Section 2 Flashcards

Question

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

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

Pre-morbid speech/language/swallowing

Answer 5

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

Answer 6

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

Answer 7

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)

Answer 8

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.

Answer 9

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

Answer 10

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

Answer 11

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

Answer 12

Rehabilitation of gross motor function Pediatrics: balance, gait, difficulties with gross motor activities Adults: balance, gait, difficulties with gross motor activities

Answer 13

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

Answer 14

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

Answer 15

Assess for, and diagnose, autism, adhd Provide developmental disorder specific care and support Indicators for autism, adhd, learning disability, genetic condition

Answer 16

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

Answer 17

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

Answer 18

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)

Answer 19

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

Answer 20

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

Answer 21

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.

Answer 22

``` 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 ```

Answer 23

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.

Answer 24

``` 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.

Answer 25

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

Answer 26

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.

Answer 27

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

Answer 28

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

Answer 29

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

Answer 30

``` 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. ```

Answer 31

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

Answer 32

``` 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 ```

Answer 33

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)

Answer 34

``` 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 ```

Answer 35

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

Answer 36

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”

Answer 37

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

Answer 38

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.

Answer 39

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

Answer 40

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

Answer 41

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.”

Answer 42

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.

Answer 43

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.

Answer 44

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)

Answer 45

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

Answer 46

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.

Answer 47

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

Answer 48

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.

Answer 49

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

Answer 50

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

Answer 51

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.

Answer 52

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.

Answer 53

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

Answer 54

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.

Answer 55

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

Answer 56

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

Answer 57

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

Answer 58

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.

Answer 59

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

Answer 60

All interventions (screening, ax, and tx)

Answer 61

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

Answer 62

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

Answer 63

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

Answer 64

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.

Answer 65

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

Answer 66

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.

Answer 67

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

Answer 68

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.

Answer 69

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.

Answer 70

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.