Ch. 11: Assessment & Treatment: Principles of Evidence-Based Practice Flashcards Preview

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Flashcards in Ch. 11: Assessment & Treatment: Principles of Evidence-Based Practice Deck (119):
1

Evidence Based Practice

Form of practice that ensures that clients receive services that are known to be based on reliable and valid research and sound clinical judgment.

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Screening

A brief procedure that helps determine whether a client should undergo further, more detailed assessment.

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Case History

Yields detailed information that helps the clinician understand the client and his or her communication disorder and associated variables. Involves gathering information about the client’s family, health, education, occupation, and other variables such as cultural and linguistic factors. Emphasis depends on the age of the client and the nature of the disorder.

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Prognosis

A professional judgment made about the future course of a disorder or disease. It is a predictive statement about what might happen under various future circumstances.

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Factors Influencing Prognosis

- Severity of the disorder
- Client’s general health
- The physiological course of an underlying disease
- Time of intervention
- Quantity, quality, and intensity of treatment offered
- Consistency with which treatment is received
- Family support for the client and participation in the treatment process
-Client’s motivation to work hard in treatment and outside the treatment setting
- Social reinforcement for maintaining gains made in treatment
- Client and family’s religious and cultural beliefs about the necessity for and efficacy of treatment

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Hearing Screening

A quick procedure to determine whether a client can be assumed to have normal hearing or needs to be more thoroughly evaluated by an audiologist.

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Orofacial Examination

An evaluation of the oral and facial structures to identify or rule out obvious structural abnormalities that affect speech production, and therefore, may require medical attention or affect communication treatment.

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Interview

Involves a face-to-face exchange with the client, family members, or both to obtain additional information given on the printed case history form. Can be used to obtain data or information, to inform the clients and their families, and to provide support. Should include:
- Orienting the interviewees to the nature of the interview
- Explaining why certain information is requested
- Not making the client feel rushed
- Listening
- Using appropriate verbal and nonverbal communication
- Assuring the client of (and maintaining) confidentiality

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Rapport

Respect, trust, and a harmonious relationship between the clinician and the family. Also involves recognizing and accounting for cultural and linguistic variables that might influence the interview.

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Speech and Language Sample

The primary means of assessing a client’s speech and language production. Many clinicians record the sample for further listening, and some clinicians videotape the sample. More naturalistic than standardized tests. Goal is to obtain a representative sample of the client’s speech-language production in naturalistic contexts that reflect the client’s everyday communication.

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Multidisciplinary Teams

Team members represent multiple disciplines, but each member conducts his or her individual evaluation, writes a separate report, and has little interaction with other team members.

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Transdisciplinary Teams

Multiple specialists work together in the initial assessment, but only one or two team members provide services.

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Interdisciplinary Team

Team members from multiple disciplines interact and use each other’s suggestions and information in interpreting data. The team collaboratively writes the evaluation report and intervention plan.

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Standardized Test

A test that is systematic. Has explicit directions and strict controls about what the examiner must say and do. Specific stimuli are used, and there are explicit rules for scoring the test. The goal is to ensure that the behaviors being measured are not influenced by the examiner’s biases. Administration should be uniform across all examiners. Results yield quantitative information, allowing the client’s performance to be compared to peer performance that was sampled in the standardization process. A test can be standardized without being norm-referenced. Limitations include inadequate and non-diverse sampling.

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Norm-Referenced Test

Purpose of this kind of test is to compare the individual client’s score to the average score of the normative group. This allows the clinician to determine if the client has a problem, if the problem is clinically significant, and whether the problem warrants intervention. The authors select tasks that they believe are valid in measuring certain behaviors and administer those tasks to groups of subjects who are thought to be representative of the population. The performance of the large sample is analyzed, resulting in normative data for specific age groups.

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Norms

Represent the average performance of a typical group of people (typically children), sampled at different age levels during the standardization of a test.

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Raw Scores

The actual scores earned on a test. Typically converted into a standard score.

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Distributions

Yield measures of the client’s performance compared to the performance of the normative sample. Used to compare the client’s performance to that of a normative group.

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Standard Deviation

The extent to which scores deviate from the mean or average score. Reflects the variability of all of the scores of the normative sample.

