Clinical Practice 1

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scope of practice statement

A list of professional activities that define the range of services offered within the profession of speech-language pathology or audiology

preferred practice patterns

Statements that define generally applicable characteristics of activities directed toward individual patients and that address structural requisites of the practice, processes to be carried out, and expected outcomes

position statements

Statements that specify ASHA's policy and stance on a matter that is important not only to the membership but also to consumers or to outside agencies or organizations

practice guidelines

A recommended set of procedures for a specific area of practice, based on research findings and current practice. These procedures detail the knowledge, skills, and/or competencies needed to perform the procedures effectively

ASHA Framework

Scope goes from broad to focused
Content goes from general to specific
All items are enveloped by the Code of Ethics

1. Scope of Practice
2. Preferred Practice Patterns
3. Position Statements
4. Guidelines
5. Knowledge & Skills Statements

KASA

knowledge and skills acquisition

EBP

evidence-based practice

How EBP affects clinicians

we have to use EBP to make sure that our treatments are useful and appropriate for the clients that we have

ASHA roles

accredit masters degree clinical training programs in speech pathology and audiology; certifies practitioners in the fields; fosters improvement of clinical procedures by holding annual conventions for continuing education; publishing professional journals; disseminate standards and ethical conduct; advocates for client by monitoring and participating in the development and implementation of education and healthcare reform proposals and programs at the federal and state level

ASHA services

-political advocacy
-networking
-continuing education
-multicultural initiatives
-research
-technical assistance.
-Referral service.
-Employment service
-specialty recognition
-special interest divisions

EBP

integration of
a) clinical expertise
b) best current evidence
c) client-patient perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve

SLP scope of practice

train to work with individuals with the following types of disorders: articulation of phonological disorders.
Fluency disorders.
Language disorders in adult
developmental language delay/disorders in children.
Voice disorders .
Cognitive disabilities
swallowing problems
oral - motor difficulty
Infants- toddlers who are at risk for developing speech/language problems and their parents
language-based reading difficulties

Audiologists scope of practice

evaluate the extent and type of hearing loss; make recommendations regarding amplification; dispense hearing aids; habilitation and rehabilitation of those with hearing disorders; provide infant screenings; cerumen management; testing for balance disorders; assessment of CAPD

Academic requirements for SLP

masters degree for SLP from CAA accredited university; program of study include minimum of 36 credit hours of academic coursework graduate level; minimum of 400 clock hours clinical practicum (25 hours must be clinical observation)

Academic coursework requirement for audiologist

an AUD or PhD degree; program of study includes 75 credit hours post baccalaureate education; minimum 12 months full-time equivalent (1820 clock hours) supervised clinical practicum

CCC

certification of clinical competence; earned the prerequisite degree for the profession including completing specified coursework specifying clinical practicum experience; having a passing score on the national exam (PRAXIS); for SLP completing nine months of clinical fellowship year under supervision of licensed, certified professional

maintain CCC

30 hours of continuing education every three years

State licensure

defined by each state; governed by a board of examiners; practitioners must meet minimum requirement; Arkansas licensure is consistent with ASHA certificate of clinical competence

Multidisciplinary

individual discipline conducts own assessment and develop discipline specific goals; minimal integration between disciplines

Interdisciplinary

individual discipline conduct own assessment but communicates with others about results; complementary goal development where all disciplines incorporate goals and objectives of related field in the plan

Transdisciplinary

single assessment of individual completed in unison by several disciplines; one professional implement intervention plan

Important skills for clinicians

excellent communication and interpersonal skills; intellect and perseverance required to complete the training; sensitivity to client needs; ability to concentrate and pay close attention to details; appreciation for precision instrumentation; ability to work in a team environment; should enjoy working with people exploring problems in depth and operating equipment

Core clinical excellence skills

critical thinking (analysis; evaluation; inference; exclamation; self-regulation); innovation and creativity; collaboration; risk-taking; self-knowledge and reflection; advanced social perception skills

Code of ethics

set of standards for ethical behavior; set of common core values; expectations of acceptable professional conduct and conscientious judgment

Infection control

receiving proper vaccinations (Hep. B, TB test); washing hands before/after sessions; making antibacterial gel available for staff and clients; using disposable gloves during certain procedures (oral mechanism exam); appropriately disposing of contaminated items (gloves, tongue depressors); decontaminating non-consumable items (ear tips, feeding items); disinfecting tables, chairs, toys, etc. at the end of each session

