Clinical Reports (6)Graduate review-fa19

AAMU CSD Clinical

Procedures

CSD 516: Advanced Practicum/ Academic Clinic

Esther Phillips-Ross MA, CCC/SLP/L Jennifer Horne MS, CCC/SLP/L

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020-p.20, 21

Important Considerations:



A. Attendance: Mandatory



Absent-Request for Absence Form (see

sample)

 Completed for EACH absence from a

practicum related event

 Onsite Clinic Assignment

 Tuesday night Academic Clinic Class  Off-site Assignment

 Excused Absence=University Excuse (UE)  Unexcused Absences= Anything other than

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.21-23

Important Considerations:

 B

. Practicum Hours Accrual: 400 hours

needed for ASHA Certification

 325 hours MUST be obtained at the graduate

level

 only direct client contact can be counted

toward practicum hours

 DIRECT= face to face interaction with the client

in assessment and treatment tasks

 ‘DIRECT’ does not refer to times used toward…

 Formulating client reports  Scoring tests

 Consulting with clinic supervisors

 ANY time that is spent in the absence of

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.21-23

Important Considerations (P-Hour Accrual):

 Hours are to be recorded on a weekly bases (on

the Clinical Practicum Report) and submitted per the Clinic Timeline Schedule—on time

 Hours submitted past 30 days, will not be

counted toward practicum experience

 Hours shared with a co-clinician are typically

divided in half

 Sessions in the clinic are 50 min. in length. If a

team is assigned to one client, ea. team member will document spending 25 min. ea. with the

assigned client (See example)

 ½ min. are not to be recorded on the

Practicum Report (ex 25.5 min.). Round to the

nearest number (ex. If 25.5 min. was spent with a client, document 26 min.)

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.21-23

Important Considerations (P-Hour Accrual):



Practicum Report

 Document client’s initials only under ‘name’  Document client information and minuets in

black ink.

 Complete the tabulation portion in pencil only.  TABULATE ALL MINUTES in the section just

above the supervisor’s signature line. Be sure to organize the min. acquired as outlined on the Practicum report document (see sample on web)

 Have your supervisor initial hours on a weekly

basis by placing the Practicum Report in the prospective supervisor’s box each Friday by noon.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.21-23

Important Considerations (P-Hour Accrual):



Practicum Report



Supervisor will return the Practicum Report

to you until the report is completely filled or

until it is time to submit hours to Ms. Nicky

or Mrs. Ross, per the clinic timeline.



Responsibility is yours to make copies

of all hours submitted, for your personal

records



Summary of clinician’s hours are provided

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.13

Important Considerations:



C. Client Sign-in Receipts

 Each client must sign in upon arrival to the clinic.

The sign-in receipts are….

 Located on a clipboard by Ms. Nicky’s reception

window

 Carbon copied

 Mandatory--be sure to let your client know that

he/she must sign in before sessions begin

 Retrieved by the clinician BEFORE the session

begins

 Clinicians--Indicate session START and END time

on each assigned client’s sign-in receipt.

 Place Sign-in receipts in the mailbox outside of

Ms. Nicky’s door in the blue folder labeled “CLIENT SIGN-IN RECIEPTS”

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.37-38

HIPPA



D. HIPAA: Health Insurance Portability

and Accountability Act of 1996



Privacy, Confidentiality, Security

 Provides federal protection for patient/client

health information (PHI)

 PHI=Identifying Information  Name

 Address

 DOB-date of birth  Dx

 Description or any other data that could

connect/link the health report to the intended individual/client.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.37-38

HIPPA

Important Considerations:



Rules for Use and Disclosure of PHI

 AAMU CSD Clinic Considerations of HIPPA:

 CSD Clinicians are required to use encrypted

drives to house client documentation AND use the CSD Bulldog encrypted email system to send files to supervisors.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.31-33

Important Consideration:



E. Emergency Procedures (i.e. fire):

AAMU Emergency Action Procedure

Handbook (2013)

 Copy on the CSD Google Webpage

 Be aware of procedure as outlined in the CSD

P&P M, page 25-28.

 In an event of an emergency

 Stay CALM….

 Evacuate AWAY from affected area

 Person discovering emergency, should alert

clinic director and program secretary.

 If for some reason these persons cannot be

reached----Activate fire alarm located on the outside of CCN Rm 104.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.31-33

Important Consideration:



E. Emergency Procedures:



Graduate clinicians are responsible for

clients in their care during an emergency

situation.



Graduate student should accompany clients

calmly and quickly to the southwest exit of

the building.



Meet parents or caregivers outside the

building directly out of the door

(southwest), then proceed to the quad for

further instructions.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.31-33

Important Consideration:



E. Emergency Procedures:

Tornado Warning

 Clinician quickly accompany the client to

clinic waiting room

 Find client’s parents or caregivers

 Move quickly to the closest designated

tornado shelter CCN 113—The College of Education, Humanities and Behavioral Sciences Conference Room and hall.

 Position clients AWAY from exits to the outside  Remain in safe designated area until an

“all-clear” message has been issued by the University.

 University will not issue an ‘all-clear’ until the

approaching threat has passed (Emergency Action Procedure Handbook, p. 15).