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Percentile Ranks

Concerted scores that show the percentage of subjects who scored at or below a specific raw score. Use percentile points to express a client’s score relative to the normal sample. 50th percentile is equivalent to the mean and the median.

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Age Equivalency

Scores that show the chronological age for which a raw score is the mean score in the standardization sample.

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Functional Assessment

Purpose is to evaluate a client’s day-to-day communication skills in naturalistic, socially meaningful contexts. Does not depend on standardized test scores. Requires the clinician to make targets, procedures, and settings of assessment as naturalistic as possible.

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Individualized/Client-Specific Procedures

Procedures that are a preferred alternative to standardized tests. Form a valid basis for developing client-specific treatments. These procedures use the evocation of speech-language samples over time, by means of culturally appropriate client-specific materials instead of standard stimuli. Baselines before starting treatment are another valid pretreatment measure of communication skills.

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Criterion-Referenced Testing

A form of assessment that minimizes the role of standardized test scores in assessing skills. The performance assessed trough any means—including even standardized tests—is evaluated not against the statistical norms, but against a standard of performance selected by the clinician. This approach gives greater flexibility to the clinician to set the criterion that may be educationally and clinically meaningful, this avoiding a more rigid comparative evaluation against the test norms. Allows for more in-depth evaluation of the client.

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Criterion

Standard of performance.

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Authentic Assessment

Naturalistic observation of skills. Seeks to sample speech and language skills in everyday settings and thus avoids contrived or formal test situations. Skills are assessed in the context of realistic learning situations and demands. Speech samples collected in classrooms, homes, and other naturalistic settings constitute the primary assessment data.

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Minimal Competency Core

The least amount of linguistic skill or knowledge that a typical speaker is expected to display, taking age and specific context into account.

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Contrastive Analysis

Appropriate for establishing whether a speech pattern is part of a speaker’s cultural background or is a disorder. Requires a knowledge of the speaker’s dialect and a naturalistic language sample to determine whether the differences found in the sample are disorders or culturally appropriate communication patterns.

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Dynamic Assessment

Alternative to standardized test-based assessment. Seeks to evaluate a child’s ability to learn when provided with instruction. Uses a test-teach-retest format. Clients are tested and their skills are measured. Then the children are taught the skills that they did not manifest during testing. Finally, the child is retested to assess how quickly and well he or she learned the material presented. A unique feature is the incorporation of intervention into the assessment process.

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Portfolio Assessment

Alternative to standardized test-based approaches. Involves collecting samples of a child’s work or performance over a period of time and observing the growth that occurs when instruction is provided. A client’s portfolio may include samples of drawings, writings, other forms of academic work, videos of conversations with family members or peers, notes from teachers, reports from other specialists, progress notes (relevant to academic performance as well as speech-language treatment), and so forth.

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Comprehensive and Integrative Assessment

In this form of assessment, the clinician will retain the necessary elements of the traditional approach (case history, interview, language sample, orofacial examination, and hearing screening). Standardized tests may not be used, but if necessary, the clinician will prudently select ethnoculturally appropriate tests and interpret all test results cautiously. Includes the elements of functional, client-specific, criterion-referenced, authentic, dynamic, and portfolio assessments along with the essential elements of the dynamic approach.

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Treatment/
Remediation/
Intervention/
Therapy

Ways of modifying impaired or deficient communication to achieve patterns or normal, functional, or socially more acceptable forms of communication. Follows a comprehensive assessment, which results in a diagnosis of a communication disorder. Teaching, training, any type of remedial or rehabilitative work, and all attempts at helping people by changing their behaviors or teaching new skills. A procedure in which contingent relations between antecedents, responses, and consequences are managed by a clinician to effect desirable changes in communication and swallowing behaviors.

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Communication Disorders

Communication behaviors that attract negative attention, create difficulty in interactions, and cause speakers to sound different from other people in their speech communities. Often also create academic, social, and occupational limitations for an individual.

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Antecedents/
Treatment Stimuli

Various objects, pictures, instructions, modeling, prompts, and other stimuli the clinician uses to evoke target responses from clients.

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Aversive Stimuli

Events people tend to avoid. Events people describe as unpleasant and hence work hard to avoid.

