Flashcards in Clinical Procedures Deck (152):
What are four major behavior observations we look for?
1 presence or absence of beh
2 frequency of beh
3 situations of beh
4 duration/magnitude of beh
Sustaining attention to a task is an example of a ___ to behavior.
Beyond a observing a percentage of the time we have ______. in what ____, and use a ____.
define behaviors we wish to observe; context; system to measure it
The guidelines for behavior observations include utilizing ____ skills, avoid comparison to a _____, separate ______, and avoid ______.
observation; predetermined standard; subjective from objective; personal bias or judgment
What are 5 applications for behavioral observations
1 assess difficult-to-test beh
2 validate info collected from other tests
3 extend assessment to other settings
4 ID functional rel btw stimuli in environment & behavior
5 monitor the effects of clinical intervention
What are the 3 basic principles of intervention?
1 eliminate the cause
2 teach compensatory strategies
3 modify a disorder by teaching specific speech, language, or pragmatic beh
What is an example of elimination of a the underlying cause of a disorder?
pe tube instertion
What is an example of teaching compensatory strategies?
What is an example of modify a disorder by teaching specific speech, language, or pragmatic beh?
articulation instruction, fluency
____ are steps to achieve long term goals.
short term goals/objectives
Short term goals are steps to achieve ___.
long term goals
Objectives need to be ___ so as to determine materials, procedures and content to assess progress formally or informally to allow the client to participate meaningfully.
The client needs to be ___ as to the nature of the task.
The client should also (ideally) ____ make goals
Objectives need to be clearly defined so as to determine ___, ___, and ____ to asess progress.
materials, procedures, and content
What is the first part of a behavioral objective?
do/performance statement (ID the action or what the client will actually do or complete)
What should we avoid in performance statements? 2
avoid avoid statements (won't have a tantrum)
avoid abstract terms (understand, discover, be aware of)
What is the second part of a behavioral objective?
condition (situation in which the target beh is performed)
What are examples of conditions? 4
1 with modelling
2 in response (vs. initiation)
3. with picture stimuli/written stimuli/no stimuli
4 in a group (fluency difficulties are harder in group settings) or one on one
What is the third part of a behavioral objective
criterion (how well it is performed)
What are normal criteria for behavioral objectives?
80 - 95%
8 out of 10 correct
over three consecutive sessions
in a five minute period
How are long term goals different than short term goals/objectives? 3
usually are functional
criteria for discharge from treatment
What is task hierarchy? 3
1 when you make decisions for your client
2 usually work least-to-most complex
3 systematic (work towards the goal changing portions as nece)
What happens with short term goals that are acheived easily? 4
adjust complexity, change type of stimuli, change accuracy levels, change from receptive vs. expressive to make more challenging
What happens with short term goals that are not acheived easily? 4
teach concept (make sure dev approp), use receptive language, work expressive language,
What is an example of working least to most complex?
receptive to expressive language
What is an example of increasing complexity of task? 3
remove cues, varying targets, changing settings
The ____ represents the degree to which intervention contexts correspond to everyday life; how functional or "real" it is.
Continuum of Naturalness
The Continuum of Naturalness ranges from ____ to ____ or ___ to ___.
least natural; most natural; clinician directed; client centered
What are 3 factors affecting naturalness?
1 intervention activity
2 physical context
3 individuals with whom the client interacts
What are 4 examples of intervention activities?
2 drill play
3 structured play
What are different physical contexts for intervention activities?
therapy room, campus shuttle, picnic, fast food restaurant, store
In ___, the clinician controls all aspects of the intervention. Clinician identifies the specific target responses.
clinician directed approaches
What are the ABC of clinician directed approaches?
antecedent - model or prompt
behavior - client response
consequence - clinician's reinforcement (not necessary reward/punishment)
Are clinician directed approaches naturalistic?
no, but maybe effective in the early stages of therapy
____ often uses real setting or simulated real settings.
Client Centered Approaches
What is the assumption with client centered approaches?
that generalization will occur more quickly
In client centered approaches, you can use ____ or ___ settings.
real or simulated real
What is a characteristic of client centered approaches? 2
1 often involves waiting for the client to initiate a comm beh.
