Overview of HIPAA, PHI, and Language Development

HIPAA

Health Insurance Portability & Accountability Act

What is HIPAA

Protects healthcare information for all living persons and up to 50 years after a person's death.

What does HIPAA stand for?

Health Insurance Portability & Accountability Act

HIPAA Privacy and Security Rules

Protect the privacy and security of individually identifiable health information.

FERPA

Family Educational Rights and Privacy Act

What does FERPA stand for?

Family Educational Rights and Privacy Act

What is FERPA

Protects the privacy of education records.

Overlap of FERPA and HIPAA

An elementary school student who is being seen by an SLP for Tx in private setting may use information from school to assist in Dx.

HIPAA Violations

Can result in Employment Termination, Fines and Penalties.

Tier 1 HIPAA Violation

If an individual obtains PHI, discloses PHI, or enables a third party to obtain/disclose PHI, the maximum fine is $50,000 plus up to one year in prison.

Tier 2 HIPAA Violation

If an individual commits a Tier 1 crime under false pretenses, the HIPAA violation fines for employees increase up to $100,000 and up to five years in prison.

Tier 3 HIPAA Violation

If an individual commits a Tier 1 or Tier 2 crime with the intent to sell, transfer, or use the PHI for commercial advantage, personal gain, or malicious harm, the maximum fine increases to $250,000, and the maximum jail time for violating HIPAA to ten years.

PHI

Protected Healthcare Information

What is PHI

Written (paper or electronic) or oral record of care that the patient has received or is going to receive.

What does PHI stand for

Protected Healthcare Information

Examples of PHI

Names, Contact information, Street address, city, county, precinct and zip code, Telephone numbers and fax numbers, E-mail addresses, URLs, IP address, Birth date, admission date, discharge date and date of death, Age over 89, Social Security numbers, Medical record numbers, health plan beneficiary numbers, Account numbers, Certificate/license numbers, Vehicle identifier, serial number, and/or License plates, Full face photo, Photo with distinctive tattoo, Biometric identifiers, including finger and voice prints.

When is disclosure of PHI permitted?

With written authorization from the patient, or without written authorization for Treatment, payment and healthcare operations, Public health activities, Research, or complying with a valid HIPAA-compliant subpoena.

Examples of Unauthorized Access of PHI

Viewing a friend's, neighbor's or family's information, viewing a colleague's information, viewing your own medical record through improper means, allowing another person to utilize your password to access a medical record system.

Protecting PHI

Use/disclose 'minimum necessary' PHI, ensure confidentiality and security of the information, properly dispose of information when no longer needed.

Reasonable Safeguards to Protect PHI

Use reasonable safeguards to prevent unauthorized access, use or disclosure of information.

PHI

Includes identifiable health data: name, address, birth date, SSN, medical records, treatment history, and billing info.

HIPAA

Covered entities must follow HIPAA privacy and security rules.

Unauthorized access

Common issue with PHI that involves access without permission.

Improper disposal of PHI

Common issue with PHI that refers to the incorrect disposal of sensitive information.

Lack of encryption

Common issue with PHI that indicates insufficient security measures to protect data.

Unsecured communication channels

Common issue with PHI that involves sharing sensitive information through insecure means.

Privacy Compromised Locations

Conversations away from the clinic/work, front desk registration conversations, conversations with the patient's family members or friends, website and e-mail messages, telephones, social media postings, lost/stolen computers and mobile devices.

Patient Rights

Patients have the right to receive a copy of their medical record, request amendments, request restrictions on disclosures, request communications by alternative means, receive an accounting of disclosures, request a notice of privacy practices, and receive a copy of their medical record by e-mail.

Phonology

The study of how speech sounds are put together to form words and other linguistic units.

Articulation

Study of how the articulators make individual sounds.

Phonemes

Include consonants, vowels, and diphthongs.

Phoneme

An individual speech sound.

Allophone

Variation in the production of a phoneme.

Phonetics

The study of the sounds of speech.

Grapheme

The printed letters of a word.

Final Consonant Deletion

Phonological process where the final consonant of a word is omitted, e.g., 'bo' for 'boat'.