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Avoidance

An action that results in not coming in contact with an aversive event and hence is repeated in the future when such contact seems imminent. A behavior exhibited by many clients and needs to be reduced in some cases.

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Baselines

Measures response rates in the absence of treatment. The natural rate of a response when nothing special is done to affect its frequency. Baselines help prove that treatment was necessary by establishing that the client did not produce the target behaviors. Also help compare the initial and final response rates under treatment. Part of reliable EBP.

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Booster Treatment

Treatment given any time after the client was dismissed from the initial treatment. It is an important maintenance strategy and may involve the original or a new form of treatment.

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Constituent Definitions

Definitions of target behaviors in dictionary terms. Defining concepts with the help of other conceptual (not procedural) terms (e.g., language is the mental capacity to communicate). Not helpful in measuring what is being defined in contrast with operational definitions.

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Corrective Feedback

Information given to the client on incorrect or unacceptable responses in an effort to decrease those responses (e.g., saying “no” or “wrong” when an incorrect response is given).

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Criteria

Guidelines for making such clinical decisions as when to judge whether a response is trained, when to move on to another target, and when to dismiss the client from treatment.

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Direct Methods of Response Reduction

Reducing behaviors by immediately providing a corrective feedback (e.g., saying “no” or “that’s not correct” when a client gives a wrong response). Contrasted with indirect methods of response reduction.

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Discrete Trials

Treatment methods in which each opportunity to produce a response (e.g., individual words in learning correct articulation; specific sentences) is counted separately. Each opportunity is clearly separated in time (e.g., by pausing for a few seconds after each attempt and scoring each response as correct or incorrect). More efficient in establishing target behaviors but are less efficient that naturalistic methods in promoting generalization.

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Escape

A behavior that reduces or terminates an aversive event after having come in contact with that event. A behavior that increases in frequency because it helped to reduce or terminate an aversive event (e.g., a person who stutters may respond to a hostile listener by terminating a conversation). A behavior to be reduced in some clients.

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Evoked Trial

Clinical procedure in which no modeling is given. Pictures, questions, and other stimuli are used to provoke a response (e.g., asking the client to name a picture or asking such questions as “Johnny, what is this?” while showing a picture or an object). Follow modeled trials.

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Exemplar

A specific target response that illustrates a broader target behavior. Individual items trained in therapy sessions (e.g., the word soup in teaching the /s/ or the phrase two cups in teaching the regular plural inflection is an exemplar).

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Extinction

Simply withholding such reinforcers as attention to reduce a response. Appropriate in reducing such behaviors as crying and interfering questioning in treatment.

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Fading

A treatment procedure in which the controlling power of a stimulus is gradually reduced whole the response is maintained (e.g., making modeling less and less audible to the client until finally only an articulatory posture is modeled and then withdrawn).

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Follow-Up

An assessment procedure designed to find out if clients have maintained their treatment gains. In most cases, follow-up involves recording a conversational speech sample to evaluate the continued use of clinically established communicative behaviors. May involve a regular schedule (e.g., semiannual or annual assessments following dismissal from treatment).

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Functional Outcomes

Effects of treatment that are generalized, broader, and socially and personally meaningful to clients, their families, caregivers, and others. Qualitative effects (e.g., posttreatment improvements in social communication for a person who had a stuttering problem) that go beyond quantitative changes in traditionally measured behaviors (e.g., reduction in the number of stuttering behaviors).

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Generality of Treatment

Evidence that a treatment found effective in one situation, by one clinician, with some clients, is effective in other situations, when used by other clinicians, with other clients. Important in recommending a treatment for broader application.

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Generalized Production

Production of a clinically established behavior in natural settings with no particular or systematic reinforcement. May be temporary unless reinforced.

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Imitation

A process of learning in which the learner reproduces what is modeled by an instructor or clinician.

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Indirect Methods of Response Reduction

Reducing undesirable behaviors by positively reinforcing, and thus increasing, desirable behaviors. For example, reinforcing quiet sitting and other cooperative behavior during treatment with verbal praise but ignoring uncooperative behaviors. Note that nothing is done directly to decrease the undesirable behaviors.

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IEPs

Individual educational programs for children with disabilities or special needs. Legally mandated in public school settings.

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ISFPs

Individualized family service plans are legally mandated for infants and toddlers with disabilities or special needs and their family members. The goal is to involve the family members in the treatment process.

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Informative Feedback

Telling clients how well they are doing in treatment sessions. Giving specific quantitative information on performance to motivate the client (e.g., telling the client, “During the last sessions, you were 70% correct; this time, you are 85% correct.”).

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Initial Response

The first simplified component of a target response the client can imitate while shaping a target response (e.g., putting the lips together for production of the word mom).

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Intermediate Response

A response that helps move toward the final target in a shaping procedure (e.g., vocalizing the /m/, opening the mouth whole vocalizing, and closing the moth in saying the word mom). An intermediate response should not be stabilized by excessive reinforcement.

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Intermixed Probes

Assessment of generalized production of trained responses by alternating trained and untrained stimulus items.

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Maintenance Strategy

Various methods used to help maintain treatment gains in natural settings. These methods include training family members and others in evoking and reinforcing target behaviors and the client’s self-monitoring of communicative skills.

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Manual Guidance

The use of physical guidance in a shaping process (e.g., moving a client’s tongue with a tongue blade to correct articulatory position; taking a child’s hand and pointing to the correct picture).

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Mode of Responses

Manner or method of a response. Typical modes include imitation, oral reading, and conversational speech.

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Modeled Trial

A discrete opportunity to imitate a response when the clinician models it. Typically preceded by a question (e.g., “What is this? Say…”).

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Modeling

The clinician’s production of the response the client is expected to learn. Used to teach imitation and is effective in establishing target behaviors. Used in the initial stages of treatment and faded out as soon as possible.

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Operational Definitions

Definitions that describe how what is defined is measured (e.g., morphologic skills include production of plural morphemes in words, phrases, and sentences with 90% accuracy). Helpful in quantitatively measuring changes in target behaviors during treatment, in contrast with constituent definitions.

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Peer Training

Training peers of clients to identify, prompt, evoke, reinforce, and record target behaviors in natural settings. A response maintenance strategy.

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Physical Setting Generalization

Production of clinically established responses in environments, such as the home, school, and office, that are outside the therapy room.

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Physical-Stimulus Generalization

Production of clinically established responses in environments, such as the home, school, and office, that are outside the therapy room.

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Post-Reinforcement Pause

Absence of responses following the delivery of a reinforcer. These pauses are more commonly observed under fixed-interval schedules of reinforcement.

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Posttests

Procedures designed to measure target behaviors after treatment to document changes from the pretests.

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Pretests

Procedures to measure target behaviors before starting treatment. Necessary to justify the need for therapy and to document changes under treatment. Compared with the results of posttests.

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Probes

Procedures to assess generalized production of responses without reinforcing them. Involve a criterion to be met before training advances to a more complex level or to another target behavior.

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Procedures of Treatment

Methods of treatment (e.g., modeling, instructions, verbal praise, prompting). Procedures are what the clinician does to teach target behaviors in clients.

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Prompts

Additional verbal (e.g., “The word starts with a t…” in teaching naming to aphasic patients) or nonverbal stimuli (e.g., showing an articulatory posture in the absence of voicing) that increase the probability of a target response. Useful with most clients.

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Punishment

Procedures of reducing undesirable behaviors by response-contingent presentation or withdrawal of stimuli. Includes corrective feedback, time-out, or response cost.

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Pure Probes

Procedures for assessing generalized production when only untrained stimulus items are presented.

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Response Cost

A method of reducing responses by withdrawing reinforcers contingent on each response (e.g., taking a token away from the client for every incorrect production of a phoneme).

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Response Generalization

Production of new (untrained) responses that are functionally similar to those that have been trained.

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Response-Mode Generalization

Production of new (untrained) responses in a mode not involved in training (e.g., spontaneous production of untrained words after correct and reinforced imitation training).

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Satiation

An internal body state that renders primary reinforcers (such as food) temporarily ineffective. For example, a client might feel full and thus not desire the food reinforcers offered.

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Self-Control

Deliberately maintaining, increasing, or decreasing specific behaviors of oneself. Useful in a response-maintenance strategy and includes such procedures as self-monitoring correct responses and self-recording undesirable behaviors.

