Final Study Guide

Chapters 5-8

where does data for goals and objectives originate from?

comprehensive assessment and/or progress monitoring activities

Screenings cannot be used to develop goals/objectives because….

they only can tell pass/fail regarding the possibility of an impairment

norm referenced tests are not good sources of data for objective development because….

they were not designed to create intervention objectives

nonstandardized tests including dynamic assessments are preferred because….

they provide more reliable and valid data for each particular client

normative approach

* aka developmental approach
* target skills and behaviors expected for the clients age
* mostly used with younger, less severely impaired children

client specific approach

* aka functional approach
* target skills/behaviors that will make a significant different to the life of the client
* do not necessarily follow norms

How to select which skills to be targeted during treatment?

select a skill that will-

* make an immediate difference in educational performance, daily living activities, or progress
* generalize to the classroom, home, etc.
* sustained over time
* prerequisites or foundational skills
* expand communication skills
* promote communication independence

When selecting skills, they must…

* fulfill a need
* be useful in daily routines
* naturally reinforced

Guidelines for selecting goals/objectives

* area of concern
* client interests and motivations
* clients current level of functioning
* cultural or linguistic factors
* task analysis and sequence

task analysis may be used because…

during an evaluation you may come across a particular skill or behavior the client is consistently struggling with and might choose it as a goal

steps for writing goals/objectivees

1. collect evaluation data
2. analyze evaluation data
3. consider


1. developmental milestones & curriculum expectations (child)
2. clients level of functioning prior to services
3. past progress if available
4. determine communication needs


1. what are major areas of weakness? positive effect on quality of everyday functioning
5. determine long term goal


1. final level the client is expected to achieve within a predetermined time frame
6. develop STO based off the task analysis, underpinning skills, or prerequisite skills

school based goals for..

students

community and vocational based goals for…

older students and adults

SMART goals

Specific, Measurable, Attainable, Relevant, and Timely

Specific

relates to the behavior and accompanying condition

measurable

* behavior must be observable and data can be collected from it
* should contain performance criterion (expected level of mastery and degree of independence)

attainable

* can be realistically achieved within the IEP cycle
* written relative to baseline data and past progress
* service delivery model designed to ensure goals are mastered during IEP

relevant

* goals should be relevant to daily activities
* ties to the clients weaknesses
* contains a behavior that will generalize to different settings and partners

timely

* has a beginning and end date
* if not making adequate progress, goals etc. should be reviewed/revised

goals/objectives need to be SMART to ensure…

they are easy to understand, target, and measure objectively

goal

aimed desire or result

objective

more specific goals that focus on a specific target

mandatory elements

* condition
* behavior
* criterion

condition

condition under which the behavior is to be performed

* situation, setting, given materials
* example: given a paper/pencil task, during a role play activity

specific behavior

* clearly defined behavior or specific action that is expected to be performed
* must be an observable behavior
* example: answer yes/no questions, define a vocabulary word, greet a peer

criterion

desired performance criteria

* level that must be demonstrated for mastery
* prompting or cueing
* independence
* steps
* grade level
* # of elements
* number of times client must demonstrate the skill/behavior
* consider prognosis for recovery and baseline data

stranger test

view the draft goals through the lens of a stranger who is unfamiliar with the child and circumstances

purposes of intervention

1. eliminate the underlying cause or impact of disorder
2. preventative intervention
3. tech compensatory strategies
4. remediate the problem fully
5. slow the progress

no “one size fits all” intervention because….

all interventions are individualized based on the client and their needs

duration

length of a session in time (ex. 50 minutes)

frequency

number of sessions per unit of time (ex. 2/week)

what makes a service intensive?

when it is 1:1

some considerations when setting up a treatment room

* following your facility’s process for selecting
* enough table space and chairs for everyone (especially if group setting)
* position yourself where you can work with the client and access therapy materials within reach
* cover materials if client will be distracted by them

lesson plans

carefully designed documents that spell out what you will do during interventions and will tell you what materials will be needed

I DO

modeling

WE DO

guided practice

YOU DO

independent application

main components of a lesson

* icebreaker
* warm up/ refresher activities
* teaching a new skill/strategy or the instructional phase with error correction
* application phase or practice
* self evaluation or cool down
* probing for next session
* homework/generalization

take into consideration when selecting materials and stimuli

* age or grade
* reading skills
* functional or educationally relevant
* motivation or fun
* obsessions, allergies, or fears
* culturally appropriate

scaffolding

* building upon the language skills a child already has
* used by:
* modeling
* simplifying questions
* slower speech
* reinforcement

error correction

* taking a recording of a client (or the below) and see if they can identify errors
* provide more or different support/scaffolding
* repetition
* clarification
* modeling
* drop back- may need to work on easier tasks

how is group size determined

* consider availability, abilities, needs, strengths, weaknesses

why choose small group?

* some clients can become distracted or need a lot of support/assistance. 1:1 or small may be best
* sometimes insurance companies may only reimburse for 1:1

why choose large group?

* good for addressing social skill goals, practicing expressive/receptive lang skills, listening comprehension
* can learn from others in the group by observing
* ex: how to greet, start a convo, stay on topic

what to look for during data collection

* measurable objectives/goals
* baseline data
* treatment plan addressing target skill
* measure progress regularly over time
* make adjustments as needed
* promote generalization and maintenance

measuring skills/behaviors

* frequency
* durational
* derivitve

frequency of a behavior/skill

* taking a tally of the number of times a client exhibits a target behavior in a specific time frame

duration of a behavior/skill

* used to quantify the amount of time a client engages in a target behavior
* total duration per session
* duration per occurrence
* works well for measuring pragmatic lang behaviors or attention

total duration per session

count up length of time behavior occurs across the session

duration per occurrence

count the length of time each behavior occurs individually

derivative of a behavior/skill

* combining two sets of data to obtain a measure
* most common= percentage data

purpose of SOAP notes

* briefly summarize evaluation results and the accompanying plan of care
* document patient performance in therapy
* document critical events like cancellations, contacts, and refusals
* justify discharging the patient and document the discharge recommendations

why do clinicians use SOAP notes

* monitor therapy progress
* communicate with other professionals
* used for third party reimbursement

when are SOAP notes needed

* after every session
* after a contact with/about a client

S=Subjective

* general impressions of client, SLP and/or family regarding happenings in the session or progress noted in the client at home
* personal opinions, observations
* direct quote from client or family
* relevant client behaviors or status
* brief

O=objective

* record data collected for each task/goal
* what did you do during the session?
* goals, progress, data- measurable numbers
* consistent day to day reporting
* if using a percentage, include number or trials
* clients level of independence

A= assessment

* analysis of what happened during the therapy session
* interpret the data for the current session; compare to previous levels of performance
* hypothesis for why change did or did not occur

P=plan

* proposed therapy targets for next session
* general direction for next session
* any needed contacts with other professionals
* any changes to therapy plan, goals, or schedule

Example of Plan

* Continue with current goals.
* No therapy on XX/XX/XX due to doctors appointment. Next session will be XX/XX/XX.
* Continue therapy, focus on reading comprehension next session.

Assessment Examples

* Patient improved in his ability to trigger swallow reflex promptly after stimulation by 20% from last week, which resulted in improved safety of swallow function.

Objective Examples

* In a structured setting, client independently produced /s/ in the initial position of words in 30 out of 40 attempts (75%).
* When playing with a peer, client spontaneously used noun + verb combinations 8 times during the 30 minute session.

Subjective Examples

* The clients mother stated “He is doing much better with his speech at home.”
* The client willingly accompanied the clinician to the therapy room. She fully participated in all activities.
* The client was crying during the session today. She stated, “My best friend isn’t talking to me.”

law

* begin as bills that move through legislative committees (state or federal)
* after they are passed by legislative bodies, different version are reconciled as necessary and signed into law or vetoed by executive officials who become responsible for implementing any current acts

what federal laws protect the rights of individuals with disabilities

* ADA (Americans with Disabilities Act)
* Section 504 of the Rehabilitation Act
* IDEA (Individuals with Disabilities Education Improvement Act)

purpose of 504 section of Rehabilitation Act

* protect the rights of qualified individuals with disabilities
* states that an individual cannot be excluded from participation in, denied the benefits of, or subjected to discrimination under any program or activity receiving financial assistance from the federal government.

what must happen before an IEP

a full evaluation

medicare

* an extension of the Social Security Act
* administered by a federal agency called the Centers for Medicare and Medicaid Services (CMS)
* available to those who turn 65, those younger than 65 who have been diagnosed with amyotrophic lateral sclerosis, a qualifying disability, or those of any age at end stage renal disease.

medicare pertaining to SLP/Aud services

Part A

* Part A provides prepaid hospital insurance
* no premium
* covers most medically necessary assessment and treatment services for speech, lang, hearing, balance disorders
* no reimbursement for hearing aids or related testing

medicare pertaining to SLP/Aud services 

Part B

* Part B offers additional optional medical insurance financed through a monthly premium paid by the individual
* does not cover hearing aids but covers AAC

Medicaid

* funding comes from state, federal, and city taxes
* run by state governments under guidelines from federal government
* created for those of low socioeconomic status with no financial means to pay for medical care

who qualifies for medicaid

It is based on age, income, retirement, disability, or unemployment

exception for providing SLP/AUD services for children under Medicaid who are under age 21

mandated to receive benefits including periodic screenings and wellness checks thought the Early and Periodic Screening, Diagnostic, and Treatment services.

Individuals with Disabilities Education Improvement Act (IDEA) ensures that

eligible children (birth-high school) with disabilities are provided special education services.

Newborn and Infant Hearing Screening and Intervention Act requires

early hearing screenings and evals for all newborns

stimuli

physical or auditory event

self injurious behaviors

behaviors that may injury the client

operant conditioning

* behavior is shaped and maintained by immediate consequence
* learned behaviors are a result of previous exposure to consequence
* infinitely varied
* EX: child touches hot stove and has immediate consequence of pain. child learned to not touch the stove again.

respondent conditioning

* occur due to past associations with antecedent events
* behavior is reflexive
* few and finite
* EX: child is bitten by a bulldog. child’s heart races every time they see a bulldog in the future.

positive reinforcement

* process of strengthening and increasing a behavior
* a desired stimulus is present immediately following a desired behavior
* EX: a child completes a task and is given their favorite toy

negative reinforcement

* process of strengthening and increasing a behavior
* an aversive stimulus is removed immediately following a desired behavior
* EX: Johnny is bothering Jane (antecedent). Jane asks Johnny to leave her alone (behavior). Johnny goes away (removal of aversive stimulus)

differential reinforcement

* occurs when a specific response is reinforced and another specific response is not reinforced
* used to increase a desired behavior and to simultaneously decrease an undesired behavior

positive punishment

* process of decreasing a specified behavior
* presentation of a stimulus immediately following a behavior that results in a decrease of that behavior
* EX: a child begins to run into the street and their parent yells stop. the introduction of the stimulus stop is effective and decreases the behavior of running into the street

negative punishment

* process of decreasing a specified behavior
* removal of a stimulus immediately following a behavior that results in a decrease of that behavior
* EX: a child refuses to clean his room and his parents remove a sticker from his chart. removal of the sticker is effective and decreases the behavior of refusing to complete a task.

token economy

visual representation of reinforcement or a reward that’s going to come later on for behavior that you’ve done now

what is the purpose of a token economy

* help visualize progress
* accept and work for delayed reinforcement
* learn to self-monitor
* learn to regulate behavior

evidence based practice

* framework integrating external scientific evidence, clinical expertise, and client perspective to answer clinical questions and make informed decisions
* necessary by ASHA to provide high quality, individualized clinical care

where can external scientific evidence be found

outside of everyday clinical practice, usually methodologically sound research

steps of evidence based practice

1. framing the clinical question
2. finding the evidence
3. assessing the evidence
4. making the clinical decision

why is external evidence important to the evidence based practice decision making process?

it helps you determine whether an approach or a service delivery model might be effective at implementing change in individuals like your client

why is professional judgment important to the evidence based practice decision making process?

because they can provide insight into how clients and caregivers feel about the services they are receiving (social validity)  and their culture and preferences

why is it important to consider your clients background?

everyone has different strengths, weaknesses, cultural beliefs, and experiences and treatment is not universal for all