Big 9

articulation, fluency, voice and resonance, receptive and expressive language, hearing, swallowing, cognitive aspects of communication, social aspects of communication, communication modalities

Receptive and expressive language

phonology morphology syntax, semantics, and pragmatics in speaking, listening, reading, writing and manual modalities

Hearing

including impact on speech and language

Swallowing

oral, pharyngeal, esophageal, and related functions, including oral function for feeding; orofacial myofunction)

Cognitive aspects of communication

attention, memory, sequencing, problem - solving, executive functioning

Social aspects of communication

including challenging behavior, and effective social skills, lack of communication opportunities

Communication modalities

oral, manual, augmentative, and alternative communication techniques and assistive technologies

Voice and resonance

including respiration and phonation

HIPAA

health insurance portability and accountability act of 1996; privacy; security

Professional ethics

publicly state the common core values and collective obligation shared by persons in a particular discipline

Reason for professional code of ethics

1) consumer protection and client welfare are safeguarded
2) the professional reputation of the discipline is maintained; three professional behavior is regulated
4) objective guidance is available for ethical dilemmas and deliberation
5)practitioners can rely on an external code in addition to their own values
6)clients have an objective standard against which to evaluate their clinicians actions

why do we have a code of ethics

enables us to look toward a common set of core values when confronted with ethical dilemmas in the workplace

Principals in the code of ethics

Responsibility to:
1) safeguard welfare of clients or research participants; treat animals humanely
2) maintain highest level of professional competence and performance
3) the public by promoting understanding of the profession and provide accurate info
4) to the professions and their relationships with colleagues, students, and members of other professions and disciplines

Principle of safeguarding client welfare

beneficence and nonmaleficence; nondiscrimination; referral; informed consent; confidentiality; prognosis and cures; infection control

beneficence

professionals promote the interest and welfare of others

Nonmaleficence

means that professionals deliberately avoid inflicting potential or actual harm (emotional harm, physical harm) on clients

Beneficence and nonmaleficence

compels professionals to monitor their own behavior as well as that of caregivers who interact with clients; for example, we are expected to report situations in which we perceive that children adults or elders may be victims of physical, emotional, and/or sexual abuse, as well as neglect by their caregivers

Nondiscrimination

clinicians do not exclude client from their professional practice for reasons other than the person potential to benefit from our services

Referral

SLP or audiologist feels that a client presents a communication disorders beyond the clinicians' level expertise and may refer to a person with appropriate clinical experience

Informed consent

clients are told about their speech language or hearing conditions and are informed about the relative strengths, weaknesses, and risks (side effects) associated with the recommended plan of action or inaction; guarantees that a client could end their course of treatment according to their own autonomy at any point during its course

Confidentiality

means that professionals share privileged information only with people directly responsible for client management and/or care and only for purposes related to clients welfare

HIPAA

mandates that clients have rights and protections regarding how and to whom their health information is shared; information includes medical records and conversations between clients in healthcare providers

Prognosis and cures

professionals must not imply or guarantee cures; instead clinicians are expected to make a reasonable prognosis

Prognosis

statement that describes the likelihood that a benefit will be gained from treatment; if a person is not likely to benefit from initial or ongoing treatment, intervention should not be recommended or continued

Infection control

hygienic precautions usually include handwashing in the use of barriers (gloves, masks); used to safeguard clients and clinicians from infectious disease; clinicians are expected to disinfect equipment and know the propers procedures for the disposal of bodily fluids; clinicians are expected to practice universal precautions

Competent practice

clinician provides effective diagnostic procedures, accurate prognosis, and appropriate therapy strategies for the particular disorder, as well as an ongoing analysis of client outcomes; clinicians can refer to ASHA's guidelines for documents about competent practice

Specialization

occurs with in-depth experience, advanced knowledge, and training beyond the initial credential in a particular population, disorder and/or service delivery model

Continuing education

enables clinicians to update their skills by keeping current on the latest trends and advances in their discipline. This can be achieved by reading textbooks and journal articles, attending workshops, taking a course at a local university, shadowing professional colleagues, and participating in research activities

Conflict of interest

occurs when an SLP or audiologist accept personal or financial gifts from clients or manufacturers that compromise professional judgment, because there are strings and/or expectations attached; clinicians can lose their sense of objectivity and decision-making becomes clouded; examples of potential conflicts include self-dealing self referral for drying cases from your primary employer for private practice

