over three consecutive sessions.

Question 49

What do you do if a client’s goals don’t match reality?

Answer 49

We never really know what clinical reality is → might think there’s no chance someone can do it, or somebody can’t do it, and you could be totally wrong
definition of clinical reality changes with experience

Educate in a gentle way over time, they have assessment results etc

Component skills → wants to be a pilot? what are all the skills you need to be a pilot?
steps along the way → want to go back to being a prof? what is the first thing you need to do? and next?

Need to keep breaking the component skills down until you can think “in a half hour session, can I work on this?” -then you’ll have a decent target –if you can design a task to work on a target in the session

Question 50

When might you discharge someone who still needs services?

Answer 50

Patient or client requests the discontinuation
Alternative services are arranged, or reasonable attempts have been made to arrange alternative services
The patient or client is given a reasonable opportunity to arrange alternative services
Restrictions in length or type of service are imposed by an agency
The patient or client is unwilling or unable to pay and reasonable attempts have been made to arrange alternative services
Discharge criteria are imposed by the employing agency
The member reasonably believes that he or she may be physically or sexually abused by the patient or client and reasonable attempts have been made to arrange alternative services.

Question 51

What are the different types of data collection?

Answer 51

Trial-by-trail: collecting data after each trial and calculating percentage correct
Great for: articulation, or rate of words spoken per minute
Initial cold probe: collect data the first time the target is presented in each session without prompts or teaching and do not collect data for the remainder of the session
Great for: prepositions, word lists with target sounds, labelling vocabulary
Generalized probe data: data is collected outside of the structure teaching (therapy) session, to determine how the performance on trained items generalized to new materials/people/environment
Great for; number of times a learned target phoneme is used with words not previously target in therapy, how accurate client is with novel exemplare of “big” and “little”, social communication goals
Duration: tally number of occurrences of a behaviour within a set time
Great for: WPM, # dysfluencies in a period, conversational turns in a 5 minute conversation
Permanent Product: a tangible product that is used for later analysis i.e. video recording
Great for: rate of speech, intelligibility, frequency of dysfluent speech etc

Question 52

When are you not required to maintain a patient health record?

Answer 52

Another member of a multidisciplinary team who is a member of a professional college maintains the record
Consultative nature to a member of a regulated college

Question 53

What information should a report include outside of performance and goals?

Answer 53

Contact information (client name, address, birthday (+age), phone/email)
*** if a child, who attended the appointment with them or dropped them off/picked up
Date
Referral source and reason for referral
Clinician name, credentials, contact information, and signature at the end
Cc: client, family doctor, referral source, school, etc… at the end of the report

Question 54

What are some things we might look for in a case history?

Answer 54

Past speech therapy
Hearing difficulties
What they hope to get out of therapy?
Occupation
Who they're referred by
Recreational interests
Past medical history
People important to the client.

Question 55

Compare a formal questionnaire to a functional probe.

Answer 55

Formal questionnaire – specific formal questions
Functional probe – informally testing things during play/conversation to based on what parents/others are telling you to guide you in which assessment tool you’ll choose

Question 56

Who should we interview on intake?

Answer 56

Parents and caregivers
Anyone who provides, sees, or manages any aspect of their healthcare (circle of care  family doctor, OT, PT, behavioral therapist, other SLPs, psychologist, social worker, neurologist, case managers, audiologists)
Daycare
School
Family doctor
Relatives

Question 57

What are effective question types for client interviews?

Answer 57

Open-ended (can be elaborated on)
Start broad and open-ended and start to narrow questions
Avoid leading questions (ie. “how does Jonny respond when he’s not understood by his peers” instead of “I imagine Jonny gets very frustrated when he’s not understood by his peers”)
If parent is using a lot of diagnostics terms/ has a guess to why they think they have _____, ask why they think this/ what led them to this conclusion (avoid them leading you down a path and vice versa)

Question 58

What are some topics we might ask about in the parent/clinical interview?