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.31-33

Important Consideration:



E. Emergency Procedures:

Fire Arm Assault

 Remain in your therapy rooms with doors

locked

 Position yourself on the ground

 Move on the ground closest to the

observation window with back turned to the window.

I.

Beginnings…….

Alabama A&M CSD Clinic Manual: Policies and Procedures 2019-2020, p.16, 17

Important Consideration:



E. Simucase:

 Simucase accounts and clients will be

dispersed by the Simucase Supervisor

 Each student is required to completed at

least 30 Simucase hours the 1st semester in

clinic

 Do not share your personally assigned

Simucase account number

 Simucase accounts are valid for one year

from the time they are assigned

 Each student will need their own

computer/laptop to access Simucase.

 CCN Rm 7 will not be available to access

II. Assessment

Considerations

1.

Assessment (Overview)—

Screening Process

Hearing Screenings by SLP

Standardized Evaluation



Speech and language

II. Assessment

Considerations

1.

Assessment (Overview)—

Hearing Screening Process

Hearing Screenings by SLP

Purpose: To identify potential peripheral hearing loss that may affect client’s communicative

development or abilities.

 Limited to pure-tone air conduction screenings and

screening tympanometry.

 3 years of age and older

 1k, 2k, 4kHz at 20-dB HL for children (3-18y/o) and

25 dB HL for adults

 More conservative critera for children: 15 dB at

500, 1000, 2000, and 4000 Hz-to reduce the risk of overlooking a mild hearing loss—requires a VERY QUIET ROOM.

 Another conservative critera is 20dB at 1K,

II. Assessment

Considerations

1.

Assessment (Overview)—

Hearing Screening Process

Preparation for Screening

 Checking the audiometer  Power On/Off Switch

 Earphones- Check earphone cables plugged into

correct ports—Treat earphones carefully.

 Earphone Placement: Accurate positioning of the

earphones is essential to a reliable screen.

 Red on RIGHT  Blue on LEFT

 When facing the client YOUR LEFT is THEIR RIGHT  Earphones should be placed directly over the

opening to the ear canal---ears must be bare (no glasses, hair, etc.)

 Place the head band on with BOTH HANDS to

prevent the headphones from popping the client in the face.

 Slide both sides of the headband down at the same time until the headband rests firmly on top of the head.

II. Assessment

Considerations

1.

Assessment (Overview)—

Hearing Screening Process

Preparation for Screening

 ASSESS the Audiometer panel for proper settings  Is the unit turned on? (Power light)

 Set Frequency Control at 1000Hz  Out put selector at “right” or “red”  Set Decibel Intensity Control at 40 dB

Position hands with one hand at the tone switch and one hand at the frequency control. Maintain this position throughout the screening. Vary the length of the

tones and the interval between tones.

 Formal Procedure:

 Present tone at 40dB, 1K Hz (identification tone)

for one to two seconds.

 If client gives no response or a weak response,

present the tone again.

 An acceptable response is one that is concrete

II. Assessment

Considerations

1.

Assessment (Overview)—

Standardized Evaluation

Assessment Basics

Test Selection Criteria



Based on Factors



Administration Dynamic?



Appropriateness?

Assessment Basics

Test Selection Criteria



Administration



Is the test efficient? Does it save time?

Is the test easy to administer and score?

Are the instructions for standardized

administration clear and easy to

understand and use?

(consider issues of adaptability, flexibility, versatility in administration)

Assessment Basics

Test Selection Criteria



Appropriateness



Is the test age appropriate?



Does the test give information that is not

obtained by informal assessments?



Does the test account for cultural/linguistic

Assessment Basics

Test Selection Criteria



Relevance/Reliability



Is the test well grounded theoretically?

(Consider models, bases for design and content)



Are the results clinically /educationally

relevant?



Was the test well standardized?



Is the test reliable?(test-retest reliability)

Is the test valid?

(Consider relations to theory, typical development, classification, other tests, sampling)

Assessment Basics

Test Selection Criteria



The Ideal Test



Test Users were poled. Here are the results…

 Takes no more than 30 minutes to administer….including

the screening component.

 Is simple (i.e. easy and fun for both the examiner and the

child) to administer and score

 Requires no addition, subtraction of multiplication  Comes in full color and animation

Assessment Basics

Distribution of Scores

 The Normal Curve AKA “Bell Curve”

 An ideal distribution of scores (measures) in which the mean,

median, and mode are identical/same

 The Mean

 The statistical average of a sample score  Composite scores=100; Sub-tests=10

 The Median

 The score (point) for which 50% of scores are higher and 50%

are lower…the middle score

 The Mode

 The point with the most frequent score

 The Standard Deviation

 The square root of the variance which forms the basis for

standard scores, standard error of measurement (SEM) and tests of significance=

15pts if Mean is 100

Assessment Basic

Anatomy of Normed Tests



Item

 Designed to elicit a response to a specific stimulus/stimuli



Subtest

 Designed to elicit responses to a sample of items that are

representative of the ability tested.



