Clinical Methods and Observations Final Exam

25 clock hours

How many hours of observation must a clinician have before beginning clinic practicum?

15 in speech/language

5 in hearing

5 either category

What is the breakdown of observation hours needed?

Clinical Observation Form

What is the name of the form that must be filled out?

400 hours (25 observations/375 clock)

How many hours does ASHA require for clinical orientation?

Log Sheet - document

- client contacts or attempts to contact

- beginning and ending therapy

- cancellation and no-shows

- filing of treatment plan, progress note, etc.

Treatment Outcome Form (FCM)

What is on the left side of the client folder?

- Test protocols

- Informal assessment (language sample, SPT, etc.)

- All forms must be completed with names, dates, etc.

What is on the right side of the client folder?

1 hour session = 50 minutes

30 minute session = 25 minutes

What are the session times?

- schedule client

- reserve a therapy room

- turn in a copy of your completed schedule to your primary supervisor

- treatment plans (ITP) are due after providing 2 hours of treatment

What is on the beginning of semester checklist?

- lesson plans are due every Friday (along with results from previous week)

-client log is completed as needed

- daily SOAP notes are to be written and emailed to supervisor within 24 hours following the session. (initials only)

- earned hours are recorded daily and signed on a monthly basis by each supervisor

Responsibilities of the clinician include:

- list clients using initials

- indicate therapy or evaluation

- indicate disorder: articulation, language, etc.

- record hours by quarter, half, three-quarters or full hour, not 20 min. or 35 min. (.25, .5, .75, 1)

- get supervisor's signature at end of the month

- after initialed, make copy for primary supervisor

- transfer hours to excel spreadsheet

How to record monthly clinic hours?

- wash hands before and after

- gloves- oral mech exam, oral motor therapy, changing diapers, handling ear molds

- mask

- clean table, materials, and toys after each use

What are the infection control and environmental cleaning protocols?

- all materials and tests are checked in and out electronically using the computer in the front office

- check out procedures can be found in the handbook and posted on the computer monitor

What are the materials check in/out procedures?

- laptops

- recorders

- iPads

- flashdrives

What are other materials the clinic has available?

- assessment

- treatment preparation & planning

- session/client management

- treatment efficacy

- writing

- professionalism

How are clinicians graded in clinic?

intervention activities/contexts vary in their degree of naturalness; therefore, documentation style/wording will vary as well

What is the intervention continuum of naturalness?

- clinician-directed

- drill, drill play

What are the least natural characteristics defined as?

- organized activities

What are hybrid methods characterized as?

- client-centered

- daily activities/ routines

What are the most natural characteristics defined as?

Individual Treatment Plans (ITP)

outline the intended plan at the beginning of therapy

Lesson Plans

describe treatment plans/activities for one or two sessions

SOAP Notes (Session Notes)

reports client's performance during the session; records data for each task so that changes can be implemented as needed

- correct spelling, grammar, punctuation

- use full names of tests on first mention, then use acronym

- use impersonal style

- word choice

- strengths and weaknesses

- exaggeration and overstatement

- differentiate information

What are the style guidelines for paperwork?

Strengths and Weaknesses

identify both the positive and negative that must be reported

Exaggeration and Overstatment

avoid, be kind use descriptive language that is supported by fact

Differentiate Information

outside information can be used but must identify original source

- identifying information

- current performance

- long-term and short-term objectives (LTOs and STOs)

- data achieved

What does a treatment plan (ITP) include?

Identifying information

- name

- DOB

- age

Current Performance

description of client and information gathered

Long-term and Short-term objectives (LTOs and STOs)

broad changes (achieved by end of semester), smaller goals achieved on the way to achieve the larger goal

SMART goals

technique that can help create clear, concise, measurable goals that make intervention implementation and data collection a much easier task

Specific

goals should be clearly defined (who, what, how, why)

Measurable

goals should reflect a data collection that can track the progress and measure outcomes

Achievable

is the goal obtainable? think about client's current levels of performance and be sure not to aim too high or too low

Relevant

is the goal appropriate to the client's overall quality of life; this can also relate to parents and teachers

Time Limited

this is the deadline, this creates and gives you a frame of reference for your treatment timeline

- performance

- condition

- criterion

What are the components of writing goals and objectives?

