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Service Delivery Models

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Systems used to organized speech,lang and hearing programs w/I employment settings. It includes the formats by which services are rendered, including where, when and with whom services are provided.

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Direct services

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occur when a clinician works in a face-to-face format with an individual patient or group of patients.

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SLP may provide direct swallowing rehab with a patient at the bedside.

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Example of direct services in hospital

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a clinician might work directly with a small group of student with lang. delays who are learning the vocab assoiated with their first-grade math curriculum

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Example of direct services in a school

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Indirect Services

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

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occurs when a classroom teacher follows the suggestion of a clinician and deliberately emphasizes the way particular sounds are pronounced by the students during a "letter of the week" activity in a kindergarten class.

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Example of Indirect Services

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when the staff of a group home follows a clinicians suggestion & develops a picture board that helps an adult with a developmental disability communicate during community outings.

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Second Example of Indirect Services

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clinical and consultative/collaborative

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Direct Services can include both______ and ______ services.

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Example of a Clinical Model within direct services

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a school SLP typically takes children out of their classroom so as to provide intensive one-to-one or small group instruction in a separate location.This is useful when standardized testing is to be done or initial teaching of particular speech-language skills.

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when a child needs a less distracting environment & when intervention protocol warrants privacy.. May be necessary for a child who stutters and needs safe place to discuss feelings.

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When can clinical models also be utilized?

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Clinical model within Medical SLP

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when an adult who has had a stroke leaves his/her home and comes to a university clinic to practice communication skills.

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Clinical or Pull-out

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Client is seen _outside of classroom____ or daycare

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Collaborative

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Members work together ____to share responsibility for intervention__. Can be inclusive or classroom based- SLP goes into the classroom to provide services

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partially direct

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Collaborative Services are

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Consultative

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SLP works indirectly by providing guidance to team members including parents (e.g teachers, direct service providers, psychologists, OT)

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indirect

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Consultative Services are

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considerable scheduling coordination among team members.

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In both clinical and consultative/collaborative therapy services, there needs to be ....what?

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Scheduling coordination in a clinical model

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classroom teachers may become concerned about the amount of instruction the child misses when absent from the classroom

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Scheduling coordination in consultative/collaborative model

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classroom curricula and activities must be scheduled flexibly to accommodate the future incorporation of speech-language goals

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both clinical and collaborative consultation services.

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Often, a client's speech-language intervention plan calls for

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Individual Services

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intense and one-to-one in nature and are typically aimed at teaching the client a specific communication skill

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when Tom, an adult with apraxia of speech, works on speech production strategies during an individual intervention session at a rehab center

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Example of Individual Services

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Group services

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include 2 or more patients who are apt to be working on similar speech-language skills or who need to practice the generalization of learned skills to additional communication partners.

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Example of Group Services

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after Tom learns speech production strategies during individual services, he might participate in a group session where he is expected to converse with other adults. A group session enables Tom to receive natural feedback from his peers.

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Self-Contained Classroom

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Another example of group services

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Self-Contained Classroom

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when the SLP is the primary educator providing both academic instruction and intensive SLP remediation. This can occur when we run a class for preschools needing focused stimulation because of severe speech sound d/o.

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Self-Contained Classroom

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The special ed teacher or SLP teaches ____all academic subjects_____ to individuals with disabilities in a special classroom. Students are not members or a regular ed. Classroom

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1. MultiDisciplinary 2. Interdisciplinary 3. Transdisciplinary

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There are three models that identify the relationships shared by team members in the facilitation of patient progress.

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Multidisciplinary model

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When many professionals are working with a client, each discipline conducts their own assessment and writes own intervention goals.

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Multidisciplinary

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Each individual discipline conducts its own assessment and develops discipline-specific goals with minimal integration of these goals across disciplines. In addition, each discipline has its own plan for the patient, with goals reflecting only its own field of expertise.

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Interdisciplinary Model

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Separate assessments but results are discussed and ___complementary goals ___ are developed.

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Interdisciplinary

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Each discipline conducts its own particular assessment but also communicates with other disciplines about the results of these assessments.

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Interdisciplinary Model

answer

when working with a patient with a TBI, language sequencing may be one objective for the SLP..As part of the program, an SLP might have the patient write down the steps associated with daily tasks. While writing, The patient can be given instructions about how to hold a pencil correctly and using eye-hand coordination strategies that had been suggested to the SLP by the client's OT. Conversely, during OT, the therapist can include verbal sequencing that was suggested by the SLP.

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TransDisciplinary Model

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Single assessment completed in unison, team weaves objectives together and decide on who the case manager will be

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Trandisciplinary Model

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This model means that team members have an ongoing dialogue in which they share info, knowledge, and skills in order to develop and implement a single integrated service plan for the client.

