METHODS EXAM 1

Intervention

The process of providing services to improve communication and/or swallowing abilities.

Behavioral objective

A specific, measurable statement that outlines a target skill, condition, and level of mastery.

baseline performance

measurement of a skill before intervention begins

generalization

the transfer of learned skills to untrained contexts

stimuli, physical environment, audience

3 factors that influence generalization:

maintence

the continued use of skills over time without clinican support

model vs. imitate

I model something, the client imitated what I just did

direct modeling

clinician demonstrates a specific bx to provide an example for the client to imitate; Used in early stages of tx (establishment) or when tx behaviors shift to higher level of difficulty

indirect modeling

clinician demonstrates a specific bx frequently to expose the client to numerous well-formed examples of the tx bx

Shaping by successive approximation

tx bx is broken down into small components and taught in an ascending sequence of difficulty; Gonna teach you very tiny parts of something until you can do it on your own in generalization

Prompts

linician provided additional verbal or nonverbal cues to facilitate a client's production of a correct response

Attentional, using exaggerated loudness or duration, hand cues , verbal cues , written cues

fading

stimulus or consequence manipulations are reduced in gradual steps while maintaining the target response.

Client produces multiple imitations for each clinician model- Only modeled something once- (ex: "Say goat five time" client says goat 5x in a row after only hearing it once)

Progressive reduction of the length of the bx modeled by the clinician

expansion

clinician reformulates a client's utterance into a more mature or complete version

ex: "That is a tractor" -> "That's right, that is a green tractor"

negative practice

client is required to intentionally produce a tx bx in error

Best used on a short-term basis, only after the client demonstrates the ability to produce a given target consistently at the level of imitation

target-specific feedback

clinician provides specific information regarding the accuracy or inaccuracy of a client's response relative to the specific target bx; Show them exactly what they need to do differently to get the correct answer

homework

given to parents to take home after child has reached 80% accuracy in tx; Useful after the establishment and stabilization of tx bx has occurred and Promotes generalization

effective instructions

Instructions to client should be short, clear, concise; State instructions in declarative form; Allow client sufficient time to respond before repeating instructions; Emphasis of instruction should be on the target bx rather than the details of the activity or game that is being used to spark interest

short term goal (STG)

specific change; the baby steps along the way to meeting your ultimate long-term goal (LTG); written in ABCD format

20

how many trials does the textbook recommend doing during baselining?

audience

ABCD FORMAT:

WHO is expected to demonstrate the behavior? (Client/Patient)

behavior

ABCD FORMAT:

WHAT do you want the client to DO? (action word)

condition

ABCD FORMAT:

What situation/condition should the behavior be performed? (when?, where?, what materials or cues?)

degree

ABCD FORMAT:

What is the targeted degree of success? (Data: 90% accuracy, 8/10 trials, <4 errors in 3 consecutive sessions, over a 10 min period, etc)

long term goals

Broad change; your hope for the end of tx/the semester/the end of your insurance approval time frame; should be SMART and functional

Specific

Measurable

Attainable

Relevant

Time-based

what does SMART stand for?

using normative data or client-specific date

What are 2 different ways you can go about choosing targets? 

normative data

tx targets are taught in the same order that they emerge in the normally developing individual

client-specific data

tx targets are chosen based on an individual's specific needs rather than norms

frequency of occurrence

b. importance to client (Maybe name is Ruston Roberts so family REALLY wants him to do his R's)

c. potential for success

components of client-specific data:

Allows clinician to monitor client progress

Permits documentation of the efficacy of a given tx strategy

Well written behavioral objectives facilitates data collection

why do we collect data?

go back and look at objective

what to do if you have trouble collecting data:

1. Select appropriate data sheets prior to onset of tx session

2. Notation system used should provide the type of info. that is most relevant to a specific client or disorder (+/-; min., mod., max assist.;Likert scale, latency)

3. Data collection system must allow the clinician to clearly distinguish among imitative, cued/prompted, self-corrected, and spontaneous responses

5. At the conversational level, it may be more efficient to base data on time vs. # of responses (# of errors per minute vs. # of errors/session)

6. Use reinforcement tokens or stimulus items as alternative to pen and paper recording

7. Record EVERY stimulus-response chain

Data-collecting guidelines:

scientific evidence, clinican expertise, client persceptives

components of EBP

probes

Instruments administered periodically throughout treatment to measure a client's progress; lets see if i can get anything for "free"