Composites

 Designed to measure a specific theoretical construct



Total

 The best measure of a collective set of constructs  Basal: # of predetermined items client must score

correctly to establish the beginning measuring point

 Ceiling: # of predetermined items the client must

score incorrectly to determine an ending measuring point

Assessment Basics

Types of Scores

Raw Score



The actual score earned on a test/subtest



Percentile Rank



A measure of relative standing in terms of

percentage of scores occurring

above/below



Standard Score/Scaled Score



A derived score based on standard

deviations



Deviation IQ Score



Standard score with mean of 100, SD of 15p

Assessment Basics

Types of Scores



Age-Equivalent Score

 CA for which a raw score is the average score



Grade-Equivalent Score

 Grade placement for which a raw score is the

average score

Composite Score: Total score made up of the some of scores on two or more subtests

Assessment Basics



Why use standard scores?



Normed for age, using the same mean and

standard deviaiton at all ages



Permit comparisons across subtests that

differ in item length



Permit comparisons among groups



Provide equal discrimination across the

Assessment Basics

Severity Ratings



In Deviation IQ Scores (Mean 100; SD 15)

 Mild 84-78p

 Moderate 77-70

 Severe 69 and below



In Z-Scores (Mean 0; SD 1)

 Mild -1.0 to -1.5

 Moderate -1.5 to -2.0  Severe -2.0 and below

AAMU Clinical Reports



Diagnostic Report



Chronological Age



Assessment Basics



Initial Therapy Plan

Lesson Plan



SOAP/Progress Note

Semester Summary



BEFORE WE GET INTO AAMU CLINICAL

REPORTS……



We have got to settle noted issues in

Chronological Age

Chronological Age

Calculations

Calculations

Typical date is recorded as :

September 11, 2019

•

However when calculating chronological age

we record

 Year

 Month

 Day

Chronological Age Cal. (con’t)

1. 2017 11 10 (test date)

1995 03 08 (age of client)

_______________________

2. 2019 01 17

1987 11 08

_________________________

Chronological Age Cal. (con’t)

3.

2016 03 18

1933 09 21

_______________________

4. 2017 02 01

2005 10 20

_________________________

Chronological Age Cal. (con’t)

5. 2019 02 05

2004 10 09

I.

Clinical Reports (CR):

What are they?

1.

Written reports that may vary in length—

from multiple-page documents, to brief

notations in client charts

2.

Inform the reader of the client’s…

 Medical status  Progress gained

 Regressions noted over time

 Notifies the reader of any medical change of

II.

How are clinical reports

different from composition

writing?



Composition writing

is…

 Generally longer than

technical writing

 Often asks the student

to assume the identity of a researcher

 Generally has one

audience (professor)

 Is written for a grade



Clinical writing is…

audiences

 Has consequences

beyond a grade

 Qualifies individuals for

federally funded disability programs

 Filled with professional

III. Clinical Writing Tips

(Roth and Worthington, pg 57 )



Avoid writing clinical reports in a conversational

style

 “He just didn’t get the point” versus,

 “The client did not appear to understand the task as

he obtained 3 correct answers out of 10 choices with the aid of maximum cues”.



Use correct spelling, grammar and punctuation

and write in complete sentences



Write in the

third

person

 i.e. The Token Test was administered by this clinician

on 7/17/2019) versus,

I. Diagnostic (DX) Report:

Components



AAMU Dx Reports have

essential components…

1.

Identifying Information

Statement of Problem

Background Information

4.

Observation and Assessment Results

Summary of Findings

6.

Prognosis

7.

Recommendations

Long Term Goals

Short Term Goals

I. Diagnostic Report:

Components (con’t)

1. Identifying information

: Any

information that can link the patient

to the report—

Name

Date of birth

Address

Age

Phone number

Email address

Diagnosis

Nationality, etc.

I. Diagnostic Report:

Components (con’t)

2. Statement of problem

:

States in paragraph form… 

Full

name and age



Location

and

date

of initial evaluation

Reason why the client is seeking clinical

intervention



Current communication status/issues as

viewed by the historian/reporter

(normally parent if client is a minor).



Referral source

The statement of problem is generally

short (3-5 sentences long)

I. Diagnostic Report:

Components (con’t)

2. Statement of problem

:

Example:

“

Clinton Binds is a 36 year old male who

was seen at Alabama A&M University on

September 16, 2019 for a complete

communication evaluation due to

difficulty speaking after a motor vehicle

accident. Mr. Binds was referred by his

physician, Dr. Weeks. Clinton currently

communicates using simple words and

often complains of memory loss per Mrs.

Binds (wife), who served as historian

.”

I. Diagnostic Report:

Components

3.

Background information

S



Prenatal and birth hx



Developmental hx (i.e. milestone dev.)

Pre-morbid hx (adult clients)



Any previous dx, or tx--specifically what

has been diagnosed in previous

examinations



Recommendations made from previous

professionals

Diagnostic Report Activity:

Tools Needed:

 Writing paper  Pen/pencil

Create:

Statement of problem for (1) & (2)

Tool Bag:

(1) Kevin Crane, Born 03/15/2013; child of Kim and Kenny Crane ( informants); referred by Dr. Walker, pediatrician; date of eval 09/22/19

Diagnostic Report Activity:

(2)

Client Information:

-Jack Moore, 31 years old

-Evaluation date, September 24, 2019 at

AAMU CSD Clinic.