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Transdisciplinary Model

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There is a single assessment of the client that is completed in unison by professionals from several disciplines; and -Together, the professionals can review the assessment data and weave together objectives that are reflective of all disciplines.

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The team typically authorizes one person who, along with the clients family members, becomes responsible for carrying out the client's intervention plan.

answer

In a transdisciplinary model,

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Example of A transdisciplinary model

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a 17-year-old client with developmental disabilities who is making the transition to living and working independently is likely to have a job coach. This job coach is responsible for teaching vocational skills by integrating several educational domains as the client learns job and communication skills and how to dress and socialize appropriately. In this situation, the job coach can link together the educational plan, and the SLP can teach the job coach strategies to facilitate workplace communication skills.

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the role of an audiologist in occupational hearing conservation and hearing loss prevention

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An ASHA technical report outlines

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the role of an SLP who provides clinical services via telepractice.-

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The role of an SLP in school-based preferred practice and an ASHA position statement identifies

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Two examples of AAA Guidelines

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1). AAA's scope of practice guidelines (AAA,2004) 2.) The position statement on the audiologist's role in the diagnosis of vestibular orders.

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educational settings- preschool & school age

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Most SLPs work in ________settings of _____& _____ age

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birth to 21

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What ages does an SLP educational setting cover?

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Early Intervention Services

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Intervention which applies to children from birth-Kindergarten.

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1.For children age birth-3 years 2. Preschoolers age 3- Kindergarten

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Two Systems of Early Intervention

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Birth-3 Years Early Intervention

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These services emphasize that the family of the child with a disability is the recipient of services.

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Birth-3 Years Early Intervention

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This intervention operates by using a transdisciplinary model, designing a single, integrated individualized family service plan (IFSP*)

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It may be direct or indirect, individual or group, and consultative or clinical.

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Service provision occurs in a variety of settings and the role may be ___ or ___, _____ or _____ , and consultative or clinical.

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mainstream young children with disabilities so as to provide rich peer language models and promote social development. Also, inclusion of daily home routines

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Primary Goal of Early Intervention in Birth-3 group

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Transdisciplinary

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Birth-3 Intervention uses what model?

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age 3 up to Kindergarten

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Preschool Intervention covers

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1.1

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Nearly ____million school children 6-21 have a primary diagnosis of "speech-language impairment" and school based clinicians provide services to children who have other educational disabilities that affect communication processes.

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Traditional

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In Preschool intervention, a ____ model is common, alone or in conjunction w/ other approaches for children with d/o of artic/phonology, fluency, voice, and language.

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are often used for children with AAC needs as well as for children with language d/o, cognitive-communication needs, and APD.

answer

In preschool intervention, Classroom-based models

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Consultative/Collaborative Services

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models occur most frequently for children with language concerns and cognitive-communication needs. Children w/ related educational diagnoses often receive this

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IDEA

answer

The most often used mechanism for providing special services for students with disabilities.

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Preschool & school-based SLP services

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Requires the child to have the label "speech-language impairment" or another educational diagnosis that will affect speech-lang develop and use

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24

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__% of School SLP's work in preschool

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Kindergarten to Age 21

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School-Based Intervention covers what ages?

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Educationally Relevant

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In a school based model, the disability must be _______ _______

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30

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___% of SLPs work in medical settings

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medical hospitals and skilled nursing facilities; also included are rehab hospitals, outpatient clinics, home health agencies, or pediatric hospitals.

answer

Most common Medical Settings for SLPs

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treating individuals with dysphagia.

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A large portion of SLPs in a medical setting spend time doing what?

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remediation of aphasia or cognitive communication d/o

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Inpatient and Outpatient Center duties may include spending more time with:

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the role includes: assessment, development of the intervention plan, and patient/ family education.

answer

The roles within Inpatient and Outpatient Centers

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-typically clients have sustained an injury or suffer an illness that impacted communication, cognitive and swallowing skills

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Within Inpatient/Outpatient Centers, what is the disposition of the client typically seen?

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Continuum of Care

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The transition of services through various settings

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Continuum of Care

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SLPs participate in the decision to move patients through the continuum. Various regulatory bodies also influence the placement of a patient into a specific type of facility

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-Service delivery is influenced by _Regulatory bodies and third party payers

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Within continuum of care, what influences services delivery?

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number of sessions you get with a client and how fast the client moves through the continuum of care

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What do Third party payers have influence over?

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Managed care

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This is the collective term for approaches to the delivery of health care that attempts to control quality while containing costs.This can be a major issue under continuum of care.