Clinical model

provide intense 1 to 1 or small group instruction in a separate location; advantageous when trying to initially teach a particular speech language skill or when standardized testing needs to be completed; can also be utilized when a child needs less distracting environment or when the intervention protocol warrants privacy; also utilized within medical speech language pathology (an adults who had a stroke leaves his or her home and comes to university clinic to practice communication skills);

Consultative/collaborative services

occurs when members in an intervention team work together and share responsibility for client outcomes; when SLP works indirectly with a client by providing guidance to the clients family members and professional colleagues who work more directly with the patient;

Individual services

intense and 1 to 1 in nature and are typically aimed at teaching the client a specific communication skills

group services

includes two or more patients working on similar speech language skills or who need to practice the generalization of learned skills to additional communication partners

Self-contained classroom

when the SLP is the primary educator providing both academic instruction and intensive speech - language remediation; can occur when a we run a class for preschoolers who need focused stimulation because they have severe speech sound disorders

Multidisciplinary and interdisciplinary

often interchanged depending on the work setting; both are popular in medical settings and schools

Work settings for the SLP

early intervention programs; preschool and school-based services; medical work settings ; private practice; colleges and universities; psychiatric centers; group home and employment settings for people with developmental disabilities

Educational settings

the majority of SLP's work in this type of setting

IDEA

most often used mechanism for providing special services to students with disabilities

30%

percentage of SLP's to work in the medical settings

Most common medical work setting for an SLP

general medical hospitals and skilled nursing facilities

ICF

international classification of functioning, disability, and health framework

ICF framework

considers the influence of body structure and function on the performance of daily activities and individuals ability to participate in life functions

continuum of care (COC)

transition through various settings

Managed care

collective term for approaches to the delivery of healthcare that attempt to control quality while containing costs

Consultant

typically the role SLP plays in a hospital setting because the stays for the clients for so brief

Types of medical settings for SLP

general medical hospitals; children's hospitals; rehabilitation units and hospitals; outpatient rehabilitation centers; transitional living centers; skilled nursing facilities; home healthcare

private practice (27%)

where the majority of audiologists practice

Types of settings for an audiologist

schools, hospitals and medical centers; medical practices; private practices; industry; colleges and universities; hearing aid manufacturers

Contemporary issues that may influence ethical competence

competition
service eligibility
discharge
resources
managed care
scope of practice
paraprofessionals

Misrepresentation

type of dishonesty that occurs when truth is distorted or falsified ; types include misrepresenting the clinicians own personal levels of training, experience, and expertise or that of person to provide clinical services; clinician should not unfairly influence client decisions; client status should not be misrepresented to gain financially

Ethical practice within professional supervision and instruction

clinical supervisors should model ethical behavior, and they're expected to monitor the ethical compliance of the persons they supervise; if unethical behavior is suspected or observed, supervisor must take action to prevent violation of ethical standards; supervisors that have a CFY participant have specific guidelines in the CFY contract

Ethical behavior within professional relationships

work to understand the nature of related disciplines and the particular job functions of our teaching, medical, and Allied health colleague; have a give-and-take open communication style so all the team members can discuss pertinent issues; avoid personal conflict and foster a climate of mutual respect

Ethics calibration quick test (EC QT)

test that enables us to analyze the ethical propriety of the situation by considering the ethical conflict, the values that are involved, the evidence, the possible plans of action, and the decision-making process

Chaben and Morris consensus model for ethical decisions

clinician is encouraged to evaluate the specific facts and values so as to specifically state the ethical dilemma; then, the analysis includes the possible courses of action and the degree to which these are consistent with professional standards, social rules and self interests

Ethical practice board

AAA committee on ethics

ASHA committee on ethics

board of ethics

role of ethics committee

to develop position statements that further define particular ethical rules already cited in each code; to handle the adjudication process when violations are alleged; to educate Asha and AAA members about ethics

CAA

council on academic accreditation in audiology and speech language pathology

AAA

American Academy of audiology

Contemporary issues that influence service delivery

functional communication
assistive and instrumental technology
evidence-based practice
managed care accountability
inclusion
collaboration
educational standards
multicultural issues
transition services
regulations and accreditation
self advocacy, family involvement, and client rights
eligibility and exit criteria
speech language pathology assistants and paraprofessionals

Direct services

occur when a clinician works in a face to face format with an individual client or group of clients

Indirect services

occur when the clinician does not have hands on contact with the client but instead is likely to consult with the clients family members, teachers, and/or medical personnel about the clients communication needs

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