-Client states having trouble sometimes

telling a story or even ordering food. Client

states that he “stutters and stammers”.

-Self referral

Write a “statement of problem” statement

with the above information

Diagnostic Report Activity:

Create Background information statements:

Medical:

Decatur General Hospital

2015 Surgery for ingrown toenail

2018 Ulcer problems

Dental: 2019 (Spring) Wisdom teeth removed

Prescription: Ranitidine (Zantac)

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual

hoarseness); change in the amount of urine produced; confusion; dark urine; depression; fast, slow, or irregular heartbeat; fever, chills, or sore throat; hallucinations; severe or persistent headache or stomach pain; unusual bruising or bleeding; yellowing of the eyes or skin.

Diagnostic Report Activity:

Background information:

Medical:

Hearing problems per his parents, Smoking

Developmental: unremarkable

Speech hx: relatives on mother’s side of the

family have had speech problems.

Siblings: One sister, 15 y/o; no speech

problems noted.

I. Diagnostic Report:

Components (con’t)

4. Observations and Assessment results–

Must have a statement for EACH area of

communication

There are main areas to be assessed:

 Peripheral Oral Examination

 Audiological (Screening)—>3.0y/o--audiologist  Articulation

 Language  Fluency  Voice

I. Diagnostic Report:

Components (con’t)

4.

Observations and Assessment results–



Reporting

:

 Oral Peripheral Examination: Jack Moore was given an

oral peripheral examination to address functionality of oral structures. Facial symmetry was within functional limits.

Jaw closure and range of motion was within functional

limits. Teeth were in good condition and there was not an excessive underbite or overbite present. Lip closure,

clamping, protrusion, retraction and appearance at rest

were within functional limits. Tongue agility of protrusion, pointing, retraction, elevation, lateralization, and

appearance at rest were all within functional limits. Hard

I. Diagnostic Report:

Components (con’t)

4. Observations and Assessment results–

Peripheral Oral Examination



Reporting

:

 Diadochokinesis: When asked to articulate “pa”, the client

performed 20 repetitions in 9 seconds (normative rate for an adult is 5-7 r/s); when asked to articulate “ta”, the client

performed 20 repetitions in 9 seconds (normative rate for an adult is 5-7 r/s); when asked to articulate “ka”, the client

performed 20 repetitions in 5 seconds (normative rate for an adult is 2.6-7.5 r/s); and when asked to articulate “pa-ta-ka”, the client performed 20 repetitions in 9 seconds (normative rate for an adult is 2.6-7.5 r/s). The clients oral and lingual structures were within functional limits with sign of slight muscle weakness or executing of motor functioning.

I. Diagnostic Report:

Components (con’t)

4.

Observations and Assessment results–

II.



Reporting:



Mr. Moore was given a pure tone audiometric

screening, using a Beltone Audiometer.

Tones were administered at 20dB HL at

1000, 2000, and 4000 Hz, bilaterally. The

client responded to each of the frequencies

administered. Hearing acuity is deemed to

be within functional limits, this date.

I. Diagnostic Report:

Components (con’t)

4. Observations and Assessment results–

III. Articulation



Reporting

:

The clinician administered the Goldman Fristoe Test of Articulation 3.

The GFTA-3 is a standardized articulation test which systematically assesses an individual’s articulation of the consonant sounds of Standard American English. This test is norm for individuals 2-21 of age.

The following articulation results are as followed:

Jack did not mis-articulate any speech sounds evaluated on the Goldman Fristoe Test of Articulation-3. He presented with a standard score of 103 on the GFTA-3 (average scores fall between 85-115 points) for sounds in words. Jack’s standard score of 103 puts him in the average/typical score range. In conversation Jack did not present with any articulation deficits that would affect speech intelligibility this date. Jack is

deemed 98% intelligible this date.

Raw Score Standard Score Age Equivalent

I. Diagnostic Report:

Components (con’t)

4.

Observations and Assessment results–

IV.



Reporting

:

 The client’s oral expression and listening comprehension was assessed

using the Oral and Written Language Scales-2 (OWLS:2). This assessment targets lexical, syntactic grammar, pragmatics, and supralinguistics or a higher order of cognition. This assessment can be administered to children and young adults ages (3 -21).  _Raw

Score Standard Score Percentile Rank EquivalenAge t Listening

Comprehension 76 86 19 15.3 Oral Expression 66 80 22 12.3 Standard Score Total   83 13 18.5 Written Language   89 23 11.6 Sum of written language, Listening comprehension, oral expression standard score 255   12 5.3

I. Diagnostic Report:

Components (con’t)

4. Observations and Assessment results–

Language

Jack’s OWLS language score reflected the following:

 Jack’s composite standard score for listening comprehension was 86 (average

scores fall between 85-115). Jack’s listening comprehension score falls within the low average range this date. Jack’s oral expression composite standard score was 80 (average scores fall between 85-115). Jack’s oral expression score of 80 points in indicative of an expressive language delay. His total standard score was 83. His score of 83 is indicative of a language delay. Jack was given the written form of the OWLS to assess written language skills. Jack’s standard score for written language was 89 (average scores fall between 85-115). Jack has strengths with syntax of word order.

