Clinical Processes Exam 2

which evidence based factors are associated with external evidence?

empirical evidence- basic and applied, practice guidelines

which evidence based factors are associated with internal evidence?

patient/contextual factors, clinical knowledge and experience

describe the 6 steps to EBP.

1. develop PICO question (allows us to take clinical question into something that is easily searchable)

2. find and evaluate internal evidence (can help identify biases)

3. find external evidence

4. critically evaluate external evidence

5. integrate internal and external evidence

6. apply and evaluate outcome of decision

D FEI FE EE IIE AE

Be able to list and identify the 4 PICO components if given PICO question.

P: problem or population

I: Intervention

C: Comparison

O: Outcome

Why is it important to assess research design when evaluating external evidence?

understand credibility of study and determine which study you might rely on more to gain accurate information

What is the difference between experimental and non-experimental research studies?

experimental: when researcher has manipulated something in order to see an effect

non-experimental: when researcher has not done something but still want to see an effect

what does it mean if an article has been peer reviewed?

journal receives an article and sends it out to other clinicians/professionals who also do similar types of research. These peers read article and validate research design and judge different qualities. The article in turn improves and authors can fix mistakes.

Name this study: level IV report that uses data from other studies to answer PICO questions with what experts think about the topic.

Expert Report

may contain bias

is an expert report experimental/non-experimental, group/no group, control/no control?

non-experimental, no control, no group

just opinions

which level of research design can you draw a definitive conclusion from?

RCT and systematic reviews

name this study: Level III study that is an in-depth and detailed individualized examination of one person/situation

case study

just recording

is a case study experimental/non-experimental, group/no group, control/no control?

non-experimental, no control, no group

name this study: Level III study that examines a situation and reports how that situation is working.

cross-sectional

mostly interview and observation

is a cross sectional study experimental/non-experimental, group/no group, control/no control?

non-experimental, no control, groups

name this study: level IIb study that establishes a baseline, makes a change and constantly observes effects of that change.

single case experimental design (SCED)

has phases, called ABA design, has repeated measures

is a SCED experimental/non-experimental, group/no group, control/no control?

experimental, control within participant, no group

individual participants change not whole group change

name this study: level IIb study that uses a test, teach, retest design and measures change in outcomes (mean scores).

quasi-experimental

one measure in time compared to another measure in time

is a quasi-experimental study experimental/non-experimental, group/no group, control/no control?

experimental, no control, one group

name this study: level Ib study that randomizes participants, does an experiment and compares groups to see which group produces better outcomes.

Randomized control trial (RCT)

is an RCT study experimental/non-experimental, group/no group, control/no control?

experimental, controlled, groups, randomized

name this study: level Ia study that is a review of experimental/control studies.

systematic review

is a systematic review study experimental/non-experimental, group/no group, control/no control?

depends but usually experimental, groups, controlled, randomized

name the studies from least to greatest credibility.

expert report

case studies and cross sectional

quasi experimental or SCED

RCT

systematic review

why is randomization important for group design studies?

ensures all groups in group design are equal and will continue to be equal throughout the study. The only difference between the two groups is the variable you are wanting to change

what is lost if you don’t randomize in group design studies?

equality between groups

How is the control different in SCED and RCT research studies?

SCED: control within participant. participant is compared to themselves before vs after treatment

RCT: control is another group of participants that have not undergone treatment

what is the difference between statistical and clinical significance?

statistical: statistics in relation to means that show that one group is different than the other based on what you are measuring (looking for effect size).

clinical: whether treatment is beneficial enough and makes a big enough impact in patient’s life for amount of money, time, energy the treatment/experiment took.

what is an example of statistical vs clinical significance?

In a study on MLU, the control group may have increased their MLU by .1 compared to the experiment group who increased they MLU by .2. This might be statistically significant for the experiment but in the eyes of a parent/client, this would not be significant because of the time, money and energy put into this therapy.

what are two barriers to evidence-based practice?

lack of time to search, read, analyze published research evidence

lack of competent abilities to efficiently search and find relevant evidence

why is it important to consider quality of research study, in addition to study design?

there can be a high level research design that has a lot of evidence but was conducted poorly. the level of research design does not automatically assign credibility.

what is the ICF-FY framework?