Weak Syllable Deletion

Phonological process where an unstressed syllable is deleted, e.g., 'medo' for 'tomato'.

Initial Consonant Deletion

Phonological process where the initial consonant of a word is omitted, e.g., 'us' for 'bus'.

Consonant Cluster Reduction

Phonological process where a cluster of consonants is reduced, e.g., 'kate' for 'skate'.

Reduplication

Phonological process where a syllable is repeated, e.g., 'baba' for 'bottle'.

Assimilation

Phonological process where a sound becomes similar to a neighboring sound.

Stopping

Phonological process where fricatives are replaced with stops.

Fronting

Phonological process where sounds produced at the back of the mouth are replaced with sounds produced at the front, e.g., 'tar' for 'car'.

Backing

Phonological process where sounds produced at the front of the mouth are replaced with sounds produced at the back.

Final Consonant Devoicing

Phonological process where voiced consonants at the end of words are pronounced as voiceless.

Prevocalic voicing

Phonological process where voiceless consonants before a vowel are voiced.

Coalescence

Phonological process where two sounds merge to form a new sound.

Epenthesis

Phonological process where a sound is added within a word, e.g., 'sahpoon' for 'spoon'.

Gliding

Phonological process where liquids are replaced with glides.

Vowelization

Phonological process where syllabic consonants are replaced with vowels.

Manner

Describes the degree or type of constriction (M)

Voicing

Whether or not the vocal folds are vibrating (V)

Substitution

Atypical process seen in more severe delays

Backing

When alveolar sounds /t/, /d/, and /s/ are substituted with velar or palatal sounds like /k/ and /g/. Example: "kime" for "time"

Affrication

When a nonaffricate is replaced with an affricate /ch/ or /j/. Example: "jat" for "bat", Age of elimination: 3 Years

Fronting

When velar or palatal sounds /k/, /g/, and /sh/ are substituted for alveolar sounds /t/, /d/, and /s/. Example: "tan" for "can", Age of elimination: 3.5 Years

Stopping

A fricative /f, v, s, z, th, sh/ or affricate /ch/ or /j/ is substituted with a stop /p, b, t, d, k, g/. Example: "pat" for "fat", Age of elimination: /f, s/ by 3, /v, z/ by 3.5, /sh, ch, j/ by 4.5, /th/ by 5

Gliding

When a liquid /r/ or /l/ is substituted with a glide sound /w/ or /y/. Example: "wed" for "red", Age of elimination: 5-6 years

Deaffrication

An affricate /ch/ or /j/ is replaced with a fricative /f, v, s, z, th, sh/ or a stop /p, b, t, d, k, g/. Example: "teap" for "cheap", Age of elimination: 4 years

Depalatalization

A palatal sound is substituted with a nonpalatal sound. Example: "tark" for "shark", Age of elimination: 5 years

Alveolarization

A nonalveolar sound is substituted with an alveolar sound /t, d, s/. Example: "top" for "shop", Age of elimination: 5 years

Labialization

A nonlabial sound is substituted with a labial sound /m, p, b/. Example: "bake" for "take", Age of elimination: 6 years

Vowelization/vocalization

When /l/ or /er/ sounds are replaced with a vowel. Example: "teacho" for "teacher", Age of elimination: No set age

Reduplication

When a complete or incomplete syllable is repeated. Example: "wawa" for "water", Age of elimination: 2.5 - 3 years

Initial Consonant Deletion

When the first consonant or consonant cluster is left off. Example: "oy" for "toy", Age of elimination: Atypical process seen in more severe delays

Final Consonant Deletion

When the final consonant or consonant cluster is left off. Example: "ma" for "mom", Age of elimination: 3.3 Years

Diminutization

Adding "ee" or consonant + "ee" to a word. Example: "cupee" for "cup", Age of elimination: No set age

Cluster Reduction

When all or some of a consonant cluster is deleted or substituted. Example: "top" for "stop", Age of elimination: 3.5-4 years without /s/, 5 years with /s/