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the accreditation commissions. JCAHCO and CARF

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Other than third party payers, what other regulatory bodies may influence service delivery?

question

the accreditation commissions. JCAHCO and CARF

answer

both have regulations that must be met regarding documentation, amount of therapy provided, communications among team members, goal setting, and inclusion of the patient in the plan for his/her intervention.

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SLPs must adhere to guidelines imposed by both the insurance companies and the accrediting bodies.

answer

SLPs must adhere to guidelines imposed by both _______ and the ____

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Accrediting bodies.

answer

Joint Commission of the Accreditation of Health Care Organizations (JCAHCO) and Commission of the Accreditation of Rehabilitation Facilities (CARF)

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This is done within a General Medical Hospital

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clients need rapid medical management, can't tolerate _long assessment or treatment , the SLP's role is to eval. the presence, type, severity of disorder and educate staff/family/patient accordingly.Here, individuals are often admitted to the ICU/acute care

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Example of medical, acute care in a General Hospital Setting

answer

Marie who had a stroke is having difficulty speaking and swallowing. She's evaluated and determined to have severe dysarthria. Her speech is difficult to understand due to severe weakeness in the oral musculature. The weakness extends from the mouth to the pharynx, resulting in a severe dysphagia, and she cannot eat or drink safely. Due to her immediate need to receive adequate nutrition, you recommend videofluroscopic swallowing study(VFSS) to determine the specific swallowing problem and possible management approaches. The procedure is carried out by a Radiologist. Following this study, a nasogastric tube is recommended as an alternative means of feeding. Additionally, you recommend speech therapy to work on speech and swallowing..Also, you collaborate with medical and rehab staff such as a PT and OT regarding contued needs and the most appropriate discharge destination.

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Another example of medical hospital/acute care setting

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In the NICU: an infant delivered at 32 weeks' gestation has numerous respiratory problems and an uncoordinated suck/swallow. The SLP may observe and evaluate the baby during feedings and provide suggestions.

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Acute Care Duties

answer

referral from neurologist -may implement AAC -may need swallowing precautions, change in diet, or feeding tube -NICU, feeding and swallowing

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These are seen in Children's Hospital

answer

Communication, dysphagia, cleft palate, TBI, Brain Tumor, disease, syndrome, birth defect( such as Mobius syndrome)

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we are responsible for evaluation, intervention, education, and discharge planning as part of the interdisciplinary team; and may act as a consultant when being discharged. -The Goal is to provide as smooth a transition as possible from hospital to the school.

answer

Children's Hospital Goal

question

Rehab Hospitals

answer

often have specific programs o acquired brain injury(ABI)—stroke,tbi; Spinal Cord injuries, or Respiratory Dysfunction.

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Rehab Hospitals

answer

Patients are generally medically stable in this setting, and they are able to participate in several hours of therapy each day.

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Assess the patient and function as a member of the team.

answer

SLP's first role in a rehab setting

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This is an example within rehab hospital setting

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If a patient has cognitive impairments that interfere with executive function, the SLP might conduct an intervention session with the OT in a kitchen and focus on assisting the patient with organization and sequencing skills required for the patient to prepare a meal, while OT addresses hand and arm control and trains patient in the use of adaptive equipment.

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Enhance communicative and cognitive functioning and prepare the patient for discharge home.

answer

Primary goal in rehab

question

multi-, trans-, or interdisciplinary

answer

Rehab Team can be

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This is seen in Outpatient rehab

answer

we evaluate the patient and set up an individualized intervention plan -The Patient & the family are likely to have significant input into the goals of intervention

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Outpatient rehab example

answer

A patient with mild dysarthria due to Parkinson's may state, "I want to talk better so I can be understood on the phone and get back to work", or, an elementary school teacher with dysphonia due to vocal nodules may state "I want to learn to use my voice so I don't get hoarse at the end of the day"

question

maximizing communicative functioning in the home & community, as well as those communication skills necessary for return to work/school.

answer

Goals of Outpatient Therapy

question

in Outpatient Therapy,

answer

-Individual lives _at home and come to rehab center 1-5 times a week

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Transitional living centers

answer

These centers are geared toward those individuals who need to return to an independent lifestyle. Most residents are young & have sustained a TBI

question

Transitional living centers Example

answer

SLP may help nursing staff to develop a plan to teach the patient his/her medication schedule and compensate for memory problems, OR we may address managing the patient's finances. Therapy is often provided in a group setting led by SLP and another team member.

question

Transitional Living Center

answer

-Team works toward _____community re-entry and self-help skills___________

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Skilled Nursing Facilities (SNF)

answer

Individuals are admitted into a ____ ____ ___ if they need ongoing nursing and medical care which cannot be managed by family members in the home. These facilities often have 2 distinct units: short term(or subacute) care and long-term care.

