327 - Exam 1: Basics and Foundations of Treatment Plans
● SLU’s Speech-Language-Hearing Clinic
○ Offers opportunity for undergraduate clinical contact hours
○ Offers source of clinical observation hours (CSD 3280)
○ Practicum (“clinic”) must be applied for (CSD 3000, CSD 4100)
○ Teaching facility : clinician and supervisor
○ Accredited: We adhere to standards!
● Supervisor
○ SLP with current CCC-SLP, or CCC-A
○ Must be qualified in area of supervision
○ Must supervise 25% minimum of clinician’s contact with client
○ Supervisor must be available for consultation with the clinician
○ Supervisor should provide direct observation, instruction, and feedback
○ Supervisor must adhere to ASHA Code of Ethics
● Clinician
○ Perform all clinical skills with supervision (screen, assess, intervene, generate reports, make clinical decisions)
○ Be an active participant in all staffings and conferences
○ Accept feedback and take action
○ Self-evaluate
○ Adhere to ethical Code of Conduct
○ Exhibit professionalism (dress, demeanor, punctuality)
● Ethical Conduct
○ ASHA and LBESPA both have a Code of Ethics that SLPs and SLP-As are required to follow
○ Protects you and your clients…(it’s protected me!)
○ Protects research participants
○ Maintains competencies
○ Protects the public/clients
○ Protects the profession from other disciplines
● Ethics and Laws
○ Confidentiality
○ HIPPA: Health Insurance Portability and Accountability Act
■ Protects your client! Signature!
○ FERPA: Family Education Rights and Privacy Act
■ Protects student confidentiality
● Professionalism
○ Appearance: See the CSD clinic manual!
○ Appropriate communication and interactions: Verbal, non-verbal, written, culturally aware and sensitive to all levels of function
○ Neurodiversity, gender identification/pronoun use, religion, cultural practices
○ Consistent self-assessment and self improvement (leave your ego at the door!)
○ Appropriate conflict resolution
● Hours & Procedures
○ Adhere to ethical, professional and SLU Clinical Procedures
○ Obtain 25 observation hours (via CSD 3280) including adult and pediatric clients
○ POTENTIALLY obtain 75-80 clinical contact hours (must be via an educational institution)
○ With 100 hours (25 observation + 75-80 contact hours with variation of SSDs and language) can apply for SLP-A license
○ Graduate school: carry over 25 observation and 50 clock hours from undergraduate program
The Foundations of Treatment Plan
● What Is A Treatment Plan?
○ Aka: plan of care, iep, care plan
○ How do you plan to intervene or treat the deficits/disorders identified via the evaluation/assessment?
○ Will include long term goals and short term objectives
○ Will include procedures for achieving the goals and objectives
● A treatment plan (iep, poc) is dynamic and can be edited and adjusted as the client’s needs change.
● Because a treatment plan in part is a continuation of assessment….you are always assessing your client!
● Assessment
○ Identify difference vs disorder
○ Identify severity and characteristics
○ Identify direction of treatment
● Principles of Intervention
○ A principle is a general rule, not a specific procedure
● General Principles of Intervention
○ Dynamic!
○ Facilitates specific aspects of communication (function!)
○ Ideally in a communicative context
○ change as the session tells you to change
○ be responsive to your clients performance
○ entertaining a client does not help them (be functional!)
○ stick to your objectives/goals (short and long term)
○ think about communication vs just verbalizing something
■ Do I want this pizza? Or is this person telling me I should want this pizza? (ABA vs Speech therapy)
○ Individualized (each client has their own objective/what they want from speech therapy)
○ In the zone of proximal development (learning zone)
■ Learning with support
■ How can I challenge my client while still keeping to the client’s abilities?
○ Evidence Based Practice
○ DEI: be sensitive to culture and language of client
■ patient and family centered care
○ Terminated once goals achieved, or maximum progress reached/no more benefit
● Session design — if you build it, progress will come
● Things to Always Include
○ Orient and set expectations (e.g., schedule and what objectives will we cover)
■ Introduction of some kind
○ Provide specific feedback
■ “I liked how you lifted your tongue tip”
■ “Your sentence has so many descriptive words!”
○ Recap: what did we accomplish and what do you think?
○ type token ratio
○ gestalt
● Continuum of “Naturalness”
○ Want them to learn to function in their natural environment
○ do therapy in a natural type of activity/environment
○ How do people learn?
● Ends of the Continuum
○ Clinician directed <—> client centered
● Examples Along the Continuum
○ Drill
○ drill play: drill and then get a reward like a sticker
○ structured play: clinician chooses a play objective (like playing dolls) and
○ literacy-based
○ play
○ unstructured tasks
● Pros and Cons
○ Clinician Directed
■ Least natural
■ example: drill
■ Can help target specific skill, teach new skill
■ does not support generalization
○ Client Centered
■ most natural
■ example: tea party, bouray
■ promotes generalization
■ may not allow you to target new or specific skill
● How to teach skills
○ Direct modeling: clinician demonstrates the skill, client imitates
■ expectation is 1 to 1
■ response after stimulus
■ model imitation
○ Indirect modeling: clinician demonstrates target skill frequently (exposure)
■ lots of exposure to model and less responses
○ Shaping: break down the target into parts to build towards more accurate approximation
■ take something hard and break it down to smaller pieces
○ Prompts/cues: any multisensory supports given to facilitate accurate execution of the skill
○ Fading: support is gradually reduced
○ Expansion: clinician repeats clients response but adds complexity, makes it more correct
○ Negative practice: client intentionally produces error to understand contrast
■ stuttering, voice, speech sound production
■ saying the word wrong to understand the difference
○ Target-specific feedback: tell them what they did wrong or right (support self-monitoring)
● Why is my client in speech therapy? What primary reinforcer or secondary reinforcer am I helping? Intrinsic reinforcement
● even with younger clients make sure they understand why they are in therapy (even if it’s just saying we’re working on our r’s)
● Methods of Reinforcement
○ Social: smile, eye contact, verbal praise, acknowledgement of the communication
○ Tangible: perceptible by touch
○ Token: earning rewards, receiving a reinforcer that is perceived as valuable
○ Performance feedback: giving specific info on why a response was correct
● Schedules of Reinforcement
○ Continuous reinforcement
○ Intermittent reinforcement — typically more effective; want to tap into primary reinforcers
● How do we learn?