1. Consist of novel stimuli that are equivalent to, but different from those used in tx

20 stimulus items/probe

2. No reinforcement and no instruction is given

3. Findings obtained are used by the clinician to determine the next step in the tx program

4. Periodic administration of probes minimizes the risk of continuing tx that in no longer effective or necessary

components of a probe:

dosing

how often the client has therapy (ex: 2x a week/1 hour); Clinician's base decision on individual characteristics and circumstances per client

stimulus

antecedent event, precedes and elicits a response

response

behavior exhibited by client upon presentation of stimulus

consequence

reinforcement

Anything that says __________ means you want to happen again

positive reinforcement

you get a reward every time you do something (Verbal reinforcement, stickers, etc)

primary positive reinforcement

reinforcing based on physiological/biological predisposition of client (Food) ; Usually get after every correct response; Susceptible to satiation

seconday positive reinforcement

Something that is learned to be perceived as rewarding; Social: Smiling, verbal praise; not very susceptible to satiation

token

Symbol/object that are no reinforcing in themselves, but ties to a contingent activity/reward 

negative reinforcement

Will take away something you do not like. Unpleasant event/condition is removed contingent on the performance of a desired behavior

escape

Requires the presence of a condition the client perceives as aversive 

avoidance

Each performance of a target bx prevents the occurrence of an anticipated aversive condition

punishment

Event is presented contingent on the performance of an undesired behavior to decrease the likelihood that the bx will occur

type 1 punishment

Involves the prompt presentation of an aversive consequence after each demonstration of an unwanted behavior (“no!” frowning) 

type 2 punishment

involves withdrawal of a pleasant condition contingent on the demonstration of an unwanted bx. (Time out, Response Cost)

continuous reinforcement

reinforcer is presented after EVERY correct performance of a tx bx

Define the primary goals of intervention in speech-language pathology

speech

refers to the physical act of generating sounds and words using our articulatory structures (mouth, jaw, tongue, etc.); how clearly we can verbally convey our thoughts and ideas to others

language

How we use words in order to communicate our ideas, wants, and needs. It encompasses understanding and speaking/writing through words, gestures, and symbols

programming, behavior modification, key teaching strategies, session design, data collection

List the 5 Essential Clinical Skills

Key features of programming:

Establishment/Stabilization/Generalization

components of behavioral objectives:

establishment

learning the tx behavior

stabilization

getting consistent with the tx behavior

generalization

using the target bx in every environment with any communication partner

progress summary- what/why?

what- Progress Summary & Initial Evaluation Report/Most Recent Evaluation Reports if you have a returning client

why- Learn important information about a patient before evaluating or treating them. Need to know the clients previous clinical condition and where their progress is now before we begin to treat them

chart review- what/why?

what- A meeting or discussion where professionals review a client's case and share information about their progress, needs, and treatment plan.

why- Make sure everyone involved in a client's care is on the same page and making the best decisions for the client

staffing- what/why?

semantics

rules relating to the meaning of language (vocabulary)

morphology

the rules of word structure; how morphemes are used

syntax

rule of sentence structure

pragmatics

rules that occur in social situations- how you would talk to a professor vs. a friend

phonology

rules of speech sounds; how phonemes are used

syntax, morphology, phonology

list the "form" components of language:

semantics

list the "content" component of language:

pragmatics

list the "use" component of language:

programming

selection, sequencing, and generalization of therapy targets

behavior modification

systematic use of stimulus-response-consequence procedures

key teaching strategies

use of basic training techniques

session design

organization and implementation of therapy sessions

data collection

systematic measurement of client performance and tx efficacy

after

potential tx goals/behavioral objectives are often obtained ______ reviewing the results of previous dx findings/results of the most recent progress summary

baseline data

Clinician-designed initial measurements of a client's performance on a specific skill—without prompts or cues—before intervention begins; Figuring out where to start therapy

Approx. 65-70%

What is the % for the zone of proximal development?

zone of proximal development

You are NOT finished with baselining skill #1 until you identify the ___________ . You continue to modify your objective (make it easier or harder depending on what the data tells you) until you find the right spot.

true

T/F:

there is no degree when baselining. Only include ABC