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This is an example of short-term care in SNF

answer

we may see a patient on with swallowing problems due to multiple sclerosis who was admitted to regulate his/her medications and to improve his/her endurance, self-care, and safety while swallowing

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Goals in short term therapy

answer

The goal for this intervention may be to train the patient and his family member to use strategies to make swallowing easier and recognize any signs of difficulty when the patient returns home.

question

Example of Long term Therapy

answer

These individuals are likely to remain in the facility for the rest of their lives. These patients may have a progressive neurological disease such as Alzheimer Disease. They may be seen in group setting for general cognitive stimulation.

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The goal of intervention here would not be to improve the patients' memory and communication but to facilitate and maintain communication as long as possible to improve the quality of life.

answer

Because Alzheimer's disease is progressive,what exactly is the goal of intervention?

question

Medicare Regulations

answer

______ regulations have greatly influenced the provision of speech therapy & there are strict guidelines regarding amount and type of therapy you can provide

question

prognosis and disability; also goals may be education or to increase comfort, quality of life

answer

In transitional care, goals and services depend on ____ and ____

question

Example of Home Healthcare

answer

The SLP may be seeing an oncology patient who had his/her larynx removed and can no longer speak.. This patient is very weak and cannot drive. The patient has had difficulty maintaining weight due to side effects of medications and needs supplemental tube feeds. A nurse may manage tube feeds,etc. The SLPs role in this situation is to help the patient learn to communicate with an electro-larynx and to educate the patient and the caregivers with techniques to facilitate communication.

question

Example of Private Practice

answer

one SLP may specialize in management of communication d/o in children with autism spectrum d/o. She may contract with several school systems and be called upon to evaluate a child, provide specific intervention recommendations, and train the teachers in management of the child's intervention

question

In psychiatric centers, we work with psychiatrists, behavior modification specialists, and psychiatric social workers.

answer

In psychiatric centers, we work with _____, _____ ____ ___, and psychiatric social workers.

question

Group Homes

answer

have gradually replaced large state institutions for people with developmental disabilities and/or intellectual disabilities.

question

indirect & consultative

answer

Services in group home setting are typically ___ and ___

question

Documenting the skills of the individual, and determining whether the individual is provided opportunities to actualize communication skills during daily routines.

answer

What does assessment in group home setting include?

question

Intervention Strategies within Group Home care

answer

Focusing on functional communication w/I every day routines and community recreational events

question

Scope of Audiologist

answer

Duties include : identification; assessment; diagnosis and management of hearing, balance, and neural systems in a non-medical fashion.

question

Eval and management of children and adults with APD.

answer

In addition to assessing peripheral hearing sensitivity, audiologists are also involved in

question

ADA

answer

Audiologists may also serve as consultants with regard to compliance with

question

-Many serve as expert witnesses for legal interpretations and audiological findings and the general effects of HL.

answer

Many audiologists also serve as

question

Audiologists screen for obvious speech-lang d/o, are involved in the use of sign language, and provide rehabilitative services including speech reading and communication management strategies.

answer

What do audiologists screen for?

question

Example of Educational Audiologist

answer

10 year old girl w/ a moderate-severe hearing loss who has recently moved into the school district ---consult regarding use of an FM amplification system and influence on educational performance.

question

20%

answer

Approximately __% of audiologists work in hospitals,

question

-in depth electrophysiological and behavioral assessments of inpatients and outpatients of all ages. Sometimes universal neonatal hearing screenings -Intraoperative Monitoring -Cochlear Implants -Assessing Ototoxic Effects of various type of drug therapies

answer

Procedures of an audiologist in a hospital setting

question

Example of an Audiologist's duties in hospital setting

answer

20-year-old man with cystic fibrosis. The patient's team of doctors learns he has recently been prescribed Amikin to help with breathing....but this drug also has ototoxic effects

question

25

answer

__% of audiologists work in a medical practice.

question

otolaryngology

answer

The medical specialty of physicians who hire audiologists is almost always _____

question

In this example, the audiologist's role is primarily diagnostic in nature and interpretation of test results will be left to the otolaryngologist.

answer

62- year old man who's been seen by an otolaryngologist w/ a complaint of episodes of dizziness. Physician referred patient to the audiologist for an eval to measure hearing sensitivity and an ENG to evaluate the vestibular system.