Answer 58

Parent/family perceptions 
Home/environment
Peer relationships and interactions
Relations with parents, family, adults (for children), etc…
Client interests and hobbies
Routine daily activities and self help skills
Learning and thinking skills
Language skills
Speech skills
swallowing/feeding
Behaviour

Question 59

Define diagnosis.

Answer 59

Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis

Question 60

What can SLPs communicate in relation to assessment results?

Answer 60

Members cannot tell patients that they have the following: stroke, autism, otosclerosis, cerebral palsy, ALS, Meniere’s Disease, Parkinson’s disease, genetic syndromes etc. They also should not document diagnostic terms above in reports and documentation ie. “suspected autism” as the client can access that documentation.
Members can communicate their clinical findings, including speech language pathology and audiology symptoms and dysfunctions if they are not the cause of symptoms.
If another authorized health professional has communicated the diagnosis, members can refer to the provided diagnosis in discussions and provide more information when asked by the patient and/or SDM
May use terms which describe symptoms and dysfunctions within their scope of practice. They may also use qualifiers such as mild, moderate, severe or profound. Some of these terms may include the word “disorder”. Members must make sure the word disorder is being used to describe symptoms; for example, “swallowing disorder” or “vestibular disorder”

Question 61

What are some terms that describe symptoms?

Answer 61

Speech, motor speech, articulation delay and disorder
Language delay and disorder
Sensorineural, conductive or mixed hearing loss
Fluid in the ear
Aphasias, dysarthrias, apraxias, including childhood apraxia of speech
Cognitive communication disorder
Stuttering, hoarseness, hypo/hyper-nasality
Tinnitus, vestibular disorders
Auditory processing disorder
Dysphagia or swallowing disorder
Velopharyngeal insufficiency
Auditory Neuropathy Spectrum Disorder

Question 62

What should be included in a prognostic statement?

Answer 62

Members and associates limit prognostic statements so that they reflect relevant patient or client clinical indicators without guaranteeing results of any intervention, procedure or product, either directly or by implication.
Individuals may make a reasonable statement of prognosis, but they shall not guarantee—directly or by implication—the results of any treatment or procedure.
Example of prognostic statement:
At this time, we can predict that…
Evidence suggests that… but every individual is different, therefore we will monitor progress throughout treatment.

Question 63

What should be included in a treatment recommendation?

Answer 63

Recommended type of intervention (1:1, group, parent training)
Frequency (how often), duration (how long each session is and how long the treatment block with be), and intensity of intervention
Who the intervention will be with (you, another SLP, a CDA or support personnel)
Recommended referrals to other professionals
Recommended strategies for parents or the client to utilize

Question 64

What are outcome measures?

Answer 64

Determination and evaluation of the results of an activity, plan, process, or program and their comparison with the intended or projected results.”
Types include:
Standardized tests (but should be used WITH measures to show function in day to day life)
GAS and SMART goals can be a type of outcome measurement if they are associated with a treatment
Looking for clinically and statistically meaningful change (ie. by using therapy science)
May analyze for: trend, variability/stability, change in level/median performance, and evidence or systemic change
IN ORDER TO MEASURE OUTCOME, YOU NEED MULTIPLE BASELINE DATA POINTS TO SHOW SIGNIFICANCE OF IMPROVEMENT DUE TO INTERVENTION

Question 65

What is the role of CASLPO?

Answer 65

To regulate the practice of the professions and to govern the members in accordance with the ASLPA, the Code and the Regulated Health Professions Act, 1991 and the regulations and by-laws flowing therefrom.
To develop, establish and maintain standards of qualification for persons to be issued certificates of registration.
To develop, establish and maintain programs and standards of practice to assure the quality of the practice of the professions.
To develop, establish and maintain standards of knowledge and skill and programs to promote continuing evaluation, competence and improvement among the members.
4.1 To develop, in collaboration and consultation with other Colleges, standards of knowledge, skill and judgment relating to the performance of controlled acts common among health professions to enhance interprofessional collaboration, while respecting the unique character of individual health professions and their members.
To develop, establish and maintain standards of professional ethics for the members.
To develop, establish and maintain programs to assist individuals to exercise their rights under the Code and the Regulated Health Professions Act, 1991.
To administer the ASLPA, the Code and the Regulated Health Professions Act, 1991 as they relate to the profession and to perform the other duties and exercise the other powers that are imposed or conferred on the College.
To promote and enhance relations between the College and its members, other health profession colleges, key stakeholders, and the public.
To promote interprofessional collaboration with other health profession colleges.
To develop, establish, and maintain standards and programs to promote the ability of members to respond to changes in practice environments, advances in technology and other emerging issues.
Any other objects relating to human health care that the Council considers
desirable.”