  Raw

Score Standard Score Percentile Rank EquivalenAge t Listening

Comprehension 76 86 19 15.3 Oral Expression 66 80 22 12.3 Standard Score Total   83 13 18.5 Written Language   89 23 11.6 Sum of written language, Listening comprehension, oral expression standard score 255   12 5.3

I. Diagnostic Report:

Components (con’t)

4.

Observations and Assessment results–

V.

The client’s fluency skills were informally evaluated during a conversational dialogue. The client

presents with fluency skills consistent with his age and gender. No atypical dysfluencies were noted this date.

VI. Voice

The client’s vocal skills were also informally

evaluated during conversational dialogue and the client’s voice was within functional and appropriate limits regarding his age, and gender and size.

I. Diagnostic Report:

Components (con’t)

5.

Summary of Findings

–paragraph

summarizing the

information

obtained during the evaluation

process

.

A “snap shot” of the client’s overall

status—deficits and strengths

I. Diagnostic Report:

Components (con’t)

5.

Summary of Findings

–

The assessment results revealed that Jack does

not present with any deficits in articulation.

However, Jack presents with expressive

language delays. To date, the client’s voice and

fluency skills are functional and need not be

targeted for remediation. His hearing acuity is

within normal limits and no further diagnostic

procedures will be given to the client in regards

to hearing. The client’s oral motor structures

were functional; therefore no further diagnostic

procedures will be given.

I. Diagnostic Report:

Components (con’t)

6.

Prognosis

– short statement of

how the clinician feels a client will

perform in therapy, given

client’s

communicative

and

medical/mental

status, support

system, etc.

Ex: The prognosis for Jack’s progression in therapy is good with family support. The client completed all diagnostic procedures with appropriate behavior, with moderate breaks during the administration of the test batteries.

I. Diagnostic Report:

Components (con’t)

7. Recommendations

– states whether

the client needs treatment



Based on DX results



States the

focus/direction

tx should take

States

how often

tx should occur



Indicates any follow up appointments the

I. Diagnostic Report:

Components (con’t)

8.

LTG/Os

– states client’s overall

communicative objective



Reflects how client is to perform at the

end of ALL treatment or at the end of a

specific period of time

I. Diagnostic Report:

Components (con’t)

9.

STG/Os

– states client’s short

term objectives or goals during a

given semester—”starter goals”



Must be obtained before the LTG/O is

achieved

II. Initial Tx Plan



Comprises of

LTG/Os

and

STG/Os

based on

diagnostic findings AND pretreatment

baseline results



Developed immediately after testing and or

is updated once baselining is completed



States what client is targeting in therapy

Goals on the LP must mirror goals on the

ITP/UTP



STGs must correlate with the LTGs under

Clinical Reports



Before we review the remainder of the

AAMU CSD reports…..

Behavioral Objectives



Baselining (pretreatment)

Tallying

Behavioral Objectives (BO)

Defined

A behavioral objective is a

statement that

describes

a specific

target behavior in

observable

and

Behavioral Objectives (BO)

Components



In order for a BOs to be

measurable

and

observable

, they must have three (3)

key components:

1.

The Performance Component

The Condition Component

Behavioral Objectives (BO)

Components (cont.)

1.

The “Do Statement”/performance statement



An

ACTION

statement that

identifies the

specific action the client is expected to perform



States

what a learner is

expected to DO

in

order to demonstrate mastery of the

objective/goal

Behavioral Objectives (BO)

Components (cont.)

1. The “Do Statement”/performance

statement



Effective DO statements use well defined

goals



Verbs (overt)

must be used that directly

state what the client is expected to

accomplish

Behavioral Objectives (BO)

Components (Performance cont.)



Overt verbs

are performances that are

directly observed via vision and or

auditory means

—(i.e. point, say)



Covert verbs

can be used, but they

need

to be clarified-

-

i.e. the client will be able to

demonstrate knowledge of five body

parts (by labeling/naming them after

clinician model) with 90% accuracy.

Behavioral Objectives (BO)

Components (Performance cont.)



Example of “DO” statement:

The client will correctly

label/name five body parts,

following clinician’s model with

90% accuracy

Behavioral Objectives (BO)

Components (Performance con’t)



Overt Verbs—

Observable

POINT

Non Observable

Verbs—

LEARN

Behavioral Objectives (BO)

Components (cont.)

2. The Condition Statement

Identifies—

a.

S

ituation

in which the target

behavior is to be performed

b.

C

ontext

of the behavior

c.

C

ondition

under which the

performance is to be done or

completed

Behavioral Objectives (BO)

Components (Condition cont.)

Example of

Condition

statement

used:

The client will correctly label/name

five body parts,

following clinician’s

model

with 90% accuracy

Behavioral Objectives (BO)

Components (cont.)

3. The Criterion Statement

Measures-



How well the target behavior must be

performed to achieve competence

Behavioral Objectives (BO)

Components (cont.)