2 clinician does not elicit predetermined targets
In client centered approach, we can _____ to maximize responses.
manipulate the physical environment
What do you when with adults client centered? 2
1 functional therapy
2 conversational group therapy
____ are midpoints on the continuum of naturalness.
What are the two components of hybrid approaches?
1 use very natural activities
2 clinician maintains ctrl over the treatment
What are the 3 main characteristics of hybrid approaches?
1 only one or a small set of gals are targeted during intervention
2 activities that promote spontaneous use are selected
3 clinician models and expands client utterances
Four main types of hybrid approaches are
1 focused stimulation
2 milieu teaching
3 script therapy
4 conversational coaching
In ___, clinician arranges the verbal and non-verbal environment to increase the likelihood that the client will produce the target. Models are provided in a functional context.
In ___, this emphasizes the use of ongoing activities. The environment is key (set up the environment to encourage communication) and incorporates operant conditioning principles (imitation, modeling, and reinforcement).
In ____, we target behaviors are taught with the context of a familiar routine. May be an event like a birthday party, ordering at a restaurant, or going to a restaurant.
In ___ is developed to facilitate functional communication btw adults with aphasia (simulates real convo w/in structured setting).
____ evidence is from published journals.
____ evidence is from client or clinician experctations/experiences, preferences/competencies, competencies, values and culture
What is evidence?
what guides our decision for eval & treatment procedures
What are two major categories of internal evidence?
- clinician experiences, preferences, competencies, values and culture
- client expectations characteristics, preferences, values and culture
What is the 3 of E3BP?
1 published professional evidence
2 clinician experience
3 client expectations
should be integrated!
What are the levels of external evidence? 1-4
IA - meta-analysis (systematic review) of multiple well-designed controlled studies
IB - well-designed randomized control study (compare 2 types of treatments (tx))
IIA - well-designed study without randomization (matched by age, play, language ability, etc.).
IIB - well-designed quasi-experimental
III - observation
IV - expert opinion
What goes into internal evidence? 3
____ means maximizing benefit.
___ means minimizing harm.
____ means means honoring self-determination and functioning independently witout extraneous influence.
Autonomy (client and clinician - clinician needs to determine their own therapy, not the facility, clinic or school district).
___ means practicing fairness and equitible distribution of therapy.
What does PICO perspective/question?
person, intervention, contrasting intervention, outcome (desired)
What is the person in PICO?
who is the client? what is his/her situation
What is the intervention in PICO?
what is one way you can do intervention? what is the dominant intervention or your instinct?
What is the contrasting intervention in PICO?
what is a DIFFERENT way you could do the intervention?
What is the outcome in PICO?
what constitutes success for an intervention
What is the 6 step approach to EBP?
1 develop PICO
2 find internal evidence
3 find external evidence
4 eval external evidence
5 integrate internal and external evidence
6 apply and eval the outcome
What are the steps in traditional articulation tx? 4
1 ID the std eng sound and discriminating it from the erred sound
2 approx and refin the approx until correct prod is acheived
3 practicing the new sound in lang segments of incr length and complexity
4 generalizing the sound to all speaking situations
What are the steps in phonological process tx? 2
1 concept and discrimination training
2 production training at word level, ch produces the error and "teaches" the adult, use minimal pairs
___ is an option available to low-weight or premie infants. This comes from DARS.
Texas Interagency Council on Early Childhood Intervention (ECI)
___ is the plan created for infants with their family in mind.
Individualized Family Service Plan (IFSP)
What are referral sources for ECI and IFSP?
screened babies at birth
ECI is based on ZIP code (can referred by MD or parent can call ECI)
Who administers preschool services?
Texas Education Agency (TEA)
Who governs a child's IEP?
ARD (Admissions Review and Dismissal) Committee
What are the steps for an Individual Service Provider? 5
1 receive a referral
2 eval the student
3 reveal results
4 provide treatment
5 communicate results of tx to others
From date of consent, the SLP has ___ calendar days to evaluate.