Question 66

What is the role of SAC?

Answer 66

Ensuring all people of Canada achieve optimal communication health.
Supporting and empowering our members and associates to maximize the communication health for all people of Canada.

Question 67

What is the role of ASLA?

Answer 67

OSLA is the unified voice that supports Speech-Language Pathologists and Audiologists practicing in Ontario to enhance the quality of life for Ontarians, especially those with communication disorders, swallowing difficulties, or hearing needs.
The Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) is the collective voice advocating for the professions practicing in the province of Ontario.

Question 68

What are the requirements of CASLPO to practice?

Answer 68

Good character
Registration in another jurisdiction
Degree
CEPT
Confirmation of employment start date and location
Confirmation of eligibility to work in Canada
Required fees
Proof of liability insurance
Proof of mentorship
Language proficiency (international only)

Question 69

What are the ethical responsibilities of an SLP according to CASLPO?

Answer 69

The primary ethical obligation of SLPs and Auds is to practice their skills for the benefit of their patients/clients
We have an ethical obligation to respect clients as persons

Question 70

What are support personnel?

Answer 70

Refers to individuals who are directly assigned clinical tasks and related work and are supervised by the member to assist in the provision of speech language pathology intervention.

Question 71

What are the SLP responsibilities in regard to support personnel?

Answer 71

a) Be an Initial or General member in good standing, without terms, conditions or limitations that preclude the supervision of support personnel
b) Have sufficient and ongoing direct contact with patients to develop a professional relationship, evaluate and update the plan of care, and ensure effective and safe delivery of quality speech language pathology services
c) Be available on a regular basis to review and discuss specific patients, issues and provide additional support to the support personnel when requested
d) Ensure that informed consent has been obtained from the patient or substitute decision maker to receive services from support personnel and that the consent is documented in the patient record. The consent process should outline the support personnel’s roles and responsibilities
e) Ensure that the support personnel has the knowledge, skill and judgement to provide the intervention assigned. If the support personnel requires additional training/education, the SLP must ensure that it is provided
f) Define his/her role as supervisor to the support personnel, patient, family and employer
g) Discuss the roles and professional boundaries to the support personnel. This includes, but is not limited to: what may be communicated to patients and other professionals, record keeping content and responsibilities, and use of an appropriate title
h) Be competent in the areas of clinical practice that he/she is supervising
i) Perform a risk analysis when considering the type of tasks assigned. This would include risk to the patient, the patient’s progress and risk to the support personnel

Question 72

What are the SAC standards in regards to practicing?

Answer 72

Professional competence: meet national membership requirements and hold provisional registration, provide service in scope of practice, considering educational level, training, expecerice, and access to supervision and assistance, maintain and enhance professional competence throughout careers, and withdraws if compromised
Safety: take every precaution to avoid harm to patients or clients, and ensure employees and/or supervised personnel comply with relevant policies and procedures.
Business practices: ensure advertisements, promotions, sales, and fees for products and/or services are honest, appropriate, and fair, disclose all applicable fees, charges, and billing arrangements prior to providing services, and donor product and service contracts.
Scholarly, clinical and research practices: obtain approval where required, doesn’t delay with methods of assessment or intervention, use peer review process, acknowledge other professionals.
Ethical: understand application of professional ethical and practical standards, cooperate with investigations, refrain from advocating, sanctioning, participating in or condoning any act or person in violation of code or bylaws/policies, and report suspected violations.

Question 73

What skills must an SLP demonstrate according to SAC to use support personnel?