3. The Criterion Statement

Measures-

In speech pathology the criterion

statement is frequently stated in

terms of accuracy

(ex. percent correct, within a given time

period, minimum #of correct responses out of # of trials)

Behavioral Objectives (BO)

Components (Criterion cont.)

Examples of

Criterion

statements

:

The client will correctly produce target…

i. In 90% of his attempts

ii. In 90% of all appropriate contexts iii.8 out of 10 attempts

iv.8 out of 10 trials

v. For 20 of 25 pictures

vi. With fewer than .5 stuttered words per minute vii. 3 conversational turns.

Examples of Well-Written BOS

The client…

will correctly produce the /r/ phoneme in all positions of words in 90% of his attempts.

2. will correctly imitate /s/ in isolation in 8 of 10 attempts.

3. raise his tongue tip to the alveolar ridge with his mouth open at least 1 ½ inches on 8 or 10 trials.

4. auditorily discriminate (by raising his hand) /s/ from /f/ in consonant-vowel combination in 90% of his attempts.

5. Correctly monitor (state if correct or not) production of the /l/ phoneme during spontaneous conversation in 90% of his attempts

6. correctly monitor (self-correct) 90% of the incorrect /s/ productions during reading.

Application and Importance

of Behavioral Objectives

The application of being able to

write

and

understand

BOs is crucial in speech pathology

Behavioral objectives are seen the 5 main

reports used for client care in AAMU CSD

Clinic:

Dx Report, ITP, LP, SOAP,

Semester

Summary Reports

How Do We Select Appropriate

Therapy Targets?

For Dx Report/Initial LP



First Step: Identify the communication

behaviors to be acquired over the course of

the treatment program (Long Term Goals)

1. Previous

diagnostic

findings

Standardized

Tests

Sampling

- administration of

pretreatment

baselines

2. Review

performance

on goals on

Pretreatment Baselines

Clinician-designed measures that provide

multiple opportunities for a client to demonstrate a given communicative behavior

Minimum of stimuli (ideal) on each pretreatment baseline-calculate a percentage of

accuracy based on correct versus incorrect responses

 For example the LTG is:

Long Term Goal 2: The client will demonstrate expressive

language skills for functional communication with 80% accuracy  And your short term goal is:

Short Term Goal 2a. The client will correctly name objects in

photo cards with 80% accuracy with minimal cueing.

A minimum of 20 photo cards will need to be presented to the client

Pretreatment Baselines

• Therapy targets for baselining are taken from the goals

generated for the Diagnostic Report, Initial Therapy Plan (post dx testing) or the Semester Summary Report.

• New goals for the Initial Therapy Plan are generated

each semester and are based on either…. • previous semester’s Semester Summary Report, OR • on current evaluation information.

• When generating goals for the ITP write them in a

logical, sequential manner:

• E.g. Receptive language tasks before Expressive

Pretreatment Baseline

(con’t)

• Receptive Language Goal first:

• Long Term Goal 1: The client will demonstrate receptive language skills for functional communication with 80% accuracy.

• Short Term Goal 1a. The client will identify

pictures/objects on command when given a verbal stimulus by pointing to the correct picture from a field of three with 80% accuracy.

• Expressive Language Goal:

• Long Term Goal 2: The client will demonstrate expressive language skills for functional communication with 80%

accuracy.

• Short Term Goal 2c. The client will correctly name objects when given picture stimuli with 80% accuracy with minimal cueing.

• Long Term Goal 3: The client will complete weekly homework assignments with 80% accuracy.

Pretreatment Baseline (con’t)

Rule of Thumb



If the client performs with

75%

accuracy or higher during

baselining of therapy targets- the

communication skill in question is

typically not in need of remediation



If the client performs below

75%

accuracy during baselining of therapy

targets - that task should be

considered as a potential intervention

target.

Pretreatment Baselining

(con’t)

 If baseline scores are below 50% accuracy, the clinician

should begin therapy at a step below the baselined response level or below the level baselining occurred

 If the client performs between 50-75% on a baseline task,

the clinician should begin therapy at baselined response level.



So….The client will correctly produce /k/ in

initial word position with 90%...

Pretreatment Baselining

 Practical:

Melissa Shelton was given the GFTA-3 where all sounds were found to be developed within norm except for /v/, /f/, /k/, and “sh”. Melissa is 6.8 years old with normal cognition. Baseline procedures at word level, rendered the following results: 1. Initial /k/: 60% accuracy 2. Medial /k/: 20% accuracy 3. Final /k/: 90% accuracy 4. Initial /v/: 10% accuracy 5. Medial /v/: 100% accuracy 6. Final /v/: 50% accuracy

7. Initial and final /f/: 66% accuracy 8. Medial /f/: 100% accuracy

9. Initial “sh”: 25% accuracy

Pretreatment Baselining

(con’t)

 Practical:

Melissa Shelton was given the GFTA-3 where all sounds were found to be developed within norm except for /v/, /f/, /k/, and “sh”. Melissa is 6.8 years old with normal cognition. Baseline procedures at word level, rendered the following results:

