Clinical Processes Exam 2

empirical evidence- basic and applied, practice guidelines

patient/contextual factors, clinical knowledge and experience

1. develop PICO question (allows us to take clinical question into something that is easily searchable)

2. find and evaluate internal evidence (can help identify biases)

3. find external evidence

4. critically evaluate external evidence

5. integrate internal and external evidence

6. apply and evaluate outcome of decision

D FEI FE EE IIE AE

P: problem or population

I: Intervention

C: Comparison

O: Outcome

understand credibility of study and determine which study you might rely on more to gain accurate information

experimental: when researcher has manipulated something in order to see an effect

non-experimental: when researcher has not done something but still want to see an effect

journal receives an article and sends it out to other clinicians/professionals who also do similar types of research. These peers read article and validate research design and judge different qualities. The article in turn improves and authors can fix mistakes.

Expert Report

may contain bias

non-experimental, no control, no group

just opinions

RCT and systematic reviews

case study

just recording

non-experimental, no control, no group

cross-sectional

mostly interview and observation

non-experimental, no control, groups

single case experimental design (SCED)

has phases, called ABA design, has repeated measures

experimental, control within participant, no group

individual participants change not whole group change

quasi-experimental

one measure in time compared to another measure in time

experimental, no control, one group

Randomized control trial (RCT)

experimental, controlled, groups, randomized

systematic review

depends but usually experimental, groups, controlled, randomized

expert report

case studies and cross sectional

quasi experimental or SCED

RCT

systematic review

ensures all groups in group design are equal and will continue to be equal throughout the study. The only difference between the two groups is the variable you are wanting to change

equality between groups

SCED: control within participant. participant is compared to themselves before vs after treatment

RCT: control is another group of participants that have not undergone treatment

statistical: statistics in relation to means that show that one group is different than the other based on what you are measuring (looking for effect size).

clinical: whether treatment is beneficial enough and makes a big enough impact in patient’s life for amount of money, time, energy the treatment/experiment took.

In a study on MLU, the control group may have increased their MLU by .1 compared to the experiment group who increased they MLU by .2. This might be statistically significant for the experiment but in the eyes of a parent/client, this would not be significant because of the time, money and energy put into this therapy.

lack of time to search, read, analyze published research evidence

lack of competent abilities to efficiently search and find relevant evidence

there can be a high level research design that has a lot of evidence but was conducted poorly. the level of research design does not automatically assign credibility.

International Classification of Functioning, Disability and Health: Children and Youth Version by the World Health Organization

holistic perspective and includes considerations of physical body and its structure, person’s activity level and participation. also includes environmental and personal factors. does not solely focus on impairment

there is really no one intervention approach or target selection strategy that is better than all the rest for every single type of client. can be difficult to take in all three sources of evidence and make a decision.

deductive: move from general assumption to something specific (fact)

inductive: going from specific instance to general conclusion

deductive

inductive is based on what you’ve observed and your general conclusion- not always right

whole amount of therapy client will receive, including practice at home

methods we use to teach

prompt or instruction, what clinician does to set up a situation

feedback from clinician

more likely to achieve your goals because you have a plan and can keep yourself accountable. you will know exactly what the outcome should be and how to get there. stay on the path!

look at assessment outcomes, client’s values and challenges, clinical evidence, progression from the pass

determine what is attainable and SMART

difference between child’s current level of independent performance on task and how they succeed at same task with assistance

make sure goals are within ZPD and break down steps, treatment should occur between what student can do on their own and what they need full support with.

big benchmark goal that is achieved during course of therapy over longer course of time

smaller goals that lead to achieving an LTG, monitor progress of that path

goal for the session, leads to an LTG, might be an STO

working on STOs all at once and working on them all together will add up to LTG

sequenced steps of STOs, must mark off previous STO before you move on, think of a pathway

Specific: detailed enough to be understood by others

Measurable: need to know when you reach goal

Attainable: belief about whether person can actually meet goal

Relevant: should be working toward something that is meaningful for client’s life

Timely: need to have timeline of when you think client will achieve goal

continuous: see client regularly within specific amount of time with normal intensity

sprint/variable: see client for blocked out amount of time with high intensity and then take a break

SLP changes antecedents and consequences in hopes of getting the right behavior.

gestures, explanations, questions, hand over hand

high five, candy, point system, verbal praise

when client is doing well and clinician makes it harder- step up expectations and give more independence

client is struggling and clinician makes it easier- step down expectations

environment, proximity, noise level

materials used to support strategies

generalize their skills outside of therapy room

skill SLP can teach where client self monitors to see if they are accomplishing their tasks correctly outside of therapy

giving less feedback/consequence as student excels and learns so they are able to complete task without your constant support and feedback

helps with motivation

know if client is making progress toward long term goals and short term objectives

make changes during session based on the data

descriptive data, journaling or observing, interview or reported info

how often behavior occurred, percentage, needs demoninator

how long behavior occurred

if behavior occurred during set amount of time

plan

objective

subjective

analysis

plan

subjective

objective

analysis

subjective