○ Gestalt: top down big picture first
○ visual
○ motor
○ kinesthetic
○ auditory
○ Bottom-up: wanting to learn the pieces first and then come together
● Planning Intervention
○ Impairment and learning style need equal consideration and the impairment might drive the learning style
○ Where might their impairment affect their learning or learning styles?
○ We need to have our sessions be multi-sensory until we figure out what works best for the client
● Diversity, Equity, and Inclusion
○ Leave yourself at the door
○ Recognize that each client may come from different backgrounds and experiences that shape their learning preferences.
Essential Functions in Speech-Language Pathology, speech-language pathology assistants and speech-language pathologists, as outlined in their respective Scopes of Practice: conduct assessments; provide intervention; consult and collaborate with other professionals, clients and family members; create and maintain professional and clinical records and conduct research in the areas of communication disorders. As such, speech-language pathology assistants and speech-language pathologists:
1. Utilize appropriate and effective spoken, written, and nonverbal communication with clients and colleagues from a variety of cultural backgrounds.
2. Learn complex information, perform clinical problem solving, and synthesize and apply information from the discipline of human communication sciences and disorders and related disciplines to formulate diagnostic and treatment judgments.
3. Perform routine client/patient care requiring sensory acuity and motor skills, social affective skills and appropriate demeanor and rapport for professional interactions and quality client/patient care.
4. Demonstrate flexibility and the ability to adjust to changing situations in professional or clinical environments.
5. Evaluate technical and personal skills that contribute to positive patient/client outcomes.
6. Accept constructive criticism and respond by appropriate modification of performance or behavior.
7. Possess reading comprehension and writing competency in English sufficient to meet curricular and clinical demands.
8. Maintain emotional and mental health necessary to use one's intellectual abilities, to promptly complete responsibilities and to develop appropriate relationships with faculty, supervisors, staff, peers, clients, parents, caregivers and other professionals
Technical Standards for the Discipline of Speech-Language Pathology, speech-language pathology assistants and speech-language pathologists, as outlined in their respective scopes of practice:
1. Demonstrate honesty, integrity, and professionalism consistent with the profession’s Code of Ethics.
2. Μaintain confidentiality of client/patient information.
3. Demonstrate appreciation and respect for peers’, colleagues’, staff’s, clients’/patients’, and significant others’ individual, social, and cultural differences.
4. Demonstrate appropriate behaviors, emotional stability, and attitudes to protect the safety and well being of clients/patients and peers.
5. Demonstrate flexibility and the ability to adjust to changing situations in professional and clinical situations.
6. Reflect on professional and clinical performance and accurately self-assess performance.
7. Observe clients’/patients’ activities and behaviors through visual, auditory, and tactile/kinesthetic modes in order to accurately interpret and document assessment and treatment procedures. Visually and auditorily identify normal and disordered communication, cognition, social interaction and feeding/swallowing.
8. Accurately monitor, through visual, auditory and tactile modalities, equipment displays and controls used for assessment and treatment of clients/patients.
9. Perform moderately strenuous continuous physical activity during clients’/patients’ assessment, treatment, or transition (i.e., push an adult in a wheelchair, pick up and carry equipment and treatment materials, engage in play activities with young children).
10. Accurately and efficiently use equipment and materials to ensure the safety of clients/patients during assessment, treatment or transition.
11. Comprehend, integrate, and synthesize a large body of information in a short period of time during assessment and/or treatment procedures.
12. Analyze and manage complex client/patient behavioral, motoric or sensory limitations.
13. Utilize appropriate and effective spoken, written and non-verbal communication. This includes active listening, quickly synthesizing information, and responding contingently.
14. Be able to communicate with clients at a level consistent with competent professional practice, as outlined by ASHA: It is the position of the American Speech-Language-Hearing Association (ASHA) that students and professionals in communication sciences and disorders who speak with accents and/or dialects can effectively provide speech, language, and audiological services to persons with communication disorders as long as they have the expected level of knowledge in normal and disordered communication, the expected level of diagnostic and clinical case management skills, and if modeling is necessary, are able to model the target phoneme, grammatical feature, or other aspect of speech and language that characterizes the client's particular problem.
15. Αccurately read, comprehend, and interpret information from diagnostic tests, equipment, and client/patient records.
16. Accurately complete documentation in a timely manner. Accurately proofread and edit own documentation.
17. Modify communication style to meet the communication needs of clients, caregivers, and other persons served and recognize when a patient's family/caregivers do or do not understand the clinician's written and/or verbal communication.
18. Maintain appropriate professional behavior including punctuality, regular attendance,
maintaining client confidentiality, and completing all duties and assignments pursuant to one's
academic plan.
19. Manage the use of time effectively to complete professional and technical tasks within realistic time constraints
20. Dress appropriately/professionally and provide for one's own personal hygiene and professional behavior.