Performance (Do)

describes what client is supposed to do

Condition

under which the action is supposed to occur

Criterion

level at which performance is considered successful

Performance characteristics

- contains a verb(s) that identifies the action the client is to perform

- point

- name

- match

- read

- say

- produce

Examples of words used to describe performance:

- understand

- learn

- remember

- know

Examples of words to avoid when describing performance:

Condition characteristics

this portion describes the behavior to be performed- when it will occur, where, in whose presence, and with what materials or cues

- following a clinician's model...

- in response to a question...

- when presented with an array of common objects...

- ... when requested by the clinician

Examples of conditions include:

Criterion characteristics

specifies how accurately target must be performed to be achieved

- ... 90% accuracy...

- ... 8 out of 10 opportunities...

- ... make fewer than 4 errors in three consecutive sessions

Examples of criterion include:

- description of the session's activities written in behavioral terms

- contain smaller objectives that work toward the goals for semester

- indicate the LSO(s) and STO(s)

- objective

- RS

- Materials

- Results

- always write in terms of the client "The client will..."

What information is included within a lesson plan?

Objective

"the client will imitatively produce /l/ at least 10 times in a 30-minute session"

RS (Reinforcement Stimuli/Schedule)

stickers, candy, verbal praise

Materials

picture stimuli, mirror, tongue depressor

Results

"8 times"

- record numerical data and clinical observations from the session

- S- subjective

- O- objective

- A- assessment

- P- plan

Daily SOAP notes (session notes) include:

SOAP: Subjective

- include qualitative descriptors of the client's affect, demeanor, responsiveness, involvement, etc.

- describe relevant behaviors, but do not label. For example, we can describe behaviors that are suggestive of depression but we cannot diagnose depression

- "AS was slow to warm up initially. After a few minutes, AS was able to point to pictures"

- "BR was in a playful mood entering therapy"

Examples of "Subjective" information:

SOAP: Objective

- session objective listed and numbered from lesson plan

- provide outcome data for each objective listed - provide data to document the client's response accuracy, latency, completeness, etc.

- data are usually provided on a goal-by-goal bases and typically are quantitative

SOAP: Assessment

- evaluate the subjective and objective information gathered during the current session relative to previous performance (i.e. baseline levels and subsequent treatment sessions)

- Is the client making adequate progress? If not, are there identifiable barriers to progress?

- BR is improving upon his baseline performance

- Compared to previous sessions, AS produced more vocalizations than in previous sessions

- EG required fewer cues from the clinician today, as compared to last week

Assessment example:

SOAP: Plan

- on the basis of your assessment, do you plan to modify or discontinue treatment?

- in most cases, the plan will be to continue the present treatment plan

- clinician will use data collected in today's session to formulate client's ITP for the semester

- further assessment will be completed to determine treatment plan

- continue with current treatment plan

- AD will be dismissed form therapy at this time as she has achieved all long-term goals

Plan characteristics could include:

- #3 best health care job

- #9 in 100 best jobs

What is Speech Language Pathology ranked as an occupation?

- national professional and credentialing association for members and affiliates who are audiologists, speech-language pathologists, and students

- Certification standards are based on skills validation studies and practice analyses involving employers, leaders in the discipline of communication sciences and disorders, and practitioners

What is ASHA?

- academic program accreditation

- clinical certification

- continuing education provider

- clinical speciality certification

What are the four different credentialing programs that span the continuum of professional development?

ASHA Code of Ethics

intended to ensure the welfare of the consumer and to protect the reputation and integrity of the professions

- preamble

- principles of ethics

- rules of ethics

What are the three parts of the ASHA code of ethics?

Preamble

introduces philosophy of ethical service delivery and overall content of code

Principles of Ethics

divided into 4 principles about conduct

Rules of Ethics

acceptable and restricted actions

individuals shall honor and abide by these principles as affirmative obligations under all conditions of applicable professional activity; rules of ethics are specific statements of minimally acceptable as well as unacceptable professional conduct

Expectations of the ASHA code of ethics:

Principle I

Welfare of persons involved

- HIPPA

- Consent

Principle II

Professional Competence

- highest level of performance

- proper use of equipment

Principle III

Promoting Public Understanding

- advocation

- dissemination of research finding

- accurate education and experience

Principle IV

Professional Relationships

- between other disciplines and professionals

- delineate areas of professional practice

- inform others (e.g.., health care providers, educators, consumers, payers, and general public) about professional roles/responsibilities of qualified providers

- support SLPs in the provision of high-quality, evidence-based services to individuals with concerns about communication or swallowing

- support SLPs in conduct of research

- provides guidance for educational preparation and professional development of SLPs

What is the purpose of the Scope of Practice in Speech-Language Pathology?