1. Initial /k/: 60% accuracy– word level 2. Medial /k/: 20% accuracy– syllable level

3. Final /k/: 90% accuracy– phrase/sentence level 4. Initial /v/: 10% accuracy– syllable level/isolation 5. Medial /v/: 100% accuracy– phase/sentence level 6. Final /v/: 50% accuracy– word level

7. Initial and final /f/: 66% accuracy– word level

8. Medial /f/: 100% accuracy–

phase/sentence level

Tallying



Tallying= is a means for the clinician to

determine client

progress

and to

determine if the

criterion

of a specific

objective

has been met



In order to tally effectively, the clinician

must

develop a symbol system

to

represent the client’s correct responses

v.s. client’s incorrect responses

Tallying



There is not a set symbol type that represents

client correct response and a set symbol type

that represents client incorrect response



Some clinicians use (+ ) for correct responses

and (–) for incorrect responses



Some use lines for correct responses and circles

for incorrect responses



Remain consistent

in using the symbol you have

Tallying



Once tallying is complete, correct and incorrect

responses are charted like fractions



The total of possible responses would represent

the

lower number

on a fraction (denominator)

and the client’s performance (client correct

response on target) will be representative of the

top number

(numerator)



To determine the percentage of client’s correct

responses, the clinician will

divide

the

numerator by the denominator and

multiply

by

100 to obtain the whole percentage

Tallying



There will be instances where the client will

need added support to achieve the target

behaviors successfully (i.e. cues)



It is also important for the clinician to

establish a

symbol

in tallying to represent

cued responses



If the clinician wants to determine how a client

performed a goal with the aid of cues, the

clinician will

add

(+)

cued client responses to

the client’s independent correct responses

and

then divide by

the denominator (

total possible

responses

)

Tallying



(+)= correct responses

(-)= incorrect responses

©= cued responses

+ + + - + - - - + +=6 (ct. correct responses)/10

(total # of possible responses)—60%

+ + c c + + - - + += 60% independently; 80% with

the aid of cues.

III. Lesson Plans

Has major

components

1.

Long Term Objectives

2.

Short Term Objectives

3.

Procedures

—The

step by step

actions the

clinician will execute to provide opportunities for

the client’s target behavior to occur. Serves as

an explanation of how the clinician will utilize

specific cues/key teaching strategies for teaching

events. (See cues)

4.

Cues

--

what the clinician will do to actually

train

client’s target behavior and correct errors—the

teaching

of targeted objectives—clinician support

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”-

Direct modeling:

clinician

demonstrates a specific behavior

for the client to imitate

 Max amount of clinician support given

 Utilized in early stages of therapy  Used when shifting from a lower

response level to a higher level of difficulty-- i.e. going from syllable to word level

 Usually performed with visual and verbal cues

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”-

Indirect modeling

– clinician

demonstrates a specific behavior

frequently to expose the client to

examples frequently--bombarding

them with a selected target

 Used at any stage of tx

 Ex. Client working on initial /s/ -

clinician may implement a significant number of initial /s/ in her off-task comments throughout the session

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”-

Shaping by successive

approximation

–

target behavior is broken down

into small components and is

taught in sequence



Example—client presents with

cluster reduction where

prominent consonant is

deleted /sn/ cluster would be

targeted as as /s/ /n/

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”-

Prompts

– clinician provides verbal

or nonverbal cues to facilitate client’s

production of a correct response



Attentional (look at me, are you

ready)



Instructional (cues to provide info

about the target behavior being

attempted – remember to raise

your tongue tip at the beginning of

each word)



May be nonverbal – card with

fluency techniques written on it,

gesture for vocal loudness

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”-

Fading

–

stimulus or consequence

manipulations (modeling, prompting,

reinforcement) are reduced in

gradual steps while maintaining the

target response



Expansion

–

clinician reformulates

the client’s utterance into a more

mature or complete version

 Used at any stage of tx

 Used mostly in language therapy

 Clinician’s interpretation of what the

client meant by an utterance (ex. Daddy cookie = Yes, daddy is eating the cookie)

III. Lesson Plans

Has major

components

4. Cues (con’t): i.e. “Key Teaching

Strategies”- Negative practice – client is required to

intentionally produce an error pattern, to differentiate between correct and incorrect

 Use only after a client demonstrates the ability to produce a target consistently imitatively

 Best used on a short term basis

 Target-specific feedback – clinician

provides info regarding the accuracy or

inaccuracy of a client’s response relative to the specific goal

 Useful throughout all phases of tx

 Provides useful info as to why a response was correct or incorrect (good job vs good, I didn’t see your tongue peeking out when you said soup)

III. Lesson Plans

Has major components

5.

Reinforcement

--what the clinician will

do to

shape

or

condition

client

behaviors

. This includes the TYPE

and SCHEDULE of reinforcement that

will be applied.



Types of Reinforcement

Types of Reinforcement



POSITIVE

POSITIVE

NEGATIVE

NEGATIVE

PUNISHMENT

PUNISHMENT

All are used to increase the

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement

Types of Reinforcement



POSITIVE –

POSITIVE

 Rewarding event or condition that is

presented after correct response

 Contingent on the performance of a

desired behavior

 Primary type used in in speech and

language tx—Why?