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Shaping

A method of teaching nonexistent responses that are not even imitated. A target response is broken down into initial, intermediate, and terminal components and those are then taught in an ascending sequence. Also known as successive approximation.

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Stimulus Generalization

Evocation of established responses by stimuli not involved in training. For example, a child might have been training to produce /s/ correctly in the words see, sun, and saw. If the clinician holds up a(n) (un)trained picture of soup and says, “What’s this?” and the child correctly says “soup,” this has occurred.

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Targets of Treatment

Skills and behaviors a client is taught.

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Terminal Response

The final target behavior in a shaping procedure. For example, with a nonverbal child, the final target might be production of selected words in conversational speech the child produces in the home or other situations.

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Time-Out

A brief period of silence, inactivity, and lack of reinforcement imposed on a response to be reduced (e.g., a silent period of 5 seconds imposed on every instance of stuttering).

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Tokens

Objects that are given for correct responses and later exchanged for backup reinforcers. Require learning to be effective, and they are powerful because a variety of reinforcers can be used as backups. Also help in resisting the satiation effect.

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Trial

A structured and discrete opportunity to produce a response. May involve showing carious kinds of stimuli, asking questions, modeling, or prompting. The response given to each trial is scored separately.

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Reinforcement

A method of selecting and strengthening behaviors by arranging immediate consequences under specific stimulus conditions.

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Continuous Reinforcement

A method of reinforcing all correct responses in treatment sessions. Can be contrasted with intermittent reinforcement.

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Intermittent Reinforcement

Reinforcement of only some responses or responses produced, with some delay between reinforcers.

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Differential Reinforcement

Teaching a client to give different responses to different stimuli (e.g., teaching the plural response to plural stimuli and the singular response to singular stimuli). Involved reinforcing the correct response while ignoring the incorrect response to the same stimuli.

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Differential Reinforcement of Alternative Behaviors (DRA)

Reinforcing a specified, desirable alternative to an undesirable behavior. Involves replacing undesirable behaviors with desirable behaviors that give the client access to the same effects or consequences (e.g., teaching a child to use words instead of whining to get attention).

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Differential Reinforcement of Low Rates of Responding (DRL)

Decreasing undesirable behaviors gradually by reinforcing progressively lower frequencies of that behavior (e.g., reinforcing a child for asking progressively fewer interfering questions during treatment until the frequency is reduced to zero or near zero).

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Differential Reinforcement of Other Behaviors (DRO)

Specifying one behavior that will not be reinforced (e.g., leaving the chair in a group treatment session) while reinforcing many unspecified desirable behaviors (e.g., quiet sitting, coloring, reading, writing), any one of which is accepted.

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Differential Reinforcement of Incompatible Behaviors (DRI)

Reinforcing a desirable behavior that cannot coexist with the undesirable behavior to be reduced (e.g. heavy reinforcing a child to sit quietly when the target is to reduce restless in-seat behavior or off-seat behavior during treatment).

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Negative Reinforcement

Strengthening of behaviors by the termination of an aversive event. Negative reinforcement is involved in aversive conditioning (e.g., strengthening a stuttering person’s avoidance of speaking situations because such avoidance also helps that person avoid or terminate aversive listener reactions.

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Reinforcement Withdrawal

Prompt removal or reinforcers to decrease a response. Includes such procedures as extinction, time-out, and response cost.

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Fixed-Interval (FI) Schedule

A schedule of reinforcement in which an invariable time duration separates opportunities to earn reinforcers. A form of intermittent reinforcement based on time lapsed between two reinforcements (e.g., in an FI 2-minute schedule, correct responses given after a 2-minute lapse following the previously reinforced response are reinforced and any responses within the interval are ignored).

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Fixed-Ratio (FR) Schedule

An intermittent schedule of reinforcement in which a certain number of responses are required to earn a reinforcer (e.g., reinforcing the fifth correct response during articulation training). Helps fade or reduce reinforcement density.

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Variable-Interval (VI) Schedule

A reinforcement schedule in which the time between reinforcers is varied around an average (e.g., reinforcing fluency on a VI 10 seconds means that the client is praised for fluent speech once in 10 seconds on the average, but from one instance of reinforcement to the other, the duration will vary). The intermittent reinforcement schedule generates a high and consistent response rate.