question

30

answer

__% of audiologists work in a private practice.

question

Rehab and fitting for hearing aids

answer

Audiologists within private practice place emphasis on

question

Example of what is seen by audiologists in private practice

answer

a 72-year old woman who has recently noticed a decrease in hearing sensitivity. Client has sought advice of her physician and the physician has provided medical clearance for amplification to her & has referred her to the audiologists' private practice.

question

for assessment of hearing sensitivity as well as the selection and fitting of appropriate hearing aids.

answer

Audiologists in private practice are responsible for

question

Rehabilitative in nature and will spend time counseling the client about proper use,etc.

answer

Audiologist's efforts in a private practice are also

question

Industrial Audiologist

answer

Primary Goal: to be a manager of an effective hearing conservation program. Assess levels of noise exposure, perform baseline and annual audiometric evals, and providing recommendations for utilizing hearing protection devices.

question

Provides an ethical code governing clinician behaviors and actions

answer

ASHA and AAA Code of Ethics

question

describes the broad range of services and supports offered by these professions

answer

ASHA and AAA scope of practice guidelines

question

Outlines acceptable client care, clinical processes, and anticipated outcomes

answer

ASHA preferred practice guidelines

question

recommends clinical practice parameters in specific work settings

answer

ASHA practice guidelines and technical reports

question

Describes policies in matters of professional practice

answer

ASHA position statements

question

an ASHA technical report outlines role of an audiologist in occupation hearing conservation and hearing loss prevention

answer

an ASHA technical report outlines the role of a(n) _______ in ____ ___ ___ and hearing loss prevention. & the role of an SLP in school-based preferred practice.

question

the role of an SLP who provides clinical services via telepractice

answer

What does an ASHA position statement identify?

question

.

answer

look at the contemporary issues that influence service delivery, p 254 table 10.4

question

91.8% seen are articulation/phonological d/o

answer

In terms of communication d/o, School-based clinicians mainly see what type of clients?

question

whether they have speech-language concerns in need of further assessment

answer

Under IDEA, Students must be screened to determine

question

non-biased assessments of their strengths, weaknesses, d/o, and/or delays

answer

Students who are potentially eligible for SLP services must participate in

question

receive free and appropriate slp intervention services in the LRE

answer

Students deemed eligible for services are entitled to

question

ongoing discussion about the students' problems and remediation plans.

answer

Family members & educators who are primarily responsible for students w/ disabilities are entitled to

question

the professional advice of related education and rehab disciplines

answer

Students with communication d/o are entitled to

question

Planning and placement team

answer

PPT

question

cognitive communication d/o

answer

Within inpatient and outpatient centers, more time may be spend with remediation of aphasia or

question

knowing the impact of the d/o on daily life functioning

answer

What helps the SLP manage patients' care and facilitate transitions from one medical setting to another as patients recover??

question

Dysphagia

answer

The disorder that medically-based clinicians spend most time on

question

Aphasia Dysarthria Apraxia Cognitive-Linguistic D/o Dysphonia Aphonia Speech Lang Delay Dysphagia

answer

Communication & Swallowing d/o

question

the influence of body structure & function on the performance of daily activities and an individual's ability to participate in life functions.

answer

WHO's International classification of Functioning, Disability, and Health framework(ICF)... The Framework considers:

question

aphasia

answer

If the health condition is a stroke, the body function & stroke could be

question

having a communication/swallowing difficulty as a result of a birth defect such as

answer

Mobius syndrome

question

brain tumor or a TBI

answer

acquired communication d/o

question

evaluation, intervention, education, and discharge planning

answer

As part of the interdisciplinary team, we are responsible for

question

documenting skills of individual, determining whether the individual is provided opportunities to actualize communication skills during daily routines.

answer

Assessment within group home setting includes

question

Focus on functional communication within every day routines and community recreational events

answer

Intervention Strategies in group homes

question

consultative capacity

answer

Audiologists often serve in a

question

Intraoperative monitoring and cranial nerve assessment

answer

Audiologists are also involved in

question

reduction of communication d/o

answer

Activities of audiologists primarily run through

question

frequency modulation system

answer

FM system

question

20% and %25 work in medical practice

answer

what % audiologists work in hospitals?

question

ABR and ElectroNystagmography(ENG)

answer

Electrophysiological tests include

question

private practice

answer

Most audiologists work in

question

Direct vs Indirect Services Clinical vs Consultative Services Individual and group services Multi,Trans,and Interdisciplinary Models

answer

Service Delivery Features of an SLP

question

Early Intervention Preschool and School based

answer

Education work settings for SLP

question

Joint Commission on the Accreditation of Health Care Organizations

answer

JCAHCO

question

Commission of the Accreditation of Rehab Facilities

answer

CARF

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