 Improves motivation

 Fosters good interpersonal

relationship between client and

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



POSITIVE –

 Primary

 Contingent event to which a client responds favorably due to the biological or

physiological makeup of the person  Food--as this fulfills a biological need  Can be very effective

 Used mostly for establishing new communicative behaviors

 Effective for low-functioning clients

 Disadvantages:

 Must be given immediately after every occurrence of the behavior

 Difficult to carry-over –unrealistic to give primary reinforcement in the “real

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



POSITIVE –

 Secondary –

 Contingent events that a client must be taught to perceive as rewarding  Three general types:

(1)Social

-- Smiling, eye contact, verbal praise  Easy to administer

 Not very susceptible to satiation  Does not disrupt therapy

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



POSITIVE –

 Secondary (Types of) –

2) Token –

 symbols/objects not perceived as

valuable alone

 Accrual of the “token” permits a

client to obtain a previously agreed upon reward (stickers, check marks, chips)

 Very powerful (client motivated)  Easy to administer

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



POSITIVE –

 Secondary (Types of) –

(3)Performance feedback –

 Information that is given to a client

regarding progress

 Doesn’t have to be verbal, not

“praise”

 Can be percentage data, graphs,

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



POSITIVE –

 Secondary (Types of) –

(3)Performance feedback (con’t) –

 Decreases reliance on external sources  Allows client to achieve internal

rewards (motivation)

 Should give informational feedback in a comparative manner:

reporting current client performance and how close the performance is to reaching the final target or some

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



NEGATIVE –

 Unpleasant event/condition is

removed contingent on the

performance of a desired behavior

 Ex. white noise being presented to

the client through earphones and when the client performs the target sound correctly, the noise stops.

 Not recommended for SLPs to use  Exposes the client to aversive

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Types of Reinforcement



PUNISHMENT –

 Event is presented contingent on the

performance of an undesired behavior to decrease the likelihood that the behavior will recur

 i.e. client says /t/ for /s/, the client would

receive a shock for incorrect productions

 Not recommended for the field of speech pathology  Elicits anger, frustration and reluctance to engage in

communication on the part of the client

 May even cause avoidance or termination of therapy

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Schedules of Reinforcement



Determined after type of

reinforcement is established



Must decide how often to deliver

reinforcement



Two types of reinforcement

schedules

 Continuous  Intermittent

III. Lesson Plans

Has major components

5.

Reinforcement

(con’t)--

Schedules of Reinforcement

Continuous – reinforcement

presented after EVERY correct performance

 Best to use when establishing new

behaviors or when transitioning from one level of difficulty to the next (word to sentence level)

Intermittent – only some occurrences

of a correct response are followed by reinforcement

 Most effective in strengthening

responses that have been previously established

III. Lesson Plans

Has major components

5.

Reinforcement

(con’t)--

Schedules of Reinforcement



Intermittent

*4 Types of intermittent reinforcement*

 **Fixed ratio (FR) – the client must give a

specific number of correct responses before a reinforcer is delivered (every 2

responses, 10 responses, etc); FR elicits a high rate of correct responses. Ex 3:1 or FR3

 Fixed interval (FR)– reinforcement is

delivered after a given amount of time has elapsed (3 min); not good for

reinforcing new speech behaviors because the response rate tends to decline after the presentation of the stimulus. For new speech behaviors, reinforcers should be continuous. Ex of doc. Is FI 3

III. Lesson Plans

Has major components

5.

Reinforcement (con’t)

--

Schedules of Reinforcement



Intermittent

*4 Types of intermittent reinforcement*

 **Variable ratio (VR) - # of reinforcers vary

from trial to trial according to a

predetermined pattern set by clinician; ex. 3, 10, 4, 7,…; client cannot predict and

anticipates a reinforcer after each response. Ex of doc. Is VR 3, 10, 4…

 Variable interval (VI) – clinician varies the

time period required to receive

reinforcement rather than # of responses; ex. 3, 10, 1, 4 min. Ex of doc… VI 3, 10, 1

III. Lesson Plans

Has major components

5.

Reinforcement

(con’t)--

Schedules of Reinforcement

Rule of thumbuse continuous

reinforcement for teaching new

speech behaviorsswitch to a

lower density intermittent

schedule when target response

rate increase 30-50% over

original baseline measures

Progression will look like this:

III. Lesson Plans

Has major components

6.

Materials

— manipulatives the

clinician will use to stimulate client’s

response

i.e. games, magazines, list of

questions, mirror, stickers, picture

cards, etc.

7.

Tally/Data

-client’s measurable

performance on given task

Lesson Plan

Criterio

n Short Term Goals Session 1 – M, T, W, R (circle) Data

90% 1a. The client will accurately demonstrate subject/verb

agreement in written sentences by selecting the correct verbs given a choice of 2 to 4 answers with 90% accuracy.

Procedures: The client will be given a subject/verb

agreement worksheet from Ed helper, and the client will be required to provide a verb for each sentence.

Cues: The student clinician will provide a written example of a sentence with accurate

subject/verb agreement. Reinforcement: verbal praise/intermittent—2:1FR Materials: worksheet and pencil

Tally: % Correct: