Midterm Study Guide

Observation & Clinical Techniques

Infection control procedures

* proper hand washing
* PPE
* housekeeping
* cleaning, disinfection, sterilizing

How an infection occurs

* direct contact to someone infected with a pathogen
* indirect contact with a contaminated item
* airborne
* droplets
* food borne, waterborne, blood borne

vectors

insect carrier transmits pathogens from infected to uninfected

carriers

carries pathogen with no evidence of disease but can spread

How to break the chain of infection

* proper hand washing
* appropriate waste disposal
* safe handling of secretions & drainage
* practice appropriate measures specific to each pathogens way of transmission

susceptible hosts

* those with weakened immune system
* age- very young or elderly
* underlying disease
* inactivity
* poor nutrition
* trauma
* side effects of meds
* emotional stress

ethics

moral principles that govern a persons behavior and influence decisions

personal ethics

formed from upbringing, acculturation, life experiences, personal choices, and education

professional ethics

establish right and wrong actions in serving clients in the workplace, publicly state common core values and collective obligation shared by people in a field

expected to comply with ASHA’s Code of Ethics

* those who are credentialed (CCC-SLP, CCC-A)
* those earning credentials (CFY)
* members of the organization

beneficence

professionals promote the interests and welfare of others

nonmaleficence

professionals deliberately avoid inflicting potential or actual harm

informed consent

client is aware of their impairment, Tx, expected outcomes, and potential risks

conflict of interest

accepting personal/financial gifts from clients/manufacturers that compromise professional judgement bc strings/expectations are attached

misrepresentation

type of dishonesty that occurs when the truth is distorted/falsified

ways to adhere to principle of safeguarding client welfare

* nondiscrimination
* referral
* informed consent
* prognosis and cures
* confidentiality

The Ethics Calibration Quick Test (ECQT)

allows clinicians to analyze the ethical propriety of a situation by considering the ethical conflict, values involved, evidence, possible plans of action, and decision making process

assigning credit

must reference and give credit to ppl who have contributed to your reports or research

maintaining professional demeanor

prohibiting misconduct such as dishonesty, sexual harassment, fraud

upholding standards of the profession

must comply with ASHA’s standards and Code of Ethics

professional environments

Aud & Speech Center, hallways, observation rooms, front office, AAC room, off campus observation sites, email, brightspace, classroom

who follows professional guidelines

CCC-SLP/A, CFY, students

dress code

dress professionally based on setting, activity, and client. consider clients culture, age, disability, and comfort

dress code- foot wear

avoid unprofessional footwear like flip flops, excessively high heeled shoes, tennis shoes, open toed shoes

dress code- hair

avoid ungroomed hair, wildly colored hair, distracting hair styles, unshaved or ungroomed facial hair

dress code- body art

remove facial piercing (especially nose), avoid large hoop or dangly earrings, avoid heavy makeup, cover visible tattoos

fragrances and perfumes

avoid ___ when providing services to clients who may be hypersensitive to smells or in small settings

modeling appropriate social skills such as

modeling appropriate eye contact, use professional/setting appropriate greetings/farewells, avoid hugging, consider the disability, culture, and religious beliefs when touching clients or shaking hands

consider volume, rate of speech, and complexity because

clients may have receptive lang, cognitive, and/or processing weaknesses or hypersensitivity to sound. avoid filler words

email etiquette

use appropriate greeting and farewell, use appropriate titles, write in complete sentences, provide context, proofread, thank them for replying or providing info

punctuality, timeliness, preparedness

be prepared and on time, access resources, take notes, ask questions,

things to avoid regarding open access social media

don’t post illegal, inappropriate or emotional things, avoid threats or bullying, no objectionable content, avid confidential or traceable client info

client-clinician boundaries

avoid non-therapeutic relationships, refrain from inappropriate communications, avoid inappropriate self disclosure, maintain confidentiality and delete protected client info from personal or public devices

supervisor roles

* establish and maintain effective working relationship with the student
* assisting the student in developing clinical goals and objectives
* assisting the student in developing and refining assessment skills
* assisting in developing and refining clinical management skills
* demonstrating for and participating with the student in the clinical process
* asist in observing and analyzing Dx and Tx sessions
* modeling professional conduct