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Variable-Ratio (VR) Schedule

A variable reinforcement schedule in which the number of responses needed to earn a reinforcer is varied around an average (e.g., reinforcing correct production oh phonemes on a VR 10 means that an average of 10 correct responses is required before praising the client, but from one instance of reinforcement to the next, the number of incorrect responses will vary). This schedule also generates a high and consistent response rate.

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Reinforcers

Events that follow behaviors and thereby increase the future probability of those behaviors. May be verbal or nonverbal and are essential to establish target behaviors.

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Automatic Reinforcer

Sensory consequences of a behavior that reinforce that behavior (e.g., the sensation associated with an autistic child’s head banging that increases its frequency).

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Backup Reinforcer

Reinforcer given at the end of a treatment session in exchange for tokens the client earned in the treatment session. For example, if the client earns 10 happy face chips during the session, he or she might get a sticker at the end of the treatment session.

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Conditioned Generalized Reinforcer

Reinforcer whose effect does not depend on a particular motivational state of the client. These reinforcers are effective in a wide range of situations and include tokens and money.

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Conditioned/Secondary Reinforcers

Events such as praise, smiles, and approval that strengthens a person’s response because of past experience.

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Negative Reinforcers

Events that are aversive and thus reinforce a response that terminates, avoids, or postpones them. For example, an aversive event might be teasing endured by a boy who stutters. The boy learns to be silent in the presence of his peers because silence helps avoid teasing; in this case, silence is negatively reinforced.

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Positive Reinforcers

Events that follow a response and thereby strengthen them. Necessary in teaching any kind of skill to any client. There may be verbal (e.g., verbal praise) or nonverbal (e.g., the presentation of a token).

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Primary Reinforcers

Events whose reinforcing effects do not depend on past learning or conditioning. Biologically determined because of their survival value (e.g., food and water). Useful for establishing target responses, not for promoting generalized productions. Also known as unconditioned reinforcers, they are especially useful in teaching infants and toddlers or those with severe intellectual disability. They are essential to reinforce verbal mands (requests for food and drink) in any client of any age.

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Secondary Reinforcers

Social or conditioned reinforcers whose effects depend on past learning (e.g., social praise and tokens).

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Normative Strategy

This strategy is based on the notion that, especially for children, norms provide the best basis for selecting target behaviors. This approach is most frequently used in treating language and articulation disorders in children. Within this approach, age-based norms dictate the target behaviors.

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Client-Specific Strategy

Within this strategy, behaviors that will improve the client’s communication and help meet the social, academic, and other demands made on the client will be selected. Some of these behaviors may be consistent with the normative strategies, but others may not be. Suitable for selecting target behaviors that are appropriate for clients of varied ethnocultural backgrounds. Because this approach emphasizes the individual’s needs and uniqueness, it allows for a consideration of the particular cultural and linguistic background of the client in selecting target behaviors.

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Functional Communication Strategy

This approach is similar to the client-specific approach. In both approaches, what is most useful, what kinds of skills help meet the social and other demands made on the client are the main considerations in selecting target behaviors. Grammatical accuracy and speech production accuracy are less important than effective communication. Targets help improve naturalistic communication. This approach is based on the assumption that any mode of response is appropriate, provided it results in effective communication.

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Integrated Approach to Target Behavior Selection

Within this approach, treatment targets are appropriate for the child’s age, ethnocultural background, individual uniqueness, and communication requirements. The targets should be functional and useful and should enhance natural communication in everyday situations, including the school, occupational settings, home, and other social situations. The approach places a greater emphasis on the client and effective communication and does not negate the importance of age-appropriate targets, especially for children.

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Treatment Contingencies

Refer to the pattern of reinforcement and corrective feedback given for correct and incorrect responses, respectively. Initially, the client is reinforced for every correct response. Soon, the reinforcement schedule is changed from continuous to intermittent.

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Follow-Up

A clinical procedure designed to find out if the client has maintained the target communicative skills and I he or she needs additional treatment. Involves assessment of communicative behaviors.

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Booster Treatment

Refers to treatment offered any time after the initial dismissal from services. Important for maintenance.