From the date of report (eval report), the SLP has ___ to complete ARD meeting.
From the date of decision, the SLP has ___ to implement the ARD committee decision..
What is RtI?
the practice of meeting the academic and beh needs of all students thru a variety of services
What are the 3 parts RtI?
1 provides high qual instruction & EB intervention for students
2 monitors progress for decision-making
3 assists joint decisions for educational placement
What are the payers for adults/geriatric age population? 4
_____ is insurance for 65 or older (part A), or for end-stage renal disease pts or railroad workers (part B).
Medicare is administered by ______
____ is insurance provided based on income.
What is CHIP?
Children's Health Insurance Program (tx of special health needs)
What does a lesson plan contain? 2
1 behavioral objectives (Short Term Goal - STG)
2 procedures are what the Clinician will do to assist the client in meetings STGs
What are important questions to ask yourself when making STGs? 2
What do I want the client to do?
What am I (the clinician) going to do?
What are the 4 lesson plan guidelines?
1 describe the materials, techniques, processes that will be utilized to assist the client in meeting STGs
2 Describe activities that will be conducted during the treatment session in the Procedures section of the Lesson Plan
3 Vary activities based on the client's age interests and goals
4 Use techniques that are evidenced based
It tends to be that words are easiest to produce in the initial. T/F
___ involves chewing, swallowing, and over extension of the tongue.
What are factors affecting naturalness? 3
1 intervention activity
2 physical context
3 individuals with whom the client interacts
____ is a short period of treatment that is used for short term goals especially in schools.
Episode of care
What is the purpose of data collection? 3
1 allows the clinician to track client progress
2 provides documentation as to the efficacy of treatment
3 maximizes clinician effectiveness
___, if designed correctly, will greatly help data collection.
recording or data collection sheets
____ should provide the type of info that is most relevant to a client or disorder.
Notation system (may have to be weird for cognitively adept adults)
____ can be used as an alternative to paper/pencil recording of responses.
Reinforcement tokens (or cards face up/down)
___ are instruments administered periodically throughout tx to measure a client's progress. They are designed to assess generalization of trained target beh. Novel stim, elicit w/o target instruct and no reinforcement.
The purpose of an eval is to determine ___ of a disorder.
presence or absence
What is the specific formula for characterizing chronological age?
subtract birthdate from test date
borrow 30 days regardless of the month
borrow 12 months
except premies, who have an adjusted age with two years
What are the four parts to evaluation functions?
1 investigate - collect clinicial info
2 analyze - define nature of disorder/ judge severity/describe beh
3 synthesize - use the info/ combo results to a coherent whole
4 prove effectiveness - proof that tx worked/accountability
What are some types of diagnostic tools? 5
1 standardized (norm & criterion ref)
2 parent/client interview
3 case history/summary (probe for more info)
4 beh observations
5 informal assessment
How do you choose which diag tools? 3
1 know the referral
2 get an idea from bg info
3 if you don't know, prepare basic arsenal
____ discerning the clients disorder as compared to other disorders (specificity).
____ is the starting abilities of the client in the initial session.
___ is an important feature of a std test, which relates to interjudge/intertest scoring is consistency.
____ is that a test is measuring what it supposed to test. (An articulation test should not test literacy).
___ is the part of the population that the test was designed for to ensure that a test is not biased towards a region, SES, race and gender.
standardization (norming) sample
___ is how far the scores spread out (it should be a bell curve).
___ is how far scores deviate from the mean.
___ is a range around the score that they get to let you know the true score.
standard error of measurement
You can skip certain items for certain age ranges. ____ is an establishment of the clients current level of performance and anything after you assume anything before should be mastered. (the number you have to get correct a row, often 5). It is a starting point.
____ is a place where the test manual tells you to stop (often certain # in a row incorrect, like 8).
What are the different norm-referenced scores? 3
1 Raw Scores (# or % correct - not report, just used for calculations)
2 Developmental scores (age/grade equiv - not very useful, basically estimates, tempting to parents)
3 Scores of Relative Standing (percentile ranks & std scores)
____ is a comparison to others of their age. Older people get lumped in to larger age groups.
Scores of Relative Standing
What are 3 types of std scores?