Main roles of clinical supervisor

* develop and maintain effective communication
* provide the guidelines associated with practicum and its requirements
* provide consistent and constructive feedback
* assist in developing diagnostic and assessment strategies
* assist in development of Tx plans
* demonstrate variety of clinical skills
* describe record keeping requirements
* evaluate
* encourage

student clinician responsibilities

* adhere to ASHA Code of Ethics
* know ASHA Preferred Practice Patterns
* understand ASHA Scope of Practice
* understand and follow clinical policies and procedures
* maintain client confidentiality
* prepare for all clinic sessions
* choose appropriate diagnostic instruments
* write measurable Tx goals
* write effective Tx plans
* submit written assignments properly
* ask questions
* self evaluate
* apply academic info
* regular attendance
* maintain accurate clinical records

basic principles of oral and written presentations

* organize all info in a logical, cohesive manner by subtopic
* clearly introduce the topic
* avoid using technical language (when you can’t, explain paranthetically)
* use objective terms (observed, completed)
* avoid redundancy
* use person first language

strategies for verbal exchange

* attend to the comfort level of the listener
* explain the purpose of your discussion
* establish trust by being active, empathetic, and nonjudgemental
* allow your communication partner to participate in the discussion
* provide processing time
* avoid imposing your own values or beliefs
* provide clarification when necessary
* use interpreters as needed

person first language

* avoids the perceived or subconscious dehumanization that occurs when discussing people with disabilities
* emphasizes person first
* favors use of having not being

electronic medical records

storing patient info in a standardized electronic template accessed thru desktop computers or hand-held tablets and digitally archived in an access restricted server

diagnostic evaluation reports

* summarize info obtained in evals
* contains background info, summary of test results, diagnostic observations, interpretations of findings, prognosis for improvement, and recommendations
* legal documents that can be called into legal proceedings to determine service provision and liability issues

case conferences

focused opportunities to present info to or about clients

screening

identifies possible impairments that may interfere with speech, language, cognition, swallowing, or meta linguistic functioning

purpose of screenings

to determine if a full evaluation and referral is needed

limitations for screenings

only can tell pass fail

when to screen

* federal or state mandated
* school or facility procedures
* as needed, requested, mandated, or when evidence suggests there is a risk

clinical process of screening

1. obtaining parental, patient, or caregiver consent as mandated by federal, state, and or local regulations
2. sensitive to cultural and linguistic diversity
3. range of age appropriate, speech/language, hearing, swallowing, and other communication functions and activities en

ethnocultural considerations

must consider factors related to the individuals culture, ethnicity, social background, and other personal variables (age, gender, education). study and understand dialectal differences

standardized (formal) screenings

actual tests given, normed

example- PLS-5, CELF-5

non standardized (informal) screenings

parent interviews, classroom observations

diadochokinetic rate

screening method that is used to determine difficulties with motor speech tasks. measure of how quickly and accurately a client can produce a series of rapid sound sequences

puh puh puh tuh tuh tuh

difficulties may be due to apraxia or dysarthria

refer client to a physician

when doing a voice screening if a client fails you must ___

a second screening must be done within a month of first screen

if a newborn fails a hearing screening

2-6 weeks

re screen school age child if fail within __

hearing loss may cause language learning difficulties

why are newborn hearing screenings important?

response to 1000, 2000, and 4000 Hz at 20 db HL in both ears

passing on a pure tone hearing screening

evaluation/assessment

gathering and interpreting information so that decisions can be made

prognosis for recovery

made based on the data from the evaluation telling us the likelihood of improvement. can be based on severity and type of impairment, family support and client motivation, and co-occurring medical conditions. estimate of future communication skills.

diagnosis

identification of the nature of an impairment with a screening and evaluation

valid

truly evaluates the intended skill

reliable

repeated evaluation of the client’s skills will yield similar findings

accurately reflects the clients communicative abilities and disabilities

referral

referring for an evaluation based on a suspected impairment

adverse effect on educational purpose

how a child is negatively affected by their impairment

purposes of evaluation

* identify presence
* determine type & severity
* identify signs and symptoms
* determine prognosis for recovery
* document progress during therapy
* counsel families & patients
* inform physicians, medical personnel, health care and reimbursement agencies
* make referrals
* determine eligibility for services

comprehensive speech evaluation

includes the person’s ability to speak, express ideas, converse socially, understand language, read and write, ability to swallow and use AAC