Weak Syllable Deletion

The weak syllable of a word is deleted. Example: "nana" for "banana", Age of elimination: 4 years

Epenthesis

When an unstressed vowel, typically the "uh" sound is added between two consonants. Example: "puhlate" for "plate", Age of elimination: 8 years

Denasalization

A nasal consonant /m/ or /n/ changes to a non-nasal consonant. Example: "boze" for "nose", Age of elimination: 2.5 years

Assimilation

When a consonant sound starts to sound like another sound in the target word (labial, velar, nasal, or alveolar). Example: "nan" for "nap", Age of elimination: 3 years

Coalescence

Two phonemes are substituted with a different phoneme that has similar features. Example: "fop" for "stop", Age of elimination: No set age

Final Consonant Devoicing

A voiced consonant, such as /b/ or /d/ at the end of a word is substituted with a voiceless consonant, such as /p/ or /t/. Example: "roat" for "road", Age of elimination: 3 years

Provocalic Voicing

A voiceless consonant at the beginning of a word, such as /k/ or /f/ is replaced with a voiced consonant like /g/ or /v/. Example: "gat" for "cat", Age of elimination: 6 years

Place of Articulation

Bilabial - both lips, Labiodental - lip and teeth, Lingua-dental - tongue between the teeth, Alveolar - tongue on alveolar ridge (hard palate, right behind front teeth), Palatal - tongue and the palate, Velar - tongue and the velum (soft palate), Glottal - in the glottis (vocal cord)

Manner of Articulation

Stop: Complete closure with release of air pressure when closure is released (/p/,/b/, /t/, /d/, /g/, /k/, /ʔ/), Fricatives: Narrow constriction that creates a noisy sound as air passes through the narrow opening (/s/, /z/, /θ/, /ð/, /ʃ/, /ʒ/), Affricates: combination of stop and fricative (/t͡ʃ/,/d͡ʒ/), Nasals: Complete oral closure - airflow through the nasal cavity (/m/, /n/, /ŋ/), Liquids: Lateral: Midline lingua-alveolar closure (/l/), Rhotic: Tongue tip "turned back" (/ɹ/), Glides (/w/, /j/)

IPA

System for transcribing speech sounds. Useful for assessing articulation and phonology.

Canonical shape

Based on phonemes, not graphemes (printed letters)

CVC

A syllable structure represented by consonant-vowel-consonant, e.g., 'cat': /kᵆt/ and 'thought': /ᶿᵓt/

Context

The broader situation in which language is used, including cultural, social, and physical environment.

Syntax

Order and placement of words and markers/sentence structure; the grammar rules that govern how words are arranged into a sentence.

Semantics

Meaning of words and sentences; the study of words and sentence meaning.

Pragmatics

Appropriateness of words/social use of language; how language is used in a social setting.

Prosody

Melody of speech; use of intonation, stressing, and rhythm of speech to alter the intent of the communication.

Morphemes

The smallest unit of language that contains meaning.

Free Morphemes

Can stand alone as independent words, e.g., 'cat', 'happy', 'walk'.

Lexical Morphemes

The primary meaning conveyed by a morpheme, especially when it functions as a standalone word.

Functional Morphemes

Shows grammatical relationships between words, e.g., prepositions, conjunctions, articles, pronouns.

Bound Morphemes

Cannot stand alone and must be attached to other morphemes.

Derivational Morphemes

Changes the meaning of a word, e.g., 'happy' vs. 'happiness'.

Inflectional Morphemes

Indicates grammatical features, e.g., tense, quantity, person.

Grammatical Morphemes

Provide the information for tensing, plurality, or possession.

Clause

A group of words that contain a subject and a verb.

Independent Clause

A complete thought that can stand alone as a sentence.

Dependent Clause

A group of words that contains a subject and a verb but does not express a complete thought.

Example of Syntax

Subject-verb-object order.

Example of Semantics

The definitions, synonyms, antonyms, and ambiguity of word choice.

Example of Pragmatics

Understanding and use of sarcasm, irony, implied meaning.

Example of Prosody

Emphasizing keywords, placing syllable intonation to alter nouns to verbs and verbs to nouns.