Answer 73

Evaluate his/her own supervisory skills
Assess the support personnel’s competencies regarding the assigned task
Determine appropriateness of assigning tasks and areas of patient care to support personnel
Monitor the support personnel’s adherence to the obligations, responsibilities and boundaries associated with their position
Identify and communicate constructive feedback to support personnel, including strengths and areas for growth

Question 74

What tasks can’t support personnel do?

Answer 74

Any task where the risk of harm is significant
Selecting, admitting, discharging or referring patients to other services
Reviewing a patient record where clinical interpretation is required
Collecting a patient’s health history where clinical interpretation is involved
Assessing speech, language or communication skills and communicating assessment results
Developing or changing patient intervention plans
Supervising other support personnel
Consulting with other professionals, families or significant others regarding specific patient care

Question 75

Describe the supervision requirements for support personnel.

Answer 75

All support personnel must be directly observed providing patient intervention on a regular basis; however, not necessarily with every patient. Direct observation can be in person, via secure live video or video recordings as close to the therapy session as possible.
The SLP must provide guidance to support personnel as requested and to intervene in service-related matters as required.
The SLP must ensure that sufficient time is available to supervise effectively every support person for which the member has responsibility.

Question 76

Describe the documentation requirements for support personnel.

Answer 76

The SLP will ensure that support personnel document necessary information and are informed of expectations related to record keeping.
The SLP must demonstrate that they review the support personnel’s documentation.
The SLP must document, either in the patient record or separately, the amount and type of supervision provided.

Question 77

What are communication health assistants according to SAC?

Answer 77

Any individual employed in a role supporting the delivery of speech-language pathology and/or audiology services AND receiving supervision in those duties by a qualified speech-language pathologist or audiologist

Question 78

What are is the SACs code of ethics in regards to delegation and supervision of care?

Answer 78

a) Are responsible for all professional services they delegate to communication health assistants and/or students under their supervision.
b) Shall accurately represent the credentials of communication health assistants and students and shall inform patients or clients of the name and professional credentials of persons providing services.
c) May endorse a student or supervisee for completion of academic or clinical training or employment only if they have had direct experience with the student or supervisee, and only if the student or supervisee demonstrates the required competencies and expected ethical practices.

Question 79

What is the SACs code of ethics regarding privacy?

Answer 79

a) Be familiar and comply with applicable federal, provincial or territorial privacy legislation in all of their clinical, administrative, scholarly and research activities. b) Ensure that any supervised personnel comply with appropriate federal, provincial or territorial privacy legislation.
c) Adhere to all relevant legislation and policies related to security, privacy, encryption, consent and documentation in the delivery of services via electronic technology

Question 80

When can SLPs disclose PHI without consent?

Answer 80

Mandatory reporting to external organizations (CAS for child abuse, harm or risk to retirement or LTC residents)
Mandatory reporting to CASLPO (sexual abuse by a regulated health care provider, peer assessment by a peer assessor)
Risk of harm (elder abuse, danger to themselves or others, medical emergency)
Legal authority (subpoena, warrant, court order)
Auditing and accreditation

Question 81

When does a privacy breach occur and what is required of an SLP?

Answer 81

A privacy breach occurs when Ontario’s Personal Health Information Protection Act (PHIPA) has been contravened, for example, where personal health information is stolen, lost or if it is used or disclosed without authority.
Agents must notify the health information custodian if there was a privacy breach when: A person used or disclosed PHI without authority
PHI was stolen
A subsequent breach flows from an initial breach
Pattern of similar breaches over time
Disciplinary action against a College member in connection with a breach
Disciplinary action against a non-college member
The breach was significant

Question 82

When do we notify CASLPO about a privacy breach?

Answer 82

An employee is terminated, suspended or subject to disciplinary action as a result of the unauthorized collection, use, disclosure, retention or disposal of personal health information by the employee.
An employee resigns and the HIC has reasonable grounds to believe that the resignation is related to an investigation or other action by the custodian with respect to an alleged unauthorized collection, use, disclosure, retention or disposal of personal health information by the employee.

Question 83

When does the circle of care apply in relation to consent?