process of evaluation- medical setting

1. weaknesses first recognized by physician who treats person for their brain injury
2. physician performs tests that require them to follow commands, answer questions, name objects, and carry on a convo
3. if communication or swallowing disorder is suspected, they are referred to an SLP
4. SLP performs comprehensive exam
5. other specialists evaluate the patient
6. create intervention plan

process of evaluation- educational setting

1. teacher makes referral based on concerns
2. SLP or Aud complete screening
3. if child fails screening, they are re screened at later date or recommended for an eval
4. if eval recommended the educational team will meet to discuss concerns and the evaluation process
5. written permission signed
6. 60 days from date of consent to complete the eval, write a report, and hold a meeting to discuss the eval team report

medical necessity

how the impairment affects the patient in areas of cognition, communication, hearing and or swallowing skills

qualities of a good evaluation

thorough, valid, reliable, tailored to individual client

standardized methods

criterion referenced and norm referenced

non standardized methods

behavioral observations, interviews, checklists, play based eval, dynamic eval, speech and lang sample analysis

instrumentation

audiometric (otoscope, audiometer, tympanometer), speech/lang, swallowing

evidence or concern of an impairment

clients are evaluated based on __

standardized assessment

test that requires the examiner to follow and standard procedure for administration and scoring

norm referenced and criterion referenced

formal testing

examiner has a strict script of directions and questions and no hints or prompting can be given

norm referenced assessments

a formal format for assessing speech and language

normative sample

allows for a comparison of a student’s performance to the performance of large normative groups

criterion referenced assessments

measures compare an individuals skills to a set of predetermined expectations

what they know at a certain age

ID what they can and can’t do

raw score

total number correct OR total number of errors

percentile rank

compares, reflect standing within the normative sample from the raw score

.01-99

standard and scaled scores

distance score is from the average, compares students

85-115

basals

starting point on a test

based on child’s age, may be able to skip past first few questions

credit given for 1-5 but if 6 & 7 are incorrect, must go back to 1

ceilings

ending point

predetermined number of consecutive errors regardless of number of questions left

test manuals

directions and scripts for tests are found in __

similarities between standardized tests

always given in the same way and scored the same way

norm referenced test properties

1. clear administration & scoring criteria
2. validity
3. reliability
4. normative sample
5. scores
6. basals and ceilings

advantages of standardized tests

* designed for diagnosing and determining some strengths and weaknesses
* allows for comparison with age or grade peers on an objective standard
* allows for comparison on several areas
* assesses discrepancies and broad strengths/weaknesses

disadvantages of standardized tests

* not suitable for all clients
* not designed to ID specific intervention objectives
* norm group may not represent the student (ethnocultural)

advantages of criterion referenced tests

* objective and easy to give
* tests for regularities in performance against a set of criteria
* useful for designing interventions
* can align with curriculum
* describes where the individual is functioning along a continuum of skills

disadvantages of criterion referenced assessments

cannot derive standard and scaled scores or percentiles

nonstandardized assessments

no formal instructions or directions for the assessment

case history

starting point for understanding the client

usually a form that is filled out by the client, caregiver, or person who gave the referral

reviewed by clinician prior to meeting client

interview

discussion with client, caregiver, teachers etc. Can be structured or unstructured, focus on the purpose

behavioral observations

conduct structured behavioral observations in the appropriate setting (home, work, care facility)

ex. if teacher cannot understand student, observe them giving a story retell

checklists

a form filled out by caregivers or teachers that can show areas of concern

play based assessment

looks at a variety of skills through play

some skills that can be assessed:

* speech/phonology
* receptive/expressive lang
* problem solving
* attention
* sensory
* fine/gross motor

dynamic assessment

* method of conducting a lang assessment which seeks to ID the skills that an individual child possesses as well as their learning potential
* emphasizes the learning process and accounts for the amount and nature of examiner invenstment
* individual is tested, skills are addressed, and then they are retested to determine treatment outcome
* can help distinguish between a lang difference and disorder

speech/lang sample

* min 50-100 words may need to be up to 200
* minimize distractions
* appropriate cues- tell me more, tell me about, why and how ?
* avoid close ended yes and no
* incorporate interests and follow their lead
* multiple settings

speech sample

* speech sounds in error
* phonological processes present
* speech sound production in connected speech
* intelligibility
* stimulability

language sample

* collect sample during real conversation
* multiple communication partners
* multiple samples
* vary contexts and activities
* time consuming
* Brown’s 14 grammatical morphemes