Confidentiality

- client's rights to privacy protected under Code of Ethics

- In addition, privacy is provided by federal and state laws (HIPPA) Health Insurance Portability and Accountability Act

- Professionals share information only with those directly related to client's welfare

- client files are NEVER allowed out of the building

- files are kept in supervisor's slot of cabinet. files may be taken from office for review or into student work room for writing reports or clinic notes. however, students are responsible for returning the files to the locked file cabinet in the office by the end of each day. use red file marker system

- all identifying information must be deleted from any information (e.g., diagnostic report, IEP) that is photocopied from a client's file

What are the Confidentiality Guidelines?

- use client initials within emails

- do not discuss your client in public areas

- do not leave client information unattended

- client documents should be written using MW computers and using MW flash drives for file transfer

Things to remember regarding clients and client reports

Health Information Portability and Accountability Act (HIPPA)

- 1996 law designed to improve the efficiency and effectiveness of the health care system

- divided into two parts

Title I: Health Care Access, Portability and Renewability

- protects health insurance coverage when someone loses or changes their job

- addresses issues such as pre-existing conditions

Title II: Administrative Simplification

- includes provisions for the privacy and security of health information

- specifies electronic standards for the transmission of health information

- requires unique identifiers for providers

- establish effective working relationship

- provide feedback

- clinical implementation

- diagnostic skills

- client management skills

- documentation

- self-analysis

- resources

- model/expect professional behavior

- evaluation

What is the role of a clinical supervisor?

- adhere to ASHAs code of ethics and scope of practice guidelines

- develop working relationship with supervisor

- follow clinic policies and procedures

- respect clients' beliefs

- preparation

- writing

- apply information learned in academic courses

- self-evaluate

- clinic hour log

Responsibilities of the student clinician?

- diagnose, treat

- communication, swallowing

- children, adults

- schools, medical sites, etc.

So what do SLPs do?

behavior to be changed + effective treatment = changed behavior

How do SLPs know how to make a difference?

- evoking

- creating

- increasing (existing)

- strengthening

- controlling

What are the basic methods of clinical treatment?

Evoking

trying to elicit or bring about a goal

- instructions

- modeling

- prompting

- physical stimuli

Instructions

- selecting the behavior to be targeted

- consider cognitive and linguistic level

- want to rehearse

- test client's understanding of the instructions

- give new instructions at the target changes and shifts

Modeling

- the clinician's production of a client's target response

- stimulus that leads to imitation

- evidence-based; widely clinically used

- type of treatment not imitation

- "fading" models

Prompting

- = cues

- AKA clues

- "partial" model

- consider fading

Physical Stimuli

- pictures, objects, and demonstrated events

- used in the beginning stages

- should not be needed in the final stages

Creating new responses: Shaping

- clinician is guiding the client to successfully approximate step by step to the desired and final target response

- can be done with any area (initial, medial, final)

Increasing response frequency: positive reinforcement

- primary reinforcers

- social reinforcers

- conditioned generalized reinforcers

- feedback

Primary Reinforcers

- food items

- use when a more natural reinforcer is not working

- always ask parent permission

Social Reinforcers

- intrinsic motivators

- naturally occurring events (smile, eye contact, high five, attention)

Conditioned Generalized Reinforcers

- associated with other

- ex. token system to exchange for a backup reinforcer

Feedback

- quality of response

- reinforcer for correct or incorrect behavior

Strengthening and Sustaining

- continuous

- fixed ratio

- variable ratio

- differential reinforcement of other behavior (DRO)

- fixed or variable interval schedule

Continuous

- every response is reinforced

- good when trying to establish a behavior

- can become unnatural- would want to fade this

Fixed Ratio

- reinforcers are given at a set given number of responses

- ex. after every 10

Variable Ratio

- reinforcement given around an average given number of responses

- avg. 5 - reinforce at 4 and 7

- produces a strong response rate

- typically used later in treatment when monitoring behaviors

- wanting targets to generalize into spontaneous speech

Differential Reinforcement of other behavior

- goal is to increase desirable behaviors and decrease undesirable behaviors without the use of punishment

- reinforcing the absence of an undesirable behavior