1 z scores (mean = 0)
2 t scores (mean = 50)
3 scaled scores (mean of 100)
Medicare part ___ covers doctor services and outpatient care, covers some preventive services to help maintain a person's helath and keep certain illnesses fro mgetting worse and pays 80% of stuff
Medicare part A is also known as ___
What age is the minimum for Medicare coverage?
What age is the maximum for ECI?
ECI = ?
early childhood intervention
Medicare part __ covers inpatient care in hospitals, and some skilled nursing facility, hospice and home health care.
Medicare part B is also known as ___
Medicare part ___ is run by private companies approved by Medicare which can either be Medicare advantage plans or separate Medicare Prescription drug plans and helps voer the cost of Rx. It is also known as __.
D; Prescription Drug Coverage
Medicare part ___ is a way to get Medicare benefits through private companies approved by and under contract with Medicare.
C; Medicare Advantage Plans
___ is government insurance for low income individuals and families.
Individualized Education Program
Individualized Family Service Plan
Free Appropriate Public Education
Least Restrictive Environment
Admission Review Dismissal
Preschool Program for Children w/ Disabilities
Other Health Impaired
Skilled Nursing Facility
Dx, Tx, Rx, Hx, s/p, d/c, LOS, OP, OTR
diagnosis, treatment, prescription, history, status post, discharge, length of stay, outpatient, occupational therapist registered.
world health organization, international classification of functioning, disability and health.
____ is a score that indicate the rank of the client compared to others (Same age or same grade) using a hypothetical group of 100 (students). You want to be 50%, there is no 100%.
___ reflects a client's rank compared to others, based on how far above or below the average ("mean") an individual score falls, using a common scale such as one with an average of 100.
Standard scores take __ into account, or the degree which scores typically will deviate from the average score.
____ are essentially groups of percentile ranks with the entire group of scores divided by 9 parts, with the largest number of individuals falling in the middle (3-7) and fewer individuals falling at the extremes.
What is the usefulness of stanines?
the relative range of a client's performance
What is the relative usefulness of standard scores?
compare individuals from different ages groups or grades, because all scores are converted to the same numerical scale.
Is a percentile the same as a percent?
NO! you can't get 100% and it isn't an amount of answers correctly answered.
How many parts are stanines broken into? Is it popular?
___ indicate that the client has attained the same score (not skills) as an average person of that age or grade.
Age or grade equivalent scores
What is the advantage/disadvantage of age/grade equivalent score?
easy to understand/often given too much significance by lay people
_____ is where the majority of all people would fall within a small range (or one "standard deviation") of the mean or average score, and where 50% of of all people would fall above and 50% would fall below the average score.
Normal curve or Bell-shaped curve
In a normal curve, ___ are above and below the mean.
In a normal curve, ___ are found within 1 standard deviation form the mean.
a majority (68%)
____ standard deviation(s) is enough to qualify for therapy in school.
___ is the rough IQ for ID (intellectual disability)
~70 (2 standard deviations)
Generally SS: ___ and below is below the average range or ___ and below on a subtest, or PR of ___ and below.
84; 6; 16th
What are the standard score mean and 1 & 2 standard deviation from the mean?
mean = 100
1 s = 85, 115
2 s = 70, 130
what are the scale scores (subtests) mean and 1 & 2 standard deviation from the mean?
mean = 10
1 s = 7, 13
2 s = 4, 16
What are the percentile ranks mean, and 1 & 2 standard deviation from the mean?
mean = 50
1 s = 16, 84
2 s = 2, 98
When reporting scores, you need to explain both the __ and ___ of a score.
location and severity
When reporting severity of score you can say ___, ___ or ____.
average (average (range), below average, above average
When reporting location of score you can say ____, ____ or ____.
less/more than one SD, outside/withing/above/ below the average/typical range, between