Answer 83

1. The Health Information Custodian (HIC) is entitled to rely on assumed implied consent. Audiologists are considered HICs.
2. The personal health information must have been received from the individual, SDM or another HIC
3. The personal health information was collected, used and disclosed for the purposes of providing health care
4. The HIC must use the personal health information for the purposes of providing health care, not research or fundraising
5. Disclosure of personal health information from one HIC must be to another HIC
6. The receiving HIC must not be aware that the individual has expressly withheld or withdrawn consent

Question 84

When must consent to obtained?

Answer 84

All interventions (screening, ax, and tx)

Question 85

What must informed consent contain?

Answer 85

the nature of the service
the expected benefits
any probable or serious risks and side effects
alternative courses of action
likely consequences of not receiving service

Question 86

When is a person deemed capable to consent?

Answer 86

A person if capable if they understand and can appreciate the reasonably foreseeable consequences of their decision

Question 87

What is required for consent to be valid?

Answer 87

Be informed.
Be given voluntarily.
Not be obtained through misrepresentation or fraud.
Relate to the service being proposed.

Question 88

Do members need to get consent personally?

Answer 88

a member is not required to personally obtain the required consent; rather a member can assign the task of obtaining the consent to the member’s services to another person. Nevertheless, the member maintains the full responsibility of ensuring that the consent obtained is valid and informed.

Question 89

What is the SACs code of ethics in relation to consent?

Answer 89

a) Inform a patient or client about the nature of their communication disorder and the services and intervention options available.
b) Ensure that the patient or client understands this information.
c) Obtain verbal or written consent from the patient or client before screening, assessment, intervention or participation in a research study.
d) Ensure that patients or clients understand their right to refuse consent or withdraw consent once given without impacting any clinical services available to them.
e) Obtain informed consent from the patient or client before sharing the patient or client’s information with others, unless the member or associate is required to do so by law

Question 90

What are the various types of outcome measures?

Answer 90

Evaluative Measures: measure the magnitude of change over time or after treatment. They are typically criterion-reference measures. They measure change in status of specific conditions or skills pre and post treatment.
Predictive Measures: are used to classify persons into categories based on what is expected regarding current status (e.g., screening) or future outcomes.
Discriminative Measures: distinguish between groups or individuals based on whether or not specific characteristics exist. Most standardized tests are discriminative.

Question 91

Discuss an SLPs responsibilities in regards to caseload.

Answer 91

SLPs have the right to choose their caseload
SLPs should be competent in the area of practice they are providing treatment for
SLPs have an obligation to refer to the most relevant profession when a client requires support outside of our scope of practice
See section on use of support personnel for when you can refer to support personnel

Question 92

What is the SACs code of ethics in relation to conflict of interests?

Answer 92

a) Using information or resources from their employer for their own personal or financial benefit.
b) Initiating or continuing intervention with a patient or client if such intervention is ineffective, unnecessary or no longer clinically indicated.
c) Endorsing any service, product or individual to accrue any personal benefit.
d) Accepting any form of benefit, financial reward or gift that may compromise or influence professional judgment or service recommendations.

Question 93

Describe the steps for resolving a disagreement between service providers.

Answer 93

1) Make reasonable attempts to resolve the disagreement directly with the other service provider and take actions in the best interest of the patient/client. If not appropriate to contact directly, document why.
2) Document all relevant information to disagreement.
3) If the disagreement is not resolved to the member’s satisfaction, the member must:
inform the patient/client of the nature of the disagreement.
inform the patient/client of any other options, including that of obtaining another opinion.
document all relevant information regarding the disagreement including information provided to the patient/client, the nature of the disagreement and the protection of the best interests of the patient/client.
respect the patient/client’s fully informed decision.

Question 94

What are CASLPOs general standards for collaboration?

Answer 94

1. Members must communicate effectively and collaboratively with all involved, focusing on a patient centered approach.
2. Members must recommend involvement of appropriate professionals and provide information about community resources when indicated.
3. Members must determine if concurrent intervention, when it arises, is in the best interests of the patient.
4. Members must make reasonable attempts to resolve disagreements between Service Providers involved in the patient care.