Overview of HIPAA, FERPA, and Speech Disorders

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.

HIPAA enactment year

A federal law that was enacted in 1996.

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, fax numbers, e-mail addresses, URLs, IP address, birth date, admission date, discharge date, 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, 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, and 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.

HIPAA Violations

Employment Terminated, 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.

FERPA

Family Educational Rights and Privacy Act

What is FERPA

Protects the privacy of education records.

FERPA enactment year

Enacted in 1974.

Overlap between FERPA and HIPAA

Overlap can occur from FERPA and HIPAA.

Both acts must be followed

One act does not negate the other.

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 or disclosure

Common issue with PHI.

Improper disposal of PHI

Common issue with PHI.

Lack of encryption and security measures

Common issue with PHI.

Sharing PHI via unsecured communication channels

Common issue with PHI.

Patients Rights

Patients have the right to receive a copy of their medical record by submitting a written request.

Request an amendment to their medical records

One of the rights patients have.

Request restrictions related to disclosure to health plans

One of the rights patients have.

Request communications of PHI by alternative means or alternative locations

One of the rights patients have.

Receive an accounting of disclosures within 60 days of their request

One of the rights patients have.

Request a notice of privacy practices

One of the rights patients have.

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

A phonological process where the final consonant is omitted, e.g., 'bo' for 'boat'.

Weak Syllable Deletion

A phonological process where an unstressed syllable is omitted, e.g., 'medo' for 'tomato'.

Initial Consonant Deletion

A phonological process where the initial consonant is omitted, e.g., 'us' for 'bus'.

Consonant Cluster Reduction

A phonological process where a consonant cluster is reduced, e.g., 'kate' for 'skate'.

Reduplication

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

Epenthesis

A phonological process common for younger children, e.g., 'sahpoon' for 'spoon'.

Union of the articulators

(P)

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

Surrounding information that includes cultural, social, and physical environment.

Syntax

The order and placement of words and markers/sentence structure.

Semantics

The meaning of words and sentences.

Pragmatics

The appropriateness of words and social use of language.

Prosody

The melody of speech, including intonation, stressing, and rhythm.

Morpheme

The smallest unit of language that contains meaning.

Free Morphemes

Morphemes that can stand alone as independent words, e.g., cat, happy, walk.

Lexical Morphemes

Morphemes that carry the core meaning of a word, e.g., nouns, verbs.

Functional Morphemes

Morphemes that show grammatical relationships between words, e.g., prepositions, conjunctions.

Bound Morphemes

Morphemes that cannot stand alone and must be attached to other morphemes.

Derivational Morphemes

Morphemes that change the meaning of a word, e.g., happy vs. happiness.

Inflectional Morphemes

Morphemes that indicate grammatical features, e.g., tense or plurality.

Grammatical Morphemes

Morphemes that provide 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.

Compound Sentences

Sentences that contain at least two independent clauses.

Complex Sentences

Sentences that contain at least one dependent clause.

Compound/Complex Sentence

A sentence that contains both structures, requiring at least two independent clauses and at least one dependent clause.

Dependent clause

"Although it was raining"

Independent clauses

"We went to the park," "We had a lot of fun."

Language Disorders

Children who show language problems comprise a diverse group.