International Classification of Functioning, Disability and Health: Children and Youth Version by the World Health Organization

why is the ICF-FY framework helpful when considering client factors, values and preferences?

holistic perspective and includes considerations of physical body and its structure, person’s activity level and participation. also includes environmental and personal factors. does not solely focus on impairment

what could make generating a clinical decision after weighing all internal/external evidence more difficult?

there is really no one intervention approach or target selection strategy that is better than all the rest for every single type of client. can be difficult to take in all three sources of evidence and make a decision.

what is the difference between inductive and deductive reasoning?

deductive: move from general assumption to something specific (fact)

inductive: going from specific instance to general conclusion

which type of reasoning is based on fact- inductive or deductive?

deductive

inductive is based on what you’ve observed and your general conclusion- not always right

define cumulative treatment intensity

whole amount of therapy client will receive, including practice at home

define treatment strategy

methods we use to teach

define antecedent

prompt or instruction, what clinician does to set up a situation

define consequence

feedback from clinician

why is it important to write treatment goals?

more likely to achieve your goals because you have a plan and can keep yourself accountable. you will know exactly what the outcome should be and how to get there. stay on the path!

how do you determine what goals are best for a client?

look at assessment outcomes, client’s values and challenges, clinical evidence, progression from the pass

determine what is attainable and SMART

what is the zone of proximal development?

difference between child’s current level of independent performance on task and how they succeed at same task with assistance

how does the ZPD relate to writing goals?

make sure goals are within ZPD and break down steps, treatment should occur between what student can do on their own and what they need full support with.

what are long term goals?

big benchmark goal that is achieved during course of therapy over longer course of time

what are short-term objectives?

smaller goals that lead to achieving an LTG, monitor progress of that path

what are session objectives?

goal for the session, leads to an LTG, might be an STO

what are additive objectives?

working on STOs all at once and working on them all together will add up to LTG

what are sequential objectives?

sequenced steps of STOs, must mark off previous STO before you move on, think of a pathway

define the SMART criteria

Specific: detailed enough to be understood by others

Measurable: need to know when you reach goal

Attainable: belief about whether person can actually meet goal

Relevant: should be working toward something that is meaningful for client’s life

Timely: need to have timeline of when you think client will achieve goal

what is the difference between continuous dosage vs sprint/variable dosage?

continuous: see client regularly within specific amount of time with normal intensity

sprint/variable: see client for blocked out amount of time with high intensity and then take a break

how does an SLP shape behavior through antecedents and consequences?

SLP changes antecedents and consequences in hopes of getting the right behavior.

what are examples of antecedents?

gestures, explanations, questions, hand over hand

what are examples of consequences?

high five, candy, point system, verbal praise

what are step up clinical strategies?

when client is doing well and clinician makes it harder- step up expectations and give more independence

what are step down clinical strategies?

client is struggling and clinician makes it easier- step down expectations

what are contextual supports?

environment, proximity, noise level

what are intervention materials?

materials used to support strategies

client self monitoring, intermittent feedback and others providing feedback are all supports that help a client to do what?

generalize their skills outside of therapy room

what is client self monitoring?

skill SLP can teach where client self monitors to see if they are accomplishing their tasks correctly outside of therapy

what is intermittent feedback?

giving less feedback/consequence as student excels and learns so they are able to complete task without your constant support and feedback

helps with motivation

why do we take data during treatment?

know if client is making progress toward long term goals and short term objectives

make changes during session based on the data

what is qualitative data?

descriptive data, journaling or observing, interview or reported info

what is frequency data?

how often behavior occurred, percentage, needs demoninator

what is duration data?

how long behavior occurred

what is interval data?

if behavior occurred during set amount of time

Categorize this information into SOAP: after this session, client with continue to practice minimal pairs with her parent during bathtime.

plan

Categorize this information into SOAP: client’s mean length of utterance during the session was 4.75.

objective

Categorize this information into SOAP: Client’s parent reported that the client’s distinction between minimal pairs has increased and the practice seems to help her understand to listen to the sounds in a word.

subjective

Categorize this information into SOAP: client’s progress is likely due to a lot of listening practice at home.

analysis

Categorize this information into SOAP: answering questions should continue to be targeted next week.

plan

Categorize this information into SOAP: client’s parents reported client was having trouble staying awake in class.

subjective

Categorize this information into SOAP: client identified a distinction between minimal pairs with 60% accuracy.

objective

Categorize this information into SOAP: client improved her ability to distinguish minimal pairs by 6%, as compared to last session.

analysis

Categorize this information into SOAP: client arrive to therapy session with parents but one parent left midway through.

subjective